Introduction to the History and Current Status of Evidence-Based Korean Medicine: A Unique Integrated System of Allopathic and Holistic Medicine

Abstract

Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been active in contributing to evidence-based medicine. Recent developments in Korean medicine have not been as well disseminated as traditional Chinese medicine. This introduction to recent developments in Korean medicine will draw attention to, and facilitate, the advancement of evidence-based complementary alternative medicine (CAM). Methods and Results. The history of and recent developments in Korean medicine as evidence-based medicine are explored through discussions on the development of a national standard classification of diseases and study reports, ranging from basic research to newly developed clinical therapies. A national standard classification of diseases has been developed and revised serially into an integrated classification of Western allopathic and traditional holistic medicine disease entities. Standard disease classifications offer a starting point for the reliable gathering of evidence and provide a representative example of the unique status of evidence-based Korean medicine as an integration of Western allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in evidence-based Korean medicine show a unique development in evidence-based medicine, adopting both Western allopathic and holistic traditional medicine. It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing conventional and complementary approaches.

Full text

Review Article
Introduction to the History and Current Status of
Evidence-Based Korean Medicine: A Unique Integrated
System of Allopathic and Holistic Medicine
Chang Shik Yin1and Seong-Gyu Ko2
1Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 130-701, Republic of Korea
2Department of Preventive Medicine, Center for Clinical Research and Drug Development, Institution for Korean Medicine,
Kyung Hee University, Seoul 130-701, Republic of Korea
Correspondence should be addressed to Seong-Gyu Ko; epiko@khu.ac.kr
Received 3 December 2013; Revised 9 January 2014; Accepted 10 January 2014; Published 14 April 2014
Academic Editor: Bo-Hyoung Jang
Copyright © 2014 C. S. Yin and S.-G. Ko. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been
active in contributing to evidence-based medicine. Recent developments in Korean medicine have not been as well disseminated as
traditional Chinese medicine. is introduction to recent developments in Korean medicine will draw attention to, and facilitate,
the advancement of evidence-based complementary alternative medicine (CAM). Methods and Results. e history of and recent
developments in Korean medicine as evidence-based medicine are explored through discussions on the development of a national
standard classication of diseases and study reports, ranging from basic research to newly developed clinical therapies. A national
standard classication of diseases has been developed and revised serially into an integrated classication of Western allopathic
and traditional holistic medicine disease entities. Standard disease classications oer a starting point for the reliable gathering of
evidence and provide a representative example of the unique status of evidence-based Korean medicine as an integration of Western
allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in evidence-based Korean medicine
show a unique development in evidence-based medicine, adopting both Western allopathic and holistic traditional medicine.
It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing
conventional and complementary approaches.
1. Introduction
Korean medicine originates from prehistoric times and shares
its origins with Chinese and Japanese medicine. However,
compared with traditional Chinese medicine, Korean
medicine is much less well-known. Although Korean and
Chinese medicine have much in common, Korean medicine
has developed on its own as a whole-person-centered medi-
cine system [1], developing unique concepts and research,
with “Four Constitution” (Sasang constitutional) medicine
[2] and Saam acupuncture [3] being representative of gen-
uinely Korean developments. In recent years, Korean medi-
cinehasbecomepartofanationalhealthsystemanditsuse
has expanded [4]. us, by integrating traditional and mod-
ern approaches, Korean medicine constitutes an exemplary
case of a national health system that encompasses many
complementary and alternative approaches and has been
active in validating and developing them.
What follows is a brief introduction to the character-
istics of Korean medicine with a focus on evidence-based
approaches, along with a historical review of a standard dis-
ease classication in Korean medicine as a representative
example of the eorts being made to implement evidence-
based medicine.
2. Korean Medicine: Tailored,
Simple, and Practical
As indicated previously, the tradition of Korean medicine
features an individualized approach based on constitutional
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2014, Article ID 740515, 6 pages
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2 Evidence-Based Complementary and Alternative Medicine
energy traits of healthy qi [3], with simple and practical sol-
utions, based on these underlying energy traits or core
principles [5].Qiandtaoarethecoreprinciplesthatthebody
and the environment are composed of and by which both of
them function [6]. Korean medicine places importance on
self-discipline, a constitutional approach, and the three trea-
sures (essence, qi, and spirit) deep in the axis of life [7]and
focuses on the power and active response of the healthy qi as
innate intelligence, intricately linked with constitutional
characteristics and human dignity, which may be reected
andevaluateddierentiallyinapatternofsystemicman-
ifestations, including disease-specic ones that are directly
linked to the pathology and nonspecic ones that may be
remote from the lesion, with no apparent linkage to the
pathology. ese nonspecic characteristics may reect the
response of the body to the pathology rather than the pathol-
ogy itself.
3. Challenges in Evidence-Based
Approaches to CAM
Evidence-based medicine is about the best decision-making
basedonthebestavailableevidence[8] and highlights a
science and practice of medicine with a rm basis of evidence
[9]. e evidence may vary in its hierarchical status and
extent, but there may not be any strong opposition to the
concept of a medicine being established and practiced based
on stronger evidence. e evidence-based approach is rapidly
gaining acceptance and expanding its realm, not only in
academic [10,11] or clinical activities but also with regard to
regulation and insurance issues [12]. Complementary and
integrative medicine is not an exception, even though there
are many barriers, like the prioritization of classical books
and practice as evidence sources [13].
In addition to the idea that traditional knowledge itself is
an important source of evidence [14], the issue of evidence-
based medicine is considered to be more challenging in the
eld of complementary and integrative medicine than in the
eld of the conventional allopathic medicine. Although a lack
of research evidence for ecacy is said not to be evidence of
a lack of ecacy [15], the main challenge is, of course,
primarilyduetotherelativescarcityofevidenceintheeldof
complementary and integrative medicine. However, in addi-
tiontothescarcity,itmaybepartiallyduetodierencesinthe
theoretical context and philosophical perspectives between
complementary and integrative medicine and conventional
allopathic medicine. is conceptual dierence is accompa-
nied naturally by dierences in clinical practice. e theo-
retical context and clinical practice of complementary and
integrative medicine have been handed down from the past
or have developed from clinical experience rather than from
the widely accepted current knowledge of modern biology,
science,andtechnology,asisthecaseinorthodoxallopathic
medicine in which measurements are devised and performed
on the basis of theoretical context, clinical practice, and
technology and are linked directly with the production of
high-quality scientic evidence [16]. Dierences in the the-
oretical context, clinical practice, and measurements, in
addition to the scarcity of evidence, complicate the issue of an
evidence-based approach in the elds of complementary and
integrative medicine.
4. Korean Medicine: An Exemplary Case in
Evidence-Based Medicine
In the history of complementary and integrative medicine,
Korea’s situation may be a unique and exemplary case.
Although many countries still lack national regulation of
CAM, Korea established the parallel operation of two inde-
pendent medical systems (Western medicine and Korean
medicine) [17]in1951,arareinstancewherebycomplemen-
tary and integrative approaches have been ocially part of the
national health system from the very start. In Korea, there
is no generalist equivalent to a general physician in other
countries. Each physician belongs to one of the two spe-
cialty professions: Western allopathic medicine or Korean
medicine. Korean medicine is a specialty profession in which
modern allopathic medicine and traditional, complementary
approaches are integrated into a profession of modern holistic
medicine. Only a few physicians satisfy the required edu-
cational and regulatory processes for both professions and
receive both licenses from the government. Each is fully
licensed to diagnose and treat patients and is independent in
practicing medicine.
Korean medicine may be described as a form of integra-
tion of Western allopathic medicine and traditional medicine
by considering the following points. (1) Educational pro-
grams for Korean medicine students and practitioners cover
not only traditional knowledge but also the same basic
andclinicalmedicalsciencesandresearchasinWestern
medicine. (2) Korean medicine practitioners are fully lice-
nsed to diagnose both disease entities of Western medicine
origin and those of traditional medicine origin. (3) Treat-
ment modalities provided by Korean medicine practitioners
include those common in both Western and traditional
medicine, as well as those specic to traditional medicine,
such as acupuncture and yinyang balance concepts.
e Korean government has been promoting the evid-
ence-based development of the national health system, espe-
cially with regard to Korean medicine, by means of stan-
dardization, research funding, and new drug development
from herbal medicines. e Korean government has been
expanding its research funding for such projects as Korean
medicine diagnosis [18,19] and new drug development from
traditional herbal medicines [20,21]. e Korean government
invested a total of about 400 million US dollars during the
rst period to foster and develop Korean traditional medicine
(2006–2010), with 63% invested in research and development
projects, and planned to invest a total of about 1 billion US
dollars during the 2nd period (2011–2015), with 34% invested
in research and development projects [4].
As a fundamental platform for an evidence-based
approach in modern Korean medicine, the history of a stan-
dard disease classication is briey examined here. A stan-
dard disease classication alone does not mean, and cannot
justify, the notion that Korean medicine is an evidence-based

Evidence-Based Complementary and Alternative Medicine 3
approach. However, a standard disease classication may
be an indispensable fundamental basis for evidence-based
medicine.
5. Standard Disease Classification in
Korean Medicine
If any evidence of medical practice is collected, interpreted,
and incorporated into evidence-based medicine, the clinical
pictures of that medicine have to be captured, classied, and
documented. A clinical picture that has not been captured
and documented may not be used as evidence. If we are to
capture the clinical picture of dierent systems of medicine,
we may need dierent classication systems of the clinical
entities targeted, evaluated, and treated with each system of
medicine.
In an eort to capture the clinical picture and produce
statistics on allopathic medicine and Korean medicine, dif-
ferent disease classication systems have been developed and
stipulated as national standards in Korea. In the allopathic
medicine eld, a Korean adaptation of the World Health
Organization (WHO) international classication of diseases
(ICD) has been stipulated as the allopathic medicine volume
for the Korean standard classication of diseases (KCD). e
rst edition of KCD appeared in 1952. It was revised in 1972,
1979,1993,2002,2007,and2010.IntheKoreanmedicineeld,
the Korean medicine volume of KCD was rst published in
1973andwasrevisedin1979,1995,and2009.Recently,the
KCDallopathicmedicinevolumeandtheKCDKorean
medicine volume were integrated into one volume, “KCD6”
in 2010 [22].
Although pattern identication for the overall analysis of
symptoms and signs is a core component of the theoretical
context and clinical practice of Korean medicine as well as
traditional medicine in China [23]andJapan,thetraditional
way of pattern identication is still being developed as a stan-
dardized, validated diagnostic tool. A recent revision of the
KCD Korean medicine volume (2009), which was then inte-
grated into KCD6 in 2010, diered from previous revisions in
several aspects. First, the hierarchy and appropriateness of the
classication were thoroughly revised and improved. Second,
theissueofpossibleoverlapbetweenallopathicmedical
entities and Korean medical entities was addressed in great
detail and every eort was made to remove possible overlap.
Possibly overlapping Korean medicine entities were replaced
with existing KCD allopathic medicine entities. e remain-
ing entities of genuine Korean medicine were classied
under “U” codes. e genuine Korean medicine entities
were classied into three categories: 97 diseases, 191 patterns/
syndromes, and 18 diseases-patterns/syndromes from “Four
Constitution” medicine. is may have been the rst attempt
in the history of disease classication in which a national
standard successfully integrated allopathic medicine entities
and genuine traditional medicine entities into one classica-
tion that is widely applicable to all major regulations, such
asthenationalhealthinsurancesystem,nationalhealthstatis-
tics, and the trac accident insurance system.
In the Joseon dynasty, about four centuries ago, there
was already a comprehensive disease classication, which was
usually composed of descriptions on related anatomy, phys-
iology, etiology, manifestations, pattern dierentiation, self-
discipline, qigong, and the simple herbs prescribed. However,
the concepts of diseases, disorders, and patterns were not so
clearly dened or dierentiated [24]. Over the course of serial
revisions to Korean medicine disease classications in the
20th and 21st centuries, the concepts of diseases, disorders,
and patterns have been dierentiated more explicitly, with the
dierentiation concepts embodied in the classication struc-
ture and entities classied. In a recent revision, many tradi-
tional medicine codes were replaced with allopathic medicine
codes, with the remaining classication of genuine tra-
ditional medicine diseases, disorders, and patterns fully
and systematically integrated with the allopathic medicine
classication.
Recently, WHO has also sought to integrate the Inter-
national Classication of Traditional Medicine (ICTM) [25]
into its standard classication of diseases (ICD) when revis-
ing ICD-10 to ICD-11 with the concept of ontology-based
disease classication by 2015 [26]. KCD, the integrated classi-
cation of diseases encompassing allopathic medicine codes
and genuine Korean medicine codes, was a valuable source
fortheWHOproject.Indeed,itisanimportantissueinthe
ICD revision project that ICD categories are listed in a
mutually exclusive and jointly exhaustive way to make them
useful for such purposes as mortality statistics and morbidity
statistics [27], which were also considered in the revision of
KCD.
e standard classication of diseases will be an essential
part of capturing the clinical pictures of medicine and a
systematically organized classication will facilitate objective
documentation, production of related statistics, and the
contribution of complementary and integrative approaches to
the general health of world citizens. In that sense, Korea’s
experiences in revising the national standard disease classi-
cationmaywellbeanexemplarycasetosupportandembody
an evidence-based approach in institutionalizing comple-
mentary and integrative approaches and integrating them
with conventional allopathic medicine.
6. Disorder and Pattern Coding in
Korean Medicine
According to the coding guidelines for the WHO ICD-10, a
main condition is dened as the condition primarily respon-
sible for the patient’s need for treatment or investigation. A
main condition is diagnosed at the end of the episode of
health care. If there is more than one condition that may be
considered as a “main condition,” the one that was most res-
ponsible for the greatest use of resources is selected as a
“main condition.” If no diagnosis was considered to be made,
themainsymptomorproblemmaybeselectedasa“main
condition” [28].
Disease codes of Korean medicine are a combined form of
Western medicine codes and traditional Korean medicine
codes. Korean medicine codes are regulated by the law.

4 Evidence-Based Complementary and Alternative Medicine
According to the existing guideline for Korean medicine clas-
sications [29], the followings are generally recommended.
Intherstplace,a“maincondition”codeisselected.
Disease classication codes may be selected from the conven-
tional Western medicine codes based on the conditions that
patients appeal most or the amount of resources consumed in
the clinical management. If the practicing physician does
not consider the conventional Western medicine codes to be
appropriate for the clinical picture of the patient, then the
traditional Korean medicine codes, that is, U-codes in KCD,
are used. When traditional Korean medicine codes in the
U-codes are considered to be appropriate, the practicing
physician should decide which category codes in the tradi-
tional Korean medicine codes are appropriate for the clinical
picture of the patient: disorder codes, pattern codes, or “Four
Constitution” medicine-related codes [29]. In addition to
the “main condition,” other conditions that coexist or develop
during the episode of health care and aect the management
of the patient may also be listed [28]. In Korean medicine,
codes for other conditions, as well as a code for a main con-
dition, may be selected from both areas of Western medicine
classication codes and traditional Korean medicine classi-
cation codes.
By following this practice, the practicing physician in
Korean medicine may select a code that is considered to be
most appropriate for the clinical picture of the patient, not
only from the conventional Western medicine codes, but
also from the traditional Korean medicine codes. us,
selected disease coding may reect the body of knowledge in
Western medicine disease classication and traditional
Korean medicine disease classication. In this sense, Korean
medicine may be considered as an integration of conventional
allopathic medicine and traditional holistic medicine.
A disease may be a set of dysfunctions in any of the body
systems that may be dened by symptomatology, etiology,
course and outcome, treatment response, linkage to genetic
factors, and linkage to interacting environmental factors.
A disorder/syndrome may be dened as a common pattern of
similar symptoms in clinical practice. As to a disorder/
syndrome, the etiology is not known or multiple etiologies
arerelatedintheclinicalmanifestations[27].
Disorders and patterns in traditional Korean medicine
that are coded in the clinical practice of Korean medicine are
the health care conditions that are responsible for the patient’s
need for treatment or investigation. Both the disorder and the
pattern are diagnosed for the sake of treatment or investi-
gation by practicing physician. Both are similar in that they
are named aer the body structures, causes, properties, sever-
ity, and so forth. However, the naming and concept of the
disorder and the pattern in traditional Korean medicine
usuallydealwithdierentialaspectsofclinicalpicturesbased
on the theories of traditional medicine:
(i) A disorder in traditional medicine is a clinical picture
that is relatively constant throughout the duration of
that disorder. A pattern in traditional medicine is
relatively temporary (constant/temporary).
(ii) A disorder in traditional medicine usually delivers
information reecting the local manifestation of the
pathology. A pattern in traditional medicine usually
delivers information reecting the systemic manifes-
tation or the systemic response of the patient (local/
systemic, pathology/patient).
(iii) A disorder in traditional medicine is a concept that
summarizes ndings that are specic to the patho-
logic process under investigation. A pattern in tra-
ditional medicine means the pattern of combination
of the manifestations that encompasses both spe-
cic symptoms/signs and nonspecic ndings such
as pulse diagnosis and tongue diagnosis (specic/
nonspecic).
(iv) A disorder may be applied for a time span. A disorder
codingmaybebasedonthemainpathologicprocess
which may show a causal relationship with the main
manifestations in the patient. A pattern may be
applied for a specic time span too. However, a
patterncodingisbasedonthesummarizedwhole
picture that may be observed in the patient based on
the perspectives of traditional medicine theories. A
pattern is recognized based on the analysis of the sys-
temic ndings in the patient’s body and mind which
reect the pathologic processes, responses to the
pathologic processes, other concomitant ndings,
andinnateoracquiredconstitutionaltraitsofthe
patient (linear/multifactorial).
(v) A disorder in traditional medicine is usually des-
cribed with general terms of anatomy-physiology
together with terms of signs and symptoms. A pattern
in traditional medicine is usually described in terms
of the traditional medicine theories that are used to
summarize the whole picture ndings in the patients
such as yin and yang balance, cold and heat, meridian,
or constitution (general/theoretical).
(vi) A disorder in traditional medicine is used to describe
the general characteristics considered to be relatively
common to general population. A pattern in tradi-
tional medicine is used to describe the individual
characteristics considered to be relatively specic to
the patient at that time (commonality/individuality).
e concept of a pattern may reect constitutional char-
acteristics of the patient in addition to the disease or disorder
characteristics. In other words, the systemic active response
and individual characteristics of the patient’s body and mind
may be the target of the concept of a pattern diagnosed
in traditional Korean medicine. However, the disorder in
traditional Korean medicine and the disorder or disease in
conventional Western medicine primarily target the disor-
dered or pathologic process itself disregarding the patient that
is actively trying to recover from that disordered process and
to maintain balanced state of health. Considering the above-
mentioned concepts, the pattern and the disorder-disease
may be considered as two complementary aspects that may be
targeted when trying to capture the clinical picture of health
care conditions.

Evidence-Based Complementary and Alternative Medicine 5
7. Conclusions
Korean medicine has been an active player, at the forefront,
in the implementation of evidence-based medicine. Korean
medicine, an integrated conventional allopathic medicine
and traditional holistic medicine, is exemplary in developing
complementary and integrative approaches into an essential
part of evidence-based mainstream medicine, implementing
a national standard disease classication encompassing both
allopathic and genuine traditional concepts. In this paper,
recent developments regarding the biological activities of
herbal medicines, diagnostic evaluations, and clinical appli-
cations are introduced. Korean medicine is expected to be an
important contributor to the establishment and implementa-
tion of evidence-based, tailored medicine, integrating com-
plementary and conventional approaches.
Conflict of Interests
ere is no conict of interests in this study.
Acknowledgment
is study was supported by a Grant of the Korea Healthcare
Technology and Korean Medicine R&D Project, Ministry of
Health & Welfare, Republic of Korea (A120642 and B120014).
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