Fatigue

Fatigue: Your most common complaint – The endpoint of all disease –
October 2004
by Todd A. Hoover, MD (from the website of The National Center of Homeopathy)

Fatigue is the single most common complaint of patients who come to my office. Patients under age 30 rarely mention fatigue, while those over 30 list it among their top 3 to 4 complaints about 90% of the time. When I began practice, I just assumed that people began to “wear out” around 30 years of age. Over time, however, I have come to believe that there is actually something more insidious occurring.

Fatigue is the endpoint of all disease. As pathological processes progress, the person gradually loses energy. Restorative mechanisms of sleep, digestion, proper breathing, exercise, and joyful experience become disturbed, limiting the person’s ability to recover. Eventually, the patient experiences this as exhaustion—but in reality it is just one outcome of the chronic and progressive disturbance of their vitality.

Since fatigue may occur in any disease process, nearly any homeopathic remedy could be of help. In fact, Van Zandvoort’s Complete Repertory lists more than 800 remedies under the various rubrics for weakness. Fatigue associated with chronic disease seldom has any distinguishing characteristics that would aid the homeopath in selecting a correct prescription. A nearly universal symptom, fatigue is used more as a measuring stick for patient improvement or decline rather than as a symptom in case-taking.

Simple answers for some
For many people, simply stopping the depletion of energy will restore health. For example, loss of energy due to improper sleep habits may be easily corrected by better care for the body. Fad diets may at times lead to physiologic imbalance and loss of energy that is best managed through proper diet. Stressful relationships can drain energy and are usually better addressed through psychotherapy or counseling, rather than with homeopathy. If fatigue is due to self-destructive practices such as alcohol or drug abuse, it may not be possible for the individual to improve without stopping these behaviors.

When exhaustion overwhelms
There are other individuals for whom fatigue is a dramatic, overwhelming, and primary feature of their case. Several situations can cause this, including:

• Severe, life-threatening acute illness: such as profound blood infections or meningitis. These illnesses typically require diligent monitoring in a hospital setting, and are beyond the scope of this article.
• Acute loss of resources: as seen in illnesses with fluid loss (e.g., severe diarrhea) or intense fever (e.g., severe flu).
• Patient has never been well since an illness or stress: for example, a patient may have had mononucleosis or a strep infection, which led into a chronic fatigue state.
• Chronic fatigue syndrome: a condition that occurs without apparent cause or associated illness.

Severe fever or fluid loss
Let us consider acute illnesses with severe fevers or fluid losses. People with these illnesses become progressively drained of resources for their bodies, and they first need to have this draining plugged. Replacing fluids and controlling the temperature severity should be considered. Homeopathic remedies in this situation should be given in 30c potency and may need to be repeated as often as every 15–30 minutes. Look for a rapid action of the homeopathic medicine.

Some remedies to consider in such situations are listed below, with their indications:

Belladonna’s hallmarks include sudden onset of intense fever, with redness of the face, fullness of blood in the head, headache that is pounding, coolness of the extremities, and exhaustion requiring the person to lie down.
Baptisia is a remedy that may be indicated for the intense fatigue associated with influenza. The person is exhausted to the point of despondency and near-delirium. They have intense fevers and cannot lift themselves from bed. They may have soreness of the body, foulness of any discharges, and coma-like sleep.

Muriatic acid is to be considered for individuals with high fever that causes profound physical exhaustion. The person is so weak they “slide down in the bed.” They may have loss of bowel or bladder control due to the intensity of their weakness. They feel like a wet dishrag. Watch for mouth or skin ulcers, a weak pulse, and appetite or thirst that comes intensely and then goes.
Arsenicum album is a remedy to think of for those who initially have restlessness despite their exhaustion. They have diarrhea or vomiting (or both) that may be burning in quality. Their fever may come with burning or intense chills (or both at once). They have a high thirst. They may pace and be very anxious, even though they appear quite exhausted and low on energy.

Veratrum album is generally useful for those with intense and relentless loss of fluids because of vomiting or diarrhea. They are very chilly and may be shaking. The cramping in the abdomen can be severe and sudden in nature. Their mood may be quite irritable or simply withdrawn.

Carbo vegetabilis is thought of when the individual has an onset of fatigue that is quite strong, with a mild fever or chills. There is discomfort and bloating in the abdomen, which is frequently associated with pains. The abdominal discomfort and sensation of exhaustion may be partially relieved by breathing slowly and deeply. They may feel short of breath even though there is no problem with their lungs. Fresh air refreshes them somewhat.

Fatigue ever since an acute illness
Frequently, patients come to my office seeking help for fatigue that began after an illness. Typically this is secondary to influenza or mononucleosis, but can occur with strep throat, meningitis, Lyme disease, West Nile fever, malaria, and others. I have also seen patients whose prolonged fatigue began after a severe mental/emotional or physical shock. These folks generally respond more slowly over weeks or months, but they frequently need only one homeopathic remedy to feel significantly better. Consultation with a trained homeopathic professional should be considered. Remedies that might be useful and their associated causes include:

Phosphoric acid: when there has been a strong grief.
Stannum metallicum: after pneumonia or lung problems.
Gelsemium sempervirens: after a fright, influenza, or a strong chill.
Zincum metallicum: after influenza, or a disease (especially of the skin) that has been suppressed in some way.
Argentum metallicum: when there is a breakdown in the nerves.
Picric acid: when exhaustion results from overwork and intense study.
Nux vomica: when there has been abuse of stimulants and alcohol, and a loss of sleep.
Kali phosphoricum: when there has been too much mental exertion or worry, especially in love relationships.
Selenium: when there is exhaustion on the sexual sphere from overindulgence.
Natrum sulphuricum: when weakness occurs after a head or back injury.

Chronic fatigue syndrome
Chronic fatigue syndrome may or may not be associated with other illnesses. The U.S. Centers for Disease Control have established the following criteria for diagnosing this syndrome.

A. Severe chronic fatigue of six months or longer with other known medical conditions excluded
B. With 4 or more of the following:

• substantial impairment in short-term memory or concentration
• sore throat
• tender lymph nodes
• muscle pain
• multi-joint pain without swelling or redness
• headaches of a new type, pattern, or severity
• unrefreshing sleep
• post-exertional malaise lasting more than 24 hours

These individuals typically have prolonged fatigue and complex cases. Such patients are best treated by an experienced professional homeopath. As an illustration, let me present the essential elements of one particular case.

Martha: 20 years in bed
Martha is a 60-year-old woman with severe fatigue that began after a bout with the flu 20 years ago. For the past several years, the fatigue has been so severe that she is confined to the house and spends most of the day in bed. Periodically, she experiences a heaviness of the body and limbs, with extreme weakness. She can sleep up to 23 hours per day and needs assistance to eat and use the bathroom. Her sleep is heavy; she snores and stops breathing at times. She sometimes wakes with a severe, one-sided headache that can be accompanied by nausea and vomiting. Her headache is particularly worse when using computer screens or performing mental work. She has photophobia, sensitivity to noise and voices, and is sensitive to being jarred. She has periods of vertigo, accompanied by difficulty concentrating, clumsiness, and illegible writing.

She is generally chilly, and she craves refreshing fruits. When she is feeling particularly bad, her thirst gets much stronger. She has an aversion to fats and can be aggravated by milk products.

In analyzing this case, a homeopath might consider Martha’s severe fatigue with overpowering sleepiness as one issue. Her intense weakness and heaviness of body and limbs is also a strong symptom set. Her headaches seem related to the fatigue, and their quality of being one-sided or associated with visual or mental strain could be considered. Additionally, there appears to be a neurological weakness that affects Martha’s concentration and coordination. You might consider influenza as the etiology (cause) of her fatigue, but given that twenty years has elapsed, you would never be exactly sure of the nature of that flu. Finally, you might consider her general nervous system sensitivity to light, noise, and jarring as a separate theme in this case.

By putting together the totality of these symptoms for Martha’s case, you would arrive at a list that includes the remedies: Agaricus muscarius, Alumina, Asarum europaeum, Causticum, Cuprum metallicum, Magnesium carbonicum, Natrum muriaticum, Natrum silicatum, Nux moschata, Nux vomica, Onosmodium virginianum, Phosphoric acid, Phosphorus, Silicea, Zincum metallicum. Other remedies that might also be considered include: Gelsemium sempervirens, Picric acid, Selenium, Valeriana officianalis, Zincum phosphoricum. After carefully studying the Materia Medica for all of these remedies, I prescribed Onosmodium virginianum 200c.
Onosmodium virginianum is a remedy for severe mental and muscular weakness that is particularly worse from mental exertion. The memory and motivation are weak. Individuals who need this remedy tend to have one-sided headaches that come from reading or using their vision too much (e.g., computer work). And they have a particular heaviness and awkwardness of the limbs.

Over the next three to six months, Martha showed steady improvement with increasing ability to perform mental and physical work, progressive independence, and more normal sleep patterns. Eventually, she was able to return to the workplace and move her residence to be closer to family. She has done well over a number of years, requiring only a single repetition of Onosmodium virginianum.

While Martha’s case was fairly straightforward, many people with chronic fatigue have cases that are much more problematic, even for the well-trained homeopath. The general lack of energy within the patient makes the response to well-chosen remedies slower and sometimes less complete. Relapses are common, especially in those who have ongoing stressors.

Get a diagnosis
Because fatigue is a common endpoint for so many diseases, it is paramount that an appropriate search for underlying pathology be conducted in all cases of chronic fatigue. Depression, cancer, autoimmune disease, and neurological disorders are just a few of the diagnostic possibilities that can underlie a serious case of fatigue. A patient must know the diagnosis in order to make reasoned decisions about homeopathic treatment and other adjunctive modalities. A good allopathic diagnostician may well be worth their weight in gold in such cases. Many patients arrive in my office undiagnosed, despite enormous expenditures on lab and x-ray analysis. Fortunately, the tools of homeopathy, including a focused and detailed history of the case and close analysis as to the organized response of the vital force, can be immensely helpful in accurately guiding medical evaluation to the correct diagnosis. With the diagnosis and prognosis known, the patient can make an informed choice about homeopathy and is more likely to see the course through if progress is slow.

Homeopathy in all cases
Homeopathic medicines should be considered in all fatigue cases, in either a primary or adjunctive role. At times, homeopathic remedies can be given even before a person has progressed to the point of having a diagnosable disease. In this function, homeopathy may actually prevent the occurrence of a deeper pathological state by returning a person to a healthy balance before significant organ deterioration can begin. While simple remedies can be considered in acute cases of fatigue, chronic issues with potential underlying diseases are best handled by a well-trained homeopathic professional with the help of a good physician.

Sidebar:
Conventional drugs don’t address chronic fatigue
A September 8, 2004 study in the Journal of the American Medical Association found that Reminyl (produced by Johnson & Johnson and used for patients with dementia) was ineffective for patients suffering from chronic fatigue syndrome (CFS). There has yet to be a conventional drug found to specifically address CFS, although allopathic doctors do prescribe drugs (e.g., antidepressants and non-steroidal anti-inflammatory drugs or NSAIDs) for various CFS symptoms. CFS patients tend to be unusually sensitive to allopathic drugs, needing one-quarter of a normal dose or less.
Consider homeopathy, a safe alternative for treating patients with CFS!

Sidebar:
Chronic Fatigue or Depression? There is a difference
With so much overlap between the symptoms of chronic fatigue syndrome and depression, some have questioned whether chronic fatigue syndrome is really a different condition than depression. A recent study published in the International Journal of Psychophysiology found that chronic fatigue syndrome and depression have distinct biological features—suggesting that they also have unique causes. Researchers found that those with chronic fatigue syndrome have lower skin conductance levels and higher skin temperatures in the arms and legs, compared to those with depression. This adds to a growing body of evidence showing that the two conditions have physiological differences.

About the author:
Todd A. Hoover, MD, is a board certified family physician and homeopath practicing in Narberth, Pennsylvania. He is a graduate of Jefferson Medical College and studied homeopathy at the New England School of Homeopathy, as well as with Ananda Zaren, Vassilis Ghegas, and others. He has been practicing homeopathy for nine years. He is also a yoga teacher, father, avid cyclist, and “full-time explorer of things unknown.”