Ask an expert - body - chest

43 questions

A:  Oddly enough it is quite a while since we have been asked about the treatment of AF, and the last 'long' answer we gave was:

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.

 



Q:  Can acupuncture help with kidney disease (Microscopic Polyangiitis)? One of the effects of my kidney disease, or my medication, is high blood pressure - generally about 155/90, target is 130/85 - can acupuncture help with this even if it cannot address the underlying kidney disease?

A:  The condition from which you are suffering is quite rare, as you probably know already, and with the development of of drugs like rituximab used alongside corticosteroids there is now a reasonably good chance of inducing remission and with that normal life expectancy.

From what we know about the condition itself hypertension does not seem to be a common aspect of the presenting problems, so it may well be the drugs which you are receiving which are the primary cause. a BP of 155/90 is not catastrophic, depending on your age, and most doctors will only just be starting to consider medication for the problem. There is a growing body of evidence, as our factsheet shows

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

for the successful use of acupuncture to bring high blood pressure under control, but a great deal depends on the precipitating cause. If there is a specific reason, like a medication routine, then to some extent one needs to be careful not to try to reverse the effects in an attempt to reverse the side effects.

However, when we are looking at the use of acupuncture for named conditions like yours it is a bit 'apples and oranges', i.e. we are working from an entirely different paradigm which understands the body as a system of energy. From a Chinese medicine perspective, the overall picture, from symptoms and signs through to the effects of medication, are factors which we would take into account for treating a patient. If the hypertension has arisen through malfunctioning elsewhere in the system or from the use of medication impacting on the Organs which process them, then we would expect to be able to make some difference. The main question would be how much difference and how sustainable any change was; there are many conditions which respond for a while and then revert, so we are always careful to assess long term benefits in this context.

When the words 'auto-immune' disease appear in a presentation most practitioners find their attention drawn to the problem. The sense of a system turning against itself can sometimes be addressed within the protocols and understanding of Chinese medicine, and as practitioners of the last resort we often have successes where conventional treatment has failed.

However, each case is unique and different, and the best advice we can give is to visit a practitioner near where you live for a brief face to face assessment of what might be possible. With more direct and indirect information at their disposal they will probably be able to give you a better assessment of what may be possible than we can at a distance.

Q:  In February 2014 I had a bad cold/flu/fever which lasted a few months. Later my white cell count was low for almost nine months then corrected. Since February 2014,  I have been unable to cough up phlegm from my lungs. Before I was able to cough up phlegm easily. Now when I lie down I can hear phlegm in my lungs and it sounds as though I'm on 60 cigarettes a day (I don't smoke). Could acupuncture help me to expectorate the phlegm sitting in my lungs?

A:  Your problem sounds quite unusual and we imagine a little unpleasant for you. If we were looking at a problem such as yours in clinic we would say that as far as Chinese medicine was concerned there are a couple of well-known syndromes involving the accumulation of Phlegm in the Lungs which would offer some hope of successful treatment, as well as a number of specific points whose action is said to 'resolve' Phlegm, i.e. render it less adhesive and easier for the body to disperse or remove.

However, finding out how to describe in Chinese medicine terms what is going on with a symptom is not the same as defining the underlying condition, and our concern would be to find out what was causing this to come about. Phlegm accumulates because an excess if fluids is either subject to heat or cold and thickens, and from a Chinese medicine perspective we would want to know how this first happened and why you in particular had this unpleasant symptom developing. Each person is unique and different, and so a set of circumstances which would generate a symptom in one person would have no effect on someone else. Treating the underlying constitution, the backdrop against which the problem arose, is as important as treating the symptom, because if this is not done, the symptom may well return.

We would also be interested in finding out more about the cold/flu you had last year. A low white cell count is unusual, and suggests that this was not a simple virus. This may not affect our diagnosis in Chinese medicine terms but may take advantage of our knowledge of western medicine to get a sense of how feasible it would be to offer hope of a rapid recovery. Some diseases floor the system for years, and when we treat people with post-viral syndrome we sometimes have to be ready for the long haul. Given that this may mean a considerable investment in time and money we want to gather as much information as we can to make our estimate of progress as sound as possible.

In your particular case there is no substitute for visiting a BAcC practitioner local to you for a brief face to face assessment of what is going on and an educated opinion about what acupuncture treatment may be able to offer. It might also be advisable to look at the register of colleagues who use Chinese herbal medicine, the Register of Chinese Herbal Medicine( http://www.rchm.co.uk/), most of whose members also belong to the BAcC. The combination of acupuncture and Chinese Herbal medicine can often be extremely effective in treating problems like this where the daily regimen of herbs can often maintain the momentum in helping the Phlegm to resolve.

Q: I am a US citizen who will be visiting  London . I suffer from atrial fibrillation that has been successfully controlled by acupuncture. My practitioner has provided me with a copy of the appropriate meridian points.  I need names of specialists who treat this condition in the event of an episode while I’m in England. Any assistance that you might provide would be greatly appreciated.

A:  Our view as Traditional Chinese medicine practitioners is that we are all generalists, i.e. because we treat the person rather than simply the condition then all of our members have achieved a minimum standard of competence to deal with the majority of patients who visit their practice and within the limits of their competence. The only areas where we are looking at defining 'expert practice' are obstetrics, paediatrics and mental health issues, largely because there is a considerable amount of conventional knowledge which it is appropriate to have for patients in these sectors.

This means, in effect, that if you use our postcode search facility on our home page, as we have just done, to check whether there are practitioners in the area, you will find a considerable list, all of whom can offer you the same high standard of care. We obviously cannot give individual recommendations, but we recognise several of the names in the area as experienced and skilled practitioners.

It is always helpful to have the benefit of someone else's diagnosis and treatment plan, especially where this has been successful. We believe that it is probably best to establish contact before you come across, and would recommend that you e-mail two or three to see if their responses are a good indicator of being people you could do business with. If so, then they would I am sure be happy to contact your practitioner in advance to exchange information.

The only tiny word of caution is that over the last couple of years we have had a scam running in the UK which begins with an e-mail saying 'I am coming to your country in July and would like to book a course of treatment in advance.... etc etc'. What happens then is quite sophisticated - ten treatments are booked, an international money order arrives for too much, the booker says the bank added their car hire on by mistake, could you send a cheque by way of refund, the cheque is sent and cashed, the international money order turns out to be a fake but takes longer to clear than the personal cheque which is long gone.  I say this because there may be some members who see an e-mail starting 'I shall be coming to the UK in July' and may delete it unread. If so, please forgive them and accept our apologies!

Q: Throughout this past winter I have suffered with chronic catarrh and an almost permanent cough-particularly in the morning when I bring up lots of mucus. I have a suspicion that I might have allergic rhinittus. I have seen my doctor, and respond well to antihistamine and a nasal spray. However,my GP is reluctant to send me for allergy testing, and therefore I wondered if acupuncture might be useful. Can you advise please?

A: We have been asked about similar problems in the past, and a recent typical response was:

Can acupuncture help chronic rhinitis?

There is a growing body of evidence that acupuncture treatment may help with a number of forms of rhinitis, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/allergic-rhinitis.html
 
However, we know from our clinical experience that although there are some, indeed many, presentations which seem to respond well to acupuncture treatment, there are a number which have their root in some physical change or restriction in the nasal cavities, or from long-term sinus infections which have become resistant to treatment. If either of these is the case, there may be much more of a struggle involved in trying to reduce the impact of the symptoms.

From a Chinese medicine perspective, however, there are a number of clearly defined patterns involving a compromised defensive system (the Chinese didn't recognise the immune system as we do but certainly had a concept of defensive energy which when compromised generates the symptoms which we associate with rhinitis) and also digestive disorders which can manifest in the fluids of the body being excessive. A skilled practitioner will be looking at the symptoms someone has in the context of their whole system, and trying to ensure that treatment is aimed at the core of the problem, not simply the way in which it manifests.

Amongst the things which the practitioner would consider are also a number of digestive factors. From the Chinese medicine perspective the intake of too much dairy produce can often produce far too much mucus in the body, and it is not uncommon as a pattern. If this is the case, though, there will be a number of diagnostic signs which point clearly in this direction.

You would be well advised to visit a BAcC member local to you for face to face advice. Most are happy to give up a few minutes without charge to assess whether acupuncture treatment is the best thing for you. 

We think that this remains the most sensible advice that we can offer. It is not surprising to us that your doctor is unwilling at this stage to send you for allergy testing. His reasons may be budgetary or they may be based on his experience that they more often than not fail to provide a clear answer. From our perspective the tests may be useful, but once the immune system has been triggered in this way there is a tendency to see a huge number of short-term sensitivities which have been triggered by the more causally related one. The list of intolerances which people are handed means that they can end up with a serious restriction in what they eat to the point that it becomes difficult to ensure a balanced diet.

We think that it is probably likely to be worthwhile to visit a BAcC member local to you for an informal assessment of what may be possible. From a Chinese medicine perspective each patient is unique and different, so the symptom may arise from a totally different cause from someone with exactly the same presentation. The strength of the system, though, from our perspective is that it treats the person, not simply the condition, and as such offers a better chance of dealing with the symptom permanently rather than turning off the alarm bell which the symptom represents because we don't like the noise.

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