How Old is Acupuncture?
Although westerners often think of this traditional Chinese treatment modality as a "new" form of alternative medicine, acupuncture is so ancient in China that its origins are unclear. According to Huangfu Mi (c. 215-282 AD), author of The Systematic Classic of Acupuncture and Moxibustion, needling therapy was first used during China's Bronze Age, over five thousand years ago. He attributes its invention to either Fu Xi or Huang Di (the Yellow Emperor), two legendary figures of the Five Emperors Period (c. 3000-2070 BC). Modern scholars generally believe that acupuncture is much older, originating more than ten thousand years ago during China's Neolithic Age (c. 8000-3500 BC).
In actuality, acupuncture may not be as ancient as has generally been assumed. A reconsideration of all extant documents and recent archaeological finds indicates that acupuncture may date back a mere 2100 to 2300 years, first appearing during China's Warring States Period (475-221 BC) and rapidly maturing during the Western Han Dynasty (206 BC-24 AD).
Questioning the generally accepted origins theory.
The currently accepted theory concerning the Neolithic origins of acupuncture is based on two premises. The first holds that bian shi, specialized sharp-edged stone tools that appeared during China's Neolithic Age, were used for an early form of needling therapy, prior to the invention of metal smelting. It is known that bian shi stone tools were utilized for a number of early medical procedures, starting during the Neolithic Age and continuing through the Western Han Dynasty (206 BC-24 AD). A number of descriptions of bian shi stone therapy appear in one of China's earliest medical works, The Yellow Emperor's Inner Classic of Medicine (Huang Di Neijing, hereafter referred to as the Neijing) (c. 104-32 BC). It has been thought that these Neolithic stone medical instruments were precursors of the metal acupuncture needles that came into use during China's Iron Age.
However, historical documents and new archaeological evidence clearly indicate that bian shi stone tools were flat and knife-like in form, used primarily to incise abscesses to discharge pus, or to draw blood (1). They were applied as surgical scalpels to cut, rather than as needles to puncture, and had nothing to do with needling therapy. According to the Code of Hammurabi, the ancient inhabitants of Mesopotamia used similarly shaped bronze knives to incise abscesses over 4000 years ago.
Prehistoric Chinese people possessed needles made of various materials, ranging from crude thorns and quills to bone, bamboo, pottery, and stone. But just as the history of the knife is not the history of surgery, so the invention of needles and that of acupuncture are two entirely different things. Needles have historically been among the most commonly used tools of daily life for constructing garments all over the world. Medically, needles are used to suture incisions just as making up clothes with darners, hollow syringe needles (as differentiated from a solid needle used in acupuncture) are applied to inject fluids into the body or draw them from it, but pricking a solid needle into the body to treat illness seems very strange and enigmatical. In English, "to give somebody the needle" means to displease or irritate someone. Most people prefer not to be punctured with needles, and associate needling with pain and injury. Many plants and animals have evolved thorns or quills as powerful weapons for protection or attack. Needles were even used for punishment in ancient China. By trial and error, healers throughout the world have found treatments for pain and other diseases independently, for instances, herbs, roots, wraps, rubs, blood-letting and surgery, but acupuncture alone is unique to Chinese. Considering the unique Chinese origin of acupuncture, it is reasonable to assume that the invention of acupuncture was not related to the availability of either sewing needles or bian shi stone scalpels during China's Neolithic Age.
The second premise supporting the theory of the Neolithic origins of acupuncture holds that acupuncture evolved as a natural outgrowth of daily life in prehistoric times. It is thought that through a process of fortuitous accident and repeated empirical experience, it was discovered that needling various points on the body could effectively treat various conditions. However, this assumption is lacking in both basic historical evidence and a logical foundation.
It is known that ancient people were aware of situations in which physical problems were relieved following unrelated injury. Such a case was reported by Zhang Zihe (c. 1156-1228 AD), one of the four eminent physicians of the Jin and Yuan Dynasties (1115-1368 AD) and a specialist in blood-letting therapy: "Bachelor Zhao Zhongwen developed an acute eye problem during his participation in the imperial examination. His eyes became red and swollen, accompanied by blurred vision and severe pain. The pain was so unbearable that he contemplated death. One day, Zhao was in teahouse with a friend. Suddenly, a stovepipe fell and hit him on the forehead, causing a wound about 3-4 cun in length and letting copious amounts of dark purple blood. When the bleeding stopped, a miracle had occurred. Zhao's eyes stopped hurting; he could see the road and was able to go home by himself. The next day he could make out the ridge of his roof. Within several days, he was completely recovered. This case was cured with no intentional treatment but only accidental trauma (2)."
If acupuncture did, in fact, gradually develop as the result of such fortuitous accidents, China's four thousand years of recorded history should include numerous similar accounts concerning the discovery of the acupoints and their properties. But my extensive search of the immense Chinese medical canon and other literature has yielded only this single case. Actually, this story offers at most an example of blood-letting therapy, which differs in some essential regards from acupuncture. The point of blood-letting therapy is to remove a certain amount of blood. But when puncturing the body with solid needles, nothing is added to or subtracted from the body.
Blood-letting therapy is universal. Throughout recorded history, people around the world have had similar experiences with the beneficial results of accidental injury, and have developed healing methods based on the principle that injuring and inducing bleeding in one part of the body can relieve problems in another area. The ancient Greeks and Romans developed venesection and cupping based on the discovery that bleeding is beneficial in cases such as fever, headache, and disordered menstruation. Europeans during the Middle Ages used blood-letting as a panacea for the prevention and treatment of disease. Detailed directions were given concerning the most favorable days and hours for blood-letting, the correct veins to be tapped, the amount of blood to be taken, and the number of bleedings. Blood was usually taken by opening a vein with a lancet, but sometimes by blood-sucking leeches or with the use of cupping vessels. Blood-letting using leeches is still practiced in some areas of Europe and the Middle East. However, nowhere did these blood-letting methods develop into a detailed and comprehensive system comparable to that of acupuncture. If acupuncture did indeed arise from repeated empirical experience of accidental injury, it should have developed all over the world, rather than just in China.
Both historical evidence and logic indicate that there is no causal relation between the development of materials and techniques for making needles and the invention of acupuncture. It is also clear that repeated experience of fortuitous accidental injury was not a primary factor in the development of acupuncture. Therefore, the generally accepted theory concerning the Neolithic origins of acupuncture, based as it is upon such faulty premises, must be incorrect. It is now necessary to reconsider when acupuncture did, in fact, first appear and subsequently mature.
Reconsidering the evidence
If acupuncture did indeed originate during China's Neolithic Age, references to it should appear throughout China's earliest written records and archaeological relics. However, this is not the case.
Early cultures believed the world to be filled with the supernatural, and developed various methods of divination. During China's Shang Dynasty (c. 1500-1000 BC), divination was practiced by burning animal bones and tortoise shells with moxa or other materials. Oracular pronouncements were then inscribed on the bone or shell, based on the resulting crackles. These inscriptions have survived as the earliest examples of written Chinese characters. Among the hundreds of thousands of inscribed oracle bones and shells found to date, 323 contain predictions concerning over twenty different diseases and disorders. However, none of these inscriptions mention acupuncture, or any other form of treatment for that matter.
Rites of the Zhou Dynasty (Zhou Li), written during the Warring States Period (475-221 BC), records in detail the official rituals and regulations of the Zhou Dynasty (c. 1000-256 BC), including those concerning medicine. Royal doctors at that time were divided into four categories: dieticians, who were responsible for the rulers' food and drink; doctors of internal medicine, who treated diseases and disorders with grains and herbs; surgeons, or yang yi, who treated problems such as abscesses, open sores, wounds, and fractures using zhuyou (incantation), medication, and debridement (using stone or metal knives to scrape and remove pus and necrotic tissue); and veterinarians, who treated animals. But this document as well contains no references to acupuncture.
Neijing (c. 104-32 BC) is the first known work concerning acupuncture. The classic consists of two parts: Suwen - Simple Questions, and Lingshu - the Spiritual Pivot, also known as The Classic of Acupuncture (Zhen Jing). Both are concerned primarily with the theory and practice of acupuncture and moxibustion. Although authorship of the Neijing is attributed to Huang Di, the legendary Yellow Emperor (c. 2650 BC), most scholars consider that this master work, which contains excerpts from more than twenty pre-existing medical treatises, was actually compiled between 104 BC and 32 BC, during the latter part of the Western Han dynasty (206 BC-24 AD). The comprehensive and highly developed nature of the medical system presented in the Neijing has led scholars to believe that needling therapy has an extremely long history, probably reaching back to prehistoric times. The original versions of the ancient texts used in the compilation of the Neijing have been lost, and with them the opportunity to further illuminate the question of when acupuncture actually first appeared. However, startling new archaeological evidence, unearthed in China in the early 1970s and 1980s, reveals the true state of Chinese medicine prior to the Neijing, and challenges existing assumptions concerning the Neolithic origins of acupuncture.
In late 1973, fourteen medical documents, known as the Ancient Medical Relics of Mawangdui, were excavated from Grave No. 3 at Mawangdui, Changsha, Hunan Province. Ten of the documents were hand-copied on silk, and four were written on bamboo slips. The exact age of the Ancient Medical Relics of Mawangdui has not been determined. However, a wooden tablet found in the grave states that the deceased was the son of Prime Minister Li Chang of the state of Changsha, and that he was buried on February 24, 168 BC. The unsystematic and empirical nature of the material contained in the documents indicates that they were written well before their interment in 168 BC, probably around the middle of the Warring States Period (475-221 BC). In any event, it is certain that these medical documents pre-date the Neijing (compiled c. 104-32 BC), making them the oldest known medical documents in existence. These documents were probably lost sometime during the Eastern Han Dynasty (25-220 AD), since no mention of them has been found from this time until their rediscovery in 1973.
Another valuable medical find, The Book of the Meridians (Mai Shu), was excavated from two ancient tombs at Zhangjiashan in Jiangling County, Hubei Province in 1983. These ancient texts, written on bamboo slips and quite well preserved, were probably buried between 187 and 179 BC, around the same time as the Mawangdui relics. There are five documents in all, three of which (The Classic of Moxibustion with Eleven Yin-Yang Meridians, Methods of Pulse Examination and Bian Stone, and Indications of Death on the Yin-Yang Meridians) are identical to the texts found at Mawangdui.
There is abundant evidence to show that the authors of the Neijing used the earlier medical texts from Mawangdui and Zhangjiashan as primary references, further indicating the antiquity of these relics. For example, Chapter 10 of the Lingshu section of the Neijing contains a discussion of the meridians and their disorders that is very similar, in both form and content, to that found in the Classic of Moxibustion with Eleven Yin-Yang Meridians, one of the documents found at both Mawangdui and Zhangjiashan.
Of course, the Neijing did not simply reproduce these earlier documents, but rather refined and developed them, and introduced new therapeutic methods. The earlier Classic of Moxibustion with Eleven Yin-Yang Meridians is limited to moxibustion, while Chapter 10 of the Lingshu section of the Neijing mentions needling therapy, or acupuncture, for the first time. Although the medical texts preceding the Neijing discuss a wide variety of healing techniques, including herbal medicine, moxibustion, fomentation, medicinal bathing, bian stone therapy, massage, daoyin (physical exercises), xingqi (breathing exercises), zhuyou (incantation), and even surgery, these earlier documents contain no mention of acupuncture.
If needling therapy did indeed originate much earlier than the Neijing (c. 104-32 BC), the medical documents unearthed from Mawangdui and Zhangjiashan, very probably used as primary references by the Neijing's authors, should also contain extensive discussions of acupuncture. However, they do not. This clearly indicates that acupuncture was not yet in use at the time that the Mawangdui and Zhangjiashan documents were compiled. Of course, it is not possible to draw a detailed picture of the state of acupuncture early in the Western Han Dynasty (206 BC-24 AD) based solely on the medical relics from Mawangdui and Zhangjiashan. But the fact that these documents were considered valuable enough to be buried with the deceased indicates that they do reflect general medical practice at the time.
The Historical Records (Shi Ji) (c. 104-91 BC) by Sima Qian contains evidence that acupuncture was first used approximately one hundred years prior to the compilation of the Neijing (c. 104-32 BC). The Historical Records, China's first comprehensive history, consists of a series of biographies reaching from the time of the legendary Yellow Emperor (c. 2650 BC) to Emperor Wudi (156-87 BC) of the Western Han Dynasty. Among these are biographies of China's two earliest medical practitioners, Bian Que and Cang Gong. Bian Que's given name was Qin Yueren. It is known that he lived from 407-310 BC, during the late Warring States Period (475-221 BC), and was a contemporary of Hippocrates (c. 460-377 BC), the father of Western medicine. Bian Que's life was surrounded by an aura of mystery which makes it difficult to separate fact from legend. His name means Wayfaring Magpie - a bird which symbolizes good fortune. It is said that an old man gave Bian Que a number of esoteric medical texts and an herbal prescription, and then disappeared. Bian Que took the medicine according to the mysterious visitor's instructions. Thirty days later, he could see through walls. Thereafter, whenever he diagnosed disease, he could clearly see the internal organs of his patients' bodies. Like the centaur Chiron, son of Apollo, who is sometimes regarded as the god of surgery in the West, Bian Que is considered to be a supernatural figure, and the god of healing. A stone relief, unearthed from a tomb dating back to the Han Dynasty (206 BC-220 AD), depicts him with a human head on a bird's body (3). The Historical Records states that Bian Que successfully resuscitated the prince of the State of Guo using a combination of acupuncture, fomentation, and herbal medicine. Bian Que is thus considered to be the founder of acupuncture, and to have made the first recorded use of acupuncture during the Warring States Period (475-221 BC).
More solid evidence connects the birth of acupuncture with the famous ancient physician Chunyu Yi (c. 215-140 BC), popularly known as Cang Gong. Cang Gong's life and work are described in detail in the Historical Records. The Historical Records state that in 180 BC, Cang Gong's teacher gave him a number of precious medical texts that had escaped the book-burnings of the last days of the Great Qin Empire (221-207 BC). At that time, adherents of all opposing schools of thought were executed or exiled, and almost all books not conforming to the rigid Legalist doctrines that dominated the Qin Dynasty were burned. Although medical texts escaped the disaster, their owners still feared persecution. The banned books that Cang Gong received might have included a number whose titles appear in the Ancient Medical Relics of Mawangdui, such as the Classic of Moxibustion with Eleven Yin-Yang Meridians, Classic of Moxibustion with Eleven Foot-Arm Meridians, Method of Pulse Examination and Bian Stone, Therapeutic Methods for 52 Diseases, Miscellaneous Forbidden Methods, and The Book of Sex.
Cang Gong's biography in the Historical Records discusses twenty-five of his cases, dating from approximately 186 BC to 154 BC. These cases studies, the earliest in recorded Chinese history, give a clear picture of how disease was treated over 2100 years ago. Of the twenty-five cases, ten were diagnosed as incurable and the patients died as predicted. Of the fifteen that were cured, eleven were treated with herbal medicine, two with moxibustion in combination with herbal medicine, one with needling, and one with needling in combination with pouring cold water on the patient's head. It can be seen from this material that Cang Gong used herbal medicine as his primary treatment, and acupuncture and moxibustion only secondarily. His use of moxibustion adheres strictly to the doctrines recorded in the medial relics from Mawangdui and Zhangjiashan. Although only two of Cang Gong's moxibustion cases are recorded in the Historical Records, it is known that he was expert in its use, and that he wrote a book called Cang Gong's Moxibustion. Unfortunately, this book has been lost. In comparison with his wide-ranging utilization of herbal medicine and moxibustion, Cang Gong applied needling therapy very sparingly. Neither of Cang Gong's two recorded acupuncture cases mentions specific acupoints or how the needles were manipulated, indicating that needling therapy at the time was still in its initial stage.
Although acupuncture was not in common use during Cang Gong's day, his two recorded acupuncture patients were cured with only one treatment, indicating the efficacy of the nascent therapy. The rapid development of acupuncture was soon to follow. By the time the Neijing was compiled (c. 104-32 BC), approximately one hundred years after the time of Cang Gong, acupuncture had supplanted herbs and moxibustion as the treatment of choice. Only thirteen herbal prescriptions are recorded in the Neijing, compared with hundreds utilizing acupuncture.
Archaeological excavations of Western Han Dynasty (206 BC-24 AD) tombs have yielded a number of important medical relics related to acupuncture, in addition to the Neijing and Historical Records. In July of 1968, nine metal needles were excavated at Mancheng, Hebei Province from the tomb of Prince Liu Sheng (?-113 BC) of Zhongshan, elder brother of Emperor Wu Di (156-87 BC) of the Western Han Dynasty (206 BC-24 AD). Four of the needles are gold and quite well preserved, while five are silver and decayed to the extent that it was not possible to restore them completely. The number and shapes of the excavated needles indicate that they may have been an exhibit of the nine types of acupuncture needles described in the Neijing. This possibility is supported by the fact that a number of additional medical instruments were found in the tomb. These included a bronze yigong (practitioner's basin) used for decocting medicinal herbs or making pills, a bronze sieve used to filter herbal decoctions, and a silver utensil used to pour medicine (4). Although many prehistoric bone needles have been unearthed, the fact that they have eyes indicates that they were used for sewing. Some scholars have inferred that prehistoric Chinese people may have used bone needles found with no eyes or with points on both ends for medical purposes. However, I believe that it is rash to draw such a conclusion based solely on relics that have lain buried for thousands of years. Rather, it is likely that the eyes of these needles have simply decayed over the millennia.
A thorough reevaluation of all extant literature, as well as documents and archaeological relics unearthed since the 1960s, confirms that acupuncture is not as ancient as has generally been assumed, and that it did not, in fact, appear and gradually develop during China's Neolithic Age (c. 8000-3500 BC). Rather, this great invention arose quite suddenly and rapidly developed approximately two millennia ago. All evidence indicates that acupuncture first appeared during the Warring States Period (475-221 BC), during the time of Bian Que, developed during the early Western Han Dynasty (206 BC-24 AD), during the time of Cang Gong, and had fully matured by the latter part of the Western Han Dynasty, at the time of the compilation of the Neijing (c. 104-32 BC).
The Western Han Dynasty (206 BC-24 AD) provided fertile ground for the rapid growth and maturation of acupuncture as a comprehensive medical system. The previous centuries had seen the blossoming of Chinese culture during the intellectual give-and-take of the Spring and Autumn (770-476 BC) and Warring States (475-221 BC) periods. The subsequent territorial unification of China by the Qin Dynasty (221-207 BC) laid a foundation for the cultural integration of the diverse states. Taken in the context of China's four thousand years of recorded history, the Western Han Dynasty was a period of intensive social and cultural advancement. Acupuncture is unique. Its invention of acupuncture in China at this time was the result of the development and unique convergence of several aspects of Chinese culture during this time, including natural science, social structure and human relations, and most importantly, holistic philosophy.
References and notes:
1. Bai Xinghua, et al., Acupuncture: Visible Holism. Oxford: Butterworth-Heinemann, 2001, pps. 15-20.
2. Zhang Zhihe (1156-1228 AD), Confucians' Duties to Their Parents (Rumen Shiqin). Quoted in Selection and Annotation of Medical Cases Treated by Past Dynasties' Eminent Acupuncturists (Lidai Zhenjiu Mingjia Yian Xuanzhu), ed. Li Fufeng. Harbin: Heilongjiang Science and Technology Publishing House, 1985, p. 143.
3. Liu Dunyuan. Stone Relief Showing Practice of Acupuncture and Moxibustion from the Eastern Han Dynast. Archaeology, 1972; (6): 47-51
4. Zhong Yiyan, Medical Instruments Unearthed from the Western Han Dynasty Tomb of Liu Sheng. Archaeology, 1972, (3): pp. 49-5