Ask an expert - body - chest

45 questions

Q:  I have had a persistent cough for 15 years. I have seen A specialist at Kings College London and been to several cough clinics, none have provided a solution. The cough is very violent and puts a great deal of stress on my body. The problem has been diagnosed as nerve damage to my throat, which causes an overreaction to the slightest irritation resulting in severe bouts of coughing. Is there any form of acupuncture that may relieve or stop the problem.

A:  We are assuming that having been under specialist care you have had all of the available tests, and we are a little surprised that nothing has shown up. However, we have seen cases like this where the body seems to have developed a sensitivity reaction for which no obvious solution can be found. We answered a question about a similar problem some time ago, and the response we gave included the following comment and advice:

If none of these has been identified as a cause, or even if they have, there may be some merit in looking at acupuncture treatment. There is not a great deal of evidence for the treatment of coughing, but this is mainly a reflection of the many different causes of coughing and the difficulties of designing a trial which generates meaningful results. Persistent coughing has certainly be a symptom recognised within traditional Chinese medicine, and if it appears alongside other symptoms and alongside the diagnostic evidence which a trained practitioner will find using Chinese medicine techniques, there are a number of clearly defined syndromes which offer treatment protocols to address the underlying patterns.

Even where there is no recognised syndrome, it is important to remember that in its earliest forms Chinese medicine was asymptomatic, i.e. it treated the patient as a whole based on the diagnostic evidence and not necessarily with regard to what they reported. In this way the treatment could truly be said to be unique. The underlying premise was symptoms only appear when the system as a whole is out of balance, and because of the internal patterns of energy flow, a symptom may not necessarily arise where the actual problem lies. The skill and art of the practitioner is to go to the root of the problem and once this is treated, there should be an improvement in the symptoms.

On that basis, and given that the problem has not always been there, it may well be worth having a brief chat with a BAcC member local to you to determine what may be possible. What the earlier answer does not cover in detail is the fact that traditional Chinese medicine sees the whole system, body, mind and spirit, as a united whole, and there are quite often connections to what is happening in a patient's life which can make some sense of an unusual symptom. Even where this is not the case, however, there is some evidence, especially from the treatment of phantom limb pain, that acupuncture treatment may be able to turn off or reduce the volume of a nerve signal to the point where it becomes more tolerable.

The only caution we have about slightly less frequent problems is that it can be quite easy to have a great many treatments where the results do not justify the continuing expense. You are probably more likely than many to notice circumstances where the reaction is less extreme, but even so we would always recommend finding some relatively objective outcome measure to assess the benefits of treatment.

Q:  My son has myotonic dystrophy and has a pacemaker, he wants to try acupuncture, will it be safe for him?

A:  The only contra-indication we recognise with pacemakers is that it is not wise to use electro-acupuncture.  The leading and authoritative text on electro-acupuncture says that:

stimulation is contra-indicated if a patient uses a demand type (synchronous) cardiac pacemaker. whether atrial or ventricular

but our view is that the fine distinctions between different types of pacemaker are probably not that well understood by patient and practitioner alike, so we prefer to make this a blanket restriction.

Pacemakers can obviously be positioned in a number of places, and we would expect practitioners to take extra care when needling in that area or indeed not needle there at all. A great deal depends on where the device is installed.

Other than that we can think of no reason why your son should not try acupuncture. There is no evidence that we can find which relates specifically to this condition, but the general basis of acupuncture involves optimising basic functions in the body and ensuring that when there are progressive degenerative conditions that what residual function remains is as effective as possible. We hope that treatment may be able to offer your son substantive results


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.

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