Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine

Volume 2015, Article ID 904926, 9 pages
http://dx.doi.org/10.1155/2015/904926

Research Article
Acupuncture for Functional Dyspepsia: A Single Blinded,
Randomized, Controlled Trial
Yulian Jin,1,2 Qing Zhao,2 Kehua Zhou,3 Xianghong Jing,4 Xiaochun Yu,4 Jiliang Fang,2
Zhishun Liu,1 and Bing Zhu4
1

Department of Acupuncture and Moxibustion, Guang An Men Hospital, China Academy of Chinese Medical Sciences,
No. 5 Beixiange Street, Xicheng District, Beijing 100053, China
2
Department of Radiology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
3
Department of Health Care Studies, Daemen College, Amherst, NY 14226, USA
4
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
Correspondence should be addressed to Jiliang Fang; [email protected] and Zhishun Liu; [email protected]
Received 11 August 2014; Revised 18 September 2014; Accepted 3 October 2014
Academic Editor: Jian Kong
Copyright 2015 Yulian Jin et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
In order to investigate the therapeutic potential of acupuncture on patients with functional dyspepsia (FD), patients were
randomized to receive acupuncture at classic acupoints with manipulations (treatment group) versus acupuncture at nonacupoints
without manipulation (control group) once every other day, three times a week, for one month and were followed up for three
months. The primary outcomes included dyspeptic symptoms, quality of life, and mental status. The secondary outcomes included
the fasting serum gastrin concentration, and frequency and propagation velocity of gastric slow waves. Sixty patients with FD
were included, among whom, four dropped out. After one months treatment, patients with FD showed significant improvements
in primary (in both groups) and secondary (in the eight patients of the treatment group) outcomes as compared with baseline
( = 0.0078 to <0.0001); treatment group has better outcomes in all primary outcome measures ( < 0.0001 except for SDS
( = 0.0005)). Improvements on dyspeptic symptoms persist during follow-up (better in the treatment group). Acupuncture with
manual manipulation had better effects on improving dyspeptic symptoms, mental status, and quality of life in patients with FD.
These effects may be related to the increased frequency and propagation speed of gastric slow waves and serum gastrin secretion.

1. Introduction
Functional dyspepsia (FD) is dyspepsia without evidence
of an organic disease that is likely to explain the cause
[1]. Based on the Rome III criteria, symptoms of FD may
include bloating, belching, early satiety, abdominal distension, nausea, or indigestion during the last three months
with symptom onset at least six month ago. These symptoms
are categorized into epigastric pain syndrome and postprandial distress syndrome [2]. Pathophysiological factors which
may cause FD include genetic predispositions, early family
environment, psychosocial factors, abnormal gastric motility,
visceral hypersensitivity, inflammation, and bacterial flora
[3]. Particularly, gastrointestinal motor abnormalities, altered

visceral sensation, and psychosocial factors have all been

identified as major pathophysiological changes in FD [3, 4].
The prevalence of FD varies between 11% and 29.2% [5]. In
the United States, FD was found in 29.2% of the population,
and in the United Kingdom the prevalence was 23.8% [6, 7].
FD greatly decreases patients quality of life as the
symptoms, particularly abdominal pain and indigestion,
cause emotional distress, problems with food and drink,
and impaired vitality [8]. Patients with FD usually require
extensive diagnostic procedures and long-term medical care
which in turn place heavy economic burden on patients
and the society. Management of FD mainly includes lifestyle
modification, H. Pylori treatment, acid suppression therapy,
prokinetics, antidepressants, and antiflatulents. Despite these

2
treatment options, treatment for FD often remains unsatisfactory [9]. The management of FD is challenging especially
when initial drug therapy fails, which is not uncommon [10].
Furthermore, besides side effects, traditional drug therapy
has been strikingly shown to have little to no efficacy [11].
For example, benefits from H. Pylori treatment were found
to be minimal [12]; acid suppression therapy was found to
be suboptimal with no apparent effects on dysmotility-like
dyspepsia [13].
From a traditional Chinese medicine (TCM) perspective, FD is characterized by disrupted qi flow inside the
middle energizer due to external pathogenic factors [14].
The middle energizer refers to spleen and stomach which
are responsible for food transformation and transportation.
Kidney is responsible for bone health and the generation
of bone marrow; excessive physical work consumes kidney
energy. Meanwhile, excessive mental work consumes blood
and causes imbalance of emotion. Blood is controlled by
heart and emotion is regulated by liver. Thus, treatment in
TCM including acupuncture should aim to facilitate qi and
blood circulation in meridians related to these organs and
thus normalizes patients status of health. With the guidance
of these diagnostic and therapeutic principles, therapeutic
effectiveness of acupuncture for abdominal pain, abdominal
distension, bloating, nausea, and others was well documented
in various TCM classics and has been reported in research
studies [1520].
Besides normalization of qi and blood in the affected
meridians, modern understandings of these results also lie
in pathophysiological research studies, in which researchers
found that acupuncture in patients with FD could accelerate
solid gastric emptying [17], increase plasma level of neuropeptide Y but not motilin [18], and induce deactivation
of the brainstem, anterior cingulate cortex (ACC), insula,
thalamus, and hypothalamus in the human body [21]. In
addition, acupuncture was also found to enhance normal
gastric myoelectrical regularity in both healthy people and
patients with diabetic gastric dysrhythmia [22, 23], alters the
frequency of gastric slow waves in healthy volunteers [24],
and accelerates solid gastric emptying in diabetic gastroparesis [25].
Acupuncture seems to be a promising treatment for FD;
however, the aforementioned clinical trials did not investigate
the effects of acupuncture on emotional symptoms [15
25], the prevalence of which has been found to be high
in patients with FD [26]; placebo effect which is common
in both patients with FD and acupuncture procedures will
likely add more uncertainties in the therapeutic effectiveness
of acupuncture [27, 28], and, finally, not all of the studies
performed acupuncture procedures based on TCM principles
including the meridian theories, such as an emphasis on Deqi
sensations.
In the present study, we aimed to determine (i) the effect
of acupuncture on dyspeptic symptoms, quality of life, and
mental status in patients with FD; (ii) the effect difference
between classic acupuncture based on TCM principles and
acupuncture on nonacupoints; and (iii) effects of classic
acupuncture on serum gastrin concentration and frequency
and propagation velocity of gastric slow waves.

Evidence-Based Complementary and Alternative Medicine

2. Material and Methods

2.1. Study Design and Setting. This was a single blinded,
randomized, controlled trial of manual acupuncture on
classic acupoints versus nonclassic acupoints performed at
the Department of Acupuncture at Guang An Men Hospital,
one of the top teaching hospitals for TCM education in
China. Hospital ethics committee approved the study protocol. Participants were recruited through advertisements on
local newspapers, posters, and hospital website and signed
informed consent before study participation.
An investigator who was not involved in acupuncture
procedures and data analyses was responsible for the generation of a random number table, based on which, participants
were allocated to receive either classic acupoint (treatment
group) or nonclassic acupoint (control group) acupuncture
treatments. Participants were blinded to acupuncture procedures.
2.2. Participants. For inclusion, patients have to fulfill the
Rome III diagnostic criteria for FD. For the last three months
with symptom onset at least six months ago, patient has
one or more of the following: (1) bothersome postprandial
fullness; (2) early satiation; (3) epigastric pain; (4) epigastric
burning; and (5) no evidence of structural disease (including
at upper endoscopy) that is likely to explain the symptoms.
In addition, the following criteria were also met: no mental
disorders; would otherwise be healthy; age 18 to 70; nonpregnant; and one week prior to and during participation,
cessation of all medication related to the gastrointestinal
system, which may include but not be limited to gastric
suppression drugs, prokinetics, H. Pylori eradication agents,
and antidepressants.
Eight patients in the treatment group also signed in
for assessment of gastrin concentration and frequency and
propagation velocity of gastric slow waves. To measure the
differences between patients with FD and healthy adults
in these assessments, eight healthy volunteers were also
included to match with these eight patients with FD in the
present study.
2.3. Treatment Protocol. All patients included were randomized into two groups: classic acupoint (treatment) or nonacupoint (control) groups. For the treatment group, acupoints
ST36 and KI3 were used in every group members; additional
acupoints of GB4, PC6, and HT7 may also be used based on
pattern recognition of symptoms. Based on TCM theories,
ST36 was used to invigorate functions of the stomach and
spleen; KI3, the Yuan-source acupoint, was used to invigorate
functions of the kidney. ST36 and KI3 function together to
restore the normal qi flow inside the stomach and spleen
meridian. In addition, for patients with obvious depression,
anxiety, or insomnia symptoms, GB41 was used to restore
liver function, and PC6 and HT7 were used to nourish the
heart to resume balance of the mind. Classic acupoints were
localized according to the 2008 World Health Organization
standards [29]. For the treatment group, needle insertion
was perpendicular with a depth of about 25 mm. In order to

Evidence-Based Complementary and Alternative Medicine

reach an optimal response which is defined as Deqi sensations including soreness, heaviness, fullness, propagation of
needling sensation, and/or adjacent muscle twitching [30],
moderate combined acupuncture manipulation of lifting,
thrusting, and twirling with a frequency of 60120 times/min
was performed. These acupuncture manipulation techniques
were performed continually to reach one to three times of
Deqi sensation (with a short interval between Deqi sensations
if more than once during the first two minutes); then, the
needle was removed. If no Deqi sensation was obtained
during the first two minutes, acupuncture needle was then left
in place for 20 to 60 minutes, and one acupuncture manipulation was applied right before needle removal regardless of
Deqi sensation.
For the control group, nonclassic acupoints in different
dermatomes but close proximity of the aforementioned
acupoints were used in the distal portion of extremities
correspondingly. KI3, ST36, and GB41 are located in the
L4, 5, and S1 dermatome; thus nonclassic acupoints located
inside anterior thigh (L2 and L3 dermatome) were used. PC6
and HT7 are located inside the C7, 8, and T1 dermatome;
thus nonclassic acupoint in the anterior antebrachium (C5
dermatome) was used. In the control group, needle insertion
was perpendicular with a depth of two to three millimeters
with needle retention of 20 minutes but no acupuncture
manipulations.
Treatments in both groups were implemented once every
other day, three to four times a week for one month.
All patients were then followed up for three months.
All acupuncture procedures were performed by the same
acupuncturist who had more than six years clinical experiences. Huatuo brand needles ( 0.35 mm 25 mm, manufactured by Suzhou Medical Appliance manufactory, Jiangsu,
China) were used for all acupuncture procedures.
2.4. Outcome Assessment. The primary outcomes of the study
included dyspeptic symptoms, quality of life, and mental
status. For dyspeptic symptoms, we used the four cardinal
dyspeptic symptoms and their corresponding assessments as
reported in the Chinese version Nepean Dyspepsia Index
(NDI) [31, 32]. The intensity, frequency, and level of interference of postprandial fullness, early satiety, epigastric pain,
and epigastric burning sensation were rated. Intensity of
each symptom was graded and scored as the following: 0,
absent; 1, mild; 2, moderate; 3, severe; 4, critical. Frequency
of each symptom was also graded as follows: 0, absent; 1,
occasionally (1-2 days/week); 2, sometimes (35 days/week);
3, frequently (every day, but intermittent symptoms), 4,
continuous symptoms. Level of interference of each symptom
was scored and graded as the following: 0, none; 1, mild
interference; 2, moderate interference; 3, severe interference; 4, critic interference. The number in front of each
grading indicates the score of the corresponding symptom;
the score for each symptom in the checklist of cardinal
dyspeptic symptoms was calculated by adding its scores in the
corresponding frequency, severity, and level of discomfort;
dyspeptic symptom sum score (DSSS) is the sum score of the
four symptoms in the checklist.

3
Quality of life was measured by the short-form 36
(SF-36) questionnaires [33]. Mental statuses of patients were
evaluated via Zung Self-Rating Depression Scale (SDS) [34]
and Self-Rating Anxiety Scale (SAS) [35]. Scoring of these
standardized assessments followed guidelines published in
the Manual of Standardized Assessment Tools in Behavioral
Medicine [36]. SF-36 measures Quality of Life (QoL) across
eight domains; score of each domain = [(actual raw score
lowest possible raw score)/raw score range] 100. For the
SDS score, the following equation was used: SDS Index =
Raw Score 1.25. Grading of SDS is as the following: SDS
Index less than 53 points is considered normal, 53 to 62 as
mild depression, 63 to 72 as moderate depression, and 73 and
higher as severe depression [36]. For the grading of SAS, the
following categories were used: normal range (less than 50),
mild anxiety (50 to 59), moderate anxiety (60 to 69), and
severe anxiety (70 and higher) [36].
The secondary outcomes include fasting serum gastrin
concentration and frequency and propagation velocity of
gastric slow waves. These measurements were performed in
the eight patients with FD in the treatment group before
and after treatment, but only once in healthy volunteers. A
fasting venous blood sample was drawn from the basilic vein
prior to breakfast early in the morning. About three milliliters
of the blood sample was sent to Peking Union Medical
College Hospital for measurement of serum gastrin levels.
Meanwhile, the participant was given 120 mL 80% (w/v)
barium sulfate suspension (Qingdao Dongfeng Chemical Co.
Ltd., Shandong, China). Participants were then placed in
a supine position. Using Prestige digital X ray (GE, USA),
gastric mucosa was observed; then, a Chinese coin of fifty
cents was placed on top of the skin over the stomach of the
participant, and gastric motions around the gastric antrum
were video recorded for one minute while the participant
was in a standing position. Frequency of gastric slow waves
was directly counted as the number of waves that passed
through the gastric antrum in one minute. Propagation
velocity of gastric slow waves was assessed by the time interval
between two consecutive waves that passed through the
gastric antrum.
Safety evaluation includes possible hematoma, local
infection, fainting, and severe pain during and after acupuncture. In addition, other conditions which warrant cessation of
acupuncture treatment or withdrawal from the study if any
were also documented and analyzed.
2.5. Statistical Analysis. The statistical analysis was performed by two independent statisticians. Results were compared between the two statisticians. Differences, if any, were
discussed and the statistic test was reperformed until a
consensus was reached between the two statisticians. The
statisticians were blinded to treatments and study protocol.
All results including baseline characteristics were based on
per-protocol (PP) analyses. Statistical Analysis System (SAS),
version 6.12, was used and a significance level was set at <
0.05.
For comparisons of baseline values, chi square test was
used to explore gender differences; -test was used to explore

Evidence-Based Complementary and Alternative Medicine

Assessed for eligibility

(n = 88)

Excluded

(n = 28)

Peptic ulcer
Superficial gastritis
Atrophic gastritis
Gastroesophageal reux disease
Cholecystitis
Hashimoto thyroiditis
Diabetes mellitus
Severe coronary artery disease
Older than 70

(n
(n
(n
(n
(n
(n
(n
(n
(n

=
=
=
=
=
=
=
=
=

4)
7)
6)
3)
2)
1)
2)
2)
1)

Patients who accepted

acupuncture
treatment (n = 60)

Treatment group (n = 30)

Dropout (n = 2)

Control group (n = 30)

Dropout (n = 2)

Figure 1: Flow chart of study participation.

differences in the duration of the disease; Wilcoxon rank sum

test was used in all comparisons of primary and secondary
outcome measures. All quantitative data including subjective
scores were expressed with mean SD.

3. Results
From July, 2010, to January, 2011, a total of 88 patients with
dyspeptic symptoms visited the Department of Acupuncture at Guang An Men Hospital in Beijing. Twenty-eight
patients were excluded from the present study due to the
following reasons: peptic ulcer (four patients), superficial
gastritis (seven patients), atrophic gastritis (six patients),
gastroesophageal reflux disease (three patients), cholecystitis
(two patients), Hashimoto thyroiditis (one patient), diabetes
mellitus (two patients), severe coronary artery disease (two
patients), and older than 70 (one patient). Sixty patients
were included and randomly assigned to either the treatment
group or the control group. Of these 60 patients, 56 patients
completed the study and four patients (two from each group)
dropped out from the study (dropout rate: 6.67%) after
the second visit. In the treatment group, one patient could
not tolerate the acupuncture Deqi sensations upon needle
manipulation, and the other patient in the treatment group
had transportation difficulties. In the control group, the
two patients directly stated to the therapist saying that the

treatment was noneffective and withdrew from participation

(Figure 1).
The treatment group consists of 11 males and 17 females
with an age range between 23 and 65 years old and disease
history of one to 40 years. The control group consists of 10
males and 18 females with an age range between 24 and 66
years old and disease history of one to 40 years. Prior to
participation, no significant differences were found between
these two groups in terms of gender, age, length of disease
history, dyspeptic symptom sum scores, and SF-36 score
(Table 1).
3.1. Primary Outcomes. At baseline, the prevalence of the four
symptoms of postprandial fullness, early satiety, epigastric
pain, and epigastric burning sensation in these 56 patients
were 98.2%, 71.4%, 76.8%, and 58.9%, respectively; the scores
for each symptom were six to nine points with a severity of
disease rated moderate to severe.
After one months treatment, as compared with baseline
values, significant differences were found in both treatment
and control groups in the dyspeptic symptom sum score, the
scores of postprandial fullness, early satiety and epigastric
pain, SDS score, and SF-36 score. Additionally, as compared
with baseline, significant differences were also found in the
score of epigastric burning sensation and SAS score of the
treatment group but not the control group. values were

Evidence-Based Complementary and Alternative Medicine

Table 1: General characteristics of patients with FD prior to participation.

Groups
Treatment
Control
value

Cases ()
28
28

Gender
Male () Female ()
11
17
10
18
0.7825

Age (year)

Disease duration (years)

Dyspeptic symptom sum score

SF-36 score

49.29 10.32
48.25 11.40
0.7229

12.20 12.20
12.11 10.20
0.6145

24.32 8.28
24.79 7.48
0.8265

52.51 13.94
54.06 16.41
0.7043

<0.0001 for all the significant intragroup comparisons except

epigastric pain, SF-36, and SDS in the control group, for
which values were 0.0078, 0.0099, and 0.0002, respectively.
As compared with the control group, treatment group has
better outcomes in all primary outcome measures. values
for these intergroup comparisons were all <0.0001 except for
SDS ( = 0.0005) (Table 2).
At three months follow-up, DSSS was recalculated for all
participants. As compared with baseline values, significant
differences were found in both groups in terms of DSSS ( <
0.0001). Meanwhile, the treatment group, as compared with
the control group, had better long-term outcomes in terms of
DSSS ( < 0.0001) (Table 3).
3.2. Secondary Outcomes. Values of preprandial serum gastrin concentration and frequency and propagation velocity
of gastric slow waves in healthy volunteers and patients with
FD were provided in Table 4. As compared with healthy
volunteers, patients with FD had lower serum gastrin concentration and less frequent and slower propagation velocity of
gastric slow waves ( = 0.0081, 0.0008, 0.0279, resp.) at baseline. After one months treatment, patients with FD showed
significant improvement in serum gastrin concentration and
frequency and propagation velocity of gastric slow waves
( = 0.0002, 0.0078, and 0.0180, resp.), and no significant
difference was found in these secondary outcome measures
between healthy volunteers and patients with FD (Table 5).
3.3. Side Effects. No serious side effects occurred. One patient
in the treatment group withdrew from the study secondarily
to intolerance to the needling sensations upon acupuncture
manipulation.

4. Discussion
4.1. Selection of Acupoints. The use of classic acupoint of
ST36 in the present study is well-supported by former
research studies [1525], so was the use of PC6 [1519, 24].
In previous research studies, researchers mainly considered
the pathophysiological relationship between the meridians
or organs of liver and spleen, heart and spleen, or spleen
and kidney; acupoint of the kidney meridian is barely used
for FD in these research studies [1525]. In the present
study, we used KI3 based on the analysis of all the pathophysiological relationships between and among organs and
meridians related to FD symptoms. These diagnostic and
therapeutic principles would be a more realistic reflection
of individualized acupuncture treatment in clinical practice.

The results of the present study add further credence to the

use of these acupoints.
4.2. Acupuncture Manipulations. Acupuncture Deqi serves
as the foundation or premise for the therapeutic effects of
acupuncture treatment [30]. Although theoretical research
articles highlight the importance and the components of
Deqi, not many researchers emphasized Deqi in their reports
of acupuncture clinical trials. The reason for lacking of
information regarding Deqi may be due to the following
reasons: the authors of the reports did not document it and
the clinicians did not pay extra attention to the importance of
Deqi during the studies. In addition, as electroacupuncture
becomes more and more popular, the evaluation of Deqi is
more difficult due to the mixture of electric therapy sensation with sensations from acupuncture itself. Nonetheless,
report of Deqi in clinical trials reflects more the standard
acupuncture treatment in clinical practice. In the present
study, manual acupuncture manipulation was stopped and
the needle was removed upon Deqi arrivals in the treatment
group. This acupuncture treatment protocol guarantees not
only the Deqi sensations thus the clinical efficacy but also
safety of acupuncture treatments. The results of the present
study indicate that traditional acupuncture with the emphasis
of Deqi manipulations has better therapeutic results than
acupuncture on nonacupoints without Deqi manipulations.
4.3. Outcome Measurement. As psychosocial factor is a common cause of FD and many patients of FD have anxiety
or depression issues, measurements of these psychological
symptoms are of great importance in the evaluation of clinical
management of FD [1, 26]. Zung Self-Rating Depression
Scale (SDS) and Self-Rating Anxiety Scale (SAS) have a high
reliability and validity in assessing psychological symptoms
in patients [34, 35]. The improvement of SDS score and SAS
score in the treatment group of the present study indicates
that acupuncture has positive impacts on the psychological
aspects of patients with FD. Psychological effects of acupuncture may be caused by placebo effects [28, 37]; however,
as acupuncture also demonstrated therapeutic effects on
psychological diseases [38, 39], we should increase our trust
on the positive benefits of acupuncture on psychological
symptoms of patients. To our best knowledge, no studies
have explored the effects of acupuncture on psychological
symptoms of FD. Thus, the present study will facilitate our
understanding of the therapeutic effectiveness of acupuncture in FD.

Evidence-Based Complementary and Alternative Medicine

Table 2: Scores of dyspeptic symptoms, quality of life, and mental status before and after the treatment.

Items
PF

ES

EP

EBS

DSSS

SF-36

SDS

SAS

Groups
Treatment
Control
IGC
Treatment
Control
IGC
Treatment
Control
IGC
Treatment
Control
IGC
Treatment
Control
IGC
Treatment
Control
IGC
Treatment
Control
IGC
Treatment
Control
IGC

28
27

Baseline
9.00 2.09
8.89 2.39

After treatment
1.57 2.28
6.22 2.59

Difference
7.43 2.47
2.67 1.88

Improvement rate
82.56%
30.03%

19
21

9.74 1.91
8.43 2.87

0.42 1.43
6.05 2.52

9.32 1.97
2.38 1.80

95.69%
28.23%

21
22

6.81 2.23
7.41 3.02

0.48 1.03
6.32 3.41

6.33 2.31
1.09 1.82

92.95%
14.71%

16
17

6.31 2.39
6.71 2.78

0.50 1.55
6.47 3.00

5.81 2.17
0.24 0.56

92.08%
3.58%

28
28

24.32 8.28
24.79 7.48

2.50 3.28
19.40 8.23

21.80 8.24
5.36 3.29

89.72%
21.62%

28
28

52.50 13.94
54.00 16.41

70.00 12.54
56.00 13.42

17.00 14.04
2.88 8.74

33.52%
5.33%

28
28

57.96 9.55
57.60 11.84

45.60 8.75
54.00 10.80

12.30 9.89
3.50 5.92

21.33%
6.07%

28
28

52.30 10.48
52.36 9.67

42.30 6.22
52.20 7.98

10.00 10.22
0.11 4.89

19.11%
0.21%

value
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
0.0078
<0.0001
<0.0001
0.25
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
0.0099
<0.0001
<0.0001
0.0002
0.0005
<0.0001
0.8533
<0.0001

PF: postprandial discomfort; ES: early satiety; EP: epigastric pain; EBS: epigastric burning sensation; DSSS: dyspeptic symptom sum score; SF-36: short-form
36 questionnaire; SDS: Self-Rating Depression Scale; SAS: Self-Rating Anxiety Scale; IGC: intergroup comparison.

Table 3: Dyspeptic symptom sum score at baseline and during follow-up.

IND
DSSS

Groups
Treatment
Control
IGC

28
28

Baseline
24.32 8.28
24.79 7.48

Follow-up
1.68 2.36
16.43 7.41

Difference
22.60 8.68
8.36 6.58

Improvement
93.09%
33.92%

value
<0.0001
<0.0001
<0.0001

DSSS: dyspeptic symptom sum score; IGC: intergroup comparison.

Quality of life is a heavy emphasis of the clinical management of all kinds of disorders. In the present study, the use
of modified NDI is well-supported by its high reliability and
validity in patients with dyspeptic symptoms [31, 32]. NDI
measures dyspepsia symptoms and dyspepsia-specific healthrelated QOL (H-QOL). Outcome measurements utilizing
NDI, SAS, and SDS will likely better capture the characteristics of acupuncture effects on FD. The improvement of
NDI in the present study concurs with results from other
acupuncture researchers regarding acupuncture treatment
for FD [1521]. Interestingly, the control group in which
acupuncture was used in nonclassic acupoints also induced
significant changes in dyspeptic symptoms except for epigastric burning sensations and SAS score. These results partially
concur with the results reported by Ma et al. [20] and
Zeng et al. [21]; however, the results differ from the results

reported by Park et al. [19]. Significant superiority of classic

acupoint acupuncture to nonclassic acupoint acupuncture
was found in both studies by Ma et al. [20] and Zeng et al.
[21]; however, they did not report changes of subcategories of
NDI in both groups which makes the analysis difficult. Park
et al. [19] did not find difference between classic acupoint
acupuncture and nonclassic acupoint acupuncture except for
pressure and cramps in upper abdomen (better results in the
classic acupoint acupuncture group). The differences may be
due to control group treatment. In the study by Park et al.
[19], dermatome information between classic acupoint and
nonclassic acupoint was not included in consideration upon
the design of control group.
FD, like other diseases, is characterized by its objective
physiological changes and subjective symptoms; thus, a
thorough evaluation of FD should simultaneously include

Evidence-Based Complementary and Alternative Medicine

Table 4: Serum gastrin concentration and frequency and propagation velocity of gastric slow waves in patients with functional dyspepsia
and healthy adults.
Items
Gastrin (pg/mL)
FGSW (n/min)
PVGSW (s)

Baseline ( = 8)
25.93 5.90
2.49 0.64
24.25 4.95

After treatment ( = 8)
44.40 6.26
3.11 0.14
19.75 2.05

Healthy adults ( = 10)

47.65 20.21
3.11 0.13
19.41 0.93

FGSW: frequency of gastric slow waves; PVGSW: propagation velocity of gastric slow waves.
Note: propagation velocity of gastric slow waves was assessed by the time interval between two consecutive waves that passed through the gastric antrum.

Table 5: Comparisons of serum gastrin concentration and frequency and propagation velocity of gastric slow waves before and after treatment
as well as between patients with functional dyspepsia and healthy adults.
Items
Gastrin
FGSW
PVGSW

Baseline versus healthy

adults

Baseline versus after

treatment

After treatment versus

healthy adults

0.0081
0.0008
0.0279

0.0002
0.0078
0.0180

0.6401
1.0000
0.6713

FGSW: frequency of gastric slow waves; PVGSW: propagation velocity of gastric slow waves.
Note: propagation velocity of gastric slow waves was assessed by the time interval between two consecutive waves that passed through the gastric antrum.
Baseline versus after treatment refers to patients with functional dyspepsia only.

these two aspects. Changes in gastric motility, mainly gastric

hypomotility or dysrhythmias, play an important role in the
pathophysiology of FD [14, 13]; thus, an objective measurement of gastric motilities is of great importance in the
evaluation of FD. Barium sulfate radiography of the GI system
provides a direct visual observation of the frequency and
propagation velocity of gastric slow waves and thus objective
measurements of acupuncture effects on FD. Gastrin is a
peptide hormone that stimulates the secretion of gastric acid
by the parietal cells of the stomach and aids in gastric motility.
Results from recent research studies indicate that abnormal
gastrin level is a possible contribution factor of FD with
gastric dysmotility [4, 40, 41]. The results of gastrin level
in the present study are consistent with the hypothesis as
patients with FD show decreased preprandial gastrin level
[4, 41]. However, He et al. [40] did not find any difference in
preprandial but postprandial gastrin levels (higher in patients
with FD) between patients with FD and healthy volunteers.
In the present study, observation of less frequent and slower
propagation velocity of gastric slow waves in patients with
FD via barium sulfate radiography also indicates a decreased
level of gastrin. Nonetheless, changes of gastrin and gastric
motility in patients with FD deserve further research. In
the present study, classic acupuncture was found to increase
preprandial gastrin level and enhance gastric motility of
patients with FD to reach similar levels as healthy volunteers.
These results are consistent with our findings in improvement
of dyspeptic symptoms.
4.4. Therapeutic Mechanism of Acupuncture. Former research studies in human beings indicate that acupuncture
could accelerate solid gastric emptying [18, 25] and enhance
percentage of normal gastric slow waves [22, 23]. The present
study showed similar results in increasing gastric motility
as demonstrated by increased frequency and propagation
velocity of gastric slow waves in patients with FD.

An accepted mechanism of acupuncture on the functions of the gastric system is related to its effects on
the autonomic nervous systems, which Takahashi [15]
summarized as follows: acupuncture at the lower limbs
(ST36) causes gastric muscle contraction via stimulating
the somatoparasympathetic pathway whereas acupuncture
at the upper abdomen causes gastric muscle relaxation via
stimulating the somatosympathetic pathway. As both main
acupoints KI3 and ST36 used in the present study are
located in the lower extremities, the result of enhanced
gastric motility is likely to be caused by activation of the
somatoparasympathetic pathway increasing the secretion of
gastrin and other hormones.
Furthermore, acupuncture has also been found to induce
changes in cerebral cortex activities of patients with FD [21].
Consequently, we hypothesize that effect of acupuncture on
the gastrointestinal system is related to its effects on the
peripheral nervous system, central nervous system, and the
endocrine systems related to the GI tract. However, to prove
the specific causal relationship among these systems, further
research studies are needed.

5. Limitations
As blinding is difficult in acupuncture studies, the establishment of a blank control group seems impossible. Although
nonclassic acupoint acupuncture procedures were used as
control in the present study, they are still acupuncture
procedures; thus we could not rule out the cofounding
factor of needling and placebo effects in the present study.
This study is performed at one clinical center with one
acupuncturist on a relatively small sample; the results of
the present study may not well characterize the response of
patients with FD to acupuncture treatments. In addition, the
analysis of the results did not include patients who dropped
out; data processing based on per protocol population may

8
decrease the credence of the results. To better capture the
response of patients with FD to acupuncture, further large
scale, multicenter, randomized placebo controlled trials are
warranted.

6. Conclusion
Classic acupuncture with manual manipulation could
improve dyspeptic symptoms, mental status, and quality of
life in patients with FD and is superior to nonclassic acupoint
acupuncture without manipulations. These effects may be
related to the increased frequency and propagation speed
of gastric slow waves as well as increased serum gastrin
secretion.

Evidence-Based Complementary and Alternative Medicine

[10]

[11]

[12]

[13]

Conflict of Interests

[14]

The authors declare that there is no conflict of interests

regarding the publication of this paper.

[15]

Authors Contribution

[16]

Yulian Jin and Qing Zhao contributed equally to this work.

Acknowledgments

[17]

This study was funded by the State Key Development Program for Basic Research of China (973, Grant code no.
2011CB505202) and the National Natural Science Foundation
of China (Grant code no. 30870668, 81273674).

[18]

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