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Q:  Following acupuncture last week on my knee, two days later I  felt extremely tired and stiff all over like I had run a marathon. Yesterday I had acupuncture again on my knee and I can now feel these symptoms returning. 

A: Had you been a first time patient we would simply have said that after a first session there is often a great amount of adjustment going on in the body. Patients often, in our experience, can have all sorts of tiredness and stiffness , to the extent that this expert is very clear with the treatment of musculoskeletal problems can often cause an initial 48 hour disruption, after which things settle down. It is also not uncommon for the first session to induce deep sleep.

However, if an 'old hand' has these symptoms this is more of a challenge to explain. Had it been a one off we might have suggested that it was a contingent problem, just coinciding with the treatment. However, a second dose of the same suggests that something has changed in the overall balance, and that the treatment may well be the cause.

We're not sure from your email what kind of treatment you're having. We have come across cases where someone has been treated for a musculo-skeletal problem by a doctor or physio, and where they have used points which are indicated for the problem in their system but which have far more profound effects in ours. There is a point for tennis elbow, for example, which can have a very powerful effect on blood pressure, and if this is needled vigorously to help a local problem it can cause fainting in someone whose balance from a Chinese medicine perspective is a little weak in some areas. This is not demeaning denigrating what doctors and physios do, but simply recognises the fact that although the points used lie in the same place they are not accorded the same overall functions which we understand.

Another possibility is that the technique your practitioner is using for the treatment is too much for your whole system. The treatment of knee problems can often be quite vigorous, and there are patients for whom constitutional treatments are OK but more robust local treatments are not. The simple answer to whether this is the case is to discuss the matter with your practitioner. He or she will be the best source of knowledge because they know what they have been trying to achieve and can tell you whether the treatment is different from what you have had before. They will also not be at all affronted if you ask them; they are more likely to be intrigued.

Failing these two possibilities, there isn't much more we can offer without actually seeing what is happening. It is not a usual after effect, and being conversant with most of the adverse event literature we can tell you that it is a rare occurrence. We think the answer probably lies in the strength of the treatment being used, and suspect that turning the volume down a bit may well generate good results without running the risk of feeling wiped out each time.

We would be failing in our duty, though, if we didn't tell you to pop along to your GP if this happens again. While not being directly causally related the treatment may be revealing another underlying problem which may need addressing, and it might well be worthwhile having some bloods taken to see whether there is an unrelated problem which the acupuncture treatment is aggravati

A:  As you might imagine there is little or no research into the use of acupuncture for bursitis in the hip. This is mainly to do with the fact that as a symptom it can be caused by any number of disturbances in and around the hip joint itself, and western research is predicated on reducing the variables to the minimum possible. Some of the causes are more intractable than others, and would make comparisons difficult.

The same applies to Chinese medicine, of course, but we live with a system of medicine that embraces multiple causes and dynamic balance, so it is less of a problem for us. Clearly, though, the same overall conditions apply; if the bursitis is caused by a systemic condition, like gout, then it is going to be more difficult to treat. However, the same general rules apply about rest until almost better apply.

From a Chinese medicine perspective, however, accumulations of fluid within a capsule are usually interpreted as a breakdown in the flow of fluids through blockage or through a change in the consistency of the fluid itself. Since this is usually indicative of a breakdown in the flow of energy, called 'qi', on which the system is based, there are a number of treatments, especially local ones, which can help to improve the flow and remove/relieve the swelling. The key issue, however, is that Chinese medicine will never look at a symptom in isolation, but always consider it within an understanding of the way that the whole body is functioning. Without this, in many cases the treatment will only have a short effect. It is a matter of not just treating the condition but treating the underlying causes of the condition. This will involve taking into account the conventional medical assessment of what is happening but focus more on the way that the whole body functions. Many people have secondary problems which they accept as normal but which greatly enrich a Chinese medicine understanding of what is going on. There is such a huge variation in presentations, though, that the best advice we can give you is to visit a BAcC member local to you for an informal assessment of what may be possible. Most of our colleagues are more than happy to offer a short amount of time to assess whether treatment would be effective, and if they believe not, to offer alternative recommendations for other treatments.

One final word: we never use the word 'cure', partly because it is not clear what 'cure' would mean i n this context but mainly because we believe that we are helping a system to restore its own flow and balance. We simply put needles in; it's the patient who does all the hard work afterwards!


Q:  Two months ago I had acupuncture done for  a migraine. Ever since I have a dull to sharp pain that goes from the middle right side of my neck up over my skull and down the right side of my back. It flares up and calms down, but is always tight.

A:  This sounds very uncomfortable.

We would probably need to know a little more to be able to make specific comment. There are points which someone can use for the treatment of migraine, especially one called Gall Bladder 20 Feng Chi, which lie in the neck just below the occiput. There is a possibility that a needle used here, or in one of a number of points in the area, may have caused a little internal bruising which could well account for a continuing sensation of discomfort in the area. If this is the case then the discomfort should gradually ease and normal function return.

If there have been no needles in the area, this becomes a little more difficult to explain. There are very occasionally where the use of needles will encourage a systemic change which in turn reveals a blockage further downstream, so to speak, and this could manifest as a dull ache. It would be unusual, however.

The other possibility, of course, is that the appearance of the ache is a coincidence. We are always very careful when we broach this possibility because it sounds as though it's a dodge to evade responsibility. The reality is, though, that with nearly four million treatments in the UK every year there are going to be occasions when a symptom appears near when a treatment took place (time or location) but which has nothing to do with the treatment. We always advise colleagues to work with the patient to try to find out what is going on and make appropriate referrals. 

We think your best course of action would be to go back to the practitioner and ask their advice based on what they did. The vast majority of our members will not feel defensive or criticised but will work with you to see in the first place whether it could be a consequence of what they did, and to offer constructive solutions for the problem. If nothing comes from this and the pain continues you may need to see your GP to get his or her advice. The most likely possibility, if the problem is not likely to be from the acupuncture treatment, is that something has gone into spasm, and massage or physiotherapy may offer a rapid solution. Or even acupuncture! We spend quite a lot of time releasing tight muscles, both by calming the system as a whole and by needling the local area itself.

Q:  I went for my second acupuncture last Friday and the acupuncturist was working alone that day and going back and forth between several patients as well as answering phone calls. He put quite a few needles in my neck, shoulder areas and the lowest one placed I remember had something to do with the heart. I don't know how long he left the needles in as I didn't have my watch on, but it was a really long time and several of the needles were a little uncomfortable. Out of nowhere I had a headrush kind of feeling and felt as if I might pass out.  Immediately following this sensation, my heart began racing very fast for at least 5 minutes or so. I take a beta blocker to prevent that very thing and it has never happened while taking my meds. I tried intentionally relaxing, deep breathing, even took a deep breath and held it several seconds before releasing it hoping it would slow my heart down but it didn't work. It slowed back down by the time he made it back into the room but I was lightheaded for at least an hour or so after my visit. I told him about the experience and he said perhaps it was because he used quite a few more needles than the last time because he felt he needed to be more aggressive after the first session didn't provide any relief. I have read that the light headedness isn't a bad thing but can mean it was a successful treatment. The ultra fast heart rate was a little unnerving and my arm pits were quite wet....and I never sweat. 

A:  We are pleased to hear that all turned out well and that you have retained your sense of humour about this. However, we have to say that we are a little bit unhappy about some aspects of what was happening, not least of which was the fact that you did not appear to have any way of attracting his attention when he was out of the room, and that you were left unattended for a considerable length of time without a clear idea of when he would return.

We are happy that people choose to work in several rooms simultaneously if they and their patients approve, but this does mean that it places an extra burden of care on the practitioner to make sure that they put patient safety first in terms of letting people know how long they will be and how to attract attention. We also have concerns about the maintenance of hygiene when moving from room to room. Working in several rooms requires a great deal of precautionary hand-washing to avoid cross infection.

As far as your symptoms are concerned, powerful treatments can sometimes induce the sensations you have experienced. You sound as though you were on the verge of a faint - light-headed, fast heartbeat, sweats - and ideally you should have been laid down with your feet higher than  your head and given a sweet drink. We sometimes call this 'needle shock' and on some sensitive patients we have to tread very carefully in terms of numbers of needles and amount of needle stimulation. However, the effects are usually transient, gone within an hour or so, and no permanent damage is done.

Hopefully the feedback which you have given to your practitioner will enable him to use a slightly more gentle approach in future. If the sane thing does happen in spite of gentle treatment you may need to discuss whether acupuncture treatment is the best option. We have known of a handful of patients for whom any needles were simply too powerful, and eventually their apprehension about treatment outweighed the benefits they derived from it.

We hope this helps. It must have been a pretty scary experience for you, one that we hope does not recur.

Q: I have an inner ear problem that is causing loss of balance and vertigo will acupuncure help and how long until I can expect a result?

A:  We have been asked a number of times about balance problems and a typical answer was/is:

A great deal depends on what accompanies the balance problem, or indeed whether it is a stand-alone problem.
 
There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
 
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows:
 

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

 
but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, that is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind
 
http://www.ncbi.nlm.nih.gov/pubmed/19606509

 
generated some very interesting results, but the formula applied would not be appropriate for everyone.
 
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

However, as we said before ,the best thing to do is to arrange to visit a BAcC member for an informal chat about what may be possible. 

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