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Ask an expert - general

161 questions

There has been an upsurge over the last few years in what has been described as 'cosmetic acupuncture' or 'facial revitalisation acupuncture'. With it has come a rather hot debate inside the profession, not least because some of the clinics where this technique is used charge fees that are considerably higher than the average fee charged by a BAcC member, and also because some of the people offering this treatment are not fully qualified practitioners but simply beauticians who have undertaken short course training.

Our general position is that there is not a specific separate discipline of cosmetic acupuncture but rather the application of traditional techniques on the face adapted for a specific purpose, but, and most importantly, taking into account the system as a whole as traditional acupuncture does. We have taken great care to get the message across that a properly trained traditional acupuncturist treats the person as a whole, not simply a named condition or a single part of the body, and that unless treatment is undertaken in this way, there can be no guarantees that short term local results can be be sustained.

We are also keen to get across the message that however limited the area of interest, acupuncture remains acupuncture wherever it is performed on the body, and our members undergo three years of degree-equivalent training to ensure that they are safe and competent and fully aware of factors affecting the safety of the patient. We do not believe that someone undertaking a short training over two weekends can realistically hope to match this level of safety training as well as learning the techniques. This is especially the case with some of the techniques commonly used in cosmetic acupuncture which are not a part of the standard protocols for body acupuncture.

We do not keep a separate register of our members who offer this type of treatment. The best bet would be to use google to identify someone in your area providing this style of treatment and then cross-refer with the BAcC Register to ensure that it is someone who is properly trained and insured.

As a general comment, though, we would want to have a look at what in your life was contributing to your wrinkles. If you are under constant stress and worry, there may be systemic treatments to help you to cope better with either in such a way as to reduce your wrinkles. We always ask whether wrinkles go when people are on holiday. You'd be surprised how many people say that they do. If so, local treatment will not be a proper solution to the problem unless it is supported by treatment of the system as a whole.

Q:  What are the rules on cupping for instance when bleeding occurs into the cup and how should cupping be done ?

A:  There are many articles and videos online which show how one can perform cupping, and of them we found this one from the Pacific College in the USA to be the clearest:

Traditional Chinese medicine brings to mind acupuncture and the use of natural herbs as healing remedies. Cupping is a lesser-known treatment that is also part of Oriental medicine, one that can provide an especially pleasant experience. One of the earliest documentations of cupping can be found in the work titled A Handbook of Prescriptions for Emergencies, which was written by a Taoist herbalist by the name of Ge Hong and which dates all the way back to 300 AD

Cupping is the term applied to a technique that uses small glass cups or bamboo jars as suction devices that are placed on the skin. There are several ways that a practitioner can create the suction in the cups. One method involves swabbing rubbing alcohol onto the bottom of the cup, then lighting it and putting the cup immediately against the skin. Suction can also be created by placing an inverted cup over a small flame, or by using an alcohol-soaked cotton pad over an insulating material (like leather) to protect the skin, then lighting the pad and placing an empty cup over the flame to extinguish it. Flames are never used near the skin and are not lit throughout the process of cupping, but rather are a means to create the heat that causes the suction within the small cups.

Once the suction has occurred, the cups can be gently moved across the skin (often referred to as "gliding cupping). The suction in the cups causes the skin and superficial muscle layer to be lightly drawn into the cup. Cupping is much like the inverse of massage - rather than applying pressure to muscles, it uses gentle pressure to pull them upward. For most patients, this is a particularly relaxing and relieving sensation. Once suctioned, the cups are generally left in place for about ten minutes while the patient relaxes. This is similar to the practice of Tui Na, a traditional Chinese medicine massage technique that targets acupuncture points as well as painful body parts, and is well known to provide relief through pressure.

Generally, cupping is combined with acupuncture in one treatment, but it can also be used alone. The suction and negative pressure provided by cupping can loosen muscles, encourage blood flow, and sedate the nervous system (which makes it an excellent treatment for high blood pressure). Cupping is used to relieve back and neck pains, stiff muscles, anxiety, fatigue, migraines, rheumatism, and even cellulite. For weight loss and cellulite treatments, oil is first applied to the skin, and then the cups are moved up and down the surrounding area.

Like acupuncture, cupping follows the lines of the meridians. There are five meridian lines on the back, and these are where the cups are usually placed. Using these points, cupping can help to align and relax qi, as well as target more specific maladies. By targeting the meridian channels, cupping strives to 'open' these channels - the paths through which life energy flows freely throughout the body, through all tissues and organs, thus providing a smoother and more free-flowing qi (life force). Cupping is one of the best deep-tissue therapies available. It is thought to affect tissues up to four inches deep from the external skin. Toxins can be released, blockages can be cleared, and veins and arteries can be refreshed within these four inches of affected materials. Even hands, wrists, legs, and ankles can be 'cupped,' thus applying the healing to specific organs that correlate with these points.

This treatment is also valuable for the lungs, and can clear congestion from a common cold or help to control a person's asthma. In fact, respiratory conditions are one of the most common maladies that cupping is used to relieve. Three thousand years ago, in the earliest Chinese documentation of cupping, it was recommended for the treatment of pulmonary tuberculosis.

There are a number of alternatives available, one of which involves a rubber cup which creates a vacuum without the need for a flame, with which some practitioners are uncomfortable.

If the cups become contaminated by blood or body fluids, the rules are fairly straightforward:

Reusable equipment, such as cups, derma rollers, guasha spoons, etc, which has been used on broken skin and/or come into contact with body fluids must be washed in warm water and detergent first, then rinsed in very hot water to facilitate quick drying and dried with a disposable paper towel. It must then be sterilised by autoclave or an acceptable chemical alternative according to manufacturers' guidelines.

Sterilisation is essential in these circumstances. However, if the cups have not been compromised there are slightly less complicated ways of washing them to an acceptable clean standard.

There is a methid of cupping called 'bleeding cupping' which is used within Chinese medicine but not by any BAcC members of whom we are aware. This involves the use of a triangular needle specifically designed to open a pinprick would through which the cupping can draw a quantity of blood. Should any practitioner member of the BAcC go down this route, we would expect them to be wearing gloves, to have impervious washable flooring, and separate facilities for cleansing equipment after use which were not used for any other purpose, i.e. a dedicated hand basin conforming to current legislative requirements.

We are aware of very few problems reported in the use of cups other than the occasional circular bruise associated with their use. These are so frequent that it is only through the practitioner's failure to forewarn someone properly that complaints arise.

Q: In your experience which is the best training course in or near London for an honours degree?

A:  We are not really able to see which is the best course, partly because it wouldn't be politic but mainly because each course suits some people better than others. Of all the possible courses we always recommend that someone takes a course which has been accredited by the British Acupuncture Accreditation Board (BAAB) because graduates of these courses are automatically eligible to join the BAcC. A full list of these courses can be found here:

http://baab.co.uk/study-acupuncture/accredited-courses.html

These courses are a mixture of university-based courses and private teaching institutions, but most of the private courses are affiliated to universities through whom their graduates receive a BScC Hons as well as a Licence or Diploma in Acupuncture.

There are other courses, some of which have affiliations to universities, but we are not well enough versed in their offer to be able to give a view.

All of the reputable colleges and courses have open days to give people a chance to see whether they like the set-up and the course, and many will be holding them soon for the September intakes. Our best advice is to see which are the easiest to get to and to visit their open days to talk to the teaching staff and to some of the students who are often on hand to talk about the courses.

Q:  Do you believe that acupuncture can be practised effectively without a full understanding of the original Chinese doctrines?
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A:  Some questions seem deceptively simple until you start to unravel them. This is one!

For starters, it depends on how you define acupuncture. This was the cause of a great deal of discontent in 2000 when the House of Lords Report led to the creation of the Acupuncture Regulatory Working Group, because the definition of acupuncture was very basic:

"Acupuncture refers to the insertion of a solid needle into any part of the human
body for disease prevention, therapy or maintenance of health. There are various
other techniques often used with acupuncture, which may or may not be invasive"

This caused a huge amount of dissent within the BAcC because a phrase such as 'according to the principles of Traditional East Asian medicine' was not included. The brute reality was, and to some extent still is, that there is a thriving tradition of Western medical acupuncture based on a neurophysiological or segmental understanding of how it works, and more to the point a tradition whose research according to these principles was largely the reason that acupuncture was promoted into Group 1 of the therapies listed in the House of Lords Report. From the WMA perspective, acupuncture works by mechanisms which are not yet fully understood but which has enough research behind some of its interventions to justify its inclusion as another tool in the toolbox within scope of practice.

From a Chinese medicine perspective, there are two issues in the question. First is the extent to which one needs to be trained. There are a number of short courses in traditional acupuncture which we do not believe have enough teaching hours to instil a good understanding of Chinese medicine principles as well as passing on all of the practical training both as an acupuncturist and as a healthcare practitioner which meets recognised standards. The training levels recommended by the World Health Organisation are set at 3600 hours of degree equivalent training, and this is the level which the British Acupuncture Accreditation Board recognises as the bottom line for an accredited course.

The theory underpinning this is precisely defined, however, as the principles of Chinese medicine. Although these courses touch on wider appreciation of Chinese doctrines, both philosophical and religious, they are not a fundamental part of the training. This would be a degree level undertaking in its own right. However, to be able to practise effectively in a medicine which presupposes an entirely different world view and whose concepts need to be unravelled in this context, some understanding of the way that Chinese thought has developed is essential. There are a number of popular books and well-attended postgraduate seminars which encourage UK practitioners to develop a broader understanding of the wider context.

So, in summary, it is possible to practise effective acupuncture within narrowly defined limits without a commitment to, or understanding of, Chinese doctrines, but to practise traditional chinese acupuncture effectively one needs to have a thorough grounding in its principles and a good background sense of thw wider social and cultural context within which it developed.

Q:  I am a PhD student in the field of Raynaud's disease and have recently been made aware of the potential benefit of acupuncture as an alternative Raynaud's treatment. My background is chiropractic and I have a Master of Chiropractic degree from the Welsh Institute of Chiropractic. My question is how would I begin to study acupuncture, and what courses are available? My brother is a Chiropractor and has done accredited weekend courses, but I am unsure if they are accredited with the BAAB as the duration seems too short. Any advice would be helpful.

A:  An interesting question! As you are probably already aware, the BAAB accredits courses which confer automatic elegibility for entry to the BAcC and a list of these can be found here:
 
 http://baab.co.uk/study-acupuncture/accredited-courses.html
 
These courses are all three year degree equivalent, and are designed to underpin a career as a practitioner in independent practice. For someone who has already completed the western sciences modules which are integral to the courses and up to a third of their overall content it is possible in some cases to get exemptions from these aspects of training. Timetabling usually means, however, that the course duration remains unchanged.
 
There are a number of courses for statutorily regulated healthcare professionals, notably those associated with entry to the two main special interest groups, the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. These are intended to provide a background in Western medical acupuncture, and offer the possibility of using acupuncture as a technique within the scope of practice already applied, as long as their is an evidence base for the intervention.
 
This is something of a hot potato at the moment, though. These are not the only courses in town, and an increasing number of less credible courses are becoming available which are much shorter in duration and also stary into areas which are not within the normal scope of practice of the SR professionals who use them. Not surprisingly this proves extremely irritating to BAcC members who see this as illegitimate encroachment on their patch. Our broader concern is that applying limited knowledge outside a well-defined paradigm is likely to provide sub-optimal treatment, and this in turn leads people to conclude that 'acupuncture doesn't work for me' when in fact it may well do in the hands of a professional.
 
A great deal depends on the extent to which you want to practise as an acupuncturist. We are always more than happy to  see more people train as full-time traditional acupuncturists, but this is a major commitment. Our best advice is to visit any college open days of courses near to you and get a sense of whether this is a realistic and desirable option for you.