Old Newsletter (New one to go here)

Locum Editorial

I am writing this editorial as locum editor filling in until Penny Holdaway returns from China. You can read some of her thoughts on China later in the newsletter and we also include next years course program so you pencil a course for next year.

With so many members being involved in accreditation and re-accreditation with the RNZCGPs there are a few things to remember. If you put it in your plan, you can count hours spent at MASNZ courses and if you hadn't you can still apply for some hours under the opportunistic learning category. If you are in an area with other acupuncturing GPs you might also like to create a Peer Group as we have done in Christchurch to use this process to widen your acupuncture expertise.

The educational - political arena has been very busy which both Wellington discusses in this newsletter and Ted outlines in the Journal. There has been some very recent progress here and we would appreciate if you could fill in the brief questionnaire enclosed and return ASAP to Linda.

Wishing everyone a safe and happy holiday season.

I thank everyone for their support to the society and will do my best for the society in the years ahead. I wish to thank Grant and the executive who have a tremendous job of setting the Society on course for our education program and the difficult issue of NZQA qualification recognition. Although the latter needs a lot more input from Ted, we have a credible structure on the NZQA framework for doctors to aim for.

 Our new executive team have had a reshuffle, but the team will still be moving the Society forwards to the challenges ahead. Our main issue is still education and the recognition of the training and skills our members have strived to achieve. To this effect, at the recent Pan Pacific Medical Acupuncture Forum the member societies have agreed to co-ordinate their education and set out a standard for the Pan Pacific Medical groups. I also understand from Joe Helms that the WHO will be presented a proposed education training standard for medical doctors, from the advisory body which he, Steven Aung and Gerald Gibb are part of. With these developments, I hope we can impress on the local authorities, we do have creditability for recognition of the status of our Medical Acupuncture training.

 To further strengthen our position, I am negotiating with the Australian Medical Acupuncture Society for those on the Register to be able to take their Part II FAMAS exam in New Zealand in 1997, with exemption for the Part I exam. This will allow us to be able to use the FAMAS exam as the standard for entry to the Register of Medical Acupuncture NZ. FAMAS qualification is recognised by the Australian authorities for Fellows to claim reimbursement for acupuncture work. Part I Exam is a written 3 hour paper, consisting of basics in acupuncture points and theories, pain theories, the science of acupuncture, and some clinical. Part II is on Clinical Therapeutics, also a 3 hours written paper, plus an oral exam. More details later if we are successful in our negotiations.

On the political front, we are being challenged by the Lay Acupuncturists and Traditional Chinese Medicine practitioners who want their status registered by a private bill. They have slyly made it such that we as medical doctors have no right to be doing acupuncture once their group is registered. This we will be opposing vehemently to the ministry and other interested medical groups. The other thing is that they are trying to get in by a grandfather clause, by just being advertised as an acupuncturist for the last five years, without any credible investigation of their qualifications or any exam system. This is unprecedented and even in Canada and US state, they all have to undergo an exam. Unfortunately with the recent influx of immigrants, a lot have arrived claiming to be medically qualified. Auckland must have the highest 'medically trained' population in the world now, not counting the doctor ratio of 1:450. The Society needs your support out in the grass root level. If you have patients who are in a position of influence please make them aware of these issues and your concerns. Patients should have the choice to seek medically trained acupuncturists if they wish, and I can vouch that the trend is to come to the medical practitioner with acupuncture skills rather than the lay acupuncturist, and they know this to their chagrin.

 The executive are arranging for a key speaker to come to our 1997 annual conference and workshop to be held in Wellington. There are a few speakers being considered, Mark Seem with a zonal and superficial acupuncture, Peter Eickmann with Korean Hand Acupuncture and Constitutional diagnosis, or Stephen Birch or Kiko Matsumoto of Japanese Hara Diagnosis and Acupuncture. They can all give us new skills in the wide field of acupuncture.

The long awaited journal is ready and is packed with great stuff for your holiday reading. I would like to exhort all members to contribute any interesting articles you come across to Penny Holdaway (our editor), and better still contribution from your work and experience. Please share your knowledge, and don't underestimate your skills, for we can progress in little steps with these tidbits from all you members. An article of your research or experience in some cases is definitely welcomed and a valued contribution for the journal or newsletter.

We hope to undertake Society sponsored research and use this as a requirement for the NZQA post graduate certificate in Medical Acupuncture. Thus I would like to see as many members participate and get credits for both a research project and the certificate. This is being investigated for 1997. The executive committee is working hard to get the MASNZ teaching course recognised as a CME accredited programme as well as a recognised national qualification. So please support the Society's courses which are of a high standard and are good value.

The members who went to the Pan Pacific Medical Acupuncture Forum were impressed with the high standard of presentation and the friendly and jovial atmosphere. I must congratulate our New Zealand contributors who did an excellent job of giving very stimulating and thought provoking, quality papers. This has been the feedback I received officially from the Australian organiser Chin Chan, and branch chairpersons of Australia. Robin Kelly's revue was tops for the social at the dinner.

I take this opportunity to wish all members a Merry Christmas and a Happy New Year. Take a good break and recharge your Qi for a busy and successful 1997. This the year of the Fire Ox - lots of creative profitable work!

 Be happy and Best Regards,

 Dr Wellington Tan

Learning acupuncture in China is very much a "Yin & Yang" experience. During my time in China, I have seen some of the best and some of the worst acupuncture ever seen.

One of the major reasons appears to be the limited teaching resources of the Nanjing TCM University. In China, at present, there are a large number of young TCM doctors with reasonably sound theoretical knowledge but much less clinical experience. Often their English is reasonably good and increasingly they are being selected to teach foreign students. Clinical teachers, in particular with good diagnostic skills, are much thinner on the ground. Many are unwilling to teach foreign students as they are paid no more for teaching foreigners, and foreign students tend to ask more questions and be more aggressive in taking knowledge in their clinic than Chinese students. Competition for the limited number of experienced teachers in very strong. During our course we had two large groups of foreign students arrive for clinical experience. This resulted in a drop in quality of Clinical Teachers and Translators for the Advanced Course. In general the University seems to give the better teachers to the one month Practical Courses than to the Advanced Course. So, if you are coming to China, the one month Practical Course is the best value. (Three of the best teachers are due to retire in the next three years, so I would come sooner rather than later.)

Of course, the spectrum of disease in China is quite different from the west. Herbal medicine is the most common form of TCM in China with 9 out of 10 patients seeking Chinese Medicine going to a herbalist. Increasingly they are combining the herbs with Western Medicine although the Herbal Doctor often seems to have little idea of the western drugs the patient is taking. In the acupuncture clinic CVA's and Bell's Palsy were the most common diseases apart from the ubiquitous back and shoulder pain. Stress related problems such as OOS, irritable bowel and even migraine appear to be much less common. With the rapid modernisation of China though, I suspect these conditions are set to rise. The majority of treatments in the clinic were purely symptomatic with little attention given to root cause. History taking is usually brief and examination of the patient on the most part non-existent. Pulse and tongue diagnosis is rarely performed in the acupuncture clinics I observed. Pulse diagnosis, in particular, is deemed to be unscientific and with the new politics of science dominating Chinese thinking, its use in acupuncture clinics is becoming less and less common. Unfortunately it does not seem to have been replaced by any form of systematic form of practical examination by the majority of doctors. An example was a lady who was needled for every conceivable cause of hypertension, all at the same time, with no one even taking her blood pressure. Xrays, CTs and occasionally laboratory tests appear to be the primary method of diagnosis, used particularly if the patient is not getting better.

With the increasing emphasis on science more and more attempts are being made to amalgamate TCM and Western Medicine. The have even started a course combining the two at the university, although I am not sure about the standard (some of the western medicine we were taught during our Advanced Course was a little wayward). Their research standards are improving and according to an Australian acupuncturist, who is helping with the translation of some of the papers, there are likely to be some good papers come out of China in the near future - CVAs, blood disorders and dermatology in particular are popular areas of research.

The theoretical side of the Advanced Course is predominantly TCM orientated although 8 hours was spent on Ear and New and Old Scalp acupuncture. About half the course was TCM physiology and the other half the course was more clinically orientated. The quality of the lectures is very reasonable but the most part failed to take into account the knowledge of acupuncture available in most western countries. It is possible to get some lecture tapes changed to areas which were more relevant to Western Acupuncture practice but the quality of the lectures sometimes suffered as a consequence. I hope the article in the BMJ heralds a change in the course design as requests and complaints by the students for the past 10 years have failed to do so.

Naturally the language barrier is a major disadvantage. It is definitely worthwhile spending time learning the Chinese name of the points before you come. It not only helps the Chinese doctor take you more seriously, but also helps you keep track of what is happening in clinic. Not everything that is said by the doctor is translated and I have picked up useful tidbits by keeping my eyes and ares open. Clinics are often far too busy to talk much anyway. Knowing the point names also allows you to correct errors in translation, both in lectures and the manual (which is the Yellow Book) - particularly in the clinical section, which has quite a few translation errors. Some of the translators, including my last one, did not know the numerical system, so was unable to translate for me. Having a reasonable knowledge of Zang Fu and point properties from a TCM perspective is also worthwhile (I can't count the times I was grateful for our own society's wonderful courses.)

To Summarise:

China still has many good acupuncturists, but there are also an increasing number of mediocre if not poor acupuncturists. If coming to China, come in a group, find out who the good teachers are and ask for them before you come, do a clinical course and buy theoretical lectures on topics you are interested in (again select the teachers carefully), state the group size you require before you come, and learn a little Chinese and a moderate amount of TCM before going.

Best Wishes for a Happy Christmas and Prosperous New Year.

by Ted Pearson

This is just to confirm, for those of you that didn't go to the Pan Pacific, that you missed an excellent conference. Chin Chan did a great job of organization (I hear that the Sydney Olympic Committee are head hunting him), most of the papers reached an adequate standard and the attitudes were a great cross section.

A Few Personal Highlights

Although it sounds parochial, I do have to say that the New Zealand contribution stood out for its quality, originality and delivery.

The opening paper was the "Wolfson Memorial Lecture" delivered by our own Gerald Gibb, who challenged us all to expand the boundaries of acupuncture. Gerald has incorporated bioenergetic techniques to extend the information available as a clinician and most importantly, prioritize it in terms of treatment options.

On the first day Gayle O'Duffy also presented her experiences of treating those cancer patients on chemotherapy and radiotherapy within rural general practice. By analysing the cytotoxic effects in terms of Chinese Medicine, she was able to treat her patients both retro-actively and pro actively with good clinical benefits.

Perhaps the most original contribution at the conference was that of Alex Chan's description of his recently delineated microsystem lying over the scapula. Alex has achieved a brilliant piece of clinical research which I personally have been able to immediately apply in my own clinic.

Another NZ contribution that excited a lot of positive feedback was the "Return of the Yellow Emperor" in which several members of the MASNZ teaching faculty gave their different perspectives of a complex case presenting with fatigue, ranging from the Strictly Western Anatomical through to the Totally TCM to Bodymind Synthesis and onwards to the Bioenergetic.

Other NZ contributions included Grant Johnston describing his integration of acupuncture and group therapy in addictions. Wellington Tan challenged the audience to diagnose and treat hot feet or cold hands, Michael Anderson and Di Turnbull discussed clinical usage of auriculotherapy and Karen Keith and Alan Clements gave us some useful clinical vignettes.

If there was a criticism of the balance of papers, it was the often excessively long discussions of educational programs. However of most relevance was Geoff Greenbaum of Melbourne outlining the development of his distance learning Acupuncture Diploma based at Monash University. This is an educational model we could adapt to NZ, especially if we could find the tertiary institution.

There were some other very useful clinical discussions, notably Steven Aung on the various Qi circulations and how to integrate and access them, Sona Tahan on an anatomical acupuncture approach to incontinence, Bryan Frank taking his needles to the worlds outback, and Roberta Chow reporting on Laser research.

Several participants discussed formal and informal research but the stand out paper was Marc Cohen describing his experiences with sophisticated electronic mapping of the skin surface, work done with a combined engineering and medical research group at Monash University. Marc impressed as an intelligent, committed, articulate and open scientist who I hope will be supported in his career.

David Lee did a good review of the identity of the Acupoints and how needle stimulation might modify physiology. Too often acupuncture related research concentrates on central mechanisms at the expense of the periphery.

Each conference day had workshops scheduled. Those that I attended were a little disappointing as they were again didactic. Of the New Zealand presenters, Gayle O'Duffy assisted by myself, grasped the challenge of a wholly interactive format in presenting a TCM enhancement of arthritis management. Of those participants who didn't leave immediately and who managed to surmount their astonishment, the experience was a good introduction to the New Zealand teaching style and excited a lot of positive feedback.

Good conferences are as much about the interactions at the breaks, the evening socialising and the exchanges over a few beers, as the formal lectures.

Each morning an enthusiastic contingent collected on the beach to great the sun with some Qi Gong under Steven Aung's masterful eye, watched by the early morning bemused walkers and joggers. Others collected with Wellington Tan for some Tai Chi forms.

At the formal conference dinner, which was in danger of being swamped by unfocussed speechifying, Robin Kelly presented several new musical items and updated "Mr Qi Gong" and the "Rapson Tap" with enthusiastic support from the backing group.