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This is a historical article from an early issue of China Now magazine
A.R. Evans gives a historical overview of the development of Acupuncture in China.

In ancient times Chinese philosophers regarded Man as an integral part of his surroundings. He was composed not only of the five elements - metal, water, wood, fire and earth - but subject to the interplay of the elemental forces of the universe. He was 'a small world within a large world', a microcosm within a macrocosm.

Man was encouraged to live in accord with, and adapt to, the order of nature and to pursue a mode of life in harmony with natural laws: to follow the Way, the Dao.

TCM Daily Cycle

The first law was that of polarity. This idea embraces a never-ending change of all things - universe, earth and man. All are subject to harmonious vibration between two poles, the theory of relativity, the positive and the negative, the Yin and the Yang. Yang, represents positive, male, warmth, light and fullness; Yin represents negative, female, cold, dark and emptiness.

As Yin and Yang opposites manipulate heaven and earth in the waxing and waning of days and seasons, so they exert an influence over the human organism. Good or ill health is determined by the fluctuation of these conflicting forces. The sympathetic and parasympathetic nervous systems are but extensions of this principle.

'If Yin and Yang are not in harmony it is as though there were no autumn opposite the spring, no winter opposite the summer. If such a body is exposed to the dew and the wind, colds and fever will set in.' So teaches the Huang Di Nei Jing (the Yellow Emperor's Classic of Internal Medicine). This deeply influential and oldest of all known medical works is traditionally ascribed to Huang Di, the legendary Yellow Emperor (2697 - 2597 BC) Certainly it seems a great part of the book existed during the Han Dynasty, but much of its content originated far earlier. Some authorities believe it to be the concentrated work of various authors, written around the ninth century BC.

The Yin-Yang doctrine in man ascribed certain organs to the Yin principle - the liver, kidney, spleen, heart and lung: and others to the Yang principle - the bladder, gall bladder, stomach, small intestine and colon. These Yin-Yang organs are paired with each other. Thus, kidney-bladder, liver-gall bladder, spleen-stomach, heart-small intestine, lung-colon. These coupled organs function more efficiently at certain times of the year and accordingly they were linked with that particular season and its corresponding element - for example: Winter, water (bladder and kidney); Spring, wood (gall bladder and liver); Summer, fire (small intestine and heart).

TCM Annual Cycle

As Spring follows Winter, so water nourishes wood. As Summer follows Spring so wood nourishes fire. In the same way, the related organs follow this pattern and nourish one another. This is known as the creative cycle or mother-son law.

Continued transgression of this natural creative tendency leads to opposite actions occurring within the cycle. Fire will melt metal; water will swamp fire; for example, kidney failure (water) attacks the heart (fire), causing dropsical swellings. This attacking or opposing action is known as the 'Go' or control cycle.

Acupuncture utilises these universal laws to heal or prevent illness. Disturbance of these energies may be caused by the seven external devils: heat, cold, wind, humidity, dryness, wetness, and trauma; or the seven internal devils: grief, worry, constitutional factors, joy, fear, anxiety and anger. Any one of these factors, in excess, was capable of causing illness by affecting the Qi, or vital body energy. Qi, the Vital Essence or Life Force, is an important concept in the ancient Chinese system of healing. It is believed to circulate continuously around the body along certain pathways called chings or meridians, and these in turn are connected to the internal organs. Acupuncture treatment in illness is aimed at restoring the normal pattern of energy flow by the insertion of needles at certain points along the meridians in order to regulate the viscera.

Acupuncture and world medicine

The spread of acupuncture to other countries probably started with Japan in the third century BC, when Xu Fu, a Daoist with medical knowledge, took seeds, plants and medical herbs along with three thousand Chinese children, with him to Japan. Many medical books and medicines were introduced during the Han Dynasty, and in the Tang Dynasty, Monk Jian Zhen (755 AD) taught medicine in Japan. For a time, during the modernisation of medicine in Japan (1884-1924), Chinese medical science was abandoned with the exception of acupuncture.

Chinese medicine spread to Korea in the third century BC, and later to Vietnam in the second century BC. Korean medical practice is based mainly on Chinese literature of the Han and Tang Dynasties. Vietnam was also under the influence of Chinese civilization during the Han Dynasty.

In Europe, the early knowledge of acupuncture began with the first missionaries. The Jesuits, in particular, studied Chinese culture and returned to amaze Europeans with their findings. The Jesuits were responsible for coining the word acupuncture, from the Latin 'acus' (needle) and 'punctura' (puncture).

The first European treatise on acupuncture (1671) was published by the Rev. Father Harvieu. It was splendidly entitled 'The Secrets of the Medicine of the Chinese, consisting in Perfect Knowledge of the Pulse, Sent from China by a Frenchman of Great Merit'. The first published article in Europe was by Girolama Cardano (1508-1576), a teacher of medicine in Milan. He reported on returned travellers' experiences of acupuncture treatment in China. Ear acupuncture was subsequently described in 1707 by Valsalva, the famous anatomist. Later, a more comprehensive study was undertaken by Gandini in 1769.

Germany was introduced to acupuncture from Japan by Dr. E. Kaempfer (1651-1716); his work 'Amoenitatum Exoticamm' was published in 1712. He introduced the word 'Moxa' from the Japanese 'Mogusa' (the herb that burns) and 'moxibustion' to acupuncture vocabulary. The German Acupuncture Association was formed in 1937.

Roughly contemporary with Kaempfer, a Dutch physician, Wilhelm Ten Rhyne, devoted twenty pages to acupuncture in a small book written in Latin and published in London in 1683.

The most significant treatise to be published in France was 'Medicine among the Chinese' by the French consul-in China, Dabry de Thiersant, in 1863. A complete chapter was devoted to acupuncture and needling techniques. Another French consul, Solie de Morant, studied acupuncture in Shanghai after observing its miraculous effects. On his return to Europe twenty years later, he demonstrated the efficiency of acupuncture at several hospitals. In 1934 he was eventually persuaded to publish his 'Synopsis of True Chinese Acupuncture', and in 1939 two volumes of 'Chinese Acupuncture'. It was largely due to this man's influential writings that acupuncture at last secured a firm hold on European imagination.

In England the first book on acupuncture - and probably the first book in English on the subject - was written by the Rev. D. Lawson Wood. It was called 'Chinese System of Healing' and was published in 1959. 'Chinese Acupuncture' by Dr Felix Mann followed shortly afterwards in 1962. The English Acupuncture Association was formed in 1960.

In 1956, following a lapse of some three hundred years, Soviet doctors again studied acupuncture in China. On their return they revived interest by opening research centres in Moscow and Leningrad.

Over forty countries are now practising acupuncture and moxibustion.


The role of acupuncture in modern China

acupuncture ear
Inserting needles into acupuncture points
on the ear to relieve hypertension

In China the integration of Western and Chinese medicine proceeded much more vigorously following Chairman Mao's directive 'Chinese medicine and pharmacology are a great treasure house. Efforts should be made to explore them and raise them to a higher level'. With the added momentum of the Great Leap Forward, medical colleges added more compulsory courses on Chinese medicine. New colleges of Chinese medicine, with courses of from three to five years, were founded and more scientific research centres and clinics were established. There was a corresponding increase in scientific articles on the development of Chinese medicine and many volumes of the ancient classics were reprinted.

In 1954 traditional medicine merged with the Chinese Medical Association. Four years later acupuncture anaesthesia was discovered. Continual experiments during the Cultural Revolution produced many new acupuncture loci on the nose, ear, face and fingers. Electrically operated needles, injections into acupuncture points, deep needling techniques and the use of points previously forbidden, helped to coin the term 'New Chinese Medicine'.

Further evidence of the wisdom of amalgamation came during the years 1962-71. During this period, the Beijing Friendship Hospital treated 1,432 cases of pneumonia in children. Combining traditional herbal remedies orally and by injection, along with blood transfusions, vitamins and intravenous drip therapy, without recourse to antibiotics, the recovery rate was 96 per cent, with an average treatment period of five days.

The first choice of treatment for acute abdominal conditions is herbal packs, infusions and acupuncture. At the Tianjin People's Hospital the combination of herbal paste, small willow splints, acupuncture and Tai Chi exercises reduced fracture healing time by one third. The exercises are designed to develop and stimulate respiratory, digestive, circulatory and nervous systems through a specific combination of body movement and breath control. They are based on the ancient Art Silk Weaving Exercises of Kung Fu which help to regulate the internal organs.

Although this article is entitled 'Acupuncture Reviewed', it must be realised that acupuncture and moxibustion are only a part of Chinese medicine. From ancient times, different areas of China used different methods of treatment - moxa in the cold North; needles of flint in the East; medicines in the West; nine fine needles in the South; with massage and breathing exercises in Central China; remedial massage, herbals and diet. Acupuncture and exercises have always formed part of treating the whole organism, mind and body alike.

Although enthusiastic regarding the growth of acupuncture, I am concerned that many books have been published without mention of the philosophical traditions inherent in its practice. These books deal mainly with formulae treatment that is, treatment without due regard to the state of the energies. The Nei Jing states that

The energy of the heavens circulates in the heavens in accordance with the same laws as those of nature; a man's energy circulates in his body in accordance with the same laws as those of nature. If that circulation is disturbed, he falls ill ... In the wrong hands an acupuncture needle is a dangerous weapon, like a sword it can kill a man. The superior physician helps before the early budding of the disease. The inferior physician begins to help when the disease has already developed, he helps when destruction has already set in and since this is so, it is said of him that he is ignorant.

The most suitable and significant conclusion to this article inevitably comes from the Nei Jing. The oldest medical classic sends its message to the newest medical climate.

Minister Ji Bo: The utmost in the art of healing can be achieved when there is unity. The Yellow Emperor: What is meant by unity?
Ji Bo answered: When the minds of the people are closed and wisdom is locked out they remain tied to disease. Yet their feelings and desires should be investigated and made known, their wishes and ideas should be followed, and then it becomes apparent that those who have attained spirit and energy are flourishing and prosperous, while those perish who lose spirit and energy.
The Emperor replied: Excellent!

Development of Acupuncture in China

acupuncture points
Ming dynasty model showing
acupuncture points

In primitive society early man relied upon his intuition and instincts to counteract disease and trauma. Scratch reflexes countered irritation and application of fire countered cold extremities, crude stone splinters were however more precise and could also be used to bleed congested tissue. Such then are the probable beginnings of acupuncture.

Recorded in 'A Dictionary of Characters' compiled during the Han Dynasty 206 BC - 220 AD 'bian' means 'the curing of disease by using stone'. Later, bone, iron, copper, bronze, gold, silver and stainless steel needles were developed and used for the same purpose. The Nei Jing mentioned earlier was compiled during the Warring States period and summarised ancient and current medical knowledge. The text takes the form of a dialogue between Huang Di and his minister Ji Bo whose questions and answers touch on almost all fields of medicine. Acupuncture and moxibustion (burning herb) combined with chapters on pulse differentiation are very detailed.

Chinese traditional medicine developed and prospered greatly during the Zhou Dynasty 1066-221 BC. State public health doctors were employed and clinical records carefully recorded. It was during this period the famous Dr. Bian Que (407-310 BC) practised medicine. His acupuncture and moxibustion treatment to cure a comatose prince was described in 'Historical Records' 2000 years ago and probably marks the earliest record of an effective cure by acupuncture. Pien Chueh also compiled the 'Nan Jing' or 'Classic of Difficulty', a medical treatise explicating eighty-one difficult passages from the 'Nei Jing'. It is thought he formulated the Chinese pulse theory and for that reason he was known as 'Father of the Pulses'. Bian Que later became a laudatory term applied to many physicians over the course of four centuries. In the Han Dynasty Hua Tuo (141-203 AD), reputedly the world's earliest surgeon as well as the first man to discover and use anaesthetics for operations, became skilled in the use of needles. He stressed the principle that too many points should not be needled. He also taught the five styles of Chinese boxing emulating animal movements.

The first Chinese medical schools began to appear in the 7th Century AD. Wang Shuhe (210-285 AD) further developed the pulse theory in diagnosis and his work 'Classic of the Pulse' discussed adequately for the first time the energy systems of the body. In 1313 a Persian physician included this book in 'An Encyclopaedia of Chinese Medicine'. The pulse technique had however been documented in the Arab world as early as the 9th century.

During the Xin Dynasty (264-240 AD) acupuncture developed rapidly and was comprehensively summed up in Rudiments of Acupuncture and Moxibustion by Huang Fu (Huangfu Mi). 70 of the 128 chapters were devoted to point location and their main function. It was the first book devoted solely to acupuncture and moxibustion theory and treatment; it also listed 649 points for the first time. The principle of superior physician (preventative); inferior physician (disease present); ignorant physician (past help) was perpetuated by him.

The Tang Dynasty (618-907 AD) brought further stability and prosperity to China and during this period the Imperial Medical College set up a special acupuncture department. The present Nei Jing with its 25 books presented for the first time appeared in 762 with comprehensive commentary by Wang Bing who claimed to have discovered and used its original edition. Another important book, 'The Thousand Gold Recipes' by Quan Qimiao, added many new acupuncture points in 674 AD.

In 1027, 'The Illustrated Manual on the Points for Acupuncture and Moxibustion as Found on the Bronze Figure', was written by Wang Weiyi, a leading acupuncturist, by order of the emperor. He made two hollow bronze figures holed with acupuncture points, linked into meridians, for use in teaching and examinations. His book was engraved on stone tablets which were placed in a temple in the capital. During the Sung, Qin, Yuan and Ming Dynasties 930-1368 AD acupuncture flourished.

The 14 Meridians Exposition by Hua Boren in 1341 classed the Governing Vessel (Du Mo) and Conception Vessel (Ren Mo) traditionally two of the eight extra meridians (as they do not pertain to any internal organs) along with the 12 ordinary meridians.

In 1368 a further summary was considered necessary and 'The Compendium of Acupuncture and Moxibustion' was compiled. At this time three more bronze figures were made. These holed figures were coated with wax or rice paper and filled with water. To pass an examination the candidate would have to needle correctly allowing the water to pour from the hole. 1556 saw the publication by Xin Qong Fu of 100 volumes on Chinese medicine. Two of these were solely about acupuncture. 20 years later an 8-volume summary of this work, including one on acupuncture, appeared under the title 'Entrance Door to the Study of Medicine'. Li Shiqen (1518-93) dealt comprehensively with the powerful eight extra reservoir meridians.

Another landmark in acupuncture history was written by Yang Qizhou in 1570. An important doctor of the Ming Dynasty, he wrote 'A Complete Treatise of Acupuncture', in which the classical teachings were converted into prose and short poems for easy memorisation. 'Acupuncture Thermocautery, Great Achievements' by Yang Qhizhou, 1601, was a version including many secret prescriptions from numerous schools of acupuncture.

An important reference book on acupuncture 'A Golden Guide Book for Doctors' was edited under the imperial order of Emperor Qianlong (1736-1795). During the Qing Dynasty (1644-1911) acupuncture faced its most testing period and fared badly. Its lowest ebb was probably the early part of the 19th century. The Qing rulers discriminated against acupuncture and moxibustion and eventually a government decree was issued in 1822 by the Grand Medical College Board banning its practice on ethical grounds; the Federal Court considered exposure of the naked form indecent. It was an impractical ban. Most of the people, especially in outlying districts, relied heavily on traditional medicine and it was they who kept such traditions alive. Herbalism, especially, during this period began to extend more influences, as did Western medicine. Acupuncture meanwhile went underground and extended its influence to other countries.

In 1911, following the foundation of the Republic, two Chinese doctors, Zheng Tanan and Long Dianqi founded the 'Medical Society of Acupuncture and Moxibustion' in an effort to revive the ancient art. They published two new books 'Chinese Acupuncture and Moxibustion' and 'Scientific Treatment by Acupuncture and Moxibustion'. In 1957 Zheng Tanan became President of the Academy of Medicine. In 1918 a petition asking for the establishment of Chinese medical schools was granted. Prior to this period acupuncture was taught mostly by private tutors.

When in 1927 the Chinese National Government was formed, returned medical doctors educated in Japan petitioned the government to prohibit traditional Chinese medicine. The Chinese people opposed this measure. In March that year a nation-wide meeting of practitioners elected a delegation and presented their case. The Government relented, withdrew, and March 17 was henceforth 'Chinese Doctors' Day. A League of Nations Conference called at Geneva in 1931 proposed organised research on Chinese medicine. Specialists on Chinese medicine from China, India, Japan, USA and Britain attended. In 1933 the Chinese Central Hospital was established with the express object of promoting and systemising Chinese medical science. There followed a period during which Nationalists and Communists argued for and against Chinese traditional medicine.

With typical foresight in 1928 Chairman Mao advocated the use of both Western and Chinese medicine. However these were difficult years and it was not until 1944 that Mao clearly defined the policy of uniting the old and new style medicines, the United Front. The decline was over.

© Copyright Society for Anglo-Chinese Understanding (SACU) 2006 : an extract from SACU's magazine China Now 61, Page 9, April 1976

The views expressed in this article are those of the author and do not necessarily represent the view of SACU.
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