Chronic fatigue syndrome , acupuncture & its related modalities

Townsend Letter for Doctors and Patients, August-Sept, 2005 by Honora Lee Wolfe

Keywords: Chinese medicine, acupuncture, chronic fatigue syndrome (CFS), seven star needling, cupping, electro-acupuncture

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Chronic fatigue syndrome (CFS) refers to long-standing severe fatigue without substantial muscle weakness and without proven psychological or physical causes. This condition is also known as chronic fatigue immune deficiency syndrome (CFIDS). The prevalence of this condition is estimated to be somewhere between seven and 38 cases per 100,000, and women are 1.3-1.7 times more susceptible to it than men. Although chronic viral infection has been proposed as the etiology of this condition, this remains somewhat controversial. Other proposed but unproven etiologies include immunologic abnormalities, endocrine abnormalities, abnormal levels of neurotransmitters, inadequate cerebral circulation, and elevated levels of angiotensin-converting enzyme. Although this diagnostic category is a relatively recent one, a number of studies have been conducted on it in the People's Republic of China in terms of its treatment with acupuncture and its related adjunctive modalities. Four studies are included below.

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Study 1. For instance, Wang Wei-hong et al. published an article titled, "A Clinical Audit of the Treatment of Chronic Fatigue Syndrome with Acupuncture Combined with Cupping." This article appeared in issue #8, 2001 of Zhong Guo Zhen Jiu (Chinese Acupuncture & Moxibustion) on pages 481-482.

Cohort description: There were 50 patients altogether in this study, all of whom were seen as out-patients at the Ju County Chinese Medical Hospital in Shandong. These 50 patients were randomly divided into a treatment and a comparison group of 25 patients each. In the treatment group, there were 18 males and seven females aged 19-52 years. The shortest duration of illness was eight months and the longest was five years. In the comparison group, there were 16 males and nine females aged 23-55 years. These patients had been ill for from seven months to three years. The criteria for establishing a diagnosis of chronic fatigue syndrome in this study were those established by the US Centers for Disease Control in 1991. These consisted of main and secondary symptoms combined with physical signs. The main symptoms included fatigue continuing for over six months. The fatigue was severe enough to limit the amount of the patient's activity. Other fatigue-inducing diseases had been ruled out in all cases.

Secondary symptoms consisted of the following occurring simultaneously with or after the fatigue and continuing or occurring repeatedly for over six months: low-grade fever, sore throat, swollen lymph nodes, generalized muscular flaccidity and weakness, muscular pain and soreness, fatigue continuing 24 hours after activity, headache, wandering arthralgia, and neuropsychiatric symptoms such as depression and sleep disturbances. Physical signs included a body temperature of 37.5-38.5[degrees]C, local pharyngitis, and swelling of the cervical lymph nodes larger than 1cm in diameter. Exclusion criteria consisted of psychosis and drug dependency or abuse.

Treatment method: Patients in the treatment group were needled at Da Zhui (GV 14), Zhi Yang (GV 9), Xin Shu (Bl 15), Ge Shu (Bl 17), Ming Men (GV4), Shen Shu (Bl 23), and Chang Qiang (GV 1) with even supplementing-even draining technique and moderate stimulation. After obtaining the qi, the needles were retained for 40 minutes. After the needles were withdrawn, cupping therapy was applied on the governing vessel and the medial and lateral lines of the foot tai yang bladder channel. Using a large cup and an oil lubricant, sliding cupping was performed on the upper back until red or dark red spots or patches appeared on the skin and the patient felt a sensation of heat on the back. After the cupping, the local skin was cleaned with a sterilized cotton ball and the patient was advised to keep their body warm and not to bathe for one day after the treatment. This treatment was given once every six days, with 30 days equaling one course of therapy. Three days rest was allowed between successive courses.

The comparison group was treated with the following Chinese medicinals in liquid extract form: Radix Astragali Membranacei (Huang Qi), Radix Panacis Ginseng (Ren Shen), cooked Radix Rehmanniae (Shu Di), Fructus Corni Officinalis (Shan Zhu Yu), Cortex Eucommiae Ulmoidis (Du Zhong), Fructus Lycii Chinensis (Gou Qi Zi), Radix Angelicae Sinensis (Dang Gui), Carapax Amydae Sinensis (Bie Jia), Herba Epimedii (Xian Ling Pi), Sclerotium Poriae Cocos (Fu Ling), and Fructus Zizyphi Jujubae (Da Zao). Twenty-five milligrams of these medicinals were administered orally two times per day in a ready-made form manufactured by the Qingdao Third Pharmaceutical Factory.

Study outcomes: Cure was defined as complete disappearance of the clinical symptoms and resumption of normal work and life. Marked effect was defined as basic disappearance of clinical symptoms and resumption of normal work and life. Some effect was defined as marked improvement in clinical symptoms but the patient was still not able to resume normal work. No effect meant that there was no obvious improvement in symptoms and the patient could not resume normal work and life. Based on these criteria, after one month of treatment, the total amelioration rate in the treatment group was 92%, while it was only 64% in the comparison group. Therefore, there was a significant statistical differences in effectiveness between these two protocols (P < 0.05).