however, does show that ME might be caused by an enterovirus and, specifically, the Coxsackie
sub-group of enteroviruses.1(505) In the USA, research seems to be more oriented towards the
Epstein-Barr virus (the one that causes "glandular fever" or mononucleosis) as a cause of ME.
Some doctors restrict the definition of ME to post-viral symptoms with a gradual and insidious
onset and accompanied by evidence of persistent infection by enteroviruses. They distinguish
this from an acute-onset post-viral syndrome clearly starting after an acute infection. ME
symptoms appear either gradually and insidiously without an apparent infection, or after an acute
infection. Typically, this can be influenza or an influenza-like infection, a specific infection such
as varicella (chicken-pox), or gastroenteritis. The symptoms at this acute stage would include
fever, shivering, aches, swollen glands, and fatigue. Various other symptoms may be present
depending on the type of infection, such as vomiting, nausea, diarrhoea, earache, dizziness, sore
throat or cough.

After an apparent recovery from the above symptoms, the person starts to feel unwell again and
various symptoms persist ever after. The main symptoms of ME are pronounced muscle fatigue
and ache, poor memory and concentration, exhaustion and a persisting, intermittent, generally
flu-like feeling.

From a Chinese medical perspective, the distinction between "true" ME with insidious onset and
other types of general post-viral fatigue is irrelevant. Any type of post-viral fatigue, whether ME
or not, can be interpreted, diagnosed and treated according to the principles of Chinese medicine.
However, in my experience, there is a difference between "true" ME characterized by a
persistent viral infection, and post-viral syndrome, characterized by a disharmony of the internal
organs following a viral infection. The main way to distinguish these two conditions is in the
symptoms of muscle ache and a general flu-like feeling: in "true" ME these are very predominant
and persistent. Also, in "true" ME the pulse has a certain Full quality, which may be Slippery or
Wiry.

The diagnosis and treatment discussed in this chapter can however be applied to any type of ME
or post-viral fatigue syndrome.

Aetiology and Pathology

Chinese medical books have, since very early times, described the cause, diagnosis and treatment
of conditions similar to ME or post-viral syndrome. The three main conditions with which ME
can manifest are:

• Residual pathogenic factor


• Latent Heat


• Lesser Yang pattern.