History Of Acupuncture

Acupuncture is based on a completely different set of theories from those of Western medicine. In the West a doctor will base his diagnosis of a patient's illness on his knowledge of anatomy, physiology, biochemistry, and pathology; then, having put a name to the disease, he will decide whether to treat the patient with medications, surgery, or other techniques. However, there are some patients whom doctors find it very difficult to treat because, although they are clearly unwell, all the tests are normal and a diagnosis cannot be made. For these patients acupuncture (like many other complementary therapies) is perfectly suitable: it does not require a diagnosis in Western terms for the patient to be treated successfully.

Acupuncture is one of the oldest therapies known to humanity; having been in use for well over two thousand years. And although developments have occurred, from time to time, its basic theory and practice are still much the same as when it was practiced twenty centuries ago. This theory also forms the foundation of Chinese herbal medicine, with which acupuncture is frequently used in the East. When acupuncture first became popular in the West it was usually used alone, but many practitioners now train in herbal medicine as well so that they can offer both therapies.

The oldest-known book on the theory of Chinese medicine is the Nei Ching, which has been published in English under the title The Yellow Emperor's Classic of Internal Medicine. The Yellow Emperor is said to have lived in the twenty-seventh century B.C. In fact, there is disagreement among scholars as to whether he lived at all or was just a mythical character-perhaps one originally based on a real person who, over the centuries, has been endowed with far more greatness than he actually warranted. It is rather like the arguments that take place in Britain as to whether there really was a King Arthur. However, even if the Yellow Emperor was a real person, it is highly unlikely that the Nei Ching in its present form can be attributed to him or even dated to his reign.

In the twenty-seventh century B.C. written Chinese was still in a fairly primitive form known as archaic, or prehistoric, ideographs. The Nei Ching is an extremely profound work, and it would have been impossible for much of it to have been expressed in this primitive script. The most recent thinking is that the Nei Ching is made up of several different treatises, possibly originating from particular medical theorists or schools: it is felt that these treatises were written at different times between about 200 B.C. and A.D. 100 then put together at the end of this period. This, of course, still makes it a work of considerable antiquity.

However, although the Nei Ching is the oldest book on Chinese medicine that has come down to us, it was unlikely to have been the first book ever written on the subject. It was not written in a way that suggests it is introducing something new and original. Indeed, by the time it was written, acupuncture was obviously widely understood and practiced in China. The Nei Ching gives the reader no instructions whatsoever on basic theory or on the points and techniques to be used-it is assumed that he already knows these. The book covers only the more esoteric aspects of theory, such as "the transmission of the essence and the transmission of the life-giving principle" and "the seasons as patterns of the viscera." The Yellow Emperor asks questions, which are then answered at length by Ch'i Po. Some of the questions are very profound, running to several pages, and among the things that Ch'i Po is asked to explain are "how it is possible that the twelve viscera send each other that which is precious and that which is worthless" and "whether the brain and the marrow govern the viscera or whether it is the stomach that governs the viscera, or whether the viscera govern the six bowels." The Yellow Emperor-real or mythical-obviously had a very good grasp of the basic theories of Chinese medicine.

Stories of great acupuncturists have also come down to us from two thousand or more years ago. A century or two before the Nei Ching is thought to have been written, although somewhat after the time of the Yellow Emperor himself, there lived a famous itinerant Chinese physician and teacher of medicine called Pien Chueh. His actual dates are unknown but, traditionally, he is said to have lived in the fourth century B.C. One story told about him describes a time when he was visiting the province of Kuo with some of his students, or apprentices. Upon reaching the town in which the king and his court resided, they saw many sacrifices being offered at the temples and arrangements being made for a funeral. When Pien Chueh asked what was happening he was told that the king's son had suddenly fallen ill and lapsed into a coma from which the court physicians had been unable to rouse him. It seemed inevitable that he would die. Pien Chueh asked his informant whether he could arrange for him to be introduced at court; he thought he might be able to prevent the boy from dying. Arrangements were made accordingly, and the king willingly allowed Pien Chueh to examine the comatose prince.

After a thorough examination Pien Chueh made a diagnosis based on his extensive knowledge of Chinese medicine. He then treated the prince, placing acupuncture needles in his head, chest, arms, and legs, after which the boy rapidly regained consciousness. Pien Chueh continued to treat him and monitor his progress for three weeks. In addition to acupuncture, he used heat treatment and herbal remedies. At the end of this period the prince was restored to full health. What happened to the court physicians the story does not tell, but it is possible that the king made arrangements for them to learn the basics of acupuncture.

The description of Pien Chueh using heat to treat his patient may be referring to moxibustion, a method-still in use today-in which the acupuncture points are stimulated by heat. The name derives from an herb known as moxa, which is burned to supply the heat. Nowadays the usual practice is to attach a small wad of moxa to the end of an acupuncture needle that has already been inserted into the patient; when this is lit the heat travels down the needle and into the point without running the risk of burning the skin. Originally, however, the custom was to put the moxa directly onto the skin or on a slice of ginger placed over the relevant acupuncture point, and this latter method is still used by some practitioners. How moxibustion fits into the chronology of acupuncture is uncertain. Some people think it may predate acupuncture, since some ancient texts have been found that mention moxa but not acupuncture. Although these particular texts were found in a tomb that dates back to the Han dynasty (206 B.C.-A.D. 220-a time during which, as we know from other sources, acupuncture was already widely used), they may have been copies of others that were considerably older. And although moxa has been used therapeutically for many centuries, the healing quality of warmth applied to the acupuncture points was probably known long before the burning properties of moxa leaves were discovered and before needles were used to treat the points. Perhaps twigs and grass were originally used to produce a similar effect. Records show that various other substances, such as charcoal, bamboo, and sulfur, have all been used in the past.

Moxa, like cannabis or that other dried leaf of ill repute, tobacco, has the ability to burn slowly and steadily: it is used primarily to treat diseases said to have been caused by cold or damp. And although it was, and still is, often found to be useful in its homeland of China, it has been used to a far greater extent in Japan. Being made up of islands, Japan tends to have a much more humid climate than the great expanse of China, so its incidence of diseases associated with damp is much greater. It is therefore appropriate that the name by which this treatment is known in the West-moxa-should, in fact, be Japanese in origin, derived from two words that mean "burning herb." The Chinese name for moxa is chiu, which means "to cauterize or blister."

It has been suggested that the accidental burning of acupuncture points may have led to the discovery of their therapeutic value. Acupuncture is such an ancient therapy that its origins are completely unknown. Strangely, in view of China's many ancient myths and folk heroes, any legend explaining how it originated. The burn theory is one of several that has been put forward. It suggests that in the days when people huddled around fires that served the dual purpose of keeping them warm and cooking their food, it is likely that they were frequently burned by sparks flying out from the fire. If a spark landed on, and a burn subsequently occurred on, an appropriate acupuncture point, people may have been "miraculously" cured of various illnesses that had been troubling them. After this had happened on a number of occasions and to a number of people, they might have started to realize that in some way these particular points on the body had healing properties. In some patients stimulation of a single point will cause a sensation to run along the meridian on which it lies. In other patients, you can sometimes see a flush spreading along the line of the meridian when a point is needled. Based on this, the early Chinese could have started to work out a system of lines that joined the points together-the predecessors of the meridians that we know today. And of course it would appear to them that the way in which to use these points therapeutically was to burn them, since it was through burning that the effects seemed to arise. This, then, ties in with the point that moxa treatment of the acupuncture points may well have developed before acupuncture itself.

A fascinating and fairly recent discovery is that acupuncture was not confined to China in its earliest days. In 1991 the body of a man was found ten thousand feet up a glacier on the northern border of Italy. He had died some five thousand years ago and been perfectly preserved by the ice. Upon examination he was found to have been suffering from an arthritic condition that would have caused him pain in his back and hips. His skin showed strange tattoos over the diseased joints and on his feet. Upon further investigation these appeared to be at the sites of acupuncture points.

If this is indeed the case-that acupuncture was being used in Europe five thousand years ago-we have an additional conundrum. Not only do we not know how and why acupuncture developed, but we are also unclear why it stood the test of time in China but died out elsewhere. What we can be fairly sure of, however, is that once the acupuncture points were discovered-by whatever means-the next stage would have been to experiment with different methods of stimulating them. The earliest acupuncture tools seem to have been sharp pieces of stone or flint, which were known as bian stones. Their use would have been limited because of their size and shape, so they were probably used just to scratch, or possibly to prick, the points on the meridian. Sharp pieces of pottery were also used. The next instruments to be developed were somewhat more versatile. They were made from sharpened bones and bamboo, which could be formed into a more needlelike shape. However, it was not until the smelting of metal had been discovered that it was possible to manufacture true needles that could be inserted through the patient's skin and into the layers below.

The earliest needles were made from various types of metals as they became available-iron, bronze, silver, and even gold. Silver and gold acupuncture needles have been found in the tomb of Prince Liu Sheng, who lived and died during the Western Han dynasty (206 B.C. through A.D. 24). Given this inclusion in burial goods, it would seem that the people of the period thought that, even in heaven, their health might need attention.

Since metal was so much more versatile than the stones, bones, and bamboo that had previously been used, it became possible to develop different shapes of needles, which could then be used for different techniques. These may originally have been made by chance since, presumably; the earliest metal-smithing was a fairly crude affair that could not be expected to produce identical needles every time. Presented with these varying shapes, however, the early acupuncture practitioners may have realized that different-shaped needles produced different effects. Therefore, as the quality of the smithing improved, they would have ordered the specific shapes that they found most useful.

When the Nei Ching was written some two thousand years ago, nine types of needles were already in common use, not unlike the variety of needles still in use today. There were fine needles, which (as now) were used for the majority of straightforward treatments. There were arrowhead needles, which were used when it was necessary only to prick the point, rather than to insert a needle. To induce slight bleeding at a point, three-sided needles were available. Needles with a triangular tip terminating in a sharp point are still used today when bleeding is required. Blunt- or round-ended needles were used when points needed pressure or massaging, and scalpel-like needles were used for incising boils and abscesses. Larger, heavier needles were available for inserting into joints. Extra-long needles were used when the most receptive part of the acupuncture point lay well below the skin surface in an area of thick muscle or fat. Today needles up to three inches long are used in areas such as the buttocks, but even these are considerably shorter than some said to have been used by the early acupuncturists.

The majority of needles used in acupuncture practice today are made of stainless steel, which was first developed in the early years of the twentieth century. Its great advantages are that it can easily be sterilized and will not rust. However, since the appearance of AIDS and the various forms of hepatitis that can be transmitted through blood, more and more acupuncturists are working with disposable needles, which are used once only and then thrown away.

Before stainless steel was developed, however, silver and gold needles were quite widely used, because these two metals are relatively inert and less likely to cause unwanted reactions when inserted into patients. There may have been other reasons for their popularity. It was thought that gold needles had, of themselves, a stimulating effect (this was also said to be true of the other yellow metal, copper), while silver and other white metal needles had a calming effect. Today needles made of precious metals have definite disadvantages in that they are much more expensive than stainless steel; too valuable to be thrown away when they become blunt, they must be re-sharpened. Some practitioners are still sufficiently convinced of their intrinsic therapeutic effects to go on using them, though.

In the same way that Western medical students learn both general medicine and surgery as part of their basic curriculum, herbal medicine (based on the same fundamental theories of body function and energy flow as acupuncture) has always been taught in China alongside acupuncture. And as you might expect with such ancient therapies, the earliest recorded medical schools were founded centuries before those in the West. The first state-sponsored school in China to teach all aspects of Chinese medicine opened in A.D. 443 but was closed again within ten years. Student physicians had to revert to the traditional method of learning-apprenticeship to an experienced doctor. In A.D. 581, during the Sui dynasty, an Imperial Medical Academy was founded. However, it was under the following Tang dynasty (618-906) that medical education really started to develop. In A.D. 624 the academy was greatly enlarged. Departments were set up to teach pharmacology, acupuncture, internal medicine, and massage-as well as Buddhist and Taoist incantation, which at the time were thought essential knowledge for a physician. For the first time it became possible to study acupuncture and moxibustion as disciplines separate from herbal medicine.

The length of training required to become a physician was as long as or longer than that required in the West today. Before a student was allowed to specialize in anyone aspect of medicine, he had to take a general basic course. When he had passed this, he was allowed to study internal medicine, which took a further seven years; or surgery, which took five years; or pediatrics, which also took five years. Less time was required to train in more limited specialties such as diseases of the ear, nose, and throat.

Like medical schools today, the Imperial Medical Academy taught from standard textbooks. The Nei Ching was, of course, one of them. Another was Huang-Pu Mi's Chia I Ching (The Classic of Acupuncture Fundamentals), which was written in the third century A.D. and is the oldest-known book of its kind, being devoted entirely to acupuncture and moxibustion. Many later books used the Chia I Ching as a source, and it played an important role in the development of acupuncture in Japan and Korea. A third standard text in use at the Imperial Medical Academy was Wang Su-Ho's Mai Ching (The Classic of the Pulse).

Pulse taking is a much more exact and detailed science in Chinese medicine than it is in the West, and it plays a far more important role in diagnosis. It may take a student many years to become an expert in interpreting the pulse. And because not just acupuncture but all forms of traditional Chinese medicine are based on the same theories of the causation of disease, pulse diagnosis is fundamental to them all. Wang Su-Ho's Classic of the Pulse was not expounding a newly developed science but was compiled from ancient diagnostic techniques that had grown up alongside Chinese medicine as it developed. Other books, published long before Wang Su-Ho's, had mentioned pulse diagnosis-including, of course, the Nei Ching, which gives some quite detailed descriptions of the quality of the pulse in different disease states. The great fourth-century acupuncturist Pien Chueh is known to have used pulse diagnosis.

Pien Chueh is said to have been the first physician to use together the four basic techniques of Chinese diagnosis. The first of these is observation, in which the physician looks at his patients complexion, color, skin, and tongue in much the same way that a Western physician does today-although of course his findings would be interpreted differently; according to traditional Chinese theory: the tongue, like the pulse, can tell a traditionally trained Chinese physician far more than it can a Western doctor, and its observation is an important method of diagnosis. The physician also observes his patients expression as an aid to diagnosis. The second technique, or group of techniques, used by Pien Chueh comprised listening and smelling. He would listen to the quality of the patients speech-normal, slurred, high pitched, and so on-and to the sound of his breathing, although of course he lacked the benefit of that modern Western tool the stethoscope. He would also smell the patient's body odors-probably more important in a society where hot and cold running water were unknown and baths were probably taken infrequently. This technique is still used by some acupuncture practitioners, however, and is even occasionally of use in current Western medicine. For example, the smell of acetone on a patient's breath is accepted as a clear indication that he is a diabetic whose condition is getting out of control. The third technique on Pien Chueh's list was questioning, which of course plays an important role in all forms of medicine-Western, Chinese, and other complementary therapies. Finally, he would use pulse diagnosis.

The Classic of the Pulse was exported to Japan and Korea in the sixth century A.D. Chinese medicine had reached both countries several centuries earlier, and techniques of pulse diagnosis were rapidly assimilated into their medical practice. The Chu Ping Yuan Hou Lun (A Discourse on the Causes and Symptoms of All lllnesses), published only a few years later in A.D. 610 was also to become extremely influential in the development of Japanese and Korean medicine. Its grandiose title was perhaps justified, since it stretched to fifty volumes and compiled virtually all the medical knowledge of the time. Its editor was Chao Yuan Fang, a physician at the imperial court.

As Chinese medicine developed during the Tang dynasty its fame spread, and soon physicians from other nations were arriving in China to learn new techniques. Arabian doctors came to learn the an of pulse diagnosis and to study infectious diseases. The Classic of the Pulse was exported to the Middle East some time in the eleventh century, and by the mid-fourteenth century it had been translated into Turkish. The great Persian physician Abu-Ali aI-Husain ibn Abdullah ibn Sina, better known as Avicenna (980-1037), wrote an immense work in Arabic called AI-Qanun fi'l- Tibb (The Canon of Medicine) in which he discussed the medical achievements of the great Greek physicians and described medical techniques that had been written about in other Arabic works. To this he added information about the methods that he himself had developed during his own years of practice, based on what he had been taught during his travels and what he had learned from reading. Among these was pulse diagnosis. Avicenna recorded twenty-four different types of pulse of which he was aware.

During the Sung dynasty (960-1279) acupuncture and moxibustion became very popular in China, mainly due to the patronage of the nobility and the emperors. But despite this, and despite the fact that acupuncture and the diagnostic techniques of Chinese medicine were now becoming familiar in other parts of Asia and in the Middle East, the Chinese imperial court felt that over the years inaccuracies had arisen in the practice of this therapy: many of the early books on acupuncture had been lost, and many of the standard reference books were compilations into which errors could have crept. In the eleventh century Wang Wei-I-the court physician to two of the emperors of the Northern Sung dynasty, Chen-Tsung (997-1022) and Jen-Tsung (1022-1063)-was instructed to investigate the validity of the system of acupuncture that was currently being practiced and to carry out what would be the first major revision of acupuncture theory.

Wang Wei-I embarked on a mammoth research program. He investigated all the acupuncture points that were currently being used and verified their locations. He also studied each point in turn and confirmed to what depth each should be punctured in order to produce an effect. Finally, he identified the effects that might be produced by the needling of each point. He published his findings in a book titled The New Illustrated Manual on the Points for Acupuncture.

Wang Wei-I's exact dates are unknown; he may well have died before 1034, which was the year in which his imperial patron, Emperor Jen- Tsung, was taken ill. The emperor, who was an orthodox Confucian and a patron of scholars, was twenty-two years old at the time and had been attended by imperial physicians who, using methods other than acupuncture, had been unable to cure him. Eventually he was successfully treated with acupuncture by a highly skilled practitioner named Xu Xi. However, the courtiers in attendance on the emperor nearly prevented the treatment from taking place. After examining the patient, Xu Xi let it be known that he proposed to insert acupuncture needles into the emperor's chest, just below the level of his heart. The courtiers were horrified and said that on no account must the treatment take place; far from curing the emperor, it would no doubt kill him. Xu Xi assured them that the treatment was quite safe and offered to demonstrate the technique on someone whose death, if it occurred, would be less of a disaster. This proposition was acceptable to the courtiers, and it was decided that he could demonstrate on the court eunuchs, who were presumably expendable. Xu Xi inserted his needles into the eunuchs at the point he had described, and the courtiers were amazed and relieved to find that he had spoken the truth: the eunuchs were unharmed. Xu Xi was therefore allowed to return to the emperor's presence and treat him in the manner that he had demonstrated. Fortunately for both Xu Xi and the emperor, the latter made a rapid recovery. Everyone at court was so impressed by this demonstration of skill that Xu Xi was appointed medical officer of the Imperial Medical Academy.

Although it seems that some of the court physicians attendant on Jen-Tsung were not particularly adept at acupuncture, Wang Wei-I, who served both him and Emperor Chen- Tsung, is still remembered for the contribution he made both to the treatment itself and to its teaching. He used a model of a man cast in bronze, the surface of which was punctured with holes accurately placed at the positions of all the acupuncture points. This was, of course, based on all the research that he had undertaken when compiling his New illustrated Manual on the Points for Acupuncture. Wang Wei-I's bronze men became valuable teaching aids for students of acupuncture, and were also used to test their knowledge in examinations held at the Imperial Medical Academy. Before the exam the model was covered with a thick layer of wax, which was then allowed to set so that the holes at the position of the acupuncture points could not be seen. The hollow interior of the model was then filled with water. A student would be told about a case and asked how he would treat it using acupuncture. After describing which points he would use and why, he was asked to locate them on the model and told to insert a needle into each of them, through the wax. If he located the points accurately, the needles would go through the wax and into the holes below so that, when the needles were removed, water would flow out.

In the mid-sixteenth century, five hundred years after Wang Wei-I cast his first bronze model, his idea was developed even further by an acupuncturist named Kao Wu. Wang Wei-l's figures had all been of men, but Kao Wu thought it important to demonstrate that the location of acupuncture points differed according to the sex and age of the patient. He therefore had bronze figures cast of women and children, which could be used in the same way as Wang Wei-l's bronze men.

Kao Wu believed that many errors had arisen in acupuncture practice since Wang Wei-I had carried out his great investigation, and he set himself the task of rectifying this. He wrote two important books on the subject. The first, Essentials of Acupuncture and Moxibustion, was a summary of earlier major acupuncture works intended as a guide for students of acupuncture who were just embarking on their studies. His other great work, Eminent Acupuncture, was for more advanced students and qualified practitioners. It gave detailed information about the meridians and the points and how they should be used in the treatment of a variety of diseases.

Like Kao Wu's Essentials of Acupuncture and Moxibustion, many other "new" acupuncture books were being written around this time that simply revised and summarized the works of earlier authors. However, in 1601 the acupuncturist Yang Jizhou published A Compendium of Acupuncture and Moxibustion. Here he not only summarized what had been written about acupuncture in previous centuries but also included a large amount of information based on the results of his own research and experience.

By this time acupuncture and traditional Chinese medicine were being used far beyond the borders of China. In some countries, such as Japan and Korea, they had become the accepted form of medical treatment. Chinese medicine had first been introduced into these two countries many centuries before, during the Chin dynasty (249-206 B.C.), but it was with the spread of Buddhism that it really began to gain popularity. Buddhism, which originated in India in the sixth century B.C., reached China sometime around the middle of the first century A.D. There it developed in tradition and practice and, in the second half of the fourth century, was introduced into Korea. Some two hundred years later it spread to Japan, where the Zen school (which today has followers all around the world) developed. Although Buddhism was not an immediate success among the Japanese people, the regent Shotoku Taishi (593-622) was converted and began to encourage Buddhist monks to come to Japan from China.

In China Buddhist monks often studied Chinese medicine and acupuncture. During the Sui (589-618) and Tang dynasties many of these physician-monks came to Japan. While they were there, they taught the Japanese whatever they wished to learn-not just Buddhist doctrine but also the fundamentals of Chinese medicine.

All the early Buddhist texts had been written in Pali but, with the spread of the religion, more scriptures were written in Sanskrit and in Chinese, and earlier works were translated. It took time before translations could be prepared for a newly converted country, however, so all the texts being used by the monks who went to Japan were in Chinese. If the Japanese converts wanted to read the original scriptures and not just hear about them from the monks (who, no doubt, were adding their own interpretations to them), they would have to learn to read Chinese. And this is what many of them did. Of course, having become proficient in Chinese, they could then read not only the scriptures but also all the texts from which the monks had been teaching them the essentials of medicine and acupuncture. During the seventh century young Japanese men started to go to China to learn the language, and many came back with knowledge not just of Chinese but of Chinese medicine as well.

Once enough Japanese physicians were fluent in the Chinese language, translations could be made of the major Chinese medical texts so that they would be available to all. The Nei Ching was one of the first to be translated; by the beginning of the eighth century it was one of the standard textbooks for Japanese medical students. Large numbers of Chinese medical books were brought to Japan in the mid-eighth century by a man named Chien-Chen, who was both a physician and a philanthropist. He established a charity clinic in Japan for the treatment of the poor. Centuries later his memory was still being venerated in Japanese temples as a result of his work with the sick and needy.

Chinese medicine remained popular in Japan until the sixteenth century, when it became overshadowed by influences from the West. This was the period of the great trading companies, with ships being sent from Europe to build up markets and find suppliers of luxuries in far-flung places around the world. The Portuguese, who were ardent believers in the superiority of Roman Catholicism over all "pagan" religions, sent ships to the Far East with more in mind than mere trading. Initially, the reception they received was hostile, since it was discovered that they were prepared to trade only with people whom they could not vanquish. Weaker communities ran the risk of being overrun and massacred. However, after being allowed access to only one town in the whole of China (and that being one with which they had to trade), the second wave of this Portuguese invasion was somewhat gentler, consisting of a number of missionaries who were able to gain a foothold in both China and Japan. Like the Buddhist monks who had come to Japan in the sixth century, these missionaries had some knowledge of medicine-although this was, of course, the comparatively primitive medicine being practiced in Europe at the time. But because it was new and different, or perhaps because of the forceful personalities of those who brought it to the East, it usurped the practice of traditional Chinese medicine in Japan.

Over the next three centuries acupuncture and Chinese medicine were still practiced in Japan, but they played second fiddle to Western medicine. In 1884 an attempt was made to wipe them out completely when an edict prohibiting the teaching of acupuncture and herbal medicine anywhere in the country was issued to coincide with the founding of the medical facility of Tokyo University. Not even this, however, could stop people from practicing the therapies in which they believed. Up to the present day traditional medicine and acupuncture have continued to be used alongside Western techniques.

Surprisingly, in 1822-sixty-two years before the teaching of acupuncture and Chinese medicine was prohibited in Japan-their use was banned in their homeland, China, by Ch'ing dynasty emperor Tao Kuang. The subjects were removed from the syllabus of the Imperial Medical Academy; but (as was to happen later in Japan) their use could not be stopped, since the people were aware of their value and would not give them up.

In 1912 the Imperial dynasty was overthrown and replaced by the radical Kuomintang party, who ruled China until the end of the Second World War when they in turn were ousted by the Communists. The Communists, aware of the people's views concerning acupuncture and traditional Chinese medicine, removed the prohibitions on their use. Indeed, acupuncture was actively encouraged and allowed to flourish. Many of the ancient Chinese medical books that had been used over the centuries as standard texts were reprinted, and many new books were written. Colleges specializing in the teaching of traditional Chinese medicine were set up, all with separate departments of acupuncture. Research institutes were founded for the investigation of acupuncture and the furtherance of its practice. In the existing medical schools-which, since the ban of 1822, had taught nothing but Western medicine-acupuncture found its way back into the curriculum. China now has many medical schools, and since 1949 acupuncture has been taught in all of them in an integrated course alongside Western medicine.

Interest in acupuncture really only developed in the West when it was realized that it could be used in place of anesthetics for controlling pain during operations. The effectiveness of acupuncture in relieving pain caused by disease had, of course, been known for centuries in the countries where it was practiced. However, surgery started to be performed on a large scale only at the end of the nineteenth century, and it wasn't until 1958 that Chinese doctors began to use acupuncture to control postoperative pain. The results they obtained were so good that they decided to see whether it was possible to control the pain of a minor operation-tonsillectomy was the first to be tried without having to use any other form of anesthesia. Again, the results were excellent, and they began to use acupuncture for other minor operations such as tooth extractions and the repair of hernias. Although they found that not all patients treated with acupuncture developed a sufficient degree of anesthesia to allow it to be used as the sole method of pain control during an operation, many patients were able to tolerate surgery without any other form of anesthetic. Nowadays even major operations are performed regularly in China's hospitals using only acupuncture to stop the pain. Of course, the advantages of this are enormous. All the risks and unpleasant side effects associated with medication-induced anesthesia are avoided.

One of the first European countries to show an interest in acupuncture was France, and one of the earliest books to be written on acupuncture by a European was by the Frenchman Placide Harvieu (1671-1746). It was splendidly titled The Secrets of Chinese Medicine and the Perfect Knowledge of the Pulse, Brought from China by a Respected Frenchman. Soon afterward, another book on acupuncture was published in France written by the Reverend Father Cleyer-who presumably did not intend to appeal to a wide audience, since he wrote it in Latin.

A Dutchman, Willem ten Rhyne (1649-1700), practiced acupuncture in Java and also wrote on the subject, but it was the French Dr. Louis-Joseph Berlioz (1776-1848) who was probably the first European actually to practice acupuncture in the West. Sadly, his pioneering work is scarcely remembered; the name Berlioz is associated in most people's minds only with his famous son, the composer Hector Berlioz. However, Dr. Berlioz left behind him a book, Memoirs on Chronic Complaints, which he had had published in 1816 and in which he devoted a chapter to the practice of acupuncture. In the following decade several books were published in France on the subject, including J. Morand's Dissertation sur l'acupuncture et ses effets therapeutiques (1825), Jean Baptiste Sarlandiere's Memoires sur l'electro-puncture, consideree comme moyen nouveau de traiter efficacement la goutte, les rhumatismes et les affections nerveuses, et sur l'emploi du moxa japonais en France; suivis d'un traite de l'acupuncture et du moxa, principaux moyens curatifs chez les peuples de la Chine, de la Coree et du Japon (1825), and Jules Cloquet's Traite de l'acupuncture (1826), while in London in 1821 James Morss Churchill published 'A treatise on acupuncturation: being a description of a surgical operation originally peculiar to the Japonese and Chinese, and by them denominated zin-king, now introduced into European practice, with directions for its performance, and cases illustrating its success'.

In Italy Francesco Rizzoli (1809-1880), who was professor of surgery at Bologna and an outstanding and innovative surgeon, was using acupressure (but not acupuncture) as early as 1854. Ten years later Sir James Young Simpson (1811-1870), who was a professor of obstetrics at Edinburgh and is mainly remembered as the first person to use chloroform in midwifery, published Acupressure: A New Method of Arresting Surgical Haemorrhage and of Accelerating the Healing of Wounds. However, despite the fact that some Western physicians were interested enough in acupuncture and acupressure to investigate them, write about them, and in a few cases even practice them, the interest did not spread among the rest of the profession.

In the early years of the twentieth century Georges Soulie de Morant, who resided in China as the representative of a French bank, decided to study acupuncture himself. At the end of his studies he was awarded the title Master Physician. He remained in China for twenty years, eventually becoming the French consul, and during this time he translated into French several works on Chinese medicine as well as writing two books of his own. Of these, The Synopsis of the True Chinese Acupuncture was published in 1934, and Acupuncture was published in two volumes in 1939.

In Germany the theory of acupuncture was first introduced at the end of the seventeenth century by Engelbert Kaempfer, a naturalist and traveler who devoted two chapters of his History of Japan to the subject. In 1906, at a time when the establishment of a Chinese medicine research institute in Germany was sparking the publication of many new books on traditional Chinese medicine and acupuncture in the German language, Kaempfer's book was translated into English but had little impact in Britain. It was not until 1958 that a group of British doctors went to Germany to investigate the use of acupuncture. Their interest may have been stimulated by a paper published the previous year in The Lancet by Dr. Louis Moss, a London general practitioner, who reported the results of the treatment of some two thousand patients suffering from arthritis. Dr. Moss found that treatment of certain "trigger points" gave these patients permanent relief from pain, and he noted that these points tallied well with the position of certain acupuncture points.

In the United States and Canada acupuncture and traditional Chinese medicine arrived with the Chinese people, who settled here from the early nineteenth century onward. But these people tended to remain within their own communities, and their customs and therapies spread little to the rest of the population. Still, there was some interest in the subject and a few books were published, such as The Chinese Way of Medicine by Edward Hume in 1940 and a partial translation of the Nei Ching by Ilza Veith in 1949. Although Dr. Veith's skill in the Chinese language enabled her to produce a readable and informative translation of this very difficult work, it is obvious that she had had no personal experience of acupuncture when she started work on the book.

In the past two decades acupuncture has grown enormously in popularity in the West. It was probably first brought into public awareness by President Nixon's visit to China in 1972. The therapy, together with Chinese herbal medicine, has received quite a lot of coverage in the popular press and on television during the past few years.

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