An Integrative Review of Chronic Fatigue Syndrome (CFS): Clinical Insights and Therapeutic Approaches in Unani and Modern Medicine

Authors

  • Rafat Afzal Assistant Professor, Department of Ilaj-Bit-Tadbeer, Inamdar Unani Medical College and Hospital, Kalaburagi, Karnataka (India).
  • Saif Ali Siddiqui Assistant Professor, Department of Ilaj-Bit-Tadbeer, Markaz Unani Medical College and Hospital, Kozhikode, Kerala, India. https://orcid.org/0009-0005-6758-7787

Abstract

Excruciating fatigue that lasts for at least six months is a defining feature of the complicated illness known as chronic fatigue syndrome (CFS). With a prevalence of 0.4% to 2.5% worldwide, CFS is becoming more common. CFS impacts more women than men. In wealthy nations, it is considered a common condition. Although CFS has no recognized cure, symptoms can be controlled and managed. Daily normal activities are significantly hampered by chronic fatigue. An imbalance of brain neurotransmitters, mitochondrial dysfunction, reduced oxidative phosphorylation, disruption of the hypothalamic-pituitary-adrenal (HPA) axis, and decreased ATP synthesis are all essential components of the pathophysiology of CFS. The current study aims to identify the herbs used as medicine for chronic fatigue syndrome (CFS) and to examine the current treatment strategies for it. The phytochemicals found in the Unani medicinal plants discussed in this article make them highly effective in treating the symptoms of chronic fatigue syndrome. The current treatment approach for chronic fatigue syndrome is also briefly covered in this review article. It includes cognitive-behavioral therapy (CBT), graded exercise therapy (GET), immunoglobulin use, psychodynamic counseling, and isometric exercises that are very helpful in reducing the symptoms of CFS. Conventional treatments for CFS include corticosteroids, immunomodulatory drugs, and antidepressants. Various Unani medicinal plants are examined in this article, along with their pharmacological characteristics, potential uses, and available therapies for mitigating the symptoms of chronic fatigue syndrome.

Keywords: chronic fatigue syndrome, brain neurotransmitters, mitochondrial dysfunction, reduced oxidative phosphorylation

Keywords:

chronic fatigue syndrome, brain neurotransmitters, mitochondrial dysfunction, reduced oxidative phosphorylation

DOI

https://doi.org/10.22270/jddt.v15i8.7295

Author Biographies

Rafat Afzal , Assistant Professor, Department of Ilaj-Bit-Tadbeer, Inamdar Unani Medical College and Hospital, Kalaburagi, Karnataka (India).

Assistant Professor, Department of Ilaj-Bit-Tadbeer, Inamdar Unani Medical College and Hospital, Kalaburagi, Karnataka (India).

Saif Ali Siddiqui , Assistant Professor, Department of Ilaj-Bit-Tadbeer, Markaz Unani Medical College and Hospital, Kozhikode, Kerala, India.

Assistant Professor, Department of Ilaj-Bit-Tadbeer, Markaz Unani Medical College and Hospital, Kozhikode, Kerala, India.

References

1. Afari N, Buchwald D. Chronic Fatigue Syndrome: A Review. Am J Psychiatry. 2003;160(2):221-236. https://doi.org/10.1176/appi.ajp.160.2.221 PMid:12562565

2. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A: The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994; 121:953-959. https://doi.org/10.7326/0003-4819-121-12-199412150-00009 PMid:7978722

3. Ibn nafees B K ibn Ooz. "kulliyat-eNafeesi" Vol.2.(Urdu Translation) Hydrabad: (Deccan);1952:19, 59-74, 266- 268, 269-272, 491.

4. Zakariya Razi (1991),'Kitab-Al-Mansoori', (urdutranslation) New Delh; CCRUM; YNM: 59-80.

5. Saifi MW, Fahad A, Bihari L, Nuzhat, Nilofar S, Fatma KF, Almas U, Shams NF, Jamal Y. An Observational Analytical Study of the Fatigue Index in Young Adult with Reference to Different Mizaj. Int J Adv Health Sci. 2024;11(4):1-9.

6. Richman JA, Flaherty JA, Rospenda KM: Chronic fatigue syndrome: have flawed assumptions been derived from treatment-based studies? Am J Public Health 1994; 84:282-284 https://doi.org/10.2105/AJPH.84.2.282 PMid:8296954 PMCid:PMC1615008

7. Lloyd AR, Hickie I, Boughton CR, Spencer O, Wakefield D: Prevalence of the chronic fatigue syndrome in an Australian population. Med J Aust 1990; 153:522-528. https://doi.org/10.5694/j.1326-5377.1990.tb126191.x PMid:2233474

8. Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, McCready W, Huang CF, Plioplys S: A community based study of chronic fatigue syndrome. Arch Intern Med 1999; 159:2129-2137 https://doi.org/10.1001/archinte.159.18.2129 PMid:10527290

9. Steele L, Dobbins JG, Fukuda K, Reyes M, Randall B, Koppelman M, Reeves WC: The epidemiology of chronic fatigue in San Francisco. Am J Med 1998; 105:83S-90S https://doi.org/10.1016/S0002-9343(98)00158-2 PMid:9790487

10. Jordan KM, Landis DA, Downey MC, Osterman SL, Thurm AE, Jason LA: Chronic fatigue syndrome in children and adolescents: a review. J Adolesc Health 1998; 22:4-18 https://doi.org/10.1016/S1054-139X(97)00212-7 PMid:9436061

11. Afari N, Buchwald D. Chronic Fatigue Syndrome: A Review. Am J Psychiatry. 2003;160(2):221-236. https://doi.org/10.1176/appi.ajp.160.2.221 PMid:12562565

12. Institute of Medicine (IOM). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press; 2015.

13. Cleare AJ, Bearn J, Allain T, McGregor A, Wessely S, Murray RM, O'Keane V: Contrasting neuroendocrine responses in depression and chronic fatigue syndrome. J Affect Disord 1995; 35: 283-289 https://doi.org/10.1016/0165-0327(95)00026-J PMid:8550954

14. Vercoulen JHMM, Swanink CMA, Zitman FG, Vreden SG, Hoofs MP, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G: Randomized, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome. Lancet 1996; 347:858-861 https://doi.org/10.1016/S0140-6736(96)91345-8 PMid:8622391

15. McKenzie R, O'Fallon A, Dale J, Demitrack M, Sharma G, Deloria M, Garcia Borreguero D, Blackwelder W, Straus SE: Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial. JAMA 1998; 280:1061-1066 https://doi.org/10.1001/jama.280.12.1061 PMid:9757853

16. Cleare AJ, Heap E, Malhi GS, Wessely S, O'Keane V, Miell J: Lowdose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet 1999; 353:455-458 https://doi.org/10.1016/S0140-6736(98)04074-4 PMid:9989716

17. Wilson A, Hickie I, Lloyd A, Wakefield D: The treatment of chronic fatigue syndrome: science and speculation. Am J Med 1994; 96:544-550 https://doi.org/10.1016/0002-9343(94)90095-7 PMid:8017453

18. Lloyd A, Hickie I, Wakefield D, Boughton C, Dwyer J: A doubleblind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome. Am J Med 1990; 89:561-568 https://doi.org/10.1016/0002-9343(90)90173-B PMid:2146875

19. Strayer DR, Carter WA, Brodsky I, Cheney P, Peterson D, Salvato P, Thompson C, Loveless M, Shapiro DE, Elsasser W, Gillespie DH: A controlled clinical trial with a specifically configured RNA drug, poly(I):poly(C12U), in chronic fatigue syndrome. Clin Infect Dis 1994; 18 (suppl 1):S88-S95 https://doi.org/10.1093/clinids/18.Supplement_1.S88 PMid:8148460

20. Natelson BH, Cheu J, Hill N, Bergen M, Korn L, Denny T, Dahl K: Single-blind, placebo phase-in trial of two escalating doses of selegiline in the chronic fatigue syndrome. Neuropsychobiology 1998; 37:150-154 https://doi.org/10.1159/000026494 PMid:9597672

21. White PD, Cleary KJ: An open study of the efficacy and adverse effects of moclobemide in patients with the chronic fatigue syndrome. Int Clin Psychopharmacol 1997; 12:47-52 https://doi.org/10.1097/00004850-199701000-00007 PMid:9179634

22. Afari N, Buchwald D. Chronic Fatigue Syndrome: A Review. Am J Psychiatry. 2003;160(2):221-236. https://doi.org/10.1176/appi.ajp.160.2.221 PMid:12562565

23. Institute of Medicine (IOM). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press; 2015. Available from: 1

24. Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, et al. Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners. 2012. Available from: 1

25. Saifi MW, Fahad A, Bihari L, Nuzhat, Nilofar S, Fatma KF, Almas U, Shams NF, Jamal Y. An Observational Analytical Study of the Fatigue Index in Young Adult with Reference to Different Mizaj. Int J Adv Health Sci. 2024;11(4):1-9. DOI: 10.5281/zenodo.12743847.

26. Wearden A, Morriss R, Mullis R: A double-blind placebo-controlled trial of fluoxetine and graded exercise for chronic fatigue syndrome (abstract). Eur Psychiatry 1996; 11(suppl 4): 273 https://doi.org/10.1016/0924-9338(96)88824-9

27. Deale A, Chalder T, Marks I, Wessely S: Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry 1997; 154:408-414 https://doi.org/10.1176/ajp.154.3.408 PMid:9054791

28. Deale A, Chalder T, Wessely S: Illness beliefs and treatment outcome in chronic fatigue syndrome. J Psychosom Res 1998; 45: 77-83 https://doi.org/10.1016/S0022-3999(98)00021-X PMid:9720857

Published

2025-08-15
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How to Cite

1.
Afzal R, Siddiqui SA. An Integrative Review of Chronic Fatigue Syndrome (CFS): Clinical Insights and Therapeutic Approaches in Unani and Modern Medicine. J. Drug Delivery Ther. [Internet]. 2025 Aug. 15 [cited 2026 Jan. 23];15(8):180-5. Available from: https://jddtonline.info/index.php/jddt/article/view/7295

How to Cite

1.
Afzal R, Siddiqui SA. An Integrative Review of Chronic Fatigue Syndrome (CFS): Clinical Insights and Therapeutic Approaches in Unani and Modern Medicine. J. Drug Delivery Ther. [Internet]. 2025 Aug. 15 [cited 2026 Jan. 23];15(8):180-5. Available from: https://jddtonline.info/index.php/jddt/article/view/7295