By Jinwoong Lim and Sena Lee
According to the World Health Organization (WHO), traditional medicine “refers to the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness.” Implicity bound up in this definition is the idea that such knowledge and expertise has been accumulated over a long period of time.
As “Asia” encompasses a vast geographical area and a multitude of different cultures, there are a correspondingly large number of forms of traditional medicine. These range from Korean and Chinese medicine to Vietnamese and Ayurvedic medicine. This article will provide an introduction to three of the principle strands of traditional medicine in Northeast Asia, which are still widely practiced – both domestically and, increasingly, globally. These are: traditional Chinese medicine (TCM), traditional Korean medicine (TKM) and Kampo medicine, from Japan.
1. Traditional Chinese Medicine (TCM)
TCM is understood to have originated in ancient China around 2000 years ago. Five semi-mythological figures – Fu Xi (복희, 伏羲), Shen Nong (신농, 神農), Huang Di (황제, 黃帝), Yao (요, 堯) and Shun (순, 舜) – are traditionally credited with founding the basic theories of TCM. The Huangdi Neijing (황제내경, 黃帝內經), the classic text which all students and practitioners of TCM are required to read, is commonly supposed to have been written at around this time (100~200 BCE).
The Shang Han Lun (상한론, 傷寒論) is the other basic text in TCM and was written around 200 CE by Zhang Zhongjing (장중경, 張仲景). It mainly deals with the harm caused by colds, flus and other infectious diseases, and paved the way for the development of new theories about the external causes of disease. These ideas still play an important role in modern TCM.
Traditional Chinese medicine flourished in China during the Song Dynasty (960-1279 CE), in large part thanks to the use of woodblock printing to disseminate medical texts and theories across the country. A process of amalgamation and compilation of various medical theories also began at around this time. In this way traditional Chinese medicine was refined and given a form which allowed it to be exported actively to neighbouring countries.
After the fall of the Song Dynasty, TCM continued to be developed and expanded. During the Ming Dynasty (1368-1644 CE), Li Shizhen (이시진, 李時珍) compiled the most complete and comprehensive botanical encyclopedia yet seen, the Bencao Gangmu (본초강목, 本草綱目).
During the subsequent Qing Dynasty (1644-1911 CE), a new theory about infectious disease was born, the Wen Bing Xue (온병학, 溫病學). This theory was developed in order to keep up with the increasing demand for therapies to treat outbreaks of new infectious diseases, following years of warfare. The Wen Bing Xue is still popular in Chinese medicine.
In the early 20th century, traditional Chineses Medicine was attacked by those in China who favoured western medical techniques. The new republican and communist governments pursued a policy of suppressing elements of Chinese tradition at odds with western theory and practice. However, TCM has subsequently regained something of its formal, important, position within the public health system. It is now often used in conjunction with modern medicine in China.
2) Traditional Korean Medicine (TKM)
Since Huangdi Neijing and other Chinese medical texts were first introduced to Korea in 561 CE, during the Three Kingdoms period (57 BC-668 CE), traditional Korean medicine has developed unique characteristics of its own. These include Hyangyak (향약, 鄕藥), preventive medicine as featured in the Donguibogam (동의보감, 東醫寶鑑), and Sasang constitutional medicine (사상의학, 四象醫學).
During the Koryo Dynasty (918-1392 CE), reliance on imported herbs from China was recognised as a problem, due to high costs and the unreliability of supply. Consequently, research was carried out by scholars on Korea’s indigenous herbs and also into the methods of treatment, known as Hyangyak (향약, 鄕藥). A text was produced, the Hyangyakgugeupbang (향약구급방, 鄕藥救急方, 1236 CE), to treat acute diseases and medical emergencies, while another text – the Hyangyakjibseongbang (향약집성방, 鄕藥集成方, 1433 CE) – was an encyclopedia of everything to do with Hyangyak. These two books were the principal texts of the Hyangyak movement through both the Koryo and Chosun dynasties.
The Donguibogam, compiled by Heo Jun (허준, 許浚) and published in 1613 CE, is the single most important text in traditional Korean medicine. It makes a clear distinction between traditional forms of medicine in Korea and those of China, and underlines the importance of preventative measures in dealing with medical complaints. It also emphasises the accumulation of vital energies as a means of both prevention and treatment. Its approach differs from that of Chinese medical practitioners of the time, who tended to stress external factors as a cause of disease. The Donguibogam drew heavily on Hyangyak techniques and methodologies, and is essentially a spiritual successor to Hyangyak. It also initiated the formulation and evolution of another distinctive feature of traditional Korean medicine; constitutional medicine.
Constitutional medicine is, put simply, a form of personalised medicine. The Donguisusebowon (동의수세보원, 東醫壽世保元), compiled by Lee Jema (이제마, 李濟馬) during the Late Chosun Dynasty, was the first text to crystalise the theory of constitutional medicine. In the Donguisusebowon, Lee categorized people according to four fundamental constitutions (Taeyang, Taeeum, Soyang, Soeum) and interpreted physiology and pathology in accordance with each constitution. The Donguisusebowon, like the Donguibogam, is another important and still relevant book in TKM.
During the Japanese colonial period, TKM was suppressed in the public health system as a result of “modernization” policies. TKM practitioners lost their livelihoods and many books disappeared at that time. However, after this dark age, the remaining TKM practitioners founded colleges and institutions to educate people and preserve TKM, and those efforts have assured it a place in public health nowadays as one part of the dualised medical system.
3) Kampo Medicine (Traditional Japanese Medicine)
Traditional Japanese medicine has its own name: Kampo, or Hwanghan (황한, 皇漢) medicine. Kampo Medicine was imported from China about 1500 years ago and has roots in medicine developed during the Han (漢) Dynasty. Importation of medical knowledge was initiated by a Korean physician named Te Lai (덕래, 德來) in 459 CE, and this was followed by several other early contacts and exchanges of knowledge with Korea and China. However, its expansion was limited by the prevalence of shamanistic practices and beliefs in Japan at that time. It was only after the arrival in Japan of the Chinese Buddhist priest Jian Zhen (감진, 鑒真) in 753 CE that interest in Chinese and Korean medicine really took hold. His vast knowledge of medicine and herbs was instrumental in spreading traditional medical practices.
The Japanese took an active interest in acquiring knowledge of “Han medicine”, dispatching delegations of scholars to both China and Korea. Despite being influenced by the medical practices of both countries, however, Kampo medicine developed in its own unique way; it often uses different herbal formulations, which usually consist of fewer types of herbs in smaller quantities, compared with ones used in China and Korea. Moreover, whilst acupuncture, moxibustion and herbal medicine are lent almost equal importance in traditional Chinese and Korean medicine, Japanese doctors focus mainly on herbal medicine.
Kampo medicine experienced a severe decline in the latter part of the 19th century due to the modernization policies of the Meiji government, and at one point almost completely disappeared. A revival after the Second World War led to four Kampo formulas being approved by the government in 1967, and since then official sanction of Kampo medicine has strengthened with many medicines available on national health insurance. Nowadays these formulas are mass produced in special, closely supervised factories by Kampo medicine companies like Tsumura & CO. As a result, Japanese physicians tend to dispense a relatively small range of pre-formulated medicines, as opposed to Korean and Chinese physicians who usually tailor their medicines to each individual patient.
Due to earlier Japanese policy there are no institutions dedicated solely to the task of teaching Kampo medicine, in sharp contrast with Korea and China. The teaching of Kampo medicine is now only a specialism within western medical training in Japan. It still has a role in public health, however.
These three strands of traditional Asian medicine share some fundamental views and underlying theories, as does much of Northeast Asian culture. However, as discussed above, they nevertheless have very different histories and distinctive features. Recent attempts to create a dialogue between traditional and modern medical practices will hopefully result in helping more people suffering various ailments that have not yet been conquered by modern medicine.
- Cha Wung-Seok, et al. Historical difference between traditional Korean medicine and traditional Chinese medicine. Neurol Res. 2007;29 Suppl 1:S5-9
- Felix Cheung. Made in China. Nature Outlook. 2011;480 Suppl S82-3
- Ichiko Fuyuno. Will the sun set on Kampo? Nature Outlook. 2011;480 Suppl S96
- Shang Han Lun: http://blog.naver.com/bluefelix?Redirect=Log&logNo=100138835764
- Bencao Gangmu: http://blog.naver.com/kawg10?Redirect=Log&logNo=60126477957
- Hyangyakjibseongbang: http://blog.naver.com/eric9310?Redirect=Log&logNo=110104150659
- Donguisusebowon, Kitasato University Oriental Medicine Research Centre: Thanks to Prof. Yousang Baik from Kyunghee University for his photos.