Acupuncture Treating PDS Of FD With Specific Acupoints Of Stomach Meridian: A Randomized Controlled Trial And A PET-CT Study

Objective:To evaluate the clinical efficacy of acupuncture for Postprandial Distress Syndrome (PDS) of Functional Dyspepsia (FD) with specific acupoints and non-specific acupoints of stomach meridian, and explore their influence on the brain function, thus providing scientific and experimental evidence for acupoints selection in the treatment of FD with acupuncture.Method:1. A multicenter, randomized controlled trial was conducted and 150 PDS patients were randomly divided into two groups:group A (Specific Acupoints of the Stomach Meridian) and group B (Non-specific Acupoints of the Stomach Meridian). The subjects of both groups were required to receive electro-acupuncture treatment once per day and continuous 5-day treatments each week, totaling 20 times for 4 weeks. Nepean Dyspepsia Index (NDI) and 36-Items Short Form Health Survey (SF-36) were applied as the main indicator to evaluate the therapeutic effect of specific acupoints and non-specific acupoints of stomach meridian for PDS at 3 stages:at the end of treatment,4 weeks of follow-up after the treatment, and 12 weeks follow-up after the treatment.2. For 18 cases (9 cases on each group) in line with the research requirements of brain function imaging that were recruited from the Chengdu Clinical Research Center, Positron Emission Tomography-Computed Tomography (PET-CT) was used for research, with treatment course the same to that of the clinical trail. The changes of cerebral glucose metabolism of the PDS patients after acupuncture treatment were observed, paving a way to explore their influence on the brain function evoked by acupuncture on specific acupoints and non-specific acupoints of stomach meridian.Results:1. The results of the clinical efficacy evaluation of acupuncture for PDS with specific acupoints and non-specific acupoints of stomach meridian are as follows:1) The two groups are comparable because both of them enjoy the same base line.2) The NDI shows the symptom total score, frequency score, severity score and influence on daily life score of PDS patients after acupuncture treatment are all significantly lower than those scores before the treatment (p<0.05) and this phenomenon lasted until 12 weeks after the treatment. In addition, compared to the B group after treatment, the A group has statistic significance (p<0.05) in symptom total score and severity score at both stages:at the end of treatment and 12 weeks after treatment, and also in the symptom frequency improvement score at the stage of 12 weeks after treatment.3) SF-36 indicates the life quality scores in 8 aspects of the SF-36 of PDS patients in both groups after acupuncture treatment are significantly higher than those scores before the treatment (p<0.05) and this phenomenon lasted until 12 weeks after the treatment. Besides, compared to the B group after treatment, the A group has statistic significance (p<0.05) in general health improvement and social activity improvement at stages of the end of treatment,4 weeks after treatment and 12 weeks after treatment, and also in the mental health improvement at the stage of the end of the treatment.2. The results of the influence on the brain function evoked by acupuncture on specific acupoints and non-specific acupoints of stomach meridian for PDS are as follows:1) The two groups are comparable because both of them enjoy the same base line.2) Changes of the cerebral limbic system of PDS patients in both groups after acupuncture treatment are: in the A group, most of the brain regions with abnormally enhanced glucose metabolism are lowered (p<0.005), including insula (BA13), anterior cingulate cortex (BA24 and BA32), middle cingulate cortex (BA32), posterior cingulate cortex (BA29 and BA31), parahippocompalgyrus (BA35), caudate nucleus, claustrum, lenticular nucleus, thalamus, hippocampus, amygdaloid nucleus, bilateral frontal lobes (BA3, BA6, BA8, BA11, BA45, and BA47), temporal lobe (BA19, BA21, BA22, and BA37), parietal lobe (BA7, BA23, BA39, and BA40), occipital lobe (BA19) and cerebellum (declive, tonsil, and pyramis), while in the B group, only some of the brain regions with abnormally enhanced glucose metabolism are lowered (p<0.005), including bilateral caudate nucleus, precentral gyrus (BA4 and BA6), inferior parietal lobe (BA40), superior temporal gyrus (BA38), cerebellum (declive, tonsil, and pyramis), left anterior cingulate cortex (BA24), right posterior cingulate cortex (BA26), left pulvinar and ventral posterolateral thalamic nucleus, left middle frontal gyrus (BA9), and right angular gyrus (BA39).3) Changes of relevant disease-related brain regions of PDS patients in both groups after acupuncture treatment are: in the A group, all the relevant disease-related brain regions with abnormal activities are significantly inhibited (p<0.05), including bilateral insula, anterior cingulate cortex, middle cingulate cortex, thalamus, and cerebellum; while in the B group, significant inhibition (p<0.05) only happens in the left anterior cingulate cortex and bilateral cerebellum.Conclusion:1. Acupuncture on specific acupoints of stomach meridian for PDS has superior efficacy to that on non-specific acupoints, which represents in more significantly reducing symptom-list score, symptom frequency and symptom intensity, and more significantly improving General Health, Sicial Functioning and Mental Health.2. Acupuncture on specific acupoints of stomach meridian can generally bring down abnormally enhanced glucose metabolism in various brain regions of PDS patients, and significantly regulate the functions of the key brain regions in relation to PDS. Compared to the non-specific acupoints, acupuncture on specific acupoints of stomach meridian can not only evoke wider synergic integrity response in the brain networks responsible for visceral motor and sensory, emotion and recognition, but also features more obvious targeting regulation in relevant key brain regions.3. Compared to the non-specific acupoints, acupuncture on specific acupoints has superior efficacy and difference of central response exists, which are research evidences for the hypothesis that there is efficacy specificity of specific acupoints over non-specific acupoints on the same meridian.