Byungmook Lim

Traditional Medicine in China, Korea, and Japan: A Brief Introduction and Comparison

Background and Purpose. Traditional medicine (TM) has been widely used in China (including the Taiwan region), Korea, and Japan. The purposes of this paper are to summarize the basic data on TM systems in these three countries and to compare them in terms of overall policy, education, and insurance. Methods. Government websites, national statistics, and authoritative papers from each country were fully searched. Further data were gathered by TM experts from each country. Results. China and Korea showed similar patterns in TM systems, whereas Japan showed different patterns. In China and Korea, TM was practiced in a dual system with conventional medicine (CM), and TM education was 6-year training programs on average for TM doctors, and acupuncture, moxibustion, and cupping were completely insured. Whereas, CM was dominant in Japan, and TM was practiced by each health care worker who has received different TM education respectively, and main TM therapies were partially insured. Conclusions. TM was developed similarly or somewhat differently based on differences in cultural background and national policies in East Asia. We cautiously propose that this study could contribute to the development of TM and also be used for reference in complementary and alternative medicine systems.

How Current Clinical Practice Guidelines for Low Back Pain Reflect Traditional Medicine in East Asian Countries: A Systematic Review of Clinical Practice Guidelines and Systematic Reviews

Objectives The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. Methods We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. Results Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. Conclusions The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues

National Health Insurance (NHI) in Korea has covered Korean medicine (KM) services including acupuncture, moxibustion, cupping, and herbal preparations since 1987, which represents the first time that an entire traditional medicine system was insured by an NHI scheme anywhere in the world. This nationwide insurance coverage led to a rapid increase in the use of KM, and the KM community became one of the main interest groups in the Korean healthcare system. However, due to the publics safety concern of and the stagnancy in demand for KM services, KM has been facing new challenges. This paper presents a brief history and the current structure of KM health insurance, and describes the critical issues related to KM insurance for in-depth understanding of the present situation.

Attempts to Utilize and Integrate Traditional Medicine in North Korea

AIM To summarize the way North Korea attempted to modernize its system of traditional medicine and integrate it with Western biomedicine. METHODS We reviewed clinical textbooks and periodicals of traditional Korean medicine published in North Korea, research reports on North Korean health and medicine published elsewhere, and conducted interviews of defectors from North Korea who were students or clinicians of traditional medicine. RESULTS Key findings of this study are: (1) North Korea has attempted several ways of integrating traditional medicine into education and clinical practices; (2) North Koreas communist government provided the main driving force for an integration policy; (3) school curricula of both Western and traditional Korean medicine incorporated knowledge of both disciplines, yet more weight was placed on traditional Korean medicine; (4) a combination of Western diagnosis and Korean therapeutics was the most frequent example of integration, while the dual system approach with reciprocal practice was also explored; (5) several forms of integrative therapeutic mixture were practiced including concurrent medication, injection on acupuncture points, and intramuscular or intravenous injection of extracts from medicinal plants; and (6) limited resources for research and the underdeveloped level of clinical research failed to secure rigorous scientific advancement. CONCLUSIONS Despite the government-driven attempt to create an ideal integrative system of medicine, according to our findings, the actual introduction of an integrative system into practice was far from the North Korean governments anticipated outcome in regards to clinical practice. We hypothesize this was due to famine, economic crisis, and political isolation from the international realm. Traditional Korean medicine seems to have served the population, which is in desperate need of treatment amid difficulties in health, while North Koreas Western biomedicine-based health delivery system has been badly affected.

Relationship between patient satisfaction with medical doctors and the use of traditional Korean medicine in Korea.

BackgroundSatisfaction with medical doctor (MD) has been studied as a possible motivation for trying complementary medicine. This study aimed to explore the relationship between Korean outpatients’ satisfaction with their MDs and their use of traditional Korean medicine (KM).MethodsData were drawn from the 2011 annual Korea Health Panel, a national representative sample. We analyzed the relationship between outpatients’ use of KM and outpatients’ satisfaction with MDs by using the responses of 9,753 outpatients, including 1,946 KM outpatients. The Andersen behavior model was applied to select the variables. The validity and reliability of the questionnaires were tested by Factor Analysis and Cronbach’s alpha. Multiple logistic regression was used to evaluate five MD satisfaction indicators (patient’s trust in MD, MD’s careful listening, MD’s sufficient explanation, MD’s consultation time, and MD’s respect for patient) and the overall satisfaction with the MD.ResultsThere was no significant difference between the MD satisfaction of KM users and that of nonusers in any of the 5 indicators of MD satisfaction. When we controlled for all independent variables from the Anderson behavior model, however, the patients’ overall dissatisfaction with MDs was associated with their use of KM (OR = 0.87,0.76–0.99). In addition, the more a patient was dissatisfied with the consultation time of their MD, the more they used KM (OR = 0.82, 072–0.94).ConclusionsPatients who were dissatisfied with their MD were more likely to use KM; the main indicator affecting MD dissatisfaction was the relatively short time of MD consultations. This could be one reason why KM plays a complementary role with conventional medicine in Korea.

Factors related to the parallel use of complementary and alternative medicine with conventional medicine among patients with chronic conditions in South Korea

Background This study aims to examine the characteristics and behavioral patterns of patients with chronic conditions behind their parallel use of the conventional medicine (CM) and the complementary and alternative medicine (CAM) that includes traditional Korean Medicine (KM). Methods This cross-sectional study used the self-administered anonymous survey method to obtain the results from inpatients who were staying in three hospitals in Gyeongnam province in Korea. Results Of the 423 participants surveyed, 334 participants (79.0%) used some form of CAM among which KM therapies were the most common modalities. The results of a logistic regression analysis showed that the parallel use pattern was most apparent in the groups aged over 40. Patients with hypertension or joint diseases were seen to have higher propensity to show the parallel use patterns, whereas patients with diabetes were not. In addition, many sociodemographic and health-related characteristics are related to the patterns of the parallel use of CAM and CM. Conclusion In the rural area of Korea, most inpatients who used CM for the management of chronic conditions used CAM in parallel. KM was the most common in CAM modalities, and the aspect of parallel use varied according to the disease conditions.

P04.53. Factors related to use of both western medicine and complementary and alternative medicine among patients with chronic diseases in South Korea

Results Of 423 respondents, 79.0% used CAM adjunctively during the hospitalization period. The most frequent type of CAM modality used was a package of herbal medicine and acupuncture (91.3%). Of the patients using CAM, 34.4% had musculoskeletal disorders and 16.1% had hypertension. Those aged 40-59 used CAM more than those aged 20-39 (OR = 4.58, 95% CI: 1.92-10.92). Males (OR = 0.33, 95% CI: 0.18-0.60) and people who had a spouse (OR = 0.26, 95% CI: 0.13-0.52) used CAM less.

P04.63. The consciousness of medical doctors about collaborative practice of Western medicine and traditional Korean medicine

Results Doctors working in conventional hospitals had comparatively negative consciousness regarding the basic concept, remedial value and necessity for collaborative practice and TKM. In regards with disease treatment’s effectiveness of collaborative practice, both groups evaluated musculoskeletal and immune disease were more effective than others. There were positive relationships between perception for cost-effectiveness and consciousness about intention to participate collaborative practice (p<0.05). Also, doctors who experienced TKM treatment had positive consciousness about collaborative practice (p=0.05). Conclusion To activate the collaborative practice of WM and TKM, some efforts should be carried out. These include promoting cooperative education programs in medical schools and traditional Korean medical schools, doing research on costeffectiveness of collaborative practice, and trying to minimize legal and systemic restrictions for collaborative practice.

P04.18. Current status of the dual medical license holders in Korea

Purpose Korea’s medical system, comprising of conventional western medicine (CWM) and traditional Korean medicine (TKM), is at the same time dichotomistic and dualistic. TKM has its own systems for education and national licensing. While there is a sharp distinction between the practices of medical doctors (MD) and TKM doctors (TKMD) legally, there are also many conflicts arising from crossover practices in reality. Dual medical license holders (DMD) having both MD and TKMD licenses are increasing because of this contradictory situation. This study aims to investigate the status of DMDs and provide basic data for developing strategies of cooperation between CWM and TKM.