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Traditional ideas about acupuncture are popular today in the West, where their presumed antiquity is an important part of their appeal. Enthusiasm for acupuncture is often coupled with condemnation of the ‘reductionism’ that is supposed to characterise modern medicine. Yet present-day Chinese researchers often wish to reconcile acupuncture with science; it is notable how many papers from China are now appearing in the pages of Acupuncture in Medicine. This approach is quite similar to that advocated by Felix Mann in the 1970s, which essentially regards acupuncture as a form of sensory stimulation that modifies the activity of the nervous system and relies on a modern understanding of anatomy and neurophysiology.1
New light on the origin of modern acupuncture
From this outline we see that there must have been a considerable shift in opinion in China in the fairly recent past. Hitherto there has been little information available to Westerners to explain how, when, and why this occurred. The gap in our knowledge has now been filled, thanks to a new book by Andrews,2 and the answers that she comes up with are surprising, to say the least. Anyone who thinks there was a more or less continuous progression in acupuncture from the earliest times to the present, perhaps with one or two temporary interruptions along the way, is in for a shock. What we see instead is a major discontinuity followed by a pretty radical reconstruction.
Andrews is an associate professor of East Asian history at Bentley University in the Boston area and teaches history of medicine at the New England School of Acupuncture. She has a PhD from Cambridge University in the history of Chinese medicine and has studied at two Chinese universities. She has also held a postdoctoral fellowship at the London University School of Oriental and African Studies. Her new book covers all aspects of medicine in China, but the history of acupuncture in the 20th century receives detailed treatment in chapter 8, where there is important information for acupuncture practitioners.
The recency of modern acupuncture
Probably the most remarkable fact to emerge from Andrews's studies is that acupuncture as we have it today is quite recent; in fact, it goes back only as far as the 1930s. Its scope and its tools are now very different from what they were in earlier times, when it overlapped with minor surgery (eg, abscess drainage). Back then, it made use of large thick needles of various shapes, including straight and hooked scalpels, retractor hooks, and drains. Many of the sets in the London Science Museum's ‘acupuncture’ collection do not contain any fine needles at all.
Acupuncture was not used by high-class physicians in the 19th century and was practised only by lower-class, often illiterate, healers. In 1757 a Confucian physician, Xu Dachan, described it as a lost art, complaining that he could not find a ‘learned’ teacher. In 1822 the teaching and practice of acupuncture and moxibustion were banned from the Imperial Medical Academy which was responsible for the medical care of the imperial household. A Ming dynasty novel alludes to acupuncture and moxibustion as treatments practised by a disreputable old woman who was patronised as a healer by the female characters. So how was acupuncture rehabilitated, and where do the description of acupuncture points in terms of modern anatomy and the routine use of fine acupuncture needles come from? The answer is Japan.
The role of Japan in Chinese medicine
The role of Japan in the development of modern Chinese medicine is important but it has not received the attention it deserves. Many people probably assume that the current of knowledge flowed in the opposite direction, and it is true that in earlier times Japanese medicine was informed by Chinese ideas. But by the 1930s the current had reversed its direction and Japanese medical ideas were entering China. The Japanese had preserved medical techniques, including acupuncture, that had been lost in China. However, medicine had undergone a transformation in Japan, which by that stage had modernised itself. The Japanese had adopted Western medicine, and although traditional medicine still existed, it too had been partly westernised. Japanese acupuncture had similarly been transformed by Western influence.
The revival of acupuncture in China
In the 1930s many Chinese doctors went to Japan to study and the medicine they encountered there was Western or Western-influenced. On their return to China they brought these ideas with them. One of these doctors was Cheng Dan'an (1899–1957) who played a decisive role in the revival of acupuncture in China. As a young man he studied both Chinese and Western medicine and then helped his father, also a physician, in his practice. When he suffered severe backache his father cured him with acupuncture after failing to do so with Western medicine, and this stimulated Cheng's interest. He began to practise acupuncture himself and to write about it. In 1931 he published a very influential book on acupuncture and moxibustion, in which he noted the virtual disappearance of these forms of treatment in China and drew on Japanese sources. In 1934 he went to Japan for a year to learn Japanese and study at the Tokyo College of Acupuncture.
Cheng revised the locations of the acupuncture points, which were not standardised in his day, basing them on Western anatomy. He said that the acupuncture tracts ‘meridians’ were a functional system that included the nerves, blood vessels and lymph nodes described by Western anatomists. Most remarkably of all, he held that acupuncture works exclusively via the nervous system. On a practical level, Cheng followed the Japanese in using fine needles like those we are accustomed to today. And he disapproved of the former practice of needling arteries deliberately. He thought that this had been done because acupuncturists were trying to reach the accompanying nerves, but there is another possible explanation. Kuriyama has suggested that acupuncture may have arisen from the practice of bloodletting, which was used at much the same time in China and Europe.3 This would have provided another reason for needling blood vessels.
Cheng's work constituted a remarkable fusion between Chinese and Western concepts of the body, in which “we see, for the first time, a Chinese medical physiology superimposed on an unambiguously Western anatomy”.2 To appreciate the revolutionary nature of this blending of East and West we have to remember that, contrary to what is sometimes said, the Chinese in earlier times did not practise dissection or study anatomy in the modern sense.3 Cheng’s decision to base the acupuncture points on Western anatomy was therefore a major innovation.
Anticipating Western medical acupuncture
There is little doubt that if Cheng Dan'an were alive today he would approve of the non-traditional form of acupuncture used by many Western health professionals. This is often called Western medical acupuncture, and given that the acupuncture revival in China in the 1930s was influenced by Japanese acupuncture, which itself was Western-influenced, this seems historically appropriate. Cheng's anticipation of Mann's view that acupuncture works via the nervous system is particularly striking. Mann could be seen as a successor to Cheng, although it is likely that he arrived at his view independently, on the basis of his own clinical experience.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.