About the authors
Understanding Acupuncture
Preface
This is an acupuncture textbook. That
may seem an odd claim for a book that offers history, research, and science
but no needling instructions. Yet, acupuncture, like many familiar Western
arts and sciences, is intellectually hierarchal. Learning acupuncture has
never been solely a matter of learning technical details. History shows
that some acupuncturists have always been technicians trained only to follow
the established procedures of a family tradition, teacher, or school. Others
have been medical artists whose refined sensory and physical skills were
honed by a social, moral, or religious philosophy. Some have been eminent
teachers and innovators, who extended acupuncture through scholarship and
experimentation. Fewer have been of such rare brilliance that their inspirations
and realizations are the landmarks of acupuncture’s history and substance
of its practice.
In Asian societies the practise of
traditional acupuncture is not unlike many modern Western careers. For
example, some electricians are trained to follow instructions known as
‘codes.’ They know how to install electrical equipment that will pass commercial
and governmental inspections. But those code books contain no history,
no science, no references; none of the information by which to judge the
intellectual or scientific foundations of the devices they install. On
the other hand, the electrical engineers who design those devices learn
not only the historical development of the principles, but also the science
necessary to create new systems. They are guided not by codes but by qualitative
and quantitative standards, some of which derive from allied fields. They
are taught not to follow rules but to understand and apply measures and
standards. Those standards are developed by physicists who refine their
ideas by subjecting them to experimental trials. Following this extended
analogy, this is a textbook for those who must judge for themselves the
utility of information provided by academic, clinical, commercial, and
scientific sources.
When traders arrive on a foreign shore
they bargain for what most brightly shines of their own values. It is thus
reasonable that the idea of acupuncture that has reached the broadest Western
audiences reflects the values of those who first discovered it. Some information,
particularly that carried by scholarly and scientific vehicles, has received
little attention, not only because it is not always applicable to the acquisition
of clinical skill, but also because commercial sources are more quickly
and easily available. This too is expected, because acupuncture’s economic
application is the most powerful stimulus for its survival and transmission.
However, there is more.
Whether it is for students evaluating
a career in acupuncture, acupuncturists who must judge the services and
products they are offered, teachers who hope to develop better courses,
or the rapidly expanding corps of physicians whose patients need to know
if acupuncture can help, technical knowledge alone is not enough. Acupuncture
must be understood as a human intellectual pursuit in order to best choose
a course of study, to make referrals, to judge efficacy, or to advise a
complex health care system.
This is not a theoretical need. Because
more and more people associated with the practice or delivery of medicine
feel, along with a majority of their patients, that there is a useful role
for acupuncture in modern medical systems, acupuncture must now adapt not
only to the needs of new patient populations but also to the demands of
Western culture. This is nothing new. Acupuncture’s 2000 year history is
a story not only of gradual dissemination to virtually every country on
Earth, but also of adaptation to the needs of many different cultures in
many different eras. Thus we have concentrated on the presentation of principles.
By examining ideas common to most views and systems, we are best prepared
to understand and apply the technical details. However, if only because
there is no consensus among systems and cultures, we have considered many
views while preparing this book. We have taken a survey approach, reporting
facts, thoughts, and opinions gathered from experts and practitioners.
Among the things that are clear from
this survey is that, without understanding the broad outlines of Chinese
medical history, it is easy, and perhaps even inevitable to misunderstand
acupuncture. The themes and techniques of acupuncture begin in history
and can only be clearly understood in relation to the needs of those who
created them. A tradition can only be understood through its history. Indeed,
even the most basic technical features of acupuncture — needle selection,
insertion technique, and stimulation — vary with time, culture, and school
of thought. It is also true that acupuncture has been widely practiced
in many countries besides China, in some for more than a millennium. Without
recognizing the contribution of these societies, acupuncture’s story is
incomplete. It is also necessary to understand something about other traditional
medicines, for example, traditional pharmaceutics and massage, to understand
acupuncture’s place among China’s traditional medical arts.
Acupuncture’s breadth must also be
understood. Acupuncture is as broad as it is ancient. It includes techniques
beyond the use of needles. Historically, not only was there a selection
of needles, nine to be exact, but several of those needles were never used
to puncture. Acupuncture also was, and is, routinely used with moxibustion,
a heat therapy. Its therapeutic repertoire has also included a bloodletting
very different from that of medieval Europe, a suction stimulation now
called ‘cupping,’ massage and physical manipulation in several forms, as
well as disciplines like qi gong that apply movement arts to medicine.
Practitioners in different times and
different cultures have thought many different things when they used the
Chinese term that today we call ‘acupuncture’. It is still a word that
is difficult to define, precisely because it is sometimes used in a very
narrow sense, and sometimes more broadly, with meanings that include many
commonly (but not universally) associated techniques. In this book we use
the term ‘acupuncture’ in its narrow sense; that is, as the therapeutic
use of needles by those specifically trained to do so. We describe moxibustion
as a separate tradition.
Today, acupuncturists use a range of
tools and techniques, from disposable needles to electric stimulators and
lasers. Each defines what they do as acupuncture. Speaking precisely, however,
zhen
in
Chinese refers to the use of needles. Although individual practitioners
have combined needling with other techniques, there has never been any
absolute link between one treatment method and another. Although the time
required to master the skills has tended to keep clinician’s practices
fairly narrow, the choice to combine different therapies has always been
a mix of personal preference, the training available, social needs, and
economic advantages.
In sum, there is no quick and easy
description of acupuncture; there is no one and only answer we can ask
you to believe at the expense of all others. There is no one and only explanatory
analogy that diminishes all others. There is no unique access to clinical
success. There is only a fascinating story of human genius applied to the
universal human quest for a long, happy, and healthy life.
It is hard to tell that story without
superlative, even mythic terms. Words such as ‘ancient’ and ‘cosmological’
are so often mixed with a space-age vocabulary of ‘energetics,’ that acupuncture
has acquired the reputation of something fantastic. It often sounds as
if writers were claiming to have found a fully functional electrical stimulator
among the wood ash and flint tools of an ancient cave. However, acupuncture’s
roots are not fantastic but indistinct. It begins in mythology and archeology,
reaches the domains of philology, anthropology, and history as early as
the –3rd century, and arrives in modern times entwined with sufficient
complexity to challenge linguistics, biology, psychology, political science,
economics, and sociology. In fact, making any statement about any of Asia’s
indigenous medicines requires the knowledge of experts in several arts
and sciences.
Yet, even for experts the facts are
elusive. China has not only burned books but has re-written them almost
routinely. Thus scholars must search for unknown authors’ meanings in texts
that have been re-edited, re-written, re-attributed, re-interpreted, and
censored. As the wisdom of one age lost favor, tradition and history, logic
and philosophy, and science and medicine were rewritten. Neither were Asian
cultures pure or isolated. Over caravan trails and through oft-told tales,
shared myths, Asian religions and cultural institutions have migrated among
populations for nearly three millennia. Thus their cultures reflect one
another, often as imperfect mirrors distorted by longevous memories of
invasions, wars, and ethnic hatreds.
Neither is reporting on acupuncture
in the modern era free of problems. In China nothing escaped the turmoil
of the 20th century. Even the so-called objective sciences suffered in
China’s political upheavals. For example, China’s once considerable progress
in genetics was surrendered to a politically correct but fallacious Soviet
theory. Then, during a devastating cultural revolution, peasants became
laboratory directors and senior scientists were sent to distant villages
for ‘rural re-education,’ a euphemism for social isolation and psychological,
and even physical, torture. Purges, plagues, and the starvation brought
about by vastly mismanaged resources may have killed as many as 20 million
Chinese in the post-liberation (1949) period. During this time, elements
of acupuncture changed dramatically, as it was conscripted to serve not
only China’s vast health-care needs but also its political imperatives.
Within the lives of China’s current
political leaders acupuncture has been described as a vile feudal superstition
that should be entirely purged from communist society. It has been seen
as a primitive, pre-Marxist dialectic and as a treasury of techniques that
might be useful if integrated with modern medicine. Then, as acupuncture
and Chinese traditional pharmacotherapies were enfused with modern medicine
to produce the synthesis known as Traditional Chinese Medicine (TCM), acupuncture
became a secondary component of the now-proposed ‘World Medicine,’ a policy-derived
goal where traditional and modern practices are to be integrated and imparted
to other nations. However, the theoretical co-equality of integrated medicine
has been comfortable for neither biomedical nor traditional practitioners,
and preserving the integrity of traditional medicine against the encroachment
of its Western rival continues to be a strong impetus for its adaptation
and development.
Today, TCM is officially one of three
theoretically co-equal branches of medicine in the People’s Republic of
China. In this policy, known as ‘The Three Roads,’ traditional practices
such as acupuncture, herbal medicine, qi gong, and the martial arts are
permitted to seek their own ground in a competitive coalition with biomedicine
and the TCM supported by the state. In fact, China’s struggle to bring
its native medicine into harmony with modern biomedicine has been a consistent
theme throughout the 20th century. In the face of truly vast public-health
problems, innovations such as the barefoot doctors, and massive people’s
campaigns against epidemic disease, have made the integration of traditional
techniques with Western science a matter of acute attention in the West.
While once highly visible techniques such as so-called ‘acupuncture anesthesia’
are now known as less worthwhile than when first brought to Western attention,
and the budgets for their development have become accordingly less generous,
the integration of traditional techniques into the Western medical infrastructure
continues to fascinate writers.
In fact, this is so much the case that
some of acupuncture’s outstanding accomplishments in China and the rest
of East Asia have received almost no attention. In an era when managed
care is the central focus of Western medical economics, China’s experience
using traditional medicine in a vast, cost-driven public health-care system
is of considerable potential value to the West. Although Japan, Korea,
and Taiwan are less often investigated than is China, acupuncture nonetheless
plays a role in the modern managed medical institutions in these countries.
Although acupuncture has earned a stable and not insignificant role, often
in regard to conditions for which Western patients seek acupuncture treatment,
this has gone nearly unnoticed in the West. Today, for example, the courses
and tests used to qualify acupuncturists in the USA are mostly drawn from
TCM sources.
Although Western views of acupuncture
have been less politically driven than in China, they are nonetheless just
as strongly colored by cultural needs and desires. Some Western writers
see in China’s medicine an antidote to what they believe to be a dangerously
technological and impersonal medicine. Others see acupuncture as the product
of a golden age, believing not only that it was fully formed in antiquity,
but also that it suffers no deficit except a loss of purity. Quoting Chinese
texts that long ago discussed lost, ancient wisdom, these writers proffer
images of pure sages who lived long lives uncorrupted by pain or disease.
While righteousness and wellness are so inextricably linked in Chinese
thought that even bubonic plagues in the 20th century were attributed to
the misbehavior of the victims, such views better mirror our own culture’s
religious images of ‘before the fall’ than they reflect the evidence of
archaeology or history.
In Western thought a long-lived idea
is no more or less true than one just now conceived; if anything, we are
biased in favor of the new, of progress. However, perhaps stimulated by
our dimming infatuation with technology, age does give ideas a patina of
truth. Because acupuncture’s patina is amazing by any culture’s standards,
its longevity often lures Western authors into projecting modern ideas
backward into antiquity. This happens even to the most cautious and well
intentioned. When George Soulie de Morant, the father of acupuncture in
the West, arrived in China in 1901, Chinese archaeology and history were
still tightly bound by tradition. Thus he returned to the West with a story
that began in the –3rd millennium. Although he accurately represented his
sources, he delivered unlikely dates that have been quoted and re-quoted.
Even today, dates of –2800 or earlier are commonly ascribed to Chinese
books written in the first century.
Today, Chinese medical history is often
treated like a rich but unpleasant uncle whom we call when in need but
otherwise ignore. Although tradition, which can only be understood through
history, is often offered as proof of acupuncture’s clinical validity,
history plays almost no role in the education of Western acupuncturists.
Authors who link modern acupuncture technically to the ancient past are
so rarely challenged that there is a popular impression that peasants in
ancient China were treated exactly like patients in modern London or Beijing.
This image obliterates not only the actual social order of feudal China,
but also the adaptive genius of acupuncture. It also burdens modern acupuncture
with a reputation for religiosity. Because acupuncture is by any measure
ancient, and by anyone’s standard one of the most longevous products of
human genius, its history cannot be so profoundly abbreviated. It did not
rise fully grown like a Mediterranean Venus but rather earned its keep
in thousands of dusty marketplaces by continual change and adaptation —
an accomplishment that needs no fantastic antiquity to earn our conscientious
attention.
In China, age is still honored to a
greater degree than the West. Furthermore, Western ideas of scholarship
have never been universal. Even today Chinese writers are rarely edited
or conform to the scholarly conventions of the West. It has been common
for Chinese authors to ascribe their writings to some ancient writer, borrowing
credibility for their ideas. The Huang Di Nei Jing of –100 to –200 was
ascribed to Huang Di, the Yellow Emperor of –2800. The Nan Jing, written
near the first century, was ascribed to the famous clinician Bian Que of
the –5th century. This practice continues throughout the history of acupuncture
in China, indeed, into the 20th century. Thus historical accounts need
to be screened carefully in order to do justice to the story.
How to proceed
In avoiding the presentation of an
entirely personal or fanciful version of acupuncture, it is not only important
to follow the journalist’s regimen of ‘who, what, when, and where,’ but
also to describe what parts of the story we have chosen not to tell. The
subject is so large that its is easy to misrepresent. Therefore, we have
followed a set of principles we have taken from the consensus of experts.
In studying any subject as vast as
acupuncture, there is considerable room for disagreement. Sinologists have
already filled that room with competing ideas of Chinese intellectual history.
However, there are principles about which there is no significant disagreement,
and it is these that we have tried to honor. For example, sinologists agree
that acupuncture, like all Chinese traditional medicines, must be understood
in its cultural context. In addition, experts agree that Chinese traditional
medicine is not a smooth and invariant monolith, but an aged sculpture
of great complexity. Some features have been worn smooth and indistinct
by time, while others are being constantly re-sculpted. Thus, sinologists
understand that we must examine the specifics of acupuncture’s practice
in each particular era. And, for example, although scholars may disagree
about the precise extent of Confucian influence, there is no disagreement
that the major Asian religions must be studied. We have thus reported the
major cultural influences.
Sinologists also agree that the history
of acupuncture cannot be divorced from the history of Chinese culture.
If we are to understand acupuncture, we must also understand the social,
economic, and political activities of each era. Thus, in the historical
summary that begins this book we have reported the major intellectual,
social, political, and economic events that affected Chinese culture. Because
Chinese history is usually reported in eras named for a hereditary ruling
family, what are called ‘dynasties,’ our report is ordered chronologically
by the generally accepted modern dates for each. However, this is only
a useful way to write a chapter, not a truth. Acupuncture probably developed
in a far less orderly way, but too much of acupuncture’s development remains
unknown for even experts to make definitive statements.
Another area of broad agreement among
experts regards the heterogeneity of Chinese traditional medicine. Chinese
traditional medicine is roughly equivalent to Western medicine in the extent
of its written history. Its library includes more than ten-thousand texts,
by thousands of writers. It is a history with hundreds of critical events
and thousands of schools of thought and practice, many of which have never
been explored by Western clinicians or scholars. It is simplistic, but
not unfair, to summarize this complexity as if there were three general
categories of Chinese traditional medicine. The first is the uncapitalized
‘Chinese traditional medicine’ — the heterogeneous medicine of China’s
long recorded history. The second is the ‘traditional East Asian medicines’
(TEAM) that evolved as other Asian societies imported medical practices
and ideas from China. The third is the capitalized Traditional Chinese
Medicine (TCM). This is the synthesis of internal medicine and biomedicine
currently taught in Chinese medical schools to which modern Chinese acupuncture
has conformed. TCM is what is best known in the West. As such, we afford
it a greater emphasis than its relatively few years of existence would
allow in an academic history.
The newer TCM is, of course, a subset
of the others. All three categories are complexes of related ideas, some
of which have been dominant at times, dormant at others. Furthermore, these
ideas are linked, intertwined and inseparable to the point that undue concentration
on any aspect can de-emphasize much of what is important. In fact, the
subject is so vast that any concentration can be misleading. Fortunately,
the work of Professor Paul Unschuld has provided us with a central theme
with which to guide your tour of acupuncture past and present.
Through his study of the surviving
artifacts and primary documents — the foundation texts of Chinese medicine
and acupuncture — Professor Unschuld has described the logical process
by which information was gathered, processed, and used to arrive at medical
conclusions. This he termed the ‘medicine of systematic correspondence.’
This is what we have taken as an organizing theme. Its principal feature,
the recognition of observable patterns in nature as the basis for medical
categorization and decision-making, is not only the development we will
follow from the beginning of Chinese history into the future, but also
the essence of each aspect of acupuncture we explore.
The medicine of systematic correspondence
Although we will later describe the
medicine of systematic correspondence in greater detail, for now, begin
by thinking of it as the discovery that humans interact with their environment
in patterns that can be realized through observation using the trained
but naked human senses. Although China never developed the science of statistics,
the observation of pattern plays a role parallel to that of statistics
in the West. Both disciplines assume that repeatability substantiates ideas.
Pattern in Chinese traditional medicines describes the most probable outcome
of a particular set of clinical observations, just as statistics are used
to predict trends. Pattern is not absolute, just as statistics are not
absolute, both represent what is probable.
Although Chinese clinical researchers
still do not use statistical analysis to any great extent, the patterns
used in acupuncture were observed over very long times. Although the mathematical
safeguards of statistics allow many misperceived relationships to be discovered,
they also tend to limit research to problems that can be assessed by statisticians.
The so-called ‘test of time’ has allowed Chinese traditional medicine to
accrete scientifically untested assumptions, but it has also provided the
ability to recognize patterns that were unseen or untestable
in the West. For example, among the
patterns of acupuncture are conditions that, with the appropriate training
can be seen, felt, and even intuited.
This reliance on the naked senses and
human perceptions has had a profound influence on all of Chinese traditional
medicine but is critical to acupuncture, which is essentially a hands-on
skill. To understand this more intuitively, imagine that you have a time
machine fitted with language translators of the utmost sophistication.
Imagine that you are able to return to China in antiquity, find the finest
physicians, the greatest physician-scholars, chosen by whatever standards
you wish. Follow them through their days and you will certainly find that
theirs was a bedside medicine. Unlike the clinical orientation of today’s
acupuncturists, these ancients and their apprentices worked at their patients’
bedsides, providing acute care, and following the progression of disease
through patient observation. Although there were social reasons for the
development of a beside medicine, the critical point is that practitioners’
senses were their most important tools.
No matter how sophisticated your time
machine, whether you looked in the imperial palace or a peasant hut, you
would not find a thermometer or a blood-pressure cuff. Acupuncture would
be already ancient before these, the most basic measurement tools of biomedicine,
would arrive. Clinicians thought about the heat perceived at the body’s
surface (‘heat effusion‘) rather than the measure of the temperature within
(‘fever’). Thus, there is very little in acupuncture that was quantified
in the way of the West. In the medicine of systematic correspondence the
microcosm is not the world of measurable bacteria, viruses, genes or the
energies of subatomic process; it is the sensorial world of humanity, our
thoughts, our feelings, our bodily experiences, the sensations of our lives.
The universe was not the infinity our modern instruments describe — vast
galaxies separated by measured expanses of invisible, cold, dark matter
— but the subtle seasons of human life revealed by steady observation.
Not only were heaven, human, and earth closer than our modern view proposes,
they were intimately linked. Thus patterns in the medicine of systematic
correspondence are at times related to calendric cycles (natural phenomena),
but are always reported according to their sensory qualities. The same
is true of disease identifications. For example, what modern TCM physicians
routinely label ‘acute conjuctivitis,’ their traditional Chinese counterparts
called ‘wind fire eye,’ for its cause, sensation, and color. What we call
‘organs,’
Chinese doctors thought of as ‘depots
and palaces,’ images that reflected their view of order in life and society.
These naked sense observations and
trained perceptions can be seen forming into a coherent system in three
landmark documents: the Ma Wang-dui scripts of the late –3rd or
early –2nd second century, the Huang Di Nei Jing texts of the –1st
century,
and the Nan Jing of the 1st
century. These documents trace over approximately 400 years the development
of the major conceptual features of the medicine of systematic correspondence.
These features include the development of the qi concept, the functional
description of bodily process, and the theory of qi circulation on which
modern acupuncture depends — what we call the ‘qi paradigm.’
‘Qi’ and ‘paradigm’ are both powerful
words. Because qi is so often translated as ‘energy’ and paradigm is usually
thought of in its Khunian but not its linguistic sense, both words have
come to note a thinker’s place in a presumed East-versus-West, tradition-versus-science
conflict. This is sometimes explained as a shift of ‘paradigms.’ Thus,
for example, questioning the equation of qi to energy, or proposing that
acupuncture shares means and methods with biomedicine, is sometimes considered
a challenge to acupuncture itself. Some writers have even proposed that
modern medical thinkers and traditional theorists inhabit such different
paradigms that they cannot share methods of research, or even participate
in a productive medical pluralism.
This is a pessimism we do not share.
Traditional and conventional medicines share many ideas and observations.
Although qi is not a shared concept, the observations upon which it is
based are often familiar. When considered individually there are some traditional
ideas of qi that can be fairly described and researched as energy. There
are also traditional ideas of qi that are entirely lost when submerged
in this connotively powerful Western idea. Thus, to understand acupuncture
we must stand aside from positions in today’s debates and examine it on
its own terms.
Acupuncture is paradigmatic, not because
it conflicts with Western ideas, but because it is a set of concepts linked,
stored, and transmitted through the linguistic relations that reflect the
experience of Asian peoples. It is true that when traditional acupuncturists
labeled an individual’s state as a ‘lung yin vacuity’ they were not referencing
laboratory tests. However, they were logically using features of their
language to access the treatment knowledge it stored, in this case by following
the top-down logic of vacuity–yin–lung to determine acupoints known to
positively affect the signs they observed. Thus, although there are instances
where Western ideas of what can be true, and how truth must be tested,
do affect how proponents and skeptics think about acupuncture, particularly
in East Asia where the faith in Western science has had considerable cultural
impact, the paradigmatic characteristic with which this text is most concerned,
is acupuncture’s coherence with the cultural constructs from which it was
derived.
Thus using the term ‘qi paradigm’ is
a way to emphasize that acupuncture is more than any one of its aspects.
It is a reminder that the whole must be explored. This text is meant as
a beginning to that exploration.
Excerpt
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