Chronic fatigue syndrome (CFS) is characterized by persistent fatigue as its core symptom, often accompanied by cognitive impairment, pain, sleep disturbances, and emotional abnormalities. Its pathophysiology involves the interplay of multiple factors including genetics, infection, dysbiosis, immune-inflammatory dysregulation, oxidative stress, and metabolic abnormalities. Clinically, the lack of specific diagnostic markers and effective treatment options have made CFS a significant public health challenge. Traditional Chinese medicine (TCM) classifies it under the categories of “consumptive disease” and “deficiency syndrome”. The core pathogenesis is attributed to dual deficiency of the spleen and kidney, leading to impaired qi transformation. Spleen deficiency results in inadequate transportation and transformation, causing deficiency of qi and blood, which in turn fails to nourish the limbs, leading to fatigue. Kidney deficiency manifests as depletion of essence and marrow, resulting in exhaustion of primordial energy, causing mental fatigue and weakness of tendons and bones. Mutual impairment of spleen and kidney disrupts qi transformation, causing internal retention of water and dampness, which further exacerbates deficiency. Throughout history, TCM case studies addressing CFS are not uncommon. Its holistic perspective and syndrome differentiation approach align with CFS’s complex, multi-targeted, and multi-pathway pathology. This study therefore systematically reviews the etiology and pathogenesis of CFS from both TCM and Western medical perspectives, summarizing the applications of both traditional and modern medicine in CFS treatment to provide insights for clinical management and academic research.

chronic fatigue syndrome  /  traditional Chinese medicine formulas  /  traditional Chinese medicine paste formulas  /  genetic susceptibility  /  pathogen infection  /  gut microbiota imbalance