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Q:  I had acupuncture today. The practitioner said he wanted to treat metal element and I specifically told him that was not the right thing for me. He went against my wishes and did it anyway and since I have been experiencing terrible symptoms from excessive confusion, dizziness, feeling sick, off balance and feel like all the energy from my body has been brought into my head. I feel worryingly ill. What should I do?  I have of course fired the practitioner as someone who goes against a patients wishes in this way should not be practicing as far as I am concerned. 

A: This is quite a tricky issue. There could be an argument here that by asking the practitioner not to do something, you were effectively withdrawing your consent to treatment. By carrying on in the way that he did he may have been technically in breach of his Code of Ethics. In situations like this, if we come across patients who have specific requests ('don't needle my feet', don't use moxa')  we can discuss with them the reasons why they might not choose to have this kind of treatment but in the end we have to find alternative ways of working with them.

The situation is a little more complex when it involves an aspect of the treatment where some form of diagnostic interpretation is called for. Treating acupuncture students can be something of a trial because they occasionally have a tendency to tell you what needs to be done, and can get quite indignant if you do something different. The bottom line, though, is that someone is paying you to use your skills and experience, and should in theory be left to get on and do what they do best.

However, many patients have now had considerable experience of acupuncture, and many are aware of things that work for them and things that don't. If a patient is reasonably well versed in the system of Chinese medicine they may well have sufficient understanding to be able to say what they can or cannot tolerate. If so, and if the practitioner feels that this is the only appropriate treatment, the only answer left to them would be 'I'm sorry that this is not possible, but in my judgement this is the only appropriate course of action and I would be unhappy to treat and charge you for an alternative treatment which I did not believe was the best possible option for you.' 

We can understand the strength of your feelings about what you consider to be a breach of trust, and we hope that you found another practitioner to help you who can make sense of the symptoms which you now have. This would be necessary to differentiate between those adverse effects which were a part of a process of recovery ('getting worse to get better' as is sometimes said) and adverse effects which may have arisen from incorrect treatment.

It is not our place here to test out responsibility and blame. Each professional body has its mechanisms for investigating what has happened when poor communication has resulted in problems or where a patient may feel that their wishes have been over-ridden. If you need to we are sure that you can find the appropriate conduit to make a formal complaint. We are simply sorry that you have had a poor experience of acupuncture treatment and hope that it has not put you off seeking help with another practitioner.

Q: I catch too many viral illnesses/flu like illnesses, about 6 or 7 a year. I am fit and well in between and not chronically ill, I am a 60 year old lady and my only other problem is asthma which is well controlled with inhalers. Could acupuncture help?

A:  You have probably heard people talk about a weakened immune system; in fact, it is a rather over-used term in modern times. However, it does sound as though this really is the case for you, especially if you are relatively fit and healthy the rest of the time.

From a Chinese medicine perspective the point of greatest interest is that you have asthma. Although it may be well-controlled it does show that there is probably some weakness in the Lung energy. We cannot be absolutely certain from the name alone; there is no direct correspondence between symptoms and disturbance in the function of an Organ (capitalised to denote the Chinese understanding of an Organ), and quite often a named condition can have its root elsewhere. However, in the majority of cases the Lung energy is involved, and this is of particular interest because the Lung is closely associated with what is called in Chinese the Wei Qi, the defensive energy of the body. If the Lung is weakened or weaker, then it is less able to circulate the defensive energy, and in theory the body is then less well protected from what the Chinese call external invasion.

Of course, being a 2500 year old tradition there is always room for plenty of disagreement about where Wei Qi develops or is generated, but most writers seem to agree that the Lung is primarily involved in its effective circulation. Boosting this energy may have an impact on improving your defences. We would be more cautious about making any claims about your asthma. The evidence is not as strong as for some named conditions which we treat, and we find that many doctors strongly advise patients against interfering with patterns of treatment which maintain good control over the condition.

How does one's defensive energy become weakened? Well, there are many ways in which one can interpret the balances of energies in the body, and in many diagnostic systems there is not necessarily a correspondence between where a symptom turns up and its originating cause. A skilled practitioner should be able to make sense of the overall pattern, but may well find out that there is a hereditary element to the problems. Our health is determined to a very large extent by the energy of our parents who create us and also by their health at the time of our conception. If this has been at all compromised on either front, then it may leave a legacy of under-performance which might make someone more vulnerable as time goes by to opportunistic viral infections. This is something which we believe can be helped by treatment.

All of this, of course, is speculation based on very little information! The best advice we can offer, given that we think there may be some benefit from treatment, is to visit a BAcC member local to you for an informal chat about whether acupuncture is likely to help. Most members are happy to give up a little time without charge, and face to face it will be far easier to offer an individualised opinion about the possible benefits.

Most of us would consider the use of tongue and pulse essential on every visit, but a great deal can depend on the style of practice. In modern Chinese practice, for example, there are occasions where the initial diagnosis might lead to a course of ten or more treatments, and the information from the initial diagnosis would not necessarily be supplemented from day to day. At the other end of the spectrum there are Japanese styles of practice where pulse taking happens dozens of times during a session to assess the impact of the needles which have just been inserted, and to adjust what is happening.

It is also important to recognise that although tongue and pulse are often referred to as the 'twin pillars of diagnosis' there are other systems of diagnosis which are equally important. In the UK, for example, there is a strong tradition of Five Element acupuncture which uses criteria like colour, sound, odour and emotion alongside the pulse as the primary diagnostic elements, and also a growing body of practitioners using Japanese meridian therapy which relies very heavily on palpation of the channels.

The bottom line is that 2500 years of acupuncture practice as seen a huge variety of systems develop, and each places a slightly different emphasis on the possible palette of options. Most include pulse taking as a primary feature, a majority feature tongue diagnosis, and even where these are not primary most practitioners use them regularly as an aid to diagnosis and assessment of treatment progress. We would expect most BAcC members to be using either or both regularly to maintain the standard of their work, but it might well be possible to defend not using them every session or to defend using other techniques as a primary marker.

We have always tried not to be too prescriptive, and for many years have used the slogan 'unity in diversity' to describe this approach. We are very aware that until the systematisation of TCM as a style in the 1950s nearly all training had been apprentice style and most often handed down within a family, so there have been extremely diverse patterns of practice. We would be reluctant to see all of this diversity lost, but at the same time we would need to be assured that a system which did not rely on these aspects could demonstrate that its treatment and feedback mechanisms were effective.

Q:The Chinese accupuncturist inserted a needle in my forehead and pain shot up into the top of my head like it was travelling in a straight line. is this ok?

A:  It is never OK to feel discomfort when having acupuncture treatment but it is a rather obvious risk from sticking sharp objects into people.

The prosaic answer from a conventional medical point of view was that the needle had hit a superficial nerve, but given what you describe it sounds much more like the kind of reaction we see sometimes when a needle activates a channel or meridian as we call them. These are distinct lines of flow of energy which travel across the body in fixed patterns. When a needle is inserted it can sometimes activate the whole channel, and there are at least five major channels on the forehead which go up and over the head. Needling a point here could well cause a sensation higher up.

If it is a reaction to treatment it will subside within minutes, or occasionally hours if the treatment carries on working. If someone has hit a nerve then the pain may last for a day or two.

It is very important to give feedback to your practitioner about what happened, if they aren't aware already. There is considerable room for adjustment of technique in Chinese medicine, and a practitioner can if need be needle to a lesser depth and also use less manipulation of the needle.

We do find some patients who when needled can tell us exactly where the channel flows across the body, but most do not experience it as a pain. A painful reaction suggests a slightly too vigorous technique for your system.

Q:,  Why did I have the big lumps on my body (arm, belly and stomach) after acupuncture? It is hurting now and also was bleeding after needles were removed. The most concern is the lumps.

A:  There are a number of occasions, usually quite rare, where the needles can cause a reaction because of the nature of the constituents, like the nickel found in the steel in some needles or the silicone coating with which some needles are treated tor smoother insertion. If there is a reaction at every point treated then it might suggest that it is a reaction to something generic rather than a freak coincidence of a similar reaction at every point. Most people with nickel allergies are usually well aware that they have them from wearing jewellery made from something other than gold or silver, but silicone is a much rarer compound in daily life and that might be a cause.

However, we are a little concerned when you say you were bleeding after the needles were removed. Although there can be a tiny drop of blood after a needle is removed, it is rare for this to involve every single needle insertion unless the practitioner is using needles that are too large, or the practitioner is manipulating the needles more vigorously than the patient can take, or the patient is not reacting normally to needling. Examples of this latter factor would be the skin being less elastic than it should be or the blood not clotting as quickly as it should.

in the case of the first two possibilities it is a matter of talking to the practitioner about changing the needles for a finer gauge or using less vigorous techniques. It might also involve him checking whether there is a coating on the needle which might be affecting you. If neither of these appears to be the case, then it might be worthwhile getting yourself checked by your GP. Wed do occasionally find that acupuncture treatment, which is invasive after all, can reveal problems which are not directly related to the treatment.

Having said all of that some people are simply very reactive to anything which pierces the skin, and if this is the case by the time you read this the lumps may well have gone down. If they recur after the next treatment then it might be worth asking yourself whether the short term inconvenience is worth the results you get from treatment.

Without seeing the exact nature of the lumps, though, (how large, what colour, etc)  it is difficult to be more specific, and we hope that spelling out all of the possibilities has not been too alarming.

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