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Q:  I have had  PHN for over more than ten years, it is affecting my left leg..the pains is still ongoing... I wonder if acupuncture can help?

A:  As you might imagine we have been asked about this many times over the years; shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

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

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

The one confounding factor about your problem is that it has now persisted for ten years. There is a kind of received wisdom that treatment becomes more difficult the longer a problem persists, and there used to be a line that treatment of a problem took as many months as the years it had persisted. Most of us don't take this too seriously, though; we have seen thirty year problems sometimes vanish within weeks. The key issue will be to determine what is happening in energetic terms. This may give some very useful pointers to what has caused the problem to persist and similarly pointers to what might make things improve.

 

Q:  I have been receiving treatment through the NHS for fibromyalgia and chronic lower back pain. I have had 5 sessions and have had needles inserted into my mid and lower back, buttocks and the backs of my knees. During sessions 2-4 I also had needles to my ankles. Following session 4 I developed an extremely uncomfortable right ankle, with a lump under the ankle bone which is quite evident by feel and very painful to touch. I cannot recall any injury, trip or fall, and at today's session we had to avoid using needles to my ankles. Could this pain and lump be related to the acupuncture I have received so far?

A:  While we could never say for certain that it is, there is no doubt that if a lump or bump appears where someone has placed needles the usual assumption is that it has happened as a consequence of the treatment. Put the other way around, if you had said that the acupuncture definitely caused the problem, we wouldn't be able to say that it didn't.

 The most common form of lump like this is a deep bruise which has resulted from a slightly over-deep or over-vigorous insertion of a needle. This can sometimes show no signs on the surface, but because the ankle is a very narrow and 'crowded' space, it can put pressure on surrounding nerves and blood vessels and be really uncomfortable. There are other possibilities to do with needling in or near joint capsules which can cause similar problems, and in all cases these usually subside within a matter of days. They should certainly be gone within a couple of weeks. The other outside possibility is that there has been an allergic reaction to the needle in this specific place (we have seen one rare case of this) but it would be most unusual to react only in one place and not in equivalent areas on the other limb.

 If the lump is showing no signs of reducing, or the pain and/or discomfort remains the same, then perhaps it would be wise to contact your GP and have the lump assessed. Although there is a strong probability that the treatment is the cause, it is always best to consider the possibility that it is entirely contingent and just happened to appear at the same time. People sometimes get involved in arguing about whether acupuncture caused a problem, or sometimes simply assume that it did, and leave it uninvestigated longer than is beneficial. A lump is a lump, and needs checking.

 We hope, and expect, that it will resolve quite quickly.

Q:  I tripped over a step over 18 months ago and hit my head. I have totally lost my balance. I have had MRI scan and cat scan.  I have been told there is nothing else they can do for me. It is not vertigo and when I am out in the dark I have to have someone with me as I stumble all over the place. I am trying a Cranial osteopath but that is doing no good. Do you think acupuncture will help get my balance back.

A:  This is a very difficult question to answer. The fact that there is no visible damage and that cranial osteopathy has had no effect are not very encouraging when trying to say whether acupuncture might help. The latter (cranial osteopathy) works in broadly similar ways, and if that is doing nothing it does not bode well.

 However, on a more positive note, we get many referrals from cranial osteopaths when patients do not respond, and on many occasions we are able to help. From a Chinese medicine perspective we are looking at functional relationships within the body, not structural ones. Our basic premise is that there is a flow of energy in the body, which we call 'qi', whose flow, rhythm and balance determines the way in which all of the functions of the body perform as they should. Our skills are to identify weaknesses and blockages in the flow which cause pathological and functional changes, and to use needles to correct them.

 Of course, it sounds a great deal simpler when put this way than it actually is, and there is a considerable skill in identifying exactly what is causing a problem. This may not always be where or how the presenting condition appears to be, and can sometimes lie elsewhere. There may have been local disruptions to what we regard as normal flow in the damage you sustained which remain even though the body appears to have healed, and there may have been other mental and emotional consequences of what happened to you which have caused a problem 'downstream', as it were. These could just as easily result in a functional disturbance like loss of balance.

 The best advice we can give for unique problems such as yours is that you visit a local BAcC member for an informal chat about what may be possible. Most are very happy to give up a short amount of time without charge to assess whether acupuncture treatment is a good option, and this also has the advantage that you can meet someone and see where they work before committing to treatment.

   

Q:  I currently live in UK and my brother studies Chinese medicine in China, Beijing. We are wondering what is the requirement if he wants to have a clinic in the UK. Does he have any benefit if he has Bachelor degree from China? Or does he need to study from 1st year or is it possible transfer ? We would like to know how to study or start for my brother?

A:  There is no statutory regulation of acupuncture in the UK. This means that in theory anyone can set up in practice with almost any level of qualification, and indeed there are people who have done very short training courses who have set up clinics. This is called a 'common  law' right in the UK; if it isn't expressly forbidden, then it's OK.

 In practice, however, there are sets of laws which are enacted by local rather than central government, and which are mainly intended to ensure that the places where people work meet basic safety standards. Many local authorities have now started to put conditions into these laws which require practitioners to be able to demonstrate that they are properly trained. The BAcC is sometimes asked to pass comment on an applicant's training if there is any doubt about how good it is.

 The standard which most people accept in the UK as an entry standard is a degree level training, usually three years or 3600 hours spread over three years. This is the standard recommended by the World Health Organisation. Some diploma level courses are also recognised, but the three month courses which used to be the only thing available for people travelling from the UK to China to train would not normally be regarded as sufficient.

 The best way to find out useful information about the UK training scene is to look at the website of our sister organisation, the British Acupuncture Accreditation Board, http://baab.co.uk. This has downloads of training standards and also information about accredited courses which would allow someone automatic eligibility to join the BAcC. There is also the website of another major UK association to which many Chinese practitioners belong, the ATCM http://www.atcm.co.uk which spells out the entry requirements for practitioners who undertake their training in China itself.

 In summary, as long as the training is about degree level and contains the major elements of the model syllabuses, it would not be a problem for your brother to train in China and then start work in the UK. If, however, he planned to come across to the UK to train, he could contact some of the teaching institutions mentioned in the websites directly and ask what he would have to do to sign up to a course in the UK. Many will accept part training as a basis for exemption from some of the course, but that would have to be by individual negotiation.

 

A:  We have rarely been asked about optic atrophy, but did have a question three years ago which refers to what remains the best evidence available, as well as the best advice about finding someone who might be able to help.

We wrote:

 A recently published meta-analysis


http://www.ncbi.nlm.nih.gov/pubmed/23545824


makes some very encouraging noises about the use of acupuncture treatment alongside conventional treatment, but concludes, as does every systematic review or meta-analysis, that more research needs to be done, and on a greater number of subjects.
However, we are always cautious about the kind of trials which generate these results. The gold standard applied to western scientific research is the randomised control trial, and to make these work, the treatment has to be standardised and the condition under investigation has to be the only outcome variable. Whatever else the patient may have by way of health related issue is discounted. From a Chinese medicine perspective, both of these positions are not best practice. Treatment is dynamic and evolutionary, building on the progress, or lack of it, and refining the treatment as it goes along. The symptom which serves as the focus of the research is also seen in a far wider context, and it would not be surprising if twenty people with optic nerve atrophy had twenty different diagnoses from a Chinese medicine perspective. The symptom is only an alarm bell which alerts the practitioner to patterns of imbalance or blockage, and these will be unique to each individual.
This means that we have to be careful with research studies. Many will be unfairly inconclusive, but equally others will be falsely encouraging, building on a fortuitous outcome that the patients selected for a small trial happened to have treatment which helped their underlying patterns.
Good Chinese medicine aims to understand the appearance of symptoms in disturbances of the function of Organs (capitalised because an Organ is seen a complex collection of functions which embrace some of the physical ones we understand in the West but many which affect mental and emotional factors), and the practitioner uses their art and skill to determine what the driving force behind the complex pattern of disharmony is. In some cases this will show direct connections with the symptom, in others only a complex pattern in which the symptom is a weakness exaggerated by problems elsewhere.
The long and short of it is that the best advice you are likely to get for the treatment of a condition such as this will come from a brief face to face assessment from a BAcC member local to you. It is probably true to say that the best you might achieve is a reduction in the rate of deterioration or a stable but not deteriorating state, but at this remove we cannot really say. If you did decide to have treatment it would be very useful to establish markers by which any change can be monitored, and also review periods to make sure that the treatment is being regularly assessed for outcome and value.
As far as practitioners are concerned, we do not recognise fields of specialism. From our perspective our members as generalists are all equally well equipped in Chinese medicine to deal with the full range of problems which people bring to their clinics. We have one or two fields like obstetrics and paediatrics where we are shortly to recognise standards of expert practice, but we do not have short term plans for other specialties. There are one or two members who focus their work on people with eye problems, an while we cannot give specific recommendations, it is a simple matter to track them down through google. 
We think that this remains the best advice that we can offer. There are several different causes of optic atrophy, and successful conventional treatment depends on working out what is causing the problem and trying to reduce its continuing effects. Chinese medicine would operate on the same general principle, but we would always advise patients to continue to seek conventional treatment alongside any treatment which we may be able to offer. The two different styles of treatment can work alongside each other perfectly well, and this is not a time to be trying to work out which is more effective.

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