The History of Acupuncture in China
Acupuncture, or needle puncture, is a European term invented by Willem Ten Rhyne, a Dutch physician who visited Nagasaki in Japan in the early part of the seventeenth century. The Chinese describe acupuncture by the character 'Chen', which literally means 'to prick with a needle', a graphic description of this therapeutic technique.

Early History
Acupuncture has a clearly recorded history of about 2,000 years, but some authorities claim that it has been practiced in China for some 4,000 years. The Chinese believe that the practice of acupuncture began during the Stone Age when stone knives or sharp edged tools, described by the character 'Bian', were used to puncture and drain abscesses. In fact the Chinese character 'Bian' means the 'use of a sharp edged stone to treat disease', and the modern Chinese character 'Bi', representing a disease of pain, is almost certainly derived from the use of 'Bian stones' for the treatment of painful complaints. The origin of Chinese medicine is a fascinating story and acupuncture represents only one facet of their medical system.

The first recorded attempt at conceptualizing and treating disease dates back to about 1500 BC during the Shang dynasty. Tortoise shells with inscriptions dating from that time have been found, and it is thought that these were used for divination in the art of healing.

Acupuncture Needles
As acupuncture developed, the Bian stones were discarded and needles of stone and pottery were used. These simple, primitive needles are still used in some of the rural areas of China. Eventually metal needles began to appear and these took the form of the classical 'nine needles'. The 'nine needles' comprised:

1.Arrowhead needle for superficial pricking

2.Round needle for massaging

3.Blunt needle for knocking or pressing

4.Three edged needle for puncturing a vein

5.Sword-like needle for draining abscesses

6.Sharp round needle for rapid pricking

7.Filliform needle, for needling in thin built males & most females

8.Long needle for thick muscles

9.Large needle for puncturing painful joints.

The main needle now used for acupuncture is the filliform as most of the others have been replaced by more sophisticated surgical instruments, for instance, the sword-like needle has been replaced by the scalpel. The 'nine needles' were initially made of either bronze, or gold and silver, and seem to have been first used about 2,000 years ago. The tomb of the Prince of Chungshan, dating from the second century BC, was excavated in 1968 and contained a set of nine needles, four being of gold and five of silver. Some acupuncturists use gold and silver needles but the majority only stainless steel filliform needles.

Moxibustion
A discussion of the history of acupuncture is incomplete without mentioning moxibustion. Moxa herb is burnt in close proximity with the skin of the patient. The Chinese character 'Chiu' is used to describe the art of moxibustion, and literally means 'to scar with a burning object'. Moxibustion does not now involve scarring, but moxa is still used to provide local heat over acupuncture points. It is made from the dried leaves of Artemisia vulgaris and the Chinese believe that the older the moxa, the better its therapeutic properties. Moxibustion developed as a medical practice completely separate from acupuncture, although it is now very much a part of current acupuncture practice in China.

It is used to treat specific types of disease and is applied over the same body points (acupuncture points) as acupuncture needles. Some of the acupuncture points, such as those around the eye, are forbidden to moxa. In ancient China, moxa was also burnt on specific acupuncture points to keep the body healthy, and was said to act as a prophylactic against disease. Moxa can be used in a variety of ways. Loose moxa is made into a cone and burnt on the skin, the cone then being removed when it is half burnt, to avoid blistering. It may also be burnt on ginger or garlic so that the skin is isolated from extreme heat, or a moxa stick may be used and burnt a centimeter or two away from the skin.

Initial Therapeutic Success
The exceptionally productive period of the Warring States also gives us the first known and recorded therapeutic success of acupuncture The Historical Records by Ssu-ma Ch'ien tells how the physician Pien Cheuh used acupuncture to revive the Governor of the State of Kuo from coma. In fact the name of the physician was Chin Yenh-jen, but by taking the legendary name of the famous Chinese physician, Pein Cheuh, we can assess his prestige. In ancient China, as today, an event like this is a powerful argument in favor of the acceptance of any form of treatment.

The Evolution of Acupuncture Points and Channels
Initially, there were no specific locations on the body for applying either moxa or acupuncture but gradually, through empirical experience, the use of specific points on the skin were shown to be of value in particular diseases. Acupuncture points are undoubtedly the end-product of millions of detailed observations and as they were developed, they were given a name and Chinese character, depending on its therapeutic properties. Acupuncture points were subsequently grouped into a system of channels which run over the body, conducting the flow of vital energy through the body. The acupuncture points on a channel are said to influence the flow of vital energy through the channel, thereby influencing disease processes in the body.

The first clear reference to the points and channels is in the Nei Ching Su Wen which defines the main channels and acupuncture points. The Nei Ching Su Wen also makes the observation 'in pain, puncture the tender spot', and the use of painful points probably represents the original method by which many of the acupuncture points were discovered. Common painful diseases consistently cause painful points to emerge in well defined anatomical locations over the body. When this point is stimulated the pain can be alleviated; hence the idea of a point for treating pain. From this simple beginning it is easy to see how a system of acupuncture points evolved. The evolution of the channels connecting these acupuncture points is more difficult to understand. These seem to have evolved from an intuitive understanding of the flow of vital energy through the body. It is unclear from where the idea of channels originated, but for the last 2,000 years they have formed an essential part of traditional Chinese medicine.

The 'New' Brozne Model for Teaching Acupuncture Points
Because of the confusion that had gone before him, Wei-yi collected and collated all the information that was available to him in the eleventh century. He redefined all the points and channels and compiled an authoritative text called Illustrated Manual on the Points for Acupuncture and Moxibustion on the New Bronze Model. This text dates from AD 1026 and details the use of 354 points on the body. A vast amount of information is given about the location of the points, the method of needle insertion into each point, and the clinical indications for the use of specific points.

The Arrival of the Europeans

During the Ming dynasty contact was established with Europe, the earliest date being 1504 when the Portuguese landed; Macao. At about the same period, China's fleets began to visit India, Persia and some of the Arab states. Cheng Ho led the first recorded fleet of merchant ships to India in 1405, but it is certain that other Chinese merchantmen had traveled far off prior to this date. The overland 'silk route' to China had been open for many centuries and merchants had for some time traveled into China and central Asia, following in the footsteps of Marco Polo. With the traders went priests to convert the 'heathen'. It was through these priests, and also various physicians who visited China, that the idea of acupuncture began to filter through to the west. The Jesuits were particularly active in collecting and disseminating this information in Europe, but the process was far from one-sided as the Jesuits also introduced Western science to China. Dominique Parrenin, a missionary, translated a textbook of anatomy into Mandarin but this was banned from general circulation by the Emperor K'ang Hsi as he recognized that many of the Western concepts contradicted those of traditional Chinese medicine.

The Decline of Acupuncture and the Rise of Western Medicine in China
1644 – 1911: This was the time of chaos for the Chinese Empire. Western influences pervaded a war-torn China, especially during the nineteenth century when various Western nations were given 'spheres of influence' on the Chinese mainland. The Ching Emperors regarded acupuncture as 'a bar to progress' and in

1822: Government decree eliminated acupuncture from the curriculum of the Imperial Medical College. During this period a great number of medical missionaries entered China to 'teach, heal and preach'. The medicine they practiced in the early part of the nineteenth century had little similarity to the Western medicine of today, as there were no anaesthetics, antibiotics or sepsis. The concept that bacteria caused disease was only disseminated in the 1860's and 1870's, and therefore the missionaries had very little real medical skill to offer. Their main advantage was their understanding of the elementary principles of surgery. The Confucian ethic had blocked completely the progress of surgery, as the Chinese felt that the dead must present themselves to their ancestors with a whole body. They were afraid of surgery. The first full-time missionary was Peter Parker who worked in Canton. At first, the activity of the medical missionaries was limited by hostility, money and manpower, but as Western influence expanded the missionary work grew.

1920: There were some 550 hospitals and out-patient clinics spread over most of the provinces and cities in mainland China. During this period the art of acupuncture was in decline. Many acupuncturists seemed to be no more than 'pavement physicians' with poor training. Their surgery was often the market place, their knowledge of traditional Chinese medicine was very limited, and their equipment was filthy and of poor quality.

The majority of 'respectable' Chinese doctors were practicing herbal medicine and massage, rather than acupuncture and moxibustion. In spite of its decline, and even at this low level, acupuncture remained the medicine of the masses. In 1929 the practice of acupuncture was outlawed in China; the passage of acupuncture has not always been smooth, even in China!

Communist Support for Acupuncture
In 1928 the Communist party of China was formed, under the leadership of Chairman Mao. A long guerrilla war ensued and the Communist party finally took power in 1949. The Communists realized that there were little or no medical services in the 'liberated areas' and actively encouraged the use of traditional Chinese remedies to keep their troops on the move. These remedies were cheap, acceptable to the Chinese peasants, and utilized the skills already available in the countryside. Acupuncture gained new momentum.

During the early 1950's many hospital opened clinics to provide, teach and investigate the traditional methods, the main research institutes being in Peking (Beijing), Shanghai and Nanking. This renaissance of acupuncture, combined with a sophisticated scientific approach, has allowed the development of many new methods of acupuncture.

New ideas Based on Traditional Chinese Medicine
Ear acupuncture has been used and developed by the French and the Chinese as a form of therapy and also, specifically by the Chinese, for acupuncture anesthesia. Many people in the West think of acupuncture as being synonymous with acupuncture anesthesia. The application of acupuncture as a form of anesthetic is a relatively new development, and a direct product of the impetus given to acupuncture by the Communists.

In 1958 acupuncture was first used by the Chinese to control post-operative pain and it then began to be used as an anesthetic for simple operations. This technique was found to be effective and its use expanded quickly. In China it is now used for a wide variety of major and minor operations. Acupuncture anesthesia has many advantages including safety and swift post-operative recovery; however, it does not always provide complete pain relief, and whilst a small failure rate is acceptable to the Chinese it would not be acceptable in most Western societies. It is obviously better to use a site far away from the area of the operation when applying acupuncture anesthesia, and this makes ear acupuncture the method of choice for anaesthetics. The concept of the homunculus is one that the Chinese have developed further. There are complete representations of the body on the hand, foot, face and nose. Each of these represents complete 'micro-acupuncture' system, capable of treating ailments throughout the body. Acute back pain can be relieved by stimulating the points on the hand that represent the back. Perhaps this can be equated with the fact that each cell in the body has the information potential to duplicate the whole human. The genetic material in each of our cells is exactly the same as the information in the cell from which we all originated, the fertilized egg.

New Ideas Based on Western Medicine
The Chinese have also applied a variety of Western techniques within the field of acupuncture. They have established research institutes and these, particularly in Shanghai and some other Chinese cities, measure up to any found in the West.

Scalp acupuncture, a technique invented in the last decade, is a direct development from the neuro-anatomy of the central nervous system. When the brain is damaged, in diseases such as a stroke, the scalp is stimulated superficially over the area of damaged brain. Although there is no clear connection between the nerves in the skin of the scalp, and the brain, this method does seem to produce an effect on the brain and the Chinese claim that they are able to alleviate some of the symptoms of a stroke with this procedure. Modern medicine has undoubtedly provided the stimulus for the development of this type of acupuncture.

Acupuncture points can also be treated by injection with ordinary injection needles, this method having been used in the West for some time although not called acupuncture. Tender, painful areas often occur in and around arthritic joints. Recent research work has shown that most of these 'tender points' are acupuncture points, and that injection therapy relieves the pain. Is it perhaps the needle insertion, rather than the fluid injection, that alleviates the pain?

Electro-acupuncture is the stimulation of acupuncture needles with small electrical currents, and its growth and development has been pioneered by the Chinese over the last thirty years. Throughout long operations, under acupuncture anesthesia, electrical machines have been used to avoid prolonged, continual manual stimulation of acupuncture needles. Electroacupuncture is now widely used in many acupuncture clinics, for acupuncture therapy as well as for anesthesia.

Contraditions Resolved?
The Chinese are well aware of the current scientific explanations of acupuncture and its mode of action, and through their research institutes they are contributing to this field. The cultural heritage of the Chinese has made it possible for them to accept the contradictions inherent in the practice of acupuncture; science versus philosophy. The concepts of traditional Chinese medicine allow the acupuncturist to approach and treat a patient. Eventually science will provide a logical explanation for these empirical findings, but, until such time as that happens, science and traditional ideas will both play an equal part in helping patients by the use of acupuncture.