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Acupuncture Wars: Folklore Vs. Science

By Narda Robinson, DO, DVM

Posted: April 25, 2012, 8:15 p.m. EDT

Acupuncture has had its ups and downs. As author Arthur M. Schlesinger Jr. noted, predictable cycles in culture and politics occur about every 30 years.1 Reviewing cycles of the past and gauging their impact on future directions can be crucial.

In 1905, philosopher George Santayana wrote, “Progress, far from consisting in change, depends on retentiveness. ... [W]hen experience is not retained, as among savages, infancy is perpetual. Those who cannot remember the past are condemned to repeat it.”2

And so it behooves us to consider the history of Chinese medicine, especially as we see the battles between folklore and science continuing today in veterinary medicine.

1920s: Science and Chinese Medicine Meet
After the Republic of China replaced dynastic rule,3,4 the government set higher standards for medicine, following the introduction of Western practices to China by missionaries in the 1800s. Those in charge of education argued, “The curriculum adopted for medical schools ... contains chemistry, anatomy and other scientific subjects. ... The object is not to impose unfair restrictions on the old-style practitioners but to raise the standard of medical education so as to conform to the progress of the world.

“It is by such means that public health measures and preventive medicine can be effectively carried out. Therefore the application for a separate set of regulations for native medical schools cannot be considered.”5

Unscientific traditional practitioners rebelled against the roots modern medicine set down. In response, “Telegraphic appeals were immediately sent out to all parts of the country [from native practitioners] calling for a mass meeting.”

Who could have guessed that 90 years later, the U.S. veterinary profession would experience a similar backlash when standards for certified veterinary medical continuing education implemented a scientific basis as prerequisite?6-8

Although most veterinary school deans surveyed had “strong opinions that inclusion of CAVM in veterinary medical curricula must be evidence-based,”9 perhaps others failed to appreciate how China itself had, a century ago, wrestled with promoters of folklore. In his presentation to the Ministry of Health in 1929, Yu Yen proposed a “Resolution for Abolishing the Native Practice” as follows:

“The medicine of to-day [sic] has advanced from the curative to the preventive stage, individual to collective medicine, personal to community emphasis. Modern public health service is based entirely on scientific medical knowledge with the corresponding political backing. I ... submit five reasons on the advisability of abolishing the native practice.

acupuncture for dogs
Canine acupuncture.Photo courtesy of Narda Robinson
“First: The old-style medicine of China adopts the doctrines of the Yin Yang principle, the five elements, the six atmospheres, the viscera and course of blood vessels. These are pure speculations having not a grain of truth.

“Secondly: In diagnosis they [the old-style physicians] depend wholly on the signs of the pulse, dividing arbitrarily one portion of the artery into three parts—inch, cubit and bar, to correspond to the internal organs. Such absurd theories are deceptive to oneself and to others. They may be classified in the same category as astrology.

“Thirdly: Since fundamentally they do not know diagnosis, it is impossible for them to certify the causes of death, classify diseases, combat epidemics, [etc.]...

“Fourthly: The evolution of civilization is from the supernatural to the human, from the philosophical to the practical. Now while the Government is trying to combat superstition and abolish idols so as to bring the people’s thoughts to proper scientific channels, the old-style physicians, on the other hand, are daily deceiving the masses with their faith healing. While the Government is educating the public as to the benefits of cleanliness and disinfection and the fact that germs are the root of most diseases, the old-style physicians are broadcasting such theories as when one catches cold in winter, typhoid will appear in spring; when one suffers from the heat in summer, malaria will come in autumn. These reactionary thoughts are the greatest hindrance to scientific progress.”10

Compare this to a passage from a recent TCVM journal exhibiting the tenacity with which “old-style” notions continue to thrive in veterinary medicine today: “Hepatitis and hepatic necrosis are associated with the following TCVM patterns: Liver Qi Stagnation, Liver Damp Heat, Liver Blood Stagnation, Liver Yin deficiency or Qi-Blood deficiency. The three causes of Liver Qi Stagnation include excess Wood constitution, stress and drug overuse.”11

1950s: Struggle for the Soul of Acupuncture12,13
Over half a century ago, Dr. Zhu Lian (1909-1978) promoted a modern scientific approach to acupuncture. She taught how reflexes between nerves at acupuncture points and central nervous system centers triggered autonomic changes. Her scientific approach “sparked intense debates.”14 Traditional practitioners resented her linking the effects of acupuncture to the nervous system.

One of Zhu Lian’s most strident critics, Xie Yongguang, resented the move toward science. Xie insisted, incorrectly, “The distribution of meridians, unrelated to our neural networks, blood vessels and lymph glands, cannot be lucidly explained by modern anatomy.”15

Sadly, no further works of Zhu Lian followed her 1951 book on the neurologic basis of acupuncture. Whether due to the anti-intellectual movement of the Great Proletarian Cultural Revolution or other reasons, it was now up to Westerners to investigate acupuncture science.

1980s: The New Era of Neuromodulation
And so they did. The 1980s produced a spate of papers on the anatomy of acupuncture points. Anatomists illustrated “a well defined morphological substrate” for acupuncture, comprising bundled neurovascular elements in columns perforating superficial body fascia.16 Dissections revealed the close correspondence of point locations and spinal nerves, cranial nerves, and the brachial, cervical, lumbar and sacral plexuses.17-22

Physiologic studies demonstrated the release of peptides and other neurotransmitters in response to acupuncture point stimulation,23 and the field of acupuncture neuromodulation got under way in earnest.

2010s: Time to Let Go of “Energy Medicine”
Despite these advancements, many continue to lecture on imagined energies called “Qi”24-26 Revered teachers even contend that belief in Qi is necessary for successful treatment.

For example, one acupuncture authority stated, “Oriental medicine is based on energetic physiology, the knowledge that energetic forces within the body control biochemical and cellular activity, that it provides the electric forces that dictate biochemical and cellular activity. How do we know this? Because when we manipulate bioenergy through acupuncture, biochemical changes occur.”27
He adds, “The more subtle schools of acupuncture ... require energetic terminology if there is to be clinical effectiveness.”
Schulman questions the entire notion of acupuncture as energy medicine.

“In the world of Chinese medicine, ‘energy talk’ predates the New Age era. With many Chinese medical terms such as yin, yang and qi, translation can be so fraught with danger that Chinese medical scholars prefer to simply stay with the Pin Yin transliteration. The translation of qi as ‘energy’ is just such a dangerous proposition.”28

The first translator of the term “Qi” was George Soulie de Morant, who translated acupuncture texts in the early 20th century. Of him, Schulman writes, “Soulie de Morant had to do what he could to render acupuncture palatable to his often-hostile audiences. In a purely pragmatic move, he harnessed the popular contemporary notion of elan vital (human energy) and equated qi with energy, although he clearly admitted his choice was ‘for lack of a better word.’”29

Regarding Soulie de Morant’s inexact translation, Schulman concludes, “We should not sell ourselves short by placing all our eggs in the energy medicine basket.”

Nor should we sell veterinary medicine short. That is, even though the Chinese government was unsuccessful in replacing metaphors with science, the veterinary profession can chart its own independent, fact-driven course of history.


Dr. Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University.

FOOTNOTES
1. Schlesinger AM. The Cycles of American History. Mariner Books, 1999.

2. Santayana G. Chapter XII – Flux and constancy in human nature. The Life of Reason. Volume 1, Reason in Common Sense. New York: Dover Publications, Inc., 1905. Accessed at http://www.gutenberg.org/files/15000/15000-h/vol1.html on 03-06-12.

3. Fan K-W. Discussion on scientification of acupuncture in Hong Kong in 1950s: with special reference to Zhu Lian’s The New Acupuncture. Asian Culture and History. 2011;3(2):2-8.

4. Wong KC and Wu L-T. Chinese Medicine Series 6. History of Chinese Medicine, 2nd edition. Taipei: Southern Materials Center, Inc. 1985. P. 159.

5. Wong KC and Wu L-T. Chinese Medicine Series 6. History of Chinese Medicine, 2nd edition. Taipei: Southern Materials Center, Inc. 1985. P. 159.

6. Scanlan N. Form letter to state boards regarding RACE.  Downloaded from www.ahvma.org. Undated.

7. Xie H. Letter regarding the RACE committee. Accessed at http://www.tcvm.com/doc/raceappealletter.pdf on 03-06-12.

8. American Association of Veterinary State Boards. 06-24-11. Accessed at http://www.aavsb.org/PDF/RACE/Marketing%20-%20RACE_revised.pdfon 03-06-12.

9. Memon MA and Sprunger LK. Survey of colleges and schools of veterinary medicine regarding education in complementary and alternative veterinary medicine. J Am Vet Med Assoc. 2011;239:619-623.

10. Wong KC and Wu L-T. Chinese Medicine Series 6. History of Chinese Medicine, 2nd edition. Taipei: Southern Materials Center, Inc. 1985. Pp. 162-163.

11. Medina C. TCVM Notes. TCVM Patterns of Hepatitis. AJTCVM. 2010;5(2):86.

12. Fan K-W. Discussion on scientification of acupuncture in Hong Kong in 1950s: with special reference to Zhu Lian’s The New Acupuncture. Asian Culture and History. 2011;3(2):2-8.

13. Taylor K. Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution. London: Routledge, 2005.

14. Fan K-W. Discussion on scientification of acupuncture in Hong Kong in 1950s: with special reference to Zhu Lian’s The New Acupuncture. Asian Culture and History. 2011;3(2):2-8.

15. Xie Y. Review of Zhu Lian’s Xin zhenjiu xue (The New Acupuncture). Zhongguo xin yiyao (New Chinese medicine), issue 31, 1957. Cited in: Fan K-W. Discussion on scientification of acupuncture in Hong Kong in 1950s: with special reference to Zhu Lian’s The New Acupuncture. Asian Culture and History. 2011;3(2):2-8.

16. Heine H. Anatomical structure of acupoints. J Trad Chin Med. 1988;8(3):207-212.

17. Dung HC. Acupuncture points of the brachial plexus. Am J Chin Med. 1985;13(1-4):49-64.

18. Dung HC. Acupuncture points of the typical spinal nerves. Am J Chin Med. 1985;13(1-4):39-47.

19. Dung HC. Acupuncture points of the sacral plexus. Am J Chin Med. 1985;13(1-4):145-156.

20. Dung HC. Acupuncture points of the lumbar plexus. Am J Chin Med. 1985;13(1-4):133-143.

21. Dung HC. Acupuncture points of the cervical plexus. Am J Chin Med. 1984;12(1-4):94-105.

22. Dung HC. Acupuncture points of the cranial nerves. Am J Chin Med. 1984;12(1-4):80-92.

23. Pert A, Dionne R, Ng L, et al. Alterations in rat central nervous system endorphins following transauricular electroacupuncture. Brain Res. 1981;224(1):83-93.

24. Lee MS, Lee Y_H, Shin B-C, et al. Is there any energy transfer during acupuncture? The American Journal of Chinese Medicine. 2005;33(3):507-512.

25. Xie H. Xie’s Veterinary Acupuncture. Ames, IA: Blackwell Publishing, 2007. P. 3.

26. Spaulding K and Chamberlin K. The transport of extremely low-frequency electrical signals through an acupuncture meridian compared to nonmeridian tissue. J Alt Comp Med. 2011;17(2):127-132.

27. Fratkin JP. Scientific criticism of Traditional Oriental Medicine: Reflections following conversations with my twin brother. Acupuncture Today. 2004;5(8). Accessed on 03-05-12 at http://www.acupuncturetoday.com/mpacms/at/article.php?id=28502.

28. Schulman D. Is ‘Energy Medicine’ a good label for acupuncture? J Alt Comp Med. 2004;10:419-421.

29. Birch S and Felt RL. Understanding acupuncture. Edinburgh: Churchill Livingstone, 1999. Cited in: Schulman D. Is ‘Energy Medicine’ a good label for acupuncture? J Alt Comp Med. 2004;10:419-421.

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Acupuncture Wars: Folklore Vs. Science

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Reader Comments
Charles from Chester,

Regarding your discomfiture term "folklore" it indeed is apt given the definition of folklore as "a body of widely held but false or unsubstantiated beliefs".

That is, unless you can tell me how tongue diagnosis is substantiated? Or pulse diagnosis? How are yin, yang, and qi substantiated? They are metaphors for reality that can neither be measured nor proven to exist.

Regarding the word "energy", it is clear from history that this was introduced less than 100 years ago, yet TCM practitioners in the West remain happily seduced into believing that the ancients approached acupuncture as a spiritual/metaphysical practice.

There are many illusions about the superiority of Chinese medicine, including those you perpetuate about TCM therapeutics being "arguably better than that of western medicine" in the late 1800s to the early 1900s. In fact, the US Pharmacopeia was founded in 1820, leading to standards of purity and strength of drugs, something that remains lacking in TCM herbs to this day, as indicated by the DNA screen from 15 TCM preparations seized by customs showing contents from critically endangered antelope, Asian black bear, and more.

LINK

It is an illusion that TCM mixtures were superior to western medicinals, which were largely herbal, influenced from European and Native American herbalism, but I see how it might serve your purpose of promoting TCM to speak of them in such lofty terms. Furthermore, if TCM was so successful, why did Mao find the need to create cadres of barefoot doctors in the mid-1900s in order to address epidemics striking China, given that there were insufficient numbers of western trained doctors to care for the rural inhabitants?
Dr. Narda, Fort Collins, CO
Posted: 6/1/2012 9:53:05 PM
Good to see accounts of the medico-political debates of 1920's China but there was too much reliance on the words of those ideologically opposed to Chinese medicine. They were chinese but their assumptions wer largely erroneous. The political context was that at that time chinese politicians had been humiliated by western military force and persuaded of the superioriry of modern medicine purely on the basis of its superior grasp of anatomy. Modern medicine had very few effective drugs then - ironically two of the effective ones were opium and ephedrine - derived formt the chinese herb mahuang. Between 1840 and 1930 TCM therapeutics was arguably far better than that of western medicine. That, for example is where we got the new life-saving anti-malarial artesunate.

My main objection, though, is with labelling classical chinese medicine as "folklore". For its 2,500 year history china has had folk medicine which was distinct from the literate medical professions which aimed to be rational and systematic and had a written and iterative approach to medicine. State controlled medical universities existed from 475 AD and became especially developed in the Song dynasty when, at any time, 3000 medical student undertook prolonged (usually 7 year) medical training with regular tests and exams and formal teaching from specialist professors. It is not appropriate to label this folklore. The explanatory model was designed to explain the body and its interactions with the environment as a complex ecological system. In medicine yin, yang, qi, etc were, and still are technical terms. The fact that the same terms were also used by astrologers and magicians should not distract us just as physicists and astrologers sharing the word "energy" should not make is believe that physicists are airheads.
So the problem with this article is that it is scholarly and so gains attention, but the scholarship is heavily laced with half-informed opinion and becomes misleading by employing a scholarship that is insufficient for purpose.
charles, chester UK, AE
Posted: 5/28/2012 8:33:18 AM
Matthew,

I appreciate your taking the time to write down your comments. However, I am confused by your response.

You wrote, "It is ironic that a specialist in veterinary medicine, who obviously believes that science-based acupuncture has a place in that field, would recite the tired anti-science criticisms of traditional acupuncture theory used by those who insist that acupuncture works only via the placebo effect as the positive benefits of acupuncture on animals clearly refutes that claim."

About whom are you referring to when you say that I listed "the criticisms...by those who insist that acupuncture works only via the placebo effect"?

Perhaps if you can indicate which statements inspired your comment I can respond more precisely.

Thanks!
Dr. Narda, Fort Collins, CO
Posted: 4/28/2012 9:44:06 PM
It is ironic that a specialist in veterinary medicine, who obviously believes that science-based acupuncture has a place in that field, would recite the tired anti-science criticisms of traditional acupuncture theory used by those who insist that acupuncture works only via the placebo effect as the positive benefits of acupuncture on animals clearly refutes that claim. Look, it is a puzzle; the traditional theories of qi, yin/yang, and meridians do on the surface seem to have no basis in science and there is no doubt that Chinese folk culture has long been infused with superstitious beliefs, but to claim that the traditional concepts behind Chinese medicine theory have been disproved on one hand while acknowledging acupuncture’s medical potential on the other demonstrates a type of prejudice that is disturbing.
The good doctor stated: “Anatomists illustrated “a well defined morphological substrate” for acupuncture, comprising bundled neurovascular elements in columns perforating superficial body fascia. Dissections revealed the close correspondence of point locations and spinal nerves, cranial nerves, and the brachial, cervical, lumbar and sacral plexuses.” Doesn’t it strike one as odd that those backward, superstitious primitives would be able to discover a completely unique method of stimulating the body’s resources that has applications in so many fields of medicine even today? What are the odds they could stumble upon this when our “superior” modern science methods could not? The fact that this remarkably safe and useful form of therapy was discovered, developed, and survived more than 2,000 years under its own unique set of theories should make us hesitate to deny those theories viability just because we cannot verify them with our own evolving science concepts.
Allow the traditional theories to be taught since those were the ones that were responsible for the practice now being considered bit just add an asterisk explaining that these traditional theories have not yet been verified by modern science. Let practitioners decide for themselves which set of theories yield better clinical results. If modern science had ruled 2,000 years ago in China, acupuncture would not have even been discovered.
Matthew, La Verne, CA
Posted: 4/27/2012 7:06:51 AM
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