Cancer-related fatigue (CRF) and Traditional Chinese Medicine Approaches
Originally written in Chinese, translated by ChatGPT.
Cancer-related fatigue (CRF) is one of the most common and distressing symptoms experienced by cancer patients, with a prevalence exceeding 50%. Unlike ordinary fatigue, CRF often does not improve with rest, sleep, or relaxation techniques such as meditation.
From the perspective of Traditional Chinese Medicine (TCM), CRF is generally categorized as a deficiency (虚证) pattern. This deficiency does not arise suddenly; rather, it reflects a gradual depletion of the body’s vital substances—Qi, Blood, Yin, and Yang—due to the chronic consumption associated with tumor growth, as well as the additional burden of treatments such as chemotherapy, radiation, and surgery. In this context, the classical principle applies: “illness comes like a landslide, but recovery is like drawing silk,” emphasizing the slow and progressive nature of restoring deficiency.
Accordingly, the primary therapeutic strategy in TCM is tonification (补法). Importantly, because the development of deficiency is gradual and cumulative, the management of CRF should also be continuous. Once fatigue symptoms emerge, sustained intervention is necessary rather than short-term or intermittent treatment. This longitudinal approach aligns with the chronic nature of both cancer and its associated fatigue, aiming not only to relieve symptoms but also to support the patient’s long-term recovery and resilience.
In terms of tonification methods, the most effective approaches are oral herbal medicine and moxibustion. Simple acupuncture alone generally has limited tonifying effect. If practitioners rely mainly on strong needling stimulation to produce a prolonged Deqi 得气sensation, it may instead consume Qi rather than replenish it.
Here are some evidence-based acupuncture studies:
China study (PubMed 40050507)
Location/Time: Taizhou, Zhejiang, China; 2024–2025
N: 65 patients
Method: 3.95 μm infrared moxibustion on ST36, CV4, CV6 (30 mins, 24 sessions)
Result: Significant improvement in Piper Fatigue Scale (PFS) and Pittsburgh Sleep Quality Index (PSQI)
Note: Modern infrared moxibustion offers a smokeless, standardized alternative to traditional moxa
Korea study (PMC8290232)
Location/Time: Korea; 2020s
N: Not specified
Method: Traditional moxibustion on CV4, CV8, ST36, 3x/week for 8 weeks
Result: Real moxibustion superior to sham and usual care for CRF
These studies support the use of moxibustion as an effective tonifying intervention for cancer-related fatigue.
Clinical experience with Chinese herbal medicine for CRF:
In China, numerous studies and clinical reports have examined herbal medicine for cancer-related fatigue, though most are in Chinese and less accessible internationally.
Treatment is generally individualized according to the patient’s specific symptoms (pattern differentiation), so prescriptions are often tailored (“one patient, one formula”). Standardized formulas such as Shi Quan Da Bu Tang (Ten Complete Tonifying Decoction) are also used, focusing on comprehensive tonification of Qi, Blood, Yin, and Yang.
Other traditional approaches include gāofāng（膏方，膏滋）, taken over the long term for restorative effects. When using tonifying herbs—especially richer or more cloying substances—the patient’s digestive function must be considered, as a “deficiency that cannot receive tonics（虚不受补）” can limit effectiveness; therefore, regulating the Spleen and stomach is important alongside supplementation.
From clinical experience, long-term and even lifelong treatment can significantly relieve CRF. Effects appear gradually, with slow onset and long treatment cycles, requiring strong cooperation between practitioner and patient. This approach demands patience and financial commitment from patients but can achieve meaningful improvement in fatigue symptoms over time.
