Sandy Williams

Sandy Williams

Q:  i am  86 yrs. old . I fell and hurt my wrist approximately 7 months ago and it has been sore ever since.  The Xray says nothing  is broken . Is it wear and tear ?

'A:  Wear and tear' is always possible for someone of mature years, but there are a number of other possibilities. We shall assume that your doctor has undertaken all of the conventional examinations. The one element of conventional treatment which you haven't mentioned, but which we would recommend if it hasn't been offered, is to get a referral to a physiotherapist within the NHS. This may take 6 to 12 weeks to come through, but in the over 70s even a non-fracture bruising can cause a joint to become immobile and painful, and physio can often help, both in the manipulation it involves and in the exercises which are usually given for someone to do at home.

As far as acupuncture treatment is concerned, the system of Chinese medicine is based on an understanding of the body as a flow of energy, called 'qi', whose rhythm, flow and balance determine health. When the flow is affected, it causes pain, and in many cases will carry on causing pain until the problem is resolved with needles. This can sometimes produce very rapid results. However, we have to be honest and say in someone your age a nasty fall can often provoke osteoarthritic changes in a joint, and these are not always that easy to reverse, although acupuncture treatment, as our factsheets show, does have a record of providing pain relief and slowing down deterioration, the 'getting worse slower' option.

However, the best advice that we can give for a specific problem like yours, which we cannot actually see, is to visit a BAcC member local to you for an informal chat about what they think may be possible based on what they can actually see. This is likely to give you the best and most informed view. The practitioner may be able to recommend other options alongside or instead of acupuncture treatment.

We would say, however, that our experience of working with our own patients over the years is that small fractures of the wrist are not always that easy to spot, even with highly trained eyes, and it is always possible that you have had a hairline fracture which has taken a long while to heal, as they do, and has been aggravated by the cold and by repeated use. There's not a great deal to be gained by getting more X-rays at this stage, but it would explain why the pain has been so persistent.

Q:  How does acupuncture treat specific symptoms? Are there particular points for specific symptoms or does acupuncture work to bring general balance to the overall body?

A:  In true Eastern fashion we'd like to say that it is both! Symptoms are not the same as the disease, but from a traditional Chinese medicine perspective indicators that some aspects of the functioning of the Organs or the flow of energy, called 'qi' has been disturbed. The art of Chinese medicine, as much as the skill involved, lies in
interpreting the overall symptom pattern, identifying what this means in terms of energy flow and functional disturbance, and then establishing the key underlying factors which are driving the process of disease. These aspects of the system may not actually be generating symptoms at all, and indeed some of the older systems of medicine, like the Five Element and Stems and Branches systems, were largely asymptomatic, gathering subtle data which pointed to the underlying causes of the disease without necessarily knowing about all of the symptoms.

However, more recent traditions, like the TCM style which is also misleadingly the overall name of the whole system, are much more symptom based, and while they still retain the subtlety of the older systems, they can be used to deal with specific symptoms in isolation from the overall position.
This style of Chinese medicine often distinguishes between the root and the branch, what are called the 'ben' and the 'biao', and there are many occasions when a symptom (biao) might be addressed before treating the underlying constitutional patterns (ben) if the practitioner believes that he or she cannot successfully treat the root without making the branch worse. The same applies to some of the Japanese acupuncture traditions, where there are sophisticated methods for addressing symptoms within an overall understanding of the body as a whole as well as specific treatments for specific presentations of disease.

More worrying from a TCM point of view has been a recent development in China which has seen the use of traditional Chinese acupuncture points based on a western differential diagnosis. This has become a very much more symptom based approach, and represents a move to harness the power of acupuncture points within a conventional medical framework, a sort of best of both approach. An influential paper from a decade or so ago called 'Keeping the Pearls and Throwing Away the String' gives you a clear idea of what the authors think of traditional theory! This has not really become the success the authors hoped for, though, and we like to believe that this is because using the system properly as it was intended simply gives better results.

So, basically, then, the symptoms are for the good practitioner of Chinese medicine like a series of alarm bells which point to malfunction in the system, and need to be interpreted within the overall picture, not simply treated and turned off because they are a nuisance. The ancient Chinese texts are full of dire warnings about symptomatic treatment, arguing that if the body does not heed the mild symptom but it is simply suppressed, more troublesome symptoms will emerge. However, it is quite likely
that a symptom which is giving a patient a great deal of grief will probably be treated alongside the major patterns to give the patient some relief. This has been refined to the point where there are often specific formula treatments for specific conditions, as well as specific points for first aid problems like fainting or uncontrolled bleeding, but in our view is not to be confused with or substituted for proper treatment.

Q:  I  have been a long term headache sufferer. My GP advised acupuncture. I have had one session. I believe there was a needle in both temple areas, my forehead and
2 needles in my should/neck area. About 1 hour after treatment I had a sensation in my fingertips (right hand only) which over the last week  went to my whole hand, right ear, scalp of my head and partially my right foot. I have spoken with the GP about this, who has said it's nothing to worry about. I am not sure this is normal. The sensation is like the remainder of pins and needles. Once the blood has come back to the area, that remainder numbness feeling.  Also a friend of mine believes the strength in my right hand is not as good as it was.

A:  This is certainly a very powerful reaction to treatment, and our first question would really be whether the treatment was administered by a traditional acupuncturist or by a doctor. This may seem strange, but there are two or three distinct and different ways of approaching acupuncture treatment with different techniques, and what you are experiencing might or  can be interpreted in a couple of different ways.

From a traditional acupuncture point of view the body is a system of energy, called 'qi' whose rhythms, flow and balance determine the state of someone's health. Where there is excess, deficiency or blockage, there will be pain or discomfort and the skill of the acupuncturist lies in moving the energy to promote balance and reduce symptoms. This can have one or two direct consequences. Quite often in the area where the needles have been applied there can be a dull, aching sensation which the Chinese call 'deqi' and which for a Chinese practitioner is a requirement of good treatment. This tends to be localised and relatively short lived. There can also be an effect from unblocking energy which can travel through the channel system and generate strange sensations across the whole of the body in very clearly identified channel pathways. This is much less common, but not unknown - unblocking something in one part of the body can occasionally reveal a blockage elsewhere which then generates new symptoms.

The important thing to say, though, is that a traditional acupuncturist will be using needles at such a superficial level that there is very little likelihood of physical damage which has secondary consequences. The practice of Chinese medicine is over 2000 years old, and over this time the safe insertion of needles has been refined to the extent that injuries are rare. The other style of treatment, often called western medical acupuncture and used by doctors and physios, is a much more formula based
treatment relying on different theories. The needling is often based on releasing knots in the muscles or having local neurophysiological effects to reduce or remove long-term discomfort. This can be a great deal more vigorous than the methods used by traditional acupuncturists, and it is just possible that there has been some local bruising in the neck which has caused a mild nerve impingement. This will go away as soon as the bruising subsides.

However, we are not sure that we agree that it is nothing to worry about, especially since the sensation is across such diverse areas. We are always careful to ensure that in cases like this there symptoms are coming from an entirely different problem, but because they emerged at the time of acupuncture treatment are assumed to be a result of it. This has to be addressed carefully because at some levels it sounds like a 'not my fault' statement, but we have seen a number of occasions where people have become
mildly obsessed with proving it was the acupuncture which caused the problem but have not dealt with the problem itself.

 If it seems unusual, then it is unusual, and you should be going back to the practitioner who applied the needles to discuss the matter with them and to get their advice. They will know where they have needled and what physical consequences there may be from where they went. If it seems unlikely to be an effect of the treatment, then you may need a referral to a neurologist to determine exactly what is happening.

On balance we think that the sensations will reduce and resolve, but we would rather people sought help and reassurance earlier rather than later in the remote case that there is something which needs following up quickly.

Q:  I am wanting to get my navel pierced, and I have read many articles online claiming that it could block an important energy channel. I do no take everything
I read online as fact, and I am asking here to get correct information. I have had fertility issues in the past, and I do not want to do anything that could
jeopardize that, with it now being healed.

A:  We are aware that it is a commonly received wisdom that piercings interfere with the flow of energy in the major channels of the body, and a rapid google search did in fact turn up a large number of websites which in some cases had very alarmist warnings about the long term effects of piercing on the body, especially navel piercing. These warnings ranged from where it is to what the metals are, and more.

We have to say that there is no evidence of which we are aware that proves or disproves the effects being described. Our own feeling is that if the effects were directly causally related, then there would be a great deal more energetic disturbance on a regular basis. This particular practitioner has seen hundreds of people with navel piercings over the years and detected no demonstrable blockages or long term health consequences in any of them which could be attributed to a piercing.

We would have to say that it is a theoretical possibility, but that it would most likely have to add to an existing weakness or defect to have any significant impact. The same issue is often raised about ear piercings and their effect on points which are related to energy systems in auricular acupuncture, but we have never seen warnings about causing unintended treatment or causing secondary disruption.

In the end it's a matter of personal choice, and as long as the piercing is undertaken by someone who is properly trained, insured and registered to do it, we cannot see how there is a strong probability that anything will be adversely affected. However, we do have to accept that in some people there may be an energetic effect. If this is going to be significant enough to impact on major issues like fertility, for example, we would assume that there may be other signs and symptoms of imbalance, and you should just
keep an eye on anything which changes in the weeks and months after the piercing.

Not everyone in our organisation will agree with this view, but without categorical evidence that it is harmful we do not feel that we can say anything different.


Wednesday, 13 May 2015 00:00

New study on acupuncture

New study on acupuncture to reduce pain and inflammation in children with acut appendicitis

Charles's black spider memos

Wednesday, 13 May 2015 00:00

Acupuncture for chronic pain in legs

Q: I am suffering from acute chronic pain in the lower part of my legs. I live in Delhi, do  you know of an acupucnturist who can treat at home?

A:  There is a long history of acupuncture being used for pain relief, as our factsheet on chronic pain

shows. The measurement of pain and its neurotransmitter trails lends itself to western research methodology.

However, the kind of pain which you describe would almost certainly be of interest to a practitioner because of how it is presenting. The theories of Chinese medicine are premised on a flow of energy, called 'qi', whose flow and balance determine the health and well-being of the person. When this flow is disrupted, pain and poor function result. For a problem such as yours, the practitioner would want to establish whether the problem was local rather than systemic, although the fact that it is on both sides seems to indicate systemic, and then to look at what aspect of the body's function was causing this to happen. The fact that you have had heart operations will almost certainly be a factor to take into account; there are a number of heart problems which dispose people to circulatory problems in the lower limbs, and a number of other conditions which predispose people to heart and circulatory disorders. An acupuncturist will always see local problems in the context of the whole person rather than simply stick needles in where it hurts.

With any treatment for pain relief, the bottom line is how much relief the treatment gives and how sustainable it is. This can often, unfortunately, come down to money and the balance between the amount of relief and the cost of achieving it. It is possible that treatment may improve the circulation and remove the pain, which we hope to be the case, but in the event that the pain arises from a condition which is unlikely to be reversed, like atherosclerosis in the arteries of the lower leg, it is important to maintain a regular review of whether the treatment is worthwhile.

We have very few overseas members working in Delhi and we have no idea of their working patterns. Many practitioners are not happy with undertaking home visits because to charge realistically for the time it takes to travel to and from the patient can sometimes make treatment unaffordable. However, you can always ask any practitioners local to you whether they are prepared to do this. Since we cannot direct you to any of our members, we can only advise that you check that the people you call are properly trained. For us, a sound training involves three years of study to a degree level. Bona fide practitioners will have done this; any others with less training may be a gamble.

A:  The BAcC gives very comprehensive advice to members about the absolute and relative contraindications for acupuncture treatment, but because there are very few absolute contraindications we do not publish a list. The majority of areas where we tell members that acupuncture treatment would be inadvisable are where patients or prospective patients have bleeding disorders, weakened immune systems, malignancies (but only as far as not treating near the tumours) or lymphoedema in certain circumstances. There are also a number of localised restrictions such as avoiding treatment near pacemakers or other implanted devices, restrictions on some techniques where patients have had heart valve replacements or rheumatic heart disease in earlier times, and restrictions on treatment where a patient's condition is unstable, as in poorly controlled epilepsy.

That said, the flexibility of traditional Chinese acupuncture means often needles can be applied in area of the body which connect with areas of disease without compromising them, so it is really only major immune suppression in blood disorders, immune system problems or post-transplant, or bleeding disorders where the INR is outside the safe range where we would say to a patient that treatment was not possible. In many cases, however, where people really want treatment and there is a question mark, BAcC members will always contact the senior conventional medical practitioner in charge of a case and seek their authority before proceeding. What the consultant says goes, and this does mean on occasion that, for example, treating lymphoedema is ruled out by a consultant, even though there is research evidence which shows that needling away from an affected limb works, because he or she places a blanket ban on all acupuncture for the patient. In these circumstances our role can only be to educate and inform, not to disobey.

There is a larger number of relative contraindications which make perfect sense - not needling into an open wound, not needling specific areas of the body - but these are more often than not a matter of professional judgement. The safety record of acupuncture treatment suggests that this works; serious adverse events from acupuncture treatment are rare and do not very often arise from using acupuncture where it would have been inadvisable.

There is also a large number of points which cannot be used from a Chinese medicine perspective for specific reasons. In pregnancy, for example, a number of points which have a heavily downward and expulsive effect are ruled out in the first trimester, as are a number of other points throughout the various stages of pregnancy. All students are taught these very carefully during their training, and all point books and charts make very clear annotations of when to avoid using specific points.

There is also an interesting set of points which we would avoid in certain patients but which are often used in western medical acupuncture for musculoskeletal problems. One of the major points for treating tennis elbow, for example, can if vigorously needled lower blood pressure quite dramatically. We are not sure that many conventional medics are aware of this, and one of our tasks is to compile a list of points which from a Chinese medicine perspective are ones where caution is needed.

We should add that our reason for avoiding a printed list is that where there are both relative and absolute contraindications for treatment, it would be unnecessarily alarmist to do so. As long as someone on anticoagulants has a stable INR, for example, there is no reason not to treat carefully with acupuncture, as long as shallow needling and minimal manipulation is used. The subtleties of this kind of judgement do not translate well to lists.

Q:  I have had recurring back pain problems for about 10 years.  I have had various physiotherpists give me exercise but I am still have back pain.  Would acupuncture help?

A: For back problems we can make a positive recommendation of acupuncture treatment. The evidence which has accumulated over the years has been sufficient to convince NICE, the body which defines suitable treatments within the NHS, that a course of up to ten treatments should be available within the NHS for chronic back pain. Unfortunately acupuncture is just one of a number of options for treatment, and we have seen very little evidence of anyone contracting with our members to provide treatment which is free at point of delivery, but in time we hope this begin to happen.

Our fact sheet on back pain

provides references to some of the research, but such is the prevalence of the problem there have been many more studies of varying degrees of rigour which all seem to point to positive outcomes.

The two factors which will be of interest to a practitioner will be the way that the problem developed and how it relates to the overall functioning of the body, and how entrenched some of the coping patterns have become. As far as the former is concerned, unless the pain has arisen as a consequence of an injury it is usually a part of the much larger picture of what is happening in the body, and this is the great strength of Chinese medicine, understanding this back pain in this person rather than simply applying formula treatments for everyone. The latter issue can sometimes be important. People learn a number of coping mechanisms to deal with the pain, such as holding their bodies in different ways, and it can sometimes take a while to encourage the muscles to revert to natural positions when they have been trained over time to hold the body in a position which avoids pain. Many of our members often work closely with osteopaths in a  two-pronged strategy to encourage the body back into its correct shape.

The best advice always, though, is to visit a BAcC member local to you for advice on whether acupuncture can help your specific problem. Although the evidence is good, most of us can tell quickly what the best options for a patient are, and are always happy to refer on to other healthcare professionals if we think that they are the best line of attack.


Q:  When I had acupuncture re-usable needles were used instead of disposable ones. I was assured by the acupuncturist that they were sterilised.  Shouldn't all acupuncture needles be disposable?

A: Don't panic! The risk of infection from a re-used needle is very very small indeed if the autoclave is used properly, the needles are prepared and stored properly and the autoclave is properly maintained. For forty years before the change to disposables autoclaving was standard practice, and there were no reports of cross infection from this method. The risk of prion transfer was taken very seriously when the BSE/vCJD crisis was happening, but was subsequently downgraded.

In short, there is no reason to get tested, and no reason to suspect that anything has gone wrong. The practitioner sounds as though she is on top of her game, and has made a choice which we would not permit for our members. For every thousand practitioner who re-use, though, there may be one who doesn't do it with proper care, and that is the one who might cause a problem.

Our view is that patients are more comfortable with disposable needles, there is no economic advantage to re-using them, and we cannot understand why someone would choose to do this. If the practitioner is one of our members, we need to know because we need to stop her from doing this. If you pass the name to us, we can take action without bringing your name into the discussion at all. If she belongs to another professional body we shall take the matter up with them; all, as far as we know, insist on disposables too. If she is working as a 'freelance' we may decide to go to the local authority licensing people, again keeping your details out of the loop. 

This is as much to protect her as it is to protect everyone else. If anyone did develop an unexpected infection, then the autoclaving would automatically tip the balance of probabilities against her because of the minute theoretical risk.

We are sorry that you have been made uncomfortable by her practice and our response to your query, but we are grateful that you have got in touch and equally certain that you have not been put at risk.

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