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Ask an expert - general
Q: I am a doctor (MD degree)but am not registered in the UK. I have also obtained 'Master in Traditional Medicine (Acupuncture, Herbology, Laser, Electrobiomagnet), Samra University of Oriental Medicine, LA, CA, USAFor'. I would like to get some experience (training and working)in the UK and was wondering if you could provide me with some advice on how I can get registration with the British Accupuncture Council.
A:There are very few restrictions to the practice of acupuncture in the UK. In the absence of statutory regulation the only primary legislation by which practitioners are governed is generic skin piercing legislation mainly concerned with health and safety. This can differ depending on where you want to work. As we wrote to someone else from the States earlier this week:
There are very few restrictions on the practice of acupuncture in the UK, and there is what is described as a common law right to practise freely. In the absence of statutory regulation or state registration the only legal requirements are for registration or licensing by local authorities. This is primarily concerned with the standards of hygiene and safety for acupuncture as a skin piercing activity, although in more recent times many local authorities have become much more assiduous in checking that practitioners are properly trained and insured. Your training and registration in the US far more than meets the basic requirements for suitable training.
In the Greater London area the London Local Authorities Act 1991 applies, which means that you would have to obtain an annual licence at about £200 - £400 to practise. If you belong to an exempt body such as the BAcC, you do not have to pay, although you have to notify the authority of your presence and they will probably inspect the premises.
Outside London the Local Government Miscellaneous Provisions Act 1982 applies. This means that you have to be registered for every practice in which you work. Registration is a one-off process, costing again £250-£500. Only doctors and dentists are exempt from this Act.
In Scotland an annual licensing scheme exists similar to that used in London, but the only exemptions allowed are for those healthcare professionals like physios and nurses who are already state registered. BAcC members have to pay. This has been a bone of contention for many years, but we remain hopeful that we can negotiate exemption.
Your registration in California is one of the tougher ones in the States, but unfortunately there is no reciprocal recognition of qualifications as yet, so application to professional associations will almost certainly be through the individual 'external applicant' route, details of which you can find on our website. There are a number of other professional bodies whom you would be qualified to join, but we believe that we are the main and most respected regulator of Traditional Acupuncture in the UK and would hope that you would join us if you re-locate to the UK.
Q: GBS Guillian Barre syndrome - I have had two rounds of VIG treatment and again my weakness is increasing. Can accupuncture help me?
How do find an accupuncturist who would know about trating guillean barre syndrome? Is accupuncture treatment given under the NHS?
A:As you might imagine, we have been asked about many conditions already, and the last response we gave to a question about Guillain Barre syndrome was:
Q: I suffered with guillian barre syndrome, I have foot drop in my left foot and tight calves. Would acupuncture offer any relief?
A: Many of the symptoms which persist after an episode of Guillain Barre syndrome spontaneously remit within a year, so it is unusual and unfortunate to be troubled by residual effects.
There is not a great deal of research evidence of the treatment of Guillain Barre syndrome, although a group of Chinese researchers have posted a protocol for a review about to take place
which might produce a better picture once they have searched the databases for information.
To answer your question really means to look at what traditional Chinese acupuncture attempts to do, and that is to reinstate and maintain the flow of energy, 'qi' as it is called, in the body to ensure that everything functions as it should. Conditions like Guillain Barre which interfere with the normal flow in the muscles and tendons are seen in Chinese medical thought to be causes of blockage and deficiency, and at a very simplistic level the treatment is aimed at reinstating a blocked or missing flow. Of course, in practice things are a little more sophisticated than that, because the practitioner will want to know what happened to the system as a whole to let these particular symptoms appear where they did, and to decide whether it is really a local problem or one which requires a more subtle and systemic approach. Any condition involving a change in muscle tone or function may be benefited by acupuncture, though, and even the western medical acupuncture tradition sees this as a worthwhile intervention.
However, one important factor to bear in mind is that in a small percentage of cases residual symptoms not only persist for a great deal longer, but are sometimes intractable to treatment. If you did decide to give treatment a go and contacted a BAcC member local to you, it would be very important to establish very clear outcomes in order to assess whether the treatment is having an impact and a very clear sense of how many sessions to have before reviewing whether there has been progress and whether it is sustainable. It is in everyone's interests to ensure that, in Dr Johnson's famous words, continued treatment is not the triumph of hope over experience.
Our advice remains substantially the same. We have heard anecdotal evidence of successful treatment and also anecdotal evidence of prolonged treatment which has had no benefit at all. Chinese medicine works on an entirely different theoretical basis, however, and a western-named disease or condition could be diagnosed in many different ways. This will obviously have a direct bearing on how successful treatment may be. The best advice will always be to see a BAcC member local to you for a face to face assessment of what might be possible.
From our perspective, all of our practitioners are equally well qualified to treat all conditions. Chinese medicine treats the person, not the disease, and so there are relatively few areas where we recognise the importance of specialist training (paediatrics and obstetrics are two that we are researching). This means that you can be confident that anyone you identify near to you will be equipped to handle your problems.
As for getting acupuncture on the NHS, this is more of a problem. Most NHS personnel who offer acupuncture, generally doctors and physios, are limited to treating conditions for which there is good evidence and which fall within their scope of practice. You might just find that if you are offered physiotherapy that your practitioner mighy use acupuncture as a part of the package, but the chances are that they will not be using Chinese acupuncture, or at least, not Chinese acupuncture as we understand it. Many healthcare professionals now use Chinese points but often do so in a very formulaic cookbook way, and this will never be as effective as these points used within the framework of Chinese medicine itself.
Q: I have a number of odd ailments, all on the left side of my body. I have problems with a molar on the left side, several enlarged (about 2 cm), but painless lymph nodes (which have been biopsied and found benign) on the left side of my neck. Recently i had an ear infection in my left ear, and I've found a lump in my left breast that I'm having an ultrasound on next week, but I'm pretty sure they will find benign too. I have also broken out in spots on the left cheek and left side of my chin.
I have 3 children, and started trying for our 4th child in February 2013, but have suffered 5 miscarriages since and still no successful pregnancy. I was told when I had my first miscarriage that I had ovulated from the left ovary, which didn't seem to bear any meaning at the time, but I'm now wondering about the coincidence of it all.
> My question is - do these one sided problems indicate acupuncture could help me? Is there a blockage somewhere? I don't know much about acupuncture, so this is guesswork.
There is absolutely no doubt that one-sided problems, or an accumulation of problems on one side of the body, are diagnostically significant. In all forms of traditional acupuncture the balance between the bilateral channels is taken seriously, and weaknesses are both identified and corrected by attending to the subtle differences between the flows of energy on each side. In some systems, indeed, like Japanese meridian therapy, there are specific disruptions to the flow of energy around the central axis of the body which arise from accidents which can lead to a long list of what we might call 'non-specific' problems, i.e. where a joint doesn't move as it should but without a specific tendon or ligament being clearly identified as the source of the problem.
However, the problems from which you have suffered and from which you are suffering could be the result of random chance in terms of location; there has to be someone somewhere who has thrown a coin 'heads' ten times in a row, and it may be a simple coincidence that you have had a succession of left-side problems.
That said, this is a fairly good spread of conditions in a number of separate systems which suggest that there may be a specific energetic reason for them all to occur. A Chinese medicine practitioner, from whatever tradition or style, would be looking carefully at the other main diagnostic signs like tongue and pulse for evidence of what is going on, and may find that palpation of some of the channels for different sensitivity informs their findings.
We see many hundreds of questions each year, and there are some which whet our curiosity as practitioners because we find them intriguing, especially where conventional medicine cannot usually find any reason for things to be as they are and would probably be dismissive of the idea that all of these problems could have a common source or have arisen against a backdrop of general weakness on one side of the body.
The one note of caution, however, is that the problem with repeated miscarriages may have nothing to do with a weakness on one side of the body. If the desire to conceive again is top of your priorities, we would be a little surprised if this aspect of laterality was directly causally linked. There may, though, be other related energetic reasons why this is happening, and also may simply be a poor balance within the system as a whole, and the basic premise of Chinese medicine, that where balance is restored symptoms resolve, may may treatment worthwhile in any event. A growing number of our members mow take postgraduate training in all things obstetric, and focus their work on the pregnant, or hoping to be pregnant, women.
Our best advice is to seek a brief face to face assessment with a BAcC member local to you. Most are more than happy to give up some time without charge to discuss with a prospective patient what acupuncture may be able to do for them, and we are fairly sure that they will be as intrigued as we are.
Q: I have had hypothyroidism for approx 6 years now, and despite endless efforts, yoga, Zumba, walking, Pilates, diets of every kind, supplements, etc etc, I have not been able to shift the extra weight I gained when my thyroid condition first presented.
I am now approx 1.5 stones overweight and very miserable and self conscious as a result. And the constant failure despite every effort is even more disheartening.
Now I am contemplating acupuncture for weight loss but need to check if I can have acupuncture if I have hypothyroidism?
I also have a brain tumour, (an ependymoma in the 4th ventricle, for which I was treated 11 years ago with surgery where some of it was able to be removed, followed by 6 weeks radiotherapy)
So, please could you advise if I am able to have acupuncture?
A:There are no contra-indications to the use of acupuncture when someone has hypothyroidism. Indeed, we are sometimes asked if acupuncture can be used to treat hypothyroidism, and a sample answer that we gave says:
A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism. What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.
For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment as the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.
That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.
If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.
We would offer the same advice today and re-iterate the fact that it can quite often take a long time to stabilise thyroid medications. If acupuncture does have the effect of improving the residual function of the thyroid it may take a while to balance the doses of medication again.
We are always cautious when people ask us about using acupuncture for weight loss. There are a number of well-defined and easily recognised syndromes in Chinese medicine where additional weight gain, often in the form of retained fluids or precipitated by an under-performance of parts of the system, may be amenable to treatment. However, even here there is no guarantee that someone will lose weight, and evidence overall for acupuncture and weight loss is poor. It is also, even when part of a successful regime, not entirely clear what causes what. Very few people do only one thing to try to lose weight, and it might be any factor or all in combination which achieve a result.
What we can say is that there may be some aspects of managing one's diet according to Chinese medicine principles might be of benefit, and most practitioners will be only too happy to share this simple wisdom whether you proceed with treatment or not. The best and only advice we could give, though, is to see a BAcC member local to you for a brief assessment of your own unique situation and whether they think acupuncture treatment may be of benefit.
A: 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 (www.nadauk.com) and SMART-UK (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.
We think this remains basically sound advice. There are a number of issues with which one has to be careful. There is certainly an argument which we have heard advanced by many colleagues that using five-point protocols is all very well, but going to a professionla acupuncturist who treats the person and not just the condition can offer some help in treating the causes of addiction as well as the addiction itself, and we have some sympathy for this view. In fact, we have had our own patients for whom the driver for their addiction problems was an imbalance which we were able to help resolve.
However, many of the problems which lead to someone becoming addicted to alcohol or any other substance are very complex, and being able to negotiate the difficulties is something for the expert, not the gifted amateur. We have seen colleagues get themselves into very uncomfortable situations by gettig out of their depth, and we always advise them that being part of a multi-disciplinary team is pretty much always the best way to help people come to terms with and control their addictions.