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Q:  I have symptoms of arrhythmia.I do have an ICD to keep my heart in check in case of a runaway tachycardia episode .I take mexiletine and sotalol to prevent that from happening. .The drugs themselves are enough to kill me.  Would acupuncture be a viable alternative to all these medications,and to better my overall health? I am more than ready for a change! (Sick and tired of being sick and tired) I am only 61 yrs old with a lot of living yet to do.  I'm in good health otherwise.Just can't do the things I used to do......frustrating!!!

A:  We have to say that acupuncture is not viable as an alternative to your current medications.

This is a problem which we confront quite often with medications, and especially those prescribed for asthma. The medications are prescribed as a preventative, and if someone's condition is stable then it is extremely unlikely that a GP will consider stopping or reducing the dose. This is not a surprise. There is evidence to suggest that if long term medications for asthma are removed there is a slightly increased risk of a serious or fatal attack, and faced with this possibility for any preventive medicine it is likely to mean a lifetime regime. Better than the alternative, as they say.

However, we do treat many people with lifetime medication regimes and there is no doubt in our minds that acupuncture can sometimes make the side effects of the medication less unpleasant, and may also start to address the underlying problem for which someone is taking the meds. There are obviously no trials to validate this statement - they'd never get ethical approval - but from a Chinese medicine perspective the drugs themselves are a toxin which will have an impact on the body's energies beyond the positive effects they have on the specific problem, and it is always possible to reduce the discomfort that these cause. A classic example for us is the use of acupuncture for the nausea caused by chemotherapy. There is a great deal of research which shows that the anti-emetic effect is strong without compromising the effect the drug has on cancer cells.

The best advice that we can give is that you visit a BAcC member local to you for a brief consultation about what benefits acupuncture may be able to offer. Your condition will have some sort of history, and even a brief narrative account may well offer some useful insights into what the problem is from a Chinese medicine perspective, what the underlying causes may be, and also what effects the medications are having on the system. This may encourage a practitioner to feel that there is a good chance of reducing the impact that these medications are having. 

A:  We find it quite difficult to answer questions about very specific problems like this. There is little or no research into problems like this, and where this is it tends to be in the form of case studies. These are interesting but offer far too many confounding factors to be able to draw any conclusions or recommendations. In modern times the advertising rules are now far too prescriptive to make claim without proper evidence (although we often argue with the ASA about what counts as 'proper'!)

However, symptoms are the same the world over, and in its 2500 year history there is a rich vein of addressing the pains and discomfort which people feel from problems like this by looking at their structure and appearance from within the framework of traditional Chinese medicine. This is an entirely different paradigm of medicine with patterns and syndromes which sound utterly alien to the untutored ear,  but it has stood the test of time. If we drop disease labels out of the picture and focus on what someone experiences as a change in the balance and flow of energy, called 'qi', on which the system is based we often find local blockages and systemic weaknesses, the correction of which can make a significant difference.

Essentially Chinese medicine treats the person, not the condition, and the practitioner will want to understand why this particular symptom developed in this person. In this sense traditional acupuncture can help in the treatment of most named conditions, but we have to be careful because 'treat' implies 'cure', and this is often not the case. All that we can do is to maximise the balance of the individual and then let nature take its course. Sometimes the results are very good, on other occasions there are many hereditary and lifestyle issues which limit what is possible.

The best advice that we can give is that you visit a BAcC member local to you for an informal chat about the possible benefits of acupuncture. You will be able to let them know a great deal more about what exactly is happening, and this will offer the chance of a much better and more precise view than we can offer here. Most do not charge to have a quick look at a problem, and of course you get to meet them and see where they work before committing yourself to treatment.


Q:  Can acupuncture make tendonitis worse, I have had 2 sessions now the first session was fine, but after my second session I was sore, which was 5 days ago & I am having trouble moving my neck, lying down & stabbing pain in my shoulder with swelling, also a slight bruise has come up on the inside of my arm. 

A:  The short answer to your question is 'yes.'

With all forms of musculo-skeletal treatment we warn patients of the potential for symptoms to become a little more pronounced after the first session or sessions. This is very often the case for back and neck problems. There is no definitive reason for why this happens. Most of us take the view that although we treat function rather than structure, when we get the balance of the body's energies more as it should be the structure of the body will start to adjust. This means that tendons and muscles which have adapted to an imperfect structure will have to tighten or loosen, and this will always involve a certain amount of discomfort. Some colleagues also talk about the restoration of energy flow being somewhat akin to putting cold feet in front of a fire after a long walk - immediate relief followed by pain as the circulation improves.

However, the fact that you have such a large range of problems suggests that the treatment may just be a little too powerful for you. Generally speaking if someone is quite sensitive to treatment, as many are, the effects may be a little too dramatic and we tend to scale back our endeavours with no loss of outcome - less really can be more. The fact that you have a small bruise, which probably comes from needling, may be indicative of this.

The most important person to discuss this with, though, is your practitioner. He or she will know exactly what they have done, and also how much they have done, and can provide you with the necessary reassurance. They can also adjust the treatment if indeed it is the strength of what they have been doing which is causing you concerns.

What we do often find, though, is that this sort of effect only happens with the first couple of treatments. After that there just tends to be steady progress, and the main concern is then how much progress and how sustainable it is.

 

A:  'Tried and tested' treatments for atrial fibrillation, and with them a 'best practice treatment' don't really sit well with the concepts of Chinese medicine.

We have been asked about AF on a number of occasions, and a composite response earlier this year said:

There are some early indications that acupuncture may have an anti-arrhythmic effect in patients with atrial fibrillation. A study published earlier this year

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/

concluded that there appeared to be benefits and that further large scale trials would be valuable to test the hypothesis more carefully.

However, it is only fair to say that needling a single point such as Neiguan repeatedly is not a fair representation of what a traditional acupuncturist does in practice. Although there is considerable overlap between eastern and western systems the arrhythmia typical of AF could be classified in several different ways within Chinese medicine, and the practitioner would be guided by evidence other than simply a reading of the rate of the pulse. That in turn would mean that ten people with AF might receive ten different treatments. To that extent, it is not that straightforward to extrapolate from research studies like this and conclude that 'acupuncture works'. 

The skill of the practitioner lies in making sense of the symptom of AF within an entirely different theoretical framework, and understanding each presentation in each individual patient as unique. The best advice we can give any prospective patient is to contact a BAcC member local to them to seek a short face to face consultation at which they can be given a better assessment of whether acupuncture might benefit them.

The one caution with AF is that most patients are taking some form of medication to control the problem, and the cessation of medication can quickly provoke a return of the symptoms. For people involved in highly technical or responsible work this might represent a serious risk. We would always recommend that any member contemplating treating someone with a condition like AF should talk to the patient's GP to ensure that nothing they do will undermine the current treatment regime. 

We have undertaken some further searches of the literature and these two articles

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321072/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673375/

say much the same as the earlier articles and indeed cite them frequently.

Most of us have treated AF cases, and they do represent something of a challenge because of the management of the case alongside western treatment and medication. Even where we manage to bring the episodes under control to a greater degree than the medication most medical practitioners are reluctant to stop the meds in case the patient has a serious recurrence when they are doing something which could have dangerous consequences (driving a car, etc etc). However, good dialogue can address these kinds of problems, and a patient with their symptoms under control is likely to be happy to facilitate good communication anyway.

The other slight issue is with the setting of outcome measures. AF can come and go, and a problem-free period can happen anyway, so a practitioner has to be careful to discuss with the patient what would count as evidence from the patient's perspective that there had been some progress.

As you can see from the responses there is a strong commitment to the idea that Chinese medicine treats the individual, not the condition itself. It may have been a strategic error for us as a profession to spend so much time talking about named conditions because it has started to develop a public perception that we are doing the same as doctors  but using needles instead. The reality is that although the symptom may be the same from a Chinese medicine perspective a dozen people with AF may be treated in a dozen different ways if the practitioner discerns a different root pattern in each system which needs to be treated to restore proper flow and balance.

Adding to what has been said above, we tend to tread cautiously with patients diagnosed with AF. Sometimes the treatments offered can have their own substantial side effects, and these need to be factored into any treatment plan. However, we tend to want to work in close contact with a patient's orthodox healthcare professionals to ensure that the condition can be brought under better control without risk to the patient.

Q: After neuro tests I have nerve damage to my left knee. This is causing difficulty in walking and knee pain ,there is also muscle wastage.

A:  A great deal depends on what caused the nerve damage. If this is as a result of an accident or illness which caused the initial problem then there may be rather more difficulty in restoring full function. However, the sort of muscle wastage you are experiencing is something which happens even to top flight athletes. It is not unusual for a footballer with a knee injury to be out of action for several weeks because the quads lose their tone really quickly and can take longer than the knee itself to become match fit.

The theories of Chinese medicine are all based on theories about energy, called 'qi', which is the basic constituent of all living structures. When this energy, which flows in well-established patterns and rhythms, is disrupted pain and weakness follow. The art and skill of the practitioner lies in determining the extent to which the poor flow is a local problem or a local problem which has persisted or failed to improve because of a greater underlying weakness or problem in the overall system. This marks the difference between traditional acupuncture and the more medically based versions used by conventional physicians. Sometimes if the problem is local, then it matters not what system to choose, and both will work. However, our experience is that very often there are good reasons from the Chinese medicine perspective why something is not improving as it should, and using systemic treatment alongside the local treatments can make a great deal of difference.

There is also the issue of how long after the initial problem the treatment is given. There is an interesting parallel with the treatment of muscle flaccidity or paralysis after stroke. In China this is treated almost immediately to ensure that proper flow is restored as soon as possible. The longer the disruption has been in place the more the body starts to accept this as 'normal' and the more entrenched the weakness becomes. This does not mean that improvement is impossible, just that iot may take a little longer.

We are assuming that you have been offered physiotherapy or exercise routines to help with your recovery. We would always advise someone to arrange to visit a BAcC member local to them for an informal assessment of what may be possible. It should be fairly straightforward to find at least one near to you who specialises in treating sports injuries, and they will be without doubt a valuable resource in putting together a package which will help you back to better mobility without pain.

 

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