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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.

Q:  After treatment 2 years ago with high dose oral steroids I experienced a raft of adverse effects, including fatty deposits on my left lower leg and foot that caused extensive nerve damage and paralysis [juxta-articular adiposis dolorosa].  Clinicians tell me that there is no way of removing the fatty lumps; however, I wonder if acupuncture could stimulate the body's own mechanisms. Any information you can offer would be most appreciated.


A:  This is one of the sorts of question where we tread with great caution. Acupuncture treatment is often a treatment of last resort and we are always concerned about raising expectations where the chances of improvement are slim. However, there have been for nearly every condition we have seen cases where there has been a remarkable turnaround, and although this is often described as 'spontaneous remission or cure', often much to our colleagues annoyance, the reality is that this is the exception rather than the rule, even if it were demonstrably caused by the treatment.

 There is, as you might have expected, no research of which we are aware or could find which suggest that acupuncture treatment might help. The condition is rare, and research studies would need a much larger cohort of people to work with to have any meaningful outcome. We have not even been able to find a case study.

 However, problems such as this have been around for thousands of years, whatever the cause, and Chinese medicine would have been used to address the manifestation, just as it would for any other condition which we now recognise under a western name. Traditional acupuncture, based as it is on a flow of energy called 'qi', would have and still does look at problems like this as blockages in the flow of qi or accumulations of energy caused by stagnation. The practitioner would be keen to establish whether it was a local problem or a local manifestation of a systemic problem, and then use the needles to try to move the qi and disperse the problem.

 All sounds rather easy when put like this, but the reality is that the growth of new tissue in the body as a consequence of conventional treatment has proved very difficult to address, and if you were to present at our clinic the best that we would ever say is that it may be worth a few treatments to see if there was any noticeable change, and if so to discuss how much and how sustainable. The problem is always to determine a scale by which change can be measured. If there are clear signs that it impairs movement or causes local pain then there are scales which one can use to determine what effect the treatment has. If it's simply a matter of trying to measure the size of a fatty lump, that would be much more difficult.

 The best advice which we can give is to visit a local BAcC member to see what they make of the presentation in the context of your overall health picture. There may be something in the systemic presentation which suggests that treatment may have an impact, but in any event it would enable much more detailed advice than we can give at a distance. Most members are happy to give up a little time without charge to help prospective patients make informed decisions about their health and healthcare options.

 In summary, we think it might be a long shot to try acupuncture treatment for this problem, but we would never say 'don't' because our work is not simply about trying to get rid of specific conditions but about trying to balance the energies of the body to enable it to function as best it can. The ancient Chinese used to believe that this would enable to body to heal itself, and we have certainly seen cases where change happened against out expectations.

 

A:  This question illustrates the problems we have with published research and its use and interpretation. There is a systematic review published a little while ago

 http://www.ncbi.nlm.nih.gov/pubmed/26502548

which appears to be quite encouraging, citing as it does the cumulative results of 13 studies. While we would normally be quite positive about this, making our usual comments  about this bearing out our clinical experience, the reality is far more complex.  In fact, the Cochrane database assessment of the value of acupuncture treatment is far less encouraging

 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014639/

 Many of the cases we see and have seen are very complex, and some of the manifestations of what can often be a very broad brush clinical definition are a great deal easier to treat than others. In all cases, though, it is making sense of the symptoms within the overall presentation which matters, and the labelling of all sorts of presentations under the one diagnostic banner headline can be misleading.

 That said, paediatric acupuncture is an area of specialism within traditional acupuncture where some of the postgraduate training has reached a stage where it may be formally recognised as the basis for claiming expert practice. In the source texts used by the courses there are several clearly identified syndromes which fall under the general heading of ADHD and some well tried treatment protocols, along with lifestyle advice, which may be beneficial.

 Rather than say blithely 'it will work' we would advise you to try to find someone in your area who has undertaken this postgraduate training and ask their advice. If it is you own child who has the problem then we would recommend that you try to arrange a brief face to face consultation to see what may be possible. Our internal procedures don't allow us to make individual recommendations, but if you use the google search terms 'acupuncture children' and the town where you live we strongly suspect that you will find someone who has undertaken training with some of the well established postgraduate courses. That is not to say that any of our members may not be able to help, but children are not simply small adults, and there are specific problems which they face which may require slightly more fine tuning than is found in ordinary generalist practice.

   

 

A:  As this expert knows only too well from personal experience, persistent hiccups/hiccoughs can be a very distressing experience, not the increasingly funny experience which many observers seem to find it. 

There is a little bit of evidence for the use of acupuncture, mostly in the form of what are called case studies about single instances where treatment has helped, or sometimes where treatment has been offered to a specific target group where hiccups often present and where there is a need to deal with them quickly, as in post myocardial infarctions. Below are a few examples of these kinds of studies

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035062/

http://www.ncbi.nlm.nih.gov/pubmed/15813167

http://www.ncbi.nlm.nih.gov/pubmed/11908864

 Most practitioners during their training learn a number of what we call 'first aid points' which are known to have an effect on specific conditions. There are certainly two or three which are commonly used to stop hiccups, and one additional one which appears to be effective for treating children with persistent hiccups. Overall, though, there isn't a great weight of evidence, and we would be a little remiss to suggest that acupuncture definitely provided a solution.

However, that said, we are practising a system of medicine where hiccups, a symptom like any other, is not always seen as the problem itself but is usually a manifestation of other imbalances and blockages in the system. As you may have read, Chinese medicine is premised on the understanding of the body as a system of energy in flow, and the skill of the practitioner lies in making sense of symptoms within the general background context against which they appear. This is why the same symptom can often be treated in a dozen different ways in a dozen different patients depending on what internal causes are allowing it to develop.

The short answer to your question is that you may have to visit a BAcC member local to you for them to be able to see what is going on and try to make sense in Chinese medicine terms of what is happening. This is the only way that you will get a clear idea of how treatable the problem is.  What we can say, though, is that with conditions like this we tend to take the view that if they are going to respond they will do so quite quickly, and as such we would caution a prospective patient about getting engaged in a long run of treatment with no obvious improvement. We would suggest three or perhaps four treatments would be the maximum we ourselves would offer before reviewing the case in depth and deciding whether there is any point in carrying on.

This all sounds rather negative, especially when many of us have stuck a needle in with almost immediate effect like a party trick. However, everything works for someone, but something doesn't necessarily work for everyone, so we would advise caution. 

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