Ask an expert - general - dizziness

7 questions

If we took your question as face value as one about peripheral neuropathy then we might be tempted to use an answer we gave quite recently:

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
shows 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.

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.

This is quite a useful start because it sets out some basic principles and also emphasises that for conditions like diabetic neuropathy in the language of modern sales talk, 'once it's gone, it's gone.'

However, without any further elaboration of the health condition which may be the root cause of your symptoms we would be looking at them as they were in  themselves and trying to make sense of them within the framework of Chinese medicine. As our factsheet on vertigo shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2599-vertigo.html

there is a growing body of evidence which suggests that acupuncture might be of benefit, but even here we would say that vertigo is simply a label for someone's experience, and that once it is put in the context of someone's overall balance it can be the result of any number of possible imbalances from a Chinese medicine perspective. That is why we invariably recommend that someone sees a BAcC member for an informal chat. Most are happy to give up a little time without charge to discuss based on a first hand view whether acupuncture treatment might the best option for you. We have confidence that if it isn't they will say so. There are alternatives if this seemed to be the case.

It does illustrate very well for us, though, how working backwards from symptoms to a disease label can make a huge difference to how one perceives a problem. The great strength of Chinese medicine is that it see symptoms in their wider context as manifestations of the disease, not necessarily the disease itself.

If we took your question as face value as one about peripheral neuropathy then we might be tempted to use an answer we gave quite recently:

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
shows 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.

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.

This is quite a useful start because it sets out some basic principles and also emphasises that for conditions like diabetic neuropathy in the language of modern sales talk, 'once it's gone, it's gone.'

However, without any further elaboration of the health condition which may be the root cause of your symptoms we would be looking at them as they were in  themselves and trying to make sense of them within the framework of Chinese medicine. As our factsheet on vertigo shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2599-vertigo.html

there is a growing body of evidence which suggests that acupuncture might be of benefit, but even here we would say that vertigo is simply a label for someone's experience, and that once it is put in the context of someone's overall balance it can be the result of any number of possible imbalances from a Chinese medicine perspective. That is why we invariably recommend that someone sees a BAcC member for an informal chat. Most are happy to give up a little time without charge to discuss based on a first hand view whether acupuncture treatment might the best option for you. We have confidence that if it isn't they will say so. There are alternatives if this seemed to be the case.

It does illustrate very well for us, though, how working backwards from symptoms to a disease label can make a huge difference to how one perceives a problem. The great strength of Chinese medicine is that it see symptoms in their wider context as manifestations of the disease, not necessarily the disease itself.

Q:  I tripped over a step over 18 months ago and hit my head. I have totally lost my balance. I have had MRI scan and cat scan.  I have been told there is nothing else they can do for me. It is not vertigo and when I am out in the dark I have to have someone with me as I stumble all over the place. I am trying a Cranial osteopath but that is doing no good. Do you think acupuncture will help get my balance back.

A:  This is a very difficult question to answer. The fact that there is no visible damage and that cranial osteopathy has had no effect are not very encouraging when trying to say whether acupuncture might help. The latter (cranial osteopathy) works in broadly similar ways, and if that is doing nothing it does not bode well.

 However, on a more positive note, we get many referrals from cranial osteopaths when patients do not respond, and on many occasions we are able to help. From a Chinese medicine perspective we are looking at functional relationships within the body, not structural ones. Our basic premise is that there is a flow of energy in the body, which we call 'qi', whose flow, rhythm and balance determines the way in which all of the functions of the body perform as they should. Our skills are to identify weaknesses and blockages in the flow which cause pathological and functional changes, and to use needles to correct them.

 Of course, it sounds a great deal simpler when put this way than it actually is, and there is a considerable skill in identifying exactly what is causing a problem. This may not always be where or how the presenting condition appears to be, and can sometimes lie elsewhere. There may have been local disruptions to what we regard as normal flow in the damage you sustained which remain even though the body appears to have healed, and there may have been other mental and emotional consequences of what happened to you which have caused a problem 'downstream', as it were. These could just as easily result in a functional disturbance like loss of balance.

 The best advice we can give for unique problems such as yours is that you visit a local BAcC member for an informal chat about what may be possible. Most are very happy to give up a short amount of time without charge to assess whether acupuncture treatment is a good option, and this also has the advantage that you can meet someone and see where they work before committing to treatment.

   

Q:  I have been diagnosed with Mal de Debarquement disorder with going on 2 1/2 months of balance issues. Have tried physical therapy, chiropractic, and now acupuncture. My acupuncturist has dealt with dizziness, but no one with this disorder. Any advice to share? We have worked on the sinus, ears, etc. 

A:  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.

As you may be aware, most health professionals are more severely limited in what they can say than ever before by the advertising restrictions which are now in place to protect the consumer/patient. The criterion for being able to name what you can treat, a particular form of research trial most frequently used for testing drugs, doesn't really work well for acupuncture treatment where variables are a part of the work, not something to be reduced to zero. It might seem a little odd, then, that when nausea is one of the conditions which we can mention, and when vertigo is not far from being accepted, as our factsheets show.

Nausea and vomiting factsheet

 

Vertigo factsheet

 

that we are not just going to say 'ah yes, you'd be well advised to have treatment.'
 
One of the main reasons is that Chinese medicine works from an entirely different theoretical basis from western medicine, and the translation from one system to another is very imprecise. In Chinese medicine there are dozens of reasons why someone might experience any of the three symptoms which you mention, but no properly trained practitioner would just treat the nausea without fitting it into the overall context of your health. That is not to say that doctors don't do differential diagnoses to eliminate more serious underlying possibilities, but once they have done the range of treatments is usually fairly small. In Chinese medicine, each person is regarded as unique, and as such the practitioner will want to know the exact details of a wide range of aspects of your health and lifestyle to determine how best to put right what is going on.
 
We believe that it is very likely that acupuncture treatment is going to be of benefit, but your best option is always going to be to arrange a short visit to a local BAcC member, hopefully without charge, so that he or she can give you a brief face to face assessment of what they think they might be able to achieve. There is no doubt that problems such as yours are high up the tables of conditions for which people seek treatment, but not every case is straightforward, and our members are willing and able to refer on to other forms of treatment if they think that these are more likely to help you, based on what they see.    
 

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