Novak Djokovic sees off Monte Carlo Masters champion Stefanos Tsitsipas to claim the last major tournament before French Open, while Iga Swiatek beats Ons Jabeur to retain the women's title.
The 19-year-old Spaniard reached his second Association of Tennis Professionals Masters final in five weeks and claimed his first win over a reigning world number one, overcoming Djokovic in front of a sell-out home crowd at the Caja Magica.
Russia's Medvedev rolled through 6-4, 6-4, 6-2 in 1hr 55min, while Greek fourth seed Tsitsipas gained a 6-3, 7-5, 6-7 (2/7), 6-4 win over unseeded Frenchman Benoit Paire.
World number four's criticism comes as Novak Djokovic was included in the Australian Open official draw, although it is still uncertain whether the Aussie government will cancel Djokovic's visa for a second time over breaking Covid protocols.
Alexander Zverev said he had begun to feel his stomach trouble coming on in the second set, and he was seen briefly by a doctor who gave him some tablets in the third.
The 6-7 (6), 2-6, 6-3, 6-2, 6-4 defeat was the first major final for Tsitsipas and 29th for Djokovic, who also won the French Open in 2016, along with nine titles at the Australian Open, five at Wimbledon and three at the US Open.
Nadal, aiming for a record-extending 10th Rome title, will next face big-serving American Reilly Opelka, who reached his first Masters semi-finals
The 20-time Grand Slam winner, Rafael Nadal, next plays the 13th seed Canadian Denis Shapovalov for a place in the quarter-final.
Spain's Rafael Nadal advanced to the semifinals at the ATP Finals for the first time in five years after knocking out the defending champion Stefanos Tsitsipas.
World number one Novak Djokovic, the 2016 champion at Roland Garros, reached his fifth final in Paris, defeating fifth seed Tsitsipas 6-3, 6-2, 5-7, 4-6, 6-1.
Greece's Stefanos Tsitsipas defeats Austria's Dominic Thiem 6-7 (6/8), 6-2, 7-6 (7/4) during the men's singles final match in London on day eight of the tournament.
The 32-year-old Serbian tennis star avenged his loss to the 21-year-old Greek 3 weeks earlier in the Shanghai Masters, with a 58-minute victory.
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