Acupuncture as a way of knowing the body

Shujian Zhang

Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,China

Abstract Observation,speculation and experimentation are the means for the generation of knowledge about acupuncture,and they also provide basic ways to understand the body from the perspective of acupuncture.Observation involves external touching and internal anatomy.Through observation,the basic patterns of meridians and acupoints can be understood.The theory of meridians and acupoints was formed based on the two speculation methods of analogy and reasoning,but speculation does not necessarily lead to truth.Another approach—holographic thinking—provides a new method of knowing the body.The greatest contribution of acupuncture experimentation lies in discovering the correlation between the body’s surface and its viscera,and this is of far-reaching significance.

Keywords Acupuncture,body,way of knowing,traditional Chinese medicine

1.Introduction

The purpose of science is to understand nature,and transforming nature for the benefit of mankind is only a welcome side effect of science.However,if we were to suggest that the purpose of medicine is to know the body,and that curing diseases and improving health are only welcome side effects,that statement will inevitably lead to controversy.Nonetheless,it seems that there is nothing wrong with considering medicine as a science.On the question of how best to know the human body,people will differ in their answers;different approaches to exploring the body will be taken by scientists,artists,surgeons and gymnasts.

How,then,do acupuncturists view the body,and what is their way of knowing the body? This question can lead not only to a body schema with unique Chinese medical characteristics,but also to a necessary reflection on understanding acupuncture.Based on the theories of acupuncture,this paper seeks to discuss the presentation of the body across a long historical span from the perspective of knowledge generation.However,the question involved arises not because acupuncture provides a conscious expression of bodily knowledge,but because of the logical inferences made during the production of acupuncture knowledge.

2.Observation

Observation is a source of all kinds of knowledge,and it is the basic approach to understanding nature and the body;its intuitive character makes it the easiest source of knowledge to accept and believe.The early theory of acupuncture was based to a great extent on observations,as can be seen inLingshu: Jingshui(Miraculous Pivot: Meridian Waters),which says,‘For an average man,his skin and flesh are there,and his conditions can be known by measuring for the outside parameters,and by dissecting the body after his death’.Measurement by touching the skin and dissection were two major methods of body observation in early Chinese medicine.The theory of meridians and acupoints is an important cornerstone of acupuncture and moxibustion,and it is also the core of body knowledge in traditional Chinese medicine.Taking meridians as an example,Lingshu: Jingmai(Miraculous Pivot:Meridians)notes,‘The twelve meridians,lying among the flesh,are deep and invisible,with the exception of the spleen meridian seen on the lateral ankle,where the skin is shallow and there is nowhere to hide it.Those surfacing and commonly seen are all collaterals.’ This makes a distinction between meridians and collaterals: those that are ‘surfacing and commonly seen’ are collaterals,while those that are ‘deep and invisible’ are meridians.However,the meridian of the spleen is visible because the muscles there are small and shallow.Another means of distinguishing between meridians and collaterals is also presented inLingshu: Jingmai:‘Lei Gong,a minister,asked Emperor Huang: “How do you know the difference between meridians and collaterals?” The Emperor said: “Meridians are often invisible,and their existence is known by palpation,and those visible are collaterals”.’ Here,‘knowing by palpation’is an act of feeling for the meridians on the body’s surface.Furthermore,a method for ‘meridian feeling’ is mentioned in the silk-bound bookMeridian Findingunearthed at Mawangdui’s Tomb of the Han Dynasty:

Press the foot five inches from the ankle with your left hand and knock the foot’s ankle softly with your right hand.If you find that other meridians are strong,and only this one is weak,it indicates a disease;if other places are smooth,and this alone is hindered,it shows a disease;if others are still,and this place moves alone,it is also an indication of a disease.(Ma,2015: 97–98)

Compared with meridians,the shapes of acupoints are more apparent.Therefore,most of the acupoints were detected by observing the body’s surface in the early days of the tradition.I once examined the descriptions of acupoints inHuangdi Neijing(The Yellow Emperor’s Classic of Medicine),which states that acupoints are where morphological characteristics,such as cavitation,bone voids,crevices between bone voids,collaterals,pulsation,tendon knots and tenderness,are apparent on the body’s surface (Zhang,2011).

Early anatomical observations are also reflected inHuangdi Neijing.At that time,the ancients still found and measured the meridians by anatomy,although their anatomical techniques were relatively crude.Moreover,the description of the working of the 12 meridians inLingshu: Jingshuistates that,in the four limbs,they can be observed by palpation on the body’s surface,but the paths inside the body were not entirely imaged by the ancients.As a one-to-one correspondence could not be established between the circulating meridians and the tissues of the body,and the ancients studied meridians mostly for practical purposes,there was no specialized discussion on the anatomy of meridians,so later generations have generally understood that meridians constitute a relatively independent physiological system.

When the meridian theory came into being,the ancients saw the meridians in terms of anatomy.Through ‘dissecting and observing’,as noted inLingshu: Jingshui,we can know ‘the rigidity and size of the viscera,the number of crevices among the joints,the length of the meridians,the cleanness of blood and the amount ofqi’.A more concrete example is found in the biography of Wang Mang in theHistory of the Han Dynasty: ‘Wang Sunqing,a follower in Zhai Yi’s uprising,was captured,and Wang Mang ordered the imperial physicians,officials of the royal pharmacy and skilful butchers to cut Wang Sunqing alive,dig out his organs,explore their functions and states,and then pierce the blood vessels with sharpened bamboo thorns to understand the start and end of his meridians,saying it can cure diseases.’ This is a record of an anatomical exploration of the meridians found in a history book.InLingshu: Dongshu(Miraculous Pivot:Dynamic Transmission),it is stated,‘Energy from the stomach is injected upward into the lung,and when its fierce force is injected towards the head,it follows through the pharynx,goes up to empty orifices before following the connective tissues between the eyes and the brain and entering the collaterals,going down to thekezhurenacupoints on the cheeks,following through the lower gum,and down to therenyingacupoints on the neck through theyangmingmeridians.’ Such a specific description could not have been made possible without anatomical practice.

The scalpels of the ancients failed to reveal the detailed and clear internal structure of the human body;even in the nineteenth century,when Wang Qingren,an anatomist in the Qing Dynasty,publishedCorrections of the Medical Field,the anatomical map presented was not particularly accurate.Furthermore,at the time,modern Western anatomy had been introduced to China,so Wang Qingren’s anatomical consciousness had something to do with his reading of works at the confluence of Chinese and Western medicines.After Wang Qingren,Benjamin Hobson’sQuanti Xinlun(Treatise on physiology) was published in 1851.This medical book published by a Western missionary and doctor resulted in a division between meridians and blood vessels in Chinese medicine,the influence of which has persisted to the present day.

Whether what is seen of the body is observed through feeling with the hands and fingers or through anatomy,the job is done via simple and intuitive observations.It is widely held that‘science is based on what can be seen,heard or touched,not on personal opinions or speculative imagination’(Chalmers,2018:1).Such an approach was adopted when the theory of acupuncture and moxibustion was established.Of course,the results of observation might not be accurate.For example,the anatomical mapPreserving the Truth,drawn by Yang Jie,a doctor in the Song Dynasty,is inconsistent with anatomical reality in many places,and it is the result of Yang Jie’s analysis and correction by‘proofreading against ancient books’ (Zhang and Zhao,2016).The method of ‘proofreading against ancient books’ means to correct the anatomical pictures against classical theories as the standard,and it was also a practice of the ‘theory-ladenness of observation’.In the process of understanding the body by acupuncture and moxibustion,however,the essence of the theory infiltrated into the observation is in fact an introduction to another method for understanding the human body:speculation.

3.Speculation

The theories involving the 12 meridians,365 collaterals and 365 acupoints cannot be derived purely by observation.How,then,did these classical bodily theories come into being?

As mentioned above,the theoretical basis for early human physiology is at least partly empirical facts,and partly something else that in theory can be regarded as the ‘explanation’ of facts,which has existed since concepts came into existence.The experiences we have undergone (let us say they are true to facts)are explained when they are described.For example,the ancients observed that there were depressions on the body’s surface,and they used words such as ‘bone voids’ and ‘a(chǎn)ir pockets’ when referring to those depressions.These concepts themselves were expounded with theories:bone voids are related to positions and structure,and air pockets to functionality and morphology.Taking the theory of meridians and acupoints as an example,these can be regarded as an explanatory model,and with them,the theories can be demonstrated more conveniently.Now let us see what tools were used in the construction of the theoretical models for meridians and acupoints.

The first tool that was used was analogy.In classical acupuncture theories,analogy is found everywhere,probably due to the limitations of observation.The main target of analogy was nature,or what the ancients called ‘the heaven’.As the saying goes,‘Man copies the heaven’;this was a basic concept for the ancients,as illustrated by the belief that ‘man is related to the heaven and earth’ (inLingshu: Weather and Man’s Health).The number,shape,functionality and pathology of the meridians were all explained by the ancients based on observation of man and nature.According toLingshu:Jingshui,‘The twelve meridians are connected and corresponding with the twelve waters in the nature outside but also belong under the internal organs of the body’.The‘twelve waters’mentioned here refers to twelve rivers(the Qing,Wei,Hai,Hu,Ru,Sheng,Huai,Ta,Jiang,He,Ji,and Zhang rivers).Guanzi:Duodi(Master Guan:Measuring the Land)clarifies that‘those which flow into the sea from the mountains are called the Flowing Rivers’.Lingshu:Jingshuialso states that ‘the twelve meridians of the internal organs have their sources outside and controllers inside,so that what is outside is connected with what is inside like an endless loop’.This explains the characteristics of the 12 meridians’endless flow,the functionality of which is also likened to that of a river.Similar analogies can also be found in other books.For example,Guanzi:Shuidi(Master Guan: Waters and the Land) states,‘Water,the blood of the earth,is like the flow of energy in meridians of the body’;Lunheng: Shuxu(On Balance: The Falsity of Books) reads,‘There are hundreds of rivers on the land,as there are veins in the body’.The rivers with smooth water flow are called the‘smooth’ones,and those of stagnation are called the‘reverse’ones.‘Therefore,those who work the waters must wait for the weather to thaw the ice,and those who bore holes in the ground must wait for the frozen land to soften,so that the water is flowing and the holes be bored in the ground,and the same are true of meridians of the body’ (Lingshu: Five Methods of Acupuncture).

Regarding acupoints,there are no physical (or imaginary)lines like meridians,but they are isolated points on the body’s surface.When the ancients looked for acupoints,they associated them with functions,as can be concluded from their names.The name ‘a(chǎn)cupoint’ itself suggests a depression,which is likened to a ‘wind cave’ by analogy with nature.In nature,a cave is the place where the wind is stored,while the acupoints on the surface of the body,called ‘a(chǎn)ir pockets’ or ‘voids’,are where energy,orqi,is stored.Wind andqiare of the same kind but have different names,so they can be associated with each other.Some acupoints are classified inHuangdi Neijing.For example,the well-known Wushu Acupoints (or Five Acupoints,including the jǐng,xíng,shū,jīng and hé acupoints)are compared to running waters inLingshu:Benshu.It says inA Classic on Medical Problems:The Sixty-eighth Problem: ‘jǐng is likened to the source of water,where theqiof meridians goes out;xíng is likened to starting small water,where theqicirculates;shū is likened to water increasing in size and depth,where theqistarts to grow;jīng is likened to water going unhindered,where theqiincreases enormously and flows smoothly;hé is where theqiconverges in the body like rivers flowing into the sea’.Thus,by comparing acupoints to running waters,a group of scattered points are constructed into a group of acupoints flowing in a particular direction.

The second tool that was used in the construction of the theoretical models for meridians and acupoints was reasoning.Analogy can be used to explain the shapes and basic functions of the meridians and acupoints in the human body.However,analogy cannot be relied upon for systematic understanding.Hence,the ancients also used reasoning to complement analogy to construct a theoretical model of meridians and acupoints.There were two theoretical models for the meridians in the Qin and Han dynasties—the 11-meridian system in the silk book found at Mawangdui Han Tomb,and the 12-meridian system described inLingshu: Jingmai.In the Spring and Autumn Period,there prevailed a concept that ‘In Heaven,six kinds of energies work,and on earth five,and the numbers are constant’.Therefore,under the influence of this concept and the belief that‘man copies the heaven’,both physically and spiritually,a model of the 11-meridian system(including fiveyinmeridians and sixyangmeridians,lacking the dominant meridian in the palm)was established.This number of meridians could not be discovered through analogies but was found by reasoning.Similarly,an understanding of the 365 acupoints was also obtained by reasoning.InHuangdi Neijing,the partSuwen:Qixue(The Fundamental Enquiries: The Voids of Energy) states,‘The 365 air pockets are established in correspondence to 365 days in one year’.However,there is no definite number of air voids in the human body,so 365 is meant only to reflect the meaning of ‘entirety’.Therefore,when talking about the 12 meridians or 365 air pockets,no real facts about the human body are referred to other than understandings obtained by reasoning under the concept‘man is related to the heaven and earth’.

The third tool that was used in the construction of the theoretical models for meridians and acupoints was holography;this is a new means of body cognition that has attracted increasing attention since the 1980s.Professor Zhang Yingqing of Shandong University,who was ordered to work as a peasant at a village in Inner Mongolia in the 1970s,after discovering an acupoint group on the second metacarpal,put forward the law of biological holography,which holds that every independent part of an organism can be regarded as the epitome of the whole body.This serves as a very powerful explanation for the microacupuncture system of the human body,which encompasses practices such as ear acupuncture,abdominal acupuncture and eye acupuncture.

A similar theory is also seen inHuangdi Neijing.For example,in the partLingshu:The Five Colours,the question of whether the changes in the five facial colours are only reflected in the‘mingtang’(nose)is discussed,and it explains: ‘Mingtangrefers to the nose;Querefers to the part between the eyebrows;Tingis the forehead;Fanis the outside of the cheeks,andBiis the parts immediately in front of the ear.’ The theory of holography is a systematic approach.As a theory or model,the idea of biological holography triggered by acupoint holography is worth pondering and studying.However,it was labelled as pseudoscience in 1996 in China,which led to people neglecting this promising way of understanding the body.However,it is an entirely new cognitive approach that is completely different from the classical man-nature analogy and the modern mechanistic viewpoints about the anatomical body,and it may open up a new picture of the human body.

4.Experimentation

Experimentation is one of the most important means to acquire knowledge,and the application of experimentation to acupuncture research is at a very mature stage.At one time,the aim of acupuncture experiments conducted in laboratories was to find the essence of meridians and acupoints—that is,to intervene in the human body through physical and chemical means in the hope of demonstrating specificity in the meridians and acupoints—but this path has now largely been abandoned.Moreover,research seeking to find special physiological structures,strictly speaking,does not belong under ‘experimentation’,but is rather observation under specific conditions.Currently,the main objective of acupuncture experimentation is to stimulate some specific parts on the body’s surface,such as the meridians and acupoints,and thus to observe the resulting effects on the body to better understand the mechanisms of acupuncture.

During an experiment,standard conditions are set up to verify a theory,and it is often necessary to compare two sets of results to reach conclusions.By constructing and adjusting conditions,the two sets of results can be compared under the same(theoretical)conditions,thus revealing the accuracy of a hypothesis.For example,we can design a very simple experiment to verify a classic theory of acupuncture that abdominal gastrointestinal diseases can be treated by working on theZu Sanliacupoint(a point beneath the knee and on the lateral part of the lower leg).First,take mice infected with gastritis and divide them into three groups: one group is treated with acupuncture at theZu Sanliacupoint,one group is treated with a known effective drug as the control group,and one is a blank control group in which the mice are not given any treatment.After a period,the effects on the acupuncture group are compared with those of the drug-controlled and the blank control groups to establish whether acupuncture at theZu Sanliacupoint has a therapeutic effect on gastritis.The purpose of this acupuncture experiment is to verify the recorded experience of ‘treating abdominal diseases via theZu Sanliacupoint’ (supposing this expression originated from experience).Assuming that the experiment is successful and positive results are obtained,the effectiveness of working on theZu Sanliacupoint can be confirmed.

If the conclusion ends here,it can be said that the statement that working on theZu Sanliacupoint can treat gastritis has been verified through experimentation.However,some experimenters may gild the lily by deducing from the experiment the existence of an acupoint;that is,they may conclude that there is a substantialZu Sanliacupoint that is independent of adjacent tissues.However,this deduction is not valid,as,although the experiment may have shown that stimulating theZu Sanliacupoint can treat a stomach disease,the effectiveness of the working mechanism may have resulted from many possible factors,and those may involve the nervous system or some unknown factor(s),so it might not necessarily be the case that the acupoints themselves played a role.Moreover,the question of whether acupuncturearoundtheZu Sanliacupoint can also be effective on stomach diseases has not been answered.If the answer is‘yes’,then the specificity of theZu Sanliacupoint is even more untenable.Therefore,this experiment can prove only that stimulation of theZu Sanliacupoint can effectively cure patients of stomach diseases.As for whether the acupoint area itself has an independent and substantial existence,that cannot be judged using this experiment.Therefore,when bodily knowledge is obtained through experimentation,conclusions should be drawn conservatively.

In fact,what could be inferred from the experiment is a correlation between the body’s surface and its internal organs.The mechanism of this correlation is not yet clear.However,the finding of that correlation is already an important contribution from acupuncture to the understanding the human body,and its significance is no less than that of proving the legitimacy of acupuncture treatment itself.

5.Summary

Observation is the basis of knowledge,but not all of the knowledge obtained from observations is true to the facts.For example,early anatomical observations gave rise to misunderstandings due to crude anatomical techniques,and the knowledge obtained therefrom was far from fact.The participation of speculation is what turns the results of observation into knowledge.Furthermore,almost all of the classical bodily theories are the products of speculative participation.For example,in the formation of the theories revolving around the 12 meridians,the 365 collaterals,the Five Acupoints and the eight extra meridians,analogy and reasoning are the major approaches.Holographic cognition,however,is a contemporary concept;its idea that‘the part reflects the whole’has its origins,to some extent,inHuangdi Neijing,but taking this as a systematic notion is something that has arisen from speculation in modern times.Although holography was once dismissed as a pseudoscience,it is at least a powerful tool for the theoretical explanation of acupuncture.

Experimentation is a means to verify theory,and acupuncturists can set conditions in the laboratory to verify the theory of acupuncture.However,most such experiments cannot prove that there is a certain essential structure with meridians or acupoints.In fact,the classical theories of meridians and acupoints are the products of speculation and can be regarded as physiological hypotheses that could not be verified by experiments.Experiments can only lead to the conclusion that a new physiological possibility exists;that is,a correlation between a specific part of the body’s surface and a certain organ or another part of the body.The discovery of such a correlation is of more significance than the verification of the classical meridian and acupuncture theory.

Speculation is not only at the core of theoretical construction,but it is also involved in observation and experimentation.In fact,there is no observation and experiment without speculation,as speculation intervenes from the beginning of observation,and all the results of observation records are classified and screened through speculation.This is especially true for experimentation,during which,from design to results,the findings are all based on speculation.

Different approaches to understanding lead to revelations about different aspects of the body theory concerning acupuncture.Observation,feeling and dissection can provide evidence for the morphological signs of the meridian and acupoint theories,such as pulse and depression on the body’s surface.Then,speculating methods such as analogy and reasoning enable the construction of the meridian and acupoint theories.Holography is tinged with the strongest colour of speculation,and its theory is formed as a result of observation;the application of holographic theory to the human body endows acupuncture with a holographic knowledge,the approach and findings of which have not been confirmed by scalpels or physiological experiments under the mechanistic view of the body.Physiological experiments conducted in the laboratory were originally intended to explain the existing meridian theory,but they inadvertently opened up a physiological picture of the body’s surface–viscera correlation.Based on this correlation,one can establish that the body under the knowledge system of acupuncture is actually one full of connections,where the above and down parts,the inside and outside parts,and the whole,are all connected by physical or imaginary means.Such a correlated body is different from the beautiful bodies in the artist’s eyes,the strong bodies of athletes,and those under the surgeon’s knife,where each minute part is clear and visible.However,it offers a unique and open approach to thinking about the body,and it proves the possibility of understanding nature in diverse ways.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Funding

The author disclosed receipt of the following financial support for the research,authorship,and/or publication of this article:This work was supported by the China National Key R&D Program about Modernization of Traditional Chinese Medicine(grant number 2022YFC3500505).

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