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Ask an expert - general
Q: I have had sciatica since the birth of my baby 5weeks ago and have not got any better and the pain is almost unbearable despite painkillers. However my physio today gave me acupuncture for the first time and whilst there is still a lot if pain there is some relief at last. She is due to come again in a week but I wonder if a week is a bit long and does acupunture benefit from more regular treatment than weekly at this stage?
A: It is certainly the case that in China, where acupuncture is often provided as an outpatient facility in hospitals, acute conditions are treated daily for five or ten days. Although this is quite difficult to arrange in the UK for reasons of convenience and cost, many practitioners will see someone two or three times a week if the situation warrants it.
However, it is important to bear in mind that it is quite common for people to have a day or two where symptoms continue after treatment and even on occasion get a little worse, and it is really only possible to assess how well a treatment has taken after everything has settled. The analogy of the mud at the bottom of the pond is often used. Clearing it can make the water far more polluted for a couple of dats but then the residues settle and you can see what difference there has been.
At this early stage it might well be helpful if you could have an additional session, but if you can hang on for another day or so you may well find that the improvement continues enough to be able to hang on till next week. If, however, you get a 24 or 48 hour improvement which then settles back to the levels of pain you experience before you should let your physio know and discuss with him or her what the best course of action is.
Q: My daughter is suffering from a virus similar to glandular fever, causing tiredness, headaches and aches. Will acupuncture provide her with any benefit?
A: The Chinese had no concept of virus or viral infection, but grouped the symptoms together and understood them as affects of the climate, because extremes of climate or rapid changes of climate induce symptoms similar to those we describe as colds or chills. The vocabulary which describes this, such as 'invasion of wind cold' or 'invasion of damp heat', is very much a part of colloquial Chinese vocabulary and accepted as an explanation for someone's illness.
As far as treatment is concerned there are protocols which have been used in China for over two thousand years. However, to our knowledge there has been little systematic research of their efficacy, partly because of the short term nature of the condition and also partly because most acupuncture research is western-medicine based, and there isn't a clear-cut enough named condition to meet the requirements of the randomised control trial.
As far as treatment for your daughter is concerned, acupuncture would certainly do no harm. Indeed, many children are treated with acupuncture and respond very well. There are two cautions, however. First, it is very important that acupuncture treatment is not substituted for any western medical or care your daughter is receiving unless it is with the knowledge and consent of her GP. Second, your daughter's age has a bearing on the treatment. A teenager will respond to treatment very much in the same way as an adult, and can be treated very much the same. Younger children tend to be more reactive, and also experience their illness in a slghtly different way. Although we do not yet recognise experts or specialisms in professional acupuncture a growing number of our members undertake postgraduate training in treating children, and it may be advisable to see someone who has had this training. That is not to say that any BAcC member cannot be effective, simply that it may be better if the person who treats your daughter has experience of treating children on a regular basis.
The best course of action is to ask a BAcC member local to you if someone has this experience and then seek their advice. We do not maintain a database of people specialising in treating specific groups, but our members are usually very aware of who locally provides this kind of service.
Q: Is there any evidence that acupuncture can help with peripheral neuropathy and if so is there a distinction between chinese and western acupuncture?
A: There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet shows here
but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.
Western and Chinese acupuncture operate from entirely different conceptual bases, although in practice many of the acupuncture points they use will be in the same places. Most western acupuncture is based on a neurophysiological understanding of acupuncture, that its effects are caused by stimulation of local and distal nerves. There are other variations on this theme, but in essence the practitioner works with a western medical diagnosis and very often uses needles in and around the affected area. Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achevement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.
The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.
A: We have published a rather dense review paper on our website please click here
which is perhaps aimed more at the medical reader than the public, but the bottom line is that there is an increasing amount of eviden which suggests that acupuncture may be of considerable benefit for treating people who have suffered strokes. However, since much of the research takes place in China and is not always as methodologically rigorous as in the West, it is not yet considered good enough to make a firm recommendation. This is not because the research is sloppy, by the way. The main problem is that acupuncture is already believed to work by the Chinese, so research is often focused on what works better or best. In the West people still aren't wholly convinced that it works, so take issue with studies which don't make this the priority.
In China acupuncture is often used to treat stroke victims, often within hours of the stroke and as much as possible within the first few weeks. The underlying belief is that the stroke has severely disrupted the flow of energy, called 'qi', in the channels of flow, and it is this disruption which causes the temporary paralysis and spasms associated with strokes. The acupuncture is used to reinstate the proper flow, and that's why it is administered so quickly. The longer it is left untreated, the more the untoward patterns become locked in and harder to shift. In the West, where people often come to acupuncture as a last resort after six months of other treatments, this can reduce the effectiveness of treatment a little.
Everyone is different, though, and it is this factor which is central to diagnosis and treatment planning in Chinese medicine which makes it difficult to generalise about all cases. The best advice always is to discuss the unique presentation with a BAcC local to you and see what they say. Most of our members are more than happy to give up some time to assess with a potential patient face to face whether treatment may be of benefit, and we trust that they are honest enough to tell you if they think it isn't.
Q: Can acupuncture be used to treat hypothyroidism ?
A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism. What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.
For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment as the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.
That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.
If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.