Acupuncture & Cupping in the Treatment of Chronic Fatigue Syndrome
Acupuncture & Cupping in the Treatment of Chronic Fatigue Syndrome
abstracted & translated by
Honora Lee Wolfe, Dipl. Ac., Lic. Ac., FNAAOM
Keywords: Chinese medicine, acupuncture, cupping, chronic fatigue syndrome
Chronic fatigue syndrome (CFS) refers to long-standing severe fatigue without substantial muscle weakness and without proven psychological or physical causes. This condition is also known as chronic fatigue immune deficiency syndrome (CFIDS). The prevalence of this condition is estimated to be somewhere between seven and 38 cases per 100,000, and women are 1.3-1.7 times more susceptible to it than men. Although chronic viral infection has been proposed as the etiology of this condition, this remains somewhat controversial. Other proposed but unproven etiologies include immunologic abnormalities, endocrine abnormalities, abnormal levels of neurotransmitters, inadequate cerebral circulation, and elevated levels of angiotensin-converting enzyme. Although this diagnostic category is a relatively recent one, a number of studies have been conducted on it in the People’s Republic of China in terms of its treatment with Chinese medicine. For instance, Wang Wei-hong et al. published an article titled, “A Clinical Audit of the Treatment of Chronic Fatigue Syndrome with Acupuncture Combined with
Cupping.” This article appeared in issue #8, 2001 of Zhong Guo Zhen Jiu (Chinese Acupuncture & Moxibustion) on pages 481-482. A precis of this study is given below.
There were 50 patients altogether in this study, all of whom were seen as out-patients at the Ju County Chinese Medical Hospital in Shandong. These 50 patients were randomly divided into a so-called treatment and a comparison group of 25 patients each. In the treatment group, there were 18 males and seven females aged 19-52 years. The shortest duration of illness was eight months and the longest was five years. In the comparison group, there were 16 males and nine females aged 23-55 years. These patients had been ill for from seven months to three years. The criteria for establishing a diagnosis of chronic fatigue syndrome in this study were those established by the U.S. Centers for Disease Control in 1991. These consisted of main and secondary symptoms combined with physical signs. The main symptoms included fatigue continuing for over six months which limited the amount of the patient’s activity and the exclusion of fatigue_inducing diseases. Secondary symptoms consisted of the following occurring simultaneously with or after the fatigue and continuing or occurring repeatedly for over six months: low-grade fever, sore throat, swollen lymph nodes, generalized muscular flaccidity and weakness, muscular pain and soreness, fatigue continuing 24 hours after activity, headache, wandering arthralgia, and neuropsychiatric symptoms such as depression and sleep disturbances. Physical signs included a body temperature of 37.5_38.5°C, local pharyngitis, and swelling of the cervical lymph nodes larger than 1cm in diameter. Exclusion criteria consisted of psychosis and drug dependency or abuse.
Patients in the treatment group were needled at Da Zhui (GV 14), Zhi Yang (GV 9), Xin Shu (Bl 15), Ge Shu (Bl 17), Ming Men (GV4), Shen Shu (Bl 23), and Chang Qiang (GV 1) with even supplementing-even draining technique and moderate stimulation. After obtaining the qi, the needles were retained for 40 minutes. After the needles were withdrawn, cupping therapy was applied on the governing vessel and the medial and lateral lines of the foot tai yang bladder channel. Using a large cup and an oil lubricant, sliding cupping was performed on the upper back until red or dark red spots or patches appeared on the skin and the patient felt a sensation of heat on the back. After the cupping, the local skin was cleaned with a sterilized cotton ball and the patient was advised to keep their body warm and not to bathe for one day after the treatment. This treatment was given once every six days, with 30 days equaling one course of therapy. Three days rest was allowed between successive courses.
The comparison group was treated with the following Chinese medicinals in liquid extract form: Radix Astragali Membranacei (Huang Qi), Radix Panacis Ginseng (Ren Shen), cooked Radix Rehmanniae (Shu Di), Fructus Corni Officinalis (Shan Zhu Yu), Cortex Eucommiae Ulmoidis (Du Zhong), Fructus Lycii Chinensis (Gou Qi Zi), Radix Angelicae Sinensis (Dang Gui), Carapax Amydae Sinensis (Bie Jia), Herba Epimedii (Xian Ling Pi), Sclerotium Poriae Cocos (Fu Ling), and Fructus Zizyphi Jujubae (Da Zao). Twenty-five milligrams of these medicinals were administered orally each time in a ready-made form manufactured by the Qingdao Third Pharmaceutical Factory two times per day.
Cure was defined as complete disappearance of the clinical symptoms and resumption of normal work and life. Marked effect was defined as basic disappearance of clinical symptoms and resumption of normal work and life. Some effect was defined as marked improvement in clinical symptoms but the patient was still not able to resume normal work. No effect meant that there was no obvious improvement in symptoms and the patient could not resume normal work and life. Based on these criteria, after one month of treatment, the total amelioration rate in the treatment group was 92%, while it was only 64% in the comparison group. Therefore, there was a significant statistical differences in effectiveness between these two protocols (P < 0.05).
Four out of seven of the points needled in the above protocol are located on the governing vessel. The governing vessel is the sea of yang, and fatigue is a failure of yang qi to be upborne and spread freely throughout the body. This failure may be due to either yang qi vacuity or blockage and obstruction to its free flow. By needling these governing vessel points, one can stimulate the yang qi of the body, leading it to rise upward and to flow outward. The other three points are those of the heart, blood, and the kidneys. The heart is the abode of the spirit which is the ruler of the entire body, while the kidneys are the former heaven root. The blood is that which nourishes and moistens the entire body and is the mother of the qi. Doing sliding cupping on the governing vessel and foot tai yang bladder channels on the back (the yang side of the body) can, likewise, lead the qi into the yang tract so that it can ascend and spread throughout the body.
One of the key things about this protocol as a Western practitioner is that it was only done once per week. This is the same treatment frequency as is common in the West. Many other Chinese protocols are based on daily or every other day treatment, and it is reassuring to know that this protocol can be clinically effective even though it is done only once per week. In addition, many patients with CFS are abnormally sensitive to and shy of needles. Therefore, the fact that this protocol only uses a very few needles and relies more on cupping is also, I think, a plus.
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