A Study of the Sa-Ahm Five Element Acupuncture Theory

Characteristics of five-phase acupoints from data mining of randomized controlled clinical trials followed by multidimensional scaling

Background

An unbiased assessment of clinical outcomes may provide greater insight into the characteristics of individual acupoints. In this study, we used machine-learning methods to examine clinical trial data for diseases treated using prescribed five-phase acupoint patterns.

Methods

We performed a search of acupuncture treatment regimens used in randomized controlled trials included in the Cochrane Database of Systematic Reviews. The frequencies of 60 five-phase acupoints were calculated based on 421 clinical trials on 30 diseases. The characteristics of prescribed five-phase acupoints were further analyzed using multidimensional scaling and K-means clustering.

Results

Among the five-phase acupoints, stream and sea acupoints were the most widely used, with well, spring, and river acupoints less common. Multidimensional scaling and cluster analysis revealed that the LR3, ST36, GB34, BL60, KI3, LI11, and HT7 acupoints exhibited distinct characteristics based on distances representing the similarity between acupoint indications.

Conclusions

The results suggest that stream and sea acupoints exhibit distinct characteristics compared to the other acupoints. Such data-driven approaches will improve our understanding of five-phase acupoints and facilitate the establishment of new models of analysis and educational resources for major acupoint characteristics.

A Literature Review of Clinical Studies Using Sa-am Acupuncture

Sa-am acupuncture originated in the Chosun Dynasty and is a distinct feature of Korean medicine. It has been used to treat various diseases and conditions in clinical practice however, there is insufficient scientific evidence to support the use of Sa-am acupuncture. We aimed to comprehensively review the clinical studies of Sa-am acupuncture retrieved from national and international databases (MEDLINE, EMBASE, the China National Knowledge Infrastructure, and 3 Korean databases). There were 52 articles reviewed including 29 case studies, 19 randomized controlled trials (RCTs), and 4 uncontrolled trials. Neurological disorders were the most frequently studied, and kidney tonification, and directional supplementation and draining were the most frequently used methods. Overall, the outcomes were generally positive however, there were many additional treatments together with Sa-am acupuncture reported in the case reports, and the quality of evidence was low in the RCTs. Future studies should report the detailed method of practicing Saam acupuncture treatment and focus on the specific effect of Sa-am acupuncture with rigorous design to scientifically support the clinical use of Sa-am acupuncture.

Diversity of Acupuncture Point Selections According to the Acupuncture Styles and Their Relations to Theoretical Elements in Traditional Asian Medicine: A Data-Mining-Based Literature Study

Acupuncture point (AP) selections can vary depending on clinicians’ acupuncture style, and therefore, acupuncture style is an important factor in determining the efficacy of acupuncture treatment. However, few studies have examined the differences in AP selections according to the acupuncture styles and theoretical backgrounds causing the differences. We compared the AP prescriptions used for 14 diseases in three classical medical textbooks, Dongeuibogam (DEBG), Saamdoinchimgooyogyeol (SADI), and Chimgoogyeongheombang (CGGHB), which represent unique acupuncture styles and have affected clinicians during this time. AP prescriptions showed more diversity between textbooks than between types of diseases. Among the three textbooks, AP prescriptions of SADI were most different compared to those of DEBG and CGGHB. Importantly, we found each style can be more clearly explained by AP attributes than by the APs per se. Specifically, SADI, DEBG, and CGGHB preferred five transport points located on the limbs, APs of the extra meridians, and source points, respectively. This suggests the possibility that the theoretical diversity of acupuncture styles results in the heterogeneity of AP selections.

Clinical Events Associated with Acupuncture Intervention for the Treatment of Chronic Inflammation Associated Disorders

Acupuncture is a key component of Chinese medicine. It describes a series of procedures involving the stimulation of skin through penetration of fine, single-use, sterile needles that result in the release of neurotransmitters. Although its use is on the growing trend, considerable controversy surrounds its value as a therapy. Standard randomized controlled trials that adhere to the accepted criteria should be conducted in the future to ensure the effectiveness of acupuncture. This article summarizes the current evidence regarding the use of acupuncture. It includes a description of the history, mode of operation, treatment of a variety of chronic disorders related to inflammation, and future directions for acupuncture use. Published clinical trials support the view that acupuncture is a possible candidate for the treatment of several chronic inflammation-related disorders.

Influence of Electroacupuncture and Laser-Acupuncture on Treating Paresthesia in Patients Submitted to Combined Orthognathic Surgery and Genioplasty

Objective: The goal of this research was to observe the influence of electroacupuncture (EA) and laser-acupuncture on the return of tactile/pain sensitivity in patients who underwent orthognathic surgery. Materials and Methods: Thirty volunteers subjected to orthognathic surgery were evaluated and randomly divided into 2 groups, in which 3 treatments were evaluated: control (n = 30) (G0, medication + placebo laser treatment) and 2 experimental treatments (n = 15) (G1, medication + EA) or G2 (medication + laser-acupuncture). The control group had n = 30 because for each experimental treatment conducted on a volunteer's hemi-face, there was a control treatment on the other hemi-face. In G1, medication was given with EA, with needles placed at predetermined points (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). For electrostimulation, the device used delivered transcutaneous electrical nerve stimulation of a burst type, with intensity and frequency variations of T = 220 ms and F = 4 Hz (30 minutes, 2 × /week). In G2, in addition to the medication, laser irradiation (at 780 nm) was applied on acupuncture points (at 0.04 cm², 70 mW, 6 s/point, 0.42 J/point, 10 J/cm², 2 × /week). All volunteers were evaluated before and during the 4 months following the surgery. Tactile sensitivity was assessed by mechanical brushing (brush #s 2 and 12) and by a 2-point discrimination test, using a bow compass. A pain test was performed with a pulp electrical test that stimulates intact nerves of the dentin-pulp complex. A Kaplan-Meier test was performed, and survival curves were plotted for comparison between groups. Cox regression analysis was also conducted (α = 0.05). Results: There were no statistically significant differences among the groups for the 2-point discrimination test (brushes #2 and #12) on the buccal mucosa region and for the pulp test on all evaluated regions. However, the tactile test using brush #12 revealed significant differences between G1 and the other groups when considering the lower lip (P = 0.024) and chin (P = 0.028) areas. Conclusions: Only EA was able to influence-using the brushing test (brush #12)-the return of tactile sensitivity on the chin and lower lip positively after combined orthognathic surgery and genioplasty.

A Modern Clinical Approach of the Traditional Korean Saam Acupuncture

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.

The Effects of Sa-am Acupuncture Simpo-jeongkyeok Treatment on the Blood Pressure, Pulse Rate, and Body Temperature

OBJECTIVES

The present study evaluated the effects of sa-am acupuncture (SAA) simpo-jeongkyeok (SPJK) treatment on the blood pressure (BP), pulse rate (PR), and body temperature (BT) of patients with hwa byung (HB).

METHODS

This patient assessor blind, randomized, placebo controlled trial included 50 volunteers, divided randomly into two groups. The treatment group underwent SPJK (PC9, LR1, PC3, KI10) while the control (sham) group received minimal needle insertion at non acupoints. The BP in both arms, PR, and BT at several acupoints were measured before and after treatment at the 1(st), 2(nd), 3(rd), and 4(th) visits and before treatment at the follow-up visit. We analyzed data by using the repeated measured analysis of variance (RM ANOVA), Mann-Whitney U, and wilcoxon signed rank tests; differences at P < 0.05 were considered significant.

RESULTS

No significant differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP) and PR between the treatment and control group were observed at each visit. However, the decrease in the SBP for the treatment group before and after each visit was significantly higher than it was in the control group. The SBP in both arms in the treatment group was decreased between visits 1 and 2, 1 and 3, 1 and 4, and 1 and follow-up. The DBP in both arms and in the right arm between visits 1 and 3 in the treatment group showed decreases. A minimal BT increase for treatment at CV06 and CV12 and a minimal BT decrease for treatment at CV17 and (Ex) Yintang were found. Patients in the treatment group who visited more frequently experienced a greater decrease in the PR, but that effect was not maintained.

CONCLUSION

The results suggest that SAA SPJK treatment has instant positive effects on the BP, PR, and BT in patients with HB, but the effects on the BP and PR are not maintained.

Treatment of Lymphedema with Saam Acupuncture in Patients with Breast Cancer: A Pilot Study

Background: Lymphedema is a troublesome complication affecting quality of life (QoL) in many women after breast-cancer treatment. Recent studies have suggested that acupuncture can reduce symptoms of lymphedema in breast-cancer survivors. Objectives: This was a pilot study. It was designed to assess the feasibility and the safety of acupuncture with the Saam acupuncture method for treating lymphedema in Korean patients after surgical therapy for breast cancer. Materials and Methods: This was a prospective, single-arm, observational pilot study using before and after measurements. The study was conducted at the East-West Medical Center at the Daegu Catholic University Medical Center, in Daegu, Korea. The subjects were 9 patients with breast cancer who presented with lymphedema of the upper limb ipsilateral to surgery. Saam acupuncture was administered 3 times per week for 6 consecutive weeks, for 30±5 minutes at each session.The primary outcome measure was severity of lymphedema as assessed by stages of lymphedema, a visual analogue scale (VAS), and by circumferential measurements of the upper extremity. The secondary outcome measure was QoL, which was assessed by a self-administered questionnaire using the Short Form-36 questionnaire. Results: Acupuncture reduced severity of lymphedema significantly, as assessed by the VAS (P<0.001) as well as by circumferential measurements of the upper extremity. Four weeks after the final treatment, symptoms were not aggravated. SF-36 scores remained significant for health status at the end of treatment. Conclusions: The Saam acupuncture method appeared to provide reduction of lymphedema among women after they had undergone surgery for breast cancer. A randomized, controlled prospective study with a larger sample size is required to clarify the role of acupuncture for managing lymphedema in patients with breast cancer.

A study of Sa-Ahm's thoughts on the four-needle acupuncture technique with the five-element theory

In order to study Sa-Ahm's underlying thoughts on the basis of Yin-Yang and the five-element theory, the 12 acupuncture meridian systems and eight extra meridian systems were investigated in detail. The clinical acupuncture points for Sa-Ahm's four-needle acupuncture technique were also reviewed. The forms of the combinations using the five Shu acupuncture points, which are based on the promotion and control cycles with tonification and sedation, were shown to connect to the acupuncture points, which represent the meridian system itself. However, not all of Sa-Ahm's clinical cases were fully explained by this doctrine, so the five correlations among the meridian systems and the acupuncture points that affect the clinical treatment and the occurrence of disease were determined. The mutual efficacies for Sa-Ahm's clinical cases can be analyzed and explained with correlativity diagrams that include five interrelations.

Efficacy of saam acupuncture treatment on improvement of immune cell numbers in cancer patients: a pilot study

OBJECTIVE

To collect preliminary data on the effects of Saam acupuncture with regard to the immunity in cancer patients.

METHODS

Ten cancer patients were analyzed for improvements in immunity. Acupuncture was applied at the 5 acupuncture points, Jingqu (LU 8), Zutonggu (BL 66), Yanggu (SI 5), Yangchi (TE 4), and Zhongwan (CV 12) for 2 weeks with 4 sessions. We assessed the effect of Korean Saam acupuncture on the immune system in cancer patients by measuring particular blood cell subsets, including CD3+, CD4+, CD8+, CD19+, and CD56+ cells, as well as total white blood cell count, absolute neutrophil count, and fatigue score. The measurement was performed before and after acupuncture and at a 2-week follow-up.

RESULTS

There was a statistically significant increase in the number of CD3+ (P = 0.023) and CD8+ cells (P < 0.001) and T-cell subsets, as well as a decrease in the fatigue severity scale (FSS) score (P = 0.001) after Saam acupuncture using the 5 acupoints.

CONCLUSION

Acupuncture may improve the immune system by increasing the counts of a few immune cells and relieve fatigue in cancer patients by decreasing FSS scores. Although this was a non-controlled study, it constitutes preliminary research investigating the potential effects of Saam acupuncture in increasing the counts of several immune cells in cancer patients.

Sa-am Five-element Acupuncture and Hwangyeon- haedoktang Pharmacopuncture Treatment for an Essential Tremor: Three Case Reports

The purpose of this study was to report the effect of a combination of Sa-am five-element acupuncture and eight-principle pharmacopuncture (EPP) for the treatment of an essential tremor (ET). This study reviewed the medical records treated at OO Korean medical hospital for ET by using diverse types of acupuncture without herbal medicine, other types of physical therapy, and western medication related ET or Parkinson’s disease and was performed after the approval of the institutional review board (IRB). The three cases that were finally selected were then extracted and reviewed. The three cases that were finally selected involved three women in their 70s to 80s. The evaluation of the progress was made by using the numeric rating scale. A combined treatment, the method of liver excess (肝乘格), from amongSa-am five-element acupuncture, and Hwangyeonhaedoktang ePP at CV23 and CV17, was applied to all cases. In all three cases, the ET was improved, and recurred ETs improved with the same treatment. The results suggest that the combined treatment of Sa-am five-element acupuncture and Hwangyeonhaedoktang ePP may be effective for treating an ET, even though this conclusion is based on only three cases.

Disappearance of an adnexal mass with Saam acupuncture: a case report

We report the case of a 30-year-old woman with a right adnexal mass resembling an ovarian cyst who declined diagnostic laparoscopy and requested treatment with acupuncture. The patient was treated with Saam acupuncture for 14 weeks. After treatment, transvaginal sonography revealed disappearance of the right adnexal mass. No adverse effects of the Saam acupuncture treatment were reported.

A clinical pilot study comparing traditional acupuncture to combined acupuncture for treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy

Traditional acupuncture (TA) and ear acupuncture (EA) are used for treatment of headache, trigeminal neuralgia, and retro-auricular pain. The purpose of this study is to develop effective treatment using combined acupuncture (CA) which consists of TA and EA and to set clinical protocols for future trials. Participants were divided into TA (n = 15) control and CA (n = 34) experimental groups. Obligatory points among Korean Five Element Acupuncture and optional individual points along with symptom points were used in the TA group. The CA group was exposed to ear points of Fossion and TA. Acupuncture treatment consisted of six mandatory sessions per patient over 3 weeks and extended to 12 sessions. Pain was assessed using the visual analogue scale. We compared TA to CA and researched their relevant publications. No significant difference was observed between the two groups (p = 0.968) which showed pain-alleviating tendency. Pain alleviation was significantly different after the fifth and sixth sessions (p = 0.021, p = 0.025), with headache being the most significantly relieved (F = 4.399, p = 0.018) among the diseases. When assessing pain intensity, both the Headache Impact Test and the Migraine Disability Assessment Scale should be adopted for headache and the fractal electroencephalography method be used in pain diseases. In the future, studies should consist of TA, EA, and CA groups; each group having 20 patients. Treatment number should to be no less than 10 sessions. Korean Five Element Acupuncture should be a compulsory inclusion along with individual points being optional inclusion in TA. EA could be selected from Nogier, Fossion and so forth. In conclusion, acupuncture treatment, whether TA or CA, showed pain alleviation in headache, trigeminal neuralgia, and retro-auricular pain, but no significant difference was seen between groups. Prospective, well-controlled, and relevant protocols using multimodal strategies to define the role of TA, EA, and CA are needed.

Sympathomodulatory effects of Saam acupuncture on heart rate variability in night-shift-working nurses

OBJECTIVE

We assessed the effects of Saam (traditional Korean) acupuncture on the autonomic nervous system in night-shift nurses using power-spectral heart-rate variability (HRV) analysis.

METHODS

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 (gallbladder jeonggyeok), 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.

RESULTS

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 normalised 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 normalised units increased by 17.41 (CI: 6.393, 27.13) with Saam acupuncture, suggesting an increase in parasympathetic activity.

CONCLUSION

Saam acupuncture may attenuate the imbalance between sympathetic and parasympathetic activities induced by night-shift work in nurses.