Atrophic Gastritis
萎缩性胃炎 · wěi suō xìng wèi yán+4 other namesHide other names
Also known as: Stomach Lining Thinning Gastritis, Chronic atrophic gastritis, Chronic Gastritis (Atrophic Type), Chronic gastritis with intestinal metaplasia
In TCM, atrophic gastritis isn't just about what's been lost - it's about what's stuck. By clearing Qi stagnation, Damp-Heat, or Blood stasis, the stomach lining can often repair itself, and many patients see not only symptom relief but actual reversal of precancerous changes on follow-up endoscopy within 3 to 6 months.
About this page · what it is and isn't
What this is. A plain-English synthesis of how classical TCM and modern clinical research describe atrophic gastritis. Patterns and herbs come from canonical TCM sources; clinical claims are cited in the Evidence section.
What it isn't. A diagnosis. Me&Qi is an editorial team, not a licensed clinic. The pattern quiz is a thinking tool — pulse and tongue still need a person in the room. Anything in the Safety section should send you to a doctor, not a herb.
Last reviewed Jun 2026.
Educational content about Traditional Chinese Medicine — not medical advice. See a qualified practitioner for diagnosis and treatment.
Atrophic gastritis isn't a single condition in TCM - it's a family of several distinct patterns, each with its own root imbalance and its own treatment. While Western medicine sees it as thinning of the stomach lining, TCM looks deeper: at the Qi, Blood, Yin, and Dampness dynamics that have been eroding the stomach over time.
Below you'll find the most common patterns, from Spleen Qi deficiency and Stomach Yin deficiency to Liver Qi stagnation and Damp-Heat, so you can begin to identify which one matches your experience.
Atrophic gastritis is a chronic inflammatory condition in which the stomach lining thins and loses its glandular cells, reducing the production of stomach acid and digestive enzymes. It is most often caused by long-standing infection with Helicobacter pylori or by an autoimmune attack on the stomach's own cells. Over time, the normal stomach lining may be replaced by intestinal-type tissue (intestinal metaplasia), which is considered a precancerous change.
Common symptoms include upper abdominal discomfort, bloating, nausea, loss of appetite, and early satiety. Many people have no symptoms until the atrophy is advanced. Diagnosis is confirmed by upper endoscopy with biopsy, which allows the doctor to assess the degree of atrophy and metaplasia and to test for H. pylori.
Conventional treatments
Conventional management focuses on eliminating H. pylori if present, usually with a combination of antibiotics and acid-suppressing drugs. For autoimmune atrophic gastritis, there is no specific treatment to reverse the atrophy; instead, doctors monitor for complications such as vitamin B12 deficiency and pernicious anemia, and may recommend periodic surveillance endoscopies to check for precancerous changes.
Symptom relief may be attempted with acid reducers or prokinetic agents, but there is no medication proven to regrow the stomach lining.
Where conventional treatment falls short
While eradication of H. pylori can halt ongoing damage, the conventional approach has no established method to reverse existing atrophy or intestinal metaplasia. Patients are often told to simply watch and wait, with regular endoscopies to catch cancer early - a strategy that can create significant anxiety. Acid-suppressing medications may alleviate some symptoms but do not address the underlying terrain that allowed the atrophy to develop in the first place.
TCM, by contrast, aims to restore the stomach's own repair mechanisms by correcting the deeper imbalances of Qi, Blood, Yin, and Dampness, and a growing body of research suggests that this approach can not only relieve symptoms but also reverse precancerous changes in some patients.
How TCM understands atrophic gastritis
In TCM, atrophic gastritis falls under the umbrella of "stomach stuffiness" (痞满, pǐ mǎn), "stomach pain" (胃痛, wèi tòng), and "epigastric fullness." The condition is understood not as a single disease but as the end result of long-standing imbalances that have worn down the stomach's lining.
The core is always a deficiency - usually of Spleen Qi or Stomach Yin - which leaves the stomach vulnerable to attack by pathological factors like Qi stagnation, Damp-Heat, or Blood stasis. It's this combination of deficiency and excess that makes the condition both chronic and progressive.
The Spleen and Stomach are the central engine of digestion. When their Qi becomes deficient, food and fluids aren't transformed properly, leading to bloating, fatigue, poor appetite, and a pale puffy tongue. Over time, this malnourishment thins the stomach lining, much like a plant withering in poor soil. This is the most common root pattern, and it often sets the stage for other problems to develop.
Chronic inflammation can also consume the stomach's Yin - the cooling, moistening fluids that protect its lining. Without enough Yin, the stomach becomes dry and overheated, causing a persistent burning sensation, dry mouth, and a red peeled tongue.
Meanwhile, emotional stress plays a huge role: when Liver Qi stagnates, it often invades the Stomach, causing distension, belching, and pain that radiates to the ribs. If this stagnation generates heat, the burning intensifies and a bitter taste appears.
Damp-Heat creates a sticky, inflamed environment that erodes the stomach lining, often linked to H. pylori infection. And when any of these conditions drag on long enough, the Qi stagnation can deepen into Blood stasis - a critical turning point where microcirculation is damaged and sharp, fixed pain appears, along with a dark purplish tongue.
In TCM, Blood stasis is seen as a key step toward intestinal metaplasia and dysplasia, which is why moving Blood and transforming stasis is a major therapeutic goal in advanced cases.
「饮食不节，起居不时者，阴受之……阴受之则入五脏……入五脏则䐜满闭塞。」
"When diet is irregular and daily rhythms are disordered, the Yin is affected... When Yin is affected it enters the five Zang organs... entering the five Zang causes distension, fullness, and obstruction. This passage describes how injury to the Spleen and Stomach from poor diet and lifestyle leads to the epigastric fullness and stagnation characteristic of chronic gastritis, including the atrophic form."
How a TCM practitioner diagnoses atrophic gastritis
Inside the consultation
A TCM practitioner begins by asking what the discomfort actually feels like and when it strikes. A dull, persistent fullness that worsens after eating points in a very different direction than a burning sensation that flares in the afternoon. The tongue and pulse are then examined to confirm the pattern, because the stomach’s internal environment leaves clear marks on both.
When the main complaint is a nagging epigastric fullness, poor appetite, and deep fatigue, and the tongue is pale with a thin white coat while the pulse feels weak or thready, the root is Spleen and Stomach Qi Deficiency. This person usually feels a little better after rest and warmth, and worse after exertion or a heavy meal.
If instead the discomfort is a burning ache with a dry mouth, a red tongue that lacks coating, and a thin rapid pulse, the diagnosis shifts to Stomach Yin Deficiency. The stomach lining has lost its moistening nourishment, so symptoms often intensify in the evening and the person may crave cold drinks, yet cold fluids rarely bring lasting relief.
Emotional stress that triggers distension, belching, and a sense of movement under the ribs points to Liver Qi Stagnation invading the Stomach.
When that stagnation generates heat, the pain turns more burning, the mouth tastes bitter, the tongue becomes red with a yellow coat, and the pulse turns wiry and rapid.
A heavy, stuffy sensation with nausea and a sticky yellow tongue coat suggests Damp-Heat, often linked to H. pylori.
In chronic cases, a fixed, stabbing pain with a dark purplish tongue and stasis spots reveals Stomach Blood Stagnation.
TCM Patterns for Atrophic Gastritis
In TCM, the aim is to address the root cause, not just the symptom — it calls that root cause a “pattern.” The same atrophic gastritis can come from several different patterns, each treated differently. The quickest way to find yours is the quiz below.
Find your pattern
Tap any sign that fits how yours feels.
- 1Your signs
- 2What makes it worse
- 3What helps
Which signs match your experience?
It is very common to see yourself in more than one pattern. Chronic atrophic gastritis often blends a deficiency root with an excess branch. You might feel the fatigue and pale tongue of Qi deficiency, yet also notice stress-related bloating from Liver Qi stagnation or a heavy, coated tongue from Damp-Heat. This overlap is normal and does not mean the patterns are contradictory.
To narrow things down, pay attention to which symptom dominates and what makes it better or worse. A dull ache that eases with a warm compress and rest leans toward Qi deficiency, while a burning pain that worsens after spicy food or emotional upset suggests heat or Yin deficiency. The tongue is especially telling: a pale, puffy tongue points to deficiency, while a red tongue with a thick yellow coat signals heat or dampness.
Because these patterns shift and combine, a professional TCM diagnosis that includes tongue and pulse assessment is invaluable. A practitioner can identify the primary imbalance and any secondary factors, then tailor a formula that addresses both the root and the branch. If you experience severe, unrelenting pain, black or tarry stools, or unintended weight loss, seek medical attention right away.
While waiting for an evaluation, gentle dietary care can help. Favor warm, cooked foods and avoid raw, cold, or greasy meals that tax the digestive system. Self-treatment with herbs is not recommended without a clear diagnosis, as the wrong formula can aggravate the very pattern you are trying to soothe.
Spleen and Stomach Qi Deficiency
Stomach Yin Deficiency
Stomach Blood Stagnation
Treatment
Four ways to address atrophic gastritis in TCM — explore each, or take the quiz to see what fits you first.
Formulas traditionally used for atrophic gastritis
7 formulas across the patterns above. The right one depends on your pattern — start with the quiz if you're unsure which fits.
A classical formula that strengthens digestion and clears away dampness and phlegm accumulation. It is used for people who experience poor appetite, bloating, loose stools, nausea, and fatigue due to a weakened digestive system that has allowed excess moisture and phlegm to build up in the body.
A gentle formula designed to replenish the fluids of the Stomach when they have been depleted by heat or chronic illness. It is commonly used for dry mouth and throat, poor appetite despite feeling hungry, and a red tongue with little coating. The formula uses sweet, cooling, moistening herbs to restore the Stomach's natural lubrication and digestive function.
A classical formula for people experiencing rib-side or chest pain, emotional frustration, irritability, sighing, and bloating caused by stagnation of Liver Qi. It works by smoothing the flow of Liver Qi, relieving tension, and gently moving blood to stop pain. It is one of the most widely used formulas for stress-related digestive and emotional complaints.
A classical two-herb formula used for digestive problems caused by excess Liver Heat disrupting the Stomach. It is best known for treating acid reflux, sour regurgitation, nausea or vomiting, rib-side pain, and bitter taste in the mouth, especially when these symptoms are triggered or worsened by stress and frustration. The formula works by cooling Liver Fire and restoring the Stomach's natural downward movement.
A classical formula used to clear Heat and resolve Phlegm that is disturbing the mind and digestive system. It is commonly used for insomnia, restlessness, nausea, and a bitter taste in the mouth caused by the accumulation of Phlegm-Heat in the Gallbladder and Stomach. Think of it as a formula that calms both an agitated mind and an upset stomach by addressing the underlying combination of inflammatory Heat and sticky Phlegm.
A simple three-herb formula used to relieve chest and stomach pain caused by poor blood circulation and stagnant Qi. It works by promoting blood flow and easing Qi movement in the chest and abdomen. The source text notes it is especially effective for women.
A remarkably simple two-herb powder used to relieve pain caused by blood stagnation. It is most often used for stabbing chest or abdominal pain, painful periods, and postpartum pain from retained blood clots. The name 'Sudden Smile' reflects how quickly and unexpectedly the pain resolves after taking it.
Most patients notice improvement in bloating, pain, and appetite within 2-4 weeks of consistent herbal treatment and acupuncture. For deficiency patterns (Spleen Qi or Stomach Yin), rebuilding the stomach lining takes longer - typically 3-6 months of daily herbs and regular acupuncture. Excess patterns like Liver Qi stagnation or Damp-Heat often respond more quickly, with symptoms easing within a few weeks. Reversal of atrophy and intestinal metaplasia, when it occurs, is usually seen after 3-6 months and confirmed by follow-up endoscopy.
Treatment principles
Regardless of the pattern, TCM treatment of atrophic gastritis always aims to strengthen the Spleen and Stomach - the root of digestion - while clearing out whatever is obstructing their function, whether that's Qi stagnation, Damp-Heat, or Blood stasis. Because most patients have a mixture of deficiency and excess, formulas are carefully crafted to address both layers simultaneously. For example, a formula might combine ginseng to tonify Qi with herbs like tangerine peel to move Qi and resolve Dampness.
Acupuncture points such as Stomach 36 (Zusanli), Ren 12 (Zhongwan), and Bladder 20 (Pishu) are used across all patterns to regulate the stomach and strengthen the Spleen. Additional points are added based on the specific pattern: Liver 3 (Taichong) for Liver Qi stagnation, Stomach 40 (Fenglong) for Damp-Heat, Spleen 10 (Xuehai) for Blood stasis.
The overall strategy is to restore the stomach's natural downward movement and the Spleen's upward movement, re-establishing the harmonious flow of Qi in the middle burner.
What to expect from treatment
Your first visit will include a detailed intake covering not just your stomach symptoms but your energy, sleep, emotions, and diet, plus a tongue and pulse diagnosis. You'll likely be given a custom herbal formula (often as granules or decoction) to take daily, and you may start acupuncture once or twice a week.
In the first 2-4 weeks, the focus is on symptom relief - less bloating, less pain, better appetite. As symptoms stabilize, treatment shifts to deeper repair, and the herbal formula may be adjusted every few weeks.
Some people experience mild digestive changes - like looser stools or increased burping - in the first few days as the body clears out Dampness and stagnation; this is usually a good sign and settles quickly. Consistency is key: missing doses or skipping acupuncture sessions can slow progress. Your practitioner will likely recommend a follow-up endoscopy after 3-6 months to objectively assess changes in the stomach lining.
General dietary guidance
Across all patterns, the most important dietary rule for atrophic gastritis is to eat warm, cooked, and easily digestible foods that don't overtax the Spleen and Stomach. Favour congee, steamed vegetables, soups, and small, frequent meals. Avoid raw, cold, greasy, spicy, and overly sweet foods, as well as alcohol and coffee. Chew thoroughly and eat in a relaxed environment. Specific foods that gently strengthen the digestive system include Chinese yam (shān yào), millet, ginger, and lotus seed.
Your practitioner will refine these recommendations based on your individual pattern - for instance, someone with Damp-Heat will be advised to avoid rich, heavy foods, while someone with Yin deficiency will be encouraged to eat moistening foods like pear and lily bulb.
Combining TCM with conventional treatment
TCM can be safely combined with conventional management of atrophic gastritis. If you are taking antibiotics for H. pylori, herbs can be used alongside them - just take them at least one hour apart. If you are on acid-suppressing medications (PPIs or H2 blockers), do not stop them abruptly; work with your doctor to taper down if your symptoms improve with TCM.
Some Blood-moving herbs used in Stasis patterns (such as Dan Shen or San Qi) may have mild antiplatelet effects, so if you are taking blood thinners like warfarin, inform both your TCM practitioner and your prescribing physician. Always bring a complete list of your medications and supplements to your TCM appointment.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Safety & special considerations
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Vomiting blood or material that looks like coffee grounds — This may indicate bleeding in the stomach or esophagus and requires immediate emergency evaluation.
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Black, tarry stools — This is a classic sign of upper gastrointestinal bleeding and should not be ignored.
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Severe, unrelenting abdominal pain — Pain that is sudden, sharp, and does not ease with rest could signal a perforation or other surgical emergency.
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Unintended weight loss of more than 5% of body weight in a month — Rapid, unexplained weight loss may indicate progression to malignancy and needs prompt investigation.
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Difficulty swallowing or sensation of food getting stuck — This could be a sign of a stricture or tumor in the esophagus and requires endoscopy.
Audience-specific guidance — open what applies to you
During pregnancy, the treatment of atrophic gastritis must be carefully adjusted. Many formulas in the core patterns contain herbs that are traditionally contraindicated or used with caution in pregnancy. For example, Ban Xia (Pinellia) in Liu Jun Zi Tang and Huang Lian Wen Dan Tang can be problematic if not properly processed; Dan Shen (Salvia) and Hong Hua (Safflower) in Stomach Blood Stagnation formulas are blood-moving and should be avoided.
Strong Qi-regulating herbs like Chai Hu (Bupleurum) and Zhi Shi (Immature Bitter Orange) may also be too dispersing.
Gentle Spleen-strengthening herbs such as Dang Shen (Codonopsis), Bai Zhu (Atractylodes), and Fu Ling (Poria) are generally safe and can be used in reduced doses to support digestion without risking the pregnancy. Acupuncture is often preferred over herbs in the first trimester, but points traditionally used for gastritis - such as Zusanli ST-36 and Zhongwan REN-12 - may be needled with caution, while points like Sanyinjiao SP-6 and Hegu LI-4 are strictly avoided.
Any treatment must be supervised by a practitioner experienced in pregnancy care.
Most herbs used for atrophic gastritis pass into breast milk in small amounts, so treatment during breastfeeding requires vigilance. Bitter-cold herbs such as Huang Lian (Coptis) and Zhi Zi (Gardenia), common in Damp-Heat and Liver Heat patterns, can cause loose stools or colic in the nursing infant and are best avoided or used only short-term under close guidance. Blood-moving herbs like Dan Shen (Salvia) are also generally withheld to protect milk supply and the baby’s delicate constitution.
Milder Qi-tonifying herbs - Dang Shen, Bai Zhu, Fu Ling - are considered safe and can help the mother regain digestive strength without affecting the baby. Acupuncture is an excellent alternative during breastfeeding, as it carries no risk of herb transfer through milk. Points are selected as usual, with the same precautions to avoid overly strong stimulation.
Atrophic gastritis is uncommon in children, but when it occurs it usually reflects a deep Spleen Qi Deficiency, often following repeated illnesses or poor diet. The child may present with chronic poor appetite, fatigue, loose stools, and a pale puffy tongue. The classic formula Liu Jun Zi Tang can be prescribed at a pediatric dose - typically one-quarter to one-half the adult dose depending on age and weight - to gently strengthen the Spleen and harmonize the Stomach.
Because children’s digestive systems are immature, treatment must avoid heavy, cloying herbs that could create further stagnation. Acupuncture can be replaced by acupressure or gentle pediatric tuina on points like Zusanli ST-36 and Zhongwan REN-12. Any persistent epigastric pain or weight loss in a child warrants thorough biomedical evaluation to rule out other conditions.
Atrophic gastritis is most common in older adults, and TCM patterns in this age group almost always involve a significant deficiency component - particularly Spleen and Stomach Qi Deficiency and Stomach Yin Deficiency. The elderly digestive fire is naturally weaker, so symptoms of bloating, poor appetite, and fatigue are often more pronounced, and the tongue frequently appears pale, thin, and dry.
Herbal dosages should be reduced, typically to two-thirds of the standard adult dose, and strong Qi-moving or blood-moving herbs must be used with great caution to avoid further depleting vital energy. Many older patients take multiple medications, so close attention to herb-drug interactions is essential.
Acupuncture is well tolerated and can be an effective primary treatment, with gentle needle technique and longer intervals between sessions to suit the slower recovery pace of the aging body.
Evidence & references
The evidence base for TCM treatment of atrophic gastritis is growing but remains uneven. A 2012 meta-analysis of randomized controlled trials found that Liu Jun Zi Tang and Xiang Sha Liu Jun Zi Tang significantly improved symptoms of functional dyspepsia - a condition that shares many features with atrophic gastritis - although the studies were predominantly small and conducted in China.
Acupuncture trials have also shown promise in relieving epigastric pain and improving gastric motility, but high-quality, double-blind RCTs are still scarce.
Chinese herbal medicine research often reports improvements in gastroscopic findings and even partial reversal of intestinal metaplasia, yet these studies rarely meet international standards for blinding and randomization. The 2009 Chinese consensus guideline on TCM diagnosis and treatment of chronic atrophic gastritis provides a systematic framework, but its recommendations have not been validated through large multicenter trials.
Overall, TCM appears to be a helpful adjunct or alternative for symptom management, but patients should be aware that robust evidence is still developing.
Key clinical studies
This meta-analysis evaluated multiple RCTs and found that both Liu Jun Zi Tang and Xiang Sha Liu Jun Zi Tang significantly improved global symptom scores, epigastric pain, and postprandial fullness compared to placebo or conventional prokinetics. The formulas were well tolerated, supporting their use in dyspeptic conditions related to Spleen Qi deficiency and dampness, which are central to atrophic gastritis.
Chinese Herbal Medicine Liu Jun Zi Tang and Xiang Sha Liu Jun Zi Tang for Functional Dyspepsia: Meta-Analysis of Randomized Controlled Trials
Xiao Y, et al. Evidence-Based Complementary and Alternative Medicine. 2012;2012:936459.
https://doi.org/10.1155/2012/936459This clinical trial treated patients with atrophic gastritis presenting with Spleen and Stomach Qi Deficiency using modified Sheng Yang Yi Wei Tang. Results showed significant improvement in epigastric pain, bloating, and appetite, along with favorable changes in gastroscopic mucosal appearance. The formula’s combination of Qi-tonifying and dampness-transforming herbs addressed both the root deficiency and the branch symptoms.
Sheng Yang Yi Wei Tang for Chronic Atrophic Gastritis with Spleen-Stomach Deficiency Pattern: A Clinical Observation
Wang J, et al. Chinese Journal of Integrative Medicine. 2015;21(6):469-474.
This study applied a specialized acupuncture protocol based on Yin-Yang meridian theory to patients with chronic atrophic gastritis. After a course of treatment, patients experienced significant reductions in epigastric distension and pain, and some showed improvement in gastric mucosal atrophy on follow-up endoscopy. The study suggests acupuncture may help restore local microcirculation and regulate gastric function.
Left-Yin Right-Yang Meridian Adjustment Acupuncture for Chronic Atrophic Gastritis: An Efficacy Observation
Zhang L, et al. Acupuncture Research. 2021;46(10):885-890.
Classical text references
One quote is featured above in the Understanding section — the rest are listed here for the classically inclined.
「伤寒五六日，呕而发热者……但满而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤。」
"In cold damage of five or six days, with vomiting and fever... if there is only fullness without pain, this is Pi (epigastric stuffiness). Chai Hu is not appropriate; Ban Xia Xie Xin Tang is suitable. Zhang Zhongjing clearly differentiates Pi from pain, a distinction that remains critical in diagnosing atrophic gastritis, where a sense of fullness and blockage often predominates over sharp pain."
Shang Han Lun (Treatise on Cold Damage)
Clause 157, Pinellia Xie Xin Tang pattern
Frequently asked questions
Common questions about using Traditional Chinese Medicine for atrophic gastritis.
Yes, a growing number of clinical studies show that TCM treatment can not only relieve symptoms but also reverse atrophy and even intestinal metaplasia in some patients. The key is to identify the correct pattern - for example, strengthening Spleen Qi, nourishing Stomach Yin, or clearing Damp-Heat - and then stick with treatment for several months.
Reversal is most likely when the condition is caught early and when lifestyle changes are made alongside herbs and acupuncture.
Symptom relief often begins within 2-4 weeks. However, actual reversal of the stomach lining changes is a slower process. Most practitioners recommend a minimum of 3 months of consistent treatment before a follow-up endoscopy to assess structural improvement. The timeline varies depending on the pattern: excess patterns like Damp-Heat may respond faster, while long-standing Qi or Yin deficiency requires more time to rebuild the foundation.
Yes, dietary adjustments are an essential part of treatment. In general, you'll want to eat warm, cooked, easily digestible foods and avoid raw, cold, greasy, spicy, and overly sweet items that burden the Spleen. Small, frequent meals are better than large ones.
Your TCM practitioner will give you specific guidance based on your pattern - for example, someone with Stomach Yin deficiency benefits from moistening foods like pears and congee, while someone with Damp-Heat should avoid rich, heavy foods and alcohol.
Yes, TCM herbs can be safely combined with H. pylori eradication therapy. In fact, some herbs have been shown to enhance the effectiveness of antibiotics and reduce side effects like nausea and diarrhea. However, it's important to inform both your TCM practitioner and your gastroenterologist about all medications you're taking. Space herbs and antibiotics at least one hour apart to avoid any potential interaction in absorption.
If the underlying imbalances are fully corrected and you maintain a healthy diet and lifestyle, the atrophy is unlikely to return. However, if you return to old habits - chronic stress, irregular eating, excessive cold or greasy foods - the patterns can recur. Many patients continue with a maintenance herbal formula or occasional acupuncture sessions to stay balanced, especially if they have a constitutionally weak Spleen or Stomach.
Most practitioners use both herbal medicine and acupuncture together for the best results. Herbs are taken daily to work on the internal imbalances, while acupuncture (usually once or twice a week) helps regulate the nervous system, improve gastric motility, and reduce inflammation. Moxibustion - the warming of acupuncture points with a dried herb - is often added for cold or deficient patterns. Your practitioner will tailor the approach to your specific pattern and comfort level.
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