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Ask an expert - body - head - eyes

12 questions

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. 
 
 
  

The interesting word in your question is 'blocked'. As you probably know from looking at our website Chinese medicine is based on an entirely different theoretical basis from conventional medicine, what is often called a different paradigm. The essence of Chinese medicine is a belief that the body, mind, emotions and spirit are all manifestations of an energy called 'qi' whose proper flow and balance means that everything functions the way it is supposed to. If this flow becomes blocked or disturbed in any way, then functional disturbances appear, often affecting all 'levels' of the system and for which needles are used by the practitioner to restore flow.
 
When someone reports two 'separate' blockages in the same general area of the body it makes one question immediately whether the energy of that area is flowing as well as it might, and a skilled and experienced practitioner could determine quite quickly whether, from the Chinese medicine perspective, there was something which might be done. Even if there were no immediately obvious signs in the area itself, the principles of Chinese medicine are founded on a notion of overall balance which means that symptoms are less critical, being indicators of a wider imbalance in the system rather than the necessary focus of attention. It would be worth your while to visit a BAcC practitioner local to you for an informal assessment of whether they believe that acupuncture treatment may be of benefit to you.
 
That said, we have to say that the research evidence for the treatment of both conditions with acupuncture is a little bit thin. There are a few studies, but one of the key factors in undertaking research from a conventional perspective is trying to reduce the variables, and this means being able to define clearly what the problem is. Both blocked tear ducts and blocked ears have several possible causes, and this means that comparing like with like becomes more difficult, and the results less reliable. What research we have identified is of relatively poor quality, and if we were making recommendations based solely on that we would have to say that it would not be worth pursuing. However, our clinical experience is that where there are clear energetic blockages treatment can sometimes have a very direct effect, and it would certainly be worth seeking advice from a BAcC member local to you.  
 

A great deal depends on what is causing the dark circles to appear. Normally we all associate dark circles under the eyes with tiredness, but assuming that this is not the case with your question, there are a number of diagnostic patterns within Chinese medicine for which dark circles might indicate an underlying weakness of energy, or 'qi' as the Chinese call it. Some people's inherited energy, for example, can have been compromised by the health of either parent at conception or by a difficult pregnancy. In these sorts of cases, their management of their life has to be a little more careful, i.e. they may not be able to manage 60 hour working weeks and party all weekend. In some cases the dark circles are a permanent feature.
 
The key thing to bear in mind is that this will be one symptom or sign amongst a number of others, and treatment would generally be focused on the underlying imbalance. You will see, however, a growing number of websites which promise to do away with dark circles and other signs with facial or cosmetic acupuncture. The BAcC's view is that these procedures are useful when used in the context of a traditional diagnosis and treatment of the whole system. If they are simply applied as one-off symptomatic treatments in many cases whatever gains are made will be lost very rapidly. That is not to say that there may not be cases where this is a sign of local stagnation which acupuncture might help to clear, but in the majority of cases treating the whole system would probably be necessary as well.
 
We cannot give out referrals to specific members who focus on this kind of work, but it is a relatively straightforward search using google to find a BAcC member in your area who also does facial or cosmetic acupuncture. There are indeed a number of organisations set up by BAcC members as support networks for people doing this kind of work, and they have searchable databases of members who have taken postgraduate training in this area. We recommend that you find someone who is both a BAcC member and trained in cosmetic acupuncture to assess whether treatment may be of benefit to your specific needs.   
 
 

We have to be very careful in answering questions about the prevention of conditions. If asked whether acupuncture is of any benefit for treating either cataract or glaucoma, we would have to say that the evidence is very thin, and that what there is of it suggests that acupuncture treatment may be a useful adjunct to conventional treatment. However, researching whether acupuncture prevented either of these conditions would require prospective studies on a scale which would be almost impossible to fund.
 
That said, the basic focus of Chinese medicine, certainly in its oldest forms and even underlying its modern ones, is not so much getting better but staying well. In ancient times the physicians were held to account if they failed to keep their charges well, and a patient seeking treatment after a problem had established itself was described as 'digging a well when he was already thirsty'. In this sense the skill of the traditional acupuncturist is to keep people well as much as it is to get them better. Keeping someone in balance was thought to stave off or hold back some of the more common deteriorations of increasing age, and while it could never be claimed that it would leave someone in completely perfect health until their eventual demise the aim would be to ensure that they did not suffer from chronic deterioration too early.
 
It is something of a leap of faith, and there is no point in providing anecdotal evidence of how long term patients seem to enjoy good health because there are so many confounding factors which make conclusions impossible to reach. However, treatment certainly won't do any harm, and may improve the overall balance in areas which people would not recognise to have been problems until they experience improvements.

It is interesting that you are able to achieve some reduction of the symptoms by complete relaxation of the upper body. This suggests either that relaxation itself is the key, for which there is considerable evidence that acupuncture may deliver short term benefts which may then extend to a more permanent solution, or that there is some structural misalignment or weakness which relaxation allows to 'reset' itself but which becomes an issue as soon as the muscles are normally loaded.
 
It is important to distinguish between those interventions which simply give a short term relief which can be reproduced but never extended, and those which can offer a permanent solution. If the cause of the problem is driven by the muscles themselves, and there are underlying mental and emotional components which allow the muscular tension to develop, there is good evidence that acupuncture can help to reduce the stress and anxiety which can often be the root cause. One frequent but unintended secondary benefit which many patients experience is feeling generally more relaxed even though this was not the problem for which they consulted a practitioner.
 
If the problem is more structural in origin, there is still a case for trying acupuncture, since there are many conditions for which there is evidence that functional treatment like acupuncture can effect structural changes. However, there would be no harm, and possibly considerable benefit, from having an 'MOT' with an osteopath or chiropractor as a first step to check the state of the upper back and neck and to assess whether a structural manipulation may not be an important part of rectifying the problem. Many patients combine treatments like acupuncture and osteopathy/chiropractic to great effect.


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