Pacific College of Oriental Medicine Alumni

The Western idea of energy circulating through invisible meridians in the body is used extensively to explain the fundamental concepts of acupuncture and Chinese medicine. Now that acupuncture is being recognized as a valid treatment approach, more medical professionals and researchers are questioning the validity of these theories. On the surface, energy circulation and invisible meridians seem incomprehensible, and possibly contrary to known physiological process. Some researchers (Ulett, Han, and Han: 1998) even note that most of the 10,000 acupuncturists in the United States: “Practice metaphysically explained ‘meridian theory’ acupuncture using needles to supposedly remove blockages of a hypothesized substance ‘Qi’.” In addition, the National Institutes of Health consensus statement on acupuncture (NIH: 1997) indicates that much confusion exists with respect to treatment approaches and research protocol. Did the ancient Chinese envision a whole different understanding of human physiology that modern science can not figure out, or is the Western “energy-meridian” theory an aberration?

About four to five hundred years ago, religious people, merchants, and other European travelers to the Orient brought back the first serious reports on Chinese medicine. Information was documented during this early exposure on pulse diagnosis, acupuncture, moxibustion, and herbal medicine as observed in Java, China, and Japan. All the academic writings at the time were in Latin and so the Chinese art of needling therapy was called “acus punctura” or acupuncture. By the mid 1500s the first European book on acupuncture was published by Girolano Cardono (1508-1576), a physician and medical teacher from Milan (Roccia: 1974). This work was based on interviews with people treated by acupuncture and moxibustion during their visits to Asia. By 1549, a Jesuit mission was already established in Japan and missionaries were knowledgeable of Chinese and Japanese terms of anatomy, physiology, and with pulse diagnosis, and the use of needling therapy and moxibustion (Michel: 1993).

Willem ten Rhijne provided the initial first-hand report on Chinese medicine in 1683 based on his two-year stay in Japan as a physician for the Dutch East India Company (Carrubba and Bowers: 1974). He had acquired four Chinese jingluo diagrams showing small spots arranged longitudinally along surface of the human body. Ten Rhijne traded information on what was the current European medical approach of the time with Chinese and Japan practitioners for explanation of the charts. The spots represented the critical nodes (jie) or junctures where collateral vessels (luo) of the longitudinal distribution blood vessels (jing) supply the superficial body. Ten Rhijne learned that Chinese medicine was based on the circulation of blood and vital air (qi) involving arteries and veins, and the Chinese mentioned the involvement of nerves as well. He noted that the main Chinese emphasis was on circulation of blood and on the structure and function of blood vessels. He also discussed the Chinese importance of the branching of larger vessels into smaller vessels. The Chinese had constructed hydraulic machines to demonstrate the continuous circulation of blood throughout the vascular system. Ten Rhijne reported clinical success by Chinese and Japanese practitioners in treating a wide range of disorders, including pain, internal organ problems, emotional disorders, and infectious diseases prevalent at the time.

By the 1800s no further investigation into Chinese medicine was considered necessary until Lois Berlioz (1776-1848) used Ten Rhijne’s report to investigate the use of acupuncture in 1810 (Roccia:1974; Agren: 1977). Soon other European physicians experimented with acupuncture, even including the first use of electroacupuncture in France and Italy. Acupuncture was imported to United States as early as 1822 when a few American physicians investigated its use (Cassedy: 1974). Ten Rhijne’s dissertation was first translated into English in 1826 and published in the North American Medical and Surgical Journal (1826; 1: 198-204) (Rosenburg: 1979) that corresponded with this early interest. One of the most notable practitioners was the Canadian physician Sir William Osler (1848-1924) who practiced a variant form of acupuncture, recommending its use to treat lumbago. By 1900, analgesia induced by electroacupuncture was in disfavor (Stillings: 1975). Then in 1901, a young man named Georges Soulie de Morant went to China from France to work as a clerk for the Banque Lehideux. He remained in China until 1917 and during his long stay he developed an interest in Chinese art, music, history, literature, and Chinese medicine.

In the 1930s Soulie de Morant was teaching acupuncture to physicians and lay people in France. He promoted the idea that Chinese medicine did not require an understanding of anatomy and physiology. He translated the Chinese character “qi” (vital air) as “energy” for lack of a better word (Zmiewski: 1994) and translated the character “jing” in jingluo as “meridian” even though both jing and luo can refer to blood vessels, and the Chinese term for meridian is actually “jingxian.” In addition, Soulie de Morant introduced more errors by translating critical juncture (jie or xuedao) which involve neurovascular structures as “point.” He also incorrectly translated “mai” which clearly means “vessel” as meridian as well, and translated “phase” (xing) as “element” and the “sanjiao” (internal membrane systems) as the “triple heater” and classified this as an imaginary organ. These major errors created a whole new Western concept that Chinese medicine was based on undefined energy circulating through imaginary meridians. Once Chinese physiology is characterized in this fashion, it is very understandable why these ideas are thought of in terms of metaphysics. After Soulie de Morant promoted his energy-meridian theory, the work of Ten Rhijne involving vascular circulation of blood and vital air was discredited as erroneous.

Had Soulie de Morant translated the Neijing (circa 600-300 BCE) he would have found out that the circulation of blood and vital air in the vascular system is fundamental to Chinese medicine (Veith: 1949). Blood circulation by means of the heart, and a rudimentary understanding of the immune system, was understood 2000 years earlier than in the West. Chinese medical theories are based on anatomical and physiological knowledge derived through post mortem dissection studies conducted by the ancient Chinese physicians. The Chinese described the internal organs, brain, spinal cord, the vascular system including superficial and internal routes, and the muscle of the body. They described inducing needling sensation and the propagation of sensations along the nodal (acupoint) sites of the superficial body.

The character “qi” was known to mean breath or air and the atmosphere was called the big air (daqi), but the Chinese understood that air was a vital component needed support metabolic processes. They also noted that other vital substances including nutrients-ying, defensive substances-wei and substances of vitality-shenjing were needed as well. Adding confusion for translators, the Chinese would sometimes substitute the character qi to collectively indicate qi, ying, wei, and shenjing when the context of the paragraph or chapter was understood. They used the term “jingluo” meaning longitudinal distribution and collateral blood vessels, to describe the vascular system formation of superficial nodes where a dense supply of fine vessels, including arterioles, capillaries, and venules supply the skin regions. Translating jing as meridian, mai as meridian, qi as energy, and nodal sights as points is consider unwarranted. Schnorrenberger (1996) translates qi as “vital strength or breath” and notes that qi “is certainly not equivalent to the Western term energy.” The other problem is that energy is an abstract concept that means “in work” and cannot be circulated. Nutrients and other vital substances have potential energy and can be circulated in the vascular system. However, for humans and other animals, energy is expended within the body cells and is not circulated. Blood is only circulated within the vascular system and it is obvious that blood cannot be circulated in meridians. Propagated sensations induced by afferent nociceptive fibers trigger by needling, are mediated by afferent proprioceptive fibers and propriospinal neural reflexes and do not constitute energy circulation. Modern research has failed to prove circulation of energy and blood through meridians; however, the Chinese physiological model is being validated.

The authentic theories and practices of Chinese medicine are consistent with the present understanding of human physiology. So, what can be said of all the individuals that have expended considerable effort and expenses to learn acupuncture and Chinese medicine using Soulie de Morant’s energy-meridian theories? As it turns out, there is good news. What has been learned in terms of diagnosis, use of acupoints, and treatment approaches can still be applied with great effect regardless if the practitioner believes it involves energy and meridians, or whether they understand it principally involves neurovascular nodes (acupoints), circulation of blood and vital substances (including vital air-qi, nutrients-ying, defensive substances-wei, and substances of vitality-shenjing), neurological mechanisms, and viscerosomatic relationships. The clinical experience gained over the years is still intact and one only needs to make a shift in how they view the body in physiological terms. The Chinese physiological model provides a rational basis for improving clinical outcomes and for designing effective research protocol.

References
Agren, H. “Treatise on Acupuncture Academic Thesis for the Degree of Medicinae Doctor at Uppsala University 16 May 1829 by Gustaf Landgren.” Comparative Medicine East and West 5 (3–4) (1977): 199–210.
Carrubba R.W., and J. Z. Bowers. “The Western World’s First Detailed Treatise on Acupuncture: Willem ten Rhijne’s De Acupunctura.” Journal History of Medicine and Allied Science 29 (4) (October 1974): 371–398.
Cassedy, J. H. “Early Use of Acupuncture in
the United States.” Bulletin of the New York Academy of Medicine 50 (8) (1974): 892–896.
Michel, W. “Early Western Observations of Moxibustion and Acupuncture.” Sudhoffs Arch Z Wissenschaftsgesch 77 (2) (1993): 193–222. (German)
NIH Consensus Statement. Acupuncture 15 (5) (November 3–5, 1997): 1–34.
Roccia, L. “Chinese Acupuncture in Italy.” American Journal Chinese Medicine 2 (1) (January 1974): 49–52.
Rosenburg, D. B. “Wilhelm Ten Rhyne’s De Acupunctura: An 1826 Translation.” Journal History of Medicine and Allied Science 34 (1) (January 1979): 81–4.
Schnorrenberger, C. C. “Morphological Foundations of Acupuncture: An Anatomical Nomenclature of Acupuncture Structures.” BMAS Acupuncture in Medicine 14 (3) (November 1996): 89–103.
Stillings, D. “A Survey of the History of Electrical Stimulation for Pain to 1900.”
Medical Instrumentation 9 (6) (November–December 1975): 255–9.
Ulett, G. A., J. Han, and S. Han. “Traditional and Evidence-Based Acupuncture: History, Mechanisms, and Present Status.” Southern Medical Journal 91 (12) (December 1998): 1115–20.
Veith, Ilza. Huang Ti Nei Ching Su Wen: The Yellow Emperor’s Classic of Internal Medicine, new edition. Los Angeles and Berkeley: University of California Press, 1949, 1966.
Zmiewski, Paul, ed. Georges Soulié de Morant, Chinese Acupuncture (L’acuponcture Chinoise). trans. Lawrence Grinnell, Claudy Jeanmougin, and Maurice Leveque, Brookline, Mass.: Paradigm Publications, 1994.