Introduction
The traditional Chinese medical practice of acupuncture is one of the oldest forms of healing known to mankind. It is considered a complementary or alternative therapy (CAM) in which fine needles are inserted into a patient’s skin at different points to generate a therapeutic response. Traditional acupuncture is centred on the belief that an energy, Qi, flows through the body in channels called meridians and illness is caused when Qi doesn't flow freely through the body. Acupuncture is traditionally used to re-establish the flow of Qi, restoring health.1
Acupuncture has only recently become widely accepted in the West, after many physicians and scientists found the philosophical basis fanciful and considered the triumphs of the treatment merely the perfect example of a placebo effect, even despite its long history.1 Once considered a Chinese phenomenon, acupuncture is now practiced in Britain by around 5,000 professionals. Under the regulation of the British Acupuncture Council (BAcC), 3,000 practice Traditional Chinese Acupuncture (TCM)2, whilst 2,000 are regulated healthcare professionals who practice Western medical acupuncture in primary or secondary care settings. Many Western doctors believe that acupuncture treatment can work for a variety of conditions however their modern medical knowledge makes it difficult for them to accept the principles of TCM3. Instead they practice Western acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles of the body causing the body to produce natural substances, such as pain-relieving endorphins1.
This article will explore the beginnings of acupuncture and how it has developed, considering how Chinese culture has influenced it. The spread of acupuncture to the West, specifically its development in the UK will also be outlined.
Origins of Acupuncture
The original philosophy of acupuncture is rooted in the Taoist tradition of meditation, observation of the flow of energy within and the reflection of man's relations with nature and the universe. The origins of acupuncture can be dated back around 4000 years to China’s early farming civilisations. Archaeological excavations indicate that heated, pointed stone instruments were used, called bian stones, which are generally considered to be a precursor to acupuncture, in the treatment of back and neck pain.4
The Development of Acupuncture to 1900
When China adopted a more feudalistic culture (770-475 BC onwards), it meant scholars could dedicate their time to philosophical thought and education5. Medicine was greatly impacted as sickness was being explained as the result of man’s discord with nature rather than due to supernatural causes. It was around this time that bian stones were replaced with more effective metallic needles. This is supported by the archaeological discovery of needles found buried in a tomb belonging to a Prince from 113BC.5
As education grew, more scholars began to record their ideas and theories; the ‘Huang Di Nei Jing’ is the first recognised book of Chinese Medicine, it is known as the Classic of Internal Medicine of the Yellow Emperor and was allegedly written by the infamous Yellow Emperor and dates back to between the first century BC and the first century AD.6 Largely it is the work of multiple academics and physicians living between the 5th and 1st centuries BC and it summarises the Chinese concepts of health, disease and medicine. All styles of acupuncture currently practised can trace their roots back to this text as it details not only the theory of acupoints but the meridians that connect them, the process for insertion, suggestions for their use and lists 295 acupoints.6, 7
Many famous doctors have contributed to the development of acupuncture in China. These include the ‘Father of Surgery’ Hua To (108-203AD) who was well known for both his great skill in surgery and for achieving remarkable results with acupuncture by puncturing no more than two points. He has been attributed with a group of 17 extra acupoints called Huatuo Jiaji points, which are still used today.5 Influential figures also include Sun Si-Mao (581-682AD), the ‘King of Medicine’. He grouped acupuncture points into 400 different treatments for various diseases and Xu Shuwei (1080-1154AD) who advanced acupuncture to treat the seasonal feverish diseases which were prevalent at the time.5
The development of acupuncture relied on the political climate. The Tang government created training establishments for acupuncturists in 618 AD. During the Song Dynasty (960 –1127AD) China used its newly invented printing presses to publish medical works, demonstrating that the development of acupuncture was a high priority in many of the Chinese dynasties.8 Although acupuncture progressed over the centuries, in 1822, following an assassination attempt against him using a thick needle, the Emperor Dao Guang declared an order to abolish acupuncture from the Imperial court.9
Spread of Acupuncture to the West
Around 2000 years after the Chinese had first begun practising acupuncture, Jesuit missionaries returning from China brought back reports of Chinese medical practices to Europe.10
In the mid 17th century Wilhelm ten Ryhne and Englebert Kaempfer, from The Dutch East India Company, gave eyewitness reports of effective acupuncture treatments. Upon his return, ten Ryhne attempted to explain acupuncture using the Western terminology of the time but, since the Chinese based their treatments on such different principles to the Western medical knowledge of people such as Andreas Versalius, the treatments were dismissed by members of the medical profession in Europe.11
As the 1700s neared their end, Europe’s inquisition into the East diminished as interactions across the world soured over trade. Many features of Chinese culture were denounced including acupuncture.
However, by the 19th century acupuncture had become commonplace around the East and had travelled around many areas of the world. The West eventually created a belief system based on points around the body that were believed to inhibit pain, these were in the same locations as China's spiritually recognised acupoints, but using different terminology.6 (6) The first comprehensive Western treatise on acupuncture was published by Willem ten Rhijne in 1683.12, 13
Acupuncture in modern China
In the late 19th Century physicians tried to explain the theory of TCM in Western scientific terms to appeal to larger audiences and give the practice legitimacy. In 1899 Liu Zhongheng penned a book entitled ‘Illustration of the Bronze Figure with Chinese and Western Medicine’, paving the way for the study of acupuncture through a combination of TCM and Western medicine.14
The People’s Republic of China was founded in 1949 and since then there has been a revival in the use of acupuncture, with the intention to preserve the cultural heritage. Consequently, the study and integration of TCM with Western medicine was encouraged whilst the philosophical aspects which did not fit with the political regime were ignored.15 In 1958 the Chairman of the Republic, Mao Zedong, promoted the practice of acupuncture and TCM as a pragmatic solution to offering health care to a massive population which was undersupplied with physicians 16 and declared that “Chinese medicine and pharmacology are a great treasure-house and efforts should be made to explore them and raise them to a higher-level”.17 The scientific community reacted and acupuncture anaesthesia was established. By combining TCM and Western medicine, acupuncture was reportedly used as a form of anaesthesia in surgical procedures.18 However, during a visit to China, the Acupuncture Study Group was able to substantiate a number of claims that almost all patients having operations under ‘acupuncture anaesthesia’ also received other agents including phenobarbital and meperidine before and during the operation, additional local anaesthesia was also used liberally.18
Modern day use of Acupuncture in the UK
Despite the fact that an explanation for acupuncture using Western science has not been produced, there has been a growth in the number of people in the UK requesting complementary therapies from the late 20th century onwards. In the UK, current estimates show that 1 in 5 people currently use some form of complementary medicine, with acupuncture now reportedly available in around 86% of NHS chronic pain services.3
In 2002 the BMA published a report into the efficacy, safety and practice of acupuncture which determined that acupuncture was more effective than control interventions in the treatment a few specific conditions such as migraine, back pain and post-operative nausea. This is convincing evidence to support acupuncture and therefore explains patient demand for the treatment and also medical establishment’s incorporating it into general practice.19
A recent YouGov survey into the views of the British general public on the effectiveness of alternative therapies highlighted that of the 1638 adults questioned, 66% believed acupuncture was genuinely effective in treating illnesses and 52% deem that acupuncture should be offered for free on the NHS.20
Conclusion
Acupuncture has 4000 years’ worth of history which has been irrevocably affected by politics and conflicting religious, spiritual and scientific beliefs. Despite the divide between the traditionalists and Western practitioners, acupuncture has come a long way since its origins and has won an uphill battle against time, misunderstanding, and criticism. Despite its successes however, it is clear that the development of acupuncture and TCM has been halted multiple times throughout history due to the difficulties of translating the works of different cultures, with fundamentally different philosophical outlooks. Whether acupuncture can become fully integrated into general practice and be valued equally with Western medicine remains to be seen. Nonetheless whilst ever people all across the world continue use and promote this treatment, it will continue to grow.