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Q:  I am a long-term sufferer from restless leg syndrome, but over recent years it has grown immeasurably worse to the point where I am unable to sleep for many houRS each night. Alongside this, I have an additional problem of tinnitus which has also increased in intensity over the past few months - though whether there is any link between these, I am obviously not qualified to say.

My question is whether you could provide me with the contact details of an acupuncturist who specialises in these conditions. I live in Dorset on the south coast, but am quite prepared to travel over a significant distance, if this is necessary. Having already had treatment from a local practitioner, I feel I would prefer to speak to someone with a specific understanding of these conditions in order to receive effective treatment.

If you could help, I would be most grateful..

A:  We have been asked about restless leg syndrome (which has now qualified for the name Ekbom Syndrome), and a stock response we have used for a couple of years is:

 Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is now
gaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/ cites several of these, and the one acupuncture review this in turn cites

http://www.ncbi.nlm.nih.gov/pubmed/18843716 mentions two to three studies which are interesting but generally concludes that the majority of studies are too small
and not methodologically sound enough to draw firm conclusions. From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.

We have not come across much in the way of new research, although another small study published early this year http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339862/

repeats the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.

Tinnitus is for many acupuncturists one of the heartsink conditions. As we have replied on many occasions:

Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. It is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted noise.

Some of our colleagues are a little more upbeat than this, but if you read the tinnitus sufferer magazines there is very little consensus about effective treatments. Every treatment will work for someone but there is not some treatment that will work for everyone.

There are, as the earlier reply suggests, a number of specific conditions understood in Chinese Medicine terms which would predispose a practitioner to being optimistic, and in turn, it is possible to link this with some of the more common causes or restless leg syndrome. However, it would be a very long shot to kill these two particular birds with one stone.

As for special expertise, all BAcC members are generalists by the very nature of Chinese medicine which treats people, not conditions. There are a number of areas where groups of members have focused their attention on particular patient groups, such as pregnant women, children or patients with mental health disorders, and we are working to define the basis on which these practitioners can call themselves expert practitioners in these fields. We have never heard of anyone specialising in treating either of these conditions.

All that we can say is that if you have tried treatment with someone local to you without success then you may find it helpful to move to a new practitioner for a slightly different approach. There is no reason to inform the existing practitioner of this move, although you may find it helpful if a former practitioner passes on notes of what they have tried already. None of us takes exception when patients transfer; it is best professional practice to do whatever is possible to make the transfer effective and to see that the patient gets the treatment best suited to them.

Q:  I have pain in my right hip / inner thigh. I have had X-Rays with results showing  I have arthritis  and have been advised by my GP  to try pain management and physio.  Would  acupuncture help me ?

A:  There is certainly evidence that acupuncture can help with both arthritis and with pain control, as our two factsheets

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

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

show. The evidence is not quite at the level where we can give an unqualified recommendation but is certainly nearing the point where we can make a stronger case to NICE for acupuncture to be considered as a legitimate intervention for GP choice and referral. The trials of osteoarthritis for the knee have nearly reached this point, and the issue is not really about whether the trials will show positive results as much as when and whether the trials will take place. Acupuncture research is expensive and
not funded by any major national organisations, so trials are not easy to set up.

As far as pain management is concerned, there are two aspects to this. From a Chinese medicine perspective pain usually arises from blockage and deficiency of energy in the body which may in your case have been caused by the degeneration of the joint or may have been causally implicated in the deterioration having happened. Using acupuncture to reverse the blockage or weakness will probably have a lasting impact on the energetic flow, and may well take care of some of the pain. The fact that the pain manifests on the inner thigh suggests that there may be an aspect of what is going on which reflects this.

However, the deterioration in the joint and the inflammation which this will continue to cause is not something which is going to go away, and the usual pathway is for the deterioration ultimately to call for a hip replacement, an operation which these days appears to be being done with immense speed and rapid recovery. If this is the case, and this pathway is by no means inevitable, then the amount of pain relief and its sustainability may come down to a simple financial question: does the amount of relief and how long it lasts warrant the cost? For people with deep pockets and a powerful need to keep going for work, this is not an issue, but for most of us it is. This is something which people usually discuss with their practitioners but ultimately it is the patient's call.

On balance, though, our experience is that it is possible to help to contain the rate of deterioration and to remove some of the secondary pain caused by energetic blockage, and we would be happy to suggest that you could visit one of our members local to you for a brief face to face assessment of what may be possible. We have also found that where someone has a hip problem on one side there is often a consequent disturbance which develops on the other side, especially in the knee, as someone shifts the balance of their weight off the painful side. This often causes a rotation of the pelvis which can then generate fresh problems. We advise many of our patients also to
have an assessment by an osteopath because there are often patters which have developed gradually as the hip has deteriorated which have not yet generated
symptoms but may well do so. If this has become a structural issue, it is often quicker to have a session or two to re-establish good 'shape' in order for the
acupuncture to encourage better function in the muscles and tendons which have been working at a mechanical disadvantage.

From a Chinese medicine perspective, however, not only is each patient unique but the presenting problem which they have is rarely the only issue they have. The patterns into which these problems all fall usually point to systemic weaknesses which treatment can help to correct and which helps in turn to sustain and maintain local improvements. This is why a face to face assessment can be so valuable.

Q: I have had acupuncture for a specific problem (achilles tendon pain) which has responded very well. Now it has been suggested that regular visits for acupuncture are beneficial to overall health and balance. Is this a generally recognised approach and if so is there a frequency of visits that is recommended e.g. is once a month too much, too little etc.

We are very pleased to hear that your ankle responded well to acupuncture treatment. Although it would be fair to say that the majority of patients in modern times consult us with a specific health problem, in ancient times the idea of staying well rather than getting better was central to the use of acupuncture and herbal medicine. Going to a doctor and seeking help when ill was said to be 'like forging a spear after the battle has started or digging a well when you are already thirsty.' The ancient practice was to have treatment to stay well, and it is believed that in some cases the doctor was paid to do this on pain of having to keep the patient in the style to which
they were accustomed if they got sick!

The key aspect of maintenance treatment is that each of us has a constitutional balance which predisposes us to certain problems at specific times of year or when we are faced with more mundane challenges of life like stressful times ahead or chronic problems. In China the seasons are very much more distinct than here, but the change of season was seen as critical as the temperature dropped rapidly or the winds picked up. The Chinese saw these as having a major impact on health (as a primarily outdoor agrarian race), and the doctor treated the person just before the season to ensure that the person was well-prepared for the change. With five seasons in the year,
this would have meant treatment every ten weeks, and there are many patients who take this seriously enough to do just that.

We find, though, that the majority of patients find a good balance by trial and error somewhere between four weeks and thirteen weeks, and in fact become very sensitive the idea of 'time for a treatment.' Of course, proving the long term benefits of this approach is very difficult; how do you demonstrate that someone is better than they might have been? However, enough patients have shown an increased resilience and overall health with regular treatment to convince us that the ancients had got it right.

The odd thing is that some people think that five treatments a year at around £200 is a mite excessive but have not the slightest hesitation in putting a perfectly well-functioning car through a full dealer service at £900. We think that the values of modern life have become a little off-centre at times! It is up to us to convince, though, to convince them that good health is more than just absence of illness but an enhanced ability to live well at all levels.

 

A:  A great deal depends on where you are and what you are trying to deal with. In most cases practitioners in the UK see people weekly because the majority of treatments are constitutional in nature, i.e. aimed at balancing the system as a whole, and the received wisdom is that it takes a week to get a clear picture of what has changed since the last treatment. There are as many analogies as there are practitioners, but many talk about re-arranging things in a pond and waiting until the ripples have ceased to see what has changed.

In some cases, a practitioner might see someone twice or even three times in a week if there are acute problems to address. It is not unusual with acute back sprains to see someone more than once weekly. This is more a matter of reinforcing the treatment regularly to make sure that it 'holds'.

If you were to visit a practitioner in China, however, it would be quite normal to see someone daily for ten days. This constitutes a 'course of treatment', and many Chinese people with a chronic or acute on chronic condition will trot along to the local out-patients department at the hospital to have treatment every day. With an increasing number of Chinese practitioners in the UK it is possible that this may begin to happen more frequently here, although the crucial difference is that in China the treatment is free at point of delivery within the national health system. In this country ten sessions, one a day, would probably be beyond most people's pockets unless the practitioner had come to an arrangement over the overall fee.

Many of us believe that there can be a tendency to over-treat unless one is careful, and again the often-used analogy is that of watering a plant. There is only so much watering that one can do before leaving the plant to make its own progress, and that is why we are very insistent that BAcC members maintain a rolling review of progress to assess how much treatment is needed and how frequently. This is a matter of professional judgement, because each patient is unique and different, and even though two patients may apparently have the same problem, the underlying cause could mean one gets sorted in two sessions where the other one needs ten sessions.

Covering all bases in our reply, we have to say that you can never be harmed by over-treatment, so if someone were treating too often there is no damage that can be done. The worst that can happen is that nothing happens or the system may feel a little unsettled, but the inbuilt safety margins of the system usually ensure that the body re-sets to a good working balance very quickly. That is why any adverse effects, like tiredness to a mild headache, tend to go very quickly.

A:  Proximal myopathy can result from a number of causes, and to a large extent how treatable it may be can depend a great deal of what is thought to have caused it. There are a number of underlying causes which involve pathological and irreversible changes in the body, and it would be unwise to start giving people unrealistic hope or expectation in cases like this. The first thing a practitioner would want to do in great detail would be to go through the medical history and see what had happened as the condition developed.

As is not surprising, there is very little research into the use of acupuncture treatment for proximal myopathy. The immense variety of presentations and the huge range of possible causes would make it rather difficult to assemble a meaningful trial. There will undoubtedly be studies in Chinese, but the majority of these are not translated into English and there are not many searchable databases along the lines of Pubmed and other western ones.

That said, the great strength of Chinese medicine is that it takes the symptoms which someone experiences, which are the same in any language and medical system, and makes sense of them through an entirely different conceptual grid. Chinese medicine is based on theories of energy, called 'qi', and its flow, rhythm and balance in the body. When symptoms arise these are seen as changes or disruptions in the flow, and there is a 2500 year history of making sense of these through an entirely different understanding of the human body. Someone may have had the same symptoms 2000 years ago before there was any understanding of the nervous system, and there would have been, and still are, strategies for addressing the problem.

A good analogy is the treatment of strokes. In China, acupuncture treatment is started on the day of the stroke because the paralysis and spasticity which happens is seen as a break in the flow of qi, and every effort is made to reinstate proper flow as soon as possible. There would be no equivalent western treatment because the model used does not give any grounds for immediate intervention at the level of mobilising the limbs, the event being largely thought to be contained within the brain itself. So, in proximal myopathy, there may be ways of treating the presentation through a look at the local conditions where the problem lies or through looking at the wider
functional disturbances which in Chinese medicine could affect the functioning of the limbs through a systemic imbalance.

The long and short of it is that we think you would be well advised to meet one of our members local to you for a brief face to face assessment of what treatment may be able to offer. An experienced practitioner should be able within a few minutes to have a good view of what may be achieved and offer you a realistic assessment. The caveat remains, however, that if there has been a major change in the body which has precipitated the problem, this may limit the extent to which you might improve.

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