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Q. I'm looking at acupuncture courses, I'm currently studying an ITC in massage and anatomy, physiology and pathology. I have been looking at travelling to China to study but am finding info about transferable qualifications tricky to find. Is their a recognised international qualification for acupuncturists?

A. Sadly, there isn't an internationally recognised standard for acupuncture training, and what you may find is that there is an almost infinite variety of training courses in China which can range from 3 month intensive training to seven years full degree and beyond. A problem we have often had in the BAcC is finding out from Chinese practitioners who apply to join the BAcC exactly what their training entailed, so difficult can it be to get hold of course transcripts which map onto the requirements for entry into the BAcC.

The situation is certainly better than it used to be because of the standardisation of training around the style rather confusingly called TCM (Traditional Chinese Medicine) This become a kind of universally acknowledged system because there will always be TCM associations in every country, and most will operate some form of reciprocal recognition with courses in universities with which they have close ties. This doesn't apply to the BAcC which has always been a broad church and has people who practise all sorts of Traditional East Asian systems as well as TCM, but the ATCM, another major association, does have links with particular Chinese courses.

Generally speaking, though, most professional associations have accreditation processes which offer automatic entry to graduates whose teaching institutions they recognise, and then operate an individual application route for people who trained elsewhere. The BAcC, for example, set up the British Acupuncture Accreditation Board over twenty five years ago, an independent body which accredits courses, and the standards which it applies for courses in terms of content are used to assess the training of individual applicants. You can read about how we do this here

https://www.acupuncture.org.uk/public-content/join-the-bacc/3915-join-the-bacc.html

and you will find the Board's site https://baab.co.uk/ interesting, not least because it has useful information for prospective students and training standards but also because it lists accredited institutions, ones that have met its standards. It might be worth considering whether any of these might meet your needs. It's certainly cheaper than travelling to China, and has a level of quality assurance built into it. The worst outcome would be to find that after the expense and inconvenience your training wasn't adequate. This sounds improbable, but we have seen it happen, and it's heartbreaking to have to tell someone that after two or three years work they have to start again.

You may find, by the way, that some of your current A & P training may count towards the acupuncture training and reduce the

Of course, this is all predicated on the assumption that you want to join a professional body! There are almost no legal requirements for acupuncture treatment in the UK other than that the practitioner must be registered or licensed under local authority skin piercing laws. Some local authorities check whether their training is bona fide, but most don't, and if we find it difficult to assess the quality of someone's training it would be equally, if not more, hard for someone who hasn't any background in Chinese medicine. The only other requirement would be adequate insurance.

Anyway, we hope that this answers your question and gives you a little more background.

Q. My son has recently been diagnosed with stage 3b/4 chronic kidney disease. He would like to use acupuncture to help him through this challenging life changing period. Our insurance will cover the costs of this type of treatment.

However, he is unable to get a Doctors note to support this type of treatment either from his GP or from his kidney consultant. Therefore he cannot make a claim from our insurance.

How can I arrange a consultation with a doctor to support his acupuncture treatment?

A. We are very sorry to hear of your problem. We have seen this a number of times where the insurer is apparently happy to cover acupuncture as an option but requires the GP or consultant to act as a gatekeeper in providing a referral letter. We are not sure which scheme provides your cover, but we are aware that the scheme providers are wary of writing a blank cheque to scheme members for treatment where there isn't an agreed protocol which offers a realistic chance of success within a fixed number of treatments. Traditional acupuncture, which is as much about maintaining health as it is repairing damage and disease is potentially open ended and contextual, i.e. the same problem occurring in twenty people might arise from twenty different causes, some of which might respond quickly and some of which might not.

Since the schemes are created on an actuarial basis, where the provider has to have a realistic idea of what the commitment is, then the doctors and consultants are often instructed only to refer those patients with conditions for which there is a goof evidence base and standard treatment. This reduces the number of referable conditions dramatically.

It may be possible to locate a doctor who is prepared to refer your son; many private hospitals have GPs who are able to see patients at a price. Whether this would count as a referral is another matter; there's no point in spending £100 for a letter which your insurance company will repudiate anyway. We have seen patients whose companies have larger schemes which they control use this as a bargaining/blackmail chip by threatening to pull all their staff our of the scheme and go elsewhere, but this does have the disadvantage of a fresh start for people with pre-existing conditions whose cover lapses immediately.

We have found that talking directly to the insurance providers is often the best bet, both for throwing yourself on their mercy and also for finding opportunities within the system which you might be able to use to your advantage. Companies are run by human being who are often predisposed to help.

Another option is to use the PALS (Patient Advisory Liaison Service) which, in our experience, is pretty effective at fighting patient's corners. If you son is under hospital supervision, which we are sure he is, then this may well be worth a go. it won't be costing the hospital a bean, and consultants do not generally want the hassle of people nagging them when they might be shown to be unsympathetic. At very least it offers you something concrete about why they are refusing to sign, and that gives you are starting point for further negotiation.

There isn't a great deal of research we can point you to to support your case, and studies such as this

https://www.ncbi.nlm.nih.gov/pubmed/28422526

are few and far between. However, if you do get to a point where evidence might help to sway someone's mind then we will do what we can to help you.

Q. I want to ask if any member has experience treating gastritis and silent reflux

A. We are often asked about acid reflux, although it is usually the version defined as GERD rather than silent reflux, but as a long answer (in italics below) earlier this year demonstrates, from a Chinese medicine perspective this is not always a meaningful distinction:

There is surprisingly little research on the use of acupuncture for the treatment of acid reflux even though it is a very common presenting condition in our clinics. There are one or two studies like this
http://www.ncbi.nlm.nih.gov/pubmed/20697939

and

http://www.ncbi.nlm.nih.gov/pubmed/17875198

and occasional articles like this one

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080874/

which suggest other possibilities for the appearance of heartburn symptoms, but not the solid body of evidence one might expect based on the usually quite effective treatment of this problem.

Obviously there are physical problems such as hiatus hernia where there has been a physical change in structure of the oesophageal tract which can cause heartburn. If this is the case, then it will seriously limit the possibilities for treatment in any system of medicine. If investigations show that this is not the case, however, then there may be some value in using acupuncture treatment.

From a Chinese medicine perspective the classic presentation of reflux or heartburn is described as Stomach Fire or Rebellious Stomach Qi where the energy of the Stomach does not follow its normal pattern of causing food to descend but lets it stay in the Stomach or reverse its flow to create the classic symptoms with which people suffer. Knowing the immediate precipitating cause, however, does not mean that one goes straight to this for treatment. The flow of energy in the body, called 'qi' in Chinese, is a complex interweaving of channels connecting Organs whose functions are also inter-related. The art and skill of the practitioner lies in determining what the primary underlying imbalances are, in the belief that treating here will cause the symptom to go and stay gone rather than be treated simply as a symptom.

This is one of the primary differences between Chinese and conventional medicine. From the Chinese medicine perspective the symptom is an alarm bell telling the practitioner that the system is out of balance. Thus twenty patients with the same symptom could have twenty different underlying causes and therefore twenty different treatments, in contrast to the standard western procedures which have two or three main strategies for a problem. In Chinese medicine the balance of the system is unique in every patient, and this means that each treatment plan is also unique.

It follows that this does limit what we can say about individual cases and why we invariably advise people to visit a local BAcC member for an informal assessment of what is going on and whether treatment would be of benefit. Most practitioners can get an idea in a very short time of what is going on and as a consequence give a good informed view of what might be possible. This would invariably take into account other changes in the way that everything functions which are perhaps not significant enough to concern anyone but from our perspective enrich the picture which we have. Reflux and heartburn are often accompanied by changes in digestion and bowel habit, and secondary information can refine the diagnosis a great deal. A practitioner can take all sorts of other factors into account, including mental and emotional ones, to offer you a much more precise assessment of what may be possible.

We have to say that this still probably represents the best advice for a prospective patient, to visit a practitioner and let them see bow the symptom manifests exactly in you.

To the extent that a component of the problem may be an excess of acid in the stomach the advice and explanation above hold good. However, in many cases of LPR. however, there is a general failure of all of the mechanisms which prevent stomach acids reaching the throat, and in cases like this reducing the acidity of the stomach may only have limited value. However, we have to believe that if treatment can help with GERD, which it often appears to do, then in principle there is no reason why it should not help LPR. Certainly one of the common experiences of LPR, the lump in the throat, is a recognised symptom within Chinese medicine where is it called 'plum pit throat - the feeling of having a plum stone stuck in the throat- and for which several clearly defined strategies exist.

As in the earlier answer we would advise that you discuss this with a local practitioner face to face. This will give you a much clearer answer than we can manage here, and also give you a chance to meet them and see where they work before committing to treatment

As to whether there are practitioners who have treated this the answer is all of us. It seems to be a common manifestation of the stresses of modern life and the strain it puts on the parts of the system which affect orderly digestion, and the proliferation of over the counter indigestion preparations is evidence of this. Even where people come in with other main complaints entirely it is very common for them to say that they are getting heartburn or indigestion on a regular basis. The immediate presenting cause is often quite obvious, but as we said in the answer above, symptoms are often alarm bells, not the problem itself, and the skill of the practitioner lies not in turning off the warning sound for a while but making it stay gone.

Q. i'm trying to find help with my (central post-stroke pain syndrome) I've had for 28 years after a stroke hemorrhage in 1990.
i have tried everything from oramorph , Trans cranial magnetic stimulation, deep brain stimulation, spinal cord stimulation HF10 and other interventions all with no benefit so would acupuncture help?

A. We have to be honest and say that if all of the other therapies you have tried over the last 28 years have failed to effect a change it would be a very considerable surprise if acupuncture treatment suddenly proved to be the answer. However, we are not entirely sure what the CVA has caused by way of continuing symptoms under the generic title of CPSP, and there are aspects of post stroke treatment where the blockages which arise at the time of the event will stay blocked until someone clears them. We do occasionally hear of people having dramatic changes twenty or thirty years after a problem began but this is quite a rare event, and we would never use examples like that as the basis for a recommendation.

We have gathered a considerable amount of information about the treatment of strokes in a rather dense review paper which can be found here

https://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html
but the short answer to questions about efficacy is that in China acupuncture treatment, when used, commences almost immediately before the system has become 'fixed' in a state of disrepair, and the evidence suggests that this maximises the chances of regaining residual function quickly. The longer people wait for acupuncture treatment, the less well it seems to work and the less overall effect it seems to have.

Pain management is something for which acupuncture has developed something of a reputation since Nixon's visit to China in the 1970s and the sight of people having operations under acupuncture anaethesia. This led to a proliferation of trials and because neurotransmitter levels are easily measured a great deal of good evidence about the use of acupuncture to stimulate their release. Many Pain Management clinics base their work on this. The central question is how much relief and how sustainable, and it may be a matter of weighing up the cost and inconvenience against the amount of relief treatment can offer, it indeed it does work a little.

The best advice that we can give is that you visit a local BAcC member to seek their view in a brief face to face assessment of what may be possible, depending in the exact presentation it is that you need help with. We also think that cranial osteopathy might be another pathway which might offer some potential for change, but we don't have a central referral point to which we can direct you. Many osteopaths use cranial techniques, but some spend a great deal of time on this work and are often the local 'go to' people for difficult cases. we would hope that any you might contact direct you to the most experienced, just as we imagine that our members might have a local 'hero' to whom they send the more challenging cases.

Q. I suffer from sciatica and had my first acupuncture treatment 5 days ago. I had my second treatment 2 days ago. For the past 3 nights, I have been running a temperature of 101. I only have fever @ night. I am afebrile during the day. Could this be from the acupuncture? I asked my acupuncturist but her English is very difficult to understand and I felt like she brushed me off. She basically told me that I may have an infection. If I had an infection, I would be febrile all the time. Please advise. Thank you!

A. We think that it is highly unlikely that you have an infection from the acupuncture treatment itself. We keep very detailed records about what are called adverse events after treatment, and also look at world-wide databases in case patterns emerge to which we ought to alert members. Infections are very rare in the West, although in countries with primitive conditions they do happen, and when they do happen it usually arises from malpractice. These sorts of problems always tend to be local if they occur at all, i.e. something unpleasant at the needle site which spreads.

There are one or two possibilities within Chinese medicine itself. Although we treat specific problems, we always look at them in their overall context because they often arise on top of systemic weaknesses. Our job is not to turn off the alarm but to find the cause of the fire, so there are times when we treat systemically and it can cause a re-balancing of the system as a whole. This might, in some circumstances, cause the release of internal heat, and there are one or two syndromes where the body may become warmer at night.

101 degrees is much more likely to indicate an infection unrelated to treatment, and this is not entirely unexpected. There are over 4 million treatments administered every year in the UK and there are bound to be times when someone gets ill at the same time as their treatment and wonders whether they have been made ill by the treatment. In these cases we always advise people to see their doctors, because if it is a separate phenomenon it makes no sense to be arguing about what caused it and every sense to get it sorted. This invariably reveals the cause.

This always sounds defensive but isn't we have decades of experience and we are very aware of what can happen from acupuncture treatments. With the safety standards in place in the West infections from treatment are very rare.

We are sorry that your practitioner's English was not able to help you. We do find that some practitioners who have English as a second language often sound like they are giving someone the brush off but this is more often to do with making what they believe to be a statement of fact without the usual sugar coating that we tend to apply. So you'll more than likely get the answer 'no' with no embellishment, which is often not reassuring. Information dispels fear!

We hope that by the time you read this the temperature has normalised, but in any event we would recommend that you talk to your local surgery and seek advice about whether to drop in so the doctor can take a quick look at what is going on. 

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