Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Myalgic Encephalomyelitis /chronic fatigue syndrome (CFS) is a complex illness that significantly affects the patient’s quality of life. The main symptom of the disease is severe fatigue and exhaustion that lasts at least 6 months. In addition to the fatigue, there are also other symptoms that make the patient’s life even more complicated: poor sleep, constant brain fog, pain and aches. The fatigue gets worse after standing, walking or doing any work to the point of exhaustion. Therefore, it’s very difficult for the patient to be involved in his usual daily activities. Communication with friends and family becomes a burden, he is unable to carry out his duty at work, and studying is a challenge due to the inability to focus.  Some patients even have to spend most of their time in a wheelchair or at home.

The particular cause for the disease is yet to be found, but there are multiple pathological changes in the body that are connected to this disease. There are some abnormalities in a proper work of the central nervous system, heart, immune system and the gut. Cell energy metabolism is also impaired, causing constant tiredness and weakness. There are many theories that could probably explain the disease; like stress, trauma or exposure to the toxins, but none has been confirmed as a single factor. Let’s have a look at a couple of them.

Chronic Viral Infection.

As a matter of fact, about fifty to eighty percent of CFS patients report being sick with “flu-like” symptoms. Despite the fact that no single infection has been identified yet, there are a few viral and bacterial infections that associate with the conditions that have been traced. The most common viruses that relate to the chronic fatigue syndrome found in studies are herpes family viruses (Epstein-Barr Virus, Human Herpesvirus -6, Cytomegalovirus (CMV), Enterovirus, Human parvovirusB19, Retroviruses and others. Most of these viruses cause sore throat, fever, fatigue, diarrhoea, swollen lymph glands and skin rash during acute stage of infection. Once the acute stage is over, the virus may remain in the body in the latent form and reactivate under certain conditions. All studies are inconclusive and can’t identify that all patients suffering from CFS/ME carry one or the other types of viruses, or even a few together at the same time. On the other hand, there is a chance that once the patient gets sick, the virus may trigger the body’s autoimmune reaction, making permanent changes and dysfunction in the immune system. Viruses also have the ability to damage the body cells’ mitochondria metabolism and DNA. Mitochondria plays role of the power station in our cells, and generates energy from the oxygen and sugar. This mitochondrial damage happens in both muscles and neutrophils- the body’s immune cells. Once the muscle can’t produce ATP- a special molecule that the body uses as a fuel, and then the body generates a very little energy, switching to the different type of metabolism. This mode of energy production is called anaerobic because the body does not use the oxygen. The side effect of the“switch” is the body generates a waste- lactic acid that has a negative impact on the muscle and nerve tissues.

Chronic Fatigue Syndrome and Leaky gut.

Many CFS/ME patients suffer from abdominal discomfort: bloating, gases, poor appetite, nausea, alteration in their bowel movement and food sensitivity. According to the ScienceDaily, up to 90% of the CFS/ME patients are also diagnosed with Irritable bowel syndrome (IBS). But regardless of the fact that the CFS/ME patients have been diagnosed with IBS or not, there is a noticeable disbalance in a gut bacterium found by the scientist from the Columbia University’s Mailman School of Public Health. They also discovered that the level of disproportion of a certain gut bacteria can make a fatigue and other symptoms worse. This is not the first research of its kind. The interest to the communication between the gut and brain, also known as the “brain- gut” axis, started at the end of the last century, and recently gained more popularity. The brain is connected to the gastrointestinal tract through vagal nerve and sends messages to regulate its function. On the other hand, nutritionally and biologically active molecules that regulate our neuro-endocrine function, sleep, mood and behaviour are delivered from the intestines into the bloodstream. As a matter of fact, 90% of serotonin, the neurotransmitter that regulates mood, is produced in the intestines.

The human gut is a very large and complex bio-complex that contains about 400 to 500 different microorganisms, bacteria, fungi and viruses. Gut microbiota plays an important role in keeping the internal wall of the intestines in a good shape. Healthy mucosa of the gut prevents pathogenic microorganism and waste from blood. Abnormal disproportion of the bacteria is associated with a change in the intestinal mucosa and the inflammation of the gut. The toxins- product of this inflammation can pass the “leaky” intestinal wall into the blood. Increased level of these waste products affects the whole body, and disturbs the normal work of the central nervous and immune systems. Therefore, the CFS/ME patients feel fatigue; they suffer from brain fog, poor sleep and autonomic disfunctions in addition to GI – related symptoms. Change in microbiome is also associated with other diseases like fibromyalgia, Alzheimer’s, stroke, Parkinson’s disease, diabetes and so on.

There are many factors that can affect gastro-intestinal microflora – stress, certain medications, diet, infections or even brain trauma.

Traditional Chinese medicine and the “brain-gut axis”.

Traditional Chinese medicine is probably the oldest medical system in the world with its own unique theoretical basis, and almost 2000 years of history. Despite the profound knowledge of human anatomy, in Chinese medicine, physiological function of organs goes far beyond our modern medical knowledge. For example, the oldest Chinese medical text – “The Yellow Emperor’s Classic of Medicine” (300 BC) provides very accurate anatomical details of the gastro-intestinal tract from the mouth to the colon. It depicts the size, diameter, volume and location of each organ – tongue, larynx, esophagus, stomach, duodenum and intestines very close to what is known to today’s science. However, as far as the physiology is concerned, the gastro-intestinal and immune systems are connected together under one “functional unit” that is called “Spleen/Pancreas”. According to TCM, this “unit” is not a single organ or a pair of two, but rather a complex structure that includes stomach, pancreas, spleen, duodenum, small and large intestines. This structure is located in the abdominal cavity, below the diaphragm and in charge of the transportation and transformation of the food, nourishment of the body and muscles, “production of blood,” and regulation of the immune, cognitive and mental functions. The pathology of this “organ” in TCM terminology or a “functional unit”- from the Western point of view, on the other hand, can lead to multiple health problems: poor digestion and nutrition, anemia, low immune system, weakness and fatigue, low energy, muscle aches, anxiety and poor sleep. Another ancient medical textbook “Treatise on the Spleen/Pancreas and Stomach” (1180-1251 CE) -“also states that the damage to the “Spleen/Pancreas” can “lead to many diseases.” “Fever, headache, visual dizziness, heavy limbs, debilitated limbs, fatigue, and somnolence” – are all symptoms of improper function of “Spleen/Pancreas” according to the ancient text. It seems like the “Spleen/Pancreas” is very close to the modern description of the “gut- brain” axis, and it’s not just a morphological structure of the body. We can assume that the Chinese medicine is the first medical system in the world that recognized the existence and significance of the gut-brain axis.

On the other hand, traditional Chinese herbal prescriptions of formulas, acupuncture and moxibustion (a stimulation of acupuncture points by heat released from a burning mugwort) aim to regulate and normalize the gut-brain axis’s function. For example, the classical Chinese formula called ´Four Gentlemen,” contains herbs to treat poor appetite, fatigue, muscle weakness and loose stool: Ginseng, Atractylodes, Poria and licorice. According to the modern research, these herbs stimulate the work of the nervous and immune systems, enhance intestinal mobility, reduce secretion in the stomach, ease abdominal spasms and adjust the work of the hypothalamic-pituitary-adrenal axis. Ginseng and Licorice can normalise the gut flora, promote growth of good bacteria, and enhance the absorption in the gut. These herbs in combination with others are widely used today to treat many gastro-intestinal, mental and cognitive complaints, such as IBS, chronic fatigue, poor mood, anxiety or insomnia.  Acupuncture and moxa also can improve the work of the brain-gut axis, immune and endocrine function and activate the vagus nerve.

Traditional Chinese medicine and Myalgic Encephalomyelitis/Chronic Fatigue syndrome.A lingering pathogen

According to the Chinese medicine, the pathophysiology of the Myalgic Encephalomyelitis/chronic fatigue associated with a pathogenic factor that entered into the body, and affects multiple systems, especially immune and digestive. This pathogen called “lingering” or “lurking pathogen”, or toxins- “Du”. As it was mentioned before, 50% to 80% of CFS patients complain about “flu-like” symptoms before the onset of the disease. In Chinese medicine, it’s called “external pathogenic factor” and associated with weather conditions, such as “wind”, “cold”, “heat -toxin” or others. Once it enters the body, it causes symptoms of common cold, sore throat, malaise, fatigue, fever, skin rash or diarrhoea. In this case, the “pathogenic factor” probably can be associated with any virus, bacteria or parasite. Some patients will be able to get rid of this “pathogenic factor” with or without treatment, depending on their immunity or other factors.  But in some patients, the “pathogen” may damage their “spleen/pancreas”. In other words, the viral or bacterial infection affects the gut microbiota, and weakens the entire gastro-intestinal and immune systems. Sometimes, patient takes medications during the course of the disease that also can affect his intestinal flora. Therefore, it creates a vicious circle. The lingering pathogen continues affecting the body; muscle and immune cell’s mitochondria, making the patient feel extremely weak. At the same time, ‘spleen/pancreas” is also weak, and the “brain-gut axis” does not function properly. The chronic gut inflammation makes mucosal barrier malfunction, the bioproduct of the inflammation- cytokines “leaks” into the bloodstream, and keep the whole body into constant low-grade inflammatory state. In addition to extreme fatigue, the patient feels brain fog, difficulty in focus and concentration, poor memory and sleep. He has IBS- like symptoms, his immune system is weak and unable to “get rid’’ of the lingering pathogenic factor.

So, what is the solution the Chinese medicine does offer? The answer is- to eliminate the ‘lingering pathogen,” and to strengthen the “spleen/pancreas”. In other words, – “to fix” the proper work of the “gut-brain axis” by healing the gastro-intestinal inflammation, restoring the gut microbiota, boost the immune system and at the same time, to “expel out” the lingering pathogen.

Most of the Chinese herbs that “release” or eliminate pathogenic factors or “toxins” have an anti-viral or antibiotic-like properties. Let’s have a look at a few of them. The sweet wormwood (Artemisia annua) is an herb that has been used for the treatment of chronic fever, inflammation (”heat” in TCM) and malaria for millennia. The active component of this herb- artimisin becomes a very popular drug in a last treatment because of its ability to treat malaria. In recent studies, it was discovered that it also works against many viruses as well, such as, cytomegalovirus and all family of herpes viruses, including the HHV-6. Other popular herbs – Chinese skullcap (Scutellariabaicalensis) or Barbat Skullcap (Scutellariabarbatae) contain a flavonoid-Baicalein, which also can restrain the HHV-6 virus in the lab.

In addition, the traditional Chinese formulas, or herbal prescription that contain multiple ingredients might also help. According to research, the classical formula to boost the “spleen/pancreas” -“Bu Zhong Yi Qi Tang” is traditionally used for fatigue, and low immune function. It increases the level of interferon gamma and natural killer cells – the body defence against viruses and bacteria. In addition, -“Bu Zhong Yi Qi Tang”  and  “ Four Gentlemen Formula” mentioned above, can also improve mitochondria bioenergetics and might repair mitochondrial DNA damage.

As far as Chronic Fatigue syndrome is concerned, in a treatment of 134 of CFS patients, another classical prescription that boosts the “spleen/pancreas” – Ren-Shen-Yang-Rong-Tang, helped 98 people return to work or school. A meta-analysis of 23 studies, which includes 1776 patients, shows that the Chinese medicine can significantly reduce fatigue severity without serious side effects.

In conclusion, Myalgic Encephalomyelitis /Chronic fatigue syndrome (CFS) is a complicated disorder that significantly affects the patient’s quality of life. Patient suffers from tremendous amount of fatigue and exhaustion. They experience brain fog and difficulties in focus or concentration, unrefreshed sleep, and some people have to stop their work. The disease also affects their relationship, making them feel anxious and depressed. The cause of the disease is unknown, but up to 80% of people say that their clinical symptoms start with a “flu-like” illness. Therefore, there is a theory that patients might suffer from chronic viral infections, such as Epstein-Barr or HHV-6 or others. On the other hand, most of CFS patients also have a complaint of IBS-like symptoms- abdominal bloating, pain, gases and change in their bowel movements. Also, it was found that patients with the chronic fatigue syndrome have changes in their gut bacteria, which can explain their fatigue, poor sleep and a constant state of low-grade inflammation. The inflammation in the gut and abnormal microbiota create a so-called “leaky gut” syndrome, when the intestinal wall allows bio-product of the intestinal inflammation enter into the lymph and blood stream. These waste materials affect the work of immune and nervous symptoms.

Traditional Chinese medicine is one of the oldest medical systems in the world that seems to recognise the brain-gut axis. From TCM prospective, the chronic fatigue is usually associated with chronic or lingering pathogenic factor that “entered” into the body during acute illness, and affected the proper work of the “spleen/pancreas” that in TCM doesn’t represent a single organ, but rather a complex functional structure that includes a gastro-intestinal tract, pancreas, and spleen together. The “spleen” controls digestion, muscles, immune and some aspect of the nervous system, such as cognition and mood. We can assume that the “spleen” represents a “gut-brain” axis as a system in the body, rather than a specific organ. Traditional Chinese herbal prescriptions, acupuncture and moxibustion aim to “get rid of” the pathogenic factor from the body, and restore the normal work of the “spleen” or the “gut-brain axis”. Some research also shows that herbs can repair the mitochondrial damage. The treatment of the EM/CFS is not a short-term course. It takes few months to achieve desirable results. The improvement is slow but steady; therefore, it requires patience and complaints with the treatment plan.

Sunrise Neuro-Acupuncture Integrative Clinic is an acupuncture and Chinese medicine clinic in Westboro, Ottawa. We provide care for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome,.  If you are interested to receive more information about Chinese Medicine Treatment plan  please contact as at: 613-853-9099