Chronic Fatigue Case Study

From Sick and Tired to Happy and Healthy

My first experience of the dramatic potential of Pañcakarma in Chronic Fatigue (Bala kshaya) came in 1897, when a patient who was suffering from fatigue and vitiated ojas decided to try a traditional ayurvedic preconception protocol. After seven days of purvakarma and pañcakarma she returned glowing and radiant.  "As I was showering off after my final sweat," she announced, "My energy returned through the crown of my head." Weeks later she was happily pregnant and is now the mother of an exceptionally gifted six-year-old.  In the years that followed, we have seen many patients recover from Chronic Fatigue with the help of judiciously administered Pañcakarma.  The following is a fairly typical case history.


Case Presentation

A twenty-eight year old woman presented with candida overgrowth, low-body temperature and fatigue.  She was able to work only twelve hours a week and found even that exhausting.  She was chronically constipated, had almost no appetite and developed nausea and bloating whenever she ate.  Over the past two years, her weight had dropped from an optimum of 135 lb. to only 116 lb.  She regretted the loss of her full figure.  She also suffered from hives, acne and allergies. She slept nine hours a night and craved sweets and chocolate. Her menstrual cycle was regular. She had a past history of jaw surgery at age seventeen and of five car accidents, which had occurred between three and five years ago. Onset of typical symptoms of Chronic Fatigue began shortly after her last car accident.

Her emotional history was significant, as she had experienced minimal nurturance as a child. Her mother was extremely neurotic and fitted a diagnosis of primary narcissism. Whatever our patient did was never good enough for her mother, who constantly expected more in terms of both filial devotion and worldly success. The emotional abuse from the mother was ongoing, with guilt being the context of every telephone call. In her depleted state, she was unable to process the emotions of suppressed anger, rage and hatred toward her mother, and remained in a generally flattened affective state. Although both the accidents and the systemic Candidiasis appear to be closely related to the onset of Chronic Fatigue, suppress emotions and long-standing abuse appear to have been the most significant factors. A year prior, she had seen an osteopathic physician who diagnosed Chronic Fatigue and yeast overgrowth. The treatments recommended by this practitioner were extremely helpful, but she was unable to continue, as she had to spend two hundred and fifty dollars a month on herbs and supplements.

On examination, she had a vata -kapha dual prakruti. Pulse diagnosis: Prakruti V3 P1 K3.  Vikruti: V4P2k 3.5. The pulse reading indicated impaired function of udana and apana vayu (the upward-moving and downward moving winds), pachak pitta in the stomach, and avalambak kapha, in the chest, consistent with her symptoms of constipation hyperacidity and congestion. showed impaired function. Ojas was weak with pitta vitiation, tejas was excessively high. The liver, stomach and bladder pulses were very weak with pitta. Pulse reading likewise indicated that rasa and majja dhatus were impaired, as indicated by her poor absorption and long-term depression. Her tongue was thickly coated and had tooth marks indicating malabsorption. Her nails had deep vertical ridges.


Preparation for Pañcakarma

She was prepared for pañcakarma with one month of herbal therapies aimed at treating her candida overgrowth, helping her bladder - as we suspected latent bladder infection - and getting some initial degree of doshic balance.  Her initial formula consisted of kaishore guggulu 2: Four Fragrances 0.5 each: Guduchi 5: Musta 2: Vidanga 1: Dashamula 2: Purnarnava 3: Haridra 3: Shankhabhasma 1. This was to be taken half teaspoon three times daily with two tablespoons Aloe Vera and a pinch of black pepper.She also took triphala tea at bedtime and a teaspoon of tikta grtam twice daily to help reduce tejas.  

Her lifestyle was pretty healthy, with a wholesome vegetarian diet and no addictions of unhealthy habits. She was encouraged to continue her yoga practice and to begin to learn to be gentle with herself.


Initial Pañcakarma

In light of her severe combination of physical and financial depletion, she was awarded seven days of low cost purvakarma and pañcakarma through a sliding scale program. She did three days of internal oleation with tikta grtam, and seven consecutive days of abhyanga with a in-house vata oil formula. To make this oil, equal parts of bramhi, ashwagandha and bala were combined. One part of this herb combination was added to 16 parts of water and cooked down to four parts of decoction. This was added to four parts sesame oil and slow-cooked until all water was evaporated.  A few drops of tulsi and sandalwood essential oils were added to the final product. She also had svedana herbalized with dashamoola and chandan and shirodhara with brahmi oil. Vaman was omitted due to her kapha depletion. She did three consecutive days of virechan using a tablespoon of castor oil in orange juice. Three bastis were performed, the first and third with four ounces of sesame oil and the second being a decoction basti using dashamula and guduchi. Because of her complaint of burning eyes with peeling eyelids, she was given netra basti with shatavari ghee.



At her initial appointment after her pañcakarma, she was not very happy.  Old emotions from childhood had been bubbling to the surface during and since her cleanse.  She felt as fatigued as ever and was quite discouraged.  Her ojas was still vitiated and tejas was still high, though the pitta in her vikruti pulse had reduced to V4 P1 K3.5. She was given a rejuvenative formula: Ashwagandha 5: Bala 5: Vidari 5: Guduchi 5: Purnarava 5: Yasti Madhu 2 as well as ashwagandhadi lehyam. At this time, she also began post-pañcakarma treatments: a month of weekly snehan, svedan, and basti.

Within three weeks her energy began to dramatically improve and she was feeling better than she could ever remember feeling. Her våta was lower and her kapha had returned to a normal level. Two months after pañcakarma, her ojas was no longer vitiated, her energy was good and her emotions had calmed. "It feels wonderful to just be 'tired' at times in place of the consistent deep fatigue," she remarked.  "Before, I was in prison. Now I am moving forward."


Continuing Progress

In the six-month period following her pañcakarma, she entered a phase of rapid physical and psychological changes and growth. Old emotions unable to move during her years of chronic fatigue bubbled to the surface and her symptoms became transitory, with rapid alternations of våta and pitta manifestations. She regained an interest in life and began seeking work and pursuing her purpose.

All the anger and rage that she had been unable to feel when fatigued now made itself apparent. She was advised to use journal techniques to help process her feelings, devoting time each day to free writing, unsent letters to her mother and other methods to help organize and synthesize her feelings. She was also taught to relate to her emotions in an ayurvedic manner, neither suppressing nor indulging, criticizing, not condemning, but simply bringing the light of awareness to bear upon them.

Six months after her initial pañcakarma, she elected to do a three day home cleanse, using the clinic's specially prepared manual. Her protocol at this time was essentially the same as in the previous pañcakarma, except that, having determined that orange juice was too acidic for her, she took her castor oil in ginger tea. She also received a marma point massage in-house.  During this pañcakarma more deep-seated emotions were released. Her appetite and hunger returned at a level she had not experienced in years.



This case history is fairly typical of our experience with using pañcakarma for Chronic Fatigue Syndrome. A sense of initial disgruntlement immediately after pañcakarma may often occur. It has been our experience that full benefits of pañcakarma are rarely obtained immediately after the initial protocol, but seem to depend upon the follow up treatments to clear residual toxins from the system. In addition, for those suffering from Chronic Fatigue, there may be a level of depletion experienced after pañcakarma, which is remedied by the rejuvenation plan. Usually, great improvement is noted within a month of pañcakarma. In women of childbearing age, the end of the first menstrual period following pañcakarma often marks a significant change. Some women with Chronic Fatigue Syndrome express that this menstrual period was more copious or had an unusual smell, suggesting that additional toxins are being released. At the far end, one patient took six months to recover his energy after pañcakarma, but then recovered fully and permanently from Chronic Fatigue Syndrome.



Pañcakarma is not a panacea for fatigue. As Dr. Lad points out [Ayurveda today, XII # 4] extremely weak patients are better suited to shamanan than to shodhan. Since candidiasis and bowel dysbiosis are typical of Chronic Fatigue Syndrome, it is important that patients are carefully prepared for pañcakarma for between one and six months, with special reference to treating candida overgrowth, parasites and chronic bladder infections. As we did in this patient's case, it is valuable to reduce pitta by herbal means before pañcakarma, so that there is the possibility of better svedan treatments, which could otherwise be severely limited due to the provoked pitta.

Not all cases of fatigue should be managed as Chronic Fatigue Syndrome. A variety of conditions including HIV, Hepatitis C and clinical depression can mimic chronic fatigue. Although pañcakarma may be beneficial in these situations too, the same dramatic benefit may not be found due to the persistent underlying condition. Furthermore, it is not enough simply to treat  chronic fatigue without addressing the underlying  beliefs and behavior patterns. Chronic Fatigue tends to occur in people who are adrenaline addicts or are extremely driven and hard on themselves.

In the case we have been describing, we worked consistently over a six-month period to encourage our patient to conserve her new-found energy for deeper healing, to resolve underlying anger and self-hatred and to cultivate a kinder and more relaxed way of dealing with herself. Without such deep changes, the condition will simply be recreated in the course of time. Emotional work, such as the awareness practices and journaling we used, are extremely valuable for those suffering from Chronic Fatigue Syndrome, for in our experience, in the majority of cases, there has been significant childhood trauma, with a residue of suppressed anger and hatred. Auxiliary therapies such as flower essences can be helpful in creating a new energetic pattern focused on self-love, while for those patients who are willing, meditation is an invaluable tool.



Chronic Fatigue syndrome may often be a metaphor for an inability, rooted in childhood abuse, to tap the abundant cosmic energies. Our patient felt herself a prisoner of the "sick, tired, and poor"syndrome. She needed, initially, an infusion of energy, in this case, in the form of sliding scale pañcakarma. Later, she began to learn to tap into the source of energy, becoming more vibrant, positive and self-sufficient. This was illustrated by her choice of a home cleanse for her second pañcakarma. She is learning, step by step, to give herself the nurturance her mother was unable to give her.



Reprinted with permission from Light on Ayurveda Journal, Vol. III, Issue 1, p. 18-20.


Please note: Articles appearing in the Banyan Vine do not necessarily reflect the opinions of Banyan Botanicals. This information is intended to apprise qualified health practitioners of possible Ayurvedic approaches. It is not intended as medical advice.