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Ask an expert - body - abdomen / gastro intestinal

38 questions

Q:  Can acupuncture help with sphincter of oddi dysfunction. It causes pain in the upper abdomen, nausea and exhaustion.

A:  One of the problems which we have in answering questions about very specifically defined disorders in conventional medicine is that it takes us further away from what we would recognise as functional disturbances when seen from a Chinese medicine perspective. This a rather elliptical way of saying that when you look at very specific muscle groups and the use of acupuncture, it encourages a view that there is a direct relationship between acupuncture points and particular disorders. While this can sometimes be the case it would be more normal to look at the functions of the whole system to see what was working well and what wasn't in order to understand why a symptom had appeared, rather than go straight to a symptom as a treatable entity. This is why a dozen people with the same symptom may be treated in a dozen different ways by a practitioner of Chinese medicine.

From the Chinese medicine perspective it would be relevant to ask the same sorts of question that a western medic might ask - where the pain is, what makes it better or worse, are the variations between day and night, and so on - but to see the answers against an entirely different conceptual grid. This might bring an understanding that there was a local blockage in the flow of energy, or a disturbance in a specific digestive function, or even an overall pattern of disharmony whose consequence had been to generate a symptom in this place. The different possibilities might generate different treatment options.

That said, there are a few studies of the use of electroacupuncture such as this one

http://www.ncbi.nlm.nih.gov/pubmed/24008012

http://www.ncbi.nlm.nih.gov/pubmed/11174298

http://www.ncbi.nlm.nih.gov/pubmed/19272582

which seem to indicate that there may be something which can be done, but the scale of the studies is far too small to be able to make a positive recommendation. The best that we could say is that we see many people with a variety of gall bladder problems, as defined in western terms, and that there are a number of clearly defined syndromes within Chinese medicine which offer treatment possibilities. These are determined more by the type and timing of pain than from the conventional name, and ultimately depend on diagnosis by the use of tongue and pulse, along with other energetic assessments.

The best advice that we can offer is that you visit a BAcC member local to you for specific advice based on your own unique presentation. This is likely to be far more informative than any guess we can make, and most members are happy to give up a small amount of time without charge to assess whether acupuncture is a good option for the problem the person has.  

Q: I'm contacting you on my wife's behalf. She has suffered from extreme indigestion/heartburn for a long time. She has had endoscopies and ultrasound tests that have all come back clear. She has one last PH test. We really need to look for alternative therapy.  Can acupuncture help?

A:  There is surprisingly little research on the use of acupuncture for the treatment of acid reflux even though it is a very common presenting condition in our clinics. There are one or two studies like this  http://www.ncbi.nlm.nih.gov/pubmed/20697939   http://www.ncbi.nlm.nih.gov/pubmed/17875198 

and occasional articles like this one http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080874/

which suggest other possibilities for the appearance of heartburn symptoms, but not the solid body of evidence one might expect based on the usually quite effective treatment of this problem.

Obviously there are physical problems such as hiatus hernia where there has been a physical change in structure of the oesophageal tract which can cause heartburn. If this is the case, then it will seriously limit the possibilities for treatment in any system of medicine. If investigations show that this is not the case, however, then there may be some value in using acupuncture treatment.

From a Chinese medicine perspective the classic presentation of reflux or heartburn is described as Stomach Fire or Rebellious Stomach Qi where the energy of the Stomach does not follow its normal pattern of causing food to descend but lets it stay in the Stomach or reverse its flow to create the classic symptoms with which people suffer. Knowing the immediate precipitating cause, however, does not mean that one goes straight to this for treatment. The flow of energy in the body, called 'qi' in Chinese, is a complex interweaving of channels connecting Organs whose functions are also inter-related. The art and skill of the practitioner lies in determining what
the primary underlying imbalances are, in the belief that treating here will cause the symptom to go and stay gone rather than be treated simply as a symptom.

This is one of the primary differences between Chinese and conventional medicine. From the Chinese medicine perspective the symptom is an alarm bell telling the practitioner that the system is out of balance. Thus twenty patients with the same symptom could have twenty different underlying causes and therefore twenty different treatments, in contrast to the standard western procedures which have two or three main strategies for a problem. In Chinese medicine the balance of the system is unique in every patient, and this means that each treatment plan is also unique.

It follows that this does limit what we can say about individual cases and why we invariably advise people to visit a local BAcC member for an informal assessment of what is going on and whether treatment would be of benefit. Most practitioners can get an idea in a very short time of what is going on and as a consequence give a good informed view of what might be possible. This would invariably take into account other changes in the way that everything functions which are perhaps not significant enough to concern anyone but from our perspective enrich the picture which we have. Reflux and heatburn are often accompanied by changes in bowel habit, and secondary information can refine the diagnosis a great deal. A practitioner can take all sorts of other factors into account, including mental and emotional ones, to
offer you a much more precise assessment of what may be possible.

Q:  I have read that acupuncture can be helpful in the treatment of abdominal adhesions  (colon to bladder) is this correct and what would be involved?

A:  We have looked back over our previous answers on topics similar to this, and we find that we continue to be unable to find any research, even case studies, which suggests that acupuncture treatment may be able to deal with adhesions. We have on a number of occasions discussed the merits of having treatment to deal with the pain which is thought to be coming from adhesions, but on each occasion we have had to say that we have never been able to say with confidence that the pain was coming from the adhesions. There are many occasions when the adhesions can in turn cause IBS because of the disruption in normal function, and it is not at all clear where the pain is
coming from.

As far as dispersing or reducing the physical manifestation of adhesions is concerned, we believe that this is highly unlikely, and the only route that we are aware of, which is surgery, remains the best option if the disruption it causes is very great. However, clearly there is some form of disturbance in the energy of the body in that region to encourage the formation of adhesions, and we would be probably more confident in saying that acupuncture would be worth a try to stop things getting worse or to try to
maintain things at a reasonably clear level after surgery. Chinese medicine in its oldest form was almost entirely asymptomatic and rested on the simple
premise that if everything was in balance symptoms would not appear.

We think, though, that this is problem best discussed face to face, and we would recommend that you visit a BAcC member local to you to discuss your own unique case. There may well be factors in your medical history which would shed light on why you have started to get adhesions, and understood from a Chinese medicine perspective these may well inform an educated assessment of what may be possible through treatment.

This is probably the best we can say. We have treated many people with unpleasant adhesions, sometimes with great success but equally often with no change, and we have to be realistic about what may be done, even though we really would wish to rid women patients of the problem.

Q:  I'm an 88 female  and have difficulty in walking & very painful neuropathy.  I  feel my life would improve if I didn't have chronic constipation. Is there any one not too far from Chessington who could help me, please?

A: Rather surprisingly for a very common problem there has been very little research over the years. A systematic review published two years ago

http://www.ncbi.nlm.nih.gov/pubmed/23895148

made encouraging noises about the use of acupuncture, but the studies were all done in China and there have been none in the West of which we are aware.

In clinical practice we have found, rather counter-intuitively for a system of medicine which is all about improving flow and movement, that constipation has been more difficult to treat than its opposite. We think it may be that the factors which predispose people to constipation are more complex, and where people are taking an increasing number of medications to help them with chronic pain, constipation is a common side effect, especially with the opiate painkillers (codeines and the like). There are often dietary factors at play too.

However, one of the great strengths of Chinese medicine is that a symptom is never treated in isolation from the whole pattern within which it sits, and it may well be that a skilled practitioner looking at how the whole system functions will find further evidence to help refine what might be done to balance the whole system up and encourage better function. Our members are also aware of the kinds of food which would affect the energetic balance and can often give people simple but effective advice about the types of food they eat and especially the times at which they eat it, both of  which can have a profound effect.

The best advice is always to see if a BAcC member local to you is able to offer you a few moments without charge to give a slightly better informed view of what might be possible based on a face to face assessment. If you look on our homepage at www.acupuncture.org.uk you will see a practitioner search function in the top right corner which enables you to use your postcode to identify people near you. We tried a random search based on a Chessington postcode and 13 names came up, at least one or two of which should be within easy reach. 

Q: ]I have a permanent horrible acid taste in my mouth, morning to night. And pain in the mouth. > I take protopump inhibitors but they make no difference. > I also suffer from vasculitis affecting the nerves in arms and legs. > Fatigue, anxiety goes with this. > Could acupunture help?

A:  This sounds like a complicated mixture of symptoms, and we have to admit that we enjoy cases like yours because very often the diagnostic systems of Chinese medicine can put together all of the problems in a single overarching diagnosis. However, here we shall take them one at a time.

The acid taste in the mouth is probably just that, if you are taking proton pump inhibitors, stomach acids which are finding there way
upwards. This is immediately suggestive to us of a hiatus hernia, where the incompetence of the muscular ring in the diaphragm allows the top of the stomach to protrude through, and thereby opens up a permanent conduit for acids to rise up with any action which squeezes the stomach, like bending over, or where the person lies flat. This needs to be addressed because the acid will
eventually start to cause problems in the oesophagus which can be more difficult to treat.

From a Chinese medicine perspective the acid or bitter taste is a sign of excessive heat in the system, and the practitioner will be looking at why this heat is being generated. The 'pain in the mouth' doesn't quite give us enough to work on. It may be a part of the same problem - acid reflux sufferers often get a persistent cough or sore throat, and in some cases this can extend to pains in the mouth, but without more detail we can't really comment. Our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/gastrointestinal-tract-disorders.html

gives a good indication of the kinds of research which have been done and how successful treatment may be.

As far as the vasculitis is concerned, again it is difficult to comment without greater detail. Vasculitis is a relatively rare condition
with many cases going into remission without needing treatment. There is nothing of consequence in the research databases about this specific manifestation, which is not surprising given the rarity of the condition.

Our advice to enquirers is very often to visit a local BAcC member for a brief face to face assessment, but in your case we believe that this is essential if you want the best possible advice. As we said at the top of the email Chinese medicine has complex diagnostic processes based on an entirely different understanding of how the body works, and it is often possible to make sense of symptoms which from a western perspective have no connection at all. Our first thought was to be intrigued and we suspect any colleague you visit will be too.

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