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Basic data of acupuncture.- We'd like to remind you of some questions mentioned above. Although we are sure that a lot of historical research has been done in China, our TCM books still don't provide us with any numerical data concerning acupuncture and its clinical use in the past and in the present.
How many acupuncture treatments have been done in this or that hospital? Which percentage of all patients was treated with acupuncture? Treating which diseases? How many patients were treated in combination with TCM herbs? How many in combination with chemical drugs? What about these figures in some city, in some province, in China? How many last year, and how many the years before?
Then, the situation of acupuncture in the past. How many TCM doctors after 1911 have also been acupuncturists? How many in times of the QING dynasty, and how many in ancient times? Have there been times where acupuncture was seldom used? Why?
How many patients, according to recent estimation, have been treated with acupuncture from 1911 - 1949? How many during the QING dynasty? How many in ancient times? Which percentage of patients was treated with herbs, which percentage with needles, which percentage combined?
Have the acupoints needled most frequently been more or less the same as today? And if not: for which reasons?
What about the use of the different needles? How many needles are nowadays produced yearly, and how many were produced in former times? When did the fine needles start to be the most frequently used type?
What about Needles and Moxibustion? How many patients nowadays get only needling or only moxibustion? How many in combination? What about related techniques like cupping, laser, electro-acupuncture, acupoint injection, intradermal needle or catgut implantations? How frequently have these methods been used? Have there been any changes recently? Any recent researches?
What about the aspects of Reinforcing (BU) and Reducing (XIE)? Which of these basic forms of stimulation is more frequent nowadays? Have their been any changes, due to the different spectrum of deseases treated with TCM methods today?
And which was the situation in former times? Have there been times in history, when needles were not frequently used, but moxibustion or cupping was? Or have moxibustion and cupping been something like “home methods”, whilst needling was left to the professionals?
These are just some questions, all of them with the same purpose: To get a better notion of China's medical reality, today as well as in the past.
How does acupuncture work? - Some Western books contain hundreds of pages trying to prove that acupuncture is effective. They talk of gate control, neuronal reflex chains, interference and inhibition and many more ... very scientific and sophisticated, but without any answer to the truly important questions of acupuncture. In fact, they only prove one aspect: That acupuncture isn't just placebo therapy, but has a real physiological effect on the body. However, this is a fact which only some stupid blockheads could ever deny, because every needle puncturing the skin causes an injury, and injuries are among the strongest available stimuli of the body. The important question is not if acupuncture works but how it works.
Acupuncture is a micro-injury therapy. - During the course of evolution, every living being had to develop physiological strategies to deal with injuries. When men were hunters and collectors, smaller injuries and bigger wounds were frequent. Reacting to these injuries, closing the wounds and healing the damage was essential for the survival of the species and the individual.
Nowadays, even small injuries are rare in the life of an adult. But the body still keeps all the mechanisms which are necessary to react in case of injuries. There is a certain probability that the system of injury healing, like any other one (including the immune system) needs regular training. This aspect might be sufficient to explain why acupuncture, even without any pain or disease, is healthy for the body and improving wellness - without needing any model of "meridians" or "flow of QI". It might also be sufficient to explain the local effect of acupuncture in case of pain or arthritis (but not the supposed distant effects).
Which is, we’d like to ask, the importance of this micro-injury resulting from the needle (but not from laser or massage techniques) and the physiological reactions following the injury?
Do the JINGLUO (“Meridians” and “Collaterals”) really exist? - To anyone not familiar with the problems of TCM, this question must seem absurd - like asking a chemist: Does oxygen really exist? But concerning acupuncture, the question is not absurd at all. Absurd is only the fact that even our acupuncture books don’t answer this question.
In 1975, the “Outline of Chinese Acupuncture” told us: “Chinese traditional medicine considers that channels (JING) and collaterals (LUO) are passages distributed in the human body in which “blood” and “qi” (vital energy) circulate.”
There must have been important discoveries in the meantime, because recent books like the acupuncture volume of the “Newly compiled English-Chinese Library of TCM” don’t speak of TCM as “considering” these things any more. Instead, the authors declare: “The science of meridians expounds the routes that connect different parts of the body based on the clinical applications of acupoints; while the science of acupoints elucidates the relation between the viscera in light of the theory of meridians. ... Meridians refer to the routes that transport qi and blood, regulate yin and yang, connect the zang-organs with the fu-organs, associate the external with the internal as well as the upper with the lower.”
One look at an acupuncture chart shows that the “Meridians” in some places seem to run parallel to some artery, vein or nerve. But there are neither blood vessels nor nerves confirming the courses of the JINGLUO in general, and there are no anatomical structures to confirm the supposed inner courses. So there should be two logical questions.
First: What did the ancients mean when talking about the JINGLUO?
Second: What does modern TCM believe?
And this is what we’d like to ask our Chinese friends: What do they personally think about the JINGLUO? Do they really believe the “Meridians” are an anatomical reality? Or a functional reality? Do they really believe that there is “QI and blood” flowing in the “Meridians”? Do they believe that the inner courses of the JINGLUO are a clinical reality? Do they believe that the Hand YANGMING channel connects with the colon, the Foot JUEYIN channel with the liver etc.?
If they believe all this, we should like them to explain something: How can these inner courses be symmetrical, even in case of asymmetrical organs like liver, spleen, stomach or gallbladder?
PSC: Taking a coincidence in part as a proof for the whole. - We dislike some TCM friends taking a singular coincidence as a proof for the whole. One of many examples have been the hopes to prove the existence of the JINGLUO by means of PSC (Propagated Sensation along the Channels). But if a certain JINGLUO in some part of the body has the same route as a nerve, it is logical that when your needle hits the nerve you get a feeling along this nerve. But has there ever been a PSC confirming the wild zigzag of Foot-SHAOYANG (Gallbladder Channel) on the surface of the head?
Clinically, the question is irrelevant anyway, because two thirds of the twenty-something regular head points are nearly never used. But is there really any TCM doctor in China believing that underneath our hair there is in fact QI and Blood running this strange way the charts tell us about the Gallbladder Channel? As to ourselves, we do not believe it - unless someone proves us that we are wrong.
The "Muscle Regions" and "Cutaneous Regions". - In 1975, the "Outline of Chinese Acupuncture" told us about the JINGLUO that traditional and Western medicine units "have come to the conclusion that the channels are closely related to the nerves, blood vessels and body fluids. But as the theory involves some unresolved problems of modern medicine and biology, further investigation remains to be done." The presentation of the JINGLUO system was limited to Channels, Collaterals and the "QIJING BA MAI".
The "Essentials of Chinese Acupuncture", published in 1980, didn't lose a word about any "further investigations" but stated: "Channels and collaterals are passages through which QI and blood circulates."
"Chinese Acupuncture and Moxibustion" in 1987 replaced the word "Channel" by "Meridian", thus proving that the authors neither understood the meaning of the word "Meridian" nor knew about the relevant terminology discussion in Western countries. Furthermore, they added two more structures: The "12 Muscle Regions" and the "12 Cutaneous Regions". These concepts are first found in the HUANGDI NEIJING, but like many concepts from this TCM bible, they weren't used much in clinical practice. We have to admit that we dislike this digging for ancient statements, especially when accompanied by a total lack of own thinking of the authors, and without looking at aspects like clinical relevance. The question is: Are these concepts absolutely necessary to understand or use the system? Or just one of many attempts of the HUANGDI NEIJING to describe a body reality which was not full understood?
How much QI and Blood are flowing in the JINGLUO? - When Westerners study the TCM classics, every page is a surprise. There are so many things which recent TCM books prefer not to mention. For example, the HUANGDI NEIJING states that "Blood is little and QI is plenty in SHAOYIN Channel", whilst "Blood is plenty and QI is little in TAIYANG Channel". Now, the theory of circular connection tells us that Hand-SHAOYIN (Heart Channel), when reaching the hand, connects to Hand-TAIYANG (Small Intestine Channel). But what happens to the "plenty of QI" of the Heart channel, when connecting to the Small Intestine Channel, where there is only "little QI" left? Did it disappear in the hand? Escaping through some hidden openings?
Probably this question is irrelevant, too, because the whole concept of how much QI and Blood is flowing in the "Meridians" seems to be purely speculative. But we’d like to know how the real experts explain this question.
The "5 SHU Points" and the triple circle of JINGLUO. - Quite similar to the contradiction concerning the amount of “QI and BLOOD” is another one: The "5 SHU-Points" on each channel (JING-Well, YING-Spring, SHU-Stream, JING-River, HE-Sea) all start from toes or fingers and run towards knees or elbows, thus indicating some kind of continuous growth in the same direction. Apparently, there was a time in the creation of the acupuncture system when people thought that QI and Blood had the same direction in all the channels, flowing from the extremities towards the body.
Then, someone must have observed (maybe when treating wounded soldiers) that there were blood vessels which, when cut, were gushing from the proximal side of the cut (arteries), whilst other ones had some blood dripping from the distal side (veins). It was a logical idea to suppose that the fluid flowing from the center to hands or feet in one vessel returned to the body in the other one. As a result, there was the concept of the 12 connected regular channels, with Blood and QI flowing in a triple circle. The idea of Blood and QI always flowing from the extremities to the body was given up, but the concept of the "Five SHU-Points", though without any logical base, remained.
Again, we think that the whole idea is purely speculative and without any clinical value (though a lot of PC software depends upon it). But if anyone could give us convincing arguments that we are wrong, we'll be glad to change our mind.
"Entry and exit points of QI". - The majority of recent acupuncture books ignore the description of older books: That "entry and exit points of QI" are not necessarily the first and the last point of the channel. This is quite logical. If the Lung (Hand-TAIYIN) Channel ends at the thumb, how does QI and blood reach the Large Intestine (Hand-YANGMING) Channel? Running back the thumb, and then to the tip of the second finger, opposite to the direction of the Large Intestine Channel?
TCM rebels think that this question, too, is irrelevant. They take the whole concept of the 12 JINGLUO running in a triple circle as a mere speculation, including the question of "exit and entry points of QI". So, is this aspect of any clinical importance? And if it is: How should it be used?
Does Acupuncture really influence the flow of substances? - We doubt that there are still many TCM practitioners in China who believe that they really promote "the flow of QI and Blood in the meridians" when they needle an acupoint and stimulate it. Or are we wrong? Are there really many doctors believing in it?
And if they do they might tell us: Where do this QI and Blood come from? Where does it go? Do you think this is real blood which might be shown by Doppler sonography?
What happens when we obtain DE QI? - Everybody knows that for a good result of acupuncture DE QI is necessary. But curious as we are, we'd really like to know: What do our Chinese friends really think about DE QI? We stupid Westerners take it as a sensation caused by nerve receptors. But what does the Chinese acupuncturist think? Does he really believe his DE QI makes some QI substance move from here to there?
Why is DE QI necessary? - If we believe that DE QI really means influencing the flow of certain substances, this, of course, would be a sufficient reason to explain why we need it. But if we don't believe it? Is it sufficient to take DE QI as an indicator we hit the right point?
The difference between Reducing and Reinforcing. - And what do you think makes the difference, when you use a "reinforcing" or "reducing" method? Is there really some substance, some real QI and Blood going from here to there? Please tell us how you explain it to yourself or to your children.
How to reduce and how to reinforce. - There has been much ado about this question (with many Westerners still speaking about "Tonification" and "Sedation" in the tradition of some French authors). There seems to be some consent nowadays that intensive stimulation with big amplitude means reducing, whilst mild stimulation with small amplitude means to reinforce. Other things are still found in many books, but we are not convinced of their clinical value. We have been told (mainly by French authors, but based on the Chinese classics) that yellow metal stimulates, whilst white metal "sedates". Even today some Chinese books tell us that clockwise rotation means to reinforce, whilst anti-clockwise rotation means to reduce, but this doesn't make sense because “clockwise rotation” on one side of the body means rotation toward the outside of the body, whilst on the other side it means rotation towards the center of the body. Nor do we believe that stimulation in the direction of the JINGLUO means to reinforce whilst stimulation against it means to reduce.
But what du the experts think?
Cupping, Laser, Electro-acupuncture, Acupoint-Injection etc. - According to theory, the question how to reinforce (BU) or reduce (XIE) is always a basic one. However, this question is often forgotten when dealing with special methods like cupping, laser, electro-acupuncture, acupoint injection, intradermal needle or catgut implantations. So that we’d like to ask: Is the aspect of reinforcing and reducing, at least when using these techniques, of secondary importance? Are there certain conventions in clinical practice? Which are your experiences?
How can you reinforce (BU) against the direction of the JINGLUO? - Let's take one of the two most frequently used acupuncture points. One of them is St-36 ZUSANLI. Dear Chinese teachers, let me ask you a question: Can we use this eminent point to reinforce (BU) Spleen and Stomach?
Of course, you'll answer - isn’t it done every day a thousand times in the acupuncture world?
Indeed, we should be happy about this answer. But in fact, we are not. According to acupuncture theory, the Foot-YANGMING (Stomach channel) has a direction, running from the head down to the feet. So, how can we reinforce (BU) Spleen and Stomach when needling St36-ZUSANLI? Does our needling result in a reverse flow of QI, from the knee upward to the stomach? Or does the QI first flow down the foot, and from there upwards? Dear teachers, could you please tell us?
Our impression: In clinical reality, nobody cares about the hypothetical direction of the JINGLUO, but needles the points as if they had a direct connection to the respective organ. Like many other age-old elements, the supposed direction of the channel flow is probably purely speculative. Which seems quite natural, because (again the simple old question): How could they have found it, if not speaking of arteries and veins?
Do you agree? If not, please give us some reasons to believe
- that the JINGLUO (if not identical with arteries, veins and nerves) really exist
- that their inner courses are correct and clinically relevant
- that there is real Blood and QI flowing in the JINGLUO
- that this flow really has a direction
- that acupuncture can really influence the flow of QI and Blood.
Or what else do our Chinese friends think about these questions?
Western patients, pain and DE QI. - As mentioned above, patients in our countries are afraid of pain. To them, any unpleasant feeling apart from itching is "pain". They have no word for sensations like "SUAN, MA, ZHANG". If you give them a strong DE-QI-feeling when needling them the first time, many of them will never come again. This is a common experience of Western acupuncturists.
The question is how to deal with this situation. There have been many Chinese doctors working abroad and many foreigners studying at China's international training centers, so teachers and authors of the TCM academies and universities should know about this problem. Surprisingly enough, even the books written for foreigners usually don't mention this aspect.
Nevertheless, we have to insist that this is a serious problem. Most of us try to keep the first acupuncture as comfortable as possible, making the patients wonder that they "didn't feel anything at all". Afterwards we tell them that a certain needle feeling is necessary, trying to get them acquainted to the DE QI. But there are many who never like it. How can we deal with these patients? Stop acupuncturing them? Or be confident in the efficiency of acupuncture as a micro-injury therapy, even without any DE QI? Or just use the setting of acupuncture, which makes it so useful to Western doctors today?
What makes an acupoint an acupoint? - The HUANGDI NEIJING postulates a number of 365 regular acupoints (though naming much less), because the year has 365 days. One has to be very simple-minded to consider this explanation convincing.
In fact, this is still an open question: Which are the specific qualities of an acupoint? And how many of them do exist? Why isn't every point along the JINGLUO an acupoint?
In the second half of the 20th century, a lot of research was done concerning things like the electrical resistance on acupoints. Compared to the surrounding area, the resistance of the acupoint is usually lower. But there are acupoints without this quality, and there are many more skin spots with lower resistance without being acupoints.
Mr. Heine, a German anatom, made some research showing that important acupoints have neuroanatomic qualities which other points do not have. Even without this research it seems logical that a point which is more sensitive to needle stimulation than other ones must have some special structural qualities. But again, there are many acupoints without sharing these qualities, and there are other spots sharing them without being acupoints.
We got the feeling that for several centuries in ancient China there was some kind of competition to find new acupoints, hoping to reach the magic number of 365. By means of this competition, probably many points were considered as acupoints which nowadays wouldn't even be considered as JINGWAIXUE. But at this time, the ancient doctors didn't see any problem in adding a spike to the course of the JINGLUO or even a new branch. It seems that after some time people lost interest in this run for new points, which only was to start anew 2000 later, when again everyone was eager to discover new points.
So, we consider the actual situation as arbitrary in many aspects and far from being satisfactory. We are afraid that accepting this situation by calling it "tradition" or even "culture" might be just a sign of laziness and the lack of hope that things might really be put in better order. Nevertheless, we hope that one day there might be someone with the courage and ability of LI SHIZHEN. We hope it might be possible to replace these strange lines called JINGLUO by a system which has a real anatomical foundation. We hope that the speculative point categories of acupuncture might be replaced by something making sense physiologically.
Maybe there are some suggestions already? Or someone who might convince us that the actual system is nearly perfect?
How can we prove the qualities of an acupoint? - This should be answered easily - theoretically. Just take 100 patients with a certain disease and needle 50 patients using a certain acupoint, and 50 patients without using it. The result will be the proof.
In reality, it's not so easy, especially in our countries. If you got enough patients, you might do this test in a double-blind study, which means you tell somebody to needle certain acupoints without telling him the disease. But if the doctors responsible for the test are really convinced that needling a certain point is necessary to obtain good results, it is unethical not to act accordingly.
Nevertheless, quite a lot of these tests must have been done in China. We'd like to know more about the results. Or maybe someone made some research of his own?
Why are some acupoints more frequently used than other ones? - It is easy to see and easy to prove that points like LI4-HEGU, St36-ZUSANLI, Sp6-SANYINJIAO, Pc6-NEIGUAN, Liv6-TAICHONG, LI11-QUCHI are frequently used, whilst other ones are seldom used or not at all. The question is: Why? Really because these points are the most powerful? Or just because they can be needled easily even when people wear thick clothes? We don't think this question is sufficiently answered in the books.
Some thoughts about the most important acupuncture points. - The point which Bachmann, one of the fathers of German acupuncture, did recommend most frequently was not St36-ZUSANLI or LI4-HEGU but K6-ZHAOHAI. As mentioned already, French acupuncturists believed the most important points were "Tonification point" and "Sedation point" of each “Meridian”. Some German acupuncture friends who desired to go to China but didn't get further than Ceylon (where popular medicine pays a special attention to the head) came back with the idea that the most versatile and important point was Du20-BAIHUI, and in a well-known German acupuncture book we still find this estimation of Du20-BAIHUI as all-important Super-Point. We told the author that this was just a local Sri Lanka misunderstanding, but being afraid of losing face, he didn't change the role of this point in his book.
What is your opinion about these and other acupoints?
Which points are essential to treat some disease, and which ones are not? - Just as a habit, we needle Liv2-XINGJIAN or Liv3-TAICHONG in certain cases of head ache. But are we really convinced that these points are essential? No, we are not. We are accustomed to needle LI4-HEGU in case of pain of the upper half of the body, but we are not sure that this point is really more efficient than, let's say, LI11-QUCHI. Concerning this doubt, we are not far away from the HUANGDI NEIJING, which usually does not describe the qualities and abilities of single acupoints, but rather of the whole channel, no matter where it was punctured. So, we'd like to know: Who was the first to suppose certain powers of single acupoints? Are there any hints how the supposed distant effects of certain points have been found? Maybe by clinical observation? And have there been interesting discussions, when someone stated some qualities, and another one didn't believe it?
And another question: How can we prove the lack of abilities of some acupoint?
What about the clinical value of the newly found points? - And what about the people who discovered them? Some 30 years ago, a lot of new points were found, presented and forgotten. There are books presenting more than 1500 of them. If they are really important, they should be thoroughly researched, and the names of the people who discovered them should be known. If not, we should like to know why they aren't really widely used. Can anyone help us?
Which is the location of Pc8-LAOGONG? - When creating the curriculum of modern TCM, some mistakes and wrong decisions must have been unavoidable. We think that one of these mistakes was the location of the acupoint Pc8-LAOGONG. The ancient scripts just state "the center of the palm". There must have been a discussion about what was the "palm": Including the thumb or not? Any old chart makes it evident that "palm" did not include the thumb, so that the point had to be located between the third and fourth metacarpal bone (as still written in the "Outline of Chinese Acupuncture" from 1975). Only when tinking in the terms of modern anatomy the thumb metacarpal counts as the first one, and as it is thicker than the small finger, the "center" should be nearer to the thumb. But sometimes the LAOBAIXING know better than the experts. If you visit a Chinese park and ask some QIGONG teacher about the location of LAOGONG, immediately he will show the point between the third and fourth metacarpal bone. Still, we should like to know: What do the Chinese acupuncturists think about this question?
Who decided that the Foot-SHAOYIN (Kidney) Channel should turn a somersault around the inner malleolus? - Old acupuncture charts show this JINGLUO with some zigzag in the foot region, but without this strange circle in recent charts. Is there anybody believing a real vessel in human body might turn a somersault? Again, we got the feeling that in the process of creating modern TCM, the lack of time and the dominance of certain gentlemen resulted in a wrong decision, and afterwards no one had the courage or competence to correct it. - But if our point of view is wrong, some expert should help us towards a better understanding.
Which is the clinical value of the functional categories? - When studying acupuncture, there are two things most time-consuming. First, memorizing the acupoints, their location and their (supposed) effect. Second, memorizing the functional categories (like the five SHU points, YUAN-Source points, XI-Cleft points etc.). Most of them have their origin in the HUANGDI NEIJING, but other ones (for example, the BA HUIXUE = "Eight Influent Points") not.
In theory, these categories seem to be of extreme importance. But again, theory and clinical application describe two different worlds. Only 4 of the 12 YUAN points are really frequently used. 10 of the 15 LUO points, 9 of the 12 JING-Well Points, 10 of the 12 YING-Spring points are of secondary importance. Especially annoying are the XI-Cleft points. This category, containing 16 points, is the largest of all. But even its three most important points (Pc4-XIMEN, Lu6-KONGZUI and SI6-Yanglao) are rarely used, and the rest of them nearly never.
When considering the explanation of these categories, once again we must ask: How could they possibly find it? How could anyone find out by clinical experience that Bl11-Dazhu could influence all the bones in the body?
So, we suppose that the majority of these categories are just speculative constructions without clinical fundament. If anyone knows better, he schould let us know.
The "Five SHU Points", "Tonification Points" and "Sedating Points". - Above, we have shown that the concept of the "Five SHU-Points" (JING-Well, YING-Spring, SHU-Stream, JING-River, HE-Sea, always starting from the distant extremities) is a clear contradiction to the model of the JINGLUO as being connected to each other, with QI and Blood flowing in a triple circle.
Apart from this contradiction, we have to ask: Was there really the slightest chance to find by clinical experience which of the distal points corresponded to Wood, Fire, Earth, Metal, and Water? We don't believe it. We are convinced that this is a purely speculative construction.
And this construction, as everybody knowing about Western TCM history will confirm, even proved fatal in several aspects. What the Chinese Books still present as "Mother points" and "Son points", via France and some strange Vietnamese scripts came to the West as "Tonification Points" and "Sedation Points". Thus, the first German acupuncture book stated: "The two most important points of each meridian are the Tonification point and the Sedation point". Up to this day, there is PC software mainly working with these points.
We think that these obscure categories should disappear from the acupuncture curriculum. But what do you think?
What about the Back-SHU points? - Westerners are eager to show the coincidence of some Back-SHU points with the "Head Zones" of modern neurology. They take it as a proof that these points were found by clinical observation. But they forget that (as stated above) the "organs" must be seen as functional units, not as anatomical entities. Besides, it seems that originally there have been much more of these Back-SHU Points, for example Bl24-QIHAISHU or Bl43-GAOHUANGSHU.
Which is, according to your point of view, the clinical role of these points? And how many Back-SHU points were there originally?
The basic question of acupuncture (1): Do the acupoints (or at least part of them) really have specific distant effects which other points don't have? -
The really important question of acupuncture is not if it works (which only some fools could ever deny), nor how it works locally. The basic question is: Do certain acupoints have effects upon distant areas which other acupoints don't have? How did the ancient find these qualities? And how could we find them today?
When we started studying acupuncture, there were some German and French books telling us that Bl60-KUNLUN was the "master point of all pains". Other Western authors make St38-TIAOKOU the "master point of shoulder pain", although Chinese TCM considers it of secondary importance. As a result, we lost much of our confidence in the specific effects of acupoints.
In case of fainting, Du26-RENZHONG is recommended. But why? Theory offers no real explanation. Is this point effective just because it is near to the brain and especially painful? We don't know. Moreover, this point plays an important role in case of acute lumbago, even to be used as a single point. But how does it work? Does it really have a direct influence upon the lower back (which again would be a contradiction to the supposed direction of "QI and Blood" in this vessel)? Or via the brain (independent from original TCM theory, which didn't know the function of the brain)?
What is your opinion? Are you absolutely convinced that certain acupoints have a distant effect? And how would you explain this specific effect? (But if you explain it with the quality of a certain functional category, don't forget to explain why other points belonging to the same category don't seem to have the same quality, or at least are less frequently used.)
The basic question of acupuncture (2): Does every acupoint have a specific effect? - According to the first part of most acupuncture books, every point has a long list of possible effects and actions, being able to treat or cure many, many symptoms, syndromes and diseases. Afterwards, in the clinical part of the same book, the majority of these points are never used at all. Which makes us wonder: Do their supposed abilities really exist? And if they exist, why does nobody use it?
We think it likely that most of these descriptions were the result of clinical exaggeration or philosophical speculation. Or do you see a way how these qualities could be found by clinical observation?
Forbidden Acupoints. - In ancient scripts we find a lot of information about acupoints which should not be needled under certain conditions, especially in case of pregnancy. There are also tales about certain points in the body which, if needled, might cause immediate death. We are convinced that most of these tales (apart from inserting a needle directly into the heart) are just nonsense. Even the brain is astonishingly robust, and modern medicine pierces kidney or liver with hollow needles ten times as thick as an acupuncture needle, without causing more harm than some pain and a bit of bleeding. Of course, nobody would puncture the belly in case of advanced pregnancy. However, we know of German acupuncturists experimentally needling other "forbidden" acupoints in pregnant women, without any negative result, but maybe they didn't try to obtain a strong DE QI.
So, we should like to know about your own experiences. Which of this information could be definitely eliminated from our books, considering that the needles used today usually are much thinner than they used to be in ancient times?
Needling habits, skin types, and how to start needling. - Most acupuncturists have some "bread-and-butter acupoints" (which in China might be called "Rice points"), which they needle always, without regarding the Patient's disease. Usually these might be LI4-HEGU, St36-ZUSANLI, Sp6-SANYINJIAO or some similar points. But such habits are seldom mentioned in the books.
There are other things which seem natural to an experienced acupuncturist, but not to a beginner. Nevertheless, they are also rarely mentioned. For example, if you are standing at the bedside, you should first needle the opposite side of the body, so that, when bending over the patient, you can't accidentally hit the needles in front of you.
Then, there's the skin type. Sometimes a tender young lady may have a skin like leather, whilst an old construction worker may have a soft skin where the needle enters like in DOUFU. You cannot see this from the outside, but you must try. However, it is better not to try it needling a point which might be painful like St36-ZUSANLI. We prefer this test on a point like LI11-QUCHI, which usually is less sensible. So we like starting our needling with this point.
If you can confirm or correct these statements, or add more of your everyday experience, please do so.
How to locate some Back-SHU points. - Most TCM authors are content to copy what other books have written already, not caring about the difficulties of their students. The location of the acupoints on the back is a good example. Let's see: How do you locate Bl19-DANSHU?
The answer is nearly the same in every book: "On the back, 1.5 cun lateral to the posterior midline, below the spinous process on the 10th thoracic vertebra."
Well, you may do this easily in case of a skinny person. But haven't there been thousands of foreigners studying acupuncture in China since 1972? Did nobody of them tell his teachers about average Canadians or US-American? Didn't their teachers ever realize by themselves that there is a problem?
If you start counting the vertebrae of a 120-kilogram man or woman (either starting from above or from the sacrum) you will know what we mean. Usually, after the 4th or 5th thoracic vertebra you start guessing, so after some trying you needle just roughly according to your estimation. In most cases, this works well, thus proving that it doesn't really matter if you miss the exact point and end a vertebra higher or lower. And if you carefully check your Chinese teachers' needling, you'll find this confirmed. Nevertheless, from the aspect of teaching this is not satisfying. There is some orientation using the scapula when needling Bl13-FEISHU or Bl17-GESHU, but this is not very reliable, because the positions of the scapula changes according to the position of the patient. For the lower back points, the iliac bone can be used as a landmark point. But what can we offer for the points between?
If you have special experiences or unknown tricks to locate important acupoints, please let us know.
Therapy more intelligent than theory. - Theoretically, an acute case leading to paralysis should be considered as a SHI syndrome, whilst a chronic paralysis persisting for a long time as a XU syndrome. So, the latter one should be treated with a "reinforcing" technique and a mild stimulation. But in practice (e.g. hemiplegia after stroke) it is more effective to use strong stimulation. The reason has nothing to do with TCM theory but with brain physiology: The brain needs intensive stimulation to re-establish the damaged functions.
Would you agree that in such cases it is better to ignore traditional theory and stick to modern science? And could you give more examples of this in clinical practice?
Which was first: The hen or the egg? - This is an eternal question among acupuncture friends: Have there first been some points, found by experience and later being connected to form the JINGLUO? Or was there first a basic knowledge about certain vessels, and afterwards the idea to use certain points to puncture them? The HUANGDI NEIJING doesn't answer this question. But what about your theory?
Has acupuncture been blood-letting? - The HUANGDI NEIJING frequently speaks about "blood-letting", but this isn't used much in modern TCM. Mr. Unschuld, one oft the most eminent TCM experts in Western countries, once supposed that all acupuncture in ancient time might have been blood-letting, and that the concepts of "Reinforcing" and "Reducing" originally had to do with this aspect. Considering that needles in former times in general were much thicker than today, this is an interesting hypothesis.
Do you agree? Or did you know about ancient scripts confirming or disproving this idea?
The "Setting" of Acupuncture. - Above and below, there are so many rebellious questions and heretical suggestions that one might wonder: Are the people behind them really friends of TCM? An not in fact hidden enemies of traditional medicine?
Well, this depends. If "traditional" means to swallow everything books and teachers tell us, never object or ask questions, we might indeed be labeled as enemies of tradition. But if it is also "traditional" to check and research what the ancients left to us, develop and make the best use of it, we are in fact ardent friends of tradition.
Concerning the "setting" of acupuncture, we are really happy: This is an opportunity to praise TCM unconditionally - though we wonder why this marvelous aspect (not found in the HUANGDI NEIJING) is never mentioned in our Chinese books.
To understand the value of this setting, we have to remember the usual situation in Western private clinics. Usually, the patient has been waiting from 30 minutes to 5 hours. Then, within three or five minutes, the doctor greets him, asks for his actual condition, writes a receipt and says goodbye.
Acupuncture makes the patient get rid of his clothing, lie down, relax for 30 minutes. The doctor personally (and not the prescribed drug) treats him. For this treatment, German language has the wonderful term "Behandlung", meaning that the doctor treats someone using his own hands. Acupuncture is pure "Behandlung". The doctor touches the body with his hands, finds the acupoints, inserts the needles and manipulates them. If necessary, this is an opportunity to talk a bit or to give some advice. But if the patient prefers tranquil meditation, that's okay too. And whilst massage (also a very good and personal "Behandlung") needs 30 minutes for half an hour's treatment, acupuncture is much more economic. Most of the time the needles go on doing the doctor's work.
All this has nothing to do with TCM, "meridians" or WU XING. If there was nothing more in acupuncture but this setting, it would be enough already to make it the perfect "complementary" treatment in a modern clinic. All the better, that besides the setting the method is also efficient. So we have good reasons to integrate acupuncture into our normal medical curriculum.
What do you think about this aspect? How should the "setting" be used and developed in the future?
Acupuncture Anesthesia: "More than two million cases". - This is an unpleasant story. We should prefer to omit it. But as we promised to speak frankly about anything, we cannot ignore statements like this one: "Performing chest surgery with anaesthesia induced by acupuncture needles since 1965, our institute has been able to reduce the number of needles from the original 40 to one. We have been able to remove parts of the lung in this way." (Beijing 1981).
Which, however, was the real clinical value oft this method? In 1978 we read in China Reconstructs: "We have used acupuncture anesthesia in over two million operations with favorable results." - In 1979, during the First International Acupuncture Congress in Beijing, we were told: "More than 2,000,000 cases have been operated in China under acupuncture anesthesia." - And more than ten years later, at the 1992 World Acupuncture Congress in Rome, Mr. Zhang Fenglou from the Chinese Academy of TCM told us once again: "The acupuncture anesthesia has been applied to more than 100 kinds of various operations and summarized more than 2.000.000 cases in clinic." - Result: We are confused.
In fact, we consider acupuncture analgesia a really helpful method for smaller local operations. And we are afraid that all these exaggerations did not promote the method, but on the contrary discredit it. So we should like to ask Mr. Zhang or anybody willing to help us: What was really going on with acupuncture anesthesia? Are there some institutes still trying to develop the method? Which are their experiences?
How can the microsystems be explained in TCM terms? - The best known micro-system (supposing the whole body represented on a small area) is ear acupuncture. But it is not the only one. There is scalp acupuncture, knee acupuncture, Chinese and Korean hand acupuncture, and many more. Mr. Gleditsch, our German compatriot, invented a "mouth acupuncture", his colleague Mr. Buchheim a "vaginal acupuncture", and in Japan there is a "Yamamoto Scalp acupuncture". None of these systems have really been checked by independent institutions, so we have reasons to doubt their efficiency altogether.
However, there are serious doctors using them with good results. So, we'd like to hear about your thoughts and your experiences. How can they be explained? What do you think about their clinical usefulness?
Ear acupuncture (1). - This is, as far as we can judge it today, a dark chapter in the history of TCM. But maybe, with the help of our friends we can illuminate it.
First, let's make clear what we are speaking about. Is it "ear acupuncture" if we needle the ear region to improve a patient's hearing? - Surely not.
Nor is it "auriculotherapy" if we needle some vessels behind or in front of the ear as suggested in the HUANGDI NEIJING.
"Ear acupuncture" is a thing totally of its own. Its four basic components are:
A) The idea that the ear resembles an upside-down fetus in the mother's womb.
B) The concept that according to this fetus image, the human ear represents the whole body, each region of the ear having a close neuroanatomic relationship to the respective region of the body.
C) The hypothesis that in case of pathological conditions of some part of the body the respective region or a certain point on the ear will become painful or can be checked by means of electric devices.
D) The hypothesis that needling a certain ear point can cure pain and pathological conditions of the respective part of the body.
As far as we know, the word "ear acupuncture" (ERZHEN) was never mentioned in any of the 15,000 ancient Chinese medical scripts. There are books telling us that the sentence "The ear is the place where all the channels meet" from the LINGSHU proves the existence of early auriculotherapy - but then we might as well believe that CHANG E constructed the first moon shuttle. None of the four basic elements of Mr. Nogier's theory - the ear resembling an upside-down fetus, representing the whole body, using points of the respective areas to diagnose and treat the whole body - was ever mentioned in Chinese literature before 1959. Only in this year, the first news about Mr. Nogier's invention appeared in Chinese journals. In the same year the first books were published, introducing the new technique.
We are still waiting for the proof of what the "Outline of Chinese Acupuncture" declared in 1975: "Since 1956 the method has been used throughout China." And we still wait for the proof of what two gentlemen from Nanjing told us on the First International Acupuncture Congress in Beijing 1979: "There are abundant materials of auricular acupuncture in the old Chinese classics. On the basis of these data, Dr. P. Nogier, a French physician, assumed that the auricle points could be considered as an upside-down fetus in the uterus."
Anyone who can provide us with a Chinese ear acupuncture book or chart published before 1950 will be highly acclaimed all over the acupuncture world.
Ear Acupuncture (2). - If it should turn out true that there has been no ear acupuncture in China before 1959, the statements denying this fact would be either errors or lies, and the "Chinese ear acupuncture" basically an intellectual theft. For some people, this might be reason enough to be angry about, especially for Mr. Nogier and his heirs. However, we are much angrier about another aspect. As you will have noticed, we prefer to speak about ear acupuncture or "auriculotherapy" as a "theory". In other words: As far as we see, none of Nogier's "4 basics" of ear acupuncture have ever been proved scientifically.
Nogier 1: The auricle as an upside-down fetus. - Let us start with the coincidence which led Mr. Nogier to his theory: The resemblance of the auricle and an upside-down fetus. If this coincidence really reflected an embryologic principle, it should be found in all mammals, because the position of the fetus is nearly the same in man, dog, cat, horse or elephant. But a look at dogs is enough to prove the contrary. Short ears, long ears, triangular ears, round ears ... no resemblance at all to the position of the fetus. So we think that the resemblance in case of the human auricle is just incidental.
Nogier 2: The whole body represented upon the auricle. - The second hypothesis: That all the structures of the body are represented upon the auricle. If this should be true, the embryologic development of the outer ear should reflect development principles of the whole organism. Thus, the ear should be constructed in part by each of the three germ layers. But that's not true. So we see no embryologic evidence indicating a representation of the whole body on the auricle. Neither do we believe in a neurological connection of the auricle areas with (according to Nogier) the corresponding body areas.
Nogier 3+4: Using the auricle diagnosing and curing the whole body. - Third and forth: Using the ear points according to the fetus topography for diagnosis and treatment. As we are not convinced of the first two pillars of Nogier's building, it is only logical that we doubt the systematic applicability of the auricle for diagnosis and treatment as well. We doubt that any of the so-called "microsystems" (each of them supposing the whole body reflected on a certain area) really has a physiological foundation. We doubt the foundation of Nogier's "RAC" ("Auriculo-Cardiac Reflex"), supposing that a pathological condition of the body, when pressing the corresponding ear point, might result in a palpable pulse reflex. We think it ridiculous that some Western doctors speak about ear acupuncture as "auriculo-medicine". We don't believe in recent theories which tell us that pathological conditions are reflected by some venules appearing at the surface of the auricle. - That's one aspect of the story.
But there is also another aspect. We are well aware of the fact that there are many things between heaven and earth that work well, even if the explanation is bad. We know many serious doctors using ear acupuncture, homeopathy and foot reflexology. Apparently, they often get good results, even if we don't see any reasonable explanation how these therapies work. So we don't object to anybody using them in a responsible way. But before using them ourselves or teaching them to our students, we want them thoroughly checked.
And that's the point which really makes us angry. The efficiency of ear acupuncture as a diagnostic and therapeutical tool has never been checked in big studies by independent hospitals. China, when hearing about Mr. Nogier's theory, would have had the chance to check it thoroughly, either proving or rejecting it. But as it seems, Chinese TCM doctors couldn't stand the fact that there might be any form of acupuncture in the world not invented in China. They were so eager to put this coin into their own pocket that they didn't take the time to check if it was counterfeit.
The result is deplorable. In many acupuncture books (like in the “Newly Compiled Practical English-Chinese Library of TCM") ear acupuncture is presented as if it had the same clinical value as classical body acupuncture. By means of this vehicle, via the auricle points, there are things entering the TCM systems otherwise systematically ignored, for example "Adrenal Gland", "Subcortex" or "Sympathetic Nerve". In TCM theory it is made clear that the ZANGFU do not mean the anatomical organs, but functional systems. But when dealing with auriculotherapy, the authors forget that the ear is supposed to represent real anatomical structures. So when they think of TCM "Spleen" (central organ of digestion), they nevertheless use the "Spleen" point on the auricle, which corresponds to the anatomical spleen, concerning mainly the immune system and blood regeneration. Ridiculous ... schizophrenic ... incredible. There is no other single aspect proving the spiritual crisis of modern TCM as clearly as its dealing with ear acupuncture.
That's our point of view, at least. But what do you think? Do you think that auriculotherapy really has become a constitutive part of modern TCM? Can you tell us about extensive studies checking and proving the diagnostic and clinical value of ear acupuncture? And what do you think of the other "microsystems"? Please let us know.
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