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Ask an expert - general

145 questions

Q:  i wonder if ther is  any data on this website about guidance for the acupuncture graduates and how to open their own business and what are the next steps after graduation? Also. is there any data available about employability of  acupuncture graduates in UK? For example what percentages of graduates stay in business after graduation?  

A: There is information about what to do when setting up a business and when dealing with the transition from study to practice, but this is one of the benefits of student membership for which someone needs to be studying at a British Acupuncture Accreditation Board accredited teaching institution. We produced a very helpful booklet called Bridging the Gap and have placed a great deal more information on the student website. If you are a student at a BAAB course, then this material will be made available to you. In certain exceptional circumstances students at other courses are allowed to become student affiliates which allows them access to the same materials. This is granted at the discretion of the Student Services Officer and the Admissions Manager.
 
As far as statistics about people remaining in practice is concerned, we have undertaken a few rudimentary surveys over the last few years to determine whether the recession is causing a greater dropout rate than previously. We were always concerned that teaching institutions were giving a slightly over-optimistic picture of how easy it was to establish a practice, and we reckoned that two years was probably the minimum time necessary to become free-standing. We have found that there has been a slight but not very significant increase in the dropout rate from membership, but of course this means only that someone ceases to belong to the BAcC. We have no idea, for example, how many people find even the heavily discounted subscriptions of the first two years something of a luxury after the cost of training, and leave the BAcC to save money. This is probably more common than leaving practice entirely, especially since the average student has spent or committed themselves to £20K or more to become a practitioner.
 
There is no more data than that. However, many of the teaching institutions, who can be found on the main BAAB site, maintain alumni groups for cohorts of graduates, and you may find that they can give you a better view. Of course, it may not be in their interests to tell you if the drop out rate is high.....!
 
As for employability, the majority of UK practice is self-employed business, so the successful transition to business is very much in the hands of the individual. There are a small number of employment opportunities in the NHS, but too few to merit anything.

Q:  How well regulated and safe are practitioners licensed under ATCM? Do practitioners generally have both registration under ATCM and the BAcC or is only one required for legality?

A:   The members of the ATCM (Association of Traditional Chinese Medicine) are all well trained and qualified. The majority of its members trained in China, and often have a five or even seven year training which in may cases includes a training in western medicine to degree level and beyond. You can be reassured that ATCM members are competent and safe. The ATCM also has regulatory systems very similar to those developed by the BAcC, and holds its members to account for their standards.
 
There is actually nothing in law which requires a practitioner to belong to any professional association. We have argued for many years that professions such as ours should be regulated by statute, but we have been deemed relatively low risk and very efficiently self-regulating, so the immediate prospect of legal registration is remote. The best guarantee that a prospective patient has of their interests being protected is only to visit a practitioner who belongs to a body like the BAcC or ATCM, both of which take their role of protecting the public interest very seriously.
 
As for joining both, this would be unnecessary. Each provides similar benefits for its members, and to join both would be to add cost without gain. That said, there are an increasing number of practitioners who do join both, and we are engaged in high level talks with the ATCM about working more closely together for our mutual benefit and for the benefit of our members.  
 

Q:  I visited a qualified acupuncturist today. She mentioned different elements involved in Chines acupuncture. Fire, water, she suggested I 'represented' metal. it was a very good session but ran out of time so please what does my personality of metal mean?

A:  The Five Elements, or more accurately the 'Five Phases', are a way of understanding the energy of the body as a microcosm which reflects the macrocosm, the world around us. The elements, which are Fire, Earth, Metal, Water and Wood, represent, for example, the different qualities which each season brings to the year but are also thought to be a way of understanding all phenomena. There are elaborate tables of correspondences which you can easily obtain by googling 'Five element acupuncture', which show how each of these elements represents an aspect of the whole.
 
The Five Element system appears in some form or other in all systems of Traditional Chinese Medicine, and can be as prosaic as a description of certain body shapes and as sophisticated as the central basis for a diagnostic system. In the UK one of the major founding schools of acupuncture was based on this as its core concept, and although this school has now closed, others have incorporated the system in their work and have graduated practitioners who choose to use this as their primary tool.
 
It is quite difficult to encapsulate in a paragraph or two a system of considerable sophistication, but when Five Element practitioners describe someone as a Fire person or a Metal person, they are often paying homage to the work of J.R.Worsley who pioneered what he called the 'causative factor' as a way of understanding the person and treating them. In his view, in each person one of the elements was the one which was primary one out of balance, and treating this part of the system would restore overall balance. This did not necessarily manifest in physical, mental or emotional problems which were associated with this particular element in the table of correspondences, because the complex inter-relationships often meant that the strain was expressed elsewhere. Worsley often likened the system to twelve people working in an office. It is highly unlikely that the two most incompetent would be showing serious signs of stress, but everyone covering for them would. Once you put the incompetent ones right, however, everything else would settle down.
 
We all 'contain' all of the elements, but the one which represents our primary area of imbalance often leads to certain characteristics which define us and which alert the diagnostician to what is really going on. These are not the same as 'faults' or 'defects', more a kind of unevenness in certain areas of behaviour. Having a problem with the part of the system which governs decision-making is unlikely to lead to no decisions or too many decisions, but much more likely to manifest as small decisions taking ages and life changing decisions being done in a trice. 'Inappropriateness' is a key word in Chinese medicine; when an element is out of balance parts of the system will react inappropriately at all levels, body, mind and spirit. 
 
The Metal element, for example, being associated with the season of autumn is often seen as the part of the system which is responsible for letting go what has been finished with and reabsorbing the essential and valuable traces which we re-use. The emotion most closely associated with the Metal Element is grief, and there are also strong associations with a sense of value and self-worth. If this part of the system is not working as well as it might one would expect to see challenges or problems in someone's life which reflect an inability to deal with some of these issues 'appropriately'. Some people might find it difficult to let go of people or things, and grieve long after the time for grief has passed. Others may have a poor sense of their own worth and seek solace in material possessions or in searching for teachers to give their lives meaning. There are so many possibilities, however, that it would be unwise to list out too many like this. We are all individual and unique, and rule one is that there are no rules. Diagnosis is a subtle and taxing art; one cannot go backwards from a single physical, mental or emotional trait and draw an immediate conclusion. That's why it takes a long time to train. 
 
However, it must be said that most people,when confronted with a description of what they are told is their main element out of balance are not at all convinced and  can even feel quite insulted. The reality is that we are all so complex that it is very rare for one part of the system to stand out as the only thing out of kilter, and the real skill of the practitioner lies in making sense of the whole.
 
The other thing to remember is that being out of balance is not in itself a pathological state. All of us are to a degree and it is the small degrees of movement away from the centre line which make us who we are. It is only when life changes and stresses push aspects of our being too far away from the centre line that the strain starts to show and we need help to restore our balance. A world full of perfectly balanced people might just be a little too uniform for our taste!
 
There are a number of extremely good websites which you can find very quickly by googling  'five element acupuncture', all of which will help to give you a better understanding of the whole.    
 

A:  There are no 'rules' as such about self-needling by practitioners. The advice most acupuncturists were given in their initial training was that a practitioner could not have sufficient objectivity to make an effective diagnosis of themselves and to make the acupuncture as efficacious as possible. However, there are some short term emergency situations, like acute toothache, where there are commonly agreed pain relieving points which can buy a few hours of relief until emergency dental treatment. There is no reason why someone should not needle themselves in this kind of situation.

Self-needling by patients is a more contentious issue. We are aware of two or three highly successful programmes where patients undergoing chemotherapy for cancer are using a well-tried and tested point to reduce the nausea this can induce. Although we have some reservations about this, as long as the patients are trained in safe needling and the safe disposal of clinical waste, we accept that this is likely to be a part of mainstream care in the future.

Our major concern with self-needling is not knowing what to do but knowing what to do when/if something goes wrong. The true test of expertise is being able to react to unpredicted responses. If someone is only able to perform one task with one expected outcome then it is difficult to expect them to be able to react if they get an adverse reaction, like bruising or fainting. The same applies, in terms of reacting, to both practitioner and patient alike with self-needling; fainting is rare but putting a needle in onself and keeling over is not a great option.

With nearly 3000 BAcC members in practice, it isn't as though there weren't enough practitioners around!

Q:  Can acupuncture help with chronic blushing and stop the body from overheating?

A: This is an interesting question. As far as the second half goes, there is a substantial element of Chinese medical theory devoted to understanding the balance of Yin and Yang in the body, and Cold and Heat are just one manifestation of this duality. The fact that someone feels that they are constantly over-heating is a symptom which can be interpreted very thoroughly in the system, and there are dozens of treatments which would be applied to help to reduce this feeling.

However, we are assuming that you have made your doctor aware of this problem. There are a number of pathologies from a western perspective, some more serious than others, and it is vital that your doctor is aware of the problem and has run the sorts of tests which would help him or her to eliminate health problems for which conventional treatment ought to be given promptly.

It may well be that blushing is a part of this process; the appearance of a flush on the face is often a local manifestation of a systemic problem, and there are a number of case studies of men having treatment for prostrate problems for whom hot flushes have been successfully brought under control with acupuncture. This one

http://www.ncbi.nlm.nih.gov/pubmed/20605360

is not untypical. The manifestation of the problem often involves flushing of the face or blushing.

However, again the caution is that the symptom is understood for what it is. There are a number of physical reasons why someone might blush frequently and also several emotional reasons, and any practitioner worth their salt will want to establish the extent to which the emotions are also involved. It may well be that the situation is a complex mish-mash of causes, where the visible physical discomfort and change of appearance itself causes stresses which make the problem exacerbate, but all medical systems try to break spirals like this by understanding their complexity and looking for ways to intervene and stop the escalation.

The advice we often give, to visit a local BAcC member and obtain a face to face assessment, applies particularly here. There is a wide range of possibilities and while at a distance we would feel cautiously optimistic it would require sight of the problem and the diagnostic indicators to give a clear idea of what acupuncture treatment may achieve.