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

       The word 'acupuncture' is derived from two Latin words: acus, meaning 'needle,' and 'punctura,' meaning 'puncture.' 'Acupuncture' has come to denote a method of healing whereby needles of various lengths are inserted into the body at specific points. The method originated in China thousands of years ago and has recently aroused scientific curiosity in the West. After a brief survey of the nature of acupuncture, this foreword will discuss the relation of acupuncture to China’s history of medicine and to the yin-yang doctrine, a basic tenet of Chinese philosophy. A somewhat detailed account of acupuncture procedures will follow, and the study will conclude with the West’s appraisal of this mysterious Chinese art.

     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.