In TCM, there is no disease specifically labeled as chronic fatigue syndrome, but ancient medical literatures of TCM have a lot of description and explanation about the symptoms presented in CFS patients. These symptoms were described as: lassitude, sensation of heavy limps, no desire and no strength to move the arms and legs, extreme tiredness with no relief after rest, etc.
Many factors contribute to extreme fatigue, such as excessive physical or mental work, inappropriate lifestyle, negative psychological stimulation, etc. According to TCM, fatigue is a deficient syndrome generally caused by the exhaustion of qi and blood.
It is due to multi-organ imbalance and general systematic dysfunction . When the balance of among zang fu organs is disturbed, they are not able to promote or suppress one another in an appropriate manner. The main treatment principle of acupuncture on CFS is to return the balance among zang-fu organs by stimulating the flow of qi among meridians, and supplementing the deficient qi and blood. According to the pathogenesis and clinical symptoms of CFS, it can be associated with the category of asthenic disease, hysteria, and depression in TCM.Various ancient medical literature of TCM had related description on CFS. For instance, the description of Lily Disease (Bai He Bing) in JIN GUI YAO LUE resembles the symptoms of CFS, including abnormal appetite, with the appetite to eat, but physically unable to take any food, abnormal sense of temperature, sometimes feeling hot, sometimes feeling chilling, abnormal sleeping and physical exertion, unable to sleep while extremely tired, wanting to move but with no strength to carry any physical activities. sometimes hallucination and illusion, very little desire to talk and no strength to talk. The pathogenesis of lily disease was deficiency of Yin with interior heat. In Treatise on Spleen and Stomach by Li Dong Heng, the symptoms description of fatigue as a disease is “short of breath, extremely tired, lassitude, no desire to speak, no appetite, easily irritated when moving.” The etiology of CFS in TCM can be categorized as the six exogenous factors, the seven emotional factors, improper diet, overstrain, stress and lack of physical exercise, phlegm fluid and stagnant blood. These factors induce disharmony of Yin and Yang, conflict between anti pathogenic qi and pathogenic qi, abnormal ascending or descending of qi .
Acupuncture treatment review
Due to the unsatisfactory outcomes from modern medical treatments, acupuncture has been applied to treat CFS, or as a combined approach. There are consistent positive results from observational studies 
There is evidence to prove the effectiveness of acupuncture for some of the common symptoms, including chronic pain, depression, insomnia, musculoskeletal pain, headache, sleep problems, tiredness, and irritable bowel syndrome. Studies show that the main benefit of acupuncture for CFS are the released endorphins, which can raise the amount of white blood cells, T-cells and anti-bodies in the body, which increase the body’s level of immunity.
When interpreting TCM’s point of view on CFS from the western medicine’s perspectives, the mechanism of TCM on treating CFS is believed to stimulate the nervous system and cause the release of neurotransmitters. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for insomnia .
Acupuncture treats CFS by restoring the balance of hormonal regulation, reducing stress, anxiety and tension, regulating a distorted immune function and promoting body detoxification. For instance, stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord  stimulating opioidergic neurons to increase the concentrations of beta-endorphin, so relieving pain; It reduces inflammation, by promoting release of vascular and immunomodulatory factors ; it improves muscle stiffness and joint mobility by increasing local microcirculation , which can reduce swelling and pain. It reduces insomnia through increasing nocturnal endogenous melatonin secretion 
Prognosis is dependent on the TCM diagnosis. CFS of liver qi stagnation and spleen qi deficiency has the best results from acupuncture treatments, while Kidney deficiency and phlegm obstruction have a slower response to treatment, and may take longer than three months. Most patients of liver qi stagnation and spleen qi deficiency type can get rid of most of the symptoms in three months. The results show more apparent effect in acute cases, which have a history of 2-3 months or less. Usually, during the process of treatment, the symptoms will improve by 70 percent to 80 percent in the first 1-1½ months. In the next 1½-2 months, the remaining 20 percent to 30 percent of the symptoms will go away .
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