An appraisal of Thomas Lewis's effort syndrome

摘要

The growth of information about alkaline buffering systems, hyperventilation and sympathetic activity, and their inter-relationships since World War I supports Lewis's concept of effort syndrome. It reinforces his view that this is not a discreet 'disease' but an enduring condition of homoeostatic impairment caused by carrying effort beyond physiological tolerance. The performance-arousal curve appears to be a useful model for classifying the psychophysiological and behavioural elements that distinguish effort syndrome from healthy function. The information reviewed here justifies the inclusion of effort syndrome in the differential diagnosis of chronic fatigue syndrome, and the assessment of buffer depletion in the investigations employed. Without exception, as far as I can see, the proponents of the various chronic fatigue syndromes publish lists of symptoms rooted in the pathophysio-logy of buffer depletion, hyperventilation and sympathetic activity. William of Occam would argue that it is their responsibility to exclude effort syndrome before they multiply entities beyond necessity. It can also be argued that these proponents should be responsible for explaining why they deny their patients the methods of rehabilitation that formerly were considered to be effective.