Sandy Williams

Sandy Williams

Q: I have had acupuncture for a specific problem (achilles tendon pain) which has responded very well. Now it has been suggested that regular visits for acupuncture are beneficial to overall health and balance. Is this a generally recognised approach and if so is there a frequency of visits that is recommended e.g. is once a month too much, too little etc.

We are very pleased to hear that your ankle responded well to acupuncture treatment. Although it would be fair to say that the majority of patients in modern times consult us with a specific health problem, in ancient times the idea of staying well rather than getting better was central to the use of acupuncture and herbal medicine. Going to a doctor and seeking help when ill was said to be 'like forging a spear after the battle has started or digging a well when you are already thirsty.' The ancient practice was to have treatment to stay well, and it is believed that in some cases the doctor was paid to do this on pain of having to keep the patient in the style to which
they were accustomed if they got sick!

The key aspect of maintenance treatment is that each of us has a constitutional balance which predisposes us to certain problems at specific times of year or when we are faced with more mundane challenges of life like stressful times ahead or chronic problems. In China the seasons are very much more distinct than here, but the change of season was seen as critical as the temperature dropped rapidly or the winds picked up. The Chinese saw these as having a major impact on health (as a primarily outdoor agrarian race), and the doctor treated the person just before the season to ensure that the person was well-prepared for the change. With five seasons in the year,
this would have meant treatment every ten weeks, and there are many patients who take this seriously enough to do just that.

We find, though, that the majority of patients find a good balance by trial and error somewhere between four weeks and thirteen weeks, and in fact become very sensitive the idea of 'time for a treatment.' Of course, proving the long term benefits of this approach is very difficult; how do you demonstrate that someone is better than they might have been? However, enough patients have shown an increased resilience and overall health with regular treatment to convince us that the ancients had got it right.

The odd thing is that some people think that five treatments a year at around £200 is a mite excessive but have not the slightest hesitation in putting a perfectly well-functioning car through a full dealer service at £900. We think that the values of modern life have become a little off-centre at times! It is up to us to convince, though, to convince them that good health is more than just absence of illness but an enhanced ability to live well at all levels.

 

Tuesday, 30 June 2015 00:00

How often can you have acupuncture

A:  A great deal depends on where you are and what you are trying to deal with. In most cases practitioners in the UK see people weekly because the majority of treatments are constitutional in nature, i.e. aimed at balancing the system as a whole, and the received wisdom is that it takes a week to get a clear picture of what has changed since the last treatment. There are as many analogies as there are practitioners, but many talk about re-arranging things in a pond and waiting until the ripples have ceased to see what has changed.

In some cases, a practitioner might see someone twice or even three times in a week if there are acute problems to address. It is not unusual with acute back sprains to see someone more than once weekly. This is more a matter of reinforcing the treatment regularly to make sure that it 'holds'.

If you were to visit a practitioner in China, however, it would be quite normal to see someone daily for ten days. This constitutes a 'course of treatment', and many Chinese people with a chronic or acute on chronic condition will trot along to the local out-patients department at the hospital to have treatment every day. With an increasing number of Chinese practitioners in the UK it is possible that this may begin to happen more frequently here, although the crucial difference is that in China the treatment is free at point of delivery within the national health system. In this country ten sessions, one a day, would probably be beyond most people's pockets unless the practitioner had come to an arrangement over the overall fee.

Many of us believe that there can be a tendency to over-treat unless one is careful, and again the often-used analogy is that of watering a plant. There is only so much watering that one can do before leaving the plant to make its own progress, and that is why we are very insistent that BAcC members maintain a rolling review of progress to assess how much treatment is needed and how frequently. This is a matter of professional judgement, because each patient is unique and different, and even though two patients may apparently have the same problem, the underlying cause could mean one gets sorted in two sessions where the other one needs ten sessions.

Covering all bases in our reply, we have to say that you can never be harmed by over-treatment, so if someone were treating too often there is no damage that can be done. The worst that can happen is that nothing happens or the system may feel a little unsettled, but the inbuilt safety margins of the system usually ensure that the body re-sets to a good working balance very quickly. That is why any adverse effects, like tiredness to a mild headache, tend to go very quickly.

A:  Proximal myopathy can result from a number of causes, and to a large extent how treatable it may be can depend a great deal of what is thought to have caused it. There are a number of underlying causes which involve pathological and irreversible changes in the body, and it would be unwise to start giving people unrealistic hope or expectation in cases like this. The first thing a practitioner would want to do in great detail would be to go through the medical history and see what had happened as the condition developed.

As is not surprising, there is very little research into the use of acupuncture treatment for proximal myopathy. The immense variety of presentations and the huge range of possible causes would make it rather difficult to assemble a meaningful trial. There will undoubtedly be studies in Chinese, but the majority of these are not translated into English and there are not many searchable databases along the lines of Pubmed and other western ones.

That said, the great strength of Chinese medicine is that it takes the symptoms which someone experiences, which are the same in any language and medical system, and makes sense of them through an entirely different conceptual grid. Chinese medicine is based on theories of energy, called 'qi', and its flow, rhythm and balance in the body. When symptoms arise these are seen as changes or disruptions in the flow, and there is a 2500 year history of making sense of these through an entirely different understanding of the human body. Someone may have had the same symptoms 2000 years ago before there was any understanding of the nervous system, and there would have been, and still are, strategies for addressing the problem.

A good analogy is the treatment of strokes. In China, acupuncture treatment is started on the day of the stroke because the paralysis and spasticity which happens is seen as a break in the flow of qi, and every effort is made to reinstate proper flow as soon as possible. There would be no equivalent western treatment because the model used does not give any grounds for immediate intervention at the level of mobilising the limbs, the event being largely thought to be contained within the brain itself. So, in proximal myopathy, there may be ways of treating the presentation through a look at the local conditions where the problem lies or through looking at the wider
functional disturbances which in Chinese medicine could affect the functioning of the limbs through a systemic imbalance.

The long and short of it is that we think you would be well advised to meet one of our members local to you for a brief face to face assessment of what treatment may be able to offer. An experienced practitioner should be able within a few minutes to have a good view of what may be achieved and offer you a realistic assessment. The caveat remains, however, that if there has been a major change in the body which has precipitated the problem, this may limit the extent to which you might improve.

Q:I have had an ongoing feeling being 'spaced out' for about 6 weeks now.  It seems to take two forms, the first -and worst- a tense, queazy, feeling in my stomach which is accompanied by the feeling almost like flu, without the flu, if that makes sense, This is generally in the mornings and it then seems to revert to a more generalised feeling of being 'spaced out' in the day. It seems to lessen in the evening. I have had blood test, all clear and an MRI scan, again all clear. I was told it could be related to a migraine issue and I have also cut out certain dietary triggers ie caffeine/ dairy. I would prefer not to take medication to try to resolve this. Do you think acupuncture could help?

This is the kind of presenting problem which many of us love to address. One of the great strengths of Chinese medicine is that it can take symptoms such as these and offer several different possible explanations within a conceptual framework which is entirely different from that used in Western medicine. As you probably already know, Chinese medicine is based on the understanding of the body mind and emotions as a flow of energy, called 'qi', the various patterns, flows and rhythms of which contribute to good functioning in the body as a whole. Where this flow is disturbed, for whatever reason, symptoms will begin to appear, although not necessarily where the imbalance
manifests.

If someone were to look at your case history there would be in all probability other aspects of your functioning which, from a Chinese medicine perspective, would probably indicate a wider pattern of which this symptom was a part. There are also some very complex diagnostic signs which would also help the practitioner to refine their view of what is happening.

If the cause is similar, from a western point of view, to vertigo or migraines, there is considerable evidence for the treatment of both of these problems, as our factsheets show

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

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

to suggest that you would not be wasting your time on giving acupuncture treatment a go. However, these are usually precisely defined in western medicine, whereas the feeling which you have is a more indefinite presentation, although none the less disturbing even though it doesn't have a distinct label.

To give you an example of how different the diagnostic process can be, this expert treated a patient once who was experiencing a similar problem, and it turned out that she was eating as much as half a pound of cheese every evening. Given the energetic balance of her body, which was already out of kilter, this contributed to the formation of what the Chinese call 'phlegm' which embraces what we give the same name but can also extend to solid lumps in the body as well as something which the Chinese call 'mist'. This is said to rise and cause all manner of symptoms of which feeling spaced out is one. Other patients can often manifest the same symptom is their work or
personal circumstances are very stressful. This can lead to a condition called the Rising of Internal Wind, again causing the same problem.

Poetic as these descriptions can sound, they are based on over 2000 years of successful clinical observation and experience, and also 2000 years of successful treatment. On that basis, we think it would be potentially very beneficial to give acupuncture treatment a go, but to make sure that you review progress very carefully so that you don't run beyond the first four or five sessions without assessing what progress there has been. This may involve you in trying to get as objective a measure as you can of how
frequent or severe the symptoms are to be able to assess as accurately as possible whether there has been a change.

Your best bet is to visit a BAcC member local to you to seek an informal face to face assessment of what may be possible. Even a ten minute chat will probably give significant clues about what is going on and whether treatment would be of benefit.

 

Q:  I have read that acupuncture can be helpful in the treatment of abdominal adhesions  (colon to bladder) is this correct and what would be involved?

A:  We have looked back over our previous answers on topics similar to this, and we find that we continue to be unable to find any research, even case studies, which suggests that acupuncture treatment may be able to deal with adhesions. We have on a number of occasions discussed the merits of having treatment to deal with the pain which is thought to be coming from adhesions, but on each occasion we have had to say that we have never been able to say with confidence that the pain was coming from the adhesions. There are many occasions when the adhesions can in turn cause IBS because of the disruption in normal function, and it is not at all clear where the pain is
coming from.

As far as dispersing or reducing the physical manifestation of adhesions is concerned, we believe that this is highly unlikely, and the only route that we are aware of, which is surgery, remains the best option if the disruption it causes is very great. However, clearly there is some form of disturbance in the energy of the body in that region to encourage the formation of adhesions, and we would be probably more confident in saying that acupuncture would be worth a try to stop things getting worse or to try to
maintain things at a reasonably clear level after surgery. Chinese medicine in its oldest form was almost entirely asymptomatic and rested on the simple
premise that if everything was in balance symptoms would not appear.

We think, though, that this is problem best discussed face to face, and we would recommend that you visit a BAcC member local to you to discuss your own unique case. There may well be factors in your medical history which would shed light on why you have started to get adhesions, and understood from a Chinese medicine perspective these may well inform an educated assessment of what may be possible through treatment.

This is probably the best we can say. We have treated many people with unpleasant adhesions, sometimes with great success but equally often with no change, and we have to be realistic about what may be done, even though we really would wish to rid women patients of the problem.

Tuesday, 30 June 2015 00:00

Acupuncture for migraines on the NHS

Q:  My GP has told me he will allow me to have acupuncture on the NHS for migraines,  but asked me to find out where I can go closest to me. Could you tell me what would be available in Essex

A:We are surprised and delighted to hear that your GP has agreed that you can have acupuncture treatment on the NHS. Although NICE have recommended acupuncture as one of the treatments for cluster headaches, we have seen very few referrals to practitioners outside the NHS itself.  The quickest way to identify a suitable practitioner is to use our online search facility at www.acupuncture.org.uk. On our home page you will see a search box which, if you enter your postcode, will show your the practitioners geographically closest to where you are. We have tried by using your postcode, and it generates a list of ten BAcC members in your area.

We hope that this helps you to find effective treatment for your problem.

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Q:  Posterior rami syndrome neck to shoulder blade to lower rib to lower right side abdomen pain,idiopathic sensory nerve syndrome.  Could acupuncture help .Maybe sacra joint dysfunction..

A:  Posterior ramus syndrome is an unusual problem which was not really precisely defined until the latter part of the last century, although its appearance had been described for at least a century before that. The key factor in the description is that its appearance is unexplained, often described in medical literature as idiopathic, which is a smart way of saying 'it just happens.' There are a few examples where there has been a pre-disposing cause from accident or injury, but the majority of cases arise without obvious reason.

Whether acupuncture could help with suppressing the activation of the nerve roots which causes the problem is a moot point. There is no research that we have been able to locate which suggests that it can. Although there are certain to have been some studies in China, very few Chinese studies are translated and many are methodologically weak, especially from a western research perspective where the randomised double blind control trial is the standard for measuring both efficacy and effectiveness.

However, we have on several occasions been asked about phantom limb pains and whether acupuncture can de-activate the nerve signals which caused referred pain from non-existent limbs, and there are a number of reasonably good quality papers which provide evidence that this can be done. On that principle there may be some hope that treatment might be able to achieve something similar.

Of course, this is to look at treatment from a very western perspective, where needles treat specific conditions. This is far from the basis of Chinese medicine, based as it is on the concept of energy 'qi' and its rhythms, flow and balance in the body. From this perspective the interpretation of the symptoms from which someone suffers is made against a complex understanding of the patterns of flow and how the symptoms sit within these patterns. This is why a number of symptoms in different parts of the body can make sense from a Chinese medicine perspective because they all lie along a channel or meridian which can link head to toe, and all points in between. Nerve pains and pain in general often have specific areas of appearance which associate with the flow of channels and the use of acupuncture treatment to restore the flow where it has become blocked can often have a beneficial effect.

Your case, however, while not unique, is specific enough not to be able to trade in generalities in a written answer on web helpline. The best advice that we can give is that you visit one of our members local to you and seek a brief face to face assessment of what benefit acupuncture treatment might bring. It may well be that they see something in your presentation or in the diagnostic signs which will give them a much clearer idea of what may be possible than we can give here. It may also suggest to them other therapeutic possibilities.

Q:  I had  a second acupuncture session for neck & shoulder. The following evening I developed hives on my  back,under arms, back of thighs (all places where no needles were used). Could this be a healing crisis or not related?

A:It is very difficult to say. Generally speaking if there is a reaction to treatment, especially a skin reaction, it is directly in the area where needles were applied. That does not mean it cannot be a systemic reaction; there are a number of well authenticated cases where there has been a reaction throughout the whole body to local treatment. However, in these cases it is more likely that the reaction is a positive one, what is commonly described as a healing reaction or healing crisis. It often involves a re-run
of a symptom or a condition, often short-lived and quite acute, and the main thing which characterises this is that the reaction is over within 24 to 48 hours.

If that is the case, then all is well. If the reaction recurs on the next treatment, then it can mean a number of things. First and foremost one would need to check whether this was an allergic reaction to the metal in the needles. Some of the needles contain traces of nickel, to which some patients are allergic, and some needles are coated with silicone for better insertion. The immune system is a defensive system, so the reaction can be quite widespread as it goes on 'red alert'. Other possibilities are allergies to something else in the treatment room - this expert, for example, is allergic to biological washing powders - and the fact that the reaction is on the back may betoken something like this is you lay on a blanket or similar couch covering.

There is, of course, the possibility that the reaction has nothing to do with the treatment, in which case if it persist for more than two days it may be worth seeking medical advice, especially if over the counter preparations are not helping. Your doctor can probably prescribe something more powerful than OTC products. The important thing is to seek treatment rather than getting into debate about what caused it. Our experience is that ractitioners can become unnecessarily defensive, which in turn can get
misinterpreted as 'trying to hide something', and from there a fine old isunderstanding can kick off.

Essentially your practitioner is your best resource. He or he will know where they needled, and if it can be established quickly that the reatment in unlikely to have caused the problem then they can be a great help n finding out what actually has happened. It would be really helpful if you ould keep a notebook of your symptoms, or better still photo, to enable him or er to make an informed assessment when they see you.

A:  Trigeminal neuraligia is a very painful and quite often intractable condition. We have been asked about it a number of times, and although we have factsheets about both facial pain and neuropathic pain

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

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

there isn't a great deal of hard evidence to which we can point by way of underpinning a recommendation for acupuncture treatment. In a previous response on the same question we said: If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.

We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and
subtle manipulation may offer possibilities.

We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient
to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.

If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accuratelybad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.

We think that this still remains the best that we can say. Our experience is that where acupuncture does work it can often work very rapidly when the reason, understood from a Chinese medicine perspective, is very clear. However, we have to be honest and say that where there is no clear pattern, i.e. where the symptom is clear but the energetic disturbance which causes it is not, we have seen cases which have remained intractable and where patients have had to remain on western medication as a
way of controlling the symptoms.

A:  Generally speaking, the track record for acupuncture treatment of migraine is very good. Although the evidence is not quite to the rather strict standards which would enable us to give an unequivocal recommendation, as our factsheet shows

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

there have been a significant number of high quality trials, and we expect that over the next decade the evidence will be better still. This is certainly the case with cluster headaches for which NICE now recommends acupuncture as a primary treatment.

Your specific mention of vestibular migraine suggests, however, that your symptom are more vertigo-like than the nausea and pain associated with the 'classic' migraine. Here again, acupuncture treatment has been well-researched

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

and there are some good quality studies suggesting that treatment is beneficial. Both migraine and vertigo, in fact, figure in the twenty conditions for which treatment is most frequently sought.

Of course, the point we have to make is that these are both western disease classifications, and the great strength of Chinese medicine is that it can take the symptoms, which are the same in anyone's language, and re-interpret them in an entirely different theoretical grid based on a concept of energy, called 'qi', and the disturbances to its flow, rhythms and balance which generate symptoms. This can often lead to a much more precisely targeted treatment than the treatment of a named condition, and mirrors what the great Canadian physician William Osler once said: 'don't tell me about the disease the patient has, tell me about the patient who has the disease.' Each person is
unique and different, and although the same reason might exist for the symptom to appear, the chain of causation may be entirely different.

This is important, because the parts of the system connected with balance also have a major involvement in the function of sight, and it would not be impossible that the photophobia shares the same root cause from a Chinese medicine perspective. Certainly the 'darkened room and absolutely no noise please' symptom which we often hear is one which does appear to be eased by treatment for migraine.

As we said, though, each patient is unique and different, and the best advice we can give you is to visit a BAcC member local to you and seek their face to face assessment of whether they believe that acupuncture treatment may be beneficial for you.

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