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Ask an expert - neuro and psycho logical

222 questions

Q:  I am currently having acupuncture by a Chinese trained TCM practitioner for a respiratory infection. She has suggested taking Chinese herbs as a tea to boost my immune system in addition to acupuncture.

I have bipolar affective disorder (manic depression) and know that some immune supporting Chinese herbs are not suitable as they could trigger a manic episode. My previous acupuncturist would leave some herbs out of her immune mix - but I don't know which ones!

The Chinese acupuncturist I am currently seeing speaks fairly good English, but I am not sure she has understood why I am cautious about taking herbs as I'm not convinced she understands what bipolar is or the potential risks associated (psychotic episode requiring hospital admission).

Please could anyone provide a list of Chinese herbs that are not suitable for someone with bipolar (in Chinese and English if at all possible please). I would like to show the acupuncturist a list of contraindicated herbs in bipolar before agreeing to take Chinese herbs as tea.

A:  It is a rather anomalous fact that Chinese medicine, which is largely acupuncture and herbal medicine, is represented by two parallel sets of organisations in the UK. This has a great deal to do with the fact that there was a strong tradition of medical acupuncture and western herbs already in existence, and the separate elements of TCM grouped around them.

As a consequence, although we have a number of members who practise Chinese Herbal medicine their herbal medicine regulation is undertaken by the Register of Chinese Herbal Medicine, to which most of them belong. The expertise necessary to respond to your question lies there, and I am sure that if you contact them at http://rchm.co.uk/ they will be more than happy to oblige with the information which you need.

The RCHM is a smaller organisation than the BAcC, and not quite so well resourced, so it may take a few days before you get a response.

 

Q:  I am currently having acupuncture by a Chinese trained TCM practitioner for a respiratory infection. She has suggested taking Chinese herbs as a tea to boost my immune system in addition to acupuncture.

I have bipolar affective disorder (manic depression) and know that some immune supporting Chinese herbs are not suitable as they could trigger a manic episode. My previous acupuncturist would leave some herbs out of her immune mix - but I don't know which ones!

The Chinese acupuncturist I am currently seeing speaks fairly good English, but I am not sure she has understood why I am cautious about taking herbs as I'm not convinced she understands what bipolar is or the potential risks associated (psychotic episode requiring hospital admission).

Please could anyone provide a list of Chinese herbs that are not suitable for someone with bipolar (in Chinese and English if at all possible please). I would like to show the acupuncturist a list of contraindicated herbs in bipolar before agreeing to take Chinese herbs as tea.

A:  It is a rather anomalous fact that Chinese medicine, which is largely acupuncture and herbal medicine, is represented by two parallel sets of organisations in the UK. This has a great deal to do with the fact that there was a strong tradition of medical acupuncture and western herbs already in existence, and the separate elements of TCM grouped around them.

As a consequence, although we have a number of members who practise Chinese Herbal medicine their herbal medicine regulation is undertaken by the Register of Chinese Herbal Medicine, to which most of them belong. The expertise necessary to respond to your question lies there, and I am sure that if you contact them at http://rchm.co.uk/ they will be more than happy to oblige with the information which you need.

The RCHM is a smaller organisation than the BAcC, and not quite so well resourced, so it may take a few days before you get a response.

Q:  I have just been dignosed with fibromyalgia and was wondering if there is any were I can get information leaflets, books etc on it and any  help I can get?

A:We can and do treat cases of trigeminal neuralgia (TN), and as our factsheet shows:

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

there is a growing body of evidence suggesting that acupuncture treatment may have a role to play in dealing with the symptoms.

However, this is one of those problems where we tend to be as realistic as possible, i.e. not making too much of the results from research. Our clinical experience has been that this can be a very intractable condition. One particular cause can be a misalignment of the tempero-mandibular joint, and if this appears to be the case we might well decide to refer someone to a cranial osteopath in the first instance to try to correct the joint. Even when this has been sorted, though, we do sometimes find that the condition can continue to be a problem. The research seems to show that acupuncture treatment alongside medication seems to work well, and can mitigate the effects of the drugs themselves.

Each case is unique and different, though, and this is very much the ethos of Chinese medicine. We regard each person as a unique pattern of energy flow and balance, and this can mean that for a named condition like TN twenty patients diagnosed with it might be treated in twenty different ways. This is a great strength, but it does mean that when we are asked 'does acupuncture treat x?' we are somewhat reluctant to give a definitive answer because it may depend on the patient. This is not just a traditional acupuncture view; the great Canadian physician William Osler often said 'The good physician treats the disease; the great physician treats the patient who has the disease.'

The best advice we can give is to pop along to a local BAcC member to get an informal assessment based on a brief chat about what might be possible. We are sure that this will give a well-informed answer, and equally sure that our members will be honest in their assessment about whether acupuncture treatment is in fact the best option for you.

Q:  My sister aged 31 had brain haemorrhage and paralysis on 30th March, 2016 (9:00 AM). She was 7 weeks pregnant that time thru IVF. Due to large infarcts in right brain, doctors went for craniotomy same day at 11:30 PM and she had 28 stitches in head.

After staying 6 days unconscious, and 22 days in ICU, she was brought home after 1 month from hospital. Now at home, her baby is normally growing and double marker test is fine. She is taking all foods from mouth directly, no support and no tubes.

But, she has no movement in her left hand and leg. Physiotherapy is going on. She is speaking well, brain working fine, memory is sharp.

Could acupuncture can help with  her paralysis?

A: We are really sorry to hear of your sister's problems; that must have been a terrible shock to all of you. It's good that she has made the recovery she has so far, and that the baby is well.

The nearest equivalent research that we have which can offer some positive hope of a good outcome is research into the use of acupuncture treatment in the recovery from stroke. On our website there is a rather dense review paper

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which goes through in great detail the various papers which show encouraging possibilities for the use of acupuncture treatment. It used to be the case, and is still likely to be, that acupuncture treatment was commenced on the day of a stroke itself. The Chinese medicine understanding of what is happening in a stroke or CVA is given the generic term 'wind stroke' and is seen as a disruption of the flow of energy in the channels caused by an uncontrolled upsurge in the head. The treatment strategy is very straightforward; restore proper flow in the channels or meridians on the affected side as soon as possible. Treatment would often involve a course of daily or even twice daily sessions for several weeks to try to restore energy flow as quickly as possible before the post-stroke pattern is established as a norm.

This always raises questions in the West, where if someone is lucky acupuncture treatment might be possible four to six weeks after the CVA itself, of whether a late start hinders the chance of recovery. We would have to be honest and say that the later start would possibly slow down progress, but not stop it. The received wisdom is that within the first year there is always something that can be done, but this is not a precise judgement. This expert has seen good changes in someone two years down the line and treated others within the year to no effect. It really is a matter of the individual circumstances and the strength of someone's constitutional energy. At 31 your sister has a better chance than many.

The confounding factor is the pregnancy. Generally we all try to treat with as little intervention as possible during the pregnancy, and there is now a solid strand of postgraduate training in acupuncture for pregnancy, fertility and childbirth that we are on the verge of defining what would constitute expert practice and the ability to define oneself as a specialist. It would be ideal if any practitioner your sister saw had this training. However, the issue here is what may have caused the infarct. From a Chinese medicine perspective there are a number of possibilities, the treatment of which alongside the pregnancy and the post-stroke recovery might call for a level of expertise and experience which not all of our members might feel that they have. You may have to ask around a little to see who might be the best person to see. We tend to be a very honest bunch, and we direct people to those colleagues who we think will be best for the patient's needs.

We hope that your sister finds acupuncture treatment beneficial, if she decides to go ahead with it, and that the rest of her pregnancy is trouble-free and rewarded with a happy outcome.

Q:  Would acupuncture ease pain caused by nerve pain following parotidechtomy. It's a type of trigeminal neuralgia.

A: This is quite a complex issue to address.

If you look on our website you will find a factsheet on neuropathic pain which deals largely with trigeminal neuralgia

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

and the evidence looks fairly encouraging. Our clinical experience, as we have written elsewhere in these answers, is that TN is one of the more difficult conditions to treat, and can be very intractable. Where it does respond to acupuncture treatment, the response can be quite rapid. We have also at various times suggested that cranial osteopathy might be a viable alternative if the problem has arisen where the trigeminal nerve passes the tempero-mandibular joint, which we often find to be out of alignment.

However, surgery brings with it a whole new range of possibilities, which from a patient's perspective is probably an advantage. Excision of tissue and the subsequent scarring can create residual pain through the nerve endings which have been cut and through the scar tissue which forms. In the case of the former there is a growing body of evidence for the treatment of phantom limb pain, where a severed nerve sends a signal from the missing part. We have answered questions on this a number of times, and a typical response has been:

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

In principle there is no reason why the same principle should not apply. If there has been unilateral damage, treatment of the opposite equivalent points combined with systemic treatment may be beneficial.

There is also an issue with scar tissue. There have been numerous examples of scar tissue causing a disruption in the flow if energy, understood from a Chinese medicine perspective, and generated some quite unpleasant pains as a consequence. We have sometimes found that very simple treatment at the site of the scar tissue can make a profound difference.

The best advice that we can give, and invariably do give, is to visit a local BAcC member for a more detailed face to face assessment. This will give you a better idea of what may be possible before committing to treatment, and will also give you a chance to meet the practitioner and see where they work before deciding how best to proceed.

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