Comparison Of Theories, Methodologies, And Practice Between Western Medicine And Traditional Chinese Medicine In Chronic Fatigue

1. IntroductionChronic fatigue is one of the most common symptoms in primary care. The article is to overview chronic fatigue and its syndrome based on evidence-based clinical practice, to explore the association between medically unexplained physical symptoms with stress, and to incorporate the advantage of traditional Chinese medicine into the intervention of functional somatic syndrome.2. Review of Chronic Fatigue SyndromeThe diagnosis of CFS relies on clinical grounds, and exclusion of other medical and psychiatric disease. The symptoms may overlap with depression, irritable bowel syndrome and fibromyalgia. The symptoms are attributing to be the result of disturbed psycho-neuro-immunological function, but the underlying pathophysiology is not known. No medication has yet been shown to provide long-term remission or "cure" in patients with CFS. The usage of medication aims at the relief of distress and promotion of life quality. Cognitive-behavior therapy and graded exercise are effective for some people of CFS.Although the last 15 years have seen intense research activities surrounding CFS, it is a controversial condition especially concerning its clinical definition and pathogenesis. Based on the lack of specific physiological or psychological cause, it has been suggested that an integrative, so-called bio-psycho-social, approach should be the best serve as an explanatory perspective on the syndrome.3. Basic Clinical Research of Chronic Fatigue Patients102 patients with chronic fatigue and 70 healthy controls were evaluated by self-reported questionnaire and systemic examination. Those with chronic fatigue had lower educational status( x~2=12.35, p<0.05 ), higher unemployed status( x~2=14.33, p<0.01) , higher prevalence of psychiatric diseases ( x~2=17.42, p<0.001=, sleep disturbance ( x~2= 13.48, p<0.001) suppressed immunity (x~2=14.71, p<0.001) and peptic ulcer ( x~2=7.75, p<0.01)。The co-morbidity rates of chronic fatigue patients were 40% in sleep disturbance, 27.4% in psychiatric disease, and 24.5% in immune problems, which were significantly higher than the control group (p<0.05 ) .The amount of psychosomatic symptoms of patients was significantly more thanthe control group (12.13 + 6.36 vs. 3.03 + 3.63, p<0.001) . There were more than half of patients suffering from mouth dryness, neck tightness, poor memory, palpitation, headache or dizziness, eye dryness or blurred vision, irritability and poor concentration.Exploring the association between objective exams and subjective symptoms in chronic fatigue patients, study revealed the symptoms were irrelevant to the result of clinical investigation.The personality of patients were more suspiciousness, sensitivity, and radicalism, comparing with the control group (p<0.05) .In conclusion, the chronic fatigue patients were relatively in stressful conditions, such as lower economic status, type A personality. Even the co-morbid symptoms were multiple, complicated and severe, the objective tests couldn't medically explain those symptoms.4. Contemplation on Modern Clinical model from Chronic Fatigue SyndromeChronic fatigue syndrome is one of functional somatic syndrome, which is common in practice. There are many illness overlap with these symptoms, including irritable bowel syndrome, fibromyalgia and depression. The symptoms are mostly unspecific and medically unexplained with significant co-morbidity, easily developing inefficient care by fragmented view of highly specialized physicians. The most common symptoms include insomnia, malaise, headache, dizziness, chest compression or pain, palpitation, dyspnea, dryness of mouth or eyes, sore throat, abdominal gas or diarrhea, polyuira, poor memory or concentration, and emotional distress.Doctors react to symptoms instinctively with laboratory workout for the medical education based on biomedical aspect. While the results show no abnormality, most doctors lack of skill to explain the symptoms. They also lack of the ability to recognize the association with other co-morbidities and the hidden cause of psychosocial origin.Patients receive overlapped, inappropriate, and unnecessary exam from different specialists for co-morbidity nature. They are also under the risk of overlapped drugs and interaction of medication, and confused to the diverse explanations among different specialists from their viewpoints.Although the exams of functional somatic symptoms are mostly normal, the suffering discomforts are genuine. Patients are easily anxious and suspicious for getting somewhat disease that cannot be found out. Doctors and the family of patients probably ignore the patients for no recognized disease, which give patients secondary hurt.Stress has been associated with both the onset and course of functional somatic symptoms. Chronic or excessive "fight or flight" activation leads to pathological consequence. Biological and epidemiological studies revealed some diseases, such as diabetes or metabolic syndrome, coronary artery disease and immune disorder, are strongly associated to allostatic load.Author believes functional somatic symptoms are likely to the stage of resistance in generalized adaptation syndrome. And the irreversible diseases of alloststic load should be the sequela of exhaustion stage. If the causal or predisposing factors of diseases came from stress, it seems that correcting parameter of disease or symptoms is not enough to interrupt the accumulating deterioration of allostatic load.The prevalence of functional somatic symptoms is quite high. To provide patients a comprehensive and efficient treatment, the physicians are supposed to facilitate the knowledge of stress-related health problems and explore the high-risk patients with bio-psycho-social model.5. Advantages of Traditional Chinese Medicine in Dealing with Chronic Fatigue Syndrome5.1 The Cause of Chronic Fatigue Syndrome: Disease Develop by OveruseAccording to Chinese philosophy, human being and nature are regarded as unified entirety. Nei-Jing said, "The principle of Yin and Yang is the foundation of the entire universe. It underlies everything in creation". With the theory that optimum health should result from living harmoniously as possible with nature, TCM developed lots of strategies to harmonize and adjust these two principles of nature. Nei-Jing also said, "The right Qi exists inside;evils cannot make disturbance." A strong, healthy, well-balanced body and mind can resist the attack from even the most extreme environmental factors. TCM places on basic preventative care through diet, exercise, breathing, regulated sex, and preventative herbal prescriptions. On the contrary, if one disobey the rule of Yang Sheng (health preserving) , diseases will develop by overusing physiological activation.The unique wisdom of eastern philosophy, harmoniously with nature, should be very important to deal with chronic stress, which cannot be fight (eradicated) or flight (avoided). And the strategies of decreasing overuse, preserving energy and promoting health in Yang Sheng theory aggressively conducts the way to prevent diseases from allostatic load.5.2 The Pathogenesis of Chronic Fatigue Syndrome: Imbalance of Ying-Yang and Qi-blood in Zang-Fu OrgansComparing with the diagnosis of diseases by data and the ignorance of medicallyunexplained physical symptoms in western medicine, TCM is patients-centered. TCM diagnoses diseases by whole body view instead of fragmented body system.The concept of TCM is that the human body is a small universe with a set of complete and sophisticated interconnected systems. Those systems usually work in balance to maintain the healthy function of the human body. The balance is described as necessarily including Ying-Yan, Qi-blood, Zang-Fu, emotions, and spirit. The main differentiation of syndromes according to four clinical diagnostics the eight outlines, searching for the primary cause (imbalance of Ying and Yang, rise and fall of pathogenic factors and vital-Qi, abnormal Qi and blood, and abnormal body fluid metabolism) and location (Zang-Fu Organs) of symptoms.The comprehensive, systemic, objective and individualized way of diagnosis in TCM is not only the unique character of TCM, but also the realization of the holistic patients care.5.3 The Characteristic of Treatment for Functional Somatic Symptoms: Search for Origin and HarmonyNei-Jing said, "In order to treat and cure diseases, one must search for their origins." The diagnosis and treatment of TCM based on overall analysis of Zheng, called the system of Bian Zheng Lun Zhi (Zheng differentiation to therapy decision) . Zheng is the pathological summary related to the disease development and course, including etiology, mechanism, location, characteristics, tendency and Zheng-Xie. According to Zheng, physicians adjust the focus of imbalance to achieve the restoration of Ying and Yang. The unique method of treatment reflects the harmonious characteristics of Chinese culture.Besides eliminate pathogenic factors like western medicine, TCM had strategy to increase body's resistance to disease and give priority to disease prevention.The way of tonifing deficiency or replenishing excess, supporting right Qi or deleting evil Qi, and the treatment basic on climatic and seasonal conditions, geographic localities and patients personal condition are one of the unique character of TCM. While the effect of treatment in FSS is still fair, this sort of approach can be an alternative way to improve the quality of care in patients.5.4 The Essence of Theories of Yang Sheng in Nei-Jing: Prevention as well as TreatmentNei-Jing said, "The sages did not wait until the sickness is there to cure the sickness, they cure before it take place." TCM suggests to prevent before disease occur and to interrupt the progression after disease develop.Apart from describing the diagnosis and treatment of Chinese Medicine, Nei-Jing also suggests a lot of insights in maintaining the psychological well-being of anindividual. It teaches us to be harmonious with the dynamic change of nature. One's emotions, daily pattern and attitude have to follow the dynamic natures of Yin-Yang and the change of weather in the four seasons in each year. Besides, one should stay away from secular desires by keeping our body and mind in a state of natural quiescence. The ultimate purpose is for the individual to become at one with heaven or the Dao by increasing spirit and moral level. As Zhuangzi stated, "Heaven, earth and I are born of one, and I am at one with all that exists.The theory of Yang Sheng, "our mind and body should be in a stable, peaceful and dynamic balance with nature e." is more deeply and vivid than, western body-mind theory.