Clinical practice guidelines for acupuncture in the treatment of functional dyspepsia (2025) proposal_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Xueping ¹ , HU Xinxin ¹ , CHEN Wei ² , YANG Chen ³ , DAI Xiaoju ⁴ , LI Bolin ⁵ , SONG Xiaojing ⁶ , CHENG Yanmei ⁷ , RONG Peijing ⁸ ,  SU Xiaolan ¹ ,  WEI Wei ¹

1. Department of Spleen and Stomach Diseases, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, P. R. China;
2. Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
3. Department of Traditional Chinese Medicine, Emergency General Hospital, Beijing 100028, P. R. China;
4. First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, P. R. China;
5. Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050011, P. R. China;
6. Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, P. R. China;
7. Department of Gastroenterology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P. R. China;
8. Institute of Clinical Basic Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, P. R. China;

Corresponding author：

SU Xiaolan, Email: suxiaolan1982@126.com; WEI Wei, Email: sxxtyy@sina.com

Keywords：

Acupuncture; Functional dyspepsia; Diagnosis; Treatment; Guideline; Proposal

DOI：

10.7507/1672-2531.202504181

Video：

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Abstract Full text Figures/Tables Video References Cited by

Functional dyspepsia (FD) is a common functional gastrointestinal disorder in clinical practice. Due to its long-term natural history, FD significantly impacts patients' quality of life and imposes a heavy social burden. Existing evidence suggests that acupuncture can effectively alleviate FD symptoms and is safe for treatment. However, current studies still face fragmented evidence regarding acupoint combinations, standardized procedures, and subtype interventions. Moreover, the existing clinical guidelines for FD do not provide specific recommendations on acupuncture treatment. To address the series of clinical issues faced by acupuncture in treating FD and to offer a scientific and standardized clinical protocol for acupuncture in FD treatment, the establishment of the "Clinical Practice Guidelines for Acupuncture Treatment of Functional Dyspepsia" was initiated by the Wangjing Hospital of the China Academy of Chinese Medical Sciences. This protocol systematically introduces the background, basic steps, working group members and their responsibilities, scope of application, the collection and determination of clinical issues and outcome indicators, evidence retrieval and evaluation methods, formulation of recommendations, external review and approval of recommendations, release and updating of the final draft, and the processes of promotion and implementation.

1.	Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology, 2021, 160(1): 99-114.
2.	陈旻湖, 方秀才, 侯晓华, 等. 2022中国功能性消化不良诊治专家共识. 胃肠病学, 2023, 28(8): 467-481.
3.	Drossman DA. Functional gastrointestinal disorder and the Rome IV process. Raleigh, N. C. : Rome Foundation, 2016.
4.	Ford AC, Marwaha A, Sood R, et al. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut, 2015, 64(7): 1049-1057.
5.	Ford AC, Mahadeva S, Carbone MF, et al. Functional dyspepsia. Lancet, 2020, 396(10263): 1689-1702.
6.	Aziz I, Palsson OS, Törnblom H, et al. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol, 2018, 3(4): 252-262.
7.	Lacy BE, Chase RC, Cangemi DJ. The treatment of functional dyspepsia: present and future. Expert Rev Gastroenterol Hepatol, 2023, 17(1): 9-20.
8.	Esterita T, Dewi S, Suryatenggara FG, et al. Association of functional dyspepsia with depression and anxiety: a systematic review. J Gastrointestin Liver Dis, 2021, 30(2): 259-266.
9.	Gracie DJ, Bercik P, Morgan DG, et al. No increase in prevalence of somatization in functional vs organic dyspepsia: a cross-sectional survey. Neurogastroenterol Motil, 2015, 27(7): 1024-1031.
10.	Sayuk GS, Gyawali CP. Functional dyspepsia: diagnostic and therapeutic approaches. Drugs, 2020, 80(13): 1319-1336.
11.	Zhou L, Zeng Y, Zhang H, et al. The role of gastrointestinal microbiota in functional dyspepsia: a review. Front Physiol, 2022, 13: 910568.
12.	Lacy BE, Chase RC, Cangemi DJ. The treatment of functional dyspepsia: present and future. Expert Rev Gastroenterol Hepatol, 2023, 17(1): 9-20.
13.	刘迈兰, 周芝根, 李波, 等. 针刺与艾灸治疗功能性消化不良: 随机对照研究. 中国针灸, 2017, 37(9): 943-946.
14.	Liao X, Tian Y, Zhang Y, et al. Acupuncture for functional dyspepsia: Bayesian meta-analysis. Complement Ther Med, 2024, 82: 103051.
15.	Miwa H, Nagahara A, Asakawa A, et al. Evidence-based clinical practice guidelines for functional dyspepsia 2021. J Gastroenterol, 2022, 57(2): 47-61.
16.	World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: World Health Organization, 2014.
17.	陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版). 中华医学杂志, 2022, 102(10): 697.
18.	Institute of Medicine (US) Committee to Advise the Public Health Service on Clinical Practice Guidelines. Clinical practice guidelines: directions for a new program. Washington (DC): National Academies Press (US), 1990.
19.	Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
20.	Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
21.	王洋洋, 陈耀龙, 王小琴, 等. 中医(中西医结合)临床实践指南制修订方法—指南小组的形成与工作流程. 中华中医药杂志, 2016, 31(4): 1313-1315.
22.	陈耀龙, 马艳芳, 周奇, 等. 谁应该参与临床实践指南的制订. 协和医学杂志, 2019, 10(5): 524-530.
23.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
24.	Likert R. A technique for the measurement of attitudes. Archives of Psychology, 1932, 22: 55.
25.	吴永泽, 王文绢. 不同应答等级对Likert式量表特性的影响. 中国慢性病预防与控制, 2010, 18(2): 215-217.
26.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
27.	Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022). Chichester (UK): Wiley-Blackwell, 2022.
28.	Ma LL, Wang YY, Yang ZH, et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better. Mil Med Res, 2020, 7(1): 7.
29.	Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
30.	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
31.	Whiting P, Savović J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 2016, 69: 225-234.
32.	Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 2015, 162(11): 777-784.
33.	Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
34.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials, 1996, 17(1): 1-12.
35.	Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
36.	Wells GA, Shea B, O’Connell D, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2020.
37.	Montgomery P, Movsisyan A, Grant SP, et al. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Glob Health, 2019, 4(Suppl 1): e000848.
38.	邓通, 汪洋, 王云云, 等. 临床实践指南制订方法——GRADE 在观察性系统评价中的应用. 中国循证心血管医学杂志, 2019, 11(2): 129-133.
39.	曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统. 中国循证医学杂志, 2011, 11(9): 985-990.
40.	Xie YL, Han F, Jin YH, et al. Organic integration of traditional Chinese and western medicines-future of clinical practice guidelines of integrated traditional Chinese and western medicines. Chin J Integr Med, 2024, 30(4): 359-365.
41.	Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
42.	Vernooij RW, Alonso-Coello P, Brouwers M, et al. Reporting items for updated clinical guidelines: checklist for the reporting of updated guidelines (CheckUp). PLoS Med, 2017, 14(1): e1002207.
43.	Ford AC, Mahadeva S, Carbone MF, et al. Functional dyspepsia. Lancet, 2020, 396(10263): 1689-1702.
44.	Ford AC, Forman D, Bailey AG, et al. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut, 2007, 56(3): 321-327.
45.	McBride D, Hardoon S, Walters K, et al. Explaining variation in referral from primary to secondary care: cohort study. BMJ, 2010, 341: c6267.
46.	Shivaji UN, Ford AC. Prevalence of functional gastrointestinal disorders among consecutive new patient referrals to a gastroenterology clinic. Frontline Gastroenterol, 2014, 5(4): 266-271.
47.	Esterita T, Dewi S, Suryatenggara FG, et al. Association of functional dyspepsia with depression and anxiety: a systematic review. J Gastrointestin Liver Dis, 2021, 30(2): 259-266.
48.	Gracie DJ, Bercik P, Morgan DG, et al. No increase in prevalence of somatization in functional vs organic dyspepsia: a cross-sectional survey. Neurogastroenterol Motil, 2015, 27(7): 1024-1031.
49.	Lacy BE, Weiser KT, Kennedy AT, et al. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther, 2013, 38(2): 170-177.
50.	Black CJ, Paine PA, Agrawal A, et al. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut, 2022, 71(9): 1697-1723.
51.	王宇, 杨静雯, 胡慧, 等. 针刺改善278例餐后不适综合征患者消化不良相关症状: 一项多中心随机对照研究的二次分析. 中国针灸, 2021, 41(6): 583-587.
52.	Zhang J, Liu Y, Huang X, et al. Efficacy comparison of different acupuncture treatments for functional dyspepsia: a systematic review with network meta-analysis. Evid Based Complement Alternat Med, 2020, 2020: 3872919.
53.	邓少杰. 温针灸联合推拿辅治功能性消化不良临床观察. 实用中医药杂志, 2024, 40(12): 2409-2411.
54.	Chen H, He M, Cao J, et al. Acupuncture and moxibustion intervention in functional dyspepsia: gastric and duodenal regulation. Heliyon, 2024, 10(17): e35696.
55.	Yang JW, Wang LQ, Zou X, et al. Effect of acupuncture for postprandial distress syndrome: a randomized clinical trial. Ann Intern Med, 2020, 172(12): 777-785.

1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology, 2021, 160(1): 99-114.
2. 陈旻湖, 方秀才, 侯晓华, 等. 2022中国功能性消化不良诊治专家共识. 胃肠病学, 2023, 28(8): 467-481.
3. Drossman DA. Functional gastrointestinal disorder and the Rome IV process. Raleigh, N. C. : Rome Foundation, 2016.
4. Ford AC, Marwaha A, Sood R, et al. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut, 2015, 64(7): 1049-1057.
5. Ford AC, Mahadeva S, Carbone MF, et al. Functional dyspepsia. Lancet, 2020, 396(10263): 1689-1702.
6. Aziz I, Palsson OS, Törnblom H, et al. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol, 2018, 3(4): 252-262.
7. Lacy BE, Chase RC, Cangemi DJ. The treatment of functional dyspepsia: present and future. Expert Rev Gastroenterol Hepatol, 2023, 17(1): 9-20.
8. Esterita T, Dewi S, Suryatenggara FG, et al. Association of functional dyspepsia with depression and anxiety: a systematic review. J Gastrointestin Liver Dis, 2021, 30(2): 259-266.
9. Gracie DJ, Bercik P, Morgan DG, et al. No increase in prevalence of somatization in functional vs organic dyspepsia: a cross-sectional survey. Neurogastroenterol Motil, 2015, 27(7): 1024-1031.
10. Sayuk GS, Gyawali CP. Functional dyspepsia: diagnostic and therapeutic approaches. Drugs, 2020, 80(13): 1319-1336.
11. Zhou L, Zeng Y, Zhang H, et al. The role of gastrointestinal microbiota in functional dyspepsia: a review. Front Physiol, 2022, 13: 910568.
12. Lacy BE, Chase RC, Cangemi DJ. The treatment of functional dyspepsia: present and future. Expert Rev Gastroenterol Hepatol, 2023, 17(1): 9-20.
13. 刘迈兰, 周芝根, 李波, 等. 针刺与艾灸治疗功能性消化不良: 随机对照研究. 中国针灸, 2017, 37(9): 943-946.
14. Liao X, Tian Y, Zhang Y, et al. Acupuncture for functional dyspepsia: Bayesian meta-analysis. Complement Ther Med, 2024, 82: 103051.
15. Miwa H, Nagahara A, Asakawa A, et al. Evidence-based clinical practice guidelines for functional dyspepsia 2021. J Gastroenterol, 2022, 57(2): 47-61.
16. World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: World Health Organization, 2014.
17. 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版). 中华医学杂志, 2022, 102(10): 697.
18. Institute of Medicine (US) Committee to Advise the Public Health Service on Clinical Practice Guidelines. Clinical practice guidelines: directions for a new program. Washington (DC): National Academies Press (US), 1990.
19. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
20. Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
21. 王洋洋, 陈耀龙, 王小琴, 等. 中医(中西医结合)临床实践指南制修订方法—指南小组的形成与工作流程. 中华中医药杂志, 2016, 31(4): 1313-1315.
22. 陈耀龙, 马艳芳, 周奇, 等. 谁应该参与临床实践指南的制订. 协和医学杂志, 2019, 10(5): 524-530.
23. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
24. Likert R. A technique for the measurement of attitudes. Archives of Psychology, 1932, 22: 55.
25. 吴永泽, 王文绢. 不同应答等级对Likert式量表特性的影响. 中国慢性病预防与控制, 2010, 18(2): 215-217.
26. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
27. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022). Chichester (UK): Wiley-Blackwell, 2022.
28. Ma LL, Wang YY, Yang ZH, et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better. Mil Med Res, 2020, 7(1): 7.
29. Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
30. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
31. Whiting P, Savović J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 2016, 69: 225-234.
32. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 2015, 162(11): 777-784.
33. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
34. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials, 1996, 17(1): 1-12.
35. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
36. Wells GA, Shea B, O’Connell D, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2020.
37. Montgomery P, Movsisyan A, Grant SP, et al. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Glob Health, 2019, 4(Suppl 1): e000848.
38. 邓通, 汪洋, 王云云, 等. 临床实践指南制订方法——GRADE 在观察性系统评价中的应用. 中国循证心血管医学杂志, 2019, 11(2): 129-133.
39. 曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统. 中国循证医学杂志, 2011, 11(9): 985-990.
40. Xie YL, Han F, Jin YH, et al. Organic integration of traditional Chinese and western medicines-future of clinical practice guidelines of integrated traditional Chinese and western medicines. Chin J Integr Med, 2024, 30(4): 359-365.
41. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
42. Vernooij RW, Alonso-Coello P, Brouwers M, et al. Reporting items for updated clinical guidelines: checklist for the reporting of updated guidelines (CheckUp). PLoS Med, 2017, 14(1): e1002207.
43. Ford AC, Mahadeva S, Carbone MF, et al. Functional dyspepsia. Lancet, 2020, 396(10263): 1689-1702.
44. Ford AC, Forman D, Bailey AG, et al. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut, 2007, 56(3): 321-327.
45. McBride D, Hardoon S, Walters K, et al. Explaining variation in referral from primary to secondary care: cohort study. BMJ, 2010, 341: c6267.
46. Shivaji UN, Ford AC. Prevalence of functional gastrointestinal disorders among consecutive new patient referrals to a gastroenterology clinic. Frontline Gastroenterol, 2014, 5(4): 266-271.
47. Esterita T, Dewi S, Suryatenggara FG, et al. Association of functional dyspepsia with depression and anxiety: a systematic review. J Gastrointestin Liver Dis, 2021, 30(2): 259-266.
48. Gracie DJ, Bercik P, Morgan DG, et al. No increase in prevalence of somatization in functional vs organic dyspepsia: a cross-sectional survey. Neurogastroenterol Motil, 2015, 27(7): 1024-1031.
49. Lacy BE, Weiser KT, Kennedy AT, et al. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther, 2013, 38(2): 170-177.
50. Black CJ, Paine PA, Agrawal A, et al. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut, 2022, 71(9): 1697-1723.
51. 王宇, 杨静雯, 胡慧, 等. 针刺改善278例餐后不适综合征患者消化不良相关症状: 一项多中心随机对照研究的二次分析. 中国针灸, 2021, 41(6): 583-587.
52. Zhang J, Liu Y, Huang X, et al. Efficacy comparison of different acupuncture treatments for functional dyspepsia: a systematic review with network meta-analysis. Evid Based Complement Alternat Med, 2020, 2020: 3872919.
53. 邓少杰. 温针灸联合推拿辅治功能性消化不良临床观察. 实用中医药杂志, 2024, 40(12): 2409-2411.
54. Chen H, He M, Cao J, et al. Acupuncture and moxibustion intervention in functional dyspepsia: gastric and duodenal regulation. Heliyon, 2024, 10(17): e35696.
55. Yang JW, Wang LQ, Zou X, et al. Effect of acupuncture for postprandial distress syndrome: a randomized clinical trial. Ann Intern Med, 2020, 172(12): 777-785.

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Latest ArticlesClinical practice guidelines for acupuncture in the treatment of functional dyspepsia (2025) proposal

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