Ask an expert - body - abdomen / gastro intestinal

34 questions

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.

Q: I would like to know the effectiveness of acupuncture in the treatment of body dysmorphia and is there a possibility to achieve a cure in the lomg run.

A:  We were once asked about using acupuncture for treating anorexia, one of the more commonly experienced types of body dysmorphia, and a part of our responses was:

Chinese medicine has an entirely different conceptual framework from conventional medicine, and is based on an wide and intricate understanding of the workings of body, mind and spirit as a flow of energy, called 'qi' (pronounced ‘chee’). This flow can become blocked, stuck, weakened or excessive in response to the circumstances of life, and when this happens symptoms develop. From this background there is the potential that Chinese medicine might provide treatment options, but we have to say that our experience is that body dysmorphia which is the root of the problem is rarely addressed directly by acupuncture and it usually requires considerable counselling and careful management to encourage someone back to full health. There is no doubt that acupuncture can help along the way; especially by aiding the restoration of natural function and calming the spirit. Acupuncture should not be seen as a primary treatment for anorexia but it can be an effective complementary therapy. However, each case is unique and it is always possible to visit a BAcC member local to you to get the benefit of face to face advice.

This is probably the best that one can say. You will read a considerable amount of accounts of traditional acupuncture treating body, mind and spirit, and traditional acupuncture treating the whole person, and this can sometimes slide into an unwitting creation of an expectation that acupuncture can treat anything. This is, of course,. technically true; acupuncture treats the individual and therefore helps with anything from which they suffer. Treat is ambiguous, however. Most people hear 'cure' when they hear 'treat', and as we said in the earlier answer we believe that body dysmorphia probably requires a great deal more than acupuncture alone to address properly. 

That said, it would do no harm to visit a local BAcC member and have an informal chat about what may be possible. There are some cases where the condition can be tracked back to specific causes, like low self-esteem or low confidence, which taken together with the other diagnostic soundings might offer a possible benefit. As a general comment, though, we think that what we said previously is the best advice that we can give.

 

A: It may sound rather odd to someone brought up within western medicine but there are very few areas of specialism within traditional acupuncture where we would recognised specific skills which someone could learn as a postgraduate option enabling them to claim to be an expert. There are three areas where the specific patient group - children, women in pregnancy and with fertility issues, and people with mental health problems - where we are looking carefully at what defines expert practice. We may eventually decide that working with these groups as a primary focus of treatment does mean that our members can claim to be offering expert practice, but for all other conditions we would regard them as being within the range of skills of all of our members.

This is essentially because Chinese medicine treats the person, not the condition. This viewpoint is not unique to Chinese medicine; the great Canadian physicial William Osler once famously said 'The good physician treats the disease; the great physician treats the patient who has the disease.' Indeed, in ancient China the specialist physician was regarded as an inferior doctor because of his limitations, and the generalist was held in high esteem.  Times change! It does mean that seeing the problem in its overall context is the best form of treatment, not simply applying a formula treatment for the disease label. This is why twenty people with the same western named condition might be treated in twenty different ways, depending on how the condition sat within their overall health picture.

Only for a few serious conditions, such as terminal illnesses or serious degenerative conditions like MND, do we occasionally make recommendations that a prospective patient see someone with greater experience, but that is only because we recognise that it can be overwhelming for a newly qualified practitioner to be dealing with a case which is not going to have a truly positive outcome. Getting worse slower is not the greatest encouragement to the newly qualified.

As far as UC is concerned, if you google the medical databases by using 'ncbi acupuncture ulcerative colitis' you will see a number of studies, mainly from  China, which show encouraging results. However, these are often treated with caution in the West because there are often methodological issues. These are not necessarily defects; the Chinese do not have the western obsession with showing whether it works or not  but rather more focus on the question of what works better. This often undermines its value in western medical eyes. The Chinese have been treating UC and its variants for over 2000 years, though, and its patterns  as understood in Chinese thought are well defined and studied.

The best advice, which we tend to give to all enquirers, is to visit a BAcC member local to you for a brief face to face assessment. This will give a far better idea of what you may be able to expect by way of benefits. Most members  are happy to do this without charge.

Q:  My daughter (aged 20) has been diagnosed with cyclical vomiting syndrome. She has had 8 episodes in 2 years and has been admitted to hospital 3 times for stays of over 1 week each time to try to stop  the vomiting and rehydrate her. The doctors cannot find any cause for this and we are just experimenting with different medications when an episode begins. I had acupuncture during my pregnancy for severe morning sickness and wondered if it might help my daughter. Can you offer any advice? 

A:  As a rather broad generalisation the use of acupuncture for stopping nausea and vomiting is well documented and researched. Our newly updated fact sheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html

provides a wealth of evidence of the various manifestations of nausea and vomiting and its treatment. As you can see from the detail the research evidence on the treatment of morning sickness is not as positive as the post operative nausea treatment, but our clinical experience is that more often than not we can reduce the severity of the episodes even if they persist. The only caution, as your daughter knows all too well, is that someone can become severely dehydrated very quickly, and we always advise colleagues not to let the patient's current conventional treatment schedules lapse while they follow someone's urge to find an alternative solution.

Of course, the major concern that we have is that the research protocols often run completely counter to the way we actually work in treating people rather than named conditions. The formula treatment often applied, while it may work well with a number of patients, will be nowhere near as good as treatment which sets this symptom in its overall context. This can often generate better results, but can also reveal underlying issues which might make a rapid fix of the problem unlikely. An honest practitioner will let you know this rather than let you pin your faith on studies which may not apply, and we trust out colleagues to work in this way.

The best advice, advice which we tend to give routinely, is for your daughter to visit a BAcC member local to her for a brief chat and informal face to face assessment of what may be possible. Most members are happy to give up some time without charge for a prospective patient to discuss what is happening, and this also gives the patient a chance to meet the practitioner and see where they work. In my personal experience, this is a very sensible and reassuring way to work, and patients appreciate the fact that they are not being railroaded into treatment about which they are uncertain.

I hope that acupuncture treatment is able to help your daughter with what I know to be a very debilitating problem.

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