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Ask an expert - body - chest - heart

6 questions

Q: I was wondering what the BAcC said on blood pressure limits;  specifically when should practitioners refuse treatment. Or more accurately could you provide figures on the lower and upper limits with regard to acupuncture treatment?

A:  There is nO point at which a BAcC member will refuse treatment because of any inherent risk in the use of acupuncture treatment when someone has extremely high or low blood pressure. In fact, the use of acupuncture for hypertension is reasonably well-researched, and although the evidence is far from conclusive (at least in those studies which meet the perhaps over-strict inclusion criteria used in the West) it is certainly encouraging. At the other end of the scale, there are a number of points which are known to lower blood pressure, and a practitioner may be a little cautious if treating someone who has hypotension, but the needle techniques used in the West are probably too gentle to creat much in the way of a major reaction. However, we have pointed out to medical colleagues that one of the points they use rather vigorously for treating tennis elbow can lower BP by ten points, and to be wary of over-doing it.

The real issue is one of patient management. We all routinely take the BP of a new patient, and if it sits at the end of what doctors take to be the normal range (above 145/95, below 90/60) we all refer to GPs to get the pressure tested in a surgery and officially noted. This would not preclude treatment, but would be simply offering the best care to the patient. If someone with very high blood pressure refused to see their GP and wanted to try to use acupuncture as a main intervention, we would almost certainly advise members to tread very carefully. Refusing to treat would not be an option - it is not our job to 'sack' patients who want to pursue their own choices and the treatment may well work - but we would want to see a member obtaining some very specific consents to treatment, and writing very thorough accounts in their notes of what is happening.

Sadly without statutory regulation we are not formally recognised within the NHS, and therefore we are subject to very strict rules about disclosure without consent. As such we could not go to a patient's GP without their consent. However, where we have met situations like this the persistence of the practitioner has invariably won in the end.

Q:  I have recently been diagnosed with coronary artery disease and unstable angina, for which I have been prescribed a raft of drugs. Please can you advise me as to whether acupuncture would be appropriate treatment, and if it would whether it could offer an alternative route to all the drugs.

A:  We have to say straight away that all of our members are under strict instruction not to interfere with prescriptions issued by a patient's GP, either by asking them to change or stop or, as importantly, supporting a patient's decision to stop taking a drug which may be life sustaining. There are, of course, a huge number of medications prescribed on a 'use as needed' basis, and if someone finds that acupuncture treatment means that they can do without the meds, so much the better.
 
In your case, however, both conditions carry a high risk factor if untreated, and it would be potentially very dangerous to stop taking your prescribed medications. That does not mean that acupuncture cannot help, and if you did decide to go ahead with treatment, you may well find that some of the symptoms are relieved. The problem you would then have is to convince a doctor who has made the prescription that the acupuncture, and not the medication, has had the desired effect. Most will conclude that the drugs are working, and be all the more reluctant to let you stop.
 
The best course of action is to discuss with your doctor what might be possible by way of a planned reduction over time, and what markers they would be looking for, whether these be achieved by medication or acupuncture. In this way it remains an open question as to what is working, but the end result is the same.
 
We have to say, though, that with both of these conditions, the chances are that the doctor will not entertain a reduction unless there were very significant and measurable changes in your heart function which made him or her confident that you were a very low risk.
 
As far as the symptoms themselves are concerned, there is a small amount of research for the use of acupuncture, but as this systematic review
 
http://www.ncbi.nlm.nih.gov/pubmed/23427379
 
clearly says, there would need to be many more trials of greater power and number to assess properly whether acupuncture is a viable treatment option.
 
It may well be worth talking to a BAcC member local to you, though, because a face to face assessment will be much more helpful than what we can offer at a distance, and we are understandably cautious when we have to work from brief descriptions of a problem.
 
 

Q I suffer from atrial fibrillation and have heard that acupuncture can help restore the heart to its normal sinus rythm. Is this the case? If so how would I find an acupuncturist who specialised in this field?

 

A: 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 esnure that nothing they do will undermine the current treatment regime. 
 
 

The majority of cases of venous insufficiency involve the circulation in the lower limbs, and while there is very little specific western research on this, we have to remind people that Chinese medicine has dealt with problems liek this for centuries, and has a number of treatment strategies for problems in which this is one of the symptoms.

 

 

It is important to be aware that Chinese medicine operates from an entirely different conceptual basis in which the flow of energy, called 'qi' in Chinese, is central to the effective flow of all body fluids and to the overall balance of the system. The practitioner of Chinese medicine uses his or her skills to try to determine how the system is out of balance and then devises treatment strategies to correct imbalances. In some cases this is symptom led, and in other cases, the treatment is much more general, aimed at correcting the overall balance premised on the simple belief that when a system is in balance, symptoms repair themselves.

 

The best course of action is to visit a BAcC member local to you to seek their advice on whether your particular case makes sense from a Chinese medicine perspective and what they would advise. In many cases acupuncture would be an appropriate treatment, but there may be other options which a practitioner may recommend as better suited for what specifically troubles you.

Although there are one or two studies published in China (and in Chinese!) which have shown promising results, there is no hard evidence that acupuncture has been proven to have a strengthening effect on the heart. For conditions such as this acupuncture may well have a general supporting function, insofar as the basic premise of Chinese medicine is to treat the person, not the disease, but it would be alongside conventional treatment, complementary and not alternative.

 

 

What we can say with a good degree of certainty is that as long as someone continues with their conventional treatment there is very little likelihood of acupuncture causing any harm. The safety statistics for acupuncture in the UK are exemplary, and even across the globe and taking in all forms of sub-optimal practice the incidence of serious adverse events is very low.

 

Both acupuncture and Chinese herbal medicine work from an entirely different knowledge base which looks at the overall functioning of the system rather than simply repairing the bits that go wrong. The symptoms which form the basis of a diagnosis in the West are used in Chinese medicine to underpin a diagnosis in entirely different terms, and the practitioner will aim to correct the imbalances and blockages which manifest as these symptoms. In that general sense there is a possibility of making everything function better.

 

This is not quite the same as claiming to help specific organs, and practitioners are cautioned at the beginning of their training to remember that an organ understood in Chinese medicine terms is not the same as the physical organ described in the West. It often embraces it, but includes a wide variety of other functions, not always physical. This is why Chinese medicine textbooks use the capital letter (Heart) to differentiate from the physical organ (heart).

 

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