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Q:  I've had 2 acupuncture treatments so far in the same week. Unfortunately, the physician is then off on vacation and can't see more until  2 weeks later. Will the fact that the treatment gets interrupted for 2 weeks after only 2 treatments means I'm starting at 0? Am I better to wait till she returns? FYI: I'm going to seek treatment for neuropathic pain in the neck and back.

A:  There are no hard and fast rules about the frequency of treatment. Most of us tend to see people weekly for the majority of problems, occasionally making that more frequent if someone has an acute problem. Once a start has been made many of us then start to space treatment out. Many use the analogy of watering a plant - enough to get it started and then what it needs as appropriate. A more common problem than spacing out too soon is carrying on too long with weekly treatment, and we get the occasional question about the necessity for continued frequent treatment.

It would be unusual to lose anything that you have gained over a fortnight's break. While it is good to establish a bit of momentum, if the treatment is working in the right direction the treatment will generally hold. The system works towards balance naturally and all we do is to make this possible. For things like neuropathic pain you are often trying to break a long-standing pattern, and once the system responds it has some sense that the fixity of the existing pattern is not as great as it might have assumed. Two sessions in close proximity might well be a good start whose benefits will continue for a couple of weeks.

Generally speaking we all tend to make professional judgements about when and whether to start treatments around our annual breaks and in the majority of cases you will find that a practitioner is usually pretty clear which cases he or she can start safely and those which need to have a consistent pattern of weekly treatment. Your practitioner has probably made this assessment and reckons that it is worthwhile kicking off.

We hope the treatment does ease your pains.

Q:  I have  motor neurone disease , affecting my right foot and leg and slowly moving to my left leg . My arms are gradually beginning to feel heavy but all still working quite well. I was diagnosed in August 2015 after experiencing a foot drop in January 2015 . For most of 2014 I experienced a lot of tripping thinking that my left ankle was just week. I had a lot of falls until the foot drop. What type of accupuncture would you recommend for me?

A: We are very sorry to hear of your diagnosis. We are aware from our own experience of treating patients with motor neurone and similar problems that even though the early stages of the disease are barely noticeable the emotional impact can be devastating. However, the progress of the disease is very hard to predict, and Stephen Hawking is but one of a number of people who have reached a plateau from which they do not move.

We were asked about MND some while ago and we answered:

We always take great care in answering questions about conditions such as motor neurone disease. From a conventional medical point of view the term 'motor neurone disease' covers four or five distinct variations of disease, but what is common to all is that they are all progressive and deteriorating, and most people survive only three to five years from the point of first diagnosis. There are some exceptions, the most notable being Stephen Hawking, the scientist, who has had the disease for over fifty years.

From a Chinese medicine perspective, a great deal depends on how the disease first presents. The ancient Chinese had a far greater understanding of anatomy and physiology than is often recognised in the West, but diseases of the nervous system such as this would have been a mystery to them. They would have looked at the symptoms as they presented, and tried to make sense of these within a framework which was underpinned by the concept of 'qi', a form of universal energy, whose flow, rhythm and balance are seen as integral to health and well being. If there was a weakness in an arm or leg, often an initial symptom in MND, it would be seen as an impairment in the flow of qi and the practitioner's aim would be to identify whether this was a local problem or a wider systemic problem and use needles and moxibustion to restore flow and balance.

Anecdotally we hear stories about people for whom treatment with acupuncture appears to arrest the speed with which symptoms get worse, but such is the unpredictability of the course of the disease there is no way of knowing whether the treatment has done this or not. There are forms of the disease where after the initial symptom appears nothing else seems to happen for many years, and this is unpredictable and difficult to measure. We would like to think that acupuncture treatment can delay more severe symptoms, but there is no evidence to suggest that it can do this. Acupuncture treatment will certainly not do any harm, and may even help with some of the anxieties and stress which accompany the condition, but more than that we could not claim.

We think that this probably still represents the best advice that we could offer. However, we do feel that we were a little bit too cautious about the use of acupuncture. In the treatment of strokes, for example, mainstream treatment in China routinely uses acupuncture to help the flow of qi in the limbs after it has been disrupted, and this is all to do with getting the local flow going, not acting on the area of the brain where the problem arose. In a similar fashion, from a Chinese medicine perspective a symptom like foot drop is simply a failure of the qi in an area, and reducing its impact would be a realistic aim of treatment. Clearly where there has been damage or loss of nerve tissue the chances of improvement will be poorer, but problems are rarely that simple that only aspect of someone's health has been affected. There may be nerve damage causing restricted use which in turn impacts on the flow of qi. There may be some possibility that acupuncture will maximise the available use.

There is very little published high quality research into the use of acupuncture for MND, although there are occasional reviews such as this one

which do report some rather encouraging developments, especially in the field of scalp acupuncture. We always have to remind people, though, that although everything works for someone, there is rarely something which works for anyone.

As far as types of acupuncture are concerned, all forms may well have a benefit. We are obviously, as Chinese medicine practitioners using traditional acupuncture convinced of the benefit of treating the patient, not the condition, and seeing symptoms within the overall context of the patient's health and balance. There are medical versions, but these tend to be more restricted in what they can offer (from our view), but may nonetheless have an effect. The scalp acupuncture practised in the UK is a postgraduate speciality just starting to be more widely trained.

The best advice that we can give is that you visit a BAcC member local to you (we have several members based in Jersey) and seek their advice in a brief face to face assessment. They will be able to offer you a much clearer explanation and view of what may be going on, and what benefits they think treatment with acupuncture may bring.

Q: We think that a more important thing to look for is not the qualification which a practitioner has but the membership organisation(s) to which they belong. Most people hold a licentiate in acupuncture, often backed by a BSc degree from a university as more UK courses are validated by universities. Some describe the qualification as a diploma, but this is normally understood to be a shorter course of perhaps two years. Most training courses offering the licentiate usually run to 3 years in line with the recommendations of the World Health Organisation which cites 3600 hours of training as the minimum necessary to achieve sufficient skill to operate in independent practice.

The trouble we often find is that it is very easy to call a sub-standard course a diploma or licentiate programme, but until there is some form of statutory regulation of training it will often be caveat emptor. Many of the courses which operate below the WHO levels tend to offer membership of their own 'tied' organisation. This does not mean that they are necessarily disreputable, but it does mean that it would be hard not to accept their own graduates.

The BAcC part funds an independent accreditation body, the British Acupuncture Accreditation Board, which sets and polices very onerous standards for the teaching institutions applying for accreditation. On the basis of meeting these standards we allow graduates automatic eligibility to the BAcC, subject to health and criminal record checks. All other entrants have to apply through an assessment and interview route which uses the BAAB standards as its baseline.

The key think about looking at membership of a professional association rather than an individual qualification is that someone else has done the hard work for you of deciding who is and who is not fit to practise, and also should have in place a comprehensive conduct process to deal with anyone failing to meet the standards of behaviour expected of a practitioner. The BAcC also provides bloc insurance cover, guaranteeing that the practitioner you are seeing is fully covered by a 'gold standard' policy. 

Q:  Is acupuncture used to treat hormonal imbalances which have led to osteoporosis? Has it been shown to be effective in re-balancing hormones? Has it been shown to be effective in treating difficulties with ovulation/menstruation/fertility?  Any risks to be aware of with such conditions?

A:  Many questions! What they seem to boil down to is whether acupuncture treatment can help to re-balance the basic hormonal patterns which determine a healthy and balanced reproductive system and which help to reduce the risks of osteoporosis in later life. We have to be honest and say that although there is a growing body of evidence for many aspects of this area, as our factsheets show:

it remains far from conclusive, although probably sufficiently encouraging to suggest that it would be worthwhile trying treatment.

The problem of many of the studies of this kind is that they used a kind of 'named condition' approach when in fact Chinese medicine is less concerned with the named condition than with the person as a whole. This is not an approach unique to Chinese medicine; the great Canadian physician William Osler once famously said 'The good physician treats the disease; the great physician treats the patient who has the disease.' What this means is that each patient will have different reasons for manifesting the same condition, and the best treatment will be aimed at helping the unique presentation that each person represents. Twenty people with the same named problem might be treated in twenty different ways.

Obviously some conditions present in broadly similar ways, and you may well find that in modern Chinese acupuncture there is a much more formula based pattern of treatment. Most of us as traditional practitioners, however, remain committed to the notion that treating the individual is the best guarantee of someone getting better and staying well. This would mean trying to establish an overall balance within the body on the simple premise that a system in balance repairs itself. In conditions like osteoporosis, though, it is only fair to say that where bone density has been lost there is no evidence that treatment has ever reversed this trend and created more bone. Getting worse slower may be the most that one could expect.

As far as risks are concerned, in the hands of a properly trained and qualified practitioner there are very few, and acupuncture has been shown to be one of the safest healthcare practices around. This mainly relates to damage caused by the treatment itself. In terms of whether there have been adverse changes to someone's hormonal balance, all we can say is that there have been no reports of this of which we are aware, but it is difficult to imagine how one would even go about showing that acupuncture treatment had caused something like this to happen, so we would not be incautious enough to offer a definitive view. However, we think it is highly unlikely. In our experience even if we do a 'wrong' treatment, the system simply resets itself within 48 hours. This is partly why acupuncture treatment is so safe. 

Q: I recently broke my tibia and fibula in the lower part of my shin which has been pinned with a tibial nail. Unfortunately I have also suffered some nerve damage during the trauma which has left me with foot drop. I have numbness along the outer edge of my calf muscle and across my foot. I am unable to move my foot upwards meaning when I walk my toes hit the floor before my heel. I do not experience any nerve associated pain. My question is do you think acupuncture could help with the recovery of the damaged nerve?

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