Ask an expert - body - abdomen / gastro intestinal

37 questions

Our factsheet on nausea and vomiting

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html
talks a great deal about the evidence for acupuncture treatment helping with this distressing side effect of chemotherapy. This quotes a study by Ezzo which is now over a decade old but which points clearly to a level of efficacy. It is in the form of a systematic review, a consolidated account of all available trials of suitable quality, and very much loved by research statisticians for giving a far clearer idea than single trials of whether something really works.We always undertake a review of literature and studies which may have been published more recently and have found several overviews for the use of acupuncture treatment with cancer treatment as a whole. One rather useful one ishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577953/which looks at all aspects of the management of cancer and its treatment. It's a little technical, as many of these studies are, but not beyond most people to be able to find some useful material. This studyhttps://www.ncbi.nlm.nih.gov/pubmed/24815460also provides useful background.The key thing we have to be clear about with all cancer patients is the limit within which we work. As you have no doubt read we always claim to treat people, not diseases, but if we are not careful this is extended to 'treating people with diseases' and then truncated to 'treating diseases'. When someone has cancer this is a message they would like to hear, but there is no evidence that acupuncture treatment can treat cancer per se. Where it can be really effective is in reducing the side effects of the conventional treatments for cancer which are often debilitating and distressing. We also believe that treating the person, not simply the problem which they have, also mobilises the body's own healing responses to address many aspects of the strain under which conventional treatment places the body and the mind.The best advice we can give is that you visit a local BAcC to discuss with them what may be possible for you. Most are willing to give up a little time to prospective patients without charge to see at first hand what they might be able to offer. This also gives you a chance to meet them and see where they work before committing to treatment.

It is often difficult to answer questions like yours because there are so many variations on this particular theme. This happens not least because the term IBS has become so elastic that it covers nearly every digestive problem from one end of the digestive tract to the other.

The first thing to say is that if you are experiencing or have experienced any episodes of diarrhoea then we are assuming, and hoping, that your GP is fully aware of this. The management of chronic diarrhoea involves ensuring that a person remains adequately hydrated and also does not develop deficiencies in some of the vital trace elements which are re-absorbed in the lower gut. We are not suggesting that you should be taking preparations like diarolyte, but we think that your doctor should be making suggestions about what it is best to do, along with organising investigations like stool tests and endoscopy to ensure that there is nothing more serious going on.

The second thing we would do, if you were a patient, would be to have one of those discussions which we enjoy (!) about what you are actually describing. Chinese medicine works from an entirely different theoretical basis from conventional medicine, with a complex understanding of the energies of the body. The term 'diarrhoea' is used to cover a wide range of presentations, and the treatment for all in conventional medicine is often the same. From a Chinese medicine perspective there are some crucial variations, which is why we need to establish exactly what is happening. There is a considerable difference between, say, the kind of explosive and often unpleasant bowel movement which often feels like heat leaving the body and the less well-formed stool that needs to be passed urgently and quickly. These point to entirely different pathologies in the system, and that would mean very different kinds of treatment.

The research evidence for the treatment of IBS is not great, as our factsheet shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/irritable-bowel-syndrome-ibs.html

but this has a great deal to do with the difficulty of assembling test and control groups with identical presentations and causes of problem. Our clinical practice involves treating many people with IBS, often as a part of a wider pattern of problems, and we usually feel confident about being able to make some progress. The question for us is often how much and how sustainable, rather than does it work, and oddly for a therapy about encouraging movement and flow we are often more able to bring loose movements under control than to deal with constipation which often forms part of a wider pattern of 'stuckness.'

IBS often sits as a part of a wider pattern of imbalance, and the strength of Chinese medicine is that in treating the person, not simply the named condition, it aims to remove underlying causes as much as addressing the symptoms alone.

The best advice that we can give is that you visit a local BAcC member for an informal chat about whether acupuncture may be appropriate for you. Most of our colleagues are willing to do this without charge so that they can give an informed view before a patient commits to treatment.

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.

Q: I've been receiving acupuncture for 15 months for digestive disorders, bloating, sluggish bowels, hemorrhoids, twisted fascia to the pelvic floor and atrial fibrillation related to the stomach. Symptoms mildly get better but return even worse within a week or sometime after treatment. Why? What do I do?

A: There is a behavourial therapy called NLP of which a a favourite premise is that "If you always do what you always did, you'll always get what you always got, so if something you're doing isn't working, do something different." On that basis it would be very tempting to say that you perhaps should change the therapy or the therapist, and sometimes there is a simple truth in this.

However, we have come across many situations where the practitioner is actually doing a good job even though the symptoms remain largely unchanged. Patients can sometimes be held in a pattern which might become far worse if not treated, and we still have a fond memory of an old patient whose lack of progress was depressing us until he said 'do you know, I think I'm getting worse slower.'

That said, bloating and sluggish bowels make for a very uncomfortable life, and we suspect that alongside your acupuncture treatment you may need to be doing something more focused on your nutrition to see the benefits of both treatment. Most of us have a rudimentary knowledge of the kinds of food which a patient should avoid given their state of balance, and in many cases the advice we give does score some good results. Sometimes, however, the advice needs to be more precise, and there are many practitioners who take this Chinese nutritional training at a much higher level, almost akin to herbal medicine. In fact, many digestive disorders, which prove intractable to acupuncture alone, are greatly benefited by Chinese herbal medicine. Most of the members of the RCHM (Register of Chinese Herbal Medicine) are also BAcC members, but you may find that going to a Chinese Herbal Medicine practitioner alongside your acupuncture practitioner might work a treat, especially if your rapport with your current practitioner is one you don't want to lose.

Before taking this step, though, it might well be worth reviewing your diet with your existing practitioner.  There are four or five 'headline' syndromes which describe bloating and sluggishness, and it should be immediately apparent what would be good for you to avoid. Timing of eating is also critical. There is an old English saying 'breakfast like a king, lunch like a lord and dine like a pauper', and we have seen some patients make dramatic improvements simply by moving towards this pattern. There are also certain food types which are just not good for some people. We had a patient whose digestive disorders alone refused to change even though everything else improved. Once he cut out lactose, though, his symptoms almost vanished.

The fact that things don't change may well mean that the treatment is not powerful enough to break the pattern of your digestion, and that something you are eating is having a more potent effect on the system. We suspect that your best move would be to have a kind of 'case conference' with your practitioner and agree a plan to move your case forward, either by adding some other dietary changes or by adding another tier of dietary change to accompany your treatment. We certainly hope this gets you going in a more positive direction.

Q:  We are not quite sure what the best advice we can give is. 'Twisted bowel' used in a medical context is a serious problem, and unless there have been extensive investigations which show that the extent of the twisting is not serious, then in most cases surgery would be very likely. The risks of loss of blood supply in or around the bowel are very considerable, and can lead to life threatening infection.

 

We suspect that you are using the term in a more informal way which people often employ when they have irritable bowel syndrome and have visited a number of complementary therapists who use the term in a slightly more loose way. As far as treatment of IBS is concerned, the evidence for the successful use of acupuncture was dismissed as inconclusive many years ago, but the last decade has seen a number of very encouraging studies as our factsheet

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/irritable-bowel-syndrome-ibs.html

 

demonstrates. These all point to an enhancement of the bowel function and positive changes in gut motility which may have an impact on what is being described as twisted bowel.

 

There is always a danger of getting too involved with the technicalities of western named conditions and forgetting that in traditional Chinese medicine the main thrust of diagnosis and treatment was and remains setting the whole system in order in the simple but effective belief that a system in balance corrects itself. Although primarily concerned with function rather than structure there is no doubt that in many cases restoring what we consider to be good function can lead to a major improvement in structure, most obviously seen in treating lower back pain. If a system is in balance, then in theory it should regain its natural shape.

 

However, we would need a great deal more detail before being able to offer a guess at a prognosis, and your best option is to visit a BAcC member local to you for a brief face to face assessment of what is going on and what benefit acupuncture treatment may bring. Most BAcC members are happy to give up a little time without charge to discuss whether acupuncture is a sensible treatment option, and this also has the benefit of you being able to meet them and see where they work before committing to treatment.

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