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Ask an expert - body - head - eyes

10 questions

Q:  Can acupuncture help with macular degeneration? I have an elderly relative who believes there has been some recent research but I cannot find it. I am concerned that she may be asked to pay a considerable amount with little evidence of it working, but we are both very open to alternative medicine. She lives in Cambridge

A:We conducted a search and the best we could come up with

http://www.ncbi.nlm.nih.gov/pubmed/21355157

a study in Chinese which appears to demonstrate that acupuncture out-performs conventional medical treatment. Otherwise the only direct reference is a Cochrane Review summary which identifies the fact that there is a systematic review or similar on their files as pending

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705651/

With conditions like this there are a number of difficulties involved in answering the 'does acupuncture work?' question. From a Chinese medicine perspective, although twenty patients may have the same named western condition there could be twenty different treatments. The symptom from this perspective is merely the weak link where an overall imbalance tips something into poor or degenerating function, and although local treatment could achieve some useful short term gains, helping to improve the underlying balance is the key to getting well and staying well. This involves treating the person as much as treating the disease.

Conditions like this can often become unintentional money pits, and it is easy to build up a treatment habit based more on hope than experience. Practitioners are often inclined to fall into the same trap in pursuit of better health for their patients. The best positive result one might achieve could be a decrease in the extent of deterioration, or as one patient put it once, 'do you know, I think I'm getting worse slower'. Of course, this is unverifiable and largely unmeasurable, but there is no doubt that many patients have reported anecdotally that they have exceeded the expectations of their clinicians in maintaining reasonable function longer than anticipated. Naturally there are a great many other factors which make this possible, not least of which is that seeking complementary treatment is itself evidence of a determination to do something which is probably reflected in someone's overall health.

From a Chinese medicine perspective the eyes as a functional unit have close relationships with two or three major Organs (capitalised to differentiate them from the western concept of an organ) and if there is evidence of a generalised weakness in relevant related Organic functions, a practitioner might think that there is some hope that treatment may be of value. There is also plenty of discussion in Chinese texts about local needling and its potential to halt or even slightly reverse decline.

We have to be realistic, though. The kind of deterioration which this condition causes is well-documented as likely to continue, and it would be a foolish practitioner who tried to instil too much optimism in a prospective patient about the chances of major improvement. However, it is always worth while talking to a BAcC member local to you, and there are some very good ones in Cambridge, who we are sure will be only to happy to give you advice on the basis of a brief face to face assessment of your mother's situation.

Q: I have been suffering with Uveitis for around 5 months and have ready that acupuncture can really help to reduce the inflammation. Are there acupuncturists that specialise in eye treatments or will any acupuncturist be able to look at this problem?

A:  We have to sound a note of caution, insofar as there is not a great deal of research to underpin claims for efficacy in treating uveitis with acupuncture. There was a small study in Vienna three years ago

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2003.tb05820.x/abstract

which demonstrated reductions in pain and improved visual acuity in five patients, but this is not robust enough evidence to make any more serious claims about efficacy.

From a Chinese medicine perspective, there are obviously other ways of looking at what happens in uveitis within the diagnostic framework. The manifestations of the problem are understood within an entirely different paradigm based on a concept of energy, called 'qi', and its rhythms, flow and balance within the system. There are both functional aspects of eyesight which are governed by different parts of the system and local energy flows which might be compromised and generate problems such as this. The skill of the practitioner lies in making sense of the symptoms within the diagnostic framework and seeing what may be done. This can sometimes generate solutions where western medicine has none to offer, but one has to be realistic and recognise that some conditions do not respond well to acupuncture.

Your best avenue is to see if a BAcC member local to you can offer a brief face to face assessment of whether acupuncture treatment may help your specific presentation. There are none that specialise in eye conditions as such, although if you undertake a google search you will find one or two who have written quite a great deal about eye problems and acupuncture. We remain committed to the policy, however, that all our members are equally well qualified to address the great majority of problems which their patients bring them, and we do not promote individual members.

Q:  Please could you advise whether acupuncture is effective for dry eye syndrome or melbomian gland disfuction. I suffer from both these conditions and haven't had any relief from pharmaceutical medicines. I have read that acupuncture can help relieve symptoms,  but I'm not sure if it can help me.

A:  There is a small amount of research in the west into this condition, and a systematic review published a few years ago
 
http://www.ncbi.nlm.nih.gov/pubmed/20337604
 
concluded, as they invariably do, that there was insufficient evidence and that larger and better trials were necessary. Without going too much into the politics of research, it would be fair to say that we have serious reservations about the models of research favoured in the west, which don't really work that well with traditional acupuncture practice, and equally fair to say that even these inadequate models never attract the funding necessary to run larger trials.
 
However, dry eyes are a symptom as old as mankind, and the ancient Chinese has a number of ways of understanding how this symptom could arise. This rests, of course, on an entirely different understanding of the physiology of the body which is itself based on theories of the flow of energy, called 'qi', which is controlled by the functions of the Organs of the body. A practitioner's skill lies in determining whether a problem such as this is a sign of a local blockage, or whether it forms a part of a wider pattern of systemic unrest which needs to be treatment to get to the core of the problem. Indeed, in some of the older systems of traditional acupuncture, symptoms were not integral to the treatment plan; the practitioner treated the person in the simple but effective belief that a system in good balance repaired itself.
 
Our best advice is that you visit a BAcC member local to you to get a face to face assessment of your specific presentation, and whether the practitioner thinks that based on this acupuncture treatment may be of benefit to you.   
 

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.  
 

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