Chronic Fatigue
Investigating the root causes of persistent, debilitating fatigue — not just learning to manage it.
Understanding chronic fatigue
Chronic fatigue is one of the most common and most frustrating presentations in integrative medicine. It is not simply tiredness — it is a profound, persistent exhaustion that does not resolve with rest, that often worsens with exertion, and that progressively limits a person's ability to work, exercise, socialise, and live fully.
It is also one of the most underserved conditions in conventional medicine. "Your tests are all normal" is a phrase heard by the vast majority of people with chronic fatigue — yet their lived experience tells a very different story. This is where integrative medicine has the most to offer.
Common symptoms
- Profound, unrefreshing fatigue present for months or years
- Post-exertional malaise — symptoms worsen after physical or mental effort
- Brain fog, poor concentration, and word-finding difficulties
- Disordered sleep — either excessive or unrestorative
- Muscle weakness and generalised body aches
- Orthostatic intolerance — symptoms worse when standing
- Sensitivity to light, sound, or chemical exposures
- Immune symptoms — recurring infections, swollen lymph nodes
- Gut disturbance — bloating, alternating bowel habits
- Mood disturbance secondary to the physical burden
"Chronic fatigue is rarely caused by a single thing. It is almost always the result of multiple overlapping drivers — viral triggers, mitochondrial dysfunction, gut dysbiosis, HPA axis dysregulation, and nutritional depletion — all compounding one another. The key is systematic investigation." — Dr Reece Yeo
Common root causes Dr Reece Yeo investigates
Post-viral and immune dysregulation
Many cases of chronic fatigue begin after a viral illness — Epstein-Barr (glandular fever), cytomegalovirus, COVID-19, or other infections. Persistent immune activation, viral reactivation, and subsequent mitochondrial damage are increasingly well-documented mechanisms.[1] Specific testing can identify active or reactivated infections and patterns of immune dysfunction.
HPA axis dysregulation (adrenal fatigue)
Chronic stress dysregulates the hypothalamic-pituitary-adrenal axis, leading to abnormal cortisol patterns — typically an initial period of elevated cortisol followed by a flattened or blunted response. This directly impairs energy production, immune function, and sleep architecture. Four-point salivary cortisol testing maps this pattern across the day.
Mitochondrial dysfunction
Mitochondria are the energy-producing organelles inside every cell. They are highly sensitive to nutritional deficiencies (CoQ10, B vitamins, magnesium, carnitine), toxic exposures, and chronic oxidative stress. Supporting mitochondrial function through targeted nutritional therapy is a core component of fatigue treatment.
Thyroid and hormonal factors
Subclinical thyroid dysfunction, poor T4-to-T3 conversion, and perimenopausal hormonal changes are all common drivers of chronic fatigue that are frequently missed on standard testing. Comprehensive hormonal assessment is a standard part of Dr Reece Yeo's workup.
Gut dysbiosis and intestinal permeability
The gut microbiome profoundly influences immune function, inflammatory status, and even mitochondrial health. Small intestinal bacterial overgrowth (SIBO), dysbiosis, and intestinal permeability are increasingly documented in ME/CFS presentations[2] and warrant targeted investigation and treatment.
Nutritional deficiencies
Iron deficiency (even without frank anaemia), B12, folate, vitamin D, magnesium, and zinc deficiencies are all common in people with chronic fatigue and directly impair energy metabolism. Standard pathology often uses reference ranges that permit significant functional deficiency.
The Chinese medicine perspective
In Chinese medicine, chronic fatigue most commonly reflects patterns of Spleen Qi deficiency, Kidney Yang deficiency, and Heart-Spleen deficiency — depending on the individual presentation. Classical Jingfang herbal formulas are selected based on your full constitutional pattern. Acupuncture and moxibustion are used to support Qi and Yang, regulate the nervous system, and address specific symptoms including sleep disruption and pain.
A realistic approach to treatment
Progress with chronic fatigue is rarely linear. Dr Reece Yeo's approach is systematic: identify and prioritise the key drivers, introduce interventions in a staged and sustainable way, and monitor progress carefully. The goal is to support genuine functional improvement where possible — working systematically toward meaningful progress rather than symptom management alone.
References
- Jurek JM, Castro-Marrero J. Gut Microbiome Disturbances and Microbial Preparations in ME/CFS: Implications for Long COVID. Nutrients. 2024;16(11):1545. PMC11173566
- Wang JH, et al. Clinical Evidence of the Link between Gut Microbiome and ME/CFS: A Retrospective Review. Eur J Med Res. 2024;29:148. PMC10908121
- Deumer US, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Overview. J Clin Med. 2021;10(21):4786. PMID 34768306
Dr Reece Yeo explores these topics in depth on The Integrative Blueprint — his podcast on integrative Chinese medicine and functional health. A good way to get a sense of his clinical thinking before your first consultation.
You deserve a thorough investigation
If you have been told your tests are normal but you still feel unwell, Dr Reece Yeo would like to hear from you.
Request a Consultation