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Q: I finish law university but I want to become professional acupuncturist. I would like to know which schools offered the best knowledge which can be approved anywhere especially in Europe.  I would prefer to learn it in China or Japan but if there is any good school in Europe It can be my choice as well.

A: We can only really comment on the schools of which we are aware in the UK. The ones of which we have direct knowledge are those accredited by the British Acupuncture Accreditation Board, whose website https://baab.co.uk/ offers a wealth of useful information about training in traditional acupuncture in the UK. Graduates of accredited course have automatic eligibility to enter the BAcC, subject to acceptable health and criminal record checks.

The issue for you, though, is that while there is no statutory regulation of acupuncture in the UK, which means that people can practise with all sorts of level of qualification under what is called common law, this is not the case across Europe. Some countries, like France and Italy, still technically regard acupuncture practised bu non-doctors a criminal act, while others like Germany and Holland, have secondary requirements for anyone wanting to operate as a healthcare practitioner. As such there are no qualifications which guarantee that someone can move freely around Europe as an acupuncture practitioner. The same would apply even if you travelled to China or Japan to get your qualification. In the BAcC we have no reciprocal recognition of qualifications with other countries, and we interview every candidate for entry who is not a UK graduate. We believe the same applies elsewhere.

It may well be that you have to work back to front - decide where you might want to work and then investigate what the baseline qualification is for these countries, and also whether you would be able to get  away with practise as a non-doctor. In France, for example, we know of few prosecutions, even though many traditional practitioners work there, and when people are caught the fines they get are strangely equivalent to what the registration fees would have been had they been official.

We do belong to a European network, the ETCMA http://www.etcma.org/, and it may be possible to use the contact details from here to ask member colleagues what currently applies in their countries, and what the relationship is between training and registration.

Q: I have tennis elbow in both arms the right arm is worse than the left.ive had 4 treatments now which lasts half an hour each time. After I have a 15 min massage the massage is so rough that the pain wants to make me cry. I was told I have bad circulation and that's why the massage is rough. So then I spend 4 days in pain after getting over the experience to go back 3 days later to have it all over again. The problem is the gentleman doesn't speak much English so I find it hard to ask him questions and get answers  I'm not seeing any progress at the moment  my question is is this normal for me to still have pain and should the massage be so vigorous?

A: We are sorry to hear of your experience.  It certainly does not help that the practitioner is not able to communicate very easily. However, we have to say that you need to be aware that you are in charge in the treatment room, and that the practitioner can only work with your consent. If you decide that the massage is too rough and ask him to stop it, then stop it he must or be guilty of common assault. It is then his problem/challenge to use his skills to circumvent the problem of not being able to get the qi moving by vigorous massage. There are always ways!

Should there be progress by now? That is a very difficult question to answer. It depends a great deal on the severity of the initial problem. Our factsheet has some reasonable evidence for the benefit of acupuncture treatment

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

but there are widely different degrees of the problem, and in some cases it can take half a dozen sessions to get the energy moving and undo the stagnation of the energy.

However, that said, the treatment should not be causing pain four days later, and unless there are stunningly good clinical results to back up continuation it would seem entirely legitimate to question whether the course of treatment is really going anywhere. There has to come a point after about four or five sessions where one can say with some certainty whether it looks like the treatment will succeed, and if it doesn't then it is important to draw a line in the sand and stop.

It is not our job to talk one of our possible members out of a job, but you need to discuss this situation with him, and if the answer doesn't help you then perhaps you might need to re-consider whether he is the best practitioner for you. We have always been very insistent that a practitioner must have sufficiently good English to address a patient's concerns because we are all too well aware of the consequences of people feeling that they haven't been heard.

And the bottom line is that it's a buyer's market. If you aren't happy with the treatment there are probably a great many other practitioners close by to whom you can transfer.

Q: I have trapped nerves in my lower back. My pain radiates down my left leg into my foot. I have now had three sessions of acupuncture. Both of my legs feel a lot worse. They ache tingle and throb. Walking is more difficult for me and I walk a lot slower. I should be having another three sessions but I am reluctant to go back.

A: We are sorry to hear that you seem to have developed slightly worse or different symptoms after your treatment.

We would be very surprised to find that the acupuncture has actually made things worse in a directly causal way. Short of sticking a needle into a nerve there isn't a great deal a practitioner can do in the lower back which would generate the symptoms of which you speak. The only time we have come across this is when someone has a trapped nerves because of changes in physical structure, and the muscles have been guarding to hold the vertebrae apart. If treatment caused these to relax, then it is just possible that this has let bony structures change position and increase the level of impingement. We do know that physios offer this as a caution when treating lower back pains and nerve impingement, but they do tend to use more vigorous techniques than we do, and this can magnify the effects.

Another, and more likely possibility, is that the treatment has started to encourage the structure of the spine into a better shape. We do sometimes find that after long periods of operating out of shape the body's musculature can start to adapt, so when improved function starts to bring the structure back into alignment some muscles relax and others tighten to accommodate the new position, both of which can generate mildly unpleasant symptoms.

Of course, the third and less palatable possibility is that something has changed or deteriorated in the back alongside rather than because of treatment, and this has created new and unpleasant symptoms such as those you now have. This can sometimes happen, and we encourage our members not to get into pointless arguments about what caused the problem but to get the person seen by their GP as quickly as possible to establish exactly is going on. This almost invariably points to causation, but crucially it makes sure that someone gets the correct attention first.

We think your best first step is to discuss the matter with your practitioner. It may simply be a matter of adapting the treatment to suit you better, perhaps by working away from the problem area or reducing the strength of treatment. If they cannot see any reason why what they have done could have caused these problems, then they will probably refer you to your GP for further examination.

We would say 'don't panic', though - we have known of very few cases where acupuncture treatment has caused serious long term adverse effects, and the majority of these have been to do with actual physical damage caused by the needles, not reactions to treatment itself. We hope you feel confident enough to talk to your practitioner about what has happened, and remind you that you are in charge in the treatment room, so if you are not happy with proceeding, then you can just draw a line straight away and stop.

Q: My mom just had acupuncture yesterday at noon as the practitioner said that she had blood deficiency (her pulse on her left wrist was too weak). Now my mom is experiencing extreme dizziness, cold sweat, fatigue, and nauseousness. Is this normal and what should we do?

A: We are sorry to hear of your mother's post-treatment episodes. However, we are confident that by the time you receive this reply everything will have settled down.

It is very rare for people to suffer serious side effects or adverse events after treatment, and the ones that do happen are invariably to do with actual physical damage caused by a needle. In the hands of a properly trained and qualified professional acupuncturist this is extremely unlikely to happen; it is only the poorly trained or inept that cause these sorts of problems.

However, it can be the case that people can 'wobble' a bit after a first session, and some of the things you mention - dizziness,  fatigue, nausea and so on  - can happen. There are a number of possible explanations for this. Sometimes it is the body starting the process of cleansing itself of energetic blockages. The Chinese believed that pathogens travelled inwards and reversing this process could often lead to a disturbance as they cleared. Some people are also energetically very sensitive, especially if they are somewhat weakened. This can be a reaction to treatment which is too powerful for them, and the practitioner will take this into account when they get feedback, and adjust the strength of treatment accordingly. This might mean fewer needles, less manipulation and so on, but all of these adjustments can make a tremendous difference if someone is a strong reactor.

Of course, there are two other more prosaic reasons. The first is that your mother may not have been warned of some of the basic housekeeping rules before treatment, as for instance making sure that you have eaten something within the last few hours rather than being treated on an empty stomach, and this can sometimes exaggerate the effects of treatment. We have seen a patient faint because she hadn't eaten for twelve hours before treatment, and then only a small bowl of cereal. The second possibility is that the symptoms are of a virus, but by coincidence have happened after treatment. With over four million treatments being given every year there are bound to be a few occasions when someone gets ill at the same time as treatment, but without any causal connection. If this is the case, then the usual steps need to be taken; bed rest, etc etc.

We strongly suspect that these are transient reactions to treatment, though, and we think they may well have subsided before you get this response. It is important to let the practitioner know, and it may well be worthwhile calling the practitioner today for advice and guidance. They will know better than we could what they have done and what your mother may need to do to help. If the symptoms have persisted for 48 hours and show no signs of relenting then it may well be worth having a word with her GP, or calling the 111 advice line, the NHS non-urgent service. We have found this to be very successful at directing people to the best help for their needs.

Q: What was the qualification to study for acupunture, and what is the cutoff  to study for acupunture?

A: Your question is a little unclear, but we think we can cover all the bases!

In order to enrol for a training course in acupuncture, most UK students have an A level standard of education which would be the normal entry standard for a university degree course, which many UK courses now are. There are obviously alternative routes depending on the kind of experience and life skills a person has. With a career on acupuncture it helps considerably to have some life experience behind you before starting to train, and many courses will offer partial exemptions and deals for people who can demonstrate that as a mature entrant, for example, they have skills which would enable them to train, even though these may not be reflected in formal qualifications.

As far as the qualifications gained are concerned these are usually licences to practice or diplomas, although the university qualifications will be degrees, usually a Bachelor of Science (BSc).

As far as cut-off is concerned, there often isn't one. In the UK it would actually be in breach of formal guidelines to refuse to take someone on as a student on the grounds of age. All that a training establishment can do is assess whether someone is fit to take the course, not factor in whether or how they can practise the skills learned or the length of time they could possibly practice.

The website of our sister institution, the British Acupuncture Accreditation Board  https://baab.co.uk/ has a wealth of information on training and a career in acupuncture, and we can think of no better resource to which to direct you.

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