Meta-Analysis Finds Acupuncture with Moxibustion Most Effective Treatment for Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS) is a poorly understood condition in western medical terms.  The person with CFS will generally experience a deep fatigue that is not relieved by rest which will happen for weeks to months to years at a time.  But the rest of the symptoms may be quite varied.  Due to these varied symptoms CFS becomes a diagnosis by exclusion (i.e. when nothing else is found clinically wrong) - which is even more frustrating to the person experiencing these issues.

Chronic Fatigue Syndrome goes by a range of other clinical names including  Myalgic Encephalomyelitis, Systemic Exertion Intolerance Disease and may seem difficult to separate from other conditions such as fibromyalgia.  Besides fatigue, some of the other symptoms are:

• Signs of nervous system dysfunction - headaches, memory issues/brain fog, sleep issues, etc.
• Signs of autoimmune related inflammation - pain in multiple joints, tender lymph nodes, sore throat, muscle pain, etc.
• Feeling poorly for long periods after any kind of physical exertion.

Regardless of the individuals particular version of CFS, it is most often a debilitating syndrome for which western medicine has no real deep answers, instead targeting treatments to any number of symptoms.

Chinese Medicine, however, due to its very nature, generally does quite well with these types of systemic conditions.  There is more on the basics of how diagnoses and treatment work in Chinese Medicine in my article "What Does Acupuncture Treat?".  To avoid repeating much of what appears in that article, suffice it to say Chinese Medicine focuses on the deepest observable causal relationships and not the end result (i.e. the symptoms).  This has obvious advantages when you are dealing with syndromes that both (a) have a poor understanding of what the mechanisms are in western terms, and (b) may manifest quite differently from person to person.

On our acupuncture for CFS treatment page (which provides fairly basic approaches for practitioners to work from), you will see a few of the more common underlying Chinese Medicine diagnoses that a person may have who is experiencing CFS symptoms.  Without getting into too much detail they can be divided into a few basic groups - one is the person is more tired and wired (what we call "yin deficiency"), another is that their body is truly weak (what we all "qi or yang deficiency") and another basic version is they are stuck and inflamed (what we call "dampness" or possibly "qi stagnation").  Each one of these underlying causes can lead to essentially the same symptoms but with enough variance for a Chinese Medicine practitioner (along with other diagnostic signs such as the tongue and pulse) to figure out how to design a treatment plan.

Before I get into the research I'll be writing about today, I'd like to make one reference to the Chinese Medicine diagnoses listed above.  The vast majority of people will think that because they feel "tired" that they are truly weak.  This "truly weak" would be yang deficiency in Chinese Medicine - or a true deep weakness of the body.  Most often in my clinical experience at least, this is not the case.  Most seem to fall more into the "tired and wire" category.  This is important because all of the self-help items people may do to compensate for the weakness (caffeine, sugar, etc.) will make the "tired and wired" people much worse and more deeply entrench the causal factors - not that those dietary choices help any of the diagnoses.  It is important then to know what diagnostic category you fall into to know what dietary and lifestyle habits will most benefit you and most quickly help to ameliorate your health issues.

The study I'm exploring today is a meta-analysis of 31 randomized controlled trials that was initiated by researchers at the Department of Epidemiology within the College of Preventive Medicine at the Third Military Medical University in Chongqing, China.  They said they wanted to look over all existing research because even though there is ample clinical evidence of acupuncture helping with CFS, there are "certain doubts" due to a perceived "lack of a comprehensive and evidence-based medical proof".

In this meta-analysis they looked at the clinical effectiveness of a variety of treatments for CFS and found acupuncture and moxibustion (see "What is Moxibustion?") combined or acupuncture or moxibustion alone were the most effective modalities.  Their analyses of existing research culminated in the following list (in order of clinical effectiveness):

• Combined Acupuncture and Moxibustion
• Acupuncture or Moxibustion Individually
• Chinese Herbal Medicine
• Western Medicine
• Sham Acupuncture

Another systemic review, carried out by the Center for Evidence-Based Medicine within the Beijing University of Chinese Medicine and others,  came to a similar conclusion after looking at 23 studies involving over 1700 participants with CFS.  This team of researchers concluded that Traditional Chinese Medicine "appears to be effective to alleviate the fatigue symptom for people with CFS".

From a practitioners perspective these types of broad analyses are helpful and should be motivating from a patients perspective as well.  But they are still a far cry from the type of information that truly benefits practitioners of acupuncture.  These others aspect would potentially be things like what diagnoses were most common, what treatment protocols were most common for those diagnoses and led to the best results, what herbal formulas were most common and for what diagnoses, etc.  Due to the tailored nature of Chinese Medicine, however, it is very hard to study in a linear fashion compared with western pharmaceuticals for example.  Due to this we have to embrace the dynamic tailoring which is ultimately what allows Chinese Medicine to be effective even when it comes at the cost of understanding it in linear terms.

What these meta-analyses provide, as I stated above, is motivation and direction for people to seek help that has true clinical value.  Your practitioner will take this medicine which has tailorability as its very nature and work with your body to alleviate the causal factors behind CFS.  By working deeper you are not only avoiding chasing symptoms with drugs, you are potentially unearthing the imbalance leading over the long-term to a much greater possibility of full resolution of these factors.