Acupuncture

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ACUPUNCTURE

All science is based on assumptions that define, a priori, the relative weaknesses and strengths of their practical application. As western science and technology have run up against limits to their comprehension and effectiveness, other approaches to both knowledge and practice have emerged to complement them. Nowhere is this more an issue than in medicine: Acupuncture has become a popular alternative to the drugs and surgeries offered by the biomedical sciences. In its fundamentally holistic approach acupuncture also presents an implicit ethical challenge to western technoscience to see the human patient in his or her entirety and within the context of the patient's life circumstances.

Acupuncture is the practice of inserting thin needles into the body to influence physiological functioning. It is an integral part of Chinese medicine, which also includes herbal medicine, massage, nutrition, and exercise. Chinese medicine began to take form during the Shang dynasty (1766–1050 b.c.e.), and an early form of acupuncture might have been practiced then, with the oldest needles having been made of sharpened stone (Gwei-Djen and Needham 1980, Unschuld 1985). There are bronze needles dating from the Chou dynasty (approximately 600 b.c.e.). By the Warring States period (475–221 b.c.e.) the classic acupuncture text, the Huang Di Nei Jing Su Wen [Yellow emperor's classic of internal medicine], had appeared.

Nature and Origins

The practice of acupuncture is thought to have started when shamans used needles to kill evil spirits that were thought to cause illnesses (Unschuld 1985). Over thousands of years the properties of specific points were discovered empirically, and those observations were tied in to traditional theories. What originally began as a superstitious ritual gradually became a flourishing medical field. The practice has grown further since its introduction to the West in the 1970s; there are more than fifty accredited schools of Chinese medicine in the United States, and practitioners are licensed independently in over forty states.

Chinese medicine was first introduced to Europe in the 1600s by Jesuit priests returning from the Orient. By the 1950s major schools of acupuncture were established in England and France. Acupuncture lost state support in China by the late 1800s and languished until a decree by Chairman Mao in 1958 that Chinese medicine should be revived according to the principles of dialectical materialism. Despite the "scientization" of Chinese in China, older traditions more grounded in a spiritual world view have survived both in Europe and in other parts of Asia that were not suppressed by the Chinese totalitarian regime.

Philosophical Orientation

According to the Shen Nong Ben Cao, one of China's oldest medical texts (second century c.e.), the highest aspect of healing involves helping patients fulfill their destiny so that they can live out the years allotted to them by heaven. The next highest aspect is the nourishment of people's inborn nature. Finally, the lowest class of healing is to treat specific physical illnesses. In its highest form, then, Chinese medicine focuses on individuals' health in the overall context of their lives. Health is manifested when one lives in harmony with the laws of nature and represents a profound integration of function on all levels: spiritual, mental, and physical. The presence of illness represents a denial and loss of the true self.

As a holistic practitioner an acupuncturist uses several diagnostic methods to determine the overall functional balance of a patient. Diagnoses occur largely within the perspective of the Chinese models of the universal poles of yin and yang and the five-element system, both of which provide qualitative standards for interpreting a range of physiological phenomena. From the yin/yang perspective practitioners consider observations in terms of internal/external, soft/hard, deficient/excess, and cold/hot, all of which point toward understanding the particular thermodynamic state of individuals and the unique manifestations of their illnesses or imbalances. For example, a practitioner might note that cold in nature tends to have a slowing and contracting influence. If the patient's pulse is slow and his or her muscles are tight the practitioner might deduce the presence of cold.

The five-element system (wuxing) was elaborated fully around 350 b.c.e. by Zou Yen (Kaptchuk 1983). The term wuxing denotes five dynamic movements—water, wood, fire, earth, and metal—that continually transform into each other as the seasons do. The language used by the early Chinese to describe their world was one of simple poetic images rich in allusions. Water is the element associated with winter because of its tendency to freeze and become focused in that season. Wood is associated with spring because it grows rapidly at that time of the year. Fire is associated with summer because of the increased heat during those months as the sun reaches its zenith. Earth is associated with late summer when the fields are full of the earth's bounty. Minerals are a natural expression of the metal element because they lie hidden beneath the ground; they symbolize the essential, precious, and rarefied aspects of life. Metal is associated with the fall, when what is of value must be harvested by the farmer's knife and everything else must be left to wither in the fields (Connelly 2002, Jarrett 1999).

Over the course of thousands of years laws were discovered and codified that described the functional dynamics of natural change. The five-element model is one example of these laws. Relating physiological functions to these qualitative standards, an acupuncturist is able to generate a diagnosis that is unique to each individual. The goal of treatment is to harmonize individuals both internally and within the context of their natural environment. The internal health of the individual and the integrity of the natural environment are seen as mutually dependent, a worldcentric view that is especially relevant at a time when technoscience has achieved the power to destroy much of nature.

How Acupuncture Works

The attempts by Western scientific research to describe how acupuncture works rely on modern biomedical concepts. Popular theories include the notion that the mode of efficacy of acupuncture can be attributed to its influence on the structure and function of the body's different systems, including the nervous, circulatory, and immune systems (National Institutes of Health 1997, World Health Organization 2002). However, to appreciate acupuncture on its own terms one must understand the traditional explanations of how acupuncture works.

Western biomedicine focuses on the quantitative analysis of physical structure; it is mechanistic and reductionist in character. By contrast, Chinese medicine focuses on the qualitative analysis of function; it is holistic and synthetic in nature (Jarrett 1999, 2003). Over four millennia the Chinese have developed a rigorous language for discussing the subtleties of human physiological function. The central physiological concept is predicated on the notion of qi (chi), a universally present influence that maintains the functional integrity not only of the organism but of all natural processes (Porkert 1982, Jarrett 1999). The functions of qi are manifest in five forms: movement, transformation, protection, retention, and warming. Any dysfunction of these attributes in any aspect of being, whether physical, psychological, or spiritual, is said to be an imbalance of qi.

Acupuncture points are discrete locations on the external surface of the human body where the internal function of the organs can be influenced and the quality and directionality of their qi can be mediated. Points that are functionally related are said to constitute a specific meridian. Each meridian is associated with the function of an internal organ system or "official." Rather than naming specific organs anatomically, the ancient Chinese conceived of each organ as being an official with a specific duty to fill. When each official did his duty, health and harmony resulted. In the Huang Di Nei Jing Su Wen each organ is personified as being in charge of specific functions (Larre and de la Vallée Rochat 1987). For example, the fourteen points most closely associated with the function of the liver official constitute the liver meridian. The liver traditionally is likened to a military general in charge of planning and decision making. Its function is associated with growth, vision, and flexibility in all aspects of being. Hence, visual disturbances, poor planning, frustration, and tightness in the tendons that limits flexibility all can be treated through acupuncture points on the liver meridian.

Each point harmonizes an unbalanced aspect of function on a continuum ranging from deficient to excessive. For example, if a patient's heart rate is too slow or too fast, an acupuncture point such as Heart-7 (shenmen, or "Spirit Gate") can be used to increase or decrease the pulse to achieve the correct rate. Similarly, a point such as Liver-14 (qimen, or "Gate of Hope") can be used to help calm a belligerent person or enhance self-esteem in a timid person.

Acupuncture has evolved as a sophisticated science of human function for at least 2,500 years. As Chinese medicine is integrated into Western cultures, patients are afforded the benefits of both biomedical and functional medicine. The worldcentric and holistic view of Chinese medicine holds special promise for helping humanity face the unique challenges of the dawn of the twenty-first century.

LONNY S. JARRETT

BIBLIOGRAPHY

Connelly, Dianne M. (2002). Traditional Acupuncture: The Law of the Five Elements. Columbia, MD: Traditional Acupuncture International.

Gwei-Djen, Lu, and Joseph Needham. (1980). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. Cambridge, UK, and New York: Cambridge University Press.

Jarrett, Lonny S. (1999). Nourishing Destiny: The Inner Tradition of Chinese Medicine. Stockbridge, MA: Spirit Path Press.

Jarrett, Lonny S. (2003). The Clinical Practice of Chinese Medicine. Stockbridge, MA: Spirit Path Press.

Kaptchuk, Ted J. (1983). The Web That Has No Weaver: Understanding Chinese Medicine. Chicago: Congdon & Weaver.

Larre, Claude, and Elisabeth Rochat de la Vallée. (1987). The Secret Treatise of the Spiritual Orchid. East Grinstead, UK: International Register of Oriental Medicine.

Porkert, Manfred. (1982). The Theoretical Foundations of Chinese Medicine. Cambridge, MA: MIT Press.

Unschuld, Paul U. (1985). Medicine in China: A History of Ideas. Berkeley: University of California Press.

World Health Organization. (2002). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Geneva: Author.