Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2026:4(1). doi:10.5281/zenodo.17792548 institutoptc.com/journal-complementary-therapies Clinical case series study Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. Ana Gomes1, Inês Lourenço2, Marta Arbona Fonseca1*, and Marta Bernardo2. 1 Coopmic – Cooperative of Integrative and Complementary Medicine, Lisbon, Portugal; 2 Independent researcher. * Correspondence: martalim[email protected] Abstract Acupuncture, rooted in Traditional Chinese Medicine (TCM), has been practiced for millennia to treat a variety of conditions, including pain, inflammation, anxiety, insomnia, and other chronic disorders. In recent decades, it has gained increasing recognition within integrative medicine for its role in enhancing physical recovery, regulating autonomic function, and promoting overall wellbeing. In the context of sports, and particularly in surfing (a discipline marked by intense physical demand and environmental exposure), acupuncture offers potential benefits such as improved muscle recovery, reduced fatigue, relief of musculoskeletal tension, enhanced circulation, and improved flexibility, balance, and endurance. It may also contribute to emotional regulation, energy support, and the mitigation of chronic conditions that could compromise athletic performance. This exploratory and descriptive case series investigates whether individualised acupuncture treatment, combined with other TCM modalities such as herbal medicine, Tui Na massage, and dietetic therapy, can support recovery, prevent symptom recurrence, and optimise resilience in surf athletes. A brief review of recent literature supports the relevance of acupuncture in musculoskeletal and neurovegetative regulation; however, evidence specific to surf athletes remains scarce. The clinical cases presented demonstrate that acupuncture, when tailored to the athlete’s constitution and sport-specific demands, may lead to significant improvements in physical recovery, emotional balance, and overall vitality. These findings support the integration of acupuncture as a safe, adaptable, and cost-effective strategy within holistic athlete care, particularly in sports involving environmental stress and high physical load, such as surfing. Keywords: Acupuncture; Sports Medicine; Traditional Chinese Medicine; Surf Athletes; Muscle Recovery; Performance Optimisation. 1. Introduction Acupuncture and TCM have gained increasing relevance within sports medicine as integrative approaches to pain management, recovery and overall physiological regulation 1-3. Athletes frequently benefit from non-pharmacological methods capable of modulating fatigue, improving musculoskeletal function and supporting autonomic balance 47, particularly in sports that combine repetitive physical load with environmental stressors. When performed according to appropriate sterile procedures, acupuncture is regarded as a safe therapeutic option for both adults and children 8,9. Surfing presents a unique constellation of physical and environmental demands 10, including prolonged paddling, rapid changes of movement, rotational forces on the spine and joints, and continuous exposure to cold water and wind. These factors may contribute Citation: Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. Journal of Complementary Therapies in Health. 2026;4(1) 10.5281/zenodo.17792548 Academic Editor: Jorge Rodrigues Received: 12 November 2025 Reviewed: 27 November 2025 Revised: 30 November 2025 Accepted: 30 November 2025 Published: 2 December 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2026 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2026: 4(1). 2 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 not only to acute injuries but also to chronic musculoskeletal tension, delayed recovery, respiratory vulnerability, sleep disturbances and emotional dysregulation 10. The holistic perspective of TCM is particularly suited to understanding these multifactorial presentations 11-14, integrating physical symptoms, emotional dynamics and environmental influences within individualised diagnostic patterns. Despite the increasing use of acupuncture among athletes, clinical documentation focusing specifically on surf practitioners remains limited. This case series aims to illustrate the role of individualised TCM assessment and treatment in supporting recovery, resilience and chronic condition management in surfers across different age groups and health contexts. The following four cases exemplify the clinical reasoning, therapeutic strategies and outcomes observed in practice. 2. Case 1 – Spleen Qi Deficiency with Dampness in an Active Female Surfer 2.1. Presentation A.B. is a 30-year-old French female surfer who also works as a fitness coach and pole dance instructor, maintaining a routine of high-intensity daily training. She reported delayed muscle recovery, recurrent lumbar pain and frequent muscular swelling, complaints that had not been resolved by previous physiotherapy. Her medical history included a disabling lumbar blockage in 2021 and a complicated urinary tract infection associated with fluctuating renal function. She had been using oral contraceptives since adolescence and experienced recurrent urinary infections and candidiasis approximately twice per year. Additional symptoms included dizziness while surfing, oily skin with a history of acne, hair loss, constant thirst, difficulty maintaining concentration and a tendency toward ruminative thought patterns. She described an overall positive mood, occasional alcohol use, non-smoking habits and a preference for warm climates. The tongue was observed to be moist and shiny with pronounced teeth marks on the edges, and the pulse indicated Spleen deficiency with Kidney weakness. Musculoskeletal palpation revealed significant tension in the lumbar region. No recent imaging exams were available. 2.2. Diagnosis From a TCM perspective, the clinical presentation reflected a combination of underlying energetic imbalances. The primary diagnosis included Spleen Qi deficiency with internal dampness 11,15,16, suggested by the delayed muscle recovery, heavy limbs, digestive and urinary susceptibility, moist tongue coating and teeth marks. Liver Qi stagnation was identified in association with chronic physical overexertion and emotional tension, contributing to dizziness, irritability, difficulty focusing 11,13 and musculoskeletal tightness. Kidney deficiency (likely aggravated by long-term contraceptive use, recurrent infections and intensive training) was considered relevant to her history of lumbar weakness and poor recovery 11. Together, these patterns revealed a functional disharmony between Spleen, Liver and Kidney, with secondary damp accumulation obstructing physiological recovery mechanisms 14. 2.3. Methods and Treatment Logic Treatment aimed to support Spleen and Kidney Qi, resolve internal dampness, regulate Liver Qi, support the lumbar region, enhance post-exertion recovery and improve mental clarity. Acupuncture was applied using a combination of local, distal and systemic points based on the treatment principles 1,2,4-7. Points included GV20, CV17, CV4, KI3, SP6, SP3, SP9, GB34, GB39, LR3, BL60, LI11 and GB20 17,18. Supporting and harmonising techniques were selected to strengthen the Spleen, nourish Kidney resources, calm the Shen 11,12, transform dampness, promote the smooth flow of Liver Qi and reduce musculoskeletal tension. LI11 and GB20 were emphasised to address post-exercise inflammation and dizziness related to surf practice. Journal of Complementary Therapies in Health 2026: 4(1). 3 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 Tui Na massage was incorporated during periods of muscular overload, focusing on the lumbar region to release tension, regulate Qi and Blood circulation 3 locally and support recovery. Lifestyle and dietetic recommendations complemented the treatment. These included prioritising rest between training sessions, consistent hydration and a diet oriented toward reducing dampness 15,16,19. Warm, cooked meals based on whole grains and seasonal vegetables were encouraged, along with moderate intake of light animal protein and fermented foods. Warming digestive spices such as ginger were recommended. Foods known to increase dampness, such as dairy products, fried foods, refined sugars, cold or raw meals, excess tropical fruits, processed wheat products and cold beverages, were discouraged. 2.4. Results and Discussion After only two acupuncture sessions, A.B. reported significant improvements, including reduced thirst, enhanced mental clarity and complete resolution of lumbar pain. Her post-training muscle recovery improved markedly. A subsequent episode of muscular discomfort following an intensive training trip abroad did occur but was considerably milder than her previous baseline. These changes suggest both symptomatic improvement and increased resilience. This clinical evolution is consistent with current literature supporting the use of acupuncture to improve circulation, modulate inflammation and enhance musculoskeletal recovery in athletes undergoing high-intensity training 1,2,5-7. It also aligns with TCM theory, in which Spleen and Kidney deficiencies contribute to chronic lumbar weakness 11,12,14 and delayed muscle recovery, especially when exacerbated by damp accumulation and overexertion. By addressing these underlying energetic patterns and optimising the body’s transformation and transportation functions, acupuncture and Tui Na facilitated both immediate symptom relief and longer-term functional improvement. This case demonstrates the potential of an integrative TCM approach to support the physical demands of high-performance athletes, particularly when treatment is individualised to constitutional patterns and environmental stressors, such as cold-water exposure, repetitive strain and intensive physical routines typical of surf sports. 3. Case 2 – Spleen Qi Deficiency with Phlegm-Damp in Obstructive Sleep Apnoea 3.1. Presentation The patient is a 55-year-old male surf journalist and instructor who leads a highly irregular professional schedule marked by frequent exposure to cold water, long periods of sedentary work during event coverage and intermittent bouts of physical exertion. He sought treatment primarily for obstructive sleep apnoea (OSA), which manifested as loud snoring, frequent nocturnal awakenings, respiratory pauses confirmed by his partner and persistent non-restorative sleep. He also reported chronic morning fatigue, night sweats, constant thirst, dry mouth, sensations of internal heat and warm extremities. Additional symptoms included mild obesity, with an estimated BMI of 30–32 kg/m², seasonal ocular itching suggestive of allergic tendencies, confirmed gluten intolerance diagnosed five years earlier and intermittent shoulder and neck pain exacerbated by prolonged sitting or emotional stress. His emotional profile was characterised by mild anxiety, nocturnal agitation, irritability in response to perceived injustices, difficulty setting boundaries and a recurring sense of frustration. His lifestyle was inconsistent, marked by an irregular diet high in refined carbohydrates and low in fresh whole foods, moderate alcohol consumption and a history of smoking cessation ten years earlier. On examination, the tongue exhibited a thick white coating with red edges, indicating internal dampness and Liver heat, while the pulse was slippery and slightly wiry 11,12. The patient expressed a clear therapeutic goal: to improve sleep quality, daytime energy, chronic fatigue and global body balance. Journal of Complementary Therapies in Health 2026: 4(1). 4 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 3.2. Diagnosis Based on TCM pattern differentiation, the clinical presentation aligned primarily with Spleen Qi deficiency with phlegm-damp accumulation, reflected in the patient’s obesity, thick tongue coating 11,15,16, digestive irregularity, fatigue and respiratory obstruction. The habitual exposure to cold water associated with surf practice and the prolonged sedentary episodes characteristic of his work contributed to impaired transformation and transportation of fluids, resulting in dampness accumulation and subsequent phlegm formation 10. This phlegm obstructed the respiratory passages, manifesting as snoring, apnoeic events and fragmented sleep. A secondary but significant pattern of Liver Qi stagnation with internal heat was evident through irritability, emotional frustration, nocturnal agitation, thirst, night sweating 11,12 and the red tongue edges. Liver Qi stagnation, perpetuated by chronic stress and emotional tension, further contributed to phlegm formation and disrupted Qi movement in the chest and throat. The presence of Shen disturbance was indicated by nocturnal restlessness, mild anxiety and difficulty relaxing at night 11,12. Together, these patterns revealed a multifactorial disharmony involving Spleen weakness, phlegm obstruction of the upper airways, Liver stagnation generating internal heat and emotional imbalance exacerbating systemic dysregulation. 3.3. Methods and Treatment Logic The therapeutic plan combined acupuncture, Tui Na massage, cupping therapy, herbal medicine and dietetic guidance, applied with the aim of supporting Spleen Qi, resolving phlegm, moving Liver Qi, dispersing internal heat, relaxing musculoskeletal tension and harmonising the Shen. Acupuncture was performed weekly. Points included ST36 to support Spleen Qi and reduce dampness; SP6 to nourish Yin and assist fluid metabolism; ST40 to transform phlegm; CV12 and SP9 to regulate digestion and fluid pathways; LR14 and GB34 to soothe Liver Qi; LU7 to open the chest and regulate Lung Qi; HT7 and Anmian to calm the Shen; CV17 and KI27 to support respiratory function; and GV20 to clear heat and anchor Yang. Local musculoskeletal complaints were addressed using GB21, LI15, SJ14 and Ashi points in the cervical and shoulder regions to improve circulation and relieve tension 12,17,18. Tui Na massage and cupping therapy were introduced from the second session. Manual techniques focusing on the cervical and upper thoracic areas (BL18–BL21) reduced muscle tightness and supported Liver and Spleen pathways. Fixed cupping over GB21, LI15 and BL20 improved regional circulation, facilitated phlegm transformation and relieved mechanical strain contributing to disrupted breathing 3. Chinese herbal medicine was prescribed to complement acupuncture. Ban Xia Hou Po Tang targeted phlegm obstruction 20 and helped regulate the Lung and Stomach Qi, reducing upper airway blockage associated with OSA. Jia Wei Xiao Yao San was used to move Liver Qi, clear internal heat and calm the Shen. The patient adhered reasonably well to the herbal regimen, with adjustments made to accommodate his schedule. Dietetic counselling emphasised Spleen-strengthening, gluten-free, warm and cooked foods, including brown rice, quinoa, azuki beans and cooked vegetables such as pumpkin and carrot. Warming spices were recommended to support digestive transformation, while damp and heat-promoting foods 15,16,19, dairy, refined sugar, greasy meals, cold beverages, alcohol, caffeine and spicy foods, were discouraged. Hydration was encouraged, as well as the inclusion of peppermint and chamomile teas to soothe Liver heat. The lifestyle component included recommendations for consistent sleep routines, reduction of evening screen exposure, gentle physical activity on sedentary days and maintaining warmth after prolonged periods in cold water 10. 3.4. Results and Discussion Clinical progression over twelve weekly sessions was favourable and consistent. The patient experienced a substantial reduction in snoring intensity, fewer respiratory pauses Journal of Complementary Therapies in Health 2026: 4(1). 5 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 and significantly improved sleep continuity. Daytime fatigue diminished, with the patient reporting increased stability of energy levels and improved emotional regulation. Night sweats and sensations of internal heat were markedly reduced. Cervical and shoulder tension improved through the combined effect of acupuncture, Tui Na and cupping, allowing for better respiratory mechanics and general relaxation 1,2,5,8. Tongue and pulse examinations indicated progressive improvement: the thick tongue coating thinned significantly, and the pulse shifted from slippery and wiry to a more balanced quality. The patient tolerated treatment well, reporting no adverse reactions to acupuncture, herbal medicine or Tui Na. Minor post-cupping soreness resolved spontaneously within 24 hours. Despite these improvements, partial adherence to dietary recommendations limited complete resolution of internal heat and prevented full regulation of Spleen function. His mixed routine, alternating between surf-related cold exposure and prolonged sedentary work, also posed challenges to maintaining consistent Qi movement and phlegm resolution. Nevertheless, the intervention demonstrated clear clinical benefits. This case illustrates how a comprehensive TCM approach that integrates acupuncture, manual therapy, herbal medicine, diet and lifestyle guidance can effectively address complex, multifactorial presentations such as OSA associated with Spleen deficiency and phlegm obstruction 11,12. The patient’s improvements reflect both symptomatic relief and deeper regulation of systemic patterns, particularly the interplay between Spleen deficiency, phlegm accumulation and Liver heat. The case reinforces the importance of integrating emotional and lifestyle components into treatment to achieve more consistent long-term results. 4. Case 3 – Liver-Kidney Yin Deficiency with Internal Wind in an Epileptic Surfer 4.1. Presentation The patient is a 26-year-old male competitive surfer who has practiced the sport since childhood and sought TCM treatment to improve resilience, recovery, emotional stability and seizure control. His medical history is significant for two chronic and lifelong conditions: Juvenile Myoclonic Epilepsy (JME), diagnosed in adolescence, and Alpha-1 Antitrypsin Deficiency (A1ATD), identified in infancy through Liver biopsy following intolerance to breast milk. These diagnoses create a complex physiological background in which neurological and metabolic vulnerabilities coexist 21,22. He reported that his epileptic manifestations began as mild childhood symptoms but progressed at age 18 to include tonic–clonic seizures occurring approximately five to six times per year. These episodes were typically preceded by sensations of internal heat in the upper limbs and followed by prolonged fatigue, amnesia, tremors and drowsiness. His most recent seizure occurred in November 2024, resulting in a minor motor vehicle accident. Throughout adulthood, emotional stress and psychological tension consistently acted as triggers 21. At the time of consultation, he described a constellation of symptoms including vertex headaches, dizziness, dry eyes, insomnia, nocturnal sweating, irritability, jaw tension, pronounced thirst, sensations of internal heat especially in the palms and soles, recurrent lumbar and left knee pain and chronic post-surf musculoskeletal tightness related to coldwater exposure. He also reported persistent ruminative thinking, emotional sensitivity, a tendency toward internal agitation and chronic discomfort in the ears. He was under stable pharmacological management with levetiracetam and lamotrigine, with no recent imaging exams or laboratory tests conducted. Tongue examination revealed a red, dry and coatingless body with red borders, and his pulse was rapid and wiry. This broad spectrum of neurological, musculoskeletal, constitutional and emotional manifestations provided a complex clinical portrait requiring individualised and cautious integration of TCM strategies. Journal of Complementary Therapies in Health 2026: 4(1). 6 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 4.2. Diagnosis From a TCM pattern differentiation perspective, the clinical picture represented a multifactorial disharmony rooted primarily in Liver and Kidney Yin deficiency. The chronic dryness, insomnia, dizziness, nocturnal sweating, heat sensations 11-13 and red, coatingless tongue strongly indicated depletion of Yin fluids and internal cooling mechanisms. Kidney Yin deficiency was particularly relevant given the long-standing history of A1ATD and constitutional vulnerability. This deficiency created the internal conditions necessary for the generation of internal heat and subsequently internal wind, both of which are traditionally associated with seizure activity 11,12,14. The rapid, wiry pulse and susceptibility to emotional triggers further supported this assessment 11,12. The presence of relative Yang excess, resulting from insufficient Yin anchoring, was evident in the upward-rising symptoms such as vertex headaches, irritability, tinnitus-like ear discomfort and intense internal heat in the extremities. Secondary elements included phlegm-damp accumulation, consistent with his musculoskeletal heaviness, glandular congestion sensations and the chronic effects of repeated cold exposure during surf practice. Although phlegm was not the primary seizure trigger here, its presence may have exacerbated neurological instability, particularly during stress or fatigue. Together, these patterns revealed a TCM diagnostic framework of Liver– Kidney Yin deficiency generating internal wind and heat, combined with phlegm-damp factors and rising Yang contributing to neurological instability and emotional reactivity. 4.3. Methods and Treatment Logic Given the patient’s chronic neurological diagnosis and ongoing antiepileptic medication, herbal medicine was considered but intentionally avoided due to the significant risk of herb–drug interactions 20. The primary therapeutic modality was acupuncture, applied with caution and adapted progressively as symptoms evolved. The treatment focused on nourishing Liver and Kidney Yin, clearing internal heat, extinguishing internal wind, regulating Liver Qi, supporting Jing, calming the Shen and harmonising the ascent and descent of Yang Qi. Acupuncture point selection reflected these principles. GV24 was used for its classical indication in epilepsy and its ability to calm the Shen and regulate neurological activity 1,2,5. ST36 supported overall vitality and Qi regulation. KI6 and LR3 nourished Yin and harmonised Liver and Kidney function. GB21 contributed to the reduction of internal wind and muscular tension. LI4 and LI11 cleared heat and regulated Qi movement. CV4 strengthened Kidney essence and supported the foundational Yin and Qi reserves. GB39 nourished marrow and was selected to prevent the re-emergence of wind rooted in Kidney deficiency. GB40 and SP10 enhanced blood and Qi circulation, supporting Liver balance and muscular relaxation. SP9 and ST40 were included to transform dampness and phlegm, particularly relevant for an athlete frequently exposed to cold and moisture. CV17 and HT3 regulated Shen activity and emotional stability. GB34 was chosen for its role in harmonising sinews and alleviating musculoskeletal tension. GV20, GB8 and GB20 were applied to subdue Yang rising, regulate neurological activity and prevent the excessive ascent of heat and wind to the head 12,17,18. Tui Na massage was used selectively during periods of muscular overload, mainly in the lumbar and thoracolumbar regions, to support circulation and reduce tension from surf-related overuse. Dietetic guidelines were introduced gradually due to the patient’s limited availability for structured follow-up. Recommendations focused on Yin-nourishing foods, avoidance of heating items and the inclusion of mildly cooling fruits, steamed vegetables, whole grains and sufficient hydration 15,16,19. Throughout treatment, care was taken to avoid overstimulation, which could destabilise neurological patterns or trigger seizures. Sessions were paced methodically and integrated with ongoing neurological management. Journal of Complementary Therapies in Health 2026: 4(1). 7 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 4.4. Results and Discussion The patient demonstrated early and consistent improvements across several domains. He reported enhanced sleep quality, a reduction in vertex headaches and diminished irritability and emotional reactivity. Thirst and internal heat sensations became more manageable, and episodes of ruminative thinking diminished. Musculoskeletal tension in the lumbar and knee areas decreased, particularly during periods of reduced surf exposure. Although seizure frequency could not yet be evaluated due to the short follow-up period, the patient described a subjective increase in resilience and a greater sense of internal stability. Improvements in sleep and emotional regulation are particularly significant given that stress and sleep deprivation are recognised triggers of JME episodes 21. The therapeutic outcomes align with classical TCM principles and emerging literature suggesting that acupuncture may modulate cortical excitability, reduce sympathetic overactivity and improve quality of life in patients with epilepsy. By nourishing Yin, reducing internal wind and stabilising Shen activity, acupuncture may contribute to a more regulated neurological environment, even when pharmacological treatment remains primary 1,2,5. This case highlights the potential of individualised TCM interventions to support young adult athletes with chronic neurological and metabolic diagnoses. The coexistence of JME and A1ATD required a cautious, personalised approach, emphasising safety, emotional regulation and constitutional strengthening. The case also underscores the importance of long-term follow-up to evaluate seizure activity, systemic inflammation and the sustainability of improvements observed in the early phase of treatment. 5. Case 4 – Paediatric Lung Qi and Kidney Deficiency in a Young Surfer 5.1. Presentation The patient is a 9-year-old male who has been a regular surf practitioner since the age of four and who is frequently exposed to cold water and ocean wind. Despite an overall balanced lifestyle, including a diet predominantly based on whole foods and the absence of dairy and soft drinks, he presented with recurrent upper respiratory tract infections, nocturnal respiratory noise, enuresis and night sweats. These symptoms were more frequent during colder seasons, particularly autumn and winter. On physical examination, the child appeared well-developed, active and without any delays in growth or psychomotor development. However, his parents reported intermittent nasal obstruction, loud breathing during sleep and a tendency toward emotional restlessness in cold weather. These recurring symptoms suggested underlying energetic vulnerability despite his apparently strong physical constitution. 5.2. Diagnosis According to TCM pattern differentiation, the child’s presentation corresponded primarily to Lung Qi deficiency with weakened Wei Qi 11-13, as evidenced by recurrent respiratory infections, nasal obstruction and susceptibility to external cold-damp pathogens 9. Prolonged exposure to cold water and cold wind during surf practice played a central role in this vulnerability 10, undermining the natural defensive Qi and compromising the Lung’s role in dispersing and descending Qi. A secondary pattern of Kidney Yin deficiency was suggested by the presence of night sweats and enuresis 11,13,23, two manifestations that, in paediatric TCM physiology, often reflect the immaturity or insufficient consolidation of Kidney essence. In children, Kidney deficiency more easily destabilises fluid metabolism, sleep regulation and Wei Qi activity. Additionally, signs of residual phlegm obstructing the Lung, such as noisy breathing during sleep, indicated impaired descent of Lung Qi 15,16,19,24. This phlegm likely originated from either Spleen weakness or incomplete resolution of previous external invasions. To- Journal of Complementary Therapies in Health 2026: 4(1). 8 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 gether, these patterns revealed an interaction between constitutional susceptibility, environmental exposure and immature paediatric organ systems, producing recurring respiratory and nocturnal symptoms. 5.3. Methods and Treatment Logic Treatment was tailored to paediatric needs, ensuring gentle yet effective interventions. Acupuncture was applied once weekly using fine paediatric needles combined with laser stimulation on selected points for increased comfort. Points included DU20 to calm the Shen and support Yang; CV17 to regulate Qi and open the chest; KI3 to nourish Kidney Yin; LU7 to disperse wind and strengthen the Lung; KI27 to resolve phlegm and benefit the thorax; CV4 to support Yuan Qi and harmonise the Spleen–Kidney axis; and LV3 to regulate Liver Qi and stabilise emotional balance 17,18. Moxibustion was used to warm the Kidney and Lung regions, particularly over the lower back and nasal pathway, to expel residual cold, support Yang and enhance Wei Qi defense 12,13. Tui Na massage was incorporated into each session, focusing on the thoracic and lumbar areas to promote circulation, improve Qi movement and relax the child before needling 3. Herbal medicine was introduced using paediatric-adapted doses. Yu Ping Feng San was prescribed to strengthen Wei Qi and reduce vulnerability to respiratory pathogens. Bu Zhong Yi Qi Tang Jia Wei was used to support Lung, Spleen and Kidney Qi while addressing enuresis through its supporting and ascending properties. These formulas were chosen for their safety, compatibility with paediatric physiology and proven efficacy in reinforcing immunity and addressing constitutional deficiencies 12,20. Dietetic recommendations emphasised maintaining internal warmth through seasonal cooked meals, soups, porridges and warm beverages 15,16,19,24. Foods known to produce dampness or phlegm, such as sugar, fried items and processed snacks, were minimised. Supporting foods such as azuki beans, black beans and miso-based soups were introduced to support Spleen and Kidney function. The family received guidance on maintaining warmth after surf practice, including adequate clothing and warm foot baths, to counteract cold exposure. 5.4. Results and Discussion Over an eight-week period, the child displayed marked clinical improvement. The frequency and intensity of respiratory infections decreased considerably, and noisy breathing during sleep resolved. Enuresis became infrequent and eventually ceased, and night sweats diminished substantially. The child also reported improved tolerance to cold environments and demonstrated greater vitality and emotional stability, particularly during colder days. Parents noted that his energy levels and mood became more consistent, and that he recovered faster from environmental exposure after surf sessions. No adverse reactions were reported with acupuncture, laser stimulation, moxibustion or herbal medicine9. Herbal formulas were well tolerated, with no gastrointestinal discomfort or allergic manifestations. The absence of pharmacological treatments simplified the clinical approach and eliminated concerns about herb–drug interactions. Although physical appearance suggested robust health, the case highlighted the discrepancy between outward vitality and internal energetic fragility typical of paediatric physiology. One challenge encountered was maintaining treatment regularity amidst school commitments and surf training schedules, which occasionally created delays. This raised important considerations regarding how to support long-term adherence in families with active lifestyles. The case underscores the particular vulnerability of the paediatric Lung and Kidney system and demonstrates how TCM interventions can strengthen constitutional foundations, reduce susceptibility to external pathogenic factors and prevent recurrence of respiratory issues. Early intervention proved essential in preventing the progression of mild but persistent symptoms into more complex patterns in adolescence 11,23. Furthermore, the Journal of Complementary Therapies in Health 2026: 4(1). 9 of 11 Gomes A., Lourenço I., Fonseca M.A., Bernardo M. Acupuncture and Traditional Chinese Medicine in Surf Sports: Case Series on Recovery, Performance, and Chronic Conditions. doi:10.5281/zenodo.17792548 combination of acupuncture, moxibustion, Tui Na and herbal medicine provided a comprehensive approach addressing both acute symptoms and constitutional weaknesses. This case highlights the importance of integrating parental education into paediatric care to ensure sustained benefits beyond the treatment period, particularly in children with regular exposure to cold, moisture and environmental stressors due to sports practice. 6. Final Remarks This case series provides a detailed exploration of the therapeutic potential of Traditional Chinese Medicine in supporting the health, recovery and physiological regulation of surf athletes across a variety of clinical presentations. Although each case reflects a distinct medical and energetic profile, several unifying themes emerge that illuminate how acupuncture and complementary TCM modalities can address both acute and chronic conditions frequently observed in individuals exposed to high physical demand, cold environments and emotional stress. Across all four cases, Spleen Qi deficiency and Liver Qi stagnation surfaced as recurrent patterns, often accompanied by dampness, phlegm, or internal heat. These patterns reflect the physiological strain imposed by surfing, a sport that combines vigorous muscular effort with repeated exposure to cold and instability, conditions that challenge the body's capacity for transformation, transportation and emotional regulation 11-13. The consistent improvement observed in symptoms such as musculoskeletal pain, delayed recovery, respiratory vulnerability, sleep disturbances, emotional agitation and autonomic imbalance suggests that individualised acupuncture treatments, when combined with supportive modalities such as Tui Na, cupping, herbal medicine and dietetic guidance, can meaningfully influence the regulatory systems that underpin athletic resilience. Another key finding of this series is the relevance of addressing not only physical symptoms but also Shen-related manifestations, including anxiety, irritability, cognitive fatigue and lack of emotional regulation. Emotional load and stress emerged as central aggravating factors in several cases, particularly in the context of obstructive sleep apnea and epilepsy. TCM's holistic framework proved valuable in understanding these connections and in designing therapeutic strategies that integrate musculoskeletal, metabolic, neurological and emotional dimensions of care. This case series also highlights the clinical importance of considering environmental exposure, particularly cold and wind, as major contributors to pathogenesis in surf athletes and paediatric surfers. Cold exposure affected respiratory function, damp accumulation, muscle tension and recovery capacity. Interventions targeting Wei Qi, body warmth and fluid metabolism were essential components of treatment plans 10. Despite the positive outcomes observed, this study is limited by several methodological factors inherent to case series designs. These include the absence of standardised outcome measures, the lack of laboratory or imaging follow-up in certain cases, and the reliance on qualitative symptom evolution rather than objective biomedical markers. Patient adherence, particularly regarding diet, lifestyle modifications and session regularity, varied across cases and influenced treatment trajectories. Furthermore, the small sample size and the individualised nature of TCM interventions restrict the generalisability of findings. Nonetheless, the results indicate that acupuncture and TCM represent safe, non-invasive, adaptable and cost-effective tools that can complement conventional medical care for surf athletes. They offer a particularly relevant contribution in managing chronic or multifactorial conditions for which biomedical approaches may provide limited relief 8 or rely heavily on pharmacological interventions. The positive clinical evolution observed across cases invites further research into the role of acupuncture in athletic performance, recovery, emotional regulation and resilience in sports involving extreme environmental exposure. Future studies would benefit from controlled designs, validated scales, longitudinal follow-up and incorporation of biomarkers related to inflammation, autonomic regulation and neuromuscular performance.