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Ask an expert - body - head - eyes

20 questions

We were asked a similar question a number of years ago, and our answer then contained the following paragraphs:

Chinese medicine is based on an entirely different theoretical basis from conventional medicine, what is often called a different paradigm. The essence of Chinese medicine is a belief that the body, mind, emotions and spirit are all manifestations of an energy called 'qi' whose proper flow and balance means that everything functions the way it is supposed to. If this flow becomes blocked or disturbed in any way, then functional disturbances appear, often affecting all 'levels' of the system and for which needles are used by the practitioner to restore flow.

When someone reports blockages it makes one question immediately whether the energy of that area is flowing as well as it might, and a skilled and experienced practitioner could determine quite quickly whether, from the Chinese medicine perspective, there was something which might be done. Even if there were no immediately obvious signs in the area itself, the principles of Chinese medicine are founded on a notion of overall balance which means that symptoms are less critical, being indicators of a wider imbalance in the system rather than the necessary focus of attention. It would be worth your while to visit a BAcC practitioner local to you for an informal assessment of whether they believe that acupuncture treatment may be of benefit to you.

That said, we have to say that the research evidence for the treatment of both conditions with acupuncture is a little bit thin. There are a few studies, but one of the key factors in undertaking research from a conventional perspective is trying to reduce the variables, and this means being able to define clearly what the problem is. Blocked tear ducts  have several possible causes, and this means that comparing like with like becomes more difficult, and the results less reliable. What research we have identified is of relatively poor quality, and if we were making recommendations based solely on that we would have to say that it would not be worth pursuing. However, our clinical experience is that where there are clear energetic blockages treatment can sometimes have a very direct effect, and it would certainly be worth seeking advice from a BAcC member local to you.  

There are, in fact, some quite useful studies of related problems like dry eye syndrome, and although it is rather technical this paper

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/

is both realistic and encouraging.

This expert has to admit that it has not been the most successful area of his practice. While few patients have come specifically for this as a problem several have had it as a secondary problem, and even where the main problems have responded well this hasn't. That said, in the minority of cases where there has been a positive change the result has been welcomed with great joy.

Acupuncture treatment is always worth a try. There is very little chance of an adverse effect, and there are enough reports of treatment working for this problem to suggest that it is worth a go. The only issue for cases where there is less evidence is to make sure that a patient doesn't get tied into a long and potentially expensive course of treatment without any tangible benefit. In another context, Dr Johnson once described something as 'the triumph of hope over experience', and we always ask our members not to succumb to joining patients in a desperate hope for good outcomes. If there is nothing happening after four or five sessions it may well mean that nothing will happen.

If you do decide to go for treatment, we hope that your case is one of the ones which does respond.

Q: My meibomiem glands are blocked causing swelling below my eye. Can acupuncture unblock these?

A: If you search the internet for problems with the meibomian glands and the use of acupuncture you will come across the occasional study like this one

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/

which is cited quite frequently in the treatment of dry eye syndrome. There are a couple of others of a similar nature, but the main concern is with a functional disturbance in the work of the glands as a contributor to the symptom rather than a straightforward blockage.

Of course, when you talk to acupuncture practitioners about blockages they tend to light up. Our work, after all is based on an understanding of the body as a complex flow of energies, and using needles to unblock areas which have become stuck is very much a part of what we do. When someone reports an area of the body where things have become 'stuck' we always feel that the use of needles may well help to unstick them.

However, we are always looking at the person as a whole, not simply the symptoms which they have, and an important concern is that the symptoms is not the tip of a much larger iceberg. Although symptoms like yours tend to be local rather than systemic, there are times when a general change in the character or viscosity of body fluids can cause accumulations in areas where the physical conduits or channels are narrow, and an experienced practitioner will want to understand your local symptom in its wider context before giving you a prognosis.

The best advice that we can give is that you visit a local BAcC member and let them have a look at the problem face to face. This will give them a much better idea of what may be possible than we can offer at a distance. The one caveat with problems like this, though, is that people can sometimes carry on with treatment far longer than the results justify. If it is a simple and local blockage there should be changes within a session or two. If there aren't then it is worth drawing a line very quickly before committing large sums of money getting nowhere, unless the practitioner is absolutely sure that there is a wider pattern which underlies and sustains the symptom.

A:  We have rarely been asked about optic atrophy, but did have a question three years ago which refers to what remains the best evidence available, as well as the best advice about finding someone who might be able to help.

We wrote:

 A recently published meta-analysis


http://www.ncbi.nlm.nih.gov/pubmed/23545824


makes some very encouraging noises about the use of acupuncture treatment alongside conventional treatment, but concludes, as does every systematic review or meta-analysis, that more research needs to be done, and on a greater number of subjects.
However, we are always cautious about the kind of trials which generate these results. The gold standard applied to western scientific research is the randomised control trial, and to make these work, the treatment has to be standardised and the condition under investigation has to be the only outcome variable. Whatever else the patient may have by way of health related issue is discounted. From a Chinese medicine perspective, both of these positions are not best practice. Treatment is dynamic and evolutionary, building on the progress, or lack of it, and refining the treatment as it goes along. The symptom which serves as the focus of the research is also seen in a far wider context, and it would not be surprising if twenty people with optic nerve atrophy had twenty different diagnoses from a Chinese medicine perspective. The symptom is only an alarm bell which alerts the practitioner to patterns of imbalance or blockage, and these will be unique to each individual.
This means that we have to be careful with research studies. Many will be unfairly inconclusive, but equally others will be falsely encouraging, building on a fortuitous outcome that the patients selected for a small trial happened to have treatment which helped their underlying patterns.
Good Chinese medicine aims to understand the appearance of symptoms in disturbances of the function of Organs (capitalised because an Organ is seen a complex collection of functions which embrace some of the physical ones we understand in the West but many which affect mental and emotional factors), and the practitioner uses their art and skill to determine what the driving force behind the complex pattern of disharmony is. In some cases this will show direct connections with the symptom, in others only a complex pattern in which the symptom is a weakness exaggerated by problems elsewhere.
The long and short of it is that the best advice you are likely to get for the treatment of a condition such as this will come from a brief face to face assessment from a BAcC member local to you. It is probably true to say that the best you might achieve is a reduction in the rate of deterioration or a stable but not deteriorating state, but at this remove we cannot really say. If you did decide to have treatment it would be very useful to establish markers by which any change can be monitored, and also review periods to make sure that the treatment is being regularly assessed for outcome and value.
As far as practitioners are concerned, we do not recognise fields of specialism. From our perspective our members as generalists are all equally well equipped in Chinese medicine to deal with the full range of problems which people bring to their clinics. We have one or two fields like obstetrics and paediatrics where we are shortly to recognise standards of expert practice, but we do not have short term plans for other specialties. There are one or two members who focus their work on people with eye problems, an while we cannot give specific recommendations, it is a simple matter to track them down through google. 
We think that this remains the best advice that we can offer. There are several different causes of optic atrophy, and successful conventional treatment depends on working out what is causing the problem and trying to reduce its continuing effects. Chinese medicine would operate on the same general principle, but we would always advise patients to continue to seek conventional treatment alongside any treatment which we may be able to offer. The two different styles of treatment can work alongside each other perfectly well, and this is not a time to be trying to work out which is more effective.

A:  There is a surprising amount of research information for the acupuncture treatment of dry eye syndrome. The last time we reviewed this condition there seemed to be one or two studies, but two have been published recently, along with a review article.

 The two studies

 http://www.ncbi.nlm.nih.gov/pubmed/21138389

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/

 show very encouraging results, and the review

 http://www.ncbi.nlm.nih.gov/pubmed/21138389

concludes that acupuncture treatment is better than the use of artificial tears for the condition. Of course, this falls a long way short of the amount and quality of evidence which would enable us to give an unqualified recommendation, but it is nonetheless very encouraging.

 We have to remember, though, that from a Chinese medicine perspective a symptom seen in isolation from the system as a whole is not that informative. There are all sorts of functional disturbances from this perspective which might lead to this symptom, and the key concern is to try to remove its causes as much as to simply try to stop the symptom alone. Sometimes this will be enough, but more often if the underlying patterns of imbalance are not addressed it will ultimately return, and that does not do justice to what acupuncture may be able to offer. A skilled practitioner will be able to make sense of why this symptom has appeared in you as a unique individual, and will use all sorts of other information to get a sense of how the whole system is functioning.

 The best advice which we can give is to visit a local BAcC member for a brief face to face consultation. This will be far more informative than we can be at this range, and most of our colleagues are usually willing to give up some time without charge to assess whether acupuncture is the best treatment option. This also has the advantage of meeting the practitioner and seeing where they work before committing to treatment.

 

A:  We are always cautious about answering questions about conditions for which there has been little research evidence. The one summary of trials on the use of acupuncture for glaucoma really does not say very much

http://www.ncbi.nlm.nih.gov/pubmed/23728656

A part of the problem here, as the author of the review says, is that the standard method of testing procedures in the West, the randomised double blind control trial, involves one group getting a real treatment and the other group getting a sham treatment, to test the difference in outcome. No physician, however, would leave a condition like glaucoma untreated because of the potential for serious sight loss, so until someone tests the effects of standard treatment against standard treatment plus acupuncture there will be nothing definitive to point to.

All of us have treated people with glaucoma, either as a primary condition or as a secondary condition after a patient has presented with another problem, and I'm sure all of us can report some success. As the author of the review says, blockages in the flow of energy which prevent the free flow of fluids sums up what glaucoma is, and it would seem intuitively possible that acupuncture would have an effect. This expert's experience, though, has been that it takes a long time to achieve sustained and sustainable results, and the medications remain a part of the picture throughout. What acupuncture seems to do well is to prevent uncontrollable variations in pressure, but there is no statistical evidence to which we can point.

We have searched the internet and found surprisingly little patient feedback about the treatment of glaucoma with acupuncture. Most of the official charities and organisations do not have a great deal of feedback from patients on their websites, and we have not been able to trace many forums of sufferers. That these exist is not in doubt; the internet has created thousands of forums across the globe. The best that we can say is that if you search, you will find quite a few, and our experience is that they tend to be  a great deal more measured than used to be the case. Where it used to be 'it works, oh no it doesn't' the entries now tend to reflect the wider range of outcomes and views.

We do not ourselves 'bank' feedback on specific conditions, primarily because we take the generalist view that we treat the person as much as or more than we treat the condition. However, our best advice as always is to go to see a BAcC member local to you for a brief face to face assessment. This will enable someone to see your problem not simply as it is but against the backdrop of your overall health. This will enable them to offer a much better view of what might be possible and also enrich any basic understanding of how your problem may have arisen from a Chinese medicine perspective.  

On this basis we would always recommend that someone should visit a local BAcC member to seek a face to face assessment and also to try to understand the problem in its overall context in the body, not just as a specific manifestation. This is how Chinese medicine works, treating people not conditions.

What we would say, however, is that occasionally you come across websites for people treating eye conditions, especially two clinics in the USA and one clinic in India, which claim amazing success rates for these kinds of conditions. Our view is that if something was that effective we would all be doing it, so there may be something unique to the character of these set-ups which is driving such spectacular improvements. We tend to agree with the last answer; success can take a while, is always relative, and often reduces the impact of the condition more than totally removing it.

However, acupuncture will certainly not do any harm, and may well do some good.

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