Q:  I would like to try acupuncture specifically for psychological healing and to release long-held emotions. Can acupuncture be used for this, and are there specialist practitioners in this field?

A:  There is no doubt that most practitioners would regard this as a normal part of their daily practice, but it's a difficult matter to talk about because there is not a great of evidence to support claims to help with these sorts of problems - it would be difficult to construct any meaningful trials using the 'gold standard' randomised double blind control trials - and it is only possible to discuss these issues in our marketing and PR material if they are underpinned by evidence.
 
The underlying premise of Chinese medicine, however, is that everything within the body mind and spirit is understood as a pattern of energy, called 'qi', in motion, and the practitioner's role is to use their skills to detemrine where and how the flow, rhythm and balance of the energy has been disturbed. A part of this understanding views the Organs, always capitalised to distinguish them from the conventional medical view of organs, as a complex set of functions on all levels, including psychological and emotional. The manner in which the patient experiences and expresses their discontents points to those areas where treatment may be of benefit. Generally speaking, we should all be able to dwell with all of the emotions appropriately, a key word in Chinese medicine, but if we get stuck in one mode or cannot experience an emotion like anger or grief, these point to inappropriate responses which may be amenable to correction.
 
All BAcC members will have looked at this kind of issue when they trained, so there is no need to look for specialists. However, the range of possible presentations is vast, and is someone has been seriously troubled for a long time with a condition which has been clinically diagnosed as a serious neurosis or psychosis then there may be a case for going to see a practitioner with greater experience in this field. Even straightforward issues can be quite challenging, and not everyone has counselling skills or aptitudes, and some practitioners may refer you on to colleagues whom they believe may be better equipped to deal with what you may bring in.
 
It is always difficult to give precise advice at this level of generality and the best option is always to contact a BAcC member local to you for a short face to face assessment of whether they think that acupuncture treatment may be of benefit. 

Q:  Can acupuncture help with anal fissures? Drugs that relax the anal muscle are effective but cause nasty side effects, and surgery can cause incontinence, so I'm looking for alternative therapies.

A:  As you might expect, there is very little research into the treatment of anal fissues, at least not to the standards taken as the norm for approval in the west, the so called randomised double blind control trial. There is quite a great deal of research from China, much of which has not been translated, and a leading American praactitioner and author, Bob Flaws, mentions one such study on his website.
 
http://bluepoppy.com/cfwebstore/index.cfm/feature/1258
 
The important section of this article for the non-acupuncturist reader is at the end where he describes in the technical language of TCM what is happening. Anal fissues are not a new phenomenon, and in the two thousand year history of Chinese medicine strategies and models have been developed both for understanding why they occur and for treating them. Chinese medicine is premised on an understanding of the body mind and spirit as a complex inter-related flow of energy, called 'qi', and its patterns of flow, rhythm and balance. The factors which disturb this flow are separated into external; and internal patterns, and ranging from emotions such as anger and grief through to external causes like getting over-cold or spending too long in damp conditions. Whichever the source of the cause, external or internal, its effects are often described in the language of external factors, and anal fissures would probably be described in terms of heat and dryness, this being what characterises them for the poor sufferer.
 
The great skill and art of the practitioner is to be able to understand them not as symptoms by themselves but as part of a wider pattern of disharmony in the body which will inform a much more accurate diagnosis,and with this hopefully a much more effective treatment. If there is heat and dryness in the system one might be looking for other signs of this, like constipation or skin problems, things which a patient might not consider remarkable in themselves.
 
There is no doubt that if the symptom can be placed in a wider context, then the effects can be very palpable, as this patient account highlights:
 
http://www.patient.co.uk/forums/discuss/acupuncture-for-anal-fissure-27239
 
However, the techniques used in the study cited by Flaws were very much more symptom orientated, so it is not an absolute requirement. At the other end of the Chinese medicine scale there are styles which treat the person, not the symptom, and these can be just as effective. The underlying premise of all is the same: the energy of the system has been compromised and it is a matter of finding the most appropriate and effective way of restoring its proper flow.
 
Our advice in these cases is always to see a practitioner face to face for a brief assessment of what they think is possible, and we always add the caution that for conditions like these where the research base is thin that you build in clear review periods, if you do decide to have treatment, and also try to establish measurable outcomes, i.e. things which clearly demonstrate if there has been a sustained improvement.
 

A:  In theory acupuncture treatment for your lower back should have no harmful side effects or secondary effects on your other health conditions. The underlying aim of all acupuncture treatment is to restore the natural flow, rhythms and balances of the energy of the body, called 'qi' in Chinese medicine, and as such it is more likely that treatment for your back may have a beneficial effect on any other conditions which you have, especially since from a Chinese medicine perspective the practitioner is treating the person, not simply the symptom.
 
In fact, this is the one caution we do tend to issue, given that we are not sure whether you are talking about Type 1 or Type 2 diabetes. In the case of the latter there is very often a residual pancreatic function generating some, but not adequate, insulin, and a combination of oral medication and diet ensure that someone is able to maintain their blood sugar at safe levels. There have been one or two cases where the use of acupuncture has stimulated this residual function, and as a consequence has reduced the blood sugar. This has never yet resulted in a serious hypoglycaemic episode, but it remains a theoretical possibility immediately after a treatment, so we tend to caution patients about carrying some glucose or a carton or orange juice in case they feel their levels dropping a little. In the main, however, acupuncture is always seen as encouraging homeostasis, a correction to normal function, rather than an 'overshoot', so this is more a theoretical than real risk.

There can be some substantial variations in the length of appointment times depending on the style of acupuncture practised by your acupuncturist and also the complexity of the case history which you bring to the treatment. One of the founding associations of the BAcC consisted of graduates of a college where the initial session was often two hours long and each treatment session up to an hour long. At the other end of the scale there are highly experienced practitioners who can often glean what they need to within half an hour and continue with half hour sessions.

Generally speaking we tell people to expect to spend somewhere between and hour and a hour and a half for the initial session and between half an hour to an hour for subsequent sessions. 
 
The obvious point to make, though, is that the quality of the treatment and the success of the outcomes are what matter, and these are not measured in minutes. 

Q:  I've had chronic lower back pain for three months now. I had my second session of acupuncture yesterday from my physiotherapist and the pain was unbearable. The first session had been painful when the needles were twisted but was bearable and it wore off. This time I had a different physio. Some needles went in fine and the twisting caused a little discomfort. However,  one needle when it was twisted caused me to scream out in pain and as he twisted I was actually shouting stop stop. Can you explain why this is? Also afterwards I felt I'll, very cold and had pins and needles in both legs. I am now reluctant to go to third session.

A: We always tread rather carefully in answering questions like this. Generally speaking, acupuncture needles should be relatively imperceptible; most people experience only a mild dull aching sensation, or a slight tingling feeling like a very weak electric shock. In some styles of practice, especially that used by many Chinese practitioners, there is a more vigorous manipulation of the needle to produce a much more significant dull ache, but many people barely feel anything, especially since the advent of guide tubes for insertion of needles which dull the sensations in the area.
 
So, in essence, the only pain which occurs beyond this can be a direct insertion into or very close to a nerve, or tangling the needle in muscle fibre. In either case, we always tell our members to remove the needle immediately, and indeed, if a patient tells you to stop, then you stop - to continue would certainly invite censure by the BAcC and possibly be construed as an assault.
 
We suspect that what has happened here is that someone has used a fairly large gauge of needle, which many musculo-skeletal acupuncture treatments use, and that it has been inserted quite vigorously into a muscle or nerve. The effects which you have experienced afterwards we would categorise as 'needle shock', a form of shock which creates the kinds of sensations which you have and which is like the delayed shock someone experiences after an accident.
 
There is a more subtle point here, as well, which rests on our belief that using acupuncture as an adjunct to orthodox medical or physiotherapy treatment is fine, as long as the practitioner is aware of the possible reactions which we would anticipate from using the same specific points in our tradition. It may be a different theory of treatment, but the needles still go in the same places. There is a point, for example, near the elbow which is used for treating tennis elbow but which can also, in our system, cause a sharp and immediate fall in blood pressure. If someone with a tendency to postural hypotension had this treatment they might faint. We have long argued that just as we have studied western medicine well enough to know when to refer someone to conventional care, conventional heathcare professionals have a duty of care to be aware of the cautions which inform our work in traditional Chinese medicine.
 
This is all very well, but what do you do? We think that you would still probably benefit from acupuncture treatment, because chronic back pain has been shown by reliable research to be benefit from acupuncture, but you should raise with the practitioner both the fact that you have had such unpleasant reactions to treatment, and the fact that you would reserve to right in future to tell him or her to stop as soon as you say so. It is important that you feel that you control the situation. If the practitioner does not agree, find someone else! If they do agree, and still carry on as before, report them to their regulator.
 
Hopefully, though, the treatment will have the desired effect and help to relieve your back pain.