A Treatise on Acupuncturation

by James Morss Churchill

ACUPUNCTURATION.

The method of performing the operation of acupuncturation is simple and easy, requiring neither practice to give dexterity, nor adroitness that it may be done with propriety. Anatomical knowledge of the human body is, however, necessary; as an imprudent application of it, by an operator ignorant of the structure of the part into which he introduces his needle, might be productive of bad consequences. To a surgeon, however, properly qualified, (and no other ought to perform this or any operation) no danger can arise; as the cautions are but few, and no risk is incurred, if they are attended to. It is only necessary that the operator, in introducing the needle, should avoid the course of large vessels, of nervous trunks, and of the tendons of muscles. It is not, however, proved, that the latter sustain injury from the puncture of the needle; but it is as well to avoid the possibility of mischief, by such a cautious mode of introducing the instrument, as shall be divested of risk. I cannot better familiarize my subject to the reader, than by a sketch of it in its native state; and as an excellent description of the operation, as performed by the Japonese natives, is given in the ninth volume of the “Modern part of an Universal History, from the Earliest Account of Time,” I shall extract it, as containing all that is known of its original practice.

“The place made choice of for the puncture, is commonly at a middle distance between the navel and the pit of the stomach, but often as much nearer to, or farther from either as the operator, after a due scrutiny, thinks most proper; and in this, and the judging rightly how deep the needle must be thrust below the skin, so as to reach the seat of the morbific matter, and giving it a proper vent, consists the main skill of the artist, and the success of the operation is said to depend. Each row hath its particular name, which carries with it a kind of direction, with regard to the depth of each puncture, and the distance of the holes from each other, which last, seldom exceeds half an inch in grown persons, in the perpendicular rows, though something more in those which are made across the body, thus,

. . .
. . .
. . .

The needles which perform the operation are made, as was hinted at first, either of the finest gold, or silver, and without the least dross or alloy. They must be exquisitely slender, finely polished, and carry a curious point, and with some degree of hardness, which is given by the maker by tempering, and not by any mixture, in order to facilitate their entrance, and penetrating the skin. But, though the country abounds with expert artists, able to make them in the highest perfection, yet none are allowed, but such as are licensed by the emperor.

“These needles are of two sorts with respect to their structure, as well as materials; the one, either of gold or silver indifferently, and about four inches long, very slender, and ending in a sharp point, and have at the other end a small twisted handle, which serves to turn them round with the extremity of the middle finger and thumb, in order to sink them into the flesh with greater ease and safety; the other is chiefly of silver, and much like the first in length and shape, but exceedingly small towards the point, with a short thick handle, channelled for the same end of turning them about, and to prevent their going in too deep; and for the same reason, some of them are cased in a kind of copper tube, of the bigness of a goose quill, which serves as a sort of guage, and lets the point in, just so far as the operator hath determined it. The best sort of needles are carefully kept in a case made of bull’s horn, lined with some soft downy stuff. This case is shaped somewhat like a hammer, having on the striking side a piece of lead, to give it a sufficient weight, and on the outside a compressed round piece of leather to prevent a recoil, and with this they strike the needle through the thickness of the skin; after which they keep turning the handle about with the hand, till it is sunk to the depth they design it, that is, till it is thought to have reached the seat of the morbific virus, which in grown persons is seldom less than half, or more than a whole inch: this done, he draws it out, and compresses the part, in order to force the morbific vapour or spirit out.

“The directions and nice rules for the performing of this curious operation are many, and require great skill and attention in the operator; and when duly performed, may be of excellent use, not only against the excruciating distemper, called Senki, but against many other topical ones, which are most commonly cured by the Indian Moxa, and other caustics. On the other hand, these last are often tried against the distemper above mentioned, by applying the caustic to the belly, on each side of the navel, and about two inches from it, but mostly without any success, it being very unlikely that such an application should reach the seat of the distemper; whereas, the benefit which has accrued from the acupuncture, in that one disease, hath encouraged others to apply it indifferently to other parts of the body, where the moxa is used, and by a due care and precaution not to prick any nerves, tendons, or other considerable blood vessels, have cured their patients by it, without putting them to the excruciating torture which attends that of the Moxa, or other caustics.”

From the little we have learned of the practice of this operation amongst the Asiatics, it would seem, that it was chiefly diseases of the abdominal cavity and viscera, which afforded opportunities for its performance, such as Colic, Tympany, &c. It is not in such diseases, however, that I have any experience of its use, but it is questionable, whether it might not be beneficial, particularly in the latter, and I would beg to recommend it as a matter of interesting experiment, to be tried in this malady; such an opportunity, should it fall in my own practice, I shall take advantage of.

The Indians, however, do not confine their practice of Acupuncturation (or Zin-king, as they call it) to diseases of this kind. They puncture the head in all cases of Cephalalgia, in Comatose affections, Ophthalmia, &c. They puncture the chest, back, and abdomen, not only to relieve pain of those parts, but as a cure for Dysentery, Anorexia, Hysteria, Cholera Morbus, Iliac Passion, &c. Local diseases of the muscular and fibrous structures of the body, also often afford them occasions for its performance; and it is for diseases of this class only, that I have hitherto practised it, and for which I would expressly recommend it.

Neither sufficient time has elapsed, nor a proper selection of cases been made since this operation has been known to me, to have afforded me, either a large number of experiments, or a great variety of diseases on which to try the effects of it: it is true I have employed it on some few, and I have it in contemplation to encrease the list, by giving my experiments a wider range, but at present I should not be doing justice to my subject, to form conclusions on such imperfect evidence; I shall therefore confine myself, merely to the description of the good effects, which I have witnessed in diseases of a rheumatic character, and in those injuries of the fibrous structures of the body, which are often observed to arise, (particularly in labouring persons) from violent exertion. This circumstance must be ever in view, and if it be not fully impressed on the mind, I doubt not but many who may be induced to try the effect of the operation, may be disappointed in it; viz. that acupuncturation does no good, nor does it produce even a temporary alleviation, when the disease for which it is used, is of an inflammatory character. This distinction seems to have regulated the practice of those, who have experimented on the subject, and to have decided them in their selection of cases for the operation. Mr. Berlioz, of Paris, has practised it extensively, and has recently published an account of the success which it has had in his hands.[1] He says,

“The eulogia given to acupuncturation by Kœmpfer and Ten-Rhyne, are just and merited. We have reason to feel surprized, that although an age or more has elapsed, since this curative measure has been known in Europe, no physician has made trial of its efficacy. The practice of the operation is attended with but little pain, and the success of it is so prompt, that the disease is alleviated or entirely ceases, as soon as the needle has been introduced the depth of a few lines; most frequently, however, the pain is not removed by the first introduction of the instrument, and it is not until after the use of it for a second, third, or fourth time, that the cure is completed. Simple nervous affections, especially demonstrate how much acupuncturation merits the attention of physicians, for there are but few remedies possessed of such prompt activity, and which produce such wonderful effects.

“But acupuncturation does not appertain in any respect to sanguineous evacuations,[2] it can only contribute sometimes to establish the indications for them. This operation is not indeed followed by any success, when the disease depends upon sanguineous turgescence and inflammation.

“In contrary circumstances, Acupuncturation, by dissipating the symptoms, demonstrates, that disorder of the nervous system only had given rise to them.”

The only cases of Rheumatism in which I have been successful with the operation, have been of the Rheumatalgic form, or that which is divested of external inflammation; characterised by pain upon motion, stiffness and coldness of the part; the disease having a disposition to change its place; is aggravated by atmospheric changes, and relieved often by stimulant Diaphoretics, Narcotics and external warmth: but I have yet met with success in some cases where the intensity of the pain would have led me to believe, that considerable inflammatory action must have given rise to such exquisite nervous sensibility.

Mr. Berlioz in speaking of the diseases to which this remedy is applicable, says, “vague and wandering Rheumatism sometimes attacks the external muscles subservient to respiration; the patient is obliged to remain motionless; every motion of the trunk compels him to cry out; a deep inspiration is very difficult, and coughing occasions such cruel pains, that expectoration is impossible. Acupuncturation dissipates instantly this state of distress, and renders to the muscles their full liberty of action. In the space of one or two minutes, a patient whose sufferings drew from him tears, exclaims he is quite cured.”

These observations of Mr. Berlioz are fully substantiated by the experience of Dr. Haime of Tours, who has devoted much time and attention to the operation of Acupuncturation, and has lately published a most interesting paper upon the subject in the 13th volume of the “Journal Universel des Sciences Medicales,” at Paris.[3]

The doctor declares that his own practice bears evidence of the fidelity of the preceding remarks of Mr. Berlioz. He accuses the Japonese and Chinese, (to whom this operation he says is peculiar practising,) practising it too extensively, which has been partly the cause of its being disregarded by Europeans, and acknowledges that it was to Mr. Berlioz’s cases, which he has related in his “estimable work,” that he owed the fortunate application which he has made of this measure.

The following cases are given by Dr. Haime, which he says support the Theory of Mr. Berlioz.

“Antoinette Boulard, 38 years of age, had experienced in April 1818, a severe attack of Rheumatism, which fixed on the inferior part of the left side of the chest; it gave way in 48 hours to the use of some sedatives, the tepid bath, and the application of a blister to the part in pain.

“Six weeks afterwards I was called to see this woman, who had fallen again into the same state. I found her with the trunk in a state of inability of action, the motion of the respiratory muscles extremely difficult, and the plaintive tone of voice indicated the violence of the pain, which drew from her cries on the least motion. The pulse was small and concentrated, but without sensible acceleration; the body was covered with cold sweats; and the unhappy patient, altogether, was in a state of inexpressible anguish. I thought it right to have recourse to the same remedies which had been successful on former occasions; but my hopes were deceived. Three days were passed in this state, and Antoinette obtained no relief: I determined therefore to practice acupunctuation. I introduced a needle[4] at the inferior margin of the cartilages of the false ribs. The instrument had hardly passed to the depth of a few lines, when the patient said the pain had changed its seat, and was descended into the abdomen, at the same time that it had lost much of its violence. I continued the introduction to the depth of an inch; by this means the pain was driven from the abdomen, and permitted the patient to breathe freely: however I maintained the needle in its place for five minutes, and then made a second puncture, and successively a third, in the place where the disease had taken refuge. This third puncture made the pain totally disappear, and the patient cried out that I had restored her to life. Sleep of eight hours duration and a state of perfect calmness succeeded this operation.

“However Antoinette sent for me on the following day, saying her sufferings had returned, but with less violence, and entreated me with much earnestness that I would repeat the operation “seeing” she said, “that it was only the sound,” (for so she named the needle) “which gave her relief.” The operation was this time still more successful. The treatment was now continued for four days, and the last puncture so entirely relieved the pain, that it has not since returned.”

In addition to the above successful case the doctor adds another not less so.

“A woman had suffered for several days with wandering Rheumatic pains, which continued daily to encrease in violence; there were however at all times fixed pains in the shoulder and in the right arm, which acquired such a degree of intensity by intervals, that the patient could not refrain from crying out. She was in this state when she came to consult me: finding, however, neither alteration in the pulse, nor encrease of heat, nor redness of the skin, nor tension, nor swelling in the part affected, I considered the case to be simple Rheumatalgia, and passed the needle to the middle of the arm, between the fibres of the Triceps Brachialis muscle; the place designated by the patient as the seat of the pain. The pain was driven into the fore arm, and the second puncture caused it to descend into the hand, and a third being made in this part, caused it totally to disappear, and the patient said with delight and astonishment, she was cured; and was so satisfied with this treatment, that she spoke of it to every body. I have not since seen her, although I requested her (and she promised) to return in the event of a relapse.” But the most remarkable case which has occurred to exemplify the triumphant effects of acupuncturation, was that of a girl of 24 years of age. She was naturally healthy and robust, and had enjoyed good health till she was 15 years old, at which time the signs of puberty were manifested. At this period the system became much disturbed, menstruation was established with difficulty, and continued with irregularity; she lost her cheerfulness, and symptoms of the nervous temperament became predominant.—Various nervous symptoms now evinced themselves, and amongst others an obstinate vomiting occurred, which subsided only during very short intervals. She continued in this state for two years[5]. From this time she gradually got worse, and in addition to the habitual vomiting which she had endured from the age of 16, she suffered extremely from violent general convulsions. Some medicines were now given which relieved the sickness, and the use of the cold bath suspended the convulsions. After the treatment had been continued two months, she was visited by Dr. Haime, (to whose description of this interesting case, I am indebted for these particulars,) who found her labouring under partial convulsions, with a disposition to vomit occasionally. The means which had been before employed were still continued, but the symptoms became more aggravated, but were a little subdued by blood-letting from the saphena vein. The convulsions were almost wholly removed, at least had become only partial; the spasmodic efforts being concentrated on the diaphragm and stomach; but a nervous hiccup supervened which acquired such a degree of intensity, that the unhappy patient experienced no intervals of ease. All the known antispasmodic remedies were now tried during the space of six months without any benefit. Blisters to the pit of the stomach afforded no sort of relief, and the cold bath gave but a short and temporary alleviation. Scarifications followed by the application of a cupping glass were made on the side of the Dorsal Vertebræ, and the situations corresponding to the pillars of the Diaphragm, which suspended the symptoms but for a few days: relief was only partially obtained by the cautery, and the hiccup returned with its original force accompanied with such a convulsive affection of the stomach, that this organ appeared to act like a pair of bellows, alternately receiving and expelling large quantities of air. At length when the hiccup ceased, it was replaced by partial convulsions or some other symptoms, and vice versa.

Seeing the want of success of all attempts to cure this obstinate disease, and reduced to the necessity of remaining a mere spectator of its dreadful effects, Dr. Haime consulted every book which he conceived might give him some information by which some other curative measure might be suggested; but his researches were totally unsatisfactory, until he met with Dr. Berlioz’s observations upon Acupuncturation, when, not less struck with the curious facts which Dr. Berlioz relates, than with the efficacy which it was reported to possess in nervous diseases, he resolved to try it as a sort of forlorn hope, upon his present patient: he accordingly proposed it to her, and readily obtained her consent to its performance. He communicated his intention to Doctor Bretonneau, Physician to the general hospital, who had seen the case with him, and had often spoken of it; and in his presence he performed the operation for the first time. A needle was introduced perpendicularly at the centre of the Epigastrium, and the two physicians soon became convinced of the astonishing promptitude of the remedy; for the instrument had hardly passed to the depth of a few lines, when the symptoms vanished as it were by enchantment. The operation not appearing to be painful to the patient, the introduction of the needle was continued to half its length, in depth from twelve to fifteen lines, where it was suffered to remain for five minutes. The result was a perfect calmness, and a total suspension of the hiccup for three days, when the same symptoms returning, the needle again was had recourse to, and with the same efficacious effect as at first; and the operation was performed again and again, at longer or shorter intervals, according as the symptoms re-appeared, and always with the same advantages. Dr. Bretonneau became convinced of its efficacy by himself performing it several times. The treatment of the case was thus continued, selecting the part for the introduction of the needle, according to the situation of the symptoms which each operation was intended to alleviate; and Dr. Haime asserts, it never once failed of success; for the convulsive motions of the head, the instrument was passed into the muscles of the neck; into the masseter muscle, to relieve constant gaping; and into the fore arm when these muscles were affected; and thus, by pursuing the disease as it were, the convulsive disposition was entirely removed, and the patient restored to health.

For the fidelity with which I have reported this case, I refer the reader to Dr. Haime’s own record in the 13th volume of the “Journal Universal des Sciences Medicales,” and should further evidence of the efficacy of this remedy be necessary from other authority, I have but to mention the experience of Dr. Demours of Paris, who has recently confirmed[6] the report of Messrs. Berlioz and Haime. He dwells with particular force upon its good effects in Ophthalmia, for which he directs five or six needles to be passed between the fibres of the supraspinatus muscle. His method of performing the operation I shall presently notice when describing this part of my subject. The following cases which have occurred in my own practice, I shall now lay before my readers, and I doubt not but I shall make it appear that the beneficial effects of the remedy employed, are sufficiently flattering to deserve the esteem I hold it in, and to justify me in bringing the subject into general notice.