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A:  We have a factsheet on the treatment of menopausal  symptoms

which makes some very encouraging noises about the treatment of some aspects of menopause. Hot flushes always feature heavily in these trials, and meet with some success, but most trials are conducted testing 'real' treatment against 'sham' treatment, which we are far from believing is a satisfactory way of assessing the benefits of treatment. We don't believe for a moment that the sham treatments have no effect!

The studies cited in our factsheet are quite old, and there have been some more recent ones which have been very positive. Examples such as


make just as interesting reading.

However, hot flushes are not the only menopausal symptoms, and unless we had more specific information it would be foolish for us to be too definite. What we can say, though, is that menopausal treatments have been a part of Chinese medicine for over 2000 years, and the Chinese view of the energetic transformations which take place as women age can really help to inform treatment in a way that is much more sophisticated than simply using set protocols for specific symptoms, which is how most trials are conducted. Traditional Acupuncture treats the individual and seeks to understand the ageing process by looking at how generic changes in the system affect someone's unique balance. This can have a significant bearing on how successful treatment might be.

Our advice in these situations is always to visit a local BAcC member to discuss your particular presentation. This will give you the best possible chance to make an informed decision about whether treatment may be beneficial. We suspect that the answer will be that it could well be, but sight unseen it is not proper for us to make a recommendation.

It will probably come as no great surprise to you that there hasn't been a great deal of research into this problem, and none that we can find about the use of acupuncture treatment. Searching the internet does generate one or two personal stories where the effect of Chinese medicine in the form of acupuncture and Chinese medicine has been tremendous, and two or three very detailed differential diagnoses by Chinese practitioners of what lichen planus may represent in TCM terms. However, evidence like this, while encouraging, is far from proof, and wouldn't in itself be the basis for a recommendation.

This is where we believe that Chinese medicine is very well placed to respond to conditions which for the most part have very few effective treatments in conventional medicine save for the almost universal use of steroids. The symptoms remains the same whichever system of medicine one uses, but the diagnostic categories of Chinese medicine have different ways of interpreting them which are often more literal and sound rather strange to the western ear - invasions of heat and damp, fire poisons and the like. However, most patients find that these sorts of labels often describe their experience of the problem to a tee.

The key thing about this kind of description and Chinese medicine categories is that it is quite rare to see a single symptom that isn't accompanied by other systemic changes which a patient may not regard as pathological, and treating the person as a whole can often mean removing a deeper layer of imbalance of which the symptom is just visible evidence. In fact, in the oldest traditional systems symptoms were almost disregarded on the simple basis that if the body as a whole was in balance then symptoms would disappear naturally.

The best advice that we can give is that you visit a local BAcC member to see what they make of the overall picture which you present. They may well see patterns which are treatable, and as such may be able to offer a good idea of how effective treatment may be. The consensus on websites suggests that a mixture of acupuncture and herbal medicine might be a good idea, and looking at the Register of Chinese Herbal Medicine list will almost certainly generate a hit of someone who belongs to both bodies. However, any BAcC member will be able to give you an idea of what may be possible.

As long as you are planning to have a natural labour for your baby and your midwifery team and specialists are not preparing you for another C-section there is nothing to stop you asking for an acupuncture practitioner to assist you in the labour as they would for any pregnancy.

We prefer not to say 'acupuncture for induction' because this implies a direct causal relationship which isn't quite how we perceive what we do. We prefer to think in terms of helping the body through the natural stages of labour as smoothly as possible. The process is a very gentle one, and carries little risk as far as we are aware. It certainly isn't going to generate sudden results. The only caution we tend to apply is checking that the facilities are ready and in place in case the process really does accelerate the labour. This is especially the case if the process kicks off over a weekend.

Although we regard ourselves as generalists obstetrics is an area where we are well advanced in our recognition of specific postgraduate training which would allow someone to lay claim to expert practice. There are four or five specialist courses which are very popular, and although we cannot name them you will find that our members who advertise themselves as specialising in working with fertility and pregnancy issues will invariably have taken this training. You can rest assured that if they have then they will have covered areas such as yours in great depth and know exactly what they are doing when treating someone with a previous C-section in their history.

We hope that all goes well for you and your baby.

There is very little risk associated with the treatment of low back pain in pregnancy. In this journal article from Acupuncture in Medicine

the house journal of the British Medical Acupuncture Society, the author makes it quite clear that low back pain in pregnancy is one of the more frequent problems addressed by acupuncture in pregnancy, alongside morning sickness and migraine. He also spells out the key risk factors, namely using some of a series of 'forbidden' points, especially during the first trimester. No properly qualified practitioner would ever use these points anyway, but it has to be said that there are very few western practitioners who needle points as vigorously as the Chinese for whom these proscriptions applied.

The treatment of back pain generally is one of the better proven uses of acupuncture (by the rather inappropriate research measures which are in the ascendant in the west). Research into the use of acupuncture for back pain in pregnancy is limited, but that which exists is largely positive. 

Although we have not yet finalised our work on specialist practice, we are looking at recognising postgraduate qualifications in obstetric acupuncture. If you are looking for a practitioner it may well be using a google search under acupuncture and pregnancy alongside your home area to identify someone who has had specialist training. There are some advantages from visiting someone who spends more time than the average practitioner treating pregnant women. We are all generalists, but there are times when a more in depth knowledge of a field of expertise is valuable.

Trigger point therapy itself is a slightly more western approach to acupuncture with slightly different diagnostic principles. In practice the needles tend to get inserted in the same place but for different reasons, but if trigger point needling is what you specifically want then you may have to check out the registers of the medical acupuncturists (BMAS and AACP) who use this technique as a stock intervention. However, we are confident that the use of traditional acupuncture would prove equally as effective, and potentially more so insofar as it looks at the performance of the whole system, not simply the presenting symptom. 



Hi. I have a.bmi of 46.and am.currently 22 weeks pregnant and have pgp. Does bmi.effect how acupuncture works?



We can say categorically that someone's BMI has no impact at all on whether acupuncture works. From a Chinese medicine perspective the body is seen as a complex flow of energy, called 'qi', and putting a needle into a point will have an effect whether the person's BMI is 15 or 50. Generally speaking there are often energetic reasons why someone gains a great deal of weight, over and above lifestyle considerations and straightforward heredity, and these may have an impact on how much progress someone can make, but that will all be a part of the picture which the practitioner builds up and works with.

Indeed, there is some very good evidence that acupuncture can help with PGP. Studies such as this one published in the BMJ seem to be very encouraging. In fact the same researcher went on to look at whether there was any potential for harm and concluded that while there may be some minor transient effects there was no serious risk

We are by nature a generalist healthcare modality, i.e. we treat the person, not the specific problems they have. In practice, of course, we are all able to go after specific symptoms as well as balancing up the whole system, but we believe that treating a symptom without regard to the whole is leaving things half finished. This means that we regard all of our members as capable of treating any patient who comes to them. However, we are close to reaching agreement on the treatment of pregnant women as an area of expert practice for which we have recognised postgraduate training. In the circumstances it would be highly advisable to go to someone who has had this kind of training and who has spent more time looking at the specific issues of pregnancy.

Unfortunately we haven't signed this work off yet, but we are pretty sure that if you type into google your place of residence, acupuncture and pregnancy it will generate a number of hits of our members who specialise in fertility and pregnancy issues. Failing that you could always call a local BAcC member and ask them to point you towards someone locally who has these skills. We are always very keen to see patients get the exact care they need.





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