Integrated causal inference modeling uncovers novel causal factors and potential therapeutic targets of Qingjin Yiqi granules for chronic fatigue syndrome

Objective:Chronic fatigue syndrome(CFS)is a prevalent symptom of post-coronavirus disease 2019(COVID-19)and is associated with unclear disease mechanisms.The herbal medicine Qingjin Yiqi granules(QJYQ)constitute a clinically approved formula for treating post-COVID-19;however,its potential as a drug target for treating CFS remains largely unknown.This study aimed to identify novel causal factors for CFS and elucidate the potential targets and pharmacological mechanisms of action of QJYQ in treating CFS.Methods:This prospective cohort analysis included 4,212 adults aged≥65 years who were followed up for 7 years with 435 incident CFS cases.Causal modeling and multivariate logistic regression analysis were performed to identify the potential causal determinants of CFS.A proteome-wide,two-sample Mendelian randomization(MR)analysis was employed to explore the proteins associated with the identified causal factors of CFS,which may serve as potential drug targets.Furthermore,we performed a virtual screening analysis to assess the binding affinity between the bioactive compounds in QJYQ and CFS-associated proteins.Results:Among 4,212 participants(47.5%men)with a median age of 69 years(interquartile range:69–70 years)enrolled in 2004,435 developed CFS by 2011.Causal graph analysis with multivariate logistic regression identified frequent cough(odds ratio:1.74,95%confidence interval[CI]:1.15–2.63)and insomnia(odds ratio:2.59,95%CI:1.77–3.79)as novel causal factors of CFS.Proteome-wide MR analysis revealed that the upregulation of endothelial cell-selective adhesion molecule(ESAM)was causally linked to both chronic cough(odds ratio:1.019,95%CI:1.012–1.026,P=2.75 e^(−05))and insomnia(odds ratio:1.015,95%CI:1.008–1.022,P=4.40 e^(−08))in CFS.The major bioactive compounds of QJYQ,ginsenoside Rb2(docking score:−6.03)and RG4(docking score:−6.15),bound to ESAM with high affinity based on virtual screening.Conclusions:Our integrated analytical framework combining epidemiological,genetic,and in silico data provides a novel strategy for elucidating complex disease mechanisms,such as CFS,and informing models of action of traditional Chinese medicines,such as QJYQ.Further validation in animal models is warranted to confirm the potential pharmacological effects of QJYQ on ESAM and as a treatment for CFS.

Effects of Intermittent Hypoxia Exposure on Symptoms of Chronic Fatigue Syndrome in Repeated Restraint Stress and Forced Swimming Induced-Mouse Model

Background: Chronic fatigue syndrome (CFS) shows as its main symptoms debilitating fatigue that is not relieved by physiological rest, depression, inflammation, learning disability and memory impairment. But, intermittent hypoxia, consisting of alternating exposure to hypoxia and normoxia, plays a very important role in improving CFS. However, the essential components for improving learning and memory in CFS patients as well as their mechanism are largely unknown. Objectives: This study aims to analyze the effects of 12% and 15% hypoxia on the expression of alpha tumor necrosis factor (TNF-α) and nuclear factor kappa B (NF-κB) in CFS induced-mouse model for clarifying the effects on the learning and memory function. Methods: A total of 48 type IC mice were used. The CFS mouse model was established using restrained stress and repeated forced swimming. Treatment of CFS was done by exposing CFS mice to intermittent hypoxia at 12% and 15%. The effects of intermittent hypoxia on learning and memory as well as its mechanism of action on inflammation were tested respectively with the Morris test, the SDS page, the immunohistochemistry technique and the Nissl staining. Results: We found that 12% and 15% intermittent hypoxia exposure improved learning capacity and memory of CFS induced-mice. SDS page showed that CFS caused higher TNF-α expression. By exposing CFS mice to 12% and 15% intermittent hypoxia, TNF-α expression decreased significantly, with a much better effect at 15%. Both TNF-α and NF-κB increased in CFS state and decreased after treatment with intermittent hypoxia. Conclusion: Intermittent hypoxia improves learning capacity and memory. It acted by decreasing NF-κB come to down-regulating TNF-α and ameliorates learning capacity and memory impairment in CFS mice.

Effects of Exercise on Behavior and Peripheral Blood Lymphocyte Apoptosis in a Rat Model of Chronic Fatigue Syndrome

This study examined the effects of exercise on behavior and peripheral blood leukocyte apoptosis in a rat model of chronic fatigue syndrome （CFS）. Thirty-six healthy male Sprague-Dawley rats were equally randomized into 3 groups： the control group, CFS model group and the exercise group in terms of body weight. A total of 25 rats entered the final statistical analysis due to 11 deaths during the study. CFS model was established by subjecting the rats in CFS model group and exercise group to electric shock, chronic restraint stress and cold water swim. Besides, rats in the exercise group took rtmning wheel exercise. After a week of conditioning feeding, model construction and running wheel exercise were performed simultaneously, and lasted for 23 consecutive days. The behavior experiments, including running wheel exercise, open-field test, tail suspension test and Morris water maze test, were conducted, either before or after the model establishment. Rats were sacrificed and peripheral blood was obtained for the assessment of lymphocyte apoptosis index by flow cytometry （FCM）. It was found that as compared with those in the control group, the weight of the rats was decreased obviously （P〈0.01）, the mobility time in the open-field and the tail suspension tests was shortened significantly （P〈0.01）, the time to locate the platform was enhanced （P〈0.01） and the cell apoptosis index was increased substantially （P〈0.01） in the CSF model group. Meanwhile, in comparison to the model group, the behavior in the open-field and the tail suspension tests was improved significantly （P〈0.05）, and the apoptosis index decreased remarkably （P〈0.01） in the exercise group. It is concluded that sport intervention can prevent lymphocyte apoptosis and improve animal behavior rather than the memory.

CLINICAL OBSERVATION ON THE TREATMENT OF CHRONIC FATIGUE SYNDROME WITH DEEPLY PUNCTURED ELONGATED NEEDLE COMBINED WITH COMPREHENSIVE NURSING

Objective： To observe the therapeutic effect of deep puncture of Zusanli （足三里 ST 36） and Qihai （气海 CV 6） with elongated needle combined with comprehensive nursing in the treatment of chronic fatigue syndrome （CFS） so as to provide new way and effective method for CFS. Methods： A total of 100 cases of CFS patients were evenly randomized into treatment group and control group which were treated with elongated needle puncture of ST 36 and CV 6 plus nursing and oral ackninistration of Shiquan Dobu Tong （十全大补汤 Decoction of Ten Powerful Tonics） separately. Acupuncture and medication were given once daily, with 7 sessions being a therapeutic course, 4 courses altogether. Results： After 4 courses of treatment, of the two 50 cases in treatment and control groups, 4 （8.0%） and 2 （4.0%） were cured, 37 （74.0%） and 16 （32.0%） experienced marked im- provernent, 6 （ 12.0 % ） and 19 （38.0 % ） had improvement, 3 （6.0 % ） and 13 （26.0 % ） tailed, with the total effective rates being 94.0% （47/50） and 74.0% （37/50） respectively. The total effective rate and markedly effective rate of treatment group were significantly higher than those of control group （P〈0.05, 0.01）. Conclusion; Deep puncture of Zusenli （ST 36） and Qihai （CV 6） with elongated needle combined with comprehensive nursing has a definite therapeutic effect in the treatment of chronic fatigue syndrome.

Accurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms

Although myalgic encephalomyelitis(ME) and chronic fatigue syndrome(CFS) are considered to be synonymous,the definitional criteria for ME and CFS define two distinct,partially overlapping,clinical entities.ME,whether defined by the original criteria or by the recently proposed criteria,is not equivalent to CFS,let alone a severe variant of incapacitating chronic fatigue.Distinctive features of ME are:muscle weaknessand easy muscle fatigability,cognitive impairment,circulatory deficits,a marked variability of the symptoms in presence and severity,but above all,post-exertional "malaise":a(delayed) prolonged aggravation of symptoms after a minor exertion.In contrast,CFS is primarily defined by(unexplained) chronic fatigue,which should be accompanied by four out of a list of 8 symptoms,e.g.,headaches.Due to the subjective nature of several symptoms of ME and CFS,researchers and clinicians have questioned the physiological origin of these symptoms and qualified ME and CFS as functional somatic syndromes.However,various characteristic symptoms,e.g.,post-exertional "malaise" and muscle weakness,can be assessed objectively using wellaccepted methods,e.g.,cardiopulmonary exercise tests and cognitive tests.The objective measures acquired by these methods should be used to accurately diagnose patients,to evaluate the severity and impact of the illness objectively and to assess the positive and negative effects of proposed therapies impartially.

Induced pluripotent stem cells as suitable sensors for fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome

BACKGROUND Fibromyalgia(FM)and myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)are devastating metabolic neuroimmune diseases that are difficult to diagnose because of the presence of numerous symptoms and a lack of specific biomarkers.Despite patient heterogeneity linked to patient subgroups and variation in disease severity,anomalies are found in the blood and plasma of these patients when compared with healthy control groups.The seeming specificity of these“plasma factors”,as recently reported by Ron Davis and his group at Stanford University,CA,United States,and observations by our group,have led to the proposal that induced pluripotent stem cells(iPSCs)may be used as metabolic sensors for FM and ME/CFS,a hypothesis that is the basis for this indepth review.AIM To identify metabolic signatures in FM and/or ME/CFS supporting the existence of disease-associated plasma factors to be sensed by iPSCs.METHODS A PRISMA(Preferred Reported Items for Systematic Reviews and Meta-analysis)-based systematic review of the literature was used to select original studies evaluating the metabolite profiles of FM and ME/CFS body fluids.The MeSH terms“metabolomic”or“metabolites”in combination with FM and ME/CFS disease terms were screened against the PubMed database.Only original studies applying omics technologies,published in English,were included.The data obtained were tabulated according to the disease and type of body fluid analyzed.Coincidences across studies were searched and P-values reported by the original studies were gathered to document significant differences found in the disease groups.RESULTS Eighteen previous studies show that some metabolites are commonly altered in ME/CFS and FM body fluids.In vitro cell-based assays have the potential to be developed as screening platforms,providing evidence for the existence of factors in patient body fluids capable of altering morphology,differentiation state and/or growth patterns.Moreover,they can be further developed using approaches aimed at blocking or reversing the effects of specific plasma/serum factors seen in patients.The documented high sensitivity and effective responses of iPSCs to environmental cues suggests that these pluripotent cells could form robust,reproducible reporter systems of metabolic diseases,including ME/CFS and FM.Furthermore,culturing iPSCs,or their mesenchymal stem cell counterparts,in patient-conditioned medium may provide valuable information to predict individual outcomes to stem-cell therapy in the context of precision medicine studies.CONCLUSION This opinion review explains our hypothesis that iPSCs could be developed as a screening platform to provide evidence of a metabolic imbalance in FM and ME/CFS.

Effect of intradermal needle at five-zang Back-Shu points on treatment of chronic fatigue syndrome

Objective:To observe the effect of intradermal needle therapy on back-shu points of five zang organs in treating chronic fatigue syndrome(CFS)and provide evidence for the usage of unilateral back-shu point.Methods:Patients were randomly divided into bilateral back-shu point group,unilateral back-shu point group and non-acupoint group,remove shedding cases,each group remaining 30 patients.In bilateral back-shu point group,both sides of back-shu points of five zang organs were selected.In unilateral back-shu point group,only one side was selected,left or right alternately.The location where non-acupoint group inserted by intradermal needles were outward from the back-shu points,left or right alternately.Fatigue Scale-14(FS-14)was used to evaluate the fatigue level and the scores’improvement of physical fatigue and mental fatigue revealed the therapeutic effect on body constituents and spirits of CFS patient.Results:After the 8-week intradermal needle therapy,the total effective rate was 83.33%in the bilateral back-shu point group,which was 76.67%in the unilateral back-shu point group and 50.00%in the non-acupoint group.The curative effects of the two groups whose back-shu points of five zang organs were inserted by intradermal needles were better than the non-acupoint group(P<0.05).There was no significant difference in clinical efficacy between the bilateral back-shu point group and the unilateral back-shu point group(P>0.05).There were statistical differences in FS-14 questionnaires including total,physical and mental scores between before and after the treatment in both the two back-shu point groups(P<0.05).Only the scores of total and physical fatigue in decreased in non-acupoint group(P<0.05),which means it couldn’t help to alleviate mental fatigue statistically(P>0.05).Conclusions:(1)The intradermal needle therapy on back-shu points of five zang organs for CFS has a satisfying clinical efficacy in curing tiredness.It can help to reduce both physical and mental fatigue for the patients.Hence,it can regulate both body constituents and spirits simultaneously.(2)Needling the unilateral acupoints can get similar clinical efficacy to the bilateral points.It reveals that we can cut cost by reducing the consumption of the amount of intradermal needles used on one side.(3)Both the groups of back-shu points get better clinical efficacy than the non-acupoint group dramatically.The reason of why the intradermal needle can treat CFS maybe that back-shu points of five zang organs can regulate the functions of five zang organs characteristically.

A Comparative Study of Antifatigue Effects of Taurine and Vitamin C on Chronic Fatigue Syndrome

Vitamin C and taurine (TR) are well known as active components for fatigue recovery. However, the mechanism of the anti-fatigue effects of vitamin C and TR is still unclear. Our study was designed to evaluate the anti-fatigue activities of vitamin C and TR in an animal test for fatigue and to compare the activities between vitamin C and TR. Materials and Methods: Vitamin C, TR or their combination were orally administrated to mice once daily for 15 days, and then metabolic activities such as blood glucose, triglyceride (TG), lactate, and lactate dehydrogenase (LDH) as well as antioxidant activities such as malondialdehyde (MDA) and superoxide dismutase (SOD) were determined (evaluated) after forced swimming test (FST). Results: Compared with the control group, C100, C200, and T50 showed a tendency to decrease mobility in FST. Moreover, TG (C100, C200, T200), LDH (C200), lactic acid (C100) and MDA (C50, C100, C200) levels were inhibited by vitamin C and TR. Conclusions: These results suggest that vitamin C and TR have anti-fatigue activities in mice, with vitamin C providing a stronger effect.

TREATMENT OF TEN CASES OF CHRONIC FATIGUE SYNDROME WITH CHINESE HERBS,ACUPUNCTURE, AND DIET PRECAUTIONS

Ten cases of chronic fatigue syndrome (CFS) were treated for 4 weeks by acupuncture, Chinese herbs and diet precautions. Diagnosis of CFS was determined by conventional medicine criteria(CDC criteria for CFS), physical examination, and routine laboratory tests. TCM diagnosis of CFS relied on Four Examination Methods and Eight Principal Patterns. They were diagnosed as Ganyu Qizhi (liver and qi stagnation) and Pixu Qiruo (spleen and qi deficiency). The treatment method is to disperse the liver and facilitate qi, rehabilitate the spleen and strengthen qi (Shugan Liqi, Jianpi Yiqi). The result of the treatment indicated that the total effective rate was 100% in terms of fatigue, difficulty concentrating, headache, sore throat, muscle pain, joint aches, feverishness, rapid pulse, insomnia, depression, irregular menses, abdominal cramps, and night sweats. The percentages of specific symptoms of CFS in the patients were comparable to the conventional medical record (Table 1).

Integrated'omics analysis for the gut microbiota response to moxibustion in a rat model of chronic fatigue syndrome

OBJECTIVE:To observe the efficacy of moxibustion in the treatment of chronic fatigue syndrome(CFS)and explore the effects on gut microbiota and metabolic profiles.METHODS:Forty-eight male Sprague-Dawley rats were randomly assigned to control group(Con),CFS model group(Mod,established by multiple chronic stress for 35 d),MoxA group(CFS model with moxibustion Shenque(CV8)and Guanyuan(CV4),10 min/d,28 d)and MoxB group(CFS model with moxibustion Zusanli(ST36),10 min/d,28 d).Open-field test(OFT)and Morris-water-maze test(MWMT)were determined for assessment the CFS model and the therapeutic effects of moxibustion.16S rRNA gene sequencing analysis based gut microbiota integrated untargeted liquid chromatograph-mass spectrometer(LC-MS)based fecal metabolomics were executed,as well as Spearman correlation analysis,was utilized to uncover the functional relevance between the potential metabolites and gut microbiota.RESULTS:The results of our behavioral tests showed that moxibustion improved the performance of CFS rats in the OFT and the MWMT.Microbiome profiling analysis revealed that the gut microbiomes of CFS rats were less diverse with altered composition,including increases in pro-inflammatory species(such as Proteobacteria)and decreases in anti-inflammatory species(such as Bacteroides,Lactobacillus,Ruminococcus,and Prevotella).Moxibustion partially normalized these changes in the gut microbiota.Furthermore,CFS was associated with metabolic disorders,which were effectively ameliorated by moxibustion.This was demonstrated by the normalization of 33 microbiota-related metabolites,including mannose(P=0.001),aspartic acid(P=0.009),alanine(P=0.007),serine(P=0.000),threonine(P=0.027),methionine(P=0.023),5-hydroxytryptamine(P=0.008),alpha-linolenic acid(P=0.003),eicosapentaenoic acid(P=0.006),hypoxanthine(P=0.000),vitamin B6(P=0.000),cholic acid(P=0.013),and taurocholate(P=0.002).Correlation analysis showed a significant association between the perturbed fecal microbiota and metabolite levels,with a notable negative relationship between LCA and Bacteroides.CONCLUSIONS:In this study,we demonstrated that moxibustion has an antifatigue-like effect.The results from the 16S rRNA gene sequencing and metabolomics analysis suggest that the therapeutic effects of moxibustion on CFS are related to the regulation of gut microorganisms and their metabolites.The increase in Bacteroides and decrease in LCA may be key targets for the moxibustion treatment of CFS.

Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome:A systematic review and comparison of pathogenesis

Lyme disease is the most common vector-borne illness in the United States and has been causing significant morbidity since its discovery in 1977.It is well-documented that about 10%of patients properly treated with antibiotics never fully recover,but instead go on to develop a chronic illness dubbed,posttreatment Lyme disease syndrome(PTLDS)characterized by severe fatigue,cognitive slowing,chronic pain,and sleep difficulties.This review includes 18 studies that detail the symptoms of patients with PTLDS and uses qualitative analysis to compare them to myalgic encephalitis/chronic fatigue syndrome(ME/CFS),a strikingly similar syndrome.In the majority of the PTLDS studies,at least four of the six major symptoms of ME/CFS were also noted,including substantial impairment in activity level and fatigue for more than 6 months,post-exertional malaise,and unrefreshing sleep.In one of the included PTLDS articles,26 of the 29 ME/CFS symptoms were noted.This study adds to the expanding literature on the post-active phase of infection syndromes,which suggests that chronic illnesses such as PTLDS and ME/CFS have similar pathogenesis despite different infectious origins.

Randomized controlled study on acupuncture treatment for chronic fatigue syndrome

Objective To observe the therapeutic effect of acupuncture treatment for chronic fatigue syndrome （CFS）. Methods Ninety cases of CFS were randomly divided into an observation group and a control group, 45 cases in each group. The observation group was treated with acupuncture at Renying （人迎 ST 9）, Fengfu（风府 GV 16）, Batihui （百会 GV 20）; the control group was treated with 250 mL 5% Glucose injeetio combined with 20 mL Shenmai injectio （参脉注射液）. Fatigue Scale （FS） was used to compare the scores between the two groups after treatment. Results The total scores in the observation group ,were 9.37±2.33 and 5.41±1.96 before and after treatment respectively, and in the control group, they were 9.08±2.27 and 7.34±2.03 respectively. FS brainwork integral, physical fatigue integral, and total integral all decreased after treatment in two groups （all P〈0.001）, and it decreased much more obviously in the observation group （P〈0.05, P〈0.01）. Conclusion Both of the acupuncture treatment and Shenmai injectio are able to decrease Fatigue Scale score, improve the fatigue symptoms of CFS patients, and the effect of acupuncture treatment is obviously superior to that of Shenmai injectio.

Observation on therapeutic effect of chronic fatigue syndrome treated with Panlongci (coiling dragon needling) and moving cupping on back

Objective To compare the differences of therapeutic effect of chronic fatigue syndrome （CFS） treated with the combined therapy of Panlongci （coiling dragon needling） and cupping on back and the western medicine therapy with prednisone. Methods Seventy-two cases were randomly divided into 2 groups of acupuncture-cupping group （37 cases） and prednisone group （35 cases）. In acupuncture-cupping group, Jiaji points （夹脊 EX-B 2） of the level of T1–L5 were applied with coiling dragon needling once a day, combining with moving cupping on back once every two days. In prednisone group, prednisone tablets of 10 mg were orally taken at 8：00 am everyday. Seven days were counted as one treatment course, and 2 courses were carried on totally. FS-14 scale and BELL’s CFS integral table were applied to evaluate the fatigue degree of patients before and after the treatment, and the therapeutic effects of both groups were compared. Results After one course of treatment, the BELL’s scores of both groups were obviously improved （both P0.01）, but there was no significant difference between the 2 groups （P0.05）; after 2 courses of treatment, the BELL’s score in acupuncture-cupping group improved more obviously than that of the prednisone group （P0.05）, and the total effective rate of 91.9% （34/37） in acupuncture-cupping group was superior to that of 71.4% （25/35） in prednisone group （P0.05）. Conclusion The therapeutic effect of chronic fatigue syndrome treated with coiling dragon needling and moving cupping on back is positive, which is superior to that of prednisone with oral administration.

Role of mitochondria, oxidative stress and the response to antioxidants in myalgic encephalomyelitis/chronic fatigue syndrome: A possible approach to SARS-CoV-2 ’long-haulers’?

A significant number of SARS-CoV-2 (COVID-19) pandemic patients have developed chronic symptoms lasting weeks or months which are very similar to those described for myalgic encephalomyelitis/chronic fatigue syndrome. This study reviews the current literature and understanding of the role that mitochondria, oxidative stress and antioxidants may play in the understanding of the pathophysiology and treatment of chronic fatigue. It describes what is known about the dysfunctional pathways which can develop in mitochondria and their relationship to chronic fatigue. It also reviews what is known about oxidative stress and how this can be related to the pathophysiology of fatigue, as well as examining the potential for specific therapy directed at mitochondria for the treatment of chronic fatigue in the form of antioxidants. This study identifies areas which require urgent, further research in order to fully elucidate the clinical and therapeutic potential of these approaches.

TCM Non-medicinal Therapy for Regulation and Treatment of Chronic Fatigue Syndrome

Chronic fatigue syndrome （CFS） is a severe issue to influence the psychosomatic health of the mankind. With the social development, because of the enhancement of the medical and hygienic levels and improvement of the life quality, people pay an increasing attention to the issue of CFS. How to solve CFS, currently due to limitation in the theory of Western medicine, there is no concrete therapeutic method, in addition to the suggestion to change bad life style, regulate the psychological status and pay attention to proper balance between fatigue and physical exercise. But, TCM non-medicinal therapies have unique advantage and remarkable therapeutic effect in the elimination of CFS. Now, current-used TCM non-medicinal therapies for sub-health are summarized in the following.

Treatment of 22 Cases of Chronic Fatigue Syndrome by Puncturing Back-Shu Points

Objective： To observe the clinical effect of puncturing Back-Shu points in treating chronic fatigue syndrome. Methods： Twenty-two subjects were recruited and treated by puncturing corresponding Back-Shu points based on syndrome differentiation. The short-form General Health Survey （MOSSF GHS） and the Chalder Questionnaires for Fatigue were adopted for evaluating the therapeutic effects. Results： Of the 22 patients, 4 cases showed a marked effect, 11 got effect, 7 got failure, and the total effective rate was 68.2%. Conclusion： Puncturing Back-Shu points is effective in relieving the symptoms of chronic fatigue syndrome and enhancing the patients＇ health standard.

Acupuncture on back-shu points of five zang for chronic fatigue syndrome:A randomized control trial

Objective: To observe the clinical efficacy of acupuncture on back-shu points of five zang in treating chronic fatigue syndrome(CFS).Methods: Sixty patients were randomized into treatment group and control group. In treatment group,the back-shu points of five zang organs were adopted for acupuncture. Shènshū(肾俞 BL23) was perpendicularly needled 15-30 mm in depth. The rest of the selected points were inserted obliquely 15-30 mm in the direction of the spine with even method of lifting-thrusting and twisting-twirling, 10 s for each acupoint. In control group, the acupoints were approximately 1.5-2 cm away outward from the back-shu points of five zang organs(about on the middle of the two sidelines of the bladder meridian of foottaiyang) and the points from the bladder meridian of foot-taiyang were excluded. Acupoints were needled6-9 mm in depth, and deqi was not required, without any manipulation. The treatments were carried out twice a week for twenty minutes each time, a total of eight treatments were given. The clinical efficacy of acupuncture treatment for CFS was evaluated through the Fatigue Scale-14(FS-14) and the Symptom Check-List 90(SCL-90) after treatment.Results: The total effective rate was 86.67% in the treatment group and 53.33% in the control group(P<0.01). In treatment group, FS-14 total scores, somatic fatigue scores, and mental fatigue scores were significantly reduced than before treatment(all P<0.01). In control group, FS-14 total scores and somatic fatigue scores were significantly reduced(both P<0.01). The improvement of FS-14 total scores, somatic fatigue scores, and mental fatigue scores in the treatment group were better than those in the control group(P<0.01, P<0.05). After treatment, SCL-90 total scores and somatization, compulsion, interpersonal sensitivity, depression, anxiety, hostility, psychoticism, and other factors scores were significantly reduced in the treatment group compared with before treatment(P<0.01). In control group, the SCL-90 total scores and the scores of somatization, compulsion, hostility, and other factors after treatment were lower than those before treatment(P< 0.01). The total scores of SCL-90 and somatization, compulsion, interpersonal sensitivity, depression, anxiety, psychoticism, and other factors in the treatment group were significantly lower than those in the control group(P< 0.01, P< 0.05).Conclusions: Acupuncture on back-shu points of five zang can significantly improve the somatic fatigue and mental fatigue of the patients, and at the same time improve their psychological status. Significant therapeutic effect was found on CFS. Compared with the control group, the acupuncture treatment can significantly improve the patient’s somatic fatigue, mental fatigue and psychological status.

Ginger-indirect moxibustion plus acupuncture versus acupuncture alone for chronic fatigue syndrome:a randomized controlled trial

OBJECTIVE:To assess the efficacy and safety of gingerindirect moxibustion for chronic fatigue syndrome(CFS).METHODS:In this central randomized,controlled trial,290 CFS participants were recruited and randomly allocated to group A(ginger-indirect moxibustion plus acupuncture)or group B(acupuncture alone).The study consisted of a treatment period of 8 weeks with a total of 24 treatments(3 sessions per week,every other day),and a follow-up period of 12 weeks.The outcome was measured by Fatigue Severity Scale(FSS),Psychological Health Report(SPHERE),the Self-rating depression scale(SDS)and the Hamilton anxiety scale(HAMA)at baseline,2,4,6,8,12 and 20 weeks.RESULTS:With the treatment undergoing,the changes of FSS,SPHERE,SDS and HAMA scores in both groups increased gradually,and the effect maintained at the 12th week.Between groups,significantly higher score changes were seen in group A in FSS after 4 weeks treatment(11.94 vs 9.12,95%CI:0.94,4.7)and in SPHERE after 2 weeks treatment(3.7 vs 2.27,95%CI:0.56,2.31).But for SDS and HAMA,the improvement did not differ significantly between groups.No severe adverse events were reported.CONCLUSION:Ginger-indirect moxibustion is a safe and effective intervention to relieve fatigue and accompanying physical symptoms of CFS.

Observation on therapeutic efficacy of tuina plus cupping for chronic fatigue syndrome

Objective:To observe the therapeutic efficacy of tuina plus cupping on chronic fatigue syndrome(CFS).Methods:A total of 100 CFS patients meeting the inclusion criteria were randomly divided into a treatment group and a control group according to the random number table in the sequence of visit,with 50 patients in each group.The treatment group was treated with tuina plus cupping therapy,3 times a week.The control group was given oral tablets of wild American ginseng lozenges.After 3 months of treatment,the score of fatigue questionnaire scale(FS-14)was observed and the efficacy was evaluated.Results:The total effective rate was 92.0%in the treatment group,versus 76.0%in the control group and the difference between the two groups was statistically significant(P<0.05).After treatment,the FS-14 scores of the two groups decreased,and the intra-group differences were statistically significant(both P<0.05).The change of FS-14 score after treatment in the treatment group was more significant than that in the control group(P<0.05).Conclusion:Tuina plus cupping is effective for CFS,and can improve fatigue symptoms significantly.

Acupuncture for Chronic Fatigue Syndrome:An Overview of Systematic Reviews

Objective To evaluate the quality of the existing studies and summarize evidence of important outcomes of meta-analyses/systematic reviews(MAs/SRs)of CFS.Methods Potentially eligible studies were searched in the following electronic databases from inception to 1 September,2019:Chinese Biomedical Literature Database(CBM),China Science and Technology Journal Database(VIP),China National Knowledge Infrastructure(CNKI),WanFang Database(WF),Web of Science,Embase,PubMed and Cochrane Library.Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)was used to evaluate the quality of evidence.The methodological quality of the literature was evaluated by A Measure Tool to Assess Systematic Reviews-2(AMSTAR-2)and the quality of the report was assessed by Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA).The intra-class correlation coefficient was used to assess the consistency of the reviewers,with an overall intraclass correlation coefficient score of 0.967.Results Ten MAs/SRs were included.The overall conclusions were that acupuncture had good safety and efficacy in the treatment of CFS,but some of these results were contradictory.The GRADE indicated that out of the 17 outcomes,high-quality evidence was provided in 0(0%),moderate in 3(17.65%),low in 10(58.82%),and very low in 4(23.53%).The results of AMSTAR-2 showed that the methodological quality of all included studies was critically low.The PRISMA statement revealed that 8 articles(80%)were in line with 20 of the 27-item checklist,and 2 articles(20%)matched with 10-19 of the 27 items.Conclusion We found that acupuncture on treating CFS has the advantage for efficacy and safety,but the quality of SRs/MAs of acupuncture for CFS need to be improved.