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45 questions

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.

Q:  I am a 27-year-old male, with chronicle hay fever and dust allergies. My doctor advices me to have allergy shots but we had to postpone it, because I am studying in the UK minimum until September. As far as i know, here they do not ractice such a treatment, only temporary reliefs with antihistamines. But I need a permanent treatment. Do you think acupuncture would help me with my dust mite allergies?

A:  We have to admit that we were rather surprised when we researched this topic to provide you with an answer. There are a couple of reasonably well-designed trials

http://www.hindawi.com/journals/ja/2014/654632/

http://www.ncbi.nlm.nih.gov/pubmed/21443446

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303983/

which appear to show that acupuncture treatment is at least as effective as drug treatment for the problems of dust mite allergy. Because the funding of trials is something of an issue, we had not suspected that many would have been done, especially in the West. Many Chinese studies exist, but few are translated.

Of course, one of the issues we have to contend with is that from a Chinese medicine perspective the allergic response would be different in each individual because the manifestation of the problem arises from the unique balance of the patient's energies. The symptom may be the same, but the cause (not the mite which is the trigger) can be very different in each case. The
strength of Chinese medicine is that it does not simply treat the symptom, but it tries to establish why this symptom in this individual and why now.

Because everyone is unique and different, we would not be able to say without qualification that acupuncture treatment would definitely help you. In order to have a better idea of this your best bet would be to visit a BAcC member local to you for a brief face to face assessment of what might be possible. However, we always advise people, if they do choose to have treatment, so set very clear markers for measuring progress, and to review treatment on a regular basis. It can be very easy to run up a large bill
getting nowhere, so it is important to be able to find objective markers which can measure progress, and to see whether the progress made justifies the time and expense involved.

 

Q: Can acupunture be used for cardiac rhythm disorders such as frequent ventriluar ectopics and non-sustained ventricular tachycardia? Is there any acupunture expert who specialises in treatments of these disorders?

A: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 rapid pulse and the irregular pulse both have 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 these two 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.

Q: I was wondering what the BAcC said on blood pressure limits;  specifically when should practitioners refuse treatment. Or more accurately could you provide figures on the lower and upper limits with regard to acupuncture treatment?

A:  There is nO point at which a BAcC member will refuse treatment because of any inherent risk in the use of acupuncture treatment when someone has extremely high or low blood pressure. In fact, the use of acupuncture for hypertension is reasonably well-researched, and although the evidence is far from conclusive (at least in those studies which meet the perhaps over-strict inclusion criteria used in the West) it is certainly encouraging. At the other end of the scale, there are a number of points which are known to lower blood pressure, and a practitioner may be a little cautious if treating someone who has hypotension, but the needle techniques used in the West are probably too gentle to creat much in the way of a major reaction. However, we have pointed out to medical colleagues that one of the points they use rather vigorously for treating tennis elbow can lower BP by ten points, and to be wary of over-doing it.

The real issue is one of patient management. We all routinely take the BP of a new patient, and if it sits at the end of what doctors take to be the normal range (above 145/95, below 90/60) we all refer to GPs to get the pressure tested in a surgery and officially noted. This would not preclude treatment, but would be simply offering the best care to the patient. If someone with very high blood pressure refused to see their GP and wanted to try to use acupuncture as a main intervention, we would almost certainly advise members to tread very carefully. Refusing to treat would not be an option - it is not our job to 'sack' patients who want to pursue their own choices and the treatment may well work - but we would want to see a member obtaining some very specific consents to treatment, and writing very thorough accounts in their notes of what is happening.

Sadly without statutory regulation we are not formally recognised within the NHS, and therefore we are subject to very strict rules about disclosure without consent. As such we could not go to a patient's GP without their consent. However, where we have met situations like this the persistence of the practitioner has invariably won in the end.

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