A History of Traditional Chinese Medicine (TCM)

The history of acupuncture and TCM reflects what is special about this medical practice. When one understands the amazing approach of these ancient physician philosophers and the knowledge that comes from thousands of years of empirical science and practice, it is easy to understand that this medical practice is proven to work.

Historically, China dated the early foundation texts of Traditional Chinese Medicine, the Inner Canon of Huang Di, and the smaller Conversations on Female Health Problems between Huang Di and a young woman, to about 2800 BC, which was believed to be the foundation era of the modern Chinese civilization. These texts were in the form of oral conversations between the Sovereign Huang Di and Qi Bo, a prominent physician, and in the second book, a young woman discussing health problems specific to females. The writing form, as a conversation, reflects the fact that these prehistorical and early historical texts were handed down through generations as oral histories in a time when written texts were rare. Since these were originally oral histories, the actual versions of the Inner Canon (Nei Jing de Huang Qi, Su Wen and Ling Shu) that were preserved on paper, date back to about 300-100 BC, and reflect both the organized practice of the Qin and Han Dynasty physicians, and also their respect for the ancient history and development of the science.

In recent years there has been an effort by various modern historians to state that proof of a developed science of Traditional Chinese Medicine and acupuncture can only be definitively dated to this time of the earliest preserved intact text. This controversy concerning proof of the dating of the science is illuminating sociopolitically, but ignores a rich documented history of medical philosophy, approach and treatment technique that led to the preserved texts that we study today. A serious look at the rich history of TCM produces a fascinating and illuminating set of facts that reveal why this practice of needle trigger point stimulation, herbal medicine, Daoist science, preventative medicine, physiotherapies, and energetic medicine has been practiced and preserved for so many thousands of years despite advances of modern science and medical practices. The reasons for the continued popularity of these ancient medical treatments include both their effectiveness and the complex and amazing natural science, history and philosophy that forms the foundations of TCM.

Throughout the world, ancient wisdom and traditional practice of medicine has systematically been ridiculed and rejected as new scientific advances have created modern techniques and medicines that accompany new theories. TCM has proven to be a survivor of this process of rejecting the old to support the new. Other ancient medicines have survived, especially in Africa and India, but have not achieved the status that acupuncture and Traditional Chinese Medicine now enjoys in the Western developed cultures of Europe and the United States. Much of this rejection of ancient theories and practices of medicine has been driven by an economy of competition for the control of medical spending, which is always guaranteed to be a significant part of the economy of any modern culture. Cultural bias and a history of empire and conquest has also played a role, as well as religious prohibition. Traditional Chinese Medicine and acupuncture has been assaulted by modern medicine and cultural bias a number of times throughout its history, even banned in China during the period of strong British influence over the Guomintang government, yet the strength of this Complementary medical science, both in its effectiveness as well as its unique theories, has resulted in worldwide scientific validation and popular support today. Today, acupuncture is the most studied and proven manual medical technique in the world because of the numerous challenges to its validity, and scientific study of herbal medicine, which was the basis for the modern chemical pharmaceutical industry, has also expanded exponentially and is now the basis for a new approach in pharmaceuticals called biologics.

Realistic approaches in examination of the prehistoric roots of Traditional Chinese Medicine

An examination of the real roots of the science of Traditional Chinese Medicine must consider not just the carbon dating of the earliest known comprehensive manual, but the rich development in prehistory of the use of surgical tools, alchemical sciences, dietary medicine, herbal formulation, and most importantly, the complex empirical natural science that became the foundation for not only the medical practice, but an integral part of the culture of China, which we now refer to as Daoism. These studies led to many scientific discoveries even beyond the scope of the medicine. Alchemical science produced gunpowder, modern metal alloys, and many industrial discoveries, as well as the chemical lexicon that was integral to modern chemistry. Daoist physicians produced concepts of inoculation and vaccination, understanding of nutritional deficiency in disease mechanism, the concept of anesthesia that expanded the use of surgery, and many other important discoveries well before the European culture and science.

The famed Cambridge historian Joseph Needham outlined this amazing history of the science and civilization of China and its close interweaving with Traditional Chinese Medicine in his six volume Science and Civilization of China, and this is still the definitive and culturally unbiased history in the English language today. An acquaintance with this history not only helps the public understand TCM and acupuncture, but helps piece together the puzzle of our global human civilization and understanding of natural science.

Types of historical evidence important in the analysis of the roots of prehistorical TCM science

One of the keys to understanding TCM lies in the analysis of historical artifacts to help us conceive the probable steps of development of the various treatment modalities that were integral to the medical science itself. This lengthy article (apologies for the unusual length of a web article) includes current documentation of these historical artifacts. Acupuncture is the most well known treatment in TCM, but the TCM foundation text, the Nei Jing, makes clear that a combination of therapies is important in the practice of the TCM physician. The massage, or physical therapies, were important, as well as dietary regimens, therapeutic routines, counseling, Qi Gong, and most importantly, herbal medicine. All of these medical modalities were practiced in accordance with a central scientific theory and philosophy.

Historical artifacts of medical practice with herbal extractions have been found dating back to 7000 BC in Jiahu, China. Needles identified as medical implements date back to the old stone age, or Paleolithic Period, between one million and ten thousand BC, and since the materials included bone, antler and shell, carbon dating is accurate on these needles. Various preserved texts detailing medical practice have been dated to at least the Shang Dynasty, around 1200 BC, on the oracle inscriptions preserved on shell, bone and bronze, which can also be dated with accurate carbon dating. Pictorial art depicting acupuncture and other aspects of Traditional Chinese Medicine, medical texts predating the oldest copy of the Nei JIng, or Inner Canon, that refer to this text, and the fact that the Inner Canon depicts a very complicated theory and practice that obviously took hundreds, if not thousands, of years to develop, all point to a conclusion that Traditional Chinese Medicine, and acupuncture itself, dates back to a very early prehistoric time in China. Choosing to date the history of TCM to the preserved texts of the Nei Jing found in the Mawangdui tomb in 1973 seems ridiculous, and reflects a very narrow view. The fact that there were no printing presses and preservation of extensive texts in prehistory does not negate this rich period of development. This article is an attempt to elucidate these facts and provide some perspective to a historical puzzle that may never be fully pieced together.

The Lore and history of TCM and acupuncture goes back to the roots of modern Chinese civilization, somewhere around 2800 BCE. It was recorded that a great catastrophe, possibly a great flood, destroyed the early Chinese human civilization at this time, and a few great historical figures were responsible for the creation of the modern civilization, including science, written language, farming, animal husbandry, industry, urban designs, and organized health care. Accounts of great floods and rebuilding of modern civilzations at this period of time in human history can be found across the planet. Archeologists are still piecing together histories from the ruins of abandoned civilzations in remote mountainous regions that we now know were formed after the severe rising of coastal waters at this time in history. It is only in recent years that we have discovered the vast ruins of famous coastal cities such as Alexandria, Egypt, that were ruined by rising coastal waters and now remain hidden under layers of silt off the coast. It is possible that the root civilization of Chinese culture existed in coastal plains that put it more in touch with other Eurasian and Middle East preshistoric cultures. This would explain the similarities of early medical sciences discovered in ancient Egyptian science and civilization and Chinese culture. It would also explain the desire of our early Greek civilization to continue to seek medical knowledge from distant China.

In recent years this concept of migration of cultures to inland valleys during a time of environmental upheaval has been confirmed by many important excavations in remote areas that were previously ignored. It has been established that ancient cultures, such as the Hindu in India, may have a common origin with these great migrating cultures. Sanskrit and Greek language have been shown to have a common origin, and the migration of the Aryan, or ‘civilized’, culture out of Northern Africa to the Indus valley in what was Northern India, and is now Pakistan, is now well documented. The blend of these developed migrating cultures, and local cultural science and technology, explain many of the mysteries of ancient societies and cultures that are still being uncovered.

Responding to natural catastrophe prompted a need to develop a more secure and technological form of civilization. It also prompted human civilization to move away from easy coastal and valley locales to inland and mountainous regions, and to develop better medical systems to help survive in these new and more difficult environments. It is thought, in China, that a unified philosophy and understanding of nature and physical laws was integral to the development of this modern civilization. TCM has its roots in this history and is thus protected in the Chinese constitution today. The Chinese name for this medicine is Zhong Yi, and shares the character Zhong with the Chinese name of the country, Zhong Guo, or the People's Republic of Zhong Guo. The character Zhong is simple, but carries with it a profound depth of meaning. It signifies an historical emphasis on a central core of knowledge pertinent to all human civilizations with which to build a civilization of the future. It also reflects the historical Chinese desire to unite all civilizations under a central core of science and civilization, combining all concepts under one roof to create a greater human potential. This concept of Zhong is the reason that China is the largest geographical and most populous culture in the world today.

The problem with written records of history from a prehistoric time

Records of TCM in this prehistorical time are problematic. Prehistorical time refers to the human history that predates the practice of recording historical events in surviving written forms. Across the whole world, the earliest surviving historical texts date from around 900-500 BCE. This was when written texts were created on materials such as papyrus and silk that didn’t decompose easily, and methods of preservation of such texts were created. Prior to this time we have mainly the words etched in stone, metal, bone and shell left preserved to recreate events and knowledge of the ancient medicine. We are still making progress in the interpretation of these ancient language characters, and cataloging pictorial etchings and symbols related to ancient medicine.

Common languages were not widely used among diverse groups or tribes during this prehistoric time, and few people had use for the written language prior to the invention of the printing press by China in about 400 AD. Because of this lack of common languages and knowledge of written language between regional groups, history was passed between generations with a tradition of oral histories, sometimes embellished with fantastic details that today we refer to as myth. This use of fantastical details in oral histories was used by cultures throughout the world, such as the Greek and Egyptian stories familiar to European cultures, and was perhaps a way to keep these stories interesting and vital to subsequent generations of listeners.

Fantastical stories, or myth, are tied to the historical sovereigns of Chinese culture, making it hard for modern scholars to determine what is fact and what is fiction. The founder of Taditional Chinese Medicine, one of the sovereigns of Chinese culture along with Fu Xi, Nu Wa, and Shen Nong, was Huang Di, and most of the foundation texts of the TCM medicine bear his name, as well as the foundation texts of what we now call alchemy, but was called Shen Dan at that time. Fu Xi, an earlier sovereign from the Yellow River valley, was said to have created the Yi Jing (I Ching), a mathematical and philosophical text that works with duality (Yin and Yang) and numerology (8 sets of 3 dualities, or trigrams, and 64 possible hexagrams) to form a text of contemplation, foretelling and divination. Much of TCM philosophy and framework was also based on this text. The context of numerological patterns such as the 8 trigrams, and later, the 5 elements, were essentially philosophical renderings of patterns observed in nature that were associated with the growth of the universe from chaos to order. In this early human history, mathematics was seen as a science of understanding the patterns of natural order, and these patterns in nature were integral to both Daoism and Traditional Chinese Medicine.

In China, a unified written language of pictorial symbols was created in about the same time frame as this medicine, and like the medicine, this written language is used throughout the various cultures in Asia today, even though each culture or region may use different spoken dialects. This fact reflects the cultural awareness of the problems associated with many differnt local written languages, and the need to create a universal set of written words in order to advance science and civilization. This Chinese, or Asian, written language is complex, with one symbol, or word, sometimes having thirty or fifty meanings, as well as the variety of spoken words associated with a single written character between regions and countries. This complexity of language also makes the understanding of Chinese history difficult, especially to Western scholars. The context of the characters in early records is important to their meaning, and the written characters are often different than the analogous characters that we use today. Thus, much of the history of TCM is still debated by scholars, and key terms are translated in ways that perhaps convey a much differnt meaning than the writers intended.

One example of the problems with interpreting language was brought up by the historian Josoph Needham in his analysis of the Nei Jing de Huang Di texts of the Qin and Han Dynasties. In his sixth volume of Science and Civilization in China, he addresses the controversy of the meaning of the character Nei in Nei Jing. This character is used in various titles and is usually translated as inner. This creates a puzzle for interpreting the meaning of the title Nei Jing. Does this refer to internal medicine, or to an inner circle of physicians, or perhaps a more esoteric meaning? Needham utilizes a lifetime of study in China and the knowledge of various uses in context for the character in Nei Dan of the alchemical practices, etc. and determines that in this context the character Nei must refer to the corporeal, or physical and tangible aspects of medicine, as opposed to the non-corporeal, or energetic and spiritual aspects. His translation of the Nei Jing into English is thus the Manual of Corporeal Medicine of Huang Di.

Written history in China began around 500 BC, and printed texts occurred after 100 AD, with the invention of block printing on hemp paper in China. The emperor of China in 213 BC, Qin Shi Huang, ordered that all books outside of his control should be destroyed. Since knowledge was the most valuable commodity in ancient China, Qin Shi Huang wanted all significant knowledge to be consolidated into a centralized state model that defined a new empire. Thus, the earliest surviving manuscripts of Traditional Chinese Medicine date from about 200 BC. The Qin Dynasty, 221-206 BC was a very violent and short-lived empire following the Warring States Period, but paved the way for the Han Dynasty, which lasted for four centuries and recreated the modern manuscripts in the tradition of the former kings of Zhou, who ruled from the eleventh century to the second century BC.

Most of these extensive preserved texts of the Qin and Han Dynasties (100 BC to 250 AD) still attributed the knowledge of TCM mainly to the physicians assembled by one of the sovereigns of Chinese culture, named Huang Di, or the Yellow Emperor, in about 2800 BC. There is still debate over whether some of these historical figures, such as Huang Di and the physician Qi Bo, were representative or actual persons in history since oral histories are known to create mythological characterizations. The Chinese government maintains the tomb of Huang Di, and still treats this historical figure as an actual historical personage. It is purported that the actual physical remains of Huang Di do not exist, which may be attributed to the fact that the body was not preserved from this extremely early date in history, or we may believe the historical texts concerning alchemical practices, that gives us the lore that Huang Di ended his life by going to a famous mountain top, performing alchemical rituals, and ascending to heaven. This may be unbelievable to many people, but it is curious that this same type of story is attributed to both Jesus and Mohammed later in history.

The foundation text of TCM in these Qin manuscripts uncovered in 1973 at the Mawangdui tomb, as stated, was the Inner Canon of Huang Di, commonly called the Huang Di Nei Jing. We may see that the contents of the Huang Di Nei Jing preceded this time period of 200 BC by centuries, though, since another famous medical text, the Nan Jing, or Classic Text of Difficult Questions (concerning the Nei Jing) was written by a famous physician Bian Que, (or a group of scholars that used the name Bian Que in the text), who lived in the Zhou or early Han Dynasty around the 3rd century BCE, or who compiled these medical discussions between the sixth and third century BC. Thus a text that dealt with complicated questions of theory from the Nei Jing existed at least one hundred years before the earliest preserved known text of the Nei Jing. This is considered by many historians as proof that the Nei Jing content existed prior to the Mawangdui manuscript. What medical scholars do know for sure is that the information, or science, is quite substantial in these texts ascribed to Huang Di and the early physicians, and remains useful to physicians today. This implies that a long history of development of theory and practice of acupuncture and Traditional Chinese Medicine must have preceded the text from the Mawangdui manuscripts, although some historians are quite firm in their relatively new belief that these manuscripts imply that the science itself dates from this time period in the Han Dynasty. The debate presents interesting historical perspectives that are all unproven and must be judged by those interested in this historical debate.

“Traditional chinese medicine is as old as the civilization itself and reflects the idea of a unified underlying naturalist philosophy that unites the billion and a half chinese citizens today.”

The theories and philosophy of TCM are integral to the cultural and scientific foundations of Chinese culture and science, and thus this medicine is called Zhong Yi Xue, while the country of China is called Zhong Guo, or actually the People’s Republic of Zhong Guo. This central philosophy and science of Chinese culture is generally called Daoism (often written as Taoism), referring to the historian Lao Zi’s (Lao Tze) famous synopsis of Chinese thought written in about 500 BC, called Dao De, or commonly, the Dao De Jing. TCM is considered a Daoist science, and is somewhat unique in this regard.

Daoism generally refers to the knowledge of the patterns of natural law that pervade all the universe. The term Dao literally means the Way (of natural science). TCM diagnosis relies on knowledge of the patterns and relationships in the body, and the holistic interconnection of the various systems in the body, as well as the connections between the body and mind, or spirit. In TCM, the realization that everything affects everything else and is in constant flow and change, a sort of quantum physics approach to biology, guides all the perspectives of diagnosis, physiology and treatment. This perspective is expressed by the terms Qi, Yin and Yang, which refers to the ever changing function from substance to activity and back to substance. These terms do not signify a specific substance or function in the body, but are terms that can be applied to physiology and anatomy in a wide variety of contexts. Qi, Yin and Yang are concepts more than they are objects, and help the TCM physician to understand difficult conceptual aspects of pathophysiology in a fluid, rather than static, manner. This type of thinking and approach is Daoist. Later in history, Daoism assumed a number of forms, some scientific, some philosophical, and some of a religiocultural aspect, obscuring the meaning of the term. Those sages and physicians from early Chinese history that we now call Daoist preceded the term Daoism, and certainly did not consider their study of natural science a religion, or even a structured philosophy as we define philosophy today. In fact, early historical sages, or scientists, did not define their study in terms of specialties as we do now, and were more concerned with a total and interconnected understanding of all of the sciences, religion, physical and metaphysical aspects of nature.

While modern biological science wants to view everything in a static state, preferably in a laboratory test tube or microscope slide, TCM has always looked to the ever changing nature of the living organism. Hence, much of TCM is based on empirical, or observed, scientific evidence, rather than reproduced laboratory experiment. If something occurs the same way thousands of times, we assume that this is proven, or evidenced. It is often difficult to recreate this evidence in the laboratory setting because the quantum of biological factors needed to recreate the biological action is too complex to recreate. Laboratory evidence may be simpler to verify objectively, but has its limitations. Science and scientific theory is not limited to that evidence that can be recreated in the laboratory. Nature's laboratory is infinitely complex and interconnected in ways that human scientists may never be able to replicate. TCM has thus accumulated its medical evidence for nearly 6000 years by collecting empirical evidence from Nature's laboratory, eliminating all that appears untrue. Of course, this does not imply that TCM rejects modern scientific method or laboratory analysis. Today, laboratory research and human clinical trials are useful tools to verify the rich empirical evidence in TCM, and do verify the efficacy and explain the physiological effects of herbs and acupuncture very concretely.

Today, modern medicine is based on limited laboratory evidence and clinical trials that we often see are also tainted by falsifying the results for monetary gain. Much of today’s medical evidence is created by the pharmaceutical companies that seek to profit from the results, and the big pharmaceutical profits are enormous. This aspect of greed in a capitalist system is the dark side that is ignored when we look at the advantages of a profit motive driving modern research. Modern TCM utilizes both its rich history of empirical evidence and this modern scientific evidence to support the practice, with a growing body of scientific studies elucidating and supporting modern TCM treatment and approach. The National Institute of Health (NIH) in the United States, the World Health Organization (WHO), and many governmental health institutes now support and fund the scientific research in Traditional Chinese Medicine. Since TCM is not a highly profitable practice, the possibility of falsified study generated to support the practice is remote. The possibility that the extremely profitable pharmaceutical and medical equipment industry would generate falsified study data to eliminate TCM as a monetary competitor is highly likely.

One historical writing, from the third century BC, noted by the famed modern historian Joseph Needham, in his seven volume Science and Civilization in China, quotes the general of the armed forces of the king of Cho-hsiang, who is also a renowned physician, on the subject of approaches in medicine. This quote elucidates the modern difference between standard allopathic medicine and TCM. The general, Phang Hsuan, refers to a conversation with a great physician, Pien Chhueh, on medical approaches. Pien Chhueh (Bian Que), whose two brothers are also physicians, is asked who is the best physician among the brothers. Pien Chhueh replies, "The eldest is the best, then the second, and I am the least worthy of the three." When asked to explain, he replied, "My eldest brother, in dealing with disease, is attentive to the spirit or vitality (Shen). Before any symptoms have formed, he has already rid the disease. Thus his fame has never reached beyond our own clan. My next brother treats disease when its signs are most subtle, so his name is unknown beyond our own village. As for myself, I use stone needles on the blood vessels, prescribe strong drugs, and fortify the skin and flesh (surgically). Thus my name has become known among all the feudal lords." This passage reflects the history of modern medicine eloquently. The TCM physicians, especially those that treat with emphasis on preventative medicine and wellness, receive little recognition or reward. The specialists that treat allopathically after the disease or injury has become severe, with harsh pharmaceuticals, surgery etc. have become rich and respected. Even in the early history of TCM this fact was well known. The physicians that persevered with these approaches of Complementary Medicine did so not to gain the most success, but because of a respect for the quality of the outcomes of this approach, and a true respect for the Daoist science that underlies this preventative and holistic approach in medicine.

“Historical artifacts of acupuncture predate even 2800 BCE.”

Evidence of the use of metal needles in treatment predates the 2800 BC origins of the medical science, and evidence of stone needles in treatment predates this by hundreds or thousands of years, with continued use up to 300 BC. The ancient Chinese symbol for acupuncture needling uses the characters for bamboo and penetrate, implying that the earliest needles were perhaps made of bamboo slivers, which deteriorated over time, and hence we find no archeological remains. The other ancient name was bian zhen, or bian shi, meaning stone needles, or stone points, respectively. Examples of some of these stone needles, at least the thicker and more durable types, have been found in ancient archeological sites, and reflect a medical purpose rather than an industrial use with analysis of their design.

Needling therapy was also recorded in Egyptian history of 1500 BC, as well as a meridian system of trigger points similar to the Chinese system. It is well substantiated by DNA evidence that people traveled great distances, bringing important knowledge and skills, in these prehistoric times, and these records of Egyptian acupuncture practice and theory may show that this knowledge was obtained from Chinese scholars at a very early date.

Archeological evidence of copper and bronze needles extend to about 5000 BC, and the history of the needle as a common medical or early surgical tool is well documented. Currently, we now are aware of over 30 distinct cultures that were in existence in China around 5000 BCE, with evidence of interaction among these clans, as well as distinguishing cultural styles exhibited in ceramic designs and jade sculptures. The use of copper and stone needles and various medicinal extracts was passed on as a working medical science crucial to survival among these various distinct cultures. Artifacts of vessels containing medicinal alcohol extracts have been found that date to this early neolithic period in China.

Historically, it is written in the foundation text of Traditional Chinese Medicine, the Nei Jing de Huang Di (Ling Shu I): "I regret that all my people must stop paying in taxes and labor because of illness. My desire is that we no longer give them medicines that poison them and that we discontinue use of the ancient stone needles. My wish is that we utilize only the mysterious metal needles by which energy is directed." This statement was attributed to the sovereign Huang Di in his conversation with the chief physician Qi Bo. This text is attributed to the 28th century BCE in its totality, if not in its exact words, which are from a number of surviving personal manuscripts from 400-100 BCE. Hence, a few slightly different versions of the Nei Jing exist today. To confuse matters further, the first emperor to conquer most of China, around 250 BCE, was named Qin Shi Huang, and many historians refer to him as Qin Shi Huangdi, confusing him historically with the sovereign Huang Di.

It was also written in the 16th century text, Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion) that stone needles originated in the Eastern cultures, while moxibustion, or stimulating the acupuncture points with heat, originated in the Northern cultures. The text states: "The bian zhen, stone-point needles, or bian shi, points of stone, came from the eastern sea. In that area, a mountain called Gao Feng (High Peak) had stones of a form similar to needles with jade heads. They were naturally long and rounded. They were ground to a sharp point so they could be used as needles in order to effectively cure disease." This 10 volume text was written by Yang Jishi of Weijin and is still an important resource text in TCM. Today, jade is still seen as a healing stone worn by many Chinese citizens and elaborate jade sculpture is often seen in key positions in the home, adhering to principles of Feng Shui.

The actual historical timeline of needle stimulation, or acupuncture, in Chinese history can be inferred from our knowledge of artifacts from arheological sites. Steel needles were first made in China and this manufacture spread then to the Middle and Near East, with many examples of fine alloy needles made in Damascus and Antioch for the Roman Empire (27 BC -476 AD). Thus the modern type of fine steel acupuncture needle existed during the Han Dynasty and the extent of the existing version of the Huang Di Nei Jing in about 200 BC. The history of various other types of needles in medical use, from the bamboo sliver, to jade or quartz points, to bronze or copper alloy needles, and so on can be derived from our knowledge of archeological findings and inferences from writings. Serious acheological research purportedly did not occur in China till about 1920, when European acheologists such as J.G. Andersson started to accumulate this data. A detailed history of ancient China was kept in an ordered Confucian manner, but often not validated by tangible archeological evidence. Certainly, Western historians and archeologists gave little regard for the validity of acupuncture, which hampered the collection of data relating to acupuncture needles. Chinese historians, on the other hand, have collected a much greater body of evidence of early examples of acupuncture needles from more recent excavations, which has been often been discounted by Western scholars.

Needles are relatively rare finds in archeological sites because of the difficulty in preservation due to rusting of the common iron needles in early history. Nevertheless, many examples of metal pins and needles have been preserved from archeological sites. Copper alloy needles were thus found more often in a preserved state, but these were less fine and not useful for domestic sewing. Bronze is an alloy of copper and tin, and bronze deterioration, or tarnish, will result in a product that is the same as copper. The Bronze Age timeline is disputed, but generally we may assume that fine bronze tools and needles were produced from about 5000 BC onward, with examples of fine bronze implements from tombs dated as far back as 2300 BC, and bronze statues and bowls found that were dated back to 3500 BC. Most of the needles found in archeological sites were actually pins, lacking the eye needed to confirm use as a sewing implement. This fact could point to the probable use of these many early pin-like needles in China as medical implements useful in the early practice of acupuncture. This history of the early needle finds can be found in the book by Mary Beaudry, professor of archeology and anthropology at Boston University, titled Findings. Bronze needles lacking the eye needed for threading, and with biconical and rounded heads, have been found extensively in burial mounds and grave sites. The reasons that these ancient peoples would bury such pins with the dead needs to be reviewed. Certainly, these artifacts could be assumed to have some significance as medical instruments, which would give them the importance necessary to include in the burial collection. The biconical and rounded heads could be construed as trigger point stimulators, and are similar in design to the classic nine needle types mentioned in the Huang Di Nei Jing, Ling Shu.

Findings of metal pins and needles used as surgical implements in ancient times are documented in the book by John Kirkup, MD, FRCS, titled The Evolution of Surgical Instruments. In this book, the author, a curator of surgical implements, purports that fine needles made of animal bones are curated and dated to the Old Stone Age, or Paleolithic period, circa one million years ago. Needles used in medical work from this early period were composed of not only bone, but shell, antler, wood, bamboo and stone. Of course, there would be many reasons to use these needles, to remove objects and splinters from the flesh, but with such a long period of documented use of needles in human history, and with the well documented development of acupuncture stimulation, it is not inconceivable that some of these early doctors noticed the effects of needle stimulation, or at least bloodletting, at a very early date. Later European bias against such medical practice is noted in the history of the Dark Ages, such as the edict of Tours in 1163 that forbade priests and monks from surgically shedding blood, effectively forcing much of the surgical practice into the hands of barbers and empirics (practitioners of what is called folk medicine). This historical bias continued into the twentieth century and is linked to the bias concerning acupuncture history in modern historical perspective.

Prior to the extensive findings of metal alloy pins dated to 5000 BC, and continuing through history until the third century BC, which was concurrent with the use of finer metal alloy and steel needles, there persisted the use of fine stone and crystalline needles, sometimes naturally alloyed with metals, that were made from jade and quartz. These stone needles, or stone points, as they were called, were definitively identified as medical implements, although the use of the finer metal needles, which produced more intense physiological reactions in the body at trigger points, were preferred by many doctors at this time. The disbelief by modern scientists and historians that simple metal needles could actually produce or trigger a complex physiological reaction in the body of medical use led to the discounting of acupuncture needle stimulation as more of a folk belief than science. Hence, there is a general discounting of archeological findings supporting acupuncture. Recent study of the effects of acupuncture confirm that this disbelief and bias was unfounded, as fMRI studies now confirm that trigger point stimulation with metal needles does indeed produce verifiable complex physiological reactions. Thus, we must review the archeological findings of the various types of needles from ancient Chinese sites with a new perspective, and determine without bias whether these various needles indeed indicate medical uses consistent with the historical development of acupuncture.

Stone needles, called bian rather than zhen, are mentioned in a large number of ancient inscriptions and texts, and in fact, a few stone acupuncture needles have been uncovered and preserved. In Neolithic ruins of Duolun county in inner Mongolia, a stone needle 4.5 inches long was discovered. One end was oval shaped with a semicircular edge typically used to incise boils and abscesses, while the other end has a pyramid shape with a square base, typically used to let a few drops of blood escape in therapeutic application. Two more stone needles were discovered in an ancient grave during archeological excavation in Rizhao county of Shandong Province in China. They were 8.3 and 9.1 cm in length and had cone shaped and fine three-sided edge ends, again for letting a few drops of blood escape from veins and also for needle stimulation of acupuncture points. The Neolithic period in China dates from about 12,000 BCE to 2000 BCE, although various sources provide different dates. To gain an understanding of how these findings of stone, or quartz, needles of specific shape identified with medical usage and stimulation, fit into the timeline of acupuncture development, the late Neolithic, or new stone age, is dated from about 5000 BCE to 2000 BCE, although the Beijing Museum of TCM dates this period from about 7000 BCE to 4000 BCE, and states that the stone needles of Mongolia date from this time. These stone needles were generally made of sharp crystalline stone. Precious metals, such as gold and silver, are generally seen in the earth mixed in veins with quartz, and slivers of quartz or other crystalline stones may have been sometimes mixed with gold and silver, leading to the observations that these metals seemed to improve certain treatment outcomes.

Stone needles are often associated with bleeding techniques rather than trigger point stimulation, and these artifacts of neolithic acupuncture and later examples of stone needles reflect this use, although we cannot infer that stone needles were used entirely for the technique of bleeding. Bleeding, as a medical practice, is very misunderstood today in terms of its historical use and method. Bleeding was a means of stimulating a reaction in the body, similar to the use of fine metal needles or focused heat at trigger points, but for specific therapeutic purposes. Bleeding, in it's usual techniques, was not, as is implied today, a method of letting large amounts of blood escape from the body to purge pathogens. This approach may have been tried in history with various severe blood infections as a last resort, but was not the usual practice in the bleeding therapy. The characterization of therapeutic bleeding technique that has become popularized is clearly an attempt to picture this treatment technique as barbaric and something to be feared. Perhaps this is because bleeding, like cupping, became very popular worldwide until the early twentieth century. Of course, historical use of metal acupuncture needles involves no loss of blood or direct involvement between the needle and the blood. The fine metal needles are meant to penetrate the interstices and pores of the tissues without causing tissue harm, and to elicit an energetic reaction of ionically charged molecules because of their metal composition. Bleeding was a widespread and effective practice in modern medicine, even in the United States, until about 1900, even with medical doctors, and this is reflected in many standard medical texts in the United States of the late 19th century. Bleeding stimulation was so safe and effective that barbers commonly practiced the technique, and hence the red and white striped barber pole signified that this barber would perform therapeutic bleeding techniques as part of his practice, once again, not to let out a large amount of blood, but to stimulate the body surface or small veins to elicit a healing response.

The ancient physicians, and modern TCM physicians as well, generally employed a bleeding method where a few drops of blood were allowed to escape at a designated area of surface veins, triggering an immune response that resulted in a cascade of physiological reactions that led to a normalizing curative response in the body. More commonly, an implement with a number of short fine points, called a hammer or roller, produces a minimal bleeding of the skin over an area to elicit an immune reaction. Modern needles used in bleeding techniques resemble the bloodstick needles employed routinely by diabetics today for collecting a drop of blood for analysis. Stone needles were more crude than the fine metal needles, but apparently produced a more dramatic response and let out more blood. In ancient Chinese medicine, bleeding was generally applied to diseases of excess rather than deficiency, and was proscribed when the patient was in a debilitated state. The term excess, or overabundance, that we see in the medical texts, implies not an excess of blood quantity, but an excess type of disease, such as high heat, swelling, active pathogens, etc. Historians that were unfamiliar with this medical terminology, used around the world, in fact, believed that the medical texts referred to a belief in the excess, or overabundance, of blood quantity as a cause of the disease, and hence removal of a large amount of blood as a therapeutic approach. Chinese historical texts show that physicians were well aware of the limited amounts of blood in circulation, and that bleeding a large quantity would harm the patient. Some rare instances of physicians that used large bloodletting in certain disorders, without a replacement transfusion, have obviously been exagerated or falsified. Studies of blood volume in the human body in pathological states have measured between 2.7 and 7.6 liters of blood volume, depending on the state of health and the size of the patient. Published reports of famous instances of large bloodletting, such as that which purportedly killed George Washington, report that as much as 1.7 liters of blood were extracted at once without transfusion replenishment. Obviously, this quantity of bloodletting would kill or seriously injure the patient, and would not be a common medical practice. Bleeding techniques were more common historically in China with ancient stone needles, and the advent of fine metal alloy needles brought about much less bleeding technique, and more stimulation of the neural reactions and metabolic changes that we see today with the use of very thin metal needles that cause no actual tissue harm.

Jade needles have been found in excavations dating to the Shang and Zhou dynasties of about 1500 BCE to 1000 BCE, and some of these are kept in the Medical Museum of the Guangzhou University of Traditional Chinese Medicine. Most of the fine jade tip needles were thought to have been broken and discarded, although a number have been found at sites throughout China. This was during a time that the use of bronze medical instruments, including needles, was documented throughout the world. The use of the jade needles at this time would certainly indicate a specialized use, with significance of this type of material, rather than a lack of similar metal needles. Jade had some significance in the alchemical theories. Jade is also a type of stone that is more easily carved or sanded into fine shapes, and today many jade carvers still create very intricate sculptural and ornamental shapes from jade in China. It is easy to see how this type of stone was fashioned into fine needles and other medical implements. Today, jade is still very popular in China as an ornament worn to prevent disease of injury, or as a sculptural form placed in the entryway of the home or office to prevent disease or injury. Clearly, this common cultural belief stems from the use of jade in medical tool application, especially in the formation of early fine stone needles, as well as the significance of jade in the alchemical sciences and philosophy.

In 1973, on the Lamma Island near Hong Kong, an archeological expedition directed by Dr. Shih Hsueh-Yen, found a half dozen natural needles of quartz ranging around 1.5 inches in length, and roughly triangular in cross section. They were still quite sharp at the points. The site was inhabited by late neolithic people, and remained inhabited until the Warring States period. This illustrates the problem of dating many of the acupuncture needles when the materials used are not easily dated and the artifacts are not found inside of a tomb that would elucidate the time period exactly. Carbon dating is a common method useful for materials that are organic, or composed of considerable carbon molecules. It is applicable only to material that was once living. This method cannot be used to date the stone or metal needles. Historians, instead, must look at the facts and make a somewhat subjective analysis of the dates of these needles based on historical context, which opens up this subject of acupuncture needle dating to a wide variety of opinions.

Discovery of acupuncture needles in historical excavation is well documented but problematic. Since needles were used for various purposes, documenting that the examples uncovered are definitively acupuncture needles is often questioned. For this reason, examples of acupuncture needles in museums need to show that the needles were definately linked to medical instruments and known physicians and found in tombs or such sites that could be dated and unquestionably identified as pertaining to the practice of acupuncture. Early in the history of archeological excavation, it is believed that many examples of acupuncture needles were found and discarded because this was not an important or well known find for the acheologists. Nevertheless, many examples of what could be bronze acupuncture needles were excavated from ruins uncovered in recent years and dating to the Shang Dynasty, in about 1000 BCE. These needles had no eyehole, and hence were not used in sewing or medical suturing. Their shapes generally imply use as a stimulating implement. Here too were found a number of engravings, or heiroglyphs, depicting physicians using needles in acupuncture practice. The association with the medical documents and the needles clearly implies that the needles were indeed acupuncture needles from about 1000 BC.

Gold and silver needles were excavated from a tomb dating to 113 BC, although typically early steel and fine copper or bronze needles were manufactured at this time. Copper and bronze were metals that were soft enough to be easily pounded into a fine needle from wire and sharpened, but gold and silver were also relatively soft metals. The use of gold and silver in these needles implied not a practical intent, for other metals commonly used at the time would produce a finer needle, but an intent consistent with the theories of the alchemists and TCM physicians regarding the energetic applications of these metals. The historian Joseph Needham writes of many descriptions of acupuncture needle production in later Chinese history that utilized esoteric science with alloys, magnetism, alchemical heating and cooling processes, and Daoist theories of natural patterns that were inscrutable to the European scientists at the time. Today, we have apparently abandoned this type of needle production and research in favor of simple and straightforward production techniques with disposable steel needles. Nevertheless, some research concerning the benefits of different metal alloys in acupuncture needles continues today, producing some interesting scientific findings.

To review the history of the modern steel acupuncture needle, by 4000 BC, examples of fine copper needles, earrings and hairclips from many different regions of the world demonstrate a quite developed knowledge of working with copper and bronze. Casting was a technique that also typically used copper, sometimes mixed with other harder metals to form a better and finer instrument. The earliest copper casting known to modern man is a copper frog cast in Mesopotamia in 3200 BC. Examples of fine bronze casting date back to about 2500 BC. Iron was a harder metal and the earliest cast iron known is from China, dating 800-700 BC. Steel is a carbon hardened iron and early types of steel were developed in China as early as 200 BC. Cast crucible steel was first produced in northern India and southern China in 500 AD, or earlier, but Europe did not discover this cast steel methodology until 1750, during the late period of experimentation with alchemy and metallurgy in Europe.

The study of alchemy and metallurgy was integral to the development of acupuncture and TCM, as well as the development of improved surgical implements, and explains the early discoveries of important technology, including metal acupuncture needles and other fine surgical implements, that originated in China. Today's needles are almost exclusively surgical stainless steel, although some are still coated with gold for it's reactive properties, and some are still wound with copper wire handles to increase the sensitivity of the needling physician to energetic or electromagnetic reactions in the patient. The Nei Jing di Huang Di mentions use of 9 types of needles, most of which did not penetrate the skin. This was during a period that produced bronze tools. Hence we see the timeline of development of the modern metal acupuncture needles from about 4000 BC and utilizing rounded needles to stimulate the surface trigger points as well as fine sharp needles to stimulate trigger point deeper in the flesh.

Historical theories in the development of acupuncture and other therapies, and the continuing use of acupuncture in practice throughout history

Historians such as Joseph Needham have found evidence that the various forms of Traditional Chinese therapies, acupuncture, moxibustion, herbal medicine, physiotherapies and apotropaics (exorcisms, spells and sacrifices) originated in different areas of the vast Chinese landscape, and reflected the types of health problems endemic to those areas. Acupuncture may have originated in the East, where a greater problem with boils and carbuncles resulted in use of sharp implements. Moxibustion, or heat stimulation, may have originated in the North, while herbal medicine may have originated in the West, where the environment housed a wider variety of wild medicinal plants. The nine needles are thought to have originated in the South, while apotropaics were more universal, or central. This history of regional developments of TCM medical practices may merely reflect the Daoist system of the five energies and directions, or it may actually be the case. Much of the official history of Chinese culture adhered to the Daoist patterns and outline. The Daoist classification became so ingrained into the culture that we may never be able to truly distinguish the facts from philosophy in history, but excavation of artifacts is helping to elucidate the history today. Certainly, the early importance of uniting the cultures and sciences of many regions into a central China played an important role in the accumulation of information and treatment techniques that eventually became a standardized Traditional Chinese Medicine.

Needles made of precious metals, such as gold and silver have also been found in excavations of tombs of the Han dynasty. Gold was historically used to tonify (bu) conditions of deficiency, while silver was used primarily to reduce (xie) conditions of excess, as noted in ancient medical texts. This classification of gold and silver in therapeutic use obviously was linked to the theories of the early alchemical science. These gold and silver needles were less fine than the needles of bronze, steel, etc., but the use of the precious metals in needles at a time when technology was manufacturing much finer needles of different metal alloys may reflect continuing theories of alchemy that were applied to the practice of acupuncture. The continued use of gold and silver needles today reflects this alchemical theory rather than the practical use of these metals. It is curious that modern computer technology utilizes gold as a bridge in very fine computer chips that employ organic molecules and ions. Other precious metals do not produce the results that gold particles do in this modern technology. This fact signifies that there was a scientific basis to the alchemical theories that prompted the use of gold in acupuncture needles.

Needle stimulation fell out of favor with the emperors for some time through the 17th to 19th centuries, who preferred the use of moxibustion to stimulate the acupuncture points. Official medical texts during this time omit the use of needles, although it was believed that use of acpuncuture needling was still popular among the people and physicians outside of the court. It is often written that acupuncture became a country doctor technique during this time. Official court medicine utilized primarily herbal formulas and pharmacology during this time period, which was the period when modern chemistry blossomed. Even herbal medicine changed during this time period of protochemistry, with imperial abandoning of the large Materia Medica, and favoring of a smaller number of 'modern' herbal extracts with broad applications. The use again of mixed mineral and vegetable components in the herbal decoctions and extracts were common, signifying a resurgence of interest in the older alchemical laboratory techniques. Of course, physiotherapies, classified as TuiNa and AnMo, were also utilized extensively throughout this period by the emperors, and a holistic approach in medicine continued to thrive, as opposed to the birth of allopathic approach in modern Europe.

Many examples of what are called divination shells and oracle bones, dating from about 3500 BCE, have been found in recent times. These were used in rituals by heating them over a fire and observing the patterns of cracks, or by applying hot brands and observing the patterns created. It was written that the sovereign Fu Xi observed the patterns in turtle shell plastrons and formulated the mathematical order found in the Yi Jing, or Book of Changes, that is still popularly read and utilized today. The Yi Jing was thought to be an integral part of the early practice of TCM physicians, helping the doctor to make a difficult diagnosis, and even today there are texts of the Medical Yi JIng available. On many of these shells and bones, some of which were used in medical practices, are examples of some of the earliest examples of the written Chinese language characters. Huang Di and his court are said to have been responsible for the development of the written language, medical sciences, silk production and military strategies. The incorporation of esoteric ritual and divination, or foretelling, in the history of Chinese medicine persisted through the ages, and puzzled the visiting European researchers.

Formalized herbal medicine purportedly dates back to the use of the ginseng root in 3000 BC, and perhaps has its origins in Chinese alchemical theory and practice, although the finding of fermented alcohol with extracts of various herbal roots, berries and leaves in Jiahu, China, dated to 7000 BC, extend this herbal timeline back considerably. Huang Di was thought to be a skilled practitioner of this type of herbal and mineral medicine that we now call alchemy, and many books of alchemical elixirs bear his name. Chinese histories have long considered the use of herbal extracts with vegetable material in life prolongation to have come before the experiments with the mineral elixirs in the alchemical research. Chinese alchemy probably has its roots in early herbal medicine, both with cooking and fermentation techniques.

Another sovereign, Shen Nong, was said to have tried a great number of herbs and was responsible for the science of categorizing herbs in relation to type, chemical taste, warming or cooling, and system of the body that they primarily affect. The text, Shen Nong Ben Cao Jing, records the early information attributed to Shen Nong in relation to herbal science. This text divided herbal medicine into vegetable, animal and mineral products, as well as three classes of products with toxicity, mild toxicity, or no toxicity. Many of the entries describe the use of the herb in life prolongation or the increase in mental and psychic abilitites, consistent with the theories of the Daoists and alchemists.

While alchemy has been maligned and slandered in the West for hundreds of years, it is now known that many famous physicians and scientists around the world seriously studied this science, including Sir Isaac Newton, who consumed many of the alchemical medicinal elixirs himself. Exhumation of Newton's body revealed a high content of mercury. Alchemical texts in China were divided into external chemistry, internal chemistry, and the experiments with transmutations of minerals to find the building blocks of the material world. This last subset of alchemy, with transmutations of minerals into gold and silver, is generally what we think of when the word alchemy is brought up today. The TCM physicians also studied the alchemy of plant and mineral extracts as they turned into useful chemistry in the body. The Chinese character for Qi is made up of the symbols for gaseous ether rising from a plants cooking in a container, such as the alchemical furnace. Alchemical science developed into a broad and complex interdisciplinary holistic medicine, much of it later divorced from any relationship to the early, and most commonly known, experiments with high heat crucibles, mercury, arsenic etc. A history of this alchemical science is found in another document on this website, under For Practitioners - Research.

Decoction of herbal medicines, which refers to the cooking of the herbs to properly extract the chemicals, was thought to have originated with Yi Yin, who began as the cook for the head of the Tang culture in the Shang Dynasty around 1500 BCE. Yi Yin became skilled with medicinal cooking and was later rewarded by being made a key advisor to Tang and later appointed the Prime Minister of the Shang Dynasty. While we take these early methods of chemical extraction for granted today, development of the various and best methods for extracting herbal medicines was a very useful and important development in human history. Rewarding Yi Yin with the post of prime minister reflects the importance of herbal medical development in the Chinese culture, and in many cultures throughout the world. Such medical advances improve the health of armies and the official workforce, and save the government much expense in times of epidemic illness.

Medical artifacts that include early inscription related to medical practice, Daoism and ritual are an important part of the history of TCM. Fossilized bone and shell are common 'herbs' used in Chinese medicine, in the animal category. Thousands of bone artifacts have been found that were to be ground into bone powder for herbalists. Many of these fossilized bone and shell artifacts were inscribed with early Chinese characters that expressed ideas about medicine and healing rituals and dated back to 1200 BC, and are commonly called oracle transcriptions. These fossilized bone products are still used in TCM herbal products today, called long gu in Chinese, which loosely translates as 'dragon bone'.

Bronze ceremonial inscriptions dating from 1100 BC also depict the practice of TCM. As stated, most of the actual personal writings of TCM physicians that predated 500 BC were unfortunately written on hemp, bamboo or some other perishable medium, which deteriorated over time or was burned in the purges of the Qin Dynasty, and so there is little to hold in our hands from the early history because of the book purges and materials used. Also, there were many languages used in China, and a standard written language did not occur until 221 BC. Because of these facts, some modern historians are insisting that there is no evidence that TCM existed prior to the existing texts of 300-100 BC. Scholars who study TCM itself, and the historical artifacts, generally think that this is ridiculous, considering the complex development of the science by 300 BC, and the inference of the medical development from the artifacts and inscriptions of earlier times. This negating of the early history of TCM may be attributed to cultural bias, and a reading of the six volume set of Chinese history by Joseph Needham is recommended reading. For a look at the alternate historical theory you may go to the end of this article, under additional information and click on the Imre Galambos conclusion.

The importance of alchemical sciences in the history of TCM

The development of what we now call alchemy, which was called Shen Dan in China, and later divided into Wai Dan and Nei Dan, first occurred in China, according to the great historian Joseph Needham, who devoted the entire fifth volume of his Science and Civilization of China to the subject of alchemy. The timeline of alchemical development shows that this science became extremely widespread and important in early human history from Asia to the Arab culture and Europe. Most governments, even in Europe, employed alchemists, and the science went through a number of interesting transformations until the development of modern chemistry, which owes its name, as well as its concepts, to the study of alchemy. The word alchemy came from the Arab Al-Kemia, which referred both to an area of mineral rich land near Nubia in Northerm Africa, as well as to the mineral elixirs that became famous in this study. From the Arab cultures, the science proceeded to Europe, where it was eventually called Black Magic by the Church and outlawed. Despite this religious condemnation, many important European scientists continued to spend much of their time studying the concepts of alchemy and preparing both the medicinal elixirs, which were purported to not only heal serious diseases, but also to extend longetivity and increase mental and psychic ability, as well as to experiment widely with the transmutation of minerals into fake gold and silver. As mentioned, Sir Isaac Newton and Robert Boyle are now well known as prolific experimenters with alchemical processes.

Alchemy, or Shen Dan, literally translated as spirit or vital mercury, was important to the development of Traditional Chinese Medicine not only because it produced medicinal elixirs, but because the theories and natural science framed the basic concepts of Daoism and the traditional medicine. Eventually, alchemy was divided into schools of thought, and Nei Dan, or corporeal alchemy, became concerned with what happened physiologically when medicines of mineral, plant or animal materials were ingested and caused the body to heal. Many theories pertinent to modern physiology and pathophysiology were developed from this study. Wai Dan, or the non-corporeal alchemy, became the subject of healthy activities and rituals that could prevent disease and repair the health. This type of alchemy eventually became most popular, and is similar to our current interest in yoga, tai chi, qi gong, nutritional healing etc.

The original alchemy, or what we think of as the original alchemy, concerned with transmutations of minerals into what was called true (zhen) gold and true silver, but were different than the refined gold and silver ores themselves, turned into protochemistry and industrial applications in China. We cannot ignore the importance of these alchemical laboratories supported by governments in China when examining the historical development of modern industrial science. These elaborate mineral transmutations in alchemy became a subject of secretive work, though, and disappeared from Chinese literature, perhaps because of the assasinations of prominent rulers with poisonous elixirs, or perhaps because it was eventually illegal to create fake gold. The type of experiments in this third type, or original alchemy, were almost exactly replicated in the elaborate notes that have surfaced in the alchemical works of Sir Isaac Newtom, which were also kept secret for hundreds of years in modern history.

The transformation of the science of alchemy into an holistic practice of preventative medicine in China, and the taking up of the subject of the original metal ore elixirs much later in Europe was perhaps integral to the development of allopathic medicine in Europe and the persistence of a more holistic approach in China. Alchemy is a subject that is very involved and elaborate in scope historically, and many of the early famous TCM physicians were well known for their alchemical knowledge as well as their knowledge of Daoism. Further information on alchemy may be found on this informational website under Practitioners - Research. Many of the alchemical minerals used in medicinal elixirs continued to be used in standard medicine until the early part of the twentieth century, and gold salts are still used today by medical doctors to treat rheumatoid arthritis and other rheumatic autoimmune disorders. Modern research into medicines rooted in alchemical science continue to produce useful medical approaches in pharmacology.

Western Historians and the paucity of serious Chinese historical study in relation to the history of medicine

There are few Western historians that have studied and written about ancient Chinese medical history. Paul Unschuld and Joseph Needham are still the only reliable Western historians of note with books on this subject. Professor Needham died in 1995 at the age of 94, but had been extremely zealous in research and writing and served as the director emeritus of the Needham Research Institute of Cambridge until his death. Needham was faced with his Eurocentric historical perspective early in his career and when he went to China to study, he discovered that indeed China had advanced many discoveries of science and medicine hundreds and thousands of years before the Europeans, including the printing press, gunpowder (an alchemical discovery), the compass, vaccination or inoculation, anesthesia, opiate pain relievers, and many engineering theories and inventions. Dr. Needham collaborated with a renowned Chinese historian for most of his career, Lu Gui-Zhen, and strove to present a history that was free of many of the rigid pretensions and apriori assumptions of modern historical interpretation. He thoroughly documents how cultural bias prevents us from learning the truth about the contibutions to science and civilization that came from China. The author Nathan Sivin carries on his work.

Most of the famous medical doctors in Chinese history also practiced TCM and studied Daoism and alchemy. Daoism, or Taoism, as it is often spelled in English, is a complex historical subject, and underwent dramatic changes throughout Chinese history. Dr. Needham found that the roots of Daoist medicine, ritual, alchemy, meditational practices and self-cultivation preceded an actual popular, or systematized, Daoist social movement or religion, and that Daoism continues throughout history operative on a number of planes. Daoism is often seen as a social and political movement diametrically opposed to the strict order of Confucianism, or as a popular religious movement linked to early Buddhist beliefs and practice. These historical perspectives obscure the important role that the Daoist philosophy and natural science played in the development of Traditional Chinese Medicine.

Historical interpretations and controversies will always be a part of the history of Traditional Chinese Medicine. Paul Unschuld is a historian that interprets and postulates theories based on his historical research, while Joseph Needham was a historian that tried to present available fact and stick to less interpretative presentation. One of the curious controversies presented by Dr. Unschuld is that there is a separation between Daoists and the TCM physicians. This theory relies on historical documents that show that Daoist philosophers believed that disease and suffering were natural conditions of the human state, while TCM physicians believed that disease and suffering could be overcome by returning health to its natural state. While these concepts could be interpreted as diametrically opposed, this is not necesarily the case.

In Daoist cosmology, the biological state could be prone to disease and suffering due to the natural way of things, or the Dao, yet returning to the most balanced natural state, or homeostasis, could eliminate these naturally occurring diseases and physical sufferings. Dr. Unschuld also speculates from historical writings that early use of acupuncture was concerned 100% with prevention, rather than treatment of disease. This too, seems to be an historical theory that defies logic and is based upon too strict of an interpretation of available historical statements. To imagine that physicians utilized acupuncture, which is proven to treat and cure, and did not realize that their treatment indeed was effective as a treatment, rather than a pure preventative measure, seems to be a theoretical stretch of logic. These differences in historical interpretation between Drs. Needham and Unschuld perhaps reflect the narrow perspective of academia in Dr. Unschuld, and the broader real world perspective of Dr. Needham. Nevertheless, these controversies make the discussion of ancient TCM history interesting, especially concerning the use of TCM in preventative medicine as well as its dramatic curative potential. As preventative medicine continues to gain popularity, TCM may emerge as a viable modern medical option in this arena.

Paul Unschuld has published a book entitled Medicine in China Historical Artifacts and Images, distributed by Redwing Book Co., ISBN: 9783791321493. Many of the images of acupuncture artifacts were from a museum collection assembled in Germany. These artifacts confirm the early prehistoric evidence of acupuncture implements. While Dr. Unschuld presents a historical perspective that could be termed Eurocentric, and seems diametrically opposed to many of the ideas of Joseph Needham, his writings do support much important historical fact in the history of TCM.

Modern History of TCM and Acupuncture

TCM continued to evolve over time and reached its height of study in the Ming Dynasty after 1600. This was an era for TCM in which many great medical texts contained extensive information both on acupuncture practice and traditional holistic medicine itself. There were many developments in acupuncture needles and techniques, as well as the development of protochemistry and application of the concepts of alchemical medicine to modern herbal extracts. The historian Joseph Needham documents a number of important and esoteric scientific developments. He demonstrates the complex blend of historical knowledge with modern scientific theory, and the skepticism with which many scientific theories and practices were met by Europeans, who often characterized them as Chinese secrets and curiosities that are rejected by the superior European minds. Needham quotes a letter of a Jesuit scientist in China, F. X. d'Entrecolles, in the 1800s, as he records various Chinese discoveries, including the development of thermo-remanent magnetisation of steel needles heated with a complex mixture of chemicals, then cooled in the earth's magnetic field. d'Entrecolles noted that he thought that all of the chemicals were unnecessary in the preparation of the needles, and that he was particularly puzzled because the orientation of the needles during cooling was extremely important in the process. These more esoteric concepts of metal transformation and magnetic properties are lost to the modern practice of acupuncture, but perhaps continued study of the history will reveal concepts rooted in ancient naturalist thought and theory that will enlighten us in the future.

In the late 1800s there was an effort to combine TCM with modern European medical practice and theory, but by the 1920s, the English, heavily influencing the Guomintang Chinese government, succeeded in outlawing the practice of TCM to promote the building of European style hospitals and pharmacies in China. This mirrored efforts by the American Medical Association to oppose herbal medicine and other medical practices that were thought to be undermining the profitability of pharmaceutical medicine and surgery. In China, by popular appeal, this ban on TCM practice was reversed, with the agreement to consolidate TCM study into a centralized official study. This was the beginning of TCM as it is practiced today. The great physician Qin Bo Wei was largely responsible for the Chinese effort to petition the government and save the practice of TCM. The consolidation of the various schools of thought of TCM into an official government practice had it pros and cons. Uniformity of practice and theory eliminated many wonderful practices in TCM, but did allow for a uniform government sanctioned body of scientific study, which perhaps is the saving grace for TCM in the modern era of evidence-based medicine.

In the 1940s, Chairman Mao decided to train many physicians in TCM to combat the growing health problems in postwar China, which proved very successful, and this prompted the inclusion of TCM study in many standard medical colleges in the 1950s. This program is referred to as the 'barefoot doctors' program in history today, reflecting one of the historical references that inspired the movement. In the 1960s, the Cultural Revolution again waged a campaign to eliminate TCM to accelerate modernization in China, but the science was too popular to eliminate. Nevertheless, many doctors trained in TCM emigrated at this time to the United States and other countries, and medical schools and official licensing of the practice sprang up in the 1970s in the United States. Most of these early colleges were in California, and California today still retains its status as the benchmark for excellence in TCM, with the California acupuncture license considered the most rigorous in the country and recognized by most other states. Once again, adversity and a move to eliminate TCM from our modern culture proved to be a significant saving grace in the long run in the development of the science.

Today, the science and practice of TCM continues to evolve and continues to be assaulted by competing professions. It is the most studied medical science in the world, and the proof of its effectiveness is overwhelming, even though the funding for studies is still too small. Clinical trials for acupuncture, tuina and even herbal medicine are difficult to devise in the double blinded placebo format. While pharmaceutical pills are easy to create a placebo for, manual therapies such as needling cannot utilize a placebo effectively. For this reason, many of the studies are criticized. Much of this criticism comes from the pharmaceutical industry, which is unable to patent herbal products, and hence stands to lose many billions of dollars when herbal prescription becomes popular. Its popularity is inevitable though, as we find more and more effective chemicals in the herbs. The World Health Organization in 2004 declared that it must use a Chinese herb as the first choice to treat malaria, the world’s number one killer. This declaration cost the pharmaceutical industry billions of dollars that they expected to make off off new antimalarial drugs that did not have the effectiveness of the herb artemesia qinghao. While millions of lives are saved, the industry still fights the use of this herb, all because of the profit factor.

In 2006, the European Union finallly mandated the coverage of acupuncture and complimentary medicine by governmental health care and insurance companies. Europe petitioned the United States to adopt equal consideration to the profession in accordance with trade laws, but the United States continues to delay these inevitable laws. The Federal Acupuncture Coverage Act, called HR1479 in 2007, and sponsored by Congressman Maurice Hinchey of New York, has languished in one form or another in committee since the NIH endorsed acupuncture in 1997, and hence the federal basis for mandated coverage is still on hold, unrecognized by Medicare and Erisa. This is because there is always a few votes shy when the call for bringing the proposed law to the floor for a vote comes up. Of course, lobbying by the powerful groups of big pharmacy, the AMA, and the insurance industry is responsible for this delay. So too, in California, proposed bills mandating coverage of acupuncture do not come up for a vote. Public awareness and written support to legislators would probably change this scenario, but an organized effort to educate and promote has not happened. In the meantime, many countries around the world have mandated Complementary Medicine and shown that the savings in overall health expenditure are tremendous when this relatively inexpensive preventative care is utilized.

Hopefully, in the debate over health care reform in the United States, the acupuncture profession will not be overlooked as a promising and effective means of lowering health care costs and promoting effective historical ideas of preventative medicine. Public support of the Federal Acupuncture Coverage Act HR1479 of Congressman Maurice Hinchey of New York is important to health care reform. To truly lower the overall health care costs in the United States we all need to support low cost and effective health care found in Complementary and Integrative Medicine, to do all we can to prevent serious and costly health problems, and to adopt a more holistic view of health that would allow us to maintain our health more effectively. The Kaiser Foundation submits that average health care costs for a family of four could exceed $25,000 in the near future if something is not done. This is not affordable for most families. Depending completely upon our federal government to lower our healthcare costs is not a practical solution. Here too, a holistic approach may be needed, where the individual does all that they can to hold down health care expenditures, to complement government reform, and a public demand that insurance companies and heath care businesses, especially the pharmaceutical industry, does not let greed destroy our economy.

TCM has historically been unprofitable. There is little chance to make big bucks performing acupuncture and tuina, or administering herbal prescriptions. The benefit of being a TCM physician still lies in the fact that one is healing people effectively without side effects or committing harm, as well as the benefit derived from studying a natural science rooted in Daosim.

Information Resources

1. The Historical Timeline of China on key points in its history are available at: http://www.chinaknowledge.de/History/Han/han.html If you have trouble accessing this website by clicking on this address, the history of the Dynasties can be easily confirmed by a search on Google.
2. The History of Casting, by the Art Foundry Kunstgiesserei in St. Gallen, Switzerland, documents the relative timeline of metal casting methods http://www.kunstguss.ch/_html/eng/01_casting/01_03_history.html If you have trouble accessing this website by clicking on this address, the history of metal casting can be easily confirmed by a search on Google.
3. The historical timeline of copper needles dating to the 5000 BC era can be verified by reference to the Gotschenberg copper mining study published in 2000: http://www.comp-archaeology.org/GotschenbergCopperBookSum.htm If you have trouble accessing this website by clicking on this address, the history of metal casting can be easily confirmed by a search on Google.
4. The historical timeline of medicinal wines or alcohol extracts dating to 7000 BC in China can be verified on the University of Pennsylvania Museum of Archeology and Anthropology website at: http://en.www.museum.upenn.edu/new/research/Exp_Rese_Disc/masca/jiahu/jiahu.shtml This information in more detail can be accessed at the Proceedings of the National Academy of Sciences of the United States of America (PNAS) website at: http://en.www.pubmedcentral.nih.gov/articlerender.fcgi?artid=539767 If you have trouble accessing this website by clicking on this address, the history of the China medicinal wine jars from Jiahu can be easily confirmed by a search on Google or Wikipedia.
5. The historical timeline of steel instrument manufacture dating to at least 300 BC can be found on Wikipedia, History of metallurgy in China, and documentation of the development of fine steel implements in India and China that could have produced early versions of the modern steel alloy acupuncture needle can be found at: http://www.solarnavigator.net/steel.htm If you have trouble accessing this website by clicking on this address, the history of steel manufacture in China can be easily confirmed by a search on Google, or by going to Answers.com and searching History of metallurgy in China.
6. An alternative view of the early history of TCM, written by Imre Galambos in 1996, is presented at: http://www.logoi.com/notes/chinese_medicine.html This theory of the origins of TCM is contrary to the extensive historical findings of the famed historian Joseph Needham.
7. Another short historical view of the early history of TCM, written by Kath Barlett in Asheville, North Caroline is presented at: http://209.85.173.132/search?q=cache:Q3yogCPYbjwJ:www.acupunctureasheville.com/

Above: Acupuncture Points
— Photo by Michele Clement