Ask an expert - general - fatigue

8 questions

Q: Your FAQ implies that chronic fatigue is a more difficult condition to treat. How can I find a practitioner who has a lot of experience in this specific condition?

A: We're not sure which specific FAQ you may be referring to, but it is true that the treatment of Chronic Fatigue syndrome can be more challenging than some health problems. We would hesitate to say 'difficult to treat' because in Chinese medicine we treat people, not conditions. That means for us that the overall balance and rhythm of someone's energies can have a profound impact on how a condition manifests and also how easily it may be treated. This can mean on occasion that a seemingly intractable condition can resolve very quickly where an apparently trivial problem can take forever.

 What is clear, though, is that CFS often responds to treatment, as our factsheet shows

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-fatigue-syndrome.html

 but it can often be a part of a complex overall presentation which may well have emotional as well as physical components. In some cases the emotional and mental issues can be integral to the development of the condition, and in other cases the emotional and mental consequences of the health issues can make it even more difficult to shift.

 We can understand why someone might want to see an experienced practitioner in these circumstances, but the reality is that nearly every presentation is unique, and all of our members are equally well qualified to make informed judgements about how best to treat the specific manifestation. The only reason where seeking a more experienced may have some merit is that treatment of CFS can sometimes take a relatively long time, and someone who has treated many cases will have lowered their expectations a little more than an enthusiastic newly qualified practitioner. On the other hand that enthusiasm is what sometimes achieves the unlikely, so as with all things in life, there are arguments both ways.

 Our members are the best source of advice for you, though. We are not in a position to say who is or isn't more likely to be what you are looking for, but we are pretty certain that if you contact a local BAcC member and ask them who has the most experience locally of treating CFS they are likely to tell you. Our over-riding concern is to do the best we can for prospective patients, even if that means referring them on to colleagues who we think may be better suited to their needs. 

Q: I had my second acupuncture session 4 days ago and just wanted to check if my symptoms were anything to be concerned about. I've suffered from ME for a number of years but have largely recovered and thought that acupuncture may help improve my health to its former level . The practitioner took this into account and gave me a gentle treatment. Although i couldn't get out of bed for 5 days a few of my symptoms seemed a little improved after this time. The second treatment, much gentler again, has had a very similar reaction but it's been accompanied by a deep painful ache down both legs. Is this part of the healing crisis i was warned about?

A:  We tend not to like the words 'healing crisis' because they do tend to be used of more outcomes than is reasonable. We are always confident that the more unusual apparent outcomes of treatment are not usually causally related because we are familiar with the range of possible adverse effects (rare in themselves) and they tend to be transient. Out main concern is that on occasion we have dealt with queries where the adverse effect was clearly nothing to do with the treatment but the belief that it was was delaying positive action to deal with it.

That said, ME and related long term health problems can generate some very odd symptoms when they start to resolve. From a Chinese medicine perspective the flow of energy is usually heavily compromised by these conditions. One consequence is that blockages in the system which would be obvious in someone in good health are hidden because the energetic flow is so weak they do not cause problems. Once the flow is starting to return to its proper levels symptoms of the blockage start to appear. We have also seen patients learn to move in a rather more restricted way when they are troubled by ME, and returning to better health can sometimes cause muscles to stretch properly again.

However, deep painful aches in the legs are always worth investigating sooner rather than later, so the first thing to do would be to contact the practitioner, explain the situation and if time and energy permit to go along to their clinic to see what sense they make of it. There may well be energetic reasons which they can find and which they can correct, or at very least put your mind at rest. If nothing is apparent, then you are best advised to pop along to your GP and ask their advice too. 

We are very heartened that the practitioner used very gentle techniques, so we are fairly sure that this means what you are suffering does not have a mechanical cause. However, the post-ME constitution is very delicate, in our experience,and setbacks are frequent even years after an apparent full recovery. Hopefully you will be on a continuing upward path soon.  

Q:  I am trying to find a member who specialises in treating chronic fatigue and fibrmyalgia in the north london south hertfordshire area

A:  We take the view that all of our members are competent to treat the vast majority of western named conditions with which patients present at their clinics, and therefore do not have specialists as such. There are one or two areas where we are developing guidelines for what we call 'expert practice' in which we recognise that for some groups of patients, especially children, pregnant women and people with mental health problems, there may be additional training which makes a practitioner better able to deal with the problems which they have. This does not mean that we would forbid our members from working with these groups without additional training, but we may decide that someone with this additional postgraduate training may be able to describe themselves as offering specialist practice.
 
Chinese medicine is very different from western medicine in one very central aspect - Chinese medicine treats the person, not the condition with which someone presents. It is founded on the belief that each person is a unique balance of energies, and that the skill and art of the practitioner lies in understanding the symptoms which someone has in the context of the patient's unique patters. This could mean thar twenty patients with headaches are treated in twenty different ways by a practitioner, a very different approach from western medicine. As such, we have practitioners who are skilled in treating people, not individual conditions which people may have.
 
In practice, we would advise that a prospective patient talks to a number of practitioners to determine for themselves who they would like to see. We have a search facility on our home page which means that you can quickly find all of the BAcC members close to your postcode, but it is important that you feel confidence in the practitioner, and all of us are more than happy to take a little time to explain who we are and what we do. Although we are all equipped to deal with problems like CFS and fibromyalgia, these can both be quite difficult conditions to treat, with results occasionally being very slow to gain and difficult to maintain, and having some experience of this can be an advantage in terms of managing expectations, from both sides!

 

Q:  My daughter has finally been diagnosed as being deficient in T3 and is on Throxine but though her T4 is normal there is no T3 synthesis. She has Hashimoto's Disease which is autoimmune. Can Acupuncture help to stimulate the thyroid to produce its own T4 and T3?

A:We publish a fact sheet

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

which summarises the current research into the use of acupuncture in this area, but it has to be said that the amount of research is not adequate for us to give an unqualified endorsement of the use of acupuncture for Hashimoto's.

We were asked a similar question last year and we answered as follows:

Q: Can acupuncture be used to treat hypothyroidism ?

A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism.

What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.

For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment has the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.

That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.

If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.

We would not really want to say anything more than this. There is certainly anecdotal evidence of which we are aware that patients have benefited from acupuncture treatment, but equally there is evidence of treatment having little or no effect. Since the essence of Chinese medicine treatment is that it is individualised, in the absence of more research we tend to be more circumspect and recommend that someone gets a face to face assessment of what may be possible.

Q:  I just wanted to ask whether acupuncture has any benefit with chronic fatigue syndrome or fibromyalgia. I have been suffering with it for some time now and I desperately need some help, but Internet search doesnt prove or confirm its efficacy. Can you please give me some input on this, so I can go ahead and find an BAcC acupuncturist.

 

A:  The problem with both of these conditions is that the research is not that good methodologically, nor entirely conclusive, as our two factsheets show.

 

Please click here
Please click here

 
One of the problems is that both conditions lack precise definition, and isolating test groups with exactly the same symptoms from the same underlying causes is extremely difficult.
 
One of the great strengths of Chinese medicine is that it can often make sense of some of the symptom groupings that characterise these problems in ways which relate directly to the functions of the Organs, as they are understood in Chinese medicine, and on the flow of energy, called 'qi', in the body. If this is the case, then a practitioner may feel considerable confidence in being able to effect some change for the better.
 
This is very much a judgement call based on the individual case, however, and we would not be able to say that, sight unseen, you would benefit from treatment. If you can find a BAcC member local to you who is happy to gove you a brief face to face assessment, hopefully without charge, they can tell you whether in their view acupuncture treatment may benefit you, and if not, what other alternative approaches they might recommend.
 

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