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Ask an expert - general
We drew up a review paper some years ago
which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.
However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK ( http://www.nadauk.com/) and SMART-UK (http://www.smart-uk.com/) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.
There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).
This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.
Q: Please could you tell me what the qualification "MAcS" stands for and what standing it has in Britain?
A: As far as we are aware, the designatory letters 'MAcS' are used by only one UK acupuncture body, the Acupuncture Society. Details of the different varieties of membership of this body can be found here:
As far as standing is concerned, there is no statutory regulation of acupuncture in the UK, so all designatory letters serve only to identify that a practitioner belongs to a professional body to which they are accountable for their professional conduct and safe practice. These also generally offer a guarantee of professional indemnity insurance cover, either through the association or as a condition of continuing membership.
The only scheme which kitemarks standards for voluntary registers is the Professional Standards Authority's Assured Voluntary Register scheme. The BAcC was one of the first professional bodies to meet their exacting requirements and members of the BAcC are allowed to use the PSA's kitemark on their promotional material.
Q: I am writing with a query regarding my husband. He had a vasectomy in August and unfortunately, due to complications during the procedure, has suffered a trapped nerve on one side which is still painful at certain times. He has been referred to a consultant and been told there is no corrective procedure for this and he would just have to make use of long term pain relief, but he does not want to take long term medication. We are wondering if acupuncture would be able to relieve the pain from this trapped nerve and, if so, what would be involved?
Treatment would involve either needles and moxibustion, the use of a burning Chinese herb, and your husband can rest assured that needles do not have to ber applied locally to achieve an effect, or no-one would ever seek help with haemorrhoids ever again. The majority of points used in early sessions lie on the lower arm and lower leg, with a number of more powerful ones on the trunk and back.
shows. Indeed, much of the early research into acupuncture in the West was focused on this area after seeing some of the film of operations in the East performed under acupuncture and demonstrations of dramatic reductions in pain that people appeared to experience from a few needles. Of course, the main western preoccupation was to make sense of this in terms of neurotransmitter chemicals or natural painkillers like endorphins and enkephalins, rather than understanding it as a reinstatement of the proper flow of energy, or 'qi' in an area, but we were grateful anyway to see acupuncture being taken more seriously.
A great deal depends on how your husband's nerve is trapped. If there is impingement of the nerve a great deal depends on whether there is post-operative inflammation in the surrounding tissue which treatment may be able to help to reduce, thus breaking the cycle of pain, or whether the operation has simply caused the nerve to be jammed between physical structures where change is less likely. There is no doubt that acupuncture treatment may well be able to achieve some pain relief, and the main issue is usually how much and how sustainable that change is.
Usually there is no way of predicting how someone will respond in circumstances like this, and most practitioners will probably say that the best way is to have a couple of sessions to allow them to assess the viability of treatment, based both on feedback from the patient and from signs and symptoms which they themselves interpret. In any event there should be some reaction within three to four sessions, and a responsible practitioner will draw a line in the sand then if the patient is not making progress, however pleasant the actual experience of treatment may be.
The best advice we can give is that you visit a BAcC member local to you and seek a face to face assessment of whether they think acupuncture treatment may be beneficial. There are a number of ways in which they cam make this assessment and we are confident that they will give you an honest view.
Q: I am regularly passing out without warning - about three times per week. It has been this regular since July this year, but has been happening for over a year (less frequently at first). I have had many hospital tests, all of which were normal results, and so it's thought in have an extreme form of vasovagal syncope - fainting. I'm told it's probably triggered by something and I am keeping a diary/cutting things out to find out what. Could acupuncture help? Particularly if it's something anxiety related, which I haven't yet explored. And what should I do as my next step?
A: We are sorry to hear of your problem. It may not be anxiety related but it must certainly be anxiety inducing.
As far as research is concerned there is not a great deal to offer. There are occasional case study reports like this one
but the majority of 'hits' you get from looking at 'acupuncture' and 'fainting' on google are because in some cases acupuncture can cause fainting, usually if someone has not eaten properly for several hours before treatment.
As the case study cited makes clear in language which may not mean much to the western ear, there are a number of ways in which the symptom of fainting was and is understood in Chinese medicine theory. Because the process of diagnosis looks at the overall functioning of body mind and emotions, it would be rare for an imbalance or disturbance to be generating a single symptom like this, and the skill and art of the practitioner lies in making sense of the whole pattern which the patient describes. If there is a clearly discernible pattern then there is some possibility that acupuncture treatment, in restoring normal function, may bring the symptom under control. Indeed, in the very early systems of Chinese medicine, symptoms were seen merely as alarm bells, and the practitioner would be guided more by signs and observations independent of the patient's description to determine what needed doing, in the simple belief that a system in balance would no longer generate symptoms.
Each person is unique in diagnostic terms, and for cases such as yours, where the symptom is not clear cut and has no identifiable pattern, it would be very important to be able to see what is going on face to face in order to be able to assess properly whether acupuncture couldbe of benefit. We suggest that you would do well to contact a BAcC member local to you and seek a professional view from them whether acupuncture treatment may be of benefit to you.
Q I am setting up some rooms for acupucturists in cancer treatment centres. Could you please tell me if it is acceptable to have carpet in those room or does it have to be hard flooring? If it has to be hard flooring; could we put a mat over the carpet in the area under the couch? Do we have to provide a sink in the room where acupuncture treatment is taking place? nd finally: could we put an ad on your website when we are recruiting?
A:The legislation under which the majority of premises in the UK outside Greater London and Scotland (Local Government Miscellaneous Provisions 1982 Act) could not be more specific:
The requirement in paragraph 2(3) that the floor of the treatment area be provided with a smooth impervious surface applies to tattooing, semi-permanent skin-colouring and cosmetic piercing but not to acupuncture or electrolysis or ear-piercing or nose-piercing using a hygienic piercing instrument.
The same rules tend to apply in London, although each borough which operates under the auspices of the London Local Authorities Act 1991 has a set of guidelines which are broadly consistent with the BAcC's own Code of Safe Practice in which we say that premises should have 'smooth, impervious flooring or short pile (not looped) commercial carpeting'.
We supplement this with further information in the Guide to Safe Practice, an internal document for members in which we say:
Impervious floor surfaces must be washed daily with appropriate cleansers. All carpets in the areas adjacent to treatment surfaces must be vacuum cleaned daily and steam cleaned annually.
The requirement for vacuum cleaning is primarily not so much about cross-infection as about general cleanliness in the clinic environment. Best practice would be to use vacuum cleaners with HEPA filters to avoid the process spreading dust particles and bacteria throughout the entire treatment room.
The requirement for steam cleaning is essential if short pile carpeting is to remain acceptable within the Code. The BAcC will continue to investigate any commercially available techniques for disinfecting carpet.
Flooring must be smooth and impervious, or short pile (not looped) commercial carpeting.
The acceptable type of flooring continues to be an area of considerable debate. The Barbour Index, the main reference guide used by environmental health officers (EHO), requires that flooring be 'smooth and impervious' and the previous BAcC Code of Safe Practice required that premises be 'clean and capable of being kept clean', ie that surfaces can be washed. Local authority byelaws have always allowed for short pile commercial carpeting as long as it is 'clean and capable of being kept clean'; there is, for example, no mention of impervious flooring in the Health and Safety Executive's Guidance on Blood-borne Viruses in the Workplace (HSE, 2001). The Barbour Index recommendations are mainly intended to apply to treatment rooms in GP surgeries and outpatient clinics where minor surgical procedures may be performed.
Given that the reported incidents of major blood and body fluid spillage are rare, and that many practitioners are not able to insist on the use of smooth impervious floor coverings in the clinics where they work, the BAcC has decided to allow the continued use of non-looped short pile carpet as long as you have the appropriate means to clean and disinfect any soiled areas in the event of spillage.
If a carpet in rented premises does not match the above criteria, rubber matting which can be cleaned easily must be laid around the treatment area.
This last provision is one which a number of members have had to apply after dealing with intractable Environmental Health Officers. We have on occasion taken on EHOs who in our view are writing their own laws, but since it is the member, not us, who will suffer if things become too adversarial, we have advised several members to do as you suggest and have rubber matting directly adjacent to the treatment couch.
As far as sinks are concerned, we allow for the possibility that someone may have a sink immediately adjacent to their treatment space, but we recognise that this may cause problems and prefer members to have running hot and cold water in the treatment space itself. The law says:
suitable and sufficient washing facilities appropriately located for the sole use of operators, including an adequate and constant supply of clean hot and cold water, soap or detergent
and we have made our provision in the Code:
You must have a washbasin with a clean running hot water supply, preferably wrist, arm or foot operated and for your and other practitioners' sole use. This must be located in or in the near vicinity (ie not necessitating opening and closing of doors with your hands) of the treatment room. You must also have: dispenser liquid soap; disposable paper towels; and an adequately sized bin, pedal operated if lidded, situated close to the basin.
supplemented with the following information in the Guide:
HAND WASHING FACILITIES
Best practice is for there to be a washbasin with a clean running hot and cold water supply in the treatment room.
However, for some practitioners working from home or for many existing clinics and centres this is not feasible. Acupuncturists working in these circumstances are advised to ensure that they do not compromise their hygiene standards when re-entering the room after using a basin in an adjoining room. It is also permissible to install a portable washbasin with a hot water supply in the treatment room.
The washbasin must be for the sole use of the practitioner(s).
There have been some problems with local authorities enforcing general skin piercing regulations, ie body and cosmetic piercing alongside acupuncture. For the more invasive techniques there is usually a requirement for two basins, one for hand washing and for the sole use of the practitioner, and a second for the cleansing of equipment prior to sterilisation. The only pieces of equipment frequently used by acupuncturists which might necessitate this are cups. All other equipment is either disposable or washable without sterilisation. In most cases the BAcC has been able to negotiate away the need for a second basin, but if your local authority stands its ground on this, then that is what you must arrange.
Dispenser liquid soap is required.
Solid soap is not acceptable, whether anti-bacterial or not. Disposable paper towels must be provided. The use of antibacterial hand gels does not substitute the need for proper hand washing with soap and water.
In our experience most EHOs are very supportive and negotiable. We only have problems where someone hasn't really understood what acupuncture entails and how good a safety record acupuncture has in the UK. If this becomes a problem for you we shall be happy to lend our support.
Finally we are very happy to forward your request on to the staff member who deals with our internal advertising, and she will be in touch with you in due course.