A medical report from the stone age?

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).

...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).

...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.

...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.