Fatigue And Its Multitude Of Manifestations

In this blog we will discuss fatigue and its multitude of clinical manifestations at the level of body, tissue, organ system, energy flow, cellular level.

Fatigue is generally considered as a lack of energy, depletion of energy, sense of not fully feeling well and many other ways one may describe or try to relay its meaning.

Chronic fatigue syndrome is not a new disease but has been around for thousands of years. The oldest Indian medical science, Ayurveda, has described this condition and is known as balakhaya or energy depleted disease, which in fact is fatigue. To understand the fatigue, one needs to understand strength, as the opposite of strength is fatigue. To understand strength we need to understand its origin, its conversion, and manifestation.

The prana, which is the life force in the body is the source of energy that keeps the physical body, mind, and the soul in place. This is a subtle finding. It is the prana, which is the life force that gives rise to a series of physiological, biochemical, neurological, endocrine and many other pathophysiological changes at the level of body and mind. Energy in the body has a source from the food that we eat, the sleep we get, the breath we breathe, and from the cosmos, the universe, which includes solar energy, lunar energy, and more. The food, the breath and the sleep are the key forces. The type of food, the kinds of food, the time the food is ingested, the quantity eaten and the emotion while it is eaten all have its affect on the digestion of the food as described in Ayurveda. It is the food that eventually forms our body and keeps the body going. It is the food from which the mind is formed. Whenever there is a depletion of energy or prana that leads to the depletion of other physiological changes, like depletion in tejas or intracellular metabolism.

There is a relation between the prana, tejas, and ojas. In Ayurveda, the panchmahabhatu (five great elements) are space, air, fire, water and earth. The permutation combination of this gives rise to tejas, ojas, and prana to some degree but all are interconnected. All three has its relation for restoration of health in the body. Any imbalance in any of one will lead to imbalance of other. The prana which is the vital form of air and space which has a relation to the respiratory system again which has a relation to the governing all physiological and metabolic process in the body through oxygen; no breath, no life. With no prana, there is no life. The restoration of prana leads to gradual restoration or imbalance of tejas and the depletion of the ojas could be restored through the prana gradually over many months to years with regular breathing exercise called pranayama. This is the key principal in yoga. It is the prana, which governs the body and has a relation with mind and the subtle body.

In patients with chronic fatigue syndrome and/or fibromyalgia patients, there is imbalance in combination of prana, tejas and ojas based on the degree and severity of underlying disease. In the early phase, there is adequate ojas present which generally gets depleted with lack of sleep, increase worry, irregular eating habits, sleeping habits, insomnia, sleep interruption, and stress.

By understanding the depleting causes of the prana or the energy, the opposite of that may further help restoration of the energy, mainly regular diet, sleep cycle, relaxation, pranayama, graded exercise, etc.

The fatigue which is generally a vague symptoms has multiple different facets and it manifests differently from person-to-person and its understanding individually further helps to tailor its need for treatment, so patients with chronic fatigue and/or fibromyalgia needs an individual personalized treatment than general treatment as the causes for each patient is different.

This entry was posted in Ayurveda, Chronic Fatigue Syndrome, Chronic Fatigue Syndrome Program and Fibromyalgia Care Program, Chronic fatigue treatment, Chronic pain syndrome, Fibromyalgia and Fatigue center, Fibromyalgia treatment center, Integrative medical treatment and management of Chronic fatigue syndrome and fibromyalgia, Low immunity, Sleep hygiene, alternative medicine, complimentary alternative medicine, treatment of fatigue and tagged , , , , , , , , . Bookmark the permalink.

9 Responses to Fatigue And Its Multitude Of Manifestations

  1. Excellent ! this is very good ! awesome :)

  2. Kelly says:

    The word “fatigue” means very different things to different people. When researchers and clinicians discuss myalgic encephalomyelitis, sometimes called chronic fatigue syndrome, they are referring to the very severe and specific symptom of post exertional malaise lasting more than 24 hours, unrelieved by rest and upon minimal exertion such as walking the dog or doing the dishes. Without this symptom the good news is you most likely do not have ME. Although graded exercise is sometimes suggested for CFS patients there is no specific research on ME patients specifically defined with the mandatory symptom of post exertional exhaustion.

    According to Dr. Gordon Broderick, one of the authors of the International Consensus Criteria for ME (Carruthers et al 2011), “The cardinal symptom of ME is a pathological low level of threshold of fatigability that is characterized by a specific pattern of inability to produce sufficient energy on demand associated with measurable, objective, adverse responses to exercise.” (Broderick 2012)

    Lumping together patients whose chronic fatigue is an integral part of many other diseases skews both clinical and research findings as well as making it difficult to extrapolate treatment results from one group to others.

    At this time there are no research studies on Ayurveda techniques in ME or CFS either.

    • Kiran Viramgama M.D. says:

      Thanks for your feedback. Your thoughs on the Fatigue and a good reference of article. Your input is highly appreciated.

      (1) Our goal of the blog is very simple. To share our experience that we see in our clinical practice and its practicle use. I am not university research physician but clincial physican and use the practicle knowledge from Allopathy medicine and Ayurveda to treat patient and help get them better. I use integrative medical management for patient with chronic fatigue and fibromyalgia. As Ayurveda is written in Sanskrit and other Indian languge many researchers are not aware so it makes difficult to give any reference.

      (2) To your question of research on Ayurveda , yes there are no reserach studied for CFS done on large scale. Ayurveda is based on individulized treatment and not group treatment. The angle of treatment is different. Still research can be done on that. Small sample based research are done which can be found on pubmed. One small reseach on CFS and ayurveda … http://www.ncbi.nlm.nih.gov/pubmed/20074439

      (3) The Ayurveda is the oldest and most documented literature for mankind. As it is in Sanskrit language and or other Sanskrit derived languge makes difficult for its review and understanding. If Principle of Ayureveda can be studied in current times and translated in English may benifit lot of patients. We have seen in our practice we use Principles of Ayurveda and its associated treatment and we see significant improvement when our compliant patient use them as we have recommended. We would like to use the best of any medical science which help patient with fatigue. One of my patient use to say doc “Patients with CFS or ME or just fatigue is looking to improve irrespective what a name is given”.

      (4) In the current blog we gave the different angle of looking at a Fatigue symptoms in a very simple understanding for a lay person. Also to get the Ayurveda angle to looking at a disease to help understand a different angle. As you said correctly word “Fatigue” is used very dfiiferently from person to person. I will stretch it longer for the word “Fatigue” . It is used differently from language to language ( if one knows more than 2-3 langugue other than English) ( author knows 5 language so can review literature outside English). It is used differently from country to country or continent to continent differently. It changes from time to time by same group of researches also. But when things are looked at mutidimentions it helps the understanding of the disease and help individualize the treatment as every patient we see in the clinic has the different cause of fatigue. We try to pin point clincal fatigue cause as much as possible. Sometime it may be as simple as history of self sleep deprivation for few years as one is working 2-3 jobs or rotating shift work.

      (5) To your lumping together commnet , You are also right that as many things are lumped in together it does makes research findings difficult to extrapolate treatment also.

      (6) Also the fatigue and its associated CFS is still the prefered term used in clinical practice ME is not used as commonly. Although one can describe the fatigue in his/own way. There is overlaping of the symptoms between the two concesus with some difference. Below is the paragraph I have taken from the http://www.cdc.gov website and gave you the reference.

      “Various terms are often used interchangeably with CFS. CFS is the preferred term because it has an internationally accepted case definition that is used in research and clinical settings. The name chronic fatigue and immune dysfunction syndrome (CFIDS) was introduced soon after CFS was defined; there is no case definition for CFIDS, and the name implies an understanding about the pathophysiology of CFS that does not currently exist. Chronic active Epstein-Barr virus (EBV) infection (chronic mononucleosis) was thought to be the cause of CFS during the 1980s, and this association is now known to be rare. However, post-infection fatigue syndromes have been associated with EBV and other infectious agents. The name myalgic encephalomyelitis (ME) was coined in the 1950s to clarify well-documented outbreaks of disease; however, ME is accompanied by neurologic and muscular signs and has a case definition distinct from that of CFS” .

      (7) If researchers looks into the Ayurveda may get a good insite of the disease, pathogenesis. manifestation, and treatment. Based on my review of the literature there is no stone unturned in Ayurveda. Any disease known to mankind including CFS has been described in someway or other in ancient Ayurvedic text Charak Samhita, Sushruta Samhita, Astanga Hyradayam. The words and pharases are different then what is used now. Goal is help the patients suffering from fatigue and how one can get them better.

      Best wishes


  3. But quality of ayurvedic medicine is very poor

    Eg Of poor manufacturing By Ayurvedic Companies, Companies such as Baidyanath Jhansi, are making metalic drug but they don’t check the purity of raw materials even if they are metal, suppose to form “Kajjalli” (HgS) an intermediate product, they require 100 gm mercury and 100 gm sulfur, if mercury is 99.9 % pure and sulfur is 98 % pure than almst 2gm mercury will remain unreacted, and can caused havoc, even the Indian government official know this but they are not acting, even after I bring it to there notice they are not acting.

    • Kiran Viramgama M.D. says:

      I understand the concern about the quality of medication. That don’t make science of ayurveda inferior to other modes of treatment. Ayurveda has lot to offer to the morden world when other treatment fails ayurvedic treatment may be a choice for many patients. What you are talking about is a manufacturing issues. Similar issues are there in allopathy also where medication is not produced today by drug company and stops without any notice in USA. That leads to doctors to treat patients with other drugs which we don’t want to use but has to replace. There are hundreds of routine drugs not manufactured in USA as it very cheap and this short supply drug is not allowed to be imported by governmental regulation to USA. So everything is again based on profit. But good quality should be maintained or it should not be manufactured. It is a vast issue that needs a proper govt. regulation and third party testing to make sure it is a good quality. It will increase the cost of Ayurvedic drug manufacture but quality has to be maintained by any means and is not a excuse. With any medication ( allopathy or ayurvedic ) production issues it is one of the problem. This is a global problem. Non-metalic ayurvedic products may be used in such situation if there is question of quality of product to treat the disease. That is the beauty of Ayurveda that there are more replacement of therapy there and can be switched to non-metallic herbs. Ayurvedic doctors should avoid using that product if doubtful in production and eventually companies may not make it. More tight law enforcement may help. Unless there is self realization by the owner of the company to make good product it is very difficult. For any bad match produced there should be penalty. More tight manufacturing regulation by governmental body who is neutral and uncorrupt is needed Globally. On the other side we have to know that the prices of ayurvedic medication are also relatively very low compared to allopathic medications. So is the low profit margin for the ayurvedic manufacturing company compared to allopathy medication. Irrespective of that product( ayurvedic or allopathic medication) should be safe and good quality is expected irrespective of the cost of the medication. Again I would like to thank you for your input. Best wishes

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