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Development of Acupuncture and Moxibustion in China

In China, acupuncture and moxibustion have been used as routine clinical procedures for thousands of years. Acupuncture involves using fine needles to pierce specific body areas, while moxibustion is the burning of moxa (the leaf of the Chinese wormwood tree) to provide a warming effect. Acupuncture and moxibustion are considered complimentary forms of treatment and are commonly used together. They have been widely adopted by the general public for its wide range of applications, good results and convenience of use.

Ancient tools for acupuncuture and moxibustion

A primitive form of acupuncture and moxibustion can be traced back as far as the Chinese Stone Age (4,0,00-10,000 years ago). While using hot stones to warm themselves, ancient people realized that pressing them against certain parts of the body could help alleviate certain sicknesses. They also found that by using bone needles and pricking themselves in a particular spot could relieve pain in other areas of the body. This knowledge helped them to establish the theory of the meridian system and also create medical instruments for healing. Because of the early medical tools were usually made of stone, people named these bian stones which were not just for pressing or pricking, but for incising abscess, drainage pus and blood letting. Later, with the invention of metal-casting techniques, the crude stone instruments gradually gave way to bronze, iron, gold and silver, and finally to today's stainless steel needles.

According to records, acupuncture and moxibustion were important and formed a large part of the entire medical system during the Warring States Period (476-221 BC). Information about the concept of the meridian system and needling therapy were clearly mentioned in Huangdi Neijing (The Yellow Emperor's Medicine Classic), the earliest concise medical writing about traditiona Chinese medicine. In the second part of the book, the Lingshu (The Vital Axis), has a whole section dedicated to the use of acupuncture and moxibustion. The Lingshu (The Vital Axis) is regarded as "Canon of Acupuncture," it laid the foundation in later development.

In the Qin and Han dynasties (221 - 207 BC), the theory of acupuncture further expanded. Under the influence of Taoist philosophies such as yin yang and the five elements, the concepts of meridian flow pattern, the extra eight meridians, special therapeutic points, needling techniques and clinical indications of acupuncutre developed. The famous surgeon Hua Tuo, who also was an expert in acupuncture, created a set of acupuncture techniques by using special acupoints located along the sides of backbone. He also emphasized the importance of obtaining needling sensations during acupuncture treatment. Another moxibustion specialist, Cao Xi, finished a monograph Caoshi Jiujing (Moxibustion Classic by Cao), in which he gathered the clinical experiences of moxibustion before the time. Cao's work contributed greatly for the spread of moxibustion in the coming period.

During the Chinese Middle Ages (ad 200-581), many famous physicians used acupuncture and moxibustion when treating their patients. They also gathered their experiences in books which greatly accelerated the use of these methods. Huangfu Mi wrote Zhenjiu Jiayijing (The ABC of Acupuncture and Moxibustion), which is considered to be the bible of acupuncture and moxibustion. The book outlines 349 acupoints, how they are distributed on each meridian, the exact locations, indications and methods of manipulation. The book is considered the earliest guide exclusively devoted to acupuncture and moxibustion. Ge Hong, a famous alchemist and physician, recorded 99 moxibustion remedies in his book Zhouhou Beijifang (Emergency Prescriptions). He and his wife were respected as the moxibustion specicalists at that time.

Acupuncture chart

During the Sui and Tang dynasties (ad 581-907), China was at its economic and cultural peak; both acupuncture and moxibustion were set to blossom fully. Acupuncture became a medical specialty, and the Imperial Medical Academy of the Tang dynasty started to appoint specialists for daily treatment and teaching duties. The acupuncture department was organized by medical officers accorded different titles, including one professor, one assistant professor, ten instructors, twenty technicians and twenty students. Sun Simiao (AD 581-682), one of the most influential physicians in the history of Chinese medicine, recorded many clinical experiences in acupuncture treatment of various schools in two of his important works. He also introduced the concept of a-shi points for the first time and designed three color hanging charts of acupuncture and moxibustion - the Charts of Three Views. The charts illustrated the twelve regular meridians, the eight extra-meridians, altogether listing 650 acupoints. They are considered the earliest color pictures of meridians and acupoints. In addition, he introduced the measuring methods that use the length of the patient's own finger knuckles to locate the acupoints accurately, and advocated moxibustion for prevention and health promotion. Later in ad 752, Wang Tao wrote an important reference book for moxibustion, Waitai Miyao (Essential Secrets from the Imperial Library), in which recorded a host of moxibustion applications of various schools.

Bronze statue for acupuncture teaching

In the Song dynasty (ad 960-1279), the government appointed a famous acupuncturist Wang Weiyi (ad 987-1067) to revise the acupuncture classics for teaching, including the locations of acupoints, related meridians and also making supplement to the indications of acupoints. Wang Weiyi compiled a book called Tongren Shuxue Zhen Jiu Tujing (Illustrated Manual of the Bronze Man Showing Acupuncture and Moxibustion Points). He also designed two life-size male bronze statues. The bronze statues were considered exquisite teaching models at that time and an advance in medical education. These statues had 657 acupoints drilled into them which were filled with water and covered with wax, when a student needled the acupoint correctly, water would leak out. With the help of the models, meridian theory became more popular and it was rapidly incorporated into the practice of herbal medicine. Another pioneer acupuncturist Wang Zhizhong, finished a book Zhenjiu Zishengjing (Nourishing Life with Acupuncture and Moxibustion). The publication is a record of his personal experiences, especially focusing on choosing acupoints based on syndrome differentiation. In his book, he also promoted moxibustion and tender points for diagnosis and clinical applications. With the invention of printing, there appeared publishing boom of acupuncture and moxibustion texts in the Song dynasty.

In the Jin-Yuan Period (ad 1115 - 1368), acupuncture and moxibustion were used more extensively, and various acupuncture points and their corresponding therapeutic virtues were validated further. Hua Shou did textual research on the pathways of the meridians as well as their relationship with the acupoints, which further expanded the theory of the meridians. He finished a book Shisijing Fahui (Exposition of the Fourteen Meridians), in which two extra meridians, the Governor Vessel (du mai) and Conception Vessel (ren mai), are put together with the twelve regular meridians. The fourteen meridians then became the standard major meridians in some schools of clinical application. Other famous acupuncturists like He Ruoyu and Dou Hanqing suggested that acupoints should be selected according to the midnight-noon ebb-flow or Chinese two-hour time chart. They studied the relationship between selection and compatible application of acu-points and the time. During the period, the evolution in schools of thought contributed to different acupuncture approaches. It was not only the Chinese who made discoveries and developed new theories regarding acupuncture and moxibustion, as the Mongols also contributed to rich the medical knowledge. Therapeutic methods like Mongolian moxibustion and blood-letting were very popular at that time.

Body points illustration in Zhengjiu Dacheng

In the Ming dynasty (ad1368 - 1644), acupuncture and moxibustion continued to be widely used and refined. Many scholars specializing in this field emerged with the publication of extensive acupuncture monographs which further expanded the treatment approaches of acupuncture. In 1443, the government ordered to recast the bronze statue marked with the acupoints after the one produced in the Song dynasty. Yang Jizhou (1522-1620) published the most significant text of the period on acupuncture, Zhengjiu Dacheng (The Great Success of Acupuncture and Moxibustion). The book describes the meridians, acupoints, needling techniques and their indications. It also discussed the use of the therapies with herbal medicines, and detailed successful and failed clinical cases of his acupuncutre and moxibustion treatments. The book gathered important information from previous texts and enjoyed much popularity within the medical community. It was regularly reprinted in subsequent centuries.

In the late Qing dynasty (ad 1644 - 1911), China went through a major breakdown in social, political and economic systems; Westernization had a significant impact on the practice of TCM. Some physicians viewed herbal medication as being far superior to acupuncture and moxibustion, so these modalities gradually lost their roles in the mainstream. In 1822, the Qing government ordered to permanently abolish the department of acupuncture and moxibustion from the Imperial Medical Academy with a declaration that "acupuncture and moxibustion are not suitable to be applied to the emperor." However, acupuncture and moxibustion still was widely used among the general public.

After the People's Republic of China was founded in 1949, preservation of traditional medicine became a priority. Medical schools and hospitals re-established acupuncture and moxibustion departments; they trained many specialists and carried out modern studies to help explore the field. These promoted further improvement in clinical approaches and efficacy, and also facilitated the addition of more acupoints. With the help of modern technology, other techniques such as auricular stimulation, electro-acupuncture, acupoint injection, scalp acupuncture and special padding methods have brought even greater effectiveness to this treatment method. One of the modern significant developments in acupuncture is its use as an anesthetic during surgery.