Chronic fatigue, defined as persistent fatigue for a duration of over six months, may be reported by up to 30 per cent of the population.
Chronic fatigue syndrome (CFS) has an incidence of 4 per 1,000 in the US. Centre for Disease Control criteria for diagnosis include fatigue that is of a few onset, not related to exertion, not alleviated by rest, resulting in reduced activity levels. Additional requirements for diagnosis are cognitive dysfunction, sore throat, swollen lymph nodes, headaches, muscle and joint pain, poor sleep, and post-exertional malaise lasting more than 24 hours. Chronic sinusitis can be a common trigger for chronic fatigue in polluted urban environments.
Outcome measures after endoscopic sinus surgery have shown reduced body pain and fatigue as positive responses to treatment. Besides headaches and musculoskeletal pain, hypoglycemia can be induced from the effects of sinus drainage, causing pancreatic irritation and hyperinsulinism.
An analysis of immune function in CFS patients demonstrates multiple abnormalities. Increased lymphotoxin alpha, IL-1 alpha, IL-1 Bea, LI-4, IL-5, IL-6, and Il 12, and decreased IL-8, IL-13 and iL-15, with no difference in TNF alpha, IFN gamma, IL-2, Il-10, IL-23 and IL-17 characterise the imbalances in CFS-related immunity. This dysfunction may be triggered by vaccination and chemical exposures. Hepatitis B vaccine and silicone breast implant reactions are documented triggers. Macrophagic myofasciitis has been described due to local deposition of aluminium hydroxide post vaccines.
Muscle biopsies from CFS patients demonstrate multiple abnormalities in gene expression and mitochondrial function. Mitochondria are the cellular substrate of the production of ‘qi’, and therefore herbs that protect and enhance mitochondrial function are essential in the management of chronic fatigue.
Neurological symptoms comprise an important component of the syndrome. CFS patients have reduced blood flow to the cerebral cortex, and increased flow in the thalamus, pallidum, and putamen. Depressed patients can be differentiated from CFS patients by the presence of less perfusion of the right prefrontal cotex. Magnetic resonance spectroscopy has revealed elevated choline/creatine ratios in the brains of CFS patients. This pathology may indicate disrupted cell membranes and dysfunctional acetylcholine-based nerve transmission.
Patients with CFS were observed for quality of life when undergoing acupuncture treatments. Patients in the treatment group were treated with acupuncture at Aihui (GV.20), Shenzhong (CV 17), Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4), Hegu (LI.4), and Zusanli (ST 36), while the control group patients were treated with acupuncture at non-meridian points, three times a week for a total of 14 times. Results indicated that, based on the World Health Organisation quality of lifescale, quality of life for CFS patients was significantly improved in the physiological field, while control group patients did not experience any positive or beneficial effects from their treatments.
The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, Delhi.
This study was done by Matt Van Benschoten, O.M.D., LAC.