Korean Hand Acupuncture-
Koryo Hand Therapy (KHT), known as Koryo Sooji Chim, Korean Hand Acupuncture or Sooji Chim, follows the theory that the hands are a micro-cosmos of the body. Using KHT, the functions of the human body are manipulated by stimulating corresponding points on the hands. Within this paper, Iʼve examined the theory of why Koryo Hand Therapy can be a useful tool in not only diagnosing areas of pain in the body, but quickly and effectively treating it as well. After an introduction of the fundamental theoretical mappings of the basic systems used in KHT, I will focus on the use of Yin Yang Diagnosis theory that KHT employs to direct hand point selection for regulating cerebral blood flow as a mechanism for pain management.
Lastly, I will examine the theoretical thoughts behind KHTʼs claim of superior treatment efficacy of pain elimination over that of traditional body acupuncture.According to the theory of KHT, there are 14 micro-meridians and 345 acupuncture points on our hands which regulate the internal organs and the physiological function of the entire human body. These acupuncture points may be stimulated by using a myriad of tools,including Hand Needles, Seoam Press-Pellets, Seaom Moxa, E-beam, Magnets, KHT Silver Ring, or Cyber Hand Therapy (mind vibration) (koryohandtherapy.com). However, I will be examining more the diagnostic methods and therapies rather than the implements used to deliver said therapies.
The theory of Koryo Hand Therapy was first originated, studied and developed by the Koreanacupuncturist, Dr. Tae-Woo Yoo between 1971 and 1975.
According to Dr. Yoo, one night in 1971, he was awakened from sleep because of severe occipital pain that would not go away, and found he was drawn to an area on the back of his middle finger.He proceeded to apply pressure to the area with a ballpoint pen, found it was sensitive, and then inserted a needle in the same spot. A practicing traditional acupuncturist for years, he was astonished at the “speed and degree of pain relief”.Continued experimentation led him to believe that not only did the tip of the finger represent the head of a human body, but that the entire body could be corresponded to the rest of the hand. From this, he established Correspondence Therapy, and the beginnings of Koryo Sooji Chim. Yoo also instituted the use of Yin Yang pulse diagnosis as a method of identifying imbalance in the organs and channels, and also as a measurement of improvement after KHT treatment.I will quickly outline the three basic stages of treatment, focusing on their uses for pain control, and then discuss the somewhat thorny dialogue of Yin Yang pulse diagnosis and its significance in KHT treatment and outcomes.There are more diagnostic and therapy regiments within KHT, such as Micro-Meridian, Three Constitutions, and Five Element Therapy, but I will not include these within the scope of this paper. Correspondence, Basic, and Organ Therapy The foundation of KHT treatment is the use of corresponding points, or Correspondence Therapy, to treat pain symptoms. Figure 1 shows the correlating points between the front and the back of the hand, and the front and back of the body.
The joints of the finger act as divisions that represent proportional joints of the body. Each hand represents the whole body, so every part of the body is represented twice, therefore right-sided headache pain would be treated with the left hand, but using Correspondence Therapy, the radial (right) side of the back of the hand on the middle finger is used. One could compare this to findings of “a shi” points used in body acupuncture, but in contrast to the needling in body acupuncture, where one searches for the “de qi” sensation at the acupuncture points, in KHT Correspondence Therapy one just penetrates the skin for a few millimeters to obtain the effect of that point (Kobrin).
Interestingly, in this system there is still a specific sensation felt by the patient when the point is properly needled.Initially, I found that Correspondence Therapy requires special attention to make the necessary conceptual transition from the body points to the hand points. However, the idea is that one begins to think of both body and hand point locations simultaneously. Obviously, one must have mastered the body points before the hand correspondence points can be studied.
When first looking at Correspondence Therapy, I thought that it was simply another correspondence system like the ear, face or foot reflex systems. I soon realized that Dr. Yoo’s system means to be more than an adjunctive system to using the traditional body points, but rather the hand correspondence system was a point-by-point parallel to the body acupuncture points.The next treatment approach is Basic Therapy, which is used to strengthen the treatment by harmonizing the functioning of the internal organs, which is often the root of disease, and in many cases, pain.
These are divided between “prescriptions” for the upper, middle, and lower burners, as well as neuropathic and lumbar point prescriptions. Each prescription acts as a set of points that are often applied prior to needling the found corresponding points during a treatment. Figure 2 shows an example of the three different burners prescriptions Lastly, I will look at a third level of treatment, known as Organ or “Ki Mek” Therapy.This isuse when the first two therapies are ineffective and follows the standard symptom-sign complexes of the “”zang fu” used in traditional body acupuncture, in that it assigns certain symptom presentations to a dysfunction of specific organs or channels. For instance, pain or tenderness at Ren 5 and Ren 4 indicates Kidney excess pathology. The reaction point for treatment is K-J23 on the hand.At this level, several needles are inserted into hand points that relate to the organ, in addition to the Basic Therapy and Correspondence Therapy points (Schmidt).
In most cases, these three aspects of therapy are tried first, followed by some of the previously mentioned techniques if they are not effective. Once the needles are removed, the points on the hand are massaged and the patient should be instructed to keep their hands clean, dry and warm. After (and often during) treatment, the patient should exercise the hands to further consolidate the treatment efficacy.Yin Yang Pulse Diagnosis and Cerebral Blood Flow While KHT also acknowledges and uses the traditional Chinese pulse diagnosis method, the “Yin-Yang” Pulse Diagnosis allows for a very precise diagnosis of the imbalances in the body. If the diagnosis is done properly, the following treatment will immediately bring a change in the pulse quality. Therefore many KHT practitioners are fond of this diagnostic method to not only ascertain a treatment plan, but also as a measure of treatment efficacy.
In KHT, the Yin-Yang pulse diagnostic system compares the radial and carotid pulses to assess the blood flow balance to the front and back of the brain. According to KHT theory, any disturbance to the circulation of blood to the head is the result of pain and disease in the body. The left and right-sided carotid and radial pulses should have a regular and equal blood flow. This balanced and equal flow means a balanced flow to the brain, indicating good circulation of blood, a balance of cold and heat in the body and normal function of the internal organs.
Therefore the purpose of treatment when the pulses are unbalanced is to regain normal balance so that the function of the brain and all of the functions of the organs normalize and pain is relieved. The thought is that while strong stimulation in any part of the body may relieve pain somewhat, there will be no actual change in the blood flow-balance to the brain. KHT, however, brings pain relief by regulating the function of the brain.In Yin-Yang pulse diagnosis, the thickness of the pulse is observed, rather than the strength, quality frequency or regularity. This is often described as thinking “of feeling the thickness of,for example, the outer case of a ball point pen compared to the thickness of the inner filler tube”.\
Palpation differentiation requires practice, and it is common in the beginning to confuse pulse width or thickness with strength. However, strength is not considered here, only the width-diameter-thickness. The greater the differential between the pulse widths, the more serious the problem. If there is no change or recovery in balance, that is, if carotid and radial pulse thicknesses do not move towards equality, then the treatment is said to be incomplete and the disease condition will continue unchanged.The carotid artery is diagnostic for the “Yang Type” pulse, at approximately the Stomach 9 “Ren Ying” location. When the carotid pulse is thicker than the radial pulse, the problem is said to be located among the six Fu-organs and Yang channels.
The blood flow through this point is easy to palpate to assess flow to the front area of the brain. However, blood flow to the back of the brain is through the vertebral arteries, and palpation of these bilateral arteries is difficult, as they pass through the cervical vertebra. Because of this difficulty, palpation of the radial artery at the traditional pulse position at the wrist (“Cun Kou” is used as the surrogate location to measure blood flow to the back of the brain.
The vertebral and radial arteries derive from a common artery, the bracheocephalic artery.Therefore the radial artery represents the Yin pulse, and is felt at approximately Lung 9 “Tai Yuan”If the radial pulse is thicker than the carotid pulse, it is called a “Yin Type” pulse and the problem is among the six Zang- organsand Yin channels. In modern Western Medicine, it is recognized that pain is felt though the stimulation of peripheral nerves and perceived by the cerebrum, and that the factors of all pain, except for traumatic injury, are related to the cerebrum. In researching the fundamental theories of KHT, I came to learn that specific patterns of cerebral activity have been identified in relation to acute and chronic visceral pain experiences.
This activity occurs as a consequence of receiving and processing neurally encoded information perceived to be arising from the organs (Silverman 294). However, most allopathic practitioners rely on pharmaceutical therapy in relieving pain, which leads to many side effects, and does not attend to the root causes of the pain. KHT Correspondence Therapy considers itself more unique than many other approaches in that it affects cerebral blood flow (CBF), and not just reflex nerve stimulation. According to Dr.Yoo, only stimulation of acupuncture points around the neck, the wrists and elbows effects CBF.
Stimulation of points such as Stomach 36 “Zu San Li”has little effect on cerebral blood flow, and although Spleen 6 “San Yin Jiao” has a positive effect on lower abdominal pain, it also has no effect on the CBF. Origins of Yin Yang Pulse Theory The concept of the CBF in KHT was first mentioned in the “Yellow Emperorʼs Classic of Internal Medicine, From Beginning to End” (Ling Shu Zhong Shi,but is not often utilized in clinical experience because of its vague and poor explanation. Much of the translation, as you will see, is open to a wide arena of debate, which adds another aspect to KHTʼs claim of superiority over body acupuncture.
One should know [by taking the pulse at the Cunkou and the Renying whether] yin and yang are in excess or deficient, balanced or not balanced, according to the wholeness of Heaven’s way. (This describes the strength of palpation or width of the pulses at the two pulse locations.)If the Renying pulse is twice as full, disease is located in the Leg Shao Yang. If it is twice as full and erratic, disease is located in the Arm Shao Yang. If the pulse at Renying on the neck is twice as full (as the pulse at the wrist), drain the Leg Shao Yang (Gallbladder) and tonify the Leg Jue Yin (Liver).If the pulse at the Cunkou is twice as full, disease is located on the Leg Jue Yin (Liver).
If the[Jue Yin pulse] is twice as full and erratic, disease will be located in the hand Heart Master.If the pulse at the Cunkou on the wrist is twice as full as the neck pulse, drain the Leg Jue Yin and tonify the Leg Shao Yang.The health of the body is also assessed by the Yin Yang pulses, as mentioned in my below translation of the Ling Shu Jin Fu “Prohibition and Submission” Huang Di said: The pulse at Cunkou controls the center (the Yin channels). The pulse at Renying controls the external (the Yang channels). Both resonate mutually. Together they go forward and together they come (they come and go together), as if connected by a string, large and small, all equal. In spring and summer the Renying pulse is slightly large.
In autumn and winter the Cunkou pulse is slightly large. He who is like this is the balanced [healthy] man.At the end of the Ling Shu Chapter 9, it reads Although pain may not lessen following the needle (ie. be reduced), the disease must lessen and departs. Hereʼs where things get interesting – there are a few ways the next passage could be translated. My initial translation for the following passage is:One must begin by freeing (unblocking) the twelve major channels that which gives birth to the “sheng bing” [disease symptoms]. Afterwards it will be possible to transmit [qi] from beginning to end [indicating within the channels].
Therefore yin and yang are not the same movements. Deficiency and repletion are not similarly inclined, although treatment for both is through the channels. However, an alternate translation for this same passage is One must understand the symptoms and signs of the twelve channels first, then [you will know how] channels transmit from one to the other.Therefore yin won’t turn into yang, while excess won’t shift to deficiency, & one must select the proper channel.
According to yet another translation of the Ling Shu by Zhao Wang L.Ac. O.M.D, this indicates that the directive is to “needle the channel in a disorder only if the pulse of Cunkou and Renying are even. (Wang 104)” His translation is of the last line of text is Needle a channel in a disorder only if there is not an imbalance of Yin/Yang involved.The variety in translation and interpretation of this passage could be seen as an open door for KHT proponents to argue the use of hand acupuncture as superior to that of traditional body acupuncture. There exists a lively ongoing debate on this topic, with leaders in the KHT field using Yin Yang pulse diagnosis as a method for illustrating their point.KHT versus Chinese Body Acupuncture.
Zhao Wang goes on to say this means the Cunkou and Renying pulse are used only for the diagnosis of disorders of a channel due to the imbalance of Yin and Yang, and not for disorders due to pathogenic-qi attacking from the exterior.In other words, if a disorder of a channel is due to outside pathogenic-qi, the Cunkou and Renying pulse would still be even. He indicates that needling a channel to treat certain pathologies would be erroneous, which would show up in a worsening of the Yin Yang pulses after treatment. This correlates to another facet of Dr. Yooʼs claims of why KHT is in many cases not only more effective than body acupuncture, but safer as well. In 2006, Dr. Yoo and others as part of the 19th Korean-Japan Seo Geum Therapy Symposium conducted an experiment that concluded that more than 90% of body acupuncture and moxibustion made disease symptoms worse. They attached various acupuncture implements to body points such as Stomach 36 and compared the Yin Yang pulse changes to those of treatment on KHT corresponding hand points. Their studies concluded that the body points increased the pulse rate, making the Yin Yang pulses worsen, and making the capillary vessels contract.
The reasoning was this overexcited the sympathetic nervous system, so no endorphins (a sympathetic response) could be secreted and the body became strained. The hand points conversely caused the pulse rate to calm and the Yin Yang pulses to even.If the pain relief effects of body acupuncture are not produced by endorphins, then where does it come from? Dr. Yoo thinks dopamine and adrenalin (parasympathetic responses) may be the reason for the pain relief received from body acupuncture, and that the mind becomes hyper sensitized and nervous when stimulated by body acupuncture, moxa and massage.Dopamine is secreted, and if over-secreted it secrets adrenalin which then increases the pulse rate.If dopamine and adrenalin are over-secreted then the sympathetic nervous system becomes strained and over excited, making the Yin Yang pulses and the illness itself worse.The thought is that dopamine and adrenalin may have pain relief effects, but only alleviate the symptoms temporally, not curing the actual disease.
This reasoning leads Dr. Yoo to believe that the use of moxibustion and needling along the channels can be dangerous to the body in many situations, and its effects and functions are not confirmed carefully enough through proper experimentation, nor is there a fully realized understanding of the scientific mechanisms involved. He also feels changes in pain relief from body acupuncture are possibly due to the effects of dopamine and adrenaline and are therefore only short term, as the patientʼs mind may be affected but not necessarily the physical symptoms the patient is being treated for. All this is measured by what KHT practitioners feel is an improper Yin Yang pulse outcome after treatment. On the other hand, Daniel Bensky, while maybe not being specific to Yin Yang pulse diagnosis, talks about pulse diagnosis potentially being misleading: “Channel findings do not always match pulse findings. Often the channels felt to be dysfunctional are different from those one would expect based on pulse diagnosis. There are many possible reasons for this.
One that appears to be true to me based on my experiences is that the pulse positions reflect the state of the organs and not the channels. For example, if someone has done some damage to the medial aspect of their knee it is unlikely to show up as a disruption of their Kidney, Liver, or Spleen pulse (unless an underlying problem with one or more of those organs made the area vulnerable)… When I have treated people with comprehensive Kidney deficiency utilizing meridian therapy protocols, if I get an immediate positive effect on the pulse the long-term effects of the treatment are minimal. That is, they may or may not feel better for a short time after the treatment, but there is no long lasting effect on how they feel and when they return to the office a couple of weeks later there is no noticeable improvement in their condition.
As such, even though the pulse “improved” significantly at the time of the treatment, this was not a good marker for the efficacy of the treatment.He goes on to say that all measurement premises should be open to question, and that ultimately, regardless of whether a patientʼs pulse (or hara) improves, success is dependent on actual improvement of patient symptoms. “If one adhered to the doctrine that the goal of acupuncture is to balance the pulse at the time of treatment, you would have to say that these treatments were disastrous. To me this is too narrow minded and shortsighted. Taking the view that it is the patient’s long term response to the needling that is the treatment, I maintain that this is just another example of how trying to fit patient’s response to treatment into some preordained box does the patients and acupuncture a disservice”.