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What you report is a little unusual but not unknown. We have come across patients who have been treated for several sessions and only then shown a reaction to needles. Sometimes there is an obvious cause - change of needles, slightly deeper insertion in muscular areas - but most often it is an unpredictable reaction. The only concern would be if the blister/bite like bumps were a potential source of infection if they became open, or if they increased in severity. At this point a practitioner might just refer on to a GP for an onward referral to a dermatologist. In the vast majority of cases, however, this tends to be a short-lived phenomenon.

The other issue to consider is whether the reaction is not a physical one but a sign of some kind of energetic release. It is very much a part of Chinese medicine theory that some of the physical problems which affect the body are the result of pathogens entering the body or pathogens which have built up in the superficial tissues because of blockage or excess. When treatment 'bites' this can sometimes cause the skin and superficial tissue to become quite reactive, as well as in some cases generating rashes and areas of heat. If this is a treatment reaction it will be short-lived; the majority of what we call adverse events are transient and minor.

The best thing to do is to ask your practitioner if there has been any change of equipment or style from the first to the second session, and if so revert to the former. If not, then it is simply a matter of keeping an eye on the small bumps to ensure that they recede as swiftly as they came. We have come across patients in whom this is a benign and continuing reaction to treatment, and as long as it is managed with common sense there won't be a problem.

We are assuming that you are asking your question from the United States. If you aren't and we have misunderstood, our apologies.

As a UK-centred organisation we are probably not the best placed people to offer comment on this question. As far as we understand it the Medicare system seems to run along similar lines to some of the major private insurance programmes in the UK with a flavour of National Health Service provision, which is practically none.

The problem with acupuncture and other CAM provision is that it lacks the evidence base which is now a requirement for provision in the NHS and with leading private health insurers (PHIs). When allocating funding a provider needs to have some assurance that the modality will work, and an equal assurance that there is a finite limit to what it will cost. Since most research into acupuncture is not accepted (complex methodological issues and funding difficulties abound) and most treatment is offered on an open-ended basis, this is not beloved by the actuaries who have to cost out provision.

We note that that you can get acupuncture if you pay for a higher level of service, and this mirrors some of the PHIs in the UK who offer money purchase packages alongside their main policies which offer additional benefits at a price. This was led, we believe, by patient demand and an awareness that keeping this group of users happy protected the mainstream PHI provision. However, it would be fair to say that as CAM has become more popular so some sectors within conventional medicine have seen it as a subversive threat, and the opposition to its inclusion within mainstream provision has greatly increased, certainly in the UK.

As an organisation we have been making representations to both NHS and PHIs throughout our whole existence to argue for the inclusion of acupuncture free at point of delivery within their offer. Some doctors and physios offer acupuncture within their existing scope of practice, and some PHIs will now pay for limited amounts of treatment. When patients ask for advice along the lines which you have done the best we can say is that you contact the local or national policy makers and try to make a case for your own needs. If you try to argue the national case you will not succeed unless you can get  a huge popular following, but you may be able to make a case for your own personal treatment if:

a) you can show that their is an evidence base for the condition with which you need help

b) you are able to make a case that a course of treatment is likely to cost less than any continuing care by conventional means. When you take into account the cost of doctor/hospital admissions and pharmaceutical products this is not a difficult case to make, especially if you have any low-cost community clinics in your area offering discounted treatment.

The best advice we can offer, though, is to talk to local acupuncture associations to see what they can advise. We are certain that they will have tried to address this issue, and will certainly have contacts whom you can follow up.

We wish you the best of luck!

Your question raises a number of important considerations about the use of acupuncture. We assume that you are referring to this 2012 study

which concludes that the use of Neiguan (PC-6) has a very positive effect in reducing AF episodes.

We addressed some of these issues in a reply at around the time when the study was first published:

There are some early indications that acupuncture may have an anti-arrhythmic effect in patients with atrial fibrillation. A study published earlier this year

concluded that there appeared to be benefits and that further large scale trials would be valuable to test the hypothesis more carefully.

However, it is only fair to say that needling a single point such as Neiguan repeatedly is not a fair representation of what a traditional acupuncturist does in practice. Although there is considerable overlap between eastern and western systems the arrhythmia typical of AF could be classified in several different ways within Chinese medicine, and the practitioner would be guided by evidence other than simply a reading of the rate of the pulse. That in turn would mean that ten people with AF might receive ten different treatments. To that extent, it is not that straightforward to extrapolate from research studies like this and conclude that 'acupuncture works'. 

The skill of the practitioner lies in making sense of the symptom of AF within an entirely different theoretical framework, and understanding each presentation in each individual patient as unique. The best advice we can give any prospective patient is to contact a BAcC member local to them to seek a short face to face consultation at which they can be given a better assessment of whether acupuncture might benefit them.

From the traditional acupuncture perspective using a single point in this way based on a single research study is quite a distance from the traditional paradigm in which the point sits. We are aware that there is a movement even within Chinese medicine to start to use this sort of formula treatment, and a very widely read paper published nearly twenty years ago, 'Pearls and String in Classical Acupuncture' has influenced a number of practitioners in the West, and is becoming slightly more common practice in China itself under the title 'best of both' - western differentiation and acupoint treatment.

Our view is that this is rather like Orwell's 'two legs good, four legs better' insofar as formula treatment may well work well for many people but probably won't work as well as a treatment which is designed for the specific imbalances of each patient. Since all patients are unique and different it would be seen as poor practice from a traditional perspective to use the same points over and over again. One of our old teachers used to refer to the use of the point as 'asking the system a question' and paying heed to the answer in following up.  'You wouldn't ask someone the same question ten times, would you?, he argued. While this may be a little extreme the general sense that acupuncture treatment is dynamic and evolutionary is critical to its nature.

We are sure that if you do want to pursue a specific approach like using the same point over and over again there are many practitioners of western medical acupuncture who would be happy to oblige. A full list can be found at the website of the British Medical Acupuncture Society, with whom, it has to be said, we have very cordial dealings. However, it seems to us that if you haven't had an episode for three months on the back of four or five traditional acupuncture sessions it might well be worth carrying on with the existing treatment plan and only considering the more formulaic approach if the traditional approach ceases to work as well.

It is a rather interesting footnote to this discussion that in Chinese medicine the specialist was usually looked down on as an inferior practitioner because of the narrow range of what they could treat whereas the generalist was held in great esteem precisely because they could treat anyone in whatever was the most appropriate manner.

There are a great many studies of this kind across the entire range of named conditions, and the main reason why they generate conclusions like this is because the 'gold standard' of research in the West, the randomised double blind control trial, demands that there are as few variables as possible. This means that trials and studies regularly have to use a single point or point combination to meet the research criteria. We have argued for years that this is an inappropriate way to test a dynamic system, but in Western medicine 'evidence based' is the new hallmark of acceptability. This is a cause of much concern for the very many conventional modalities which don't fit easily into trials intended for testing pharmaceuticals where neither patient nor practitioner knows what is being offered/prescribed as a guarantee of eliminating unconscious bias. 

We have been asked about muscular tension in recovery after injury a few times, and a typical answer has been:

A: It certainly couldn't do any harm to try traditional acupuncture. We choose out words carefully, though; when we say traditional acupuncture we mean acupuncture based on an understanding of the principles of Chinese medicine. There is a great deal of acupuncture being offered these days by people whose focus is primarily musculo-skeletal, such as physios, osteopaths and chiropractors, and while we have no doubt that they often do very good treatment as an adjunct to their primary discipline, there are times when this kind of 'point and shoot' approach will not be enough. The problem from our perspective, of course, is that when this doesn't work people say 'acupuncture didn't work', to which we respond 'only a very reduced form of it.'
Chinese medicine looks at the body as a dynamic structure of energy, called 'qi' in Chinese thought, whose flow, rhythms and balances are integral to good health and well-being as well as to good recovery from the injuries which everyone experiences from time to time. In cases like yours this means two things. First, it is possible that there has been disruption to the flow of energy locally which, by the use of both local and distal treatment, a practitioner might be able to correct. If there is a local weakness or blockage, most treatments are only going to be partially successful in restoring function.
Second, there are often cases where an injury manifests as an acute problem on top of a more chronic weakness which has not generated any symptoms as yet, and also may manifest against a backdrop where the entire body is running below par. The problem with  acute then chronic problems is that they prevent the system as a whole from recovering and lock the problem in for a long time. 
Acupuncture treatment may be able to address both of these issues, and a visit to a BAcC member local to you for a brief face to face assessment may be able to establish very quickly whether the practitioner thought that there was something they could do to help.
As general guidance we think that this is still a good start. When applied to specifics, like an ACL reconstruction, we would want to ask a number of additional questions based on our experience over the years. This would involve asking about and looking for scar tissue, checking the geometry of the joint to see that it hadn't been minutely altered by the work done to the ACL, and also looking at any learned postural habits which have become slightly more entrenched during a recovery period. It is not uncommon, for example, for people to develop a slight rotation at the sacro-iliac joint as they favour the opposite leg during recovery, and this can have all sorts of implications for the body's flexibility even where the deviation is very small.

The advice we gave before, to visit a local BAcC member for an informal chat, is by far the best thing to do. Each case is unique and different, and it often takes a brief face to face chat and examination to give a properly informed view.

As you might imagine we have been asked this question on several occasions and our answers have tended to be rather upbeat, as for example:

The evidence for the use of acupuncture to treat migraines and tension type headaches is encouraging enough that NICE, the National Institute for Health and Clinical Excellence has recommended it as a treatment for many types of headache. Our factsheet

provides details of a great deal of the research which has been undertaken. 

However, we have to be a little cautious. The great strength of Chinese medicine is that it understands the symptom within its overall context, and that does mean that while the majority of people will experience some benefit there will always be those whose overall balance means that short term success is less likely. On the other hand, the majority of research trials tend to be undertaken with formula acupuncture in order to meet the criteria espouse in the West, where the outcome is the only variable, and we have long argued that this is not the best way to test a system which is geared to the individual and where treatment evolves as the patient progresses. In many cases this refinement of treatment generates much better results than the orthodox trials suggest are likely, but until we come up with ways of preserving the integrity of what we do in a research setting we are where we are.

The best advice we can give you is to visit a BAcC member local to you for a short face to face assessment. Most of us are happy to give up a few minutes without charge to assess whether acupuncture is the best treatment for what troubles you, and this will also give you a better idea of what we do, who you might see and the surroundings in which they work. We find that this means prospective patients feel more empowered in making their choices rather than simply being booked in sight unseen.

We think that it is important to add riders like this. Research very often uses formula treatments, and this goes against our ethos of treating the person, not the condition, of seeing symptoms in their overall context. Just as there are occasions when an individualised treatment will exceed formula treatment in effect, there are equally occasions when formula treatment will not be appropriate, nor will individualised treatment be much better. Talking to a practitioner before committing to treatment is a wise move.

The reply should probably point out that the evidence for cluster headaches per se is not quite as compelling, although the one study cited in the factsheet

comes from the GERAC trials in Germany in 2006 which are particularly interesting because the figures were gleaned from German medical doctors and were statistically significant by virtue of the sheer size of the trial.

Our advice from the earlier answers remains very apposite on one main point, though, and that is the fact that each person is unique and individual in their balance of energies, and for problems like cluster headaches which can arise from a number of systemic problems it is essential that someone has sight of a patient before blithely making any prognostications about what may be possible. Most members are happy to give up a little time without charge to prospective patients to enable them to make properly informed decisions about having treatment.

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