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Ask an expert - neuro and psycho logical

222 questions

Q:  My husband was diagnosed with Parkinsons disease some 11 years ago and has been on medication which fortunately has been successful with the exception of a shaking right arm. He has some control over it but it causes him stress and embarrassment. Do you think acupuncture may relieve this problem.

We tend to be a little tentative in offering advice on conditions like Parkinsons which are often chronic and degenerative. A typical response that we have given in the past reads:
 

From the perspective of research studies alone it would be difficult to give any firm recommendations for acupuncture as a treatment of Parkinson's Disease. There are a number of studies, some undertaken in the US but the vast majority in China, which show some positive signs, but not of sufficient change in a significant number of patients under study to draw any firm conclusions. You can see some of the studies if you google 'ncbi acupuncture parkinson's disease' - the National Centre for Biotechnical Information in the States is a convenient way to find many of the the more significant papers. There is also a Cochrane Review of a protocol for assessing the value of acupuncture, but as far as we are aware this has not been put into action yet.

With all chronic degenerative conditions the extent to which acupuncture can help has to be carefully explained. It is often, as one rather ironic patient said, a case of 'getting worse slower', and this is extremely difficult to quantify in a condition like Parkinson's where the disease progression is neither smooth nor predictable. Anecdotally there are many accounts of patients finding that treatment helps with some of the manifestations of the disease, such as the periods of rigidity and freezing, and a general sense of well-being, but these are not documented sufficiently well to be able to claim any undisputed levels of efficacy.

The best course of action is to see whether a BAcC member local to you will give you an honest assessment from an eastern perspective of what they might be able to achieve for your own unique patterns. There may be elements of how the condition manifests which they may feel that they can help.

As you can see, we are very cautious in our choice of words. The shaking of the arm with Parkinsons has been tested in some small studies, as in this one

http://www.ncbi.nlm.nih.gov/pubmed/12210879

and there is some optimism in the write-up but it is a very small study.

From a Chinese medicine perspective there are a number of syndromes which describe the shaking of the limbs, and which provide explanations of them in the terms which we use as practitioners. This can sometimes cause a little confusion because it gives an impression that a symptom which is treatable in Chinese medicine may mean that the same symptom might be easily treatable from a western perspective. Where there is a physical change in the brain, however, it would be unwise to get too excited about the possibilities.

In any situation like this, though, we find that it does not help to be negative because there may be multiple reasons why someone's tremor might be quite bad, not least in the fact that stress itself can make the symptoms of Parkinsons more noticeable. We have found in clinical practice that reducing stress can sometimes make the frequency and severity of symptoms reduce, and it would certainly be worthwhile talking to a BAcC member local you you about what may be possible.

 

Q:  I have been seeing things on the internet that a daith ear piercing helps with migraines. Is there any truth in this?

A:  It is a fair bet that everything will work for someone. The real issue is finding something that will work for everyone.

Ear acupuncture is a relatively modern phenomenon, developed largely by a French neurologist called Paul Nogier in the late 1950s. There are some classical and traditional antecedents, but it is a mainly modern practice. From our understanding of the sections of the ear where the Daith piercings are inserted have no direct connection with points as understood after Nogier which might have an impact on migraines. That said, we would be the first to say that there are no specific points for migraines, and if an imbalance in the system which was the root cause of a migraine-causing imbalance happened by chance to be treated by the Daith piercing it is possible that it may have an effect.

We have borrowed this short section of text from the website of an American practitioner who has researched this practice thoroughly because we believe that this is about the best that you can say:

  • The daith does not come anywhere close to stimulating points that acupuncture experts use to treat migraine headaches.
  • Clinical experience suggests that body piercings offer temporary (1-2 weeks) therapeutic benefit at best. They definitely do not represent a long term cure for any condition, including migraines.
  • The daith is an advanced piercing that is often done incorrectly and with inappropriate jewelry. A bad piercing and/or the wrong jewelry is likely to result in excessive pain and serious problems with healing, including the formation of unsightly (and sometimes permanent) bumps around the piercing, as well as potentially serious infections.
  • All cartilage piercings require diligent aftercare (including daily washing and soaking with saline) for the entire six month period of time that it takes to heal. During the healing period ear buds and swimming must be avoided.

Most of this is not exactly unfamiliar territory to those having normal ear piercing. Ear infections are not only painful but far too close to the brain and other delicate structures to be allowed to develop. However, we understand that this type of piercing in this area is slightly more dangerous, although for a professional assessment you might have to talk to someone who specialises in this kind of work.

We would be remiss if we did not mention that traditional acupuncture has a good record in treating migraines, as our factsheet shows

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

and as the recommendation by NICE for acupuncture in the treatment of chronic headaches shows. If you are a migraine sufferer you might want to seek the advice of a BAcC member local to you about what treatment may be able to offer. 

A:  The evidence for the use of acupuncture to treat migraines and tension type headaches is encouraging enough that NICE, the National Institute for Health and Clinical Excellence has recommended it as a treatment for many types of headache. Our two factsheets#

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

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

provide details of a great deal of the research which has been undertaken.

As you can imagine we are asked this question quite frequently, and a recent answer included the following paragraphs:

When we conduct online surveys of the main reasons why people consult a BAcC member headaches in one form or another appear in the top ten reasons.

However, we have to be a little cautious. The great strength of Chinese medicine is that it understands the symptom within its overall context, and that does mean that while the majority of people will experience some benefit there will always be those whose overall balance means that short term success is less likely. On the other hand, the majority of research trials tend to be undertaken with formula acupuncture in order to meet the criteria espouse in the West, where the outcome is the only variable, and we have long argued that this is not the best way to test a system which is geared to the individual and where treatment evolves as the patient progresses. In many cases this refinement of treatment generates much better results than the orthodox trials suggest are likely, but until we come up with ways of preserving the integrity of what we do in a research setting we are where we are.

The best advice we can give you is to visit a BAcC member local to you for a short face to face assessment. Most of us are happy to give up a few minutes without charge to assess whether acupuncture is the best treatment for what troubles you, and this will also give you a better idea of what we do, who you might see and the surroundings in which they work. We find that this means prospective patients feel more empowered in making their choices rather than simply being booked in sight unseen.

We think that it is important to add riders like this. Research very often uses formula treatments, and this goes against our ethos of treating the person, not the condition, of seeing symptoms in their overall context. Just as there are occasions when an individualised treatment will exceed formula treatment in effect, there are equally occasions when formula treatment will not be appropriate, nor will individualised treatment be much better. Talking to a practitioner before committing to treatment is a wise move.

On the whole, however, headaches of all kinds tend to be a major element of day to day practice, and most of us approach treatment with quite a great deal of confidence


Q:  I have been diagnosed with Schizo Affective Disorder. I recently have formed a growth on the bridge of my nose as well. I read somewhere that phlegm in connection to the heart could be the cause of my problem. However,  the underlying factors may not be just because of my spleen, they may be because of liver or kidney function. How would I be able to trace where exactly my problems began? 

A:  One of the problems with the increasing availability of western textbooks which offer considerable detail about Chinese medicine and the syndromes, especially within TCM, is that there has been a developing tendency to reverse diagnosis. This is not simply with patients but often practitioners too. This is not meant to be critical; we are happy that people really find the work we do interesting enough to read up on it! However, the information has to be used with care.

It is true that some of the symptoms of schizoaffective disorder match quite closely the Chinese descriptions of Phlegm Fire Misting the Mind and so on, and there are rare but dramatic occasions where treatment can have a very powerful effect. This 'expert' had a patient whose behaviour became increasingly erratic but was probably not helped by the fact that she was eating the best part of a pound of cheddar cheese every evening. Stopping the cheese and resolving the phlegm made a dramatic difference.

However, these kind of cause-effect results are rare. Phlegm often arises in the system, but the subtle interplay of the Organs as functional units could mean that imbalance could lie anywhere in the system, and simply manifest as a symptom in phlegm and its consequences. Diagnosis involves a complex process of understanding aetiology and pathology in Chinese terms and then using some of the bedrock techniques like looking at the tongue and taking the pulse to home in on the most efficient way to restore balance. This might involve resolving the phlegm alone, or in conjunction with other treatment, or even in treating something entirely different in the knowledge that this will have a cascade effect through the system. Indeed, the very ancient traditions of Chinese medicine were often asymptomatic, treating the constitution alone in the simple belief that a system in balance sorted out all of its own problems.

So, without wanting to sound as though we practise some kind of arcane art it would be very difficult to point to an absolute and defined pathway from a symptom back to an underlying cause without reference to the unique imbalances of the individual. We are not alone in this. The great Canadian physician William Osler once said ' don't tell me about the disease the patient has, tell me about the patient who has the disease.'

Often there is a dynamic interplay within an individual's system which means that treatment can change week to week, especially where a symptom develops a life of its own. Treatment of root or branch is an important consideration when a practitioners works with a complex pattern, and there are some very subtle judgements in play. Probably the best, and only, way that you are going to be able to make sense of the situation is to visit one of our members local to you and ask their advice about what may be possible, and a view of what is taking place. Some may baulk at being put on the spot, but most members are happy to give an idea of what they can see from a brief assessment and then discuss how well treatment may be able help.

 

Q:  I read your answer to  another person about shaky hands. The answer is not in a straight forward manner and vague. Please clearly and directly tell that can acupuncture play an effective role in tremor management?. 

 

A:  We are sorry that you found our answer vague.

There are two reasons why we could not say with certainty that acupuncture will be an effective treatment for essential tremor. The most important one, which all of our answers on tremor say, is that Chinese Medicine treats people, not symptoms, and so there are no guaranteed treatments for specific conditions. From our perspective the same symptom could arise in a dozen people and be treated in a dozen different ways. The exact treatments will be geared to the individual, and a great deal will depend on their overall state of health and balance. Clearly a young person with good energy is likely to respond a little more quickly to treatment than someone of 70 years of age who has lived a hard life. However, even that is not a certainty; we have seen patients of 90 who have responded magnificently to treatment.

The other reason that we cannot give a more definite answer is that all advertising and marketing on the internet is now governed by the same restrictions as print media. The Advertising Standards Authority has very strict rules on claims for efficacy, and in healthcare provision the bar has been set at the level of randomised double blind control trials. This criterion of research works well for drug trials but is inappropriate for acupuncture treatment (and surgery!), which is why there is a very small number of problems for which we can make unequivocal claims for efficacy. This is in spite of the fact that there are many thousands of studies which show very positive results.

This is why we are cautious in what we say, but also why we recommend in nearly every case that the best way to find out whether treatment may be beneficial is to visit a local BAcC member for an informal assessment of what may be possible. A practitioner who sees the symptom in the context of the person's overall health is likely to be able to give a much more useful opinion than we can at a distance.

We are sorry if this sounds equally vague.

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