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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.

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

Q: Hi. I suffer from ventricular ectopics,I have seen Drs regularly and take beta blockers which work to a degree. I have periods when things aren't too bad and periods when things are really bad,I do get quite down during these times. Do you think acupuncture would help?

A: We have been asked similar questions before, and in reply to one we said:

One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The irregular pulse has clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

http://www.ncbi.nlm.nih.gov/pubmed/18992625

Some of the published research also involves animal experiments, sometimes called 'ratpuncture' in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what the conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.


There have been a couple of other systematic reviews

https://www.ncbi.nlm.nih.gov/pubmed/28432528

http://www.internationaljournalofcardiology.com/article/S0167-5273(11)00227-0/fulltext

which make largely positive noises, but as in all of these kinds of studies the treatment which is given is largely formulaic, and does not really represent what a traditional acupuncturist does, which is to gear treatment to the individual and his/her unique balance of energies. Where trials offer designs which allow the practitioner to do what they might normally do, so called 'black box' trials, the results tend to get better and better.

The bottom line, though, is that from a Chinese medicine perspective there are often functional disturbances which can generate symptoms, often far away from the source of the manifesting problem. The skill and art of the practitioner is to make sense of the diagnostic information and treat the root of the problem. This can often cause a symptom to reduce or even disappear without there having been any apparent connection between where the needles were placed and the part of the body in distress.

The advice we gave before still holds good, to visit a local BAcC member for advice and a short face to face assessment of what may be happening. Most BAcC members are only too happy to give a small amount of time without charge to prospective patients to enable them to assess whether acupuncture is the best treatment for their problem. This will obviously give a far better idea of what may be possible than what we can say at a distance.

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