Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine

Volume 2015, Article ID 703439, 8 pages
http://dx.doi.org/10.1155/2015/703439

Review Article
A Modern Clinical Approach of the Traditional
Korean Saam Acupuncture

Manyong Park1,2 and Sungchul Kim1,2

1
Wonkwang University Korean Medical Hospital, Department of Acupuncture & Moxibustion, Gwangju, Republic of Korea
2
ALS Center of Wonkwang University Korean Medical Hospital, Gwangju, Republic of Korea

Correspondence should be addressed to Sungchul Kim; kscndl@hanmail.net

Received 19 March 2015; Accepted 28 April 2015

Academic Editor: Salih Mollahaliloglu

Copyright © 2015 M. Park and S. Kim. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Saam acupuncture is one of the original therapeutic modalities representing traditional Korean medicine. It was originally described
in a manuscript that is estimated to be published at some point between 1644 and 1742, in the middle of the Cho Sun dynasty, by
a Korean Buddhist monk whose name is unknown. The principle of combining five shu points is based on the theory of Nan-
jing. The treatment and diagnosis concepts in Saam acupuncture were mainly influenced by Dongeuibogam and Chimgoogyeong-
heombang. The basic characteristic of combining five shu points in Saam acupuncture is the selection of the tonification and
sedation points along the self-meridian and other meridians based on creation and governor relationships. Saam acupuncture
clinical studies have mainly focused on musculoskeletal pain and autonomic nervous system regulation. From a neurophysiological
perspective, Saam acupuncture, which involves five shu points as the main treatment aspect, has the advantage of increasing
parasympathetic nerve activation and adjusting the balance of the autonomic nervous system. Inserting a needle into the skin
layer while considering the respiratory phase and stimulating the needle gently and lightly could maximize the effect of Saam
acupuncture. The specific Saam acupuncture prescribed should be identified on the basis of the neurobiological perspective.

1. Introduction and control cycles of the five-element theory. Therefore, the

combination of acupoints in Saam is easier to understand
Saam acupuncture, which is one of the original therapeutic from the perspective of traditional medicine.
modalities representing traditional Korean medicine, is a The meridian is divided into three parts: the arm or
unique treatment method that has a different origin than the foot, three yin and yang, and six ZangFu parts. A total
modalities from China and Japan. The basic characteristic of 24 deficiency and excess symptoms, with 24 coldness
of combining five shu points in Saam acupuncture is the and fire symptoms, exist across the 12 meridians, but the
selection of the tonification and sedation points along the diagnostic criteria related to these symptoms are too ambigu-
self-meridian and other meridians based on creation and ous for selecting a correct meridian. Except for the regular
governor relationships. In China, five element acupuncture, 48-treatment protocol, the treatment strategies are largely
tonification, and sedation points along only the self-meridian variable. Efforts were made to produce Saam treatments that
are selected. Japanese meridian therapy added source point, are more effective by including other acupoints, with the
connecting point, cleft point, alarm point, and transport main points firmly based on the regular pattern [2]. However,
point on the basis of Korea Saam acupuncture conception of because the explanation regarding acupoint selection is very
the combined five shu points [1]. brief or elided, applying Saam acupuncture in the clinic is
Saam acupuncture is based on the traditional concepts difficult.
of yin-yang, five elements, ZangFu (viscera and bowels), Various Korean scholars have suggested different meth-
qi, and meridians. Saam acupuncture treatment cannot be ods for applying Saam acupuncture in the clinic. Lee [3] pro-
separated from these viewpoints. In particular, it involves posed a diagnostic system by comparing pulse examination,
the application of five shu points according to the creation whereas Kim [4] proposed a symptom-based diagnosis.
2 Evidence-Based Complementary and Alternative Medicine

Cho [5] established visceral pattern identification for provid- points. Further, an acupuncture method based on the five
ing easy access to Saam acupuncture by analyzing Neijing element principles is presented in the acupuncture section
(Internal Classic), Nan-jing (Classic of Difficult Issues), and of the Dongeuibogam. The idea of treating a disease derived
Yixuerumen (Introduction to Medicine). Moreover, Kwon [6] from viscera/bowel dysfunction by using five shu points
studied constitutional acupuncture, and Kim [7] reviewed the influenced Saam acupuncture [1].
mind-based aspect of Saam acupuncture.
However, a description of the mechanism of acupuncture 3. The Basic Theory of Combining Five Shu
to both clinicians and patients in mainstream medicine by
Points in Saam Acupuncture
using the contemporary concepts of neurobiology would be
helpful for incorporating Saam acupuncture into mainstream The following phrase is taken from the 69th chapter of Nan-
medicine [8]. An important difference between traditional jing: “In the case of depletion, fill the respective mother, in
Korean medicine and the Western medical approach is the case of repletion, drain the respective child, one must
the diagnostic process. In traditional Korean medicine, the fill the first and then drain afterward.” Gao-Wu, of the Ming
diagnosis is made by using the principles of syndrome Dynasty of China (1519 A.D.), was the first acupuncturist to
differentiation, which could be in accordance with the state describe the use of tonification and sedation points along the
of the ZangFu or qi or with the doctrine of the meridians self-meridian by using the five shu points according to the
[9]. This diagnostic process does not match the patterns in 69th issue of Nan-Jing. Zhang Shi Xian advocated the use of
Western medicine. five shu points in other meridians in Jiao Zheng Tu Zhu Nan
In this paper, several neurobiological mechanisms of Jing (Illustrated note of Classic of Difficult Issues) [11]. On the
Saam acupuncture treatment are presented from the per- basis of Gao-Wu and Zhang Shi Xian treatment, Saam added
spective of the clinician. Saam acupuncture clinical trials are the role of the governor. This notion originated from the 50th
also discussed. Further, the historical background of Saam and 75th chapters of Nan-Jing.
acupuncture and the basic principle of combining acupoints In Saam acupuncture, the relationship with the governor
are briefly reviewed. is important, as is the relationship between the mother
and son. The governor is sedated under the condition of
2. The Historical Background of deficiency and is tonified under the condition of excess [13].
Saam Acupuncture The basic rules are those of the creation and governor
relationships. In the case of insufficiency of any meridian, the
The original manuscript that described Saam acupuncture is mother points of its mother and its own meridians should
estimated to have been published between 1644 and 1742, in be tonified and the governor points of its governor and its
the middle of the Cho Sun dynasty, by a Korean Buddhist own meridians should be sedated. For example, the following
monk whose name is unknown. Because Chimgoogyeong- is applied if the lung meridian is diagnosed as deficient:
heombang (Experiential Prescriptions of Acupuncture and earth tonification, lung meridian-earth point LU9 and spleen
Moxibustion), which was published in 1644, is quoted in the meridian-earth point SP3 and fire sedation, lung meridian-
manuscript of Saam acupuncture, the publication period of fire point LU10, and heart meridian-fire point HT8 (Table 1).
the Saam acupuncture manuscript can be estimated to be The other meridians follow the same rule, as described above.
after 1644 [10]. After 1742, Gy-san’s clinical experience was In the case of the excess of any meridians, the governor
added to the original manuscript of Saam acupuncture, that points of its governor and its own meridians should be
is, Gyeongjeyogyeol (Essential Rhymes on Acupuncture and tonified and the son points of its son and its own meridians
Moxibustion by Master Saam). This is the oldest existing should be sedated. For example, the following is applied if the
manuscript associated with Saam acupuncture. The physiol- lung meridian is diagnosed to be excessive: fire tonification,
ogy, pathology, and disease identification sections of Saam lung meridian-fire point LU10, and heart meridian-fire point
were handed down to its disciples, but the clinical experience HT8 and water sedation, lung meridian-water point LU5, and
section of Gy-san coexists in the currently published Saam kidney meridian-water point KI10 (Table 2).
acupuncture-related books [11]. Another simple but rarely used one is coldness-fire
Viscera/bowel-based acupuncture was developed in acupuncture treatment derived from the deficiency-excess
Chimgoogyeong-heombang (Experiential Prescriptions of acupuncture treatment. For cold symptoms, the fire points
Acupuncture and Moxibustion), with integration of the of its own and the fire meridians are tonified and the Water
meridian/exterior theory with the viscera manifestation points of its own and the water meridians are sedated. For
theory, which in turn provided various methods for viscera heat symptoms, the water points of its own and the water
diagnosis. Viscera identification became the basis of Saam meridians are tonified and the fire points of its own and the
acupuncture treatment [12]. fire meridians are sedated (Table 2).
The Dongeuibogam (Treasured Mirror of Eastern Among the clinical case studies of Saam, 85% used
Medicine) contains the following phrase: “One acupuncture either a tonification or a sedation formula, whereas 15%
needle in all the diseases, up to within four acupuncture used variations of the tonification and the sedation formulae
needles, acupuncture on the whole body is not a good idea.” [13]. Saam treatment primarily focuses on the viewpoints
This phrase represents the characteristics of the traditional of deficiency-excess symptoms rather than cold-heat symp-
Korean acupuncture method. In this context, Saam toms [1]. The 240 acupuncture treatments described in the
acupuncture treated the disease within four acupuncture Gyeongjeyogyeol consist of 100 regular forms on the basis of
Evidence-Based Complementary and Alternative Medicine 3

Table 1: Saam’s combination of five shu points for deficiency and excess of the meridians.

Deficiency Excess
Meridian
Tonify Sedate Tonify Sedate
Lung SP3 LU9 HT8 LU10 HT8 LU19 KI10 LU5
Large intestine ST36 LI11 SI5 LI5 SI5 LI5 BL66 LI2
Stomach SI5 ST41 GB41 ST43 GB41 ST43 LI1 ST45
Spleen HT8 SP2 LR1 SP1 LR1 SP1 LU8 SP5
Heart LR1 HT9 KI19 HT3 KI19 HT3 SP3 HT7
Small intestine GB41 SI3 BL66 SI2 BL66 SI2 ST36 SI8
Bladder LI1 BL67 ST36 BL54 ST36 BL54 GB41 BL65
Kidney LU8 KI7 SP3 KI3 SP3 KI3 LR1 KI1
Pericardium LR1 PC9 KI10 PC3 KI10 PC3 SP3 PC7
Triple energizer GB41 TE3 BL66 TE2 BL66 TE2 ST36 TE10
Gall bladder BL66 GB43 LI1 GB44 LI1 GB44 SI5 GB38
Liver KI10 LR8 LU8 LR4 LU8 LR4 HT8 LR2

Table 2: Saam’s combination of five shu points for cold and heat symptoms of the meridians.

Cold Fire
Meridians
Tonify Sedate Tonify Sedate
Lung HT8 LU10 LU5 KI10 LU5 KI10 SP3 LU9
Large intestine SI5 ST41 LI2 BL66 LI2 BL66 SI5 ST41
Stomach ST41 SI5 ST44 BL66 ST44 BL66 ST36 BL54
Spleen SP2 HT8 SP9 KI10 SP9 KI10 SP3 KI3
Heart HT8 KI2 HT3 KI10 HT3 KI10 HT8 KI2
Small intestine SI5 BL60 SI2 BL66 SI2 BL66 SI8 ST36
Bladder SI5 BL60 SI2 BL66 SI2 BL66 ST36 BL54
Kidney HT8 KI2 KI10 HT3 KI10 HT3 SP3 KI3
Pericardium HT8 PC8 PC3 HT3 PC3 HT3 SP3 PC7
Triple energizer TE6 BL60 TE2 BL66 TE2 BL66 TE6 BL60
Gall bladder GB38 SI5 GB43 BL66 GB43 BL66 BL54 GB34
Liver LR2 HT8 KI10 LR8 KI10 LR8 LR3 SP3

the 69th issue of Nan-Jing, 140 irregular forms on the basis the effect that can be attributed to Saam acupuncture is
of the 73rd and 75th issues, and various special acupuncture difficult. Notably, treatments other than Saam acupuncture
points, which include the source, connecting, accumulation, were well controlled in five cases.
alarm, and back-transporting points [14]. In the case of a sleep disorder caused by a traffic accident,
tonification of gall bladder improved sleep quality [15]. In
4. Saam Acupuncture Clinical Research traditional Chinese medicine (TCM), the gall bladder serves
to buffer psychological anxiety. Because the cause of insomnia
To review clinical articles on Saam acupuncture, we used the was determined to be a gallbladder deficiency, gallbladder
following six databases: “Korean Studies Information Service tonification was selected as the solution.
system (KISS)”, “National Discovery for Science Leaders Modified Saam acupuncture was used to treat 17 patients
(NDSL),” “Research Information Sharing Service (RISS),” with refractory, sudden sensory-neuronal hearing loss of
“Oriental Medicine Advanced Searching Integrated System more than 3 weeks after a failed trial of conventional
(OASIS),” PUBMED, and Google Scholar. The key words were treatment including corticosteroids. The total improvement
“Saam” and “Saam acupuncture.” The retrieved papers were rate at 70.4 days after the initial visit was 47.1%. Thus,
screened so that only articles related to clinical research were Saam acupuncture might be effective for refractory sensory-
retained. We selected 28 case studies and 17 clinical studies. neuronal hearing loss in which conventional therapy has
failed [16].
4.1. Saam Acupuncture Case Studies. Saam acupuncture has A 30-year-old woman with a right adnexal mass was
been applied for several diseases, and these are summa- treated with Saam acupuncture for 14 weeks. After treat-
rized in Table 3. However, the number of cases is low, and ment, transvaginal sonography revealed disappearance of
various therapeutic modalities were combined with Saam the right adnexal mass. This effect may have been evoked
acupuncture except for some cases. Therefore, recognizing by modification of autonomic nerve activity as a result, for
4 Evidence-Based Complementary and Alternative Medicine

Table 3: Saam acupuncture clinical case reports.

Year Disease 𝑁 Period

1964 Eyelid edema 1 7 days
1975 Indigestion, HNP of lumbar 3 2–5 days
1981 Neurosis, duodenal ulcer 2 14 days
1998 Hyperemesis gravidarum 1 15 days
2002 Hwa-byung 2 5 months
2002 Wei symptom 1 2 months
2002 Oral dyskinesia 1 1 month
2003 Hemichorea-hemiballism 1 8 days
2003 Sequelae of CVA 1 10 months
2003 Hemorrhoid 2 10 days
2003 Fracture 1 1 month
2004 Lumbar compression fracture 1 14 days
2004 Insomnia 20 3 days
2006 Otitis media 3 1 month
2007 Tic disorder 1 3 months
2008 Knee strain 1 1 week
2008 Inflammatory acne 1 2 months
2009 Cancer pain 1 2 months
2010 Hearing loss 17 10 weeks
2011 Foot coldness 1 1 week
2012 ALS 1 5 days
2012 Meniere’s disease 1 3 weeks
2013 Adnexal mass 1 14 weeks
2013 Calcific tendinitis of shoulder 1 7 days
2013 ALS 18 5 days
2014 Cancer 10 14 days
2014 Chronic post-stroke hemiparesis 7 1 month
𝑁: number, ALS: amyotrophic lateral sclerosis, CVA: cerebrovascular accident, and HNP: herniated nucleus pulposus.

example, of reflex alteration of ovarian sympathetic nerve to knee pain derived from osteoarthritis [23], posterior ear
activity [17]. pain due to Bell’s palsy [24], and chronic tension headache
Modified Saam acupuncture (LU8, BL66, SI5, TE4, and [25]. Musculoskeletal pain-related clinical researches of Saam
CV12) was used to treat 10 cancer patients for 2 weeks with 4 acupuncture mentioned above showed good results.
sessions. CD3+, CD8+, and T-cell subsets were significantly In clinical trials related to autonomic nervous system
increased and the fatigue severity scale score was significantly dysfunction, visceral pattern identification was used as the
decreased. Therefore, Saam acupuncture may improve the diagnostic criteria. For example, in case of Hwa-byung
immune system [18]. (Korean somatization disorder) [26–28], the heart or peri-
Finally, peripheral capillary oxygen saturation (SpO2 ) cardium meridian, which is associated with psychological
was significantly increased in 18 amyotrophic lateral sclerosis
states in TCM, was selected. A tonification of pericardium
patients with respiratory dysfunction who were treated with
was effective on the treatment of Hwa-byung. When the
lung tonification [19].
balance of the autonomic nervous system was disrupted by
4.2. Saam Acupuncture Clinical Research. Clinical studies of night-shift working [29], the gallbladder meridian that fits the
Saam acupuncture were mainly performed in relation to mus- psychological proportion was selected. A tonification of gall-
culoskeletal pain and autonomic nervous system regulation bladder could attenuate the imbalance between sympathetic
(Table 4). Meridian identification was predominantly used and parasympathetic activities. When the face temperature
when Saam acupuncture was applied to musculoskeletal pain. dropped because of smoking [30], the fire acupoints of a
For example, when leg pain and numbness were present due fire organ (heart) and water organ (kidney) (HT8 and KI2,
to a herniated disc, bladder tonification was selected if the resp.) were selected as the treatment points. 5 of the 7
symptom occurred towards the back of the leg, and gall blad- subjects showed increased temperatures after fire tonifica-
der tonification was used if the symptom occurred towards tion treatment. In order to decrease hypertension in stroke
the lateral side of the leg, according to the flowing area patients [31], the bladder meridian, which has water and
of the meridian [20–22]. This principle was applied equally cold attributes, was applied. After 30 minutes of treatment,
Evidence-Based Complementary and Alternative Medicine 5

Table 4: Saam acupuncture clinical research.

Year Disease 𝑁 Period Method

1999 Lumbar HNP 28 5 weeks SA + GBA/GBA
2002 Sciatica and back pain 40 10 days SA + GBA/GBA
2002 Lumbar HNP 29 1–10 weeks SA + GBA/GBA
2003 Dysarthria 20 10 days SA/GBA
2004 Hypertension 60 1 hour SA/BR
2004 Posterior ear pain 30 10 days SA/GBA
2006 OA of knee 78 4 weeks SA/ShA (Park sham needle)
2007 Chronic tension headache 26 2 weeks SA/ShA (nonacupoint)
2007 Dysmenorrhea 8 1 month SA/ShA (acupoint not related to gynecological disorders)
2007 Obesity 60 4 weeks SA/ShA (Kim sham needle)/NA
2007 Fatigue 56 4 weeks SA/ShA (nonacupoint)
2007 Hwa-byung 23 2 weeks SA/ShA (nonacupoint)
2008 Hwa-byung 52 2 weeks SA/ShA (nonacupoint)
2011 Autonomic nerve disorder 6 6 days SA/ShA (Park sham needle)
2011 Hwa-byung 50 2 weeks SA/ShA (nonacupoint)
2012 Facial temperature 7 6 days SA/ShA (Kim sham needle)
2013 Peripheral neuropathy 10 8 weeks SA/NA
HNP: herniated nucleus pulposus; OA: osteoarthritis, SA: Saam acupuncture; GBA: general body acupuncture; ShA: sham acupuncture; BR: bed rest; NA: no
acupuncture; 𝑁: number.

a tonification of the bladder meridian significantly depressed nervous system, thereby controlling chemical or hormone
the systolic and diastolic blood pressure. release to the diseased or disordered organs for treatment.
Although the method of setting the test and control From this point of view, inserting a needle in the distal limb
groups differed slightly for each study, the use of a sham may be more advantageous for inducing physiological activity
needle device for the control group appears to be the most caused by acupuncture than needling in the trunk.
desirable condition for scientific research. The Park sham Acupuncture likely has an effect on homeostasis via the
needle was used to blind the participants [32], and the Kim somatic autonomic reflex [35]. This homeostasis between
sham needle was used to blind both the practitioner and the sympathetic and parasympathetic nerve is frequently
participants [30]. believed to be the scientific basis for the concept of the
Comparing the simultaneous application of Saam balance between yin and yang in TCM. The neural pathways
acupuncture and general body acupuncture and a single involved in this acupuncture action have been well investi-
application of general body acupuncture is not suitable gated in animal studies [36, 37].
[20–22] because the amount of stimulation is different. Sato [37] showed that acupuncture stimulation in the
Treating the control group by needling a nonacupoint is extremity facilitates gastric motility through a somatic
also problematic because the selection of nonacupoint near parasympathetic reflex associated with the vagal nerve in
the five shu points could result in similar neurobiological animal studies. In his studies, the response disappeared after
activity. Notably, no significant difference was observed either spinal transaction at the cervical level or bilateral
between the test and control groups in the Hwa-byung severance of the vagal nerves. This suggests that a mechanism
studies [26, 27]. In fatigue studies, the test group as well as exists at the brain level related to a somatic parasympathetic
the control group exhibited statistically significant effects in reflex through the vagal nerve.
the multidimensional fatigue scale [33]. Nishijo et al. [38] revealed that acupuncture stimulation
at PC4 decreased the heart rate as a result of the reciprocal
coordination of an increase in cardiac vagal activity and a
5. Neurobiological Mechanisms of Saam decrease in cardiac sympathetic activity in healthy humans.
Acupuncture for Clinical Application In this case, the reflex pathway might involve an afferent
somatic nerve that goes to the brain and spreads to various
Saam acupuncture principally uses the acupoint below the structures in the hypothalamus, the midbrain, the medulla,
elbow and knee joint. The five shu points occupy large areas and eventually to the autonomic efferent nerve.
in the cortical representation in the postcentral sensory gyrus Acupuncture stimulation on the abdomen impedes gas-
in the brain. Cho et al. [34] stated that, based on their tric motility [37]. Studies also showed that the response was
knowledge of Western medicine, it is difficult to believe that maintained after spinal transection at the cervical level but
acupuncture treats organ-related disorders and diseases by was absent after bilateral severance of the gastric sympathetic
direct control of organs. Acupuncture may first stimulate nerve. This suggests that the reflex pathway is propagated
or activate the corresponding brain cortex via the central within the spinal level, and acupuncture points within certain
6 Evidence-Based Complementary and Alternative Medicine

spinal segments in the trunk tend to affect the functioning of 6. Conclusion

the organs that receive autonomic innervation from the same
spinal segments through the sympathetic nerve. The original Korean acupuncture method, Saam acupunc-
The effect of acupuncture stimulation varies depend- ture, was invented 400 years ago by a Korean Buddhist
ing on the depth of the insertion, the respiratory phase, monk based on the foundation of Dongeuibogam and
stimulation dose, and observation period. Mori et al. [39] Chimgoogyeong-heombang. He embodied Nan-jing’s theory
showed that needling at TE5 induced pupillary constriction as an acupuncture treatment. Because Saam acupuncture
by increasing parasympathetic nerve action. An increase was created on the basis of the theory of oriental medicine,
in parasympathetic nerve function was observed after gen- approaching Saam acupuncture in the clinic via the oriental
tle, superficial acupuncture stimulation. Bäcker et al. [40] medical diagnosis is easy. However, for Saam acupuncture
revealed that, when inserting the needle at LI4, high-dose to be recognized as a medical acupuncture and to be used
stimulation resulted in a greater increase in sympathetic as a universal treatment in many countries, the mechanism
nerve activity than low-dose stimulation. of Saam acupuncture should be explained through scientific
verification. Saam acupuncture, which operates with five shu
Haker et al. showed that stimulation of the thenar muscle points as a main aspect of treatment, has the advantage of
(LI11) resulted in a significant increase in sympathetic and increasing parasympathetic nerve activity and adjusting the
the parasympathetic activity during the stimulation period balance of the autonomic nervous system. To maximize this
and during the poststimulation period. A significant decrease effect, inserting a needle into the skin layer and providing
in the heart rate at the end of the poststimulation period gentle and light stimulation while considering the respiratory
was also demonstrated. Superficial needle insertion into the phase may be desirable.
skin overlaying the right thenar muscle caused a pronounced
increase in the balance of both the sympathetic and parasym-
pathetic activities during the 60 min poststimulation period Conflict of Interests
[41].
The authors declare that there is no conflict of interests
Tanaka et al. demonstrated that SES (superficial needling regarding the publication of this paper.
exhalation phase in a sitting position) stimulation signif-
icantly decreased headache intensity, with a strong trend
towards decreasing static electromyography (EMG) activity Acknowledgments
compared to CONT (without considering the respiratory
phase) stimulation [42]. This suggests that the effect of This study was supported by Wonkwang University in 2015.
acupuncture is derived from point selection of matching
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