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Ask an expert - body - chest - heart

12 questions

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.

Q: I am a US citizen who will be visiting  London . I suffer from atrial fibrillation that has been successfully controlled by acupuncture. My practitioner has provided me with a copy of the appropriate meridian points.  I need names of specialists who treat this condition in the event of an episode while I’m in England. Any assistance that you might provide would be greatly appreciated.

A:  Our view as Traditional Chinese medicine practitioners is that we are all generalists, i.e. because we treat the person rather than simply the condition then all of our members have achieved a minimum standard of competence to deal with the majority of patients who visit their practice and within the limits of their competence. The only areas where we are looking at defining 'expert practice' are obstetrics, paediatrics and mental health issues, largely because there is a considerable amount of conventional knowledge which it is appropriate to have for patients in these sectors.

This means, in effect, that if you use our postcode search facility on our home page, as we have just done, to check whether there are practitioners in the area, you will find a considerable list, all of whom can offer you the same high standard of care. We obviously cannot give individual recommendations, but we recognise several of the names in the area as experienced and skilled practitioners.

It is always helpful to have the benefit of someone else's diagnosis and treatment plan, especially where this has been successful. We believe that it is probably best to establish contact before you come across, and would recommend that you e-mail two or three to see if their responses are a good indicator of being people you could do business with. If so, then they would I am sure be happy to contact your practitioner in advance to exchange information.

The only tiny word of caution is that over the last couple of years we have had a scam running in the UK which begins with an e-mail saying 'I am coming to your country in July and would like to book a course of treatment in advance.... etc etc'. What happens then is quite sophisticated - ten treatments are booked, an international money order arrives for too much, the booker says the bank added their car hire on by mistake, could you send a cheque by way of refund, the cheque is sent and cashed, the international money order turns out to be a fake but takes longer to clear than the personal cheque which is long gone.  I say this because there may be some members who see an e-mail starting 'I shall be coming to the UK in July' and may delete it unread. If so, please forgive them and accept our apologies!

Q: Can acupunture be used for cardiac rhythm disorders such as frequent ventriluar ectopics and non-sustained ventricular tachycardia? Is there any acupunture expert who specialises in treatments of these disorders?

A:One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The rapid pulse and the irregular pulse both have clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

http://www.ncbi.nlm.nih.gov/pubmed/18992625

Some of the published research also involves animal experiments, sometimes called 'ratpuncture in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what these two conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.

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