Ancient Medical Relics of Mawangdui (c. prior to 168 BC)
The Ancient Medical Relics of Mawangdui (c. prior to 168 BC), which contain the two oldest known texts concerning the meridians, make no mention of needling or acupoints. These documents discuss the application of moxibustion to the general meridians and diseased or very large areas, rather than to specific points.
Historical Records (c. 104-91 BC)
The first mention of needling is found in the Historical Records (c. 104-91 BC), in the biography of Cang Gong (c. 215-140 BC). Cang Gong, the first recorded practitioner of traditional Chinese medicine, lived during the early part of the Western Han Dynasty (206 BC-24 AD) at the time of the birth of acupuncture.In four of the cases mentioned in the biography, Cang Gong applied moxibustion or needling to the general meridians and adjoining areas. However, no specific acupoints were mentioned in his treatments. The places he needled, referred to as suo (areas), were without names or precise locations. (See Table)
Table Cang Gong's four moxibustion and needling cases
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Disease
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Therapy
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Areas
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Repetitions
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Difficulty in urination, yellow urine, swelling of lower abdomen
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Moxibustion
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One suo (area) oneach side of Foot Jueyin Meridian
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One treatment
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Hot sensation in feet,
restlessness
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Needling
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Three suo (areas) oneach side of the sole
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One treatment
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Tooth decay
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Moxibustion
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Left Hand Yangming
Meridian
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One treatment
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Headache, fever, restlessness
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Needling
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Three suo (areas) oneach side ofFoot Yangming Meridian
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One treatment
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This table is based on Chapter 105 of Historical Records, pps. 486-491.
Neijing (c. 104-32 BC)
The Neijing (c. 104-32 BC)is the oldest extant document to mention specific acupoints. Four chapters include discussions of acupoints. The Neijing states that there are 365 acupoints, corresponding to the 365 days of the year, although only 160 are mentioned by name. The following points indicate that the Neijing, the seminal work of traditional Chinese medicine, was compiled at the beginning of the transition from stimulation of the general meridians to stimulation of specific acupoints.
First, the Neijing, like the Ancient Medical Relics of Mawangdui, generally calls for treatment of the general meridians rather than specific points. Examples include:
[ In cases of retention of urine, puncture theFoot Shaoyin and Foot Taiyang Meridians, and the sacral region with long needles. (Chapter 22 of the Lingshu)
[ In cases of dry throat or heat and sticky sensation in the mouth, select theFoot Shaoyin Meridian; in cases of sore throat, select theFoot Yangming Meridian if the patient cannot speak, but select theHand Yangming Meridian if the patient can speak. (Chapter 26 of the Lingshu)
[ In cases of toothache, select theFoot Yangming Meridian if the patient prefers cold drinks, but select theHand Yangming Meridian if the patient shows an aversion to cold drinks.
[ In cases of deafness, select theFoot Shaoyang Meridian if there is no pain, but selecttheHand Shaoyang Meridian if there is pain. (Chapter 26 of the Lingshu)
Second, even when the Neijing mentions specific acupoints, it calls for needling of the general anatomical regions where they are located, rather than the points themselves. For instance:
[ In cases of wind type tetany, first needle theFoot Taiyang Meridian and its collateral on the popliteal fossa [approximate location of UB40-Weizhong] to cause bleeding. Combine with Sanli [approximate location ofST36-Zusanli] if there is interior cold.
[ In cases of retention of urine, needle the Yinqiao Meridian and the area on the top of the big toe [approximate location of LR1-Dadun] to cause bleeding. (Chapter 23 of the Lingshu)
[ In cases of deafness, select the regions at the meeting of the nail and flesh of the fourth finger and toe [approximate location of SJ1-Guanchong and GB44-Zuqiaoyin]. First needle the finger and then the toe. (Chapter 24 of the Lingshu)
[ In cases of blurred vision and dizziness, select the area below the outer side of the ankle joint [approximate location of UB62-Shenmai].
[ In cases of flaccidity, cold limbs, and restlessness, needle the area two cun above the web between the big and second toes [approximate location of LR3-Taichong]. (Chapter 28 of the Lingshu)
[ In cases of Foot Yangming type malaria, needle the dorsal section of theFoot Yangming Meridian [approximate location of ST42-Chongyang]. (Chapter 36 of the Suwen)
The Neijing indicates that the acupoints on the limbs, especially those below the elbows and knees, were the first to be discovered. Among the 160 acupoints recorded in the Neijing, eighty-two are located below the elbows and knees. These eighty-two original points account for 71% of the 114 acupoints below the elbows and knees in use today. The names and locations of these points have not changed since they were first recorded. These acupoints are discussed in detail in the Lingshu section of the Neijing, while the more recent Suwen section concentrates on acupoints on the trunk and head, only mentioning those on the limbs in passing. It can therefore be inferred that stimulation, either moxibustion or needling, was first applied to the distal portions of the limbs.
Classic of Bright Halls (c. 32 BC-106 AD)
The full development of the acupoints and acupuncture was achieved during the period immediately following the Neijing, and was marked by the compilation of the Classic of Bright Halls(c. 32 BC-106 AD). The Classic of Bright Halls, which deals specifically with the acupoints, was compiled prior to 106 AD, between the latter part of the Western Han Dynasty (206 BC-24 AD) and the middle of the Eastern Han Dynasty (25-220 AD). Like the Neijing and many other classical texts, authorship of this classical medical document is attributed to Huang Di, the legendary Yellow Emperor. The book remained popular in the Sui (581-618 AD) and Tang (618-907 AD) Dynasties, when it was considered a primary medical textbook[1].
Although the original version of the Classic of Bright Halls was lost during the Northern Song Dynasty (960-1127 AD), around the time of the publication of Illustrated Classic of Acupoints on the Bronze Model(1027 AD)[2], its contents are well preserved in the Systematic Classic of Acupuncture and Moxibustion(c. 256-259 AD)[3]. Most of the material concerning acupuncture and moxibustion included in the Classic of Bright Halls was adapted from the Neijing, indicating that the Neijing preceded it and served as its primary source.
The Neijing and the later Classic of Bright Hallsdiffer primarily in their selection of areas to be stimulated. The Neijing focuses on the general meridians, while the Classic of Bright Halls calls for stimulating specific acupoints, with a focus on those below the elbows and knees. For example, in cases of malaria with attacks every other day and no thirst, the Neijing calls for needling of the general Urinary Bladder Meridian of Foot Taiyang, while the Classic of Bright Halls selects UB60-Kunlun, a specific point on the Urinary Bladder Meridian. In cases of febrile disease in which pain first occurs in the forearm,the Neijing calls for needling thegeneralHand Yangming and Hand Taiyin Meridians, while the Classic of Bright Halls selects LU7-Lieque, a point on the Lung Meridian of Hand Taiyin.
In addition to reflecting the development of acupuncture from general meridians to specific acupoints, the Classic of Bright Halls reflects the theoretical and clinical development of the acupoints in the following areas.
First, there was a rapid increase in the discovery of new acupoints in the period immediately following the Neijing. The number of acupoints rose from 160 in the Neijing to 349 in the Classic of Bright Halls. This is an increase of 189 acupoints within less than two hundred years. A mere twelve additional acupoints were added during the following 1600 years, to today's total of 361.
Second, acupoint theory made great progress. The Neijing mentions the five types of shu (transport) acupoints of eleven of the twelve Regular Meridians. The Classic of Bright Halls added not only the fiveshu (transport) acupoints of the twelfth Regular Meridian, the Heart Meridian, but also additional specific acupoints, including the mu (assembly), xi (cleft), and jiaohui (intersection) acupoints.
Third, indications of the acupoints were expanded. The Neijingcalls primarilyfor moxibustion or needling of the general meridians, rather than specific acupoints. The Classic of Bright Halls, on the other hand, lists acupoints indicated for treatment of 270 diseases and disorders, including 185 internal conditions, 20 surgical conditions, 23 gynecological and pediatric conditions, and 42 disorders of the five sensory organs.
Discussion
A close investigation of the history of the meridians and acupoints indicates that the acupoints were not discovered prior to the meridians, as has generally been assumed. Rather, the identification of the meridians came first, and laid the necessary foundation for the identification of the acupoints.
The earliest medical documents, the Medical Relics ofMawangdui (c. prior to 168 BC), discusstreating the general meridians. The Historical Records (c. 104-91 BC) gives cases of treating suo (areas) of the meridians, rather than their entire pathways; however, the emphasis is on the meridians, and no specific names or locations are given for the areas. For example, in cases of difficulty in urination, moxibustion is applied to bilateral suo (areas) of the Foot Jueyin Meridian. In cases of headache and fever, three bilateral suo (areas) of the Foot Yangming Meridian are needled.(See Table 9.)
The first mention of the acupoints occurs in the Neijing(c. 104-32 BC), which refers to them as qixue(caves of qi) or qifu (mansions of qi). They are defined as the areas where qi issues out of the meridians. Chapter 59 of the Suwen section of the Neijing, entitled "Discussion of Qifu,"lists the approximate locations of the acupoints of a number of meridians, including the six Hand and Foot Yang Meridians and the Ren and Du Extraordinary Meridians. In each case, the acupoints are discussed in the context of their meridians, for example, "The Urinary Bladder Meridian of Foot Taiyang has seventy-eight acupoints from which its qi issues." (Chapter 59 of the Suwen)
From the earliest mention of acupoints in the ancient documents until their maturity at the time of the Classic of Bright Halls(c. 32 BC-106AD), they have been considered to be integral parts of the meridians, rather than discrete islets on the surface of the body. They are generally located on specific areas of the meridians, including the bony holes or depressions in the bones; between the bones, muscles, or tendons; around or on the joints of the limbs, such as wrist, elbow, shoulder, ankle and knee; near the arteries (referred to classically as the moving vessels); and above the hairline or on the extremities[4]. The Classic of Bright Hallsuses the term xian (depression) to describe the anatomical characteristics of the acupoints. Just as water flows to depressions in the earth, so the qi and blood of the meridians converge in the areas of the acupoints.
Consequently, familiarity with the pathway of a meridian will enable the practitioner to easily locate its specific acupoints. The Neijing succinctly states: "There are a total of 365 acupoints. If one grasps the essentials of meridian theory, the numerous acupoints can be described with just one sentence. If one fails to grasp these essentials, the points will seem boundless." (Chapter 1 of the Lingshu)
When the body is out of balance, positive signs will usually appear along the pathways of the affected meridians. These signs, which may include soreness, tenderness, scleroma, and changes in skin color, are generally located at or near acupoints. The Neijing stresses repeatedly that before applying stimulation, the pathways of the affected meridians should always be examined and palpated in order to locate the exact acupoints. This practice is known as point diagnosis. It now becomes clear how the ancient Chinese discovered so many acupoints within such a short time. Once they had identified the pathways of the meridians and developed meridian theory, point diagnosis enabled them to rapidly determine the precise locations of the acupoints.
Finally, it is necessary to mention that thediscovery of the acupoints was a direct result of the practice of acupuncture. While moxibustion can be applied to a large area of the body, or even along the entire course of a meridian, needles can only be inserted into the body through discrete points. The classical term for acupoint used in the Neijing, qixue(cave of qi), indicates that the acupoints are three-dimensional openings, which allow the needles to be inserted into the body without injury to the tissues. Chapter 4 of the Lingshu states: "The acupuncturist should needle the qixue(caves of qi) and avoid the muscles. When the needle is inserted into the qixue(caves of qi), it is similar to moving through a lane or alley. There will be pain if the muscles are needled." (Chapter 4 of the Lingshu) The close relation between the acupoints and acupuncture can be seen in this definition of the acupoints from the Suwen: "All three hundred and sixty-five qixue (caves of qi) are areas through which the needles enter the body." (Chapter 58 of the Suwen)
References
1. Bright Hall or mingtang (明堂) originally referred to a building where the emperors, starting with Emperor Wu Di (c. 140 BC) of the Western Han Dynasty (206 BC-24 AD) promulgated their decrees. There were a total of twelve Bright Halls, one corresponding to each month of the year. The Emperor lived in each hall in turn for one month, rotating through all twelve halls over the course of a year. In the same way, each of the twelve Regular Meridians was considered to correspond to one month, and the flow of qi and blood through the interconnected system of twelve Regular Meridians to the progress of the twelve months of the year. Furthermore, acupoints were selected according to the waxing and waning of the moon. Thanks to these correspondences, the term "Bright Halls" gradually became a synonym for acupoints, and acupoint charts were called Maps of Bright Halls (mingtang tu 明堂图). Of the many books on acupoints named in this way, the Classic of Bright Halls is the oldest. See Compilation and Annotation of the Yellow Emperor's Classic of Bright Halls (Huang Di Mingtangjing Jijiao 黄帝明堂经辑校) (c. 32 BC- 106 AD.), ed. Huang Longxiang. Beijing: Chinese Medicine and Science Press, 1987, pps. 239-240.
2. The Illustrated Classic of Acupoints on the Bronze Model (Tongren Shuxue Zhenjiu Tu Jing铜人腧穴针灸图经) was written by Wang Weiyi (987-1607 AD) in 1027 AD and engraved on stone. Bronze models which illustrated the acupoints discussed in the book were used as aids for teaching acupuncture. See Guo Shiyu, History of Chinese Acupuncture and Moxibustion (Zhongguo Zhenjiu Shi 中国针灸史). Tianjin: Tianjin Science and Technology Press, 1989, pps. 152-157.
3. The Systematic Classic of Acupuncture and Moxibustion, also translated as The ABC of Acupuncture and Moxibustion (c. 256-259 AD) (Zhenjiu Jiyi Jing 针灸甲乙经), compiled by Huangfu Mi (215-282 AD) during the Wei Dynasty (220-265 AD), is the earliest complete work on acupuncture and moxibustion extant in China. It contains material on acupuncture and moxibustion adapted from the Neijing and Classic of Bright Halls, and reflects the state of acupuncture and moxibustion at the time of the Wei Dynasty.
4. The Neijing also refers to acupoints as gukong or empty spaces of the bones. Chapter 60 of the Suwen, "Discussion of Empty Spaces of the Bones," lists a number of acupoints located in bony holes or between the bones, including UB31-34 Baliao, LI15-Jianyu, UB60-Kunlun, DU16-Fengfu. (Suwen, 60:318-326.)
