Rheumatology 2004;43:662–663 doi:10.

1093/rheumatology/keg005

Heberden Historical Series/Series Editor: M. I. V. Jayson

A brief history of acupuncture

A. White and E. Ernst

Acupuncture is generally held to have originated in China, being

first mentioned in documents dating from a few hundred years

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leading up to the Common Era. Sharpened stones and bones that
date from about 6000 BCE have been interpreted as instruments for
acupuncture treatment [1, 2], but they may simply have been used
as surgical instruments for drawing blood or lancing abscesses [3].
Documents discovered in the Ma-Wang-Dui tomb in China, which
was sealed in 198 BCE, contain no reference to acupuncture as such
[3], but do refer to a system of meridians, albeit very different from
the model that was accepted later [4]. Speculation surrounds the
tattoo marks seen on the ‘Ice Man’ who died in about 3300 BCE and
whose body was revealed when an Alpine glacier melted [5]. These
tattoos might indicate that a form of stimulatory treatment similar
to acupuncture developed quite independently of China.
The first document that unequivocally described an organized
system of diagnosis and treatment which is recognized as
acupuncture is The Yellow Emperor’s Classic of Internal
Medicine, dating from about 100 BCE. The information is
presented in the form of questions by the Emperor and learned
replies from his minister, Chhi-Po [6]. The text is likely to be a
compilation of traditions handed down over centuries [7],
presented in terms of the prevailing Taoist philosophy, and is
still cited in support of particular therapeutic techniques [8]. The
concepts of channels (meridians or conduits [3]) in which the Qi
(vital energy or life force) flowed are well established by this
time, though the precise anatomical locations of acupuncture
points developed later [9].
Acupuncture continued to be developed and codified in texts
over the subsequent centuries and gradually became one of the
standard therapies used in China, alongside herbs, massage, diet
and moxibustion (heat) [2]. Many different esoteric theories of
diagnosis and treatment emerged, sometimes even contradictory
[3], possibly as competing schools attempted to establish their
exclusiveness and influence. Bronze statues from the fifteenth
century show the acupuncture points in use today, and were used
for teaching and examination purposes (Fig. 1) [2]. During the
Ming Dynasty (1368–1644), The Great Compendium of Acupuncture
and Moxibustion was published, which forms the basis of modern
acupuncture. In it are clear descriptions of the full set of 365
points that represent openings to the channels through which
needles could be inserted to modify the flow of Qi energy [7]. It
should be noted that knowledge of health and disease in China
developed purely from observation of living subjects because
dissection was forbidden and the subject of anatomy did not exist.
Interest in acupuncture among the Chinese declined from the
seventeenth century onwards as it came to be regarded as
superstitious and irrational [2, 6]. It was excluded from the
Imperial Medical Institute by decree of the Emperor in 1822.
The knowledge and skill were retained, however, either as an
interest among academics or in everyday use by rural healers. With
China’s increasing acceptance of Western medicine at the start of
the twentieth century, final ignominy for acupuncture arrived in
1929 when it was outlawed, along with other forms of traditional FIG. 1. This bronze figure showing acupuncture points is
medicine [2]. After the installation of the Communist government a reproduction of one cast in AD 1443. (Reproduced from
in 1949, traditional forms of medicine including acupuncture were An outline of chinese acupuncture published by Foreign
reinstated, possibly for nationalistic motives but also as the only Languages Press, Peking 1975.)

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT UK.
662
Rheumatology Vol. 43 No. 5 ß British Society for Rheumatology 2004; all rights reserved
 A brief history of acupuncture 663

practical means of providing even basic levels of health to the the sites of traditional acupuncture points with their associated
massive population. Chairman Mao is quoted as saying, in relation meridians [22]. There is a plethora of suggested mechanisms of
to traditional medicine, ‘Let a thousand flowers flourish’ although action of acupuncture, but little valid data on which, if any,
he himself rejected acupuncture treatment when he was ill [3]. mechanisms are relevant to clinical practice. Evidence of clinical
The divergent strands of acupuncture theory and practice were effectiveness is also still elusive for many conditions such as chronic
brought together in a consensus known as traditional Chinese pain [23], but in the last decade of the twentieth century systematic
medicine (TCM) [8], which also included herbal medicine. reviews have provided more reliable evidence of acupuncture’s
Acupuncture research institutes were established in the 1950s value in treating nausea (from various causes), dental pain, back
throughout China and treatment became available in separate pain and headache [24].
acupuncture departments within Western-style hospitals. Over the
same period, a more scientific explanation of acupuncture was
sought by Prof. Han in Beijing who undertook ground-breaking
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