A Study of the Sa-Ahm Five Element Acupuncture Theory

Article Outline

• Abstract
• 1.. Introduction
• 2.. Basic Theory
  • 2.1.. The root of diseases
  • 2.2.. The effect of acupuncture points and major rules of point selection
    • 2.2.1.. Efficacy of acupoints
    • 2.2.2.. Tonification and efficacy of sedation
  • 2.3.. Characteristics of the Five Shu points
• 3.. The Difficult Issues in Nan-Ching
  • 3.1.. The 50th difficult issue
  • 3.2.. The 69th difficult issue
  • 3.3.. The controller (governor) cycle
  • 3.4.. Applied principle for treatment
  • 3.5.. Tonification and sedation by Gao-Wu
    • 3.5.1.. The basic theory
    • 3.5.2.. The Four Needle method: combining the Within-and-Between Elements treatments
    • 3.6.. Tonification and sedation by Sa-Ahm
    • 3.6.1.. Tonification and sedation for deficiency and excess
      • 3.6.1.1.. In deficiencies
      • 3.6.1.2.. In excesses
    • 3.6.2.. Tonification for cold symptoms and sedation for fire symptoms
      • 3.6.2.1.. Cold symptoms
      • 3.6.2.2.. Fire symptoms
• 4.. Discussion
  • 4.1.. The characteristics of the Five Shu points
  • 4.2.. The basic theory of Sa-Ahm's acupuncture
  • 4.3.. The merits and faults of Sa-Ahm's Five Element acupuncture
  • 4.4.. From the viewpoints of overall acupuncture treatment
• Acknowledgment
• References
• Copyright

Abstract 

This study is a review of the theoretical basis of Sa-Ahm Five Element acupuncture devised about 360 years ago. A total of 21 books and papers ranging from the ancient Huang Di Nei Jing to modern biomedical acupuncture for pain management were researched in relation to the Five Shu points. Gao-Wu, in the Chinese Ming Dynasty, used the Five Shu points for the first time based on the creation cycle as the tonification and sedation treatment, termed the “tonification and sedation treatment of self meridian”. Since then, and for no particular reason, this method has been rarely used until Sa-Ahm's new doctrine, which includes the concept of the destruction cycle, was asserted. Sa-Ahm Five Element acupuncture is a method in which the Five Shu points are used from the viewpoints of the simultaneous tonification and sedation methods that are based on the promotion and control cycles. Although it is currently the most utilized method in accordance with the practitioner's points, this method is in need of designated guidelines by which Sa-Ahm acupuncture can be practiced effectively.

Key Words:  clinical guidelines , Five Shu points , neurophysiological mechanisms of acupuncture , Sa-Ahm Five Element acupuncture , tonification and sedation treatment

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1. Introduction 

Acupuncture as a medical science has constantly evolved, particularly since 1950s, when the science of acupuncture became widely developed, both in theory and practice [1]. There are two general viewpoints regarding how acupuncture functions [2]. One is the classic Qi model, which involves the meridian and acupoint system based on the theories of Yin-Yang and a Five Element system, and the other is related to the Western neurophysiological model, which is based on neuroendocrine, immunological, and other physiological processes. Recently, the functions of acupuncture were studied on the basis of findings from radiological instruments, such as functional magnetic resonance imaging and positron emission tomography [3]. Cho et al were the first to identify relationships between particular acupoints and visual-cortex activation using functional magnetic resonance imaging [4, 5]. Ma et al proposed the integrative neuromuscular acupoint system for pain management, producing a standardization of the treatment procedure [6].

In the classical Qi model, most illnesses and disturbances are known to be rooted in inter ruptions or imbalances within or over a network of meridians; interruptions are stagnation and irregularity, while imbalances are deficiency and excess [7]. The acupoints in and around the local areas, special points such as connecting, cleft, and alarm points, could be used for interruptions in correlation to an acupoint's efficacy, but the Five Shu points, located below the elbow and knee joints, could be used corresponding to the Five Phases for imbalances in correlation to tonification and sedation [8].

The 50th issue of Nan-Ching explains the pathology of the Five Evils [9, 10] and the 69th issue of Nan-Ching describes the treatment for these evils. Gao-Wu, during the Ming Dynasty (1519 AD), was the first and foremost medical acupuncturist to tonify deficiency and sedate excess on the basis of either depletion or repletion of the promotion cycle, which is explained in “The Four Needle method” by Ross [7, 11].

The Korean monk, Sa-Ahm [12], about 360 years ago, proposed Five Element acupuncture that simultaneously uses the Five Shu points of the promotion and control cycles, called the “Four Needle technique” by Hicks et al [13] and the “Eight Needle method” by Ross [7]. This method consists of, in a broad sense, the method of “tonificationsedation between deficiency and excess” as well as the method of “tonification-sedation between coldness and heat”.

In this report, the theory of Sa-Ahm acupuncture is briefly reviewed to improve the understanding of the theory's details, based on Ahn's treatise [14] as well as from review of the content of other foreign scholars' treatises [7, 13].

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2. Basic Theory 

2.1. The root of diseases 

Most illness and disturbances are rooted in interruptions or imbalances in a network of meridians. Interruptions comprise stagnation and irregularities, and imbalances are deficiency and excess [7].

2.2. The effect of acupuncture points and major rules of point selection 

In acupuncture, point selection for treatment, major empirical principles, and rules based on the traditional knowledge of Oriental medicine are employed. These acupuncture tools have been extended over the last 30 years through the findings of modern scientific research.

For interruptions, acupoints may be selected based on local and special effects in correlation to the efficacy of an acupoint while, for imbalances, the Five Shu points may be selected either by deficiency or excess in correlation with tonification and sedation.

2.2.1. Efficacy of acupoints 

2.2.2. Tonification and efficacy of sedation 

2.3. Characteristics of the Five Shu points 

Giovanni [16]: The sections of channel between fingers/toes and elbows/knees are more superficial than the rest, which is one of the reasons for the importance of the points lying along its path. The energetic action of the points along a section of such a channel is much more dynamic than other points, which explains their frequent use in clinical practice. Another reason for the dynamism of these points is that, at the tips of fingers and toes, the energy changes polarity from Yin to Yang or vice versa and, due to this polarity change, the Qi of the channel is more unstable and thus more easily influenced. The progression of the Five Element points along the channel is probably in relation to this change of polarity, as the second point belongs to the Fire in the Yin channels and the Water in the Yang channels. Five points situated along this channel section are particularly important and are called the Five Transporting points; they also coincide with what are called the Elements points. However, the dynamic of these points is irrespective of their Five Elements character.

Yun-Tao-Ma [6]: An interesting neurologic fact is that the limbs below the elbows and knees occupy large regions in the brain sensory gyrus. Thus, the acupoints below the elbows and knees also occupy a large region in the cortical representation of the brain's postcentral sensory gyrus. This correlation may explain the reason why the acupoints below the elbows and knees contain more sensory receptors and needling stimulation of these points can induce a greater reaction and activity in the brain. This principle clearly supports the concept of using certain acupoints below the elbows and knees (the so-called ‘Five Shu points’ in the classic meridian system) as diagnosis and treatment points during acupuncture treatment.

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3. The Difficult Issues in Nan-Ching 

3.1. The 50th difficult issue 

Among the illnesses are the depletion, repletion, destroyer, weakness, and regular evils. How are they distinguished?

3.2. The 69th difficult issue 

In case of depletion, it should be filled, while in case of repletion, it should be drained. When neither repletion nor depletion is present, the illness should be removed from the conduits. What does that mean? In the case of depletion, fill the respective (conduit's) mother. In case of repletion, drain the respective (conduit's) child. One must fill first and then drain afterward.

3.3. The controller (governor) cycle 

This characteristic of Sa-Ahm's acupuncture is the addition of the control (grandmother-grandchild) cycle to the promotion cycle (mother and son elements). This method, surprisingly, includes a new concept of the “governor meridian” in the application of the law of the Five Elements based on the inter-destructive cycle (Figure 1; Table 2).

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• Figure 1. 

  The Five Phases of the creation and governor cycles in relation to the 12 meridians.

Table 2. The 12 meridians according to the mother-son-governor law

3.4. Applied principle for treatment 

Wang Sheng Xiu Qiu Si is another of Wu Xing's concepts [17]; Wang Sheng Xiu is a family and in a promotion cycle of the Five Phases, while Qiu Si is an enemy and in a control cycle of the Five Phases. In promoting the cycle of the Five Phases, a reinforcing method can be done while in control cycle of the Five Phases, requiring a reducing method. It is meaningful that each element promotes like a family in the promoting cycle while each element reduces like an enemy (Table 3).

Table 3. The relationship between the Five Evils and Five Phases

3.5. Tonification and sedation by Gao-Wu 

3.5.1. The basic theory 

In deficiency, to determine which site is the tonification point for a meridian, one selects the Mother Element on the meridian in question. In the case of the Lung meridian, for example, the Mother Element of the Lung is Earth (Earth is the Mother of Metal), and thus the tonification point of the Lung meridian would therefore be the Earth point on the Lung meridian, namely Lung 9 [11].

In excesses, to determine which is the sedation point for a meridian, one selects the Child Element on the meridian in question. In the case of the Lung meridian, the Child Element of the Lung is Water (Water is the Child of Metal), and thus the sedation point of the Lung meridian would be the Water point on the Lung meridian, namely Lung 5. The same principle holds true for the other eleven regular meridians [11].

3.5.2. The Four Needle method: combining the Within-and-Between Elements treatments 

This consists of the Within-Reinforce-Tonification point and the Within-Reduce-Sedation point, which are tonification and sedation of Gao-Wu, as well as the Between-Reinforce-Element point and the Between-Reduce-Element point [7], which are tonification and sedation among other meridians, and are used in Sa-Ahm's acupuncture (Table 4).

Table 4. The Four Needle method: combining the. Within and Between Elements treatments

3.6. Tonification and sedation by Sa-Ahm 

This makes use of the tonification and sedation points along the promotion cycle as well as points along the control cycle in cases of deficiency and excess; and along the fire and water meridians in cases of heat and coldness.

3.6.1. Tonification and sedation for deficiency and excess 

The basic rules, based on the writings of Nan-Ching [9, 10], are those of the creation (mother-son) and governor (destruction) relationships. In the case of any meridian's insufficiency (weakness), the points of its mother and its own meridians should be tonified and the points of its governor and its own meridians should be sedated. In the case of any meridian's excessiveness (fullness), the points of its governor and its own meridians should be tonified and the points of its son and its own meridians should be sedated [18] (Figure 2).

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• Figure 2. 

  Principle and acupuncture selection for deficiency and excess treatment.

3.6.1.1. In deficiencies 

Needle 1: Tonify the deficient meridian at its mother (tonification) point. With a Lung deficiency, tonify the Earth point of the Lung, Lung 6.

Needle 2: Tonify the master point on the Mother Element. The Mother of Metal is Earth, hence, the Mother of Lung is Spleen and the master (Earth) point of the Spleen (Earth), namely Spleen 3, should be tonified.

Needle 3: Sedate the Controller Element on the affected meridian. The Controller of Metal is Fire, so the Fire point on the affected meridian, the Lung or Lung 10, should be selected.

Needle 4: Sedate the master point on the Controller Element. The Controller Element is Fire; hence the Controller of lung is Heart. The master (Fire) point on the Heart (Fire), namely Heart 8, should be sedated.

To summarize this principle for deficiency conditions [19]:

Tonify the first 2 needles, Tonify the Mother Element point on the affected meridian,

Tonify the master point on the Mother Element itself;

Sedate the second 2 needles,

Sedate the Controller Element point on the affected meridian,

Sedate the master point on the Controller Element.

For example, if the stomach is believed to be underactive: (a) Fire tonification, stomach meridian-Fire point ST41, small intestine meridian-Fire point SI5; (b) Wood sedation, stomach meridian-Wood point ST43, gallbladder meridian-Wood point GB41 (Table 5). The other meridians follow the same rule, as described above.

Table 5. Sa-Ahm's points of tonification for deficiency and sedation for excess

3.6.1.2. In excesses 

Needle 1: Sedate the Child Element point on the affected meridian. For Spleen excess, the Metal (Child) point of the Spleen, sedation point Spleen 5, should be sedated.

Needle 2: Sedate the master on the Child meridian. The Child of Spleen is Lung. The master (Metal) point of the Lung, Lung 8, should be sedated.

Needle 3: Tonify the Controller Element on the affected meridian. The Controller of Earth is Wood and thus the Wood point on the Spleen (Earth) meridian, Spleen 1, should be tonified.

Needle 4: Tonify the master point on the Controller. The Controller is Liver (Wood) and thus the master (Wood) point on the Liver, namely Liver 1, should be tonified.

To summarize this principle for excess conditions [19]:

Sedate the first 2 needles,

Sedate the Child Element (sedation) point on the affected meridian,

Sedate the master point on the Child meridian;

Tonify the second 2 needles,

Tonify the Controller Element on the affected meridian,

Tonify the master point on the Controller meridian.

For example, if the stomach is believed to be overactive: (a) The stomach meridian belongs to the element of Earth and should be sedated by sedation at the Metal point, which is ST45, of its own meridian in accordance with the mother-son (creative cycle of the Five Elements) law. Metal is the son of Earth. Also, the Metal point of the large intestine, LI1, the son meridian of the stomach meridian, should be sedated. (b) The gallbladder meridian is opposed to the stomach meridian by the destructive cycle of the law of the Five Elements (the governor meridian). This meridian should be tonified at its Wood point, GB41, to destroy the overactive element of Earth. Also the stomach meridian should be tonified at its Wood point, ST43, to destroy the element of Earth within the self meridian (Table 5). The other meridians follow the same rule described above.

Ross [7] calls acupoint selection of tonification and sedation among its own meridians “Within Element treatments” and acupoint selection of tonification and sedation among other meridians “Between Element treatments”. This selection, the Four Nee dle method, is based on the theory of promotion cycle of the Five Elements. He also explains the Eight Needle method which selects another acupoint based on the theory of the inhibition cycle of the Five Elements, in addition to the Four Needle method. He did not explain the originality of its treatments, but the selection is the same as the Sa-Ahm Five Element acupuncture (Table 6, Table 7).

Table 6. The Eight Needle method in deficiency over control

Table 7. The Eight Needle method in deficiency under control

3.6.2. Tonification for cold symptoms and sedation for fire symptoms 

Some kinds of diseases are caused by the imbalance between fire and coldness in the body and the corresponding treatments consist of using the Water and Fire points along the self meridian, the Water meridian, and the Fire meridian. For a fire symptom, the Water points of the master and Water meridians are selected to tonify the Water, as well as the Fire points of the master and Fire meridians selected to sedate the Fire. For a cold symptom, the Fire points of the master and Fire meridians are selected to tonify the Fire, as well as the Water points of the master and Water meridians selected to sedate coldness (Figure 3).

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• Figure 3. 

  Principles and channels of tonification and sedation for coldness and fire.

3.6.2.1. Cold symptoms 

In the case of cold symptoms in the lungs, the cold symptom can be balanced by both the tonification of heat and sedation of coldness. Accordingly, the Fire points, Yuji (LU10) of the self meridian and Shaofu (HT8) of the Fire (heart) meridian, should be tonified to warm “coldness”. Conversely, the Water points, Chize (LU5) of the self meridian and Yingu (KI10) of the Water (kidney) meridian, should be repressed (Table 8). The other meridians follow the same rules described above.

Table 8. Sa-Ahm's points for cold and fire-symptoms

3.6.2.2. Fire symptoms 

In the case of heat symptoms in the lungs, the Fire symptom can be controlled by Water, and the Water points, Chize (LU5) of the self meridian and Yingu (KI10) of the Water (kidney) meridian should be tonified. Conversely, the Fire points, Yuji (LI10) of the self meridian and Shaofu (HT8) of the Fire (heart) meridian, should be repressed (Table 8). The other meridians follow the same rule described above.

In addition, the “tonification-sedation between coldness and heat” method has not been generally applied clinically, although some doctors do use them. The method needs to be studied in the future from the viewpoints of differential diagnosis, which includes the deficiency-excess methods.

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4. Discussion 

The goal here is to summarize the basic theory of Sa-Ahm's acupuncture, consisting of the Five Shu points, as well as their clinical application, and then to discuss them from the perspective of overall acupuncture treatment.

4.1. The characteristics of the Five Shu points 

The Five Shu points distal to the elbow and knee correspond to the Five Phases and include a tonification and a sedation point. First, the tonification point that corresponds to the “Mother Element” according to the law of the Five Phases tonifies the energy of the corresponding channel and organ. The tonification points are selected in deficiency conditions of organs and channels with stimulation by the tonification methods. Second, the sedative point of the Five Shu points corresponds to the “Son Element” according to the law of Five Phases. The Qi of channels and organs can be sedated by stimulation of these points, and thus the sedative points are needled in excess conditions with stimulation by the sedative method. Third, the energetic action of the points situated in the section of channels below the elbow or knee joints is much more dynamic than other points, which explains their frequent use in clinical practice, because at the tips of fingers and toes the energy changes polarity from Yin to Yang or vice versa. Five of the points situated along this section of channel are particularly important and called the Five Transporting points; they also coincide with what are called the Element points, but the dynamic of these points is irrespective of their Five Element character.

4.2. The basic theory of Sa-Ahm's acupuncture 

Gao-Wu was the first acupuncturist to describe the use of “tonification and sedation points” along the self meridian using the Five Shu points during the Ming Dynasty (1519 AD). The basis of his treatment was the creation (mother-child) cycle and is included in the “Four Needle method” with the following rules: to determine the tonification point for a meridian, select the Mother Element on the meridian in question, and to determine the sedation points, select the Child Element. But Sa-Ahm, on the basis of Gao-Wu's treatment, created a Five Element acupuncture therapy by adding the control (grandmother-grandchild) cycle, as well as selecting acupuncture points among other related meridians. From the above approach, this theory consisted of two tonification and two sedation points, which are selected from among the Five Shu points. These five points have characteristics of their particular Five Element theory according to the difficult issues in Nan-Ching. But its principles originate from the creation and control cycles among the Five Elements and have the following rules: to determine the tonification and sedation points for a meridian in deficiencies, first, for selection of tonification points, select its mother element on the meridian as well as the master point on the mother element, and second, for selection of sedation points, select its Controller Element on the affected meridian as well as the master point on the Controller Element meridian; to determine the tonification and sedation points for a meridian in excesses, first, for selection of sedation points, select its Child Element point on the affected meridian as well as the master point on the Child meridian, and second, for selection of tonification points, select its Controller Element on the affected meridian as well as the master point on the Controller meridian.

There is another coldness-fire acupuncture treatment, derived from the deficiency-excesses acupuncture treatment, that is simple and rarely used because it selects only Water and Fire points among a meridian and has the following rules: for cold symptoms, to determine the tonification and sedation points for a meridian, first, for selection of tonification points, select its Fire Element point on the affected meridian as well as the Fire point on the Fire meridian, and second, for selection of sedation points, select its Water Element on the affected meridian as well as the Water point on the Water meridian.

For heat symptoms, to determine the tonification and sedation points for a meridian, first, for selection of sedation points, select its Fire Element point on the affected meridian as well as the Fire point on the Fire meridian, and second, for selection of tonification points, select its Water Element on the affected meridian as well as the Water point on the Water meridian.

4.3. The merits and faults of Sa-Ahm's Five Element acupuncture 

The scope of Sa-Ahm's treatment can be extensive because of its diverse laws, such as the promotion and inhibition cycle among the Five Elements and its connected meridians. A meridian consists of three parts, that is, arm or foot, the more or less of Yin and Yang, and one of six Organs and six Fus. Seem [18] suggests that the Five Phases keep us focused on the energetic movements of disharmonies, which are fleeting and the essence of what we are after, while the Eight Guiding Criteria enable us to apply a systematic analysis of all data, gathered in a consistent manner, to measure a patient's pattern of disharmony against the major patterns of Chinese medical pathology. This can be demonstrated in a diagram in which the Five Phases are energetic movements with definite cycles and the Eight Cri teria are the constants that must be assessed in whatever Phase is being investigated.

Although there are currently many clinical books on Sa-Ahm acupuncture in Korea, a definitive general standard for the selection of symptom patterns has not been proposed. In 1985, the general use of Sa-Ahm acupuncture was advanced in the following manner: the method can be used mainly from the theoretical viewpoints of Zhang-Fus, the etiology of disease, as well as the more or less of three Yang and three Yin. Three examples are: in the case of knee pain, liver tonification can be used because the liver controls the muscle and joint according to theory of Zhang-Fus; in the case of headache due to uprising of liver-Yang, liver sedation may be used; and in the case of backache due to dampness, either spleen-sedation to sedate dampness or Yang Ming-tonification (large intestine or stomach) to tonify dryness is employed. As these few viewpoint examples cannot fully explain Sa-Ahm acupuncture, study of differential diagnosis, which many acupuncturists may have in common from the method, is needed.

Seem [18] also noted that treatment by means of the Four Needle technique is very powerful, should only be initiated when strong energetic manipulation is required, and only when it is certain of the primary Element or Phase affected. The reason for this should be obvious; the Four Needle technique tonifies twice and then disperses twice, leading to a very concentrated tonifying or dispersing action on the affected Element and meridian. If the primary Element affected is not certain, it is far more judicious to use the more gentle tonification and dispersal points.

Kim [19] has laboriously investigated the book of Sa-Ahm Five Element acupuncture and his works have served as stepping stones for its careful examination. He proposed that this book was written after 1644 AD when the “Experienced Treatments of Acupuncture and Moxibustion” had been published and was based on the I-Ching, Yin-Yang Five Elements, and the influences of Chu Tan-Hsi and Yu Shu, who were Chinese scholars of Chinese medicine. The 240 acupuncture treatments described in the book [13] consist of 100 regular forms on the basis of 69th difficult issue, 140 irregular forms on the basis of the 73rd and 75th difficult issues and various special acupuncture points, which include the source, connecting, accumulation, alarm and back transporting points [19].

Lee, who interpreted the basic forms of Sa-Ahm acupuncture differently, asserted that the basic form of Sa-Ahm acupuncture, concerning the type of acupuncture prescriptions, cannot be fully understood although there is a main form, called the regular form [17]. As Sa-Ahm noted “Muscle, bone and meridian change endlessly. Birth, vigor, rest, person and evolution are never stopped”, they change endlessly with the sequence of the season, as not an Element but an evolutionary Phase, while the five agents do not always dominate. In the promoting cycle of the Five Phases, a reinforcing method can be used and, while in control cycle of the Five Phases, a reducing method must be used, which means that each Element promotes like a family in the promoting cycle, while each Element reduces like an enemy in the control cycle. According to this, Wang Sheng Xiu uses a reinforcing method, while Qiu Si uses a reducing method, but some part of Sa-Ahm acupuncture, particularly of the 75th difficult issue, was used to reinforce the mother point as well as to reduce the child point simultaneously. The former is in a state of family opposing to enemy, while the latter is in a state of family facing trouble. He asserts that this understanding must be included in Sa-Ahm's principle. Although it would be logical to propose this interpretation in a sense, it remains to be studied whether these kinds of symptoms can be found in clinical treatments.

Generally speaking, the Sa-Ahm treatment primarily focused on the viewpoints of deficiency-excess symptoms rather than cold-heat symptoms. However, the relationships between the deficiency-excess symptoms and the cold-heat symptoms need to be studied in detail to form reasonable guidelines for effect-friendly treatments. As there are many different ways to select the Five Shu points from the various viewpoints of Five Element acupuncture, detailed guidelines need to be designed in the future for patterns of symptoms.

4.4. From the viewpoints of overall acupuncture treatment 

As most illnesses contain imbalances caused by deficiency and excess through a network of meridians as well as interruptions manifested by stagnation and irregularities, acupuncture treatments need to cover these two sides in correlation with an acupoint's efficacy and sedation-tonification. It might be more effective to use an acupuncture method based on an acupoint's efficacy to correct interruptions together and concurrently with the Sa-Ahm treatment based on the tonification-sedation effect to correct imbalances. It is proposed here that an acupuncture method based on an acupoint's efficacy to correct interruptions be called a “branch treatment” and an acupuncture method based on the tonification-sedation effect to correct imbalances as a “root treatment” in relation to an acupuncture treatment's principle.

Seem [18] stated that the choice of a local point orients the treatment strategy to the affected energetic functional sphere or zone (in internal energetic disturbances), while the distal points serve to determine the nature of the energetic manipulation (including tonification, dispersal, warming, cooling, and harmonizing). The combination of local and distal points forms a pattern of treatment that resembles the pattern of disharmony treated. Ross [7] stated that the points between the finger tip and elbow, or toe tip and knee, are among the most energetically powerful points of the body and they include not only the Five Trans porting points but also the connecting points and the accumulation points. This is said to be because, between fingers and elbows, or between toes and knees, the polarity of the energy is changing, from Yin to Yang or Yang to Yin, and it is where the polarity is changing that the greatest therapeutic effects can be produced.

Analyzing the writings of Sa-Ahm, it is apparent that he also tried to produce more effective treatments by using other acupoints, as well as by adding points, with the main points firmly based on the regular pattern. Seem explained the limitation of the Five Element treatment [20]. The Five Element principles taught by some schools, for example, do not apply to the use of the secondary vessels and Eight Extraordinary Meridians. As the latter constitute the bulk of the energetic system of acupuncture, the Five Element treatment strategies seldom apply. The two dominant styles of practice, Traditional Chinese Medicine and Five Element acupuncture, both emphasize the Zang-Fu (called “Officials” by Five Element practitioners of the Worsley school) and the regular meridians only, and ignore the complex surface and primal energetic networks, which constitute human energetics. In this sense, they are disembodied approaches to acupuncture.

Sa-Ahm tried to use other effective points to produce more effective treatments. Beyens [21] states that the “law” of Five Elements, condemned as an uncompromising model of dynamic relations within the body, is restored when it is considered as a method of systemic and organized expression of organic and clinical reality. Besides, in the field of acupuncture, it is difficult to accept the Five Shu points and their therapeutic use according to the “law” as a reflection of any kind of reality. The Five Elements in Chinese medicine, even more than the Five Shu points of acupuncture, are not part of the basic nucleus. It was necessary, however, to examine this concept in its proper and correct perspective and it is known that some medical acupuncturists assert that the Five Elements and the Five Shu points need to be examined in their proper and correct perspective.

In conclusion, there are two general viewpoints of how acupuncture works — the classical Qi and the modern biological models. Each acupoint has a local effect on the surrounding area, the corresponding channel, and its related channel axis. However, some special points, such as the connecting, cleft, alarm, and back Shu points have special effects, while the distal points, particularly the Five Shu points located below elbow and knee joints, correspond to the Five Phases and are used as tonification and sedation points. From the viewpoint of a biological model, the Five Shu points below the elbows and knees not only occupy larger areas in the cortical representation in the post-central sensory gyrus in the brain and, from the viewpoints of classical model, also have an energy flow with strong dynamism due to their changes in polarity. Sa-Ahm's acupuncture treatment lies in the selection of the Five Shu points according to tonification and sedation, which are based on the creation and control cycles of the Five Element theory as well as Nan-Ching 's issues. Sa-Ahm's treatment consists of deficiency and excess treatments as well as coldness and heat treatments using the Five Shu points. In case of deficiency, its principle lies in tonification of the Mother points of the self meridian and Mother meridian as well as in sedation of Control points of the self meridian and Control meridian. In case of excess, its principle lies in tonification of the Control points of the self meridian and Control meridian as well as in sedation of the Child points of the self meridian and Child meridian. In case of coldness, its principle lies in tonification of the Fire points of the self meridian and Fire meridian as well as in sedation of the Water points of the self meridian and Water meridian. And in case of heat, its principle lies in tonification of the Water points of the self meridian and Fire meridian as well as in sedation of the Fire points of the self meridian and Fire meridian. Clinical applications are mostly focused on deficiency and excess treatments, and coldness and heat treatments rarely used. Sa-Ahm's acupuncture consists of the regular form on the basis of the 69th difficult issue as well as irregular forms on the basis of the 73rd and 75th issues and various special points, including the source, connecting, accumulation, alarm, and back Shu transporting points. As there are many different ways to select Five Shu points from the various viewpoints of Five Element acupuncture, detailed guidelines need to be designated in the future for patterns of symptoms. Sa-Ahm's acupuncture needs to include other kinds of acupuncture methods because it emphasizes the Zang-Fu and the regular meridians only and ignores the complex surface and primal energetic networks, such as the secondary vessels and Eight Extraordinary Meridians which, taken as a whole with the regular meridians, constitute human energetics. The Sa-Ahm treatment is designed to correct imbalances of deficiency or excess using the Five Shu points, while other treatments to correct interruptions of stagnation or irregularities use local and special points from the viewpoints of overall acupuncture treatment. The Sa-Ahm treatment based on the Five Elements and the Five Shu points needs to be examined in its proper and correct perspective.

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Acknowledgment 

This study was supported by a grant from Dongeui University (2008AA113).

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References 

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