With chronic fatigue syndrome (CFS), you feel so worn out that you are unable to do even half of your normal daily activities—and the feeling doesn't go away. This syndrome affects twice as many women as men. It may last a month, a couple of years, or many years.

• Severe fatigue that comes on suddenly, especially after you've had the flu
• Low-grade fever (100.4^oF) and chills
• Sore throat and swollen glands
• Muscle and joint aches
• Headaches
• Feeling of being in a fog and unable to concentrate or remember

No one knows what causes CFS, but a virus may be responsible. Risk factors include extreme stress or anxiety, flu-like illness that doesn't completely go away, and poor eating habits.

Your health care provider will go over your symptoms, check your medical history, and do a physical examination. He or she may use laboratory tests, such as a blood or urine test, to rule out other problems. If you have CFS, your health care provider will prescribe drugs to treat your symptoms, or will suggest herbs, vitamins, or dietary changes to help you. Usually these treatments and time will be enough to cure the problem.

If the usual treatments do not work, your doctor may check for other conditions, such as a psychiatric illness, muscle disease, or exposure to a toxic agent, that can cause symptoms similar to those of CFS.

Chronic fatigue syndrome is a stressful disease to have. It is important to get emotional support as well as treatment for your symptoms. Treatment for symptoms includes antidepressants and drugs to boost your immune system. Pain relievers and anti-inflammatory drugs help relieve muscle and joint aches. Support groups and stress-management techniques can help you to cope with the disease.

• Antidepressants—depending on type, in addition to relieving depression, they can reduce fatigue, muscle tension, or insomnia; various side effects
• Benzodiazepines—help reduce anxiety; various side effects
• Histamine blockers—block production of stomach acid, improving energy
• Nonsedating antihistamines—relieve allergy symptoms; side effects include drowsiness and headache
• Immune system boosters—to activate or enhance the immune system; some of these drugs are experimental

Aspirin, acetaminophen, and ibuprofen—reduce pain; side effects may include nausea, vomiting, gastrointestinal bleeding, and kidney damage

Following nutritional guidelines and using herbs and homeopathic remedies as recommended may alleviate the debilitating symptoms of CFS and improve overall vitality. Counseling, support groups, meditation, yoga, and progressive muscle relaxation are stress-management techniques that may help as well.

Avoid refined foods, sugar, caffeine, alcohol, saturated fats, dairy products, and gluten-containing grains. Eat more fresh vegetables, legumes, whole grains (non-gluten), protein, and essential fatty acids (found in nuts, seeds, and cold-water fish).

The following supplements may help reduce symptoms of CFS.

• Beta-carotene (50,000 IU per day) to strengthen immune function.
• Vitamin C (250 to 500 mg two times per day) to increase endurance.
• B-complex (50 to 100 mg per day or 2 ml by injection one to two times per week) with additional B6 (100 mg per day) and B5 (100 to 250 mg per day) to reduce the effects of stress.
• Pantothenic acid (4 to 7 mg per day).
• Magnesium aspartate (400 to 1,000 mg per day) to support energy production.
• L-carnitine (330 mg one to three times per day) to support energy production in the cells.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted. As with any therapy, it is important to work with your provider on getting your problem diagnosed before you start any treatment.

A tincture of Siberian ginseng (Eleutherococcus senticosus), schizandra berry (Schizandra chinensis), ashwaganda root (Withania somnifera), gotu kola (Centella asiatica), and astragalus root (Astragalus membranaceus). Take 20 to 30 drops two to three times per day. These are safe to take long-term and may need to be taken for four to six months for maximum benefit.

Herbs that support overall vitality and relieve exhaustion include licorice root (Glycyrrhiza glabra), lomatium root (Lomatium dissectum), skullcap (Scutellaria lateriflora), passionflower (Passiflora incarnata), lavender (Lavandula angustifolia), and rosemary leaf (Rosmarinus officinalis). Take 20 to 30 drops two to three times per day. Do not take licorice if you have high blood pressure.

Essential oils of jasmine, peppermint, and rosemary are calming and restorative and may be used in aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

The appropriate homeopathic treatment for CFS depends on the individual's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual. Some remedies commonly used by professional homeopaths to treat CFS include:

• Arsenicum -- for restlessness and fatigue accompanied by chills and burning pains that are worse at night
• Gelsemium -- for mental exhaustion, including drowsiness and indifference, and physical weakness, such as heaviness of the limbs and eyelids
• Pulsatilla -- for people who are moody and emotional, although usually with a calm and gentle disposition
• Sulphur -- for people who feel fatigue and tend to be lazy and unproductive; usually not as emotionally sensitive as those requiring Pulsatilla

While no trials have specifically investigated the use of acupuncture in treating CFS, a number of promising studies have found that acupuncture may be helpful for conditions with similar symptoms such as fibromyalgia, depression, headache, and irritable bowel syndrome. There is also some evidence that acupuncture may help boost an individual's immune system.

Acupuncturists treat people with CFS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of CFS, a qi deficiency is usually detected in the spleen or kidney meridians, but a deficiency may also be found in the lung or liver meridians. Acupuncturists may use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) in addition to needling therapy, as it is thought moxibustion helps to provide a deeper and stronger treatment. Practitioners with herbal training may recommend specific herbal remedies as well as dietary changes.

Although no well-designed trials have evaluated chiropractic treatment for CFS, some chiropractors suggest that spinal manipulation may boost energy and decrease pain in certain individuals with the condition. In these cases, it is believed that spinal manipulation may have a stimulating effect on the nervous system.

Therapeutic massage can reduce stress-related symptoms, improve circulation, and increase your overall sense of well-being.

Your health care provider will do routine checkups while you are taking the drugs or following the treatments he or she has prescribed. Contact him or her if new symptoms develop.

The effects of herbs in pregnancy have not been fully investigated and they should be used only under the careful supervision of your health care provider. Avoid high doses of vitamin C if you are pregnant.

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