Build Up of Stress:

◼ Emotional Trauma

◼ Physical Trauma/Pain

◼ Immunological Trauma (Infections or Sensitivities/ Allergies)

◼ Environmental Trauma (Pollution)

◼ Other Pathologies

This leads to excessive strain on the sympathetic nervous system, leading to ME/CFS. Further investigation into this theory has shown that this overload is probably caused by toxins building up in the spinal cord and the brain. For a ME/CFS sufferer, these toxins fail to drain properly. In fact, evidence has shown a backflow of the drainage leading to a further build-up of neurotoxins causing a worsening breakdown of the brain’s normal function leading to the diverse symptoms seen in ME/CFS.

Yes and no. Although there is some argument about this, Dr Perrin looks at both of them within the same spectrum of disease, with ME/CFS producing post-exertion malaise as the principal complaint and FMS’s main symptom being widespread severe pain throughout the body.

It is also very important to realise that post-exertion malaise is not the same as post-exercise malaise. Often patients can exercise a little without suffering the consequences. It is exertion that precipitates the many symptoms of ME/CFS – in other words, doing more than the patient feels happy doing or capable of, and it doesn’t have to be physical exertion. Mental, emotional or immunological exertion can trigger a worsening of symptoms. Dr Perrin states that there are some patients who were often very fit before they were ill with ME/CFS or FMS who feel much better exercising, but when they have a cold or are under emotional or mental stress they crash and may spend the next few weeks bedridden following perhaps an innocuous virus or extra stress at work.

The reason for the different clinical presentations of FMS and ME/CFS is that the toxins in FMS predominantly affect the nuclei of the brain that control pain. This is why widespread pain is the most prominent feature in FMS rather than in ME/CFS where the toxins mainly affect areas of the brain responsible for coping with change and preventing many other physical, emotional and cognitive problems. However, FMS and ME/CFS share the same common physical findings that we in clinic use as an aid to the diagnosis of both disorders.

ME/CFS and FMS can affect all ages and all ethnic groups and social backgrounds and do affect men as well as women. However, many more women suffer from ME/CFS and FMS than men. 

According to Dr Perrin's research, this is because:

1. Women’s hormone systems are so much more complex than men’s and those hormonal changes affect the hypothalamus which is the central controller of hormones in the brain and is affected by toxins in ME/CFS and FMS.

2. Levels of the cytokine leptin, which is a hormone affecting satiety and hunger and appetite or loss of it, and is found more in females, has been shown to be directly linked with the symptom severity of ME/CFS.

3. There is much more lymphatic tissue in the female breast and thus there is much more potential for congestion of the tissue in the chest, creating more toxic build-up, irritating more of the sympathetic nerves in this important area.

The Perrin Technique stimulates the motion of fluid around the brain and spinal cord via cranial techniques. In normal circumstances this fluid carries toxins away from the brain and spinal cord to areas of the body where they can be processed and disposed of. 

Treatment to the spine, as well as certain exercises, further aids drainage of these toxins out of the cerebrospinal fluid. 

A specific lymphatic drainage technique and massage of the soft tissues in the head, neck, back and chest direct all the poisons out of the lymphatic system and into the blood, and eventually to the liver where they are broken down and readily detoxified. Some of the drainage travels out of the body via the bowels and genitourinary tract or through the skin.

Eventually, with less poisons affecting the central nervous system, the brain starts to work better, gradually stimulating improved lymphatic drainage. Thus, the body starts to function correctly, and, providing patients do not overstrain themselves as the nervous system is recovering, their symptoms should gradually improve.

Dr Perrin's method of treating ME/CFS, using the principle above, is analogous to mending a blocked main drain in your home. By increasing pressure into the main drain, one pumps out the blockage and reverses any backflow.

It is obviously more complex in the body, and by cranial treatment, articulation of the spine and specific manual lymphatic drainage massage techniques, one stimulates the movement of cerebrospinal fluid from the brain and the spine to the lymphatics. This increases pressure in the correct direction and thus improves the central drainage of lymph fluid from the lymphatic ducts into the blood.

One proof that the Perrin Technique is not a placebo is the fact that most patients feel somewhat worse at the beginning of the treatment. Placebo treatments do not generally make you feel worse. The reason for this initial exacerbation in symptoms is because, for the first time, the toxins embedded – for years, possibly – in the central nervous system are being released into the rest of the body.

The most common symptoms in the early stages of treatment include nausea, headaches, general pain and the appearance of spots, boils and other skin problems. A reminder from Dr Perrin is that one should always remember the old adage ‘Better out than in’!

The worse the patient is in the early stage of treatment, the better the overall prognosis is usually likely to be. The main aspect to focus upon is the change that occurs with the treatment. If change has not occurred in any way in the first 12 weeks, it does not mean that the patient has no hope of recovery, but it might be a much slower process than they had envisaged. It may also mean that they have to seek an alternative/additional therapy on top of this technique in their search for a remedy. Some fortunate patients do improve immediately, so it is not necessarily the case that a ME/CFS patient’s condition worsens before improvement.

Every patient is different, and some recover much more quickly than others. The majority of patients improve significantly in the first year. Some mild cases can be resolved in a few months and the very severe bedridden patients may take years to achieve a much better quality of life, but Dr Perrin's methods have helped some patients who had virtually given up but now are on the road to recovery, with many leading a completely normal life after the treatment programme.

Dr Perrin says:

Once the patient has noticed a reduction in their symptoms, they can begin the uphill battle to improve health and stamina. One has first to convalesce, which for those younger readers who have never heard of the word, means to rest in order to get better after an illness. Convalescence is no longer a fashionable concept. People having some operations nowadays tend to be discharged from hospital within a day and may be at work within the week. Convalescent rest, however, is a must during the recovery process from ME/CFS and FMS. In order to turn the remission period in ME/CFS and FMS into a permanent state of health, as well as convalescence one has to keep to the ‘half rule’ until one has been symptom-free for at least six months, that is doing only half of what one feels capable of doing safely. As I tell my patients, ‘Remember that half of more is still more’. In other words, as one recovers and can do more before fatigue and other symptoms begin, one should only gradually increase activity, while still taking care to avoid too much exertion.

At the beginning of treatment, the patient is usually treated once a week. As the symptom picture improves, there should be a gradual increase in the period between consultations. Generally begin every 2 weeks when patient is @ 6/10.

However, the lower the score at the beginning, the longer it takes before recovery starts and so it may be over six months plus before the practitioner spaces out the weekly sessions in cases who initially score 3/10, which represents 30% of what one would call good health.

A patient with moderate symptoms with a score of 5/10 on my scale usually adheres to the following treatment schedule.

Treatment schedule

Weeks 1–12: weekly

Weeks 13–24: every 2 weeks

Weeks 25–36: every 3 weeks

Weeks 37–52: every 4 weeks

Months 12–18: every 3 months

Month 24: Final check-up (if symptom-free for six months, patient is discharged).

Waking up

Let us start with getting up in the morning. It should be morning, not after midday. This is very important, as getting into a reasonably normal sleep pattern is essential. One should aim at getting up every day, and even in severe cases one should try to wake up at the same time, preferably in the morning.

The sleep-awake cycle is controlled by the hypothalamus, with the pineal gland in the brain which produces the hormone melatonin stimulated by the dark and supressed by how much light passes through the eyes, which is why some people refer to the pineal gland as the third eye. Dark and light stimulate the production of melatonin and serotonin respectively. The melatonin/serotonin balance is crucial in maintaining a good diurnal rhythm and helping us stay awake during the day and sleep at night.

In the winter the darker days aggravate the rhythm and some people suffer a drop in serotonin and become more depressed, leading to what is known as SAD (seasonal affective disorder).

Also, many ME/CFS and FMS patients sleep much worse in the summer as they have too little melatonin and too much in the winter. To help the balance in winter, a SAD light which mimics daylight hours does often help. So, if you have this problem, a SAD light is important first thing in the morning at dawn for an hour, and another hour later on in the evening at twilight/dusk is also recommended.

Getting out of bed

If this is possible always alight from the bed in stages; never jump up as the control over blood pressure is often disturbed and experiencing dizziness when getting out of bed is common. So, before sitting up make sure you are lying on your side and slowly swing your legs over the edge of the bed and gradually sit up at the side of your bed where you should remain for a minute or so before slowly standing up. If you suffer from POTS you should stay seated for at least three minutes before trying to stand up.

Shower in morning

This should never be too hot or too cold as the hypothalamus is the thermostat of the body and too extreme temperatures will stress an already overloaded part of the brain. Make sure any soaps, shampoos and shower-gels are not too perfumed. It is worth buying the least allergenic products recommended by your local pharmacist even if they are more expensive.

Try to avoid hot baths at any time. They are worse than showers as besides overheating the body, the muscles will relax while the spine is in an unhealthy position unless you are able to float in the bath. Sitting in the bath places extra strain on the lower back and can aggravate any postural problem. With ME/CFS and FMS it is double trouble as the heat and the postural strain together exacerbate any inflammatory changes in the spine, which creates more toxicity within the central nervous system.

Comfortably cool baths that you can lie in are healthier for ME/CFS and FMS patients and sometimes relieve many of the symptoms, but if the water is too cold it will aggravate the condition by increasing tone in already tightened muscles. If you are going to try cool baths, make sure that when you are lying there you are not shivering and that you are comfortable. Dr Perrin recommends about 10 minutes at a time.

Showers are usually better for ME/CFS but if the patient feels dizzy or weak standing and does not have a bath then they should use a shower chair. If a patient constantly feels faint or actually faints in a hot shower and the heart rate frequently races, then again suspect possible POTS.

Having frequent short cold showers of around 16–23°C may also be of benefit to some ME/CFS and FMS patients. As with cool baths, moderately cold showers have been shown to reduce pain by stimulating the production of endorphins which reduce pain without causing any harm.

Cool showers and baths have been shown to stimulate the locus coeruleus in the brain stem which forms a major axis, together with the hypothalamus, in the control mechanism of the neuro-lymphatic drainage system. In health this axis switches off during the night in deep restorative delta-wave sleep.

It has been shown that in ME/CFS, delta waves are produced in the brain throughout the day with the axis switching off at the wrong time leading to the patient feeling sick and exhausted as the toxins drain out of the brain. To reverse this problem, we need to stimulate the locus coeruleus during the day. So in brief, comfortably cool hydrotherapy in the morning will greatly help some patients.

Exposure to cold typically causes activation of the sympathetic nervous system (SNS) which can cause problems with ME/CFS and FMS since the sympathetic nerves are usually overloaded. However, small amounts of stressful or harmful agents can sometimes be beneficial. This phenomenon is known as hormesis. Similar to the body’s immune response needing to first be exposed to an infectious agent before it builds an immunity, as seen in vaccination, it is believed by some that exposure to cold can temporarily reverse autonomic dysfunction and therefore improve symptoms.

Try the hydrotherapy once in the morning for just a few minutes, either lying in a cool bath or having bursts of a cold shower for a few seconds at a time over a couple of minutes. If it brings any relief, continue each morning as long as you always feel well afterwards. If it worsens your condition in any way, then immediately stop as it isn’t for you.

Dr Perrin highlights the fact that every ME/CFS and FMS patient is different, and unfortunately people respond differently to any stimulus.

Getting dressed

Loose clothes that are easy to slip on and off are recommended as clothes that are too tight may restrict circulation of blood and lymph and lots of buttons etc can place strain on the hands that do get fatigued and sometimes become very painful, especially in FMS. For women, tight bras are a definite no-no, especially tight underwired bras, which do place extra pressure on the breast lymphatics. Sports bras tend to be better, but the main issue is finding a properly fitted bra; bra-fitting services should be used and are available at good quality shops around the world.

Deodorants, antiperspirants and cosmetics

Most should be avoided as much as possible, especially heavily perfumed products as they usually contain high levels of petrochemicals and other neurotoxins. There are safer products that are less toxic, but one has to shop around. Dr Perrin says: In the same vein, many of my patients relax by lighting scented candles at home. Unfortunately, aromatic candles are nearly all highly toxic with the wax usually having a high petrochemical content and the wicks usually containing heavy metals. If you enjoy candles to relax please try and use beeswax candles with natural, non-metallic wicks.

Mealtimes

Diets have been discussed at length, but the basic advice which Dr Perrin gives is not to eat anything in excess and generally ‘Variety is the spice of life’. Eating a large variety of food generally places less strain on a particular part of the gastrointestinal system, which is often disturbed in ME/CFS and FMS patients, with many having irritable bowel syndrome and gut dysbiosis.

Dietary intake of sugar should be low as it stimulates the production of yeast. Patients with ME/CFS and FMS should eat less casein (found in milk-based products), less gluten, as well as less yeast, as these are all composed of large molecules and therefore require the lymphatics to drain the excess away from the gut.

Small meals eaten regularly are best and Dr Perrin often advises patients to divide each meal into two, eating frequently but less at a time. Adults should drink around 2 litres a day of water and healthy drinks such as herbal non-caffeinated teas. Patients should reduce the intake of caffeinated coffee and tea as caffeine can over-stimulate the nervous system. Alcohol should be avoided at all costs as, besides it obviously placing extra strain on the liver, it has been shown that patients with ME/CFS and FMS have overactive receptors in the brain that are stimulated by NMDA, the neurochemical activated by alcohol intake. Dr Perrin says: Most of my patients do not find this advice difficult to follow as they feel worse after a little sip and almost drunk following the smallest amount of alcohol.

Chillax (chill and relax)

During the day and especially at night the patient has to learn how to relax and possibly meditate. A new word has been coined that embodies both relaxing and remaining chilled and calm: ‘Chillax’. There are plenty of different strategies to do this, including mindfulness.

Bedtime

Difficulty falling asleep and staying asleep, known as insomnia, and hypersomnia, when the patient sleeps too much, and other sleep disturbances are very common symptoms of ME/CFS and FMS. Leading sleep experts including Dr Jason Ellis, who is a Professor of Sleep Science and Director of the Northumbria Sleep Research Laboratory in the UK, advocate cognitive behavioural therapy for insomnia, often called CBT-I.

CBT-I is an approved method for treating insomnia aimed at changing sleep habits and includes regular, often weekly, visits to a clinician and completing a sleep diary to work out the best way of tackling the specific disorder. Sleep clinics around the world offer many ways of analysing the sleep problem and for those patients with severe sleep disorders a polysomnography test is essential. Also known as a sleep study test, polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements.

It is best to have a set bedtime and stick to it as closely as possible.

Use blackout curtains and switch off all lights in the room.

It’s best to take all the electronic gadgets away from the bed. 

Avoid tea, coffee and any other drinks with caffeine before bed.

Sometimes having a small meal an hour before bed helps. As one knows after a heavy meal during the day, one often feels very drowsy. This is because hormones released after eating can also stimulate the sleep centres. These hormones are controlled by the hypothalamus which is, as we have seen, the main part of the brain disturbed in ME/ CFS and FMS. Eating food can calm the hypothalamus and help induce sleep.

The best position for sleep is lying on one’s side, which places minimal strain on to the spine. It has also been shown that neuro-lymphatic drainage occurs more when lying on one’s side (no particular side, just the one you feel most comfortable on).

Some patients may develop sleep apnoea which is when one stops breathing during one’s sleep for short periods. This obviously can be dangerous...we need to breathe; so contact your GP if you think you have this problem. You may need an aid to support breathing at night called a continuous positive airway pressure machine (CPAP), which is the most effective treatment if you have moderate to severe sleep apnoea.

Sleeping pills and low-dose tricyclic antidepressants, such as 10 mg amitriptyline, are prescribed by GPs to be taken an hour before bed. Some patients taking amitriptyline report feeling very drowsy the next morning, so if you have a problem inform your GP.

The hormone melatonin is important for sleep so sometimes this is prescribed by physicians around the world to help ME/ CFS patients sleep but it is important to know that melatonin only helps patients fall asleep but does not control the amount and quality of the sleep.

Post-exertion malaise (PEM) is the most common symptom in ME/CFS. Any activity that does not over-exert you will be okay and activity is actively encouraged if possible, as long as it does not exhaust you. PEM may not be immediate; the malaise may kick in up to three days following exertion, so beware of this problem.

It is best to avoid all exertive exercise and sport until you are virtually symptom- free and then you can revitalise your deconditioned body by gradually increasing your activity. The dreaded graded exercise therapy (GET) helps only ME/CFS and FMS patients who are fortunate enough to have recovered from most of their symptoms, but due to the forced reduction of activity over a protracted period are deconditioned. Even when their concentration returns and when feeling much more energetic, they still often remain basically unfit and one of the best ways of reconditioning the body is by gradually increasing physical activity.

Rehabilitation and reconditioning patients’ weakened bodies has to be done safely. Dr Perrin states that: graded activity does not help ME/CFS and FMS patients recover but helps re-condition the recovered patient.

Hobbies are very important for patients’ sense of purpose and sanity, especially if housebound. They can also be a crucial part of rehabilitation, re- introducing physical and mental activity to a life that was just about existing from day to day. If the hobby involves arts and crafts, the patient may be suffering neurotoxicity from the paint, paint thinners and solvents they use. These and many other hobbies involving toxins should be kept to a minimum for obvious reasons. Patients should wear a mask if there is any danger of exposure to poisonousfumes.

Playing musical instruments is a favourite among some patients as they increase their abilities. This is highly recommended, but again try to space out the sessions whatever instrument you enjoy playing, and when playing the piano, to begin with, use a supportive chair rather than a standard piano stool as sitting with no back support will place extra strain on your spine.

If recovering patients take to the garden, they have to be careful not to expose themselves to organophosphates, such as pesticides and herbicides. Also, patients should invest in tools with long handles that reduce the need to stretch and bend. Be careful when carrying out repetitive actions to prevent overstraining weakened muscles.

People always think watching TV is a very passive activity and cannot overload the nervous system. They couldn’t be more wrong, says Dr Perrin. TV images create a hive of neuronal activity in the brain as one has to digest what is going on in each scene of a play, film or even a gameshow or the news.

Screens also send out ‘blue light’, which has been shown to stimulate alpha waves. During the morning the blue light is beneficial as it boosts mood, reaction times and concentration, but in the evening, and especially just before bed, it reduces good restorative sleep, so the advice to all patients is: do not watch TV for at least an hour before bed. A survey by a leading phone manufacturer found that almost nine out of ten 18–34-year-olds have trouble sleeping because they use their smartphones at bedtime.

Technology firms have acknowledged the problem, with some major mobile tech providers introducing special settings that reduce blue light. Special yellow or orange tinted glasses can be used to filter out the harmful blue light.

Blue light filter glasses or blue light filter apps should definitely be used if using a computer for long periods. Many of my younger patients, says Dr Perrin, spend much of their day playing on computer games or looking at their phones. These screens should be set up with filters that shield the blue light as the day draws to a close. As with TV, all screens should be avoided for an hour before bed even when using the filter.

Dr Perrin recommends listening to relaxing music, reading or, if reading is difficult, listenin to a talking book last thing at night is a good alternative.

Any screen-time should be restricted during the day as spending too long in one position can lead to postural strain on the spine and repetitive strain injuries when using game consoles or texting. Muscles are much more susceptible to damage from constant repetitive trauma, especially in fibromyalgia

Hands-free options and non-metal cases on phones should be used to reduce radio frequency exposure.

There are two viewpoints concerning pregnancy and ME/CFS. Some experts believe that pregnancy is a time when a better balance is achieved within the woman’s body and it can help reduce the symptoms of ME/CFS. However, this is unpredictable. Some healthy women blossom when pregnant; if the ME/CFS patient is lucky enough to be that type, her symptoms will probably reduce during pregnancy. However, if the mother-to be is one of those who generally have a difficult pregnancy, her ME/CFS symptoms may worsen for most of the nine months as her hormone levels fluctuate, producing more nausea and fatigue. ME/CFS and especially FMS present a problem for the actual delivery of the baby as the natural pain in childbirth will be exacerbated and aggravate the widespread pain due to the illness. Gas and air or hypnosis should be considered before opting for any other forms of anaesthetic for the birth itself.

It’s not just the pregnancy, points out Dr Perrin, it’s the baby afterwards that obviously places more strain on the mother, and this is more of a problem. I would usually advise a patient to wait until they are well on the mend before they consider pregnancy. A survey found that 21% of a group of ME/CFS patients decided not to have a child because they thought that their debility would interfere with their ability to raise their child.

Breastfeeding carries the risk of toxins being transferred from mother to baby. So, the best advice regarding this factor is for the mother to have as much detox treatment before she plans on getting pregnant.

There is also the genetic factor to consider. As mentioned earlier there is a 15% chance of ME/CFS being familial (running in families). However, I would never advise patients not to have children because they didn’t want the risk of them also getting the disease, syas Dr Perrin,  I do believe ME/CFS is preventable, with the physical signs appearing before the symptoms, so if a patient is worried about his/her child developing the illness, the child can be assessed for the five physical signs and if there is a problem they can be treated before any symptoms arise. The physical signs will reduce quickly, and the child should remain healthy.

Sometimes it is not patients themselves who are directly exposed to a pollutant or environmental toxin. It can often be a family member who may be an engineer, a hairdresser or a car-paint sprayer. Many patients have had a possible neuro-lymphatic drainage problem since birth and have been harmed by living in a household where one or both parents have jobs that bring them into increased contact with toxins. The parents come home and may hug their baby and wash their clothes in the same machine as their child’s clothes. This cross-contamination over the years can lead to the gradual build-up of neurotoxins in the brain and spinal cord, with the child eventually having sufficient exposure to trigger the onset of ME/CFS or FMS.

Sometimes the onset of illness is many years later when the patient is an adult.

Medicines for babies and children are given in minimal dosages since the young are much more susceptible to the effects of toxins, illustrating the fact that in the young toxic exposure does not have to be great to inflict harm.

When visiting the dentist, avoid having mercury amalgam dental fillings. 

When going to have your hair done at the hair salon, the use of chemicals in your hair should be limited, especially since some have been shown to harm the actual hairdresser.

Remember that the scalp is very close to the brain and it is not advisable to massage poisons into the skin in this area. Take care to make sure that your neck is in a comfortable position, too, when your hair is being washed in a back basin.

Patients who are hairdressers themselves, or in other occupations that use large amounts of toxic materials, should take extra measures to avoid further exposure, such as wearing gloves, masks and having plenty of ventilation. This is advice that is all too familiar during the Covid-19 outbreak, but any patient working with toxins should continue to take these measures after the pandemic is over.

If you live in the countryside, take a trip away from home during crop spraying days.

If your work entails exposure to harmful toxins, you may need to consider a career change.

If both spouses or a few people in the same street develop ME/CFS or FMS, then try and see if there are any sources of pollution close by that may be a cause.

This is a tricky question to answer says Dr Perrin. 

The simple answer is yes. 

Over the years, I have had the wonderful pleasure of working alongside some amazing doctors. One is leading neurologist Dr Margareta Griesz-Brisson in Harley Street, London. She always says: ‘Ray, we are treating the physiology not the pathology’. In other words, the treatment is designed to aid the restoration of a healthy neuro-lymphatic system, which physiologically will encourage the central nervous system to work better, ecoing Dr Bruce Carruthers “treat the dis-ease not the disease.

So, many problems affecting the nervous system should be helped by the Perrin Technique.

I have treated a few patients with Alzheimer’s disease, says Dr Perrin, and one elderly man in the early stages of the disorder received once a month treatment for four years with no deterioration in his symptoms throughout the four years. In fact, he sometimes came in for his monthly session saying he had had the best month yet, with increased energy and concentration and memory as good as ever. Sadly, he subsequently had a fall and injured his head which led to a speedy deterioration in his condition.

Another condition that Dr Perrin has helped many patients with over the years is Lyme disease; with this infection, the reverse flow of lymphatic drainage leads to a build-up of the bacterium Borrelia burgdorferi in the central nervous system. Research has also shown that problems with lymphatic drainage of the brain may also lead to some forms of clinical depression and rarer conditions such as Creutzfeldt-Jakob disease (CJD).

The neuro-lymphatic drainage pathway was shown to be affected in patients with the severe acute respiratory syndrome (SARS) caused by the corona virus infection of 2003, with some developing a ME/CFS-like illness. The coronavirus in Covid-19 seems to be causing the same post-viral fatigue states, leading to a post-Covid-19 syndrome (long Covid), which has all the hallmarks of ME/CFS, and could very well affect the drainage in the olfactory pathway leading to loss of smell and taste, and an effect on the hypothalamus leading to high fever.

Dr Perrin says that in May 2020, he saw a 42-year-old man in clinic who responded very well to neuro-lymphatic treatment a month after having had severe post-Covid-19 symptoms and who was completely symptom-free two months later. We are seeing more and more post Covid-19 patients in clinic with all the physical signs and many symptoms of ME/CFS and most will respond very quickly to the Perrin Technique if caught in the first few months after coming down with the virus.

As the lymphatic drainage of the brain is being further investigated by neuroscientists around the world, more conditions will probably be connected to the dysfunction of this important process. This will probably indicate the validity in using the techniques shown in Dr Perrin's book to treat many other neurological diseases that, at the time of writing, have no successful treatment and continue to baffle the medical world.

As patients recover, says Dr Perrin, if they overdo things, suffer from infections or have to cope with too much stress, their symptoms may return or worsen. Some patients do suffer recurrences when they have significantly improved, but few experience relapses once they have been discharged, unless they push themselves too far day after day. ME/CFS and FMS patients, once recovered, need to reassess their lifestyle and take steps to reduce the continual stress that may have been part of what led to the illness in the first place. One should be able to exert oneself when better, but knowing when to stop is important.

Patients who have been discharged (10/10 on Table 10.3 in Chapter 10 – page 317) should continue the dorsal rotation exercises three times a day for life. Self-massage to the chest and neck should be done once a week in the shower. An annual check-up is advisable.

Should a relapse occur, it may take a long time to reverse, but remember that, if the treatment worked the first time, it should work again and perhaps more quickly the second time, says Dr Perrin. Psychologists and counsellors are invaluable in these cases. The important rule in treatment, and even more so after relapse, is to remain as positive as possible.

Negative thoughts create further neurotoxicity.

To secure a permanent remission and to remain in good health, one has to focus on the task ahead by means of sensible pacing (the ‘50% rule’), thus achieving a slow, sure return to good health.

Following a graded exercise programme, but only when better, is a good idea, not to treat the ME/CFS or FMS itself, but to help recondition the body and to remain fit and well in the future.

I am one of the few practitioners who maintain that ME/CFS and FMS can be prevented, says Dr Perrin.

The physical signs are very real and usually are seen long before the symptoms begin. This is why in the very early stages of the disorder only a physical and postural- based examination can detect the development of these disorders before the sympathetic nervous system breaks down.

If ME/CFS or FMS is found in more than one family member, there is probably a genetic predisposition that leads to a restricted flow of toxins from the brain and spine. Dr Perrin has discovered when examining children, siblings or even parents of the patient that they present some or all of the five physical signs of ME/CFS and FMS .

When treating pre-ME, as I call it, says Dr Perrin, the signs significantly reduce, usually with only a few weeks or months of treatment. For this reason, I believe that ME/CFS is preventable if treated and managed properly in the early stages.

The advice to physicians given by the International Association of ME/CFS states that establishing a diagnosis of ME/CFS as soon as possible will usually give the patient a much greater chance of relief.

The very severe cases of patients in bed all day and night in silent, darkened rooms should never happen, as early diagnosis should then be followed up quickly with advice on pacing and the appropriate treatment. The severe cases may be as a result of the wrong treatment or bad advice being given in the early stages of the illness, with patients being instructed and sometimes coerced to increase their activity, and sometimes medicated with drugs that have severe effects on the central nervous system.

If all practitioners around the world were taught to examine patients for the early physical signs, which are evidence-based, and to carefully review the patient’s history and symptoms for indications and signs of neurotoxicity, there would be far fewer severe cases. If patients were given advice to pace at the outset, together with prompt treatment to restore a healthy neuro-lymphatic system, it could help prevent ME/CFS and FMS developing in the first place, and one day make these terribly cruel illnesses a thing of the past.