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A:  We publish a factsheet on vertigo http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/vertigo.html which summarises the position for a number of conditions, and in it the authors refer to a study which seem well worth reading http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136456/ which provides a review of the evidence from western and eastern studies. We note this because it is often quite difficult to get hold of studies in Chinese, and even having got hold of them getting them translated is a major obstacle. There are literally thousands every year, of which only a fraction make it to western journals or into translation. The upshot of the
review is positive but cautious, as is often the case. Acupuncture treatment appears to help, but larger and more methodologically sound trials are needed.

As you can see from the number of conditions grouped under the general banner of vertigo, though, this is a great illustration of where the Chinese medicine perspective and western medicine perspective don't translate exactly. There are a number of clearly defined syndromes and organic disturbances as understood in Chinese medicine where the group of symptoms which they can cause could lead to one of several definitions in western medicine, so two people with the same diagnosis in Chinese medicine might be labelled as having vertigo, Meniere's, or labyrinthitis in the West. By the same token each of these conditions, whose symptoms are very similar. might
lead to an entirely different diagnosis in Chinese medicine. This is more likely, insofar as from a Chinese medicine perspective each patient is unique and different. Having the same symptom tells you very little; what you need is to establish how the loss of balance in the system as a whole led this symptom to appear in this person.

The best advice is to visit a BAcC member local to you and seek their opinion based on an face to face assessment. We are confident that treatment will be able to reduce the severity of your symptoms, and also perhaps make you better able to deal with the secondary problems of confidence and stress which often arise after a while. Our clinical experience is that there is usually an effect, but how much of an effect and how sustainable it may be are unknowns. We are always very keen to set regular
review periods when we treat people with any of the balance or inner ear problems to avoid a long term 'treatment habit' developing when the results are neither large or sustainable enough to warrant continuing. The practitioner can then discuss other possible options, based on an understanding in both eastern and western terms of what is going on.

Q:  In February 2014 I had a bad cold/flu/fever which lasted a few months. Later my white cell count was low for almost nine months then corrected. Since February 2014,  I have been unable to cough up phlegm from my lungs. Before I was able to cough up phlegm easily. Now when I lie down I can hear phlegm in my lungs and it sounds as though I'm on 60 cigarettes a day (I don't smoke). Could acupuncture help me to expectorate the phlegm sitting in my lungs?

A:  Your problem sounds quite unusual and we imagine a little unpleasant for you. If we were looking at a problem such as yours in clinic we would say that as far as Chinese medicine was concerned there are a couple of well-known syndromes involving the accumulation of Phlegm in the Lungs which would offer some hope of successful treatment, as well as a number of specific points whose action is said to 'resolve' Phlegm, i.e. render it less adhesive and easier for the body to disperse or remove.

However, finding out how to describe in Chinese medicine terms what is going on with a symptom is not the same as defining the underlying condition, and our concern would be to find out what was causing this to come about. Phlegm accumulates because an excess if fluids is either subject to heat or cold and thickens, and from a Chinese medicine perspective we would want to know how this first happened and why you in particular had this unpleasant symptom developing. Each person is unique and different, and so a set of circumstances which would generate a symptom in one person would have no effect on someone else. Treating the underlying constitution, the backdrop against which the problem arose, is as important as treating the symptom, because if this is not done, the symptom may well return.

We would also be interested in finding out more about the cold/flu you had last year. A low white cell count is unusual, and suggests that this was not a simple virus. This may not affect our diagnosis in Chinese medicine terms but may take advantage of our knowledge of western medicine to get a sense of how feasible it would be to offer hope of a rapid recovery. Some diseases floor the system for years, and when we treat people with post-viral syndrome we sometimes have to be ready for the long haul. Given that this may mean a considerable investment in time and money we want to gather as much information as we can to make our estimate of progress as sound as possible.

In your particular case there is no substitute for visiting a BAcC practitioner local to you for a brief face to face assessment of what is going on and an educated opinion about what acupuncture treatment may be able to offer. It might also be advisable to look at the register of colleagues who use Chinese herbal medicine, the Register of Chinese Herbal Medicine( http://www.rchm.co.uk/), most of whose members also belong to the BAcC. The combination of acupuncture and Chinese Herbal medicine can often be extremely effective in treating problems like this where the daily regimen of herbs can often maintain the momentum in helping the Phlegm to resolve.

Q:  GP reffered me to physiotherapist for knee pain. He diagnosed osteoarthritis and I agreed to a course of acupuncture. I have read your other post regarding pain else where in the body and have understood. Nevertheless my pain occured three days later, thinking I had toothache. I went to the dentist, who took an xray and found nothing, I have been taken co-codomol for two day's and the pain is excrutiating.. It is no longer on the tooth but now all over my right jaw top and bottom five days later. My question is, could this be a side effect of the acupuncture, is this the Qi working, and sending the pain away from the initial problem?

A:  Judging by how you describe what is happening to you, which sounds highly unpleasant, we would have to say that it is not very likely that the treatment for the knee has caused such a major problem at such a distance from where the needles were mainly inserted. To be honest, even when practitioners have needled near the teeth and jaw we have not had reports of such a major disturbance ever before. That doesn't mean that it can't happen, just that it would be extremely rare.

The understanding of pain in Chinese medicine is that it arises from a deficiency of energy in an area, an excess of energy or a blockage. In each case the kinds of symptoms someone gets will point to the problem, i.e. a deficient pain is more likely to give a chronic dull pain than a pain from excess which is likely to be more hot and inflamed. There are rare occasions where uncovering and treating a blockage in one part of the body can improve the flow of energy in the system as a whole, and reveal a blockage 'further downstream' but where this does happen it rarely causes the level of distress from which you are suffering. If the secondary blockage caused this
level of distress it would almost certainly have been generating symptoms already.

However, without knowing exactly what the practitioner did we are a bit in the dark. If the treatment was administered by a physiotherapist, the chances are that most, if not all, of the needles will have been inserted where the problem is. There are a couple of points adjacent to the knee which could have an impact on the whole system, but we have never heard of the use of these provoking such a reaction. The kind of acupuncture done by physios is more specialised around the kinds of problems which physios
deal with, and it is unlikely that if you go back to him/her for advice they will be able to offer you much help unless they happen to be trained in traditional acupuncture as well. It might be worthwhile seeking the advice of a BAcC member local to you, though. In a brief face to face assessment, which most of our members are willing to offer without charge to see whether a problem is treatable with acupuncture, they may be able to provide you with a possible explanation for what is happening to you.

On the basis of our clinical experience of working with patients with similar pains, we think that other areas worth pursuing are investigations into the possibility of trigeminal neuralgia, which can produce serious pains of the type you describe, or some displacement or disturbance of the tempero-mandibular joint which can also generate some very unpleasant symptoms of the same type. If the latter is the case, another treatment option you might want to consider is cranial osteopathy which in our experience is
very good at handling these sorts of issues. It might also be worth getting some bloods done. Although your X-rays are clear there can still be infection which does not show up and which bloods would reveal very quickly. We think this is unlikely but it is always best to work by elimination and rule out the obvious without assuming that it can't be this.

We are very sorry to hear of your distress, though, and hope you find some means of treating it successfully as soon as possible.

Q:  Can acupuncture work for thyroid disease? I have Hashimoto's Disease and although on levothyroxine for this, it is neverunder control and I feel extremly ill. I am considering acupuncure and would love to hear your thoughts on this.

A:  We publish a fact sheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/thyroid-disease.html which summarises the current research into the use of acupuncture in this area, but it has to be said that the amount of research is not adequate for us to give an unqualified endorsement of the use of acupuncture for Hashimoto's.

We were asked a similar question last year and we answered as follows:

Q: Can acupuncture be used to treat hypothyroidism ?

A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism. What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.

For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone
stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment has the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.

That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the
relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise, that where there is balance symptoms disappear, would nonetheless apply.

If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.

We would not really want to say anything more than this. There is certainly anecdotal evidence of which we are aware that patients have benefited from acupuncture treatment, but equally there is evidence of treatment having little or no effect. Since the essence of Chinese medicine treatment is that it is individualised, in the absence of more research we tend to be more circumspect and recommend that someone gets a face to face assessment of what may be possible.

Q:  We think that this still remains the best advice that we can give. When treating people with thyroid problems we tend to have two concerns, one being the potential to unbalance a stable routine, the other being the exact opposite, to establish a stable pattern. It can happen that acupuncture treatment can help the system to react more evenly to medications. This is an outcome which we have witnessed in clinic but there is no research of which we are aware which puts statistical weight behind this. As a general observation, however, we do find that where the body can sometimes struggle to deal with a foreign substance the support given to the system as a whole by traditional acupuncture can reduce some of the side effects of the medications.

Q:  I have lost my sense of smell after a car accident years ago, but I can still taste foods and such. How come? Smell and taste are connected, doctors have told me if you lose one, you lose both, so why can I still taste?

A:  As the NHS website on anosmia (loss of sense of smell) says http://www.nhs.uk/conditions/anosmia/Pages/Introduction.aspx around 80% of the taste of food depends on the sense of smell, but this does leave a residual 20% which does mean that food does have a taste. As we understand it, the sense of taste is largely confined to much more basic distinctions between sweet, salty, etc, but there are cases where people with no sense of smell appear to be able to make finer distinctions. The NHS
website mentions a number of potential causes for loss of the sense of smell, and one of them, physical damage or obstruction, may be relevant if there has been some damage to your nasal passages which means that the smells are being diverted by an unusual route. However, it is more likely that there has been some neurological damage, although without knowing the detail of the accident that is hard for us to say.

As far as the use of acupuncture to treat anosmia is concerned, we have been asked this question a number of times, and our answer has always been:

Google is a massively powerful search facility, and if you google 'acupuncture anosmia' it looks as though there are a number of studies which give cause for hope. If you look carefully, however, you will see that there is but one study http://aim.bmj.com/content/21/4/153.long which is frequently quoted, generating a number of secondary references. This study, what we call an n=1 case study because it is the report of a single case, is important because it suggests that there may be something worth looking at in the use of acupuncture treatment. The weakness of n=1 studies, of course, is that they are not designed to test acupuncture, and the positive outcome could
have arisen for any number of reasons, especially since the case study can provide no evidence for the sudden onset of the problem.

That is not to say that acupuncture treatment is not worth trying. The use of Traditional Chinese medicine involves a great deal of questioning and examination to determine the state and flow of the energies of the body, called 'qi', and the state of the organs which are responsible for all of the functional aspects of the body. Even where there is no obvious cause from a conventional medical point of view, it is rare for a symptom to stand alone in Chinese medicine other than where it derives from a blockage. In
this case, if the blockage is removed, the function is restored. We strongly suspect that this is what happened in the case study, and blockages of this kind can sometimes occur for no obvious reason.

Generally speaking, though, a pattern of disharmony will generate a number of symptoms or changes in function, not all of which are clinically significant from a
conventional perspective, and these may point t specific imbalances affecting Organic function. Note that we capitalise the word 'Organ' - what we understand
by this in Chinese medicine is a great deal more than a physical unit in the body. The Chinese understanding of an Organ embraced functions on all levels, body mind and spirit, and whenpractised properly Chinese medicine can legitimately claim to be holistic.

The best advice we can give is that you visit a BAcC member local to you for advice on whether they think that acupuncture treatment may be of benefit, and to
discuss briefly with you the other aspects of your health which may indicate wider patterns which in turn may link to your problem. That is not to say that there may not be as simple a treatment as the one described in the paper, and one of the points used has the Chinese name 'Welcome Fragrance' suggesting that it may have a direct bearing on the sense of smell. You would certainly not do any harm. However, we would be more likely to look at this as a functional disturbance and be looking at other factors in the system which might point to a treatable pattern.

There is not much more that we can say than this. From a Chinese medicine perspective, however, the functions of taste and smell are assigned to specific, and different, parts of the system, and if there has been a functional disturbance in one it may not necessarily mean a loss of function in the other. It may be interesting to see what a practitioner can find, because if either function has been disturbed there will be other confirming evidence.

Another treatment option, if acupuncture treatment does not present itself as a good choice, is cranial osteopathy. There is a very close association between good neurological function and a healthy structure in the head and spine, and accidental damage some distance away from a faculty can nonetheless affect it.

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