The traditional Chinese medicine, electroacupuncture, on enhanced recovery after surgery in the “Healthy China 2030” plan: More robust understanding

Abstract

In 2016, the outline for “Healthy China 2030” plan was issued, and it put forward clear requirements for vigorously inheriting and developing traditional Chinese medicine, which should be an important part of the domestic healthcare system. Electroacupuncture, as a complementary therapy, has significant efficacy and potential in the field of enhanced recovery after surgery based on current available evidence. Despite some challenges, electroacupuncture is expected to play a greater role in healthcare practice through policy support and technological innovation in the future under the “Healthy China 2030” plan.

Key Words: Enhanced recovery after surgery; Electroacupuncture; Traditional Chinese medicine; Complementary therapy

Core Tip: A multicenter randomized controlled trial evaluated electroacupuncture for postoperative early rehabilitation following laparoscopic gastrectomy for gastric cancer, which was published in Gastroenterology. This trial found that electroacupuncture was effective in improving enhanced recovery after surgery. Despite some challenges, we believe that electroacupuncture is expected to play a greater role in healthcare practice through policy support and technological innovation in the future of the “Healthy China 2030” plan.

TO THE EDITOR

I read with great interest the article “Electroacupuncture reduces duration of postoperative ileus after laparoscopic gastrectomy for gastric cancer: A multicenter randomized trial” by Pei et al[1], which found that electroacupuncture may reduce the duration of postoperative ileus, regarding times to first flatus, defecation, water intake, tolerance of solid diet, and ambulation, etc. This study provided compelling evidence on the effectiveness of electroacupuncture on bowel function rehabilitation in the field of enhanced recovery after surgery (ERAS). Another similar randomized controlled trial on laparoscopic gastrectomy demonstrated similar results[2]. A meta-analysis of colorectal surgery showed that postoperative electroacupuncture could improve gastrointestinal function and reduce pain severity[3]. Other than abdominal surgery, electroacupuncture can also be applied in ERAS after various surgical procedures, such as orthopedic, neurological, thoracic, and breast surgeries[4]. Moreover, electroacupuncture is recommended for treating post-gastrectomy gastroparesis. Therefore, electroacupuncture has become a popular complementary treatment for ERAS in China during the past decade.

However, potential limitations of the studies on postoperative electroacupuncture should be addressed. Conflicting findings may be derived from unpublished negative results. The willingness of surgical patients will influence the acceptability of postoperative electroacupuncture, especially among low-risk patients with postoperative ileus. Identification of selective high-risk candidates for postoperative electroacupuncture should be a cost-effective approach. The specific technical training and standardization may restrict the reproducibility of the transcutaneous approach in electroacupuncture. Additionally, both researcher bias and placebo bias must be considered with caution. A more balanced understanding would provide a comprehensive view of the current state of research on electroacupuncture in ERAS.

Despite the above limitations, those multicenter randomized controlled trials have demonstrated that electroacupuncture is more effective as a complementary therapy for ERAS compared to sham treatment or control groups[1,2]. Under the “Healthy China 2030” plan, we believe that the inheritance and development of traditional Chinese medicine (TCM) will become a robust trend in China.

In 2016, the outline for the “Healthy China 2030” plan was issued, and it put forward clear requirements for vigorously inheriting and developing TCM, which should be an important part of the domestic healthcare system. In this plan, the specific role of non-pharmacological therapies of TCM in the prevention and treatment of prevalent and chronic diseases is emphasized. Traditional acupuncture has been a classic and time-honored technique of non-pharmacological therapies in TCM for over 2500 years[5]. Electroacupuncture was modified from traditional manual acupuncture, and combined with an electronic stimulator to deliver low-frequency electrical impulses. It was able to regulate physiological function by modulating nerve activity, promoting blood circulation, and triggering the release of endorphins and other natural pain-relieving chemicals, therefore improving the recovery of physiological functions including gastrointestinal and skeletal muscular motility. To date, electroacupuncture has been widely accepted among both healthcare providers and recipients throughout China.

Furthermore, the development of TCM has kept pace with the times by integrating modern science and technology, such as electroacupuncture, herb purification, and Chinese patent pharmaceuticals, etc. Currently, the concepts and methodologies of evidence-based medicine have been introduced into the downstream field of the TCM industrial chain, and are expected to help to develop a rational and standardized TCM good practice recommendation methodology model, which may guide the formulation of recommendations based on clinical experiences[6,7].

However, there are still many challenges in the high-quality development of TCM in China, including the following: (1) The capacity of scientific innovation and translation; (2) The establishment and cooperation of the whole industrial chain; (3) The standardization of research, manufacture, and clinical practice; (4) The specialty education and training; (5) The integration of TCM with modern medicine; and (6) The cultural promotion into both domestic and international demands[8-10]. Thus, the forward iteration of governmental policy may be desired to systematically and consistently reform TCM development in China.

CONCLUSION

In conclusion, electroacupuncture, as a complementary therapy, has significant efficacy and potential in the field of ERAS based on current available evidence. Despite some challenges, electroacupuncture is expected to play a greater role in healthcare practice through policy support and technological innovation in the future under the “Healthy China 2030” plan.