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Q:  I had acupuncture for a neck muscular problem 2 days ago and had a wave of panic during the session. I have had awful panic attacks since and haven't slept
properly for 2 nights. Whilst I do suffer with general anxiety I don't get panic attacks that often or at least not as severe or as long as this.  Do these feelings go away and if so, how long before you get back to normal. I feel as though I'm going to be like this forever!

A:  This is a rather strange consequence of treatment, and we rarely see anything on this scale. The first and most important thing to say, though, is that most adverse effects of acupuncture treatment are transient, lasting 24 to 48 hours at most. In fact, we strongly suspect that by the time that we have got this reply to you, the Bank Holiday having intervened, the episodes will have grown less frequent and perhaps stopped altogether. The only slight concern would be that they become self-sustaining - worrying about whether a panic attack will happen can sometimes convert a more manageable general anxiety into something a bit more troublesome.

As to what has caused this, a great deal depends on the kind of treatment which you were given. It would be most unlikely that there has been a physical cause. We can't think of any physical structure which could generate panic attacks if it were to be touched by a needle. The only thing we can surmise is that for some reason the muscular tension in the neck is a reflection of a somatisation of the anxiety which you have been experiencing at a lower level, and releasing the muscles has generated a small surge of the kinds of feelings which are 'contained' there. This is much more common an experience in deep tissue massage where colleagues often report that working on
deep structure can often release some very powerful emotional responses in people who would not have suspected that this lurked within. As we say, this is unusual but not unknown with acupuncture treatment, and if this is the case then the effect is likely to be short lived.

The best person to speak to about this is the practitioner who treated you. Knowing exactly what they did will make it far easier for them to make sense of what has happened, and they will almost certainly be able to treat you for the panic attacks in order to break any cycle which sustains the feeling. Chinese medicine works on many different levels simultaneously, and although someone may use points which affect the physical structure of the neck, these can impact on accompanying issues in the mind and emotions, and the practitioner may well be able to make sense of exactly what has happened.

As we said, however, we strongly suspect that the attacks will be subsiding even as we pen this response.

A:  Surprisingly there are very few studies of the use of acupuncture treatment of polymyalgia. We suspect that the principal reason is that the condition can present in so many different forms and that the diagnosis itself is not always 100% accurate (it could be a number of other problems) that it is difficult to identify clear enough trial and control groups to set up the kinds of trials which are favoured in the West, the so-called randomised double blind control trials.

However, the symptoms which people experience are not a modern phenomenon, and Chinese medicine has been confronted by, and dealt with, similar presentations for over two thousand years, and has ways of interpreting what is happening within an entirely different conceptual framework. Chinese medicine, as we are sure you already know, is based on an understanding of the body as a flow of energy, called 'qi', whose flow and balance in the body determines someone's overall health and well-being. Any excesses, deficiencies or blockages cause pain, and the skill of the practitioner lies in determining how best to restore correct function and flow in the whole system.

Clearly from this perspective each patient is unique and different, and when dealing with a problem like PMR this is a positive strength, since it takes seriously the individual presentation which the patient reports rather than shoe-horning all cases into a generic formula treatment. From a Chinese medicine perspective the emergence of PMR pointsto both local and systemic disturbance, and the underlying question is why these symptoms have arisen in this person. This means that ten people presenting with the same symptoms may have ten different treatments, based on the different nature of the problems which have generated the same symptom.

PMR is such a wide-ranging problem that we would be reluctant to offer any kind of prognosis here. Some cases are very straightforward; but in our experience the majority aren't. The best advice we can give is that you visit a BAcC member local to you for an informal chat about what acupuncture treatment may be able to offer you.

As far as electro-acupuncture is concerned we are not really able to offer a view. Although many of our members use EA alongside traditional treatments, there is an equally large number of practitioners out there who use it on the basis of a western medical diagnosis and on a much more local treatment basis. There is not a great deal of evidence for the effectiveness of EA on PMR in David Mayor's definitive textbook and online resource, but that is not to say that it does not work. The same considerations apply as to the remarks above about research; it is difficult to assemble a trial with a condition with such wide variations of presentation. The best that we can say
is that if the EA is applied according to traditional Chinese medicine principles, we would believe it had the same likelihood of dealing with the imbalances in the energy as ordinary needles.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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