Following the recent episode of Dragon’s Den in which a contestant presented a proposal for an ear seed business the BAcC has received inquiries about this form of therapy and acupuncture for myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).
The current evidence-base: acupuncture ME/CFS
In the last 20 years a considerable amount of research has been conducted into acupuncture. However, the majority of the high-quality clinical trials have investigated chronic pain conditions such as: low back pain, headache, osteoarthritis of the knee and shoulder pain. These have been compiled in individual patient data meta-analysis that indicates acupuncture is effective for these chronic pain conditions, the benefits last for at least a year and is not purely placebo effects (Vickers et al, 2018).
Unfortunately, chronic fatigue syndrome has not been investigated to the same degree. The studies that have been conducted are often of low quality. The vast majority of studies have been conducted in China. This creates an extra layer of difficulty in assessing the relevance of this evidence to people in the UK. The number and frequency of treatments given in Chinese studies is often higher than typically given in the UK. As many people must access acupuncture privately the expense can limit the number of treatments. The recent systematic reviews suggest that acupuncture may be beneficial for those with chronic fatigue syndrome (Factsheet). However, these reviews also note that until high-quality clinical trials are conducted, it is not possible to be confident in these results.
CFS and traditional acupuncture
CFS/ME is a complicated condition. The BAcC represents practitioners fully trained in the traditional theories. This is a holistic practice. A traditional acupuncturist does not base treatment on the diagnosis of ‘chronic fatigue syndrome’ or ‘myalgic encephalomyelitis’. They will take a full case history and arrive at a diagnosis using the traditional theory. This diagnosis is called 证 zhèng. Zhèng is usually translated as pattern. Even for conditions where the signs and symptoms are fairly consistent, such as osteoarthritis of the knee, patients can be diagnosed with different zhèng-patterns. This means that patients with osteoarthritis of the knee we will get slightly different treatments depending on their overall signs and symptoms.
CFS is far more complicated, beside the tiredness there may be other significant symptoms such as pain, headaches, insomnia, flu-like symptoms. A standard Chinese medicine textbook may list 20 zhèng – patterns associated with tiredness, 17 with headaches, and 9 associated with insomnia. Therefore, people with CFS/ME will often receive different treatments. Whilst there is some overlap, different acupuncture points will be selected depending on the pattern. In addition, some of these patterns may require the use of moxibustion not just needles. This is a complicated issue and probably can only be fully understood through studying the traditional theories. However, hopefully, the central point is clear: there is no one-size-fits-all treatment for conditions such as chronic fatigue syndrome.
The evidence from China suggests that combinations of acupuncture and moxibustion plus Chinese herbal medicine may lead to the best outcomes. It may well be that an integrated approach, where individuals select the modalities that they find most useful, is the best way forward. However, this level of complexity does not readily fit with the current gold standard research of randomised controlled trials.
Ear seeds and ear-acupuncture
At present, we are unaware of any clinical research that has evaluated ear seeds alone for CFS/ME. The clinical research conducted in China uses body acupuncture as the first line treatment which is often combined with moxibustion. Ear seeds may be used as an adjunct to the acupuncture treatment. From a traditional acupuncture perspective the ear seeds need to be located precisely on specific points. Therefore, it is not possible to self-administer the ear seeds. The advantage of ear seeds is that they are held in place by tape and can remain in the ear for days. Once in place, people can stimulate the points themselves by pressing the seeds.
Unfortunately, due to the lack of high-quality clinical trials it is currently not possible to draw firm conclusions about the benefits of acupuncture for chronic fatigue syndrome. However, the evidence that does exist indicates that acupuncture and moxibustion may have positive benefits.
For those with chronic fatigue syndrome, who are interested in trying acupuncture, we recommend finding a BAcC practitioner who will be able to tailor the treatment to address your ‘zhèng-pattern’. An initial course of four to six treatments should enable you to gauge whether acupuncture is beneficial for you.
To assess the benefits of acupuncture in the UK setting, it is essential that high quality clinical research is undertaken. This will require funding. The British Acupuncture Council is willing to collaborate in research projects with universities, charities, government bodies.
British Acupuncture Council
The British Acupuncture Council (BAcC) guarantees high standards of training, safe practice and professional conduct.
Look for the letters MBAcC after the name of your acupuncturist to be sure of:
- extensive training – minimum three years degree level – with relevant western medicine including anatomy and physiology
- adherence to the BAcC codes of safe practice and professional conduct
- compliance with current health and safety legislation
- full cover for medical malpractice and public/products liability
- mandatory continuing professional development to keep knowledge and skills up to date
The BAcC is an Accredited Register with the Professional Standards Authority for Health & Social Care (PSA). The PSA protects the public by overseeing the regulation and registration of healthcare professionals – including statutorily regulated professions, such as the Nursing and Midwifery Council, and Accredited Registers like the BAcC. This offers a quality mark for high standards of training, safe practice, and professional conduct. Statutory regulated healthcare professionals, such as member of the General Medical Council, can use Accredited Register status as an assurance the safety and quality of care provided when making referrals.