Is traditional Chinese acupuncture more art than science?
Looking into the body of modern scientific research on acupuncture, there is a plethora of articles out there detailing research projects, many of which come to highly variable or contradictory conclusions regarding its efficacy as a therapy.
With the very real therapeutic effects of placebo treatments, the inherent difficulties involved in successfully administering sham acupuncture (and the question of whether it is in fact inert at all, either when using blunt needles or selecting “non-active” acupoints), the infinite number of variables regarding the pathological presentation of subjects, and the problematic lack of sufficient samples (participants) or doses (number and depth of treatments), it is extremely hard to arrive at any conclusive evidence.
Being a branch of medicine that people tend to resort to for chronic conditions, which are poorly treated by symptomatic medicine, and often in fact merely disguised or controlled by pharmaceuticals and never actually treated in a meaningful way at all, methods of assessing response to treatment leave a lot to be desired.
For example, how does one measure pain? How do you establish a baseline? How do you quantify how it changes? And how do you establish commonality between different individuals? With such a subjective experience as pain, trial designers must often resort to decidedly unscientific techniques such as self-assessment questionnaires. With regard to the relatively small size of acupuncture trials, methods such as this will tend to produce highly skewed results.
And the trouble is, the abstracts (or summaries) of published trials that catch the attention of journalists tend to focus on the headlines and conveniently minimise any issues or flaws admitted (or ignored) by the trial’s designers, which tend to be glossed over and buried towards the back of an article.
Not only are there likely flaws in scientific method, and in the collection and interpretation of data, inevitably there are the personal or institutional motivations, incentives, and natural biases of those running trials, or participating in them, whether that be intellectual or financial, unconscious or otherwise.
You should ask yourself, why and by whom has this trial been funded? Why has it been published? Where has it been published? Science is never pure; it can never absolve itself of the inherently flawed, intentional, and non-objective humans that design its processes. (Until, of course, the machines take over!)
There are issues too with the clinical setting and therapeutic relationship between patient and practitioner. It is especially crucial in the field of acupuncture that there is trust and genuine, open communication on both sides. The patient must be able to relax sufficiently for the parasympathetic nervous response to activate for healing to be possible. In clinical trials that are set up to test a theorem, rather than to facilitate real healing, is that essential therapeutic relationship really present?
Trials are often set up in such a way as to exclude the more subjective or qualitative elements that would ordinarily feed the diagnosis of a traditional acupuncturist. Everything from gait, posture, complexion, body shape, and even a person’s smell, to the nervous disposition, lustre of the eyes, manner and tone of speech, way of moving, and degree of animation, all contribute to the diagnosis, besides any aetiological factors or the actual verbal content of a consultation.
One question that tends to be met by first-time patients with either bemusement or surprise is the practitioner’s interest in the shape, texture, colour, and frequency of their stools; a strange and inexplicable fetish peculiar to the traditional acupuncturist!
Also peculiar to traditional acupuncture is the attention paid to the shape, colour, and coating of the tongue, as pertaining to the patient’s longer-term state of being. The tongue provides an unexpected window on a person’s health. For an accurate viewpoint on the current, moment-to-moment state of being, we use the pulse. By listening through the fingertips to different positions of the radial pulse, we can ascertain the condition of the various energetic networks in the body. It is a live feed to the processes and relative harmony, or disharmony, of the body’s systems.
From my perspective as a second-year BSc student, this is most certainly an opaque and mysterious art, rather than a transparent and graspable science! I have learnt to tune into the more obvious, broad-stroke indications of the pulse, but an experienced practitioner can read an immense amount of detail from the qualities of the different pulse positions and depths. One tutor I have seen monitoring the pulse while she needles the patient, listening for changes and altering her needling technique or even selecting a different point entirely should the desired results not manifest in the pulse. This is a highly subtle (and to me at least still rather mysterious) art that would essentially be impossible to integrate into an ostensibly objective clinical trial.
From my own admittedly limited experience, pulse diagnosis requires a suspension of cognitive function, of the reasoning mind. You have to get out of your own way and simply listen openly to the pulse as it presents itself to you. Search and analysis are unhelpful tools. You must be quiet and present, and as you tune into the sensations beneath your fingertips a picture gradually begins to form. It’s like a blurry image gradually coming into focus, and that focus is achieved through silent, patient, open, wordless inquiry. Through intuition. You have to literally feel your way there. Knowledge underpins the process; it does not rule it.
Instinct plays a big role in pattern diagnosis, too. Chinese medicine practitioners do not arrive at an illness described by a set of symptoms; rather, they diagnose a “pattern”, which is a picture that describes the current presentation of the whole human being. This pattern is, like the rest of the universe, in a constant state of flux.
The various energetic systems of the body as described by Chinese medicine interact with each other and result in a unique pathology, which can be broadly categorised but is in fact a highly individual and ever-changing condition. The same set of symptoms might fit several different patterns, and so the skilled acupuncturist will draw on experience, inquiry and instinct to arrive at their diagnosis.
Because of this holistic understanding of disease, as opposed to the more reductive approach of conventional medicine that sees a group of symptoms, labels them, targets specific and isolated areas, and prescribes a particular medication or surgical procedure, standard protocols of particular acupoint combinations are dubious at best. Unfortunately, especially with the proliferation of Western dry needling techniques, this “one size fits all” approach is becoming increasingly prevalent.
In certain circumstances, such as very specific musculoskeletal injuries, this standardised approach can be effective, particularly with modern practices such as electro acupuncture. But when it is applied to more general conditions, and particularly those that have a more psycho emotional aspect, protocol-based dry needling falls seriously short. The notion that “this point has this effect” is overly simplistic and disregards the rich complexity of traditional acupuncture. This could go a long way towards explaining some of the less favourable or ambiguous results of many acupuncture trials.
Certainly, a local treatment can be designed based on the anatomical areas that are being affected. But that would be doing a disservice to the wisdom, subtlety, and deep understanding of the entire human being that this ancient art possesses. We can use distal points. We can use the Yin and Yang relationships of the channels. We can use the anterior/posterior relationships of channels paired arm to leg. We can balance left and right, front and back. We can mirror or holographically superimpose the whole body, or parts of it, on to individual areas. We can employ the five-element model. We can use the eight trigrams and sixty-four hexagrams. Eight principles. Six stages. Four levels. Three burners. The heavenly stems. We can work with the twelve primary meridians, or with the eight extraordinary vessels. We can devise treatments based on time of day, or time of year. Certain esoteric methods even make use of the constellations.
We can think of different point categories: five Shu points, source points, connecting points, accumulation and gathering points; back transporting and front collecting, points of the four seas, or the window of heaven points, ghost points, heavenly star points, command points… all these we can combine into a highly effective, bespoke treatment plan that can shift and direct a person’s energetic systems in a precise and specific manner. If we’re any good, that is.
Perhaps those with more conservative (they might say rational) mindsets might scoff at the idea of working out medical treatments according to the lay of the stars. But we ourselves are beings of the cosmos. And, according to Daoist philosophy, in which Chinese medicine is very much based, we are a microcosm of the universe. We are not separate from reality, despite what your innate and individualistic sense of self might tell you. We are not observers; we are right in it. Why shouldn’t we be influenced by the motions of those great entities all around us? We’re certainly changed by those mysterious and alien processes perpetually underway within ourselves.
We are surrounded by mystery, and we enclose it. Our lives are bookended by it. Even our most familiar apparatus, consciousness itself, is apparently intrinsically unfathomable. It used to be the consensus that consciousness was an emergent phenomenon produced by our brain activity. More recently there has been a movement towards the notion that consciousness is a fundamental feature of the cosmos. It is not so much something that we generate, or even access, but something that we are. And not only that: everything is conscious. All the energy and matter (which is just further organised, denser energy) around us and within us is conscious. The whole universe is aware.
This isn’t a new thought. It has been with us through shamanic and animist traditions since prehistory. Rather than a new development, it is more a remembering. Unfortunately, it is largely a recollection born of theory and philosophy, rather than the direct experience, the trance and revelation, of those ancient cultures. Still, it’s a beginning, and to my mind infinitely preferable to the bleak, depressing, “dead matter theory” that has been with us since the Age of Enlightenment.
Chinese medicine supports the concepts of spirit and rebirth. You are not required to sign up to particular religious beliefs in order to practise traditional medicine, but it is fascinating to me that such a sophisticated and integrated system has embedded within it such ideas as the Ethereal Soul, or Hun of the Liver, which yearns for Heaven, continues after death and wanders the dreamlands of our sleep; and the Corporeal Soul, or Po of the Lungs, which yearns for the Earth and dies with the body.
The Shen, or Mind-Spirit, is housed in the Heart, and is something the acupuncturist will often seek to work with, generally indirectly through the Pericardium, for example, as a crucial part of the patient’s journey towards health and harmony.
Conventional medicine has only recently begun to recognise the importance of a person’s psychological and emotional well-being. For a long time, it has treated the body like a broken car to be fixed, working with the physical structures in isolation and largely ignoring the mind and spirit. Let’s hope that, supported by the approach of complementary therapies, the emerging trend towards an emphasis on mental health and holistic recovery continues to grow.
But I would advocate a circumspect attitude towards the importance of establishing and expanding a scientific evidence base in the established model. In so many ways, a tailored, complex, and refined practice such as traditional acupuncture simply doesn’t fit. It is by its very nature not a standard, repeatable procedure.
The elegant beauty of a minimal and effective treatment relies not on some magic formula, but on the insight, skill and knowledge of the practitioner, on the quality of the therapeutic relationship, and on an understanding of body, mind and spirit that lies within an entirely different paradigm to that of conventional scientific inquiry.
Science, for the time being at least, has no room for Qi. I suspect it will stay that way, for science needs things that can be pinned down and observed. Qi is process. Qi is change itself. While it can be experienced directly, by its very nature it cannot be reduced to a molecular structure or mathematical equation.
Unfortunately, it would appear science is not even prepared to meet the Eastern paradigm halfway. It insists on its own objective parameters, and in large part persists in ignoring even the basic requirements of traditional medicine. I have happened upon research papers in which needles are inserted for only five minutes. There is no mention of needling technique, of manipulation for tonification or draining, or the attaining of De Qi (the dull, grabbing sensation that occurs when a needle engages with the body’s energetic flow).
There is little or no importance placed on the Yi, or practised intention of the acupuncturist, either. This is a shame, for without such fundamental aspects real acupuncture loses its essence and power. Stripped of its blood and vital organs, it is then dismissed by the scientific community as a worthless, empty husk.
I am by no means opposed to evidence-based medicine, and certainly welcome an open-minded investigation of complementary therapies, but with regard to assessing the efficacy of something so tailored and intricate as acupuncture, you have to ask if the very method you are employing to test its effectiveness is itself fundamentally flawed. Where a science lies in the realm of quantification, deduction and induction, art lies in the realm of qualities, subjectivity, and intuition.
Traditional Chinese medicine straddles both these worlds, but in my view it leans heavily towards the side of art. No two practitioners are likely to concoct the same prescription for a given patient, and no one patient should receive the same prescription on successive treatments. Why? Because acupuncture is about dealing with change. It is about tuning into the process of change within a human being, and influencing that process through the intervention of needles, (along with moxibustion, cupping, Tui Na, and so on) and a conducive therapeutic relationship. The pattern is always changing. Everything is in flux.
Science largely requires the world to be static, reproduceable, and predictable. But Nature is none of these things, in truth, particularly when the variables of human mind, emotions and spirit are considered. Yes, certain things obey Newton’s laws, or the laws of relativity. These include human bodies. But these do not include human beings.
Thankfully, there has been some progress. In the UK acupuncture can now be recommended by doctors as an effective treatment for chronic pain. But for those within the field, this small gesture, whilst appreciated, and encouraging to hear, is also kind of laughable. Before the advent of conventional medicine to the East, acupuncture (alongside herbal medicine) was medicine for countless centuries.
Sharpened stones and bone tools thought to be the precursors of acupuncture needles have been found by archaeologists and dated as far back as 6,000 BCE. Who knows how old this ancient art really is? Are we really suggesting that our ancestors remained superstitious idiots for millennia, believing in all this “made-up hocus-pocus”? The arrogance of this belief is quite staggering, and to my mind an unfortunate residue of the new scientific age, which is long overdue a hefty rethink, an adjustment in its own self-belief.
Long before our modern obsession with the nature of matter, our eternal, and perhaps ultimately foolish, rainbow-chasing quest for the most fundamental particles of existence, now swamped in a morass of quantum phenomena, our ancestors had a sophisticated understanding of the body as space. Yes, we were flesh and blood and bones and organs and fascia, but we were also dark, empty caves and interlinking conduits.
They mapped the spaces in our bodies as a network of streams and rivers. They meditated and came to understand in an experiential way the flow of energy through these channels and spaces. They identified the Dan Tian, the Chong Mai, the microcosmic orbit, and the entire energetic body that we in the post-Enlightenment West have largely forgotten or dismissed as nonsense. We have neglected the importance of space. Without space, we have no structure. Without space, we have no room to breathe. No room to grow. No room to flow.
This poses a problem in terms of acupuncture’s acceptance as a valid and effective treatment. For how can science study empty space? It requires “stuff”. For years they searched for these mysterious meridians in the body. They never found them because they were looking for something. The meridians were there all along, there in the spaces that the scientists rigorously ignored.
Tibetan tantric Buddhism knew of the Central Channel and inner winds. Chan, and later Zen, Buddhism knew the importance of emptying the self, and taught of the fundamental emptiness of all things, being so profoundly interdependent and impermanent. Yogic traditions knew of all-permeating prana, the vital breath of the universe. Daoist alchemists knew that Qi had to be built and circulated through the channels, while the mind and body profoundly rested, to attain its optimum state of health. Such concepts pervade spiritual traditions worldwide, from Christian mysticism to Native American animism.
I’m not trying to claim all these ideas of emptiness are the same thing; they are not. But they are expressions of the universal acknowledgment of the fundamentality of space. Astronomers look through its vastness to focus on stars and galaxies. Perhaps we should pay more attention the space itself? To the space within us, as well as without.
Perhaps we should learn to trust our own inner inquiry, instead of relying solely on the external observations of scientific method. To be quiet and still and pay attention to our own inner natures, instead of always looking out at a world whose appearance relies upon the filters of our senses and the presence of our minds.
Or the presence of Mind…
The Azure Dragon 