Did acupuncture using metal needles develop from bian stone therapy?
Acupuncture in China is so ancient that its origins are unclear. According to Huangfu Mi (c. 215-282 AD), author of The Systematic Classic of Acupuncture and Moxibustion (zhenjiu jiayi jing), needling therapy was first used during China's Bronze Age, over five thousand years ago. He attributes its invention to either Fu Xi or Huang Di (the Yellow Emperor), two legendary figures of the Five Emperors Period (c. 3000-2070 BC) (插图：黄帝). Modern scholars generally believe that acupuncture is much older, originating more than ten thousand years ago during China's Neolithic Age (c. 8000-3500 BC).
Figure Yellow Emperor (Huang Di)
One important premise supporting the theory of the Neolithic origins of acupuncture holds that bian shi, specialized sharp-edged stone tools that appeared during China's Neolithic Age, were used for an early form of needling therapy, prior to the invention of metal smelting. It is believed that the ancients had to use stone needles for acupuncture because iron-smelting technique had not yet been developed. Quan Yuanqi, who lived during the Liang dynasty (502-557 AD), offered the first such interpretation in his annotation of the Su Wen1:
"Bian stone therapy was an external healing method used in ancient times. Since there was no iron-smelting in antiquity, stone was used to make needles."2
This statement indicates that bian stone therapy was no longer in use during Quan's times. It also implies that Quan considers the only difference between bian stone therapy and acupuncture lies in the materials used to make the instruments. I believe, however, that there are intrinsic difference between the two therapies.
The ancient definition of the Chinese character bian is often used to support the theory that bian stone therapy was the direct precursor of acupuncture. The definition given for the character bian in the oldest dictionary of Chinese characters is "to ci disease with stone."3 In contemporary usage, the character ci means thorn, or to stab with a thorn-like material. The phrase is therefore usually interpreted as "to needle or stab disease with stone." This interpretation naturally leads to the association of bian stone therapy with acupuncture.
However, I believe that this phrase should rather be interpreted as "to incise disease with stone," for the following reason. The same dictionary defines ci as "the act of the monarch killing his senior officials."4 It is a knife rather than a needle is used to kill, and "to kill with a knife" was the primary meaning of ci in ancient times. Even today, the term ci ke means a knife-wielding assassin. This indicates that bian stones were knife-like rather than needle-like.
Now the question arises as to what kinds of "disease" bian stones were used to incise. Were they used to treat all diseases, or only certain conditions? References in the ancient documents show that bian stone therapy was used specifically to treat yong and ju conditions (suppurative skin problems such as boils, carbuncles, furuncles etc.)5.
Yong and ju syndromes were common in ancient times, with special chapters on them appearing in both the Ancient Medical Relics of Mawangdui and the Ling Shu. The Rites of the Zhou Dynastyrefers to a specialized type of surgical practitioner during the Zhou dynasty (c. 1100-256 BC) called yang yi, who treated problems such as swollen abscesses, open sores, and wounds using zhuyou (incantation), medication, and incision6. Specific treatments appear in the Ancient Medical Relics of Mawangdui in sections on bian stone therapy and yong and ju syndromes. The treatment of yong and ju is divided into presuppurative and postsuppurative stages. Zhuyou (incantation), moxibustion, and medication, including oral medicine and external and hot compresses, are employed during the first stage; bian stone therapy is used to drain pus during the second stage.
The Ancient Medical Relics of Mawangdui states that to prevent unwanted side effects when using bian stones to drain pus, the size of the stone should be appropriate to that of the abscess. Four kinds of improper treatment are listed:
"First, to incise a deep abscess superficially is insufficient; second, to incise a shallow abscess deeply is excessive; third, to incise a large abscess with a small bian stone is insufficient; fourth, to incisea small abscess with a large bian stone is excessive."7
The authors of the Nei Jing were obviously very familiar with the history of bian stone therapy. They definitively state that bian stone therapy originated in eastern China and was used specifically to treat yong and ju syndromes. Chapter 12 of the Su Wen states:
"The east is the birthplace of heaven and earth. It is close to the sea and teems with fish and salt, so local people eat a lot of fish and prefer a salty flavor. Fish is a hot food; eating too much fish produces heat in the interior. Salt enters the blood; overeating of salt consumes blood and leads to slow flow of blood. The combination of interior heat and stagnant blood results in furuncles and sores. Thus people in the east often have dark skin and commonly suffer from swelling abscesses. Accordingly bian stone, an ideal implement for puncturing abscesses, was developed in this area."
Although metal needles, including feng or sharp-edged and pi or sword needles, were used to drain abscesses by the time of the Nei Jing, many practitioners still employed bian stones for this purpose8.
Bian stones were designed to be used as a surgical knife to drain pus in yong and ju syndromes. This type of local surgery has nothing in common with acupuncture. If, as has been previously assumed, bian stones were used for acupuncture by the ancients solely because they had no metal to make needles, then acupuncture using metal needles should have replaced bian stone therapy as soon as smelting was invented and metal instruments came into widespread use. However, this is not the case. No documents or archeological finds indicate that bronze needles were used medically during the Bronze Age (c. 3500-1000 BC). Even after the discovery of iron working early in the Spring and Autumn Period (770-476 BC), the use of iron needles for medical treatment was minor compared to the broad application of iron implements for other uses. At the time of The Ancient Medical Relics of Mawangdui, iron instruments including staffs, surgical knives, and cauldrons were widely used, and iron was also administered orally as a medicine. But, as has been previously discussed, no historical references from the time mention the use of iron needles for acupuncture.
The original meaning of the Chinese character zhen or needle, was a needle used for stitching. Sewing has a very long history in China. The earliest needles weremade of animal bone or bamboo. Many primitive bone needles have been unearthed. The presence of an eye indicate that these needles were used for sewing. Because bone needles have been found with no eye or with points on both ends, some scholars have inferred that the ancients may have used bone needles for medical purposes. However, I believe that it is rash to draw such a conclusion based solely on relics that have lain buried for thousands of years. Rather, it is likely that the eyes of these needles have simply decayed over the millennia.
Iron smelting was invented in China during the Western Zhou dynasty (c.1100-771 BC). Iron sewing needles were invented during the early Spring and Autumn Period (c.770-476 BC). However, the earliest extant reference to the use of metal needles for acupuncture is found in the Nei Jing [c. 104-32 BC] that contains detailed descriptions of nine types of needles, including their shapes and indications.
Might it be possible that the ancient Chinese drew inspiration from bian stone therapy when they devised the needles used for acupuncture? It appears not. First of all, incising abscesses to drain pus is not peculiar to ancient Chinese medicine. For instance, Babylonians used bronze knives over four thousands years ago to excise abscesses, yet never developed a system of acupuncture9. In addition, of the nine acupuncture needles shown in the Nei Jing, three were modeled after sewing needles, but none were modeled after bian stones.
The historical documents and archaeological evidence discussed above lead me to conclude that bian stone therapy was entirely unrelated to the invention of acupuncture, despite the common assumption to the contrary. In fact, the origin of needles and their applications are two entirely different things. The composition of ancient needles, whether stone, bone, bamboo, bronze, or iron, sheds no light on the origins of acupuncture. It is the use, rather than the composition, of the needle that is important. Needles made of various substances are universal, but only the ancient Chinese were brave enough to needle the body for medical purposes.
Notes and References:
1. Quan's book has been lost since Southern Song Dynasty (1127-1279 AD). Some excerpts are preserved in the Tang Dynasty (618-907 AD) version of the Suwen annotated by Wang Bing in 762 AD. Wang Bing reorganized the entire work and added at least seven chapters of his own. This and the Song Dynasty (960-1279 AD) version, The Revised and Annotated Inner Classic of the Yellow Emperor: Simple Questions (Chongguang Buzhu Huang Di Neijing Suwen重广补注黄帝内经素问), annotated by Lin Yi in 1056-1067 AD, are considered the standard versions of the Suwen.
2. Suwen, 25:161.
3. Xu Shen (c. 58-147 AD), Analytical Dictionary of Characters (Shuowen Jiezi 说文解字) (c. 100 AD). (Beijing: China Book Company, 1963. p. 195. This is one of the earliest dictionaries of Chinese characters. It was compiled c. 100 AD, about one hundred years later than the Neijing, and discusses the origins of many Chinese characters.
4. Ibid., p. 92.
5. Yong 痈is usually translated as carbuncle and ju疽 as cellulitis. These are two important Chinese medical terms for suppurative skin disorders, equivalent in modern medical terms to suppurative furuncle and acute purulent lymphadenitis.
6. Rites of the Zhou Dynasty (Zhou Li 周礼), written during the Warring States period (475-221 BC), is one of the Confucian classics. It records the official rituals and regulations of the Zhou Dynasty (c. 1000-256 BC). Royal doctors at that time were divided into four categories: dieticians, who were responsible for the rulers' food and drink; doctors of internal medicine, who treated diseases and disorders with grains and herbs; surgeons, or yang yi 疡医, who treated problems such as swollen abscesses, open sores, and wounds using zhuyou (incantation), medication, and incision; and veterinarians, who treated animals. The History of Chinese Medicine (Zhongguo Yixue Shi 中国医学史), ed. Zhen Zhiya, et al. (Shanghai: Shanghai Science and Technology Press, 1984), 15.
7. Ibid., pps. 286-290.
8. Lingshu, 81:153-155. This chapter is entitled "Discussion of Yong and Ju," and is specifically concerned with the treatment of yong and ju syndromes using bian stone (bian shi 砭石).
9. The famous Code of Hammurabi states: "If the doctor shall treat a gentleman and shall open an abscess with a bronze knife and shall preserve the eye of the patient, he shall receive ten shekels of silver. If the patient is a slave, his master shall pay two shekels of silver." Douglas Guthrie, A History of Medicine, p. 18.
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