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Q:  My coctor told me I have tennis elbow. He offered no medication  but told me to apply Ibugel  which I have continued to do.  I am still in a lot of pain could acupuncture cure this and roughly how many sessions would it take.

A:Somewhat astonishingly we have realised that no-one has asked this question in the three years during which we have been providing this service. This runs counter to our clinical experience, where this is one of the more established reasons for seeking acupuncture treatment.

We do have a factsheet

which makes encouraging noises about the small number of studies which appear to demonstrate that acupuncture may be an effective way to treat the condition.The problem which bedevils some of the studies, and not just in studies of tennis elbow, is that many are Chinese and start from the premise that acupuncture works and are intended to establish what works best. This means that from a western medical point of view the studies are flawed as evidence on which one could base a recommendation.

However, our clinical experience is that this is a condition which responds quickly if it is going to respond. This particular expert tends to draw a line at three or occasionally four sessionbs if there has been no sustained improvement. There can sometimes be a few good days followed by a reversion to roughly status quo, and unless the point of return starts to creep upwards, it may be better to look at alternatives. That's about as far as we would commit on the number of treatments necessary, and it is best practice for many conditions to review progress after four or five sessions to see whether there has been sustained improvement. For this extremely clear outcome measures are necessary.

The best advice we can offer, and we do for many problems, is to visit a BAcC member local to you for a brief face to face assessment. This will give you a really clear idea of what might be possible, and will enable the practitioner to have a quick look at the wider picture to see what else, if anything, may be hindering the natural process of healing.

There may be one or two activities you will be asked to avoid while the elboe recovers, though. Especially tennis!

Q:  Can acupuncture help relieve symptoms of painful bladder syndrome / interstitial cystitis?

A: Rather surprisingly, there is very little research into this problem. This came as something of a surprise to us because we have colleagues who have made this an area of special interest for a number of years, and we had assumed that this would have been evidence of a more general interest in researching this problem. The most recent study we could find

is typical of many areas of research, where what is available is an extended case report which is suggestive of benefit but a long way short of the standards of proof accepted in the West for claims of efficacy.

However, this does not mean that Chinese medicine has nothing to offer. Problems like this are not modern inventions, and there are a number of recognised syndromes within one of the prevailing styles of Chinese acupuncture which address the problem directly. However, it has to be said that the underlying premise of traditional Chinese medicine is that it treats the person, not the disease, and the practitioner will be interested in seeing the overall pictuire, the backdrop against which the problem developed. This is why, to much puzzlement in the West, the same named condition in twenty people might be treated in twenty entirely different ways. Symptoms are not necessarily the same as the disease, but usually regarded only as evidence that the system as a whole is out of balance.

The main issue with problems such as interstitial cystitis is that they can have good and bad patches, and if someone does decide to have treatment it can be difficult on occasion to work out whether a good run is just simply a good run or whether the treatment is working. Outcome measures are important, but so is regular review of progress and also careful consideration of whether a good patch is down to treatment or not. We have seen a number of case over the years where progress has been written off as 'just a random good run' where practitioners have been less careful about agreeing reliable outcome measures, and this is an opportunity missed.

The best advice we can give, though, is to visit a BAcC member local to you to see whether in their view there is something to be done for you. We are confident that in many cases there will be some positive change but the unknown factor is how much and how sustainable the change is.

Q:  Who are the people who access more acupuncture treatments? Educated or non-educated people?

A:We have no data on which we can base any comment.

It used to be something of a piece of 'received wisdom' that traditional acupuncture was a middle class preserve for financial reasons. Indeed some of the more innovative ways of providing acupuncture, such as community clinics and mutli-bed clinics, have their origins in the United States where a very forceful group argued that acupuncture would be beyond the means of working people without initiatives such as these.

However, in our view this may not be the case at all. Although the cost of treatment has risen over the years it is no longer beyond the means of an ordinary working person. Nor is there a direct correlation between class and educational background as there may have been thirty or forty years ago, leaving aside what 'educated' might mean.

Essentially, the message of traditional Chinese medicine is not one which requires a great deal of intellectual capacity or the ability to understand esoteric concepts. The very direct way in which it describes and addresses the sorts of problems which everyone has makes its message easily accessible, and it is always very reassuring when giving talks to audiences of all kinds to see the recognition which greets some of the descriptions of the ways in which disharmony and imbalance can affect the body, mind and spirit.

Q: On behalf of a friend, is there any point in trying acupuncture for scleroderma, at present in the lungs and skin.  I have had remarkable success with acUpuncture for rheumatoid arthritis.

A: In our view, there is always good reason to try acupuncture treatment! By its very nature, traditional Chinese medicine treats the person, not the disease, and the physical manifestation of a problem is seen within a picture of the whole person involving all aspects of their body, mind and spirit. We find that this can often be a very rewarding way of approaching auto-immune conditions where there is no obvious physical cause. This obviously doesn't mean that there is an alternate cause in mind or spirit, but from a Chinese medicine perspective symptoms are not the problem, simply an indication that the system as a whole is not in balance. Indeed, the earliest systems of Chinese medicine were asymptomatic, using the symptoms only as indicators of returning overall balance,

As far as research into scleroderma is concerned, there are a number of studies which are encouraging, good examples of which are

but even here this is far from standard treatment fare. Of course, one of the problems with conducting research is that to meet western research protocol standards as many variables as possible have to be taken out of the equation. Since scleroderma is a relatively rare condition and can present in many different ways, it is not that easy to assemble a meaningful sample and control group for testing.

However, as we have already said, and as you have personally experienced, acupuncture treatment can often provide remarkable benefits where there is not a great deal of conventional medical treatment available. We tend to take the view that there will always be a benefit, but how much and how sustainable are open questions. We rely on the probity of our members to set clear outcome measures and regular review periods to enable everyone involved to assess whether there is sufficient impact from treatment to warrant continuing for a longer time.

The best advice we can give you for your friend is to visit a local BAcC member for a brief face to face assessment of what might be possible. This will always be far better than any 'remote' answer that we can give.

Q.  Looking for an acupuncture specialist with special focus on (men) bladder problems, accessible Buckinghamshire/M4. I know that most of your members may be generalists but I am looking for somebody with special focus on this topic.

A:We are sorry to say that you are absolutely right; our members are by definition generalists through the nature of Chinese medicine, and we do not have any members who specialise in specific conditions. Chinese medicine treats the person, not the disease, and a western named condition could have any number of root causes within the differentiations of Chinese medicine. We understand that there is a growing trend in China to offer specific treatments against named conditions, often heralded as 'best of both', but we have some reservations about how traditional it is possible to claim that this is.

There are one or two areas where we believe that a focus of work on a specific group may warrant defining expert practice, and three areas - obstetrics, paediatrics and mental health - are under review. This is not because there is any 'new' Chinese medicine theory to take on, but because it is possible to refine treatment slightly better to the specific problems with each group. In all other areas we are happy to stand by the principle that every BAcC member is fully equipped to treat any patient who comes to them within the agreed scope of practice.

Our only recommendation to you can be that you approach practitioners close to where you live and see if on contact they reassure you that they have met the kinds of problems you have before and are knowledgeable about conventional medical aspects as well as experienced in looking at similar problems in the past. You will find that most members are refreshingly honest about who is best able to provide treatment in their patch, and if they know that you see long experienced practitioners we are sure that they will direct you to them.