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Q:  I am middle aged and my body still produces lovely, smooth fat. When I was 45, the fat on the back of my hands "ran away". The back of my hands got injured by trauma. . Could acupuncture redistribute the fat onto the back of my hands where the fat belongs? Could qi gong exercises help?

A:  This is quite a tricky question to answer. If you were to ask whether there is any evidence for this kind of treatment the answer would be 'no.' It would be difficult to determine what was a pathological condition and what was simply a part of the normal ageing process. 

That said, the ageing process can be very much affected by issues like diet, lifestyle and exercise, and both traditional acupuncture and qi gong are aimed at improving the balance of the body as much as possible and maximising proper function. In that sense, it is possible that regular treatment or qi gong exercise would be of great benefit to you as a whole, and may have an impact on the way that your body shows signs of ageing. Not all ageing signs are necessarily evidence of that process; not for nothing do we talk about people with serious illnesses looking like they have aged ten years. However, if you are otherwise healthy, there may be elements of your overall balance which could benefit from either acupuncture or qi gong.

We have to remind patients sometimes that treatment in ancient times was intended not to make people better but to keep people well. Going to a traditional doctor after falling sick was likened by the Chinese to 'digging a well after you're thirsty or forging a spear after the battle had started.' In the modern context of trying to tell people what acupuncture treats, this most crucial aspect of the process gets lost quite often. Most of the queries on this thread are 'can acupuncture treat x?', when the main point of treatment used to be, and still is, treating the person.

The best advice we can give you is to visit a BAcC member local to you and see if they are happy to give you a brief face to face assessment without charge to look at this presentation in the overall context of your current health. This will allow them to get a better sense of what is going on and with that a much clearer idea than we can give here of what treatment may be able to achieve.

Q: Please can you advise me if there are any contraindications to using acupuncture during conventional treatment of breast cancer in a woman aged 25?
For example, could it cause any conflicts during chemo or radiotherapy therapy treatment? I have researched the positive effects and do not find much in the way of acupuncture opposing treatment in anyway. 

A:  There is, as you say, quite a bit of evidence gathering for the use of acupuncture to treat the side-effects of chemotherapy, as you can see in the relevant sections of our factsheet on nausea

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html

There is also a growing body of evidence for the treatment of chemo-induced neuropathy, although not quite robust enough for us to make claims of efficacy.

In general, the use of acupuncture to help with the side effects of chemotherapy and radiotherapy is becoming well established within cancer treatment centres. The only contra-indications we have ever encountered are to do with the treatment of the limb beneath where lymph nodes have been stripped. In mastectomies and even some lumpectomies the lymph nodes under the armpit are stripped as well, and the received wisdom is that treatment of the affected arm creates an enhanced risk of infection, especially if the person has lymphoedema as a consequence of the removal of the glands. 

There has been a considerable amount of argument inside the profession about this, because in China doctors happily treat the affected limbs with acupuncture, and we can find no evidence of any 'smoking gun', a case where infection has been attributed to acupuncture treatment. We strongly suspect that this arose from the view of a small number of consultants and in the absence of evidence either way everyone has played safe. This is not an impediment to treatment, however. One of our colleagues, Beverley de Valois, has published several very authoritative studies showing that treatment according to traditional principles using substitute points elsewhere on the body has been just as effective as local treatment. A full list of her publications is to be found here:

https://www.researchgate.net/profile/Beverley_De_Valois/publications

The main factor which we have to bear in mind is that someone being bombarded with chemicals and radiation is immuno-suppressed and may not have as much resistance as the average patient. As a result we take special care with such patients, and may, for example, routinely swab all points before needling where normally we rely on professional judgement. Our health and safety consultant was always emphatic, though, that following our Codes of Safe Practice to the letter was a guarantee of safety from cross infection.

There is no evidence, either, of conflicts with any other forms of conventional treatment, as in trying to restore cells which the conventional treatment is trying to destroy. Because we are working from a different paradigm the treatments are aimed at different levels of function within the body, and do not cancel each other out.

If you do decide to have some acupuncture treatment, and we believe it will probably offer some real benefits, you can discuss this in depth with your practitioner. Our members are well informed on areas like this, and have had to address similar concerns on many occasions.

Q:   I live in the south west of London area, and I am just trying to find out if there is a acupuncturist treatment on the NHS. I am unemployed at the moment, but I can get a referral from my GP.

A: We are sorry to say that there is not a great deal of acupuncture provision on the NHS. Some doctors and physiotherapists inside the NHS use acupuncture but this tends to be restricted to their normal scope of practice and generally is only allowed for specific treatments for which there is a good evidence base. This tends to rule out the use of acupuncture for general well-being and for those areas which are our stock trade, where there is substantial lower grade evidence but not a great deal of gold standard trials. We, of course, are not happy with using an inappropriate standard as a yardstick, for reasons which are too complex to cover here, but that is the situation. 

There are also a number of Pain Clinics which routinely offer acupuncture treatment, and your GP could refer you to these if your problems fell within their general scope.

We are assuming that your circumstances are such that you need treatment to be free at point of delivery. We doubt that you will find many of our members who are able to offer treatment for nothing, but all of us have at various times taken on patients at highly reduced fees because we want to ensure that treatment does not become a kind of middle-class preserve because those on low incomes or the unwaged cannot afford it. This is a matter of personal choice, and if you ask around there may well be practitioners within relatively easy reach who could off some kind of deal - we have over 500 members in Greater London.

Some members have also started to set up what are called multibed clinics to try to provide acupuncture at relatively low cost, often £10 - £15. A list of such clinics can be found at http://acmac.net/acu/clinics, and the ACMAC website makes for interesting reading. The standard of treatment remains high, but obviously being treated in a community setting does not quite offer the same levels of individual care or privacy that one to one work offers. However, it does mean that acupuncture becomes more widely available.

We hope that you manage to track down someone who can help you.

Q:  I have something called mal de debarquement syndrome which began immediately when I set foot on dry land following a cruise, I've had it ever since and that was four months ago. Symptoms are like being in a boat 24 hours a day every day combined with brain fog, fatigue, confusion, sensory overload, head pressure, migrane etc. It's  apparently very rare and therefore there is no medical treatment, it can by all account last from months to many years. Will acupuncture help?

A:  We were asked this question a couple of years ago and our answer then was:

MdDS is quite a rare condition, although the overlap with a number of better documented problems such as Meniere's Disease or vertigo could mean that it is under-reported. As is always the case with relatively rare conditions there is hardly any research, even in conventional medical literature.

We searched for whatever we could find, and there are certainly a number of anecdotal accounts from people with this condition who have found acupuncture in combination with some fairly low level medications has done the trick. This sample is self-selecting, though; there is less chance that someone who hasn't found it useful will post the bad news.

For problems like this we have to say that the way that Chinese medicine works, interpreting the symptoms against a completely different theoretical framework and supplementing what is reported with findings from, for example, looking at the tongue, taking the pulse at the wrist and other clinical observations, can sometimes generate solutions where conventional medicine cannot. Chinese medicine is based on an understanding of energy, called 'qi', and its flow, rhythm and balance in the body. The flow is affected both functionally by weaknesses in the Organs of the body which sustain it, and also positionally because of local blockage and disturbance. It is probable that a practitioner may find evidence of changes or blockages in the flow, and by re-aligning these start to reduce the symptoms. This is certainly the case with other balance problems, where the evidence for the effectiveness of acupuncture treatment, while not conclusive, is certainly encouraging enough to suggest that treatment is worth a try.

The best advice we can give is that you visit a BAcC member local to you and seek a brief face to face assessment. We are confident that in person they will be able to offer a much better view of what may be possible. The only caution we have is that conditions can become more difficult to treat the longer they have been entrenched, and a fifteen year history suggests that improvements may take a while. However, life is full of surprises, and we have seen longstanding problems vanish almost overnight, so the best idea is probably to have no expectations either way.

We have checked the databases to see what else might have been published since we wrote this in 2014, but apart from a 2013 study which uses a form of magnetic therapy

http://www.ncbi.nlm.nih.gov/pubmed/23202153

we have not found anything else which would affect what we have said either way.

The only addition we would make to this answer is to mention that there are one or two other forms of treatment, notably cranial osteopathy, which might also offer some relief and improvement. Although the evidence for acupuncture and MdDS is a bit thin, there is a considerable amount of good quality research on vertigo and other balance problems like Menieres and labyrinthitis. From a Chinese medicine perspective, the disease labels of western medicine are less interesting to us than the functional disturbances which a patient reports. We have ways of interpreting these within the conceptual grid of Chinese medicine which makes direct equivalences hard to establish - some presentations with different western names are the same as far as we are concerned, and twenty people with the same named presentation may be treated twenty different ways.

Hopefully a practitioner will find something which makes sense of your problem and can give you a much clearer idea than we can here of the potential for treatment with acupuncture.

Q:   I was having acupuncture done once a week every week. However, financial circumstances currently prevent me from doing this routine. I am able, however, to do acupuncture once every three weeks. I am debating whether it would be wise to try to practice acupressure on myself during the weeks I am not having a treatment or if I would harm myself more so by practicing acupressure on myself. What are your thoughts? I feel as if there may be no "right" answer to this question, so if you don't have an answer that is okay too.

A:  It's a shame that finances are getting in the way of your treatment. The first thing to say is that many practitioners are quite flexible about their charges when patients run into difficulties, and most of us are prepared to reduce our fees if need be. This mainly applies to those of us who have unlimited access to our premises, either working from home or leasing a clinic for full time use. For those working in fixed sessions and in premises where the overheads are high, this may not be possible.

We cannot see how acupressure could cause any problems if done carefully and under the indirect supervision of the acupuncture practitioner. Generally speaking the chances of an adverse effect from acupressure are fairly low, and it should be fairly straightforward to devise 'holding' treatments to keep the momentum going.

We can't speak for your practitioner, though, and most of us would probably prefer to find ways of improvising a fee arrangement to maintain more regular acupuncture. We would advise you to have a talk with them about this, and see what the outcome is.

The bottom line, however, is that a patient can do pretty much what they want, and we have heard tales of patients acquiring needles and treating themselves. This is something we definitely do not recommend! If acupressure between acupuncture sessions is the only realistic option then we would recommend that you discuss this fully with your practitioner, and establish what adverse effects might arise which would be a sign that you were over-doing it or that the system did not like what was happening. It would be hard to cause damage, but you might be able to work yourself into a state of mild nausea or headaches for several days, and would need to know what constituted a good reason to pack it in.

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