Myalgic encephalomyelitis (ME) Chronic Fatigue Immune Dysfunction
Syndrome (CFIDS)
by Giovanni Maciocia |
Apart from Heat itself, Damp-Heat is a very frequent residual pathogenic factor after a febrile disease. There are two main reasons for this. First of all, in the course of a febrile disease, the ascending and descending movements of Spleen and Stomach are upset. Thus, because Stomach-Qi cannot descend, turbid fluids are not transformed, and because Spleen-Qi cannot ascend, the clear fluids cannot be transformed: this leads to the formation of Dampness. Secondly, Heat burns the body fluids which can then condense into Dampness. Once formed, Dampness tends to be self-perpetuating. In fact, Dampness impairs the Spleen transformation and transportation which in itself leads to more Dampness being formed, thus establishing a vicious circle.
Antibiotics are one of the most common causes of residual pathogenic factor in our society. Whilst they do destroy bacteria, from the point of view of Chinese medicine they tend to "lock" the pathogenic factor into the Interior and do not release the Exterior in the beginning stages of an exterior invasion, nor do they clear Heat or resolve Phlegm in the later stages.
Besides causing the above symptoms and signs, Latent Heat also tends to injure Qi and/or Yin, thus establishing a vicious circle of Heat and deficiency. In the case of ME, Latent Heat usually takes the form of Damp-Heat. This process, the "incubation" of an exterior pathogenic factor in the Interior to emerge as Heat later, explains many cases of ME Latent Heat may move outward to emerge on the surface by itself, as described above; alternatively, it may be "pulled" towards the surface by a new invasion of external Wind, in which case, in addition to the above symptoms of interior Heat, there would also be some exterior symptoms such as shivering, fever, occipital headache, aches and sneezing. The pulse (Fine and Rapid) and tongue (Red), however, clearly point to interior Heat.
Another factor that may draw Latent Heat towards the surface is emotional stress. This may pull Latent Heat outwards, especially when it affects the Liver and causes Heat.
Thus Latent Heat occurs when an individual suffers an invasion of exterior Wind without developing immediate symptoms and the pathogenic factor remaining in the Interior turns into Heat that comes out months later. The underlying reason for this is usually a Kidney deficiency. If the body condition and the Kidneys are relatively good, a person will develop symptoms at the time of invasion of external Wind. This is a healthy reaction. If the Kidneys are weakened by overwork and excessive sexual activity, the body's Qi is too weak even to respond to the invading external Wind. The Wind penetrates the Interior without the person developing exterior symptoms; once in the Interior, it incubates and turns into Heat, which comes out some months later.
The ancient doctors believed in particular that if the Essence is properly guarded and not dissipated, pathogenic factors will not enter the body and Latent Heat will not develop. The "Simple Questions" in chapter 4 says: "The Essence is the root of the body, if it is guarded and stored Latent Heat will not appear in springtime." This concept is very important in practice as it implies that resistance to pathogenic factors depends not only on Lung-Qi (which influences Defensive Qi), but also on Kidney-Qi and Kidney-Essence. In fact, Defensive Qi is spread by the Lungs but it has its root in the Kidneys, specifically Kidney-Yang. Moreover, in chronic, recurrent infections such as ME, Kidney-Qi is very often deficient, leading to a decreased immune response.
Another possible cause of Latent Heat can be immunizations, when attenuated or inert forms of certain pathogenic organisms are injected into the body, by- passing the body's first line of resistance. From a Chinese medical perspective it is as if an external pathogenic factor penetrated the body's Interior directly, completely by-passing the Exterior levels. From the perspective of the Four Levels, immunizations consist in injecting a pathogenic factor (albeit attenuated) directly at the Blood level.
Latent Heat can also take the form of the Lesser Yang (Shao Yang) syndrome, characterized by alternation of shivers and feeling of heat, when the pathogenic factor is "trapped" between the Interior and Exterior: for this reason, when it goes towards the Exterior the person feels cold, when it goes towards the Interior the person feels hot. This pattern is more common in teenagers and young people.
In all the above conditions the underlying cause is overexertion and lack of adequate rest as explained above.
To summarize, three factors can give rise to ME:
The four groups of symptoms that are, in my opinion, essential to
diagnose ME are:
I personally consider these to be the essential manifestations of what I call "true" ME, by which I mean one characterized by a persistent, chronic viral infection. If one or more of these four groups of symptoms are absent, I call the condition "not true" ME or simply "Postviral Fatigue Syndrome", i.e. a state of fatigue following an acute febrile disease but without a persistent viral infection. Although the aetiology, pathology and treatment of ME and Postviral Fatigue Syndrome are exactly the same, I believe this distinction is important for prognosis as "true" ME is much more difficult to treat and will take longer to respond to treatment.
As for the muscle ache, from the Chinese point of view it is directly related to Dampness: the more Dampness there is, the greater the muscle ache, and vice versa. From a Western perspective, I relate the muscle ache intensity to the viral infection.
Table #1: Differentiation between Deficiency and Excess in ME | |||
---|---|---|---|
SYMPTOMS | TONGUE | PULSE | |
DEFICIENCY | No or little muscle ache, no pronounced flu- like feeling | Thin coating, not too Swollen | Weak, Choppy or Fine |
EXCESS | Pronounced muscle ache and flu-like feeling | Thick coating, Swollen | Full, Slippery or Wiry |
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