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Acupuncture, Magic, and Make-Believe

Article

George A. Ulett

Volume 27.2, March / April 2003

Traditional Chinese acupuncture is an archaic procedure of inserting needles through the skin over imaginary channels in accord with rules developed from pre-scientific superstition and numerological beliefs. New research has replaced this mystical sham medical procedure with a simple evidence-based no-needle treatment that stimulates motor points and nerve junctures and induces gene-expression of neurochemicals and activates brain areas important for healing. This is a scientifically based alternative to the previous metaphysical theories and magical rituals.

In all early cultures around the world, people observed the magic of nature with great awe. They formulated explanations in the form of myths such as the God of Thunder and the Goddess of Lightning. Behavior, including rituals of sacrifice and prayer, was governed by interpretations of such myths formed from the primitive knowledge of the time. Later, as knowledge of the world expanded, myths became scientific theories. But even these theories resemble myths in that they may be only temporary explanations that direct behavior until the theories change, augmented or supplanted by yet more scientific evidence. Persons who, in the face of contradictory scientific facts, continue to base their actions on disproved ancient myths are behaving in a "make-believe” fashion. Today scientific evidence makes the metaphysical explanations that are the basis of traditional Chinese acupuncture obsolete. The estimated 20,000 acupuncturists in America are therefore practicing a “make believe” kind of medicine. This was the opinion of the American Medical Association quoted in newspapers on August 4, 1974, stating "The AMA Calls Acupuncture Quackery.”

In the late 1960s, before acupuncture was introduced in the U.S., I had learned of it on a trip to Japan. Dr. Kodo Senshu, a retired physician, was translating one of my psychiatric texts into Japanese. When I informed him that we in America knew nothing about acupuncture he set about to rectify my ignorance. He demonstrated the technique on my teenage daughter and I returned home with a textbook and a box of needles. In the following months I tried the method on a number of my patients. I discovered what the Chinese had known for centuries, that acupuncture could be of benefit to patients suffering from chronic pain. I was, however, greatly bothered by the pre-scientific explanations of the mystical needle ritual I was using. As a seventy-year member of the International Brotherhood of Magicians, I had long ago learned that behind every event that appears magical there is a string or a mirror.

Early Chinese Acupuncture

My special hobby is Chinese magic and I was eager to look for a scientific explanation of acupuncture. In tracing magic’s early roots in China I found a copy of an engraving showing the sorcerer Yu the Great in the pre-Shang court of the Emperor Shun, around 2,400 b.c. I learned that magicians like Yu were shamans. China’s first physicians mixed their healing with magic rituals and whatever herbal remedies nature offered. These early shamans were also alchemists and practiced astrology. Yu was an expert in divination, and is depicted predicting the future by scapulomancy (reading the cracks produced by heating an animal’s scapula or the carapace of a turtle). He could also prophesy from patterns formed by casting a mixture of long and short yarrow sticks. In later centuries the patterns formed by these sticks were ultimately organized into eight trigram designs of long and short lines. These in turn were doubled and created the sixty-four hexagrams of the I Ching, the “Book of Changes,” one of the most famous fortune-telling books of all times.

Although it is before recorded history, some believe that Yu the Great was a minister in the court of Huang Ti, the legendary Yellow Emperor, reputedly the father of Chinese medicine. The book bearing his name, the Huang Ti Nei Ching, commonly translated as The Yellow Emperor’s Manual of Corporeal Medicine, has been referred to as “China’s Hippocratic Corpus.” Its two main sections, the Su Wen (questions and answers about living matter) and the Ling Shu (the vital axis) were not compiled until the early Han Dynasty (200 b.c.). They are in the form of conversations between the emperor and his ministers. While some credit the Yellow Emperor with being the inventor of writing and author of the text, the work appears to be a compilation of ancient superstitions and concepts from numerology gathered by many authors over preceding centuries.

The Yellow Emperor’s Classic is a fascinating volume containing the metaphysical theories that serve as the foundation for all of the world’s several hundred varieties of acupuncture. Traditional Chinese acupuncture is based on the belief that disease is caused by blockages of qi, a mysterious body energy said to travel in imaginary channels known as meridians. The concept of such a body of energy is common to many cultures throughout the world. It goes by different names, including prana, spiritus, and pneuma. The Chinese ideogram for qi was developed from the pictogram of a pot of boiling rice with the top blown off by rising steam. When I learned of this I thought back to boyhood days of sandlot baseball when our fatigued pitcher was described as “running out of steam.” Today it is known that body energy results from inner- and intra-cellular metabolism manifesting in measurable nervous energy.

There are many hypothetical meridians in which qi is thought to travel. The major ones are bilaterally paired and twelve in number, corresponding to the twelve months and animals of the Chinese zodiac. They also represent twelve body systems, including a vaguely defined mythical organ called the “triple heater.” A minister is said to have told the Yellow Emperor, “On these channels there are 365 acupoints, one for each day of the year.” These points are thought to be hollow areas, hsueh, where qi is believed to come to the surface for manipulation to balance the yin/yang dualism. Traditionally such manipulation is by needles (acupuncture), finger pressure (acupressure), or heat (moxibustion). The manner of application differs with the need to weaken (sedate) or strengthen (tonify) the body energy.

The early Chinese were primarily agrarian and dependent upon the vagaries of nature. Medicine was a part of religion and philosophy, both of which centered on the theme of oneness with nature. Man is but a microcosm of the major cosmos; what happens in nature happens in man. To understand these older conceptions of Chinese medicine is to recognize this cosmogony of the world. There was no supreme creator; instead the world arose from chaos having been formed by the forces of yin and yang, darkness and light. This ancient belief was ultimately given form chiefly in Taoism where the number of paired opposites is seemingly endless with examples such as man/woman, black/white, heaven/earth, cold/warm, etc. The need for the physicians to give prime consideration to balancing yin/yang forces in all the body’s organs permeates medical thinking. Actions, thoughts, food, and medicines all have their ying/yang attributes.

Among the superstitions of ancient China, numerology plays a major role. Here numbers, in addition to any quantitative or ordinal characteristics, have a special magic meaning. Of all numbers, five is by far the most mystical.

An important theory underlying the principles forming the ritual practice of traditional acupuncture is commonly known as wu hing, or “five element theory.” Actually hing is better translated as movement, so the five elements--earth, fire, wood, metal and water--are usually taught using the term “essences.” According to the “rule of correspondences,” derived from ancient numerology, the number five is a governing magical number. Each of the five elements corresponds to classifications of body parts: five odors, five tastes, five orifices, five tissues, etc. As man’s relation to nature renders him susceptible to diseases according to the weather, seasons of the year must also fall under the rule of five.

To solve this dilemma, summer is divided into two parts, “early summer” and "late summer.” In this manner numerology strongly determines the ritual application of acupuncture needles.

The Placebo Factor

Traditional acupuncture is done with needles. Needles have a powerful advantage as it is commonly believed that a “shot” is more powerful than a pill. Treatment is effected by a man in a white coat calling himself a “doctor of acupuncture.” He inserts needles without pain. His office is adorned with posters of human bodies replete with strange lines and Chinese hieroglyphics. Here, then, are all the ingredients for a strong placebo cure. Many of the treatments of alternative medicine depend upon such placebo action for their healing reputation.

Placebo comes from the Greek, meaning “I shall please” and is created by the patient’s belief in the treatment’s efficacy. The response is strengthened when the doctor demonstrates his own faith by an air of confidence. Thus placebo is a mind/body phenomenon.

Research reports suggest that the placebo response is actuated by neurochemicals in the brain. It is estimated that 30 to 50 percent of all healing is due to placebo action. Even the drama of sham surgery has, in double-blind studies, been shown to have a powerful pain-modulating action. During the Middle Ages when medicine consisted mainly of witch’s brew, civilization survived by placebo action combined with the fact that an estimated eighty percent of all illnesses are self healing.

In 1997 the practice of Chinese needle acupuncture was given strong support from a National Institutes of Health/Office of Alternative Medicine consensus meeting. The studies reviewed were done in the traditional manner, and the committee stressed the need for better controlled investigations. The committee was also aware of the placebo factor, as its report mentions that “. . . so called `non-specific' effects account for a substantial proportion of its effectiveness and thus should not be casually discounted.”

Professor Song Keel Kang of Kung Hee Medical School in Seoul, South Korea, wrote that, “The psychological factor becomes important in methods that rely upon endogenous modulation. But whatever placebo effect acupuncture has must be by means of an underlying physiological mechanism.” It is therefore of great importance to examine the scientific evidence for a biological basis of acupuncture.

Acupuncture in America

Early Chinese science was advanced. The Chinese were the first to invent the compass, printing, and gunpowder. But China’s isolation impeded incorporation of knowledge from the Industrial Revolution in the West that spawned the roots of scientific medicine. Opium wars with Britain and dissension over port treaties with foreign powers enhanced a xenophobia and stifled advances of modern medicine. Missionaries brought some knowledge of Western medicine to China, and in the late 1800s a modern hospital and medical school were established in Shanghai. In 1882, when the emperor saw the superiority of Western medical techniques, he banned the teaching of acupuncture in the Imperial Medical College. But the triumph of science over sorcery was short lived. China’s isolation was intensified by the xenophobic Boxer rebellion, war with Japan, and the Communist revolution. Thus the acupuncture “meridian theory” continued unchanged and a “bamboo curtain” impeded the flow of knowledge between China and the United States (figure 1).

In the 1940s, Chairman Mao faced millions in need of medical care with only a very limited number of Western-trained physicians. He solved the problem by re-establishing traditional Chinese medicine. With the stroke of a pen he set back Chinese medical progress by two thousand years. Teenagers were taken into the Red Guard and given three months of training in herbs, acupuncture, and First Aid. Armed with The Barefoot Doctor’s Manual, they spread ancient Chinese medicine throughout the country, giving new credence to ancient beliefs that were solidly established in rural areas. Chinese medical schools now taught both modern and traditional medicine.

When President Nixon’s delegation returned from their visit to China in 1972, they introduced traditional acupuncture to a U.S. enamored of New Age thinking and alternative medicine. These beliefs from the mysterious Orient came as yet another miracle cure-all. In view of the AMA’s negative pronouncement, physicians were reluctant to adopt or study acupuncture. So it was mainly those without medical training who became “acupuncturists.” They thus could play at being doctor without the necessity of going to medical school. Dozens of acupuncture seminars offered expensive courses, and most states soon established certification requirements of up to 1,700 hours of training in pre-scientific Chinese metaphysics. Third-party insurers are increasingly paying for needle acupuncture despite its unscientific basis.

Acupuncture Becomes Scientific

In 1972 the University of Missouri received the first National Institutes of Health acupuncture grant. Colleagues and I designed a study to compare acupuncture and hypnosis for modulation of experimental pain. We were able to report that acupuncture was not hypnosis. Most important was our finding that when the needles were stimulated by electricity it significantly increased acupuncture’s ability to control pain. Although aware of its placebo effect, we were convinced that acupuncture worked by some neuro-physiological mechanism (Ulett and Han 2002). On a trip to China I met Professor JiSheng Han of Beijing Medical University. He showed me that, by transfusion of spinal fluid, he had transferred acupuncture analgesia from a treated to an untreated animal. This proved the neurochemical basis of acupuncture. He then spent thirty years unveiling the biological mechanisms of acupuncture by mapping the anatomical pathways and biochemistry of this ancient practice (Han 1998). He found that with proper electrical stimulation of the nervous system, specific frequencies could effect the gene expression of specific neuropeptides in the central nervous system. Thus he showed that acupuncture could significantly increase the spinal fluid content of substances such as endorphins and dynorphins. These had specific healing actions in the brain and spinal cord. Endorphins, for example, can activate an opioid receptor that is now known to have an important anti-anxiety effect. He also showed that there was a cross-tolerance between acupuncture and morphine in the treatment of drug addiction. Han demonstrated that stimulation could be done with polymer conducting EKG-type pads placed on the surface of the skin over motor points. No “magic needles” were necessary.

By 2001 functional magnetic resonance imaging (fMRI) studies, especially those of Professor Z.H. Cho of the University of California Medical School at Irvine, demonstrated significant supporting evidence of a biological basis for acupuncture. Cho showed that electro-acupuncture stimulation can affect the diencephalic area of the brain, a region that promotes the body’s own healing responses. Here sensory stimulation of the hypothalamus enhances homeostasis through activating the autonomic nervous system, balancing hormonal regulation by action of the pituitary gland and effecting anti-pain and limbic system responses (Cho, Wong, and Fallon 2001).

Conclusion

Traditional Chinese acupuncture is an archaic procedure in which needles are inserted through the skin over imaginary channels in accord with rules developed from pre-scientific superstition and numerological beliefs. The needles are manipulated to supposedly influence an imaginary body energy whose blockage is presumed to create diseases that are diagnosed and defined in a manner antithetical to modern medical knowledge. New information from research by Chinese scientists has replaced this mystical sham medical procedure with a simple, evidence-based, no-needle treatment. This method stimulates motor points and nerve junctures. Specific electrical currents induce the gene expression of neurochemicals and activate brain areas important for healing. Here then is a scientifically based alternative to the metaphysical theories and magical rituals of traditional Chinese acupuncture.

Western medicine prides itself on being evidence-based. Schools of medicine, nursing, chiropractic, and naturopathy should therefore avoid teaching pre-scientific traditional needle acupuncture to their students. The integration of unproven mystical methods will serve only to contaminate a scientific curriculum with make-believe medicine. Evidence-based neuro-electric stimulation is an effective, simple, no-needle, drug-free method of treatment that can be taught in an hour’s time (Ulett and Han 2002). Our own experience and reports from clinics abroad have shown this to be a potent technique giving lasting relief from chronic pain with a reduced dependency upon medication. It has also been found useful for a variety of neurological, psychiatric, and psychosomatic illnesses.

References

George A. Ulett

George A. Ulett, M.D., Ph.D., is a clinical professor of psychiatry at the University of Missouri School of Medicine and Missouri Institute of Mental Health, St. Louis, MO 63139, and author of The Biology of Acupuncture.