In part one of this article, I discussed the 20-year-long, highly acclaimed research of Professor Long-xiang Huang, vice president of the Acupuncture Institute of the Academy of Chinese Medical Sciences in Beijing. In his opinion, today's traditional acupuncture is like a pearl necklace, where the pearls of wisdom and vast empirical/clinical experience are strung together by the strings of outdated theories and inadequate explanations.
For part two, I asked my good friend Dr. Yuan-sheng Tan, deputy director of the Office of Acupuncture Standardization, secretariat of the World Federation of Acupuncture Societies (WFAS), Beijing, for an interview for the readers of Acupuncture Today. Dr. Tan specializes in acupuncture theory and acupuncture historical literature. His professional duties involve the standardization of acupuncture medicine and are sponsored by the World Federation of Acupuncture Societies and the World Health Organization.
Ma: For many years you have been involved in research regarding the relationship between traditional Chinese medicine (TCM) and acupuncture medicine (AM). What have you discovered?
Tan: Presently, acupuncture theories are being carefully examined in China. For a long time AM has been mistakenly regarded as a subspecialty affiliated with TCM. This implies that TCM is the first-order specialty, while AM is a second-order subspecialty within TCM. Accordingly, acupuncture training is always carried out in a department of a TCM university instead of at its own independent institution. Thus, if you would like to study acupuncture, you have to study TCM and then study acupuncture the TCM way. For example, academic acupuncture textbooks use TCM theories to guide AM practice and indiscriminately apply TCM diagnostic methods to AM practice.
Here is a comparison of the educational settings between TCM and AM. From the table below, you can see that acupuncture training blindly follows the standard TCM theories.
| Traditional Chinese Medicine | Acupuncture Medicine |
| TCM Theories | TCM Theories |
| TCM Diagnosis | TCM Diagnosis |
| TCM Pharmacology | Meridianology and Acupointology |
| TCM Pharmacy-Logical Prescription | Acupoint Prescription |
| Internal medicine and other subspecialties of TCM | Application of AM to other subspecialties |
The table demonstrates that TCM imposes its own theories on AM and practically absorbs AM. However, AM is not a subspecialty of TCM. Now that the acupuncture mechanism is fairly understood by scientific research and acupuncture practice is widely acceptable, the difference in clinical mechanisms between AM and TCM has become obvious. Thus, the educational settings for AM should be modified, and AM should and will have its own theories and methodology.
Ma: We are taught to believe that AM is part of TCM. You have offered a radically different point of view. Why is AM not a subspecialty of TCM?
Tan: The major difference lies in the fact that AM uses mechanisms of needling to stimulate the acupoints, while TCM uses natural substances such herbs, minerals or parts of animals to treat diseases. Due to this drastic difference in clinical mechanisms, AM has its own theories and needs diagnostic and treatment methodologies that are different from those of TCM.
Traditionally, the natural substances used in TCM are classified into different groups according to the "four natures" (cold, hot, warm and cool) and "five flavors" (pungent, sweet, sour, bitter and salty). Any prescription uses various combinations of natural substances from the four natures and five flavors categories. Also, in TCM, the clinical diagnosis of each patient is based on identifying an imbalance in the patient's symptoms and then identifying the symptomatic natures of the imbalance, such as excessive or insufficient cold or heat. The symptoms are then balanced by pharmacological substances based on the four natures and five flavors theories. For example, pharmacological substances from the hot group balance cold symptoms; tonic substances balance deficient symptoms.
AM has different physiological mechanisms. Acupuncture needling creates a lesion which stimulates acupoints on the body. A needling-induced lesion stimulates a neuro-psyco-immunological response involving other physiological reactions through the release of neurotransmitters. Acupoints do not have particular pharmaceutical "natures" or "flavors" as herbs do. The same acupoint, for example Du 14 (Da Zhui), can be used to treat either high fever or hypothermia. The therapeutic function of each acupoint is related to the physiological baseline of the body and the stimulating methods. Thus, acupoints should not be classified as having pharmacological natures.
Ma: In other words, the function of acupuncture is to use needling-induced lesions to stimulate the biologically built-in, self-regulating mechanisms to normalize physiology and to restore the balance (homeostasis)?
Tan: Correct. The ancient Chinese doctors understood the difference between TCM and AM quite well. They considered TCM and AM as parallel medical modalities. The Yellow Emperor's Canon of Internal Medicine (Huang Di Nei Jing) consists of two parts: Fundamental Questions (Su Wen) and Spiritual Pivot (Ling Su). Su Wen is a theoretical system for guiding TCM practice, while Ling Su addresses AM practice.
Sometimes these two parts share the same ideas due to the same philosophical and cultural environment, but each part is presented as a different theoretical system and is very well differentiated. During the Jin Dynasty (265-420 A.D.), Huan-fu Mi compiled and systematized the AM in his famous textbook, The Systematic Classic of Acupuncture and Moxibustion (Zhen Jiu Jia Yi Jing, 282 A.D.). From the very beginning, and later on until the early 20th century, AM was an independent medical system, not a subspecialty of TCM.
Ma: TCM and AM have different physiological mechanisms, so logically they should have different underlying theories. Could you explain why today we are experiencing confusion and blindly applying TCM theories to AM?
Tan: Many factors have contributed to this confusion. I am going to mention some of the most important ones that lead to the creation of this ongoing misunderstanding.
1. TCM and AM were originated, developed and nursed in the same cultural environment; they use the same hieroglyphs (same terminology) to describe different concepts and theoretical systems. For example, the character Mai was used for both blood vessels and meridians. This created and continues to create deep confusions for practitioners.
2. Within the past 200 years there has been an active interaction between Western medical science and Chinese medicine, which also creates ongoing confusion. For example, Westerners who know for sure that the anatomical liver is located on the right side of the body are confused by the TCM teachings that the conceptual liver is located on the left side. To aggravate this confusion in Chinese medicine, the same hieroglyph Liver (Gan) is used for both anatomical liver and conceptual liver.
Western invasion threatened the survival of TCM and AM in China and emphasized a demarcation between the Western science-based medicine and the empirical Chinese medicine. In the 1920s, the Chinese government issued an order to ban the practice of both TCM and AM as backward, nonscientific practices. Amazingly, the president of Peking University, Dr. Hu Shi, said in the 1920s that although Western medicine cannot cure many diseases, it is scientific and should be practiced, while Chinese medicine can cure many diseases but is not scientific and should be banned. Sadly, this point of view was supported at that time by many modern-educated professionals throughout China.
The Chinese government's decision to forbid the practice of Chinese medicine would have left hundreds of thousands of practitioners jobless. TCM and AM practitioners had to join forces and fight for their survival, which meant proving that TCM and AM are scientifically based and clinically effective.
The well-known Dr. Chen Dan-an tried to incorporate the nervous system into acupuncture theory and published a textbook. Other doctors tried to analyze the biochemical composition of herbs. The intention was to prove that Chinese medicine was scientific and should be allowed to be practiced.
3. During this time, the final mix-up happened. In the 1920s, an acupuncture master, Luo Zhao-Ju, proposed a new concept of the "pharmaceutical nature of acupoints," blending TCM with AM on the assumption that because TCM and AM shared the same philosophy, they should share the same theoretical system (as you see, again and again, cutting the feet to fit the shoes). Luo's pharmaceutical idea was much easier to understand than the neurological idea of Dr. Chen and became widely accepted. Thus, the pharmaceutical principles and prescription methods of TCM were artificially applied to AM. At that point, AM lost its own identity and became a part of TCM.
Ma: What is the consequence of this process?
Tan: We are seeing the consequence of this mix-up every day. Presently, it is a general belief that AM and TCM share the same underlying theories. Practitioners use TCM theories and methods to guide their AM practice such as routinely using pulse and tongue diagnosis in their acupuncture medicine practice. Most importantly, the artificial binding of AM to the theories of TCM prevents the development of acupuncture medicine.
Ma: You have definitely shed light on the difference between TCM and AM and clarified some problems that confuse many practitioners. It is also very clear that the obligation of modern acupuncture medicine is to respond to the needs of our patients. The difference between TCM and AM is not just an academic problem. This difference directly influences the practical daily efficacy of acupuncture medicine.
Conclusion
Presently, some "strings" based on false beliefs have become "the narrow neck of the bottle," preventing further development of acupuncture medicine. It is not possible to improve false beliefs. When the false "stings" are carefully discarded, immortal "pearls" will shine brilliantly. Acupuncture medicine is a powerful, worldwide-recognized modality with unique and scientifically explained mechanisms. I deeply believe that in the near future, AM will be an indispensable part of mainstream medical care.
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