History of Acupuncture

There is no known event or individual known for originating the theory and practice of acupuncture. Around 600-100 BC a systematic treatment method of piercing the skin at certain points and refering to a developed theory first appears in medical texts.

Ancient Textbooks
Probably the oldest mentions of the use of stone needles occur in the Shan Hai Ching- Classic of the Mounts and Rivers composed around the -5th century BC.
The text book "Huang Ti Nei Ching, Su Wen"- written in the 2nd century BC has a great deal to say about acupuncture, and the "Huang Ti Nei Ching, Ling Shu" of the 1st century BC comprehensively discusses acupuncture.

Physical evidence for the beginning of acupuncture
Sharpened stone flints and bones have been found in tombs, however these could have been be used for varous purposes such as lancing boils, or other non-medical purposes such as sewing.

Gold and Silver Needles
Evidence of acupuncture instruments has been found in early tombs in the neolithic age (-10200-2000 BCE). Sharpened stones and bones seem to have been used first, however any perishable needles made of thorns or bamboo probably wouldn't survive to the present day.
Early Sharpened stones and bones found in Chinese tombs and excavations appear to be the first physical evidence of acupuncture instruments, not only of the neolithic age, but also from Warring States burials, as at Erh li Kang near Cheng Chow.
They were unearthed from the grave of Prince Liu Sheng of the Western Han dynasty (206B.C.~A.D. 24) in Mancheng, Hebei province in 1968 and are on display in the Hebei Province Museum. Four needles were made of gold and another 6 needles were made of silver in round shape. The gold needles are in perfect form, but the silver needles are damaged. Their length is from 6.5 cm~6.9 cm with a diameter of 0.12~0.18cm. They are bigger than the needles now we are using. They have a square handle and there is a hole in the 1/3 middle of the body. With textual research, they are similar to the needles described in the Ling Shu ·Jiu Zhen Shi Er Yuan (Spiritual Pivot, Nine Needles and Twelve Sources). These needles appear to be the early acupuncture needles, now kept in the Chinese National Museum- Beijing.

Gold needles ,unearthed from the grave of Prince Liu Sheng of the Western Han Dynasty, (206 B.C-A.D. 24) in Macheng, Hebei province in 1968, kept in the Hebei Province Museum

A total of 4 gold needles and 6 silver needles were unearthed. The length of the gold needles ranges from 6.5 to 6.9 centimeters. The handles of the gold needles are broken and in rectangular shape with small round holes and the shapes of needle tips vary. The silver needles are badly damaged and their original looks can't be established. One of the silver needles is damaged in the upper part, but its lower part is intact and thicker than a gold one. According to research, these needles can be confirmed as early forms of needles for the exclusive use in acupuncture.

The first evidence of acupuncture being practiced are sharpened stones and bones that were placed in Acupuncture is generally considered to have originated in China, with the most ancient evidence being sharpened stones and bones that date from about 6000 BCE.
have been interpreted as instruments for acupuncture treatment [2, 3], but they may simply have been used as surgical instruments for drawing blood or lancing abscesses [3]. Documents discovered in the Ma-Wang-Dui tomb in China, which was sealed in 198 BCE, contain no reference to acupuncture as such [3], but do refer to a system of meridians, albeit very different from the model that was accepted later [4]. Speculation surrounds the tattoo marks seen on the ‘Ice Man’ who died in about 3300 BCE and whose body was revealed when an Alpine glacier melted [5]. These tattoos might indicate that a form of stimulatory treatment similar to acupuncture developed quite independently of China.

The first document that unequivocally described an organized system of diagnosis and treatment which is recognized as acupuncture is The Yellow Emperor’s Classic of Internal Medicine, dating from about 100 BCE. The information is presented in the form of questions by the Emperor and learned replies from his minister, Chhi-Po [6]. The text is likely to be a compilation of traditions handed down over centuries [7], presented in terms of the prevailing Taoist philosophy, and is still cited in support of particular therapeutic techniques [8]. The concepts of channels (meridians or conduits [3]) in which the Qi (vital energy or life force) flowed are well established by this time, though the precise anatomical locations of acupuncture points developed later [9].

Acupuncture continued to be developed and codified in texts over the subsequent centuries and gradually became one of the standard therapies used in China, alongside herbs, massage, diet and moxibustion (heat) [2]. Many different esoteric theories of diagnosis and treatment emerged, sometimes even contradictory [3], possibly as competing schools attempted to establish their exclusiveness and influence. Bronze statues from the fifteenth century show the acupuncture points in use today, and were used for teaching and examination purposes (Fig. 1) [2]. During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. In it are clear descriptions of the full set of 365 points that represent openings to the channels through which needles could be inserted to modify the flow of Qi energy [7]. It should be noted that knowledge of health and disease in China developed purely from observation of living subjects because dissection was forbidden and the subject of anatomy did not exist.

FIG. 1.
This bronze figure showing acupuncture points is a reproduction of one cast in AD 1443. (Reproduced from An outline of chinese acupuncture published by Foreign Languages Press, Peking 1975.)

Interest in acupuncture among the Chinese declined from the seventeenth century onwards as it came to be regarded as superstitious and irrational [2, 6]. It was excluded from the Imperial Medical Institute by decree of the Emperor in 1822. The knowledge and skill were retained, however, either as an interest among academics or in everyday use by rural healers. With China’s increasing acceptance of Western medicine at the start of the twentieth century, final ignominy for acupuncture arrived in 1929 when it was outlawed, along with other forms of traditional medicine [2]. After the installation of the Communist government in 1949, traditional forms of medicine including acupuncture were reinstated, possibly for nationalistic motives but also as the only practical means of providing even basic levels of health to the massive population. Chairman Mao is quoted as saying, in relation to traditional medicine, ‘Let a thousand flowers flourish’ although he himself rejected acupuncture treatment when he was ill [3]. The divergent strands of acupuncture theory and practice were brought together in a consensus known as traditional Chinese medicine (TCM) [8], which also included herbal medicine. Acupuncture research institutes were established in the 1950s throughout China and treatment became available in separate acupuncture departments within Western-style hospitals. Over the same period, a more scientific explanation of acupuncture was sought by Prof. Han in Beijing who undertook ground-breaking research on acupuncture’s release of neurotransmitters, particularly opioid peptides [10].

The spread of acupuncture to other countries occurred at various times and by different routes. In the sixth century, Korea and Japan assimilated Chinese acupuncture and herbs into their medical systems [6]. Both countries still retain these therapies, mostly in parallel with Western medicine. Acupuncture arrived in Vietnam when commercial routes opened up between the eighth and tenth centuries. In the West, France adopted acupuncture rather sooner than other countries [7]. Jesuit missionaries first brought back reports of acupuncture in the sixteenth century, and the practice was embraced by French clinicians fairly widely. Berlioz, father of the composer, ran clinical trials on acupuncture and wrote a text in 1816 [11]. French acupuncture today has been deeply influenced by a diplomat, Souliet du Morant, who spent many years in China and published a number of treatises about acupuncture from 1939 onwards.

The first medical description of acupuncture by a European physician was by Ten Rhijne, in about 1680, who worked for the East India Company and witnessed acupuncture practice in Japan [6, 11]. Then, in the first half of the nineteenth century, there was a flurry of interest in both America and Britain, and a number of publications appeared in the scientific literature including a Lancet editorial article entitled ‘Acupuncturation’ [12]. By mid-century, acupuncture had fallen into disrepute and interest lay dormant, though it was briefly resurrected in one edition of Osler’s textbook in which he describes dramatic success in the treatment of back pain with hat-pins [13]. Interestingly, this comment was deleted from subsequent issues [14].

In 1971, a member of the US press corps was given acupuncture during recovery from an emergency appendectomy in China, which he was visiting in preparation for President Nixon’s visit. He described the experience in the New York Times [15] and subsequently teams of US physicians made fact-finding tours of China to assess acupuncture, particularly its use for surgical analgesia [16]. Despite initial excitement at the operations they witnessed, acupuncture proved to be utterly unreliable as an analgesic for surgery in the West. Acupuncture finally reached its present level of acceptability in the USA when an NIH consensus conference reported that there was positive evidence for its effectiveness, at least in a limited range of conditions [17].

The traditional theories of acupuncture have been challenged in the West, most notably by Mann in the UK [18] and Ulett in the USA [19]. Ancient concepts of Qi flowing in meridians have been displaced in the minds of many practitioners by a neurological model, based on evidence that acupuncture needles stimulate nerve endings and alter brain function, particularly the intrinsic pain inhibitory mechanisms [10]. The first magnetic resonance imaging study of acupuncture may also prove to be a landmark [20]. Other workers have noted the marked similarity between the trigger points of Travell [21] with their specific pain referral patterns, and the sites of traditional acupuncture points with their associated meridians [22]. There is a plethora of suggested mechanisms of action of acupuncture, but little valid data on which, if any, mechanisms are relevant to clinical practice. Evidence of clinical effectiveness is also still elusive for many conditions such as chronic pain [23], but in the last decade of the twentieth century systematic reviews have provided more reliable evidence of acupuncture’s value in treating nausea (from various causes), dental pain, back pain and headache [24].

History of Acupuncture and Moxibustion
Archaeological findings from a 3rd-century B.C. tomb near Mawangdui Village in Hunan Province provide convincing evidence that Chinese physicians had systematized clinical experience in both acupuncture and moxibustion more than 20 centuries ago. Exca­vated in 1973, this tomb revealed a series of medical works. Two of these entitled Zu Bi Shi Yi Mai Jiu Jing (Eleven Channels/or Moxibustion of the Arms and Feet) and Yin Yang Shi Yi Mai Yan Jing (Eleven Channels for Moxibustion in the Yin and Yang System) dis­course respectively on pain, spasm, numbness and swelling that may occur along the channels, mouth and sense-organ symptoms as well as symptoms of vexation, cold and drowiness, which are all amenable to treatment by moxibustion.

Later, in the 3rd century B.C., Nei Jing (Canon of Medicine) dealt in various ways with diseases curable by acupuncture and mox­ibustion and exemplified the application of these therapies to various visceral diseases, fevers, malaria and carbuncle. The Canon also offered detailed discourses on certain techniques in these treatments. Examples are: re-enforcing and reducing by manipulation, and puncturing the corresponding points on the left and right sides of the body alternately.

Among the physicians who specialized in acupuncture and moxibustion was Bian Que whose biography appears in Shi Ji (Records of the Historian). This doctor is said to have arrived in the state of Guo in what is now Baoji in Shaanxi Province at a time. when the crown prince of that state had just expired. Bian Que rushed with his apprentices to the royal palace, enquired concerning the prince's symptoms and pronounced his "death" reversible. The king was informed and lost no time in requesting Bian Que's help in saving his son. The physician examined and felt the pulse of the patient, enquired as to further symptoms and concluded that the prince was in a coma or a state of shock, and not dead at all. Acupuncture and moxibustion were included in the rescue, which resulted in the coming round and full recovery of the patient. News of Bian Que's remarkable "resurrecting of the dead" spread, the re­port indicating not only wide application of acupuncture and moxi­bustion between the 5th and 3rd centuries B.C. but that the methods were considerably improved.

Two medical works, Huang Di Ming Tang Jing (The Yellow Emperor's Classic on Acupuncture and Moxibustion) written towards the end of the 3rd century B.C. and Zhen Jiu Jia Yi Jing (A Classic of Acupuncture and Moxibustion) compiled in the 3rd century A.D., gave more reliable and comprehensive information on the experi­ences gained .in treating patients by these therapies. These works provided more systematic clarification on selection of "points" in treating different diseases as well as the therapeutic properties of the points. Besides these books, on which the development of these therapies in succeeding centuries was based, there were a number of other important medical writings illustrated to show the points for acupuncture or moxibustion.

During the period from the 4th to the 10th century, works dealing with these therapeutic techniques grew not only in number but also in variety. These centuries also saw the publication of col­oured charts and diagrams for acupuncture and moxibustion, special books on moxibustion, and writings on the veterinary application of these techniques. Sun Simiao (581-682) and Wang Tao (702- 772) were celebrated physicians whose works Qian Jin Yao Fang (The Thousand Golden Formulae) and Wai Tai. Mi Yao (Medical Secrets Held by an Official) especially emphasized acupuncture and moxibustion. Sun drew three large-size coloured charts showing the anterior, posterior and lateral views of the body. The 12 channels were marked out in coloured lines, the eight extra channels in green. Wang Tao's charts numbered 12, the lines representing the regular and extra channels also in different colours. At that time acupunc­ture and moxibustion were officially recognized as courses in the curriculum of the imperial medical college, while Canon of Medicine and The Yellow Emperor's Classic on Acupuncture and Moxibustion were among the textbooks selected. Such titles as master, assistant master, lecturer, technician and apprentice of acupuncture were accorded physicians of the Imperial Medical Bureau.

An even greater number of writings on acupuncture and moxi­bustion were published from the 7th century to modern times. Best known among these are Tong Ren Yu Xue Zhen Jiu Tu Jing (Illustrated Manual on the Points for Acupuncture and Moxibustion on the Bronze Figure) compiled under the supervision of the imperial physician Wang Weiyi of the 11th century, and Zhen Jiu Da Cheng (Compendium of Acupuncture and Moxibustion) by Yang Jizhou of the 16th century.

When Wang Weiyi was preparing his Illustrated Manual in 1027 he headed a group that cast two bronze figures inscribed with the acupuncture channels and points. Besides serving as teaching materials, the figures were used in examinations given to students of acupuncture. The examinee was asked to puncture the figure, which was filled with mercury, coated over with wax, and clothed. The accuracy of the student’s puncturing was easily determined by whether or not the mercury leaked.

Such bronze figures proliferated, some cast by imperial hospitals, others by civilian doctors or apothecaries. Many of these valuable figures were destroyed in wars, while some were seized by imperialist powers in their aggressive military campaigns against China. The one cast by the Imperial Hospital towards the middle of the 15th century was among looted items taken out of the country by the Russian army that invaded China in 1900 along with seven other imperialist powers. This invaluable bronze figure is still being held by the Leningrad Museum in the USSR.

Improvements in the materials and technique used in acupunc­ture and moxibustion over the centuries include red-hot needling, warm needling and plum-blossom needling. Moxibustion was enriched and refined by applying heat from burning cones of drug or rush and the use of "moxa rolls".

The Theory of Channels and Collaterals
The effectiveness of acupuncture and moxibustion in treating a wide range of diseases depends among other factors on the nature and intensity of the stimulation produced by puncturing or applying heat. It also depends on the point selected, and the organism's power to transmit the stimulation resulting from the acupuncture or moxibustion. The distinctly Chinese traditional theory of channels and collaterals elucidates this. Long experience in treating disease lies behind and substantiates the theory.

Named in the 3rd-century B.C. medical books found in the tomb near Mawangdui Village are the "tooth channel", "ear channel" and "shoulder channel", all taken from the main transmission route of the stimulation produced by acupuncture or moxibustion at a certain point on one of the channels. This nomenclature was the forerunner of the theory of channels and collaterals. The authors of such ancient medical works as Eleven Channels for Moxibustion of the Arms and Feet pioneered in dealing systematically with the channels and numbering them as 11. They went further to rename and classify the channels, basing themselves on the theory of the upper and lower extremities of the body and also the theory of yin and yang.

Canon of Medicine carried these researches to a new level by establishing the number of channels as 12. It also modified the discourses on the specific route of each channel and its diagnostic and therapeutic significance. The Canon thus laid down the scientific principles of acupuncture and moxibustion by developing the theory of channels and collaterals.

The main features of the theory of channels and collaterals are the view that these routes exist over the entire human body, and their function as transmitters of vital energy and coordinators of the different parts of the body. The whole network of channels and collaterals reaching every part of the body extend deep .into the visceral organs. There is circulation along these routes. Channels are the trunks, while the collaterals and the sub-collaterals are their branches and sub-branches. Besides this system of 12 channels there are eight extra channels.

Physicians named the acupuncture points over the body on the basis of the theory of channels and collaterals. The authors of Canon of Medicine located all these points as along the channels. A Classic of Acupuncture and Moxibustion set the total of these points at 654.

Chinese physicians of later generations steadily clarified the thera­peutic value of each point and the relationship between points and the visceral organs. Improvement continued in therapeutic effec­tiveness of acupuncture and moxibustion with the identification of additional points.

The Spread of Acupuncture and Moxibustion from China
Playing an important role in the advance of Chinese medical science, acupuncture and moxibustion have also served to promote medical and health work world-wide.

China's friendly trade relations and cultural exchanges with Korea, Japan and the southeastern and central Asian countries date from the 3rd century B.C. Chinese medical science, essentially acu­puncture and moxibustion, were introduced into those countries at that time and won recognition by both rulers and people. The Chi­nese doctor Yang Er went to Japan as a professor of medicine in A.D. 513, while Zhi Cong took medical writings and acupuncture and moxibustion diagrams to Japan when he went as a doctor in 550. In 552 the Emperor Wen Di of the Liang Dynasty presented Zhen Jing (Canon of Acupuncture) to the Japanese court. This was followed by visits to China by Japanese students of medical science including acupuncture and moxibustion. The Taiho Code promulgated by the Imperial Government of Japan in 701 stipulated that medical institutes include compulsory courses based on The Yellow Emperor’s Classic on Acupuncture and Moxibustion and A Classic of Acupunc­ture and Moxibustion. Measures were appended to ensure enforce­ment of this stipulation. There thus grew up in Japan a circle of Japanese physicians and writers specializing in these methods, and institutes of acupuncture and moxibustion were founded.

In what is now Korea the ancient kingdoms of Silla, Paekehe and Koguryo adopted a civil examination system comparable to China’s between the 7th and 10th centuries, making Canon of Acu­puncture, The Yellow Emperor’s Classic on Acupuncture and Moxi­bustion and A Classic of Acupuncture and Moxibustion compulsory reading for medical students,

The development of navigation after the 10th century favoured China's trade and other exchanges with Africa and Europe. Acu­puncture and moxibustion were among the Chinese techniques taken to those parts of the world. English, French, German, Dutch and Austrian physicians took up these techniques in their clinical practice and research. Textbooks on these branches of medical science were translated from Chinese into a number of other languages.