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Integrative
Medicine
Research
jo u rn al h o m e p a g e :w w w . i m r - j o u r n a l . c o m
Review
Article
Personalized
acupuncture
treatment
with
Sasang
typology
Han
Chae
a,∗,
Jeongyun
Lee
b,c,
Eun
Sang
Jeon
a,d,
Jae
Kyu
Kim
eaDivisionofLongevityandBiofunctionalMedicine,SchoolofKoreanMedicine,PusanNationalUniversity,Korea bDepartmentofSasangConstitutionalMedicine,PusanNationalUniversityKoreanMedicineHospital,Korea cKoreaInstituteofOrientalMedicine,Korea
dDepartmentofAlternativeMedicine,MedipolMegaHospital,Turkey
eDivisionofClinicalmedicine,SchoolofKoreanMedicine,PusanNationalUniversity,Korea
a
r
t
i
c
l
e
i
n
f
o
Articlehistory:
Received31March2017
Receivedinrevisedform
27June2017
Accepted5July2017
Availableonline14July2017
Keywords: differentialdiagnosis personalizedacupuncture Sasangtypology Tae-GeukAcupuncture
a
b
s
t
r
a
c
t
TheSasangtypology,traditionalKoreanpersonalizedmedicine,dividespeopleintofour
Sasangtypesandsuggeststype-specificmedicalherbsandacupunctureformoresafeand
effectivetreatment.ThemainideaofSasangtypologyseemsrelativelysimple;however,
theSasangtypediagnosisandtype-specifictreatmentinclinicalsituationhasbeendifficult
forthecliniciansandresearchers.Thisstudyprovidedclinicalproceduresoftype-specific
Tae-GeukAcupuncture(TGA)therapyalongwithbasicunderstandingsonSasangtypology
andclinicalindicesforSasangtypedifferentiation.TheTGAtherapywouldbeusefulfor
psychosomatic complaintsandchronicpainsbyrestoringthebalanceofYin–Yang.The
clinicalapplicationofTGA,itsrelatedbiologicalmechanisms,andimplicationsforfurther
prospectiveclinicalstudywerediscussed.
©2017KoreaInstituteofOrientalMedicine.PublishedbyElsevier.Thisisanopenaccess
articleundertheCCBY-NC-NDlicense
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
1.
Introduction
Thepersonalizedmedicine foreffectiveand safetreatment
haslongbeenofinterestsinceHippocratesandGalenofthe
WestandYellowEmperorandAyurvedaoftheEastandwas
encouragedwiththerecentHumanGenomeProject.1–3 The
SasangtypologyisatraditionalKoreanpersonalizedmedicine
systematicallytheorizedbyJemaLee(1837–1900)andhisbook
LongevityandLifePreservation inEasternMedicine(1894,1900)
∗ Correspondingauthor.DivisionofLongevityandBiofunctionalMedicine,SchoolofKoreanMedicine,PusanNationalUniversity,30
Jangjeon-dong,Geumjeong-gu,Busan50610,RepublicofKorea.
E-mailaddress:[email protected](H.Chae).
based on Confuciusunderstandings on humannature and
thousandsyearsofclinicalexperiencesinKorea.2–5
TheSasangtypologydividespeopleintofourSasangtypes,
Tae-Yang,So-Yang,Tae-Eum,andSo-Eum,withtype-specific
psy-chobiological traits2,6 and pathophysiological symptoms.7,8
TheSasangtype-specifictreatmentswithmedicalherbs9and
acupuncturecouldbeappliedconsideringone’sSasangtype
http://dx.doi.org/10.1016/j.imr.2017.07.002
2213-4220/©2017KoreaInstituteofOrientalMedicine.PublishedbyElsevier.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense
Table1–GeneralcharacteristicsofSasangtypologyintemperament,physicalshape,pathophysiologicalsymptomsand type-specifictreatment.
Sasangtype (prevalence)
Tae-Yang(赋蛈)(<0.1%) So-Yang(蔯蛈)(30%) Tae-Eum(赋褋)(40%) So-Eum(蔯褋)(30%) Originofthenature Sorrow(蚃)by
benevolence(襗) Anger(羺)by righteousness(褠) Gladness(辯)bycourtesy (螎) Enjoyment(肸)bywisdom (譣)
Theyfeelsadwhenthey realizetheir
self-transcendentidea isobstructed.
Theybecomeangrywhen theyareblocked.Theanger canberegulatedby fairness.
Socialapprovalcanbe obtainedwithcourtesy. Theyaregladwhenthey getwhattheywant.
Worriescanberelieved withwisdom.Theyenjoy whattheyhavenow. Pathophysiological
characteristic
LargePae(lung)system, smallGan(liver)system (趸耵糥蔮)
LargeBe(spleen)system, smallShin(kidney)system (萂耵蘣蔮)
LargeGan(liver)system, smallPae(lung)system (糥耵趸蔮)
LargeShin(kidney)system, smallBe(spleen)system (蘣耵萂蔮)
Strongsympathetic activation,weak anabolismand energy-storing
Strongintakeanddigestion, weakwithwastedischarge.
Stronganabolismand energy-storing,weak sympatheticactivation
Strongwithwaste discharge,weakintakeand digestion
Lowthresholdin sympatheticactivation.
InthemiddleofTae-Eum andSo-Eumasforthe autonomicreactivity.Inthe middleofTae-Eumand So-EumasfortheSDFI.
Lowthresholdin
parasympatheticactivation. HighSDFIandlowFDQOL. Highinsulinresistance. highTriglyceride, cholesterolconcentration, andbloodpressure
Lowthresholdin sympatheticactivation. LowSDFIandhighFDQOL. Lowimmunefunction
Personalityor temperament
Masculine,move forward,originative
Active,externallyoriented, talentedforbusiness.
Still,withdrawn, conservative
Feminine,internally oriented,self-centered.
HighSPQ HighSPQHigh
Novelty-Seekingandlow Harm-Avoidance(TCI).High Extraversion(NEO-PI).
InthemiddleofSo-Yang andSo-EumasfortheSPQ, Novelty-Seeking,
Harm-Avoidanceand ExtraversionLowinTrait Anxiety(STAI).
LowSPQ.LowExtraversion. LowNovelty-Seekingand highHarm-Avoidance.High inTraitAnxiety.
Bodyshapeor constitution
Similartothe So-Eumtype
Shortandlittle Tallandbig(notfator obese)
Shortandlittle SimilartotheSo-Eumtype,
butmoremuscularthan So-Eumtype
HighPI,BMR,BMI,bodyfat mass,bonedensityand Waist-hipratio.High width-heightratioofface. Biggerneckandchest circumference
LowPI,BMIandWaist-hip ratio.Lowwidth-height ratioofface.Smallerneck andchestcircumference
Concernsforthe goodhealth
Enoughurination Easywithdefecation Enoughperspiration Gooddigestion Avoiddehydrationand
overexertionofmental andbodilyresources
Avoidover-activationand overloadsofbodily functions
Maintainadequatelevelof catabolic,sympatheticand circulatorysystem
Maintainhealthydigestive function,peristalsis,and bodyheat Frequentsymptomsor disease Emesis, nervous-ness/neurasthenia, suddenweaknessin lowerextremities Constipation, gastroesophageal (laryngopharyngeal)reflux disease,affectivedisorder, insomnia,heatonchest
Noperspiration,diabetes, metabolicsyndrome, hypertension,stroke, obesity,obstructivesleep apnea,irritablebowel syndrome
Indigestionordyspepsia, upperrespiratoryinfection, neuroticsymptoms Type-specificmedical herbs ChaenomelisFructus, AcanthopanacisCortex, PhragmitisRihizoma
RehmanniaeRadix,Corni Fructus,Hoeoen,Alismatis Rhizoma,OstericiRadix, AngelicaePubescentisRadix
EphedraeHerba,Liriopis Tuber,SchisandraeFructus, DioscoreaeRhizoma,Platycodi Radix,CoicisSemen,Puerariae Radix
GinsengRadix,Atractylodis RhizomaAlba,Glycyrrhizae Radix,CinnamomiCortex, CitriPericarpium,Zingiberis RhizomaCrudus
Type-specific acupuncturepoints
HT8(+),LR3(+)and LU9(−)
HT3(+),KI3(+)andSP3(−) HT4(+),LU9(+)andLR3(−) HT7(+),SP3(+)andLI4(−) BMI,bodymassindex;FDQOL,functionaldyspepsia-relatedqualityoflife;NEO-PI,NEOPersonalityInventory;PANAS,PositiveandNegative AffectSchedule;PI,PonderalIndex;SDFI,SasangDigestiveFunctionInventory;SPQ,SasangPersonalityQuestionnaire;STAI,StateandTrait AnxietyInventory;TCI,TemperamentandCharacterInventory.
incombinationwithcold–hot subgroupandseverityofthe illness(Table1).
Although the Sasang typology showed its clinical
usefulness10–17 and seems relatively simple, the clinical
application ofSasangtype-specific treatmenthas notbeen
easy even with many articles and books on it. In many
cases,clinicianshavefailedtoincorporateitfromthe
diagnosis,thereby makingtheclinicalusefulnessofSasang
typologysuspicious.Therefore,evidence-basedanddetailed
explanations on the diagnosis and treatment of a patient
with Sasang typology are needed for the interested
clini-cians.Inthisreview,wesystematicallydescribetheclinical
applicationofSasangtypologyfrom theSasangtype
differ-entiationwithtype-specificpathophysiologicalsymptoms7,8
totheTae-Geuk(Tai-ChiinEnglish)Acupuncture(TGA)with
type-specificacupuncturepoints.8,18
TGAwasoriginallysuggestedbyDrByunhaengLeewith
referencetotheSasangtypologyandclinicalexperiencesin
1974,19andDrJaekyuKimintroducedtheclinicalexamination
techniqueofInsangParkandJungjaeKim20andreportedits
clinicalefficacypreviously.18,21
JemaLeewrotehisexperiencewithtype-specific
acupunc-turetreatmentinhisbookas“Previously,IhavemetSo-Eum
Sasangtypepatientsufferingfromdigestivesystemqi
prob-lems and was successfully treated with acupuncture on
LI4.And I alsoexperiencedimmediate effectsof
acupunc-ture treatment that the medications couldn’t get. Since
therewouldbeacupuncturetechniqueusefulfortheSasang
typology,theSasang type-specific pointsandmanipulation
techniqueshouldbeimprovisedtocontroltheSasang
type-specificpathophysiologicalmechanisms.”4
ThoughTGAwasnotsuggestedinJemaLee’soriginalbook,
itwassystematizedbytheclinicalspecialistofacupuncture,
anditsclinicalefficacyonchronicpainsinmultiplesitesand
psychosomatic complaints were supported with
retrospec-tivestudies.18,20–22TGAwasreportedtobeusefulforinstant
confirmationofSasangtypedifferentiationwithsimpletest;
however,itwasoutofreachfortheforeigncliniciansuntilnow
Fig.1–SchematicflowforSasangtypediagnosisand treatmentwithtype-specificacupoints.
BMI,bodymassindex;PI,Ponderalindex;SDFI,Sasang DigestiveFunctionalInventory;SPQ,SasangPersonality Questionnaire.
sinceup-to-datereportsonSasangtypedifferentiation2,6–8,23
havenotbeensupplementedwithdetailedclinicalprocedures
ofTGA.
Thisstudywouldprovideclinicalproceduresof
acupunc-ture treatment with Sasang typology (Fig. 1) along with
generalfeaturesofeachSasang typefordiagnosis(Table1;
Fig.2),Sasangtype-specificacupuncturepoints(Table1),and
Fig.2–ProfilingofeachSasangtypewithtype-specificclinicalmeasures.
BMI,bodymassindex;HA,harmavoidance;NS,noveltyseeking;PI,Ponderalindex;SDFI,SasangDigestiveFunctional Inventory;SE,So-Eum;SPQ,SasangPersonalityQuestionnaire;SY,So-Yang;TCI,TemperamentandCharacterInventory; TE,Tae-Eum;TY,Tae-Yang.
Fig.3–Examinationofepigastricregiontenderness.
Theepigastricregiontendernessisexaminedbypressingwithtwohandsfortestingwhethercorrecttype-specificpoint stimulusisapplied.IftherightSasangtype-specificstimulusisapplied,thenthereboundpressureonthisregionis significantlydecreased.
methodsforexaminingclinical responsetoTGA (Fig. 3). It
wouldprovideagateway forSasang type-specific
acupunc-turetreatmentandmorestructuredclinicalresearchonits
effectiveness.24
2.
Characteristic
features
of
the
Sasang
typology
Literally,everyKoreanhasheardabouttheSasangtypology;
however,understandingitstheorieshasbeenachallengeeven
forKoreandoctors.Thereareseveralcharacteristicfeatures
of Sasang typology to be acknowledged for better
under-standings on Sasang typology, including the fact that the
philosophicaltheoriesofSasangtypologyisbasedon
Confu-cianismandfourclues(benevolence,righteousness,courtesy,
andwisdom)andthatofEast-AsianmedicineisTaoismand
fivephase.3,4
The Sasang typology is a reformation and restructure
of medical theories and clinical experiences of East-Asian
medicine;it uses same medical herbs and acupuncture of
East-Asianmedicinedependingonone’sinnate
pathophysio-logicalpredispositionsratherthantheirmomentaryclinical
manifestations in prognosis.3,4 Jema Lee stated that the
glimpseofSasangtypologywasshowninchapter72of
Mirac-ulousPivot(脵貥) ofthe Canon ofInternalMedicine (Huangdi
Neijing, circa 300 BC), and parts of clinical application of
SasangtypologywereprovidedintheTreatiesonColdDamage
andMiscellaneousDiseases(ShanghanzubinglunbyZhongjing
Zhang,circa3c).4
However, since the Sasang typology has unique
four-internalorgansystembasedonthousandsyearsofEast-Asian
clinical experiences, up-to-date medical theories, and
per-sonalitystudiesofConfucianism,themedicalterminologyof
Sasangtypology hasadifferentmeaningcomparedtothat
ofEast-Asiantraditionalmedicine;furthermore,Korean
pro-nunciationofmedicaltermswould beappropriatetoavoid
confusionswithbasicwordsincludingnamesofeachSasang
typesandinternalorgans.3
ThetermTae-Eumtype(赋褋襖)referstoaspecificgroup
ofa person havingcourtesy and gladness as the origin of
their natureand weaksympatheticandstrong
parasympa-thetic activation (Table 1), notsomeone with characteristic
symptomsofLargeYinfromtheThreeYinandThreeYinas
describedinCanonofInternalMedicineandTreatiesonColdInjury.
Asforpathophysiologicalmechanisms,theSasang
typol-ogy suggests the innate hyper- and hypo-activity of four
internalorgans,suchasPae(lung),Be(spleen),Gan(liver),and
Shin(kidney),2,3 nottheimbalanceoffiveinternalorgansin
Canon ofInternalMedicine. TheShim(heart)isregarded asa
concealedgovernorofpsychobiosocialfeaturesfollowingthe
traditionofthebookMencius(circa300BC)andCorrectingthe
ErrorsinMedicalField(1830),notamemberoffiveviscerain
CanonofInternalMedicine.3,4
JemaLeenotedonfour-internalorgansysteminhisbook
as“FourinternalorgansofPae(Lung),Be(Spleen),Gan(Liver),
andShin(Kidney)arethepivotalonesforcharacter
develop-ment,andtheShim(Heart)isthegoverningcenterofthese.
The matured expressionofbiopsychosocial traitsofa
per-son might beachieved bydeveloping four socialnatureof
benevolence,righteousness,courtesy,andwisdomlocatedin
four organs.Ifyoucarefullyexaminethefourpoorly
devel-opednaturesofrude,flippant,greedy,andlazycharacters,you
wouldgettoknowhowtoaccomplishmaturedcharacter.”4
Inadditiontothefour-internalorgansystem,theSasang
typology alsohasunique pathophysiologyemphasizing the
balance ofYin–Yang(e.g.,balanceoftwointernalorgansin
pairasforqi/fluidandfood).PaeandGan(lungandliverorP-G
domain)controltheusageorstorageofqiandbodyfluid,and
theBeandShin(spleenandkidneyorB-Sdomain)regulatethe
digestionofgrainsandwaterordischargeofitswaste(Table1).
TheTae-Yangtypehashyper-activatedPae(lung)with
acti-vatedusageofqiandbodyfluidandhypo-activatedGan(liver)
withsuppressedstorageofqi andbody fluid;however, the
Tae-Eum typehashyper-activatedGan(liver) withactivated
storageofqiandbodyfluidandhypo-activatedPae(lung)with
suppressedusageofqiandbodyfluid.TheSo-Yangtypehas
hyper-activatedBe(spleen)withgooddigestionofgrainsand
waterandhypo-activatedShin(kidney)withpoorlycontrolled
dischargeofthewaste;however,theSo-Eumtypehas
wasteandhypo-activatedBe(spleen)withpoordigestionof
grainsandwater.3,4
Asfortheclinicalapplication,althoughfourSasangtype
groupsarecategoricallyclassified,thosecanbediscriminated
withacombinationofcontinuousclinicalvariables,
includ-ing temperament measures, body shape ofPonderal index
(PI),and bodymassindex(BMI), andtwelveclinical indices
(Table1;Fig.2).25,26TheclinicaldiagnosisofSasangtypesis
similartothepatternidentificationorprofileanalysisofother
East-Asiantraditionalmedicine,22andthedemographic
char-acteristicsofsex,jobs,culture,andethnicitymightinfluence
theprevalenceofeachSasangtype.27–29
Since the Sasang typology has these similarities and
disparitieswithtraditionalEast-Asianmedicine,TGA
incor-porates meridians and acupuncture points of traditional
East-Asianmedicineand suppressand supportmethodfor
controllingtheinnateimbalancesoffour-internalorgan
sys-temofSasangtypology.Now,wewoulddiscusstheprocedures
ofTGA along withSasang typedifferentiationwithclinical
measures.
3.
Sasang
type
differentiation
and
type-specific
acupuncture
treatment
Theclinical procedureforSasangtypediagnosisand
treat-ment with acupuncture (Fig. 1) may be divided into three
steps:(1) differentiationofpatient’s Sasang typewith
clin-icalsymptomsand biopsychologicaltraits; (2)confirmation
ofSasangtypewithtype-specificacupuncture;and(3)
type-specificacupuncturetreatmentwithTGA.
3.1. Diagnosisofpatient’sSasangtypewithclinical information
TheSasangtypedifferentiationmightbethemosttrickyand
difficultpartfortheclinicians.Reliableclinicalindicesof
psy-chological,physical,andclinicalsymptomsareneededforthe
Sasangtypediagnosis.
Asforthepsychologicaltraits(Fig.2A),theSasang
Person-alityQuestionnaire(SPQ)isaclinicallyvalidatedmeasureof
Yin–YangtemperamentandSasangtypology2,15andshowed
positiveand negativecorrelation withNoveltySeekingand
Harm AvoidanceofTemperament and Character Inventory
(TCI),respectively.15,22,23,25TheSPQscoreofSo-Yang,Tae-Eum,
andSo-EumSasangtypesareindecreasingorderandstay
sta-bleovertheagesevenwithpathologicalsymptoms.2,30
Asphysicalcharacteristics(Fig.2B),thePIandBMIof
Tae-Eum,So-Yang,andSo-Eumareindecreasingorderandstable
overtheages.2,6,31TheBMIandPIrepresentthebigandtall
body shapeofTae-Eum and So-YangSasang typesfrom the
highparasympatheticreactivityandenergeticbodilyactivity,
respectively.6 Thoughtherewere alsostudieson
circumfer-enceofneckandchestandfacialwidth-heightratioofTae-Eum
Sasangtypes,2 clinicalvalidationconsideringethnicity,sex,
andageisneededforgeneralizationasfornow.
There are seven categories of clinical symptoms
(Fig. 2D)7,8,26 including digestive function, bowel
move-ment and defecation, temperature preference, perspiration
(amountandfeelingafterit),urination,sleep,and
susceptibil-itytostressandfatigue.Thetype-specificpathophysiological
symptoms and bodyshape (Fig.2C)are useful fordividing
Tae-EumandSo-EumSasangtypes,andthesearesupposedto
bebasedontheindividualityofautonomicreactivity.7
Theclinicians shouldcombinethesethree categoriesof
clinicalmeasurestoidentifytheSasangtypeofapatient.22,25
Forexample,theclinicianmightdiagnoseonepatientas
So-EumtypewhensheorhehaslowSPQ,PI,andSasangDigestive
FunctionalInventory(SDFI)score,andhighHarmAvoidance
score,andpreferswarmfoodanddrinks(Table1;Fig.2).
3.2. Sasangtype-specificacupuncturepointsofTGA
Thereareseveralrulesforselectingsix(orfive)Sasang
type-specificpointsofTGA18,21,22,32;however,thedetailedrationale
wasnotexplainedinfulltillnow.Threetype-specificpoints
(Table1)are selectedforpatient’sSasang typeand another
threesupplementarypoints(ST36,LI4,andLI11)arealso
com-binedtoenrichtheqicirculationduringtheTGAtreatment.
Threetype-specificpoints(Table1)areselectedasfollows:
First, select onepoint from the heart meridian(HT8, HT3,
HT4,andHT7),whichisaconcealedgovernor,tocontrol
(sup-press)thehyper-activationofPae(metaltrait),Be(firetrait),
Gan(woodtrait),and Shin(watertrait)ofTae-Yang, So-Yang,
Tae-Eum,andSo-EumSasangtypes,respectively.
Second,selectprimarypointsofliver(LR3),kidney(KI3),
lung (LU9),andspleenmeridian(SP3)tosupportthe
hypo-activationofGan(livermeridian),Shin(kidneymeridian),Pae
(lungmeridian),andBe(spleenmeridian)ofTae-Yang,So-Yang,
Tae-Eum,andSo-EumSasangtypes,respectively.
Third,selectprimarypointsoflung(LU9),spleen(SP3),liver
(LR3),andlargeintestinemeridian(LI4)tosuppressthe
hyper-activationofPae, Be,Gan,andShinofTae-Yang,So-Yang,
Tae-Eum,andSo-EumSasangtypes,respectively(Table1).Asfor theSo-Eumtype,theprimarypointoflargeintestine,apair
organofkidneyinSasangtypology,isselectedasasubstitute
ofkidneymeridiantofollowthetraditionnottosuppressthe
kidney.
For example, the Tae-Yang type has
hyper-activatedPae(lungandmetaltrait)andhypo-activated
Gan(liverandwoodtrait)astheirinnateorgansystem.The
firepoint(HT8)oftheheartmeridianissupportedtocontrol
themetaltrait.Theprimarypointoflung(LU9)isstimulated
tosuppressthehyper-activityofthelungmeridian,andthe
primarypointofliver(LR3)isstimulatedtosupportthe
hypo-activityofthelivermeridian(Table1).Asfortheneedling,the
cliniciansshouldrotatetotheleftforsuppressingandtothe
rightforsupportingpoints.Furthermore,breathingtechnique
isalsousedtopreventtheadverseeventofsyncopeduring
theacupuncturestimulation.
3.3. SasangtypediagnosisandTGAprocedures
The Sasang type diagnosis with type-specific point
stimu-lation andclinical applicationofTGAprocedures wouldbe
explainedwithrepresentativeclinicalcaseforbetter
3.3.1. Initialdiagnosisofpatient’sSasangtype(Fig.1A)
Two candidate Sasang types, such as So-Yang (with 70%
possibility)and Tae-Eum(30%possibility), areselected after
examiningSasangtype-specificpsychologicaltraits,physical
characteristics,andclinicalsymptoms(Table1;Fig.2)along
withage,sex,chiefcomplaints,andpasthistory.
3.3.2. Confirmationofpatient’sSasangtype differentiation(Fig.1B)
Theclinicalresponsetotype-specific acupunctureis
exam-inedwithepigastricregiontenderness(Fig.3),whichwould
besignificantlydecreasedwithcorrecttype-specific
acupunc-turestimulus.Forexample,theepigastricregiontenderness
isexaminedafterstimulatingSo-Yangspecificpoints[HT3(+),
KI3(+),andSP3(−)inTable1].Then,theepigastricregion
ten-dernessisexaminedafterstimulatingTae-Eumspecificpoints
[HT4 (+), LU9 (+), LR3 (−) in Table 1]. The examination of
epigastricregiontendernesswiththeSo-Yang-specific
stim-uluswas performedonceagain tocomparethe magnitude
ofthe decrease ofepigastric region tenderness. The
type-specificstimulusofSo-Yang(>70%)showedsignificantlylarger
decreaseofepigastricregiontendernessthanthatofTae-Eum
(<30%).
3.3.3. Sasangtype-specificacupuncturetreatment (Fig.1C)
SincethepatientwasdiagnosedasSo-Yangtype,three
type-specificpoints(HT3,KI3,andSP3)andthreesupplementary
points(ST36,LI4,andLI11)arefinallyselectedforTGA
treat-ment(Table1).22
Thestainlesssteelneedle,40mminlengthand0.25mm
indiameteris usedforTGA stimulus.21 De-qiofachingor
dullsensationisacquiredaftermanualstimulationof
insert-ing 0.3–1.5cm in depth, and retention time of 20minutes
along with deep breathing and self-relaxation is provided.
Theacupointsupportingtechniquemeansrotatingthe
nee-dleclockwiseduringinhalewithahintofpushing-in,andthe
acupointsuppressingtechniqueisrotatingtheneedlecounter
clockwiseduringexhalewithafeelingofpulling-out.TGAcan
bepracticedtwotothreetimes aweek,howeverevery day
whenrequired.
4.
Discussion
and
conclusion
The Sasang typology is a biopsychosocial medicine of
the East with proven clinical usefulness,10–14,20 and the
individuality of autonomic reactivity,7 Novelty Seeking
and Harm-Avoidance,15,22,23,25 Extraversion,25 and Yin–Yang
temperament33wassuggestedasitsbiomedicalmechanism.7
This review provided detailed description for Sasang type
differentiation with clinical information and type-specific
treatmentwithacupuncture.
TGA was suggested to be useful for the restoration of
biopsychosocialdisturbances.ItwasreportedthatTGAmight
be effectivefor unexplained autoimmune disease,
psycho-somaticillness,depressionandanxiety,chesttightnessand
pressure, insomnia, cognitive dysfunction, chronic fatigue
syndrome,chronicpainsinmultiplesitesfromneuromuscular
conditions, shoulder stiffness, and imbalance of
sympa-theticandparasympatheticsystemsthoughitneedsfurther
validation.17,18,20–22
TGA was originally constructed to enhance the qi and
blood circulation for restoring the balance of Yin–Yang in
Sasang typology.18,20,21 Considering that clinical effects of
biopsychosocial interactions might be explained with the
autonomic balance of sympathetic and parasympathetic
system34 and the anti-inflammatory effect of vagal tone
control,35 theimprovementofclinicalsymptomswith
type-specificacupuncturewouldbearesultofrestored balances
inautonomic reactivity,andthe decreaseofepigastric
ten-derness by TGA might be a measure of vagal tone and
gastrointestinalbalanceofautonomicnervoussystem.
TheTGAtechniquemighthavelimitationsevenwithits
suggestedclinicalefficacyandpopularity.20,22Thereare
the-oreticaldiscrepanciesinselectingtype-specificacupuncture
points of TGA, such as selecting meridians and
acupunc-ture points for treatment based on formerly established
East-Asianmedicine.Theremightbenotabledisparitiesand
similaritiesasforthefunctionofinternalorgans;however,
alternativesforselectingacupuncturepointsexcludingthat
wouldnotbeavailablesinceperfectlymatchingtheoriesfor
thefour-internalorgansysteminacupuncturecouldnotbe
improvised without previously established clinical
experi-ences,asdescribedinJemaLee’sbook.36,37Anotherstudyby
clinicalspecialistofSasangtypologyhasalsosuggested
sev-eraltype-specificpointsbasedonmedicalclassicsandSa-Am
acupuncture;KI3andGB34arespecificfortheSo-Yangtype,
ST36 forthe Tae-Eumtype,and LI4and LR3forthe So-Eum
type.38Prospectivestudieswithtype-specificpointstoshow
clinical efficacyare warrantedinnearfuture.39,40
Addition-ally,studiesonstandardizationofepigastricregiontenderness
measure andrelated biologicalmechanism withheart rate
variabilityareguaranteedsincetheclinicalreliabilityofTGA
dependsonthese.7,41
TheSasangtypologyisapreventivemedicineefficientfor
improving physicaland psychologicalsubjectivesymptoms
andrestoringYin–Yangbalancebeforeanysignificanthealth
problemsprominent.2,22Althoughthetype-specific
acupunc-tureandherbalmedicationmightbeclinicallyuseful,JemaLee
hasstronglyinsistedthatthecharacterdevelopmentof
Con-fucianism,Moderation,orGoldenMeanisthemostimportant
entityforthehealthpromotion.42Theimportanceof
charac-terdevelopmentinmentalandphysicalhealthwassupported
byrecentpersonalitystudies.43–45
TheSasangtypologywouldbeusefulforthepersonalized
applicationoftraditionalmedicinesuchasacupunctureand
medicalherbs3;however,itwasnotwidelyusedbyclinicians
duetolackofinformationonclinicaldiagnosisandtreatment.
ThedetailedreviewonTGAtechniqueanddifferential
diag-nosiswithclinicallyvalidatedSPQ,SDFI,andPIinthisstudy
wouldbeusefulforforeignclinicianswhowanttouseSasang
typologyandclinicalresearchersplanningprospective
clini-caltrials.2,6,16,24,26TheSasangtype-specificherbalmedication
requiresunderstandingonthecold–hotsubgroupand
sever-ityofdiseaseincombinationwithSasangtypedifferentiation,
Conflicts
of
interest
Theauthors declarethat there are no conflicts ofinterest
regardingthepublicationofthispaper.
Funding
Thisworkwassupportedbya2-yearResearchGrantofPusan
NationalUniversity.
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