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Q. Would acupuncture be used to lower blood pressure as I have bad sude effects from all medication prescribed and I am at my wits end

A. Although we publish a factsheet on hypertension
it does not have a great deal of evidence to suggest that acupuncture is that effective as a stand-alone treatment for high blood pressure. However, two more recent systematic reviews, summaries of all trials, tend to the conclusion which we find in clinical practice, that a combination of medication and acupuncture tends to be the most effective treatment. You can see the reviews here

but they are a little complex!

One of the main reasons that there will usually only be trials of acupuncture and medication against medication alone is that no clinician would be able to leave high BP untreated as a control against which the acupuncture was tested. What we find, though, is that when we use acupuncture treatment alongside medication people are often able, after discussion with their doctor, to begin to reduce the amount or numbers of medications they use. For many people this can mean the difference between debilitating side effects and mild inconvenience. Reductions can only be done in concert with the GP, though; patients changing their own medications can sometimes cause major complications. Our members would never advise anyone to so do.

The best advice that we can give is that you visit a local BAcC member for a brief chat about what may be possible. We treat people, not conditions, and it is highly likely that your high blood pressure sits within a wider context which may make a great difference in how much change you might be able to achieve. The same named condition can be treated in dozens of different ways because each patient is unique, so there is no one set treatment. This can mean a considerable difference in the confidence we feel about effecting change.

Most members are happy to give up a few minutes without charge to prospective patients, and this will enable you to make a properly informed choice about whether to proceed with treatment.

q. I have sarcodosis and my lymph have flared up, leaving me with no circulation from my knees to my toes would acupuncture help me?

A. You will not be surprised to know that there has been very little research into the use of acupuncture for treating sarcoidosis and its related problems. The occasional case study appears, but it is always dangerous to draw conclusions or make recommendations from small amounts of information.

However, the great strength of Chinese medicine is that it has a different way of interpreting symptoms through an understanding of the body as a flow of energy and the organs as a set of functions which control the flow of energy. When symptoms appear it is a matter of undertaking a kind of detective work to understand which parts of the system are not functioning as they should. There is also a level of blockage in the more superficial levels of energy which can cause swelling and inflammation, and this can very occasionally be very considerably helped by needling in the area where the swelling occurs.

There are one or two functional disturbances which can cause the sorts of problem with which you are having to cope, and if there are clear indications that these are the cause of your problems then there may be a chance that you might benefit from treatment. Obviously there are no guarantees, and with problems which are a little out of the ordinary we are always keen to set very clear limits to how much treatment we are prepared to offer before drawing a line in the sand. We do not want to have people running up a large bill getting nowhere, and after three or four sessions most of us have an idea of what may be possible and whether there is a chance of longer term improvement. It is also very helpful to establish as objective a measure as possible of change.

The best advice, then, is to visit a local BAcC member for an informal chat about the possible benefits of acupuncture. Most are happy to offer a few minutes without charge to prospective patients so that they may make an informed choice.

Another option you might want to investigate is manual lymph drainage, a form of massage which concentrates on lymphatic flow. This can sometimes have a dramatic effect, but you will need to make sure that the person who you see is properly qualified. Many offer this as a service, but there is a recognised standard of specialist training, and for your problems this would be essential.

Q. I had been suffering,for a few weeks, with chronic pain in my left buttock/pelvis area. I had seen three different Physiotherapists, one I had seen privately and he thought it was emanating from my sacro illeac joint. The second one I saw in A & E at my local hospital and he said it was nerve pain and could be Piriformis syndrome. The third one wasn’t sure and gave me exercises to do, pending the outcome of my MRI scan. However prior to this scan I had been in such pain, although no pain at all below my left knee, that I paid to see an acupuncturist. She is registered with the BAC. During the session she used a Moxa stick and placed a needle in my lower left leg at the side of my knee. I felt an immediate deep dull ache/pain. I told her this but she left the needle in. She said this was normal. Nearly 4 weeks later I am still experiencing severe pain in my lower left leg. It seems to radiate from the needle insertion point to the front of my leg/shin. It keeps me awake at night and nothing seems to ease this pain. This area was not included in the MRI scan. I am extremely concerned that this young acupuncturist has damaged my leg in some way. She denies any responsibility for this. I am a healthy, usually active lady in her mid sixties, of a normal weight.

A. We are very sorry to hear what has happened to you. We are keenly aware that unusual outcomes after treatment can be very distressing.

The most common cause of what are, we have to say, quite rare events is that the needle has caused some deep bruising which is not visible on the surface of the skin. This can stay in situ for several weeks until it is cleared by the body. In the interim this can impinge some of the nerves in the area, and this in turn can cause pains in the area or lower down the limb. It should, however, clear up within a matter of weeks. Serious damage to local tissue is highly unlikely; the needles are too fine to penetrate most physical structures. The use of pre-sterilised needles in the manner in which all practitioner are trained will also rule out infection.

However, what is happening to you does sound a little serious, and were you to be our patient we would want you to attend your doctor's surgery for further investigation. Serious adverse events from acupuncture treatment are rare, but they can happen. When a symptom persists for more than a few days it is important to rule out anything more serious than a local bruise. In the old days of re-usable needles it might have suggested a piece of broken needle but in modern times where everyone uses single-use disposable needles this is unheard of.

As practitioners we would also be interested to hear of the state of the other problems you have been experiencing. One positive outcome, if we could call it that, would be if the treatment has caused an adjustment of the physical structure such that pains in the lower back/pelvis area had abated but been replaced by pains elsewhere. We do occasionally see a pattern where good adjustments in the torso can precipitate pains lower down the limbs, but in your case the fact that the pains started as the treatment took place suggests otherwise.

Our advice, then, is to arrange further investigation through your doctor. We think it is highly unlikely to be permanent damage or even serious damage, and it may have been a rather maladroit expression of this by the practitioner which has clearly added to your upset. The professional handling of patients is as much a concern to us as the safe practice of acupuncture itself. If you feel that the standard of care at this level was unacceptable or below our published standards we have clear procedures for handling such complaints to which we can direct you.

We hope, however, that you manage to see your GP and receive reassurance through further investigation that this is a transient, albeit longer lasting than usual, reaction.

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.

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