A Literature Review of Clinical Studies Using Sa-am Acupuncture

Article information

J Acupunct Res. 2021;38(3):183-191
Publication date (electronic) : 2021 August 24
doi : https://doi.org/10.13045/jar.2021.00115
1Department of Acupuncture and Moxibustion, Mokhuri Neck and Back Hospital, Seoul, Korea
2Department of Korean Medicine Rehabilitation, Mokhuri Neck and Back Hospital, Seoul, Korea
*Corresponding author: Jinwoong Lim, Department of Acupuncture and Moxibustion, Mokhuri Neck and Back Hospital, 338, Seocho-daero, Seocho-gu, Seoul, 06632, Korea, E-mail: jwlim0123@gmail.com
Received 2021 June 28; Revised 2021 July 13; Accepted 2021 July 16.

Abstract

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 Sa-am 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.

Introduction

Sa-am acupuncture was invented by Sa-am in the Chosun Dynasty and is a method of acupuncture which originated in Korea [1]. It uses the characteristics of acupuncture points and meridians based on Huangdineijing, which is different from conventional acupuncture [2]. In a survey of clinical practice in Korea in 2005, Sa-am acupuncture was the 2nd most frequently used acupuncture method following conventional acupuncture, and 50.6% of Korean medicine doctors used Sa-am acupuncture [3].

Sa-am acupuncture uses the 5 Shu acupuncture points, and the main principles are “tonification-sedation between deficiency and excess” and “tonification-sedation between coldness and heat [4].” If a patient is diagnosed with lung deficiency, the lung-tonification method is used in Sa-am acupuncture by tonifying LU9, SP3, and sedating HT8 and LU10. The 4 acupuncture points are selected based on the 5 Shu acupuncture points theory, and the practitioner can use a supplementation and draining method (SDM). However, there is no generally approved SDM. Consequently, this is an obstacle when using Sa-am acupuncture in clinical practice and describing the possible benefits of Sa-am acupuncture.

Clinical studies of Sa-am acupuncture are being conducted however, Sa-am acupuncture is usually assessed alongside conventional acupuncture, and has not been paid as much attention as conventional acupuncture. A comprehensive review of clinical studies (rather than classic text books) using Sa-am acupuncture, has not been conducted therefore, we aimed to comprehensively review clinical studies investigating Sa-am acupuncture, and suggest directions for future studies using Sa-am acupuncture.

Materials and Methods

Data sources and search method

National and international online databases were searched (MEDLINE, EMBASE, the China National Knowledge Infrastructure for Chinese studies, the Research Information Sharing Service, the National Digital Science Library, and the Oriental Medicine Advanced Searching Integrated System) using the search term “Sa-am acupuncture” in each language. Articles published up to 31 March 2021 were included in the review.

Inclusion criteria

Clinical research articles where Sa-am acupuncture was investigated were included and reviewed in this study. Any type of clinical study, such as randomized controlled trials (RCTs), uncontrolled clinical trials (UCTs), observational studies, and case studies was included in this review.

Exclusion criteria

Animal studies, literature reviews and clinical studies that did not investigate Sa-am acupuncture were excluded from this review.

Data collection

Two researchers selected articles based on the inclusion and exclusion criteria. Two researchers independently extracted data. Data on the 1st author, country, publication year, study type, disease or health condition of patients, number of patients, Sa-am acupuncture method including a SDM, additional treatments, control group intervention (if available), outcome measurements, and overall results were extracted for review. Additionally, for RCTs, the risk of bias was assessed using the Cochrane risk of bias tool.

Results

A total of 105 articles were retrieved after excluding duplications. There were 54 articles selected after reviewing the titles and abstracts. After reviewing the full manuscript, 52 articles were included in the literature review. A flowchart of this study using Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 is shown in Fig. 1 [5].

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses flow diagram of the review.

There were 29 articles which were case studies [634], 19 articles were RCTs [3553], and 4 articles were UCTs [5457]. There were 44 studies conducted in Korea, and 10 studies in China. Neurological disorders were the most frequently studied diseases [6,912,2022,25,35,40,49,51,53,5557], followed by musculoskeletal disorders [15,16,21,23,24,26,29,30,50,52]. Kidney tonification was used in 11 studies [6,9,10,13,17,21,24,31,33,50,57] and was the most frequently studied method followed by gallbladder tonification, which was used in 6 studies [9,21,32,34,40,54]. The most frequently used SDM was directional SDM which was used in 26 studies [11,12,15,1820,2226,3540,4244,47,48,50,52,54,56], followed by twirling SDM which was used in 7 studies [8,10,16,18,25,37,38].

Case studies

Of the 29 case studies, 27 were conducted in Korea [610,1334] and 2 were conducted in China [11,12]. A total of 162 cases were reported. Psoriasis [21,28], stroke [6,21], and herniated lumbar intervertebral disc [10,12] were reported in 2 studies each. Kidney tonification was the most frequently reported method that was used in 9 studies [6,9,10,13,17,21,24,31,33], followed by gallbladder tonification [9,11,21,32,34] and liver tonification [14,20,21,27,28]. Directional SDM was the most frequently used SDM which was used in 11 studies [11,12,15,1820,2226], followed by twirling SDM which was used in 5 studies [8,10,16,18,25]. The number of acupuncture treatment sessions ranged from 4 to 87. There were 24 studies [6,810,1219,2126,2833] which used other treatments, including body acupuncture, herbal medicine, or pharmacopuncture. Outcome measures varied across studies, and the overall results were generally positive for the treatments. The characteristics of each study are summarized in Table 1.

Summary of the Included Case Studies.

Randomized clinical studies

There were 12 RCTs which were conducted in Korea [3543,45,47,48], and 7 RCTs were conducted in China [44,46,4953]. Strokes were studied in 5 RCTs [35,36,49,50,53] and were the most frequently studied condition/disease, followed by Hwa-byung, which was reported in 4 studies [39,42,43,48]. Modified methods were used in 4 studies [44,49,51,53], and kidney tonification [46,50], large intestine tonification [50,52], bladder tonification [36,40], pericardium tonification [43,48], and Noyugyogbang [37,47] were used in 2 studies. Directional SDM was used in 13 studies [3540,4244,47,48,50,52], and was the most frequently used SDM followed by open-closed SDM which was used in 3 studies [44,50,52]. The number of acupuncture treatment sessions ranged from 1 to 30. Ten studies used additional treatments [35,3841,45,47,49,51,53], including body acupuncture, herbal medicine, and usual care. Outcome measures varied across the studies, and the results were generally positive, however, 4 studies reported no significant differences in the measurements [38,40,41,45]. The characteristics of each study are summarized in Table 2.

Summary of the Included Randomized Controlled Trials.

Risk of bias of randomized clinical studies

1. Random sequence generation

There were 7 studies which reported an adequate method of random sequence generation and were considered to have a low risk of bias [37,38,41,43,44,47,48]. Eight studies did not report methods of random sequence generation and were considered to have an unclear risk of bias [35,36,39,40,42,45,46,49]. Two studies randomized the participants depending on the time of visit [51,53], and 2 studies randomized the participants depending on the order of visit [50,52], therefore, 4 studies were considered to have a high risk of bias.

2. Allocation concealment

There were 3 studies which reported adequate methods of allocation concealment and were considered to have a low risk of bias [43,47,48]. Sixteen studies did not report methods of allocation concealment and were considered to have an unclear risk of bias [3542,4446,4953].

3. Blinding of participants and personnel

There were 4 studies which reported that they did not use blinding of participants and personnel and were considered to have a high risk of bias [35,36,45,47]. Blinding of participants was performed in 7 studies [3740,42,43,48] and 7 studies did not report the methods of blinding in the study [44,46,4953], consequently, these 14 studies were considered to have an unclear risk of bias. One study reported they used a double-blind method and was considered to have a low risk of bias [41].

4. Blinding of outcome assessment

There were 2 studies which reported blinding the outcome assessment and were considered to have a low risk of bias [43,48]. There were 17 studies which did not report blinding the outcome assessment and were considered to have an unclear risk of bias [3542,4447,4953].

5. Incomplete outcome data

There were 10 studies which reported all participants’ data and were considered to have a low risk of bias [4346,4853]. Seven studies did not report the number of participants used in the outcome data analysis and were considered to have an unclear risk of bias [3540,42]. One study did not report all participants’ data and was considered to have a high risk of bias [41]. One study used a full analysis set and per-protocol set, and was considered to have an unclear risk of bias [42].

6. Selective reporting

There were 2 articles which were considered as 1 trial and reported different outcome measures [43,48], therefore, were considered to have a high risk of bias. Seventeen studies reported all outcome measures and were considered to have a low risk of bias [3542,4447,4953].

7. Other bias

The included studies appeared to be free of other sources of bias. The risk of bias for each study is summarized in Fig. 2.

Fig. 2

Risk of bias summary.

Uncontrolled clinical studies

There were 4 UCTs included in this review. Three studies were conducted in Korea [5456], and 1 study was conducted in China [57]. Insomnia [54], amyotrophic lateral sclerosis [55], post-stroke hemiparesis [56], and migraine [57] were studied and treated with gallbladder tonification [54], lung tonification [55], liver sedation [56], and a modified method (lung tonification with liver sedation) [57]. Directional SDM was used in 2 studies [54,56], and the number of acupuncture treatment sessions ranged from 3 to 12. Overall, outcomes were generally positive for Sa-am acupuncture treatment. The characteristics of each study are summarized in Table 3.

Summary of the Included Uncontrolled Trials.

Discussion

Sa-am acupuncture has distinct characteristics compared with conventional acupuncture and is of clinical importance in practices in Korea. However, few clinical studies have been published since the 1st case study in this review in 1975 [6]. All the available clinical studies were retrieved, and not only limited to RCTs, so that a comprehensive review of Sa-am acupuncture research could be performed.

Sa-am acupuncture originated in Korea, therefore, the included studies in this review were mostly conducted in Korea. Studies conducted in other countries are necessary to investigate the effect of Sa-am acupuncture in diverse populations and to avoid possible location bias. Moreover, the SDM is a major component in Sa-am acupuncture treatment and could influence the effect of acupuncture [58], however, 40.7% of the studies included in this review did not report the SDM used. Future studies investigating Sa-am acupuncture should report the SDM, and the clinical differences between SDMs should be further investigated.

The case reports in this review showed that Sa-am acupuncture had been generally successful in the treatment of various conditions. However, 24 out of 29 studies reported treatments additional to Sa-am acupuncture and the duration of treatments varied across the studies, therefore, to describe the possible benefit of Sa-am acupuncture from the studies may be misleading. Future case studies need to focus on the specific effect of Sa-am acupuncture and report detailed treatment methods.

The included RCTs attempted to investigate the advantages of Sa-am acupuncture over body acupuncture, usual care, or sham acupuncture. It is encouraging that various diseases have been studied and those studies have shown generally positive outcomes for Sa-am acupuncture. However, the quality of the RCTs included in this review was low, and it would be inappropriate to report the specific effect of Sa-am acupuncture as beneficial. RCTs with a rigorous design are warranted to support the clinical beneficial effects of Sa-am acupuncture.

UCTs reported positive outcomes of Sa-am acupuncture on several diseases, however, the number of studies was low compared with case studies, and RCTs. More UCTs with detailed description of the Sa-am acupuncture treatment used, such as duration, session numbers, and the SDM used are needed.

This study has some limitations. Since this study aimed to comprehensively review the clinical studies where Sa-am acupuncture was used, meta-analysis for specific conditions or interventions was not conducted. Consequently, the effect of Sa-am acupuncture on a specific condition or disease could not be determined. Additionally, this study did not detail the prescriptions of Sa-am acupuncture for conditions and diseases, because this varied across the studies, and the prescriptions could be different based on pattern diagnosis. Further studies focusing on a particular condition or disease are needed.

In this study, we summarized the clinical studies of Sa-am acupuncture and identified the possible benefits and directions for future Sa-am acupuncture studies. Sa-am acupuncture has been used to treat various diseases, including neurological, musculoskeletal, and psychiatric diseases. However, the specific effect of Sa-am acupuncture has not been clearly described because treatments additional to Sa-am acupuncture have been performed, and various treatment durations have been reported in case studies, and the quality of RCTs was low. Since Sa-am acupuncture is a distinct component in Korean medicine, further studies with rigorous designs and detailed information of the Sa-am acupuncture treatment used are warranted to identify the specific effects and possible clinical benefits of Sa-am acupuncture.

Acknowledgments

This study did not receive any grant from funding agencies.

Notes

The authors have no conflicts of interest to declare.

References

1. Ahn CB, Jang KJ, Yoon HM, Kim CH, Min YK, Song CH, et al. Sa-Ahm five element acupuncture. J Acupunct Meridian Stud 2010;3:203–213.
2. Lee S, Kim KH, Kim K. Literatural study on Sa-am experienced usage of Sa-am-do-in-chi-gu-yo-kyul. J Korean Acupunct Moxib Soc 1996;13:130–164. [in Korean].
3. Han C, Park J, Ahn S, Choi S. A survey about the recognition regarding the Korean acupuncture method and research direction. J Korean Med History 2005;18:89–101. [in Korean].
4. Ahn CB, Jang KJ, Yoon HM, Kim CH, Min YK, Song CH, et al. A study of the Sa-Ahm five element acupuncture theory. J Acupunct Meridian Stud 2009;2:309–320.
5. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71.
6. Park YH. The study of cure of palsy in accordance with the method of Saam acupuncture. Korean J Orient Med 1975;12:40–42. [in Korean].
7. Chung S, Kim Y. Two cases of hemorrhoid treated with SaAhm acupuncture. J Korean Orient Ophthal Otorhinolaryngol Dermatol 2003;16:252–259. [in Korean].
8. Park S, Kang J, Kim D, Kim J, Yin C, Woo H, et al. Clinical study on 1 case of Hemichorea-Hemiballism patients with Diabetes mellitus treated by Saamchimbeop Ganjeonggyeok. J Korean Acupunct Moxib Soc 2003;20:230–236. [in Korean].
9. Cho BH, Yu BC, Kim YS, Seol IC. A clinical study of two patients suffering from normal pressure hydrocephalus. Korean J Acupunct 2005;22:43–53. [in Korean].
10. Han J, Song H. The Effect of Sa-am Acupuncture and Dongssi acpuncture treatment on a HIVD patient. J Spine Joint Korean Med 2005;2:97–101. [in Korean].
11. Sun G, Sun Z. Experience of Sheyan acupuncture treatment of migraine. Chin Med Mod Distance Educ China 2005;3:55. [in Chinese].
12. Quan T, Li X. Sheyan five elements acupuncture treatment of lumbar intervertebral disc herniation. Chin Med Mod Distance Educ China 2005;3:45–46. [in Chinese].
13. Yang DH, Oh KM, Kim BK. A case report of the Sa-am acupuncture and other treatment for the tic cisorder patient with tachycardia. J Orient Neuropsychiatry 2007;18:225–236. [in Korean].
14. Kim HY, Sung EJ, Yun CS, Yun C, An MS, Kim HY, et al. One case report of inflammatory acne treated with the Ko-Bang and the Sa-am acupuncture. J Korean Orient Ophthal Otorhinolaryngol Dermatol 2008;21:226–234. [in Korean].
15. Lee S, Lim S, Lee S. A Case Ctudy of Sa-am Acupuncture in Knee Pain Caused by Traffic Accident. J Spine Joint Korean Med 2008;5:35–44. [in Korean].
16. Ko J, Kim J, Lee J, Nam S, Choi D. CRPS type-I patient treated with acupuncture and bee-venom acupuncture: A case report. J Korean Acupunct Moxib Soc 2009;26:165–170. [in Korean].
17. Song JY, Jerng UM, Jeong JS, Park JW, Yoon SW. Cancer Pain Relieved by Acupuncture on a Patient with Colorectal Cancer: Single Case Report. J Korean Tradit Oncol 2009;14:37–44. [in Korean].
18. Jang E, Kim H, Yoon G, Lee S. Case Report: A Case of Liver Seunggyeok Sa-am Acupuncture on Coldness of Both Feet. J Spine Joint Korean Med 2011;8:61–69. [in Korean].
19. Oh K. A Clinical Report on Episodic Vertigo with Meniere’s Disease Treated by Saam Acupuncture Sojangjungkyuk. J Korea Inst Orient Med Diagn 2012;16:35–44. [in Korean].
20. Lee S, Kim S, Jung H, Park M, Lee J, Park O, et al. Effects of Sa-am Acupuncture Treatment on a ALS(Amyotrophic Lateral Sclerosis) Patient. J Korean Acupunct Moxib Soc 2012;29:187–195. [in Korean].
21. Choi J, Nam S, Kim Y, Lee J. A Study of Eight Cases According to Hyeongsang Diagnosis Applying Sa-am Acupuncture Therapy. J Korean Acupunct Moxib Soc 2012;29:139–150. [in Korean].
22. Jeong JJ, Sun SH. Sa-am Five-element Acupuncture and Hwangyeon-haedoktang Pharmacopuncture Treatment for an Essential Tremor: Three Case Reports. J Pharmacopuncture 2013;16:49–53.
23. Lee J, Lee S, Yoon K, Kim E, Choi D, Kim J. A Case Report of Left Shoulder Pain from Calcific Tendinitis Located at Supraspinatus Treated with Sa-Am Acupuncture Sojangjeonggyeok. J Spine Joint Korean Med 2013;10:35–45. [in Korean].
24. Ji M, Lim S, Kim J, Lee H, Lee Y. A Clinical Case Study on the Burst Fracture Patient Improved by Saam Acupuncture and Herbal Medicine. J Spine Joint Korean Med 2014;11:18–24. [in Korean].
25. Park JH, Kim S, Kwon M, Cho D, Lee S, Kim J, et al. A Case Report of Both Lower limb Dysesthesia after Myelotomy Treated with Traditional Korean Medicine Treatment Focusing on Saam Acupuncture. J Spine Joint Korean Med 2015;12:1–9. [in Korean].
26. Lee H, Jo J, Ahn J, Choi J, Yoong K, Kang J. A Case Report on Right Elbow Pain Caused by Lateral Epicondylitis Treated with Sa-Am Acupuncture. J Spine Joint Korean Med 2015;12:35–48. [in Korean].
27. Jeon YC, Lee HB. Treatment of an Adult Patient with Atopic Dermatitis Using Traditional Korean Medicine, Especially Sa-Am Acupuncture. J Acupunct Meridian Stud 2016;9:322–324.
28. Jeon Y-C. Treatment for an Adult Patient with Psoriasis with Traditional Korean Medicine, Especially Sa-Am Acupuncture and Herbal Medicine. J Acupunct Meridian Stud 2016;9:88–92.
29. Bae HY, Lee BH. Report on a ankle pain by contusion treated with acupuncture. J East West Med 2017;42:43–49. [in Korean].
30. Choi H, Jee S, Hwangbo M. A case report of shoulder pain treated with SAAM acupuncture therapy. J Jeahan Orient Med Acad 2017;15:1–7. [in Korean].
31. Lee G, Jung YO. A Case Study on a Chronic Pompholyx Treated by SAAM Acupuncture. J Saam Acupunct 2019;1:59–65. [in Korean].
32. Yoong DW, Bahk K. A Case Study on the Efficacy of Sa-Ahm Acupuncture and Herbal Medicine in the Treatment of Fibromyalgia. J Saam Acupunct 2020;2:57–68. [in Korean].
33. Byeon JS, Jung YO. A Case Study of a Chronic Allergic Contact Dermatitis Treated by SAAM Acupuncture and Herbal Medicine. J Saam Acupunct 2020;2:69–74. [in Korean].
34. Park S, Jo E, Choi H, Hong J, Park M. Acupuncture Application Case Report for Symptom Relief of Oral Leukoplakia. J Physiol Pathol Korean Med 2020;34:97–101. [in Korean].
35. Song M, Kim Y, Jang S, Kim J, Yim Y, Kang J, et al. Clinical comparison studies on 20 cases of stroke patients with dysarthria by Sa-Am & General acupuncture. J Korean Acupunct Moxib Soc 2003;20:160–167. [in Korean].
36. Park Y, Kim E, Kim Y, Hong K, Lee H. The Depressive effect of Sa-Am Acupuncture treatment in Stroke Patients. J Korean Acupunct Moxib Soc 2004;21:217–223. [in Korean].
37. Kim S, Park H, Park H, Jang J, Hwang K, Lee S. The Clinical Study on the Effect of SAAM Acupuncture Treatment for Patients with Fatigue. J Korean Acupunct Moxib Soc 2007;24:149–157. [in Korean].
38. Lee I, Youn H, Jung K, Kim S, Min Y, Kim C, et al. Effect of Sa-am Acupuncture Treatment on the Dysmenorrhea (Pillot Study, Single Blind, Randomized, Sham Acupuncture, Controlled Clinical Trial). J Korean Acupunct Moxib Soc 2007;24:63–79. [in Korean].
39. Jung IC, Lee SR, Park YC, Hong KE, Koo YS, Jo JH, et al. The Effect of Sa-am Acupuncture Treatment for Major Symptom of Hwa-byung: A Preliminary Study. J Orient Neuropsychiatry 2007;18:79–94. [in Korean].
40. Hong K, Park Y, Jo J, Jo H, Jung I, Kang W, et al. Effect of Sa-am Acupuncture Method for Chronic Tension-type Headache; A Randomized Controlled Trial. J Korean Acupunct Moxib Soc 2007;24:13–28. [in Korean].
41. Kim S, Jang E, Na W, Lee S, Lee J, Moon H, et al. A Pilot Study of Sa-am Acupuncture Treatment Used by Sham Acupuncture for the Simple Obesity. J Korean Acupunct Moxib Soc 2007;24:67–88. [in Korean].
42. Jung IC, Lee SR, Park YC, Hong KE, Lee YK, Kang WC, et al. The Effect of Sa-am Acupuncture Simjeongkyeok Treatment for Major Symptom of Hwa-byung. J Orient Neuropsychiatry 2008;19:1–18. [in Korean].
43. Choi WJ, Lee SG, Son IB, Sun SH. The effects of Sa-am Acupuncture Simpojeongkyeok Treatment on Hwa-byung: Randomized, patient-assessor blind, placebo-controlled acupuncture, pilot clinical trial. J Orient Neuropsychiatry 2011;22:1–14. [in Korean].
44. Cui S, Jin R, Xu L. Chinese Korean medical sheyan needling method treatment taiyinren constipation: a randomized controlled trial. J Med Pharm Chin Minor 2012;18:1–5. [in Chinese].
45. Jeon E, Kwon H, Shin I, Jung E, Kang S, Shon H. Efficacy of Saam Acupuncture for Diabetic Peripheral Neuropathy - A Pilot, Randomized Controlled Study. Korean J Acupunct 2013;30:289–297. [in Korean].
46. Cui S, Xu L, Lin H. Clinical Observation on the Treatment of Dysmenorrhea in Shaoyang People with Korean Medicine Sheyan Acupuncture. J Med Pharm Chin Minor 2014;20:12–13. [in Chinese].
47. Kim JE, Seo BK, Choi JB, Kim HJ, Kim TH, Lee MH, et al. Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: A multicenter, nonblinded, randomized controlled trial. Trials 2015;16:314.
48. Choi WJ, Cho YY, Sun SH. The Effects of Sa-am Acupuncture Simpo-jeongkyeok Treatment on the Blood Pressure, Pulse Rate, and Body Temperature. J Pharmacopuncture 2015;18:33–41.
49. Zhu Z, Pu D, Xu L. Clinical Study on Standardised Treatment of Aphasia after Stroke in Taiyin Patients by Korean Medicine. J Med Pharm Chin Minor 2016;22:3–5. [in Chinese].
50. Lin H, Cui S, Wang Z. Clinical Observation on the Treatment of Shaoyang People’s Low Back Pain with Korean Medicine Sheyan Acupuncture. J Med Pharm Chin Minor 2016;22:12–13. [in Chinese].
51. Pu D, Zhu Z. Clinical Study on Treating Post-stroke Depression and Phlegm Depression Syndrome in Taiyin People with Reduohanshao Decoction and Sheyan Acupuncture. Electronic J Clin Med Literature 2019;6:12–13. [in Chinese].
52. Lin H, Jin R, Zhu Z. Clinical Observation on the Treatment of Leaking Shoulder Wind of Hand-Yangming Meridian with Korean Medicine Sheyan Acupuncture. J Med Pharm Chin Minor 2019;25:4–5. [in Chinese].
53. Li S, Zhu Z, Pu D. Korean Medicine Tonifying Kidney and Sedating Spleen Treatment for Dysphagia after Stroke in Shaoyang People. Electronic J Clin Med Literature 2020;7:10–11. [in Chinese].
54. Shin K, Lee S, Park K, Cho J. Clinical Study on Sa-Am Acupuncture of insomnia in traffic accident. J Korean Inst Orient Med Inform 2004;10:51–60. [in Korean].
55. Lee S, Kim S. The effects of sa-am acupuncture treatment on respiratory physiology parameters in amyotrophic lateral sclerosis patients: A pilot study. Evid Based Complement Alternat Med 2013;2013:506317.
56. Baek K, Kwon D, Park G. Study of the Effects of Sa-am Acupuncture on Upper Limb Spasticity in Patients with Chronic Post-stroke Hemiparesis using Real-time Sonoelastography. Korean J Orient Int Med 2014;35:1–11. [in Korean].
57. Cui M, Li Y, Yu L. Clinical Observation on Treatment of Migraine in Taiyin Patients with Sheyan Acupuncture and Zhongfeng Tongluo Decoction. Guangming J Chin Med 2015;30:2168–2169. [in Chinese].
58. Na CS, Park CK, Jang KS, So CH. Analysis of YoungSu & Wonbang Acupuncture Method by the Measurement of Physiological Signals on Acupoints. J Korean Acupunct Moxib Soc 2000;17:43–54. [in Korean].

Article information Continued

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses flow diagram of the review.

Fig. 2

Risk of bias summary.

Table 1

Summary of the Included Case Studies.

1st author year [ref] country Disease or condition No. of patients Sa-am acupuncture method (no. of sessions) SDM Additional treatments Outcome measures Overall results
Park 1975 [6] Korea Stroke 42 Liver SM, heart SM, spleen TM, lung SM, kidney TM n.r. HeM Effective rate Positive

Chung 2003 [7] Korea Hemorrhoid 2 Large intestine TM (7 sessions), large intestine CM (6 sessions) Kyeong-rak SDM, Nine-six SDM None BRS Positive

Park 2003 [8] Korea Hemichorea-Hemiballism with diabetes mellitus 1 Liver TM (8 sessions) Twirling SDM, Nine-six SDM BA, HeM, conventional medication Movement of ankle and metatarsal joint Positive

Cho 2005 [9] Korea Normal pressure hydrocephalus 2 Case 1 Gallbladder TM, kidney TM (64 sessions) n.r. HeM, moxibustion 5-level rating scale Positive
Case 2 Spleen TM, kidney TM (14 sessions) n.r. HeM

Han 2005 [10] Korea Herniated intervertebral disc of lumbar spine 1 Modified kidney TM (10 sessions) Twirling SDM Dong-si acupuncture SLR test, Bragard test Positive

Sun 2005 [11] China Migraine 32 Gallbaldder TM (1–10 sessions) Directional SDM None Effective rate Positive

Quan 2005 [12] China Herniated intervertebral disc of lumbar spine 50 Large intestine TM (10 sessions) Directional SDM BA Effective rate Positive

Yang 2007 [13] Korea Tic disorder with tachycardia 1 Kidney TM n.r. BA, HeM YGTSS Positive

Kim 2008 [14] Korea Inflammatory acne 1 Small intestine TM, lung TM (12 sessions) n.r. HeM KAGS Positive

Lee 2008 [15] Korea Knee pain after traffic accident 1 Stomach TM (7 sessions) Directional SDM HeM, cupping, moxibustion, physiotherapy VAS, SF-MPQ, ODI, pain drawing Positive for VAS, ODI, pain drawing, negative for ST-MPQ

Ko 2009 [16] Korea CRPS type I 1 Liver TM (8 sessions) Directional SDM Bee-venom, BA, moxibustion VAS, DITI, McGill pain questionnaire Positive for VAS and DITI

Song 2009 [17] Korea Cancer pain related with colorectal cancer 1 Bladder TM, kidney TM, Pericardium TM, stomach TM, liver TM (8 sessions) n.r. HeM VAS, ECOG performance status Positive

Jang 2011 [18] Korea Coldness of both feet 1 Liver TM (7 sessions) Directional SDM, twirling SDM HeM, BA electroacupuncture, bee-venom, moxibustion VAS, verbal scale, CISS, DITI Positive

Oh 2012 [19] Korea Meniere’s disease 1 Small intestine TM (5 sessions) Directional SDM HeM VAS Positive

Lee 2012 [20] Korea Amyotrophic lateral sclerosis 1 Lung TM, heart TM, liver TM (15 sessions) Directional SDM None EtCo2, respiratory rate, SpO2, pulse rate Positive
1st author year [ref] country Disease or condition No. of patients Sa-am acupuncture method (no. of sessions) SDM Additional treatments Outcome measures Overall results
Choi 2012 [21] Korea Case 1 Low back pain, arthralgia 8 Kidney TM (8 sessions) n.r. BA Subjective assessment Positive
Case 2 Abnormal heartbeat, fever Heart CM, Simsinguheo bang, stomach TM (9 sessions) n.r. None
Case 3 Singultus, insomnia Liver TM (19 sessions) n.r. HeM
Case 4 Psoriasis Small intestine TM, lung TM (8 sessions) n.r. Bee-venom, HeM
Case 5 Sequelae of stroke Kidney TM (7 sessions) n.r. None
Case 6 Chest pain, insomnia Kiwool bang, triple energizer TM, gall bladder TM (5 sessions) n.r. None
Case 7 Insomnia Sanghwa bang, gallbladder TM, Yeoldam bang, heart CM, Aejabjeung bang (142 sessions) n.r. None
Case 8 Hip arthrosis Gallbladder TM, small intestine TM, spleen TM, liver TM (13 sessions) n.r. BA, pharmacopuncture

Jeong 2013 [22] Korea Essential tremor 3 Liver SM Directional SDM Pharmacopuncture NRS Positive

Lee 2013 [23] Korea Calcific tendinitis of supraspinatus tendon 1 Small intestine TM (7 sessions) Directional SDM, Su-beob SDM BA, HeM, pharmacopuncture, electroacupuncture PRS, SPADI, ROM Positive

Ji 2014 [24] Korea Burst fracture 1 Kidney TM (48 sessions) Directional SDM HeM VAS, K-MBI, CR Positive

Park 2015 [25] Korea Lower limb dysesthesia after myelotomy 1 Spleen SM (17 sessions) Directional SDM, twirling SDM Bee-venom, cupping, physiotherapy, HeM SF-MPQ Positive

Lee 2015 [26] Korea Lateral epicondylitis 1 Heart TM (7 sessions) Directional SDM, Su-beob SDM BA, infra-red, HeM VAS, pain-free maximum grip strength, PRTEE Positive

Jeon 2016 [27] Korea Atopic dermatitis 1 Modified lung TM (81 sessions) n.r. None Photographs Positive

Jeon 2016 [28] Korea Psoriasis 1 Modified lung TM (36 sessions) n.r. HeM Photographs Positive

Bae 2017 [29] Korea Ankle pain by contusion 1 Bladder TM (4 sessions) n.r. Dong-si acupuncture VAS Positive

Choi 2017 [30] Korea Shoulder pain 1 Triple energizer TM (3 sessions) n.r. BA, infra-red ROM Positive

Lee 2019 [31] Korea Chronic pompholyx 1 Modified kidney TM n.r. HeM Photographs, subjective assessment Positive

Yoon 2020 [32] Korea Fibromyalgia 1 Small intestine HM, stomach TM, stomach HM, modified methods (12 sessions) n.r. HeM NRS, subjective assessment Positive

Byeon 2020 [33] Korea Chronic allergic contact dermatitis 1 Modified kidney TM (30 sessions) n.r. HeM Photographs, subjective assessment Positive

Park 2020 [34] Korea Oral leukoplakia 1 Gallbladder TM (87 sessions) n.r. None VAS, photographs Positive

BA, body acupuncture; BRS, behavioural rating scale; CISS, cold intolerance symptom severity questionnaire; CM, coldness method; CR, compression ratio; CRPS, complex regional pain syndrome; DITI, digital infrared thermal imaging; ECOG, Eastern cooperative oncology group; EtCO2, end-tidal carbon dioxide; HeM, herbal medicine; HM, heatness method; K-MBI, K-modified Barthel index; KAGS, Korean acne grading system; n.r., not reported; NRS, numeric rating scale; ODI, Oswestry low-back pain disability index; PRS, pain rating score; PRTEE, patient-rated tennis elbow evaluation; ROM, range of motion; SDM, supplementation and draining method; SF-MPQ, short-form McGill pain questionnaire; SLR, straight leg raise; SM, sedation method; SPADI, shoulder pain and disability index; SpO2, peripheral oxygen saturation; TM, tonification method; VAS, visual analogue scale; YGTSS, Yale global tic severity scale.

Table 2

Summary of the Included Randomized Controlled Trials.

1st author year [ref] country Disease or condition No. of patients (experimental/control group) Sa-am acupuncture method (no. of sessions) SDM Additional treatments Control group Outcome measures Overall results
Song 2003 [35] Korea Stroke patients with dysarthria 10/10 Modified method Directional SDM HeM BA Articuration accuracy, vowel accuracy, alternation, speed of reading the sentence Significant for articuration accuracy, alternation, and speed of reading sentence
Park 2004 [36] Korea Hypertension in stroke patients 40/20 Bladder TM (1 session) Won-bang SDM, directional SDM None No treatment Blood pressure Significant for lowering blood pressure
Kim 2007 [37] Korea Fatigue 28/28 Noyugyogbang (8 sessions) Directional SDM, twirling SDM None SA MFS Significant at 2nd week
Lee 2007 [38] Korea Dysmenorrhea 23/26 Small intestine TM (6 sessions) Directional SDM, twirling SDM BA SA MMP, MMSL Not significant
Jung 2007 [39] Korea Hwa-byung 13/13 Heart SM (6 sessions) Directional SDM BA SA Primary: Likert scale for major symptom of Hwa-byung
Secondary: STAXI-K, STAI-K, BDI-K, HRV
Significant for the primary outcome and the expression-control score in STAXI-K
Hong 2007 [40] Korea Tension-type headache 13/13 Bladder TM, stomach TM with coldness, gallbladder SM, or gallbladder TM (6 sessions) Directional SDM BA SA VAS, HDI, 6 points Likert scale Not significant
Kim 2007 [41] Korea Obesity in female 18 (acupuncture)/18 (SA)/24 (non-treatment) Spleen SM (12 sessions) n.r. Lifestyle guidance Group 1: SAGroup 2: Lifestyle guidance Primary: body composition analysis Secondary: blood cholesterol Not significant
Jung 2008 [42] Korea Hwabyung 26/26 Heart TM (6 sessions) Directional SDM None SA Primary: likert scale for major symptom of Hwa-byung
Secondary: STAXI-K, STAI-K, BDI-K, HRV
Significant for the expression-control score in STAXI-K
Choi 2011 [43] Korea Hwabyung 25/25 Pericardium TM (4 sessions) Directional SDM None SA Likert scale for major symptom of Hwa-byung, STAXI-K, STAI-K, BDI-K Significant for the likert scale and BDI-K
Cui 2012 [44] China Constipation in Tae-eum persons 30/30 Modified method (10 sessions) Directional SDM, open-closed SDM None BA Score of defecation status, ER Significant for all the outcomes
Jeon 2013 [45] Korea Diabetic Peripheral neuropathy 6/4 Daily changed on practitioner’s discretion n.r. Vitamin B12 Vitamin B12 Primary: TTS, MNSISecondary: nerve conduction test Not significant
Cui 2014 [46] China Dysmenorrhoea in So-yang persons 30/30 Kidney TM n.r. None BA, Warm acupuncture ER, pain score + medication score Significant for the pain score + medication score
Kim 2015 [47] Korea Chronic fatigue syndrome and idiopathic chronic fatigue 51(Sa-am acupuncture)/49(BA)/50(usual care) Noyugyogbang (10 sessions) Directional SDM, Nine-six SDM Usual care Group 1: BA, Group 2: usual care Primary: FSS
Secondary: SRI, BDI, NRS, EQ-5D
Significant for BDI, and NRS
Choi 2015 [48] Korea Hwabyung 25/25 Pericardium TM (4 sessions) Directional SDM None SA Blood pressure, pulse rate, body temperature Significant for all the outcomes
Zhu 2016 [49] China Aphasia after stroke in Tae-eum persons 30/30 Modified method (Lung TM with liver SM, 30 sessions) n.r. HeM, BA, language rehabilitation, scalp acupuncture, tongue acupuncture, Language rehabilitation CR-RCAE, ER Significant for all the outcomes
Lin 2016 [50] China Low back pain in So-yang persons 30/30 Large intestine TM, kidney TM Directional SDM, open-closed SDM None BA ER Significant
Pu 2019 [51] China Depression after stroke in Tae-eum persons 31/31 Modified method (Lung TM with liver SM, 30 sessions) n.r, HeM, BA, scalp acupuncture Western medicine ER, HAMD Significant for the HAMD
Lin 2019 [52] China Leaky shoulder wind 32/32 Large intestine TM Directional SDM, open-closed SDM None BA ER, pain score, range of motion Significant for all the outcomes
Li 2020 [53] China Dysphagia after stroke in So-yang persons 31/31 Modified method (Kideny TM with spleen SM, 30 sessions) n.r. HeM, BA, low-frequency electrical stimulation, ice stimulation, oral rehabilitation Low-frequency electrical stimulation, ice stimulation, oral rehabilitation WST, SSA Significant for the SSA

BA, body acupuncture; BDI-K, Beck’s depression inventory-K; BDI, Beck’s depression inventory; CR-RCAE, China rehabilitation research center aphasia examination; EQ-5D, Euro-Qol-5 dimension; ER, effective rate; FSS, fatigue severity scale; HAMD, Hamilton depression rating scale; HDI, headache disability inventory; HeM, herbal medicine; HRV, heart rate variability; MFS, multidimensional fatigue scale; MMP, measure of menstrual pain; MMSL, menstrual symptom severity list; MNSI, Mishigan neuropathy screening instrument; n.r., not reported; NRS, numeric rating scale; SA, sham acupuncture; SDM, supplementation and draining method; SM, sedation method; SRI, stress response inventory; SSA, standardized swallowing assessment; STAI-K, State-Trait anxiety inventory-K; STAXI-K, State-Trait anger expression inventory-K; TM, tonification method; TTS, total symptom score; VAS, visual analogue scale; WST, water swallow test.

Table 3

Summary of the Included Uncontrolled Trials.

1st author year [ref] country Disease or condition No. of patients Sa-am acupuncture method (no. of sessions, if reported) SDM Additional treatments Outcome measures Overall results
Shin 2004 [54] Korea Insomnia after traffic accident 20 Gallbladder TM (3 sessions) Directional SDM, Nine-six SDM None Effective rate
SMH Hospital questionnaire
Korean sleep scale A
Positive
Lee 2013 [55] Korea Respiratory parameters in amyotrophic lateral sclerosis patients 18 Lung TM (10 sessions) n.r. None EtCO2, SpO2, respiratory rate, pulse rate, ALSFRS Significant for pulse rate, and SpO2
Baek 2014 [56] Korea Upper limb spasticity in patients with chronic post-stroke hemiparesis 7 Liver SM (12 sessions) Won-bang SDM, Directional SDM None FMA, MBI, MAS, MI, electromyogram, real-time sonoelastography Positive for FMA, MAS, MI, muscle spasticity, and muscle thickness
Cui 2015 [57] China Migraine in Tae-eum persons 92 Modified method (Lung TM with liver SM) n.r. HeM Effective rate, frequency, and severity of migraine Positive

ALSFRS, amyotrophic lateral sclerosis functional rating scale; EtCO2, end-tidal carbon dioxide; FMA, Fugl-Meyer assessment scale; HeM, herbal medicine; MAS, modified Ashworth scale; MBI, modified barthel index; MI, motricity index; n.r., not reported; SDM, supplementation and draining method; SM, sedation method; SMH, St. Mary hospital; SpO2, peripheral oxygen saturation; TM, tonification method.