Chronic Fatigue Syndrome

Dr Charlotte Mendes Da Costa shares how homeopathy can help patients suffering from a condition causing intense mental & physical exhaustion

Chronic fatigue syndrome is a debilitating illness with many  sufferers in the UK. Over the years this condition has been called  different names including among other things neurasthenia, post-viral  fatigue syndrome and myalgic encephalitis (ME). There are an estimated 250,000 people in Britain affected by this illness the cause of which is largely unknown. The main symptoms of CFS  are severe and debilitating fatigue, both physical and mental. The  fatigue can be persistent or come and go but will have lasted at least  four months before a diagnosis can be made: it is not relieved by rest.  The fatigue is accompanied by a myriad of physical and mental symptoms.  Physical symptoms include painful muscles, joint pains, sore throat,  headache, dizziness, flu-like symptoms or difficulty regulating ones  temperature. Mental symptoms include poor short-term memory and  concentration; depression is also common. Sufferers often complain of  disturbed sleep and that the fatigue is usually worse a day or two after  increased mental or physical activity and can then be prolonged.  Infections or immunisations may also precipitate a worsening of the  fatigue. Many people also become completely intolerant of alcohol.While no single cause of CFS has been identified there are known  triggers. These are often infections particularly glandular fever caused  by the Epstein Barr virus. A fatigue state may be brought on if a  person has insufficient rest during an infection or sometimes if fever  suppressant drugs are used. Less common triggers include major trauma  and operations, vaccinations and organophosphate pesticides. There is  wide debate as to the causes of CFS but as yet no laboratory tests exist  to confirm the diagnosis. What is known is that it is commonly  associated with a respiratory or gastrointestinal viral infection and is  related to a resulting abnormality in the immune system, which is seen  by some as being in a state of overactivity. There is some evidence that  the mitochondria (parts of the cell which provide energy) in muscles of  patients with CFS are also abnormal.CFS can have a huge impact on those suffering from the condition, as  they are often severely limited in their ability to carry out normal  activities of daily living including work, household duties, social and  sporting pastimes. The severity of CFS is defined by the degree to which  the condition affects a person’s functioning and daily life. This is  quite simply mild, moderate or severe. With mild CFS people are mobile,  can care for themselves and may be able to work, although they will  often need a whole weekend to rest. At the severest end of the scale  sufferers are unable to do any activity for themselves, may spend most  of their time in bed, have severe cognitive problems and are often  wheelchair dependent.

Difficult diagnosis

Diagnosis is not easy and should only be made by a healthcare  professional or specialist (usually a neurologist). It is a diagnosis of  exclusion, so other possible diagnoses must first be excluded and the  symptoms should persist for at least four months in an adult or three  months in a child, where a paediatrician should confirm the diagnosis.  There are a multitude of illnesses causing severe and prolonged fatigue,  and these need to be excluded by a doctor. The doctor should have taken  a clinical history, examined the patient which characteristically in  cases of CFS involves a thorough physical examination. Conditions that  have symptoms very similar to CFS include: hormonal (diabetes,  hypothyroidism), infection (glandular fever, hepatitis B or C),  neurological (multiple sclerosis), rheumatological (rheumatoid  arthritis), cancer (any type), gastrointestinal (coeliac disease,  inflammatory bowel disease). The doctor of a patient presenting with CFS  symptoms will request investigations, which will be mainly blood tests.  These include checking for anaemia, specific infections – for example  the Epstein Barr virus – liver and kidney function.

Treating chronic fatigue syndrome

There is no conventional drug treatment for CFS although  antidepressants are sometimes used to treat the depression. The essence  of treatment is conventionally “activity management” and graded  rehabilitation. There is evidence that cognitive behaviour therapy is  helpful. Other approaches that can be beneficial in the treatment of CFS  are:Rest periods are essential although they should not be too lengthy e.g. 30 minutes at a time.

A good and healthy diet

Returning to the case of Henry, I  concentrated on his general symptoms and prescribed Lycopodium clavatum  as a 12c potency to be taken twice daily for five days out of every  fortnight. At a follow-up appointment a couple of months later Henry  reported that he had had no more episodes of the fatigue and felt  extremely fit. When I bumped into his wife outside the surgery not long  after, she thanked me for her husband’s new personality as he was a much  easier man to live with now!

The homeopathic approach

After this lengthy introduction to CFS, which is essential in  understanding something about the illness and the impact it has on  sufferers’ lives, we can now look in more detail at how homeopathy can  play a part in treating it. It should be pointed out, however, that CFS  is not an easy illness to treat, so it is important not to promise an  instant cure while at the same time remaining positive, emphasising that  even if cure is not possible some alleviation of symptoms may well be  hoped for. Under the symptom heading “Weakness” in our homeopathic  repertory there are at least 900 homeopathic medicines. So choosing the  right one is not easy, especially as the main symptom is often fatigue  that worsens with any kind of exertion. As always in homeopathy, once a definite diagnosis of CFS has been  made it is vital to take a full homeopathic history. The emphasis should  be on what is individual and special about the patient’s symptoms, for  example the particular feelings they have in their muscles e.g.  twitching, or the type of headaches they have. General symptoms are also  important such as their reaction to the weather and temperature, the  time of day, along with food desires and aversions. Particular note  should be taken of any cause of the CFS if it is known, for instance  influenza, or gastroenteritis, or glandular fever, and also if any  conventional treatment was given at that time. Choosing the correct  medicine will usually take time and consideration with the homeopath and  patient having to be prepared to try more than one homeopathic medicine  if there is no result with the first. The patient needs to be patient! Here are examples of a few medicines that are more commonly indicated  in CFS. However, in many cases a homeopathic medicine that does help a  patient could well be one in which fatigue is not necessarily the first  symptom that springs to mind. From the following descriptions it can be  seen that different homeopathic medicines can have a lot of symptoms in  common, so generally it would be advisable to seek help from a  professionally qualified homeopath before deciding on a particular  medicine, and a doctor should always be consulted to exclude other  serious illnesses that CFS may mimic – or vice versa.

  • Gelsemium: Indicated by weakness with drowsiness, dizziness,  dullness and trembling. Muscle aches with heaviness and weakness.  Tremors and twitching of the muscles may also be a feature. The sufferer  might have a dull heaviness in the head and have blurred vision, feel  worse in damp, cold weather and mentally be dull with a lot of anxiety. A  strange symptom with Gelsemium is that symptoms are better for profuse  urination.
  • Kali phosphoricum: Possibly one of the most widely used  remedies for CFS, especially if the illness follows a bout of influenza.  The mental symptoms of Kali phosphoricum are anxiety with depression,  insomnia and nightmares. The anxiety may present as a fear of crowds and  agoraphobia. Loss of memory might be a problem. There is muscle  weakness and aches and pains, all worse with exercise, the cold and  mental effort. The symptoms are better from sleep, eating and gentle  movement. A suitable dose might be 6c twice daily, reducing with  improvement.
  • Mercurius solubilis: Also known in the abbreviated form Merc  sol, this is often a good remedy for acute glandular fever (caused by  the Epstein-Barr virus). If those symptoms become more chronic and  result in CFS, then Merc sol may still be a good medicine to give. The  patient may have a persistent sore throat with enlarged cervical lymph  nodes (glands) and have a lot of salivation. They may also be sensitive  to both heat and cold. Insomnia with great restlessness at night and  nightmares may also be a feature. The muscle pains will be deep with  tender bones. As with Kali phosphoricum there may be loss of memory and  poor recall of names.
  • Phosphoric acid & other “acid” remedies: Weakness and  exhaustion is a feature common to all the “acid” remedies. With  Phosphoric acid the nervous exhaustion comes first, followed by the  physical. It may be the remedy to give when someone has CFS following an  illness such as prolonged diarrhoea. The patient may be listless,  apathetic – even sullen – find it difficult to cope and suffering  depression as well. They may also be very sensitive, especially to  music. The patient’s physical symptoms may include looking worn-out,  pale and thin, and they may have blue rings round the eyes. They will  probably be very chilly with a poor appetite while being very thirsty.The other acid remedies include Picric acid, Muriatic acid and  Sulphuric acid. Exhaustion is the common feature of these acid remedies.  The exhaustion in these remedies may have been preceded by  overactivity, and Vithoulkas has described the mental exhaustion of  Picric acid, the emotional exhaustion of Phosphoric acid and the  physical exhaustion of Muriatic acid. Picric Acid has extreme muscular  weakness with trembling and twitching. The legs may feel tight or have  pins and needles and the person will have to lie down, which does  provide relief.
  • Scutellaria: Also known as Mad-dog skullcap, Scutellaria is a  plant native to North America and has been used in folk medicine to  treat many nervous disorders like epilepsy, anxiety and headaches. Dr  Margaret Tyler, author of Homeopathic Drug Pictures, described  Scutellaria as her “sheet-anchor in treating post influenza neuroses”.  As such it can be used in the treatment of CFS especially following flu,  where the patient is nervous and forgetful, having frequent dull  headaches accompanied by aching and weakness of the limbs and muscle  twitching.
  • Zincum metallicum: The Zincum picture is one of weakness with  restlessness and depression. The memory is poor and the patient is  lethargic, irritable and hypersensitive especially to noise; restless  legs accompanied by muscular twitching are also common features.  Numbness and coldness and strange sensations in arms and legs are also  common. All symptoms are worse from alcohol.
  • Nosodes: I have included the general term nosodes as the  approach of using nosodes to treat CFS can be a useful one. A nosode is a  homeopathic medicine derived from diseased tissue including  micro-organisms. They are useful when there has been a history of a  particular illness and the individual has reported being unwell ever  since that time. So in relation to the homeopathic treatment of CFS,  Influenzinum may be used when CFS has developed following flu; or the  Glandular fever nosode following glandular fever, and so forth.While these homeopathic medicines are generally indicated in the treatment of CFS, they are by no means the only ones.

Sophie’s story

Sophie is 24 years old and has complained of feeling tired all the  time. Her symptoms started five years before when she’d had prolonged  diarrhoea while living in Singapore. The diarrhoea had lasted on and off  for a few months. She feels lethargic on waking and by mid-afternoon  feels exhausted. She is able to work full-time and can take exercise,  but this produces aching muscles especially in her legs. She feels  numbness in her fingers and toes as well as cramping. She has headaches,  sometimes lasting for about five days.Diagnosed as having a mildly underactive thyroid two years ago,  Sophie was prescribed a low dose of thyroxine but this made her unwell  and she lost weight, so she was advised to stop the medication. Sophie likes hot and sunny weather, dislikes the cold and always has  cold hands. Thunder makes her feel on edge and she feels better when  near the sea. She desires potatoes and pasta, while milk, bread and  cheese aggravate her causing diarrhoea. She is generally an easy-going  person, quite calm, with no real fears. She likes to be organised and  tidy.Mainly on the basis of the fatigue symptoms alone and the fact that  her thyroid gland was underactive previously, Sophie was prescribed  Thyroidinum 6x three times daily. This is an isopathic medicine made  from a sheep’s thyroid gland. An isopathic medicine is derived from the  causative agent of the disease itself or from a product of the disease  process. It was expected that this would be the first prescription and  she would need a more “constitutional” medicine based on her general  symptoms and her personality such as Silicea or Phosphorus or China.  However when Sophie was reviewed about six weeks later she was much  better, less fatigued and now felt energised by exercise, not exhausted,  so she was advised to continue the Thyroidinum for a few more weeks.

Summary

Although the two cases I’ve highlighted  show how effective  homeopathic intervention can be in treating CFS, it is important to  remember that in most chronic fatigue cases it is highly likely that  more than one remedy will be needed on different occasions. CFS is a  serious and disabling illness, causing varying degrees of disability. In  the past it has not always been given much recognition as a severe  illness –mainly by doctors, it must be said – probably because the  direct causes and pathology of CFS are not really known.To help patients with this illness more than one approach will  usually be needed, homeopathy being one, as well as physiotherapy and  psychological treatments. Support groups can be useful. The ME Association offers particularly good advice and support. For more  information visit www.meassociation.org.uk