Published online Sep 27, 2026. doi: 10.4240/wjgs.119666
Revised: May 20, 2026
Accepted: June 25, 2026
Published online: September 27, 2026
Processing time: 157 Days and 23.6 Hours
Gastrointestinal injury is frequently observed in patients with colorectal cancer (CRC) postoperatively, necessitating improved postoperative management.
To analyze the effects of auricular vagus nerve stimulation with press needles combined with moxibustion at the Zusanli acupoint on gastrointestinal function and hormones as well as serum inflammatory markers in patients with CRC post
A total of 105 patients with CRC who underwent surgery from April 2022 to April 2025 were selected as study participants, 50 patients treated with moxibustion at Zusanli assigned to the control group, whereas 55 patients who received auricular vagus nerve stimulation with press needles combined with moxibustion at Zusanli were included in the research group. Clinical data collected from both groups included clinical efficacy, postoperative pain assessed using the visual analog scale, gastrointestinal function (e.g., time to recovery of bowel sounds, time to first flatus, and time to first defecation), gastrointestinal hormones (e.g., gastrin and motilin), serum inflammatory markers (e.g., C-reactive protein, interleukin-6, tumor necrosis factor), and quality of life assessed using the Short Form Health Survey.
Compared with the control group, the research group showed significantly higher total effective rate (90.91% vs 72.00%), greater postoperative pain relief, shorter time to recovery of bowel sounds, time to first flatus, and time to first defecation, higher postoperative gastrin, motilin, and Short Form Health Survey scores, and lower C-reactive protein, interleukin-6, and tumor necrosis factor-α.
Auricular vagus nerve stimulation with press needles combined with moxibustion at Zusanli significantly im
Core Tip: Several analyses revealed that this combined therapy significantly improved treatment efficacy, reduced pain at 12 hours and 48 hours postoperatively, and promoted gastrointestinal function recovery. It also exerted positive effects in suppressing serum inflammation and improving quality of life, providing a safe, effective, and non-invasive rehabilitation strategy integrating traditional Chinese and Western medicine.
- Citation: Chen XX, Lin N, Chen YB, Zhou XH, Zhang YJ. Effects of auricular vagus nerve stimulation with press needles plus Zusanli moxibustion on patients with colorectal cancer postoperatively. World J Gastrointest Surg 2026; 18(9): 119666
- URL: https://www.wjgnet.com/1948-9366/full/v18/i9/119666.htm
- DOI: https://dx.doi.org/10.4240/wjgs.119666
Colorectal cancer (CRC) is the third most common malignancy in men and the second most common cancer in women[1]. The risk of mortality from CRC varies by region, with the highest mortality risk observed in Asia (54.2%), followed by Europe (26.2%)[2]. Obesity, processed foods, sugary beverages, alcohol consumption, and smoking all increase CRC risk[3]. Surgical intervention remains the gold standard for CRC treatment, and its efficacy has been well established[4]. However, gastrointestinal stimulation induced by systemic diseases, anesthesia, surgery, and inflammatory responses may impair gastrointestinal function, potentially causing adverse events such as intestinal dilation, intestinal miscolonization, and abdominal bloating, which further lead to poor nutritional status, prolonged hospitalization, and unfavorable clinical outcomes[5,6]. Therefore, promoting postoperative gastrointestinal function recovery in patients with CRC is clinically significant.
According to traditional Chinese medicine (TCM), the core pathogenesis of postoperative gastrointestinal dysfunction after CRC surgery is associated with surgical trauma, which damages the spleen, stomach, and meridians, resulting in stagnation of qi and blood, disordered qi ascent and descent, and obstruction of visceral qi[7]. Therefore, strengthening the spleen, regulating qi, eliminating dampness, promoting blood circulation, and removing blood stasis are considered major treatment strategies for protecting gastrointestinal function in patients with CRC postoperatively[8]. The Zusanli acupoint is commonly used in the treatment of gastrointestinal diseases and can improve patients’ digestive function and alleviate gastrointestinal discomfort when combined with moxibustion therapy[9,10]. Moxibustion is an external TCM therapy in which moxa or other herbs are burned on specific acupoints to provide thermal stimulation, thereby warming and unblocking meridians and harmonizing qi and blood[11]. Moxibustion at Zusanli may alleviate gastrointestinal mucosal damage and gastrointestinal motility disorders by regulating local gastrointestinal inflammation, oxidative stress, and immune microenvironment, thereby exerting potential protective effects on the gastrointestinal function of patients with CRC postoperatively[12]. Auricular vagus nerve stimulation with press needles is a non-invasive therapy combining TCM auricular acupoint theory with modern neuromodulation principles. Through superficial intradermal puncture at specific ear acupoints, including Tinggong, Yifeng, and Shenmen, the auricular branch of the vagus nerve is gently stimulated to regulate the autonomic nervous system and central nervous system functions[13]. This therapy has been applied not only in patients with chronic insomnia, xerophthalmia, and myopia, but also in patients with CRC following laparoscopic radical resection to prevent ileus via autonomic nerve regulation and anti-inflammatory effects[14-16].
Currently, relevant clinical research on auricular vagus nerve stimulation with press needles combined with moxi
A total of 105 postoperative CRC patients admitted to Sanmen People’s Hospital were enrolled as the study’s subjects, with 50 patients receiving moxibustion at Zusanli assigned to the control group, whereas 55 patients receiving auricular vagus nerve stimulation with press needles combined with moxibustion at Zusanli were included in the research group. No statistically significant differences were observed in baseline data between the two groups (P > 0.05), indicating good clinical comparability.
Inclusion criteria: (1) Meeting the diagnostic criteria for CRC; (2) Expected survival > 6 months; (3) American Society of Anesthesiologists classification I-II; (4) Tumor-node-metastasis stage I-III; (5) Indication for laparoscopic radical resection of CRC; and (6) Complete medical records.
Exclusion criteria: (1) Receipt of radiotherapy, chemotherapy, or targeted therapy preoperatively; (2) History of abdo
The control group received moxibustion at Zusanli. Treatment began on postoperative day 1. The moxa stick was ignited, placed in a moxibustion box, and fixed at the Zusanli acupoint for at least 15 minutes each session until local skin flushing occurred. Treatment was administered once daily, with 14 consecutive days constituting one treatment course, totaling 8 courses.
The research group received auricular vagus nerve stimulation with press needles in addition to the treatment admi
Clinical efficacy: Markedly effective: Symptoms and signs, including abdominal distension and pain, nausea, and vomiting, disappeared; all nutritional indicators returned to normal; and the patients exhibited a good mental state after treatment; effective: Discomfort symptoms were relieved and all nutritional indicators returned to normal levels after treatment; ineffective: Symptoms did not improve significantly after treatment, and patients exhibited a poor mental state.
Postoperative pain: Pain intensity was assessed using the Visual Analog Scale (VAS) at 6, 12, 24, and 48 hours postoperatively. Score ranged from 0 to 10, with higher scores indicating greater pain intensity.
Gastrointestinal function: The time to recovery of bowel sounds, time to first flatus, and time to first defecation were recorded in both groups.
Gastrointestinal hormones: Fasting venous blood samples (5 mL) was drawn from each patient before treatment and at 3 days after treatment. Serum was separated via centrifugation, and gastrin (GAS) and motilin (MTL) levels were measured using radioimmunoassay.
Serum inflammatory markers: Preoperative and postoperative serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured using enzyme-linked immunosorbent assay.
Quality of life: Quality of life was assessed pre- and postintervention using the Short Form Health Survey (SF-36) scale, including physical functioning (PF), bodily pain (BP), role-emotional (RE), social functioning (SF), mental health (MH), and general health (GH). Total score was 0-100 points, with higher scores indicating better quality of life.
Continuous variables are expressed as mean ± SD. Inter-group comparisons were performed using the independent sample t-test, where within-group comparisons before and after treatment were analyzed using the paired t-test. Cate
As shown in Table 1, baseline data, including sex, age, body mass index, tumor-node-metastasis staging, tumor type, pathological type, and tumor diameter, were comparable between the research and control groups (P > 0.05).
| Factors | n | Control group (n = 50) | Research group (n = 55) | Z/t/χ2 | P value |
| Gender | 0.017 | 0.896 | |||
| Male | 56 | 27 (54.00) | 29 (52.73) | ||
| Female | 49 | 23 (46.00) | 26 (47.27) | ||
| Age (years) | 105 | 55.22 ± 8.00 | 57.62 ± 9.48 | 1.395 | 0.166 |
| Body mass index (kg/m2) | 105 | 23.00 (21.00, 25.00) | 23.00 (21.00, 25.00) | -0.013 | 0.990 |
| Tumor-node-metastasis staging | 0.416 | 0.812 | |||
| I | 21 | 10 (20.00) | 11 (20.00) | ||
| II | 41 | 21 (42.00) | 20 (36.36) | ||
| III | 43 | 19 (38.00) | 24 (43.64) | ||
| Tumor type | 0.089 | 0.766 | |||
| Colon cancer | 52 | 24 (48.00) | 28 (50.91) | ||
| Rectal cancer | 53 | 26 (52.00) | 27 (49.09) | ||
| Pathological type | 0.192 | 0.661 | |||
| Adenocarcinoma | 93 | 45 (90.00) | 48 (87.27) | ||
| Other | 12 | 5 (10.00) | 7 (12.73) | ||
| Tumor diameter (cm) | 105 | 3.60 (3.16, 4.09) | 3.64 (3.11, 4.37) | -0.549 | 0.583 |
The numbers markedly effective, effective, and ineffective cases were 27, 23, and 5, respectively, in the research group and 20, 16, and 14, respectively, in the control group. The research group demonstrated significantly higher total effective rate than the control group (90.91% vs 72.00%; P = 0.012; Table 2).
| Factors | Control group (n = 50) | Research group (n = 55) | χ2 | P value |
| Markedly effective | 20 (40.00) | 27 (49.09) | ||
| Effective | 16 (32.00) | 23 (41.82) | ||
| No effect | 14 (28.00) | 5 (9.09) | ||
| Total effective rate | 36 (72.00) | 50 (90.91) | 6.318 | 0.012 |
No significant differences in VAS scores were observed between the two groups at 6 hours [7.00 (6.00, 8.00) points vs 7.00 (5.00, 8.00) points] or 24 hours [3.00 (3.00, 5.00) points vs 4.00 (3.00, 5.00) points] postoperatively (P > 0.05). However, at 12 hours [4.00 (3.00, 5.00) points vs 6.00 (5.00, 7.00) points] and 48 hours [3.00 (2.00, 3.00) points vs 3.00 (2.00, 5.00) points] postoperatively, the VAS scores in the research group were considerably lower than those in the control group (P < 0.05; Table 3).
| Factors | Control group (n = 50) | Research group (n = 55) | Z | P value |
| Visual Analog Scale | ||||
| 6 hours after surgery | 7.00 (5.00, 8.00) | 7.00 (6.00, 8.00) | -1.346 | 0.178 |
| 12 hours after surgery | 6.00 (5.00, 7.00) | 4.00 (3.00, 5.00) | -5.579 | < 0.001 |
| 24 hours after surgery | 4.00 (3.00, 5.00) | 3.00 (3.00, 5.00) | -0.999 | 0.318 |
| 48 hours after surgery | 3.00 (2.00, 5.00) | 3.00 (2.00, 3.00) | -2.468 | 0.014 |
As shown in Table 4, the research group exhibited significantly shorter time to recovery of bowel sounds (36.96 ± 11.54 hours vs 45.64 ± 15.91 hours), time to first flatus (59.42 ± 11.82 hours vs 69.90 ± 13.98 hours), and time to first defecation [5.00 (4.00, 6.00) hours vs 7.00 (6.00, 8.00) hours] than the control group (P < 0.01).
| Factors | Control group (n = 50) | Research group (n = 55) | Z/t | P value |
| Time to return of bowel sounds (hours) | 45.64 ± 15.91 | 36.96 ± 11.54 | 3.221 | 0.002 |
| Time to flatus (hours) | 69.90 ± 13.98 | 59.42 ± 11.82 | 4.160 | < 0.001 |
| Time to defecation (hours) | 7.00 (6.00, 8.00) | 5.00 (4.00, 6.00) | -5.139 | < 0.001 |
Figure 2 shows no significant intergroup differences in baseline GAS (147.56 ± 35.35 pg/mL vs 147.04 ± 24.86 pg/mL) or MTL (274.75 ± 28.46 pg/mL vs 270.20 ± 28.55 pg/mL) levels before treatment (P > 0.05). However, after three days of treatment, GAS (108.47 ± 18.51 pg/mL vs 93.18 ± 14.82 pg/mL) and MTL (224.27 ± 32.17 pg/mL vs 212.46 ± 22.01 pg/mL) levels were significantly reduced in both groups (P < 0.05), with the research group exhibiting higher levels than the control group (P < 0.05).
Figure 3 shows no significant differences in preoperative CRP (5.62 ± 2.30 mg/L vs 6.08 ± 1.98 mg/L), IL-6 (18.38 ± 4.78 ng/L vs 17.58 ± 3.80 ng/L), or TNF-α (30.49 ± 6.09 ng/L vs 30.14 ± 4.96 ng/L) levels between groups (P > 0.05). However, all three markers increased significantly after 3 days of treatment (P < 0.05) and were significantly lower in the research group (CRP: 14.87 ± 3.86 mg/L vs 25.00 ± 4.68 mg/L; IL-6: 37.47 ± 5.09 ng/L vs 48.58 ± 5.86 ng/L; and TNF-α: 45.55 ± 5.00 ng/L vs 57.12 ± 6.40 ng/L) (P < 0.05).
The SF-36 was used to evaluate the quality of life in both groups, including PF (60.67 ± 6.92 points vs 58.60 ± 5.03 points), BP (54.09 ± 5.90 points vs 55.56 ± 5.01 points), RE (58.69 ± 6.51 points vs 59.82 ± 5.25 points), SF (54.02 ± 5.42 points vs 53.00 ± 5.78 points), MH (51.69 ± 6.13 points vs 51.66 ± 5.73 points), and GH (62.60 ± 7.05 points vs 64.38 ± 6.52 points). No significant inter-group differences were observed in the SF-36 scores across all dimension before treatment (P > 0.05). After treatment, the SF-36 scores increased significantly in both groups (P < 0.05) and were significantly higher in the research group (PF: 76.87 ± 7.69 points vs 72.16 ± 6.61 points; BP: 72.76 ± 7.89 points vs 67.30 ± 6.68 points; RE: 77.00 ± 9.88 points vs 71.66 ± 7.46 points; SF: 68.31 ± 7.07 points vs 62.38 ± 7.01 points; MH: 68.13 ± 8.35 points vs 60.12 ± 5.72 points; and GH: 76.80 ± 7.22 points vs 70.88 ± 6.23 points) (P < 0.05; Figure 4).
This study comprehensively evaluated the effects of moxibustion at Zusanli alone vs auricular vagus nerve stimulation with press needles combined with moxibustion at Zusanli on gastrointestinal function and hormones as well as serum inflammatory markers in patients with CRC postoperatively. Our findings demonstrated that the combined therapy achieved superior efficacy, suggesting a synergistic therapeutic effect. Moxibustion at Zusanli restores gastrointestinal function after intestinal cancer surgery by invigorating the spleen and stomach, tonifying vital energy, and regulating qi[17]. This therapy also bidirectionally regulates peripheral blood lymphocytes and neutrophils in patients with CRC postoperatively, improves T-lymphocyte subsets and natural killer cells, and accelerates immune function recovery[18]. Auricular vagus nerve stimulation with press needles may inhibit CRC lymphangiogenesis by regulating the vascular endothelial growth factor C/vascular endothelial growth factor receptor 3/phosphatidylinositol 3-kinase/protein kinase B signaling pathway, thereby controlling tumor progression and improving intestinal barrier function[8,19,20]. These findings indicate that the two therapies improve tumor progression and gastrointestinal function through different pathways, which may partially explain the synergistic strengthening effect of the combined therapy. Zhang et al[21] similarly reported that acupuncture targeting acupoints such as Zusanli, Shangjuxu, Neiguan, and Sanyinjiao effectively promoted gastrointestinal function recovery and shortened postoperative ileus duration in patient with CRC, complementing this study’s findings.
Additionally, the combined therapy significantly reduced the pain at 12 and 48 hours after surgery. Auricular point stimulation at Jiaogon and Shenmen may regulate the central descending pain inhibitory system, whereas moxibustion at Zusanli yields local warming stimulation and promotes endogenous opioid peptide release, working synergistically to reduce pain sensitivity. Wang et al[22] also reported that auricular vagus nerve stimulation with press needles alleviated motion-induced pain in patients after open radical gastrectomy. Moreover, the combined therapy markedly improved gastrointestinal function recovery in patients with CRC, mainly manifesting as shortened times to recovery of bowel sounds, first flatus, and first defecation. Auricular vagus nerve stimulation at Jiaogan and Shenmen with press needles is believed to improve autonomic nervous dysfunction, while stimulation at the stomach, large intestine, and small intestine acupoints reduces the inhibition of gastrointestinal function and promotes the recovery of gastrointestinal motility. Similar findings have been reported elsewhere. Guo et al[23] demonstrated that press needle therapy, with acupoints selected according to the “Yuan (source points) - Luo (connecting points) - He (lower He-Sea points)” theory, significantly promoted gastrointestinal function recovery and alleviated gastrointestinal symptoms in patients with gastrointestinal tumors. Qiu et al[24] showed that acupuncture at Zusanli significantly shortened the times to first flatus and defecation in patients who received colorectal surgery and distal gastrectomy. Huang et al[25] further reported that electrical stimulation to Zusanli significantly reduced the pain intensity at 48 hours after surgery and shortened the time to first flatus. Regarding gastrointestinal hormones, the combined therapy significantly mitigated the postoperative reductions in GAS and MTL levels in patients with CRC, suggesting a protective effect on gastrointestinal function by reducing the impact of surgery on gastrointestinal hormones. Auricular vagus nerve stimulation with press needles may non-invasively activate the auricular branch of the vagus nerve-nucleus tractus solitarius pathway, enhance vagal efferent regulation of gastrointestinal function, and promote the secretion of MTL and GAS[26]. Regarding serum inflammatory markers, the combined therapy significantly suppressed CRP, IL-6, and TNF-α levels in patients with CRC postoperatively surgery, indicating a pronounced anti-inflammatory effect. Sun et al[27] also reported that moxibustion at Zusanli significantly reduced the levels of these inflammatory markers after radical CRC surgery, consistent with our results. The underlying mechanism may involve stimulation at Zusanli activating cholinergic anti-inflammatory pathways and thereby suppressing postoperative local inflammatory responses[28]. The anti-inflammatory effect of auricular vagus nerve stimulation with press needles may also be associated with the modulation of autonomic nerve output and innate immune signaling, helping maintain systemic inflammatory homeostasis[29]. The combination of these interventions may therefore produce a synergistically enhanced anti-inflammatory effect. Consequently, the combined therapy showed more significant effects on improving postoperative quality of life in patients with CRC. The intervention effectively alleviated clinical symptoms, improved nutritional and psychological status, relieved postoperative pain, and promoted gastrointestinal function recovery, thereby improving patients’ quality of life.
This study has several limitations. First, the sample size was relatively small, with only 105 postoperative CRC patients included; future multicenter studies with larger sample sizes are needed to improve the generalizability of the findings. Second, additional research is needed to further elucidate the underlying mechanisms underlying auricular vagus nerve stimulation with press needles combined with moxibustion at Zusanli acupoint. Finally, the cost-effectiveness of the combined therapy was not evaluated. Future economic analyses may help facilitate broader clinical implementation of this therapy.
Based on these findings, auricular vagus nerve stimulation with press needles combined with moxibustion at Zusanli demonstrated superior therapeutic effects in patients with CRC postoperatively. The combined therapy effectively relieved postoperative pain at 12 and 48 hours, regulated gastrointestinal hormone levels, inhibited serum inflammation, and improved quality of life, indicating strong potential for clinical application. These findings provide evidence for a safe, effective, and non-invasive integrated traditional Chinese and Western medicine rehabilitation regimen for postoperative CRC patients and may serve as a reference for clinical decision-making regarding combination therapies in this patient population.
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