Herbal Medicine

A single case study: Treating post-viral fatigue syndrome
with Herbal Plants

Introduction

Fatigue can be described as a subjective feeling of lack of energy or reduced physical function due to physical or mental stress syndrome (Warrell, Cox & Firth, 2015). Fatigue is caused by several different factors such as infections and a viral infection is a very important cause of fatigue. Different viruses such as retroviruses, Epstein–Barr virus have been reported to cause post-viral fatigue syndrome (Warrell, Cox & Firth, 2015). Patients who present with post-viral fatigue syndrome provide a history suggestive of acute infections at the outset and therefore the term ‘post-viral fatigue syndrome’. The most common symptoms in post-viral fatigue syndrome include an onset of severe fatigue for six successive or longer periods that is not relieved by rest or sleep; poor memory and concentration; un-refreshing sleep; muscle pain; pains in multiple joints; sore throats, dizziness, headaches and tenderness in cervical or axillary lymph nodes (Yancey & Thomas, 2012).

The general approach to a patient with severe fatigue is supposed to begin with a history and physical examination where the focus should be to identify the etiology of the fatigue, most worrisome symptoms and red flag signs that might indicate a more serious underlying disease. There is no known pharmacological cure for post-viral fatigue syndrome but there are treatments that may assist in easing symptoms (Wilson et al, 2014). However, some evidence indicates that graded exercise therapy and cognitive behavioural therapy can improve symptoms for some people. Complementary and alternative medicine (CAM) therapies have been widely used to support health and healing, relieve side effects and symptoms and also lower stress. CAM consists of various healing approaches, philosophies and treatments that embrace a holistic approach to care (Alraek et al, 2011). Studies have shown that some CAM therapies can be effective in treating chronic fatigue syndrome. For example homeopathy has been shown to improve fatigue and cognitive function (Alraek et al, 2011).

Case Presentation

A 30 year old woman, height and weight proportionate (height: 168cm and weight: 58kg) presented with ongoing severe fatigue, poor memory and concentration and recurrent dizziness on standing. All these symptoms were constant and frequent. The patient attributed her symptoms to work stress and described the symptoms as having started when she was aged 25 years. The fatigue was systematic and got worse with exercises and did not get better with either sleep or rest. The following tests were taken: complete blood count; thyroid panel; iron studies and liver function test and they showed no abnormalities. However, fasting blood glucose reduced at 3.4 mmol/l. Her blood pressure was 88/50, temperature 37.6 and respiratory rate 18. Observations showed that the patient was tired with large black rings under eyes while physical examination indicated inflamed oropharynx with tonsillar exudate. Palpation showed that both cervical and axillary lymph nodes were tender and enlarged.

The patient reported a history of having had a very stressful work-related episode when she was aged between 22-24 years and having contracted glandular fever when she was 18 years old but was resolved by age 20. Patient considers that the symptoms started at age 25. In addition, the patient reported a family history of dementia, hypertension, hypothyroidism and depression. There was no use of medication but she was on using the following supplements: Liquid extract of equal parts of Eleuthrococcus senticosus; Panax ginseng; Gotu cola— 5ml tid pc. General B-complex as directed. In regard to the patient’s dietary profile, she stated that she ate balanced diet and tried being a vegetarian. For the physical activity, the patient used to exercise regularly but due to fatigue she was no longer able to exercise.

Discussion

The red flags that must be addressed in the patient include the onset of severe fatigue, low blood pressure at 88/50 and inflammation of oropharynx with tonsillar exudate and enlarged and
tender cervical and axillary lymph nodes (Wilson et al, 2014). The fatigue in the patient may be a red flag for a serious underlying disease or condition such as chronic fatigue syndrome, malignancy, anemia or even cardiac arrhythmia. Inflammatory signs such as inflammation of oropharynx may indicate presence of an autoimmune disease (Yancey & Thomas, 2012). Another red flag is the low blood pressure which was 88/50 which maybe a pointer to some other health concerns. In this patient, the low blood pressure maybe an indicator to serious conditions such as a serious heart disease, heart arrhythmias, neurological disorders, depression or hypoglycemia or even hypothyroidism (Elliott, Black & Gavish, 2004).

Therefore, it would be appropriate to ensure that all the aforementioned red flags are investigated and take into consideration all differential diagnoses for the patient. Additionally, whenever a patient presents with suspected post-viral fatigue syndrome, further investigations should be performed on all red flag to rule out other etiologies of the patient’s disease symptoms (Voss et al, 2011).

The patient’s symptoms indicate that she may be post-viral fatigue syndrome as manifested by the presenting symptoms. Globally, a number of patients with diseases such as the patient in this case study tend to often use complementary and alternative medicine. Numerous treatments for fatigue syndrome have been explored but none has demonstrated consistent significant outcomes in people with post-viral fatigue syndrome. In this case study, the patient used three types of herbal medicines namely: Eleuthrococcus, Panax ginseng and Gotu cola.

Eleuthrococcus senticosus is a herbal medicine used in combating fatigue and help the body during mental, physical and metabolic stress by protecting the adrenal glands during stressful times (European Medicines Agency, 2014). The main compounds in Eleuthrococcus senticosus include phenyl propane compounds, lignanes: (+),coumarins, triterpensaponines, polysaccharides (heteroglycans and eleutherans) as well as steroids, carbohydrates and essential oil (Davydov & Krikorian, 2000). The rationale of using Eleuthrococcus senticosus for this patient was due to its anti-stress properties, anti-fatigue effect and as a tonic. This is because the patient is experiencing ongoing severe fatigue, poor memory and loss of concentration. According to European Medicines Agency (2014) Eleuthrococcus senticosus is used as a tonic in case of reduced performance like fatigue, weakness and loss of concentration.Arushanyan et al., (2003) also indicates that Eleuthrococcus senticosus as adaptogen is used for increasing body resistance to stressful conditions. Studies further show that Eleuthrococcus senticosus contains eleutheroside E and E(2) which have potent abilities to relieve physical and mental fatigue. This is supported by Facchinetti, Neri & Tarbusi (2002) who found out that during exercises, Eleuthrococcus senticosus deceases fatigue by inhibiting exercise-induced 5-HT synthesis and TPH expression in the dorsal raphe. Therefore, Eleuthrococcus senticosus treatmentis principle to alleviate fatigue and improve the patient’s concentration (Facchinetti, Neri & Tarbusi, 2002).

Panax ginseng contains two important group of compounds namely ginsenosides and polysaccharides. Evidence shows that ginsenosides have regulatory effects on the central nervous system, cardiovascular system, immune system and more (Baranov, 1982). Additionally, Mitra et al (1996) found that Panax ginseng boosts energy and relieves stress due to its nutritive, restorative and normalizing effects that improve homeostasis and offset adverse effects that result from stressors. Panax ginseng helps in restoring the normal functioning of the body’s key stress response system, the hypothalamic-pituitary-adrenal axis (HPA axis). Panax ginseng treatment is used to improve the patient’s general physical and mental wellbeing (Mitra et al, 1996). The patient is experiencing severe fatigue and thus Panax ginseng will help in alleviating the fatigue.

Gotu cola is an important rejuvenatie herb in Ayurvedic Medicine. It is a brain tonic and hence helps in memory and intelligence. It reinforces the adrenal glands, purifies the blood and combats stress and depression. The rationale of using Gotu cola in the patient was for treating the poor memory and concentration. According to Nalini (1992) Gotu cola demonstrated a remarkable improvement in memory in rats and it supports healthy memory function.

Overall, there is evidence that support efficacy of Eleuthrococcus senticosus,
Panax ginseng and Gotu cola in treating fatigue and other symptoms such as poor memory and concentration that are common in chronic fatigue syndrome.

Conclusion

The patient manifested symptoms of post-viral fatigue syndrome (CFS). She was using herbal plants namely; Eleuthrococcus senticosus,
Panax ginseng and Gotu cola. There is evidence supporting use of all the three plants in treating fatigue and related symptoms. Therefore, these herbal plants might be successful in treating the patient.This article can assist in expanding treatment options of healthcare practitioners to encompass more diverse set of modalities such as herbal plants. Further research is required to investigate the role of complementary and alternative medicine (CAM) in the treatment of chronic fatigue syndrome.

References

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