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134 questions

Q: When I had acupuncture one of the needles in my neck between ear and nape did not hurt at first but when needle turned I got  a shooting pain in the  bottom left side of skull where my headaches are.It was  only painful for about 20 seconds then calmed to dull ache.  Now my headache here seems worse than before treatment. Can damage be caused?

A:  Acupuncture treatment remains one of the safest therapies with a very low incidence of what are called adverse events. That said, sticking sharp objects into a body is always inherently risky, which is why all of us have a three year degree level training which includes a year of western medical science to make sure we don't do it. There is also a 2000 year history
in Chinese medicine of safe needling which prescribes the exact depth and direction of the needles to minimise risk.

The feeling of a sharp pain which lasts for about 10 to 20 seconds and is followed by a dull ache describes a common reaction to treatment where the energy is activated and then settles down to a sensation which the Chinese call 'deqi', pronounced 'derchee', which is for Chinese people a vital part of the treatment process. This explains why many Chinese trained practitioners use some very vigorous techniques to stimulate the energy, techniques which many westerners find uncomfortable. As for the headaches appearing to be worse, this can often be a consequence of treatment as the system re-establishes balance. Headaches
and backaches are very often the two things which do seem to get a great deal worse in the short term, and we always advise patients that this may happen. However, although we talk about things getting worse to get better, sometimes things are getting worse or are the result of actual physical damage caused by the needles. If the problem persists it would be wise to see
your GP for reassurance. It is occasionally possible for a needle to cause a bruise in deeper tissue which remains invisible on the skin but causes some irritation of a nerve with subsequent pain, and this will go over time. If there is anything which makes your GP suspect that there may have been more serious damage, which we think is highly unlikely, then that is the fastest route to thorough investigation.

Q:  I am a veteran of acupuncture treatment having used it for high blood pressure, stress, injury, boosting immune system during flu and cold season. My acupuncturist is an 85 year old Chinese lady so extremely experienced and talented. During my last treatment, I experienced what I will call an
"episode". Increased heart rate, heavy breathing, dizzy, light nausea, feeling of rush of blood from abdomen up thru chest and midway down to
elbows. I did not mention it at the time, nearly like a panic attach. However, post treatment, I had five more "episodes" spaced exactly 2 hours
apart. They lasted about 2 minutes each. No headache or lingering effects. Next day, no more episodes. I am thinking it has to do with some "energy"
release associated with the treatment. Can you offer any insight?>


In cases such as yours, which can be distressing even if you are a veteran patient, the best person to ask for advice and clarification is the practitioner herself. It may well be as you surmise, some form of energy release associated with the treatment, and the exact two hour spacing is suggestive of an energetic effect - as your practitioner may well have told you, in Chinese medicine there are regular two hour pulses where the different Organs are seen to be at their peak and it is not unknown for these transition points to be clearly marked to transient symptoms. Sometimes this can happen frequently enough to be recognised as a pattern in itself; Deficient Gall Bladder energy, for example, can make someone wake at 3.00 am bright awake and raring to go.

However, your practitioner will be able to make sense of these against the backdrop of your energetic balance and the patterns she has treated for many years. We have absolutely no doubt that she will find your report fascinating and diagnostically significant. At this distance, however, and with no other information to hand there isn't a great deal that we can add. Each patient is unique and different, and even though this cluster of symptoms could appear in twenty different patients there would be twenty different reasons why this was so.

The one rider we would add is that although the episodes happened during and immediately after an acupuncture session, they may be unconnected. If you do experience similar episodes but not immediately after acupuncture treatment it may be worthwhile having a chat with your GP about other possibilities. This is not intended to alarm, but we do occasionally fall prey to what is termed the 'post hoc, propter hoc' problem where because something happens at the time of treatment or shortly after it is assumed to be directly related. What we try to avoid at all costs is patients and practitioners getting locked into discussions about whether an effect was or was not attributable to treatment while the effect goes untreated and univestigated.


Q:  I had an acupuncture session yesterday for severe neuropathic pain in my kneecap, which started after a spine operation four years ago. Today the pain is very much worse. Should I be worried about that or is this normal? The acupuncturist is Chinese and extremely experienced.

There is no reason to be worried. It is not at all unusual for there to be a short term reaction to treatment which can make a musculo-skeletal problem in particular feel a great deal more painful. We tend to give advice to patients that they can expect up to 48 hours after treatment of these problems during which things may get a little worse, but thereafter there should be steady improvements. These kinds of reactions tend to be more common after the first or second session while the body gets used to treatment.

There are a number of reasons offered for this kind of experience. In conventional medical terms there are often reactions in the local muscles and tendons as the physical structure starts to free up, and in Chinese medicine it is often surmised that it is the reinstatement of the flow of energy which can cause an amount of pain, rather in the way that restoring blood circulation after being cold can be quite unpleasant. It is more difficult to explain an increase in neuropathic pain in conventional terms without knowing more about the circumstances which triggered it.

That said, we always take these kinds of reports seriously. Sometimes thing feel worse because they are worse, and a practitioner will always be alert to the fact that there are a small number of patients for whom acupuncture treatment does not really work - they are sometimes too sensitive to the treatment and other options may be more suitable. However, there are a number of adjustments which a practitioner can make in technique and needle selection which may go a long way to reducing painful but transient after effects, and if treatment continues to stir things up, it is well worth talking this over with the practitioner. No responsible acupuncturist will fail to do their best to make the treatment as comfortable as possible. 

A:  I had my first acupuncture session a week ago and after the session I noticed some localised swelling at the point between the thumb and index finger on both hands.  After a few hours it  had gone. However, my second session took place two days ago and the swelling is back in my right hand (between thumb and index finger) and hasn't gone down at all. It is quite tender and feels a little weird. Also things like writing now feel a little numb too. Will this swelling reduce over the next few days?

Generally speaking, after effects of the kind you describe, what we call transient adverse events, resolve within 24-72 hours after treatment. The area of the point where you were needled is rich in blood vessels and it is not unknown for a small bruise to be formed under the skins which can cause considerable swelling and look quite dramatic when it comes out. The thumb joint is in constant use in the average day, and this is clearly going to impact on a whole hist of activities. The swelling is going to be pressing on some of the nerves in the area and causing what is technically called impingement, leading to numbness and loss of sensation, and occasionally slight weakness in performing standard operations like writing.

The sensation should, as we have said, already be starting to subside and we would anticipate by the weekend will be back to normal. However, the fact that the same point has generated the same reaction twice in a row suggests that either you are being needled too vigorously or that you have a slightly raised tendency to bruise. If it is the latter then this is something which we assume you would have mentioned and/or just seem this event as another version of a common problem, so we suspect it is the former. It is very important to let your practitioner know what has happened and if need be ask them not to use this point again until it has healed fully, and then with as little needle action and depth as possible.

In the unlikely event that the problem persists into the beginning of next week without manifest sign of bruising, it may then be worth touching base with your GP to have a good look at it. There is very little they are likely to do in the short term, but it marks the spot in case the problem continues and shortens the timescale for onward referral to a neurologist. This is highly unlikely, though; there have been very few reports of permanent or semi-permanent damage at this point site, but we have seen several patients over the years who have bruised very colourfully because of the nature of the tissue into which the needle has been inserted. 

Q:  After my first acupuncture treatment  I was lightheaded and fatigued. I went  home and rested after which I  went from hot to cold with soreness around my  left ear. Is this normal?

There are a number of short term after effects from acupuncture treatment which are common enough for us to mention these in the after-care advice leaflets which many practitioners offer to patients. Light-headedness and fatigue are relatively frequent after effects, and both will usually subside within 24 hours. On occasion the feeling of fatigue can continue for a while longer, but this should be relatively predictable from the case history. If a patient has, for example, been working flat out in a very stressful job for many months or has been through an emotionally difficult period, it is not unusual for the body to play catch-up in the sleep and rest which it has missed. This can mean that the process of turning things around initiates a period of tiredness.

The feelings of hot and cold are also a possible outcome from treatment. In Chinese medicine there are some very clear patterns which accompany the release of blocks and pathogens from the system, especially if someone has had a number of colds or infections which the body has failed to clear, and variations in temperature can occur. There is also in Chinese physiology an Organ responsible for maintaining the body's temperature, but since this is related to the whole system it may have a slight hiccough in maintaining balance while the whole system is adjusting.

The soreness behind the ear is more unusual, and we would need to know a little more about which needles were inserted where. If needles had been placed there it would be not unusual for there to be a palpable feeling for a day or so. If needles were placed elsewhere there may be a connection between the points and the other parts of the channel on which they lie, several of which run behind this area. The best person to ask is your practitioner; he or she will be able to explain this far more fully and be more than happy to do so.

In the vast majority of cases short term side effects disappear within a couple of days at most. We sometimes talk of treatment being like dropping a stone in a pond and causing ripples which eventually subside and then let us see what the picture is like after everything has stilled again. Most people, we find, only get these reactions in the first couple of sessions. After the system gets used to treatment, reactions tend to be less obvious, and where they do continue the practitioner cna then adjust the treatment to make it more comfortable for the patient.

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