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Q: I have been diagnosed with lumbar spinal stenosis.  I find it difficult to stand for any  length of time or walk any distance. I have to sit because of a severe ache in my  lower back.
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A:  We were asked this question a couple of years ago and our answer then

Q. Following an MRI scan I have been diagnosed as having "central canal stenosis with degenerative changes at L4-L5 level and moderate disc herniation". I have difficulty walking more than 200 metres. Is it at all likely that acupuncture would have a significant positive effect?

A. We are sorry to hear of your difficulties. We were asked this question many years ago, and our advice has not changed that substantially. Back then we wrote:

Lumbar canal stenosis can manifest in many symptoms dependent on the extent of the stenosis. Our colleagues in America are very upbeat about the potential for success in treating lumbar canal stenosis; if you google 'lumbar stenosis acupuncture' you will see an article on the www.acupuncture.com site which speaks positively of success rates, as well as an 'acupuncture today' listing which also gives good cause for hope.

Personally we tend to take a slightly more guarded view of the chances of success, and base our own prognoses on gathering as much information as we can about the condition - how long the person has suffered from it, is it degenerative, does it have peaks and troughs, has it been exacerbated by accident or trauma, and so on - before committing to treatment. Even though we are working with entirely different diagnostic systems, if a condition has some very severe manifestations based on irreversible physical change, the expectations of a 'good' result have to be lowered accordingly, even what might count as a 'good' result.

The best advice that we can give is that you discuss this with a practitioner whom you might consider seeing and ask their advice. Many of our colleagues are happy to discuss someone's concerns with them rather than book them straight in, and a significant number are happy to set aside a few minutes to meet someone and offer a more informed view of whether they can help based on a rapid assessment of the actual presentation.

Since we gave this advice there have been a number of studies such as this one

http://www.ncbi.nlm.nih.gov/pubmed/22534725 :

which give some cause for optimism, although finding a UK practitioner able to deliver this particular form of treatment may take some doing. The most recent systematic review

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373659/

is much more guarded in its views.

However, it is often possible that the symptoms from which people suffer are not directly related to a physical change in the same area. We find that many people are told that arthritic changes in the lower spine are responsible for their chronic low back pain, but we often see the pain reduce or vanish without any accompanying physical change. Acupuncture has, in fact, been accepted within NICE guidelines as an effective treatment for the treatment of chronic low back pain, and the evidence base is certainly more compelling than for many other western named conditions. Our fact sheet on back pain
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html
gives more background.

The best advice we can give remains the same - visit a BAcC member local to you for a brief face to face assessment of whether they think you might benefit from acupuncture treatment.

still represents the clearest expression of what we think may be possible. Stenosis tends not to be reversible, and it would be unwise to encourage too much optimism about the possibility for change and improvement. However, we have to remind ourselves sometimes when we take on case with very fixed western names and well determined causes that we are working in a paradigm of medicine which starts with the patient's experience of their pains and discomfort and then works towards an understanding of that through the lens of Chinese medicine. As we said in the earlier response, not every experience of disease is necessarily reducible to the physical findings which are discovered through investigation. Although most are, there remain some where treatment with acupuncture may have a significant impact.

We can only repeat what we said in the earlier reply: ask a BAcC member local to you for advice. Most are more than happy to give up time without charge to discuss with prospective patients whether treatment may be of benefit to them.

Q:  I have a number of odd ailments, all on the left side of my body. I have problems with a molar on the left side, several enlarged (about 2 cm), but painless lymph nodes (which have been biopsied and found benign) on the left side of my neck.  Recently i had an ear infection in my left ear, and I've found a lump in my left breast that I'm having an ultrasound on next week, but I'm pretty sure they will find benign too. I have also broken out in spots on the left cheek and left side of my chin.
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 I have 3 children, and started trying for our 4th child in February 2013, but have suffered 5 miscarriages since and still no successful pregnancy. I was told when I had my first miscarriage that I had ovulated from the left ovary, which didn't seem to bear any meaning at the time, but I'm now wondering about the coincidence of it all.
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> My question is - do these one sided problems indicate acupuncture could help me? Is there a blockage somewhere? I don't know much about acupuncture, so this is guesswork.

A:Difficult question!

There is absolutely no doubt that one-sided problems, or an accumulation of problems on one side of the body, are diagnostically significant. In all forms of traditional acupuncture the balance between the bilateral channels is taken seriously, and weaknesses are both identified and corrected by attending to the subtle differences between the flows of energy on each side. In some systems, indeed, like Japanese meridian therapy, there are specific disruptions to the flow of energy around the central axis of the body which arise from accidents which can lead to a long list of what we might call 'non-specific' problems, i.e. where a joint doesn't move as it should but without a specific tendon or ligament being clearly identified as the source of the problem.

However, the problems from which you have suffered and from which you are suffering could be the result of random chance in terms of location; there has to be someone somewhere who has thrown a coin 'heads' ten times in a row, and it may be a simple coincidence that you have had a succession of left-side problems.

That said, this is a fairly good spread of conditions in a number of separate systems which suggest that there may be a specific energetic reason for them all to occur. A Chinese medicine practitioner, from whatever tradition or style, would be looking carefully at the other main diagnostic signs like tongue and pulse for evidence of what is going on, and may find that palpation of some of the channels for different sensitivity informs their findings.

We see many hundreds of questions each year, and there are some which whet our curiosity as practitioners because we find them intriguing, especially where conventional medicine cannot usually find any reason for things to be as they are and would probably be dismissive of the idea that all of these problems could have a common source or have arisen against a backdrop of general weakness on one side of the body.

The one note of caution, however, is that the problem with repeated miscarriages may have nothing to do with a weakness on one side of the body. If the desire to conceive again is top of your priorities, we would be a little surprised if this aspect of laterality was directly causally linked. There may, though, be other related energetic reasons why this is happening, and also may simply be a poor balance within the system as a whole, and the basic premise of Chinese medicine, that where balance is restored symptoms resolve, may may treatment worthwhile in any event. A growing number of our members mow take postgraduate training in all things obstetric, and focus their work on the pregnant, or hoping to be pregnant, women.

Our best advice is to seek a brief face to face assessment with a BAcC member local to you. Most are more than happy to give up some time without charge to discuss with a prospective patient what acupuncture may be able to do for them, and we are fairly sure that they will be as intrigued as we are.

Q:  Can you advise if acupuncture can help with severe clonus in the leg together with spascity? I am under neurology at the Royal Free but they are in a quandary as to what can be causing it after various tests (4 days in hospital).

A: There are a number of papers such as this one

http://www.ncbi.nlm.nih.gov/pubmed/18973910

which appear to offer hope to sufferers with these problems. There is similar material buried deep in the rather dense review paper

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which we have prepared about the use of acupuncture in the treatment of recovery from stroke, which has some overlap with clonus and spasticity.

We are bound to say that we come at these problems from an entirely different background. Chinese medicine is based on a theory of energy, called 'qi', whose flow, rhythms and balance determine the health of each individual. In cases like yours the practitioner will be aiming to understand why the symptoms have arisen from within this entirely different theoretical framework. This can sometimes offer possibilities both for understanding what has gone wrong with someone's balance and putting it right. This might involve local treatment to relieve the problems where they are occurring, but more often than not involves treating the system as a whole, based on an understanding that local weaknesses or disruptions tend to occur when the system as a whole is impaired and gets in the way of the body's normal recovery.

We think that you could do yourself no harm in seeking the advice of a BAcC member local to you about what might be possible. You may also find that certain western acupuncture techniques, such as the use of trigger point acupuncture, may be helpful, and this opens up avenues of possible treatment within the NHS. For a condition like this where the research is largely good but short of conclusive, any possibility of giving treatment a try is worth pursuing. We tend to the view that there are occasions when western medical acupuncture and traditional acupuncture may both offer local relief, but we remain convinced that traditional treatment is a more effective treatment in offering the additional possibility of securing a balance in the system which reduces the chances of a recurrence of the problem. However, if you can get access to free treatment within the NHS as a first step this may be a good way of assessing whether acupuncture is worth pursuing more formally.

Q: Can acupunture be used for cardiac rhythm disorders such as frequent ventriluar ectopics and non-sustained ventricular tachycardia? Is there any acupunture expert who specialises in treatments of these disorders?

A:One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The rapid pulse and the irregular pulse both have clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

http://www.ncbi.nlm.nih.gov/pubmed/18992625

Some of the published research also involves animal experiments, sometimes called 'ratpuncture in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what these two conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.

Q: I have suffered from peripheral neuropathy for 16 yrs which is a nerve damage problem. I walk with the aid of crutches. Would acupuncture help this problem?

A:We have been asked several times about the treatment of peripheral neuropathy, and one answer which still seems to sum up our position says:

Q: Is there any evidence that acupuncture can help with peripheral neuropathy and if so is there a distinction between chinese and western acupuncture?

A: There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html

but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.

Western and Chinese acupuncture operate from entirely different conceptual bases, although in practice many of the acupuncture points they use will be in the same places. Most western acupuncture is based on a neurophysiological understanding of acupuncture, that its effects are caused by stimulation of local and distal nerves. There are other variations on this theme, but in essence the practitioner works with a western medical diagnosis and very often uses needles in and around the affected area. Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.

The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

We are mindful of the fact that you have suffered for 16 years and have been forced to use crutches to move around. This suggests perhaps a greater level of damage than that about which we are often asked, and perhaps the expectation from treatment has to be geared down. However, we are always careful to remind ourselves that we are talking about an entirely different way of looking at the body and how it functions, and there are occasions when making good a blockage or imbalance which has lain untreated for many years can have extraordinary effects.

As we said in the earlier reply, though, the best advice is to visit a BAcC member local to you and let them make a face to face assessment. This is likely to be far more informative than we are here, and may well generate other treatment options for your specific problem.