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Background Chuna Manual Therapy (CMT) has been widely used in Korea, and coverage in Korean National Health Insurance (NHI) was finally implemented in 2019. The objectives of this study were to analyze the process of NHI coverage for CMT qualitatively, and to summarize important roles, streams, and implications regarding its inclusion in the modern public health insurance system. Methods Related literature was collected and 8 key personnel involved in the policy-making process were qualitatively interviewed, and Zahariadis’ version of the Multiple Streams Framework (MSF) was applied to analyze the policy agenda setting and the roles of stakeholders. Results Through the collaborative efforts of various stakeholders, a pilot coverage project for CMT was implemented in 2017, and coverage was expanded nationwide in 2019. MSF showed that it was mainly achieved through three streams: governmental change (political stream), demand from the general public and KM doctors (problem stream), and strengthening/reinforcement of the feasibility and acceptability of the policy (policy steam). Also, the roles of policy entrepreneurs and resulting changes were shown to be significant for the overall process. Conclusion NHI coverage for CMT was realized through collective policy and research efforts from the government and academic sectors. The roles of stakeholders were shown to be significant in the overall process, and documentation of their involvement is hoped to be of use of other countries that utilize traditional and/or manual medicine.

Background Traditional medicine (TM) is widely used in South Korea and Taiwan, and both societies have similar systems for the management of TM. This study aimed to compare the TM systems in South Korea and Taiwan. Methods We searched for studies on the TM systems and collected statistical data from the websites of relevant government agencies in both countries. Interviews were conducted with experts on TM and officials from government agencies. The two TM systems were described and examined in terms of policies, resources, utilization, licensing, and educational systems. Results Both South Korea and Taiwan have a dual system that separates the administration, licensing and educational systems between TM and Western Medicine (WM), and the TM systems are well established and highly standardized. Comparing with South Korea, however, Taiwan has a more flexible dual medical system in which education courses for producing dual licensure are provided. Additionally, in the system in Taiwan, dual license holders can use both TM and WM methods without limitations and WM doctors can apply acupuncture under some circumstances. Because of the strict dual medical system in South Korea, TM and WM conflict with each other on most health issues. Conclusion Both South Korea and Taiwan have the advantages of preserving TM, as TM and WM are systemically independent and together provide a more holistic approach. The institutionalization of TM in South Korea and Taiwan may be a good reference for countries considering modernization of their TM.

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. Keywords: chronic disease, complementary and alternative medicine, parallel use, traditional Korean Medicine

Objectives: This study aimed to investigate the experiences and awareness of Korean Medicine professors towards research ethics issues and curriculum development. Methods: Electronic mails for requesting the survey participation were sent to 531 professors who were listed in the DB of Association of Korean Medicine. Professors who agreed to participate in the survey were connected to the self-administered questionnaire site, and the responses were stored in real time. Professors were asked the experience of research misconduct cases, the necessity, contents and evaluation method of research ethics education, etc. ANOVA was performed to test the differences of ethics education effects among sub-groups of respondents. Results: Of 137 professors who opened the e-mail, 127 completed the questionnaire. Most professors (87.4%) reported to witness the research misconduct cases, and felt the necessity of research ethics education for professors as well as students. 31.4% of respondents preferred the practice-focused course, and 43.3% preferred the PASS/FAIL basis evaluation system. Professors with shorter education career and professors majoring basic Korean Medicine expected higher effect of ethics education than others. For detailed items of research ethics education, 'ethical writing' and 'ensuring research integrity' were prioritized in the aspects of both personal ethics and social demand. Conclusions: In this study, detailed matters of research ethics education in Korean Medicine area were drawn. Further study and policy development are needed to facilitate the introduction of formal education of research ethics.

Objectives : Zizyphus jujuba fruits(ZJF), a traditional Korean medicine has various biological activities such as anti-inflammatory, anti-oxidative and neuro-protective effects. However, it is still unclear whether ZJF has any biological effect on anti-aging. In this study, we examined the effect of ZJF on lifespan and thermal stress in C. elegans. Methods and Results : ZJF water extracts were fermented for 7 days(F7-ZJF) and 14 days(F14-ZJF) by Laetiporus sulphureus to increase secondary metabolites such as aglycone of flavonoids and terpenoids. In the lifespan assay, ZJF water extracts and fermented ZJF were treated on the agar medium plate with age synchronized egg stage of C. elegans. Treatment of F7-ZJF- with OP-50 E. coli and F14-ZJF- with OP-50 E. coli significantly increased life span of C. elegans(N2) at thermal stress condition of . Moreover mRNA levels of lifespan associated HSP 16.1, HSP 70, and HSF-1 were increased at thermal stress condition of . However, in the equilibration temperature of after stress condition of for 2 hr, F-14-ZJF- treatment decreased the levels of heat shock protein in hsp16.2/GFP C. elegans. Conclusions : Our study indicates that prolong role of fermented-ZJF in C. elegans is mediated by control HSPs production.

Objectives: The aim of this study was to identify the complementary and substitute relationships between the use of Korean medicine (KM) and that of Western medicine (WM) in the treatment of musculoskeletal disease. Methods: We analyzed the 2009 Korea Health Panel dataset. General characteristics and the medical utilization of respondents were analyzed descriptively. Logistic regression, negative binominal regression, and Tobit regression analysis were used to identify the relationships between the use of KM and the use, visit frequency, and expenses of WM, respectively. Results: In the treatment of musculoskeletal disease, KM use and non-herbal treatments with Korean medicine significantly reduced WM use. Herb medication use significantly increased WM visit frequency. There were no significant relationships between KM use and WM expenses. Conclusions: There are substitute relationships between WM use and KM use, especially non-herbal treatments in KM. Therefore we need to develop the clinical protocols of KM and WM treatments in the treatment of musculoskeletal disease for proper distribution medical resources.

Unique dual medical system in Korea has resulted in the emergence of dual-licensed medical doctors (DLMDs) who have both traditional Korean medicine (KM) and Western medicine (WM) licenses. There have been few studies on DLMDs in spite of their growing number and importance within the medical system. We surveyed the current status and attitudes of DLMD to assess their role in integrative medicine. Questionnaires were administered to the members of the association of DLMD. Data from 103 DLMD were collected and statistically analyzed. 41.4% of DLMD were copracticing both WM and KM at a single clinic, preferring the WM approach for physical examinations, laboratory tests, and education for patients—and the KM approach for treatment and prescription. Musculoskeletal, gastroenterologic, and allergic diseases were considered to be effectively treated with co-practice. DLMD highly agreed on the efficiency of copractice for disease control and patients’ satisfaction. On the other hand, they regarded the lack of health insurance coverage for copractice and increased medical expenditure as major problems in providing co-practice. To expand the role of DLMD as mediators of integration in primary health care, the effectiveness of their co-practice should be evaluated and a corresponding health insurance reimbursement system should be established.

To summarize the way North Korea attempted to modernize its system of traditional medicine and integrate it with Western biomedicine.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.Key findings of this study are: (1) North Korea has attempted several ways of integrating traditional medicine into education and clinical practices; (2) North Korea's 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.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 government's 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 Korea's Western biomedicine-based health delivery system has been badly affected.

Background: Satisfaction 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). Methods: Data 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. Results: There 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). Conclusions: Patients 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.

This study aimed at assessing whether there are differences in the reporting of ethical aspects of complementary and alternative medicine (CAM) and mainstream medical research.Review of published literature.Research department of medical school.Reports of ethical aspects including adherence to clinical guidelines, ethical approval from ethics committees, consent of the patient, declaration of conflict of interest, and declaration of funding for a study.We included 21 articles from CAM journals, as well as 16 from equal impact factor mainstream (EIF) journals and 27 from high impact factor (HIF) journals. A statistically significant difference was found in the reporting of ethical approval: 62% of all CAM articles, 75% of the EIF and 93% of the HIF journal articles reported approval from ethics committees [chi2 = (2, n = 64) 6.631, p0.05]. Regarding the reporting of obtaining patients' consent there were no statistically significant differences: 48% of all CAM articles, 38% of the EIF mainstream and 67% of the HIF mainstream journal articles explicitly stated that patients signed a consent form [chi2 = (2, n = 64) 3.813, p.05]. High impact factor journals were more likely to report on ethical standards than other journals on conflicts of interests and sponsorship. However, they were less likely to report a reference to ethical guidelines. Articles from CAM journals had more strict reporting requirements than mainstream medicine journals with comparable impact factors.Differences exist between complementary and orthodox medical journals in the reporting of ethical aspects of trial design.

In Korea, the teaching of traditional medicine (TM) has been institutionalized for more than five decades, and accordingly the formulated educational system has a structure similar to that of Western medicine (WM). The authors therefore assumed that TM and WM students would share similar attitudes and values regarding professionalism. To test this hypothesis, we administered a questionnaire to TM students nationwide, and compared the results with those of WM students. We found that, despite the large differences in philosophy, concepts, and clinical content between the medical disciplines, the professional socializations of TM and WM students were progressing in a similar way.

ObjectivesThe 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.MethodsWe 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.ResultsThirteen 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.ConclusionsThe 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.

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.

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

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.

Background Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal. Objective To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee. Design Randomised, controlled trial. Setting Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and one clinical trials facility. Patients 570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ± 8.4 years). Intervention 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks. Measurements Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36). Results Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, −2.9 [95% CI, −5.0 to −0.8]; P=0.01) but not in WOMAC pain score (mean difference, −0.5 [CI, −1.2 to 0.2]; P=0.18) or the patient global assessment (mean difference, 0.16 [CI, −0.02 to 0.34]; P> 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, −2.5 [CI, −4.7 to −0.4]; P=0.01), WOMAC pain score (mean difference, −0.87 [CI, −1.58 to −0.16]; P=0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P=0.02). Limitations At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis. Conclusions Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

Purpose:To examine the process of change on the concepts of the ‘Jeokchwi’ and to investigate the process of change on categorization and classification system of these diseases. Methods: Eighteen comprehensive medical books published between the third century and the eighteenth century were included. Lesion location, pathophysiology, and symptoms of the ‘Jeokchwi’ and its subordinate diseases were extracted from each book. Results: The ‘Jeokchwi’ has been recognized since the third century. There has been little change on the concept of the ‘Jeokchwi’ until the Jin-Yuan Dynasties( • ). After Zhuzhenheng( ) reestablished the theory for etiology of the ‘Jeokchwi’, two pathophysiologic concept of this disease have coexisted since the Ming Dynasty( ). Four criteria(lesion location, lesion mobility, mobility of painful areas, and existence of an obvious lesion border) which classified the ‘Jeokchwi’ into the ‘Jeok’( ) and the ‘Chwi’( ) in the Nanjing ( ) have been used until the Ming-Qing Dynasties( • ). As Zhuzhenheng’s theory for etiology of the ‘Jeokchwi’ also applied to the theory for etiology of the ‘Jeok’ and the ‘Chwi’, pathophysiologic concepts of these diseases reestablished. The ‘Jeok of five viscera’( ), which is a principal subordinated disease of the ‘Jeok’, is the collective disease for five diseases(‘Bigi’( ), ‘Bokryang’( ), ‘Bigi’( ), ‘Sikbun’( ), and ‘Bundon’( )). Three criteria(lesion location, size or pattern of local lesion, mutated symptoms) in the Nanjing , and two criteria in the Maijing ( ) for classifying the five diseases have been passed down until the Ming-Qing Dynasties. The concept of the ‘Chwi’ and the ‘Six Chwi’( ) has been developed in detail than that of the ‘Jeok’ and the ‘Jeok of five viscera’. Conclusion: The pathophysiology and symptom of the ‘Jeokchwi’ were mostly recognized before the third century, and most of them have been passed down until the MingQingDynasty. Some concepts about this disease term changed through theprocess of creation, extinction, integration, or separation. Contact: Ui Min Jerng, breeze@kiom.re.kr

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.