Any thoughts on why someone with a main complaint of fatigue would feel much more tired for several days following acupuncture treatment? The patient is a young man who had shingles late last year. He has no other symptoms. My initial thought was that his immune system may be fighting the virus still, diverting his resources to the fight and causing fatigue. Perhaps the acupuncture stimulated the immune system, further exacerbating the fatigue. Another suggestion on the Facebook group was if the virus could’ve caused the HPA axis issues.

Chris Kresser:  Yeah, I think those are both reasonable suggestions. One thing I’ve noticed both with my patients and myself is sometimes if a person is activated, they’re in some form of stress and their HPA axis is overstimulated. If you induce a parasympathetic response, it allows them to relax and let their guard down, so to speak. And then once they do that, they’re able to actually experience the fatigue that was always there, but they were not experiencing because their nervous system was activated. So if you imagine it this way, let’s say you’re in a really traumatic, I don’t know, let’s say your life is in danger and you’re having to run away from a threat for several days. I’m not thinking of a good example. Or I don’t know, some kind of crisis situation like there’s an earthquake and your house is destroyed, and then you move to a shelter and you’re there with hundreds of other people and you’re hardly able to sleep. Maybe at first you don’t actually feel exhausted and tired because you have so much adrenaline going through your system because you’re responding to this crisis, you’re taking care of your family. But then as soon as that crisis is passed and you’re actually able to get some rest, you go to sleep. But then you wake up and you’re totally exhausted, even though that’s after the first night of sleep you’ve had in a long time.

It’s kind of the same phenomenon. It’s like when the HPA axis is really hyper-activated, the patient could be really fatigued. But they’re not experiencing that because they’re experiencing the effects of the stress hormones. But then you do acupuncture and get them into a parasympathetic state, and the stress hormones go down, and then that fatigue that was already there, then comes through and the best response in that case would be to just rest. But a lot of people override that either because of their schedule or because they just don’t think they should be tired, and then they don’t respond in an appropriate way. So those are the possibilities that I would consider.