ACUPUNCTURE GOES WEST

THE DOCTOR'S BAG

the blog about the medicine and surgery of yesteryear

Keith Souter aka Clay More

Acupuncture was an integral part of my medical practice since the early '80s until I retired just before the pandemic. I hold a professional qualification in  the subject and over the decades have treated many thousands of cases. Now, since the pandemic the only needles I wield are the ones used to put vaccines into arms.

Nonetheless, in my view acupuncture is a highly effective treatment for many disorders, especially pain-related conditions.

ACUPUNCTURE EAST AND WEST

Acupuncture is essentially a treatment derived from ancient Chinese medicine. It involves the insertion of fine needles at certain points in the body for therapeutic or preventive purposes. 

It is either practiced as part of Traditional Chinese Medicine (TCM), as it has been practiced in the East for centuries, or as Western Medical Acupuncture, which is based on western medicine and physiology. 

In TCM acupuncture, the concept is that life energy, called Qi  flows around the body in interconnected meridians and that blockage or disturbance of flow results in symptoms, disorders and disease. The needles inserted at acupoints on the meridians are thought to balance the energy, stimulate healing and promote relaxation. 

In Western Medical Acupuncture  conventional medical diagnosis is followed by the insertion of needles to stimulate sensory nerves in the skin and muscles, which results in the release of natural substances including pain-relieving endorphins. 

Both systems use the same meridian system and location of acupoints along all of the meridians to locate and record which points are being used. In antiquity it was thought that the meridians were channels like arteries and veins through which Qi or life energy flowed. 

There are twelve main meridians , each of which is related to a particular organ of the body. These are bilateral, so there are twelves on each side of the body. Each acupoint has a traditional name, but the international classification is now numerical, so that points are described by the initials of the meridian and a number. For example, a powerful pain-relieving point is traditionally called Hoku, or Co 4. This is the fourth point on the colon meridian, which is found in web space between the thumb and forefinger. 

(It is sometimes also referred to as LI 4, or Large Intestine 4).

Hoku, or Co 4

There is inevitably some overlap between the two methods of practice.

THE ROOTS OF ACUPUNCTURE

The origin of acupuncture goes back into the mists of ancient Chinese history. The first  written records appear in the Nei Ching, known in the West as The Yellow Emperor's Classic of Internal Medicine. It dates from the period of the Warring States (403-221 BC)

This classic text was written in the form of a dialogue between the legendary Emperor Huang-Ti, who is believed to have lived about 2697-2596 BC, and his minister Ch'i-Po. The Emperor poses questions which are answered by Ch'i-Po with a fairly lengthy discourse. Each of these discourses takes a medical point and explores ethical issues arising from it and links it with Taoism, which was the man religious philosophy at the time the book was written.

The book is in two sections, first the Su Wen, meaning 'simple questions,' which contains the principles of Traditional Chinese Medicine, and the second, Ling Sou, meaning 'Magic gate' or 'Spiritual Pivot,' which deals with therapy. The meridian pathway system that is fundamental to acupuncture is described. 

Essentially there are twelve paired meridians (ie, one on each side of the body), each of which is associated with an organ of the body. In addition there is one central one on the front and the back of the body, the back one being the Governing Vessel or brain meridian and the front being the Conception Vessel meridian. 

Chinese medicine was introduced to Japan sometime between 100 BC and Ad 700. It is thought that it reached Korea in the sixth century AD The Nei Ching was the fundamental text. 

The author's acupuncture mannequin

ACUPUNCTURE GOES WEST

Seemingly, Jesuit missionaries became aware of acupuncture and its related treatment of moxibustion in the sixteenth and seventeenth century. In 1671 the Jesuit father Placide Harvieu wrote Les Secrets de la Medicine des Chinois, The Secrets of Chinese Medicine.

It was not until several generations later that the medical profession picked up on this therapy. Dr Louis Joseph Berlioz (1776-1848), the father of the composer Hector Berlioz, was the first western practitioner of acupuncture. He introduced the practice in his hospital in Paris.

The first doctor to practice in America was Dr Franklin Bache, the great-grandson of Benjamin Franklin.  He had in about 1825 obtained a copy of Memoire sur L-Acupuncture by M J Mourand, a physician at the Hospital Saint-Louis in Paris. 

Dr Franklin Bache (1792-1864)

At a colleague's suggestion he translated this into English. 

He also began practising the method on prisoners under his care at two prisons in Philadelphia, including the Walnut Street State Prison where he was the physician in charge. In 1826 he published a paper, Cases Illustrative of the Remedial Effects of Acupuncturation in the North American Medical and Surgical Journal. 

Dr Bach predominantly treated pain conditions using what he called acupuncturation, which we would nowadays call trigger point acupuncture. Interestingly, this was the method used by Sun Sou-miao, a renowned physician of the seventh century during the Tang dynasty.

Dr Sun Ssu-miao (590-682 AD)

Sun Sou-miao wrote Pei chi chin yao fang, meaning 'Thousand Golden Prescriptions for Medical Emergencies.'

The practice of acupuncture in the nineteenth century involved using quite long, hard and thick needles. Doctors suggested using ladies' hat bonnet pins. 

Acupuncture came and went in medical practice over the decades.  Indeed,  Dr T Ogier Ward, an English physician describes this in an article he wrote an article in the British Medical Journal of 1858:

Acupuncture is a remedy that seems to have its floods and ebbs in public estimation; for we see it much belauded in medical writings every ten years or so, even to its recommendation in neuralgia of the heart, and then it again sinks into neglect or oblivion; and it is not unlikely that its disuse may be occasioned, partly by fear of the pain, and partly by the difficulty the patient finds to believe so trifling an operation can produce such powerful effects. Another reason for its neglect may be that, like every other remedy, it fails occasionally, and the practitioner, disgusted at having persuaded his patient to submit to a pain, which, though slight, has been attended with no benefit, will not again undergo such a disappointment. However this may be, its use is not as frequent as it deserves

In America the situation was similar in terms of the medical profession. A difference, of course was that with the great influx of Chinese immigrants the practice of Traditional Chinese Medicine including acupuncture flourished. This was not just the trigger-point acupuncture that Dr Franklin  Bache and his colleagues and followers practiced, but was the traditional methods as first promulgated in the Nei Ching. However, as such it was not much practiced outside the Chinese communities. 

A huge boost was given to acupuncture in the United States in 1972 when President Nixon visited China and was shown treatments carried out under acupuncture. Since then it has been extensively studied and utilised as an effective and valuable treatment modality.

Sir WILLIAM OSLER AND ACUPUNCTURE

The doyen of late nineteenth - early twentieth century physicians was Sr William Osler, professor of Medicine at McGill University in Canada and Oxford University in England. His Principles and Practice of Medicine was published in 1892 and was the standard textbook of medicine for decades. In it he describes the technique used by many doctors (including I have no doubt, Doc Logan Munro of Wolf Creek) to treat lumbago.

"For lumbago acupuncture is, in acute cases, the most efficient treatment. Needles from three to four inches in length (ordinary bonnet-needles, sterilized, will do) are thrust into the lumbar muscles at the seat of the pain, and withdrawn after five or ten minutes."

*****