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Q: I am trying to find out if I can have acupuncture as an anaesthetic for a knee operation in the UK. Is this possible in a hospital and are there any practitioners in the UK please?

A: We have been asked about the use of acupuncture anaesthesia a number of times, and a typical answer has been:

The answer to your question is that in theory acupuncture can be used as an anaesthetic, but we suspect that you will find it very difficult to locate a practitioner prepared to do it.

After Nixon's visit to China in the 1970s, and the remarkable pictures of people having some very serious operations using acupuncture anaesthesia (AA) , there was something of a surge of interest in the West in researching the use of acupuncture for pain relief and even trying to use AA. However, what the images from China did not show was that in every case there was a bank of conventional anaesthetic equipment ready for immediate use in case the AA wore off. The effects were not always guaranteed and reliable, and in the past two decades its use has now diminished to being an occasional novelty rather than mainstream practice.

We did have a colleague who agreed with great reluctance to use AA for a rhinoplasty in a patient who could not have a general anaesthetic, but he did have to study books to work out what to do. The fact that the operation went well, there was less bleeding and the patient recovered much faster was not enough to make him succumb to the blandishments of the consultant who wanted to offer him a permanent slot. He found the whole business far too stressful.

If you can find someone willing to do this your best bet may be someone who regularly uses electro-acupuncture (EA). This has the advantage of being consistent over time, and can also be ramped up if the effect starts to diminish. You might well find that some of the medical acupuncturists are more conversant with this than traditional acupuncturists, and indeed some of the physios who use acupuncture may also use EA more. Both of their registers ( and may offer search options, as well as our own. We think you may just have to ring around until someone points you towards a practitioner they know of who regularly uses EA and may be prepared to do AA.

We are not sure that we can say any more or better than this. The only times we have come across someone having AA in the West are when an operation is necessary but for some reason the patient cannot tolerate either general anaesthetics or epidural injections. There would have to be a very strong reason for doing it, we suspect, for a consultant to be able to take what may be an enhanced risk in working in this way.

That said, a great deal depends on the operation for which you are lined up. If we are talking serious surgery like knee replacement or similar then we think it is highly unlikely. However, for arthroscopy and a number of much simpler procedures you may be able to make a case. You would probably have to sign some very serious disclaimers and make a very robust case for sidestepping the usual procedures, but nothing ventured, nothing gained.

We wish you luck, and hope that you do manage to find someone who can help you.

Q: how does acupuncture help in managing osteoarthritis. Does it only relieve pain or can it also slow down the progression of the disease

A: There is a very large and increasing body of evidence for the use of acupuncture as a treatment for osteoarthritis, as our factsheet shows

Many of the studies are quite clear that reduction in pain with acupuncture is a reasonable expectation of outcome for treatment, and many of the studies cited here speak of the reduction in physical dysfunction which acupuncture treatment seems to achieve.

However, it is a fairly large step from pain reduction and functional improvements to statements about slowing down the progression of the disease. To the extent that changes in physical movement wrought by the pain and inflammation can both make the situation worse, any reduction or change in either will stop the condition feeding off itself, i.e. the symptoms become a part of the causal pattern which causes deterioration. However, the factors which predispose someone to osteoarthritis may still be as active as they were before, be they genetic, environmental or lifestyle, so it would only be reasonable to say that unless these change then slowing down the disease progression may not as easy to achieve.

This is to look at things from a conventional medical perspective, though. The ancient Chinese were just as prone to osteoarthritis as modern people, but the whole nature of the understanding of disease in Chinese medicine is different, and from this perspective there may be something which a practitioner could reasonably hope to achieve to remove some of the causal factors. Chinese medicine is predicated on an understanding of the flow of the energies of the body, called 'qi', and its patterns of flow and balance. Factors which affect this are often described in physical terms  - heat, cold, damp, etc - as a reflection of the conditions in which most people worked on the land. The Chinese would see the joint being directly affected by these conditions and use acupuncture and herbs to reduce the impact on the body.

In doing so they would also be mindful of the unique balance of the individual and the constitutional patterns which they had inherited which made some people more prone than others to develop osteoarthritis (the Chinese called it Bi Syndrome, and classified it according to its presentations - Hot Bi, Cold Bi, Damp Bi, etc). In this sense an experienced practitioner might hope to reduce the symptoms as well as addressing some of the deeper factors which predisposed someone to suffer with OA. From this perspective it might well be possible to look at slowing down the disease progression.

No treatment for OA works in isolation, though. An integrated approach, involving not just acupuncture but physical therapy, diet and exercise, will always offer the best chance of making life more tolerable for an OA sufferer.

Q: Hi. I suffer from ventricular ectopics,I have seen Drs regularly and take beta blockers which work to a degree. I have periods when things aren't too bad and periods when things are really bad,I do get quite down during these times. Do you think acupuncture would help?

A: We have been asked similar questions before, and in reply to one we said:

One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The irregular pulse has clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

Some of the published research also involves animal experiments, sometimes called 'ratpuncture' in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what the conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.

There have been a couple of other systematic reviews

which make largely positive noises, but as in all of these kinds of studies the treatment which is given is largely formulaic, and does not really represent what a traditional acupuncturist does, which is to gear treatment to the individual and his/her unique balance of energies. Where trials offer designs which allow the practitioner to do what they might normally do, so called 'black box' trials, the results tend to get better and better.

The bottom line, though, is that from a Chinese medicine perspective there are often functional disturbances which can generate symptoms, often far away from the source of the manifesting problem. The skill and art of the practitioner is to make sense of the diagnostic information and treat the root of the problem. This can often cause a symptom to reduce or even disappear without there having been any apparent connection between where the needles were placed and the part of the body in distress.

The advice we gave before still holds good, to visit a local BAcC member for advice and a short face to face assessment of what may be happening. Most BAcC members are only too happy to give a small amount of time without charge to prospective patients to enable them to assess whether acupuncture is the best treatment for their problem. This will obviously give a far better idea of what may be possible than what we can say at a distance.

Q: I had chemotherapy 4years ago, I lost my finger and toe nails. Since I have suffered terrible discomfort in my feet. I now find it hard to sleep because of the pain. Would acupuncture help?

A: We are sorry to hear of your problems after chemotherapy, and hope that the treatment worked for the condition at which it was aimed.

As you can imagine we have been asked before about neuropathy induced by chemotherapy, and a typical answer has been:

There is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

We have to be careful not to get too drawn into a conventional medicine perspective when answering questions like this, though. If there has been physical damage to the nerve endings then the condition is less likely to be reversible, although there is some cutting edge research which does suggest that peripheral nerves can regenerate. If the nerves are not too badly affected, however, it is important from a Chinese medicine perspective to see how the chemotherapy has affected the whole system. A symptom can be generated by any number of functional disturbances as understood within Chinese physiology, and can also arise from a simple blockage in the flow of energy at a local level. Problems like neuropathy are often a manifestation of both phenomena, and offer a number of treatment options. The skill of the practitioner lies in seeing how the system as a whole is functioning to narrow down the possibilities for treatment selection.

This does not mean that acupuncture can achieve miracles where modern medicine cannot. What we find, however, is that where western medicine assumes a direct causal path between the chemicals and the nerve damage or loss of function, Chinese medicine offers a number of potential routes where, for example, the chemotherapy may have affected a functional unit which in turn has weakened the energy at the periphery.  This is turn may offer a slightly different focus for treatment with better chance of success.

It also explains why people are often confused by the fact that the same symptom  can be apparently treated twenty different ways. From the Chinese medicine perspective the symptom is often only an alarm bell sounding for wider-ranging imbalances, and the practitioner will always look at the overall context to determine how to proceed.

Having looked at this as an answer we think it still represents the best advice that we can offer. We have had another look at the databases, and there has been nothing new since we wrote the earlier reply. Franconi's systematic review, a paper which gathers together results from all other papers, is perhaps the most recent and best summary, but as we said in the earlier reply, he concludes that the results, while encouraging, are far from conclusive.

What we didn't say is that most BAcC members are more than happy to take a look at problems for prospective patients by giving up a few minutes without charge. A short face to face assessment is always going to be far more authoritative than anything we can offer at this remove, so it would be worthwhile contacting BAcC members local to you to see what they think. This also gives you a chance to meet them and see where they work before committing to treatment.

Q: I am very interested in Acupuncture.

I am 32+ weeks pregnant and I was thinking to begin acupuncture in the 37+ week. I read it can relief a lot the pain in labour and helps deliver quicker. Could you please advice me? Because it seems that midwifes and GPS don't know much about it.

A: As you can see from our factsheet on obstetrics

there has been a considerable amount of research into many areas of pregnancy, from early stage morning sickness through breech presentation and on to delivery itself. While the evidence is a long way from conclusive (it does tend to be, but this is more a reflection of the standards used in the West which may not be the most appropriate for evaluating acupuncture treatment), it does show a trend towards acupuncture treatment being worth a try for many of the problems/challenges associated with pregnancy/delivery.

Although we describe ourselves as generalists - we primarily treat people, not diseases or conditions - there are one or two areas where the training which we all have can be usefully supplemented by postgraduate training. In two of the most clear-cut cases, obstetrics and paediatrics, the training is now sophisticated enough to warrant a decision on recognising expert practice, i.e. someone can legitimately claim within our rules to be an expert at treating these specific patient groups. While we are not yet yet in a position to do this, ultimately it will mean that we can specify which training people have had and point to providers who all keep lists of their graduates and affiliates. In the absence of this, the best that we can say is that if you use google and search on 'acupuncture pregnancy' and your home area you will without doubt generate a number of hits, most of whom will be BAcC members.

There are a number of websites associated with the training providers which can be very helpful, often addressing many of the questions which people bring and have brought to their practitioners. The best advice we can offer, though, is that having located a person or people in your area who may be able to help you should arrange to see them for an informal chat to see how they can help you and also to see whether they are people you feel comfortable with. In most cases we would say that one practitioner is as good as any other, but childbirth  is a very intimate process and it would be especially good if you have confidence in and rapport with the practitioner. The earlier you establish this contact the better, even though you may not call on their services until near due date.

We are sorry that there is such a dearth of provision within the NHS. There have been a few hospitals like the Derriford in Plymouth which had a remarkable unit which incorporated acupuncture in all aspects of pregnancy, but that unit, like many others, has closed. The problem for NHS professionals is that most provision is evidence based, and as we said at the top, the evidence for the benefits of treatment is not quite good enough for NHS providers to bring acupuncture treatment within mainstream care. You may find some midwives with training in the basic skills, but these are few and far between.

We hope that you do manage to locate a good practitioner locally, and wish you every happiness with your baby's birth.

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