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Ask an expert - body - abdomen / gastro intestinal

38 questions

A:   There are no specialists within the BAcC in the treatment of IBS. This is not because we lack expertise; there are hundreds of extremely experienced practitioners, and the standard of graduate entrant is also very high. The issue is that Chinese medicine primarily treats the person, not the condition, so for every twenty people who have the generic label 'IBS sufferer' there may be twenty different diagnoses in Chinese medicine, each requiring a different treatment strategy. To that end, every practitioner is properly equipped to treat every patient whom they see according to Chinese medicine principles.
 
This is, of course, very different from saying that acupuncture can help every named condition. There are many conditions where treatment will only have a marginal effect, say, for example, in the treatment of Type 1 diabetes. However, there are always aspects of someone's health which can be improved, even if only at the level of helping someone to be better able to cope with what they have.
 
IBS is, in fact, one of the more common problems with which people present, and we recently answered a specific question about IBS in which were the paragraphs:
 

Q: Can acupuncture be an effective treatment for serious IBS issues? Medical diagnosis recently has indicated that the lower intestine and bowel are severely inflamed and twisted. The only recommended treatment is a drug which is also used as an anti-psychotic, with serious side effects. I am seeking a treatment regime more sympathatic to the body but do not know if acupuncture could work.
 
A:  We have produced a factsheet on IBS

 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/irritable-bowel-syndrome-ibs.html
 
which summarises the overall position and makes reference to a number of research studies which show that acupuncture treatment may well have a significant benefit for the IBS sufferer.
 
However, in our experience the diagnosis of IBS is usually nowhere near as specific as the one which you have, which seems to indicate visible changes in the bowel and its position within the lower abdomen. The majority of cases are mainly, it often appears, diagnosed on the basis of reported symptom, and are often addressed by changes to diet and various strategies which help to reduce the stress which seems to aggravate the condition...........
 
..............The best course of action is to discuss the situation with a BAcC member local to you. We are confident that they will be able to give you much more specific advice based on a face to face assessment of what is going on from a Chinese medicine perspective.


 

Q: Can acupuncture be an effective treatment for serious IBS issues? Medical diagnosis recently has indicated that the lower intestine and bowel are severely inflamed and twisted. The only recommended treatment is a drug which is also used as an anti-psychotic, with serious side effects. I am seeking a treatment regime more sympathatic to the body but do not know if acupuncture could work.

A:  We have produced a factsheet on IBS
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/irritable-bowel-syndrome-ibs.html
 
which summarises the overall position and makes reference to a number of research studies which show that acupuncture treatment may well have a significant benefit for the IBS sufferer.
 
However, in our experience the diagnosis of IBS is usually nowhere near as specific as the one which you have, which seems to indicate visible changes in the bowel and its position within the lower abdomen. The majority of cases are mainly, it often appears, diagnosed on the basis of reported symptom, and are often addressed by changes to diet and various strategies which help to reduce the stress which seems to aggravate the condition.
 
In your case, however, it sounds as though there is a very clear pathological change in the gut, and we would always advise patients in your situation to follow western medical advice about medication in the short term to bring the problem under control. Contrary to what many people believe, though, acupuncture and conventinal treatment are not an either/or. That is the true virtue of being a complementary therapy; it can work alongside conventional medicine. That is not to say that we do not believe that conventional medicine does not put a strain on the system, and just as the medication usually has a long list of side effects which appear in the factsheets which come with them, so from a Chinese medicine perspective there are going to be parts of the system which suffer slightly from processing the drugs. However, everything has to be seen in its wider context. The positive effects of the medication reduce pressures on other areas, and good acupuncture treatment will support both the reduction in symptoms and the pressure on the parts of the system coping with the medication.
 
We usually recommend that people have acupuncture treatment alongside the conventional treatment because the first priority is to bring the problem under control. We are sure that your GP will not want to carry on prescribing medications any longer than is necessary, and if the symptoms do subside, you can discuss with the GP how to reduce the dose and eventually stop taking them. We are certain from the evidence available that regular acupuncture treatment after that will help to control any recurrence of symptoms.
 
We are sometimes asked why we simply don't recommend acupuncture as an alternative to medication, but our view is that each person is unique and different, and to make such a recommendation sight unseen could have serious consequences. If, however, the symptoms are stable and bearable and your GP is happy to delay the start of the course of drugs for a month or six weeks, you could probably have enough treatment over that period to see what benefits acupuncture treatment may offer. If there was a reduction in symptoms, then you could maintain a watching brief with the GP over the next three months.
 
However, we offer this advice with some caution, because we cannot judge from your brief description of your case just how serious the problem is, and we would not want to have encouraged you to delay conventional treatment if your GP and your consultant are anxious that your start as soon as possible.
 
The best course of action is to discuss the situation with a BAcC member local to you. We are confident that they will be able to give you much more specific advice based on a face to face assessment of what is going on from a Chines medicine perspective.

Q: My husband is suffering from sever rectal pain. He has not been able to sit down for over 3 weeks. He has had a colonoscopy and has been diagnosed with anismus.  Would acupuncture help his condition?

A:   We are sorry to hear that your husband is in such pain, and wish that we were able to say with confidence that acupuncture treatment would be of benefit. However, as far as the research goes, which is the only basis on which we are able to make claims to efficacy, there is very, very little. This probably has a great deal to do with the fact that conditions like tenesmus and anismus often spontaneously reverse, and are therefore quite difficult to research because gathering a trial and control group is hard. The other problem is that most people are trying just about everything at the same time, so a clear difference between acupuncture and acupuncture plus the normal treatment is not easy. Most people simply say 'throw everything at it.'
 
Clearly from a Chinese medicine perspective, based as it is on the underlying belief in an energy, called 'qi', and the understanding of its balance, flow and rhythm, there are ways of looking at conditions like this which are different from a conventional western medicine understanding. These could range from a simple consideration of what is flowing in the area, i.e. which channels might be affected, to a functional concern, i.e. which part of the system maintains good function in the end of the colon and rectum, and a broader look at what might have caused the problem to begin. The ancient Chinese, for example, had a very complex understanding of the effects of heat, cold and damp on the system, and very often attributed griping and spasmodic pain to the invasion of cold into a body orifice. For a race which was largely agricultural this kind of phenomenon was seen to be based on common sense. Although it is not as common in modern life to be exposed to extremes of climate in this way we have seen several cases where people have literally been exposed to cold breezes while inadequately dressed and suffered symptoms such as these.
 
From the Chinese medicine perspective, however, there would also be other signs and symptoms in the patient's presentation which would guide the practitioner's strategy, and these might just as easily point to a systemic problem of which your husband's symptom was a small manifestation.
 
Our only advice in cases like this is to visit a BAcC member local to you and seek their advice in person. This is the sort of case where there is no effective substitute for discussing with the patient what is happening, and offering a more rounded judgement on the potential benefit of acupuncture treatment.     

Q:  I have had chronic nausea for two years. Many investigations have not found a cause.   I am on antidepressants at the moment. Can accupuncture help me?

A: As our factsheet on nausea shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html
 
acupuncture treatment has been used with some success in treating a number of specific types of nausea, mainly those ones where there is a clearly defined cause which enables an acceptable research protoco, to be drawn up.
 
In Chinese medicine itself there are a number of well-recognised protocols which have been developed over the last two months for understanding not simply the symptom but its possible cause in Chinese medicine terms. There are a number of disturbances of functions of the Organs (always capitalised when we talk about Organs because the Chinese concept is far wider than the physical organ of coventional medicine) which can lead to nausea, and the art and skill of the practitioner is in determining which of these patterns or syndromes need to be addressed.
 
Although we would feel optimistic, based on our clinical experience, that acupuncture treatment may be of benefit, each case is unique and different, and it would be important to set measurable outcomes and set review periods if you did decide to have treatment.
 
However, you mention that you are on anti-depressants, and this raises two issues. Firstly, in conventional medical terms, the nausea may simply be a side effect of the drugs you are taking. Although most people who experience a reaction to a medication find that the effect is almost immediate, there are some for whom this kind of reaction develops over time. It may be worthwile exploring with your doctor whether there is another tablet from the same group which you might try to see if this reduces the nausea.
 
The other issue is that from a Chinese medicine perspective medications are dealt with by Organs, primarily the Liver and Kidney, which can be put under a constant low grade strain by having to process the chemicals. There are a number of Liver syndromes for which nausea is one of the presenting symptoms, and it may be that while you are taking medication this may always be a concomitant factor. A skilled practitioner should be able to support these functions and reduce the side effects.
 
It is important, though, that if you find not only that the nausea reduces but also your overall mood lifts through having treatment, as is sometimes the case, that you keep your GP in the loop about any changes to your medications. We occasionally have patients whose improvements encourage them to stop taking their anti-depressants, and sudden stopping of the tablets can cause a rebound effect which makes the condition recur, only more severely. Most GPs are happy to discuss planned reductions in medication. 

Q:  Can acupuncture help with anal fissures? Drugs that relax the anal muscle are effective but cause nasty side effects, and surgery can cause incontinence, so I'm looking for alternative therapies.

A:  As you might expect, there is very little research into the treatment of anal fissues, at least not to the standards taken as the norm for approval in the west, the so called randomised double blind control trial. There is quite a great deal of research from China, much of which has not been translated, and a leading American praactitioner and author, Bob Flaws, mentions one such study on his website.
 
http://bluepoppy.com/cfwebstore/index.cfm/feature/1258 [this link is now defunct; no replacement since this piece was written]
 
The important section of this article for the non-acupuncturist reader is at the end where he describes in the technical language of TCM what is happening. Anal fissues are not a new phenomenon, and in the two thousand year history of Chinese medicine strategies and models have been developed both for understanding why they occur and for treating them. Chinese medicine is premised on an understanding of the body mind and spirit as a complex inter-related flow of energy, called 'qi', and its patterns of flow, rhythm and balance. The factors which disturb this flow are separated into external; and internal patterns, and ranging from emotions such as anger and grief through to external causes like getting over-cold or spending too long in damp conditions. Whichever the source of the cause, external or internal, its effects are often described in the language of external factors, and anal fissures would probably be described in terms of heat and dryness, this being what characterises them for the poor sufferer.
 
The great skill and art of the practitioner is to be able to understand them not as symptoms by themselves but as part of a wider pattern of disharmony in the body which will inform a much more accurate diagnosis,and with this hopefully a much more effective treatment. If there is heat and dryness in the system one might be looking for other signs of this, like constipation or skin problems, things which a patient might not consider remarkable in themselves.
 
There is no doubt that if the symptom can be placed in a wider context, then the effects can be very palpable, as this patient account highlights:
 
http://www.patient.co.uk/forums/discuss/acupuncture-for-anal-fissure-27239
 
However, the techniques used in the study cited by Flaws were very much more symptom orientated, so it is not an absolute requirement. At the other end of the Chinese medicine scale there are styles which treat the person, not the symptom, and these can be just as effective. The underlying premise of all is the same: the energy of the system has been compromised and it is a matter of finding the most appropriate and effective way of restoring its proper flow.
 
Our advice in these cases is always to see a practitioner face to face for a brief assessment of what they think is possible, and we always add the caution that for conditions like these where the research base is thin that you build in clear review periods, if you do decide to have treatment, and also try to establish measurable outcomes, i.e. things which clearly demonstrate if there has been a sustained improvement.
 

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