1. Background and purpose
Fatigue is a term that indicates a subjective feeling of tiredness or lack of energy, and one of the most common symptoms, which may weaken a person's capability to lead an ordinary life or reduce the quality of life. Radical urbanization and industrialization have increased the chances of many people being exposed to fatigue and stress. A survey conducted in the 1980s reported that approximately 10-20% of subjects in the general Korean population suffered from persistent fatigue. Fatigue is usually the result of many pathogens, but the etiology of persistent fatigue is still unclear, especially in patients who have complaints of prolonged severe fatigue. the argument that persistent fatigue, which is not medically explained, is not a physiological phenomenon or a symptom of a disease, but its existence as an independent disease is becoming increasingly accepted.
According to the United States Centers for Disease Control and Prevention (CDC), there is no cure for chronic fatigue, although many attempts have been made to establish appropriate diagnostic criteria, effective management, and treatment methods. therefore, it is recommended that patients with chronic fatigue syndrome improve their quality of life by seeking to relieve fatigue and its accompanying symptoms. In addition, in terms of diagnostic criteria and management methods for chronic fatigue, the protagonist of decision-making has shifted from healthcare providers to patients.
In the view of Korean medicine, fatigue is considered a pathological condition and the result of a state of imbalanced inter-functioning among qi and blood characteristics. therefore, fatigue has been treated by regulating qi and blood related disorders, and the number of patients who want to take complementary and alternative medicine to treat this debilitating illness is rising. According to the CDC, the use of Korean medical interventions such as acupuncture, massage (chuna), and qigong can be considered in the management of patients with chronic fatigue syndrome.
the need for the development of evidence-based standard clinical practice guidelines (CPGs) in Korean medicine for patients complaining of persistent fatigue without a clear cause of disease has been rising steadily. therefore, a committee composed of members of the Society of Korean Medical Diagnostics and the Society of Sasang Constitutional Medicine was formed. this committee developed the Korean medicine CPGs for chronic fatigue based on many clinical trials, several systematic reviews and several CPGs according to CPG development methods.
the Korean medicine CPGs for chronic fatigue were developed according to an evidence-based medical methodology guided by clinical experts. Potential users of the guidelines in Korean medicine also participated in the development of the guidelines on chronic fatigue. the development team revised the guideline draft to take into account the clinical environment in which these guidelines were used. the purpose of this guideline is to provide an effective, safe, and standardized Korean medicine treatment strategy for improving symptoms and fatigue in patients with chronic fatigue.
2. Overview of disease
Chronic fatigue refers to a case of persistent or recurrent fatigue for more than six months, but no sufficient and obvious cause to medically explain the severe fatigue. Chronic fatigue can be classified into chronic fatigue syndrome and idiopathic chronic fatigue, a condition that does not satisfy the minor diagnostic criteria for chronic fatigue syndrome. Chronic fatigue syndrome is also called myalgic encephalomyelitis, benign myalgic encephalomyelitis, post-viral fatigue syndrome, or systemic exertion intolerance disease. the cause and pathological mechanism of chronic fatigue are still unclear, and diagnostic criteria with slight differences have been used depending on the purpose of use. there is still no approved treatment for
chronic fatigue syndrome. However, some symptoms that appear in chronic fatigue syndrome can be treated or managed. therefore, improving the quality of life is the main goal of treatment. the treatment and management of idiopathic chronic fatigue are generally in accordance with chronic fatigue syndrome.
In addition to persistent fatigue, chronic fatigue is often accompanied by symptoms such as post-exertional malaise, sleep disorders, multi-site pain, depression, and anxiety. In addition, motor-sensory neuropathy, recurrent cold-like symptoms, cognitive impairment, short-term memory impairment, and high susceptibility to infection, systemic ailments, such as gastrointestinal tract disorders, genitourinary disorders, cardiovascular disorders, cold/heat intolerance, unstable temperature control, and orthostatic intolerance can also be observed. the Korean medical treatment for chronic fatigue is based on pattern identi cation.
the major patterns include spleen qi de ciency pattern, disharmony of liver and spleen system pattern, heart and spleen system de ciency pattern, qi-blood de ciency pattern, liver and kidney yin deficiency pattern, and late yang stage pattern. Herbal medicine, acupuncture, moxibustion, cupping, chuna, and qigong have been used to manage various symptoms of chronic fatigue.
