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Ancient approaches to a modern plague.


A much wider problem than just tiredness.

Understanding Fatigue

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.

How is Chronic Fatigue diagnosed?

Chronic Fatigue Syndrome (CFS) was formally defined in 1988, then amended in 1994 by the United States Centers for Disease Control and Prevention as severe chronic fatigue for at least 6 months with other known medical causes excluded by clinical diagnosis, and including 4 or more of the following symptoms, which must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue:

  1. post-exertional malaise
  2. impaired memory or concentration
  3. unrefreshing sleep
  4. muscle pain
  5. multi-joint pain without redness or swelling
  6. tender cervical or axillary lymph nodes
  7. sore throat
  8. headache

Currently there is no accepted biochemical test for CFS.

There is some resistance among sufferers to using this catch-all term, as some have chronic tiredness without exactly matching the above definitions. However it does allow us to look at common features of the many fatigue problems and we shall use it in the review as a convenient basket term. Because this topic does generate strong views, particularly among those affected feeling misunderstanding from health care professionals and media, we shall look for supportive evidence as we go.

Many herbs are suitable for self-care. However if a health condition does not resolve with home remedies we recommend using the information in Herbal Reality along with your health advisors, especially herbal practitioners from the professional associations listed in our Resources page (‘If you want to find a herbalist”). When buying any herbal products, you should choose responsible manufacturers with independently assured quality standards and sustainability practices. Check the label carefully for the appropriate safety and sustainability information.

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