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Q. I am contacting you on behalf of my mother who has experienced a loss of functionality and feeling in the lower body due to a suspected spinal cord inflammation; feeling/mobility has shown slow/small sign of returning.

Can acupuncture assist in reinvigorating nerve path ways and also address "pain"?

I would be interested in speaking to a specialist who could help discuss this and also understanding the possible help acupuncture could offer.

Thank you for your time and help with this matter.

A. We would be very reluctant to be too committal about the reinvigoration of nerve pathways. There is a small amount evidence for nerve regeneration through the use of acupuncture but this is mainly based on experiments with animals, what our colleagues sometimes refer to as 'ratpuncture' and usually only the peripheral nerves which even in western physiology can show signs of regeneration. Spinal nerves are another matter, and we suspect that a great deal depends on the extent of the impingement caused by the suspected inflammation.

The one hope would be that from a Chinese medicine perspective something has caused a blockage in the flow of energy, some of the more important channels run along the length of the spine, and that treatment might restore proper flow. It is a long shot, but that doesn't mean that it cannot work. What it does mean, though, is that if there is a blockage it will clear quickly, so we would be reluctant to see anyone commit to a long course of treatment.

When it comes to pain there are stronger grounds for believing that acupuncture might bring some relief. After Nixon's visit to China in the 1979s there was a great deal of research into acupuncture for pain relief and anaesthesia, and it was easy to demonstrate that treatment can cause the release of neurotransmitters. Many Pain Clinics now routinely offer acupuncture treatment. The main question is how much relief treatment gives and how sustainable the changes are. If the changes are short-lived then treatment may not be the answer unless it is precisely targeted at times when people need to be pain-free.

As far as specialists are concerned most traditional acupuncture practitioners are by the nature of the system of medicine generalists, and we have never heard of anyone specialising in this field. from our perspective we treat people, not conditions, and our understanding is based on looking at how the whole system functions. Your local BAcC member is perfectly well qualified to offer you a view of how much benefit your mother might derive from treatment. indeed,most of our colleagues are happy to give up a few minutes without charge to prospective patients so that they can make a properly informed choice about treatment.

Q. Hi, i suffer from a condition called Gilberts syndrom, its basically a faulty gene/missing gene in the liver. A family friend has acupuncture for a different liver problem and she said maybe i should try it, the main symptoms i have are nausea/dizzyness/tiredness. Is this something that acupuncture could help with? Also i suffer with anxiety (mainly from my health problems) would it aid with this as well? thanks

A. This is one of the problems which illustrates rather well the difficulty of talking named conditions in one system of medicine and their treatment in another. As you are better away than we, we are sure, Gilbert syndrome can be relatively asymptomatic, although you have been in the unlucky minority for whom nausea and dizziness are common. There is no research of which we are aware which suggests that acupuncture can successfully treat GS. However, what we are talking about is a functional disturbance of the Liver (understood in the West as a genetic abnormality), which in its capitalised form is a Chinese medicine definition of the Liver which embraces the liver as understood in western medicine. And, from the Chinese medicine perspective, the Liver is indeed often involved in pathologies like nausea and dizziness, which are very often a part of Liver syndromes.

Of course, nothing is that straightforward! The essence of Chinese medicine is to treat the individual, not the disease, and although the distress might be expressed through Liver symptoms the art and skill of the practitioner lies in looking at the overall context and seeing what might be causing this distress. Sometimes this is a primary Liver imbalance, and sometimes it is the Liver reacting to an imbalance elsewhere. This makes a profound difference to the way that a practitioner will treat the person, and create what many in the West find quite anomalous, twenty patients with a named condition being treated in twenty different ways.

We would suspect, though, that given that these problems can often be traced back to disturbances of Liver function there may well be something which acupuncture can assist.

The treatment of anxiety is an area where, in spite of the difficulties of translation between systems, there has been a great deal more research which suggests that acupuncture treatment has a role to play, as our factsheet

shows. It also tends to be one of the more omnipresent conditions accompanying other main complaints with which people present. From a Chinese medicine perspective it is often the sign of a not unreasonable response to a challenging situation being maintained long after it is appropriate to do so. Appropriate is a key word in Chinese medicine. It is fine to be anxious for a short term, but there comes a point where it persists and becomes a problem. Restoring someone's balance should in theory go some way to addressing these kinds of inappropriate ways of dealing with the world, but it can take a long while. Anxiety can unwittingly become a way of life.

What we always advise is that someone visits a local BAcC member to get a sense of what may be possible. Most of our colleagues are happy to give up a few minutes without charge to prospective patients to ensure that they are properly informed about what make work for their own unique case before committing to treatment.

Q. I have been suffering from migraines for a few years and have just started acupuncture in the hope it will help. Could you kindly advise how often I should have a treatment and for how long should I plan to continue to have the sessions to fully see if it is successful?

A. It is surprising how infrequently we are asked about the treatment of migraines, since it is one of the more common referrals we get. The evidence, which you can see from our factsheet

is pretty good.

Of course, the one thing that we always have to say is that each person is unique and different, and the standard treatments used in these trials are not always indicative of the way that we actually work. Twenty people presenting with the same named condition might be treated twenty different ways.

This also means that each individual presentation, the problem and the context in which it lies, can profoundly affect how much treatment and for how long. Most of us would regard a good routine as four or five sessions at once a week, and then stretching the gaps to a fortnight and up to a month over the next three to four months. We have found that simply treating weekly until the symptoms abate is not always successful, and that without later follow-up there is a danger that the migraines will return. Patients then conclude that the treatment didn't work, which is probably not the case.

Of course, this routine can vary tremendously. If someone has three migraines a week then treatment might be more than once a week to bring things under control. In other cases, where the migraines are related to specific patterns like the menstrual cycle a practitioner might target particular times of month for a few months.

All we ask that our members do is that they review treatment at regular intervals to ensure that there really is some progress, and to ensure that the patient is happy to give continuing consent. What we try to avoid is a treatment 'habit' where someone books week after week without realising that they've run to ten or fifteen sessions without result. This can sometimes make patients unhappy.

However, most people appear to benefit from treatment, and we hope that this is the case for you.

Q. Can it help with tension headaches and TMJ?

A. These are both problems of which we see a great many cases in practice. There is a certain amount of research, as you can see from our two factsheets

but it has to be said that the quality of trials is not that great and as ever the conclusion from any trial will always be that more and better research is needed.

The predominant reason for this is that there are so many precipitating causes for both problems that even researchers fight shy of testing whether the symptom can be relieved by treatment. This is rather ironic, because this is precisely the way that Chinese medicine looks at every symptom, not as a problem in itself but as a problem which has emerged against a backdrop which is unique to each individual. That means that twenty people with the same problem may end up being treated twenty different ways because the underlying patterns were different.

Obviously there are going to be some cases where you can pinpoint the cause. We often come across TMJ syndrome which has been caused by rough dentistry when the jaw has been pushed wide for some time and slightly dislocated. It's not a fantastically stable joint, and once it is slightly out of alignment it can cause facial pain and sometimes headaches too. If we suspect that this is the case we sometimes refer people to cranial osteopaths who can go straight after the problem. This doesn't mean that we aren't interested in why this happened in this particular patient, but it could take a great deal longer to get the same change by restoring better function.

As far as headaches are concerned, though, there are literally dozens of differentiations in the more syndrome orientated acupuncture styles which can define precisely what kind of headache it is and alongside that several very long established styles of treatment aimed at restoring the overall balance. That is why we would never venture a view on a specific question because so much depends on the individual presentation. That is why we invariably say that a brief visit to a local BAcC member for a chat is a great idea. Most will offer a small amount of time without charge to prospective patients to give them a better view of what might be possible, and help them to make an informed choice. It has to be said, though, that headaches remain one of the more common presentations we see in clinic, and many are referrals from people who have been successfully treated themselves.

Q. I have been suffering from intense heel pain in both feet now for 6 years. I've been through years of physio/insoles/MRI/surgery etc in attempts to find the cause. Research now leads me to consider peripheral neuropathy. 15 years ago I suffered an almost terminating attack of Guillain-Barré Syndrome and I wonder whether this may be involved. I live on Hampshire/Surrey border. Could I get some recommendations for expert acupucture in this area, specialising in Peripheral Neuropathy.

A. The first thing to say is that there are only a couple of areas where we take specialism seriously - paediatrics and obstetrics - and where are are eventually likely to recognise expert training. Chinese medicine is by its very nature generalist because we treat people with conditions, not the condition itself. In that sense we are all qualified to treat everything, although we have to be very careful how we say this because treat implies cure, and treating people with, for example, cancer is not about curing so much as maximising the body's balance. It's an easy misunderstanding to foster.

That said, many problems present locally against a backdrop of systemic weakness, so some protocols emerge which can be applied within the overall context which we would primarily treat. We have been asked about peripheral neuropathy on a number of occasions, and a typical answer has been

There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet

shows but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.
Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.
The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

From a conventional/western perspective it is quite possible that the Guillain Barre episode has resulted in nerve damage, and to that extent there may be a limit to what is achievable. We do come across cases, though, where the disruption in the flow of energy as we see it produces a pain which is assumed to arise from a broader condition someone has. Once people get a disease label it seems quite common to refer everything back to it. This is why we always recommend in cases like yours that a chat with a local BAcC member is always worthwhile. It is sometimes possible to see signs of blockage which would encourage the view that treatment may help.

We always have to be realistic, though, and after 15 years of unrelenting pain it would be a long shot for acupuncture to do the trick quickly. This does leave you open to the possibility of running up a large bill in the attempt which achieves nothing significant, so if you do decide after talking to someone to go ahead we would recommend that you try to find as objective as possible an outcome measure of progress and agree regular review periods before you start.

Good luck!

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