TCM Principles - Chronic Fatigue Syndrome

TCM Principles


Chronic Fatigue Syndrome (CFS)



Chronic Fatigue Syndrome (CFS) involves fatigue that is sufficiently intense and persistent to reduce normal daily activities by at least 50% for a minimum of six months. These patients often experience sudden onset of severe fatigue, developing over a few hours to a few days and often after an acute viral illness. Their fatigue worsens following any physical exertion (e.g. after exercise). Women account for 70% of cases of CFS, in fact, women are affected almost twice as often as men. The condition affects about 0.5% of the population.


Aetiology & Risk Factors

The exact cause of CFS is unknown, though in many cases CFS may be precipitated by infectious agents, such as Borrelia burgdorferi, herpes viruses, Candida albicans, and parasitic agents. This may very well be a multifactorial pathologic entity with lifestyle and constitutional/psychological makeup contributing factors. Other factors known to increase a person’s risk of developing CFS include:

  • An overworked, “stressed immune system caused by recent acute illness, chronic health problems, emotional factors (anxiety, depression), and/or poor nutrition. 
  • Exposure to certain environmental pollutants and contaminants.
  • High levels of oxidative damage caused by free radical exposure.
  •  Uncontrolled, chronic inflammation within the body caused by toxicity, leaky gut, poor diet, autoimmunity or allergies.
  • Extreme and/or prolonged emotional stress.

Symptoms & Signs

As well as prolonged, persistent fatigue, patients with CFS also experience symptoms such as: 

  • Low-grade fever and chills 
  • Sore throat
  • Lymphadenopathy
  • Myalgias and arthralgias 
  •  Headaches 
  • Sleep disturbances
  • Decreased ability to concentrate or remember 
  •  Allergies
  • General muscle weakness

Lifestyle Support

For patients with CFS the following recommendations may help support them

  • Short-term counselling can assist the patient in restoring self-esteem, problem solving, and coping with life stresses. 
  • Acupuncture is effective in reducing the symptoms of fatigue. 
  • Regular exercise is crucial to improving energy, at a level that is tolerated.
  • Yoga, Tai Chi or other relaxing activities may also be useful.

Dietary Recommendations

The following suggestions may help a patient with CFS;

  • Each meal should have adequate protein to provide amino acids for healthy neurotransmitter production and blood sugar control.
  •  Diet should be low in sugar and carbohydrates, as hypoglycaemia can be a trigger for fatigue.
  • Emphasise foods high in magnesium, zinc, vitamin C and antioxidants, such as green vegetables and nuts.
  • Patients should eat small, regular meals.
  • Patients should avoid coffee, cola and other caffeinated drinks.
  • They should avoid excessive alcohol consumption.
  •  Patients must avoid known food allergens. An elimination diet may be beneficial for some people.
  • Foods should be well cooked and warm to facilitate easy digestion, avoid raw foods and cold drinks.


Standard Treatment Options

Your CFS patient may already take the following medication

  •  Antidepressants - depending on type, in addition to relieving depression, these drugs can reduce fatigue and muscle tension, and improve sleep. Side effects vary.
  • Benzodiazepines - help reduce anxiety.
  • Histamine blockers - block production of stomach acid, but can also help improve energy in some patients.
  • Nonsedating antihistamines - relieve allergy symptoms, which are often a problem in CFS patients. 
  •  Nonsteroidal anti-inflammatory drugs (including ibuprofen and naproxen) - help reduce inflammation and musculoskeletal pain.
  • Immune system boosters - to activate or enhance the immune system. Some of these drugs are experimental.

CFS - TCM Patterns

When looking at the TCM treatment of CFS, the following patterns are often mentioned in modern Chinese medicine literature.  These patterns are based on CFS aetiology, which typically includes:

  • Overwork, 
  • External contraction seasonal evil, 
  • Emotional difficulties/negative mental attitude,
  • Weak constitution, and/or
  • Long illness.

Note: It is important to note that patients diagnosed with CFS tend to present with a group of patterns rather than a clear cut textbook pattern. Hence, although this article is going to list different distinct patterns in the pattern differentiation section, it is important in clinic to establish which patterns your patient exhibits in what priority and to tailor treatment accordingly.


1. Qi vacuity


2. Spleen vacuity with damp encumbrance 

  • Symptoms and signs: Lassitude of spirit and lack of strength, pale face, tiredness worse in the mornings, shortness of breath and disinclination to talk, short hasty breathing and a weak voice, tendency to take a breath in order to continue speaking, slight muscle ache, muscle fatigue after slight exertion, spontaneous sweating, dizziness, palpitations, poor appetite, slight abdominal distension, loose stool. Pale tongue with white coating, vacuous weak pulse. 


3. Qi vacuity with blood stagnation


4. Dual qi and blood vacuity


  • Symptoms and signs: Lassitude of spirit and lack of strength, shortness of breath and disinclination to talk, short hasty breathing and a weak voice, tendency to take a breath in order to continue speaking, spontaneous sweating, dizziness and flowery vision, palpitations, insomnia, white lustreless or yellowish complexion, numbness in hands and feet, pale nails, pale scanty menstrual flow, pale tender-soft tongue, fine weak forceless pulse.       
  • Formula: Ren Shen Yang Ying Tang [Ginseng Nutritive Combination].
  • Modifications:

o   Dizziness, pronounced: Tian Ma [Gastrodia], Ju Hua [Chrysanthemum].

o   Insomnia, pronounced: Suan Zao Ren [Zizyphus], Ye Jiao Teng [Polygonum Stem].

o   Numb limbs: Ji Xue Teng [Milettia], Dan Shen [Salvia], Si Gua Luo [Luffa].


5. Dual qi and yin vacuity

o        Dry cough with little sputum: Sha Shen [Glehnia], Mai Dong [Ophiopogon].

o         Dry mouth and sore throat: Shi Hu [Herba Dendrobii], Yuan Shen [Radix Scrophulariae Ningpoensis].

o         Tidal heat effusion, hot palms and soles: Jin Yin Hua [Lonicera], Chai Hu [Bupleurum], Qin Jiao [Gentiana macroph], Mu Dan Pi [Moutan].

o         Dry stool: He Shou Wu [Ho Shou Wu], Rou Cong Rong [Cistanche].


6. Liver spleen disharmony


7. Liver kidney yin vacuity


8. Spleen kidney yang vacuity


Xu Lao - Vacuity Taxation


Xu Lao is any pattern of severe vacuity and refers to a chronic state of fatigue and exhaustion that does not go away by merely resting. “Xu" means, of course, deficiency, and “lao" means “tiredness" hence the term means “tiredness from deficiency.


Herbs (all quantities in raw herbs)


Cang Zhu [Atractylodes] 6-10 g &

Bai Zhu [Atractylodes, white] 10-15 g

Strengthen the spleen & harmonise the stomach, dry dampness, lift yang & dissipate depression.

Benefit qi & engender blood.

Bai Zhu [Atractylodes, white] 9-10 g &

Ji Nei Jin [Nei-Chin] 6-10 g

Strengthen the spleen & dry dampness, benefit qi & engender blood, disperse stagnation. Nourish stomach yin, engender stomach liquid, eliminate food stagnation.

Zhi Shi [Citrus sinensis] 5-10 g &

Bai Zhu [Atractylodes, white] 10-15 g

Break qi, disperse accumulation, abduct stagnation, eliminate glomus, alleviate pain. Supplement spleen & dry dampness, benefit qi & engender blood, harmonise the centre & dissipate stagnation.

Bai Zhu [Atractylodes, white] 10-15 g &

Fu Ling [Hoelen] 10-15 g

Supplement the spleen & dry dampness, benefit qi & engender blood, harmonise the centre & disperse stagnati

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