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Ask an expert - general

166 questions

There are no age restrictions on acupuncture treatment. The only limiting factors are the informed consent necessary for treatment and relatively small number of clinical circumstances where treatment is contra-indicated or inadvisable.

At the 'lower' end of the scale, children under the age of 16 have to be accompanied by a parent or guardian, and consent lies with the parent. A child of 14 or 15 is now deemed by case law (this used to be called 'Gillick competent') to be able to refuse to have treatment, but we have not yet encountered any cases where a 14 or 15 year old has sought treatment when accompanied by a responsible adult who is not their parent or guardian. We would take legal advice should this question be asked of us; it is a highly technical argument.

At the other end of the scale the question of competence is just as important. From a Chinese medicine perspective based on the balance of energy and the enhancement of the quality of life there is never a stage where treatment would not be deemed beneficial. However, if someone is starting to exhibit clear signs of dementia or other forms of mental incapacity, a practitioner may need to proceed with caution. The issue of who has authority to give consent is a tricky one, and questions of a highly technical nature abut power of attorney start to present themselves. It is not, as is widely believed, simply a matter for the next of kin to decide.

The other factor in the treatment of children, especially the very young, is that although we do not require members to have undertaken specialist training, we have now published recommendations for what we would regard as minimum levels of postgraduate training and experience for treating children. While it is perfectly safe to treat children of any age with generalist skills, we do recognise that optimal treatment sometimes requires additional training; children are not simply small adults, and there are variations in children's energies which is it valuable to understand.

A:  Pins and needles, often called paresthesia in conventional medicine, is usually associated with poor circulation or some kind of interference with the nerve pathways. Generally speaking, it is self-correcting, so when it occurs all the time it needs to be investigated thoroughly. We don't want to sound like harbingers of doom, but there are several quite serious conditions for which constant pins and needles are a symptom or general warning sign. It is really important to discuss this with a GP and possibly arrange for a consultation with a neurologist just to be sure that this is not the tip of a much larger iceberg. The chances of it being more than it appears are remote, but we have a duty of care to our patients to ensure that there is nothing for which conventional treatment is required.
 
There is, as you might imagine, very little research in this area under the general heading of paresthesia. What you will find is a certain amount of research on peripheral neuropathy, which is one condition where pins and needles sensations are among the range of possibilities. We answered a question on this a short while ago, and you can see our answer here:
 
http://www.acupuncture.org.uk/public-content/public-ask-an-expert/ask-an-expert-general/ask-an-expert-general-general-uncategorised/can-acupuncture-help-with-peripheral-neuropathy.html
 
However, symptoms like this have existed since we started walking upright, and Chinese medicine, which has a 2500 year history, has been addressing such problems within its own conceptual framework. As you may already know by looking at our website, Chinese medicine is based on a theort of energy, called 'qi', which flows around the body in specific patterns whose flow, rhythm and balance are a precondition of good health. When the flow is disturbed or blocked, then ill health in the form of symptoms will start to emerge. The flow is maintained by the Organs of the body (always capitalised in Chinese medicine because these are groups of functions overlapping with the physical organ as it is understood in conventional medicine), and when symptoms like pins and needles appear, it usually points to a number of specific possibilities for Organic malfunction.
 
Nothing is as straightforward as that, however! The interconnections of all parts of the system mean that there is a considerable art and skill in the practitioner's interpretation of what is happening. That a part of the system is causing a problem is not difficult to determine. Whether that is the source of the problem or whether that part of the system is reacting to imbalance elsewhere is critical. Treating in the 'point and shoot' manner of cookbook formulae may help for a while, but if the underlying problem is not addressed the symptoms will come back or worse still, be suppressed while the problem continues to develop. This is why the BAcC sets so much store by the degree-level training our members have; it takes that long to be able, in our view, to begin to master these skills.
 
The best advice we can give in situations like these, where the range of possibilities tends to be quite wide, is to arrange a visit to a BAcC member local to you for a brief face to face assessment and discussion of whether acupuncture treatment is appropriate for this problem. Most members are very happy to do this, usually without charge, to ensure a good 'fit' in terms of type fo therapy and patient. If they feel that there may be other better options, be they conventional or complementary, they will probably say so. 
 
 

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.

Although we are honoured to have as members practitioners of the stature of David Mayor, one of the leading electro-acupuncturists in the UK, the range of possible users runs from people like David with 30 years or more experience in a specialist field to members who use small devices occasionally in clinic for use with musculo-skeletal problems. If we create a list it would be essential for us to set a standard which became a criterion for entry on the list, and we do not have the resources even to begin that task, let alone a realistic chance at this stage of agreeing criteria.

It is extremely important, when we make recommendations about specific techniques or members treating specific groups of patients, that we are able to say with confidence what a patient can expect. For example, we have two working groups currently developing standards in paediatric acupuncture and obstetric acupuncture so that someone visiting a member offering this as a specialist service can be assured that the member is able to bring specialist training to the table.

Unfortunately we do not think there is a likelihood in the short term of being able to offer the same kind of 'kitemarking' for electro-acupuncture. Most members within our local communities of practitioners, however, are usually aware of which of their colleagues uses EA more regularly. If this is a modality which you would prefer to have than needles alone, we are sure that you can be directed to someone who can meet your needs by contacting a BAcC member local to you and asking for their advice.