Published online Nov 27, 2026. doi: 10.4240/wjgs.122391
Revised: July 14, 2026
Accepted: July 27, 2026
Published online: November 27, 2026
Processing time: 152 Days and 18.8 Hours
With an accelerating aging population, the number of elderly patients undergoing gastrointestinal surgery is increasing annually. Postoperative pharmacotherapy efficacy and negative emotion management are critical factors that influence pati
Core Tip: This review summarizes the current evidence regarding the application of traditional Chinese medicine (TCM) emotional nursing in elderly patients undergoing gastrointestinal surgery. It discusses the potential benefits of TCM emotional nursing in improving postoperative recovery, enhancing treatment efficacy, alleviating anxiety and depression, relieving pain, and improving overall quality of life. Furthermore, the review analyzes the limitations of existing studies, including methodological weaknesses and insufficient high-quality evidence, and proposes future research directions to promote standardized clinical application and provide stronger evidence for integrating TCM emotional nursing into perioperative care.
- Citation: Liu YQ, Yao JX, Liu LJ, Zhang YX, Ling QY. Research progress on traditional Chinese medicine emotional nursing for drug efficacy and negative emotions in elderly post-gastrointestinal surgery patients. World J Gastrointest Surg 2026; 18(11): 122391
- URL: https://www.wjgnet.com/1948-9366/full/v18/i11/122391.htm
- DOI: https://dx.doi.org/10.4240/wjgs.122391
Gastrointestinal surgery is a key treatment for benign and malignant diseases of the stomach and colorectal tract in the elderly. Owing to the decline in physiological function and reduced immunity in these patients, often compounded by underlying conditions such as hypertension and diabetes, they are prone to postoperative complications. These complications include gastrointestinal dysfunction, surgical site infections, pain, and overall recovery in this population tends to be relatively slow. Clinical management typically involves analgesia, anti-infective therapy, gastrointestinal motility enhancement, and nutritional support. However, the efficacy of these interventions is often influenced by factors such as the patient’s physical constitution, psychological state, and adherence to treatment. Concurrently, postoperative pain, surgical trauma, and concerns regarding prognosis frequently trigger negative emotions such as anxiety and depression, which further exacerbate the body’s stress response, diminish treatment efficacy, and delay the rehabilitation process.
Rehabilitation for geriatric conditions emphasizes synergy between the body and mind. Traditional Chinese medicine (TCM) emotional care, centered on the principle of “unity of form and spirit”, focuses on harmonizing emotional regulation with organ function. It offers advantages such as simplicity of application, low cost, noninvasiveness, and high patient acceptance, making it particularly suitable for elderly patients. In recent years, the combined application of emotional care with modern rehabilitation and pharmacological treatments has become increasingly common, demonstrating positive effects in improving emotional states, alleviating stress responses, enhancing treatment efficacy, and promoting postoperative recovery. This article aims to review the current progress in the application of TCM emotional care among elderly patients following gastrointestinal surgery, with a view to provide guidance for clinical nursing practice.
In this review, the term “drug efficacy” is used in a broad clinical context. Rather than solely referring to the intrinsic pharmacological activity of medications, it encompasses factors that may influence therapeutic effectiveness in elderly postoperative patients, including medication adherence, gastrointestinal absorption, pharmacodynamic responsiveness, symptom control, and overall clinical outcomes. Because emotional status may affect several of these processes, emotional nursing is discussed as a complementary strategy that may indirectly contribute to the optimization of treatment effectiveness (Figure 1).
Emotional care in TCM is rooted in the theories of “the unity of form and spirit” and “emotions causing disease” as outlined in the Huangdi Neijing (The Yellow Emperor’s Classic of Internal Medicine), which holds that emotional fluctuations are closely linked to the functions of the internal organs. Excessive or imbalanced emotions can lead to distur
TCM emotional care is patient-centered and emphasizes the synergistic recovery of both the mind and body. It employs various methods, including verbal communication, behavioral guidance, environmental adjustments, and appropriate TCM techniques, to regulate emotions and alleviate negative feelings. Its core principles are reflected in the following three aspects: First, precise diagnosis-based care, whereby individualized care plans are formulated according to the patient’s emotional characteristics, constitutional differences, and postoperative stage[5]. For patients with marked anxiety or insomnia, the focus is on emotional guidance combined with auricular acupressure using bean-sized pellets and pressure on acupoints that calm the mind. For those with poor appetite, abdominal distension, or fatigue, care is tailored to their constitutional type, with a focus on dietary regulation and guidance on restoring spleen and stomach function, ensuring that nursing measures are highly targeted. Second, it involves integrated mind-body intervention, combining emotional regulation with dietary management, acupoint stimulation, rehabilitation training, and pharmacological care to achieve harmony between the physical and mental aspects[6]. The “emotional regulation-diet-acupoint” integrated intervention model explored in perioperative practice involves, in addition to routine nursing care, the simultaneous provision of emotional counselling and communication support, combined with postoperative dietary guidance and supplemented by appropriate TCM techniques such as acupoint pressure and auricular acupressure. This approach aims to alleviate patients’ anxiety, pain, poor sleep, and delayed gastrointestinal recovery, embodying a nursing philosophy that promotes the synergistic advancement of “emotional regulation-organ function-postoperative rehabilitation”. Third, a step-by-step intervention approach is adopted, using phased psychological support and communication guidance to enhance patients’ ability to cope positively[7]. For example, preoperative care focuses on emotional reassur
Elderly patients who have undergone gastrointestinal surgery often face multiple sources of stress, including surgical trauma, pain, gastrointestinal dysfunction, and uncertainty about their prognosis, which can easily trigger negative emotions such as anxiety and depression. Such emotional disturbances frequently lead to reduced treatment compliance and poor adherence to medication, ultimately resulting in diminished efficacy of drug therapy and delayed postoperative functional recovery[9]. Emotional care in TCM is currently undergoing a paradigm shift. Intervention strategies have evolved from a single-dimensional model to a multidimensional, precision-oriented, and collaborative approach, forming a multidimensional integration of rehabilitation training, dietary management, and medication management. This establishes a rehabilitation care framework for elderly patients that harmonizes their physical and mental well-being[10,11].
Before implementing individualized emotional nursing, elderly patients should undergo standardized psychological screening using internationally recognized assessment instruments. The Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, Geriatric Depression Scale, and Generalized Anxiety Disorder-7 are recommended for evaluating anxiety and depressive symptoms, whereas the Confusion Assessment Method and Pittsburgh Sleep Quality Index may be used to identify postoperative delirium and sleep disorders, respectively. Based on the assessment results, patients are stratified into low-, moderate-, and high-risk groups, allowing nurses to develop individualized intervention plans. Patients with mild emotional symptoms may benefit from health education and supportive communication, whereas those with moderate symptoms may require structured psychological interventions combined with music therapy or relaxation training. Patients with severe anxiety or depression should receive multidisciplinary management involving psychological consultations, family participation, and TCM emotional nursing interventions. Such a standardized assessment-based approach may contribute to the feasibility and reproducibility of precision emotional nursing.
Targeted verbal counselling has moved beyond the traditional binary paradigm of listening and comforting to emphasize proactive communication and the provision of psychological support. Through effective interaction, nursing staff gain insight into the underlying mechanisms of patients’ emotional states, employing strategies such as explanation, encouragement, and guidance to alleviate anxiety and depression, thereby reinforcing their belief in recovery. At the same time, they use plain language to explain the nature of the surgery, the rehabilitation timeline, and the targets of drug action, providing tailored support for those with a low pain threshold or low mood and engaging family members in collaborative communication to optimize treatment compliance[12].
Music therapy, mindfulness training, relaxation therapy, and environmental optimization are evidence-based, non-pharmacological nursing interventions that have been widely applied in modern perioperative psychological care. Within the framework of TCM emotional nursing, these interventions are integrated with syndrome differentiation and emotional regulation theory to form a holistic mind-body intervention model.
Emotional regulation nursing employs the “overcoming emotions with emotions” theory as its theoretical framework, integrating diverse approaches such as music therapy, recreational activities, and relaxation training to deliver targeted interventions. For patients with the anxiety subtype, soothing music combined with breathing relaxation techniques may be applied, while for those with the depression subtype, emotional re-regulation is achieved through activities such as board games, vocal training, or watching comedy, supplemented by mindfulness meditation training. Furthermore, simple emotional regulation exercises developed based on meridian theory help relax the mind and body and optimize sleep architecture[13,14].
In addition to improving ward cleanliness, regulating the microenvironmental temperature and humidity, and optimizing the lighting spectrum, scenario-based environmental interventions create a tranquil and comfortable recuperative microenvironment by placing green plants, playing soothing music, and implementing acoustic management. Simultaneously, elements of TCM culture are incorporated to personalize the space, such as displaying health-promoting aphorisms, setting up a rehabilitation progress wall, and creating a TCM corner to alleviate negative emotions and enhance the quality of the patient experience[15].
Integrated traditional Chinese and Western medicine nursing combines emotional nursing, TCM dietary regulation, acupoint nursing with modern pharmacotherapy, and rehabilitation training to establish a comprehensive intervention paradigm integrating “emotional state-dietary regimen-acupoints-pharmacotherapy”. Dietary adjustments adhere to the principles of lightness and easy digestibility, with dynamic modifications based on the patients’ emotional states and constitutional typing. Acupoint nursing primarily targets core points such as Baihui (GV20), Shenmen (SP6), Neiguan (PC6), Zusanli (ST36), and Zhongwan (CV12) to calm the mind, stabilize emotions, strengthen the spleen, and harmonize the stomach, ultimately leading to improved gastrointestinal function, alleviation of negative emotions, and promotion of postoperative recovery[16].
Postoperative management in geriatric gastrointestinal surgery primarily focuses on pain relief, infection control, promotion of gastrointestinal motility, and nutritional support. Commonly used medications include opioids, nonsteroidal anti-inflammatory drugs, cephalosporin antibiotics, and prokinetic agents such as mosapride and domperidone. The efficacy of these medications is influenced not only by the patient’s physical condition but also by their psychological state, gastrointestinal function, and adherence to treatment. TCM emotional care can work synergistically with pharmacological treatments by regulating emotions, improving gastrointestinal function, and enhancing compliance, thereby enhancing overall efficacy and reducing adverse reactions.
In elderly patients, the decline in gastrointestinal physiological function, coupled with slowed gastrointestinal motility and reduced secretion of digestive juices following surgery, results in a state of underlying gastrointestinal weakness[17]. Furthermore, negative emotions such as postoperative anxiety and depression can, through “brain-gut regulation”, further inhibit gastrointestinal smooth muscle contractions, interfere with the secretion of digestive fluids such as gastric acid and pepsin, and disrupt the balance of the gut microbiota. This impedes the dissolution and absorption of drugs within the gastrointestinal tract, reducing the bioavailability of oral medications and delaying the recovery of gastrointestinal functions such as postoperative flatus and bowel movements[18].
TCM emotional care is based on the core principles of “soothing the liver and regulating qi, and strengthening the spleen and harmonizing the stomach” (improving gastrointestinal motility and digestive function). Interventions such as emotional counselling, acupressure (e.g., Zusanli and Zhongwan), and dietary management can regulate the flow of qi, improve the transport and transformation functions of the spleen and stomach, and directly promote gastrointestinal motility and secretion of digestive fluids[19]. Furthermore, emotional care can regulate the structure of the gut microbiota, which increases the abundance of beneficial bacteria and reduces the colonization of harmful bacteria, thereby repairing the intestinal mucosal barrier and optimizing the intestinal environment[20]. In addition, when combined with derivative interventions such as acupuncture or electrical stimulation of acupoints, emotional care can reduce the risk of postoperative gastrointestinal dysfunction, accelerate the recovery of gastrointestinal function, and lay a physiological foundation for the efficacy of pharmacological treatments[21].
Surgical trauma can activate the body’s stress response system, while postoperative negative emotions, acting as psychological stressors, further exacerbate disruptions in the neuro-endocrine-immune network, resulting in a “trauma-emotion” dual stress effect[17]. This stress response can influence drug metabolism and efficacy via multiple pathways: On the one hand, under stress conditions, the hypothalamic-pituitary-adrenal axis becomes overactivated, leading to increased cortisol secretion, which accelerates the activity of hepatic drug-metabolizing enzymes, shortens the drug half-life, and appears to influence the duration of drug action[22]. On the other hand, stress-induced inflammatory responses, such as elevated levels of pro-inflammatory factors like tumor necrosis factor-α, interleukin-6, and interleukin-1β, weaken the body’s sensitivity to analgesics and anti-infective drugs, leading to poor analgesic efficacy and increased difficulty in controlling infections. Simultaneously, they may induce adverse outcomes such as exacerbated postoperative pain and delirium, with particularly significant effects on elderly patients[23,24].
Treatment adherence is a prerequisite for medication efficacy. Because of issues such as memory loss, declining cognitive function, and lack of understanding of their condition and medication, elderly patients are prone to missing doses, taking medication incorrectly, or adjusting their dosage without medical advice. This behavior directly undermines the standar
TCM emotional care, using a multidimensional approach combining “emotional guidance, health education and behavioral intervention”, can effectively improve treatment adherence among elderly patients. First, nursing staff use personalized communication to alleviate postoperative anxiety and fear, thereby dispelling patients’ concerns regarding recovery and medication use. Second, health education is delivered in accordance with TCM theory, using plain language to explain the effects of medication, dosing schedules, adverse reactions, and the link between emotional regulation and postoperative recovery, thereby reinforcing patients’ understanding of proper medication use. Finally, measures such as medication reminders, collaborative supervision by family members, and personalized nursing follow-ups are employed to compensate for the cognitive and memory deficits common in elderly patients[25].
Elderly patients undergoing gastrointestinal surgery often experience negative emotions such as anxiety, depression, fear, irritability, and loneliness following the procedure, due to surgical trauma, pain, delayed recovery of gastrointestinal function, disturbed sleep, and concerns about the outcome of their illness. Such emotions not only diminish patients’ subjective sense of well-being and confidence in their recovery but also affect the quality of their rest, their engagement in rehabilitation, and their ability to self-regulate, thereby hindering overall perioperative recovery. Consequently, this advocates the implementation of categorized, syndrome-differentiated, and tiered progressive interventions tailored to the patient’s age, postoperative stage, emotional type, and specific clinical presentation. Consequently, TCM emotional care holds significant value in the management of negative emotions in elderly patients following gastrointestinal surgery.
Anxiety is the most common negative emotion experienced by elderly patients following gastrointestinal surgery. It primarily manifests as nervousness and restlessness, repeated inquiries about the condition, and concerns regarding pain and prognosis, and may be accompanied by physical reactions such as palpitations, sweating, and insomnia. In TCM, this is attributed largely to stagnation of liver qi and restlessness of the mind, which may correspond to relieving autonomic nervous system hyperactivity and reducing stress-related neuroendocrine responses. Nursing care should therefore be guided by the principles of regulating the liver and harmonizing qi, as well as calming the mind and soothing the spirit (calming the mind: Reducing sympathetic activation and improving emotional regulation)[17,26]. In clinical practice, particular attention should be paid to identifying patients with significant pain, pronounced sleep disturbances, high information needs, and severe concerns regarding prognosis. Uncertainty should be alleviated through personalized communication, combined with measures such as acupressure at points including Baihui, Shenmen, and Neiguan; auricular seed therapy; and optimization of the ward environment to relieve mental tension and difficulty falling asleep, thereby promoting early postoperative emotional stability[23,26].
Depressive symptoms often manifest subtly in elderly postoperative patients and commonly present as low mood, reduced speech, diminished interest, loss of appetite, fatigue, and lack of motivation for rehabilitation. According to TCM pattern differentiation, these symptoms are frequently associated with spleen-stomach deficiency, qi and blood deficiency, inadequate nourishment of the heart and spirit, and emotional stagnation. Therefore, nursing care should focus on strengthening the spleen, tonifying qi, nourishing the heart, calming the spirit, and regulating the liver to resolve stagnation[17,26]. Nursing staff should pay particular attention to patients who are silent or taciturn, show low engagement in rehabilitation, or exhibit a marked loss of appetite. Self-efficacy should be enhanced through supportive communication, encouragement via small goals, and continuous observation[24,26]; simultaneously, measures such as diet therapy based on syndrome differentiation, eating small meals frequently, re-establishing daily rhythms, and incorporating five-element music and light recreational activities should be employed to improve negative experiences and promote active rehabilitation[27,28].
In addition to anxiety and depression, elderly postoperative patients frequently experience delirium, sleep disorders, social isolation, and postoperative cognitive decline, all of which are closely associated with prolonged hospitalization, reduced treatment adherence, and poor recovery outcomes. Routine perioperative screening using standardized tools such as the Confusion Assessment Method, Pittsburgh Sleep Quality Index, Mini-Mental State Examination, and Montreal Cognitive Assessment are recommended to facilitate early identification of these conditions[21,23]. TCM emotional nursing may contribute to comprehensive management through individualized emotional support, sleep-promoting interventions, five-element music therapy, auricular acupressure, acupoint stimulation, environmental optimization, and family-centered care. Combining standardized assessments with individualized emotional nursing may improve sleep quality, reduce delirium risk, enhance cognitive recovery, and strengthen social support, thereby promoting holistic postoperative rehabilitation in elderly patients[17,18,23].
TCM emotional nursing has achieved certain outcomes in the postoperative rehabilitation of elderly patients undergoing gastrointestinal surgery. However, multiple challenges remain during clinical implementation, constraining its standardized development and overall efficacy improvement.
Currently, there is a shortage of multiskilled professionals within the nursing workforce who possess a foundation in TCM theory, emotional care skills, and psychological communication abilities. Some staff members have not received systematic training in TCM emotional care; they have limited theoretical knowledge, and their practical techniques are often non-standardized, such as acupoint massage and auricular seed therapy. Their capacity for psychological assessment and counselling is also limited, resulting in interventions that often remain as superficial reassurance. This makes it difficult to provide precise individualized emotional care and effectively address the diverse rehabilitation needs of elderly patients.
There is a lack of standardized clinical protocols, clearly defined indications, and an evaluation system for outcomes. Nursing plans are often formulated based on individual experience, resulting in significant variations in implementation across institutions and among staff. Some practices place excessive emphasis on uniformity of form, neglecting individual differences in patients’ physical constitution, emotional state, cognitive level, and cultural background. However, there is insufficient integration of emotional care with drug therapy, rehabilitation training, and other aspects, and a systematic, replicable pathway for mind-body coordinated care has yet to be established. Implementation-oriented research indicates that an “evidence-practice gap” is prevalent in the integration of traditional medicine; pathways must be designed in accordance with the specific context of the health system rather than simply applying a standardized model[29].
Existing research is predominantly characterized by small sample sizes and single-center observational designs, with a scarcity of high-quality randomized controlled trials and long-term follow-up data. Research designs lack rigor, with outcome measures largely focusing on short-term emotional changes, while paying limited attention to key dimensions such as quality of life, complications, and long-term prognosis. Exploration of mechanisms of action remains largely anecdotal, lacking empirical explanations grounded in modern scientific approaches such as neuroendocrinology and biomarkers. Methodological evaluations of acupuncture-based interventions have revealed significant shortcomings in areas such as control group design, standardization of interventions, and outcome measurement[30], which severely limit the strength of the evidence and its value in clinical translation.
Some elderly patients and their families have misconceptions regarding emotional care, viewing it as “nonessential” psychological comfort, resulting in low levels of willingness to participate and cooperation. Influenced by cultural habits or difficulties in expressing emotions, patients often conceal their true feelings, thereby increasing the difficulty of assessment. During the post-discharge home-based rehabilitation phase, family members often focus on the recovery of physical function while neglecting the continuity of psychological support, which leads to the discontinuation of emotional interventions. Research indicates that family members’ health literacy and level of involvement in care directly influence the quality of the patient’s discharge preparation and the effectiveness of the rehabilitation transition[31]; preoperative psychological state and levels of social support are significantly correlated with postoperative resilience[32], and a lack of awareness tends to undermine overall rehabilitation efficacy.
To address the aforementioned bottlenecks, the in-depth development of TCM emotional nursing must adhere to a problem-oriented approach, focusing on capacity building, system optimization, evidence-based reinforcement, and collaborative support, thereby promoting its standardized, precise, and sustainable application in postoperative rehabilitation for elderly patients.
A tiered training mechanism comprising “fundamental theory, practical skills, and clinical innovation” has been established, incorporating TCM theories on emotions, communication skills for the elderly, and case studies into the core curriculum. Structured communication training can significantly improve the quality of person-centered care, with the expression of empathy and adaptability of communication with older adults being key supporting factors[33,34].
By bringing together multidisciplinary teams comprising TCM, surgery, psychology, and rehabilitation specialists, we have developed standardized operational guidelines and a core indicator system covering assessment, intervention, and evaluation. We have also incorporated individualized assessment modules such as constitutional identification, emotional well-being scales, and cultural background, thereby achieving an organic integration of “standardized protocols” and “personalized adjustments”. We promote close collaboration between emotional care and perioperative medication management, nutritional support, and functional training to establish an integrated pathway for mind-body care. Perioperative management practices demonstrate that dynamically aligning structured processes with patients’ individual needs can significantly enhance consistency of care and improve the patient experience[35,36].
Designing large-scale, multicenter randomized controlled trials with long-term follow-up points should be prioritized to systematically evaluate the impact of emotional care on mood improvement, medication adherence, complication management, and long-term quality of life. By integrating objective indicators such as neuroimaging, inflammatory markers and autonomic nervous system function, the modern scientific implications of the “unity of form and spirit” theory should be thoroughly elucidated. In response to issues such as high heterogeneity and the lack of long-term evidence in digital health intervention studies[37,38], it is necessary to strengthen protocol standardization, process quality control, and harmonization of outcome measures, thereby providing high-level evidence-based support for clinical implementation.
A diverse range of educational resources should be developed, such as science popularization videos, illustrated handbooks, and mobile microcourses, to clearly explain the scientific principles and rehabilitative value of emotional care, thereby enhancing the level of understanding and sense of active participation among patients and their families. Establishing a coordinated mechanism of “in-hospital guidance-family implementation-community follow-up” can be used to train family members in basic emotional observation and support techniques; digital tools such as “smart wristbands combined with emotional health apps” can enable real-time emotional monitoring and personalized intervention reminders, thereby facilitating a seamless transition between in-hospital and community-based rehabilitation[39,40] and strengthening a sustainable emotional support network.
Postoperative geriatric gastrointestinal surgery patients are prone to significant negative emotions, and the efficacy of medication is subject to interference from multiple factors that directly affect recovery outcomes. TCM emotional care considers “the unity of form and spirit” and “emotional factors as the root cause of disease”. Through innovative appro
Future research should establish standardized assessment protocols that integrate internationally recognized psychological assessment tools with TCM syndrome differentiation, to facilitate individualized emotional nursing. High-quality multicenter randomized controlled trials are also warranted to clarify the comparative effectiveness of TCM-specific interventions and general psychological nursing strategies while expanding outcome evaluation to include postoperative delirium, sleep quality, cognitive function, social participation, and long-term quality of life.
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