How Important Was Acupuncture in Ancient China?

Acupuncture is arguably one of the more popular alternative therapies, after dietary supplements and chiropractic. The mystical explanations for its supposed benefits, such as balancing the mysterious energy force known as Ch’i, are not generally accepted in the mainstream medical community. But there are a fair number of healthcare providers who believe acupuncture has meaningful clinical benefits, and some individuals make attempts to explain these in more conventional scientific terms. In my opinion, the evidence is still most consistent with the position that acupuncture is an elaborate placebo that affects how people feel without truly altering the state of their physical health. But there is room for debate about the effects of sticking needles in patients.

Regardless of the issue of whether or not acupuncture is a beneficial therapy in some instances, however, many of the claims made to promote it are clearly exaggerated or simply false. In the veterinary field, for example, it is often claimed that acupuncture has been used to treat animals for thousands of years. Yet a close look at the actual historical record shows this to be untrue. And while acupuncture is more popular than some other alternative therapies, its popularity is routinely exaggerated, and conventional therapies are preferred even in China and other places where acupuncture has been a generally accepted practice for some time.

A recent article in the Journal of Integrative Medicine provides some interesting information concerning on of the most common claims made for acupuncture—that it was a popular and successful therapy in ancient China for thousands of years. The author, a practitioner and advocate for so-called Traditional Chinese Medicine (TCM), makes the case that acupuncture was actually a marginal practice in ancient China and that its current popularity is a recent, 20th century phenomenon. Though the author probably wouldn’t agree, it strikes me that this fits quite well with the hypothesis recently discussed in Slate magazine that TCM is not actually an ancient historical method but an ad hoc collection of unrelated, even competing practices pulled together in a bit of nationalist historical revisionism by Mao Tse Tung.

Lehmann H. Acupuncture in ancient China: How important was it really?J Integr Med. 2013; 11(1): 45-53.

The abstract summarizes the author’s conclusions that acupuncture was never a popular or important therapy even in ancient China.

…the clinical application of the needle therapy in ancient China was always a limited one. From early times there have been warnings that acupuncture might do harm. In books like Zhang Zhongjing’s Shanghanlun it plays only a marginal role. Among the 400 emperors in Chinese history, acupuncture was hardly ever applied. After Xu Dachun called acupuncture a “lost tradition” in 1757, the abolition of acupuncture and moxibustion from the Imperial Medical Academy in 1822 was a radical, but consequent act. When traditional Chinese medicine was revived after 1954, the “New Acupuncture” was completely different from what it had been in ancient China.

Of course, the author puts a positive spin on these conclusions, suggesting that the marginal role of acupuncture historically doesn’t negate its benefits (despite the fact that these are often justified by claiming a long, successful history) but simply, “The best time acupuncture ever had was not the Song dynasty or Yuan dynasty, but is now – and the future of acupuncture does not lie in old scripts, but in ourselves.”

The author reviews the written records of ancient Chinese medicine and concludes that while there is discussion of the theory and practice of acupuncture, there is no evidence that it was widely accepted or employed. He also discusses the artifacts often cited as evidence of ancient acupuncture practices and why they do not support the idea that an intervention similar to modern acupuncture was widely used. The author also identifies several mentions of the risks of historical acupuncture, which include the same problems of infection and organ damage that still occur today.

And although people in ancient time knew nothing about microbes, they knew very well that needling could do harm to the body. For example, the Zhenjiu Juying  talks about “poison” contained in iron.

Moreover, there were always warnings of the dangers of the needling. As early as in 81 BC, the Yan Tie Lun criticizes incompetent physicians with the words: They

stab in their needles at random, without the least beneficial influence on the illness, and only succeed in injuring the flesh and the muscles. And Wang Tao writes in his Wai

Tai Mi Yao: Acupuncture can kill healthy people, and cannot revive those who are dead. If one desires to adopt this technique, I am afraid he will harm life. [Therefore] at this present compilation I do not adopt [the technique of ] the Acupuncture Classic, I only adopt moxibustion.

He then goes on to cite prominent ancient Chinese medical authorities to illustrate that they rarely recommended acupuncture and sometimes recommended against it. And he emphasizes that while the best and most esteemed therapies would have been employed for the emperors in ancient China, it appears the emperors almost never received acupuncture.

He also makes a particularly interesting point that claims about acupuncture as an ancient “lost art” may simply be part of the tradition of complaining that previous generation possessed medical skills and techniques that have been lost and must be rediscovered:

…when Xu Dachun in 1757 lamented acupuncture as a “lost tradition”, this is only a proof that it was not widely used at his time. It does not prove that it really had been very important before. Remember: complaining that the medical art of the ancients was lost has been part of Chinese medical writing from its very beginning – the Huangdi Neijing itself does nothing else.

This seems consistent with the ubiquitous human tendency to imagine the past as a Golden Age better than the present. Certainly, this is a mainstay of the marketing of alternative therapies, which are often promoted as a rediscovery of or return to better ideas and approaches despite the convincing evidence that human beings today enjoy the longest and healthiest lives of any who have ever lived.

Finally, the article discusses an event often ignored or downplayed by acupuncture advocates who wish to portray the modern practice as a well-established and historically continuous practice handed down from ancient times, rather than a politically motivated invention of the 1950s communist leadership. In 1822, the emperor officially prohibited acupuncture from being taught or practiced at the Imperial Medical Academy.

Emperor Daoguang, in the second year of his reign and at this time 40 years old, declared: Acupuncture and moxibustion, as not being suitable to be applied to the Emperor, will be banned forever from the Imperial Medical Academy.

This move is sometimes portrayed as the result of Western influence, however the author of this article claims that the move predates any significant influence of European medicine on China:

One reason which makes it so interesting is the time of the decree: this was the last period in Chinese history where medical aspects were discussed WITHOUT comparing TCM to scientific medicine.

Indeed, the conflicts with Western countries had already begun. However, it was not before 1830 that the foreign missionaries adopted “the idea of making the practice of medicine an auxiliary in introducing Christianity to China.”

Whatever came later (for example Wang Qingren’s Yi Lin Gai Cuo in 1830, in which he attempted to correct some of the many errors in TCM literature) could not escape the everlasting struggle in which traditional practitioners tried to defend TCM theory against the superior methodology of scientific medicine. We might say: Banning acupuncture from the imperial court was the last independent act in the history of traditional Chinese medicine.

Furthermore, he argues that the ban was almost certainly not a whim on the part of the emperor, but a considered rejection of the practice by the most prestigious Chinese scholars of the day:

In fact, it is unlikely that the idea of the edict originally came from the emperor himself…Like today, such things were left to a court commission. There, specialists discussed the matter and presented a suggestion.

…So, we can be sure that there were extensive discussions among court advisors, physicians and teachers of the Imperial Medical Academy before the edict was decided. And we may believe that the men deciding this question were the most learned scholars of their time. Even if some of them were no medical experts we can be sure that they listened very carefully to what the physicians and the teachers of the Imperial Medical Academy said.

And if this commission nevertheless recommended the abolition of acupuncture, we can be sure of one thing: that they saw very good reasons to do so.

This author also argues that there was no outcry against this edict from the physicians of the day, suggesting that acupuncture was not widely valued in the medical community. And there appears to be little evidence of acupuncture being commonly used in China after the 1822 edict, until “re-invented” in the 1950s. His conclusion starkly contrasts with the usual acupuncture mythology:

When acupuncture was revived after 1954, this was no continuation of an unbroken tradition,but in fact a completely new invention… the methods and experience of ancient acupuncture are mostly irrelevant for us.

Now clearly, it is irrelevant how old acupuncture is or how commonly practiced it was in ancient times to the issue of whether or not it works. If it were true that modern acupuncture were a revival of a long-standing ancient practice, this wouldn’t be evidence that it was safe or effective any more than the long history of bloodletting somehow validates that therapy. However, from a marketing point of view, people appear to find the claims made for modern acupuncture more palatable or believable if they imagine it as the revival of  ancient wisdom, instead of a politically motivated invention of the 1950s. It may be useful, therefore, to recognize this as an unsubstantiated myth that does not help us in evaluating the risks and benefits of acupuncture today.

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8 Responses to How Important Was Acupuncture in Ancient China?

  1. Karen Bauer says:

    I beg to differ. Racehorses, racing dogs, professional sports teams, professional dance troupes, and the Metropolitan Opera all use acupuncture to keep their top performs at their optimum level of health and happiness so they can get the best performance out of the huge investment they have made in these stars.

    Here’s proof acupuncture works: My father was the anesthesiologist present at the first open heart surgery and the first brain surgery performed in the United States without ANY anesthesia except acupuncture. He is a scientists scientist, I come from a long line of physicians and scientist on my Dad’s side of the family. He was so impressed he tried to get acupuncture incorporated into the practice of anesthesia so they could reduce the amount of toxic anesthetics used during surgery to improve recovery time and avoid the many negative side effects and serious complications of such toxic substances. It was early days, and he was unsuccessful in generating enough interest in it. Here’s proof that my Dad was no slouch in the brains or professional skills department: He was up for a position at Stanford University Hospital in the Anesthesia Department.

    Anyway, here’s the rub: Animals don’t know what acupuncture is, so it has NO PLACEBO EFFECT on them, yet they instantly get better when they are needled. I’ve seen it numerous times in my own pets. If it didn’t work, professional athletes and dancers and opera singers wouldn’t bother. They use what works, period. They are often the pioneers of what is new in medicine, because their highly paid careers depend on them remaining healthy and sound of body.

    So there!

  2. skeptvet says:

    You are free to differ, but you are mistaken on several points. The “placebo effect” involves far more than simply the effect of expectations and belief. Thwere is strong evidence for a placebo effect on owners and veterinarians, who are the ones evaluating whether a treatment works. There is even evidence that placebo effects can influence such apparently objective symptoms as epileptic seizures in dogs, so the claim that ebcause the patients are animals the placebo effect goes away is nonsense.

    I would love to see the published report on this supposed open heart and brain surgery performed with only acupuncture. Similar claims have been made for procedures in China, and close investigation has found liberal use of narcotics, local anesthetics and other pharmaceuticals as well as significant evidence of pain experienced by patients. Definitive evidence to support your claim would require a well-documented published case report at least.

    The fact that your dad is smart and is a doctor doesn’t prove he cannot be mistaken about the effects of acupucnture. The best and brightest minds in history have been mistaken about many medical therapies we no longer use today. HUman beings are easily fooled, and being smart and well-educated doesn’t protect us very much, which is why we need scientific research in the first place. Likewise, the fact that peopel believe in acupuncture and use it for their animals only proves they believe in it and use it, not that they are right to do so.

    Again, you are making a purely faith-based argument here, and that isn’t how science works.

  3. v.t. says:

    In the case of pets: When you give a pet any attention in any gentle manner, the pet is most likely to respond because he/she enjoyed the attention or relaxation, not needling – pets don’t know what qi, chi and imaginary meridians are, nor do they care. The rest is purely subjective or imagined on the part of owner and practitioner.

  4. Sebastian says:

    This is the first I’ve heard of acupuncture on animals, although considering the many therapies that people apply to them it’s surprising I haven’t come across the idea previously. You provide an interesting position, and raise the issue of needing scientific studies in the arena of acupuncture so there can be more objective proof and get away from debates of placebo and pseudoscience. Thanks for the multiple citations and point of view.

  5. Pingback: how is acupuncture used in china | Question About Acupuncture

  6. I happen to be the author of the essay presented above (Hanjo Lehmann). As to the conclusions drawn above, I agree with most of them – but NOT with the basic one: that acupuncture ist just some kind of PLACEBO.
    Astonishingly, there is a question which neither the friends nor the critics of the needling therapy usually ask: WHAT IS REALLY SCIENTIFICALLY CONFIRMED ABOUT ACUPUNCTURE?
    Having practiced and researched acupuncture for more than 30 years, I first have to state that 95 percent of what the acupuncture societies teach and examine is NOT scientifically confirmed: Not the existence and the course of the so-called “meridians”. Not their alleged system of “Qi and Blood flowing in an triple circle”. Not the existence and the qualities of all those functional point categories like “Alarm Points”, “Master Points”, “Xi-Cleft-Points” etc.
    Equally uncomfirmed is what in clinical practice is the most important part of applied acupuncture: the alleged specific properties of the points. We are able to state that points like St46-Zusanli, LI4-Hegu and Sp6-Sanyinjiao are used most frequently (though they were not in some ancient times or regions). But we don’t know if their frequent use is really due to their superior qualities, or just some kind of convenient habit.
    However, there ist on fact about acupuncture which even the fiercest critic will find hard to deny: that acupuncture (omitting moxibustion for the time being) is a therapy which is inflicting WOUNDS. Although these wounds are microscopically small, the result is the activation of the wound healing system, which is a very important and powerful system in itself. As the body can never act as precise and locally limited like a surgeon, it seems obvious to me that the activation of this system will have a positive result at least considering local inflammations and similar painful disorders.
    If and how it may cause systemic effects as well, is still open to further research. However, the mere fact of activating this underestimated system seems sufficient for me to be convinced that acupuncture ist certainly more than a placebo – though I do not deny that the patients’ belief in things like “harmonising yin and yang” will have an additional effect.
    Best greetings from Berlin
    Hanjo Lehmann

  7. Remark to the moderator: In my statement just posted a minute ago, please change “St46-Zusanli” to the correct “St36-Zusanli”. Thanks – Hanjo Lehmann

  8. skeptvet says:

    Thanks for your comment. I have a few thoughts in response.

    However, there ist on fact about acupuncture which even the fiercest critic will find hard to deny: that acupuncture (omitting moxibustion for the time being) is a therapy which is inflicting WOUNDS. Although these wounds are microscopically small, the result is the activation of the wound healing system, which is a very important and powerful system in itself. As the body can never act as precise and locally limited like a surgeon, it seems obvious to me that the activation of this system will have a positive result at least considering local inflammations and similar painful disorders.

    There is no question that:
    1. acupuncture causes local trauma
    2. This trauma leads to physiologic responses, including nerve activity, release of inflammatory mediators, cytokines, and all sorts of other compounds, locally and systemically

    The important question, and what has not yet been demonstrated, is does this lead to a specific, predictable, and targeted response that can be harnessed as a treatment for specific diseases or symptoms, or is it simply a non-specific response that may or may not have any effect on the problem the acupuncturist intends to treat? Dropping a hammer on my toe, burning my hand on a stove, getting a paper cut on my finger, and many other things cause wounds or trauma just like acupuncture does. The difference is that people claim acupuncture can be intentionally applied in precise locations to yield predictable improvements in medical problems with minimal or acceptable side effects. This sort of claim has not been convincingly demonstrated scientifically despite decades of research, which begs the questions “Is acupuncture just a non-specific mild trauma like stubbing your toe or getting a paper cut which does not have any greater medical significance?”

    This is actually a large part of what I mean when I assert acupuncture is a placebo. “Placebo” does not mean “imaginary.” Placebo effects occur through many mechanisms, and belief or expectancy is only one of these. Some placebo effects certainly occur with acupuncture, since you can reproduce them with “sham” acupuncture treatments, and since you can make them stronger or weaker depending on how you have the acupuncturist present the therapy. All therapies, including those proven to work directly through a specific physiological mechanism, also induce placebo effects. The question is not whether acupuncture has placebo effects, but whether it has any other effects.

    So far, research has not convincingly shown that an appropriate sham acupuncture procedure to which the patient is effectively blinded is consistently less effective than “real” acupuncture, so I think the question is still viable whether acupuncture is any more than a placebo. It is also a particularly difficult question to answer since you cannot effectively blind the therapists who administer the treatment, and it has been shown that the behavior of the therapist significantly influences the perceived response of the patient.

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