Ryan Valeri Religion 195

Professor Lubin 30 March, 2003

Acupuncture

Keywords: acupuncture, Taoism, Confucianism, traditional Chinese medicine, qi, Huang Di Nei Jing, Han dynasty, acupoints, meridians, healing system

I. Abstract

This brief paper provides a basic overview of the evolving medical system of acupuncture. The precise origins of acupuncture are unknown; however, during the Han dynasty, the system of acupuncture was officially placed into writing. The Huang Di Nei Jing or “Yellow Emperor’s Canon of Internal Medicine,” is the first known text devoted to acupuncture and set forth the fundamental tenets of the system. In addition to providing a manual for acupuncture practice, the work synthesized the known efficacy of the system with prevailing ideals of Taoism and Confucianism. The effectiveness of the practice itself, according to Chinese traditionalists, is accredited to its correction in the flow of qi – the life force – and the return to balance of the yin and yang. Today, the West fails in attempts to explain acupuncture’s success, but the healing art still enjoys its greatest popularity - in both Asia and the West - to date.

II. Scope and Purpose of the System

In the most literal sense, acupuncture is identified as the insertion of very fine needles - possibly in combination with electrical stimulus or aromatic heat - into the skin at defined acupuncture points in order to influence bodily functions. However, the Chinese healing art of acupuncture has existed for at least two thousand years, and includes an elaborate theory to explain the literal practice. Acupuncture has its historical roots in the Han dynasty circa the first century, where it became the first Chinese healing practice to eliminate demons and the supernatural as causes of illness. Acupuncture arose from both Confucian and Taoist thought, with the essence of its theory based in Taoist value of balance (Fishman). The Huang Di Nei Jing is the earliest Chinese medical text, and almost solely devoted to acupuncture. Chinese acupuncturists could then identify their practice as having serious medical benefits consistent with a general religious theory.

Generally speaking the theory behind the efficacy of acupuncture begins with the Taoist conception of the yin and the yang. Yin and yang are an inseparable couple; one cannot exist without the other, and both continually flow throughout the individual and the universe. Good health entails a natural balance and harmony between the yin and the yang in the body. When such a proper balance exists, the body has a healthy flow of the life force qi - the breath or vital fluid intrinsic to the health of the human body. When the flow of qi becomes interrupted, insufficient, or imbalanced, yin and yang become imbalanced, and illness results (Little 127). Acupuncture claims efficiency in diagnosing illness, and treating it through either opening blockages or closing meridians of qi. The ancient art experienced success in the West despite the inability of current western science to explain why it works. However, through numerous studies, the West has proven acupuncture’s efficacy in relieving pain, removing addictions, treating allergies, and many other illnesses. Despite numerous Western conjectures as to why acupuncture is effective, none of which dominate with any certainty. Generally, what once thrived only in China and parts of Japan and Korea is now a very popular, complex, and legitimate alternative, or supplement, to Western medicine, available all over the world often at a much lower price.

III. Authority Structure

a. Sources and Criteria of Valid Knowledge

The great classics of medicine composed during the Han dynasty are arguably the most important source of knowledge for the system of acupuncture. Specifically, we will focus on the Huang Di Nei Jing, which was the first great work devoted to acupuncture. It describes the use of acupuncture and moxibustion, pathology of the meridians and viscera, acupuncture points, indications, contraindications, and the application of nine kinds of needles. The Nei Jing is organized into two main books, each with multiple sections. In the first book, Su Wen - “Fundamental Questions” - conversation between the emperor and his physician “develops in a lucid and attractive way a theory of humans in health and disease and a theory of medicine” (Fontanarosa 128). The second book titled Ling Shu or “Spiritual Axis” is essentially an acupuncture manual. In combination, the two books explained the assimilation of the yin and yang theory, the concept of qi, and the notion of diagnosis based on somatic symptoms. While the first discussion lays down the philosophical basis of traditional Chinese medicine, and makes the Nei Ching Su Wen more of a treatise on health and disease rather than a textbook of medicine, the second book delves into more practical matters. The Ling Shu identifies twelve qi channels and one hundred thirty-five accepted acupoints, and outlines the basic tenets of modern acupuncture, which served as the foundation for the schools of Japan and Korea, and eventually in the West.

The Confucian ideals in China created a common acceptance that illness and disease were not caused by the supernatural, but had some relation to human action. Confucian ideals also impinged on biomedical advancements in that it was opposed to the development of anatomy and surgery. One of its main tenets being that the whole body was sacred and should remain complete throughout life and also in death. Acupuncture - a non-invasive healing art - was a logical response. As the success of acupuncture became obvious, two questions remained: How and why does it work? The Tao, and the theory of the yin and yang, provided those answers. The Tao literally means the “way” and the philosophy of Taoism is a method of maintaining harmony between man and his world, and between this world and beyond. The Tao, or the “way,” has been linked to a separate creed called Taoism, but its basic naturalistic philosophies permeate all Chinese thought. The Taoist concept of health is to attempt to attain perfect harmony between the opposing forces of the natural world, Yin and Yang. The only way to be healthy is to adjust to the natural forces within the world and become part of their rhythm. In essence, the ideal of health is perfect harmony between the forces of Yin and Yang; this represents the correct “way” or Tao. When qi, the source of life in all living things circulates properly, the body exists in a state of healthiness. If qi becomes imbalanced, disharmony and illness result (Little 127-131). It is within this widely accepted Taoist view that the acupuncturist finds support for its mechanism.

b. Methods of Inquiry

There are multiple ways for someone outside of the system of acupuncture to acquire knowledge of it. The easiest is to go directly to the source itself. Allow yourself to be a patient of acupuncture. Then, you can be the judge of how effective it really is. However, your inquiring appetite may not be fulfilled simply with empirical proof. In which case, you may be interested in how acupunctural knowledge and training is generally acquired.

During the Sui dynasty (561-618 AD), the very first medical college was “established [in China] to administer medical research and to train doctors” (Lewith). Acupuncture, moxibustion, and other herbal medicines made up the entire curriculum, which consisted primarily of lessons from the Nei Ching Su Wen and the Classic of Acupuncture and Moxibustion (Lewith). However, the majority of the teaching and practice of acupuncture was never formalized in medical colleges. Instead, knowledge is more often passed down from father to son or teacher to apprentice. Only recently has this medical apprentice relationship begun to die out, although many older acupuncturists today have been trained in this manner (Lewith).

Unlike the East, most Western countries require biomedical degrees and training before a acupuncturist can legally practice. In most of Europe, a person who wants to legally practice acupuncture must first be a trained medical doctor (AAMA). In the United States, depending on local laws, a traditional acupuncturist can teach, learn, and practice acupuncture without any biomedical study. In some states, “nonbiomedical acupuncturists have achieved licensure, certification, or registration,” while other states require a M.D. and D.O., and still others call for additional training (Baer 95-96). Overall, depending on the local laws, gaining sufficient acupunctural knowledge can be accomplished as easily as an apprenticeship, or necessitate multiple years of formalized Western medical study.

c. Institutions and Professional Structure

In neither the East nor the West is their one authoritative body on the field of acupuncture. In the East, knowledge resides in many individuals who have had no formal teaching, and simply pass knowledge down from one generation to the next - either through their sons or apprentices. Granted there are many schools of acupuncture throughout China, Japan, and Korea, no one deems itself as a central authority. Rather they all refer to the great classics for structure, particular the consolidation of all known acupuncture techniques by Li Shih-Chen during the Ming dynasty (Lewith).

In an attempt to professionalize themselves, acupuncturists throughout the United States have established training institutions. Twenty American universities, mainly along the coasts, offer masters degrees in acupuncture, but the “rigor of training at the many acupuncture or East Asian medical schools is difficult to assess” (Baer 97). However, with no national laws on acupuncture licensing, it is difficult to establish any central authority on the art. Rather, local laws and reputation determine the unofficial hierarchy of credited practitioners.

IV. History

Acupuncture has a clearly recorded history of about 2,000 years, but some authorities claim that it has been practiced in China for some 4,000 years. The Chinese believe that the practice of acupuncture began during the Stone Age when stone knives or sharp edged tools, described by the character “Bian,” were used in bloodletting to puncture and drain abscesses. In fact the Chinese character “Bian” means the use of a sharp edged stone to treat disease, and the modern Chinese character “Bi,” representing a disease of pain, is almost certainly derived from the use of “Bian stones” for the treatment of painful complaints (Lewith). Alternative theories have also surfaced. There has been speculation that acupuncture may have developed from observation of arrow wounds received in battle, but this seems intuitively unlikely since the trauma of the wound would probably obscure any incidental symptomatic relief of pre-existing symptoms. Another, more plausible, idea is that acupuncture may have developed from the practice of bloodletting, which was used in ancient China as well as in Europe. The method was more sophisticated than is generally realized; different sites were used for different symptoms and this may have provided a basis for discovering specific therapeutic effects of local needling (Kuriyama). Acupuncture may also have developed from tattooing, which existed in most ancient civilizations. It does not seem unlikely that it would on occasion have provided relief from pre-existing pain and that this would have led to its being specifically used for that purpose. Also, acupuncture needles found in ancient Chinese tombs could very well be needles used for tattooing. (Kuriyama). Most, if not all of this theorizing, is unverifiable, but still worth mentioning. There are no written records of the development of Chinese approaches to science and medicine until the Zhou, which is where a documented, accurate account of acupuncture’s systematic birth and growth begins.

During the middle Zhou (771-480 BC) leading Chinese thinkers, much like the Pre-Socratics, tried to eliminate God and the supernatural as immediate forces in the natural world. Chinese medicine, at this point, began to develop as a separate activity and occupy a “place distinct from religion in the social order” (Birch 8). The birth of Confucianism was in part responsible for such a transformation. Confucianism, the first of the three pillars of Chinese thought, made powerful claims for a connection between “responsible human behavior and desirable outcomes” (Birch 9). Confucianism’s call for social and ethical responsibility translated into a parallel movement in medicine - one that linked human health with human action, not the supernatural. Although the theory of acupuncture is not rooted in Confucianism, the medical art might never have been established without this link.

While the middle Zhou produced the social philosophy of Confucius, the later Zhou (480-221 BC) brought the birth of Taoism. Unlike most western systems which immediately replace older ideas upon the success of new ones, Chinese thought tends to accumulate ideas, retaining previous ones. This allowed both Confucianism and Taoism to flourish in unity, and the medical system, which was now developing as an institution, to borrow from both of them. Subsequently, the Qin dynasty (221-206 BC) put a temporary halt to medical advancements. The Qin was characterized by a incessant drive for power and wealth, focusing almost all resources towards economic prosperity (de Bary 191). Even though the Qin dynasty did little to further medicine during its rule, their empire inadvertently laid the groundwork for the inventiveness and prosperity of the following Han dynasty.

The Han dynasty (206-220 BC) took full advantage of the wealth accumulated throughout the Qin, and after peacefully loosening governmental control, society prospered on all levels (de Bary 228). Lowered taxes, governmental decentralization, and policy changes led to a flourishing society with great advancements in medicine and acupuncture. The great classics of Chinese medicine were all composed during the Han Dynasty. Specifically, we will focus on the Huang Di Nei Jing, which systemized the art of acupuncture. In combination, the two books of the Nei Jing synthesized the philosophical claims of acupuncture with Taoist support and mechanized the system’s practical aims. The Nei Jing offered identification of numerous qi conduits and acupoints. By the time of the Nan Jing - “The Classic of Difficult Issues” - two more channels had been identified and an estimated two hundred ninety-five of the current six hundred seventy acupoints were known. The channel or meridian system then became further elaborated, and the belief that harmonious circulation of qi was the basis for health now dominated. The human body came to be identified as a relationship between functional units or organs, all of which were essentially constructed of qi (Fishman). Qi was acknowledged as the most basic unit of life and the human organism, and monitoring its flow was of the utmost importance to the physician. By the end of the Han dynasty, the essentials of diagnosis and treatment had been laid forth, and the system of Chinese acupuncture had reached maturity.

From this point forward, with its theoretical and practical canons in place, acupuncture as a system continued to develop and gain popularity. In 282 AD the Zhen Jiu Jia Yi Jing - “The Systematic Classic of Acupuncture and Moxibustion” - continued the early progressions of the new healing art throughout China. The Jia Yi Jing reported only twenty less acupoints than have been currently discovered. The text also emphasized acupuncture’s usefulness in disease prevention, and listed multiple different treatments for a variety of illnesses. The ideas set forth at this point are for the most part congruent to those in place through modern times. Throughout the subsequent dynasties and centuries, acupuncture remained stable as a practiced medicinal art, rarely declining and constantly, slowly developing further, assimilating Buddhist ideas into the system. The only threat to acupuncture, besides modern Western medicine, worth noting came during the Ming dynasty (1368-1643 AD). Education and information became available to the masses unlike any times prior, creating an expanding intellectual community and diversity in thought. It was at this point that acupuncture slightly declined due mainly to its criticism of other systems. Acupuncture rebounded, however, with the construction of the Zhen Jiu Da Cheng and Ben Cao Gang Mu. These texts are “strong representatives of classical clinical acupuncture,” that were not just individual treatises, but the consensus of an entire acupuncture community reasserting its dominance (Birch 33).

Meanwhile, Japan and Korea increasingly acknowledged acupuncture. In 702 AD, the first Imperial medical college was founded in Nara, Japan, where studies focused mainly on the classical texts. Korea followed Japan’s lead and established multiple schools; in both countries, acupuncture schools became widely accepted and remain today.

As the twentieth century began, the practice of acupuncture declined rapidly, barely able to cope with the influx of Western culture. After the disastrous blows of opium abuse and extreme famine in the final stages of the Qing dynasty, the new Chinese republic looked to follow more prosperous nations for modernized success (Fishman). In the medical realm, that meant demanding all Chinese health students and practitioners to meet western standards. However, not everyone was favored the elimination of traditional medicine. The Zhong yi - “Chinese medicine” - movement formed by a group of traditional healers attempted to resist the encroachment of xi yi or “Western medicine.” Though unsuccessful at the time, this group insured a basic foundation for the resurgence of traditional medicine following World War II. China faced an almost impossible task of providing health care for its population. There was no other choice; with forty thousand western doctors and five hundred thousand traditional practitioners, China had to promote acupuncture and other traditional medicine (Fishman). General successes in acupuncture at this time established the beginnings for future success. Taking notice of the accomplishments in Asia, Western physicians began researching the ancient healing art. Even though Western science and traditional Chinese medicine cannot synthesize a view on why acupuncture works, both societies have deemed it effective.

Currently, Acupuncture enjoys its greatest popularity to date even though it has been a relatively recent development. This has only been a brief overview of the system of acupuncture, but I hope that I have made it clear that this system is based on classical religious theory and has had a complex history. After experiencing centuries of gradual success, acupuncture fought its way through misunderstanding and criticism in the twentieth century to earn its current recognition. As a system, acupuncture continues to battle legislation and public opinion in hopes for universal acceptance and practice. Its future is uncertain, but advocates are optimistic, claming that modern acupuncture “offers a comprehensive, integrated and well tested theory: its application, which is inexpensive, non-invasive, safe and effective, is surely a key form of treatment for the future” (Firebrace 143).

V. Representative Examples of Argumentation

Throughout the history of acupuncture in China, the system gradually grew more popular and was accepted as successful. Its efficacy was never really a concern, but questions regarding its mechanisms were raised and answered. Outlined first in the Huang Di Nei Jing, borrowing general ideas from the philosophy of the Tao, Chinese acupuncturists presented an unverifiable, but legitimate argument explaining acupuncture’s efficacy. As I mentioned before, the Taoist health ideal rests in harmony between all of the forces of the earth, specifically, the yin, yang, and qi. According to Taoist theories, life takes place in alternating patterns of yin and yang, but no period of yin exists without some yang, and likewise no period of yang exists without a trace of yin (Little 131). Qi, the invisible energy force in the human body, circulates harmoniously in a healthy individual throughout channels, or meridians in the human body. These meridians are not physical, and have no relation to the human circulatory or nervous systems. When the flow of qi throughout the meridians is blocked or imbalanced, the yin and yang suffer similarly and illness results (Little 127). Over multiple years and after countless personal observations, acupuncture developed a core of empirical laws including numerous ways to manipulate needles as a healing therapy. The fact is that the application of these laws works in a highly significant proportion of people. Therefore, it would be fair to say that if it did not work, acupuncture would not have been adopted within both Western and Eastern cultures to such a degree.

The West, on the other hand, defends the validity of acupuncture in a very different manner. Before western culture could defend or argue in favor of the system of acupuncture, it had to run multiple studies to see for itself that acupuncture really was successful. In November of 1997, the National Institute of Health, after “funding numerous research projects on acupuncture, including clinical trials and other studies,” issued a consensus statement on acupuncture in general (Fontanarosa 453). The NIH concluded that “while there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in post-operative dental pain” (Fontanarosa 453). Also, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofacial pain, osteoarthritis, low back pain, carpal tunnel syndrome, asthma, and other disorders may call for acupuncture in addition to or as an alternative to Western medicine. Only after conclusive results could Western physicians attempt to explore the reason why acupuncture is successful.

Western medicine has hypothesized five possible ways, which may work alone or in accordance with the others, in which acupuncture work:

“- The augmentation of immunity, which raises the level of triglycerides, prostaglandins, white blood cells, y-globulins, and antibody levels.

- The endorphin theory, by stimulation of enkephalin in the body.

- As a neurotransmitter, in which certain neurotransmitter levels (serotonin and noradrenaline) are affected.

- As circulatory theory, with the effect of constricting or dilating blood vessels through the release of histamines.

- As gate-control theory, in which the perception of pain is controlled by a part of the nervous system that regulates the impulse, which will later be interpreted as pain. This part of the nervous system is called the gate. If the gate is hit with too many impulses, it is overwhelmed and this closes. This prevents some soft impulses from getting through. The first gates closing are the smallest. The nerve fibers that carry the impulses of pain are rather small nerve fibers called C fibers. These are the gates that close during acupuncture (Fontanarosa 128-129).”

VI. Suggested Position in Comparative Scales

A. Relative emphasis on traditional authority(0) ----- or the testimony of experience(10)

7.Compared to most systems of medicine, acupuncture has roots based far more in experience than authority. The development of the practice preceded the religious authority that supported it. However, since acupuncture was supported by fundamental Taoist assumptions, I could not rate it as being entirely based on experience.

B. Relative centralization of authority(0) ----- or decentralization (individual inquiry, lay teaching)(10)

8.The trouble with this scale is that the practice of acupuncture varies greatly in Asia and the west. Unlike China where many traditional acupuncturists taught themselves, or learned though apprenticeship, the Western standards have somewhat mechanized the study of acupuncture. Acupuncture needles are now reviewed by the US Food and Drug Administration, admitting the system of acupuncture into the realm of biomedicine (Fontanarosa 453). Even though acupuncture has taken its first step towards synthesis with Western authority, the system as a whole has a long way to go before it can be considered centralized.

C. Relative emphasis on invisible (spiritual or heavenly) realities(0) ----- or material, earthly ones(10)

4.Unlike most medical systems, which emphasize empirical and material support, acupuncture is backed by Taoist explanations involving qi. Even though popularity in the West is due to successful scientific studies, no western explanations of efficiency leave Taoist claims as still viable possibilities. Therefore, acupuncture as a system is primarily based on faith of the existence of invisible qi, and has little earthly support.

D. Mainly spiritual or moral objectives(0) ----- or pragmatic aims (prediction, healing, etc.)(10)

9.Even though acupuncture can be explained in spiritual terms, it existed before Confucianism and Taoism, and has no religious objectives. Like most medical systems, acupuncture’s goal is to better human health, and almost purely pragmatic.

E. Most power or agency reserved for a divine being(0) ----- or realizable in individuals(10)

9.Acupuncture is practiced both in the west and in Asia without formal religious training or faith in all Taoist beliefs. No divine being is behind acupuncture’s proven success, but there is still some mystery as to why it works – which forces me to leave some room for the possibility of a divine agency.

Annotated Bibliography

Primary Sources:

American Academy of Medical Acupuncture - 2003. <<http://www.medicalacupuncture.org/acu_info/index.html>>

This site, created by the American Academy of Medical Acupuncture, offers answers to frequently asked questions, basic history and background information, as well as sample case studies. In addition, it has some useless commercial applications that help patients find local acupuncturists and discuss local news and events.

Birch, Stephen J., and Robert L. Felt. Understanding Acupuncture. Paradigm

Publications: Brookline, Massachusetts,. 1999.

This text concentrates on the historical and scientific roots of acupuncture. It examines ancient and modern history, theory, clinical efficacy, patient/practitioner relations, and the current economic status of the system.

Baer, Hans A. Biomedicine and Alternative Healing Systems In America.

University of Wisconsin Press: Madison, Wisconsin, 2001.

This text follows developments in Western medicine from the 19th century to the present - both bio medicine and alternative. The only sections I read through applied to the emerging professionalization of acupuncture, licensing, and registration.

Firebrace, Peter. Acupuncture: Restoring the Body's Natural Healing Energy. Harmony

Books: New York, New York, 1988.

This work follows many of the developments of acupuncture throughout the progression of the system. In addition it discusses the theory and efficacy of the system itself.

Fontanarosa, Anthony J. Alternative Medicine: An Objective Assessment. American

Medical Association: 2000.

Fontanarosa’s work provides results of original research studies and scholarly articles that present new scientific information and critical perspectives on a variety of alternative medicines. Sections devoted to the theory behind acupuncture and studies by the NIH were most useful to me and my topic.

Lewith, George T. “The History of Acupuncture in China.” (excerpted from:

Acupuncture - Its Place in Western Science) 2003.

<<http://www.healthy.net/asp/templates/article.asp?id=1819>>

This excerpted text not only discusses both ancient and modern history of Chinese and Western acupuncture, but also looks at theory, training, texts, and a variety of other worthy topics.

Shudo, Denmei. Introduction to Meridian Therapy: Japanese Classical Acupuncture.

Eastland Press: Seattle, Washington, 1990.

This text was basically a manual for acupuncture practice with some fundamental theory and case studies spliced sporadically throughout.

Secondary Sources:

de Barry, Theodore, William and Irene Bloom. Sources of Chinese Tradition: From

Earliest times to 1600: Second Edition. Colombia University Press: New York,

New York, 1999.

This work is a self proclaimed comprehensive and authoritative sourcebook of Chinese civilization. It traces the lives of numerous Chinese thinkers and dynasties, constantly referring to and analyzing primary texts.

Fishman, Jon. “The History of Acupuncture.” 17 December 2000.

<<http://www.acupuncture.com/library.htm>>

This site provides the reader with a detailed history of Chinese civilization in relation to acupuncture. Fishman outlines Chinese history both before and after the advent of the healing art, and traces its evolution. Other works on this site offer Western theories if explanation, descriptions of modern acupuncture, and numerous research studies.

Kuriyama, S. The expressiveness of the body and the divergence of Greek and Chinese

Medicine. Zone Books: New York, New York, 1999.

This text examines the contrasts between the human body as described in classical Greek culture and the one envisioned by the ancient Chinese. It specifically looks for answers in topics like the history of knowledge acquisition and the evolution of blood-letting.

Little, Stephen. Taoism and the Arts of China. The Art Institute of Chicago: Chicago,

Illinois, 2000.

This extensive work traces the philosophy of Taoism in detail from its origins to more modern times. The text also features some more specific sections of arts, architecture, song, and other aspects of Chinese Taoist culture. For my purposes, the most useful sections were those that discussed the philosophy of the Yin and the Yang, and the role of the acupuncturist in correcting the flow of qi.