Historical Artifacts and Foundations of Traditional Chinese Medicine

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Historical theories in the development of acupuncture and other therapies, and the continuing use of acupuncture in practice throughout history

Historians such as Joseph Needham have found evidence that the various forms of Traditional Chinese therapies, acupuncture, moxibustion, herbal medicine, physiotherapies and apotropaics (exorcisms, spells and sacrifices) originated in different areas of the vast Chinese landscape, and reflected the types of health problems endemic to those areas. Acupuncture may have originated in Eastern China, where a greater problem with boils and carbuncles resulted in use of sharp implements. Moxibustion, or heat stimulation, may have originated in the North, while herbal medicine may have originated in the West, where the environment housed a wider variety of wild medicinal plants. The nine needles are thought to have originated in the South, while apotropaics (rituals such as shamanism and qi gong) were more universal, or central. This history of regional developments of TCM medical practices may merely reflect the Daoist system of the five energies and directions, or it may actually be the case. Much of the official history of Chinese culture adhered to the Daoist patterns and outline. The Daoist classification became so ingrained into the culture that we may never be able to truly distinguish the facts from philosophy in history, but excavation of artifacts is helping to elucidate the history today. Certainly, the early importance of uniting the cultures and sciences of many regions into a central China played an important role in the accumulation of information and treatment techniques that eventually became a standardized Traditional Chinese Medicine.

Needles made of precious metals, such as gold and silver have also been found in excavations of tombs of the Han dynasty. Gold was historically used to tonify (bu) conditions of deficiency, while silver was used primarily to reduce (xie) conditions of excess, as noted in ancient medical texts. This classification of gold and silver in therapeutic use obviously was linked to the theories of the early alchemical science. These gold and silver needles were less fine than the needles of bronze, steel, etc., but the use of the precious metals in needles at a time when technology was manufacturing much finer needles of different metal alloys may reflect continuing theories of alchemy that were applied to the practice of acupuncture. The continued use of gold and silver needles today reflects this alchemical theory rather than the practical use of these metals. It is curious that modern computer technology utilizes gold as a bridge in very fine computer chips that employ organic molecules and ions. Other precious metals do not produce the results that gold particles do in this modern technology. This fact signifies that there was a scientific basis to the alchemical theories that prompted the use of gold in acupuncture needles.

Needle stimulation fell out of favor with the emperors for some time through the 17th to 19th centuries, who preferred the use of moxibustion to stimulate the acupuncture points. Many official medical texts during this time omit the use of needles, although it was believed that use of acupuncture needling was still popular among the people and physicians outside of the court. It is often written that acupuncture became a country doctor technique during this time, a notion that persisted even into the 20th century, when medical doctors in the large cities succeeded in briefly outlawing the practice in 1928, declaring it "unscientific". Official court medicine during this period utilized primarily herbal formulas and pharmacology, which was the period when what we know as modern chemistry blossomed. Even herbal medicine changed during this time period of protochemistry and iatrochemisty, with imperial abandoning of the large Materia Medica, and favoring of a smaller number of 'modern' herbal extracts with broad applications. The use again of mixed mineral and vegetable components in the herbal decoctions and extracts were common at this time, signifying a resurgence of interest in the older alchemical laboratory techniques and theories. Of course, physiotherapies, classified as TuiNa and AnMo, were also utilized extensively throughout this period by the emperors, and a holistic approach in medicine continued to thrive, with inclusion of dietary medicine and lifestyle regimens still popular as preventive of disease and injury, as opposed to the more allopathic approach in modern Europe, where surgery, purging and bleeding, and the creation of asylums for those afflicted with neurological and psychological disease became the norm. Obviously, acupuncture stimulation did not cease during this time period in China, though, as some historians have purported, but was still very popular in the 20th century as an effective and proven therapeutic treatment.

Medical artifacts supporting TCM in early civilization

Many examples of what are called divination shells and oracle bones, dating from about 3500 BCE, have been found in recent times. These were used in rituals by heating them over a fire and observing the patterns of cracks, or by applying hot brands and observing the patterns created. It was written that the sovereign Fu Xi observed the patterns in turtle shell plastrons and formulated the mathematical order found in the Yi Jing, or Book of Changes, that is still popularly read and utilized today. The Yi Jing was thought to be an integral part of the early practice of TCM physicians, helping the doctor to make a difficult diagnosis, and even today there are texts of the Medical Yi JIng available. On many of these shells and bones, some of which were used in medical practices, are examples of some of the earliest examples of the written Chinese language characters. Huang Di and his court are said to have been responsible for the development of the written language, medical sciences, silk production and military strategies. The incorporation of esoteric ritual and divination, or psychic understanding, in the history of Chinese medicine persisted through the ages, and puzzled the visiting European researchers, although the use of the Book of Changes is rooted in mathematical patterns and the study of chance in natural occurrence. The study of probability, causality and chance, and the use of mathematics in prediction continues in modern physics, and this science of change in ancient China cannot be dismissed as pure superstitious belief. In Europe, divination, or soothsaying, was used extensively through the ages as well, though, representing a practice of determining hidden significance or cause, and utilizing techniques to add information to the solution of practical problems. The Greek Oracles, the shamans in many world cultures, prophets, and even priests were examples of specialists in divination to help solve problems. While the subject of divination is ridiculed today, citing popular games of Tarot and the Ouija board, medical intuition and even the ritual of healing prayer is still seen, and studied, in the modern medical setting. China still maintains medical schools devoted to Qi Gong practice, despite the controversies surrounding the supposed Falun Gong Qi Gong group, which is largely a political organization created to protest the Communist Party in China, not a real Qi Gong tradition. In the United States we still have schools of medical Qi Gong practice as well.

Formalized herbal medicine purportedly dates back to the use of the ginseng root in 3000 BC, and perhaps has its origins in Chinese alchemical theory and practice, although the finding of fermented alcohol with extracts of various herbal roots, berries and leaves in Jiahu, China, dated to 7000 BC, extend this herbal timeline back considerably. Huang Di was thought to be a skilled practitioner of this type of herbal and mineral medicine that we now call alchemy, and many books of alchemical elixirs bear his name. Chinese histories have long considered the use of herbal extracts with vegetable material in life prolongation or healthy aging to have come before the experiments with the mineral elixirs in the alchemical research. Chinese alchemy probably has its roots in early herbal medicine, both with cooking and fermentation techniques, with many examples now found in very early human history of medicinal decoctions, alcohol extracts, etc.

Another sovereign, Shen Nong, was said to have tried a great number of herbs and was responsible for the science of categorizing herbs in relation to type, chemical taste, warming or cooling, and system of the body that they primarily affect, or organized protochemical science. The text, Shen Nong Ben Cao Jing, records the early information attributed to Shen Nong in relation to herbal science. This text divided herbal medicine into vegetable, animal and mineral products, as well as three classes of products with toxicity, mild toxicity, or no toxicity. Many of the entries describe the use of the herb in healthy aging (yang sheng), or the increase in mental and psychic abilities, consistent with the theories of the Daoists and alchemists. While the fantastic stories of Shen Nong are most often repeated, there is no doubt that this person or persons in actual Chinese history gave us much practical science, and these theories formed the earliest extent formalized protochemistry and chemical categorization theories.

While alchemy has been maligned and slandered in the West for hundreds of years, it is now known that many famous physicians and scientists around the world seriously studied this science, including Sir Isaac Newton, who consumed many of the alchemical medicinal elixirs himself. Exhumation of Newton's body revealed a high content of mercury. Alchemical texts in China were divided into external chemistry (Wai Dan), internal chemistry (Nei Dan), and the experiments with transmutations of minerals to find the building blocks of the material world. This last subset of alchemy, with transmutations of minerals into gold and silver, or aurifaction, is generally what we think of when the word alchemy is brought up today. The TCM physicians also studied the alchemy of plant and mineral extracts as they turned into useful chemistry in the body (macrobiotics). The Chinese character for Qi is made up of the symbols for gaseous ether rising from medicinal plants or minerals cooking in a container, such as the alchemical furnace, or brazier. Alchemical science developed into a broad and complex interdisciplinary holistic medicine, much of it later divorced from any relationship to the early, and most commonly known, experiments with high heat crucibles, mercury, arsenic etc. A history of this alchemical science is found in another document on this website, under For Practitioners - Research. Even in the twentieth century, such famed scientists as Louis Kervran and Madam Curie studied and wrote of biological transmutations, or macrobiotics.

Decoction of herbal medicines, which refers to the cooking of the herbs to properly extract the chemicals, was thought to have originated with Yi Yin, who began as the cook for the head of the Tang culture in the Shang Dynasty around 1500 BCE. Yi Yin became skilled with medicinal cooking and was later rewarded by being made a key advisor to Tang and later appointed the Prime Minister of the Shang Dynasty. While we take these early methods of chemical extraction for granted today, development of the various and best methods for extracting herbal medicines was a very useful and important development in human history. Rewarding Yi Yin with the post of prime minister reflects the importance of herbal medical development in the Chinese culture, and in many cultures throughout the world. Such medical advances improve the health of armies and the official workforce, and save the government much expense in times of epidemic illness.

Medical artifacts that include early inscription related to medical practice, Daoism and ritual are an important part of the history of TCM. Fossilized bone and shell are common 'herbs' used in Chinese medicine, in the animal category. Thousands of bone artifacts have been found that were to be ground into bone powder for herbalists. Many of these fossilized bone and shell artifacts were inscribed with early Chinese characters that expressed ideas about medicine and healing rituals and dated back to at least 1200 BC, and are commonly called oracle transcriptions. These fossilized bone products are still used in TCM herbal products today, called Long gu in Chinese, which loosely translates as 'dragon bone'.

Bronze ceremonial inscriptions dating from 1100 BC also depict the practice of TCM. As stated, most of the actual personal writings of TCM physicians that predated 500 BC were unfortunately written on hemp, bamboo or some other perishable medium, which deteriorated over time or was burned in the purges of the Qin Dynasty, and so there is little to hold in our hands from the early history because of the book purges and materials used. Also, there were many languages used in China, and a standard written language did not occur until 221 BC. Because of these facts, some modern historians are insisting that there is no evidence that TCM existed prior to the existing texts of 300-100 BC. Scholars who study TCM itself, and the historical artifacts, generally think that this is ridiculous, considering the complex development of the science by 300 BC, and the inference of the medical development from the artifacts and inscriptions of earlier times. This negating of the early history of TCM may be attributed to cultural bias, and a reading of the six volume set of Chinese history by Joseph Needham is recommended reading. For a look at the alternate historical theory you may go to the end of this article, under additional information and click on the Imre Galambos conclusion.

The importance of alchemical sciences in the history of TCM

The development of what we now call alchemy, which was called Shen Dan in China, and later divided into Wai Dan and Nei Dan, first occurred in China, according to the great historian Joseph Needham, who devoted the entire fifth volume of his Science and Civilization of China to the subject of alchemy and protochemistry. The timeline of alchemical development shows that this science became extremely widespread and important in early human history from Asia to the Arab culture and Europe. Most governments, even in Europe, employed alchemists, and the science went through a number of interesting transformations until the development of modern chemistry, which owes its name, as well as its concepts, to the study of alchemy. The word alchemy came from the Arab Al-Kemia, which referred both to an area of mineral rich land near Nubia in Northern Africa, as well as to the mineral elixirs that became famous in this study. From the Arab cultures, the science proceeded to Europe, where it was eventually called Black Magic by the Church and outlawed. Despite this religious condemnation, many important European scientists continued to spend much of their time studying the concepts of alchemy and preparing both the medicinal elixirs, which were purported to not only heal serious diseases, but also to extend longetivity and increase mental and psychic ability, as well as to experiment widely with the transmutation of minerals into fake gold and silver. As mentioned, Sir Isaac Newton and Robert Boyle are now well known as prolific experimenters with alchemical processes. In fact, Sir Isaac Newton was given a job by the British government which involved his well known knowledge of aurifaction and fake gold and silver circulating as currency.

Alchemy, or Shen Dan, literally translated as spirit or vital mercury, was important to the development of Traditional Chinese Medicine not only because it produced medicinal elixirs, but because the theories and natural science framed the basic concepts of Daoism and the traditional medicine. Eventually, alchemy was divided into schools of thought, and Nei Dan, or corporeal alchemy, became concerned with what happened physiologically when medicines of mineral, plant or animal materials were ingested and caused the body to heal. Many theories pertinent to modern physiology and pathophysiology were developed from this study. Wai Dan, or the non-corporeal alchemy, became the subject of healthy activities and rituals that could prevent disease and repair the health. This type of alchemy eventually became most popular, and is similar to our current interest in yoga, tai chi, qi gong, nutritional healing etc. The practice of Wai Dan is thus becoming popular again as a public health practice.

The original alchemy, or what we think of as the original alchemy, concerned with transmutations of minerals into what was called true (zhen) gold and true silver, but were different than the refined gold and silver ores themselves, turned into protochemistry and industrial applications in China. We cannot ignore the importance of these alchemical laboratories supported by governments in China when examining the historical development of modern industrial science. These elaborate mineral transmutations in alchemy became a subject of secretive work, though, and disappeared from Chinese literature, perhaps because of the assassinations of prominent rulers with poisonous elixirs, or perhaps because it was eventually illegal to create "fake" gold. The type of experiments in this third type, or original alchemy, were almost exactly replicated in the elaborate notes that have surfaced in the alchemical works of Sir Isaac Newtom, which were also kept secret for hundreds of years in modern history. In China, such laboratory study led to many scientific advances, such as the creation of gunpowder, and advances in chemical technology. To malign historical alchemy as we do is nonsense.

The transformation of the science of alchemy into an holistic practice of preventative medicine in China, and the taking up of the subject of the original metal ore elixirs much later in Europe was perhaps integral to the development of allopathic medicine in Europe and the persistence of a more holistic approach in China. Alchemy is a subject that is very involved and elaborate in scope historically, and many of the early famous TCM physicians were well known for their alchemical knowledge as well as their knowledge of Daoism. Further information on alchemy may be found on this informational website under Practitioners - Research. Many of the alchemical minerals used in medicinal elixirs continued to be used in standard medicine until the early part of the twentieth century, and gold salts are still used today by medical doctors to treat rheumatoid arthritis and other rheumatic autoimmune disorders. Modern research into medicines rooted in alchemical science continue to produce useful medical approaches in pharmacology.

Western Historians and the paucity of serious Chinese historical study in relation to the history of medicine

There are few Western historians that have studied and written about ancient Chinese medical history. Paul Unschuld and Joseph Needham are still the only reliable Western historians of note with books on this subject. Professor Needham died in 1995 at the age of 94, but had been extremely zealous in research and writing and served as the director emeritus of the Needham Research Institute of Cambridge until his death. Needham was faced with his Eurocentric historical perspective early in his career and when he went to China to study, he discovered that indeed China had advanced many discoveries of science and medicine hundreds and thousands of years before the Europeans, including the printing press, gunpowder (an alchemical discovery), the compass, vaccination or inoculation, anesthesia, opiate pain relievers, and many engineering theories and inventions. Dr. Needham collaborated with a renowned Chinese historian for most of his career, Lu Gui-Zhen, and strove to present a history that was free of many of the rigid pretensions and apriori assumptions of modern historical interpretation. He thoroughly documents how cultural bias prevents us from learning the truth about the contibutions to science and civilization that came from China. The author Nathan Sivin carries on his work.

Most of the famous medical doctors in Chinese history also practiced TCM and studied Daoism and alchemy. Daoism, or Taoism, as it is often spelled in English, is a complex historical subject, and underwent dramatic changes throughout Chinese history. Dr. Needham found that the roots of Daoist medicine, ritual, alchemy, meditational practices and self-cultivation preceded an actual popular, or systematized, Daoist social movement or religion, and that Daoism continues throughout history operative on a number of planes. Daoism is often seen as a social and political movement diametrically opposed to the strict order of Confucianism, or as a popular religious movement linked to early Buddhist beliefs and practice. These historical perspectives obscure the important role that the Daoist philosophy and natural science played in the development of Traditional Chinese Medicine.

Historical interpretations and controversies will always be a part of the history of Traditional Chinese Medicine. Paul Unschuld is a historian that interprets and postulates theories based on his historical research, while Joseph Needham was a historian that tried to present available fact and stick to less interpretative presentation. One of the curious controversies presented by Dr. Unschuld is that there is a separation between Daoists and the TCM physicians. This theory relies on historical documents that show that Daoist philosophers believed that disease and suffering were natural conditions of the human state, while TCM physicians believed that disease and suffering could be overcome by returning health to its natural state. While these concepts could be interpreted as diametrically opposed, this is not necessarily the case.

In Daoist cosmology, the biological state could be prone to disease and suffering due to the natural way of things, or the Dao, yet returning to the most balanced natural state, or homeostasis, could eliminate these naturally occurring diseases and physical sufferings. Dr. Unschuld also speculates from historical writings that early use of acupuncture was concerned 100% with prevention, rather than treatment of disease. This too, seems to be an historical theory that defies logic and is based upon too strict of an interpretation of available historical statements. To imagine that physicians utilized acupuncture, which is proven to treat and cure, and did not realize that their treatment indeed was effective as a treatment, rather than a pure preventative measure, seems to be a theoretical stretch of logic. These differences in historical interpretation between Drs. Needham and Unschuld perhaps reflect the narrow perspective of academia in Dr. Unschuld, and the broader real world perspective of Dr. Needham. Nevertheless, these controversies make the discussion of ancient TCM history interesting, especially concerning the use of TCM in preventative medicine as well as its dramatic curative potential. As preventative medicine continues to gain popularity, TCM may emerge as a viable modern medical option in this arena.

Paul Unschuld has published a book entitled Medicine in China Historical Artifacts and Images, distributed by Redwing Book Co., ISBN: 9783791321493. Many of the images of acupuncture artifacts were from a museum collection assembled in Germany. These artifacts confirm the early prehistoric evidence of acupuncture implements. While Dr. Unschuld presents a historical perspective that could be termed Eurocentric, and seems diametrically opposed to many of the ideas of Joseph Needham, his writings do support much important historical fact in the history of TCM.

Modern History of TCM and Acupuncture

TCM continued to evolve over time and reached its height of study in the Ming Dynasty after 1600. This was an era for TCM in which many great medical texts in Asia contained extensive information both on acupuncture practice and traditional holistic medicine itself. There were many developments in acupuncture needles and techniques, as well as the development of protochemistry and application of the concepts of alchemical medicine to modern herbal extracts. The historian Joseph Needham documents a number of important and esoteric scientific developments. He demonstrates the complex blend of historical knowledge with modern scientific theory, and the skepticism with which many scientific theories and practices were met by Europeans, who often characterized them as Chinese secrets and curiosities that are rejected by the superior European minds. Needham quotes a letter of a Jesuit scientist in China, F. X. d'Entrecolles, in the 1800s, as he records various Chinese discoveries, including the development of thermo-remanent magnetisation of steel needles heated with a complex mixture of chemicals, then cooled in the earth's magnetic field. d'Entrecolles noted that he thought that all of the chemicals were unnecessary in the preparation of the needles, and that he was particularly puzzled because the orientation of the needles during cooling was extremely important in the process. These more esoteric concepts of metal transformation and magnetic properties are lost to the modern practice of acupuncture, but perhaps continued study of the history will reveal concepts rooted in ancient naturalist thought and theory that will enlighten us in the future. Today, thermoremanent magnetization, the magnetization that igneous rock acquires from a natural magnetic field where it originates when the temperature from the magma in which it forms falls below the Curie point during cooling and solidification, is still being studied. Natural mineral rock carries a natural remanent magnetization (NMR) that is the vector sum of all the different possible components of magnetization acquired over its history, and mineral substances with low relaxation may be susceptible to remagnetization by time, temperature or chemical changes to produce secondary components of magnetization. Today, we see a renewed interest in the use of magnetic fields in medical practice, yet our modern science lacks the fundamental understanding of how these fields work.

In the late 1800s there was an effort to combine TCM with modern European medical practice and theory, but by the 1920s, the English, heavily influencing the Guomintang Chinese government, succeeded in outlawing the practice of TCM to promote the building of European style hospitals and pharmacies in China. This mirrored efforts by the American Medical Association to oppose herbal medicine and other medical practices that were thought to be undermining the profitability of pharmaceutical medicine and surgery. In China, by popular appeal, this ban on TCM practice was reversed, with the agreement to consolidate TCM study into a centralized official study. This was the beginning of TCM as it is practiced today. The great physician Qin Bo Wei was largely responsible for the Chinese effort to petition the government and save the practice of TCM. The consolidation of the various schools of thought of TCM into an official government practice had it pros and cons. Uniformity of practice and theory eliminated many wonderful practices in TCM, but did allow for a uniform government sanctioned body of scientific study, which perhaps is the saving grace for TCM in the modern era of evidence-based medicine.

In the 1940s, Chairman Mao decided to train many physicians in TCM to combat the growing health problems in postwar China, which proved very successful, and this prompted the inclusion of TCM study in many standard medical colleges in the 1950s. This program is referred to as the 'barefoot doctors' program in history today, reflecting one of the historical references that inspired the movement. In fact, by the mid-1950s, Chairman Mao Zedong wrote extensively of the importance of supporting practitioners of Traditional Chinese Medicine (Zhong Yi Xue), and highly criticized the central committee for regulations prohibiting TCM physicians from joining hospital staffs. His directive to carry out the Central Committee's guidelines of fully integrating the specialties of TCM with modern medicine led to a large health care reform in China. Chairman Mao wrote: "This problem must be resolved; this mistake (not integrating TCM) must be corrected. It requires first of all that the health care administration departments at all levels should change their way of thinking. Henceforth, the most important thing is to first ask practitioners of Western medicine to study (Traditional) Chinese Medicine, and not for practitioners of (Traditional) Chinese Medicine to study Western medicine." Such thinking led to the demand that hundreds of modern doctors in China be required to spend time studying medicine in the TCM schools, and later to the dictate that a percentage of medical schools and hospitals in China be inclusive of the TCM specialty. "It is a glorious (endeavor) for practitioners of Western medicine to study (Traditional) Chinese Medicine, because after studying and promoting it they will be able to remove the boundary between (Traditional) Chinese Medicine and Western medicine and form a unified Chinese medical science as a contribution to the world." (The Writings of Mao Zedong, by Michael Y. M. Kau and John K. Leung, East Gate Books, N.Y.). While most Western historians write that Mao Zedong instituted revolutionary cultural reforms purely to rid China of its adherence to past ideals and practices, this writing shows that Mao was also very interested in preserving important Chinese cultural history. His work led to the translation of many TCM historical texts into modern Chinese and compilation of a set of official systematic texts on TCM science and practice. He wrote: "(Traditional) Chinese Medicine should be well protected and developed. Our country's Chinese medicine has a history of several thousand years, and it is an extremely important asset of our homeland. If we simply let it decline it would be a crime on our part." A number of health ministers that opposed TCM were removed from office, and a broad systematic program to develop the TCM Materia Medica and herbal research was instituted, which today provides the world with many invaluable medicines. Even in China many in the medical profession tried to erase this rich history of traditional medicine and exclude the specialty from modern institutions. The difference between China and the rest of the world appeared to be the efforts of Chairman Mao.

In the 1960s, the Cultural Revolution again waged a campaign to eliminate TCM to accelerate modernization in China, but the science was too popular to eliminate, and was still strongly supported by Chairman Mao. Nevertheless, many doctors trained in TCM emigrated at this time to the United States and other countries, and medical schools and official licensing of the practice sprang up in the 1970s in the United States, prompted by the famous experience of James Reston, a New York Times reporter accompanying President Richard Nixon to China in 1971. Mr. Reston was accompanying Henry Kissinger on a critical part of the historic U.S. trip to China, when he was stricken with appendicitis and an appendectomy was performed, delaying his work as he was experiencing much pain. Reportedly, Zhou En-Lai himself sent a famous doctor to perform acupuncture to speed recovery, and Mr. Reston reported that with just one treatment and 3 needles applied to points on the knee and elbow areas, that the pain and swelling resolved in a couple of hours and never returned, allowing Mr. Reston to report on this historic state visit. This report of the amazing effects of acupuncture prompted the establishment of the first official medical licensing of the acupuncture profession in California, stating that the medical specialty must address both symptoms of any injury or disease, as well as the underlying and related causes, or in other words, an holistic approach in medicine. Most of these early TCM colleges were in California, and California today still retains its status as the benchmark for excellence in TCM, with the California acupuncture license considered the most rigorous in the country and recognized by most other states. Once again, adversity and a move to eliminate TCM from our modern culture proved to be a significant saving grace in the long run in the development of the science.

Today, the science and practice of TCM continues to evolve and continues to be assaulted by competing professions. It is the most studied medical science in the world, and the proof of its effectiveness is overwhelming, even though the funding for studies is still too small. Clinical trials for acupuncture, tuina and even herbal medicine are difficult to devise in the double blinded placebo format. While pharmaceutical pills are easy to create a placebo for, manual therapies such as needling cannot utilize a placebo effectively. For this reason, many of the studies are criticized. Much of this criticism comes from the pharmaceutical industry, which is unable to patent herbal products, and hence stands to lose many billions of dollars when herbal prescription becomes popular. Its popularity is inevitable though, as we find more and more effective chemicals in the herbs. The World Health Organization in 2004 declared that it must use a Chinese herb as the first choice to treat malaria, the world's number one killer. This declaration cost the pharmaceutical industry billions of dollars that they expected to make off off new antimalarial drugs that did not have the effectiveness of the herb artemesia qinghao. While millions of lives are saved, the industry still fights the use of this herb, all because of the profit factor.

In 2006, the European Union finally mandated the coverage of acupuncture and complementary medicine by governmental health care and insurance companies. Europe petitioned the United States to adopt equal consideration to the profession in accordance with trade laws, but the United States continues to delay these inevitable laws. The Federal Acupuncture Coverage Act, called HR1479 in 2007, and sponsored by Congressman Maurice Hinchey of New York, has languished in one form or another in committee since the NIH endorsed acupuncture in 1997, and hence the federal basis for mandated coverage is still on hold, unrecognized by Medicare and Erisa (Employee Retirement Income Security Act for all federal employees). This is because there is always a few votes shy when the call for bringing the proposed law to the floor for a vote comes up. Of course, lobbying by the powerful groups of big pharmacy, the AMA, and the insurance industry is responsible for this delay. So too, in California, proposed bills mandating coverage of acupuncture do not come up for a vote. Public awareness and written support to legislators would probably change this scenario, but an organized effort to educate and promote has not happened. In the meantime, many countries around the world have mandated Complementary Medicine and shown that the savings in overall health expenditure are tremendous when this relatively inexpensive preventative care is utilized.

Hopefully, in the debate over health care reform in the United States, the acupuncture profession will not be overlooked as a promising and effective means of lowering health care costs and promoting effective historical ideas of preventative medicine. Public support of the Federal Acupuncture Coverage Act HR1479 of Congressman Maurice Hinchey of New York is important to health care reform. To truly lower the overall health care costs in the United States we all need to support low cost and effective health care found in Complementary and Integrative Medicine, to do all we can to prevent serious and costly health problems, and to adopt a more holistic view of health that would allow us to maintain our health more effectively. The Kaiser Foundation submits that average health care costs for a family of four could exceed $25,000 in the near future if something is not done. This is not affordable for most families. Depending completely upon our federal government to lower our healthcare costs is not a practical solution. Here too, a holistic approach may be needed, where the individual does all that they can to hold down health care expenditures, to complement government reform, and a public demand that insurance companies and heath care businesses, especially the pharmaceutical industry, does not let greed destroy our economy.