Analysis of Patients Visiting an Oriental Hospital with Idiopathic Chronic Fatigue or Chronic Fatigue Syndrome

Chang-Gue Son; Son, Chang-Gue

doi:10.13048/jkm.13017

JKM > Volume 34(3); 2013 > Article

Son: Analysis of Patients Visiting an Oriental Hospital with Idiopathic Chronic Fatigue or Chronic Fatigue Syndrome

Original Article

Journal of Korean Medicine 2013; 34(3): 119-125.

Published online: September 30, 2013

DOI: https://doi.org/10.13048/jkm.13017

Analysis of Patients Visiting an Oriental Hospital with Idiopathic Chronic Fatigue or Chronic Fatigue Syndrome

Chang-Gue Son

Internal Department of Oriental Medicine College, Daejeon University

Correspondence to: 손창규(Chang-Gue Son), 대전시 중구 대흥동 22-5번지 대전대학교 부속한방병원 간장면역학교실, Tel: +82-42-229-6807, Fax: +82-42-254-3403, E-mail: ckson@dju.ac.kr

Received July 09, 2013 Revised September 2013 Accepted July 10, 2013

Abstract

Objectives:

Medically unexplained fatigue includes chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). These disorders quite impair quality of life while no effective therapies exist. Therefore, patients with CFS or ICF frequently choose treatments based on traditional Korean medicine. The study aimed to analyze characteristic of patients visiting an Oriental clinic with CFS or ICF.

Methods:

Patients who met criteria for CFS or ICF were enrolled in this study, from March 2011 to Jun 2013. Clinical information focused on symptom differentiation and Sasang constitution was analyzed. Pearson’s chi-square test was used to compare the frequency among sub-groups.

Results:

In total, 77 patients (49 male and 28 female) were diagnosed with CFS (17 male and 13 female) or ICF (32 male and 15 female). The symptom differentiation was 37.7%, 26.0%, 13.0%, and 23.3% for “Qi deficiency of both spleen and lung ( jkm-34-3-119-10i1.tif

)”, “Yin deficiency of both liver and kidney ( jkm-34-3-119-10i2.tif

)”, “Blood deficiency of both heart and spleen ( jkm-34-3-119-10i3.tif

)” and “Yang deficiency of both spleen and kidney ( jkm-34-3-119-10i4.tif

)”, while Sasang constitutional distribution was 59.7%, 22.1% and 18.2% Soeumin, Taeumin and Soyangin, respectively. The fatigue severity was notably different between CFS (63.7 ± 12.1) or ICF (52.2 ± 15.3) according to the Chalder fatigue scale (10-point scale for eleven questions). There was statistical significance regarding symptom differentiation and Sasang constitution (p < 0.05).

Conclusions:

In the process of traditional Korean medicine-based development of therapeutics for patients with chronic fatigue or related conditions, this report can serve as reference data.

Keywords: Chronic fatigue, idiopathic chronic fatigue, chronic fatigue syndrome, traditional Korean medicine

Table 1.

Criteria for Diagnosing Chronic Fatigue Syndrome

A. Unexplained, persistent fatigue for six months or more

B. At least four of the following signs (CFS), or less than four signs (ICF)

1) Extreme exhaustion lasting more than 24 hours after physical or mental exercise
2) Unrefreshing sleep
3) Loss of memory or concentration
4) Unexplained muscle pain
5) Pain that moves from one joint to another without swelling or redness
6) Headache of a new type, pattern or severity
7) Enlarged lymph nodes in your neck or armpits
8) Sore throat

Table 2.

Chalder Fatigue Severity Questionnaire

Questions	Indication
1. Do you have problems with tiredness?
2 Do you need to rest more?	0 = None
3. Do you feel sleepy or drowsy?	.
4. Do you have problems starting things?	.
5. Do you lack energy?	.
6. Do you have less strength in your muscles?	.
7. Do you feel weak?	.
8. Do you have difficulty concentrating?
9. Do you make slips of the tongue when speaking?	9 = Unbearable
10.Do you find it more difficult to find the correct word?
11. How is your memory?

Table 3.

Category of Syndrome-differentiation

Symptom differentiation	Main symptoms or signs
Qi deficiency of spleen and lung	Pale face, fatigue, lack of energy, lack of appetite, small quantity of meal to eat
Blood deficiency of heart and spleen	Pale face, sleep disturbance, plenty dream, bleeding tendency, feeling the lack of energy, dizziness, palpitation
Yang deficiency of spleen and kidney	Highly susceptible of cold, Cold hands and feet, Coldness in lower abdomen, diarrhea tendency
Yin deficiency of liver and kidney	Clod sweat at night, heating feeling at chest, palm and sole, weakness of waist and knee, insomnia, nocturnal emission

Table 4.

General Characterization of Patients

Item	Total	CFS		ICF

		Male	Female	Male	Female
Number of patients	77	17	13	32	15
Average age (Range)	42 (15–70)	38 (20–59)	39 (21–56)	43 (15–61)	45 (20–70)
Fatigue severity (NRS)^**	56.9 ± 15.1	63.1 ± 14.7	64.5 ± 8.4	50.9 ± 15.7	55.1 ± 7.8

** p < 0.01, using independent t-test for fatigue severity between chronic fatigue syndrome and idiopathic chronic fatigue

Table 5.

Distribution of Symptom Differentiation

Symptom differentiation	Total	CFS		ICF

		Male	Female	Male	Female
Qi deficiency of spleen and lung	29 (37.6%)	6 (35.3%)	4 (30.8%)	16 (50.0%)	3 (20.0%)
Blood deficiency of heart and spleen	18 (23.4%)	4 (23.5%)	4 (30.8%)	5 (15.6%)	5 (33.3%)
Yang deficiency of spleen and kidney	10 (13.0%)	1 (5.9%)	3 (23.1%)	3 (9.4%)	3 (20.0%)
Yin deficiency of liver and kidney	20 (26.0%)	6 (35.3%)	2 (15.3%)	8 (25.0%)	4 (26.7%)

No significant difference was observed regarding distributional frequency of symptom differentiation using Pearson’s chi-square test (p > 0.05).

Table 6.

Distribution of Sasang Constitution in Patients and Control Group

Symptom differentiation	Total^**	CFS^**		ICF^**
Symptom differentiation	Total^**	Male	Female	Male	Female
Taeumin	17 (18.2%)	3 (17.7%)	3 (23.1%)	9 (28.1%)	2 (13.3%)
Soeumin	46 (59.7%)	9 (52.9%)	8 (61.5%)	16 (50.0%)	13 (86.7%)
Soyangin	14 (22.1%)	5 (29.4%)	2 (15.4%)	7 (21.9%)	0 (0.0%)

** p < 0.01, Pearson’s chi-square test was used for comparing the distributions of the Sasang classified patients and the healthy subjects.

Table 7.

Distribution of Symptom Differentiation according to Sasang Constitution

Sasang constitutional^*	CFS/ICF	Qi deficiency of spleen and lung	Blood deficiency of heart and spleen	Yang deficiency of spleen and kidney	Yin deficiency of liver and kidney
Taeumin	CFS	10 (83.3%)	0 (0.0%)	0 (0.0%)	2 (16.7%)
	ICF	4 (80.0%)	0 (0.0%)	0 (0.0%)	1 (20.0%)
	Total (17patient)	14 (82.4%)	0 (0.0%)	0 (0.0%)	3 (17.6%)

Soeumin	CFS	12 (48.0%)	8 (32.0%)	3 (12.0%)	2 (8.0%)
	ICF	2 (9.5%)	9 (42.9%)	5 (23.8%)	5 (23.8%)
	Total (18patient)	14 (30.4%)	17 (37.0%)	8 (17.4%)	7 (15.2%)

Soyangin	CFS	0 (0.0%)	1 (8.3%)	1 (8.3%)	10 (83.4%)
	ICF	1 (50.0%)	0 (0.0%)	1 (50.0%)	0 (0.0%)
	Total (14patient)	1 (7.1%)	1 (7.1%)	2 (14.3%)	10 (71.5%)

* p < 0.05, Pearson’s chi-square test was used for comparing the distributions of the symptom differentiation according to Sasang constitution

References

1.. Jorgensen, R. Chronic fatigue: an evolutionary concept analysis. J Adv Nurs, (2008). 63(2), 199-207.

2.. Fukuda, K, Straus, SE, Hickie, I, Sharpe, MC, Dobbins, JG, & Komaroff, A. The chronic fatigue syndrome: a comprehensive approach to its definition and study, International Chronic Fatigue Syndrome Study Group. Ann of Intern Med, (1994). 121(12), 953-9.

3.. Son, CG. Review of the Prevalence of Chronic Fatigue Worldwide. J Korean Oriental Med, 212. 22(2), 25-33.

4.. Kim, CH, Shin, HC, & Won, CW. Prevalence of chronic fatigue and chronic fatigue syndrome in Korea: community-based primary care study. J Korean Med Sci, (2005). 20(4), 529-34.

5.. Papadopoulos, AS, & Cleare, AJ. Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome. Nat Rev Endocrinol, (2011). 8(1), 22-32.

6.. Kralik, D, Telford, K, Price, K, & Koch, T. Women’s experiences of fatigue in chronic illness. Journal of Advanced Nursing, (2005). 52(4), 37280.

7.. Martin, A, Chalder, T, Rief, W, & Braehler, E. The relationship between chronic fatigue and somatization syndrome: a general population survey. J Psychosom Res, (2007). 63(2), 147-56.

8.. Jones, JF, Maloney, EM, Boneva, RS, Jones, AB, & Reeves, WC. Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States. BMC Complement Altern Med, (2007). 7, 12.

9.. Adams, D, Wu, T, Yang, XS, Yang, X, Tai, S, & Vohra, S. Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome. Cochrane Database Syst Rev, (2009). (4), CD006348.

10.. Wang, T, Zhang, Q, Xue, X, & Yeung, A. A systematic review of acupuncture and moxibustion treatment for chronic fatigue syndrome in China. Am J Chin Med, (2008). 36(1), 1-24.

11.. Kim, HG, Yoo, SR, Park, HJ, & Son, CG. Indirect moxibustion (CV4 and CV8) ameliorates chronic fatigue: a randomized, double-blind, controlled study. J Altern Complement Med, (2013). 19(2), 134-40.

12.. Centers for Disease Control and Prevention. Available at:www.cdc.gov/cfs. Accessed Jun, 23, 2013

13.. Morriss, RK, Wearden, AJ, & Mullis, R. Exploring the validity of the Chalder Fatigue scale in chronic fatigue syndrome. J Psychosom Res, (1998). 45(5), 411-7.

14.. Kwak, KK, Cho, JH, & Son, CG. Study on Chronic Fatigue Syndrome from Oriental Medicine Point of View. J Korean Oriental Med, (2008). 29(4), 962-9.

15.. Lee, TG, Hwang, MW, Ham, TI, Choi, BK, Koh, BH, & Song, IB. A study on distributionalrate of Sasangin in Korea. J Sasang Const Med, (2005). 17(3), 12-21.

16.. Sharpe, M. The report of the Chief Medical Officer’s CFS/ME working group: what does it say and will it help? Clin Med, (2002). 2(5), 427-9.

17.. Cho, JH, & Son, CG. Need for development of oriental medicine-derived systemic treatments against chronic fatigue-associated symptoms. J Korean Oriental Med, (2009). 30(4), 28-36.

18.. Griffith, JP, & Zarrouf, FA. A Systematic Review of Chronic Fatigue Syndrome: Don’t Assume It’s Depression. Prim Care Companion. J Clin Psychiatry, (2008). 10(2), 120-8.

19.. Lee, NH, & Son, CG. Fatigue severity of patients with idiopathic chronic fatigue compared to healthy subjects. J Tradit Chin Med, (2012). 32(3), 355-7.

20.. Kim, SH, Lee, JH, Lee, SB, Choi, MY, Kim, YC, & Woo, HJ. Speculation of the Correlationship between Public Health Practice, Consumption and Fatigue in Patients who Complain Fatigue. Korean J Orient Int Med, (2008). 29(1), 219-30.

21.. Poeschla, B, Strachan, E, Dansie, E, Buchwald, DS, & Afari, N. Chronic fatigue and personality: a twin study of causal pathways and shared liabilities. Ann Behav Med, (2013). 45(3), 289-98.

22.. Cho, CH, Cho, YS, & Lee, SK. Study of Personality Traits in So-yang, So-eum and Tae-eum Using NEO-PI-R. Korean J. Orient. Physiology & Pathology, (2005). 19(6), 1491-5.

23.. Christley, Y, Duffy, T, Everall, IP, & Martin, CR. The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma. Curr Psychiatry Rep, (2013). 15(4), 353.

24.. Cho, JH, Yoo, SR, Cho, JK, & Son, CG. Analytic Study for Syndrome-differentiation and Sasang-constitution in 72 Adults with Chronic Fatigue. Korean J. Orient. Int. Med, (2007). 28(4), 791-6.