|Journal of Integrative Medicine: Volume 11, 2013 Issue 1
|Acupuncture in ancient China: How important was it really?
|Hanjo Lehmann (Deutsches Institut für TCM, Cranachstr. 1, D-12157 Berlin, Germany E-mail: Lehmann@tcm.de) |
ABSTRACT: Although acupuncture theory is a fundamental part of the Huangdi Neijing, 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. The conclusion, however, is a positive one: 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.
Lehmann H. Acupuncture in ancient China: How important was it really? J Integr Med. 2013; 11(1): 45-53.
Received April 27, 2012; accepted June 18, 2012.
Open-access article copyright © 2013 Hanjo Lehmann.
Correspondence: Dr. med. Hanjo Lehmann; Tel: +49-175-6449006; E-mail: Lehmann@tcm.de
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In China, the most important part of applied traditional medicine has always been drug therapy, mostly of herbal origin. In most Western countries, things are different: acupuncture (in theory including moxibustion, but in reality mostly needle therapy) comes first, and traditional Chinese medicine (TCM) drugs still have to overcome severe resistance from politicians and medical pressure groups.
However, using, teaching and researching acupuncture raise many questions. For example, these ones:
- How can we integrate acupuncture in our scientific medical curriculum?
- How can we get rid of those parts of TCM theory which have to be considered as clearly obsolete?
- How can we further develop acupuncture without violating its core of age-old clinical experience?
The last question, of course, has one precondition: that this “age-old clinical experience” really exists, or at least existed. Most TCM friends are convinced of it. A conviction, however, is no proof, even if shared by millions of believers.
And that’s what leads us to our question: How important was acupuncture really in ancient China? Not in theory and in books, but in daily practice?
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1 Stones, needles and moxibustion
In Chapter 12 of the Suwen we are told: The stone therapy came from the east ... drug therapy came from the west ... moxibustion came from the north ... acupuncture with the 9 needles came from the south ... massage and body exercise came from the center.
If this was true may be doubted. Nevertheless, we can see that the Suwen considered stone therapy, moxibustion and needle therapy as totally different methods: invented, developed and used in different parts of the country (which is, by the way, one reason why in this essay “acupuncture” does NOT mean Zhenjiu – needles and moxa – but in most cases only “needling therapy”).
And we have to ask:
- When and how did stone therapy, needling and moxibustion form a combined therapy?
- Were they all related to the Jingluo system from the beginning?
- When did acupuncture spread all over China – and did it really?
- Was acupuncture, as Paul Unschuld supposes, originally a kind of blood-letting?
- Or is it true that Chinese acupuncture, according to Lu and Needham , never was blood-letting?
- Was there ever a time or a region in China where acupuncture was frequently used as a single therapy, without adding drugs?
- Is there any estimation which percentage of patients have been treated with acupuncture in different times and in different regions?
- Which kinds of diseases were treated with acupuncture in ancient China?
- Which acupoints have been used? Were the points most frequently used the same as today?
- How many needles were used at one session? How deep were they punctured?
- Which manipulation techniques were used? How long did the needles remain in their places?
- How many needling sessions were usual – one or several or many?
- Are there any records about inflammations and purulency caused by the needling?
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2 Books and legends – but little about clinical reality, numbers and percentages
Unfortunately, very few books try to answer such questions, or at least ask them. Not the older books of the new China, like Cheng Danan’s Zhongguo Zhenjiuxue (《中国针灸学》)  or Zhu Lian’s Xin Zhenjiuxue (《新针灸学》) . Not the Outline of Chinese Acupuncture , China’s first acupuncture book in English language. Not the second “official” teaching book for foreigners, Essentials of Chinese Acupuncture , or its successor Chinese Acupuncture and Moxibustion . Not the 14-volume A Practical English-Chinese Library of Traditional Chinese Medicine . Not the 21-volume The English-Chinese Encyclopedia of Practical Traditional Chinese Medicine . Not the 14-volume A Newly Compiled Practical English-Chinese Library of Traditional Chinese Medicine . Not the 1 492 pages of Zhenjiuxue (《针灸学》) . Not the 4-volume General History of Chinese Medicine (《中国医学通史》) . Not the 992 pages of the History of Chinese Zhenjiulogy (《中国针灸学史》) .
The acupuncture history presented in all these books is nearly entirely a history of ideas, of books, and famous acupuncturists. But they tell us very little about ancient medical reality.
If we are lucky, our TCM books tell us something about the different kinds of medical practitioners in former times. They tell us that according to the Zhou Li (《周礼》) there were four kinds of doctors, namely physicians for inner medicine, so-called “surgeons” for wounds and bone settings, dietitians and veterinary doctors. Or we are told something about the different levels of education, from the physicians at the imperial court, working and teaching at the Tai Yi Yuan (太医院), down to illiterate quacks who mixed some herbs and claimed their pills or decoctions had miraculous powers.
But what about numbers and percentages, so that we might have some realistic idea of those times?
Which percentage of all the medical people during Tang, Song, Yuan, Ming or Qing dynasty were scholars? How many physicians were employed by pharmacies? Which percentage were bell doctors, traveling on their own? How many patients did an average bell doctor treat during a day, a month, a year? Which percentage of all the men in medical business knew to write and read, and how many were illiterate? How many medical books or scripts did they usually know? Which percentage of the practitioners during Tang, Song, Yuan, Ming or Qing dynasty knew the Huangdi Neijing, the Nanjing, the Shanghanlun or other medical classics? And, most important for the question of this essay: How many of them did regularly use acupuncture?
Unfortunately, I have to state: None of the common acupuncture books tells anything significant about numbers, quantities and percentages (or at least tries an estimation).
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3 Relics, facts and common sense
However, there are some important historical relics, documents and well-known facts. Other questions can be answered by common sense.
Let us start with the beginning: the so-called “stone needles”. And we have to state: Calling these stone instruments “needles” is only wishful thinking. They might have been used to open an abscess, but never for anything which might be called “acupuncture”.
Next, there are the needles unearthed in 1968 from the Western Han tomb. The silver needles found there are rotten and can hardly be judged, but the gold needles can. Photos of them can be found in many sources, for example in An Illustrated Book on the Historical Development of Chinese Acupuncture (《中国针灸史图鉴》) . The shafts of these gold needles have a diameter of more than a millimeter, so their insertion must have been quite painful. These needles must have been used for a kind of therapy quite different from modern acupuncture.
Then, there are the “9 Needles” mentioned in the Lingshu. Apparently they are of great importance, described in the first chapter, and then again, near the end, in the 78th chapter. But is this a proof that all of them were really widely used?
Again, we have reasons to doubt. One reason is that their necessity in the Lingshu is not based upon clinical needs, but upon cosmological speculation: The nine in the needle is a number in heaven and earth, it commences in one and terminals in nine. The first kind of needle is following the example of heaven, the second kind of needle is following the example of earth, the third kind of needle is following the example of man ... 
Strange enough, the illustrations showing those 9 needles usually come from the Ming dynasty, for example from the Zhenjiu Dacheng (《针灸大成》), published in 1601. Three of the needles shown there (No. 3, No. 6 and No. 7) seem nearly identical, different only in length, giving the impression that even Yang Jizhou, the author of the Zhenjiu Dacheng, had no clear idea what the “9 needles” had been like.
Another aspect concerning the use of needles is common knowledge: usually, people do not like pain. But as I said, the insertion of needles with a diameter of more than a millimeter must have been painful. To make a true filiform needle, however, could not be done without advanced steel making. But even when the steel makers were able to produce such fine needles, there was no stainless steel at this time. So even those filiform needles, after some time of use, must have corroded and lost their original smoothness.
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4 Ancient acupuncture was dangerous for the patient
And no matter which needles were used – once puncturing the skin, there were always two dangers. First, due to the lack of anatomical knowledge, the danger that any deep puncturing might damage internal structures or inner organs. Second, the danger that these needles, usually without disinfection of neither needle nor skin, caused inflammations, purulency or infections.
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 (《针灸聚英》, 1537)  talks about “poison” contained in iron. It recommends the iron of horse bits and bridles which was thought free of poison, which of course was a mere hope, as we know today. However, there are good reasons why there was always an inborn aversion of man against anything artificial inserted in the body.
Therefore, common sense lets us expect that acupuncture even in ancient China rarely was a standard therapy, but usually a therapy for special cases. Let us not forget that Chapter 13 of the Suwen explicitly reserves acupuncture for external diseases: Nowadays, patients are treated with drugs internally and acupuncture externally (今世治病，毒药治其内，针石治其外).
Moreover, there were always warnings of the dangers of the needling. As early as in 81 BC, the Yan Tie Lun (《盐铁论》) 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 (《外台秘要》, published in 752): 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.
Or, as Lu and Needham summarize it: Yet it is not difficult to understand why some physicians at all times feared the technique, for not only there was the danger of piercing nerve-trunks and blood-vessels by careless or ignorant handling, but also the risk of infection, the unwitting inoculation of pathogenic bacteria. Nothing was known in those days about the necessity of sterilization, and not all the acupuncturists carried out systematic procedures which more or less amounted to it .
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5 Ancient acupuncture was dangerous for the acupuncturist
Besides, there was the legal aspect. It was always important, but it must have been decisive when members of rich families were treated – and, most of all, treating the emperor and his family.
As we know, physicians in ancient China were held responsible if a patient died. When the emperor was severely ill, who was willing to be the only person responsible? When using pills and decoctions the responsibility could be shared: one doctor recommended a prescription, and the other court physicians would give their opinion. If they agreed, they also accepted part of the responsibility. Using needles, things were different. No matter how many doctors agreed, it was always one hand which inserted the needle. If the patient died, the man who owned this hand would be responsible. Who was willing to carry such a burden?
Strangely enough, this aspect is never discussed in our acupuncture books. For me, this seems to be a hint that most of the stories of famous physicians treating kings or princes with acupuncture are not reliable.
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6 Acupuncture in the Shanghanlun
The minor role of acupuncture in ancient China is confirmed by one of the highest authorities of ancient TCM: the Shanghanlun. In its nearly 400 sentences, acupuncture, hot needling and moxibustion are mentioned about 30 times. However, one third of them are not recommendations but, in the contrary, warnings that hot needling or moxibustion might have a negative effect. Then, there are 3 sentences recommending hot needling. 5 sentences recommend moxibustion. And if my counting is correct, only 9 sentences of 398 directly recommend the use of normal needling.
Above, I asked if the acupoints used in ancient China were the same as today. Concerning this aspect, the preferences of the Shanghanlun are surprising.
None of the 3 “Big Points” of modern acupuncture (ST36-Zusanli, LI4-Hegu and SP6-Sanyinjiao) is mentioned in the Shanghanlun.
By far the most important point is LR14-Qimen, recommended 5 times (sentences 108, 109, 143, 216 and 171). With one exception (sentence 171) it is recommended as the only acupoint.
Twice, the main recommendation is DU14-Dazhui, BL13-Feishu and BL18-Ganshu. Once, GB20-Fengchi and DU16-Fengfu are recommended – and that’s it.
So, it is no exaggeration if we state: Although Zhang Zhongjing knew all about theory and application of acupuncture, in his clinical recommendations needling plays only a marginal role.
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7 Acupuncture and the emperors
Back to our question: How important was acupuncture in ancient China really?
One might object: How can we know? Who cared to write down if a sick peasant in times of the Tang dynasty was treated with herbs or acupuncture, or not treated at all?
However, there were the noble houses where such reports were written down.
And there were, most important of all, China’s emperors.
If I am not mistaken, there were altogether about 400 emperors in Chinese history, from the short-lived Qin dynasty to the late Qing dynasty. Some emperors ruled only for days, some of them half a century or more. Nothing was more important than the emperor. Whatever he did, said or ordered in public was written down. He got the best food, the best clothes, the best artists, the most beautiful concubines – and of course the best physicians, or at least those who were thought to be the best.
So, when it came to cure a sick emperor: What about acupuncture?
The answer is depressing, if not devastating: Not even a handful of all those 400 Chinese emperors have ever been treated with acupuncture.
One of the few examples of a Chinese ruler being treated with acupuncture is Cao Cao (who did not call himself “emperor”, but nevertheless may be counted as one). There is a story that Huatuo cured his headache and Cao Cao afterwards wanted to keep him as a court physician, which Huatuo rejected. However, this may be legend, like the stories claiming that Huatuo did successful abdominal surgery.
Yet there was one emperor who (as it seems) really kept acupuncture in high esteem: Renzong, the 4th emperor of the Song dynasty. In 1023 – one year after ascending to the throne – the court physician Wang Weiyi was ordered to compile a systematic work on acu-moxa therapy. Moreover Wang cast a famous bronze acupuncture model for teaching and examination purposes.
However, there are reasons to doubt if it really was Renzong who ordered the acu-moxa compilation and the casting of the bronze model. Born in 1010, Renzong was a boy of 12 when he became emperor, and he was 13 when Wang Weiyi was ordered to start his work on acu-moxa therapy. So, probably it was either the reigning empress dowager Liu who ordered Wang Weiyi’s research, or one of the ministers.
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8 Xu Xi inserts a needle near the emperor’s heart
Nevertheless, there are two stories about Renzong using needles himself, or having them applied on his own body. Surprisingly, most Chinese acupuncture books do not mention them. Here comes the first story:
[Sometime] during 1034, Renzong did not feel well. His attending physicians repeatedly administered drugs but to no avail. The people’s hearts filled with worry and fear. The Princess Supreme of Hebei recommended Xu Xi [for the emperor’s treatment]. Xu examined the emperor and said: “If I needle between the lower aspect of the heart and the cardiac envelope junction tract, then recovery will be rapid.” The observers in the room contended saying it cannot be so. Several Palace Gentlemen begged to use their bodies to test the treatment. Xu needled them and there was no harm whatsoever. Subsequently, Xu needled Renzong, and the emperor’s disease was cured. He then ordered Xu made an official at the Medical Institute, gave him a red robe, a decoration of official rank, goods, and money. 
Just as the story about Huatuo and Cao Cao, this story may very well be a legend. The lack of any symptom of the emperor’s disease, of any diagnostic hint, of any clear medical information (including the place where the needle had been inserted) is striking. In 1034, Renzong was 24 years old. What kind of disease might this have been? And if acupuncture was so dominant in the thinking of emperor Renzong – why did none of his court physicians think of it? Why did the princess have to suggest an outsider?
Where was the famous Wang Weiyi, Renzong’s head physician, the most acclaimed acupuncture specialist of this time? He was the man who had finished his great work on acu-moxa therapy and his famous acupuncture model just some years ago. Where was he when his emperor “did not feel well”?
Indeed, the story is fishy. There is only one thing which can be believed without any doubt: that the advisors were afraid of a needle inserted in the emperor’s body near his heart. The rest is doubtful, even their courage. Being afraid the needle might do harm – why not first try it on slaves or servants?
Besides, there was the question raised above: even if nothing happened when Xu Xi inserted the needles into their body – who knew what might happen if they were inserted just a little bit deeper?
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9 Emperor Renzong needles himself
The second story is even more strange: In the year 1056, Renzong became ill and was confined to bed. [He] himself inserted needles [into a location] on the back of his head. As soon as the needles were removed, he opened his eyes and said, ‘it is good to be clear-headed [xingxing 惺惺]’. The following day, the emperor felt well. He decided to name the acu-point he needled ‘head-clearing’ or xingxing. 
The emperor himself inserting a needle on the back of his head ... at a place he could not see ... quite strange, indeed. Where did he get the needle from? Was it just lying around? But what did the emperor have his physicians for? If the role of acupuncture at Renzong’s court was really as important as the stories about Wang Weiyi make us think – shouldn’t all the court physicians have been able acupuncturists?
Goldschmidt, who tells the story, has his doubts, too, when he states: It may well be an attempt to promote the status of acupuncture by attributing its usage to the emperor . I agree.
And the other 400 emperors in China’s history? If we go on searching, I am quite sure that here and there we may find some more reports about some emperors who occasionally were treated with acupuncture.
But even if we find a dozen of further reports, this cannot change the basic fact: When it came to treating a sick emperor, acupuncture in ancient China was only of marginal importance.
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10 Did anyone use acupuncture as a single therapy?
The stories of Huatuo curing Cao Cao and Xu Xi curing Renzong give the impression that they used acupuncture as a single therapy, without adding herbs or additional dietetic recommendations.
But even if this was true, the question is: Was acupuncture really frequently used without additional medication?
Again, there are good reasons to suppose that this did not happen very often.
One aspect – which is, although realistic and important, never mentioned in our acupuncture books – is the psychology of success, failure and payment.
In the books, the suggested treatment is always correct, and success should be sure. In reality, success is never sure, especially in severe cases – even more if the doctor (as frequently happened in ancient China) was given only one chance to treat the patient, and if he failed, another doctor was called.
Now, let us compare an unsuccessful acupuncture treatment with an unsuccessful drug description. With drugs, the physician always had some excuses. Maybe, the pharmacy had sold inferior herbs. Or there had been a mistake preparing the decoction.
But what if the doctor applied acupuncture and nothing else, inserting his own needles with his own hands in places he himself had chosen? Then, the failure was his alone, and no one and nothing could be blamed but himself.
And there was always, as mentioned above, the legal responsibility. When prescribing drugs, the patient and his family could discuss the prescription. With acupuncture, it was different. Even if the physician told in advance which acupoints he would use, the family would never know exactly the spot to be needled, nor the exact depth of the needle. And when something went wrong, there was only the mark of the needle, but no proof of the punctured depth.
Enough reasons to doubt if acupuncture was frequently used as a single therapy.
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11 Lamenting acupuncture as a “lost tradition”
Usually, the time from Song dynasty to Yuan dynasty is considered as the climax in China’s acupuncture history. If this was true, we don’t really know. As I said above: at present, we have neither statistics nor reliable estimations about how many patients at a certain time were treated with drugs, how many with acupuncture and how many with both. We have no proof that even during Song and Yuan dynasty acupuncture was really of great clinical importance.
So, 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.
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12 Turning Point 1822: the abolition of acupuncture
Finally, in 1822 something happened which in fact is one of the most interesting events in the history of TCM. 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 (针刺火灸，终非奉君之所宜，太医院针灸一科着永远停止).
Astonishing, indeed. When the Imperial Medical Academy had been founded in Chang’an in the year 624, there was a department for pharmacology and one for medicine, the latter one further divided into 4 departments: Medicine (医科), Acupuncture (针科), Massage (按摩科), and Incantation-exorcism (咒禁科). For nearly 1200 years acupuncture had been a basic part of imperial medical education. Now it was banned from the court forever.
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 (《医林改错》) 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.
There is another aspect which makes the Daoguang edict interesting: How was TCM theory taught at the Imperial Medical Academy after acupuncture was forbidden? Did they still teach the Jingluo as the “vessels in which qi and blood flow”? Did they still teach the functional categories like the “5 Shu Points”, the “Yuan Points” or the “Luo Points”? What about the theory describing the qualities of drugs according to their pertaining layer (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin)?
Unfortunately, I found none of these questions ever asked in any TCM book I know.
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13 What our books tell us about 1822
Suddenly, a fundamental branch of ancient Chinese medicine was eradicated from the court and from the Imperial Medical Academy. How could it come to such a decision?
Most TCM authors do not spend much time thinking about this question. The acupuncture volume of the University Textbook of Traditional Chinese Medicine for Overseas Advanced Students (全国高等中医药院校外国进修生教材) states a simple reason: The authorities of the Qing Dynasty trampled the science of acupuncture, and abolished the Acupuncture-moxibustion Department from the Imperial Medical Academy, resulting in a decline of acupuncture and moxibustion during the last period of the Qing Dynasty. (清王朝对针灸医学采取歧视态度，停止了太医院的针灸科。所以至清代末叶，针灸乃走向衰落).
But why did they do this? Why did they “show a different attitude” (Chinese text) and “trample the science of acupuncture” (English text)? Was it just a sudden idea of the emperor who had nothing better to do? Hard to believe.
In fact, it is unlikely that the idea of the edict originally came from the emperor himself. Usually, such decrees were suggested by his advisors, or by an outsider who had the courage to write to the emperor. If it was a complicated matter, the emperor would decide neither immediately nor by himself. Like today, such things were left to a court commission. There, specialists discussed the matter and presented a suggestion.
To abolish a subject which had always been a fundamental part of medical education was a great matter indeed. 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 surely all of these teachers and doctors knew the basic books of their profession. They knew very well that suggesting to abolish acupuncture was identical with the statement: We, the court physicians of the glorious Qing dynasty in the second year of the reign of Emperor Daoguang, consider books like the Huangdi Neijing Lingshu, the Zhenjiu Jiayijing or the Zhenjiu Dacheng as useless speculations.
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.
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14 Forbidding acupuncture: reasoning about the reasons
Which, however, were these reasons?
In Chinese Acupuncture and Moxibustion, China’s third “official” acupuncture textbook for foreigners, we read: From the establishment of the Qing Dynasty to the Opium War (1644-1840), the medical doctors regarded herbal medication as superior to acupuncture, therefore acupuncture and moxibustion gradually turned to a failure. Or, in the Chinese original: 清代从开国到鸦片战争这一历史时期 (公元 1644 ~ 1840 年), 医者重药轻针，针灸逐渐转入低潮.
Funny. Did the author of these lines never enter a TCM hospital? Because if he did, he should know: Even today, with disinfection and risk-free needling, the acupuncture department of his own hospital may treat between 20 and 100 patients a day – whilst in the other TCM departments 10 times this number will be given “herbal medication”. Aren’t these numbers a proof that even today TCM doctors in most cases “regard herbal medication as superior to acupuncture”?
Of course, Cheng Xinnong (if it was he who wrote these lines) was right in one aspect: when the Qing physicians recommended the abolition of the acupuncture department, indeed they regarded herbal medication as “superior”. But even if acupuncture was considered “inferior”, it might have had some value in special cases. Apparently, the Qing doctors did not see this value. They must have been convinced that acupuncture was completely useless – or that its dangers never justified its possible healing effects.
And it doesn’t seem likely that this conviction entered their minds suddenly in 1822. We may suppose that this was common opinion for decades already, if not centuries. Everybody knows how conservative TCM is and has always been. So, the courage of Emperor Daoguang’s physicians to eliminate a whole department from the medical curriculum is indeed remarkable.
Personally, I admire these court physicians. But thinking of them also makes me sad. As I said above, the decade from 1820 to 1830 was the last period in Chinese history when medical affairs were discussed without staring at Western medicine. In this historical situation the court physicians had the courage and the spirit to suggest a substantial change. Who, within so many TCM universities, has a similar courage today?
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