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Recovering from Chronic Fatigue Syndrome: A Guide to Self-Empowerment

  [ 296 votes ]   [ Discuss This Article ] • November 1, 2002

By William Collinge, M.P.H., Ph.D.,

From Chapter 10 of Recovering From Chronic Fatigue Syndrome.

Breath, Energy, and Emotion

"I feel great. I have more energy now than than I've had in weeks. And normally I'm wiped out at this time of day."

John, through his tears, after a group breathing exercise late one afternoon at 7000 feet. In my clinical experience with CFS I have found breathing, energy, and emotion to be intimately related. While I have touched on them several times already, I feel they warrant a separate chapter because of their importance. In this chapter I will discuss how they complement each other. I will then present some exercises you can use on your own to create more energy through the breath.


Healing takes energy. Ironically, conventional western medicine does not actually have much to say about what energy is or how it works. However, oriental medicine has made a science of the body's energy for thousands of years. Here are some general principles of oriental medicine which I believe are especially relevant to CFS:

1. The body we live in is an energy system. Life-force energy, or "chi," is constantly flowing and circulating through our organs and along energy pathways called "meridians."

2. We are vulnerable to disease because of blockages, imbalances, or deficiencies in the flow of energy through the body. The flow of energy can be disturbed by many things, including too little or too much of certain food substances, too little or too much exercise, chronic emotional or physical stress, environmental toxins, drugs or alcohol, or other unhealthful habits.

3. When the body's defenses must face a pathogen such as a virus, cancer cell, or bacteria, it takes chi to fuel the response. If not enough chi is available, disease can ensue. In oriental medicine, CFS is considered a chi deficiency disease. Assuming CFS is triggered by a virus, then the immune system was not able to subdue the virus and prevent it from doing its damage. It now takes chi for the immune system to heal itself, return to normal, and, if the virus remains in the system, keep it in a latent state.

4. We are all endowed with an abundance of chi at birth. We can strengthen our chi in several ways, including nutrients, herbal medicine, treatments such as acupuncture, and a variety of self-help exercises, some of which will be presented later. Two of the most immediate ways you can work with your energy on a moment to moment basis are with fuller breathing and emotional expression.

I believe the insights of oriental medicine help illuminate the path of recovery in CFS. Health requires a flowing and harmonizing of energy. Anything you can do to promote a harmonious flow of energy will be of benefit. With this in mind, I would now like to revisit a frequent subject in this book, and a very important source of energy: emotion.


Picture for a moment a crystal prism, with a beam of light entering at one point, passing through, and being divided into a rainbow of different colors as it leaves the other side. Now imagine trying to place a finger over a part of the prism to block out the green from being included in the rainbow. What happens to the rainbow? It is impossible to block out one color without distorting or disturbing the entire spectrum of colors.

In this analogy, I would like to use the prism to represent the person, and the beam of light to represent the life force or life energy moving through us. The rainbow of colors represent the emotions, the various expressions that life energy takes as it passes through. All emotions come from the same source, and when we attempt to interfere with the flow of life energy through us--that is, when we try to deny or deaden ourselves to particular emotions--we distort the entire flow of our life energy.

We have all grown up in a culture in which emotion is poorly understood. Most of us have been taught that this mysterious, powerful, and sometimes unpredictable energy is something to be controlled. Much of our early childhood conditioning around this energy was to limit its expression. Our culture places great value on control and orderliness in many areas of life. Control represents a form of "mastery" which supposedly enhances our power and ability to lead a successful life.

Unfortunately, this attitude has pitted us against our emotions, resulting in harm to our health. It simply does not work to treat emotion as an inconvenience, as an adversary, to be controlled or avoided. What is needed is an attitude of allowing, letting this natural energy be expressed.

We consume a tremendous amount of energy in suppressing or repressing emotion. Perhaps you can recall a time of having to hold back anger or some other strong emotion because it would be disastrous to express your true feelings in the situation, such as when you are applying for a bank loan. You wanted to shout or punch the loan officer, but you controlled yourself. Recall how exhausted you felt afterward.

Now remember a situation in which you were openly angry and expressing yourself. Do you recall the level of energy or excitement you felt at the time? It was probably the most "alive" time of your day. This was because you were allowing a very powerful form of energy to flow through you. Every cell of your body was a little more awake because of that blast of life energy. This includes your white cells.

We need to avoid the mistake of labeling emotions as negative or positive, for they are neither. Emotion is simply raw energy, the energy of life. What we do with it determines whether it brings us negative or positive consequences.

We will now consider the primary emotions, all of which need full expression: anger, fear, sadness, joy and love. While there are other terms we sometimes use to describe our emotions, they can generally trace their roots back to these five basics.


Anger is a powerful energy of change. For Linda, it was through embracing her anger that she was able to take the step of leaving an abusive marriage. After that change, she was able to get her healing program on track and give herself the time and care she needed. She called this the turning point in her recovery.

There may not always be such dramatic actions needed to release anger. When action is needed, the anger is certainly a potent fuel. But it can also be vented effectively through writing it out in a journal, telling someone directly how you feel, or expressing it with the body, as we will see in a later exercise.

Many people erroneously equate anger with hostility and shy away from it, thinking that it is destructive. Anger and hostility are not the same. Anger is a simple energy which can energize actions, constructive or destructive. Hostility refers to actions which carry an intention to harm another.

If you grew up in an environment where anger was only expressed through hostile acts, this distinction may be harder to see. Still, if you are to have a positive attitude toward emotional expression, you must understand this difference. Only then can you reap the benefits of increased energy and mental clarity that can come from fully expressing your anger.


Fear, like anger, needs to be acknowledged and expressed rather than buried. It too is a form of life energy moving through you. By allowing its expression you can free yourself from the tension and depletion it can cause.

Recall a time when you felt fear and tried to contain it. Remember keeping a straight face, while feeling the tension or butterflies in your stomach, and the clenching and holding patterns in your body. Now recall the relief of sharing it with someone else. Talking about your fear is one of the most freeing things you can do. Recall Sharon's experience of reporting her fear to her husband during a panic attack (Chapter 5). Merely putting the feeling into words helps the fear dissipate. Let your fear come alive. Feel it as fully as you can. This may even mean exaggerating it at first, by shaking or shivering, or crying.

Confiding in another, writing in your journal, or having a talk with your inner child are all means of helping fear move through. Once you let it be felt completely, it will pass more easily.


Sadness is a healing form of energy, which helps us recover from loss. It may be loss of a relationship, a physical ability, an opportunity, a prized possession, or a dream. Sadness works much like the energy that knits a wound back together. As the healing process expresses itself, the remnants of the wound, such as any scar tissue, gradually diminish until they are almost undetectable. But we must allow the healing process to fully express itself. By scratching, rubbing, or otherwise meddling with the wound, we impede the process.

Likewise, healing from loss means the expression of sadness. As with the other emotions, this may be helped by writing, drawing, or sharing with another. It is like excising a wound.

Perhaps you can recall the relief of giving in to what you might call "a good cry." When we truly allow our sadness to move freely through us, there arises a feeling of lightness, harmony, and balance, even a "sweet" feeling. Some people experience a renewed sense of power and potency when they cry heartily.

The good feelings you feel after crying are the evidence that your body has undergone an energetic transformation. You have released a great deal of tension, and you have allowed the energy to move through you. And as it moves through, it helps restore balance in all your bodily systems, including your hormonal and immune systems.

Joy and Love

When we talk about unexpressed emotions, the focus is usually on anger, fear, and sadness. Little or no attention is given to our withholding joy or its close relative, love. And yet, you can probably recall many instances in which you felt genuine joy or love but felt inhibited about expressing it. Perhaps you can recall being left with a feeling of incompleteness.

Since emotion is the energy of life flowing through us, then to block the expression of our joy or love may be just as harmful as blocking other forms of emotional expression. And, as was discussed in Chapter 4 with the study of the Mother Theresa film, such feelings can have a stimulating effect on the immune system.

Bernie Siegel, M.D., has called love the most powerful chemotherapy of all. It may be that something about the experience of love, or even observing it, tells the healing system that life is worth living, and health is worth fighting for. Giving and receiving love involves a movement or flowing of energy. We have all probably experienced the greater feeling of well-being and heightened energy that comes from both giving and receiving.


What do you do a thousand times each hour, twenty-four thousand times each day, and eight million times a year, most of the time without realizing it? You inhale. And you exhale. Imagine the potential impact on your energy level with just a two percent increase in the volume of each breath.

Of all the sources of energy we use, breathing is the one most critical to our life on a moment to moment basis. You can live without food for days, but air, only minutes.

I have observed a common pattern of shallow and inadequate breathing in people with CFS. Perhaps it is because the syndrome somehow affects the neurology of the breathing process. Or perhaps there is a "background state" of anxiety which causes people to adopt a characteristic pattern of holding or constriction in their chest and rib cage.

In either case, attention to the breath is of particular value in CFS for several reasons. Breathing directly affects your energy level. Shallow constricted breathing keeps you close to a state of oxygen deprivation, hovering around the "poverty line." Yet your white cells are dependent on oxygen to do their healing work. Your marrow requires oxygen in order to produce new, healthy white cells.

Your nervous system depends on your breath to have the energy to orchestrate the myriad healing responses needed, including communication with your white cells. Oxygen is also needed to help dissolve and release toxins that have occurred as a result of illness, as well as normal metabolism.

An oxygen-rich environment supports all your healing responses, and actually inhibits viruses. On the other hand, an oxygen-poor environment makes it easier for pathogens, many of which are "an-aerobic" (living without oxygen) to thrive.

Then there is the relationship between anxiety and breathing. When we are in a state of anxiety our breathing tends to become more shallow and constricted. This of course is the opposite to what we need, which is fuller, deeper breathing to give us more energy to cope with the stress of CFS.

As discussed in Chapter 2 of my book, anxiety or panic attacks are common. And the simplest, most direct antidote to such attacks is to immediately move into full, relaxed, deep breathing. Many patients have discovered that before or during such attacks they have been actually holding their breath. Naturally the body will go into a panic reaction when it is suffocating, yet the person may not even think of the disturbance in breathing patterns as a factor in the attacks.


If someone asked you how to control strong emotions, what instructions would you give? Perhaps you would suggest that they slow or restrict their breathing in order to contain any emotions that might be welling up. We all learned how to control emotion this way, by contracting and constricting certain muscle groups, such as the jaw, the neck and shoulders, or the chest. Of course, holding the breath is most effective of all. It is the closest we can come to cutting off the flow of energy through the body. Energy, emotion, and breathing are all reduced together.

On the other hand, to increase any one of these can bring increases in the others. As shown in the illustration below, there is a circular relationship among them. With full, deep breathing, there is a dislodging or releasing of held emotion. And when full emotional expression is happening, invariably it is accompanied by fuller breathing. Finally, both of these conditions are accompanied by increased energy.

As a result, if you decide to improve your breathing, be prepared to feel your emotional life more deeply and powerfully. Understand that as you increase the availability of energy in your body through the breath, your emotions will come to the surface more readily. For this reason, having a healthful attitude toward emotion and its full expression goes hand in hand with tapping the healing power of the breath.

Full breathing will tend to release pent-up or repressed emotion from the past, which will in turn leave you in a more relaxed state. During a practice session of full breathing, you may find that emotions arise which you had no idea you had. While this may take some getting used to, allowing emotion to flow more freely can only be healing for your body.


Through conscious awareness of your breathing, and through specific practices, there is a great deal you can do to help your breathing. The most fundamental guideline is to practice abdominal breathing. This means that the point of greatest apparent movement is the abdomen or belly rather than the chest. You might think of the abdomen as like a bellows which opens, drawing air in, and then relaxes, pushing the air back out.

Of course as the abdomen moves and expands it is really making space for the diaphragm to move and the lower part of the lungs to expand, thereby allowing for more thorough filling and emptying of the lungs. With chest breathing, and without such movement of the abdomen, the lower part of the lungs are not so free to expand. Breathing will be shallower and less thorough.

Our culture tries to teach us that a tight belly is desirable, and many people try to hold their bellies in and make them stiff like a board. This may fit the current media image of the ideal figure, but it certainly is unnatural, and is counterproductive to healthful breathing. The abdomen should be free to move, with the belly as the point of origin of each breath.

Ideally, each breath is like a flowing wave that begins in the abdomen as it expands, followed by the rib cage and chest expanding. On the out-breath, the reverse takes place--the chest and rib cage relax, followed by the relaxation of the belly.


Below is an exercise designed to use gentle breathing movements for breathing more deeply, making more energy available to the body, breathing with less effort, and removing blocks to the breath.

Sit in an upright position with spine erect or lying flat on the floor, and move gently into deep, full, relaxed breathing which after a short while becomes more automatic. Breathe into your belly, letting your belly be the center of your breathing, letting your abdomen expand in all directions, and then let go.

Imagine someone rowing a boat across a pond, and see how their arms move in a continuous, circular motion, with no gap between one stroke and the next. Breathe in this same way, with no separation between breaths. Let each breath flow into the next.

Or picture a tidal pool near the ocean, and see how the water pours in, filling up the tidal pool, and then reverses flow, pouring back out, only to return with the next surge... See the continuing, endless process of flowing in and flowing out.

The key is to keep the breath moving. Let your entire torso be involved in the breathing, as if you are opening or expanding all the way from your pelvis to your collarbones. You may even feel a subtle lifting of your collarbones at the top of the breath before letting it all go... And as you exhale, gently draw your belly back in, as if you are reaching toward your spine with your navel.

It may help to use your favorite soothing, relaxing music in this process. Let the session last anywhere from fifteen to forty-five minutes, depending on what feels right to you. Some people experience tingling sensations or tightness in parts of the body such as hands, fingers, or lips. This indicates that energy blocks are being opened, and you need not be concerned about this. You also need not be concerned about hyperventilation, which is prevented by maintaining the breathing with long, slow breaths. Most of us hypoventilate -- that is, we don't take in nearly as much air (energy) as we could use.

As a result of this process, you can become more aware of the potential of your breath in daily life as a source of greater energy, and a device for relaxation and stress reduction.

This can be a very effective and gratifying exercise, especially for people in the midst of an energy crisis. Another benefit is that it can lead to deeper awareness and release of emotions whose presence may not have been fully acknowledged. For some people it can be a highly emotional experience, in which case professional support may be recommended.


In 1978, a team of researchers from Harvard Medical School, including Herbert Benson, M.D. visited China to study the mysteries of "chi kung" (also spelled "qi gong"). Every morning at dawn in the parks of Beijing, they witnessed hundreds of people practicing the movements and postures of this five thousand year old tradition.

Chi kung is the mother of all the martial arts. It is estimated that 1.3 million residents of Beijing use these practices, with tens of millions more nationwide. In Shanghai there is even a hospital devoted to treating cancer with these methods. Chi kung is the oriental counterpart to western behavioral medicine, and contains elements of meditation, relaxation training, visualization, movement, and breathing exercises. In the orient it serves both as a form of exercise for physical fitness, and a self-healing tool.

In CFS, chi kung can help both with symptoms and with building chi. As Colin states, "The chi kung is the one thing I've found that makes me feel balanced again. I used to get a lot of physical pain and nerve inflammation. It calms my body and my nervous system down."

The subject of exercise is a delicate issue. While some exercise is beneficial, it is difficult to know your boundaries and what might trigger relapse. Hence, chi kung offers a good option. It too is a form of exercise, but rather than challenging your aerobic or muscular fitness, it works directly with your energy, strengthening the body from within.

Chi kung uses breathing and visualization to generate and circulate energy. Some practices can be done sitting or lying down. Some even use sexual energy as a potent healing resource. Rather than thinking of sexual energy as something to be discharged through orgasm, it is circulated through the body to build more chi.


There are thousands of variations in how chi kung can be done. Some are specifically intended to promote healing of disease processes. An example of this is "the six healing sounds." While most of the methods of chi kung require instruction from a trained teacher, the six healing sounds are simple enough to give you a taste of chi kung. In my experience, this has proven useful for CFS since it requires no exertion, and can be done sitting or even lying down.

The intention of the six healing sounds is to help restore balance and harmony in the flow of energy through the body. This is done by breathing fully and making certain sounds, subvocally, on the out-breath. The vibrations of these sounds cause a resonance in certain organs where emotions are typically held. By making the sound you help energy flow through the organs, releasing any emotional energy that was stagnating there. This clearing or cleaning of the major organs helps the body as a whole to be in balance as a system of energy. It also helps you find a feeling of emotional well-being.

There are postures you can learn which accompany the sounds. A good resource for developing this practice is the work of Mantak Chia, a chi kung master who lives in the United States and has published several books which are available in popular book stores. (Also see Appendix C).

The six healing sounds can be a daily practice in which you set aside a regular time to concentrate on this exercise. Here is an introduction to the method:

It is recommended that you do all six sounds in one sitting. Sit with your spine straight on the edge of a seat. Repeat each sound six, nine, twelve, or twenty four times. As with all the breathing exercises, let the out-breath be long, thorough, and complete as you make the sound.

1. The lung sound. Place your tongue behind your teeth and with a long slow exhalation make the "SSSSSS" sound (as in "hiss"). As you do this, imagine that your lungs are releasing grief, sadness, or depression. Picture these energies being released through your breath, as if they are a cloud being exhaled from the lungs. As the release takes place, imagine that your lungs are being filled with feelings of courage and righteousness.

After completing the number of breaths, rest silently for a few moments while imagining that the lungs are continuing to make this sound. Then move on to the next sound.

2. The kidney sound. Form you lips in an "O" and with a long slow exhalation make the sound "WOOOOO" as if you are blowing out a candle. The sound is made with the rush of air, not with your vocal chords. As you make this sound, imagine that you are exhaling fear, which has gathered in your kidneys. Imagine the fear coming out in a cloud originating in the kidneys and being released through your mouth. Imagine that the fear is being replaced with a feeling of gentleness in the kidneys.

Rest silently, while imagining that the kidneys are continuing to make this sound.

3. The liver sound. With a long slow exhalation make the sound "SHHHHHH" (as in "shoe") and imagine that anger is being released from the liver in the form of a cloud, pouring up from the liver and out through the mouth. As the liver empties of this anger, imagine it is filling with feelings of kindness.

Rest silently, while imagining that the liver is continuing to make this sound.

4. The heart sound. Open your mouth wide and with a long slow exhalation make the "HAWWWWWW" sound (as in "hawk"). The sound is made with the rush of air, not the vocal chords. Imagine that any feelings of impatience, hate, or arrogance are being exhaled from the heart. Imagine that as these feelings leave, they are being replaced with feelings of joy, love, and happiness.

Rest silently, while imagining that the heart is continuing to make this sound.

5. The spleen sound. Place your tongue against your palate and with a long slow exhalation make the "WHOOOOO" sound. This is a more "throaty," guttural sound than the kidney sound, and it resonates in your chest. Again, the sound is made with the rush of air, not the vocal chords. As you make this sound, imagine that the cloud of worry and anxiety from the spleen is being exhaled out through your mouth. Imagine the spleen is being filled with feelings of fairness.

Rest silently, while imagining that the spleen is continuing to make this sound.

6. The "triple warmer" sound. The triple warmer is the name given to the three large sections of the torso: the upper section (heart lungs), the mid section (liver, kidneys, stomach, pancreas, spleen), and the lower section (intestines, bladder, sex organs). This sound is best done lying down. The sound is "HEEEEE" made with the rush of air through your mouth. As you make this sound with a long slow out breath, imagine a huge rolling pin flattening out your body from head to toe. This rolling pin is re-balancing all the energies activated by the other sounds, and helps harmonize the energies of the three large sections.

Now rest, and imagine your entire torso and all your organs being very relaxed and comfortable.

The six healing sounds were originally developed as a practice to be used before bed. They have a calming effect on the neurological system, and can help with the sleep disturbance of CFS.

However, they have an added benefit for people who want to deal more effectively with their emotions. Many have had the experience of becoming emotionally aroused and expressing strong feelings, only to find that they have triggered heightened immune activation and a relapse. The hypersensitivity of the immune system is at the root of this problem. The stress response can be triggered unexpectedly or in circumstances that you would not ordinarily consider stressful.

If this has been the case for you, you no longer need to suppress strong feelings. The six healing sounds are a safe and effective method of emotional release that can help you maintain that state of inner equilibrium you seek.

(c) William Collinge, M.P.H., Ph.D., "the creator of the first mind/body program for CFS." For more information about Dr. Collinge, please visit

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