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Ask an expert - neuro and psycho logical - stress

7 questions

Can acupuncture make PTSD symptoms worse? I had acupuncture done on my ears and I had my first PTSD episode in 3 months.

A: The short answer would be 'probably not' unless there was something about the treatment itself which re-awakened some of the trauma which initiated the problem. We have encountered this on a couple of occasions with patients who have been stabbed, but it is rare.

What is more likely is that the treatment has released something which the body has held on to. We often find that shock and stress can be held almost like memories in the system, and from our perspective as Chinese medicine practitioners this them interferes with the normal flow of energy, and can manifest in the sorts of symptoms which are classified as PTSD and to which the system ultimately adjusts to get on with life. Once a practitioner starts to balance things up again these patterns can often be released, and this can sometimes result in a resurgence of the original problems and even the initial shock.

The homoeopaths actually acknowledge this formally within their systems as the 'law of cure' where symptoms can re-appear in the reverse chronological order, and although we would not go this far we are aware that when we treat people with a history of migraine or other problems from the past which it is assumed they have 'grown out of' there is a strong chance that they might have another bout.

One small concern is that you talk about using ear acupuncture. We think this can be a valuable modality for addressing many issues, and there are indeed practitioners in the UK who train exclusively in this based on the work of people like Nogier, a French man who really developed this as a working method in the 1950s and 1960s. We would hope that the person who is offering the treatment is doing so within a framework which provides proper support to you as a patient. If you have had the treatment for one problem and it brings back another one we would expect that there is some safety net in place which means that you haven't had this very unpleasant problem dropped back on you without some chance to address it.

We suspect that it will be a one-off episode, but even so we know just how difficult it can be and how frightened that people can become that it returns for a longer time. If this episode continues we would probably advise you not to continue having ear acupuncture unless it is within a setting which affords you proper and appropriate support.

Q:  I was diagnosed from an adrenal stress test with stage 4 adrenal exhaustion..by then all I could do was lie in bed all day.I took prescribed supplements and after 3 months my energy was much better,as I also have sore kidneys I was advised to try acupuncture.the acupuncturist diagnosed my liver as being the source of my exhaustion.  I agree with this. She has 20 years experience but after 7 treatments,when I was gradually gaining strength a treatment devastated my adrenals and I was thrown back 3 months with my symptoms.It is 3 weeks and I haven't recovered.I feel she was too heavy handed I pointed out how sensitive I am before treatment but this has not been taken into account.  Can you recommend an acupuncturist who has a light touch,who can treat my liver/kidneys? 

A:  We are very sorry to hear of your experience. We have come across a small number of cases like yours where a treatment may well have been a little too powerful for the patient. To be absolutely fair, though, we also have to say that our experience of patients recovering from all sorts of long term chronic problems like adrenal exhaustion or the various ME-related conditions is that they can often have a good run with treatment and then for no discernible reason have setbacks which feel like they are back to square one.

The overall strategy with these sorts of conditions appears to be to treat as gently as possible, and to the extent that this is something that any practitioner can do it is simply a matter of negotiating with the practitioner about what they do. This expert, for example, has a patient who insists on no more than three needles per session at a very superficial level, and our experience of doing more than that has been very educational - she gets blown away by treatment and ends up being disorientated for a week.

The question really is whether you have lost confidence in the practitioner. If so, then the best thing to do is to use our postcode search facility to find a number of BAcC members near to you, and then to visit each of them in turn for a brief face to face chat to explain your predicament. The fact that you have had treatment with someone else is something which they will be duty bound not to discuss with the previous practitioner if you ask them not to, and you should assess whether you have confidence in any of them to keep the treatment as simple as possible. It may well be that you feel that the existing practitioner still has your confidence, and this would obviously be the best route to follow. She will know your energies well, and if it is simply a matter of turning the volume down, then she should be well capable of doing that.

We hope you manage to make some good progress. We are aware that adrenal exhaustion is not always accepted by the orthodox professionals, and this can make for a very uncomfortable situation when someone's genuine inability to work is not backed up by doctors who cannot fit the symptoms into their diagnostic models.

Q:  I am having difficulty switching off and relaxing. This results in tension in my neck and other areas. I am interested in finding a "good" acupuncturist for, perhaps, treating stress. My stress isn't chronic but I'd like to try such therapy. Other than emailing each acupuncturist located in my area suggested by your site, is there any way of telling which ones are better experienced in certain treatments?

A:  The short answer is 'no'. From our perspective, all of our members are equally well qualified to treat all patients. The only areas where we are looking to develop standards which define expert practice, and which may have an impact on our recommendations, are obstetrics, paediatrics and mental health problems. In each of these areas, there is additional learning, often in conventional medicine but in the case of paediatrics in Chinese mediicne, which would mean that someone working primarily with each group maybe better qualified to deal with what they find.
 
In all other respects, the Chinese medicine which underpins the approach is known by all, and to a large measure is independent of the conventional disease labels which we all tend to use. Chinese medicine treats the person rather than the disease, and a label like 'stress' can mean as many different diagnoses in Chinese medicine as it can mean descriptions of stress in conventional medicine. The skilled practitioner will listen to what you tell them about how the stresses manifest in your system and from that, using Chinese diagnostic signs as well, determine areas of imbalance and poor flow which they need to correct.
 
Having said that, many patients like to be able to make a good rapport with their practitioner as a part of the process of improving their health, and phoning rather than simply e-mailing often gives a prospective patient a good idea of who they are going to be dealing with. In this respect we're just like any other business; the services are pretty standard but we use the ones which suit us as individuals.
 
Word of mouth referral still remains very important, though, and although you may not want to divulge your intention to anyone else you may well find that someone you know has had treatment and can give you a personal recommendation. This is the best guarantee of finding what you want and remains the most valued and effective source of referrals for most practitioners.
 

Q: I have a recurring problem with my shoulder and neck caused by stress and tension. I have received physiotherapy and osteopathy but I would now like to try something different. Is accupunture suitable for treating shoulder/neck complaints. I think the issue is mainly muscular but also affects the nerve in my arm.

A: There is no doubt that a great many people have acupuncture treatment for neck and shoulder problems, as well as coming along for stress and tension which they themselves recognise are the cause of neck and shoulder problems. On both fronts there is a gathering body of evidence which suggests that acupuncture may be of benefit, as our factsheets on stress
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/stress.html
 
and other factsheets on sports injuries and muscular problems show.

 

We are sure, then, that acupuncture may be a suitable treatment for your problems. You will find that many conventional medical doctors and physiotherapists also use acupuncture in the form of 'trigger point acupuncture' to unknot the muscles. Our concern, however, would be to discover what the causes of the tension were. For many people the modern workplace is a significant and unavoidable source of a great many neck and shoulder problems, and even your 'expert' is starting to suffer this afternoon, having spent the last couple of hours at a keyboard and screen without a break. If this is the case then while acupuncture may help to reduce the problems they will tend to recur. Adapting the workplace or looking at various postural techniques such as the Alexander Technique may offer a longer term solution.

 

In most cases, though, it is not simply the physical stress of work but the mental and often emotional stress which can be a large contributory factor. The systems of Chinese medicine were developed over two thousand years ago with the key word 'appropriate' underlying much of the understanding. All of us will, and perhaps should, experience some tension and stress in life, just as we should have our fair share of grief, anger, joy, and so on. The key thing is that there is an appropriate length of time to hang on to any emotion or mental response, and then we should be able tmove on. The stresses of modern life are relentless, however, and we find very often that they affect the system such that people get stuck. From a Chinese medicine perspective, where body mind and spirit are interlinked, a mental or physical blockage may impact the whole system in the same way, and there are means of treating both, wherever the body's reaction is no longer 'appropriate.'

The best advice we can give is that you visit a BAcC member local to you to ask if in their view your own case is suitable for treatment. We are confident that a brief face to face assessment will be far more informative that we can be here, and may offer you a better perspective on whether acupuncture or some other modality like massage or related techniques may be a better bet.      

The factsheet on our website  here outlines a number of systematic reviews and randomised control trials which show some positive evidence for the effect of acupuncture on hypertension/high blood pressure. Taken as a whole the evidence is not quite good enough for us to make unequivocal claims for the efficacy of treatment, but there are certainly a great many patients who, alongside their western medication, use acupuncture regularly to help to maintain a relaxed approach to life and to help to break the cycle of anxiety/tension leading to high BP leading to anxiety/tension into which people can become 'locked'.
 
Clearly the ancient Chinese did not have sphygmomanometers to measure blood pressure, and the diagnosis of the patient rested on the symptoms raising from the high BP which they experienced and some of the signs which a Chinese medicine practitioner looks for when taking the pulse at the wrist, looking at the tongue and a number of other indicators of imbalance. Not surprisingly the overlap between high BP and some of the syndromes into which the symptoms are grouped is very imprecise. This is one reason, for example, why research can prove problematic because the same reading of the BP in 20 patients can arise from 20 different diagnoses in Chinese medicine, which is not helpful if you're trying to standardise all the elements in a piece of research.
 
The best course of action, as we say in nearly every response, is to visit a local BAcC member and ask their advice face to face. There are no rules about how many sessions someone should have for a condition, and a great deal will depend on whether in the practitioner's view the problem is a part of a much deeper pattern of distress or whether there are simple problems like blockages in the energy flow which mght be the prime cause. All that we ask our members to do is to remember to set reasonable outcomes, to review treatment regularly and certainly to review progress after four or five sessions to ensure that it is worth continuing and to make sure that the patient is happy to keep coming in. 
 

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