Conditions

GERD is recurrent reflux of gastric contents causing heartburn, regurgitation or oesophageal irritation. TCM treatment focuses on restoring the descending function of Stomach Qì while addressing Liver constraint, Heat, food retention, phlegm-dampness or deficiency.

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit presenting with comedones, papules, pustules or nodules. TCM differentiation commonly involves Lung Heat, Stomach Heat, damp-heat, phlegm with blood stasis, or constitutional deficiency.

Evidence, TCM patterns, and point protocols for natural conception and IVF support

Acute bronchitis is a short-term inflammation of the bronchi, most commonly associated with a viral respiratory infection. It typically presents with cough, with or without sputum, and may include chest discomfort, fatigue, sore throat, nasal symptoms or mild wheeze. In otherwise healthy people it is usually self-limiting, although the cough may persist for three to four weeks. Antibiotics are not routinely indicated for uncomplicated acute bronchitis. TCM management is based on differentiation of Wind-Cold, Wind-Heat, Phlegm-Heat, Cold-Phlegm or a lingering deficiency pattern and must not delay assessment for pneumonia, asthma, COPD exacerbation, influenza, COVID-19 or another serious respiratory disorder.

Acute cystitis is an infection or inflammation of the urinary bladder, most commonly caused by bacteria ascending through the urethra. Typical symptoms include dysuria, urinary frequency, urgency, suprapubic discomfort and sometimes haematuria. Fever, chills, flank pain, nausea or vomiting suggest possible upper urinary tract involvement rather than uncomplicated cystitis. TCM pattern differentiation commonly includes Damp-Heat in the Bladder, intense Heat-Toxin, Liver Qì constraint transforming into Heat, Spleen Qì deficiency with Dampness, or Kidney deficiency in recurrent presentations. Acupuncture and Chinese herbal medicine should be used only as adjunctive care and must not delay urine testing, antimicrobial treatment or medical assessment where clinically indicated.

Acute gastritis is a sudden inflammation of the stomach lining. Acute gastropathy causes mucosal injury with little or no inflammation but may produce similar symptoms. Presentations may include epigastric pain or burning, nausea, vomiting, early satiety, postprandial fullness, reduced appetite and occasionally gastrointestinal bleeding. Causes include Helicobacter pylori infection, non-steroidal anti-inflammatory drugs, alcohol, severe physiological stress, infection, bile reflux and other chemical or medication-related irritation. TCM management commonly differentiates Cold invading the Stomach, Food Stagnation, Liver Qì invading the Stomach, Damp-Heat in the middle jiao, Stomach Fire or acute injury progressing to Blood stasis. Acupuncture and Chinese herbal medicine are adjunctive and must not delay investigation or treatment of gastrointestinal bleeding, perforation, severe dehydration, acute coronary syndrome, pancreatitis, biliary disease or another serious cause of upper abdominal pain.

Acute lumbar sprain or strain refers to sudden mechanical low back pain arising from injury or irritation of lumbar muscles, fascia, tendons, ligaments or adjacent joints. It commonly follows lifting, twisting, awkward movement, prolonged loading or an abrupt increase in activity. Symptoms may include local pain, muscle spasm, restricted movement and pain aggravated by bending, rising, rolling or changing position. Most uncomplicated episodes improve with conservative management and continued activity as tolerated. TCM differentiation commonly includes Qì and Blood stagnation, Cold-Damp obstruction, Damp-Heat obstruction or an underlying Kidney deficiency that predisposes the lumbar region to recurrent injury. Acupuncture is adjunctive and must not delay assessment for fracture, cauda equina syndrome, infection, malignancy, abdominal or vascular pathology, inflammatory disease or progressive neurological compromise.

Acute otitis media is an acute infection or inflammation of the middle ear, occurring most commonly in infants and young children, often following an upper respiratory infection. Typical features include ear pain, irritability, disturbed sleep, reduced hearing, fever and a bulging or inflamed tympanic membrane. Spontaneous tympanic membrane perforation may cause ear discharge and temporary pain relief. Many uncomplicated childhood cases improve within approximately three days without antibiotics, although symptoms can last up to one week. Pain relief is central to early management, while antibiotic decisions depend on age, severity, examination findings, bilateral disease, otorrhoea and the risk of complications. TCM differentiation commonly includes Wind-Heat invading the Shaoyang channels, Wind-Cold obstructing the ear, Liver and Gallbladder Fire, Damp-Heat steaming upward, or residual Phlegm-Dampness impairing hearing after the acute infection. Acupuncture and Chinese herbal medicine are adjunctive and must not delay otoscopic examination, analgesia, antimicrobial treatment or urgent assessment where clinically indicated.

Acute pancreatitis is a sudden inflammatory disorder of the pancreas that can range from a mild, self-limiting illness to severe necrotising disease with organ failure. Common causes include gallstones and alcohol use, while other causes include hypertriglyceridaemia, medicines, endoscopic procedures, trauma, infection, hypercalcaemia, anatomical abnormalities and genetic factors. Typical features include severe persistent upper abdominal pain, often radiating to the back, nausea, vomiting, abdominal tenderness, fever and a rapid pulse. Diagnosis and severity assessment require hospital-based biomedical investigation. TCM descriptions may overlap with acute epigastric pain, abdominal fullness, vomiting and jaundice and are commonly differentiated as Damp-Heat, Liver and Gallbladder constraint transforming into Heat, Food Stagnation with Heat, Heat-Toxin, or Qì stagnation and Blood stasis. Acupuncture and Chinese herbal medicine must never be presented as substitutes for emergency assessment, intravenous fluids, analgesia, nutritional management, biliary intervention, intensive care or surgery. Any adjunctive TCM care should occur only after diagnosis, with approval from the treating medical team and careful consideration of fasting status, haemodynamic stability, bleeding risk and medicine interactions.

Acute pharyngitis is an acute inflammation or infection of the pharynx and sometimes the tonsils. Most episodes are viral and improve without antibiotics, usually within about a week. Bacterial causes include group A Streptococcus, which is important because confirmed infection may require antibiotic treatment to reduce transmission and complications. Symptoms may include throat pain, painful swallowing, fever, swollen cervical lymph nodes, tonsillar erythema or exudate, headache and malaise. Cough, rhinorrhoea, hoarseness, oral ulcers and conjunctivitis favour a viral cause, although symptoms alone cannot always distinguish viral from streptococcal infection. TCM differentiation commonly includes Wind-Heat invading the Lung, Wind-Cold constraining the exterior, Lung and Stomach Heat, Heat-Toxin congesting the throat, Phlegm-Heat, or residual Lung and Stomach Yīn deficiency. Acupuncture and Chinese herbal medicine are adjunctive and must not delay airway assessment, diagnostic testing, antimicrobial treatment or urgent management of deep-neck infection, epiglottitis, peritonsillar abscess, diphtheria, anaphylaxis or sepsis.

Acute sinusitis, more accurately termed acute rhinosinusitis, is a sudden inflammation of the nasal cavity and paranasal sinuses. It commonly follows a viral upper respiratory infection and causes nasal obstruction, nasal discharge, facial pain or pressure, reduced smell, headache, cough and sometimes fever or upper-tooth pain. Most cases are viral and improve without antibiotics. A bacterial cause becomes more likely when symptoms persist for more than approximately 10 days without improvement, are unusually severe, or worsen after initially beginning to improve. TCM differentiation commonly includes Wind-Heat invading the Lung, Wind-Cold obstructing the nasal passages, Lung and Stomach Heat, Liver and Gallbladder Damp-Heat, Phlegm-Heat obstructing the sinuses, or residual Spleen and Lung Qì deficiency with Dampness. Acupuncture and Chinese herbal medicine are adjunctive and must not delay assessment or treatment of orbital cellulitis, intracranial infection, severe systemic illness, invasive fungal disease, dental infection or another serious cause of facial pain.

Acute tonsillitis is an acute inflammation or infection of the palatine tonsils, usually occurring as part of an acute sore-throat or tonsillopharyngitis syndrome. Symptoms may include throat pain, painful swallowing, fever, headache, fatigue, enlarged tender cervical lymph nodes and red, swollen tonsils with or without white exudate. Most acute sore-throat illnesses are viral and improve within approximately one week without antibiotics. Group A Streptococcus is an important bacterial cause, particularly in school-aged children, and confirmed or appropriately diagnosed infection may require antibiotic treatment to reduce transmission and prevent complications. Clinical features alone cannot always reliably distinguish viral from streptococcal infection. TCM differentiation commonly includes Wind-Heat invading the Lung, Wind-Cold constraining the exterior, Lung and Stomach Heat, Heat-Toxin congesting the throat, Phlegm-Heat obstruction, or residual Lung and Kidney Yin deficiency. Acupuncture and Chinese herbal medicine are adjunctive and must not delay airway assessment, streptococcal testing, prescribed antibiotics, abscess drainage or urgent management of epiglottitis, peritonsillar abscess, deep-neck infection, diphtheria, anaphylaxis or sepsis.

Acute urticaria is the sudden appearance of transient, raised, usually itchy or burning wheals caused by the release of histamine and other inflammatory mediators in the skin. Individual wheals characteristically resolve within 24 hours, although new lesions may continue to appear elsewhere for days or weeks. Acute urticaria lasts less than six weeks and may be associated with viral or bacterial infection, foods, medicines, insect stings, contact exposures or physical triggers, although no definite cause is identified in many cases. Angioedema may accompany urticaria and produces deeper swelling, commonly affecting the lips, eyelids, face, hands, feet or genital region. Urticaria alone is not necessarily anaphylaxis, but hives accompanied by breathing difficulty, throat or tongue swelling, wheeze, persistent cough, voice change, dizziness, collapse, hypotension or severe gastrointestinal symptoms may represent anaphylaxis. Anaphylaxis is a medical emergency for which adrenaline is first-line treatment. Second-generation, non-sedating H1 antihistamines are the principal biomedical treatment for uncomplicated urticaria. TCM differentiation commonly includes Wind-Heat affecting the exterior, Wind-Cold constraining the skin, Damp-Heat, Blood Heat generating Wind, gastrointestinal accumulation producing Heat, or Qì and Blood deficiency with susceptibility to Wind. Acupuncture and Chinese herbal medicine are adjunctive and must never delay adrenaline, emergency services, airway management, antihistamines or medical assessment.

Addison's disease is primary adrenal insufficiency caused by damage or dysfunction of the adrenal cortex, resulting in inadequate cortisol production and commonly inadequate aldosterone production. Causes include autoimmune adrenalitis, infection, adrenal haemorrhage, infiltrative disease, genetic disorders, malignancy and surgical removal of the adrenal glands. Symptoms may develop gradually and include persistent fatigue, muscle weakness, loss of appetite, weight loss, abdominal discomfort, nausea, vomiting, diarrhoea, salt craving, low blood pressure, postural dizziness and increased skin or mucosal pigmentation. Diagnosis and long-term management require endocrinological assessment, hormone testing and lifelong glucocorticoid replacement, with mineralocorticoid replacement usually required in primary adrenal insufficiency. Acute illness, vomiting, trauma, surgery, dehydration or missed steroid doses can precipitate adrenal crisis, a rapidly fatal emergency requiring immediate hydrocortisone and intravenous fluid treatment. TCM descriptions may overlap with Spleen and Kidney Yang deficiency, Kidney Qi deficiency, Qi and Blood deficiency, Spleen Qi deficiency with Dampness, or Yin-fluid depletion after prolonged illness. Acupuncture and Chinese herbal medicine may be considered only as adjuncts for medically stable symptoms such as fatigue, appetite disturbance, sleep difficulty or musculoskeletal discomfort. They must never replace hormone replacement, sick-day steroid dosing, emergency hydrocortisone injection, electrolyte management or specialist care.

Adhesive capsulitis, commonly called frozen shoulder, is a painful condition characterised by progressive restriction of both active and passive glenohumeral movement. External rotation is usually particularly restricted. The condition involves inflammation, fibrosis, thickening and contraction of the shoulder-joint capsule. It may occur without a clear precipitating event or develop after injury, surgery, stroke, prolonged immobilisation or another shoulder disorder. It is more common in people with diabetes and is also associated with thyroid disease. The clinical course is often described as painful freezing, stiff frozen and recovery or thawing phases, although individual presentations vary. Symptoms can persist for many months and sometimes several years. Biomedical management may include education, activity modification, analgesia, physiotherapy-guided mobility exercises, intra-articular corticosteroid injection, hydrodilatation and, in persistent severe cases, manipulation under anaesthesia or arthroscopic capsular release. TCM differentiation commonly includes Qi stagnation and Blood stasis obstructing the shoulder, Cold-Damp Bi syndrome, Phlegm-Damp obstruction, Qi and Blood deficiency failing to nourish the sinews, or Liver and Kidney deficiency. Acupuncture may be considered as adjunctive pain and rehabilitation support but must not replace diagnostic assessment, rehabilitation, diabetes management, injection therapy or surgical referral when required.

Allergic rhinitis is an IgE-mediated inflammatory disease of the nasal mucosa triggered by exposure to allergens such as grass pollens, tree pollens, weed pollens, house dust mites, mould spores and animal dander. Symptoms include repetitive sneezing, nasal itching, clear rhinorrhoea, nasal congestion, itchy palate, itchy throat, watery itchy eyes and postnasal drip. Fatigue, impaired concentration and disturbed sleep frequently occur because of chronic nasal obstruction. Allergic rhinitis commonly coexists with asthma, eczema, chronic rhinosinusitis and allergic conjunctivitis. Diagnosis is based on clinical history supported where appropriate by skin-prick testing or allergen-specific IgE testing. First-line biomedical management includes allergen avoidance where practical, regular intranasal corticosteroids, oral or intranasal antihistamines, saline irrigation and allergen immunotherapy in selected patients. Traditional Chinese Medicine commonly differentiates Wind-Cold, Wind-Heat, Lung Qi deficiency, Spleen Qi deficiency with Dampness, Kidney Yang deficiency or Lung-Kidney deficiency. Acupuncture and Chinese herbal medicine may provide adjunctive symptom management but should never replace emergency treatment of anaphylaxis, severe asthma or significant respiratory disease.

Alopecia areata is an autoimmune, non-scarring hair-loss disorder in which immune activity targets anagen hair follicles. It commonly presents as one or more smooth, well-defined patches of hair loss on the scalp, beard, eyebrows, eyelashes or other hair-bearing areas. More extensive forms include alopecia totalis (complete or near-complete scalp-hair loss) and alopecia universalis (extensive body-hair loss). Exclamation-mark hairs, broken hairs, yellow dots and black dots may be seen on dermoscopy. Nail pitting, ridging or roughness can occur and may be associated with more extensive disease. Alopecia areata can begin at any age, follow an unpredictable relapsing course and undergo spontaneous regrowth, although recurrence is common. It is associated with other autoimmune or atopic conditions including autoimmune thyroid disease, vitiligo and atopic dermatitis. Diagnosis is usually clinical but dermoscopy, laboratory testing or scalp biopsy may be required when the presentation is atypical. Biomedical management depends on age, disease duration, activity, extent, location and patient preference — options include observation, topical or intralesional corticosteroids, topical minoxidil as an adjunct, contact immunotherapy, systemic corticosteroids, immunomodulatory medicines and approved oral Janus kinase inhibitors for selected patients with severe disease[1][2][5][6]. TCM differentiation commonly includes Blood deficiency generating Wind, Liver and Kidney deficiency, Qi and Blood deficiency, Liver Qi stagnation with Blood stasis, Blood Heat generating Wind or Spleen deficiency with Dampness. Acupuncture and Chinese herbal medicine may be considered as adjunctive support but must not replace dermatological diagnosis, screening for alternative causes of hair loss, evidence-based treatment or monitoring of systemic immunomodulatory medicines.

Alzheimer's disease is a progressive neurodegenerative disease and the most common cause of dementia. It gradually affects memory, learning, language, orientation, judgement, behaviour and the ability to perform everyday activities. The underlying disease process is associated with abnormal accumulation of beta-amyloid plaques and tau-related neurofibrillary tangles, synaptic dysfunction, neuronal loss and progressive brain atrophy. Early symptoms commonly include difficulty retaining recent information, repeating questions, losing items, becoming disoriented, difficulty finding words and reduced ability to manage complex tasks. Progression may lead to impaired communication, behavioural and psychological symptoms, loss of independence, swallowing problems, reduced mobility and increased vulnerability to infection, falls and malnutrition. Diagnosis requires comprehensive medical assessment rather than a single test and may include history from the patient and a knowledgeable informant, cognitive and functional assessment, medication review, neurological examination, blood tests and brain imaging. Biomarker testing may be used in selected specialist settings. Management is individualised and may include cholinesterase inhibitors, memantine, treatment of contributing medical conditions, cognitive and functional support, exercise, hearing and vision care, advance-care planning, caregiver education and environmental adaptations. Anti-amyloid medicines may be considered for carefully selected people with early symptomatic Alzheimer's disease in jurisdictions where they are approved and available, but require specialist confirmation of amyloid pathology and monitoring for amyloid-related imaging abnormalities. TCM descriptions may overlap with Marrow Sea deficiency, Kidney essence deficiency, Spleen Qi deficiency with Phlegm, Phlegm misting the mind, Blood stasis obstructing the collaterals, Heart-Spleen deficiency or Liver-Kidney Yin deficiency. Acupuncture and Chinese herbal medicine may be considered only as adjunctive supportive care for selected stable symptoms. They must not replace neurological assessment, prescribed dementia medicines, management of delirium, stroke or infection, medication monitoring, safeguarding, caregiver support or advance-care planning. [1][2][3][4][5][6][7][8]

Amenorrhoea means the absence of menstrual periods. Primary amenorrhoea generally describes menstruation that has not commenced by the expected age or developmental stage, while secondary amenorrhoea describes the cessation of previously established menstrual periods. Amenorrhoea is a clinical sign rather than a single disease. Pregnancy is the most common cause of secondary amenorrhoea and should generally be excluded first whenever biologically possible. Other causes include breastfeeding, menopause, functional hypothalamic suppression associated with low energy availability, eating disorders, substantial weight change, excessive exercise or psychological stress, polycystic ovary syndrome, thyroid disease, hyperprolactinaemia, primary ovarian insufficiency, pituitary or hypothalamic disease, congenital reproductive-tract differences, uterine scarring and medication effects. Evaluation may include menstrual and sexual history, pregnancy testing, nutritional and exercise assessment, examination, hormone testing and pelvic imaging, with additional investigations directed by the suspected cause. Management targets the underlying condition and may involve nutrition rehabilitation, exercise modification, psychological care, hormonal treatment, fertility management, thyroid or prolactin treatment, or specialist surgery. Prolonged hypo-oestrogenism can adversely affect bone density, cardiovascular health, sexual function and fertility. TCM differentiation commonly includes Kidney essence deficiency, Kidney Yang deficiency, Liver and Kidney Yin deficiency, Spleen Qi and Blood deficiency, Liver Qi stagnation, Phlegm-Damp obstruction, Cold congealing with Blood stasis or Qi stagnation and Blood stasis. Acupuncture and Chinese herbal medicine may be considered only as adjunctive care after pregnancy and significant endocrine, nutritional, anatomical and systemic causes have been appropriately assessed. [1][2][3][4][5][6][7]

Anaemia is a condition in which the concentration of haemoglobin or the number of circulating red blood cells is below the expected range for the person's age, sex, pregnancy status and clinical circumstances. Because haemoglobin carries oxygen, anaemia can cause fatigue, weakness, reduced exercise tolerance, breathlessness, dizziness, headache, palpitations and pallor. Anaemia is a clinical and laboratory finding rather than a single diagnosis. It may result from blood loss, reduced red-cell production, increased red-cell destruction or a combination of these mechanisms. Common causes include menstrual or gastrointestinal blood loss, pregnancy-related iron requirements, inadequate iron intake, impaired absorption, vitamin B12 or folate deficiency, chronic kidney disease, inflammatory or autoimmune disease, infection, malignancy, bone-marrow disorders, haemoglobin disorders and medication effects. Investigation commonly includes a full blood count, red-cell indices, blood film, reticulocyte count, ferritin and iron studies, with additional tests guided by the presentation. Treatment must target the underlying cause and may include oral or intravenous iron, vitamin B12, folate, treatment of bleeding or inflammation, erythropoiesis-stimulating therapy, immunological or haematological treatment and, in selected severe or symptomatic cases, blood transfusion. Iron should not be prescribed automatically because anaemia is not always caused by iron deficiency and excess iron can be harmful. TCM differentiation commonly includes Spleen Qi deficiency, Qi and Blood deficiency, Spleen and Kidney Yang deficiency, Liver and Kidney Yin deficiency, Heart and Spleen deficiency, Blood stasis or Damp-Heat damaging the Blood. Acupuncture and Chinese herbal medicine may be considered only as adjunctive support after the type, severity and cause of anaemia have been appropriately investigated. [1][2][3][4][5][6][7][8]

Anaphylaxis is a severe, rapidly developing and potentially fatal systemic hypersensitivity reaction. It can affect the airway, breathing, circulation, skin, gastrointestinal tract and nervous system. Common triggers include foods, medicines, insect stings, latex and, less commonly, exercise or an unidentified trigger. Anaphylaxis may occur without a rash or other skin symptoms. Warning signs include difficult or noisy breathing, wheeze, persistent cough, throat tightness, tongue swelling, hoarse voice, difficulty speaking, dizziness, collapse, pallor or floppiness in a young child. Abdominal pain or vomiting can indicate anaphylaxis after an insect sting or injected medicine and may accompany other reactions. Intramuscular adrenaline, also called epinephrine, is the first-line emergency treatment and should be administered immediately when anaphylaxis is suspected. In Australia, an available adrenaline autoinjector should be used according to its instructions, followed by a call to triple zero (000) for an ambulance. The person should usually be laid flat and must not be allowed to stand or walk; a person with breathing difficulty may sit with legs extended, and a pregnant person should lie on the left side. Additional adrenaline may be required according to the current ASCIA action plan and emergency guidance. Antihistamines do not treat airway obstruction, bronchospasm or shock and must not replace adrenaline. Corticosteroids are not first-line emergency treatment. Every suspected episode requires medical observation and follow-up, including trigger investigation, allergy-specialist referral where appropriate, an individualised action plan, adrenaline-device education and strategies to reduce future exposure. Acupuncture and Chinese herbal medicine have no role in treating acute anaphylaxis. After complete medical stabilisation, complementary care may be considered only for associated anxiety, general wellbeing or separately diagnosed chronic allergic symptoms. It must never be represented as preventing, reversing or replacing emergency adrenaline treatment. [1][2][3][4][5][6][7][8][9]

Ankylosing spondylitis is the radiographic form of axial spondyloarthritis, a chronic immune-mediated inflammatory disease that primarily affects the sacroiliac joints and spine. It commonly begins before age 45 and may cause persistent lower-back or buttock pain, morning stiffness, alternating buttock pain, night pain and improvement with movement rather than rest. Peripheral arthritis, enthesitis and dactylitis may also occur. Extra-articular manifestations include acute anterior uveitis, psoriasis and inflammatory bowel disease. Chronic inflammation may result in reduced spinal mobility, postural change, vertebral fusion, osteoporosis and an increased risk of spinal fracture. Diagnosis is based on clinical history, examination, imaging and laboratory findings rather than any single test. A normal C-reactive protein, erythrocyte sedimentation rate or negative HLA-B27 result does not exclude axial spondyloarthritis. Management commonly includes rheumatology care, education, regular exercise, specialist physiotherapy, smoking cessation and medication. Non-steroidal anti-inflammatory drugs may be used for symptoms, while biologic or targeted synthetic medicines may be considered for persistently active disease. Acupuncture may be considered as adjunctive symptom support but does not suppress the underlying immune-mediated disease or prevent structural progression. TCM patterns commonly include Cold-Damp Bi, Damp-Heat Bi, Kidney Yang deficiency, Liver-Kidney deficiency, Qi and Blood stagnation and Phlegm with Blood stasis. [1][2][3]

Anorexia nervosa is a serious and potentially life-threatening eating disorder characterised by persistent restriction of energy intake, intense fear of weight gain or behaviours that interfere with weight restoration, and disturbance in body-image experience or recognition of illness severity. Some people binge, vomit, misuse laxatives, diuretics or medicines, or exercise compulsively. Atypical anorexia nervosa can cause equally serious medical and psychological complications even when body weight is within or above a statistically expected range. Eating disorders can affect people of every gender, age, culture and body size and are not a lifestyle choice. Complications may involve the heart, circulation, electrolytes, kidneys, gastrointestinal tract, endocrine and reproductive systems, bones, muscles, brain, blood and immune system. Assessment should include eating-disorder symptoms, rate of weight change, physical observations, cardiovascular status, blood tests, electrocardiography when indicated, mental-health risk, exercise, purging, medicines and social circumstances. Treatment commonly involves an eating-disorder-informed multidisciplinary team, nutritional rehabilitation, psychological therapy, medical monitoring and family or carer involvement when appropriate. Children and adolescents require prompt specialist care because malnutrition can impair growth and pubertal development. Refeeding must be medically managed in patients at risk because rapid nutritional change can cause dangerous fluid and electrolyte shifts. TCM patterns may include Spleen Qi deficiency, Spleen and Stomach Qi-Yin deficiency, Heart-Spleen deficiency, Liver Qi stagnation attacking the Spleen, Stomach Yin deficiency, Spleen-Kidney Yang deficiency and Qi-Blood deficiency. Acupuncture and Chinese herbal medicine must remain secondary supportive interventions and must never replace nutritional rehabilitation, psychotherapy, medical monitoring, safeguarding or hospital treatment. [1][2][3][4][5][6]

Anosmia is the complete loss of the sense of smell, while hyposmia means reduced smell. Smell disturbance may also involve parosmia, in which familiar odours smell distorted, or phantosmia, in which an odour is perceived without an external source. Common causes include viral upper-respiratory infections, COVID-19, allergic rhinitis, chronic rhinosinusitis, nasal polyps, nasal obstruction, head injury, ageing and some medicines. Less commonly, smell loss may be associated with neurological disease, intracranial pathology, toxin exposure, congenital conditions or previous surgery. Because smell contributes substantially to flavour perception, patients may report loss of taste even when basic sweet, salty, sour, bitter and umami sensation remains intact. Assessment may include the timing and pattern of onset, nasal and neurological symptoms, recent infection, trauma, medicine and occupational exposure, nasal examination, validated smell testing and selected imaging or specialist investigations. Management targets the underlying cause. Smell training is commonly recommended for persistent post-viral smell loss and involves repeated, structured exposure to selected odours over an extended period. Patients must also address safety risks involving smoke, fire, gas leaks and spoiled food. Acupuncture and Chinese herbal medicine may be considered only as adjunctive care. Evidence is insufficient to conclude that they reliably restore olfactory nerve function or treat structural, neurological or intracranial causes. TCM patterns may include Wind-Cold obstructing the Lung, Wind-Heat attacking the Lung, Lung Qi deficiency, Spleen Qi deficiency with Phlegm-Dampness, Qi and Blood stasis obstructing the nasal orifices and Kidney essence deficiency. [1][2][3][4]