acupuncture

acupuncture is perhaps most helpfully defined in general as the insertion of one or more needles into the body with therapeutic intent. The advantage of this wide definition is that it covers the many current different variants of this ancient practice, without being specifically tied to any one of them. At the broadest level, the most critical difference of approach lies between classical Oriental forms of acupuncture and those rooted more in modern Western biomedicine. Most of the main differences in practice are based on this dichotomy, although there are significant distinctions both between and within these two traditions, in terms of such issues as the model used to explain the operation of acupuncture and the scope of its practice. There are also debates in both traditions about the number and location of the acupuncture points themselves.

What is not in dispute, however, is that acupuncture has a history spanning well over 2000 years, taking its origin from ancient China. One of the oldest known books on acupuncture here is the Yellow Emperor's classic of internal medicine (the Nei Jing), which is held to date back many hundreds of years bc. From China, acupuncture spread to such local cultural areas as Korea and Japan, where it became incorporated into mainstream medicine by the seventh and eighth centuries ad. By the sixteenth and seventeenth centuries knowledge of it had reached Europe, mainly through missionaries and ships' surgeons who had witnessed its use in the East, but who had only a rudimentary understanding of its operation.

In the early nineteenth century it began to be practised by a number of doctors in Britain and the US. It went into something of a decline in most countries in the Western world thereafter — and even, briefly, in China in the modernization period under the Kuomintang in the first half of the twentieth century. However, the advent of ‘ping-pong’ diplomacy between China and the West in the first half of the 1970s, associated with dramatic television pictures of open-heart surgery being carried out by the Chinese with the use of ‘acupuncture anaesthesia’, led to spiralling public interest. This interest has continued to grow in both medical and non-medical circles up to the present day, alongside other complementary and alternative therapies—resulting in increasing numbers of acupuncturists and its widespread employment in the West in pain clinics and other settings.

In its classic application within traditional Chinese medicine, acupuncture is seen as being underpinned by the interplay of yin and yang; disease is seen as deriving from the disequilibrium of such opposing forces. In this conceptualization, drawing on Taoist philosophy, acupuncture treatment for the sick is used to correct imbalances and to maintain equilibrium in the healthy to prevent illness. This involves manipulating the patient's Qi, the life force, by stimulating needles strategically placed at selected acupuncture points which lie on the 12 main meridians that run along the body and connect with central internal organs. Typically, the needles are placed in sites at a distance from the condition itself. In this frame of reference — and as employed in China and many other Oriental societies — acupuncture is seen as something of a panacea, which can deal with a wide range of disorders spanning from asthma and ulcers to depression and angina.

Acupuncture, though, is characteristically used very differently in Western biomedicine — mainly as a more narrowly defined remedy for pain and for addictions of various kinds. The traditional Chinese philosophies about acupuncture are usually seen as problematic within this framework, not least because there is no consistent correspondence between biomedical conceptions of the physical structures of the body and the classical acupuncture points and the meridians along which they are held to run. Indeed, within more Westernized approaches, needling often occurs in situ rather than at a distance. Other explanations of its operation have also typically been sought by Western doctors, generally based on neurophysiology. Initially the ‘gate-control’ theory was widely adopted, centred on the notion that the stimulation of the larger nerve fibres can block pain. More recently, however, emphasis has shifted to the notion that endorphins — opiates of a type naturally produced by the body — are released by acupuncture, thus giving rise to its analgesic effects. However, neither theory adequately explains the long-term relief of chronic pain nor the wider therapeutic effects traditionally claimed for acupuncture.

From a conventional Western perspective, many studies of acupuncture to date have been methodologically unsound — although its proponents might point to the difficulties of evaluating its efficacy through randomized trials in view of its holistic, classical Oriental origins. Current evidence based on trials of its efficacy in treating pain is growing, though, even if rigorous trials of acupuncture for other disorders are few and far between and are not always supportive of the claimed benefits. Another important issue in the West is the regulation of acupuncture practice and whether it should be formally restricted either to doctors or to those appropriately trained in acupuncture, given that it is an invasive technique. In untutored hands, acupuncture has occasionally given rise to a number of complications, such as Hepatitis B and AIDS, and the puncturing of the heart and lungs, which carry potentially fatal consequences.

It should be stressed in conclusion that, even as discussed here, there are difficulties in clearly defining the boundaries of acupuncture. There are, for example, associated forms of treatment which do not employ needles, but which use acupuncture points. These range from the traditional application of finger pressure, through shiatsu and the burning of a herb, moxa, at such points, to the stimulation of acupuncture points using electrodes, as with techniques such as TENS (transcutaneous electrical nerve stimulation) in modern medical practice. Equally, there are surgical techniques, like suturing and the injection of medicinal substances, that are closer to the definition of acupuncture in so far as they involve needles, but are not conventionally regarded as such. Notwithstanding these definitional issues, though, acupuncture in both its traditional and modern forms looks as if it will continue to be important in the foreseeable future in both the contemporary Western and Eastern worlds, where it is being subjected to increasing use and scientific study.

Mike Saks

Bibliography

Lewith, G.,, Kenyon, J.,, and and Lewis, P. (1996). Complementary medicine: an integrated approach. Oxford University Press.
Lu Gwei-Djen and and Needham, J. (1980). Celestial lancets: a history and rationale of acupuncture and moxa. Cambridge University Press.
Mole, P. (1992). Acupuncture: energy balancing for body, mind and spirit. Element, Longmead.
Saks, M. (1995). Professions and the public interest: medical power, altruism and alternative medicine. Routledge, London.