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Book Reviews
Medicine
In China: Historical Artifacts And Images
By Paul U. Unschuld
Translated from German by Sabine Wilms, Prestel Verlag
Reviewed by Allen McDaniels, MD
In the early 17th century, the official Tung Ch'i-ch'ang, barely in
his 50s, retired from the chaos and intrigue of the Ming court to his
country villa for meditation and contemplation. There, surrounded by
nature, he continued to work in his garden as an influential painter,
poet, and calligrapher.
In Paul Unschuld's new book, Medicine in China: Historical Artifacts
and Images, English readers of this expansive and precise writer of
the history of Chinese medicine will enjoy a shortened text on the subject.
Readers will especially savor the accompanying photographs of substantiating
artifacts, many from the author's private collection. Beautifully printed
plates and figures supplement the text with images that give form to
history.
Although Tung Ch'i-ch'ang was not a physician, he held various high
public offices and rose to be President of the Board of Rites. He and
his elite colleagues, the men with something worthy of expression, were
the scholar-gentlemen, the literati, who, through education, cultivation
of the humanities, and a sincere devotion to nature, were attuned to
the order and flow of life. This virtue, the attunement to nature, originated
in Chinese culture long before the Ming, but they encouraged its practice.
The diversity of expression by Tung and his colleagues, as officials
as well as artists, should inspire modern physician- acupuncturists
to expand their own personal expression beyond just the practice of
medicine. In his book, Unschuld refers to practitioners of this time
as medical scholars or scholar physicians to distinguish between those
who used their skills almost exclusively within their extended families,
and those who used their classical medical education professionally.
Professional practitioners were ranked somewhat lower in social status
because they rebelled against the Confucian ethic not to receive payment
for their medical work. Whether medical scholar or scholar physician,
the Chinese emphasized scholarship, study of the classics, and committing
one's work to posterity through authorship.
This book is a companion work to the author's volumes published in 1985,
Medicine in China: A History of Ideas and Medicine in China: A History
of Pharmaceutics. Unschuld's attention to historical precision, accuracy,
and a social context's effects on medical models permeates the works.
The spirit of Unschuld's writing is in the tradition of German academic
historiography. While reading this latest volume, the reader might be
surprised to learn that:
-
The benchmark
for the history of medicine in China is the Mawangdui manuscripts,
unearthed in a family tomb near Changsa, Hunan, in the early 1970s.
-
They date
from 168 BC. The tomb contained 14 medically-related texts that
reflect the whole spectrum of medicine as practiced in the 2nd century
BC.
-
In the
context of Chinese medicine, Qi "refers to the minute material
or immaterial influences which the organism absorbs, transforms,
transports to the individual functional centers (Zang/Fu), utilizes
as 'constructive' or 'protective influences,' and finally eliminates
as waste."
-
Traditional
Chinese pharmaceutics, not acupuncture, played the primary role
in the treatment of illness for the past 2000 years in China.
-
Until
the 2nd century BC, bleeding as a therapeutic modality was practiced
widely in China. No historical references are known to prove that
acupuncture existed before this date. The older editions of the
Huang Di neijing (Inner Classic of Huang Di), which date from near
the turn of the Common Era, contain instructions to treat illness
by bleeding. Through a process that cannot yet be explained, the
practice of bleeding might have developed into acupuncture.
-
The Huang
Di neijing lingshu (Divine Axis) probably contains the earliest
(1st century AD) enumeration and description of acupuncture needles.
The earliest acupuncture model, a bronze one for teaching students,
dates from 1027. The drawing of acupuncture teaching charts evolved
from the early models. Beautiful examples of body charts appear
in the book's plates.
-
Sum Simiao
(c. 580-682), who gained fame as a clinician, author, and ethicist,
evolved into a cultural icon, a medicine god whose help is invoked
even today for healing. Many figures of Sun Simiao with dragon and
tiger appear in the plates.
Unschuld's
book is finely written and beautifully illustrated. My criticisms are
few and mild. The text and images emphasize Chinese pharmaceutics. The
author points out that pharmaceutics, not acupuncture, dominated medicine
in China for 2 millennia. Although his extensive collection of pharmacy
delivery containers pictured in the book makes me, a novice collector
of Chinese snuff bottles, envious, I would have enjoyed the book more
if it contained as much acupuncture paraphernalia.
My second point is a bit perplexing. The development of medicine in
China, according to Unschuld, has been an interplay between European
and Chinese traditions since the early 19th century. In 1805, Pearson,
a physician with the East India Company, introduced the feasibility
of Jenner's smallpox vaccination to the Portuguese colony of
Macao. But what about the work of the Jesuits more than 2 centuries
earlier? They introduced into China contemporary European developments
in mathematics, astronomy, and other sciences from the late 16th century
onward. Was medicine somehow left out? It seems more likely the introduction
of European medicine in China followed the model of Japan. In the latter
17th century, Willem ten Rhijne, a physician with the Dutch East India
Company, learned about acupuncture and moxibustion and discussed Dutch
medicine with Japanese physicians. Could not similar exchanges have
occurred in China, with seeds of contemporary European medicine planted
much earlier than 1805? Perhaps Unschuld's tacit point is that proof
of such cross-fertilization remains undiscovered in Chinese documents.
The medicine Tung Ch'i-ch'ang contemplated in his garden was an integral
part of a comprehensive, naturalistic, and organic world view that reinterpreted
and expanded traditional Confucianism to include concepts that had been
included in Taoism. This was the legacy of the Neo-Confucian synthesis,
which had occurred under the Sung (960-1279). Neo-Confucianism was as
close as China got to a renaissance. Taoist and Buddhist concepts, under
the guise of Confucianism, subsequently influenced Chinese thought more
than ever. Amid the civil strife during the latter Ming Dynasty, there
was much intellectual diversity. New interest in interpreting the ancient
classics stimulated new ways of applying them to contemporary social
conditions. When he considered medicine, Tung might have contemplated
its role in improving the general welfare when the reinterpreted knowledge
of the ancients was adapted to the conditions and circumstances of his
own time. In this book, Unschuld helps us gain a meaningful historical
perspective so that we as physician-acupuncturists might create improvement
in health care during our own time.
REVIEWER
INFORMATION
Dr Allen McDaniels is in the private practice of Medical Acupuncture
in San Pedro, California. Dr McDaniels is the Chairman of the AAMA's
Continuing Medical Education Committee.
Allen McDaniels, MD
603 W Sixth St
San Pedro, CA 90731-2325
Phone: 310-548-5935 • Fax: 310-548-8455 • E-mail: QMcDuck@pacbell.net
Clinical
Acupuncture: Scientific Basis
By Gabriel Stux and Richard Hammerschlag, Editors
Springer-Verlag; 2000
Reviewed by David P. Sniezek, MD
This text is a state-of-the-art review of acupuncture research. At a
time when practice guidelines, algorithms, and evidence-based care plans
have emerged as dominant features of patient care, creating an evidence-based
textbook for acupuncture is an excellent idea and a worthy goal.
The overall format follows the traditional approach of its predecessor,
Scientific Bases of Acupuncture, published 12 years ago. The initial
3 chapters review studies related to acupuncture analgesia. Specifically,
Pomeranz discusses the neural mechanisms of acupuncture analgesia and
the evidence for endorphin, midbrain monoamine, and pituitary hypothalamic
system involvement in acupuncture analgesia. Pomeranz also reviews studies
that attempted to answer some of the old questions about acupuncture
research, such as the effectiveness of using true acupuncture points
vs sham points, the question of unique anatomical structures and physiologic
features at acupuncture points, and which nerves are activated by acupuncture.
Concurrently, in chapter 2, Takeshige reviews studies that help explain
the mechanism of acupuncture analgesia produced by low-frequency electrical
stimulation. Takeshige recounts the mechanisms and which anatomically-distinct
brain pathways are used during analgesia with acupoints and non-acupoints.
Mechanisms of pain modulation with opioid and antiopioid peptides are
discussed in chapter 3 by Han. This section reviews the current understanding
of endogenous opion peptides in acupuncture analgesia, the role of cholecystokinin,
and other putative antiopioid peptides in the central nervous system,
such as angiotensin II and orphanin FQ. Neuropeptide interaction in
the synaptic cleft is touted as a major target of research in this millennium
and promises to yield important medical applications. This is a must-read
section for anyone interested in acupuncture physiology. The work was
supported by the Natural Science Foundation of China, and a grant from
the U.S. National Institute on Drug Abuse.
Some of the most puzzling questions about developmental biology and
acupuncture research are discussed in chapter 4 by Shang. Ontogeny,
phylogeny, and physiological function of the meridian system, as well
as the distribution of the meridian and Chakra systems and germ cell
tumors, the high electric conductance of acupuncture points, and polarity
effects of electroacupuncture are just a few of the topics discussed.
Greater understanding of these advances have broad implications in biomedicine
beyond acupuncture. Shang eloquently justifies the importance of meridian
system research, and compares the current state as analogous to that
of "physics in the early 19th century, during the transition from
Newtonian mechanics to electromagnetics." Such information would
be invaluable in all aspects of medicine. Consider the potential implications
of better understanding the theory of singularity and separatrix in
morphogenesis, and its predictions of the high electric conductance
and high density of gap junctions at organizing centers such as blastopores
and zone of polarizing activity in relation to stem cell research.
The authors in chapter 5 investigate acupuncture using functional magnetic
resonance imaging (fMRI), thereby testing some aspects of Oriental medical
theory. In particular, fMRI has been able to identify neural correlates
of acupuncture analgesia. Needling of acupoints in the leg and foot
for treatment of eye and ear dysfunctions has revealed activity in the
visual and auditory lobes of the brain through the use of fMRI. The
use of brain imaging is not new to acupuncture research
because studies have shown that computed tomographic scans have been
effective in predicting which stroke patients are likely to benefit
from acupuncture.
A review of the neurophysiological basis of auricular acupuncture is
discussed in chapter 6. It is often a challenge to explain to Western
physicians and scientists the rationale behind auriculotherapy. This
chapter goes far in helping validate and clear much of the confusion
about this method of treatment. At least 30 articles of the 59 cited
are from the past decade, making this a good source for bolstering any
discussion with skeptical Western scientists. Oleson is without question
one of the leaders in this field and he does a masterful job at making
the case for microacupuncture systems. Auricular acupuncture research
for obesity, pain, and withdrawal from opiate drugs are thoroughly discussed.
Systematic analysis of various studies involving treatment with acupuncture
are discussed in chapter 7. The role of the Cochrane Collaboration in
conducting and maintaining systematic reviews in complementary medicine,
including acupuncture, is detailed. In particular, reviews of acupuncture
efficacy are discussed for chronic pain, lower back pain, osteoarthritis,
fibromyalgia, acute dental pain, headache, asthma, nausea and vomiting,
and smoking cessation. In like manner, chapter 8 reviews acupuncture
research in the area of stroke, addiction, and other health problems.
The final sections in the book discuss unique problems associated with
research in Oriental medicine, proposed methods and standards of acupuncture
treatment for clinical studies, and designing acupuncture trials. In
the final chapter, Hammerschlag and Lao outline a new direction for
research on the physiology of acupuncture. They pose the question, "What
can acupuncture tell us about how the body functions that Western medicine
and physiology have not yet discovered?" They search for additional
biomedical correlates for acupuncture effectiveness to discover new
ways to understand human health and disease.
Our profession is experiencing an explosion in research, and this ambitious
undertaking of creating a concise, evidence-based compendium of acupuncture
research largely succeeds. I highly recom-
mend it to anyone from the newest student to the established practitioner
interested in acupuncture. Since U.S. acupuncture is now considered
by many to be mainstream medicine, there is an interest and need for
all health care practitioners to understand current theories, basic
applications, and breakthrough research in the field of Medical Acupuncture.
REVIEWER
INFORMATION
Dr David P. Sniezek is in solo private practice in Washington, DC, specializing
in Medical Acupuncture, Pain Management, and Physical Medicine and Rehabilitation.
David P. Sniezek, DC, MD, Lac
2021 K Street NW, #710
Washington, DC 20006
Phone: 202-296-3555 • Fax: 202-296-0214 • E-mail: sniezek@aol.com
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