Traditional Chinese Medicine (TCM) as it exists today is the result of the Chinese peoples struggle against nature over several millennia’s. From earliest antiquity, experience of disease and how it affects the human being was built up and developed so that man could survive the most demanding aspects of nature. Acupuncture and Moxibustion are disciplines within the multiple systems that form TCM. They involve the study of meridians, acupoints, methods of manipulation, mechanisms of disease, clinical treatment and even anaesthesia.
The Origins of Acupuncture and Moxibustion
The creation myths of Chinese folklore refer mainly to how the gods bestowed knowledge on the ‘black haired people’ (the Chinese). The first three gods to take a central role in the Chinese belief system were referred to as the ‘Three August Ones’. Two of them helped in the development of TCM, Fu Xi was a god who was half human and half snake. He gave the Chinese people therapeutic techniques with stones and the Eight Trigrams, which form some of the basic principles underpinning much of the theory of TCM. Shen Nong possessed a purely human form and is acknowledged as endowing the knowledge of agriculture and herbal medicine.
After the ‘Three August Ones’ came ‘The Five August Rulers’. A combination of myth and history depict them as gods, demi-gods and humans, and meant to rule China before the Xia dynasty around 2697 – 2597 B.C. They were China’s first rulers and served to show how future emperors should behave and rule their people. Of them Huang Di, the Yellow Lord or Yellow Emperor, is regarded as the farther of acupuncture and moxibustion. Some ascribe the authorship of the Huang Di Nei Ching (the Yellow Emperor’s Classic of Internal Medicine) to him. However, it is much more likely that it was written in the Han dynasty around 4th – 5th century A.D.
We know that humans appeared in China as far back as 1.7 million year ago, with the oldest human remains, Lan Tian Man, dating back 650,000 – 800,000 years. With the discovery of fire these early people, of the Old Stone Age, found that the warming of local areas with hot stones, earth wrapped in bark or animal skins could relieve certain symptoms and diseases. This developed into the use of smouldering branches or dried grass administered to the skin to treat disease. It was later discovered, that the leaf of Chinese Mugwort (artrmisia vulagris) had the greatest curative properties and moxibustion was born.
It is also known that these ancestors were able to use stone tools to incise abscesses, drain pus and let blood for therapeutic purposes. These stone tools were know as bian shi (sharp stone). With accumulation of experience, refining of technique and improved stone manufacturing the bian shi were developed into a specialised medical tools by the time of the New Stone Age. Evidence of 4.5-inch stone needles have been found in New Stone Age ruins in Inner Mongolia and Shandong. This is powerful evidence that acupuncture originated early in primitive society. Gradually the use of bone and bamboo needles developed and with the discovery of the meridian theory acupuncture therapy emerged.
The Development and Preservation of Acupuncture
The early dynasties, Xia, Shang, Western Zhou, and Spring and Autumn Period (2100 – 476 B.C.), witnessed major development of medical theories. Inscriptions have been found on bones and tortoise shells of this time, depicting diseases such as intestinal parasites and toothache. During this time the theories of Yin and Yang and the Five Elements were developed and a basic understanding of the pulse, qi, essence, shen and body fluid were gained. A concept of pathology induced by the natural environment was attained and thus emerged the first shoots of TCM theory.
The development of bronze casting lead to the introduction of bronze medical needles but the bian shi remained the main tool for medical procedures until birth of iron instruments during the Warring States Period (475-221 B.C.). Nine types of needle were initially developed, as recorded in the Miraculous Pivot, which were used for puncturing, surgical incision and massage.
Shi Huang was the ‘First’ emperor of China and founded the Qin dynasty (221-207 B.C.), he was a harsh ruler and burned many books that encouraged free thinking but all medical journals were spared. He also greatly helped the development of TCM by bringing about the standardisation of measuring systems. This enabled for accurate measurement of acupuncture point locations and the recording of these locations.
The Han dynasty (206BC-220AD) saw China flourish under the new less tyrannical rule of the Hans and witnessed the emergence of Confucianism. With the rapid expansion of China many skirmishes and battles occurred. This gave doctors a great opportunity to expand medical science through the treatment of the casualties of war. This period saw some of the most notable names in TCM emerge. The medical classic Huang Di Nei Jing is believed to have been written during this period. This book and its teachings still form the core knowledge for students studying TCM today.
Hua Tuo (190-265 A.D.) was one of the most famous TCM doctors of all time. Even though he lived nearly 2000 years ago, his skills in surgery permitted him to apply local anaesthesia, via herbal formulas and the selection of specific acupoints, he was then able to perform various operative techniques. Unfortunately he angered the leader of the state and was put to death and his works burned. Without written records his practices fell into disuse and were lost. A religious stigma was attached to the practise of surgery, the social position accorded to the surgeon became increasingly lower making a revival of Chinese surgery, sadly impossible.
The outstanding physician Zhang Zhongjing noted many different forms of acupuncture in his book Shang Han Za Bing Lun (Treatise on Febrile and Miscellaneous Diseases). In it he analysed different febrile diseases according to the theory of the six channels and wrote a total of 269 prescriptions for their treatment. Later it was split into ‘Treatise on Febrile Diseases’ and ‘Synopsis of the Golden Chamber’ which again are books still studied to this day by TCM students.
Although many books were written by the beginning of the Three Kingdoms Period (220-280 A.D.) locations and names of acupuncture points were not unified. To systemise the problems Huang Fumi (215-282 A.D.) compiled the Zhen Jiu Jia Yi Jing (A-B Classic of Acupuncture and Moxibustion). In his book verified the location of 349 points, described the therapeutic properties of each point and summarized the methods of manipulation needed. The book also introduces the theory of qi, blood, channels & collaterals (jing luo) and viscera & bowls (zang fu).
During the wars of the Jin dynasties (256-420 A.D.) and the Northern and Southern dynasties (420-581 A.D.) acupuncture knowledge boomed because of its convenient use, and many monographs were produced. By the time of Tang dynasty (618-907) Sun Simiao (581-682 A.D.) was able to compile two books which provided huge contributions to the fields of acupuncture and moxibustion. ‘Prescriptions Worth a Thousand Gold for Emergencies’ (650-654) and ‘A Supplement to the Prescriptions Worth a Thousand Gold’ (680-682) listed 5,300 and 2,571 prescriptions respectively, looking at various different schools of thought. He also made the Ming Tang San Ren Tu (Three Persons Chart of Mingtang). This chart depicted the twelve main meridians and the eight extra channels in various colours, altogether 650 points were shown. He also introduced ethics into the practise of acupuncture saying that a practitioner should not look to make money through medicine and their only priority should be the patient’s health.
Also during the Tang dynasty the Imperial Medical Bureau was set up for medical education, this was the first systemised teaching system to be set up. Before knowledge had been passed through family lineage or from master to student. Teaching techniques greatly improved and with the advent of printing there was a rapid acceleration in the amount of literature available. In 1026 A.D. Wang Weiyi had two life size bronze figures made with the meridians and points engraved on them. For examination of students, the figures were filled with water and covered with beeswax and if the correct acupoints were located water would issue forth. In 1057 A.D. the government also set up the ‘Bureau for Correcting Medical Books’ to research and collate the medical classics. They republished many of the classic texts over a ten year period.
The ‘scholar debate’ took place during the Jin and Yuan dynasties and was carried out by four major schools of thinking; each with their own view of what was the main cause of disease. The School of Cold and Cool, the School of Attacking and Purging, the School of Nourishing the Earth and the School of Nourishing Essence all argued that theirs was the right method of treating the ill. The result of this debating was substantial development in many fields of TCM and the emphasis on treating patients as individuals depending on their ailments was developed further. Theories relating to scorching (scaring) moxibustion and the selection of acupuncture points in relation to anatomical location of the internal organs developed further during this time.
The Ming dynasty (1368-1644 A.D.) was a high point for acupuncture and moxibustion tremendous achievements were experienced during this period. Literature again was collected and revised. Manipulation of acupuncture needles was researched and twenty kinds of compound manipulation were developed. Warming therapy was evolved with the moxastick and moxa cone, the extra points were systemised and time acupuncture was developed further.
Modern History of Acupuncture and Moxibustion
The Qing dynasty (1644-1840 A.D.) saw the sudden decline of acupuncture and herbal medicine took a more superior footing. By 1822 the authorities of the Qing leadership declared an order to abolish permanently the acupuncture and moxibustion department from the Imperial Medical College stating, “acupuncture and moxibustion are not suitable to be applied to the emperor.”. Following the Opium War of 1840, the influx of foreign nationals into China saw acupuncture reach its lowest point in history. By 1937 there were 300 Western hospitals open in China, which led to severe discrimination against TCM. The Westerners denounced acupuncture as medical torture and referred to the needles as the ‘deadly needle’. During the 1920’s members of the government were calling for the banning of TCM and the adoption of the more scientific Western medicine. Thirteen provinces went on strike at this motion but it never made it through parliament.
Even though Western Medicine was attacking it, this period saw acupuncture and moxibustion spread throughout the peasant population, as it was very cheap to administer in comparison to the expensive Western drugs. It was welcomed by the people who wanted to preserve their heritage by the continued use of TCM. Many doctors unrelentingly worked to promote TCM back to its rightful place and set up schools and associations to achieve this but this time they also made attempts to explain it in terms of Western medical concepts.
By the time of Mao Zedong’s communist party Chinese doctors trained in Western medicine were carrying out research work on acupuncture and moxibustion. In 1945 an acupuncture clinic was opened in the International Peace Hospital, this was the first time acupuncture was to enter a comprehensive hospital. In 1950 Chairman Mao started a policy to unite doctors of both Western and traditional schools and in 1956 TCM colleges were set up in five of Chinas major cities. Soon other provinces in China followed and now there are 26 TCM colleges and 30 academies in existence. They all teach TCM in combination with orthodox Western medicine in an attempt to bring about integration of the two medical systems. In 1990 there were 340,000 TCM doctors with a total 1,500 hospitals.
Acupuncture and Moxibustion Outside of China
As early as 500 A.D. acupuncture was introduced to Japan; it enjoyed great success and by 701 A.D. institutions of education had begun to be set up. The Japanese doctors studied the classic Chinese medical texts and many books were published through out the Nala, Heian and Edo periods. It was scorned after the Meiji Reformation of Japan only to be revitalised in the middle of the 19th century. Experimental studies have been carried out in Japan on acupuncture since 1867 and it is still a very popular practise today.
In 541 A.D. doctors were sent to Korea and with them they took the knowledge of acupuncture and moxibustion. By 692 A.D. the doctors had begun teaching and again the Koreans studied the classic Chinese texts and began developing their own theories and formulas for use on their people. The theories taught by the Chinese nearly 1,500 years ago have stayed as part of the traditional medicine of these two countries until today.
China also sent out doctors to many of the Asian countries including India and Vietnam and by the 17th century it had reached the United States and was spreading through Europe. In the 1950’s China gave help to the Eastern European countries in training their acupuncturists. In 1975 the World Health Organisation (WHO) requested that China set up International Acupuncture Training Courses in Beijing, Shanghai and Nanjing to train acupuncturists from other countries. Now there are more than 120 different countries who posses their own acupuncturists.
By spreading TCM to other countries, China has shown that it has a medical system that is useful and effective enough to attract doctors to train from all around the world. This has also helped preserve knowledge and literature, as many texts have survived in foreign countries even if they were lost in China. The Chinese TCM doctors also came back from the other countries with knowledge of other medical systems which they then could integrate with their own, helping TCM to adapt and diversify its treatments. This has been instrumental in the preservation of TCM’s long history.
It can be seen that there were many contributing factors that have lead to this medical system spanning history. For one there is the continual perseverance and diligence of the doctors who continually adapted their art to improve the treatment of their patients. They have relied on written texts to carry the knowledge of the learned and passed it on for generations but have also continually systemized and updated the classics so as to keep the literature relevant from generation to generation. The roots of acupuncture theory lie in the simplistic theories of TCM which freely allow expansion and interpretation. This in turn empowers the practitioner with the freedom to think and develop organically in many different directions.
TCM has also persevered so long because of the fact that the knowledge was shared with other countries, who were encouraged to practise the art. It has also recently successfully integrated with Orthodox Western medicine prolonging its practise into the future.
But the greatest factor in the survival of TCM must be its effectiveness and its ability to heal regardless of race or beliefs.
Deng L., Gan Y., He S., Ji X., Li Y., Wang R., Wang W., Wang X., Xu H., Xue X. & Yuan J. (1997). Chinese Acupuncture and Moxibustion. Beijing: Foreign Language Press.
Long Z. (1998a). Basic Theories of Traditional Chinese Medicine. Beijing: Academy Press.
Ouyang B. & Gu Z. (1996) Essentials of Traditional Chinese Medicine. Jinan: Shandong Science & Technology Press.
Palmer M & Zhao X. (-). Essential Chinese Mythology. Thorsons.
Qui M., (1993) Chinese Acupuncture and Moxibustion. Singapore: Longman Singapore Publishers.
Veith I. (1992). The Yellow Emperor’s Classic of Internal Medicine. Malaysia: Pelanduk Publications.
Zhang E. (1990). Basic Theory of Traditional Chinese Medicine (I). Shanghai: Publishing House of Shanghai College of Traditional Chinese Medicine.
Zhang D. & Du G. (1996). Acupuncture – Moxibustion Therapy. Jinan: Shandong Science & Technology Press.
About the author:Article written by Alex Owen BSc. (Hons) TCM, Bachelor of Medicine (Beijing), MATCM
To subscribe, simply enter your email address below: