How to chose your acupuncturist

There is nothing more difficult than choosing a new  health practitioner. You want someone that you can trust and will be competent enough to help you with your complaint. So when choosing an acupuncturist, a lot of people rely on word of mouth.
Whilst this is a good way to do a first 'screaning', there are a lot of other things to take into account.

First of all, it is worth remembering that, as acupuncture isn't regulated in the UK, anyone can set up an acupuncture clinic and start seeing patients. The training that people have in this field varies greatly.

• Some people have had some extensive training in the UK. The basic training would now be a 3 year full time course at degree level (validated by a University such as the Middlesex University).
• Health professional such as doctors, or physiotherapists can choose to do a few weekends course on acupuncture. They usually use acupuncture as an adjunct to the therapy they already use. This is quite often the case with health professionals practising medical acupuncture.
• Some people have trained solely in China, sometimes extensively. This is often the case for Chinese practitioners who have emigrated to the UK.

Then there are different type of acupuncture. I am just listing a few below.

• Traditional Chinese Medicine and Five Element Acupuncture originate from China and are based on the same principles (Yin and Yang, Qi etc...). These practitioners have an emphasis on treating the whole person (whilst also treating the symptoms) and re-establishing balance in the body.
• Auricular Acupuncture consists in putting needles in the ear of the person. The ear is seen as a micro system where each part of the body is represented. So putting a needle in the shoulder area of the ear will help with shoulder pain. The most well known use of auricular acupuncture is the NADA protocol used  in the treatment of addictions.
• Medical Acupuncture is a more westernized way of using needles. It came about when some practitioners realized they could bring pain relief to patients by using (injection) needles without injecting anything. This was also called dry needling. The emphasis is on muscles and trigger points, mainly to help with musculo-skeletal conditions.

Acupuncture is a very safe therapy but it can only be if you are treated by someone who is properly trained.
So when choosing your acupuncturist, it is very important that your practitioner is safe and competent. I would recommend that you ask:

1. What sort of training they've had and the length of the training
2. What sort of acupuncture they are practicing
3. If they have an insurance including full medical malpractice and public/products liability insurance cover.
4. If they are part of an organisation such as the British Acupuncture Council (BAcC), which will ensure that the practitioner is following a Code of Safe Practice and a Code of Professional Conduct.

Finally, remember that it is important that you feel comfortable with that practitioner. If, for whatever reason, it doesn't feel right, you can still try and find a more suitable practitioner for you.

Endometriosis treatment with Acupuncture

Endometriosis is a relatively common problem. Between 2~22% of women are estimated to have endometriosis, climbing to 40~60% of women with dysmenorrhea (painful periods).

Endometriosis is a chronic condition. It is the presence of cells from the uterus lining (endometrial tissue) outside the uterus. The endometrial tissue can be found in the pelvic cavity, for example on the bowels, but also in other parts of the body. It still responds to the hormonal changes of the menstrual cycle in the same way than the cells in the uterus lining which leads to bleeding, inflammation and pain.
Some women are unaware that they have endometriosis or have very mild symptoms. Others however experience pain, from mild to severe, painful sex, heavy bleeding and fertility problems.

Western medicine approach to the treatment of endometriosis include painkillers such as NSAIDs, hormone treatments such as the combined oral contraceptive pill and surgery, most commonly through laparoscopy. There is no definite cure for endometriosis and the management of pain in women with endometriosis is often inadequate.

Endometriosis and Acupuncture

A 2010 study on acupuncture and endometriosis has shown that women receiving acupuncture showed a significant reduction of pain intensity after the first 10 treatments. Previous studies also show that electroacupuncture can effectively relieve endometriosis-induced dysmenorrhea and that Japanese style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain.
Acupuncture has also been shown to be efficient in the treatment of dysmenorrhea.

How does Acupuncture help with endometriosis

In Chinese Medicine, endometriosis is seen mainly as an issue with Blood Stagnation (which is exactly what it sounds like) with some associated pathologies (Heat, Cold, Qi deficiency...).
The aim of the treatment will be to reduce the pain, reduce the Blood stagnation and regulate the menstrual cycle.

The treatment is quite often linked to the woman's cycle, the intend of the treatment depending if it's the second part of the cycle, the time during the periods or just after the periods.
As the aim of acupuncture is to treat the whole person, other imbalances are also taken care of during the treatment so each patient will have a personalized treatment plan.

As it is often the case with acupuncture,  the length of treatment will vary a lot from one person to the next. However, endometriosis usually requires regular treatment on a on longer term than other conditions, around 3 to 9 months.

How often do I need to get an acupuncture treatment?

This is probably one of the most common questions that people ask during their first consultation. The other is whether they will need to keep having acupuncture on a weekly basis to keep the getting the effect.

Traditionally, in China, doctors were not paid when their patients were getting ill. They were paid when their patients were well and healthy. This is in contrast with the way we only go and see our GP when we are ill. Traditional Chinese Medicine has a strong emphasis on re-establishing balance within the body and on preventing illness rather than trying to get better once the person is ill.

So let’s say someone is coming to see with nausea and vomiting during the first trimester of her pregnancy (also called morning sickness). Acupuncture can achieve fantastic results and calm the nausea and vomiting down very quickly, sometimes even after just one treatment.

However, that patient will need several treatments after that. This is because, with acupuncture, I would be trying to treat both the symptoms and the root causes of the problem. If only the symptoms are treated, they are very likely to come back. This is a bit like taking one pill to calm the nausea down. As the effect wears off, so the nausea comes back. As the root causes of the problem are tackled and the body is brought back into balance, the length of time without nausea increases and the results are sustained.

How long this will take depends largely on the patient and the length of time he or she has had that illness. The longer the problem has existed, the longer the treatment will take to re-establish balance within the body. Even when the illness is very recent, it may take time to ensure that the results are sustained. This is because an illness can be the sign that your body has been out of balance for a long time, even without obvious symptoms, and therefore will take time to recover. This also explains why 2 persons who have had a similar accident can heal at such different rates.

So as a general rule, I usually say that people will have some improvements within 5 to 8 treatments, with some people experiencing major changes after just one treatment. The length of the treatment itself will depend a lot on the patient and the length of time the imbalance has been present and if there are still some external causes for the illness (for example, stress or a very physical work).

Finally, I would really recommend to anyone who has had acupuncture in the past and found it beneficial to have some regular ‘top ups’, perhaps every 6 weeks or so.

Turning breech babies with acupuncture

In 2005, a Cochrane review on turning breech babies with moxibustion showed that moxibustion, a type of Chinese medicine which involves burning a herb close to the skin, may be helpful in turning a breech baby when applied to the little toe.
 In 2008, a systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL 67 (situated on the little toe) to correct breech presentation suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation.

So what is actually involved in turning a breech baby with acupuncture?

Well, in most cases, the acupuncturist will use moxibustion. This treatment protocol is over 1,000 years old and has been developed in China. It involves burning a tightly compacted herb (artemisia vulgaris) near the little toe of the pregnant woman. There is no need for needles and women only feel a pleasant feeling of warmth in the area.

After checking that there is no contra-indication to the treatment, the acupuncturist will do one treatment with moxa, showing the woman (and if possible a partner) the procedure at the same time.
The same procedure will have to be repeated at home for 10 days so full explanation and enough moxa for the treatment will be given too.

It is usually recommended to start the procedure between 34 and 36 weeks in the pregnancy as the baby has more room to turn. However it can be used up to full term.
Moxibustion may also be helpful even if the woman decides to have an ECV (external cephalic version) to help and turn the baby.

Image: Sura Nualpradid / FreeDigitalPhotos.net

Treating Back Pain with Acupuncture

When I am asking people if they’ve had acupuncture before and what it was for, back pain is probably the most common answer. This is hardly surprising as acupuncture is known for its ability to relieve pain but also because back pain is a very common complaint.

Back pain is one of the most prevalent reasons people seek health care. It is the UK leading cause of disability and one of the main reasons for work-related sickness absence.

In most instances, people are suffering from lower back pain. One of the top causes of back pain are sprains (overstretching one or more of the ligaments in the back) and strains (a rip or tear in the muscle caused by sudden force). This can happen from an injury, poor posture, or improper lifting.
Sciatica is another common form of back pain. Sciatica is a term used to describe pain that extends down into the buttocks and leg which comes from an irritation of a larger nerve in the lumbar spine called the sciatic nerve. Sciatica can accompany sprains, strains, herniated discs as well as back pain emanating from other sources.
Back pain can also happen during pregnancy, because of stress, viral infection or kidney infection.

Research has shown that acupuncture can help back pain by providing pain relief, improving muscle stiffness and joint mobility and reducing inflammation.

The National Institute for Health and Clinical Excellence (NICE) guidelines on best practice now recommend that GPs offer a course of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain.

Acupuncture and Back Pain:

The aim of acupuncture is to restore the flow of energy in the body to promote self-healing. Different techniques can be used: needling but also cupping (vacuum cups to help relax the muscles, improve blood and energy flow) and moxibustion (a warming technique which involves burning tightly packed herbs near the patient skin on a needle or with a stick).

When treating back pain, an acupuncturist will palpate your back to find the areas that are the most sensitive and needle those. But it is also possible to use distal points, acupuncture points that are further away from the area of pain, usually on the hands and feet. These are just as efficient as local points and are particularly suitable in case of an acute injury.
He/she might also check where are the restrictions in movement and where is the pain associated with a certain movement (referred pain).
Cupping will help improving the blood flow in the area and relax the muscles.
Moxibustion, because of its warming effect, helps relaxing the muscles, especially if the area is cold to the touch.

Finally, the acupuncturist will also choose constitutional points to work on the root causes of the problem, i.e. what sort of imbalances are present that made the body weaker and therefore more prone to back pain.

 This is an important point of an acupuncture treatment. As a holistic therapy, acupuncture and Traditional Chinese Medicine always seek to treat the whole person and not just the symptoms. By concentrating both on the symptoms (reducing pain) and on the root cause of the problem (the energetic imbalances in the body), acupuncture can achieve long lasting relief and avoid a pattern of recurring back pain.

Acupuncture and Menopause

Hot flushes plague many women during menopause because at that of their life, women experience fluctuations in hormone levels. Well, it looks like acupuncture is now recognized as providing relief from this miserable symptom. Studies have shown that acupuncture may help relieve hot flushes from menopause. And another study also showed that acupuncture can improve not just the frequency of the hot flushes but also the women's quality of life.

What is Menopause?

Menopause is a transitional period marking the cessation of ovulation in a woman's body. This time of change may last a few months to several years. Symptoms vary from mild to severe, and are brought on as our bodies try to adapt to decreasing amounts of oestrogen. Symptoms include hot flushes, night sweats, insomnia, fatigue, mood swings, memory loss, vaginal dryness, headaches, joint pain, and weight gain.

Practitioners of Traditional Chinese Medicine (TCM) offer another paradigm in which to consider the experience of menopause. In TCM, life goes in cycles of 7 years for women (and 8 years for men). At the end of the seventh cycle (7x7 so 49 years old), menopause occurs and the woman becomes infertile.

In TCM, Essence is responsible for birth, growth, development, sexuality, maturation, and aging and is associated with the Kidney.  The gradual depletion of Kidney Essence is the mechanism responsible for the timing and signs or symptoms of menopause. It is also responsible for weakening of the bones, loss of teeth, hearing loss, confusion and memory problems—all manifestations associated with the Kidney. Weakness and lack of energy are also a common condition of depleted Kidney Essence, along with lumbar pain, as the Kidney is located in the lower back.

It is important to note that in Traditional Chinese Medicine, the organs, such as the Kidney, do not share the same meaning than in Western Medicine. They are rather symbolic entities whose function is defined at the level of the body but also on an emotional level and in relation with the other organs in the body. So the Kidney is associated with the formation of urine but also with Fear and houses the Essence.

Diagnosis and Treatment of Menopause

In Western Medicine, the treatment of choice for hot flushes is HRT (Hormone Replacement Therapy). Whilst HRT can certainly help women, it can have a number of significant side effects including increasing the risk of breast, ovarian and uterine cancer. It is therefore an unsuitable choice for some women, for example women with a family history of breast cancer.

Like many other conditions that patients bring to acupuncturists today, menopausal syndrome is a biomedical disease category. There is actually no evidence that it was recognised as a medical problem in Traditional Chinese Medicine. Instead Traditional Chinese Medicine is working as a holistic therapy, treating the person as a whole and taking into account all the different symptoms of that particular patient to establish the diagnosis. Because not everyone will have exactly the same symptoms, each patient will receive a treatment specific to his own imbalances, including a different acupuncture points prescription and/or lifestyle and diet advice.

 As more and more research shows that acupuncture can be an effective modality to treat hot flushes, acupuncture is proving to be one option to ease the transition phase during menopause. So don’t suffer in silence!

Period Pains: You don’t need to suffer in silence.

Period pains are painful sensations felt in the lower abdomen that can occur both before and during a woman's menstrual period. The pain ranges from dull and annoying to severe and extreme.  It can affect the lower abdomen, the lower back and the thighs but can also be accompanied by nausea, dizziness or bloating.
Surveys show that 70 per cent of young women regularly use painkillers to cope with the pain and at least 50 per cent say it seriously disrupts their lives.

There are 2 types of painful periods  - primary and secondary dysmenorrhea.

·         Primary dysmenorrhea is the most common type and is characterized by pain in the lower abdomen and lower back pain beginning 1-2 days before the period and lasting from 2 to 4 days. There is no underlying problem that is causing the pain.

·         Secondary dysmenorrhea is characterized by cramping pains that are due to an identifiable medical problem such as endometriosis, uterine fibroids, or pelvic inflammatory disease.

In most cases, pain is controlled with nonsteroidal anti-inflammatories (NSAIDs) or with oral contraceptives.

Now, a Cochrane database systematic review on period pain (dysmenorrhoea) has concluded that current evidence supports the use of acupuncture to reduce menstrual pain. Overall, there was an improvement in pain relief from acupuncture compared with a placebo control, NSAIDs and Chinese herbs.  In two trials, acupuncture reduced menstrual symptoms (for example nausea and back pain) compared with medication and in one trial acupuncture improved quality of life compared with usual care.

This is great news for the numerous women who, each month, suffer from very bad period pain as it offers them a safe, natural alternative to medication.

Image: Ambro / FreeDigitalPhotos.net

Conquering Osteoarthritis with Acupuncture

Osteoarthritis is a debilitating illness where the cartilage and others structures around the joints are damaged and/or inflamed resulting in pain and stiffness. The knees and the hips are commonly affected but osteoarthritis can affect the hands or the neck too.

A recent review of all the treatments available to support patients suffering from osteoarthritis has shown that acupuncture may be beneficial. But how does it work?

On a biomedical level, Acupuncture treatment may help to relieve pain and improve function in patients with osteoarthritis by:
• releasing of endorphins and inhibiting pain through the modulatory effects of endogenous opioids
• reducing inflammation
• increasing local microcirculation, which aids dispersal of swelling.

In Acupuncture and Traditional Chinese Medicine (TCM), osteoarthritis is a ‘Bi syndrome’, a group of syndromes that affects the bones and joints and is usually characterized by pain, soreness or numbness of tendons, muscles or joints. This is the result of the body being ‘invaded’ by a pathogenic factor such as Wind, Cold, Heat and/or Damp. These pathogens will lodge into the body’s meridian (the energy pathways) and will block the free flow of energy (called Qi). This is what causes the pain and reduction in movement associated with the arthritis. The aim of the acupuncture treatment is to free the energy, removing the blockages and harmonizing Qi to eliminate pain, inflammation and swelling.

Traditional Chinese Medicine does not recognize osteoarthritis as one particular syndrome. The diagnosis is dependent on which pathogenic factor is present/the strongest and on the manifestation of the illness (Is there some swelling, is the joint warm to touch, worse in the morning etc…). So the treatment will be different too from one patient to the next. Each patient will receive a unique, customized treatment with different acupuncture points and different lifestyle and diet recommendations.

Acupuncture, a holistic therapy

Chinese Medicine and Acupuncture are said to be a holistic therapy. But what does it really mean?

Firstly, it means that when doing a diagnostic, the practitioner looks and treats the person as a whole, not just the symptoms. So it is not unusual that a patient coming for, let’s say lower back pain, sees changes and improvements in other areas of their life too, for example their energy levels.

It also means that the acupuncturist will look at both the roots (the ‘cause’ of the disease) and the branches (the ‘symptoms’ of the disease). One way to look at it is to think about a tree with its roots and its branches. If you cut the branches (symptoms), they are likely to grow again (so the symptoms come back). If you cut the roots (address the root causes of the imbalance), then the tree and the branches are unlikely to grow again and you will be able to stay symptom free.
The idea is that the patient will get relief from the symptoms by addressing the branches but will also get long term relief by addressing the roots.

Finally, it means that when doing a diagnosis, the acupuncturist will take everything into account, from the patient’s  physical imbalances and/or  emotional issues to the environment the patient lives in (eg:  type of work, family circumstances, lifestyle…) and their diet. The practitioner will then be able to create a treatment adapted to that specific patient.

For me, it symbolizes my commitment to each patient in finding lasting solutions to their health  needs, not just temporary fixes.

Protecting yourself from colds

I don’t know about you but with the temperatures going down, I have seen more and more people coming up with a cold recently. Some people seem to get one cold after the other during the whole winter whilst others just sail through and never seem to be ill. So what can you do to be in that latest category of people?

According to Chinese Medicine, a cold or flu is the invasion of a pathogenic factor. To avoid an invasion, you should avoid the pathogenic factors and have enough defensive energy to repel them. So what should you do?

1-      Avoid getting cold. Having enough layers on, not going out with damp/wet hair, not going to bed with wet hair all help to prevent colds (There is some truth in our grand-mothers’ advice!).

2-       Protect your kidneys. If there is one area that needs to stay covered, it’s the lower back.

3-      Eat well cooked simple foods. So slow cooking dishes, soups, stews should be an important part of a strengthening diet. On the other side, raw and cold foods such as ice-cream, salads and other raw vegetables should be avoided.

4-      Avoid dampness in your environment (such as a damp house but also like staying in a wet swimming costume) and in your diet. Dampening foods such as dairy products (except a little butter and yogurt), ice cream and foods full of sugar are all mucus forming and contribute to the apparition of colds.

5-      Sleep well, at least 8 hours a night. It doesn’t sound like rocket science but you do need 7 to 8 hours of solid sleep every night. Going to bed before 11 o’clock also helps.

And if you still get a cold? As soon as you feel the symptoms of the cold coming, you can try to drink a herbal tea made of fresh ginger (grated or sliced) and sliced onion.

And if everything fails, take it easy. Rest is still the best medicine.

Image: David Castillo Dominici / FreeDigitalPhotos.net

Feeling depressed? Can Acupuncture help?

Depression is a mood disorder characterized by both physical and psychological symptoms that can be detrimental to one's normal daily functioning. Depressed individuals often suffer from poor sleeping habits, crying spells, anxiety, worry, poor memory, inability to concentrate, body aches, stomach disturbances and a lack of interest in activities previously enjoyed. In most cases, the treatment involves antidepressant and/or counselling.

So can Acupuncture help with low mood and depression? A recent study on acupuncture in the treatment of major depressive disorder shows that acupuncture could be a safe and effective treatment for depression, even when standard antidepressant medications aren't suitable, giving hope for the thousand of people suffering from depression every year.

Firstly, it is worth to note that Chinese medicine does not recognize depression as an illness as such. But it aims to treat the specific symptoms that are unique to each individual to restore balance within the person, addressing at the same time body, mind and emotions.

As a general rule, Chinese Medicine associate depression with Deficiency and 2 organs, the Heart (the organ associated with Joy) and the Spleen (the organ associated with being grounded and content, or its opposite worry). Quite often, there is also involvement of the Liver (the organ asociated with stress) so not only people are feeling bad but they can also experince more stress!

Once the patterns (diagnosis) are determined, the acupuncturist can  select a combination of points which are specific to that individual. The practitioner can also advise on dietary changes and lifestyle changes.

Finally, certain acupuncture points have been shown to affect areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and reducing anxiety and worry [1]. This can probably explain why so many patients find acupuncture treatment in itself so relaxing (a lot of people actually fall alseep during the treatment!) but also goes a long way to explain how it can support someone through depression.

[1] Hui KK et al. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Auton Neurosci. 2010 Oct 28;157(1-2):81-90

Thinking about acupuncture ... but afraid of needles?

I was doing a talk this week at a WI group about acupuncture and how it can help people. As soon as I said that I am an acupuncturist, I could see some people becoming uneasy, one of them jokingly wondering if it was safe to come near me. This isn't an uncommon reaction. But why?

Needles...

Most people recoil in horror thinking about them. They associate them with injection needles, hospital appointments and a whole lot of other uncomfortable procedures.

But with acupuncture needles, this doesn't need to be the case. Unlike injection needles, acupuncture needles are solid, thin and flexible. The needles I use are 0.16mm diameter, about the width of a hair. They are made of high quality surgical stainless steal and are very smooth.

The needles are also single use and sterile to eliminate any issue of cross-contamination.

After insertion, patients report very little sensation or perhaps a little bit of a prick. In most cases, what you can feel is the guide tube, a little plastic tube that rest on the skin to help putting the needle in.

Once the needle is inserted, it is normal to sometimes feel some heaviness, tingling around the needle. This is a sign that the energy has come to the needle and it is starting to have some effect.

The number of needles used varies greatly depending on the person and the condition treated. In average, I use about 10~14 needles which are mainly inserted on the arms (between the elbow and the tip of the fingers) and the legs (between the knee and the tip of the toes). They are retained for about 20 min. Most people find this a very relaxing experience, with quite a few patients drifting off to sleep!

So why not giving it a try?