Background: Clinical studies showed that abdominal acupuncture was an effective and safe treatment for depression. However, the underlying neural mechanism was still largely unknown. The present study investigated the brain spontaneous activity changes following with the abdominal acupuncture treatment in female depressive patients with different levels, to explore the neural basis underpinning abdominal acupuncture treatment efficacy. Methods: Fifteen female depression patients (nine mild and six moderate-serious participants) were recruited for the present study, these patients treated by abdominal acupuncture for 4 weeks. The resting-state functional magnetic resonance imaging (fMRI) data was collected at before and after treatment stages. The changes of resting state regional homogeneity (ReHo) were examined between these two stages, to suggest the acupuncture treatment effect on spontaneous neural activity. Further analysis was performed to explore the correlation between ReHo changes and clinical measurements (Self-rating depression scale SDS and Montgomery-Asberg Depression Rating Scale MADRS scores). Results: The scores of SDS and MADRS had gradually declined after-treatment stage in mild and moderate-serious depression, compared with those of before-treatment stage. There were statistically differences of SDS and MADRS scores after treatment at 1st, 2nd, 3rd and 4th week's (P<0.05). Compared with the before-treatment state in mild depression, brain regions with increased ReHo were found in Frontal_Sup_L, Frontal_Inf_Tri_L, Frontal_Inf_Tri_R, and Parietal_Inf_R. Meanwhile, the brain regions including Temporal_Pole_Sup_R, Occipital_Inf_R, Occipital_Inf_R, Temporal_Sup_R, Cuneus_R and Temporal_Mid_L were observed with decreased ReHo. In moderate-serious depression, brain regions with increased ReHo were found in Frontal_Med_Orb_Rand, and Cingulum_Mid_R; meanwhile, the brain regions including Lingual_L and Postcentral_R were observed with decreased ReHo. There were a large of quantity regional homogeneity changes which correlated with scores of SDS and MADRS. Conclusion: Abdominal acupuncture treatment could induce spontaneous brain activity change in depression patients. However, there were different regional homogeneity changes in different depression levels. ReHo changes in mild depression were mainly distributed in prefrontal and temporal lobe, but the ReHo change in prefrontal, Parietal, Occipital lobe and limbic system in moderate-serious depression. Prefrontal region took important roles in the acupuncture treatment effect on depression patients. Together, the findings of the present study provided new evidence for that abdominal acupuncture was an effective treatment for depression, and the ReHo was efficacy evaluation objective indicators of acupuncture treatment for depression.