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Q: My son  aged 29 is having very bad neads undergoing tests. They say after an EEG that its not epilepsy. He collapses,and can loose all speach/feelings  and his only communication is by blinking. Orthe more traditional jerking. upper body cramps that can last for hours. Bells palsy during attack, returning to normal after. He has just started seeing a neurphycologist?  Could accupuncture help him please?

A: NEADS is a very poorly understood syndrome in conventional medicine and used to be called 'pseudo-epilepsy' or 'pseudo-seizures', which tended to sound a little demeaning of the condition and not validating the very real distress the condition can cause to the sufferer. The treatment offered is usually psychotherapy or psychology in some form. There is no medication to address the problem, although some NEADS patients have a background of anxiety or depression for which prescribed medications may be effective and which reduce the frequency of attacks where this is a part of the underlying cause.

There is no research of which we are aware for the use of acupuncture treatment for NEADS, although a great deal of evidence for the treatment of anxiety and depression which can often be a part of the picture. However, we have to be clear that Chinese medicine operates from an entirely different conceptual framework developed over 2500 of use in which the symptoms of problems such as NEADS have been seen for all of this time and understood within the diagnostic patterns which have developed.

This leads to some interesting but occasionally confusing near-parallels between conventional medicine medicine and Chinese medicine. Conventional medicine has a concept of epilepsy as a disorder whose diagnosis is confirmed by scans or X-rays showing pathological changes in the brain. Chinese medicine works from the symptoms and signs as reported and observed, and then makes sense of these through the patterns of energy flow and the functions of the Organs as understood in a Chinese way. This means that there is no direct correspondence between East and West; some of the syndromes which make sense of symptoms in Chinese medicine will include both epilepsy and pseudo-epilepsy from a western perspective, and the cases of epilepsy confirmed by western diagnosis may be then separated into several different syndromes in Chinese medicine.

The bottom line in Chinese medicine, though, is that each patient is unique and different, and a practitioner needs to make sense of what happens through looking at all of the systems of the body as they are now and asking the patient about their medical history, how they have come to this point. These questions, along with examinations of the tongue and radial pulse unique to Chinese medicine, will help the practitioner to tailor treatment to meet someone's specific needs.

It is very difficult to say with any certainty that acupuncture treatment will work for your son. We generally advise people to visit a BAcC member local to them for advice based on a brief face to face examination, but apart from one or two very clearly defined syndromes which would lead a practitioner to conclude quite quickly that there was something very obviously treatable, the majority of cases appear to have a substantial psychological component. Although acupuncture treatment has been demonstrated to be effective for treating anxiety and depression, these are but a small proportion of the huge range of psychological issues with which a patient may be dealing. Some of these really are the province of specialists who work directly with them, i.e. they may fall outside the limits of competence of the average acupuncture practitioner. This does not mean that acupuncture may not be very helpful in supporting someone with NEADS, but it may mean that it has to be a part of a package of treatments, some of which are talking therapies which go to what may be the root causes of the problem.

We are confident that you will not be wasting your time visiting a BAcC member local to you for a brief chat. There may be specifics in your son's case which lead them to believe that they can make a difference, and this expert has treated a number of people with NEADS-like disorders over the years who have responded well to treatment. One has to be careful, though, in knowing one's limitations and knowing when treatment has plateaued out and can do no more.   

 

Q:  I'm doing a project (an EPQ) on a comparison of the treatment of issues surrounding the heart in modern medicine and traditional Chinese medicine. For a while now I've been struggling to find any hard evidence (facts and figures) from reliable tests on the effectiveness of acupuncture. I appreciate Western and traditional Chinese acupuncture differ, however if you have any ideas on where I could find some evidence like this for either form I would greatly appreciate it.

A: We think you might be struggling a bit with this.

We often use the NCBI database as the one which tends to be the most accessible for patients and general enquirers who do not have access to specialist facilities. If you search using the terms 'ncbi' 'acupuncture' and then something like 'atrial fibrillation', 'ventricular arrythmia' or 'heart failure', you will find a small number of studies and a slightly greater number of proposed but as yet unstarted studies which make encouraging noises about acupuncture. None of these are anywhere near to meeting the so-called 'gold standard' of western research, the randomised double blind control trial (RCT), and most employ very rudimentary acupuncture, like the repeated use of Neiguan, a point on the forearm.

Very few traditional practitioners would repeatedly use the same point; it would be regarded as very poor acupuncture, which for us is a dynamic and evolutionary process where treatment is amended in response to the outcomes of the previous session. Many of the trials were conducted by western medical practitioners, but there will be very little evidence base in the UK here because the existence of an evidence base is intended to be the criterion for inclusion in medical practice as 'another tool in the toolbox.' While in reality many doctors and physios are treating outside the very narrow evidence base which does exist (back pain, knee pain, etc), this is not formally recognised and therefore there is no net to catch positive results.

Broadly speaking, the concept of the Heart in Chinese medicine (always capitalised to distinguish it from the physical heart) is much broader in definition, and embraces a great many more emotional and mental aspects than would be recognised in the West. At the same time some of the pathologies of the heart are picked up in Chinese medicine as disorders in other Organs, so it becomes almost impossible to make meaningful comparisons. That does not mean that practitioners do not have some notable successes treating problems like atrial fibrillation and the like, but such evidence as exists is largely anecdotal.

The culturally interesting element of the discussion is that in some of the older versions of Chinese medicine, the Heart was treated as sparingly as possible, being regarded as the Emperor of the internal system and therefore charged only with maintaining balance within the rest of the system rather than having specific functions, with what we regard as heart functions commonly devolved or delegated to other Organs to perform. Indeed, in modern Japanese acupuncture, based on some of the early classical texts like the Nan Jing, there is a marked reluctance to treat the Heart at all, and many patients with heart problems are referred straight to a cardiologist.

Sorry not to be more useful, but even where the evidence at a lower level than RCT is available, there isn't very much of it and much of it is not a great better than simple data collection. The search terms we have offered may be of use, and we have two factsheets on coronary heart disease and arrhythmias

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/3771-coronary-heart-disease.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4008-arrhytmias-and-heart-failure.html

which may point you towards some studies which you may be able to use.

 

Q: Does acupunture work for anxiety disorder I take a mild antidepresent but they don't help.

A:  A:  We have produced factsheets on both of these areas:
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html
 
and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html
 
which give some cause for optimism, as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently
 
 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001518

There is also a link on our home page today to a new study about anxiety

http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3546-anxiety-the-silent-sufferers.html

However, we could do worse than reproduce the text of a piece we provided for Anxiety UK some months ago.

ANXIETY AND ACUPUNCTURE

Anxiety is more than just being anxious. Just as migraine sufferers get righteously indignant when someone claims to be a fellow sufferer but can still get to work, eat and stand the daylight, so anxiety sufferers know that they bear only the slightest resemblance to people who feel a bit nervous or have 'butterflies in the tummy.' Clinical anxiety is a crippling affliction which can sometimes defy all of the medications and talking therapies that someone can throw at it.

Why, then, has acupuncture been found to be successful in treating it? The main reason is that in conventional medicine, there is no single treatment for each sufferer as each person has differing symptoms. However, in traditional acupuncture every patient is considered to be unique, and this means that the practitioners will be looking and listening very carefully to everything that the patient says to establish a diagnosis and find the specific keys to unlocking the patterns of the symptoms the patient is suffering. They will aim to identify the imbalances which cause the symptoms of anxiety, not just treat the symptoms themselves. This whole 'package' – taking the patient's individual story seriously and giving them time to tell it, trying to hone precisely the diagnosis, and selecting the optimum way to use the least needles to achieve the greatest effect – has been found to be very effective.

The theory of traditional acupuncture is very straightforward. The free flow and internal balance of energy (Qi) is seen in eastern medicine as essential for good health. Any prolonged exposure to extremes or intense situations, be they physical, mental, emotional or spiritual, will cause the flow and balance to be affected. This disruption in balance then ripples through the whole system, causing symptoms which sometimes bear little apparent relation to the underlying causes. An acupuncturist's skill lies in making sense of seemingly unconnected symptoms and understanding the unique nature of someone's energies in such a way as to restore balance. A treatment plan may simply involve needles and moxibustion, the use of a warming herb, and tui na, a form of traditional Chinese massage, but can extend to address issues in someone's diet, their exercise patterns and their lifestyle.

People sometimes ask why, if acupuncture is so successful, there isn't much research to back up its claims and make it more freely available within conventional care. A major reason for this is the unique nature of treatment which resists putting people in pigeon holes and which changes as the person's balance begins to improve. Both of these confound attempts to organise research according to western models where a named condition receives a single treatment and all other variables are taken out of the equation. In Chinese medicine the variables are called patients!

Where do our patients with anxiety come from? Word of mouth still remains the most common and most reliable form of referral, and more people have had acupuncture than you think. If you ask around your support groups you are almost certain to find someone who has tried acupuncture and found that it works. Perhaps this time it's your turn!

People also usually want to know whether the treatment will 'stick', whether they have to keep on having acupuncture. Some don't – a single course of treatment can set them on a good path which, as long as their life remains well-balanced and relatively stress-free, means that they will stay anxiety-free. Many, though, like to keep 'tuned up', and realise that spending a fraction of what they spend on keeping their cars roadworthy keeps the driver in good shape too.

As always, though, we still think that the best advice we can give is that you contact a BAcC member local to you to see if acupuncture would be appropriate for your own unique circumstances. 

As far as finding someone in your area is concerned, there is a postcode search facility on our home page www.acupuncture.org.uk which will enable you to find the nearest available practitioner - entering 'Dagenham' may not pick put a practitioner who is much closer but lives just over a town border. The best thing to do is to see if the practitioners near you are willing to spend a little time with you to discuss whether acupuncture treatment may be the best option. Most are very honest; if they think there are better options for you they will say so. The majority, though, treat a great many people with anxiety and depression, sometimes as a main complaint and sometimes alongside a main complaint.

The only caution is that conditions like this can have good days and bad days. This can make it a little harder to work out whether things are getting better, so it's always good to identify things which happen in your life where changes in how you feel or respond will be clearer.

 

Q: have PCOS and recently had a miscarriage in August after nearly 4 years of trying. I am keen to conceive again.  I have fortnightly reflexology appointments and am interested in acupuncture as I have heard positive reviews. Would this be beneficial for me to try this along with reflexology? Would this be likely to increase my chances?

A:   We have been asked about PCOS on a number of occasions, and a typical answer we have given has been:

Q. i suffer from pcos on both ovaries, i also suffer from weight issues due to this but have been told by nhs that they cannot help until my bmi is below 30. I know that i need to help myself but can accupuncture help whilst trying to concieve. Have been trying for 5 years.

A. The evidence for the treatment of fertility problems with acupuncture is a little thin, as our factsheet  shows. 

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

There are a number of studies which appear to indicate that acupuncture may help PCOS and the attendant fertility problems which it can cause, but not enough and not enough of consistently high quality for us to make any claims.

  However, traditional Chinese medicine has a very long history of treating exactly the same issues which trouble people today, and although its conceptual basis is entirely different from conventional western medicine, the symptoms which people have and the way in which they describe them haven't changed, and have been diagnosed and treated in Chinese medicine terms for centuries. There are a number of patterns or syndromes in Chinese medicine which reflect quite closely the sorts of problems which PCOS sufferers have and their problems with fertility, and a practitioner may be able to use these as the basis of a worthwhile strategy.

We have to be realistic, though, PCOS makes pregnancy difficult, whatever system of medicine you use to diagnose it. Our main concern is that you are not led into unnecessary time and expense for something which cannot help, and not diverted from conventional treatment which may ultimately be of benefit. Our members are responsible and safe practitioners, and if you visit one local to you, we hope that they are happy to see you for a short consultation, hopefully without charge, to determine whether the unique case which you represent in Chinese medicine terms is one for which they feel that treatment may offer some hope.

We think that this remains sound advice. Acupuncture treatment will certainly do no harm, and from a Chinese medicine perspective, where treatment is aimed at the person rather than the named condition from which a person suffers, there is a great deal to be said for maximising the body's function. The simple but profound belief underpinning a great deal of eastern medicine is that if everything is functioning as it should, then symptoms will disappear. However, one has to be realistic; where there has been longstanding pathological change it may be a much harder task to try to return basic functions to their normal state, and we are always very careful to make sure that we do not give patients false and unrealistic expectations of what might happen.

We also need to re-iterate what we have said in earlier answers, that something of an industry has built up around female fertility issues which, in this expert's view, have started to see practitioners charging more for their services than they would for 'ordinary' treatment. There is nothing, in my view, to justify this; acupuncture treats the person, not the condition, and there is very little additional expertise available in Chinese medicine to treat the problems with fertility which does not form a part of the basic training which all practitioners have. The only advantage of expert training in fertility problems is that it imparts greater knowledge of the western medicine involved and passes on the wisdom and experience of expert practitioners. This may warrant a small additional charge, but we have seen acupuncture being offered within some of the fertility clinics outside the traditional acupuncture 'circuit' at alarming fees.

We are confident that if you visit a BAcC member local to you for advice you will get a fair and realistic assessment of how and whether acupuncture treatment may be of benefit to you. 

 

 

Q:  My daughter has a learning disability and some years ago was treated for this with acupuncture with great results.  Unfortunately, this practitioner returned to Japan and we have never been able to find another. Her condition, I have been told by her doctor, is only slight - but would be pleased to know if there is a practitioner now to be found.

A:   We are pleased to hear that your daughter managed to make measurable improvements through acupuncture treatment. Finding a practitioner is not a problem. Using the search facility on the BAcC home page at www.acupuncture.org.uk and opting for the postcode search will generate a number of results - we have just tried and there are at least ten practitioners within easy reach of Ashford, many of whom we recognise as having been around for a very long time. We cannot give individual referrals, unfortunately, but most practitioners are happy to give up a small amount of time to meet prospective patients in order that the patient can decide who to see. Individual rapport is not essential to successful treatment, but is good if it exists as well.

As far as the treatment itself is concerned, we are not really in a position to comment much without knowing exactly what your daughter's difficulties were/are and also the style of treatment being used. As far as formal research is concerned there is very little evidence for the successful use of acupuncture as a treatment. Anecdotally we have heard stories of patients making considerable improvements, but it has been difficult to assess whether this was simply a contingent matter, i.e. it would have happened anyway but the person just happened to be having treatment at the time, or whether there really was something in the treatment which worked. Certainly within Chinese medicine the development of many natural skills is seen as being rooted in sound and robust energy inherited from the parents and a well-ordered development as an infant, and there are a number of syndromes which are amenable to treatment if a person is slow to develop in some areas. This is very much dependent on face to face assessment, though; at this remove we could not say with any certainty whether what might be possible.

We are also intrigued by the mention that the practitioner went back to Japan. There are a number of styles of acupuncture which have been developed by Japanese practitioners in the last twenty years, including a number involving scalp acupuncture, for which some very far-reaching claims have been made and for which initial evidence, mainly anecdotal, appears encouraging. If the practitioner whom your daughter saw was using a style of treatment which is not in the mainstream of Chinese medicine practised in the UK, it may be wise to see if there is someone within easy reach who offers the same style of practise. It is often better to travel further to go to something which you know works rather than get a lesser result around the corner.

In any event we are confident that the practitioners near your daughter will give her sound advice on the best options available to her.