Objective,2,TTo analyze the psychological burden and its correlation with gut microbiota distribution in postoperative patients at early and middle stage of rectal cancer.,Methods,2,A cross-sectional study was conducted， including a total of 44 postoperative patients with early and middle stage rectal cancer from October 2020 to July 2021 with the diagnosis and treatment through Xiyuan Hospital of China Academy of Chinese Medical Sciences and Peking University Cancer Hospital on psychosomatic rehabilitation platform of integrated traditional Chinese and western medicine. Different TCM characteristic factors were divided by TCM syndrome differentiation， Traditional Chinese Medicine Spleen Deficiency Scale （TCM-SDS）and Traditional Chinese Medicine Kidney Deficiency Scale （TCM-KDS）. The distribution of postoperative psychological burden and gut microbiota diversity among patients with different TCM characteristics was analyzed and compared. Species differences were compared， and environmental factors were analyzed to determine the influencing factors of different degrees of TCM characteristics and psychological burden on gut microbiota.,Results,2,Among 44 patients with early and middle stage colorectal cancer，there were 20 cases of liver depression and spleen deficiency （45.4%）， 17 cases of spleen and kidney deficiency （38.6%）， 4 cases of phlegm-dampness internal resistance （9.0%）， 1 case of qi stagnation and blood stasis （2.2%） and 1 case of liver and kidney deficiency （2.2%）. 22 patients with TCM-SDS score ,>, 1.98 were divided into spleen-qi deficiency group and 22 patients with TCM-SDS score ≤1.98 were divided into non-spleen-qi deficiency group. 19 cases with TCM-KDS score ,>, 2.14 were divided into kidney deficiency group， and 25 cases with TCM-KDS score ≤2.14 were divided into non-kidney deficiency group.The scores of self-rating anxiety scale （SAS）， self-rating depression scale （SDS） and brief cancer recurrence fear scale （FCRI-SF） in spleen-qi deficiency group were higher than those in non-spleen-qi deficiency group （,P,<,0.05）. SAS score， SDS score and FCRI-SF score in kidney deficiency group were higher than those in non-kidney deficiency group （,P,<,0.05）.Among 44 patients with early and middle colorectal cancer， there were 24 patients with high anxiety， 20 patients with low anxiety， 31 patients with high depression and 13 patients with low depression.Alpha diversity analysis showed that patients with high anxiety had higher Sobs index （,P,<,0.05）. The Sobs index of patients with high depression was lower， but the difference was not statistically significant （,P,>,0.05）. The analysis of species differences between groups showed that at the genus level， the abundance of micrococcus rariorum in the intestinal flora of patients with high anxiety level was higher than that of patients with low anxiety level， while the abundance of Veillococcus and Chaetomium was lower than that of patients with low anxiety level （,P,<,0.05）. The abundance of Proteus in intestinal flora of patients with high depression was higher than that of patients with low depression （,P,<,0.05）.RDA/CCA environmental factor analysis showed that TCM-SDS score was more correlated with the distribution of intestinal flora in patients with high anxiety and depression （,P,<,0.05）， and TCM-KDS score was more correlated with the distribution of intestinal flora in patients with low anxiety and depression （,P,<,0.05）. The degree of spleen deficiency and kidney deficiency was negatively correlated with the abundance of Bifidobacterium， but positively correlated with the abundance of Bacteroides.,Conclusion,2,The psycho-emotional burden and intestinal flora of patients with early to mid-stage colorectal cancer are associated with the degree of spleen and kidney deficiency.