Chronic Fatigue Syndrome (ME/CFS)

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome, now often called ME/CFS, is a chronic illness that causes severe fatigue, worsening of symptoms after exertion, and problems with thinking, sleep and the body's automatic functions. It is often preceded by an infection, and it overlaps with the long-lasting illness that follows some cases of COVID-19.^{[1, 2]}

ME/CFS is serious and affects millions of people worldwide, yet up to 91% of people with it in the United States were estimated to remain undiagnosed.^[2]

Common symptoms

The core symptom is fatigue that is not relieved by rest and a marked worsening of symptoms after physical or mental effort, called post-exertional malaise. Cognitive, immune and autonomic (automatic body function) symptoms are also common.^{[2, 3]}

• Unrefreshing sleep and disturbed sleep
• Slowed thinking, poor concentration and memory problems
• Lightheadedness or racing heart when standing
• Muscle or joint pain, headaches, sore throat or tender glands
• Sensitivity to light, sound, foods or medicines^[2]

Causes and risk factors

The cause is not known. Current research points to a combination of genetic vulnerability and environmental triggers, especially viral infections, followed by immune dysregulation, chronic inflammation, changes in gut bacteria and disturbed energy metabolism.^{[4, 5]} Because of this overlap, many people with long COVID meet ME/CFS criteria.^[1]

How it is diagnosed and treated conventionally

There is no specific diagnostic test, so ME/CFS is diagnosed from symptoms using clinical criteria, after other causes of fatigue are ruled out.^{[3, 5]} Clinicians who specialize in ME/CFS advise a symptom-focused approach built on pacing, which means staying within limited energy to avoid crashes.^{[2, 5]}

There is no cure. Cognitive behavioral therapy may help with coping but is regarded as adjunctive rather than curative, and a 2025 review states that graded exercise therapy is contraindicated because of potential harm.^[5] The US and other governments and major health organizations have withdrawn graded exercise and cognitive-behavioral therapy as the treatment of choice.^[2] A Cochrane review of 8 trials found exercise therapy probably reduced fatigue in the short term, but the trials used older definitions, had a high risk of bias, and the risk of harm is uncertain, so this evidence is debated.^[3]

Why Chronic Fatigue Syndrome calls for a whole-person approach

ME/CFS does not have one cause or one fix. Immune activity, inflammation, energy production, the nervous system, gut health and the effects of activity all appear to play a role, and they differ between people.^[4]

For that reason, care that looks at sleep, pain, stress, digestion and energy use together can be a reasonable companion to medical management, even though it does not treat the illness itself.

Infection and immune activity

Many people date their illness to an infection, and research implicates immune dysregulation and chronic inflammation.^{[1, 4]}

Energy metabolism

Mitochondrial dysfunction and oxidative stress are studied as central features of ME/CFS, although there are still no definitive biomarkers to diagnose it.^[5]

The autonomic nervous system

The autonomic nervous system controls heart rate, blood pressure and other automatic functions, and autonomic dysfunction is part of the illness.^{[2, 3]} Some acupuncture research has measured heart rate variability for this reason.^[6]

Gut health

Researchers have linked ME/CFS to gut dysbiosis, an imbalance of gut bacteria, and some herbal trials have examined gut microbiota changes.^{[4, 7]}

Pacing and exertion

Because symptoms can worsen after effort, managing activity within an individual energy limit is a core part of care.^{[2, 5]}

Acupuncture for Chronic Fatigue Syndrome

What the research shows

Acupuncture may reduce fatigue in some people, but the evidence is limited by small and low-quality trials. A 2019 meta-analysis of 16 studies (1,346 people) found that acupuncture beat sham acupuncture on overall response rate (4 studies, low certainty) and also beat Chinese herbal medicine. The authors concluded that no firm conclusion could be reached because of limited data and poor quality.^[8]

An overview of 10 systematic reviews found most conclusions favorable but sometimes contradictory, rated 17 outcomes as moderate (3), low (10) or very low (4) quality evidence, and judged the reviews themselves to be of critically low methodological quality.^[9] A 2022 network meta-analysis of 51 trials (3,473 people) found acupuncture and moxibustion outperformed other treatments, with GRADE ratings low.^[10] A review of 15 moxibustion studies (1,030 people) found benefit, with evidence rated moderate to very low.^[11]

Individual trials show the same pattern. In a single-blind, sham-controlled trial of 127 people in Hong Kong, 8 sessions over 4 weeks gave moderate net benefits in physical and mental fatigue, although the sham group also improved considerably.^[12] In a nonblinded Korean trial of 150 people with chronic fatigue syndrome or idiopathic chronic fatigue, 10 sessions of body acupuncture added to usual care lowered fatigue scores at 5 weeks compared with usual care alone.^[13]

How acupuncture may work

Researchers propose that acupuncture may influence the autonomic nervous system. In a Chinese trial of 175 people with CFS, acupuncture and moxibustion changed heart rate variability measures, with different effects depending on the points used.^[6] This is a proposed explanation, not settled fact.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with a course of several visits and a reassessment. The trials above gave 8 to 10 sessions over about 4 weeks, or 10 treatments every other day.^{[6, 12, 13]} Because exertion can worsen symptoms in ME/CFS, travel and visit length should be planned around your energy limits.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Chronic Fatigue Syndrome

The Ayurvedic view

Ayurveda has no single classical name for ME/CFS. Persistent exhaustion is traditionally described as depleted ojas (vital essence), weak agni (digestive fire) and aggravated Vata. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is individualized and gentle, and traditionally combines:

• A regular daily routine with rest, steady sleep hours and warm, nourishing meals
• Warm oil massage
• Herbs and classical rasayana (rejuvenating) formulas, prescribed individually by a qualified practitioner
• Stress-reducing practices within your energy limits

Panchakarma cleansing procedures are not appropriate during pregnancy, acute illness or frailty, and generally not for a person who is very depleted, so they are used cautiously, if at all, in severe ME/CFS.

What the research shows

No clinical trials of Ayurvedic treatment for ME/CFS were found in PubMed. The research that exists is about symptoms. In a 12-week placebo-controlled trial of 40-to-75-year-old overweight adults with stress and fatigue, ashwagandha did not beat placebo on the main stress measure, but fatigue scores fell more than with placebo. These participants did not have ME/CFS.^[15] A meta-analysis of 9 trials (558 people) found ashwagandha reduced stress and anxiety scores compared with placebo, with some mild to moderate side effects.^[16]

Herbal medicine for Chronic Fatigue Syndrome

Herbs and formulas that have been studied

Chinese herbal formulas are the most studied. A review found 84 randomized trials of 69 different formulas, and one classical formula, Sijunzi decoction, has been tested in a placebo-controlled trial in people with CFS and spleen deficiency.^{[7, 17]} Ashwagandha has been studied for stress and fatigue in people without ME/CFS.^{[15, 16]}

What the research shows

The evidence for herbal medicine is limited by quality. A meta-analysis of 84 trials (6,944 people) found Chinese herbal medicine lowered fatigue and mood scores and raised the effective rate, with no serious adverse events reported, but the authors said study quality was generally not high.^[17]

In a double-blind trial of 127 people, Sijunzi decoction did not significantly beat placebo in the main analysis, though a per-protocol analysis found a significant difference of about 2 points on a fatigue scale, and no serious adverse events were seen.^[7]

Safety and herb-drug interactions

Herbs are active substances. Ashwagandha has been linked to stomach upset, liver injury, and effects on thyroid and adrenal function, so people with thyroid or liver disease and those taking prescribed medicines need a practitioner's review first.^[18] Herbal and dietary supplements now account for about 20% of drug-induced liver injury cases in the United States.^[19]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have kidney disease, or have surgery planned. Transdermal medication therapy, an herbal preparation applied to the skin, is also offered, and no ME/CFS studies of it were found.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes this kind of exhaustion as qi deficiency, spleen and kidney deficiency or yang deficiency. Researchers study things that loosely parallel this picture, such as autonomic regulation, energy metabolism, inflammation and gut bacteria.^{[4, 6, 7]}

Ayurveda's depleted ojas and weak agni describe a state of low reserves and poor digestion and assimilation. No study has shown that a TCM pattern or a dosha corresponds to a specific biological process in ME/CFS.

How this care fits with your medical care

Integrative care for ME/CFS is complementary. We do not diagnose ME/CFS or the other conditions that can cause fatigue, so new or unexplained exhaustion should be medically evaluated first. Keep your physician and any specialists, and do not stop or change prescribed medicines without your prescriber.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, recent blood test results, a full list of medicines and supplements, and a note of what triggers your crashes.

When to seek urgent medical care

Some symptoms in a person with long-lasting fatigue point to a different or more serious problem and need prompt assessment.^[2]

• Chest pain, a racing or irregular heartbeat, fainting, or severe shortness of breath
• New weakness, numbness, confusion or trouble speaking
• Fever with severe headache or stiff neck
• Unexplained weight loss, night sweats, or blood in stool or urine
• Being unable to eat, drink or care for yourself

If any of these occur, call 911 or go to the nearest emergency department.