Drug lore, herbal medicine, and magical practices are essentially universal aspects of traditional and ancient medical systems. Chinese medicine is unique, however, in the development of the techniques known as acupuncture and moxibustion and the sophisticated rationalizations that justified these very ancient practices. Both acupuncture and moxibustion could be used to restore the free flow of yin and yang that was essential to health.
For at least 2,500 years, acupuncture, the art of inserting needles at specific points on the surface of the body, has been a part of Chinese medicine. Moxa or moxibustion, a related technique in which burning tinder made from the powdered leaves of Artemisia vulgaris (mugwort or wormwood) is applied to specific points on the skin, may be even more ancient than the art of needling. Acupuncture has attained considerable notoriety and a degree of acceptance in the West, but moxi-bustion has been largely ignored. Although moxibustion may produce burns and scars, practitioners claim that the pain is not unpleasant. Skeptics, however, find it difficult to imagine a burn associated with a ''pleasant pain.''
The goddesses Scarlet and White are said to have given the secret of acupuncture to the Yellow Emperor, who then devised nine kinds of needles from flint and bone. According to obscure and fragmentary references to the use of pointed stones to open abscesses and cure disease in China's semi-legendary past, marvelous needle-like stone implements were found at the foot of a jade-crowned mountain. Unfortunately, the series of steps leading from opening abscesses with sharp stones to the sophisticated system described in the Nei Ching remains obscure.
In the Nei Ching, the total number of acupuncture points is said to be 365. However, Huang Ti seems to name only about 160. The number 365 may represent a theoretically perfect system symbolically correlating the number of degrees in the celestial circle, the days in the year, and the number of parts in the human body. The points are said to be distributed along a complex system of tracts, channels, or meridians that make their way through the body. In its mature form, the acupuncture system consists of twelve main tracts, each of which carries the name of the solid or hollow organ with which it is primarily associated. The system also accommodates various auxiliary tracts and organs. For outside observers, the most disconcerting aspect of this system is probably the lack of any apparent relationship between the organ or disorder being treated and the site of the therapeutic acupuncture point.
Theoretically, acupuncture practitioners gain access to the system of tracts that are said to distribute energy throughout the body by inserting needles into specific points where the tracts are close to the surface. The idea that the acupuncturist can extract, purge, or drain energy by needling points on the tracts may reflect the evolution of the system from its empirical foundation as a means of draining pus or blood from an abscess. In the course of treating localized lesions, practitioners may have discovered that needling particular points elicited generalized effects. Certain sensations are supposed to show that the points were properly selected. These include warmth, numbness, and the feeling that these sensations are traveling slowly up or down the limbs or trunk. If the points are the primeval basis of the system, it is possible that the subjective sensation of a response traveling through the body when points are needled gave rise to maps of the tracts.
Much ink has been spilled in Western writings as to whether the tracts enjoy a true physical existence. While the functional aspects of the tracts remain a fundamental principle of classical Chinese medicine, it is possible that the system of vessels is essentially a mnemonic devise that allows practitioners to learn how to associate diverse physiological phenomena with empirically determined points. Aspiring physicians could learn the art of acupuncture from illustrated manuals and by practicing on specially prepared bronze models or wooden dolls. Ultimately, the physician had to leave behind idealized models and work with patients who were large or small, fat or thin, male or female, old or young. According to scholar-physicians, the most dangerous aspect of the acupuncture system is the possibility of misuse by ignorant or evil practitioners, because the system included a number of ''forbidden points.'' Inserting needles at forbidden points could cause serious damage or even death.
Acupuncture was especially recommended for all disorders involving an excess of yang. Moxibustion was thought to be preferable when yin was in excess. However, the relationships among yin and yang, the five phases, and the organs are so complex that the use of either method could be justified. Moxa was generally recommended for chronic conditions, such as tuberculosis, bronchitis, and general weakness, but it was also used for toothache, headache, gout, diarrhea, and some psychological disorders. Pao Ku, wife of the alchemist Ko Hung (254334), was famous for treating skin diseases with moxibustion. Officials of seventh century China would not undertake a journey unless protected against foreign diseases and snakebites by fresh moxibustion scars. In modern China, physicians have been experimenting with moxa in the treatment of influenza, chronic bronchitis, and infections of the respiratory tract.
Today, there are professional acupuncturists in Russia, Europe, North America, and South America, as well in Asia. Nevertheless, the legal status of practitioners in some countries remains ambiguous. Until the 1970s, the legal status of acupuncture was of no interest to the American medical community. Traditional Chinese medicine was dismissed as pure quackery. What could be more bizarre than killing pain by sticking needles into people (unless, of course, the needles were hypodermics full of narcotics)? Practitioners of alternative and unorthodox medicine, however, were often eager to explore the potential of acupuncture, acupressure, and moxibustion. As acupuncturists increasingly gained both notoriety and clients, the medical profession began to pay attention. The American Medical Association took the position that acupuncture was folklore, not science, but that it could only be performed by licensed physicians because needling was an invasive procedure. In 1975, Nevada became the first state to establish a state Board of Chinese Medicine and require that physicians and nonphysi-cians pass an examination to qualify as licensed acupuncturists. Although other states have established licensing procedures, the status of acupuncturists and other practitioners of Chinese medicine is often ambiguous.
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