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Sandy Williams

Sandy Williams

A:There are very few restrictions on the practice of acupuncture in the UK, and there is what is described as a common law right to practise freely. In the absence of statutory regulation or state registration the only legal requirements are for registration or licensing by local authorities. This is primarily concerned with the standards of hygiene and safety for acupuncture as a skin piercing activity, although in more recent times many local authorities have become much more assiduous in checking that practitioners are properly trained and insured. Your training and registration in the US far more than meets the basic requirements for suitable training.

In the Greater London area the London Local Authorities Act 1991 applies, which means that you would have to obtain an annual licence at about £200 - £400 to practise. If you belong to an exempt body such as the BAcC, you do not have to pay, although you have to notify the authority of your presence and they will probably inspect the premises.

Outside London the Local Government Miscellaneous Provisions Act 1982 applies. This means that you have to be registered for every practice in which you work. Registration is a one-off process, costing again £250-£500. Only doctors and dentists are exempt from this Act.

In Scotland an annual licensing scheme exists similar to that used in London, but the only exemptions allowed are for those healthcare professionals like physios and nurses who are already state registered. BAcC members have to pay. This has been a bone of contention for many years, but we remain hopeful that we can negotiate exemption.

Your registration in California is one of the tougher ones in the States, but unfortunately there is no reciprocal recognition of qualifications as yet, so application to professional associations will almost certainly be through the individual 'external applicant' route, details of which you can find on our website. There are a number of other professional bodies whom you would be qualified to join, but we believe that we are the main and most respected regulator of Traditional Acupuncture in the UK and would hope that you would join us if you re-locate to the UK.

Q: Is  there any evidence to support the use of acupuncture for the treatment of hereditary neuropathy with pressure palsy either as a preventative measure or during an episode?

A:If by evidence you mean appropriately conducted trials, the answer is no, at least as far as we know in the West. Research into acupuncture is not as commonplace as we would wish for a number of reasons, and when trials are conducted they tend to be for conditions where a substantial number of individuals can be gathered with exactly the same symptoms. HNPP is not very common. It is possible that there have been some research in China, but the vast majority of papers are not translated, and are often methodologically unacceptable in the west, working as they do from the assumption that acupuncture works and often more concerned with what works better, rather than checking whether it works.

That said, the two systems of medicine, conventional and Chinese, are based on entirely different conceptual bases, and the framework of Chinese medicine, based on the understanding of all phenomena as embodiments of energy (called 'qi'), can occasionally offer ways of interpreting and treating symptoms where conventional medicine has no answers. Advanced as Chinese understanding was in ancient times, it had none of the sophisticated interpretation of neurological disturbances which we have but looked at them through the framework of energy flow as a failure of local flow often predicated upon weaknesses in the flow of the whole system. Using needles to restore flow could help to reverse the deficiencies and blockages from which symptoms developed.

However, one has to be realistic with hereditary genetic conditions. Chinese medicine also has its concepts of genetic inheritance in the energy which is transmitted from parents to child in its creation, and while all energy is technically mutable, our experience is that inherited patterns are often quite difficult to treat and just as resistant to change as genetic conditions as understood in the West. Never say 'never', though. Our experience is equally that an although an imbalance may have been handed down from parent to child this does not that it becomes more greatly untreatable.

We would not want to generate false hope or expectation, though. As we said in an answer to a question about peripheral neuropathy:

Q: Is there any evidence that acupuncture can help with peripheral neuropathy?

A: There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet 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 achevement 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 remains the best advice we can give you. A practitioner may see something in your state of balance which is a basis for treating the system as a whole with some expectation of change, however limited. The question may well be how much change and how sustainable. If it managed to quell the worst symptoms during an attack, which based on evidence for acupuncture and pain relief may be possible, then treatment may be very worthwhile.

Q: I have just had replacement shoulder surgery following a fall.  I have lots of aches and pains in my lower arm, wrist and elbow.  Would acupuncture help with the pain relief?

A: We often get enquiries in practice abotu problems such as yours. Any kind of fracture and subsequent surgical repair can lead to a number of aches and pains in the surrounding tissue and especially, as in your case, in muscles and tissues 'downstream' of the area of the injury.

We use the term 'downstream' advisedly. The theory of Chinese medicine is based on an understanding of the body as a system of energy, called 'qi', in movement through well-defined pathways. These are variously called channels or meridians, and as the names suggest, they need to be maintained and flowing for all the functions of the body to perform as they should. Where is a break, and especially where there has been surgery, there is always a chance that the flow has been disrupted, with consequent pain in the area and occasionally a disruption of organic function as the gradual weakening of the flow causes internal organs to under-perform.

This can especially be the case where there has been the formation of scar tissue, and treatment can often be quite simplistic, rather like 'joining the dots'. However, a practitioner will always be interested to see what makes one individual heal more quickly than another, and there may well be deeper underlying reasons in the whole system which have interfered with normal healing. This is one of the great strengths of Chinese medicine. In treating the person rather than the condition it can make sense of the great differences in people's rates of recovery by seeing the problems within the context of the overall pattern.

The one factor to take into account is that the shoulder is a very unstable joint. The ball and socket is not that well-defined in bone itself and the stability of the joint as a whole depends on layers of over-lapping muscles. Anything which disturbs the exact balance of these muscles can cause a large number of problems in the muscles which travel over the joint, rather like disturbing a cat's cradle in the childhood game. There may be a need for some form of massage to encourage the muscles to return to better function. Many members offer a form of Chinese massage, called tui na, alongside their acupuncture treatment, but most will know local massage therapists who may be able to help you if they feel that this is what you need.

Q:  How do I find an acupuncturist who specialises in chronic pain (resulting from a car accident - spine and shoulder injuries). The only treatment offered are morphine based pain killers, which is not very appealing as it impedes ability to work and drive.

A:The important point to make is that from our perspective all of our members are equally well equipped to treat chronic pain. The nature of Chinese medicine is that it treats the person, not the condition, and although as in your case the problems do not arise from within the system itself, the ability to maximise your system's ability to heal itself would in our view be an important factor in your recovery. All of our members are trained to the same high standard, and there are oly a very few areas of work where we are beginning to recognise that there may be scope for postgraduate training to underpin expert practice, such as paediatrics or obstetrics.

As far as chronic pain is concerned, there is a substantial amount of evidence that acupuncture can be beneficial in providing pain relief. This rests largely on the fact that acupuncture became more popular in the West research into its effects focussed on pain relief because the outcome measures were relatively easy to assess, both the chemical ones such as neurotransmitters and also the patient assessment of their own levels of pain. We have produced a factsheet

which highlights some of this research, but while the experimental, i.e lab, results have been good, the more elaborate trials have been more equivocal. We believe that this owes a great deal to the trial designs, though; using formula treatments to achieve results is far removed from traditional practice.

However, as we said earlier, traditional acupuncture treats the person, not the condition, and this means that the best advice we can give you is to visit a BAcC member local to you to seek a brief face to face assessment of how they think treatment might be of benefit to you.

Our feeling about this is that acupuncture treatment will always bring you some relief from chronic pain. The only question is how much relief it provides and how sustainable the changes are. Although it might be positive boon to be pain free for a couple of days, if this is all that treatment can manage it is probably not financially sustainable, unless the patient has very deep pockets. BAcC members will always maintain a rolling review of chronic cases to ensure that their treatment remains focussed and that a treatment 'habit' doesn't lead people into expenditure beyond what they had intended or expected.

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Tuesday, 30 September 2014 11:47

Cam acupuncture help Guillian Barre syndrome?

Q:  GBS Guillian Barre syndrome -  I  have had two rounds of VIG treatment and again my weakness is increasing.  Can accupuncture help me?
How do  find an accupuncturist who would know about trating guillean barre syndrome?  Is accupuncture treatment given under the NHS?

A:As you might imagine, we have been asked about many conditions already, and the last response we gave to a question about Guillain Barre syndrome was:

Q: I suffered with guillian barre syndrome, I have foot drop in my left foot and tight calves. Would acupuncture offer any relief?

A: Many of the symptoms which persist after an episode of Guillain Barre syndrome spontaneously remit within a year, so it is unusual and unfortunate to be troubled by residual effects.

There is not a great deal of research evidence of the treatment of Guillain Barre syndrome, although a group of Chinese researchers have posted a protocol for a review about to take place

which might produce a better picture once they have searched the databases for information.

To answer your question really means to look at what traditional Chinese acupuncture attempts to do, and that is to reinstate and maintain the flow of energy, 'qi' as it is called, in the body to ensure that everything functions as it should. Conditions like Guillain Barre which interfere with the normal flow in the muscles and tendons are seen in Chinese medical thought to be causes of blockage and deficiency, and at a very simplistic level the treatment is aimed at reinstating a blocked or missing flow. Of course, in practice things are a little more sophisticated than that, because the practitioner will want to know what happened to the system as a whole to let these particular symptoms appear where they did, and to decide whether it is really a local problem or one which requires a more subtle and systemic approach. Any condition involving a change in muscle tone or function may be benefited by acupuncture, though, and even the western medical acupuncture tradition sees this as a worthwhile intervention.

However, one important factor to bear in mind is that in a small percentage of cases residual symptoms not only persist for a great deal longer, but are sometimes intractable to treatment. If you did decide to give treatment a go and contacted a BAcC member local to you, it would be very important to establish very clear outcomes in order to assess whether the treatment is having an impact and a very clear sense of how many sessions to have before reviewing whether there has been progress and whether it is sustainable. It is in everyone's interests to ensure that, in Dr Johnson's famous words, continued treatment is not the triumph of hope over experience.

Our advice remains substantially the same. We have heard anecdotal evidence of successful treatment and also anecdotal evidence of prolonged treatment which has had no benefit at all. Chinese medicine works on an entirely different theoretical basis, however, and a western-named disease or condition could be diagnosed in many different ways. This will obviously have a direct bearing on how successful treatment may be. The best advice will always be to see a BAcC member local to you for a face to face assessment of what might be possible.

From our perspective, all of our practitioners are equally well qualified to treat all conditions. Chinese medicine treats the person, not the disease, and so there are relatively few areas where we recognise the importance of specialist training (paediatrics and obstetrics are two that we are researching). This means that you can be confident that anyone you identify near to you will be equipped to handle your problems.

As for getting acupuncture on the NHS, this is more of a problem. Most NHS personnel who offer acupuncture, generally doctors and physios, are limited to treating conditions for which there is good evidence and which fall within their scope of practice. You might just find that if you are offered physiotherapy that your practitioner mighy use acupuncture as a part of the package, but the chances are that they will not be using Chinese acupuncture, or at least, not Chinese acupuncture as we understand it. Many healthcare professionals now use Chinese points but often do so in a very formulaic cookbook way, and this will never be as effective as these points used within the framework of Chinese medicine itself.

A:There are very few research papers for the treatment of spondylitis with acupuncture, and those which have become available are generally Chinese studies which are both small and often methodologically flawed. A good example is this one:

This does not mean that it has no significance. The problem is that in the West there is more focus on the 'does it work?' question rather than, until recently in China, a focus on 'what works better?'. When you are using a two-thousand year old tradition which is embedded in the culture the use of the western drug testing model, the randomised double blind control trial, is not likely to be your model of choice. This latter test is not entirely appropriate for testing acupuncture, because reducing the variables to one is inconsistent with how good acupuncture is practised, so unsurprisingly the number of meaningful trials is limited.

That said, pain relief was one of the most heavily tested aspects of acupuncture treatment when it became more popular in the West, which is generally taken to be after Nixon's visit to China in the 1970s. The outcome measures for research purposes, the various neurotransmitters, and the patient reports of pain are easily measured, and many studies were done which showed that acupuncture does have an effect on the experience of pain. Our fact sheet on chronic pain

cites a number of the better known ones.

The main issue with using acupuncture for pain relief is weighing up the extent and sustainability of te relief against the cost of treatment, to put it bluntly. If, for example, treatment offers 48 hours of pain free life followed by a couple of days of bearable pain, then someone with deep pockets might find acupuncture treatment a reasonable investment. The vast majority of us, though, are not in this position, and also the greater majority of practitioners tend not to like to continue treatment indefinitely if there is no sign of a permanent reduction in the levels of pain.

The key aim with a condition like spondylitis is not a reversal of the fusing of vertebrae ultimately caused by the condition but a breaking of the cycle of inflammation which tends to sustain itself, i.e, inflamed areas press against surrounding tissue and further aggravate the inflammation. If treatment, whether by medication or acupuncture, can break this cycle there is a chance of maintaining a level of manageable pain.

The disease label covers a wide range of presentations, and you would need to see a BAcC member local to you for a brief face to face assessment of whether treatment would be worthwhile for you. From a Chinese medicine pesrspective there are also a number of systemic problems which can underpin what is in effect a local problem, and a practitioner will be able to assess quite rapidly what else may be going on in the system to inform the diagnosis in Chinese medicine terms and to give a clearer sense of the prognosis. He or she, if you do decide to have treatment, will be very clear about setting clear outcome measures to see whether the treatment is working, and regular review periods to assess whether treatment continues to be of benefit.

Tuesday, 30 September 2014 11:40

Can acuuncture help lumbar spinal stenosis?

Q: I have been diagnosed with lumbar spinal stenosis.  I find it difficult to stand for any  length of time or walk any distance. I have to sit because of a severe ache in my  lower back.

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

Q. Following an MRI scan I have been diagnosed as having "central canal stenosis with degenerative changes at L4-L5 level and moderate disc herniation". I have difficulty walking more than 200 metres. Is it at all likely that acupuncture would have a significant positive effect?

A. We are sorry to hear of your difficulties. We were asked this question many years ago, and our advice has not changed that substantially. Back then we wrote:

Lumbar canal stenosis can manifest in many symptoms dependent on the extent of the stenosis. Our colleagues in America are very upbeat about the potential for success in treating lumbar canal stenosis; if you google 'lumbar stenosis acupuncture' you will see an article on the site which speaks positively of success rates, as well as an 'acupuncture today' listing which also gives good cause for hope.

Personally we tend to take a slightly more guarded view of the chances of success, and base our own prognoses on gathering as much information as we can about the condition - how long the person has suffered from it, is it degenerative, does it have peaks and troughs, has it been exacerbated by accident or trauma, and so on - before committing to treatment. Even though we are working with entirely different diagnostic systems, if a condition has some very severe manifestations based on irreversible physical change, the expectations of a 'good' result have to be lowered accordingly, even what might count as a 'good' result.

The best advice that we can give is that you discuss this with a practitioner whom you might consider seeing and ask their advice. Many of our colleagues are happy to discuss someone's concerns with them rather than book them straight in, and a significant number are happy to set aside a few minutes to meet someone and offer a more informed view of whether they can help based on a rapid assessment of the actual presentation.

Since we gave this advice there have been a number of studies such as this one :

which give some cause for optimism, although finding a UK practitioner able to deliver this particular form of treatment may take some doing. The most recent systematic review

is much more guarded in its views.

However, it is often possible that the symptoms from which people suffer are not directly related to a physical change in the same area. We find that many people are told that arthritic changes in the lower spine are responsible for their chronic low back pain, but we often see the pain reduce or vanish without any accompanying physical change. Acupuncture has, in fact, been accepted within NICE guidelines as an effective treatment for the treatment of chronic low back pain, and the evidence base is certainly more compelling than for many other western named conditions. Our fact sheet on back pain
gives more background.

The best advice we can give remains the same - visit a BAcC member local to you for a brief face to face assessment of whether they think you might benefit from acupuncture treatment.

still represents the clearest expression of what we think may be possible. Stenosis tends not to be reversible, and it would be unwise to encourage too much optimism about the possibility for change and improvement. However, we have to remind ourselves sometimes when we take on case with very fixed western names and well determined causes that we are working in a paradigm of medicine which starts with the patient's experience of their pains and discomfort and then works towards an understanding of that through the lens of Chinese medicine. As we said in the earlier response, not every experience of disease is necessarily reducible to the physical findings which are discovered through investigation. Although most are, there remain some where treatment with acupuncture may have a significant impact.

We can only repeat what we said in the earlier reply: ask a BAcC member local to you for advice. Most are more than happy to give up time without charge to discuss with prospective patients whether treatment may be of benefit to them.

Q:  I have a number of odd ailments, all on the left side of my body. I have problems with a molar on the left side, several enlarged (about 2 cm), but painless lymph nodes (which have been biopsied and found benign) on the left side of my neck.  Recently i had an ear infection in my left ear, and I've found a lump in my left breast that I'm having an ultrasound on next week, but I'm pretty sure they will find benign too. I have also broken out in spots on the left cheek and left side of my chin.
 I have 3 children, and started trying for our 4th child in February 2013, but have suffered 5 miscarriages since and still no successful pregnancy. I was told when I had my first miscarriage that I had ovulated from the left ovary, which didn't seem to bear any meaning at the time, but I'm now wondering about the coincidence of it all.
> My question is - do these one sided problems indicate acupuncture could help me? Is there a blockage somewhere? I don't know much about acupuncture, so this is guesswork.

A:Difficult question!

There is absolutely no doubt that one-sided problems, or an accumulation of problems on one side of the body, are diagnostically significant. In all forms of traditional acupuncture the balance between the bilateral channels is taken seriously, and weaknesses are both identified and corrected by attending to the subtle differences between the flows of energy on each side. In some systems, indeed, like Japanese meridian therapy, there are specific disruptions to the flow of energy around the central axis of the body which arise from accidents which can lead to a long list of what we might call 'non-specific' problems, i.e. where a joint doesn't move as it should but without a specific tendon or ligament being clearly identified as the source of the problem.

However, the problems from which you have suffered and from which you are suffering could be the result of random chance in terms of location; there has to be someone somewhere who has thrown a coin 'heads' ten times in a row, and it may be a simple coincidence that you have had a succession of left-side problems.

That said, this is a fairly good spread of conditions in a number of separate systems which suggest that there may be a specific energetic reason for them all to occur. A Chinese medicine practitioner, from whatever tradition or style, would be looking carefully at the other main diagnostic signs like tongue and pulse for evidence of what is going on, and may find that palpation of some of the channels for different sensitivity informs their findings.

We see many hundreds of questions each year, and there are some which whet our curiosity as practitioners because we find them intriguing, especially where conventional medicine cannot usually find any reason for things to be as they are and would probably be dismissive of the idea that all of these problems could have a common source or have arisen against a backdrop of general weakness on one side of the body.

The one note of caution, however, is that the problem with repeated miscarriages may have nothing to do with a weakness on one side of the body. If the desire to conceive again is top of your priorities, we would be a little surprised if this aspect of laterality was directly causally linked. There may, though, be other related energetic reasons why this is happening, and also may simply be a poor balance within the system as a whole, and the basic premise of Chinese medicine, that where balance is restored symptoms resolve, may may treatment worthwhile in any event. A growing number of our members mow take postgraduate training in all things obstetric, and focus their work on the pregnant, or hoping to be pregnant, women.

Our best advice is to seek a brief face to face assessment with a BAcC member local to you. Most are more than happy to give up some time without charge to discuss with a prospective patient what acupuncture may be able to do for them, and we are fairly sure that they will be as intrigued as we are.

Q:  Can you advise if acupuncture can help with severe clonus in the leg together with spascity? I am under neurology at the Royal Free but they are in a quandary as to what can be causing it after various tests (4 days in hospital).

A: There are a number of papers such as this one

which appear to offer hope to sufferers with these problems. There is similar material buried deep in the rather dense review paper

which we have prepared about the use of acupuncture in the treatment of recovery from stroke, which has some overlap with clonus and spasticity.

We are bound to say that we come at these problems from an entirely different background. Chinese medicine is based on a theory of energy, called 'qi', whose flow, rhythms and balance determine the health of each individual. In cases like yours the practitioner will be aiming to understand why the symptoms have arisen from within this entirely different theoretical framework. This can sometimes offer possibilities both for understanding what has gone wrong with someone's balance and putting it right. This might involve local treatment to relieve the problems where they are occurring, but more often than not involves treating the system as a whole, based on an understanding that local weaknesses or disruptions tend to occur when the system as a whole is impaired and gets in the way of the body's normal recovery.

We think that you could do yourself no harm in seeking the advice of a BAcC member local to you about what might be possible. You may also find that certain western acupuncture techniques, such as the use of trigger point acupuncture, may be helpful, and this opens up avenues of possible treatment within the NHS. For a condition like this where the research is largely good but short of conclusive, any possibility of giving treatment a try is worth pursuing. We tend to the view that there are occasions when western medical acupuncture and traditional acupuncture may both offer local relief, but we remain convinced that traditional treatment is a more effective treatment in offering the additional possibility of securing a balance in the system which reduces the chances of a recurrence of the problem. However, if you can get access to free treatment within the NHS as a first step this may be a good way of assessing whether acupuncture is worth pursuing more formally.

Q: Can acupunture be used for cardiac rhythm disorders such as frequent ventriluar ectopics and non-sustained ventricular tachycardia? Is there any acupunture expert who specialises in treatments of these disorders?

A:One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The rapid pulse and the irregular pulse both have clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

Some of the published research also involves animal experiments, sometimes called 'ratpuncture in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what these two conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.

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