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Q:  I have heard that acupuncture can be helpful with multiple sclerosis - how do I locate a practitioner with this expertise.

A:  As our factsheet says:

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

there has been very little research into the use of acupuncture for MS. There are many reasons for this, but very high up the list will be the fact that presentations of MS vary so differently and the outcomes are also difficult to measure.

One of the problems we often find in practice is that once someone has a disease condition with a label like MS or Parkinson's or Type 2 Diabetes, it is not uncommon to see this as the root of a great many physical and emotional problems, and in truth sometimes these conditions are, but there are times when a symptom is from an entirely different cause and eminently treatable.

From a Chinese medicine perspective, where each patient is unique and different, it is important to understand how each specific presentation arises from this same perspective. This does not mean that everything is curable if its start and progression can be plotted, but it might offer the possibility of slowing down the deterioration which can often result from these conditions. The ancient Chinese probably understood nerves, but not the microbiology of nerve structure and specifically the demyelination which characterises MS, so their attempts to understand the steady loss of function would have been understood in the changes in function of the Organs of the body as they, for example, no longer provided energy in the extremities, causing numbness and loss of sensation. As we said, this does not mean that by switching perspectives one can find cures which conventional medicine cannot offer. It may, mean, however, that there may be treatments which can help to slow down the loss of function or even correct those symptoms which have arisen contingently and are not related to the MS.

We do not have specialists in treating specific conditions. There are growing numbers of members who are developing expert practice with specific groups, such as children and pregnant women, but noen as far as we are aware, who look at specific diseases. All our members are capable of using Chinese medicine to the same high standards to diagnose and treat within its principles. Our best advice is always to contact a BAcC member local to you and seek their advice face to face; they will be far better equipped to offer options based on what they can see than we can at this remove.

Q:  Is it safe to have accupunture 5 years after a total colectomy with new pouch and rectum. All the large bowel was taken away. So my small bowel is flopped down over over everything

A:  It is perfectly safe, as far as we are aware, to have acupuncture treatment after a colectomy. Assuming that all of the wounds caused by the operation have healed well, and that there were no post-operative complications for which you are receiving further treatment or on medication, then we believe that treatment can do no harm, and may well be of benefit.

There are a number of situations where the removal of the physical organ, such as the gall bladder, spleen, or in your case large intestine, may have implications for the Organ (we always capitalise this because in Chinese medicine Organs are functional entities ranging over body, mind and emotion) in its other functions, as understood from a Chinese medicine perspective, and we are often able to support the affected Organ when the physical part of it has been removed.

You do not say in your question whether there aspects of your post-operative situation which you would like to improve or whether it is simply for general health and well-being that you are keen to explore treatment. We do find that this latter aspect is often very important after major surgery. The whole system is often very seriously affected by major surgery, and acupuncture treatment in its most ancient traditional forms was all about helping the body to regain normal balance and function. However, there may be specific aspects of your digestive function which may continue to give you problems, and it is possible, within the constraints of working with a functionally altered set-up, that acupuncture treatment may be of benefit.

There is obviously no research, at least in English, that we can find which looks at acupuncture after colectomy, and your situation will be unique to so. This is why we always advise people to ask a BAcC member local to them for advice after a brief face to face assessment. This is likely to be more informed and informative than anything we can offer at this distance. We are sure that they will be interested in exploring with you the circumstances which led to your operation and whether this shows evidence of patterns of imbalance which might inform their advice on what is possible for you.A: 

Q:  I am suffering from severe neck pain.  Also how do I go into studying acupuncture and go into this field of work?

As far as the neck pain is concerned, there is considerable evidence for the use of acupuncture for a number of problems which can manifest as neck pain. Our factsheets on pain relief, osteoarthritis and so on, which can be found at this location

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

all point to encouraging studies which, although far from conclusive, would indicate that you may well get some relief from treatment.

We are a little concerned about the use of the word 'severe', however. The first thing we would ask if your were a patient would be not just a description of all aspects of the pain, but more importantly how it has developed. In modern life there are many reasons why people develop neck pain, in the use of computers for hour after hour, for example, and if their work depends on this they sometimes have to keep soldiering on to the point where a niggling pain may become something far more severe. There are also a number of accidents or near misses which can leave people in this state, and which may or may not have been thoroughly checked out.

We would probably want to be reassured that you had had some conventional medical tests like Xrays or scans to establish where there is a physical cause. Our concern would be that acupuncture treatment might offer pain relief and reduction of some of the inflammation but leave an underlying problem untreated which might deteriorate further. This may sound alarmist but is simply common sense; we believe that patients should get the best of all possible worlds, and if there is structural damage no amount of treatmentis going to change that. Unlikely, it is true, but we would need to check.

The best advice we can give is that you 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. This will enable them to ask the kinds of question that we might, and to advise you accordingly.

As far as studying acupuncture is concerned, we offer automatic elegibility to graduates of courses accredited by the British Acupuncture Accreditation Board, a list of which can be found here:

http://baab.co.uk/study-acupuncture/accredited-courses.html

There are other courses, but we believe that these have the highest standards of training and enable us to maintain the standards of professionalism which we espouse.

We hope that if you do decide to have acupuncture treatment it works well for you. Nothing could be a greater encouragement to start training!

Q:  Do you believe that acupuncture can be practised effectively without a full understanding of the original Chinese doctrines?
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A:  Some questions seem deceptively simple until you start to unravel them. This is one!

For starters, it depends on how you define acupuncture. This was the cause of a great deal of discontent in 2000 when the House of Lords Report led to the creation of the Acupuncture Regulatory Working Group, because the definition of acupuncture was very basic:

"Acupuncture refers to the insertion of a solid needle into any part of the human
body for disease prevention, therapy or maintenance of health. There are various
other techniques often used with acupuncture, which may or may not be invasive"

This caused a huge amount of dissent within the BAcC because a phrase such as 'according to the principles of Traditional East Asian medicine' was not included. The brute reality was, and to some extent still is, that there is a thriving tradition of Western medical acupuncture based on a neurophysiological or segmental understanding of how it works, and more to the point a tradition whose research according to these principles was largely the reason that acupuncture was promoted into Group 1 of the therapies listed in the House of Lords Report. From the WMA perspective, acupuncture works by mechanisms which are not yet fully understood but which has enough research behind some of its interventions to justify its inclusion as another tool in the toolbox within scope of practice.

From a Chinese medicine perspective, there are two issues in the question. First is the extent to which one needs to be trained. There are a number of short courses in traditional acupuncture which we do not believe have enough teaching hours to instil a good understanding of Chinese medicine principles as well as passing on all of the practical training both as an acupuncturist and as a healthcare practitioner which meets recognised standards. The training levels recommended by the World Health Organisation are set at 3600 hours of degree equivalent training, and this is the level which the British Acupuncture Accreditation Board recognises as the bottom line for an accredited course.

The theory underpinning this is precisely defined, however, as the principles of Chinese medicine. Although these courses touch on wider appreciation of Chinese doctrines, both philosophical and religious, they are not a fundamental part of the training. This would be a degree level undertaking in its own right. However, to be able to practise effectively in a medicine which presupposes an entirely different world view and whose concepts need to be unravelled in this context, some understanding of the way that Chinese thought has developed is essential. There are a number of popular books and well-attended postgraduate seminars which encourage UK practitioners to develop a broader understanding of the wider context.

So, in summary, it is possible to practise effective acupuncture within narrowly defined limits without a commitment to, or understanding of, Chinese doctrines, but to practise traditional chinese acupuncture effectively one needs to have a thorough grounding in its principles and a good background sense of thw wider social and cultural context within which it developed.

Q: I was wondering what the BAcC said on blood pressure limits;  specifically when should practitioners refuse treatment. Or more accurately could you provide figures on the lower and upper limits with regard to acupuncture treatment?

A:  There is nO point at which a BAcC member will refuse treatment because of any inherent risk in the use of acupuncture treatment when someone has extremely high or low blood pressure. In fact, the use of acupuncture for hypertension is reasonably well-researched, and although the evidence is far from conclusive (at least in those studies which meet the perhaps over-strict inclusion criteria used in the West) it is certainly encouraging. At the other end of the scale, there are a number of points which are known to lower blood pressure, and a practitioner may be a little cautious if treating someone who has hypotension, but the needle techniques used in the West are probably too gentle to creat much in the way of a major reaction. However, we have pointed out to medical colleagues that one of the points they use rather vigorously for treating tennis elbow can lower BP by ten points, and to be wary of over-doing it.

The real issue is one of patient management. We all routinely take the BP of a new patient, and if it sits at the end of what doctors take to be the normal range (above 145/95, below 90/60) we all refer to GPs to get the pressure tested in a surgery and officially noted. This would not preclude treatment, but would be simply offering the best care to the patient. If someone with very high blood pressure refused to see their GP and wanted to try to use acupuncture as a main intervention, we would almost certainly advise members to tread very carefully. Refusing to treat would not be an option - it is not our job to 'sack' patients who want to pursue their own choices and the treatment may well work - but we would want to see a member obtaining some very specific consents to treatment, and writing very thorough accounts in their notes of what is happening.

Sadly without statutory regulation we are not formally recognised within the NHS, and therefore we are subject to very strict rules about disclosure without consent. As such we could not go to a patient's GP without their consent. However, where we have met situations like this the persistence of the practitioner has invariably won in the end.