The Evolution of Acupuncture: From Ancient China to Worldwide Recognition
It is commonly believed that acupuncture played a key role in China’s medical history and is often seen as an integral part of China’s traditional health care, at least in the west. However, was this actually the case? The real story is much more complex than this, and in fact, the use of the practice seems to have ebbed and flowed as wider medical knowledge advanced, or as governments changed.
The Misty Origins of Acupuncture
The exact origins of acupuncture are somewhat hazy. While historians are sure the practice began in China, the exact date is contested. Sharpened stones thought to be used in the place of needles have been found from around 6000 BC; however, it is not clear that these were used for acupuncture. Instead, they may have been used in other procedures, such as bloodletting or lancing abscesses.
Documents from 198 BC that were found within the Ma-Wang-Dui tomb in China hold no references to acupuncture procedures – although they mention the theory of ‘meridians’ (explained below). There is also evidence from the ‘Ice Man’, who was found preserved from 3300 BC when the Alpine glacier melted, that these meridians were being used to treat disease. His body was covered with tattoo marks, which seem to have been from treatment that involved them.
As David Ramey and Paul D Buell argue, when acupuncture is believed to begin depends on what evidence is accepted, as well as how we define the practice. While there are early mentions of ‘needling’, it is unclear whether this practice can be considered acupuncture. If we take the use of any kind of penetrating instrument to be acupuncture, then the practice began in very early China. But if this logic is used, it can also be applied to other early societies that used bloodletting or cautery on the human body, both of which involved the use of a penetrating instrument.
In the 1970s, archaeologists found, inside the tomb of Han Dynasty Prince Liu Sheng (?-113 BC) four gold and five silver needles. However, it is unclear what kind of ‘needling’ these were used for, if any, and they may not have been used for acupuncture at all.
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Ancient Chinese statue showing acupuncture points. Source: Yü Lan / Adobe Stock
The first mention of therapeutic ‘needling’ is in a historical text The Shiji (Records of the Historian) of Sima Qian written in 90 BC. While the text mentions ‘needling’, it does not mention insertion points or the flow of qi within the body (explained below), or how it may be influenced by such a practice.
The earliest written documentation of acupuncture can be found in The Yellow Emperor's Classic of Internal Medicine which dates from about 100 BC. This book is set out as a conversation between the emperor and his learned minister Chhi-Po, with the latter answering the former’s questions. It is thought that the methods described in the text includes traditions handed down over centuries. While this book mentions meridians, the exact site of acupuncture points is developed after its time.
For the next few centuries, acupuncture continued to develop and is mentioned in other texts. It gradually became one of the standard therapies used in Chinese health care. It was relied on in medical practice alongside the use of herbs, massages, diet, and moxibustion (heat).
It wasn’t until between the 14th and 16th centuries (during the Ming Dynasty, 1368-1644), when The Great Compendium of Acupuncture and Moxibustion was published, that acupuncture became what we understand it to be today. The Great Compendium... was published while the Ming dynasty was flourishing, and it was during this period that the practice developed into what would become modern acupuncture.
The book itself describes 365 acupuncture points where there are openings to the channels and through which needles can be placed to modify the flow of qi. These observations, like all other internal medical observations, were made from living subjects because dissection was forbidden. Medical theorists and practitioners where therefore unable to examine the inner workings of the human body and had to rely on inferences they made from the outside.
The text is made up of three sections, all written by different authors from different times. The dates of each section are unclear, although the main content of the book is thought to date to around the 5th to 8th centuries AD. Most of what remains went through a final revision in the 11th century AD, which means what remains of the earlier work may not be the original.
Ramey and Buell argue that during the Song period (960-1279 AD) acupuncture, or an early form of what we know as acupuncture, was increasingly used. Later, theories of systematic correspondence and qi were integrated. Then finally, no earlier than late Qing times (1644-1911 AD), there came the development of fine steel needles.
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Chinese Medicine: Drawing, a standing figure showing the series of acupuncture points for controlling diseases of the heart and sexual organs. 18th century (Wellcome Images / CC-BY 4.0)
Chinese Medical Theories
The theories behind acupuncture were closely tied to the general understanding of medicine in ancient China. Those who used acupuncture believed that the body contained energy that flowed within it. This energy, if channelized correctly, could create balance and health. This energy flow is called qi.
It was believed that qi flowed through the body via three main channels called ‘meridians.’ These meridians were representative of the main organs and functions of the body, but did not follow the exact routes of the nerves and the blood.
Prior to this, in the earliest case, Chinese medicine was linked to beliefs in ancestors. It was believed that dead ancestors were able to endanger or end human life; therefore, early healing practices attempted to restore not only the living, but the dead too.
As this understanding of medicine declined in popularity, the belief in magical, demonological, or supernatural forces increased. It was believed that demons in the body could cause medical issues, and that inserting needles or stone lancets could kill or expel them.
The most influential period in the development of early Chinese medicine was during the Han Dynasty (2nd century BC to 2nd century AD). During this period, medical theories took a dramatic turn. Natural laws, which were conceptualized through doctrines like ‘yin-yang’ and ‘five elements’, became popular. While people in this period certainly still relied on old theories of demons and ancestors, the theories were overwhelmingly a lot more rational.
The Decline of Acupuncture
From about the 17th century onwards, the use of acupuncture in China began to decline. While the practice had been a minor tradition throughout Chinese history, people began to associate it with superstitions and saw it as irrational. Then in 1822, the practice was essentially outlawed when the emperor issued a decree which excluded acupuncture from the Imperial Medical Institution. This was an effort to modernize medicine. However, as expected, rural healers and some scholars continued to practice acupuncture and held on to their knowledge. The practice was also outlawed in this period in Japan.
The rise of western medicine in China during the 20 th century led further to its decline. In 1929, it was again outlawed by the government, along with other forms of traditional Chinese medicine.
Acupuncture chart with a series of points indicated on the figure of a standing Chinese man. Watercolour, China, 17 – (Wellcome Collection / CC BY 4.0)
The Revival of Acupuncture
During the Great Leap Forward in the 1950s and the Cultural Revolution of the 1960s came the revival of traditional forms of medicine, including acupuncture. This was promoted by Chairman Mao Zedong himself; however, it is said that Mao rejected the use of acupuncture when he was ill, in favor of more modern methods.
Diverging strands of acupuncture theory were brought together to create one consensus known as traditional Chinese medicine; this also included herbal medicine. Special research centers for acupuncture were set up in the 1950s throughout the country, and the practice was made available at hospitals. These western-style hospitals often had separate acupuncture departments. These traditional methods were presented to the population as pragmatic solutions to health issues in a country that was severely undersupplied with doctors.
The Spread of Acupuncture to Other Countries
Acupuncture spread to many countries throughout history. It made its way to Korea and Japan in the 6th century. It also made its way to Vietnam through commercial routes when they were opened up between the 8th and 10th centuries.
It is said that Chinese medical techniques were mentioned for the first time in Western literature as early as the 13th century. This was in a travelogue by William of Rubruck; however, the West would not gain the knowledge of needling until a few centuries later. It spread more thoroughly to the west with the East India Company and Ten Rhijne. Rhijne worked for the company and described the practice medically around 1860.
The practice of acupuncture had reached France and Germany a bit earlier. In the Escorial in Madrid, there are a few 16th century manuals on the practice, and it seemed to be somewhat popular in Europe for a while. It first reached France via Jesuit missionaries who brought back reports of the practice in the 16th century. It was then embraced widely by French physicians. In the 18th and 19th centuries, several prominent physicians from France advocated for its use. However, they face opposition from other, equally prominent, physicians. The latter accused the formed of “resurrecting an absurd doctrine from well-deserved oblivion” (Ramey and Buell, 2010). Later, French acupuncture was greatly influenced by the diplomat Souliet du Morant, who spent a number of years in China and published several treatises about it from 1939 onwards.
In the first half of the 19th century, America developed an interest in acupuncture. Particular interest was gained when, in 1971, a member of the US press corps was treated with the method while he recovered from an emergency appendectomy in China. The procedure was successful and he described the experience to the New York Times. The practice was finally truly accepted in the US when a NIH consensus conference reported positive evidence for its effectiveness in some conditions.
In 19th century Britain, there was also a brief period of popularity. A journal published in 1821 recorded the process of acupuncture. However, in 1929, the editor of the Medio-Chirurgical Review noted that no one was talking about the practice anymore. It seems that it went out of fashion rather quickly.
To conclude, the use of acupuncture has a long and complex history, one that is often hard to trace in its entirety. What is evident though, is that it did experience some periods of popularity in both China and the wider world. As with a lot of medical practices from the past, however, it changed and developed with the ebb and flow of medical and surgical advancement.
Top image: Therapist giving acupuncture to a woman. Source: juripozzi / Adobe Stock
By Molly Dowdeswell
Mandal, A. 2019. Acupuncture History. Available at https://www.news-medical.net/health/Acupuncture-History.aspx
Ramey, D. and Buell, P. 2010. A True History of Acupuncture. Available at https://onlinelibrary.wiley.com/doi/full/10.1211/fact.2004.00244
White, A. and Ernst, E. 2004. A Brief History of Acupuncture. Available at https://academic.oup.com/rheumatology/article/43/5/662/1788282