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Q: I have had 4 strokes and I have diabetes, high blood pressure and high cholesterol. I have been falling a lot lately, tripping over my own feet. This happens a lot more when I am tired. My neurologist says that my falling is multi-factorial - the diabetes he feels has caused some neuropathy in my feet and the strokes have messed up my center for balance in my brain. I am at my wits end trying to avoid falling. Do you think that acupuncture could help my condition(s)?

A:  There is certainly no likelihood of any hard from trying acupuncture treatment; it remains one of the safest medical interventions, with very few adverse effects, most of which are transient.

We have been asked about diabetic neuropathy on a number of occasions. Our factsheet on neuropathic pain tends to address neuralgias more than neuropathy itself, and our answer to our last enquirer, slightly more specific than your question, was:

Q: My husband has diabetic lumbosacral radiculoplexus neuropathy. Please advise if he should find an acupuncturist specializing in this condition. .We live in west wales and would be grateful if you could recommend a practitioner.

A:The first thing we have to say is that you are unlikely to find an acupuncturist who specialises in treating this condition, but that is in the nature of Chinese medicine which is inherently generalist. In fact, in ancient China the specialist was regarded with disdain because they were restricted to treating a small number of conditions, whereas the generalist could treat all. Chinese medicine treats the person, not the condition from which they suffer. It would not be unusual for twenty patients with the same presenting conventional named condition, say migraine, to be treated in twenty entirely different ways.

Symptoms, what the patient experiences, are the same whatever system of medicine one practises, however, and it is the sense which a practitioner can make of them which determines whether treatment is possible. The normal symptoms of this form of diabetic neuropathy - pain, weakness in the limbs, muscle wasting and so on - would be seen by a Chinese medicine practitioner in the context of the Chinese medicine system which is premised on an understanding of the body as a flow of energy, called 'qi'. How qi flows. The balance and rhythms of this flow determine whether someone is healthy or not, and unsurprisingly where the flow is blocked or out of balance, pain and loss of function will result.

This is a rather long-winded introduction to saying that the Chinese medicine practitioner will be less interested in the name given to the condition than in how it presents, and will try to make sense of that both as a local disturbance and as a manifestation of the balance of the whole system. This can mean on occasion that acupuncture treatment can achieve changes where people thought change was impossible, but this has more to do with the fact that the causal relationships on which conventional medicine relies can be misinterpreted. Nearly everyone over the age of 60 has some degeneration of the lower spine visible on X-ray but that doesn't mean that every backache is caused by it.

In the case of diabetic lumbosacral radiculoplexus neuropathy, however, the diagnosis tends to be more precise and what we can say is that there is a limited amount of evidence for the use of acupuncture in the treatment of neuropathy and considerably more evidence for the treatment of chronic pain wtih acupuncture to suggest that acupuncture treatment may be able to take the edge off your husband's pain. Working at this remove, though, and without being able to see exactly how it manifests we are somewhat limited in what we can say. The best advice we can give is that you go to see a BAcC member local to you for an informal face to face assessment of whether acupuncture treatment may be of benefit. A skilled practitioner should very quickly be able to tell you based on what they can observe whether they think that treatment applied locally may help, or indeed whether balancing the whole system may help the body's own mechanism's to function better and take charge of its own recovery.

As far as finding a practitioner is concerned, there is a 'find a practitioner' feature on our home page www.acupuncture.org.uk which should be able to provide you with a list of names of working in or near your postcode area. We always recommend using postcodes; the search engines are very specific and if you name a county you may find that someone works just over a county border who is far closer than the practitioners operating in your own town or county.

We think there is enough overlap here to answer some of your question, but we would probably place greater emphasis for you on the fact that acupuncture treats the person, not the disease itself. Given that you have a number of quite serious health problems, it is sometimes more advantageous coming at them from a different perspective to avoid taking on symptom after symptom, one at a time. We see many patients taking bucketloads of medicine as a consequence of this approach, and while we are not at all opposed to the use of medication, we are always concerned that this overloads the body with the complex interactions between the medicines and generally addes a few more symptoms.

The traditional acupuncture practitioner will try to make sense of the patterns which have developed in such a way that they can apply the minimum amount of treatment to the most needy areas to encourage the person's own healing process. While it is possible to use acupuncture treatment in a more targeted way, we believe that taking a holistic approach offers the best way not just to help the patient to get better but to stay well. In ancient times the traditional doctor was paid to keep someone well, not to get someone better after they had become ill. This was, said the Chinese, like 'digging a well when you are already thirsty, or forging a spear after the battle had started.'

The best advice, as we said in our earlier reply, is to visit a BAcC member local to you and seek a brief face to face assessment of whether acupuncture treatment may be of benefit to you.

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

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007797/pdf

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.

A:  In the case of treatment for tinnitus, we have expressed some reservations about how responsive to acupuncture the condition can be, and we have reproduced below our last answer which addressed this problem:

Can acupuncture help with severe tinnitus?

As you can imagine, we have been asked this question on several occasions, and our replies have not been that encouraging. The fact sheet which we have on the website
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html
 
is quite upbeat about a number of small studies, but our clinical experience is not as good, with tinnitus among the more intractable conditions with which patients present. In a recent answer, to which we can probably not add a great deal more, we said:


 A. Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. It is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifiable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted

A:  Pins and needles, often called paresthesia in conventional medicine, is usually associated with poor circulation or some kind of interference with the nerve pathways. Generally speaking, it is self-correcting, so when it occurs all the time it needs to be investigated thoroughly. We don't want to sound like harbingers of doom, but there are several quite serious conditions for which constant pins and needles are a symptom or general warning sign. It is really important to discuss this with a GP and possibly arrange for a consultation with a neurologist just to be sure that this is not the tip of a much larger iceberg. The chances of it being more than it appears are remote, but we have a duty of care to our patients to ensure that there is nothing for which conventional treatment is required.
 
There is, as you might imagine, very little research in this area under the general heading of paresthesia. What you will find is a certain amount of research on peripheral neuropathy, which is one condition where pins and needles sensations are among the range of possibilities. We answered a question on this a short while ago, and you can see our answer here:
 
http://www.acupuncture.org.uk/public-content/public-ask-an-expert/ask-an-expert-general/ask-an-expert-general-general-uncategorised/can-acupuncture-help-with-peripheral-neuropathy.html
 
However, symptoms like this have existed since we started walking upright, and Chinese medicine, which has a 2500 year history, has been addressing such problems within its own conceptual framework. As you may already know by looking at our website, Chinese medicine is based on a theort of energy, called 'qi', which flows around the body in specific patterns whose flow, rhythm and balance are a precondition of good health. When the flow is disturbed or blocked, then ill health in the form of symptoms will start to emerge. The flow is maintained by the Organs of the body (always capitalised in Chinese medicine because these are groups of functions overlapping with the physical organ as it is understood in conventional medicine), and when symptoms like pins and needles appear, it usually points to a number of specific possibilities for Organic malfunction.
 
Nothing is as straightforward as that, however! The interconnections of all parts of the system mean that there is a considerable art and skill in the practitioner's interpretation of what is happening. That a part of the system is causing a problem is not difficult to determine. Whether that is the source of the problem or whether that part of the system is reacting to imbalance elsewhere is critical. Treating in the 'point and shoot' manner of cookbook formulae may help for a while, but if the underlying problem is not addressed the symptoms will come back or worse still, be suppressed while the problem continues to develop. This is why the BAcC sets so much store by the degree-level training our members have; it takes that long to be able, in our view, to begin to master these skills.
 
The best advice we can give in situations like these, where the range of possibilities tends to be quite wide, is to arrange a visit to a BAcC member local to you for a brief face to face assessment and discussion of whether acupuncture treatment is appropriate for this problem. Most members are very happy to do this, usually without charge, to ensure a good 'fit' in terms of type fo therapy and patient. If they feel that there may be other better options, be they conventional or complementary, they will probably say so. 
 
 

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.  
 

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