Wang, Tian-Fang, Xue, Xiao-Lin · Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine · 2008
This study clarifies that 'sub-health'—a state of feeling unwell that falls short of diagnosed disease—is different from ME/CFS. The authors explain what fatigue, chronic fatigue, and ME/CFS actually are, and discuss how doctors can tell them apart using established diagnostic criteria. Understanding these differences helps ensure people with ME/CFS receive appropriate diagnosis and care.
Distinguishing ME/CFS from sub-health states is clinically important because it prevents diagnostic confusion, ensures appropriate management pathways, and validates ME/CFS as a distinct medical condition rather than a vague state of poor wellness. Clear diagnostic criteria help patients receive targeted treatment rather than dismissal of symptoms.
This review does not provide new epidemiological data, biomarkers, or mechanistic evidence about ME/CFS. It does not establish causation or identify new diagnostic tools; rather, it synthesizes existing diagnostic frameworks. As a conceptual paper with an evidence level of E3, it cannot replace rigorous clinical or laboratory studies defining disease etiology.
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
Wang, Tian-Fang & Xue, Xiao-Lin (2008). [Sub-health state and chronic fatigue syndrome].. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine. https://pubmed.ncbi.nlm.nih.gov/18418978/
BibTeX
@article{mecfsatlas-wang-2008-sub-health,
author = {Wang, Tian-Fang and Xue, Xiao-Lin},
title = {[Sub-health state and chronic fatigue syndrome].},
journal = {Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine},
year = {2008},
note = {PubMed: 18418978},
url = {https://www.mecfsatlas.com/evidence/wang-2008-sub-health},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/wang-2008-sub-health
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