Three treatments should be adequate to assess whether a patient will respond to acupuncture. If there has been no response to treatment after the first three sessions then it is doubtful whether any response will occur. This should be taken as a general guideline and not as an unbreakable rule as sometimes the symptoms of a particular condition may be very fluctuate, and it may be difficult to obtain a clear assessment of the results of treatment. Occasionally the patient may not find it easy to remember exactly what the condition was like three weeks before and this too can create difficulties, so it is wise to keep a diary and assess day by day the changes that are arising in the problem being treated. This will allow the patient and the acupuncturist to develop a clear idea of the response to treatment, and to assess whether the treatment is worthwhile.

Most acupuncturists continue to treat a patient until there is no further improvement in their condition. The response, as shown by the graph, tends to 'level off' towards the end of treatment (usually after five or six treatments) and this 'leveling off' signifies that further treatment will probably not give further benefit. Acupuncturists in the West tend to treat people on a weekly basis; in China treatment is given daily, but this seems to be more from habit rather than for any good medical reason. Weekly treatments allow both patient and acupuncturist to gain a clear assessment of the progress and response to treatment.

Reactions
Sometimes a patient may experience a temporary worsening of symptoms due to acupuncture; this is a response to treatment and is a good sign. Such 'reactions' to treatment only last for a short time, perhaps a day or two, and are usually followed by improvement. A 'reaction usually means that the acupuncture needles have been overstimulated as some patients are very sensitive to acupuncture and may respond to normal stimulation by overreacting. If a 'reaction' occurs, the patient should be stimulated less at the next treatment session, this means giving a shorter and less aggressive treatment. Sometimes the improvement may be very delayed and the condition may not improve until the treatment has ceased. Occasionally patients who have been abandoned, with no improvement after three weeks, will suddenly find improvement some weeks after the acupuncture has ceased.

Although I have outlined general guidelines about the response to treatment it is important to take each problem as it arises. The general rules are not always obeyed, and if they are followed too dogmatically then the versatility of acupuncture may be lost.

Cure or Symptom Relief?
Acupuncture can be a cure, or it can act as a palliative treatment; this depends on the condition that is being treated. If a chronically painful arthritic knee is treated with acupuncture then, on average, the improvement will last about six months and the knee will then require re-treatment. Some acupuncturists treat their patients every three months or so to avoid any deterioration in their condition. The traditional Chinese approach is to attempt to maintain the patient in a state of health and a regular three-monthly treatment pattern is therefore justified; however, many acupuncturists just treat patients when the symptoms recur. If the condition is self-limiting, such as the pain from an attack of shingles, then no further treatment is required after the pain is relieved.