Acupuncture: The Facts

1
Acupuncture The Facts

• Robert Imrie, DVM
• 448 NE Ravenna Blvd., 106
• Seattle, WA 98115
• aleonis_at_seanet.com

2
What Have You Heard?
Practiced for thousands of years
Used by 20 of the worlds population
Must use specific points along specific lines
Refined through history
EVERYTHING YOUVE HEARD IS FALSE
An Important Tradition of Chinese Medicine
3
Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) as practiced
today, consists essentially of herbalism and
acupuncture. Before addressing acupuncture
specifically, its important to briefly consider
two fundamental questions

• Just how Chinese is it?

...
And just how traditional is it?
4
The Huangdi neijing (The Inner Cannon of the
Yellow Emperor) is far and away the most
important early Chinese text dealing with human
acupuncture.
It may date to 200 BC, at the earliest.
(Existing copies date to no earlier than the 5th
to the 8th centuries AD, and may or may not
accurately reflect what was in earlier editions.)
5
Human TCM
Noted Sinologist and historian of Chinese
medicine, Dr. Paul Unschuld, has observed that
information presented in the Huangdi neijing is
not necessarily even Chinese in origin. Qi Bo,
the most important interlocutor of the Yellow
Emperor in The Inner Cannon of the Yellow Emperor
may be none other than Hippocrates of Cos.
Unschuld P. Chinese Medicine. Brookline, Mass
Paradigm Press, 1998, Pg. 12
Paul Unschuld
Hippocrates of Cos
6
One and the Same?
Hippocrates of Cos
Qi Bo
7
The figure Qi Bo has no background in Chinese
history or mythology, and this fact, together
with the Han-period pronunciation of his name
G'ieg Pak, allows speculation that the fame of
the Greek physician reached China two centuries
after his death.
Unschuld P. Chinese Medicine. Brookline, Mass
Paradigm Press, 1998, Pg. 12
Hippocrates of Cos
Paul Unschuld
8
Obviously, for millennia both goods and ideas
flowed in both directions along the Silk Road.
Regardless, evidence that the roots of Chinese
medicine might lie in the West has been almost
entirely ignored by modern scholars. At least,
thats so with regard to human medicine.
The West-to-East flow of medical ideas and
practices has been more clearly documented in
veterinary medicine.
9
Consider, for example The Yuan Heng liaoma
ji, "Yuan and Heng's Collection for Treating
Horses, dates to 1608, but parts of it may date
to as far back as 900 AD.

Text and illustration to the horse disease foam
spitting due to coldness in the lungs, Quantu
Niumatuojing, (Complete Illustrated Classic of
Cattle, Horse and Camel Diseases,) Yuan Heng
liaoma ji, 1608.
10
Sinologist and historian of Chinese medicine,
Dr. Paul Buell, has noted that theres a marked
similarity between procedures and herbal
treatments described in the very earliest
Chinese veterinary literature, and those
described in the much older Greek and Roman
literature.
In fact theres even evidence of direct copying.
For example, one of the operations described in
the Yuan and Heng Manual is essentially
identical, word-for-word, to an operation
described in a much older Byzantine source.
11
Greek and Latin sources even call for "needling,"
in a manner much like the needling described in
Chinese texts a thousand or more years later.
They also call for bleeding and burning in
connection with specific locations associated
with the layout of the blood vessels, just like
the later Chinese texts.
12
European illustrations of bleeding and
cauterization points are nearly identical to
Chinese drawings, and predate them by centuries.
13
West-to-East Transmission of Medical Ideas?
? Western frog pose figure from the Hellenistic
Period (?) (323BC 31BC).
Note the very similar figures from the later Han
Period (?) (208BC 220AD) in China
?
14
The association of points with therapeutics is
neither uniquely nor originally Chinese, nor is
it unique to acupuncture. The Ancient Greeks and
Egyptians, Medieval Arabs, 13th century Armenians
and Renaissance-Europeans all bled and cauterized
at specific points.
15
Compelling evidence suggests that much of what
constituted traditional Chinese medicine both
human and veterinary, was actually derived from
much older Indian, Arabic, Mongol, Persian, and
especially European traditions.
So TCM apparently isnt all that Chinese, but
surely its thoroughly traditional isnt it?
16
Well
not really.
Historian of Chinese medicine, Kim Taylor, has
recently written that much if not most of what
currently passes for TCM in humans was
essentially made up in the late 1950s and early
1960s.
During that period, for political reasons,
various academies of Chinese medicine were
established in order to promote same.
Unfortunately, there was little printed material
available that might serve as the basis for
textbooks.
17
Worse still, Chinese medicine consisted of a huge
and often contradictory assortment of theories,
ideas and practices.
Prospective textbook authors had no choice but to
either pick and choose from such a hodge-podge
and/or come up with material from scratch and
then attempt to formulate a single standardized
model.
As a result, much of the resulting TCM literature
is more a reflection of Marxist/Leninist dogma
than anything the ancient Chinese ever thought or
did.
18
Taylor points out that, remarkably, the term
Traditional Chinese Medicine didnt even appear
until 1954 and was coined by communist
government officials. Prior to that, in the
Chinese literature, Chinese medicine had always
been just Chinese medicine.
19
So now, back to ACUPUNCTURE
Since the 1970s, human and veterinary textbooks,
journal articles, lecturers, and on-line course
notes have claimed that the Chinese have been
treating people and animals by means of
acupuncture for thousands of years.
They universally claim that human acupuncture has
been around for at least 2000 years and in some
cases, even since the Stone Age.
Are these claims true?
When was human acupuncture first practiced?
How old is veterinary acupuncture?
What does the best available evidence tell us?
20
The Evidence
The best available evidence comes from the
ancient Chinese themselves
Copies of some medieval and early modern Chinese
veterinary texts survive to the present.
Copies of even older human medical texts survive.
To a lesser extent, archeological artifacts shed
light on the issues.
21
How old is human acupuncture?
The earliest Chinese medical texts known today
were discovered in 1973 at the Mawangdui graves,
which were sealed in 168 BC.
View of the recently excavated Mawangdui tomb,
1973.
22
These documents, a total of fourteen medical
texts written on silk and wood, provide a unique
and apparently comprehensive picture of Chinese
medicine as it existed during the third and early
second centuries BC.
Excerpt from the Mawangdui textual fragment
Formulas for 52 Illnesses. Ink on silk. Ca. 167
BC.
23
The Mawangdui documents are of particular
interest, not only because of their extreme
antiquity, but because theyre the only such
comprehensive medical texts to have descended
through the ages totally untouched and
unmodified.
Excerpt from Mawangdui manuscript II with
drawings of individuals engaged in physical
exercise. Condition at the time of the tombs
opening in 1973.
24
The Mawangdui texts describe moxa-cauterization
(i.e., moxibustion the burning of mugwort,
Artemisia sp., next to the skin), compresses,
fumigations, medicinal baths, minor surgery,
magical incantations, magical ritual movements,
massage, cupping, steaming, pressure with stones,
and some 217 pharmaceutical agents.
Modern reconstruction of images depicted on
previous slide
25
Although the Mawangdui texts offer a broad and
apparently comprehensive account of therapeutic
procedures available in China at the time, there
is one modality they fail to mention at all
The texts offer not even the slightest hint of
anything remotely resembling fine needle
twiddling or anything else that might
reasonably be construed as acupuncture.
ACUPUNCTURE!
26
How could this possibly be, if as many
proponents claim -- human acupuncture has been a
significant part of Traditional Chinese Medicine
for at least 3000 years?
27
The earliest literary reference to any kind of
therapeutic needling (zhen) is found in the
Shiji, Records of the Historian, of Sima Qian,
written circa 90 BC.
No known Chinese source prior to this time refers
unequivocally to such a technique.
28
The definition of the word zhen, or needling,
is problematic. It turns out that, in classical
Chinese, needling can mean anything done with
a sharp or hot instrument.
But branding, cauterizing, scarifying, bleeding,
lancing of abscesses and performing minor surgery
dont qualify as acupuncture.
29
The Shiji
Sima Qian mentions needling in passing just
three times in the Shiji. He offers no
indication that the practitioners were aware of a
system of insertion points or that they were
acquainted with the fundamental system of
conduits (described in later centuries) whose qi
flow might be influenced by needling.
He awakens the dead and brings them back to
life. Event from Bian Ques life, Shiji (90
BCE) Bian Que awakens the Crown Prince of Guo.
Temple mural from Anguo, near Beijing.
30
The Shiji
Do these brief passages from the Shiji refer to
verum (true) acupuncture?
Probably not. The details seem more consistent
with either therapeutic phlebotomy (bloodletting)
or the lancing of an abscess.
He awakens the dead and brings them back to
life. Event from Bian Ques life, Shiji (90
BCE) Bian Que awakens the Crown Prince of Guo.
Temple mural from Anguo, near Beijing.
31
The Huangdi neijing (The Yellow Emperor's Inner
Classic of Medicine,) is one of the best-known
and most important documents dealing with
traditional Chinese medicine.
Hsüan Yüan, the Yellow Emperor, legendary ruler
of antiquity Tu-hsiang pen-tsao meng-chüan
32
The Huangdi neijing is the earliest work
describing in depth the practice and theoretical
underpinnings of what clearly is acupuncture in
the modern sense -- i.e., the manipulation of qi
or vapors flowing in vessels or conduits by means
of needling.
Chi po, the supernal teacher legendary
minister of the Yellow Emperor and knowlegeable
in medicine. Tu-hsiang pen-tsao meng-chüan
And that is the definition of acupuncture.
33
So, how old is the Huangdi neijing? Does it
really date to 2,000 BC or earlier?
In fact, there is no reference to a text by this
name until the late first century BC, and the
book mentioned may or may not have been a version
of one of the surviving texts.
Today there are three distinct texts known
collectively as the Yellow Emperor's Inner Canon,
and the earliest surviving recensions date to
between the 5th to the 8th century AD.
These facts, of course, dont rule out the
possibility that the later texts accurately
reflect earlier literature and thought, but
34
The fact is the very earliest surviving texts
that unequivocally refer to acupuncture are no
more than 1,600 years old. Its impossible to
know what earlier texts said until and unless
they become available to us.
Therefore, claims that the Chinese have been
practicing acupuncture for thousands of years
or for more than 1,600 years are not directly
supported by the available evidence.
35
In the 1970's, four gold and five silver lancets
were excavated from the tomb of Han Dynasty
Prince, Liu Sheng (2nd Century BC), in Hebei
Province. Acupuncture proponents have claimed
that they are acupuncture needles.
Since these artifacts were found in association
with other therapeutic instruments, they were
presumably employed in therapeutic needling of
some sort.
36
The precise nature of this needling remains
unclear since needles were used in ancient
China not only for what might now be construed as
acupuncture, but for many other purposes,
principally bloodletting and the lancing of
various lesions.
The sheer diameter of these needles suggests
they were not intended for therapeutic
twiddling.
37
Needles made out of metals other than steel are
either too soft or too brittle to effectively
drive into tissues and then twirl in the manner
of modern acupuncturists.
The fine needles employed by acupuncturists today
can only be manufactured from drawn steel.
Its worth noting that the requisite steel
wire-drawing technology didnt exist until about
400 years ago.
38
What about veterinary acupuncture?
The earliest surviving relevant source is the 6th
century AD Qimin yaoshu.
This popular farming encyclopedia provides
insight into the character of veterinary medicine
as practiced in medieval China.
The Qimin yaoshu says nothing about acupuncture.
39
The Yuan Heng liaoma ji dates to 1608 with
parts several centuries older than that. This
work is universally cited by veterinary
acupuncture proponents as the first source that
deals in depth with veterinary acupuncture.

Text and illustration to the horse disease foam
spitting due to coldness in the lungs, Quantu
Niumatuojing, (Complete Illustrated Classic of
Cattle, Horse and Camel Diseases,) Yuan Heng
liaoma ji, 1608.
40
Does the Yuan Heng liaoma ji really deal with
veterinary acupuncture?

Yes!
It does!
But not in the way acupuncture proponents claim!
Text and illustration to the horse disease foam
spitting due to coldness in the lungs, Quantu
Niumatuojing, (Complete Illustrated Classic of
Cattle, Horse and Camel Diseases,) Yuan Heng
liaoma ji, 1608.
41
The ancient Chinese made clear distinctions
between humans and animals.
Consider the Discussion of Po Los Needling --
from the An ji ji (The Pacification of Horses
Collections), cited in Yuan and Heng
42
Dongxi said
The needling depressions
for horses are not the same as those of humans.
Why?
Qu Chuan said
The human is the
divine element among the myriad things.
Now,
as for animals, they are things.
43
The animal needling in the Yuan Heng liaoma ji
includes therapeutic bleeding, scarification,
lancing, minor surgery, branding and
cauterization, but not acupuncture.
So the source that veterinary acupuncture
advocates universally site as the most important
early work dealing with veterinary acupuncture
not only fails to mention veterinary
acupuncture...
It, in fact, suggests that acupuncture MAY NOT BE
APPROPRIATE IN ANIMALS!
44

• ACUPUNCTURE, according to the ancient/medieval
  Chinese, involves
• 1. Treating points
• 2. These points occur along channels
• 3. Qi is manipulated along these channels by
  means of needing
• As such, acupuncture has NEVER been part of the
  historical practice of Chinese veterinary medicine

45
Historian of medicine, D. C. Epler, Jr., has
observed
The technique acupuncture in humans is said to
be over 2,000 years old and contemporary authors
continue to cite ancient texts when describing
its theoretical foundations. However, when these
ancient texts are approached as historical
documents, rather than as source books that can
be continually reinterpreted for medical
practitioners, then they indicate vast
differences between the early use of needles and
the present form of acupuncture. What is now
known as acupuncture is thus the result of a long
development and bears little resemblance to its
ancestral version.
46
Unschuld confirms that probing the internal
workings of the body was of little interest to
historical Chinese physicians.
Epler explains the situation as follows as
cosmological theory became more important in
medical thought, purely anatomical factors tended
to become less significant. Hence in the history
of Chinese medicine, rather than progressing from
a reasonable, although incomplete, knowledge of
the body to a more detailed one by systematic
dissection, the medical writers go in the
opposite direction, under the sway of the
cosmologists, to a less accurate picture.
47
So, when was acupuncture first transmitted from
the East to the West?

• Chinese medicine but, curiously, not
  acupuncture is first mentioned by a European in
  the 13th Century in the travelogue of William of
  Rubruck.
• Word of acupuncture first reaches Europe with the
  return of missionaries in the late 16th century.
  
• A century later, in 1680, Wilhelm Ten Rhijn, a
  Jesuit and a practicing physician, travels from
  Java to China. He writes, in Latin, the treatise
  De Acupunctura. However, this tract clearly does
  NOT deal with acupuncture as we know it.
• No specific points identified or mentioned.
• No mention of qi Ten Rhijn treated winds
• Large needles
• The needle must be long, sharp and round. It
  must have a spiral-grooved handle and be made of
  gold. Ten Rhijn
• Needles sometimes implanted deep into skull or
  womb
• Left in place for 30 respirations -
• Subsequently, acupuncture is rejected, forgotten,
  and then rediscovered in the West in at least
  four major waves.

48
Transmission to the West 18th Early 19th
Centuries

18th and 19th centuries Acupuncture is
embraced by several French physicians, but
equally prominent doctors accuse them of
resurrecting an absurd doctrine from
well- deserved oblivion. February 18,
1821 Acupuncture is introduced into England
when Edward Joukes, sourgeon-accouher
(midwife) to the Westminster Medical
Institution applies needles to a Mr. Scott who
suffers from severe pain in the loins.
49
Transmission to the West 19th Century

• In 1822 J. M. Churchill wrote a treatise on
• acupuncturation.
• In an 1828 British veterinary journal, an
  anonymous
• author wrote
• On the whole, these acupuncture experiments
  have been very unsatisfactory. The sudden
  and magical relief which the human being has
  sometimes experienced has not been seen in the
  horse, and probably from the thickness of the
  integument, the animals suffered extreme torture
  during the insertion of the needles

50
From Gustaf Landgren's Treatise on acupuncture
Academic thesis for the degree of Medicinae
Doctor at Uppsala university, 16th May 1829.

• Two decades ago (1809) acupuncture was ridiculed
  by the medical community, then Berlioz in France
  published in 1816 concerning its efficacy in
  digestive and nervous disorders. Sarlandiere
  cured a cataleptic, and soon numerous French
  articles in every medical journal attested to its
  use. The Italians became exaggeratedly
  enthusiastic, and Germans used it successfully.
• A number of physicians in France have
  experimented with fine needles in brain, heart,
  lung, and stomach in animals without causing
  notable pain or remarkable phenomena. The author
  repeated these in cats, with no harm found.
  (Note the reference to animal acupuncture.)

51
Transmission to the West 19th Century

• 1816 French physician, Louis Berlioz, applies
  DC current to acupuncture needles by means of
  Leyden jars.
• Prior to 1825 Electroacupuncture undertaken by
  Chevalier Sarlandière.
• 1825 Physician and chemist Franklin Bache,
  great-grandson of Benjamin Franklin, translates
  (from French) Morands Memoir on Acupuncture.
  Has U.S. edition published in Philadelphia.
• 1826 J. Hunter Ewing reports he has used
  acupuncture many times and has been present
  when others have performed it, apparently with
  positive results.

52
Transmission to the U.S. 19th Century

• 1826 Philadelphia physicians Edward J. Coxe,
• D. Coxe, and Samuel Jackson, conduct exper-
• iments with acupuncture as possible means of
• resuscitating drowned people.
• European experimenters claimed to success-
• fully revive drowned kittens by inserting
  needles into their hearts. (Strangely
  reminiscent claims recently appeared in the
  Journal of the American Veterinary Medical
  Association regarding the resuscitation of
  kittens. These claims have likewise been
  contested.)
• The American physicians, unable to duplicate
  alleged European successes,

Philadelphia 1857
gave up in disgust.
53
Transmission of acupuncture to the West

• Edward Coxe reported
• whatever others may think of the
• possibility of resuscitating drowned
• persons by acupuncturation, I can only say that
  I should think myself highly culpable, if, called
  to a case of asphyxia, I were to waste time,
  every moment of which is precious, in endeavoring
  to resuscitate by a means which I sincerely
  believe to be good for nothing.

Philadelphia 1857
54
Transmission of acupuncture to the West

• In 1836, the first mention of veterinary
  acupuncture in print appears in France. The case
  reported is of a paralyzed ox treated by
  implanting 3 inch long needles in two rows on
  either side of the lumbar spine. The needles are
  described as being driven in with a mallet and
  left in place for two days.
• By 1860, acupuncture popularity seems to have
  waned. Only half a dozen references to the
  practice appear in the medical literature over
  the subsequent half century.

55
Transmission to the West Early 20th Century

• References to the use of acupuncture appeared in
  two standard human medical texts in the early
  20th century.
• In 1907, A. R. Edwards wrote regarding the
  treatment of myalgia, Deep injection of water
  into the muscles of the back may relieve pain
  but is often vigorously opposed by the patient.
• William Osler, in 1917, recommended treating
  lumbago by thrusting three to four inch long
  needles into the lumbar musculature. He assures
  the reader that ordinary bonet needles,
  sterilized, will do.

56
Acu-Points and ChannelsLost in Transmission!

• Note In none of these pre- and early 20th
  Century examples of Western acutherapy is there
  any referecnce to points or channels.
• Needles are simply inserted near either the point
  of the pain or the lesion in question.
• This is quite different from acupuncture as
  practiced by the Chinese.

57
Soulié de Morant

• 1939 Georges Soulié de Morant, publishes
  LAcupuncture Chinoise, invents the term
  meridian and, for the first time, equates qi
  with energy.
• Qi was originally vapor rising from food.
• Meridians were either channels or channel
  vessels.
• Soulié de Morant went to China at the turn of the
  century, where he served as French Consul in
  Shanghai, and then as a judge in the French
  Concession.
• He became convinced that acupuncture could cure
  cholera, among other things.
• Soulié de Morant returned to France in 1917,
  where he began actively promoting acupuncture
  among medical professionals.

58
1940s and 50s

• 1940s During WWII a small group of proponents
  forms in secret in Paris.
• 1943 The French Society for Acupuncture founded
  -- the oldest such society in the western world.
  
• Paris becomes the center for western acupuncture
  for many years.
• The Deutsche Gesellschaft fur Akupunktur (The
  German Society for Acupuncture) founded in . 1952
• 1954 The Austrian Society for Acupuncture
  founded.

59
1957 Human auricular acupuncture
( or earupuncture -)
Traditional Chinese therapy invented in by
French physician, Dr. P.M.F. Nogier.
Based on his sudden intuition that the
antihelix of the ear is equated with the human
vertebral column in the inverse direction.
60
In the 1970s, veterinary proponents coopt ear
acupuncture. Now its part of Traditional
Chinese Veterinary Medicine, too!
(Note the striking resemblance to the equine
vertebral column in the inverse direction or
maybe not.)
61
and it works in pigs too!
62
and, of course, cows!
63
Proponents of both human and veterinary
acupuncture tend to overlook the fact that, after
the introduction of scientific biomedicine in
Asia, acupuncture largely fell out of favor
there. In an effort to modernize medicine, the
Chinese government attempted to ban acupuncture
first in 1822, and several times later. In
Japan, acupuncture was similarly prohibited in
1876. By 1911, acupuncture was no longer a
subject for examination in the Chinese Imperial
Medical Academy. Prior to the Second World War,
the Nationalist Chinese government tried to ban
the use of traditional Chinese medicine
altogether.
64
1949 1956 Mao Rescues Chinese Medicine
In an abrupt about face, on Maos orders Chinese
medicine is revived for political reasons. There
are not enough scientifically trained
practitioners in China to go around (only about
10,000). The only alternative to Chinese
medicine is no medical care at all. Mao
originally expresses the intention that,
eventually, Chinese medicine and its
practitioners will somehow be brought up to
scientific snuff. Ultimately, he seems more
intent upon dealing a blow to the elitist,
arrogant and ideologically suspect Western
medical community. He forces them to swallow the
distasteful pill of embracing Chinese medicine on
an equal if not superior footing to scientific
biomedicine.
65
Chinas medicine and pharmacology is a great
treasure-house!! Mao Zedong, October
11, 1958
According to his Western-trained personal
physician, Mao stated that even though I believe
we should promote Chinese medicine, I personally
do not believe in it. I dont take Chinese
medicine
66
1971-2 Journalist James Restons and Richard
Nixons physicians experiences during a 1972
visit to China are often cited as the seminal
events leading to the introduction of acupuncture
in the West. It was widely reported (and many
people still believe) that Reston had his
appendix removed under acupuncture anesthesia.
In fact, chemical anesthesia was used.
Acupuncture was administered the day after
surgery, and Reston claimed that an hour after
the needles were inserted, he experienced pain
relief. Its more likely that pain relief was
merely the result of the return of normal bowel
motility.
67
Almost certainly bogus photo of open heart
surgery Note that though the chest has been
opened, the patient appears to not be on a
respirator of any kind. How is he managing to
breathe?
68
Who is Dr. Xie?
Good question!
From his Website Shen Huisheng Xie, DVM, PhD,
is a third generation Traditional Chinese
Medicine (TCM) practitioner who was born and
educated in China. His teaching reflects a deep
commitment to this way of life, and he
specializes in making this rather complex
information palatable and understandable to the
western mind emphasis added. After teaching
university students these techniques for a number
of years, he recognized the need to simplify and
organize this information in a user-friendly way
so as to clarify it to dovetail with the Western
approach, and make it practical and useful for
everyday application. In 1998, Dr. Xie founded
the Chi Institute in Reddick, Florida to train
veterinarians in Chinese Acupuncture and Herbal
Medicine. He is a head-clinician of TCVM in the
Veterinary Medical Teaching Hospital at the
University of Florida.
69
As one of the chosen peer reviewers for the
Journal of the American Veterinary Medical
association, he is also largely responsible for
making sure that JAVMA never publishes any
accurate information regarding either the history
or the practice of so-called Traditional Chinese
Veterinary Medicine. (He has nixed the
publication of several papers written by myself,
Paul Buell and others on the basis that they
contradicted everything he had ever been taught
by the communist government academies about
acupuncture and TCM/TCVM.)
Note Dr. Xie acupuncturing a dog, just like they
did(nt) in ancient China.
and a horse.
For 149.00 plus tax you can buy his book. (pub.
in PRC)
For about 4,000 a pop, vets can take one of his
many training courses.
70
Ironically, over the last 35 years, as TCM has
grown ever more popular in the West, it
seems to have grown ever less so in China. In
1995 the Committee for Scientific Investigation
of Claims of the Paranormal (CSICOP) was
invited by the Chinsese Associ- ation for
Science and Technology (CAST) to send physicians
and scientists to investigate the current
status of TCM in China. Oncologist, Wallace
Sampson, and psychologist Barry Beyer- stein
made the following observations while describing
their visit to the China Academy of Traditional
Chinese Medicine in Beijing We were told
that, these days, the proportion of Chinese
patients choosing TCM, nationwide, is only about
15 to 20 percent, a figure that surprised us
The 15 to 20 percent estimate was later
reiterated by other informants who practiced TCM
in Shanghai Diagnoses for the patients we saw
had generally been made by biomedical physicians,
and the patients had elected to receive TCM in
addition to their Western treatments.
71
Veterinary AcupunctureMid-20th Century to
Present
There is no evidence of verum acupuncture being
employed in animals anywhere in the world prior
to the mid-20th Century.
(A few folks may have been sticking needles into
animals and calling it acupuncture earlier than
that, but no one was attempting to manipulate qi
in channels or meridia by means of needling
specific points.)
Even modern proponents of veterinary acupuncture
admit that there is no information on small
animal acupuncture from ancient China. (Klide
and Kung, 1977, pg 67)
Thats because the ancient Chinese didnt treat
small animals at all, much less with acupuncture.
72
Small animal veterinary medicine (i.e., medical
practice applied to dogs, cats and domestic fowl)
did not exist in ancient China. As historian of
Chinese medicine Catherine Despeux has observed
The art of healing horses was
well-developed. Then comes the buffalo, the hog
and the camel. Fowl (chicken and ducks) have
never been the subject of developed treatments,
and even less dogs and cats, the latter having
become pets only recently among a small minority
of Chinese. Living in a half-wild state, the dog
and the cat were only accepted as guardians and
hunters of rodents. Just look at the strong
reactions of many Chinese in France to the many
pets there to understand the scorn the Chinese
have for all animals in general, except for the
most useful. The human and civilized world
should never mix with the savage one, according
to Confucian tradition Despeux C,
Apercu historique de l'art vétérinaire en Chine.
Revue d'acuponcture vétérinaire, 1981 921-22
73
1950s 1960s Europe

• According to Phillip A. M. Rogers European
  pioneers of modern vet AP in the 1950's and 60's
  included Kothbauer (Austria), Milin (France) and
  the late Westermayer (Germany).
• Milin used acupuncture on small animals in Paris
  during the 1950s. He employed an electrical
  point detector to locate acupuncture points in
  dogs and formulate canine acupuncture charts.
  Supposedly he confirmed that one could
  successfully transpose point and meridian
  locations from humans to dogs. He published in
  various French language journals as early as
  1963.
• Westermeyer and Kothbauers activities were
  limited primarily to cattle.

74
1950s 1960s Europe

• In the late 50s and early 60s, Kothbauer
  discovers Kothbauer points in cattle. The
  latter are alleged to be reflex points on the
  skin associated with various major internal
  organs. He located these points by injecting
  Lugols solution into cattle and then employing
  an electrical point detector.
• 1961 Kothbauer publishes On pain point
  diagnosis and neural therapy in animals, Wiener
  Tierarztl. Monattschr., 53, 282.

75
1977 The first veterinary acupuncture text
published in the West
Alan Klide, VMD
Klide and Kungs Veterinary Acupuncture,
University of Pennsylvania Press, 1977.
76
By far the most interesting and revealing
material in this book is ten pages of text
translated directly from the Chinese Veterinary
Handbook published in 1972 by the Chinese
government.
This material is devoted almost entirely to
therapeutic phlebotomy (bleeding), hot needling
(cauterization), and the lancing of lesions in
order to drain swelling and release gas rather
than to anything we would recognize as
acupuncture.
Anon. 1972, Chinese Veterinary Handbook, Lan
Chou Veterinary Research Institute. Gan Shu,
China The Peoples Publishing
77
Hemoacupuncture from Klide and Kung
Note the needle hammer gt
lt Needle hammering point HN18 which looks
an awful lot like the jugular vein
Hammering hemoacupuncture point FL16 gt
78
Consider the various needles described
79
And
Note that only 6 out of these 18 needles appear
to be what one might reasonably construe as
acupuncture needles. The four on the left are
hot or cauterizing needles.
OUCH!!!
80
Not surprisingly, the Yuan Heng liaoma ji (1608
veterinary manual) specifies that the lancets and
blades employed in needling (bloodletting,
cautery and lancing) in animals should not be
rotated for fear of causing uncontrollable
hemorrhage!
Klide and Kung offer several examples of
acupuncture stabilization. Obviously, such
stabilization wouldnt be required for a
procedure as benign as what we construe as
acupuncture.
81
Klide and Kung go on to describe not only
Horseupuncture
82
but also Cowupuncture
83
Camelpuncture
84
Catupuncture
85
Dogupuncture
86
Pigupuncture
87
Goatpuncture
88
And, my personal favorite Chickenpuncture!
89
Understatement of the Millennium?
The practical application of Meridian theory is
late in coming to Chinese veterinary medicine.
Alan Klide, DVM
Klide and Kung, 1977, Pg. 16
As veterinary acupuncturist Sheila White has
observed Equine (animal) acupuncture (points
and) meridians date only to the 1970s and were
invented at the insistence of Western
practitioners. White S in Schoen A
(ed.), Veterinary Acupuncture, 1994, pg 584
90
The more things change, the more they stay the
same. A quarter century after the original came
out, Klide and Kung was re-released. Note a
single word was changed!
How many biomedical textbooks in the 21st century
can go 25 years without requiring a major update?
Acupuncture scholarship is literally going
nowhere fast.
91
The physicians of today have been cut off from
the ancient tradition of human medicine how
much more does this apply to veterinary
medicine! Hsü Ta-chun, 1757
From the I-hsüeh Yüan Liu Lun of 1757, by Hsü
Ta-chun, translated by Paul U. Unschuld,
Forgotten Traditions of Ancient Chinese Medicine
A Chinese View from the Eighteenth Century, 1998
92
Do Acupuncture Points Really Exist?

• In humans, acupuncture points were never in
  precise locations
• The earliest human texts contain no point charts

93
Do Acupuncture Points Really Exist?
In humans, there were originally 360 acupuncture
points. The basis for this number was
cosmological (i.e. the number of days in the
year) rather than empirical.
Currently, more than 2000 acupuncture points have
been discovered in humans.
Felix Mann has commented that if modern human
acupuncture texts are to be believed, there is no
skin left which is not an acupuncture point.
(Mann is the is the founder of the Medical
Acupuncture Society and First President of the
British Medical Acupuncture Society.)
94
Do Acupuncture Points Really Exist?
As anatomical entities, acupuncture points may be
located in the vicinity of peripheral nerves,
ligaments or tendons. However, there is no
consistent association with any one specific
gross anatomical structure.
Several investigators have reported various
histological findings at acupuncture points, such
as nerve terminals, neurovascular bundles or mast
cell accumulations however, none of the studies
used statistical evaluation of quantitative
histological data to confirm the significance of
their findings.
No method of determining acupuncture point
locations has yet been shown to be precise or
repeatable.
95
Do Acupuncture Points Really Exist?
Electrical skin resistance, which can be detected
by various devices, has been shown to be an
inaccurate and unreliable method of detection.
Its influenced by such factors as
Shape and surface area of the electrode.
Dryness of the skin
Local variations in skin thickness
Scanning speed of the device
Pressure placed on the electrode
Inclination of the electrode
Electrode gel used
Room temperature and humidity
96
Do Acupuncture Points Really Exist?
As anatomical entities, acupuncture points may be
located in the vicinity of peripheral nerves,
ligaments or tendons. However, there is no
consistent association with any one specific
gross anatomical structure.
Several investigators have reported various
histological findings at acupuncture points, such
as nerve terminals, neurovascular bundles or mast
cell accumulations however, none of the studies
used statistical evaluation of quantitative
histological data to confirm the significance of
their findings.
No method of determining acupuncture point
locations has yet been shown to be precise or
repeatable.
97
Do Acupuncture Points Really Exist?
Functional MRI is a new technique that measures
brain activity by detecting changes in oxygen
delivery to parts of the brain during stimulation.
Recent studies have suggested that acupuncture
caused such changes in parts of the brain.
Unfortunately, such studies have failed to employ
sham acupuncture controls, so its not possible
to state that such changes, if theyre
significant, are specific to acupuncture points.
Increased brain activity would be expected from a
wide variety of sensory inputs.
98
Do Acupuncture Points Really Exist?
Acupuncture points have failed to demonstrate
sensitivity to palpation relative to other points
on the human body therefore, relying on point
sensitivity as the sole form of point location is
likely to be of dubious utility.
Finally, directional and proportional methods for
measuring acupuncture point locations - the most
widely used methods for locating acupuncture
points in man - have also been shown to be
grossly imprecise
99
Do Acupuncture Points Really Exist?
The irrelevance of specific points for any
effects of acupuncture is underscored by the fact
that most studies that have compared sham and
real acupuncture points have been unable to
show a consistent difference in response to
manipulation between sites. I.e., overall,
sham acupuncture tends to work nearly as well
as real acupuncture in controlled clinical
trials.
In the same vein, similar efficacy has been
asserted between traditional and
transpositional points in horses -- i.e. points
misidentified from ancient Chinese equine
bleeding and cautery charts vs those transposed
onto horses from human acupuncture charts.
100
Do Acupuncture Points Really Exist?
Thanks to transposition from humans to animals,
horses have been blessed with a gallbladder
meridian even though they dont have gallbladders!
101
Do Acupuncture Points Really Exist?
acupuncture points are no more real than the
black spots that a drunkard sees in front of his
eyes. (Felix Mann. Reinventing Acupuncture A
New Concept of Ancient Medicine. Butterworth
Heinemann, London, 1996, 14.)
102
Do Acupuncture Meridians Really Exist?
The term meridian is taken from geography and
was coined in France in 1939.
Theyre alleged to be channels through which qi
flows.
In human acupuncture, meridians described in
the earliest literature as mai have changed
dramatically in number, name, character, and
position over the last 2200 years. (How many
other anatomical structures can claim such
flexibility over such a brief period?)
103
Do Acupuncture Meridians Really Exist?
Blood vessels are the obvious original referent
of mai. The earliest attestation of the word is
fourth century B.C., in a Zuozhuan description of
a horse chaotic vapor, untamed, erupts dark
blood springs forth, coursing ridges of swollen
vessels (mai) bulge. (Zouzhuan, Xi
15,14.3a)Don Harper. Early Chinese Medical
Literature, pg. 82
104
Do Acupuncture Meridians Really Exist?
Early Chinese texts describe 11 mai containing
both blood and qi.
By the late first century BC, 12 vessels are
described, and they follow different courses than
the original 11.
To confuse the issue further, a Western Han tomb
figurine, discovered in 1993, depicts 9 channels
two of which are different from those mentioned
in earlier sources.
105
Do Acupuncture Meridians Really Exist?
So, a proper response might be Which
meridians do you mean?... from what period?
In any case, one might ask what about the
various studies that have alleged to demonstrate
the existence of meridians or at least the
meridians used by most modern Chinese
acupuncturists?
106
Do Acupuncture Meridians Really Exist?
Histological Evidence In humans, meridians have
been examined for their correspondence with
nerves, blood and lymphatic vessels.
Its difficult to assess these reports, because
they have often included minimal detail.
It does appear that points are occasionally
linked by the same nerve, or the same blood
vessel or, although less likely, the same
lymphatic channel.
However, no channel studied has ever completely
correlated with any of these three structures.
107
Do Acupuncture Meridians Really Exist?
Radiotracer studies
There have been at least three attempts to
validate the concept of meridians using
radiotracer injections.
Early investigators concluded that an injected
radiotracer was cleared by non-lymphatic and
non-venous pathways and suggested that this
demonstrated the existence of acupuncture
meridians.
However, a subsequent attempt to replicate this
finding was unsuccessful and the authors
concluded that the radiotracer was removed along
normal venous pathways.
108
Do Acupuncture Meridians Really Exist?
Radiation of sensation
Insertion of acupuncture needles may cause a
radiation of sensation in humans away from the
point of insertion. However, this sensation
doesnt generally correspond to the paths
described for the postulated meridians.
Studies fairly conclusively demonstrate that its
the nervous system, and not changes in qi flow
through meridians, that result in the
acupuncture sensations reported in humans.
109
Do Acupuncture Meridians Really Exist?
Thermography, Ultrasonography, Magnetism, Light,
Heat
Some investigators have claimed that temperature
changes on the surface of the body are a
reflection of meridians.
Others have claimed that a variety of modalities,
including ultrasound, magnetism and light have
demonstrated their existence.
Such experiments are difficult to assess because
the details provided are generally sketchy and
the investigations are rarely conducted under
rigorous, well controlled conditions.
110
Do Acupuncture Meridians Really Exist?
If acupuncture points and meridians really
existed, one might expect they would have been
recognized in the study of anatomy and
physiology.
No such recognition has been forthcoming.
111
What about efficacy? Does acupuncture work?
An appropriate response might be
Does which acupuncture work?... and what exactly
do you mean by work?
112
Was there ever just one acupuncture?

• No. Common sense, geography and the
• historical record indicate just the opposite.
• China is a huge country. One would
• expect a wide variety of Chinese medicines
• to have arisen from various local schools
• of thought, and during various eras.
• In addition to various Chinese acupunctures,
  there are various Japanese, Thai, Korean and
  Indian acupuncture modalities most of which
  have been invented over the last few decades.

113
Some variants involve just the scalp
others just the hand
others just the ear
and still others, just the just the foot.
114
Some variants involve just the tongue.
and others just the cheek and chin.
Some call for deep needle placement, some for
superficial placement, and others call for sham
acupuncture where there is no penetration at all.
115

• Some traditions call for the passage of
  electrical current through needles. Others call
  for the use of dermal pad electrodes with no skin
  penetration at all.
• Therapeutic touch over acupuncture points is
  really therapeutic non-touch. I.e., it merely
  involves therapeutic hand-waving over said
  points.
• Practitioners of all of these traditions claim
  substantial clinical efficacy just as
  therapeutic phlebotomists did for bleeding prior
  to the mid-19th century.
• The fact that efficacy is claimed for all these
  variants strongly suggests that acupuncture has
  no specific, above placebo, beyond distraction,
  etc., effects.

116
What about efficacy? Does acupuncture work?
Most acupuncture trials and reviews in man are
handicapped by poor methodological and design
quality.
These flaws frequently include failure of
blinding, failure of randomization and/or errors
in allocation, variable or post hoc selection of
endpoints, inadequate numbers of subjects,
variable/inappropriate choice of control
treatment/placebo, inappropriate lumping of
various unrelated acu-therapies together.
Publication bias and other seemingly-benign
sources of error probably account for the slight
edge active acupuncture seems to enjoy among
lower-quality trials and systematic reviews. The
fact is, positive results tend to get published,
negative results tend to end up in the dumper.
117
What about efficacy? Does acupuncture work?
It has been shown that the higher the quality of
acupuncture/TCM clinical trials RCTs, the more
likely they are to yield negative results, and
vice versa. Most of the highest quality trials
have been negative.
Do certain countries produce only positive
clinical trials? Unfortunately, the answer is
yes. One study found that, over a 30 year
period from 1966 to 1996, all acupuncture
clinical trials published in China, Japan,
Russia/USSR, and Taiwan were positive. Over that
period, no trial published in China or Russia
found any test treatment to be ineffective.
If you know that a given country produces only
positive trial results, how much weight should
you reasonably lend any trial conducted or
published in that country?
118
What about efficacy? Does acupuncture work?
What about undetected fraud?
The Cochrane Collaboration and other entities
putatively dedicated to evidence based medicine
EBM fail to take into account either prior
probability of efficacy or the possibility of
fraud.
119
Why Acupuncture may Seem to Work when it Doesnt
1. Counter-irritation (physical, direct)
2. Attention diversion (mental, secondary - as
with misdirection in magic). Stick a needle in
the body and the body notices.
3. Expectation
4. Suggestion
5. Mutual consensus (folie a' deux).
Principals of Norm of Reciprocity and Compliance
Demand. How are you? Im fine, thank you
(even though I may be suffering from a terminal
disease.)
6. Causality error mistaking the resulting
lessened symptoms as due to needling rather than
to other effects. Also known as post hoc
reasoning and misattribution.
7. Classical conditioning unconscious,
resulting in unconscious conditioned response.
120
Why Acupuncture may Seem to Work when it Doesnt
8. Reciprocal Conditioning symptom worsens
when treatment stops.
9. Operant (Skinnerian) conditioning. Personal
action results in a reward.
10. Operator conditioning (another invented
term, meaning effects on the operator the
operator becomes victim of causality error and
conditioning, just as the subject does. Operator
also has economic and political investment.
Subject and operator become a self-perpetuating
system (folie a deux.)
11. Reinforcement - whole conditioning system
recycles with each recurrence. 
121
Why Acupuncture may Seem to Work when it Doesnt
12. Group, cultural consensus efficacy concept
becomes "embedded in the culture," an
axiomatic belief system evolves, transmitted from
individual to individual and by societal
pressures.
13. Economic and emotional investment. (Once
invested, dont stop now, or all will be lost.)
14. Social and/or political disaffection
(Dominant biomedicine is perceived as
unsuccessful and physicians/biomedicine is
therefore dismissed.
15. Socking in the belief. Social rewards for
expressing beliefs also reinforce said beliefs.
16. Endorphin release? Endorphin release is
largely non-specific and may be a
minor contributor to other more powerful
non-specific effects cited here.
122
Why Acupuncture may Seem to Work when it Doesnt
17. The variable course natural history of
disease especially chronic disease. (This is,
in part, the basis for all the previously cited
factors. All of these factors are superimposed
over the natural waxing and waning of disease
symptoms.)
18. Regression to the mean. People present to
therapists (or present their animals to
therapists) when they are feeling worse. Due to
the variable natural history of most diseases,
they will almost certainly be feeling better
within days or hours. This improvement, if it
follows an ineffective therapeutic intervention,
is likely to be attributed to that intervention.
19. All placebos are not created equal.
Acupuncture is invasive, mildly painful, and
involves close interaction with the therapist
unlike a sugar pill.
123
Mechanisms of action
(or explanations in search of something that
needs explaining)
The Gate Theory of Melzack and Wahl
A weak neural signal is supposed to block a
stronger one at the level of the spinal chord.
124
Mechanisms of action
Though its now thought that pain perception is
modulated primarily at the level of the brain
rather the spinal chord, this mechanism may play
a minor role in acupuncture effects just as
rubbing ones toe after stubbing it helps to
relieve the pain to a degree.
125
Mechanisms of action
The endorphin theory
It has been hypothesized that acupuncture effects
are mediated by beta-endorphins or other
neuro-peptides.
While endorphins, etc., may play a minor role in
perceived acupuncture effects, they are
non-specific. I.e., a great many noxious stimuli
result in elevated levels of endogenous opioids.
The latter have a very short half-life
generally on the order of a few minutes and
should not be responsible for the long term
effects claimed by acupuncture proponents.
Endorphins are also credited by some
investigators as the mediators for the placebo
effect, itself.
Loading a horse into a trailer or throwing a
stick for a dog will cause endorphin release, but
that doesnt mean these are effective medical
interventions.
126
The Best Case Evidence for Efficacy
First things first
While chronic pain is the condition for which
acupuncture is most often employed today, the
ancient Chinese didnt use acupuncture as a
treatment for pain, per se. In fact, they
maintained that acupuncture was not for the
treatment of manifest disease at all. I.e., it
was so subtle an intervention that it should only
be employed at the very beginning of a disease
process. Furthermore, they observed that it was
only likely to work if the patient believed it
would work!
In any case, acupuncture has not been shown to
alter the natural history or course of any
disease in any species.
127
The Best Case Evidence for Efficacy
Post-operative nausea and vomiting (PONV), nausea
due to chemotherapy, post-operative dental pain,
tennis elbow (lateral epicondylitis), and
migraine have in recent years generally been
considered the indications for which the
best/strongest objective scientific evidence for
acupuncture efficacy currently exists.
For most of the remaining conditions for which it
is used, such as for human back pain, and various
addictions, it is either impossible to draw
conclusions about efficacy due to conflicting or
poor quality data, or the conclusions are
negative.
In other areas for which acupuncture was
previously advocated, such as for surgical
anaesthesia, the use of acupuncture has been
largely abandoned even in China.
128
The Best Case Evidence for Efficacy
In the interest of brevity, Ill consider only
acupuncture as a treatment for post-operative
nausea and vomiting as a best case for efficacy.
In 1999, Anesthesia and Analgesia published a
meta- analysis by Lee and Done titled The use of
nonpharmacologic techniques to prevent post
operative nausea and vomiting.
What follows is based on a letter to the editors
submitted by Kim Atwood, MD, critiquing Lee and
Dones meta-analysis. (The editors refused to
publish Kims letter. It eventually was
published, several years later, in the Scientific
Review of Alternative Medicine.)
129
The Best Case Evidence for Efficacy
The meta-analysis included such techniques as
acupuncture, electro-acupuncture,
transcutaneous electrical nerve stimulation
TENS, acupoint stimulation and acupressure.
Nineteen randomized trials (out of a total of 24
identified) were deemed eligible for the
meta-analysis, and all of them involved
stimulation of the P6 acupuncture point (on the
wrist.)
Eleven trials were reported as positive and eight
as negative. All four trials in children were
negative.
Lee and Done concluded that these techniques are
effective in adults, but not in children. Their
conclusion is unlikely to be valid for the
following reasons
130
The Best Case Evidence for Efficacy
Prior to the publication of the meta-analysis an
article had appeared demonstrating that during
the period 1966-1995 (the entire period
investigated) certain countries produced only
positive RCTs of acupuncture or any other
intervention, for that matter. The authors of
that paper concluded that this was evidence of
publication bias. It is also evidence of other
types of bias. One of the countries that produced
only positive studies was Taiwan.
In the Lee and Done meta-analysis four of the
positive trials, but none of the negative, had
been performed in Taiwan. Among these was the
only trial that Lee and Done awarded the highest
methodology rating. But that trial reported an
improbable result in the intervention group only
1/30 post-op caesarian patients had nausea and
0/30 had vomiting.
131
The Best Case Evidence for Efficacy
The incidence of nausea and vomiting after
cesarean section in humans is typically at least
20-30. Thus it is reasonable to dismiss all
four reports from Taiwan as unreliable.
Of the seven remaining positive trials, Lee and
Done gave a methodology rating of 1 point (out
of a possible 5) to four. None of the negative
trials received that low a rating. According to
Lee and Done, a rating of 1 meant either that
the study described itself as randomizedbut with
no explanation of the method of randomizationor
that that the study gave the number and reason
for withdrawals. Thus a study neednt have been
blinded, appropriately randomized, or randomized
at all to be included in the meta-analysis. It is
reasonable to dismiss all trials rated 1 as
unreliable.
132
The Best Case Evidence for Efficacy
Of the three remaining positive trials, one
reported an anomalous result the incidence of
vomiting in the intervention group was four
times higher than the incidence of nausea in the
same group. The authors reported no
methodological or statistical explanation for
this (