Headaches
Headaches can be due to a multitude of factors; arthritis of the neck, dental problems, sinusitis, stress and tension, and head injury are a few of the many causes. Headaches have been dealt with as a separate section because they are so common and they span many of the 'body systems'.

Migraine is a particular type of headache and worthy of special mention. Migraine can be induced by a variety of stimuli such as foods, noise and stress, and such headaches are usually accompanied by severe incapacitating pain, nausea, vomiting, and visual patterns or flashes in front of the eyes. Many people describe severe 'tension headaches' as migraines and although these headaches are not strictly migraines, the dividing line between other headaches and migraine is frequently rather woolly. Migraine is probably best thought of as a severe headache associated with nausea.

Headaches are a common complaint and a notoriously difficult one to treat effectively, and they can be the cause of a considerable amount of distress and marital disharmony. Acupuncture has been used to treat a wide variety of headaches, particularly migrainous headaches, and the results obtained have been very encouraging. The published work suggests that between 65-95 per cent of all headache sufferers obtain significant and long lasting pain relief from acupuncture treatment. Migraines seem to respond as well as, if not better than, other types of headache.

Acupuncture therapy for headaches may cause the headaches to vanish completely, or occur with a markedly decreased intensity and/or frequency. The pain relief resulting from acupuncture can sometimes be maintained for some years and re-treatment is usually required less frequently for headaches: than for other conditions such as osteoarthritis.

Diseases of the Nervous System

Strokes
A stroke is caused by a disturbance of the blood supply to the brain. The blood vessels that normally supply blood to the brain can be compromised by becoming blocked or bleeding. This results in a deficient blood supply to the brain tissue and these events can be precipitated by a variety of factors such as raised blood pressure, hardening of the arteries and severe head injury. The brain is divided into many different functional areas, one area controlling speech, while another dominates the sensations of touch and pain. The functional impairment that occurs with a stroke depends on the area of the brain that is damaged; if the speech area is damaged by a lack of blood supply then the patient may be unable to speak properly. In China, acupuncture is the standard treatment for strokes. In the West, the mainstays of stroke treatment are speech therapy, physiotherapy and occupational therapy, but the Chinese feel that these methods have less to offer than acupuncture. Both scalp and body acupuncture are techniques that can be used to aid recovery from a stroke. The research work so far completed suggests that acupuncture increases the blood supply to the brain, and for some unexplained reason this seems to improve functional ability and acts as a stimulus to recovery after a stroke.

Clinical trials completed by the Chinese state that some effect can be gained from acupuncture in about 80 per cent of strokes. These trials are difficult to interpret clearly as a significant number of stroke patients recover spontaneously; furthermore, the Chinese trials are poorly designed and the exact definition of the success and failure of treatment is unclear. The success rate claimed is very high but to some extent this success rate is mirrored by the experience of a variety of doctors in the West. Whatever criticism one has about Chinese research methods, Western medicine often has little to offer the stroke patient and therefore acupuncture is always worth considering. Ideally strokes should be treated within six months of the damage occurring. The patient may continue to benefit for up to two years after the stroke but, as a rule, acupuncture can effect little improvement if the damage has been present for more than two years.

The Neuralgias
The neuralgias are a collection of poorly understood and frequently painful conditions. The more common and clearly defined types of neuralgia will be discussed in the following section.

Trigeminal neuralgia usually presents with severe unilateral facial pain. Its cause is unclear but the painful facial spasms are often precipitated by cold or wind. The Chinese claim to be able to gain some improvement, with acupuncture, in about 70 per cent of cases of trigeminal neuralgia. Judging by the experience of Western acupuncturists this success rate represents a rather high figure, although acupuncture can undoubtedly have a beneficial effect on this type of pain.

Postherpetic neuralgia is the pain that occurs after an attack of shingles. Shingles is a viral infection of the nerves, and the nerves affected by shingles can occasionally continue to cause severe pain after the shingles has cleared.

Postherpetic neuralgia is an uncommon disease in China; this may be because the Chinese treat all cases of shingles with acupuncture before the postherpetic neuralgia can develop. There are other possible explanations for its decreased incidence in China, perhaps postherpetic neuralgia is affected by diet, or racial characteristics; however, it is much more reasonable to suggest that the dearth of postherpetic neuralgia in China is due to the daily treatment of shingles with acupuncture. It seems that of those patients with established postherpetic neuralgia, about 40 per cent gain some degree of long term benefit from acupuncture. If this figure could be substantiated with proper clinical research work, it would represent a significant advance in the treatment of this condition.

There are a vast number of aches and pains that are often described as neuralgic. Many of these occur as facial pain and most of them cause severe discomfort. It is always worth while to attempt to alleviate these pains by using acupuncture. Some people respond and others do not; it is impossible to give figures for success, or even estimates, without going into great detail about the exact cause and type of neuralgia being treated.

Anxiety, Depression and Other Nervous Disorders
It is difficult to be objective about the treatment of disorders such as anxiety and depression, as the problems themselves are difficult to assess objectively, and therefore no good clear figures are available about their treatment with acupuncture.

In spite of this, many acupuncturists, including the Chinese, treat a wide range of 'mental disorders' with acupuncture. Many people have stated that acupuncture is clearly effective in helping symptoms such as insomnia and bed-wetting, and can also create a feeling of general well-being. Patients who receive acupuncture for specific problems, such as ankle pain, will often note how well they feel after the treatment. It would be very misleading to give figures of 'cure rates' for these problems because such disorders naturally relapse and remit, often improving when a sympathetic listener becomes involved. I think it is fair to say, however, that acupuncture can sometimes effect mood changes that help these problems significantly. The Chinese have completed trials on some of the more clearly defined and serious mental diseases, such as schizophrenia. In a trial involving over 400 patients they claim a 54 per cent cure rate for this disease, with a further 30 per cent showing 'significant improvement'. These figures are exceptionally high and, if correct, are most interesting. Their criteria for evaluating a 'cure' or a 'significant improvement' are not clearly stated and so it is difficult to be sure whether these results are valid. Many claims have been made for the effects of acupuncture in the treatment of a variety of 'nervous disorders' but, sadly, there is no good hard evidence to substantiate or refute such claims; however, from a variety of excellent research papers it is clear that acupuncture can influence quite radically many areas of the central nervous system. This work is of a purely scientific nature and at present it is not directly applicable to the clinical effects of acupuncture therapy.

Nerve Paralysis
There are three major types of nerve destruction that cause paralysis. Children may be born with an incomplete nervous system, such as spina bifida, an accident may occur that destroys part of the nervous system, or a disease may be present causing destruction or dysfunction of nervous tissue.

Chinese research workers claim that acupuncture can be used to treat the symptoms of spina bifida, such as incontinence, although no claim has been made that acupuncture can affect the anatomical abnormality. Traumatic paralysis, due to accidental destruction of the nervous system, can also be treated by a variety of acupuncture techniques. The acupuncture must be continued for a long period, sometimes daily for six months, but the results from some of the Chinese work are encouraging. They claim that some 50-60 per cent of patients are likely to gain significant return of function if treated with acupuncture, but it is wise to remember that a good number of these injuries would allow the spontaneous recovery of significant function. Facial paralysis (Bell's palsy) is a disease of sudden onset that causes one side of the face to lose muscular power; the cause of this is unknown. Acupuncture and moxibustion can be used to treat this and the Chinese claim a 75 per cent complete recovery rate but, again, this disease allows a significant percentage of spontaneous recovery. The Chinese also claim that a further 20 per cent gain benefit from acupuncture, although not complete recovery. Even allowing for the known level of spontaneous resolution in facial paralysis it does seem that acupuncture has something extra to offer.

Other Nervous Diseases
Acupuncture has been claimed to be effective in Parkinson's disease, nerve deafness, and a large variety of other problems. Some of these claims are far from proven (or disproven), but it is always wise to remember that acupuncture is a harmless technique and can sometimes give excellent results where other medical methods have failed.

Diseases of the Digestive System

There has not been a great deal of good clinical research work published about the effects of acupuncture on the digestive system, so it is difficult to be sure exactly how useful it is in such diseases. This section is therefore deliberately rather vague as it is far more sensible not to quote exact facts and figures when there is little evidence to substantiate them. Animal experiments, both in China and the West, show quite clearly that acupuncture does have an effect on the digestive system, and in spite of the lack of clinical research there are good grounds for believing that acupuncture can influence a variety of disorders within this system.

Indigestion
Indigestion is a symptom rather than a disease, and can be caused by a variety of factors such as over-indulgence, stress and acid regurgitation. It is important to investigate long standing indigestion so that the exact reasons for this symptom can be clearly defined.

Acid regurgitation is one of the commoner causes of indigestion and often presents with symptoms such as heartburn. The sensation of heartburn is caused by irritation due to the acid reflux from the stomach into the tube connecting the stomach to the mouth (the oesophagus). This syndrome may be called a 'hiatus hernia' although a variety of other names can also be used to describe exactly the same symptoms.

Acupuncture is not the treatment of choice for all types of indigestion. For instance, the best treatment for over-indulgence is to eat less, but some other causes of indigestion such as hiatus hernia and stress are definitely amenable to acupuncture therapy. Exact figures for success rates are not available, but the 'clinical impression' that arises from a number of acupuncturists indicates that about 60 per cent of patients gain some long-term relief of their symptoms with acupuncture. Symptoms do recur and usually require re-treatment after about six to twelve months.