Most women I see in the clinic living with chronic fatigue syndrome (CFS/ME) and fibromyalgia describe feeling “stuck on high alert.” Anxiety, inability to relax even during rest, the body feels like as if it is under constant threat. This pattern is closely linked with the autonomic nervous system, which governs how we respond to stress and how we recover afterwards.
Sympathetic vs. Parasympathetic Balance
The autonomic nervous system has two main branches:
- The sympathetic nervous system, often described as “fight or flight,” this branch prepares the body for action.
- The parasympathetic nervous system, often described as “rest and digest,” this branch supports recovery, digestion, and repair.
Confirming my clinical experience working with women diagnosed with CFS/ME and fibromyalgia, research has also shown that the sympathetic branch is often overactive, while the parasympathetic branch is under-active. This imbalance may contribute to symptoms such as unrefreshing sleep, post-exertional malaise, widespread pain, cognitive difficulties, anxiety, and increased heart rate.
Perspectives from Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) offers a complementary way of understanding these patterns. From a TCM perspective, CFS/ME and fibromyalgia often involve an imbalance of Yin and Yang and a depletion of Qi (vital energy). Prolonged stress and over-activation of the “fight or flight” response can be seen as excessive Yang activity, which consumes Yin, considered the “rest and digest” state and leaves the system overheated and depleted.
Practices that nourish Yin and regulate Qi such as acupuncture, qigong, tai chi, and herbal medicine are traditionally used to calm the mind, nourish the body, and encourage balance. Interestingly, modern research has begun to explore how these approaches may influence autonomic function. For example, treatment on the left auricular sympathetic acupuncture point improved heart rate variability and reduced the heart rate significantly suggesting a positive impact on parasympathetic tone. (Dieu-Thuong et al. 2023)
Supporting the Parasympathetic Nervous System
CFS/ME and fibromyalgia are complex conditions and there is no single intervention that works for everyone. Evidence however suggests that practices which gently stimulate the parasympathetic system can be beneficial and anyone working with me knows how much I talk about engaging the parasympathetic nervous system! These include:
- Slow breathing techniques, especially those emphasising longer exhalations
- Vagus nerve stimulation strategies, such as humming, gargling, or gentle cold-water exposure
- Restorative activities, including yoga, mindfulness, and relaxation practices
- Meditation, which has been shown to increase parasympathetic activity, reduce stress hormone levels, and improve HRV over time (Tang et al., 2009; Pascoe et al., 2017)
- Social connection, which has been shown to support autonomic balance and feelings of safety
- Traditional Chinese practices, such as tai chi and qigong, which combine gentle movement, breath, and awareness to restore balance
The aim is not to force relaxation, but to create conditions where the body can gradually move from a state of survival into a state of repair.
Conclusion
Engaging the parasympathetic nervous system is an important aspect of managing chronic fatigue and fibromyalgia in my clinical practice. Both modern research and Traditional Chinese Medicine point towards the importance of restoring balance, calming overactivity, and supporting the body’s natural capacity for repair. By combining evidence-based strategies with traditional practices, individuals may improve resilience, reduce symptom severity, and enhance overall quality of life.
