Chronic Fatigue

Chronic Fatigue & ME/CFS

If you live with chronic fatigue, you may already know how difficult it can be to have the severity of the condition taken seriously. Many patients arrive after extensive testing has ruled out an obvious cause, only to be left with the impression that reassuring results mean there is nothing physically wrong. Some have also been encouraged simply to exercise more, despite finding that exertion can leave them markedly worse for days afterward.

We approach chronic fatigue differently. Normal investigations do not make the symptoms less real, and treatment has to respect the body’s limited capacity rather than continually testing its limits. In conditions where exertion can provoke a delayed worsening of symptoms, restraint is not therapeutic timidity; it is part of treating the condition intelligently. We begin gently, pay close attention to how you respond, and adjust the pace of treatment accordingly, with the aim of addressing sleep, fatigue, pain, digestion, and day-to-day resilience without asking an already depleted system to do more than it can sustain.

Chronic fatigue is a symptom with many possible causes. ME/CFS — myalgic encephalomyelitis/chronic fatigue syndrome — is a specific, complex illness in which post-exertional malaise is a defining feature. Not everyone with persistent fatigue has ME/CFS, and establishing that distinction belongs within an appropriate medical evaluation. Our treatment is adapted to the diagnosis you have, the symptoms you are experiencing, and, most importantly, how your body responds.

What we treat

• Persistent or chronic fatigue after appropriate medical evaluation
• ME/CFS
• Post-viral fatigue, including Long COVID and fatigue following mononucleosis, influenza, or another infection
• Persistent fatigue and other symptoms following Lyme disease, including post-treatment Lyme disease syndrome (PTLDS)
• Post-exertional malaise — the delayed worsening of symptoms after physical or cognitive exertion that is a defining feature of ME/CFS
• Unrefreshing sleep, and sleep that has become inverted or fragmented
• Brain fog — word-finding difficulty, lost concentration, and poor recall
• Orthostatic symptoms — dizziness, lightheadedness, palpitations, or worsening symptoms on standing
• Muscle and joint aching and headaches
• Digestive symptoms, including changes in appetite, nausea, bloating, or altered bowel function
• Persistent fatigue associated with long-term illness or recovery from a serious one

How we approach it

For patients with ME/CFS or post-exertional malaise, the first principle is pacing, and it governs everything else. Treatment is deliberately conservative: shorter sessions where needed, fewer needles, gentler technique, and careful attention to how much treatment the person can comfortably tolerate.

With ME/CFS, even relatively modest demands can sometimes provoke a disproportionate response. We therefore err on the side of doing less and adjust treatment according to how you respond. If a treatment leaves you significantly more fatigued or worsens other symptoms afterward, we need to know. We adjust rather than simply repeating the same treatment and hoping your body will adapt to it.

Chinese medicine also differentiates between different presentations of fatigue rather than treating everyone with low energy in the same way. One person may be profoundly tired and cold, with poor appetite and weak digestion; another may sleep for many hours without feeling restored; another may have prominent pain, headaches, brain fog, or disrupted sleep. Some people function reasonably well within a narrow range of activity but experience a significant delayed crash when they exceed it.

Treatment is built around the whole presentation and around what the person can comfortably tolerate. The intention is not to stimulate an exhausted body into producing more energy on demand. It is to support the functions that are struggling — sleep, digestion, pain, recovery, and energy — while respecting the limits the illness is imposing.

Chinese herbs may be added when appropriate, based on the individual presentation and after reviewing medications and supplements. Dietary work can also be useful, particularly when appetite or digestion has become impaired. The emphasis is on nourishment and what can be comfortably digested and sustained, rather than imposing a restrictive diet on someone who already has limited reserves.

With established ME/CFS, timeframes can be long, and we will not pretend otherwise. Progress is better measured over months than from one treatment to the next. Improvement is not necessarily linear, and temporary setbacks do not mean that you have failed or that every gain has been lost.

Long COVID

Persistent fatigue is one of the common presentations of Long COVID, often accompanied by brain fog, disturbed sleep, pain, post-exertional worsening, dizziness, palpitations, digestive symptoms, or other changes that began with or followed the infection.

Long COVID varies considerably from one person to another, so treatment is based on the symptoms that are actually present rather than on the diagnosis alone. When post-exertional malaise is part of the picture, we use the same conservative principles we use with ME/CFS: respecting current energy limits, avoiding a push-through approach, and adjusting treatment according to the response afterward.

Acupuncture may be used to address prominent symptoms such as sleep disturbance, pain, digestive difficulties, headaches, and the broader experience of fatigue. Chinese herbs may also be considered when appropriate. Neither replaces the medical care you are receiving for Long COVID, and we are glad to work alongside your physician or Long COVID clinic.

Working with your medical care

If you have not had an appropriate medical workup for persistent or unexplained fatigue, have one. Fatigue has many possible causes, and some are readily treatable. Anemia and iron deficiency, thyroid disease, sleep disorders such as sleep apnea, diabetes, celiac disease, nutritional deficiencies, medication effects, autoimmune conditions, and other illnesses can produce or contribute to similar symptoms.

Bring your results and tell us about the medical care you already have in place. Acupuncture and Chinese medicine are not substitutes for determining why persistent fatigue is occurring. Once serious and treatable causes have been appropriately investigated, we can work alongside your medical care to address the symptoms that continue to affect daily life.

Tell us everything you take, prescription and otherwise. If herbs become part of the treatment plan, we need a complete medication and supplement list so that potential interactions can be considered.

Common questions

Will treatment exhaust me?

I take a less-is-more approach, especially when someone is already sensitive or depleted. We begin gently and pay attention to how you feel not only immediately afterward but over the following day or two. Your response helps us decide how much treatment is appropriate the next time.

How often should I come?

It depends on your level of fatigue and how you respond to treatment. We often begin with shorter treatments scheduled closer together — twice a week in the beginning, if scheduling allows — and adjust from there.

How long before I improve?

There is no reliable timetable. In Chinese medicine, we often think in three-month cycles — the length of a season — and I find that a useful timeframe for assessing change in chronic conditions such as ME/CFS. Progress may not follow a straight line, so we look for meaningful changes over that period in sleep, pain, digestion, cognitive function, recovery after activity, and eventually the amount of daily life you can comfortably sustain.

Should I be exercising?

If you have ME/CFS or post-exertional malaise, we do not recommend pushing through symptoms or following a graded exercise program that increases activity according to a predetermined schedule. Pacing means learning your current energy limits and managing activity within them to reduce post-exertional crashes. Activity can be adjusted as your condition changes rather than increased simply because a schedule says it is time to do more.

Do I need herbs?

Often, yes. Herbs can be an important part of treatment for some patients, but whether they are appropriate depends on your presentation, medications, other medical conditions, and your preference.

Can you treat Long COVID?

We work with patients experiencing Long COVID, particularly when fatigue, post-exertional worsening, sleep disturbance, pain, headaches, digestive symptoms, or brain fog are prominent. Treatment is individualized and used alongside appropriate medical care.

Nobody has been able to find anything wrong with me.

That history is common in people with persistent fatigue. Normal test results do not mean your symptoms are imaginary; they mean the tests performed have not identified an explanation for them. We take the symptoms seriously while continuing to support appropriate medical investigation when it is needed.