The Saam Acupuncture Tradition: Classical Roots and Clinical Application (by Toby Daly)

Book Review of a New Title on the Korean System of Acupuncture

When I was an acupuncture student at what’s now called NUNM in Portland, Oregon, I was dazzled by the beauty of the classical Chinese cosmology that we spent most of our first year soaking up. Under the tutelage of Dr. Heiner Fruehauf, I marveled at the intricate correspondences between macrocosm (the world out there) and microcosm (the world within). Here was an entirely organic, process-oriented vision of the body as an ecosystem of mountains and rivers, constellations and climate zones.

If that sounds nebulous or hopelessly abstract, it took a practical turn once we began learning herbal medicine (herbs were Dr. Fruehauf’s specialty, and the reason I had entered the program). Things got more practical skill once it was time to start prescribing herbal formulas to actual patients in the clinic, “where the rubber meets the road,” as Heiner likes to say. Happily, I found that the use of classical formulas was a natural outgrowth (if not always a straightforward one) of the way of thinking I’d been steeping in.

When it came to herbal medicine, theory flowed beautifully into practice. But I didn’t have an analogous experience when it came to learning acupuncture.

Sure, the channels and points made reference to the theory, but it all seemed tangential, somehow. The TCM (relatively modernized, institutionalized “traditional Chinese medicine”) we had to learn for the sake of board exams seemed less like a coherent system than a hodgepodge of ideas and techniques. I think most of my classmates and I could sense on some level that somewhere along the way lineage transmission had faltered when it came to TCM acupuncture. Most of us gravitated towards other acupuncture styles (in my case, these included exacting subtleties of Japanese Meridian Therapy, though that style never fully took root as my main approach). In the end, like many I graduated with a ‘little bit of this, a little bit of that’ in my acupuncture toolkit. Not a terrible foundation by any means, but also less than a fully functional, complete system of medicine.

My first few years in practice bore out these concerns. Whether working in a community acupuncture setting or in my small private practice, I felt ten times more confident with herbs than with needles. My acupuncture treatments clearly helped some times; at other times they didn’t, but at no point was I clear on how to identify my mistakes, learn from them or course-correct. I felt stuck in my development as a practitioner, and increasingly frustrated. I thought of throwing in the towel and sticking with herbs, my first love.

That’s when I caught wind via the Qiological podcast and community forum of Saam acupuncture. The word was that Saam was a self-contained system based on familiar classical Chinese principles put together in a unique way by a 17th century Korean Mahayana monk. Apparently the treatments were simple but dramatic: dramatically good if you got it right, dramatically bad if you didn’t. One way, the patient improved and you learned something. The other way, at least you learned something and—here was the key that really piqued my interest—you knew what to do to turn things around (more on this aspect in a bit).

Reading through the practitioners forum where colleagues were discussing Saam principles and cases, my appetite was whetted. Within a couple months I found myself taking an intro weekend course in Saam taught by one Toby Daly.

Mr. Daly was cut from a familiar cloth, I must have thought: lanky, cerebral, laser-focused (both of us San Jiao excess types, as I’d soon learn). Moreover, like me he had spent some formative time traveling in South Asia in his twenties, and (again like me) had ended up rather the worse for the wear. As he writes in the Introduction to his new book, The Saam Acupuncture Tradition:

Traveling on a budget in India had wreaked havoc on my digestive system. I had been plagued with diarrhea for months and had completely lost my appetite. My normal weight of 190 pounds on a six-foot-four-inch frame had been reduced to a mere 150 pounds.

The monk and I traveled together for the next six weeks…it was apparent from my frequent trips to the bathroom and emaciated body how ill I was. My new traveling companion repeatedly offered to help me with his acupuncture needles.

Since my grandfather had been a medical doctor, and my background was in science, I was reluctant. I felt very confident that needles without any medicine going through them intravenously could do nothing for me. After a few weeks of traveling, I relented, thinking, “He’s such a nice man, this won’t do anything for me, but it will make him feel better if he thinks he’s helping me.”

He inserted four needles into my hands and feet, and I rested for twenty minutes. I got up from my first acupuncture treatment and ate an entire meal with three desserts. I could not believe it. My digestive system normalized and my fascination for and appreciation of acupuncture was born.¹

The monk eventually became Daly’s teacher. “He freely gave me so much and only asked that if I ever had the opportunity to share this tradition, I should do so.”² For the last six or seven years, he’s been doing just that, first through classes and now through this clearly-written, well-edited volume.

Having taken the Saam intro class (and another couple of Saam weekends) with Toby Daly, I can say that The Saam Acupuncture Tradition is an elegant, pithy distillation of the class’s core content. As in the weekend course, Daly starts with a foundation of first principles: yin-yang, the five phases, the six qi. In the second chapter he comes to the “twelve divisions in the macrocosm,” writ-large versions of the body’s 12 organs or channel systems, as Daly calls them (Fruehauf uses the term organ networks; like much of Chinese medical terminology, there are endless translations).

For each of the twelve channels, Daly gives us a full-page color photo of a place on earth that best embodies the qi: the Amazon river (yin, warm, damp throughout), for example, or the fiery Kilauea rift zone (a combination fire and water). With descriptions and images he drives home that this medicine operates not merely by paying lip service to natural processes, but taking its most basic cues and core strategies from the larger world and applying them directly to the smaller one contained within our skin.

In the body, that Amazon river jungle ecosystem—warm, steamy, squishy—corresponds to the Spleen [capitalized here to differentiate the East Asian Medical concept from its biomedical counterpart].

As Daly explains at the start of the book’s third chapter, “the qualities inherent in each channel system are revealed when that system is in a state of excess.”³ When it comes to excess of the Spleen channel in particular, “the patient is likely to display some of these symptoms and signs:

• The outside of the body, most notably the skin, will be moist

• The inside of the body, most notably the abdominal cavity, will have abnormally high deposits of visceral adipose tissue

• The body will be slightly warm, heavy and soft

• They will be prone to laziness and boredom

• They will have a sweet tooth

• They will have weak bones, teeth and gums

• They will have severe numbness

• They will exhibit pathology along the Spleen channel and Large Intestine channel [the counterbalancing channel] trajectories”⁴

Why? It’s hard to resist quoting Daly’s clear exposition at more length here:

Since the Spleen channel system has a Tai Yin [i.e. damp] conformation and an Earth [i.e. damp] phase, a patient with excess in this system will exhibit signs of outer and inner dampness, including an obese body and moist or oily skin. Like a compost pile, their damp body will generate extra warmth. Their body will feel subjectively heavy, and soft to palpation.

The heaviness of their double-damp body will lead these patients to feel lethargic and unmotivated. To sustain the dampness patients will be drawn to consume foods with a sweet taste. Like metal corroding in a damp jungle, the patient’s bones, teeth and gums will decay in this damp inner environment. Since dampness muffles normal body sensations, patients with Spleen channel system excess will experience profound numbness.⁵

Doing much the same for each of the twelve channels, Daly takes us through the nuances of the Saam system’s characteristic synthesis of the five phases with the six qi (or six conformations). Elsewhere in the acupuncture world, these two theoretical structures are rarely integrated so neatly—and therein lies the clinical power of Saam, which is able to exploit the fact that (continuing our example) the Spleen is not only damp in nature, as every acupuncture student knows, but doubly damp, i.e. damp both inside and out. (This fact turns out to be key to its leveraging the Spleen and its counterbalancing channel, the Large Intestine, successfully.)

The qualities of the eleven other channels are teased out in detail as well. For acupuncturists not familiar with Saam, some of these channel qualities will be familiar (i.e. Heart excess gives rise to heat signs like a rapid pulse and flushed skin), while others will be novel: Triple Warmer excess yields bright, piercing eyes, while Urinary Bladder excess is evident in a tight, cool abdominal midline. The Saam tradition has correlated dozens of these clinical pearls, extremely useful in clinic, and Daly is careful to convey them all just as learned them from his teacher with the help of a few carefully-chosen photos: a cracked medial heel (sign of Small Intestine excess), a full, inflated thenar eminence (sign of Lung excess) or a deflated one (Stomach excess).

Throughout, he peppers the text with well-chosen quotes from the Chinese medical classics (Nei Jing and Nan Jing) as well as from later authors such as Xu Dachun and some non-Chinese thinkers of relevance. From the Nei Jing, for instance: “It is by virtue of the twelve channels that human life exists, that disease arises, that human beings can be treated, and illness cured. The twelve channels are where beginners start and masters end. To beginners, it seems easy; masters know how difficult it is.”⁶

After laying out the channels, their respective qualities and clinical characteristics, the exposition moves towards treatment strategies. At its core, the Saam system is brilliantly simple. Once a channel excess is identified, treatment consists in supplementing the counterbalancing channel—for each channel does indeed have exactly one counter-balancer. In the case of Spleen excess, one would supplement Large Intestine, which is as dry as the Spleen is damp, in order to move the system toward harmony. (On occasion, an advanced practitioner might actually drain the Spleen instead of supplementing its opposite number, but Daly opts not to get into the draining strategies in this introductory book, as draining contains more inherent potential for harm.)

If it’s not already clear, Daly’s book is aimed squarely at practitioners with a solid background in East Asian medicine concepts and an acupuncture license. It’s not overly technical, but it does assume some basic acupuncture knowledge such as point locations, especially in the later, more clinically-oriented chapters. That said, a motivated layperson reader would stand to learn a good deal about how a living East Asian Medicine tradition works, even if some of the technical details go over their head.

After a chapter on the four-point combinations used to supplement each of the twelve channel systems (and the elegant rationales for these combinations), a “Clinical Practicalities” section details such matters as Saam-style abdominal palpation, which is used to help confirm certain diagnoses, and assessing the suitability of a treatment once the needles go in. In print, Daly emphasizes the important of seeing an improvement in complexion, though in class he has also emphasized watching the degree to which the patient settles—a factor I’ve found to be extremely relevant.

To slow down for a moment around this crucial topic: with a system as powerful as Saam can be, it’s critical to heed these subtle signs that a treatment is moving in the right direction, for an unsettled treatment response on the table (e.g. a fidgety patient, one who keeps opening their eyes, or whose complexion becomes blotchy) translates to a worsening of symptoms and the need for a reverse treatment using the counterbalancing channel at the earliest opportunity. With Saam, there are no half-measures or harmonizing strategies: you’re going all in, so the stakes are higher than with other styles. But it’s exactly this built-in feedback mechanism that allows the practitioner to course-correct and learn from mistakes, and that creates safety for the patient in the form of built-in “antidotes” to potential mis-steps.

Back to the text. Helpfully, the Practicalities section also includes photos of faces characteristic of the various excess patterns, from a highly symmetrical Kidney excess face to a red, flushed Heart excess face. There is little here on the pulse, for Saam almost completely de-emphasizes this form of diagnosis in favor of a combination of observation and palpation (of abdomen and skin quality, combined with skillful questioning.

A penultimate chapter covers technical considerations (such as needle gauge, needling technique, retention time, etc.) before things wrap up with a set of three case studies. The cases are clear and convincing, and beautifully illustrate Saam’s principles in action. Each study allows us to follow the clinical narrative of a patient over the course of three to seven treatments, each of which alters the inner landscape in the direction of harmony.

Of course, in reality, as Daly likes to say, “clinic is hard,” and not every case (even of Daly’s) proceeds as smoothly as the ones he’s chosen to highlight in the book.

It’s certainly understandable to choose ideal, unequivocally successful cases to illustrate the system under discussion.But as a practitioner who’s had to learn through a certain amount of trial and error (as we all do), I can’t help wishing that Daly had included at least one example of a case that got off track, as he does in his Saam teaching. Dealing with such mis-treatments is part and parcel of learning and practicing Saam, and there’s a missed opportunity here for the student to witness what it can look like when the needles send someone in exactly the wrong direction—and how to recover. Daly does, however, discuss the general procedure for reversing a wrong treatment in an earlier section, so the newbie isn’t left entirely without a line. And part of the beauty of Saam is that each mis-step has a clearly defined way to correct it, provided the practitioner has gone slowly and not overextended by doing too much at once.

As mentioned, Daly does opt to omit any mention of more advanced aspects of the tradition, such as draining strategies, bilateral treatments, modified point combinations, and the simple Ren and Du channel treatments. This is definitely understandable in an intro text, as a little knowledge can dangerous; Daly probably doesn’t want to give folks ideas. But here’s hoping a sequel is eventually forthcoming to lay out the missing pieces.

Back in the Preface, Toby Daly stated his misgivings about writing a book like this one. “I have real concern about compromising the dynamic vitality of a living oral tradition by codifying it into an unchanging book…”⁷ Thankfully, with Saam enjoying a renaissance in the States and beyond, the tradition seems unlikely to become ossified or unchanging any time soon. And that’s thanks in large part to Daly, his teacher, and the long line of needle-wielding monks before him.

Here’s to them, and to all of the practitioners doing their part to keep the flame of this remarkable wisdom tradition burning bright. The future is going to need every bit of this medicine.

1. Toby Daly, The Saam Acupuncture Tradition: Classical Roots and Clinical Applications, 15.

2. Daly, 16.

3. Daly, 53.

4. Daly, 61.

5. Daly, 62.

6. Daly, 53, quoting Deadman’s translation of the Huang Di Nei Jing, Ling Shu, Chapter 17.

7. Daly, 11.