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Ask an expert - body - chest - heart

14 questions

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:  '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:  My son has myotonic dystrophy and has a pacemaker, he wants to try acupuncture, will it be safe for him?

A:  The only contra-indication we recognise with pacemakers is that it is not wise to use electro-acupuncture.  The leading and authoritative text on electro-acupuncture says that:

stimulation is contra-indicated if a patient uses a demand type (synchronous) cardiac pacemaker. whether atrial or ventricular

but our view is that the fine distinctions between different types of pacemaker are probably not that well understood by patient and practitioner alike, so we prefer to make this a blanket restriction.

Pacemakers can obviously be positioned in a number of places, and we would expect practitioners to take extra care when needling in that area or indeed not needle there at all. A great deal depends on where the device is installed.

Other than that we can think of no reason why your son should not try acupuncture. There is no evidence that we can find which relates specifically to this condition, but the general basis of acupuncture involves optimising basic functions in the body and ensuring that when there are progressive degenerative conditions that what residual function remains is as effective as possible. We hope that treatment may be able to offer your son substantive results


A:  Oddly enough it is quite a while since we have been asked about the treatment of AF, and the last 'long' answer we gave was:

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 prosepctive 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.

 



Q:  Can acupuncture help with kidney disease (Microscopic Polyangiitis)? One of the effects of my kidney disease, or my medication, is high blood pressure - generally about 155/90, target is 130/85 - can acupuncture help with this even if it cannot address the underlying kidney disease?

A:  The condition from which you are suffering is quite rare, as you probably know already, and with the development of of drugs like rituximab used alongside corticosteroids there is now a reasonably good chance of inducing remission and with that normal life expectancy.

From what we know about the condition itself hypertension does not seem to be a common aspect of the presenting problems, so it may well be the drugs which you are receiving which are the primary cause. a BP of 155/90 is not catastrophic, depending on your age, and most doctors will only just be starting to consider medication for the problem. There is a growing body of evidence, as our factsheet shows

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

for the successful use of acupuncture to bring high blood pressure under control, but a great deal depends on the precipitating cause. If there is a specific reason, like a medication routine, then to some extent one needs to be careful not to try to reverse the effects in an attempt to reverse the side effects.

However, when we are looking at the use of acupuncture for named conditions like yours it is a bit 'apples and oranges', i.e. we are working from an entirely different paradigm which understands the body as a system of energy. From a Chinese medicine perspective, the overall picture, from symptoms and signs through to the effects of medication, are factors which we would take into account for treating a patient. If the hypertension has arisen through malfunctioning elsewhere in the system or from the use of medication impacting on the Organs which process them, then we would expect to be able to make some difference. The main question would be how much difference and how sustainable any change was; there are many conditions which respond for a while and then revert, so we are always careful to assess long term benefits in this context.

When the words 'auto-immune' disease appear in a presentation most practitioners find their attention drawn to the problem. The sense of a system turning against itself can sometimes be addressed within the protocols and understanding of Chinese medicine, and as practitioners of the last resort we often have successes where conventional treatment has failed.

However, each case is unique and different, and the best advice we can give is to visit a practitioner near where you live for a brief face to face assessment of what might be possible. With more direct and indirect information at their disposal they will probably be able to give you a better assessment of what may be possible than we can at a distance.

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