Recently, I was speaking with a colleague who had just finished a round of acupuncture when I told him about my research into the practice in Chinese history. ‘I had completely forgotten,’ he responded with an embarrassed laugh, ‘that acupuncture even came from China.’

My colleague’s belated realisation was hardly unique. Today, acupuncture has become so common in many parts of the Western world that it is easy to forget that it only emerged as a popular practice in the United States half a century ago, at a time when the People’s Republic of China (PRC) was just beginning to reopen to the ‘capitalist’ West. In contrast to my colleague’s experience, acupuncture was considered anything but ordinary when it first rose to international prominence—and anything but American.

At the turn of the 1970s, acupuncture entered the global imagination as a distinctly Chinese practice—one that seemed to distil the entirety of China’s cultural heritage, as well as its revolutionary present, into the shape of a needle. The pointed association of acupuncture with China was precisely the intention of the Chinese Communist Party (CCP). Throughout the decade, the governing regime worked assiduously to promote the practice on an international scale, in the process shaping it into a vehicle through which to express the identity, values, and innovative capacity of the PRC and its people.

How could a device as small as a needle come to stand for the complexities and nuances of a country like China? This was the challenge the CCP faced, and its response was not consistent across time. In the early years of the 1970s, the acupuncture needle became synonymous with revolution and the socialist doctrines that then-chairman of the CCP Mao Zedong extolled. By the later years of the decade, after Mao had died and leadership of the party had been taken over by the reformer Deng Xiaoping, the needle was promoted no longer as a revolutionary practice but as a traditional one. Framed as an intrinsic part of an unbroken Chinese culture, acupuncture was upheld under Deng’s regime as a crucial facet of a lengthy and continuous national identity. Regardless of this rhetorical shift, however, one thing stayed the same: acupuncture had become more than just a medical procedure; it had become a symbol of Chineseness—as well as a unique indication of what China could offer the world.

Revolutionary Acupuncture

Throughout much of the twentieth century, most people beyond Asia had likely never encountered acupuncture, if they had even heard of the technique at all. Although acupuncture had been written about and practised sporadically in countries like the Netherlands and France from as early as the seventeenth century, it was hardly a household name (Lu and Needham 1980; Barnes 2009; Bivins 2010). In the United States, acupuncture experienced a brief period of fascination in the early decades of the twentieth century before fading almost completely from popular attention by World War II. By the 1970s, therefore, very few Americans had even a passing familiarity with the practice (Venit Shelton 2019).

This changed almost overnight in the early 1970s, when acupuncture exploded into mainstream American attention. The shift came about largely due to the CCP’s global promotion of a procedure called ‘acupuncture anaesthesia’ (针刺麻醉). As its name suggested, acupuncture anaesthesia used needling as a surgical analgesic: a way to dull the senses to pain such that pharmaceutical anaesthetics either could be used in limited quantities or did not need to be used at all. The technique was first discovered in 1958 when doctors in China, heeding Mao’s encouragement to unite Chinese and Western medicine, realised that acupuncture was not just useful for postoperative pain but could also be used to prevent pain altogether. Approximately 30 minutes before an operation was scheduled to take place, acupuncturists would insert one or more needles into a patient’s strategic acupoints and then manipulate the needles by hand or with the help of an electric generator. The twirling technique, it was reported, produced enough analgesia that patients did not need to be given local injections or larger doses of medicinal anaesthetics. Instead, with just the benefit of a needle, major surgeries could proceed (Huajian Yiyao Youxian Gongsi 1971).

Despite having risen to the attention of Chinese physicians in the late 1950s, acupuncture anaesthesia was not used in any substantial quantity until the early 1970s, when China began tentatively to reopen to the outside world after the upheaval of the Cultural Revolution. Whenever foreigners came to China as part of political, medical, or people-to-people exchanges, acupuncture anaesthesia inevitably appeared on their itinerary alongside visits to communes and farms. Even Henry Kissinger and First Lady Pat Nixon were introduced to the technique. As Kissinger wrote in a memorandum to President Richard Nixon in 1971, he had been taken to a hospital in Beijing where ‘the ancient Chinese practice of acupuncture … was being put to modern use’ (Kissinger 2006).

The reason acupuncture anaesthesia featured so prominently on the agendas of visiting delegations was because of how directly (and viscerally) it communicated the underlying principles and impressive achievements of revolutionary Maoism. According to party-issued propaganda documents, unlike medicinal anaesthetics, the precise doses and administration of which required years to master, acupuncture was a simple technique that could be easily learned without lengthy schooling. The simplicity of the procedure aligned with the CCP’s reimagination of medical education in high socialist China, which was truncated, expedited, and geared towards immediately practical results rather than intensive research and high theory (Zhang 2017).

Simultaneously, because acupuncture did not require high-tech equipment, expensive laboratories, or even electricity, it could be practised (at least in theory) anywhere at any time. And because patients remained awake during surgery, they could actively participate in the success of the procedure, telling their surgeon if something felt amiss and encouraging their doctors to reach a speedy resolution. Acupuncture, in other words, was a way of equalising the unequal status between urban and rural, doctor and patient, Western and Chinese trained. It eliminated the entrenched hierarchies that were so pervasive within the medical culture of the capitalist world, and offered an alternative pathway to providing accessible care, regardless of a person’s location, condition, or socioeconomic status (Renmin Weisheng Chubanshe 1972; Huajian Yiyao Youxian Gongsi 1971).

Whenever foreign delegations witnessed the technique, they were simultaneously exposed to its accompanying ideology. Patients brought Mao’s Little Red Book into the operating theatre with them and liberally recited from it throughout their procedure. Some foreigners reported how patients would prop themselves up on their elbows after their surgery, lower themselves unaided to the floor, proudly hold up their Little Red Book, and proclaim: ‘Long live Chairman Mao and welcome American doctors!’ (Dimond 1971). Surgeons and anaesthesiologists regaled visiting delegations with tales of the technique’s recent history and revolutionary origins. Inspired by the encouragement to do more with less, to find ways of providing medical care to the rural masses, and to think beyond existing paradigms in ‘Western’ medical knowledge, physicians had breathed new life and meaning into an ancient technique (Huajian Yiyao Youxian Gongsi 1971; People’s Liberation Army Daily 1971).

When foreigners returned to their countries of origin, they published extensively about what they had seen, embedding close-up photographs of needles and electric generators in their texts. Over a handful of years, thousands of articles, colour photographs, television broadcasts, and first-person testimonials appeared in both scientific and popular journals, the mass media, and on the evening news. The Italian filmmaker Michelangelo Antonioni even featured the procedure in his full-length documentary Chung Kuo (China), which was released in 1972. Readers and viewers could barely wade through one report before a new exposé or firsthand account appeared in a venue like Newsweek, Reader’s Digest, or CBS. While consuming these intimate portrayals of life in communist China, foreigners naturally began to wonder: if the communists could induce anaesthesia with nothing but a pinprick, what other magic and mystery lay behind the Bamboo Curtain? What else had the CCP discovered when the world was not watching?

The curiosity about acupuncture infected countless pain sufferers and chronically ill patients, who wrote desperate letters to recent returnees wondering how they, too, could obtain a visa and a ticket to China. And some American doctors, inspired by what they had seen while abroad, began to advocate for a Mao-like approach to medicine within the United States. Recognising that access to medical treatment was unequal across the country—divided by race, class, and geography—physicians like the public health specialist Victor Sidel, who travelled to China in the summer of 1971, as well as organisations like the Black Panther Party and the Young Lords, argued that acupuncture could potentially be a solution to some of the problems facing the American medical system (Sidel 1975; Baum 2021; Burton-Rose and Wu 2021). Inspired by Mao’s revolutionary medical program, forward-thinking advocates experimented with using acupuncture for drug and alcohol addiction as well as the treatment of chronic pain.

Only a short time after acupuncture anaesthesia had become a global phenomenon, it appeared to have accomplished its goal: not just introducing the world to the medical promises of acupuncture but also, more importantly, galvanising international attention to the achievements of Chinese socialism. Acupuncture, in other words, had come to stand for the ideology and practice of Maoism writ large, neatly encapsulated in a single steel needle.

Acupuncture as Chinese Tradition

A few years after Mao died in 1976, the leadership of the CCP was passed to Deng Xiaoping. Deng’s priorities diverged in many ways from those of his predecessor and, over the 1980s, he set to work undoing some of the more radical elements of Mao’s ideological, economic, and political agenda. Acupuncture was no exception. In contrast to the preceding years, when acupuncture was portrayed as inseparable from revolutionary socialism, the Deng regime began to strip the practice of all hints of Maoist ideology. Acupuncture continued to be practised on a large scale, but it was taken over by professionally educated and licensed acupuncturists rather than the barefoot doctors who had primarily been trained in short courses. And while acupuncture anaesthesia persisted for a few years after Mao’s death, it was eventually phased out. With it went the Little Red Books, the Maoist slogans, and the calls for a revolutionary type of medicine that could serve as a deliberately equalising force.

In its place, a new vision of acupuncture emerged—one that was more closely tied to ‘traditional’ Chinese culture. Rather than foregrounding a radical break from China’s past, the post-Mao regime emphasised acupuncture’s longstanding continuity with its peoples’ cultural heritage. In English-language publications like the Beijing Review, acupuncture was described as an ancient technique that dated all the way back to the Warring States era (476–221 BCE) and the Yellow Emperor’s Inner Canon (皇帝内经), a canonical medical text compiled during the Han Dynasty (202 BCE – 220 CE) (Beijing Review 1979). Minister of health Qian Xinzhong described acupuncture in a 1980 speech as being ‘part of our country’s rich medical and pharmacological heritage’—a treasure trove that had been used to heal ‘since ancient times’ (Qian 1980). And under the sponsorship of the Ministry of Health, physicians were encouraged to compile, annotate, and publish medical cases and acupuncture tracts from China’s esteemed traditional doctors. As one article in the Guangming Daily (1978) put it: ‘Acupuncture is one of the treasures in our national medical treasury … It has been in wide use continuously for over a thousand years.’

Newspapers, meanwhile, condemned how acupuncture had been approached under the negative influence of Lin Biao, Mao’s erstwhile predecessor who was later accused of plotting a coup, and the Gang of Four, a political faction that included Mao’s wife, Jiang Qing. As Deng-era mouthpieces proclaimed, extensive cuts had been made to acupuncture research under their oversight, while at the same time the Gang of Four had intentionally ‘exaggerated’ the needle’s effectiveness, claiming (without scientific basis) that ‘all diseases’ could be cured ‘by a single needle’. The result was both a baseless oversimplification of what acupuncture could achieve and elimination of support for the doctors who already practised it. By contrast, the new leadership aimed to ‘restore and advance’ the ancient technique, subjecting it to clinical trials and upholding its central place within China’s unique cultural heritage (Guangming Daily 1978).

The outcome of this rhetorical shift was that China’s worldwide promotion of acupuncture took on a noticeably softer and more inclusive tone under the Deng regime. Rather than positioning itself as the sole global authority on acupuncture, the PRC adopted an increasingly collaborative approach to both researching the technique and championing it beyond Chinese borders. As early as 1979, China began to host international academic exchanges with the goal of ‘swapping experiences’ in both clinical use and theoretical study. Collaborating with hundreds of scientists from abroad, Chinese acupuncturists aspired to learn more about the physiological rationale for acupuncture and explore further applications (China Reconstructs 1979; Zhang 1984). The China Association of Acupuncture and Moxibustion worked closely with both the World Health Organization (WHO) and the United Nations to support the latter’s goal of achieving ‘health for all by the year 2000’ (Liu 1987). And, under the leadership of the WHO, an international committee—comprising representatives from China, Korea, Japan, France, Venezuela, and the United States, among others—worked to standardise acupuncture’s nomenclature so that the technique could be applied more easily in ‘international exchange’ (WHO 1991). By sharing acupuncture with the world, as the China Daily News put it, the Chinese were working towards not only ‘the health of mankind’ but also ‘world peace’ (Liu 1987).

Nevertheless, even with this shift in how acupuncture was described and promoted, its use as a type of soft power—a force that attracted the positive attention of people worldwide—continued to bridge the years both before and after Mao’s death. Throughout the 1980s, the CCP leadership aggressively marketed acupuncture both domestically and internationally as a kind of ‘cultural bridge’—one that, as Qian Xinzhong (1980) put it, ‘had played an important role in cultural exchanges’ since ‘ancient times’. Starting in 1978, the Chinese Ministry of Health began to sponsor international acupuncture conferences and establish acupuncture schools, in which the languages of instruction included English, Russian, Japanese, and French. By 1987, the China Daily boasted that more than 1,200 doctors from 64 countries had been trained in the technique, and in the same year, Beijing hosted the first World Conference on Acupuncture, which brought together more than 1,500 scholars from 70 countries (China Daily 1987).

News reports bragged about acupuncture’s ability to shine a positive light on the PRC, quoting foreign students as saying that China was the ‘cradle of acupuncture’. The Deng regime also recycled some of the talking points from its predecessors but reframed them to appeal to visiting scholars from Europe and the United States rather than to the needs of underserved populations. Since acupuncture only required a ‘simple apparatus’ (the needle), it was economical, could be learned in courses of only three months, and produced no side effects, thereby making it a useful ‘supplement to modern Western medical science’ (China Daily 1986, 1987). Acupuncture, under Deng, was not a practice that required a fundamental re-evaluation of Western medical culture, but one that could sit comfortably alongside it.

Subtle Changes

Across the 1976 divide, acupuncture remained both indelibly tied to the Chinese nation and showcased as proof of Chinese innovation. What that nation stood for—and what that innovation entailed—unquestionably evolved as leadership of the PRC passed from Mao to Deng. Even so, while much of the rhetoric surrounding acupuncture changed from the 1970s to the 1980s, the underlying impetus for its worldwide promotion had not. Starting in the later years of the Cultural Revolution, and continuing through the period of Reform and Opening, acupuncture was continuously used as a type of soft power: a way to attract positive international attention to Chinese scientific innovation and to reveal how the Chinese had long been capable of making medical discoveries that could have useful applications across the globe.

As the PRC has turned inward since the outbreak of Covid-19, this approach has changed in subtle but significant ways. Although Chinese medicine continues to be upheld as a symbol of national identity and a badge of national pride, the CCP has targeted these efforts more at PRC citizens and the Chinese diaspora than at all Westerners. In 2020, for instance, the CCP mailed care packages to Chinese students living abroad, which were filled with traditional medicines and accompanied with nationalistic expressions like ‘the motherland is by your side’ (Cheng 2020). The goal was to associate health with a patriotic longing for home, rather than stimulate foreign curiosity and galvanise international cooperation.

This was not the case several decades ago, however, when the PRC was turning outward instead of mainly looking in. ‘Chinese acupuncture has entered the world,’ one article from 1985 triumphantly proclaimed, ‘becoming the collective treasure of the people of all countries’ (Yi 1985; China Daily 1982). Even though acupuncture had its origins in China, the article made clear, it was not exclusive to the national boundaries of the PRC—nor just to the Chinese people. Acupuncture was an offering that China had given to the world—one that synthesised and reproduced Chinese national identity in each bodily pinprick. That acupuncture’s geographic origins are so easily overlooked in the United States today is either proof of the long-term failure of this soft-power project or evidence of acupuncture’s indisputable international success.