Acupuncture is one of a number of treatments that are part of Traditional Chinese Medicine (TCM); it involves inserting small metal needles into specific locations on the body, known as acupoints, which are claimed to  be located on special internal body channels, (meridians), through which, it is claimed, flows a special form of energy, known as Qi or Chi.

The technique is known in Chinese as zhēn jiǔ — which literally translates as "needle"; the English name is derived from the Latin acus, "needle", and pungere, "prick". Although acupuncture is believed to have originated in China, and, along with herbal medicine, formed the basis of TCM; over time the practice spread to Korea (541 AD), Tibet and, according to Omura (2003), a Chinese doctor, Chi Chung, introduced the practice to Japan around AD 561, (p. 15).

The earliest references to the use of needles in Chinese medicine are contained in the Huang-ti nei-ching, (the Inner Classic of the Yellow Sovereign, also known as the Inner Canon of the Yellow Emperor). This book comprises two parts, the Su-wen, hereafter referred to as Plain Questions, and the Lingshu Jing, hereafter referred to as The Divine Pivot. While the Plain Questions only briefly mentions acupuncture, The Divine Pivot, deals much more extensively with the technique. Although authorities, such as Lu and Needham (1980b), date the Inner Classic from the 1st century BCE, it appears to actually be a collection of much earlier and much later material, written by a number of unknown authors. Thus, Epler (1980) indicated that while approximately one-third of the material originated between the 3rd – 1st centuries BCE (p. 338), the remainder appears to have been written during the T'ang Dynasty, (618-907 A.D.) The material had been gathered together, and, in a practice common in past ages, so that it might be assigned a greater degree of authority, the material was attributed to the Yellow Emperor a legendary Chinese cultural hero.

The importance of the Inner Classic is that it reveals evidence Chinese medical ideas had begun a move from the older primitive beliefs that disease and illness were caused by supernatural forces, to one in which factors such as physical and environmental conditions were perceived as influencing an individual's health. However, these aspects were considered to be only minor influences and superstition and religion remained the dominant features of Chinese medicine. The fundamental basis of TCM and acupuncture, were, and remain, metaphysical cosmic forces; these are: -


According to TCM philosophy, the health of every individual depends upon the constant interaction, and in particular, the balance produced by the harmonious combination of the Yin, Yang, Qi and the Five Elements. Lu and Needham (1980a) referred to this cosmic harmony as krasis, a condition produced by a combination of substances, which, although diverse in their individual natures, function perfectly together to create balance and stability.

Coordinating these forces were astrological influences similar to the Western concept of the Macrocosm-Microcosm. The Chinese believed that there was an inexorable link between the heavens, the "great cosmos" and the Earth, the "small cosmos" and that everything that occurred on Earth was a "reflection" of events in heaven. It was for this reason that one of the most important duties of Chinese emperors was to make annual sacrifices to propitiate heaven. These rituals were performed during the summer and winter solstices to ensure that heavenly harmony would flow down to Earth, ensuring bountiful harvests, and peace and contentment, throughout the land. 

Around 500-400 BCE Chinese medical philosophy was profoundly influenced by Confucianism and Taoism, both of which stressed the concept of "harmony". Confucianism stressed the concepts of righteousness, and good relations with neighbours, so as to produce a harmonious and stable society. Taoism, (which became a state religion in 440 BCE) had similar ideals, but while Confucianism was primarily concerned with a secular code of conduct, Taoism was based upon a belief in an indefinable universal energy that was perceived as being part of, and flowing through, all things animate and inanimate. As such, it represented a union of opposites, whereby the various mystical cosmic forces combined to create a sense of harmonious balance throughout the cosmos.

Possibly the best known example of this "cosmic balance" was the concept of the Yin and Yang. Essentially a dualistic concept, Yin represented darkness, disorder, evil, the intuitive and the female aspect of nature, while Yang represented light, order, goodness, rationale and the male aspect of the natural world. These two aspects of a single concept, represented the,"… two sides of the same or as polar areas of a single whole…" (Capra, 1977, p. 21) It was the "dynamic interplay" between these two opposing forces that produced continuing balance throughout the cosmos. Thus, in their endless cycles of interaction, one would gain in strength, reach a climax, and would then retreat, at which point the other aspect would begin to gain ascendancy until, once again, cosmic equilibrium was achieved.  Over time, these concepts came to be applied to the fundamental principles of human life, so that, it was reasoned, if one lived in harmonious balance with the natural order of the cosmos, then they would also experience good health. It was this cosmological deviation which, as Epler (1980) observed, diverted TCM into a stagnant backwater of primitive insularity, rather than pursuing the scientific development that occurred in the West. (p. 348)

Of primary importance for practitioners of TCM and acupuncture was the concept of Qi energy and its ability to flow through the body in regular cycles. According to Manaka and Urquhart (1973) individuals are born, "… with a fixed energy quotient" (p. 22), known as Xian Tian Qi, which is inherited from the parents, and, although each day they use some of this limited supply, they are able to supplement it with post birth Qi, (Hou Tian Qi) which comes from food and the air. The most important aspect of this Qi energy was that it had to be maintained at a harmoniously balanced level; too much, or too little, could result in imbalance, or disharmony with dire results.

There were numerous factors that could upset this vital balance; unfavourable environmental conditions, a poor diet, too much physical or emotional stress, all could produces imbalances that could result in physical or mental disorders. As Lu and Needham (1980a) observed, "…disease was essentially a malfunction or imbalance, one or other component entity in the body having unnaturally gained the lead over the others." (p. 862).  The ultimate aim of TCM was to restore the vital balance when it was out of harmony and for this reason acupuncture is sometimes referred to as, "treating patterns of disharmony."

Acupuncture philosophy assumed there existed within the body a system of special channels, (jing luo — called meridians in English), through which the Qi energy flowed, "…in a pre-determined direction from meridian to meridian circulating through the entire body, (Omura, 2003, p. 24). It was believed that any interference with this flow of Qi could produce disharmony, (sickness), in the body, but that harmony could be restored by inserting small needles into some of the 361 (WHO, 1993) specific acupoints, (xue – literally, a hole or cave), located along six yin, six yang, and eight extraordinary channels  through which the Qi flows. This needling process, it was claimed, could produce a significant effect upon the flow of Qi through these meridians.

The pathways of the meridians and the locations of the acupoints are based upon traditional Chinese concepts. While the various acupoints were believed to have a relationship to particular organs, they were not necessarily located near those particular organs; furthermore, not all acupoints are located on the various meridians. The meridian system appears to be a Chinese fantasy, for when Simon et al. (1988) injected technetium 99m — a radioactive tracer substance, into both acupuncture and control points, they noted lymphatic and venous drainage of the technetium 99m at the site of the initial injection, and the substance was then absorbed into, and transported through the veins, with no evidence of it being carried along the courses of the imaginary acupuncture meridians.

In addition to the use of needles acupoints can also be stimulated by Moxibustion, massage or Cupping. Moxibustion involved the use of burning sticks, or small cones comprising incense and finely ground herbs such as Mugwort or Wormwood which were placed directly on the acupoint, then ignited to allow the heat to stimulate the acupoint; in some instances these cones were allowed it to burn down to the skin to form a small blister. These were either used alone or in conjunction with the needles. Cupping involved the use of glass globes heated to expel air so that, when they were applied to the skin, the reduced air pressure caused them to adhere to the skin.

Although the actual origins of acupuncture are uncertain, it appears certain that it began as an early form of bloodletting, (phlebotomy), a form of "medical treatment" widely used in ancient times that was based upon the primitive belief that illness was caused by evil spirits invading the body, and that one could only be cured by forcibly removing them.

According to Seigworth (1980) the process probably developed from the Neolithic practice of trepanning, where stone tools were used to open the human skull to release evil spirits, (possibly from the insane who would have been thought to be "possessed"). By about 1,000 BCE, the Egyptians had begun to create deliberate wounds in specific parts of the body, in the belief the evil spirits that were causing sickness could "escape" from the diseased portion of the body. An alternative view by Glasscheib (1964), was that the act of bloodletting was actually a form of, "…rudimentary human sacrifice, an offering of human blood in place of the body" (p. 155), but whereas other cultures continued to release large amounts of blood, in China, the practice, "…was replaced by pin pricking and scalding which are still practiced today — in other words, acupuncture." (p. 155).

In China the earliest known tools for bloodletting were bian stones, samples of which have been found in Inner Mongolia dating from circa 3000 BCE. These sharpened, arrow-shaped stones, sometimes called "needle-stones" (Chinese Acupuncture and Moxibustion, 2008), were used to treat disease, (Wertz, 2008). The importance of this early practice is reflected in the ancient Chinese word for medicine; Omura (2003) described how the ancient Chinese word for medicine comprised three symbols,
[a] "alcohol in a bottle" 
[b]  "arrow kept in box" or "box to keep arrow" and
[c] to, "hold something, or weapon in hand".
He suggests that early in Chinese history, these items were probably important parts of the medical kit of early Chinese physicians, and that the arrow was possibly used for, "minor surgery or acupuncture" (p. 22).

Later, the Chinese word for acupuncture,  zhēn or chen evolved; this comprised two characters, chin — meaning "two pieces of metal in soil" and wu meaning a "wound"  thus the name means literally, "to bite, or wound, with metal" (Omura, 2003, p. 22).

Eventually, according to Manaka and Urquhart (1973), these stones were replaced by needles made of bamboo, fish-bones (p. 95) and even animal bones (Lu and Needham, 1980a, p. 863), then, in the Shang Dynasty, (1600 – 1046 BCE), the development of bronze casting techniques enabled the first metal needles to be produced. These were not the fine diameter needles that are used today (0.18mm to 0.51 mm), but, as Omura (2003) noted, they were between 1 – 2 millimeters in diameter, (p. 36) and would have caused considerable pain, and produced a reasonable amount of bleeding, when inserted into the skin; however it appears this was the principal intention for, as Epler (1980) noted, practitioners were directed to insert the needles, "… so that blood flows out." (p. 350).

The potential of Acupuncture as a form of therapy needs to be examined from two separate aspects: -


There remains considerable disagreement as to whether or not acupuncture is a valid form of therapy in the treatment of actual physical diseases. No research could be found dealing with the use of acupuncture in the treatment of diseases per se. This possibly reflects the fact that traditionally diseases were believed to be due to the interference with the flow of Qi, causing an imbalance, or disharmony in the body. As such, the general philosophy was to use acupuncture as a secondary form of therapy, in the belief that, by stimulating and strengthening the flow of Qi, the natural healing ability of the body would be maximized, and so be able to deal with the actual diseases.

The principal areas of effectiveness for acupuncture appear to be those disorders that have a degree of psychosomatic input. Numerous studies suggest that acupuncture can produce positive physical responses in a range of disorders such as post-operative nausea, Lee and Done (2004); migraines, Linde et al. (2005); neck pain, Trinh et al. (2007); and chronic lower back pain, Haake et al. (2007), unfortunately there are three major problems with these results: -


The NCAHF Task Force on Acupuncture found that, in general, there were numerous methodological problems with many of the studies into the effectiveness of acupuncture. Two common problems that emerged from those studies which indicated positive results for acupuncture was that,


In a meta-analysis of ninety-one separate studies on the use of Acupuncture for pain control, ter Riet, Kleijnen, and Knipschild (1990) concluded the studies were generally of poor quality and that, the poorer their design, the more likely they were to "prove" that acupuncture was an effective treatment. By contrast, better designed studies, with much stricter controls, revealed no evidence that acupuncture was an effective form of treatment. As a result, the efficacy of acupuncture in the treatment of chronic pain remains somewhat dubious.

A major problem with any research, and certainly one that is not unique to acupuncture studies, is that all too often researchers begin with a definite bias, and so, with a preconceived agenda, when the results do not fully support their thesis, they tend to "manipulate" the results. While not deliberately lying, they will often "bury" negative results in the text and then ignore them in the final analysis. An example of this is found in Smith, Crowther and Beilby, (2002) who reported on a study comparing the effectiveness of
to treat nausea dry retching and vomiting in early pregnancy.

In discussing the findings the report emphasized that, "Traditional acupuncture was shown to be an effective treatment for … nausea and dry retching in early pregnancy" yet it failed to mention that while 23% of those using traditional acupuncture were free from nausea, the results were even better for those using sham acupuncture, (25%). Similarly, no mention was made in the final analysis that a larger percentage of the sham acupuncture group were free from dry retching, (59%), compared to those receiving traditional acupuncture, (56%). While these findings clearly indicate that there is some common factor occurring with both acupuncture and sham acupuncture, these facts were apparently ignored in favour of evidence that "acupuncture works."

In trials by Linde et al. (2005) on the effectiveness of acupuncture on migraines, two groups of subjects were given either traditional acupuncture or sham acupuncture, while a third group were placed on a "waiting list". Results indicated that both those receiving the traditional and sham acupuncture were able to reduce the period in which they experienced migraines by 2.7 days.

Time after time, in comparisons between the use of traditional acupuncture and sham acupuncture, the results indicated little, or no actual difference, between the two forms of treatment. Richardson and Vincent (1986a and b) analyzed 28 studies of the effectiveness of the use of traditional and sham acupuncture in the relief of pain; of these fifteen studies showed no difference between the two, while of the thirteen that indicated acupuncture was more effective, the differences were too minor to be significant. Most studies that have compared traditional and sham acupuncture have produced similar results, indicating that acupuncture is no more effective than the sham treatment, (Lee, Andersen, et al., 1975; Moor and McQuay, 2005).

Such results suggest that, rather than being purely a physiological effect, there is also an important psychological component in the acupuncture process. Significantly, many of the attributes of traditional acupuncture, in particular, the reduced perception of pain that is frequently presented as evidence of the efficacy of acupuncture, are surprisingly familiar to those found in the use of hypnosis.

In all forms of hypnosis, it is always ultimately the subject who initiates the various actions, however, their willingness to do so is to a great degree subject to their level of suggestibility, and that in turn is influenced by their own unique beliefs and expectations of the outcome of what is suggested to them. In addition the degree to which a subject can be hypnotized also has a profound effect upon their degree of suggestibility because, the deeper they go into hypnosis, the less able they are to be logical and analytical about what is being suggested to them; this particularly applies to their ability to control pain. As Hilgard (1974) noted, the ability of subjects to control sensations of pain was clearly related to the subject's level of hypnotizability, [p. 122]. Similarly, with respect to pain-control, it appears there is a positive relationship between suggestibility and the patient's response to acupuncture.

This relationship between hypnosis and acupuncture has long been noted; Katz, Kao, Spiegel, and Katz (1974) found that subjects with the highest levels of hypnotizability responded best to acupuncture, and that generally, subject with low hypnotizability levels had little or no pain relief. This correlates with the conclusions of Mendelson (1977) that, "…there was a tendency for patients who showed little or no hypnotic suggestibility to fail to achieve the highest level of relief from pain. (p. 646) which is exactly what one would expect if the basis of the acupuncture phenomena is a form of suggestion.

There is additional evidence to support this proposal. When used as a form of anesthesia for major operations, both hypnosis and acupuncture appear to be only effective on a small number of patients. In various Chinese hospitals the number who volunteered for operations using acupuncture ranged from 7% to 30%, and of these the acupuncture was only, "… successful in about 90 per cent of these cases." (DeBakey, 1973, p. 166)

The exact nature of pain, and how it can be its alleviated, is a complex issue, and the actual pain relief factors involved in the use of either hypnosis or acupuncture, remains conjectural. Nevertheless it has been demonstrated that hypnosis can act as a powerful form of anesthesia and it was widely used in this role before the discovery of chemical anesthetics.

One example of the use of hypnosis, (Mesmerism) was that of British surgeon, Dr. James Esdaile, (1808 – 1859) who, as an employee of the East-India Company used a mesmeric technique to perform, "…thousands of painless minor operations and about 300 capital ones." (Bramwell 1906, p. 16). These operations, performed on the native employees of the East-India Company, included the removal of 200 scrotal tumours ranging from 4.5 to 47 kilograms, amputations of an arm and a breast, the amputations of two penises, and the removal of three cataracts, (Edmonston, 1981, p. 110).

The technique he used, mesmeric passes, is a basic form of hypnosis. Unbeknown to Esdaile, it was similar to a traditional Indian technique known as jar-phoonk; for this reason was readily accepted by the Indian coolies. The ready acceptance of a particular form of traditional healing within a particular cultural setting possibly explains why it is that acupuncture appears to be much more effective when used by indigenous Chinese, compared to its effectiveness on other cultural groups.

Of course there are many other factors that contribute to the effectiveness of acupuncture in China; possibly the most important aspect is the enormous political pressure, both blatant and subtle, that is a major part of acupuncture treatment in China, and helps to explain why it is that while acupuncture is widely used in China for major surgical procedures, it is rarely used for this purpose in the West.

Skrabanek (1984) detailed how, in 1972 Chinese acupuncture patients were first subjected to several days of intense indoctrination by the therapist, usually a politically dedicated young woman, who encouraged them to adopt a positive attitude towards the treatment and, "…the works and thoughts of Chairman Mao."   (p. 1169). Other significant variables listed by Kroger (1977) that influence the use of acupuncture are, rehearsals of the procedure, "...the ideological fervour … patriotic adherence to Maoist doctrine; and … the characteristic stoicism of the Chinese. " (p. 224). Given that most Chinese patients would likely have been exposed to a lifetime of belief in the efficacy of acupuncture, and have been indoctrinated to accept it as an important part of the revolutionary medical system, one can perceive that the patients would be most amenable to suggestion, and so prepared to undergo even major operations. However, even then, not is all as it seems.

Skrabanek (1984) reported that during surgical operations the patients not only received acupuncture, but the patient also received, "…premedication, local anaesthesia with procaine, and an intravenous drip with pethidine and other drugs," (p. 1169). Similarly,  as DeBakey (1973) reported in an open-heart operation he observed in Shanghai, the patient was extremely drowsy, having been given Phenobarbital and morphine, which combined to produce a deep state of relaxation, "…and put him in a suggestive state." (p. 162)
 
DeBakey (1973) also made it quite clear that not everyone was suited to use acupuncture; actual numbers varied between hospitals, with only  from 7% to 30% of patients being considered suitable for acupuncture anesthesia, and, of these the acupuncture treatment was only, "…successful in about  90 per cent of these cases." (p. 166)

Several theories have been proposed to explain the fact that both hypnosis and  acupuncture do have a positive effect on alleviating pain: -


Claims, such as that by Lu and Needham (1980a) that there must be something in the process because acupuncture has, "…been the sheet-anchor of so many millions of sick people for so many centuries…" (861), are not necessarily valid. There are numerous examples of pseudo-sciences, such as astrology, which, as Skrabanek (1984) noted, have also been popular belief systems for thousands of years (p. 1170), yet which have no scientific validity. While acupuncture practitioners strive to present the practice as having a legitimate scientific basis, closer examination reveals that the practice is little more than a collection of pre-scientific religious and philosophical concepts, masquerading as a form of medical treatment. Acupuncture is based upon primitive metaphysical concepts that have absolutely no relationship to legitimate medicine; some examples of the core-beliefs of acupuncture are: -


As Epler (1980) observed, although the present form of acupuncture is, "…the result of a long development and bears little resemblance to its ancestral version."  (p. 337), nevertheless it retains its ancient pseudo-scientific concepts, and, as such has absolutely no relationship to scientific medicine.
  


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