Acupuncture

by Chris Sullivan

Keywords: acupuncture, moxibustion, acupressure, Traditional Chinese Medicine, Oriental Medicine, Chinese Medicine, needles, herbal medicine, qi, yin, yang, yellow emperor, China, TCM

I. Abstract

Elucidated in the following paper are the basic processes of acupuncture, a brief history of its development, as well as how it is viewed by Western medicine compared to its founding Confucian and Daoist philosophies. Unfortunately, this paper doesn’t even begin to scratch the surface of acupuncture. The issue of qi and Yin-Yang theory is also vastly more complex than its brief relationship to acupuncture described below. The details of Chinese history have a great significance not offered here, and other social and health arguments for and against acupuncture could comprise another entire paper of great length. The following sections will provide enough information for the curious reader to learn a bit about what acupuncture is, where it comes from, and how it works.

II. Scope and Purpose of the System

Acupuncture is an aspect of Chinese medicine, a holistic system of medicine, that began in China over 2,000 years ago. The basic practice of acupuncture “involves the insertion of thin, sterile, [and usually disposable] stainless steel needles into points of the body to a depth just below the skin.”[1] Upon insertion, a patient may feel a number of sensations ranging from numbness to tingling or aching. “This sensation, which is not pain, is called deqi (pronounced dah-chee).”[2] The points at which the practitioner inserts the needles have been very carefully mapped. Today, there exist hundreds of acupoints located along meridians, pathways through which the life force, qi (pronounced chee), flows.

The specific points chosen for needle insertion are determined through the mysterious practice of pulse diagnosis. The acupuncturist can feel “the flow of qi through each of the twelve major meridians.”[3] Other aspects of the diagnosis involve observation of a patient’s demeanor, skin, complexion, emotions, or body build. Acupuncturists who don’t speak English will have no discussion with their patient, while others may provide questionnaires or conduct thorough interviews.

Once the needles are inserted, the practitioner will occasionally move them to cause stimulation. Treatment times last from a few seconds to forty minutes. The acupuncturist may stay with the patient during treatment, or leave the room allowing the patient to relax or sleep.

There are four other systems in Chinese medicine that are periodically used in addition to and/or in conjunction with acupuncture. Herbal medicine brings balance to the qi in three forms, the raw herb, a tablet or pill form for swallowing, and as an herbal extract for making tea. Moxibustion is the burning of mugwort on an acupoint to introduce heat into the treatment. Acupressure, or needle-less acupuncture is a massage of acupoints and meridians to stimulate qi. Finally, wires connected to needles provide electric stimulus during treatment.

Acupuncture exists to make the patient feel better physically or emotionally. Most popularly used to treat pain (chronic, surgical, arthritic, etc.); it has also proved successful as an anesthetic during surgery. The traditional basis of acupuncture resides in Confucian and Daoist philosophies and the Yin-Yang Theory. In brief, yin and yang are opposing forces in the world, such as cold and warm. Yet, yin and yang are inseparable and one can not exist without the other. In Chinese medicine, yin and yang combine to become the qi. A person’s health is affected when there is an imbalance of qi in the body. Through the above described processes, acupuncture stimulates qi and restores natural balance to the body to bring about mental, physical, and emotional well-being.

III. Authority Structure

1. Sources and Criteria of Valid Knowledge

Texts written hundreds and thousands of years ago are the true sources of acupuncture knowledge. Some of the most important throughout history are as follows:

· Ma Wang-dui scripts – As one of the three earliest texts of Chinese medicine from the Han dynasty (206 BC to 220 AD), it helped shed light on the theory and conceptualization of medicine at that time.

· Nan Jing (The Classic of Difficult Issues) – It integrated “for the first time all aspects of health care into the yin-yang and five-phase doctrines.”[4] Meridians are also elaborated upon and qi is a more prominent force. The greatest contribution of this text was the development of pulse diagnosis. It is the second of the three earliest texts from the Han dynasty.

· Huang Di Nei Jing (The Yellow Emperor’s Canon of Internal Medicine) – Considered the most important acupuncture text, the Nei Jing is comprised of two books, the Su Wen (Fundamental Questions), a history of medical theory, and the Ling Shu (Spiritual Axis/Pivot), an acupuncture manual. These books explained the theory of yin and yang in the body as well as developed the meridians, hundreds of acupoints, and how the qi is related to them. It is the third of the three earliest texts from the Han dynasty.

· Zhen Jiu Jia Yi Jing (The Systematic Classic of Acupuncture and Moxibustion) – Written by Huang-fu Mi in 282, this text emphasized disease prevention and healing techniques through acupuncture. It took a prophylactic approach as well as mapped moxibustion points.

· Zhen Jing Zhi Nan – Dou Han-jing’s publication of this text during the Song dynasty (960 to 1264) provided a description of acupuncture performed in accordance with calendar cycles.

· Shi Si Jing Fa Hui (An Elucidation of the Fourteen Channels) – In 1341, Hua Shuo continued the development and research of meridians and acupoints.

· Zhen Jiu Da Quan – Xu Feng’s Ming dynasty text (1368 to 1643) continued calendar and body cycle acupuncture treatment research.

· Zhen Jiu Ju Ying – Also during the Ming dynasty, Gao Wu “introduced the use of supplementing and draining acupoints.”[5]

· Zhen Jiu Da Cheng – Yang Ji-zhou’s 1601 work continued to develop acupoints as well as reflect upon consensual medical theories in the Chinese community.

· Ben Cao Gang Mu – Li Shi-zhen’s Ming dynasty text also looked at acupuncture from the view of the greater consensus.

2. Methods of Inquiry

The process by which one went about obtaining knowledge of acupuncture and Chinese medicine in ancient times is not wholly clear. If someone had access to the texts described above, they could have learned on their own. This method seems highly unlikely. The system is so deep and complicated that it would take someone years of study just to begin to grasp its concepts without aid, not to mention being a well versed and able practitioner of the system.

It is probable that aspiring acupuncturists were under the tutelage of a teacher or guru. There is evidence that this tutor was a member of the family and the trade was passed from generation to generation, but there is also support for the case that the person was the local medicine man who was believed to posses a special healing ability, teaching his craft to pupils who would carry it on. It is likely that both of these scenarios occurred. These people would instruct their students through means of textual study, demonstration and/or experimentation, and various spiritual practices in accordance with their belief of and adherence to Confucian or Daoist principles.

3. Institutions and Professional Structure

Not until 702 was the first school of Chinese medicine established, ironically, in Japan. Gradually, more and more schools were developed through present day, and thus the typical means for acquiring this knowledge is in a formal classroom setting. One dramatic example was during the Ming dynasty when great prosperity and sharing of knowledge led to the establishment of many schools across China, each unique and based on its own interpretation of popular theories and ideologies.

In the 1950’s, as a result of need for health care, China established schools that incorporated aspects of Chinese and Western medicine through a “standardized curricula… (teaching) basic biomedical sciences, traditional pharmacotherapy, and acupuncture.”[6] This marked the beginning of a regulated interrelation between the two systems of medicine. The World Health Organization continued this trend when it sponsored a series of programs in the 1970’s that caused a great movement by physicians to go to China to learn about acupuncture. Its success led to similar programs elsewhere for non-physicians.

Today most states in the U.S. require certification or licensing for acupuncture now. For example, in the U.S. in 1996, twenty two states licensed acupuncturists, twelve limited their licensing to MD’s and DO’s, eight allowed it under the supervision of a physician, and the rest had no regulations. This is typical of many other countries as well.

IV. History

Beginning in China over two thousand years ago, acupuncture is one of the most ancient medical systems still in practice today. The seeds of acupuncture were planted during the Middle and Late Zhou dynasties (772 BC to 221 BC), when its founding philosophies, Confucianism and Daoism, arose.

The Qin dynasty (221 BC to 206 BC) provided no medical progress due to political and civil unrest, but the Han dynasty (206 BC to 220 AD) was the opposite. During this time three “primary” texts of acupuncture, the Ma Wang-dui scripts, the Nan Jing, and the Huang Di Nei Jing were published. (*Note: More details on each book, school, or other source of acupuncture is described in more detail in Section III.) The body was now seen in terms of the interdependence of its organ systems and how the flow of qi through those systems was essential in maintaining health and well being. By the end of the Han dynasty, Chinese medicine and acupuncture were in full bloom.

The following centuries brought varying periods of advancement and decline in acupuncture. The introduction of Buddhism to China (220 to 589) caused political strife. The religion had little influence on acupuncture and the system continued to develop, most notably, Huang-fu Mi’s Zhen Jiu Jia Yi Jing. The ability to heal through acupuncture was being realized and qi, in relation to diagnosis and acupoint choices, was also further researched. The popularity and success of the system caused its spread into Korea, Vietnam, and Japan.

The Sui dynasty (590 to 617) saw the medicine man Sun Si-miao combine “Daoism and Buddhist theory with that of systematic correspondence”[7] to create measurement techniques to describe acupoint positions that are still used today. Despite economic well being, the emperors of the Tang dynasty (618 to 906) were more interested in alchemy, astrology, and the search for the elixir of immortality. Thus medicine saw little advance other than a new edition of the Huang Di Nei Jing. The spread of acupuncture to Nara, Japan did result in the first Imperial medical college during this time though.

After fifty years of decline, the Song dynasty (960 to 1264), marked by Neo-Confucianism, brought a renewed view of qi as well as rigorous study of the Nan Jing. The greatest text from this period was Dou Han-jing’s Zhen Jing Zhi Nan, which expanded upon the second edition Huang Di Nei Jing. The Mongol ruler Genghis Khan governed China during the Yuan dynasty (1264 to 1368). Despite this, flow of philosophical and medical knowledge was not hindered, and thus acupuncture continued to grow in the form of Hua Shuo’s Shi Si Jing Fa Hui.

The Ming dynasty (1368 to 1643) retook China and wide spread education and knowledge prevailed. More books were available than ever before and medical schools were established across the empire. Due to abundant knowledge, acupuncture experienced its first criticism from other systems and philosophies. This criticism was great enough to cause a slight decline in its popularity. However, it did not prevent new research. Xu Feng published Zhen Jiu Da Quan and Zhen Jiu Ji Ying was written by Gao Wu. The most important work was Yang Ji-zhou’s Zhen Jiu Da Cheng. Along with Li Shi-zhen’s Ben Cao Gang Mu, it comprised “the most comprehensive medical volumes of Chinese medical knowledge before modern times.”[8]

The Qing dynasty (1644 to 1911) was the final dynasty in China. Though under Manchurian rule, these three peaceful centuries were nothing but decline due to numerous circumstances. The peace broke out in rebellion in the 19^th century due to food shortages, leading to the formation of the Chinese Republic. Acupuncture and Chinese medicine fared similarly. Strong Western influences and the lack of any new developments caused people to give up on traditional medicine. A few “traditionalists” attempted to revive it under the Han-Xue movement, but by 1930 were unsuccessful. In fact, in 1929, “registration of traditional doctors was ceased, and an announcement was made by the Ministry of Health proposing the abolishment of traditional medicine altogether.”[9]

After World War II, Chinese medicine made its come back out of necessity. The People’s Republic of China had millions of people in need of health care and only about 40,000 Western physicians. But, 500,000 people trained in traditional medicine also existed. An agreement was reached during the 1950’s to set up traditional medical schools that would incorporate aspects of Western medical science. From this arose the use of acupuncture as an anesthetic in Western medicine during surgery. In the 1970’s, the World Health Organization sponsored acupuncture programs, facilitating its rebirth. Thousands of people every year obtain Chinese medicine and acupuncture licensing or certification where it is available and usually required. After such a long and difficult history, acupuncture finds its greatest popularity and success in the modern era. This is a tribute to the strength of the system, while steeped in tradition and strong philosophical beliefs, it is still flexible and accepting enough to new ideas to ensure its survival for another two thousand years.

V. Representative Examples of Argumentation

Ever since the initial meeting between Western and Chinese medicine, there have been varying degrees of conflict and criticism between them. Most argumentation revolves around how it works internally.

The supporters of Confucian and Daoist beliefs defend acupuncture in the following manner. As a holistic system, Chinese medicine focuses on the body as a whole rather than what is being directly affected by the ailment. According to these philosophies, “in the beginning there is the Great Ultimate (T’ai-chi). It engenders yin and yang…”[10] Often considered the most important concept of Chinese medicine, the Yin-Yang Theory encompasses the world. “All things in the universe are either yin or yang. However, there are no absolutes: nothing is ever all yin or all yang, but a balance between the two forces.”[11] Two examples from the Huang Di Nei Jing illustrate this concept very well:

Day gives way to night, night to day; a time of light and activity (Yang) is followed by darkness and rest (Yin)… Yin/Yang is a constant, continual flow through which everything is expressed on the one hand and recharged on the other. They are an inseparable couple. Their proper relationship is health; a disturbance in this relationship is disease.[12]

The yin-yang symbol is also another good example of the relationship between the two.

The white half is yin and the dark is yang, but the circle of yang in the yin half and the circle of yin in the yang half symbolize how one can never be without the other. Yin and yang are also commonly associated with opposite entities or characteristics, for example: yin is female, night, moist, and while yang is male, day, dry, and hot, just to name a few.

The last sentence in the selection above from the Huang Di Nei Jing demonstrates the yin-yang relationship to Chinese medicine. It translates in such a way that “nature and laws that govern the natural world are used to help us understand the inner world, the world of the body. The person is seen as a microcosm of a holographic universe.”[13] Like the world is characterized by yin and yang, so too are opposing parts of the body. These concepts are the fundamentals of qi. Yin and yang together make up qi in the body, thus an imbalance in either of these energies creates an imbalance in one’s qi, which leads to sickness, pain, or injury. Thus, “every treatment modality is aimed at one of these four strategies:

To tonify Yang

To tonify Yin

To eliminate excess Yang

To eliminate excess Yin.”[14]

As stated, the qi is the vital life force that flows through the body. “Qi is derived from two main sources: the air we breathe and the food we eat.”[15] It affects all organs, tissues, structures, and fluids. Qi can stagnate, or become imbalanced for any number of reasons: emotional problems, excess heat or cold, mechanical injury, etc. Through acupuncture treatments, the practitioner is ultimately affecting the qi to heal the patient.

On the other hand, Western medicine tends to explain the inner workings of acupuncture based on five primary theories:

1. “Augmentation of Immunity” Theory – Acupuncture raises levels of hormones, white blood cells, triglycerides, globulins, and other anti-bodies.
2. “Endorphin” Theory – Endorphin levels are raised through treatment.
3. “Neurotransmitter” Theory – Treatments affect neurotransmitter levels such as serotonin.
4. “Circulatory” Theory – Acupuncture can control vasodilation and vasoconstriction.
5. “Gate Control” Theory – This popular theory states that nerves, when stimulated enough, will shut down. The smaller nerves being those that shut down first. Nerves relaying pain signals tend to be smaller, and therefore acupuncture is temporarily shutting them down.

After examining both sides of the issue, people will still ask why these reasons work to heal. When it comes down to it, most people after trying it will be satisfied with the reason: It just does! From a personal perspective, I have received acupuncture four times for chronic lower back pain. Three of those times were performed by an elderly Chinese man, Dr. Bill Tseng, and each a success. The fourth time it was performed by a young white man, Dr. Rick Woodward, and it had no effect. When I told Dr. Tseng about Dr. Woodward’s treatment, he said that “sometimes a white practitioner will be too tentative with the needles and not apply enough stimulation because they are afraid they will injure the patient. This is a result of them not understanding the body and how the systems work.” By “understanding the body and how the systems work,” I took Dr. Tseng to be a believer in the qi and yin-yang (Chinese heritage not withstanding). Ironically, when asked about this issue, his reply was: “They just didn’t know what to call a nerve 1,000 years ago.” On the other hand, when the same question was put to Dr. Woodward, he emphatically described his belief in qi and ancient philosophies. This experience with these doctors has not only shown me that people will take unexpected positions in their support of how acupuncture works, but also that it doesn’t matter who one is, as long as the results are good and they believe in it, then acupuncture is a legitimate solution to medical concerns.

VI. Suggested Position in Comparative Scales

The following section hopes to “rate” acupuncture on a set of scales from 1 to 10 in hopes of facilitating its comparison to other types of magical, scientific, or religious systems.

a. Relative emphasis on

traditional authority testimony of experience

1 2 3 4 5 5.5 6 7 8 9 10

I judge this at a 5.5 because this category has to be examined from two sides, practitioner and patient. For the most part, the acupuncturist’s authority on the system comes from some kind of traditional source whether it is his schooling, either Western or Chinese, or his faith. On the other hand, most patients’ belief in acupuncture is through personal experience.

b. Relative

centralization of authority decentralization of authority

1 2 3 4 5 6 7 8 9 10

Today, the majority of acupuncture education takes place in a formal, educational setting of some type and a practitioner is required to be licensed in most areas. But, due to the long history of and occasional continued decentralized teaching, I will score this category with a 4.

c. Relative emphasis on

invisible/spiritual/heavenly realities material/earthly realities

1 2 3 4 5 6 7 8 9 10

Many people know and understand acupuncture as a system of medicine and do not realize the religious philosophies that are its founding traditions. Practitioners are in part to blame for this because they will often advertise their skill as means for healing, which is not untrue, but not the entire picture. The other object of blame is acupuncture’s continuing integration with Western medicine, which is wholly focused on earthly realities. Thus, I believe a 7 is appropriate.

d. Mainly

spiritual/moral objectives pragmatic objectives

1 2 3 4 5 6 7 8 9 10

This category follows from the previous, and a 9 is in order as most acupuncture treatments today aim for immediate, concrete healing goals. Though, there are the instances of acupuncture being used in conditions such as alcoholism which could be viewed as a moral objective.

e. Most power or agency

reserved for a divine being realizable in individuals

1 2 3 4 5 6 7 8 9 10

In Confucian and Daoist beliefs there is no divine being. There is a “higher power” that may be thought of as divine, but no single entity. This “higher power” is what the qi and yin-yang stem from, but these are completely accessible to practitioner and patient for healing and to be healed, thus a 10.

VII. Bibliography

1. Primary Sources

Huang Di Nei Jing, 2^nd or 1^st century BC.

The first and official book of acupuncture from ancient times.

Tseng, Bill, L.Ac. Interview. Alamo Acupuncture, San Antonio, Texas. January 2003.

Acupuncturist whom I received 3 treatments from and conducted semiformal interviews with during those times.

Woodward, Rick, L.Ac. Interview. Aspen, Co. December 2003.

Acupuncturist whom I received treatment from and conducted a semiformal interviews with during that time.

2. Secondary Sources

“Acupressure.” http://www.acupuncturetoday.com/abc/acupressure.html.

Brief essay on the basics of acupressure.

“All About Acupuncture.” http://www.acupuncturetoday.com/abc/acupuncture.html.

Essay on basics of many aspects of the acupuncture system.

Chan, Wing-Tsit. A Source Book in Chinese Philosophy. Princeton, New Jersey: Princeton University Press, 1963.

One of the selections from our class reading, helped with understanding of yin-yang and qi.

Cho, Hun Young. Oriental Medicine, A Modern Interpretation. Korea, 1934.

Helped explain aspects of acupuncture through clarification of many selections from various primary sources.

Collinge, William, The American Holistic Health Association Complete Guide to Alternative Medicine. New York, New York: Warner Books, 1996.

Explained acupuncture in the setting of its role in Chinese Medicine as well as helped to relate it to other aspects of the system.

Dragon, Victoria. “Why Qi Can Stagnate.” http://acupuncture.com/Diagnosis/qistag.htm.

Essay on the nature of qi.

Fishman, Jon. “The History of Acupuncture.” http://acupuncture.com/Acup/history.htm. Dec. 17, 2000.

Essay on the history of acupuncture and Chinese medicine as it developed in China.

“Qi, Jing, Blood and Jin Ye: The Body’s Vital Substances.” http://www.acupuncturetoday.com/abc/qijingshen.html.

Very informative essay on qi’s relationship to other bodily fluids.

“The ABC’s of TCM and Acupuncture.” http://www.acupuncturetoday.com/abc/.

Basics of acupuncture and traditional Chinese medicine.

Veith, Ilza – translator. The Yellow Emperor’s Classic of Internal Medicine. Los Angeles, California: University of California Press, 1972.

A modern translation of the primary text book of acupuncture.

“Yin and Yang Theory.” http://www.acupuncturetoday.com/abc/yinyang.html.

Essay on yin-yang theory.

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[1] AHHA Guide to Alternative Medicine, pg. 30

[2] Acupuncture: A Brief Introduction, acupuncture.com

[3] AHHA Guide to Alternative Medicine, pg. 27

[4] Understanding Acupuncture, pg. 18

[5] The History of Acupuncture, acupuncture.com

[6] The History of Acupuncture, acupuncture.com

[7] The History of Acupuncture, acupuncture.com

[8] The History of Acupuncture, acupuncture.com

[9] The History of Acupuncture, acupuncture.com

[10] A Source Book in Chinese Philosophy, pg. 263

[11] Yin and Yang Theory, acupuncturetoday.com

[12] Huang Di Nei Jing

[13] AHHA Guide to Alternative Medicine, pg. 14

[14] The Foundations of Chinese Medicine, pg. 7

[15] Qi, Jing, Blood and Jin Ye: The Body’s Vital Substances, acupuncturetoday.com