American Journal of Chinese Medicine

Voi. 1, No. 1, pp. 75—83

An Introduction to Classical Acupuncture*

Nguyen van Nghi
27, Boulevard d’Athenes, Marseille, France

Guido Fisch
Chemin du Frenell 1004, Lausanne, Switzerland

John Kao
Yale School of Medicine, New Haven, Connecticut

History
In China, acupuncture has been known for several thousand years. Being part of tra-
ditional Chinese medicine it is based on the principle that a disease occurs simulta-
neously with a disturbance of bodily vital energy and can be treated by puncturing,
warming or massaging specific points on the surface of the body, thus re-establishing
the disturbed energy circulation. The science of acupuncture deals with the punctur-
ing of these control points.
In early times, i.e. two to three thousand years B.C., chips of stone and flint
were used as needles. Later needles were made of various metal alloys (gold, silver,
copper, platinum, steel, etc.). The principles of acupuncture have been handed down
to us in numerous documents. These include the Su-Wen and the Nei-Ching which
are still considered today to be fundamental to the understanding of acupuncture.
In China, acupuncture was transmitted by means of the above-mentioned docu-
ments and many schools developed around different teachers. Since written knowl-
edge was partly lost, and since traditional Chinese medicine was not taken seriously
during the colonial period, the tradition remained in the hands of many so-called
masters whose qualities varied considerably. For this reason, many established prin-
ciples were forgotten and replaced by mystification. Although the latter sometimes
resulted in cures, it lacked connection with the original principles and their logical
and coordinated background. It was difficult to distinguish the true expert from mere
quacks.
Since the early nineteen-fifties, the whole system of acupuncture has been re-
adapted and gradually introduced as a required subject in Chinese medical schools. In
the course of many years of research, the study of ancient manuscripts has been sup-

*Reprinted with permission from the Journal of Biological Medicine

75
 NGUYEN VAN NGHI GUIDO FISCH JOHN KAO

plemented with the results of experimental research, and efforts have been made to
put the entire system on a scientific and logical accessible basis.
Prior to 1930, there existed several reports in Europe, especially from mission-
aries, concerning acupuncture. During the thirties, acupuncture was introduced to
the West by a non-medical man, who had been French consul in China for many
years, and who spoke and wrote fluent Chinese. This man, Soulié de Morant pub-
lished a manual on acupuncture: L’Acupuncture Chinoise. Through his influence, a
number of schools developed, and there can be no doubt about his great merit. How-
ever, Soulié de Morant was not a medical man, and he familiarized himself with
acupuncture at a time when even in China this branch of medicine was in a chaotic
state, making it extremely difficult to get a comprehensive view on the subject. With
knowledge gained from Soulié de Morant, his pupils set up their own schools and
societies which turned the basic ideas of acupuncture into a mysterious curing method
employing dogmas and axioms different from those used in China. We in the West
owe the first neutral discussion of acupuncture to the French doctor A. Chamfrault
and his translations of the ancient text-books Su-Wen and Nei-Ching.

Energy
Acupuncture is based on the principle of energy. We can regard the universe as the
gradual transformation of existing nature, whereby the first amino-acids developed
followed by the first living protein chains, gradually giving rise to the living world
with its micro-flora, vegetable kingdom, and finally man. Comparative zoology and
embryology point out criteria which permit a classification of the processes of life. In
order to reach its proper stage, each kind of animal has to pass through the lower
stages in its phylogenetic as well as embryological development. All these stages de-
veloped under the influence of different energies and are rooted in the chromosomal
structure in order to assure the specific characteristics of each kind of animal or
plant.
The ancient Chinese investigated and classified natural laws, and related them
to man as microcosmos. This lead them to conclusions which are only now being
confirmed by Western science in connection with nuclear physics. A few hints:
* energy = matter
* dualism of action and reaction
* electrical current with a positive and negative pole, which are necessary for
the flow of electricity
* the existence of anti-matter
The principle of energy has been applied to the human organism inasfar as
every process of life is related to metabolic energies and requires a specific energy
circulation. Health is the normal flow of this energy. Disease results from distur-
bance in the flow of energy.

Ying-Yang The general flow of energy is interpreted in traditional Chinese

Medicine by means of the principle of Yin and Yang, symbolizing two opposed and
at the same time complementary energies. This results in a duality, which is encoun-
76
 AN INTRODUCTION TO CLASSICAL ACUPUNCTURE

tered again and again in the whole of nature: man and woman, positive and nega-
tive, day and night, cold and warm, yes and no, beautiful and ugly, heaven and earth,
and so on. This is the general principle: Yang actuates Yin and Yin produces Yang.
As far as the macrocosmos is concerned, the sky with sun and heat corresponds
to Yang energy, while the earth with cold and water corresponds to Yin energy. As far
as the microcosmos, i.e. man, is concerned, Yang energy comes from above and is
exterior, while Yin energy comes from below and is interior, i.e. it flows deep in the
organism. Under certain circumstances, i.e. with the secondary vessels, Yang energy
flows invariably from below to above.

The Organs and Their Energies According to the concept of Yin-Yang, the organs oi
the human body are classified into those storing energy in the deep bodily interior
corresponding to the Yin principle, which are the so-called storage organs, and those
producing energy and in contact with the external world, the so-called hollow Yang
organs. Thus the energetics of organs is one of the most important basic principles of
traditional Chinese medicine. It is based on the assumption that organs within the
body produce energy, which is perceptible in terms of energy conditions on the sur-
face of the body. Any disturbance of these energy principles results in disease; this is
the basis of pathology in Chinese medicine.
We must not be misled by our Western way of thinking, in which by organ we
mean one particular organ. Here the term organ refers to everything which is con-
nected in any way with this organ and its specific energy; similarly Western usage
speaks of the lymphatic system, which covers not only the lymphocytes but all asso-
ciated lymph functions etc.
Chinese medicine considers the organs to be paired, with joint and complemen-
tary functions. One homologous partner belongs to the Yin principle while the other
belongs to the Yang principle. However, both partners are penetrated by both ener-
gies, i.e. Yin and Yang. The Yin organs or storage organs disguise pure energy.
They have a core, but are not hard and have no fringe. The Yang organs or hollow
organs convey the residues of digestion, which they eliminate without any retention.
The Yang organs are covered with fringes. There also exists another type of organ,
the so-called singular organs. Their exterior resembles that of the Yang hollow organs,
but they have the same function as the Yin storage organs. They comprise the fol-
lowing systems: nervous system (brain and spinal cord), bone system, blood circula-
tion, hepatic-biliary system, and genital system.

The Organs and the Hollow Organs Essentially there are six storage organs and six
hollow organs. The storage organs are the following: lungs, kidneys, liver, heart and
spleen. Another storage organ is the envelope of the heart (circulation). For the
Chinese, this last term covers all cardiac functions, as well as those of the heart mus-
cle and the heart defence. From the Chinese point of view, the heart also represents
the center of psychical energy. The hollow organs are the following: large intestine,
bladder, gall bladder, small intestine, triple-burner, and stomach.
As has already been mentioned, there is an affinity between a storage organ and
its respective hollow organ, since both homologues belong to one element. Conse-
77
 NGUYEN VAN NGHI GUIDO FISCH JOHN KAO

quently each pair of organs is related to one of the so-called Five Elements, with the
exception of fire which is divided into imperial and ministerial fire. (Fig. 1)

Element Storage Organ Hollow Organ

Wood Liver <——_______> Gall bladder
Fire Heart ++ Envelope <————> Small Intestine +-
of the Heart Triple-burner

Earth Spleen ———_——_—> Stomach

Metal Lungs «————___—_—__—> Large Intestine

Water Kidneys «—_——~————> Bladder

. homologous pairs :
Figure 1.

Each storage organ and hollow organ respectively has a certain time of day dur-
ing which its energy flow shows a maximum, i.e. where its energetic tonus is at its
highest. A so-called organic clock has been designed to demonstrate this, which also
corresponds to the direction of energy flow. This flow of energy is thought to begin
in the lungs (3:00 A.M.—5:00 A.M.), and to progress in order through the follow-
ing organs: large intestine —> stomach — spleen > heart — small intestine >
bladder — kidneys —> envelope of the heart > triple burner — gallbladder >
liver.

The Different Energies Among the numerous energies of traditional Chinese medi-
cine, we distinguish the following principle elements: Ying energy, Wei energy, es-
sential energy, the blood, ancestral energy, mental energy and the body humors.

The Ying and Wei energies: The Triple Burner In order to understand these ener-
gies, we must first discuss the function of the triple-burner. This hollow organ is ac-
tually an organic function. The triple-burner and its function are intimately related to
stomach function. The term triple-burner is derived from the three “digestion reac-
tors” situated in the mucous tissue of the stomach. These reactors are responsible for
the transformation or processing of foods into energy. The middle-burner is situated
in the region of the greater curvature of the stomach and produces pure energy. In
this context pure has a figurative meaning. The pure energy is light and flows up-
wards, while the impure energy is heavy and flows downwards into the intestinal
canal which is sometimes referred to as the inner canal of the triple-burner.
From the middle-burner, the pure energy, being light and consequently tending
upwards, flows to the upper-burner, which is situated on the cardia, and from there
to the lungs. The pure energy is Ying energy. In the lungs, it mixes with energy de-
rived from respiration and then circulates in the meridians, which are discussed
below. Ying energy is the true alimentary energy of the organism, flowing in the inte-
rior of the body (i.e. Yin).
The lower-burner, located in the region of the pylorus, is known as the focus or
78
 AN INTRODUCTION TO CLASSICAL ACUPUNCTURE

reactor of Wei energy. It is from here that the impure, heavy energy is purified as it
flows into the intestines, i.e. into the inner canal of the triple-burner and then into
the kidneys. During this process, one part of the impure energy is transformed into
Wei energy in the kidneys, while the rest is stored in bladder as waste water. From
the kidneys, the Wei energy flows to the liver and the spleen.
Wei energy has great force. It is produced by alimentation and is fast and agile.
It does not penetrate into the meridians, and therefore circulates subcutaneously, in
the muscular fibers, and in the peritoneum. It is in the chest as well as the abdomen.
Because it circulates as a rule outside the meridians, the Wei energy is consequently
the principle energy of the secondary vessels. This means that Wei energy circulates
at the body surface (Yang). The Wei energy therefore represents the defence energy
of the human body. It nourishes skin and hair, opens and closes the pores, and de-
fends the human organism against atmospheric aggression.

Blood and Energy Under the influence of the middle-burner, organic fluid and Ying
energy are converted into blood. As a rule, this takes place in the liver. Blood is a
material substance, while Ying energy is immaterial. According to the principle of
Yin and Yang, this means that blood is Yin and energy is Yang. This does not mean,
however, that Ying energy is Yang under all circumstances. For in relation to Wei or
defence energy which is Yang, the Ying energy which is situated in the meridians of
the body interior, is Yin.

Essential Energy Essential energy is nothing else but a union of supernal energy (i.e.
air; material element) and the energy of the earth (i.e. food; material element).
Thus its function is to maintain the body by alimentation. The substances of alimen-
tation pass into the stomach, the middle and lower burners to be converted into en-
ergy. In this energy, six solid organs and the six hollow organs are bathed. Depending
on whether this energy takes the direction of Ying energy or Wei energy, it will be
one or the other of these two energies. Essential energy is the true, principle and
vital energy of man. Supernal energy (air and respiration) and the energy from the
earth (food and digestion) are called primary energies. Under the influence of the
triple-burner, they are transformed into secondary energies.

Ancestral energy Ancestral energy is the energy which is transmitted by the parents
and situated in the chromosomes. In other words, it is the innate, ancestral energy
which constitutes the basis of all somatic organization. Consequently, it is responsi-
ble for the development of the various somatic systems (i.e. nervous, bone, muscu-
lar).
Ancestral energy develops gradually and grows progressively more vigorous,
making its appearance during stages of growth and in the course of mental and sex-
ual development. Ancestral energy. accumulates in the adrenal glands (kidneys),
which develop especially from the age of 8 (1 x 8). For this reason, the first teeth
fall out and and the hair grows particularly fast during this period. By the age of 16
(2 x 8), the renal energy becomes still more vigorous and the child is in full growth.
-The spermium start to develop and procreation becomes possible. At the age of 64
(8 x 8), the spermium are exhausted and the renal energy becomes less powerful.
These same stages apply to females, but are based on periods of 7 years.
79
 NGUYEN VAN NGHI GUIDO FISCH JOHN KAO

The ancestral energy reinforces the Wei defence energy. Furthermore, in order
to pass from the kidneys to the surface of the body, it does not flow along the princi-
ple meridians as might be expected, but takes its own course along the singular ves-
sels, which are described below. In flowing to the body surface, the ancestral energy
also assumes a defence function. Another special feature of the ancestral energy is
that it has its own organs, namely the singular organs mentioned above, which con-
tain a high amount of ancestral energy on which they rely heavily.
Mental energy As a rule, mental energy manifests itself in thought and conscious-
ness. It is already being produced during the fertilization process, and increases dur-
ing fetal development. The pure energy of alimentation is responsible for the conti-
nuity and maintenance of mental energy. According to the Su-Wen, the five flavors
are preserved in the stomach and intestines during alimentation in order to maintain
the five energies (Wei, Ying, pure, ancestral and mental). By being mixed with the
five flavors, the energy is transformed into organic humors and mental energy. Thus
the pure energy results from alimentation, and therefore constitutes the material
basis of all organic activities. Essential energy is composed of the pure energy of the
aliments and energy from respiration. It acts as the principle energy underlying the
physiological functions of the body. The mental energy combines all normal physio-
logical functions of the body. The union of essential and pure energies results in
mental energy. If there is a sufficient amount of these, then mental energy will be
sufficient. On the other hand, a deficiency of mental energy may be caused by a lack
of essential or pure energy. A deficiency in pure energy will always result in a lack of
essential energy and vice versa.
The Body Humors The totality of the water element in the body is called the body
humor. It is produced under the influence of the stomach, the intestines, the bladder
and the triple-burner. On this subject, we find in the Nei-Ching that “Under the in-
fluence of digestion”, the aliments produce nutritive substances or “pure substances”
which are converted into pure energy which flows to the spleen and then to the lungs.
When the lungs have accomplished their part which consists of the transformation
and circulation of the energies, the body humors follow the course of the energies
and are distributed over the whole body. The water of the body always represents
pure energy, which flows through the meridians of the organs. On the other hand, the
eliminated water represents merely impure energy.
The organs are situated in the body interior and the exterior is comprised of the
skin, subcutaneous region, the seven senses and the joints. Due to the body humor,
the bodily exterior and interior are in a state of harmony and balance. According to
the Nei-Ching, the body humor is of alimentary origin. Despite their different names,
pure energy, essential energy, the organic humor, the meridians and vessels are all
based on a single kind of energy, and their common origin is constituted by alimen-
tation and their interrelated processes of development. This developmental inter-
dependence explains why, for example, a lack of humor weakens the energy and the
blood, and vice versa. Excessive perspiration, violent vomiting, grave diarrhea lead
to exhaustion of the organic humor. A corresponding weakening of the blood may
then be observed: the circulation seems to be cut off, the energy is insufficient, the
pulse is small and frail, the heart thumps and the limbs are cold. After a hemor-
80
 AN INTRODUCTION TO CLASSICAL ACUPUNCTURE

rhage, we can always observe the symptoms of an exhaustion of the organic humor:
dry mouth, thirst, infrequent urination and slow action of the bowels.

The Meridians or Channels of Energy

The 12 principal meridians or principal energy conductors represent the basic struc-
ture of the entire system of energy channels. They correspond to the six storage or-
gans and the six hollow organs, as well as to the circulation. They flow from the head
to the feet, from the feet to the chest, and from the chest to the upper extremities.
The meridians which are assigned to the hollow organs flow along the outside of the
limbs and along the back. The energy channels belonging to the storage organs or
interior organs pass along the inside of the limbs and along the front of the body.
Each meridian passes along its proper channel. Where there are no principal merid-
ians the body receives its energy supply from sub-meridians or capillaries. For the
practice of acupuncture the following physiological principles are of the greatest im-
portance,
The meridians provide communication between exterior and interior and be-
tween the upper part of the body and its lower regions. Coming from the organs, the
three upper Yin meridians flow to the hands; the three upper Yang meridians flow
towards a hollow organ. From the hollow organs the three lower Yang meridians
flow towards the feet and the three lower Yin meridians fiow to a storage organ. For
example, as a Yin meridian, the lung meridian flows from the lungs to the hand,
more precisely to the thumb, while the large intestine meridian takes its course from
the hand via the arm to the large intestine. A further example: the stomach meridian
flows from its hollow Yang organ, which is the stomach, to the foot. The Yin merid-
ian of the spleen flows from the foot to the spleen, which is the storage organ.

Exterior and Interior Communicate From the finger tip, each Yin meridian con-
tinues as a Yang meridian. At the level of the supra-clavicular fossa, the Yang meridian
enters the thorax, flows into a hollow organ and finally into the corresponding,
homologous storage organ. The lung meridian, for instance, continues from the
finger tip as the large intestine meridian. The latter enters the thorax at the level of
the supra-clavicular fossa, then is in contact with the large intestine which is a hol-
low organ, and finally with the lungs which are a storage organ.
All Yang meridians pass at the tips of the toes into the homologous Yin merid-
ians. At the level of the inguinal region, the Yin meridian penetrates first into the
abdomen, then into the storage organ, and finally into the hollow organ. The stomach
meridian, for instance, continues as the homologous spleen meridian.

Upper and Lower Regions Communicate All Yang meridians of the hand ascend to
the head where they pass into the Yang meridians of the foot. The latter flow to the
foot, from where they continue as the homologous Yin meridians, which again rise to
meet an upper Yin meridian at the thorax, which in turn flows towards the hand.
This explains the polarization which occurs at the tips of the toes and fingers, and
which is observed in the hollow and storage organs. Energy increases and decreases
according to its location: interior or exterior, upper or lower region, Yin or Yang.
The energy of the upper Yin meridian comes from the interior and is Yin. As soon
81
 NGUYEN VAN NGHI GUIDO FISCH JOHN KAO

as it reaches the finger tips, it is polarized into the homologous, upper Yang merid-
ian. At the level of the head, the Yang meridian of the hand joins the one of the foot,
thus connecting the upper region with the lower region. At the thorax, the Yin me-
ridian of the foot joins the one of the hand.
Along the principal currents or channels, the Ying energy dominates, but is ac-
companied by the defensive Wei energy and by ancestral energy. Thus the Wei en-
ergy and ancestral energy circulate in and outside the principle meridians.
The Meridians The twelve meridians or energy conductors (Ching-Lo) which we
have described above can take an interior or deep course (Yin) and an exterior or
surface course (Yang). Here surface and depth are not to be interpreted as interior
and exterior channels. Each meridian has an exterior channel and an interior branch
which is constantly in contact with its organ. The borderline between interior and
exterior, and consequently between Yin and Yang, goes through the elbow and knee.
Accordingly, the Yin and Yang meridians pass through a Yin region as well as a
Yang region. The decisive factor is whether the flow of energy is proximal or distal
in relation to knee or elbow. From the necessary relativity of all connotations of Yin
and Yang, there arise the following distal and proximal distinctions:
¢ Yang zone with Yang meridians: Yang in Yang
* Yang zone with Yin meridians: Yin in Yang
¢ Yin zone with Yang meridians: Yang in Yin
* Yin zone with Yin meridians: Yin in Yin
Submeridians and Subcurrents of Energy; The Tendino-Muscular Meridians So far
we have dealt only with the principal meridians or main currents of energy. Among
the numerous ramifications of these principal meridians, we shall confine our discus-
sion to the tendino-muscular meridians. However, the different kinds of secondary
energy conductors are enumerated below:
* tendino-muscular meridians
¢ transversal Lo meridians
¢ longitudinal Lo meridians
¢ special meridians
* ancestral meridians
* interior courses of the principal meridians (already mentioned)
* connecting meridians
The tendino-muscular meridians draw energy in a centripetal fashion from the
Tsing (Well) loci, and they get their supply of Wei energy from muscles and ten-
dons. They do not penetrate into storage or hollow organs. Each principal meridian
has its tendino-muscular meridian, which is usually a surface energy current which
flows. along the channels of its respective principal meridian. They also possess
branches whose anatomy must be thoroughly mastered, since a lack of such knowl-
edge may result in errors of diagnosis and treatment. The energy flow in the tendino-
muscular meridians proceeds from lower to upper regions, and from the extremi-
ties towards the center of the body. The tendino-muscular meridians also supply re-
gions through which principal meridians do not pass. The tendino-muscular merid-
ians are not capable of alternately carrying Yang and Yin energy. As a rule, they
carry only Wei and ancestral energy.
82
 AN INTRODUCTION TO CLASSICAL ACUPUNCTURE

Three unipolar tendino-muscular meridians have a common meeting area,

where they join, not at a specific point, but in a multitude of common capillaries
spread over a small area. Thus:
¢ the 3 t.m. Yang meridians of the foot meet at the cheek-bone
* the 3 t.m. Yang meridians of the hand meet at the parietal bone above the ear
* the 3 t.m. Yin meridians of the foot meet above the symphysis
the 3 t.m. Yin meridians of the hand meet on the side of the thorax.
The pathological symptoms of the tendino-muscular meridians are of local
character: pain in the tendons, muscles or joints. They are rarely associated with dis-
eases of storage or hollow organs. The tendino-muscular meridians explain numer-
ous healing processes which were formerly either unknown or incorrectly inter-
preted. The loci of a principal meridian can have a therapeutic influence on an area
through which this particular meridian is not passing, if its associated tendino-
muscular meridian itself is passing through. The Ho-Ku and the Yang-Hsi loci, for in-
stance, act on migraine through the tendino-muscular meridian of the large intestine.
This energy current rises to the head along the front and descends on the opposite
side towards the maxilla.
The tendino-muscular meridian takes its energy from the principal meridian at
the Tsing locus. Additional points can be determined only if they are painful and
readily palpable along the path of energy flow. Of importance is the common area
shared with the other two associated subcurrents, as mentioned above, as well as the
so-called insertion points, which provide contact with the joints.

83