Acupuncture and moxibustion for postoperative gastrointestinal disorders: An efficacy analysis

Abstract

BACKGROUND

Gastrointestinal disorders (GIDs) frequently develop after abdominal surgery and impede postoperative recovery and quality-of-life improvement.

AIM

To determine whether acupuncture and moxibustion (Acu-Mox) can improve clinical outcomes in patients with postabdominal surgery GID.

METHODS

We selected 105 patients with GID following abdominal procedures between December 2022 and December 2024. Comparative analyses were conducted on 50 patients in the control group receiving conventional Western medical treatment and 55 cases in the research group who additionally received Acu-Mox, with endpoints including overall effectiveness, the Intake, Feeling Nauseated, Emesis, Physical Exam, and Duration of Symptoms (I-FEED) scale score and its normalization time, gastrointestinal function recovery (bowel sound recovery, exhaust/defecation time, first liquid diet intake time), serum inflammatory indicators (C-reactive protein, interleukin-6, tumor necrosis factor-α), and complications (ileus, constipation, bloating, abdominal pain).

RESULTS

The research group showed a markedly higher total effective treatment rate than the controls. This group also exhibited a notable reduction in posttreatment I-FEED scores, C-reactive protein, interleukin-6, and tumor necrosis factor-α that were statistically lower vs the control group, together with shorter time to I-FEED score normalization, bowel sound recovery, exhaust/defecation, and the first postoperative liquid diet, as well as an obviously lower overall complication rate.

CONCLUSION

Acu-Mox for post-abdominal surgery GID is more effective than traditional Western medicine, deserving promotion in clinical practice.

Key Words: Acupuncture–moxibustion; Abdominal surgery; Gastrointestinal disorders; The Intake, Feeling Nauseated, Emesis, Physical Exam, and Duration of Symptoms; Complications

Core Tip: In this study, 105 postabdominal surgery patients with gastrointestinal disorders were selected strictly according to the inclusion and exclusion criteria. Comparative analysis assessed the clinical effects of routine western medicine treatment vs combined western medicine treatment and acupuncture–moxibustion. Multidimensional evaluation results showed higher curative effects of Western medicine + acupuncture–moxibustion therapy on gastrointestinal disorder patients after abdominal surgery. Such therapy alleviates clinical symptoms, promotes postoperative gastrointestinal function recovery, inhibits serum inflammation, and ensures higher clinical safety. The results can provide a better treatment option for these patients.

INTRODUCTION

Continuous iterative upgrades in surgical technology have transformed abdominal procedures into minimally invasive laparoscopic approaches; nevertheless, patients still face a high risk of postoperative complications, especially postoperative gastrointestinal disorders (GIDs)[1]. Postoperative GIDs manifest as early-stage postoperative GI intolerance and may involve nausea, vomiting, and eating difficulties. The progressive stage is postoperative GI dysfunction (POGD), which, if further deteriorates, can induce postoperative ileus, exerting different degrees of negative impact on patients’ postoperative recovery and life quality[2,3]. The pathogenesis of this condition is multifactorial and may involve anesthesia, surgical traction injury, inflammatory reactions, electrolyte disorders, and neurogenic factors[4]. Reports indicate a postoperative GID incidence of 10%-56%, which imposes a substantial economic burden[5]. In the United States, POGD-related annual medical expenditure has increased by as much as United States dollar 1.5 billion[5]. At present, the conventional Western medicine treatment for postoperative GID includes fasting, GI decompression, vital sign monitoring, fluid replacement, acid-base adjustment, and abdominal massage, but the curative effect remains limited[6]. Acupuncture and moxibustion (Acu-Mox) is a millennia-old practice in traditional Chinese medicine (TCM). Being minimally invasive and nonpharmaceutical, it regulates the body’s energy balance by stimulating specific meridians, with wide applications to GI pathology treatment, including defecation, gastroparesis, and irritable bowel syndrome[7]. Acu-Mox also applies to postoperative GID treatment and can promote or inhibit gastric peristalsis depending on the clinical condition[8]. The therapeutic and protective mechanism of Acu-Mox on GI function may also be related to its regulation of inflammation, gut-brain axis, intestinal flora, visceral hypersensitivity, and the gastroduodenal mucosal barrier[9]. A systematic review and meta-analysis reported that Acu-Mox treatment of functional GID not only alleviates symptom severity but also results in fewer adverse events than pharmacotherapy, placebo, and other auxiliary interventions[10]. Reports on Acu-Mox for GID after abdominal surgery remain scarce, with most studies focusing on appendectomy or isolated procedures such as liver, hepatorenal, or gynecological surgeries, and splenectomy. By targeting the surgical cohort covering all these operations, this study aims to verify the wider clinical use of Acu-Mox in postoperative GID and to provide treatment strategies for those affected.

MATERIALS AND METHODS

Patient baseline

With the approval of the Affiliated Hospital of Gansu University of Chinese Medicine Ethics Committee, 105 patients with post-abdominal surgery GID were enrolled (December 2022 to December 2024) for retrospective analysis. The control group (n = 50) received routine care, while the research group (n = 55) received additional Acu-Mox treatment. Baseline characteristics between groups were comparable (P > 0.05), which ensured their comparability.

Inclusion and exclusion criteria

Patient eligibility: A GID diagnosis postabdominal surgery[11]; age: 18-80 years; GID symptoms (abdominal distension, nausea, vomiting, weakened or disappeared bowel sounds) of varying degrees after standard postoperative fasting (3-5 days); complete medical records.

Ineligibility: Severe postoperative infections or complications; preoperative ileus; chronic constipation/diarrhea; significant cardio-/cerebrovascular diseases or cardiac/hepatic/renal insufficiency; benign/malignant tumors; psychiatric disorders; pregnancy/Lactation.

Therapeutic methods

The control group received conventional Western medical treatment: (1) Patients were kept fasting and water-deprived and placed in a semirecumbent position for continuous GI decompression. Vital signs (e.g., blood pressure and heart rate) and abdominal findings were closely monitored; (2) Nutritional support included intravenous fluid therapy and antibiotic administration to correct water-electrolyte imbalances and maintain acid-base equilibrium; and (3) Patients were assisted with clockwise abdominal massage and encouraged to ambulate early.

In addition to the abovementioned measures, the research group received Acu-Mox treatment. Patients lay in the supine position and underwent routine disinfection, with attention paid to thermal insulation. Based on the Stomach meridian of Foot-Yangming, and in accordance with the principles of local and proximal acupoint selection, meridian-based distal acupoint selection, and avoidance of surgical incision sites, the following acupoints were selected: Zusanli, Yinlingquan, Sanyinjiao, Xiajuxu, Shangjuxu, Taichong, Neiguan, and Tianshu (all selected bilaterally), as well as Hegu and Zhongwan. Qihai, Guanyuan, and Xuehai were additionally selected for patients with qi-blood deficiency. Acupuncture intensity was adjusted based on the patient’s constitution, with Deqi defined as sensations of soreness, heaviness, distension, or numbness. After achieving Deqi, Zusanli was managed using the reinforcing method, Yanglingquan using the reducing method, and the remaining acupoints using a mild reinforcing-reducing method. Needle manipulation included twirling, rotating, lifting, and thrusting techniques, with electrical stimulation applied every 3-5 minutes. During needling or immediately after needle withdrawal, a moxa roll was ignited and properly fixed on a warm-moxibustion rack or moxibustion apparatus. Zusanli, Qihai, Zhongwan, Xiawan, Tianshu, Xiajuxu, and Shangjuxu received moxibustion treatment as appropriate. A safe distance between the moxa roll and the skin was maintained to ensure warmth without causing burns. The duration of needle retention or moxibustion was 15-30 minutes per session, administeredonce or twice daily, with 7 days constituting one treatment course. During Acu-Mox therapy, patients were closely monitored for changes in condition to prevent adverse events such as syncope, needle retention, burns, or scalding. All acupuncture procedures were performed by licensed TCM practitioners with > 10 years of clinical experience, holding nationally issued qualification certificates, to ensure technical accuracy and treatment consistency.

Outcome measures

Overall treatment effectiveness: Markedly effective - normalization of stool frequency and color, passage of flatus within 24 hours, essential disappearance of abdominal pain, distension, nausea, and vomiting, and the return of normal bowel sounds[12]. Effective - the presence of bowel sounds and anal flatus within a 24-hour to 72-hour window, plus marked alleviation of clinical symptoms. Ineffective - a failure to pass flatus beyond 72 hours, persistently weak or absent bowel sounds, and unimproved/worsened initial symptoms. The total effective rate is the percentage of the sum of markedly effective and effective cases out of the total number of cases.

Intake, Feeling Nauseated, Emesis, Physical Exam, and Duration of Symptoms score: This tool evaluates intake, nausea, vomiting, abdominal examination, and symptom duration domains on a scale of 0-3. Patients’ postoperative GI function was judged as normal (0-2 points), postoperative GI intolerance (3-5 points), or POGD (≥ 6 points) based on the total score. In addition, Intake, Feeling Nauseated, Emesis, Physical Exam, and Duration of Symptoms (I-FEED) score recovery time, i.e., the time required to recover to a “normal” state from the beginning of the intervention, was recorded[13].

GI function recovery: Bowel sound recovery, as well as the first flatus/defecation/Liquid diet postoperation, was monitored.

Serum inflammatory biomarkers: Before and 1 week after treatment, each patient provided fasting blood samples (5 mL) for serum separation via centrifugation. Enzyme-linked immunosorbent assays were then conducted for C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) quantification.

Complications: Cases suffering from ileus, constipation, bloating, and abdominal pain were counted, and the overall incidence rate in each group was computed.

Statistical analysis

Data analyses used SPSS 20.0, employing a P < 0.05 significance threshold. Continuous data that followed a normal distribution were statistically described using mean ± SD, with inter-group and intra-group (pre-treatment vs post-treatment) comparisons made with the t-test and the paired t-test, respectively; for the data that did not follow a normal distribution, they were expressed as median (interquartile range) [M (P₂₅, P₇₅)]. Qualitative data, expressed as n (%), were compared by χ² tests.

RESULTS

General clinical data

Baseline comparability between study cohorts was confirmed, with no notable differences in gender distribution, age, disease course, anesthetic technique, or surgery type (P > 0.05; Table 1).

Table 1 Baseline data assessment, n (%).

Indicators	Control group (n = 50)	Research group (n = 55)	χ2/t	P value
Sex			0.100	0.752
Male	27 (54.00)	28 (50.91)
Female	23 (46.00)	27 (49.09)
Age (years)	53.64 ± 7.87	56.53 ± 9.79	1.657	0.101
Disease duration (weeks)	11.48 ± 3.75	12.16 ± 2.95	1.037	0.302
Anesthetic technique			0.405	0.525
General anaesthesia	26 (52.00)	32 (58.18)
Epidural anesthesia	24 (48.00)	23 (41.82)
Type of surgery			1.181	0.758
Appendicectomy	24 (48.00)	28 (50.91)
Hepatobiliary surgery	16 (32.00)	15 (27.27)
Gynecological surgery	7 (14.00)	6 (10.91)
Splenectomy	3 (6.00)	6 (10.91)

Clinical effectiveness

The research group had higher overall effectiveness than the control group (90.91% vs 74.00%, P < 0.05; Table 2).

Table 2 Efficacy comparison, n (%).

Indicators	Control group (n = 50)	Research group (n = 55)	χ2	P value
Markedly effective	20 (40.00)	27 (49.09)
Effective	17 (34.00)	23 (41.82)
Ineffective	13 (26.00)	5 (9.09)
Overall effectiveness	37 (74.00)	50 (90.91)	5.272	0.022

I-FEED scores

Prior to intervention, I-FEED scores were comparable between the groups (P > 0.05). Both groups’ scores decreased posttreatment (P < 0.05), particularly in the research group (P < 0.05). The research group showed a significantly shorter recovery time than the control cohort (P < 0.001; Table 3).

Table 3 The Intake, Feeling Nauseated, Emesis, Physical Exam, and Duration of Symptoms score and normalization time.

Indicators	Control group (n = 50)	Research group (n = 55)	Statistic	P value
I-FEED (points)
Pre-treatment	6.00 (6.00, 8.00)	6.00 (6.00, 7.00)	-0.242	0.809
Post-treatment	4.00 (3.00, 5.00)a	2.00 (1.00, 3.00)b	-5.507	< 0.001
Recovery time (hours)	108.28 ± 20.57	72.11 ± 19.19	9.321	< 0.001

^aP < 0.05.

^bP < 0.01.

GI functional recovery

Assessment of GI functional recovery, based on the return of bowel sounds, first flatus, first defecation, and first liquid diet, showed shorter times in the research group, indicating faster recovery than in the controls (P < 0.001; Table 4).

Table 4 Gastrointestinal recovery (hours).

Indicators	Control group (n = 50)	Research group (n = 55)	t	P value
Return of bowel sounds	32.32 ± 6.02	25.91 ± 6.65	5.159	< 0.001
Time to first flatus	40.94 ± 8.47	33.55 ± 5.56	5.331	< 0.001
Time to first defecation	45.80 ± 8.33	39.60 ± 7.56	3.998	< 0.001
Time of first liquid diet	71.84 ± 21.92	52.18 ± 21.00	4.692	< 0.001

Serum inflammatory biomarkers

Enzyme-linked immunosorbent assay-based CRP, IL-6, and TNF-α measurements were equivalent between groups prior to treatment (P > 0.05). While both treatments led to significant reductions in all markers postintervention, the research group achieved consistently lower final levels than the controls (P < 0.05; Figure 1).

Figure 1 Serum inflammatory biomarkers in the control and research groups. A: Pre- and post-treatment C-reactive protein; B: Interleukin-6 before and after treatment; C: Tumor necrosis factor-αpre- and post-treatment. ^aP < 0.05, ^bP < 0.01, ^cP < 0.001. CRP: C-reactive protein; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α.

Complications

Safety assessment (Table 5), based on the incidence of complications including ileus, constipation, bloating, and abdominal pain, revealed a statistically significant reduction in the aggregate complication rate in the research group (10.91%) vs the control group (34.00%) (P < 0.01). All of the above complications were mild to moderate in severity, and no severe cases requiring surgical intervention occurred. The patients with relatively obvious symptoms were effectively controlled through standard symptomatic treatments (e.g., laxation, pain relief, GI decompression) without affecting the overall treatment plan.

Table 5 Postoperative complication rates, n (%).

Indicators	Control group (n = 50)	Research group (n = 55)	χ2	P value
Ileus	4 (8.00)	0 (0.00)
Constipation	3 (6.00)	1 (1.82)
Bloating	4 (8.00)	2 (3.64)
Abdominal pain	6 (12.00)	3 (5.45)
Total	17 (34.00)	6 (10.91)	8.163	0.004

DISCUSSION

In this analysis of 105 patients with postabdominal-surgery GID, those receiving adjunctive Acu-Mox (research group) demonstrated a markedly higher overall efficacy rate than those receiving conventional care (90.91% vs 74.00%). TCM theory conceptualizes postoperative GID as a consequence of vital energy deficiency (qi and blood), organ dysfunction (spleen-stomach), circulatory obstruction (qi stagnation, blood stasis, and meridian obstruction), and systemic imbalance (Yin-Yang)[14]. Therapeutic strategies are therefore directed toward strengthening the body’s resistance, replenishing vital energy, promoting circulation, resolving stagnation, and restoring functional balance. In this study, stimulation of Zusanli by Acu-Mox was considered to replenish qi, regulate vital energy, dispel spleen dryness and dampness, promote the descent of intestinal qi, and alleviate weakness. Yinlingquan is believed to invigorate the spleen and eliminate dampness; Shangjuxu to dredge fu-qi and facilitate the transfer and resolution of accumulated stagnation; Zhongwan to strengthen the middle energizer and regulate qi; Qihai to strengthen the lower energizer, replenish vitality, and circulate qi to dissipate stagnation; and Guanyuan to tonify the kidney, nourish essence, and warm yang to relieve depletion. Xuehai, in combination with Zusanli, Sanyinjiao, and Tianshu, is thought to help warm yang, dispel cold, and regulate the spleen and stomach. The application of moxibustion-related thermal stimulation to these acupoints provides additional benefits, including improved local blood and lymphatic circulation, alleviation and resolution of smooth muscle spasm, and subsequent anti-inflammatory and analgesic effects[15].

Furthermore, Acu-Mox outperformed conventional Western medicine by achieving a more pronounced decrease in the I-FEED score and a faster return to normal scores. Patients receiving Acu-Mox also exhibited quicker recovery of bowel sounds, earlier flatus and defecation, and an accelerated time to their first liquid meal. Li et al[16] similarly reported Acu-Mox’s ability to markedly accelerate the first defecation/exhaust/ambulation and prevent GID in postmajor abdominal surgery patients. Zhou et al[17] applied Acu-Mox to POGD patients after colorectal cancer surgery and observed significantly shorter times to liquid-diet tolerance and bowel-sound recovery, consistent with our results. The promoting effect of Acu-Mox on GI function recovery after surgery may be related to its stimulation of the vagus nerve through solitary nucleus neurons and its regulation of GI peptide hormone secretion[18].

Serum inflammatory indicator assessment showed significant CRP, IL-6, and TNF-α inhibition by Acu-Mox in postabdominal surgery GID patients, consistent with He et al[19], who reported marked CRP and IL-6 reductions on postoperative day 3 after radical gastrectomy for gastric cancer. Acu-Mox may achieve this serum inflammation inhibition effect in our cohort by stimulating Zusanli, which exerts an enteritis preventive effect through intestinal neurons that mediate vagal nerve signals, or by regulating the inflammatory microenvironment balance through vagal-adrenal pathway activation[20,21]. Acu-Mox can inhibit the activity of nuclear factor κB by regulating the Janus kinase 2/signal transducer and activator of transcription 3 signaling cascade mediated by the α7 nicotinic acetylcholine receptor in macrophages, thereby reducing the release of inflammatory factors in the body[22]. According to our data, postabdominal surgery GID patients under Acu-Mox intervention experienced fewer overall complications (ileus, constipation, bloating, abdominal pain; 10.91% vs 34.00%). Ying[23] reported Acu-Mox application in laparoscopic appendectomy patients with enhanced GI function recovery and reduced postoperative complication rates, consistent with the present study.

CONCLUSION

Acu-Mox has a definite effect on postabdominal surgery GID patients. It can effectively relieve clinical symptoms, promote postoperative GI function recovery, inhibit serum inflammation, and provide higher clinical safety. These findings may provide better treatment options for such patients.