Frontiers in Medical Science Research, 2026, 8(2); doi: 10.25236/FMSR.2026.080212.
Ruocheng Xu1, Xinyuan Qu1, Ruoyu Wang2, Yixiang Xia1, Bingru Cai1, Peiqin Li1
1The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
2The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
This study analyze the research status of randomized controlled trials (RCTs) on acupuncture treatment for chronic fatigue syndrome (CFS). We searched databases including CNKI, WanFang Data, CBM, VIP, PubMed, EMbase, The Cochrane Library, and Web of Science. RCTs on acupuncture for CFS published from database inception to April 28, 2025, were collected. Basic characteristics, intervention methods, and outcome measures of the literature were extracted for categorization and visual statistical analysis. A total of 104 RCTs were included, involving 8,526 participants. They covered 57 outcome measures, used a cumulative total of 334 times. These outcome measures were summarized into 8 measurement domains: TCM syndromes, symptoms/signs, quality of life, mental health, laboratory tests, patient satisfaction, safety events, and long-term prognosis. Commonly used acupoint prescriptions for acupuncture treatment of CFS included ST36 (Zusanli), BL23 (Shenshu), SP6 (Sanyinjiao), BL20 (Pishu), GV4 (Guanyuan), and CV6 (Qihai). Current research exhibits issues such as non-standard methodological design, significant variations in scale usage, laboratory tests being limited mainly to immunological indices, unclear primary and secondary outcome measures, lack of economic evaluations, insufficient long-term follow-up, and a deficiency in highlighting TCM characteristics. Acupuncture is objectively effective for treating CFS. However, related RCTs urgently require standardization in methodological design and the selection of outcome measures. It is recommended to unify clinical evaluation criteria, standardize the setting of outcome measures, and enhance research and evidence quality.
Chronic Fatigue Syndrome (CFS); Acupuncture and Moxibustion; Randomized Controlled Trial (RCT); Outcome Indicator; Evidence Map
Ruocheng Xu, Xinyuan Qu, Ruoyu Wang, Yixiang Xia, Bingru Cai, Peiqin Li. Evidence Map Analysis of Acupuncture for Chronic Fatigue Syndrome. Frontiers in Medical Science Research (2026), Vol. 8, Issue 2: 100-114. https://doi.org/10.25236/FMSR.2026.080212.
[1] E. Lim, Y. Ahn, E. Jang, et al, Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), J Transl Med, 2020 , 18 (1):100-114.
[2] M.S. Wood, N. Halmer, J. Bertolli, et al, Impact of COVID-19 on myalgic encephalomyelitis/chronic fatigue syndrome-like illness prevalence: A cross-sectional survey, Plos One, 2024 , 19 (9): e0309810.
[3] A.R. Valdez, E.E. Hancock, S. Adebayo, et al, Estimating Prevalence, Demographics, and Costs of ME/CFS Using Large Scale Medical Claims Data and Machine Learning, Front Pediatr, 2019 , 6: 412.
[4] C. Chen, H. Lee, S. Chang, et al, Risk of chronic fatigue syndrome after COVID-19: A retrospective cohort study of 3227281 patients, J Infect Public Heal, 2024 , 17 (11): 102559.
[5] S. Steiner, A. Fehrer, F. Hoheisel, et al, Understanding, diagnosing, and treating Myalgic encephalomyelitis/chronic fatigue syndrome - State of the art: Report of the 2nd international meeting at the Charité Fatigue Center, Autoimmun Rev, 2023 , 22 (11): 103452.
[6] Z. Yun, Z. Miaomiao, J. Jie, Research Progress in Chinese Medicine for Chronic Fatigue Syndrome, Chinese Journal of Modern Applied Pharmacy, 2023 , 40 (11): 1571-1577.
[7] P. Jun, W. Xiongjiang, L. Longming, et al, Research Survey on Intervention of Chronic Fatigue Syndrome by External Therapy of Traditional Chinese Medicine, Liaoning Journal of Traditional Chinese Medicine, 2017 , 44 (10): 2226-2229.
[8] D.L. Katz, A. Williams, C. Girard, et al, The evidence base for complementary and alternative medicine: methods of Evidence Mapping with application to CAM, Altern Ther Health M, 2003 , 9 (4): 22-30.
[9] P.R. Williamson, D.G. Altman, H. Bagley, et al, The COMET Handbook: version 1.0, Trials, 2017 , 18 (Suppl 3): 280.
[10] K. Fukuda, S.E. Straus, I. Hickie, et al, The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group, Ann Intern Med, 1994 , 121 (12): 953-959.
[11] M.E. Hyland, Y. Antonacci, A.M. Bacon, Comparison of the symptom networks of long-COVID and chronic fatigue syndrome: From modularity to connectionism, Scand J Psychol, 2024 , 65 (6):1132-1140.
[12] M.L. Joustra, C.A. Hartman, S.J.L. Bakker, et al, Cognitive Task Performance and Subjective Cognitive Symptoms in Individuals With Chronic Fatigue Syndrome or Fibromyalgia: A Cross-Sectional Analysis of the Lifelines Cohort Study, Psychosom Med, 2022 , 84 (9): 1087-1095.
[13] M. Aoun Sebaiti, M. Hainselin, Y. Gounden, et al, Systematic review and meta-analysis of cognitive impairment in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Sci Rep-Uk, 2022 , 12 (1): 2157.
[14] I. Banovic, I. Šaban, A. Ayad, et al, Cognitive functioning in patients with chronic fatigue syndrome: Slowed information processing or a deficit in attentional selectivity? Neuropsychology, 2025 , 39 (2): 152-161.
[15] S. Saito, S. Shahbaz, M. Osman, et al, Diverse immunological dysregulation, chronic inflammation, and impaired erythropoiesis in long COVID patients with chronic fatigue syndrome, J Autoimmun, 2024 , 147: 103267.
[16] J. Van Campenhout, Y. Buntinx, H. Xiong, et al, Unravelling the Connection Between Energy Metabolism and Immune Senescence/Exhaustion in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Biomolecules, 2025 , 15 (3): 357.
[17] R. Xiong, C. Gunter, E. Fleming, et al, Multi-‘omics of gut microbiome-host interactions in short- and long-term myalgic encephalomyelitis/chronic fatigue syndrome patients, Cell Host Microbe, 2023 , 31 (2): 273-287.
[18] X. Yana, J. Bo, Z. Qin, et al, Effects of Electroacupuncture on Serum Inflammatory Cytokines and Intestinal Flora in Chronic Fatigue Syndrome Rats with Liver Depression and Spleen Deficiency, Chinese Journal of Information On Traditional Chinese Medicine, 2021 , 28 (11): 63-68.
[19] J. He, Q. Yu, C. Wu, et al, Acupuncture of the Beishu acupoint participates in regulatory effects of ginsenoside Rg1 on T cell subsets of rats with chronic fatigue syndrome, Ann Palliat Med, 2020 , 9 (5): 3436-3446.
[20] C. Andrade, The primary outcome measure and its importance in clinical trials, The Journal of Clinical Psychiatry, 2015 , 76 (10): e1320-e1323.
[21] D. Araja, U. Berkis, A. Lunga, et al, Shadow Burden of Undiagnosed Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) on Society: Retrospective and Prospective-In Light of COVID-19, J Clin Med, 2021 , 10 (14): 3017.