Chronic Fatigue Syndrome & "Malaria": A Preliminary Discussion of Their Chinese Medical Connection

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Malaria & CFIDS

I’ve only known one person in my life who for sure had the Western disease malaria. This was a French doctor working in Zaire who was in my acupuncture class at the Shanghai College of Chinese Medicine in 1982. In 20 years of clinical practice, I have never had a case of malaria. However, I have seen numerous cases of malaria-like disease. In fact, I believe the traditional Chinese disease category of malaria-like disease is a very important though currently over-looked one in the Western practice of Chinese medicine. In Chinese, nue ji means a malaria-like disease with periodic or recurrent episodes of fever and chills. Why I say "malaria-like" is because patients manifesting the Chinese disease category nue may or may not have the Western disease category malaria. In my experience, many patients with the Western disease diagnosis of chronic fatigue immune deficiency syndrome (CFIDS) manifest a nue condition in Chinese medicine.

The concept of nue in Chinese medicine

Although there are a number of different types of nue in Chinese medicine, malaria-like diseases are mostly due to external invasion of summerheat dampness or cold damp invasions during the heat of summer. These summerheat evils hide in the half exterior-half interior or shao yang division of the body where they A) damage and consume the qi and yin and B) periodically become active. Thus the evils associated with malaria-like diseases are fu xie or hidden evils and, most often, hidden warm evils.

Summerheat evils may cause glomus and oppression, nausea and vomiting, diarrhea and dysentery, and abdominal pain and loss of appetite in terms of spleen-stomach/stomach-intestinal symptoms. They may also cause effusion of heat (i.e., fever), headache, and bodily aches and pains due to damp heat impediment. Because dampness and turbidity obstructs the middle burner, summerheat evils tends to damage the spleen qi, resulting in fatigue. Because heat evils consume yin fluids, enduring summerheat causes damage and detriment to yin, blood, and body fluids.

In real-life, summerheat is actually only a species of damp heat. Therefore, one can have malaria-like conditions due to evils contracted in other seasons than summer. When foods cause outbreaks of malaria-like conditions, this is called food nue in Chinese medicine. When people have suffered from malaria-like conditions for some time and their righteous qi has become vacuous and debilitated, this is called lao or taxation nue. In this case, there are symptoms of damp heat or summerheat-like evils superimposed on a qi and blood or qi and yin vacuity. In some cases, that may also be a yin and yang vacuity, and any of these patterns may be further complicated by food stagnation, qi stagnation, blood stasis, or phlegm turbidity.

The treatment of taxation nue with Chinese herbal medicine

Xing Fu-zhong, in his Qing dynasty Ming Yi Zhi Chang (Making Medicine as Clear as the Fingers on Your Palm), says of vacuity nue:

Vacuity nue endures and does not stop. It is appropriate to nourish the righteous. It is not ok to (further) cut in half (what is already insufficient). Mostly administer Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) and it will automatically stop.

Ye Tian-shi, one of the greatest Chinese doctors of the Qing dynasty, also recommended treating taxation nue with Li Dong-yuan’s famous yin fire formula, Bu Zhong Yi Qi Tang. However, Ye suggested adding Fructus Amomi Tsao-kuo (Cao Guo) and Rhizoma Anemarrhenae Aspheloidis (Zhi Mu). Anemarrhena is a fire-draining, yin-enriching medicinal which clears vacuity heat and treats yin fire. Tsao-kuo scatters cold and dries dampness and is used for damp turbidity in warm diseases even though its own nature is warm. It is also known for its specific empirical effect as an anti-nue medicinal, harmonizing intermittent fever and chills. Bensky & Gamble, in Chinese Herbal Medicine:Materia Medica, say that the combination of Radix Bupleuri (Chai Hu), Anemarrhena, and Tsao-kuo is a good one for malaria-like diseases characterized by extreme fatigue.

Likewise, Wiseman & Feng, in A Practical Dictionary of Chinese Medicine, suggest Bu Zhong Yi Qi Tang plus Radix Achyranthis Bidentatae (Niu Xi), processed Radix Polygoni Multiflori (He Shou Wu), and Fructus Pruni Mume (Wu Mei) for taxation nue. Achyranthes supplements the liver and kidneys and strengthens the sinews and bones, quickens the blood and leads it to move downward. It is an important medicinal for pain in the lower part of the body and especially if that pain in due, at least in part, to blood not nourishing the sinews and vessels. Polygonum Multiflorum nourishes the blood and enriches yin, thus nourishing the sinews and vessels. Processed Polygonum is less slimy and glossy than uncooked Polygonum, and thus does not tend to aggravate dampness in the stomach and intestines. In addition, Polygonum Multiflorum is specifically anti-nue, while Heiner Fruehauf says that Polygonum Multiflorum is an especially good supplement when there are gu parasites. In my experience, Radix Polygoni Multiflori also shares some of the spirit-quieting effects of Caulis Polygoni Multiflori (Ye Jiao Teng).

Fructus Pruni Mume is a fluid-enriching astringent which also dispels worms or parasites. Enriching fluids, Mume helps protect and engender fluids which have been damaged by persistent heat evils. As an astringent, Mume helps secure the exterior defensive, thus preventing further recurrent invasion by external evils. It also harmonizes the dry effects of other acrid, windy medicinals in this formula. And as a worm-dispelling medicinal, Mume has a therapeutic effect on the stomach and intestines when these have been compromised by the presence of parasites. Although it engenders fluids, it is regularly used for damp heat conditions in the intestines. Although Fruehauf does not list Mume as an anti-gu medicinal, I certainly do. And, although Ye Tian-shi did not, to my knowledge, combine Mume with Bu Zhong Yi Qi Tang for the treatment of malaria-like diseases, he did use it in other formulas for nue and seems to have used this ingredient more than any other famous Chinese doctor I know. According to Ye, Mume’s sour flavor also restrains the liver. I believe that Mume is a more important medicinal than many Chinese doctors currently acknowledge and I have written about its functions and effects more extensively in an essay on Perilla and Mume published at www.bluepoppy.com.

The afore-mentioned Xing Fu-zhong also recommended the combination of Mume and Tsao-kuo for the treatment of vacuity nue, along with Radix Panacis Ginseng (Ren Shen), Herba Agastachis Seu Pogostemi (Huo Xiang), and uncooked Rhizoma Zingiberis (Sheng Jiang) in a based of Ping Wei San (Level the Stomach Powder) and Er Chen Tang (Two Aged [Infredients] Decoction). Therefore, the combination of Mume and Tsao-kuo for vacuity or taxation nue is precedented.

Most patients diagnosed with CFIDS suffer from extreme, enduring fatigue which gets better and worse in relationship to the weather, taxation, and diet. They typically suffer from recurrent low-grade fevers, and they also typically present with bodily aches and pains. If one does a Chinese medical pattern discrimination, one will usually find pronounced symptoms of qi, blood, and/or yin vacuity with less pronounced symptoms of cold damp or damp heat impediment. If there’s heat, it is typically Li Dong-yuan’s concept of yin fire. In addition, such patients usually have a medical history which suggests some sort of candidiasis, parasitosis, or, at least, intestinal dysbiosis. Therefore, I recommend combining Ye Tian-shi’s formula for taxation nue with that given by Wiseman & Feng and then modifying the resulting combination based on the patient’s individual signs and symptoms.

Rx:

Radix Astragali Membranacei (Huang Qi)15 parts

processed Radix Polygoni Multiflori (He Shou Wu)12 parts

Radix Achyranthis Bidentatae (Niu Xi)12 parts

Radix Codonopsitis Pilosulae (Dang Shen) 9 parts

Rhizoma Atractylodis Macrocephalae (Bai Zhu) 9 parts

Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) 9 parts

Fructus Pruni Mume (Wu Mei) 9 parts

Fructus Amomi Tsao-kuo (Cao Guo) 6 parts

mix-fried Radix Glycyrrhizae (Gan Cao) 6 parts

Radix Angelicae Sinensis (Dang Gui) 6 parts

Pericarpium Citri Reticulatae (Chen Pi) 6 parts

Rhizoma Cimicifugae (Sheng Ma)4.5 parts

Radix Bupleuri (Chai Hu) 3 parts

The importance of traditional Chinese disease categories in treatment

One of the important steps in doing Chinese medicine in a professionally standard way is to state the Chinese disease category of the patient. This step is, in my experience as a teacher, often omitted by Western students and practitioners. For instance, after writing down that the patient has been diagnosed as suffering from CFIDS, if they also manifest periodic recurrent fevers and/or chills, then one should also write down nue. If these episodes of fever are provoked and accompanied by marked fatigue, then the Chinese disease diagnosis is lao or taxation nue. If one knows that one’s patient is presenting with the symptoms categorized as nue or malaria-like disease in Chinese medicine, then one can go to the Chinese medical literature and research the diagnosis and treatment of nue. Therefore, I believe that this is an extremely important step in the process of diagnosis and treatment in contemporary Chinese medicine.

While professional Chinese medical treatment is primarily based on the patient’s pattern discrimination, the patient’s Chinese disease diagnosis does tell us something about the natural history of the disease and often does guide us to certain medicinals we might have otherwise over-looked. Living and practicing in Colorado, I do not see that many cases of actual summerheat disease. However, I often find myself prescribing medicinals from the summerheat-clearing category or medicinals that are anti-"malarial" because of a combination of spleen vacuity with damp heat evils where dampness is more pronounced than heat or at least vacuity is more pronounced than heat.