Synthesis
The published evidence supports three conclusions about ME/CFS in global and low-resource settings. First, post-infectious fatigue burden is geographically co-located with infectious disease burden — the countries with the most dengue, chikungunya, and TB are the countries with the least ME/CFS data. Second, illness labeling is culturally moderated — ME/CFS may be called neurasthenia, shenjing shuairuo, post-dengue fatigue, or kamzori depending on where the patient is, and Western diagnostic criteria may undercount cases in non-Western settings. Third, traditional Chinese medicine provides the only systematically reviewed traditional-medicine evidence base of any modality — and even that is low-quality and insufficient for treatment guidelines.
What the evidence cannot show — because the data do not exist — is the global prevalence of ME/CFS, the ME/CFS disease burden in any Sub-Saharan African or South Asian country, the effectiveness of any traditional-medicine system other than TCM, or whether ICD coding translates to practical disability protection outside high-income countries. These are not weaknesses of the evidence. They are the evidence of the weakness.
The LMIC Fatigue Blind Spot — the inference from Iran. Post-Infectious Fatigue Follows Infectious Disease Burden Geographically — the arboviral fatigue literature. Neurasthenia: The Cultural Precursor to Global ME/CFS — the cultural-variation literature. Cultural Idioms Beyond East Asia — the research gap beyond East Asia. ME/CFS Meets the Definition of a Neglected Disease in Global Health — the neglected-disease argument. What Would a Global ME/CFS Surveillance System Look Like? — the surveillance-gap question. TCM Herbal Formulations: Signal Without Strength, TCM Mind-Body Exercises: Moderate Effect, Low Risk, Acupuncture and Moxibustion: Widely Available, Moderately Supported — the TCM evidence. Traditional Medicine Evidence is Fractional and Culturally Bounded — the evidence-fraction limitation. Clinical Diagnosis Without Exclusionary Testing Is the Global Default — the diagnostic-access constraint. ICD Coding Exists; Disability Recognition Does Not — the disability-recognition gap.
Consequence: The global ME/CFS community knows — with high confidence — where the evidence gaps are and why they matter. What it does not know is how many patients worldwide are affected, where they are, and what they need. Until those questions are studied in the countries with the highest infectious-disease burden, the global picture of ME/CFS will remain geographically bounded by diagnostic access — and the patients outside those boundaries will remain invisible. Severity applicability: all.