Ask an expert - general - swelling

8 questions

Q. Can acupuncture get fluid off your feet and ankle

A. We are assuming that you have already sought appropriate medical advice about the swelling in your feet and ankles. Although in the vast majority of cases this is a relatively benign symptom it can in one or two cases be the first sign of something more serious and these conditions need to be eliminated before you proceed.

As far as the swelling itself is concerned this is not a 20th century phenomenon, and the Chinese were just as susceptible to these kinds of problems 2000 years ago. Chinese medicine has a different way of looking at the physiology of the body, and especially at the way the Organs of the body work. Because everything is understood as the balance and movement of energy, the Organs are responsible for functional aspects of the flow which extend far beyond what we see an organ doing in the west. The poor distribution of fluid in the body, especially the pooling of fluids in the lower parts, points immediately to a weakness in a specific part of the system as the most likely cause.

That said, it isn't simply a matter of sticking a needle or two in formula points and away you go. in the majority of cases a weakness in one part of the system is a consequence of patterns of imbalance across the whole system, and our belief is that the most important need to be corrected so that the lesser ones will clear. Symptoms are alarm bells, not the problem itself, and although there will be times when a symptom is just what it is and no more, most of the time it requires the skill and expertise of the practitioner to determine how best to unravel the complex patterns.

The best advice that we can give is that you visit a local BAcC member for a brief chat about what may be possible. Most members offer a small amount of time without charge to prospective patients to enable them to make an informed choice about treatment. It will also enable the practitioner to assess whether they need to take care in needling. We try not to needle into heavily swollen areas to reduce the chances of cellulitis and other nasty problems, and this can condition what we are able to do. Working at a distance is just as effective, i.e. needling arms to address problems in legs, and one of our colleagues has led the field in researching the effectiveness of this. It can be quite disconcerting to a patient, though, and a chat before treatment starts may well prepare them for this outcome.

We are usually asked more specific questions, such as 'can acupuncture help trochanteric bursitis?', and the last time we were asked a generic question about 'bursitis' was in 2012. Remarkably, we said then pretty much what we would have said now had we not found this reply:

The first question we'd have to ask is 'where?'. Many patients present at acupuncture clinics with bursitis of the major joints like the hip, knee, shoulder or elbow, and to a degree the outcome depends on exactly which joint is affected. The same would apply in western medicine; some joints are easier to treat than others, and some easier to immobilise while healing takes place.However, Chinese medicine is very different in its approach to an understanding of the body and the way it works. The theory of Chinese medicine is based on a flow of energy called 'qi' of which the body consists in different forms, and the understanding of how its balance and flow can be affected by illness, lifestyle and constitution. When people suffer from bursitis in a joint, the practitioner will want to establish first whether this is a local problem, caused by an injury or from over-use, or whether it is a consequence of a systemic problem affecting all of the joints to a degree, or a bit of both, as is often the case. Treatment will then be aimed at the appropriate cause, but will almost certainly involve some needles close to where the bursitis is.Because this is quite a broad question, we can't be more specific. There are a number of web-based research resources which will identify relevant papers if you google 'acupuncture, bursitis and the joint concerned', but we strongly suspect that they will tend to say, as many do, that the signs are positive but not conclusive. Not a great deal of research meets rigorous western standards, and the conclusions drawn from it are often cautious. This is not to say that things aren't well researched. Many thousands of studies are conducted in China each year, but they are often premised on the fact that acupuncture works and researching what works better. In the West the policy makers are still troubled by whether acupuncture works or not. We believe that it does, of course!Your best bet is to visit a BAcC member local to you to discuss your specific problem. We trust that they will give you the best advice possible about whether they can help, and if not, what other alternatives there may be.  This remains the best advice we can give, especially the last paragraph about visiting a local BAcC member for a chat about whether treatment may help. Most are only too happy to give up a small amount of time without charge to prospective patients to assess whether acupuncture treatment is the best option.As to your supplementary question, the theories of Chinese medicine tend to describe bursitis in generic terms either as Dampness, a state where the fluids of the body become more viscous and gather in confined areas such as joint capsules, or as blockages due to local obstruction. In both cases the needles stimulate movement in the energy which in turn moves the gathered fluids, but in the case of the former there is usually a systemic element which underpins the local problem. When the bursitis is accompanied by heat and pain there is also an issue about Heat which has to be dispersed. The capitalisation of phenomena like Heat, Damp, Cold and the like is indicative of an entirely different paradigm of medicine which uses terms to describe changes in the microcosm which reflect similar changes on the macrocosm. Chinese medicine abound with illustrations from nature, and in some of the diagnostic systems the annual rhythms of nature are said to be reflected in the balanced nature of the energy of the body. Alterations in this balance are said to reflect what happens in nature if there is too much heat or too much rain.This all sounds a little odd to the western ear, but a system which has survived and continues to provide relief to millions after 2500 years of use must have something more than a placebo effect going for it!

A:  This is quite a difficult question to answer without knowing a little more about the swelling. There are all sorts of reasons why a thyroid gland can swell, from a benign cyst which can be drained through to the goitres one would associate with Hashimoto's Disease or Graves Disease. If we are talking about the latter, where the swelling is a part of a larger pattern of pathological changes in the body, then acupuncture may be more relevant but the advice less specific.

If this is a pattern of thyroid enlargement causing hyperthyroidism (over-active thyroid) then the evidence from research for the use of acupuncture is not that encouraging or plentiful. Our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/thyroid-disease.html

cites three studies which address some of the more common manifestations of hyperthyroidism, but while the results are quite positive the samples are too small to generalise.  there are some Chinese studies of the treatment of benign thyroid nodules, and these again, while encouraging, are quite small.

However, one of the great dangers in trading in symptoms from a conventional medical perspective is that it does not do justice to Chinese medicine theory which has developed over 2500 years. Thyroid problems are not new, and although the ancient Chinese would not have understood hormone levels and thyroid function as we know it, they would certainly have made sense of all of the symptoms associated with thyroid hyperactivity, and would have been able to address them within the system of medicine. That does not mean that they would always be able to treat them successfully, and we have to be very careful not to let our maxim of 'treating the person, not the disease' lead people to believe that anything is possible. However, it does mean that there is a chance of bringing the symptoms under control.

However, without more specific information we would struggle to say more. It may simply be a benign swelling, in which case there may be more cause for optimism about what treatment can achieve. What we always say, though, is that if you are on medication for thyroid malfunction we always tread with great care. It can take a long time to achieve a good working balance from a diseased thyroid, and treatment can affect a good balance which has taken months of establish. We tend to work as closely as we can with a patient's medical team to ensure that everything is managed to maintain a good and stable pattern.

The best advice we can give is that you pop along to see one of our members local to you. This will give you the best chance to describe in greater detail what is going on and to be able to get from them a better idea of what may be possible. 

A:  From a Chinese medicine perspective the $64,000 question is what is causing the fluid retention, and your question illustrates perfectly how difficult it is to take a symptom by itself and offer a view about its treatability. There are a number of reasons in Chinese medicine why someone might start to retain fluid, many of which track back to under-performance in one or two organs (we capitalise the word because an organ in Chinese medicine is not simply a physical object but a description of a range of functions in body, mind and emotion). The fact that we can then say that a spleen or kidney is under-performing leads to the next level of questioning: what is it about
the overall balance in the person's system which causes this part to malfunction? Is the problem in the organ itself, or is it caused by another organ not working well and having a knock-on effect?

This again leads to questions about the person's lifestyle and daily routines. As an example, many cases of fluid retention track back to the Spleen, which in Chinese thought is responsible both for sending fluids around the body and also for holding things up, a sort of internal gravity. When it does not work well, fluids gather and tend to sink, so many people end up with swelling in the middle and lower part of the body and then related problems like varicose veins. The Spleen does not thrive on cold and damp conditions, so a diet rich in raw fruit and vegetables, dairy produce and other cold, damp foods will already put pressure on the Spleen even if it is healthy,
and in one which is already under-performing push it a stage further into malfunction. Treatment might then be supplemented by dietary advice.

However, this is jumping the gun! The very first thing that a practitioner might do would be to look at the circulation in the area, not just the blood circulation from a western point of view but the energy circulation from a Chinese medicine perspective. There are often functional disturbances behind problems like this, but there can also be much simpler superficial disturbances, the treatment of which can be much more straightforward.

To have a really good idea of what is going on, and to avoid guessing at how problems like this might respond to treatment it is always best to trot along to a local BAcC member who with very little investigation will probably be able to offer you a reasonably accurate estimate of what may be possible after looking at your feet and asking you a number of questions. Crucially they will also be able to take the pulse at the wrist and look at the tongue, both Chinese methods of diagnosis that can very rapidly point to major areas of disturbance and change. On this basis they are likely to be able to give you a fairly good idea of what may be possible.

Q:  Is there a treatment for fibrolipoma.(large midline subcutaneous cervico-dorsal lipoma measuring 15.5(cc)x71.(AP)x16.3(Tr)CM in size

A: There is little or no research evidence to suggest that acupuncture treatment can be used with fibrolopomas of this size, indeed little or no evidence for the treatment of fibrolipomas at all. However, this does not mean that they have not been treated, simply that there has been no systematic attempt to gather a trial group together and test acupuncture against a suitable control group.
 
Traditional acupuncture is premised on the flow of energy, called 'qi', whose flow and balance is seen to be integral to the maintenance of good health and absence of symptoms. Where conditions like fibrolipomas develop, this is generically viewed as a blockage in the flow, and also at a very generic level often seen as an accumulation of fluid, called Damp in Chinese medicine, which has become more solid under the influence of Heat or other factors to form Phlegm, the Chinese name for these kinds of lumps and bumps.
 
In theory, there are both systemic and local treaments for dealing with these problems, and all of us have good anecdotal accounts of addressing problems like these on a relatively small scale. However, if we have read the dimensions correctly, this is an immense growth, and we would not expect acupuncture treatment to make a great deal of impact on such a lipoma. When things have reached this stage, surgical options may the best thing to consider. It might be worth establishing whether there is an energetic imbalance which contributes to the pattern, so that after surgery there is more chance of ensuring that the fibrolipoma does not return, but we do not think that acupuncture would be a very good primary treatment for the problem.      

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