Therapeutic evaluation of a classical Unani polyherbal formulation in chronic fatigue syndrome: A case report

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a chronic, debilitating multisystem disorder characterized by persistent fatigue, post-exertional malaise, unrefreshing sleep, cognitive dysfunction, and impaired quality of life, with no universally effective treatment established. In Unani medicine this presentation corresponds closely to I'yā' (fatigue); Jawarish Falafali is a classical Unani polyherbal formulation traditionally prescribed for conditions associated with fatigue and diminished vitality.

A 36-year-old woman presented with an eight-month history of persistent fatigue, post-exertional malaise, unrefreshing sleep, muscle pain, multiple joint pain, frequent headaches, and impaired memory and concentration. Clinical evaluation and laboratory investigation excluded alternative causes of chronic fatigue, and the patient fulfilled the Fukuda diagnostic criteria for chronic fatigue syndrome. She was treated with Jawarish Falafali, 6 g twice daily, for 30 days.

Progressive improvement was observed throughout treatment. By Day 30, the patient reported marked improvement in fatigue, post-exertional malaise, sleep quality, stamina, and daily functioning. The Chalder Fatigue Scale score improved from 25 to 2 (92% reduction) and the FibroFatigue Scale score from 34 to 2 (94.1% reduction); seven of eight SF-36 domains improved, with the Role-Emotional domain unchanged. Laboratory safety parameters remained within normal limits, and no adverse events were reported.

This single case suggests Jawarish Falafali is associated with clinically meaningful improvement in fatigue and quality of life in chronic fatigue syndrome, but a single, uncontrolled observation cannot establish efficacy or causality; controlled studies are needed.