The American Society of Anesthesiologists, therefore, was neither accepting nor rejecting the use of acupuncture, but instead it was simply arguing for rigorous testing. These level-headed experts were not interested in anecdotes, but rather they wanted ‘objective evaluation’ with large numbers of patients. In other words, they wanted to see acupuncture submitted to the sort of clinical trials discussed in Chapter 1, which had decided the effectiveness of treatments such as bloodletting and lemon juice for scurvy. Perhaps acupuncture would turn out to be as useless as bloodletting, or perhaps it would be as effective as lemons. There was only one way to find out: do proper research.
During the 1970s universities and hospitals across America began submitting acupuncture to clinical trials, all part of a massive effort to test its impact on a variety of ailments. Some of the trials involved just a handful of patients, whereas others involved dozens. Some tracked the impact of acupuncture in the hours immediately following a one-off treatment, while others looked at long-term treatments and monitored the progress of patients over several weeks or even months. The diseases studied ranged from lower back pain to angina, from migraine to arthritis. Despite the wide variety of clinical trials, they broadly followed the principles that had been laid down by James Lind: take patients with a particular condition, randomly assign them either to an acupuncture group or to a control group, and see if those receiving acupuncture improve more than the control group.
A huge number of trials had been conducted by the end of the decade, so in 1979 the World Health Organization Inter-regional Seminar asked R. H. Bannerman to summarize the evidence for and against acupuncture. His conclusions shocked sceptics and vindicated the Chinese. In Acupuncture: the WHO view, Bannerman stated that there were more than twenty conditions which ‘lend themselves to acupuncture treatment’, including sinusitis, common cold, tonsillitis, bronchitis, asthma, duodenal ulcers, dysentery, constipation, diarrhoea, headache and migraine, frozen shoulder, tennis elbow, sciatica, low back pain and osteoarthritis.
This WHO document, and other similarly positive commentaries, marked a watershed in terms of acupuncture’s credibility in the West. Budding practitioners could now sign up to courses with confidence, safe in the knowledge that this was a therapy that genuinely worked. Similarly, the number of patients waiting for treatment began to rise rapidly, as they became increasingly convinced of the power of acupuncture. For example, by 1990 in Europe alone there were 88,000 acupuncturists and over 20 million patients had received treatment. Many acupuncturists were independent practitioners, but slowly the therapy was also becoming part of mainstream medicine. This was highlighted by a British Medical Association survey in 2002, which revealed that roughly half of all practising doctors had arranged acupuncture sessions for their patients.
The only remaining mystery seemed to be the mechanism that was making acupuncture so effective. Although Western doctors were now becoming sympathetic to the notion that needling specific points on the body could lead to apparently dramatic changes in a person’s health, they were highly sceptical about the existence of meridians or the flow of Ch’i. These concepts have no meaning in terms of biology, chemistry or physics, but rather they are based on ancient tradition. The contrast between Western incredulity and Eastern confidence in Ch’i and meridians can be traced back to the evolution of the two medical traditions, particularly the way in which the subject of anatomy was treated in the two hemispheres.
Chinese medicine emerged from a society that rejected human dissection. Unable to look inside the body, the Chinese developed a largely imaginary model of human anatomy that was based on the world around them. For example, the human body was supposed to have 365 distinct components, but only because there are 365 days in the year. Similarly, it seems likely that the belief in twelve meridians emerged as a parallel to the twelve great rivers of China. In short, the human body was interpreted as a microcosm of the universe, as opposed to understanding it in terms of its own reality.
The Ancient Greeks also had reservations about using corpses for medical research, but many notable physicians were prepared to break with tradition in order to study the human body. For instance, in the third century BC, Herophilus of Alexandria explored the brain and its connection to the nervous system. He also identified the ovaries and the fallopian tubes, and was credited with disproving the bizarre and widely held view that the womb wandered around the female body. In contrast to the Chinese, European scientists gradually developed an acceptance that dissecting the human body was a necessary part of medical research, so there was steady progress towards establishing an accurate picture of our anatomy.
Autopsies were becoming common by the thirteenth century, and public dissections for the purpose of teaching anatomy were taking place across Europe by the end of the fourteenth century. By the mid-sixteenth century, the practice of dissection for teaching anatomy to medical students had become standard, largely thanks to the influence of such leading figures as Vesalius, who is acknowledged to be the founder of modern anatomy. He argued that a doctor could not treat the human body unless he understood its construction, but un fortunately obtaining bodies was still a problem. This forced Vesalius, in 1536, to steal the body of an executed criminal still chained to the gibbet. His aim was to obtain a skeleton for research. Luckily much of the flesh had already rotted away or had been eaten by animals, so much so that the bones were ‘held together by the ligaments alone’. In 1543 he published his masterpiece, De Corporis Fabrica or The Construction of the Human Body.
Early European anatomists realized that even the most elementary discoveries about the human body could lead to profound revelations about how it functions. For instance, in the sixteenth century an anatomist named Hieronymus Fabricus discovered that veins contain one-way valves along their length, which implies that blood flows in only one direction. William Harvey used this information to argue in favour of blood circulating around the body, which in turn ultimately led to a clear understanding of how oxygen, nutrients and disease spread through the human body. Today, modern medicine continues to develop by ever-closer examination of human anatomy, with increasingly powerful microscopes for seeing and with ever finer instruments for dissecting. Moreover, today we can gain insights into a living dynamic body, thanks to endoscopes, X-rays, MRI scans, CAT scans and ultrasound — and yet scientists are still unable to find a shred of evidence to support the existence of meridians or Ch’i.
So, if meridians and Ch’i are fictional, then what is the mechanism behind the apparent healing power of acupuncture? Two decades after Nixon’s visit to China had re-introduced acupuncture to the West, scientists had to admit that they were baffled over how acupuncture could supposedly treat so many ailments, ranging from sinusitis to gingivitis, from impotence to dysentery. However, when it came to pain relief, there were tentative theories that seemed credible.
The first theory, known as the gate control theory of pain, was developed in the early 1960s, a decade before scientists were thinking about acupuncture. A Canadian named Ronald Melzack and an Englishman named Patrick Wall jointly suggested that certain nerve fibres, which conduct impulses from the skin to more central junctions, also have the ability to close a so-called ‘gate’. If the gate is closed, then other impulses, perhaps associated with pain, struggle to reach the brain and are less likely to be recognized as pain. Thus relatively minor stimuli might suppress major pain from other sources by shutting the gate before the troubling pain impulse can reach the brain. The gate control theory of pain has become widely accepted as an explanation of why, for example, rubbing a painful limb is soothing. Could gate control, however, explain the effects of acupuncture? Many acupuncturists in the West argued that the sensation caused by an acupuncture needle was capable of shutting gates and blocking major pain, but sceptics pointed out that there was no solid evidence to show that this was the case. The gate control theory of pain was valid in other situations, but acupuncture’s ability to exploit it was unproven.