MEDICAL ACUPUNCTURE

Volume 20, Number 2, 2008

© Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2008.0605

Case Report

Acupuncture Treatment for Gastroparesis

San Hong Hwang, MD, Chiling Chuang, OMD, Anupama Kizhakkeveettil, MAOM

ABSTRACT

Background: Gastroparesis is a digestive disorder in which the motility of the stomach is either abnormal or
absent. Symptoms include, but are not limited to, a feeling of fullness after only a few bites of food, bloating,
excessive belching, and nausea. Traditional Chinese Medicine (TCM) has been used to treat a wide variety of
visceral disorders.
Objective: To evaluate the clinical efficacy of TCM in treating patients with gastroparesis.
Design, Setting, and Patient: Single case (a 61-year-old woman with a 2-year history of gastroparesis) pre-
sented to Southern California University Health Center (Whittier, CA) in June 2005. She was followed up
through Fall 2005.
Intervention: The treatment protocol for her digestive disorder included acupuncture treatment twice a week
on Ren 14 and ST 36, and the administration of traditional Chinese herbal formula Xiao Ban Xia Jia Fu Ling
Tang.
Main Outcome Measures: Gastric emptying test and patient report of symptoms.
Results: The patient reported significant improvement in symptomatic relief after acupuncture and herbal treat-
ments within 5 visits. The frequency of nausea was significantly diminished by the fourth visit. Energy levels,
emotional symptoms, constipation, and abdominal distention were improved over the course of treatment. Be-
fore treatment, gastric emptying was 25% at 2 hours and 69% at 4 hours. After treatment, gastric emptying was
84% at 2 hours and 100% at 4 hours.
Conclusions: Acupuncture and herbal treatment together relieved this patient of gastroparesis symptoms and
allowed her to experience an enhanced quality of life. This is an area of active investigation because current
therapy is suboptimal and existing treatments have not been well studied. Evidence-based investigation is re-
quired to have better approaches to this challenging condition.

Key Words: Traditional Chinese Medicine, Gastroparesis, Acupuncture, Herbal, Gastric Emptying

INTRODUCTION cause of a number of abdominal complaints.1 Symptoms in-

clude a feeling of fullness after only a few bites of food, bloat-

G ASTROPARESIS IS A MEDICAL TERM for stomach weakness,

a common disorder in which the stomach takes too long
to empty its contents. It is an abnormal function of the stom-
ach without any physical evidence of obstruction. It can be the
ing, excessive belching, nausea and vomiting, and regurgitation
of stomach fluid into the mouth.2 In some patients, symptoms
can be quite non-specific, such as persistent heartburn, abdom-
inal pain, or poor glucose control in patients with diabetes.3

Southern California University of Health Sciences, Whittier, CA.

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Medications that reduce or eliminate stomach acid usu-
ally do not afford substantial relief. Standard care of gas-
troparesis relies on dietary modification, antiemetic drug
therapy, and initiation of medications that stimulate gastric
motor activity. Recent advances include pyloric injection of
botulinum toxin and surgical implantation of an electrical
neurostimulator.1 Other surgical therapies are reserved for
refractory cases. No single treatment modality provides
complete relief to all patients, and the condition may relapse
after periods of remission.
The diagnosis of gastroparesis is confirmed through one
or more of the following tests: barium x-ray, barium beef-
steak meal, radioisotope gastric-emptying scan, gastric
manometry, and blood tests.4 The following case report de-
scribes a gastroparesis patient who sought acupuncture and
herbal formula as an adjunctive therapy.
CASE REPORT
Patient History
The patient, a 61-year-old woman, was referred for
acupuncture treatment to the Southern California University
of Health Sciences (Whittier, CA) health center because of
chronic intermittent nausea for more than 2 years. The nau-
sea was accompanied by epigastric distention and indiges-
tion. Whenever her stomach was empty, she experienced a
burning sensation in her stomach and vomiting. She also re-
ported pain surrounding her mouth that seemed to be closely
related to her stomach condition; it usually occurred along
with onset of her stomach symptoms.
Her stomach disorder started in May 2002, with the ma-
jor complaint of constant nausea. At that time, abdominal
ultrasound revealed gallstones and cholecystectomy was ad-
vised. The nausea symptoms subsided for a brief period af-
ter the gallbladder surgery but recurred in August 2002. At
that time, the patient was diagnosed with mild acid reflux
disorder and was treated with rabeprazole, lansoprazole, es-
omeprazole, metoclopramide, trimethobenzamide, and su-
cralfate. The patient reported that she had some temporary
relief while she was taking these medications but never had
long-term relief of symptoms. In August 2003, she reported
that the nausea and stomach discomfort became more se-
vere. She was then diagnosed as having a nervous stomach
that was probably reacting to the medication taken for a den-
tal procedure. Prior to her gallbladder removal, in April
2002, she had intensive dental work done for root canals.
The dental work left her with a “burning mouth syndrome.”
Since then, she experienced frequent nausea and stomach
upsets.
In April 2004, she was hospitalized due to severe nausea,
stomach discomfort, and dehydration. She was then diagnosed
with idiopathic gastroparesis by a gastrointestinal specialist.
At that time, she was evaluated via laboratory tests, CT scan,
HWANG ET AL.
and endoscopy; all findings were negative except a small hi-
atal hernia was found during endoscopic examination. No
clinical findings could explain the etiopathogenesis of her
nausea symptom, which had recently become quite severe. In
October 2004, the patient underwent a stomach-emptying
study that showed a slower than normal emptying time. She
also underwent a 24-hour acid reflux test and had her first ra-
diologic report on a gastric emptying test (on solid only). It
showed that 2 hours after food intake, approximately 25% of
the gastric contents were emptied (normal range, 40%-76%)
and in 4 hours, 69% of the gastric contents were emptied (nor-
mal range, 84%-98%). The impression of the radiologist was,
“The findings are compatible with moderate delay in gastric
emptying. Visual inspection of the images confirms the above
numerical values.”
As all pathogenesis for other diseases had been ruled out,
the patient was diagnosed as having “idiopathic gastropare-
sis” by her gastrointestinal specialist. Metoclopramide was
prescribed to help empty her stomach at a better rate. She
took this medication for 2 weeks with no relief of symp-
toms. She also stated that stress appeared to be a contribut-
ing factor to her stomach disorder because sometimes, her
symptoms became exaggerated when she was in a stressful
situation. Because medication did not improve her symp-
toms, a surgical procedure was recommended in which a
pacemaker-like device would be installed to regulate her
stomach’s peristalsis. She refused the surgery and sought
acupuncture as an alternative treatment.
The patient had been treated by another acupuncturist for
2 months on a weekly basis. The acupuncture points used
for her condition then were ST 12, ST 13, ST 20, ST 21,
ST 25, PC 6, SP 4, ST 36, SP 6, ST 44, and LR 3. Two
herbal formulas, Bao He Wan and Ping Wei San, were pre-
scribed then for daily use. In addition, proteolytic enzymes
were also prescribed to aid in her digestion. However, al-
most all enzymatic therapy tended to cause a flare-up in the
patient’s gastric distress. The above treatments provided
temporary relief and her symptoms typically recurred within
a few days. She was referred to us by this acupuncturist for
further assessment and clinical care.
Equipment
For needling ST 36, we used a sterile needle (Seirin,
Tokyo, Japan) 0.25 x 40 mm (#32). The needle was inserted
on both sides perpendicularly with 1.4 cun in depth. For
needling Ren 14, we used a sterile needle (Seirin) 0.25 x 30
mm (#32). The needle was inserted perpendicularly with 0.8
cun in depth.
RESULTS
The patient presented to us in June 2005 with the chief
complaints of severe nausea and burning sensation in her
ACUPUNCTURE FOR GASTROPARESIS
stomach. She also reported sleep problems due to frequent
nausea at night. Tenderness and mild resistance at the epi-
gastrium were present during the physical examination, but
no definite tumor mass was palpable. Her tongue was
slightly flabby and slightly red with teeth marks at the sides
and topped by a thick, white, greasy coating. Her pulse was
moderate and soft on the right and slightly wiry on the left.
According to Traditional Chinese Medicine (TCM), she was
diagnosed as having Qi Deficiency of the Stomach and
Damp Accumulation at the Middle Energizer. Our initial
treatment included acupuncture on Ren 14 and herbal for-
mula Xiao Ban Xia Jia Fu Ling Tan, 2 tablets 3 times daily.
At her second visit in July 2005, the patient reported some
improvement in her nausea symptoms. She still reported
stomach discomfort after eating and stools containing undi-
gested food. Her tongue was slightly flabby with a thick
white greasy coating. Her pulse was slippery on the right
side and thready on the left side. She was treated with
acupuncture at ST 36 on both sides, Ren 14, and herbal for-
mula Xiao Ban Xia Jia Fu Ling Tan, 3 tablets 3 times daily.
Her third visit was 4 days later when she reported that
the nausea improved, but she still had nausea and a burning
sensation in her stomach upon wakening. After each meal,
she felt that her food had not digested properly. She expe-
rienced 2 days of constipation and 1 day of diarrhea that
week. Her tongue was slightly purple on the side with teeth
marks and thick white coating. Pulse was slippery and
thready on the right side and slippery on the left side. The
same treatment was continued during this visit.
A second gastric emptying test was done after her third
visit. The test report revealed that 84% of the gastric con-
tents were emptied in 2 hours, and 100% of the gastric con-
tents were emptied in 4 hours. The radiologist reported that
results of the study were normal for gastric emptying.
At her fourth visit 3 days later, the patient reported that
she was feeling better by 25%. She woke up with nausea
that would go away after eating. Distention in the stomach
was reduced. She underwent a gastric emptying test ordered
by her gastroenterologist that showed that her stomach emp-
tying rate was within normal range. Her tongue was red at
the tip with a thick white coating; pulse was slippery on the
right side, and slippery and moderate on the left side. She
was treated at the same acupuncture points and the herbal
formula was changed to 2 tablets twice daily.
At her fifth visit 4 days later, the patient reported im-
provement in all of her clinical symptoms. Nausea had com-
pletely subsided, no more undigested food was found in the
stool, and bowel movements became regular. Occasionally,
she experienced some hiccups when her stomach was empty.
Her tongue was slightly purple on the side with greasy white
coating; pulse was thready on the right side, and soft and
slippery on the left side. Her treatment remained the same.
At her sixth visit 3 days later, the patient was free of all gas-
tric symptoms. Her treatment was again the same.
She was followed up by phone 3 months later and re-
125
ported that she was still symptom-free without any stomach
discomfort.
DISCUSSION
The patient reported here had significant improvement in
symptomatic relief after the acupuncture and herbal treat-
ments. Frequency of nausea was noticeably diminished af-
ter the first treatment. Energy levels, emotional symptoms,
constipation, and abdominal distention were also much im-
proved over the course of treatment. There were no adverse
effects experienced throughout the entire treatment.
Gastroparesis is a digestive disorder in which the motil-
ity of the stomach is either abnormal or absent. It is also
known as delayed gastric emptying. Gastroparesis occurs
when the nerves to the stomach are damaged or do not
function well. Diabetes is the most common cause.3 No
treatment as yet provides complete relief from this disor-
der. Surgery is considered as a last resort for patients with
intense gastric stasis. There are limited controlled data
concerning surgical treatment of idiopathic gastropare-
sis.5 In general, most uncontrolled studies report disap-
pointing responses to even operative resection in these
patients.6
Acupuncture needling is mainly to stimulate smooth mus-
cle contraction of the stomach and increase gastric motility.
The herbal supplement helps to alleviate the associated
symptoms, especially nausea, vomiting, and burning sensa-
tion in the stomach.
Location of Ren 14 (Ju Que) is 1 cun below the xyphoid
process, and 6 cun above the umbilicus, just anterior to the
stomach organ anatomically. The vasculature around Ren 14
includes superior epigastric artery and vein, and the nerve
innervations include the anterior cutaneous branch of the 7th
intercostal nerve. Under acupuncture stimulation on Ren 14,
the stomach may increase its peristalsis under the influence
of Qi induced by the acupuncture needle. Ren 14 is also the
Front Mu point of the Heart and potentially pacifies emo-
tional stress.7
The herbal formula Xiao Ban Xia Jia Fu Ling Tang is
composed of Ban Xia (pinellia 48%) that harmonizes the
stomach and relieves nausea and vomiting; Fu Ling (poria
cocos 40%) that promotes urination to eliminate Damp from
the Middle Energizer, as well as to strengthen the spleen,
the major digestive organ in TCM; and Sheng Jiang (fresh
ginger 12%) that soothes stomach Qi and helps the other 2
herbs to alleviate nausea and vomiting.8
CONCLUSIONS
Acupuncture treatment may be effective in promoting
gastric motility with less adverse reactions or side effects.9
From the data shown on the 2 gastric emptying tests in this
126
patient, the stomach emptying rates prior to and after
acupuncture treatment are significant.
Several tests are available for the evaluation of patients
with suspected gastroparesis. Treatments of gastric dys-
motility rely on dietary, pharmacologic, and surgical ther-
apies that relieve symptoms and maintain adequate nutri-
tion. This case study shows that TCM can offer promising
results for treating patients with gastroparesis. This is an
area of active investigation because the current therapy is
suboptimal and existing treatments have not been well
studied. Evidence-based investigation may be required for
approaches to this challenging condition. Acupuncture and
herbal treatment together enabled this patient to reduce
her symptoms of gastroparesis and experience an en-
hanced quality of life.
REFERENCES
1. Hasler WL. Nausea, gastroparesis, and aerophagia. J Clin Gas-
troenterol. May–Jun 2005;39(5 suppl):S223–S229.
2. Ali T, Hasan M, Hamadani M, Harty RF. Gastroparesis. South
Med J. 2007;100(3):281–286.
HWANG ET AL.
3. Diabetic neuropathy: an intensive review. Am J Health Syst
Pharm. 2004;61(2):160–173.
4. Horowitz M, Fraser RJ. Gastroparesis: diagnosis and manage-
ment. Scand J Gastroenterol Suppl. 1995;213:7–16.
5. Jones M, Maganti K. A systematic review of surgical ther-
apy for gastroparesis. Am J Gastroenterol. 2003;98:
2122–2129.
6. Quigley E, Hasler W, Parkman H. AGA technical review on
nausea and vomiting. Gastroenterology. 2001;120:263–286.
7. Cheng X. Chinese Acupuncture and Moxibustion. Rev ed. Bei-
jing, China: Foreign Language Press; 1999:154, 239.
8. Hong-Yen H. Commonly Used Chinese Herbal Formulas. 2nd
Rev ed. OHAI Press; 1997:646.
9. Zhong Y, Zhou H, Zhong L. Clinical observation on effect of
weichangshu in treating diabetic gastroparesis. Zhongguo
Zhong Xi Yi Jie He Za Zhi. 2005;25(3):203–206.
Address correspondence to:
Anupama Kizhakkeveettil, BAMS (Ayurveda), MAOM
16200 East Ambervalley Drive
Whittier, CA 90604
E-mail: anu@scuhs.edu