Welcome to Chinese Medicine Bristol's official blog! Here, Acupuncture and TCM pracitioner Sandra Arbelaez will share information about Acupuncture and Chinese Herbal Medicine, how they work, and the latest research and developments related to TCM. You will also find knowledge and ideas on how to enjoy a full, healthy life that she has picked up over the course of 15 years of exploring the world of natural health

Friday, 11 May 2012

On ME: some definitions, TCM views, and self-help ideas

It is M.E awareness week. M.E is a condition that causes a lot of suffering to many people and that is greatly misunderstood. Here is some of what I have learnt from the wonderful people I have met who have been diagnosed with this condition, and my attempt to make sense of it using TCM ideas.

 Myalgic encephalomyelitis (M.E.), also known as Chronic Fatigue Syndrome (CFS), is generally defined as a condition of unknown cause characterised by fatigue made worse by exercise, which can be accompanied by any of a myriad of symptoms which may be severe and disabling. In the UK, the prevalent school of thought regarding M.E is psychiatric, so the focus of research has long been the belief systems and fears that perpetuate the condition rather than the mechanisms by which the symptoms occur. This is partly because what actually causes M.E has not yet been understood. 

There are many different working definitions of M.E, all of which consist of a list of possible symptoms that serve as a guide to diagnosis. Studies (1) have found that definitions that regard prolonged fatigue as the most important symptom for diagnosis, such as the Oxford criteria used in the UK, can create confusion between M.E. and other conditions that can also cause fatigue such as cancer, depression, Parkinson’s disease, burn out, infections, etc. It is thus down to physicians to explore all possible causes of the fatigue before issuing an M.E diagnosis, but unfortunately this is not always done thoroughly enough. As a result, it is possible that in the UK many people may be diagnosed with M.E when they actually have something else; including some treatable conditions (there are documented cases of this including Lyme disease, post-traumatic stress disorder, depression, etc.).

Researchers throughout the world have attempted, and so far failed, to find a single neurological, immunological, endocrinological, and genetic cause of this condition (2). Nevertheless, up to 60% of cases are triggered by identified infections, and viral infections have been suspected for many years while more recently gut infections, including candidiasis have been regarded as possible triggers (3). There are comparatively many more people who get no identifiable infection but perhaps only a sudden fatigue with some fluey symptoms or just a mild cold/flu from which they never recover. Because immune tests are limited in their power (they can only find what they're looking for!), it is always possible that there has been an actual infection but one that wasn’t suspected, or from a bug that is not well-known. The important thing here is that in most cases the immune system seems to be struggling with something, whether a known organism or not. So it is the immune system, not the actual bug that needs to be the focus of the treatment. Many things could weaken the immune system to the point of it being unable to fight off an infection. It could be a question of weak constitution or a malnourished body from poor diet and poor life-style choices, a polluted environment, vaccinations, over-use of antibiotics, or severe and prolonged stress. 

Pollution, amongst other things, can weaken our immunity

M.E symptoms are not limited to the immune system but can manifest at a neurological and endocrine levels. This is due to the close relationship between these three systems which are sometimes regarded as one single entity called the neuroendocrine-immune axis (6).

TCM views of M.E

The TCM diagnosis of M.E may involve patterns such as Residual pathogenic factor, Latent heat, Lesser yang pattern, and Yin fire (4). Damp pathogens are also regarded as a significant primary cause of the disease (5), while it is thought that all CFS sufferers have underlying deficiency.
References to “Chronic fatigue syndromes” found in classical TCM texts do not reflect the current condition that presents neurological, immunological and endocrinological dysfunction; and which is most probably influenced by pollution, vaccinations, and other modern-day practices. This is where a combination of theoretical knowledge, clinical experience, and flexibility are needed for a TCM practitioner to be able to provide a suitable treatment for M.E. Because M.E. is a condition that is extremely complex and varies from one individual to the next, there cannot be a set treatment protocol. Instead, the condition needs to be understood in terms of the clinical history, constitutional traits, and presenting symptoms of each individual. Even after treating several people with M.E it may still be difficult to know how an individual will react to treatment until you get to know them well.

In my experience treating M.E. with Acupuncture and Chinese herbs, treatment needs to involve a combination of clearing pathogenic factors (you may call it a virus or a bug, nerve damage, etc. while in TCM it would be Heat, Damp, Qi/Blood stagnation and so on); and strengthening the vital energy and the immune system. This has to be done very carefully because if you clear too harshly the patient will become even more exhausted, while too much strengthening may result in the reinforcement of the pathogen and worsening of flu-like symptoms, night sweats, inability to relax etc. 

Acupuncture is most useful for pain, digestive problems, low energy, insomnia and dream-disturbed sleep, and emotional imbalances related to M.E. Chinese herbal medicine can work at at deeper level addressing the actual pathogen directly and can be more effective for stronger or long-term symptoms. As important as the treatment approach though, is to compassionately listen to -and work with- each individual, rather than follow any prejudices or pre-conceived ideas regarding M.E. Each M.E. sufferer is an expert in his/her own condition, and they hold the key to their own recovery. A trusting relationship with the practitioner and a commitment to work as a team are key to the healing process.

What you can do for yourself if you have M.E:

This is by no means a comprehensive list, just an attempt to summarise what I believe are the most important aspects to be addressed when you have not just M.E but any chronic condition:

Diet:  Diet is always a complex issue and there is no one diet that will fit everyone. This is especially relevant for those with M.E as food intolerances can be quite extreme in some cases. Generally speaking, I would recommend following the Chinese Medicine principles of diet by supporting digestive fire and consuming warming foods that have been thoroughly cooked. You can find some tips for healthy eating following these principles here, and an explanation of the TCM view of the digestive process here.
In addition you really should try to:
- Avoid all refined and processed foods especially inverted sugars, hydrogenated fats, and chemical additives such as preservatives and natural or artificial flavourings/colourings. As in M.E there is a constant battle going on at deep levels of the immune system, further exposing the body to the toxicity caused by substances the body cannot recognise can only make the situation worse.
- Stay clear of damp-forming foods. According to TCM, most cases of M.E have an element of Damp and Phlegm which are the pathogens that can be behind symptoms such as muzzy head, inability to think clearly, heaviness and aching in the body especially the limbs, and digestive sluggishness and food intolerances. If you suffer from these symptoms you may benefit from having a de-humidifier in the room you sleep in at all times (this is particularly relevant to our damp Bristol climate!) and from avoiding damp-forming foods such as: 
  • All dairy products, especially the full fat versions. Goat and sheep milk products are not as bad but I would recommend non-GM soya products unless you are allergic to soya   
  • Pork and rich meats 
  • Peanuts, especially when roasted   
  • Concentrated juices, especially orange and tomato: try home-made freshly squeezed ones instead, or just stick to water and herbal teas 
  • Wheat and preferably all types of bread 
  • Yeast   
  • Beer   
  • Bananas   
  • Sugar and sweeteners. Good quality honey and molasses are good alternatives   
  • Saturated fats   
  • Too much raw, cold, sweet or rich food

Rest: Many people with M.E feel exhausted but cannot rest because they feel wired inside. This is a difficult symptom to deal with, but there are some things that can help:
  • Avoid stimulants such as coffee, tea, alcohol, sugary drinks, coke, chocolate, and drugs. Stimulants do not give you energy, they draw from your deepest energy to give you a false and short-lasting boost only to leave you feeling more tired than before. 
  • What you really need is to be able to access a truly relaxed state where your parasympathetic system can kick in so that true rest and energy recovery can occur. For this you need to make a habit of consuming calming herb teas such as camomile, passiflora, lime flowers, hops and lettuce leaves. I would not recommend valerian here as it is an energetically warming herb that in some cases can stimulate rather than calm. 
  • Gentle massage, Reiki and Acupuncture can also induce this relaxed state so if you are unable to “switch off” by yourself it is worth trying one of these therapies so that your body and mind can learn how to do it.
Relaxation-inducing treatments can teach us how to "switch off"

Meditation: Any type of daily meditation for any length of time (a few minutes per day are definitely better than nothing!) will help you work on the all too familiar over-thinking that does not allow for proper rest or healing. In addition, meditation will help you be in the present, and even if you don’t like your present very much it can take you away from guilt, fear, and anger that will naturally spring up especially when you are going through a bad patch. These emotions are natural but not useful for the healing process so it is of paramount importance to find ways of feeling them without holding on to them. This is no easy task and may take a long time, but should be one of your goals for improving your health.

Avoid over-doing it: It is only natural that on "good days", when you suddenly seem to have a bit more energy you will want to do all those things that you have been unable to do for ages. This can however be counter-productive as it is common to be unaware of when to stop so you may easily go too far. Exhaustion and stress lower immune response and, as your immune system is already engaged dealing with something (known or not), this can either exacerbate your symptoms or leave you exposed to further infections. This will further stretch your immune system and can set you back days if not weeks. This is why it is so important to keep calm and rested!
Although positive thinking and affirmations can be of great benefit, it needs to be said that pushing yourself too hard will not help you feel any better. There is a fine line between overcoming your fears regarding activity and being unaware of the consequences of too much activity. Only trial and error will tell you what is right for you, and you may have to go through periods in which you went too far before you find out what works for you. It is all part of the process.

Love yourself in sickness and in health: Accepting that our mental and physical abilities are diminished indefinitely and that we are unable to perform jobs or tasks that we see as closely linked to our identity is a tough call, but it needs to be done. This, however, does not mean that you have to resign yourself to your situation: Acceptance is not the same as giving up. While being in denial and going against the tide are both exhausting and not conducive to healing, admitting that you are unwell, scared, and at a loss can instead be the first step towards making positive changes to improve your health.
Accepting ourselves as we are in the midst of illness can release some of the anger, frustration, and guilt that lock our energy in an emotional vicious circle. We can then use this energy for our recovery. Ask yourself this: can I really expect others to understand my suffering and accept me in my illness, when I am unable to do this for myself? Never forget that we are much more than our physical bodies and our creative power and loving energy can still represent a unique contribution to the world even if we cannot physically make or do things. 

Last but not least..

Any organ can be involved in TCM M.E pathology. I recommend you read my posts on the Liver, Kidneys, Spleen , and Heart to find out how it’s all linked together and how you can nourish and strengthen your whole body. 

Like all chronic conditions, M.E is multi-dimensional. Not only it affects the various systems of the body but it also has an impact at mental, emotional, and spiritual levels. In my view, working at these levels is necessary for true healing, although this is not necessarily done all at once but following each individual process. 

A person with M.E is confronted with a lot of fear especially about the future, and this is often fuelled by lack of understanding from everyone around. Loving care and compassion from friends and family is possibly more important than anything else for those who are experiencing M.E. They need to feel allowed to experience their symptoms without feeling judged and without guilt. This type of condition is becoming more prevalent in the developed world, so we all need to remember that we are not invincible and that one day it may be us on the receiving end.


  1. Carruthers et al., 2003 “Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocols”, Journal of Chronic Fatigue Syndrome, 11 (1), pp. 7- 115. 
  2. Baker&Shaw, 2007 ‘Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance’, British Medical Journal, 335(446) 
  3. Lakhan & Kirchegessner, 2010 ‘Gut inflammation in chronic fatigue syndrome’, Nutrition and Metabolism, 7(79) 
  4. Maciocia, 2008 The practice of Chinese medicine: The treatment of diseases with acupuncture and Chinese herbs.  
  5. Jiang & Franks, 1994 ‘Analysis of 50 cases of M.E. treated with Chinese herbs and acupuncture’, Journal of Chinese Medicine, 44, pp.13-20.
  6. Petrovsy, 2001, "Towards a unified model of neuroendocrine-immune interaction", Immunology and Cell Biology, 79, pp. 350-35. Can be accessed online here


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