...or How Acupuncture Almost Disappeared in Early 20th Century China and How the Politics of Its Revival Affects Our Practice in the West Today
"Who knows only his own generation remains forever a child"
...Cicero
It is my experience that many Western practitioners of acupuncture have an interest in the history of Chinese medicine, its development through the centuries, and how the history has an impact on all of us as practitioners. I also know that the history of Chinese medicine is not widely known here in the West. Some schools have a short obligatory course on the subject, but few give it more than a nod because the curriculum is already so lengthy. Clinical knowledge seems, and indeed may be, more important.
In 2008, when Bob wrote the first version of this white paper on the modern history of acupuncture in China, it was destined only as another article on the Blue Poppy website. After reading it, however, I thought it deserved more exposure than that. At the time, we were working on a revised edition of an older book, Sticking to the Point: A Step-by-Step Approach to TCM Acupuncture Therapy. The information in Bob’s article seemed to me to dovetail perfectly with one main thesis of this book: that TCM-style acupuncture is a mature, effective, evidence-based system and not the ugly step-child it is occasionally made out to be. Thus, the book acquired a new opening chapter.
Still, no one book, essay, article, or blog has more than limited exposure to the total marketplace of readers. So I offer this material again in an edited version, but this time as a stand alone essay, with the hope that readers find the history enlightening. For my part, knowing more about the history of our medicine adds richness, depth, and appreciation to my knowledge and to my clinical practice as well.
This is a long blog...way longer than my usual (since it is actually an excerpt from a longer book). Whether you agree with the conclusions that Bob and I make in this piece, thanks for reading, and enjoy!
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The historical development of modern Chinese acupuncture is not a subject that most Western acupuncturists are familiar with. However, without at least some understanding of the history of our art in China, it is difficult to truly appraise and appreciate how acupuncture is taught and practiced in China today and, therefore, by extension how it is also taught and practiced at Chinese-dominated schools in the West. Frequently, competing schools and styles of acupuncture in the health care marketplace denigrate modern Chinese acupuncture as being something lesser and debased. Based on our decades of study and practice of this style of acupuncture, we believe this opinion is untrue and obscures the strengths, both pedagogical and clinical, of this style of treatment. Therefore, we would like to say a few things to help set this record straight. Since the early development of acupuncture and moxibustion via the Nei Jing (Inner Classic) and Nan Jing (Classic of Difficulties) is relatively better known, we will begin in the Qing dynasty (1644-1911) when acupuncture was in decline in China and in danger of dying out altogether.
The state of acupuncture in the late Qing dynasty
According to White and Ernst in an article titled “A Brief History of Acupuncture:”
Interest in acupuncture among the Chinese declined from the seventeenth century onwards as it came to be regarded as superstitious and irrational. It was excluded from the Imperial Medical Institute by decree of the Emperor in 1822. The knowledge and skill were retained, however, either as an interest among academics or in everyday use by rural healers.1
From the onset of the Qing dynasty to the Opium Wars (1644-1840), herbal medicine became the main modality of the rising tide of professional scholar physicians and acupuncture was relegated to itinerant folk healers who were largely illiterate.2, 3 During this period in history, China was ruled by a foreign dynasty–the Man-zi or Manchus–and educated ethnic Chinese (the Han-zi) debated among themselves how their great country had come to such a sorry pass. One explanation for this calamity was that the Chinese people had strayed from their sturdy classical roots in Han dynasty Confucianism to the essentially foreign4 and “corrupting” influences of so-called Neo-confucianism. Those who felt this way advocated a national revival via a return to Han learning and especially a rejection of the Song-Jin-Yuan dynasty Neo-confucianism. This Han Xue Pai (School of Han Learning) affected all aspects of Chinese society during the Qing, including medicine, and Xu Da-chun (a.k.a. Xu Ling-tai), the most avid and articulate supporter of this movement within Chinese medicine criticized the acupuncturists of his day “for incorrect channel and point location, over-reliance on formula acupuncture, ignorance of the generic five-phase points, loss of supplementation and draining theory and technique, and ignorance of seasonal correspondences and the methods of internal medicine.”5
Although interested in learning acupuncture and recovering the medical skills of antiquity, Xu complained that he was unable to find anyone learned in acupuncture to teach him the practice.6 Thus, as Xu described, the art of acupuncture was in decline throughout this period. Many acupuncturists seemed to be no more than “pavement physicians” with poor training. Their clinic was often the marketplace; their knowledge of traditional Chinese medicine limited to say the least; their equipment filthy and of poor quality. The majority of “respectable” Chinese doctors practiced herbal medicine and massage rather than acupuncture and moxibustion.7 A contemporary saying asserted that acupuncture needling and moxa cautery were absolutely inappropriate for all gentlemen. Carried out by ignorant itinerants or illiterate elderly women with no knowledge of either anatomy or sanitation, acupuncture and moxibustion frequently resulted in disfiguring burns or festering wounds.8 The final ignominy for acupuncture in China arrived in 1929 when it was outlawed, along with other forms of traditional medicine.9 In fact, by the 1930s, there was only one acupuncturist in all of Canton.10
At the beginning of the 20th century, China’s last imperial government abolished the civil service examination system in 1905 and set up a system of technical schools based on the German-Japanese model, and other educators followed suit with their own technical colleges. Hence, supporters of Chinese medicine also began establishing technical colleges of Chinese medicine during the 1910s and 1920s, but none of these new curricula included acupuncture.11 In 1936, the Nationalist Government first published its regulations governing the licensure of Chinese medicine physicians. These physicians were required to pass examinations in numerous medical subjects, including anatomy and physiology, but the regulations failed to list acupuncture as a necessary or even a desirable skill.12
Cheng Dan-an & the reinvigoration of acupuncture in China
It was Cheng Dan-an who reintroduced and reinvigorated the study and practice of acupuncture in south China during the 1930s. Cheng lived from 1899-1957 and used Western anatomy to rehabilitate acupuncture as a respectable skill. Cheng visited Japan in the early 1930s and studied acupuncture there. This is where he was also exposed to Western ideas about anatomy and physiology as well as Japanese acupuncturists’ responses to these.13 When Cheng returned to China in 1933, he opened the first modern acupuncture college in Wuxi. In Chinese Acupuncture and Moxibustion Therapeutics (1932), Cheng insisted that acupuncture must be an effective medical therapy because its mechanism of action was the stimulation of the nerves described in European medical theory. Therefore, Cheng repositioned the classical acupoints away from blood vessels (where previously they might have been used for blood-letting) and toward the nerve pathways. He illustrated his revisions by painting the new acupuncture pathways onto the skin of volunteers and then photographing them, a technique that gave his book a greater air of modernity and reflected the increasingly common use of photographic illustrations in European medical books of the time. Cheng's new “scientific” acupuncture was a great success in China. His book went through many editions from 1930 to 1960, and he set up his own college of acupuncture. Graduates of Cheng’s college went on to become important acupuncture practitioners and educators throughout the world. For instance, the late James Tin Yau So, founder of the New England School of Acupuncture, and Ted Kaptchuk, author of The Web That Has No Weaver, were both trained by direct students of Cheng Dan-an.14 Cheng achieved such prominence in the Chinese medical community that after the Communist takeover in 1949, he was asked to serve on several national committees in charge of medical policy and education. Cheng’s work helped acupuncture regain sufficient credibility to be reincorporated into the teaching and practice of the new Chinese medicine.
If we look at Cheng’s Zhong Guo Zhen Jiu Xue (A Study of Chinese Acupuncture & Moxibustion) published by the People’s Health & Hygiene Press, in 1957,15 what we see is that each chapter is devoted to a traditional Chinese disease category, such as damage due to cold, warm heat diseases, vacuity taxation, coughing and wheezing, etc. Under each disease, Cheng then discusses its disease causes, signs and symptoms, a basic acupuncture-moxibustion treatment protocol, modifications to that protocol, recommended adjunctive treatment (typically very simple herbal formulas, and not recommended in every case), the condition’s prognosis, classical references, and Cheng Dan-an’s personal comments or “notes.” In some cases, there is also a rudimentary discrimination of patterns. In terms of the acupuncture treatment protocols, Cheng gives specific instructions for needling each point. He also recommends moxibustion (usually direct, non-scarring moxibustion) and bleeding.
Communism & acupuncture in China
In 1927, the Chinese Communist Party (CCP) and the Kuomintang (KMT, Guo Min Dang) split and the CCP was massacred, with more than four of every five members being killed. The only major section of the party which survived was the section built around Mao Ze-dong which established the Soviet Republic of China in some remote areas within China. After a number of military assaults by the KMT against these enclaves, the CCP had to give up their bases and started their “Long March” (1934-1935) in search of a new base.16 During the Long March, Mao Ze-dong and his followers were largely without modern medical supplies. Thus they were forced to rely on indigenous healers and their methods, including acupuncture-moxibustion. In this way, the new leaders of the Communist Party got a firsthand experience of these modalities and their benefits.
In 1940, the Communist Party set forth a policy of creating a “new democratic culture.” This new culture took as its by-words the new (xin), science (ke xue), and unity (tuan jie). The “new” meant freedom from superstition from the past. Because of the accretionist nature of traditional Chinese society, practical life had become difficult due to so many traditions and beliefs constraining each and every activity. People could not do what needed to be done efficiently and effectively because of the accretion of so many traditional rules and regulations, rituals, and beliefs. By “science,” Mao did not mean the Western scientific method per se but rather the validation of ideas through practical experience. In terms of medicine, these two principles led to the CCP’s support of evidence-based medicine (EBM, although that term was decades away from being coined). “Unity” meant the unification of an empire into a single country, a collection of different peoples into a single people with a single language and culture. Unity also meant that knowledge should be pooled for the benefit of all and that secret, family lore, including medical lore, should become the property of all.17 These principles have had a great impact on the development of Chinese medicine and acupuncture-moxibustion in the People’s Republic of China ever since, and I do not think they are necessarily bad or unnecessary principles.
On October 30, 1944, Mao gave a speech titled “The United Front in Cultural Work” where he called for the up-dating of “old,” i.e., Chinese, medicine with “new” Western medicine in order to create a consolidated form of medicine, a new synthesis which could satisfy the health needs of the Chinese nation. Shortly after this speech, a meeting was called between traditional Chinese and modern Western doctors in the region controlled by the CCP in order to explore “the scientification of Chinese medicine and the popularization of Western medicine.” At this meeting, Ren Zou-tian (1886-1950) offered to teach Western medical practitioners acupuncture and moxibustion so that they could research its healing effects. Zhu Lian, a Western-style MD at that meeting, signed up to take Ren Zou-tian’s class. Zhu was one of the few who continued their study of this art until well after Liberation (1949), eventually publishing her Xin Zhen Jiu Xue (New Acupuncture-Moxibustion). Zhu organized her book according to modern Western medical disease categories and got rid of such traditional concepts of qi, yin, yang, and the five phases. She also eliminated the channel system as a way of organizing the acupoints and introduced the points by body part. Like Cheng Dan-an, she believed that acupuncture worked mainly by way of the nerves. However, at roughly the same time, Lu Shou-yan (1909-1969) published a book titled Zheng Jiu Zheng Zong (A Gathering of Orthodox Acupuncture & Moxibustion). While Lu also organized his book by Western medical diseases, he kept the channel and network vessel system.18 Thus we see that Zhu’s radical elimination of traditional Chinese medical theory from the “New Acumoxa” was short-lived and never wholly supported. In fact, Zhu’s influence waned through the 1950s. Nevertheless, she was instrumental in the preservation and development of acupuncture during the early days of New China.19
The advent of Chinese medical colleges
A number of private Chinese medical colleges, organized similar to Western-style colleges and universities as opposed to the old master-disciple apprenticeship, had been founded in Republican China, especially in Shanghai. However, in 1956, government-supported colleges of Chinese medicine were founded in Shanghai, Guangzhou, Chengdu, and Beijing.20 These colleges all had departments of acupuncture and moxibustion,21 and these departments needed textbooks and curricula.22 In creating such didactic materials, “the new,” “science,” and “unity” were still basic principles promoted by the CCP. Superstitions were eliminated, the remainder was clinically and sometimes even experimentally verified, and a concerted attempt was made to synthesize the various family, regional, and theoretical schools of acupuncture. In this effort, the classics and other premodern texts on acupuncture-moxibustion were consulted and cited. However, individual experimentation with self-needling was also encouraged in an attempt to find out the “truth” of past practices and prohibitions. Therefore, there was an attempt to blend the best of the past with A) what was clinically verifiable in the present and B) Western biomedical anatomy, physiology, pathophysiology, and disease categorization and diagnosis.
In addition, since internal or so-called herbal medicine had risen to preeminence within the practice of Chinese medicine since at least the beginning of the Qing dynasty, most of the famous “old Chinese doctors”23 involved in this reorganization and systematization were themselves primarily practitioners of internal medicine. In attempting to create a single systematized methodology for diagnosis and treatment, these leaders essentially adopted and adapted the methodology of Chinese herbal medicine to acupuncture and moxibustion. By this I mean the step-by-step movement from disease diagnosis (now a modern Western disease followed by corresponding traditional Chinese medical diseases) to pattern discrimination to treatment principles to treatment plan, with the treatment plan consisting of a basic formula which is then modifiable by additions and subtractions as individually necessary. Under the rubric of unity, this basic methodology was applied to Chinese herbal medicine, acupuncture-moxibustion, tui na or Chinese medical massage, Chinese dietary therapy, and all the other modalities and specialties that were incorporated into the state-endorsed and promoted version of Chinese medicine. Because of this unification of methodology, Chinese doctors could now speak to one another and share information, peer review one another, refer over the length and breadth of China, and teach efficiently. Students were taught a step-by-step methodology which had standards of right and wrong as well as standards of care (SOC).
This adoption of the methodology of internal medicine resulted in the “herbalization” of Chinese acupuncture and moxibustion. Prior to this, acupoints were not ascribed theoretical functions. Now they were. Therefore, one could now say that Zu San Li (St 36) fortifies the spleen and supplements the qi, harmonizes the middle and disinhibits the qi dynamic. These theoretical functions are simply abstractions based on a Chinese medical understanding of the disease mechanisms responsible for the diseases a point is empirically known to remedy, i.e., its clinical indications. An example of this “herbalization” of acupuncture during this time is Wang Le-ting’s creation of acupuncture formulas based on the theories of Li Dong-yuan in which each acupoint is described as if it were a corresponding medicinal in one of Li’s formulas. Thus Wang had acupuncture analogs to Li’s Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) and Tiao Zhong Yi Qi Tang (Regulate the Center & Boost the Qi Decoction) among others.24 Wang was a very famous acupuncturist and teacher of acupuncture in northern China, and his formulas and methods were very influential during the 1970s and 1980s.
The Cultural Revolution
No account of the development of modern Chinese medicine can fail to include the Cultural Revolution. The “Great Proletarian Cultural Revolution” was a struggle for power within the Communist Party of China that manifested as wide-scale social, political, and economic chaos which grew to include large sections of Chinese society and eventually brought the entire country to the brink of civil war. It was launched by Mao Ze-dong, the Chairman of the CCP, on May 16, 1966 officially as a campaign to rid China of its “liberal bourgeoisie” and to continue revolutionary class struggle.25 Once set in motion, the Cultural Revolution generated waves of power struggles between rival factions both nationally and locally. Although Mao himself officially declared the Cultural Revolution to have ended in 1969, the term is today widely used to also include the period between 1969 and the arrest of the Gang of Four in 1976.26
During the Cultural Revolution, political correctness was prized above all else under the motto, “Better Red than expert.” In fact, all schools were shut down, including medical colleges, both Western and Chinese. In order to provide minimal health care to the masses, so-called barefoot doctors were trained in three and sixth month “paramedic” classes seasoned with heavy doses of political indoctrination. Since acupuncture in its simplest form is easy to teach and learn and since it is a prototypically Chinese art, acupuncture was an important part of this paramedic training. This acupuncture, called New Acumoxa, was a stripped down form that could be taught in a matter of weeks, not years. It used a repertoire of only the most famous points for basically symptomatic indications along with very strong stimulation. In addition, the few books on this “People’s” form of acupuncture that were published (some of which were translated into English) included verbose passages of hortatory party rhetoric. Since the influence of the Cultural Revolution lasted until 1976, and Nixon “opened” China to the West in 1972, it was this New Acumoxa that suddenly was exported to the West.27
This super-simplified version of acupuncture was denigrated by overseas (KMT) Chinese acupuncturists as “Maoist acupuncture” or “Communist acupuncture.” I [Bob] can remember my first acupuncture teacher, the late Eric Tao (Hsi-yu), reading to us from an acupuncture book published in China during the Cultural Revolution and mocking the politically inspired passages. And it is true this New Acumoxa was only a pale reflection of this ancient art. It is also true that during the Cultural Revolution, access to the premodern classics of Chinese medicine was drastically curtailed. Teachers at the state college of Chinese medicine who had advocated such “archaic” things as five phase theory were beaten and even forced to commit suicide because of their “feudal,” “reactionary” beliefs.
However, by the late 1970s, the state colleges of Chinese medicine were open again along with their libraries. Teachers who had been “sent down to the countryside” were brought back and reinstated, and the Chinese became aware of Westerners’ growing interest in acupuncture. In order to export this great indigenous Chinese art to the rest of the world, the four main colleges of Chinese medicine–Shanghai, Beijing, Nanjing, and Guangzhou–developed three month crash courses in acupuncture-moxibustion for foreigners. These three month courses were jointly sponsored and endorsed by the World Health Organization (WHO) and were aimed primarily at Western MDs.28 In order to have a textbook for these courses, the Foreign Languages Press in Beijing compiled and published what was first know as Outline of Chinese Acupuncture & Moxibustion. Several years later, this became Essentials of Chinese Acupuncture & Moxibustion which became Introduction to Chinese Acupuncture & Moxibustion. This book was created specifically to teach acupuncture to Western MDs in a very short period of time. While the theory this book contained was more than that of the New Acumoxa of the Cultural Revolution, it was highly simplified, as suggested by its names “Outline” and “Essentials.” This was due to two different points of view held by the Chinese at that time. First, Chinese believed that there was only so much Westerners could understand of traditional Chinese culture. Therefore, theory was kept to a minimum and technical medical terms were commonly and inexactly translated by Western biomedical terms. Secondly, there was only so much of their nation’s precious secrets these Chinese wanted to share with foreigners. During this time, I [Bob] was told that I was not allowed to purchase more in-depth Chinese books on acupuncture and Chinese medicine because I was a foreigner, that such teachings were nei bu (内部), for internal consumption only. The point I am getting at here is that the Chinese medicine taught to foreigners in the late 1970s and early-to-mid- 1980s was not necessarily representative of the state of the art in China itself. By the early 1980s, doctors were free to read any of the thousands of premodern books contained in their schools’ libraries, and they were free to explore in clinic a wide variety of theories and treatment approaches. Therefore, by the mid-1980s, any perceived paucity of information or lack of depth in the study and practice of Chinese medicine in China , including acupuncture-moxibustion, was only that, a lack of knowledge on the part of Westerners of the state of the art in China because of distance and inability to read the primary language literature in its original language. By this time, the political harangues of the Cultural Revolution had been edited out of books and other teaching materials. What remained were those theories and techniques which had been proven to work in clinic.
By proven here, we do not just mean based on the anecdotal evidence of individual case histories. Chinese students and doctors have been engaged now for decades in doing both clinical and experimental research verifying that acupuncture-moxibustion does work. Scores (if not hundreds) of well-designed studies are published in Chinese medical journals each year. These consist of retrospective cohort studies and prospective, randomized, comparison trials. Not only is there a huge body of evidence that acupuncture works, there is also a huge body of clinical and experimental evidence of how it works in terms of Western biomedicine.
The strong points of modern Chinese acupuncture
Over the last 30 years or more, we have studied most of the main national and many individual styles of acupuncture: Japanese meridian acupuncture, Korean constitutional acupuncture, Taiwanese five phase acupuncture, Leamington (or Worsleyan) five element acupuncture, European biomedical acupuncture, and modern Vietnamese acupuncture to name a few, and, personally, we find nothing second-rate or lesser about modern Chinese acupuncture from the People’s Republic of China. In fact, we find a lot about modern Chinese acupuncture that I think is worthwhile and even superior to other available styles.
First, through a process of broad-based study, clinical and experimental research, and consensus among the eminent Chinese acupuncturists of the mid-20th century, the superstitious, clinically unverifiable accretions of 2,000 years have been rightfully winnowed, separating the wheat from the chaff. As a neophyte, I [Bob] often worried that the Chinese had “thrown the baby out with the bathwater.” However, three decades on, I no longer feel that way. As I myself have become a more knowledgeable and mature practitioner, I see that many of my naive and romantic Orientalist beliefs were just that, naive and romantic and not grounded in clinical reality. I know of nothing in the history of Chinese medicine which is clinically efficacious that is not currently available in modern Chinese medicine, including acupuncture and moxibustion. The study and consensus that resulted in the systematization of Chinese medicine and acupuncture was not carried out by uneducated political hacks but by the greatest Chinese scholar-doctors and clinical practitioners of their day, and I believe these preeminent authorities did an excellent job overall.
Secondly, this system is organized in such a way that it is relatively easy to teach with generally reproducible results. One only has to look at the number of U.S. acupuncture schools (approximately 60 as of this writing) basically teaching the Chinese medical and acupuncture curriculum developed in China in the mid-20th century and the number of graduates they turn out each year able to pass state and national licensing examinations. While some of these graduates may fail to succeed at private practice, in my experience this is not due to their Chinese medical education as much as it has to do with their lack of preparation to be small business owners and entrepreneurs.
Third, this system has a definite, step-by-step methodology that can be critiqued and peer-reviewed at every step of the way. Using this system of practice, there are not only good, better, and best answers, but there are also right and wrong answers to our patients’ clinical conundrum. This is important in our world which is increasingly dominated by third party payees (Workers’ Comp., private insurance, etc.) and their need for quality control. Because this system has definite standards, adherence to these standards can be judged by others.
Fourth, because this system has standards, it is “portable.” By this we mean that one can refer a patient to another practitioner of this system and have some assurance that treatment will be the same or basically similar to that initiated elsewhere. This is important because we live in a mobile society. One can only make good referrals if one can be sure of the quality of care the patient will receive from the practitioner to whom they are referred. Since there are norms within this system, such an assurance is possible (as long as one adheres to those norms).
Fifth, because so much research has been done in China using this system, there is a great deal of evidence backing up the clinical efficacy of this system. Unfortunately, too few Western students are currently able to read this literature in its original language, and there is also too much of it to realistically translate it all. Nevertheless, this Chinese research can tell us whether or not an acupuncture protocol works in patients with a specific pattern of a specific Western disease. In medicine, clinical outcomes are the bottom line, and there is no lack of clinical and experimental research using this system. Thus we can say that modern Chinese acupuncture most certainly is evidence-based medicine.
Conclusion
In our opinion, it is not modern Chinese acupuncture that is lacking in terms of either sophistication of theories or clinically effective techniques. Rather, in our experience, it is Western students’ and practitioners’ understanding and application of this system as a system that is responsible for most of its clinical failures outside the country of its origin. The more we non-Chinese practitioners understand and apply this system as it is applied in China, the better results we will see. This means not only picking the right points based on the patient’s pattern discrimination but also scheduling treatments close enough so that one treatment really does build on the positive effects of the previous one. In any case, it is our belief that modern Chinese acupuncture is not some debased form of acupuncture but rather it is as mature and clinically effective a form of this art as any the world has seen.
Endnotes:
1 White, A. & Ernst, E., “A Brief History of Acupuncture,” http://rheumatology.oxfordjournals.org/ cgi/content/full/43/5/662, last retrieved 3/11/2008
2 “History of Acupuncture in China,” http://www.acupuncturecare.com/acupunct.htm, Suvow, Scott, L.Ac., last retrieved 3/11/2008
3 For an excellent discussion and description of this rising tide in professional scholar-physicians, see Volker Scheid’s Currents of Tradition in Chinese Medicine 1626-2006, Eastland Press, Seattle, 2007.
4 Neo-confucianism was strongly influenced by Buddhism which had won the hearts and minds of the Chinese people during the Tang dynasty (618-907). In order to coopt this interest in Buddhist cosmology and metaphysics, Neo-confucianists attempted to put a Chinese face on this adopted cosmology and metaphysics. However, those who were interested in ethnic pride and, therefore, purity, saw Buddhism as a foreign import from India.
5 Fishman, Jon, “The History of Acupuncture,” http://www.acupuncture.com/education/theory/historyacu.htm, last retrieved 3/11/2008
6 Andrews, Bridie J., “Acupuncture and the Reinvention of Chinese Medicine,” http://www.ampainsoc.org/pub/bulletin/may99/history.htm, last retrieved 3/11/2008
7 Lewith, George T., “The History of Acupuncture in China,” http://www.healthy.net/scr/Article.asp?Id=1819&xcntr=8, last retrieved 3/11/2008
8 Andrews, op. cit.
9 White, A. & Ernst, E., op. cit., last retrieved 3/11/2008
10 Fishman, Jon, op. cit.
11 Andrews, op. cit.
12 Ibid.
13 Elman, Benjamin A., “On Their Own Terms: Science in China, 1550-1900”, http://books.google.com/ books?id=KPEpPhlzPg0C&pg=PA408&lpg=PA408&dq=cheng+%22dan+an%22&source=web&ots=mqYgUdTSR-&sig=qj-ytPvBw_EOZ_ 8vgNDygFx6WlU&hl=en#PPA408,M1, last retrieved 3/11/2008
14 Dr. So’s Mandarin name was Su Tian-you. He was a student of Zeng Tian-zhi, a brilliant disciple of Cheng Dan-an. Dr. So began practicing medicine in 1939 and established Acupuncture and Moxibustion Medical College of Hong Kong in 1940. Dr. So lived and worked in a number of different countries during his life and founded a number of acupuncture colleges. He is sometimes respectfully referred to as “the father of American acupuncture and moxibustion.”
15 A partial translation of this book is available under the title of Acupuncture and Moxibustion Formulas & Treatments, translated and edited by Wu Ming, Blue Poppy Press, Boulder, CO, 1996.
16 “The Communist Party of China,” Wikipedia, http://en.wikipedia.org/wiki/ Communist_Party_of_China, last retrieved 3/11/2008
17 Hsu, Elizabeth, “Innovation in Chinese Medicine,” http://books.google.com/books?id= BbYYstLfSyUC&pg=RA1-PA354&lpg=RA1-PA354&dq=cheng+%22dan+an%22&source= web&ots=kE02iVok6A&sig=zfrS1bynu5i3GqPrCO_Qa-ihzkA&hl=en#PRA1-PA345,M1, last retrieved 3/11/2008
18 Ibid.
19 New China is the CCP’s term for China after Liberation in 1949.
20 “2000 Years of Chinese Acupuncture,” http://www.iastam.org/collateral/TAC _Exhibition.pdf, last retrieved 3/11/2008
21 In the ensuing years, many more provincial and metropolitan colleges of Chinese medicine were founded, so that every province and major city has such a college, all with acupuncture and moxibustion departments.
22 In particular, much of the development of this standardized Chinese medical curriculum took place at the Shanghai College of Chinese Medicine, now the Shanghai University of Chinese Medicine & Pharmacology. This university is the lineal successor of the private Chinese medical colleges founded in Shanghai (primarily by the students of Ding Gan-ren) during the Republican period. Therefore, in a sense, the early teachers at the Shanghai College of Chinese Medicine were simply carrying forward a process of systematizing Chinese medicine and its teaching that had started well before the advent of New China.
23 Lao zhong yi, old Chinese doctor, is a title of respect attesting to both clinical acumen and efficacy. It is not just a recognition of a doctor’s chronological age. This title implies that it takes many years for one’s understanding and practice of Chinese medicine to really mature. This is because of the volume of (oftentimes conflicting) information that must be retained precisely as well as the judgment based on clinical experience that is necessary for this information’s successful application. Lao yi sheng are the senior teachers, authors, and theoreticians of Chinese medicine.
24 For more information on Wang Le-ting’s formulas, see Golden Needle Wang Le-ting: A 20th Century Master’s Approach to Acupuncture by Yu Hui-c
"Who knows only his own generation remains forever a child"
...Cicero
It is my experience that many Western practitioners of acupuncture have an interest in the history of Chinese medicine, its development through the centuries, and how the history has an impact on all of us as practitioners. I also know that the history of Chinese medicine is not widely known here in the West. Some schools have a short obligatory course on the subject, but few give it more than a nod because the curriculum is already so lengthy. Clinical knowledge seems, and indeed may be, more important.
In 2008, when Bob wrote the first version of this white paper on the modern history of acupuncture in China, it was destined only as another article on the Blue Poppy website. After reading it, however, I thought it deserved more exposure than that. At the time, we were working on a revised edition of an older book, Sticking to the Point: A Step-by-Step Approach to TCM Acupuncture Therapy. The information in Bob’s article seemed to me to dovetail perfectly with one main thesis of this book: that TCM-style acupuncture is a mature, effective, evidence-based system and not the ugly step-child it is occasionally made out to be. Thus, the book acquired a new opening chapter.
Still, no one book, essay, article, or blog has more than limited exposure to the total marketplace of readers. So I offer this material again in an edited version, but this time as a stand alone essay, with the hope that readers find the history enlightening. For my part, knowing more about the history of our medicine adds richness, depth, and appreciation to my knowledge and to my clinical practice as well.
This is a long blog...way longer than my usual (since it is actually an excerpt from a longer book). Whether you agree with the conclusions that Bob and I make in this piece, thanks for reading, and enjoy!
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The historical development of modern Chinese acupuncture is not a subject that most Western acupuncturists are familiar with. However, without at least some understanding of the history of our art in China, it is difficult to truly appraise and appreciate how acupuncture is taught and practiced in China today and, therefore, by extension how it is also taught and practiced at Chinese-dominated schools in the West. Frequently, competing schools and styles of acupuncture in the health care marketplace denigrate modern Chinese acupuncture as being something lesser and debased. Based on our decades of study and practice of this style of acupuncture, we believe this opinion is untrue and obscures the strengths, both pedagogical and clinical, of this style of treatment. Therefore, we would like to say a few things to help set this record straight. Since the early development of acupuncture and moxibustion via the Nei Jing (Inner Classic) and Nan Jing (Classic of Difficulties) is relatively better known, we will begin in the Qing dynasty (1644-1911) when acupuncture was in decline in China and in danger of dying out altogether.
The state of acupuncture in the late Qing dynasty
According to White and Ernst in an article titled “A Brief History of Acupuncture:”
Interest in acupuncture among the Chinese declined from the seventeenth century onwards as it came to be regarded as superstitious and irrational. It was excluded from the Imperial Medical Institute by decree of the Emperor in 1822. The knowledge and skill were retained, however, either as an interest among academics or in everyday use by rural healers.1
From the onset of the Qing dynasty to the Opium Wars (1644-1840), herbal medicine became the main modality of the rising tide of professional scholar physicians and acupuncture was relegated to itinerant folk healers who were largely illiterate.2, 3 During this period in history, China was ruled by a foreign dynasty–the Man-zi or Manchus–and educated ethnic Chinese (the Han-zi) debated among themselves how their great country had come to such a sorry pass. One explanation for this calamity was that the Chinese people had strayed from their sturdy classical roots in Han dynasty Confucianism to the essentially foreign4 and “corrupting” influences of so-called Neo-confucianism. Those who felt this way advocated a national revival via a return to Han learning and especially a rejection of the Song-Jin-Yuan dynasty Neo-confucianism. This Han Xue Pai (School of Han Learning) affected all aspects of Chinese society during the Qing, including medicine, and Xu Da-chun (a.k.a. Xu Ling-tai), the most avid and articulate supporter of this movement within Chinese medicine criticized the acupuncturists of his day “for incorrect channel and point location, over-reliance on formula acupuncture, ignorance of the generic five-phase points, loss of supplementation and draining theory and technique, and ignorance of seasonal correspondences and the methods of internal medicine.”5
Although interested in learning acupuncture and recovering the medical skills of antiquity, Xu complained that he was unable to find anyone learned in acupuncture to teach him the practice.6 Thus, as Xu described, the art of acupuncture was in decline throughout this period. Many acupuncturists seemed to be no more than “pavement physicians” with poor training. Their clinic was often the marketplace; their knowledge of traditional Chinese medicine limited to say the least; their equipment filthy and of poor quality. The majority of “respectable” Chinese doctors practiced herbal medicine and massage rather than acupuncture and moxibustion.7 A contemporary saying asserted that acupuncture needling and moxa cautery were absolutely inappropriate for all gentlemen. Carried out by ignorant itinerants or illiterate elderly women with no knowledge of either anatomy or sanitation, acupuncture and moxibustion frequently resulted in disfiguring burns or festering wounds.8 The final ignominy for acupuncture in China arrived in 1929 when it was outlawed, along with other forms of traditional medicine.9 In fact, by the 1930s, there was only one acupuncturist in all of Canton.10
At the beginning of the 20th century, China’s last imperial government abolished the civil service examination system in 1905 and set up a system of technical schools based on the German-Japanese model, and other educators followed suit with their own technical colleges. Hence, supporters of Chinese medicine also began establishing technical colleges of Chinese medicine during the 1910s and 1920s, but none of these new curricula included acupuncture.11 In 1936, the Nationalist Government first published its regulations governing the licensure of Chinese medicine physicians. These physicians were required to pass examinations in numerous medical subjects, including anatomy and physiology, but the regulations failed to list acupuncture as a necessary or even a desirable skill.12
Cheng Dan-an & the reinvigoration of acupuncture in China
It was Cheng Dan-an who reintroduced and reinvigorated the study and practice of acupuncture in south China during the 1930s. Cheng lived from 1899-1957 and used Western anatomy to rehabilitate acupuncture as a respectable skill. Cheng visited Japan in the early 1930s and studied acupuncture there. This is where he was also exposed to Western ideas about anatomy and physiology as well as Japanese acupuncturists’ responses to these.13 When Cheng returned to China in 1933, he opened the first modern acupuncture college in Wuxi. In Chinese Acupuncture and Moxibustion Therapeutics (1932), Cheng insisted that acupuncture must be an effective medical therapy because its mechanism of action was the stimulation of the nerves described in European medical theory. Therefore, Cheng repositioned the classical acupoints away from blood vessels (where previously they might have been used for blood-letting) and toward the nerve pathways. He illustrated his revisions by painting the new acupuncture pathways onto the skin of volunteers and then photographing them, a technique that gave his book a greater air of modernity and reflected the increasingly common use of photographic illustrations in European medical books of the time. Cheng's new “scientific” acupuncture was a great success in China. His book went through many editions from 1930 to 1960, and he set up his own college of acupuncture. Graduates of Cheng’s college went on to become important acupuncture practitioners and educators throughout the world. For instance, the late James Tin Yau So, founder of the New England School of Acupuncture, and Ted Kaptchuk, author of The Web That Has No Weaver, were both trained by direct students of Cheng Dan-an.14 Cheng achieved such prominence in the Chinese medical community that after the Communist takeover in 1949, he was asked to serve on several national committees in charge of medical policy and education. Cheng’s work helped acupuncture regain sufficient credibility to be reincorporated into the teaching and practice of the new Chinese medicine.
If we look at Cheng’s Zhong Guo Zhen Jiu Xue (A Study of Chinese Acupuncture & Moxibustion) published by the People’s Health & Hygiene Press, in 1957,15 what we see is that each chapter is devoted to a traditional Chinese disease category, such as damage due to cold, warm heat diseases, vacuity taxation, coughing and wheezing, etc. Under each disease, Cheng then discusses its disease causes, signs and symptoms, a basic acupuncture-moxibustion treatment protocol, modifications to that protocol, recommended adjunctive treatment (typically very simple herbal formulas, and not recommended in every case), the condition’s prognosis, classical references, and Cheng Dan-an’s personal comments or “notes.” In some cases, there is also a rudimentary discrimination of patterns. In terms of the acupuncture treatment protocols, Cheng gives specific instructions for needling each point. He also recommends moxibustion (usually direct, non-scarring moxibustion) and bleeding.
Communism & acupuncture in China
In 1927, the Chinese Communist Party (CCP) and the Kuomintang (KMT, Guo Min Dang) split and the CCP was massacred, with more than four of every five members being killed. The only major section of the party which survived was the section built around Mao Ze-dong which established the Soviet Republic of China in some remote areas within China. After a number of military assaults by the KMT against these enclaves, the CCP had to give up their bases and started their “Long March” (1934-1935) in search of a new base.16 During the Long March, Mao Ze-dong and his followers were largely without modern medical supplies. Thus they were forced to rely on indigenous healers and their methods, including acupuncture-moxibustion. In this way, the new leaders of the Communist Party got a firsthand experience of these modalities and their benefits.
In 1940, the Communist Party set forth a policy of creating a “new democratic culture.” This new culture took as its by-words the new (xin), science (ke xue), and unity (tuan jie). The “new” meant freedom from superstition from the past. Because of the accretionist nature of traditional Chinese society, practical life had become difficult due to so many traditions and beliefs constraining each and every activity. People could not do what needed to be done efficiently and effectively because of the accretion of so many traditional rules and regulations, rituals, and beliefs. By “science,” Mao did not mean the Western scientific method per se but rather the validation of ideas through practical experience. In terms of medicine, these two principles led to the CCP’s support of evidence-based medicine (EBM, although that term was decades away from being coined). “Unity” meant the unification of an empire into a single country, a collection of different peoples into a single people with a single language and culture. Unity also meant that knowledge should be pooled for the benefit of all and that secret, family lore, including medical lore, should become the property of all.17 These principles have had a great impact on the development of Chinese medicine and acupuncture-moxibustion in the People’s Republic of China ever since, and I do not think they are necessarily bad or unnecessary principles.
On October 30, 1944, Mao gave a speech titled “The United Front in Cultural Work” where he called for the up-dating of “old,” i.e., Chinese, medicine with “new” Western medicine in order to create a consolidated form of medicine, a new synthesis which could satisfy the health needs of the Chinese nation. Shortly after this speech, a meeting was called between traditional Chinese and modern Western doctors in the region controlled by the CCP in order to explore “the scientification of Chinese medicine and the popularization of Western medicine.” At this meeting, Ren Zou-tian (1886-1950) offered to teach Western medical practitioners acupuncture and moxibustion so that they could research its healing effects. Zhu Lian, a Western-style MD at that meeting, signed up to take Ren Zou-tian’s class. Zhu was one of the few who continued their study of this art until well after Liberation (1949), eventually publishing her Xin Zhen Jiu Xue (New Acupuncture-Moxibustion). Zhu organized her book according to modern Western medical disease categories and got rid of such traditional concepts of qi, yin, yang, and the five phases. She also eliminated the channel system as a way of organizing the acupoints and introduced the points by body part. Like Cheng Dan-an, she believed that acupuncture worked mainly by way of the nerves. However, at roughly the same time, Lu Shou-yan (1909-1969) published a book titled Zheng Jiu Zheng Zong (A Gathering of Orthodox Acupuncture & Moxibustion). While Lu also organized his book by Western medical diseases, he kept the channel and network vessel system.18 Thus we see that Zhu’s radical elimination of traditional Chinese medical theory from the “New Acumoxa” was short-lived and never wholly supported. In fact, Zhu’s influence waned through the 1950s. Nevertheless, she was instrumental in the preservation and development of acupuncture during the early days of New China.19
The advent of Chinese medical colleges
A number of private Chinese medical colleges, organized similar to Western-style colleges and universities as opposed to the old master-disciple apprenticeship, had been founded in Republican China, especially in Shanghai. However, in 1956, government-supported colleges of Chinese medicine were founded in Shanghai, Guangzhou, Chengdu, and Beijing.20 These colleges all had departments of acupuncture and moxibustion,21 and these departments needed textbooks and curricula.22 In creating such didactic materials, “the new,” “science,” and “unity” were still basic principles promoted by the CCP. Superstitions were eliminated, the remainder was clinically and sometimes even experimentally verified, and a concerted attempt was made to synthesize the various family, regional, and theoretical schools of acupuncture. In this effort, the classics and other premodern texts on acupuncture-moxibustion were consulted and cited. However, individual experimentation with self-needling was also encouraged in an attempt to find out the “truth” of past practices and prohibitions. Therefore, there was an attempt to blend the best of the past with A) what was clinically verifiable in the present and B) Western biomedical anatomy, physiology, pathophysiology, and disease categorization and diagnosis.
In addition, since internal or so-called herbal medicine had risen to preeminence within the practice of Chinese medicine since at least the beginning of the Qing dynasty, most of the famous “old Chinese doctors”23 involved in this reorganization and systematization were themselves primarily practitioners of internal medicine. In attempting to create a single systematized methodology for diagnosis and treatment, these leaders essentially adopted and adapted the methodology of Chinese herbal medicine to acupuncture and moxibustion. By this I mean the step-by-step movement from disease diagnosis (now a modern Western disease followed by corresponding traditional Chinese medical diseases) to pattern discrimination to treatment principles to treatment plan, with the treatment plan consisting of a basic formula which is then modifiable by additions and subtractions as individually necessary. Under the rubric of unity, this basic methodology was applied to Chinese herbal medicine, acupuncture-moxibustion, tui na or Chinese medical massage, Chinese dietary therapy, and all the other modalities and specialties that were incorporated into the state-endorsed and promoted version of Chinese medicine. Because of this unification of methodology, Chinese doctors could now speak to one another and share information, peer review one another, refer over the length and breadth of China, and teach efficiently. Students were taught a step-by-step methodology which had standards of right and wrong as well as standards of care (SOC).
This adoption of the methodology of internal medicine resulted in the “herbalization” of Chinese acupuncture and moxibustion. Prior to this, acupoints were not ascribed theoretical functions. Now they were. Therefore, one could now say that Zu San Li (St 36) fortifies the spleen and supplements the qi, harmonizes the middle and disinhibits the qi dynamic. These theoretical functions are simply abstractions based on a Chinese medical understanding of the disease mechanisms responsible for the diseases a point is empirically known to remedy, i.e., its clinical indications. An example of this “herbalization” of acupuncture during this time is Wang Le-ting’s creation of acupuncture formulas based on the theories of Li Dong-yuan in which each acupoint is described as if it were a corresponding medicinal in one of Li’s formulas. Thus Wang had acupuncture analogs to Li’s Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) and Tiao Zhong Yi Qi Tang (Regulate the Center & Boost the Qi Decoction) among others.24 Wang was a very famous acupuncturist and teacher of acupuncture in northern China, and his formulas and methods were very influential during the 1970s and 1980s.
The Cultural Revolution
No account of the development of modern Chinese medicine can fail to include the Cultural Revolution. The “Great Proletarian Cultural Revolution” was a struggle for power within the Communist Party of China that manifested as wide-scale social, political, and economic chaos which grew to include large sections of Chinese society and eventually brought the entire country to the brink of civil war. It was launched by Mao Ze-dong, the Chairman of the CCP, on May 16, 1966 officially as a campaign to rid China of its “liberal bourgeoisie” and to continue revolutionary class struggle.25 Once set in motion, the Cultural Revolution generated waves of power struggles between rival factions both nationally and locally. Although Mao himself officially declared the Cultural Revolution to have ended in 1969, the term is today widely used to also include the period between 1969 and the arrest of the Gang of Four in 1976.26
During the Cultural Revolution, political correctness was prized above all else under the motto, “Better Red than expert.” In fact, all schools were shut down, including medical colleges, both Western and Chinese. In order to provide minimal health care to the masses, so-called barefoot doctors were trained in three and sixth month “paramedic” classes seasoned with heavy doses of political indoctrination. Since acupuncture in its simplest form is easy to teach and learn and since it is a prototypically Chinese art, acupuncture was an important part of this paramedic training. This acupuncture, called New Acumoxa, was a stripped down form that could be taught in a matter of weeks, not years. It used a repertoire of only the most famous points for basically symptomatic indications along with very strong stimulation. In addition, the few books on this “People’s” form of acupuncture that were published (some of which were translated into English) included verbose passages of hortatory party rhetoric. Since the influence of the Cultural Revolution lasted until 1976, and Nixon “opened” China to the West in 1972, it was this New Acumoxa that suddenly was exported to the West.27
This super-simplified version of acupuncture was denigrated by overseas (KMT) Chinese acupuncturists as “Maoist acupuncture” or “Communist acupuncture.” I [Bob] can remember my first acupuncture teacher, the late Eric Tao (Hsi-yu), reading to us from an acupuncture book published in China during the Cultural Revolution and mocking the politically inspired passages. And it is true this New Acumoxa was only a pale reflection of this ancient art. It is also true that during the Cultural Revolution, access to the premodern classics of Chinese medicine was drastically curtailed. Teachers at the state college of Chinese medicine who had advocated such “archaic” things as five phase theory were beaten and even forced to commit suicide because of their “feudal,” “reactionary” beliefs.
However, by the late 1970s, the state colleges of Chinese medicine were open again along with their libraries. Teachers who had been “sent down to the countryside” were brought back and reinstated, and the Chinese became aware of Westerners’ growing interest in acupuncture. In order to export this great indigenous Chinese art to the rest of the world, the four main colleges of Chinese medicine–Shanghai, Beijing, Nanjing, and Guangzhou–developed three month crash courses in acupuncture-moxibustion for foreigners. These three month courses were jointly sponsored and endorsed by the World Health Organization (WHO) and were aimed primarily at Western MDs.28 In order to have a textbook for these courses, the Foreign Languages Press in Beijing compiled and published what was first know as Outline of Chinese Acupuncture & Moxibustion. Several years later, this became Essentials of Chinese Acupuncture & Moxibustion which became Introduction to Chinese Acupuncture & Moxibustion. This book was created specifically to teach acupuncture to Western MDs in a very short period of time. While the theory this book contained was more than that of the New Acumoxa of the Cultural Revolution, it was highly simplified, as suggested by its names “Outline” and “Essentials.” This was due to two different points of view held by the Chinese at that time. First, Chinese believed that there was only so much Westerners could understand of traditional Chinese culture. Therefore, theory was kept to a minimum and technical medical terms were commonly and inexactly translated by Western biomedical terms. Secondly, there was only so much of their nation’s precious secrets these Chinese wanted to share with foreigners. During this time, I [Bob] was told that I was not allowed to purchase more in-depth Chinese books on acupuncture and Chinese medicine because I was a foreigner, that such teachings were nei bu (内部), for internal consumption only. The point I am getting at here is that the Chinese medicine taught to foreigners in the late 1970s and early-to-mid- 1980s was not necessarily representative of the state of the art in China itself. By the early 1980s, doctors were free to read any of the thousands of premodern books contained in their schools’ libraries, and they were free to explore in clinic a wide variety of theories and treatment approaches. Therefore, by the mid-1980s, any perceived paucity of information or lack of depth in the study and practice of Chinese medicine in China , including acupuncture-moxibustion, was only that, a lack of knowledge on the part of Westerners of the state of the art in China because of distance and inability to read the primary language literature in its original language. By this time, the political harangues of the Cultural Revolution had been edited out of books and other teaching materials. What remained were those theories and techniques which had been proven to work in clinic.
By proven here, we do not just mean based on the anecdotal evidence of individual case histories. Chinese students and doctors have been engaged now for decades in doing both clinical and experimental research verifying that acupuncture-moxibustion does work. Scores (if not hundreds) of well-designed studies are published in Chinese medical journals each year. These consist of retrospective cohort studies and prospective, randomized, comparison trials. Not only is there a huge body of evidence that acupuncture works, there is also a huge body of clinical and experimental evidence of how it works in terms of Western biomedicine.
The strong points of modern Chinese acupuncture
Over the last 30 years or more, we have studied most of the main national and many individual styles of acupuncture: Japanese meridian acupuncture, Korean constitutional acupuncture, Taiwanese five phase acupuncture, Leamington (or Worsleyan) five element acupuncture, European biomedical acupuncture, and modern Vietnamese acupuncture to name a few, and, personally, we find nothing second-rate or lesser about modern Chinese acupuncture from the People’s Republic of China. In fact, we find a lot about modern Chinese acupuncture that I think is worthwhile and even superior to other available styles.
First, through a process of broad-based study, clinical and experimental research, and consensus among the eminent Chinese acupuncturists of the mid-20th century, the superstitious, clinically unverifiable accretions of 2,000 years have been rightfully winnowed, separating the wheat from the chaff. As a neophyte, I [Bob] often worried that the Chinese had “thrown the baby out with the bathwater.” However, three decades on, I no longer feel that way. As I myself have become a more knowledgeable and mature practitioner, I see that many of my naive and romantic Orientalist beliefs were just that, naive and romantic and not grounded in clinical reality. I know of nothing in the history of Chinese medicine which is clinically efficacious that is not currently available in modern Chinese medicine, including acupuncture and moxibustion. The study and consensus that resulted in the systematization of Chinese medicine and acupuncture was not carried out by uneducated political hacks but by the greatest Chinese scholar-doctors and clinical practitioners of their day, and I believe these preeminent authorities did an excellent job overall.
Secondly, this system is organized in such a way that it is relatively easy to teach with generally reproducible results. One only has to look at the number of U.S. acupuncture schools (approximately 60 as of this writing) basically teaching the Chinese medical and acupuncture curriculum developed in China in the mid-20th century and the number of graduates they turn out each year able to pass state and national licensing examinations. While some of these graduates may fail to succeed at private practice, in my experience this is not due to their Chinese medical education as much as it has to do with their lack of preparation to be small business owners and entrepreneurs.
Third, this system has a definite, step-by-step methodology that can be critiqued and peer-reviewed at every step of the way. Using this system of practice, there are not only good, better, and best answers, but there are also right and wrong answers to our patients’ clinical conundrum. This is important in our world which is increasingly dominated by third party payees (Workers’ Comp., private insurance, etc.) and their need for quality control. Because this system has definite standards, adherence to these standards can be judged by others.
Fourth, because this system has standards, it is “portable.” By this we mean that one can refer a patient to another practitioner of this system and have some assurance that treatment will be the same or basically similar to that initiated elsewhere. This is important because we live in a mobile society. One can only make good referrals if one can be sure of the quality of care the patient will receive from the practitioner to whom they are referred. Since there are norms within this system, such an assurance is possible (as long as one adheres to those norms).
Fifth, because so much research has been done in China using this system, there is a great deal of evidence backing up the clinical efficacy of this system. Unfortunately, too few Western students are currently able to read this literature in its original language, and there is also too much of it to realistically translate it all. Nevertheless, this Chinese research can tell us whether or not an acupuncture protocol works in patients with a specific pattern of a specific Western disease. In medicine, clinical outcomes are the bottom line, and there is no lack of clinical and experimental research using this system. Thus we can say that modern Chinese acupuncture most certainly is evidence-based medicine.
Conclusion
In our opinion, it is not modern Chinese acupuncture that is lacking in terms of either sophistication of theories or clinically effective techniques. Rather, in our experience, it is Western students’ and practitioners’ understanding and application of this system as a system that is responsible for most of its clinical failures outside the country of its origin. The more we non-Chinese practitioners understand and apply this system as it is applied in China, the better results we will see. This means not only picking the right points based on the patient’s pattern discrimination but also scheduling treatments close enough so that one treatment really does build on the positive effects of the previous one. In any case, it is our belief that modern Chinese acupuncture is not some debased form of acupuncture but rather it is as mature and clinically effective a form of this art as any the world has seen.
Endnotes:
1 White, A. & Ernst, E., “A Brief History of Acupuncture,” http://rheumatology.oxfordjournals.org/ cgi/content/full/43/5/662, last retrieved 3/11/2008
2 “History of Acupuncture in China,” http://www.acupuncturecare.com/acupunct.htm, Suvow, Scott, L.Ac., last retrieved 3/11/2008
3 For an excellent discussion and description of this rising tide in professional scholar-physicians, see Volker Scheid’s Currents of Tradition in Chinese Medicine 1626-2006, Eastland Press, Seattle, 2007.
4 Neo-confucianism was strongly influenced by Buddhism which had won the hearts and minds of the Chinese people during the Tang dynasty (618-907). In order to coopt this interest in Buddhist cosmology and metaphysics, Neo-confucianists attempted to put a Chinese face on this adopted cosmology and metaphysics. However, those who were interested in ethnic pride and, therefore, purity, saw Buddhism as a foreign import from India.
5 Fishman, Jon, “The History of Acupuncture,” http://www.acupuncture.com/education/theory/historyacu.htm, last retrieved 3/11/2008
6 Andrews, Bridie J., “Acupuncture and the Reinvention of Chinese Medicine,” http://www.ampainsoc.org/pub/bulletin/may99/history.htm, last retrieved 3/11/2008
7 Lewith, George T., “The History of Acupuncture in China,” http://www.healthy.net/scr/Article.asp?Id=1819&xcntr=8, last retrieved 3/11/2008
8 Andrews, op. cit.
9 White, A. & Ernst, E., op. cit., last retrieved 3/11/2008
10 Fishman, Jon, op. cit.
11 Andrews, op. cit.
12 Ibid.
13 Elman, Benjamin A., “On Their Own Terms: Science in China, 1550-1900”, http://books.google.com/ books?id=KPEpPhlzPg0C&pg=PA408&lpg=PA408&dq=cheng+%22dan+an%22&source=web&ots=mqYgUdTSR-&sig=qj-ytPvBw_EOZ_ 8vgNDygFx6WlU&hl=en#PPA408,M1, last retrieved 3/11/2008
14 Dr. So’s Mandarin name was Su Tian-you. He was a student of Zeng Tian-zhi, a brilliant disciple of Cheng Dan-an. Dr. So began practicing medicine in 1939 and established Acupuncture and Moxibustion Medical College of Hong Kong in 1940. Dr. So lived and worked in a number of different countries during his life and founded a number of acupuncture colleges. He is sometimes respectfully referred to as “the father of American acupuncture and moxibustion.”
15 A partial translation of this book is available under the title of Acupuncture and Moxibustion Formulas & Treatments, translated and edited by Wu Ming, Blue Poppy Press, Boulder, CO, 1996.
16 “The Communist Party of China,” Wikipedia, http://en.wikipedia.org/wiki/ Communist_Party_of_China, last retrieved 3/11/2008
17 Hsu, Elizabeth, “Innovation in Chinese Medicine,” http://books.google.com/books?id= BbYYstLfSyUC&pg=RA1-PA354&lpg=RA1-PA354&dq=cheng+%22dan+an%22&source= web&ots=kE02iVok6A&sig=zfrS1bynu5i3GqPrCO_Qa-ihzkA&hl=en#PRA1-PA345,M1, last retrieved 3/11/2008
18 Ibid.
19 New China is the CCP’s term for China after Liberation in 1949.
20 “2000 Years of Chinese Acupuncture,” http://www.iastam.org/collateral/TAC _Exhibition.pdf, last retrieved 3/11/2008
21 In the ensuing years, many more provincial and metropolitan colleges of Chinese medicine were founded, so that every province and major city has such a college, all with acupuncture and moxibustion departments.
22 In particular, much of the development of this standardized Chinese medical curriculum took place at the Shanghai College of Chinese Medicine, now the Shanghai University of Chinese Medicine & Pharmacology. This university is the lineal successor of the private Chinese medical colleges founded in Shanghai (primarily by the students of Ding Gan-ren) during the Republican period. Therefore, in a sense, the early teachers at the Shanghai College of Chinese Medicine were simply carrying forward a process of systematizing Chinese medicine and its teaching that had started well before the advent of New China.
23 Lao zhong yi, old Chinese doctor, is a title of respect attesting to both clinical acumen and efficacy. It is not just a recognition of a doctor’s chronological age. This title implies that it takes many years for one’s understanding and practice of Chinese medicine to really mature. This is because of the volume of (oftentimes conflicting) information that must be retained precisely as well as the judgment based on clinical experience that is necessary for this information’s successful application. Lao yi sheng are the senior teachers, authors, and theoreticians of Chinese medicine.
24 For more information on Wang Le-ting’s formulas, see Golden Needle Wang Le-ting: A 20th Century Master’s Approach to Acupuncture by Yu Hui-c
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