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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

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013215/

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

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/type-2-diabetes.html

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:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/cystitis.html

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

https://www.jcm.co.uk/the-treatment-of-interstitial-cystitis-by-acupuncture.html

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.

A:  As you can imagine we have been asked this question a number of times, and a typical answer was:

Can acupuncture help with plantar fasciitis?

Plantar fasciitis can be a very unpleasant and debilitating problem, as you no doubt know. There is some evidence for the use of acupuncture treatment, as this paper shows,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094706

and if you google 'acupuncture' and 'plantar fasciitis' you will find a number of other papers which suggest that there may be benefits from treatment. However, the combined weight of the various studies is not enough to be able to give an unqualified recommendation.


 

That said, the strength of Chinese medicine is that it operates from an entirely different paradigm or theoretical basis, and has different ways of making sense of the symptoms which a patient is experiencing. This can sometimes offer treatment options which would not necessarily translate into a western understanding of physiology, although there is usually an overlap. The system of medicine rests on a theory of energy, called 'qi', whose flow and balance determine how well the various systems of the body function. Many problems like plantar fasciitis point to local blockages and disturbances, often due to over-use or poor gait, which once they have become established remain a problem even after someone's habits have changed. Symptoms such as this can also point to more systemic problems, and the skill of the practitioner lies in making a clear diagnosis of the whole system before starting to correct aspects of it.

In this case, since the presentations of plantar fasciitis can be very different, we would advise you to visit a BAcC member local to you for a brief face to face assessment of the problem before committing to treatment. We are fairly sure that you will have seen a chiropodist as well as your GP, but if you have not, we would highly recommend that you do. There are a number of treatment options which can work alongside acupuncture treatment to great effect, and with these sorts of problems it is often a combined approach which pays the greatest dividends.

We believe that this remains sound advice. Our own personal experience of treating the condition is that if the treatment is going to work it begins to show evidence of change fairly promptly. The real problem with chronic conditions like this is that it can occasionally lead to a treatment habit developing where hope triumphs over experience and treatment can continue far beyond a time when it is clear that nothing is happening. If you did decide to go ahead it would be wise to identify as objective as possible outcome markers for improvement, something which can be measured, and to ensure that progress is reviewed carefully every three or four sessions.

As an additional aside we have recently heard a number of reports of osteopathy being used to good effect alongside acupuncture treatment to provide better relief, as well as reflexology often being mentioned as a worthwhile option. We mention this because if acupuncture did fail to generate results it is good to know that there are other options for treatment available.  

Q: Throughout this past winter I have suffered with chronic catarrh and an almost permanent cough-particularly in the morning when I bring up lots of mucus. I have a suspicion that I might have allergic rhinittus. I have seen my doctor, and respond well to antihistamine and a nasal spray. However,my GP is reluctant to send me for allergy testing, and therefore I wondered if acupuncture might be useful. Can you advise please?

A: We have been asked about similar problems in the past, and a recent typical response was:

Can acupuncture help chronic rhinitis?

There is a growing body of evidence that acupuncture treatment may help with a number of forms of rhinitis, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/allergic-rhinitis.html
 
However, we know from our clinical experience that although there are some, indeed many, presentations which seem to respond well to acupuncture treatment, there are a number which have their root in some physical change or restriction in the nasal cavities, or from long-term sinus infections which have become resistant to treatment. If either of these is the case, there may be much more of a struggle involved in trying to reduce the impact of the symptoms.

From a Chinese medicine perspective, however, there are a number of clearly defined patterns involving a compromised defensive system (the Chinese didn't recognise the immune system as we do but certainly had a concept of defensive energy which when compromised generates the symptoms which we associate with rhinitis) and also digestive disorders which can manifest in the fluids of the body being excessive. A skilled practitioner will be looking at the symptoms someone has in the context of their whole system, and trying to ensure that treatment is aimed at the core of the problem, not simply the way in which it manifests.

Amongst the things which the practitioner would consider are also a number of digestive factors. From the Chinese medicine perspective the intake of too much dairy produce can often produce far too much mucus in the body, and it is not uncommon as a pattern. If this is the case, though, there will be a number of diagnostic signs which point clearly in this direction.

You would be well advised to visit a BAcC member local to you for face to face advice. Most are happy to give up a few minutes without charge to assess whether acupuncture treatment is the best thing for you. 

We think that this remains the most sensible advice that we can offer. It is not surprising to us that your doctor is unwilling at this stage to send you for allergy testing. His reasons may be budgetary or they may be based on his experience that they more often than not fail to provide a clear answer. From our perspective the tests may be useful, but once the immune system has been triggered in this way there is a tendency to see a huge number of short-term sensitivities which have been triggered by the more causally related one. The list of intolerances which people are handed means that they can end up with a serious restriction in what they eat to the point that it becomes difficult to ensure a balanced diet.

We think that it is probably likely to be worthwhile to visit a BAcC member local to you for an informal assessment of what may be possible. From a Chinese medicine perspective each patient is unique and different, so the symptom may arise from a totally different cause from someone with exactly the same presentation. The strength of the system, though, from our perspective is that it treats the person, not simply the condition, and as such offers a better chance of dealing with the symptom permanently rather than turning off the alarm bell which the symptom represents because we don't like the noise.

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