Early History
Acupuncture has a clearly recorded history of about 2,000 years, but some authorities claim that it has been practiced in China for some 4,000 years. The Chinese believe that the practice of acupuncture began during the Stone Age when stone knives or sharp edged tools, described by the character 'Bian', were used to puncture and drain abscesses. In fact the Chinese character 'Bian' means the 'use of a sharp edged stone to treat disease', and the modern Chinese character 'Bi', representing a disease of pain, is almost certainly derived from the use of 'Bian stones' for the treatment of painful complaints.

The origin of Chinese medicine is a fascinating story and acupuncture represents only one facet of their medical system. The first recorded attempt at conceptualizing and treating disease dates back to about 1500 BC during the Shang dynasty. Tortoise shells with inscriptions dating from that time have been found, and it is thought that these were used for divination in the art of healing. The philosophical basis of much of the very early Chinese medicine seems to have been to seek harmony between the living and their dead ancestors, and the good and evil spirits that inhabited the earth.

The Development of the Chinese Approach to Medicine and Science
The first known acupuncture text is the Nei Ching Su Wen and there is a great deal of controversy about the exact origins and authorship of this book. The Nei Ching Su Wen is divided into two main sections, the Su Wen, or simple questions and the Ling Shu, or difficult questions. The book is also known by a variety of alternative titles such as the Yellow Emperor's Classic of Internal Medicine, or the Canon of Medicine, but all these titles refer to the same basic text.

The initial section of the Nei Ching Su Wen involves a discussion between the Yellow Emperor, Huang Ti, and his Minister, Ch'i Pai. This discussion lays down the philosophical basis of traditional Chinese medicine, and makes the Nei Ching Su Wen more of a treatise on health and disease rather than a textbook of medicine. Early Greek texts on medicine are mainly of interest to the medical historian rather than the practicing physician. For instance, Hippocrates does make many excellent philosophical and practical observations about disease and the doctor-patient relationship, but for the most part these texts are recipe books for a variety of ill-defined diseases. The Nei Ching Su Wen is timeless and deals almost exclusively with philosophical concepts, many of which seem to be as important today as they were 2,000 years ago.

Professor Joseph Needham, one of the greatest living experts on Chinese scientific philosophy, describes some aspects of the ancient Chinese system of science as mediaeval and retrogressive He feels that many of these concepts have distorted that development and obvious potential of Chinese medicine There is undoubtedly an element of truth in this but there is still a great deal of useful and valuable information within the traditional Chinese approach to medicine.

The Western doctor observes the facts before him and uses the current physiological theories to explain them. Chinese medicine is based on a much wider world view, which is described in the Nei Ching Su Wen, and these ideas are woven into a complete and intact system based on a philosophy different from that of modern Western medicine. The concepts of Yin and Yang, and the number five, are two of the more important ideas that permeate much of traditional Chinese scientific thought.

Yin and Yang are opposite aspects of the material world. Like night and day they are interdependent, and the existence of one end of the spectrum presupposes the existence of the other aspect; i.e. Yin is necessary for Yang to exist, and vice versa. At first the idea of Yin and Yang seems very simplistic; it is not, it describes the fundamental fluctuating balance of nature. A modern concept that pre-supposes the existence of Yin and Yang is ecology, one of the main principles of which is that the forces of the environment must be in a fluctuating balance.

The number five is also very important to Chinese thought. For example, there are five notes in the musical scale, five tastes for food and five elements in the physical world (earth, fire, water, wood and metal). The five elements are not just atomic constituents of matter, they have also been described as the five transitional stages of all physical materials. It is these philosophical ideas that form the basis of much of the discussion in the Nei Ching Su Wen.

The authorship of the Nei Ching Su Wen is attributed to Huang Ti, the Yellow Emperor, but there is some doubt as to whether Huang Ti actually existed and a great deal more doubt about the claim that he wrote the Nei Ching Su Wen. Genealogies of the Chinese dynasties list him as the third of first five rulers of China, and ascribe the dates 2697-2579 B.C to him. Ssu-Ma Ch'ien, an historian of the second century BC begins the Historical Records with an account of Huang Ti and defines him as the founder of the Chinese civilization, and the first ruler of the Empire. He is one of three legendary Emperors who founded the art of healing; the others are Shen Nung and Hsi.

It is probable that the Nei Ching Su Wen was written by a variety of people and was updated by several important Chinese physicians. Some authorities date the Nei Ching Su Wen from 1000 BC whilst others, probably more correctly, date this text to the Warring States period (475-221 BC). The Ling Shu was almost certainly added during the Warring States period, and the twenty-four chapters that comprise the Nei Ching Su Wen were probably revised and re-written at this time.

The Development of Chinese Philosophy
The Warring States period is a particularly interesting time in Chinese history and has exerted a great deal of influence on Chinese thought. Two main philosophical ideologies became part of the mainstream of Chinese thought at this time, Taoism and Confucianism.

Confucianism defined the social status of prince and pauper within Chinese society and elected the Emperor a god. It result in a basically feudal and totalitarian system of government that still exists today, in an adapted form. Confucianism impinged on medicine in that it was opposed to the development of anatomy and surgery, one of its main tenets being that the whole body was sacred and should remain complete throughout life and also in death. The Confucians believed that it was important to present oneself to 'the ancestors' whole, and there-fore one of the most feared methods of execution in ancient China was decapitation. Acupuncture and related methods were the logical answer to this constraint, as they were able to cure internal disease with external means.

The Tao literally means the 'way' and the philosophy of Taoism is a method of maintaining harmony between man and his world, and between this world and beyond. The Tao, or the 'way', has been linked to a separate creed called Taoism but its basic naturalistic philosophies permeate all Chinese thought and religion, including Buddhism. Yin and Yang are very much part of the Tao, as the Book of Changes states, 'one Yin, one Yang, being called the Tao'. The religion of Taoism became formalized during the Warring States period and a book of poems entitled the Tao attributed to Lao Tsu (c. 500 BC ), describes many of the basic concepts within this philosophy.

The Taoist concept of health is to attempt to attain perfect harmony between the opposing forces of the natural world, between Yin and Yang, the belief being that the only way to be healthy is to adjust to the natural forces within the world and become part of their rhythm. It is further realized that the natural forces are completely dependent on each other; earth is dependent on rain and rain is dependent on heaven, which in turn cannot exist without the earth. In the same way Yin cannot exist without Yang, and yet the two are opposites. The concept of a unified, but at the same time polar force, governing natural events, is central to much of Chinese thought.

At first glance these concepts seem to be an irrelevant side-line to the development of a system of medicine, but acupuncture, and its development can only really be understood if the reader grasps the traditional Chinese approach to health and disease In essence, the ideal of health is perfect harmony between the forces of Yin and Yang; this represents the correct 'way' or Tao. Disharmony brings disease and death. Taoism is a passive philosophy, exalting the art of detailed and accurate observations. This was also an essential part of the development of Chinese medical thought and allowed detailed observations on organ structure and function to be made, as discussed in the first chapter.

Acupuncture Needles
As acupuncture developed, the Bian stones were discarded and needles of stone and pottery were used. These simple, primitive needles are still used in some of the rural areas of China. Eventually metal needles began to appear and these took the form of the classical 'nine needles'. The 'nine needles' comprised the arrowhead needle for superficial pricking, the round needle for massaging, the blunt needle for knocking or pressing, the three edged needle for puncturing a vein, the sword-like needle for draining abscesses, the sharp round needle for rapid pricking, the filliform needle, the long needle for thick muscles and the large needle for puncturing painful joints.

The main needle now used for acupuncture is the filliform as most of the others have been replaced by more sophisticated surgical instruments, for instance, the sword-like needle has been replaced by the scalpel.

The 'nine needles' were initially made of either bronze, or gold and silver, and seem to have been first used about 2,000 years ago. The tomb of the Prince of Chungshan, dating from the second century BC, was excavated in 1968 and contained a set of nine needles, four being of gold and five of silver. Some acupuncturists use gold and silver needles but the majority only stainless steel filliform needles.

Moxibustion
A discussion of the history of acupuncture is incomplete without mentioning moxibustion. Moxibustion is the burning on the skin of the herb moxa. The Chinese character 'Chiu' is used to describe the art of moxibustion, and literally means 'to scar with a burning object'. Moxibustion does not now involve scarring, but moxa is still used to provide local heat over acupuncture points. It is made from the dried leaves of Artemisia vulgaris and the Chinese believe that the older the moxa, the better its therapeutic properties.