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A brief history of acupuncture

A. White and E. Ernst

“Acupuncture is generally held to have originated in China, being first mentioned in documents dating from a few hundred years leading up to the Common Era.The first document that unequivocally described an organized system of diagnosis and treatment which is recognized as acupuncture is The Yellow Emperor’s Classic of Internal Medicine, dating from about 100 BCE.

The spread of acupuncture to other countries occurred at various times and by different routes. In the sixth century, Korea and Japan assimilated Chinese acupuncture and herbs into their medical systems. Both countries still retain these therapies, mostly in parallel with Western medicine. Acupuncture arrived in Vietnam when commercial routes opened up between the eighth and tenth centuries. In the West, France adopted acupuncture rather sooner than other countries. Jesuit missionaries first brought back reports of acupuncture in the sixteenth century, and the practice was embraced by French clinicians fairly widely. Berlioz, father of the composer, ran clinical trials on acupuncture and wrote a text in 1816. French acupuncture today has been deeply influenced by a diplomat, Souliet du Morant, who spent many years in China and published a number of treatises about acupuncture from 1939 onwards.

The first medical description of acupuncture by a European physician was by Ten Rhijne, in about 1680, who worked for the East India Company and witnessed acupuncture practice in Japan. Then, in the first half of the nineteenth century, there was a flurry of interest in both America and Britain, and a number of publications appeared in the scientific literature including a Lancet editorial article entitled ‘Acupuncturation’. By mid-century, acupuncture had fallen into disrepute and interest lay dormant, though it was briefly resurrected in one edition of Osler’s textbook in which he describes dramatic success in the treatment of back pain with hat-pins. Interestingly, this comment was deleted from subsequent issues.

In 1971, a member of the US press corps was given acupuncture during recovery from an emergency appendectomy in China, which he was visiting in preparation for President Nixon’s visit. He described the experience in the New York Times and subsequently teams of US physicians made fact-finding tours of China to assess acupuncture, particularly its use for surgical analgesia. Despite initial excitement at the operations they witnessed, acupuncture proved to be utterly unreliable as an analgesic for surgery in the West. Acupuncture finally reached its present level of acceptability in the USA when an NIH consensus conference reported that there was positive evidence for its effectiveness, at least in a limited range of conditions.

The traditional theories of acupuncture have been challenged in the West, most notably by Mann in the UK and Ulett in the USA. Ancient concepts of Qi flowing in meridians have been displaced in the minds of many practitioners by a neurological model, based on evidence that acupuncture needles stimulate nerve endings and alter brain function, particularly the intrinsic pain inhibitory mechanisms. The first magnetic resonance imaging study of acupuncture may also prove to be a landmark. Other workers have noted the marked similarity between the trigger points of Travell with their specific pain referral patterns, and the sites of traditional acupuncture points with their associated meridians. There is a plethora of suggested mechanisms of action of acupuncture, but little valid data on which, if any, mechanisms are relevant to clinical practice. Evidence of clinical effectiveness is also still elusive for many conditions such as chronic pain, but in the last decade of the twentieth century systematic reviews have provided more reliable evidence of acupuncture’s value in treating nausea (from various causes), dental pain, back pain and headache.”