Ask an expert - body - chest

43 questions

Q:  I was diagnosed with sarcoidosis in my lungs 18 months ago. I was told by my GP at the time I had chronic scarring on my lungs as a result. I had another x- ray recently and the condition still exists. I suffer from shortness of breath and at times have to take an inhaler. I am really anxious to know if acupunture could be of any benefit to me.

A:  There is very little research to support the use of acupuncture in the treatment of sarcoidosis, and that is a requirement for us to be able to offer the kind of advice which you seek.

If you do a websearch, however, you will find individual case studies such as this one about the use of Chinese herbal medicine and sarcoidosis

http://webhealth.co.uk/case-studies/a-case-of-sarcoidosis-and-sarcoid-lymphoma-treated-by-chinese-herbal-medicine/

which illustrate very clearly the problem of trying to treat named western conditions with traditional Chinese medicine. The authors are at pains to point out that there is very rarely a one to one correspondence between a disease and a syndrome as understood in Chinese medicine, and more to the point, each person will present an individual syndrome pattern which has generated the symptoms which are gathered together under the western heading 'sarcoidosis.'

Symptoms are the bridge between different systems of medicine, the one factor which is usually not in dispute, Chinese medicine has an entirely different conceptual framework against which those symptoms are assessed and interpreted, and from our perspective it would be a matter of seeing how your symptoms arose and how they manifest. Chinese medicine systems are 2500 years old and although they may at times use language which is alien to most westerners there is considerable sophistication in how the whole system is interpreted.

The only advice we can give you for a condition such as yours is that you visit a BAcC practitioner local to you and seek their advice based on a face to face assessment of whether treatment may be beneficial. Chinese medicine certainly has a long tradition of treating breathing difficulties, and many differential diagnoses for their cause, but from a distance we are unable to say whether your symptom pattern 'fits' any of these classifications.

What we would say, however, by way of advice is that with chronic conditions such as this it is very important to establish good outcome measures to assess progress while at the same time acknowledging the continuing damage which the condition causes. We are sometimes asked questions by patients who have had twenty or thirty sessions with no discernible benefit, and we are most keen that BAcC members undertake regular reviews to establish whether the treatment is of benefit.

Q:  Are there any adverse effects of acupuncture on pacemakers?

A:  As far as we are aware, there have been no reported adverse events from the use of manual acupuncture alone in relation to pacemakers. We publish a guide for our members' use which adds background advice and best practice suggestions to help them to comply with the Code of Safe Practice, and the advice we give there relates only to electro-acupuncture (EA):

Patients who have a pacemaker should not be treated with electro-acupuncture since there is a risk that the electrical stimulus of the acupuncture device may interfere with the pacemaker

If you search the internet you will find case reports such as this one:

http://www.ncbi.nlm.nih.gov/pubmed/21386114

which suggest that EA is safe to use for pain relief even when a pacemaker is fitted, but also reports such as

http://www.ncbi.nlm.nih.gov/pubmed/7471851

which suggest there is a measurable effect from using EA with a pacemaker in place.

The leading authority on EA in the UK, David Mayor, recommends in his comprehensive textbook on electroacupuncture that EA must be absolutely contra-indicated for anyone using a demand led pacemaker

 

 

Q: My 34 year old daughter has suffered with asthma and eczema to a greater or lesser degree for most of her life.   She has also had a skin condition for a year or so which I understand is called Prurigo Nodularis.   She is having perscribed treatment under the NHS which involves medication and UV light treatment.  In particular her main discomfort is the itchyness particularly at night time. I wonder if acupunture could improve this situation ?

A: We have been asked about prurigo nodularis a couple of times, and our most recent answer was:
 

 

Can acupuncture help in treating prurigo nodularis

 

There is not a great deal of evidence that acupuncture has been used successfully for treating this condition. This becomes very clear when you undertake any searches for evidence. There is a single paper for the use of acupuncture and hypnotherapy ('hypnopuncture')

 

http://www.ncbi.nlm.nih.gov/pubmed/21598842

 

which is cited over and over again without any further additions, a certain sign that there is no other evidence. We are sure that there are probably a large number of trials which have been undertaken in China, but the great majority of these have not been translated and are often regarded in the West as methodologically flawed.

 

However, skin diseases are as old as mankind, and the systems of Chinese medicine do have ways of interpreting the signs and symptoms of diseases like prurigo within its framework. These often use terms like 'invasions' of 'heat', 'wind' or 'damp' which sound alien to the western ear but describe the effects of climate (as experienced by a largely agrarian population) on the flow of energy, called 'qi', especially where this disrupted the flow, rhythm and balance near the skin surface. Everyone is aware of the short term effects of exposure to extremes of climate, and from a Chinese medicine perspective, whether this is the primary cause of a problem, or whether there is an underlying weakness which makes particular people vulnerable, the skill of the practitioner lies in assessing the overall balance as well as the presenting symptoms, and attempting to restore balance.

 

The best advice that we can give you is that you visit a BAcC member local to you for a brief face to face assessment of the problem. Crucial  to this assessment will be whether the problem is local or widespread. In broad terms, the more localised, the more treatment options there are. We would also recommend that you might want to see advice from someone who also does Chinese herbal medicine. The majority of the members of the Register of Chinese Herbal Medicine are also BAcC members. We say this because herbal medicine has developed a very good reputation over the years for treating skin conditions, the daily dose of herbs helping to maintain a treatment momentum. It may be that a combination of acupuncture and herbal medicine may prove a more potent force in helping your problem, but to what extent would depend on a more thorough assessment than we can give here.

 

We would not want to add anything to this advice about the prurigo, but the fact that it has appeared against a longstanding backdrop of asthma and skin problems suggests that it may be quite a difficult condition to influence. As our review paper on the use of acupuncture for the treatment of asthma shows

 

 

 

there is a growing body of evidence that acupuncture may be of benefit. However, there is a close correlation between ashma and ezcema in Chinese medicine which suggests a constitutional weakness which may impact on how successful treatment may be. That said, there are a number of what we call 'empirical points', points which have been discovered over the years to have specific effects no matter what the underlying constutional position may be, and one or two of these have been shown to be highly effective at reducing itching across the body, especially where this is impacting on someone's sleep.

Q:  I have recently been diagnosed with coronary artery disease and unstable angina, for which I have been prescribed a raft of drugs. Please can you advise me as to whether acupuncture would be appropriate treatment, and if it would whether it could offer an alternative route to all the drugs.

A:  We have to say straight away that all of our members are under strict instruction not to interfere with prescriptions issued by a patient's GP, either by asking them to change or stop or, as importantly, supporting a patient's decision to stop taking a drug which may be life sustaining. There are, of course, a huge number of medications prescribed on a 'use as needed' basis, and if someone finds that acupuncture treatment means that they can do without the meds, so much the better.
 
In your case, however, both conditions carry a high risk factor if untreated, and it would be potentially very dangerous to stop taking your prescribed medications. That does not mean that acupuncture cannot help, and if you did decide to go ahead with treatment, you may well find that some of the symptoms are relieved. The problem you would then have is to convince a doctor who has made the prescription that the acupuncture, and not the medication, has had the desired effect. Most will conclude that the drugs are working, and be all the more reluctant to let you stop.
 
The best course of action is to discuss with your doctor what might be possible by way of a planned reduction over time, and what markers they would be looking for, whether these be achieved by medication or acupuncture. In this way it remains an open question as to what is working, but the end result is the same.
 
We have to say, though, that with both of these conditions, the chances are that the doctor will not entertain a reduction unless there were very significant and measurable changes in your heart function which made him or her confident that you were a very low risk.
 
As far as the symptoms themselves are concerned, there is a small amount of research for the use of acupuncture, but as this systematic review
 
http://www.ncbi.nlm.nih.gov/pubmed/23427379
 
clearly says, there would need to be many more trials of greater power and number to assess properly whether acupuncture is a viable treatment option.
 
It may well be worth talking to a BAcC member local to you, though, because a face to face assessment will be much more helpful than what we can offer at a distance, and we are understandably cautious when we have to work from brief descriptions of a problem.
 
 

Q:  Have wondered if acupuncture would help with hay fever. I have been given steroidal nasal spray (by doctor) for severe running eyes and nose. Don`t want to keep the steroids up. Tablets (anti-histamine) make me very drowsy, although they advertise that they shouldn't.   I also seem to be alergic to dust etc.

A:  Hay fever is usually grouped under the generci term 'allergic rhinitis', and as the BAcC fact sheet shows
 
Please click here

 it has been a frequently researched condition over the years because the diagnosis is easy to make from the cluster of symptoms and willing patients are plentiful. Unfortunately a great deal of the research is on too small a scale or methodologically flawed, so the results are often inconclusive, encouraging but some way short of saying that acupuncture is guaranteed to deliver. There are a number of reasons for this to do with the level of evidence required in the West, the randomised control trial, which is not the best way to assess traditional acupuncture, but even allowing for that, our clinical experience is that there are patients for whom treatment makes not a jot of difference.
 
That said, allergic rhinitis is not a new phenomenon, and Chinese medicine, which developed in treating people whose lives were mainly spent outdoors, has a number of ways of understanding how the  symptoms present in terms of the systems of Chinese medicine and also how this can derive from a number of systemic weaknesses. This latter enterprise has been the subject of a great deal of debate amongst modern practitioners as the number of environmental factors which can create similar symptoms has escalated alarmingly. In short, Chinese medicine has a number of strategies for dealing with the various presentations of the condition, and also a way of looking at the overall health of the patient as a potential underlying factor which predisposes someone to the problem. This means that in many cases treatment is aimed at the person, not the symptoms, a strategy which underpinned a great deal of the practice of the ancients.
 
The received wisdom inside the modern profession is that it is better to commence treatment before the time that the condition, if it is seasonal, would norally present, and our clinical experience has been that once the condition has kicked in, a reduction in the severity of the symptoms is the best that one can hope for. If the condition is always present, it can sometimes be a long haul to bring the system back to a point where the symptoms are minor and bearable.
 
Each sufferer is unique and different, however, and the best thing you can do is to find a BAcC member local to you and arrange for a brief chat so that he or she can establish whether acupuncture treatment might be of benefit to you.
 
 
 
 
 
 

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