Unfortunately, this pinnacle of traditional acupuncture was not long maintained. During the Ming dynasty, the split between the scholar physicians and the familial practitioners became more entrenched. In fact, one of the latter, Zhao Xue-min(188) (c.1730 -1805 A.D.) became quite famous although he used an approach that was not based on the classical teachings of either Yin/Yang or Five Element theory, but rather on the idea that herbs have their effects based on four properties: ascending nature, descending nature, interrupters of pathological processes and repellers of exogenous pathogenic factors. His ideas have nevertheless been subsequently incorporated into traditional herbal theory.(189)
Figure 85: ZHANG JIE-BIN (1563-1640 A.D.)
founder of the “Yang tonification” school of thought.
Figure 86: YANG JI-ZHOU (1522-1620 A.D.),
author of the Great Compendium of Acupuncture and Moxibustion, an epochal work which contains the seeds of the various styles of traditional acupuncture as practiced in the twentieth century, to be discussed in Chapter Five.
As time went on, more and more emphasis was placed on herbal medicine. This must have been due, at least partially, to the monumental work of China’s greatest naturalist, Li Shi-zhen (1518-1593 A.D.)(190) who after 40 years of research published the Great Pharmacopaea in 1578 A.D., listing over 1800 herbs and 1,000 prescriptions, a work which has had world-wide impact and is felt to have influenced both Linnaeus and Darwin(191) (Fig.87). Li was also interested in acupuncture, however, and wrote a book on the Eight Extraordinary Meridians as well as one on pulse diagnosis in which he described the 27 classical pulse qualities.(192)
Figure 87: LI SHI-ZHEN (1518-1593 A.D.)
author of the Ben Coo Gang Mu (Great Pharmacopaea) whose influence reached to both Linnaeus and Darwin.
The tide continued to turn more toward herbal medicine and away from acupuncture. In 1532 A.D., Wang Ji (1463-1539 A.D.)(193) published a book called Questions and Answers on Acupuncture in which he stated, “Acupuncture can cure diseases of abundance, but not those of deficiency” and he strongly criticized the mechanical application of phase energetics to acupuncture, having himself suffered from “incompetent treatment by those who pretended to know, while not knowing at all.”(194) Also, several new ideas were hotly debated during the Ming dynasty. The importance of the Fire of the Vital Gate or “Ming Men” and its differentiation from the Right Kidney as it was described in the Nan Jing was discussed by Zhao Xian-ke(195) (c. 1687 A.D.) who stressed that the Kidney as an embodiment of the Element Water, controls the Fire of the Vital Gate.(196) Both Wang and Zhao made memorable contributions to the practice of herbal medicine, the former popularizing the prescriptions known as Si Jun Zi Tang and Ba Zhen Tang, while the latter did the same for both Ba Wei and Liu Wei Di Huang Tang, all famous prescriptions in common use today in TCM.(197) Around the same time, Li Zhong-zi(198) (died 1655 A.D.) developed the idea that the Kidney and the Spleen were the roots of the inherited and the acquired constitutions, respectively,(199) a doctrine which accounts for the subsequent focus of TCM on these two Organs in almost every illness. This approach was a natural outgrowth of the synthesis of the various theories I mentioned as having been introduced in the Jin and Yuan dynasties.
Towards he end of the Ming dynasty, an outbreak of the plague decimated the provinces of Hebei, Shandong, Jiangsu and Zhejiang in 1641. Based on his experiences in treating its victims, the herbalist Wu You-xing(200) published a surprisingly “Western” treatise, the Theory of Epidemics in 1642 A.D., wherein he distinguished epidemics from ordinary infectious diseases and claimed they were due to disease substances or pestilential energy (li qi) which enter their victims through bodily orifices–nose, mouth, pores, etc. (Fig.88). It is interesting to note that the first European book on acupuncture was published only a few years later (1658 A.D.),(201) both works being harbingers of the cross-fertilization of Eastern and Western medical thought. Ironically, the causative bacillus of plague was actually discovered in Hong Kong, by Alexander Yersin in 1894.(202)
The last Chinese dynasty, the Qing, began in 1644 and lasted until 1911. The most significant developments in traditional medicine it produced were several herbal theories on how to treat illnesses due to exogenous heat (wen bing): The first was the theory of the Four Divisions(203) developed by Ye Tian-shi(204) in 1746 (Fig.89). An alternative approach based on the theory of the Three Heaters was developed by Wu Ju-tong(205) in 1798, and both of these theories became part of the orthodox teachings of TCM. While herbal medicine continued to experience some growth, traditional acupuncture all but died out. What remained of traditional acupuncture was a modern revision in which diagnoses were fomulated according to the system being developed for herbal medicine (which I am about to describe) for which matching acupuncture prescriptions were devised in which the Points were described as carrying out the functions formerly ascribed only to the individual herbs comprising each herbal prescription. For example, some Points were said to transform dampness, other Points to regulate the Blood, and still others to relieve the Exterior, etc. This development has been referred to as “the herbalization of acupuncture,” a characterization first mentioned by Kaptchuk, and popularized by Flaws.(206) There were three refinements in the art of diagnosis during the Qing dynasty which paved the way for this evolution, each of which was ideally suited to the philosophy of the dialectical materialists who later formulated the specifics of TCM. The first and most significant factor was the formalization of the differentiation of syndromes according to the Eight Principles(207) by Cheng Zhong-ling (c. 1732, also known as Cheng Guo-peng), which as I have mentioned, has become emblematic of TCM(208) as has the Five Elements become emblematic of LA. Combined with the Eight Principles, was the determination of the “visceral system manifestation type,”(209) otherwise known as the syndromes of the Zang/Fu, or Organs. Sivin describes this as a “recent system of analysis which in effect leads the medical student from a list of symptoms, without further exercise of judgement, to a specific manifestation type.” He points out that while the origins of this methodology go back to the “Classic of the Central Viscera” attributed to Hua Tuo (but more probably written in the Northern Song dynasty) it has only become highly ramified and widely used in the last generation. The third facet of this diagnostic approach was the systematization and more generalized use of tongue diagnosis starting late in the nineteenth century, as exemplified in Zhou Xue-hai’s Simplified Study of External Diagnosis written in 1894.(210) Although these three diagnostic methods were evolving during the Qing dynasty, (and later became pillars of the resurrected TCM) acupuncture itself was beginning a period of roughly two hundred years of virtual eclipse in China. Before looking at the reasons for this however, I would like to point out that the traditional forms of acupuncture which had been spreading out from China across the Orient, for the most part did not incorporate these most recent developments. Thus traditional acupuncturists in Japan for instance, usually have no familiarity with either tongue diagnosis, Zang/Fu syndromes, or the Eight Principles, and as a result, have been at a severe disadvantage in achieving licensure in those Western jurisdictions which use examinations largely based on the TCM approach to acupuncture.
Figure 88: WU YOU-XING (1582—1652 A.D.),
an herbalist whose theory of pestilential energy paralleled the Western concept of infectious diseases.
Figure 89: YE TIAN-SHI (1667—1746 A.D.),
developed the theory of the Four Divisions for combatting Heat diseases (wen bing).
Figure 90: LOK YEE-KUNG
a master acupuncturist trained by the royal astronomy staff under the last Qing Empress, now living in Las Vegas.
As for the decline of acupuncture during the Qing dynasty, Needham cites a 1757 Chinese publication which speaks of acupuncture as a “lost art, for there were then left very few experts in it, and young physicians were at a loss to find teachers who could instruct them in it.”(211) Why this happened is open to speculation. Lok Yee-Kung, a master pr
actitioner who was personally trained by a member of the staff of astronomy under the last Qing Empress, relates that the rulers of the Qing dynasty (Manchus who were seen as occupying invaders by most of the Chinese) were afraid of the acupuncturists, because they thought the acupuncturists would murder them with their needles (Fig.90). Therefore, the royal family ordered acupuncture not to be used.(212) Needham cites the Confucian proscription against damaging or even exposing the body,(213) however, this explanation begs the question of why the decline of acupuncture occurred as late as the Qing dynasty. I prefer to think that the most important factor was the evolution of Oriental medical thought itself, which began to swing towards a greater interest in herbal medicine as early as the Han dynasty with the movement from philosophical to religious Daoism and its attendant alchemical teachings. The search was on for a corporeal “immortality” which demanded a pharmaceutical as opposed to an energetic methodology. Also, we should not underestimate the effect of the exposure of traditional China to western beliefs and practices, especially following China’s defeat by the Western imperialist powers in the two Opium Wars in the mid 1800’s. Western medicine spread rapidly once it was introduced into China, and all but eclipsed the indigenous health-care system. The Kang Xi emperor himself was successfully treated for a feverish illness with cinchona (Peruvian bark) supplied by a Jesuit missionary, de Fontaney,(214) culminating many years of Jesuit influence in the imperial court begun by Matteo Ricci in 1601. Finally, in 1822, the Imperial Government of Emperor Dao Guang issued a decree banning the teaching of acupuncture in the Imperial Medical College(215) and subsequently even the practice of acupuncture itself was banned.(216) Eventually, all of traditional medicine fell into disrepute as Western medicine became more widespread. There was an attempt to salvage Chinese medicine by combining it with Western medicine which produced the “School of Sino-Western Convergence and Intercourse” under the leadership of Tang Zong-hai (1846-1897), and a similar strategy was adopted by the leadership of the Taiping rebellion but neither achieved lasting success, although they undoubtedly influenced the form in which TCM re-emerged in the twentieth century. Chen Guo-fu, founder of the Institute for National Medicine, tried to explain the traditional medical theories of Yin/Yang and the Five Elements as no more than symbolic terminology for natural physiological processes, but as his critics pointed out, “if you replace the old medical ideas with universal scientific principles, why call it ‘Chinese Medicine’?”(217) With the fall of the Chinese empire and its replacement by a republic, the minister of education under the Guo-min-dang was quoted in 1914 as saying, “I have decided to abolish Chinese medicine and to use no more Chinese remedies as well,”(218) a threat which was enacted into law in 1929.(219) With the subsequent communist revolution, there was no immediate change in attitude. As late as 1941, a prominent Marxist, T’an Chuang, could still call Chinese medicine, the “collected garbage of several thousand year.”(220) However, the realities of the health needs of the Chinese people dictated that traditional medicine be allowed a place, and as early as 1928, Mao Ze-dong had advocated the use of “both Chinese and Western treatment,”(221) the blending of which was established as a goal by the National Conference on Health in Beijing in 1950. It was only in 1958, based on the prestige associated with the development of acupuncture “anesthesia,” a feat which finally impressed even the Western world, that Mao made his famous remark, “Chinese medicine is a great treasure house! We must make all efforts to uncover it and raise its’ standards.”(222) This was at the beginning of the “Great Leap Forward” and a similar burst of publicity accompanied the introduction of the “Barefoot Doctors,” who used techniques from both Chinese and Western medicine for emergency care, starting in 1966 with the “Great Proletarian Cultural Revolution.”
Traditional acupuncture, having been “kept in the dark for hundreds of years” in China, was thus brought back into the light as TCM by a government that required all aspects of society to conform to the ideology of dialectical materialism. It is impossible to give a precise date for the origin of TCM,(223) but it should be understood that this approach is a modern development. Unschuld states that “earlier this century, the fiction of a so-called chung-i (Chinese medicine) was created–a conceptual system artificially extracted out of the wealth of tradition and presented in such a way that it appears to resemble Western medicine as a homogeneous system of ideas and practices.”(224) Sivin concurs in noting that chung-i, officially translated as “Traditional Chinese Medicine,” should be distinguished from the ideas and methods which have not survived modern reinterpretation, which he calls “classical medicine.” He locates the separation of TCM and classical medicine as occurring “somewhat after 1900.”(225) There has not been much material published, at least in English, which would document how TCM was thus created,(226) but the following observations should serve as a rough outline.
Two institutions seems to have exercised predominant control over this process: The Experimental Institute of Acupuncture and Moxibustion Therapy set up in 1951 under the Ministry of Public Health, and the Institute of Acupuncture and Moxibustion set up in 1955 under the Academy of Traditional Chinese Medicine.(227) The former Institute, under the directorship of Mme. Zhu Lian (1910-1978) (Fig.91A) emphasized the integration of Western medical concepts into TCM as seen in Figure 91B from her 1955 publication New Study of Acupuncture and Moxibustion. This book presents the acupuncture Points according to bodily regions, disregarding Meridian theory almost entirely. Under her guidance, electrical stimulation of acupuncture points, or electroacupuncture, was intensively studied and subsequently incorporated into the clinical methods of TCM. The second Institute, under the leadership of Cheng Dan-an (1899-1957) (Fig.92), the head of the TCM school of Jiangsu Province, probably played a greater role in codifying TCM theory. Flaws has this to say about his work: “Cheng Dan-an was in the early forefront of re-establishing acupuncture in China as a credible therapy. He created for himself and others a practical style suitable for mass instruction in Western style colleges to students influenced by Western educational methods. However, Cheng Dan-an himself organized and rationalized his acupuncture protocols strictly according to traditional Chinese medical theory and terminology. He did not admix his presentation with borrowings from Western medicine.”(228) It should be kept in mind, however, that Cheng had also studied Western medicine, and was undoubtedly influenced by it. Kaptchuk has cited Cheng Dan-an as the source for the styles of treatment now being used in TCM, which Cheng had been developing and teaching since the 1930’s.(229) Dr. Cheng was himself traditionally trained, having studied under Chiu Chien-chuang and came from a family of traditional medical practitioners, but was unusual in that he had also studied in Japan and translated Japanese works on acupuncture into Chinese.(230) It was after this experience that he founded one of the first modern schools of acupuncture and moxibustion at Chengdu.(231) Mme. Zhu on the other hand was obviously more deeply influenced by her Western medical training. (232) Her work was important however, in that she had a significant international impact. She taught a seminal group of Russian doctors from 1956 to 1957 at her Institute in Beijing, and her book was reportedly used as a core teaching text in Vietnam.(233)
Figure 91: (A) ZHU LIAN (1910—1978),
director of the Experimental Institute of Acupuncture and Moxibustion Therapy. (B) The Autonomic Nervous System, an illustration in Mme. Zhu’s New Study of Acupuncture and Moxibustion, which indicates her emphasis on Western medical concepts.
In 1955, both Zhu and Cheng published books under their own names, but more importantly in that year not only was the Academy of TCM established, but by then so were four of the five main colleges of TCM which were charged with developing a “modern curriculum” out of which the original textbooks of TCM were created.(234) According to Kaptchuk, it was during the 1950’s that the Chinese medical schools developed the rationalizations of Acupoint functions which allowed for a fully herbalized approach to acupuncture.(235) Perhaps t
he clearest example of “herbalized acupuncture” was the work of Wang Le-ting (b. 1894) who compiled acupuncture formulae to specifically duplicate the effects of well-known herbal prescriptions, such as the widely used formula Shi Quan Da Bu Tang.(236) This prescription has ten herbal ingredients which are matched in a one to one correspondence by ten Acupoints having the same functions according to Wang, whose teachings were published in Beijing in 1984. A rationale for consciously “herbalizing” acupuncture has also been given by Peng Jingshan who wrote, “Herbal prescriptions are made according to the seven prescription and ten pharmaceutical forms, and this may be similarly applied to acupuncture, by simply changing herb names to acupuncture point names.”(237)
It would be inaccurate however, to portray TCM as a rigid, unchanging discipline. Actually, depending on the political climate at the time, TCM has encompassed a wide variety of approaches–the one area it has never accommodated being the more mystical, spiritual and shamanistic practices; however, even that may be changing now with the recent interest in the medical uses of both external and internal Qi Gong. These practies are inextricably connected to meditation and other “spiritual” methods, and as yet have no experimentally verifiable material basis. More typical developments within TCM have included such diverse practices as acupuncture analgesia (first described as suitable for surgery in 1958)(238) and the injection of medications (both Western pharmaceuticals and Chinese herbs) into acupoints in attenuated dosages. The current Chinese approach to the development of TCM was made explicit in 1980-1981 as the “Three Roads” policy under which Western medicine, TCM and the integrated use of both together are all considered valuable and valid methods of health care, which should be allowed to freely develop according to their own inner logic.(239) Before finishing this pre-sentation on the history of TCM, I would like to mention briefly its most materialist phase during the Cultural Revolution, when there was an attempt to expunge everything that could not be scientifically verified. During this time, “New Acupuncture” was developed in which only the Points were retained, the Meridians being dismissed as outmoded superstitution.(240)
In the Footsteps of the Yellow Emperor Page 10