Chronic Fatigue Syndrome (CFS)

Chronic fatigue syndrome (CFS) causes extreme fatigue that continues over a period of at least six months. Some people may also experience persistent fatigue following viral infection (post-viral fatigue).

What are the symptoms of CFS and post-viral fatigue?

The defining characteristic of CFS is unexplainable fatigue that persists for at least six months, and that is accompanied by cognitive problems such as concentration difficulties and poor short-term memory.

Before a diagnosis of CFS is confirmed, all other explanations for the persistent fatigue need to be ruled out, and at least four of the following symptoms must have been present consistently or repeatedly since its onset:

  • Unrefreshing sleep
  • Fatigue and malaise that persists for more than 24 hours after exertion
  • Cognitive problems (such as impaired concentration and short-term memory and difficulty finding the right words to use in conversation)
  • Muscle pain (myalgia)
  • Sore throat
  • Inflammation and/or tenderness of the lymph nodes
  • Joint pain that affects multiple joints but isn’t accompanied by redness or swelling
  • Headaches

The fatigue of CFS interferes with the sufferer's ability to continue with their normal work, study, social or personal activities. It persists despite sleep or rest, and is not caused by excessive exertion.

In fact, even minor physical or mental exertion can leave patients feeling exhausted and extremely unwell, sometimes causing them to 'crash' for 24 hours or more afterwards.

A wide variety of additional symptoms may also occur, including lowered resistance to infection, low-grade fever, muscle pains and weakness, dryness of the mouth and/or throat, gastrointestinal issues (including diarrhoea, bloating, nausea and stomach pain), low blood pressure (sometimes causing dizziness or fainting) and respiratory symptoms such as coughing and shortness of breath.

Many sufferers become highly sensitive to light, noise and smells and/or develop intolerances to alcohol, chemicals and/or particular foods.

Mood problems often arise as a result of the frustration and despair at being unable to engage in normal day-to-day activities.

Although CFS can persist for many months or even years, most people with it have periods of feeling relatively well, followed by episodes of relapse and debilitation.

The symptoms of post-viral fatigue are similar to those of CFS, but differ in that they can be directly traced to a viral infection, and do not include cognitive problems. In this situation, the fatigue and tiredness that are common symptoms of viral infections continue after the other symptoms have been resolved.

What causes CFS and post-viral fatigue

The causes of CFS and post-viral fatigue have not been determined, but they are believed to have their origins in infection, perhaps in combination with abnormal responses to it due to underlying immune system dysfunction.

Post-viral fatigue occurs after infection with the Epstein-Barr virus (EBV, which is responsible for glandular fever), or by any of a number of other viruses that affect the respiratory and gastrointestinal tracts.

Infection with EBV and numerous other viruses are also common triggers for the onset of CFS, but do not actually cause the condition. A period of intense physical or mental stress is also a trigger for some people, but in others no initiating event can be determined.

Other factors that have been hypothesised to contribute to CFS and/or aggravate its symptoms include:

  • Immune system dysfunction, including the presence of allergies
  • Dysfunctional immunological and skeletal muscle responses to physical activity, contributing to the unusual degree of fatigue that occurs following even minor exertion
  • Dysfunction of the mitochondria (the cellular structures responsible for the production of the energy that fuels all our physiological functions)
  • Genetic predisposition
  • Toxic overload from exposure to environmental toxins (such as agricultural chemicals, cleaning products and heavy metals)
  • Blood sugar imbalance
  • Hormonal problems (for example, disruptions of the hormones produced by the hypothalamus, pituitary and adrenal glands, known as the HPA-axis)
  • Inflammation of pathways in the nervous system

From the perspective of traditional Chinese medicine (TCM), characteristics of CFS and post-viral fatigue such as impaired production of cellular energy and abnormal muscle responses to exercise are broadly suggestive of deficiencies of Qi (life force energy), and Yang (the energy responsible for stimulation, movement and activity).

Other symptoms are suggestive of deficient Yin (the energy that nourishes the body, mind and spirit), including the impairment of immune function and the presence of low-grade fever, sweating, and dryness of the mouth, throat and mucous membranes.

How do I treat CFS and post-viral fatigue?

Chinese herbs for CFS and post-viral fatigue

Depending on the specific symptoms experienced, suitable Chinese herbs to aid the management of CFS and post-viral fatigue may include those that invigorate the Qi (including Astragalus, Codonopsis, Atractylodes, Chinese Licorice and Schisandra), often in combination with Yin-nourishing tonics such as Ligustrum.

Of these, Chinese Licorice have additional benefits thanks to its effects on adrenal gland function, and Astragalus is specifically indicated to promote convalescence and recovery after illness, for which purposes it is often taken with Siberian Ginseng.

Herbs and nutrients to support immune defences

CFS relapses are often triggered by infections such as colds and flu, so support your resistance to infection by taking herbs like Andrographis, Echinacea and Olive Leaf, along with key nutrients for healthy immune function, such as zinc and vitamin C.

CoQ10 supports energy production, muscle function and immunity

Coenzyme Q10 is crucial to the functioning of the mitochondria, which are responsible for the cellular production of energy, so may have a role to play in the management of CFS.

In addition to helping to maintain and improve general wellbeing, it supports muscle activity, exercise tolerance and healthy immune function.

Research suggests that symptoms of low CoQ10 levels may include fatigue, reduced stamina and endurance, and muscle aches and pains.

Diet and lifestyle recommendations for CFS and post-viral fatigue

  • Even when you're feeling well, it's important not to overdo things. Flare ups of CFS are often triggered by stress, lack of sleep or too much activity, so avoid putting yourself under pressure or taking on more than you’re capable of
  • Allow yourself as much sleep and rest as you need, and don’t be tempted to push through your fatigue, or you may suffer for it afterwards
  • Avoid strenuous exercise unless under the supervision and care of your physiotherapist or other specialist, who can create a program for you that gradually increases in length and intensity to help prevent loss of muscle strength and support your energy levels
  • Gentle, breath-based forms of exercise such as Qigong and Tai Chi may also be suitable in some circumstances, and are traditionally believed to help maintain adequate Qi
  • Stick to a well-balanced diet that includes plenty of filtered water and is based on fresh fruit and vegetables, high quality lean protein and whole grains, nuts and seeds. Choose organic options where possible to minimise your exposure to toxic chemicals
  • Steer clear of junk food, caffeine, alcohol, refined sugars and cigarette smoke
  • If you’re concerned that your diet or other substances you come into contact with during your day-to-day life are exacerbating your symptoms, keeping a symptom diary may help you and your healthcare practitioner identify any intolerances that are occurring

When should you see your doctor or other health professional about CFS and post-viral fatigue?

Chronic fatigue syndrome is a complicated and debilitating condition that’s not suitable for self-diagnosis or self-management. If you’re concerned you may be affected, it’s important to see your doctor or healthcare professional because there are many causes of long-term fatigue, ranging from poor diet and lifestyle right through to serious health problems, and all of these need to be ruled out before a diagnosis of CFS is determined.