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Ask an expert - general

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,A:  As well as producing factsheets, we also produce review papers which give our research people a chance to go into a little more depth. The menopause and its symptoms are one of the areas where they have done this, and the paper

makes some very positive noises about the possible benefits of treatment for hot flushes. However, the paper acknowledges that there are a few methodological problems with the field, especially since some of the studies are from China where there less interest in checking whether acupuncture works and more in working out which treatments work better. This does not meet the standards set in the West, and although we have consistently maintained that the randomised double blind control trial from drug testing does not work for acupuncture, it remains the 'gold standard.' This underpins papers like this one

which tend to portray the glass as half empty rather than half full.

The thing to bear in mind is that the Chinese have been treating menopausal symptoms for over 2000 years. Although the theoretical basis of Chinese medicine is entirely different, based on theories of energy called qi, the Chinese have found ways of understanding the process of change in middle age which underpin a number of syndromes which provide treatment options.

Naturally, these have to be adapted to the individual because from a Chinese medicine perspective everyone is different, i.e. there are no formula treatments where the same needles work for everyone. However, the standard forms of imbalance can be interpreted within the context of the individual's energy to help them deal with the symptoms which arise.

The best advice is always to visit a BAcC member local to you to ask for an informal face to face assessment of what they think may be possible. This will be far more informative than our speculation at one remove, and the practitioner will probably be able to give you a good idea of what frequency and extent of treatment may be necessary. On balance, though, most of us find that we can treat hot flushes to a degree, and the main question we have is more a matter of how much change we can effect and how sustainable it is rather than does it work at all.

Q: What are the entry requirements for BAcC membership? What are the requirements for accreditation/registration, and what are the requirements for being retained on the register?

A:  The majority of new registrants of the BAcC are graduates of three year degree level courses which have been accredited by the British Acupuncture Accreditation Board, an independent body part funded by the BAcC. The courses are split between university courses which are often validated by the university itself and lead to a BSc, and private teaching institutions. You
can read a great deal about the courses themselves on the BAAB website,

The BAcC also has what we call an 'external applicant route'. The admissions process is spelled out clearly on our website at this

Essentially the standard we are looking for would be equivalent to that achieved by an accredited course graduate, and there is a
very detailed process of application which looks at course transcripts, experience of practice and skills to assess applicants who achieve membership after a summative interview.

Once someone becomes a member, the only requirement over and above complying with the Codes of Professional Conduct and Safe Practice is to complete a mandatory renewal declaration each year which informs the BAcC of any significant or material changes in practice or health/criminal issues of which we would not otherwise be aware.. In the form is a statement of
compliance with our annual CPD requirement which is stated as roughly 30 hours per year but undertaken through the creation of a Personal Development Plan. This is now being actively monitored in the same way that the HCPC/GOsC./GCC
oversees the requirements for CPD.

It is fair to say that it is very difficult to be able to assemble a degree equivalent training in traditional acupuncture without having
undertaken a structured training course at an accredited college. The appearance of a number of pre-registration postgraduate courses for first degree holders of two years duration may make the time commitment slightly less onerous, but the argument advanced by the course providers heading down this path is that the same hours (3600) are now compressed into the two years by
dint of shorter vacation periods. These courses are still the subject of quite heated debate.

We have in the past considered applications from people who have travelled to China and taken intensive courses, and we have also very occasionally looked at apprentice-style training as is found in Japan. As the process has tightened up, however, and now requires a great deal more documentary proof the chances of being able to complete the external applicant route reduce.

We are assuming from your address that you are a chiropractor, and we are happy to tell you that we have been trying for many
years to encourage the osteopathy and chiropractic registers and professional bodies to establish special interest groups equivalent to the AACP within the Chartered Society of Physiotherapists. This is mainly because we are concerned at people not knowing their limits of competence - you can't know what you don't know - but the formation of a special interest group tends to encourage
graduated training which moves people further along a route which might qualify them for BAcC membership. So far, though, this request has not generated much interest.

 We suppose the short and truthful answer to your question is 'no' if by it you mean 'can acupuncture accelerate a natural process?'. The rate at which young people enter adolescence can vary dramatically, and 'late starters' often accelerate very rapidly to catch up with their peers and sometimes overtake them. One of the basic premises of traditional acupuncture is that it encourages best function in the body, mind and spirit, and to this extent works within the potential which each person has by making everything function as well as it can. If the body has its own game plan for an adolescent, acupuncture treatment cannot change that by speeding things up.

That said, there can come a point where someone's growth may start to attract clinical attention, and where clinicians in orthodox medicine will start to commission hormone tests to see what is happening. Once this is the case, and a pathological pattern has been identified, there may be some scope for using acupuncture to help to normalise matters. The research evidence for the treatment of hormonal problems is a little sketchy, but slow growth and development in later adolescence has been examined by Chinese physicians for over 2000 years, and there are a number of ways of understanding and making sense of this within the terminology and conceptual framework of Chinese medicine.

However, our advice to any twelve year old who presented at our clinic would be to have patience and wait for changes which in the vast majority of cases will occur within the 'normal' band for teenage development. Only when someone reaches the end of this range at about 15 or 16 would most medical practitioners start to consider that things may not be as they should.

However, we wouldn't want to deter someone from trying acupuncture before that! In ancient times, acupuncture treatment was primarily aimed at keeping people well, not getting them better after they had become ill. This, said the ancient Chinese, was like digging a well when you were already thirsty or forging a spear after the battle had started. In a world dominated by disease labels and getting rid of problems treatment for healthy living and encouraging better function often get set aside from the way we present what we do, and we believe that we could perhaps be doing more to get this message across.  


Q:  This question is not strictly related to acupuncture, but i couldn't find answers anywhere else so I'm hoping an expert here could help me. Last week I accidentally punctured the palm of my hand with a large thumb tack by putting my weight on the desk when standing,  not realising the was an upturned pin under where I put my hand. It was a shock to say the least but the pain subsided quickly after I pulled the pin out. There was very little blood but my ring finger did twitch and my forearm felt tingly. Now a week on I am still feeling uncomfortable sensations in my ring finger, like a tightness and slight pain. The pin went in about two inches below the base of my ring finger. I should mention also that about a year ago I accidentally sliced open my hand about 1 inch below my ring finger and pinky. At the time I had it glued with butterfly stitches. There was no remaining pain once the slight swelling etc had gone down.

A: We're sorry to hear what has happened to you.

As you say, it isn't an acupuncture-related injury, but if we did have a patient report of similar response to an acupuncture needle, we would probably say that the reason for the continuing pain is most likely to be from deep bruising which has caused a clot to form and which is pressing on the nerve, replicating the pains you felt when the accident first happened. If this is the case, then it will clear within a fortnight or so with a gradual reduction in the unpleasant sensations.

It is possible that there has been some damage to the nerve itself, or any one of several nerves which traverse the area, and the outcome here may be a little more difficult to predict. We have certainly come across one case where a direct hit on a nerve generated unpleasant sensations for a number of months. However, this would be very rare, and if the symptoms continue with the same level of intensity thrughout the next fortnight, or even become a bit worse, then you will need to see your GP to get a referral to a neurologist. There may be no harm in seeing your GP early anyway; waiting list medicine sometimes demands that people try to get themselves on the treadmill sooner rather than later. If your GP has on inspection any reason to suspect nerve damage, then an early referral is a good idea.

On the balance of probabilities, though, the symptoms should begin to subside during this week.

As an aside, there are a number of powerful acupuncture points on the palm of the hand, and you may have given yourself an unwitting treatment. Two of the major channels travel where you report symptoms, but the chances that they would resonate for this long are very small. Not the nicest way to have acupuncture treatment either!

Q:   My uncle has just completed treatment for bowel cancer and he's suffering really badly with burning hot feet. I asked a family friend, who is an acupuncturist, if she thought treatment would help. She seemed to know the symptoms I'd described and called it 'something' syndrome (I can't remember what the name of it was and now I'm not able to get back in touch with her to clarify). Is this something that you are familiar with and could you offer any advice - including if there are any specialists in this area in the north west of England?

A:  While we admire our colleague's diagnostic prowess (!), we'd have to say that the symptom has to be seen in the wider context of the patient's overall patterns of energy. While there may be one or two syndromes where this symptom is central to the diagnosis, it is always possible that it is a secondary reaction to a deeper underlying pattern which could only really be identified by looking very carefully at all aspects of someone's functioning.

We don't know exactly what treatment your uncle has had, although very often it involves surgery and chemotherapy, and occasionally radiotherapy, but we do know that it usually has significant effects on the whole system, and that includes body, mind and emotions. It is really important to be able to assess first hand what effects it has had. This is why in Chinese medicine the same symptom can be treated in dozens of different ways. Even in conventional medicine the great Canadian physician William Osler famously said 'it is more important to find out what patient has the disease than what disease the patient has.'

The best course of action for your uncle is to visit a BAcC member local to him to see if they can give him a brief face to face assessment of whether in their view he would benefit from treatment. The great majority are willing to do this without charge in order to give the patient as much information as possible before they commit to treatment. There are no specialists in this field, but this is not because of the field but because of the nature of Chinese medicine which treats the person, not the named condition. In reality, though, so common is cancer and its treatment in modern times it would be unusual to find a practitioner who has not had experience of treating someone who is recovering after cancer treatment.

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