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File under general -- general

We think that with the range of symptoms you have, and considering their nature, the first thing to do if you haven't already done so is to visit your GP to see what they make of the signs and symptoms. There are a number of quite serious conditions which can generate symptoms like this, and the first thing we would do if you came to us would be to refer you to your doctor for examination and blood tests. This would eliminate some of the possibilities at a stroke, but may actually lead to an important diagnosis and treatment.

If it turns out that there is nothing to be worried about in conventional medicine terms, then it would be advisable to visit a BAcC member local to you for them to take a look at what is happening. We can think of a number of reasons why the problem might be manifesting, when viewed from our perspective, but without sight of the problem itself we would be reluctant to start making guesses which would in all probability be wrong.

We would also be looking at dietary and environmental factors which might be involved. A surprising number of our patients have allergies and sensitivities of which they are not aware and which cause reactions across the body. The same sometimes happens with cosmetics and detergents. We are sure you have looked at factors like this, but we always check because it can cause these sorts of problems.

Even if there is no obvious cause from a Chinese medicine point of view, we hold the view that putting the system back in balance will always help to reduce symptoms. There is also a very considerable body of evidence about the use of acupuncture for pain relief, and while this can never guarantee that the problem will go it can sometimes offer long stretches without discomfort, for which many patients are very grateful.

As we said, however, this is an unusual problem for which it would be necessary to examine what was happening before venturing a view about how amenable it would be to treatment.



Hi. I have a.bmi of 46.and am.currently 22 weeks pregnant and have pgp. Does bmi.effect how acupuncture works?



We can say categorically that someone's BMI has no impact at all on whether acupuncture works. From a Chinese medicine perspective the body is seen as a complex flow of energy, called 'qi', and putting a needle into a point will have an effect whether the person's BMI is 15 or 50. Generally speaking there are often energetic reasons why someone gains a great deal of weight, over and above lifestyle considerations and straightforward heredity, and these may have an impact on how much progress someone can make, but that will all be a part of the picture which the practitioner builds up and works with.

Indeed, there is some very good evidence that acupuncture can help with PGP. Studies such as this one published in the BMJ seem to be very encouraging. In fact the same researcher went on to look at whether there was any potential for harm and concluded that while there may be some minor transient effects there was no serious risk

We are by nature a generalist healthcare modality, i.e. we treat the person, not the specific problems they have. In practice, of course, we are all able to go after specific symptoms as well as balancing up the whole system, but we believe that treating a symptom without regard to the whole is leaving things half finished. This means that we regard all of our members as capable of treating any patient who comes to them. However, we are close to reaching agreement on the treatment of pregnant women as an area of expert practice for which we have recognised postgraduate training. In the circumstances it would be highly advisable to go to someone who has had this kind of training and who has spent more time looking at the specific issues of pregnancy.

Unfortunately we haven't signed this work off yet, but we are pretty sure that if you type into google your place of residence, acupuncture and pregnancy it will generate a number of hits of our members who specialise in fertility and pregnancy issues. Failing that you could always call a local BAcC member and ask them to point you towards someone locally who has these skills. We are always very keen to see patients get the exact care they need.





Q: I have been for 3 acupuncture session over the last week. I am going for various reasons, CFS/ME, anxiety and the flu amongst some other moans and groans. After the first session I was pretty ill with indigestion and nausea and aching. Nothing much after the second session but a headache. After the third session however I am feeling very strange, I feel almost out of it for lack of a better description. I cant seem to get myself to focus at work no matter what I do and had a panick attack which I don't usually suffer from. I am spaced and feel removed. I am also a bit nauseous. Is this normal and has anyone else described this. When will it pass? I need to work and I am getting anxious. Is it a good sign.

A: It's always very difficult for us to comment when we do not have a full case history in front of us, and better still, an actual patient. We are always aware that if we take issue with what someone has done without knowing the full picture we might make an unfair criticism for which we might be held to account.

What we do wonder, though, is whether it is entirely wise to do as much treatment in a week to someone with a background of MS/CFS who has reacted very strongly to the initial session. In people whose immune systems have been weakened by long term illness it is always wisest to start slowly with the strength of treatment and to row back if they throw quite severe reactions. This is not a universal rule, but it is impossible to tell after a single session whether the effects are a clearing of imbalances or an adverse reaction to treatment.

We suppose that since the second treatment didn't really cause anything over-dramatic the practitioner decided that it was the former, a mild-ish reaction which could indicate the beginning of the process of healing, and treated again. In the event, the further reactions after the third session might call for a review of that judgement.

It is highly likely that if you have been slightly overtreated the effects will not last that long. Acupuncture is a remarkably safe therapy, and the only serious incidents involve the penetration of organs with needles, and these occasions are very rare. If someone has a strong reaction to treatment then it normally lasts no more than 48 hours at most, and usually less. We suspect that by the time you receive this you will already be feeling a great deal more 'normal'.

It may, of course, be that the problems are not at all connected to the treatment; CFS issues can often come up at any time. However, it does look like the treatment is implicated, so it is really important that you discuss this with your practitioner in determining how to proceed. This might mean less frequent or less powerful treatment, and we are sure that a properly trained and qualified practitioner will listen to your concerns and respond accordingly.

We did say, though, that without looking at you and the case history we could not say for sure whether the practitioner was in any way at fault, and it may well be that he or she is surprised by this outcome and well able to respond positively to the feedback you are providing. Treatment is sometimes like a voyage of discovery where a practitioner can only find out what the best strategy is by setting off as normal and then reacting if the signs are that the treatment is too much for the patient. The practitioner may well have made a judgement that you needed frequent treatment based on your case notes, but your reactions might suggest that this is not the best way forward.

Q: Does acupuncture help in the treatment of tinnitus associated with severe Menieres Disease? It has left me totally deaf. I have had successful acupuncture before for arthritis and muscle strains.

A: We have been asked about Meniere's Disease on a number of occasions, and a typical answer has been:

There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, this latter is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind, for example,
generated some very interesting results, but the formula applied would not be appropriate for everyone.
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

We believe that this still covers most of the ground pretty well. We have undertaken a survey of more recent research and there is a paper

which gives a guarded but generally positive view of the value of acupuncture treatment for these types of cases.

This doesn't mention tinnitus directly, although the studies often mention tinnitus and deafness as a part of the constellation of symptoms, and where the deafness accompanies balance problems there is often an all-round improvement.

We have had a further look at papers which directly refer to hearing loss and tinnitus, and we found this one

which concludes that balance problems can be helped but not hearing problems. However, the selfsame reason why the authors qualify positive statements about balance - small trials, poor methodology - are the ones which they cite to not write off acupuncture for hearing problems too quickly.

We used to be quite downbeat about tinnitus treatment, but as a recent answer said:

Our experience in practice was that tinnitus could prove intractable to treatment. However, as our factsheet shows

and as some recent personal experience in clinic has shown too, there may be some hope.

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you  for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.

Invariably we check for more evidence when we are asked a question to which we have responded before, and the evidence trail for the fact sheet stops some time ago. We found a number of small studies like this one

which seem on the face of it to encourage the belief that there is a recognised connection between acupuncture treatment and symptom relief. There is also a systematic review, a 'trial of all trials' beloved of researchers because it aggregates to a much more powerful study than the individual ones.

This draws the usual sorts of conclusion about the need for more and better trials, but the authors do conclude that acupuncture is worth trying as a safe alternative which seemed to have shown some success in addressing the problem.

The advice we gave before, though, holds good. Each case is unique and different, as is each treatment plan, and the best advice you can get will always come from someone who can see your problem in its overall context.

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