Acupuncture regulating the gut-brain axis for postoperative ileus: Neuroimmune mechanisms and clinical translation prospects

Postoperative ileus remains a significant challenge in surgical recovery. Increasing evidence highlights the gut-brain axis as a promising target for managing gastrointestinal motility disorders. Acupuncture, particularly at Zusanli (ST36), has shown considerable potential to regulate gut function, although its mechanisms warrant further investigation. This editorial discusses a clinical study demonstrating that electroacupuncture at Zusanli (ST36) accelerates gastrointestinal recovery in patients with postoperative ileus by activating the vagus nerve-cholinergic anti-inflammatory pathway, suppressing pro-inflammatory cytokines, and rebalancing gastrointestinal hormones. We further summarize how acupuncture modulates the gut-brain axis through neural, immune, endocrine, microbial, and central pathways, supporting integration with modern neuroimmunology. These findings support incorporating acupuncture into enhanced recovery after surgery protocols. Future studies should prioritize mechanistic investigations using multi-omics technologies, large-scale clinical trials to enable standardization, and exploration of acupuncture-microbiota-gut-brain interactions to broaden clinical applications in gastrointestinal disorders.