This is my hypothesis, but finding a way to gradually exercise without triggering a crash its going to be crucial for most to heal. A very good amount of symptoms from ME are from an extreme case of deconditioning, Biologically we are made to be active, when we can´t we get sick, there are studies about how the inmune system, and organs start to malfunctioning and begging to shutdown from deconditioning. and that generates a whole cascade of other symptoms, and it makes a loop for whatever possible infection its inside you worsening your state. even when the infection its gone, most people are so messed up physically that they would be in the same state.
I believe most sympthoms of ME its from an extremely disfunctional inmune system triying to get rid of a pathogen or a virus without success + The consequences of basically being on a vegetative state from lack of an active life.
The problem is that ME its tricky because of the PEM. in that case. I think the cure would be a mix of treating the hidden infection, supporting the immune system and a very gradual increase of movement at the same time.
I´m being controversial here but the ME protocol of pacing still makes people sicker. they maintain symptoms but they slowly worsen overtime and they fault themselves "Oh I was too active, my fault" no dude, you can´t blame yourself for this its the protocol it ,doesn´t work, maybe it doesn´t make you sicker than GET, but its still a shitty protocol that makes you sicker, just more slowly, even people who cannot move at all are in the worst state they keep getting worse.
I have also wondered if PEM its just a herx reaction of a more active inmune system, just an extreme version of this reaction, because a herx reaction sounds awfully similar to PEM in basics: Worsening symptoms and even new ones, a lot of brain fog and fatigue. that can last until there is no more of the infection.
This is because the inmune system reacts to the pathogen being excreted. if that its the case, running from PEM would actually be what makes people sicker. in bacteria and fungi infections the herx reaction happens very frequently. what if a "viral overgrowth" exist, and PEM its just an extreme reaction of the virus dying and the immune system reacting to this.
Yes, I´m doing a lot of assumptions, but the inmune system works very similarly in mechanics towards pathogens, maybe some virals ones triggers an extreme version of this.