Ask an expert - body - head

92 questions

Q:  I have something called mal de debarquement syndrome which began immediately when I set foot on dry land following a cruise, I've had it ever since and that was four months ago. Symptoms are like being in a boat 24 hours a day every day combined with brain fog, fatigue, confusion, sensory overload, head pressure, migrane etc. It's  apparently very rare and therefore there is no medical treatment, it can by all account last from months to many years. Will acupuncture help?

A:  We were asked this question a couple of years ago and our answer then was:

MdDS is quite a rare condition, although the overlap with a number of better documented problems such as Meniere's Disease or vertigo could mean that it is under-reported. As is always the case with relatively rare conditions there is hardly any research, even in conventional medical literature.

We searched for whatever we could find, and there are certainly a number of anecdotal accounts from people with this condition who have found acupuncture in combination with some fairly low level medications has done the trick. This sample is self-selecting, though; there is less chance that someone who hasn't found it useful will post the bad news.

For problems like this we have to say that the way that Chinese medicine works, interpreting the symptoms against a completely different theoretical framework and supplementing what is reported with findings from, for example, looking at the tongue, taking the pulse at the wrist and other clinical observations, can sometimes generate solutions where conventional medicine cannot. Chinese medicine is based on an understanding of energy, called 'qi', and its flow, rhythm and balance in the body. The flow is affected both functionally by weaknesses in the Organs of the body which sustain it, and also positionally because of local blockage and disturbance. It is probable that a practitioner may find evidence of changes or blockages in the flow, and by re-aligning these start to reduce the symptoms. This is certainly the case with other balance problems, where the evidence for the effectiveness of acupuncture treatment, while not conclusive, is certainly encouraging enough to suggest that treatment is worth a try.

The best advice we can give is that you visit a BAcC member local to you and seek a brief face to face assessment. We are confident that in person they will be able to offer a much better view of what may be possible. The only caution we have is that conditions can become more difficult to treat the longer they have been entrenched, and a fifteen year history suggests that improvements may take a while. However, life is full of surprises, and we have seen longstanding problems vanish almost overnight, so the best idea is probably to have no expectations either way.

We have checked the databases to see what else might have been published since we wrote this in 2014, but apart from a 2013 study which uses a form of magnetic therapy

http://www.ncbi.nlm.nih.gov/pubmed/23202153

we have not found anything else which would affect what we have said either way.

The only addition we would make to this answer is to mention that there are one or two other forms of treatment, notably cranial osteopathy, which might also offer some relief and improvement. Although the evidence for acupuncture and MdDS is a bit thin, there is a considerable amount of good quality research on vertigo and other balance problems like Menieres and labyrinthitis. From a Chinese medicine perspective, the disease labels of western medicine are less interesting to us than the functional disturbances which a patient reports. We have ways of interpreting these within the conceptual grid of Chinese medicine which makes direct equivalences hard to establish - some presentations with different western names are the same as far as we are concerned, and twenty people with the same named presentation may be treated twenty different ways.

Hopefully a practitioner will find something which makes sense of your problem and can give you a much clearer idea than we can here of the potential for treatment with acupuncture.

Q:  Two months ago I had acupuncture done for  a migraine. Ever since I have a dull to sharp pain that goes from the middle right side of my neck up over my skull and down the right side of my back. It flares up and calms down, but is always tight.

A:  This sounds very uncomfortable.

We would probably need to know a little more to be able to make specific comment. There are points which someone can use for the treatment of migraine, especially one called Gall Bladder 20 Feng Chi, which lie in the neck just below the occiput. There is a possibility that a needle used here, or in one of a number of points in the area, may have caused a little internal bruising which could well account for a continuing sensation of discomfort in the area. If this is the case then the discomfort should gradually ease and normal function return.

If there have been no needles in the area, this becomes a little more difficult to explain. There are very occasionally where the use of needles will encourage a systemic change which in turn reveals a blockage further downstream, so to speak, and this could manifest as a dull ache. It would be unusual, however.

The other possibility, of course, is that the appearance of the ache is a coincidence. We are always very careful when we broach this possibility because it sounds as though it's a dodge to evade responsibility. The reality is, though, that with nearly four million treatments in the UK every year there are going to be occasions when a symptom appears near when a treatment took place (time or location) but which has nothing to do with the treatment. We always advise colleagues to work with the patient to try to find out what is going on and make appropriate referrals. 

We think your best course of action would be to go back to the practitioner and ask their advice based on what they did. The vast majority of our members will not feel defensive or criticised but will work with you to see in the first place whether it could be a consequence of what they did, and to offer constructive solutions for the problem. If nothing comes from this and the pain continues you may need to see your GP to get his or her advice. The most likely possibility, if the problem is not likely to be from the acupuncture treatment, is that something has gone into spasm, and massage or physiotherapy may offer a rapid solution. Or even acupuncture! We spend quite a lot of time releasing tight muscles, both by calming the system as a whole and by needling the local area itself.

Q: I have an inner ear problem that is causing loss of balance and vertigo will acupuncure help and how long until I can expect a result?

A:  We have been asked a number of times about balance problems and a typical answer was/is:

A great deal depends on what accompanies the balance problem, or indeed whether it is a stand-alone problem.
 
There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
 
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows:
 

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

 
but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, that is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind
 
http://www.ncbi.nlm.nih.gov/pubmed/19606509

 
generated some very interesting results, but the formula applied would not be appropriate for everyone.
 
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

However, as we said before ,the best thing to do is to arrange to visit a BAcC member for an informal chat about what may be possible. 

Q:  I am 84 years old and have had no sense of taste or smell for about 20 years. I have seen an ear, nose and throat specialist and they have found nothing wrong. Can acupuncture help this condition?

A: We have been asked questions of a similar kind several times, and we have a very comprehensive answer quite recently which said:

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, but in most cases there really is no clear reason.

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.

We think that this still represents the best advice we can give. The fact that you have had tests which suggest that there is nothing wrong is, from our perspective, rather strangely a cause for some hope. If there had been a physical or neurological change that might have made matters a little more difficult, Unexplained problems, which we see very often as you can imagine, are sometimes amenable to our style of working.

However, we are not in the business of encouraging people to chase rainbows, so if you did decide to give acupuncture treatment a try it would be worth drawing a sharp line after three or four sessions if there has been no overall progress. Otherwise it is quite easy to fall into a costly treatment habit when there is no sign of any progress.

A: We are always cautious about answering questions about conditions for which there has been little research evidence. The one summary of trials on the use of acupuncture for glaucoma really does not say very much

http://www.ncbi.nlm.nih.gov/pubmed/23728656

A part of the problem here, as the author of the review says, is that the standard method of testing procedures in the West, the randomised double blind control trial, involves one group getting a real treatment and the other group getting a sham treatment, to test the difference in outcome. No physician, however, would leave a condition like glaucoma untreated because of the potential for serious sight loss, so until someone tests the effects of standard treatment against standard treatment plus acupuncture there will be nothing definitive to point to.

All of us have treated people with glaucoma, either as a primary condition or as a secondary condition after a patient has presented with another problem, and I'm sure all of us can report some success. As the author of the review says, blockages in the flow of energy which prevent the free flow of fluids sums up what glaucoma is, and it would seem intuitively possible that acupuncture would have an effect. This expert's experience, though, has been that it takes a long time to achieve sustained and sustainable results, and the medications remain a part of the picture throughout. What acupuncture seems to do well is to prevent uncontrollable variations in pressure, but there is no statistical evidence to which we can point.

We have searched the internet and found surprisingly little patient feedback about the treatment of glaucoma with acupuncture. Most of the official charities and organisations do not have a great deal of feedback from patients on their websites, and we have not been able to trace many forums of sufferers. That these exist is not in doubt; the internet has created thousands of forums across the globe. The best that we can say is that if you search, you will find quite a few, and our experience is that they tend to be  a great deal more measured than used to be the case. Where it used to be 'it works, oh no it doesn't' the entries now tend to reflect the wider range of outcomes and views.

We do not ourselves 'bank' feedback on specific conditions, primarily because we take the generalist view that we treat the person as much as or more than we treat the condition. However, our best advice as always is to go to see a BAcC member local to you for a brief face to face assessment. This will enable someone to see your problem not simply as it is but against the backdrop of your overall health. This will enable them to offer a much better view of what might be possible and also enrich any basic understanding of how your problem may have arisen from a Chinese medicine perspective.  

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