<p>Fibromyalgia, a chronic condition characterized by widespread pain and a constellation of other symptoms, presents a significant health challenge globally. Its underlying mechanisms remain elusive, and conventional treatments often fail to provide adequate relief. While conventional medications have a role, exploring complementary therapies becomes increasingly important. Traditional Chinese medicine (TCM), with its holistic approach and emphasis on balancing bodily systems, offers potential avenues for fibromyalgia management. This systematic review aims to critically evaluate the effectiveness and underlying mechanisms of TCM techniques in the management of fibromyalgia symptoms, based on recent randomized controlled trials. A systematic review was conducted, searching multiple databases for recent randomized controlled trials. Eighteen studies were included, involving 1595 participants. Techniques studied included acupuncture (manual and scalp), electroacupuncture, cupping, moxibustion, and herbal therapy. Acupuncture is suggested to be effective in reducing pain and fatigue, and improving the quality of life. Mechanisms may involve neurotransmitter modulation and improved brain connectivity. Cupping seems effective in reducing pain and improving quality of life. Its mechanisms may involve enhanced blood circulation and opioid release. Regarding moxibustion, it may be able to reduce pain levels and improve sleep quality. Mechanisms may involve inflammation modulation and brain activity regulation. <i>Qigong</i> also showed benefits in reducing pain, fatigue, and improving the quality of life. Mechanisms may involve nervous system regulation and energy balance. Finally, herbal Therapy’s limited evidence showed conflicting results. Traditional Chinese medicine techniques may be valuable complementary treatments for fibromyalgia. However, efficacy should be further investigated.</p>