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A: We have received relatively few enquiries about the treatment of psoriatic arthritis and the most recent, three years ago said:

  We have to be honest and say that the research studies which exist for both rheumatoid arthritis (which from a Chinese medicine perspective is very similar to psoriatic arthritis) and psoriasis are not that helpful. Our factsheets

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

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/eczema-and-psoriasis.html

point out that studies are few and far between, and often methodologically weak. 
 
This does not mean that acupuncture may not be able to help at all. Many patients with auto-immune arthritic conditions often use acupuncture for relieving specific symptoms, such as pains in a particular joint, and we do hear of people deriving considerable benefit. This is principally about limitation of discomfort and pain relief, however, not about reversing the main condition.
 
When people have enquired about psoriasis in the past, we have also offered very cautious advice. The last response we gave in October said:
 
There hasn't been a great deal of research in the use of acupuncture for the treatment of psoriasis, and where small studies have been done there has not been a great deal of success on which one could base a positive recommendation.
 
This is not to say that acupuncture treatment may not be of benefit. Skins problems such as eczema and psoriasis can have a variety of causes, some of them mental and emotional as well as environmental and the universal 'idiopathic', which is western medical speak for 'it just happens', or 'we don't know what causes it'. Traditional Chinese medicine was initially premise on the simple but profound belief that symptoms were merely alarm bells that the system as a whole was out of balance, and that a skilled physician would be able to assess what was needed to restore balance and by doing so eradicate the symptoms. There is no doubt that each year many people have acupuncture on this more general basis and experience some very encouraging results.
 
However, we have to say that the received wisdom in the acupuncture profession is that Chinese herbal medicine often generates better results for skin conditions, possibly because the regular daily or twice daily treatment is better suited to dealing with the problem or possibly because the precise adjustments of the prescription achieve what broader techniques may not. In any event, it may well be worth your while contacting a member of the Register of Chinese Herbal Medicine (RCHM) for advice. You will probably find that the person you speak to is also a BAcC member, since more than 90% of the RCHM membership is dual-registered.
 
This does not mean that we would entirely rule out acupuncture as your first option, and you may still find it valuable to discuss your own unique presentation with a BAcC member local to you. He or she will be able to give you a better face to face assessment depending on the spread and location of the condition than we could do here.

Looking back at this we think it might be a little over-cautious. While it would be foolhardy to suggest that there is a cure we have seen a number of cases where someone's rate of deterioration has slowed down, or at least they have perceived it as such, or where symptoms which were assumed to have been a part of the overall picture have been considerably lessened because they were not as closely connected with the 'headline' problem as was believed to be the case.

 On that basis it would certainly do no harm to see what acupuncture treatment can offer. The key concern is of running up a large bill for treatment which really has not achieved very much. It is really important to set regular review periods and, difficult as it may be, to set measurable outcome targets, things which would let you know without doubt whether things were improving or not. Greater endurance, better grip, etc etc - something which can be measured and not simply be a reflection of how you feel on the day.

 There is no set cost for treatment. We tend to distinguish between London, where first sessions can cost between £50 and £75 and subsequent sessions £40-£60, and the rest of the UK where first sessions are often a little less £40-£60 and subsequent sessions £35-£50. In reality, though, there is a difference in the overheads of working from home and working from a Grade 2 Listed building in a city centre, and this is often reflected in the cost of treatment. There is also a growing number of members offering treatment in multi-bed clinics where the aim is to reduce the cost of treatment by working in a group setting. For someone with long term treatment in prospect this can be a welcome development.

 

Q:  I have had  PHN for over more than ten years, it is affecting my left leg..the pains is still ongoing... I wonder if acupuncture can help?

A:  As you might imagine we have been asked about this many times over the years; shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

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

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

The one confounding factor about your problem is that it has now persisted for ten years. There is a kind of received wisdom that treatment becomes more difficult the longer a problem persists, and there used to be a line that treatment of a problem took as many months as the years it had persisted. Most of us don't take this too seriously, though; we have seen thirty year problems sometimes vanish within weeks. The key issue will be to determine what is happening in energetic terms. This may give some very useful pointers to what has caused the problem to persist and similarly pointers to what might make things improve.

 

Q:  I have been receiving treatment through the NHS for fibromyalgia and chronic lower back pain. I have had 5 sessions and have had needles inserted into my mid and lower back, buttocks and the backs of my knees. During sessions 2-4 I also had needles to my ankles. Following session 4 I developed an extremely uncomfortable right ankle, with a lump under the ankle bone which is quite evident by feel and very painful to touch. I cannot recall any injury, trip or fall, and at today's session we had to avoid using needles to my ankles. Could this pain and lump be related to the acupuncture I have received so far?

A:  While we could never say for certain that it is, there is no doubt that if a lump or bump appears where someone has placed needles the usual assumption is that it has happened as a consequence of the treatment. Put the other way around, if you had said that the acupuncture definitely caused the problem, we wouldn't be able to say that it didn't.

 The most common form of lump like this is a deep bruise which has resulted from a slightly over-deep or over-vigorous insertion of a needle. This can sometimes show no signs on the surface, but because the ankle is a very narrow and 'crowded' space, it can put pressure on surrounding nerves and blood vessels and be really uncomfortable. There are other possibilities to do with needling in or near joint capsules which can cause similar problems, and in all cases these usually subside within a matter of days. They should certainly be gone within a couple of weeks. The other outside possibility is that there has been an allergic reaction to the needle in this specific place (we have seen one rare case of this) but it would be most unusual to react only in one place and not in equivalent areas on the other limb.

 If the lump is showing no signs of reducing, or the pain and/or discomfort remains the same, then perhaps it would be wise to contact your GP and have the lump assessed. Although there is a strong probability that the treatment is the cause, it is always best to consider the possibility that it is entirely contingent and just happened to appear at the same time. People sometimes get involved in arguing about whether acupuncture caused a problem, or sometimes simply assume that it did, and leave it uninvestigated longer than is beneficial. A lump is a lump, and needs checking.

 We hope, and expect, that it will resolve quite quickly.

Q:  I tripped over a step over 18 months ago and hit my head. I have totally lost my balance. I have had MRI scan and cat scan.  I have been told there is nothing else they can do for me. It is not vertigo and when I am out in the dark I have to have someone with me as I stumble all over the place. I am trying a Cranial osteopath but that is doing no good. Do you think acupuncture will help get my balance back.

A:  This is a very difficult question to answer. The fact that there is no visible damage and that cranial osteopathy has had no effect are not very encouraging when trying to say whether acupuncture might help. The latter (cranial osteopathy) works in broadly similar ways, and if that is doing nothing it does not bode well.

 However, on a more positive note, we get many referrals from cranial osteopaths when patients do not respond, and on many occasions we are able to help. From a Chinese medicine perspective we are looking at functional relationships within the body, not structural ones. Our basic premise is that there is a flow of energy in the body, which we call 'qi', whose flow, rhythm and balance determines the way in which all of the functions of the body perform as they should. Our skills are to identify weaknesses and blockages in the flow which cause pathological and functional changes, and to use needles to correct them.

 Of course, it sounds a great deal simpler when put this way than it actually is, and there is a considerable skill in identifying exactly what is causing a problem. This may not always be where or how the presenting condition appears to be, and can sometimes lie elsewhere. There may have been local disruptions to what we regard as normal flow in the damage you sustained which remain even though the body appears to have healed, and there may have been other mental and emotional consequences of what happened to you which have caused a problem 'downstream', as it were. These could just as easily result in a functional disturbance like loss of balance.

 The best advice we can give for unique problems such as yours is that you visit a local BAcC member for an informal chat about what may be possible. Most are very happy to give up a short amount of time without charge to assess whether acupuncture treatment is a good option, and this also has the advantage that you can meet someone and see where they work before committing to treatment.

   

Q:  I currently live in UK and my brother studies Chinese medicine in China, Beijing. We are wondering what is the requirement if he wants to have a clinic in the UK. Does he have any benefit if he has Bachelor degree from China? Or does he need to study from 1st year or is it possible transfer ? We would like to know how to study or start for my brother?

A:  There is no statutory regulation of acupuncture in the UK. This means that in theory anyone can set up in practice with almost any level of qualification, and indeed there are people who have done very short training courses who have set up clinics. This is called a 'common  law' right in the UK; if it isn't expressly forbidden, then it's OK.

 In practice, however, there are sets of laws which are enacted by local rather than central government, and which are mainly intended to ensure that the places where people work meet basic safety standards. Many local authorities have now started to put conditions into these laws which require practitioners to be able to demonstrate that they are properly trained. The BAcC is sometimes asked to pass comment on an applicant's training if there is any doubt about how good it is.

 The standard which most people accept in the UK as an entry standard is a degree level training, usually three years or 3600 hours spread over three years. This is the standard recommended by the World Health Organisation. Some diploma level courses are also recognised, but the three month courses which used to be the only thing available for people travelling from the UK to China to train would not normally be regarded as sufficient.

 The best way to find out useful information about the UK training scene is to look at the website of our sister organisation, the British Acupuncture Accreditation Board, http://baab.co.uk. This has downloads of training standards and also information about accredited courses which would allow someone automatic eligibility to join the BAcC. There is also the website of another major UK association to which many Chinese practitioners belong, the ATCM http://www.atcm.co.uk which spells out the entry requirements for practitioners who undertake their training in China itself.

 In summary, as long as the training is about degree level and contains the major elements of the model syllabuses, it would not be a problem for your brother to train in China and then start work in the UK. If, however, he planned to come across to the UK to train, he could contact some of the teaching institutions mentioned in the websites directly and ask what he would have to do to sign up to a course in the UK. Many will accept part training as a basis for exemption from some of the course, but that would have to be by individual negotiation.

 

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