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Ask an expert - general

161 questions

Q: Is there any evidence for the use of acupuncture in the treatment of Lupus? I have been told it is considered to be a contraindication by the Lupus organisation.

A:  There is a small amount of evidence that acupuncture treatment may be of benefit for people suffering with lupus/SLE. Studies such as this:
 
http://www.ncbi.nlm.nih.gov/pubmed/19029279
 
seem to point to a worthwhile benefit, but it is a single study with a relatively small sample group, so we cannot really put too much emphasis on the results. A much larger study would need to be done, and also need to be replicated by other researchers for us to make any specific claims.
 
One problem, of course, is that SLE can manifest in dozens of different ways, and at various levels of severity. There are very likely to be cases at the less serious end of the spectrum which go undiagnosed, and some which are diagnosed where the symptoms are relatively few and possibly respond well to treatment. At the other end of the scale there are severe cases which do not respond at all, and many of us have find memories of a professional colleague who died from SLE many years ago for whom enormous amounts of acupuncture were of no benefit.
 
The best view to take is that from a Chinese medicine perspective we treat the person not the disease. This means that although twenty people may have a standard named western condition, each one of the twenty may be diagnosed differently in Chinese medicine. The theoretical basis of CM is underpinned by a concept of energy, called 'qi', and its correct flow, rhythm and balance, and by an understanding of the Organs as functional units which do more than the western correlates (hence the capital letters). A skilled practitioner would look at the unique presentation of symptoms and make sense of these in terms of changes or disruptions in the flow and changes in the function of the Organs. This could mean that some cases were more amenable to treatment than others, but in every case would mean that the treatment was unique and different just as each individual is unique and different.

 Our best advice is to visit a BAcC member local to you and seek their advice. There is no substitute for a face to face assessment of what may be possible. From a western perspective there is no 'cure' for SLE, but from our practical experience this is just one of a number of auto-immune diseases where we have seen a considerable slowing down or halt in the disease process, and for many patients 'getting worse slower' is a viable and valuable treatment aim.

 As far as contraindications are concerned we have looked at all of the lupus organisation websites and have not seen anything which seems to contraindicate the use of acupuncture. If you have seen one we would be grateful to be sent details. If there is actual evidence of potential detriment we need to see it, and if not, we may need to discuss with them why they are 'dis-recommending' acupuncture. In severe cases where the immune system is badly compromised, our members all have clear guidelines to ensure that they minimise the risk of opportunistic infections, but we have never heard of any cases of problems arising as a consequence of treatment. 
 
 

 

 
 

 

 

 

 

 

 

 

Q:  Is the British Acupuncture Council on the approved list for blood donors, and what is the time scale for giving blood after a treatment?

A:  The most recent press release which we published on this subject was in June 2013. It said:

 

Blood donation current status June 2013

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·         Email

Date: Friday, 21 June 2013 12:42

The BAcC continues to receive calls and emails about the NHBTS policy that any patient who has had acupuncture treatment delivered by a practitioner who is not statutorily regulated has to wait four months before they can donate blood. This change to the NHSBT's donor criteria came into effect in late 2009,and with the statutory regulation of acupuncturists now unlikely in the foreseeable future, this could mean that someone having regular treatment with a BAcC member would never qualify to donate blood.

 The BAcC has exemplary safety standards and campaigned vigorously to challenge this decision. We have since done our best to make sure that all of our members let their patients know that they must wait four months to donate blood or bone marrow products.

 The official notification and rationale for the decision is available onhttp://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_32.pdf andhttp://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_33.pdf but some enquirers have found this difficult to locate on official sites.

 The BAcC is fully committed to reversing this decision for the benefit of the patients of its members. The recent accreditation of the BAcC under the Professional Standards Authority Assured Voluntary Register scheme has given us hope that this new flagship scheme will provide the recognition of exemplary standards the BAcC needs for its members to be granted exemption from the deferral period for donation.

 Since then, we have met senior officials in the NHBTS, and discussed with them how we might help to re-instate the donation of blood by non-statutorily regulated healthcare profesisonals, there having been no reported instances of blood borne virus transmission by acupuncture practitioners in the last decade. In order to change policy, however, there has to be evidence, and the NHBTS is proposing to conduct an analysis of previous screened donors to establish the level of risk. This study will take place later this year or early this year.
 
The wheels of bureaucracy turn slowly, and until that time anyone who has had acupuncture treatment from a BAcC member will have to wait four months until they are allowed to give blood.
 
We are sorry that many thousands of donors have been 'disenfranchised' by this change of policy and are working our hardest to bring them back within the list of eligible donors. 
 

 

 

 

China is a very large country, and it would be difficult to offer a definitive view. However, as we understand it, the majority of acupuncture practice in China is offered through the state hospital system, and there are a variety of degree qualifications which mean that most practitioners are also trained in western medicine to a far greater extent than would be the case in the UK. This reflects the fact that acupuncture is in many areas of clinical specialty offered within the state system, and the training which people undertake can be as much as five to seven years long. There are shorter degree courses in China, but these tend to harness acupuncture to a western clinical skill. With the difficulty of making sense of the apparently infinite varieties of course available this means that we often have problems with determining the full extent of someone's competence when they apply through our external applicant route. What we can say with some confidence, though, is that it would be highly unlikely to find a course in China which replicated the form of UK courses, with the acupuncture skill being primary and sufficient western medicine included (about one third of course time) to ensure that practitioners can integrate their work with conventional medicine and be aware of red flag conditions requiring immediate referral.
 
That said, there is no doubt that there are more rural areas where acupuncture is still an apprentice-style system, often within families, which is roughly how it was pre-1945, and in these areas one assumes that if a practitioner was good enough they would be able to eke out a living. How the authorities might react to this is another matter, and we have not heard of any western Europeans who have taken their skills back to China in this way.
 
However, a number of the UK courses have close affiliations with Chinese hospitals and universities, and their students undertake six week or three month study programmes in China, and often undertake postgraduate training in China. Working within a specialist hospital department may give a practitioner a chance to see hundreds, if not thousands, of similar cases in a very short period of time, and this can provide invaluable clinical understanding.
 
There are also a number of short courses in cities like Nanjing and Beijing which offer three or six month training from scratch to westerners, and many of the senior figures in the profession undertook this training when UK training was in its infancy. We have a number of members who in the last decade have begun their training in this way and gone on to work successfully in Chinese hospital departments, but it has to be said that in each case they have had to meet our requirements in the UK and had to undertake a fair bit of additional training in clinical management and western medicine before we could admit them to membership.
 
The short answer, though, is that it would probably be unusual for a UK trained practitioner to be able to drop straight into mainstream acupuncture practice in China because of the way that this is offered as part of an integrated package of medicine through the state system.
 

Q:  Is acupuncture an effective treatment of Bile Salt Malabsorption? I've put on about 3 stone since I've had this, and there is no cure. I'm desperate to lose weight and get some treatment for this condition, which although isn't life threatening is debilitating. Any advice you can give would be much appreciated.
>
A:  Bile Acid Malabsorption syndrome is one of those conditions which appears to have only recently warranted a name of its own, so there hasn't been a great deal of chance for anyone to research the use of acupuncture under problems with this name. We are fairly sure that you have done a great deal of research on the internet over the time that you have suffered from these problems, so you are probably conversant with the different ways in which the condition can manifest and some of the causes. Unhelpfully, of course, one of the most frequent labels is 'idiopathic', which is a Western medical way of saying 'it just happens and we don't know why'.
 
From a Chinese medicine perspective, though, the disease labels are often very unhelpful. What interests a practitioner of Chinese medicine is the symptoms with which a patient presents, together with the history and sequence of how they developed and the patterns which they form. The Chinese understanding of the body is very different from the Western one, with the concept of 'qi', or energy, being a central one. The quantity, flow and balance of qi determines good health, and the Organs of the body (we always use capital letters because what they do is very different from the way they are understood in the West) have a variety of functions which with a good flow of qi they maintain. When symptoms arise, they point to a weakness of flow in parts of the system. With the help of the patient's description of their symptoms and case history, together with diagnostic signs which are unique to Chinese medicine like looking at the tongue and taking the pulse at the wrist, the practitioner aims to establish where disharmony lies and addresses it.
 
In your case the weight gain, which is commonly reported in this condition, might have one of a number of recognised causes from an Eastern perspective, and if the diagnostic signs and answers to questions about other bodily systems point in consistent directions, there may be something for which a practitioner could offer hope. In Chinese medicine,for example, weight gain can often be tracked back to the poor function in the Spleen (note the capital letter - we are not talking about the western organ, the spleen!), which can cause an accumulation of fluids, especially in the central part of the body. If this is malfunctioning to a significant degree, then other aspects of the Spleen's functions will start to manifest problems. Someone may find they are visiting the toilet more frequently and urgently with looser stools, or they may find themselves bruising more easily, or their short term memory and concentration may be not as good as it was. These are all signs that the Spleen may be off key. The Chinese medicine practitioner would ask many questions to get a sense of what may be going on, and if the tongue and pulse supported this diagnosis, there are clear protocols to follow.
 
The beauty and complexity of Chinese medicine,however, lies in its ability when practised well to go to the heart of the problem, not simply treating where symptoms arise. The complex inter-relationships within the system can mean an Organ under-performs not because it is actually suffering but because it is not being supported by another Organ, and the reason that one can never reduce good Chinese medicine to formula treatments for named conditions is that a single named condition might have any one of a dozen different causes - it is the skill of the practitioner which enables them to go the point which will have the greatest effect in putting things back in order.
 
This may not seem as though it is directly addressing your problem, but what we are saying is that this is one of a number of conditions where the symptom and disease label alone are not enough for us to be able to offer a view at a distance, especially since the variety of possible causes means that there has not even been any targeted research on the basis of the evidence of which we could offer a view. What you need is a brief face to face assessment by a practitioner, hopefully without charge, to establish whether what they see encourages them to offer treatment with some hope of success.
 
That is not to say that there has to be a distinct and visible cause from a Chinese medicine perspective; the oldest systems still in use were broadly asymptomatic, treating people rather than diseases in the straightforward belief that a system in balance did not generate symptoms. However, even within this system, a practitioner can usually give an honest appraisal of the possible value of treatment before committing your time and money.
 
You can find a list of all the BAcC members in your area by using the practitioner search function on the BAcC's home page.    
    


Q:  Is acupuncture an effective treatment of Bile Salt Malabsorption? I've put on about 3 stone since I've had this, and there is no cure. I'm desperate to lose weight and get some treatment for this condition, which although isn't life threatening is debilitating. Any advice you can give would be much appreciated.
>
A:  Bile Acid Malabsorption syndrome is one of those conditions which appears to have only recently warranted a name of its own, so there hasn't been a great deal of chance for anyone to research the use of acupuncture under problems with this name. We are fairly sure that you have done a great deal of research on the internet over the time that you have suffered from these problems, so you are probably conversant with the different ways in which the condition can manifest and some of the causes. Unhelpfully, of course, one of the most frequent labels is 'idiopathic', which is a Western medical way of saying 'it just happens and we don't know why'.
 
From a Chinese medicine perspective, though, the disease labels are often very unhelpful. What interests a practitioner of Chinese medicine is the symptoms with which a patient presents, together with the history and sequence of how they developed and the patterns which they form. The Chinese understanding of the body is very different from the Western one, with the concept of 'qi', or energy, being a central one. The quantity, flow and balance of qi determines good health, and the Organs of the body (we always use capital letters because what they do is very different from the way they are understood in the West) have a variety of functions which with a good flow of qi they maintain. When symptoms arise, they point to a weakness of flow in parts of the system. With the help of the patient's description of their symptoms and case history, together with diagnostic signs which are unique to Chinese medicine like looking at the tongue and taking the pulse at the wrist, the practitioner aims to establish where disharmony lies and addresses it.
 
In your case the weight gain, which is commonly reported in this condition, might have one of a number of recognised causes from an Eastern perspective, and if the diagnostic signs and answers to questions about other bodily systems point in consistent directions, there may be something for which a practitioner could offer hope. In Chinese medicine,for example, weight gain can often be tracked back to the poor function in the Spleen (note the capital letter - we are not talking about the western organ, the spleen!), which can cause an accumulation of fluids, especially in the central part of the body. If this is malfunctioning to a significant degree, then other aspects of the Spleen's functions will start to manifest problems. Someone may find they are visiting the toilet more frequently and urgently with looser stools, or they may find themselves bruising more easily, or their short term memory and concentration may be not as good as it was. These are all signs that the Spleen may be off key. The Chinese medicine practitioner would ask many questions to get a sense of what may be going on, and if the tongue and pulse supported this diagnosis, there are clear protocols to follow.
 
The beauty and complexity of Chinese medicine,however, lies in its ability when practised well to go to the heart of the problem, not simply treating where symptoms arise. The complex inter-relationships within the system can mean an Organ under-performs not because it is actually suffering but because it is not being supported by another Organ, and the reason that one can never reduce good Chinese medicine to formula treatments for named conditions is that a single named condition might have any one of a dozen different causes - it is the skill of the practitioner which enables them to go the point which will have the greatest effect in putting things back in order.
 
This may not seem as though it is directly addressing your problem, but what we are saying is that this is one of a number of conditions where the symptom and disease label alone are not enough for us to be able to offer a view at a distance, especially since the variety of possible causes means that there has not even been any targeted research on the basis of the evidence of which we could offer a view. What you need is a brief face to face assessment by a practitioner, hopefully without charge, to establish whether what they see encourages them to offer treatment with some hope of success.
 
That is not to say that there has to be a distinct and visible cause from a Chinese medicine perspective; the oldest systems still in use were broadly asymptomatic, treating people rather than diseases in the straightforward belief that a system in balance did not generate symptoms. However, even within this system, a practitioner can usually give an honest appraisal of the possible value of treatment before committing your time and money.
 
You can find a list of all the BAcC members in your area by using the practitioner search function on the BAcC's home page.