Analysis of Patients Visiting an Oriental Hospital with Idiopathic Chronic Fatigue or Chronic Fatigue Syndrome

Article information

J Korean Med. 2013;34(3):119-125
Publication date (electronic) : 2013 September 30
doi :
Internal Department of Oriental Medicine College, Daejeon University
Correspondence to: 손창규(Chang-Gue Son), 대전시 중구 대흥동 22-5번지 대전대학교 부속한방병원 간장면역학교실, Tel: +82-42-229-6807, Fax: +82-42-254-3403, E-mail:
Received 2013 July 09; Revised 2013 September ; Accepted 2013 July 10.



Medically unexplained fatigue includes chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). These disorders quite impair quality of life while no effective therapies exist. Therefore, patients with CFS or ICF frequently choose treatments based on traditional Korean medicine. The study aimed to analyze characteristic of patients visiting an Oriental clinic with CFS or ICF.


Patients who met criteria for CFS or ICF were enrolled in this study, from March 2011 to Jun 2013. Clinical information focused on symptom differentiation and Sasang constitution was analyzed. Pearson’s chi-square test was used to compare the frequency among sub-groups.


In total, 77 patients (49 male and 28 female) were diagnosed with CFS (17 male and 13 female) or ICF (32 male and 15 female). The symptom differentiation was 37.7%, 26.0%, 13.0%, and 23.3% for “Qi deficiency of both spleen and lung ( )”, “Yin deficiency of both liver and kidney ( )”, “Blood deficiency of both heart and spleen ( )” and “Yang deficiency of both spleen and kidney ( )”, while Sasang constitutional distribution was 59.7%, 22.1% and 18.2% Soeumin, Taeumin and Soyangin, respectively. The fatigue severity was notably different between CFS (63.7 ± 12.1) or ICF (52.2 ± 15.3) according to the Chalder fatigue scale (10-point scale for eleven questions). There was statistical significance regarding symptom differentiation and Sasang constitution (p < 0.05).


In the process of traditional Korean medicine-based development of therapeutics for patients with chronic fatigue or related conditions, this report can serve as reference data.

Criteria for Diagnosing Chronic Fatigue Syndrome

Chalder Fatigue Severity Questionnaire

Category of Syndrome-differentiation

General Characterization of Patients

Distribution of Symptom Differentiation

Distribution of Sasang Constitution in Patients and Control Group

Distribution of Symptom Differentiation according to Sasang Constitution


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Article information Continued

Table 1.

Criteria for Diagnosing Chronic Fatigue Syndrome

A. Unexplained, persistent fatigue for six months or more
B. At least four of the following signs (CFS), or less than four signs (ICF)
  • 1) Extreme exhaustion lasting more than 24 hours after physical or mental exercise

  • 2) Unrefreshing sleep

  • 3) Loss of memory or concentration

  • 4) Unexplained muscle pain

  • 5) Pain that moves from one joint to another without swelling or redness

  • 6) Headache of a new type, pattern or severity

  • 7) Enlarged lymph nodes in your neck or armpits

  • 8) Sore throat

Table 2.

Chalder Fatigue Severity Questionnaire

Questions Indication
1. Do you have problems with tiredness?
2 Do you need to rest more? 0 = None
3. Do you feel sleepy or drowsy? .
4. Do you have problems starting things? .
5. Do you lack energy? .
6. Do you have less strength in your muscles? .
7. Do you feel weak? .
8. Do you have difficulty concentrating?
9. Do you make slips of the tongue when speaking? 9 = Unbearable
10.Do you find it more difficult to find the correct word?
11. How is your memory?

Table 3.

Category of Syndrome-differentiation

Symptom differentiation Main symptoms or signs
Qi deficiency of spleen and lung Pale face, fatigue, lack of energy, lack of appetite, small quantity of meal to eat
Blood deficiency of heart and spleen Pale face, sleep disturbance, plenty dream, bleeding tendency, feeling the lack of energy, dizziness, palpitation
Yang deficiency of spleen and kidney Highly susceptible of cold, Cold hands and feet, Coldness in lower abdomen, diarrhea tendency
Yin deficiency of liver and kidney Clod sweat at night, heating feeling at chest, palm and sole, weakness of waist and knee, insomnia, nocturnal emission

Table 4.

General Characterization of Patients

Item Total CFS ICF

Male Female Male Female
Number of patients 77 17 13 32 15
Average age (Range) 42 (15–70) 38 (20–59) 39 (21–56) 43 (15–61) 45 (20–70)
Fatigue severity (NRS)** 56.9 ± 15.1 63.1 ± 14.7 64.5 ± 8.4 50.9 ± 15.7 55.1 ± 7.8

p < 0.01, using independent t-test for fatigue severity between chronic fatigue syndrome and idiopathic chronic fatigue

Table 5.

Distribution of Symptom Differentiation

Symptom differentiation Total CFS ICF

Male Female Male Female
Qi deficiency of spleen and lung 29 (37.6%) 6 (35.3%) 4 (30.8%) 16 (50.0%) 3 (20.0%)
Blood deficiency of heart and spleen 18 (23.4%) 4 (23.5%) 4 (30.8%) 5 (15.6%) 5 (33.3%)
Yang deficiency of spleen and kidney 10 (13.0%) 1 (5.9%) 3 (23.1%) 3 (9.4%) 3 (20.0%)
Yin deficiency of liver and kidney 20 (26.0%) 6 (35.3%) 2 (15.3%) 8 (25.0%) 4 (26.7%)

No significant difference was observed regarding distributional frequency of symptom differentiation using Pearson’s chi-square test (p > 0.05).

Table 6.

Distribution of Sasang Constitution in Patients and Control Group

Symptom differentiation Total** CFS**
Male Female Male Female
Taeumin 17 (18.2%) 3 (17.7%) 3 (23.1%) 9 (28.1%) 2 (13.3%)
Soeumin 46 (59.7%) 9 (52.9%) 8 (61.5%) 16 (50.0%) 13 (86.7%)
Soyangin 14 (22.1%) 5 (29.4%) 2 (15.4%) 7 (21.9%) 0 (0.0%)

p < 0.01, Pearson’s chi-square test was used for comparing the distributions of the Sasang classified patients and the healthy subjects.

Table 7.

Distribution of Symptom Differentiation according to Sasang Constitution

Sasang constitutional* CFS/ICF Qi deficiency of spleen and lung Blood deficiency of heart and spleen Yang deficiency of spleen and kidney Yin deficiency of liver and kidney
Taeumin CFS 10 (83.3%) 0 (0.0%) 0 (0.0%) 2 (16.7%)
ICF 4 (80.0%) 0 (0.0%) 0 (0.0%) 1 (20.0%)
Total (17patient) 14 (82.4%) 0 (0.0%) 0 (0.0%) 3 (17.6%)

Soeumin CFS 12 (48.0%) 8 (32.0%) 3 (12.0%) 2 (8.0%)
ICF 2 (9.5%) 9 (42.9%) 5 (23.8%) 5 (23.8%)
Total (18patient) 14 (30.4%) 17 (37.0%) 8 (17.4%) 7 (15.2%)

Soyangin CFS 0 (0.0%) 1 (8.3%) 1 (8.3%) 10 (83.4%)
ICF 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%)
Total (14patient) 1 (7.1%) 1 (7.1%) 2 (14.3%) 10 (71.5%)

p < 0.05, Pearson’s chi-square test was used for comparing the distributions of the symptom differentiation according to Sasang constitution