ANTA The Natural Therapist Vol 35 No. 4 Summer 2020

The

Natural

EDITION 35 NO. 4 | SUMMER 2020

Therapist ISSN 1031 6965

Summer 2020

The Official Journal of THE AUSTRALIAN NATURAL THERAPISTS ASSOCIATION

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This is especially true of the body’s internal clock - circadian rhythm, which regulates our sleep-wake cycle. Blue light exposure disrupts this cycle by inhibiting melatonin production, delaying sleep onset and reducing sleep quality.2,3 Excessive blue light exposure has also been found to damage the macular retina, altering visual acuity.4

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PAGE 4 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

MET6948 - 09/20

Macular carotenoids, lutein and zeaxanthin, have been shown to filter and absorb blue light, allowing the production and release of melatonin while also mitigating the damaging effect it has on the retina. Research supports the use of 20 mg/d of lutein and 4 mg/d of zeaxanthin, improving sleep quality, headaches, visual performance, eye strain and fatigue in individuals exposed to at least six hours of daily screen time.5 In a digitally driven world where quality sleep is hard to come by, lutein and zeaxanthin support healthy circadian rhythm and restorative sleep.

Contents Edition 35 No. 4

|

Summer 2020

ANTA News

From the Chair 6

8 ANTA News 10 World Health Symposium 28 Healthy Recipes 49 ANTA CPE Guidelines

Executive Officer Report

12

19

The Upside to a Very Challenging Time

Diagnosis and Treatment of Chronic Fatigue Syndrome with Traditional Chinese Medicine

Shaun Brewster gives a thank you to ANTA Members during COVID-19. Shaun explains the challenges that many manual therapists faced during the pandemic.

Tony Reid explores how Traditional Chinese Medicine can help with the treatment of Chronic Fatigue Syndrome.

25

Fire Risk in Massage and Health Practice Isaac Enbom explains the risks of freshly laundered linen and the consequences that practitioners need to be aware of.

30

42

46

Chronic Fatigue Syndrome: A Clinical Evaluation and Eastern Perspective on Treatment Options

Can Herbs Help During Cancer Chemotherapy?

More Insights on Fucoidans: A Focus on Anti-Viral and Infection Control Properties

Kerry Bone investigates which key herbs can help during cancer chemotherapy.

George Thouas gives more insight into

Kaitlin Edin writes about how Eastern

Fucoidans and their benefits on anti-viral

medicine practitioners can help their clients

infections.

with Chronic Fatigue Syndrome.

EDITION 35 NUMBER 4 – SUMMER 2020

ISSN 1031 6965

ANTA BRANCH CHAIR PERSONS

The

Natural Therapist

The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers.

Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.

Elizabeth Greenwood • National President • Director of ANTA • National Western Herbal Branch Chair • ICNM Ambassador • CPE/Seminar Chair • CMPAC Director • Registration Chair • Website & Media Chair • ANTAB Committee Member • ANRANT Committee Member Warren Maginn • National Vice-President • Director of ANTA • National Nutrition Branch Chair • TGA Chair • Ethics Panel Chair • ANTAB Committee Member • ANRANT Committee Member Shaun Brewster • National Treasurer • Director of ANTA • National Myotherapy Branch Chair • ANTAB Chair • Health Fund Chair • ANRANT Committee Member

Ananda Mahony • Director of ANTA • National Naturopathy Branch Chair Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair • ANTAB Committee Member • ANRANT Committee Member Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair • ANTAB Committee Member • ANRANT Committee Member Mark Shoring • Director of ANTA • National Multi-Modality Branch Chair • ANTAB Committee Member • ANRANT Committee Member Tony Reid • Traditional Chinese Medicine Industry Advisor Jim Olds • Executive Officer • Company Secretary • Business Plan Chair • CMPAC Director • ANRANT Chair

The

Natural Therapist

Marketing & Production Tasha Kemsley Circulation Enquiries 1800 817 577

Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au

ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 W: www.anta.com.au

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 5

ANTA Executive Welcome Summer 2020

From the Chair I am constantly reminded of how our Members’ lives and in particular their workplaces have been disrupted for an extended period during 2020.

ANTA has monitored the situation consistently throughout the events of 2020 by way of our collaboration with three major Associations, two of which are located in Melbourne.

Two Victorian-based National Branch Chairs, Isaac Enbom - Remedial Therapy Branch and Shaun Brewster - Myotherapy Branch, responded to notifications from the Victorian Government departments and worked together to collate and distribute vital data through the ANTA National Administration Office each time notifications came to hand. Isaac and Shaun’s professionalism and leadership through this trying time is exemplary and I am sure everyone involved in this process will join us in thanking Shaun for his sterling effort to inform the ANTA Board and Administration Staff of the latest breaking details affecting our Members in Victoria generally.

The entire ANTA Board responded with support and recognition for the conditions in the Melbourne metropolitan region, constantly updating at regular meetings to understand and respond to our Members’ needs. In particular, it left the Board and Staff feeling incredibly powerless at times when trying to understand and ameliorate the impact on everyone located in such an adversely affected region.

Summer 2020

the offset to the burdens which where described to ANTA. The respect and admiration we feel for all those affected and in particular, our ANTA Members and their inter-association colleagues is immense. The professional manner in which they endured the conditions fill us with awe at their determination and resilience to be ready to return to business at the first opportunity.

Our continuing collaboration with professional Associations and the lead lobbyist have our enduring gratitude for their availability and timely support and responses to inform all Members of each event as it occurred. We have all learned how to function effectively through digital appliances and our meetings and results demonstrate the level of understanding and cooperation we achieved through working as a team delivering consistently accurate information from the respective State Government Offices to provide current information to our combined membership. We are indebted to all our Association Directors and external groups working on common ground to assist all therapists during this challenging period.

The staff at the National Administration Office have provided a high level of understanding and support to all ANTA Members and I thank them sincerely for the professionalism and dedication to the task they have displayed throughout 2019 – 2020. This level of service continued during the disaster and destruction of the bushfires, the regional flooding and the Australian Government’s decision to remove Private Health Fund rebates from fifteen natural therapy services that had a profound effect on the therapists’ clinics delivering these services across Australia.

Our National President and Naturopathy Branch Chair, Elizabeth Greenwood, and National Vice President and Nutrition Branch Chair, Warren Maginn, combined their knowledge and experience in higher education to respond to the Australian Minister for Education’s plea to collaborate with educational institutions to support Higher Education providers in helping current Students to progress their studies and In summary, the natural therapies profession and minimise the external effects on study and ANTA Members have faced numerous, tangible financial burdens. This effort was made to achieve challenges to our raison d’être, more-so within a PAGE 6 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

ANTA Executive Welcome Summer 2020

recent two year period. It is deeply satisfying to work for an Association governed and operated largely by current, clinical practitioners who share a deep and abiding interest in continuing services to colleagues, Students and new Members to provide the highest quality support and leadership they can offer to ANTA, its Members and the profession as a whole.

World Health Symposium

To continue this work as we emerge from these prolonged periods of intense focus, we have emerged with the determination to provide a world-class event being offered to all traditional and natural therapists across the globe.

ANTA will virtually host the World Health Symposium in February 2021.

Abstracts are being received from prominent Australian and International speakers who have registered their interest at first notice. This event is promising to change the way ANTA has approached state-based and national events in the past, as a benefit of restricted travel we have developed a heightened appreciation for digital communications and the applications that are available for such an event, the real value will be in the quality of speakers it is attracting from around the world!

More information can be found at www.worldhealthsymposium.com.au.

ANTA Member Support

I am pleased to report our understanding and support for Registered Training Organisations and Colleges is allowing Student Members to complete their education in a timely manner without sacrificing authentic clinical experiences for potential graduates. If you are unclear about how ANTA is supporting your educational institution, then call the National Administration Office and we will explain how any delay in your course completion has been minimised through the cooperation and support from ANTA that will contribute to your timely graduation. Standards have been maintained and delivery modified to ensure graduates are workplace ready following graduation.

Costs and Fees to Members

ANTA is also conducting a moratorium on Membership fees. Fees have remained the same for over 20 years as a result of sound management and a lean and agile ANTA Administration Team. A slight increase to the lowest tier fees occurred in 2019, however, this tier remains the lowest across professional Associations in Australia. We also have payment plans for Members. If you would like more information, please call the ANTA Administration Office during the renewal period. There are no fee increases planned for 2020-21.

Continuing Professional Education (CPE)

The ANTA Board Members have also contributed their time, experience, and knowledge to providing fresh, new topics in webinars and tutorials available free of charge to our Members.

These resources are available to all Members to contribute/accumulate to your CPE requirements for 2020. Many of our Directors have been and will continue to deliver webinars to ANTA Members free of charge going forward.

Regards

Jim Olds

ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM.

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 7

ANTA News Summer 2020

ANTA News

Continuing Professional Education points will continue for 2020

Important!

New condition of Membership - Working with Children Check or Police Check ANTA has been advised by Health Funds that all Members will now require a Working with Children Check or a Police Check to be eligible for Health Fund recognition and ANTA Membership going forward.

Please be aware that all Australian States and Territories have different policies and procedures when it comes to these Checks. ANTA requires your document to be emailed as soon as possible. If this is not completed your Health Fund and Membership status might be in jeopardy.

AHPRA registered Members do not need to complete this requirement as it is a condition of AHPRA registration.

As an Association recognising practitioners within the healthcare industry, ANTA has an obligation to ensure the public’s safety by ensuring all Members have a completed and clear criminal history check.

Although 2020 has been a year full of ups and downs, ANTA and the Health Funds still require all ANTA Members to complete their 20 Continuing Professional Education (CPE) points for 2020. ANTA has offered many free resources from interactive webinars, journals and subscriptions to academic research databases.

ANTA requires all CPE activities to be lodged in your Member Centre by the 31st December 2020.

If you have issues, please call ANTA on 1800 817 577 or admin@anta.com.au. Please see page 49 for ANTA’s CPE Guidelines.

ANTA Closure Period The National Administration Office will be closed over the Christmas/New Year break.

ANTA will close on the 23rd December 2020 and re-open 6th January 2021.

ANTA National Council and Administration Staff wish everyone a happy and safe Christmas and New Year.

Membership Renewals

ANTA Membership Renewal Notices (excluding Victorian and AHPRA registered Members) were issued in October. Payments have to be made by 31st December 2020.

Please check your junk/spam folder or contact ANTA if you did not recieve your email.

PAGE 8 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

ANTA News Summer 2020

Important Information for ANTA Members registered with Health Funds Members who are recognised by Health Funds need to be aware of some new requirements in regard to Bupa and Medibank (including AHM).

Bupa – as of 1st February 2021, Bupa will be implementing their new Ancillary Provider Terms.

Members who are eligible for Bupa provider recognition are advised to read the new terms and ensure that they are adhering to the requirements.

These new terms are available on ANTA’s website in the Member Centre under Health Funds > Bupa Recognised Ancillary Provider Criteria. You can also visit Bupa’s website https://www.bupa.com.au/forproviders for further information.

Medibank (including AHM) – as of 1st April 2021, Medibank’s recognition criteria will be updated to reflect the requirement for electronically issued or printed invoices/receipts. This means that after 1st April 2021 Medibank will no longer accept fully or partially handwritten invoices/receipts. Medibank have advised that if providers do not comply with this new rule, their status as a Recognised Provider of Medibank may be reviewed and they may be suspended or cancelled. The updated ancillary billing standards for Medibank (including AHM) are available on ANTA’s website in the Member Centre under Health Funds > Medibank Recognised Ancillary Provider Criteria. You can also visit Medibank’s website https://www.medibank.com.au/providers/ for further information. ANTA recommends that you start implementing this practice as soon as possible prior to 1st April 2021.

It has come to ANTA’s attention that a large number of practitioners are not adhering to the rules of the various Health Funds and we stress that it is very important to familiarise yourself with each of the Health Fund’s rules and regulations. By following the simple guidelines below, Members can greatly assist their clients in achieving a successful outcome with their Health Fund. Failure to provide any of the following requirements will result in your name and clinic details not being sent to the Health Funds and your client’s claims being rejected.

Change of Address or Name: Ensure any changes to your clinic address, e.g. new clinic address or leaving clinic address, and/or name (i.e. marriage etc.) are notified to ANTA as soon as any change occurs. If your change of address, change of name etc. is not provided to ANTA in a timely manner, your current details will not be included on the lists of ANTA

Members sent to Health Funds. If your name and/ or clinic address shown on receipts issued to your clients does not match your name and/or clinic address shown on the reports sent to Health Funds, your client’s claim will be rejected by the Health Fund.

Professional Indemnity Insurance: Ensure your Professional Indemnity (PI) insurance is renewed before it expires. You will be required to provide a copy of your Certificate of Currency to ANTA. Members who do not provide ANTA with a copy of their PI Certificate of Currency in a timely manner will not be included on lists sent to Health Funds and your current provider number/s will be cancelled.

First Aid Qualification (HLTAID003 or subsequent updates): Ensure your First Aid qualification is renewed before it expires and that you provide ANTA with a copy of the renewed qualification before the expiry date of your current certificate. Members who do not provide ANTA with a copy of their renewed First Aid qualification in a timely manner will not be included on lists sent to Health Funds and your current provider number/s will be cancelled.

Police Check or Working with Children Check: Ensure you have provided ANTA with your current Police Check or Working with Children Check. Members who provide new clinic address details and do not have a current Police Check or Working with Children Check, will be required to supply a check before Health Funds are notified of your new address change.

Continuing Professional Education (CPE): Ensure that you complete and log 20 hours of CPE each calendar year (January to December) on your personal profile within the ANTA Member Centre.

Renew your ANTA Membership: Ensure that you renew your ANTA membership before it expires.

Membership expires on the 31st December each year and your renewal notice will be forwarded to you in October each year. [Note: Acupuncture and Chinese Herbal Medicine members expire 31st March each year – renewal forwarded to you in January each year]. Members who do not renew their membership in a timely manner, i.e. before the 31st December [or 31st March for Acupuncture/Chinese Herbal Medicine practitioners], will not be included on lists sent to Health Funds and your current provider number/s will be cancelled.

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 9

Learn from the World's best natural therapists Hone your skills and reputation with the latest developments in your field! Cutting-edge knowledge for 14 modalities, including acupuncture, body work, herbal medicine and more!

The World Health Symposium, organised by the Australian Natural Therapists Association, will be holding a virtual event, with presentations by 16 speakers across 14 modalities, delivered via Webinar Jam. The event runs from the 6th February 2021 to the 7th February 2021, with every presentation able to be rewatched.

Tickets are avilable now! More speakers being announced shortly!

Visit worldhealthsymposium.com.au or call ANTA on 1800 817 577 for more information!

Speakers Neurological Assessment: Understanding the Clinical Implications of Neurological Findings

SHAUN BREWSTER - AUSTRALIA

Shaun Brewster is Myotherapist and Exercise Pyhsiologist with over 20 years experience in clinical practice and education. In addition to working in private practice, Shaun is the Director and founder of Advanced Clinical Education, a provider of post-graduate professional development for manual therapists.

Shaun is also an ANTA Director and the Myotherapy Branch Chair at ANTA.

PAGE 10 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

Natural and Un-Natural Toxins: Uncovering Personal Obstructions to Metabolism

WARREN MAGINN - AUSTRALIA

Warren Maginn is a Clinical Nutritionist and college lecturer who emphasises an individualised approach to the management of chronic health conditions through the principles of Functional & Nutritional Medicine. Warren mentors naturopathic and medical practitioners around Australia and New Zealand in their use of functional laboratory testing, nutritional compounding and clinical nutraceuticals as a basis to holistic and integrative health management.

DR JOHN Z. SRBELY, DC PHD - CANADA

John Z. Srbely is a full-time Associate Professor in the Department of Human Health and Nutritional Science, University of Guelph (Guelph, Ontario, Canada).

His interests in nueophysiology evolved during his formative years as a primary health care provider in chiropractic and acupuncture that focused on treating and managing chronic myofascial pain. His two decades of clinical observation underscored the fact that these have a profound impact on human physiology, the scope and mechanisms of which are still poorly characterised.

Myofascial Trigger Points and Chronic Musculoskeletal Pain: Exploring their Enigmatic Pathophysiology and Dynamic Clinical Manifestations

JAY P. SHAH, PHD - UNITED STATES OF AMERICA

Jay P. Shah is a physiatrist and clinical investigator in the Rehabilitation Medicine Department at the National Institutes of Health in Bethesda, Maryland, USA. His interests include the pathophysiology of myofascial pain and the integration of physical medicine techniques with promising complementary approaches in the management of neuro-musculoskeletal pain and dysfunction. He also completed the one-year UCLA Medicial Acupuncture course and a two-year Bravewell Fellowship at the Arizona Center for Integrative Medicine.

Reflections on Trauma Informed Acupuncture Practice

KAITLIN EDIN - AUSTRALIA

Kaitlin Edin has been an acupuncturist for over a decade. She has studied with many teachers, as is the way in the West. Her original training began in Japan and continued for a number of years within the Japanese Meridian Therapy traditions of Dr Manaka, Nagano/Mastumoto and Toyohari. The contributions of Lonny Jarrett and Leon Hammer have been strongly influential since she was a student. She is a current Director of ANTA and holds the Acupuncture Branch Chair on their National Council.

Molecules of Energy: Herbal Energetics and Plant Chemistry

ELIZABETH GREENWOOD - AUSTRALIA

Elizabeth Greenwood holds a Masters of Herbal Medicine and has spent many years in the profession of Naturopathy and has seen the strengths and weaknesses first hand. She is dedicated to the strength and professionalism of Naturopathy through education, mentoring and international recognition of Naturopathy as a viable and reliable method of healthcare.

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 11

ANTA Director Article Summer 2020

The Upside to a Very Challenging Time To say that 2020 has provided a difficult time for all of us in the health community is a huge understatement. Every practitioner, in every modality, in every state has had to adjust and adapt in one way or another. In my role at ANTA as the Myotherapy Branch Chair, and also as the National Council representative on COVID-19 matters, I have been in contact with many therapists and heard their stories this year. While there have been many people express their worry and fear over what their professional futures may hold, there have also been some incredible stories of discovery, creativity and positive change.

Telehealth and virtual consultations have become a major feature of the health landscape in 2020.

In the early days of nation-wide restrictions this year, ANTA surveyed its Members on their use and application of this type of medium for consultation. Our data showed a dramatic uptake of online consults with a vast array of tools being used by our Members. The general consensus has been that while this medium has its limitations, there are in fact a number of positives to it. Some Members noted that their clients often preferred to attend their appointments online because of the time saved in commuting to the clinic.

Therapists pointed out that it gave them greater flexibility in when they could “see” clients, giving them more control over their schedules and a greater capacity to maximise their available hours during the week. Depending on the modality practised by each individual therapist, their ability to apply all the tools of their trade is of course limited. Through those limitations, we’ve seen many therapists come up with some fantastic innovations to help close those gaps in their consults. For those practising physical therapies such as Remedial Massage or Myotherapy, there has been an increase in the number of online stretching classes, self-treatment workshops and virtual ergonomic assessments being conducted.

PAGE 12 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

Speaking to many of these therapists, the feedback they are receiving has been fantastic and they plan to keep these services going into the future.

Due to the increased time required to undertake COVID-19 related cleaning and hygiene procedures, and to reduce the chance of infection, many therapists reduced the duration of their consultations to make space in each day. It was noted by some that this reduction in available time with each client forced them to apply much more clinical reasoning to their assessment and treatment plans, and to fine-tune their interventions so as to maximise their outcomes.

Obviously, nobody wants to be forced to shorten their consultation times, but if doing so results in more efficient treatments, better results for the client and less of a time commitment for them also, then surely this is a positive.

Financially, COVID-19 has hit many therapists hard. The forced reduction of movement in many communities, a tightening of household budgets and a change in people’s priorities has meant that some clinics just haven’t had the number of people through their doors that they normally would. For a lot of business owners, this has forced them to look very closely at their business models and investigate where their inefficiencies are, where they can reduce running costs and what they can do to make their businesses more streamlined in the way they operate. We’ve seen people increase their prices and decrease their opening hours, diversify staff responsibilities, purchase stock in bulk to obtain bigger discounts, provide new and different services, advertise into different markets and much more. And of course, the implementation of virtual consults has meant that therapists don’t always need to physically be in the clinic, utilising administrative and other resources.

ANTA Director Article Summer 2020

In addition to COVID-19 impacting clinical practices and those working within them, it has also challenged us here at ANTA to consider what and how we can do things differently to better serve our Members. This year has seen us implement a steady stream of webinars and online learning opportunities for members which have had an enormously positive response. So much so that we have decided to expand that offering and to create an international online conference that will bring the best in the world right to you via your computer screens. The World Health Symposium will be held on February 6th & 7th 2021 and will showcase presentations from a range of modalities from presenters from around the globe. For more information, please visit www.worldhealthsympoisum.com.au.

Something that we are very proud of that came out of a very challenging year was the collaborative efforts of a number of other Associations that joined forces with ANTA to communicate with Government and advocate on behalf of our Members. The result of this was a louder and more cohesive voice, a voice that demonstrated that our industry is a community of people, all with common needs, common

challenges and common motivations. Those collaborative efforts have continued to this day and we will strive to build on those going forward.

Lastly, I’d like to say that I’ve been both humbled and massively impressed by the response of our Members and from the broader health practitioner community during this very challenging year. It has demonstrated very clearly that we are a robust and resourceful group of people, driven by our love of the work we do and by the people that we are here to serve.

To you all I say… well done.

Regards

Shaun Brewster

ANTA Director ANTA National Myotherapy Branch Chair

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ANTA Member Article Summer 2020

Tony Reid

M.Ac (Acupuncture) M.TCM (Traditional Chinese Medicine)

Diagnosis and Treatment of Chronic Fatigue Syndrome with Traditional Chinese Medicine

Introduction Two recent review papers have noted that the best available evidence, while deemed to be of poor quality, suggests that Chinese Herbal Medicine may provide much better treatment outcomes than Western Medical interventions for Chronic Fatigue Syndrome. Moreover, while the etiology and pathogenesis of this condition

Chronic Fatigue Syndrome in Western Medicine Around 30% of patients seeking medical help complain of long-term fatigue. However, far fewer suffer from Chronic Fatigue Syndrome (CFS).

Unfortunately, there is no biomarker for this condition and therefore since the 1990’s, when it was first described, there have been several different definitions as well as names for it, i.e. ‘fibromyalgia’ (FM), ‘myalgic encephalitis’ (EM), and ‘systemic exertion intolerance disease’ (SEID). Estimates of prevalence within the community are hampered by these facts, as well as doctors’ reluctance to diagnose CFS, together with the inevitable imprecision of selfreporting in community surveys. Thus, the prevalence of CFS in the population is likely to be at least 0.2% and may be as high as 2.6%. It does appear to occur more commonly in women4,5. In recent years, the condition is most commonly named as Chronic Fatigue Syndrome/ Myalgic Encephalitis (CSF/ ME) or Myalgic

remain elusive within the biomedical paradigm, Traditional Chinese Medicine may potentially elucidate some of these issues, through a biomedical understanding of the mechanisms of action of successful Traditional Chinese Medicine treatments1,2.

Encephalitis/ Chronic Fatigue Syndrome (ME/ CSF) or simply CSF. The critical difference between simple fatigue (a.k.a. chronic idiopathic fatigue) and CSF is exertional exhaustion, the consequence of which is that ‘people with CFS must make significant lifestyle changes to conserve their physical resources and mental concentration to stay competent in normal occupational, educational, and social settings. They are often limited to a few hours per day of productive endeavours, with the remainder of the time spent resting with slow and partial recovery from the disorganised thoughts, total body pain, malaise, and other features of their chronic fatigue state’4.

Etiology and Pathogenesis

Although viral and bacterial infections as well as immunological, neuroendocrine, genetic, gastroTHE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 15

ANTA Member Article Summer 2020

intestinal and psychological abnormalities have been detected in patients diagnosed with CFS, there is no single pathology that is universal, nor has a causative factor been established. In general, if the source of the fatigue can be explained, the patient most likely does not have CFS4,6. Unfortunately, there is an element of logical absurdity here, as this makes CFS an entity that is largely defined by what it is not. Thus, with this ‘non-definition’, all of our knowledge must be skewed to a certain extent. The more than ten-fold variability in the figures for prevalence, cited above, speaks to this conundrum; and we need to be aware that because of this difficulty with the definition, all studies, clinical or otherwise, contain unavoidable biases, considerably lowering their ranking.

Based on the current biomedical knowledge base, it would be reasonable to assume that the constellation of symptoms that define CFS may be the outcome of various pathophysiological changes, different in each individual case. Thus, in CSF we are most likely looking at a heterogeneous group of disorders, more in line with the ancient Chinese classification system. As can be readily observed in the following discussion, this approach makes more sense than the presumption of a single cause.

Therefore, it is proposed that CFS be considered as a group of diseases with a common core symptomatology, but with various etiologies.

Moreover, it appears that some of the very complex diagnostic criteria (i.e. the Canadian Consensus Criteria), outlined below, reveal more about the limitations of a statistic approach to the problem; where the square peg of clinical reality is forced into the round hole of a false initial assumption. This may be why some authorities maintain that the majority of people with CFS remain undiagnosed6. Therefore, a more logical approach to naming this group of disorders would be ‘Chronic Fatigue Syndromes’ or simply ‘Fatigue Syndromes’.

Diagnosis

CFS is a complex disease involving profound dysregulation of the central nervous system and the immune system, chronic inflammation, dysfunction of cellular energy metabolism and ion transport, together with cardiovascular abnormalities4,7. According to the United Kingdom criteria4, which are favoured in our present discussion because they are comprehensive and precise, patients are diagnosed with CFS when they have the following clinical features: • Presence of debilitating fatigue, which may be persistent or recurring, for more than six months, but not lifelong • Cognitive dysfunction • Total body pain (i.e. myalgia, arthralgia, headache) PAGE 16 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

• Unrefreshing sleep that does not restore normal function • Post-exertional malaise, where exertion or other stressors leads to exacerbation of the above symptoms, the onset of which may be immediate or delayed • The level of impairment must be moderate to severe and present more than 50% of the time • No other diseases that may explain the main symptoms can be found Other symptoms, which are generally also present, include sore throat, tender lymph nodes (which may or may not be enlarged), and orthostatic intolerance.

The fatigue in CFS causes a marked reduction in the ability to perform activities related to work, learning, personal relationships, recreation and normal daily living, compared with abilities prior to the onset of the condition. There is a loss of physical and mental stamina, rapid development of muscle fatigue, mental fatigue and general malaise after exertion (including general body pain and cognitive dysfunction).

Recovery from post-exertional malaise is slow, generally taking from two to 24 hours or longer.

Unrefreshing sleep is a characteristic of this condition.

Recently the six months’ duration has been called into question with the very reasonable argument that it is inhumane to force patients to suffer for six months before something is done about their condition7.

Cognitive dysfunction, commonly denoted as ‘brain fog’, ‘confusion’ or ‘inability to concentrate’, refers to the mental state of patients that arise as a consequence of exertion. It is characterised primarily by the temporary loss of working memory, while short-term and long-term memory are mostly intact.

This contrasts with dementia where the memory loss is permanent and progressive.

A common symptom in CFS patients is orthostatic intolerance. This refers to the difficulties experienced on prolonged standing, e.g. when waiting in a queue or while shopping. They may become light-headed, dizzy, nauseous, experience spatial disorientation or visual changes, or simply feel unwell.

Approximately 20% of patients suspected of having CFS are eventually found to suffer from other diseases, with severe fatigue being the main presenting symptom. Therefore, a careful initial diagnosis and periodic reappraisals are

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recommended4.6. Some of the more common conditions that should be excluded before diagnosis of CFS include: • Organ failure (e.g., emphysema, cirrhosis, cardiac failure, chronic renal failure) • Chronic infections (e.g., HIV/ AIDS, hepatitis B or C) • Rheumatic and chronic inflammatory diseases (e.g., Systemic Lupus Erythematosus (SLE), Sjögren’s syndrome, rheumatoid arthritis, inflammatory bowel disease, chronic pancreatitis) • Major neurological diseases (e.g., multiple sclerosis, neuromuscular diseases, epilepsy or other diseases requiring ongoing medication that could cause fatigue, stroke, head injury with residual neurological deficits) • Diseases requiring systemic treatment (e.g., organ or bone marrow transplantation, systemic chemotherapy, radiation of brain, thorax, abdomen, or pelvis) • Major endocrine diseases (e.g., hypopituitarism, adrenal insufficiency) • Primary sleep disorders (e.g., narcolepsy)

Symptomatology

In addition to debilitating physical and mental fatigue that is considerably exacerbated by exertion, there are a raft of other symptoms, none of which are specific, that commonly occur in patients with CSF. While these symptoms are of limited significance in Western Medical (WM), they are important in Traditional Chinese Medicine (TCM), where they provide critical information regarding etiology, pathogenesis and differential diagnosis in an individual case.

According to the Canadian Consensus Criteria, the clinical features of CFS are as follows4,7: a. Neurological and cognitive (at least two of the

following): Impaired short-term memory (self-reported, or observed difficulty recalling information or events).

Difficulty maintaining focused attention. Disturbed concentration may impair the ability to remain on task or to screen out extraneous or excessive stimuli.

• Loss of visual depth perception • Difficulty finding the right word • Frequently forget what wanted to say • Absent-mindedness • Slowness of thought • Difficulty recalling information • Need to focus on one thing at a time • Trouble expressing thought • Difficulty comprehending information • Frequent loss of train of thought • Sensitivity to bright lights or noise • Muscle weakness and/ or muscle twitches b. At least one symptom from two of the following three categories: I. Orthostatic and visceral manifestations: • Dizziness or fainting • Feeling unsteady when standing up • Disturbed balance • Palpitations with or without cardiac arrhythmias • Positive tilt table test for postural orthostatic tachycardia or neurally mediated hypotension • Shortness of breath • Nausea • Irritable bowel syndrome or bladder pain II. Thermal instability and appetite: • Recurrent feelings of feverishness and cold extremities • Sweating episodes • Intolerance of extremes of heat and cold • Subnormal body temperature • Marked changes in weight and/ or appetite

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 17

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III. Interoceptive manifestations: • Recurrent flu-like symptoms • Repeated feverishness and sweats • Non-exudative sore or scratchy throat • Lymph nodes tender to palpitation with minimal or no swelling • Chemical irritant sensitivities to food, odours, or chemicals (non-allergic rhinopathy)

Treatment Options

As there are no curative medications for CFS, treatment is aimed at managing symptoms and trying to improve functional capacity. Pharmacotherapy is used for pain reduction, headache relief, restoring normal sleep patterns and alleviation of mood disorders. Physiotherapy, psychotherapy, occupational therapy and, commonly, graded exercise programmes are also employed. Pharmacotherapy is limited by patients’ increased susceptibility to adverse reactions and the need to prescribe lower dosages. Additionally, none of the commonly applied treatments have a solid evidence base and this is reflected in the conflicting advice given in the various medical guidelines, which also differs substantially from the preferred treatments of patients and their support groups4,6.

FATIGUE SYNDROMES IN TRADITIONAL CHINESE MEDICINE

The earliest record of a comprehensive discussion on the diagnosis and treatment for severe fatigue is found in the General Treatise on the Causes and Manifestations of Diseases (zhubing yuanhuo lun) from the Sui Dynasty (581 – 618 CE). This text is a compilation of medical knowledge of that time, written under imperial decree by a group of medical scholars and court physicians headed by Chao Yuan-fang. This text laid the foundation for the contemporary TCM branch of internal medicine (nei ke), with its systematic expositions on the causes and symptom patterns of various disease entities, defined by a particular key symptom. The original chapter devoted to fatigue syndromes provided the basis for the disease category of xu lao in contemporary TCM. The literal meaning of xu lao is ‘deficiency-(over) work’, representing the concept of severe fatigue or exhaustion with depletion of the vital substances (i.e.

Qi, Blood, body Fluids, Kidney Essence).

Clinicians in contemporary China approach CFS according to xu lao, together with expulsion of exogenous and/ or endogenous pathogens. Due to the nature of this disorder, the syndromes due to excess pathogens are not acute, i.e. they are not located at the Exterior of the body but have penetrated either into the muscles or the Lesser Yang (shao yang). The Lesser Yang level is a concept elaborated by Zhang Zhong-jing (circa 150–219 CE) in his text on infections PAGE 18 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

caused by Cold pathogens. It refers to a stage in the progression of an infection where the pathogen, which initially attacked the Exterior of the body (skin and upper respiratory system), begins to overwhelm the body’s resistance and starts to penetrate into the Interior (e.g. the Lung or other internal organ systems), while at the same time pathogenic Cold gradually transforms into Heat. At this stage, pathogenic activity is located midway between the Exterior and the Interior, affecting the Gallbladder and San-jiao Channels. The key symptomatology here is alternating fever and chills; these opposite symptoms may follow one another in rapid succession or there may be a delay of several hours between them. There may also be nausea (or vomiting), bitter taste in the mouth and dry throat.

When pathogens, specifically Damp and Heat, are in the muscles the main symptoms are muscular pain with joint pain and stiffness. The source of these pathogens may be exogenous, when they invade from the outside; or endogenous, due to Internal organ system dysfunction, as part of the xu lao (severe deficiency) syndrome. Endogenous Damp may be accompanied by other pathogens, such as Phlegm, Heat or Cold8,9.

Treatment must proceed by stages and is usually prolonged and difficult due to the necessity to resolve pathogens, while at the same time supporting the body’s health Qi (zheng qi) without inadvertently strengthening the pathogens. This is a delicate balancing act because lower doses of pathogen dispelling herbs must be used in order not to further weaken the patient and worsen the deficiency condition. At the same time, a minimal amount of tonifying herbs needs to be applied in order to support the body resistance and ensure the complete expulsion of pathogens.

This is the main reason why treatment of CFS should progress slowly, often with small relapses along the way. Unfortunately, due to the widespread perception that Chinese medicine has many powerful tonics that can effectively treat fatigue, practitioners may feel pressured by their patients to provide quick results by prescribing tonifying herbal formulas early on.

However, in many cases this is inappropriate, and results in a rapid worsening of the condition; the patient may then lose faith in the treatment and also in the practitioner. The TCM treatment principle to remove pathogens first and tonify afterwards should be strictly followed. If strong tonifying formulas are given before the eradication of pathogens, you risk strengthening the pathogens rather than the patient, with a resultant deterioration and loss of progress in what is usually a slow and arduous course of treatment.

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It is worthwhile considering the various pathways of pathogenesis, as this knowledge can provide the basis for ongoing lifestyle and other modifications during the course of treatment and beyond8,9,10.

• Congenital factors leading to a weak body constitution (with Spleen and/or Kidney deficiency) • Emotional factors, which affect the Liver Qi and the Liver-Spleen interaction • Exogenous pathogenic factors that invade the body and are incompletely resolved, resulting in ‘lingering’ or ‘latent’ pathogen syndromes • Endogenous pathogens, mainly Damp and Heat, generated by Spleen deficiency and unsuitable diet • Lifestyle factors, such as overwork or over-training and insufficient sleep, which may deplete the Kidney • Dietary factors, such as inappropriate eating, overeating, eating on the run, or excessive alcohol, may damage the Spleen, which, in turn, may lead to Qi and Blood deficiency (affecting other organs and tissues) and also retention of Damp or Phlegm Although the earlier TCM discussions of CFS centred on post-viral syndromes, subacute viral syndromes and immune system deficiency8,11, this paper takes a more comprehensive approach, based upon the most widely used criteria for diagnosing the disease9,10.

In line with this approach, the treatment protocols outlined below address syndrome-patterns that underlie the essential symptomatology of CFS according to the United Kingdom criteria, discussed above: • Debilitating fatigue • Cognitive dysfunction • Pain (i.e. myalgia, arthralgia, headache) • Unrefreshing sleep that does not restore normal function • Post-exertional malaise Additionally, these are the diagnostic criteria that are generally used in Chinese studies on TCM treatments for CFS1,2,3.

Traditional Chinese Medicine Patterns for Fatigue Syndromes

The most elaborate contemporary exposition on severe debilitating fatigue syndromes is found in Maclean, Lyttleton et al.10, the essential points of which are summarised below. The key issues in dealing with such patients are that, in general, there are both excess and deficiency factors underlying the main symptoms, and that patients mostly present with mixed syndrome-patterns. Thus, even though each TCM pattern is described as a discrete clinical entity, practitioners need to be aware that an individual patient’s clinical features should be interpreted in light of excess and deficiency, together

with the possibility of combined deficiency patterns.

In terms of prescribing, things are not as complicated as it may seem. As discussed above, the initial aim of treatment is to determine the nature of the pathogens and focus on expelling them while gently supporting the health Qi (zheng qi) with simple Qi tonifying formulas at lower dosage. This is discussed in more detail below.

Excess Patterns • Lesser Yang stage pathogens • Retained Damp • Retained Phlegm Deficiency Patterns • Qi deficiency • Blood deficiency • Yin deficiency • Yang deficiency • Kidney Essence deficiency

Key Clinical Features and Treatment Formulas

1. Lesser Yang stage pathogens Clinical features: Sometimes feeing cold and sometimes feeling hot, tender lymph nodes (that may or may not be swollen), intermittent low-grade fever, red edges on the tongue.

Formula: Xiao Chai Hu Tang (a.k.a. Resistance 2 Formula).

2. Retained Damp Clinical features: Muscle and joint pain, sense of bodily heaviness, thick tongue coat.

Formulas: Huo Xiang Zheng Qi Wan (a.k.a. Agastache Formula) or Ping Wei San (a.k.a. Magnolia & Ginger Combination).

3. Retained Phlegm Clinical features: Excessive sputum in the respiratory tract, nasal congestion, nausea or vomiting, brain fog, greasy tongue coat, slippery pulse.

Formula: Wen Dan Tang (a.k.a. Clear the Phlegm Formula).

4. Qi deficiency Clinical features: Poor appetite, feeling full after only eating a small amount, loose stools, weak pulse.

Formula: Bu Zhong Yi Qi Tang (a.k.a. Energy Tonic Formula).

5. Blood deficiency Clinical features: Dizziness, insomnia, apathy, poor concentration and memory, palpitations, muscle cramps, dry skin and hair, dry stools possibly with THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 19

ANTA Member Article Summer 2020

constipation, pale tongue, thready pulse.

Formula: Si Wu Tang (a.k.a. Nourish the Blood Formula).

6. Qi-Blood dual deficiency Clinical Features: Combined features of Qi deficiency and Blood deficiency.

Formulas: Gui Pi Tang (a.k.a. Restore the Spleen Formula), or Ren Shen Yang Rong Tang (a.k.a. Qi & Blood Tonic 1 Formula), or Ba Zhen Tang (a.k.a. Qi & Blood Tonic 2 Formula), or Shi Quan Da Bu Wan (a.k.a.

Ginseng & Danggui Ten Formula).

7. Kidney Yin deficiency Clinical features: Nervous and agitated manner; insomnia; irritability; flushed face or neck; sensations of heat in the palms, soles or centre of chest, particularly at night time; feeling hot in the afternoons; night sweating, dry mouth and throat that is not alleviated by fluid intake; dry stools; constipation; red tongue with very little coating; thready and rapid pulse.

Formulas: Liu Wei Di Huang Wan (a.k.a. Yin Tonic Formula), or Zhi Bai Ba Wei Wan (a.k.a. Empty Heat Formula).

8. Kidney Yang deficiency Clinical features: Sensitivity to the cold; cold hands, feet and lower abdomen pallor with a dull and lifeless complexion; loose stools possibly containing undigested food; fluid retention (e.g. ankle edema).

Formula: Fu Gui Ba Wei Wan (a.k.a. Rehmannia Eight Vitality Formula).

9. Kidney Essence deficiency Clinical features: Low back pain and weakness, loss of libido, infertility, dull eyes, flat affect, poor memory, possibly also confusion, tinnitus and hearing loss, signs of Yin deficiency or Yang deficiency.

Formulas: You Gui Wan (Right Returning Formula) – for Yang deficiency; Zuo Gui Wan (Left Returning Formula) – for Yin deficiency.

Treatment Protocols

As discussed above, the overall symptomatology of CFS strongly suggests the presence of retained pathogens. Specific diagnostic clues for the presence of pathogens include muscle and joint pain, tender and/ or enlarged lymph nodes (usually in the neck or groin), thick or greasy tongue coat, pain or discomfort that does not improve or worsens with rest.

Therefore, it is best PAGE 20 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

to begin treatment with a combined approach, both expelling pathogens and gently supporting the health Qi. This approach may result in an apparent worsening of the condition, with signs of pathogen retention becoming more pronounced, as the body resistance improves to the point where pathogens are able to be shifted. This should be taken as an encouraging sign that the treatment is working and that the specific TCM diagnosis, and hence the pathogenesis, of this complex condition is becoming clearer.

The main clinical challenge in CFS is in negotiating your way through the first stage of treatment, which is focused on promoting the expulsion of pathogens. After this has been successfully achieved, the underlying deficiency pattern/s can be addressed, using one or more of the formulas outlined under treatment of deficiency patterns, above. Once again, practitioners should be aware that treatment with tonifying formulas should not begin prematurely.

If the pathogenic factors have not been completely expelled, the patient’s condition will worsen when tonifying formulas are given, and the relapse may be seen as a treatment failure.

Therefore, it is critically important that the first stage of treatment should continue for an additional 7 – 10 days after all signs of retained pathogens have been resolved. In regard to tonifying treatments, the best protocol is to begin by tonifying the Spleen Qi to promote digestion and absorption of nutrients and to facilitate Qi and Blood production. The appropriate formulas at this stage are those discussed below under Qi deficiency as well as those under Qi and Blood dual deficiency. Once general improvement has been achieved, an appropriate Kidney tonifying formula may be given, if it is deemed necessary.

1. Early stage treatment • Damp obstruction in the muscles Clinical Features: Muscular pain, swollen lymph nodes, poor appetite, nausea, loose stools or diarrhea, thick tongue coat, weak pulse that may be soft, slow or wiry.

Formula: Huo Xiang Zheng Qi Wan (a.k.a.

Agastache Formula).

Dosage: 30 – 50 pills twice daily.

Variations: a. With signs of Heat (low grade fever, abnormal sweating, bitter taste in the mouth, yellow tongue coat), combine with: Formula: Huang Lian Jie Du Wan (a.k.a. Antitox 2 Formula).

Dosage: 8 – 12

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capsules (or 30 – 40 pills) twice daily. b. With poor appetite and indigestion, combine with: Formula: Bao He Wan (a.k.a. Digest-Aid Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) before meals.

• Lesser Yang stage pathogen Clinical Features: History of viral infection (respiratory or gastro-intestinal) that immediately preceded the severe fatigue, sometimes feeling hot and sometimes feeling cold, tender lymph nodes, nausea, dry throat, wiry pulse.

Formula: Xiao Chai Hu Tang (a.k.a. Resistance 2 Formula).

Dosage: 8 – 12 capsules (or 30 – 40 pills) twice daily.

Variations: a. With retained Damp (loss of appetite, swollen lymph nodes, thick tongue coat), combine with: Formula: Ping Wei San (a.k.a. Magnolia & Ginger Combination).

Dosage: 20 – 30 pills twice daily. b. With severe Qi deficiency (loss of appetite, severe fatigue, pale tongue with normal coat, weak and thready pulse), combine with: Formula: Bu Zhong Yi Qi Tang (a.k.a. Energy Tonic Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily for 3 – 5 days a week, or 3 – 5 days every second week.

2. Second stage treatment – to be applied at least seven days after signs of retained pathogens have disappeared and continued for several months.

• Qi deficiency Clinical features: Poor appetite, feeling full after only eating a small amount, loose stools, weak pulse.

Formulas: Bu Zhong Yi Qi Tang (a.k.a. Energy Tonic Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily.

• Qi-Blood dual deficiency Clinical Features: Combined features of Qi deficiency and Blood deficiency.

Formulas: (select one) Gui Pi Tang (a.k.a. Restore the Spleen Formula); Ren Shen Yang Rong Tang (a.k.a. Qi & Blood Tonic 1 Formula); Ba Zhen Tang (a.k.a. Qi & Blood Tonic 2 Formula); Shi Quan Da Bu Wan (a.k.a.

Ginseng & Danggui Ten Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily.

• Kidney Yin deficiency Clinical features: Nervous and agitated manner; insomnia; irritability; flushed face or neck; sensations of heat in the palms, soles or centre of chest, particularly at night time; feeling hot in the afternoons; night sweating, dry mouth and throat

that is not alleviated by fluid intake; dry stools; constipation; red tongue with very little coating; thready and rapid pulse.

Formulas: (select one) Liu Wei Di Huang Wan (a.k.a.

Yin Tonic Formula); Zhi Bai Ba Wei Wan (a.k.a. Empty Heat Formula) – with pronounced signs of Heat (e.g. night sweats, sensations of heat in the hands, feet or centre of chest that are worse at night).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily.

• Kidney Yang deficiency Clinical features: Sensitivity to the cold; cold hands, feet and lower abdomen pallor with a dull and lifeless complexion; loose stools possibly containing undigested food; fluid retention (e.g. ankle edema).

Formula: Fu Gui Ba Wei Wan (a.k.a. Rehmannia Eight Vitality Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily.

• Kidney Essence deficiency Clinical features: Low back pain and weakness, loss of libido, infertility, dull eyes, flat affect, poor memory possibly also confusion, tinnitus and hearing loss, signs of Yin deficiency or Yang deficiency.

Formulas: (select one) You Gui Wan (Right Returning Formula) – for Yang deficiency; Zuo Gui Wan (Left Returning Formula) – for Yin deficiency.

Dosage: 20 – 30 pills twice daily.

Variations (for stage two treatment protocols): a. Poor appetite and indigestion, combine with: Formula: Bao He Wan (a.k.a. Digest-Aid Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) before meals. b. Insomnia, combine with: Formula: An Shen Ding Zhi Wan (Ziziphus & Polygala Formula).

Dosage: 20 – 30 pills, twice daily (afternoon and evening). c. Emotional volatility, combine with: Formula: Xiao Yao San (a.k.a. Stress Relief 2 Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily. d. Anxiety, combine with: Formula: Yi Gan San (a.k.a. Settle the Emotions Formula).

Dosage: 6 – 9 capsules (or 20 – 30 pills) twice daily.

Clinical Research

While much of the clinical research on the treatment of CFS with Chinese medicine has been deemed to be of poor quality with a high risk of bias12, much of these perceived shortcomings arise from the difficulties of making research that incorporates the TCM paradigm fit into the Western randomised controlled trial (RCT) model. As mentioned above, the high degree of THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 21

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uncertainty surrounding the definition and hence the diagnosis of CFS introduces an element of bias and imprecision into all clinical studies on this condition.

Moreover, as there is always at least some degree of bias in even the most rigorously conducted clinical trials, it always comes down to the critical judgement of healthcare practitioners to determine how best to apply this information in their clinical encounters13.

Traditional herbal formulas that, when appropriately applied, have been shown to be effective in CFS include the following1,2: • Bu Zhong Yi Qi Tang (a.k.a. Energy Tonic Formula): For Spleen Qi deficiency pattern. Has beneficial effects on the immune system. Commonly prescribed together with Xiao Chai Hu Tang (a.k.a.

Resistance 2 Formula).

• Gui Pi Tang (a.k.a. Restore the Spleen Formula): For Spleen Qi deficiency with Heart Blood deficiency. Has beneficial effects on the immune system.

• Ren Shen Yang Rong Tang (a.k.a. Qi & Blood Tonic Formula): For general Qi and Blood deficiency. Has beneficial effects on the immune system.

• Jia Wei Xiao Yao San (a.k.a. Stress Relief 1 Formula) or Xiao Yao San (a.k.a. Stress Relief 2 Formula): For Liver constraint with Liver-Spleen imbalance. Helpful in cases with mood disturbance with gastrointestinal symptoms.

• Xue Fu Zhu Yu Tang (a.k.a. Blood Moving 1 Formula): For Blood stasis patterns; alleviates somatic pain and insomnia.

• Liu Wei Di Huang Wan (a.k.a. Yin Tonic Formula): For Yin deficiency of the Liver and Kidney. Helps to improve cognitive function, alleviates night sweating.

• Fu Gui Ba Wei Wan (a.k.a. Rehmannia Eight Vitality Formula): For Kidney Yang deficiency.

Suitable for patients with cold sensations and sensitivity to the cold.

• Yi Gan San (a.k.a. Settle the Emotions Formula): For Liver Constraint with Wind-Phlegm. Used for alleviation of anxiety and mood stabilisation.

• Jin Gui Suan Zao Ren Tang (a.k.a. Ziziphus Combination): For insomnia with Liver-Heart Blood and Yin deficiency.

• Xiao Chai Hu Tang (a.k.a. Resistance 2 Formula): For latent or lingering pathogen at the Lesser Yang Level. Used for fatigue due to viral infection or post viral syndromes.

accessing the ‘best available’ evidence, as mandated by the tenets of evidence-based medicine14,15, especially in light of the limitations (and hence sources of potential bias) imposed on all CFS research due to diverse definitions and the absence of a diagnostic marker. Unfortunately, in 2018 a compilation of studies on Chinese Herbal Medicines in the treatment of all types of chronic fatigue syndromes was withdrawn from the Cochrane database of systematic reviews because none of the 16 studies, all in Chinese, that had initially been selected by the authors were deemed to meet the inclusion criteria, according to the Cochrane risk of bias tool12. However, this potentially useful material could have been presented in the form of a general review, as has been done by other researchers cited here1,2. Sadly, it was withdrawn from publication and is now completely inaccessible to nonChinese speaking researchers.

Looking at some of the available studies from China and Japan, we find that around 50% of CFS patients treated with Chinese Herbal Medicines were able to resume normal activities by the end of the study period (generally less than three months), and that most of the remainder showed some degree of improvement in levels of fatigue14,15,16. In the absence of any pharmaceutical interventions that are able to provide relief from severe fatigue, Chinese Herbal Medicines would appear to be a potentially fruitful avenue for future research, which merits the close attention of the medical community. While the authors of the withdrawn Cochrane study note that specific TCM-friendly guidelines for Chinese medicine trials and systematic reviews need to be developed in the future, surely a practical first step is to examine the data that is already available, together with a careful analysis of the potential limitations of each study. In this way the authors would be making the best available evidence more widely accessible, along with suitable caveats, so that clinicians may make up their own minds regarding the suitability of such information when treating patients.

Epilogue

From the above discussion, it should be clear why the TCM approach to CFS does not readily lend itself to the pharmaceutical industry style RCT model one that seeks the elusive, but highly marketable, magic bullet. However, this should not stop us from PAGE 22 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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PAGE 24 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

ANTA Director Article Summer 2020

Isaac Enbom

National Remedial Therapy Branch Chair ANTA Director

Fire Risk in Massage and Health Practice

Spontaneous combustion… Whoever would have thought?!

It’s a very real risk albeit a rare one in the healthcare landscape with freshly laundered linen. There are all kinds of stories of practices burning to the ground because of towels catching fire or self-combusting.

This article attempts to identify the risk and provide some simple steps all practitioners should take to mitigate the risk, especially for businesses that launder their own linen.

What is the Risk?

The risk occurs typically when hot laundered towels or other linen are taken directly from a tumble dryer and stored without sufficiently cooling down. The heat from the towels is insulated and gradually builds until the towels eventually catch fire.

It occurs due to oxidation of the hot materials which is an exothermic reaction, exacerbated by the presence of oil. Where hot towelling from a laundry dyer is left in a pile, the additional heat that is released by the reaction is insulated, and so the temperature within the pile increases, which may lead to a runaway condition and ultimately fire.

Factors that can Increase the Risk

• Using an electric dryer rather than hanging the towels out to dry naturally.

• The presence of oils in the towel or cloth can be

attributed to increasing the risk of self-heating and spontaneous combustion. This can be a direct result of inadequate laundering or removal of oils during the laundering process.

• Not allowing the towels or cloth to sufficiently aerate and cool down after the drying cycle. This can occur when the towels are left in the dryer or if taken directly from the dryer and left in a pile.

• Overloading the drying machine can compromise the drying capability as heat would struggle to permeate the density of the load while increasing the temperature of the outer layers. This also poses a fire hazard within the machine itself.

How can Practitioners Mitigate the Risk?

• Not overloading the washing machine: Overloading the washing machine may lead to insufficient cleaning of the cloth and thus removal of oils. If this process is not effective, it will mean a greater volume of residual oils left in the towels.

Done repeatedly, this will gradually build up over time.

• Towel turn over: The age of the towels/linen can increase the risk as there are always some residual oils left in the towels after laundering. The type of oil also plays a part but it can be expected that an older towel will hold more residual oils and is a greater risk.

• Types and amounts of oils used: Organic oils such as coconut, sweet almond and jojoba oil are harder to remove whereas a synthetic or ‘water disbursal’ THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 25

ANTA Director Article Summer 2020

oil is easier to clean. Obviously, practitioners who use a greater amount per client will also contribute to oil build up in the linen.

• Ensuring towels are clean: An obvious step but one that is commonly overlooked especially in busy practices where someone other than the practitioner is conducting the laundering process and may be unaware of the risk of hygiene requirements.

• Inspecting each towel for cleanliness before storage: It is recommended that practitioners inspect each towel after the laundering process before it is stored. Specifically, practitioners should be mindful of the ‘feel’ of the towel – that it is sufficiently dry and clean. If towels have an ‘oily’ or ‘greasy’ feel to them, they may be insufficiently cleaned or past their life cycle. Likewise, if they start to develop an unpleasant odour.

• Storage from the dryer: Towels removed directly from the dryer should be aerated to cool immediately, before being folded and stored.

This may be achieved by hanging them in a wellventilated area or gently shaking each one before folding and storing.

• Laundering process: Check that sufficient laundry detergent and/or water temperature is used. These can affect the cleaning efficiency but are largely dependent on the appliance. Air drying towels rather than using a tumble or electric dryer will obviously mitigate the risk as would using an external laundering company.

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How does this Relate to Good Practice Hygiene?

The risk is almost totally mitigated if practitioners are following good hygiene practices with their linen. This will mean ensuring each towel is sufficiently cleaned after each use and again inspecting each towel before it is packed away. A new set of towels should be used for each client. Practices such as ‘flipping’ or reusing linen for the next client are not accepted practices. Practitioners should also be aware of crosscontamination and should clearly store and transport clean towels in a designated area or receptacle separate to that of the used linen.

Conclusion

Spontaneous combustion is a rare hazard in the complementary health industry. Businesses that do not follow good hygiene practices and who do not regularly check the cleanliness of their linen will have a higher risk of spontaneous combustion occurring in the workplace, especially if freshly laundered linen is neglected after the drying cycle.

Following accepted practices when it comes to cleaning, maintenance and storage of linen will not only help reduce the risk of cross-contamination but also mitigate the risk of fire caused by spontaneous combustion.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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Ultra Muscleze® For Juniors: is a comprehensive magnesium formula for the support of healthy children’s nervous and immune systems, muscles and bones.

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©BioCeuticals® 2020 ACN 062 851 683 BC_2584_B0014139_ANTA_JNRS_250920_D3

Key features and benefits

ANTA Member Recipes Summer 2020

Healthy Recipes

Rachel Knight is a Chef and Naturopath based in Melbourne. Her passion for food as medicine has led her to a career in educating the importance of good nutrition and how to maintain a healthy balanced diet.

She currently teaches primary students the fundamentals of cooking and how to utilise fresh produce from the school garden through the Stephanie Alexander Program. She also works as a Head Chef, Food Editor and Stylist for Natvia and the Sugar Free Living Magazine.

Cardamom Kulfi Categories Vegan Option

Diary-free

Gulten-free

Cold Dessert

Low Carb High Fat

Kids Treats

Keto

Low Carb

Recipe data Serves

5

Prep

10 minutes

Cook / Chill

Overnight

Nutrition Carbohydrates

Protein

Fats

Energy (kJ)

Calories

Serving size

4.7g

5.2g

29.4g

1290kJ

308

130g

Ingredients • • • • •

250ml Coconut Cream (1 cup) 250ml Coconut Milk (1 cup) 2 tbsp Honey 70g Pistachios, finely chopped (1/2 cup) 2 tsp Cardamom, ground

To Serve

• 2 tbsp Pistachios, finely chopped

Method

1. In a saucepan combine the coconut cream, coconut milk and honey, bring to the boil. Add the chopped pistachios and cardamom to the saucepan, simmer for 5 minutes.

2. Remove from the heat and leave the mixture to cool to room temperature.

3. Pour into dariole moulds and place into the freezer.

4. Once frozen, loosen the kulfi by dipping the mould in warm water. Top with ground pistachio before serving.

PAGE 28 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

Nutritional Information Tips

• For a vegan friendly recipe exchange the honey with maple syrup.

• Nutritional information is per kulfi.

ANTA Member Recipes Summer 2020

Larb Gai Categories Vegan Option

Diary-free

Gulten-free

Keto

Low Carb

Low Carb High Fat

Recipe data Serves

4

Prep

30 minutes

Cook / Chill

10 minutes

Nutrition Carbohydrates

Protein

Fats

Energy (kJ)

Calories

Serving size

5.1g

44.4g

26.1g

1840kJ

439

250g

Ingredients

• 600g Chicken Mince • 1 tbsp Coconut Oil • 5cm piece of Ginger, peeled and cut into matchsticks • 2 Lebanese Cucumbers, julienned • 2 Garlic Cloves, finely chopped • 1 Long Red Chilli, seeds removed, finely sliced • ½ Red Onion, finely sliced • 2 Carrots, peeled and julienned finely • 3 Spring Onions, sliced • ½ bunch Coriander, leaves only • ½ bunch Mint, leaves only, roughly chopped • ½ bunch Thai Basil, leaves only • 2 tbsp Unsalted Peanuts, roughly chopped

3. For the dressing, melt the honey in a tablespoon of hot water. Whisk all of the ingredients together in a small bowl (I like to taste my dressing at this point to ensure it has a nice balance of sweet, sour and salt flavours).

4. Place the chicken mince mixture into the salad and pour over the dressing. Toss to combine.

5. Serve topped with extra chopped peanuts and lime wedges.

Nutritional Information Tips

• For a vegan friendly recipe, exchange the chicken mince with 375g tofu, omit the fish sauce and use equal amounts of coconut sugar to replace the honey.

Dressing

• 2 tbsp Tamari • 60ml Lime Juice (1/4 cup) • 1 tbsp Fish Sauce • 1 tsp Honey • 4 drops Sesame Oil

To Serve

• Lime Wedges • Chopped Peanuts

Method

1. In a large frying pan lightly fry the ginger and garlic in the coconut oil until soft. Add the chicken mince and cook for 5 minutes, breaking up the mince into small pieces as it cooks. Set aside.

2. Place the rest of the prepared salad ingredients in a bowl and toss to combine.

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 29

ANTA Director Article Summer 2020

Kaitlin Edin

Acupuncturist | Eastern Herbal Medicine Chinese Medicine Practitioner National Acupuncture Branch Chair - ANTA

Chronic Fatigue Syndrome

A Clinical Evaluation and Eastern Perspective on Treatment Options Myalgic encephalomyelitis/ chronic fatigue syndrome, known commonly in Australia as ME/ CFS, is a complex, serious and debilitating condition characterised by extreme exhaustion, intolerance to physical exertion, sleep disturbances, cognitive dysfunction and pain. It “affects many parts of the body, including the brain and muscles, as well as the digestive, immune and cardiac systems, among others.

ME is classified as a neurological disorder by the World Health Organisation” 1. It has been known by a range of other names including “post viral syndrome, chronic Epstein Barr viral syndrome, myalgic encephalomyelitis (ME) and chronic neuromuscular viral syndrome” 2.

It is complex in part because there hasn’t been a clear or definite aetiology for Chronic Fatigue Syndrome (CFS), and without that it is difficult to determine the diagnostic guidelines to apply, even harder to then know which treatment options to unfurl. Without diagnosis all clinicians are in the dark.

As a medical condition it can be profoundly debilitating, and yet for decades it was considered by many, both in mainstream medical circles as well as within the broader public, to be as much a psychological condition as a physiological one.

And because of this, historically, it wasn’t taken as seriously as it should have been.

Due in part to this response, and the way that a PAGE 30 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

name can affect our expectations and understanding the Institute of Medicine (2015) have suggested that the label of CFS has so adversely impacted both patients’ own perception and the broader society’s understanding of the disease, that they believe a name change is required3.

They maintain that the label of CFS can ‘trivialise the seriousness of the illness and promote misunderstanding about it’. They have suggested it be relabelled “Systemic Exertional Intolerance Disorder (SEID), because as a name, it more effectively captures the characteristic nature of the disease; that exertion of any kind can adversely affect patients in multiple organ systems”3.

While as Eastern medicine practitioners (Acupuncturists, meridian therapists and Chinese Medicine Herbalists) we are not ‘disease name therapists’4 it is worth being cognisant of both the new terminology and interesting to consider what is in a name, if only to remember, naming can be prescriptive and narrow our thinking too much. To consider the ways in which early thinking about a disease tends to set researchers and clinicians down a particular route from which it is difficult to return can give us insight into our own diagnostic thinking and assumptions. To avoid confusion, and to use the standard Australian terminology, ME/ CFS or CFS will be used in this discussion.

ANTA Director Article Summer 2020

In 2007 there was a trial called “Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/ myalgic encephalomyelitis or encephalopathy”. Otherwise known as the PACE trial.

“It showed that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) gave moderate benefit in persons with CFS”5. Even now the most recent studies cite that CBT is a moderately useful therapy for ME/ CFS6,7. What they don’t explain is why.

The weight of evidence from the PACE trial suggested that CBT was of moderate benefit to participants. This was due no doubt to it being a strategy that helped patients cope with the illness because the quality of life is so constrained. One of the characteristics of chronic illness, is that living with the illness can often lead to depressive symptoms.

It should be noted here that physical trauma (such as a surgery or a car accident) or physical, mental, or emotional stress may contribute to the onset of the condition8. This though is different to saying something is causative. And to this end the authoritative voice on ME/ CFS in the United States is at pains to point out that it is a medical condition and not a psychiatric or psychological one3.

It is important to highlight the silence around this elsewhere. CBT is not a treatment for the illness itself, rather the complications of living with a chronic and debilitating illness. Following that logic, other forms of counselling and psychological support will assist also.

While the PACE trial has been widely accepted as good research and showed responses that indicated treatment possibilities, according to Bateman and Spotila (2013), even the “GET should be administered with great caution… because even mild exercise can provoke post-exertional malaise and severe symptom flare-up that correlate with gene expression findings” 9. And yet GET too is still mentioned in the most recent literature about ME/ CFS as being of moderate usefulness as a treatment strategy.

If the disease had been called Systemic Exertional Intolerance Disorder (SEID) in the first instance, a decade before the trial, I wonder whether we’d even be considering both therapies as some kind of treatment strategy for it.

So, before we get to how we might think about it from an Eastern framework, let’s have a look at the

medical criteria sets for ME/ CFS because they will be part of our thinking about diagnostics and treatments and give an indication of what symptoms patients generally present with.

In the late 1990’s the diagnostic checklist was extensive. There were major and minor diagnostic criteria. The language of the checklist from that time is revealing in itself: “The Major Diagnostic criteria, of which both criteria must be met [were]: 1. New onset of persistent or relapsing debilitating fatigue (of muscular type) that impairs daily activity to below 50% of the premorbid level for at least six months.

2. Complete exclusion of other physical or psychiatric disorders that may produce similar symptoms”.

“The Minor criteria, where either six symptoms, plus two physical criteria or eight out of the 11 symptoms had to be met, are listed as follows: 1. Mild fever 2. Recurrent sore throat 3. Painful lymph nodes 4. Muscle pain 5. Muscle weakness 6. Prolonged fatigue after exercise 7. Generalised headache 8. Neuropsychiatric complaints (poor concentration, confusion, excessive irritability, depression) 9. Migratory joint pain 10. Sleep disturbances 11. Rapid onset of symptom complex” 2.

These days, some 30 years on, the diagnostic criteria are more succinct; there is a reduced burden on patients to ‘meet the list’, less presumption of it being ‘all in your head’ and a recognition that it can fundamentally affect all areas of life, wellbeing and decrease living standards. Recent data shows that two thirds of 1000 surveyed participants lived below the poverty line10. A staggering burden primarily on women who already face considerable economic suppression and disadvantage11.

The current United States guidelines for differential diagnosis within a Western medical model require: “The patient has the following three symptoms: 1. A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest, and 2. Post-exertional malaise*, and THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 31

ANTA Director Article Summer 2020

3. Unrefreshing sleep.

At least one of the two following manifestations is also required: 1. Cognitive impairment* or 2. Orthostatic intolerance”. “*Frequency and severity of symptoms should be assessed. The diagnosis of ME/ CFS (SEID) should be questioned if patients do not have these symptoms at least half of the time with moderate, substantial or severe intensity”3.

“It is believed that many people with CFS don’t know they have it, [which tells us that there are a lot of people pushing through fatigue and cognitive impairment] or it is yet to be diagnosed”3, so we need to accept that even with all the available and current data, the full profile of the disease may still be unclear.

We do know the following: According to Yancey & Thomas (2012)12 women are twice as likely as men to have CFS. According to Emerge Australia (2019) it is more like 75-80% of patients suffering from ME/ CFS are women8. It was usually thought to occur between the ages of 20 and 40 years of age2, with onset often coming around the mid-thirties3. Onset in childhood, adolescence or older age is not unheard of within the literature however, and there are many who report that symptoms begin to emerge from the ages of 11 - 2010. The onset can be sudden or it can be gradual and the reason for why this is the case is not currently understood from a Western medical viewpoint. From an Eastern perspective, within its emphasis on individual constitutional factors, and pathogenic trajectories (the six divisions) and how the nature of disease is thought to progress, the answer to this could be well articulated with the diagnostic framework of lingering pathogens and the how it affects latency within the living human body.

“It is thought that approximately two out of every

Figure 1: Chronic Fatigue Syndrome

PAGE 32 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

three patients with the illness follow a clearly defined viral illness, however no single virus has been consistently associated with the syndrome” 2, although Epstein Barr is often part of the clinical picture3.

“Evidence from prospective cohort studies13 indicate that up to 10% of patients with post-infectious syndromes develop CFS, regardless of the type of infectious agent” 9. On their website, Emerge Australia (2019) states that “infection is the most common, but is not a universal trigger for the condition”, with environmental toxins also being a significant factor8.

“There are no diagnostic biomarkers or tests for ME/ CFS even now, however there are many biological abnormalities that researchers have found in people living with the condition” 1. And while researchers and clinicians are always cautious about claiming a definitive aetiology of CFS, there are “peer-reviewed publications which support a physiologic aetiology of CFS” 9. “These include an abnormal physiological response to exercise, altered immune function, changes in the bacteria in the gut, and impaired energy production”. There are studies too, that suggest that there are genetic changes and markers that are part of the ME/ CFS profile14 adding more weight to the notion that there are changes being wrought on the human organ systems that have a physiological cause.

At what point did Western medicine forget that a pathogen or combination of pathogens (virus, bacteria, parasite, etc.) might be able to wreak such damage on our bodies and our lives?

And this notion of a post-infectious syndrome is significant, because as Eastern medicine practitioners, it is the something we understand and treat pretty well. Within Chinese Medicine, “you are really studying different perspectives on how to look at the human condition through the lens of illness, and how to bring the individual back to a state of wellbeing” 15.

We call post-infectious syndromes lingering pathogens and have whole traditions devoted to its

ANTA Director Article Summer 2020

Figure 2: Chronic Fatigue Syndrome with a Vector-borne Pathogen

treatment. In this case, what is important is not what we call a syndrome or even its criteria but how we understand the constellation of symptoms and the treatment principle we use to address them.

The Shang Han Lun, a classic diagnostic and herbal treatment text outlines the extent to which the pathogens of cold, heat, dampness and wind affect the human body and its ability to recover. All these ‘climatic’ characteristics are terms that refer to both the external and internal worlds. They are alternative terms for things like fungi, viruses, bacteria, parasites, microbes. And in ME/ CFS it is possible that there is a constellation of these pathogens at work.

So let’s try and find the dynamic at play here, let’s come back to first principles and start by mapping out what we might know or see in the clinic.

Figure 1: We can start with the exertional and profound fatigue and a range of symptoms that we think resemble ME/ CFS. First, we need to consider or ask whether there is a possibility of an infectious agent (either latent or active). Has there been a vector-borne pathogen?

Tick, mosquito and less often spider bites can introduce a range of bacteria, microbes, parasites, viruses and toxins into the human bloodstream.

We need to consider these extremely carefully. For example, while Lyme Disease is not recognised by the

mainstream medical establishment in Australia16 it is remarkably similar in its symptomology to CFS. Figure 2: If there has been exposure to a vector like a tick or a mosquito, we need to consider whether it is still active or whether it has gone into latency.

If it has gone latent, or it is a ‘late stage’ infection from said vector, then it is likely to be across multiple organ systems, and may well be refractory. Consider whether there is lingering heat in the system or whether it has gone ‘cold’.

If there is active heat in the system perhaps it’s because it has been caught early or the person has a strong constitution and the wei qi is mounting a defence. It is important at this stage that the yang qi of the body is as protected and nurtured as possible.

Pathogens can in fact be in all of the yang levels simultaneously. Particularly if we accept that the Taiyang can represent the nerves and nervous system, Yangming expresses in the digestive system and Shaoyang syndromes can compromise the fascial layers and soft connective tissue.

Even with a vector, don’t discount what else might be happening in the environment of the patient.

Figure 3: If there is no vector that the patient reports, still consider that there may well be infectious agents, although they are unlikely to be systemic unless the THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 33

ANTA Director Article Summer 2020

Figure 3: Chronic Fatigue Syndrome without a Vector-borne Pathogen

person is extremely weak. Yang qi can be weakened by a number of factors, (including childbirth, traumatic or highly stressful experiences, overworking, surgery etc.) of course, once in a weakened state the likelihood of contracting opportunistic infections is heightened.

Consider also that for some systemic viral or bacterial infections (such as Lyme or Lyme-like infections) there is a possibility that exposure is second hand, through relational or sexual partners and so may be less likely to be considered.

The steps in figure 3 can assist you in making a differential diagnosis if you feel that the symptom set is not really sitting within the ME/ CFS frame, but further consideration of the environment could be warranted with or without a vector. The external environment can include things like black mould, or even C02 build up in houses that are well sealed and insulated or the use of un-flued gas heaters in the winter. These symptoms might tend to fluctuate with the seasons. Other toxins might include exposure to cleaning solvents or materials, pesticides and herbicides, or heavy metals (from old paints etc.).

The social environment can be where much of our stress comes. Family of origin dynamics, relationships, employment or financial worries can be just as toxic in the burden of stress as any pathogen. Relationship factors can be fracture lines that exacerbate ‘pathogenic factors’ and bring up underlying dynamics such as depression or anxiety. Birth, childhood or PAGE 34 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

personhood trauma can and may continue to be significant stressors in a patient’s life. Under these conditions of profound or ‘toxic’ stress, even a mild cold for someone in this condition could be overwhelming.

The internal environment can include poor or inadequate diet, food additives or allergens, compromised immunity from other factors, any kind of illness and poor recovery, hormonal dysfunction due to stress, and/or uterine or ovarian disruptions medications or addictions, constitutional issues of the heart or lung. It is also important to remember that liver function in people with ME/ CFS is often impaired, so sometimes herbal or ingestive treatments have to be done very carefully and slowly. Because of an impaired immune function Candida is a common co-current infection and can impact on digestive function and permeability2.

Social, emotional or internal organ weakness can create fertile ground for the MS/ CFS symptom constellation to appear. How often have we seen someone in the clinic who feels like everything has ‘gone wrong’ all at once, or has had one thing after another such that all their internal and external resources are depleted? This is a state of significant vulnerability to opportunistic or latent infections.

Figure 4: The full diagram here gives a quick overview of how we can map the symptoms and get a handle

ANTA Director Article Summer 2020

on the complex factors inherent in this syndrome.

How we then treat is up to our own understanding and preferred diagnostic focus, patient preference and the realities of the present moment within treatment sessions.

Treatment Strategies

Treatment strategies for ME/ CFS as part of an Eastern medicine paradigm can include insertive acupuncture treatments: Dr Tan’s Balance method techniques, particularly his advanced spiral balances for multisystem conditions are extremely helpful17.

The Meridian Conversion and Seasonal balances which are also part of the advanced Si Yuan system can affect a number of meridian systems with very few pins, so this is an elegant and powerful way of working at several levels and keeping the pins to a minimum17.

Susan Robideaux’s scalp and abdominal acupuncture treatments18 in combination also work well if your patient is more robust or there are significant cognitive or emotional components in the picture.

Non-insertive treatments like Dr Manaka cord treatment protocols19 or treatments from within Japanese meridian therapy traditions can be helpful for those particularly weak patients. These treatments will usually involve the use of ion pumping cord treatments as well as needle head moxa at the

back shu points which can be an important way of supporting the wei and yang qi of the body.

Cord treatments will often use the Eight Extraordinary Meridian connections, but as the cords are thought to move wei qi (more so than yuan qi) these treatments can be great for structural issues, including orthostatic intolerance. Needling in these treatments is often very shallow or kept to a minimum with taped silver spike points used instead.

Non-retaining needling techniques along the spine can also be supportive of the yang qi if the patient is not robust4. Meridan Therapy silver needle or teishin techniques are also of great benefit to support the wei qi and mood of the ME/ CFS patient.

Direct moxa treatments can be particularly rejuvenating for those patients with latency or cold type presentations. If moxa is used on its own as a therapy (with a combination of chinetsukyu, okyu and tiger or elephant warmer) it will assist consolidation of the yang qi and support the nervous system.

Sometimes patients are too weak for inserted pins, so this is a wonderfully relaxing and supportive treatment strategy.

The indirect forms of moxa (such as the platform or ibuki moxa, as well as moxa sticks) can be good for home use, especially getting the patient or a support person to moxa St36 and GV20.

Figure 4: Quick Guide to Map Chronic Fatigue Syndrome

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 35

ANTA Director Article Summer 2020

If your patient is strong enough and can manage guasha (often the thin Liver Blood types love this, the Spleen damp people less so) surprisingly this is an excellent way of releasing the waste and toxins that get sequestered into the connective tissue, and the Shaoyang.

A good way to support lymphatic drainage after guasha, especially if there is some congestion or swelling in the lymph is with the application of essential oils (in dilution). The ones especially good for lymphatic congestion include Bay Laurel, Eucalyptus, Fennel and Grapefruit15. Castor Oil can be a good carrier oil for removing toxins and resolving phlegm and damp.

Castor Oil packs as a home recommendation can be a good way to engage the patient in their healing and support the practitioner led treatments. Another great way to assist lymphatic decongestion is with dry brushing, particularly around the creases of the body20.

Holistic Aromatherapy from within a Chinese Medicine diagnostic model and application using the Eight Extraordinary Vessels can be a beautifully calming and supportive treatment option, very good if there are issues for the patient around their blueprint or curriculum as Yuen (2018) terms it15. The challenges of this syndrome can go very deep for people.

Blends of oils for topical application, or even single oils in diffusers can work very well. They work effectively at a number of levels of the human energy system, are generally well tolerated and don’t require much effort from a generally already overwhelmed patient.

PAGE 36 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

(For more on the application of oils within a Chinese Medicine framework see Jeffrey Yuen (2018)15 and an interesting book Essential Oil Analogues of Traditional Chinese Medicine Herbal Formulas by Aldrich & Bornemann (2013))21.

If we fully embrace the energetics of the Eastern medical approach, we maintain our vibrancy as practitioners as well as the opportunity to perceive differently. Before we were herbalists or acupuncturists, we were translators. We spent years translating the terms of the dominant (Western) medical language and perspectives into a different medical and philosophical engine. Often Chinese Medicine is applied like a filter, put on over the top of our Western medical knowledge and understanding.

This will take us only so far. If we understand the dynamics of the physical and energy body from within the Eastern medical paradigm, account for the individual constitution, and consider the many ways and approaches we can use to treat, it doesn’t really matter whether we call it CFS, SEID, or a Lingering Pathogen. We will always have something to offer to our patients.

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A quiz can be found in your ANTA Member Centre for this article. Email your completed quiz to thenaturaltherapist@anta.com.au to receive your certificate.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

The compound form of magnesium – a critical determinant of bioavailability

By Samuel Peters (BHSc Naturopathy)

Magnesium deficiency is an increasing concern Whilst the typical western diet may provide enough magnesium to avoid a frank deficiency, it is unlikely to provide the levels required to maintain optimal magnesium levels. Recent evidence suggests that the current recommended daily allowance (between 300 and 420mg/day) is insufficient to provide optimal health and longevity and that many individuals require an additional 300mg per day in order to lower their risk of chronic disease, which may require the use of additional supplements.1 There is a growing body of literature which suggests that subclinical magnesium deficiency is one of the leading causes of chronic diseases and should now be considered a public health crisis.1

These findings have been confirmed by more recent studies which have found that magnesium citrate increases both serum levels and urinary excretion of magnesium over a 24 hour period, compared to magnesium oxide.5 In another clinical study, magnesium citrate was found to equally increase plasma magnesium levels when compared to magnesium oxide, however intracellular ionic magnesium was significantly higher in leukocytes of the individuals supplemented with magnesium citrate.6,7 Recent preclinical research also suggests that magnesium citrate is able to dose-dependently increase blood, brain and muscle tissue magnesium concentrations, with magnesium glycinate effectively increasing brain and blood magnesium concentrations.2

Choosing superior magnesium forms

Gastric acid secretion and magnesium absorption

Magnesium can be chemically classed as either organic or inorganic magnesium.

Inorganic forms of magnesium found as salts, metals, minerals and other carbonfree forms (such as chloride, oxide and sulphate) are generally more poorly absorbed in the gastrointestinal tract when compared to organic forms such as magnesium citrate and magnesium glycinate.2 Although consensus has yet to be reached, numerous clinical studies have found that the organic forms of magnesium show the highest rate of bioaccessibility (dissolution and availability of the active drug in the digestive tract), and bioavailability (proportion of the active drug that reaches systemic circulation), compared with inorganic magnesium salts.3

The solubility of the compound form of magnesium appears to be an important precondition for absorption, with increased solubility correlating with increased absorption.8,9 In a simulation of various concentrations of gastric acid secretion, magnesium citrate was found to have a significantly greater solubility compared with magnesium oxide at all concentrations. Importantly, at a concentration of complete acid inhibition (resembling a state of achlorhydria), whilst magnesium oxide was virtually insoluble (0.8% magnesium recovery), magnesium citrate was still highly soluble (55% magnesium recovery).10 This finding may be of significance for individuals with impaired gastric acid secretion (such as the eldery, anxious or medicated patient) as most magnesium is thought to be absorbed as an ion (Mg2+) through the GIT.8,9

Clinical studies In a randomised, double-blind study, both magnesium citrate and magnesium amino acid chelate were found to be more bioavailable than magnesium oxide, exhibiting significantly greater 24hr urinary magnesium excretion. In addition, magnesium citrate significantly increased salivary magnesium concentration whereas no change was observed with magnesium oxide supplementation.4

For further clinical support, see BioMedica’s technical sheet ‘Assessing magnesium forms for optimal clinical outcomes’ at biomedica.com.au/magnesium References available on request

BioMedica Nutraceuticals P 1300 884 702 | www.biomedica.com.au

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 37

Are complex probiotics a solution for managing the treatment of SIBO?

By Evan Hayes, lead developer of Scobiotics and Factors Group ANZ Managing Director While many things have changed in the last two thousand years, Hippocrates’ idiom that everything starts in the gut is truer now that it ever was. We know the gastrointestinal tract is a complex system, responsible for digestion, immunity, absorption of essential nutrients, vitamins and minerals, homeostatic control of energy balance and detoxification.

The complexity is problematic. The body has evolved elegant, conserved solutions to manage these complex processes, however we still haven’t determined the key mechanisms by which it does so. Less researched and understood relationships are those between the bacterial communities as well as the effects they have on each other and on different microbiota such as yeast and fungi. We are also still to identify exactly how these syntrophic interactions are paramount to optimal health.

Of growing concern to practitioners is small intestinal bacterial overgrowth (SIBO). SIBO can be caused by dysfunction such as blind loops. This results in a change of environment in the small intestine, which allows for an overgrowth of bacteria in a region where, typically, there are very little. This imbalance can cause abdominal pain, fatigue, increased gas and constipation. Treatment of the condition attempts to determine the root cause, eradicate the invading bacteria and restore normal functions such as the migrating motor complex.

Research has revealed a more holistic approach to supporting and restoring gastrointestinal homeostasis by including beneficial bacteria, as well as other potentially beneficial organisms and nutrients.

This innovative science has led to the development of ScobioticsTM by leading practitioner-only brand, Bioclinic Naturals. ScobioticsTM are a more complex form of probiotic that is made up of syntrophic blends of mixed cultures of bacteria, fungi and blue-green algae.

SIBO Balance is a ScobioticTM blend for the support of small intestinal health and function. It can help relieve SIBO symptoms with metabolite production allowing probiotics to flourish and multiply faster, while the production of chemicals allows the eradication of invading pathogens. Multiple colonies of Lactobacilli can then act as intestinal competitors, adhering to the small intestinal site wall and stopping bacteria from proliferating.

Containing garlic, standardised to allicin as a potent antimicrobial, and Iberis amara, SIBO Balance is engineered to help support gastrointestinal health, and relieve symptoms such as gastrointestinal inflammation, bloating and gas. Arthrospira platensis or spirulina, is also present as an anti-inflammatory, antioxidant and is a rich source of nutrients. SIBO Balance is a unique combination of ingredients supporting a healthy small intestinal environment.

Given the current level of research and the extreme complexity of gut communities and relationships, we are looking through a keyhole to diagnose and treat SIBO. To even attempt to add value to the GIT microbial colonies, we need to be using more of the microbiota than current probiotics do. This would not only better treat SIBO, but also return the body to homeostasis and therefore harmony once more.

SIBO Balance provides all of the necessary tools to do this effectively and should be considered as a preferred approach in cases of small intestinal dysbiosis.

To find out more about the range visit www.bioclinicnaturals.com.au/scobiotics.

PAGE 38 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

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Courses & Seminars Summer 2020

ANTA Member Article Summer 2020

Kerry Bone

Founder and Director of Research at MediHerb Principle of Australian College of Phytotherapy Adjunct Professor of New York Chiropractic College

Can Herbs Help During Cancer Chemotherapy?

Countless surveys have shown that a significant percentage of cancer patients undergoing chemotherapy also take herbal supplements at the same time. For example, a United Kingdom systematic review of published studies found usage of herbal medicines ranged from 3.1% to 24.9% of cancer sufferers1. The reasons for this are many. An Australian survey of breast cancer patients identified the following key reasons for the use of vitamin and herbal remedies2: • To improve physical wellbeing (major reason) • To boost the immune system (major reason) • To reduce chemotherapy side effects (major reason for herbs only) • To improve emotional wellbeing • To prevent recurrence • To assist in treating the cancer • To reduce symptoms

In my clinical experience the key motivator for patients seeking to take herbs during chemotherapy is empowerment, taking control, being an active participant and wanting to do everything possible to achieve the best outcome. A key part of this goal is to minimise the often terrible and debilitating side effects of the drug treatment. But is such a practice safe and beneficial? Do herbal treatments interfere with the chemotherapy? In the light of such uncertainties it is best to take an evidence-based approach.

Tonic and adaptogenic herbs have always been thought to have non-specific (whole body) antitoxic PAGE 42 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

effects. Because they improve the resistance of the whole body to the stressor, the chemotherapy, they are less likely to interfere with its effects at a cellular level. The herb here with best evidence is Ginseng.

In a key long-term Korean study, the impact of Korean Red Ginseng (Panax ginseng) therapy on postoperative immunity and survival was investigated in patients with gastric cancer3. Forty-nine patients who had undergone gastric resection with lymph node removal by the same surgeon for histologicallyproven AJCC (American Joint Committee on Cancer) stage III gastric adenocarcinoma were enrolled in the trial. After the application of predefined exclusion criteria, 22 patients were given Ginseng (4.5g/day) for the first six months after surgery and 20 acted as placebo controls. All patients were also treated with chemotherapy each month for six months after surgery. The study demonstrated five-year disease-free survival and overall survival rates that were significantly higher in patients taking Ginseng compared to controls (68.2% versus 33.3%; 76.4% versus 38.5% respectively, p<0.05). In other words, the patients taking Ginseng during their chemotherapy lived substantially longer!

Ginseng has also improved energy and quality of life (QOL) during chemotherapy.

ANTA Member Article Summer 2020

Sun Ginseng is a Red Ginseng extract manufactured under a patented process in Korea.

A randomised, placebocontrolled, double-blind trial in 53 cancer patients undergoing â&#x20AC;&#x2DC;usual medical treatmentâ&#x20AC;&#x2122; found that 12 weeks of 3g/day of Sun Ginseng significantly improved QOL (p=0.02) and general health (p<0.01)4. A well-publicised study in 282 cancer patients on American Ginseng Root (Panax quinquefolium), found that 750 to 2000mg/day for eight weeks significantly reduced cancer-related fatigue5.

I also recommend other adaptogenic herbs during chemotherapy. Two key herbs here are Withania and Astragalus.

There is certainly evidence of benefit for the latter, which is commonly used in China (often in combination) during chemotherapy.

A meta-analysis of 34 randomised clinical trials involving patients with non-small-cell lung cancer treated with platinum-based chemotherapy and Astragalus-based Chinese products suggested a benefit from the combination6. Most trials involved formulas featuring Astragalus, but two were of Astragalus alone. The herbs were administered by injection in around one third of the trials. Twelve trials measuring outcomes reported significantly lower mortality rates after 12 months when Astragalus was combined with chemotherapy (risk ratio 0.67). Nine studies reported significantly lower mortality rates after 24 months when Astragalus was combined with chemotherapy (risk ratio 0.73). Most of the studies included were of low methodological quality.

A Cochrane review identified four relevant trials where a decoction of Astragalus or a formulation featuring Astragalus were combined with chemotherapy regimens in patients with colorectal cancer7.

Chemotherapy-induced nausea, vomiting, and low white cell count were all decreased by administration of Astragalus decoction, and immune function was improved. The trials were of low quality, suggesting larger, more rigorous trials are needed to confirm these results.

Codonopsis is widely prescribed in China in conjunction with conventional cancer therapies to reduce side effects and support immunity8. It was used as an adjuvant in 76 cancer patients during radiotherapy and reduced its immunosuppressive effect. Pharmacological studies suggest it can help white and red blood cell production9.

Nausea is a common side effect of chemotherapy. A randomised, controlled trial compared Ginger Root Powder 1000mg with the anti-nausea drugs Metoclopramide and Ondansetron in 50 cancer patients.

Ginger Root was as effective as Metoclopramide and slightly less effective than Ondansetron in controlling vomiting and relieving nausea10. Chemotherapy-induced delayed nausea was significantly reduced by a high protein meal and drink in conjunction with Ginger Root (1000mg Ginger Root Powder) twice a day in a controlled clinical trial11. In a large clinical study funded by the United States National Cancer Institute, 744 cancer patients, mostly with breast cancer, were included in a double-blind trial12. Patients were either given a placebo or three different doses of Ginger Root as 250mg capsules for six days, starting three days before chemotherapy. On the day of chemotherapy, they were also given a standard antiemetic drug. All the tested doses of Ginger Root significantly reduced nausea compared with the placebo, and surprisingly the largest reduction occurred for the lower Ginger Root doses (500mg and 1000mg).

Mushrooms can also play an important role and can help mitigate the damage to the immune system from chemotherapy, due to the beta-glucans found in their fruiting bodies. The results of a randomised, doubleblind, placebo-controlled trial indicate that Ganoderma Extract (equivalent to 90g/day of mushroom) may play an adjunct role in the treatment of patients with advanced lung cancer. After 12 weeks of Ganoderma Extract treatment, stable disease occurred in 35% of patients, compared to 22% in the control group.

Palliative effects on cancer-related symptoms and an increase in Karnofsky performance score occurred in a greater number of patients receiving Ganoderma Extract13.

Ganoderma Extract enhanced the immune responses of patients with advanced stage cancer (mainly lung, breast, liver, colon, prostate, bladder, brain) in an uncontrolled trial of 12 weeks duration. Compared to baseline values, treatment with Ganoderma Extract resulted in a significant increase in the mean plasma concentrations of interleukin (IL)-2, IL-6 and interferongamma and in the mean natural killer activity14.

Similar results were observed in a trial involving patients with advanced lung cancer. In addition, treatment with Ganoderma THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 43

ANTA Member Article Summer 2020

Extract (equivalent to 81g/day of mushroom) decreased plasma tumor necrosis factor-alpha in more than half the patients. Most of these patients experienced less body weight loss, chronic nausea, fatigue, insomnia and profuse sweating15.

Treatment with Ganoderma Extract for more than 12 weeks in uncontrolled trial lead to a stable disease state in 26.6% of patients with advanced solid tumours (mainly liver, lung, breast, ovary)16. In other uncontrolled trials Ganoderma Extract improved the immune function and stamina of debilitated patients and cancer patients undergoing chemotherapy and radiotherapies17.

Polysaccharide K (PSK) is a beta-glucan isolate from the fruiting body of the mushroom Coriolus (Trametes) versicolor approved as an adjunctive cancer treatment in Japan. The usual dose is 1.5g - 3g daily in conjunction with chemotherapy, but also with radiotherapy and surgery. Significant improvements in five year survival rates in breast, lung, oesophageal, colorectal and gastric cancers have

PAGE 44 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

been demonstrated in controlled clinical trials, and in one meta-analysis (n=8009) from eight randomised controlled trials (RCTs)18.

A 2015 Canadian systematic review of use of PSK in lung cancer patients undergoing chemotherapy included 11 clinical trials of which six were RCTs. The evidence showed benefits for a range of endpoints, including immune and haematological function, performance status and body weight, tumourrelated symptoms such as fatigue and anorexia, as well as survival. The review concluded PSK may improve immune function, reduce tumour-associated symptoms, and extend survival in lung cancer patients19.

A final word of caution: Any herbs, other than the ones mentioned above, are best used cautiously during chemotherapy (unless you have good evidence that they will not interfere). If there seems to be a good reason for taking them, they are best used around the chemotherapy, that is not within a 24 to 48-hour window either side of the actual chemotherapy treatments.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

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Vitamin K2: Building Bones While Supporting Hearts Vitamin K2 can improve functional equilibrium of key systems – namely the cardiovascular and skeletal systems – that ensure robust, active health.

Balance for both systems are achieved via Vitamin K2’s interaction with Calcium, which on its own can create an undesirable seesaw effect. On one side, incoming Calcium is utilised to help build bone. In the opposite direction, Calcium tends to settle inside arteries and soft tissues, causing them to stiffen and impede blood flow.

Vitamin K2 simultaneously supports both systems by activating proteins already present in the body: • Osteocalcin binds calcium to the bone mineral matrix • Matrix Gla Protein (MGP) inhibits calcium from depositing in arteries and soft tissues But if the body does not have enough Vitamin K2 daily intakes, the proteins are not prompted to work, leaving bone and cardiovascular health compromised. More important to note: it is near impossible for those consuming even the healthiest diets to obtain adequate Vitamin K2, which makes supplementation a viable alternative.

Ground-breaking clinical trials demonstrated extraordinary results in healthy postmenopausal women supplementing with 180 mcg/day of MenaQ7 Vitamin K2 for three years: • Bone measurements showed improved bone mineral density and content, leading to increased bone strength • Cardiovascular measurements revealed improved arterial flexibility2 1 2

Knapen MHJ et al. Osteoporos Intl, 2013;24(9):2499-2507.

Knapen MHJ et al. Thrombosis and Haemo, 2015 May;113(5):1135-44.

THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 45

ANTA Member Article Summer 2020

George Thouas, Ph.D

Head of Research & Development, Max Biocare Pty. Ltd

More Insights on Fucoidans: A Focus on Anti-Viral and Infection Control Properties Introduction We have no doubt read with interest in recent issues about the versatility of fucoidans, the family of sulfated polysaccharides derived from marine seaweed species. Fucoidans have attracted intense interest from practitioners around the world, particularly in Asian countries, for their immune-boosting, anti-inflammatory, blood pressure lowering and cardioprotective Anti-Viral and Infection Control Effects

Viruses are microscopic, particle-like microbial pathogens that randomly invade the body via entry points, especially the oral and nasal cavities, and open wounds. Although transmission is random, the odds of cross-infection are greatly increased with more contagious and typically seasonal viral species, and with closer proximity1. Once inside, viruses then gain further access to the respiratory tract, gut, and other internal organs via the bloodstream. They undergo a carefully orchestrated ‘virus life-cycle’, which involves PAGE 46 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

benefits. They have even been explored as complementary therapies for patient support in oncology. Given the extraordinary events that have unfolded during 2020, it seems fitting to revisit the antiviral and immune stimulating roles of fucoidans. This article provides a brief focus on the therapeutic potential of fucoidans in the management of viral infections. binding to and crossing cell membranes to replicate their own genetic material, in order to multiply and spread to other sites2. Viruses achieve this by bypassing the host immune system and hijacking the cell’s own machinery to reproduce, which ultimately destroys the host cells, causing local tissue damage and toxicity. The host immune system then reacts by mounting local and systemic responses of varying intensity, as indicated by symptoms such as fever, lethargy and swelling with pain in affected tissues.

ANTA Member Article Summer 2020

Many synthetic anti-viral drugs have been engineered to target and block specific points of the virus life cycle. In a similar way, fucoidans from brown seaweed and other marine plant species have been shown to block the cellular attachment and entry of envelope-type viruses. This has been shown for Herpes Simplex Viruses (HSVs) and Cytomegalovirus (CMV)3, Influenza A Virus4, Dengue Virus5, Human Immunodeficiency Virus (HIV)6, and most recently Serve Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2)7. In this way, fucoidans behave as broadspectrum anti-virals with the capacity to interrupt the first steps of viral infection. Unlike standard anti-viral drugs, however, fucoidans also influence specific cellular and molecular mechanisms that support key immune responses specific to viral infection. In the case of Hepatitis B viral infection, pre-clinical evidence has shown that fucoidans from brown seaweed are able to stimulate the production of viral antigens and viral recognition proteins (interferons) by infected cells, resulting in dose-dependent declines in viral Deoxyribonucleic Acid (DNA) levels8. In the case of Avian influenza virus, other pre-clinical evidence has demonstrated that dosage escalation of Mekabu fucoidan led to increases in the production of neutralising antibodies to four different strains, while lowering post-infection viral loads in serum and lung fluids by more than 80%9. Furthermore, fucoidans have been shown to increase the activity of cytotoxic T-cells and natural killer (NK) cells, which are both involved in recognising and eliminating virally infected cells10.

As a support mechanism, the antioxidant properties of fucoidans have also been implicated in helping to restore more complex imbalances in the proantioxidant systems that occur during viral infection at different stages and in different tissue sites11. It is also worth noting that other trace compounds in fucoidan extracts, including iodine, may provide some nutrient level immune support roles. So in combination, these mechanisms may contribute to (i) slowing down viral replication; (ii) assisting in immune defence responses to infection; (iii) preventing tissue damage, and finally (iv) promoting recovery toward normal function. This has been highlighted in a recent report of improved lung pathology following fucoidan therapy, in a lab model of severe influenza infection12.

Clinical Evidence

In an open-label trial of a combination extract containing fucoidan with a micronutrient mix, involving ten healthy adults, intake was associated with an immune stimulating effect13. This was indicated by an increase in levels of cytotoxic T-, B- and NK cells, increased activity of phagocytes (debris removing cells) and decreased interleukin 6 (IL-6) production over a four week period. Another randomised, placebo-controlled pilot study of Undaria fucoidan found that fucoidan users showed significantly higher levels of leucocyte progenitor cells, and modest, dosage dependent increases in interferon-gamma (IFN-Y), which has distinct anti-viral involvement14. These results suggest that fucoidan helps to target some of the immune pathways involved in viral infection, as described above. Another randomised, placebo-controlled, double-blind study of Japanese nursing home residents with seasonal influenza showed that Undaria (Mekabu) fucoidan intake was associated with a significant elevation in antibody concentrations for three different influenza strains, compared to placebo15. For one strain, this effect was sustained for 20 weeks, while previously unvaccinated subjects showed a more enhanced stimulatory effect with fucoidan, compared to placebo.

Fucoidan also appears to show promise in more chronic and less common types of viral infections, as well as cases of immunosuppression. A study of 15 Japanese subjects with Hepatitis C viral infection who took fucoidan over an eight to tenmonth period demonstrated a progressive decline in viral Ribonucleic Acid (RNA) load and transient improvements in liver enzymes16. While in a group of 17 individuals with infections from a range of Herpes Virus Strains, Undaria fucoidan intake led to a promotion of healing rates and inhibition of skin outbreaks, with pain reduction in some cases, as well as stimulation of T-cell activity17. In sufferers of human lymphotropic T-cell virus (HTLV) infection (a retrovirus related to HIV), which is associated with more severe immune system problems, neuropathies and some cancers, fucoidan intake resulted in a THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 47

ANTA Member Article Summer 2020

significant decrease in viral DNA load18. Furthermore, in a sample of 11 individuals with newly acquired HIV infections, fucoidan administration resulted in a mild improvement in CD4+ T-helper cell production (cells that assist in recognising infected cells) and mild reductions in viral RNA after three months, interpreted as a stabilisation of their condition, with no adverse effects reported19.

One of the less well understood consequences of viral infection is the possible connection to cancer risk. It has been known for several decades that some viruses, through changes in our own DNA caused by remnants of viral DNA, can initiate changes that transform normal cells into cancerous ones20.

Such viruses have been referred to as â&#x20AC;&#x2DC;oncovirusesâ&#x20AC;&#x2122;.

Cancerous cells also behave very much like virally infected cells, in that they bypass the immune system and suppress the production of new immune cells.

Considering that fucoidan has been used safely in an oncology setting, and has a stimulatory effect

PAGE 48 | SUMMER 2020 | THE NATURAL THERAPIST VOL35 NO.4

on the host immune system in people who are virally challenged or immunocompromised, then characterisation of the most effective dosage regimes of fucoidans, and better understanding their target actions is worthy of further research.

Conclusion

Fucoidans from marine plants, such as brown seaweeds, show inhibitory effects on a range of viruses, as well as immune stimulatory effects that may counteract infections and their associated symptoms. Given the current historical events around viral infections, and the growing body of evidence described here, the relevance of fucoidans as a therapeutic option to improve clinical outcomes is relevant and provides more support for their use as a protective phytomedicine.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

ANTA CPE Guidelines Why is CPE Necessary CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge.

ANTA requires members to complete 20 CPE hours annually (January to December). Completion of 20 CPE hours annually is a requirement for your ongoing ANTA membership. It is also a requirement for provider recognition with all health funds and WorkCover authorities (if applicable). Note: If you do not complete 20 hours of CPE annually, your ANTA membership will be suspended until you have completed the 20 hours required. If you are registered with health funds and WorkCover authorities they will terminate your provider recognition.

Please note that 1 hour of CPE activity = 1 CPE point.

For members registered with health funds, please note that they carry out audits of your records each year to ensure 20 hours of CPE have been completed.

By the end of each calendar year ensure that you lodge details of 20 hours of CPE on your personal profile within the ANTA Member Centre. We recommend that you also keep a copy of your CPE records (e.g. attendance certificates) in the event of an audit by a health fund (if applicable).

Required CPE Hours ANTA members must accumulate a minimum of 20 CPE hours per annum (January to December). At least 50% of CPE hours undertaken must be related to the modalities you are accredited in by ANTA. Note: hours in excess of 20 completed in the current year are not permitted to be carried over to subsequent years.

• Give lectures/tutorials • Give CPE seminar presentations • Undertake further study • Complete short courses • Contribute an article to the ANTA journal “The Natural Therapist” and ANTA website • Contribute an article to other relevant journals, magazines and publications • Read articles in the tri-annual ANTA journal “The Natural Therapist” • Subscribe to and read other professional publications and journals • View webinars • View online DVDs or recordings on relevant topics • Listen to recordings on relevant topics • Radio/ TV broadcast on relevant topics • Read and research information on topics relevant to your practice Note: First Aid and CPR courses are not recognised or accepted as CPE by ANTA or Health Funds.

ANTA and other CPE seminars are communicated to members via the ANTA website, ANTA eNews and in “The Natural Therapist”. Members should regularly check the ANTA website for details of seminars.

Maintaining your own personal online CPE Record ANTA provides members with simple easy to use online facilities to complete and lodge their CPE hours in their own personal and permanent CPE online record fully maintained with the ANTA Member Centre (Note: your CPE history is retained for future reference and you should not delete any of your online CPE records as ANTA may be required to present them to health funds if requested).

Members registered with CMBA/ AHPRA must abide by the CMBA/ AHPRA CPD/ CPE Guidelines for the modalities of Acupuncture and Chinese Herbal Medicine and must also submit their CPE to ANTA (http://www.ahpra.gov.au/chinese-medicine.aspx).

To submit/ edit/ view your CPE hours online with ANTA • Sign into the ANTA Member Centre • Click on “CPE Activity” tab • Click on “Add a new CPE Activity” to add a new record or “Edit an existing CPE Activity record” to edit or delete a record

CPE Activities Members can undertake CPE hours in many ways including the following: • Attend ANTA free seminars • Research scientific information (IMGateway, EBSCOhost, eMIMS Cloud) • View seminar recordings and seminar presentations • Complete courses on ANTA eLearning Centre

Enter the following details for each activity: • Date of activity • CPE year (for auto calculation) • Resource, e.g. Book, Course, Seminar, Webinar, etc • Short description of activity (including author or link where applicable) • Number of hours of activity (if an activity is half an hour record as 0.5) THE NATURAL THERAPIST VOL35 NO.4 | SUMMER 2020 | PAGE 49

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