Ask an expert - body - head

92 questions

Q:  My son, John aged 31 years, has just been diagnosed with a very large ganglioglioma tumor 9,5cm x 6cm x 4,5cm on the right hemisphere. He has been living with this tumor since a child. So far  he is only suffering headaches, no convulsions. We understand that he will need neuro surgery which may take a couple of months to organise. Our question is what can we reasonably expect from acupuncture whilst waiting for the operation?

A: As you might expect there is no research save a few case studies which we can find about the treatment of ganglioglioma itself with acupuncture, so there is nothing we can usefully add about the treatment of the problem. Surgical resection, especially in the young adult otherwise in good health, shows a reasonably high rate of success, with recurrence levels being quite low unless the tumour has been difficult to remove fully because of its location.

 We are aware that there are ways of looking at problems like this from a Chinese medicine perspective which might give someone expectations that acupuncture treatment will offer a 'cure'. The ancient Chinese did not have the benefit of MRI and X-ray images, and from their perspective any accumulation of fluids or tissue in the body represented a functional disturbance whose origins could be traced to particular Organs of the Body (capitalised because this means something specific and different in Chinese medicine). If this were the case then there would be other signs and symptoms to guide the practitioner, and some hope of dealing with this as a systemic functional disturbance.

 However, it is very dangerous to translate between 'oranges and apples' medical systems because there will be unintended implications that working in one will deal with a problem in the other. What we can say, however, based on our own experience is that acupuncture treatment can have a demonstrable effect in reducing someone's anxiety levels, and anecdotally appears to aid recovery after surgery. The early systems of acupuncture were largely asymptomatic but aimed primarily at establishing balance and harmony in the body's energetic flow and functions in the simple belief that a system in balance was best placed to address any health issues it had. 

 On that basis we would certainly be happy to recommend that your son has treatment in preparation for what might be some very difficult times ahead, but not with any expectation that it would reduce or delay the need for surgery. The fact that he has been carrying this for over twenty years suggests that it is not rapidly growing, and that surgery will be successful. We certainly hope so for his and your sake.  

Q:  Query R.E problems breathing through nose.  For a long time ( many years) I seem to have a stuffy nose only at night time .( I used a Vick stick on and off for years ) any slight cold would cause problems and I would use vick spray . About 3 years ago I had a hysterectomy and a couple of months later I had some sort of virus that lasted approcimately 12 weeks which resulted in bad headaches. Doctors prescribed amitriptyline I was on 50g a day for about 2 years. During this time my problems with blocked nose got worse and affected  me 24 hours a day. I came off the amitriptyline gradually and stopped about 10 months ago .Last winter I was terrible for about 3-4 months and was constantly using Vicks spray. Doctors prescribed beconase and was ok during the summer, but have been having problems since September again . I also have slight post nasal drip
Can acupuncture help?

A:  First of all we need to congratulate your for getting off amitriptyline. Although it is not often regarded as a highly addictive drug we have had a number of patients over the years who have really struggled with the rebound symptoms from trying to come off a long term use. The fact that you have is a tribute to your determination.

 We have been asked questions before about allergic rhinitis and chronic rhinitis, both of which share similarities with your problems, and a typical answer has been:

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. 

 The importance of this is that from a Chinese medicine perspective it doesn't really matter what the western medical name of a problem is. The symptoms which the patient reports, along with signs which the practitioner can observe, all point to disturbances in the flow, rhythm and balance of the energies of the body, and the skill and art of the practitioner lies in being able to make sense of them within the theoretical framework of Chinese medicine. This can mean that twenty people with the same 'named' condition can find themselves being treated in twenty different ways.

 As far as the advice we gave before is concerned there are probably a number of lifestyle recommendations about diet which a practitioner would make, especially relating to the kinds of food you are eating and also the times of day at which you are eating them. Small adjustments here can have a profound impact, especially when you consider that one of the main two digestive functions in Chinese medicine is also responsible for maintaining fluid flow and can create mucus and phlegm if it is impaired.

 We are surprised that in the earlier answer we did not mention Chinese herbal medicine. Although we routinely offer this as an alternative suggestion for skin problems we have also found that our colleagues who also use herbs are able to address some of the long term rhinitis issues rather well. The quickest way to find a qualified practitioner is to look on the website of the Register of Chinese Herbal Medicine, http://rchm.co.uk/. Most RCHM members are also members of the BAcC, and you can enjoy the best of both forms of treatment.

 As a first step we would advise you to talk to a BAcC member local to you. Most are very happy to give up a small amount of time without charge and can give you a brief face to face assessment which is far more likely to offer you a clear prognosis than we can offer at this remove.

 

Q: Can acupuncture help with Sjoegrens syndrome, immune disease affecting connective tissue, salivary glands, symptoms include dry mouth, reynauds tingling/burning hands and feet.

A: As you are probably fully aware Sjogrens can occur as either a primary or secondary condition whose origin is not entirely clear. Treatment is usually supportive and symptomatic rather than curative, and the wide array of potential symptoms which arise from the change in moisture producing cells means that research studies are not as common as would normally be the case.

 This is certainly the case with acupuncture trials and Sjogrens. We wouldn't want to quote specific studies because they tend to be small and methodologically 'under-powered' but if you use an open access database like NCBI by typing in 'ncbi acupuncture Sjogrens' you will find at least half a dozen studies which report significant changes from treatment, whether it be with acupuncture, auricular acupuncture, electroacupuncture or Chinese herbal medicine. What most conclude, however, is that the sample size is too small to make any firm recommendations other than that larger studies should be organised.

 Of course, from a Chinese medicine perspective the somewhat disparate nature of potential symptoms plays to one of its greatest strengths, the ability to make sense of what appear to be unconnected symptoms within a framework based on an entirely different conceptual structure. Chinese medicine is based on theories of energy, called 'qi', whose rhythm, flow and balance determine the overall health of the individual. Within this overarching picture are Organs which have specific functions within the flow. Organs are different from the western concept of an organ, being seen as functional units whose effects can be seen in several areas of the body. This can often mean that symptoms which would be treated separately in western medicine are treated as a part of one functional disturbance.

 This means that when a practitioner looks at each presentation within the Sjogrens pattern he or she will be analysing them across the range of functional disturbances which might show common roots, and this can often mean an individual treatment for the person as a unique presentation rather than a standard formula treatment.

 It is also fair to say that in many cases of connective tissue disorder the various symptoms are all assumed to be fruit of the same tree when in reality some of them may from a Chinese medicine perspective be consequences of weaknesses in the system caused by the Sjogrens. Some may well be amenable to constitutional treatment.

 The bottom line, therefore, is that acupuncture treatment may be able to offer some benefits, and will certainly do no harm. In order to say more, though, we would have to see your symptoms in their overall context, which online is not an option. The best advice that we can give is that you visit a BAcC member local to you and seek a brief face to face consultation to assess what might be going on. Most members are willing to give up some time without charge to give a better view of what may be possible, and this gives you a chance to meet them and see where they work.

A:  We have rarely been asked about optic atrophy, but did have a question three years ago which refers to what remains the best evidence available, as well as the best advice about finding someone who might be able to help.

We wrote:

 A recently published meta-analysis


http://www.ncbi.nlm.nih.gov/pubmed/23545824


makes some very encouraging noises about the use of acupuncture treatment alongside conventional treatment, but concludes, as does every systematic review or meta-analysis, that more research needs to be done, and on a greater number of subjects.
However, we are always cautious about the kind of trials which generate these results. The gold standard applied to western scientific research is the randomised control trial, and to make these work, the treatment has to be standardised and the condition under investigation has to be the only outcome variable. Whatever else the patient may have by way of health related issue is discounted. From a Chinese medicine perspective, both of these positions are not best practice. Treatment is dynamic and evolutionary, building on the progress, or lack of it, and refining the treatment as it goes along. The symptom which serves as the focus of the research is also seen in a far wider context, and it would not be surprising if twenty people with optic nerve atrophy had twenty different diagnoses from a Chinese medicine perspective. The symptom is only an alarm bell which alerts the practitioner to patterns of imbalance or blockage, and these will be unique to each individual.
This means that we have to be careful with research studies. Many will be unfairly inconclusive, but equally others will be falsely encouraging, building on a fortuitous outcome that the patients selected for a small trial happened to have treatment which helped their underlying patterns.
Good Chinese medicine aims to understand the appearance of symptoms in disturbances of the function of Organs (capitalised because an Organ is seen a complex collection of functions which embrace some of the physical ones we understand in the West but many which affect mental and emotional factors), and the practitioner uses their art and skill to determine what the driving force behind the complex pattern of disharmony is. In some cases this will show direct connections with the symptom, in others only a complex pattern in which the symptom is a weakness exaggerated by problems elsewhere.
The long and short of it is that the best advice you are likely to get for the treatment of a condition such as this will come from a brief face to face assessment from a BAcC member local to you. It is probably true to say that the best you might achieve is a reduction in the rate of deterioration or a stable but not deteriorating state, but at this remove we cannot really say. If you did decide to have treatment it would be very useful to establish markers by which any change can be monitored, and also review periods to make sure that the treatment is being regularly assessed for outcome and value.
As far as practitioners are concerned, we do not recognise fields of specialism. From our perspective our members as generalists are all equally well equipped in Chinese medicine to deal with the full range of problems which people bring to their clinics. We have one or two fields like obstetrics and paediatrics where we are shortly to recognise standards of expert practice, but we do not have short term plans for other specialties. There are one or two members who focus their work on people with eye problems, an while we cannot give specific recommendations, it is a simple matter to track them down through google. 
We think that this remains the best advice that we can offer. There are several different causes of optic atrophy, and successful conventional treatment depends on working out what is causing the problem and trying to reduce its continuing effects. Chinese medicine would operate on the same general principle, but we would always advise patients to continue to seek conventional treatment alongside any treatment which we may be able to offer. The two different styles of treatment can work alongside each other perfectly well, and this is not a time to be trying to work out which is more effective.

A:  There is a surprising amount of research information for the acupuncture treatment of dry eye syndrome. The last time we reviewed this condition there seemed to be one or two studies, but two have been published recently, along with a review article.

 The two studies

 http://www.ncbi.nlm.nih.gov/pubmed/21138389

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/

 show very encouraging results, and the review

 http://www.ncbi.nlm.nih.gov/pubmed/21138389

concludes that acupuncture treatment is better than the use of artificial tears for the condition. Of course, this falls a long way short of the amount and quality of evidence which would enable us to give an unqualified recommendation, but it is nonetheless very encouraging.

 We have to remember, though, that from a Chinese medicine perspective a symptom seen in isolation from the system as a whole is not that informative. There are all sorts of functional disturbances from this perspective which might lead to this symptom, and the key concern is to try to remove its causes as much as to simply try to stop the symptom alone. Sometimes this will be enough, but more often if the underlying patterns of imbalance are not addressed it will ultimately return, and that does not do justice to what acupuncture may be able to offer. A skilled practitioner will be able to make sense of why this symptom has appeared in you as a unique individual, and will use all sorts of other information to get a sense of how the whole system is functioning.

 The best advice which we can give is to visit a local BAcC member for a brief face to face consultation. This will be far more informative than we can be at this range, and most of our colleagues are usually willing to give up some time without charge to assess whether acupuncture is the best treatment option. This also has the advantage of meeting the practitioner and seeing where they work before committing to treatment.

 

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