Myalgic Encephalomyelitis/chronic fatigue syndrome: a critical narrative review of modern concepts and unani perspectives

Abstract:

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, disabling, multisystem illness characterized by persistent fatigue, post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE), unrefreshing sleep, and cognitive impairment. Classical Unani medicine does not recognize ME/CFS as a distinct disease entity. However, its descriptions of fatigue (I’yā), particularly I’yā Dhātī (spontaneous fatigue), provide a basis for examining parallels with ME/CFS.

Objective: To examine I’yā Dhātī (spontaneous fatigue) and its three simple subtypes (I’yā Qarūḥī, I’yā Tamaddudī, and I’yā Waramī) and compare them qualitatively with contemporary ME/CFS, including areas of similarity and discordance.

Methods: This critical narrative review used structured searches of PubMed, Scopus, Google Scholar, ScienceDirect, and Web of Science. Eight primary Unani sources were examined: Al-Qānūn fi al-Ṭibb, Kulliyāt al-Qānūn, Kitāb al-Ḥāwī, Kitāb al-Murshid, Kitāb al-Manṣūrī, Dhakhīrah-i Khwārazm Shāhī, Kitāb al-Kulliyāt, and Al-Mukhtārāt fi al-Ṭibb. The three subtypes were compared using predefined qualitative domains based on contemporary ME/CFS features and classical descriptions.

Results: I’yā Tamaddudī (distensive fatigue) showed the greatest phenomenological overlap with ME/CFS, particularly spontaneous fatigue, generalized heaviness, sleep disturbances, mental dullness, reduced functional capacity, and diffuse somatic manifestations. However, no clearly documented classical equivalent of delayed PEM/PESE was identified, representing a major area of discordance.

Conclusion: I’yā Tamaddudī (distensive fatigue) showed the greatest phenomenological/conceptual overlap with ME/CFS among the subtypes examined. This represents a historical and interpretative correspondence, not biological, diagnostic, or therapeutic equivalence. Independent operationalization and prospective evaluation are required before its clinical or biological relevance can be established.

Keywords: Chronic fatigue syndrome; Integrative medicine; I‘yā; I‘yā dhātī; I‘yā tamaddudī; Myalgic encephalomyelitis; Narrative review; Unani medicine.

Source: Israr IM, Eram F, Ahmed MM. Myalgic Encephalomyelitis/chronic fatigue syndrome: a critical narrative review of modern concepts and unani perspectives. Explore (NY). 2026 Oct 10;22(6):103545. doi: 10.1016/j.explore.2026.103545. Epub ahead of print. PMID: 42874496. https://pubmed.ncbi.nlm.nih.gov/42874496/

Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study

Abstract:

Fibromyalgia and chronic fatigue syndrome are disorders that often occur simultaneously and are characterized by widespread pain and persistent fatigue. The patients are associated with disability and impairment social and physical functions. There are many remedies in traditional Persian medicine suggested for management of the disease complaints. The aim of this study was to investigate the clinical presentations and pathophysiology of disorders with the basic and principal textbook of traditional Persian medicine written by Avicenna ( Canon of Medicine).

According to Persian medicine, the term E'aya can be matched by mentioned disorders. Avicenna believed that strenuous activities play an important role in the beginning of some types of fatigue. He classified fatigue into 4 groups, and in each type the clinical symptoms varied. The multifaceted entity of fibromyalgia and chronic fatigue syndrome in Persian medicine and conventional medicine suggests multidisciplinary therapies in management of these disabling disorders.

Source: Mahjoub F, Salari R, Noras MR, Yousefi M.Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study.J Evid Based Complementary Altern Med. 2017 Jan 1:2156587217712763. doi: 10.1177/2156587217712763. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/28597692