Tibetan Acupuncture
The acupuncture system of Tibetan medicine is deeply tied to two therapies: moxibustion and venesection. Namkhai Norbu posits that moxibustion originated 4,000 years ago in the ancient kingdom of Shang Shung. The Tibetan word for moxibustion is me btsa which Norbu suggests is the etymological root of the term for moxa that was adopted in other Asian countries (such as China and Japan). In India, moxibustion is referred to as agni karma (“healing with fire”). However, I have not been able to find any evidence of Ayurvedic practitioners using moxa in the form of artmesia as the Chinese and Tibetans do. It seems that the Ayurvedic approach to “moxa” was metal rod therapy. A rod is fashioned out of gold, silver, or copper (each metal having qualities resonant with the three doshas). The end of the rod is heated and applied directly to the skin of the patient. Tibetans also use this practice and may be the only ones still applying it clinically. It is the most invasive form of moxibustion, as it scars the skin, but such strong approaches were historically in favor.
Why did the Tibetans develop such a sophisticated system for performing moxibustion? Is needling acupuncture only found in China? If so, why did the Tibetans favor burning moxa over needling? The Tibetans clearly had a full conception of the energy-process within the human body and they also used needles for venesection, yet there appears to be no conception of needling acupuncture in the manner that Chinese medicine currently practices. Perhaps the closest analog is the golden needle therapy, in which a 24kt gold needle is heated and then inserted into the crown chakra. Atop the needle, a small bit of moxa is burned, which radiates heat through the needle into the point. The needle may also be heated directly with a flame and then applied to the patient, without the addition of moxa. This is considered a powerful treatment for nervous system disorders.
Some practitioners have suggested that the Tibetan emphasis on moxibustion has a climatic component. Tibet is a cold country at elevation where cold disorders are more common, hence moxa simply had more clinical relevance. This is obviously true, but it leaves me somewhat unsatisfied as an explanation. The reason being that the Four Tantras devote eleven chapters to the discussion of heat disease, but there is no such compendium devoted to cold disorders. The chapters on heat disease state that by understanding heat diseases, one also understands the nature of cold disorders. Thus, the tantras intend to cover both cold and heat disorders within the category of heat. This begs the question: why does the classical text of Tibetan Medicine focus on heat disease as a device for also understanding cold instead of the other way around, given the prevalence of cold disorders in the Tibetan plateau? Also, in the discussion of heat diseases, we find ample reference and recommendation for venesection as an external therapy to clear diseases of mkhris pa (Skt. pitta) and khrag (Blood), but there is no discussion of simply inserting a needle into specific points in the mode of Chinese acupuncture.
In addition to climatic factors, it may be that the Tibetans intentionally favored moxibustion because of its non-invasive nature and relatively broad applicability. While it is commonly intended as a treatment for cold and wind disorders, it can be used for some heat conditions (especially those which are fueled by wind) . Also, by adjusting the relative strength of heat (via proximity of the moxa stick to the point) and the length of time spent heating a point, it is possible to moxa for heat conditions in a manner that restores the balance of life-energy without increasing heat / inflammation. Anyone who has experienced a moxa treatment can attest to its quality as a soothing and nourishing treatment. In my experience, the actual energetic sensation in the point and channels is identical whether moxa or needling is performed. However, in the case of moxa, the warmth brings a certain nourishing and circulatory power, while the needle has a more neutral and cooling influence. This is echoed in Chinese Medicine where acupuncture is seen as a “dispersing” therapy.
The Tibetan medical paradigm of venesection already shows us that the Tibetans saw needling as an appropriate therapy for heat. In venesection, needles are used to drain small amounts of blood, or simply to release the vapor of excess heat without drawing blood. Tibetan medical texts describe 77 bloodletting points and feature depictions of a number of sophisticated scalpel-like tools for performing venesection. The intention of venesection can be to either drain impure blood from a channel or to simply open an aperture at the appropriate energetic locus along the veins which will release pathogenic heat in the form of vapor. With the latter approach, a needle is used to make an incision and then cupping is applied to draw the vapor out of the point until the condensation is visible inside the cup.
The minor incision that an acupuncture needle creates does seem to release some degree of vapor and has a quality of relieving pressure and constriction due to blood and heat. In classical styles, the tonification technique requires the needle to be inserted slowly, in the direction of the flow of the meridian, turned slightly clockwise, removed swiftly, and then the incision hole is pressed with the finger to prevent leakage of energy. In contrast, the sedation technique requires the needle to be inserted quickly, removed slowly, and the hole is left open to drain excess energy.
In his book, Sowa Rigpa Points, Dr. Nida suggests that the knowledge of needling acupuncture is lost knowledge to the Tibetans. He asserts that the classical Tibetan reference to needling acupuncture is known as thur me. Nida suggests that needles can be used on the moxibustion and venesection points identified in Tibetan medical texts. He notes that the needling of moxa points is sometimes more effective than burning moxa on them. Whether Dr. Nida’s ideas have any classical basis or not is difficult to answer. There are also conscious and unconscious efforts on the part of Tibetan physicians to establish likenesses with Chinese Medicine, as a form of traditional medicine that is widely accepted now in the West. Given how well-preserved Tibetan Medicine is, both in theory and praxis, I find it hard to believe that the knowledge of needling acupuncture was simply lost, especially in light of its centuries-long practice in neighboring countries.