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Q:  My husband is suffering from cluster headaches;  severe headaches the cause is unknown to medicine. Every 3-4 months he wakes up in pain in the early morning for a period of 1-2 weeks.  Then they go as suddenly as they came. We have done all tests but there is nothing wrong with him physically. Do you think acupuncture can help?

A:  The evidence for the use of acupuncture to treat cluster headaches is improving but still a long way short of a quality which could allow us to make an unequivocal recommendation. However, the current NICE guidelines for the treatment of cluster headaches in young people, which have slightly different criteria for inclusion, make a good case for recommending up to 10 sessions of acupuncture as a treatment
 
http://www.nice.org.uk/nicemedia/live/13901/60853/60853.pdf
 
Much of the research for the use of acupuncture treatment for headaches focuses on migraine, maonly because it is easier to define and therefore easier to set clear outcome measures. As you say, cluster headaches are not so well understood from a conventional medical perspective, and the relatively small number of treatment options reflects this.
 
Acupunture treatment is based on the principles of Chinese medicine which have been developed over 2000 years, and there are many different ways of understanding headaches based on their location, frequency, and severity. A skilled practitioner will often find other signs and symptoms which underpin a specific diagnosis, and the fixed point and severe nature of the pain suggest a few very specific alternatives within a Chinese medicine understanding.
 
However, each patient from a CM perspective is regarded as unique and different, and so with conditions like this which are not so well understood, it is always best to seek the advice of a BAcC member local to you based on a face to face assessment of what is going on. This will give you a very much clearer sense of what could be achieved.
 
It is very important that if your husband goes ahead there are very clear review periods and where possible a clear outcome measure to help assess what progress has been made. 
 
 

Q: I'm a 57 year old male, and suffer from hypertension.  In my capacity as an electrician, I have on two different occations worked in a Chinese surgery where two different practitioners have advised me that after 10 to 12 sessions of accupuncture I can come off my blood pressure medication. What are your thoughts on this?

The factsheet on our website  outlines a number of systematic reviews and randomised control trials which show some positive evidence for the effect of acupuncture on hypertension/high blood pressure. Taken as a whole the evidence is not quite good enough for us to make unequivocal claims for the efficacy of treatment, but there are certainly a great many patients who, alongside their western medication, use acupuncture regularly to help to maintain a relaxed approach to life and to help to break the cycle of anxiety/tension leading to high BP leading to anxiety/tension into which people can become 'locked'.
 
Clearly the ancient Chinese did not have sphygmomanometers to measure blood pressure, and the diagnosis of the patient rested on the symptoms raising from the high BP which they experienced and some of the signs which a Chinese medicine practitioner looks for when taking the pulse at the wrist, looking at the tongue and a number of other indicators of imbalance. Not surprisingly the overlap between high BP and some of the syndromes into which the symptoms are grouped is very imprecise. This is one reason, for example, why research can prove problematic because the same reading of the BP in 20 patients can arise from 20 different diagnoses in Chinese medicine, which is not helpful if you're trying to standardise all the elements in a piece of research.
 
The best course of action, as we say in nearly every response, is to visit a local BAcC member and ask their advice face to face. There are no rules about how many sessions someone should have for a condition, and a great deal will depend on whether in the practitioner's view the problem is a part of a much deeper pattern of distress or whether there are simple problems like blockages in the energy flow which mght be the prime cause. All that we ask our members to do is to remember to set reasonable outcomes, to review treatment regularly and certainly to review progress after four or five sessions to ensure that it is worth continuing and to make sure that the patient is happy to keep coming in.  
However, we would add that from a conventional medical perspective there are many reasons why someone can have high blood pressure, and not all of them are capable of resolution. Some may be managed effectively with a combination of medication and acupuncture, and some are capable of management by acupuncture alone. The chances that the problem can be solved once and for all are not that high that one could predict this outcome with confidence.
 
Of course, it may be that the Chinese doctors whom you saw recognised factors which from their perspective gave them confidence that you hypertension could be dealt with once and for all, but even if this were the case any reduction in medication needs to be managed carefully with the co-operation of your GP. The risks from sudden withdrawal from medicines which control your BP can be considerable, but there os no reason why a carefully monitored programme of reduction should not be possible.
 


Q: I don’t think this is the normal ‘bad back’ complaint.   I’ve had a bad back for probably over ten years.   However,  I’ve been to osteopaths and they’ve really helped relieve the pain, it’s not cured. To cut a long story short, I think the reason for my back pain is actually that my hip is ‘locked up’ and while the pain is felt in my back, the actual problem lies in my hip.
Every morning I wake up with my right hip feeling tight, this feeling goes all the way down to my  feet. When I walk and run I can feel my stride isn’t right and the right leg has a smaller range of movement than my left.  I can stretch, not sure which muscle it is, kind of between my bum and my hamstring….and I can feel my leg and foot relax. This stays relaxed for a short time before tightening up again.
My gut feeling is that a nerve in my hip is constantly aggravated – it doesn’t cause me direct pain but I think the muscles in my leg are tightening up to protect that nerve. Maybe the stretch releases some of the pressure on the nerve? Also, my big toe nearly always feels numb, like when you have pins and needles which make me think it's nerves.
Does this diagnosis seem probable? Do you think acupuncture could help by ‘re-setting’ the nerve? 

A:   We have to say, if this doesn't sound too odd, that we (well, this particular 'expert' anyway) love the challenge of a problem that has been treated and held at bay for years without having been fully sorted out. You will know from reading around the subject that acupuncture is particularly well-regarded as a treatment for back pain, as our factsheet shows
 
 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html
 
but then again, so it osteopathy, and we would be fairly sure that if the problem was a structural one, the osteopaths would have taken care of it a long time ago.
 
It is possible that the nerve is being constantly pinched and inflamed (entrapment is the technical term) which means that a cycle develops of inflammation causing irritation causing inflammation, and so on. Acupuncture has a fairly good track record as a treatment for inflammation, but again, the osteopathy should also have corrected the gait to the point where the nerve should gave settled down.
 
So, the points of interest are first the numb toe, which from a conventional understanding point to a nerve issue but from a Chinese medicine perspective indicate a loss of 'qi' or energy in the extremity, and second, a strong sense of asymmetry between right and left leading to tension and muscle spasm in the right leg. Our first questions would be about what happened when the pains started, and in particular whether there was any hint of a rotational injury, for example being throwh forward while wearing a seatbelt or twisting to pick up a heavy object. There are a number of subtle injuries caused by 'twist' injuries where the internal geometry of the body is thrown out of kilter, and these tend to resist attempts to deal with manipulation to put them right. It is rather like a functional, rather than structural, disturbance.
 
The numb toe could be either a systemic problem, and itself be the tip of a larger iceberg where more toes and fingers will follow eventually, or it could be an indicator of a simple blockage in the channel system. These can have profound effects; a small airlock is, after all, enough to stop a whole central heating system working. A skilled practitioner should be able, by using the pulse at the wrist, determine which is the case.
 
It is a rather unusual problem, and although we always stand by our public position that all of our members are equally skilled enough to be able to work from a Chinese medicine perspective on every patient who comes through the door, there are some styles of treatment which your problem suggests might be more worthwhile investigating. Our experience is that Japanese acupuncture styles are particularly good for these kinds of subtle functional shifts, and in particular for looking at these kinds of rotational problems. That said, most practitioners would be able to offer a number of very effective treatments for some of the problems you report, and we are confident that you may find that acupuncture treatment can just take you that step further, after the osteopathic treatment has set the scene, towards recovery.
 
If you contact a BAcC member local to you, we are sure that they will give you an honest assessment based on a face to face view of what they may be able to achieve and possibly also who may be the practitioner best suited to see what they can do.    
 
 



Our fact sheet on urinary incontinence
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/urinary-incontinence.html
 
provides a small amount of background, but mainly focuses on incontinence, stress and urgency/frequency in women. There are, however, a number of small studies such as
 
http://www.ncbi.nlm.nih.gov/pubmed/24494323
 
which point to the possibility that acupuncture may be able to help with nocturia, which is a slightly different problem.
 
The first thing we would ask, however, if you were a patient would be whether you had seen your GP to have your prostate gland examined. Enlargement of the gland in benign prostatic hyperplasia is one of the most frequent causes of nocturia, and if this is the case, the value of acupuncture treatment may be greatly reduced. A swelling of this kind may be amenable to treatment, but in the majority of cases it is not. There are some studies, though such as
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625218/
 
which seem to indicate that acupuncture may have an effect on BPH.
 
If the prostate function is normal, the practitioner would want to assess this particular symptom in relation to whatever else was happening in the body. From a Chinese medicine pespective it is unusual to find a single symptom in an otherwise healthy person. The body is understood as a system of Organs which each perform a number of specific functions in body mind and emotion, and a symptom would generally track back to a specific Organ and with that a number of other problems which the patient may not regard as so serious (poot concentration, poor digestion, etc). The skill of the practitioner lies in understanding not simply which functions are going wrong but what the sequence of weakness has been, i.e. what has led to what. The symptom is not often exactly where the treatment is offered; treatment primarily involves making sure that the whole system works well in the simple belief that a balanced system deals with its own problems.
 
The best advice we can give, after seeing your GP, is to visit a BAcC member local to you and get a better view from a face to face assessment of what acupuncture treatment may well be able to offer you.       
 
 



A:  There are one or two studies, one very old and one more recent, which give a small amount of encouragement for the use of acupuncture treatment with blepharospasm:
 
http://www.ncbi.nlm.nih.gov/pubmed/10025045
 
and
 
http://www.ncbi.nlm.nih.gov/pubmed/23046295
 
These are very small studies, though, and one uses electroacupuncture, which is not a modality used by many practitioners.
 
From a Chinese medicine perspective, however, the symptoms commonly associated with blepharospasm, such as muscle twitching, light sensitivity and dry eyes, can all be viewed as part of a wider picture of imbalance within the body. The Chinese understanding of Organs (capitalised to emphasise the difference) is completely different from the single organ with specific physiological functions from conventional medicine. Organs in CM perform a huge range of functions on all levels, body mind and emotions, and a practitioner will look at problems such as this as evidence of fucntional disturbance in the whole system. Sometimes there are simple local problems which can be rectified by local treatment, but the majority of problems are either local problems lying on top of a number of functional disturbances which have 'allowed' the symptom to develop, or ar a direct manifestation of one Organ not performing well. If this is the case, the practitioner's skill in using the pulse at the wrist and looking at the tongue, along with other diagnostic signs, will help them to understand what is going on.
 
This does mean, of course, that from a Chinese medicine perspective every patient is unique and different, so it becomes extremely problematic to offer definitive views about a condition like this which only occurs about once per 20,000 population; the more of something we treat, the easier it becomes to predict the likelihood of change. The best advice we can give is to visit a BAcC member local to you and seek a brief face to face assessment of what they think acupuncture treatment may be of benefit.