The Scientific Review of Alternative Medicine

Introduction

This is the third in a series of three papers examining the objectivity, accuracy, and reliability of the historical scholarship manifested in the veterinary acupuncture literature.

Many sources emphasize the popularity of both human and veterinary acupuncture and traditional Chinese medicine (TCM). These sources often state or imply that said popularity is due to the methods’ efficacy rather than to social, political, and economic factors. While the evidential and scientific bases for efficacy claims are beyond the scope of this paper, we will examine the historical bases for these claims.

The “Preferred Therapy for One Quarter of the World’s Population”?¹

In China today, scientific biomedicine is the dominant modality. While some advocates claim that TCM and “Western” medicine have undergone significant “integration,” of the 46 major medical journals published by the Chinese Medical Association a decade ago, not one is devoted to acupuncture or its variants. Still, many clinics offer TCM exclusively, and an increasing number offer both scientific biomedicine and Chinese medicine. As was the case early in the twentieth century, there are calls for objective scientific evaluation of traditional therapeutic claims.^2,3

Advocates of veterinary acupuncture have claimed that acupuncture “is the main treatment for 1/4 of the world’s population.”⁴ Jaggar, however, correctly points out that “in the Peoples Republic of China (PRC,) humans are more often treated with herbal therapy than with acupuncture, which is viewed as more invasive.”⁵ In any case, as of 1997, the entire population of the PRC accounted for only 21% or one-fifth of the world’s population.⁶ Therefore, claims that acupuncture is the “preferred” therapy for “1/4 of the world’s population” may be dismissed out of hand.

Proponents of both human and veterinary acupuncture tend to overlook the fact that, subsequent to the introduction of scientific biomedicine in Asia, the practice 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.⁷ In Japan, acupuncture was similarly prohibited in 1876. By 1911, acupuncture was no longer a subject for examination in the Chinese Imperial Medical Academy.⁸ Prior to the Second World War, the Nationalist Chinese government tried to ban the use of traditional Chinese medicine altogether.

In 1995, the Committee for Scientific Investigation of Claims of the Paranormal (CSICOP) was invited by the Chinese Association 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 Beyerstein 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.⁹

The Politics and Economics of Acupuncture

In order to understand the recent, renewed popularity of acutherapies in China, one must look to politics. During the Great Leap Forward of the 1950s and the Cultural Revolution of the 1960s, China was in the grip of intense nationalism. Acupuncture appealed to contemporary political leaders because it was a traditional Chinese practice. In fact, Chairman Mao Zedong took a personal interest in promoting TCM, though, when it came to his own personal health care, he apparently eschewed traditional medicine entirely in favor of Western biomedicine. According to his Western-trained personal physician, Mao stated, “even though I believe we should promote Chinese medicine, I personally do not believe in it. I don’t take Chinese medicine. . . .”¹⁰

It appeared that at least some aspects of acupuncture (particularly in the case of ear acupuncture) might even be “validated” by highly-regarded Western scientific biomedicine. Moreover, in 1949, the Communist regime inherited a population of more than one half billion that was attended to by fewer than 30,000 physicians trained in scientific biomedicine (most of them concentrated in large cities and subject to politically suspect background).¹¹

In view of these facts, the Communist Party undertook an effort to convince the masses that TCM, like other aspects of Chinese culture, was not merely equivalent to but superior to decadent “imperialist” alternatives.

Acupuncture and traditional herbal therapies provided Chinese political leaders an expedient and face-saving alternative to the only other health-care option available to the masses: no health care at all. With regard to their own personal health care, however, these same leaders and members of the political and intellectual elite have demonstrated a consistent and overwhelming preference for scientific (Western) biomedicine.

On the other hand, the Chinese have now recognized acupuncture and Chinese herbal medicine as lucrative export products. Commercial interests in China have been particularly adept at circulating idealized reports. Cliché-filled titles such as “Healing from the Far East” are promoted in large-circulation magazines.¹² Programs now exist whereby foreign physicians and veterinarians may visit China for the specific purpose of receiving training in TCM.^13,14

Politics and Acupuncture Scholarship

The alleged antiquity of human and veterinary acupuncture has even been cited in the interest of prohibiting animal acupuncture by non-veterinarians. The June 15, 1997 issue of the Journal of the American Veterinary Medical Association states:

In an effort to stop human acupuncturists from practicing on animals, the Maryland VMA introduced legislation in accordance with the AVMA guidelines, then amended it to require human acupuncturists to work under the direct supervision of a veterinarian. . . . According to Dr. Allen Schoen . . . as early as 1100 b.c., veterinary medicine and human acupuncture were considered separate branches of medicine. “They were wise enough to realize the difference a few thousand years ago,” Dr. Schoen said. . . . “There is absolutely no precedent for this in history.”

Schoen makes the same claim elsewhere, but does not cite his sources.^15,16

It seems likely this claim is based on the Zhou Li (Ritual of the Zhou [dynasty]), also known as the Zhou Guan (Official [Organization] of the Zhou [dynasty]). This text describes in great detail the organization of the bureaucracy of the Zhou dynasty, which came to power not long after 1100 bc. The text describes a number of medical officials. Among these was the Shou Yi (“animal physician”) who was responsible for what we would call veterinary medicine. None of these physicians or veterinarians are said to have used acupuncture. Modern scholars reject the notion that the Zhou Li dates from 1100 bc. The consensus view is that it dates from around the beginning of the imperial age in the third century bc and should be regarded as an idealized and prescriptive text rather than a descriptive outline of government organization as it actually existed at the time.¹⁷

Four Waves of Acceptance and Rejection in the West

The human and veterinary acupuncture literature focuses much attention on the “introduction” of acutherapies into the West during the 1970s. The experiences of journalist James Reston in 1971 and Richard Nixon’s physician during a 1972 visit to China are often cited as the seminal events leading to the introduction of acupuncture in the West.^18,19 Many veterinary authors offer little suggestion that acupuncture was known at all in the US or in Europe prior to its current vogue.²⁰ For instance, Bossut flatly states that acupuncture “was introduced in Western countries only in the last century.”²¹ As Skrabanek points out, the reality is quite different:

Acupuncture reached Europe in the seventeenth century and has since been rejected, rediscovered, and forgotten again in four major waves.^23,24 In the last two decades of that century, acupuncture was fairly well established in Europe, though many physicians, including Thomas Sydenham²⁵ were skeptical. Several prominent French physicians (Dujardin, Vicq-d’azyr, Berlioz, Cloquet) advocated acupuncture in the eighteenth and nineteenth centuries, but other, equally prominent doctors were not impressed. For example, Trousseau and Pidoux in their Traité de Thérapeutique (1836) accused Dr. Louis Berlioz (the father of the composer) of resurrecting an absurd doctrine from well-deserved oblivion²⁶. . . .²²

Soulié de Morant, a French diplomat in China, fascinated by acupuncture as a cure for cholera, published his influential book L’Acupunture Chinoise in 1939.

In the United States, acupuncture enjoyed a brief period of popularity during the first half of the nineteenth century, particularly among physicians in the Philadelphia area.²⁷

In 1825, physician and chemist Franklin Bache, a great-grandson of Benjamin Franklin, translated (from French) Morand’s Memoir on Acupuncture and had an American edition published in Philadelphia. In 1826, J Hunter Ewing reported that he had used acupuncture “many times” and had “been present when others have performed it,” apparently with positive results.²⁸ In the same year, three Philadelphia physicians, Edward J Coxe, DT Coxe, and Samuel Jackson, conducted experiments with acupuncture as a possible means of resuscitating drowned people.²⁹ European experimenters had claimed to have successfully revived drowned kittens by inserting needles into their hearts. (Strangely reminiscent claims regarding the resuscitation of kittens have very recently appeared in the Journal of the American Veterinary Medical Association³⁰ and have likewise been contested.^31,32) The aforementioned 19th-century American physicians were unable to duplicate these “European successes” and therefore “gave up in disgust.” Edward Coxe reported that “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.”³³

The 1829 edition of Tavernier’s Elements of Operative Surgery included three pages on how and when one might perform not only acupuncture, but also “electro-acupuncturation.”³⁴ In 1833, Medical Magazine carried an article on acupuncture by Englishman John Elliotson.³⁵ Beginning in 1845, American editions of the Cyclopedia of Practical Medicine carried the same article.³⁶ In 1836, the Boston Medical and Surgical Journal carried a reprint from a then-recent edition of the Southern Medical and Surgical Journal, wherein author William M. Lee, of Indian Town, South Carolina, reported his experiences after having employed acupuncture for six years on “many cases”—primarily cases involving rheumatism. (Lee assured his fellow physicians that the method produced quick results, involved little pain, and that the requisite needles were “easily obtainable through medical supply houses.”)³⁷ In 1843, Robley Dunglison reported his use of acupuncture to “drain off the fluid from cellular membrane anasarca.”³⁸ Even more important was his overt role in publicizing acutherapy by means of his 1839 compendium, New Remedies, which included an eight-page account of acupuncture therapy.³⁹

Bache was, by far, the most active among these early 19th-century US advocates. In 1825, he set out to test acupuncture on a dozen prisoners upon whom he’d been called to serve. These individuals were afflicted with “rheumatism,” “neuralgia,” “ophthalmia,” and various other painful maladies. He ultimately reported varying successes among these and half a dozen other non-incarcerated patients. (One epileptic patient who suffered excruciating pain in the forehead and temples apparently derived no relief from needling. According to Bache, this patient’s pain increased until a state of “complete phrenitis [delerium] was induced.” Fortunately, Bache was able to effectively combat the latter by means of “bleeding, cupping and blisters to the head.”)⁴⁰

A curious feature of these early American accounts of acupuncture is that none of them make any mention of acupuncture “points” or “meridia,” per se. They all claim substantial “success” for acutherapy, but only as a result of inserting needles directly into, or in the immediate vicinity of, painful or otherwise afflicted areas.

By the second half of the 19th century, acupuncture had largely been abandoned by US practitioners. Samuel D. Gross concluded in 1859 that “its advantages have been much overrated, and the practice . . . has fallen into disrepute.”⁴¹ This judgment is supported by the fact that the index catalogue of the Surgeon General’s library includes barely a half-dozen titles on the subject for the entire half-century 1850–1900.

Discussion

Discussions of “acupuncture theory” in the veterinary literature quite reasonably reflect similar material in the human literature. In some cases, however, the human and veterinary acupuncture literature bear more than a

passing resemblance. The authors have found one instance wherein more than eight hundred words of text dealing with “oriental concepts of acupuncture” in a veterinary source have been copied, essentially verbatim, and without attribution, from a previously published human acupuncture source.^42,43

Proponents of acupuncture assert that the fact that acupuncture has survived over millennia constitutes a de facto field trial and should be accepted as such.⁴⁴ Unfortunately, this “test-of-time” argument proves precious little. The history of medicine abounds with examples of remedies that have passed this “test,” but were eventually discovered to be ineffective and even hazardous. Blood-letting is a case in point. Therapeutic phlebotomy was a part of virtually all prescientific medical traditions and was thought, even in the West, to be a panacea until about 150 years ago. Today, we know it almost certainly killed many more patients than it helped.⁴⁵ There are, of course, several possible reasons for this widespread and long-standing misapprehension of efficacy. One, which may be of relevance to the issue of traditional acupuncture therapy, is the placebo effect. Another is the cyclic “natural history” of many disease processes. These and other nonspecific factors can and often do account for impressive improvements when an inherently ineffective therapy is applied. In the absence of a control group (i.e. in routine clinical practice) such nonspecific effects can perfectly mimic a specific therapeutic effect. Throughout the history of medicine, physicians and veterinarians have been only too keen to mistake the former for the latter.

At the very least, it seems clear that, in the Western human and veterinary acupuncture literature—both professional and popular—there is a nearly universal bias “for” TCM procedures previously unknown in the West and “against” those that have been tried and discarded or are absurd in the light of scientific biomedicine. For instance, there is no rational explanation as to why “standard” (“Hau Chen”) acupuncture—using fine-gauged needles, moxibustion, and Chinese herbs—are widely described, embraced, and promoted in the West, but therapeutic bleeding, fire needling, cupping, firing irons, pulse diagnosis, scarification, morphological divination, “unlucky-day” prohibitions, astrological considerations, and tongue diagnosis are not. Western veterinary and human acupuncture literature appear to present only those elements of Chinese medicine that suit their purposes. The choice of “which therapies to embrace” and “which therapies to eschew” is entirely personal, subjective, and arbitrary.⁴⁶ And, adding a geographic dimension, why embrace one or another mainland Chinese variant of acupuncture rather than substantially different Korean, Japanese, or Taiwanese alternatives?

The chaotic nature of TCM, as revealed by the objective historical literature, has a crucial bearing on the future of veterinary education and practice in the United States. For nearly three decades, US advocates have been lobbying intensely, and with considerable success, to have acutherapy and TCM politically embraced by national and state veterinary associations and “integrated” into the curricula of veterinary schools nationwide. They’ve routinely employed a distorted and often abjectly false “history” to further their cause. Such efforts at “integration” naively presume that standardization of TCM or acutherapies is possible and that they can somehow be made compatible with scientific biomedicine. Neither presumption has a basis in reality. Much of the “theory” underlying traditional and “scientific” acupuncture not only contradicts modern scientific knowledge but is self-contradictory as well.

In scientific biomedicine, the standardization and integration of new fields of study, notwithstanding differing “schools of thought,” is generally possible, because everyone is playing by the same, objective rules. When dealing with systems of folk or pseudoscientific medicine, genuine standardization and integration are not possible, because the “rules” for each are subjective, variable, and arbitrary. The inevitable conflict between various “schools” of TCM and acutherapy has already become manifest.⁴⁷

Students attending one clinic in southern Germany are astounded to hear the therapies there are not spoken of flatteringly in another clinic in southern Germany, and vice versa. The reason for this is that the doctors in the one clinic come from Peking, whereas those in the other are from Shanghai. Each group practices its own version of “Chinese medicine,” and denies the other version any legitimacy, even though it has no empirical or scientific grounds for doing so.

When veterinary or human medical colleges attempt to select qualified, competent TCM/acupuncture faculty, they’re certain to eventually confront several unsettling realities. To cite just a few: there are many factions within the domain of TCM, even more within the realm of acupuncture, and most of them contest the competence of all the others.⁴⁸ There are groups who regard the use of electrical stimulation (electro-acupuncture) as a prerequisite for success (which suggests the question as to how acupuncture might have enjoyed two millennia of alleged “success” without the benefit of artificial electricity), while others claim equal success from shallow needling, in which the needles penetrate the skin no more than a millimeter. There are groups who insist, again, without any scientific or evidential basis, that acupuncture can only produce effects when ancient Chinese notions are followed, yet these same fundamentalists formulate their allegedly “classical” notions in a way the ancient Chinese would not have recognized. Other factions would prefer to discard ancient Chinese concepts altogether, convinced that acupuncture’s legitimacy can (and certainly will) only be established by means of modern scientific theories and study. As Unschuld points out:

It is not possible to make a reasonable choice from this plethora of options. Wherever a choice has been made, it has rested on local availability and personal recommendations. The students taught by such staff cannot be sure what quality of training they are getting since the chances are that in the nearest medical bookstore they will pick up a “standard work” of acupuncture that represents a completely different approach, or that they will come across an introduction to Chinese medicine whose terminology follows a completely different system of interpretation, translation, or transcription from the one to which they are accustomed.⁴⁹

Conclusion

When presenting medical history in literature written for medical professionals, accuracy must be of paramount concern. The primary consideration manifested in the veterinary acupuncture literature is the casting of acupuncture in a positive light. Objective historical and archeological data that refute or fail to support claims of great antiquity, efficacy, and historical popularity for acupuncture are routinely ignored or mischaracterized. Elements of acupuncture and traditional Chinese medicine that are embarrassing or absurd in the light of 20th-century scientific knowledge are largely overlooked by Western advocates. Moreover, once a positive but false claim is introduced into the advocate literature, it assumes a life of its own. Subsequent advocate authors cite the material, making little or no effort to either check the references or to rectify the false information. While some authors have undoubtedly been guilty of intentionally publishing misleading information, the great majority have simply relied, “in good faith,” on the unreliable work of others. This situation can only be rectified by future authors and investigators demanding greater scholastic and scientific rigor of themselves and by making factual rather than merely promotional information available to all honest investigators.

Unfortunately, though advocates of human and veterinary acupuncture are ostensibly writing about the same things as sinologists and historians of medicine, the historical literature produced by the former group is largely contradicted by that of the latter. For objective and open-minded veterinarians and physicians hoping to winnow acupuncture fact from acupuncture fiction, the historical literature produced by acupuncture proponents is of very limited utility.

References

1. Klapheke R, Schoen A, Let’s get to the point: A scientific approach to equine acupuncture. Equine Veterinary Acupuncture Network. ND. Available at http://iaep.com/pages/bulletins/health/acupuncture.html.
2. Rosenthal MM. Health Care in the People’s Republic of China. Boulder, CO: Westview. 1987:page(s)?
3. Petty R. Images of China. Journal of the Royal College of Physicians of London. 1991; 25;(4):344–346.
4. Stefanatos J. How to Promote Holistic Veterinary Medicine. City, ST: The American Holistic Veterinary Medical Association and the International Veterinary Acupuncture Society. 1993:25.
5. Jaggar D. History and basic introduction to veterinary acupuncture. In Schoen (ed.), Problems in Veterinary Medicine: Veterinary Acupuncture. Philadelphia: Lippincott. 1992:2.
6. The World Almanac and Book of Facts: 1998. New York: World Almanac Education Group. 1997:752,838.
7. Skrabanek P. Acupuncture: Past, present, and future. In Stalker D and Glymour C (eds.), Examining Holistic Medicine. Amherst, NY: Prometheus Books. 1989:183.
8. Prioreschi P. A History of Medicine, Volume 1. Omaha, NE: Horatius Press. 1995:179.
9. Beyerstein B, Sampson W. Traditional medicine and pseudoscience in China: A report of the second CSICOP delegation, part 1. Skeptical Inquirer. 1996; 20(4). Available at http://www.csicop.org/si/9607/china.html.
10. Li Z. The Private Life of Chairman Mao: The Inside Story of the Man Who Made Modern China. London: Chatto & Windus. 1994:84.
11. Petty. Op. cit.
12. Unschuld P. Chinese Medicine. Sausalito, CA: Paradigm Press, 1998;117.
13. Rogers P. A brief history of acupuncture (AP) and the status of veterinary AP outside Mainland China, part 2. The Medical Acupuncture Web Page. Available at http://users.med.auth.gr/~karanik/english/vet/histor2.htm.
14. Beyerstein, Sampson. Op. cit.
15. Schoen A. AAEP acupuncture lecture gets point across. JAVMA. 1996;208(3):325.
16. Suzik H. Acupuncture on animals raises questions. JAVMA, 1997;210(12):1711.
17. Cullen C. Personal correspondence. Year?
18. Unschuld P. Op. cit.:110.
19. Ernst E. Complementary medicine: The facts. Phys Ther Rev. 1997;2:50.
20. Jaggar. Op. cit.:17.
21. Bossut D. Veterinary clinical applications of acupuncture, J Altern Complement Med. 1996;2(1):65–69.
22. Skrabanek P. Op. cit.:182.
23. Ackerknecht E. Zur Geschichte der Akupunktur. Anaestetist. 1974;23:37–38.
24. Ackerknecht E. Akupunktur: Gestern, Heute, Morgen. Schweizerische Aerztezeitung. 1972;33:1067–1068.
25. Lu G, Needham J. Celestial Lancets: A History and Rationale of Acupuncture and Moxa. Cambridge: Cambridge University Press. 1980:292.
26. Lacassagne J. Le docteur Louis Berloiz: Introducteur de l’acupunture en France. Presse Médicale. 1954;62:1359–1360.
27. Cassedy J. Early uses of acupuncture in the United States [addendum, Franklin Bache]. Bull NY Acad Med. 1974 [1826];50(8):892–906.
28. Ewing J. Case of neuralgia cured by acupuncturation. N Amer Med Surg J. 1826;2:77–88.
29. Coxe E. Observations on asphyxia from drowning. N Amer Med Surg J. 1826;2:292–293.
30. Skarda J. JAVMA. 1999;214(1):37–39.
31. Fausel S. JAVMA. 1999;214(5):618.
32. Rattan J. JAVMA. 1999;214(5):616,618.
33. Coxe. Op cit.:292–293.
34. Tavernier A. Elements of Operative Surgery. Gross S (trans. and ed). Philadelphia: Grigg, Crissy, Towar & Hogan, Auner. 1829;55–57.
35. Elliotson J. Acupuncture. Med Mag. Year?;1:309–314.
36. Elliotson J. Acupuncture. In Sajous CEdeM (ed.), Cyclopedia of Practical Medicine. Philadelphia: Lea & Blanchard. 1845;1:54–57.
37. Lee W. Acupuncture as a remedy for rheumatism, Southern Med Surg J. 1836–1837;1:129–133.
38. Dunglison R. Editorial additions to Elliotson J., Acupuncture, in Cyclopedia of Practical Medicine. op. cit.
39. Dunglison R. Ibid.
40. Bache F. Cases illustrative of the remedial effects of acupuncturation. North Amer Med Sur J. 1826;1:311–321.
41. Gross S. A System of Surgery, Volume 1. Philadelphia: Blanchard & Lea. 1859;575–576.
42. Limehouse J. In Schoen A (ed.), Problems in Veterinary Medicine: Veterinary Acupuncture. Philadelphia: Lippincott. 1992:53–54,58,59.
43. Kaptchuk T. The Web That Has No Weaver. City, ST: Congdon and Weed. 1983;2–4, 7,53,65–66,77–80,275.
44. Smith C. Acupuncture: An ancient treatment modality under scientific scrutiny. JAVMA. 1992;201(9):321–325.
45. Kuriyama S. Interpreting the history of blood-letting. History Med. 1995;50:11–46.
46. Macdonald A. Acupuncture: From Ancient Art to Modern Medicine. London: Allen and Unwin. 1982:3.
47. Unschuld P. Op. cit.:120.
48. Unschuld. Ibid.
49. Unschuld. Ibid.:121.

About the Authors

Robert Imrie, companion-animal practitioner, private practice, Seattle, WA. David Ramey, equine practitioner, private practice, Glendale, CA. Paul Buell, sinologist and historian of medicine, Seattle, WA.

Correspondence: Managing Editor, The Scientific Review of Alternative Medicine, P.O. Box 7441, Amherst, NY 14226-0741.