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Ask an expert - body - skin conditions

31 questions

Q:  Can acupuncture help manage a skin condition on my forearms,  topical treatments are not effective. Currently I am being kept awake by constant itching  arms.  I am unable to work due to flare ups and I become very distracted.

A:  It is very difficult to answer your question without a great deal more information than we have here. There is no doubt that the evidence for the use of acupuncture treatment, while far from conclusive, is encouraging enough to warrant seeking advice from one of our members about whether they may be able to help you. Looking at the condition at first hand, and also making a few basic diagnostic soundings, should give you a better idea of whether treatment would be of benefit.

Our website has a number of sections under the 'research' area in factsheets such as this one:

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/eczema-and-psoriasis.html

which speak of a few trials for eczema and psoriasis. Our experience, however, is that most presentations of skin problems are unique, not because they manifest differently but because they have to be seen in the context of someone's overall health and patterns of energy, and this can make a huge difference to how a problem is treated. Each one of a number of people with the same western named condition might be diagnosed differently in Chinese medicine, and this would lead to individualised treatment, not simply the application of a formula treatment.

We also tend to recommend that people with skin problems consider the possibility of seeing a BAcC who also uses Chinese herbal medicine. Most members of the RCHM, one of the main Chinese herbal medicine associations, are also members of the BAcC, and members of the ATCM, another leading body for Chinese medicine, use both modalities. Our experience is that skin problems seem particularly well suited to Chinese herbal medicine, and while we are sure that acupuncture treatment may be able to have an effect (at least to some extent) the daily regimen of herbal preparations seems to suit these kinds of problem where sustained daily treatment seems to pay off.

Not all problems of this nature are amenable to treatment, though, and we recommend that you make sure that you have some form of face to face assessment before committing to treatment. Progress may be gradual and that may mean a considerable financial outlay. You need to ensure that you have clear and measurable outcomes and regular review periods if you decide to go ahead with treatment.  

A: There are a number of studies of the use of acupuncture for treating Raynauds, such as:
  
and
  
which are also included in our factsheet

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/raynauds.html

but as we conclude there, the evidence is not really conclusive enough to give any guarantee that acupuncture would be of benefit.
 
However, Chinese medicine looks at the functioning of the body in entirely different ways from orthodox medicine, and the theories, which are based on the flolw of energy called 'qi' in the body, can often provide treatment strategies where western medicine has nothing to offer. This is not to claim acupuncture will succeed where orthodox medicine failed; many conditions are just as difficult to treat in the eastern paradigm as they are are in the western one. The different understanding of human physiology and the different techniques often provide alternative approaches where western medicine has run out of options, and Raynauds Syndrome is a condition whose intractability means that sufferers are often left with few options.

In particular, an acupuncturist might focus on the parts of the system which are understood in Chinese medicine to be responsible for ensuring that energy is properly distributed to the extremities. Some of these Organs (capitalised to differentiate the concept from that of a western organ) have a number of wide ranging functions, and if one aspect is failing there should be evidence of poor performance in other functions which confirm what is going on. The taking the pulse at the wrist and looking at the tongue can also provide evidence of how different parts of the system function and inter-relate. After taking a look at how the whole system is functioning a practitioner will have a clear idea of whether there is a functional dusturbance in the whole system or local blockage, and treat accordingly. Whatever he or she finds will be unique to you; the very great strength of Chinese medicine is that it treats patients, not simply conditions, and finding out why you in particular have this problem is an essential part of trying to solve it. 

 Our best advice is to contact a BAcC member local to you and seek their advice face to face in whether they can help with the Raynauds as it manifests in your system. We are confident that they will give you an honest assessmenmt of whether acupuncture would be of benefit to you. 


 

A:  We have a factsheet on our website
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html
 
which outlines some of the research evidence for the treatment of herpes zoster (shingles) and makes encouraging noises.
 
However, from a Chinese medicine perspective, shingles is described in terms of being an 'external invasion of wind and heat', and there are protocols which are used for its treatment when it first appears. As in the equivalent western treatment, the taking of acyclovir, there is a strong correlation between early treatment and reduction in the severity of the symptoms. In Chinese medicine, there are many case studies which describe how rapid intervention to expel the pathogens seems to make a considerable difference.
 
Once the condition is entrenched, though, it becomes more difficult to shift, whichever system of medicine is used, and the best that one can hope for from acupuncture treatment is usually only the reduction in severity of the symptoms.
 
A great deal depends on where the rashes have appeared. Those of the face and head can be particularly uncomfortable, and many patients are happy to accept whatever relief they can get. We always counsel caution in cases like this, because relief can be transient, and prolonged treatment  can become very expensive. If someone values the relief they get, whatever the expense, we like to ensure that they do so as a conscious choice and not simply rack up a large bill over time through habit. Our experience is that patients like to be in charge of this kind of process and can become upset if they aren't involved in regular reviews of progress and outcome.
 
 
 

Chinese medicine works from an entirely different theoretical basis which can often make sense of a symptom for which there is no obvious classification in conventional medicine. In fact, there are occasions where problems which people would not take to a GP fall within an understanding of possible pathologies from a Chinese medicine perspective.
 
However, you do need to at least check with your GP whether there is anything going on with your system as a whole. Although it would be rare for your symptom to be a sign of a serious underlying illness, there are a small number of conditions where excessive redness of the face together with a sensation of heat might be pointing to a condition which requires conventional treatment.
 
After that it would be worth your while to seek the advice of a BAcC member local to you. There may be other indicators in the way that your system is functioning which point to more general patterns of imbalance, or there may be local blockages in the flow of energy which are causing the symptoms to manifest - a great deal depends on exactly where the symptom appears, and when.
 
We would advise you to be careful, however. BAcC members are particularly careful not to embark on long sequences of treatment for conditions like this, where changes may or may not occur, and regularly review what they do to ensure that the patient retains control of the process. We have heard of less scrupulous practitioners, though, and anyone who guarantees success or asks for a commitment to ten sessions is to be treated with caution.    
 

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')

Please click here

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.

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