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Ask an expert - body - skin conditions

37 questions

Q: I have had urticaria for almost 2 years now and I have been on antihistamines for a year. Traditional medicine does not offer any solution in my case - none of the doctors can establish what causes it and no one knows how to get rid of it. My only hope at the moment is alternative medicine and I have heard that acupuncture could offer a solution. Do you have any record of it helping with my condition ?

A:   We were asked about the treatment of urticaria with acupuncture a little while ago, and our response then was:

Can acupuncture treat urticaria with any level of success?

Success is a very loaded word in the context of what one can now claim in marketing and advertising. The standard of proof in all healthcare advertising is the randomised, double blind control trial, the model most often used for testing drugs, and it has to be said that it is not very well suited to assessing whether acupuncture 'works' or not. Reducing variables is the last thing a practitioner would try to do in Chinese medicine; understanding and interpreting their variations is integral to the way that the system works. Hence a paper such as this one from 1998
 
http://www.ncbi.nlm.nih.gov/pubmed/9828874
 
is a great example of the problems we face when asked questions such as this. The manifestations of urticaria, understood in Chinese medicine terms as a description of the specific symptoms, have always been around and like any complete system of medicine, Chinese acupuncture has ways of understanding how the heat and swelling develop, and within the system has developed clear protocols to deal with the problem.
 
However, as the paper acknowledges, getting precise enough definitions if urticaria itself to assemble a trial is a problem, as indeed would be the next stage, ensuring that the test and control groups had the same western and eastern conditions to guarantee objectivity. However, when one takes into account that in Chinese medicine the person with the disease is as important, if not more so, than the disease which the person has, it becomes rather difficult to talk meaningfully of treating a named condition.
 
That said, there are papers which examine the presentations and treatments of urticaria such as this one
 
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/
 
where there is a very positive reference (60) to a paper which on the surface appears to meet the criteria for inclusion in a growing body of good evidence.
 
We prefer to hold to the view that each patient is individual, and that it is the unique assessment of their energy by a skilled practitioner which is the best judgement of whether treatment may be beneficial. It is true that many patients present themselves for treatment with urticaria-like symptoms, and anecdotally we here of success in both acute and chronic cases. However, if you wanted to establish whether acupuncture treatment was a good option for yourself or someone on whose behalf you are asking, then a brief face to face assessment by a BAcC member local to you is your best way of establishing this. 
 

We think that this still represents the best advice we can give. Anecdotally we have all had some very positive experiences of treating people with urticaria. Of all the skin conditions this appears to be the most amenable to acupuncture. For many other conditions, like psoriasis or eczema, we have often recommended the use of Chinese herbal medicine alongside acupuncture treatment. There are a considerable number of BAcC members who are also members of the Register of Chinese Herbal Medicine, and there may be some advantage on seeing someone who uses both, although as we have said, you may well find that acupuncture treatment by itself can offer a solution.

If you do go ahead, it is very important to set measurable outcomes and to ensure that your review the treatment at regular intervals. It is quite easy to run up a large bill in pursuit of success without realising, and the responsible practitioner will always check on a regular basis that there are enough signs of improvement to warrant carrying on. 

 

 Q:  My mum (74 and very active) has a leg ulcer on her right outer ankle and is in a lot of pain, taking constant paracetamol and ibuprofen. Is there any evidence acupuncture can help? 

A: We were asked a similar question last year and the advice we gave then was:

It depends a great deal on whether you are asking about treatment for the pain from the ulcer or for the ulcer itself.  As far as the treatment of ulcers themselves is concerned, there are a number of techniques within Chinese medicine for dealing directly with ulcers but these are often quite rough and ready, using a great deal of local needling and the technique of moxibustion. While this is a common approach in China, in the west it is highly likely that someone with a chronic ulcer is being treated according to protocols which involve frequent dressing changes and removal of the fluids gathering in the ulcer, and we would be reluctant to advise anyone to mix and match the two forms of treatment. However, in Chinese medicine theory ulcers are understood in a number of ways which might make treatment at a distance from the ulcer site possible, and in more general terms still, Chinese medicine was and is primarily concerned with re-establishing balance in the whole system in the belief that a system in balance is better equipped to right itself. On this basis it may well be possible to speed up the pace of recovery.
 
As far as pain relief is concerned, there is a long history of research into the use of acupuncture for pain relief, and the question here is not whether it works, but how much it works and how sustainable the relief is. If someone needs treatment twice a day for several weeks to reduce the pain, this raises issues about cost and attendance at a clinic. However, if one or two sessions a week can bring the pain down to tolerable levels it may be worth considering having treatment. The problem we foresee here is the site of the ulceration. The outer ankle is not really an area which one can easily immobilised, and it may well be difficult to counter the effects of continued minor irritation from movement.
 
However, sight unseen we cannot give a conclusive answer. We have a number of members in her area, and we are sure that any of them will be able to give you and your mother an objective assessment of what might be possible if you can arrange a short visit, hopefully without charge, to discuss the problem with them.

We think this probably still represents the best advice we can give. In our experience leg ulcers can be a very difficult problem to treat, especially where there are a number, and it is highly likely that treatment may be inconsistent with the conventional care being offered. However, long experience has taught us never to say never because occasionally acupuncture treatment can produce unexpected but substantial results. What we would say, though, is that our expectation would be low, and if you do find someone who thinks the condition is treatable, we would advise frequent and regular reviews to assess whether there is any change. It is not difficult to run up to a very large number of sessions without tangible result, and we advise members to ensure that a patient has the best possible information to inform the decision to continue with treatment when results to date have not been great.

Q: On behalf of a friend, is there any point in trying acupuncture for scleroderma, at present in the lungs and skin.  I have had remarkable success with acUpuncture for rheumatoid arthritis.

A: In our view, there is always good reason to try acupuncture treatment! By its very nature, traditional Chinese medicine treats the person, not the disease, and the physical manifestation of a problem is seen within a picture of the whole person involving all aspects of their body, mind and spirit. We find that this can often be a very rewarding way of approaching auto-immune conditions where there is no obvious physical cause. This obviously doesn't mean that there is an alternate cause in mind or spirit, but from a Chinese medicine perspective symptoms are not the problem, simply an indication that the system as a whole is not in balance. Indeed, the earliest systems of Chinese medicine were asymptomatic, using the symptoms only as indicators of returning overall balance,

As far as research into scleroderma is concerned, there are a number of studies which are encouraging, good examples of which are

http://www.ncbi.nlm.nih.gov/pubmed/23885611

http://www.ncbi.nlm.nih.gov/pubmed/9673897

but even here this is far from standard treatment fare. Of course, one of the problems with conducting research is that to meet western research protocol standards as many variables as possible have to be taken out of the equation. Since scleroderma is a relatively rare condition and can present in many different ways, it is not that easy to assemble a meaningful sample and control group for testing.

However, as we have already said, and as you have personally experienced, acupuncture treatment can often provide remarkable benefits where there is not a great deal of conventional medical treatment available. We tend to take the view that there will always be a benefit, but how much and how sustainable are open questions. We rely on the probity of our members to set clear outcome measures and regular review periods to enable everyone involved to assess whether there is sufficient impact from treatment to warrant continuing for a longer time.

The best advice we can give you for your friend is to visit a local BAcC member for a brief face to face assessment of what might be possible. This will always be far better than any 'remote' answer that we can give.

A:  Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.
 
All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.
 
Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.
 
Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.
 
The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.  
 

Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.
 
All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.
 
Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.
 
Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.
 
The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.  

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