The Three Types of Acupuncture
In my recent study of George Soulié de Morant’s impressive tome, Chinese Acupuncture, I came across the following excellent passage in which the author summarizes three distinct approaches to acupuncture:
There are many kinds of acupuncture. One is simplistic and primitive. It consists of puncturing the place of pain without considering any other knowledge. Except for conditions of recent, acute pain, such treatment gives only partial, short-term relief.
Another method, somewhat better, uses points in memorized formulae. Problems are treated with little attention given to the patient or the action of the needles; i.e., in order to tonify or disperse such and such an organ, such and such a point is used; for this particular symptom, that particular point is used. This method allows moderate regulation of the organs, but does not treat the underlying cause of the problem, nor control the vital energy.
The truest form of acupuncture, which we describe here, enables the practitioner to evaluate imbalances of the vital energy, the basis of all functional illness. This is achieved above all through the study of the pulses. True acupuncture is founded on the relationship between the organs, based on the circulation of energy, a system which often differs from the Western anatomical physiological model. The method demands that we locate the exact center of each point, where its action is at a maximum. Although there are failures, these are rare. More difficulties with acupuncture arise in Europe, where the abuses of Western medicine greatly modify natural reactions.
—George Soulié de Morant, Chinese Acupuncture, p. 3.
Soulié de Morant’s descriptions are a useful distinction given the nature of acupuncture as a diverse clinical modality. In the West, we ordinarily think of “acupuncture” in a one-dimensional sense as a form of needling therapy that is uniform in nature. However, such uniformity could not be farther from the truth. Acupuncture refers to a broad range of approaches. In many cases, the only commonality between such approaches are the fact that needles are used, while the theory and practice are entirely different. There are classical acupuncture styles, modern styles, and syncretic styles. Classical acupuncture has its roots largely in the Nan Jing (and, thus, in five-phase theory) but other theoretical paradigms also exist (notably yin-yang, six channel theory, and eight principles). Classical styles tend to focus on a single paradigm while modern and syncretic styles may oscillate between paradigms. The realities of lineage, oral tradition, and politics have also greatly influenced the present-day complexity of acupuncture. An additional source of this complexity is cultural in nature—acupuncture originated at least two-thousand years ago in China but has developed significantly in the last several centuries in Japan, Korea, Taiwan, France, and England.
Soulié de Morant was fluent in Chinese and gained significant exposure to classical acupuncture in China in the late-19th and early 20th century. He is regarded as the father of acupuncture in the West. His text, Chinese Acupuncture (translated from the original French) represents the transmission of acupuncture from East to West. Soulié de Morant passed in 1955, around the same time that J.R. Worsley was studying acupuncture in East Asia. Worsley is a key figure who followed in the footsteps of Soulié de Morant, championing classical acupuncture in a European context. All of this is to say that acupuncture is a relatively recent phenomenon in the West, even though it has rooted itself rapidly in Western culture. For this reason, patients, students, and practitioners alike struggle to make sense of the now cross-cultural and cross-pollinated system of medicine that acupuncture has become.
This is why I found Soulié de Morant’s three distinctions to be helpful. While he is describing three approaches to acupuncture, I find these delineations to be universally applicable as fundamental clinical approaches, even across medical systems. In what follows, I have taken Soulié de Morant’s distinctions and classified them in three categories: Local—First-Aid, Allopathic-Branches, and Homeopathic-Root. Beneath each category I have given Soulié de Morant’s description in italic text. This is followed by my own commentary in bullet points.
Local—First-Aid
primitive, simplistic, puncturing the place of painAll practitioners of any healing modality should be versed in first-aid approaches. There are few frustrations greater than being trained in a sophisticated system of holistic medicine but unable to address an acute situation quickly and in the moment. Soulié de Morant characterizes this approach to as being “primitive, simplistic” and based on “puncturing the place of pain without considering any other knowledge”. He is clear on the value of this approach in acute conditions, but is critical of it as a primary clinical approach, as it only provides “partial, short-term relief”. At the same time, as holistic practitioners, it is a grave error to fully eschew this methodology and to only pursue root-treatment in the face of an acute condition where temporarily relief is not only compassionate but also necessary in order to pursue the root with the time and patience required for long-term healing.
J.R. Worsley was perhaps the strongest proponent of root-treatment in recent time, though a conception of root-treatment is also found in Japanese styles. However, in his text, Classical Five-Element Acupuncture: Points and Meridians, he does provide a list of “First-Aid Points” and gives first-aid indications underneath point listings where applicable. This is only pragmatic.
While Soulié de Morant is criticizing the “first-aid” orientation as a primary clinical approach, I must note that first-aid treatments are deceptively simple in concept but required a practiced hand in reality. The ability to properly diagnose the acute condition and treat it effectively within the appropriate span of time requires a firm grasp of theory and practice, and its execution must flow responsively without too much thought. In my experience, thinking too much about acute first-aid situations will quickly lead one down the wrong path.
The “first-aid” approach can be summarized in the modern acupuncture adage, “Find where it hurts and put a needle in it”. A key example of this approach is the concept of ashi points in Chinese and Japanese systems. These are tender points that are notably sensitive to the patient upon palpation. An analog of this idea can be found in the concept of “trigger points” in modern bodywork systems. Acupuncture can be practiced entirely on the basis of identifying these points and needling them respectively. However, as noted, such an approach only yields the most temporary of results.
There is a great satisfaction in being able to provide first-aid treatment appropriately in the moment with good results. It allows one to feel that the sometimes lofty aims of medical practice have not lost all translation in the realm of the immanent. To this end, I keep a copy of Constantine Hering’s The Domestic Homeopathic Physician on my bookshelf as an invaluable resource.
Allopathic—Branches
somewhat better, allows moderate regulation of the organs, does not treat underlying cause or vital energySoulié de Morant describes this second approach as “somewhat better”. It is characterized by the use of point prescriptions and is the standardized form of acupuncture taught today. This prescriptive approach employs a pattern-diagnosis based on the symptomatic presentation of the patient and designs the treatment around points that are indicated in alleviating these symptoms (indications taken from and couched in the language of herbal therapeutics). This is a somewhat deeper approach than pure first-aid in that it identifies syndromic patterns of imbalance and corrects them. In the context of acupuncture, this approach is often rooted in yin-yang theory and its expansion into “eight principles”, the theoretical cornerstone of “TCM”. It is worth noting that much less emphasis is placed on exact point location in this approach, as the therapeutic basis is not seen in the points themselves but in their groupings.
This approach targets and opposes symptoms. I consider it “allopathic” in the literal sense of treating on the basis of opposites—heat is used to treat cold, cold to treat heat, yin to balance yang, yang to balance yin, etc. The allopathic approach does not address the system as a whole or the fundamental life-force of the bodily system. Rather, it controls the surface symptomatic expression for a time (granted, it does address a larger context of imbalance than mere first-aid). Soulié de Morant says “this method allows moderate regulation of the organs, but does not treat the underlying cause of the problem, nor control the vital energy”.
In my view, the allopathic approach corresponds to the “branches” aspect of the classical “root and branches” philosophy in Asian medicine. This approach has value when used in conjunction with root-treatment. In Japanese styles, a single treatment will include groupings of points for both “root” and “branch”, though this is not necessarily the case, as many examples exist of Japanese masters who made an effective clinical practice purely on the basis of root-treatment. Such purists tend to eschew branch-treatment altogether, asserting that a proper root-treatment naturally tends to the branches. However, branch advocates argue on the basis of perceived pragmatism for the role of palliation in patient care. In order to nourish a plant, we feed the soil so the roots will be strong. It is true that strong roots will make healthy branches. Yet, some will say there is no impediment in also pruning branches, removing weeds, and pulling away yellowing leaves. In some views, this only expedites the process and magnifies the virtue of the root.
The modern conceptualization of “TCM” acupuncture is a key example of an allopathic-branches approach in acupuncture treatment. Japanese acupuncture (Meridian Therapy) is a prime example where the focus is maintained on the root but branch treatment is often given in the same treatment. In Japan, some great Masters were known to only administer root-treatment. Advocates a pure root-treatment approach (such as J.R. Worsley) also often do have a “branch” aspect to their treatment plan, even while their clinical focus is rigorously maintained upon the root. (In Worsley’s system, I consider the “branches” to be the clearing of “blocks” which necessarily precede root-treatment according to his design).
Homeopathic—Root
truest form, evaluates imbalances of vital energy, locate exact center of pointThis approach is characterized by a holistic view of the physiology, in which organ function is linked via a vital energetic network (or meridians). Soulié de Morant notes that the primary diagnostic method of this approach is the pulse. The orientation is toward identifying the fundamental energetic imbalance in the meridian system. When this is corrected, the organic system will be restored to its natural integrity. This is what characterizes the homeopathic approach as a “systems-based” approach, rather than a local or syndromic approach.
The homeopathic approach treats on the basis of the law of resonance. By restoring the natural resonance of the system, health is restored. This stands in contrast to the allopathic method of opposing symptoms and treating on the basis of opposites to restore health. In this case, treatment is directed at the inner root of disease, rather than a resolution of the surface. This notion is summarized in J.R. Worsley’s rendering of the law of similars, “Like reaches like”. Such an approach places significantly less emphasis on symptomatic presentations, but seeks to understand the causative factor of symptoms as a whole. This causative factor is seen as a fundamental root, not a symptomatic pattern or syndromic gathering of symptoms.
The homeopathic approach to healing is not limited to the formal European system of “Homeopathy”, but is found cross-culturally since antiquity. In this regard, there is a clear relationship between classical acupuncture and homeopathy, as Soulié de Morant notes: “In 1903, Weihe, a German homeopath, published a list of points that he had gradually discovered to become painful following an intoxicating dosage of a remedy or poison. Since the symptoms of intoxication from a particular remedy corresponded to those cured by a homeopathic dose of that remedy, he named each point after its associated remedy. His knowledge of the points came to him from a relative in China, but his genius was in looking for an experimenting with the connections between the points and the homeopathic remedies. This proves that there is an action of the same order in both sciences”. It is also noteworthy that J.R. Worsley’s emphasis on selecting points for treatment based on their names (an approach he called the “Spirit of the Points”) bears significant resemblances to the homeopathic method of identifying remedies. Furthermore, Worsley’s conceptualization of the “causative factor” also bears some resemblance to the homeopathic idea of a “constitutional remedy”.
The root approach is characteristic of classical Nan Jing acupuncture and its five-phase theoretical basis. This system was revived in the 1920s in Japan in what became known as “Meridian Therapy”. Meridian Therapy was a significant influence on J.R. Worsley’s “five-element” system, the other significant influence being the transmission of classical acupuncture in Europe via Soulié de Morant.
I am personally biased toward the third approach which I regard as being the most holistic and depthful. However, I am also of the view that practitioners should be trained in all three approaches and be able to use them artfully in clinical practice. I see much fragmentation in the acupuncture field today. Patients are not educated on these differences and neither are many practitioners. The standardized “TCM” curriculum has accomplished its goal of monopolizing the theory and praxis of acupuncture with the empty spirit of modernity and scientific materialism. At the same time, classical Chinese medicine is experiencing a revival, and much more education on this topic is beginning to find its way into school curriculums. Rather than settling on one approach over against the other, I would recommend students to practice their hand in all three, and to also receive treatment in these different approaches. Only through practice and personal experience can one come to know the subtle differences in these approaches, what their respective value is, what the shortcomings are, and when to apply what.
It is a basic tenet of medicine that the root of disease is what must be diagnosed and treated. Yet, root-treatment is incredibly rare in the modern world, even in the so-called “holistic” systems of the East. In a time where the “progress” of modernity appears unchecked, we must all inspect the roots of our own medicine, and turn again to its classical origins. In doing so, we will find many lasting solutions for the ills of the present day. True progress is not over against, but a continuation, an evolution. Progress requires an open mind and a humble spirit toward what has preceded us. Wherever there is a fracture, integration is the truth that will bring healing.
A visual summary of the three approaches to acupuncture, their theoretical basis, level of affect, and clinical goal.