Integrating Traditional Chinese Medicine into Endurance Sports: A Narrative Review of Evidence and Applications

Background: Traditional Chinese Medicine (TCM) is a holistic medical system with millen-nia-old theoretical foundations, including the Huangdi Neijing and other classical texts. TCM emphasizes the balance of Qi, blood, and organ systems, offering potential complementary strategies for athlete recovery, performance optimization, and injury prevention.Objective: This review evaluates the application of TCM modalities, including acupuncture, moxibustion, cupping therapy, Tuina, and Qigong, in endurance sports, focusing on physiologi-cal, neuromuscular, and psychophysiological outcomes.Methods: Evidence was synthesized from randomized controlled trials, pilot studies, systematic reviews, and mechanistic investigations addressing the effects of TCM interventions on endur-ance capacity, recovery, musculoskeletal rehabilitation, immune function, hormonal modula-tion, and psychological resilience.Results: TCM modalities offer complementary benefits for athletes. Acupuncture may enhance endurance, recovery, and neuromuscular function. Cupping primarily improves tissue flexibil-ity and reduces fatigue markers. Moxibustion supports muscle recovery, immune modulation, and hormonal balance. Auricular acupuncture and vagal nerve stimulation aid cardiovascular recovery and coordination. Qigong promotes psychological well-being, body composition, and immune regulation. Tuina enhances musculoskeletal rehabilitation, particularly when combined with exercise.Conclusion: TCM offers a multifaceted, complementary framework for supporting endurance athletes by addressing recovery, physiological stress, and holistic performance optimization. While preliminary evidence indicates potential benefits across multiple domains, robust, high-quality randomized trials are required to standardize protocols, validate efficacy, and clar-ify underlying mechanisms.