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A: There is no published research for the treatment of hidradenitis suppuritiva that we can find, at least, not in English; we have no doubt that it has been studied and researched in China but the vast majority of Chinese studies are never translated. Generally speaking when we cannot find research we often do internet searches, as you no doubt have done, to see that the popular perception is of the use of acupuncture, and we found surprisingly little. It is estimated that about 1% of the population suffer from HS, but a great deal goes undiagnosed as people simply live with it or, given where it often appears, are too embarrassed to go to the GP. Even so, there are usually more of the 'acupuncture fixed my problem' postings, so we suspect that the success rate has not been high.
Of course, traditional acupuncture treats the person, not the condition, and each patient is regarded as unique and different. This means that a properly trained practitioner will look at the whole system to find out what generates the imbalances which then lead to symptoms. Named conditions are what bring patients to a practitioner, but the work is not focused on the named condition alone. Treating a symptom in isolation from the overall pattern is seen by the Chinese as turning of an alarm because you don't like the noise without investigating what made it go off. The general pathology of HS suggests what the Chinese would call local accumulations of Heat and Damp, but why they manifest in ten sufferers might lead to ten entirely different diagnoses.
We often advise prospective patients to seek a brief face to face assessment with a local BAcC member to see if they can get a better idea of whether acupuncture treatment might help. In your case, though, we think there may well be merit in seeing someone who is also trained in Chinese Herbal Medicine. The RCHM is a national organisation for Chinese herbal medicine, and about 90% of its members are also BAcC members. It is something of a piece of received wisdom in the profession that skin problems often respond really well to herbal medicine, and if you are thinking of using Chinese medicine, this may give you the best shot of getting rid of this truly distressing problem.
Q: Can acupuncture can be useful for back and body acne. I am having an outburst for which they prescribed antibiotic treatments, but I am lookingfor an alternative valid solution.
A: Not surprisingly we have been asked about acne on several occasions and an example of the reply we often give is:
Q: I suffer from a severe form of acne and have despaired of all the drugs, treatments and diets. Can I be recommended a specific practitioner with experience of treating skin conditions?
A: As our factsheet shows
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/acne.html there is some evidence to suggest that acupuncture treatment may offer some hope of relief for sufferers from this condition. However, the trials on which this conclusion are based are almost all ones conducted in China and generally on a rather small scale with some methodological weaknesses, so we would be reluctant to say that you would be guaranteed positive results from treatment. We do know that it wouldn't do any harm, but after years of suffering that is not going to be a unique selling point. When people approach us about skin problems we very often suggest that they consider Chinese Herbal medicine alongside, or possibly even instead of, acupuncture treatment. There is no doubt that the evidence from herbal medicine for treating skin problems in general is encouraging, and although CHM is based on the same diagnostic criteria which underpins a large percentage of conventional treatments, the fact that treatment is daily and that the herbal preparations are mixed for the specific presentation can add value to the outcomes. The greater majority of practitioners on the Register of Chinese Herbal Medicine (RCHM) are also BAcC members, and the Association of Traditional Chinese Medicine (ATCM) has members who are dual qualified in acupuncture and herbal medicine. Both have websites where you can find members near to you and it is highly likely that they will be able to offer you a brief consultation without charge to give you a face to face assessment of whether acupuncture and/or herbal medicine may be worth pursuing for your condition.
We think that this remains the most appropriate advice. Since this was written, however, there has been another publication, albeit a rather dense one, which seems to make encouraging noises about the use of acupuncture treatment for acne. You can find it here:
and although it is a hard going to read, it does cover the ground very thoroughly. As it says, more and better trials are warranted, but as a start this is promising.
Q: I have neuropatic condition symptoms - itching, prickling, stabbing pains in my back . Would acupuncture help these conditions?
A: A great deal depends on the exact nature of the neuropathic condition. Some, like shingles/herpes zoster for example, are from both a conventional and chinese medicine perspective difficult to treat once they have become entrenched. Rapid treatment after their onset can often achieve quite a great deal from both perspectives. Other neuropathic pains can result from disturbances of the structure of the body, like problems with vertebral discs, and these can equally be a challenge. If the pain arises from a structure problem then the limit of what is possible may be a short term reduction in the pain.
Indeed, acupuncture has a long history of being used for pain relief and for this to be heavily researched, mainly because the variables in the body's chemicals can be precisely measured and the patient's responses easily assessed. The question here is how much relief and how sustainable, and then how affordable.
Without knowing a great deal more about the precise nature of your systems and the overall picture within which they present it is difficult for us to say more. However, we have to say that the system of Chinese medicine is very different from conventional medicine, based as it is on a belief in an energy called qi which makes up the body in all its aspects and on the regular and harmonised flow of that energy in defined channels. When there are disturbances in the energy symptoms appear, and the precise nature of the symptoms points to specific problems in the flows of energy. This in turn often points to systemic imbalances and a practitioner will often find that a patient has a number of signs and symptoms to accompany the pains and which point to a treatment strategy.
Of course, the only way to make this determination is for a practitioner to look at the patient, and you will almost certainly find that any of the BAcC members local to you will be more than happy to give up a little time without charge to assess face to face what is going on and give you an idea of whether acupuncture treatment may help, and if so how much may be necessary.
Q: I have had urticaria for almost 2 years now and I have been on antihistamines for a year. Traditional medicine does not offer any solution in my case - none of the doctors can establish what causes it and no one knows how to get rid of it. My only hope at the moment is alternative medicine and I have heard that acupuncture could offer a solution. Do you have any record of it helping with my condition ?
A: We were asked about the treatment of urticaria with acupuncture a little while ago, and our response then was:
Can acupuncture treat urticaria with any level of success?
Success is a very loaded word in the context of what one can now claim in marketing and advertising. The standard of proof in all healthcare advertising is the randomised, double blind control trial, the model most often used for testing drugs, and it has to be said that it is not very well suited to assessing whether acupuncture 'works' or not. Reducing variables is the last thing a practitioner would try to do in Chinese medicine; understanding and interpreting their variations is integral to the way that the system works. Hence a paper such as this one from 1998 http://www.ncbi.nlm.nih.gov/pubmed/9828874 is a great example of the problems we face when asked questions such as this. The manifestations of urticaria, understood in Chinese medicine terms as a description of the specific symptoms, have always been around and like any complete system of medicine, Chinese acupuncture has ways of understanding how the heat and swelling develop, and within the system has developed clear protocols to deal with the problem. However, as the paper acknowledges, getting precise enough definitions if urticaria itself to assemble a trial is a problem, as indeed would be the next stage, ensuring that the test and control groups had the same western and eastern conditions to guarantee objectivity. However, when one takes into account that in Chinese medicine the person with the disease is as important, if not more so, than the disease which the person has, it becomes rather difficult to talk meaningfully of treating a named condition. That said, there are papers which examine the presentations and treatments of urticaria such as this one http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/ where there is a very positive reference (60) to a paper which on the surface appears to meet the criteria for inclusion in a growing body of good evidence. We prefer to hold to the view that each patient is individual, and that it is the unique assessment of their energy by a skilled practitioner which is the best judgement of whether treatment may be beneficial. It is true that many patients present themselves for treatment with urticaria-like symptoms, and anecdotally we here of success in both acute and chronic cases. However, if you wanted to establish whether acupuncture treatment was a good option for yourself or someone on whose behalf you are asking, then a brief face to face assessment by a BAcC member local to you is your best way of establishing this.
We think that this still represents the best advice we can give. Anecdotally we have all had some very positive experiences of treating people with urticaria. Of all the skin conditions this appears to be the most amenable to acupuncture. For many other conditions, like psoriasis or eczema, we have often recommended the use of Chinese herbal medicine alongside acupuncture treatment. There are a considerable number of BAcC members who are also members of the Register of Chinese Herbal Medicine, and there may be some advantage on seeing someone who uses both, although as we have said, you may well find that acupuncture treatment by itself can offer a solution.
If you do go ahead, it is very important to set measurable outcomes and to ensure that your review the treatment at regular intervals. It is quite easy to run up a large bill in pursuit of success without realising, and the responsible practitioner will always check on a regular basis that there are enough signs of improvement to warrant carrying on.
Q: My mum (74 and very active) has a leg ulcer on her right outer ankle and is in a lot of pain, taking constant paracetamol and ibuprofen. Is there any evidence acupuncture can help?
A: We were asked a similar question last year and the advice we gave then was:
It depends a great deal on whether you are asking about treatment for the pain from the ulcer or for the ulcer itself. As far as the treatment of ulcers themselves is concerned, there are a number of techniques within Chinese medicine for dealing directly with ulcers but these are often quite rough and ready, using a great deal of local needling and the technique of moxibustion. While this is a common approach in China, in the west it is highly likely that someone with a chronic ulcer is being treated according to protocols which involve frequent dressing changes and removal of the fluids gathering in the ulcer, and we would be reluctant to advise anyone to mix and match the two forms of treatment. However, in Chinese medicine theory ulcers are understood in a number of ways which might make treatment at a distance from the ulcer site possible, and in more general terms still, Chinese medicine was and is primarily concerned with re-establishing balance in the whole system in the belief that a system in balance is better equipped to right itself. On this basis it may well be possible to speed up the pace of recovery. As far as pain relief is concerned, there is a long history of research into the use of acupuncture for pain relief, and the question here is not whether it works, but how much it works and how sustainable the relief is. If someone needs treatment twice a day for several weeks to reduce the pain, this raises issues about cost and attendance at a clinic. However, if one or two sessions a week can bring the pain down to tolerable levels it may be worth considering having treatment. The problem we foresee here is the site of the ulceration. The outer ankle is not really an area which one can easily immobilised, and it may well be difficult to counter the effects of continued minor irritation from movement. However, sight unseen we cannot give a conclusive answer. We have a number of members in her area, and we are sure that any of them will be able to give you and your mother an objective assessment of what might be possible if you can arrange a short visit, hopefully without charge, to discuss the problem with them.
We think this probably still represents the best advice we can give. In our experience leg ulcers can be a very difficult problem to treat, especially where there are a number, and it is highly likely that treatment may be inconsistent with the conventional care being offered. However, long experience has taught us never to say never because occasionally acupuncture treatment can produce unexpected but substantial results. What we would say, though, is that our expectation would be low, and if you do find someone who thinks the condition is treatable, we would advise frequent and regular reviews to assess whether there is any change. It is not difficult to run up to a very large number of sessions without tangible result, and we advise members to ensure that a patient has the best possible information to inform the decision to continue with treatment when results to date have not been great.
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