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A:  Acupuncture has traditionally been used for chronic pain, often because the first major publicity event for acupuncture in the West, Nixon's visit to China in the 1970s, saw operations carried out without anaesthetic under acupuncture, and a great deal of research was stimulated into the pain relieving and anaesthetising effect of treatment. Many pain management clinics now feature acupuncture as a part of their offer. The main question is not whether the treatment will relieve the pain as much as how much relief it will give and hows sustainable its effects are. Used in this way it can sometimes, if affordable, be enough to keep someone going.

However. from a Chinese medicine perspective pain only arises where the flow of energy, called 'qi', has been affected, either from a blockage, or from a deficiency or excess in the channels through which it is said to flow. Knowing where pain appears is less important than understanding how this sits against the backdrop of the whole system. On many occasions the pain is local and to do with specific local issues, but even here the question is how the system has lost its ability to repair. More often than not, however, the pain appears as evidence of a deeper functional disturbance, and the skill of the practitioner lies in making sense of the local manifestation of discontent in the context of someone's overall balance.

The way in which energy flows in the body, and the various functions which are grouped together under the heading of an Organ (capitalised because the meaning is far broader in Chinese medicine) often show greater connections than are apparent from a conventional medical point of view. If the symptoms, for example, tended all to lie on the same channel, and this channel happened to be associated with an Organ generating other symptoms of functional disorder, this would immediately inform the practitioner and point to various treatment possibilities.

The best advice for concerns like yours is to visit a BAcC member local to you and seek a brief face to face assessment to see what they think may be possible. We would be very surprised if they did not immediately make some connections which informed their view, and if so, we think they will probably advise you that four or five sessions may be a worthwhile investment to see how well your system reacts.

 

Q:  What can I do to help a alleviate the pain at the needle insertion site between thumb and finger, it's normal reaction but lasts several days

A:  The use of this particular acupuncture point should not leave a sensation for several days, so we would be reluctant to classify what's happening to you as 'normal'. What this suggests is that the needle is being used slightly too vigorously for your physical structure in that area and causing deep bruising which may not be apparent on the surface. We have come across cases where points like this can have an enduring energetic effect lasting two or three days, but usually only when they are first used. The body often gets used to the treatment and accommodates the effect of the needles more easily as time goes on.

If there is bruising in the deeper tissues we are aware that many of our patients use preparations like arnica cream to help, but we obviously cannot recommend something like this because it lies outside our scope of practice. If the effect is felt on one side only, then there may well be some advantage to massaging the same place on the other hand. The channels are bilateral and have a close reciprocal relationship of which we take full advantage when we needle one limb to help the other when we cannot needle the site itself (because, for example, it is bandaged or in a cast). There are also points at the other end of the body which may be massaged to good effect. In this case, it might be useful to massage a point on the opposite foot between the big toe and first toe at the tip of the 'V' which if felt as the finger is drawn up toward the ankle. This reciprocal relationship between points on the opposite limb in roughly equivalent locations is also one of the more unusual treatments visitors to China often see (such as needles in the wrist to treat a twisted ankle).

From our perspective, however, if a patient came back and told us that a point was painful for several days after a session, and that this had happened more than once, we would be inclined to needle more gently or to choose another point which had less enduring impact. If the patient said they did not mind, we might still be inclined to do something different. Pain in any form is a sign of blockage or disruption to the flow, and if this is a clear cause/effect relationship, we would be wondering why this carried on.

Q:  I had accupuncture for longstanding low back pain radiating down the right leg. It helped considerably. I had 5 sessions, each time it helped more. On the 6th and last session the needles hurt more when inserted and I was very achey. A month later all my symptoms have returned and I am in considerable pain. The only difference I can think of is that before the last session I did some exercise in the gym about an hour before and my muscles were more taut. What can I do?

A:  On reading your account we doubt very much that there was anything about the final session or what you did thereafter which has led to the return of your symptoms. If there has been a severe reaction to treatment, or if something a patient has done like over-eat or over-exercise immediately before or after a treatment, then the reaction is usually pretty immediate. However, as quickly as the reaction comes it usually goes; most adverse effects after treatment wear off after about 48 hours.

It is more likely that the treatment provided some pain relief without actually changing the underlying pattern of discontent in the system. We often give advice to people with chronic back pain along the lines of assessing how much pain relief the treatment offers and how sustainable the change is. We find sometimes that the underlying problem doesn't really shift, but acupuncture treatment can push it into the background for a while as long as it is continued. The question then is whether it is practical and cost-effective to keep on with treatment, and this can take into account all sorts of factors.

The other possibility, and we say this with great caution not knowing what kind of treatment has been offered, is that the treatment did not really focus on the system as a whole but was aimed primarily at the back itself as a symptom. There are a considerable number of physiotherapists and doctors offering acupuncture treatment, and generally speaking we are not too concerned. Many use acupuncture to great effect, and our view is that the more people who have successful treatment, the better for all of us. However, they tend to take a much more symptomatic approach with formula treatments, and our view is that for many people the symptoms which they have have to be understood in the context of how the energy of the whole body is flowing. The symptom is merely an alarm bell, and turning it off doesn't change the underlying pattern. If that is what the treatment did, then the symptom will return.

As we said, though, we can't really be more specific than that without knowing exactly what has been done and with what intent. If acupuncture treatment worked before it will certainly work again, but it would be useful to discuss with the practitioner what continuing treatment may be necessary to sustain the improvements you make. Our experience is that people with chronic back pain tend to develop all sorts of changes to the way that they hold themselves which over time become their familiar 'shape', and it can often take quite a while to encourage this shape to soften and allow the body to regain and maintain the better posture which treatment can encourage. Osteopaths and Alexander teachers often find the same problem; getting someone back into the correct shape is not as much a problem as keeping them there.

Q  A chinese doctor just told me the following diagnosis:hot skeletons and wet inside.  What does it mean? What can i do with it?


A:  A very tricky question! It sounds as though the Chinese doctor's English was a little stretched, and we are only able to make an educated guess at what he might mean.

'Wet inside' may well be a reference to a condition the Chinese call 'Dampness'. This usually arises because of a malfunction in the Spleen, but do take note of the capital letter - when we use Organ names in Chinese medicine we are referring to a group of functions in body, mind and spirit which overlap with the western definition of the physical organ but are usually much wider. The Spleen in Chinese medicine has amongst its responsibilities the movement of fluids around the body, and when it under-performs fluid tends to build up, creating a condition the Chinese called 'Damp.' This might cause a number of symptoms in the body involving too much water being in the wrong place. However, there are a number of other organic functions which could lead to an accumulation of fluids, and this illustrates one of the basic premises of Chinese medicine, that a symptom could come from a number of different causes and is usually not treated as just a symptom.

As far as the hot skeleton is concerned, we're scratching our heads a little. That he means that Heat has gathered somewhere in the body doesn't seem to be in doubt, but while the obvious association is with bones, he could just mean that there is too much Heat in the interior of the body, and that this, combined with the gathering of fluid in the outer part of the body, is causing some of the problems for which you consulted him.

The best and only person to tell you, though, is the practitioner himself. Although many practitioners for whom English is a second language practise in the UK, there are usually some very clear guidelines about the standard of English which they are able to comprehend and use, and the practitioner should be able to expand on what he or she means. If they can't, but can give a slightly more Organ-based expression of their diagnosis we would be able to guide you to much more comprehensive information about what he or she has found.


1. I'm keen to start acupuncture for lifelong constitutional problems. I'm 19 weeks pregnant. My husband, a doctor, isn't open to acupuncture and doesn't want me to have it especially during pregnancy as he's concerned about the risk of infection from the insertion of acupuncture needles into the skin. Would you be able to direct me to good quality scientific evidence about this topic to relay to him please?

2. My issues are lifelong, longstanding and are manifest through mental health issues and psychosomatic symptoms. I feel the five element approach to acupuncture may address my issues and benefit me most. Is there a way of finding an accredited acupuncturist in my area that uses this approach and will be interested in addressing my type of issues in a deeper sustainable way?

 

The best evidence that we can offer you comes in the form of three studies conducted some years ago, two by members of the British Acupuncture Council and the other by members of the British Medical Acupuncture Society. Two of the studies were published in the BMJ

http://www.bmj.com/content/323/7311/486

http://www.bmj.com/content/323/7311/485

and showed remarkably similar outcomes from a similar number of treatments, with very few transient events and these themselves being transient. A second study by MacPherson - MacPherson H, Scullion T, Thomas K, Walters S. "Patient reports of adverse events associated with acupuncture: a large scale prospective survey." Quality & Safety in Health Care. 2004; 13: 349-355 ]

showed a slightly higher incidence of transient adverse events, but again these are well below the numbers for allopathic procedures and have enabled us to say with some certainty that acupuncture is a relatively safe procedure.

As far as infection is concerned, our practitioners all follow a Code drawn up with the help of Professor Norman Noah of the London School of Hygiene and Tropical Medicine, the UK's leading expert on skin piercing and infection. His published statement is that as long as a practitioner follows the Code precisely there is no risk of cross infection from acupuncture treatment. The use of single-use disposable needles means that the only possibility of infection is from a practitioner touching the shaft of a needle, using some form of oil or salve on the skin which is not cleaned away before needling, or from an autogenic occurrence where a bacterium from the skin surface is pushed deeper into the dermal layers where it causes an infection.

We are aware of one case in the UK in recent times where a practitioner may have negligently caused an infection in a number of patients, although the causation in this case has not been established, i.e. it is assumed that the acupuncture was the cause, but the exact causal chain has not been demonstrated. There are, obviously, a number of well-publicised studies about acupuncture and safety, notably those written by Edzard Ernst who has become something of a one-man industry in this field. A typical example is

http://www.who.int/bulletin/volumes/88/12/10-076737/en/

He rightly points out the rather serious potential dangers of treatment, but more often than not fails to highlight that many of the adverse events take place in countries where needle sterilisation is poor, with needles being used several times over, and often by untrained practitioners. He has also included details in one study of a cardiac tamponade caused by a woman trying to self-administer acupuncture with a knitting needle, which we thought was not entirely reliable evidence.

The usual rebuttal is that absence of evidence is not evidence of absence, and that many cases of infection from acupuncture treatment go unreported because the connection is not being made being cause and effect. We think that this is unlikely. In former times people were for a number of reasons less likely to implicate their practitioners, but our sense is that the modern patient is very well informed and very likely to assume that unforeseen outcomes after treatment are caused by treatment. Our insurance statistics, however, are unvarying, with very few claims every year and almost none with any clear link to infection.

As far as finding a Five Element practitioner is concerned, we are not able to check from our own listings who does and does not practise in this way. We did consider asking people to state their place of training on the register, but we found that most had undertaken postgraduate training in several styles of treatment, and in many cases this meant that they no longer specialised in their initial discipline. Similarly self-declarations were considered unreliable because, as is not uncommon in professional fields, there were disagreements about who was and wasn't doing authentic Five Element treatment.

Our best advice to you is to look at the list of BAcC members close to you and make a few phone calls or look at websites. We are sure that any practitioner you contact will know which of their colleagues locally practises in the way which you want to be treated. We are equally sure that all of them would be more than happy to spare a few minutes without charge for you to be able to meet them and decide based on what they tell you face to face whether their approach accords with what you want. We realised that this may take a little longer, but if you are looking to explore complex issues then a little extra time spent at the outset will be more than repaid over time.

As a final word, we just need to tell you that all of our members are trained in the safe use of acupuncture during pregnancy, and most adopt a very conservative approach to treatment to avoid any harm to the baby. There are very few practitioners in the West who use techniques anywhere nearly as powerful as those used in the Far East, but all abide by the same lists of forbidden points to avoid the remotest risk to the mother and child.

We hope that this is sufficient for your needs, but can go into greater detail on specific concerns if need be.

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