Ask an expert - body - head - mouth - dry mouth

3 questions

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.

Q: I am seeking help to treat dry mouth (xerostomia). I know there is some research demonstrating that acupuncture is effective in cancer patients. My dry mouth has been investigated, no obvious cause, salivary glands normal. None of the practitioners websites I have looked at specify that they treat dry mouth. Should I be looking for someone with specialist knowledge in this area or would any acupunturist be able to treat it (the research report does specify the areas to insert needles into). 

A:  As you say there has been research into the use of acupuncture for xerostomia arising from cancer treatments, and we touched on this in an answer we gave some time ago

We were asked this question once in relation to xerostomia induced by radiotherapy, and our answer was, taken from our factsheet on palliative care and further supplemented:

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O’Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

There is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
http://www.ncbi.nlm.nih.gov/pubmed/23104718

 http://www.ncbi.nlm.nih.gov/pubmed/22072272
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to you to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 

There is a chance, of course, that the xerostomia which you are asking about is not related to cancer treatment. From a Chinese medicine perspective this makes no difference. The understanding of the mechanics of the disruption of the physiology of salivation from within the Chinese medicine paradigm will be the same whatever the cause, although the cause, again seen from this perspective, may have a considerable impact on the treatment. By this we mean that radiotherapy might be seen as a cause of great heat and dryness within the system as a whole or locally, and this would almost certainly feed into the treatment strategy.
 
As we said above, speaking to a BAcC member local to you who can assess the problem face to face may well be the best option for you before committing to treatment.  

We have used bold highlighting for one paragraph because it emphasises the point that from a Chinese medicine perspective there is no single treatment for the problem, and it will be addressed as every other presenting symptom is within the overall context of the patient's health and balance. What this means, of course, is that there is unlikely to be an expert in treating the problem because there is no discrete body of knowledge about this condition alone. In Chinese medicine the relationship between generalist and specialist is the complete opposite of conventional medicine. In ancient times, specialists who only treated a few conditions were regarded as inferior!

The advice we gave before holds good. Our postcode search facility shows a number of members within easy reach, and most are willing to give up a few minutes without charge to assess whether your specific presentation would be likely to benefit from acupuncture treatment. All our members are equally well-trained and qualified, and the choice you finally make may well depend on the rapport you make with the ones you see. This can be quite a positive factor in treatment.

We were asked this question once in relation to xerostomia induced by radiotherapy, and our answer was, taken from our factsheet on palliative care and further supplemented:

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O’Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

 there is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
http://www.ncbi.nlm.nih.gov/pubmed/23104718
 
http://www.ncbi.nlm.nih.gov/pubmed/22072272
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to you to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 

There is a chance, of course, that the xerostomia which you are asking about is not related to cancer treatment. From a Chinese medicine perspective this makes no difference. The understanding of the dhe nechanics of the disruption of the physiology of salivation from within the Chinese medicine paradigm will be the same whatever the cause, although the cause, again seen from this perspective, may have a considerable impact on the treatment. By this we mean that radiotherapy might be seen as a cause of great heat and dryness within the system as a whole or locally, and this would almost certainly feed into the treatment strategy.
 
As we said above, speaking to a BAcC member local to you who can assess the problem face to face may well be the best option for you before committing to treatment.  

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