Acupuncture: principles, history and the state of the evidence

In 1027, a Song court physician named Wang Weiyi had two life-size bronze statues cast, pierced with holes at the location of the acupuncture points. For the examination, the statue was coated in wax and filled with water: if the candidate hit the right spot, a trickle escaped. If not, the needle struck metal. A millennium before medical simulators, China assessed its acupuncturists on the object itself.

That scene says most of what Chinese acupuncture is: a map of the body, learned, standardised, examined, transmitted through texts that can be dated. The rest, what those points actually do, has occupied clinical research for fifty years and still divides it.

The word says two things#

Chinese has no word for "acupuncture" alone. It says 针灸 (zhēnjiǔ), literally "needle and moxa". The second half of the term refers to moxibustion: dried mugwort, 艾 (ài), is burned above a point or on the needle to heat the area. In traditional Chinese practice the two gestures go together and are chosen according to the case.

The basic vocabulary#

Deqi deserves a word: it is the heaviness, numbness or spreading sensation the patient should feel when the needle reaches its target. Practitioners treat it as the sign that the session is working, and it serves as a marker in modern research protocols, not without argument.

The classical system counts twelve main meridians, each linked to an organ, plus two midline vessels, the Ren mai and the Du mai. The World Health Organization published a standardised nomenclature in the late 1980s setting the number of classical points at 361, with an international code for each.

Three thousand years of texts#

Archaeology places the possible ancestors of the needle in shaped stones, the bianshi (砭石), used in the Neolithic to incise or press. Nothing proves they served what we call acupuncture, but ancient texts refer to them as an earlier age.

The silk manuscripts unearthed in 1973 from the Mawangdui tomb, sealed in 168 BCE, are the first material evidence. They describe eleven channels along which breath circulates, and prescribe moxibustion above all. Notably, they mention no points. The map of the channels therefore precedes the map of the points.

The 黄帝内经 (Huángdì Nèijīng), the Inner Canon of the Yellow Emperor, compiled under the Han, fixed the doctrine. Its second part, the Lingshu (灵枢), is devoted to the needle and describes nine types of instrument. In the third century, Huangfu Mi gathered that knowledge in the Zhenjiu Jiayi Jing, the first systematic treatise of the discipline, which ordered the points and their indications.

Chinese medicine did not invent acupuncture at a stroke: it first drew the roads, then placed the stops along them.

The eclipse and the return#

Contrary to a widespread idea, acupuncture was not practised in China without interruption or without challenge. In 1822, Emperor Daoguang removed it from the Imperial Medical Academy, judging it unfit for the sovereign's person. In the twentieth century, the Nationalist government considered abolishing traditional medicine outright in 1929, a plan dropped in the face of practitioners' mobilisation.

The reversal dates from the 1950s. The People's Republic, facing a shortage of doctors, rehabilitated and institutionalised Chinese medicine, trained practitioners in state schools, then deployed barefoot doctors in the countryside, auxiliaries trained in a few months who carried needles and herbs in their bags.

How the West found out#

The Jesuits had written about it as early as the seventeenth century, and nineteenth-century French physicians had run trials. But the tipping point was a newspaper article. In July 1971, New York Times journalist James Reston fell ill in Beijing while preparing Nixon's visit. Operated on for appendicitis, he received needles for his post-operative pain and published a detailed account on his return. The article appeared a few months before the diplomatic opening of 1972 and triggered a wave of American interest.

China then showcased acupuncture anaesthesia in filmed demonstrations of open-heart surgery. Those sequences left a mark; later analyses showed they were accompanied by analgesics and involved selected patients. The technique did not survive scrutiny.

In 2010, UNESCO inscribed acupuncture and moxibustion of traditional Chinese medicine on the representative list of the intangible cultural heritage of humanity.

What the clinical trials say#

The state of the evidence is more nuanced than either supporters or detractors would like.

The strongest results concern chronic pain. An individual patient data meta-analysis published by Andrew Vickers and colleagues, covering some twenty thousand patients from randomised trials, concludes that acupuncture does better than no treatment, and slightly better than sham acupuncture. The gap with placebo is real but modest, which is exactly what fuels the debate: for some it is a specific effect, for others proof that most of the benefit lies in the ritual of care.

Systematic reviews also retain a benefit in migraine prevention and against chemotherapy-induced nausea. Conversely, the broad indications sometimes claimed, from infertility to smoking cessation, are not supported by convincing data.

On safety the picture is clearer: with sterile single-use needles, serious adverse effects are rare and well documented, the main risk being pneumothorax from badly placed chest punctures.

China, Japan, Korea: three schools#

The discipline differentiated as it travelled. The Chinese school favours thicker needles, strong stimulation and the explicit pursuit of deqi. The Japanese school, shaped by the tradition of blind practitioners, works in fineness, with abdominal palpation and shallow insertion. The Korean school developed its own systems in the twentieth century, including the hand acupuncture devised by Yoo Tae-woo in 1971, which maps the whole body onto the palm.

Read alsoTraditional Chinese medicine: qi, yin-yang and needles

The wider framework of which acupuncture is only one of five branches.

Read alsoTai chi chuan: the Chinese art of slow movement

The other practice built on the circulation of qi, but without a needle.

FAQ#

Does acupuncture hurt? The puncture is barely painful, the needles measuring between 0.16 and 0.30 millimetres in diameter. The sensation sought, deqi, is described as a diffuse heaviness or numbness, distinct from outright pain.

Do meridians exist anatomically? No anatomical structure corresponds to them. They are a functional map inherited from ancient texts, and modern research treats them as a location system rather than as physical conduits.

Which indications are best supported? Chronic pain (low back pain, osteoarthritis, neck pain), migraine prevention and post-chemotherapy nausea. For these, several systematic reviews conclude there is a modest but reproducible benefit.

What is the difference between acupuncture and moxibustion? The first inserts a needle, the second heats the point by burning mugwort, with or without contact. The Chinese term zhenjiu covers both, and a traditional session often combines the two.

Are there risks? They are low with sterile single-use equipment. Serious incidents reported in the literature are rare and mostly involve punctures at the wrong depth. Choosing a trained, registered practitioner remains the first precaution.

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