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Ask the Expert
Q: My 69 year old mother was diagnosed with a benign brain tumor over 12 years ago, however, due to risks involved in conventional treatment we did not opt for a surgery. As a result, my mother is almost blind. She has serious difficulty in walking and also has diabetes. Her tumor causes her pain in one of the cheeks and in nose. We are now interested in alternative therapies such as acupuncture. Please advise us if it is a viable option and if treatment is possible for her brain tumor including her detoriating eyesight, and pain in cheek, and nose.
A: We are very sorry to hear of your mother's problems.
The situation in which she finds herself is too complex for us to be able to offer you a definite answer here. Some of the problems she has, such as the brain tumour, diabetes and blindness, are ones where we would always be very realistic in our assessment of the position and say that there was very little chance that acupuncture treatment would make a difference. Our main aim would be avoid creating unrealistic expectations about what could be done. There may, however, be a small possibility that treatment may help to reduce the pains from which she is suffering in her cheek and nose. Pain control is one of the more frequently researched aspects of acupuncture treatment, and there is considerable evidence for its efficacy, as our factsheet shows:
The overall state of your mother's health is so complex, however, that it is very difficult for us to offer the kind of assessment we think you deserve. We believe that you would be best served by visiting a BAcC member local to you with your mother and seeking a brief face to face assessment of whether they believed that acupuncture treatment might help her.
A: There are a number of case studies, relatively small in terms of the numbers of participants, which seem to show positive and encouraging results for the use of acupuncture for foot drop after strokes. However, the evidence is by no means comprehensive or conclusive enough for us to give a positive recommendation for treatment.
However, a great deal depends on what else is going on in your system. Foot drop as an isolated symptom is unusual, and very often there is a more complex neurlogical picture within which this sits. If there isn't, then from a Chinese medicine perspective the weakness would be understood in terms of a blockage or weakness in the flow of energy, or 'qi' as it is called. The practitioner would probably use a combination of local and distal points to try to restore proper function in the tendons and muscles affected by or causing the condition.
If there is a wider pattern of dysfunction, however, then the chances are that this will bea a neurological problem whose treatment with acupuncture wouldm be less likely to be successful.
However, there is no substitute for a face to face assessment in cases like yours and we believe that it would be worthwhile visiting a BAcCc member local to you to benefit from their advice. If they feel that acupuncture will not be of use, we are confident that they may have other suggestions about what forms of treatment may be best for you.
A: A great deal depends on which type of diabetes you are asking about. Type-1 diabetes, the insulin dependent variety, is not likely to be amenable to acupuncture treatment. In nearly all cases there is no residual pancreatic function, and the sufferer will have to take insulin by injection for life. There may be a case to be made for using acupuncture to enhance the whole system in an attempt to reduce the long-term impact of circulatory problems which tend to develop in later years, but there is no evidence to back up claims that treatment can do this. Anecdotally we hear of patients who believe that some of the numbness, or neuropathic pain or erectile dysfunction which accompanies the condition has been resolved to a degree, but the evidence is not plentiful.
The situation with Type-2 diabetes, non-insulin dependent diabetes, is not a great deal more positive as our factsheet
shows. There is very little research on which to base positive recommendations, although the paper does say that acupuncture can be a valuable part of an overall strategy to bring all aspects of long term care - diet, exercise, etc - together.
We have heard of occasional cases where there has been some residual pancreatic function which has responded well to treatment, and many practitioners warn NIDDM patients to taske care in the days after a first session in case a sudden revitalising of the insulin-producing cells causes an renewed production which in turn could cause a hypoglycaemic coma, but we have never heard of this happening.
Q: My 34 year old daughter has suffered with asthma and eczema to a greater or lesser degree for most of her life. She has also had a skin condition for a year or so which I understand is called Prurigo Nodularis. She is having perscribed treatment under the NHS which involves medication and UV light treatment. In particular her main discomfort is the itchyness particularly at night time. I wonder if acupunture could improve this situation ?
A: We have been asked about prurigo nodularis a couple of times, and our most recent answer was:
Can acupuncture help in treating prurigo nodularis
There is not a great deal of evidence that acupuncture has been used successfully for treating this condition. This becomes very clear when you undertake any searches for evidence. There is a single paper for the use of acupuncture and hypnotherapy ('hypnopuncture')
which is cited over and over again without any further additions, a certain sign that there is no other evidence. We are sure that there are probably a large number of trials which have been undertaken in China, but the great majority of these have not been translated and are often regarded in the West as methodologically flawed.
However, skin diseases are as old as mankind, and the systems of Chinese medicine do have ways of interpreting the signs and symptoms of diseases like prurigo within its framework. These often use terms like 'invasions' of 'heat', 'wind' or 'damp' which sound alien to the western ear but describe the effects of climate (as experienced by a largely agrarian population) on the flow of energy, called 'qi', especially where this disrupted the flow, rhythm and balance near the skin surface. Everyone is aware of the short term effects of exposure to extremes of climate, and from a Chinese medicine perspective, whether this is the primary cause of a problem, or whether there is an underlying weakness which makes particular people vulnerable, the skill of the practitioner lies in assessing the overall balance as well as the presenting symptoms, and attempting to restore balance.
The best advice that we can give you is that you visit a BAcC member local to you for a brief face to face assessment of the problem. Crucial to this assessment will be whether the problem is local or widespread. In broad terms, the more localised, the more treatment options there are. We would also recommend that you might want to see advice from someone who also does Chinese herbal medicine. The majority of the members of the Register of Chinese Herbal Medicine are also BAcC members. We say this because herbal medicine has developed a very good reputation over the years for treating skin conditions, the daily dose of herbs helping to maintain a treatment momentum. It may be that a combination of acupuncture and herbal medicine may prove a more potent force in helping your problem, but to what extent would depend on a more thorough assessment than we can give here.
We would not want to add anything to this advice about the prurigo, but the fact that it has appeared against a longstanding backdrop of asthma and skin problems suggests that it may be quite a difficult condition to influence. As our review paper on the use of acupuncture for the treatment of asthma shows
there is a growing body of evidence that acupuncture may be of benefit. However, there is a close correlation between ashma and ezcema in Chinese medicine which suggests a constitutional weakness which may impact on how successful treatment may be. That said, there are a number of what we call 'empirical points', points which have been discovered over the years to have specific effects no matter what the underlying constutional position may be, and one or two of these have been shown to be highly effective at reducing itching across the body, especially where this is impacting on someone's sleep.
A: There is no reason not to have acupuncture when you are taking warfarin.
We publish a Guide to Safe Practice for our members which provides detailed guidance on issues like this, and on the treatment of people on anti-coagulant medication we wrote:
Patients on anti-coagulant medication
You must take great care when needling patients who are taking anti-coagulant drugs such as Warfarin. Only very superficial needling with fine needles (0.20mm) is recommended.
The risk appears small but internal bleeding leading to compartment syndrome can have extremely serious consequences. There is one report in the medical literature of a case of compartment bleeding following acupuncture in a patient taking anti-coagulants (see link to article at the end of this section).
Warfarin prevents the body from metabolising vitamin K. Vitamin K controls the formation of a number of coagulation factors in the liver and is an essential substance for blood clotting. Vitamin K is present in most of the foods that are considered to be blood-forming according to Chinese medicine such as green leafy vegetables. This is important to consider if you are giving dietary advice to patients on Warfarin since these foods can lessen the desired effect of the drug.
Patients are put on Warfarin or other anti-coagulants for a number of different reasons. These may be purely preventive if, for example, the patient suffers from atrial fibrillation or has mechanical heart valves, or because of recent surgery, stroke, heart attack or thrombosis. The dosage of the medication depends on the desired amount of anti-coagulation for that particular condition.
Every patient on Warfarin has to undergo tests on a regular basis to check how long it takes for their blood to clot. The frequency of these tests depends on the dosage of their medication and their condition. It is good practice to encourage your patient to have more frequent tests while they are receiving a course of acupuncture as the treatment can positively influence their blood values and may require their Warfarin dosage to be reduced.
Ask your patient for their INR (international normalised ratio). The INR is a ratio established by measuring the prothrombin time (PT), which is the length of time it takes for the patient’s blood to clot, and then by comparing this value to an average.
In a healthy person the INR is about 1.0. Patients on Warfarin tend to have an INR somewhere between 2.0 and 3.0 or even higher, depending on the desired amount of anti-coagulation. A higher INR signifies a stronger effect of anti-coagulation.
The main risk associated with acupuncture is internal bleeding. Depending on the depth of needling and the underlying structures involved this may be insignificant, but there is a chance that it can result in compartment syndrome. Although the risk is small this condition can have serious consequences and often requires surgery.
Needling should only be done superficially and with fine needles. The higher the INR, the greater the risk of bleeding. Patients with an INR of 3.5 (sometimes therapeutically necessary in the treatment of valvular disease) or higher should be treated with greater care.
It is also advisable not to use guasha and cupping on patients on anti-coagulants since these techniques tend to draw blood to the upper layers of the skin and can cause severe and prolonged bruising to larger areas of the body.
Further information and research articles can be found on the internet. Here are a few examples:
Our members will always take these factors into account when treating, especially when they are dealing with a problem which might require slightly more vigorous needling. The majority of UK trained practitioners, however, use very fine needles and very gentle techniques, and we have had very few reported cases over the years of bruising or bleeding after treatment in people taking warfarin or other anti-coagulant medication.