Case Report

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Journal of Acupuncture Research 2023; 40(2): 143-149

Published online May 31, 2023

https://doi.org/10.13045/jar.2022.00402

© Korean Acupuncture & Moxibustion Medicine Society

Korean Medicine Treatment for Dyspepsia and Constipation in a Patient with HIV: A Case Report

Ji-Su Ha1 , Han-Song Park2 , Hyun-Seo Park2 , Ka-Hyun Kim3 , Hae-Won Hong4 , In-Ae Youn5

1Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea
2Department of Internal Medicine of Korean Medicine, National Medical Center, Seoul, Korea
3Department of Korean Medicine Rehabilitation, Daejeon Jaseng Hospital of Korean Medicine, Daejeon, Korea
4Department of Acupuncture and Moxibustion Medicine, Daejeon Jaseng Hospital of Korean Medicine, Daejeon, Korea
5Department of Acupuncture and Moxibustion Medicine, National Medical Center, Seoul, Korea

Correspondence to : In-Ae Youn
Department of Acupuncture and Moxibustion Medicine, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea
E-mail: eknowkey@naver.com

Received: December 7, 2022; Revised: February 14, 2023; Accepted: February 23, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Functional dyspepsia (FD) is a chronic and recurrent upper gastrointestinal symptom that has no organic cause. A 49-year-old male patient positive for human immunodeficiency virus (HIV) visited the clinic because of FD and constipation. He received complex Korean medicine treatment, including acupuncture and herbal medicines, from April 14 to July 18, 2022 (27 times) in the outpatient department. Gastrointestinal Symptom Rating Scale (GSRS), Nepean Dyspepsia Index (NDI), FD-related quality of life (FD-QoL), Euro QoL visual analog scale (EQ-VAS), and Numerical Rating Scale (NRS) were used as evaluation tools in this study. Symptoms were relieved after 3 months of treatment, and his QoL improved (GSRS, 15–3; NDI, 110–21; FD-QoL, 52–20 [eating status, 10–3; liveliness status, 12–8; psychological, 1–0; role-functioning status, 18–9]; EQ-VAS, 40–65; NRS, 8–4). The results revealed that complex Korean medicine treatment could alleviate FD and constipation in patients with HIV.

Keywords Acupuncture; Dyspepsia; Herbal medicine; HIV; Medicine, Korean traditional

Functional dyspepsia (FD) is a disease characterized by one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain, or epigastric burning that occurs at least 3 days per week, lasts for at least 3 months, and started at least 6 months ago. Additionally, explaining the organic cause of FD based on related biochemical, endoscopic, and imaging tests is not possible [1]. The prevalence of FD, which is common in clinical practice, is approximately 25% in South Korea. However, FD treatment is difficult because of the presence of various pathophysiological mechanisms, and it may result in a patient’s quality of life (QoL) deterioration because of its chronicity [2].

Gastrointestinal symptoms are common in people living with human immunodeficiency virus (HIV) (PLWH), and more than one-third of them complain of various upper gastrointestinal symptoms, such as upper abdominal pain, early satiety, nausea, vomiting, and bloating [3].

However, a clear causal factor for FD has not yet been identified, nor a treatment has been developed. Hence, the need for complementary and alternative medicine, including Korean medicine, is emerging, and related studies have been conducted [4,5].

Korean medicine classifies FD as a digestive ailment or hysteria. FD includes various symptoms such as gastric stuffiness, heart pain, stomach duct pain, nausea, stuffiness and fullness, belching, and acid regurgitation [6]. Many studies have been reported on FD, including clinical studies [7-11] and literature reviews [12]. However, there are no studies on FD in PLWH in South Korea.

Herein, we report the effects of complex Korean medicine on FD in PLWH.

1. Medical history

A 49-year-old male patient presented with epigastric and abdominal bloating, early satiation, indigestion, and constipation with no definable cause in November 2021.

He was diagnosed with HIV in 2000 and had been receiving antiretroviral therapy (ART).

He underwent upper gastrointestinal endoscopy and colonoscopy at the Department of Gastroenterology at Natioanl Medical Center (NMC) on January 27, 2022, due to his gastrointestinal symptoms, which revealed no abnormalities. Additionally, abdominal computed tomography conducted at Wonju Severance Christian Hospital was normal as stated by the patient.

2. Treatment

The patient underwent a total of 27 treatment sessions (Table 1).

Table 1 . Dates of outpatient visits

MonthDate
April14, 21, 25, 28
May4, 6, 9, 12, 16, 19, 23, 25, 30
June2, 8, 10, 13, 15, 20, 23, 27, 30
July4, 7, 11, 14, 18

1) Acupuncture

Disposable sterile acupuncture needles 0.25 × 40 mm (Dongbang Medical Co., Ltd.) were applied to each point for 20 minutes at a time at a depth of 1.5–2 cm.

First to eleventh treatment sessions: Acupuncture was bilaterally applied to SI5, ST41, GB41, and ST43 (Sa-am stomach tonifying acupuncture).

Twelveth to twenty-seventh treatment sessions: Acupuncture was bilaterally applied to KI10, LR8, LU8, and LR4 (Sa-am liver tonifying acupuncture).

2) Herbal medicine

Banhahubak-tang (from April 25 to May 25) and Jowiseunggi-tang (from May 25 to July 18) were prescribed twice daily (Hankooksinyak, Korean Medicine Insurance Extract).

3) Electroacupuncture

Electrical stimulation (1 Hz) was applied to the 2 acupoints and performed for 20 minutes using an 8-channel low-frequency stimulator (GP-302; Goodpl Co. Inc.).

First to eleventh treatment sessions: Standard disposable sterile acupuncture needle 0.20 × 45 mm was applied to CV12 and CV13.

Twelveth to the last treatment sessions: Standard disposable sterile acupuncture needle 0.45 × 90 mm was applied to CV10 and CV12.

4) Cupping and moxibustion

Dry cupping was performed for 5 minutes using disposable cupping cups at the tenderness of the back-shu point. Moxibustion was conducted on CV12 and CV4 indirectly for 15 minutes each.

5) Western medicine treatment

At the time of the first visit to the Department of Korean medicine, he was taking medication from the Department of Infectious Diseases and Gastroenterology. Additionally, he was prescribed medicine by the Department of Dermatology and Urology during the treatment period.

3. Evaluation

The evaluation was done 4 times (April 14, May 19, June 15, and July 18).

1) Gastrointestinal Symptom Rating Scale

The Gastrointestinal Symptom Rating Scale (GSRS) is a questionnaire, consisting of 15 items, that was developed in 1988 and validated for irritable bowel syndrome and peptic ulcer disease evaluation. It can identify the overall upper and lower gastrointestinal symptoms [13].

2) Nepean Dyspepsia Index

The Nepean Dyspepsia Index (NDI) is a tool used to evaluate dyspepsia symptom-specific QoL. It consists of a symptom score table and items on QoL. Only the symptom score table was used in this case [14].

3) Functional dyspepsia related quality of life

FD-QoL, consisting of 21 items, with a higher total score indicating lower QoL, is used to evaluate the effect of FD on the QoL of patients.

4) Euro quality of life visual analog scale

The Euro QoL visual analog scale (EQ-VAS) was used to subjectively evaluate the health status using the VAS. Zero is the worst imaginable and 100 is the best imaginable health state.

5) Numerical Rating Scale

The Numerical Rating Scale (NRS) was used to numerically identify a patient’s subjective discomfort. It indicates the state with no discomfort as 0 and the state with the worst discomfort as 10.

4. Progress

The total GSRS score decreased from 15 points on the first visit to 3 points on the last visit. Only abdominal pain, distension, and a feeling of incomplete evacuation scored 1 point each during the last visit evaluation (Table 2, Fig. 1).

Table 2 . Changes in each item of Gastrointestinal Symptom Rating Scale

SymptomApril 14May 19June 15July 18
Abdominal pain3211
Heart burn0000
Acid regurgitation0000
Sucking sensations in the epigastrium0000
Nausea and vomiting0000
Borborygmus1110
Abdominal distension3321
Eructation0000
Increased flatus1110
Decreased passage of stools1110
Increased passage of stools1110
Loose stools0000
Hard stools1100
Urgent for defecation2100
Feeling of incomplete evacuation2111

Fig. 1. Changes in the total Gastrointestinal Symptom Rating Scale score.

The frequency, intensity, and severity of the symptoms noticeably decreased in the symptom evaluation of NDI. The patient demonstrated all the listed symptoms except for upper abdominal cramps, during the first visit. Pain and discomfort in the upper abdomen, inability to finish regular meals, fullness after eating, pressure, and bloating in the upper abdomen remained during the last evaluation, but they were greatly reduced (Table 3, Fig. 2).

Table 3 . Changes in each item of Nepean Dyspepsia Index

SymptomApril 14May 19June 15July 18
Upper abdominal pain11663
Upper abdominal discomfort11663
Upper abdominal burning5000
Heart burn5000
Upper abdominal cramps0000
Chest pain4000
Inability to finish regular meal12974
Bitter-tasting fluid that comes to your mouth8000
Fullness after eating11775
Upper abdominal pressure121033
Upper abdominal bloating121033
Nausea5000
Belching5330
Vomiting1000
Bad breath8700

Fig. 2. Changes in Nepean Dyspepsia Index scores at the first visit and the last visit.

The emotional aspect was the largest change among the QoL evaluation items. QoL improved from 12 points before treatment to 0 points after treatment. Additionally, the QoL improved in terms of eating, vitality, and social functioning (Table 4).

Table 4 . Changes in functional dyspepsia related quality of life

CategoryApril 14May 19June 15July 18
Eating status10553
Liveliness status12888
Psychological12640
Role-functioning status1812129
Total score52312920


The subjective health status evaluation score increased from 40 points on the first visit to 65 points on the last evaluation. The NRS for gastrointestinal symptoms decreased from NRS 8 before treatment to NRS 4 after treatment (Fig. 3).

Fig. 3. Changes in Euro quality of life visual analog scale (EQ-VAS) and Numerical Rating Scale (NRS).

FD is characterized by chronic epigastric gastrointestinal symptoms with idiopathy. Patients may complain of psychological symptoms, such as anxiety and depression, as well as physical pain because many cases show no response to continuous treatment.

HIV has become a manageable disease and is no longer an incurable disease with highly active ART (HAART) development. However, many PLWH still suffer from complications caused by continuous drug administration and various symptoms of opportunistic infections [15]. Drug safety in managing symptoms of PLWH should be considered because polypharmacy is associated with physiologic frailty, drug burden, and drug interaction [16]. Non-pharmacological approaches are needed. The study revealed gastrointestinal symptoms, including bloating, heartburn, diarrhea, and constipation, in 50–70% of PWLH [17], and the burden and severity of symptoms are higher than in non-PWLH [18]. The patient reported that his symptoms had started 6 months ago, at which time he underwent tests, which revealed no organic cause. He continued to take gastrointestinal medications, but no symptoms improved. However, the symptoms and QoL improved without adverse effects after receiving Korean medicine treatment for approximately 3 months.

The blood test before and after treatment revealed normal liver function test results, with no interference with CD4 count recovery, which is an immune state indicator (Table 5). This revealed no negative drug interactions between herbal medicine and HAART.

Table 5 . Laboratory finding before and after treatment

Blood testFebruary 21September 13Normal value
Lymphocyte subsets
CD4 count (%)2.75.123.0–48.2
CBC
WBC (103 cell/μL)6.77.04.0–10.0
RBC (106 cell/μL)4.14.624.2–6.3
Hgb (g/dL)14.316.013.0–17.0
HCT (%)40.948.339.0–52.0
Liver function test
AST (U/L)16120–40
ALT (U/L)870–41
Renal function test
BUN (mg/dL)13116–20
Creatinine (mg/dL)0.90.90.7–1.2

CBC, complete blood count; WBC, white blood cell; RBC, red blood cell; Hgb, hemoglobin; HCT, hematocrit; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen.



Sa-am acupuncture [19] and electroacupuncture [20] are commonly used in clinical practice for FD and are effective in improving QoL and gastrointestinal symptoms in FD treatment. No study used both Sa-am acupuncture and electroacupuncture for FD, but some studies used both Sa-am acupuncture and electroacupuncture for Mami syndrome [21] and low back pain [22]. The Front-Mu point was selected using the patient’s Sa-am acupoint [23].

Banhahubak-tang is a prescription according to the “Golden Chamber.” It prevents vomiting by down-regulating qi, disperses nodules and stuffiness, and removes distention by circulating qi. Therefore, it can be used for chest stuffiness and fullness, indigestion, and abdominal pain [24]. Previous studies have demonstrated the pharmacological action of Banhahubak-tang using medical imaging [25].

Jowiseunggi-tang is used to treat constipation because it inhibits water reabsorption in the large intestine, promotes intestinal peristalsis, and increases intestinal osmotic pressure [26].

This study has several limitations. First, the patient had to visit a rural area, and the treatment was discontinued without confirming a complete symptom resolution. Second, complex Korean medicine was administered to the patient; therefore, the effects of a single intervention could not be evaluated. Lastly, this study was based on a single case; therefore, generalizing these results is difficult.

However, this case study confirmed that complex Korean medicine treatment could not only relieve symptoms but also improve the QoL of FD and constipation in PLWH. PLWH is decreasing worldwide through various prevention and treatment projects, but it has been steadily increasing in Korea since its first diagnosis in 1985 until 2019 [27]. A Korean medical approach is needed to help symptoms in PLWH.

This is the first case report describing the benefits of complex Korean medicine treatment for FD in PLWH. Further studies are needed to examine the beneficial effects of Korean medicine treatment on various PLWH symptoms.

Conceptualization: JSH, IAY. Data analysis: JSH. Funding acquisition: IAY. Formal investigation: Han-Song Park, Hyun-Seo Park, KHK, HWH, JSH. Methodology: IAY. Writing – original draft: JSH, IAY. Writing – review & editing: All authors.

This work was supported by a grant of National Medical Center, Republic of Korea (Grant number: NMC 2020-PR-07).

The study was approved by the Institutional Review Board of the National Medical Center (NMC-2022-08-098).

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Article

Case Report

Journal of Acupuncture Research 2023; 40(2): 143-149

Published online May 31, 2023 https://doi.org/10.13045/jar.2022.00402

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Korean Medicine Treatment for Dyspepsia and Constipation in a Patient with HIV: A Case Report

Ji-Su Ha1 , Han-Song Park2 , Hyun-Seo Park2 , Ka-Hyun Kim3 , Hae-Won Hong4 , In-Ae Youn5

1Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea
2Department of Internal Medicine of Korean Medicine, National Medical Center, Seoul, Korea
3Department of Korean Medicine Rehabilitation, Daejeon Jaseng Hospital of Korean Medicine, Daejeon, Korea
4Department of Acupuncture and Moxibustion Medicine, Daejeon Jaseng Hospital of Korean Medicine, Daejeon, Korea
5Department of Acupuncture and Moxibustion Medicine, National Medical Center, Seoul, Korea

Correspondence to:In-Ae Youn
Department of Acupuncture and Moxibustion Medicine, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea
E-mail: eknowkey@naver.com

Received: December 7, 2022; Revised: February 14, 2023; Accepted: February 23, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Functional dyspepsia (FD) is a chronic and recurrent upper gastrointestinal symptom that has no organic cause. A 49-year-old male patient positive for human immunodeficiency virus (HIV) visited the clinic because of FD and constipation. He received complex Korean medicine treatment, including acupuncture and herbal medicines, from April 14 to July 18, 2022 (27 times) in the outpatient department. Gastrointestinal Symptom Rating Scale (GSRS), Nepean Dyspepsia Index (NDI), FD-related quality of life (FD-QoL), Euro QoL visual analog scale (EQ-VAS), and Numerical Rating Scale (NRS) were used as evaluation tools in this study. Symptoms were relieved after 3 months of treatment, and his QoL improved (GSRS, 15–3; NDI, 110–21; FD-QoL, 52–20 [eating status, 10–3; liveliness status, 12–8; psychological, 1–0; role-functioning status, 18–9]; EQ-VAS, 40–65; NRS, 8–4). The results revealed that complex Korean medicine treatment could alleviate FD and constipation in patients with HIV.

Keywords: Acupuncture, Dyspepsia, Herbal medicine, HIV, Medicine, Korean traditional

INTRODUCTION

Functional dyspepsia (FD) is a disease characterized by one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain, or epigastric burning that occurs at least 3 days per week, lasts for at least 3 months, and started at least 6 months ago. Additionally, explaining the organic cause of FD based on related biochemical, endoscopic, and imaging tests is not possible [1]. The prevalence of FD, which is common in clinical practice, is approximately 25% in South Korea. However, FD treatment is difficult because of the presence of various pathophysiological mechanisms, and it may result in a patient’s quality of life (QoL) deterioration because of its chronicity [2].

Gastrointestinal symptoms are common in people living with human immunodeficiency virus (HIV) (PLWH), and more than one-third of them complain of various upper gastrointestinal symptoms, such as upper abdominal pain, early satiety, nausea, vomiting, and bloating [3].

However, a clear causal factor for FD has not yet been identified, nor a treatment has been developed. Hence, the need for complementary and alternative medicine, including Korean medicine, is emerging, and related studies have been conducted [4,5].

Korean medicine classifies FD as a digestive ailment or hysteria. FD includes various symptoms such as gastric stuffiness, heart pain, stomach duct pain, nausea, stuffiness and fullness, belching, and acid regurgitation [6]. Many studies have been reported on FD, including clinical studies [7-11] and literature reviews [12]. However, there are no studies on FD in PLWH in South Korea.

Herein, we report the effects of complex Korean medicine on FD in PLWH.

CASE REPORT

1. Medical history

A 49-year-old male patient presented with epigastric and abdominal bloating, early satiation, indigestion, and constipation with no definable cause in November 2021.

He was diagnosed with HIV in 2000 and had been receiving antiretroviral therapy (ART).

He underwent upper gastrointestinal endoscopy and colonoscopy at the Department of Gastroenterology at Natioanl Medical Center (NMC) on January 27, 2022, due to his gastrointestinal symptoms, which revealed no abnormalities. Additionally, abdominal computed tomography conducted at Wonju Severance Christian Hospital was normal as stated by the patient.

2. Treatment

The patient underwent a total of 27 treatment sessions (Table 1).

Table 1 . Dates of outpatient visits.

MonthDate
April14, 21, 25, 28
May4, 6, 9, 12, 16, 19, 23, 25, 30
June2, 8, 10, 13, 15, 20, 23, 27, 30
July4, 7, 11, 14, 18

1) Acupuncture

Disposable sterile acupuncture needles 0.25 × 40 mm (Dongbang Medical Co., Ltd.) were applied to each point for 20 minutes at a time at a depth of 1.5–2 cm.

First to eleventh treatment sessions: Acupuncture was bilaterally applied to SI5, ST41, GB41, and ST43 (Sa-am stomach tonifying acupuncture).

Twelveth to twenty-seventh treatment sessions: Acupuncture was bilaterally applied to KI10, LR8, LU8, and LR4 (Sa-am liver tonifying acupuncture).

2) Herbal medicine

Banhahubak-tang (from April 25 to May 25) and Jowiseunggi-tang (from May 25 to July 18) were prescribed twice daily (Hankooksinyak, Korean Medicine Insurance Extract).

3) Electroacupuncture

Electrical stimulation (1 Hz) was applied to the 2 acupoints and performed for 20 minutes using an 8-channel low-frequency stimulator (GP-302; Goodpl Co. Inc.).

First to eleventh treatment sessions: Standard disposable sterile acupuncture needle 0.20 × 45 mm was applied to CV12 and CV13.

Twelveth to the last treatment sessions: Standard disposable sterile acupuncture needle 0.45 × 90 mm was applied to CV10 and CV12.

4) Cupping and moxibustion

Dry cupping was performed for 5 minutes using disposable cupping cups at the tenderness of the back-shu point. Moxibustion was conducted on CV12 and CV4 indirectly for 15 minutes each.

5) Western medicine treatment

At the time of the first visit to the Department of Korean medicine, he was taking medication from the Department of Infectious Diseases and Gastroenterology. Additionally, he was prescribed medicine by the Department of Dermatology and Urology during the treatment period.

3. Evaluation

The evaluation was done 4 times (April 14, May 19, June 15, and July 18).

1) Gastrointestinal Symptom Rating Scale

The Gastrointestinal Symptom Rating Scale (GSRS) is a questionnaire, consisting of 15 items, that was developed in 1988 and validated for irritable bowel syndrome and peptic ulcer disease evaluation. It can identify the overall upper and lower gastrointestinal symptoms [13].

2) Nepean Dyspepsia Index

The Nepean Dyspepsia Index (NDI) is a tool used to evaluate dyspepsia symptom-specific QoL. It consists of a symptom score table and items on QoL. Only the symptom score table was used in this case [14].

3) Functional dyspepsia related quality of life

FD-QoL, consisting of 21 items, with a higher total score indicating lower QoL, is used to evaluate the effect of FD on the QoL of patients.

4) Euro quality of life visual analog scale

The Euro QoL visual analog scale (EQ-VAS) was used to subjectively evaluate the health status using the VAS. Zero is the worst imaginable and 100 is the best imaginable health state.

5) Numerical Rating Scale

The Numerical Rating Scale (NRS) was used to numerically identify a patient’s subjective discomfort. It indicates the state with no discomfort as 0 and the state with the worst discomfort as 10.

4. Progress

The total GSRS score decreased from 15 points on the first visit to 3 points on the last visit. Only abdominal pain, distension, and a feeling of incomplete evacuation scored 1 point each during the last visit evaluation (Table 2, Fig. 1).

Table 2 . Changes in each item of Gastrointestinal Symptom Rating Scale.

SymptomApril 14May 19June 15July 18
Abdominal pain3211
Heart burn0000
Acid regurgitation0000
Sucking sensations in the epigastrium0000
Nausea and vomiting0000
Borborygmus1110
Abdominal distension3321
Eructation0000
Increased flatus1110
Decreased passage of stools1110
Increased passage of stools1110
Loose stools0000
Hard stools1100
Urgent for defecation2100
Feeling of incomplete evacuation2111

Figure 1. Changes in the total Gastrointestinal Symptom Rating Scale score.

The frequency, intensity, and severity of the symptoms noticeably decreased in the symptom evaluation of NDI. The patient demonstrated all the listed symptoms except for upper abdominal cramps, during the first visit. Pain and discomfort in the upper abdomen, inability to finish regular meals, fullness after eating, pressure, and bloating in the upper abdomen remained during the last evaluation, but they were greatly reduced (Table 3, Fig. 2).

Table 3 . Changes in each item of Nepean Dyspepsia Index.

SymptomApril 14May 19June 15July 18
Upper abdominal pain11663
Upper abdominal discomfort11663
Upper abdominal burning5000
Heart burn5000
Upper abdominal cramps0000
Chest pain4000
Inability to finish regular meal12974
Bitter-tasting fluid that comes to your mouth8000
Fullness after eating11775
Upper abdominal pressure121033
Upper abdominal bloating121033
Nausea5000
Belching5330
Vomiting1000
Bad breath8700

Figure 2. Changes in Nepean Dyspepsia Index scores at the first visit and the last visit.

The emotional aspect was the largest change among the QoL evaluation items. QoL improved from 12 points before treatment to 0 points after treatment. Additionally, the QoL improved in terms of eating, vitality, and social functioning (Table 4).

Table 4 . Changes in functional dyspepsia related quality of life.

CategoryApril 14May 19June 15July 18
Eating status10553
Liveliness status12888
Psychological12640
Role-functioning status1812129
Total score52312920


The subjective health status evaluation score increased from 40 points on the first visit to 65 points on the last evaluation. The NRS for gastrointestinal symptoms decreased from NRS 8 before treatment to NRS 4 after treatment (Fig. 3).

Figure 3. Changes in Euro quality of life visual analog scale (EQ-VAS) and Numerical Rating Scale (NRS).

DISCUSSION

FD is characterized by chronic epigastric gastrointestinal symptoms with idiopathy. Patients may complain of psychological symptoms, such as anxiety and depression, as well as physical pain because many cases show no response to continuous treatment.

HIV has become a manageable disease and is no longer an incurable disease with highly active ART (HAART) development. However, many PLWH still suffer from complications caused by continuous drug administration and various symptoms of opportunistic infections [15]. Drug safety in managing symptoms of PLWH should be considered because polypharmacy is associated with physiologic frailty, drug burden, and drug interaction [16]. Non-pharmacological approaches are needed. The study revealed gastrointestinal symptoms, including bloating, heartburn, diarrhea, and constipation, in 50–70% of PWLH [17], and the burden and severity of symptoms are higher than in non-PWLH [18]. The patient reported that his symptoms had started 6 months ago, at which time he underwent tests, which revealed no organic cause. He continued to take gastrointestinal medications, but no symptoms improved. However, the symptoms and QoL improved without adverse effects after receiving Korean medicine treatment for approximately 3 months.

The blood test before and after treatment revealed normal liver function test results, with no interference with CD4 count recovery, which is an immune state indicator (Table 5). This revealed no negative drug interactions between herbal medicine and HAART.

Table 5 . Laboratory finding before and after treatment.

Blood testFebruary 21September 13Normal value
Lymphocyte subsets
CD4 count (%)2.75.123.0–48.2
CBC
WBC (103 cell/μL)6.77.04.0–10.0
RBC (106 cell/μL)4.14.624.2–6.3
Hgb (g/dL)14.316.013.0–17.0
HCT (%)40.948.339.0–52.0
Liver function test
AST (U/L)16120–40
ALT (U/L)870–41
Renal function test
BUN (mg/dL)13116–20
Creatinine (mg/dL)0.90.90.7–1.2

CBC, complete blood count; WBC, white blood cell; RBC, red blood cell; Hgb, hemoglobin; HCT, hematocrit; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen..



Sa-am acupuncture [19] and electroacupuncture [20] are commonly used in clinical practice for FD and are effective in improving QoL and gastrointestinal symptoms in FD treatment. No study used both Sa-am acupuncture and electroacupuncture for FD, but some studies used both Sa-am acupuncture and electroacupuncture for Mami syndrome [21] and low back pain [22]. The Front-Mu point was selected using the patient’s Sa-am acupoint [23].

Banhahubak-tang is a prescription according to the “Golden Chamber.” It prevents vomiting by down-regulating qi, disperses nodules and stuffiness, and removes distention by circulating qi. Therefore, it can be used for chest stuffiness and fullness, indigestion, and abdominal pain [24]. Previous studies have demonstrated the pharmacological action of Banhahubak-tang using medical imaging [25].

Jowiseunggi-tang is used to treat constipation because it inhibits water reabsorption in the large intestine, promotes intestinal peristalsis, and increases intestinal osmotic pressure [26].

This study has several limitations. First, the patient had to visit a rural area, and the treatment was discontinued without confirming a complete symptom resolution. Second, complex Korean medicine was administered to the patient; therefore, the effects of a single intervention could not be evaluated. Lastly, this study was based on a single case; therefore, generalizing these results is difficult.

However, this case study confirmed that complex Korean medicine treatment could not only relieve symptoms but also improve the QoL of FD and constipation in PLWH. PLWH is decreasing worldwide through various prevention and treatment projects, but it has been steadily increasing in Korea since its first diagnosis in 1985 until 2019 [27]. A Korean medical approach is needed to help symptoms in PLWH.

This is the first case report describing the benefits of complex Korean medicine treatment for FD in PLWH. Further studies are needed to examine the beneficial effects of Korean medicine treatment on various PLWH symptoms.

AUTHOR CONTRIBUTIONS

Conceptualization: JSH, IAY. Data analysis: JSH. Funding acquisition: IAY. Formal investigation: Han-Song Park, Hyun-Seo Park, KHK, HWH, JSH. Methodology: IAY. Writing – original draft: JSH, IAY. Writing – review & editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

This work was supported by a grant of National Medical Center, Republic of Korea (Grant number: NMC 2020-PR-07).

ETHICAL STATEMENT

The study was approved by the Institutional Review Board of the National Medical Center (NMC-2022-08-098).

Fig 1.

Figure 1.Changes in the total Gastrointestinal Symptom Rating Scale score.
Journal of Acupuncture Research 2023; 40: 143-149https://doi.org/10.13045/jar.2022.00402

Fig 2.

Figure 2.Changes in Nepean Dyspepsia Index scores at the first visit and the last visit.
Journal of Acupuncture Research 2023; 40: 143-149https://doi.org/10.13045/jar.2022.00402

Fig 3.

Figure 3.Changes in Euro quality of life visual analog scale (EQ-VAS) and Numerical Rating Scale (NRS).
Journal of Acupuncture Research 2023; 40: 143-149https://doi.org/10.13045/jar.2022.00402

Table 1 . Dates of outpatient visits.

MonthDate
April14, 21, 25, 28
May4, 6, 9, 12, 16, 19, 23, 25, 30
June2, 8, 10, 13, 15, 20, 23, 27, 30
July4, 7, 11, 14, 18

Table 2 . Changes in each item of Gastrointestinal Symptom Rating Scale.

SymptomApril 14May 19June 15July 18
Abdominal pain3211
Heart burn0000
Acid regurgitation0000
Sucking sensations in the epigastrium0000
Nausea and vomiting0000
Borborygmus1110
Abdominal distension3321
Eructation0000
Increased flatus1110
Decreased passage of stools1110
Increased passage of stools1110
Loose stools0000
Hard stools1100
Urgent for defecation2100
Feeling of incomplete evacuation2111

Table 3 . Changes in each item of Nepean Dyspepsia Index.

SymptomApril 14May 19June 15July 18
Upper abdominal pain11663
Upper abdominal discomfort11663
Upper abdominal burning5000
Heart burn5000
Upper abdominal cramps0000
Chest pain4000
Inability to finish regular meal12974
Bitter-tasting fluid that comes to your mouth8000
Fullness after eating11775
Upper abdominal pressure121033
Upper abdominal bloating121033
Nausea5000
Belching5330
Vomiting1000
Bad breath8700

Table 4 . Changes in functional dyspepsia related quality of life.

CategoryApril 14May 19June 15July 18
Eating status10553
Liveliness status12888
Psychological12640
Role-functioning status1812129
Total score52312920

Table 5 . Laboratory finding before and after treatment.

Blood testFebruary 21September 13Normal value
Lymphocyte subsets
CD4 count (%)2.75.123.0–48.2
CBC
WBC (103 cell/μL)6.77.04.0–10.0
RBC (106 cell/μL)4.14.624.2–6.3
Hgb (g/dL)14.316.013.0–17.0
HCT (%)40.948.339.0–52.0
Liver function test
AST (U/L)16120–40
ALT (U/L)870–41
Renal function test
BUN (mg/dL)13116–20
Creatinine (mg/dL)0.90.90.7–1.2

CBC, complete blood count; WBC, white blood cell; RBC, red blood cell; Hgb, hemoglobin; HCT, hematocrit; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen..


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Feb 29, 2024 Vol.41 No.1, pp. 1~73

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