Latest posts are at the bottom of this page.
Use the filter buttons above to help find answers - click on the boxes

Ask an expert - body

362 questions

As you might expect there is very little published research on the treatment of lichen planopilaris (LPP) with acupuncture. We are sure that there are many reasons for this, not least of which is that it is quite a rare condition and collecting enough cases for a study may prove difficult. There isn't even a great deal of published research on the commoner varieties of alopecia.

From a conventional medicine perspective treatment, usually heavily steroid led, is aimed at reducing or slowing down the spread of the condition by reducing the inflammatory responses which characterise its spread. We suspect that insofar as we use acupuncture to treat many forms of inflammation there may be some possibility of replicating or augmenting the effect of conventional treatment.

However, we are always keen to point out that the Chinese medicine perspective is a very different one from what most people think of as medicine. The idea of named conditions is not really at the heart of the system, and each patient is seen as a unique combination of energies whose patterns, rhythm and flow are the basis for understanding why symptoms appear. The blockages and changes of flow which create symptoms are sometimes local and directly related to the problem as it appears, but more often than not there are systemic problems which need to be addressed for local problems to have any chance of being properly removed.

The language of Chinese medicine is often quite literal, and will talk of Heat, Cold and Damp as factors within the system, so someone with an inflammatory response would be seen as manifesting Dry Heat or Damp Heat, and the treatment would be aimed at expelling this, and at the same time treating the system to ensure that it does not flare up again. This may all sound a little airy fairy but with 2500 years of history behind it Chinese medicine is a very sophisticated diagnostic and treatment tool.

We often find that with skin problems Chinese Herbal Medicine can be used to great effect, and BAcC members who are also members of the Register of Chinese Herbal Medicine may be the ones to approach for advice. Most RCHM members belong to the BAcC, so using their practitioner search function will almost certainly generate a hit near you. We always advise people to visit a practitioner for an informal chat because as is obvious from what we have said about individual treatment there really is no substitute for having a direct look at a problem. Most members are happy to give up a little time to prospective patients without charge to assess what the best treatment options may be.

We think, though, that you might have to accept that where hair has been lost the chances of regrowth are slim, and that the best treatment might be able to achieve would be a slowing down of the disease progress together with a lessening of some of the discomforts associated with it. 

We are sorry to hear that you are experiencing what sound like very unpleasant side-effects from a treatment.

We are not sure from your email what the provenance of your practitioner is. The technique you describe is called percutaneous posterior tibial nerve stimulation, about which you can read here:

https://www.nice.org.uk/guidance/ipg362/chapter/1-Guidance

It is not really an acupuncture technique as such, at least it certainly is not a part of the ancient traditional Chinese medicine which we all practise. It is a modern technique using needles as electrodes which, as is often the case in modern developments of acupuncture, is described as working 'by a mechanism which is not yet properly understood.' It may well be that a traditional acupuncturist has decided to add this to their repertoire, but it is not a part of our core training.

As far as your strange symptoms are concerned, in conventional medicine it might be possible to make a case for some of the local ones, i.e. pain or tingling in the immediate area of the electrodes, because there may have actually been irritation of the nerves or small bruises which have consolidated to generate the symptoms from which you suffer. However, there would be very little that western medicine could do to explain why that should be generating sensations in your left arm and in your head.

From a traditional acupuncture perspective it might just be possible that the stimulation has had an effect on the channels of energy, and there are certainly internal connections between hand, foot and head which might explain what is going on. However, the mystery here would be what was causing the connection to be made several days after the treatment. If there are after effects or adverse effects after treatment they are generally immediate and subside within the first 48 hours. It is rather unusual for something to kick in three or fours days after the event and then to generate something which we call propagated needle sensation at this stage. This kind of effect takes a great deal of work to generate, and it is difficult to see what could be replicating this so long after a session.

Of course, we do have to bear in mind that there are sometimes occasions when a new symptom arises after, but not because of, a treatment. With four million treatments a year this can always be a possibility. The first thing we always advise, and what applies especially in your case, is to seek medical advice to find out exactly what is happening. This may take a referral to a neurologist, but since it sounds like a neurological effect getting advice here may well establish causation, i.e. whether the treatment actually caused what it happening. In an event this will point the way towards making it go away.

It might also be worthwhile talking to the practitioner about what they have done. They will know better than anyone else what points and techniques they have used, and may be able to make sense of what has happened to you.

It may be comforting to be aware that very few serious adverse events take place each year, and where these do happen from acupuncture treatment it is usually from penetration of an organ or direct physical damage. The remainder tend to be short-lived and transient, and we are confident that if this is really an effect of treatment it will subside relatively quickly. 



We are not quite sure from your question whether you mean atrial flutter or atrial fibrillation. The difference between them is not substantial - in fibrillation the increased atrial beat is irregular whereas in flutter the increase tends to be regular - but the impact of both is much the same: faintness, tiredness, palpitations, shortness of breath and dizziness.

We have answered questions on atrial fibrillation before, a typical answer being:

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.

This represents probably the best that we can still say. There is no evidence of research into atrial flutter as such, and we suspect that for the purposes of the trials which have taken place the distinction has not been drawn.

What we did not say in our earlier reply is that most of our members are only too happy to give up a little time to prospective patients, usually without charge, to give them a better idea of what may be possible. Most conditions like this do not occur in isolation from a Chinese medicine perspective, and there are often other signs and symptoms which together make more sense of what is happening. From a Chinese medicine perspective each person is unique and different, and although a dozen patients share the same named condition there may be a dozen different ways of looking at it and treating it. Having a  word with a skilled and experienced practitioner might make more sense of what is going on and give a better idea of how treatable it may be.

We are sorry to hear of your problems. It must be disheartening to have a symptom for which no adequate explanation can be given.

We have been asked about reflux many times, and a typical answer has been:

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

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 heatburn are often accompanied by changes in 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.

This remains pretty good advice, even if we say so ourselves! Your description does tend to the fact that this is a physiological problem of the 'containment' structures not working, and that, as we have said, may limit what the possibilities are. However, traditional acupuncture is based on restoring functional integrity to the system, and that may have some impact on the way that the body controls the contents of the stomach. There are other imbalances besides Stomach imbalances which interfere with the steady downward progress of digested food, and a skilled practitioner might well recognise something like this straight away and be able to assess how treatment might well help.

There are also some new treatments which offer possibilities if the existing remedies fail to work. One of our patients has just had this device fitted:

http://www.toraxmedical.com/linx/

and his experience after fitting has been extremely positive after many years of suffering. There comes a point where long term reflux starts to cause serious damage to the oesophagus, and investment in these kinds of treatment are much more cost effective than managing the consequences of tissue damage in the longer term.

We hope, though, that you give acupuncture a try to see what it can achieve. This isn't a blank cheque, and it would be well to set a target of, say, five treatments to see what can be done. If there is no change then it may be sensible to explore other alternatives.

We suppose the underlying issue here is whether the mitral valve prolapse is actually connected to the symptoms which your son is experiencing. The ones which you report are not the standard problems noted in these cases, and if this is a separate and unrelated problem then it substantially changes the advice we can offer.

As far as the treatment of MVP itself is concerned there is no evidence that we can find that acupuncture treatment has been documented in helping to reduce the symptoms associated with MVP. There are several complementary medicine articles which point to the use of magnesium, which has been linked to the muscle weakness, but nothing which mentions treatment by acupuncture. Whether magnesium is effective as a supplement is beyond our scope for comment.

If, however, the symptoms are of a different problem related to a weakened immune system, i.e. not directly resulting from the MVP, then there may be some reason for cautious optimism. There have been a number of studies which have shown effective increases in immune response and immune system body chemistry as a consequence of treatment, and a greater number of studies of of successful treatment of some of the emotional disorders associated with a weakened immune response, anxiety being one of the primary ones. The research is far from conclusive, but suggestive of the fact that there may be a chance that change will happen.

The bottom line with complex presentations is that it really needs someone to take a look at the individual to see how the symptoms present against the backdrop of all aspects of the person's health. Not only does the traditional acupuncturist treat the individual rather than simply treat the condition, but the health of the individual can seriously affect the speed with which something can clear up, or indeed whether it can clear up. The best advice is to see a local practitioner for this kind of informal assessment before committing to treatment.

The one caution about treating anyone with MVP is that there is thought to be a known increase in risk of endocarditis if the skin is not cleaned before needles of any kind are inserted, and there is an absolute embargo on the use of any form of retained needle. This is occasionally disputed, as in this paper

https://www.ncbi.nlm.nih.gov/pubmed/14620303

but we always advise our members to treat people with heart valve problems as though they were immuno-compromised
Page 1 of 73

Post a question

If you have any questions about acupuncture, browse our archive or ask an expert.

Ask an expert

BAcC Factsheets

Research based factsheets have been prepared for over 60 conditions especially for this website

Browse the facts