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This
foreword was written in 1972, by Frances Hamilton, my mother, when I was two
years old. I can only hope that my
compilations of acupuncture texts represent a worthy expansion of western
(American) awareness of acupuncture since 1972. Acupuncture: Ancient Art in a Modern
World
Acupuncture is primarily used to relieve pain. This may seem ironic at
first the insertion of needles into the body to eliminate pain. Acupuncture,
properly practiced, is a bloodless, apparently painless procedure, however, and
it has no unpleasant aftereffects. Hungarian-born Stephan Palos, a Buddhist monk
thoroughly familiar with acupuncture procedures, reports that acupuncture
produces no pain, except on the fingers (108). Other sensations may be produced,
however, such as a bitter or sour taste or a feeling of warmth.
Acupuncture has been successfully employed in the treatment of a variety
of diseases and ailments, including such diverse disorders as hay fever, ulcers,
blindness, deafness, conjunctivitis, hemorrhoids, leukemia, anemia, tonsillitis,
dysentery, tuberculosis, nephritis, diabetes, eczema, meningitis, high blood
pressure, hepatitis, Parkinsonism, and insomnia. Between 1953 and 1955,
ninety-eight cases of infantile paralysis were treated by acupuncture at Peking
Children’s Hospital (Palos 119-120). The rate of success in illnesses with a
duration of less than one year was 100 per cent.
Illnesses with a duration of one to two years had a success rate of 92
per cent. Cases with a duration exceeding two years were found to resist
acupuncture. Despite some dramatic results, acupuncturists generally do not
claim the ability to cure serious organic illnesses (Lang 16). As was mentioned
earlier, the primary purpose of acupuncture is the relief of pain. In some
cases, acupuncture eliminates symptoms while the disorder itself remains
unchecked. In a case of appendicitis, for example, acupuncture may alleviate the
pain and fever while the inflammation continues to worsen (Lang 16).
Today China has about one million licensed acupuncturists, 150,000 of
whom are physicians (White 147). Almost every Chinese citizen is familiar with a
few basic acupuncture points, however, so that with the application of pressure
to the appropriate point, minor discomforts, such as toothache, headache, or
spasmodic stomach pains, may be relieved before a doctor is consulted. This type
of self-treatment, called "natural acupuncture," involves no needles
and is more accurately classified as massage (Palos 104).
The Chinese first became interested in acupuncture in the fifth millenium
BC when they observed that warriors struck by arrows appeared to recover from
ailments in unrelated organs of their bodies. Flint arrowheads were used to
stimulate this process. In time the arrowheads were replaced with stone needles,
which were also used for surgery. Some of these "needles" were
actually small lances. Others had ball points or triple cutting edges. Copper
and iron needles replaced the stone ones, and these, in turn, were replaced by
needles made of gold or silver. There is some evidence that needles made of a
particular material are more effective than others in treating a specific
illness (Palos 104). Most needles in use today are made of stainless steel.
Widespread use of acupuncture began about 2600 BC. when Emperor Huang Ti
ordered that acupuncture replace all other forms of medicine. It was used, not
only as a cure for illnesses, but in the maintenance of good health as well.
Ancient Chinese physicians were paid only as long as their patients remained
well (Lang 14). If a patient became ill, the doctor was required to pay his
medical expenses.
The first written records on the subject of Chinese healing date back to
the Thirteenth or Fourteenth Century BC. Excavations have unearthed oracle bones
from this period bearing the characters for various diseases. The first mention
of acupuncture was in the historical work Tso Chuan, compiled by
Tso Chiu-ming who lived sometime between the Third and Fifth Centuries BC.
China’s first medical book, which is also the original text on the subject of
acupuncture, was written about 300 BC. This work has been translated by Dr. Ilza
Veith, professor of the history of health sciences at the University of
California (San Francisco), as The Yellow Emperor’s Classic of Internal
Medicine.
In many instances Chinese medical knowledge significantly preceded its
Western counterpart. The Yellow Emperor's Classic of Internal Medicine
unmistakably refers to the circulation of blood through the body, a phenomenon
which was not demonstrated in Europe for another 1500 years. Diagnosis by taking
a patient's pulse was practiced by Pien Ch'ueh as early as the Fifth Century BC.
Anesthesia was used in the Second Century BC, and skulls reveal that certain
cranium operations were performed in China thousands of years ago. By the middle
of the Sixteenth Century, it had been discovered that a powder prepared from the
secretion from smallpox vesicles or from the dried vesicles themselves provided
a powerful immunization against, the disease when sniffed into the nose. This
method of immunization, which had long been popular in folk medicine, spread to
Russia and Turkey. Vaccination was not discovered by Western doctors, however,
until 1717. The use of acupuncture for the maintenance of good health has
already been mentioned. The Yellow Emperor's Classic of Internal Medicine
also encouraged more conventional methods of disease prevention: "regular
habits, proper diet, a suitable combination of work and leisure and the
maintenance of a calm mind (Horn 75)." One thousand years later the concept of
disease prevention remained foreign to the West, where illness was widely
regarded as punishment for sin.
In light of these early discoveries, it may seem curious that Chinese
medical knowledge did not advance more rapidly than it did. Two factors,
primarily, are responsible for this: the Chinese philosophy and the vastness of
the Chinese territory. Chinese philosophy did not encourage scientific
investigation. Confucius taught
that "the body which one had received from one’s parents should not be
mutilated but be returned to one's ancestors after death in a state of
completeness (Palos 12)." Amputated parts if, indeed, amputation were
performed--were buried with the person to whom they belonged. Dissection,
likewise, was taboo, although it was sometimes secretly performed on the corpses
of hanged criminals. This tradition persisted until the Chinese Revolution.
Because China’s territory is so vast, climate and accordingly illness
varies greatly from one region to another. Different types of treatment also
evolved in various sectors. Until the coronation of the first emperor in 221 BC,
China comprised small, often warring, principalities. There was little
communication between them aimed at cultural advance. Linguistic difficulties
also posed a barrier. Diseases were known by different names in different
provinces. These terminological difficulties persist today.
During the first Opium War (1839-1842),
China was introduced to modern Western medicine. Little attention was
paid to Western practices, however, until after the People's Revolution of 1911.
Then the government began to replace Chinese traditional medicine, including
acupuncture, with modern Western techniques.
With the Communist takeover in 1949, Mao Tse-tung realized the
impossibility of training China’s 500,000 traditional practitioners in the
methods of Western medicine. He therefore, directed that modern and traditional
methods of treatment be fully combined. Teachers of modern medicine were
"sent to the countryside for a period of political reorientation (Dimond
18)." While they were away, their institutions came under the management of
revolutionary committees, the chairmen of which were usually army officers. When
the Peking Research Institute for Chinese Traditional Medicine opened in 1953,
Mao Tse-tung required that Western-trained doctors undergo thirty months of
intensive training in traditional medicine. Many of these doctors are now
enthusiastic about the use of acupuncture (Lang 14).
Following his trip to China in mid-1971, Dr. E. Grey Dimond of the
University of Missouri highly praised this unique synthesis which enabled China
to achieve a higher standard of medical care than would have been possible using
either system alone. Today China is up-to-date on the treatment of heart
disease, has an excellent public health program, and maintains high standards of
hospital care, including nursing, laboratory procedures, and cleanliness (Dimond
18). Dr. Dimond reports, however, that no Chinese medical journals have been
published for three years (Dimond 18). Rather, journals from the United States
are studied.
A basic understanding of the yin-yang doctrine is essential to the study
of acupuncture. The terms yin and yang were first-mentioned in the
Book of Changes, written sometime during the first half of the first
millenium BC. Yang represents the positive, active, masculine force in
the universe. It predominates in things that are light and warm. Yin represents
the negative, passive, feminine force and predominates in things cold and dark.
Every object, every season, every aspect of Chinese life may be classified as
either yin or yang. There is some yin implicit in every yang, however, and vice
versa (Palos 28). It is the balance of these two forces which results in
universal harmony.
The yin-yang doctrine became the link between two divergent schools of
Chinese philosophical thoughts the humanistic Confucianism and the naturalistic
Taoism (Chan 52). The yin-yang doctrine embodied the idea of harmony embraced by
both schools. Confucianism taught the idea of central harmony; Taoism taught
inner harmony. Both schools emphasized the importance of harmony between Man and
Nature. The forces of yin and yang are thought to flow through the human body, which is viewed by the Chinese as a microcosm of the universe. These forces must remain in precise balance if good health is to be maintained. "When that energy is blocked, an excess of one or the other force builds up in a specific part of the body and causes illness (Lang 14)." It is the job of the acupuncturist to "determine the location of the blockage, the organs involved in the energy excess or deficiency, and the points of acupuncture which will remedy the situation (Lang 14)." Strange as this concept may sound to one familiar with modern medical knowledge, it is not completely divorced from the Western medieval practice of bloodletting, which "was traditionally used to treat 'humours’ or disease, by draining putrefactions from the body to redirect human energies (Science News 400)."
Organs of the body were also classified as yin or yang, depending upon
whether their function was active or passive. The yin, or passive, organs are
the liver, lungs, spleen, heart, and kidneys. To these is added a sixth
"organ," the "controller of the heart." The
"controller" regulates the composition of the blood and the supply of
blood to the yin organs. These six organs are complemented by six yang, or
active, organs: the large intestine, stomach, small intestine, urinary bladder,
gall bladder, and "triple warmer." The "triple warmer"
regulates respiration, digestion, ingestion, and the urogenital system. In so
doing, it determines the chemical state of the entire organism and represents
the body's main source of energy.
These twelve organs are believed to be linked in a kind of cyclical
pathway. Along this pathway flows chi, the universal energy combination of yin
and yang. The order of the organs in this cycle is as follows (Palos 43): liver,
lungs, large intestine, stomach, spleen, heart, small intestine, urinary
bladder, kidneys, "controller of the heart," "triple
warmer," and gall bladder. In this cycle two yin organs are followed by two
yang organs and so on.
Each organ may be affected by a number of acupuncture points, some of
which are quite distant from the organ itself. An acupuncture point may be
defined as a point "at which the insertion of a needle will produce a
physiological effect (Time 38)." The exact number of acupuncture points
is difficult to determine. Records indicate that originally there were 295 such
points. Additional points have been discovered with the passage of time,
however. Today there are said to be 722 "generally acknowledged"
acupuncture points and an additional 180 secret points known only to the masters
(Saar 34). Other sources report that the number of insertion points has recently
been increased to about 1000 due to volunteer efforts of members of the People's
Liberation Army who probed their own bodies with fine needles (Galston 14). An
acupuncture point is one-tenth of an inch in diameter. One misplaced needle can
kill in a matter of hours (Saar 34).
All points affecting the same organ are believed to be interconnected.
They lie along a more or less vertical pathway called a meridian. There are
twelve major meridians--one for each organ. Each meridian has a duplicate on the
opposite side of the body. Some meridians traverse the trunk or the head, but
the meridians are mainly distinguished by their positions on the limbs. There
are three yin meridians on the inside of each limb and three yang meridians on
the outside (Palos 44-45). The average number of points on a meridian is
twenty-six. The heart and "controller of the heart" meridians have the
fewest points, with nine each (Palos 50-55). The urinary bladder meridian, with
sixty-seven points, has the most (Palos 62).
The points on a meridian are not equally effective in treating a disorder
of that meridian's particular organ. Some points affect other parts of the body
whose function is related to the function of that organ. For example, some
points on the stomach meridian affect the mouth, the gullet, or the stomach
lining. Some points on the lung meridian affect the nose, the windpipe, the
bronchia, or the lung vesicles. In addition, some points on a meridian can
affect conditions completely unrelated to the organ with which that meridian is
associated. Points on the heart meridian, for example, may affect, or may
indicate diseases of the small intestine, the larynx, or the eyes (Palos 50).
Points on the small intestine meridian may affect functional disorders of the
stomach or heart, psychosis, Parkinsonism, or epilepsy (Palos 55).
In addition to the twelve major meridians are eight "special"
meridians, twelve divergent meridians, and twelve "muscle" and
cutaneous meridians (Palos 41). Of the eight special meridians the most
important are two which run along the midlines of the body, one in front and one
in back. The twelve divergent meridians serve as links between the major,
vertical meridians. In each case they connect a yin meridian with a yang
meridian. The muscle and cutaneous meridians comprise additional points which
affect the skin and muscles rather than the internal organs.
Acupuncture treatment consists chiefly of tonification and sedation.
Tonification is the strong, persistent stimulation of an organ. It is used in
cases where the passive yin predominates and hypofunction occurs. Sedation is a
weak, calming influence, which is used in cases where an overpowerful yang
causes increased organic activity. A weak stimulus usually has a tonifying
effect; a strong stimulus a sedating effect. Although this may seem paradoxical,
it may be explained by considering the effect of the stimulus on the cortex of
the brain. The reaction of the cortex to a weak or short stimulus causes
increased organic activity. A strong stimulus, however, generates a
"protective inhibition," which has a sedating effect (Palos 110).
Stimulation may be varied by varying the method of insertion--jabbing or
twirling--or by varying the length of duration. In determining the degree of
stimulation, the acupuncturist must consider each patient as an individual
(Palos 112). What would be a relatively weak stimulus for one patient might
produce a strong reaction in another. Regarding tonification and sedation,
"the most effective treatments are those which not only affect the meridian
and the points belonging to the particular organ, but which also (in the case of
tonification) stimulate the preceding organ and (in the case of sedation) affect
the organ which follows it in the sequence (Palos 43-44)."
In making his diagnosis, the acupuncturist listens to his patient's
complaints, observes his general behavior, his complexion, and his tongue,
searches for points of tenderness along the meridians, and feels the pulse (Horn
74). Feeling the pulse is by far the most important aspect of diagnosis. It may
require as long as one-half hour, and if the patient is agitated the examination
may have to be postponed (Horn 74). Although the pulse is sometimes taken in the
arteries of the neck and legs as well as the wrist, an entire diagnostic system
has evolved just from taking the pulse in the wrist. By taking six pulses in each wrist, the acupuncturist can determine the condition of each of the twelve organs. These different pulses are found by using different fingers and by varying the degree of pressure exerted. In each case, slight pressure reveals the condition of a yang organ; strong pressure reveals the condition of a yin organ. Israeli-born Giore Harel, who practices acupuncture in Taipei offers this comment on the feeling of the pulse: "In acupuncture you must take six pulses in each wrist to decide the diagnosis. Because there are twenty-eight qualities for each pulse, it is very difficult. Acupuncture succeeds in about eighty per cent of cases. The method is infallible, but sometimes we fail in application because we are human beings (Saar 34)."
The body of the patient must be firmly propped during acupuncture. A
sitting posture is most common, the patient resting his forearms on a table
(Palos 107). The patient may also lie on his stomach, back, or side, using a
cushion to support his limbs or as a pad for his elbows.
The "individual inch" is the basic unit of measurement used in
locating acupuncture points (Palos 105-107). It is equal to the length of the
central bone on the patient's middle finger, as measured from one joint to
another. Although it is seldom necessary for an experienced acupuncturist to
rely on this method, it is essential
for the novice to do so. Soviet acupuncturists believe that the location of
Caucasian acupuncture points varies slightly from that of Oriental points (White
149).
Most needles used for acupuncture are slender and flexible. Some,
however, have a triple cutting edge. "Skin
needles," also, are occasionally used. They consist of five or six
separate, adjacent needles contained in one holder. They are usually used in
treating children, when only tapping is needed (Palos 104). The length of
acupuncture needles varies from one-half inch to ten inches. The needles are
sterilized before use. This was
formerly done by dipping them into a solution prepared from medicinal herbs.
Today, however, they are boiled in the same manner as hypodermic needles.
Probably many acupuncturists follow procedures similar to those employed in a
particular Taipei office, where needles are cleaned in alcohol only at the end
of the day. Insertions are sometimes made through a patient's clothing. Yet
there has not been one case of infection in sixteen years (Saar 34).
There are three basic angles at which the needle can be inserted (Palos
107). More sensitive points, and points located above thick layers of muscle,
are usually stimulated with the needle at a right angle to the surface of the
skin. Points on the chest are usually stimulated at a forty-five degree angle,
and points on the face, head, and neck are usually stimulated at an angle
ranging from twelve to fifteen degrees. The depth of insertion varies. Usually
it is less than one-half inch. Sometimes it may be as great as six or seven
inches, however. Depending upon the desired degree of stimulation, the needles
may be rotated, withdrawn or left in the acupuncture point for a long period of
time--sometimes longer than a day.
A relatively recent development is the use of acupuncture for anesthesia.
Originally needles were placed superficially in the skin and allowed to remain
there for ten to thirty minutes. A newer technique consists of placing the
needles as deep as two inches and manipulating them in a one-half inch
up-and-down motion (120 times per minute) while twirling them between the thumb
and fingers (White 148). The latest development, however, is the use of
electricity in conjunction with acupuncture. This technique, called
electroacupuncture, was developed primarily by a woman, Dr. Chu Lien. It has
come into general use only since 1966 although experiments were conducted for
the previous decade. In electroacupuncture, electrodes are attached to the ends
of needles, which are inserted in the usual manner, and the patient receives a
0.5 milliampere current from a five-volt source for a period of twenty minutes.
During his recent trip to China, Major General Walter R. Tkach, physician
to President Nixon, observed three operations in which the sole anesthesia was
acupuncture. Major General Tkach reports that doctors prepared their patients
for acupuncture and surgery by discussing the surgery with them and explaining
where the needles would be inserted and what type of incision would be made (Reader’s
Digest 146). A bond of confidence between doctor and patient was thus
established. There was no evidence of hypnosis, however.
The first case Major General Tkach observed involved a
sixty-five-year-old man who underwent surgery for advanced cataracts on his left
eye (Tkach 146). The two needles used in the electroacupuncture technique were
inserted into his left ear. One needle passed through ear, almost parallel to
the man’s skull. The second needle, about three inches long, passed into the
ear at a right angle to the head and probably penetrated to the base of the
skull. The second case involved a twenty-six-year-old girl with a large thyroid
tumor. She was anesthetized by the use of two needles in each ear. The third
case involved a thirty-seven-year-old woman with an ovarian cyst. Her anesthesia
consisted of five needles inserted in the vicinity of her nose. Major General
Tkach observed that each needle was inserted with a twirling motion which
allowed it to slip past, rather than penetrate, nerves or blood vessel (Tkach
147).
None of these patients showed any sign of discomfort during either the
acupuncture or the surgery. They conversed with doctors during their operations,
and their vital signs remained normal. Afterwards they walked unassisted to
their rooms. The cataract patient reported that he had felt "no sensation
whatsoever (Tkach 147)." The woman with the ovarian cyst said she felt
"something like a scratch" on her stomach (Tkach 147).
There are several advantages to the use of acupuncture for anesthesia. It
enables the patient to communicate with the doctor during surgery; it eliminates
the need for complicated anesthetic equipment; and it minimizes the risks
encountered with chemical anesthesia. Kao Fa-hsiang, head of the
"revolutionary committee'' which runs Peking’s No. 3 Hospital, affiliated
with the Peking Union Medical College, reports that over 400,000 operations have
been performed there using acupuncture as the anesthetic (Martin 25). The rate
of success in these cases, involving patients ranging from babies to
eighty-year-olds, was eighty per cent.
The use of acupuncture during surgery does not prevent post-operative
pain. Frequently, however, this pain may be alleviated with simple acupuncture
techniques. Following his emergency appendectomy in Peking, New York Times
columnist James Reston received acupuncture treatment to dispel intestinal gas.
Three needles were inserted into his right elbow and below his knee. These were
rotated for about twenty minutes to stimulate the intestine. Reston reports that
this sent "ripples of pain" racing through his limbs and at least
diverted his attention from the pain in his abdomen (37-38). The doctor next lit
two pieces of an herb and held the smoldering wads near Reston's abdomen. The
columnist soon felt better although he could not explain why.
Acupuncture was introduced into Western medicine in 1683 when the Dutch
physician Ten Rhyne wrote a treatise on the subject (Gutman viii). Greater
interest was aroused with Soulie de Morant's translations of some basic Chinese
medical texts around 1930. It is only since World War II, however, that Western
scientists have begun serious investigation of acupuncture. Most of this has
been conducted in the Soviet Union, where there are about 1000 acupuncture
specialists (White 149). Soviet acupuncturists seldom use needles, however.
Instead they rely upon electrical stimulation, massage, ointments, or
occasionally laser beams (White 149). Additional research has been carried out
in Germany, Britain, and France, where the International Society of Acupuncture
has its headquarters. American interest in acupuncture was not awakened until
mid-1971, when Dr. Arthur Galston of Yale and Dr. Ethan Signer of Massachusetts
Institute of Technology returned from China with their impressions of the art.
Although they are not physicians, these two men were the first American
scientists to visit Peking since 1949 (Galston 14).
Researchers throughout the world are attempting to explain acupuncture in
terms acceptable to modern science. Although many acupuncture points are located
near a nerve, the entire configuration of points fails to follow any anatomical
system recognized by the West. In 1898 the English neurologist Henry Head
discovered zones on the skin "which become hypersensitive to pressure when an
organ connected by nerves to this skin region is diseased (Gutman viii)." This
notion, incorporated with the idea of skin resistance, is foremost among
theories currently being offered in explanation of acupuncture. In China,
Europe, and the Soviet Union, electropotentiometers have been developed for
measuring skin resistance. These devices have recorded constant potential values
along the meridians but fluctuating values elsewhere (Palos 76). Such results
were achieved even on corpses. Other experiments have shown that electrical
conductivity on points along the major meridians is significantly higher than on
the rest of the skin. Moscow experimenters have confirmed electronically that
acupuncture points are located in connective tissue and that the tissue is
looser in the vicinity of the points than in other places (Palos 76).
Some investigators believe that acupuncture may affect nerve impulses or
stimulate the blood supply to the nerves. A neurologist, who wishes to remain
anonymous because he has little data to support his speculation, says: "By
placing probes into specific nerves with or without electricity, one could block
local sensations and/or stimulate blood flow to various organs. The results
could dull pain and perhaps arrest a disease process by increasing blood flow to
a specific organ (Science News 400)." An experimental neurophysiologist,
who also insisted upon anonymity, comments: "In the United States
electrodes applied to the body, intense sounds, and other nerve stimulation have
been used to relieve pain. Acupuncture
may work in basically the same way by increasing nerve stimulation to the brain,
by telling the brain to refuse pain sensation. (Science News 400)."
Many scientists, particularly in the United States, view acupuncture as a
form of quackery. Dr. Galston points out that one reason the West is reluctant
to accept the idea of acupuncture is that analgesic drugs and other pain-killing
devices are readily available (Galston 14). Many persons, including Dr. Veith,
believe that the patients emotional attitude plays an important part in
acupuncture. Treatment is frequently extended over a period of several weeks.
For some patients, the knowledge that they have a physician's care and attention
during this time is enough to cure them of their illness. Some scientists
suggest that patients may practice self-hypnosis. Experiments conducted on
animals, which are not susceptible to the power of suggestion, indicate that
acupuncture is more than a psychosomatic cure-all, however. Acupuncture is
successfully practiced on animals at the Veterinary Medical Institute of Alfort
in France. A team of Rumanian investigators experimentally implanted a gall
bladder fistula in a horse (Gutman ix). When a point on the skin, said be
related to the gall bladder, was pricked, the flow of bile was increased. This
did not happen when other points were pricked.
American doctors continue to discredit acupuncture by saying that most
illnesses disappear in time anyway. Such an approach is dangerous, for it
indicates an unwillingness to investigate a form of treatment which has been
practiced--apparently successfully--for nearly seven thousand years. Although
the data is presently inconclusive, perhaps even contradictory, evidence
indicates that acupuncture is a subject which merits further study. It is likely
that some knowledge will emerge from this research which will enlighten man on
the intricate operation of his body.
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