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Q: A few weeks ago I went in for acupuncture for an injury to my finger. I was recommended to come in for the 2nd session which I did, and at that point have mentioned about my struggles with my weight which  I thought could be related to a hormone issue. The practitioner then offered to do something to "help with my metabolism and curve my appetite" while also doing the treatment for my finger. I've done acupuncture before and thought it harmless so I didn't question it even though he didn't bother to check my health condition first before adding on this treatment. In addition to needles around my injury, he placed a couple on my stomach, one on my left leg, on my right arm and right ear. Immediately after the session, on my way home I started to feel very dizzy and fatigued. I had to lie down immediately after I arrived home and the dizziness and nauseous feeling didn't go away for days. Then for a few days it got better before it got worse again. Other symptoms include bowl irregularity (I've always been regular), frequent diarrhea, weakness, hard time focusing, sensation of "pulling" in back of my head. Most concerning is that I noticed my vision had refractive issues.  If I read something close and try to read something far right away, it blurs for several seconds before my vision adjusts. I'm just wondering if these kind of symptoms sometime happen and if acupuncture can cause anything permanent? Like the disruption of the energy flow? Can it also effect the brain?  The  vision which has mostly been affected is in  my left eye. Is that related? I've done acupuncture many times before (only for sprains) but never experienced anything like this. Any help you could give would be so much appreciated. 

A:  We are a little concerned about the changes to your vision, and our first thought would be that you should seek an immediate appointment with your GP. With over 2.5 million treatments being given by our members each year, there are going to be occasions when something happens after treatment which is not directly related to the treatment itself, and our job as practitioners is to make sure that we don't get into arguments about whether or not we have caused something, but first and foremost to ensure that a patient gets the treatment they need. The combination of visual disturbance, nausea and the pulling sensation at the back of the head, while not the sort of 'red flag' that means you should hasten to your local A and E, is enough to warrant a same day appointment with your GP, if you can make one.

We are aware of most of the studies and surveys about adverse events after treatment, and also of the normal causal pathways of adverse. Where these occur, they are most often understood in a conventional medical sense, i.e. a needle hits a nerve, or touches an internal organ, etc. These events are exceedingly rare, and a practitioner has to be either careless or extremely unlucky for this to happen. Energetic effects, where a needle used in a traditional style causes a reaction elsewhere in the body which can be explained by channel or functional connections, are possible, but the vast majority of these settle down within a few hours or days at most. Changes such as you have experienced across a number of body systems, and enduring for more than a few days would be most unusual. We would be concerned that there is an underlying medical condition which has developed at the same time as the treatment.

That said, there are elements of the treatment experience itself which ring alarm bells for us. Treating people for weight problems always needs to be done with great care, not because it is dangerous but because there are a number of reasons in both conventional medicine and traditional Chinese medicine which predispose a person to weight gain, and while some are treatable, many are not. Since even the best weight loss programmes take months or years rather than weeks, and since people are often trying several approaches at once, we try to avoid treating simply for the sake of it. That is not to say that acupuncture treatment is not beneficial anyway, but that if a patient has expectations that it is directly affecting their metabolism, there has to be a valid line of reasoning in Chinese medicine principles which supports the treatment.

For this it is vital to take a full case history, and our concern would be that the application of points without a full breakdown of factors in the patient's life could cause some quite powerful energetic disturbances. It is possible that the practitioner is so experienced that they can diagnose from taking the pulse and looking at the tongue only; such practitioners do exist, and most of us can get pretty close with minimal examination. However, none of us would consider treating without a full case history, and indeed we insist that even when practitioners use needles to help people stop smoking they only do so after taking a full history.

As we said at the top, however, we think it would be advisable to see your GP, and ask for their advice about the visual disturbances.

Q: I have had accupunture several times before. It didn't always "cure" the problem but it often made it more bearable. I had a lumbar puncture to rule out viral meningitis. I developed a "spinal headache" after the test. I went to my neurologist's office and had a blood patch. While it lessened the pain  it didn't go away. I thought I would try accupunture to relieve this headache. My normal practitioner is out of town but he gave me a name of an acupunturist who might be able to help. The practitioner put needles primarily on my right side. 15 minutes into the treatment it was all I could do not to yank out the needles and get the heck out of there. Once the needles were removed I felt a little better but the rapid heart rate and flight response seem to still be   there. This isn't (or hasn't) been typical for me.  Is this a known side effect? Any idea what triggered it?

A:  There can be quite a considerable difference in the techniques used by traditional acupuncturists, and indeed medical acupuncturists, to the extent that even people working in the same overall style can differ in effect. A great deal depends on whether the practitioner sets out to achieve a sensation in the patient called 'deqi', a dull aching sensation which gathers at the base of the needle and which can often travel along the channels associated with the point. To do this, people sometimes use more needle manipulation, insert needles a little more deeply, and often use a slightly thicker gauge of needle. At the other end of the spectrum are practitioners who use a more Japanese-style technique which involves shallow insertion, less manipulation, and in some cases a rapid insertion and withdrawal of the needle. All of these variations are authentic, and depend on what the practitioner likes to achieve, and of course how they were trained.

Some people find that some styles are too powerful. However, even where the immediate effect of needling is uncomfortable, the sensation should diminish within hours, and there should not be a lingering effect. It depends how long ago this happened before you wrote to us, but at most the adverse effect should last no more than 48 hours. If the heart rate and adrenaline response last any longer than this, it may be as a result of the 'shock' which the body has experienced, and under normal circumstances we would always recommend that a patient go back to the practitioner who treatment them and ask for advice and re-adjustment.

However, we realise that sometimes this is not likely to be possible, especially if the problem relates directly to the manner in which the treatment was given. If you do feel able to call them it may be that they are able to make sense of your reaction in the context of what they have done, and could well be able to reverse the problem. Most practitioners are easily able to adjust the 'weight' of treatment if asked to do so. Some people are highly sensitive to treatment, and we all have had the experience of having to use fewer needles and much more gently than normally.

It is important, however, not to rule out the possibility that the reaction to treatment may be related to the effect of the needles against your existing medical condition, so if the problem persists longer than 48 hours we would recommend that you made an appointment with your GP to see what they make of it. It would be possibly time-wasting to try to establish whether or not the treatment caused the problem when the problem could be treated with conventional medicine. We only mention this because on a  number of occasions we have seen people become focused on whether treatment actually caused a problem to the detriment of getting the problem treated. Our first priority is to ensure that a problem gets addressed, whether by needles or through conventional treatment, and then to sort out what actually happened.

We hope, however, that by the time that this reaches you the problem has subsided, and we further hope that this has not discouraged you from further treatment.

Q:  My wife had a spinal fusion 3 years ago Although this was a success she is in severe pain due to scar tissue touching the nerves in the back In addition she suffers severe depression which is historical and increased by her continuous pain and lack of movement Can acupuncture help her?

A:  There is some increasingly good evidence for the use of acupuncture in the treatment of depression, as out factsheet shows
and as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently

Where the depression is linked to a continuing health problem, however, the situation becomes a little more complex. We find that when someone has a chronic and unpleasant physical pain which does not yield it can become a great deal more difficult to deal with the depression that this causes and the underlying depression to which this has added.

If your wife's pain results from scar tissue, then this will take a finite time for the body to deal with. Evidence suggests that this can reduce in impact over time, but some does not. We are reluctant to commit ourselves on whether internal scarring is treatable with acupuncture. We have certainly a great deal of anecdotal evidence about helping with problems at a superficial level by reinstating the flow of energy across operation scars, but less clearly demonstrable evidence for the internal scarring which occurs after lower back operations or disc herniations.

However, as a general principle, traditional acupuncture is concerned with the maintenance of a good flow of energy in well-defined pathways in the body, and any major surgery or injury will interfere with this flow. Using needles to restore as much flow as possible to its original state can never do harm and may do a great deal of good. The term 'speeding up the healing process' is often used and this is what many patients believe that we achieve, but one has to be careful because trials designed to validate this are hard to construct, expensive and not always reliable.

Where there is an interaction between two problems such as these, we tend to believe that the best advice we can give is to visit a BAcC member local to you and get a brief face to face assessment of what may be possible. Nearly all of our members are happy to give up a small amount of time without charge to assess someone's suitability for treatment, and because we look at everything which is going on in the person we can often make some very rapid but valuable assessments of the context and backdrop against which the presenting problems have appeared. This can make a very substantial difference to the kind of prognosis a practitioner might offer. It is also possible to direct someone to other forms of treatment if that would be more appropriate, and this often allows for the kind of personal referral which helps prospective patients find their way through the very large number of complementary therapists practising in their area.

Q:  I'm thinking of doing a recognized degree in Acupuncture in Australia. As I am also a British citizen, would it be ok to practice in the UK?

A: There are very few restrictions on the practice of acupuncture in the UK. In the absence of statutory regulation and agreed standards for training, the only people who are empowered to make a check are the environmental health departments which register or license people for practice. These officials are more interested in the safety and hygiene standards, and the legislation under which they operate does not stipulate what levels of training someone should have. In practice, however, many now use the BAcC standards as a yardstick and have also begun to check whether practitioners are properly insured and certified.

The only other factor which affects people who trained abroad is the right of residency, and if you are a British citizen this should not be a problem. We can't tell from your e-mail whether you are a UK citizen by birth or by marriage, and there are changes looming to the legal and potential employment status of people who have UK citizenship by marriage which may impact on many people who do not realise that this is an issue. It is not really within our sphere of competence to comment on this, but we always recommend that prospective members from overseas check with the relevant authorities where major life changes are in prospect.

As far as membership of professional associations is concerned, there are no reciprocal recognitions in place yet, but our knowledge of the statutory standards in Australis is that they are equal to or better than our standards. We have never yet set additional tasks for anyone applying to us after arriving from Australia, and if the course which you are planning to take is accredited and leads to automatic entitlement to register with the statutory body we cannot foresee any problems.

We hope you enjoy your training!

Q:  Can acupuncture help with sphincter of oddi dysfunction. It causes pain in the upper abdomen, nausea and exhaustion.

A:  One of the problems which we have in answering questions about very specifically defined disorders in conventional medicine is that it takes us further away from what we would recognise as functional disturbances when seen from a Chinese medicine perspective. This a rather elliptical way of saying that when you look at very specific muscle groups and the use of acupuncture, it encourages a view that there is a direct relationship between acupuncture points and particular disorders. While this can sometimes be the case it would be more normal to look at the functions of the whole system to see what was working well and what wasn't in order to understand why a symptom had appeared, rather than go straight to a symptom as a treatable entity. This is why a dozen people with the same symptom may be treated in a dozen different ways by a practitioner of Chinese medicine.

From the Chinese medicine perspective it would be relevant to ask the same sorts of question that a western medic might ask - where the pain is, what makes it better or worse, are the variations between day and night, and so on - but to see the answers against an entirely different conceptual grid. This might bring an understanding that there was a local blockage in the flow of energy, or a disturbance in a specific digestive function, or even an overall pattern of disharmony whose consequence had been to generate a symptom in this place. The different possibilities might generate different treatment options.

That said, there are a few studies of the use of electroacupuncture such as this one

which seem to indicate that there may be something which can be done, but the scale of the studies is far too small to be able to make a positive recommendation. The best that we could say is that we see many people with a variety of gall bladder problems, as defined in western terms, and that there are a number of clearly defined syndromes within Chinese medicine which offer treatment possibilities. These are determined more by the type and timing of pain than from the conventional name, and ultimately depend on diagnosis by the use of tongue and pulse, along with other energetic assessments.

The best advice that we can offer is that you visit a BAcC member local to you for specific advice based on your own unique presentation. This is likely to be far more informative than any guess we can make, and most members are happy to give up a small amount of time without charge to assess whether acupuncture is a good option for the problem the person has.  

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