Chronic fatigue syndrome - Wokingham, Berkshire

1. Overview

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) or ME/CFS, is a complex, debilitating chronic condition characterised by profound, persistent fatigue that is not relieved by rest and that is worsened by physical or mental activity — a defining feature known as post-exertional malaise (PEM). CFS/ME is recognised as a disorder of the brain by both the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), and affects an estimated 1% of the global population — around 17–24 million people worldwide, with approximately 250,000 people affected in the UK.

CFS/ME can affect people of any age, sex or background, but is most common in women aged 20–45. It is frequently misunderstood, misdiagnosed and under-treated in conventional medicine, with no single pharmaceutical treatment proven to be curative. Traditional Chinese medicine (TCM), including acupuncture and Chinese herbal medicine, takes a holistic approach to CFS that addresses the underlying patterns of deficiency and stagnation driving the condition, rather than suppressing individual symptoms in isolation. Research evidence supports the use of acupuncture and moxibustion for relieving CFS symptoms, reducing fatigue severity and improving quality of life.

2. Symptoms

CFS/ME is characterised by a cluster of symptoms that fluctuate in severity and are worsened by exertion. The hallmark and defining symptom is post-exertional malaise (PEM): a disproportionate, delayed worsening of symptoms following physical or cognitive activity that can persist for 24 hours or more after the triggering exertion. Core and associated symptoms include:

Profound, disabling fatigue — an overwhelming exhaustion that is not relieved by sleep or rest, is present on most days and significantly reduces the person’s capacity for work, study and daily activity
Post-exertional malaise (PEM) — a characteristic relapse of symptoms following physical or mental effort, often delayed by 12–48 hours, during which the person may be unable to function at all
Cognitive impairment (brain fog) — difficulty with memory, concentration, word-finding and processing information, often described as thinking through cotton wool
Unrefreshing sleep — sleeping for long periods but waking without feeling rested; disrupted sleep architecture, insomnia and hypersomnia
Orthostatic intolerance — symptoms that worsen when upright (standing or sitting), including dizziness, lightheadedness, nausea and heart palpitations; some patients develop postural orthostatic tachycardia syndrome (POTS)
Widespread pain — muscle pain, joint pain, headaches and nerve pain are common, and CFS frequently overlaps with fibromyalgia
Immune and autonomic dysfunction — recurrent sore throats, tender lymph nodes, temperature dysregulation, night sweats, sensitivity to light, noise and chemical stimuli
Mood disturbance — depression, anxiety and emotional lability are common secondary features, though CFS is not primarily a psychiatric condition

3. Causes and risk factors

The precise cause of CFS/ME remains unknown, but research suggests it is a multifactorial condition involving interactions between viral or infectious triggers, immune dysregulation, autonomic nervous system dysfunction, mitochondrial impairment and neuroendocrine abnormalities. CFS/ME is significantly more common following viral infections, and the COVID-19 pandemic has brought the condition wider recognition through the associated condition of long COVID, which shares many features with ME/CFS. Recognised risk factors and associated factors include:

Viral and infectious triggers — CFS frequently develops following acute viral illness. Common precipitating infections include Epstein-Barr virus (glandular fever/infectious mononucleosis), SARS-CoV-2 (COVID-19), enteroviruses and other respiratory infections. The post-COVID condition (long COVID) is now considered by many researchers to represent a significant new cohort of post-viral CFS/ME
Immune dysregulation — abnormal immune activation, elevated inflammatory cytokines and evidence of autoimmune processes have been found in CFS/ME research. The chronic low-grade inflammation contributes to many CFS symptoms including fatigue, pain and brain fog
Autonomic nervous system dysfunction — dysregulation of the autonomic nervous system underlies orthostatic intolerance and the abnormal physiological responses to exertion seen in CFS/ME
Mitochondrial and energy metabolism impairment — emerging research points to impaired mitochondrial function and cellular energy production as a biological basis for the profound fatigue in CFS, explaining why rest does not restore energy
Female sex — CFS/ME affects women approximately three times more often than men, suggesting a role for hormonal and immunological sex differences
Psychological and physiological stress — high levels of sustained stress, trauma, overwork and burn-out prior to illness onset are commonly reported by CFS patients and are relevant to both the development and management of the condition

4. Diagnosis

CFS/ME remains a clinical diagnosis — there is no single diagnostic blood test or biomarker. Diagnosis is based on the characteristic symptom pattern, particularly the presence of post-exertional malaise, unrefreshing sleep and cognitive impairment alongside fatigue of six months’ duration or more, with exclusion of other conditions that could explain the symptoms. Key diagnostic criteria include:

NICE guideline NG206 (2021) — the current UK standard, which requires post-exertional malaise, unrefreshing sleep or sleep disturbance, and cognitive impairment alongside fatigue, and critically no longer recommends graded exercise therapy (GET) as a treatment, recognising that it can worsen PEM and functional capacity in ME/CFS
The International Consensus Criteria (ICC) and Canadian Consensus Criteria (CCC) — widely used research and clinical criteria that emphasise the neurological, immune and autonomic features of ME/CFS and the central role of PEM
Investigations to exclude other causes — blood tests typically include full blood count, thyroid function, inflammatory markers (ESR, CRP), vitamin B12 and folate, vitamin D, ferritin, fasting glucose and liver and kidney function to exclude thyroid disorders, anaemia, diabetes and inflammatory conditions
Severity assessment — CFS/ME severity ranges from mild (able to undertake most normal activities with significant effort) to severe (housebound or bedbound). Severity determines which treatment approaches are appropriate, and overexertion in any severity category risks worsening

5. Chronic fatigue syndrome in Chinese medicine

In traditional Chinese medicine, CFS/ME corresponds to a presentation known historically as “xu lao” (deficiency taxation or exhaustion syndrome) — a pattern of chronic Qi, Blood, Yin or Yang deficiency that has become so profound it cannot be restored by ordinary rest. TCM recognises that treating this condition requires time and a systematic approach to rebuilding depleted reserves, rather than simply symptom management. The most common TCM patterns seen in CFS include:

Kidney and Spleen Qi deficiency — the most common pattern, reflecting the exhaustion of the foundational energy reserves (Kidney Jing and Qi) combined with impaired digestive Qi production (Spleen Qi). Manifests as profound fatigue, poor digestion, loose stools, cold limbs, low back weakness, poor memory and a sensation of being completely depleted. Treatment focuses on tonifying Kidney and Spleen Qi with specific acupuncture points and tonic herbal formulae such as Bu Zhong Yi Qi Tang
Heart and Spleen Blood deficiency — common in those whose CFS developed after prolonged overwork, stress, blood loss or post-partum depletion. Characterised by fatigue, palpitations, poor memory, difficulty concentrating (brain fog), insomnia, pallor and anxiety. The Heart-Mind (Shen) is insufficiently nourished, which explains the cognitive and emotional features. Treatment nourishes Blood and calms the Shen
Liver Qi stagnation with Spleen deficiency — in patients whose CFS is accompanied by significant emotional stress, frustration, depression and anxiety. The Liver’s function of ensuring the smooth flow of Qi is impaired, creating stagnation alongside underlying deficiency. Produces fatigue, chest tightness, sighing, mood fluctuation, poor digestion and hypersensitivity to stress. Treatment smooths Liver Qi while tonifying the Spleen
Yin deficiency with Empty Heat — seen in patients with night sweats, low-grade fever, afternoon heat sensations, dry throat, red tongue with little coating, insomnia and agitation. Common in post-viral CFS where the viral pathogen has consumed Yin fluids. Treatment nourishes Kidney and Lung Yin and clears Empty Heat
Damp obstruction with Spleen deficiency — in patients where the prevailing symptom is a heavy, foggy quality to the fatigue, with a sensation of being weighed down, mental cloudiness (brain fog), digestive sluggishness and possible weight gain. Dampness obstructs the clear Yang from rising to the head. Treatment resolves Damp and strengthens Spleen transport

6. Acupuncture for chronic fatigue syndrome

Acupuncture addresses CFS through multiple physiological mechanisms: it modulates the autonomic nervous system, reduces systemic inflammation, regulates HPA axis (stress hormone) function, improves sleep architecture and directly promotes mitochondrial ATP production. Research using randomised controlled trials has demonstrated that acupuncture can relieve the core and associated symptoms of CFS, including fatigue severity, pain, insomnia, brain fog and depression. Specifically, acupuncture for CFS works by:

Stimulating acupuncture points in muscles and other tissues, which changes the processing of pain and fatigue signals in the brain and spinal cord
Regulating immune function and reducing the chronic low-grade inflammatory state associated with CFS
Modulating the HPA axis to normalise the abnormal cortisol patterns and autonomic dysfunction common in CFS
Improving sleep quality by increasing melatonin and serotonin production and reducing nocturnal sympathetic nervous system activity
Reducing muscle pain and stiffness by improving local circulation and reducing inflammatory cytokine levels in affected tissues
Supporting neurological function and reducing cognitive symptoms by improving cerebral blood flow and neurotransmitter regulation

Research evidence

A systematic review and meta-analysis by Zhang et al. (2019), published in the Journal of Evidence-Based Medicine, included 16 RCTs with 1,346 subjects and found that acupuncture was effective in relieving symptoms of CFS, reducing fatigue and improving quality of life. An overview of systematic reviews by Yin et al. (2021), published in the Chinese Journal of Integrative Medicine, evaluated the quality and outcomes of all existing meta-analyses of acupuncture for CFS and confirmed that acupuncture produces meaningful improvements in fatigue severity, physical function and overall symptom burden. A systematic review and network meta-analysis by Fang et al. (2022), published in Medicine (Baltimore), found that the effect of acupuncture and moxibustion in treating CFS was significantly greater than that of other treatments, concluding that TCM approaches should be used more widely for CFS. A 2025 meta-analysis of acupuncture-based Chinese medicine for CFS confirmed improvements in fatigue, functional mobility and mental health outcomes across included RCTs.

Watch the video below which explains how acupuncture relieves pain:

7. Chinese herbal medicine for chronic fatigue syndrome

Chinese herbal medicine is a particularly important part of CFS treatment within TCM because it can address the deep deficiencies that drive the condition more directly and continuously than acupuncture alone — a tailored herbal formula can be taken daily, providing ongoing tonification and support between acupuncture sessions. Herbal treatment is prescribed individually based on the patient’s TCM pattern diagnosis and adapted as the presentation evolves. Commonly used formulae and herbs for CFS include:

Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi decoction) — the classical formula for Spleen and Stomach Qi deficiency with sinking Qi. Contains Huang Qi (Astragalus), Ren Shen (Ginseng), Bai Zhu (Atractylodes) and other tonifying herbs to restore digestive energy production and lift fatigue
Gui Pi Tang (Restore the Spleen decoction) — for Heart and Spleen Blood deficiency presenting as fatigue, palpitations, poor memory, insomnia and anxiety. Nourishes Blood, tonifies Qi and calms the Heart-Mind
Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and its variants — for Kidney Yin deficiency with Empty Heat, post-viral depletion, night sweats and afternoon fatigue
Xiao Yao San (Free and Easy Wanderer) — for Liver Qi stagnation with Blood deficiency and Spleen weakness, useful when CFS is accompanied by significant emotional stress, depression and irritability
Individual tonic herbs — Huang Qi (Astragalus), Dang Shen (Codonopsis), He Shou Wu (Polygonum multiflorum) and Gou Qi Zi (Lycium berries) are frequently incorporated to address specific deficiency patterns and support immune recovery

All herbs prescribed at this clinic are pharmaceutical-grade granule extracts supplied by Sun Ten (Taiwan), ensuring consistent potency and purity. An online Chinese herbal medicine consultation is available for patients who cannot attend in person.

8. Moxibustion for chronic fatigue syndrome

Moxibustion — the application of warming moxa (dried Artemisia) over specific acupuncture points — is particularly effective for CFS patterns characterised by Yang deficiency, Cold and Damp. The warming, tonifying qualities of moxibustion directly replenish depleted Yang Qi, improve circulation and counteract the heavy, cold, exhausted quality that many CFS patients experience. Key points used for moxibustion in CFS include CV4 (Guanyuan, the Gate of Original Qi), CV6 (Qihai, Sea of Qi), ST36 (Zusanli) for tonifying Stomach and Spleen Qi, and KD3 (Taixi) for nourishing Kidney Yin and Yang. A network meta-analysis of moxibustion for CFS found significant benefits for fatigue severity and overall response rate compared to control treatments.

Heat therapy with an infrared TDP lamp over the abdomen and lower back further supports Yang Qi tonification and can meaningfully improve the cold fatigue pattern that responds well to warmth in CFS.

9. Self-care

Self-management of CFS requires careful pacing and an understanding that pushing through fatigue (the “boom and bust” cycle) consistently worsens the condition through PEM. The following strategies support recovery alongside acupuncture and herbal medicine treatment:

Pacing and energy management — the most important self-management strategy in CFS. Identifying each individual’s energy envelope and staying within it, avoiding overexertion and building activity very gradually over time. A heart rate monitor can help identify the anaerobic threshold above which PEM risk rises sharply
Sleep hygiene and rest — establishing consistent sleep and wake times, avoiding screens before bed, keeping the sleep environment cool and dark, and incorporating scheduled rest periods during the day. Rest periods involve genuine rest — lying down in a quiet environment, not passive screen use
Dietary support — a whole-food diet that supports the Spleen and Stomach in TCM terms: warm, cooked foods, regular meals and avoidance of raw, cold or highly processed foods that burden digestion. Adequate protein intake is important for tissue repair and immune support. Some CFS patients benefit from identifying and eliminating food sensitivities. Chinese food therapy principles can guide appropriate dietary choices for each TCM pattern
Stress reduction — the autonomic dysregulation in CFS is worsened by psychological stress. Gentle mind-body practices such as breathwork, meditation, yoga nidra and gentle stretching within the energy envelope can help regulate the nervous system without risking PEM
Vitamin and mineral support — deficiencies in vitamin D, vitamin B12, magnesium, iron and CoQ10 are common in CFS and contribute to fatigue severity. Testing and addressing these deficiencies alongside acupuncture and herbal treatment optimises recovery
Temperature regulation — many CFS patients are sensitive to temperature extremes. Keeping warm, avoiding cold environments and cold foods and using heat (hot water bottles, warm baths) to relieve muscle pain and fatigue can provide meaningful symptom relief

10. Treatment at my clinic

I treat chronic fatigue syndrome at my clinic in Wokingham, Berkshire, combining acupuncture, Chinese herbal medicine and moxibustion in a tailored programme matched to the individual’s TCM pattern and current energy capacity. Treatment is adapted to each patient’s severity level — gentler, less stimulating treatment is used for those in more severe or unstable phases to avoid triggering PEM.

CFS is a condition that genuinely takes time to respond — most patients notice some improvement in sleep quality, pain and mood within four to eight sessions, with more significant improvements in energy and cognitive function developing over three to six months of regular treatment. Chinese herbal medicine, taken between sessions, accelerates the recovery of depleted reserves and is strongly recommended as part of a combined programme. See the prices page for treatment costs and the online herbal consultation page for those who prefer to begin herbal treatment remotely.

11. Frequently asked questions

Can acupuncture help with chronic fatigue syndrome?

Yes. Multiple systematic reviews and meta-analyses of randomised controlled trials have found that acupuncture reduces fatigue severity, pain, sleep disturbance and depressive symptoms in CFS/ME patients, and improves quality of life. A 2022 network meta-analysis found acupuncture and moxibustion to be significantly more effective than other treatments for CFS. Acupuncture works through multiple mechanisms including autonomic regulation, immune modulation, HPA axis normalisation and pain pathway modulation, all of which are relevant to CFS pathophysiology.

How many acupuncture sessions are needed for chronic fatigue syndrome?

CFS/ME is a chronic condition that requires a sustained course of treatment. Most patients notice initial improvements in sleep, pain and mood within four to eight weekly sessions. More significant improvements in energy levels and cognitive function typically develop over three to six months of treatment. Given the tendency of CFS to relapse, periodic maintenance treatment after the initial course can help sustain gains and prevent deterioration.

Is Chinese herbal medicine effective for chronic fatigue syndrome?

Chinese herbal medicine is considered an important part of CFS treatment in TCM because it addresses the deep constitutional deficiencies that drive the condition more directly than acupuncture alone can. Tonifying formulae such as Bu Zhong Yi Qi Tang and Gui Pi Tang have specific applications for the common CFS patterns of Qi and Blood deficiency, and can be taken daily to provide continuous support between acupuncture sessions. Combined acupuncture and herbal treatment is generally more effective than either approach alone for chronic deficiency conditions.

What is the difference between CFS and long COVID?

Long COVID (post-COVID syndrome) and ME/CFS share many features — both are post-viral conditions characterised by post-exertional malaise, profound fatigue, cognitive impairment and sleep disturbance — and many researchers consider long COVID to be a new cause of ME/CFS. In TCM terms, both conditions involve post-viral depletion of Qi, Yin or Yang and residual pathogenic factors. The treatments overlap significantly, and acupuncture, Chinese herbal medicine and moxibustion can help both. See the long COVID page for more information on that specific presentation.

Does acupuncture worsen fatigue in CFS?

In sensitive or severely affected patients, an acupuncture session that is too stimulating can temporarily increase fatigue as part of the body’s response to treatment — similar in some ways to PEM. This is why treatment for CFS is adapted carefully to the individual’s current energy capacity, using gentler needling, fewer needles and shorter sessions in more severely affected patients. As the patient strengthens, the pace and intensity of treatment can be gradually increased. This cautious, graduated approach minimises the risk of post-treatment fatigue flares and is an important part of managing CFS with acupuncture safely.