THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 3, Supplement 1, 1997, pp. S-5-S-10 Mary Ann Liebert, Inc.

A Brief History of Acupuncture's Journey to the West

GARY KAPLAN, D.O., DABFP, DABPM

ABSTRACT

Acupuncture stands on the threshold of acceptance by the medical establishment in the United States. This medical philosophy and practice is challenging the basis of our understanding of health and illness. The history of acupuncture's journey to the West is chronicled in a re­view of milestones of medical history. The historical journey out of the orient began with Je­suit missionaries who entered China in the 16th century. By the end of the 19th century, many of France's most prominent physicians were using acupuncture. Probably the most influen­tial French acupuncturist was George Soulie DeMorant, whose text, VAcupuncture Chinoise (Chinese Acupuncture) was published in 1939. In the United States, acupuncture was first mentioned in the medical literature in 1822, and was endorsed by Sir William Osier for the management of lumbago in his text. The Principles and Practice of Medicine, published in 1892. The news report by New York Times reporter James Reston in 1971 relating his experi­ence with acupuncture for postoperative pain, sparked massive interest on the part of the American medical community. This interest continues to this day, and more and more physi­cians and nonphysician health practitioners are involved in the use of acupuncture. With in­creasing interest in complementary and alternative medicine, acupuncture will likely be used more commonly, and will also serve to broaden the traditional concepts of health and illness.

Acupuncture stands on the threshold of be- velopment rooted in scientific methodology, ing accepted by the medical establishment Acupuncture's origins are to be found in Chi-

in this country. This article chronicles the jour- nese mythology, its practice an extension of ney of a medical philosophy and practice that Taoist philosophy that evolved through em-is challenging the basis of our understanding piricism. While Western medicine struggles to of health and illness in the West. Acupuncture's reconcile a paradigm rooted in Cartesian phi-journey to the West is as much a study about losophy, which created a duality of mind and beliefs and pohtics as it is about science and body, body mind unity was never questioned medicine. Whereas Western medicine focuses in the body mind East. on physiology, acupuncture's focus is on the Acupuncture's proponents in America have vital force they refer to as Qi. Western medi- met with consistent opposition and rejection by cine traces its origins to the Greeks, Hip- the conventional medical establishment. The pocrates and Asclepiades, its evolution and de- practice of acupuncture in this country has

Kaplan Clinic, Arlington, Virginia. Medical Acupuncture Research Foundation, 5820 Wilshire Blvd., Suite 500, Los Angeles, CA 90036.

S-5

S-6 KAPLAN

grown through public demand and legislative this text in the latter half of the 17th century mandate. Acupuncture is informed by a para- provided Western physicians with their first in-digm that is not compatible with Western med- depth insight into the practice of acupuncture ical understanding of human physiology. (Hehns, 1995; Lu and Needham, 1980). However, because of pubhc demand, the con­ventional medical establishment in the United States is beginning seriously to reconsider its WESTERN EXPOSURE position on acupuncture. This article looks briefly at the past to help us more fully appre- The first Western accounts of acupuncture date the monumental changes that are occur- were reported not by physicians, but by Jesuit ring in Western medicine as it struggles to rec- missionaries who had entered China in the 16th oncile itself with its Oriental counterpart. century. One of the earliest and most compre­

hensive of these reports was provided in 1671 by P.P. Harviell, S.J., in his paper "Les Secrets

ANCIENT ORIGINS De La Medicine Des Chinois, Consitant En La Porfaite Connoissance Du Pauls" (Carubba and

Chinese medicine is a comprehensive system Bowers, 1971). The fact that a missionary work-of health care of which acupuncture is one dis- ing among the people would come into contact cipline. The origins of Chinese medicine are as- with acupuncture indicates how widespread cribed to Huang Ti, the Yellow Emperor, this practice was in China. Furthermore, it is Huang Ti, the third of China's five legendary ironic that a man dedicated to saving the hu-emperors is reported to have ruled between man soul first introduced the concept of Qi to 2696 and 2598 B.C. The Huang Ti Nei Ching or the traditions of Western medicine. Yellow Emperor's Classic of Internal Medicine is The first physician to write about acupunc-the oldest medical text known, and established ture was Dr. Willen Ten Rhijne. Dr. Rhijne was the foundation for the theory and practice of exposed to the technique while working for the all Chinese medicine. The Nei Ching is divided Dutch East Indies Company in Nagasaki, into two sections. The first entitled Su Wen Japan. He described the practice of both (simple questions) focuses on the etiology, acupuncture and moxibustion in his paper, "A pathophysiology, diagnosis, and prevention of Dissertation on Arthritis," written in 1683. Dr. disease. The second entitled Ling Shu (the mys- Rhijne was clearly impressed with the proce-terious pivot) addresses the clinical applica- dure and is quoted as saying, "Burning and tions of acupuncture and moxibustion. The text acupuncture are the two primary operations is probably a compilation of written and oral among the Chinese and Japanese who employ traditions handed down through the centuries, them to be free from every pain. If these two and was first published during the Han Dy- peoples were deprived of the two techniques, nasty: 206 to 220 A.D. (LU and Needham, 1980; their sick would be in a pitiful state without Unschuld, 1985; Veith, 1973). hope of care or alleviation" (Carubba and Bow-

Over the centuries the Nei Ching has under- ers, 1971). Dr. Rhijne not only described gone numerous revisions and clarifications, acupuncture in the treatment of arthritis, but One of the most significant occurred during the also for headaches, vertigo, cataracts, apoplexy. Western Jin Dynasty (265-316 A.D.) with the stiff necks, nervous convulsions, epilepsy, di-pubhcation of the first comprehensive text de- arrhea, and cattarh. Dr. Rhijne was succeeded voted exclusively to acupuncture and moxi- in Japan by Dr. Englebert Kaempfer. It would bustion for the treatment of disease and main- be Dr. Kaempfer and not Rhijne whose work tenance of health. The work underwent further would have the greatest influence on intro-revision during the Ming Dynasty between ducing acupuncture to the West. Published in 1368 and 1644. This book. The Great Com- the original Latin in 1712, his detailed and sym-pendium of Acupuncture and Moxibustion, is the pathetic accounts of acupuncture were well re-basis for all modern day Chinese texts on ceived in Europe and underwent translations acupuncture. Interpretation and translation of into German, Dutch, English, and French

A BRIEF HISTORY OF ACUPUNCTURE S-7

(Dolan, 1973). Acupuncture's potential as a medical technique was further championed by the great German surgeon Lorenz R. Heister (1683-1758) in his text Chirurgie, 1758, which was translated into six languages and under­went 20 printings (Bowers, 1978).

THE FRENCH EXPERIENCE

By the end of the 19th century, many of France's most prominent physicians were using acupuncture. Because Paris was considered one of the great centers of Western medicine attract­ing students from throughout the Western world, knowledge of acupuncture spread throughout Europe and the Americas. The French interest in acupuncture was further in­fluenced by their military adventures into In­dochina in the mid- to late 1800s. By the early 1900s the teachings and practice of acupuncture by the French scholar-diplomat George Soulie DeMorant provided one of the most significant influences on European acupuncture in the 20th century. Soulie DeMorant studied acupuncture for 20 years while French Consul in Shanghai. His text V Acupuncture Chinoise (Chinese Acupuncture) published in three volumes in 1939,1941, and 1955, not only expounded on the technique, but made accessible the theory of the classic texts and presented acupuncture as a comprehensive medical system. Today, as part of the legacy of DeMorant, acupuncture is offi­cially recognized by the Academia De Medicine as part of the formal practice of medicine in France (Bowers, 1978; Hehns, 1995).

AMERICAN HISTORY

Acupuncture was probably first introduced to the United States by Chinese immigrants, but mainstream American medicine was not in­fluenced by these early practitioners. It wasn't until the early 1820s, when the French were both practicing and teaching acupuncture, that American medical journals began to report on European experiences. Given their earlier en­counters with the importation of European medical "advances" such as mesmerism.

phrenology, and hydropathy, American physi­cians were cautious about using acupuncture. In 1822 an editorial in Medical Repertory spoke of these concerns. "We should, e'er this, have given some account of acupuncturation and its surprising powers; but we reckon it, erro­neously it would seem, akin to the famous trac­tors and remembering how many were gold by that simple bauble, we felt backwards in trou­bling its Eastern relative, lest we might lend ourselves to swell the list, already too numer­ous of the prejudice and enthusiastic. But, we have probably been mistaken. Acupunctura­tion is likely to become, employed with dis­crimination and directed with skill, a valuable resource" (Cassedy, 1974).

In 1825 Dr. Franklin Bache, great-grandson of Benjamin Franklin and a physician practic­ing in Philadelphia, became the first Ameri­can physician to translate and publish a sig­nificant work on acupuncture. Translating from the original French, Bache published an American edition of Morand's, Memoir on Acupuncture (Morand, 1825). A year later, Bache published his own experiments with acupuncture entitled, "Cases Illustrative of the Remedial Effects of Acupuncture" in the North American Medical Surgery Journal (Bache, 1825). Dr. Bache had conducted his experi­ments on prisoners at the state penitentiary in Philadelphia where he was an assistant physi­cian. He treated a wide range of problems in­cluding muscular rheumatism, chronic pains, and neuralgia. He concluded that acupunc­ture could be "a proper remedy in almost all diseases whose prominent symptom is pain" (Bache, 1825). The initial flurry of excitement about acupuncture was confined to physicians around the Philadelphia area with a few scat­tered publications from up and down the East coast. While it was still practiced by some physicians, no major publications appeared until the very end of the 19th century. In 1892, no less a physician than Sir William Osier en­dorsed the use of acupuncture for the treat­ment of lumbago in his text. The Principals and Practices of Medicine (Osier, 1916). Despite Osier's enthusiastic endorsement, acupunc­ture remained a medical oddity in the United States isolated to Oriental enclaves and ig­nored by mainstream medicine.

S-8 KAPLAN

MODERN AMERICAN HISTORY public interest, acupuncture continued to face major hurdles in the United States. In the early

In 1971, New York Times reporter James Res- 1970s organized medicine was expressing its ton was in China reporting on the opening of collective doubt in a number of ways. In 1973 diplomatic relations between the United States the Food and Drug Administration rated and China. He developed acute appendicitis acupuncture equipment as class III medical de-and was rushed to the Anti-Imperiahst Hospi- vices, making them experimental and thus ac-tal in Beijing. He underwent an appendectomy cessible only under appropriate research pro-with conventional anesthesia. The next day he tocol (Federal Register, 1973). In 1974 the developed postoperative pain and the house American Medical Association (AMA) de-acupuncturist, Li Chang Yuan, provided near clared acupuncture an experimental medical immediate relief (Reston, 1971). Reports soon modality (Schwartz, 1981). Wolpe theorized followed of miraculous surgeries performed that it was, in part, an attempt to keep the prac-with acupuncture in place of general anesthet- tice of acupuncture out of the hands of non-ics. Delegations of American physicians went physicians practitioners and to limit its use by to China to report on what seemed to be mir- physicians (Wolpe, 1985). It was becoming acles performed with slender needles. The first more and more difficult for Americans to prac-group of physicians led by Dr. E. Gray Dimond tice acupuncture. Despite the difficult situation went to China and reported on the successful at home, a number of physicians and non-use of acupuncture for anesthesia in the Jour- physicians left the country in an attempt to nal of the American Medical Association (Dimond, learn more about acupuncture. 1971). While the article raised medical curios- They returned from places like England, ity, the report came under almost immediate France, and China believing in acupuncture's criticism because none of the physicians in- efficacy and were anxious to begin the practice volved were anesthesiologists. Furthermore, of acupuncture at home. These practitioners attempts by American physicians to replicate were not wanting for patients when they re-the Chinese experience with acupuncture turned to the United States. In time they began proved, for the most part, unsuccessful. to teach others and organize schools and train-

To further compound the establishment's ing programs in acupuncture for both physi-skepticism, this unique approach to human cians and nonmedical practitioners. In 1973 the health and illness did not fit the current bio- first physician acupuncture organization. The medical model and made little sense to many New York Society of Acupuncture, for physi-Western physicians. While the medical com- cians and dentists formed (Liao et al., 1994). munity had its doubts, the American public They began to organize some of the first for­bad become thoroughly infatuated with mal physician training programs in this coun-acupuncture. Many articles were published in try. Nonphysician acupuncture training began the lay literature extolling the virtues of this to proliferate and by the early 1980s there be-Oriental medicine. Prominent American soci- came a need to standardize the educational ologist Paul Wolpe summed up the situation programs in these schools and create an ac-saying, "The overwhelming media and lay in- creditation process. In 1982, the Counsel of Col-terest in acupuncture quickly became anath- leges of Acupuncture and Oriental Medicine ema to most of organized medicine. Physicians was created for the purposes of advancing the had no experience in acupuncture and no status of acupuncture and oriental medicine in knowledge of physiologic mechanisms that the United States. Also, the National Accredi-could account for it. Indeed it seemed to vio- tation Commission of Schools and Colleges of late the laws of anatomy and neurophysiology. Acupuncture and Oriental Medicine was cre-Acupuncture was an aUen philosophical basis ated, as well as the National Commission for and reported as a package from the East: it was the Certification of Acupuncturists (Flaws, not an alternative modality that reacted to (and 1991). In just 10 short years an entire system for was thus informed by) the biomedical model" acupuncture training and accreditation were (Wolpe, 1985). Despite growing intrigue and established in the United States.

A BRIEF HISTORY OF ACUPUNCTURE S-9

Despite growing public acceptance and a sig- vidual doctors, but also by the medical estab-nificant move toward regulating training and ac- lishment. The demand is clear. The survey pub-creditation, the AMA continued its attempt to lished in 1993 by Harvard Medical School enforce barriers to the practice of acupuncture, showed that one in three Americans use non-Arguing that there is a lack of scientific evidence traditional treatments, spending a total of 14 as to the efficacy of acupuncture or an explana- billion dollars per year compared with just un-tion as to its mechanisms of action, in 1981 the der 1 trillion dollars spent on conventional AMA again reaffirmed its position that acupunc- treatments (Eisenberg et al., 1993). In 1993 a ture was an experimental medical modality. Federal Drug Administration report estimated

In 1974, however, the American Osteopathic that at least half a billion dollars per year was Association became the first major medical in- being spent on acupuncture treatments alone stitution to endorse the practice of acupuncture (Lytle, 1993). In 1994 the National Institute of as part of the practice of medicine (Helms, Health and the Federal Drug Administration 1974). In 1982, through its extension program, convened a technology assessment meeting to the University of California Los Angeles Med- evaluate the status of acupuncture needles. As ical School became the second major medical a result of the evidence presented in that meet-school in the United States after New York Uni- ing, in 1996 the Food and Drug Administration versity to endorse an acupuncture training pro- reclassified acupuncture needles to class II gram for physicians. In 1987 the American medical devices, making them available to all Academy of Medical Acupuncture was qualified practitioners (Eskinazi, 1996). founded as a means of representing licensed Presently 34 jurisdictions provide for the reg-physicians who had integrated acupuncture istration, certification, or licensure for the prac-into their medical practices. The Academy was tice of acupuncture by nonphysicians. Thirty-also the first national physicians organization nine states regard the practice of acupuncture to establish minimal training requirements to as being within the scope of a physician's med-obtain membership. In 1994 the Academy es- ical license, while 11 states and the District of tablished the first national proficiency exam for Columbia have imposed additional training re-physicians practicing acupuncture. quirements (Mitchell, 1997). Health mainte-

By 1991 it was estimated that there were ap- nance organizations (HMOs), which for better proximately 9000 physician and nonphysicians or for worse have become the barometer of practicing acupuncture in the United States. At what is considered acceptable medical treat-that time, 23 states and the District of Colum- ments, are beginning to cover alternative ther-bia had established licensing requirements for apy. While most HMOs already cover chiro-nonphysician acupuncturists (Kaplan, 1991). practic, some are adding acupuncture to the list Amazingly, the number of acupuncture practi- of admissible treatments. In 1997 Oxford tioners continued to grow and states legislat- Health Plans, a profitable HMO, offered the ing licensure of acupuncture continued to in- most extensive program to date, crease despite consistent opposition by state medical boards and a lack of good scientific ev­idence demonstrating either the efficacy or THE FUTURE OF AMERICAN mechanism of action of acupuncture. Patients ACUPUNCTURE and practitioners of a Chinese medicine based on Taoist philosophy and Eastern empiricism In November 1997, the National Institute of were successfully challenging Western medical Health will convene a consensus conference on science's cultural authority as the sole arbiter acupuncture. The Office of Alternative Medi-in defining health and illness. cine has taken the lead in making significant

funding available to evaluate the clinical effi-ACUPUNCTURE TODAY ^^^y ^^ acupuncture and to study its mecha­

nisms of actions. As we seek to incorporate this It appears as if acupuncture is on the verge Oriental perspective on health and illness into

of acceptance, not only by patients and indi- our health-care system it is important that we

S-10 KAPLAN

embrace the opportunity that Oriental medi­cine offers us. Acupuncture is not simply an­other technique, but an opportunity to broaden our concepts of health and illness. It is hoped by accepting the challenge to expand our per­spective we, as American physicians, can greatly improve the health care system and the lives of our patients.

ACKNOWLEDGMENT

My thanks to Patti Spiegel for her help in preparing the text of this manuscript, CoUette McNamara for her transcription, and Dr. Robert Umlauf for editorial assistance.

REFERENCES

American Academy of Medical Acupuncture, 5820 Wilshire Blvd., Suite 500, Los Angeles, CA 90036.

Bache F. Cases illustrative of the remedial effects of acupuncture. North Am Med Surg J 1825;! :311.

Bowers ]Z. Reception of Acupuncture by the Scientific Community from Scorn to a Degree of Interest. Pro­ceeding of Annual Meeting. American Association for the Advancement of Science, February 16, 1978.

Carubba R, Bowers JZ. The Western world's first detailed treatise on acupuncture: Willem Ten Rhijnes's De Acupuncture. J History Med Allied Sci 1971;29:3.

Cassedy JH. Early uses of acupuncture in the United States, with an addendum (1826) by Franklin Bache, M.D. Bull NY Acad Med 1974;50(8):892-906

Dimond EG. Acupuncture anesthesia: Western medicine and Chinese traditional medicine. JAMA 1971;218: 1558-1563.

Dolan JR. Some early European observation on acupunc­ture. J S C Med Assoc 1973;69(5):173-177.

Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs and patterns of use. N Engl J Med 1993;328:246-52.

Eskinazi DP, Guest Editor. NIH Technology Assessment Workshop on Alternative Medicine: Acupuncture. J Al­tern Complement Med 1996;2(1).

Federal Register. March 9, 1973;36(44). Flaws B. Viewpoint. American Acupuncture education:

Has a wrong turn been taken? Am J Acupuncture 1991;19(1):63-71.

Helms JM 1995 Acupuncture Energistics: A Clinical Ap­proach for Physicians. Medical Acupuncture Publish­ers, Berkeley, CA.

Kaplan G. The status of acupuncture legislation in the United States: A comprehensive review. The AAMA Rev Vol. 3.1 1991.

Liao SJ, Lee MHM, Ng LKY 1994 Principles and practice of contemporary acupuncture. Marcel Dekker, New York.

Lu GD, Needham J. Celestial Lancets. 1980 A History and Rationale of Acupuncture and Moxa. Cambridge Uni­versity Press, Cambridge.

Lytle CD. An overview of acupuncture. Center For De­vices and Radiological Health, FDA, PHS, DHHS, May 1993.

Mitchell BB. Acupuncture and Oriental medicine laws. 1997. National Acupuncture Foundation, Washington, D.C.

Morand M; Bache F, trans. 1825 Memoir on Acupunc­turation, Embracing a Series of Cases. Drawn up under Inspection of M. Julius Cloquet Paris, 1825. Philadel­phia.

Osier W 1916 The Principles and Practice of Medicine. Eighth edition D. Appleton & Co., New York.

Reston J. Now About My Operation In Peking. New York Times, 26 July 1971, 1,6.

Schwartz, R. Acupuncture and expertise: A challenge to physician control. Hasting Center Reports Science 11:5-7, 1981.

Unschuld, PU 1985 Medicine in China: A history of ideas. University of California Press, Berkeley, CA.

Veith I, trans. 1973 The Yellow Emperor's Classic of In­ternal Medicine. University of California Press, Berke­ley, CA.

Wolpe RR. The maintenance of professional authority: Acupuncture and the American physician. Soc Probl Vol. 32, No. 5. June 1985;32(5):409-424.

Address reprint requests to: Gary Kaplan, D.O., DABFP, DABPM

Kaplan Clinic 5275 Lee Highway, Suite 200

Arlington, VA 22207