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Q: I had my second acupuncture session 4 days ago and just wanted to check if my symptoms were anything to be concerned about. I've suffered from ME for a number of years but have largely recovered and thought that acupuncture may help improve my health to its former level . The practitioner took this into account and gave me a gentle treatment. Although i couldn't get out of bed for 5 days a few of my symptoms seemed a little improved after this time. The second treatment, much gentler again, has had a very similar reaction but it's been accompanied by a deep painful ache down both legs. Is this part of the healing crisis i was warned about?

A:  We tend not to like the words 'healing crisis' because they do tend to be used of more outcomes than is reasonable. We are always confident that the more unusual apparent outcomes of treatment are not usually causally related because we are familiar with the range of possible adverse effects (rare in themselves) and they tend to be transient. Out main concern is that on occasion we have dealt with queries where the adverse effect was clearly nothing to do with the treatment but the belief that it was was delaying positive action to deal with it.

That said, ME and related long term health problems can generate some very odd symptoms when they start to resolve. From a Chinese medicine perspective the flow of energy is usually heavily compromised by these conditions. One consequence is that blockages in the system which would be obvious in someone in good health are hidden because the energetic flow is so weak they do not cause problems. Once the flow is starting to return to its proper levels symptoms of the blockage start to appear. We have also seen patients learn to move in a rather more restricted way when they are troubled by ME, and returning to better health can sometimes cause muscles to stretch properly again.

However, deep painful aches in the legs are always worth investigating sooner rather than later, so the first thing to do would be to contact the practitioner, explain the situation and if time and energy permit to go along to their clinic to see what sense they make of it. There may well be energetic reasons which they can find and which they can correct, or at very least put your mind at rest. If nothing is apparent, then you are best advised to pop along to your GP and ask their advice too. 

We are very heartened that the practitioner used very gentle techniques, so we are fairly sure that this means what you are suffering does not have a mechanical cause. However, the post-ME constitution is very delicate, in our experience,and setbacks are frequent even years after an apparent full recovery. Hopefully you will be on a continuing upward path soon.  

A:  We have to say that a great deal depends on the extent of the damage resulting from the diabetes, and to a lesser extent whether you have type 1 or type 2 diabetes.  Generally speaking, there is a growing amount of evidence suggesting that acupuncture may be able to help with pain arising from diabetic neuropathy, and a number of studies and papers which make very encouraging noises. We aren't going to reference them here because they are quite complex and not easy going even for us. If you want to look at the scientific evidence, however, you might want to google 'ncbi acupuncture diabetic neuropathy.' This accesses a database of all the studies in the largest medical databases, and will provide with references to dozens of papers.

Numbness of the feet is another matter, however. There are fewer papers, although the ones that we could find, such as this one.

http://www.ncbi.nlm.nih.gov/pubmed/20633522

seem very positive.  Using the same search technique for the term peripheral neuropathy will generate another list of studies, most of which refer to PN induced by chemotherapy, but some of which, including the one we have mentioned, do address the problem from a diabetic perspective.

In traditional Chinese medicine, however, numbness of the feet can be a symptom of a much wider number of problems with the system than the small number usually identified in the west. Chinese medicine has an entirely different diagnostic system based on an understanding of the body as a system of energy in flow, called 'qi'. If this flow is interrupted, for any reason, then pain or numbness can result, and the skill of the practitioner lies in being able to determine whether the flow is damaged by local disturbance of systemic problems. There are functional disturbances in the whole system which can prevent energy getting to the extremities.

This does mean that there can on occasion be symptoms which are automatically assumed to be a part of a larger condition but which may not always be so. A good example for us is the number of patients with low back pain and X-rays with degenerative problems in the spine but who now have no pain although it was assumed that the spinal damage would continue to generate the same problems.

What we would suggest is that you visit a BAcC member local to you for an informal chat to see whether there are particular features of your presentation which encourage them to believe that treatment may help. We are confident that they will be honest in their assessment and tell you if they think there is nothing that they can do. It is likely that this is what they may conclude; the nerve damage caused by diabetes is usually irreversible. However, there is always a possibility that the causal chain is a bit more complex and that they may find diagnostic information which leads them to believe that they may be able to help.

 

Q:  Does an acupuncturist have the right to refuse acupuncture to a patient who is non compliant with treatment for HIV and therefore a higher infection risk or do you accept that universal infection control standards are adequate protection and that the person cannot be discriminated against? 

A:  There are quite a number of significant issues wrapped up in this question. First and foremost, though, we have to say that our Codes are written such that they provide protection in all circumstances against the transmission of blood borne viruses as long as the provisions are followed to the letter. From our perspective anyone could have a BBV, and someone could be a symptomless carrier of, say, Hep B  and pose a considerable risk, mainly to the practitioner it has to be said - the use of single use disposable needles has eradicated cross-infection by needle.

However, when someone is known to have a BBV, and especially HIV where a patient is not following the treatment regime they have been prescribed, the stakes are raised a little. Our informal ruling has been that someone with a high viral load might present an increased risk if they have an opportunistic infection , but again we have stood by our ruling that the Code, if followed, provides adequate protection. We had to address this issue some years ago with a practitioner about to graduate who was Hep C positive, and the advice of our Health and Safety expert was that this did not present a risk to the patient unless the practitioner had a high viral load and might unwittingly transfer something to a patient by sneezing, etc etc. However, Hep C is far more easily transmissible than HIV, and transfer of the HIV virus by any other than direct contact is virtually unknown.

Finally, though, none of our members is required to see any and every patient who wants to see them. We may take up cases if we felt that there were racial or religious reasons for refusal to treat, but in general a practitioner can take a view that someone who is not interested in looking after themselves is not a good candidate for acupuncture treatment. That said, most of us would take this as a challenge and would hope to convince someone over time that a potentially life-enhancing treatment was in their best interests. Refusal to accept this is a part of the pathology, and we might be interested to see what could be done to balance them and see if this made a difference.

However, it isn't for us to take a view about what people choose to do or not do, and all of us have seen 'train wreck' patients over the years whose lifestyles are leading to an inevitable collapse bit who resolutely avoid all good advice.


A: We would have serious concerns if acupuncture treatment was being used as the only treatment for a c difficile infection, except in cases where the symptoms are very mild and where the patient has been advised that stopping antibiotic treatment may be enough. Although c difficile usually develops in settings like hospitals where people are already being prescribed strong antibiotics which can allow the infection to take root, and although discontinuing the antibiotics is often the first stage of treatment, the disease has to be managed with considerable care thenceforth. Complications can arise with serious consequences, and there is also the question of continuing treatment for the condition which necessitated the antibiotic treatment in the first place.

Certainly the symptoms of c difficile infection can be interpreted within the frame of reference of Chinese medicine, and there are a number of both symptomatic and constitutional treatments which might offer help and which might speed up recovery. Quite often there is a background of weakened immune response, and although the research in this area is not very precise it is a long held belief that constitutional treatments like acupuncture can help to boost someone's overall health. Papers such as this one and similar

http://www.ncbi.nlm.nih.gov/pubmed/20399151

suggest that further research may well demonstrate that there is an enhancement of immune response after acupuncture treatment.

For now, however, we would see the potential benefit of acupuncture treatment as something which sat alongside, and not instead of, the conventional treatment for c. difficile. It may well offer symptom control as well as helping to restore the balance of the whole system, as understood in Chinese medicine terms. If someone has been told that no further conventional treatment is necessary, then the practitioner's duty of care extends to ensuring that both they and the patient ensure that any worsening of the condition is not misinterpreted as 'getting worse before getting better' and that if symptoms re-appear with increasing severity an immediate referral for conventional care is made. 

If the symptoms are mild, then we are confident that acupuncture treatment can be helpful. There are several clearly defined syndromes which reflect the variations in the presentation, and when these are treated within the context of an overall assessment of the patient they have been found over the centuries to be effective at reducing the severity of the symptoms.

Q:  I have arthritis  in my hip.  I had accupuncture yesterday for the firs time  which was fine.  Today the pain in the affected leg is worse than before.  Is this normal as I have more booked next week.  How long should this pain last? 

A:  There are no hard and fast rules but we would be surprised if the pain lasted for more than 48 hours. It is not at all uncommon for pain to increase slightly after a first treatment for musculo-skeletal problems, and most of us tell our patients to expect a slight increase for the next day or two. If the pain continues for longer than that at the same level of intensity then it is certainly worthwhile giving the practitioner a ring to see what they make of it. They will know your case history well and also know what they did, which will make them best placed to tell you what is going on.

Aside from the energetic effects of treatment there is also the possibility of a slight bruise deep within the tissue which can sometimes occur if the needling is slightly deeper. There may be no external signs, but these can cause nerve impingement which can last for a few days.

Most likely, though, is a treatment effect. This can either be because of the restoring of energy to an area, and equally to the effects of the treatment encouraging better structure. This can often cause a re-alignment of muscles and their relative tensions, which can result in discomfort as the body starts to find its correct position.


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