E0 ConsensusPreliminaryPEM unclearSystematic-ReviewPeer-reviewedMachine draft
Is there a role for traditional and complementary medicines in managing chronic fatigue? a systematic review of randomized controlled trials.
Li, Yuxiao, Yang, Jingya, Chau, Chi Ian et al. · Frontiers in pharmacology · 2023 · DOI
Quick Summary
This review looked at 62 research studies testing traditional and complementary medicines for chronic fatigue syndrome, involving over 5,200 patients. The researchers found that certain Chinese herbal combinations appeared to help reduce fatigue and improve symptoms, with no serious side effects reported. However, the quality of the studies varied widely, making it difficult to draw firm conclusions about whether these treatments truly work.
Why It Matters
This review addresses a critical gap for ME/CFS patients who often turn to complementary approaches when conventional treatments fail. By synthesizing evidence on traditional medicines, it provides an overview of which interventions have research support and which need better study, helping inform shared decision-making between patients and clinicians.
Observed Findings
- 62 RCTs investigating 43 types of traditional and complementary medicines for CFS were included, involving 5,231 total participants.
- Chaihu Guizhi Decoction and Buzhong Yiqi combined with Xiao Chaihu Decoction showed the most consistent efficacy across studies.
- 148 botanical ingredients were identified in effective formulations, with Astragali Radix, Glycyrrhizae Radix et Rhizoma, and Bupleuri Radix appearing most frequently.
- No serious adverse effects were reported across the 62 trials.
- Fatigue symptom improvement was the most frequently observed benefit, followed by TCM-diagnosed symptom improvement and psychological condition changes.
Inferred Conclusions
- Some evidence supports the efficacy and safety of traditional and complementary medicines in reducing CFS-related fatigue.
- The quality and methodological rigor of existing RCTs are insufficient to make definitive clinical recommendations.
- Future research must employ standardized diagnostic criteria, larger sample sizes, objective outcome measures, and better bias control to establish robust evidence.
Remaining Questions
- Which specific herbal compounds or ingredients are most therapeutically active for ME/CFS fatigue?
- How do these traditional medicines compare in efficacy to pharmacological interventions or psychological therapies in head-to-head trials?
What This Study Does Not Prove
This review does not prove that any complementary medicine definitively treats ME/CFS, as the included studies had significant quality and methodological problems. The findings do not establish causation or safety in well-controlled settings with standardized diagnostic criteria. Small effect sizes and publication bias in favor of positive results may inflate the apparent efficacy of these interventions.
Tags
Symptom:Fatigue
Method Flag:Weak Case DefinitionMixed Cohort
Metadata
- DOI
- 10.3389/fphar.2023.1266803
- PMID
- 37942489
- Review status
- Machine draft
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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