Home ׀ Health News ׀ Treatments ׀ Articles ׀ Links ׀ Disclaimer ׀ Forms/Directions
CHRONIC FATIGUE AND FIBROMYALGIA
John G. Connor, M.Ac., L.Ac.
June 2004
TABLE OF CONTENTS
Most patients we see who suffer from Chronic Fatigue and Fibromyalgia have tried many different forms of therapy and medical care before they have seen us; so we are very well acquainted with how difficult and trying it is to find a successful treatment for these conditions. Barbara and I have a high level of success in treating both these conditions using the wonderful combination of acupuncture, craniosacral therapy and hara visceral work. When indicated we also make dietary recommendations and may prescribe herbs, supplements and lifestyle adjustments. We have written this article to help give you a better understanding of these conditions and how we treat them. We hope you find the information helpful.
The cause of Chronic Fatigue or Chronic Fatigue & Immune Dysfunction Syndrome (CFIDS) remains obscure. Some possible causes are: Epstein Barr virus, cytomegalovirus, herpes simplex virus, oral and genital and herpes type-6 virus. It is thought that dormant viruses are allowed to replicate when the immune system stops functioning properly, encouraging the syndrome of chronic fatigue In particular it is thought that the production of cytokinase is responsible for the symptoms of CFIDS. Cytokines are known to cause the flu-like symptoms associated with many acute infections and have also been shown to induce a CFIDS-like syndrome when administered for therapeutic purposes.
Persons with CFIDS have down-regulated antibody levels and few natural killer cells. They also release less of the good cytokines gamma-interferon and interleukin-2, as well as tumor necrosis factor alpha. When natural killer cells are low, parasites and viruses can gain hold and flourish. People with CFIDs have elevated helper T-cell to suppressor T-cell ratios and elevated B-cells and auto antibodies in the blood. CFIDS patients also have high histamine levels which contributes to allergic symptoms. And they also have low blood levels of the immune regulating hormone DHEA and higher levels of cortisol.
To meet the criteria for CFIDS patients must have both of two major and eight of 11 minor symptoms or six of 11 minor symptoms and two of three physical findings.
The majority of patients state that their illness began on a particular day with a flu-like syndrome characterized by fever, pharyngitis, adenopathy, myalgias and related symptoms, however, unlike the usual flu, they have never fully recovered. The most prominent symptom is fatigue.
WESTERN EXPLANATION OF FIBROMYALGIA
Fibromyalgia, also called Fibromyalgia Syndrome or FMS, is a condition mostly affecting women between 20-50 years of age. Symptoms come on gradually and slowly increase in intensity. They can be triggered or made worse by a number of different factors including overexertion, stress, lack of exercise, anxiety, depression lack of sleep, trauma, extremes of temperature and or humidity and infectious illness. It is characterized by chronic, widespread, severe muscular aching, pain, and stiffness accompanied by insomnia, fatigue, and depression. It is however, neither a rheumatic, inflammatory, progressive or degenerative disorder.
The cause or causes of FMS are not known. Some evidence points to a problem with the immune system; certain immunologic abnormalities are common among people with FMS. A disturbance in brain chemistry may also be involved; many people who develop FMS have a history of clinical depression. Other possible causes that have been proposed include infection with the Epstein-Barr virus or with the fungus Candida albicans, chronic mercury poisoning from amalgam dental fillings, anemia, parasites, hypoglycemia and hypothyroidism.
FMS can be differentiated from other chronic muscle-joint pain by the presence of pain or tenderness upon pressure in at least 11 out of 18 specific points on the body. In addition FMS sufferers are also typically hypersensitive to odors, bright lights, and loud noises. Headaches and jaw pain (TMJ) are common.
The muscular pain associated with FMS is described as deep, burning, throbbing, shooting and/or stabbing. And the fatigue may range from simple, random exhaustion to being unable to get out of bed. Most FMS sufferers are also mildly depressed.
WESTERN TREATMENT OF CFIDS AND FMS
Western medicine has no single treatment for CFIDS or FMS per se. Anti-depressants such as Prozac are commonly prescribed for the sleep and mood. However Prozac has side effects such as skin rashes, hives, and itching, headache, nervousness, insomnia, drowsiness and fatigue, tremors, dizziness and impaired concentration,
NSAIDS are commonly prescribed for the pain. However, NSAIDS can have their own side effects too such as skin rashes, hives and itching, headache, dizziness, blurred vision, ringing in the ears, depression, mouth sores and gastrointestinal upset. There are also some concerns about NSAIDS effects on the kidneys when taken over a prolonged period of time.
Since FMS is not an inflammatory condition, although secondary inflammation of the joints may sometimes occur because the contracted muscles harboring trigger points can pull bones slightly out of alignment, the use of NSAIDS as an anti-inflammatory drug is questionable. In fact NSAIDS often disrupt the deepest stage of sleep and can contribute to permeable gastric mucosa.
If one is using tricyclic agents such as amitriptyline be aware that the side effects of this drug include myocardial infarction, stroke, arrhythmia, coma, seizure and alopecia.
CHINESE MEDICAL EXPLANATION OF CFIDS AND FMS
In Traditional Chinese Medicine (TCM) literature CIFIDS-like symptoms appeared in the book the Shang Han Lun where it shows up as the "Disease of a Thousand Names". From a TCM perspective CFIDS would be called XiaoYin Bing characterized by fatigue, pale complexion and weak, feeble pulse.
In TCM terms part of their Wei Qi (Defensive Qi) is on its toes and trying to clean up everything (the elevated Cytokines) at the same time there is this deficiency (the Natural Killer Cells are sluggish). And the very by-products of the body's own metabolism (as after strenuous exercise) are taken as antigens.
Lymphadema can be due to Kidney Qi Deficiency. Fatigue is often caused by Damp Stagnation --the Qi is low and locked up and unavailable to use. Cognitive dysfunction can be due to Damp, Heat in the Heart or Qi Deficiency. Joint pain can be due to Damp Accumulation in the tissues.
From the point of view of Chinese medicine two main conditions explain the pathogenesis of FMS and CFIDS: 1) Residual Pathogenic Factor and 2) Latent Heat.
Residual Pathogenic Factor
If an External Pathogenic Influence (EPI) such as Wind, invades the body and is not cleared properly, or if the person fails to rest during an acute invasion of Wind, the EPI may remain in the interior (usually as Heat or Damp Heat). This predisposes the person to further invasions of EPIs because it obstructs the proper spreading and descending of Lung-Qi and/or Yin. In the course of a febrile disease the ascending and descending movements of the Spleen and Stomach are upset. Thus because Stomach Qi cannot descend, turbid fluids are not transformed and because Spleen Qi cannot ascend, the clear fluids cannot be transformed leading to Dampness.
Secondly Heat burns the body fluids which can then condense into Dampness. Once formed, Dampness is rather self-perpetuating.
Latent Heat
What happens to create latent heat is that it begins with a person who has a Qi deficiency created by a constitutional predisposition, improper eating, sleep, exercise or sex, etc. This is followed by an External Pathogenic Influence (EPI) that penetrates the exterior. The EPI, e.g., Wind Cold, enters the exterior via the Tai Yang channel which runs along the back. Because the Kidney is in the low back and opens into the Tai Yang the EPI clamps down on the Kidney Yang. And because the EPI is on the Exterior it stagnates the Qi which generates Heat and/or Damp Accumulation in the TMMs (tendinomuscular meridians) causing fibromyalgia. The EPI intertwines with the person's good Qi encumbering the body's ability to expel the Cold lodged in the exterior Over a long period of time the Yin becomes increasingly consumed and it interferes with the body's attempt to heal.
According to TCM there are 3 excess states in FMS and CFIDS, viz.:
1) Damp Heat in the muscles, 2) Heat lurking in the Interior and 3) Lesser Yang pattern and there are 3 deficiency states viz: 1) Qi Deficiency, 2) Yin Deficiency and 3) Yang Deficiency.
The three excess states exist but they overly the deficiency states because the excesses are relatively weak compared to the deficiencies. Most persons are deficient interiorly and have FMS on the exterior. They dont have enough Qi and/or Blood to overcome the FMS. It is the deficient states, not the excess states, which generate the disorders. So although in FMS you have an excess state such as Dampness, you have this state overlying a deficient state, viz, Spleen Qi deficiency. The Spleen is the single most important Chinese organ in FMS (and CFIDS) and its dysfunction accounts for the majority of FMS and CFIDS symptoms. So you must treat the root cause which is primarily Spleen Deficiency but it may also involve Kidney Deficiency or Blood Deficiency.
EFFICACY OF ACUPUNCTURE AND CRANIOSACRAL THERAPY IN TREATING CFIDS AND FMS
According to a study published in Rheumatology International "Acupuncture treatment of patients with fibromyalgia was associated with decreased pain levels and fewer positive tender points as measured by VAS (visual analog scale) and dolorimetry." In addition their serotonin concentrations in their platelets decreased and their serum serotonin increased. This study confirms that acupuncture does help FMS sufferers in terms of their muscle-joint pain.
According to a study published in the March 1999 issue of The Journal of Family Practice real acupuncture based on Oriental theories and techniques is more effective for the treatment of fibromyalgia than merely sticking needles in people at random locations. In other words, there is something scientifically provable about the efficacy of acupuncture for FMS.
According to a recent study in the British Medical Journal on fibromyalgia there was improvement in actively treated patients who received electroacupuncture in terms of duration of morning stiffness, overall pain, sleep quality and overall assessment of the disease. The results were comparable to those reported for some medical treatments such as with the antidepressant drug Elavil or amitriptyline.
According to a Russian study by Zborovskii and Babaeva done in 1996 acupuncture is useful in treating FMS.
According to Devin Starlanyl, MD in her book The Fibromyalgia Advocate craniosacral releases may be beneficial for nonmedical symptom relief and for headaches due to myofascial trigger points.
And according to Travell and Simons (1983) acupuncture is useful in treating myofascial pain syndrome.
USEFUL FOODS FOR SPLEEN QI DEFICIENCY
Quinoa, parsnip, aduki beans, black beans, pine nuts, garbanzo beans, cooked squash, cooked turnips, oats, rice, cooked cherries, cooked carrots, cooked leeks, mussels, shrimp, cardamom, black pepper, cooked strawberries, ginger, tapioca and custards, cooked yams, cooked onions, cooked rutabagas, cooked pumpkin, cooked peaches, dried litchi, cinnamon, arrowroot, dried figs, nutmeg sweet potato, garlic, fennel. Moderate amounts of honey, molasses, barley malt, maple syrup and raw sugar. Small amounts of chicken, lamb, beef, turkey and anchovies.
FOODS TO AVOID IN CASES OF SPLEEN QI DEFICIENCY
Too many sweets, seaweed, milk, chilled, iced or frozen food or liquids; citrus fruits and citrus juices; tofu, cheese, salads, too much salt, millet, too many liquids with meals, raw foods, hard to digest food, undercooked grains, buckwheat, agar,
Lettuce, amaranth, asparagus, wild blue green algae, white pepper, vinegar, papaya, chaparral, Pau darco, celery, turnip, rye, barley, aduki beans, alfalfa, pumpkin.
Useful Foods For Spleen Dampness:
Celery, turnip, rye, barley, aduki beans, alfalfa, pumpkin, Chinese cabbage, watermelon, corn, anchovy, kidney beans, button mushrooms, shrimp, chestnuts, kohlrabi, mustard greens, radish, chicken, chicken gizzards, mackerel.
FOODS TO AVOID IN CONDITIONS OF DAMPNESS
Dairy products, meat, eggs, tofu, pineapple, salt, concentrated sweeteners, peanuts, ice water, ice cream
Foods to Avoid in Cases of Spleen Damp Conditions:
Salt, milk, cheese, eggs, sugar, soybeans, pine nuts, asparagus, cucumber, seaweed, tofu, bamboo shoots, kelp, agar, cabbage, coconut milk, spinach, olives, black sesame, goose, duck, pork, shellfish, clams, mussels, crabs, sardines, octopus, shark meat, red meat, excessive watery foods. Also use sour foods sparingly.
USEFUL FOODS AND HERBS FOR DAMP HEAT CONDITIONS
Aduki beans, lima beans, mung beans, black beans, celery, carrots, winter squash, potatoes with skins, asparagus, mushrooms, corn, peas, amaranth, Chinese barley, day lily, bamboo shoots, wax gourd, white gourd, cucumber and duck. Lemon (diluted juice), cranberry juice, huckleberries, bananas, Chinese pears and watermelon.
Useful herbal teas: Uva ursi, dandelion leaf, plantain leaf, flax seed, watermelon seed and pipsissewa (pipsissewa is good for chronic bladder infections).
FOODS TO AVOID IN CASES OF DAMP HEAT
Refined sugar, concentrated sweeteners, meat, greasy, oily foods, too much starch, and overeating.
Magnesium - supplementation may be beneficial. In one study, chronic fatigue patients taking magnesium claimed to have improved energy levels, better emotional state and less pain. Magnesium is a critical mineral for energy function. It directly influences the metabolic rate through its involvement in the hypothalamic-pituitary-thyroid axis and may be an important trace mineral for CFIDS and FMS patients.
Coenzyme Q10- supplementation appears to give symptomatic improvement according to one clinical study. CoQ10 stimulates the immune system to kill bacteria and increase antibody response. Serum IgG levels have also been shown to increase with very small doses. It is also known to enhance natural killer cell activity and most importantly to CFIDS sufferers it increases ATP production. Without adequate ATP we feel tired and experience muscle weakness and impaired immunity. CAUTION: If you are currently taking digitalis, beta-blockers or ACE inhibitors your prescription drug dose will need to be lowered once you start it.
Sterols and Sterolins - may be beneficial. They enhance the activity of the T-cells by inducing the synthesis of the immune-regulating cytokines interleukin-2 and gamma-interferon while decreasing the inflammation-causing cytokine interleukin-4. This ultimately leads to the control of allergic conditions, autoimmune processes and the ability of the immune response to deal with latent viruses, bacteria or parasites. Sterols and sterolins also enhance natural killer cell activity and DHEA levels.
Essential Fatty Adds - may be beneficial. In a recent study on persons with CFIDS, those taking fish and evening primrose oils showed a 74% improvement in 5 weeks and an 85% improvement in 15 weeks compared with only 23% and 15% improvements respectively in the placebo group.
Glutathione - Studies have shown that low levels of glutathione are consistent with depressed immune systems and that oxidative stress underlies many of the symptoms of CFS.
Thiamine - plays a role in the respiratory chain. Thiamine deficiency symptoms are strikingly similar to many of the symptoms experienced by FMS patients.
SAMe - supplementation may be useful. According to one study in Denmark SAMe produced improvement in pain, fatigue, morning stiffness and mood.
Malic acid - supplementation may be beneficial as it is a powerful detoxifier of aluminum and has been shown to reduce the pain associated with FMS.
Vitamin B12- supplementation may be beneficial.
Highly preliminary evidence suggests that DHEA might be helpful for chronic fatigue syndrome. (Himmel et al, 1999)
There is evidence that capsaicin cream may be helpful for relieving pain due to fibromyalgia.
5-HTP is useful for fibromyalgia according to a study by Caruso et al 1990.
Limit your consumption of green peppers, eggplant, tomatoes and white potatoes. These foods
contain solanine, which interferes with enzymes in the muscles and cause pain and discomfort « Avoid alcohol and cigarettes.
Chinese herbs - are beneficial. You should consult your acupuncturist or herbalist before embarking on the use of any Chinese herb.
Base pulse rate You should take your pulse before you get out of bed for 5 days in a row. Then average it to get the base line pulse rate. If your pulse is 10% or higher than your base line rate then dont do anything out of the ordinary that day because your body is still in repair mode from the day before,
Gentle aerobic exercise - In a 4.5 year prospective study of 60 patients, aerobic exercise, stress management treatment and treatment as usual induced short-term FMS improvement. Also gentle stretching, yoga and meditation are helpful.
Deep tissue massage - particularly myofascial release therapy can be helpful in relieving pain in FMS patients who can tolerate it.
Support groups - Attending CFIDS or FMS support groups is beneficial.
Balch, James F.. M.D., and Balch, Phyllis A, C.N.C, Prescription for Nutritional Healing Garden City Park: Avery Publishing Group, 1997
Berman, B.M.; Ezzo, J; Hadazy, V.; Sweyers, J.P., "Is Acupuncture Effective in the Treatment of Fibromyalgia?" Journal of Family Practice, March 1999, 48:3, 213-8
Bratman, Steven, MD & Andrea M. Girman, MD MPH, Mosbys Handbook of Herbs and Supplements and their Therapeutic Uses, St Louis: Mosby, 2003
Buchwald, Dedra S, M.D., "Chronic Fatigue Syndrome" Cortland Forum March 1991
Flaws, Bob, Curing Fibromyalgia Naturally with Chinese Medicine, Boulder Blue Poppy Press 2000
Fulghum Bruce, Debra The Fibromyalgia Handbook, New York: Henry Holt 1999
Lipski. Elizabeth, MS. CCN, Digestive Wellness, Los Angeles: Keats Publ. Co. 2000
Maciocia, Giovanni, The Practice of Chinese Medicine, Edinburgh: Churchill Livingston 1994
Pitchford, Paul, Healing with Whole Foods, Berkeley: North Atlantic Books 1993
Sprott, H; Franke S; Kluge H; Hein G, "Pain Treatment of Fibromyalgia by Acupuncture" Rheumatology International. 18:1, 35-6 1998
Starlanyl, Devin J., MD, The Fibromyalgia Advocate, Oakland: New Harbinger Publications 1999
Vanderhaeghe, Lorna R. and Bouic, Patrick J.D., Ph.D., The Immune System Cure, New York: Kensington Publishing Corp. 1999
Werbach, Melvyn R., M.D, Nutritional Influences on Illness, Tarzana: Third Line Press, 1996
Home ׀ Health News ׀ Treatments ׀ Articles ׀ Links ׀ Disclaimer ׀ Forms/Directions
Compassionate Acupuncture & Healing Arts, 4501 Valley Forge Rd., Durham, NC 27705 Tel. 919-309-7753 Email: compassionateacu@mindspring.com
Copyright © 2005 John G. Connor