Chronological Development
Republic of Korea has its own system of traditional medicine called “Korean Medicine” (KM) or also known as “Traditional Korean Medicine” (TKM). Korean medicine (KM) was gradually developed throughout the country’s history for over 500 years. KM experienced the harsh modernisation of the 19th century however has successfully maintained its social status as clinical profession. KM also established unique educational systems based on the distinctive cultural, social, and political situations of Korea.
*Throughout this page KM will be used to describe term of Traditional Korean Medicine (TKM) or Korean Medicine (KM)
Table 1: Chronological development of Korean Medicine
| Years | Historical Milestone |
|---|---|
| Between 1232 – 1251 | Oldest existing Korean medical book is the Hyangyak Gugeupbang (鄕藥救急方, Formulas Using Korean Herbs for Emergencies) was printed in woodcut. [1] |
| 1423 | The Joseon period government (now known as Republic of Korea/ South Korea) dispatched envoys to China to learn how to identify herbs and compare the efficacy of domestic and Chinese herbs. [1] |
| 1433 | Publication of the Hyangyakjipseongbang (鄕藥集成方, Compendium of Formulas Using Korean Herbs) which contained 10,706 prescriptions for 959 disease patterns using 703 korean domestic herbs. [1] |
| 1445 | A draft of the Classified Collection of Medical Formulas, the Euibang Youchui (醫方類聚), was compiled, in which almost all of the medical textbooks available in East Asia were collected and reorganised. [1] |
| 1477 | After 30 years of reorganisation and revisions, 30 sets and 266 volumes of the Euibang Yoochui (醫方類聚, Classified Collection of Medical Formulas) was published, which is the most extensive database on East Asian medicine to date. There are currently no known artifacts of this book except for one set that was plundered during the war with Japan in 1592 and remains in Japan’s Kunaicho (宮內廳) library. [1] |
| 1596-1597 | The period where the project of DongUiBoGam is launched and it’s outline was drafted. The King Seonjo took interest in medicine as a mean to salvage his subjects from pain and suffering. So he summoned Heo Jun in the Byungshin Year (丙申年, 1596 A.D.), who was a Taeui (태의/太醫), a royal physician at the time, and ordered a compilation of medical text into a single encyclopaedia and categorise the medicinal ingredients so the people may access the knowledge easily. Upon hearing the King’s words, Heo Jun set up an organisation to start it’s draft. However, when its outline was almost set, the work came to a hiatus due to the uprising of Jeongyu Jaeran (정유재란/丁酉再亂), the second Japanese invasion in the year 1597, which resulting the dispersion of the physicians in all directions. [7] |
| 1597-1608 | After the Jeongyu Jaeran (정유재란/丁酉再亂) or the second Japanese invasion, the publication of DongUiBoGam was left entirely to the hands of Heo Jun. However, before he could even finish drafting half of the text, the event of King Seonjo’s death results in his banishment. Afterwards, the late King gave orders for Heo Jun to continue in his work alone, and provided him with over 500 medical texts stored at the court to aid his research. But before he could even reach halfway into his work, the new King too, passed away. [7] |
| 1608-1610 | The completion stage during his exile which lasted two and a half years. In the Gyeonsul Year (경술년, 庚戌年, 1610 A.D.) the third year of King Gwanghaegun’s ascension to the throne, Heo Jun finally completed his work and presented it before the king, which totaled 25 volumes under the title DongUiBoGam. King Gwanghaegun, pleased with the report of its completion. [7] |
| 1610-1613 | The printing and publication period of DongUiBoGam. The presswork venue was changed from Naeuiwon (내의원/內醫院) to Hasam-do, the three provinces of Chungcheong-do, Jeolla-do, and Gyeongsang-do due to financial burdens, then re-shifted to Naeuiwon where it was finally published for distribution. [7] |
| 1613 | Joseon period government (now known as Republic of Korea/South Korea) published the Dongui Bogam (東醫寶鑑, Treasured Mirror of Eastern Medicine), which contributed to the medical development of the neighbouring countries of China and Japan. [1] |
| 1948 | Republic of Korea was established (after the liberation from the Japanese in 1945, Korea established a modern independent state), discussions were initiated regarding how to deal with traditional medicine within the modern national healthcare system during the process of reforming the specifics of the constitution. [1] |
| 1837-1900 | Dongui Suse Bowon (東醫壽世保元, Longevity & Life Preservation In Eastern Medicine) written by Lee Jema was the most recognizable medical text published around this period. Lee Jema, who is known as the founder of Korean Sasang constitutional medicine (SCM), argued for medicine based on humans rather than diseases, using the keyword constitution as a focal point. His philosophy remains influential today. [1] |
| late 19th century. | Birth of Sasang Constitutional Medicine (SCM). Sasang constitutional medicine categorizes humans into four constitutions and discusses the relevant pathogenesis and treatment. This system is currently a major feature of Korean medicine. [1] |
| 1905-1945 | Korean Medicine (KM) suffered a period of decline during the Japanese occupation period (1905-1945) in Korea due to the Japanese emphasis on western medicine. [1] |
| 1910 | The suppression of KM by Japan during the invasion [1] |
| 1951 | The revival of Korean Medicine. The National Medical Services Law passed in 1951 was the beginning of the unique dual national medical license system of Korea which led to the modern Korean healthcare system, was initiated by the government-in-exile (Korean war between North Korea and South Korea broke out). [1] Traditional Korean Medicine (TKM) education system had four-year curriculum [8] |
| 1964 | Traditional Korean Medicine (TKM) education system has been reorganized into a six-year curriculum comprising of a two-year premedical course and a four-year medical course. [8] |
| 1987 | Traditional medicine was included in the Korean national medical insurance system, and its scope of application continued to widen. [1] |
| 1994 | The Korean government founded the Korean Institute of Oriental Medicine. [1] |
| 1998 | Korean Medicine doctors have been permitted to work as ‘public health doctors’ in place of their 2-year compulsory military service. [1] The medicinal plant supply control system has been implemented to facilitate domestic herb production. [1] |
| 2003 | Korean government enacted the Oriental Medicine Promotion Act to enhance the value of Korean medicine. [1] |
| 2004 | The Institute of Korean Medicine Education and Evaluation was established in 2004 to evaluate and certify the education of TKM schools nationwide. [8] |
| 2006 | Biobank of Korea Constitutional Multicenter Bank (KCMB) based on Sasang Constitutional Medicine (SCM) was founded. The aim of the KCMB was a foundation to providing the scientific basis of SCM. The KCMB serve to verify and validate SCM theories and practices. It may also provide new insights into SCM mechanisms. [2] |
| 2007 | Use of standardized Medicinal material has been obligatory since 2007. |
| 2009 | Dongui Bogam (東醫寶鑑, Treasured Mirror of Eastern Medicine) was registered as the UNESCO Memory of the World [3] |
| 2013 | English version of the Dongui Bogam (東醫寶鑑, Treasured Mirror of Eastern Medicine) was completed after 6 years of translation in 2013, 400th anniversary of the classic’s first publication, as 9 volumes, including the index, references, main text, and pictures. The translation is favoured by researchers and professionals in the culture sectors related to the traditional medicine for its faithful and precise translation. [4] |
| 2016 | The Institute of Korean Medicine Education and Evaluation which was established in 2004 to evaluate and certify the education of TKM schools nationwide, from now on since 2016, has been acting as a government-certified evaluation authority. [8] |
| 2017 | The number of licensed TKM doctors increased by 9809 over the past ten years, from 14 818 in 2088 to 24 627 in 2017. TKM hospitals increased to 312, 14 155 TKM Clinics and 595 Herbal Medicines Pharmacies in Republic of Korea. [5] |
Current Practice
- After enactment of The National Medical Services Law in 1951, the Korean and Western medicine doctor licenses coexisted independently in the form of medical dualization/dual system.
- Combining conventional modern medicine (CM) and Traditional Korean Medicine (TKM) education would be a total of 6-year training programs on average for Korean Medicine doctors with degree qualification.
- Main therapeutic methods of traditional medicine in Korea consist of acupuncture, moxibustion, cupping, herbal medicine (called Hanbang by local Korean) and manual therapies (called Chuna by local Korean).
- Acupuncture, moxibustion, and cupping were completely insured, covered and included in benefit package of Korea National Health Insurance since 1987.
- In Korea, licensed Korean Medicine doctors can practice all main therapeutics methods of Korean Medicine as long as the Korean Medicine doctors passed the Korea Health Personnel Licensing Examination/ Korean Medical Licensing Examination (KMLE)
- Additionally, Korea is a member of the World Health Organization (WHO) Pharmacovigilance Program for monitoring adverse drug reactions, including those related to the use of herbal drugs. [9]
Prevalence of Korean Medicine
- Korea has highest percentage (15.26%) of Korean Medicine (KM) doctors in hospitals and clinics in East Asia [9].
- 69% of the Korean population has experienced KM [10]. Since 1987 acupuncture, moxibustion, and cupping are usually covered by medical insurance in Korea and most herbal extracts are covered, with the exception of decoctions of raw herbs.
- A study conducted in 2012 found the most commonly used KM therapies were acupuncture (91.2%), herbal medicine therapy (38.2%), cupping (30.8%), and moxibustion (27.6%) [14].
- Latest report by Ministry of Health & Welfare which was published in 2013, ratio of Korea Medicine Doctors (DKM) over western conventional modern doctors is 21,355 : 109,562 / ( 1:5 ) in Republic of Korea [1].
- A study conducted in 2021 found increasing trend in human resources of Korean Medicine for over the past ten years. Statistic recorded Doctors of Korean Medicine (DKM) was 5.5% (24, 627 head counts) accounted from total health personnel [5].
- Annual average growth rate of the DKM number in year 2008 until 2017 is 5.8%, a relative increment of health facilities establishment, recorded have increased to over 300, dominated by Korean Medicine clinics compared to other facilities [5].
Administration (Official Body)
Main Therapies of Korean Medicine
Basic Philosophy and theories of Korean Medicine
Throughout the long history of Korean Medicine (KM), KM has developed a deep understanding on the interactions between intra-body energy circulation and environmental consequences towards one body system. KM understands human physiology in terms of balance. KM practitioners or officially term as Doctors of Korean Medicine (DKM) understand that all kinds of disease and symptoms manifested are a sign of balance-disharmony between the human body and environment and the disbalance within one’s body itself. Treatment proposed by DKM then would vary corresponding to the level of imbalance detected based on manifested symptoms. [1]
Diagnosis method of Korean Medicine include visual inspection, listening, inquiry and palpation, which are sometimes aided by modern diagnostic tools. Palpation is a distinctive Korean medical diagnostic method in which the intensity, velocity and pattern of the pulse are categorized into dozens of patterns. The practitioner then will determine the what kind of Qi (氣) circulation inside the body, and how the Qi (氣) flow induce corresponding symptoms prior deciding the therapeutic principles and treatment methods that should be applied on patients. [1]
Policy & Regulations of Korean Medicine
- Pharmaceutical Affairs Act
(Latest revised on January 5, 2021 as Act No. 17883) - Medical Service Act
(Latest revised on March 4, 2020 as Act No. 17069) - Korean Medicine and Pharmaceutics Promotion Act
(Latest revised on October 22, 2012 as Act No. 11524)
The Republic of Korea initiative on translating their legislation collectively could be retrieved and readable online by visiting online database of Korean Law Information Centre Website.
Insurance coverage of Korean Medicine
The Republic of Korea has Korean Medicine formally integrated into the national health system and has well-established national statistics. Korea operates a dual system in which Conventional medicine and Korean Medicine services are provided separately within one national health system [5].
In February 1987, the Ministry of Health and Social Affairs (currently known as Ministry of Health and Welfare since 1994) implemented a nationwide program that covers oriental medical care of Korean Medicine in National Health Insurance (NHI) after completion of a 2 year pilot project [17].
Insurance for Korean Medicine played a crucial role in helping to popularise it by increasing its use by the average person [1]. In 1994, Korean Medicine test devices such as Yangdorak (Ryodoraku) and pulse detector were covered. In 2009, three Korean Medicine physical therapies (hot pack, ice pack, infrared irradiation) were added for insurance coverage [16].
Table 1 shows the Korean Medicine insurance benefits covered in National Health Insurance [16]
| Treatment | Examination |
|---|---|
| Cupping (cupping only or with bloodletting) | Pulse diagnosis |
| Moxibustion (Direct or indirect type) | Meridian diagnosis |
| Powdered herbal preparation (58 types of herbal formula and 68 single herb preparations) [13] | Yangdorak (Ryodoraku) |
| Hot/Cold pack | Pattern identification (Bianjing) |
| Infrared-radiation | Dizziness test |
| General Acupuncture | Personality test |
| Electro-acupuncture / Laser-acupuncture | Dementia test |
| Chuna manupulative therapy | |
| Special acupuncture •Acupuncture in intraorbital cavity •Acupuncture in intranasal sinus •Acupuncture in intraperitoneal cavity •Acupuncture in intra-articular joints •Acupuncture in intervertebrae spaces •Penetration acupuncture | Psycho-therapy •Individual psychotherapy •Psychiatric personal history taking •Family psychotherapy |
In 2012, Korea Medicine represented 7.1% of total NHI claims and total expenses attributed to Korean Medicine is 1,932 millions USD, representing 4.0% of total cost of NHI treatments [1]. In 2017, total expenses attributed to Korean Medicine increased to 2,237 millions USD [5].
Facilities
Globalization Centre of Korean Medicine Industry
- National Institute for Korean Medicine Development (NIKOM)
Designated by the Ministry of Health and Welfare as an organization to support overseas expansion of Korean Medicine and attract foreign patients. It supports medical systems that combine Korean Medicine doctors, products and hospitals, such as overseas licensing and registration of herbal preparation and opening of Korean Medicine department at local hospitals. It is also striving to expand items such as medical devices to enter foreign markets.
Research Facilities of Korean Medicine
- Association of Korean Medicine (AKOM)
Played a key role in the institutional revival of Korean Medicine doctors after liberation of Korea in 1945. Association of Korean Medicine pave a way for the public to not face any inconvenience in using Korean Medicine clinic and hospital.
- Korean Institute of Oriental Medicine (KIOM)
Organize International Training Program ‘Modernization of Traditional Medicine’ annually. This program specifically designed to provide comprehensive understanding on theory, policy, educational system, and R&D of Korean Medicine, and finally contribute to the settlement of future strategies to improve national policy and medical services on traditional medicine of participating countries (government servant from participating countries will be sponsored meal, accommodations, flight ticket and daily allowance)[20]
Supportive facilities for Korean Medicine
- Korean Institute of Medicine Education and Evaluation (KIMEE)
Korean Institute of Medicine Education and Evaluation (KIMEE) is responsible for the evaluation and accreditation of Korean Medicine (KM) education programs. KIMEE is recognized as a legitimate ‘Authorized Association of Accreditation’ by the government of the Republic of Korea. KIMEE was in operation in the year 2004 and was recognized by the Ministry Of Health and Welfare (MOHW) in the year 2016 based on the Article 32 of Civil Code. Only the graduates of educational institutes accredited by the KIMEE would be qualified to take the Korea Health Personnel Licensing Examination after 2017.
- National Health Personnel Licensing Examination Board (NHPLEB)
NHPLEB is a body that conducting Korea Health Personnel Licensing Examination or also known as Korean Medical Licensing Examination (KMLE) to assess only qualified graduates would be certified as Doctor of Korean Medicine (DKM) and allowed to practice.
Korea Health Personnel Licensing Examination assess 23 occupations (27 categories) of health professional personnel including Oriental Medical Doctor / Doctors of Korean Medicine, oriental medicine pharmacist, oriental medicine dispenser, and midwife [15].
- Korean Medical Hospital Association (KOMHA)
An association to evaluate the quality of physicians’ training, hospital facilities, and systems of Korean Medicine.
Training & Education
Korean Medicine practitioner’s journey could be summarized into 3 phase as illustrated in Figure 3 below.
Formal University Education
First phase of acquiring Doctors of Korean Medicine (DKM) requires a minimum 6 years of university study which is divided into two years of pre-medical courses and four years medical courses, including one year of bedside teaching. Modernised Korean Medicine universities have incorporated instructor-led clinical knowledge lectures, subject-specific seminars, and clinical education in large hospitals with disease-specific departments, evolving from the traditional apprenticeship in small groups with medical classics books [11].
Some big percentage of the course would consist of modern medicine syllabus such as physiology, pathology, diagnostic, ‘western’ anatomy, neuropsychiatry, dermatology & surgery, internal medicine, gynaecology and obstetrics. Remaining course would focus on philosophy, theory and diagnostics of traditional Korean Medicine. Knowledge on biomedicine and western medical clinical skills were purposely included to support the clinical practice of KM [12]. Universities in the Republic of Korea offering Korean Medicine are currently limited to twelve universities, only one of which is public university, while the rest were private universities as listed (refer PDF). Successfully graduating from one of these twelve universities will qualify them to sit for Korean Medical Licensing Examination (KMLE).
List of universities
List-of-KM-universitiesLicensed Medical Personnel
According to Article 27 (Prohibition against Unlicensed Medical Practices) of the Medical Service Act, ‘Any non-medical personnel shall not perform medical practices; and even medical personnel shall not perform any medical practice other than those licensed’ [18]. Passing Korean Medical Licensing Examination (KMLE) would allow the graduates to practise Korean Medicine as researcher or Korean Medicine Specialist or general practitioner.
To obtain a license as a Korean Medicine specialist, one must train for 1 year in an internship. To obtain a licence as a Korean Medicine Specialist, 1 year internship training course and 3 years hospital residency training is a must. Upon completion of residency training, licences are authorised upon passing the qualification exam. Exams are govern by the Association of Korean Medicine, delegation from the Ministry of Health and Welfare, while licences is authorised by the Minister of Health and Welfare. There are eight areas for specialisation in Korean Medicine, including Internal Medicine, Pediatrics, Gynecology, Psychiatry, Acupuncture & Moxibustion, Eye-ear, Nose, and Throat (ENT) & Dermatology, Rehabilitation Medicine, and Sasang Constitutional Medicine [19].
Foreign Doctors with Korean Medicine License
Acquiring Korean Medicine License for korean or non-koreans whom graduated from universities outside of Republic of Korea is possible. Guide for international graduates are as follows [15]:
Please refer here for more information and details on document, procedure and protocol needed.
Foreign doctors with Korean medical licences are allowed to treat patients in Korea. They must first obtain a doctor’s licence in their home country with prior accreditation by the Korean Ministry of Health and Welfare. The Ministry of Health and Welfare reviewing process includes evaluation of school systems, curriculums, and academic affairs. Upon approval of the university recognition review process, they must sit for two tests: the Preliminary Examination (written test and clinical skill test) and the Korean Medical Licensing Examination (KMLE). The Preliminary Examination is a requirement for taking the KMLE together with a certificate of TOPIK (Test of Proficiency in Korean) of a level 5 or higher. KMLE will be held in Korean language for both written test and clinical skills test [15].
References
1. Lim B, Cha W, Koh B, Kim Y, Lim B, Kim Y. Korean Medicine: Current Status and future prospects. Shinjin Commun. 2015. [cited 9 May 2022]. Available from: https://drive.google.com/file/d/1VueBEgzgqH-y91BL2Xvjq0Fv70zRMUmf/view
2. Jin HJ, Baek Y, Kim HS, Ryu J, Lee S. Constitutional multicenter bank linked to Sasang constitutional phenotypic data. BMC complementary and alternative medicine. 2015 Dec;15(1):1-8. [cited 9 May 2022]. Available from: https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-015-0553-3
3. Donguibogam: Principles and Practice of Eastern Medicine | United Nations Educational, Scientific and Cultural Organization [Internet]. Unesco.org. 2019 [cited 9 May 2022]. Available from: http://www.unesco.org/new/en/communication-and-information/flagship-project-activities/memory-of-the-world/register/full-list-of-registered-heritage/registered-heritage-page-2/donguibogam-principles-and-practice-of-eastern-medicine/
4.Korea Institute of Oriental Medicine. 한국한의학연구원 English Translation of the Donguibogam [Internet]. Kiom.re.kr. [cited 9 May 2022]. Available from: https://kiom.re.kr/modedg/contentsView.do?ucont_id=CTX001017&menu_nix=jFB45u4H&srch_mu_lang=ENG
5. Park J, Yi E, Yi J. The Provision and Utilization of Traditional Korean Medicine in South Korea: Implications on Integration of Traditional Medicine in a Developed Country. InHealthcare 2021 Oct (Vol. 9, No. 10, p. 1379). Multidisciplinary Digital Publishing Institute. [cited 9 May 2022]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544406/
6.Korean Ministry of Health & Welfare : Policies > Challenges & Tasks Ahead [Internet]. Mohw.go.kr. [cited 9 May 2022]. Available from: https://www.mohw.go.kr/eng/pl/pl0103.jsp?PAR_MENU_ID=1003&MENU_ID=100326
7. The Society of Korean Medicine [Internet]. Skom.or.kr. [cited 9 May 2022]. Available from: https://www.skom.or.kr/eng/05/02_01.php
8. Kyeong HK, Ju AL, Ho-Yeon G, Sunju P, Sangwoo S. Traditional Korean Medicine education in the World. Integrative Medicine Research. 2020 Jun;9(2).
9. Park HL, Lee HS, Shin BC, Liu JP, Shang Q, Yamashita H, Lim B. Traditional medicine in China, Korea, and Japan: a brief introduction and comparison. Evidence-based complementary and alternative medicine. 2012 Oct 24;2012.
10. Ryu GC, Lee HW, Oh SJ, Park CJ. International competitiveness and tasks of Korean traditional medicine from the perspective of international comparison of curricula and research. Journal of Korean Institute for Health and Social Affairs. 2005;25(2):107-46.
11. Hur J. Treasured mirror of eastern medicine (Donguibogam). Seoul: Hur, June; 1610
12.Chae WS. Introduction to Korean Medicine. Seoul: Daesungmunhausa. 1997;310.
13. Huang CW, Hwang IH, Lee YS, Hwang SJ, Ko SG, Chen FP, Jang BH. Utilization patterns of traditional medicine in Taiwan and South Korea by using national health insurance data in 2011. PLoS One. 2018 Dec 27;13(12):e0208569.
14.Kim JH, Nam CM, Kim MY, Lee DC. The use of complementary and alternative medicine (CAM) in children: a telephone-based survey in Korea. BMC complementary and alternative medicine. 2012 Dec;12(1):1-9.
15.Guide for International graduates [Internet]. Korea Health Personnel Licensing Examination Institute. 2020 [cited 27 June 2022]. Available from: https://www.kuksiwon.or.kr/EngHome/cnt/c_3105/view.do?seq=17
16. Lim B. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues. Integrative Medicine Research. 2013 Sep 1;2(3):81-8.
17. Kim SM, Kim YI. 2020 National health insurance statistical yearbook. Seoul: Health Insurance Review & Assessment Service, National Health Insurance Service. 2021.
18.Gukchaegyeonguwon-ro, Sejong-si 30147 Kore. [Internet]. Korea Legislation Research Institute Mar 4, 2020. Available from: https://elaw.klri.re.kr/eng_service/lawView.do?hseq=53532&lang=ENG
19. Han SY, Kim HY, Lim JH, Cheon J, Kwon YK, Kim H, Yang GY, Chae H. The past, present, and future of traditional medicine education in Korea. Integrative medicine research. 2016 Jun 1;5(2):73-82.
20.KKIO. KOICA’s Fellowship Program [Internet]. 한국한의학연구원 KOREA INSTITUTE OF ORIENTAL MEDICINE. [cited 2022Jun29]. Available from: https://www.kiom.re.kr/modedg/contentsView.do?ucont_id=CTX001022&menu_nix=02155BB9&srch_mu_lang=ENG
Last Update : 29 June 2022
