Fatigue is a subjective sensory symptom, which refers to a feeling of tiredness, lack of energy or exhaustion around the body. Some people divide fatigue into two aspects: brain fatigue and physical fatigue. Brain fatigue is a subjective feeling of lack of motivation and alertness, which is manifested as dullness of the mind, difficulty in concentrating and even thinking, forgetfulness, decreased desire, easy to make mistakes in work, and decreased work efficiency. Physical fatigue is a feeling of lack of energy or strength in the muscles, often manifested as easy fatigue after certain physical activities, or fatigue does not disappear easily, and even affects daily life and work to varying degrees. In 1988, the Center for Disease Control (CDC) named the complex symptom group characterized by debilitating fatigue as chronic fatigue syndrome for the first time and formulated the corresponding diagnostic criteria, which was revised in 1994 on this basis. In order to facilitate clinical research, the US Centers for Disease Control (CDC), in its 1994 study outline, collectively referred to self-reported fatigue lasting one month or more as “prolonged fatigue”; fatigue lasting or recurring for six months or more was defined as “prolonged fatigue”. Fatigue that lasts or recurs for 6 months or more is defined as Chronic Fatigue; chronic fatigue that cannot be explained medically is further divided into two categories. If the severity of fatigue or the accompanying symptoms do not meet the diagnostic criteria, then it is classified as “primary chronic fatigue” (Idiopathic Chronic Fatigue). The criteria are: (1) clinically assessed unexplained persistent or recurrent chronic fatigue, which is new or has a definite duration of onset (no life span); is not the result of sustained exertion; does not resolve significantly with rest; and results in a significant decline in work, education, social or personal activities. (2) Four or more of the following symptoms occur simultaneously, and these symptoms have persisted or recurred for 6 months or longer, but should not precede fatigue: ① a significant decrease in short-term memory or concentration; ② sore throat; ③ swollen and tender lymph nodes in the neck or axilla; ④ muscle pain; ⑤ polyarticular pain without redness or swelling; ⑥ a headache of a new type and degree; ⑦ inability to relieve sleep; ⑧ post-exercise fatigue lasting more than 24 h. According to the literature, 24% of adults in the United States experience fatigue for 2 weeks or longer, and 59% to 64% of them have no apparent medical cause. In a study, it was also shown that 24% of the first-time patients reported having had prolonged fatigue (1 month), and many of them had been fatigued for more than 6 months, i.e., chronic fatigue. 1. Western medical understanding of the etiology and pathogenesis of CFS There is no definite conclusion about the etiology and pathogenesis of CFS. According to research reports, CFS patients mainly have the following system dysfunction: (1) Immune system dysfunction: Many studies have shown that CFS patients have abnormal immune function, especially cytokines are closely related to the appearance of CFS symptoms. Therefore, CFS is also referred to as “chronic fatigue immune dysfunction syndrome”, and this abnormality varies from study to study and from individual to individual. The most common manifestations are: (1) increased levels of antiviral antibodies; (2) decreased numbers or activity of natural killer (NK) cells; (3) increased or decreased levels of immunoglobulins; (4) increased or decreased levels of immune circulating complexes; (5) increased or decreased levels of cytokines; and (6) altered ratios of helper to suppressor T cells. The most consistently reported is a decrease in the number or activity of NK cells. (2) Alterations in the neurological and endocrine systems: In addition to chronic fatigue, patients with CFS often have psychoneurological symptoms such as amnesia, difficulty concentrating, sleep disturbance (insomnia or drowsiness), headache, photophobia and shame, depression, and irritability. Experimental studies have also shown that abnormalities in the central nervous system and endocrine system play an important role in the development of CFS. For example: ① MRI shows that high signal punctate areas are more likely to be seen in the cortical layer of the brain in CFS patients than in normal controls. (ii) Measurements of the vegetative nervous system often show abnormalities in the sympathetic and parasympathetic nervous systems. It was found that hypotension occurred in 96% of adults with a clinical diagnosis of CFS on the tilt table test, compared to 29% of controls. (iii) Abnormalities of the hypothalamic-pituitary-glandular axis. Abnormalities of the hypothalamic-pituitary-glandular axis, particularly the hypothalamic-pituitary-adrenal axis (HPA), have been reported in patients with CFS. It is also believed that CFS occurs because physical or emotional stress activates the HPA axis, leading to an increase in the release of cortisol and other hormones that affect the immune system and many other systems, which in turn affects certain behavioral patterns. However, recent studies have also shown that patients with CFS often produce lower levels of cortisol than healthy controls, but their concentrations still vary within the normal range. It has also been suggested that some patients may have a biological susceptibility to CFS, triggered by certain factors, and that CFS occurs as a result of a combination of the nervous, endocrine, and immune systems, with hormones (e.g., pituitary hormones, catecholamines) and cytokines (e.g., IL-1 and TNF) released by immune activated cells playing an important role. The causes of the above-mentioned neurological, endocrine, and immune system disorders may be more closely related to the following two aspects: (1) Viral infection: Since some CFS patients present with sudden onset and epidemic tendencies, accompanied by flu-like symptoms such as fever, sore throat, and swollen and painful lymph nodes, many early researchers believed that CFS was caused by viral infection, and some referred to it as “post-viral fatigue syndrome”, while focusing their research on the determination of the virus and its markers. Many subsequent reports have shown that any evidence that CFS is caused by a viral infection is insufficient and, therefore, the diagnosis of CFS cannot be made by relying exclusively on the determination of viral markers and antibodies. as for the relationship between viral infection and immune function, it may be that the infection itself reduces and/or disturbs immunity, which leads to the development of the disease; or it may be that the altered function of the immune system in patients with CFS (compromised, hypo ) leading to reactivation of the virus and recurrent infections. In addition, it has been considered from the perspective of neuropathic reactions that the viral infection may lead to organic changes in the brain and cause the patient to show signs of cognitive-behavioral impairment, such as memory loss and difficulty in concentration. (2) Stress: The relationship between stress and disease has received increasing attention from the medical community, especially mental stress. In recent years, many foreign investigations have found a close relationship between CFS and stress, such as a case-control study by the CDC in Atlanta, which found that more people in the CFS case group reported stressful events in the year before the onset of CFS; in addition, two case-control studies by the CDC in New Jersey also showed that stress is a significant factor in the development of CFS. -controlled study in New Jersey also showed that stress is an important risk factor for the development of CFS. It has also been shown that the risk of developing CFS is significantly associated with the number of stressors, and that three or more stressors are particularly likely to cause CFS. Therefore, more and more researchers are focusing on the altered mental, neurological, and psychological status of CFS patients, such as the findings that CFS patients have more stressful life events, higher levels of fatigue, lower overall activity levels, more social withdrawal and depression, and lower NK cell activity than healthy controls. In addition, according to our preclinical practice, we also found that patients with CFS often feel stressful life, work, or study or have experienced stimulation from adverse events (e.g., divorce, loss of love, etc.) before the onset of the disease, and after the onset of the disease, they often have neuropsychiatric symptoms such as depression, impatience, irritability, forgetfulness, etc. Laboratory indices often show a decrease in NK activity, norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine ( 5-HT) and other neurotransmitters. In conclusion, the cause and pathogenesis of CFS involves a variety of factors, and most people believe that the occurrence of the disease may be the result of the disruption of the neuro-endocrine-immune network due to multiple factors such as viral infection and stress, among which factors such as viral infection and mental stress alter the immunity of the body as an important part of the occurrence of the disease. As for how these factors interrelate and influence each other, leading to the occurrence of CFS, and whether there is a common mechanism that leads to the occurrence of CFS, it needs to be further explored in future studies. 2. The understanding of CFS in TCM Chronic fatigue syndrome is not recorded in TCM literature. However, fatigue, as a common symptom in TCM, is often described as “slackness”, “slackness”, “tiredness of the limbs”, ” In modern TCM clinics, the terms “weakness of the body”, “weariness of the limbs”, “fatigue of the mind” and “fatigue of the body” are mostly used. In modern TCM clinics, it is often described as “weakness of the body”, “tiredness of the limbs” and “fatigue of the mind”. According to the theory of Chinese medicine, the weakness and easy fatigue of the body are directly related to the liver, spleen and kidney. For example, “Suwen・showing the theory of connubiality” points out that “liver deficiency, kidney deficiency, and spleen deficiency all make people tired of weight injustice.” Su Wen – Six Sections and Hidden Elephants says: “The liver is the origin of the strike”, clearly pointing out that liver dysfunction is an important cause of fatigue. The liver is the master of tendons, and the “Suwen Jiezi” explains “tendons, the strength of the flesh”, so if the tendons are not healthy and the movement If the tendons are not healthy and the movement is not favorable, fatigue will easily occur. The spleen is the master of the muscles and limbs, and if the spleen is not functioning well, the limbs will become tired and fatigued, just as in the Su Wen – Tai Yin Yang Ming Discourse: “Now the spleen cannot move its fluids for the stomach, and the four branches cannot endow the water and grain with gas, so the gas will decline day by day, and the pulse paths will be unfavorable, and the tendons and muscles will have no gas to produce, so they will not be used.” The kidney is the master of bone, and the waist is the house of the kidney. If the kidney is deficient and the bone loses its nourishment, the waist and knees will easily become sore and weak, and walking will be weak. According to the analysis of qi, blood, fluid and etiology, fatigue is a manifestation of qi deficiency and low function of the body; while the soreness and tiredness of limbs and joints are also related to dampness and poor qi flow. Some researchers, based on TCM theory and clinical practice, believe that liver and spleen dysfunction plays an important role in the occurrence and development of CFS. As mentioned above, the liver and spleen are directly related to limb movement and muscle strength. In addition, the function of the liver is mainly to drain and collect blood, especially its drainage function is important. The physiological characteristics of the liver are that it is the main promoter of Qi, preferring to regulate the flow of Qi but not depression, and by regulating the Qi flow around the body, the movement of Qi up and down and in and out of the body is coordinated and balanced, thus maintaining the normal functional activities of the internal organs. In addition to regulating the qi, the liver also has the functions of unblocking the blood vessels, regulating the water channels, draining the bile, helping the spleen and stomach to transport and transform, and coordinating breathing. If the liver’s drainage is not normal, it will produce pathological changes such as qi stagnation, blood stasis, bleeding, and abnormal metabolism of water and fluid distribution, so the ancients said “qi is the longest of all diseases” and “if there is fries, all diseases will arise”. Another aspect of the liver is the regulation of the emotions, which is closely related to the emotional activities. If the liver is well regulated, it has a high tolerance to emotional stimuli and a strong self-regulatory ability. They noted that many CFS patients had stressful events before the onset of the disease, and the onset of the disease was closely related to emotional factors. It can be seen that the regulation of liver qi plays an important role in the development and evolution of CFS. Treatment should pay attention to liver regulation as an important aspect, regardless of deficiency or actuality, and should be considered to varying degrees to unblock qi, relieve stress, improve emotions (including abnormalities in emotions due to illness), treat and prevent further development of the disease. The spleen is the backbone of the body and is responsible for transporting and transforming, as well as raising and clearing. The relationship between the liver and spleen lies in the mutual influence between the draining function of the liver and the transportation of the spleen. The liver can assist and regulate the transportation function of the spleen, as pointed out in Su Wen (The Treatise on the Protection of Life and the Whole Form), which states that “earth can be reached by wood”. Therefore, in the “Jin Kui Yao – The Evidence of Successive Diseases of the Internal Organs and Meridians”, it is said that “if you see a liver disease, you know that the liver transmits the spleen, so you should first strengthen the spleen”. Based on the above, researchers believe that the occurrence of CFS is due to the stimulation of long-term stress and unpleasant events, which affects the drainage of the liver and the transportation and transformation of the spleen, thus leading to the dysregulation of the liver and spleen. After treatment with the Chinese herbal formula “Eliminate Fatigue and Ease the Mind Oral Liquid”, which is based on the principle of tonifying qi and regulating the liver and spleen, most patients with CFS showed significant improvement in their symptoms. Therefore, they believe that the dysfunction of liver and spleen is one of the mechanisms for the occurrence of chronic fatigue syndrome. Treatment 1. Basic treatment Treatment: Diversify the liver and spleen, tonify the heart and kidney, strengthen the brain and nourish the mind, and eliminate fatigue; acupuncture and moxibustion are also used, as well as tonic methods. Prescriptions: Baihui, Yin Tang, Shen Men, Tai Xi, Tai Chong, Sanyinjiao, and Shu San Li. Directions: ①Baihui and Yin Tang are points of the Governor’s Vessel, which can clear the head and eyes and strengthen the brain and nourish the mind; ②Shen Men and Tai Xi are the original points of the Heart and Kidney meridians respectively, so they are compatible with each other to transport the heart and kidneys; ③Tai Chong, Sanyinjiao and Shu San Li dredge the liver and regulate Qi to restore physical strength. Addition and subtraction: ① insomnia, sleepiness and wakefulness: Annmian and Neiguan – nourish the heart and calm the mind; ② palpitations and anxiety: Neiguan and Xin Yu – calm the heart and fix the mind; ③ dizziness and lack of concentration: Sishencong and Hang Zhong – strengthen the brain and educate the mind. -strengthens the brain and improves mental health. Operation: The main points are operated routinely. Treatment 2 to 3 times a week. 2. Other therapies (1) Skin acupuncture: tap on the Governor’s Vessel, Pinnacle and Dorsal Yu points for 15 to 20 minutes each time. Once a day. (2) Ear acupuncture: take the heart, kidney, liver, spleen, brain, subcortical, shinmen and sympathetic points. Select 3 to 5 points at a time and apply pressure with Wang Bu Liu Xing seeds. Alternate between the two ears and change every 2 to 3 days. (3) Electro-acupuncture: Based on acupuncture, connect the electro-acupuncture therapy instrument and stimulate weakly with sparse and dense waves for 20 to 30 minutes. (4) Anointing and moxibustion method: IV. Research ideas of chronic fatigue syndrome With the increased awareness of competition in contemporary society, the accelerated pace of society and life, the number of patients with mental tension and chronic fatigue as the main complaints in clinical practice is increasing, thus chronic fatigue syndrome is increasingly receiving high attention from the medical profession. According to a recent survey conducted by researchers at the Centers for Disease Control, chronic fatigue syndrome has involved about 500,000 Americans, and it is estimated that about 183 out of every 100,000 adult U.S. citizens have symptoms consistent with the definition of chronic fatigue syndrome. Although chronic fatigue syndrome is not life-threatening, it has a serious impact on the ability to work, efficiency and daily life of patients. Since the pathogenesis of CFS is still unclear, there are few studies on CFS from the perspective of animal experiments in Western medicine, and only a few models of viral infection by injection of virus have been seen. According to previous studies, viral infection may only be a precipitating factor for the occurrence of CFS, while some foreign epidemiological surveys and clinical reports show that many patients with chronic fatigue syndrome have had long-term mental tension, unpleasant life events and changes in lifestyle habits before the onset of the disease (i.e., related to psychological and social stress factors), and the onset of the disease is often accompanied by mental depression, or impatience and irritability, forgetfulness, concentration, and other psychoneurological symptoms. The onset of CFS is often accompanied by psychoneurological symptoms such as depression, irritability, forgetfulness, difficulty in concentration, cognitive and behavioral changes, and immune dysfunction. Based on the current understanding of the pathogenesis and clinical characteristics of CFS in Chinese and Western medicine and the theory of stress, some researchers have developed an animal model of chronic fatigue with clinical manifestations similar to those of CFS by using a combination of psychological and somatic stress factors (i.e., the factors of emotion and overwork in Chinese medicine) to provide a basis for further exploration of the pathogenesis of CFS and the development and evaluation of effective Chinese medicine preparations for the prevention and treatment of chronic fatigue syndrome. In the development of the animal model, the study was carried out in the following way In the development of the animal model, researchers believe that not only the similarity of the modeling factors with the pathogenesis of CFS patients should be considered, but more importantly, whether the behavioral performance of the animal model is similar to the clinical performance of CFS should be evaluated from the behavioral perspective. Therefore, in the specific experiments, in addition to observing the general conditions of the animals such as body weight, diet and feces, some behavioral indicators were selected to evaluate the physical strength, emotion and memory of the animals. The main experiments were exhaustion swimming experiment, rat tail suspension experiment, open field experiment and water maze experiment. The time from swimming to exhaustion at room temperature is a classical index to reflect the animal’s physical strength and measure whether the animal is fatigued; the intermittent immobility time of the animal in the rat tail suspension experiment can reflect the animal’s muscle strength and physical condition to a certain extent. The open field experiment is a classic method to reflect the exploratory behavior and emotion of rats in a new environment, and can be used to test the “excitement” or “depression” state of the central nervous system. The rat tail suspension test can also reflect the animal’s “disappointment” and “depression” state. The water maze was used to evaluate the state of brain fatigue by observing the learning and memory ability of rats. Based on the above idea, the researchers developed an animal model of chronic fatigue by using a combination of chronic restraint and cold water swimming with electrical stimulation during feeding. The results showed that: ①The model group rats’ exhaustion swimming time was significantly shorter than that of the control group; the time and number of struggles to overcome abnormal body position were relatively significantly reduced in the body upside down state. This indicates that the rats were already in the state of somatic fatigue. In the upside-down condition, the rats in the model group were “disappointed” and the number of struggles to overcome the abnormal body position was significantly reduced. It showed that the model group animals were in a relatively “depressed” state. (3) The memory of the rats in the model group was significantly reduced, the time of leaving the water maze was significantly prolonged, and the number of swimming in the wrong direction was significantly increased, which reflected that the brain power of the model animals was also in a state of fatigue. The above results are basically similar to the clinical manifestations of chronic fatigue syndrome. 2.Clinical research Since the official naming of CFS by CDC in 1988, Australia, UK, Japan and other countries have developed their own standards and research outlines, and conducted epidemiological surveys and related clinical research. In contrast, the reports on CFS in China are limited to reviews of some foreign studies and summaries of scattered cases of CFS treated with TCM, but there is a lack of systematic studies on the epidemiology, risk factors and clinical aspects of CFS. In clinical practice, researchers have found that many patients who present with fatigue as the main complaint and whose disease cannot be found by various tests are not clearly diagnosed with CFS due to the lack of awareness of the disease among doctors and patients. It has also been observed that these patients do not fully meet the diagnostic criteria for CFS established by the Centers for Disease Control in the United States. The onset of CFS in many patients is closely related to social and psychological stressful events, and relatively few are significantly associated with viral infections. It is evident that, in order to further study CFS, it is necessary to develop a diagnostic criterion for CFS that fits the characteristics of our population. In addition, due to the inexact understanding of the pathogenesis of CFS, there is a lack of effective treatment methods in Western medicine. The current treatment methods are: ① symptomatic therapy using immune stimulants, immunosuppressants, antidepressants, hypnotics, analgesics, antihistamines; ② supportive therapy using vitamin A, C, B12 and coenzyme Q-10, selenium, germanium, zinc, iron, magnesium and other minerals; ③ cognitive-behavioral therapy. With the increase of foreign studies, there are also reports of using TCM to treat CFS and achieve efficacy in China. The diagnosis and treatment of Chinese medicine focuses on identifying and grasping the overall state of the organism from a macroscopic perspective, and achieving the purpose of treatment by adjusting the state of the organism and mobilizing the organism’s enthusiasm. Therefore, in order to meet the clinical needs of our country and alleviate the suffering of patients, we should use TCM theory as a guide and combine with modern science and the latest CDC CFS research outline to conduct clinical research on CFS in the following aspects: (1) Use clinical epidemiology/DME methods, such as case-control studies, cohort studies, and clinical research on CFS. (1) Using clinical epidemiology/DME methods, such as case-control studies, cohort studies, cross-sectional studies, etc., we conducted comprehensive and detailed questioning and collection of CFS patients’ medical histories, investigated the incidence of CFS in China and various factors related to the development of CFS, combined with modern multivariate statistical methods and internationally recognized statistical software SPSS or SAS software to analyze and summarize the risk factors for the development of CFS, and explored the causes of CFS from both Chinese and Western medicine perspectives. (1) To explore the etiology and pathogenesis of CFS from both Chinese and Western medicine perspectives, and to provide a basis for finding effective preventive and therapeutic measures. (2) Combining some existing scales (fatigue scale, depression scale, anxiety scale), the patient’s fatigue, depression, anxiety and other symptoms (including tongue and pulse) were assessed semi-quantitatively, and modern statistical methods were used to analyze the symptoms and symptoms of CFS in China, so as to provide a basis for the development of diagnostic criteria for CFS that meet the national conditions of China. By observing the clinical efficacy of Chinese medicine and relevant laboratory indexes, we analyze the mechanism of Chinese medicine in treating CFS, so as to establish a comprehensive clinical treatment plan and find effective Chinese medicine preparations. (3) To classify and observe CFS patients according to their specific manifestations, such as the onset and urgency of the disease, symptoms and symptoms, and follow up regularly to study their development, regression and prognosis, so as to provide a basis for further comprehensive understanding of the pathogenesis of CFS and the evolution of symptoms.