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Development of acupuncture in ancient China

2100 B.C. to 476 B.C.

From the twenty-first century B.C. when China entered the slave society to 476 B.C. Chinese history went through the Xia, Shang and Western Zhou Dynasties and the Spring and Autumn period. Three thousand years ago in the Shang Dynasty the hieroglyphs of acupuncture and moxibustion appeared in the inscriptions on bones and tortoise shells. Because of the development of bronze casting techniques there appeared bronze medical needles. But bian stone was still used as the main tool for treating diseases. During this period the philosophical thinking of yin-yang and five Elements was formed, and in the field of medicine the ancient physicians had a preliminary understanding of pulse, blood, body fluid, qi, shen (manifestations of vitality), essence, five sounds, five colours, five flavours, six qi, eight winds, etc., as well as the ideology of relevant adaptation of the human body to natural environment. Thus germinated the sprout of the basic theory of traditional Chinese midicine.

475 B.C. to 24 A.D.

From the Warring States Period (475 B.C.-221 B.C.) to the Qin Dynasty (221 B.C.-207 B.C.) and to the Western Han Dynasty (206 B.C.- 24 A.D.), it was the establishing and strengthening stage of the feudal system in China. With the introduction and application of iron instruments, bian stone needles were replaced by metal medical nedles. This broadened the field of acupuncture practice, bringing about a development of acupuncture by leaps and bounds. As recorded in the book Miraculous Pivot, there were nine kinds of metallic needles at that time with different shapes and usage. They are named as nine needles including the needles for puncturing, surgical incision and massage. In 1968, in Mancheng County, Hebei province, an ancient tomb of the Western Han Dynasty buried in 113 B.C. was excavated. Among the relics, there were four golden needles and five decaying silver ones. These discoveries demonstrate the original shapes of the ancient needles. The doctors of this period treated diseases with multiple techniques. For example, the famous doctor Qin Yueren (or Bian Que) who lived in about the fifth to fourth century B.C.. had a good command of medical knowledge in various clinical branches. He treated patients by needling, moxibustion, herbal decoction, massage and hot compression. He rescued a critically ill prince by acupuncture, and this story went down in history. Another famous doctor Chunyu Yi of the second century B.C. was good at acupuncture- moxibustion and herbal treatment. There is an account of his case reports of twenty-five patients in the book Historical Records, in which four cases were treated with acupuncture and moxibustion. In the period of Warring States, ancient doctors began to generalize and summarize medicine and pharmacology, and writings on acupuncture and moxibustion apprared. Two silk scrolls recording meridians and collaterals written in the third century B.C., were discovered in the excavation of the No.3 Han Tomb at Mawangdui in Hunan Province, which reflected the earliest outlook of the theory of meridians and colaterals. The book Huangdi Internal Classic passed onto now is a medical classic concerning the theory of traditional Chinese medicine, with its authorship ascribed to the ancient Emperor Huangdi. It includes two parts: Miraculous Pivot, in anorher name Huangdi's Canon of Acupuncture, and Plain Questions. On the basis of previous literature it takes the theories of yin-yang, five elements, zang-fu, meridians and collaterals, mentality and spirit, qi and blood, body fluid, five emotions and six exogeneous pathogenic factors as the basic knowledge of traditional Chinese medicine, and acupuncture and moxibustion as the main therapeutic technique. It explained the physiology and pathology of the human body, the principles of diagnosis, the prevention and treatment of diseases from the perspective of atheism, holistic conception, the viewpoint of development and change, and the relationship between the human body and the natural environment. This laid a theoretical foundation of traditional Chinese medicine and pharmacology, including acupuncture and moxibustion. During this period also appeared the books Huangdi Canon of Eighty-One Difficult Problems and Essentials of Points, Acupuncture and Moxibustion, both related to the fundamental theories of acupuncture and moxibustion. Unfortunately the latter book has been lost.

25 to 265

From the Eastern Han Dynasty (25-220) to the Three Kingdoms period (220-265), another gereralization and smmarization of traditional Chinese medicine and pharmacology was made. Many famous doctors paid great attention to the study of acupuncture and moxibustion. For example, Hua Tuo who was the pioneer to apply herbal anesthesia for surgical operations only selected one to two points in acupuncture treatment and took much notice to the propagation of needling sensation. He was ascribed the authorship of Canon of Moxibustion and Acupuncture Preserved in Pillow (again, lost). The outstanding medical doctor Zhang Zhongjing also mentioned the methods of acupuncture, moxibustion, fire neeedling, warm needling, in his book Treatise on Febrile and Miscellaneous Diseases. He stressed very much on combining acupuncture with medicinal herbs as well as applying the treatment according to the differentiation of symptom complex. During this period the basic theories of acupuncture and moxibustion had already been formed. But the locations and names of acupuncture points were neither unified nor systemized. A bamboo scroll of medicine of the Eastern Han Dynasty which was excavated from Wuwei County in Gansu Province, mistook Zusanli to be located "five cun below the knee." Hua Tuo located Back-Shu points as "one cun bilaterally along the spine," defferent from other books both in locations and names. Because the earliest acupuncture books contained mistakes, were different in naming the points, and had missing information, the famous medical doctor Huanfu Mi compiled the book Systematic Classic of Acupuncture and Moxibustion in 256-260 by collecting information of acupuncture and moxibustion from the ancient books Plain Questions, Canon of Acupuncture and Essentials of Points, Acupuncture and Moxibustion. The book consists of 12 volumes with 128 chapters, including 349 acupuncture points. He edited and arranged the contents according to the following order: the theories of Zangfu, Qi and Blood, channels and collaterals, acupuncture points, the pulse diagnosis, manipulating techniques of acupuncture and moxibustion, and their clinical application in various branches of medicine. It is the earliest exclusive and systemized book on acupuncture and moxibustion which has been one of the most influential works in the history of acupuncture and moxibustion.

265 to 581

During the Jin Dynasty and the Northern and Southern Dynases (265- 581) the chaos was upheaved by wars. The physicians advocated acupuncture and moxibustion therapy very much because of its convenient use in times of turmoil, and the masses of Chinese people also knew something about moxibustion therapy. The famous doctor Ge Hong wrote the book Prescriptions for Emergencies to popularize medical knowledge, especially the therapeutic methods of acupuncture and moxibustion. From the Jin Dynasty to the Northern and Southern Dynasties, Xu Xi's family were expert in the art of healing for several generations, insluding Xu Qiufu, Xu Wenbo and Xu Shuxiang, all well known in the history of acupuncture and moxibustion. In this period there appeared more and more monographs on acupuncture and moxibustion, and charts of acupuncture points, such as Acupuncture Chart from Lateral and Posterior View and Diagrams of Meridiand and Points.

581 to 907

During the Sui (581-618) and Tang dynasties (618- 907), China was undergoing the process of economical and cultural prosperity of the feudal society. The science of acupuncture and moxibustion also had great development. The famous physician Zhen Quan and his contemporary Sun Simiao both had good command of the knowledge of traditional Chinese medicine and studied acupuncture and moxibustion thoroughly. The Tang government, in the years around 627-649, ordered Zhen Quan and the others to revise the books and charts of acupuncture and moxibustion. Sun Simiao compiled Prescriptions Worth a Thousand Gold for Emergencies (650-652), and A Supplement to the Presciptions Worth a Thousand Gold (680-682), in which a great deal of clinical experiences in acupuncture treatment of various schools were included. He also designed and made Charts of Three Views, in which "the twelve regular meridians and the eight extra meridians were illustrated in various colours, and there were altogether 650 points. "They are the earliest multi-coloured charts of meridians and points, but have been lost. In addition, Yang Shangshan of the Tang Dynasty compiled Acupuncture Points in Internal Classic, which revised the relevant contents of Internal Classic. Wang Tao wrote the book The Medical Secrets of An Official, in which a host of moxibustion methods of various schools were recorded. During this period there appeared monographs on the treament of special diseases, for example, the book Moxibustion Method for Consumptive Diseases written by Cui Zhidi, in which moxibustion treatment of tuberculosis was described. It has been found that the earliest block-printed edition of acupuncture and moxibustion is A New Collection of Moxibustion Therapy for Emergency, which appeared in the year of 862, specially describing the moxibustion therapy for emergencies. In the seventh century, acupuncture and moxibustion had already become a special branch of medicine, and those specialized in this field were entitled acupuncturists and moxibustionists. During the Tang Dynasty, the Imperial Medical Bureau responsible for medical education, was divided into four departments of medical specialities and one department of pharmacology. And the department of acupuncture was also one of them, in which there were one professor of acupuncture, one assistant professor, 10 instructors, 20 technicians and 20 students. The acupuncture professor was in charge of teaching the students the meridian-collaterals and acupuncture points, pulse diagnosis, and manipulating methods of needling.

907 to 1368

In the five Dynasties (907-960), Liao Dynasty (916-1125), Song Dynasty (960- 179), Jin Dynasty (1115- 1234) and Yuan Dynasty (1206-1368), the extensive application of printing technique greatly promoted the accumulation of medical literature and speeded up the dissemination and development of Chinese medicine and pharmacology. Supported by the Northern Song goverment, the famous acupuncturist Wang Weiyi revised the locations of the acupuncture points and their related meridians, and made a supplement to the indications of acupuncture points. In 1026, he wrote the book Illustrated Manual on the Points for Acupuncture and Moxibustion on a New Bronze Figure, which was block printed and published by the government. In 1027, two bronze figures designed by Wang Weiyi were manufacured, with the internal organs set inside and the meridians and points engraved on the surface for visual teaching and examination. These achievement and measures promoted the unification of the theoretical knowledge of acupuncture points and meridians. The famous acupuncturist Wang Zhizhong of the Southern Song Dynasty wrote the book Canon on the Origin of Acupuncture and Moxibustion, in which he stressed on practical experiences including folk experiences, exerting a great influence on later generations. The famous doctor Hua Shou of the Yuan Dynasty did textual research on the pathways of meridians and collaterals as well as their relationship with acupuncture points. In 1341 he wrote the book Exposition of the Fourteen Meridians, which further developed the theory of meridians and acupuncture points. In this period there were plenty of famous doctors who were good at acupuncture and moxibustion. Some of them emphased on the theory and technique of a particular aspect. So different branches of acupuncture and moxibustion were formed. For example, the publication of Canon of Acupuncture and Moxibustion for Children's Diseases (lost), Moxibustion Methods for Emergencies, The Secret of Moxibustion for Abscess and Ulcer and so on, showed the development of acupuncture and moxibustion into various areas of the clinic. Xi Hong of the early Southern Song Dynasty who was from a famous acupuncturist family, particularly stressed the manipulating technique of acupuncture. And his contemporary Dou Cai wrote a book entitled Bian Que's Medical Experiences, in which he highly praised the scorching moxibustion, and even gave a general anesthesia to avoid pain while applying scorching moxibustion. At the same time, Yang Jie and Zhang Ji observed autopsies, and advocated selecting acupuncture points in the light of anatomical knowledge. He Ruoun and Dou Hanqin of the Jin and Yuan dynasties suggested that the acupuncture points should be selected according to ziwuliuzhu (Chinese two-hour time on the basis of Heavenly Stems and Earthly Branches).

1368 to 1644

In the Ming Dynasty (1368-1644) acupuncture and moxibustion were worked up to a climax that many problems were studied deeper and broader. There were more famous doctors specialized in this field. Chen Hui of the early stage of Ming Dynasty, Ling Yun of the middle stage, and Yang Jizhou of the later stage, all known far and wide in China, exerted a tremendous influence upon the development of acupuncture and moxibustion. The main accomplishments in the Ming Dynasty were:

  1. extensive collection and revision of the literature of acupuncture and moxibustion, e.g. the chapter of acupuncture and moxibustion in the book Prescriptions for Universal Relief (1406), A Complete Collection of Acupuncture and Moxibustion by Xu Feng in the fifteenth century, An Exemplary Collection of Acupuncture and Moxibustion by Gao Wu in 1529, Compendium of Acupuncture and Moxibustion in 1601 based on Yang Jizhou's work, Six Volumes on Acupuncture Prescriptions by Wu Kun in 1618, and An Illustrated Supplement to Systematic Complilation of the Internal Classic by Zhang Jiebin in 1624, etc. All these works were the summarization of the literature of acupuncture and moxibustion through the ages.
  2. studies on the manipulating methods of acupuncture. On the basis of single manipulation of acupuncture, more than twenty kinds of compound manipulation were developed and an academical contention was carried out about different manipulation methods, Questions and Answers concerning Acupuncture and Moxibustion by Wang Ji in 1530 was the representative work of that academical dispute.
  3. development of warm moxibustion with moxa stick from burning moxibustion with moxa stick from burning moxibustion with moxa cone.
  4. Sorting out the previous records of acupuncture sites located away from the Fourteen Meridians and formation of a new category of extra points.

1644 to 1840

From the establishment of the Qing Dynasty to the Opium War (1644-1840), the medical doctors regarded herbal medication as superior to acupuncture, therefore acupuncture and moxibustion gradually turned to a failure. In the eighteenth century Wu Qian and his collaborators compiled the book Golden Mirror of Medicine by the imperial order. In this book the chapter "Essentials of Acupuncture and Moxibution in Verse" took the practical form of rhymed verse with illustrations. Li Xuechuan compiled The Source of Acupuncture and Moxibustion (1817), in which selection of acupuncture points according to the differentiation of syndromes was emphasized, acupuncture and herbal medication were equally stressed, and the 361 points on the Fourteen Meridians were systematically listed. Besides these books, there were many publications, but none of them were influential. In 1822 the authorities of the Qing Dynasty declared an order to abolish permanently the acupuncyure-moxibstion department from the Imerial Medical College because "acupuncture and moxibustion are not suitable to be applied to the Emperpor".

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