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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.

A:  We tend not to like words like 'heal' and 'cure', partly because the former lends itself to pejorative interpretations of what we actually do and the latter begs the question of what counts as a 'cure' anyway. However, that aside, traditional acupuncture came into prominence in the popular consciousness in the West after Nixon's visit to China in the 1970s mainly as a form of pain relief, but has a 2500 year history of being used to treat a huge range of conditions, many very successfully. The World Health Organisation, for example, publishes a list
 
 
http://apps.who.int/medicinedocs/en/d/Js4926e/5.html
 
of all the conditions for which evidence of acupuncture's benefits can be demonstrated.
 
One of the principal reasons that acupuncture treatment has not received the recognition we believe it deserves in the UK healthcare system is that the standard of evidence required, the randomised double blind control trial, is more suitable for testing drugs, not dynamic interactions like acupuncture. Setting up trials is both costly and difficult, and at the moment no-one is particularly interested in funding them. It is interesting, though, that the NICE guidelines for conditions like lower back pain and some forms of headache now recommend acupuncture as an option.
 
Of course, a fundamental difference between Chinese medicine and orthodox medicine is that CM treats the person, not simply the illness or disease which they have, and to that extent to say that it deals with conditions is to miss the point slightly. Every patient with a named western condition will probably receive a different treatment because the presentation will be unique to each patient and with that the combination of points used and the reasons for using them. There is quite a large amount of background material on our website which explains this more thoroughly.
 



Why the emphasis on pain relief? Well, one certainty in measuring the effects of acupuncture in pain relief is that there are some very specific chemicals whose levels can be determined exactly, and for the purposes of research this is a very exact outcome measure. When acupuncture was first tested scientifically it was an obvious choice, and because the results were good, pain relief became associated with acupuncture as a primary reason for its use. For some types of pain acupuncture is a good choice, although from a Chinese medicine perspective pain arises from specific changes in the system. If the treatment did no more than provide temporary relief, a master practitioner would be asking themselves what else they could do to effect lasting change, and if that did not happen, would be talking to the patient about whether the extent of the relief and the time it lasted were worthwhile and whether other options for treatment might be more advisable.    
 
 


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

 

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 on http://www.transfusionguidelines.org/document-library/documents/change-notification-no-32-2009/download-file/dl_change_note_2009_32.pdf and http://www.transfusionguidelines.org/document-library/documents/change-notification-no-33-2009/download-file/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. 
 

 

 

 

 

A: The short, and somewhat trite, answer is that they make sure that they are properly trained to begin with. Training in the UK, at least for entry to registering bodies such as the BAcC, requires a three year degree equivalent course which ensures not only that the basic knowledge is wired in but also that the bestg possible clinical practice is inculcated in the students. Knowledge without wisdom and good practice is irrelevant, and the crucial element in training is not being able to generate lists of symptoms and syndromes but to be able to respond to the unique problems which each patient brings to the clinic. This requires a great deal of supervised practice, in our view, to give practitioners the confidence to be able to adjust and refine their work to the patient's best advantage, and also to deal with situations where things don't go as well as they hoped. Knowing what to do is important, but knowing what to do when something goes wrong is the sign of true skill and mastery.
 
Making sure that someone follows best practice is an individual responsibility, but regulatory bodies such as the BAcC have the responsibility for checking that practitioners registered with it maintain their skills and develop as practitioners. As well as offering our own advice and support, with a great deal of valuable material being available on our website and through our professional journals we also have a mandatory requirement for members to undertake what is called CPD, Continuing Professional Development, which is aimed at making practitioners develop their skills after they have qualifed and for as long as they practise.
 
That, of course, is the carrot. The stick is that we have some very well defined rules of behaviour, skill and conduct to which  we expect our members to adhere, and we are always ready to take sanctions against someone who does not continue to meet or adhere to our standards. Expelling members is a rare event, but we do have occasion to ask members to up their game in terms of basics like good record keeping or respecting boundaries. The BAcC is a particularly well-behaved professional body, and disciplinary cases are rare. Above us, however, sits the Professional Standards Authority, a government agency with whom we are accredited, and its task is to ensure that professional associations such as ours continue to demonstrate that we are protecting the public by making sure our members are properly trained and accountable, and that members of the public have access to advice, support and pathways to complain if they are unhappy with any aspect of the treatment which they receive.  

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