BIRMINGHAM CENTRE FOR CHINESE MEDICINE
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CASE HISTORIES - CHRONIC FATIGUE
Chronic fatigue syndromes are common, but often have no convincing conventional diagnosis and are poorly understood. There is sometimes a background of viral infection (for example glandular fever) after which the sufferer finds it extremely difficult to break back through to normal energy levels. Another scenario is a life-crisis, perhaps following a period of intense hard work and commitment to success, a path that for one reason or another can no longer be sustained.
CASE
The patient was a man of 33 who had suffered a loss of energy over a 5-year period. The background was many years of incredibly hard work as a marine engineer (18 hours a day), without break. He suffered a collapse 6 months before the first visit, and was hospitalised. There was no visible history of infection and tests for literally thousands of organisms (the patient had travelled the world) proved negative. The patient therefore came without any plausible conventional diagnosis, which is not at all uncommon in patients seeking help from Chinese medicine.
The patient had numerous signs and symptoms, including extreme fatigue, frequent nausea, severe muscle fatigue and pain, poor concentration, heavy sleep (11 hours) with a sense of heaviness in the mornings, abdominal bloating and diminished appetite, palpitations, black spots in front of the eyes, marked shortness of breath, sinus congestion, recurrent flu-like feelings, dry mouth and very frequent urination. His tongue was somewhat red with a slightly yellow coat, the pulse was ‘soft’ and particularly weak in that aspect which suggests a depletion of underlying reserves of energy. He was taking no medication, having come off an anti-inflammatory (ibuprofen) two months before the first visit.
The analysis of this case was as follows:(a) exhaustion can be a feature of many patterns of disharmony. Energy can be depleted through overactivity or by a blockage of some sort which inhibits the normal flow of Qi, which may affect any or several of the Organs. In this case the origin was evidently a long period of obsessively hard work. However, it is likely that the crisis was not just about the quantity of work, but also about a loss of sense of purpose in work.
(b) when the Qi is depleted, a person will be susceptible to harm from pathogenic factors, whether of external or internal origin. In the present case, the Spleen function was damaged, leading to an accumulation of Dampness manifesting as abdominal bloating, reduced appetite and nausea. Here Dampness has a different range of effects from the cases of eczema and IBS discussed above. In this case the effects of Dampness include include muscle fatigue and pain, together with poor concentration (a common complaint in chronic fatigue syndromes), and heavy sleep that fails to bring a sense of refreshment. Some Heat is also present, suggested by recurrent flu-like symptoms and a slightly yellow tongue coating.
(c) when the Qi is depleted, any Organ may be affected: palpitations point to an involvement of the Qi of the Heart, while the shortness of breath and sinus congestion indicate a weakening of the Lung Qi.
(d) when the Qi is depleted, a person will have to draw on reserve energy, and if this goes on for long enough, the fluid or Yin aspect begins to get damaged, rather like an engine with insufficient lubrication (in this case, the development of a dry mouth is one suggestion of that). Part of that is called Blood deficiency. The indications of Blood deficiency overlap with those of anaemia, but it is not the same thing and there might be signs of Blood deficiency (in the present case black spots in front of the eyes) which are not associated with anaemia according to conventional tests.
In time depletion of reserves of energy will undermine the fluid or Yin aspect further, and will affect the Kidney energy. The Kidneys are related to urinary function, but in the Chinese medicine tradition they are also seen as the fundamental grounding of a person's vitality. In the present case the urinary symptoms (together with the character of the pulse) showed a severe depletion of the patient's underlying resources.
The main treatment principles were to transform and drain Damp, to supplement the Qi of the Spleen and Lungs, to support the Kidneys and to nourish the Yin aspect. These principles are stated in broad-brush terms. However, in clinical practice the particular choice of 'tonic' or 'Damp-clearing' herbs, the relative dosages and the way in which they are combined will result in an individualised prescription. There is a wide range of 'supplementing' or 'tonic' herbs with a variety of functions, and the herbs used to treat Dampness vary greatly depending on the effect to be achieved: aromatic herbs are used to 'fragrantly transform Damp', 'draining Damp' herbs to achieve a diuretic effect, and varieties of bitter-cold herbs to deal with patterns associated with the presence of Damp-Heat or Toxins.
In the first stage of treatment, the aim was to transform and drain Damp and combat nausea (Huo Xiang [Herba Agastaches], Sha Ren [Fructus Amomi], Fu Ling [Sclerotium Poriae Cocos], Shi Chang Pu [Rhizoma Acori Graminei], Ban Xia [Rhizoma Pinelliae Ternatae], Chen Pi[Pericarpium Citri Reticulatae]), to supplement the Qi of the Spleen and Lungs (Huang Qi [Radix Astragali], Ren Shen [Radix Ginseng], Bai Zhu [Rhizoma Atractylodis Macrocephalae], honey-fried Gan Cao [Radix Glycyrrhizae]), to clear Heat and assist in overcoming fatigue (Sheng Ma [Rhizoma Cimicigugae]) and to a small degree to nourish the Yin (Mai Men Dong [Tuber Ophiopogonis]), bearing in mind that while Dampness (which is a Yin pathogen) is still present it is not advisable to strongly 'tonify the Yin'.
After two weeks the patients was less tired with less nausea, far fewer palpitations, less sinus congestion, no flu-like feelings and less dry mouth. After a further two weeks there was much less fatigue, muscle fatigue and nausea, less shortness of breath, no palpitations, visual disturbances or flu-like feelings. His concentration was also somewhat improved. The abdominal symptoms remained, there was little change in the urination pattern, and he also developed some epigastric discomfort with acidity, and became constipated. The approach was modified to take these features into account (introducing Huang Lian [Rhizoma Coptidis], Wu Zhu Yu [Fructus Evodiae], Huo Ma Ren [Semen Cannabis Satviae]). Later, the formula was modified to deal more with the Kidney deficiency, with less emphasis on 'clearing' pathogenic factors and with the introduction of more tonics (Dang Gui [Radix Angelicae Sinensis], Bai shao [Radix Paeoniae Lactiflorae], Mai Men dong [Tuber Ophiopogonis], Sheng di huang [Radix Rehmanniae Glutinosae], Rou cong rong Cistanches Deserticolae]) Four weeks using this modified approach brought further major improvement in most symptoms, though the urinary pattern had not significantly changed. After that the patient moved to another city and contact was lost, but the case demonstrated how Chinese medicine has the ability to trigger rapid improvement where no conventional treatment is available.
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Birmingham Centre for Traditional Chinese Medicine Ltd. Directors: M.R. Ehrenberg BA, PhD, LSSMDip, DipAc, MBAcC, CertAc(Kunming); N. Lampert BA, PhD, DipAc, MBAcC, CertAc(Nanjing) MRCHM; C. Wylde BA, DipAc, MBAcC, CertAc(Nanjing).