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Q: My creatinin is stable at 250 all trace elements are with in spec .  I have no swelling  and feel good.  I have started with acupuncture twice a week . What other TCM can I use to reduce my creatinin level?

A: We are not quite sure how to respond to your question. The creatinine level you have is moderately high, but at the moment does not seem to be generating any other symptoms, although your medical team would undoubtedly like to see it fall to more 'normal' levels. 

Our feeling, from your question, is that you would like to do as much as you can to help this process along. However, with twice weekly acupuncture you are already doing something quite substantial, and we believe that the best advice we can give at the moment is to see how far this changes things. Any other forms of TCM will work on the same diagnostic principles, and are going to reinforce what the acupuncture is doing. However, they may not be necessary, and we suspect that your practitioner will only start to look at supplementing the treatment if the acupuncture does not work as well as it could from a Chinese medicine perspective, although he or she will also be guided by the readings from your conventional tests.

The range of additional modalities is considerable - moxibustion, cupping, tui na (a form of massage), dietary therapy, and even some forms of herbal medicine, if she or he is trained in their use. It may well be that some of these are appropriate, but a great deal will depend on the nature of your condition from a Chinese medicine perspective.

Of course, we haven't touched on the most important aspect of the case, and that is what is causing the creatinine levels to rise to their current levels. We are assuming that this is not a random idiopathic occurrence 'just happened'), and the causal patterns which led to the rise of levels will have been taken into account when the practitioner formulated their treatment plan. These more than anything else will guide a practitioner in the choices of TCM intervention they use.

We tend to talk to patients about watering plants as a good analogy for treating patients. If you over-water a plant you sometimes can prevent its growth. The same, we believe, can happen with patients. There are times when a system needs time to adjust and assimilate change, and over-treatment, the relentless stirring up of the energy, may not give the body time to settle and stabilise. If the acupuncture begins to show improvements stick with it and see how far the improvement goes before it levels out. If there is no improvement then it may be worth investigating what can be added to the treatment mix.

We should add, by the way, that the evidence from a conventional medical point of view is not that great, and much of it derives from experiments with the treatment of animals. However, the levels themselves, which would not have been known in ancient Chinese medicine, will probably be accompanied by a number of diagnostic indicators which will be assessed within a Chinese medicine perspective, and your practitioner will have 2000 years of accumulated wisdom on which to draw in treating you.

Q: As a result of aucpuncture treatment, I have been left with a large sore or infection on my right leg. Is this temporary and how should it be treated?

A:  There are a number of transient adverse effects from treatment which one could classify as 'normal', such as mild headaches or feeling drowsy, but sores and infections are definitely not. You should see your GP as soon as is practicable to assess what kind of sore/infection you have and to get medical treatment for it.

At this distance we have no way of knowing whether or not the acupuncture was the direct cause. Generally speaking the advent of single use disposable sterile needles in 1999  put an end to any remote possibility of cross-infection from patient to patient, and the only way in which a needle could cause infection would be improper use by the practitioner, as for example in touching the shaft of the needle before insertion (again since the advent of sterile guide tubes virtually unheard of) or more likely from the needle pushing bacteria from the skin surface into deeper layers of tissue. The problem may not always manifest where the needles were inserted. although if this does happen, again a rare event, then the primary infection is usually at the needles site.

However, at this stage the priority is getting the problem properly diagnosed and treated. The options after that are numerous. We usually recommend that patients contact their practitioner for advice and support, but we have to be realistic and know that many practitioners will become quite defensive, which is not the outcome we would like to see. Unless the practitioner's technique is potentially at fault, in which case they may have good reason to be defensive, then accidents and adverse outcomes occasionally happen even in a practice as safe as traditional acupuncture. That is why responsible practitioners belong to sound professional associations which often, like the BAcC, provide a very high standard of insurance cover to ensure that patients who suffer detriment are properly covered. Your practitioner can almost certainly direct you to their insurers, as well as to their professional body if you feel that the standards of hygiene and practice fell below what you would expect.

In the first instance, though, you need to see your GP for conventional treatment.

Q:  I have had a permanent migraine headache for months that is stopping me from doing just about everything. A while ago my GP referred me to a pain clinic re acupuncture and I was told acupuncture is a no as I have epilepsy.  My seizures are not  controlled and I am trying different medications but I only have partial  seizures and do not lose  consciousness. I cannot see why  these would stop me from trying  acupuncture.

A:  We are somewhat at a loss to understand this as well. The only cautions which we offer about epilepsy in our internally-published Guide for members are that they should not use electroacupuncture in a patient with epilepsy and to take especial care when someone has poorly controlled epilepsy.

While there is very little positive research for the successful use of acupuncture, as this Cochrane review shows

there is also no evidence that acupuncture can cause problems: the injunction against electroacupuncture is more precautionary than anything else. Many of the textbooks written by orthodox medical professionals explicitly state that there is no reason for an epileptic not to be treated with acupuncture.

The only thing that we can surmise is that there is either something in the overall neurological picture which the tests are trying to establish but which might make acupuncture inadvisable or the doctors do not want anything else to generate changes in your overall picture while they are conducting tests. Testing often involves controlling variables which might make the results of the tests unreliable.

That said, if there is no obvious clinical reason why you are being asked no to use acupuncture treatment we would be more than happy to enter into a dialogue with your medical team if they have any doubts about your safety. Acupuncture has a long and successful record for the treatment of headaches and migraines, and is among the options recommended by NICE for cluster headaches. It would seem a terrible shame if you were not able to enjoy the potential benefits of treatment through a misunderstanding of the effects of acupuncture treatment.

Q:  My wife is diabetic with numb feet, leg pains and some dizziness. Can acupuncture be effective ?

A:  We have produced a factsheet on Type-2 diabetes

which points out that research into the treatment of diabetes itself is very scarce. This is partly to do with the fact that diabetes, of either Type 1 or Type 2, can manifest in many different ways, and partly to do with the fact that the loss of pancreatic function is not regarded as reversible, and as such there is no reason to embark on expensive studies to try to show otherwise. We are always slightly cautious when we treat people with diabetes because there may be some residual pancreatic function in the insulin-producing cells, and since acupuncture is aimed at balancing the whole system there is a slight but possible chance that this may improve function in the working tissues. A sudden and unexpected boost to the amount of insulin could interfere with a carefully balanced maintenance regime.

There have been a number of articles in the last few years in magazines for diabetics and most of these refer to the potential benefits of acupuncture for specific aspects of the condition, like neuropathy. We were asked about this again recently, and we wrote:

 We have been asked a number of times about peripheral neuropathy, but this has mainly been where the problem has arisen of its own accord or where it forms part of a broader medical condition like diabetes or Charcot Marie Tooth disease. Clearly this places limitations on the potential outcome, since these conditions are not usually reversible, and the practitioner is usually limited to 'things getting worse slower'.

However, there is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

As for interfering with your current treatment, there is no evidence of any kind that acupuncture treatment can interfere with the function of medications which people are prescribed for cancer treatment. Indeed, there is no evidence from outside the acupuncture profession that treatment can interfere with any drug regimes, although we are understandably careful where we use points which are said in Chinese medicine to affect the blood flow, blood pressure and the like when someone is on medication to try to achieve the same result. Our usual response, however, is that the treatments are apples and oranges, two entirely different ways of treating the person which do not interfere with each other. There are even advantages to acupuncture treatment alongside western medication routines where unwanted side effects, like PN or nausea, can make a patient's life difficult, and treatment can make the regimen more bearable.

From a Chinese medicine perspective the symptom, while it may be associated with a common presenting condition like diabetes, is seen in the context of the overall functioning of the body as it is understood in Chinese medicine terms. This means that there won't be a single treatment for the condition but a unique treatment plan based on the exact nature of the patient's individual constitution. Obviously there will be many overlapping features with people suffering from the same problems, and modern Chinese practice has veered alarmingly towards a non-traditional use of specific points for western-differentiated problems. However, authentic traditional acupuncture practice will always seek to understand the symptom within the overall pattern.

This becomes all the more important insofar as it is not uncommon for patients with a recognised disease label to use this as the frame of reference for all problems. Someone can be diabetic and suffer from dizziness without necessarily any direct causal connection between the two problems, and the practice of traditional acupuncture is predicated on understanding the unique balance of energies within each patient. We often advise people to visit a BAcC practitioner near to them for an informal assessment of what may be possible, and would seriously recommend this in your wife's case.

We would also add the rider that if the problems are diabetes related, then it may be more a matter of reducing rather than reversing the severity of the symptoms. The tissue damage which arises in diabetes is not usually reversible, and it would be incorrect to imply that all of these problems can be 'fixed' once and for all.  

Q: I have been diagnosed with non specific chronic cystitis and was wondering whether acupuncture would be beneficial.  If so, how many sessions it would normally take to see an improvement.

A:  For such a commonly experienced problem not only have we not been asked about this very often but nor is there a great deal of research into the treatment of cystitis with acupuncture, as our factsheet shows:

The Norwegian studies which it mentions are still the most recent research on the subject.

Of course, there are good reasons why the problem is not well-researched because from western medical perspective the causes of the problem can be very varied, as can its presentations, and research methodology tends to want to reduce the variables to the very minimum to test like against like. There are many studies in Chinese which have not been translated, but a great many of of these are concerned to find out what works better rather than whether it works, and as such are not usually published in the West because they will on this basis alone be challenged.

That said, cystitis is not a new problem, and practitioners of Chinese medicine have been addressing the problem for over two thousand years. Some idea of the complexity of the ways of understanding the problem can be seen in this article from the Journal of Chinese Medicine

which, badly laid out as it is, shows a variety of ways of unravelling what goes on. It is quite clear straight away that the different ways in which it presents, along with all of the accompanying symptoms elsewhere in the body, can make a profound difference to the way that the problem is diagnosed. This is because in Chinese medicine each patient is unique and different, and even though the presentation might be classified as 'blood stasis', to take one example, the question will be: what caused this to happen in this patient and not in that one?

The best advice that we can give you is that you talk to a BAcC member local to you for their advice. It is very difficult to predict how many sessions are needed sight unseen, and to be honest not that easy even when presented with the patient. What most of us do is to treat three or four times, once a week, and then review progress. In most cases there will have been small signs that the condition is on the mend, but a practitioner may be able to glean even in the absence of palpable changes that there is enough energetic change to make them confident of progress. Outcome measures are the key, knowing what counts as change in measurable ways and being able to log this. It is often difficult to make this assessment without hard evidence, and our experience is that even five good days can be forgotten after two bad ones unless we ask patients to record accurately what happens in between sessions.

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