The anatomy of acupuncture

Acupuncture is the medical practice of inserting fine needles at specific places in the body, named acupoints. These points are located on pathways (called meridians) that run through the body, normally depicted as lines on the body's surface. According to the medical paradigm of the Han era (206BCE-220CE) these are areas where the Qi or vital essence of the body can be accessed and manipulated to engender harmony and balance, thereby promoting health. Meridians and acupoints are widely considered to be esoteric in nature, and how they were originally discovered is an enduring mystery. Today, the exact nature of meridians and acupoints, along with the mechanism through which acupuncture acts, are the subject of substantial debate and research. The first descriptions of meridians are found in the ancient Chinese Mawangdui medical manuscripts, which were found in the Mawangdui tomb, closed in 168BCE and reopened in 1973CE. This initial exposition is developed in the later Huangdi Neijing, a substantial collation of medical texts spanning the whole Han dynasty. In the four papers that comprise this thesis, I resolve this ancient mystery by uncovering how these meridians and acupoints were arrived at. I hypothesise that Han era physicians conducted systematic anatomical examination of the body over an extended period of time (>300 years) and that the meridians and acupoints are detailed descriptions of their observations. This early anatomical research is roughly contemporaneous with the early Greek anatomists Herophilus and Erasistratus whose works were destroyed in the fire at the library of Alexandria. The ancient Chinese texts, by contrast, survived. The Mawangdui manuscripts are thus the earliest surviving anatomical atlas in the world based on humans. The papers that comprise my thesis are presented in the order in which they were written: The first is about the use of the Chinese character for silk as part of the name for the meridian network. I show that fascia has a silk-like visual and textural quality, and suggest that the meridian pathways may be related to fascial pathways. The second is a study of parts of the later Huangdi Neijing describing a single meridian, 'chong'. This paper shows, again through dissection, that the character for 'chong' describes the vasculature of the body, primarily veins. The same character is used in the names for acupoints which lie over key vascular landmarks. The third paper is an extended exploration of the relationships between the various anatomical structures found at acupoints, and the characters used in their naming. I show extensive correlations between naming conventions and anatomical structures. The fourth is an exposition of the Mawangdui medical texts. We explain how the texts refer to particular parts of the body and the structures that pass through them. Many of these structures are only visible on dissection and some, like the perforating veins in the leg, require careful and methodical dissection to visualise. This strengthens the argument that this was dissection carried out for the purpose of anatomical examination. All four papers thus demonstrate that these works constitute an anatomical atlas that was arrived at through direct observation of the human body through dissection. They show what is being described, and how that knowledge was embedded into Han medical culture. This has implications for Chinese medical history, which can now fill a gap that has existed for millennia. That meridians and acupoints form an anatomical atlas rather than a network of physiologically 'special' areas also requires that modern researchers re-evaluate what they are investigating. My work thus establishes a new foundation for medical studies of acupuncture and the history of medicine in the Han dynasty.