Zhu, Zixin, Zhao, Xueke, Ouyang, Qiuyue et al. · Annals of translational medicine · 2022 · DOI
This study looked at whether spending time in a waterfall forest environment in China could help people with ME/CFS feel better. Researchers tracked what participants looked at, measured their fatigue and mood, and checked blood markers for inflammation and antioxidants. They found that people who spent time near the waterfall had less fatigue and depression, lower inflammation, and higher antioxidant levels.
ME/CFS patients often seek non-pharmacological interventions for fatigue and mood symptoms with limited effective options. This study provides preliminary evidence that natural environments may reduce inflammation and oxidative stress—pathways implicated in ME/CFS pathophysiology—potentially opening investigation into accessible environmental interventions.
This study does not establish causation; exposure to the waterfall environment correlates with improvements, but lacks a proper control group or blinded design, so placebo effects and selection bias cannot be excluded. The findings are specific to one geographic location and cannot be generalized to other environments or populations without replication. The study does not prove that negative oxygen ions or metabolic rebalancing are the active mechanisms—these are post-hoc inferences.
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
Zhu, Zixin, Zhao, Xueke, Ouyang, Qiuyue, Cong, Shuo, Zhou, Mingyu, Xiong, Yan, et al. (2022). Mechanism of the Huangguoshu waterfall forest environment's promotive effect on human health in Guizhou, China.. Annals of translational medicine. https://doi.org/10.21037/atm-22-3787
BibTeX
@article{mecfsatlas-zhu-2022-mechanism-huangguoshu,
author = {Zhu, Zixin and Zhao, Xueke and Ouyang, Qiuyue and Cong, Shuo and Zhou, Mingyu and Xiong, Yan and Zhang, Manman and Luo, Xinhua and Cheng, Mingliang},
title = {Mechanism of the Huangguoshu waterfall forest environment's promotive effect on human health in Guizhou, China.},
journal = {Annals of translational medicine},
year = {2022},
doi = {10.21037/atm-22-3787},
note = {PubMed: 36110995},
url = {https://www.mecfsatlas.com/evidence/zhu-2022-mechanism-huangguoshu},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/zhu-2022-mechanism-huangguoshu
Contribute
Private, reviewed by a human. Not a public comment thread.