Acupuncture has been practiced in China for centuries, but American scientists were largely skeptical of its efficacy when they were widely exposed to it in the early 1970s. Chinese doctors explain the phenomenon using a conception of the body unfamiliar to Westerners. Western physiologists, at first largely baffled, have in the past few decades been able to explain the startling analgesic effects of acupuncture in their own terms. I show how a teacher may effectively use the contrasting explanations and research practice, east and west, to teach the cultural contexts of science.
The Chinese explanation for acupuncture, however, accounted for why the points and their effects could sometimes be so distant from each other. Because qi flows along meridians, needles inserted along one meridian may be effective anywhere along that meridan, even though they may be far from the place of the effect. Thus a needle at ho-ku can affect a headache or abdominal cramps because all lie on the `large intestine' meridian.
Acupuncturists also use the notion of qi in inserting the needle. When needles are placed in the correct location, the patient usually feels a slight distension or numbness. The sensation is called de qi, or "striking the qi," relfecting the view that the patient perceives how the flow of qi changes. Patients can sometimes also feel the numbness of de qi spread along the line of the meridian. Thus, even if the meridians and points have no Western anatomical "reality," they do have a basis in sense perception. And these perceptions guide treatment. For the practicing acupuncturist and the patient, at least, the traditional theory explains key observations.
Historically, acupuncturists learned exactly where the points were and how they were connected along meridians by experience. No one could predict, apparently, the sometimes zig- zagging pathways of the meridians--and there is no reason in the Chinese view why they follow the paths as now described. Instead, the meridian maps represent the collected wisdom of generations of acupuncturists.
Westerners could not explain the relationship of points in acupuncture. Not that they hadn't noticed similar phenomena. They were familiar, for example, with `referred pain'. In these cases, pain from an injured internal organ was felt on the surface of the body, but not always near the organ. Perceptions generally occurred within segments of the body, however. They did not always match the sometimes distant separation of acupuncture points and their effects.
Westerners were also familiar with another set of points, discovered at the end of last century, that evoke pain when pressure is applied. These are now known as `trigger points'. One physician claimed that sometimes pressure on these points can also alleviate pain. Researchers found in the 1970s that there is a strong correlation between the location of the trigger points of the West and the acupuncture points of traditional Chinese medicine (Melzack et al 1977; Baldry 1993). But again, no one understands fully why trigger points produce pain, sometimes at specific locations remote from the point. In neither case--for trigger points or referred pain--is there an explanation in Western terms why these points might be related to pain relief.
The cross-cultural dimensions of acupuncture can be highlighted once again by new discoveries. In recent years, many points have been found that do not lie on traditional meridians. How would a Western skeptic likely interpret this fact? How might a Chinese doctor interpret the same fact? What can the pair of interpretations reveal about the cultural context of science?
Science is a process and the pursuit of research can be as significant as its results. Scientists cannot pursue every question, and so they make choices. In addition, their research involves equipment, human effort and time. They must decide where they will invest their limited resources. As noted above, for example, research on acupuncture and its clinical efficacy reflected a degree of commitment, even if based on skepticism. Ultimately, the factors that can influence what research is done help shape science itself. But which research is pursued, and why?
Chinese and American cultures offer very different contexts for the pursuit of research on acupuncture. Acupuncture is valued in China partly in an economic context. It is a relatively "low- tech" form of medicine. It requires little equipment, though it does require expertise and substantial training for the acupuncturist. It is a labor-intensive rather than capital-intensive form of medicine. It was through a deliberate program of research in the late 1950s, in fact, that the Chinese first applied and then developed acupuncture as a form of analgesia for dental work and, subsequently, surgery.
The circumstances for acupuncture research in highly industrialized, capitalist nations are quite different. Because acupuncture involves no product to sell, drug companies and other investors have had little incentive to fund acupuncture research. There is no opportunity for profit. By contrast, research on endorphin-like molecules that may relieve pain has been well funded. Funds exist for research on pain relief, but only for certain types of pain relief. The prospect for knowing more about acupuncture thus depends on certain sources of funding to support research--in this case, support for `basic' research.
In addition, acupuncture in the U.S. is still widely viewed as an "alternative" or "folk" medicine. It has peripheral status. Many insurance companies or health plans, for example, do not pay for acupuncture treatments. Even Western doctors sympathetic to acupuncture often recommend it only when Western medicine fails or is first shown to be ineffective. Many practitioners and health administrators say that scientific assessments leave the efficacy and explanations of acupuncture still uncertain. They also continue to cite the potential for fraud (see, e.g., Consumer Reports, 1994). With the current commitments to Western medicine, the potential of acupuncture--and hence research on it--will be limited. What we know about acupuncture will be shaped, as it has in the past, by the research that is done.
Second, neither account conveniently reduces to the other. The Western accounts of nerve pathways and the effects of endorphin offer powerful ways to relate acupuncture to other aspects of pain and physiology in general where traditional Chinese explanations remain silent. At the same time, the Chinese lay claim to the original discovery and to explanations on the sensations of de qi and clinical practice. Neither culture has "cornered the market" on explanations for acupuncture. The standards for scientific practice in each culture relate to what each knows. I suggest that such tensions offer the cognitive dissonance or discrepant episodes that effectively prompt students to reflect on the cultural contexts of science.
A basic test for a cultural case study, then, is whether it works symmetrically. That is, the example should be equally effective from each cultural perspective, or if the cultural perspective is reversed.
Other topics lend themselves equally well to teaching the cultural contexts of science: for example, archeaoastronomy, ethnobotany, metallurgy, agricultural systems, and counting systems (see list below). In particular, each are amenable to cultural symmetry and to viewing the effectiveness of science from two or more cultural perspectives simultaneously:
Gerdes, Paulus: 1994, Explorations in Ethnomathematics and Ethnoscience in Mozambique, Instituto Superior Pedagogico (Mozambique).
Mshigeni, Keto: 1991, Traditional Medicinal Plants, Dar Es Salaam University Press (Dar Es Salaam, Tanzania).
Selin, Helaine: 1992, Science Across Cultures: An Annotated Bibliography of Books on Non- Western Science, Technology and Medicine, Garland Publishing (New York).
Selin, Helaine: forthcoming, Encyclopedia of the History of Science, Technology and Medicine in Non-Western Cultures, Garland Publishing (New York).
Sofowora, Abayomi: 1985, Medicinal Plants and Traditional Medicine in Africa, Spectrum/John Wiley (Ibadan).
Thomas-Emeagwali, Gloria: 1993, African Systems of Science, Technology and Art, Karnak (London).
Vortloff, Charles: 1988, `Chi'mu Irrigation Systems', Scientific American.
Williamson, Ray A. (ed.): , Archaeoastronomy in the Americas, Center for Archaeoastronomy (College Park, MD).
Baldry, P.E.: 1993, Acupuncture, Trigger Points and Musculoskeletal Pain. Churchill Livingstone (Edinburgh).
Hagen, J., D. Allchin and F. Singer, 1996, Doing Biology, Harper-Collins (Glenview, IL).
Kroger, William S.: 1972, `Hypnotism and Acupuncture', JAMA 220:1012-13.
Liao, Sung J., Matthew H.M. Lee and K.Y. Ng Lorenz: 1994, Principles and Practice of Contemporary Acupuncture, Marcel Dekker (New York).
Lu, G.-D. and J. Needham: 1980, Celestial Lancets: A History and Rationale of Acupuncture, Cambridge University Press (Cambridge).
Melzack, Ronald, Dorothy M. Stillwell and Elisabeth J. Fox: 1977, `Trigger Points and Acupuncture Points for Pain: Correlations and IMplications', Pain 3:3-23.
Pomeranz, Bruce: 1987, `Scientific Basis of Acupuncture', in Acupuncture: Textbook and Atlas, G. Stux and B. Pomeranz (eds.), Springer-Verlag (Berlin), pp. 1-34.
Research Group of Acupunture Anesthesia, Institute of Medicine and Pharmacology of Fujian Province: 1986, `Studies of Phenomenon of Blocking Activities of Channels and Collaterals', in Research on Acupuncture, Moxibustion and Acupuncture Anesthesia, Science Press (Beijing) and Springer-Verlag (Berlin), pp. 653-67.
Schoen, A.M. (ed.): 1994, Veterinary Acupuncture: Ancient Art to Modern Medicine, American Veterinary Publications (Goleta, CA).
Ulett, G.A.: 1982, Principles and Practice of Physiologic Acupuncture, Warren H. Green, Inc. (St. Louis).