Traditional Chinese Medicine as an Integrative Adjunct in Oncology Perioperative Practice: Analgesia, Immune Modulation, and Translational Challenges

ABSTRACT Traditional Chinese medicine (TCM), including herbal analgesic adjuvants and acupuncture‐based interventions, has gained increasing attention as an integrative strategy for perioperative pain management in oncology. Bioactive phytochemicals—such as terpenoids, flavonoids, alkaloids, and polyphenols—exert multimodal pharmacological effects relevant to perioperative analgesia through modulation of ion channels, GABAA receptors, inflammatory signaling pathways (MAPK/COX‐2), and redox homeostasis. In parallel, acupuncture activates endogenous analgesic systems, including opioid and monoaminergic descending inhibitory pathways, modulates autonomic balance via vagal anti‐inflammatory reflexes, and alters local perfusion, thereby influencing nociception and perioperative immune responses. Recent advances in nano‐enabled delivery systems—such as lipid and polymeric nanoparticles, micelles, enzyme‐responsive hydrogels, and acupoint‐targeted formulations—aim to overcome key pharmacokinetic limitations of phytochemicals by improving solubility, stability, and site‐selective release. These platforms may be combined with acupoint‐based approaches to enhance localized exposure in perioperative settings. Preclinical and early translational studies suggest that such integrative strategies can modulate nociceptive signaling and perioperative inflammatory or immune processes within the tumor microenvironment (TME). However, clinical translation remains limited. Most evidence is derived from animal models, small clinical studies, or nononcologic surgical populations, with substantial gaps in standardized formulations, pharmacokinetic and drug–drug interaction data, regulatory clarity, and randomized trials incorporating immunologic or oncologic end points. This narrative review critically synthesizes current mechanistic and emerging clinical evidence and outlines a translational roadmap emphasizing standardized analytics, integrated PK/toxicity assessment, biomarker‐informed patient stratification, and rigorously designed clinical trials to determine whether TCM modalities can safely provide opioid‐sparing analgesia without compromising perioperative immune function or oncologic outcomes.