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Ask an expert - body - head - eyes

11 questions

Q:  Is  there  any truth in the micro acupuncture treatment for stargardt eye disease? We found many mentions of it and  the success after treatment.  Is this true?  is there anyone in the uk who  provides this treatment and  would you know roughly  the cost?

A:  The treatment of Stargardt's Syndrome with acupuncture, along with a number of similar conditions like retinitis pigmentosa, is a cause of some concern to us. There is very little research into the use of acupuncture for treating these problems, and it would be difficult to give a recommendation for treatment on the basis of what there is. At the same time there are a number of clinics using acupuncture, both in North America and in India, which claim some fairly remarkable results. We are as a consequence cautious, because although conventional medicine can often be dismissive of anecdotal evidence, it is often anecdotal evidence which points the way for more formal studies.

In the case of microsystems work you are fortunate insofar as there is a separate regulatory association for many of the microsystems, and their secretary is a BAcC member with a very sound understanding of the subtleties involved in these questions. He can be contacted through the website www.macrwg.org, and perhaps direct you to any of his constituent associations who treat this condition.

In general, we tend to take the view that with genetic conditions in which progressive deterioration is the usual outcome, one has to be realistic about what cna be achieved. 'Getting worse slower' may not sound like a very positive outcome, but as we have found when treating people with Parkinson's disease or MS, any slowing down of the disease is welcomed. There will be no research to validate claims of this kind because no-one has a clue about how fast an untreated disease may have progressed, but many patient's express a certainty that their conditions have stabilised with treatment.

Our best advice is that you proceed with caution and be rightly suspicious of any claims that sound too good to be true, because in our experience they usually are. Genetic conditions do not suddenly reverse of their own accord. If you do find someone who claims to treat this as a condition, set a very finite number of sessions with some very clear outcomes if you do go ahead. The average first session/subsequent session fee range for our members is £75/£50 in London, and £60/£40 outside London, if this helps to get a sense of proportion.

We have to say that targeting a condition as a unique problem is not the way that traditional acupuncture is practised. The underlying wisdom of the Chinese medicine system is that symptoms, of whatever kind, are simply an expression of a lack of balance in the whole system, and that in order to effect lasting and permanent change one has to work on the system as a whole. However, there are a number of conditions for which slightly more western orientated strategies have developed, especially in the microsystems acupuncture world, and their continued use suggests that there may be something which this approach can offer for a number of problems where someone's health is otherwise fine except for the unique presenting problem.

Q:  Can acupuncture help with macular degeneration? I have an elderly relative who believes there has been some recent research but I cannot find it. I am concerned that she may be asked to pay a considerable amount with little evidence of it working, but we are both very open to alternative medicine. She lives in Cambridge

A:We conducted a search and the best we could come up with

http://www.ncbi.nlm.nih.gov/pubmed/21355157

a study in Chinese which appears to demonstrate that acupuncture out-performs conventional medical treatment. Otherwise the only direct reference is a Cochrane Review summary which identifies the fact that there is a systematic review or similar on their files as pending

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705651/

With conditions like this there are a number of difficulties involved in answering the 'does acupuncture work?' question. From a Chinese medicine perspective, although twenty patients may have the same named western condition there could be twenty different treatments. The symptom from this perspective is merely the weak link where an overall imbalance tips something into poor or degenerating function, and although local treatment could achieve some useful short term gains, helping to improve the underlying balance is the key to getting well and staying well. This involves treating the person as much as treating the disease.

Conditions like this can often become unintentional money pits, and it is easy to build up a treatment habit based more on hope than experience. Practitioners are often inclined to fall into the same trap in pursuit of better health for their patients. The best positive result one might achieve could be a decrease in the extent of deterioration, or as one patient put it once, 'do you know, I think I'm getting worse slower'. Of course, this is unverifiable and largely unmeasurable, but there is no doubt that many patients have reported anecdotally that they have exceeded the expectations of their clinicians in maintaining reasonable function longer than anticipated. Naturally there are a great many other factors which make this possible, not least of which is that seeking complementary treatment is itself evidence of a determination to do something which is probably reflected in someone's overall health.

From a Chinese medicine perspective the eyes as a functional unit have close relationships with two or three major Organs (capitalised to differentiate them from the western concept of an organ) and if there is evidence of a generalised weakness in relevant related Organic functions, a practitioner might think that there is some hope that treatment may be of value. There is also plenty of discussion in Chinese texts about local needling and its potential to halt or even slightly reverse decline.

We have to be realistic, though. The kind of deterioration which this condition causes is well-documented as likely to continue, and it would be a foolish practitioner who tried to instil too much optimism in a prospective patient about the chances of major improvement. However, it is always worth while talking to a BAcC member local to you, and there are some very good ones in Cambridge, who we are sure will be only to happy to give you advice on the basis of a brief face to face assessment of your mother's situation.

Q: I have been suffering with Uveitis for around 5 months and have ready that acupuncture can really help to reduce the inflammation. Are there acupuncturists that specialise in eye treatments or will any acupuncturist be able to look at this problem?

A:  We have to sound a note of caution, insofar as there is not a great deal of research to underpin claims for efficacy in treating uveitis with acupuncture. There was a small study in Vienna three years ago

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2003.tb05820.x/abstract

which demonstrated reductions in pain and improved visual acuity in five patients, but this is not robust enough evidence to make any more serious claims about efficacy.

From a Chinese medicine perspective, there are obviously other ways of looking at what happens in uveitis within the diagnostic framework. The manifestations of the problem are understood within an entirely different paradigm based on a concept of energy, called 'qi', and its rhythms, flow and balance within the system. There are both functional aspects of eyesight which are governed by different parts of the system and local energy flows which might be compromised and generate problems such as this. The skill of the practitioner lies in making sense of the symptoms within the diagnostic framework and seeing what may be done. This can sometimes generate solutions where western medicine has none to offer, but one has to be realistic and recognise that some conditions do not respond well to acupuncture.

Your best avenue is to see if a BAcC member local to you can offer a brief face to face assessment of whether acupuncture treatment may help your specific presentation. There are none that specialise in eye conditions as such, although if you undertake a google search you will find one or two who have written quite a great deal about eye problems and acupuncture. We remain committed to the policy, however, that all our members are equally well qualified to address the great majority of problems which their patients bring them, and we do not promote individual members.

Q:  Please could you advise whether acupuncture is effective for dry eye syndrome or melbomian gland disfuction. I suffer from both these conditions and haven't had any relief from pharmaceutical medicines. I have read that acupuncture can help relieve symptoms,  but I'm not sure if it can help me.

A:  There is a small amount of research in the west into this condition, and a systematic review published a few years ago
 
http://www.ncbi.nlm.nih.gov/pubmed/20337604
 
concluded, as they invariably do, that there was insufficient evidence and that larger and better trials were necessary. Without going too much into the politics of research, it would be fair to say that we have serious reservations about the models of research favoured in the west, which don't really work that well with traditional acupuncture practice, and equally fair to say that even these inadequate models never attract the funding necessary to run larger trials.
 
However, dry eyes are a symptom as old as mankind, and the ancient Chinese has a number of ways of understanding how this symptom could arise. This rests, of course, on an entirely different understanding of the physiology of the body which is itself based on theories of the flow of energy, called 'qi', which is controlled by the functions of the Organs of the body. A practitioner's skill lies in determining whether a problem such as this is a sign of a local blockage, or whether it forms a part of a wider pattern of systemic unrest which needs to be treatment to get to the core of the problem. Indeed, in some of the older systems of traditional acupuncture, symptoms were not integral to the treatment plan; the practitioner treated the person in the simple but effective belief that a system in good balance repaired itself.
 
Our best advice is that you visit a BAcC member local to you to get a face to face assessment of your specific presentation, and whether the practitioner thinks that based on this acupuncture treatment may be of benefit to you.   
 

Q:  Can acupuncture help with optic nerve atrophy and if so are there any specialists in London?

A :  A recently published meta-analysis
 
http://www.ncbi.nlm.nih.gov/pubmed/23545824
 
makes some very encouraging noises about the use of acupuncture treatment alongside conventional treatment, but concludes, as does every systematic review or meta-analysis, that more research needs to be done, and on a greater number of subjects.
 
However, we are always cautious about the kind of trials which generate these results. The gold standard applied to western scientific research is the randomised control trial, and to make these work, the treatment has to be standardised and the condition under investigation has to be the only outcome variable. Whatever else the patient may have by way of health related issue is discounted. From a Chinese medicine perspective, both of these positions are not best practice. Treatment is dynamic and evolutionary, building on the progress, or lack of it, and refining the treatment as it goes along. The symptom which serves as the focus of the research is also seen in a far wider context, and it would not be surprising if twenty people with optic nerve atrophy had twenty different diagnoses from a Chinese medicine perspective. The symptom is only an alarm bell which alerts the practitioner to patterns of imbalance or blockage, and these will be unique to each individual.
 
This means that we have to be careful with research studies. Many will be unfairly inconclusive, but equally others will be falsely encouraging, building on a fortuitous outcome that the patients selected for a small trial happened to have treatment which helped their underlying patterns.
 
Good Chinese medicine aims to understand the appearance of symptoms in disturbances of the function of Organs (capitalised because an Organ is seen a complex collection of functions which embrace some of the physical ones we understand in the West but many which affect mental and emotional factors), and the practitioner uses their art and skill to determine what the driving force behind the complex pattern of disharmony is. In some cases this will show direct connections with the symptom, in others only a complex pattern in which the symptom is a weakness exaggerated by problems elsewhere.
 
The long and short of it is that the best advice you are likely to get for the treatment of a condition such as this will come from a brief face to face assessment from a BAcC member local to you. It is probably true to say that the best you might achieve is a reduction in the rate of deterioration or a stable but not deteriorating state, but at this remove we cannot really say. If you did decide to have treatment it would be very useful to establish markers by which any change can be monitored, and also review periods to make sure that the treatment is being regularly assessed for outcome and value.
 
As far as practitioners are concerned, we do not recognise fields of specialism. From our perspective our members as generalists are all equally well equipped in Chinese medicine to deal with the full range of problems which people bring to their clinics. We have one or two fields like obstetrics and paediatrics where we are shortly to recognise standards of expert practice, but we do not have short term plans for other specialties. There are one or two members who focus their work on people with eye problems, an while we cannot give specific recommendations, it is a simple matter to track them down through google. 
 
 
  

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