Jou nal o Complemen a y The apies in Heal h
ISSN 2975-9323 |eISSN 2975-9552
Jou nal o Complemen a y The apies in Heal h 2026:4(1). doi:10.5281/zenodo.17721261 ins i u op c.com/jou nal-complemen a y- he apies
Clinical case s udy
E ec s o Complemen a y and In eg a ed The apies on
Pe o mance and Reco e y in Moun ain Ul a-Endu ance
Running: A Case S udy.
Helena Pe ei a Alonso1*, Rossana Manei a Manso1, Micael Sil a Ribei o1, Ana Dias de F ei as1,
Isabel de Sousa Nascimen o1, and Joana Fe ei a Fa ia1.
1 IPN – Po uguese Ins i u e o Na u ology, Po o, Po ugal.
* Co espondence: [email protected]
Abs ac
Moun ain ul a-endu ance unning ep esen s one o he mos physiologically demanding spo s,
combining biomechanical s ess, ca dio espi a o y demands, me abolic s ain, and psychological
esilience. This s udy p o ides a comp ehensi e case analysis o a 44-yea -old male a hle e special-
ising in aces exceeding 100 km, wi h a compe i i e his o y including dis ances up o 308 km. The
in es iga ion in eg a es Wes e n physiological insigh s wi h T adi ional Chinese Medicine (TCM)
diagnos ic amewo ks and he apeu ic app oaches. Biomechanical and physiological mechanisms
unde lying pe o mance and inju y isk a e desc ibed, ollowed by a longi udinal clinical assess-
men o ecu en musculoskele al complain s, sys emic imbalances, and he apeu ic in e en ions.
T ea men s included acupunc u e, au iculo he apy, moxibus ion, manual he apy, and Chinese
he bal medicine, combined wi h mode n supplemen a ion s a egies. Resul s sugges ha in eg a-
ion o TCM-based in e en ions wi h con en ional physiological unde s anding may suppo en-
du ance a hle es in inju y p e en ion, eco e y, and pe o mance s abili y.
Keywo ds: Biomechanics; Endu ance Physiology; T ail Running; T adi ional Chinese Medicine; Ac-
upunc u e; Moxibus ion; Ul a-Ma a hon; Spo s Inju ies.
1. In oduc ion
T ail unning, as an o ganised spo , has i s o igins in in o mal compe i ions along
na u al ou es, wi h his o ical e e ences da ing back o he la e 19 h cen u y and gaining
i s mode n o m in he 20 h cen u y h ough emblema ic aces such as he Dipsea Race in
he USA and simila ini ia i es in Eu ope and Asia. The ield e ol ed apidly om sho
ail and hill challenges o he ul a-endu ance e en s seen oday, ma ked by dis ances
well beyond he ma a hon, signi ican ele a ion change, echnical e ain, and exposu e
o a iable en i onmen al condi ions 1-3. Ul a-endu ance ail e en s di e undamen-
ally om oad unning and s anda d ma a hons due o he mul idimensional physiolog-
ical, mechanical, and psychological demands in ol ed. A hle es mus con end wi h une-
en su aces, s eep ascen s and descen s, ex eme wea he , sleep dep i a ion, and p o-
longed pe iods o muscula and me abolic s ess. This leads o mul i-sys emic esponses,
po en ially a ec ing he ca dio ascula , enal, musculoskele al, immunological, and ne -
ous sys ems in ways no obse ed in con en ional endu ance e en s 4-6.
Despi e he g owing popula i y o ail unning, he e emains unce ain y ega ding
he physiological esponses elici ed by di e en uphill locomo ion s a egies, pa icula ly
when con as ing unning and walking on s eep inclines. Key ac o s such as maximal
oxygen up ake (VO2max), unning economy (C , de ined as he ene gy cos o unning,
Ci a ion: Alonso H.P., Manso R.M.,
Ribei o M.S., de F ei as A.D. Nasci-
men o I.S., Fa ia J.F. E ec s o Com-
plemen a y and In eg a ed The apies
on Pe o mance and Reco e y in
Moun ain Ul a-Endu ance Running:
A Case S udy. Jou nal o Comple-
men a y The apies in Heal h.
2026;4(1) 10.5281/zenodo.17721261
Academic Edi o : Jo ge Rod igues
Recei ed: 7 No embe 2025
Re iewed: 20 No embe 2025
Re ised: 24 No embe 2025
Accep ed: 25 No embe 2025
Published: 26 No embe 2025
Publishe ’s No e: IPTC s ays neu al
wi h ega d o ju isdic ional claims in
published maps and ins i u ional a -
ilia ions.
Copy igh : ©2026 by he au ho s.
Submi ed o open access publica-
ion unde he e ms and condi ions
o he C ea i e Commons A ibu ion
(CC BY) license (h ps://c ea i ecom-
mons.o g/licenses/by/4.0/).
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 2 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
o he amoun o ene gy equi ed o anspo he body a gi en dis ance), and he p opo -
ion o VO2 sus ained h oughou he ace ha e demons a ed conside able a iabili y
ac oss s udies, o en due o di e ences in es ing p o ocols and a hle e popula ions 7.
Addi ionally, impo an biomechanical and me abolic de e minan s, including mus-
cle s eng h, a chi ec u e, ib e ec ui men pa e ns, and e ain cha ac e is ics, in luence
he ene ge ic cos o unning uphill. The in e play be ween indi idual a hle e cha ac e is-
ics and he opog aphical p o ile o each ace u he complica es he p edic ion o pe -
o mance and a igue. Gi en hese complexi ies, compa a i e s udies conduc ed in ealis-
ic ail unning condi ions emain sca ce. Despi e he su ging popula i y and pa icipa-
ion in ul a- ail e en s, he ene ge ic demands and physiological esponses expe ienced
by a hle es in hese ex eme con ex s emain inadequa ely cha ac e ised, pa icula ly in
eal-wo ld acing condi ions. The complexi y o con inuously measu ing me abolic and
ca diopulmona y pa ame e s o e se e al consecu i e days has con ibu ed o a pauci y
o ield-based esea ch. Consequen ly, much o cu en unde s anding is de i ed om
labo a o y s udies o sho -du a ion ou doo expe imen s, limi ing ecological alidi y. Re-
cen ly, case s udies 6,7 conduc ed in ac ual e en s ha e begun o shed ligh on he me a-
bolic cos , e iciency o locomo ion, and adap i e s a egies a hle es employ du ing moun-
ain ul a-ma a hons. P elimina y indings sugges ha , con a y o expec a ions, well-
adap ed a hle es may sus ain exe cise in ensi ies and mechanical e iciency e en as a igue
accumula es, po en ially h ough p og essi e locomo o adap a ions o e he cou se o
he ace. Howe e , he in e play be ween en i onmen al challenges, ace s a egies, and
physiological adap a ions dese es u he in es iga ion o in o m aining, p epa a ion,
and eco e y p o ocols o ail endu ance a hle es.
The apeu ic in e en ions o ul a-endu ance ail unne s ha e adi ionally cen-
ed on con en ional spo s medicine, ocusing on acu e inju y managemen (e.g., muscu-
loskele al inju ies), hyd a ion s a egies, nu i ional p o ocols, and physio he apy. The a-
pies such as c yo he apy, non-s e oidal an i-in lamma o y d ugs, and physical he apy
emain p edominan among hese a hle es, wi h s udies indica ing mo e han 90% o ul-
a-endu ance unne s use such con en ional ea men s egula ly. Howe e , despi e he
widesp ead adop ion o hese con en ional me hods, challenges emain in p e en ion,
eco e y, and managemen o ch onic a igue, o e aining, and sub le me abolic-immune
imbalances 5,6,8.
TCM is inc easingly conside ed a complemen a y o al e na i e he apeu ic modali y
o endu ance a hle es. Clinical and expe imen al e idence highligh s TCM’s holis ic
amewo k, inco po a ing he bal he apy, acupunc u e, uina massage, and die a y mod-
i ica ions, as suppo ing ene gy balance (Qi), accele a ing eco e y, and add essing no
only acu e musculoskele al complain s bu also unde lying sys emic a igue and immune
modula ion. Howe e , su eys and ecen sys ema ic e iews sugges ha , globally, less
han 10% o ul a-endu ance a hle es consis en ly inco po a e TCM in e en ions com-
pa ed o con en ional ea men s 9-13.
Wi hin TCM, he me idians and o gans mos o en a ec ed by ul a-endu ance ail
unning include he Spleen and S omach ( esponsible o nou ishmen and ene gy ans-
o ma ion), Li e (go e ning endons and smoo h low o Qi), Kidney (basis o endu ance
and bone s eng h), and Hea ( egula ing ci cula ion and men al esilience). Excessi e
physical exe ion, en i onmen al exposu e, and inadequa e eco e y a e belie ed o de-
ple e Spleen Qi, inju e Kidney Jing, s agna e Li e Qi, and dis u b Hea Shen, esul ing in
ch onic a igue, muscle/ endon inju ies, oedema, subop imal eco e y, and psychological
imbalance. TCM’s a ge ed in e en ions, especially when mapped o hese me idians and
o gan sys ems, may o e dis inc bene i s: imp o ing nu i ional assimila ion, p omo ing
musculoskele al esilience, enhancing immune eco e y, and acili a ing psychological
adap a ion o he igo s o ul a-endu ance spo s. These ad an ages jus i y u he in e-
g a ion and igo ous compa a i e s udy o TCM wi hin spo s medicine o his unique
popula ion 11-13.
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 3 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
2. Case p esen a ion
This case s udy de ails he he apeu ic managemen o an ul a-endu ance a hle e
who sus ained wo signi ican musculoskele al inju ies du ing mul i-s age ul a-dis ance
e en s in 2023 and 2024. The case illus a es he in eg a ion o acupunc u e, moxibus-
ion, cupping he apy, manual he apies, and phy o he apy guided by he p inciples o
TCM o acili a e eco e y and pe o mance main enance.
The subjec is a male ail unne a ilia ed wi h EDV Viana T ail Club om Po ugal,
enowned o pa icipa ion and success in na ional and in e na ional ail endu ance com-
pe i ions. His body weigh is wi hin he no ma i e ange o high-pe o mance endu ance
a hle es, and he egula ly compe es a dis ances equi ing signi ican ae obic and muscu-
loskele al adap a ion.
Gi en he ex eme demands and endu ance-speci ic haza ds o he scheduled ul a-
ail e en s, he clinical and spo s in e en ion eam op ed o a comp ehensi e, longi u-
dinal moni o ing app oach. The aim was ea ly de ec ion and managemen o po en ial
musculoskele al, me abolic, o sys emic physiological de e io a ions ha may occu o e
high cumula i e aining and compe i i e loads. I should be no ed ha he a hle e is an
ama eu who wo ks in an en i onmen wi h clima e con ol se o cold empe a u es. A
no able ac o in his case is he a hle e's occupa ional exposu e o a cold wo king en i-
onmen . This ch onic exposu e o cold empe a u es is ecognised as a p ima y con ib-
u ing ac o o he de elopmen o In e nal Cold and Yang De iciency synd ome. Such
en i onmen al s ess leads o impai men o Yang ene gy, esul ing in symp oms includ-
ing cold in ole ance, educed me abolic unc ion, and comp omised ci cula ion. This syn-
d ome hea ily in luenced he subsequen ea men p o ocols, wi h wa ming he apies
such as moxibus ion and he use o wa ming he bal o mulas being cen al o he he a-
peu ic s a egy.
O e he cou se o se e al weeks he a hle e unde wen egula clinical e alua ions
and pe o mance moni o ing. These included musculoskele al examina ions, nu i ional
assessmen s, physiological and biochemical es ing, and con inuous eedback du ing p e-
pa a o y and compe i i e phases. The in e en ion eam’s objec i e was o sa egua d he
a hle e’s physical in eg i y, op imise pe o mance, and scien i ically documen adap i e
o pa hological changes in he con ex o epea ed high-load exposu es.
As a non-p o essional eli e-le el compe i o , he a hle e demons a ed me iculous
p epa a ion and commi men o peak pe o mance, seeking o ep esen his club a he
highes s anda d. The clinical o e sigh allowed p omp iden i ica ion o a igue, inju y,
o maladap i e esponses, suppo ing a ge ed in e en ions and pe sonalised he apeu-
ic s a egies h oughou he pe iod o obse a ion.
A dedica ed ollow-up eam was es ablished o p o ide moni o ing and in e en ion
h oughou he obse a ion pe iod, pa icula ly in an icipa ion o musculoskele al inju y
o physiological decline. This mul idisciplina y eam was asked wi h eal- ime assess-
men o he a hle e’s physiological and musculoskele al condi ion, enabling he apeu ic
in e en ions as equi ed.
The need o a ge ed he apeu ic in e en ion a ose on mul iple occasions du ing
he moni o ed aces, as well as in he eco e y phases be ween compe i ions. Acu e and
subacu e he apies we e employed in esponse o eme ging symp oms, including muscu-
loskele al discom o , unc ional decline, o gene al a igue.
The apeu ic s a egies included a combina ion o acupunc u e sessions, wi h he se-
lec ion and combina ion o acupunc u e poin s ailo ed acco ding o he a hle e’s clinical
p esen a ion a each in e en ion. The se o acupunc u e poin s used a ied case by case,
depending on ongoing physical indings, ene ge ic assessmen , o speci ic complain s.
Addi ional supplemen al he apies we e inco po a ed as indica ed, mos no ably, i amin
D supplemen a ion and o he mic onu ien s we e p esc ibed as needed, acco ding o bi-
ochemical sc eening and a igue s a us.
O he he apeu ic in e en ions, such as manual he apy, igge poin elease, phys-
io he apy modali ies, and nu i ional adjus men s, we e u ilised based on he p e ailing
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 4 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
clinical scena io and indi idual esponse. This dynamic and adap i e app oach aimed o
op imise eco e y, minimise inju y isk, and p omo e o e all unc ional esilience
h oughou he pe iod o in ense physical demand.
Pain assessmen was sys ema ically pe o med using he Nume ical Ra ing Scale
(NRS) o pain, as ecommended by he Po uguese Di ec o a e-Gene al o Heal h (DGS)
14. This alida ed ool allowed quan i a i e documen a ion o pain in ensi y a each assess-
men poin , acili a ing objec i e moni o ing and indi idualised adjus men s o he he a-
peu ic s a egy. The pe cep ion o a igue was assessed using he Ra ing o Fa igue (ROF)
scale, a alida ed ool o quan i ying subjec i e a igue in ensi y in a hle ic popula ions
15. The NRS and he ROF a e alida ed pa ien - epo ed ou come measu es ha use an 11-
poin nume ic scale anging om 0 o 10. Fo bo h scales, 0 ep esen s he absence o NRS
o pain o ROF, while 10 indica es he wo s imaginable pain o a igue. These scales
p o ide a simple, eliable means o quan i y symp om in ensi y, acili a ing clinical as-
sessmen and moni o ing o ea men e icacy.
2.1. Fi s Inju y and Ini ial P esen a ion
In Sep embe 2023, ollowing a 100 km ace, he a hle e epo ed pain localised on he
an e io aspec o he le leg along he emo al ne e pa h, mo e speci ically co espond-
ing o he saphenous ne e. Palpa ion e ealed al e ed muscle one wi hou incapaci a ing
ea u es, allowing con inued aining despi e discom o . A he conclusion o he ace,
pain co esponded ana omically o he li e me idian be ween poin s F5 and F6. Clinical
pulse and ongue signs indica e li e Qi s agna ion and damp hea .
2.2. Second Inju y and P og ession
In Decembe 2023, du ing a 308 km ace (ALUT- Alga iana Ul a T ail), he a hle e
de eloped diges i e complain s, oedema and pain in he igh cal , seconda y o a com-
pensa o y p o ec i e pos u e. Pos 15-day es , muscula pain in he igh leg pe sis ed
wi h symp oms e lec i e wi h palpa o y ende ness along he Kidney, Bladde , and Li e
me idians.
2.3. Acu e Hea S oke
The a hle e expe ienced a hea s oke du ing he ace, which occu ed on a 281 km
ail e en called PT 281. Du ing an in ensely ho pe iod, he wen o app oxima ely h ee
hou s wi hou access o luid eplacemen on a sec ion o he ail whe e au onomous hy-
d a ion was he a hle e's esponsibili y. This p olonged lack o hyd a ion unde ex eme
hea condi ions led o he onse o hea - ela ed illness. Hea s oke, an imbalance cha ac-
e ised by excessi e in e nal hea and Yin-Qi de iciency comp omising he mo egula ion.
3. The apeu ic In e en ions and esul s
3.1. 1s inju y - Sep embe 2023
Table 1. Acupunc u e poin s and me idians used in he ea men sessions, as well as he ea men p ocedu e
T ea -
men
Session
Poin /Me idian
Selec ion
P ocedu e Ta -
ge
Me idian-Based Ra ionale
NRS
Be-
o e
NRS
A e
2 weekly
sessions
GB34, ST40,
SP9, ST34, LR2,
LR3, LR5 (uni-
la e al)
Tendon in lu-
ence, oedema,
Qi ci cula ion,
li e i e dis-
pe sion
GB34 (“Mas e poin o endons”) a ge s pain/s i ness in
lowe limb endons; LR2/LR3 dispe se Li e Qi/ i e and ea
ension nea he saphenous ne e; ST40 clea s dampness/oe-
dema; SP9 suppo s lowe limb luid/oedema; ST34 Xi-cle )
ac s on acu e pain and mobili y; LR5 connec s me idian in lu-
ence a he le el o he inju y.
8
2
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 5 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
The a hle e epo ed pa ial pain elie bu did no adhe e o es ecommenda ions,
con inuing in ensi e aining.
3.2. 2nd inju y - Decembe 2023
Table 2. Poin s and me idians used in he ea men sessions, as well as he ea men p ocedu e
Timing &
Session
Poin /Me idian
Selec ion (o Au-
iculo he apy Re-
gion)
P ocedu e
Ta ge
Me idian/Ea Poin Ra ionale
NRS
Be-
o e
NRS
A e
Du ing ace
(acu e
phase)
Au iculo he apy:
cal , s omach,
li e , spleen, shen-
men
To elie e
pain and di-
ges i e com-
plain s
Au icula poin s mapped o lowe limb (cal ), diges ion
(s omach, spleen), Li e o muscle- endon egula ion,
shenmen o modula e pain and emo ional/physiological
s ess; engages agus and c anial ne es o sys emic
pain/diges i e modula ion in acu e demand.
9
8
Du ing ace
(acu e
phase)
Lympha ic d ain-
age massage
Reduce oe-
dema and
clea lac ic
acid
Me hod enhances pe iphe al ci cula ion, mobilises issue
luid, and imp o es eco e y in acu e musculoskele al
o e load scena ios.
—
—
4 sessions
weekly, 15
days pos -
ace
LI4, LR3, GB30,
SP6, ST36, GB34
(bila e al use)
Muscula e-
co e y, pain,
o e all Qi
/blood sup-
po
LI4 (dispe ses Qi s agna ion), LR3 (Li e Qi mo emen ),
GB34 ( endon/muscle pain), ST36 & SP6 (diges i e &
s amina), GB30 (deep glu eal, scia ica elie ). Ra ionale:
syne gy o pain, eco e y, and esol ing bo h local and
sys emic s asis a e endu ance inju y.
7
0
The pain was esol ed ully a e mul iple sessions.
3.3. Follow-up: Feb ua y 2024-May 2024
Table 3. Poin s and me idians used in he ea men sessions, as well as he ea men p ocedu e.
Timing &
Sessions
Poin /Me idian
Selec ion
P ocedu e Ta -
ge
Me idian-Based Ra ionale
ROF
Be-
o e
ROF
A e
16 weekly
sessions
(gene al
suppo )
BL62, SP3, GB34,
KI3, LR8, LR3,
ST36, SI3 (bila -
e al)
Nou ish Qi,
blood, Yang;
suppo s om-
ach, spleen, kid-
ney, li e
BL62 and SI3 ha monise Du pa hway (Yang Qiao/Wei);
GB34, LR3, LR8 suppo Li e -blood and muscle eco -
e y; ST36 and SP3 s eng hen Spleen, Ki3 nu u es kid-
ney essence and Yang. Syne gis ic p o ocol o es o ing
ene gy and o gan unc ion pos -endu ance s ess.
6
3
3.4. T ea men a e acu e Hea S oke – July 2024 – Augus 2024
Table 4. Poin s and me idians used in he ea men sessions, as well as he ea men p ocedu e.
Schedule
Poin /Me id-
ian Selec ion
P ocedu e
Ta ge
Me idian-Based Ra ionale
NRS/ROF
Be o e
NRS/ROF
A e
3 ses-
sions
weekly
GV20, KI6,
CV6, LI11
Hea exhaus-
ion cooling,
Yin suppo ,
and Qi egula-
ion
GV20 (Baihui) s imula es b ain and clea s Yang hea ;
KI6 nou ishes Kidney Yin and mois ens d yness pos -
hea ; CV6 (Qihai) boos s Yuan Qi and ci cula ion; LI11
(Quchi) is a s ong hea -clea ing poin , educes e e
and in lamma ion by eleasing excess hea om he
body.
—
—
Subsequen ongue changes e lec ed inc eased mois u e, e idencing he apeu ic e -
ec .
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 6 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
3.5. Reco e y and Main enance: Sep embe -Decembe 2024
Table 5. Poin s and me idians used in he ea men sessions, as well as he ea men p ocedu e.
Timing
& Ses-
sions
Poin /Me idian
Selec ion
P ocedu e Ta -
ge
Me idian-Based Ra ionale
ROF
Be-
o e
ROF
A e
16
weekly
sessions
CV4, CV6, CV12,
ST36, SP6, KI3 +
moxibus ion
S eng hen
spleen and kid-
ney unc ion
Poin s CV4, CV6, and CV12 suppo Ren Mai (Concep ion
Vessel) o cen al Qi and Yin-Yang balance; CV12 aids up-
pe diges ion and spleen ST36 and SP6 enhance diges ion,
Qi and blood p oduc ion; KI3 suppo s Kidney essence and
Yang; Moxa adds wa ming and Yang ein o cemen .
9
0
Pos hea s oke, he a hle e unde ook mul iple aces anging om 49 km o 300 km
wi h in e mi en diges i e complain s and a igue. T ea men ocused on s eng hening
spleen (BP) and kidney (KI) unc ion using acupunc u e poin s CV4, CV6, CV12, ST36,
SP6, and KI3, complemen ed by moxibus ion and phy o he apy. Th oughou he ea -
men pe iod, he a hle e epo ed p og essi e imp o emen s in pe cei ed a igue and ex-
haus ion le els.
Gi en he a hle e's daily exposu e o cold en i onmen s, ea men emphasised ex-
pelling in e nal cold, suppo ing Qi and Yang o spleen and kidney, p ima ily ia acu-
punc u e wi h moxibus ion Poin s included KI3, SP6, ST36, CV4, and CV6.
Phy o he apeu ic in e en ion included a o mula known as Qi Hai Yao Fang (Sea o
Qi), a mode n adi ional Chinese medicine o mula ion designed o supplemen and in-
igo a e he Qi and Yang o he spleen and kidney, suppo diges i e and me abolic unc-
ions, and add ess ch onic de iciency synd omes, combined wi h Ashwagandha.
In his pe iod, he a hle e comple ed mul iple aces wi hou inju y, epo ing im-
p o ed ene gy and physical condi ioning pos - ea men .
4. Labo a o y Findings and Supplemen a ion
Se um analysis in Ma ch 2024, e ealed i amin D de iciency, ele a ed co isol, and
no mal bu low-end es os e one le els o an a hle e. Supplemen a ion wi h Chinese phy-
o he apy (Qi Hai Yao Fang), Ashwagandha ( o co isol modula ion), i amins (D, K2), ma-
ine mine als, zinc, EPA, and DHA we e ini ia ed o add ess biochemical imbalances.
Table 6. In eg a i e mapping be ween Wes e n physiological indings and co esponding TCM synd omes.
Wes e n Medical Finding
TCM Synd ome
TCM Synd ome In e p e a ion
Ele a ed co isol, ch onic a igue
Kidney Jing/ Yin De i-
ciency
Loss o deep i al ene gy and egula o y essence; mani es s
as exhaus ion, poo eco e y, ho monal dys egula ion.
Low es os e one
Kidney Yang De iciency
Impai ed wa ming and ac i a ing ene gy; causes cold in ol-
e ance, low i ali y, and poo ho monal ou pu .
Vi amin D de iciency, cold expo-
su e
Spleen/Kidney Yang De i-
ciency
Weak ans o ming and ac i a ing o ce; esul s in me a-
bolic slowing, suscep ibili y o cold, low esilience.
Poo diges ion, pe sis en a igue,
lab abno mali ies (spleen, kidney)
Spleen Qi De iciency, Kid-
ney Qi De iciency
De icien ene gy o nu ien assimila ion and ese e e-
plenishmen ; mani es s as a igue, weakness, impai ed e-
co e y.
Oedema, musculoskele al com-
plain s pos -exe ion
Qi s agna ion, Li e Qi
disha mony
Blockage in ene gy mo emen and egula ion; causes swell-
ing, muscle pain, emo ional i i abili y.
5. Final ema ks
Ul a-endu ance ail unning anks among he mos physiologically demanding a h-
le ic endea ou s, demanding sus ained ca dio ascula , me abolic, musculoskele al, and
psychological adap a ions unde ex eme and a iable en i onmen al condi ions. The
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 7 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
p esen case illus a es hese challenges, emphasising he cascading impac s o in ense
p olonged exe ion compounded by en i onmen al ac o s such as hea s ess, dehyd a-
ion, and e ain complexi y. As hese unique s esso s p ecipi a e mul i-sys em pe u ba-
ions encompassing ene gy me abolism, endoc ine egula ion, immune unc ion, and neu-
omuscula in eg i y, s anda d spo s medicine app oaches a ge ing isola ed clinical
mani es a ions o en ail o adequa ely add ess he complex, in e dependen dys unc ions
e iden in ul a-endu ance a hle es.
Consis en wi h he in oduc ion, he mul i ac o ial na u e o a igue, sys emic in-
lamma o y ac i a ion, and musculoskele al o e load in ul a- ail pe o mance necessi-
a es mul imodal assessmen and indi idualised in e en ion. Con en ional inju y man-
agemen and nu i ional suppo (while ounda ional) lea e a gap in add essing ch onic
a igue synd omes, subclinical immune dys egula ion, and au onomic imbalances e-
quen ly eme ging du ing ul a-endu ance compe i ion cycles. Mo eo e , his case sup-
po s eme ging e idence o he complemen a y use o TCM echniques, which o e ho-
lis ic amewo ks in eg a ing o gan sys em ene ge ics wi h symp om amelio a ion.
No ably, acupunc u e and moxibus ion in e en ions a ge ing he Spleen, Kidney,
Li e , and S omach me idians add ess undamen al TCM pa hogeneses consis en wi h
Wes e n ma ke s iden i ied in he a hle e, such as i amin D de iciency and co isol excess.
These he apies po en ially es o e Qi and Yang, enhance mic oci cula ion, alle ia e in-
lamma ion and oedema, and suppo psychological esilience, domains which a e
aligned wi h he pa hophysiology o o e aining synd ome and ch onic a igue s a es.
The pa ien ’s p og essi e subjec i e a igue educ ion as quan i ied by ROF sco es and
unc ional eco e y e i ies he physiological and psychophysical alue o in eg a ing
TCM wi h s anda d p o ocols.
The addi ion o phy o he apeu ic agen s, including Ashwagandha o co isol modu-
la ion, and onic wa ming o mula, Qi Hai Yao Fang can po en ia e me abolic homeos a-
sis and endoc ine no malisa ion, unde sco ing he necessi y o ailo ed nu i ional sup-
plemen a ion in comp ehensi e ul a-endu ance a hle e ca e. The combined biochemical
imp o emen s and clinical amelio a ion obse ed ad oca e o ea ly, p e en i e sc een-
ing and in e en ion s a egies encompassing nu ien s a us and ho monal balance.
This case u he delinea es a p ospec i e p o ocol emphasising con inuous, mul i-
dimensional moni o ing including p ecise ROF, de ailed musculoskele al e alua ion, bi-
ochemical sc eening, and dynamic he apeu ic adjus men . Such a p o ocol enables p e-
emp i e mi iga ion o o e aining isks, suppo s sus ained a hle ic pe o mance, and
may ex end a hle ic longe i y.
Fu u e andomised con olled ials should explo e in eg a i e app oaches combin-
ing TCM and e idence-based con en ional medicine, speci ically cha ac e ising mecha-
nis ic pa hways, dose- esponse ela ionships, and long- e m ou comes. Addi ionally,
spo -speci ic adap a ions o TCM diagnos ic amewo ks and ea men egimens me i
e inemen o op imise e icacy and a hle e accep ance.
Gi en he ising popula i y and compe i i e in ensi y o ul a-endu ance ail un-
ning, his in eg a i e ca e model could become a pi o al ancho in a hle e heal h manage-
men , educing inju y bu dens, imp o ing eco e y ajec o ies, and enhancing pe o -
mance h ough mul idimensional syne gy.
To he bes o ou knowledge, he e a e no o he s udies ega ding he use o TCM
on pe o mance and eco e y in moun ain ul a-endu ance unning.
6. Conclusion
This case s udy highligh s he complex physiological demands and mul isys em chal-
lenges aced by ul a-endu ance ail unne s, especially unde ex eme en i onmen al
condi ions such as hea s ess and p olonged exe ion. The in eg a i e he apeu ic ap-
p oach, combining con en ional spo s medicine p ac ices wi h TCM, including acupunc-
u e, moxibus ion, and phy o he apy, demons a ed p omising ou comes in managing
musculoskele al inju ies, a igue, and sys emic imbalances.
Jou nal o Complemen a y The apies in Heal h 2026: 4(1). 8 o 9
Alonso H.P., Manso R.M., Ribei o M.S., de F ei as A.D. Nascimen o I.S., Fa ia J.F.
E ec s o Complemen a y and In eg a ed The apies on Pe o mance and Reco e y in Moun ain Ul a-Endu ance Running: A Case S udy.
doi:10.5281/zenodo.17721261
The a ge ed modula ion o key me idians and o gan sys ems acili a ed symp om
elie , imp o ed unc ional capaci y, and enhanced subjec i e a igue pe cep ion. Supple-
men a ion wi h phy ochemicals and mic onu ien s add essing iden i ied biochemical de-
iciencies complemen ed he ea men spec um.
This holis ic p o ocol unde sco es he po en ial bene i s o in eg a ing Eas e n and
Wes e n he apeu ic amewo ks o op imise a hle e eco e y, minimise inju y isk, and
sus ain high-le el pe o mance in ul a-endu ance ail e en s. Ne e heless, u he ig-
o ous, con olled in es iga ions a e wa an ed o alida e hese indings and e ine s and-
a dised in eg a i e p o ocols ailo ed o he unique needs o ul a-endu ance a hle es.
E ec i e mul idisciplina y managemen combining objec i e moni o ing and pe -
sonalised in e en ions ep esen s a i al e olu ion in he ca e o a hle es unde aking he
physiological ex emi ies o ul a-endu ance ail unning.
C edi au ho s a emen : All au ho s con ibu ed equally and ha e ead and ag eed o he published
e sion o he manusc ip .
Funding: This esea ch did no ecei e any speci ic g an om unding agencies in he public,
comme cial, o no - o -p o i sec o s.
Con lic o In e es : The au ho s decla e ha he e a e no con lic s o in e es .
Ins i u ional Re iew Boa d S a emen : No applicable.
In o med Consen S a emen : No applicable.
Da a A ailabili y S a emen : The o iginal con ibu ions p esen ed in his s udy a e included in
he a icle. Fu he inqui ies can be di ec ed o he co esponding au ho .
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