Today, we'll continue our exploration of the origins of the meridians through early Chinese medicine texts.
1. The Book of Mawangdui
The origins of acupuncture and its development over time continue to be debated among scholars. Recent discoveries of ancient texts in the Mawangdui tomb in China have shed new light on early forms of acupuncture channels and points. Mawangdui is an archaeological site located in Changsha, China, and consists of two saddle-shaped hills. The site contains the tombs of three people from the Changsha Kingdom during the Western Han Dynasty (206 BC - 9 AD): Chancellor Li Cang, his wife Xin Zhui, and a male believed to be their son. The site was excavated from 1972 to 1974. Mawangdui contained numerous classical texts, including astronomy texts depicting planetary orbits and comets, Huang Lao Taoist texts with early versions of I Ching and Tao Te Ching, and medical texts featuring acupuncture scripts and herbalogy scripts. Two medical texts about acupuncture and moxibustion found at the Mawangdui tomb revealed unique characteristics of early acupuncture meridians:
- The meridians were used only for moxibustion, suggesting that acupuncture was not the primary treatment method in ancient times.
- The texts described meridian lines but not acupoints, indicating that the concept of acupoints likely developed later than channels.
- The texts mentioned eleven meridians, not twelve as commonly known in modern acupuncture, indicating that the understanding of meridians was still evolving.
- Only two or three of the eleven meridians were connected to organs, unlike modern acupuncture, where all meridians are interconnected and part of a unified circulatory system. This suggests that the understanding of the relationship between meridians and internal organs was not fully developed at that time.
- The meridians described in these texts were independent of each other, unlike the unified circulatory system of twelve meridians in the Huang Di Nei Jing, further indicating that the concept of acupuncture meridians was not a circular system in its early days.
2. Siposhan Wooden Figurines (179 B.C. to 141 B.C.)
This meridian-marked doll, unearthed in 1993, is believed to date back to the Han Dynasty. The doll features carvings of nine channels, including the Du Mai (governor channel), which was not present in the Mawangdui medical texts. Interestingly, like the Mawangdui texts, this doll does not depict any points, but only meridians (channels).
3. Sanjing of the Six Dynasties (AD 200-600)
"Shi Mai Tu" (十脈圖), an acupuncture point chart found in the Six Dynasties-era text "Shanjing" (産經), illustrates the Heart channel. However, in other sources, the channel depicted is referred to as the Pericardium channel. This discrepancy does suggest that during the early development of Traditional Chinese Medicine (TCM), there might not have been a unified understanding of channels and their connections.
4. Inconsistency in the order of acupuncture points and routes
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| Urinary bladder channel in Huó Rén Shū (活人書) of Song, Yuan and Ming dynasty |
Additionally, the routes of acupuncture meridians have evolved over time. For example, the urinary bladder meridian routes on the back and waist were depicted as a single line rather than two in Zhū Gōng'(朱肱) s book 'Huó Rén Shū (活人書)' during the Song and Yuan dynasties. However, in the Ming dynasty edition, it is illustrated as two separate lines.
The location of the two routes also sparked controversy. While it is generally accepted that the first line of the urinary bladder channel should be 1.5 cun apart from the spine, there are differing opinions on how to measure this distance. Most people measure 1.5 cun from the midline, but the prominent acupuncture book Shén Yìng Jīng (神應經, 1425) argues that the first line should be measured from the lateral end of the vertebra. This discrepancy results in a 0.5 cun difference.
These variations in acupoint order and meridian routes highlight the continuous evolution and refinement of Traditional Chinese Medicine throughout history. As knowledge was passed down, debated, and revised, a more standardized understanding of channels, their connections, and acupoint sequences emerged, eventually leading to the modern TCM practices we know today.
5. Changes in the number of acupuncture points
The modern number of acupuncture points, 361, originates from the Qing Dynasty's Acupuncture book 'Exploring the origin of acupuncture medicine (針灸逢源)'. Nei Jing states that there are 365 points, but not all the points are explained, only less than half 160 points are introduced. The number of 365 acupuncture points is largely abstract and metaphorical. The fact the earliest herbalogy book, Shen Nong Ben Cao Jing introduces also 365 herbs seems to be not a coincidence.
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| Number of acupoints in history |
Throughout history, the number of acupoints has been a topic of discussion and debate among practitioners of Traditional Chinese Medicine (TCM). Some believe that the 361 points originated from the 'Míng Táng Kǒng Xué Zhēn Jiǔ Zhì Yào (明堂孔穴鍼灸治要)' in the Han dynasty. However, this text is no longer extant, and the only evidence we have is a citation from the 'ABC of acupuncture(甲乙經)' which mentions 361 points, but 'ABC of acupuncture' actually lists 349 points. In modern TCM, 361 regular points are recognized, and any newly discovered points are considered extra points.
It is important to note that the 361 points used in modern TCM may not be entirely supported by historical or academic rationale. To this day, there are inconsistencies in the location of acupuncture points among practitioners in Korea, China, and Japan. For example, Japanese and Korean acupuncturists locate Du 26 at the halfway point of the philtrum, while Chinese acupuncturists place it at 1/3 of the length. Efforts have been made to standardize the practice, and since the International Organization for Standardization of Acupuncture Points was established in 1981, experts have convened in meetings for the past 10 years to develop standard terms for 361 acupuncture point names, acupressure points, and 48 extra points. Nonetheless, it is important to question whether medical knowledge, such as the location of the appendix, should be based solely on consensus. All acupoints should be verified through evidence-based research rather than merely relying on agreement among practitioners. As TCM continues to evolve and integrate with modern medicine, further research and evidence-based studies will be crucial in refining the understanding and standardization of acupuncture points and their locations.
Download link: WHO Standard Acupuncture Point Locations
Conclusion
From the facts discussed above, it is evident that during the Ming Dynasty, there was no absolute standardization of meridian routes, order, and location of acupuncture points as there is today. The characteristics of ancient meridians and acupuncture points can be summarized as follows:
- The connection to the intestines was not established.
- The order of points was not fixed.
- The meridians were not circulatory.
- The urinary bladder had a single line in the back.
Returning to the previous questions—What are the actual meridians? Why are there 12 meridians? Who first discovered them and how? How do you know which direction a meridian runs?
Even though you cannot answer then with one word, I am sure you can now appreciate that the number of acupuncture points, routes, order, and other aspects of meridian theory have been continuously verified and refined from ancient times to the present. New hypotheses have emerged, been modified, and evolved over time. The meridian theory is the result of accumulated experience in actual clinical treatment and diagnosis, as well as efforts to explain the phenomena observed through it. TCM theories have not been fixed at any particular point in history, but have progressed with history. TCM is not history, but has history, still writing new chapters, alive and thriving in the present.
In closing this article, I would like to quote a column by a friend and esteemed scholar, Professor Kim Ki-Wang of Pusan National University:
"The classical theory of meridian acupuncture is nothing more than an explanatory system proposed more than 2,000 years ago. It has been around for far too long. We need to put aside the burden of tradition and verify what is the best explanation for now and the future, just like ancient acupuncturists did. What we should be looking for in the classics is not the doctrine the ancients believed, but the facts they observed."고전 경락경혈학설은 2000여 년 전에 제안된 하나의 설명체계에 지나지 않는다. 그것이 너무 오랜 세월 이어져왔다. 전통의 짐을 잠시 내려놓고 현재의 상황에서 최적의 설명체계가 무엇인지 검토해 볼 필요가 있다.고전에서 찾아야 할 것은 고인들의 믿음이 아니라 고인들이 관찰한 것들이다
Reference;
1. Jeon, Jongwook & Lee, Sanghun. (2013). The Meanings and Prospects of Primo Vascular System from the Viewpoint of Historical Context. Evidence-based complementary and alternative medicine : eCAM. 2013. 439508. 10.1155/2013/439508.
2. Chang-Sik and Ko Gyong-Gyun, What are Meridians and Acupoints?, Korean J Med Hist 14∶137-150 Dec 2005)
3. The Origin of Mingtangyangfutu(명당앙복도) in 『YiXueRenMen』, 대한한의학원전학회지, 2019, vol.32, no.1, 통권 88호 pp. 75-93 (19 pages) DOI : 10.14369/jkmc.2019.32.1.075