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= Constitutional Acupuncture =

Constitutional Acupuncture, which is also called as Korean Acupuncture, is a traditional and unique medicine system based on the traditional Korean medicine (TKM) having the kindred base with traditional Chinese medicine(TCM) but has developed into a different system. . Differ from the form of Western medicine, constitutional acupuncture treats every patient and make the therapeutic remedy due to the patient's unique constitution, which contains the specific way his or her organs affect health, living habits, how he or she looks and behaves. Individualized approach of constitutional acupuncture, which including Saam acupuncture, Taegeuk acupuncture, eight constitution acupuncture and herbal acupuncture, is based on the theory called constitutional energy traits, and is able to assist to cure neurological disorders and analgesic.

History
Constitutional acupuncture is generally recognized as a traditional alternative medicine system that originated in China before thousands of years and developed into a complete system in Korea. The oldest document that described the system and treatment of constitutional acupuncture unambiguously is The Huangdi-Neiching, which is a medical book dating back to 100 BC. Chinese acupuncture had been codified in texts during the process of continuous development over the following centuries, and had spread to other Asian countries, such as Japan and Korea, in the sixth century, which is the origin of the constitutional acupuncture.


 * In 561 AD, when China was in the periods of Western & Eastern Jin Dynarties and Southem & Northern Dynarties, a man named Cong Zhi brought more than 164 medicine books that contain a few acupuncture books, such as The Huangdi-Neiching, or Canon of Internal Medicine and Mingtang Acupuncture to Koryo (the name of Korea at that time), which is the earliest record in Korea’s history showing the establishment of constitutional acupuncture.
 * In 692 AD, Silla, which was one of the countries in the Korean peninsula, firstly introduced education of the constitutional acupuncture in Korea. Two specialists were assigned to teach the constitutional acupuncture course, which was focused on the theoretical knowledge of acupuncture. Differ from the original acupuncture education spread from China, a unique approach to medical education was applied in Silla. Nan-Jing The Classic Inquiries was chosen as the teaching material to educate and develop the basic medical education system.
 * In 676 AD-935 AD, huge numbers of constitutional acupuncture books were introduced into Korea. Furthermore, a medical book called Thousand-Golden-Prescriptions stimulated Korean to combine decoction therapy with acupuncture therapy, which developed the practicality of constitutional acupuncture.
 * Around 1406, female doctors, children and maids were recruited by Korea’s hospitals to learn Acupuncture Method and Maijing in order to cure women's diseases by constitutional acupuncture.
 * In 1485, Swelling Treatment Hall had been set up. Constitutional acupuncture had been found to be more useful on curing swelling.
 * In the 17th century, Saam, who is a Buddhist monk, applied, summarized and developed Saeng and Geuk cycle relationship on Five Phase theory and created Saam acupuncture, which is a theory within constitutional acupuncture.
 * In 1837–1900, Jema Lee theorized Sasang typology, which refers to divided patients into four Sasang types, and use herbs and the constitutional acupuncture to cure following the characteristics of type-specific.
 * After 1942, Dr. Hong Gyeong Kim added more detailed clinical experience into Saam acupuncture and push its further development.
 * In 1965, Dr. Dowon Kuon first introduced the Eight constitution acupuncture, which is a brand-new acupuncture theory based on Sasang theory, at the International Congress of Acupuncture and Moxibustion in Japan.

Basic theory
Constitutional acupuncture takes a summarized and individualized point of view to explain a person’s biologic phenomena and make therapeutic remedy. In traditional theory, the core and the foundational concept of constitutional acupuncture are “Qi”, which can be translated to “energy”. Constitutional acupuncture presents that every person is given a special set of weakness and strengths at conception, which includes the unique and difference function of every person’s Zangfu(can be known as viscera and bowels) and Jingmai(or meridian). The unique order of the weakness and strengths in the set responds a person’s Qi, which means the ‘constitution’. The theory of constitutional acupuncture simplifies the complex understanding on the imbalance of the core body system and believed that the balance, steady, healthy combination of several kinds of Qi is able to inherit and maintain the balance of the body. In contrast, diseases are associated by the imbalance, sparseness or blockage of those energies. Constitutional acupuncture can be treated as a tool to use special needles to guide and control those Qi to make them harmonious, restore the functioning's original order and then help patients’ body to bounce back to wellness.

Modern explanation
Constitutional acupuncture is able to achieve several clinical effects, such as analgesia, by using special needle to stimulate acupoints. Although the whole theory system of constitutional acupuncture is a far cry from the modern western medical theory, numerous modern medical theories with the support by basic researches try to explain its principle. For instance, there is a theory that constitutional acupuncture helps to suppress external painful stimuli and then reduce pain perception by stimulating A-delta fibers in skin and muscle to press impulsive force to spinal grey matter. Furthermore, experts also speculate that constitutional acupuncture has an effective adjustment effects on the central pain network in the hypothalamus and the limbic system or constitutional acupuncture is able to affect the release of beta‐endorphin and met-enkephalin, which has the excellent analgesic effect in the brain.

Recorded result of functional magnetic resonance imaging(MRI) experiment provides evident for part of the above theories. For instance, the scanned patients’ brains by using functional magnetic resonance imaging have shown that constitutional acupuncture has an influence on human brain’s specific structures, and could affect the central nervous system by acting as an input of neuromodulation. The studies’ investigations also indicate that Korean acupuncture could stimulate diverse analgesia systems and arouse the pain-modulating system to release neurotransmitters like endogenous opioids. Furthermore, there exists research data to suggest that constitutional acupuncture has a great effect on the protein expression profile of the hypothalamus due to neuropathic pain and protect dopaminergic neurons.

Individualized treatment
Constitutional acupuncture contains four individulized treatment, which are Saam acupuncture, Taegeuk acupuncture, eight constitution acupuncture and herbal acupuncture.

Saam acupuncture
Saam acupuncture, which is one of the forms of constitutional acupuncture, presents that 12 energy traits, which are controlled by 12 meridians energy, form the manifold response of biologic phenomena. The traditional concept of Yin(-)-Yang(+), the cycle of five elements, Zangfu with different characteristics, energy, meridian are the foundation of the Saam acupuncture. Saam acupuncture explains its theory that the arm or foot, three Yins (Gwoleum- ‘absolute Yin’, Soeum- ‘lesser Yin’, and Taeeum- ‘greater Yin’) and three Yangs (Soyang- ‘lesser Yang’, Yangmyeong-‘brilliant Yang’, and Taeyang-‘greater Yang’) and six viscera and bowels' features (Wind, King Fire, Earth, Premier Fire, Metal and water) consists of the whole meridian system, which can show 24 deficiencies and excess manifestation with 24 coldness and fire symptoms that indicates as different physiologic and pathologic processes external. Constitutional acupuncture believed that through stimulating the combination of acupoints can adjust the meridian energy and cure the corresponding disease effectively.

Taegeuk acupuncture
Taegeuk acupuncture is built on the base of Sasang theory indicating to devise a treatment due to the patient original constitution. Sasang theory classified the divergence of energy among major organs to four different internal constitutions for people, which is Taeyang, Taeeum, Soyang and Soeum. Practitioners could provide four treatment plans and different herbal combination simply to patients by following this theory and do not need to design therapies for different disease manifestations. However, the original Sasang theory did not contain the treatment of acupuncture for four classified constitutional groups. Regard to the lack of clinical application for Sasang theory, Taegeuk acupuncture, which is an acupuncture system based on the constitution theory is developed.

In Targeuk acupuncture theory, stimulating the HT meridian points could help practitioners to determine a patient’s unique type of constitution as HT energy plays a key role in the adjustment of organs. After determination of the four types of constitution, practitioners are able to target the unbalance organs, which may occur excess or deficiency result, and then do tonificating or sedating respectively by stimulating the corresponding meridian points to restore the balance of internal organs’ energy.

Eight constitution acupuncture
Eight constitution acupuncture is a type of immunotherapy and approaches that restore and strengthen the balance of the immune system by eliminating internal imbalances energy of organs, which presented by Dr. Dowon Kuon in 1965 at the International Congress of Acupuncture& Moxibustion.

As with the development of the Taegeuk acupuncture, eight constitution acupuncture is also developed from Sasang theory. Although the core theory of eight constitution acupuncture and Taegeuk acupuncture is homologous, which means both of them try to classify patients into numbers of groups by their unique constitutions, eight constitution acupuncture do this process in more details. Differ from Sasang theory, eight constitution acupuncture determined eight constitutions rather than four, which is subdivided from the original four constitutions Sasang theory presented. Eight constitution acupuncture defines eight constitutions as Metal+, Metal-, Earth+, Earth-, Wood+, Wood-, Water+, Water-.

Another discrepancy between eight constitution acupuncture and Taegeuk acupuncture is the way of determining the patient constitution. In the eight constitution acupuncture system, there exists a relative, special method of pulse examination that could reveal these eight constitutions accurately, which is discovered by Dowon Kuon in 1965. In addition, Dowon Kuon also introduced a new acupuncture way that called Four Needle Technique to apply with the way of pulse examination.

Herbal acupuncture
Herbal acupuncture, or can be called as pharmacopuncture, is a relatively new approach that combines the advantages of herbal medicine and traditional theories in constitutional acupuncture system, such as energy (Qi) and the meridian theory. Herbal acupuncture is usually considered to be originated in China in the 20th century, which is called as Aqua-acupuncture(AA). Herbal acupuncture injects hybrid herbal medicine extract at corresponding acupoints and special points following by the meridian theory. The core principle of the herbal acupuncture is similar to other types of individualized treatment, which is cure patients by coordinating the energy of organs and restoring the body to its original healthy function.

Herbal acupuncture contains four groups about different systems of therapy, which are Meridian Field Herbal Acupuncture, Eight-Principles Herbal Acupuncture, Animal-Based Herbal Acupuncture, and Single Compound Herbal Acupuncture. The most commonly used herbal acupuncture in therapeutic areas is Bee-venom acupuncture. In addition, herbal acupuncture has an excellent clinical effect for diseases related to the musculoskeletal system.

Therapeutic areas
Constitution acupuncture has success recorded report of clinical cases in the treatment of sleep disorder, analgesic, premenstrual syndrome and other diseases with a duration of treatment from 7days to 10 months.

In many clinical trials, constitution acupuncture is proved that is able to provide a positive effect on the insomnia, which may be caused by anxiety, fatigue, the negative reaction of the body after experiencing accidences or other reasons. In general, the causes of insomnia can be treated as a Gallbladder excess, Heart excess, Kidney deficiency or other unique situation in the traditional theory, which determined by the patient’s personal physical condition. Constitution acupuncture, such as Taegeuk acupuncture and eight constitution acupuncture can be applied by placing needles in special acupoints, which promotes the supplement or dispersion of corresponding unbalance energy. For instance, there is an actual case shows that a middle-aged man used to suffer from erratic sleep, more dreams embolism and insomnia accompanied with other symptoms like a mild headache and neck stiffness. The practitioners determined his unique constitution that is Heart excess by pulsing and then use constitutional acupuncture to tonify KID-10 Yingu and Shaohai HE-3 and disperse Taibai SP-3, Shenmen HE-7effective, which alleviate the patient's sleeplessness effectively in 20 minutes.

In addition, constitutional acupuncture also has the effect of analgesia suggested by a few clinical trials and research. Functional magnetic resonance imaging (MRI) has proved that constitutional acupuncture can affect the pain-modulating system and arouse the release of beta‐endorphin, met-enkephalin, or endogenous opioids reducing the pain greatly. Clinical research also shows that Saam acunpuncture and Taegeuk acunpuncture, which are introduced as individualized treatment of constitutional acupuncture, are applied to ease musculoskeletal pain with meridian identification. For instance, using Gallbladder tonification to ease the pain and numbness occurring on the outside of the leg, and select Bladder tonification to treat the symptom occurring towards the back of the leg, which are both caused by a herniated disc. The pain due to arthritis of the knee joint, chronic tension headache, the ear pain attributable to Bell's palsy, back pain, sciatica and other painful symptoms also can be reduced by constitutional acupuncture using the similar principle and treatment. In addition, bee venom acupuncture, which belongs to herbal acupuncture and is one of the most widely applied constitutional acupuncture, has been proved as having a greater clinical therapeutic effect on pain-relieving for knee osteoarthritis than general traditional treatments.

Furthermore, constitutional acupuncture is recognized as having an observably curative effect for premenstrual syndrome (PMS). Symptoms of the premenstrual syndrome include behavioral and emotional alterations caused by physical and psychological instability, which may occur in one or two weeks before the menstrual cycle. Although concrete and detailed pathogenesis of the premenstrual syndrome is still unknown, the causes of PMS is considered to be something penetrated in Korean constitution medicine, such as Zangfu and meridians of energy. Constitutional acupuncture uses the method that warming or stimulates the relative acupoints on hands to strengthen the flow of blocked energy in meridians, rebalance the internal energy of organs, which could help the body to restore for an original and harmonious function, to ease premenstrual syndrome. A clinical report in2003 has shown that constitutional acupuncture results in a significant improvement in cold sweats, nausea, and vomiting and other symptoms caused by premenstrual syndrome. Compare with other therapies for premenstrual syndrome including self-management and drug using, constitutional acupuncture has shown more practical efficacy and has no side effects or dependencies.

Controversial issue
Placebo effects and mechanism is one of the controversial parts of constitutional acupuncture. Although constitutional acupuncture has been widely used applied and accepted by numbers of countries and a few clinical practices show that constitutional acupuncture seems to work effectively, most of the evidence for it lacks a critical stance. Furthermore, part of the traditional, unique theories in this system differing from modern medicine system is still not fully supported by indubitable evident providing by scientific data and researches. Therefore, whether the clinical effect, results and evaluation of constitutional acupuncture is credibly and explicable or the seemingly good clinical results are just resulted by a placebo response rather than its precise treatment outcomes is still controversial. For instance, the clinical studies’ outcomes of same symptoms may arise discrepancy among volunteers. The situation that a half volunteers consider constitutional acupuncture is effective and the other part of volunteers oppose it sometimes happens, which means the effectiveness of constitutional acupuncture in clinical practice contains lots of uncertainty outcomes, and may not be so positive and effective. In addition, a part of opponents also raises that most of the supporters for constitutional acupuncture from the originating countries rarely to deny the effectiveness of the constitutional acupuncture