A medical report from the stone age?
During the last decades of this century several prehistoric human mummies with well-preserved tattoos have been found in Siberia, Peru, and Chile. Some of the tattoos were obviously decorative, but others were of less aesthetic value and of unknown use.In the well-preserved mummy of a Scythian horseman ( figure 1), there are ornamental and non-ornamental tattoos. The difference in the tattoos is so obvious that there is speculation about a possible therapeutic importance of the ones in the perivertebral and retromalleolar region.
In 1992, a mummy was discovered in the necropolis of Chiribaya Alta, southern Peru. The mummy had ornamental tattoos depicting stylised apes, birds, and reptiles on the forearms, hands, and lower legs (figure 2, top). There were additional tattoos on the neck and the upper part of the back. They are circular, of simple shape, and remain hidden by the neckhairs and the clothing (figure 2, bottom). The hidden position of these marks points to the possibility that they have therapeutic importance (SG, KS, unpublished observations).
The Tyrolian Iceman, the oldest European mummified human body with tattoos, shows some 15 groups of tattoo-lines on the back and legs. They do not seem to have decorative importance because they have a simple linear geometric shape and are located on the less visible parts of the body. The question arises as to whether they also have medical significance.
One of us (FB) was looking through photographs in the book The Man in the Ice and noticed a striking proximity of some of the tattoo locations to the locations of classical acupuncture points. This initiated our investigation; Austria we hypothesised that there might have been a medical system similar to acupuncture (Chinese Zhenjiu: needling and buming) that was practised in Central Europe 5200 years ago.
In acupuncture, the location of points is defined by a relational measure (the cun, Chinese for inch) derived from the anatomy of the patient. The cun is defined by the width of the interphalangeal joint of the thumb but can also be determined by a certain fracfion of the length of the femur, the tibia, or the radius. Using these relations and published data of the Iceman, we calculated that cun was about 22 mm or about an inch. We then converted the morphometric measures of the tattoos to cun and overlayed the locations of the tattoos to topographical representations of the Chinese acupuncture points as referenced in acupuncture texts. To investigate the in-situ situation in the mummy, one of us (LD), an experienced acupuncturist, subsequently investigated the tattoos morphometrically during a visit to the Iceman in his special chamber at the Prehistoric Museum of Bozen, Bolzano, Italy.
The results are shown in the table. Expert opinions from three acupuncture societies indicate that nine of the tattoos could be identified as being located directly on or within 6 mm of traditional acupuncture points. Two more tattoos are located on an acupuncture meridian but not close to a point. One tattoo is a local point. Three tattoos are situated between 6 mm and 13 mm from the closest acupuncture points.
Figure 3 illustrates some of our findings. The top part of figure 3 shows four tattoo groups on the left side and one on the right side of the dorsal spine. They are close to or lie directly over acupuncture-points of the urinary bladder-meridian. The bottom part of this figure shows one of the tattoo crosses, which is situated behind and above the left lateral malleolus, corresponding to the urinary-bladder 60 acupuncture point.
In acupuncture, needling at specific points modifies the underlying "qi energy" affecfing inner organs, pain perception, and infiammatory processes. The traditional points are predominantly located on 12 principal and a few minor meridians. Each meridian corresponds to an organ or organ system. Interestingly, nine of the tattoo-groups are located on the urinary bladder meridian and three on the gall bladder meridian.
There are several types of acupuncture treatment. In the traditional form, classical points are used, and the objective is to restore and maintain a balanced "energy" state in the individual. These classical points may be remote from the diseased site. Another form of treatment involves the application of needles surrounding the symptomatic areas (locus dolendi therapy).
Histological investigations of the Iceman's tattoos' have shown that rounded pigment particles, possibly consisting of charcoal, were used as a colouring agent. This led to the hypothesis proposed by Capasso' that the tattoos were produced by incision of the skin surface followed by the burning of herbal powder in the wound. Van der Velden and colleagues concluded from their histological study that contemporary therapeutic tattoos found in India and Africa were strikingly similar to those of the Iceman. Clearly there is a methodological difference between tattooing and needle acupuncture. However, this difference may be comparable to the difference between applying a pharmacological agent either by injection or by intravenous infusion: the application is different but the idea is the same.
From radiological studies the Iceman had moderate arthrosis in the hip joints, knee joints, ankle joints, and the lumbar spine. Tattoos situated near the affected areas are shown in the table. From our results we conclude that the tribe of the Iceman was familiar with a simple form of locus-dolendi acupuncture as proposed recently. If a modern acupuncturist were to diagnose lumbar arthrosis, points on the urinary-bladder meridian, running from the head along the back to the fifth toe would be punctured. In published work on acupuncture the urinary-bladder 60 point is regarded as a "masterpoint for back pain". On the Iceman, one of the two tattoo-crosses is located on urinary-bladder 60 point behind the lateral malleolus of the ankle (see bottom part of figure 3).
As mentioned, nine of the 15 tattoos are located on the urinary bladder meridian. Taken together the tattoos could be viewed as a medical report from the stone age, or possibly as a guide to self-treatment marking where to puncture, when pains occur. The fact that not randomly selected points, but rather corresponding groups of points were marked by tattoos, seems especially intriguing. From an acupuncturist's viewpoint, the combination of points selected represents a meaningful therapeutic regimen. Slight differences between the location of some of the tattoo points and classical acupuncture-sites might be explained by twisting of the Iceman's skin relative to underlying structures that may have occurred during 5000 years in the ice. This is especially obvious in the tattoos on the back (top part of figure 3), which are very likely to have been applied symmetrically to the spine and are partly shifted today out of symmetry according to their location on the twisted body.
There are other tattoo points, which are not addressed in the radiological results. Most are located on the gall bladder, spleen, or liver meridian (see table). These points are used when a patient has abdominal disorders. Recent findings revealed numerous eggs of whipworms (Trichuns trichiura) in the Iceman's colon. This would no doubt have affected his abdominal function as speculated by Capasso. The finding of a remarkable amount of charcoal in the colon of the Iceman: and the presence of a phytotherapeutic remedy, the woody fruit of Pip toporus betulinus found in the Iceman's belongings, testify to the Iceman's abdominal problems.
The above findings provide strong evidence that a form of medical therapeutics, very similar to what we know as Chinese acupuncture, was already in practice 5200 years ago in Central Europe. The permanent tattoos served either as a form of prolonged treatment for the arthrosis and the abdominal disorders, or as markers for application of acupressure or acupuncture to be applied by a non-medical person. The locations of the tattoos are similar to points used for specific disease states in the traditional Chinese and modern acupuncture treatment.
A treatment modality similar to acupuncture thus appears to have been in use long before its previously known period of use in the medical tradition of ancient China. This raises the possibility of acupuncture having originated in the Eurasian continent at least 2000 years earlier than previously recognised.
We thank Dora Hsu and Philip Kilner for essential suggestions conceming the final version of the manuscript.
THE LANCET • Vol354 • September 18, 1999 Lancet 1999; 354:1023-25
Physlologlcal Institute, University of Graz, Austria (L Dorfer MD, M Moser PhD, T Kenner MB);
Austrian Society for Controlled Acupuncture Graz, Austria (L Dorfer);
Joanneum Research Institute for Noninvasive Diagnosis, Weiz, Austria (M Moser,T Kenner);
German Academy for Acupuncture and Auriculomedicine, Munich, Germany (E Bahr MB);
Institute for Pre- and Protohistory, University Innsbruck, Austria(K Spindler PhO);
Pathological Institute, Bozen/Bolzano, Italy (E Egarter-Vigt MD);
Centro Maliqui, Iio, Peru (S Giulien PhD);
Institute for Hlstology and Embryology, University Graz, Austria (G Dohr MD)
M Moser, Physiological Institute, University of Graz, A-8010 Graz, Harrachgasse 21
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Authors: L Dorfer, M Moser, F Bahr, K Spindler, E Egarter-Vigl, S Giull‘n, G Dohr, T Kenner