At the time of writing the Nei Ching, some 2,000 years back, people were already using nine different types of acupuncture needles - which were quite similar to the array of needles that are used by acupuncturists even now. Some of the needles were very fine, which, like in contemporary times were employed mostly for all uncomplicated treatments. In addition, some needles had arrowheads and these were employed by the practitioners only to prick an acupuncture point, instead of inserting the needle into the meridian. Even three-sided needles were available and these were used to bring on minor bleeding. Even to this day, acupuncturists use needles having triangular tips that terminate into a sharp point when they need to induce bleeding. Round-ended or blunt needles were employed when the acupuncture points had to be massaged or pressure applied on them, while needles akin to a scalpel were employed to make incisions in abscesses and boils. In fact, comparatively large and heavy needles were used for inserting them into the joints. When the most sensitive acupuncture points that were considerably beneath the surface of the skin having fat or a thick muscle had to be stimulates, they used needles that were extra long. In present times, acupuncture practitioners even use needles that are as long as three inches in some body areas like the buttocks. However, these needles are also significantly shorter compared to some of the needles employed by the acupuncture practitioners in the early stage.
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Presently, nearly all needles that are used for the purpose of acupuncture are manufactured from stainless steel. In fact, stainless steel needles were first made in the early part of the 20th century and they provide immense advantages, as it is easy to sterilize them and they also do not rust. Nevertheless, ever since the emergence of AIDS as well as different types of hepatitis that is passed on through blood, an increasing number of acupuncture practitioners have started using disposable needles - which are used only once and then discarded.
Prior to the introduction of stainless steel, needles made from silver and gold were used extensively, as these two precious metals are comparatively inert and are very unlikely to result in any undesirable reactions when they are inserted into any individual's skin. However, it is possible that some other reasons may also have been responsible for the popularity of gold and silver needles. It was believed that gold needles themselves possessed some kind of invigorating effect, while needles made from silver as well as other white metals had a soothing impact. It was also believed that needles made from copper had a stimulating effect. However, in present times, needles made from precious metals have some specific disadvantages - compared to stainless steel needles, they are more expensive and are so valuable that they cannot be discarded after using them once. In addition, these needles require re-sharpening. Nevertheless, a number of acupuncturists still have much faith in their inherent healing effects and, hence, they continue using needles made from gold and silver even today.
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In the West, the basic curriculum of medical students includes general medicine as well as surgery. Similarly, students learning the techniques of acupuncture in China and also taught herbal medicine, which is also founded of the same basic principle of the functioning of the body as well as flow of energy, as in acupuncture. As you may have thought, medical schools imparting knowledge on acupuncture techniques and herbal medicine in China were founded much before the West set up its very first medical school. Although the earliest medical school funded by the state and imparting knowledge on every aspect relating to Chinese medicine opened in China in A.D. 443, it was closed down within a decade. This compelled the medicals students to return to their traditional mode of learning and apprenticeship under a veteran physician. Several years later, an Imperial Medical Academy was set up during the Sui dynasty in A.D. 581. However, medical education actually began developing in China under the Tang dynasty, which reigned between A.D. 618 and A.D. 906. The academy underwent significant expansion in A.D. 624 and several departments were established to teach acupuncture, pharmacology, internal medicine and message, in addition to Buddhist as well as Taoist invocations, which was considered to be essential for any physician in those days. It was the first time that one could learn acupuncture as well as moxibustion as separate disciplines - independent from herbal medicine.
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The students were required to study medicine for a duration that is more or less the same or slightly longer than the medical course in the West now. It was mandatory for a student to complete a common basic course prior to specializing in any one stream of medicine. After a student had passed the specialized course, he was able to learn internal medicine - a seven-year course, or paediatrics or surgery, both courses lasting for five years each. However, a student had to spend much less time for being trained in other limited specialities, for instance, ailments related to the throat, ear and nose.
Similar to the medical schools in present times, the Imperial Medical Academy also used standard textbooks to train students. Besides the Nei Ching, Chia I Ching, a book written by Huang-Pu Mi in the 3rd century B.C., was another standard textbook that was used by the academy to train its students. The Chia I Ching or The Classic of Acupuncture Fundamentals, is considered to be the oldest that is completely dedicated to acupuncture as well as moxibustion that has come down to us. It is important to note that the Chia I Ching has been used as a reference is several books published later and it is learnt to have played a vital role in developing acupuncture in neighbouring nations like Japan and Korea. The Imperial Medical Academy also used another standard textbook called the Mai Ching or The Classic of the Pulse written by Wang Su-Ho.
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In Chinese medicine, pulse taking is considered to be a more precise as well as comprehensive science in comparison to the West, as it has a much more important role in diagnosing ailment. In fact, a student may spend several years to specialize in understanding the pulse. Moreover, since all types of traditional Chinese medicine, including acupuncture, are founded on identical conjectures relating to origins of diseases, diagnosing the pulse is elementary to all these forms. The Classic of the Pulse by Wang Su-Ho did not talk about or develop a new stream of science, but was a compilation from various primeval diagnostic modus operandi that had developed together with the advancement of Chinese medicine. Various other books that were published much before The Classic of the Pulse had also talked about diagnosing the pulse. These books include the Nei Ching, which presents somewhat comprehensive accounts pertaining to the pulse quality in different stages of diseases. It is said that the fourth century legendary acupuncture practitioner Pien Chueh also diagnosed the pulse to treat diseases.
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It is said that the great acupuncturist Pien Chueh was the first ever physician who used all the four fundamental methods of Chinese diagnosis together. The first technique is observation, which involves the physician to examine the patient's color, complexion, tongue and skin in the same manner as a contemporary physician in the West performs the initial examination of his patient. However, a practitioner of Chinese medicine and a physician in the West would interpret their findings differently. In traditional Chinese medicine, the tongue is considered to be similar to the pulse, which is able to offer much more to a qualified Chinese physician compared to what it will tell a doctor in the West. Hence, the observation of the tongue is essential for the proper diagnosis of a patient.
The second Chinese diagnose technique, or a combination of methods, which were used by Pien Chueh including smelling and listening. He would closely observe the patient's quality of speech - for instance, normal, garbled or shrill and likewise, as well as listen the sound of the patient's breathing. However, Pien Chueh definitely did not get the benefit of using the present Western examination device called the stethoscope. In addition, the legendary Chinese medicine physician would smell the body odour or his patient - this is perhaps something significant in a culture where people were not familiar with running water, both hot and cold, and people also did not bathe regularly. While a number of acupuncture practitioners continue to use this method even to this day, sometimes it is also used in contemporary Western medicine. For instance, if a physician smells acetone in the breath of the patient, it is generally considered to be a hint that the patient has diabetes and his condition is going beyond control.