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Ask an expert - body - chest - heart

9 questions

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:

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.

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:  Are there any adverse effects of acupuncture on pacemakers?

A:  As far as we are aware, there have been no reported adverse events from the use of manual acupuncture alone in relation to pacemakers. We publish a guide for our members' use which adds background advice and best practice suggestions to help them to comply with the Code of Safe Practice, and the advice we give there relates only to electro-acupuncture (EA):

Patients who have a pacemaker should not be treated with electro-acupuncture since there is a risk that the electrical stimulus of the acupuncture device may interfere with the pacemaker

If you search the internet you will find case reports such as this one:

which suggest that EA is safe to use for pain relief even when a pacemaker is fitted, but also reports such as

which suggest there is a measurable effect from using EA with a pacemaker in place.

The leading authority on EA in the UK, David Mayor, recommends in his comprehensive textbook on electroacupuncture that EA must be absolutely contra-indicated for anyone using a demand led pacemaker



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
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.

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