Q:  can acupuncture help alopecia areata I do not have a lot of money and am scared of going on a wild goose chase please be honest

A:  We have been asked this question a couple of times and embedded the answer to the first occasion in the answer to the second, which read as follows:

How many acupuncture treatments required for alopecia areata?

Q:  My daughter has had 3 courses of acupunture with 14 sessions for each course.  She has alopecia areata and has had for the last year.   She now has small blond hairs growing on the bald patch which covers the whole of the top of the head.  Her acupuncturist advises that she needs another course of treatment -  14 more sessions.  I am concerned he is treating for the sake of treatment and dare I say payment  although he seems to be a reputable acupuncturist. 
Can you please advise if the course should continue further or has the treatment reached its full potential in your opinion after so many sessions?

A: This is a very difficult question to answer without sight of the patient and the notes. Each practitioner works in their own tried and tested way, and it is not for us to pass comment on practice methods which they have developed over the course of their career. At the same time there are going to be occasions when a question such as yours reveals something which warrants further investigation, and we have to tread carefully so that we do not prejudice the outcome of any more serious investigation.

Alopecia is a difficult condition to treat. We were asked for a view some while ago and our answer was:
 

Allopecia treated with acupuncture

Q: I´m a family doctor who recently graduated in acupuncture with the masters from our Medical Council in Barcelona. I have a friend who is suffering from a alopecia associated with stress the last 2 years, having also skin problems since his childhood (hipercrhomia and vitiligo). Does anyone has experience or a good literature source about alopecia treated with acupuncture?

 A: There is not a great deal of literature to assist you, we're sorry to say. We tend to undertake the same sorts of literature searches which you might do using the 'ncbi' resource to access most of the Pubmed resource, mainly because we are constrained under UK advertising law to be very clear about the existing evidence for the treatment of specific conditions and extremely clear about what level of certainty this generates. Given that traditional acupuncture and randomised control trials are not a happy mix, the evidence is generally scant. In the case of the acupuncture treatment of alopecia there are only two or three articles in English and these date back to the 1980s and 1990s. There are undoubtedly hundreds in Chinese but we do not have the resources to translate them and assess them carefully for their methodological soundness.
 
There are a number of articles available in the traditional acupuncture press, such as
 
http://www.jcm.co.uk/product/catalog/product/view/6412/the-treatment-of-alopecia-with-acupuncture-and-related-techniques/
 
but if your training is in medical or western acupuncture, as we suspect it might be, then much of what these articles say will be largely incomprensible.
 
Certainly from an eastern or traditional acupuncture perspective we would be likely to see what else was happening in the patient's system which might place the symptom of alopecia in a wider and more informative context. Although the problem might be a local one the chances are that there are wider patterns of disharmony and imbalance, and correcting or addressing these patterns might offer the best chance of sustainable improvement. That said, there are a number of treatments which do involve the insertion of a number of needles both within and on the margins of the affected area. From an eastern perspective this is seen as encouraging the local flow of 'qi', and from a western perspective is understood in neurophysiologial and segmental terms, and there is an outside chance that this may help to reduce or reverse the condition. Our experience, however, is that alopecia is not very easy to treat, and we tend to ensure that patient expectations are as realistic as possible.

The fact that your daughter has shown some improvement over the last year is itself very encouraging, although we would be the last people to apply the 'post hoc, propter hoc' argument, that simply because improvement happened while someone has acupuncture does not in and of itself mean that it happened because of the treatment. Alopecia can spontaneously resolve of its own accord.
 
There are a number of conditions for which treatment can continue for a very long period of time, and we would expect, if this were the case, for there to be underlying patterns in the patient's energetic balance which warranted further treatment and which the practitioner could explain. Otherwise that would reduce what we do to the simple treatment of a symptom in itself, and someone could reasonably challenge the basis on which the treatment was continued if the symptom appeared to be responding well. It would certainly be reasonable to ask for a more in-depth rationale for continuing, even if you do have to end up on the receiving end of a lesson in Chinese medicine.
 
We are a little concerned about the 'course of fourteen treatments.' We tend to take a much more conservative view in our advice through these pages, and often suggest that four or five sessions constitute a good review period at which one can question whether the treatment is working and with what frequency it should continue. The aim of most practitioners is to reduce the frequency of treatment where the natural healing processes start to kick in, and many of us use the analogy of watering plants to explain this, that where you might need to water frequently to begin with the need decreases as the plant becomes healthy again. We're not suggesting that there is over-watering going on here but we would feel a little uneasy about a straightforward commitment to so many sessions without a good underlying reason. This was one of the most frequent complaints we had to deal with when people came to us for help in dealing with high street shops, where paying for ten sessions up front regardless of prognosis was often the norm.
 
Our advice to you is to raise this with the practitioner directly, both in terms of the need to book a course of treatments, and the frequency with which treatment needs to take place. If you are not happy with the response there are a number of options. It is always possible to seek treatment from another practitioner with whom you could discuss your concerns. Alternatively you can raise the matter with our Ethics Department if you feel that the practitioner's financial well-being is taking precedence over your daughter's needs.
 
We can understand your concern, and hope that better communication will resolve the issue. This is the most frequent reason for matters to get adversarial. However, if you are not satisfied with the outcome of any future exchanges we would urge you to let us know and to enable us to follow up. It is always a matter of concern to us if any of our members falls below the standards to which we all aspire. 
 

Q:  My daughter has had 3 courses of acupunture with 14 sessions for each course.  She has alopecia areata and has had for the last year.   She now has small blond hairs growing on the bald patch which covers the whole of the top of the head.  Her acupuncturist advises that she needs another course of treatment -  14 more sessions.  I am concerned he is treating for the sake of treatment and dare I say payment  although he seems to be a reputable acupuncturist. 
Can you please advise if the course should continue further or has the treatment reached its full potential in your opinion after so many sessions?

A: This is a very difficult question to answer without sight of the patient and the notes. Each practitioner works in their own tried and tested way, and it is not for us to pass comment on practice methods which they have developed over the course of their career. At the same time there are going to be occasions when a question such as yours reveals something which warrants further investigation, and we have to tread carefully so that we do not prejudice the outcome of any more serious investigation.

Alopecia is a difficult condition to treat. We were asked for a view some while ago and our answer was:
 

Allopecia treated with acupuncture

Q: I´m a family doctor who recently graduated in acupuncture with the masters from our Medical Council in Barcelona. I have a friend who is suffering from a alopecia associated with stress the last 2 years, having also skin problems since his childhood (hipercrhomia and vitiligo). Does anyone has experience or a good literature source about alopecia treated with acupuncture?

 A: There is not a great deal of literature to assist you, we're sorry to say. We tend to undertake the same sorts of literature searches which you might do using the 'ncbi' resource to access most of the Pubmed resource, mainly because we are constrained under UK advertising law to be very clear about the existing evidence for the treatment of specific conditions and extremely clear about what level of certainty this generates. Given that traditional acupuncture and randomised control trials are not a happy mix, the evidence is generally scant. In the case of the acupuncture treatment of alopecia there are only two or three articles in English and these date back to the 1980s and 1990s. There are undoubtedly hundreds in Chinese but we do not have the resources to translate them and assess them carefully for their methodological soundness.
 
There are a number of articles available in the traditional acupuncture press, such as
 
http://www.jcm.co.uk/product/catalog/product/view/6412/the-treatment-of-alopecia-with-acupuncture-and-related-techniques/
 
but if your training is in medical or western acupuncture, as we suspect it might be, then much of what these articles say will be largely incomprensible.
 
Certainly from an eastern or traditional acupuncture perspective we would be likely to see what else was happening in the patient's system which might place the symptom of alopecia in a wider and more informative context. Although the problem might be a local one the chances are that there are wider patterns of disharmony and imbalance, and correcting or addressing these patterns might offer the best chance of sustainable improvement. That said, there are a number of treatments which do involve the insertion of a number of needles both within and on the margins of the affected area. From an eastern perspective this is seen as encouraging the local flow of 'qi', and from a western perspective is understood in neurophysiologial and segmental terms, and there is an outside chance that this may help to reduce or reverse the condition. Our experience, however, is that alopecia is not very easy to treat, and we tend to ensure that patient expectations are as realistic as possible.

The fact that your daughter has shown some improvement over the last year is itself very encouraging, although we would be the last people to apply the 'post hoc, propter hoc' argument, that simply because improvement happened while someone has acupuncture does not in and of itself mean that it happened because of the treatment. Alopecia can spontaneously resolve of its own accord.
 
There are a number of conditions for which treatment can continue for a very long period of time, and we would expect, if this were the case, for there to be underlying patterns in the patient's energetic balance which warranted further treatment and which the practitioner could explain. Otherwise that would reduce what we do to the simple treatment of a symptom in itself, and someone could reasonably challenge the basis on which the treatment was continued if the symptom appeared to be responding well. It would certainly be reasonable to ask for a more in-depth rationale for continuing, even if you do have to end up on the receiving end of a lesson in Chinese medicine.
 
We are a little concerned about the 'course of fourteen treatments.' We tend to take a much more conservative view in our advice through these pages, and often suggest that four or five sessions constitute a good review period at which one can question whether the treatment is working and with what frequency it should continue. The aim of most practitioners is to reduce the frequency of treatment where the natural healing processes start to kick in, and many of us use the analogy of watering plants to explain this, that where you might need to water frequently to begin with the need decreases as the plant becomes healthy again. We're not suggesting that there is over-watering going on here but we would feel a little uneasy about a straightforward commitment to so many sessions without a good underlying reason. This was one of the most frequent complaints we had to deal with when people came to us for help in dealing with high street shops, where paying for ten sessions up front regardless of prognosis was often the norm.
 
Our advice to you is to raise this with the practitioner directly, both in terms of the need to book a course of treatments, and the frequency with which treatment needs to take place. If you are not happy with the response there are a number of options. It is always possible to seek treatment from another practitioner with whom you could discuss your concerns. Alternatively you can raise the matter with our Ethics Department if you feel that the practitioner's financial well-being is taking precedence over your daughter's needs.
 
We can understand your concern, and hope that better communication will resolve the issue. This is the most frequent reason for matters to get adversarial. However, if you are not satisfied with the outcome of any future exchanges we would urge you to let us know and to enable us to follow up. It is always a matter of concern to us if any of our members falls below the standards to which we all aspire. 
 
 

Q:  I have many dark marks on my  face and back.  On my back I have body marks, same as chicken pox marks.

A:  It is very difficult to offer a view of whether acupuncture could be of benefit to you without a great deal more background information that we have before us. This exemplifies the difference between western and eastern medicine. In conventional medicine, a symptom such as this alreayd narrows down the field of possibilities, and a good doctor will,with the asking of a few more questions, be able to hone in on the best course of action without necessarily having to see the patient. In eastern medicine the practitioner would need to see how the whole system was performing to be able to make sense of individual symptoms which arise, because from an eastern perspective the symptom is only a part of what the practitioner works on, not necessarily the primary focus of treatment.
 
Based on our experience, however, we would be less optimistic about treating this kind of problem with success unless there were a very clear pathway, i.e. something which stood out as a cause of the problem in eastern terms. It is true that Chinese medicine treats the person, not the disease, and that simply attending to someone's constitutional balance may help all manner of problems, but skin problems tend to be difficult to resolve at the best of times, and we often recommend that prospective patients see someone who is also trained in Chinese herbal medicine, because herbal approaches seem to be more able to shift longstanding skin problems. This may be because the daily treatment helps to maintain a momentum for resolving the problem.
 
In the absence of more detail, though, there is not a great deal more we can say unless we knew how the markings arose, what other health problems were around, and so on. Our best advice is always to seek a brief face to face assessment with a practitioner local to you who can see the problem as it manifests and give much better advice on the suitability of treatment.  
 
 

Success is a very loaded word in the context of what one can now claim in marketing and advertising. The standard of proof in all healthcare advertising is the randomised, double blind control trial, the model most often used for testing drugs, and it has to be said that it is not very well suited to assessing whether acupuncture 'works' or not. Reducing variables is the last thing a practitioner would try to do in Chinese medicine; understanding and interpreting their variations is integral to the way that the system works. Hence a paper such as this one from 1998
 
http://www.ncbi.nlm.nih.gov/pubmed/9828874
 
is a great example of the problems we face when asked questions such as this. The manifestations of urticaria, understood in Chinese medicine terms as a description of the specific symptoms, have always been around and like any complete system of medicine, Chinese acupuncture has ways of understanding how the heat and swelling develop, and within the system has developed clear protocols to deal with the problem.
 
However, as the paper acknowledges, getting precise enough definitions if urticaria itself to assemble a trial is a problem, as indeed would be the next stage, ensuring that the test and control groups had the same western and eastern conditions to guarantee objectivity. However, when one takes into account that in Chinese medicine the person with the disease is as important, if not more so, than the disease which the person has, it becomes rather difficult to talk meaningfully of treating a named condition.
 
That said, there are papers which examine the presentations and treatments of urticaria such as this one
 
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/
 
where there is a very positive reference (60) to a paper which on the surface appears to meet the criteria for inclusion in a growing body of good evidence.
 
We prefer to hold to the view that each patient is individual, and that it is the unique assessment of their energy by a skilled practitioner which is the best judgement of whether treatment may be beneficial. It is true that many patients present themselves for treatment with urticaria-like symptoms, and anecdotally we here of success in both acute and chronic cases. However, if you wanted to establish whether acupuncture treatment was a good option for yourself or someone on whose behalf you are asking, then a brief face to face assessment by a BAcC member local to you is your best way of establishing this. 
 
 

Q:  I broke my ankle 5 years ago and have since had two lots of repeat surgery to correct it. The bone is now structurally strong, but i have a build up of scar tissue inside the ankle joint which is now causing pain when I exercise. Please could you let me know if acupuncture would be beneficial on reducing scar tissue that has built up over the past 5 years? My other option is more surgery to remove the scar tissue, but my surgeon and I are reluctant to do this if i can manage the pain in a less intrusive manner. I am a 28 year old female.

A:  We would be reluctant to make any claims for the use of acupuncture treatment for the reduction or removal of scar tissue. There is very little reputable evidence to suggest that it would work, and some of the anecdotal evidence you may find on the internet is a little questionable.
 
However, scar tissue does have implications for someone's health within Chinese medicine. As you may have read from our website, the theories of Chinese acupuncture are based on the understanding of the body mind and emotions as a complex flow of energy called 'qi'. The distribution, balance and flow of this energy in what are called meridians or channels are what sustain us and keep us in good health. Scar tissue impacts on this flow in Chinese medicine theory as much as it impacts the physical health of an area in conventional medicine, and is especiually relevant in Chinese medicine because it is seen to impair flow. When this happens, the result is pain; a great many of the surface aches and pains which people experience often link to blockages or local stagnation, and the use of needles can often help to disperse this.
 
However, as with any system of medicine there are no guarantees, and while all of us have had experiences where treating alongside or across scar tissue has helped to reduce pains, we have also had as many occasions where the scarring, especially keloid tissue, has proved intractable to treatment and been a simple yet immovable source of continuing pain.
 
Our best advice to you is to seek a short face to face assessment with a BAcC member local to you. He or she will be able to see where the scarring lies and assess whether and to what extent this may be impacting on the flow of energy locally. If you did decide to have treatment we would recommend that you try as much as possible to set measurable outcomes for any change. Pains like this can often ebb and flow in the normal course of events, and whether it feels better or not can depend on when you are asked. It is helpful to establish if there are specific movements which generate or increase the discomfirt, because these can be tested to see whether the treatment is working.