2,000yearsofChineseacupuncture
InChinatodaymostmedicalpractitionershavesometraininginbiomedicalandtraditionalmedicine.Varyingdegreesofintegrationareevidentinstitutionallyinthedeliveryofhealth-careathospitals,indiagnosis,explanatorymodelsofdisease,therapeuticpaths,anddrugpreparations.Someindigenoustraditions,suchaspharmacotherapy,acupunctureandmoxibustionormassageareonofferinmodernhospitalandclinicalsettings,andevenonemergencywards.
Farfrombeingsubsumedunderthehightideofagloballypowerfulbiomedicine,accordingtoWHOestimatesin2002,traditionalmedicinestillaccountsforabout40%ofChinesehealthcare.Indeedamulti-millionpoundtradeinpreparedChinesemedicinesworld-widetestifiestoatwo-waytransferofknowledgeandtechniques.Withmassemigrationandtheglobalisationofapluralityofmedicaltraditions,Chinesemedicinenowsurvivesinmanydifferentforms,transformingasitcomesintocontactwithdifferentculturesaroundtheworld.
ChineseHealthCare
HealthcareinChinaembracesawidevarietyofdifferenttraditions.Fromwellbeforethebeginningofimperialhistory(221BCE),therearenaturalistictheoriesofhealthanddiseasebaseduponideasaboutman’srelationshipwiththeheavensandearth,theweather,andthepassingoftheseasons.Equally,forthemostpartofthepasttwothousandyearsChinesescholarlymedicaltraditionshaveregardedthehumanbodyasvulnerabletointerferencebyancestors,demonsandspirits.
ClassicalChinesephysiology,baseduponideasaboutman’srelationshipwiththespirits,withtheheavensandearth,theweather,andthepassingoftheseasonsiswell-documentedfromthelateWarringStatesperiod(c600-221BCE).Thiswasatimewhenphilosophersandgentlemenhawkedtheirskillsaroundthecourtsofthekings.Thefirstemperorwasparticularlyfondoffangshi(gentlemenofremedies)who,itissaid,transmittedtheartsofZouYan.LittleisknownaboutZouYanexceptthathis‘school’waspurportedtobetheinstitutionaloriginoftheYinandYangphilosophies.Indocumentsofstategeneratedbytheseadvisers,intheirmilitarytactics,divination,medicalandreligiousmatters,wefindtheearliestrecordsofYinYangandthewuxing(fiveagents).
EarliestcorrespondenceswithYinandYang
TheYinandYangsystemofcorrespondencebecametheenduringorganizingprincipleoftheepistemologicalframeworkbehindmanyChinesetraditions.
Table1setsouttheearliestcorrespondenceswithYinandYang.Basedinlargepartonobservationsofchangeinthenaturalenvironment,theywereasimplemappingtoolfororderingtimeandspace,usedindivination,medicine,orasaguidetomilitaryaction.Individualpairschangeaccordingtotimeandcontext.
TheEarliestCorrespondenceswithYinYang
Yang YinHeaven EarthSpring AutumnSummer WinterDay NightBigStates SmallStatesImportantState UnimportantStatesAction InactionStretching ContractingRuler MinisterAbove BelowMan WomanFather ChildElderBrother YoungerBrotherOlder YoungerNoble BaseGettingonintheworld BeingstuckwhereoneisTakingawife/begettingachild MourningControllingothers BeingcontrolledbyothersGuest HostSoldiers LabourersSpeech SilenceGiving Receiving
YinandYanginmedicine
IntimemedicaltheoristsadaptedtheYinandYangcorrespondencestointerpretsignsandsymptomsofillnessspecificallyformedicalintervention.
Yang YinOuter InnerUpper LowerDorsal VentralQi氣 Xue血(Blood)Vitalfunction MaterialSubstrateStimulation RestraintIncrease,Growth Decrease,DeclineAscent DescentOutwardOrientation InwardOrientation
ThisrepresentationofYin-yangdatingtoca11thcenturymodelschangebyrepresentingtheopposingbutcomplementaryforcesofYinandYang.Eachflowsinto,andcontainstheseedof,theother.
DivinationinHealthCare
AsaschemeforinterpretingthechangingnatureoftheworldtheYinYangsystemfollowsinthewakeoftheYiJing(ClassicofChanges),agreatrepositoryofwisdomthattookshapeinthefirstmillenniumBCE.ThesymbolsusedinYiJingdivinationarethe‘8trigrams’,whichwhencombinedmake‘64hexagrams’,eachonethenrelatedtoacrypticstatementinthetext.Traditionallytherelevanthexagramisidentifiedbythrowingyarrowstalks,butinmoderntimesdivinerstendtousecoins.Thedivinerthenbringsthehexagramsalivethroughinterpretingthecypticstatementaccordingtothetopicofconcerntothequestioner,whetherthatbetodecidewhentogotowar,whentomarryortoforetelltheoutcomeofanillness.
SomeoftheearliestwritingsinChinawereinscribeduponturtleshellsandcowscapulas.TheyaretherecordsofdivinersinthecourtsoftheShangdynastykings(trad.Dates1766–1122BCE).Someoftherecordsrelatetothekingsillnesses.
TheWuxing(fiveagents)correspondences
TheFiveAgentscorrespondencesexpandedthecorrelationalbasisforinterpretingexternalphenomenonwithgroupsoffive.Xing,meaningliterally‘togo’isoftentranslated‘element’,butthisdoesnotdojusticetothedynamicqualitiesimpliedbytheterm.Ratherthaninertsubstancestheyareconstantlytransformingforcesthatpowertheworld.Fromtheirearliestincarnationsasaschemetointerprettheriseandfallofdynasties,theyultimatelygavebroaderdefinitiontotherelationshipbetweentheexternalworldandthehumanbodywithgroupsoffive:fiveseasonsoftheyear,fiveflavours,fiveorgansetc.Inpracticephysicianschosetoemphasisedifferentsetsofcorrespondencesatdifferenttimes,buttheeverevolvingsystemsofcorrespondenceshapedanenduringsciencefoundedonmetaphysicalthought.
WuXingcorrespondencesaccordingtoTheAnnalsofLuBuwei(239BCE)
Wood Fire Earth Metal Water8 7 5 9 6Spring Summer LateSummer Autumn WinterEast South Centre West NorthSour Bitter Sweet Acrid SaltyGoatish Burning Fragrant Rank RottenJupiter Mars Saturn Venus MercuryWind Heat Thunder Cold RainWheat Beans Pannicled
MilletHemp Millet
Liver Heart Spleen Lungs KidneyEyes Tongue Mouth Nose EarsAnger Joy Desire Sorrow FearShouting Laughing Singing Wailing GroaningBlue-green Red Yellow White BlackScaly Feathered Naked Furred Shelled
TheMianyangfigurine
Thisfigurineexcavatedfromamilitaryofficer’stombinSichuan,WestChina,anddatingtoca118BCE,istheearliestimageofthebodycontouredbylines.Itdoesnotmarkacupuncturelociandnolociarementionedinrecordsthatdatebeforethistime.Wecanonlybecertainthatitwasamapofthebodyconsideredimportantenoughtobeplacedintheoutercoffincompartmentofthetomb.Asthelinesclusterandmeetaroundthesenseorgans,theymustrelatetheirauthor’sideasaboutvision,hearing,sight,tasteandtouch,andarethereforelikelytorepresentpartofthehumanstructurethatboundsandmediatesbetweentheinternalandexternalworlds.Isthisthenasensorymapofthebody,ratherthanamodelconcernedwithillness–theearsandeyesofitsdeceasedowner?
EarlyToolsandPractices
Acupunctureandmoxibustionarisefromasynthesisofoldermedicalpracticessuchaspettysurgery,massage,bloodletting,hotstonetreatment,andexorcisticarcherywithnewideasaboutthenatureoftheuniversethatflourishedinthelateWarringStates.AlthoughsharpstoneandboneneedlesandknivessurvivefromNeolithictimes,acupunctureandmoxibustionwerefirstlinkedtogetherwithatheoryofthechannelsinHantimes(206BCE–220CE),althoughtheaccountsdescribeproceduresquiteunlikethetreatmentsthatweknowtoday.
EarlyChinesestonesthatmayhavebeenusedformassagingthechannels.
MappingtheBody
Theearliestversionsofthechannelsillustrateaspectsofskeletal,muscularandarteriovenousstructures.Theyalsomapasensoryexperienceofthebody:ofpain,pleasureandpassion.AtthesametimetheearlytextsmatchtheacupuncturechannelsandthemovementofqiinthebodytotheriversofChinaandtothecyclesoftheheavenlybodies.
AreconstructionofasilkchartfromtheMawangduitomb(closed168BCE)showingtherapeuticexercisesfromtheWesternHanperiod.
SelfCultivationandChineseMedicine
Ideasaboutthemovementofthespiritsandsouls,aswellasqiinthebodydevelopedasscholarswroteaboutlongevitypracticessuchassexualandbreathtechniques.Intakingtheinnerrealmofthebodyasitsfocusforimprovement,self-cultivationculturegeneratedclassicalChineseconceptsofphysiologicalprocesswherebythegrossmaterialofthebodycouldbeinvigoratedandrejuvenated.
Manyofthesetraditionssurviveaspartofanever-changingfundoffolkmedicalknowledge:elderlypeoplegatherintheparkstopracticeTaijiquan,theslow,gentlemartialartthatmovesqiandstrengthensthespirit.Theypassonassumptionsaboutdietarycareandtonicmedicines.
AreconstructionofasilkchartfromtheMawangduitomb(closed168BCE)showingtherapeuticexercisesfromtheWesternHanperiod.
BianQueandMrWhite
IntraditionalhistoriestheoriginsofacupunctureoftenrelatetothelegendofBianQue,acultfigureassociatedwithahumanheadedbird.Hisname,togetherwiththeYellowEmperorandthemysteriousBaiShi,“MrWhite”,islistedinthetitlesofmedicalliteratureintheofficialhistoryoftheWesternHandynasty(202BCE–23CE).NothingisknownaboutMrWhite,butabiographyofBianQue,attributingtohimsupernaturalpowers,isinShiJi(RecordsoftheGrandHistorian,comp.104-87BCE),InthisEasternHan(25-220CE)stonereliefBianQue,inthecentre,isgivingatreatmenttoawomanpatient.
TheYellowEmperor
TheYellowEmperorwasoneofthemythologicalculturebringers.Chargedwithcivilisingasavageworld:hemodelledpunishments,lawandthecalendarafterdivinepatternsthoughttobeimmanentinHeavenandEarth.Hehadaroleindivinationanddividingtheseasons–anditistheseskillsthatlinkedhimwithessentialmedicalarts–aknowledgeofthebody’srelationshipwiththecyclesandphasesofnatureandtheaccuratepredictionoftheprogressofdisease.ItishisnamethatwefindlendingauthoritytothemostcomprehensivecollectionofearlyChinesemedicaltexts,theYellowEmperor’sInnerCanon.Herewecanfindthebodydividedintotwelvedistinct‘channels’throughwhichqi(theall-pervasivestuffthatpowerstheuniverse),wasthoughttomoverhythmicallyaroundthebody.ThechannelssurfacedintheformofthepulseatplaceswhereancientChinesephysicianscouldexaminetheconditionofthebody’sqi,andtheorgansthroughwhichitflowed.Alargenumberofpulsetypesweredistinguished,suchasfloating,superficial,sunken,hesitant,andthisbecamethepre-eminentmethodofdiagnosisforelitephysicians.
Background:ImagesofPulseQualitiesMojueShanghaiMedicalUniversity
Moxibustion
Moxibustion,aformofheattreatment,wasoneoftheearliestandmostimportantmethodsfortreatingthechannels.Beingmoreaccessibleandcheaperthanneedlesitwasamorepopularandwidespreadtreatment.Thedriedandgroundleavesofmugwort(artemesiavulgaris)burntonandoverthebodyarefirstknowninatropaictechniquesusedtoprotectthehouseholdfromattackbydemons.Chinesemedicalpractitionersnowadayswillburnitontheendofmetalneedles,usecigar-shapedrollsofmoxibustion,orrollconestostimulateparticularpointsorpainfulpartsofthebody.
ASongdynastypaintingdepictingacountrydoctorperformingtreatmentonapatient’sback.ImagecourtesyoftheNeedhamResearchInstitute.
TheEarliestSurvivingMoxibustionCharts
AmongthethousandsofBuddhistmanuscriptsdiscoveredacenturyagoinahiddencavelibraryatDunhuangontheSilkRoadweresome100medicalmanuscripts.Onedamagedseriesofsketchesofthebody,nowheldintheBritishLibrary,givessimpleinstructionsforthetreatmentofspecificconditionswithmoxibustion.Thefiguresconstitutetheearliestsurvivingmoxibustionchartsandpre-datetheNorthernSongacupuncturebronzesthatlayoutcomprehensivenetworksofacupunctureloci,bysomethreeorfourcenturies.CharacteristicoftheDunhuangarchiveisthatitpreservesaverywidevarietyoftechnicalmanuscriptsinwhichwefindintimateglimpsesofpopularmedicaltheoryandpracticeinTangdynasty(618–907CE)ChinaatthisNorthwesternoutpostoftheempire.
BritishLibraryOr.8210/S.6168
InnerAlchemy
ClassicalChineseperceptionsofthemedicalbodymirroredthegeographical,philosophical,politicalandreligiousrealitiesofearlyChina.Thesurfaceofthebodywaslandscapedwithmountainrangesandwaterways,anditsparkledwithrepresentationsofthesunandmoon,starsandconstellationsinthenamesofanatomicalandacupuncturelocations.Patternsandhierarchiesofimperialbureaucracyandadministrationstructuredtheimaginationofphysiologicalprocess.
InmediaevaltimesChinese‘inneralchemy’oftenassociatedwiththeShangqing(SupremePurity)schoolofDaoism,wasonecontextwithinwhichlyricalimageoftheinnerbodyflourished.Precededbytheolderpracticeofcompoundingofelixirsfrommetalsandminerals,‘InnerAlchemy’aimstoproduceanelixirthroughpracticesthatrefinethesubstanceswithintheadept’sbody.
NineNeedles
ClassicsofChineseacupuncturetendtoexpressdissatisfactionwiththecrudemethodsassociatedwithearlyacupuncture.Yetmuchofthetherapydescribedinoneearlytreatiseknownas‘NineNeedles’describespettysurgery,blood-lettingandmassage.Needlesformovingqiwereofrarequality,likenedto‘finehair’.
AMing(1368–1644CE)reconstructionoftheNineNeedles
TheSong(960–1279CE)Bronzes
ImperialpatronageofacupunctureflourishedintheTangperiodandwasonthecurriculumoftheSongImperialMedicalCollege.InSongtimesscholarssoughttosystemisemedicalknowledge.BronzeacupuncturefigurineswerefirstcastbyWangWeiyi(11thcentury)forthepurposesofteachingandexamination.Theyclearlydisplaythecirculationnetworksandlabeleachacupuncturepoint.Whenthemodelwascoveredwithalayerofyellowwaxandfilledwithwater,medicalstudentshadtolocatetherequiredacupointexactlywithaneedle,causingwatertogushoutofthemodelthroughthehole.
Abronzefigurinemadetoimperialdecreein1727CEPhoto:WellcomeMedicalMuseum
AfifteenthcenturyinterpretationofWangWeiyi’sbronzesBeijingNationalMuseumofHistory
MedicalPlurality
Survivingdocumentaryevidenceofacupuncturetheoryrecordstheworkofascholarlymedicalelite.ButthroughoutChinesemedicalhistorywefindtracesofmorepopularpractice.Mingnovels,forexample,describelargegroupsofcompetingandcomplementarypractitioners.Acupunctureemergesasalowerclassofpractice,lessprestigiousthantheprescriptionofChinesemedicaldrugs,andoftentheworkofwomen.InJapansomeofthemostrespectedpractitionersofacupuncturearetobefoundintheblindcommunity.
‘Belldoctors’wereitineratephysicianswhocalledattentiontotheirpresencebyringingabell.WellcomeLibrary
AcupunctureinLateImperialChina(1368–1911)
DuringtheMingandQingdynastiestheimportanceofacupuncturedeclinedrapidly.PhysicianslikeZhangJiebin(1563-1640)andXuDachun(1693-1771)notedthattherewerefewwell-knownacupuncturiststobefoundintheirtime.In1822theImperialAcademyprohibitedtheteachingandpracticeofacupuncture.Thereasonsforthisdeclineincludedadislikeofneedlesamongpatients,theemergenceofgentlertherapiessuchastuinamassage,andthepreferenceofelitephysiciansforherbalmedicine.Acupuncturewasamanualtherapyunsuitedforthescholar-physiciansthatdominatedthefieldofmedicine.Itbecameaspecialistdisciplineoftenpractisedbyexternalmedicinephysiciansasapartofalargerrepertoireofpettysurgerytechniques.
ThephotoshowstheacupuncturetoolsofYuJinghe(1847-1907),aphysicianfromChangshuinJiangsuProvince.
TheModernisationofChineseMedicineinRepublicanChina(1911–1949)
Fromthelatenineteenthcenturyonward,physiciansofChinesemedicineincreasinglyadvocatedtheneedtomodernizetheirtraditionifitwastosurviveinarapidlychangingsociety.ThisincludedtheestablishmentofWestern-styleschools,collegesandhospitals,thefoundingofprofessionalassociations,andthepublicationoflearnedjournals.Duringthisperiod,traditionalmedicinealsohadtodefenditselfagainsteffortsbymoreradicalmodernizerstodisbanditspracticealtogether.
In1929,amotionintendedtoprohibitthepracticeoftraditionalmedicinewasputbeforeparliament.Inresponse,physiciansoftraditionalmedicineunitedforthefirsttimeintheirhistoryintoonesinglegroupataconferenceheldinShanghaion17March1929.TheconferencesentadelegationtothecapitalNanjingthatsuccessfullylobbiedtohavethemotiondeferred.TheeventsofMarch1929arethereforeseenasthebirthofmodern“traditional”ChinesemedicineandMarch17thisstillcelebratedinTaiwanandSingaporeas“NationalMedicineDay.”
TheNewChinaChineseMedicineCollegeinShanghaiandthe1929DelegationtoNanjing.
TheDevelopmentofChineseMedicineinContemporaryChina(1949–)
ChineseCommunistleadershadlongviewedChinesemedicineasa“feudalsuperstition.”However,asMaoZedongbegantodistancehimselffromtheSovietUnionhechangedhismind.Mao’sChinesecommunismfocusedon“patriotism,”on“beingselfreliant”and“native”andChinesemedicinefittedthisbill.From1954onwarditwasusedasasymbolforChina’sculturalgenius.CollegesofChineseMedicinewereopenedinShanghai,Guangzhou,ChengduandBeijingin1956,andin1958Chinesemedicinewasdeclaredanationaltreasurebythegovernment.ButChinesemedicinewasnotlefttoitsowndevices.Itwasexpectedtomodernise,scientise,andeventuallyintegratewithWesternmedicine.Inthe1980s,itwasdefinedbylawasbeingpartofapluralhealthcaresysteminChinaanditsinfrastructuredevelopedfurther.Sincethe1990s,theChinesegovernmenthasmadeeffortstoglobaliseChinesemedicineandtodevelopitseconomicpotential.
CalligraphybyMaoZedong“Chinesemedicineisagreattreasurehouseandshouldbediligentlyexploredandimprovedupon.”
ModernAcupuncture
Poverty,lackofpublichealthcareandageneralspiritofrenewalstimulatedsomedoctorsinRepublicanChinatopromoteacupunctureasacheapalternativetodrugbasedmedicine.OneofthemwasChengDan’an(1899-1957),anacupuncturistandpaediatricianfromJiangsu,whohadvisitedJapanintheearly1930s.OnhisreturntoChinain1933,heopenedthefirstmodernacupuncturecollegeinChinainWuxi.Hisacupuncturewasbasedonclassicaltheorybutattemptedtosystematizeitinordertomeettheneedsofamodernaudience.Throughhisstudents,hiswritings,andhispoliticalactivityChengDan’anexertedaprofoundinfluenceonthedevelopmentofacupunctureinChina.AtthesametimethatChenDan’anwasdevelopinghisacupunctureinChina,JapaneseacupunctureinJapanalsowitnessedarevival,whereacupuncturistslikeYanagiyaandSawadadeveloped“meridiantherapy”.Althoughpromotedunderthebanner“returntotheclassics”,it,too,wasadistinctlymoderninnovation.ThroughitsdiffusionintoTaiwan,GermanyandFranceitinfluencedthedevelopmentofacupunctureintheWest.
Oldacupuncturecharts
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