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92 questions

Q:  Please could you forward details of an acupuncturist qualified to treat lingual nerve damage. The nerve was severed during a routine wisdom tooth operation.  I subsequently had microsurgery to rejoin the nerve.  Although the nerve was rejoined I still suffer continual chronic pain on the left side of my tongue

A:  We are afraid that we cannot give specific recommendations for individual practitioners, although using our postcode search function on our home page www.acupuncture.org.uk will generate a significant number of names. The more important point, though, is that from a Chinese medicine perspective, there are very few areas where we acknowledge specialist practice. At the moment the three categories of patient for which we believe it may be possible to define expert practice are children, pregnant women and people with mental health problems. For all other patients, every BAcC member is equally well qualified to treat any patient because the skills of Chinese medicine rest in treating the person, not the named conditon. Indeed, ancient China the generalist practitioner was held in much greater esteem than the specialist who was seen as markedly inferior in the narrowness of the focus of their practice.

As far as your specific problem is concerned, there are many studies for the use of acupuncture in the treatment of chronic pain, as our factsheet shows:

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

but very few studies which we can trace for the use of acupuncture in the treatment of lingual nerve damage. There are a number of studies which look at sensory deficit after dental surgery, but only one which were able to trace which appeared to indicate that acupuncture has been used for this specific problem but with unclear results.

However, it is fair to say that much of the research into conditions like this is conducted within conventional medical research facilities which use a far less sophisticated form of acupuncture than that used by Chinese medicine practitioners. There are a number of different ways of addressing problems such as yours, from a local problem caused by energetic disruption inherent in any surgery through to level of shock caused by the procedure through to a more widespread weakness in the system which impairs healing throughout. The skill of the Chinese medicine practitioner lies in making sense of the complex pattern which each individual represents, and treating with the best focus for achieving sustainable change.

The best advice that we can give is that you visit a BAcC member local to you and ask for a brief face to face assessment of what they think they might be able to achieve. In cases like yours which are quite rare it would be sensible, if you did decide to go ahead with treatment, to set some very clear review stages at set points to assess progress, and also to try to set measurable outcomes. This avoids the course of treatment meandering on without apparent benefit, which in our experience invariably leads to bad feeling.

Q: I have pulsatile tinnitus, it is extrely distracting as I can hear my heartbeat in my ear constantly. The only thing that eases it is putting pressure on my neck near my ear. Would acupuncture be of any help to me?

A:  Although our factsheet on tinnitus is relatively upbeat
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html
 
our own clinical experience of treating the condition is that unless it relates to one or two very specific syndromes, tinnitus can be one of the more intractable conditions. There is no doubt in our minds that acupuncture treatment can often make the tinnitus sufferer better able to handle the problem, but shifting the problem itself is a more difficult problem. As the various support group magazines ably demonstrate, there is always something which works for some people but nothing that works for all people, so you will often read articles that suggest that almost anything you may name can work. Cynics tend to take the view that tinnitus can often disappear of its own accord, and like pass the parcel, whatever someone happened to be doing as a treatment at the time is given the credit. This may not always be far of the mark.
 
However, pulsatile tinnitus is a much more specific presentation, and although tracing which blood vessels may be causally related to the condition is difficult, from a Chinese medicine perspective the sense that there is blockage and constriction in an area is one with which a practitioner could work from a Chinese medicine perspective. One of the strengths of Chinese medicine is being able to take the symptoms which a patient experiences together with some of the signs with which they present and make a diagnosis of patterns of imbalance within the system which treatment may be able to adjust or correct. This can result in improvement.
 
To make this assessment, however, someone would have to see you face to face, and the best option is to use our find a practitioner option on the home page www.acupuncture,org.uk and arrange to see a BAcC member local to you for a brief assessment. We also think that you might want to hold in reserve a possible referral to a cranial osteopath. If there has been some change in the subtle structure of the skull this may be affecting blood vessels locally and causing the condition. Cranial osteopathy may be another possible modality for trying to address this problem.
 
 

A:'Balance problems' is probably not quite enough for us to go on to be able to offer you specific advice. There are a number of reasons why someone's balance may be starting to fail, and these can range from problems like vertigo and inner ear infections to muscular weaknesses to neurological disorders, and so on. There is no formula for 'balance' as such, and a BAcC member faced with someone who had balance problems would want to know the same things that your GP would ask, such as:

When did you first notice the problem?
Did it come on slowly or start quickly
When does it happen?
Are there any triggers you have noticed which make the problem come on or get worse?
Have you found anything which seems to help?

and so on.

Once a practitioner has this sort of information, they can begin to make sense of it within their diagnostic framework, be it Western or Eastern.

Within Chinese medicine, which has just as clearly defined an understanding of balance problems as western medicine, there may be other aspects of your general health and well-being which enable the practitioner to place your problem within the context of what is happening within your own system, and make treatment that much more strategically precise.

However, we have to be honest and say that at your age there is going to a slight deterioration in your ability to balance anyway, and the real issue is the extent to which what you are experiencing is over and above what a normal 70-year old should feel. We would advise that you talk to your GP as a matter of course because there are a number of neurological issues for which a loss of balance can be a symptom which acupuncture treatment may not be able to help, and you need to make sure that these have been discounted or, if present, treated promptly.

After that we suggest that you visit a BAcC member local to you and ask their advice, based on a brief assessment of what they can find, on whether acupuncture treatment may be of benefit to you.

Q: I have just been diagnosed with an acoustic neuroma and they have decided to wait to see if the tumour grows.  A symptom  of this is deafness and tinnitus in my left ear.  I have read that acupuncture  can help. How would I go about finding a suitable therapist?

A:  As far as finding a suitable practitioner is concerned, that couldn't be easier. If you go to our homepage www.acupuncture.org.uk you will see a search facility called 'find a practitioner' which can be used with postcodes or with area names to find someone close to where you would prefer to have treatment. All BAcC members are fully trained and qualified, and all are covered by the BAcC's bloc professional indemnity insurance cover.

As far as the acoustic neuroma is concerned, there are very few reliable studies which would enable us to venture an opinion based on evidence. Some of the support websites cite a number of case studies, and there are one or two accounts of auricular acupuncture being used to help deal with the problem, but nothing which meets the standards of evidence which we have to meet to be able to recommend acupuncture.

Tinnitus and deafness are, in our view, quite difficult to treat. In TCM, one of the styles of acupuncture used frequently in the UK, there are a couple of specific syndromes where tinnitus forms a part of a collection of symptoms, and in these cases one could say that there is a chance that the problem will be helped. In cases where tinnitus is caused by a physical obstruction or locally situated problem, as in a neuroma, or where it is idiopathic (medical speak for 'it just happens') we are not very convinced of its efficacy, and this particular expert will only venture four or five sessions before drawing a line in the sand.

However, while it has become more commonplace over the last decade to discuss the named conditions which acupuncture can or can't treat, we must not forget that in ancient times and in authentic modern versions acupuncture treats the person, not the disease or condition. Chinese medicine is based on an understanding of the body mind and emotions as a system of energy, called 'qi', whose flow, rhythms and balance determine health. Symptoms are simply signs that the system as a whole is out of kilter, and addressing the overall balance should, in theory, help to resolve all symptoms. One has to be careful because this can get mistranslated as 'acupuncture can treat anything' and give unreasonable and false expectations, but to the extent that it treats people, not things, it does give some hope in nearly all examples of imbalance, even if this is simply a matter of getting worse slower.

The best advice, as we always say, is to visit a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture treatment may be of benefit. Most members are happy to give up a few minutes without charge so that they can offer a realistic assessment, and from a prospective patient's perspective it is always good to be able to meet the person and see where they work before committing to treatment

Q:  Can acupuncture help with macular degeneration? I have an elderly relative who believes there has been some recent research but I cannot find it. I am concerned that she may be asked to pay a considerable amount with little evidence of it working, but we are both very open to alternative medicine. She lives in Cambridge

A:We conducted a search and the best we could come up with

http://www.ncbi.nlm.nih.gov/pubmed/21355157

a study in Chinese which appears to demonstrate that acupuncture out-performs conventional medical treatment. Otherwise the only direct reference is a Cochrane Review summary which identifies the fact that there is a systematic review or similar on their files as pending

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705651/

With conditions like this there are a number of difficulties involved in answering the 'does acupuncture work?' question. From a Chinese medicine perspective, although twenty patients may have the same named western condition there could be twenty different treatments. The symptom from this perspective is merely the weak link where an overall imbalance tips something into poor or degenerating function, and although local treatment could achieve some useful short term gains, helping to improve the underlying balance is the key to getting well and staying well. This involves treating the person as much as treating the disease.

Conditions like this can often become unintentional money pits, and it is easy to build up a treatment habit based more on hope than experience. Practitioners are often inclined to fall into the same trap in pursuit of better health for their patients. The best positive result one might achieve could be a decrease in the extent of deterioration, or as one patient put it once, 'do you know, I think I'm getting worse slower'. Of course, this is unverifiable and largely unmeasurable, but there is no doubt that many patients have reported anecdotally that they have exceeded the expectations of their clinicians in maintaining reasonable function longer than anticipated. Naturally there are a great many other factors which make this possible, not least of which is that seeking complementary treatment is itself evidence of a determination to do something which is probably reflected in someone's overall health.

From a Chinese medicine perspective the eyes as a functional unit have close relationships with two or three major Organs (capitalised to differentiate them from the western concept of an organ) and if there is evidence of a generalised weakness in relevant related Organic functions, a practitioner might think that there is some hope that treatment may be of value. There is also plenty of discussion in Chinese texts about local needling and its potential to halt or even slightly reverse decline.

We have to be realistic, though. The kind of deterioration which this condition causes is well-documented as likely to continue, and it would be a foolish practitioner who tried to instil too much optimism in a prospective patient about the chances of major improvement. However, it is always worth while talking to a BAcC member local to you, and there are some very good ones in Cambridge, who we are sure will be only to happy to give you advice on the basis of a brief face to face assessment of your mother's situation.

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