LAMP TCM & ACUPUNCTURE 44: Pulse Diagnosis, Questions to Ask, Mastitis, Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is the current name for a disorder characterized by debilitating fatigue and a variety of associated physical, constitutional and neuropsychological complaints. The clinical manifestation of CFS includes fatigue, difficulty concentrating, headaches, sore throat, tender lymph nodes, muscle aches, joint aches, fever, difficulty sleeping, psychiatric problems (such as depression), allergies, abdominal cramps, weight loss or gain, rash, rapid pulse, chest pain, and night sweats.

Women are twice as likely as men to be diagnosed with CFS. Most patients with CFS are generally between 25 and 45 years old, although cases in childhood and in middle age have been described.

The diverse names for the syndrome reflect the equally numerous and controversial hypotheses about its etiology. It is often postinfectious, associated with immunologic disturbances, and is commonly accompanied by depression. Recent controlled studies of patients with chronic fatigue syndrome documented abnormalities in endocrine function consistent with reduced production of corticotropin-releasing hormone in the hypothalamus.

The typical case of chronic fatigue syndrome arises suddenly in a previously active individual. An otherwise unremarkable flu-like illness or some other acute stress is recalled with great clarity as the triggering event. Unbearable exhaustion is left in the wake of this incident. Other symptoms, such as headaches, sore throat, tender lymph nodes, muscle and joint aches, and frequent feverishness, lead to the belief that an infection persists, requiring medical attention. Over several weeks, the impact of reassurances proffered during the initial evaluation fades as other features of the syndrome become evident, such as disturbed sleep, difficulty concentrating, and depression.

Physical examination and routine laboratory tests are required to rule out other possible causes of the patient's symptoms. Prominent findings argue strongly in favor of other processes. However, no laboratory test, no matter how esoteric or exotic, can diagnose this condition or measure its severity.

Many symptoms of chronic fatigue syndrome respond to treatment. Nonsteroidal anti-inflammatory drugs can alleviate headaches, diffuse pain and feverishness. Antihistamines or decongestants may help allergic rhinitis and sinusitis in patients with CFS. Non-sedating antidepressants improve mood and disordered sleep and thereby attenuate the fatigue to some degree.