Staged integrative traditional Korean medicine for physiological resilience recovery in a frail postoperative older adult with sarcopenia: a case report

Postoperative acute frailty and sarcopenia compromise functional recovery in older adults, often driven by gastrointestinal dysfunction accelerating muscle wasting through impaired nutrient absorption. While megestrol acetate (MA) is commonly used for postoperative anorexia, preventing metabolic rebound during withdrawal is challenging. This report demonstrates a staged integrative traditional Korean medicine approach managing MA discontinuation and postoperative sarcopenia. Coordinating herbal medicines with conventional care ensured a transition from MA while promoting muscle preservation and functional recovery. This framework mitigates medication-related risks and addresses acute frailty in postoperative older adults. A 79-year-old male presented with generalized weakness, orthostatic dizziness, and inability to ambulate unassisted following benign prostatic hyperplasia surgery and prolonged hospitalization for gastrointestinal bleeding and enteritis. Upon admission, he showed impaired functional metrics: Short Physical Performance Battery (SPPB) score of 3, Korean Activities of Daily Living (K-ADL) score of 14, and appendicular skeletal muscle mass (ASM) of 6.58 kg/m². A three-stage traditional Korean medicine intervention (herbal medicines, intravenous hydration, acupuncture, cupping) was administered over 16 days. Stage 1 prioritized gut stabilization using Samryeongbaekchulsan and Insamyangyeong-tang alongside MA to enhance nutrient absorption. This improved total protein (6.3 to 7.1 g/dL), albumin (3.5 to 4.0g/dL), and normalized C-reactive protein (1.50 to 0.11 mg/dL), achieving independent ambulation (SPPB 8). Following MA discontinuation, he experienced transient rebound anorexia and dehydration. To manage this, Stages 2 (Recovery/Deprescribing) and 3 (Metabolic Stabilization) utilized tailored herbal medicines (Palmul-tang-gami A/B, Saengmaek-san) and intravenous hydration. This mitigated withdrawal stress, preserving skeletal muscle mass (22.5 to 22.7 kg) and maintaining functional recovery at discharge (SPPB 6, K-ADL 13). Additionally, heart rate variability parameters (total power, LF/HF ratio) closely mirrored the clinical trajectory, demonstrating utility in monitoring autonomic homeostatic reserve. In conclusion, coordinating herbal medicine with conventional supportive care restored physiological resilience in apostoperative older patient. This integrative model functions as a physiological bridge during MA deprescribing, providing a safe framework for complex geriatric management.