Although Professor Worsley doesn’t use a guide tube to insert needles, his level of concentration and concern as an acupuncture practitioner is reminiscent of the medieval Japanese practitioner in Figure 2.
Which brings me to an explanation of how I came to write this book. It was only on a recent lecture trip to England that I was labelled as being an historian. For the past twenty years I have thought of myself first as a physician, and foremost as an acupuncturist, but now that I think about it, I have been doing historical fieldwork for just about as long as anything else. My dear friend Allegra Wint from Oxford reminded me of a dinner party some of us students gave for Professor Worsley when we were beginning our acupuncture studies with him back in 1974. While my classmates took it upon themselves to make it a social evening, I used the occasion to pester my revered teacher with questions about his background—where did he learn such-and-such, did he study with so-and-so, etc? Perhaps the reason I became something of an historian was due to his persistent reticence. As I didn’t get much information out of him, I just kept asking the same questions over and over again of anyone who might have some information, until it became a part of me—a quest, or perhaps simply a Zen koan. In any case, this process reflects the focus of my discussion of Western acupuncture on Worsley and LA. In no way do I wish to imply that the other styles of acupuncture taught in the West, even in England itself, are any less authentic. In fact, I will discuss many of them in passing, but as my process in this regard has been the attempt to shed light on the mystery of where Worsley got his goods, I have reported the results of my detective work as they materialized from the numerous letters sent and interviews conducted around the world over the years.
On a similar note, my choice of TCM as the “foil”—that is, as the dominant style of acupuncture with which to contrast the teachings of LA is not meant as a slight to any of the other styles of acupuncture practiced in the Orient. The dedication of this book reflects the debt of gratitude I feel to the Japanese tradition, both for the historical role it has played and for the assistance its practitioners provided in gathering the necessary materials to tell this story. I wish in doing my research I could have used the same method of interviews and letters for tracing the development of TCM—unfortunately I have had neither the time, the contacts, nor the linguistic skills to do a proper job of it, so my account therefore is based entirely on secondary sources. Finally, my capsule presentation of the long history of TOM is admittedly far from complete, and is offered simply as an ice-breaker. If my work turns out to be somewhat amusing and educational without being too offensive to the established professors of history, then its purpose will have been fulfilled.
I might jump the gun here with a bit of contemporary history which I think nicely illustrates some of the themes I will be discussing. Let’s go back to July 12, 1971, when the aforementioned James Reston finally arrived in Beijing after having been delayed in his trip from the U.S. for several days in Canton by bureaucratic red tape. He was anxious to interview the Chinese leadership in the capital, which would have been quite a reportorial coupe as China had, until then, been closed behind a “bamboo curtain” for quite some time. You can imagine, then, his reaction when he was informed on his arrival in Beijing that Henry Kissinger had just “scooped” him by announcing plans for President Nixon to pay an official visit to China the following year (Fig. 5). As soon as this news was delivered, Reston felt a sharp pain in his abdomen which developed into a classical case of appendicitis. He was rushed to the Anti-Imperialist Hospital (which by the way, was formerly the Peking Union Medical College, built and paid for by the Rockefeller Foundation in 1916) where he underwent an emergency appendectomy under conventional Western anaesthesia. In the following days, he began to experience post-operative abdominal pain and distention and was offered acupuncture as a possible treatment. This was accepted, and he was treated by the staff acupuncturist who inserted three needles in his right elbow and below his knees, and then used burning moxa(4) to warm his abdomen. This treatment was successful in relieving his distress, and the Western world began to hear about acupuncture in a big way (Fig.6). Now Reston’s treatment serves as a good example of the practice of TCM—his condition was handled as an organic physiological derangement, both from the point of view of Western medicine and of TCM which were used conjointly to successfully treat him. But what of Reston’s own perception of the experience? He was quite clear that the most sensible explanation for his illness was his reaction to the news of Kissinger’s triumph. The relationship of the mind and the body has become a prominent field of study which in the context of health care has led to the development of “psychosomatic medicine.” Curiously enough, it is just this psychosomatic approach, in which terms Reston tried to understand his illness, which is the primary focus of LA. Thus, in addition to addressing Reston’s abdominal discomfort, an acupuncturist of the LA persuasion would have tried to ensure that Reston’s troubled Spirit had also been eased, using needles and moxa for instruments, just as had the TCM acupuncturist. In this anecdote I am caricaturing TCM and LA more or less in the following ways: I see TCM as having adopted those elements of TOM that are most compatible with Western science. The thrust of its development has indeed been to integrate these two materialist approaches to health care so that its practitioners might most appropriately be referred to as doctors. LA on the other hand, seems to me to have preferentially adopted those elements of TOM of a more metaphysical character: the place of Man in the cosmos, and the meaning—be it physical, psychological or spiritual–of his moment to moment experience in health or in illness which assigns its practitioners to a role that might better be termed “healer” or “medicine man.” In order to understand how these different styles of “traditional acupuncture” compare, and how each of them can stand as complete systems of medicine parallel to the one we are familiar with in the West, I have developed a model which I will elaborate in the first two chapters, following which we will travel backwards in time several thousand years in an attempt to discover the origins of these arcane practices.
Figure 5: RICHARD NIXON IN CHINA
Nixon’s ceremonial visit to the Great Wall took place in 1972.
Figure 6: JAMES RESTON IN CHINA.
Following his recuperation from surgery, Reston was photographed visiting the acupuncture department of a hospital in Thao Yang, and he was instrumental in exposing many Westerners to acupuncture for the first time.
1
The Circle
It is impossible to write an intelligent history of traditional acupuncture without establishing at least a basic level of understanding of the subject matter itself. There are several books that I think do a good job and which I encourage the reader to investigate for some alternative points of view, but I cannot avoid the necessity of covering this ground myself.(5)
Acupuncture simply means the insertion of needles into the body to bring about some desired change as a result of the needles’ direct effects, and not from the injection of any materials through the needle. There are many ways to use needles to produce acupunctural effects as illustrated in Figure (7). The subject of this book is traditional acupuncture therapy, a use of acupuncture which developed within the context of a system of medicine known as traditional Oriental medicine. Although TOM starts from a different paradigm or conceptual framework than that of Western medicine, both systems share a similar underlying structure, which is in fact the structure of any complete medical system. This structure can be represented by a circle with eight divisions corresponding to the categories enumerated in Figure (8), which I call the Circle.(6) In this chapter I will introduce the eight categories of the Circle, outlining the approach to each one in TCM and LA, and also show how they parallel the categories of Western medicine.
The first category consists of axioms and other basic principles or natural laws underlying TOM. At this level are some assumptions that are quite different from those of contemporary Western medicine, but surprising
ly similar to those of its historical antecedents. The first of these is the concept of Qi (pronounced “chee”), a Chinese word that merits a different translation for each context in which it is used. Sometimes it means breath, sometimes energy, and often it seems to be synonymous with the vital force or “vis medicatrix naturae” (natural healing force) which was recognized in Western medical circles at least until the nineteenth century. There is a famous Chinese epigram stating that the universe is nothing more nor less than Qi and the laws which govern its behavior. Thus the discussion of basic principles will fall into two subcategories: the fundamental substances, of which Qi is the prototype, and the energetic laws which govern its behavior.(7) TCM places great emphasis on studying the transformations or metabolism of the fundamental substances which are derived from Qi, especially the more tangible ones known as Blood and Fluids (Fig.9). TCM’s energetic orientation is primarily the theory of Yin and Yang. LA on the other hand, accepts Qi as the all-inclusive fundamental substance or bodily constituent, but is less interested in the relationships of its derivative forms, singling out for special attention only the least tangible one known as Spirit. LA’s energetic orientation is primarily the theory of the Five Elements. If we compare this level of analysis in TOM with its counterpart in Western medicine, we would probably be discussing elementary particles and quantum mechanics as the two corresponding subcategories of natural law. While Western science is currently searching for a unified field theory to encompass the diverse energetic laws it has discovered, TOM has since its inception operated from the intuitively recognized “unified field theories” of Yin/Yang and the Five Elements, though neither of these models can be applied with the mathematical rigor demanded by Western science. There have been a number of books pointing to this similarity of Eastern and Western science, but I think that it is important to maintain a distinction between the two—one synthetic and inductive, the other analytic and deductive. They are complementary ways of perceiving and organizing reality that are not reducible, one to the other.
Figure 7:
VARIOUS USES OF ACUPUNCTURE The most frequent confusion in the popular understanding of acupuncture is due to a failure to distinguish acupuncture analgesia from acupuncture therapy.
Figure 8: THE CIRCLE
This is the model used by the author to compare various styles of medical practice, whether of Western or Eastern origin
Figure 9: THE BASIC SUBSTANCES
Qi is both the inclusive term for all the vital substances in the body, and also a specific type of bodily substance when used in a more restrictive sense.
The second category of the Circle is the study of the vital functions, of which there are twelve singled out as being of primary importance in TOM. Once again, TCM and LA emphasize different aspects of these twelve. TCM refers to them as “Organs” while LA calls them “Officials.” Both approaches however recognize the same twelve traditional components which have names that are already familiar to us such as Lung, Large Intestine, Stomach, etc. These same terms have a fundamentally structural connotation in Western thought, while in TOM it is not their physical make-up, but what they do, that is considered essential, and this priority of function over structure is shared by both TCM and LA.
Every function must be associated, however, with some type of structure, and so the third category of the Circle relates to the human body, starting from those parts associated with the twelve primary functions. Once again, the obvious structural correlations to us Westerners are not the ones of primary concern in TOM. Rather than focussing on the anatomy of the Organs themselves, acupuncturists are most concerned with the regions of the body that each Organ influences. These regions are traversed by invisible but nonetheless meticulously described Meridians or Channels, which among other roles transport the Qi throughout the body (Fig.10). It is also along these Meridian pathways that the acupuncture Points are located, where practitioners insert their needles to alter the flow of Qi, and by this effect are able to influence bodily functions in health and in illness. The objective reality of the Meridians and their Points has never been established to the satisfaction of Western scientists, although there have been numerous suggestive studies.(8) Regardless, these anatomically defined “structures” remain the backbone of the practice of acupuncture. Both TCM and LA emphasize study of the twelve Principal Meridians which are associated with the Organs, whereas several of the less well known styles of acupuncture which I will mention in Chapter Five have focussed on other components of the Meridian system, called “Secondary Vessels,” which include the Extraordinary Meridians, the Divergent Meridians, the Connecting Meridians and the Tendinomuscular Meridians.
The fourth category of the Circle is etiology, or the study of the causes of disease. In contrast to Western medicine which posits the basic cause of most disease as being an invasion from without (for example, germs, toxins and allergens) Oriental medicine places more emphasis on the maintainance of health from within. Health is said to be maintained by the activity of Righteous Qi which repels any incursion by pathogenic factors known as Evil Qi. Of course the virulence of pathogenic forces and the strength of host resistance are both important factors to take into account in any system of medicine, but their relative primacy varies. The Classics of TOM teach that if a person follows the correct way of life, he will be immune to attacks of illness. A similar emphasis on the terrain underlying the development of disease can be found in pre-twentieth century Western medical theory. Having said this much, it is important to notice that TCM and LA place different emphases on these etiological categories. TCM tends towards a greater focus on the types of Evil Qi which contest with the Righteous Qi, for example Wind, Cold or Dampness—whether of Exogenous or Endogenous origin. LA on the other hand has an almost exclusive interest in the type of malfunction of the Righteous Qi, insofar as it relates to the Five Elements and their Twelve Officials. The mental, emotional and spiritual causes for these aberrations are given relatively greater prominence. This difference in emphasis is in keeping with the general approaches of TCM as more materialistic and LA as more spiritualistic in nature.
Figure 10: THE ACUPUNCTURE MERIDIANS
Various charts of the Meridians have been drawn by individual authors. This chart by the late Japanese teacher Honma Shohaku artistically illustrates the Points, Meridians and Organs to which they connect internally.
The fifth category of the Circle is pathology, or the study of the alterations of the human organism which occur in disease. To some authors, the development of the science of pathology in the 1800’s, as fathered by Rudolf Virchow, was the crucial factor which allowed for the emergence of modern Western medicine. I would venture to say that a parallel development has never occurred in TOM, whose pathological theories remain more elementary. Both TCM and LA recognize imbalance, per se, as the basic pathological condition, with TCM focussing more on its qualitative manifestation such as the formation of abnormal bodily substances including Phlegm and Stagnant Blood, for example, while LA focussing more on the quantitative imbalances subsumed under the categories of Excess and Deficiency. These are of course not absolute differences in approach, but recognizing this distinction is essential to understanding the consequent differences between the two styles of acupuncture in the realms of examination, diagnosis and treatment.
Category six involves the methods of examination employed by acupuncturists, which are traditionally listed as seeing, hearing, questioning and feeling. All of these methods are dependent on the direct perceptual skills of the practitioner which are therefore the most important part of a practitioner’s training. There is very little counterpart to the use of laboratory and other “third party” methods of examination and testing which form such an important component of contemporary Western medicine. Examination is really the process of gathering data, and in TCM this process is oriented around those preceding issues pertinent to this style: Yin/Yang, the Qi, Blood and Fluids, the Organ functions and the different qualitative typ
es of pathology. The examination in LA on the other hand, is oriented around the Five Elements, the emotional and spiritual state of the patient, especially with respect to the functions of the twelve Officials, and the quantitative imbalances in the distribution of Qi. This difference is most easily appreciated in the contrasting methods of pulse diagnosis employed by the two styles, to be described in Chapter Two.
From the data gathered by examination, a diagnosis can then be formulated. The hallmark of Western medical diagnosis is naming or identifying the specific disease from which a patient is suffering. In TOM, although this approach to diagnosis does exist, relatively greater emphasis is placed on identifying the energetic mechanism or pattern underlying the specific disease manifestation. Discriminating the pattern in Yin/Yang terms has become formalized in TCM as the “Eight Principles,” a short-hand term that is often substituted for TCM much as “Five Elements” is casually used as an interchangeable term for LA. The Eight Principles, or as I prefer to think of them, the Eight Diagnostic Categories will also be spelled out in Chapter Two as will the major diagnostic theory of LA referred to as the Causative Factor.
Finally, based on all the preceding steps, a method of treatment is chosen and carried out. As the subject under discussion is acupuncture, that will be the focus of my presentation, however, I should reiterate that the Chinese word which is usually translated as acupuncture, zhen jiu, actually means the use of needles and cauterization, so a more accurate translation would be acupuncture-moxibustion; but in English that becomes rather unwieldy. Both acupuncture and moxibustion are forms of physical therapy, however the reader should keep in mind that TOM encompasses many other forms of treatment including internal medicines (herbal), diet, meditation and therapeutic exercises to name a few of the more common ones. Other than noting that TCM acupuncture has been strongly influenced by herbal medical practice, with which it is usually conjoined and whose history will therefore also be reviewed, I will not devote much attention to these other methods. In some ways, the differences between TCM and LA style acupuncture can best be appreciated by recognizing this close link between TCM and herbal medicine on one hand, and the absence of any such linkage for LA on the other.
In the Footsteps of the Yellow Emperor Page 2