Gavin Erickson

Gavin Erickson

Q: how does acupuncture help in managing osteoarthritis. Does it only relieve pain or can it also slow down the progression of the disease

A: There is a very large and increasing body of evidence for the use of acupuncture as a treatment for osteoarthritis, as our factsheet shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/osteoarthritis.html

Many of the studies are quite clear that reduction in pain with acupuncture is a reasonable expectation of outcome for treatment, and many of the studies cited here speak of the reduction in physical dysfunction which acupuncture treatment seems to achieve.

However, it is a fairly large step from pain reduction and functional improvements to statements about slowing down the progression of the disease. To the extent that changes in physical movement wrought by the pain and inflammation can both make the situation worse, any reduction or change in either will stop the condition feeding off itself, i.e. the symptoms become a part of the causal pattern which causes deterioration. However, the factors which predispose someone to osteoarthritis may still be as active as they were before, be they genetic, environmental or lifestyle, so it would only be reasonable to say that unless these change then slowing down the disease progression may not as easy to achieve.

This is to look at things from a conventional medical perspective, though. The ancient Chinese were just as prone to osteoarthritis as modern people, but the whole nature of the understanding of disease in Chinese medicine is different, and from this perspective there may be something which a practitioner could reasonably hope to achieve to remove some of the causal factors. Chinese medicine is predicated on an understanding of the flow of the energies of the body, called 'qi', and its patterns of flow and balance. Factors which affect this are often described in physical terms  - heat, cold, damp, etc - as a reflection of the conditions in which most people worked on the land. The Chinese would see the joint being directly affected by these conditions and use acupuncture and herbs to reduce the impact on the body.

In doing so they would also be mindful of the unique balance of the individual and the constitutional patterns which they had inherited which made some people more prone than others to develop osteoarthritis (the Chinese called it Bi Syndrome, and classified it according to its presentations - Hot Bi, Cold Bi, Damp Bi, etc). In this sense an experienced practitioner might hope to reduce the symptoms as well as addressing some of the deeper factors which predisposed someone to suffer with OA. From this perspective it might well be possible to look at slowing down the disease progression.

No treatment for OA works in isolation, though. An integrated approach, involving not just acupuncture but physical therapy, diet and exercise, will always offer the best chance of making life more tolerable for an OA sufferer.

Tuesday, 30 May 2017 08:32

I suffer from ventricular ectopics

Q: Hi. I suffer from ventricular ectopics,I have seen Drs regularly and take beta blockers which work to a degree. I have periods when things aren't too bad and periods when things are really bad,I do get quite down during these times. Do you think acupuncture would help?

A: We have been asked similar questions before, and in reply to one we said:

One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The irregular pulse has clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

http://www.ncbi.nlm.nih.gov/pubmed/18992625

Some of the published research also involves animal experiments, sometimes called 'ratpuncture' in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what the conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.


There have been a couple of other systematic reviews

https://www.ncbi.nlm.nih.gov/pubmed/28432528

http://www.internationaljournalofcardiology.com/article/S0167-5273(11)00227-0/fulltext

which make largely positive noises, but as in all of these kinds of studies the treatment which is given is largely formulaic, and does not really represent what a traditional acupuncturist does, which is to gear treatment to the individual and his/her unique balance of energies. Where trials offer designs which allow the practitioner to do what they might normally do, so called 'black box' trials, the results tend to get better and better.

The bottom line, though, is that from a Chinese medicine perspective there are often functional disturbances which can generate symptoms, often far away from the source of the manifesting problem. The skill and art of the practitioner is to make sense of the diagnostic information and treat the root of the problem. This can often cause a symptom to reduce or even disappear without there having been any apparent connection between where the needles were placed and the part of the body in distress.

The advice we gave before still holds good, to visit a local BAcC member for advice and a short face to face assessment of what may be happening. Most BAcC members are only too happy to give a small amount of time without charge to prospective patients to enable them to assess whether acupuncture is the best treatment for their problem. This will obviously give a far better idea of what may be possible than what we can say at a distance.

Q: I had chemotherapy 4years ago, I lost my finger and toe nails. Since I have suffered terrible discomfort in my feet. I now find it hard to sleep because of the pain. Would acupuncture help?

A: We are sorry to hear of your problems after chemotherapy, and hope that the treatment worked for the condition at which it was aimed.

As you can imagine we have been asked before about neuropathy induced by chemotherapy, and a typical answer has been:


There is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

We have to be careful not to get too drawn into a conventional medicine perspective when answering questions like this, though. If there has been physical damage to the nerve endings then the condition is less likely to be reversible, although there is some cutting edge research which does suggest that peripheral nerves can regenerate. If the nerves are not too badly affected, however, it is important from a Chinese medicine perspective to see how the chemotherapy has affected the whole system. A symptom can be generated by any number of functional disturbances as understood within Chinese physiology, and can also arise from a simple blockage in the flow of energy at a local level. Problems like neuropathy are often a manifestation of both phenomena, and offer a number of treatment options. The skill of the practitioner lies in seeing how the system as a whole is functioning to narrow down the possibilities for treatment selection.

This does not mean that acupuncture can achieve miracles where modern medicine cannot. What we find, however, is that where western medicine assumes a direct causal path between the chemicals and the nerve damage or loss of function, Chinese medicine offers a number of potential routes where, for example, the chemotherapy may have affected a functional unit which in turn has weakened the energy at the periphery.  This is turn may offer a slightly different focus for treatment with better chance of success.

It also explains why people are often confused by the fact that the same symptom  can be apparently treated twenty different ways. From the Chinese medicine perspective the symptom is often only an alarm bell sounding for wider-ranging imbalances, and the practitioner will always look at the overall context to determine how to proceed.

Having looked at this as an answer we think it still represents the best advice that we can offer. We have had another look at the databases, and there has been nothing new since we wrote the earlier reply. Franconi's systematic review, a paper which gathers together results from all other papers, is perhaps the most recent and best summary, but as we said in the earlier reply, he concludes that the results, while encouraging, are far from conclusive.

What we didn't say is that most BAcC members are more than happy to take a look at problems for prospective patients by giving up a few minutes without charge. A short face to face assessment is always going to be far more authoritative than anything we can offer at this remove, so it would be worthwhile contacting BAcC members local to you to see what they think. This also gives you a chance to meet them and see where they work before committing to treatment.

Q: I am very interested in Acupuncture.

I am 32+ weeks pregnant and I was thinking to begin acupuncture in the 37+ week. I read it can relief a lot the pain in labour and helps deliver quicker. Could you please advice me? Because it seems that midwifes and GPS don't know much about it.

A: As you can see from our factsheet on obstetrics

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1592-obstetrics.html

there has been a considerable amount of research into many areas of pregnancy, from early stage morning sickness through breech presentation and on to delivery itself. While the evidence is a long way from conclusive (it does tend to be, but this is more a reflection of the standards used in the West which may not be the most appropriate for evaluating acupuncture treatment), it does show a trend towards acupuncture treatment being worth a try for many of the problems/challenges associated with pregnancy/delivery.

Although we describe ourselves as generalists - we primarily treat people, not diseases or conditions - there are one or two areas where the training which we all have can be usefully supplemented by postgraduate training. In two of the most clear-cut cases, obstetrics and paediatrics, the training is now sophisticated enough to warrant a decision on recognising expert practice, i.e. someone can legitimately claim within our rules to be an expert at treating these specific patient groups. While we are not yet yet in a position to do this, ultimately it will mean that we can specify which training people have had and point to providers who all keep lists of their graduates and affiliates. In the absence of this, the best that we can say is that if you use google and search on 'acupuncture pregnancy' and your home area you will without doubt generate a number of hits, most of whom will be BAcC members.

There are a number of websites associated with the training providers which can be very helpful, often addressing many of the questions which people bring and have brought to their practitioners. The best advice we can offer, though, is that having located a person or people in your area who may be able to help you should arrange to see them for an informal chat to see how they can help you and also to see whether they are people you feel comfortable with. In most cases we would say that one practitioner is as good as any other, but childbirth  is a very intimate process and it would be especially good if you have confidence in and rapport with the practitioner. The earlier you establish this contact the better, even though you may not call on their services until near due date.

We are sorry that there is such a dearth of provision within the NHS. There have been a few hospitals like the Derriford in Plymouth which had a remarkable unit which incorporated acupuncture in all aspects of pregnancy, but that unit, like many others, has closed. The problem for NHS professionals is that most provision is evidence based, and as we said at the top, the evidence for the benefits of treatment is not quite good enough for NHS providers to bring acupuncture treatment within mainstream care. You may find some midwives with training in the basic skills, but these are few and far between.

We hope that you do manage to locate a good practitioner locally, and wish you every happiness with your baby's birth.

Q: I am seeking a bit of advice. I suffer from migraines and acupuncture has been extremely helpful to me which was suggested by my neurologist. I am now 16 weeks pregnant and I am having another episode where I am struggling to function the same as they were 12 months ago. The physiotherapist that treated me with acupuncture previously has refused to treat me this time due to the risks of miscarriage due to where the needles should be placed. Could you advise me if this is the case and that I should avoid for the foreseeable future?

A: The BAcC has been giving advice on its website for years which says:

How can acupuncture help during pregnancy?
Many conditions which routinely crop up during pregnancy would benefit from a natural solution. Acupuncture, when provided by a trained practitioner, can give relief for a range of pregnancy related conditions:

  • Morning sickness
  • High/low blood pressure
  • Anxiety
  • Tiredness
  • Constipation
  • Tender breasts
  • Migraine and other headaches
  • Back ache
  • Pelvic pain (Symphysis Pubis Dysfunction)
  • Varicose veins

This very much reflects what Debra Betts, one of the leading acupuncture experts in the field of obstetrics says on her own website

https://acupuncture.rhizome.net.nz/acupuncture/pregnancy-childbirth/acupuncture-use-pregnancy/

The problem usually arises when people use formula acupuncture, that is a kind of 'cookbook' approach where each condition with which someone presents has a specified group of points which a practitioner can use. There are, indeed, a number of points which we avoid during pregnancy because they have a strongly downward and expulsive effect, and it is highly likely that some of these are in the cookbook which the physiotherapist is using.

However the great strength of traditional acupuncture is its self-contained and completely systematic understanding of the system which means that there are many alternative ways of addressing the imbalances in the system which are causing the migraines. This may mean that you have to seek treatment with another acupuncture practitioner, but we have always taken the view that in the hands of a properly qualified and trained practitioner there should be no risks at all in treating migraines and many other conditions during pregnancy.

There are an increasing number of BAcC members who now take specialist postgraduate training in obstetrics, and in the foreseeable future we expert to recognise them as 'expert practitioners.' When this happens we will be able to offer a list of possibilities, but for now you will find that using google and searching under 'acupuncture and pregnancy' alongside your area will generate a number of hits of our members with specialist training. These may be the best bet, because they will probably have a more in depth understanding of the energetics of pregnancy.

We mean no disrespect to the physio, by the way, but because the majority of their work is western medical acupuncture and within their scope of practice it is not surprising that they are cautious when taking on more specialist areas of practice, and for that your practitioner should be commended.

We wish you a peaceful and stress-free pregnancy, and hope that treatment brings you the relief you need. We also hope that if you do see a BAcC member with specialist training they can perhaps help you with some of the later stages of the pregnancy.

Q: Doed obtaining the Chiway swiss Diploma in Acupuncture and Tuina entitle one to be registered in the Uk as a licensed acupuncturist?

A: The first and most important thing to say is that in the absence of statutory regulation in the UK there is no single registration process for someone to become a licensed acupuncturist. Under what is termed common law, anyone can set up practice without any restriction. The only legal requirements are those which involve registration with local authorities under a number of different byelaws which regulate skin piercing activities. These mainly concern the standards of hygiene and waste disposal in a practice, but in recent years there has been an increase in interest in the standards of training which people who are trying to register have. We have heard stories of people with very short training courses behind them, perhaps a two weekend course, being refused registration. However, the majority of courses of this nature are provided for medical health professionals like doctors and physios who are usually exempt from registration anyway, so in practice there are very few people trying to become licensed as traditional acupuncturists on the basis of rudimentary training.

The majority of UK practitioners belong to one of a number of different acupuncture associations, membership of some of them giving people exemption from licensing in the Greater London area. Most have clearly identified and published entry standards, and it would really be a matter of whether your training from Switzerland met the minimum criteria for membership. None of the associations of which we are aware has any reciprocal recognition of qualifications, so we suspect that you would have to make an individual application and be interviewed about the extent of your training. We have looked at the website of the school which provided your training, and on the surface it looks fairly comprehensive, but we have seen similar programmes for course which lasted a couple of weeks, so without a course transcript detailing hours of training it would be difficult to say how easy it would be to register in the UK.

Our own standards and entry process are to be found here:

https://www.acupuncture.org.uk/public-content/join-the-bacc/3915-join-the-bacc.html

where our Admissions process is described, and a broader outline of training standards can be found on the website of our sister organisation, the British Acupuncture Accreditation Board here:

https://www.baab.co.uk/

The documentation here outlines the degree level training which accredited courses have and which lead to automatic eligibility to join the BAcC. All other applicants are interviewed and assessed individually.

Q: I had an embryo transfer today and had acupuncture after the lady used a heat lamp on my abdomen after reading up I am worried as it says don't heat stomach.

A:

We are sorry to hear that you are concerned about this on a day when you are probably incredibly concerned about what is happening anyway.

You have probably found websites about heat lamps which say something like:

We recommend that the lamp is not used in cases of fever, diabetes, peripheral vascular conditions, or serious arteriosclerosis. All of these conditions are contraindicated where the application of heat treatment is concerned. In the cases of diabetes (I & II) and peripheral vascular conditions, the specific reason is that the individual may experience lack of sensitivity and/or numbness in certain areas which could in turn lead to possible burning of the skin should the lamp be placed too close to the body. Not suitable for pregnant women. Patients with hypertension must avoid treatment of the head. Patients who wear a pacemaker should avoid treatment of the chest. If using the lamps around the head or face, ensure that the eyes are protected.

and this indeed is the information which we tend to use with members asking about safety. One of our members, Zita West, who writes extensively about this aspect of fertility treatment sets out some very straightforward guidelines here:

http://www.zitawest.com/do-i-need-to-rest-after-an-embryo-transfer/

However, if your practitioner is properly trained and qualified, and we assume that she is, then we suspect that there are probably energetic reasons for applying heat to the lower abdomen to maximise the chance of a successful implantation. Many cases of problem fertility have a root, in part at least, in coldness in the lower abdomen, and if the practitioner believes that this is the case it would not be surprising if this were to be added to the treatment.. This would be more a matter of enhancing the chances of implantation after transfer rather than interfering with an existing pregnancy.

The simplest solution in cases like this, though, is always to ask the practitioner herself why she used the lamp, and whether it is safe. A responsible and trained practitioner will invariably be more than happy to explain what they do and explain too the safety of nearly all acupuncture procedures. A part of our work is to be available to patients before, during and after treatment to set their minds at rest about what we do. We use acupuncture every day, so it is not an exceptional thing for us, and we have to remember all the time how unusual and a little weird it is still perceived to be by many people.

If the answer you get is unsatisfactory, or even if it is and you still don't feel comfortable with heat being used, then simply ask that this is not done again. We doubt that what you have had done already could have done any harm, and it may be quite the reverse.  However, it is very important at this time that you feel as relaxed and confident as possible, so if this is likely to be a source of concern, then ask the practitioner not to do it again.

We wish you well, and hope that the transfer has been successful.

Q: My meibomiem glands are blocked causing swelling below my eye. Can acupuncture unblock these?

A: If you search the internet for problems with the meibomian glands and the use of acupuncture you will come across the occasional study like this one

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/

which is cited quite frequently in the treatment of dry eye syndrome. There are a couple of others of a similar nature, but the main concern is with a functional disturbance in the work of the glands as a contributor to the symptom rather than a straightforward blockage.

Of course, when you talk to acupuncture practitioners about blockages they tend to light up. Our work, after all is based on an understanding of the body as a complex flow of energies, and using needles to unblock areas which have become stuck is very much a part of what we do. When someone reports an area of the body where things have become 'stuck' we always feel that the use of needles may well help to unstick them.

However, we are always looking at the person as a whole, not simply the symptoms which they have, and an important concern is that the symptoms is not the tip of a much larger iceberg. Although symptoms like yours tend to be local rather than systemic, there are times when a general change in the character or viscosity of body fluids can cause accumulations in areas where the physical conduits or channels are narrow, and an experienced practitioner will want to understand your local symptom in its wider context before giving you a prognosis.

The best advice that we can give is that you visit a local BAcC member and let them have a look at the problem face to face. This will give them a much better idea of what may be possible than we can offer at a distance. The one caveat with problems like this, though, is that people can sometimes carry on with treatment far longer than the results justify. If it is a simple and local blockage there should be changes within a session or two. If there aren't then it is worth drawing a line very quickly before committing large sums of money getting nowhere, unless the practitioner is absolutely sure that there is a wider pattern which underlies and sustains the symptom.

Wednesday, 10 May 2017 11:35

Philip Rose Neil

Philip Rose Neil is the Chair of the Governing Board.

Phil is one of the relatively rare traditional acupuncturists who had an ambition and a desire to make traditional acupuncture their profession and career from the beginning. He follows in the footsteps of his father Sidney Rose-Neil who was a founder of the profession.

He graduated in Traditional Acupuncture with first class honours from Oxford Brookes University in 2011. Phil’s practices are based in the Midlands, East Anglia and London.

Phil has always been an active member of the BAcC and has been the Regional Group Coordinator in Northamptonshire and sat on various committees before joining the Governing Board in 2013. He is extremely passionate and devoted to the promotion and values of traditional acupuncture.

He has very recently become a proud first time parent. 

Wednesday, 10 May 2017 09:05

Can acupuncture help anosmia?

Q: Can acupuncture help anosmia?

A: We have been asked this question a number of times, and our answer has always been:

Google is a massively powerful search facility, and if you google 'acupuncture anosmia' it looks as though there are a number of studies which give cause for hope. If you look carefully, however, you will see that there is but one study http://aim.bmj.com/content/21/4/153.long which is frequently quoted, generating a number of secondary references. This study, what we call an n=1 case study because it is the report of a single case, is important because it suggests that there may be something worth looking at in the use of acupuncture treatment. The weakness of n=1 studies, of course, is that they are not designed to test acupuncture, and the positive outcome could have arisen for any number of reasons, especially since the case study can provide no evidence for the sudden onset of the problem.

That is not to say that acupuncture treatment is not worth trying. The use of Traditional Chinese medicine involves a great deal of questioning and examination to determine the state and flow of the energies of the body, called 'qi', and the state of the organs which are responsible for all of the functional aspects of the body. Even where there is no obvious cause from a conventional medical point of view, it is rare for a symptom to stand alone in Chinese medicine other than where it derives from a blockage. In this case, if the blockage is removed, the function is restored. We strongly suspect that this is what happened in the case study, and blockages of this kind can sometimes occur for no obvious reason.

Generally speaking, though, a pattern of disharmony will generate a number of symptoms or changes in function, not all of which are clinically significant from a conventional perspective, and these may point t specific imbalances affecting Organic function. Note that we capitalise the word 'Organ' - what we understand by this in Chinese medicine is a great deal more than a physical unit in the body. The Chinese understanding of an Organ embraced functions on all levels, body mind and spirit, and when practised properly Chinese medicine can legitimately claim to be holistic.

The best advice we can give is that you visit a BAcC member local to you for advice on whether they think that acupuncture treatment may be of benefit, and to discuss briefly with you the other aspects of your health which may indicate wider patterns which in turn may link to your problem. That is not to say that there may not be as simple a treatment as the one described in the paper, and one of the points used has the Chinese name 'Welcome Fragrance' suggesting that it may have a direct bearing on the sense of smell. You would certainly not do any harm. However, we would be more likely to look at this as a functional disturbance and be looking at other factors in the system which might point to a treatable pattern.

There is not much more that we can say than this.  We have re-checked the research databases, and there has been nothing new to report. However, we have come across a couple of anecdotal accounts from colleagues, so we would not say that treatment definitely could not help, but that it would be unusual if it did.

Of course, a great deal does depend on the reasons why the condition may have developed, which is why we would always recommending talking to someone face to face. This may offer useful clues which could increase the chances of some improvement if the causes were more physical than neurological.