Alternative View: Patterns of Disharmony
By Glenn S. Rothfeld, MD

According to a recent study in the New England Journal of Medicine, millions of patients are turning to so-called Alternative Medicine to treat their conditions, many times without discussing their plans with their primary physician. The slowness with which orthodox medicine has acknowledged the existence of Chronic Fatigue Syndrome, and the lack of a coherent pattern of diagnosis and treatment, have set many CFS patients along this course.

This paper will focus on one such alternative approach which is being used by many with CFS. Chinese Medicine (Oriental or Eastern Medicine are other terms) includes acupuncture, Chinese herbal medicine, and QiGong exercises and massage techniques. These treatments are sometimes used separately and sometimes together. All are based on principles of Chinese Medicine written some 2500 years ago and based on even older concepts.

The ancients studied the natural world, and described events in the human body in terms of those forces of nature. Because they revered their dead, they did not dissect or biopsy for information. Rather, their medicine was based on what they observed in the living patient, and what the pattern of symptoms were.

One can see why Chinese Medicine is an attractive way of approaching CFS. Firstly, Chinese Medicine starts with the concept of Qi (pronounced “chee”), translated as “energy” or “life force”. For a patient whose primary symptom is lack of energy (particularly fatigue which is highly variable, disabling, and invisible to the outside world), a system which at least acknowledges the existence of life energy as a concept is refreshing.

Secondly, there is no question of whether this is a “real” illness in Chinese Medicine. That is to say, ANY combination of symptoms and patient presentation is seen in terms of the imbalance of energy, and treated as such. There is no division of mind and body (or of “spirit” for that matter: more on that later) in this medicine. An emotion is seen as the non-physical representation of an illness. There is no hierarchy of physical and mental, and no need for a patient to plead for a SPECT scan to prove that they don’t need a psychiatrist.

Thirdly, because Chinese Medicine focuses on patterns of presentation and on the interrelationship of body systems rather than on causative factors and discrete organ pathologies, one can easily explain the global effects of an illness such as CFS. The myriad symptoms of the neurologic, psychologic, gastrointestinal, reproductive, respiratory, hematologic, dermatologic, and immunologic systems can confound (and sometimes, cause “turf wars” between) Western medical specialists. For Chinese Medicine, they are different hues to paint a more complete picture of imbalance.

Finally, since the forces of nature never change, the patterns described in CFS are familiar ones to a practitioner of Oriental Medicine. The diagnosis and treatment is based on the skill of the practitioner and does not change rapidly with advances in immunology and pharmacology.

A full discussion of Chinese medical diagnosis is beyond the scope of this article. But, here are some patterns of disharmony commonly seen in CFS. The organ names (Kidney, Spleen, etc.) are NOT referring to the anatomical organs, but to energetic functions related to the organs, as the Chinese understood them. top

Yin/Yang Disharmony

All of life involves an interplay of active and passive principles: day/night, summer/winter, hot/cold, exterior/interior, sympathetic/parasympathetic. The Yang part of the Qi is that part of us which is in movement, warms us, is active, external, and lifts us up. The Yin part is interior, replenishes, anchors and nourishes us, creates stillness, and is cool and fluid.

Common Yin/Yang disharmony in CFS patients presents as Yang Deficiency (collapsed fatigue, difficulty waking in the morning, cold limbs, sluggish digestion and other body processes, diminished libido) and/or Yin Deficiency (restless fatigue and insomnia, hot flushes, stiffness and deep aching pain). top

Shao Yin (Kidney) Disharmony

In Chinese Medicine, the Kidney Qi is the deepest energy and holds the reserves and the will. Therefore, any chronic illness will eventually deplete the Kidney Qi, especially the Yin aspect which is like an underground spring: deep, refreshing, and liquid. Kidney Yin Deficiency is a common pattern in CFS, as it is in AIDS and in other chronic debilitating conditions. (The similarity of some AIDS and CFS symptoms cause confusion and frustration in the research, clinical and political worlds; in Chinese Medicine they can be seen as different degrees of the same disharmony patterns.)

Kidney Yin Deficiency can show up as frequent urination, severe exhaustion, weak legs and knees, dizziness and tinnitus, dry mouth and throat, disturbed, restless sleep which does not relieve the fatigue, night sweats, fearfulness and lack of resolve and willpower.

The Shao Yin channel also includes the Heart energy, which holds the Spirit, or “Shen.” This Shen, the spark of liveliness within us, is not really a mental process in Chinese Medicine, but has to do with our potential to live life fully. I have had patients who have had their “spark” drained by their constant battle with chronic illness, such that they became flat and hopeless. Every so often, they awake feeling some energy, and they put a smile on and fill their day with activity. Yet, these patients are frequently treated as having endogenous depression, and given mood elevators. top

Wei Qi Disharmony

The Lung governs the Wei, or Protective Qi, which prevents our receiving foreign influences (viruses, toxins). A weakness in the Wei Qi will lead to repeated episodes of viral-like illnesses, scratchy throat, slight fever (especially later in the day), shortness of breath, and a dry cough, as well as exhaustion. top

Damp-Heat Syndrome

This frequently comes from an infection (a common precipitant in CFS) or from unhealthy lifestyle patterns. Dampness is the term given to the waste products of metabolism and digestion, which can accumulate in the channels of energy. This leads to aching and tiredness in the muscles, heaviness of body or head, fatigue after any exertion, bloating and sour digestion, and a lack of concentration and clouded feeling in the brain. With heat (from infection, or depletion of yin) can come burning on urination, foul gas and vaginal discharge. top

Circulation-Sex Syndrome

Five Element acupuncture, popularized in the West by Professor J.R. Worsley, includes the concept of the Heart Protector (or Circulation-Sex channel), which guards the Heart (frequently likened to the Pericardium). Thus, when one’s intimacy is breeched (by rape, abuse or even “heartbreak”) the Heart Protector is adversely affected, so that external factors are allowed in which should not be, and those which should get in are kept out. This can manifest as environmental sensitivity (overreacting to things which should not be threatening), as issues involving intimacy, or as tightness in the chest and as coldness and paresthesias of the limbs (Qi staying close to the Heart.) top

Therapies:

Acupuncture

There are approximately 8,000 acupuncturists in the U.S., 1/4 of whom are MDs. Acupuncture involves the placement and manipulation of thin needles in “points” along the channels of energy, or meridians. This facilitates the movement of stuck Qi, and helps repair the dysharmonies. Points also may be stimulated by a burning herb (called “moxa”), by electrical current, magnets, or lasers. A typical course of acupuncture involves treatments 1-2 times per week. CFS, as a chronic illness, takes a while to treat effectively, but common results after a few weeks of treatment are less heat sensations, less muscle and joint pains, and an increased sense of well-being. top

Western Perspective

Acupuncture was first introduced in the U.S. as an alternative to anesthesia, and most of the Western research has still focused on this, somewhat peripheral, use. The discovery that acupuncture needles stimulate the type 3 afferent muscle fibers to release endorphins, and that acupuncture releases ACTH and TRH in the central nervous system helps to understand the effects which (unlike TENS machines) last for days after the needles are removed. However, it is the application of electromagnetic field theory and of quantum physics to the neuro-endocrine system which is beginning to articulate a basis for understanding how acupuncture works. top

Chinese Herbal Medicine

There are hundreds of Chinese herbs, and they are combined into formulas, which are then given in pill, powder or tincture form, or cooked whole until the liquid extracts the resins and is drunk. A course of therapy is usually several weeks, after which the prescription is altered according to response.

An herbal prescription usually contains the herbs of main action (e.g. Kidney tonic herbs for treating Kidney Deficiency syndrome), secondary herbs to help correct the imbalances, and herbs to ameliorate any side effects (e.g. herbs to protect the stomach from irritation). This allows the herbalist to use smaller (and therefore safer) doses of any single herb, and still get a powerful cumulative effect. The current push in psychiatry toward poly-pharmacy, and the “step” approach in antihypertensive therapy use similar principles. top

Western Perspective

The current interest in the antineoplastic drug Taxol, produced from the Pacific Yew tree, and the investigation of trichosanthes (Chinese cucumber) and various mushrooms have brought Chinese herbal medicine to the attention of Western scientists. When studied, various herbs have antimicrobial (isatis, astragalus), antiparasitic (…), antineoplastic (…) and antihypertensive (…) effects. There are also resins called terpins and saponins that are prevalent in herbs such as ginseng, astragalus and licorice, which have what is called an “adaptogenic” effect on the adrenal and other endocrine organs. However, studies of the prescriptions themselves rather than the component herbs, are just beginning to appear in Western journals. top

Qi Gong

The PBS/Bill Moyers special “Healing and the Mind” has brought QiGong (formerly spelled Ch’i Kung) to prominence. QiGong literally means “energy exercise” and can include anything from Tai Ch’i (a dance-like series of movements) to Kung Fu and other martial arts. A QiGong practitioner will teach a patient exercises to build the Qi, and to encourage it to circulate within the patient’s channels. The exercise form is not stressful, and can be done by patients who are otherwise disabled. QiGong can also involve treatment with a form of massage called acupressure, which the patient can be taught to self-administer. top

Western Perspective

There is some controversy over the use of exercise in CFS. QiGong is actually similar to yoga in that the mind and the breath are used with gentle movements and postures. Whereas yoga and meditation have been studied some, studies of QiGong await the acceptance in the West that concepts like “energy” and “well-being” are real and tangible to patients. top

Conclusion

In 18.., Dr. Ehrlich published … and began what is known as the search for the Magic Bullet. This paradigm, that there is an infectious cause of a disease and therefore a discrete curative substance which merely awaits discovery, has dominated medicine through the current century. This in turn has led to major medical successes over bacterial and related diseases. But it has also steered us down an increasingly expensive path of capsular protein antigen assays and fourth-generation antibiotics.

Chronic Fatigue Syndrome, with its wide range of symptoms and of target organs, its insidious onset and variable course, and its focus on the patient’s own report of their energy, poses an elusive and complex problem for this model. Chinese Medicine and its therapies give CFS patients a different perspective of their illness, and offer some the hope of an effective adjunct or primary form of treatment.