Ask an expert - body - chest - difficulty breathing

4 questions

Q:  Can acupuncture help moderate sleep apnoea? Are there any outcome studies that compare acupuncture for moderate sleep apnoea with C-pap technologies?

A:  Rather oddly we have not been asked questions about the use of acupuncture treatment in sleep apnea before, and on investigation we found three studies

http://www.ncbi.nlm.nih.gov/pubmed/20615853

http://www.ncbi.nlm.nih.gov/pubmed/17023212

http://www.ncbi.nlm.nih.gov/pubmed/19186731which appear to give very encouraging results. As always the studies are rather small, and this does mean that they are not really considered robust enough to make substantive claims for what might be possible. However, they are significantly better than some we see which fail to draw any conclusions.

Unfortunately there are no studies which compare the use of acupuncture with C-Pap machines. The trials all test acupuncture against sham acupuncture, itself a rather difficult comparison because it is based on the premise that sham acupuncture has no effects, where from our perspective it may simply be testing sub-optimal treatment against optimal treatment. We suspect it might be possible to find research data from the use of C-pap machines and compare the outcomes, but this is beyond what we can meaningfully generate and fraught with methodological problems.

The issue for us, though, is not whether there is evidence of studies to underpin the treatment but whether there are discernible patterns of disturbance in the energy of the body which give some clue in Chinese medicine terms about what is happening. Some systems of TCM have very specific syndromes where the symptoms of apnea are accompanied by other pathological changes which point directly to potential treatments, but even this is not an essential requirement for successful treatment. The very early systems of diagnosis and treatment were often asymptomatic, literally treating the person rather than the condition with which they presented, in the simple belief that a system in balance took care of itself.

The best advice we can offer, and usually do, is to visit a BAcC member local to you for a brief face to face assessment of what may be possible. This will be able to take into account some of the unique aspects of your presentation which will better inform a skilled practitioner about what is going on.

 

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 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:  I am looking for a qualified acupuncturist for my dad who is 73.  He has bilateral vocal cord paralysis and is encoutering breathing difficulties even though he has had a cordotomy.  Can you help him?

 

A:  There are a relatively small number of studies which report successed in treating vocal cord paralysis, two examples of which are
 
http://www.ncbi.nlm.nih.gov/pubmed/2741280
 
http://www.ncbi.nlm.nih.gov/pubmed/848460
 
The abstracts of the papers do not cite the exact treatments used, and both speak of acupuncture being used in conjunction with other forms of treatment. In one paper, as is commonly found to be the case, the use of acupuncture alongside the conventional treatment appears to speed up the patient's recovery.  However, it is best to consider these papers as indicative rather than conclusive; there are no large scale studies which make a confident prediction possible. A great deal will also depend on the extent of the cordotomy. The operation is not supposed to interfere with a patient's vocal capacity if they recover naturally, but as with all surgical procedures there is an inherent risk that some of the changes are not reversible.
 
We suspect that some of the treatment offered in the studies was local, i.e. in the area near the problem, and this can often be very effectively in stimulating a return to good function. However, a practitioner may well want to establish whether this is simply a local problem or whether this is the tip of a much larger iceberg - this would have implications for how much treatment may be required and whether it is worthwhile attempting to address this as a local issue if there is a backdrop of much more extensive imbalance.
 
If we were being brutally honest we would say that treatment may be more in hope than in expectation, but acupuncture treatment has a reputation for occasionally achieving unexpected but significant results,. so we would be happy to advise you to seek a face to face assessment with a BAcC member local to you who can give you a much better assessment by looking at the problem and your father's health in the round. 
 
 

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