Four Needles, Five Elements and

Six Qi: Treatment using Korean

SaAm Acupuncture
Andreas Brüch

ABSTRACT (Five Element) points of the twelve main meridians in 48 basic

SaAm acupuncture is one of the main acupuncture styles combinations of four predetermined acupoints to address both
of Korean medicine. It encompasses all basic theories of the physical and mental-emotional aspects of illness. General
‘standard’ Chinese medicine. Additionally, it relies heavily on introduction to SaAm acupuncture can be found, for example,
the theory of the Six Qi (liu qi) or Six Climatic Energies. The in Ahn et al. (2010), Jeon (2016), Kim (1994) or Kim (1998).
Six Qi provide a model of balancing climatic meridian energies
that can be used either for directly treating disease syndromes SaAm acupuncture theory
or as a framework for treatment of general constitutional and SaAm acupuncture utilises all basic concepts found in
emotional factors of disease. The purpose of this article is to conventional Chinese medicine acupuncture, like the theories of
introduce basic SaAm acupuncture theory, and to highlight its yin and yang, Five Elements, zang fu syndromes, Six Pathogens
specific features and practical approach by discussing some and Eight Principles. In contrast to TCM it sets special focus on
case examples of the author. the theory of the Six Climatic Energies or Six Qi (liu qi) and offers
a special framework to understand emotional factors of disease
INTRODUCTION derived from the concept of the Six Qi. The main objective of
SaAm acupuncture evolved about 300 years ago. Its name is this article is to explain these specialties.
attributed to the assumed founder of the system. The term
SaAm (舍岩) is a pseudonym. ‘Sa’ translates to ‘dwell’ and The Six Qi
‘Am’ means ‘rock’ making up a ‘person living in a cave’. The unique aspect of SaAm acupuncture is to combine the
concept of the Six Qi with the energetic qualities of the Five
According to historical analysis Master SaAm was a Buddhist Elements. The Six Qi are mainly described in the Huang Di
monk and doctor of Oriental medicine living during the Nejing Suwen chapters 68 to 71. They describe the qualities of
Korean Chosun Dynasty (1392-1910) but there is no further climate and weather of the seasons in nature. The Six Qi are
evidence about his true identity or where and when he lived tai yin (Dampness), yang ming (Dryness), shao yin (Heat),
exactly (Kim, 1993). The only remaining manuscript about tai yang (Cold), jue yin (Wind/inwards movement) and shao
his original acupuncture concept SaAm’s Essential Rhymes on yang (the light of Ministerial Fire/outwards movement). This
Acupuncture and Moxibustion (舍岩道 人針灸要訣/SaAam climatic understanding is transferred to the human body and
doin chim gu gyeol) was published sometime between 1644 the physiological functions of the twelve main meridians.
and 1742 (English translation see Lee & Hahn, 2009). Several
decades later an individual named Jisan added more extensive The combination of the climatic aspects of the Five Element
comments and case examples to SaAm’s own text, which theory with the Six Qi creates a unique understanding of the
help to understand SaAm’s primary descriptions of clinical human body’s microcosm and the individual energetic qualities
treatments. Over the centuries, handwritten manuscripts of the twelve meridians as shown in table 1. Note that in SaAm
about SaAm acupuncture practice by different individuals were acupuncture, the meridians’ climatic nature of the Six Qi is
handed down and the system was continually developing. considered dominant to the Five Elements. Therefore, in those
pairings where the combination of the two concepts appears
Today, SaAm acupuncture is widely practised among South to be contradicting, the Six Qi decide for the meridian’s main
Korean traditional medicine doctors. However, it is not well climatic quality. For example, in the Foot yang ming Stomach
known outside of Korea as lectures and formally published meridian the Five Element characteristic is Earth/Dampness
instructional material in non-Korean language have only and the yang ming quality is Dryness, but the overall climatic
emerged recently. SaAm acupuncture utilises the Shu-Transport characteristic has a drying effect.

20 The European Journal of Oriental Medicine

Four Needles, Five Elements and Six Qi: Treatment using Korean SaAm Acupuncture
Andreas Brüch

The combination of Five Elements with the Six Qi divides the on their respective climatic aspect. Six meridians have a mixed
twelve meridians into two main groupings. In six meridians or incongruent quality, such as the Heat of the Fire Element
the climatic characteristics of both concepts are identical or and the inward moving Wind of jue yin in the Pericardium
congruent, such as the Dampness of Earth and the Dampness meridian. These meridians can influence two climatic aspects
of tai yin in the Spleen meridian. These meridians carry only simultaneously. But their influence on the main Six Qi climatic
one pure climatic quality and therefore have a strong effect aspect is weaker than in the meridians with pure quality.

Table 1: Climatic characteristics of the meridians

Meridian Five Element Six Qi Combined climatic

characteristic climatic quality meridian characteristic

Climatic factor: Humidity

Hand tai yin Lung Metal (Dry/Cool) Moisture Mixed Damp and Cool

Foot tai yin Spleen Earth (Warm/Moist) Moisture Pure Dampness (Warm)

Hand yang ming Large Intestine Metal (Dry/Cool) Dryness Pure Dryness (Cool)

Foot yang ming Stomach Earth (Warm/Moist) Dryness Mixed Dry and Warm

Climatic factor: Temperature

Hand shao yin Heart Fire (Hot) Monarch Fire Pure Heat
(Heat/Warm light)

Foot shao yin Kidney Water (Cold) Monarch Fire Cold and Heat
(Heat/Warm light) (at the same time)

Hand tai yang Small Intestine Fire (Hot) Cold Mixed Hot and Cold
(= slightly Warm)

Foot tai yang Urinary Bladder Water (Cold) Cold Pure Cold

Climatic factor: Movement of air (Wind = inward) and light (Ministerial Fire = outward))

Hand jue yin Pericardium Fire (Heat) Wind Mixed Wind-Heat

(moving inwards)

Foot jue yin Liver Wood (Wind) Wind Pure Wind

(moving inwards)

Hand shao yang Triple Heater Fire (Heat) Ministerial Fire Pure Fire
(movement of light (moving outwards)
radiating outward)

Foot shao yang Gall Bladder Wood (Wind moving inward) Ministerial Fire Mixed Fire and Wood
(movement of light (complex inwards/outwards
radiating outward) movement)

The European Journal of Oriental Medicine 21

The twelve main meridians can be grouped into the three main of a certain quality that is missing. This can be understood
climatic categories of humidity (Damp vs. Dry), temperature as the classical idea of balancing yin-problems with a yang-
(Cold vs. Hot) and (direction of) movement of light and factor and vice versa. For example, if we find a very Dry and
air (inwards vs. outwards movement) (see table 2). The Cold condition, we can balance this by increasing Moist
basic strategy of treating health conditions is to harmonise and Warm aspects. Thus, the tonification of Spleen (Warm
unbalanced internal climatic conditions with the energy of a and Moist) might be chosen as a treatment. The secondary
meridian that has the opposite climatic quality, by tonification possibility is to sedate an excess climatic factor directly.

Table 2: Overview of climatic balancing meridians

Yin Yang

Dampness

Dampness Dryness

Hand tai yin Mixed Damp and Cool Mixed Dry and Warm Foot yang ming
Lung Stomach

Foot tai yin Pure Dampness (Warm) Pure Dryness (Cool) Hand yang ming
Spleen Large Intestine

Temperature

Heat Cold

Hand shao yin Pure Heat Pure Cold Foot tai yang
Heart Urinary Bladder

Foot shao yin Mixed Hot and Cold Mixed Cold and Hot Hand shao yin
Kidney Small Intestine

Movement

Inward movement Outward movement

Hand jue yin Mixed inward – Warm Complex inward-outward Foot shao yang
Pericardium (Warm Wind) movement (light and Wind) Gall Bladder

Foot jue yin Pure Wind Pure outward movement Hand shao yang
Liver (cooling Wind) (Warm light of Fire) Triple Heater

Mental-emotional treatment of these qualities is the same scheme as the climatic

In the 1980s, the concept of meridian energy in SaAm acupuncture categories of the Six Qi. The meridians associated with
was further developed by Hong-Gyeong Kim, a doctor of traditional these emotional states are responsible for creating specific
Korean medicine. He added a model of categories of mental-emotional emotional states. The Yin meridians reflect the satisfaction
characteristics found as a distinct feature in each meridian. The treatment or positive feelings of each mental aspect. The yang
principle is identical to physical diseases: Emotional conditions are meridians are associated with dissatisfaction or negative
mostly balanced by increasing the energies of opposite emotional feelings. Thus, the presence of an unhealthy abundance of
quality or sedating the excess condition directly (Kim, 1991, 1994). either satisfaction or dissatisfaction of an emotional quality
can be balanced by tonification of the opposing meridian.
Each mental-emotional category is represented by two opposing (Jung, 2019). See table 3 for descriptions of the mental-
emotional qualities that balance each other. The classification emotional categories.
 

22 The European Journal of Oriental Medicine

Four Needles, Five Elements and Six Qi: Treatment using Korean SaAm Acupuncture
Andreas Brüch

Table 3: Overview of mental-emotional categories in SaAm acupuncture

Satisfaction – yin meridians Dissatisfaction – yang meridians

1st level: Need for food, Hand tai yin Lung: Foot yang ming Stomach:
nutrition and material
resources Satisfaction when having (enough) money, Feelings of
shelter, material resources. Includes • not having enough money or material
Satisfaction and dissatisfaction feelings of: resources
in relation to: • richness, generosity • ‘noble poverty’
• food and nutrition • relaxation, comfort • absence of greed
• money, financial resources
• material possessions Foot tai yin Spleen: Hand yang ming Large Intestine:
• housing/shelter
Feelings in relation to having enough food/ Feelings in regards of not having enough food
drink/nutrition: and drink:
• content and satiated like after a • anxiety
satisfying meal • clear, headed, sharp, alert like in a
• dull, lazy and without motivation to be hungry state
active like when overeating, indecisiveness • straightforward, decisive motivation and drive

2nd level: Need for Hand shao yin Heart: Foot tai yang Urinary Bladder:
emotional fulfilment
Satisfaction with feelings of losing oneself Negative emotions with ‘cold’ feelings such as:
Satisfaction and dissatisfaction in pleasure: • alertness
in relationship to: • romantic, aesthetic, or emotional joy • anxiety, fear, phobia
• romantic feelings and love and happiness • fear of death
• sexual pleasure • sense of humour
• aesthetic/artistic enjoyment • passion for what you strive for
• motivation to make a sacrifice

Foot shao yin Kidney: Hand tai yang Small Intestine:

Satisfaction from losing oneself in: Fear in combination with happiness (Fire and
• erotic or sexual joy and happiness Water) creating attention, protective feelings
• sexual drive and caretaking.
• ‘flow’-experience

3rd level: Intellectual and Hand jue yin Pericardium: Foot shao yang Gall Bladder:
power needs
Satisfaction obtained from acquisition of: Dissatisfaction with feelings of:
Satisfaction and dissatisfaction in • knowledge, technical/academic skills • anger, shame, inferiority, humiliation
relation to: • More related to intellectual performance • criticism, explosive, revolutionary spirit,
• status than assertiveness and power bravery
• ego, power • Includes the mental function of acquiring • desire to give guidance, advice or
• knowledge, skills, intellect and storing knowledge and memories to patronise
• academic/professional
achievement Foot jue yin Liver: Hand shao yang Triple Heater:
• assertiveness, self-esteem
Satisfaction due to having or obtaining: Feelings of:
• high self-esteem/self-consciousness • inferiority, sarcasm, knowing too little
• power, influence or status • Includes the function of forgetting or
• more related to power, status and ‘deleting’ memories and emotional trauma
assertiveness than knowledge

The European Journal of Oriental Medicine 23

Please note that an excess of positive emotions can also result acupoints from the shu-transport-points (Five Element Antique
in unhealthy mental states. For example, the second level is points 五兪穴, Korean: 오수혈). The selection of points as well
related to the satisfaction of ‘needs for emotional fulfilment’. as their tonification or sedation is decided upon based on the
Compulsion of too much losing oneself in positive pleasure may promoting and controlling cycle of Five Element theory. The first
result in negative consequences. In the extreme, this can end up two needles follow the principle of using the promoting cycle as
in thrill-seeking or escapism from the responsibilities of everyday described in Huang Di Neijing Suwen, chapter 69: ‘In cases of
life and can lead to psychopathological syndromes like deviant deficiency tonify the mother; and in cases of excess sedate the
sexual behaviour or drug addiction. The dissatisfaction side of son’. Master SaAm’s genius was to expand the point prescriptions
the mental-emotional dimensions does not mean it is completely by adding two more points utilising also the controlling cycle
negative and undesirable although it contains negative emotions. and in that way exerting increased influence on the manipulated
To a reasonable degree the emotions associated with the yang- meridian’s energy. The tonification strategy is named by the
meridians have important functions for a healthy mental state Korean term jeong gyeok. Sedation is named seung gyeok.
because they balance an excess of the positive yin-side and can
establish motivational factors in certain situations. For example, 1. Tonification method: jeong gyeok (정격)
the emotions of inferiority, frustration and anger associated with • Promoting cycle: 1st point: tonify the mother point of the
shao yang Gall Bladder can give a person the drive to change an own meridian; 2nd point: tonify the element point of the
unacceptable or unsatisfying situation. mother meridian
• Controlling cycle: 3rd point: sedate the grandmother point
The mental-emotional aspect of SaAm theory has many clinical of the own meridian; 4th point: sedate the element point of
applications that cannot be discussed in this short text but unfold the grandmother point
once the model is understood. For instance, the meaning of the
Triple Heater, in contrast to traditional Chinese medicine theory, is 2. Sedation method: seung gyeok (승격)
to be the ‘mental waste disposal’ of the organism. Specifically, this • Promoting cycle: 1st point: sedate the son point of the own
means Triple Heater energy helps to get rid of mental-emotional meridian; 2nd point: sedate the element point of the son meridian
‘waste’. Thus, Triple Heater tonification is applied to drain a person’s • Controlling cycle: 3rd point: tonify the grandmother point
mind from traumatic or psychologically negative memories due to of the own meridian; 4th point: tonify the element point of
post-traumatic stress disease or childhood trauma. the grandmother meridian

SaAm point combinations and needling method Table 4 shows the point combinations for tonification and
Each of the 12 meridians can be addressed with a tonification sedation for all 12 meridians according to the principles described
and sedation strategy, resulting in 24 basic acupuncture point above. In clinical practice the tonification strategy (jeong gyeok/JG)
prescriptions.1 Each of these prescriptions uses four predefined is used for most cases (about 85 per cent).

Table 4: Point combinations for tonification and sedation of the twelve meridians

Meridian Jeong gyeok (JG): Tonification strategy Seung gyeok (SG): Sedation strategy
Tonify Sedate Tonify Sedate
Lung (Lu) Lu 9+ Sp 3+ Lu 10- Ht 8- Lu 10+ Ht 8+ Lu 5- Ki 10-
Large Intestine (LI) LI 11+ St 36- LI 5- SI 5- LI 5+ SI 5+ LI 2- Bl 66-
Stomach (St) St 41+ SI 5+ St 43- GB 41- St 43+ GB 41+ St 45- SI 1-
Spleen (Sp) Sp 2+ Ht 8+ Sp 1- Liv 1- Sp 1+ Liv 1+ Sp 5- Lu 8-
Heart (Ht) Ht 9+ Liv 1+ Ht 3- Ki 10- Ht 3+ Ki 10+ Ht 7- Sp 3-
Small Intestine (SI) SI 3+ GB 41+ SI 2- Bl 66- SI 2- Bl 66- SI 8+ St 36+
Urinary Bladder (Bl) Bl 67+ LI 1+ Bl 40- St 36- Bl 40+ St 36+ Bl 65- GB 41-
Kidney (Ki) Ki 7+ Lu 8+ Ki 3- Sp 3- Ki 3+ Sp 3+ Ki 1- Liv 1-
Pericardium (P) P 9+ Liv 1+ P 3- Ki 10- P 3+ Ki 3+ P 7- Sp 3-
Sanjiao /Triple Heater (TH) TH 3+ GB 41+ TH 2- Bl 66- TH 2+ Bl 66+ TH 10- St 36-
Gallbladder (GB) GB 43+ Bl 66+ GB 44- LI 1+ GB 44+ LI 1+ GB 38- SI 5-
Liver (Liv) Liv 8+ Ki 10+ Liv 4- Lu 8- Liv 4+ Lu 8+ Liv 2- Ht 8-

1 SaAm acupuncture has also a warming and cooling strategy consisting also of 24 four-point combinations. Clinically these are only seldom used and not
in the scope of this article. This makes up for 48 standard point prescriptions.

24 The European Journal of Oriental Medicine

Four Needles, Five Elements and Six Qi: Treatment using Korean SaAm Acupuncture
Andreas Brüch

For tonification and sedation of acupuncture points Korean 1. Local channel treatment: In case a condition is allocated
acupuncturists largely use the same methods also established to the pathway or area covered by a particular meridian, for
in classical Chinese medicine, namely inserting the needle in or example, pain from trauma or bi syndrome, the meridian’s Upright
against the meridian flow, inserting while inhaling or exhaling, Qi (zhen qi) usually is strengthened with the tonification strategy
removing the needle while exhaling or inhaling, and closing or jeong gyeok.
leaving the point open when removing needles.
2. Treatment according to zang fu syndrome diagnosis:
Additionally, many SaAm practitioners apply a complex yet Conditions explained by zang fu theory can be directly treated
effective principle of clockwise or counter-clockwise needle with the point combination related to the affected organ. In
rotation, taking into account the yin and yang factors of the SaAm acupuncture all zang fu diagnoses are classified according
particular meridian, side of the body, upper or lower limbs, time to deficiency or excess conditions. In case of deficiency the upright
of day and the patient’s gender (Ahn et al., 2010). This method qi is considered weak and in excess there is an overabundance
was described by Lee Chan (李梴) in the classic Yi Xu Ru Men of pathogenic qi (Cha et al., 2014). This means all syndrome
(醫學入門/Introduction to Medicine) in 1575, but is beyond the patterns of a particular zang fu usually classified as deficiency can
scope of this article (Lee, 2018). Clinically every SaAm four- be addressed by the jeong gyeok combination (JG). Diagnoses
point prescription is applied only unilaterally on the right or left in the excess category can be treated with seung gyeok (SG).
extremities. Following traditional rules, the four points are used For example, Liver JG addresses Liver blood deficiency, Liver yin
on the right for women and on the left for men except for deficiency or Liver Wind due to Blood deficiency. Liver sedation
one-sided conditions where the SaAm pattern is administered (SG) is used for Liver yang rising, Liver Wind, Liver Heat, Liver Fire,
contralateral to the diseased side. etc. A more general approach is to address a zang fu’s imbalance
by not even making a differentiation between excess and
Combining the SaAm four needle strategy with deficiency, but instead following in every case the idea of always
supplemental treatment boosting the upright qi of the diseased organ with the point
The central SaAm treatment strategy can be supplemented combination of jeong gyeok in order to correct the problem. For
usually on the opposite side of the body by needling additional instance, simple Liver qi stagnation can be addressed following
acupuncture points or using moxibustion, gua sha and other this principle (Choo, Brüch, Janowitz, 2017). The detailed
treatment methods. theoretical rationale for these approaches goes beyond this article.
However, this makes SaAm acupuncture an easy to use method
The task of this procedure is to have an extended treatment for in case of zang fu syndromes because the practitioner does not
disease aspects not covered by the selected main SaAm approach need to memorise and apply so many point combinations as in
such as addressing the disease from other Oriental medicine conventional Chinese medicine, instead it follows a universal
perspective, treating secondary conditions or symptomatic principle for point selection.
and reactive points. SaAm acupuncture is an open system and
it is no problem to select points from a broad theoretical or 3. Six Qi climatic treatment: This modality follows the above
methodological background. This could be for example zang fu described model of climatic conditions. The diagnosed climatic
theory, Eight Extraordinary Vessels, Master Tong acupuncture, disharmony is usually balanced by tonification of the opposing
ear acupuncture, Korean hand acupuncture and so forth (Choo, climatic factor. For example, signs and symptoms that indicate a
Brüch, Janowitz, 2017). In more advanced SaAm acupuncture general tendency to let too much energy or bodily fluids go to the
there is also the possibility to use several four-point combinations outside, combined with Heat signs like acne, sweating, inflamed
in one treatment or to apply only selected points from a four- skin conditions or hot flushes can be balanced by promoting the
needle strategy. Liver’s astringent, inwardly directed, moving and cooling Wind
characteristic according to Six Qi theory. This can be due to
Modalities of treatment in SaAm acupuncture pathogenic influences or long-time constitutional factors.
As already explained, the four-point combinations not only
function to treat climatic imbalances and mental emotional 4. Mental-emotional treatment: This category covers problems
conditions but to also address all major conventional disease that can be understood and treated by Dr Hong-Gyeong Kim’s
categories of standard Chinese acupuncture. This makes SaAm model of mental-emotional conditions that has been described
acupuncture a comparatively fast and easy to use acupuncture above. For example, Foot jue yin Liver meridian’s tonification
style. In summary, the treatment with the SaAm tonification and promotes self-esteem and assertiveness. This balances Hand shao
sedation strategies can be classified in the following four main yang Triple Heater’s characteristic feelings of inferiority, sarcasm or
categories (Choo, Brüch, Janowitz, 2017): low self-confidence.

The European Journal of Oriental Medicine 25

An overview of these four treatment categories is shown in chart 1. In clinical practice it often happens that several of these
modalities may overlap. Thus, considering multiple analytical perspectives is helpful to understand the patient’s disease and select
the best meridian for treatment.

Chart 1: Treatment modalities and steps to selecting a meridian for treatment

Localised condition: JG: Tonify selected

channel treatment meridian

Collect and
Deficiency condition JG: Tonify selected
evaluate
diagnosis zang fu
diagnostic
information SG:
zang fu syndrome Excess
Remove pathogen
diagnosis condition diagnosis
from zang fu

Decide for No differentiation for JG: promote upright

excess or deficiency qi of affected zang fu
treatment
approach
Identify imbalance & JG: Strengthen
Six Qi diagnosis:
excess climatic balancing climatic
Climatic treatment
condition energy

Identify excess JG: Strengthen

Mental-emotional
mental-emotional balancing mental
treatment
aspect energy

Case examples is extremely adipose. After eating greasy food, she gets diarrhoea.
For the following case descriptions, it should be pointed out that Her facial skin is blemished and oily. Pulse: fast, superficial, thin
treatment interventions chosen additionally to the main SaAm and slippery with little force in the deep position, thready-full
strategy are the author’s personal approach: Combining SaAm at the Liver/Gall Bladder and Spleen/Stomach position. Tongue:
acupuncture with points selected according to conventional normal coloured body with red spots, very wet (lots of saliva) with
Chinese medicine principles plus moxibustion Korean and a greasy, yellow coating in a stripe along a decent stomach crack,
Japanese style. The supplemental treatment can greatly vary her under-tongue veins are extended.
according to the practitioner’s individual style and preferences. The
particular cases were selected to highlight the different modalities Diagnosis: Climatic excess of Dampness and Heat according to
of localised channel treatment, zang fu syndrome pattern Six Qi theory.
treatment, treatment according to Six Qi climatic energies and
mental-emotional treatment or the overlap of these modalities. Treatment: SaAm strategy: Large Intestine jeong gyeok (LI
This all can be covered using the 24 basic point prescriptions. tonification: LI 11 qu chi+, St 35 du bi+, LI 5 yang xi-, SI 5 yang
gu-) on the right side. Supplemental points: needling of Sp 9 yin
Case 1: Female, 29 years, chronic migraine headache. ling quan, LI 4 he gu; EXP tai yang, Liv 3 tai chong, GB 38 yang
The patient has been suffering from migraine headache since age fu-, hardened muscles of the shoulder-neck area treated with
21 with the last three years becoming considerably worse. She needles and rice corn moxa (e.g. GB 20 feng chi, Bl 10 tian zhu,
has temporal burning pain on the right side with a feeling of her GB 12 wang gu, trapezius muscle, levator scapulae).
‘head melting from heat’. The pain is accompanied by nausea
and dizziness. Her head feels like wrapped in cotton and dull. The Discussion: This case is an example of the main treatment
headache gets worse with change of weather especially when strategy derived exclusively from Six Qi climatic considerations
the conditions turn wet. When there is not an acute attack of with other pathophysiological aspects (like zang fu syndrome
migraine, she suffers from headaches every day continuously. She or channel reference of the pain) left out completely. The
has little thirst and likes cold drinks. She has hypothyroidism and patient very clearly has a Damp-Heat constitution according to

26 The European Journal of Oriental Medicine

Four Needles, Five Elements and Six Qi: Treatment using Korean SaAm Acupuncture
Andreas Brüch

Six Qi theory with Dampness predominating. She shows this in system and therefore is often tonified in conditions of weak
many signs and symptoms as well as in her tongue and pulse immune function. Supplemental points: Ki 7 fu li and Sp 5 shang
information. However, according to SaAm constitutional ideas the qiu (metal points) are selected to tonify Kidney and Spleen energy
extreme obese physical build alone would be enough to decide on with the supposed connection to also influencing the immune
an excess of tai yin (Dampness). Since yang ming Large Intestine system function corresponding to the Metal element. St 36 zu
energy is the most drying energy of all meridians and additionally san li and Ren 12 zhong wan strengthen Spleen qi, ding chuan
has a cooling effect, tonification of Large Intestine is balancing calms dyspnoea and wheezing. LI 4 he gu, LI 11 qu chi and Du 12
this condition. The supplemental points are chosen to directly shen zhu reduce Wind, regulate the defensive qi and are used in
address Dampness in her digestive system (Sp 9 yin ling quan), Korean and Japanese moxibustion to boost immune function. Lu
enable the upward and downward movement of clear and turbid 5 chi ze is used as a reactive moxa point for respiratory conditions.
fluids and remove internal Wind (LI 4 he gu), move qi stagnation
(Liv 3 tai chong), and reduce Heat in the Gall Bladder meridian as Case 3: Male, 52 years, calcaneal spur. This patient is standing
concluded from the pulse and location of pain (GB 38 yang fu-). and walking a lot in his profession. For several months stabbing
and burning pain is present in the right heel with a focus
Case 2: Male, 44 years, allergic rhinitis and allergic asthma. spot close to Ki 2 ran gu. Repeated shock wave therapy, heel
The condition is persistent since early puberty. The patient is cushioning and medical insoles showed no effect. In his former
allergic to the hair of cats and dogs. His symptoms after contact profession as an artisan he was working for several years while
with animal hair are dyspnoea, cough and sneezing with little sitting on his knees a lot in a cold environment, he had kidney
or no sputum. He contracts trivial cold and rhinitis easily and stones seven years ago and often has cold hands and feet.
too often which then shows unusual persistent progression. His
physical build is moderately overweight, he has always felt warm Diagnosis: Weakness of upright qi in the Kidney meridian, from
since early childhood and is seldom freezing in cold weather Six Qi perspective the climatic factor of tai yin (cold) is in excess.
conditions. Tongue: normal colour but red and thin at the lung
area with teeth-marks, also teeth-marks on the sides of the Treatment: SaAm strategy: Left side Kidney jeong gyeok (Ki
tongue, very little coating. Pulse: fast and thin, weak at Spleen tonification: Ki 7 fu liu+, Lu 8 jing qu+, Ki 3 tai xi-, Sp 3 tai bai-).
and Lung position. Kidney yin and yang position also deficient. Supplemental points at the side of pain (right): First needling ah
shi points at the heel, in a second step extensive rice corn moxa
Diagnosis: Zang fu: Lung yin deficiency with Heat, Spleen qi covering the whole area of pain.
deficiency, some Kidney deficiency; Six Qi: excess of Heat
and Dampness. Discussion: This case shows the possibility of a relatively
phenomenological approach in SaAm acupuncture disregarding
Treatment: SaAm strategy: Lung jeong gyeok (Lu tonification: any information from pulse or tongue diagnosis when treating
Lu 9 tai yuan+, Sp 3 tai bai+, Lu 10 yu ji-, Ht 8 shao fu-) and Large conditions that can be allocated to the local distribution of a
Intestine jeong gyeok (LI tonification: LI 11 qu chi+, St 36 zu san meridian. Kidney JG is chosen to strengthen the upright qi of the
li+, LI 5 yang xi-, SI 5 yang gu-) on the left body side in interchange Kidney channel here solely because of the problem’s location.
of treatment sessions, with Lung JG preferably at times when more Such a simple and fast approach of identifying the location of a
respiratory discomfort is present. Supplemental points: Right side musculoskeletal problem and then tonifying the related channel
and on the back. Needling: Ki 7 fu liu, Sp 5 shang qiu, St 36 zu san (JG) is very often applied in SaAm acupuncture. From a zang
li, Ren 12 zhong wan, EXP ding chuan. Rice corn moxa: LI 4 he gu, fu perspective it might be argued that this patient shows signs
LI 11 qu chi, Lu 5 chi ze, Du 12 shen zhu. of Kidney yang deficiency as well. As already explained, the
tonification strategy of jeong gyeok covers all different diagnoses
Discussion: This case highlights a combination treatment after of deficiency. Hence, it is not needed to choose special points
zang fu syndrome diagnosis and Six Qi climatic aspects. First, the for Kidney yin or yang deficiency. From Six Qi perspective his
point combination of Lung JG addresses mainly the Lung zang fu constitution is diagnosed as tai yin (= Cold) excess that can be
deficiency syndrome by tonification and boosting the upright qi balanced by using the shao yin Heat of Kidney energy.
of the respiratory system. The alternating tonification of the Large
Intestine meridian here has a twofold aspect. The physical build Case 4: Male, 57 years, chronic gastritis. He was sent by his
and general feeling of always being warm shows a moderate gastroenterologist, because biomedical therapy had no further effect.
constitutional excess of Dampness (= overweight) and Heat. Yang Three years ago, he was diagnosed with gastritis including massive
ming Large Intestine climatic energy is cooling and drying and petechial bleeding in the stomach and oesophagus. His symptoms
thus balancing these factors. Additionally, in SaAm theory yang are bloating, heartburn, abdominal tension, acid regurgitation,
ming Large Intestine energy is corresponding to the immune stomach pain, loss of appetite and frequent ravenousness.

The European Journal of Oriental Medicine 27

Proton pump inhibitors and later antiemetic medication were raised and competence in relation to issues of skills and knowledge
over time to the maximum permissible dosage but showed only and can be used to reduce symptoms due to professional stress.
temporary improvement. The patient often wakes up at night due Also, the Pericardium channel has an inner branch reaching into
to stomach pain. With vocational stress his symptoms get worse. the stomach to move stagnation in the digestive system with the
His build is skinny-emaciated and he has lost an additional 4 kgs Pericardium’s climatic moving aspect of Wind. The supplemental
in the past few months. He is easily freezing with cold hands and acupoints are used to direct counterflow qi downwards (Sp 4
feet. He is also suffering from allergic rhinitis and frequent muscular gong sun, P 6 nei guan), tonify Spleen qi and yin (Sp 6 san yin
cramps. Tongue: teeth-marks, many transversal and longitudinal jiao), move Liver qi stagnation (Liv 3 tai chong), furthermore
cracks, little coating, red and completely peeled in the Stomach improve Spleen qi and the digestive system (Liv 13 zhang men,
area with a large longitudinal Stomach crack. Pulse: full, fast and Ren 9 shui fen, Ren 12 zhong wan), and remove qi stagnation in
superficial, weak at the Spleen position, full-wiry pressure at the the abdominal area with rice corn moxa.
Stomach and Small Intestine position.
Case 5: Female, 54 years, tinnitus, dizziness, neck pain and
Diagnosis: Zang fu: Spleen qi deficiency, Stomach qi stagnation, hot flushes. For the last nine months she has suffered from a
Heat and yin deficiency with counterflow of qi, secondary Blood feeling of pressure wandering up the neck to the temples and
deficiency. Six Qi: Emaciated physical build and lack of tongue top of the head, dizziness, neck pain, occipital headaches, the
coating means an excess of yang ming Dryness, his general feeling of pressure behind the eyes, hot flushes and repeated
tendency to freeze can be understood either as an excess of nausea during a situation with a lot of emotional stress. About
tai yang Cold or as an stagnation of shao yin Heat stuck in the five weeks ago she started to have tinnitus with a high pitch
middle burner not moving to the extremities. and a pulsating feeling in her right ear. Consulting with her
GP and ENT specialist resulted in no findings. Her orthopaedist
Treatment plan over a course of six months: SaAm strategy: thought her condition might be due to some problem in her
Predominantly Spleen jeong gyeok (Sp tonification: Sp 2 da du+, cervical spine but physiotherapy and osteopathic treatment
Ht 8 shao fu+, Sp 1 yin bai-, Liv 1 da dun-), in some sessions had no lasting effect. Since about four weeks she also has
Stomach jeong gyeok (St tonification: St 41 jie xi+, SI 5 yang some sleeping disorders. Abdominal diagnosis shows sensitive,
gu+, St 43 xian gu-, GB 41 di wu hui-), in sessions when the hardened spots at the Korean-style localisation of Liver and Gall
patient reported increased stress Pericardium jeong gyeok (PC Bladder mu-alarm points. Tongue: red on the Heart and Liver
tonification: P 9 zhong chong+, Liv 1 da dun+, P 3 qu ze-, Ki 10 area; pulse: fast, thin, weak with both distant pulse positions
yin gu-). Supplemental treatment: Needling Sp 4 gong sun, P 6 representing the upper burner comparatively fuller and the pulse
nei guan, Sp 6 san yin jiao, Liv 3 tai chong; cone moxa on Liv 13 position for Kidney yin empty.
zhang men, Ren 12 zhong wan, Ren 9 shui fen; rice corn moxa on
painful, reactive spots of all acupoints in the upper abdomen with Diagnosis: Six Qi: Flaming up of shao yang Ministerial Fire. Zang
palpation of the ren, Kidney, Stomach, Liver and Spleen meridian. fu: Liver Yang rising with Liver and Kidney yin deficiency.
This makes up to 10-15 reactive moxa points on the abdomen
depending on the present state. Treatment: SaAm strategy: Gall Bladder seung gyeok (GB
sedation: GB 38 yang fu-, SI 5 yang gu-, GB 44 zu qiao yin+, LI 1
Discussion: This case shows a combined approach of Six Qi shang yang-) left side, supplemental points: LI 4 he gu, Sp 6 san
constitutional perspective and zang fu syndrome. The use of yin jiao, Ki 3 tai xi, TH 17 yi feng, SI 19 ting gong, GB 20 feng chi
tonification of Spleen (JG) here has a twofold purpose. First, it on the right, needling and rice corn moxa on muscular trigger
addresses problems of Spleen deficiency. Second, according to Six points in the shoulder-neck area.
Qi theory increasing tai yin Spleen energy means strengthening
the climatic factors of Dampness and Warmth therefore balancing Discussion: According to Hong-Gyeong Kim’s mental emotional
the Dry and somewhat Cold constitution of this patient. The theory excess negative emotions like anger, aggression,
rationale of using the tonification of Stomach JG not so often frustration, or feeling of lack of power and self-confidence
here is to not increase the Stomach’s yang ming drying climatic are associated with shao yang Gall Bladder. In Six Qi theory
energy because of the predominating Dryness. However, as both Ministerial Fire is related to the climatic characteristics of shao
Spleen and Stomach are Earth element, tonification of their yang. Emotional disturbance can create an upward flaming of
(slight) climatic warmth can cool down the intensive stagnated Ministerial Fire which shows in typical signs of alleviated stress
Heat in the intestines by putting out Fire with Earth and moving like hot flushes, headache, tinnitus, etc. Therefore, many physical
stagnation in the middle burner to guide out the general cold symptoms which are understood as Liver yang rising in standard
(freezing extremities). According to SaAm mental-emotional TCM can be interpreted as excess of shao yang Gall Bladder
theory jue yin Pericardium improves feelings of self-assertiveness energy from a Six Qi perspective (Gary, 2012). To reduce this

28 The European Journal of Oriental Medicine

Four Needles, Five Elements and Six Qi: Treatment using Korean SaAm Acupuncture
Andreas Brüch

excess, Gall Bladder seung gyeok (sedation) is applied here. In of meridian energy. The theory of Six Qi is combined with the Five
SaAm acupuncture this approach is clinically the most often and Elements to create a climatic understanding of human physiology.
very effectively applied sedation strategy because of our modern Based on the Six Qi, Hong-Gyeong Kim’s mental-emotional theory
life’s stress and daily hassles. Supplemental treatment is used to offers a framework for the psychological aspects of meridian
improve movement of clear and turbid fluids and remove internal energy. These approaches add two more layers to the standard
Wind (LI 4 he gu), tonify yin (Ki 3 tai xi, Sp 6 san yin jiao), improve modalities of Chinese medicine.
local circulation of the ear (SI 19 ting gong, TH 17 yi feng) and
relax the muscles of shoulder and neck. Additionally, the three climatic dimensions of humidity
(overweight vs. skinny), temperature (hot vs. cold general
CONCLUSION sensations) and movement of Wind are utilised for a concise
Fruehauf (1999) argues that in modernised TCM aspects of constitutional model. A general excess of any of these qualities
‘old school’ classical Chinese medicine have been omitted for can be interpreted as constitutional imbalance. By balancing this
practical or political reasons, either to adapt it to westernised excess with the energy of a meridian having opposite climatic
medical thinking or to cut out some of its many branches in quality the body can be supported to heal itself from the present
order to make Chinese medicine less complex and fit into condition. This feature of SaAm acupuncture reflects the main
the political setting of Mao’s China. It is the author’s opinion distinguishing character of Korean medicine in comparison to
the Six Qi might be one of the concepts that has suffered Chinese medicine: To rely more on constitutional factors and focus
this development, but it has been further developed and has less on treating specific disease patterns.
flourished in Korean SaAm acupuncture.
Overall, these differences from Chinese medicine at first make it
The Six Qi create a more complete understanding of the 12 main somewhat confusing for the practitioner to consider all possible
meridians and their true meaning. The meridians’ full naming such perspectives for diagnosis and treatment. However, after some clinical
as Hand yang ming Large Intestine or Foot shao yin Kidney clearly practice the systematic approach, the use of only four needles for the
carries the correspondence to their Six Qi climatic characteristics. main treatment strategy and the constitutional approach provide a
SaAm acupuncture fully incorporates this often disregarded aspect useful and fast toolbox to fight our patients` diseases.

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