Ask an expert - body - chest

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Bronchial asthma is one of a small number of conditions where we have prepared review papers which are more comprehensive than our customary factsheets, and the one for asthma can be found at:
 
http://www.acupuncture.org.uk/arrc/public-review-papers/bronchial-asthma-and-acupuncture-the-evidence-for-effectiveness.html
 
As you can see from this, the jury is still out in terms of claims for clinical efficacy. The evidence is not conclusive, and although we could make a great deal of the inappropriateness of the accepted research criteria for acupuncture (the randomised double blind control trial which only truly works for drug trials), the fact is that even a badly designed trial should show a trend towards treatment having an impact, and some trials have failed to do this.
 
That said, asthma has existed since the birth of Chinese medicine well over 2000 yeras ago, and there are a number of very well-established protocols for understanding the various ways in which asthma can be classified and for making sense of these within the system of Chinese medicine. In practice few of us do not believe that we can make a difference, but we all run up against a major limiting factor, and this is the accepted western treatment with steroids and bronchodilators.
 
We are always very clear that there are a significant number of medications which are vital to life and good functioning, and our members are trained neither to suggest stopping them nor to encourage patients to stop them, even passively by not speaking up against someone's stated intention. There are a number of western medications, however, where there is a rather problematic position in which patients sometimes find themselves. In the case of asthma, and sometimes epilepsy, a patient may be taking medications for years without suffering an attack, and not unreasonably ask whether they could stop taking the medications because the underlying problem has resolved and the drugs are no longer necessary. There is evidence, however, that the body achieves over time an effective balance with the medications, and their withdrawal can cause an attack. In the case of asthma there is documented evidence that rebound attacks after steroids have been withrawn can be very serious, and for this reason our members are advised to refer patients who want to question their medication back to their doctors for further discussion. Few doctors, in our experience, will let someone come off anti-asthma medication because of the theoretical risk of a fatal or serious attack.
 
However, you did talk about 'having an impact', and there is no doubt that anecdotally we hear of many cases where a patient's use of and reliance on bronchodilators reduces over time. Most asthmatics manage, rather than banish, their condition with the aid of medications, and we are sure that over time the use of bronchodilators in particular will be shown by research to fall after acupuncture treatment. We are also treating people, not simply their conditions, and we find that treatment often helps people to cope better with long-term health problems over and above any relief it brings to the problem itself.
 
Each prospective patient is unique and different, though, and the best advice we can give is that you contact a BAcC local to you and seek a brief face to face assessment with them of whether acupuncture treatment might be suitable for your own case.  

Q:  My 23 year old daughter has always suffered with colds/bad throats throughout her childhood. Unfortunately it has carried on into adulthood and this last year she has had one after the other. Would acupuncture help her, she also has at  times suffers with hair loss, leading to bald patches.
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A:  The evidence for the treatments of cold and flu, as you can see from our factsheet


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

does exist but is a little less than convincing. This does not come as a great surprise to us, though. The kinds of trials favoured in the west for proof of efficacy, the so-called randomised double blind control trial borrowed from drug testing, does not particularly suit acupuncture treatment in general, and colds and flu in particular. The aim of RCTs is to reduce the number of variables to measure a specific outcome, but from our perspective the biggest variables are patients whose unique energy balances we work with, the from any perspective deciding what counts as 'identical' in two colds to make testing possible is well nigh impossible.

Chinese medicine has a very rich understanding of the conditions which from its perspective create the symptoms which we describe as colds, and most are related to the climate and changes within it. The Chinese were essentially an agrarian race, and factors such as exposure to wind and cold, or damp and heat, were seen as inherently threatening to a system unprepared for them. The fact that we are not exposed to similar conditions does not change the fact that the symptoms as they appear in modern times are amenable to the same treatments.

However, while there are agreed protocols for treating what we call colds, the situation with a cold which continues without really clearing, or which renders the person susceptible to cold after cold is slightly different, being seen by the Chinese as a weakness in the immune system, although this was not a word they used; in Chinese medicine the defensive energy of the body would be said to be weakened to the point where it cannot throw off the 'invasion' of the factor which generates symptoms. While the treatment of a relatively fresh cold is often aimed at clearing a pathogen, the treatment of a long-term weakness often involves building the whole system up. In modern times the advent of conditions grouped under names such as ME, or Post-Viral syndrome or Chronic Fatigue syndrome often display clinical features which are similar to defensive energy weakness.

This does not mean that they are automatically treatable. As you know, many people are crippled with ME and it can take years for someone to recover, so we would not even begin to estimate whether your daughter can be helped by acupuncture treatment. Our best advice is for her to visit a local BAcC member and to ask in person what, based on her signs and symptoms he or she may be able to achieve. This is likely to be far more helpful than bland positivity from us.

As far as hair loss is concerned, we have been asked questions about this before and we repeat our most recent advice below. There is a cautionary overtone to our response as you can see, because we have found that the fact that sufferers are highly self-conscious about their appearance can, if you are not careful, be mis-used in running up a large treatment bill. We are not suggesting that this is what the practitioner here is/was doing, but it is something which has to be borne in mind.

It may well be, though, that the weakness in the immune system is a contributory factor, so it may be worth seeing, if you decide to pursue acupuncture treatment, whether straightforward constitutional treatment helps to reduce the problem. 

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.

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