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Living By The Commandments Is Easy

I've always heard that it is hard to live a clean, good, Christian life. I've heard people say we as humans are not meant to be perfect. I've heard we are born of sin and that we are inherantly evil and bent to sin. Bur I say the Bible tells us uf good people. Noah Joseph Moses Elijah Joshuah Abraham David Soloman Ruth Naomi Rahab Mary 1. Enoch. Enoch was a man of character because he literally walked with God (Genesis 5:24). In fact, he walked so closely with God that the Lord simply took him home one day. Scholars believe that he and Elijah were the only men to walk so closely with God that they didn’t experience death. That’s character worth imitating! 2. Noah. Genuine manhood requires difficult choices—including choices that don’t make sense. For those times, Noah provides a great example of biblical character. God called him to build a boat and prepare for a flood even though it had never rained (Genesis 6:11-22). Responding in obedience to that kind of challenge requires godly character. 3. Abraham. With a GPS system in the palms of our hands, it’s hard to contemplate making a trip without knowing the final destination. But God told Abraham (then known as Abram) to move to an unknown land (Genesis 12:1-3). He also promised to make Abraham into a great nation when logic said that wasn’t possible. But Abraham knew how to have faith in God, and Abraham waited. Examples of godly character in Scripture often remind us that we can’t get ahead of God’s direction or God’s timing. 4. Moses. Many examples of godly character in the Bible demonstrate incredible leadership. Of that group, Moses stands out as the first and, possibly, greatest leader of God’s people. Despite his initial objections (Exodus 3-4), Moses eventually accepted God’s call to confront Pharoah and lead the Israelites. Through his example, we learn to seek God’s wisdom in leadership and His strength to make tough decisions. Leaders who demonstrate godly character are not always popular, but they are committed to following God’s design for leadership. 5. David. The prophet Samuel (another solid example of godly character) once described David as a man after God’s own heart (1 Samuel 13:13-15). And while we see His passion for God throughout His life, we might learn about godly character best in our greatest failures. After committing adultery with Bathsheba and murdering her husband, David hid his sin for a while. But once confronted with the truth, he begged God for forgiveness (Psalm 51). Godly character isn’t about perfection. Often, it’s about turning back to God in humility once you’ve fallen. 6. Elijah. Throughout Scripture, God led His representatives to confront people in powerful positions. Elijah had an ongoing battle with Israel’s King Ahab and Queen Jezebel that started with God withholding rain (1 Kings 17:1-3) and culminated with Him sending fire from heaven (1 Kings 18:20-39). All the while, Elijah demonstrated godly character by speaking truth, even if the people in charge didn’t want to hear it. He never compromised, and he never backed down. That’s a powerful example of biblical character. 7. Daniel. Godly men wrestle with the balance between finding common ground and selling out. Daniel demonstrated a God-ordained knack for walking that tightrope. He was able to work humbly and graciously with kings and their officials (Daniel 1-2), but he also refused to back down when non-negotiable convictions were threatened (Daniel 6). He determined to be an example of godly character whether he was praised for interpreting dreams or sent to a lion’s den for his prayer life. 8. Andrew. Among Jesus’s disciples, guys like John or Peter or even Judas are probably more notable. But Andrew is a great example of godly character in the Bible because he was always bringing people to Jesus. First, it was his brother (John 1:42). Later, he found the boy who gave his bread and fish to Jesus (John 6:7-10). Then, just days before Jesus’s crucifixion, he joined Philip in introducing some Greeks to the Lord (John 12:20-22). Men of godly character are always looking for ways to connect others with Jesus, just like Andrew. 9. Barnabas. Whether it’s a kind word, a loving action, or the gift of presence, friends who pick us up are priceless. That’s the role Barnabas played in the early church. His real name was Joseph, but everyone called him Barnabas, which means “son of encouragement.” He sold the property to help people in need (Acts 4:36-37), stood up for Saul (later Paul) when everyone else steered clear (Acts 9:26-28), and served in both the local church and the mission field (Acts 13:1-3). He served others where they were living and helped them become more like Jesus. For that, he earns a place among the great examples of godly character in the Bible. 10. Philip. Most guys create their own plan and act it out. Philip, an early lay leader of the church, took the opposite approach. He learned how to hear the Holy Spirit and follow His plans. As a result, his ministries tore down walls, first in Samaria (Acts 8:4-8) and then with an Ethiopian official (Acts 8:26-40). Either would have been despised by most Jews, but he showed godly character by overcoming prejudice and obeying God. Even as a child of God, you might not be familiar with Enoch. His name appears and disappears quickly in a Genesis genealogy of Adam’s descendants. But one thing we do know is amazing—he chose to walk with God in a way that was both intentional and extraordinary. Enoch embraced the importance of walking with God, living a life of faith daily. In fact, most scholars agree that he walked so closely with God that one day he simply walked into God’s presence: “Enoch walked with God; then he was not there because God took him” (Genesis 5:24). For Enoch, following God’s path meant being one of only two men in the Bible (along with Elijah, 2 Kings 2:11) to escape physical death. And while that’s the exception rather than the rule, it makes sense for us to consider what walking with God means today. “Walking” in the Bible When it comes to connecting with God and deepening one’s relationship with Jesus, the Bible is filled with walking images. It serves as one of the most common metaphors for our spiritual lives in Scripture. For example, even before Enoch walked into heaven, Adam and Eve experienced the presence of God in the garden of Eden. Genesis 3:8 says that they heard God walking in the garden, and some scholars believe that walks with God were a regular habit for the first humans. But regardless of what form this fellowship took, it set the stage for God’s ongoing desire to “walk” with people across the ages. In the Old Testament, we’re told that those who avoid walking like the wicked are blessed (Psalm 1:1) and that God expects His people to walk humbly with Him (Micah 6:8). In the New Testament, Paul challenged his readers in Ephesus to walk “worthy” of their spiritual calling (Ephesians 4:1) and to walk wisely “because the days are evil” (Ephesians 5:15-16). John later encouraged his friends to “walk in the light” (1 John 1:7) and to walk as Jesus walked (1 John 2:6). The comparison of walking and living a life of faith daily makes sense. Walking implies progress toward a destination, which also characterizes a consistent relationship with God. Walking often suggests fellowship with someone, which, again, fits who we are as believers learning to put our faith in God. And walking is not a sprint. Likewise, deepening our relationship with Christ happens over months and years, not seconds or minutes. Strengthening your walk In a sense, we know when a person is walking with God. Despite humanity’s incredible ability to deceive ourselves, the quality of our spiritual walk—our connection with God—reveals itself over time. After all, the apostle Paul highlighted several indicators of a healthy walk with God, indicators that include speaking to others well, dealing with anger, loving people, working hard, protecting integrity, and forgiving like Jesus (Ephesians 4:27-32). He also gave us the fruit of the Spirit to measure how well we’re following God’s path for our lives (Galatians 5:22-23). But knowing what it looks like and knowing how to get there are two different things. To really learn what it means to walk with God and to live a life of faith daily, we’ve got to dig a little deeper. Below are five keys for walking with God in a way that faces challenges head on and makes a difference in the world for His glory. Start with a personal relationship You cannot walk with God unless you accept His offer of salvation through Jesus. You can’t deepen your relationship with Christ if no relationship with Him exists. Without accepting the sacrifice that Jesus made on the cross as the penalty for your sin, you will never move forward with God. If you’ve made that commitment already, that’s awesome. If not, speak with a friend, family member, or minister you trust about taking this first step in the most important journey of your life. Die to yourself each day Along with walking, another common biblical metaphor is dying. In particular, Christ followers are called to die to their own desires and passions. Paul even compared it to being crucified—executed—each day (Galatians 2:20). The idea is to surrender everything we are and everything we have to Jesus on a daily basis. This allows us to put God first in our lives, while also focusing on others more than on ourselves. It’s not easy, but it’s a necessary part of following God’s path for our lives. Spend time with Him When my wife and I were dating, she lived in one state and I lived in another. When we got together, we took walks to reconnect. Those personal moments gave us a chance to talk about where we’d been, where we were in the moment, and what we hoped for the future. As believers, the best ways to spend time with God—to walk with Him—come through prayer and Bible study. You talk to Him, and He talks to you. If walking with God is all about building a relationship with Him, this is how the relationship grows. Guard your heart and mind The world is filled with distractions that will derail your walk with God. For every step you take toward deepening your relationship with Jesus, you’ll be tempted to stray off the path. That’s why the writer of Proverbs warned his readers to “guard your heart above all else” (Proverbs 4:23) and Paul told the Christians in Rome to “be transformed by the renewing of your mind” (Romans 12:2). You can’t just wander into a healthy walk with God. You’ve got to be vigilant and careful about the voices you hear and the steps you take. Learn to trust God Think about your drive home each day. You probably could choose any number of roads to get from the office back to your house, but time and experience have taught you which route is the best. The same is true with following God’s path. He has a plan and a purpose for your life. He knows the best way to move you from where you are to where you need to be. So, you’ve got to trust Him—especially when it doesn’t make sense. The writer of Proverbs said that if we trust the Lord instead of trusting ourselves, He “will make your paths straight” (Proverbs 3:5-6). In other words, following God’s path is the fastest route to becoming the best version of ourselves. Walk with the right people Whether we like to admit it or not, we’re influenced by the people around us. As Paul told the Corinthians, “Bad company corrupts good morals” (1 Corinthians 15:33). But the influence doesn’t have to be negative. Proverbs 13:20 flips the coin by highlighting the positive impact of others in living a life of faith daily: “The one who walks with the wise will become wise.” Surrounding yourself with the right people can be a gamechanger when it comes to walking with God. The support and accountability offered by wise mentors can keep you on the right path and challenge you to put one foot in front of the other each day. The Christian life is a team sport, so build a quality team around you.

Testimony

THE WORD has every answer, every guide.The first 5 books lay it all out. Christ told the saved man on the cross that he would "stand with him in Paradise that day. I died of cardiac arrest while mowing my yard in April of 2023. The instant I died I found myself standing in Paradise. There was a man there with his back to me. He turned to me and said. "What are you doing here? I never sent for you. Go on back and I'll send for you when I'm ready." He held his hand up between us and we were close enough that it blocked his face. As soon as he stopped talking I turned away and woke up laying in my back yard. I didn't realize I had died. I thought I had fainted. I was wearing a Holter Monitor that my doctor had ordered the day before. I typed a message into the machine, "I think I just fainted." I got up, restarted my lawn mower and pushed it to finished the last strip of grass and put it away. My shorts were wet. I had peed myself while I was dead. I went in the house, showered and went to bed. I slept well. I got up the next day and cooked 3 meals for me and my son ( I live with him.) I washed, dried and put away a load of laundry, swept and mopped, did the dishes. and went to bed again that evening. I felt fantastic. At 10 pm I got a call from the Holter Monitor company telling me to call an ambulance. I asked "Why, I've never felt better They said "Just call, you have had a Cardiac Incident." So I called. When the ambulance got here I told them I felt fine but the monitor ppl wanted me to call them to take me to the ER. They checked me out and found nothing wrong. They took me to the ER. I was in the ER for 7 hours (till 5am and they ran every heart test they could but they could not find anything wrong. The ER doctor sent me to the admitting hospital 35 miles away and I was admitted to the cardiac unit at 6 am. I told them the monitor story and the ER story. The admitting nurse called my heart doctor and they sent an admitting nurse practitioner. She called the monitor company. By 9 am I was having a heart cath and then a stint in my "widow-maker" artery that was 99% blocked. After I got back to my room the heart Dr came and told me that I had been dead when laying in my yard. He wanted to know who did CPR on me. I said no one, Messiah told me to "go back" and I did. I know I stood in HIS presence in Paradise. There is hope, there is mercy. The WORD is 100% true and salvation is here for anyone that wants it and lives by GOD's (YHWH's) commandments, all 613 of them. Look them up. Learn them. Live them. Stand in Paradise with your savior. -Barbara

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Tomato Zucchini Pasta

Tomato Zucchini Pasta Ingredients: 8 oz pasta (spaghetti, penne, or linguine) 2 tbsp olive oil 2 medium zucchinis, sliced in circles 1 1/2 cups cherry tomatoes, cut in half 3 tsp minced garlic 1/2 tsp salt 1/4 tsp black pepper 1/2 tsp red pepper flakes (optional) 1 tsp Italian seasoning 1/4 cup grated Parmesan cheese 1/4 tsp basil 1/2 cup reserved pasta water (if needed) Directions: Bring a large pot of salted water to a boil. Add the pasta and cook according to the package directions until al dente. Drain the pasta, reserving 1/2 cup of pasta water, and set aside. While the pasta cooks, heat olive oil in a large skillet over medium heat. Add the zucchini slices and cook for 3-4 minutes, stirring occasionally, until tender but still crisp. Add the minced garlic to the pan and sauté for another 1 minute until fragrant. Add the halved cherry tomatoes to the skillet and cook for 2-3 minutes, until they start to soften and release their juices. Add the cooked pasta to the skillet with the zucchini and tomatoes. Sprinkle in the salt, black pepper, red pepper flakes (if using), and Italian seasoning. Toss everything together to combine. If needed, add reserved pasta water to loosen the sauce and help everything come together. Stir in the grated Parmesan cheese and chopped basil, and toss until the pasta is evenly coated and the cheese is melted. Serve and enjoy !! Marie added a little Italian Dressing on top of the pasta

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I had the gaedest time waking up this morning because of the gentle rain hiting the trailer roof and sides. It always takes me back to my childhood and growing up in the trailers while Daddy was in the Army. I had a blessed childhood, not perfect, but blessed. I truly love my older sister, Nancy. I couldn't have had a better playmate and friend. Our parents saw that our bellies were full and that we were clean, dressed and housed. So many childern had so mucch less than us. I felt loved and safe, especially when Daddy was home. Today is Father's Day and I miss Daddy so much it hurts. He was my everythin, my hero and I was his little girl. I was so blessed to have him as my father. I don't want to be too long inded. Bye

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Dolly’s recipe calls for chopped green or purple cabbage and onion, grated carrot, diced red bell pepper, and minced dill pickle. If you don’t have a jar of pickles on hand, Dolly recommends using pickle relish. To make the salad, you simply have to toss all the vegetables in a bowl with one part pickle juice, one part white vinegar, and four parts mayonnaise, and season with a touch of granulated sugar, salt, and black pepper. It’s a formula so simple you could memorize it, and it can be made all in one bowl—you don’t even have to whisk the dressing together in a separate vessel.

The sharpness of the pickle juice and white vinegar cuts through the creaminess of the mayonnaise and prevents the slaw from being overly cloying. The brine also lends subtle notes of dill, coriander, and mustard—in other words, pickle spices—adding a flourish of seasoning that is often missing from coleslaw. Each bite of chopped pickle is a welcome surprise that I, a lover of relish and all things tangy, begin to look forward to with each new bite.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC2816380/

Skip to main content Traditional Chinese Medicine for Chronic Fatigue Syndrome

. 2008 Feb 27;7(1):3–10. doi: 10.1093/ecam/nen017

Traditional Chinese Medicine for Chronic Fatigue Syndrome

Rui Chen ^1,2, Junji Moriya ², Jun-ichi Yamakawa ², Takashi Takahashi ², Tsugiyasu Kanda ^2,^✉

PMCID: PMC2816380 PMID: 18955323

Abstract

More and more patients have been diagnosed as having chronic fatigue syndrome (CFS) in recent years. Western drug use for this syndrome is often associated with many side-effects and little clinical benefit. As an alternative medicine, traditional Chinese medicine (TCM) has provided some evidences based upon ancient texts and recent studies, not only to offer clinical benefit but also offer insights into their mechanisms of action. It has perceived advantages such as being natural, effective and safe to ameliorate symptoms of CFS such as fatigue, disordered sleep, cognitive handicaps and other complex complaints, although there are some limitations regarding the diagnostic standards and methodology in related clinical or experimental studies. Modern mechanisms of TCM on CFS mainly focus on adjusting immune dysfunction, regulating abnormal activity in the hypothalamic-pituitary-adrenal (HPA) axis and serving as an antioxidant. It is vitally important for the further development to establish standards for ‘zheng’ of CFS, i.e. the different types of CFS pathogenesis in TCM, to perform randomized and controlled trials of TCM on CFS and to make full use of the latest biological, biochemical, molecular and immunological approaches in the experimental design.

Keywords: chronic fatigue syndrome, herbal therapy, traditional Chinese medicine

Introduction

Chronic fatigue syndrome (CFS) is defined by: (i) clinically unexplained, persistent or relapsing fatigue of at least 6 months’ duration, and (ii) concurrent occurrence of at least 4 accompanying symptoms, such as significant impairment in memory/concentration and muscle pain (1). Factors causing this condition remain unclear. Thus, the diagnosis depends upon an evaluation of the self-reported symptoms while the pathophysiology remains uncertain.

As yet there is no definitive treatment, rather, therapy is directed toward relieving symptoms, which often cause different side-effects (2) (Table 1). Therefore, utilization of complementary and alternative medicine (CAM) has been common in fatiguing illnesses (3). As a form of CAM, tradition Chinese medicine (TCM) has been reported to be useful and without any side-effects for CFS not only in China but also in other parts of the world (4–5). In this study, we explore the benefits that TCM can provide for CFS and its limitations. We also provide some suggestions for further development.

Table 1.

Therapeutic effect and side-effects of Western medicines in the treatment of CFS

	Therapeutic effect	Side-effect
Antidepressant therapy	No beneficial effect 9 (44).	Greater than15% patients with certain side-effects such as gastrointestinal complaints, headache, anxiety.
Steroid therapy	Short-term benefits with low-doses for hypoactivity of the HPA axis but no effect after withdrawal (45).	High doses associated with significant side-effects such as Cushing's syndrome, ulcers, acne, osteopenia, immunosuppression, etc.
Immunotherapy	Intravenous immunoglobulin therapy effectively relieves symptoms for CFS following an acute viral infection (46), while another study found no effect (47).	Of the subjects, 82% treated with IgG have intense side-effects such as gastrointestinal complaints, headache, arthralgia and sometimes worse fatigue.
Nutritional supplements	Benefits from nutritional supplements (48).	No side-effects reported.
NADH therapy	Efficacy observed only during the first trimester of the trial (49).	No severe adverse effects but mild effects included poor appetite, dyspepsia and abdominal distension.

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NADH denotes reduced form of nicotinamide adenine dinucleotide.

Ancient Records on the Treatment of ‘fatigue syndrome’ with TCM

In a search of the ancient literature of TCM, we did not find the term ‘chronic fatigue syndrome’. On the other hand, the symptoms, etiology, pathogenesis and treatment for ‘fatigue syndrome’ have been recorded in detail.

Symptoms, Etiology and Pathogenesis

Nearly 70 types of symptoms were recorded in the chapter on ‘fatigue syndrome’ in Zhubing Yuanhou Lun, a famous tract about the etiology and symptoms of disease written during the Sui Dynasty. The symptoms can be categorized into two groups: somatic symptoms including fatigue, a somatic sense of heaviness, cold knees, puffiness, headaches, somatic pain (joint pain and muscle pain) and so on; and psychological symptoms, such as depression, anxiety, restlessness and so on. For an explanation of TCM, the ultimate reasons for the symptoms described earlier are induced by deficiencies in five organs (including qi, blood, yin and yang deficiencies) caused by the invasion of an exogenous pathogen, excessive physical strain (manual labor, mental labor and sexual intercourse), abnormal emotional states (elation, anger, worry, anxiety, sorrow, fear and terror) or an improper diet.

Obviously, although such symptoms do not exactly mimic the Centers for Disease Control and Prevention (CDC) research criteria for CFS, they are extremely similar to CFS, as Table 2 indicates. Certainly, the limitations of symptom-related records are also obvious. First, there were not criteria for the diagnosis of ‘fatigue syndrome’ in this text or even other ancient TCM texts. Second, the characteristics of each symptom were not clearly described. For instance, no duration, no relieving or aggravating factors and no other characteristics were recorded about the symptom of ‘fatigue’. Third, some symptoms are not consistent with CFS, such as the hemorrhage of different organs.

Table 2.

Comparison of the symptoms of CFS and ‘fatigue syndrome’ recorded in Zhubing Yuanhou Lun

	Symptoms of ‘fatigue syndrome’ described in Zhubing Yuanhou Lun	Symptoms of ‘chronic fatigue syndrome’ (1) (50–51]
General symptoms	Fatigue; asthenia; weak and lean; malaise; pseudoheat; fever; puffiness; susceptible hidrosis; deficient night sweating; postmorbid sweating; hyperhidrosis; irregular chills and fever; osteopyrexia and fever.	fatigue; post-exertional malaise lasting >24 h; unusually warm; abnormal sweating; sudden changes in skin color; tender cervical/axillary lymph nodes.
Nervous system symptoms	Insomnia; dream-disturbed sleep; headaches; decreased visual acuity; decreased acoustic sensibility; anxiety; depression.	Sleep disorders including periodic movement disorder, excessive daytime sleepiness, apnea and narcolepsy; impaired short-term memory or concentration; headaches; tinnitus; anxiety; depression.
Symptoms of the digestive system	Poor appetite; impairment of digestive function; intestinal obstruction; abdominal distention; abdominal pain; vomiting; dry mouth and excessive thirst; swollen tongue; profuse saliva; gingival bleeding; hematemesis; hemorrhinia; blood in stools; loose stool; diarrhea; constipation.	Fullness and bloating after a small meal; abdominal distension; nausea; loss of appetite; irritable bowel symptoms including abdominal pain, diarrhea, loose stools, etc; mouth sores; dry mouth; vague complaints of dysesthesia and dysgeusia.
Symptoms of the musculoskeletal locomotor system	Painful extremitities; spasms; paralysis; ecdysis of the hands and feet; cold and soft knees; somatic feelings of heaviness; lumbago; joint pain and muscle pain; cool limbs.	Muscle pain; multi-joint pain without swelling or redness; pain in the facial and masticatory muscles; temporomandibular joint dysfunction; shivering hands; acrocyanosis, cool extremities.
Respiratory symptoms	Dry and painful pharynx; expectoration and excessive phlegm; uneven breathing; poor inspiratory effort.	Sore throat; hyperventilation.
Circulation system symptoms	Palpitation; irregular pulse.	Palpitation.
Symptoms of the genital system	Acyesis; contraction of the genital organs; spermacrasia; spermorrhea; hemospermia; impotence; premature ejaculation.	No related symptoms.
Symptoms of the urinary system	Edema; polyuria; dysuria; turbid urine; hematuria.	Edema.

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Treatment

We checked for the term ‘fatigue syndrome’ in more than 600 TCM e-books in the software of Encyclopedia of Traditional Chinese Medicine, published by Hunan Electronic Audio-Video Publishing House, including Bencao Gangmu (Compendium of Materia Medica), Pujifang and so on, and found many records about its treatment.

Prescriptions

We searched for some prescriptions for ‘fatigue syndrome’ in Pujifang, the most monumental prescription book produced during the Ming Dynasty, in which there are about 975 items for ‘fatigue syndrome’. According to the theory of TCM, most were used for repleting the body's deficiency, ameliorating sleep and abnormal emotion, and especially for invigorating kidney essence [the fundamental energy in the body (6)] and spleen qi [vital energy for maintaining normal digestive function and controlling blood in the blood vessels (6)] (Fig. 1). Some examples of the main prescriptions for ‘fatigue syndrome’ patients recorded in this book are Liu-Wei-Di-Huang-Wan (Rokumi-gan in Kampo), Bu-Zhong-Yi-Qi-Tang (Hochu-ekki-to in Kampo), Xiao-Chai-Hu-Tang (Sho-saiko-to in Kampo) and so on.

Drugs

We searched Chinese crude drugs that have a therapeutic effect on ‘fatigue syndrome’ in 50 ancient monographs of Chinese materia medica. Most treated ‘fatigue syndrome’ by invigorating qi and yang (Fig. 2), nourishing yin and blood (Fig. 3), adjusting abnormal sleep and emotion (Fig. 4) and clearing heat-pathogens (systemic or local febrile factors) (Fig. 5). At the same time, some beneficial meals for CFS were also found in these sources as displayed in Figure 6.

Frequency of nourishing *Yin* and Blood drugs for ‘fatigue syndrome’ in 50 famous ancient materia medica texts. BawF, Barbary Wolfberry fruit (*Lycium chinense* Mill.); FrsR, Fragrant Solomonseal rhizome (*Polygonatum officinalle* All.); OphT, Ophiopogon tuber [*Ophiopogon japonicus* (Thunb.) Ker-Gaw]; DenS, Dendrobium nobile stems (*Dendrobium nobile* Lindl.); RehR, Rehmannia root; Gela: Gelatin (*Equus asinus* L.); HumP, Human placenta (*Placenta hominis*); AngR, Angelica root; TokG, Tokay Gecko (*Gekko gecko Linnaeus*); PeoR, Peony root; ChaR, Chinese Asparagus root [*Asparagus cochinchinensis* (Lour.) Merr.]; DodS, Dodder seed (*Cuscuta chinensis* Lam.).

Frequency of adjusting abnormal sleep and emotion drugs for ‘fatigue syndrome’ in 50 famous ancient materia medica texts. ChaK, Chinese Arborvitae Kernel (*Biota orientalis* Endl.); OysS, Oyster shell (*Ostrea gigas* Thunb.); FooM, Fossilia Ossis Mastoidi; Stal, Stalactite; ZizS, Ziziphus seed (*Zizyphus spinosus* Hu.); PolR, Polygala root; Fluo, Fluorite; Magn, Magnetite.

Frequency of clearing heat-pathogen drugs for ‘fatigue syndrome’ in 50 famous ancient materia medica texts. SwwH, Sweet Wormwood herb (*Artemisia apiacea* Hance); BupR, Bupleurum root (*Bupleurum scorzoneraefolium* Willd.); MouB, Moutan bark (*Paeonia suffruticosa* Andr.); AneR, Anemarrhena rhizome (*Anemarrhena asphodeloides* Bge.); MulB, Mulberry bark (*Morus alba* L.); LycB, Lycium bark (*Lycium chinense* Mill.); ScuR, Scutellaria root (*Scutellaria baicalensis* Georgi.); Rhub, Rhubarb (*Rheum tanguticum* Maxim. Et Rgl.); TriR, Trichosanthes root (*Trichosanthes kirilowii* Maxim.); Gyps, Gypsum.

Frequency of meat, fishes, grains and other nutriments for ‘fatigue syndrome’ in 50 famous ancient materia medica texts. FeS, Fermented soybean; LoR, Lotus root; EdM, Edible mussel; ChC, Chinese chive; Pot, Potato; GlR, Glutinous rice; SoB, Soya bean; Ter, Terrapin; ToM, Tortoise meat; HiM, Hilsa herring meat; CyC, Cyprinus carpio; JaE, Japanese eel; Mut, Mutton; Beef, Beef; Pork, Pork; FoM, Fox meat; Chi, Chicken; Duck, Duck meat; Cub, Cubilose; Wine, Wine; SmP, Smoked plum; DiK, Diospyros kaki.

Present Evidence to Support the Efficacy of TCM in Treating ‘fatigue syndrome’

Present Evidences

Some of the ancient prescriptions are also used in the modern clinic effectively. In a double-blinded, placebo-controlled trial, Liu-Wei-Di-Huang-Wan, a famous general herbal tonic for invigorating kidney essence (6), was proven able to accelerate the speed of information processing, enhance cognitive ability and benefit dementia patients or help the elderly recover from a cognitive defect, which is one of the most important clinical manifestations of CFS (7). A randomized trial of Bu-Zhong-Yi-Qi-Tang in combination with Xiao-Chai-Hu-Tang, which theoretically invigorates spleen qi (6) and smooths the liver qi [functional activities of vital energy and an emotion regulator (6)], in the treatment of 38 CFS patients showed that 18 patients were able to resume normal work and daily activity while the symptoms of 16 additional patients were relieved (8). Ren-Shen-Yang-Rong-Tang (Ninjin-yoei-to in Kampo), a prescription for invigorating qi and nourishing the blood, was used in the management of 134 CFS patients and of these, 98 patients returned to work or school (9). Shi-Quan-Da-Bu-Tang (Juzen-taiho-to in Kampo) can also lessen fatigue and other symptoms caused by cancer or anticancer treatment in carcinoma patients (10). Prescriptions of smoothing the liver qi (6) have often been used to treat the psychological symptoms, which are the main complaints of CFS patients. Yi-Gan-San can improve the psychological symptoms of dementia and activities of daily living in a randomized, observer-blind, controlled trial (11). Sleep disorders are one of the main symptoms of CFS. Suan-Zao-Ren-Tang is the most commonly used over-the-counter sleeping drug in Hong Kong (12).

Chinese crude drugs that can improve the symptoms of CFS have already been studied for a long time, especially drugs with the effect of invigorating qi and yang. At present, Ginseng root (Panax ginseng C.A. Mey.) has been the most widely researched herb for fatigue or CFS. However, the results of studies on Ginseng's antifatigue activity are conflicting. Some showed no difference between Ginseng and placebo on relieving fatigue (13). On the other hand, in a randomized controlled trial of Ginseng for chronic fatigue, fatigue severity and duration were significantly improved in response to Ginseng and treatment was effective at 2 months for 45 subjects who had less severe fatigue among the group of 76 patients studied (14). In addition, Ginseng's ability to enhance cognitive performance in CFS patients was proven in a double-blind, placebo-controlled study (15). Yet, Ginseng was no different from placebo for improving a sleep dysfunction despite Ginseng's benefits for increasing alertness, relaxation, appetite and quality of life in Wiklund's controlled trial (16).

Evidence about other herbs for invigorating qi and yang on CFS have also been reported, but these have been vague and sporadic. Poria (Poria cocos Wolf.) was reported to possess antineurasthenia activity (17) and to improve sleep (18). Cistanche Deserticola [Cistanche salsa (C.A. Mey) G. Beck] is able to prolong the duration of swimming (19) and hexobarbital-induced sleeping time (20). Glycyrrhiza root (Glycyrrhiza uralensis Fisch.) is a herb with the property of corticosteroids which can improve the symptoms of CFS (21).

Crude drugs that nourish yin and blood have also been used for CFS or its main symptoms not only in this clinic but also in animal experiments. Angelica root [Angelica sinensis (Oliv.) Diels] markedly alleviated the sleep disturbances and fatigue of menopausal women (22). Aatalpol, an iridoid glycoside isolated from Rehmannia root [Rehmannia glutinosa Libosch. f. hueichingensis (Chao et Schih) Hsiao], can treat cognitive impairment via enhancing endogenous antioxidant enzymatic activities and inhibiting free radical generation (23). In animal experiments, treatment with Peony root (Paeonia lactiflora Pall.) inhibits 5-HT synthesis and tryptophan hydroxylase expression, which may reduce fatigue, both during exercise and the resting state (24). One of the active components of Peony root, paeoniflorin, has also been reported to be able to reverse or alleviate behavioral and cognitive impairments (25).

Adjusting abnormal sleep patterns and emotion is another evidence-based way of possibly employing crude drugs for CFS or its main symptoms. The active component tenuifoliside B, 3,6′-disinapoylsucrose (26) and BT-11 (27) in Polygala root (Polygala tenuifolia Willd.) has cognition-improving effects. In mice, an 80% methanol extract of Fossilia Ossis Mastoidi elicited GABA receptor-mediated anxiolysis, potentiation of pentobarbital sleeping time, reduced locomotor activity and anticonvulsive activity (28). Magnetite has been associated with a significant improvement in muscle fatigability (29). It is also able to reduce the threshold dose of pentobarbital sodium and shorten a rodent's incubation period for falling asleep (30).

Limitations of Ancient Records and Present Related Evidence

First, some recorded drugs do not attenuate the symptoms of CFS and may even aggravate such symptoms. For example, the mineral drug fluorite was recorded as possessing an antifatigue activity, but evidence-based studies have shown that cerebral impairment occurs with its use due to exposure to its main component (fluoride), and that it causes general malaise and fatigue (31). Second, some crude drugs may improve some of the symptoms of CFS such as fatigue, sleep disorders and so on, but this does not mean that they are effective for CFS. Third, there is no proof in recent studies to clarify the activity of crude drugs that can eliminate heat-pathogens. Crude drugs that can eliminate heat-pathogens were often used for viral or bacterial infections. Perhaps they are beneficial for the initial microbial infections of CFS. However, there currently is no evidence to support this hypothesis.

Clinical Benefits of TCM in the Treatment of CFS Patients Nowadays

Two kinds of therapeutic methods are often applied in a TCM clinic. One is treatment for the symptoms and the other is for the TCM pathogenesis. The former is called ‘Bianbing Lunzhi’. The latter is named ‘Bianzheng Lunzhi’ which the treatment is based on the TCM pathogenesis summarized from the systemic symptoms and signs. In the CFS clinic, the two methods are widely utilized.

Bianbing Lunzhi

The effect of a single prescription or single crude drug on CFS often has been observed in the clinic that mirrored the scientific evidence for the ancient texts presented earlier. Most belong to ‘Bianbing Lunzhi’. Hence, unnecessary details will not be repeated here.

Bianzheng Lunzhi

The key point of this type of treatment is ‘zheng’, also known as TCM's view of pathogenesis. The TCM's view of the pathogenesis of CFS recently has become diverse. The following five items are universally accepted and treatment based upon them can often be clinically effective (4).

Qi-deficiency of the spleen (6), characterized by lassitude of the limbs, poor appetite, a pale tongue with white coating and a thready pulse. Gui-Pi-Tang (Kihi-to in Kampo) is often used (6).
Incoordination between the liver and spleen (6), characterized by mental depression, sighing, fatigue, decreased food intake, abdominal distention, a pale tongue with a white coating and a strong pulse. Jia-Wei-Xiao-Yao-San (Kami-shoyo-san in Kampo) is often prescribed.
Blood stasis due to qi deficiency, characterized by poor spirit, lassitude, somatic pain, insomnia, a pale dim tongue with a white coating and unsmooth-feeble pulse. Xue-Fu-Zhu-Yu-Tang is often selected.
Yin-deficiency of the liver and kidney (6), characterized by weakness, forgetfulness and insomnia, and soreness and weakness of the waist and knee joints, tinnitus, dry throat and mouth, dysphoria with feverish sensations in the chest, palms and soles, night sweating, a red tongue with little coating and a thready-rapid pulse. Liu-Wei-Di-Huang-Wan is the best choice for this.
Yang-deficiency of the spleen and kidney (6), characterized by cold limbs, listlessness, cold and pain in the waist and knee joints, a pale tongue with a white coating and a deep-thready pulse. Shen-Qi-Wan (Hachimi-jio-gan in Kampo) is often applied.

Limitations

Although CFS can be diagnosed using international standards, there are somewhat different from the symptoms and signs of the ‘zheng’, which are quite difficult to standardize. In addition, anecdotal clinic trials and no randomized trials constitute a very large proportion of the publications on the TCM treatment of CFS, which lack scientific rigor and are less persuasive.

Modern Mechanisms of TCM on CFS

Adjusting the Immune Dysfunction of CFS by TCM drugs

Immune system dysfunction and its close interactions with the nervous and endocrine systems have been clearly reported in recent years as playing a role in the development of CFS (32). Hence, maintaining an efficient and equilibrated immune system is a reasonable approach to prevent certain chronic illnesses.

Drugs that invigorate qi and tonify the spleen (6) has been used most frequently for CFS patients and have shown outstanding effects in improving their immune situation. In animal experiments, Bu-Zhong-Yi-Qi-Tang significantly enhanced running activity in a Brucella abortus induced mouse model of CFS by decreasing the organ weight of spleen and interleukin (IL)-10 mRNA expression in the spleen (33). It can also significantly inhibit tumor necrosis factor-α, IL-6, IL-10 and transforming growth factor- β1 production in CFS patients (34). Kuibitang (identical to Chinese Gui-Pi-Tang, Japanese Kihi-to) markedly inhibits lipopolysaccharide-induced tumor necrosis factor-α, IL-10 and transforming growth factor-β1 production and increases interferon-γ production in the peripheral blood mononuclear cells of CFS patients (35). Ren-Shen-Yang-Rong-Tang can ameliorate lower NK cell activity, which is an important immune characteristic of CFS patients (9). Furthermore, extracts of Ginseng can also boost natural killer cell function and the cellular immunity of patients with CFS (36). In short, the TCM therapeutic approach of invigorating qi and tonifying the spleen (6) can improve the function of immune organs and immune cells as well as alter the expression of immune molecules which are abnormal in CFS patients and experimental animals.

Regulating the Abnormal Activity of the HPA Axis of CFS by TCM Drugs

Subtle dysregulation of the HPA axis has been proposed as an underlying pathophysiological mechanism in CFS (37). There is evidence for a hypofunction of the HPA axis in a proportion of the patients with CFS, despite the negative studies and methodological difficulties (38, 39). Several underlying mechanisms have been proposed. Main findings include mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids (39).

Ito reported that a type of Japanese Kampo named Koso-san (Xiang-Su-San in Chinese medicine) had antidepressant-like effects due to its suppression of the hyperactivity of the HPA axis in a mouse model of depression. It can reduce the increased levels of corticotropin-releasing hormone mRNA expression in the hypothalamus and proopiomelanocortin mRNA expression in the pituitary, and reverse the decreased glucocorticoid receptor protein expression in the hypothalamus paraventricular nucleus to normal (40).

Antioxidant Effect

A number of studies have shown that oxidative stress may be involved in the pathogenesis of CFS pathogenesis, and, therefore, CFS should be treated with specific antioxidants (41). Some specific natural antioxidants from herbs, such as Withania somnifera, Quercetin and Hypericum perforatum L. have been used for the treatment of CFS with the intent of reducing lipid peroxidation, restoring the glutathione levels and increasing the superoxide dismutase levels in the brains of CFS mice (42). Ginkgo biloba and Vaccinium myrtillus (bilberry) have also been reported to possess beneficial antioxidants for CFS (43).

Recommendations for the Further Study of TCM in Treating CFS

Herbal medicines are used by an increasing number of CFS patients primarily because of their perceived advantages such as being natural, effective and safe. Nevertheless, in order to further develop their use, ways to overcome their limitations must be explored and promoted.

First, more evidence-based clinical trials and animal experiments should be performed to demonstrate the efficacy of Chinese crude drugs and prescriptions in the ancient texts for the treatment of CFS, especially regarding the drugs that diminish heat-pathogens which may be the initial infection of CFS, since there currently are no data in this area.

Second, it is vitally important to establish standards for the ‘zheng’. As a first step, the clinical data collected from CFS patients should be quantitated with the help of modern apparatuses. Then, we can formulate definitive TCM classification guidelines for CFS.

Third, large randomized, controlled clinical trials are required to confirm the effect of TCM on CFS. Modern statistical methods should be used in the design of every clinical trial. If performed in this manner, reliable and persuasive results can be obtained and published in high impact journals.

Fourth, full use should be made of the latest biological, biochemical, molecular and immunological techniques. Experiments should be designed in consideration of the most current hypotheses regarding the pathogenesis of CFS and should explore the mechanisms by which TCM alleviate CFS.

Acknowledgements

This study was supported in part by a grant for promotion research from Kanazawa Medical University (S2004-2 and S2005-5), a grant for project research from the High-Technology Center of Kanazawa Medical University (H2004-7), a research grant from the Grant-in-Aid for Scientific Research (C), the Ministry of Education, Science and Culture of Japan (No. 17590767) and the science research promotion fund of the Promotion and Mutual Aid Corporation for Private Schools of Japan.

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