Hashimoto, N · Nihon rinsho. Japanese journal of clinical medicine · 1992
This article reviews how ME/CFS was officially defined by the CDC in 1988 and identifies problems with that definition. The author points out that while the definition tries to rule out other conditions, it has trouble distinguishing ME/CFS from similar conditions like fibromyalgia and depression, and it's difficult to measure in real-world clinical practice.
Diagnostic criteria are fundamental to clinical practice and research. This early critical examination of the CDC definition helped identify structural weaknesses that would eventually lead to refined diagnostic criteria (such as the Fukuda criteria refinements and later the International Consensus Criteria), improving how ME/CFS patients are identified and studied.
This review does not provide new empirical data or test alternative diagnostic criteria. It does not prove what the correct definition should be, nor does it establish the prevalence or etiology of ME/CFS. This is a critical analysis rather than a study generating primary evidence.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Hashimoto, N (1992). [Definition of the chronic fatigue syndrome and its issues].. Nihon rinsho. Japanese journal of clinical medicine. https://pubmed.ncbi.nlm.nih.gov/1287235/
BibTeX
@article{mecfsatlas-hashimoto-1992-definition-chronic,
author = {Hashimoto, N},
title = {[Definition of the chronic fatigue syndrome and its issues].},
journal = {Nihon rinsho. Japanese journal of clinical medicine},
year = {1992},
note = {PubMed: 1287235},
url = {https://www.mecfsatlas.com/evidence/hashimoto-1992-definition-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/hashimoto-1992-definition-chronic
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