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Q:   Can acupuncture help with infertility, endometriosis, fibroid and severe abdominal pain. I live in Ghana, how do I find a specialist in this field?

A:We have to say that we are finding it very difficult to locate a reputable practitioner in Ghana. We don't mean that there aren't any, but we have no way of checking from this distance whether someone is a bona fide practitioner or not. There are a number of companies which appear to advertise themselves as having outlets all over Ghana, but the ones that we can find are mainly based in Accra. If you can locate one of these they may be able to help you to find professional colleagues elsewhere in the country. The other option is to ask your Department of Health. Acupuncture is quite often regulated by the state, and this means that there may be a nationwide listing.

As far as the conditions which you mention are concerned. we have a number of factsheets which can tell you how successful is in treating these conditions, The main ones are:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/female-fertility.html

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

We have been asked a number of questions about these problems over the years, and one answer which may be of use to you was:

I have 3, 4cm Fibroids. I am also trying for a baby. Does accupuncture help to reduce the size of these fibroids and improve fertility?

From a western perspective the evidence for treating fibroids is not that good. In a major review undertaken two years ago

http://www.thecochranelibrary.com/userfiles/ccoch/file/Acupuncture_ancient_traditions/CD007221.pdf

the authors concluded that while acupuncture was heavily used in China to treat fibroids, there was not enough research conducted according to the best practice in the West to be able to draw firm conclusions. The same applies to acupuncture for the treatment of (in)fertility. As our own factsheet acknowledges such evidence as there is does not really provide a strong enough foundation to make sustainable claims.

However, one of the great strengths of Chinese medicine is that it operates with an entirely different understanding of pathology and physiology. There are ways in which conditions which are given western labels like 'fibroids' are understood which do not overlap or translate exactly with the western label. Fibroids, for example, are sometimes described as 'Blood stasis' or as manifestations of 'Dampness', and the treatment protocols are aimed at these as systemic problems which manifest in the local disturbance. If the diagnosis is one of 'blood stasis' or 'dampness' there may well be other symptoms and diagnostic signs which confirm this pattern.

As far as fertility is concerned, much the same reasoning applies. The Chinese took the simplistic, but effective, view that if everything was in balance, then natural processes should happen without problem. If a natural process like conception did not function, then it was simply a matter of correcting the overall balance and letting nature take its course. Even if there are specific symptoms which are implicated in the failure to conceive, these may still be best understood as part of an overall pattern and treated accordingly.

Our one word of caution is that the acupuncture treatment of fertility issues, especially related to assisted reproduction such as IVF and ICSI, has become a growth industry over the last few years, and alongside BAcC members many other individuals and clinics have set up which often charge extremely high fees for treatment which is no better than that offered by any BAcC member. While we do not recognise specialisms, there are many BAcC members who focus their work on fertility and pregnancy issues, and often have a wealth of additional background knowledge in these areas. For women undergoing IVF and ICSI this understanding can be a valuable addition to the work that a BAcC member does. The acupuncture treatment itself, however, is based on principles over 2000 years old which underpin the work of all BAcC members.

It is also worth using the search facility on our home page to see what other answers we have given over the years, many of which may be relevant to you.

What we have to say, though, is that the evidence for the use of acupuncture treatment of endometriosis and fibroids is not great, but that is mainly a reflection of the fact that there isn't a great deal of it in the West, and the studies from China, of which there are hundreds, are often methodologically flawed. Anecdotally we can say that we have had some success with all aspects which you touch on but we would have to be honest and say that fibroids and endometriosis, particularly the latter, can be very treatment resistant, and if they are becoming a source of secondary problems, such as infertility, there may be no other resort than surgical options.

As you can see from the embedded answer, the treatment of fertility problems has become something of a growth area in the last decade, and with it have come entrepreneurs on the fringes of the complementary health world happy to cash in on what is a highly emotionally charged situation. We would advise you to take special care if you do find people who promise results at a price. A bona fide professional will see fertility problems as just another manifestation of problems in someone's energies, and will treat the person exactly as they would if the presenting symptom were headaches or IBS.

That said, we are on the point of recognising expert practice in this field in the UK, and practitioners who have undertaken significant postgraduate training in working with this group will be able to lay claim to recognition as expert practitioners.

We wish you well in your search for a good practitioner.

Q:  What exactly do the needles do to effect a cure. Do they touch nerves for instance?  Is there some sort of chain reaction?  I would like to understand this technique before using it. In the past I did have acupuncture for migraine but do not understand how it works.

A:Many of our patients believe that acupuncture works by touching nerves, and indeed one of the main theories of western medical acupuncture is based on the neurophysiological consequences of putting needles into tissue with significant amount of nerves.
 
However, Chinese medicine has an entirely different understanding of the body, mind and spirit. In Chinese thought, everything is regarded as a manifestation of energy, which the Chinese call 'qi', and the human body in all its complexity is understood as a flow of qi which has distinct patterns and rhythms. These patterns can be disrupted by external causes like climate and food, but also internal causes like strong emotions or mental strains. Because everything is interlinked, blockages or disruptions in the flow of energy can have effects on all sorts of levels - a physical pain will often be accompanied by a corresponding mental or emotional state which may not appear to be related at first sight to the primary problem- and also a problem in one area can ramify to create problems in other areas. This is why traditional Chinese medicine practice does not place all of its reliance on symptoms; these may simply be secondary problems where the main problem lies elsewhere and may not even be generating symptoms itself.
 
This world view is not unique to China. The Japanese have the concept of 'ki' and Indian culture has a concept of 'prana', both of which fulfil the same sorts of function in understanding how the body, and indeed the world, can be understood and treated. This is vastly different from mainstream western thought which has rejected this kind of theory, sometimes called 'monism' which rests on a belief in a single universal substance from which everything is made. Instead in the West the dualism which has held sway since Descartes is very much predicated on a material substance in the world which can be understood in purely mechanical ways, and something of a different order on mind and soul which is not reducible to a physical state.
 
That said, at the cutting edge of scientific thought in quantum physics, some interesting parallels are starting to emerge, and it is highly possible that the next hundred years will see ancient Chinese medicine theory being better understood within mainstream science as these state of the art understandings start to permeate more popularly understood science.
 
The use of acupuncture needles, therefore, is to influence the flow of energy and to make good areas of the body where the flow of qi has been compromised. With a 2000 year history acupuncture has a wealth of sophisticated means of diagnosing and treating imbalance, and while the basics are relatively easy to learn, by contrast to the highly complex training in Western medicine, the application of these principles can involve a lifetime's endeavour. The saying used to be that Western medicine was hard to learn but once learned easy to practice, whereas Eastern medicine was easy to learn but very hard to practice. So much depends of the observational and sensory skills of the practitioner, and requires a level of development beyond day to day experience. This is why we sometimes describe our work as mastery of an art rather than technical knowledge of a skill.
 
In the end, though, there will always be patients for whom taking this on board is a step too far, and all we can say to them is that we are happy to be judged by our results.  

Q:  I have just graduated with a bachelors degree from Changchun Chinese Medicine University.  I would like to know if you can advise me, what is needed in terms of licensing and registration to open my own acupuncture clinic in the UK.

A: It basically depends where you intend to work in the UK. If you are based in Greater London, most boroughs have adopted the London Local Authorities Act 1991 which means that unless you belong to an exempt body, such as the BAcC or the ATCM< you will have to pay for an annual licence. In Scotland, a similar situtation obtains, insofar as unless you are a statutorily regulated healthcare professional, there is a requirement for annual licences. As you are probably aware there is currently no statutory regulation of acupuncture, nor likely to be in the short term.
 
In the rest of the UK the Local Government Miscellaneous Provisions 1982 Act applies which requires a one-off registration for the practitioner in each practice in which they work, i.e. if someone joins an existing registered practice they have to register personally, and they are already registered in a borough but set up a new practice in the same borough they have to register that.
 
The registration and licensing processes involve an inspection of premises, and usually also a check on the training of the person who is applying to work there.
 
You will also need professional indemnity insurance, and the local authority will almost certainly want to see proof of this.
 
There are no other statutory requirements for setting up in business asa practitioner, but clearly quite a lot of planning legislation of which one must be aware, as well as some keenly policed restrictions on marketing and advertising which can be found on the Advertising Standards Authority website.
 
We believe that the wisest course of action is to join a professional association in order to benefit from updates about the current legislation and also to belong to a network of fellow professionals. It is tough setting up business at the moment, and the support and advice of professional colleagues is invaluable.  
 

Q:  I have cut my leg down to the bone.  I dont want to take antibiotics but I might have to.  Can you help with the healing process and get blood supply etc to the area? I am on a zimmer frame.

A:  We have to say that in this situation for your own safety you will probably need to be on antibiotics. We hope we are not presuming too much by thinking that a zimmer frame means that you are retirement age or over, but if this is the case then antibiotics are all the more important. Infections in open wounds in people in their sixties and beyond have a capacity to get out of control very quickly.

As to whether acupuncture encourages wound healing, we would certainly say that from personal experience in practice we often receive feedback from patients that their conventional medical practitioners are surprised by how quickly they have recovered, but proving this through research would be quite difficult, and as a result we aren't able to give a more definite recommendation than that. However, the basic premise of Chinese medicine is treating the person rather than the condition and encouraging all body systems to work as well as they can. On that basis we would have to say that it creates the best possible environment for healing from that perspective.

We have nearly 3000 members all over the country, and the quickest way to find out if there is someone near you is to use the practitioner search facility on the home page at www.acupuncture.org.uk. If possible you can arrange to see one for a brief assessment of whether acupuncture treatment is the best option for you.

Q: My friend has fractured his elbow and is in a lot of pain. He had a plaster cast but got it removed after a few weeks because the pain had increased. The pain he says is becoming almost unbearable. Would acupuncture help?

A: This is a tricky one. There is no doubt that acupuncture can be used for pain relief, and this was indeed one of the first uses in the West and one for which a considerable amount of research exists - researchers love precise definition, and there are a number of neurotransmitters involved in pain control by the body which can be measured very precisely to assess whether treatment with acupuncture has an effect. Our fact sheet is very clear on this:

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

The main issue is how much pain relief treatment can achieve and how sustainable any relief is. If the equation works in someone's favour regular treatment can make a fracture bearable while it heals.

Fractures are as old as time, and there are a number of points used within Chinese medicine for specific bone mending purposes. Because they have always formed a part of the teachings which we have each been given when we trained most of us routinely use specific points when patients have broken bines, and nearly always receive feedback from patients that their bones are healing quickly and well, often faster than their doctors expect. However, this has not been well-researched and although there are cases studies like this

http://www.ncbi.nlm.nih.gov/pubmed/23131374

and a number of studies using animals which suggest accelerated bone healing, there are no results which are substantial enough evidence for us to be able to give an unqualified recommendation for the use of treatment.

We are a little concerned to hear that the pain continues, and we are assuming that this is something which his health team are aware of. It may well be worth trying to have the joint X-rayed again to ensure that there is good healing of the tissue, and possibly MRI'd to make sure that there is no local nerve impingement. If this is all under control, then another factor to consider and which may bring your friend into the realm of acupuncture treatment, is that from a Chinese medicine perspective the bone itself is just a part of the energetic construction of the elbow area, and the fact that this is healing does not necessarily mean that the blockages created by the injury have all resolved. This can sometimes lead to situations where on the surface everything appears to have healed, but the energy of an area can still be severely disrupted. From the Chinese medicine point of view, the equation is simple - blockage equals pain.

Another rather more contentious way of looking at this which is to be found in some forms of osteopathy is that the shock of the accident can in some ways be still 'contained' within the healed bone even though to all intents and purposes it is as good as new. Some forms of treatment are aimed at releasing this shock, although it has to be said that this is far from universally agreed within the osteopathic world.

The best advice we can give to you to pass on to your friend is that they should visit a BAcC member local to them for an informal assessment of what acupuncture treatment may be able to do. We are sure that a face to face assessment of the problem will be enough for a practitioner to offer a very clear opinion of what may be possible.

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