Fatigue after Intracerebral Hemorrhage in a Patient with Severe Obesity: A Korean Medicine Case Report

Objectives: Post-stroke fatigue (PSF) is a common complication of intracerebral hemorrhage (ICH) that often leads to impaired quality of life and delayed recovery. Severe obesity is a risk factor for prolonged fatigue. This report describes a case treated with Korean medicine, focusing on both PSF and obesity-related factors.Methods: A 34-year-old male with a history of basal ganglia ICH and severe obesity (BMI 38) presented with fatigue, limb weakness, and digestive discomfort. He received acupuncture and two sequential herbal prescriptions, Buzhongyiqi-tang-gamibang and Wiryeong-tang-gamibang. Fatigue severity was assessed using the Fatigue Severity Scale (FSS), Numeric Rating Scale (NRS), and EQ-5D-5L.Results: Fatigue worsened after initial administration of Buzhongyiqi-tang-gamibang. After switching to Wiryeong-tang-gamibang, fatigue, digestive symptoms, and quality of life improved significantly (FSS: 3.3→1.8; NRS: 6→2; EQ-5D-5L: 70→85).Conclusions: This case suggests that fatigue after ICH with obesity may require a pattern-based individualized approach, and prescriptions targeting phlegm-dampness may be effective.