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Q:  I suffer from recurrent episodes of sinusitis, which leaves me with a blocked nose and extreme headache and facial pain, often for several days/weeks at a time. I am reluctant to use medication and prefer to treat with menthol and steam which is time-consuming and often inconvenient. Can you tell me whether acupuncture has been proven to treat sinusitis?

A:  We sympathise; this 'royal we' used to suffer similarly as a child, and it is surprising how little other people regard this as a debilitating problem, preferring to see people as 'a little blocked up.' It's far worse than that.

We have produced a factsheet

which is disappointing in terms of hard evidence, because there isn't really very much. What we do find in clinical practice is that this sort of problem is very often to do with an underlying systemic problem with the fluids of the body as a consequence of which really bad blockages occur locally. Treatment, therefore, involves trying to use needles where the problem is to restore the proper flow of energy and then treating the system as a whole to ensure that what has been unblocked stays unblocked.

Chinese medicine has a very sophisticated view of the workings of the body mind and spirit as an interconnected flow of energy, and the practitioner's role is to look at the whole picture to find out what is going on. Symptoms are rarely the same as the problem itself, more often than not being alarm bells for problems elsewhere. Chinese medicine also extends to looking at the factors which contribute to problems, especially to do with diet and lifestyle, and it is highly likely that a practitioner would look at issues like this to be taken into account alongside treatment.

The best advice we can give, because each person is unique and different, is to visit a BAcC member local to you for advice. What we would say, though, based our own clinical experience is that this is the sort of problem which can be difficult to shift with acupuncture treatment, and it is very sensible if you decide to go ahead to set very clear review periods to assess what change there has been and to try to agree measurable outcomes for improvement. This helps to ensure that the treatment doesn't run away unchecked to twenty or thirty sessions without result because a kind of 'habit' sets in.

Q: Please could you tell me if acupuncture can definitely help with muscle tension dysphonia which affects the voice box, excessive mucus production and choking due to constriction of the entrance to the trachea. A: None of us could say that acupuncture can definitely help with anything. From a Chinese medicine perspective each individual has a unique balance of energies, and even where several people have the same visible symptom they could nonetheless each be treated differently depending on the patterns of disharmony in their general energy flow. We were asked earlier this year about spasmodic dysphonia which has overlaps with the MTD you describe and we replied: A: There are a very small number of studies such as these and which provide a basis for arguing that a larger scale trial would be useful. However, small scale trials are always problematic when being used in evidence for a form of treatment. Although we are not great fans of the randomised double blind control trial which is often taken as the gold standard for research, the need to take individual and unique variations out of the equation is important, and case studies on this scale can often owe a great deal to extraneous factors. However, that said, Chinese medicine has a very different way of looking at the functioning of the human body, one which rests on a theory of energy called 'qi' and its flow and circulation around the body. When blockages or deficiencies occur, this can lead to aggravation and symptoms. The Organs of the body as understood by Chinese medicine (always capitalised to differentiate them from a western understanding of organs) have a variety of functions on all levels - body, mind and emotions - some of which may have an impact on the ability to speak. One of the great strengths of Chinese medicine is that each patient is seen as unique and different, and the practitioner will look at all of the systems of the body, as well as all of the circumstances surrounding the onset of the problem, to try to understand the patterns of causation. Although symptoms can suddenly appear out of nowhere, there are often underlying issues which predispose someone to develop these symptoms. If this were to be the case with your problems, then there may be something in the overall presentation to encourage a practitioner to feel that they may be able to help to sort things out. Given that each case is unique and that research on this condition is sparse, your best bet would be to visit a BAcC member local to you for a brief face to face assessment of whether in their view acupuncture treatment might be of benefit. Even when there isn't a clear 'audit trail', the premise of the very old traditional systems was that treating the person and re-establishing balance would surely remove symptoms. This can cause problems in modern practice; it is possible to get rid of a symptom without anyone ever establishing what caused it, which some people find perplexing! The standard options, such as botulin injections, remain available to you, we imagine, but these offer only temporary relief from the problem. It would be nice to think that acupuncture treatment might offer a more lasting solution, but we have to be realistic and say that if you do choose to have some acupuncture sessions, you should set a very clear review date to make sure that acupuncture doesn't become a habit process. We have known patients to clock up a dozen sessions or more without much change because weekly bookings become a weekly pattern which easily stacks up to a large-ish sum of money. This is basically the same advice we would give now for your problem. The one factor which you mention, the excessive mucus production, is a factor in the condition anyway, but would certainly be of particular interest to a Chinese medicine practitioner because there may be other aspects of the system which are contributing to the problems you have.

A:We were asked this question a little while ago, and our answer was:

A great deal depends on what is causing the dark circles to appear. Normally we all associate dark circles under the eyes with tiredness, but assuming that this is not the case with your question, there are a number of diagnostic patterns within Chinese medicine for which dark circles might indicate an underlying weakness of energy, or 'qi' as the Chinese call it. Some people's inherited energy, for example, can have been compromised by the health of either parent at conception or by a difficult pregnancy. In these sorts of cases, their management of their life has to be a little more careful, i.e. they may not be able to manage 60 hour working weeks and party all weekend. In some cases the dark circles are a permanent feature.

The key thing to bear in mind is that this will be one symptom or sign amongst a number of others, and treatment would generally be focused on the underlying imbalance. You will see, however, a growing number of websites which promise to do away with dark circles and other signs with facial or cosmetic acupuncture. The BAcC's view is that these procedures are useful when used in the context of a traditional diagnosis and treatment of the whole system. If they are simply applied as one-off symptomatic treatments in many cases whatever gains are made will be lost very rapidly. That is not to say that there may not be cases where this is a sign of local stagnation which acupuncture might help to clear, but in the majority of cases treating the whole system would probably be necessary as well.

We cannot give out referrals to specific members who focus on this kind of work, but it is a relatively straightforward search using google to find a BAcC member in your area who also does facial or cosmetic acupuncture. There are indeed a number of organisations set up by BAcC members as support networks for people doing this kind of work, and they have searchable databases of members who have taken postgraduate training in this area. We recommend that you find someone who is both a BAcC member and trained in cosmetic acupuncture to assess whether treatment may be of benefit to your specific needs.

We think that with the benefit of hindsight we placed too much emphasis on the use of 'facial' or 'cosmetic' acupuncture.' That is not to say that this is not an interesting case of an ancient technique being used to meet modern needs, but there are more cases of darkness under the eye which are the result of a long-standing systemic weakness or simple genetic inheritance than there are case which are going to be fixed by a couple of good nights sleep and a few needles.

We would advise you to visit a BAcC member local to you, not necessarily one who uses cosmetic acupuncture, and see what they can tell you based on a brief face to face assessment.

Q: I have macular degeneration and I would like your opinion on the work of Dr. Lundgren and his Santa Fe protocol. Has no one followed this up in the U.K.? If I can obtain any reassurance I would certainly go to the States for treatment.

A: We have been asked about the treatment of macular degeneration before, and our most recent answer was:

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

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

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 we are sure that our members will be only to happy to give you advice on the basis of a brief face to face assessment.

We are aware of the work of the clinic you mention, as well as two or three similar clinics in India. However, we do not have enough independent corroboration of the results claimed to offer a view, although we have to say that the techniques in the Santa Fe Protocol are not traditional acupuncture. The use of ear acupuncture, electroacupuncture and scalp acupuncture are used by an increasing number of BAcC members, but are not within the mainstream traditional acupuncture training.

We are sorry not to be able to give you more positive advice, but it would be remiss of us to support something whose provenance we cannot check. The best we can offer by way of advice is that you try to find someone who has undergone the treatment with whom you can discuss their experience. In our experience American blog sites abound, and if someone has had a very good, or indeed very bad, experience, you are certain to be able to read about it and make contact.

Q:  Is  there  any truth in the micro acupuncture treatment for stargardt eye disease? We found many mentions of it and  the success after treatment.  Is this true?  is there anyone in the uk who  provides this treatment and  would you know roughly  the cost?

A:  The treatment of Stargardt's Syndrome with acupuncture, along with a number of similar conditions like retinitis pigmentosa, is a cause of some concern to us. There is very little research into the use of acupuncture for treating these problems, and it would be difficult to give a recommendation for treatment on the basis of what there is. At the same time there are a number of clinics using acupuncture, both in North America and in India, which claim some fairly remarkable results. We are as a consequence cautious, because although conventional medicine can often be dismissive of anecdotal evidence, it is often anecdotal evidence which points the way for more formal studies.

In the case of microsystems work you are fortunate insofar as there is a separate regulatory association for many of the microsystems, and their secretary is a BAcC member with a very sound understanding of the subtleties involved in these questions. He can be contacted through the website, and perhaps direct you to any of his constituent associations who treat this condition.

In general, we tend to take the view that with genetic conditions in which progressive deterioration is the usual outcome, one has to be realistic about what cna be achieved. 'Getting worse slower' may not sound like a very positive outcome, but as we have found when treating people with Parkinson's disease or MS, any slowing down of the disease is welcomed. There will be no research to validate claims of this kind because no-one has a clue about how fast an untreated disease may have progressed, but many patient's express a certainty that their conditions have stabilised with treatment.

Our best advice is that you proceed with caution and be rightly suspicious of any claims that sound too good to be true, because in our experience they usually are. Genetic conditions do not suddenly reverse of their own accord. If you do find someone who claims to treat this as a condition, set a very finite number of sessions with some very clear outcomes if you do go ahead. The average first session/subsequent session fee range for our members is £75/£50 in London, and £60/£40 outside London, if this helps to get a sense of proportion.

We have to say that targeting a condition as a unique problem is not the way that traditional acupuncture is practised. The underlying wisdom of the Chinese medicine system is that symptoms, of whatever kind, are simply an expression of a lack of balance in the whole system, and that in order to effect lasting and permanent change one has to work on the system as a whole. However, there are a number of conditions for which slightly more western orientated strategies have developed, especially in the microsystems acupuncture world, and their continued use suggests that there may be something which this approach can offer for a number of problems where someone's health is otherwise fine except for the unique presenting problem.

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