11 May

Drug  lore, herbal  medicine,  and  magical  practices  are  essentially uni- versal aspects of traditional and ancient medical systems. Chinese medi- cine is unique, however, in the development  of the techniques known as acupuncture and moxibustion and the sophisticated rationalizations that justified  these  very  ancient   practices.   Both  acupuncture  and  moxi- bustion  could  be used  to  restore  the  free flow of  yin and  yang  that was essential to health.

For at least 2,500 years, acupuncture, the art of inserting needles at specific points  on the surface of the body,  has been a part  of Chinese medicine. Moxa  or moxibustion, a related  technique  in which burning tinder  made from the powdered  leaves of Artemisia vulgaris (mugwort or  wormwood)   is  applied   to  specific  points   on  the  skin,  may  be even more ancient  than  the art  of needling. Acupuncture has attained considerable notoriety  and a degree of acceptance in the West, but moxi- bustion  has been largely ignored.  Although  moxibustion  may produce burns  and  scars,  practitioners claim  that  the  pain  is not  unpleasant. Skeptics, however, find it difficult to imagine a burn  associated  with a ‘‘pleasant pain.’’ The goddesses Scarlet and White are said to have given the secret of acupuncture to the Yellow Emperor,  who then devised nine kinds of needles from flint and bone. According to obscure and fragmentary references  to  the  use  of  pointed  stones  to  open  abscesses  and  cure disease in China’s semi-legendary past, marvelous needle-like stone implements were found at the foot of a jade-crowned mountain. Unfor- tunately,  the series of steps leading from opening  abscesses with sharp stones  to the sophisticated system described  in the Nei Ching remains obscure.

In the Nei Ching, the total number of acupuncture points is said to be 365. However, Huang Ti seems to name only about 160. The number 365 may represent  a theoretically  perfect system symbolically correlat- ing the number  of degrees in the celestial circle, the days in the year, and  the  number  of parts  in the  human  body.  The  points  are  said  to be distributed  along a complex system of tracts,  channels, or meridians that make their way through  the body. In its mature form, the acupunc- ture  system consists  of twelve main  tracts,  each  of which  carries  the name of the solid or hollow organ with which it is primarily associated. The system also accommodates various auxiliary tracts and organs. For outside observers, the most disconcerting  aspect of this system is prob- ably the lack of any apparent relationship  between the organ or disorder being treated  and the site of the therapeutic acupuncture point.

Theoretically,  acupuncture practitioners gain access to the system of  tracts  that  are  said  to  distribute   energy  throughout the  body  by inserting needles into specific points where the tracts are close to the sur- face. The idea that the acupuncturist can extract, purge, or drain energy by needling points on the tracts may reflect the evolution  of the system from its empirical foundation as a means of draining  pus or blood from an abscess. In the course of treating  localized lesions, practitioners may have  discovered  that   needling  particular  points   elicited  generalized effects. Certain  sensations  are supposed  to  show that  the points  were properly selected. These include warmth,  numbness, and the feeling that these sensations  are traveling  slowly up or down the limbs or trunk.  If the points  are the primeval  basis of the system, it is possible that  the subjective  sensation  of  a  response  traveling  through   the  body  when points are needled gave rise to maps of the tracts.

Much  ink has been spilled in Western  writings as to whether  the tracts  enjoy a true  physical existence. While the functional  aspects  of the tracts remain a fundamental principle of classical Chinese medicine, it is possible that  the system of vessels is essentially a mnemonic devise that allows practitioners to learn how to associate diverse physiological phenomena with  empirically  determined   points.  Aspiring  physicians could  learn  the  art  of  acupuncture from  illustrated  manuals  and  by practicing  on specially prepared  bronze  models or wooden  dolls. Ulti- mately,  the physician  had  to leave behind  idealized  models  and  work with patients  who were large or small, fat or thin,  male or female, old or young.  According  to scholar-physicians, the most dangerous  aspect of the acupuncture system is the possibility of misuse by ignorant  or evil practitioners,  because  the  system  included  a  number   of  ‘‘forbidden points.’’ Inserting  needles at forbidden  points could cause serious dam- age or even death.

Acupuncture was especially recommended  for all disorders  involv- ing an excess of yang. Moxibustion was thought to be preferable  when yin was in excess. However, the relationships among  yin and yang, the five phases, and the organs are so complex that the use of either method could be justified. Moxa was generally recommended  for chronic conditions,  such as tuberculosis,  bronchitis,  and general weakness, but it  was  also  used  for  toothache, headache,  gout,  diarrhea,   and  some psychological disorders.  Pao Ku, wife of the alchemist Ko Hung (254–

334), was famous  for treating  skin diseases with moxibustion. Officials of seventh century China would not undertake a journey unless protec- ted against  foreign diseases and snakebites  by fresh moxibustion  scars. In modern China, physicians have been experimenting with moxa in the treatment of influenza,  chronic  bronchitis,  and  infections  of the respi- ratory  tract.

Today,  there  are  professional  acupuncturists in Russia,  Europe, North  America,  and South  America,  as well in Asia. Nevertheless,  the legal status of practitioners in some countries remains ambiguous.  Until the  1970s, the  legal status  of  acupuncture was  of  no  interest  to  the American  medical  community.  Traditional Chinese  medicine was dis- missed as pure quackery.  What could be more bizarre than  killing pain by sticking needles into people (unless, of course, the needles were hypodermics full of narcotics)? Practitioners of alternative and unortho- dox medicine, however, were often eager to explore the potential  of acu- puncture,  acupressure,  and moxibustion. As acupuncturists increasingly gained both  notoriety  and clients, the medical profession  began to pay attention. The  American  Medical  Association  took  the  position  that acupuncture was folklore,  not  science, but  that  it could  only  be per- formed   by   licensed  physicians   because   needling   was  an   invasive procedure.  In 1975, Nevada  became  the first state  to establish  a state Board  of Chinese Medicine and require  that  physicians and nonphysi- cians   pass   an   examination    to   qualify   as  licensed  acupuncturists. Although  other  states have established  licensing procedures,  the status of acupuncturists and  other  practitioners of Chinese medicine is often ambiguous.

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