A Brief History of Chinese Acupuncture and Moxibustion

I. The Origin of Acupuncture and Moxibustion

Acupuncture and moxibustion are important inventions of the Chinese nation which originated as early as in the clan commune period of primitive society. The activities of human beings appeared in China about 1,700,000 years ago. It was about 100,000 years ago that China entered the clan commune period which lasted till 4,000 years ago. In ancient literature, there were many legends about the origin of acupuncture and moxibustion such as Fu Xi's creation of therapeutic techniques with stone needles and Huang Di's invention of acupuncture and moxibustion. The above-mentioned Fu Xi and Huang Di in legend actually are the representatives of the clan commune of primitive society.

In the classics of two thousand years ago, it was frequently cited that acupuncture instruments were made of stone and were named bian stone. For example, in Commentary on the Spring and Autumn Annals, there is a paragraph in historical records for 550 BC saying: "Praise pleasant to hear that does an ill turn is worse than advice unpleasant to hear that acts like a stone." Fu Qian in the second century explained that "stone" here meant bian stone. Quan Yuanqi who lived around the 5th-6th centuries pointed out: "bian stone is an ancient appliance for external treatment and was known by three names: 1. needle stone; 2. bian stone; 3. arrow-headed stone. In fact, they are the same thing. Because there was no iron casting in ancient times, the needles were made of stone." This is correlated with the fact that the stone instruments were extensively used in the primitive society. Primitive period in China was divided into two stages, the Old Stone Age (from remote antiquity to 10,000 years ago) and the New Stone Age (from 10,000-40,000 years ago). In the Old Stone Age the ancestors knew how to use stone knives and scrapers to incise an abscess, drain pus and let blood out for therapeutic purposes. With the accumulation of experiences the indications of the treatment by bian stone were gradually increased. In the New Stone Age because of the improvement in their technique of stone manufacturing, the ancient people were able to make bian stone as a special tool with more medical usage. In China, a bian stone needle 4.5 cun long was discovered in the New Stone Age ruins in Duolun County of Inner Mongolia. At one end, it is oval shaped with a semicircular edge used for incising boils and abscesses, and at other end, it is pyramid shaped with a square base used for bloodletting. Two more bian stones were discovered as funerary objects in a late New Stone Age grave in Rizhao County of Shandong Province. They are 8.3 cm and 9.1 cm in length respectively, with three-edged and cone-shaped ends used for bloodletting and regulating Qi circulation. The discovered relics of bian stone have provided powerful evidence that acupuncture originated early in the primitive society.

According to the records of Chapter 12 of Plain Questions: "The treatment with bian stone needle was originated in the east coast of China where the inhabitants lived on fishery, and moxibustion was originated in the north where the people subsisted on animal husbandry. Because it was cold and windy in the northern areas, people had to warm themselves by fire. Living in camps and subsisting on milk, they easily suffered from abdominal pain and distension by cold, suitable to be treated by heat. Through long-term accumulation of experiences, moxibustion therapy and hot compression were created."

II. The Academic Accomplishments of Ancient Acupuncture and Moxibustion

From the twenty-first century BC when China entered the slave society to 476 BC, Chinese history went through the Xia, Shang and Western Zhou dynasties and the Spring and Autumn Period. Three thousand years ago in the Shang Dynasty the hieroglyphs of acupuncture and moxibustion appeared in the inscriptions on bones and tortoise shells. Because of the development of bronze casting techniques there appeared bronze medical needles. But bian stone was still as the main tool for treating diseases. During this period the philosophical thinking of Yin-yang and five elements was formed, and in the field of medicine the ancient physicians had a preliminary understanding of pulse, blood, body fluid, Qi, Shen (manifestations of vitality), essence, five sounds, five colors, five flavors, six Qi, eight winds, etc., as well as the ideology of relevant adaptation of the human body to natural environment. Thus germinated the sprout of the basic theory of traditional Chinese medicine.

From the Warring States Period (475 BC-221 BC) to the Qin Dynasty (221 BC-207 BC) and to the Western Han Dynasty (206 BC-AD 24), it was the establishing and strengthening stage of the feudal system in China. With the introduction and application of iron instruments, bian stone needles were replaced by metal medical needles. This broadened the field of acupuncture practice, bringing about a development of acupuncture by leaps and bounds. As recorded in the book Miraculous Pivot, there were nine kinds of metallic needles at that time with different shapes and usage. They are named as nine needles, including the needles for puncturing, surgical incision and massage as well. In 1968, in Mancheng County, Hebei Province, an ancient tomb of the Western Han Dynasty buried in 113 BC was excavated. Among the relics, there were four golden needles and five decaying silver ones. These discoveries demonstrate the original shapes of the ancient needles. The doctors of this period treated diseases with multiple techniques. For example, the famous doctor Qin Yueren (or named Bian Que) who lived in about the fifth to fourth century BC, had a good command of medical knowledge in various clinical branches; he treated patients by needling, moxibustion, herbal decoction, massage and hot compression. He rescued a critically ill prince by acupuncture, and this story went down in history. Another famous doctor Chunyu Yi of the second century BC was good at acupuncture-moxibustion and herbal treatment. There is an account of his case reports of twenty-five patients in the book Historical Records, in which four cases were treated by acupuncture and moxibustion. In the period of Warring States, ancient doctors began to generalize and summarize medicine and pharmacology, and writings on acupuncture and moxibustion appeared. Two silk scrolls recording meridians and collaterals written in the third century BC, were discovered in excavation of the No. 3 Han Tomb at Mawangdui, Hunan Province, which reflected the earliest outlook of the theory of meridians and collaterals. The book The Medical Classic of the Yellow Emperor passed on to now is a medical classic concerning the theory of traditional Chinese medicine, with its authorship ascribed to the ancient Emperor Huangdi (the Yellow Emperor). It includes two parts: Miraculous Pivot, in another name Huangdi's Canon of Acupuncture, and Plain Questions. On the basis of previous literature, it takes the theories of Yin-yang, five elements, zang-fu, meridians and collaterals, mentality and spirit, Qi and blood, body fluid, five emotions and six exogeneous pathogenic factors as the basic knowledge of traditional Chinese medicine, and acupuncture and moxibustion as the main therapeutic technique; it explained the physiology and pathology of the human body, the principles of diagnosis, the prevention and treatment of diseases from the perspective of atheism, holistic conception, the viewpoint of development and change, and the relationship between the human body and the natural environment. This laid a theoretical foundation of Chinese medicine and pharmacology, including acupuncture and moxibustion. During this period also appeared the books The Yellow Emperor's Classic of Eighty-one Difficulties and Essentials of Points, Acupuncture and moxibustion, both related to the fundamental theories of acupuncture and moxibustion, but the latter book has been lost.

From the Eastern Han Dynasty (AD 25-220) to Three Kingdoms Period (220-265), another generalization and summarization of traditional Chinese medicine and pharmacology was made. Many famous doctors paid great attention to the study of acupuncture and moxibustion. For example, Hua Tuo who was the pioneer to apply herbal anesthesia for surgical operations only selected one or two points in acupuncture treatment and took much notice to the propagation of needling sensation. He was ascribed the authorship of Canon of Moxibustion and Acupuncture Preserved in Pillow (lost). The outstanding medical doctor Zhang Zhongjing also mentioned the methods of acupuncture, moxibustion, fire needling, warm needling, etc. in his book Treatise on Febriles. He stressed very much on combining acupuncture with medicine herbs as well as applying the treatment according to the differentiation of symptom complex. During this period the basic theories of acupuncture and moxibustion had already been formed, but the locations and names of acupuncture points were neither unified nor systemized. A bamboo scroll of medicine of the Eastern Han Dynasty which was excavated from Wuwei County in Gansu Province, mistook Zusanli to be located "five cun below the knee." Hua Tuo located Back-Shu points as "one cun bilaterally along the spine," with a great difference in locations and names of the points when compared with other books. Because the earliest acupuncture books contained mistakes and differences, and had missing information, the famous medical doctor Huangfu Mi compiled the book Systematic Classic of Acupuncture and Moxibustion in 256-260 by collecting the materials of acupuncture and moxibustion from the ancient books Plain Questions, Canon of Acupuncture and Essential of Points, Acupuncture and Moxibustion. The book consists of 12 volumes with 128 chapters, including 349 acupuncture points. He edited and arranged the contents according to the following order: the theories of Zang-Fu, Qi and Blood, channels and collaterals, acupuncture points, the pulse diagnosis, manipulating techniques of acupuncture and moxibustion, and their clinical application in various branches of medicine. It is the earliest exclusive and systemized book on acupuncture and moxibustion which has been one of the most influential works in the history of acupuncture and moxibustiom.

During the Jin Dynasty and the Northern and Southern Dynasties (265-581), the chaos was upheaved by wars. The physicians advocated acupuncture and moxibustion therapy very much because of its convenient use in times of turmoil, and the masses of Chinese people also knew something about moxibustion therapy. The famous doctor Ge Hong wrote the book to Prescriptions for Emergencies to popularize medical knowledge, especially the therapeutic methods of acupuncture and moxibustion. From the Jin Dynasty to the Northern and Southern Dynasties, Xu Xi's family were expert in the art of healing for several generations, including Xu Qiufu, Xu Wenbo and Xu Shuxiang, all well known in the history of acupuncture and moxibustion. In this period there appeared more and more monographs on acupuncture and moxibustion, and charts of acupuncture points, such as Acupuncture Chart from Lateral and Posterior Views and Diagrams of Meridians and Points.

During the Sui (581-618) and Tang dynasties (618-907), China was undergoing the process of economical and cultural prosperity of the feudal society. The science of acupuncture and moxibustion also had great development. The famous physician Zhen Quan and his contemporary Sun Simiao both had good command of the knowledge of traditional Chinese medicine and made deep study on acupuncture and moxibustion. The Tang government, in the years around 627-649, ordered Zhen Quan and the others to revise the books and charts of acupuncture and moxibustion. Sun Simiao compiled Prescritions Worth a Thousand Gold for Emergencies (650-652), and A Supplement to the Prescriptions Worth a Thousand Gold (680-682) in which a great deal of clinical experiences in acupuncture treatment of varies schools were included. He also designed and made Charts of Three Views, in which "the twelve regular meridians and the eight extra meridians were illustrated in various colors, and there were altogether 650 points." They are the earliest multicolored charts of meridians and points, but have been lost. In addition, Yang Shangshan of Tang Dynasty compiled Acupuncture Points in Internal Classic, which revised the relevant contents of Internal Classic; Wang Tao wrote the book The Medical Secrets of an Official, in which a host of moxibustion methods of various schools were recorded. During this period there appeared monographs on the treatment of special diseases, for example, the book Moxibustion Method for Consumptive Diseases written by Cui Zhidi, in which moxibustion treatment of tuberculosis was described. It has been found that the earliest block-printed edition of acupuncture and moxibustion is A New Collection of Moxibustion Therapy for Emergency, which appeared in the year 862, specially describing the moxibustion therapy for emergencies. In the seventh century, acupuncture and moxibustion had already become a special branch of medicine, and those specialized in this field were entitled acupuncturists and moxibustionists. During the Tang Dynasty, the Imperial Medical Bureau responsible for medical education was divided into four departments of medical specialities and one department of pharmacology. And the department of acupuncture was also one of them, in which there were one professor of acupuncture, one assistant professor, ten instructors, 20 technicians and 20 students. The acupuncture professor was in charge of teaching the students the meridian-collaterals and acupuncture points, pulse diagnosis, and manipulating methods of needling.

In the Five Dynasties (907-960), Liao Dynasty (916-1125), Song Dynasty (960-1279), Kin Dynasty (1115-1234) and Yuan Dynasty (1206-1368), the extensive application of printing technique greatly promoted the accumulation of medical literature and speeded up the dissemination and development of Chinese medicine and pharmacology. Supported by the Northern Song government, the famous acupuncturist Wang Weiyi revised the locations of the acupuncture points and their related meridians, and made a supplement to the indications of acupuncture points. In 1026, he wrote the book Illustrated Manual on the Points for Acupuncture and Moxibustion on a New Bronze Figure, which was block printed and published by the government. In 1027, two bronze figures designed by the Wang Weiyi were manufactured, with the internal organs set inside and the meridians and points engraved on the surface for visual teaching and examination. These achievements and measures promoted the unification of the theoretical knowledge of acupuncture points and meridians. The famous acupuncturist Wang Zhizhong of the Southern Song Dynasty wrote book Canon on the Origin of Acupuncture and Moxibustion, in which he said stress on practical experiences including folk experiences, exerting a great influence on later generations. The famous doctor Hua Shou of the Yuan Dynasty did textual research on the pathways of meridians and collaterals as well as their relationship with acupuncture points. In 1341 he wrote the book Exposition of the Fourteen Meridians, which further development the theory of meridians and acupuncture and moxibustion. Some of them laid emphasis on the theory and technique of a particular aspect. So different branches of acupuncture and moxibustion were formed. For example, the publication of Canon of Acupuncture and Moxibustion for Children's Diseases (lost), Moxibustion Method for Emergencies, The Secret of Moxibudtion for Abscess and Ulcer and so on, showed the deep development of acupuncture and moxibustion into various branches of the clinic. Xi Hong of the early Southern Song Dynasty, who was from a famous acupuncture family, particularly stressed the manipulating technique of acupuncture. And his contemporary Dou Cai wrote a book entitled Bian Que's Medical Experiences, in which he highly praised the scorching moxibustion, and even gave a general anesthesia to avoid pain while applying scorching moxibustion. At the same time, Yang Jie and Zhang Ji observed autopsies, and advocated selecting acupuncture points in the light of anatomical knowledge. He Ruoyu and Dou Hanqin of the Kin and Yuan dynasty suggested that the acupuncture points should be selected according to ziwuliuzhu (Chinese two-hour time on the basis of Heavenly Stems and Earthly Branches).

In the Ming Dynasty (1368-1644) acupuncture and moxibustion were work up to a climax that many problems studied deeper and broader. There were more famous doctors specialized in this field. Chen Hui of the early stage of Ming Dynasty, Ling Yun of the middle stage, and Yang Jizhou of the later stage, all were known far and wide in China, and exerted a tremendous influence upon the development of acupuncture and moxibustion. The main accomplishments in the Ming Dynasty were: 1. Extensive collection and revision of the literature of acupuncture and moxibustion, e.g. the chapter of acupuncture and moxibustion in the book Prescriptions for Universal Relief (1406), A Complete Collection of Acupuncture and Moxibustion by Xu Feng in the fifteenth century, An Exemplary Collection of Acupuncture and Moxibustion by Gao Wu in 1529, Compendium of Acupuncture in 1601 based on Yang Jizhou's work, Six Volumes on Acupuncture Prescriptions by Wu Kun in 1618, and An Illustrated Supplement to Systematic Compilation of the Internal Classic by Zhang Jiebin in 1624, etc. All these works were the summarization of the literature of acupuncture and moxibustion through the ages. 2. Studies on the manipulation methods of acupuncture. On the basis of single manipulation of acupuncture, more than twenty kinds of compound manipulation were developed, and an academic contention was carried out about different manipulation methods. Questions and Answers Concerning Acupuncture and moxibustion by Wang Ji in 1530 was the representative work of that academic dispute. 3. Development of warm moxibustion with moxa stick from burning moxibustion with moxa cone. 4. Sorting out the previous records of acupuncture sites located away from the Fourteen Meridians and formation of a new category of extra points.

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. In the eighteenth century Wu Qian and his collaborators compiled the book Golden Mirror of Medicine by the imperial order. In this book the chapter "Essential of Acupuncture and Moxibustion in Verse" took the practical form of rhymed verse with illustrations. Li Xuechuan compiled The Source of Acupuncture and Moxibustion (1817), in which selection of acupuncture points according to the differentiation of syndromes was emphasized, acupuncture and herbal medication were equally stressed, and the 361 points on the Fourteen Meridians were systematically listed. Besides these books, there were many publications, but none of them were influential. In 1822, the authorities of the Qing Dynasty declared an order to abolish permanently the acupuncture-moxibustion department from the Imperial Medical College because "acupuncture and moxibustion are not suitable to be applied to the Emperor."

III. Modern Decline and New Life of Acupuncture and Moxibustion

Following the Opium War in 1840, China fell into a semi-feudal and semi-colonial society. The Revolution of 1911 ended the rule of the Qing Dynasty, but the broad masses of Chinese people were in deep distress until the founding of People's Republic of China, and acupuncture and moxibustion were also trampled upon. Introduction of Western medicine to China should have been a good turn, but the colonists used it as a medium for aggression. They claimed: "Western medicine is vanguard of Christianity and Christianity is the forerunner promoting the sale of goods." With such a purpose, they denounced and depreciated Chinese traditional medicine, and even defamed acupuncture and moxibustion as medical torture and called the acupuncture needle a deadly needle. From 1914, the reactionary government of China continuously yelled to ban traditional medicine and adopted a series of measure to restrict its development, resulting in a decline of Chinese traditional medicine including acupuncture and moxibustion.

Because of the great need of the Chinese people for medical care, acupuncture and moxibustion got its chance to spread among the folk people. Many acuouncturists made unrelenting efforts to protect and develop this great medical legacy by founding acupuncture associations, publishing books and journals on acupuncture, and launching correspondence courses to teach acupuncture. Among those acupuncturists, Cheng Dan'an made a particular contribution. At this period, in addition to inheriting the traditional acupuncture and moxibustion, they made efforts on explaining the theory of acupuncture and moxibustion with modern science and technology. In 1899, Liu Zhongheng wrote a book entitled Illustration of the Bronze Figure with Chinese and Western Medicine, paving the way for studying acupuncture through combination of traditional Chinese and Western medicine in the history of acupuncture. In 1934 The Technique and Principles of Electro-acupuncture and the Study of Electro-acupuncture written by Tang Shicheng et al. started the use of electro-acupuncture in China.

At this period, acupuncture and moxibustion gained its new life in the revolutionary base area led by the Communist Party of China. In October of 1944, after Chairman Mao Zedong made a speech on the United Front of Cultural and educational workers in Shanxi-Gansu-Ningxia border region, many medical doctors trained in Western medicine began to learn and to do research work on acupuncture and moxibustion, and to spread its use in the army of the base area. In April 1945, an acupuncture clinic was opened in the International Peace Hospital in the name of Dr. Norman Bethune in Yan'an. This was the first time that acupuncture and moxibustion entered into a comprehensive hospital. In 1947, the Health Department of Jinan Military Area Command compiled and published Practical Acupuncture and moxibstion. An acupuncture training course was sponsored by the health school affiliated to the Health Bureau of the People's Government in northern China in 1948. All these efforts like the seeds spread over the liberated area, and promoted the understanding of acupuncture and moxibustion for Western medical doctors.

IV. Rejuvenation of Acupuncture and Moxibustion in People's Republic of China

Since the founding of the People's Republic of China, the Chinese Government has paid great attention to inheriting and developing the legacy of traditional Chinese medicine and pharmacology. In 1950 Chairman Mao Zedong adopted an important policy to unit the doctors of both Western and traditional schools; in the same year, Zhu De wrote an inscription for the book New Acupuncture, pointing out, "Chinese acupuncture treatment has a history of thousands of years. It is not only simple and economical, but also very effective for many kinds of diseases. So this is science. I hope that the doctors of both Western and traditional schools should unite for the further improvement of its technique and science." Deng Xiaoping also inscribed in the book Newly Compiled Acupuncture with the following statement: "It is an important job for us to critically assimilate and systematize our multifarious scientific legacies." With the support and concern of the government leaders, authorities of different levels took a series of measures to develop Chinese medicine. In this way acupuncture and moxbustion were unprecedentedly popularized and promoted.

In July 1951, the Experimental Institute of Acupuncture-Moxobustion Therapy affiliated directly to the Ministry of Public Health was set up. It became the Institute of Acupuncture and Moxibustion attached to the Academy of Traditional Chinese Medicine in 1955. Since then the research organizations of traditional Chinese medicine and pharmacology on provincial, municipal and autonomous regional levels have been set up one after the other, in which the research divisions of acupuncture and moxibustion are included. In a few provinces and cities institutes of acupuncture and moxibustion have also been established. There are teaching and research groups of acupuncture and moxibustion in every college of traditional Chinese medicine, and in some of the colleges departments of acupuncture and moxibustion have been founded. In many city hospitals, special clinical departments of acupuncture and moxibustion have been set up. Acupuncture and moxibustion have been carried out even in commune hospitals. Many institutes and colleges of Western medicine have put it into the teaching curriculum and taken it as a scientific research item.

To apply modern scientific knowledge to the research work on the basis of exploring and inheriting the traditional acupuncture and moxibustion is the prominent characteristic of the present research on acupuncture and moxibustion. In the early 1950s, the main work was to systematize the basic theory of acupuncture and moxibustion, to observe its clinical indications, and to make a systematic exposition of acupuncture and moxibustion with modern methods. From the later stage of 1950s to the 1960s, the following were carried out: deep study of the ancient literature, extensive summarization of the clinical effect on various disease entities, propagation of acupuncture anesthesia in clinical use, and experimental research to observe the effect of acupuncture and moxibustion upon the functions of each system and organ. From the 1970s up to now, investigations have been done on the mechanism of acupuncture anesthesia and acupuncture analgesia from the viewpoints of operative surgery, anesthesiology, neuroanatomy, histochemistry, analgesia physiology, biochemistry, psychology and medical electronics, on the phenomena and nature of the meridians from the viewpoint of propagated acupuncture sensation and other angles, and on the relationship between acupuncture points and needling sensation, between acupuncture points and zang-fu organs. Now the accomplishments of acupuncture and moxibustion research gained in China including sorting out of the ancient legacy, the clinical effect and the theoretical research by modern scientific methods are in the forefront of the world.

V. The Dissemination of Acupuncture and Moxibustion to the World

In the sixth century, acupuncture and moxibustion were introduced to Korea. The Emperor Liangwu sent medical doctors and craftsmen to Baiji in AD 541. The Xinluo royal court of Korea in AD 693 gave the title of Acupuncture Professor to those who taught acupuncture students. It was also in the sixth century that acupuncture and moxibustion were passed on to Japan. The Chinese Government presented the book Canon of Acupuncture to the Mikado of Japan in AD 552. Zhi Cong of Wu County brought Charts of Acupuncture and Moxibustion and other medical books to Japan. In the seventh century, the Japanese government sent many doctors to China to study Chinese medicine. In AD 702 the Japanese government issued an Imperial Order to copy the medical educational system of the Chinese Tang Dynasty and set a speciality of acupuncture and moxibustion. Since the introduction of Chinese acupuncture and moxibustion to Japan Korea, acupuncture and moxibustion have been regarded as an important part of their traditional medicine and handed down up to now. With the cultural exchanges between China and foreign countries, acupuncture and moxibustion were also disseminated to Southeast Asia and the continent of India. In the sixth century, MiYun from Dun Huang of Gansu Province introduced Hua Tuo's therapeutic methods and prescriptions to Daochang State of north India. In the fourteenth century, Chinese acupuncturists Zou Yin went to Viet Nam to treat diseases for the Vietnamese nobles, and he was given the honor of Magi Doctor. Acupuncture and moxibustion began to be introduced to Europe in the sixteenth century. Later more and more people engaged in the cause of acupuncture and moxibustion. France made an early contribution to spreading this therapy through Europe.

Since the founding of the People's Republic of China, the propagation of acupuncture and moxibustion to the world has been speeded up. In the 1950s, China gave assistance to the Soviet Union and other Eastern European countries in training acupuncturists. Since 1975, at the request of the World Health Organization, the International Acupuncture Training Courses have been run in Beijing, Shanghai and Nanjing, and acupuncturists have been trained for many countries. Up to now, more than one hundred countries have had acupuncturists, and in some countries teaching and scientific research on acupuncture and moxibustion have been carried out with good results. Since its founding in 1979, All-China Association of Acupuncture and Moxibustion has strengthened the connections and exchanges with the corresponding academic organizations of various countries; and China will make greater contributions to international development of acupuncture and moxibustion.