With the advent of renewed interest in China, and also the wish of various European nations to 'discover and colonize' the non-European world, the Portuguese began to establish trading settlements in mainland China. With the traders went priests to convert the 'heathen'. It was through these priests, and also various physicians who visited China, that the idea of acupuncture began to filter through to the west. The Jesuits were particularly active in collecting and disseminating this information in Europe, but the process was far from one-sided as the Jesuits also introduced Western science to China. Dominique Parrenin, a missionary, translated a textbook of anatomy into Mandarin but this was banned from general circulation by the Emperor K'ang Hsi as he recognized that many of the Western concepts contradicted those of traditional Chinese medicine.
The Decline of Acupuncture and the Rise of Western Medicine in China
The Ching dynasty (A.D.1644-1911) was a time of chaos for the Chinese Empire. Western influences pervaded a war-torn China, especially during the nineteenth century when various Western nations were given 'spheres of influence' on the Chinese mainland. The Ching Emperors regarded acupuncture as 'a bar to progress' and in 1822 a government decree eliminated acupuncture from the curriculum of the Imperial Medical College.
During this period a great number of medical missionaries entered China to 'teach, heal and preach'. The medicine they practiced in the early part of the nineteenth century had little similarity to the Western medicine of today, as there were no anaesthetics, antibiotics or sepsis. The concept that bacteria caused disease was only disseminated in the 1860's and 1870's, and therefore the missionaries had very little real medical skill to offer. Their main advantage was their understanding of the elementary principles of surgery.
The Confucian ethic had blocked completely the progress of surgery, as the Chinese felt that the dead must present themselves to their ancestors with a whole body. They were afraid to submit themselves to surgery in case they died and went to their ancestors with part of the body missing; surgery was therefore the province of the medical missionary and the basis on which their medical skills were accepted. The first full-time missionary was Peter Parker who worked in Canton. At first, the activity of the medical missionaries was limited by hostility, money and manpower, but as Western influence expanded the missionary work grew. By the 1920's, growth had reached a peak and there were some 550 hospitals and out-patient clinics spread over most of the provinces and cities in mainland China.
During this period the art of acupuncture was in decline. Many acupuncturists seemed to be no more than 'pavement physicians' with poor training. Their surgery was often the market place, their knowledge of traditional Chinese medicine was very limited, and their equipment was filthy and of poor quality. The majority of 'respectable' Chinese doctors were practicing herbal medicine and massage, rather than acupuncture and moxibustion. In spite of its decline, and even at this low level, acupuncture remained the medicine of the masses. The Imperial denigration of acupuncture reflected not only the poor standard of practice but also the fact that some of the educated Chinese were looking to the West for progress. After the pneumonic plague of 1910 the Viceroy of Manchuria, Hsi Liang, remarked, 'The lessons of the epidemic are great . . . if railways, telegraphs and other modern inventions are indispensable to the material welfare of this country, we should also make use of the wonderful resources of Western medicine.'
Western medical colleges were set up by the missionaries, the first being in Canton. The missionaries translated Western medical books into Chinese and in 1886 began to print the China Medical Missionary Journal which was the first scientific journal in China. Another medical college was established shortly afterwards in Tientsin and there was a gradual increase in the number of Western-trained Chinese doctors. In 1929 the practice of acupuncture was outlawed in China; the passage of acupuncture has not always been smooth, even in China!
Communist Support for Acupuncture
In 1928 the Communist party of China was formed, under the leadership of Chairman Mao. A long guerrilla war ensued and the Communist party finally took power in 1949. The Communists realized that there were little or no medical services in the 'liberated areas' and actively encouraged the use of traditional Chinese remedies to keep their troops on the move. These remedies were cheap, acceptable to the Chinese peasants, and utilized the skills already available in the countryside.
Acupuncture gained new momentum; in 1940 Yang Shao proposed to 'scientificize, "Sinocize" and popularize' traditional Chinese medicine. During the early 1950's many hospital opened clinics to provide, teach and investigate the traditional methods, the main research institutes being in Peking, Shanghai and Nanking. This renaissance of acupuncture, combined with a sophisticated scientific approach, has allowed the development of many new methods of acupuncture.
New Ideas Based on Traditional Chinese Medicine
Ear acupuncture is a particularly useful new acupuncture method. The Ling Shu states: 'The ear is the place where all the channels meet', and with this statement the Chinese justify the origin of ear acupuncture. The external ear is an homunculus, or little man, with all the organs and parts of the, body being represented on the ear. Puncturing the external ear at a specific point allows a disease to be treated in the body; for instance, if the arm is hurting then needling the arm point on the, external ear will alleviate the pain in the arm.
Ear acupuncture has been used and developed by the French and the Chinese as a form of therapy and also, specifically by the Chinese, for acupuncture anesthesia. Many people in the West think of acupuncture as being synonymous with acupuncture anesthesia. The application of acupuncture as a form of anesthetic is a relatively new development, and a direct product of the impetus given to acupuncture by the Communists. In 1958 acupuncture was first used by the Chinese to control post-operative pain and it then began to be used as an anesthetic for simple operations. This technique was found to be effective and its use expanded quickly. In China it is now used for a wide variety of major and minor operations.
Acupuncture anesthesia has many advantages including safety and swift post-operative recovery; however, it does not always provide complete pain relief, and whilst a small failure rate is acceptable to the Chinese it would not be acceptable in most Western societies. It is obviously better to use a site far away from the area of the operation when applying acupuncture anesthesia, and this makes ear acupuncture the method of choice for anaesthetics.
The concept of the homunculus is one that the Chinese have developed further. There are complete representations of the body on the hand, foot, face and nose. Each of these represents complete 'micro-acupuncture' system, capable of treating ailments throughout the body. Acute back pain can be relieved by stimulating the points on the hand that represent the back. Perhaps this can be equated with the fact that each cell in the body has the information potential to duplicate the whole human. The genetic material in each of our cells is exactly the same as the information in the cell from which we all originated, the fertilized egg.
New Ideas Based on Western Medicine
The Chinese have also applied a variety of Western techniques within the field of acupuncture. They have established research institutes and these, particularly in Shanghai and some other Chinese cities, measure up to any found in the West.
Scalp acupuncture, a technique invented in the last decade, is a direct development from the neuro-anatomy of the central nervous system. When the brain is damaged, in diseases such as a stroke, the scalp is stimulated superficially over the area of damaged brain. Although there is no clear connection between the nerves in the skin of the scalp, and the brain, this method does seem to produce an effect on the brain and the Chinese claim that they are able to alleviate some of the symptoms of a stroke with this procedure. Modern medicine has undoubtedly provided the stimulus for the development of this type of acupuncture.
Acupuncture points can also be treated by injection with ordinary injection needles, this method having been used in the West for some time although not called acupuncture. Tender, painful areas often occur in and around arthritic joints. Recent research work has shown that most of these 'tender points' are acupuncture points, and that injection therapy relieves the pain. Is it perhaps the needle insertion, rather than the fluid injection, that alleviates the pain?
Electro-acupuncture is the stimulation of acupuncture needles with small electrical currents, and its growth and development has been pioneered by the Chinese over the last thirty years. Throughout long operations, under acupuncture anesthesia, electrical machines have been used to avoid prolonged, continual manual stimulation of acupuncture needles. Electroacupuncture is now widely used in many acupuncture clinics, for acupuncture therapy as well as for anesthesia.
Contradictions Resolved?
The Chinese are well aware of the current scientific explanations of acupuncture and its mode of action, and through their research institutes they are contributing to this field. The cultural heritage of the Chinese has made it possible for them to accept the contradictions inherent in the practice of acupuncture; science versus philosophy. The concepts of traditional Chinese medicine allow the acupuncturist to approach and treat a patient. Eventually science will provide a logical explanation for these empirical findings, but, until such time as that happens, science and traditional ideas will both play an equal part in helping patients by the use of acupuncture.