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Q. I want to ask if any member has experience treating gastritis and silent reflux

A. We are often asked about acid reflux, although it is usually the version defined as GERD rather than silent reflux, but as a long answer (in italics below) earlier this year demonstrates, from a Chinese medicine perspective this is not always a meaningful distinction:

There is surprisingly little research on the use of acupuncture for the treatment of acid reflux even though it is a very common presenting condition in our clinics. There are one or two studies like this
http://www.ncbi.nlm.nih.gov/pubmed/20697939

and

http://www.ncbi.nlm.nih.gov/pubmed/17875198

and occasional articles like this one

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080874/

which suggest other possibilities for the appearance of heartburn symptoms, but not the solid body of evidence one might expect based on the usually quite effective treatment of this problem.

Obviously there are physical problems such as hiatus hernia where there has been a physical change in structure of the oesophageal tract which can cause heartburn. If this is the case, then it will seriously limit the possibilities for treatment in any system of medicine. If investigations show that this is not the case, however, then there may be some value in using acupuncture treatment.

From a Chinese medicine perspective the classic presentation of reflux or heartburn is described as Stomach Fire or Rebellious Stomach Qi where the energy of the Stomach does not follow its normal pattern of causing food to descend but lets it stay in the Stomach or reverse its flow to create the classic symptoms with which people suffer. Knowing the immediate precipitating cause, however, does not mean that one goes straight to this for treatment. The flow of energy in the body, called 'qi' in Chinese, is a complex interweaving of channels connecting Organs whose functions are also inter-related. The art and skill of the practitioner lies in determining what the primary underlying imbalances are, in the belief that treating here will cause the symptom to go and stay gone rather than be treated simply as a symptom.

This is one of the primary differences between Chinese and conventional medicine. From the Chinese medicine perspective the symptom is an alarm bell telling the practitioner that the system is out of balance. Thus twenty patients with the same symptom could have twenty different underlying causes and therefore twenty different treatments, in contrast to the standard western procedures which have two or three main strategies for a problem. In Chinese medicine the balance of the system is unique in every patient, and this means that each treatment plan is also unique.

It follows that this does limit what we can say about individual cases and why we invariably advise people to visit a local BAcC member for an informal assessment of what is going on and whether treatment would be of benefit. Most practitioners can get an idea in a very short time of what is going on and as a consequence give a good informed view of what might be possible. This would invariably take into account other changes in the way that everything functions which are perhaps not significant enough to concern anyone but from our perspective enrich the picture which we have. Reflux and heartburn are often accompanied by changes in digestion and bowel habit, and secondary information can refine the diagnosis a great deal. A practitioner can take all sorts of other factors into account, including mental and emotional ones, to offer you a much more precise assessment of what may be possible.

We have to say that this still probably represents the best advice for a prospective patient, to visit a practitioner and let them see bow the symptom manifests exactly in you.

To the extent that a component of the problem may be an excess of acid in the stomach the advice and explanation above hold good. However, in many cases of LPR. however, there is a general failure of all of the mechanisms which prevent stomach acids reaching the throat, and in cases like this reducing the acidity of the stomach may only have limited value. However, we have to believe that if treatment can help with GERD, which it often appears to do, then in principle there is no reason why it should not help LPR. Certainly one of the common experiences of LPR, the lump in the throat, is a recognised symptom within Chinese medicine where is it called 'plum pit throat - the feeling of having a plum stone stuck in the throat- and for which several clearly defined strategies exist.

As in the earlier answer we would advise that you discuss this with a local practitioner face to face. This will give you a much clearer answer than we can manage here, and also give you a chance to meet them and see where they work before committing to treatment

As to whether there are practitioners who have treated this the answer is all of us. It seems to be a common manifestation of the stresses of modern life and the strain it puts on the parts of the system which affect orderly digestion, and the proliferation of over the counter indigestion preparations is evidence of this. Even where people come in with other main complaints entirely it is very common for them to say that they are getting heartburn or indigestion on a regular basis. The immediate presenting cause is often quite obvious, but as we said in the answer above, symptoms are often alarm bells, not the problem itself, and the skill of the practitioner lies not in turning off the warning sound for a while but making it stay gone.

Q. i'm trying to find help with my (central post-stroke pain syndrome) I've had for 28 years after a stroke hemorrhage in 1990.
i have tried everything from oramorph , Trans cranial magnetic stimulation, deep brain stimulation, spinal cord stimulation HF10 and other interventions all with no benefit so would acupuncture help?

A. We have to be honest and say that if all of the other therapies you have tried over the last 28 years have failed to effect a change it would be a very considerable surprise if acupuncture treatment suddenly proved to be the answer. However, we are not entirely sure what the CVA has caused by way of continuing symptoms under the generic title of CPSP, and there are aspects of post stroke treatment where the blockages which arise at the time of the event will stay blocked until someone clears them. We do occasionally hear of people having dramatic changes twenty or thirty years after a problem began but this is quite a rare event, and we would never use examples like that as the basis for a recommendation.

We have gathered a considerable amount of information about the treatment of strokes in a rather dense review paper which can be found here

https://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html
but the short answer to questions about efficacy is that in China acupuncture treatment, when used, commences almost immediately before the system has become 'fixed' in a state of disrepair, and the evidence suggests that this maximises the chances of regaining residual function quickly. The longer people wait for acupuncture treatment, the less well it seems to work and the less overall effect it seems to have.

Pain management is something for which acupuncture has developed something of a reputation since Nixon's visit to China in the 1970s and the sight of people having operations under acupuncture anaethesia. This led to a proliferation of trials and because neurotransmitter levels are easily measured a great deal of good evidence about the use of acupuncture to stimulate their release. Many Pain Management clinics base their work on this. The central question is how much relief and how sustainable, and it may be a matter of weighing up the cost and inconvenience against the amount of relief treatment can offer, it indeed it does work a little.

The best advice that we can give is that you visit a local BAcC member to seek their view in a brief face to face assessment of what may be possible, depending in the exact presentation it is that you need help with. We also think that cranial osteopathy might be another pathway which might offer some potential for change, but we don't have a central referral point to which we can direct you. Many osteopaths use cranial techniques, but some spend a great deal of time on this work and are often the local 'go to' people for difficult cases. we would hope that any you might contact direct you to the most experienced, just as we imagine that our members might have a local 'hero' to whom they send the more challenging cases.

Q. I suffer from sciatica and had my first acupuncture treatment 5 days ago. I had my second treatment 2 days ago. For the past 3 nights, I have been running a temperature of 101. I only have fever @ night. I am afebrile during the day. Could this be from the acupuncture? I asked my acupuncturist but her English is very difficult to understand and I felt like she brushed me off. She basically told me that I may have an infection. If I had an infection, I would be febrile all the time. Please advise. Thank you!

A. We think that it is highly unlikely that you have an infection from the acupuncture treatment itself. We keep very detailed records about what are called adverse events after treatment, and also look at world-wide databases in case patterns emerge to which we ought to alert members. Infections are very rare in the West, although in countries with primitive conditions they do happen, and when they do happen it usually arises from malpractice. These sorts of problems always tend to be local if they occur at all, i.e. something unpleasant at the needle site which spreads.

There are one or two possibilities within Chinese medicine itself. Although we treat specific problems, we always look at them in their overall context because they often arise on top of systemic weaknesses. Our job is not to turn off the alarm but to find the cause of the fire, so there are times when we treat systemically and it can cause a re-balancing of the system as a whole. This might, in some circumstances, cause the release of internal heat, and there are one or two syndromes where the body may become warmer at night.

101 degrees is much more likely to indicate an infection unrelated to treatment, and this is not entirely unexpected. There are over 4 million treatments administered every year in the UK and there are bound to be times when someone gets ill at the same time as their treatment and wonders whether they have been made ill by the treatment. In these cases we always advise people to see their doctors, because if it is a separate phenomenon it makes no sense to be arguing about what caused it and every sense to get it sorted. This invariably reveals the cause.

This always sounds defensive but isn't we have decades of experience and we are very aware of what can happen from acupuncture treatments. With the safety standards in place in the West infections from treatment are very rare.

We are sorry that your practitioner's English was not able to help you. We do find that some practitioners who have English as a second language often sound like they are giving someone the brush off but this is more often to do with making what they believe to be a statement of fact without the usual sugar coating that we tend to apply. So you'll more than likely get the answer 'no' with no embellishment, which is often not reassuring. Information dispels fear!

We hope that by the time you read this the temperature has normalised, but in any event we would recommend that you talk to your local surgery and seek advice about whether to drop in so the doctor can take a quick look at what is going on. 

Q.  Is accuputure any good for sinus problems?

A. For such a common problem it is surprising how infrequently we are asked about whether acupuncture can help. An answer which we have given and which still seems current was:

As our factsheet shows


http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sinusitis.html

the evidence from the few trials there have been of sinus problems have not been that encouraging. This reflects the clinical experience of many practitioners, that sinus problems can be intractable and defy all attempts to relieve them. It would be good to be able to conclude that surgical options like rhinoplasty and sinus washes were the best alternative, but many acupuncture patients who come to treatment with sinus problems find that surgery has only offered temporary relief.

A great deal depends on the wider backdrop of your health against which the problems can be seen. Chinese medicine looks at the whole picture of someone's health, and it would be unusual for someone to be troubled by a single, quite unpleasant problem without their being other health issues, even if these are not particularly troublesome in themselves. It is this whole complex picture which can give the practitioner a better idea of what is happening and by the same logic a better idea of how difficult or how straightforward it will be to treat a problem. The best advice is to visit a BAcC member local to you so that they can offer a better assessment based on a face to face chat.

What we often find, however, is that there is often a lifestyle factor such as diet which is at least contributory to the problem. Many people eat a great deal of dairy produce in the form of milk or cheese, and this can often have aa significant effect on the body's fluids, from a Chinese medicine perspective making them more thick and less free-flowing. Cutting out some of these foods can often have a profound effect. A practitioner would very quickly be able to assess whether this was the case, and also consider other common contributory factors.
We think that this still remains pretty good advice. Each person is unique and different from a Chinese medicine perspective, and there are occasions when it becomes clear very quickly that the sinus problems have an obvious cause which is responsive to treatment. More often, though, people usually come to acupuncture treatment when the problem has existed for some time, and by this stage it has actually become a more fixed problem in itself, whatever the original cause. Your best bet is, as we said in the earlier response, to visit a BAcC member local to you for a more informed assessment based on seeing what is actually going on.

We have checked the databases again, and there is nothing new of interest. However, this is not entirely surprising; sinus problems are usually multifactorial, i.e. involving a number of separate causes, and it is quite difficult to design trials which can compare like with like.

The advice which we pretty much always give in these situations is to visit a local BAcC member for a quick chat about what might be possible. Five minutes face to face is often enough to make an assessment on the run about whether someone has factors which point to the potential benefit of acupuncture treatment, and most members are quite happy to give up a few minutes without charge to help prospective patients to make an informed choice.

We have been asked about the treatment of atrial fibrillation on a number of occasions, and a typical answer has been:

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 prospective patient is to contact a local practitioner to seek a short face to face consultation at which they can be given a better assessment of whether acupuncture might benefit them.
From the traditional acupuncture perspective using a single point in this way based on a single research study is quite a distance from the traditional paradigm in which the point sits. We are aware that there is a movement even within Chinese medicine to start to use this sort of formula treatment, and a very widely read paper published nearly twenty years ago, 'Pearls and String in Classical Acupuncture' has influenced a number of practitioners in the West, and is becoming slightly more common practice in China itself under the title 'best of both' - western differentiation and acupoint treatment.
Our view is that this is rather like Orwell's 'two legs good, four legs better' insofar as formula treatment may well work well for many people but probably won't work as well as a treatment which is designed for the specific imbalances of each patient. Since all patients are unique and different it would be seen as poor practice from a traditional perspective to use the same points over and over again. One of our old teachers used to refer to the use of the point as 'asking the system a question' and paying heed to the answer in following up. 'You wouldn't ask someone the same question ten times, would you?, he argued. While this may be a little extreme the general sense that acupuncture treatment is dynamic and evolutionary is critical to its nature.
It is a rather interesting footnote to this discussion that in Chinese medicine the specialist was usually looked down on as an inferior practitioner because of the narrow range of what they could treat whereas the generalist was held in great esteem precisely because they could treat anyone in whatever was the most appropriate manner.
There are a great many studies of this kind across the entire range of named conditions, and the main reason why they generate conclusions like this is because the 'gold standard' of research in the West, the randomised double blind control trial, demands that there are as few variables as possible. This means that trials and studies regularly have to use a single point or point combination to meet the research criteria. We have argued for years that this is an inappropriate way to test a dynamic system, but in Western medicine 'evidence based' is the new hallmark of acceptability. This is a cause of much concern for the very many conventional modalities which don't fit easily into trials intended for testing pharmaceuticals where neither patient nor practitioner knows what is being offered/prescribed as a guarantee of eliminating unconscious

We must have been in a long-winded mood that day! we have undertaken a sweep of the databases to see what other evidence there may be, and there is nothing new to report.

Your question, though, says 'recurrence' and this may indicate that it is something from which you used to suffer and no longer do, but worry that it might recur. This always poses problems for a health professional because it can often be impossible to prove an absence. we have this problem with people on medications for things like asthma and epilepsy where they have had no attack for years and feel that treatment has made it unlikely to happen again, but conventional medicine would rather see this as a success for the continuing treatment and keep people on lifetime treatment.

What we can say is that traditional chinese medicine was always predicated on keeping people well, not getting then better. This was seen as a failure by the doctor to do their job well, and so the aim of the system was entirely preventative. We see many patients on this basis, people who are well or who have had problems which are in abeyance, and who want to stay that way. It is always hard to show how successful this is but we take what evidence we can get. Recently one of my patients who has been coming to treatment for 25 years went to a college reunion and found that he was the only one of the group not taking some form of regular medication. Possibly random chance but he is convinced that the treatment has left him better able to handle contingent illnesses and more balanced to ward them off in the first place.

As we said above, though, each person is unique and different, and your best bet will always be to talk to a practitioner about what they think may be possible for your individual presentation.

 

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