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Q: I was wondering what the BAcC said on blood pressure limits;  specifically when should practitioners refuse treatment. Or more accurately could you provide figures on the lower and upper limits with regard to acupuncture treatment?

A:  There is nO point at which a BAcC member will refuse treatment because of any inherent risk in the use of acupuncture treatment when someone has extremely high or low blood pressure. In fact, the use of acupuncture for hypertension is reasonably well-researched, and although the evidence is far from conclusive (at least in those studies which meet the perhaps over-strict inclusion criteria used in the West) it is certainly encouraging. At the other end of the scale, there are a number of points which are known to lower blood pressure, and a practitioner may be a little cautious if treating someone who has hypotension, but the needle techniques used in the West are probably too gentle to creat much in the way of a major reaction. However, we have pointed out to medical colleagues that one of the points they use rather vigorously for treating tennis elbow can lower BP by ten points, and to be wary of over-doing it.

The real issue is one of patient management. We all routinely take the BP of a new patient, and if it sits at the end of what doctors take to be the normal range (above 145/95, below 90/60) we all refer to GPs to get the pressure tested in a surgery and officially noted. This would not preclude treatment, but would be simply offering the best care to the patient. If someone with very high blood pressure refused to see their GP and wanted to try to use acupuncture as a main intervention, we would almost certainly advise members to tread very carefully. Refusing to treat would not be an option - it is not our job to 'sack' patients who want to pursue their own choices and the treatment may well work - but we would want to see a member obtaining some very specific consents to treatment, and writing very thorough accounts in their notes of what is happening.

Sadly without statutory regulation we are not formally recognised within the NHS, and therefore we are subject to very strict rules about disclosure without consent. As such we could not go to a patient's GP without their consent. However, where we have met situations like this the persistence of the practitioner has invariably won in the end.

Q:  Can acupuncture assist in the recovery of a long term (over 4 years)bells palsy sufferer?

A:  The BAcC has a factsheet on Bell's Palsy
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/bellas-palsy.html
 
which makes encouraging noises about what acupuncture can achieve, and there is certainly a huge amount of research literature from China where this is a much higher incidence of the problem. Chinese medicine describes this as a problem to do with 'invasion of wind.' This is rather alien sounding to the western ear, but Chinese medicine is based on a fundamental theory about the flow of energy, called qi, in the body, and what helps and hinders its flow. In Chinese medicine theory external/climate factors are just as relevant and important as internal or material causes, and for an agrarian race exposed to the climate day to day, the idea that the wind as a pervasive force could disrupt the flow is a natural consequence of the thought pattern. In fact, one common cause, before aircon became standard, of Bell's Palsy was driving along motorways on sunny days with the window open for fresh air, and getting a 70mph blast of air on one side of the face. This expert has treated half a dozen people who did this very thing.

 

The one concern we have, however, is the length of time which you have had the problem. In China problems like this are treated immediately and vigorously, often daily, to expel the pathogen (wind is said to invade, and so needs to be removed) and to restore the flow in the area. Once the patter has settled, however, it becomes more difficult to shift. It is almost as though the body accepts this as a natural state and accommodates it. The Chinese talk about stagnation and stasis of conditions like this where the flow is disturbed for a long time, and it can take a great deal of effort to make things move again.

 

There is also the question of the backdrop against which it is set. Chinese medicine rarely looks at a symptom in separation from the whole system, and many cases of Bell's Palsy resolve relatively quickly of their own accord. A practitioner will automatically look at the whole system anyway, because that's what we do, but would in particular be interested to see if the healing responses of the body as a whole were compromised in some way, hindering attempts to get local improvement. There would be signs which the practitioner could see but perhaps other aspects of overall health which the patient might not recognise as evidence of a wider pattern, like sleeping badly or having mild digestive problems.

 

Our best advice is to visit a BAcC member local to you for a brief face to face assessment of the problem. If you do decide to go ahead with acupuncture treatment, however, we would recommend that you set a finite limit of treatments, perhaps four or five, and set very clear outcome measures and review periods to see whether the problem is improving. It is far too easy to build up a 'treatment habit' where through no-one's fault the clock can run to a dozen sessions or more with no discernible change. We are very keen to ensure that good dialogue is maintained to make the decision to take a longer time a conscious one.     

 

 

This is almost impossible for us to quantify. Electro-acupuncture (EA) is not a main element within the BAcC scope of practice, i.e. we would not expect all BAcC members to be familiar with the basic skills and knowledge of EA devices for them to register with us. However, EA is within the extended scope as one of a number of aspects of traditional acupuncture in modern times which we might reasonably expect someone to offer within their practice and thus insurable under our existing professional indemnity cover.
 
A significant number of our members use EA in specific contexts, as for example in the late stages of pregnancy during delivery, and we have a number of members who are dual qualified as osteopaths, chiropractors and physiotherapists who routinely use EA techniques within their practice, but we do not assess the numbers regularly.
 
If we were asked to guess, we would say that the figure is probably no higher than about 10-15%, but this really is a guess based on personal knowledge rather than based on audit or research.
 

There are a number of small studies such as
 
http://www.ncbi.nlm.nih.gov/pubmed/19912491
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297434/
 
which seem to show that acupuncture may be of great benefit. However, these are very small studies, and a much larger trial would need to be conducted for us to make a positive recommendation.
 
However, when we were asked a similar question two years ago we mentioned the fact that a question had recently been posted on our website forums for members which had provoked very little response. By a rather strange coincidence a similar question about vulvodynia posted a fortnight ago has created a very productive dialogue, with over fifty contributions so far.
 
The upshot of all this traffic is that there are a number of ways in which vulvodynia can be understood in Chinese medicine, both as a local problem and as the local manifestation of a systemic problem. As you may know, the theories of Chinese medicine are premised on the flow of energy called 'qi' and the way in which this is balanced in the body. This balancing is carried out by the Organs (capitalised to distinguish them from the conventional medical understanding of an organ), and if these are affected, then the balance of the body will be affected. Similarly, if there are local reasons why the flow of energy may have been affected, these may generate symptoms in an otherwise healthy person.
 
The skill and art of the practitioner lies in the ability to make sense of the symptoms within the whole picture, and to determine what adjustments are needed and where. Most problems which appear to be isolated are in fact a part of a much wider picture of imbalance, the logic of Chinese medicine being refreshingly straightforward - if the system is in balance, the body heals itself.
 
The best advice we can give is to visit a BAcC member local to you and ask their advice. Most will be able to offer a fairly good assessment based on a brief visit of whether the acupuncture treatment will be able to help. If they are not convinced that they can help you we are confident that they will be able to recommend other alternatives based on the signs and symptoms with which you present.     
 
 
 
 


A:  There are no set rules about the gaps between treatment, but the majority of UK practitioners will see someone weekly to begin with and then, depending on the condition, space the treatment out further. In some cases where someone has an acute condition the treatment may be twice weekly or even more. This would be the normal pattern in China, for example, where a course of treatment offered in an outpatients' department might involve daily treatment for ten days. However, in the UK this is often not possible because of clinic timetables and also, to be truthful, because working out payment schedules for multiple treatments in a short period of time is not to every BAcC member's taste.
 
The wisdom of weekly treatment is that this allows the practitioner to get a really good idea of how well the treatment has taken. Our old teachers used to use images like dropping a stone in a pond and waiting for the ripples to cease, or more appositely, clearing mud from the bottom of a pond and waiting for the water to clear again to see how well one had succeeded, but the message is intrinsically the same - treat too early and it may not be easy to make sense of what is happening.
 
By the same token most members do not like to leave long gaps between treatments when a course of treatment starts. It is important to be able to assess what changes have taken place, and after two or three weeks most patients, apart from the diary keepers, find it difficult to recall how they felt. Small changes which to a practitioner may have significance are not recalled. There is also a question of momentum; weekly treatment for the first four or five sessions often has greater accumulated power than the same number of treatments spread over several weeks.
 
If you have any queries about the specific gaps between your own treatments we are confident that your practitioner will be very happy to explain what is going on.