A Study Of Traditional Chinese Medicine Syndromes In Patients With Chronic Fatigue Syndrome In Barcelona

Background:Chronic Fatigue Syndrome(CFS)is a complex condition characterized by persistent and disabling physical and mental fatigue lasting for at least six months and accompanied by four or more of the following symptoms:impairment in short-term memory or concentration,sore throat,tender cervical or axillary lymph nodes,muscle pain,multi-joint pain without joint swelling or redness,headaches,and unrefreshing sleep.It has an incidence of 0.2%?2.2%in adults and 0.1%?0.5%in adolescents.Although many theories have been proposed;its etiology remains unclear and no therapeutic method has shown any curative effects.Cognitive behavioral therapy and Graded exercise therapy have shown some effectiveness in relieving symptoms while the role of corticosteroids,anxiolytics,dietary supplements,magnesium,Nicotinamide Adenine Dinucleotide(NAD)and Prolonged Rest needs further investigation.This frustrating therapeutic scenario has led many investigators to shift their focus to Complementary and Alternative Medicine in the quest for better outcomes.In the case of Traditional Chinese Medicine(TCM)one of the biggest challenges is to overcome the different diagnostic criteria between Western Medicine and TCM.There is no disease in TCM diagnostic system identical to CFS and the TCM diagnostic patterns that could gather CFS symptoms are many.Objectives:The objective of my study is to describe TCM syndromes present in patients of Barcelona 's Clinic Hospital Chronic Fatigue Unit(previously diagnosed of CFS)as an attempt to start revealing the characteristics of CFS in the western world from the viewpoint of TCM;with the future perspective of developing evidence based complementary treatments for this condition.Considering the theoretical body of TCM and the published related papers a higher percentage of patients with Qi deficiency and either Liver qi stagnation or Blood stasis was expected to be found.These were the two syndromes that had shown the highest frequency on the studies reviewed and the ones that are more closely related to the clinical manifestations of CFS.Fatigue is a cardinal symptom of qi deficiency and the rest of the diagnostic elements(specially the pain)could be explained by qi or blood stagnation.Methods:A Clinical Data Survey that goes through different aspects of the TCM syndrome differentiation procedure(Cold and heat sensation,Perspiration,Pain,Diet and taste,Defecation and urination,Emotions,Sleep,Female and male conditions,Tongue inspection,Pulse taking and Other specific symptoms and signs)was designed for the study;inspired on the traditional“10 questions" recommended by Jiebin Zhang and the syllabus textbooks.It was intended to provide the necessary information to reach a syndrome diagnosis after being filled out.Invitation brochures were handed to consulting patients of the Barcelona's Clinic Hospital Chronic Fatigue Unit and sent to different local Patients Organizations for the broadcasting of the study.The ones interested contacted the author by phone or e-mail.An appointment was set at the hospital's facilities where the interviewer(Dr.Pablo Notti)completed the clinical surveys.Forty-three patients,who have already been diagnosed of CFS,were interviewed.The inclusion criteria were:1.Meet diagnosis criteria for CFS according to CDC 19942.Aged between 18 to 753.Signed Informed Consent formThe exclusion criteria were:1.Presence of active or chronic medical condition(or medical treatment)that may explain chronic fatigue2.Major depressive disorder with psychotic or melancholic features3.Bipolar disorder4.Schizophrenia5.Delusional disorder6.Dementia7.Eating disorders8.Alcohol or other substance abuse9.Severe obesityForty eligible patients were included in the sample.Three were excluded(one suffered from bipolar disorder,and two from eating disorders)The Clinical Data Surveys were sent to Beijing University of Chinese Medicine(BUCM)tutor,Professor Tianfang Wang,for her supervision and diagnostic confirmation.Collected data was analyzed with Center for Disease Control(CDC)Epi InfoTM program.It was clustered relating multiples variables like syndrome diagnosis(combined and separately),organs and vital substances involved,yin and yang aspects,gender,age,progression of the disease and comorbidities.Results:Results showed that 10 patients of the sample(25%)had Liver qi stagnation and Spleen qi deficiency,7 patients(17,5%)suffered from Spleen qi deficiency and Blood stasis,5 patients(12.5%)suffered from Kidney yang deficiency,3 patients(7.5%)accounted for Spleen yang deficiency and Kidney yang deficiency,3(7.5%)patients from a Phlegm syndrome,3(7.5%)others from Liver yin deficiency and Kidney yin deficiency,2 patients(5%)were diagnosed with Spleen yang deficiency,2 patients(5%)had Spleen qi deficiency and Damp,2(5%)were diagnosed with Spleen qi deficiency and Blood deficiency,1 patients(2.5%)had Liver blood deficiency and Kidney Yin deficiency,1 patient(2.5%)was diagnosed with Liver yin deficiency and Spleen qi deficiency,and the last one had(2.5%)Kidney yang and Kidney yin 10 patients(25%)suffered from a single syndrome(Spleen yang deficiency,Kidney yang deficiency and Phlegm syndrome)while 30(75%)suffered from a combined or complex syndrome.Considering the frequency of syndromes separately we can see that 2 patients were diagnosed with Spleen yang deficiency(3%),22 patients with Spleen qi deficiency(33%),7 patients with Blood stasis(10%),1 patient with Liver blood deficiency(2%),5 patients with Kidney yin deficiency(7%),9 patients with Kidney yang deficiency(13%),5 patients with Liver yin deficiency(6%),10 patients with Liver qi stagnation(15%),2 patients with Damp(3%),3 patients with Phlegm(5%)and 2 patients with Blood deficiency(3%).As far as the organs involved,13 patients presented a syndrome related to the Spleen(35%),4 related to the Liver and Kidney(12%),3 related to the Spleen and Kidney(8%),11 related to the Liver and Spleen(30%)and 6 related to the Kidney(16%).If the alterations of the vital substances are taken into consideration,22 patients showed Qi deficiency(49%),10 patients Qi stagnation(15%),7 patients showed Blood stasis(16%),4 showed Blood deficiency(9%)and 5 patients showed body fluids related alterations(11%)(Damp and Phlegm in this case).If focusing on the yin and yang theory,10 patients manifested Yang deficiency(63%),5 patients Yin deficiency(31%)and 1 patient Yin and Yang deficiency(6%).Discriminating the diagnosed patients by gender most males were diagnosed a spleen qi deficiency related condition(40%)and only four syndrome types were found in them(Spleen yang deficiency,Spleen qi deficiency and blood stasis,Spleen qi deficiency and Damp,Phlegm syndrome)On the other hand,female patients showed a bigger diversity and number of syndromes;except for the Spleen yang deficiency pattern that was only diagnosed in men.The most frequent syndromes present in these groups were Spleen yang deficiency in males(40%)and Liver qi stagnation and Spleen deficiency(24%)in women.Considering age,a larger number of patients fell in the range between 45 and 55 years old;followed by the one between 35 and 45.No patients from 18 to 25 five years old were interviewed.The majority of older patients(range from 45 to 75)showed a higher prevalence of Spleen qi deficiency and Blood stasis than the younger(18 to 45)that presented more Liver qi stagnation and Spleen qi deficiency cases.If the progress of the disease is considered,we can see that Qi and Yang alterations seem to manifest first while Yin damage seems to appear in later stages of the disease.Finally,if comorbidities are examined,the most frequent ones in descending order were Depression(28%),Fibromyalgia(26%),Multiple chemical sensitivity(16%),Hypothyroidism(12%),Anxiety(8%),Asthma(6%)and Irritable bowel syndrome(4%).If focusing on the TCM syndromes present in each comorbidity group,we can see that Phlegmpresence is more related to Asthma as comorbidity and Damp to Irritable Bowel Syndrome(IBS).Multiple Chemical Sensitivity(MCS)group has the higher prevalence of Liver qi stagnation and Spleen qi deficiency,and the Anxiety group has the bigger percentage of Spleen qi deficiency and Blood stasis.Conclusions:The study doesn't show a one to one relationship between any TCM syndrome and CFS;nor any singular pattern shows a significant tendency to test the hypothesis that CFS is a given syndrome in TCM.The outcome of the research showed similar results to the ones expected:a higher frequency of Qi deficiency plus either Qi stagnation or Blood stasis.Spleen alterations seem to be the key element in CFS pathogenesis and symptomatology in the TCM perspective.Most CFS patients apparently suffer from a combined syndrome in TCM terms.CFS,in TCM viewpoint,seems to be a complex combination of syndromes that could reveal different manifestations or stages of the same disease.Lung patterns absence in the sample may suggest that these syndromes were overlapped during the diagnosing procedure or that,for some yet undetermined reasons,lungs don't have a significant role in CFS symptomatology and pathogenesis in the TCM viewpoint.More investigations with bigger samples and including patients without as many comorbidities should to be carried out;in order to strengthen the value of these results.Validated measurement instruments for TCM syndrome diagnosis need to be assembled so that the clinical and research standards are improved.Standardization of TCM syndrome diagnosis proves to be a fundamental necessity in order to ameliorate the quality,validity and applicability of TCM investigations.