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Q. Anxiety where will the needles be put?

A. A very difficult question to answer because of the nature of Chinese medicine. Whereas in the West each condition has a set treatment, in Chinese medicine we treat the person, not the condition. This means that we take everything about someone into account when we make a diagnosis, and then use the theoretical framework of the system to determine where the needles go.

Obviously there are some points which are quite frequently used, and some of the 'cookbook' treatment protocols will say 'for anxiety needle x'. Rather worryingly some modern Chinese practice has become a little similar. These points can sometimes work, even in the absence of a proper diagnosis, but not as well as when someone it treated properly. Many of these points lie on or near the wrist crease.

Generally speaking, though, the majority of points used in the early stages of treatment are on the arm below the elbow and on the leg below the knee. These tend to be the starting point, and very often do all that is needed. Occasionally there are blockages which will see needles used on the torso, and occasionally again on the back, but most practitioners will start off quite gently. As treatment progresses there may be some body points brought to bear, especially on the upper back, but nothing about which anyone needs to feel the slightest bit worried.

The important thing you have to remember is that treatment can only take place with the consent of the patient, and if someone decides that there are 'no go' areas, then they can ask that this be acknowledged and followed. If a practitioner says that they cannot work under those circumstances, and some might, then it's just a matter of finding a new practitioner. We can't compel someone to treat a patient, a practitioner can't compel a patient to have a treatment they don't want.

Q. Is acupuncture suitable for treating polymyalgia rheumatica?

A. As you can imagine, we have been asked about PMR several times, and a stock responses has been:

There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition. However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently.

From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles.

The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case.

The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.
If asked by a patient what the evidence for the success of acupuncture for PMR is, though, we would have to be honest and say that not only does it not meet the gold standard of western research, the RCT, but often fails to meet any reasonable standard. We believe that this is partly to do with the difficulties of assembling a meaningful cohort for a trial, the diagnosis not always being precise, but partly to do with the fact that treating it as a purely physical condition may not be dealing with the underlying causes, some of which are often mental and emotional.
We believe that, downbeat as it may be, this is still a good answer. PMR is a condition which can on occasion be intractable, and it would be remiss of us to start making claims for treating all cases with great success. For many people the diagnosis is much broader than PMR itself, and there are often complex emotional problems which arise from having been incapacitated for a long time.

So, this doesn't sound entirely encouraging. However, there are several styles of acupuncture which describe a problem like PMR very accurately but from a Chinese medicine perspective so perhaps it is a little over-cautious to be so downbeat. One of the great strengths of Chinese medicine is that it can make connections between different parts of the body and different organic functions by way of an understanding of the way that energy flows in the body. this can sometimes point to functional disturbances or even straightforward blockages, so without having had sight of your unique presentation we should perhaps be more open to possibilities. We are sure that visiting a local BAcC member for advice about what they can see in your system remains your best option.

Q. I am contacting you on behalf of my mother who has experienced a loss of functionality and feeling in the lower body due to a suspected spinal cord inflammation; feeling/mobility has shown slow/small sign of returning.

Can acupuncture assist in reinvigorating nerve path ways and also address "pain"?

I would be interested in speaking to a specialist who could help discuss this and also understanding the possible help acupuncture could offer.

Thank you for your time and help with this matter.

A. We would be very reluctant to be too committal about the reinvigoration of nerve pathways. There is a small amount evidence for nerve regeneration through the use of acupuncture but this is mainly based on experiments with animals, what our colleagues sometimes refer to as 'ratpuncture' and usually only the peripheral nerves which even in western physiology can show signs of regeneration. Spinal nerves are another matter, and we suspect that a great deal depends on the extent of the impingement caused by the suspected inflammation.

The one hope would be that from a Chinese medicine perspective something has caused a blockage in the flow of energy, some of the more important channels run along the length of the spine, and that treatment might restore proper flow. It is a long shot, but that doesn't mean that it cannot work. What it does mean, though, is that if there is a blockage it will clear quickly, so we would be reluctant to see anyone commit to a long course of treatment.

When it comes to pain there are stronger grounds for believing that acupuncture might bring some relief. After Nixon's visit to China in the 1979s there was a great deal of research into acupuncture for pain relief and anaesthesia, and it was easy to demonstrate that treatment can cause the release of neurotransmitters. Many Pain Clinics now routinely offer acupuncture treatment. The main question is how much relief treatment gives and how sustainable the changes are. If the changes are short-lived then treatment may not be the answer unless it is precisely targeted at times when people need to be pain-free.

As far as specialists are concerned most traditional acupuncture practitioners are by the nature of the system of medicine generalists, and we have never heard of anyone specialising in this field. from our perspective we treat people, not conditions, and our understanding is based on looking at how the whole system functions. Your local BAcC member is perfectly well qualified to offer you a view of how much benefit your mother might derive from treatment. indeed,most of our colleagues are happy to give up a few minutes without charge to prospective patients so that they can make a properly informed choice about treatment.

Q. Hi, i suffer from a condition called Gilberts syndrom, its basically a faulty gene/missing gene in the liver. A family friend has acupuncture for a different liver problem and she said maybe i should try it, the main symptoms i have are nausea/dizzyness/tiredness. Is this something that acupuncture could help with? Also i suffer with anxiety (mainly from my health problems) would it aid with this as well? thanks

A. This is one of the problems which illustrates rather well the difficulty of talking named conditions in one system of medicine and their treatment in another. As you are better away than we, we are sure, Gilbert syndrome can be relatively asymptomatic, although you have been in the unlucky minority for whom nausea and dizziness are common. There is no research of which we are aware which suggests that acupuncture can successfully treat GS. However, what we are talking about is a functional disturbance of the Liver (understood in the West as a genetic abnormality), which in its capitalised form is a Chinese medicine definition of the Liver which embraces the liver as understood in western medicine. And, from the Chinese medicine perspective, the Liver is indeed often involved in pathologies like nausea and dizziness, which are very often a part of Liver syndromes.

Of course, nothing is that straightforward! The essence of Chinese medicine is to treat the individual, not the disease, and although the distress might be expressed through Liver symptoms the art and skill of the practitioner lies in looking at the overall context and seeing what might be causing this distress. Sometimes this is a primary Liver imbalance, and sometimes it is the Liver reacting to an imbalance elsewhere. This makes a profound difference to the way that a practitioner will treat the person, and create what many in the West find quite anomalous, twenty patients with a named condition being treated in twenty different ways.

We would suspect, though, that given that these problems can often be traced back to disturbances of Liver function there may well be something which acupuncture can assist.

The treatment of anxiety is an area where, in spite of the difficulties of translation between systems, there has been a great deal more research which suggests that acupuncture treatment has a role to play, as our factsheet

shows. It also tends to be one of the more omnipresent conditions accompanying other main complaints with which people present. From a Chinese medicine perspective it is often the sign of a not unreasonable response to a challenging situation being maintained long after it is appropriate to do so. Appropriate is a key word in Chinese medicine. It is fine to be anxious for a short term, but there comes a point where it persists and becomes a problem. Restoring someone's balance should in theory go some way to addressing these kinds of inappropriate ways of dealing with the world, but it can take a long while. Anxiety can unwittingly become a way of life.

What we always advise is that someone visits a local BAcC member to get a sense of what may be possible. Most of our colleagues are happy to give up a few minutes without charge to prospective patients to ensure that they are properly informed about what make work for their own unique case before committing to treatment.

Q. I have been suffering from migraines for a few years and have just started acupuncture in the hope it will help. Could you kindly advise how often I should have a treatment and for how long should I plan to continue to have the sessions to fully see if it is successful?

A. It is surprising how infrequently we are asked about the treatment of migraines, since it is one of the more common referrals we get. The evidence, which you can see from our factsheet

is pretty good.

Of course, the one thing that we always have to say is that each person is unique and different, and the standard treatments used in these trials are not always indicative of the way that we actually work. Twenty people presenting with the same named condition might be treated twenty different ways.

This also means that each individual presentation, the problem and the context in which it lies, can profoundly affect how much treatment and for how long. Most of us would regard a good routine as four or five sessions at once a week, and then stretching the gaps to a fortnight and up to a month over the next three to four months. We have found that simply treating weekly until the symptoms abate is not always successful, and that without later follow-up there is a danger that the migraines will return. Patients then conclude that the treatment didn't work, which is probably not the case.

Of course, this routine can vary tremendously. If someone has three migraines a week then treatment might be more than once a week to bring things under control. In other cases, where the migraines are related to specific patterns like the menstrual cycle a practitioner might target particular times of month for a few months.

All we ask that our members do is that they review treatment at regular intervals to ensure that there really is some progress, and to ensure that the patient is happy to give continuing consent. What we try to avoid is a treatment 'habit' where someone books week after week without realising that they've run to ten or fifteen sessions without result. This can sometimes make patients unhappy.

However, most people appear to benefit from treatment, and we hope that this is the case for you.

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