- Author: Hyo-Jung Kwon(Department of Acupuncture & Moxibustion, Brain & Neurological Disorders and Pain, Yong-Suk Kim(Kangnam Korean Hospital, Kyung Hee University, Seoul, Korea)
- Copyright © 2015 by authors and Scientific Research Publishing Inc.
5. Practice of Saam Acupuncture
Saam acupuncture is primarily focused on Five Shu points, which contradicts other acupuncture methods. For example, backache can be caused by disturbances of the Bladder Meridian, so one can use tonification or sedation of the Bladder Meridian depending upon deficiency or excess. Backache can also be caused by weakness of the Kidney Meridian, which one can then treat by using tonification of the Kidney Meridian. Finally, backache is caused due to excessive dampness of the Spleen, which can be diagnosed in obese people. One can then use tonification of the dry Large Intestine Meridian or Stomach Meridian in order to dry out dampness. Sedation of the damp Spleen Meridian can also be used on rare occasion. The selection of tonification or sedation depends wholly upon the diagnosing practitioner.
Backache is generally associated with Kidney or Bladder functions. The Governor vessel and Gallbladder Meridian, with little connection to other Meridians, can also be involved in backache. Saam acupuncture treats backache using a novel approach. It relates backache to the malfunction of connected Organs (i.e. the Bladder, Kidney and Gall Bladder) to the imbalance of Yin and Yang (Six Qi) while primarily using Five Shu acupuncture points. It is a wonder how the combination of the acupoints distal to the painful region and located beneath the elbow and knee joints can treat diseases such as backache, shoulder pain, and whatnot. This wonder may be understood using Yun-Tao-Mao’s neurobiological fact: as the limbs below the elbows and knees occupy larger areas in the sensory gyrus in the brain and the acupoints below the elbows and knees contain more sensory receptors, needling stimulation to these points may induce a greater reaction and activity in the brain. This principle clearly supports the concept of using certain acupoints below the elbows and knees, such as the Five Shu points, as diagnosis and treatment points during acupuncture treatment.
In cases of interruption, acupoints are selected based on local and special effects in correlation with efficacy. Five Shu points are selected for either deficiency or excess conditions to tonify or sedate in cases of imbalance. Overall acupuncture treatment method that covers the treatment of interruptions and imbalances of illnesses should be selected. For instance, more effective treatment result may be achieved if we use Saam acupuncture as a “root treatment” to correct imbalances but then combine it with Meridian style acupuncture, channel therapy acupuncture (which uses local and distal acupoints), special acupuncture points, or symptomatic treatment Meridian therapy, as “branch treatments”, to correct interruptions in proper stimulation technique.
The original form of Saam acupuncture can be used from the perspective of the Five Organs, disease etiology, imbalanced Yin and Yang, the mind-only theory and the comparing-pulse diagnoses such as Lee [21] and Kim [22].
6. Saam Acupuncture in Research
It was reported that treatment following Saam acupuncture theory produced a positive effect on the dysarthria symptom of stroke patients, which was more prominent than the effects noted from using body acupuncture common in Korean acupuncture and traditional Chinese medicine [23]. It was also reported that acupuncture following Saam acupuncture treatment combined with conventional body acupuncture produced more pronounced results than those of body acupuncture alone [24].
One recent study [25] reported that Saam acupuncture may attenuate the imbalance between sympathetic and parasympathetic activities induced by night-shift work in nurses. Hwang et al assessed the effects of Saam acupuncture
on the autonomic nervous system in night-shift nurses using power-spectral heart-rate variability (HRV) analysis. This study had a 2 × 4 cross-over design with a series of six (n = 1) controlled trials. Six night-shift nurses were randomly divided into two groups, and each nurse received four acupuncture treatments on the third day of night-shift work. One group started with Saam acupuncture (Gall Bladder-tonification), while the other started with sham acupuncture. Saam acupuncture and sham acupuncture were applied in turn. HRV was measured before and after treatment. For statistical analysis, the results of the two groups were combined, and a Bayesian model was used to compare the changes in HRV values before and after treatment, between Saam and sham acupuncture. As the ratio of low-to high-frequency power (LF/HF) for HRV increased on the third day of night-shift work in the pilot study, HRV measurements were made on the third day. Compared with sham acupuncture, Saam acupuncture reduced sympathetic activity; the overall median treatment effect estimate in LF normalized units decreased by −17.4 (confidence interval (CI): −26.67, −8.725) and that for LF/HF decreased by −1.691 (CI: −3.222, −0.3789). The overall median treatment effect estimate in HF normalized units increased by 17.41 (CI: 6.393, 27.13) with Saam acupuncture, suggesting an increase in parasympathetic activity.
7. Taegeuk Acupuncture
Taegeuk acupuncture is based on Sasang constitutional medicine, which makes the Heart the Central Ultimate, or taichi (“taegeuk”), of the Organs and classifies the body into four types by the relative size of the Organs. It decides the constitution first and tonifies or sedates the source point of the relevant Organ according to the size of the Organs. For example, Tae-yang (Greater Yang) constitution belongs to Metal, Tae-eum (Greater Yin) to Wood, So-yang (Lesser Yang) to Fire, and So-eum (Lesser Yin) to Water, and thus the Fire, Metal, Water, and Earth acupoints (HT8, HT4, HT3, HT7) of the Heart Meridian are tonified, for they are of the Five Elements that control the original dominant Organs. By doing so it compensates for the loss of balance, and can further balance the power of Organs by depleting the source point of the relevant Meridian according to the size of the other Organs, thus helping the patient get over his or her own disease by him or herself.
Sasang constitutional medicine describes four constitutions—Tae-yang, Tae-eum, So-yang and So-eum—which indicate constitutional energy discrepancies among major Organs. According to the Sasang constitutional theory, an aggravated energy discrepancy among major Organ energies is the underlying causative imbalance of superficial pathologic conditions [4] [26]. Lee Je-Ma, founder of the Sasang constitutional medicine, prescribed different combinations of herbs for his patients based on their respective constitutions, even if the patients came to seek him with apparently similar diseases. Rather than dealing with thousands of different diseases, practitioners could deliver four simple types of treatment for diverse illnesses aimed at recovering the energy balance of the constitution. Lee Je-Ma’s original system of Sasang constitutional medicine lacked an acupuncture treatment system for the four constitutions.
Taegeuk acupuncture is originated by Lee Byeong-Haeng, as a response to Lee Je-Ma’s testament that stated, “A doctor needled LI4 of a patient of So-eum constitution suffering dysarthria from stroke and the effect was astonishing that there may be other diseases that are better cured by acupuncture than medicine. Acupoints may be applied to the four constitutions as well; therefore further research is called for in the future”. LI4 is the source point of the Large Intestine Meridian, and theoretically in Sasang constitution the Large Intestine is substituted for Kidney because of the principle that the Kidney should not be sedated. The source point is sedated for Kidney is the large Organ in So-eum constitution.
Taegeuk acupuncture provides acupuncture prescriptions for the correction of the underlying energy discrepancies that are assumed in Sasang constitutional medicine. Lee Byeong-Haeng suggested that observation of reactions to acupuncture stimulation of the Heart Meridian acupoints might be helpful in determining the type of constitution that the patient belongs to, because Heart energy plays a central role in controlling other Organs in the system of Sasang constitutional medicine [4].
For example, the constitutional characteristics of the Tae-yang constitution come from the discrepancy between a large Lung and a small Liver energy. According to the Taegeuk acupuncture theory, Tae-yang constitution is considered to be in a state of Metal excess, which may be regulated by stimulating HT8, the Fire point of the Heart Meridian. Fire suppresses Metal from the perspective of the control cycle relationships of the Five Elements. Similarly, people with the Tae-eum constitution have a large Liver and small Lung energy, and are considered to be in a state of Wood excess, which can be regulated by stimulating HT4, the Metal point of the Heart Meridian.
Kim [27] testifies that in his experience the duration of treatment lasted in average three to four months, and some diseases took six to seven months to cure. Lee Byeong-Haeng used the rotation method and numbers method to tonify and sedate. Kim added respiratory method to prevent fainting during acupuncture intervention. To tonify, place needle while the patient inhales and rotate clockwise for nine times or the multiple of nine times. To sedate place needle while the patient exhales and rotate counter-clockwise for six times or the multiple of six times. Rotate until deqi is attained.
The judgment of the constitution may be the most important step in practicing Taegeuk acupuncture. It is done by tonifying the controlling Five Elements acupoint of the Heart Meridian and tonifying or sedating the source point of the small and large Organs’ Meridians of an assumed constitution. After placing those three needles, press the solar plexus to confirm the constitution by the tenderness response. When the needles placed are in accord with the patient’s constitution the tenderness is gone about 60% – 70%, and when the acupoints are not relevant with the patient’s constitution they reply about 20% – 30% of the tenderness is gone. It is best to do the test 1 – 2 minutes after practicing Taegeuk acupuncture.
The symptoms for which Taegeuk acupuncture is effective are listed below by Lee. The exemplified treat ments are for patients with So-yang constitution.
- A stroke patient with hemiplegia can move his or her limbs when HT3 is tonified.
- Tinnitus disappears at the site.
- Headache, stomachache and numbness of hands and feet are cured at the site.
- Hiccupping stops short.
- It is hard to confirm the cure of stomach cancer but the pain disappears at the site.
- Eyesight becomes bright.
- Fatigue is recovered at the site.
- Myalgia is reduced.
- Low back pain is cured at the site.
Kim also summarizes his clinical experience and introduces the response of patients after Taegeuk acupuncture.
- Taegeuk acupuncture is effective for psychogenic disease with symptoms such as palpitation, forgetfulness, insomnia, anxiety, impatience, chest discomfort, shortness of breath, headache, dizziness, and nausea. They relate
to disease such as depression, chronic insomnia, aphasia, tic disorder and deficiency of Heart, Gall Bladder and Spleen. - Taegeuk acupuncture is effective for illnesses caused by blood circulation disorder such as blurry eyesight, pallor, headache, dizziness, stiff neck, menstrual pain, morning edema, small joint pain, etc.
- Taegeuk acupuncture is effective for incurable diseases such as hand tremor, shaky head, facial spasm, convulsion of unknown reason, and for diseases for which standard acupuncture worsens the symptoms.
- Taegeuk acupuncture can be used alongside standard acupuncture for:
1) Tinnitus or sudden deafness by needling TE21, SI19, TE17 of the affected side;
2) Trigeminal neuralgia by needling ST4-ST6, ST7-TE17, GB14-TE23 (electro-acupuncture) of the affected side;
3) Bell’s palsy by needling ST4-ST6, ST7-TE17, GB14-TE23 (electro-acupuncture) of the affected side;
4) Unhealed ankle sprain after 3-6 months by using standard acupuncture following the Meridian of the affected side.
In cases of patients with marked solar plexus tenderness, Taegeuk acupuncture is practiced after the diagnosis of the constitution, regardless of the chief complaint whether it is stiff neck, lower back pain or knee joint pain. The following reaction usually results.
1) The mind is calmed and head becomes clear;
2) Chest discomfort disappears;
3) Vision becomes bright;
4) Digestion is boosted, and one feels hunger;
5) One becomes drowsy;
6) The acupuncture treatment site is painful;
7) One does not notice any difference.
The above 1 – 7 reactions are those of the patients right after one treatment session of Taegeuk acupuncture. After 1 – 2 days of the first treatment, the reactions are as follows:
1) Sleeps well at night after acupuncture treatment;
2) Body feels lighter;
3) Fatigue seems to be less;
4) Chronic and recurrent joint pain such as neck stiffness, knee pain and backache seems to be relieved;
5) Myalgia and spasm seem to be improved;
6) Still not sure of any difference.
In one recent study [28] Taegeuk acupuncture had potential as an effective means of stabilizing mental stressinduced
imbalance of autonomic nervous system for So-yang constitution. In this study eight women diagnosed as So-yang constitution participated in a study on reducing mental stress assessed by heart rate variability.
They were randomly divided into group A and group B. Each participant went through 3 sessions every week with 1 week of washout period in between each session. HRV was measured three times at every session; at baseline, after administering mentally stressful circumstances and after applying either one of simple rest, So-yang Taegeuk acupuncture or So-eum Taegeuk acupuncture. This study was designed as a crossover clinical trial. After same initial simple resting session for both groups at week 1, acupuncture for group A were executed in the or der of So-yang Taegeuk acupuncture and So-eum Taegeuk acupuncture at week 2 and 3 respectively, with acupuncture for group B conducted in reverse order.
The simple rest and So-eum Taegeuk acupuncture did not show the significant changes in response to LF(norm) and HF(norm) after stress stimuli. So-yang Taegeuk acupuncture did, however, significantly decrease LF(norm) and increase HF(norm). So-yang Taegeuk acupuncture, compared to So-eum Taegeuk acupuncture, significantly stabilized autonomic nervous system.
