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378 questions

Q. Is there any evidence that acupuncture can help with urology problems ie enlarged prostrate.. P s a 7.5 blood reading,am on wait and see for next 6 months advised.

A. There isn't a great deal of research evidence for the treatment of prostate problems, which we find rather surprising given that it is one of the more frequently occurring problems and more recently the most prevalent cancer in men.

There was a systematic review published exactly a year ago

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380320/

which made encouraging noises but as usual said that more and better research was needed. Systematic reviews are the top of the pile in research terms. Because they accumulate the results of several trials they tend to iron our anomalies, and so random excessively good and bad results get evened out. If there is a general report of good results that is good news.

Of course, prostate problems are not a modern invention! That said, there is much about the modern lifestyle which predisposes men to issues in this area. The issues which men have in terms of discomfort, problems with passing water and occasional blood in the water have affected men since time began, and the diagnostic systems of Chinese medicine have ways of looking at the symptoms which are the same whatever the system of medicine in use and placing them within a framework which interprets them as blockages and changes in the flow of energy.

The great strength of Chinese medicine is that if places these disturbances in the context of the overall pattern of energy. This causes what many western physicians find problematic, the same disease being treated in as many different ways as there are patients. This means that the symptoms are seen as alarm bells that the whole system is out of balance, and rather than simply treat what appears to be wrong, Chinese medicine tries to address the underlying causes.

This means that in practice we find it quite difficult to say 'yes it will ' or 'no it won't' without seeing the patient in whom the condition manifests. We are not alone in this; the great Canadian physician William Osler often said 'The good physician treats the disease; the great physician treats the patient who has the disease'. This is, we believe, the way to achieve lasting change.

The best advice we can give, then, is that you visit a BAcC member local to you and see if they can offer you a brief chat about whether they think that acupuncture treatment would be beneficial for you. Most are happy to give up a little time without charge to prospective patients, and it means that someone can make a properly informed choice about what to do.

 

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.  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.

 

Your question raises a number of important considerations about the use of acupuncture. We assume that you are referring to this 2012 study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/

which concludes that the use of Neiguan (PC-6) has a very positive effect in reducing AF episodes.

We addressed some of these issues in a reply at around the time when the study was first published:

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 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.

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.

We are sure that if you do want to pursue a specific approach like using the same point over and over again there are many practitioners of western medical acupuncture who would be happy to oblige. A full list can be found at the website of the British Medical Acupuncture Society, with whom, it has to be said, we have very cordial dealings. However, it seems to us that if you haven't had an episode for three months on the back of four or five traditional acupuncture sessions it might well be worth carrying on with the existing treatment plan and only considering the more formulaic approach if the traditional approach ceases to work as well.

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 bias. 

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