Bridging Traditions: Integrating TCM Into ERAS for Enhanced Gastrointestinal Recovery —A Scoping Review
TL;DR
Evidence stratification showed standardized EA has moderate-certainty benefits for shortening flatus and defecation time and lowering postoperative ileus incidence, whereas herbal and external treatments only have low-certainty evidence restricted by small cohorts, inadequate blinding and inconsistent operating protocols.
Abstract
Abstract This scoping review complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) to synthesize clinical and preclinical evidence of Traditional Chinese Medicine (TCM) applied in gastrointestinal Enhanced Recovery After Surgery (ERAS) for postoperative gastrointestinal dysfunction (PGD). Literature searches across PubMed, Embase and Web of Science covered January 2016 to June 2026, yielding 815 initial citations; after duplicate removal and two-stage blinded screening, 99 original studies were retained. Narrative synthesis was adopted rather than pooled meta-analysis due to marked clinical and methodological heterogeneity. Guided by TCM Spleen-Stomach and Qi Movement theories, we categorized four major TCM intervention types: electroacupuncture (EA), transcutaneous electrical acupoint stimulation, oral herbal prescriptions and external therapies. Evidence stratification showed standardized EA has moderate-certainty benefits for shortening flatus and defecation time and lowering postoperative ileus incidence, whereas herbal and external treatments only have low-certainty evidence restricted by small cohorts, inadequate blinding and inconsistent operating protocols. A five-path synergistic regulatory network was summarized, with the Toll-like receptor 4/nuclear factor-kappa B-p38 mitogen-activated protein kinase (TLR4/NF-κB-p38 MAPK) and short-chain fatty acid-G protein-coupled receptor 43/41-vagus nerve (SCFA-GPR43/41) axes as core molecular hubs. However, most mechanistic data are derived from separate animal and single-marker human experiments lacking unified multi-omics validation in patient samples. Existing research has notable drawbacks: clinical trials are mostly single-center without long-term cross-ethnic follow-up; basic research rarely uses human intestinal tissues for verification; global unified TCM operating standards and objective syndrome biomarkers are absent. Future work should carry out multinational sham-controlled randomized trials, establish standardized perioperative TCM specifications, utilize multi-omics and gene-edited animal models to verify the proposed regulatory network, and build international TCM terminology frameworks to produce high-level evidence supporting worldwide integrated Chinese-Western surgical rehabilitation.
