Ask an expert - general

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Q:  My mother has been experiencing pain across the bridge of her nose, which causes considerable discomfort, especially when wearing glasses.    She has been to her doctor and had a MRI scan which has shown no problems. Her doctor now says that because there are no visible issues, there is nothing further they can do.

Could Acupucture help with this and what sort of treatment may be subscribed?

 

A: Although acupuncture treatment is very often one of the therapies most used for 'orphan' symptoms, symptoms which can't be placed within any recognised condition or disease pattern, we have to be careful not to give the impression that anything is treatable by acupuncture. The fact that Chinese medicine treats the person, not the symptom, can be mis-read as a claim to be a panacea, and there are clearly many conditions which are highly unlikely to respond to treatment.
 
Chinese medicine, though, is based on a fundamental premise that there is an energy, called 'qi', which in its many forms makes up the human body and mind and which treatments like acupuncture, herbal medicine and massage help to re-balance and improve the flow. In that sense it is probable that any of these treatments will always help the person to a degree, but whether they help a specific symptom depends a great deal on the factors which have made it appear where it appears. As a consequence most treatment is aimed at the overall picture and also at local or specific blockages. If something has been caused to block by, for example, the pinching effect of glasses on the bridge of the nose or behind the ear there is likely to be pain and discomfort, and locally placed needles may be able to reinstate good flow.
 
We know that many of our members work closely with osteopaths, especially those who use cranial osteopathy, and this might be another option your mother might want to consider. Minute variations in the way that the bones of the skill and face are positioned can be the cause of considerable local pain and also have an effect on other parts of the body.
 
The best advice, however, is to take your mother to a BAcC member local to her and ask their advice based on what they can glean from a face to face conversation. This will get you the clearest asessment of whether treatment may be beneficial.
 
 

 

 

 

Q: Can acupuncture help with hypoglycemia? I am also confused which type of acupuncture to choose because there is traditional Chinese or the type Jans de Vries uses which is dry needling but don't know which one would be better?

 
A:  Most of the research on the effects of acupuncture on hypoglycaemia is primarily concerned with the management of diabetes, and a great deal is done using laboratory animals, so the results are not always transferable to human physiology. The theories of Chinese medicine, however, are based on an entirely different conceptual structure based on an understanding of energy ('qi) and its flow and balance in the body. The practitioner uses his or her skill and experience to make sense of symptoms, which are the bridge between all systems of medicine, and to use needles, moxa and often in the case of digestive problems appropriate dietary advice to try to achieve a better balance within the system. Whatever the complexities of Chinese medicine as practised one of the fundamental beliefs is that if everything is in balance and functioning as it should symptoms should disappear. The symptom, from an eastern perspective, is a warning sign that the system as a whole is not working well, and is not necessarily the problem itself.
 
As far as different systems of acupuncture are concerned, you can do worse than read Jan de Vries' own description of what dry needling is
 
http://www.jandevrieshealth.co.uk/services.asp?int_service_id=22
 
to get a sense of where this system comes from. We are reluctant to say that one system is better than another. Jan de Vries' assessment that dry needling or western medical acupuncture is more commonly used for musculoskeletal conditions is probably correct, but that has a great deal to do with the fact that the use of western medical acupuncture within the NHS is strictly limited to those interventions for which there is an evidence base, and as we said above, the evidence for hypoglycaemia is pretty thin.
 
There is a considerable overlap between the different systems, not so much in theory as in clinical practice. We are bound to say, however, that we believe Chinese acupuncture, with its broad focus on the whole system, offers advantages in cases where things are not that straightforward. For simple musculoskeletal problems, however, there may be little to choose between all the systems of acupuncture (there are many!) unless there happens to be a more subtle cause for a symptom than is apparent from first gaze.
 
In our experience all reputable practitioners are willing to give some time to prospective patients to discuss what they do and offer their best assessment of what they think they might be able to achieve. Most are also very frank about the limits of their scope of practice. We would recommend that you talk to a few, perhaps of different systems, and decide which appeals to you. None will do you any harm, and there are likely to be some benefits from any system of acupuncture treatment.
 
 
 
 

Q: I am a nurse supporting a lady who has 2 DVT's in the past and is currently on warfarin. She is looking to have a course of acupuncture to improve circulation. Is this something you think would recommend?

 

A:  There is very little published research which points to the successful use of acupuncture in the treatment of DVTs. Generally management is by medication, and BAcC members will be very clear about not interfering with any long term prescriptions in cases such as DVT where settling and maintaining the INR level can take a long time.
 
However, there is no doubt that within its own terms of reference Chinese medical theory offers some solutions to some of the functional disorders which DVT is seen to represent in both the quality of the blood in the vessels and also in the ability of the body to maintain sufficient venous power to enable good return. A BAcC member may be able to identify specific weaknesses in the system whose correction and improvement may achieve some improvement in venous return. Even where this is not the case, the overall aim of re-balancing the body's energies as a whole may still help to correct symptoms, wherever they appear.
 
BAcC members are trained to be very careful in the needling of patients taking anti-coagulant medications. Our advice to them, published in an internal document called the Guide to Safe Practice says:
 

 

Patients on anti-coagulant medication

 

You must take great care when needling patients who are taking anti-coagulant drugs such as Warfarin. Only very superficial needling with fine needles (0.20mm) is recommended.

 

 

 

The risk appears small but internal bleeding leading to compartment syndrome can have extremely serious consequences. There is one report in the medical literature of a case of compartment bleeding following acupuncture in a patient taking anti-coagulants (see link to article at the end of this section).

 

 

 

Warfarin prevents the body from metabolising vitamin K. Vitamin K controls the formation of a number of coagulation factors in the liver and is an essential substance for blood clotting. Vitamin K is present in most of the foods that are considered to be blood-forming according to Chinese medicine such as green leafy vegetables. This is important to consider if you are giving dietary advice to patients on Warfarin since these foods can lessen the desired effect of the drug.

 

 

 

Patients are put on Warfarin or other anti-coagulants for a number of different reasons. These may be purely preventive if, for example, the patient suffers from atrial fibrillation or has mechanical heart valves, or because of recent surgery, stroke, heart attack or thrombosis. The dosage of the medication depends on the desired amount of anti-coagulation for that particular condition.

 

 

 

Every patient on Warfarin has to undergo tests on a regular basis to check how long it takes for their blood to clot. The frequency of these tests depends on the dosage of their medication and their condition. It is good practice to encourage your patient to have more frequent tests while they are receiving a course of acupuncture as the treatment can positively influence their blood values and may require their Warfarin dosage to be reduced.

 

 

 

Ask your patient for their INR (international normalised ratio). The INR is a ratio established by measuring the prothrombin time (PT), which is the length of time it takes for the patient’s blood to clot, and then by comparing this value to an average.

 

 

 

In a healthy person the INR is about 1.0. Patients on Warfarin tend to have an INR somewhere between 2.0 and 3.0 or even higher, depending on the desired amount of anti-coagulation. A higher INR signifies a stronger effect of anti-coagulation.

 

 

 

The main risk associated with acupuncture is internal bleeding. Depending on the depth of needling and the underlying structures involved this may be insignificant, but there is a chance that it can result in compartment syndrome. Although the risk is small this condition can have serious consequences and often requires surgery.

 

 

 

Needling should only be done superficially and with fine needles. The higher the INR, the greater the risk of bleeding. Patients with an INR of 3.5 (sometimes therapeutically necessary in the treatment of valvular disease) or higher should be treated with greater care.

 

 

 

It is also advisable not to use guasha and cupping on patients on anti-coagulants since these techniques tend to draw blood to the upper layers of the skin and can cause severe and prolonged bruising to larger areas of the body.

 

 

 

Further information and research articles can be found on the internet. Here are a few examples:

 

www.medicalacupuncture.com/aama_marf/journal/vol13_2/case4.html

 

www.doctorslounge.com/hematology/labs/inr.htm

 

http://aim.bmj.com/cgi/content/abstract/20/2-3/105

 

 

It is worth asking a BAcC local to you for their professional view of whether they think, based perhaps on a short interview with the patient, that acupuncture might be beneficial in her specific case. In the hands of a properly trained and qualified professional it will certainly not do any harm.
 
 


 

 

Q: I suffer from severe hyperhydrosis, (severe excessive sweating), specifically of the head, face and neck. This condition is very distressing and frankly is ruining my life. Please can you tell me if acupuncture is an appropriate therapy for this condition? I have had acupuncture previously (about 15 years ago) for back pain, and it worked beautifully, and I thoroughly enjoyed the sensation, I found it very relaxing.

 

A:  We have been asked this question before and we replied:

 

 

 

We always stress in cases such as yours that the different way of looking at the body and its functions in Chinese medicine can sometimes offer additional possibilities for treatment. Although, as we said, there is not a great deal of research evidence accepted in the West, in China nearly every condition has been researched at some stage, including hyperhydrosis. Results are often slightly equivocal - the question becomes not 'does it work?' but 'how much does it work and how sustainable is the improvement?' - but this reflects life; some people improve after treatment, others don't.
 
We can say with certainty that treatment at the hands of a properly trained and qualified practitioner will not do you any harm, and the practitioner may, by assessing your problem in the light of what else is happening in your system, be able to offer some help. The best advice, as always, is to contact a BAcC member local to you and ask their advice face to face.

 

 

 

We would add, though, that if you have had some success with acupuncture treatment before this bodes well. We often find that 'good responders' enjoy similarly good results from treatment for a variety of ailments. The underlying theories of acupuncture often ascribe the changes achieved by treatment not to the specific treatment of symptoms but to the re-establishment of the overall balance. If someone has a symptom which responds to this overall re-balancing, it is probable that other symptoms will be amenable to treatment.

 

 

 

 

There is very little published research for the use of acupuncture in the treatment of cystic fibrosis. If you google 'ncbi acupuncture cystic fibrosis', NCBI being an American resource for healthcare information, you will find one or two reviews of the paediatric uses of complementary medicine which suggest that there may be some benefit in using acupuncture and other complementary medical treatments alongside conventional treatment, but as is often the case, there is a call for better research which we are fairly sure has not yet been heeded - research is expensive.
 
However, it would be unfair to be so weakly positive. Chinese medicine has an entirely different way of looking at the human body and its energy flows, and the symptoms of the disease labels of western medicine are often dis-aggregated and understood within an entirely different conceptual structure. This does not mean that anyone would claim that a condition like cystic fibrosis would be treated successfully, i.e. removed, but it may mean that some of the symptoms which condition generates might be helped, and given the distressing nature of these, small changes are often very welcome.
 
In Chinese medicine, however, each person is seen as a unique individual, and there are no general statements which one could make which would be better than asking the advice of a practitioner face to face. We would recommend that you contact a practitioner local to you to discuss a specific presentation of the problem. Acupuncture will certainly not do any harm alongside other treatment, and there are preliminary indications that it may be of benefit.
 
 

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