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Ask an expert - general

232 questions

We have generally tended to be quite upbeat about treating shingles, as this sample 'nested' response

shows:As you might imagine we have been asked about this many times over the years, and a recent answer was:
Shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

We have had a good look through the research databases to see what further evidence is available (the factsheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).
The advice we gave earlier holds good, and that is to visit a local BAcC member for an informal chat about what may be possible. This is by far the best way to get a clear idea of your prospects, and most members are only too happy to see prospective patients in this way.

However, your symptoms seem to us to be particularly severe. This does not mean that it won't be amenable to treatment; there have been many occasions when severe symptoms improve quickly while mild symptoms remain intractable. Common sense dictates, though, that the fact that this has endured for two years probably means that it will require an extended course of treatment to see whether change is possible.

This can often generate problems because whereas we normally say that a practitioner should review progress after four or five sessions, if something might take twenty sessions to deal with there is something of a leap of faith about what can be a quite considerable level of expenditure. Difficult as it is to establish meaningful scales for pain or movement we encourage practitioner and patient to work together at finding an objective measure of improvement which can help both to assess whether there is sustainable progress. Anyone can have good or bad days but objective measures allow a better perspective for making decisions about carrying on.

Q. I have been receiving acupuncture for chronic migraines in the last 6 weeks (twice a week). It has improved a lot but it has been expensive and my acupuncturist is still advising me to attend twice a week. This is something I cannot keep up with financially and I believe she has her own interests in mind with the advice she is giving. I'm asking for some impartial advice on whether I should cut down to once a week at this point? Many thanks.

A. We are all too aware that because the majority of us are in private practice the cost of treatment can sometimes become an issue. Until and unless acupuncture treatment by a properly qualified traditional acupuncturist becomes free at the point of delivery inside the NHS this will remain the case.

We have to say in all sincerity that only on a couple of occasions over the last thirty years have we come across situations where we have had a suspicion that frequency of treatment was driven by the practitioner's need to bump up their income, and in both cases the circumstances were exceptional. When someone asks a person to attend twice a week it is almost always to try to bring a difficult situation under control. This is often the case with acute problems, but can sometimes be the case when someone has a problem which has lasted for years. The body develops a kind of 'habit energy' and it can sometimes take frequent reminders to maintain changes. This is not a problem unique to acupuncture; you will find that many Alexander teachers have to begin with similar levels of frequency to encourage change.

Our advice in these situations will always be to talk to the practitioner about the difficulty of keeping up a twice weekly treatment schedule. If someone told us that we would probably be looking at some form of discount if we felt that continued frequent treatment was going to be of benefit. This can be finessed by making one session the major one and the other one a more brief top-up. We do have sympathy with practitioners who rent space by the hour or day for whom each space must pay for itself, but most people can squeeze a few minutes extra out of a schedule.

If the practitioner doesn't bend or won't discount fees, then it is a hard thing to say but there are usually plenty of others in most areas, and you could well find that someone else will be able to help you at a price you can afford. There are also more multibed clinics which offer treatment in a group setting where you might be able to carry on treatment at greatly reduced fees.

We suspect, though, that after six weeks of bi-weekly treatment it may well be time to step back to once a week sessions, and your practitioner will probably agree. It will only be an issue if as a consequence the migraines return, in which case you might need to have that talk.

We do hope that you continue to make progress and become migraine-free .


We are all too aware that because the majority of us are in private practice the cost of treatment can sometimes become an issue. Until and unless acupuncture treatment by a properly qualified traditional acupuncturist becomes free at the point of delivery inside the NHS this will remain the case.

We have to say in all sincerity that only on a couple of occasions over the last thirty years have we come across situations where we have had a suspicion that frequency of treatment was driven by the practitioner's need to bump up their income, and in both cases the circumstances were exceptional. When someone asks a person to attend twice a week it is almost always to try to bring a difficult situation under control. This is often the case with acute problems, but can sometimes be the case when someone has a problem which has lasted for years. The body develops a kind of 'habit energy' and it can sometimes take frequent reminders to maintain changes. This is not a problem unique to acupuncture; you will find that many Alexander teachers have to begin with similar levels of frequency to encourage change.

Our advice in these situations will always be to talk to the practitioner about the difficulty of keeping up a twice weekly treatment schedule. If someone told us that we would probably be looking at some form of discount if we felt that continued frequent treatment was going to be of benefit. This can be finessed by making one session the major one and the other one a more brief top-up. We do have sympathy with practitioners who rent space by the hour or day for whom each space must pay for itself, but most people can squeeze a few minutes extra out of a schedule.

If the practitioner doesn't bend or won't discount fees, then it is a hard thing to say but there are usually plenty of others in most areas, and you could well find that someone else will be able to help you at a price you can afford. There are also more multibed clinics which offer treatment in a group setting where you might be able to carry on treatment at greatly reduced fees.

We suspect, though, that after six weeks of bi-weekly treatment it may well be time to step back to once a week sessions, and your practitioner will probably agree. It will only be an issue if as a consequence the migraines return, in which case you might need to have that talk.

We do hope that you continue to make progress and become migraine-free .
We are usually asked more specific questions, such as 'can acupuncture help trochanteric bursitis?', and the last time we were asked a generic question about 'bursitis' was in 2012. Remarkably, we said then pretty much what we would have said now had we not found this reply:

The first question we'd have to ask is 'where?'. Many patients present at acupuncture clinics with bursitis of the major joints like the hip, knee, shoulder or elbow, and to a degree the outcome depends on exactly which joint is affected. The same would apply in western medicine; some joints are easier to treat than others, and some easier to immobilise while healing takes place.However, Chinese medicine is very different in its approach to an understanding of the body and the way it works. The theory of Chinese medicine is based on a flow of energy called 'qi' of which the body consists in different forms, and the understanding of how its balance and flow can be affected by illness, lifestyle and constitution. When people suffer from bursitis in a joint, the practitioner will want to establish first whether this is a local problem, caused by an injury or from over-use, or whether it is a consequence of a systemic problem affecting all of the joints to a degree, or a bit of both, as is often the case. Treatment will then be aimed at the appropriate cause, but will almost certainly involve some needles close to where the bursitis is.Because this is quite a broad question, we can't be more specific. There are a number of web-based research resources which will identify relevant papers if you google 'acupuncture, bursitis and the joint concerned', but we strongly suspect that they will tend to say, as many do, that the signs are positive but not conclusive. Not a great deal of research meets rigorous western standards, and the conclusions drawn from it are often cautious. This is not to say that things aren't well researched. Many thousands of studies are conducted in China each year, but they are often premised on the fact that acupuncture works and researching what works better. In the West the policy makers are still troubled by whether acupuncture works or not. We believe that it does, of course!Your best bet is to visit a BAcC member local to you to discuss your specific problem. We trust that they will give you the best advice possible about whether they can help, and if not, what other alternatives there may be.  This remains the best advice we can give, especially the last paragraph about visiting a local BAcC member for a chat about whether treatment may help. Most are only too happy to give up a small amount of time without charge to prospective patients to assess whether acupuncture treatment is the best option.As to your supplementary question, the theories of Chinese medicine tend to describe bursitis in generic terms either as Dampness, a state where the fluids of the body become more viscous and gather in confined areas such as joint capsules, or as blockages due to local obstruction. In both cases the needles stimulate movement in the energy which in turn moves the gathered fluids, but in the case of the former there is usually a systemic element which underpins the local problem. When the bursitis is accompanied by heat and pain there is also an issue about Heat which has to be dispersed. The capitalisation of phenomena like Heat, Damp, Cold and the like is indicative of an entirely different paradigm of medicine which uses terms to describe changes in the microcosm which reflect similar changes on the macrocosm. Chinese medicine abound with illustrations from nature, and in some of the diagnostic systems the annual rhythms of nature are said to be reflected in the balanced nature of the energy of the body. Alterations in this balance are said to reflect what happens in nature if there is too much heat or too much rain.This all sounds a little odd to the western ear, but a system which has survived and continues to provide relief to millions after 2500 years of use must have something more than a placebo effect going for it!
The first thing we would ask in cases like this is what investigations you may have had already. There are a number of medical conditions like blocked tear ducts and the related dry eye syndrome which may be the cause of the swelling, and this can impact on the success for which one might hope. We answered a question on both a couple of years ago, and the answer is worth repeating for the wider context in which it places treatment. 




Chinese medicine is based on an entirely different theoretical basis from conventional medicine, what is often called a different paradigm. The essence of Chinese medicine is a belief that the body, mind, emotions and spirit are all manifestations of an energy called 'qi' whose proper flow and balance means that everything functions the way it is supposed to. If this flow becomes blocked or disturbed in any way, then functional disturbances appear, often affecting all 'levels' of the system and for which needles are used by the practitioner to restore flow.

When someone reports blockages it makes one question immediately whether the energy of that area is flowing as well as it might, and a skilled and experienced practitioner could determine quite quickly whether, from the Chinese medicine perspective, there was something which might be done. Even if there were no immediately obvious signs in the area itself, the principles of Chinese medicine are founded on a notion of overall balance which means that symptoms are less critical, being indicators of a wider imbalance in the system rather than the necessary focus of attention. It would be worth your while to visit a BAcC practitioner local to you for an informal assessment of whether they believe that acupuncture treatment may be of benefit to you.

That said, we have to say that the research evidence for the treatment of both conditions with acupuncture is a little bit thin. There are a few studies, but one of the key factors in undertaking research from a conventional perspective is trying to reduce the variables, and this means being able to define clearly what the problem is. Blocked tear ducts  have several possible causes, and this means that comparing like with like becomes more difficult, and the results less reliable. What research we have identified is of relatively poor quality, and if we were making recommendations based solely on that we would have to say that it would not be worth pursuing. However, our clinical experience is that where there are clear energetic blockages treatment can sometimes have a very direct effect, and it would certainly be worth seeking advice from a BAcC member local to you.  There are, in fact, some quite useful studies of related problems like dry eye syndrome, and although it is rather technical this paperhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/is both realistic and encouraging.This expert has to admit that it has not been the most successful area of his practice. While few patients have come specifically for this as a problem several have had it as a secondary problem, and even where the main problems have responded well this hasn't. That said, in the minority of cases where there has been a positive change the result has been welcomed with great joy.

Acupuncture treatment is always worth a try. There is very little chance of an adverse effect, and there are enough reports of treatment working for this problem to suggest that it is worth a go. The only issue for cases where there is less evidence is to make sure that a patient doesn't get tied into a long and potentially expensive course of treatment without any tangible benefit. In another context, Dr Johnson once described something as 'the triumph of hope over experience', and we always ask our members not to succumb to joining patients in a desperate hope for good outcomes. If there is nothing happening after four or five sessions it may well mean that nothing will happen.
If, however, the bags under the eyes are a result of loss of muscle tone, then we enter the area of facial or cosmetic acupuncture which has been in vogue for the last few years. There is no doubt that there is some basis for this work, as studies like this one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745857/suggest. There may also be reasons to do with straightforward blockage where treatment may have an effect. Our belief, though, is that treatment of local blockages really needs to be done in the context of a wider diagnosis of a person's balance, and only by doing this can the results be maintained.The last decade has seen a proliferation in people training to do 'facial acupuncture' or 'cosmetic acupuncture', many of whom have no background in acupuncture at all. We are not being protectionist in saying that in the courses which people do, many of which are of one or two day's duration, we do not think that anyone can learn properly skills which form a part of a three year training programme. If you do decide to seek the help of someone offering facial or cosmetic acupuncture we would fully recommend that you make sure it is someone who is also properly trained as a professional acupuncture practitioner.

We are sorry to hear of your experience with your practitioner. Making a good rapport with a patient is seen as central to what we do, and our training standards for students make this an important feature of our work. We depend on people feeling comfortable with sharing information with us, and since in traditional acupuncture we treat the whole person anything and everything which may help us is important. We can sometimes make predictive statements based on what the diagnostic signs tell us, but not at the expense of giving the patient plenty of time first to tell us what is going on. 'Rushed' does seem to be the key word.

As far as treatment of vertigo is concerned, acupuncture has a fairly good research base, as you can see from our factsheet

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2599-vertigo.html

and various balance problems like vertigo, Meniere's disease, labyrinthitis and the like have always formed a good percentage of our regular referrals. However, we are aware that treating problems like this can take several sessions, and more to the point where blockage is involved, it can cause a few ripples on the surface when treatment starts. This 'expert' along with many of his colleagues is usually unwilling to start a course of treatment for many chronic conditions immediately before someone goes away because the chances of an immediate positive outcome are slim, but the chances of a short term disruption are often quite high. The last thing any of us wants is a patient with a reaction to treatment over a thousand miles away with no access to treatment.

We don't want to over-dramatise the situation, and in the vast majority of cases nothing would happen. However, simply in terms of being able to work incrementally with a patient building on the results of the previous treatment it doesn't make sense to do a single session and then wait a few weeks to follow up. If there has been some momentum then we want to be able to capitalise on this. Only in very acute situations of chronic pain or immobility do we feel that a one-off session is usually worthwhile.

However, if you use the postcode database search function on our home page www.acupuncture.org,uk you will find a number of BAcC member within easy reach, and it may well be worth your while contacting one or two with a view to finding someone better attuned to your needs ready for when you get back. It may be that they find something which is a kind of 'holding' treatment to take the edge off what you are experiencing without too much risk, and that could well make the different between a good journey and a great one.

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