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Q:  I have had hypothyroidism for approx 6 years now, and despite endless efforts, yoga, Zumba, walking, Pilates, diets of every kind, supplements, etc etc, I have not been able to shift the extra weight I gained when my thyroid condition first presented. 
I am now approx 1.5 stones overweight and very miserable and self conscious as a result. And the constant failure despite every effort is even more disheartening. 
Now I am contemplating acupuncture for weight loss but need to check if I can have acupuncture if I have hypothyroidism? 
I also have a brain tumour, (an ependymoma in the 4th ventricle, for which I was treated 11 years ago with surgery where some of it was able to be removed, followed by 6 weeks radiotherapy) 
So, please could you advise if I am able to have acupuncture?

A:There are no contra-indications to the use of acupuncture when someone has hypothyroidism. Indeed, we are sometimes asked if acupuncture can be used to treat hypothyroidism, and a sample answer that we gave says:

A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism. What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.

For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment as the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.

That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.

If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.

We would offer the same advice today and re-iterate the fact that it can quite often take a long time to stabilise thyroid medications. If acupuncture does have the effect of improving the residual function of the thyroid it may take a while to balance the doses of medication again.

We are always cautious when people ask us about using acupuncture for weight loss. There are a number of well-defined and easily recognised syndromes in Chinese medicine where additional weight gain, often in the form of retained fluids or precipitated by an under-performance of parts of the system, may be amenable to treatment. However, even here there is no guarantee that someone will lose weight, and evidence overall for acupuncture and weight loss is poor. It is also, even when part of a successful regime, not entirely clear what causes what. Very few people do only one thing to try to lose weight, and it might be any factor or all in combination which achieve a result.

What we can say is that there may be some aspects of managing one's diet according to Chinese medicine principles might be of benefit, and most practitioners will be only too happy to share this simple wisdom whether you proceed with treatment or not. The best and only advice we could give, though, is to see a BAcC member local to you for a brief assessment of your own unique situation and whether they think acupuncture treatment may be of benefit.

Q: I fractured my ankle 2 years ago and had metal put in (later removed). I still have aching and stiffness. Could acupuncture cure this?

A:  A great deal depends on the cause of the aching and stiffness. There is no doubt that acupuncture treatment can have beneficial effects on chronic pain and on various forms of osteoarthritis, as the factsheets on our website clearly show. The evidence in some cases is very good, while in others slightly more equivocal, but it would be fair to say that we tend to see many cases like yours where from a conventional perspective recovery has been very good but there remains residual pain and discomfort.

The theory which underpins Chinese medicine is based on a concept of energy('qi') and its proper flow and balance within the system. When the body is damaged this can interrupt the flow of qi in a quite profound way. This can mean that even though recovery appears to have been complete, there remains blockage or stagnation in the area which will remain and continue to cause problems long after the patient has been signed off. This is most clearly the case with scar tissue which can have surprisingly powerful effects, but broken bones can be equally troublesome.

How much a practitioner might be able to do is not easy to predict, however. From a Chinese medicine perspective each patient is unique, and even though they might have the same injuries, the overall pattern of energy as the context in which healing takes place can make a huge difference. That is why twenty people with the same problem could receive twenty different treatments.

The best advice that we can give you is to visit a BAcC member local to you and ask advice about your specific problem. Most are only too happy to set aside a few minutes without charge to assess face to face whether a problem is amenable to treatment, and to give you a sense of how much treatment may be necessary. In the absence of any published evidence for the treatment of this kind of problem it is critical that if you go ahead with treatment you set clear review periods and try to set measurable outcomes, something which demonstrates that change is happening. We are always concerned that slightly less well-defined problems can quite quickly run to ten or twenty treatments without discernible change, and therein lies potential disgruntlement.

]Q: Are there any studies available to show that acupuncture is beneficial for high tone muscle tension following a stroke. Could it help or harm?

A:The first thing that we can say is that acupuncture treatment will do no harm if it is done by a properly trained and qualified practitioner, as all BAcC members are. The only long term damage which a practitioner could do would be the penetration of an internal organ, and we are all trained in the careful use of needles to avoid this outcome.

Acupuncture has been very heavily researched, especially in China, for its use in helping recovery from stroke. We have a review paper on our website

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which highlights a number of the more significant studies which have been published over the last decade or so. Most of the papers are referenced in the footnotes, and there are many more which can be accessed by using the search 'ncbi acupuncture stroke' in google. NCBI is an American database which gathers together the results from several major databases, like Pubmed and Medline.

In Chinese hospitals the use of acupuncture after a stroke is routine. It is not at all uncommon for someone to have daily treatment starting immediately, and the logic is very simple - stroke, or wind-stroke as it is called in Chinese medicine, causes a disruption in the flow of energy ('qi') in the limbs and it is critical to re-establish this as soon as possible. The longer that one leaves treatment. the more entrenched the poor flow and subsequent blockages become and the more difficult to re-activate are the affected muscles. Of course, the problem in the West is that very often acupuncture is only considered some way further down the line, and so we often begin with a very much more difficult problem than might have been the case.

It is very important to be very realistic in taking on a patient with the kind of high tone muscle tension which exists three or six months after a stroke. Progress may well be very slow, and may also be difficult to discern - people have good days and bad days anyway, and judging whether there is an upward trend is hard. We suspect that the best answer, if you are considering acupuncture treatment, is to visit a BAcC member local to you and ask for a brief face to face assessment. Most will be happy to give up a few minutes without charge, and can assess better than we can at a distance whether a specific presentation can be treated or not.

 We wonder whether you mean 'tendonitis' of the wrist. If so, there is not a great deal of specific evidence about treating tendonitis in the wrist which we can offer you as solid evidence.

However, these sorts of problem are very often the ones which eventually find their way to our treatment rooms when the conventional treatments such as medication or physiotherapy, even with the use of acupuncture in physio hands, do not have the desired sustained effect. Problems like tendonitis often have their roots in over-use of some of the tendons or in poor positioning in, for example, a workplace or sporting activity, and it is quite often necessary to investigate carefully to find out how to stop the problem from re-occurring.

The critical thing to do, however, is to break the cycle of pain. The swelling and inflammation, once it occurs, can often regenerate itself, and what one aims to do is to reduce the pain and swelling at the same time as creating better working conditions and, crucial from a Chinese medicine perspective, finding out how to boost the system as a whole to stop any recurrences of the problem. For the many thousands of people who play sport or who work in difficult conditions, only a few develop significant problems with tendonitis, and it is often a consequence of an underlying imbalance in the system which does not allow the body to repair as well as it could.

There is also a great deal to be done locally for the problem. Chinese medicine developed against a backdrop of people working in extremely difficult conditions in the fields, and problems from over-use and exposure to hard climate were the bread and butter conditions of early practice. Ancient Chinese practitioners had a very complex understanding of the way that joints and tendons can be affected, and a large number of ways to treat them, and this wisdom, which is retained within modern practice, is no less relevant in modern times when the causes may be different but the presentations the same.

The best advice we can give is that you visit a BAcC member local to you and seek their advice. Most are more than happy to give up some time without charge to assess whether treatment may be helpful, and they will be able to see the specific way in which the problem presents, which is something we cannot do at a distance.

Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.

All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.

Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.

Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.

The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.