In chronic disease (for which acupuncture is most appropriate) treatments are generally given at intervals of 1 or 2 weeks at first; later the intervals become longer. It is undesirable to treat more frequently because of possible delays in the appearance of improvement; it takes at least a week for the response to the first treatment to become clear. (The Chinese seem to give daily treatment for 10 days or so in chronic disease, but most medical acupuncturists in this country are not convinced that this is a good idea.) In acute disease, however, more frequent treatment may be desirable.
If there is no response after the first treatment it is generally justifiable to try once or twice more, but seldom worth trying more than three times in all. In some cases, if a response appears unlikely, one treatment may be all that is worth doing. A ‘course’ of treatment usually consists of 3 to 6 episodes, after which a ‘plateau’ is generally reached. Some patients may be totally cured, but many more are helped but require further treatments at intervals. As a rule I regard 8 weeks as the shortest practicable maintenance period; if the effect of acupuncture wears off sooner than this it may be said to have failed. However, there are exceptions to this rule.
If improvement fails to be sustained even after a number of treatments one should consider what factors may be perpetuating the problem (stress, posture). For example, a faulty posture at work may cause pain in the arms or neck; driving is another major source of trouble for many people.
If symptoms keep recurring in spite of attempts to eliminate whatever seems to be causing them you need to try to think of some other way of approaching the problem. TENS may be a solution for some patients. Others may be willing to practise self-acupuncture. Of course, candidates for this have to be carefully selected, and only certain anatomical sites are suitable, but it can be valuable. (Appendix 3 contains a sample instruction sheet which may be given to patients to remind them of what they have been taught.)