Bonghan Ducts & Knowledge production in acupuncture research
A Review
By Esther Lee
Advised by Summer Nguyen and Sophia Peng
Acupuncture, a complementary, integrative medicine developed over thousands of years, has been a significant subject of modern research. Of greatest interest has been assessing the efficacy of acupuncture, most commonly through the same clinical research study methods used to determine biomedical therapeutic modalities (see Danica Pietrzak’s essays “Statistical Methods in Acupuncture Research” and “The Flexibility Trials”). However, as Pietrzak and historians such as Volker Scheid explain, current biomedical research tools can be exclusionary and limiting because they use reductionist approaches that undermine the breadth, depth, and plurality of Traditional Chinese Medicine (TCM) and acupuncture.
For instance, the current “golden standard” for assessing the efficacy of medical treatments is randomized controlled trials (RCTs). In the United States, the standard protocol for the FDA to approve pharmaceuticals is to run large-scale RCTs. As a result, most of the research today on acupuncture falls into the categories of RCTs or observational case studies that monitor the effectiveness of acupuncture for multiple patients with similar conditions. However, while the strict controls of these scientific methods are ideal for assessing newly developed drugs, applying the same measures (minimizing patient-provider interaction (Dickman et al. 2007), using the same acupoints for each patient, etc.) to acupuncture – a practice that requires personalization as a foundation of its efficacy – can produce data that is far less meaningful.
Another complication that devalues the validity of acupuncture when assessed through RCTs is the presence of cultural biases and the influences of conventional Western medicine. Different cultural backgrounds and levels of exposure to acupuncture instill varying degrees of confidence regarding the efficacy and validity of acupuncture. These skeptical preconceptions are mainly present in Western-centric healthcare systems where acupuncture is seen as a pseudoscience. It is well known that an individual's pre-existing beliefs influence outcomes in clinical research, particularly the efficiency of health interventions. Multiple articles have alluded to this obstacle; in the case of TCM, a 2008 RCT study of tender point acupuncture by Itoh et al. in Kyoto, Japan, specifically remarked that: "Previous experience with acupuncture and confidence in acupuncture may influence the measurement of efficacy" (Itoh, 2008). RCTs eliminate the biases within acupuncture that make the practice what it is. Consequently, acupuncture research cannot fit the mold of RCTs and Western research methods. Thus, to make significant advancements, TCM researchers must ask, why not look into endeavors other than proving acupuncture's efficacy concordant with Western standards?
The dominance of conventional Western practices as well as the issue of bias, block research progress in the field of acupuncture. Much of the scientific community believes that acupuncture research has minimal progress and continually needs to scientifically prove its validity (Langevin and Wayne, 2018). Yet, it is precisely the restricting nature of evidence-based research and Western superiority in medicine that hinders acupuncture as a medical practice from being respected. For acupuncture research to gain acceptance, it may be necessary to pivot from relentlessly attempting to conform to Western-centric research models. After all, TCM has a rich philosophy base that should be emphasized in pursuing knowledge production. As East Asian medicine Researcher Volker Scheid describes in his paper, “All of [Traditional Chinese Medicine], and not merely some isolated parts, is a modern reconfiguration of a greater tradition. This tradition offers multiple understandings of almost anything, from the nature of the disease to how a specific problem like menopause should be treated, even if its practitioners agree on a few core ideas and concepts. Rather than misconstruing Chinese medicine as a static tradition that offers specific treatments for specific conditions, CAM research must embrace the realistic and evidence-based view that it is a “tradition to think with.” Acupuncture is a traditional, long-standing practice that should not hinder the field from growth and discovery untethered to Western methods of progress. New knowledge can be generated within spheres of TCM when notions of fixed tradition are rejected.
In 1961, North Korean physician and researcher Bonghan Kim challenged Western conventions of medicine by discovering that the anatomical and physical foundations of acupuncture meridians form a novel circulatory system distinct from the blood vessel or lymphatic system (Kim, 1965). He named these connections “Bonghan ducts” and further explained that the contents of Bonghan ducts, “Bonghan liquor,” have regenerative healing properties (Kim, 1965). Though North Korea applauded Kim’s work as a monumental discovery worthy of a Nobel Prize, the Western medical community was far more wary. Bonghan ducts were a foreign framework and did not fit into conventional knowledge of anatomy. Accepting BH ducts as a newfound vascular system would dismantle Western understandings of bodily systems and even weaken Western dominance in medical discourse. These Western anxieties around a destabilization of current medical practices due to a traditional, unconventional practice of acupuncture may have led the scientific community to reject the BH system.
Figure 1: 1964 North Korean Stamp of Bonghan Kim
On top of this lack of acceptance, Kim was criticized for lack of transparency in his research methods, which made his outcomes challenging to reproduce. Kim disappeared in 1965 after publishing five articles and never fully disclosed his experimental methods. Thus, in the past 60 years, many have questioned the validity of his findings and the reason for his disappearance. Skeptics of BH ducts speculate that Kim fabricated his results to gain recognition and align himself with North Korean ideologies of Juche (independence and self-sufficiency) to prove his loyalty to Eastern medicine and the North (Hwang, 2016). Others believe that Bonghan Kim was “purged” by the North Korean government for reasons such as his use of unethical human experimentation, the failure of his research to gain Western medicine approval, or simply because the dictatorship found Kim undesirable for unrelated political reasons.
Figure 2: Stereomicroscopic images of Bonghan ducts and corpuscles on the surface of rabbit internal organs. (Ogay, 2009)
While recent research by Kwangsup Soh (Soh, 2009) in South Korea replicates Kim’s work and validates the existence of BH ducts, the discovery has not garnered nearly as much attention as it did in the 1960s. Much acupuncture research follows suit in designing experiments around RCTs and observational case studies. Despite their ambiguous legacy, Bonghan ducts remain a vital conversation because they showcase a novel approach to scientific acupuncture research that produced new knowledge. Of equal significance, the progression of Kim’s research reinforces just how embedded knowledge production is within culture and politics.
The field of acupuncture is gaining momentum (Langevin & Wayne, 2018), and acupuncture research has the potential to carve the ontological direction of this growth. While Western standards are unlikely to disappear as a means of analysis, they should not limit the production of scientific knowledge on acupuncture. Keeping Bonghan ducts in mind, it could be a generative pursuit to deconstruct the superiority and preference for conventional Western medical understandings, thus, allowing room for advancements accommodating TCM theories and unconventional knowledge pathways.
CITATIONS
Bong Han Kim. (1965). Kyungrak system and theory of sanal : these two papers were read by Kim Bong Han at the first scientific symposium of the Korean Society of Kyungrak held in Pyongyang on April 15, 1965. Medical Science Press.
DICKMAN, R., SCHIFF, E., HOLLAND, A., WRIGHT, C., SARELA, S. R., HAN, B., & FASS, R. (2007). Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Alimentary Pharmacology & Therapeutics, 26(10), 1333–1344. https://doi.org/10.1111/j.1365-2036.2007.03520.x
Hwang, I. T. (2016, November 6). 경혈·경락 실체 밝혔다는 납북 김봉한 박사와 봉한학설은 왜 자취를 감췄나? - 당신의 건강가이드 헬스조선. Health.chosun.com. https://health.chosun.com/site/data/html_dir/2016/10/31/2016103101696.html
Itoh, K., Ochi, H., & Kitakoji, H. (2008). Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) – a pragmatic trial. Chinese Medicine, 3(1), 14. https://doi.org/10.1186/1749-8546-3-14
Langevin, H. M., & Wayne, P. M. (2018). What Is the Point? The Problem with Acupuncture Research That No One Wants to Talk About. The Journal of Alternative and Complementary Medicine, 24(3), 200–207. https://doi.org/10.1089/acm.2017.0366
Ogay, V., Bae, K. H., Kim, K. W., & Soh, K.-S. (2009). Comparison of the Characteristic Features of Bonghan Ducts, Blood and Lymphatic Capillaries. Journal of Acupuncture and Meridian Studies, 2(2), 107–117. https://doi.org/10.1016/s2005-2901(09)60042-x
Pietrzak, D. (2021a). Flexibility Trials. MRD. https://www.mrdlab.org/flexibilitytrials
Pietrzak, D. (2021b). Stastistical Methods in Acupuncture. MRD. https://www.mrdlab.org/statisticalmethods
Scheid, V. (2007). Traditional Chinese medicine—What are we investigating? Complementary Therapies in Medicine, 15(1), 54–68. https://doi.org/10.1016/j.ctim.2005.12.002
Soh, K.-S. (2009). Bonghan Circulatory System as an Extension of Acupuncture Meridians. Journal of Acupuncture and Meridian Studies, 2(2), 93–106. https://doi.org/10.1016/s2005-2901(09)60041-8
