Lu YY, Li YP, Yan XY. Integrated traditional and western medicine spleen-stomach support in geriatric gastrointestinal cancer care. World J Gastrointest Oncol 2026; 18(9): 119709 [DOI: 10.4251/wjgo.119709]
Corresponding Author of This Article
Xiao-Yan Yan, Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42 Wenhua West Road, Lixia District, Jinan 250011, Shandong Province, China. sharon.yan@163.com
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Oncology
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Lu YY, Li YP, Yan XY. Integrated traditional and western medicine spleen-stomach support in geriatric gastrointestinal cancer care. World J Gastrointest Oncol 2026; 18(9): 119709 [DOI: 10.4251/wjgo.119709]
Yu-Yin Lu, General Practice of Traditional Chinese Medicine, The Fourth People's Hospital of Jinan, Affiliated to Shandong Second Medical University, Jinan 250031, Shandong Province, China
Ya-Ping Li, School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
Xiao-Yan Yan, Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
Author contributions: Lu YL initiated research, Li YP designed the experiments and conducted clinical data collection, performed postoperative follow-up and recorded the data; Lu YL and Yan XY conducted the collation and statistical analysis, and wrote the original manuscript and revised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Corresponding author: Xiao-Yan Yan, Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42 Wenhua West Road, Lixia District, Jinan 250011, Shandong Province, China. sharon.yan@163.com
Received: March 3, 2026 Revised: March 26, 2026 Accepted: April 20, 2026 Published online: September 15, 2026 Processing time: 190 Days and 1.7 Hours
Abstract
Elderly patients with advanced gastrointestinal tumors often face severe challenges, such as malnutrition, substantial symptom burden, and poor quality of life due to tumor-related cachexia, organ dysfunction, and treatment-related toxicity. This phenomenon underscores an urgent need for optimized supportive care strategies. The traditional Chinese medicine (TCM) theory that “the spleen and stomach are the foundation of postnatal life and the source of vital energy and blood” offers a unique perspective, with the “strengthening and protecting the spleen and stomach” approach aiming to restore the central digestive functions as a core supportive strategy. This review summarizes and evaluates the current application and efficacy of the integrated TCM and western medicine approach of “strengthening and protecting the spleen and stomach” in supportive care for this population. PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were searched from inception to December 2025 using the following terms: “gastrointestinal tumors”, “gastric cancer”, “colorectal cancer”, “elderly”, “strengthening and protecting the spleen and stomach”, “invigorating the spleen”, and “supportive care”. A total of 101 relevant studies were included for analysis. The integrated approach combines TCM principles—such as strengthening the spleen, benefiting qi, harmonizing the stomach, and reducing counterflow—with modern nutritional support and symptom management. It demonstrates potential in alleviating cancer-related anorexia–cachexia syndrome, managing treatment-related side effects, relieving cancer pain and opioid adverse effects, and improving cancer-related fatigue, showing synergistic benefits in enhancing treatment tolerance and quality of life. The integrated approach holds significant clinical value. However, current evidence primarily derives from small-sample studies, and its mechanisms require further elucidation. High-quality clinical research is needed to explore standardized and individualized practices for its systematic application in tumor supportive care.
Core Tip: This review outlines the integrative “strengthening and protecting the spleen and stomach” approach in supportive care for elderly patients with advanced gastrointestinal tumors. By combining spleen-invigorating, stomach-harmonizing methods with nutritional and symptom management, it shows synergistic benefits in improving anorexia-cachexia, reducing treatment toxicities, alleviating pain and opioid side effects, and relieving fatigue. This strategy enhances quality of life and treatment tolerance, offering new insights into integrative supportive oncology.
Citation: Lu YY, Li YP, Yan XY. Integrated traditional and western medicine spleen-stomach support in geriatric gastrointestinal cancer care. World J Gastrointest Oncol 2026; 18(9): 119709
Gastrointestinal tumors primarily include gastric and colorectal cancers, which continue to rank among the leading malignancies worldwide in terms of incidence and mortality rates[1]. The median age of onset for patients with gastrointestinal tumors is relatively high, with nearly one-third of patients being over 65 years old at diagnosis[2]. With the acceleration of global population aging, the burden of gastrointestinal tumors in the elderly continues to intensify. According to the Global Burden of Disease Study, 3854209 new cases of digestive system cancers among the older adult population (aged ≥ 60 years) were recorded worldwide in 2021, with an age-standardized incidence rate of 360.89 per 100000; the number of deaths was 2856742, with an age-standardized mortality rate of 270.14 per 100000[3]. For colorectal cancer in older adults, 1617011 new cases were reported worldwide in 2021, with an age-standardized incidence rate of 149.16 per 100000; the number of deaths was 827471, with an age-standardized mortality rate of 77.51 per 100000[4]. Regarding gastric cancer in older adults, the number of new cases in the global population aged 50-74 years increased by 17.32% in 2021 compared with that in 1990. The median age at diagnosis for gastric cancer is approximately 68 years; in East Asia, over half of patients with gastric cancer are aged ≥ 65 years[5]. Approximately 85% of new gastric cancer cases occur in individuals aged ≥ 65 years[6]. Furthermore, the age-standardized prevalence rate of colorectal cancer in older adults has shown a continuous upward trend, with an average annual percentage change of 0.63% from 1990 to 2021[4].
Owing to the lack of apparent clinical symptoms and signs in the early stages, most patients present with distant metastases upon seeking medical attention[7,8]. No significant differences in clinicopathological features have been observed between older and non-older patients; however, older patients present with poorer nutritional status and a higher burden of comorbidities[6]. The frailty phenotype, characterized by a great number of comorbidities and poor nutritional status, is a prominent feature of the older adult population with rectal cancer[9]. Elderly patients with advanced gastrointestinal tumors experience a combination of organ dysfunction, inadequate nutritional intake, and diminished immune function, compounded by the high metabolic demands of cancer cell proliferation and widespread metastasis. This unique clinical physiology poses significant challenges[10,11]. For patients with advanced gastrointestinal tumors who cannot undergo surgical treatment, chemotherapy, radiotherapy, and targeted therapies become crucial treatment modalities. While effective in killing tumor cells, these treatments are often accompanied with significant gastrointestinal toxicities that exacerbate malnutrition and weight loss, potentially leading to treatment interruptions or dose reductions and thereby influencing the efficacy of antitumor therapies[12-14]. Older patients (aged ≥ 65 years) receive significantly fewer cycles of FLOT regimen chemotherapy compared with younger patients (4.5 cycles vs 7 cycles, P = 0.03) and have a higher risk of chemotherapy-related adverse events of grade ≥ 3, particularly fatigue (15% vs 5%) and infections[15]. Cancer-related fatigue (CRF) and cachexia, which are common debilitating syndromes in patients with advanced cancer, are closely linked to inflammatory states, metabolic disorders, and insufficient nutritional intake and severely impairing patients’ functional abilities, treatment tolerance, and willingness to survive[16-18]. As a consequence, the focus of treatment for elderly patients with advanced gastrointestinal tumors has shifted from pursuing “cure” to goals of palliative and supportive care aimed at “extending quality survival time, effectively controlling symptoms, and improving quality of life”[19].
The effective management of treatment-related toxicities and tumor-related symptoms has become a pressing clinical issue in the supportive care of elderly patients with advanced gastrointestinal tumors. Traditional Chinese medicine (TCM) posits that “the spleen and stomach are the foundation of postnatal life and the source of vital energy and blood”. The spleen governs the transformation and transportation of nutrients, and the stomach is responsible for receiving and digesting food; together, they are fundamental for the digestion, absorption, and distribution of nutrients necessary for generating vital energy and blood, nourishing the body, and sustaining life[20,21]. When the spleen and stomach are deficient, the normal metabolism of qi, blood, and bodily fluids is impaired, leading to the formation of pathological products such as phlegm, blood stasis, and toxins, which can subsequently give rise to tumors. Once a tumor has developed, the internal accumulation of tumor toxins further compromises the digestive functions of the spleen and stomach, resulting in a vicious cycle of “spleen and stomach damage - tumor growth - exacerbated consumption”, clinically manifesting as poor appetite, abdominal distension, fatigue, and weight loss. This pathological process aligns closely with the gastrointestinal toxicities, malnutrition, and cachexia observed in modern medicine[22]. The “strengthening and protecting the spleen and stomach” approach aims to break this vicious cycle, establishing itself as a core strategy in TCM supportive care for tumors.
The TCM approach “strengthening and protecting the spleen and stomach” encompasses a comprehensive regimen of diverse therapeutic methods, including “strengthening the spleen and benefiting qi” to enhance digestive capacity, “harmonizing the stomach and reducing counterflow” to alleviate nausea and bloating, “regulating qi and promoting movement” to facilitate the flow of bodily functions, and “transforming dampness and awakening the spleen” to eliminate obstructions. Its essence lies in restoring the normal function of the central digestive system[23-25]. This TCM approach aims to improve specific gastrointestinal symptoms and facilitates the recovery of spleen and stomach functions, invigorating the body’s “righteous qi” and thereby enhancing patients’ inherent ability to combat tumors and tolerate treatments and achieving the goal of “supporting the righteous to resist the pathogenic”.
With the deepening of evidence-based medicine concepts, research on integrated TCM and western medicine in tumor supportive care has increased. The integration of TCM principles and therapies with modern oncology nutrition, symptom management, and rehabilitation medicine has led to the formation of a systematic “strengthening and protecting the spleen and stomach” supportive care approach with potential advantages. Preliminary clinical studies suggest that this combined approach may have positive effects of reducing gastrointestinal reactions to chemotherapy, improving nutritional indicators, alleviating CRF, delaying cachexia progression, and enhancing quality of life scores[26,27]. However, existing evidence remains scattered, the underlying mechanisms require further exploration, and high-quality clinical research designs need standardization. Therefore, this review aims to summarize and evaluate the current application and efficacy of the integrated TCM and western medicine approach of “strengthening and protecting the spleen and stomach” in the supportive care of elderly patients with advanced gastrointestinal tumors. It focuses on elaborating the clinical progress in improving nutritional status, managing treatment-related toxicities, alleviating cancer pain, and ameliorating CRF, thereby providing a reference for clinical practice and offering insights for further research in the field of integrative medicine.
The literature screening process of this study is shown in Figure 1. A systematic search of PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform yielded 876 relevant records. After the removal of duplicates (312 records), screening of titles and abstracts (402 records excluded), and review of full texts (61 records excluded), 101 studies were ultimately included in the analysis.
Figure 1 Literature screening flowchart.
CNKI: China National Knowledge Infrastructure.
CHALLENGES IN MODERN SUPPORTIVE CARE FOR CANCER AND ITS RELATION TO TCM’S CONCEPT OF “STRENGTHENING AND PROTECTING THE SPLEEN AND STOMACH”
Cachexia and the concept of “spleen and stomach deficiency, insufficient source of qi and blood”
Cancer-related anorexia is one of the most prevalent symptoms among patients with advanced tumors, with up to 80% of patients suffering from late-stage gastrointestinal cancers ultimately developing cancer cachexia[28]. Cachexia is a syndrome characterized by significant weight and muscle loss, which cannot be fully reversed by conventional nutritional support[29]. Its pathological core lies in systemic inflammation and severe disturbances in protein and energy metabolism. Modern medical approaches to treating cachexia include appetite stimulation, enhancing gastrointestinal motility, anti-inflammatory agents, enteral or parenteral nutrition, exercise, and psychosocial interventions[30,31]. While these treatments can yield certain therapeutic effects, they often come with numerous side effects. For instance, clinical trials on the use of high-dose progestins discovered significant improvements in appetite and weight but also adverse effects such as lower limb edema, venous thromboembolism, gonadal dysfunction, adrenal insufficiency, and increased mortality[32]. Similarly, the use of tumor necrosis factor (TNF)-α receptor antagonists and monoclonal antibodies to inhibit TNF-α was proven ineffective in preventing muscle wasting in patients with cachexia[33]. Simple enteral or parenteral nutrition can partially supplement substrates, but it struggles to correct abnormal metabolic signals and may increase the risk of refeeding syndrome, gastrointestinal intolerance, or catheter-related infections in elderly patients[34].
Muscle wasting, appetite loss, and inflammatory state reflected in cachexia closely align with the TCM concept of “spleen governing muscles” and “spleen governing transformation and transportation”. When the spleen and stomach are weakened and their transformative functions are impaired, the essence of food cannot be transformed into qi and blood, leading to the accumulation of dampness and phlegm. Qi deficiency results in insufficient propulsion, causing blood stagnation and bruising. Prolonged illness can affect the kidneys, resulting in the depletion of essence and qi. This phenomenon resonates with the pathological state observed in cachexia research, where “resistance to anabolic metabolism” coexists with “excessive catabolism”[35]. The TCM approach of “strengthening and protecting the spleen and stomach” aims to regulate the levels of inflammatory factors through spleen tonification and qi enhancement, improve gastrointestinal motility and digestion through dampness transformation, and ultimately restore the body’s anabolic capacity from a functional standpoint, aligning with the modern nutritional goal of “metabolic regulation”. Huang and Chen[36] found that compared with simple intravenous nutritional support, the combined use of ginseng and Atractylodes injection via intravenous drip more effectively increases patient weight, alleviates related clinical symptoms, improves albumin and hemoglobin levels, enhances overall nutritional status, and boosts quality of life. Liu et al[37] confirmed that ginseng and Astragalus injection significantly improves appetite, increases weight, and effectively enhances the quality of life for patients with gastrointestinal cancer cachexia.
Symptom control and the concept of “middle jiao dysfunction, qi mechanism disruption”
Symptom control is a direct manifestation of supportive care; however, elderly patients with advanced tumors often face the dilemma of “gaining one while losing another”. Preventive antiemetic regimens centered around 5-hydroxytryptamine receptor type 3 (5-HT3) antagonists and neurokinin-1 receptor (NK-1) receptor antagonists have significantly improved chemotherapy-induced nausea and vomiting (CINV); however, some of these medications can cause side effects such as headaches, constipation, and prolonged QT intervals[38-40]. Opioids are the first-line choice for moderate-to-severe cancer pain; however, opioid-induced constipation occurs frequently and severely in elderly, frail patients with gastrointestinal tumors, and conventional laxatives often prove ineffective, severely affecting the quality of life[41]. Although targeted peripheral μ-opioid receptor antagonists exist, issues of cost and accessibility remain[42]. Furthermore, the unique diarrhea induced by targeted therapies [such as epidermal growth factor receptor (EGFR) inhibitors] and immune checkpoint inhibitors necessitates balancing efficacy with toxicity, as conventional antidiarrheal medications often have limited effectiveness and require vigilance for the risk of bowel obstruction[43]. Elderly patients with advanced tumors often experience CRF due to increased tumor burden and the cumulative toxicity of chemotherapy and radiotherapy[44]. CRF manifests as a persistent sense of physical and mental exhaustion that is not alleviated by rest, diminishing treatment adherence, severely affecting the quality of life, and potentially shortening survival[45]. Modern medicine primarily addresses CRF with symptomatic support; however, this approach has limitations, and notable side effects, such as central nervous system stimulants potentially causing insomnia and anxiety, yield a relief rate of less than 50% for moderate-to-severe CRF[46]. These challenges illustrate that treating single symptoms often falls short in addressing the complex coexistence of multiple symptoms in elderly patients with advanced tumors and might even lead to the emergence of new treatment-related symptoms.
Functional decline and the concept of “vital qi deficiency, toxicity and pathogenic factors depleting the body”
The overall decline in functional status among elderly patients with advanced gastrointestinal tumors corresponds to the TCM concept of “vital qi deficiency”. Symptoms such as appetite loss, muscle wasting, weight loss, anemia, and hypoalbuminemia directly correlate with the TCM diagnosis of “deficiency of both qi and blood” and “exhaustion of essence and qi”. CRF, cold intolerance, movement slowness, and soft-spoken demeanor reflect “deficiency of yang qi”, leading to dysfunction in propulsion and warming. Recurrent infections and rapid disease deterioration correspond to “deficiency of defensive qi”, indicating a collapse of the immune defense system. Symptoms of depression, anxiety, and altered consciousness are manifestations of “deficiency of qi and blood, with the spirit not residing in the body”.
As a parasitic entity, tumors voraciously consume the host’s nutrients to meet their unbounded proliferation needs, a phenomenon corresponding to “depletion”. Viewed as “pathogenic qi”, “cancer toxicity” obstructs the flow of qi, clogs the meridians, generates heat and dampness, continuously depleting the body’s essence and disrupting the normal physiological functions of the spleen and stomach, leading to an inability to transform and absorb essence. Akin to TCM’s “damp-heat” and “stasis toxicity”, the inflammatory factors released by tumors further exacerbate the disorder of the internal environment. “Vital qi deficiency” and “toxic depletion” are not independent; they form a vicious cycle through the “spleen and stomach” as a central hub. The ultimate goal of supportive care is to maintain patients’ functional status and quality of life, aligning with TCM’s palliative philosophy of “supporting vital qi while allowing the disease to remain”. Strengthening and protecting the spleen and stomach is the most fundamental approach to “supporting the righteous”. By tonifying the spleen, replenishing the kidneys, enhancing qi, nourishing the blood, harmonizing the stomach, reducing counterflow, and promoting digestion, we can restore the basic functions of reception and transformation in the spleen and stomach, breaking the cycle at its origin. Once the functions of the spleen and stomach are restored, an adequate intake and transformation of food can lead to a sufficient source of vital qi, improving patients’ physical state, immune function, and emotional well-being and thereby reestablishing partial control over the tumor and potentially delaying its progression. Recent studies showed that certain spleen-tonifying herbal formulas can positively influence cachexia and fatigue by regulating gut microbiota, improving intestinal barrier function, and modulating the immune microenvironment, providing a preliminary biological explanation for this theoretical connection[47-49].
SPECIFIC APPLICATION OF THE “STRENGTHENING AND PROTECTING THE SPLEEN AND STOMACH” APPROACH IN SUPPORTIVE CARE
The main application areas and core strategies of the integrated TCM and western medicine approach of “strengthening and protecting the spleen and stomach” approach in supportive care for advanced elderly gastrointestinal tumor patients are summarized in Table 1.
Table 1 Main application areas and core strategies of the integrated traditional Chinese and western medicine “strengthening and protecting the spleen and stomach” approach in supportive care for elderly patients with advanced gastrointestinal tumors.
Application area
Core TCM strategy
Synergy point of integrated treatment
Improving nutritional status & CACS
Invigorating spleen to promote transportation, supplementing qi and nourishing blood (e.g., Xiangsha Liujunzi decoction, Shenling Baizhu powder); Acupuncture (ST36, CV12)
Combining with nutritional support; utilizing Chinese medicine/acupuncture to restore spleen and stomach function, regulate inflammation and metabolism, achieving synergy between “function” and “substance”
Invigorating spleen for dampness, astringing intestines to stop diarrhea (e.g., Shenling Baizhu powder, Zhenren Yangzang decoction)
Synergize with conventional antidiarrheal therapy to protect the intestinal mucosa, regulate gut microbiota, and shorten the duration of diarrhea
Myelosuppression (CIM)
Supplementing qi to generate blood, invigorating spleen and tonifying kidney (e.g., Danggui Buxue decoction, Jianpi Yishen granules)
Combined with hematopoietic growth factors to reduce the incidence of severe myelosuppression and promote endogenous hematopoietic recovery
Oral mucositis
Clearing heat and removing toxicity, supplementing qi and nourishing yin (Chinese herbal mouthwash)
Direct action on the lesion to reduce inflammation and promote mucosal repair, showing superior effects compared to conventional mouthwashes
Alleviating cancer pain & opioid side effects
Invigorating spleen and supplementing qi to treat the root, promoting qi and activating blood to treat the branch (modified Xiangsha Liujunzi decoction)
Synergize with opioids for analgesia while reducing side effects like constipation, improving the overall symptom cluster
Improving CRF
Invigorating spleen and supplementing qi to nourish the source of qi and blood (e.g., Buzhong Yiqi decoction, Bazhen Huaji decoction)
Combined with Western symptomatic management and non-pharmacological interventions to fundamentally improve fatigue and enhance quality of life
Improving nutritional status and cancer anorexia-cachexia syndrome
Cancer anorexia-cachexia syndrome is one of the leading causes of death among patients with advanced gastrointestinal tumors[50], characterized by persistent appetite loss, involuntary weight loss, and progressive muscle wasting. Simple nutritional supplementation often fails to reverse the underlying pathological state, which is driven by systemic inflammatory responses and metabolic disorders[51,52]. TCM succinctly encapsulates this condition as “cancer toxicity depleting the body, spleen and stomach failing, and insufficient source of qi and blood”. Therefore, the core strategy of integrative supportive care lies in providing necessary “nutritional raw materials” through modern nutrition while employing TCM methods to “strengthen and protect the spleen and stomach”, thereby restoring the “functional factory” of digestion and absorption. This dual approach aims to break the vicious cycle of “insufficient intake - metabolic disorder - exacerbated consumption”.
At the heart of the TCM strategy is the combination of “transportation” and “nourishment”. For elderly patients with weakened spleen and stomach functions, treatment is far from merely stimulating appetite. The foundational steps include strengthening the spleen and assisting its function, soothing the stomach, and relieving obstruction. Commonly used herbs such as dried hawthorn[53], toasted barley sprout, and medicated leaven[54] help with digestion and reduce accumulation. Amomum[55] and Saussurea awaken the spleen and promote qi flow. For patients with thick and greasy tongue coating, herbs such as dried tangerine peel[56] and poria[57] can help transform dampness and harmonize the stomach. The fundamental approach focuses on nourishing qi and blood to replenish the body’s postnatal essence. As the digestive function begins to recover, the timely administration of Astragalus[58], Codonopsis[59], white atractylodes, and poria can enhance the spleen and qi. Adding Angelica and Polygonatum for blood nourishment or even using placenta and other blood-replenishing substances to restore the source of “qi and blood transformation” can be considered.
In clinical practice, the supportive treatment for elderly patients with advanced gastrointestinal tumors is stratified in accordance with regular nutritional assessments and dietary guidance. For patients capable of oral intake, classic formulas such as Fragrant Sand Six Gentlemen decoction[60] and ginseng and poria powder[61] are modified or combined with proprietary formulas such as spleen strengthening and kidney nourishing granules[62] to systematically improve spleen and stomach function. In addition, nonpharmacological acupuncture shows unique advantages by safely and effectively improving appetite through the regulation of gastrointestinal hormones (such as gastrin) and neural pathways[63]. For patients with refractory advanced cancer reliant on enteral or parenteral nutrition, the focus of TCM intervention shifts to enhancing nutritional tolerance and utilization efficiency. For instance, combining spleen-strengthening and qi-regulating herbs during nutrient infusion can alleviate complications such as bloating and diarrhea. For those suffering from severe vomiting, using ginger and Pinellia as a topical application on the Zhongwan and Shenque acupuncture points can help stop vomiting and warm the stomach[64,65]. A randomized controlled trial (RCT) involving patients with advanced gastric cancer undergoing chemotherapy indicated that the addition of spleen-strengthening and qi-enhancing herbs to standard nutritional support significantly improved the patients’ weight, upper arm circumference, and serum albumin levels while reducing gastrointestinal toxicity from chemotherapy[66]. A meta-analysis of 15 RCTs confirmed that acupuncture (primarily at points such as Zusanli and Zhongwan) improved the appetite, increased the weight, and enhanced the quality of life of patients with cancer-related anorexia relative to the control groups[67]. A clinical study revealed that Four Gentlemen decoction could exert effects through multiple pathways, including downregulating inflammatory factors, modulating the hypothalamic appetite center, and improving gut microbiota[68].
Managing treatment-related toxicity and side effects
Elderly patients with advanced gastrointestinal tumors often face the risk of treatment interruption or dose reduction due to toxicities from chemotherapy, targeted therapies, and radiation, severely influencing efficacy and prognosis. TCM views these toxic side effects as “medicinal toxicity” or “radiation effects”. It posits that external pathogens harm the body’s vital qi, particularly in the middle jiao, and depletes the spleen and stomach’s qi, blood, and fluids. The integrative strategy centered on “strengthening and protecting the spleen and stomach” aims to use herbal medicine to “reduce toxicity” and protect spleen and stomach functions, thereby enhancing patients’ tolerance to modern anticancer treatments and ensuring the smooth completion of treatment plans.
CINV/radiation-induced nausea and vomiting: CINV and radiation-induced nausea and vomiting are the most common gastrointestinal toxicities in patients with cancer. Standard Western treatment includes 5-HT3 receptor antagonists, NK-1 receptor antagonists, and dexamethasone; however, some patients still experience breakthrough or delayed vomiting[69]. TCM attributes this phenomenon to medicinal toxicity disturbing the stomach, causing qi to rebel upward. Methods to harmonize the stomach and descend rebellious qi are adopted as fundamental strategies. Classic formulas such as Xiao Banxia decoction and its modified versions (e.g., Banxia Houpu decoction and Xuanfu Daizhe decoction) are widely used[70,71]. Combining these herbal medicines with standard triplet antiemetic regimens can significantly reduce the incidence and severity of delayed nausea and vomiting, enhancing patients’ appetite and quality of life[72,73]. The underlying mechanisms may involve the regulation of gastrointestinal 5-HT, substance P, and dopamine levels and central antiemetic effects[74-76].
Radiation enteritis/targeted therapy-related diarrhea: Radiation enteritis is a common complication of pelvic radiotherapy. Targeted therapies, such as the use of EGFR inhibitors, often lead to severe diarrhea. Overzealous use of antidiarrheal medications can lead to internal dampness obstruction. Western medicine primarily focuses on rehydration, antidiarrheal agents (such as loperamide), and symptomatic support; however, excessive use of antidiarrheal drugs can risk internal dampness stagnation. TCM recognizes that, although the disease manifests in the large intestine, it is closely related to the functions of the spleen and stomach and its later stages may involve the spleen and kidneys. The core pathogenesis lies in the deficiency of the spleen and stomach and damage to the intestinal organs. Heat toxicity or damp-heat accumulation often plays a critical role during acute phases, and prolonged illness may transition to the yang deficiency of the spleen and kidneys or dual deficiency of qi and yin. Therefore, treatment emphasizes reinforcing the body’s defenses and restoring the foundation, focusing on strengthening the spleen and nourishing the kidneys while flexibly employing methods to tonify qi and nourish yin, clear heat and transform dampness, and warm yang and astringe[77].
Clinical studies showed that various classic formulas and custom prescriptions exhibit good effects on treating radiation enteritis and diarrhea related to targeted therapies. For patients with spleen and kidney yang deficiency, the combination of Zhenren Yangzang decoction and peach blossom decoction can effectively alleviate symptoms. The combination of reinforcing and cleansing intestinal decoction with probiotics has also shown high efficacy in clinical observations. Formulations such as Wumei pill and Banxia Xiexin decoction have demonstrated significant therapeutic effects[78]. In foundational treatment, ginseng and poria powder, the commonly used formula for strengthening the spleen and draining dampness, is often paired with kudzu root to elevate and stop diarrhea or with chebulic myrobalan and pomegranate peel to astringe the intestines and prevent fluid loss. Clinical trials indicated that these integrative approaches can effectively reduce the frequency of diarrhea, improve stool consistency, and shorten the duration of diarrhea, often showing superior overall efficacy compared with simple symptomatic treatments while demonstrating potential advantages in protecting the intestinal mucosal barrier and regulating gut microbiota[79].
Chemotherapy-induced bone marrow suppression: Chemotherapy-induced bone marrow suppression is one of the most common dose-limiting toxicities in cancer treatment, primarily manifested by decreased peripheral blood white blood cell, red blood cell, and platelet counts, leading to increased risks of infection, anemia, and bleeding and often affecting the treatment process and intensity[80]. TCM categorizes this condition under “blood deficiency” and “deficiency syndrome”, believing that the core pathogenesis lies in chemotherapy drugs damaging the digestive functions of the spleen and stomach and thereby causing a deficiency of the “source of qi and blood transformation”. Prolonged illness may also impact the kidneys, further depleting kidney essence and affecting the innate basis of “the kidneys govern bone and produce marrow”.
Current western medicine treatments for chemotherapy-induced bone marrow suppression primarily rely on hematopoietic growth factors (such as granulocyte colony-stimulating factor and erythropoietin), which can rapidly elevate blood counts but often provide only temporary effects and may be accompanied with side effects including bone pain and fever. Meanwhile, TCM employs a holistic approach to strengthen the body’s defenses and restore the foundation, aiming to improve the hematopoietic microenvironment and promote the recovery of endogenous hematopoietic function to achieve a “treating both symptoms and root causes” strategy[81]. Clinical research has shown that Yinlian and stomach granules can significantly improve the state of bone marrow suppression in elderly patients with gastric cancer during postoperative adjuvant chemotherapy while simultaneously enhancing their nutritional and immune functions[82]. For those diagnosed with qi and blood deficiency, representative formulas such as Angelica blood nourishing decoction (emphasizing astragalus and angelica) or proprietary formulas including spleen strengthening and kidney nourishing granules can promote blood production by “tonifying qi and nourishing blood”, which at the cellular level can manifest as the regulation of hematopoietic factor secretion and support for the proliferation and differentiation of hematopoietic stem/progenitor cells. For patients with spleen and kidney yang deficiency, formulas such as Huangqi Jianzhong decoction can warm and tonify the middle jiao and strengthen spleen function, achieving “yang generates yin” effects to improve a series of deficiency-related symptoms[83]. Multiple clinical studies[84,85] indicated that combining the aforementioned TCM approaches with standard supportive treatments can effectively reduce the incidence of grade III-IV severe bone marrow suppression, decrease reliance on hematopoietic growth factors, and promote the stability and recovery of blood counts after chemotherapy, fully embodying the TCM wisdom of “strengthening the postnatal spleen and stomach to nourish the innate kidney essence”.
Oral mucositis: Oral mucositis is one of the most common adverse reactions in patients with cancer undergoing chemotherapy and targeted therapy. Its incidence can reach 30%-40% among patients receiving standard chemotherapy regimens, often leading to severe pain and difficulty eating and significantly affecting their nutritional intake and quality of life[86]. TCM attributes the core pathogenesis to excessive heat and toxicity, which attack the mouth and tongue and deplete qi and yin, resulting in the mucosa lacking nourishment[87]. Treatment involves systemic regulation and the direct use of TCM mouthwash, sprays, or ointments that have qi-nourishing, yin-replenishing, and heat-clearing properties and can directly act on the lesions, reduce local inflammatory responses, and promote mucosal repair and regeneration[88,89]. Clinical research confirms that such topical TCM preparations can effectively reduce the severity and incidence of oral mucositis and alleviate pain, often showing superior effects for mucosal protection and healing compared with conventional mouthwashes (such as sodium bicarbonate solutions)[90].
Classic prescriptions and new formulations show potential in the specific applications of formulas. For instance, the Liangge powder from “Taiping Huimin Heji Ju Fang” demonstrates significant efficacy in clearing heat and resolving toxicity; modern studies showed that its combination with western medicine can substantially improve oral inflammation and reduce recurrence rates[91]. The compound formulation Banxia Xiexin decoction, composed of herbs such as Pinellia, skullcap, and Coptis (Hangeshashinto used in Japan), has been shown to effectively shorten the duration of oral mucositis caused by chemotherapy in patients with gastrointestinal cancer and provide analgesic effects[92] at a concentration of 5%.
In summary, the integrative approach of “strengthening and protecting the spleen and stomach” in managing treatment-related toxicities and side effects embodies the wisdom of “treating both symptoms and root causes”. Western medicine can rapidly control acute symptoms (symptomatic treatment). TCM, through a combination of local and systemic adjustments, aims to eliminate heat toxicity and protect qi and yin, fundamentally enhancing tissue repair and tolerance (root cause treatment). Together, they complement each other, providing significant support for patients to successfully complete their anticancer treatments.
Alleviating cancer pain and managing opioid side effects
The mechanisms underlying cancer pain involve complex interactions among the tumor microenvironment, peripheral sensitization, and central sensitization. Persistent stimulation exacerbates the body’s state of exhaustion, making it susceptible to negative psychological responses such as anxiety and depression and creating a vicious cycle of “pain - fatigue - emotional disturbances”[93,94]. Western medicine’s three-step analgesic approach has limitations, including the risk of addiction and the potential for side effects such as constipation and nausea[95]. TCM posits that the core pathogenesis of cancer pain lies in the deficiency of vital qi, with weakened spleen and stomach functions leading to insufficient sources of qi and blood. Qi deficiency results in weak propulsion, and blood deficiency leads to inadequate meridian nourishment. In addition, phlegm and blood stasis can obstruct the meridians, resulting in pain due to lack of flow. Therefore, treatment emphasizes “strengthening and protecting the spleen and stomach” as a central theme, promoting the functions of the middle jiao to nourish the source of qi and blood and ensuring that the organs and meridians receive adequate nourishment; methods to invigorate qi and activate blood circulation to alleviate stagnation are also employed, achieving the dual goals of “nourishment prevents pain” and “smooth flow prevents pain”[96,97].
In specific differential diagnosis and treatment, attention should be paid to the state of the spleen and stomach and the presence of pathogenic factors. For patients with spleen and stomach qi deficiency and inadequate heart spirit nourishment, treatment often involves strengthening the body’s defenses against cancer while tonifying the spleen, nourishing qi, and calming the spirit. Formulas such as Fragrant Sand Six Gentlemen decoction can be modified to include herbs such as Astragalus, Codonopsis, white atractylodes, poria, dried tangerine peel, Saussurea, and Amomum to strengthen the spleen and regulate qi and sour jujube seed and longan to nourish the heart and calm the spirit. This strategy aims to restore digestive function, ensure adequate qi and blood flow, and alleviate pain and associated anxiety. For managing side effects such as constipation from opioid use, additional herbs that promote qi movement and relieve stagnation, such as toasted barley sprout, toasted medicated leaven, hemp seed, and angelica, may be added to reduce reliance on stimulant laxatives. For patients with liver qi stagnation and spleen deficiency and whose pain is significantly linked to emotional fluctuations, treatment focuses on soothing the liver and relieving depression while regulating spleen and stomach qi. Formulas such as Banxia Houpo decoction or Chaihu Guizhi Ganjiang decoction may be modified to include herbs, such as bupleurum, white peony, and corydalis to soothe the liver and regulate qi for pain relief; Atractylodes, magnolia bark, and poria to strengthen the spleen and transform dampness; and calcined dragon bone and calcined oyster to calm the spirit. This approach aims to restore the normal rise and fall of qi in the middle jiao and harmonize the liver and spleen, alleviating the pain caused by emotional distress, qi stagnation, and blood stasis.
Improving CRF and enhancing quality of life
CRF is one of the most common and distressing symptoms experienced by patients with cancer, with an incidence rate as high as 34%-76%. It often persists throughout the course of the disease, severely impairing patients’ functional status and quality of life[98]. At present, no standard treatment for CRF is available. Western medicine mainly employs medications (such as hematopoietic stimulants, antidepressants, and stimulants) and non-pharmacological interventions (such as exercise and cognitive behavioral therapy) for symptomatic management; however, their efficacy remains controversial, and evaluation evidence is lacking[99]. TCM classifies CRF as a “deficiency syndrome”, with its core pathogenesis linked to a deficiency of vital energy. The body’s vital energy originates in the kidneys and is nourished by the spleen and stomach, which serve as the source of qi and blood transformation. If the spleen and stomach are weak and fail to perform their functions, then the essence of food cannot be transformed into qi and blood, resulting in insufficient vital energy and leading to a series of symptoms such as fatigue, weakness in the lower back and knees, and a pale complexion, all indicative of “qi deficiency”[100]. Thus, “strengthening and protecting the spleen and stomach” to nourish the source of qi and blood is the fundamental strategy for improving CRF.
On the basis of this pathogenesis, clinical practice often employs key herbs such as astragalus and ginseng or codonopsis to tonify qi and strengthen the spleen. Modern research confirmed their multiple effects, including alleviating fatigue and modulating immune function[101]. The representative formula Buzhong Yiqi decoction operates through a multicomponent, multitarget synergistic effect, i.e., regulating the middle jiao, replenishing qi and blood to address root causes, and potentially exerting comprehensive benefits by intervening in tumor cell proliferation and apoptosis, thereby improving patients’ quality of life[102,103]. Some empirically derived formulas focused on strengthening the spleen and supporting the body’s defenses have shown promising efficacy. For example, the Qingjie Fuzheng decoction, composed of roasted Astragalus, Codonopsis, and scutervulin, exemplifies a combination of reinforcing and purging strategies, achieving reliable clinical efficacy[104]. The Yishen Tongluo Juanpi decoction significantly reduces CRF severity[105]. Clinical observations in patients with gastrointestinal cancer indicated that combining Bazhen Huaji decoction with the capecitabine and oxaliplatin (XELOX) chemotherapy regimen improves scores on quality-of-life measures [European organization for research and treatment of cancer quality of life questionnaire core 30 (EORTC QLQ-C30)] and physical status (Karnofsky score) compared with chemotherapy alone[106]. In addition to decoctions, preparations such as Kangai injection and ginseng and Astragalus Fuzheng injection are also widely used in clinical settings to help improve multiple assessment indicators, including fatigue scores, immune function, and hematological parameters. In summary, multiple systematic evaluations confirmed that integrative approaches combining TCM and western medicine demonstrate additional efficacy and safety advantages in improving CRF compared with conventional western medicine treatments alone[107].
CONCLUSION
This study elucidates the unique value and current application of the TCM core strategy of “strengthening and protecting the spleen and stomach” in conjunction with modern supportive care for managing the complex clinical issues faced by elderly patients with advanced gastrointestinal tumors. Existing evidence suggests that through synergistic “functional regulation” and “nutritional/symptomatic support”, this combined approach can intervene at multiple points in the vicious cycle of “spleen and stomach impairment - tumor cachexia”. It also demonstrates comprehensive benefits in improving nutrition, reducing toxic side effects, alleviating pain and fatigue, and enhancing overall quality of life.
However, the current research is not without limitations, such as the small sample sizes of most clinical trials, the need for improved methodological rigor, and the elucidation of underlying mechanisms still in exploratory stages. Future efforts should focus on conducting well-designed, large-scale, multicenter RCTs to obtain high-level evidence. Employing systems biology, microbiomics, and other advanced technologies will help reveal the scientific underpinnings of how the “strengthening and protecting the spleen and stomach” approach regulates metabolism, immunity, and gut microbiota. Standardized yet individualized clinical pathways for integrative supportive care that combines TCM and western medicine must be developed. This integrated model provides a distinctive Chinese solution to optimize comprehensive supportive treatment for elderly patients with advanced gastrointestinal tumors.
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