Ancient approaches to a modern plague.


A much wider problem than just tiredness.


One of the most common presentations to herbal practice is persistent tiredness, “tired all the time”. This is however often accompanied by other distressing symptoms: compromised immune defences, poor digestive performance, depression, cognitive impairment, and a variety of aches and pains. The tiredness itself can be severely depleting, even paralysing.

Sometimes the condition comes with a name already attached to it: myalgic encephalomyelitis (ME), post-viral syndrome, Lyme disease, glandular fever or mononucleosis, post-traumatic stress disorder (PTSD), Gulf War syndrome, and most recently ‘long covid’. It may be a feature of other conditions such as fibromyalgia (see Arthritis section). Sometimes it is simply the result of overwhelm: punishing work schedules, intolerable domestic or social pressures, simple exhaustion.

One approach has been to group the many conditions and circumstances as ‘chronic fatigue syndrome’ (CFS). Whatever the term or diagnosis, most sufferers report lack of support or even understanding from conventional medicine (occupational therapists and physiotherapists can be a notable exception). Often they are prescribed antidepressants or otherwise get the impression that the doctor feels this is ‘all in the mind’. The Victorian term for fatigue syndrome ‘neurasthenia’ (weakness of the nerves) still influences modern medical thinking in the west, and psychiatric treatment is still often considered. What all this does of course is reflect the lack of tools in conventional medicine for dealing with fatigue. Doctors do feel uncomfortable in dealing with something they cannot treat.

There are better prospects in taking a whole view of persistent fatigue, how it was understood through human history and what modern insights can tell us. These point to a complex disruption of immunological, neurological and endocrine networks leading to both psychological and somatic symptoms. They also point to well-used treatment approaches.

However, before going any further it is important to rule out other causes of fatigue. Anaemia is a common reason and blood tests should be carried out as a routine with long term fatigue. These may also be needed to pick up less common but serious causes like kidney failure and cancer.

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