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Sandy Williams

Sandy Williams

Q:  My sister has a long standing back injury, she fell on a concrete surface and injured her lower back in 1997. She has been in tremendous pain over the years, chiropractors, physios, pain killers the lot. Recently someone advised acupuncture, and we all recommended she go. After this length of time she'd try anything for relief. The acupuncturist told her she needed at least 6 sessions, then they could decide further. My sister managed 3 sessions. All 3 were very painful, and the pain lasted for days mostly at the points where the needles were inserted, mostly her left shoulder. After the last session, she was very dizzy, lightheaded, started experiencing blackouts and fainting, unable to stand, unable to get up and down stairs we took her into hospital because she'd hurt herself when she fainted. Her MRI is clear, 2nd one also clear. All results clear. They are now focussing on getting her mobile, saying its like her brain has forgotten the function of her legs and that is  why she isn't walking. My sister has a 5 year  and has now been in hospital a week. Any advice  would be greatly appreciated.

A:   This is certainly a very strange outcome after acupuncture treatment. Generally speaking, acupuncture is an extremely safe treatment, and such few adverse effects as there are tend to be short-term and transient. Of course, one can never rule out a causal connection, but at this stage what really matters is finding a solution to your sister's problems.

The practitioner has certainly taken an approach we favour, which is to set a target of four to six sessions and then review progress. The placing of needles in the shoulder is something on which we could not comment without detailed access to the notes. Chinese medicine treats the person as much as it treats the condition, so needles are inserted where they need to be for achieving balance across the whole system, and this may be far away from the site of the problem. Even symptomatic treatments can be a long way from the problem; a standard first-aid point for frozen shoulder is on the shin.

What would interest us most is the fact that the treatment itself was painful. We are assuming that your sister made her feelings known to the practitioner about how painful it was. In this situation a responsible and caring practitioner will inevitably look to use even shallower needle insertion with less 'action' on the needle (less needle rotation), and in some cases to move to other areas of the body where the patient experiences less pain. We find quite often that with backs in spasm treating directly in the area of the pain can appear to aggravate the sensations, and we often work at a distance, making use of the channel connections to affect the painful area.

On the assumption that the practitioner did respond positively to your sister's distress, it may simply be that acupuncture is not the best treatment for your sister. We have come across a handful of patients in our time who are too sensitive for needles and for whom treatment is a form of torture, even when they are committed to it and really want it to work. If this is the case, it may also rule out some of the hands-on therapies which may also feel highly uncomfortable.

We still believe that acupuncture may have a role to play in helping your sister, although we would not be surprised if she decided that this was a bad option. If she does go ahead, it will be important to establish with the practitioner that the treatment has to be extremely gentle and involve as few needles as possible. If the practitioner will not agree to this, find another practitioner. Other than that, we wonder whether cranial osteopathy might offer a possibility. This is an extremely gentle form of treatment with profound effects, and a growing number of osteopaths now offer this as their primary technique. If the problem may be more neurological, and on the assumption there is no actual physical damage to her system, there may be some mileage in looking at hypnotherapy as an option. This is a highly problematic area, though; there is no statutory regulation of hypnotherapy, and the range of training levels for people to be able to call themselves hypnotherapists is vast. At one end you have degree level practitioners, especially those using Ericksonian hypnotherapy in which this expert has great faith, and there are weekend trained 'look into my eyes' people whose standards may not be as good. However, where learned patterns are forgotten, this is something to bear in mind.

We hope that your sister does improve and hope that she is able to try acupuncture again on the basis we have suggested. If not, we hope that the two pointers we have given may be useful.  

Q:  I am an acupuncturist & possibly moving to Bali. Just wondered if you know what the rules are re practising there ... Or who could I contact to find out how you can practice while I'm there ...?

A:  Well, to be honest we were a bit stumped and started doing the same sorts of internet searches which you have probably already done, and found the following information (in rotten English!) about the history of acupuncture regulation in Indonesia  

http://www.wfas.org.cn/en/show.asp?men=10&liststate=0&id=1925&Position=members%20%3E

http://translate.google.co.uk/translate?hl=en&sl=id&u=http://www.infokursus.net/ormit/ormitdetil.php%3Fid%3D19&prev=search

Then, of course, we did what we should have done from the off to see if any existing BAcC Oversease members are working there, and amazingly Day Post, who used to be involved with the BAcC Research Committee is working in Bali. His details, which we took from the BAcC website are

Address:

Jalan Sri Rama 63

Villa 3

Legian, Seminyak

Bali

80118

Indonesia

Mobile:

+62 822 91183911

Email:

This email address is being protected from spambots. You need JavaScript enabled to view it.

Website:

www.acupost.com

and we are absolutely sure that he would be delighted to fill you in on the background to working there. The fact that he is means that our own level of qualification more than meets the requirement for registration, as far as one can be certain from the documentation above.

We are just the tiniest bit envious of someone thinking of working in such a beautiful location, and if you do decide to move, we hope it is as good as it sounds like it could be.

Tuesday, 16 December 2014 16:30

Can acupuncture help urticaria?

Q: I have had urticaria for almost 2 years now and I have been on antihistamines for a year. Traditional medicine does not offer any solution in my case - none of the doctors can establish what causes it and no one knows how to get rid of it. My only hope at the moment is alternative medicine and I have heard that acupuncture could offer a solution. Do you have any record of it helping with my condition ?

A:   We were asked about the treatment of urticaria with acupuncture a little while ago, and our response then was:

Can acupuncture treat urticaria with any level of success?

Success is a very loaded word in the context of what one can now claim in marketing and advertising. The standard of proof in all healthcare advertising is the randomised, double blind control trial, the model most often used for testing drugs, and it has to be said that it is not very well suited to assessing whether acupuncture 'works' or not. Reducing variables is the last thing a practitioner would try to do in Chinese medicine; understanding and interpreting their variations is integral to the way that the system works. Hence a paper such as this one from 1998
 
http://www.ncbi.nlm.nih.gov/pubmed/9828874
 
is a great example of the problems we face when asked questions such as this. The manifestations of urticaria, understood in Chinese medicine terms as a description of the specific symptoms, have always been around and like any complete system of medicine, Chinese acupuncture has ways of understanding how the heat and swelling develop, and within the system has developed clear protocols to deal with the problem.
 
However, as the paper acknowledges, getting precise enough definitions if urticaria itself to assemble a trial is a problem, as indeed would be the next stage, ensuring that the test and control groups had the same western and eastern conditions to guarantee objectivity. However, when one takes into account that in Chinese medicine the person with the disease is as important, if not more so, than the disease which the person has, it becomes rather difficult to talk meaningfully of treating a named condition.
 
That said, there are papers which examine the presentations and treatments of urticaria such as this one
 
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/
 
where there is a very positive reference (60) to a paper which on the surface appears to meet the criteria for inclusion in a growing body of good evidence.
 
We prefer to hold to the view that each patient is individual, and that it is the unique assessment of their energy by a skilled practitioner which is the best judgement of whether treatment may be beneficial. It is true that many patients present themselves for treatment with urticaria-like symptoms, and anecdotally we here of success in both acute and chronic cases. However, if you wanted to establish whether acupuncture treatment was a good option for yourself or someone on whose behalf you are asking, then a brief face to face assessment by a BAcC member local to you is your best way of establishing this. 
 

We think that this still represents the best advice we can give. Anecdotally we have all had some very positive experiences of treating people with urticaria. Of all the skin conditions this appears to be the most amenable to acupuncture. For many other conditions, like psoriasis or eczema, we have often recommended the use of Chinese herbal medicine alongside acupuncture treatment. There are a considerable number of BAcC members who are also members of the Register of Chinese Herbal Medicine, and there may be some advantage on seeing someone who uses both, although as we have said, you may well find that acupuncture treatment by itself can offer a solution.

If you do go ahead, it is very important to set measurable outcomes and to ensure that your review the treatment at regular intervals. It is quite easy to run up a large bill in pursuit of success without realising, and the responsible practitioner will always check on a regular basis that there are enough signs of improvement to warrant carrying on. 

 

Tuesday, 16 December 2014 16:26

Acupuncture and cerebral palsy

Q: My daughter is in Anerqerque where her little boy with cerebral palsy is being treated with scalp acupuncture by Dr Jaso Hao. Daniel is 3 yrs 5months old. Intensive physio both on and off horses has had a monumental effect in getting him to walk, albeit still unsteady.However, after only 3 sessions of treatment with Dr Hao he is walking with confidence and speed. I have seen the video she sent me and it phenominal what this has done for him. Her story may of great interest to you. We need this here in the UK

A:  Many thanks for getting in touch with us about your grandson. We are very heartened to hear of his progress.

We have been aware of Dr Hao for some time since the publication of his book by Blue Poppy Press in the States, and also of Dr Yamamoto and his system of scalp acupuncture. This is fairly cutting edge material; although it has its roots in the classical traditions it is a modern development. This means that at the moment it does not form a part of the mainstream training in Chinese medicine, and slightly more problematically for us, does not yet have recognised training standards which have been accredited. When something is being offered, often as a last resort for people with desperate needs, it is crucial that there are some forms of standard and accepted evidence to support the claims which practitioners make and to underpin any training they offer.

That said, we note with interest that a number of UK practitioners have undertaken postgraduate work in scalp acupuncture and are quite quickly and easily traced. When stories such as your about your grandson start to circulate it will be relatively straightforward for prospective patients to track down a local practitioner.

We hope that your grandson continues to improve and that his success is an inspiration to others.    

 

Q: Nearly 6 years ago I had a cancerous tumour removed from my mouth , following the successful operation I then had radiotherapy treatment. In a nutshell since the operation I have been suffering with chronic pain in my mouth which makes life unbearable I am taking up to 16 strong painkillers everyday.  My surgeon referred me to A  pain relief specialist,  but the tablets he prescribed me sent me crazy.   Someone has mentioned today I should consider acupuncture.  I would be greatly obliged if you could give your thoughts and if you have had previous success with acupuncture treatment for this problem

A:  There is no doubt that acupuncture has been used successfully in treating some of the consequences of radiotherapy treatment in the mouth. Most notably we were asked not long ago about a condition called xerostomia (dry mouth) which is quite common after radiotherapy in the area, and our answer was:

We were asked this question once in relation to xerostomia induced by radiotherapy, and our answer was, taken from our factsheet on palliative care and further supplemented:

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O'Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

There is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
http://www.ncbi.nlm.nih.gov/pubmed/23104718
 
http://www.ncbi.nlm.nih.gov/pubmed/22072272
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to you to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 

There is a chance, of course, that the xerostomia which you are asking about is not related to cancer treatment. From a Chinese medicine perspective this makes no difference. The understanding of the mechanics of the disruption of the physiology of salivation from within the Chinese medicine paradigm will be the same whatever the cause, although the cause, again seen from this perspective, may have a considerable impact on the treatment. By this we mean that radiotherapy might be seen as a cause of great heat and dryness within the system as a whole or locally, and this would almost certainly feed into the treatment strategy.
 
As we said above, speaking to a BAcC member local to you who can assess the problem face to face may well be the best option for you before committing to treatment.  

The reason we quote this at length, although it is not the identical problem to that from which you suffer, is that if we start to trawl research databases for the treatment of specific problems, we always run up against the problem that the treatment offered is rarely good quality traditional acupuncture and most often uses a very reduced palette to meet the dictates of the trial design which seeks to reduce the number of variables. The huge strength of Chinese medicine is that it treats the person, not simply the condition, and the this is even reflected in the wisdom of the great Canadian physician William Osler who said 'it is more important to find out about the person who has the disease than the disease the person has.'

The confounding factor in your case is that six years of powerful medication are going to have generated secondary problems which someone will have to take into account, and therefore any assessment of what may be possible will have to look at this as a part of the overall picture. We are sure that if you contact a BAcC member local to you they will be only too happy to spare some time to discuss whether acupuncture treatment is a good option.

We have to say, though, that when we researched the treatment of another cancer recently we were very pleasantly surprised at the number of recent studies which show that acupuncture is used increasingly often for palliative care and for the reduction of post-treatment pain, a pattern which seems to be reflected across a number of different areas. Radiotherapy is a necessary but brutal treatment which causes massive disturbance of the energies of the body, and there is a growing body of evidence which suggests that acupuncture treatment, even some time after the treatment, can have a significant impact in restoring proper flow. Hopefully you will find that there is still good reason to hope for improvement even after this length of time.

Tuesday, 16 December 2014 16:20

Can acupuncture help pancreatic cancer?

Q:  Can acupuncture be used to treat cancer of the pancreas? If not, are there any other alternative remedies which would help?

A: We have to be as careful as we can in answering questions like these. Our view of traditional acupuncture is that it treats the person, not the named condition, and this has been the basis on which it has been practised for over 2000 years. This means that we believe that treating the system as a whole corrects imbalances in the system which generate symptoms, and successful treatment can reverse symptoms.

However, and this is a really big however, it is really easy for people to mis-hear this as a claim to treat anything and everything, and the word 'treat' is then misunderstood as 'cure', in the way that a doctor might say that he can treat headaches, i.e. you hear 'can help to get rid of them.' Cancers are not usually thought of as treatable by acupuncture practitioners in this sense. Once the system has gone this far into disrepair, there is not much that any practitioner can offer except some relief from the worst symptoms and also some help in dealing with the side-effects of the medications on which people become more reliant as the disease progresses.

As you are probably well aware, pancreatic cancer is one of the less treatable cancers within conventional medicine, and the most that doctors will offer is the possibility of slowing down the progress of the disease and dealing with symptom relief. To that extent we would say that our experience of acupuncture treatment as a part of this process of relief has been good, and that the control of symptoms in the palliative care stage has helped many patients lead a generally less pained life. 

There have been a number of studies published in the last two or three years which offer some support for the use of acupuncture treatment. Three such are:

http://www.ncbi.nlm.nih.gov/pubmed/24280575

http://www.ncbi.nlm.nih.gov/pubmed/20683216

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734160/

and there are a number of other studies about the use of acupuncture in palliative care

http://www.ncbi.nlm.nih.gov/pubmed/24338183

http://www.ncbi.nlm.nih.gov/pubmed/23868190

which also offer encouragement for experimenting with treatment.

You will find that many of the other complementary therapies to which people turn, like herbal medicine or homeopathy, take the same stance, steering well away from any misunderstanding about possible cure and focusing instead on the control of symptoms and pain reduction. Our view is that as with all forms of complementary medicine it is worth trying a variety, perhaps one at a time, to see which seems to have the greatest effect on you, or which combination seems to work best.

This is an area where you need to exercise great caution. Anyone who makes excessive promises for what might be possible needs to be avoided, in our view. If you visit a BAcC member local to you for a brief face to face assessment we are confident that they will be able to give you an honest and realistic assessment of what may be possible. 

Q: I have long term conditions and neuro damage as a result of near fatal RTA, plus Ehlers Danlos et al. I have had acupuncture on the NHS in the pain management clinic for 14 years now. It helps with the severe muscle spasms which heighten the neuro pain.It allows me to have a quality of life and not take as much morphine as I would otherwise need to do. The local CCG have now said all acupuncture will be stopped except for a 6 session course for new patients. Their reason is they say all research shows acupuncture does not help with long term conditions/long term use! Any information on efficacy of acupuncture long term with spasms/pain would assist.

A:  We are sorry to say that this is a depressingly familiar situation. The evidence supporting the use of acupuncture for a wide range of conditions does not often meet the somewhat unrealistic 'gold standard' for research in the West, the randomised double blind control trial, called RCTs in the trade. This was designed for drug testing, and tries to reduce variables to the point where there is no doubt that a drug is working.

Of course, for acupuncture treatment this format is completely inappropriate. Not only would a skilled acupuncturist not repeat the same treatment over and over again, he or she would also amend the treatment as the patient progressed, gearing it to their current individual needs. We often find ourselves in a strange situation that when trials like this show good results we benefit from the good publicity of what isn't really good acupuncture, but all the good evidence from 2000 years or more of effective use is dismissed as 'anecdotal', used in a slightly pejorative sense.

While we are never happy to see provision being reduced we have a certain amount of sympathy for the new CCGs. Hidden in the revised funding arrangements were budget cuts of nearly 20% over the next five years, and although doctors have greater control of their affairs, they have less money, and some services on which people have relied are bound to suffer.

We have no evidence available for Ehler Danlos syndrome which is sufficiently robust to convince a CCG. However, there may be some mileage in looking at the study of low back pain undertaken by Hugh MacPherson and his colleagues in York several years ago. Hugh has written a large number of articles over the years, and on his website pages lists all of the ones dating back a decade or so

http://www.hughmacpherson.com/journal-articles.html

Amongst these is a paper cited here

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570795/

which shows quite clearly that in what are called 'pragmatic trials', where practitioners use their normal treatment approach and this is compared with conventional treatment, the use of acupuncture is extremely cost effective compared to conventional treatment.

It may be possible to assemble a case that if you have to resort to medication as a long term alternative this will cost more than the acupuncture you were having in direct costs, and that is before you add in the long term health consequences of the medications themselves. Many of these can, over time, prove very serious, and once this has been factored in the cost of acupuncture treatment in a facility which is already providing treatment is negligible.

The one thing in your favour is that although the CCGs are having to save money where they can, they are now doctor led and there is a greater chance that you may be able to argue for an ad hoc decision on clinical grounds. We hope that the information we have cited may help you to make that case, and are only sorry that we don't have the kind of evidence at our disposal to provide you with a clinching argument in one go.

Indeed, one of our great challenges is to argue that 2500 years of successful clinical practice is as robust as any modern study, and that the reason for the survival of our tradition is that it works. Unfortunately we live in times where the definition of 'evidence based' has been narrowed to the point where more than half of conventional techniques do not meet the criteria, so our chances of succeeding on this front in the short term are slim. 

 

Q: How do acupuncturist find the right place to treat since there are many meridians and combinations of meridians that could treat a problem?

A:   This question highlights the central difference between conventional medicine and traditional Chinese medicine. We are very used in the West to the idea that the work of diagnosis is rather like the forensic work of a policeman and lawyer, gathering evidence and sifting facts. This comes to a single conclusion which explains what is going on and then provides a set tariff of treatments which have to be followed one after another, like NICE guidelines. The TV series House starring Hugh Laurie was/is a great example of this, where the tortured genius lets the observed facts and diagnostic test results mould into a unique and brilliantly presented conclusion.

By contrast, Chinese medicine is inherently pluralistic. At various times during its 2500 year history there have been innovations which at some levels have contradicted the mainstream theories, but as long as they worked in well-defined conditions they were retained as another string to the practitioner's bow. A modern practitioner of Chinese acupuncture might employ TCM, the rather skeletal and simplified framework first written down in the 1950s as a system, or Five Element Acupuncture which is rooted in the classics but developed heavily in France and Japan, or Stems and Branches, a numerologically based system which has existed for over 2000 years, or Japanese Meridian Therapy which, designed with blind apprentice-trained practitioners in mind has a huge palapatory bias, and so on. Each of these systems has ways of working with the whole which are a mixture of the same root understanding of the core energetics of the body mind and spirit, and a heuristic framework which allows scope for the skill and art of the practitioner. Each of the variations, and in the modern practitioner these might all find their way to the diagnostic mix they employ, offers a way of bringing balance back to the whole.

The question for each practitioner is really what is the most elegant and effective way with the least intervention to achieve overall balance. Because of the nature of the interaction between patient and practitioner concepts like 'intention' and 'rapport' can play a part in the diagnostic and treatment choices, and in many ways each practitioner may generate a different solution to how best to treat a single patient. There may well be common agreement about the main features of a case, but each practitioner may favour a slightly different strategy for dealing with the information.

You can see immediately why such a flexible system is often derided in the West as nothing more than a placebo, especially since the practitioner's extraordinary range of choices and personal involvement in the process lend themselves to the pejorative interpretation that no-one has 'an answer' and that it is the 'will' of the practitioner which conditions the patients to improve.  This is sad, because in nearly every other form of skillful endeavour it is readily accepted that an overall goal or aim can be achieved in many different ways, like putting a destination in google maps and seeing four choices emerge. With a complex organism like a human being it seems perverse to say that this and this alone is the problem, and this the solution, when we all realise that most problems cascade more widely than the simple origin.

Anyway, to return to your original question, even if two practitioners agreed on a diagnosis they might each find different ways of effecting change. Such is the vast number of interconnections between the different channels, there are often dozens of ways to influence the internal Organs, or to have an effect on a specific part of the body. This can be a valuable resource in itself; if a woman has had a mastectomy with lymph nodes stripped and can no longer be needled on the arm, then it is always possible to find ways of treating the lower limb to 'reach' the affected area. The same applies to treatment of a limb encased in plaster; needling the equivalent points on the other limb can have a major impact.

In short, the system is such that there are dozens of variations in the diagnostic systems, and dozens of possibilities within each system, for achieving the same results. They are all based on the same understanding of the channel systems and the same location of the points (broadly speaking - some of the Japanese systems pay more attention to blockages which are where you find them!), but each system will use a slightly different understanding of the these shared resources to effect change. We often used to refer to this phenomenon as 'unity in diversity', the sharing of a tradition founded on the same underlying principles but showing the inherent strength of something which has developed in different strands for over 2500 years.     

 

Tuesday, 16 December 2014 16:11

Facial acupuncture

Q:  During a normal acupuncture session, when a needle is inserted into  the face of a person, does the needle actually touch the bone or does the needle simply pierce the skin?

A: In theory, the needle should only pierce the skin and enter soft tissue or muscle. If the skin and tissue is very thin at the point where the needle is inserted, then the usual technique is to adopt a very shallow oblique angle of insertion rather than a near perpendicular one. This avoids the needle having so little of its shaft inserted that it starts to bend over with the weight of the shaft and handle. An alternative is to switch to a shorter and considerably lighter needle.

However, there are no guarantees that a practitioner will not accidentally touch the bone in cases where they have inserted a needle a little too far. This may be a little painful for the patient, but the greater potential for harm lies in the fact that the tip of the needle is likely to be deformed and will cause slight tears in the tissue when it is removed. This might then lead to a small amount of pain and bruising.

However, there are no case reports of which we are aware, certainly in the UK, of any damage being done to facial bone as a consequence of acupuncture treatment, or that if done this can have long term consequences. If you are wondering this because of what has happened during your own treatment, then you should ask the practitioner to explain what they did, and ask them to consider whether this was possibly what happened. A reputable practitioner will take the matter seriously and give your question the time of day. 

You should bear in mind, though, that there are a number of sensations which can be caused by needles when they are inserted which feel like a very dull ache and can sometimes be mistaken for a more 'solid' feeling than is the case. This is particularly so with one called 'deqi' by the Chinese which is often experienced as a very dull ache and feels on occasion like something has been knocked into.

 

 We tend not to use the word 'cure' for a number of reasons, one of which is that there are many conditions where acupuncture treatment may help reduce the symptoms considerably, but long term sustainable change may require some significant lifestyle changes by the patient themselves. The greater majority of cases of intermittent claudication have their basis in atherosclerosis of the arterial circulation, especially in the lower limb. This is the formation of a plaque-like coating, mainly brought about by diet and lifestyle, which impairs the circulation when additional demands are placed on the limb. Alcohol, tobacco and fatty foods are often a contributory factor, and a practitioner treating someone with intermittent claudication may well encourage the patient to cut down on all three.

As far as research is concerned, there is surprisingly little. We managed to find a small number of what are called 'case studies', interesting one-off patients with the problem for whom acupuncture has proved successful, but these are unreliable to source as evidence. With only one case to look at you cannot exclude all of the other possible reasons why the problem might have gone away, and having acupuncture might just have been a coincidence.

To look at the possible benefit of acupuncture treatment, we have to go back to basics about what Chinese Medicine is and does. It is based on a theory of energy, called 'qi' (pronounced 'chee') and its balance and flow throughout the body. To put it very simplistically, pain and discomfort only arise where the flow is blocked, or where there is a deficiency or an excess in one of the well-defined pathways, called meridians, where the energy flows. A Chinese medicine practitioner would want to find out where the pains are, what they feel like (burning, dull, etc), what makes them better or worse, and so on, not that different from what a conventional medical practitioner might ask. From a Chinese medicine perspective, though, there is an important distinction between where a pain arises and what may be causing it. The practitioner will always look at the whole system to assess whether this is a local problem or a problem which has arisen against a backdrop of a generalised weakness of flow. If it is the latter, then treating the system as a whole is essential; treating the symptom alone will buy a little short term relief but then it may well recur.

The major question mark is the extent to which the problem has developed. The conventional treatment of exercise or drugs are often used to reduce the severity of the problem, but if it has reached a level where angioplasty, the surgical widening of the arteries, is necessary, then we would be a little less optimistic about how effective acupuncture treatment may be. We would certainly not recommend it as an alternative if surgery is the route your doctor advises.

You best bet, and our best advice, is to visit a BAcC member local to you to see a brief face to face assessment of what they think acupuncture treatment may be able to offer. This is going to be a great deal more informative than anything we can say here, and will take into account your specific circumstances. Most members are only too happy to give up a little time without charge to ensure that a prospective patient can make an informed choice about treatment.

Our only advice would be, if you go ahead with treatment, to make sure that agree specific review periods to assess whether treatment is working, and also to try to identify measurable outcomes - distances covered, etc etc. Our experience of treating patients with symptoms like these is that it can be quite hard to tell whether the treatment is working, because when it hurts it hurts, without having some externally referenced marker to check against.

 

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