Resultats de la recerca derivats del tractament de dades amb el programa Atlas-Ti

treatments have a lesser effect or no effect at all, because acupunc-ture, being a biological and not mechanical process, works in an irregular fashion.

2 The Initial Improvement reaches a Plateau, which mostly consists of minor ups and downs, but may be nearly even throughout its duration.

The Plateau may last a few hours, days or weeks. As treatment progresses, not only should the Plateau become higher (as the Initial Improvement becomes greater), but the duration of the Plateau should become longer. However, some treatments are better than others, so it may well follow an irregular course.

If the duration of the Plateau does not lengthen, the acupunc-ture will not help long term. If, for example, each treatment lasts 3 days before wearing off, it can easily happen that in the end it helps for only a few hours and finally not at all.

3 If the Plateau reaches 100% and lasts, the patient is cured. If it reaches, say,75% and lasts, it is not ideal but often good enough. If

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Fig. IX.1 Patients’ response to acupuncture

it does not last we have a Decline, which may happen rapidly or slowly or in several stages.

Sometimes there is a Decline for 1 or 2 days, which then stops and the Plateau is reached again, all without the patient having had any treatment or obvious change of circumstances. If the Decline is not complete and there is still a residual improve-ment of 10%, 20% or 30% it is of course better than a complete Decline.

TIMING OF SUBSEQUENT TREATMENTS

If a patient has a second treatment whilst the Initial Improvement is still taking place, he can sometimes have a reaction (see Chapter IV) and be temporarily worse. This may sometimes nullify the effect of both the second and even the first treatment.This type of over treatment reaction is more likely to happen in Strong and Hyper-Strong Reactors, but can even happen in Normal Reactors and hence if possible should be avoided.This may involve not treat-ing a patient at all on one visit. If this has happened once, I explain the situation to the patient so that, if it happens again, they can tele-phone me to cancel the appointment and come again instead a week or two later.

If a patient has a second treatment whilst they are still on the Plateau, the same type of reaction can happen as during the stage of Initial Improvement. However, it is less likely to happen, par-ticularly in a Normal Reactor. If possible, it is sometimes wise to defer treatment, unless the doctor proceeds with care and gently.

The ideal timing of the second treatment is 2 days or more after the Decline has started. I write 2 days, rather than less, as sometimes the Decline is of its own accord arrested and the improvement in the patient’s symptoms continues or returns to the Plateau. There is no need to wait until the Decline has reached the bottom of its course, though one can if it is convenient – it does not matter.

Once the Decline has been reached it makes no difference if the patient is treated again at once or some time later. The important thing, if possible, is to avoid treating a patient before the decline sets in.

I D E A L F R E QU E N C Y O F T R E AT M E N T B Y AC U P U N C T U R E

It is for all the above reasons that I initially treat patients only once every 2 weeks, and, as they become better, they may come again after a month and finally after a 2 month gap. If a patient has symptoms only once a month, as with some gynaecological condi-tions or, say, infrequent migraines, I only treat the patient once a month.

I see quite a number of patients from abroad who stay here only a short time, so that I cannot leave two or more weeks between treatments. I then treat these patients, possibly even twice a week, but it requires considerable skill on my part not to overtreat them.

I also think the failure rate is higher and in addition requires a larger number of treatments to achieve the same result.

I should add that, in my type of specialist practice, I treat mainly patients with chronic diseases and hence what I have written applies mainly to them. GPs who see more acute diseases can, of course, treat their patients more frequently, possibly once or twice a week. In China they sometimes treat patients every day, some-thing which I only do, and even then rarely, in acute cases.

Acupuncture is a subject where many of the experts disagree with one another. Perhaps there are many roads to Rome. I have one or two patients who are so sensitive that they feel the effect of a treat-ment for the following 6 weeks and hence I treat them only once every 6 or 8 weeks.

Probably the most difficult diagnosis in the whole of acupunc-ture is to distinguish the Hyper-Strong Reactor from the Strong Reactor from the Normal Reactor from the Inhibited Patient. To this should be added the difficulty sometimes experienced in dis-tinguishing the Initial Improvement from the Plateau from the Decline. It should also be remembered that if the same patient is needled in the same way on two separate occasions, the needle prick may hurt more on one occasion than on another and hence, unintentionally, the treatment may be stronger. And finally, the same patient may react differently to acupuncture on separate occa-sions. It is not easy to achieve perfection in acupuncture.

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This chapter elucidates in greater and more practical detail the six or so (an arbitrary figure) different categories of acupuncture areas mentioned in Chapter II. Also described is the practical applica-tion of the neurophysiological research, particularly that of Sato, described in Scientific Aspects of Acupuncture*.

TENDER AREAS

There are certain areas of the body which are tender in the major-ity of patients whether they have a disease or are completely healthy. Such areas, many of which are mentioned in this book, include the cervical articular pillar area (Section 4), the medial infragenual area (Section 6), the gastrocnemius tendon area (Section 7), the varicose ulcer area (Section 8), the trapezius/

occiput area (Section 10), the medial and lateral anterior elbow area (Sections 9 and 17), etc. These areas, even though they are tender in the healthy state, may become even more tender in disease related to that area.

Generally speaking these constantly tender areas are more effec-tive in acupuncture than areas which are normally not tender but become tender only in disease.

In addition there are quite a number of areas which are on the borderline of being constantly tender areas, depending to some extent on the degree of digital pressure applied to these areas. Two X