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Tuina may reduce fatigue severity in chronic fatigue syndrome, but evidence is pending from an ongoing randomized controlled trial.

This is a study protocol for a multicenter, parallel-group randomized controlled trial evaluating Tuina (traditional Chinese manual therapy) for chronic fatigue syndrome (CFS). The trial will enroll 166 participants with CFS, randomized 1:1 to Tuina (twice weekly for 8 weeks) or standardized usual care (health education and symptom management). The primary outcome is change in Fatigue Scale-14 (FS-14) score from baseline to week 8, with secondary outcomes including quality of life, sleep, pain, anxiety, depression, gastrointestinal symptoms, bowel function, and handgrip strength. Exploratory mechanistic outcomes include plasma tryptophan-pathway metabolites, gut microbiota profiling, resting-state fMRI, and magnetic resonance spectroscopy.

Last updated: Aug 28, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Tuina for chronic fatigue syndrome: study protocol for a randomized controlled trial integrating tryptophan metabolism, gut microbiota, and brain network alterations.

observational

Jin M, Fang S, Xu S, Cao B, Li J, Ren J, Wang S, Kong L, Zhu Q, Fang M · Frontiers in neuroscience (2026)

Participants: N/A
Duration: 8 weeks treatment, with follow-up at 12 and 24 weeks post-treatment
Intervention: Tuina (traditional Chinese manual therapy) administered twice weekly for 8 weeks
Outcome: Change in Fatigue Scale-14 (FS-14) score from baseline to week 8; secondary outcomes include quality of life, sleep, pain, anxiety, depression, gastrointestinal symptoms, bowel function, handgrip strength, and exploratory gut-brain measures
Effect Size: N/A (protocol; results not yet reported)
Population: Adults with chronic fatigue syndrome (CFS) (n=166)

Result:

PubMed: 42656510DOI: 10.3389/fnins.2026.1859226

Mechanism Graph

Tuina stimulates somatosensory, autonomic, and stress-related pathways
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Modulates gastrointestinal function and gut microbiota composition
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Alters tryptophan metabolism and downstream metabolites (e.g., kynurenine, serotonin)
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Influences brain network activity and connectivity via gut-brain axis, potentially reducing fatigue

Limitations

  • ⚠This is a study protocol; no clinical results are available yet, so efficacy cannot be confirmed.
  • ⚠The control group receives usual care (not sham Tuina), so placebo effects cannot be fully controlled.
  • ⚠Exploratory mechanistic outcomes may be underpowered to detect significant changes in gut-brain measures.

Frequently Asked Questions

What is Tuina and how is it applied in this trial?▼

Tuina is a traditional Chinese manual therapy involving massage and manipulation of soft tissues. In this trial, it is administered twice weekly for 8 weeks to participants with chronic fatigue syndrome.

What is the primary outcome of this trial?▼

The primary outcome is the change in Fatigue Scale-14 (FS-14) score from baseline to week 8, measuring fatigue severity.

How many participants are enrolled and how are they allocated?▼

The trial plans to enroll 166 participants with CFS, allocated in a 1:1 ratio to either the Tuina group or a standardized usual care group.

What mechanistic measures are being explored?▼

The trial explores plasma tryptophan-pathway metabolites, gut microbiota profiling, resting-state functional magnetic resonance imaging (fMRI), and magnetic resonance spectroscopy to understand gut-brain interactions.

Products

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References

  1. 1.Jin M, Fang S, Xu S, Cao B, Li J, Ren J, Wang S, Kong L, Zhu Q, Fang M. "Tuina for chronic fatigue syndrome: study protocol for a randomized controlled trial integrating tryptophan metabolism, gut microbiota, and brain network alterations.." Frontiers in neuroscience, 2026. PMID: 42656510 DOI: 10.3389/fnins.2026.1859226
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.