Development of Acupuncture and Moxibustion
As far as the origin of acupuncture and moxibustion is concerned, there exist only conjectures.
In SHANHAIJING we read the following: “Five hundred miles to south there is a mountain called Fuli, on the top of which gold and jade is to be found and at the bottom of which many needle stones lie.” The expression needle stone (zhenshi) is explained as a stone from which a kind of needle was produced, by means of which ulcers and swellings could be cured.
Further mentioning of acupuncture and moxibustion is found in NEIJING and NANJING from the Han dynasty (207 B.C. – 220 A.D.). NEIJING, which is ascribed to the mythological Yellow Emperor (2697-2597 B.C.), the founder of the Chinese civilization, is the oldest extant medical work. Probably a great part of it existed during the Han dynasty, but much of its contents is of older origin, handed down by oral tradition.
NEIJING is the basis of Chinese medicine as a whole. It consists of two parts: NEIJING SUWEN (Yellow Emperor’s Classic of Internal Medicine – Simple Questions) and LINGSHUJING (The Mystical pivot). NEIJING is written in the form of a dialogue between the emperor and his minister Qi Bo. From NEIJING it is obvious that at the time when it was written acupuncture and moxibustion had been already in use for a longer period of time. In NEIJING we read the following:
“The present generation treats internal diseases with the poison medicine and they treat the external diseases with acupuncture, and sometimes the patients are healed. How can you explain this?”
In the chapter “The Different Methods of Treatment and Appropriate Prescriptions” we read the following:
“The people of the regions of the East… Their diseases are ulcers, which are most properly treated with acupuncture by means of a needle of flint. Thus the treatment with acupuncture with the needle of flint has its origin in the regions of the East.”
“The North is the region of storing and lying by. The country is hilly and mountainous, there are biting cold winds, frost and ice. The people of these regions find pleasure in living in this wilderness, and they live on milk products. The extreme cold causes many diseases. These diseases are most fittingly treated with cauterization by burning the dried tinder of the artemisia (moxa). Hence the treatment with cauterization has its origin in the regions of the North.”
The expression which was used for the needle in the oldest medical writings was zhenshi, in which the character zhen was written in three different ways and it is not clear, what exactly the relation between them was.
We can assume that the first needles were made from a flint, which gradually was substituted by metal.
While in SUWEN acupuncture and moxibustion are only mentioned, more details can be found in LI NGSHUJING. This work was formerly also called ZHENJING (Classic on Acupuncture). Being very rich in contents, it deals systematically with Jingluo (vessels and arteries), Shuxue (acupuncture and moxibustion points), Cifa (ways of insertions) etc. For the first time it describes the use of nine needles in acupuneture.
The Yellow Emperor says to Qi Bo:
“I love my people, educate them and receives taxes from them; I feel sorry that sometimes they are not able to produce products because of being ill. As far as the treatment is concerned, I wish they might not only rely upon the poison medicines and might not use only flints but I should like they could insert thin needles into the vessels and bring in to harmaony Blood and Qi, so that both might circulate in the vessels without any hindrance.”
LINGSHUJING appeared as late as in the eleventh century and it is considered to be the work of Wang Bing from the 8th century, but probably it contains a lot of old writings.
In the third century B.C. there appeared the work NANJING (Solution of 81 questions), which elucidates many obscure places from NEIJING SUWEN. The 23rd to the 29th chapter deals with the Jingluo, the 62nd to the 68th chapter deals with the acupuncture and moxibustion points and the 69th to the 81st chapter deals with the method of needling. This work is ascribed to the most famous physician of ancient China Pian Que, who is said to have brought to life the dead prince Guo by means of acupuncture.
The other physicians using acupuncture were Zhang ZhongJing (from late Han dynasty), author of the Treaties on Typhoid Fever, who mentions wenzhen (warm acupuncture) and shaozhen – hot acupuncture and Hua Tuo (141-203 A.D.), a famous surgeon, inventor of an anaesthetic called “mafusan” and gymnastics called “wu qin xi” – a play of five animals. In HOUHANSHU the Book of Late Han his great successes in acupuncture are described. He made the famous general Cao Cao get rid of violent migraine and cured a cripple. He stressed the principle that too many points should not beneedled.
The first book dealing only with acupuncture and moxibustion is ZHENJIU – JIAYIJING (Rudiments of Acupuncture and Moxibustion) written by Huangfu Mi (215-282 A.D.) of the Jin dynasty. The book has 128 chapters altogether, 70 of which deal only with the points and their main function. It is the first book describing acupuncture and moxibustion systematically and sums up all the previous knowledge in this branch. Till now it is being recommended for studies in China. Huangfu Mi’s theory about preventive medicine is very well known. He stressed the principle that the best physician begins with the treatment when the disease has not yet appeared, the physician with average skill treats the disease when it is not yet serious, while the one with below average skill tries to cure the declining patient. The most important feature of his book is the arrangement of the points according to the meridians.
In later dynasties medicine came to upsurge. The centre of the medical activity was Taiyizhou, the forerunner of Taiyiyuan (Imperial Medical College).
From the Tang Annals we learn that there was one professor of acupuncture, one assistant, ten physicians, who acquainted the 20 students with the meridians and the points so that they would be able to become physicians. Besides there were 30 technicians.
During the Sui dynasty (581-618 A.D.) Zhen Quan (541-643 A.D.) wrote the books MAIJING (Pulse Classic), ZHENFANG (Principles of Acupuncture) and MINTANG – RENXINGTU (Human Body in Illustrations).
In MINTANG – RENXINGTU the Twelve Meridians were designated in different colours and the Eight Extra Meridians were designated in green colour. He has the merit in unifying the acupuncture points. His work is lost, but its contents can be partly found in QIANJIN YAOFANG.
The two most famous physicians of the Tang dynasty (618-907 A.D.) are Sun Simiao (581- 82 A.D.) and Wang Tao (cca 750).
Sun Simiao wrote many works, the most famous of which is QIAN JIN YAOFANG (The Most Precious Prescriptions) and its supplement QIAN JIN YIFANG.
Ming Wong says about his work:
“Il s’agit d’une encyclopédie médicochirurgicale exposant une pathologie dej tres riche et que l’Occident arabe, byzantic ou latin ne connaitront que beaucoup plus tard.”
In his work details about acupuncture and moxibustion are to be found. He took Zhen Quan as a basis but expressed many of his own ideas.
Wang Tao put a great stress on moxibustion and in his work WAITAIBIYAO (Secret Notes of a Medical Officer) we can find more about this method of treatment. Wang Tao was a curator of a large medical library and wrote his work as an expression of filial piety.
During the Sung dynasty (960-1279) Wang Weiyi (also called Wang Weide) became famous for his book TONGREN SHUXUE – ZHENJIU – JING (Bronze Man with Acupucture and Moxibustion Points and Charts and Legends) in 1026. The book consists of three volumes. It became obligatory study for all students of acupuncture and moxibustion. A year later, in 1027, he cast two bronze figures on which the points bearing the names were designated. One figure was kept in the imperial Palace and the other one in the Imperial Medical College. The hollow figure was filled with water and covered with an opaque layer of wax on the surface so that the points could not be seen. This model was used during the examinations. If the student needled the point at the correct place, water flew out of the hole. How important the figure was considered to be could be seen from the fact that in 1128 Jin asked for the surrender of a model of the figure as a condition for peace negotiations.
Other books from the Sung dynasty dealing with moxibustion are ZHENJIU – ZISHENGLUN (Development of Acupuncture and Moxibustion) in 7 volumes by Wang Zhizhong, XIAOER MINTANG – JIUJING (Classic on Moxibustion for Children) by Wu Fugui, BEIJI – JIUFA (Moxibustion in Emergency) by Qi Nian and GAOMANG SHUXUE – JIUFA (Moxibustion Points Used in Serious Diseases) by Zhuang Chuo.
The usurpers of the Chinese throne, the Mongols, became sinised very soon and their rule was.a blossoming period not only in literature and art but also in medicine. Under the supervision of an imperial committee a monumental encyclopedia was compiled and again reedited in 1300. There existed only a few copies during the Ming dynasty (1368 – 1644) and during the Qing dynasty (1644 – 1911) many efforts were made to find the lost parts of it.
From the Mongol dynasty (1273 – 1368) it is worthy to mention ZHENJING – ZHINAN (A Guide to Acupuncture) by Dou Hanqing. This book was written in the form of songs so that it might be remembered by the students more easily.
In 1303 Hutaibilie wrote JINLAN-XUNJING (Treatise on Acupuncture) in one volume accompanied by two anatomical charts. That book was lost, but on its basis Hua Shou (or Hua Shouren) in 1341 wrote SHI SI JING FAHUI (Elaboration of the 14 Meridians) in three volumes. It was due to him that the Conception Vessel (Renmai) and Governing Vessel (Dumai) were excluded from the Eight Extra Meridians and added to the original Twelve Meridians.
In acupuncture, as far as the names of the points are concerned, there existed many discrepancies. The same point had several names and several points often had the same name. Xu Feng was the first man who unified the names of the points and stated the most important 145 points efficacious in 64 diseases.
In 1530 Wang Ji wrote a book ZHENJIU-WENDUI (Replies to Questions in Acupuncture and Moxibustion) in three volumes. The first two volumes deal with acupuncture, while the third one deals with moxibustion, meridians and points. Its conciseness and lucidity make it possible to remember the contents.
From 1529 we have ZHENJIU-QUYING (Gems of Acupuncture and Moxibustion) by Gao Wu. The work was written on the basis of NANJING and NEIJING and includes the author’s own opinions. He is also the author of ZHENJIU SUNAN-YAOZHI (Essential Points from Suwen and Nanjing concerning Acupuncture and Moxibustion). He cast three bronze figures, that of a man, a woman and a child.He tried to eliminate some superstitious elements in acupuncture and was strongly against the habit of needling through the cloth.
The most famous man in the field of medicine from the Mingdynasty is Yang Jizhou (1573-1619) whose work ZHENJIU-DACHENG (Compilation on Acupuncture and Moxibustion) has been in use till now. It is a unique work summarizing all that was known concerning acupuncture and moxibustion till the Ming period. He was the first who stressed the importance of massage performed on the spot of the points. It is mostly on his work that Soulié de Morant and consequently the European acupuncture rely. The original title ZHENJIU-DAQUAN (published in 1602 at the beginning of the Qing period) was changed into ZHENJIU-DACHENG. Other well-known works from this period are QI JING BA MAI KAO (A Study of the Eight Extra Meridians) by Li Shizhen, ZHENJIU-YUANSHU (Central Pivot of Acupuncture and Moxibustion) by Wu Jiayan, ZHENJIU-YAOLAN (A Survey of Acupuncture and Moxibustion) by Guo Long,. ZHENJIU TUJING (A Classic on Acupuncture and Moxibustion Accompanied by Charts) by Yao Liang, GUJIN-YITONG (Ancient and Contemporary Medicine) by Xu Chunfu and ZHENFANG LIOU JI (Principles of Acupuncture in Six Volumes) by Wu Kun.
The Qing dynasty is a period of general decay in Chinese culture and it also means a decline for Chinese medicine, especially for acupuncture and moxibustion. The feudal court considered exposure of the naked body during the treatment as indecent and not suitable for a genuine gentleman – junz. In the second year of the reign Daoguang (1821-1851) it was decided to abandon acupuncture and moxibustion in the Imperial Medical College. Thus the knowledge of these two branches of medicine continued only among the people. After the Chinese became acqainted with the European medicine, acupuncture and moxibustion were even more neglected as pure superstitious belief and thus it happened that acupuncture and moxibustion remained barely alive.in their own cradle in China. This situation was not much better in.the republic before the second world war. In 1929 the reactionary Chinese government made an effort to abandon the traditional Chinese medicine altogether, but the decree was not carried out.
After the foundation of the Chinese republic in 1911 two physicians tried to revive the art of acupuncture and moxibustion, namely Cheng Dan’an (whose main work is ZHONGGUO-HENJIUXUE, Chinese Acupuncture and Moxibustion) and Ceng Tianzhi, who wrote KEXUE ZHENJIU-ZHILIAOXUE (Scientific Treatment by Acupuncture and Moxibustion). They founded the Medical Society of Acupuncture and Moxibustion (Zhenjiu-yishe), Cheng Dan’an founded the first school for acupuncture and moxibustion in Chengdu and brought up many students. In 1957 he became president of the Academy of Medicine.
It was not till after the liberation of China that acupuncture and moxibustion were studied systematically. In Peking the Experimental Institute for Acupuncture and Moxibustion (Zhenjiu-liaofa shiyansuo) was founded, headed by Lu Zhiyan.
According to Wong Ming there exist two schools in China, the didactive one whose representative is Cheng Dan’an and the experimental one represented by Zhu Lian.
Zhu Lian succeeded the deceased Cheng Dan’an in 1958 as the president of the Academy of Medicine and trained many students, not only Chinese but from all over the world.
Till now there exist in China traditional medicine (zhongyi) and western medicine (xiyi) and there are more physicians of the traditional school. In 1954 the Chinese Medical Association (Zhongguo-yishe) embraced both schools. It stands to reason that between these two groups there exist rivalry and certain antagonism. There is a tendency of taking the healthy nucleus of traditional medicine and after putting it on a scientific basis to incorporate it into the western system. That is exactly what is happening with acupuncture and moxibustion, which exist in all hospitals of the western type in the department of physical therapy.
Acupuncture and moxibustion are not only limited to China. They spread all over Eastern Asia, Japan, Korea and Vietnam hundreds years ago and later reached Europe, too.
In 541 A.D. Chinese medicine reached Korea and according to a Chinese legend a Chinese by the name Zhi Cong brought the medical works to Japan. Later Japan sent students to China and asked China to send Chinese physicians to come to Japan as professors. The Japanese established a similar system of medicine after the Chinese pattern.
According to the Japanese legend the first Japanese studying acupuncture and moxibustion was Kikabeko Omaro, who in 624 after his return from China founded a school. In the 8th century a title for physicians of acupuncture was established by the Japanese emperor.
In the period of Kamakura (1185-1333) acupuncture declined, but during the Tokugawa period (1603-1867) two punctators are known: Misono Isai and Yume Bunsai who invented a slightly curved rounded mallet by means of which the needles were inserted into skin. Another well-known Japanese is Sugiyuma Waichi who made a needle called kudahari. He founded 45 schools all over Japan. His work consisting of 3 volumes has been in use till now.
The Japanese used the bronze life-size statue which was brought to Japan in the 11th century together with four medical writings. During the disorder of the Tokugawa period the statue and the medical literature became lost. In 1806 they were founded only to be lost again soon and were not discovered until later by Yoshida, a professor at a school for the blind. In Japan many blind people practise acupuncture and moxibustion because of their highly developed sense of touch.
In Japan a medical faculty of western type was established in 1884 and for 40 years Chinese traditional medicine was completely neglected. It is interesting to observe that modern Japanese physicians educated in the western methods gradually begin to be interested in the ancient Chinese methods. Among the famous physicians belong Tamamori, Nakayama, Tatse etc.
Neither in Greek nor Roman literature can we find any hints about acupuncture or moxibustion. In Europe acupuncture was mentioned for the first time by Francisco Mendez Pinto in the 16th century, but Europeans did not learn anything concrete about acupuncture until in the 17th century when Wilhelm Ten Rhyne devoted 20 pages to acupuncture in a small book entitled DISSERTATIO DE ARTHRIDE. More details were given by Engelbert Kämpfer, who was a surgeon of the East Indian Company and later a secretary at the Dutch Embassy in Japan where he came to be interested in acupuncture and moxibustion. His work AMOENITATUM EXOTICARUM, a voluminous book of 912 pages, was published in Germany in 1712.
The records of these two travellers, however, did not draw much attention. One” hundred years later Desjardin in his HISTOIRE DE LA CHIRURGIE (Paris 1774) mentions again Ten Rhyne and Vicq d’Azyr in his ENCYCLOPÉDIE MÉTHODIQUE (1787) spoke of the records of Ten Rhyne as well those of Engelbert Kämpfer and expressed regret that these methods had not yet been used and thus it was not clear whether they were worthy of studying or not.
As the first physician who applied acupuncture in practice, the Frenchman Louis Berlioz (1776-1849), father of the composer Hector Berlioz, is often mentioned. He cured mostly nervous diseases by this method. After some successful trials acupuncture came to be studied and used more intensively in France as well as in England and very soon it became a fashion. It was used as a miraculous treatment for all diseases. The knowledge of acupuncture, however, was insufficient (too long needles were used and the lying insertions lasted sometimes over 20-30 hours), and the European physicians had no practical experience whatsoever. This was the reason of the setback after a wave of enthusiasm and acupuncture was forgotten again. When Dabry (1842-1898) published his work LA MEDECINE CHEZ LES CHINOIS in 1863, Europe showed little interest for this ancient medical treatment. Credit must be given to Soulié de Morant for his attitude toward acupuncture. Born in 1878 in Paris, he became a consul at the French Embassy in Shanghai, where he devoted himself to the study of Chinese language and literature. He maintained that it was the miraculous effects of acupuncture that led him to study Chinese medicine. When duties took him to Yunan, he witnessed how an rampant epidemic of cholera was checked more effectively by needles than by any drugs known at that time. After his return to Europe he propagated acupuncture, but met only mistrust and suspicion until Dr Ferreyolles encouraged him to write about it. His duty was to translate those documents concerning acupuncture in which the physician might be interested. On the basis of his translations doctors Martiny M. and Martiny Th. carried out their experiments. Morant’s most famous works are PRÉCIS DE LA VRALE ACUPONCTURE CHINOISE (1934), L’ACUPONCTURE CHINOISE (1939-41) and TRAITÉ D’ACUPONCTURE.
He used Chinese sources (mostly Yang Jizhou’s ZHENJIU-DACHENG) as well as Japanese sources. Now in Europe every student of acupuncture must become acquainted with Morant’s work. It is due to him that this branch of ancient Chinese medicine widespread in France. Acupuncture is also very popular in West Germany, it is practised in England and since 1956 it has been studied systematically in Soviet Union. Recently it has begun to be studied in some of the socialist countries of Eastern Europe.