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Ask an expert - general

174 questions

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.

There has been an upsurge over the last few years in what has been described as 'cosmetic acupuncture' or 'facial revitalisation acupuncture'. With it has come a rather hot debate inside the profession, not least because some of the clinics where this technique is used charge fees that are considerably higher than the average fee charged by a BAcC member, and also because some of the people offering this treatment are not fully qualified practitioners but simply beauticians who have undertaken short course training.

Our general position is that there is not a specific separate discipline of cosmetic acupuncture but rather the application of traditional techniques on the face adapted for a specific purpose, but, and most importantly, taking into account the system as a whole as traditional acupuncture does. We have taken great care to get the message across that a properly trained traditional acupuncturist treats the person as a whole, not simply a named condition or a single part of the body, and that unless treatment is undertaken in this way, there can be no guarantees that short term local results can be be sustained.

We are also keen to get across the message that however limited the area of interest, acupuncture remains acupuncture wherever it is performed on the body, and our members undergo three years of degree-equivalent training to ensure that they are safe and competent and fully aware of factors affecting the safety of the patient. We do not believe that someone undertaking a short training over two weekends can realistically hope to match this level of safety training as well as learning the techniques. This is especially the case with some of the techniques commonly used in cosmetic acupuncture which are not a part of the standard protocols for body acupuncture.

We do not keep a separate register of our members who offer this type of treatment. The best bet would be to use google to identify someone in your area providing this style of treatment and then cross-refer with the BAcC Register to ensure that it is someone who is properly trained and insured.

As a general comment, though, we would want to have a look at what in your life was contributing to your wrinkles. If you are under constant stress and worry, there may be systemic treatments to help you to cope better with either in such a way as to reduce your wrinkles. We always ask whether wrinkles go when people are on holiday. You'd be surprised how many people say that they do. If so, local treatment will not be a proper solution to the problem unless it is supported by treatment of the system as a whole.

Q:  What are the rules on cupping for instance when bleeding occurs into the cup and how should cupping be done ?

A:  There are many articles and videos online which show how one can perform cupping, and of them we found this one from the Pacific College in the USA to be the clearest:

Traditional Chinese medicine brings to mind acupuncture and the use of natural herbs as healing remedies. Cupping is a lesser-known treatment that is also part of Oriental medicine, one that can provide an especially pleasant experience. One of the earliest documentations of cupping can be found in the work titled A Handbook of Prescriptions for Emergencies, which was written by a Taoist herbalist by the name of Ge Hong and which dates all the way back to 300 AD

Cupping is the term applied to a technique that uses small glass cups or bamboo jars as suction devices that are placed on the skin. There are several ways that a practitioner can create the suction in the cups. One method involves swabbing rubbing alcohol onto the bottom of the cup, then lighting it and putting the cup immediately against the skin. Suction can also be created by placing an inverted cup over a small flame, or by using an alcohol-soaked cotton pad over an insulating material (like leather) to protect the skin, then lighting the pad and placing an empty cup over the flame to extinguish it. Flames are never used near the skin and are not lit throughout the process of cupping, but rather are a means to create the heat that causes the suction within the small cups.

Once the suction has occurred, the cups can be gently moved across the skin (often referred to as "gliding cupping). The suction in the cups causes the skin and superficial muscle layer to be lightly drawn into the cup. Cupping is much like the inverse of massage - rather than applying pressure to muscles, it uses gentle pressure to pull them upward. For most patients, this is a particularly relaxing and relieving sensation. Once suctioned, the cups are generally left in place for about ten minutes while the patient relaxes. This is similar to the practice of Tui Na, a traditional Chinese medicine massage technique that targets acupuncture points as well as painful body parts, and is well known to provide relief through pressure.

Generally, cupping is combined with acupuncture in one treatment, but it can also be used alone. The suction and negative pressure provided by cupping can loosen muscles, encourage blood flow, and sedate the nervous system (which makes it an excellent treatment for high blood pressure). Cupping is used to relieve back and neck pains, stiff muscles, anxiety, fatigue, migraines, rheumatism, and even cellulite. For weight loss and cellulite treatments, oil is first applied to the skin, and then the cups are moved up and down the surrounding area.

Like acupuncture, cupping follows the lines of the meridians. There are five meridian lines on the back, and these are where the cups are usually placed. Using these points, cupping can help to align and relax qi, as well as target more specific maladies. By targeting the meridian channels, cupping strives to 'open' these channels - the paths through which life energy flows freely throughout the body, through all tissues and organs, thus providing a smoother and more free-flowing qi (life force). Cupping is one of the best deep-tissue therapies available. It is thought to affect tissues up to four inches deep from the external skin. Toxins can be released, blockages can be cleared, and veins and arteries can be refreshed within these four inches of affected materials. Even hands, wrists, legs, and ankles can be 'cupped,' thus applying the healing to specific organs that correlate with these points.

This treatment is also valuable for the lungs, and can clear congestion from a common cold or help to control a person's asthma. In fact, respiratory conditions are one of the most common maladies that cupping is used to relieve. Three thousand years ago, in the earliest Chinese documentation of cupping, it was recommended for the treatment of pulmonary tuberculosis.

There are a number of alternatives available, one of which involves a rubber cup which creates a vacuum without the need for a flame, with which some practitioners are uncomfortable.

If the cups become contaminated by blood or body fluids, the rules are fairly straightforward:

Reusable equipment, such as cups, derma rollers, guasha spoons, etc, which has been used on broken skin and/or come into contact with body fluids must be washed in warm water and detergent first, then rinsed in very hot water to facilitate quick drying and dried with a disposable paper towel. It must then be sterilised by autoclave or an acceptable chemical alternative according to manufacturers' guidelines.

Sterilisation is essential in these circumstances. However, if the cups have not been compromised there are slightly less complicated ways of washing them to an acceptable clean standard.

There is a methid of cupping called 'bleeding cupping' which is used within Chinese medicine but not by any BAcC members of whom we are aware. This involves the use of a triangular needle specifically designed to open a pinprick would through which the cupping can draw a quantity of blood. Should any practitioner member of the BAcC go down this route, we would expect them to be wearing gloves, to have impervious washable flooring, and separate facilities for cleansing equipment after use which were not used for any other purpose, i.e. a dedicated hand basin conforming to current legislative requirements.

We are aware of very few problems reported in the use of cups other than the occasional circular bruise associated with their use. These are so frequent that it is only through the practitioner's failure to forewarn someone properly that complaints arise.

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