Ask an expert - body - chest

47 questions

Q: I am 70 years male living in Manchester.  I am suffering lungs diseases - emphysema and bronchitis for  five years.  It is mild not severe. Please let me know whether  it can be treated with acupuncture.

A: We always choose our words very carefully when we answer questions like yours. The reason lies in the nature of traditional acupuncture and the fact that it treats the person, not the condition. From our perspective our work is aimed at getting the whole system to work as well as it can in the belief that when the underlying balance of the body's energies is as good as it can be this will help to remove or reduce the symptoms which people are experiencing.

 We always tread carefully, though, because when we are asked ' do we treat something?', when we say yes we mean that we treat the person with the something. However, people tend to hear the word 'cure' when someone says 'I treat X', and this can give false expectations about what may be possible.

 In your case, the emphysema and bronchiectasis are unlikely to be reversible, and treatment would be aimed at getting the system to work as well as it can do within these restrictions. We have treated many people over the years with similar levels of impairment, and it has always seemed to help to a degree, even if the change wasn't so much in the actual physical limitations but in the attitude which people had to their problems. It is not unusual for people with lung damage to feel anxious and a little negative, and changing this alone can make a difference.

We would always advise someone to visit a local BAcC member for a brief face to face consultation to see what might be possible. This is always more useful than advice given at a distance, and most of our colleagues would be happy to offer someone a short amount of time without charge to establish whether treatment was a good option.

We also wonder whether some form of limited exercise like tai chi or qi gong might be a useful addition to treatment. These are both exercise routines within Chinese medicine which help to improve the flow of energy, and we have known people to use them to very good effect to supplement the help they get from acupuncture treatment.

 

Q:  I am 71 years old man.At present I have two lungs problems, emphysema brochieatasis since five years. Before these problems I got tueberculosis which was cured with one year treatment with allopathic medicines..I want to know if my dieases are treatable with acupuncture.

A: We would have to be honest and say that although anything is treatable with traditional acupuncture, in the sense that we aim to restore balance to the body's energies and maximise the performance of the whole system, the more precise use of the word 'treat' meaning have a confident expectation of positive results would not apply. The combination of the TB and the bronchiectasis have probably permanently affected your ability to gather the oxygen you need, and we have never seen any studies which suggest that using acupuncture treatment could improve this exchange or reverse any physical deterioration which has taken place.

Obviously if you search the internet you may well find case studies where someone will claim that they have used acupuncture to great effect, but in general these are usually in cases where the problem is relatively fresh and has not caused too much permanent damage.

That said, one of the consequences of a part of the system being affected is that the imbalances ripple through the whole system, and people can often feel very much under the weather in areas where the problem does not directly sit. Because we believe that body mind and spirit are all interconnected physical problems can often lead to mental or emotional issues like anxiety or worry, and we do often treat people with problems which aren't going to get better to great effect. Many of us have helped to improve the quality of life for people with Parkinsons or MS, and from that perspective it may well be worth considering treatment.

What we invariably recommend is that you visit a practitioner for an informal assessment of what may be possible. The chances of an improvement in what has been lost are very small, so if anyone makes large claims for what they can do you should be careful. A responsible practitioner will always give you an honest answer so that you can make a properly informed choice about how to proceed.

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. 

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.

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