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Chronic
fatigue syndrome (CFS) is an increasingly common diagnosis in China,
as evidenced by the regularly appearing articles on its treatment
in Chinese medical journals. Below are summaries of three recently
published Chinese articles on the treatment of CFS with Chinese herbal
medicine.
Article 1
On page 65 of issue #4, 2007 of the Shi
Yong Zhong Yi Nei Ke Za Zhi (Journal
of Practical Chinese Medicine Internal Medicine), Zhuo
Li-yong published "The Treatment of 94 Cases of Chronic Fatigue Syndrome
with Liu Wei Di Huang Wan with Additions & Subtractions."
Cohort Description
Altogether, there were 190 cases of CFS enrolled in this study. All of these
cases met both Chinese and American diagnostic criteria for this condition.
These 190 cases were then randomly divided into a treatment group of 94 and
a comparison group of 96. In the treatment group, there were 39 males and 55
females, 17-58 years of age, with an average age of 37 years. These patients
had suffered from CFS for from eight months to 15 years, with an average disease
duration of five years. In the comparison group, there were 42 males and 54
females, 18-60 years of age, with an average age of 35. These patients had
suffered from CFS from six months to 14 years, with an average disease duration
of 5.5 years. Thus these two groups were considered statistically comparable
for the purposes of this study in terms of sex, age, and disease duration.
Treatment Method
All members of the treatment group were orally administered the following modified
version of Liu Wei Di Huang Wan:
- Shu Di Huang (cooked Radix Rehmanniae), 15g
- Shan Yao (Radix Dioscoreae),
24g
- Fu Ling (Poria), 12g
- uncooked Huang Qi (Radix Astragali), 24g
- Xian He Cao (Herba Agrimoniae),
30g
- Shan Zhu Yu (Fructus Corni), 10g
- Ze Xie (Rhizoma Alismatis), 12g
- Yin Yang Huo (Herba Epimedii), 15g
- Tu Si Zi (Semen Cuscutae), 24g
- Shi Hu (Herba Dendrobii), 15g
- Da Zao (Fructus Jujubae), 7 pieces
If there was marked qi vacuity, 15 grams of Xi Yang Shen (Radix Panacis
Quinquefolii) were added. If there was marked yin vacuity, 15 grams
of mix-fried Gui Ban (Plastrum Testudinis) were added.
One packet of these medicinals was decocted in water down to 300
milliliters of medicinal liquid and administered in divided doses morning
and evenings 30 minutes after eating. Four continuous weeks of this
treatment equaled one course of treatment.
All members of the comparison group were administered the Chinese ready-made
medicine Xiao Pi Ling Ke Li (Disperse Exhaustion Magically Effective Pillules,
manufactured by the Zhejiang Great Virtue Pharmaceutical Company). Ten grams
of these pills were administered each time, three times per day after meals.
Treatment lasted four weeks. During the course of treatment, all members of
both groups stopped taking any other medications and regulated their lifestyles.
Treatment outcomes were analyzed for both groups after one course of treatment.
Study Outcomes
Cure was defined as complete disappearance of fatigue with no recurrence on
follow-up after six months. Marked effect was defined as complete disappearance
of fatigue but some recurrence on follow-up after six months. Some effect meant
that the fatigue was markedly less and that there were occasional recurrences
on follow-up after six months. No effect meant that there was no obvious change
in the patient's condition from before to after treatment. Table 1 shows
the outcomes of the two groups based on these criteria.
Table 1: Study 1
Outcomes
Group |
Cured |
Marked Effect |
Some Effect |
No Effect |
Total Effect |
Treatment |
45 |
21 |
18 |
10 |
89.4% |
Comparison |
9 |
19 |
35 |
33 |
65.6% |
Discussion
The etiology of CFS is presently unknown. However, research has shown
that its onset is somehow related to lifestyle and psychology. According
to Dr.
Zhuo, CFS corresponds to the traditional Chinese disease category of vacuity
taxation. According to Chinese medical theory, the kidneys are the former
heaven root and govern the storage of essence. Essence, qi, and spirit are
the material bases of the human body. If essence, qi, and spirit tend to
be vacuous, then any of hundreds of diseases may arise. If thought and worry
are excessive, they may consume and exhaust the heart and spleen. Because
the heart is the child of the liver, worry may also eventually damage the
liver, and the liver and kidneys share a common source. Hence yin and blood
are internally consumed, and kidney yin also become vacuous. This can lead
to lassitude of the spirit and lack of strength, dizziness and vertigo, insomnia,
impaired memory, low back and knee soreness and limpness, low-grade fever,
and sore throat, all typical symptoms of liver-kidney yin vacuity. In this
case, the disease mechanism mostly is viscera and bowel depletion and vacuity
with essence, qi, and spirit insufficiency. Liu Wei Di Huang Wan originated
in the Tang dynasty, and its functions are to enrich and supplement the liver
and kidneys. Within this formula, Shu Di enriches kidney yin and boosts the
essence and marrow. Shan Yao enriches the kidneys and supplements the spleen.
Shan Zhu Yu enriches the kidneys and boosts the liver. Xian He Cao, when
combined with Da Zao, boosts the qi and supplements vacuity, disperses and
eliminates fatigue and taxation. Ren Shen (Radix Ginseng) [sic] and Yin Yang
Huo are both effective for fatigue taxation and are even more effective for
this purpose when prescribed together. Huang Qi is an extremely important
qi-supplementing medicinal. It is able to boost the qi and rectify the blood.
It also promotes a human's disordered bodily qi and blood to obtain
balance. In particular, it is able to eliminate the symptom of fatigue. Thus,
this formula restores the evenness and harmony of the entire body's
yin and yang as well as fortifies or brings back to health the function of
all the viscera and bowels. Hence, it achieves relatively good therapeutic
effects in the treatment of this condition.
Article 2
On pages 394-395 of issue #7, 2007 of the Zhe Jiang
Zhong Yi Za Zhi (Zhejiang
Journal of Chinese Medicine), Shi Xue-ying published "The Therapeutic
Effects of Treating Liver Depression-Spleen Vacuity Pattern Chronic Fatigue
Syndrome with Xiao Yao San (Rambling Powder) in Patients with Immune Function
Disturbance."
Cohort Description
Forty-six patients meeting the US Centers for Disease Control (CDC) criteria
for CFS were enrolled in this cohort study. Among these 46, there were 14 males
and 32 females, aged 18-65 years. Eight of these cases were under 30 years
of age, 16 were 31-40, 11 were 41-50, and 11 were over 50 years old. Twenty
cases had suffered from CFS for six months to two years, and 26 patients had
suffered from CFS for more than two years. These patients made up the treatment
group, and they were compared to a healthy group of 25 persons who were statistically
comparable in terms of age and sex.
Treatment Method
All patients in the treatment group were administered the following version
of Xiao Yao San:
- Chai Hu (Radix Bupleuri)
- Dang Gui (Radix Angelicae Sinensis)
- Bai Shao (Radix Alba Paeoniae)
- scorched Bai Zhu (Rhizoma Atractylodis
Macrocephalae)
- Fu Ling (Poriae), 10g each
- mix-fried Gan Cao (Radix Glycyrrhizae),
6g
- Sheng Jiang (uncooked Rhizoma Zingiberis)
- Bo He (Herba Menthae Haplocalycis),
5g each
One packet of these medicinals was decocted
in water two times and administered orally in divided doses morning
and evening. This treatment
was given continuously for two months. During that time, patients stopped
taking any other Chinese or Western medicines. The severity of patients' clinical
signs and symptoms were assessed before and after treatment. Natural
killer (NK) cells in the blood were measured before and after treatment
as well as IgA, IgG, and IgM.
Study Outcomes
Table 2 shows the differences of severity of the symptoms of CFS in the treatment
group from before to after treatment.
Table 2: Severity of Symptoms Pre- and Post-Treatment
Symptoms |
Before Treatment |
After Treatment |
|
Slight |
Moderate |
Severe |
Slight |
Moderate |
Severe |
Chest, rib-side, lesser abdomen, breast distention & pain |
12 |
23 |
5 |
19 |
2 |
0 |
Poor appetite |
10 |
3 |
1 |
6 |
2 |
1 |
Vexation, agitation, irritability |
1 |
17 |
28 |
21 |
8 |
0 |
Anxiety & restlessness |
14 |
23 |
6 |
23 |
3 |
0 |
Emotional depression |
7 |
28 |
9 |
25 |
2 |
0 |
A tendency to great sighing |
12 |
23 |
6 |
20 |
1 |
0 |
In all cases, there was a significant
reduction in the overall severity of the above symptoms from before
to after treatment. Except for poor
appetite in one case, none of these patients suffered from severe symptoms
after treatment. By assigning a point system to the severity of the
above symptoms, the median points before treatment were 42.06 ± 8.25,
while the median points after treatment were only 18.23 ± 6.18.
Similarly, using this same point system, nine cases were judged clinically
cured, 31 cases experienced a marked effect, three cases experienced
some effect, and three cases experienced no effect, for a total effectiveness
rate of 87%.
Table 3 shows mean serum NK cell numbers and IgA, IgG, and IgM in both the
healthy comparison group and the treatment group before and after treatment.
Table 3: Results in Healthy Comparison Group and Treatment Group
Group |
NK cells (%) |
IgA (g/L) |
IgG (g/L) |
IgM (g/L) |
Healthy comparison group |
37.10 ± 7.26 |
1.770 ± 0.456 |
11.168 ± 2.762 |
1.520 ± 0.531 |
Treatment group: Before treatment |
30.46 ± 8.15 |
1.341 ± 0.548 |
10.135 ± 1.732 |
1.206 ± 0.425 |
After treatment |
36.82 ± 7.41 |
1.563 ± 0.523 |
11.147 ± 2.328 |
1.431 ± 0.472 |
As the reader can see, mean serum NK cells in
the treatment group were low compared to the healthy group and markedly
increased after
treatment to just slightly less than the normal healthy group. IgA,
IgG, and IgM were also all low in the treatment group and also all
increased significantly after treatment, although remaining less than
the normal healthy group.
Discussion
According to Dr. Shi, loss of regulation between the liver and spleen is the
main pattern he sees in patients with CFS. Therefore, he commonly treats this
condition with Xiao Yao San (Rambling Powder). Within this formula, Chai Hu
courses the liver and resolves depression, while Dang Gui and Bai Shao nourish
the blood and emolliate the liver. Bai Zhu, Fu Ling, and Sheng Jiang fortify
the spleen and stomach and strengthen movement and transformation. Bo He assists
coursing, scattering, spreading, and extending. Gan Cao boosts the qi and harmonizes
the center. Hence, when these medicinals are used together, they have the effect
of coursing the liver and resolving depression, fortifying the spleen and harmonizing
the constructive. As this research shows, patients with CFS have a hypofunctional
immune system, and treating their presenting pattern with Chinese medicinals
improves immune function as measured by NK cells and immunoglobulins.
Article 3
On page 94 of issue #6, 2007 of Xin Zhong Yi (New
Chinese Medicine), Wang Qiu-ping
published "The Treatment of Chronic Fatigue Syndrome Via Three Steps
Based on Knowledge Gained from Experience." In this article, Dr. Wang
outlines a three-step treatment protocol for this condition.
1. Level the liver and extinguish wind; quickly treat the tips [or
branches].
Dr. Wang's first step of treating patients with CFS is based on his experience
that these patients commonly present with dizziness, headache, sore neck, heart
palpitations and fearful throbbing, vexation, agitation, restlessness, insomnia,
profuse dreams, a dry mouth with a bitter taste, thin, yellow tongue fur, and
a vacuous, agitated pulse. These symptoms correspond to a pattern of ascendant
liver yang hyperactivity with internal wind harassing above. The liver's
main physiologic functions are its governance of the storage of blood and its
governance over coursing and discharge. Its body is yin, but its function is
yang. The liver is categorized as wood in terms of the five phases. Therefore,
it governs stirring and upbearing. It is the liver's ability to store
the blood that controls and restrains ascendant liver yang hyperactivity. The
nature of CFS is that it is a long-term condition that exhausts and consumes
the body's yin and blood internally. As Wang Bing said,
The liver stores the blood, [while] the heart moves it. Stirring
leads to
the blood's movement within all the channels. [However, when]
a person
[is] still, this leads to blood returning to the liver viscus.
If liver blood is consumed internally,
it is not able to control and restrain liver yang. Yin is vacuous,
and yang becomes hyperactive.
Thus, vacuity wind harasses the clear orifices above, leading to dizziness
and headache. This harassment also stirs the heart spirit, which leads
to heart palpitations and fearful throbbing, vexation, agitation, and
restlessness. The liver stores the ethereal soul, and the ethereal
soul is nothing other than a manifestation of the spirit. Blood is
the main material basis of both the spirit and the ethereal soul. Therefore,
it is said, "The liver stores the blood [and] the blood is the
abode of the ethereal soul." If liver blood is insufficient,
the spirit has no abode in which to lodge. The clinical manifestations
of this are susceptibility to fright, profuse dreams, and restless
sleep. Agitation and stirring of wind and yang consume and damage fluids
and humors, thus leading to a dry mouth with a bitter taste as well
as thin, yellow tongue fur and a vacuous, agitated pulse.
Based on the above, Dr. Wang says that one first should level the liver and
extinguish wind using the following formula:
- Sheng Di Huang (uncooked Radix Rehmanniae), 40g
- Ci Ji Li (Fructus
Tribuli)
- uncooked Mai Ya (Fructus Germinatus Hordei)
- Yin Chen Hao (Herba
Artemisiae Scopariae), 6g each
- Gou Teng (Ramulus Uncariae Cum Uncis)
- He Huan Pi (Cortex Albiziae)
- Yu Jin (Tuber Curcumae), 10g each
- Ye Jiao Teng (Caulis Polygoni
Multiflori)
- Fu Shen (Sclerotium Pararadicis Poriae), 30g each
- Dang Shen (Radix
Codonopsis)
- Shi Jue Ming (Concha Haliotidis)
- Dan Shen (Radix Salviae Miltiorrhizae),
15g each
Within this formula, a heavy dose of Sheng
Di Huang enriches and nourishes the liver and kidneys, cools the
blood and moistens dryness.
Gou Teng levels the liver and extinguishes wind. It also has the function
of settling and stilling. Shi Jue Ming levels the liver and subdues
yang. Ci Ji Li courses the liver and dispels wind, levels the liver
and regulates the liver qi. A small amount of Yin Chen Hao clears heat
from the liver and gallbladder as well as rectifies liver-gallbladder
depression. Hence, heat is dispersed, and depression is upborne. This
is assisted by uncooked Mai Ya, which also effuses and upbears the
qi. Its nature is to regulate the flow of the liver qi's spreading
and extending. Ye Jiao Teng and He Huan Pi nourish the blood and resolve
depression, quicken the blood and free the flow of the network vessels,
quiet the spirit and stabilize the mind. Dang Shen fortifies the spleen
and supplements the qi, while Fu Shen disinhibits water and seeps dampness,
thus preventing the accumulation of dampness from producing phlegm.
It also calms the heart and quiets the spirit. The use of these two
medicinals is based on the saying, "[If] one sees liver disease,
know that the liver transmits to the spleen [and] so one must first
replete the spleen." Yu Jin and Dan Shen soothe and ease the
flow of the qi mechanism, free the flow and out-thrust stasis and stagnation.
Therefore, they free and ease the flow of both the qi and the blood.
2. Enrich and nourish the liver and kidneys, balance yin and yang.
After wind and yang have been leveled and extinguished, respectively, clinically
one sees marked signs of liver-kidney insufficiency as the root of the disease.
This is evidenced by unremitting fatigue accompanied by heart palpitations,
insomnia, restlessness, and a fine, weak pulse. In this case, the pattern
is categorized as liver-kidney essence depletion with blood not nourishing
the spirit. If liver blood and kidney essence become insufficient, then the
spirit suffers from lassitude and the body from lack of strength. In addition,
there are heart palpitations and fearful throbbing. To treat this, Dr. Wang
says one should supplement and boost the liver and kidneys and enrich, nourish,
and quiet the spirit. The formula he suggests is Zuo Gui Yin (Restore the
Left Beverage) and Sheng Mai Yin (Engender the Pulse Beverage) plus Suan
Zao Ren Tang (Zizyphus Spinosa Decoction) with additions and subtractions:
- Suan Zao Ren (Semen Zizyphi Spinosae)
- He Huan Pi (Cortex Albiziae)
- Shan Zhu Yu (Fructus Corni)
- Tu Si Zi (Semen Cuscutae)
- Dang Shen (Radix Codonopsis)
- Mai Men Dong (Tuber Ophiopogonis),
10g each
- Fu Shen (Sclerotium Pararadicis Poriae)
- Ye Jiao Teng (Caulis Polygoni
Multiflori)
- He Shou Wu (Radix Polygoni Multiflori), 30g each
- Sheng Di Huang
(uncooked Radix Rehmanniae)
- Shu Di Huang (cooked Radix Rehmanniae)
- Dan Shen (Radix Salviae Miltiorrhizae),
15g each
- Gua Lou (Fructus Trichosanthis), 6g
Within this formula, Suan Zao Ren, Ye Jiao Teng, and He Huan Pi nourish
the heart and boost the liver, quiet the spirit and stabilize the mind.
He Shou Wu astringes the essence and secures the qi, supplements the
liver and enriches the kidneys. Sheng Di Huang and Shu Di Huang enrich
yin and supplement the kidneys, nourish the blood and boost the essence.
Shan Zhu Yu supplements the liver, astringes the essence, and secretes
the qi. Tu Si Zi boosts the three yin and strengthens the defensive
qi. Dang Shen and Mai Men Dong boost the qi and nourish yin, nourish
and clear the heart. Fu Shen, Dan Shen, and Gua Lou transform phlegm
and dispel stasis, move the blood and quiet the spirit. When all these
medicinals are used together, they supplement and boost the liver and
kidneys, and enrich, nourish, and quiet the spirit. When the essence
is engendered and the blood is sufficient, fatigue and lack of strength
are improved and ameliorated.
3. Fortify the spleen and nourish the heart, improve and ameliorate
the physical body.
According to the authors of the Su Wen (Simple
Questions):
The spleen and stomach, large intestine, small intestine, three burners,
and the bladder are the root of the storehouse of endowment and the
abode of the constructive... They are of the category of utmost yin and communicate
with the earth qi.
Earth is the origin of the tens of thousands
of things. Thus, it is said, "The spleen is the latter heaven root." Liver
blood and kidney essence both come from this source, and supplementing
and filling the spleen qi enriches, engenders, and transforms this
source. Therefore, if the spleen qi is fortified and moving, the finest
essence of food and drink is full and sufficient. This then leads to
the engenderment and transformation of the liver and kidney essence
and blood having a source. This promotes and ameliorates the physical
body and secures the therapeutic effects already gained. The formula
Dr. Wang recommends for this purpose is Gui Pi Tang (Restore the Spleen
Decoction) with additions and subtractions:
- Huang Qi (Radix Astragali)
- Dang Gui (Radix Angelicae Sinensis)
- Suan Zao Ren (Semen Zizyphi
Spinosae)
- Yuan Zhi (Radix Polygalae)
- Mai Men Dong (Tuber Ophiopogonis)
- Mu Xiang (Radix Auklandiae)
- Dang Shen (Radix Codonopsis), 10g each
- Fu Shen (Sclerotium Pararadicis
Poriae)
- Ye Jiao Teng (Caulis Polygoni Multiflori)
- Bai Shao (Radix Alba Paeoniae)
- Dan Shen (Radix Salviae Miltiorrhizae),
15g each
- Wu Wei Zi (Fructus Schisandrae)
- Gan Cao (Radix Glycyrrhizae), 3g
each
Within this formula, Huang Qi, Dang Shen, and Gan Cao supplement
the spleen and boost the qi. When the spleen qi is strong, it is able
to engender and contain the blood. Fu Shen, Yuan Zhi, Suan Zao Ren,
and Ye Jiao Teng supplement the heart and boost the spleen. When heart
yin recovers, it is able to engender the blood and construct the spleen.
Dang Gui and Dan Shen nourish the blood and construct the heart. Mu
Xiang moves the qi and soothes the spleen. Mai Men Dong and Wu Wei
Zi promote the boosting of the lungs and kidneys. Bai Shao restrains
the liver and enriches the kidneys. When all these medicinals are used
together, they promote the sufficiency of heart blood, the strength
of the spleen qi, and fortification of both the mother and child. Hence,
all the symptoms of fatigue and lassitude are eliminated.
In the representative case history Dr. Wang provides as an example
of this approach, he prescribed formula No. 1 for one week. At the
end of that week,
the patient's heart palpitations and agitation had remitted. Then Dr.
Wang prescribed formula No. 2 for 20 days based on the fact that the patient
was still fatigued and had a sore neck and that these were worse after activity.
After this, he prescribed formula No. 3 in order to regulate and rectify and
generally improve the patient's condition. Although he does not say how
long the patient took formula No. 3, he does say that this regime was very
effective.
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Poppy Press, 2007. All rights reserved.
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