Traditional Chinese Medicine (TCM) as it exists today is the result of the Chinese people’s struggle against nature over several millennia. From the earliest antiquity, they observed and passed on their experience with disease and its effects in order to survive the most demanding aspects of nature. Within TCM’s multiple systems, acupuncture and moxibustion are disciplines which study meridians, acupoints, methods of manipulation, and mechanisms of disease, clinical treatment, and even anesthesia.
As early as the clan commune period of primitive Chinese society (8000–2000 B.C.), acupuncture and moxibustion were important innovations of the Chinese nation. Ancient Chinese legends about the origin of acupuncture and moxibustion include Fu-Xi’s creation of therapeutic techniques with stone needles, and the Yellow Emperor’s invention of acupuncture and moxibustion.
Humans were in China 1.7 million years ago, and the oldest human remains, Lantian Man, date back 650,000–800,000 years. With the discovery of fire, these Old Stone Age people found relief from certain symptoms and diseases by warming certain body areas with hot stones, and earth wrapped in bark or in animal skins. Eventually, they put smoldering branches or dried grass on the skin to treat disease. Later they discovered that the Chinese Mugwort (Artemisia vulgaris) leaf had the greatest curative effect. These ancestors used stone tools to incise abscesses, drain pus, and let blood for therapeutic purposes. With accumulated experience, refined technique, and improved manufacture, these stone tools, Bian Shi (
, “sharp stone”), developed into specialized medical tools by the New Stone Age. Stone needles measuring 4.5 inches, found at Inner Mongolia’s and Shandong Province’s New Stone Age ruins, are powerful evidence that acupuncture originated early in primitive society. Bone and bamboo needles were developed and, with the discovery of the meridians, acupuncture therapy emerged.
The Academic Accomplishments of Acupuncture and Moxibustion in History
During the Xia, Shang, and Western Zhou dynasties, and the Spring and Autumn Period (2100–476 B.C.), medical theories were substantially developed. Inscriptions on bones and tortoise shells of this era depict diseases such as intestinal parasites and toothache. The theories of Yin and Yang, and the Five Elements were developed; a basic understanding of pulse, Qi, essence, Shen, and body fluid was gained; a concept of environmentally-induced pathology was attained; and TCM theory was born.
Bronze medical needles were introduced with the development of bronze casting, but Bian Shi remained the main medical tool until iron instruments were developed during the Warring States Period (475–221 B.C.). As recorded in The Miraculous Pivot, nine needle types were initially developed, and used to puncture, surgically incise, and massage. In this period, ancient doctors generalized and summarized medicine and pharmacology, and wrote special books on acupuncture and moxibustion. In the No. 3 Han Tomb excavation at Mawangdui, Hunan Province, two third century B.C. silk scrolls were discovered that recorded meridians and collaterals. Another milestone for this period, the Nan Jing (The Classic of Difficulties), discusses the five elements theory, aura diagnosis, the eight extra meridians, and other important topics.
During the Huang Di or Yellow Emperor period (2697–2597 B.C.), a famous dialogue between Huang Di and his physician Qi Bo was a milestone in acupuncture history. Their discussions on the whole spectrum of the Chinese Medical Arts later became a monumental text — The Internal Canon of the Yellow Emperor 
. This earliest book on Chinese Medicine was compiled around 305–204 B.C., and consists of two parts:
Basic Questions 
in 9 volumes and 81 chapters, introduces anatomy, physiology, disease etiology, pathology, diagnosis, syndrome differentiation, prevention, Yin–Yang, the five elements, treatment, and man’s relationship to nature and the cosmos.
The chapters of The Miraculous Pivot 
focus on acupuncture, acupuncture point functions, the nine needle types, needling techniques, meridian descriptions, Zang–Fu organ functions, Qi types, and 160 location points.
In approximately 1000 B.C., during the Shang Dynasty, hieroglyphs showed evidence of Acupuncture and Moxibustion. Bian Shi remained the main needle, but bronze needles were also excavated from ruins.
Qin Shi Huang, the first Chinese emperor, founded the Qin dynasty (221–207 B.C.), but was a harsh ruler who burned many books that encouraged free thinking, yet spared all medical journals. He greatly furthered TCM development by standardizing measures, which enabled the recording of accurately measured acupuncture point locations.
China flourished under the less tyrannical rule of the Hans (206 B.C.–220 A.D.), and Confucianism emerged. China fought many battles during its rapid expansion, which afforded Chinese doctors a great opportunity to expand medical science while treating war casualties. Some notable TCM doctors emerged. Hua Tuo pioneered herbal anesthesia for surgery, selected only one to two points for acupuncture treatment, and took much note of the distribution of the needling sensation. He is credited with writing The Canon of Moxibustion and Acupuncture Preserved in a Pillow (lost). The outstanding physician Zhang Zhongjing finished his Treatise on Febrile and Miscellaneous Diseases 
, a book still studied by TCM students now.
From 260 to 265 A.D., the famous physician Huangfu Mi organized all ancient literature into his classic text, Systematic Classics of Acupuncture and Moxibustion. This 12-volume text describes 349 Acupuncture points. It is organized by theory: Zang–Fu, Qi and blood, channels and collaterals, acupuncture points, and clinical application. This noted book is one of the most influential texts in the history of Chinese Medicine.
Acupuncture was very popular during the Jin, Northern, and Southern Dynasties (265–581 A.D.). For generations, the Xu Xi family was known as Acupuncture experts. During this period, important texts and charts enhanced knowledge and application.
Acupuncture developed substantially during the Sui (581–618 A.D.) and Tang (618–907 A.D.) Dynasties. The Tang government (627–649 A.D.) requested, and the famous physician Zhen Quan revised, the important Acupuncture texts and charts. Another famous physician of the time, Sun Simio, wrote Essentially Treasured Prescriptions (650–692 A.D.), which includes acupuncture data from various scholars. During the Tang dynasty, the first systematic teaching system, the Imperial Medical Bureau, was established for medical education. Before then, knowledge was passed through family lineage or from master to student. Then, teaching techniques greatly improved, and with the advent of printing the amount of available literature rapidly accelerated. Acupuncture became a special medical branch, practitioners were named “acupuncturists,” acupuncture schools appeared, and acupuncture education became part of the Imperial Medical Bureau.
During the Song Dynasty (960–1279), the famous physician Wang Weiyi wrote The Illustrated Manual on Points for Acupuncture and Moxibustion, which included the description of 657 points. He also engraved meridians and points on two life-size bronze figures. The figures were filled with water, and covered with beeswax for student exams. When acupoints were correctly located, water issued forth.
In 1057, the government also established the Bureau for Correcting Medical Books to research and collate the medical classics. It republished many classic texts over a ten-year period. During the Jin and Yuan dynasties, four major schools of thought carried out scholarly debates on the main cause of disease. The four Schools — Cold and Cool, Attacking and Purging, Nourishing the Earth, and Nourishing Essence — all argued for their method of treating illness. These debates resulted in substantial TCM development in many fields, and an emphasis on ailment-based, individual patient treatment. Other further developing theories included scorching moxibustion and acupuncture point selection based on internal organ anatomical locations.
The Ming Dynasty (1568–1644) was an enlightened time for Acupuncture advancement. The many new developments included: revision of the classic texts, refinement of Acupuncture techniques and manipulation, development of Moxa sticks for indirect treatment, and development of extra points outside the main meridians. The encyclopedic work of 120 volumes, Principles and Practice of Medicine, was written by the famous physician Wang Gendung.
In 1601, Yang Jizhou wrote Principles of Acupuncture and Moxibustion. This great treatise on Acupuncture reinforced the principles of the The Inner Canon of the Yellow Emperor 
and The Classic of Difficulties 
. This work was the foundation of the teachings of G. Soulie de Morant, who introduced acupuncture to Europe.
From the Qing Dynasty to the Opium Wars (1644–1840), Acupuncture was suppressed, and herbs became the main tool of physicians. Following the Revolution of 1911, both acupuncture and Chinese herbology were suppressed, and Western Medicine was introduced. However, large populations needed medical care, and the “barefoot doctors” emerged. Acupuncture and herbs remained popular among folk people. Acupuncture was used exclusively during the Long March (1934–1935) and, despite harsh conditions, helped maintain the army’s health. This was noted by Mao Zedong, the Communist Party leader.
Acupuncture’s first entry into a comprehensive hospital came in 1945, when an acupuncture clinic opened in the International Peace Hospital. In 1950, Chinese government leader Chairman Mao Zedong officially announced that acupuncture remained an important element in China’s medical system, and he called for the “uniting of Traditional Chinese Medicine with Western Medicine.” Therefore, acupuncture was established in many hospitals.
From the late 1950s to the 1960s, researchers studied acupuncture’s ancient texts, anesthesia, and clinical effect on diseases and internal organs. In 1956, TCM colleges were set up in five major Chinese cities. Soon, other Chinese provinces followed, and there are now 26 TCM colleges and universities and 30 academies. They teach TCM combined with orthodox Western medicine, and try to integrate the two medical systems.
Since the 1970s, acupuncture has played an important role in China’s medical system. China’s leading research into acupuncture’s application and clinical effects, including anesthesia and analgesia, has promoted worldwide acupuncture development. Since the 1987 founding of the World Federation of Acupuncture and Moxibustion Societies (WFAS), Chinese acupuncture experts have been selected, three times, to chair the Federation, and have made outstanding contributions to developing and popularizing acupuncture science.
Statistics show that, in China, TCM hospitals serve 200 million patients a year, with two million and seven hundred thousand of them being inpatients. Acupuncture is modernizing, but it will never lose its connection with a philosophy established thousands of years ago.
Spread of Acupuncture and Moxibustion Beyond China
The History
The spread of acupuncture to other countries probably started when Xu Fu, a third century B.C. Taoist with medical knowledge, took seeds, plants, medical herbs, and 3000 Chinese children with him to Japan. As early as 500 A.D., acupuncture was introduced to Japan, and it had great success by 701 A.D. Monk Jian Zhen (755 A.D.) taught medicine in Japan. Many medical books and medicines were introduced during the Han Dynasty, and during the Tang Dynasty educational institutions were established. Japanese doctors studied classic Chinese medical texts, and many books were published in the Nala, Heian, and Edo periods. After Japan’s Meiji Reformation, and during Japan’s medical modernization (1884–1924), Chinese medical science was abandoned with the exception of acupuncture. By 1867, the Japanese conducted acupuncture experiments. Acupuncture is popular in Japan today.
Chinese medicine spread to Korea in the third century B.C., and Korean medical practice is based mainly on Han and Tang Dynasty literature. In 541 A.D., doctors were sent to Korea with knowledge of acupuncture and moxibustion. By 692 A.D., Korean doctors again studied classic Chinese texts, began teaching, and started developing their own theories and formulas.
Chinese medicine spread to Vietnam in the second century B.C. Vietnam was influenced by Chinese civilization during the Han Dynasty. Theories taught by the Chinese nearly 1500 years ago are still part of traditional Korean and Vietnamese medicine. China also sent doctors to many Asian countries, including India, and by the 17th century TCM reached the United States and was spreading through Europe.
In Europe, early knowledge of acupuncture began with the first missionaries. The Jesuits, in particular, studied Chinese culture, and returned to amaze Europeans with their findings. They coined the word “acupuncture,” from the Latin “acus” (“needle”) and “punctura” (“puncture”).
Girolama Cardano (1508–1576), a teacher of medicine in Milan, published Europe’s first acupuncture article, when he reported travelers’ experiences with Chinese acupuncture treatment. Father Harvieu (1671) published the first European treatise on acupuncture, splendidly entitled The Secrets of the Medicine of the Chinese, consisting in Perfect Knowledge of the Pulse, Sent from China by a Frenchman of Great Merit. In 1707, Valsalva, the famous anatomist, described ear acupuncture. In 1769, Gandini undertook a more comprehensive study.
In 1712, Germany’s Dr. E. Kaempfer (1651–1716) introduced acupuncture from Japan with his publication Amoenitatum Exoticamm. He introduce the word “moxibustion” into the acupuncture vocabulary with “Moxa,” from the Japanese “Mogusa” (“the herb that burns”). The German Acupuncture Association was formed in 1937.
Roughly contemporarily with Kaempfer, a Dutch physician, Wilhelm Ten Rhyne, devoted 20 pages to acupuncture in a small book written in Latin and published in London in 1683. In 1863, the French consul in China, Dabry de Thiersant, published the significant Medicine Among the Chinese. A complete chapter was devoted to acupuncture and needling techniques. Another French consul, Solie de Morant, studied acupuncture in Shanghai after observing its miraculous effects. On his return to Europe 20 years later, he demonstrated acupuncture’s efficiency at several hospitals. He was eventually persuaded to publish Synopsis of True Chinese Acupuncture in 1934, and two volumes of Chinese Acupuncture in 1939. Acupuncture at last secured a firm hold on the European imagination, largely due to this man’s influential writings.
In 1950, China helped train Eastern European acupuncturists. In 1956, Soviet doctors again studied acupuncture in China after a lapse of some 300 years. On their return they opened research centers in Moscow and Leningrad.
England’s first book on acupuncture, and probably the first acupuncture book in English, was written by Rev. D. Lawson Wood: Chinese System of Healing was published in 1959. Dr. Felix Mann published Chinese Acupuncture in 1962. The English Acupuncture Association was formed in 1960.
In 1975, the World Health Organization asked China to set up International Acupuncture Training Courses in Beijing, Shanghai, and Nanjing to train acupuncturists from other countries. Over 40 countries are now practicing acupuncture and moxibustion.
China has shown other countries that TCM is useful and effective enough to attract doctors from around the world. This also helped preserve knowledge and literature, because many texts which were lost in China have survived in foreign countries. In addition, Chinese TCM doctors brought back other countries’ medical knowledge, integrated it with TCM, and helped TCM adapt and diversify its treatments. This has been instrumental in the preservation of TCM’s long history.
Acupuncture Development Outside China
Eastern countries
Singapore became home to many Chinese and, by the 19th century, TCM was an important medical system there. In the last 20 years, Chinese medicine has become an essential factor in Singapore’s various medical care enterprises. At present, there are more than 30 TCM treatment organizations and 1000 TCM clinics.
Malaysia’s roughly 3000 medicine shops sell Chinese medicine. Although the Malaysian Medical Ministry has supported TCM development, it does not register TCM doctors. Thus, Malaysians can practice medicine without being registered, but most pharmacies are family-apprenticed trades.
Thailand’s government has given TCM legal status, and doctors must be tested for their provisional charter. As early as 1987, the government passed a Chinese medicine proposal, and now there are more than 800 Chinese medicine stores, most with consulting doctors available for customers.
Vietnam has, early on, allowed Chinese medicine to operate alongside Western medicine. Nearly 200 large-scale pharmacies operate in the country, and 16 Chinese drug companies are licensed to produce and sell medicine in Vietnam.
Japan’s Government has given increasing support and attention to Chinese herb application and research since the 1980s, and has contributed to the quick development of Chinese medicine. According to statistics, about 15,000 Japanese engage in Chinese herb application, approximately 100,000 in acupuncture and massage, and nearly 30,000 in research. Japan has more than 10 Chinese medical research institutions, and 44 public or private medical colleges have herb areas in their drug departments.
Western countries
England, the center of the 14th–16th century Renaissance, was an originator of modern medicine. Chinese medicine spread in England in the 16th century and was accepted until the 17th century. Along with its own progress in modern civilization and scientific technology, England prudently introduced external culture, science, and technology. In recent years, Chinese medicine, due to its remarkable effects, has obtained more and more recognition both from the government and the society. When Queen Elizabeth II travels, she takes Chinese medicine.
England’s Chinese medicine has developed rapidly in the last ten years, and England’s herbal medicine market is the third-largest in the European Community. An estimated 2.5 million English people spend, yearly, 90 million pounds (US$158 million) on TCM therapies such as acupuncture, massage, and herbal medicine. England has more than 350 Chinese medicine pharmacies, and imports 60% of its Chinese medicine from China.
Germany’s TCM institution statistics show that one-sixth of Germany’s doctors (50,000) treat patients with Chinese medicine, and that more than 2 million patients see Chinese medicine doctors yearly. However, although millions of Germans favor TCM, and although it has effectively treated many chronic and difficult illnesses, government authorities and national health insurers have still basically excluded TCM from Germany’s healthcare insurance.
The United States has widespread acceptance of acupuncture, which has been or is being legally licensed in a majority of the states. There are more than 20 acupuncture medical centers in the country. TCM, and increasingly traditional Chinese herbals, is truly becoming an alternative holistic medical practice. Statistics show that approximately 5% of all patients take natural medicine; among them, 80% take Chinese herbs in the course of treatment.
Canada’s Chinese acupuncture is done in personal clinics. In recent years these services have developed quickly, and approximately 2000 people engage in Chinese acupuncture. The acupuncture clinics which have spread throughout the country have mostly been established by overseas Chinese. Chinese medicine and acupuncture does enjoy medical insurance coverage in Canada (depending on the province policy).
South Africa passed legislation to recognize TCM, making it one of the first countries on the African continent to legalize TCM.
Arab countries currently turn to TCM for healthcare, weight loss, and cosmetology. Because of this extreme popularity, nearly all of the 21 Arab countries have Chinese medicine clinics and herb shops. In the 1950s, Chinese foreign aid medical teams brought Chinese medicine to the Middle East. In 1988, the United Arab Emirates established the Chinese Medicine Treatment Center, while Saudi Arabia, Oman, and Yemen discussed the prospect of introducing experts from China into the three Gulf countries.