Acupuncture II

Any discussion of acupuncture is incomplete without mentioning moxibustion (the Chinese ideagram is shown in red to the right). Moxibustion is the burning on the skin of the herb moxa. The Chinese character 'Chiu' is used to describe the art of moxibustion, and literally means 'to scar with a burning object'. Moxibustion does not now involve scarring, but moxa is still used to provide local heat over acupuncture points. It is made from the dried leaves of Artemisia vulgaris and the Chinese believe that the older the moxa, the better its therapeutic properties.

Moxibustion developed as a medical practice completely separate from acupuncture, although it is now very much a part of current acupuncture practice in China. It is used to treat specific types of disease and is applied over the same body points (acupuncture points) as acupuncture needles. Some of the acupuncture points, such as those around the eye, are forbidden to moxa. In ancient China, moxa was also burnt on specific acupuncture points to keep the body healthy, and was said to act as a prophylactic against disease. Most often, warmed cups are applied to the skin, and when they are cooled by the atmosphere, a vacuum results which sucks the skin and subdermal blood inward toward the cup.

Moxa can be used in a variety of other ways. Loose moxa is made into a cone and burnt on the skin, the cone then being removed when it is half burnt, to avoid blistering. It may also be burnt on ginger or garlic so that the skin is isolated from extreme heat, or a moxa stick (an acupuncture needle with smoldering moxa at its top; see the photo to the left) may be used and burnt a centimeter or two away from the skin.

Initial Therapeutic Success
The exceptionally productive period of the Warring States also gives us the first known and recorded therapeutic success of acupuncture The Historical Records by Ssu-ma Ch'ien tells how the physician Pien Cheuh used acupuncture to revive the Governor of the State of Kuo from a coma. In fact the name of the physician was Chin Yenh-jen, but by taking the legendary name of the famous Chinese physician, Pein Cheuh, we can assess his prestige. The Governor was treated by acupuncture and subsequently with herbal medicines. In ancient China, as today, an event like this is a powerful argument in favor of the acceptance of any form of treatment.

The Evolution of Acupuncture Points and Channels
Initially, there were no specific locations on the body for applying either moxa or acupuncture but gradually, through empirical experience, the use of specific points on the skin were shown to be of value in particular diseases. Acupuncture points are undoubtedly the end-product of millions of detailed observations and as they were developed so each of them was given a name and Chinese character, depending on its therapy properties.

Acupuncture points were subsequently grouped into a system of channels which run over the body, conducting the flow of vital energy through the body. The acupuncture points on a channel are said to influence the flow of vital energy through the channel, thereby influencing disease processes in the body. The first clear reference to the points and channels is in the Nei Ching Su Wen which defines the main channels and acupuncture points. The Nei Ching Su Wen also makes the observation 'in pain, puncture the tender spot', and the use of painful points probably represents the original method by which many of the acupuncture points were discovered. There is an instinctive urge to cause more pain over a painful area; the image of a person with toothache, pressing on the painful tooth, is a frequent cartoonists' joke. Common painful diseases consistently cause painful points to emerge in well defined anatomical locations over the body. When this point is stimulated the pain can be alleviated; hence the idea of a point for treating pain. From this simple beginning it is easy to see how a system of acupuncture points evolved. The evolution of the channels connecting these acupuncture points is more difficult to understand. These seem to have evolved from an intuitive understanding of the flow of vital energy through the body. It is unclear from where the idea of channels originated, but for the last 2,000 years they have formed an essential part of traditional Chinese medicine.

Acupuncture Texts and Teaching Methods
Another major text, the Classic of Acupuncture and Moxibustion, also made its appearance during the Warring States period. This was written by Huang Fu Mi in the third century BC Together with the Nei Ching Su Wen these two texts form the basis for the anatomical descriptions of the main channels, and some 349 acupuncture points on these channels. The Warring States period saw the coalescence of acupuncture, and indeed most of Chinese thought, in the mold in which it existed until the recent Communist revolution.

During the Sui dynasty (AD 561-618) the first medical college in China was founded. The Imperial Medical College was established to administer medical research and to train doctors. Acupuncture and moxibustion, as well as herbal medicine, formed the basis of the curriculum. According to the Old History of the Tang Dynasty the Imperial College had one professor of acupuncture, ten instructors, twenty needle craftsmen and twenty students. The main teaching texts were the Nei Ching Su Wen and the Classic of Acupuncture and Moxibustion. The bulk of the teaching and practice of traditional Chinese medicine, however, has never been based in formalized medical colleges, although these colleges have been in existence since the Sui dynasty. The medical arts have more often been handed down from father to son, or from master to apprentice. This type of medical apprenticeship has only recently died out, and in fact some of the older acupuncturists in China today have been trained in this way.

The Tang dynasty saw a great flowering of the art of acupuncture, and the Thousand Golden Remedies by Sun Szu-Miao was one of the products of this period. This text was the first to contain clear color charts of the channels with front, side and back views of the body; obviously a great boon to students and teachers of acupuncture. We are aware of the existence of these charts from the references made to them in a number of other texts, but unfortunately they have been lost.

Printing and Language
China developed the art of printing in the Sui and Tang dynasties, although it was not widely used during these periods as most books were copied by hand. Early Chinese printing is rather like a lino-cut, the characters being carved on stone and hand-made prints taken from each block. During the Sung dynasty (AD 960-1280), printing techniques were improved and used extensively. This gave a great boost to acupuncture as far more books became available. Many of the pre-Sun, books suffered from repetition and confusion, especially over the location of various points and channels. These books were copied by non-medical calligraphers and this led to a great deal of confusion over the exact meaning of some of the characters in the text.

Chinese characters can change their meaning completely with a slight change in the text, and therefore a transcription error can easily change the sense of the text. The ambiguity of Chinese characters still poses a great problem in the translation of classical Chinese; for instance the character 'Ni' can mean to disobey, or to be in accord with someone. Exact translations therefore require the translator to understand the sense of the text and translate in accordance with this. The advent of more efficient printing techniques led to a more exact and faithful copy of the author's work, and therefore a clearer interpretation of the meaning of the characters. It is interesting to note that in Chinese philosophy all things have their natural opposites inherently within them (there is Yin in Yang, and Yang in Yin), and this is also displayed in the language as each of the characters may have a diametrically opposite translation.

The 'New' Bronze Model for Teaching Acupuncture Points
Because of the confusion that had gone before him, Wei-yi collected and collated all the information that was available to him in the eleventh century. He redefined all the points and channels and compiled an authoritative text called Illustrated Manual on the Points for Acupuncture and Moxibustion on the New Bronze Model. This text dates from AD 1026 and details the use of 354 points on the body. A vast amount of information is given about the location of the points, the method of needle insertion into each point, and the clinical indications for the use of specific points. There are also illustrations in the text to assist teaching and to act as a method of swift reference for the acupuncturist.

The Chinese were so impressed by this book that a statue was erected with the whole text on it! Two huge stone tablets were carved, some two metros high and seven metros wide, containing all the characters in Wang Wei-yi's book. These tablets stood in the capital of the Sung dynasty, now the city of Kaifeng in Honan province, where they could be read directly, or used like a brass-rubbing to make a permanent copy of the book.

Wang Wei-yi also directed foundry men to create two life sized bronze models for acupuncture. These hollow models had on them the exact locations and names of the acupuncture points, and were used for teaching. Chou Mi, of the southern Sung dynasty, records in the Historical Anecdotes the way in which these models were used to examine students. The model was coated with wax and then filled with water, the student being given the name of an acupuncture point and a needle. If the point was punctured correctly the student was soaked as a fountain erupted from the model; failure to achieve this result meant that the acupuncture point had been missed.

In the Yuan dynasty (AD 1280-1368) the capital of China was moved to Tatu, now better known as Peking. The stone tablets and the bronze model were moved to the Imperial Medical College in Peking, but they were very worn and overused. Reproductions were therefore made in the mid-thirteenth century. Until fairly recently, the original model and tablets were thought to have been lost, but in 1971 five fragments of the original stone tablets were found in Peking, with much of the information still legible.


The Consolidation of Acupuncture Techniques
Acupuncture grew and developed over the next three hundred years; no new concepts evolved, but the old ones were refined. During the Ming dynasty (AD 1368-1644), Chinese society underwent the beginnings of an industrial revolution as paper mills, and textile and iron workshops began to emerge; Ming means 'bright' and this was undoubtedly a bright period of Chinese history. Acupuncture and related medical arts were encouraged, as were all the arts and crafts in China.

Li Shih-chen, one of the most outstanding physicians of this period, wrote and compiled the classical Chinese Materia Medica describing the pharmacology and botany of many indigenous herbs. He was also an expert acupuncturist and wrote a treatise on the Eight Extra Channels, describing their course and the indications for their use. Kao Wu collected the essential principles from many of the old acupuncture texts, editing the material into A Summary of the Writings on Acupuncture and Moxibustion. He soon found a great demand for this text and in 1537 he went further, compiling a similar but more detailed and complete text entitled Essential Readings in Acupuncture and Moxibustion. Some of the observations in Kao Wu's book give us a amusing insight into the mores and morals of Chinese society The Chinese seem very reluctant to allow a doctor to remove their clothing, and this habit is as widespread today as it was in the Ming dynasty. Kao Wu makes a point of disapproving strongly of the method of needling a patient through the clothing, but perhaps the fact that a patient can be diagnosed without removing clothing is one of the unsung benefits of Chinese pulse diagnosis!

Yang Chi-chou edited the Compendium of Acupuncture and Moxibustion during this period. Kao Wu's books were really short summaries for acupuncture students, but the Compendium was a complete collection of all the available material on this subject. It is copiously annotated and integrates the herbal remedies used with acupuncture and moxibustion. The Compendium was first published in 1601 and is still used as reference text. Many of the source materials for this book have subsequently disappeared and consequently the Compendium represents an invaluable reference for those interested in acupuncture.

The Arrival of the Europeans
During the Ming dynasty contact was established with Europe, the earliest date being 1504 when the Portuguese landed; Macao. At about the same period, China's fleets began to visit India, Persia and some of the Arab states. Cheng Ho led the first recorded fleet of merchant ships to India in 1405, but it is certain that other Chinese merchantmen had traveled far afield prior to this date. The overland 'silk route' to China had been open for many centuries and merchants had for some time traveled into China and central Asia, following in the footsteps of Marco Polo.

With the advent of renewed interest in China, and also the wish of various European nations to 'discover and colonize' the non-European world, the Portuguese began to establish trading settlements in mainland China. With the traders went priests to convert the 'heathen'. It was through these priests, and also various physicians who visited China, that the idea of acupuncture began to filter through to the west. The Jesuits were particularly active in collecting and disseminating this information in Europe, but the process was far from one-sided as the Jesuits also introduced Western science to China. Dominique Parrenin, a missionary, translated a textbook of anatomy into Mandarin but this was banned from general circulation by the Emperor K'ang Hsi as he recognized that many of the Western concepts contradicted those of traditional Chinese medicine.

[to Acupuncture III]