User:Madalibi/History of acupuncture and moxibustion

The precursors of acupuncture include lancing and bloodletting – which were practiced by means of pointed stones or bones very early in Chinese history – but also a physiological theory claiming that the human body was crossed by channels (or "vessels", "tracts", "meridians") that could be stimulated for healing purposes. These channels were first used for cauterization, though not along specific points. Cauterization eventually transformed into moxibustion, the burning of moxa tinder on specific points along channels. Because acupuncture moxibustion share common origins and rely on similar concepts, their histories are closely intertwined. Together, they are often referred to as "acumoxa".

By the first century BC, these channels were considered to be lined with tiny "holes" (acupuncture points) that should be stimulated in various combinations to promote healing.

Needles were larger than modern ones.

For centuries, acupuncture was practiced mainly outside elite social circles, by itinerant doctors, women, monks, and other folk healers who also practiced minor surgical operations. In the early twentieth century, while many Chinese intellectuals advocated the abolition of Chinese medicine as superstitious and not corresponding with modern "western medicine", reformers. Very fine needles were borrowed from Japan, the acupuncture points were remapped along western anatomical lines as corresponding to the nerves instead of blood vessels. This "new acupuncture" received new legitimacy. During the Cultural Revolution, acupuncture was promoted as an anesthetic method, and Chinese diplomats promoted acupuncture in other Third-World countries, especially in Africa.

Today acupuncture is taught and practiced in numerous countries.

Precursors and multiple origins

Acupuncture

In addition to practicing exorcism and medical divination, healers of the Eastern Zhou, Spring and Autumn, and Warring States periods sometimes used stone or bone needles for bloodletting (drawing blood) and lancing.^[1] Such needles found in ancient tombs led Joseph Needham to speculate that acupuncture might have been carried out as early as the Shang dynasty (14th–11th century BC).^[2] However, most historians now make a distinction between medical lancing or bloodletting in that broad sense and acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels ("meridians") in accordance with theories related to the circulation of Qi.^[3] The earliest evidence for acupuncture in this sense dates to the second or first century BCE.^[4]

Mature acumoxa therapy resulted from the merging of earlier technical and conceptual elements.^[5]

Lancing and other minor surgical practices alone did not develop directly into acupuncture.^[6] One "crucial precedent" of acupuncture was the cauterization of "channels" – vessels for qi: the ancestors of the so-called "meridians" – to cure illnesses.^[7] This treatment method is recommended in Recipes for Fifty-Two Ailments and other Mawangdui medical manuscripts (ca. 200 BC) such as the Cauterization Canon of the Eleven Yin and Yang Vessels. These Mawangdui texts, which describe a wide range of therapeutic techniques, do not mention acupuncture at all.^[8]

Precursors of vessel (channel, meridian) theory can be seen in the Mawangdui manuscripts, the Zhangjiashan texts, the Wuwei texts, and the biography of Chunyu Yi (淳于意) in chapter 105 of the Sima Qian's Shiji. Cauterization of channels, but on no particular points (Cauterization Canon). Eleven vessels instead of the 12 in mature theory as seen in Neijing.

Only in the Huangdi Neijing, or Yellow Emperor's Inner Canon, has the vessel theory become mature, with 12 vessels, each corresponding to an internal organ, and lined with acupoints (xue 穴, literally "holes") that had to be needled in various combinations to treat medical disorders.

Moxibustion

Strictly speaking, moxibustion refers to cauterization performed with "moxa", that is, mugwort leaves prepared into small and easily combustible tinders. The earliest mention of cauterization with mugwort—though not with moxa—dates to the Recipes for Fifty-Two Ailments (ca. 215 BCE), which recommends cauterizing the crown of the head with "a kind of cigarette" made with hemp waste wrapped in mugwort leaves in cases of "inguinal swelling" (tui 頹), a bloating of the groin area.^[9]

Acupuncture in China

Between Han and Tang

Many works on acupuncture and moxibustion were written between the fall of the Han dynasty in AD 220 and the beginning of the Tang in 618, but few have survived to this day.^[10] Three notable ones from the third century are Huangfu Mi's AB Canon of Acumoxa (Zhenjiu jiayi jing 針灸甲乙經), the Canon of Problems (Nanjing 難經), and the Canon of the Pulse (Maijing 脈經), the latter compiled by Wang Shuhe (王叔和). All adopted the classical precepts found in the Yellow Emperor's Inner Canon.

Donald Harper warns that "cauterization therapy in the MWD medical manuscripts is not solely practiced in conjunction with vessel theory; and several materials are used to cause the burn (see Section Three, "Therapy"). One of the materials is ai 艾 (mugwort), but the use of mugwort tinder (moxa) is not attested. Thus, it is anachronistic to refer to cauterization therapy in the medical manuscripts as moxibustion."^[11]

During China's medieval period, needling and moxibustion continued to be used amidst ritual treatments to treat demonic possession, an approach that has made Michel Strickmann speak of "exorcist acupuncture and cauterization".^[12]

The Tang dynasty (618–907)

No work on acupuncture between the AB Canon and Sun Simiao's chapters on acupuncture has survived.^[13] Nearly 50 works on acumoxa are listed in the Book of Sui's "Monograph on Bibliography", which inventoried the content of the imperial library of the Sui dynasty.^[13] Only 12 titles appear in the equivalent chapter in the two official histories of the Tang.^[13] This dwindling number of works shows that acupuncture did not play a central role in Tang-era medicine.^[13]

One of the earliest printed books in China concerned moxibustion techniques. It was printed with woodblocks in the Tang capital Chang'an no later than 861, a few years before the earliest extant printed book – an imprint of the Diamond Sūtra dating to 868.^[14]

Wang Tao, who compiled a formulary for the Tang government, claimed that acupuncture "can kill people and cannot raise the dead".^[15]

The Song dynasty (960–1279)

Acupuncture was among the medical techniques promoted by the government of the Song dynasty. In 1023, Emperor Renzong (r. 1022–1063) put Wang Weiyi 王惟一, a medical official, in charge of collating a standard work on acupuncture and moxibustion.^[16] Wang finished his Illustrated Canon of Acu-moxa (Tongren yuxue zhenjiu tujing 銅人腧穴針灸圖經, or Illustrated Canon of Acu-Moxa for the Bronze Figure and its Acupoints) in 1026.^[16] As its long title indicates, the book was used alongside a bronze statue of the human body depicting the circulation channels and punctured by small holes at the location of the 354 acupuncture points discussed in the book.^[17] It was easier to learn the location of points with the statute than with textual descriptions or printed illustrations.^[18] The life-size statue was covered with wax and filled with water, and students were asked to treat the statue by acupuncture. Water would flow out if they inserted the needles in the correct points.^[19] Their ability to pierce through wax and let water out shows that Song acupuncture needles were thicker than modern ones.^[20] Historian Asaf Goldschmidt sees the Illustrated Canon and the bronze statues as "the first attempt to standardize Chinese medicine".^[21]

The History of Song records that in 1034 Renzong received acupuncture treatment – he was needled in the chest – against the advice of his courtiers.^[22] Acupuncture was one of the 13 subjects taught at the Medical School (Yixue 醫學) founded by Emperor Huizong in 1103.^[23]

Yet more and more Song physicians disparaged acupuncture, which they saw as a "manual" practice rather than a scholarly pursuit.^[24] Rather than using needles, they preferred to prescribe medicinal drugs, and they focused their discussions on pharmacopeia and the treatment of epidemics in the tradition of the Shanghan Lun.^[24]

Late imperial China

Both during and after the Song, acupuncture continued to be practiced and transmitted by Daoist masters or specialists of alchemy.^[25] Such Daoist features moved acupuncture even further away from the mainstream of medicine, which was becoming increasingly Confucian.^[26] After the Song, only a few medical masters – like Luo Tianyi (羅天益; fl. 1280s) and Hua Shou (滑壽; 1304–1386) – held acupuncture in high regard.^[24] Song Lian, a high official of the early Ming dynasty (1368–1644) who befriended literati physicians and gave great importance to medical learning, agreed that "those who transmit the method of the nine needles are rare".^[24]

Like other manual skills like ophthalmology, the treatment of skin diseases, and minor surgeries, acupuncture was taught orally and practiced by popular healers who were often illiterate.^[27] These included women, who were often noted for their skills in acupuncture and moxibustion.^[27] Scholarly doctors considered such medical practitioners – men and women alike – lowly and vulgar.^[28] Despite being marginalized by the literati, these less literate doctors remained popular in society.^[29] Both popularity and marginalization are illustrated in the Jinpingmei, a seventeenth-century novel, in which a male character scolds on old female healer for "sticking in needles and cauterizing you at random".^[30]

Lamenting the loss of acupuncture skills since the time of the Inner Canon,^[31] Xu Dachun (徐大椿; 1693–1771) claimed that "acupuncture has fallen into disrepute today, and the technique is no longer widely practiced".^[32]

In 1822, acupuncture was removed from the curriculum of the Imperial Academy of Medicine (Taiyiyuan 太醫院) in Beijing, an institution that trained and employed physicians to provide healthcare to the emperor and his family.^[33] A modern Chinese historian has argued that the Daoguang Emperor (r. 1821–1850), who ordered this prohibition, had witnessed two assassination attempts on his father and predecessor the Jiaqing Emperor, and was afraid that acupuncture needles could be used to attack him.^[34]

By late imperial times, acupuncture was usually practiced by itinerant doctors (jianghu yi 江湖醫) of low social status who also practiced lancing, bloodletting, and other minor surgical operations.^[35] Like these traveling healers, Buddhist monasteries and nunneries that provided acupuncture services had a mostly popular clientele.^[36] A saying circulating in the 1820s said that "acupuncture needling and moxa cautery are absolutely inappropriate to all gentlemen".^[33]

Acupuncture in Japan

Beginnings and early history

Acupuncture was probably introduced to Japan in the fifth century by migrants from the kingdoms of Paekche and Silla on the Korean Peninsula.^[37] The first textual record of this introduction is from the Nihon Shoki (720), a chronicle of Japanese history which records that when a Chinese monk named Chisō 知聰 traveled from the Lower Yangtze region to the Japanese islands in 562, he was carrying dozens of medical texts with him, including anatomical diagrams called the Charts of the Illuminated Hall (Mingtang tu 明堂圖).^[38] A genealogical text titled Shinsen Shōjiroku (815) does not mention that Chisō was a monk, but concurs that he was carrying "pharmaceutical books and acupuncture charts" and adds that he founded a family lineage that specialized in pharmaceutical knowledge.^[39]

With the Taihō Code of 701, the Japanese state deepened earlier reforms in which it had already adopted the political and legal institutions of the Tang dynasty. As part of these reforms, the court created an official curriculum for studying medicine in which acupuncture played an important role. An imperial edict dated 757 stated that acupuncture students (針生者) the National Academy should study four Chinese texts: the Basic Questions (one version of the Yellow Emperor's Inner Canon), the Classic of Acupuncture (another name for the Lingshu), the Mingtang 明堂, and the Maijue 脈訣, whereas medicine students (医生者) would be tested on the Taisu (another version of the Inner Canon) the AB Canon of Acumoxa, the Canon of the Pulse, and the Shennong Bencao Jing, a work on materia medica.^[40]

The Ishinpō (984), which cites an abundance of Korean and Chinese medical texts, contains a chapter on acupuncture and moxibustion, but it mostly explains the needling of specific acupoints without discussing the conduits ("meridians") along which Chinese theories of acupuncture said they were located. Medical historian Shizu Sakai sees this disregard of conduits as a sign of "skepticism about abstract theory" that remained characteristic of traditional Japanese medicine for its entire history.^[41]

Early modern Japan

Little is known about acupuncture and moxibustion in Japan from the 8th to the 15th century. The fact that they were barely mentioned in monk Kajiwara Shozen's (梶原性全; 1266–1337) Ton'isho 顿医抄 (1302), a vast compendium of medical knowledge, suggests that they had entered a period of decline by the Kamakura period (1197–1333).^[37]

Sugiyama Waichi 杉山和一 (1610–1694), Gotō Konzan 後藤艮山 (1659–1733), Suganuma Shūkei 菅沼周桂 (1706–1764), Ishizaka Sōtetsu 石坂宗哲 (1770–1841)

Insertion tubes, filiform needles.

Early Western interest

Moxibustion was used outside the Chinese cultural sphere, for instance in the Mongol Ilkhanate (modern-day Iran), where in 1303 Mahmud Ghazan (1271–1304) was cauterized (in vain) by Chinese physicians after Muslim doctors had failed to cure him of his ophthalmia.^[42]

The Japan connection

The first Westerner to write an account of acupuncture was Jakob de Bondt (1592–1631), a Danish physician who served as surgeon general for the Dutch East India Company. As the Dutch were the only nation allowed to travel to Japan, he observed and took note on the practice of needling in Japan.

Those who wrote about acupuncture and moxibustion discovered it through Japan and did not necessarily know that the practice was originally Chinese. From Japan they acquired the name moxa, a deformation of the Japanese pronunciation mogusa, and specimens of mugwort designed for moxibustion.

Written testimonies of westerners who claimed to have cured gout with moxibustion encouraged others to eat to study the practice. Dutch physician Willem ten Rhijne went to Nagasaki—the only Japanese port open to foreigners—aiming to study acumoxa. He did so for two years before returning to the Dutch colony of Indonesia. He wrote the first western book on acupuncture. A German physician who also worked for the Dutch East Indies wrote a long section on acupuncture in his work... Both ten Rhijne and the other guy were cited for a long time.

Engelbert Kaempfer (1651–1716)

Dejima, Nagasaki, Edo period and sakoku, Rangaku

European scholarship

The twentieth century

Japan

Japan limited acupuncture points to 70.^[43] The Meiji government granted licenses to healers who specialized in acupuncture and moxibustion.^[44]

China

In the Republican period, the Chinese social elite still considered acupuncture to be an inferior therapeutic practice along with petty surgery, bloodletting, and the lancing of purulent sores.

Inspired by such new developments and by Japanese scholarship and policies, Chinese reformers of the Republican period rediscovered acupuncture.^[45]^[46]

In the 1930s, however, Cheng Dan'an (承淡安; 1899–1957) proposed to reform its theoretical foundation. He had already practiced a revised acupuncture in the 1920s, and founded the Society for Research into Chinese Acupuncture in Wuxi (Jiangsu province) in 1930.^[47] Instead of mapping the acupoints along various places, including veins and arteries, he stated that they should lie along the nerves. By redefining the acupuncture loci according to western anatomy, he. After a one-year visit to Japan in 1934 during which he attended the Tokyo College of Acupuncture, Cheng advocated modernizing acupuncture as Japan had. "new understanding of how acupuncture worked".^[47] Cheng's book Chinese Acupuncture and Moxibustion Therapeutics (Zhongguo Zhenjiu Zhiliaoxue 中國針灸治療學) went through seven editions from 1931 – the year of its first publication – to 1937, when Japan attacked China and Cheng had to move to Chongqing with the Kuomintang-led government. Chinese historians of medicine have singled out Cheng's work as the most influential rethinking of acupuncture in the first half of the 20th century. In several ways, Cheng's work marked "a major shift in acupuncture theory and practice".^[20]

The Institute of National Medicine, founded in 1931 to defend and promote Chinese medicine from the critiques who wanted to abolish it, promoted a curriculum that did not include acupuncture.^[48]

After the Communist Party led by Mao Zedong won the civil war in 1949, Cheng founded the Institute for the

During the Cultural Revolution (1966–1976), the Chinese government showed foreign visitors major surgical operations that purported to be conducted entirely under acupuncture anesthesia.^[49] This technique was also widely applied in some Chinese hospitals.^[50] This use of acupuncture suited the "Marxist–Maoist values" promoted by the Cultural Revolution.^[51] In 1974 a Chinese author presented the rise of acupuncture anesthesia as "a tremendous victory for dialectical materialism over the doctrine of external cause and the doctrine of passivity".^[52] After 1976, however, under the slogan of "Seeking truth from facts" promoted by Deng Xiaoping, the analgesic effects of acupuncture were found to have been grossly exaggerated for propaganda purposes, and acupuncture was judged unsuitable as a method of anesthesia.^[53]

Outside East Asia

Acupuncture today

References

Notes

^ Cook 2013, p. 11.
^ Lu & Needham 1980; Harper 1998.
^ Lu & Needham 1980; Harper 1998; Epler 1980.
^ Unschuld 1985, pp. 92–93; Harper 1998.
^ Lo 2001, p. 20, note 7.
^ Unschuld 1985, p. 95; Harper 1998, p. 5, note 2; Lo 2002, p. 209; Liao 2012, p. 314.
^ Harper 1998, p. 5, note 2.
^ Unschuld 1985, p. 94; Harper 1998, p. 5.
^ Harper 1998, p. 263, note 7 (the citation is Harper's interpretation, not a phrase from the original text).
^ Goldschmidt 2009, p. 28.
^ Harper 1998, p. 5, note 1.
^ Strickmann 2002, p. 242–243.
^ ^a ^b ^c ^d Despeux 1987, p. 41.
^ McDermott 2006, pp. 10–11.
^ Lo 2005, p. 237.
^ ^a ^b Goldschmidt 2009, p. 31.
^ Goldschmidt 2009, p. 34.
^ Goldschmidt 2009, p. 40.
^ Goldschmidt 2009, pp. 34–36.
^ ^a ^b Andrews 2014, p. 201.
^ Goldschmidt 2009, p. 36.
^ Goldschmidt 2009, pp. 30–31.
^ Goldschmidt 2009, p. 52.
^ ^a ^b ^c ^d Leung 2003, p. 383.
^ Leung 2003, pp. 383–84.
^ Leung 2003, p. 384.
^ ^a ^b Leung 2003, p. 396.
^ Leung 2003, p. 397.
^ Leung 2003, p. 398.
^ Cullen 1993, pp. 127–28.
^ Lu & Needham 1980, p. 160; Unschuld 1998.
^ Unschuld 1998, p. 248.
^ ^a ^b Andrews 2014, p. 197.
^ Andrews 2014, p. 197, citing Ma Kanwen 馬勘文.
^ Andrews 2014, p. 37.
^ Andrews 2014, p. 44.
^ ^a ^b Hiromichi 2010, p. 2.
^ Lu & Needham 1980, p. 264; Hiromichi 2010, p. 2.
^ Kornicki 2015.
^ Bender & Zhao 2010, p. 2. This edict by Empress Kōken (r. 749–758, 765–770) can be found in the Shoku Nihongi.
^ Sakai 2003, p. 755.
^ Allsen 2001, p. 143.
^ Andrews 2014, p. 198.
^ Lei 2014, p. 159, citing Hiromichi 2010.
^ Lei 2014, p. 159.
^ Vigouroux 2015.
^ ^a ^b Andrews 2014, p. 200.
^ Andrews 2014, p. 4.
^ Andrews 2014, p. 5.
^ Unschuld 1985, p. 363, quoting a Chinese newspaper article from 1980.
^ Unschuld 1985, p. 254.
^ Unschuld 1985, p. 255.
^ Unschuld 1985, p. 262.

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