Professional Documents
Culture Documents
SCOPE
Apart from their use to provide non-specific support
for recuperation and repair, specific phytotherapeutic
strategies include the following.
Treatment of:
chronic fatigue syndrome;
fatigue and debility after illness, injury or trauma
(convalescence).
Management of:
fatigue linked to clinical depression;
fatigue due to unbeatable or terminal illness.
,
Because of the use of secondarj~plant products, caution is necessary in applying phytotherapy in cases of:
severe digestive depletion;
renal or hepatic failure.
ORIENTATION
A debilitating symptom
Phytotherapists increasingly find that a major indication for treatment is a degenerative or debilitating illness. Unlike their forebears, for whom acute diseases
were the norm and recuperative support of debility
was usually convalescent aftercare, the modern practitioner will be less often involved in first-line treatment. Patients will more often report for help after
years of ill health or when conventional medicine has
run out of options.
There are many diseases that can lead to such signs
of debility as tiredness, inability to rest, weakness,
depression, wasting and anorexia. Indeed, any illness of
sufficient duration or severity can lead to such symptoms; chronic low-grade infections, especially viral
infections, are particular precursors in modern times. In
some cases severe or traumatic diseases from the distant
past can lead to a legacy of weaknesses of this type. A
few are constitutionally enfeebled and are prone to
debilitating responses to a range of stressors. A good
practitioner will obviously seek to address current problems as far as possible. However, one of the prominent
elements of a debilitating condition is that the weakness
imposes its own limitations on any treatment. It is often
impractical to embark upon the usual treatment strategy while the patient is at a lcw ebb as even the gentlest
remedies can provoke uncomfortable responses.
Finding a regime of treatment that simply addresses the debility, with little consideration of the causes
or background factors, might be the only strategy
feasible if the condition is especially severe. The
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Immunologic abnormalities
Patients with CFS have a mild central adrenal insufficiency secondary to either a deficiency of corticotropin-releasing hormone (CRH) or some other
central stimulus to the pituitary-adrenal axis.16 This
leads to a decreased response of the adrenal cortex.
Abnormalities in the regulation of the hypothalamicpituitary-adrenal (HPA) axis are also a well-recognized feature of endogenous depression. It has been
suggested that, since cytokines potently influence the
HPA axis, their activation may underlie many of the
features found in CFS and depression.17
Circulatory abnormalities
Biochemical abnormalities
Clinical trials
Despite the large number of published studies or. CFS,
there have been very few clinical trials. In particular,
the evening primrose oil study cited above has not
been
A Japanese
was used
to successful!y treat CFS in an open clinical trial.19
This complex tonifyjng formula included Panax,
Rehmannia, licorice, cinnamon, Astragalus, dong quai
and Schisandra.
PHYTOTHERAPEUTICS
Clinical impressions of fatigue
Chronic fatigue syndrome appears to involve a complex interaction between emotional, infectious and
environmental stressors leading to subtle immune
dysfunctions. The extreme debility sometimes ttncountered has the unfortunate effect of blocking many
treatment approaches: rest may be disrupted, exercise
may be debilitating and even the simplest foods may
seem to be too demanding. Many otherwise useful
remedies may be too stimulating or unsettling.
Fatigue may take different forms and arise from
different stresses. There may be a deficiency condition,
there may be an obstruction to normal functions (such
as the effects of clinical depression) or fatigue may follow excessive activity, perhaps marked by anxiety and
nervous stress. The therapeutic approach in each case
will be different. In the first instance, nutritional and
supportive therapies will dominate. In the second,
there may be the need to embark upon substantial constitutional and metabolic strategies. Where tension is
the predominant factor then repair will be difficult if
there is not some relaxant or even sedative relief.
Sometimes benefits will follow a focus on what
could be exacerbating or even causative factors. These
might include:
intestinal dysbiosis, endotoxaemia or similar
syndromes;
allergies or food intolerances;
toxins, e.g. dental amalgam, hair dyes, pesticides;
recurrent fungal, viral or bacterial infection.
Above all else, it is important to ensure that sleep
and rest are adequate and much useful treatment
effort can be directed to this end as a first priority.
Whatever the initiating disturbance, the treatment of
fatigue must be marked by extreme gentleness and
patience.
Convalescence
With any fatigue syndrome the fundamental principle
of treatment is to set up an appropriate recuperative
1 ; . "E
Although these may s e e n contraindicated, immuneenhancing herbs are often needed to help prevent the
recurrent viral infections xvhich can plague patients
with chronic fatigue syndrome. Ir'cases of infection,
treatment with tonic herbs may need to be discontinued so that defensive measures can be applied.
Echinacea angustifolia and E. p~rrp~rea
are safe to use
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-d*ical clinical guides
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Antiviral herbs
Panax ginseng
Astragalus membranaceus
Crataegus spp fol.
Ginkgo biloba (standardized)
Picrorrhiza kurroa
Glycyrrhiza glabra
Scutellaria baicalensis
Case histories
Astragalus membranaceus
Panax ginseng
Ginkgo biloba (standardized for
flavonoids)
Echinacea angustifolia
1 :2
1 :2
30 ml
15 ml
1 :2
20 ml
35 ml
100 ml
Total
Dose 5 mL tds
1 :2
10 ml
1 :2
40 ml
1:2
20 rnl
1:2
30 ml
Total
100 ml
Dose 5 ml with warm water up t o five times a day.
1 :2
1 :2
1 :2
1 :2
1:l
1 :2
Total
15 ml
30 ml
20 ml
20 ml
15 ml
20 ml
30 ml
150 ml
Dose 8 ml tds
TONICS
Plant remedies traditionally used as tonics
Application
The state of digestion is the main determinant of
dosage times. Tonics may be best taken with or after
meals if the stomach and digestive system are weakened; in severe cases, they may need to be taken with
fluid nourishment. Dosage should be rather more than
less frequent: 'little and often' might be a useful axiom.
Long-term therapy with tonics is generally indicated
and often advisable.
CHINESE TONICS
In Chinese medicine, tonic remedies are generally
divided into four groups, depending on whether they
are seen to particularly support qi, yang, xue or yin.
The first two groups tend to be warming, the last two
cooling. They are often more dynamic than the tonics
listed above and may thus be more likely to generate
adverse reactions. It is more important, therefore, to
be careful in their prescription and to take close
account of the interpretation of debilitated conditions
that Chinese practitioners use. However, they reflect a
perspective on debility and its treatment that is not
well articulated in the Western traditions.
In the following review, Chinese terms will therefore be used. They are briefly introduced in the summary of Chinese herbal medicine in this text (see p.5)
but any practitioner wishing to apply them should be
well trained in that tradition. Nevertheless, there is
some overlap with Western remedies and some useful
insights are possible for a Western phytotherapist.
associated with such symptoms as fatigue and depression with depressed digestion, diarrhoea, abdominal
pain or tension, visceral prolapse, pale yellow complexion with a tinge of red or purple, pale tongue with
white coating and/or languid, frail or indistinct pulses.
This may lead in turn to a 'damp' condition developing.
In the second case, extreme or prolonged stress
or disease, or chronic pulmonary disease, leads to
depletion or cold in the Lungs, with easy fatigue and
prostration associated with disturbances of regulation,
shortness of breath or shallow breathing, rapid, slow
or little speech, spontaneous perspiration, pallid complexion, dry skin, pale tongue with thin white coating,
weak and depleted pulses.
Yang tonics
These remedies support the active energies, particularly
those of the Kidneys (but also Heart and Spleen).
Deficient Kidney yong leads to listlessness with a
feeling of cold and cold extremities, back and loins;
there may be weak legs, poor reproductive function,
frequency of micturition, nocturia, diarrhoea (especially early in the morning), pale complexion and
submerged weak pulses.
Deficiency affecting the Heart involves poor performance and coordination associated with profuse cold
sweating, asthmatic states, thoracic or anginal pain
on exertion, palpitations and fear attacks, cyanosis,
white tongue coating and/or diminished, hesitant or
intermittent pulses.
Qi tonics
Xue tonics
Yin tonics
Remedies for replenishing the body fluids and essence,
supplying condensed energies and nourishment, for
the most depleted conditions. Areas in most need of
support are the Kidneys, Liver, Lungs and Stomach.
Deficient Kidney yin often follows very serious debilitating disease or, alternatively, extended sexual or alcoholic abuse or overwhelming nervous stress. It may
manifest as a deficient Fire condition, marked by a pale
complexion with red cheeks, red lips, dry mouth, dry
but deeply red tongue, dry throat, hot palms and soles,
References
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1 et al. Clinical laboratorv test
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