Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) Overview:

Chronic fatigue syndrome or CFS, is a complex syndrome characterised by long term (6 months or more) severe or disabling fatigue with no other clinical explanation (such as influenza or other viral infection). The United States Centers For Disease control and Prevention (CDC) list the following as diagnosis for CFS:

  1. Severe idopathic pain lasting 6 months or longer
  2. Having 4 or more of the following symptoms:
    • Post-exertional malaise
    • Impaired memory or concentration
    • Unrefreshing sleep
    • Muscle pain
    • Multi-joint pain without redness or swelling
    • Tender cervical or axillary lymph nodes
    • Sore throat
    • Headache
  3. The symptoms must have persisted or been recurring for 6 months or longer and have not predated the fatigue.

In the past this condition was referred to as "neurasthenia", and more modernly "myalgic encephalomyelitis" or "post viral fatigue syndrome". Doctors used to dismiss these patients of being "hypochondriacs" as there was no identifiable cause for the illness.



Possible causes:

+ Viruses

  • Epstein Barr (EBV)
  • Herpes simplex virus (HSV) (HHV-6)
  • Coxsackie B Virus
  • Human parvovirus (HPV)-B19

+ Bacteria

  • Mycoplasmal blood infections
  • Staphylococcus spp.
  • Borrelia burgdorferi (Lyme disease)

+ Fungi

  • Candida albicans

+ Immune abnormalities and inflammation

  • Increased levels of IL-1, IL-6, TNF-alpha, and TNF-beta have all been noted to be high in CFS patients.
  • Reduced NK levels have also been noted in CFS patients.

+ Pituitary And Hypothalimic Abnormalities

  • Structural abnormalities
  • Tumour

+ Circulatory abnormalities

  • Congestive heart failure
  • COPD

+ Brain and cognitive abnormalities

  • Alzheimer's disease
  • Parkinson's disease
  • Depression


Chronic (>6 months) of disabling fatigue

Mild fever

Sore throat

Painful lymph nodes

Weight gain

Exertion malaise

Muscle weakness

Joint pain

Muscle pain





Cognitive impairment

Visual impairment

Sleep disturbances


Diagnostic Considerations:

  1. Severe idopathic pain lasting 6 months or longer
  2. Having 4 or more of the following symptoms:
    1. Post-exertional malaise
    2. Impaired memory or concentration
    3. Unrefreshing sleep
    4. Muscle pain
    5. Multi-joint pain without redness or swelling
    6. Tender cervical or axillary lymph nodes
    7. Sore throat
    8. Headache
  3. The symptoms must have persisted or been recurring for 6 months or longer and have not predated the fatigue.


  • FBE
  • Iron studies
  • B12/folate, vitamin D, RBC fatty acid profile
  • Thyroid panel – TSH, fT4/T3
  • Organix acids
  • Functional liver detoxification profile
  • Hair mineral analysis
  • Serum/saliva cortisol
  • Functional digestive stool analysis
  • Intestinal permeability – lactulose / mannitol

Therapeutic Aims:

1. Support The Adrenals

Depending on the cause for CFS, the adrenals will likely need to be regulated (adaptogens) or toned (adrenal tonics)

  • Adaptogens(Withania somnifera, Panax quinequefolius, Panax ginseng)
  • Adrenal Tonics(Rehmannia glutinosa)

2. Support The Immune System

Used to prevent recurring viral and bacterial infection common with CFS patients. When using tonic herbs, they are often contraindicated during infection, so preventing these infections are of utmost importance.

  • Immunomodulators(Glycyrrhiza glabra, Astragalus membranaceus, ganoderma lucidum, Lentinus edodes, Echinaceae purpurea)
  • Immune Stimulants
  • Antivirals ()
  • Antibacterials(Hypericum perforatum, Salvia officinalis, baptisia tinctoria, Thymus vulgaris, Tabebuia impetiginosa)

3. Reduce Inflammation

Downregulate cytokine production and other immune responses.

  • Antinflammatories (COX and LOX inhibitors)(Curcuma longa, Boswellia serrata)
  • Antinflammatories (glucocoritcomimetics)(Glycyrrhiza glabra, Rehmannia glutinosa)
  • Antinflammatories (eicosanoid synthesis modulators)(Scutellaria baicalensis)
  • Antinflammatories (TNF-a & NF-kB)(Curcuma longa)
  • Immunosupressants(In some cases)
  • Antioxidants(Camellia sinensis, Vitis vinefera)

4. Identify & Address Infection

  • Antibacterials(Thymus vulgaris)
  • Antivirals()
  • Antifungals(Tabebuia impetiginosa)
  • Antiparasitics()

5. Address Any Nutritional Deficiencies

6. Optimise Neurotransmitter Function

  • Nootropics (Bacopa monieri, ginkgo biloba, Camellia sinensis, Vinca major, Romarinus officinalis)
  • Nervine Trophorestoratives (Centella asiatica)

7. Promote Gentle Detoxification

  • Depuratives(Taraxicum offinale, Urtica dioica (leaves), Trifolium pratense, zanthoxylum clava-herculis, Calendula officinalis, Rumex crispus)

8. Improve Sleep Quality

  • Sedatives(Scutellaria lateriflora, Passiflora incarnata, matricaria recutita, Zizyphus jujube, Humulus lupulus, Valeriana officinalis)
  • Adaptogens(Withania somnifera)

9. Support Mood

  • Antidepressants(hypericum perforatum, Trichilia catigua)
  • Thymoleptics(Melissa officinalis, Turnera diffusa)
  • Nervine Relaxants(Passiflora incarnata, Scutellaria lateriflora, Verbena officinalis)

Differential Diagnosis:

Adrenal insufficiency, fibromyalgia, cancer


Herbs For Chronic Fatigue Syndrome:

  • Lycium spp
  • Hypericum perforatum
  • Salvia miltorrhiza
  • Gingko biloba
  • Valerian
  • Avena sativa
  • Phytolacca decandra
  • Astragalus membranaceus
  • Echinacea spp.
  • Scutellaria lateriflora
  • Andrographis paniculata
  • Thymus vulgaris

Nutrients For Chronic Fatigue Syndrome:

  • B vitamins
  • Vitamin, C, D
  • Mg
  • Zn
  • EFAs
  • 5-HTP
  • SAMe
  • CoQ10
  • L-carnitine
  • Probiotics

Pharmaceutical Interventions For CFS:

  • SSRIs, tricyclic antidepressants for sleep disorders
  • Aspirin, NSAIDS for pain management
  • Serotonergic modulators (fluoxetine) (SSRIs, SNRIs, NRIs) for associated mood disorders

  • Benzodiazepines for anxiety
  • Non-sedating histamines for allergic responses
  • Gammaglobulin therapy: administered intramuscularly two to three times per month for passive immunity (no evidence of efficacy and expensive)
  • Alpha-interferon – enhances immune response.

Herb & Nutrient Interactions With Pharmaceutical Interventions:

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Justin Cooke

The Sunlight Experiment

Updated: March 2018

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