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Ask an expert - body - skin conditions

41 questions

 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.

Q: On behalf of a friend, is there any point in trying acupuncture for scleroderma, at present in the lungs and skin.  I have had remarkable success with acUpuncture for rheumatoid arthritis.

A: In our view, there is always good reason to try acupuncture treatment! By its very nature, traditional Chinese medicine treats the person, not the disease, and the physical manifestation of a problem is seen within a picture of the whole person involving all aspects of their body, mind and spirit. We find that this can often be a very rewarding way of approaching auto-immune conditions where there is no obvious physical cause. This obviously doesn't mean that there is an alternate cause in mind or spirit, but from a Chinese medicine perspective symptoms are not the problem, simply an indication that the system as a whole is not in balance. Indeed, the earliest systems of Chinese medicine were asymptomatic, using the symptoms only as indicators of returning overall balance,

As far as research into scleroderma is concerned, there are a number of studies which are encouraging, good examples of which are

http://www.ncbi.nlm.nih.gov/pubmed/23885611

http://www.ncbi.nlm.nih.gov/pubmed/9673897

but even here this is far from standard treatment fare. Of course, one of the problems with conducting research is that to meet western research protocol standards as many variables as possible have to be taken out of the equation. Since scleroderma is a relatively rare condition and can present in many different ways, it is not that easy to assemble a meaningful sample and control group for testing.

However, as we have already said, and as you have personally experienced, acupuncture treatment can often provide remarkable benefits where there is not a great deal of conventional medical treatment available. We tend to take the view that there will always be a benefit, but how much and how sustainable are open questions. We rely on the probity of our members to set clear outcome measures and regular review periods to enable everyone involved to assess whether there is sufficient impact from treatment to warrant continuing for a longer time.

The best advice we can give you for your friend is to visit a local BAcC member for a brief face to face assessment of what might be possible. This will always be far better than any 'remote' answer that we can give.

A:  Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.
 
All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.
 
Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.
 
Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.
 
The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.  
 

Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.
 
All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.
 
Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.
 
Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.
 
The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.  

Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.

All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.

Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.

Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.

The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.

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