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Q: I have an auto-immune system discorder and my finger joints get swollen and at the last stage the skin around affected area gets broken. The trigger is the temperature drop in end October and these symptoms keep hurting me until April/May. Can acupuncture help heal my conditions?
A: As you can see from our factsheet for one auto-immune disorder affecting the joints, rheumatoid arthritis
the evidence for the use of acpuncture treatment is equivocal. The gold standard for evidence, the ramdomised double blind control trial, it has to be said, is not the best method for assessing acupuncture, and there is a great deal of slightly lower grade evidence from China which is encouraging.
However, acupuncture as a system of medicine is premised on an entirely different understanding of the human physiology as a flow of energy, called 'qi' whose flow and balance is crucial to good health. Qi is also said to make up all of nature, and so interactions between man and his world would and could have a direct bearing on health. The fact that your symptoms seem to kick in when the cold weather starts and remain until it lifts would immediately draw a practitioner's attention, and when you bear in mind that Chinese medicine developed for people whose main occupation was agriculture, there is considerable understanding of, and refinement in, the treatment of conditions which were driven by the climate.
The best course of action with problems such as these, however, is to visit a BAcC member local to you for advice. Most are more than willing to give up some time without charge to give someone a better assessment face to face of whether acupuncture treatment is a good bet, and most are always willing to refer on to other forms of treatment if they think something else would be better for the patient.
In your case the clear causal relationship between cold and discomfort would suggest immediately three or four options, but much would depend on an assessment of the whole system. We don't talk about 'healing', by the way, and in conditions like this we prefer to talk more of management than resolution. We find that some of the auto-immune problems can be brought under control, but this often involves continuing work by the patients themselves to stay well, eating well and looking after themselves in a way which assists their balance.
A: The great majority of traditional acupuncturists work in private practice. You can find them by using the search facility on the BAcC website (for our members) or through the BAcC's Yellow Pages and Yell.Com entries, or through looking at the acupuncture section of your local information networks. Many people now use the internet to locate practitioners near to where they live or work.
Finding acupuncture treatment inside the NHS is more difficult. Doctors and physios are limited to treating conditions for which there is a NICE guideline or for which there is a body of evidence which meets western standards. This can quite difficult to track down, and is usually quite limited as far as the number of sessions is concerned.
Q: What training do you need to become an acupuncturist? Also what could stop acupuncture from working?
A. The training required to become a member of the British Acupuncture Council is a three degree course or degree-equivalent course. Most new members come from colleges or universities whose courses have been accredited by the British Acupuncture Accreditation Board whose website (www.baab.org) provides useful links to all of the colleges and courses which are accredited, as well as useful background information on the course contents.
There are a number of other pathways to becoming an acupuncturist. We tend to reserve the title to people who use acupuncture full time as a practice, but there are a number of healthcare professionals such as doctors and physiotherapists who use acupuncture principally as another tool in the toolbox within their existing scope of practice, and their training is shorter. It is also based on an entirely different concept of what acupuncture is and how it works.
There are a number of professional organisations as well as the BAcC. Some also have three year degree level entry training, and others two year diploma level training. We regard the accredited courses as the 'gold standard' for training, but the other practitioners are all safe and competent acupuncturists.
Acupuncture always works to a degree; the question is to what degree and how sustainable the change is. There is nothing which stops it working, but there are a number of factors which might impact on how much benefit someone can derive from treatment. A number of factors within a patient's control, like alcohol, large meals or over-strenuous exercise immediately after treatment, can limit the success of treatment, There are also factors such as essential drugs which impact on overall health which can make progress slower, and there are a number of progressive and deteriorating health conditions which acupuncture might help to slow down but could not be expected to reverse.
In general, however, there is usually progress, however slight, and the professional skill and judgement of the patient lies in ensuring that someone's progress is reviewed regularly to ensure that the time and investment in treatment continues to be worthwhile.
Q: I am currently a first year student studying pharmacy in the National University of Singapore . I am currently doing my research on complementary and alternative medicine (CAM) and would like to know if anyone could share with me their views on whether acupuncture is a CAM and it's usefulness as a type of CAM .
A: We'd love to be able to give you a brief answer to your question, but this is am immense subject capable of being pursued in dozens of ways.
The very brief answer, as far as the UK is concerned, is that the practice of acupuncture as a full time profession lies outside the mainstream of UK healthcare in the National Health Service, and to that extent it would deserve the title 'CAM'. However, over 2500 doctors and 6500 physiotherapists routinely use acupuncture within orthodox healthcare as 'another tool on the toolbox' and do so within their normal scope of practice for problems for which there is an evidence base. The style of acupuncture is characterised as 'western medical acupuncture' and is based on neurophysiological and segmental principles rather than eastern concepts of qi and yin/yang.
That said, there have been a number of conditions for which research over the last decade has brought traditional acupuncture slightly more into the mainstream of orthodox care through its inclusion in treatment guidelines issued by the National Institute for Clinical Excellence. NICE guidelines mean that doctors can offer modalities like acupuncture where they have been included, and some sub-contract these treatments to traditional practitioners.
There is, though, a very solid resistance from some sections of the orthodox medical community to greater inclusion of acupuncture as a CAM as well as CAM in general in orthodox healthcare, and the battle lines tend to get drawn up on the question of research. As long as the RCT (randomised double blind control trial) remains the gold standard, CAM therapies which work with multivalent outcomes and dynamic and evolutionary diagnostic patterns are never going to be adequately researched. At the same time those research studies which do manage to meet the criteria, such as the Paulus Protocol for assistance in IVF transfer, are so far from normal practice that trading on their success in research trials is risking undermining the individualised and dynamic diagnoses which underpin authentic eastern medicine.
As to its usefulness, as full time practitioners we are bound to say that as a system of medicine which focuses as much on preserving health and preventing disease as much as on treating illness and disease, we believe that its potential for benefit in western society is as yet nowhere near fully realised. Not only is there a huge mass of evidence from trials which near, but do not meet, RCT criteria, the growth of the popularity of acupuncture treatment in the west is largely by word of mouth and often predicated on the less definable outcomes which generate referrals - 'feeling better in myself', 'feeling more balanced.' We are a very long way from the orthodox profession recognising this as a valuable outcome of treatment, and where it happens it is largely written off as placebo effect. However, over time there will be studies which demonstrate that acupuncture treatment, along with treatment by other CAM therapies, contributes to better health over time. Those of us who have practised for a long time have plenty of anecdotal evidence suggesting that patients tend to stay well, but funding prospective studies over a decade may be beyond our means for the foreseeable future.
There are literally hundreds of papers about these kinds of questions, and you may find that some of the publications by the Kings Fund (www.kingsfund.org.uk) on CAM are worth looking at for an overview of the issues involved. The House of Lords Select Committee's on Science and Technology's Report from a decade ago (http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm)
Q: My uncle was paralysed owing to a severe hit on the back of his head when he was 6 years old. His left side of body (hand and foot)was disabled during a gradual trend (shrinking posture). He is 50 years old. I am trying to find new treatment for his problem. If acupuncture could be a remedy to what extent could it be useful ?
A: This is an extremely difficult question to answer with any accuracy.
The very fact that your uncle suffered severe neurological damage over 40 years ago and is continuing to deteriorate suggests that the damage is irreversible, and that at very best treatment of any kind might slow down, but not halt or reverse, the decline in his health. In a complex case such as this, however, it would only be possible to give an informed view of what may be achieved through having sight of the patient directly and offering an opinion based on a face to face assessment.
There is no doubt that acupuncture can be beneficial to a degree in treating some forms of paralysis after neurological damage. It is frequently used as a treatment after stroke, especially in Chinese hospital care, and its use is founded on the theory that the flow of energy, called 'qi' in Chinese medicine, has been disrupted by the stroke and needs to be reinstated as soon as possible. It is not uncommon for a course of treatment to be commenced on the day of the stroke itself. However, this itself is underpinned by an understanding of the cause of the disruption of energy in the first place, and even the Chinese medicine practitioners in Chinese hospitals may be less optimistic about the success of treatment after a physical injury of this magnitude.
However, in many cases the symptoms which people experience are rarely caused by single imbalances, and if the system as a whole has been badly affected by an injury there always remains a possibility that some of the symptoms have arisen from a secondary source and may be helped. As we have said, though, it would only be possible to give a more balanced and informed view by seeing the patient face to face.