Diagnosis of POGD in Western medicine Following selective auxiliary examinations based on the detailed medical history and physical examination, POGD can be diagnosed if vital organ diseases and metabolic abnormalities are excluded. The diagnostic criteria in this guideline are primarily in accordance with the Consensus of Experts on Diagnosis and Treatment of Irritable Bowel Syndrome in TCM (2017) issued by the Spleen and Stomach Disease Branch of China Association of Chinese Medicine, Rome IV diagnostic criteria for functional gastrointestinal disorders, and relevant literature. Diagnostic criteria for POGD 1) Medical history: Patients underwent anesthesia and surgery, without a history of preoperative functional gastrointestinal disorders; 2) Symptoms: Postoperative gastrointestinal symptoms, including nausea, vomiting, abdominal distension, abdominal pain, constipation, diarrhea, etc. 3) Physical signs: Through inspection of physical examination, abdominal asymmetric distension was observed and tenderness might appear after palpation in the abdomen; hyperactive or diminished bowel sounds were heard on auscultation; 4) Electrogastrogram: Electrogastrogram denoted abnormal gastrointestinal electrical rhythms such as bradygastria or tachygastria; 5) Imaging manifestations: Gastroparesis syndrome ultrasound or X-ray examinations exhibit no gastric peristalsis, weak peristalsis, or ineffective peristalsis; the stomach contains copious fluid accumulation; postoperative paralytic ileus manifests multiple dilated bowel loops and gas-liquid interfaces in erect or lateral positions of X-ray. Note: Preliminary diagnosis can be made if 1) 2) 3) are met, and the diagnosis and subtype can be confirmed when 4) or 5) is also satisfied.

Diagnosis of POGD in TCM As the term for “POGD” is not clearly documented in TCM, we have formulated TCM diagnostic criteria of POGD according to the disease definitions in TCM. (1)Patients underwent anesthesia and surgery without a history of functional gastrointestinal disorders; (2)Patients who manifest postoperative symptoms such as abdominal fullness, hiccup, nausea, vomiting, abdominal distension, abdominal pain, constipation, and diarrhea can be diagnosed to have “stuffiness and fullness”, “nausea”, “vomiting”, “intestine impediment”, “intestinal obstruction”, “constipation”, or “diarrhea” in TCM.

Preoperatively, TCM mental therapy is recommended to facilitate early postoperative gastrointestinal function recovery. (1B)

Acupuncture, acupoint pressing, auricular point therapy, electrical stimulation of acupoints, and music therapy are recommended to improve mood disorders like preoperative fear and anxiety. (1B)

It is recommended to apply acupoint stimulation techniques such as TEAS, electroacupuncture, auricular acupressure, and acupoint application before abdominal and spinal surgery to prevent POGD. (1B)

For special operations or patients requiring preoperative bowel preparation, oral administration/enemas of Chinese medicine prescriptions such as Major Purgative Decoction, Minor Purgative Decoction and their modified prescriptions, Bowel Cleansing Formulas are recommended to prevent and treat POGD. (2C)

Intraoperative general acupuncture or electroacupuncture is recommended to prevent POGD. (1B)

Patients with diarrhea after gallbladder and gastrointestinal tumor surgery are recommended to take oral Chinese medicine such as modified Middle-Tonifying Qi-Replenishing Decoction, True Man Zang Organ-Nourishing Decoction, and Qinseng, Poria and White Atractylodes Powder. (1B)

Patients experiencing surgery should adopt acupoint stimulation techniques to prevent and treat PONV. Commonly applied techniques comprise electroacupuncture, TEAS, general acupuncture, auricular acupressure, acupoint pressing, and a combination of different acupoint stimulation techniques. (1C)

Among patients with paralytic ileus after abdominal surgery, they are recommended to combine conventional treatments in Western medicine with Chinese medicine prescriptions such as modified Major Purgative Decoction, modified Minor Purgative Decoction, and modified Four Milled Ingredients Decoction. (1B)