Acupuncture is not new to England, the first known British acupuncturist being John Churchill who, in 1821, published a series of results on the treatment of tympany and rheumatism with acupuncture. John Elliotson, a physician at St Thomas' Hospital, also use acupuncture widely in the early part of the nineteenth century. In 1823 acupuncture was mentioned in the first edition of the Lancet and in 1824 Dr. Elliotson began to use this method of treatment. In 1827 he published a series of results on the treatment of forty-two cases of rheumatism by acupuncture, and came to the conclusion that this was an acceptable and effective method of treatment for these complaints.

Ear Acupuncture
Those who traveled to China brought back information about body acupuncture. Ear acupuncture has been developed largely outside China. It is quite clear that there are some ancient Chinese manuscripts that mention the use of the external ear for acupuncture, but classical Chinese acupuncture applies to the body rather than the ear. The detailed ear map that is now being used by most acupuncturists was developed by Dr. Paul Nogier in France in the early 1950's.

Ear acupuncture was known to the ancient Egyptians. Ear cauteries have been found in the pyramids; these were used for burning or scarring specific ear points for conditions like sciatica. Hippocrates also mentions that the external ear could be used to treat conditions such as impotence.

In 1637 a Portuguese doctor, Zactus Lusitanus, described the use of auricular cautery for sciatica, and in 1717 Valsalva demonstrated the use of ear acupuncture for toothache. These early European and Middle Eastern experiments with ear acupuncture are a completely separate discovery; they have nothing to do with the growth and development of acupuncture in China. Sciatica seems to have been a disease that was particularly amenable to this crude form of acupuncture, and studies in the mid-nineteenth century indicate that 56 per cent of people who were treated with ear cautery for sciatica, obtained relief from their symptoms.

It was this crude form of acupuncture that interested Dr. Nogier in the early 1950's. Some of his patients had received ear cautery and obtained relief from pain, and therefore Dr. Nogier began to develop and investigate this form of treatment. He soon produced an ear map and since the early 1950's he has refined and developed this technique. One of his earliest findings was that if there was pain in the body then the equivalent part of the ear also became painful.

If the hand is painful then the part of the ear representing the hand also becomes painful when slight pressure is applied to the relevant part of the ear. If the painful ear point is punctured with a needle then the hand pain will be relieved. The picture of a pirate with a gold ear ring through his ear lobe is a well remembered childhood image; according to folklore the gold ring is supposed to increase the visual ability of the pirate, so that he can see ships to plunder before he is seen by them! Strangely enough, the ear ring usually seems to be placed in the eye point on the ear lobe.

Painful Points
Within the context of Western medicine, the development of acupuncture points on the body demonstrates an interesting story of re-discovery. Over the last fifty years many Western physicians have discovered independently that pressing, stimulating or injecting various superficial body points can help to relieve pain. This is particularly true of muscular or rheumatic-like pains. These points are not necessarily at the site of pain, but often over distant areas. For instance, neck pain is frequently referred to the shoulder or arm and can present to the doctor as shoulder or arm pain. On close examination of the patient it is quite easy to define the origin of the pain, and to show that the neck is the cause of the problem. Injection, or stimulation of the painful points around the shoulder or arm, will often relieve the pain and free the movement of the neck.

These points have a variety of names, such as trigger points (for pain), or motor points. In 1977 Dr. Melzack, who has been awarded the Nobel prize for his work in the field of pain, correlated these trigger points with acupuncture points, and found that most of the trigger points were already well known as acupuncture points. There are a number of explanations for the existence of trigger points but, as yet, there is no clear answer to this phenomenon. It is interesting to note that the Chinese realized this fact at least some three thousand years ago, and the Ling Shu summarises this approach when it says 'In pain, puncture the tender point'.

The Future
Acupuncture is now quite widely used in Europe and North America, both as a method of therapy and, in a few centers, as a method of anesthesia. Operations with acupuncture as the main anesthetic have been carried out in France and Austria, and the results have been comparable with those of the Chinese. Since its intimate contact with the Chinese in the 1950's, the USSR has also been using and researching into acupuncture, although the relationship between Russia and China could not be described as good. In 1972 a Russian researcher published work suggesting that acupuncture points were points of low electrical resistance on the body. He also found a network of low resistance points in both animals and plants. The use of acupuncture in the USSR steadily increased during the 1970's and in 1972 acupuncture clinics were planned for all the major medical centers in the Soviet Union. The Russians claim they are using acupuncture for a wide variety of conditions such as asthma, stomach ulcers, raised blood pressure and angina, as well as for pain. In the West, acupuncture has been used mainly for pain relief. This is primarily because acupuncture for pain is easy to learn, and does not require a knowledge of traditional Chinese concepts in order to obtain results. The concepts of traditional Chinese medicine can seem alien and unacceptable to Western doctors and they are therefore rejected in favor of a simpler and probably less efficient method of treatment, in spite of the value of many of the traditional concepts. Some doctors practicing acupuncture in the West are simply puncturing tender points as this seems a rational and logical approach.

Acupuncture has become very popular in North America since President Nixon reopened relationships with the Chinese. There are many research clinics evaluating the effectiveness of acupuncture, and also investigating the basic physiological mechanisms involved. The research output from North America is prolific and some excellent work has been done much of which re-emphasizes that acupuncture is an effective form of therapy for many conditions, especially pain, although it is not a guaranteed cure. Over the last twenty years the West has developed a great deal of technological hardware which is now being applied in the field of acupuncture. The chapter on modern acupuncture techniques describes briefly the use of a variety of electrical machines and sources of stimulation, such as lasers and electroacupuncture. Many of these techniques are still in their infancy and some will be rejected whilst others may prove to be important.

China is a poor nation without enough resources and trained manpower to research and develop acupuncture adequately. Until fairly recently few useful statistics were available from the acupuncture clinics in China, and most of the research into the basic mechanism of acupuncture had come from Western research institutes. Within this context it is probable that many of the major advances in acupuncture will come from the West rather than from the East.