7월 18, 2011

1. Characteristics of Korean Medicine - Point on History



[Dongeuibogam]

1) The compilation background of Dongeuibogam(東醫寶鑑;a.k.a. Treasured Mirror of Eastern Medicine)

Dongeuibogam is a medical book which is written by Heo-Joon(許浚). This book is estimated to compile the East Asia medicine. This book has affected to the development of Traditional Korean Medicine and its academic value is high. In 2009 July 31 the unesco appointed this book to Memory of the World because of its the spirit of the times, originality, importance in world history. It is the 7th Memory of the World of Korea, the first Memory of the World of medical book.
The origin of Dongeuibogam is that Seon-Jo(宣祖; the king of Cho-sun) commanded to Heo-Jun to publish an overall medicine book in 1596. The mainstream of Korean medicine at that time is that developed the Korean medicine through the importing a medicine of Song(宋;one of the empire of China) until the Koryo Dynasty(高麗. But after that time Eui-bang-yoo-chui(醫方類聚;Classified Assemblage of Medical
Prescriptions) was published to use the medicinal stuffs in Hyang-yak-jip-seong-bang(鄕藥集成方;Compendium of Prescriptions from the Countryside) usefully. In the Chosun Dynasty(朝鮮) period according to demand of the practical medicine which combinate the clinical medicine with theory the medicine of Chosun was developed in focusing "Medical of Jin Dynasty and Yuan Dynasty(金元醫學;those dynasties were Chinese dynasties)" Because the Medical of Jin Dynasty and Yuan Dynasty was developed by starting to restudy the "Huangdi’s Internal Classic(黃帝內經)" a overall medicine book which combinate the "Huangdi’s Internal Classic(黃帝內經)" with Medical of Jin Dynasty and Yuan Dynasty was demanded. And also the reestablishment of "Hyangyak(鄕藥;the korean wild herbs which is grown at countryside)" was demanded. Therefore, according to the needs of the times Heo-Jun started the compilation of Dongeuibogam through establishing editorial department with Jeong-jak, Yang-ye-su, Kim-eung-tak, Lee-myung-won, Jeong-ye-nam. But next year, after suspension in second Hidyoshi's Invaion to Korea, Seon-Jo commanded to Heo-Joon to complete the compilation for itself. After that time Heo-Joon was exiled because of the responsibility as a royal physicianto pass away of Seon-Jo(At that time the chosun Dynasty has custom that a royal physician has to be exiled after pass way of king). But Heo-Joon continued to write the book and finally completed in 1610 and named the book to Dongeuibogam. Thus in 1613, it was published to 25 volumes 25 chapters through using the printing type of Hun-ryeon-do-gam(訓鍊都監;The largest military camp of Chosun) in Nae-ui-won(內醫院;The royal medical center in palace).

2) The organization and content of Dongeuibogam(東醫寶鑑)

Looking at the organization of Dongeuibogam, it is composed distinguishingly unlike the Chinese overall medicine book, the Huangdi’s Internal Classic(黃帝內經) and Eui-bang-yoo-chui(醫方類聚;Classified Assemblage of Medical Prescriptions), etc. Generally in classifying diseases , the traditional Korean medicine names diseases in many viewpoints. According to external cause, diseases are named as six excesses(六淫, in means a collective term for the six excessive or untimely climatic influences as external pathogenic factors: wind;風, cold;寒, summerheat;暑, dampness;濕, dryness;燥, and fire;火. also the same as six climatic pathogenic factors ). And diseases are named according to an aspect of specific disease. And according to the system of pattern identification/syndrome differentiation(辨證體系;diagnosis of the pattern/syndrome, through comprehensive analysis of symptoms and signs, which has implications for determining the cause, nature and location of the illness and the patient’s physical condition), diseases is classified to Yin and Yang(陰陽;Yin-Yang means the general descriptive terms for the two opposite, complementary and inter-related cosmic forces found in all matter in nature. The ceaseless motion of both yin and yang gives rise to all changes seen in the world.) or deficiency and excess.(虛實;one of the guiding principles for analyzing the condition of the body’s resistance to pathogenic factors, in which deficiency refers to deficiency of the healthy qi and excess refers to excessiveness of the pathogenic qi)And diseases are classified according to cause factors like dmapness pathogen(濕邪), and phlegm pathogen(痰), etc.
While Heo-Joon put the diverse classification in the traditional Korean medicine in the Dongeuibogam. But Dongeuibogam doesn't take the listing many section(門) simply. Roughly divides into three parts that are the chapter of internal organs(Naegyungpyun;內景篇), chaater of apperance(Oihyungpyun;外形篇), chapter of various diseases(Jabyungpyun;雜病篇). Meanwhile medical herbs and acupuncture and moxa which related to treatment are classified to chapter of medical herbs and chapter of acupuncture and moxa. This is a more sensible method than a classification of Chinese medical books, so this is a convenient system to study medical practice.
In detail, the Dongeuibogam consists of chapter of internal organs(內景篇) which related to internal medicine 4 volumes , chapter of appearance(外形篇) which related to surgery 4 volumes, chapter of various diseases which consists of an epidemic, an acute disease, gynecology, pediatrics 11 volumes, The chapter of herbal(medicinal) decoction(湯液篇;Tangaekpyun) which related to pharmacology and pharmacology 3 volumes, chapter of acupuncture and moxa 1 volume, chapter of index 2 volumes in total 25 volumes.

3) The Uniqueness and Individuality of Korean Medicine(韓醫學) that can be looked about Dongeuibogam(東醫寶鑑)

“Dongeuibogam(東醫寶鑑;Treasured Mirror of Eastern Medicine)” doesn`t only have high value as a medical book about materia medica and fomula study of "Hyangyak(鄕藥;the korean wild herbs which is grown at countryside)", but also unites and reestablishes the contents of "Huangdi’s Internal Classic(黃帝內經)" and "Medical of Jin Dynasty and Yuan Dynasty(金元醫學)".
In other words, Dongeuibogam is not only for clinical medicine, but also for basis theory of medicine which condenses "Huangdi’s Internal Classic(黃帝內經)" and "Medical of Jin Dynasty and Yuan Dynasty(金元醫學)" and the medical study of "Hyangyak(鄕藥)".
As a evidence for that, the most of the Dongeuibogam`s chapter is quoted the theory of Medical of Jin Dynasty and Yuan Dynasty(金元醫學) which was established by Zhu Zhenheng(朱震亨), Liu Wansu(劉完素), Li Gao(李杲), Zang Congzheng(張從正) a.k.a. the four great masters.
Especially, quotations of the "Huangdi’s Internal Classic(黃帝內經)" can be seen easily at the head of each chapter of Dongeuibogam.
And, it is a special feature that Dongeuibogam is described every herb`s name(鄕名;Hyangmyung) which is native plants of korean countryside.
So, Dongeuibogam is not just induction of TCM(Traditional Chinese Medicine), but can be an encyclopedia of Korean Medicine in independent unifying comtemporary every medical knowledge.
Moreover, the backgroud of its medical thought is also the other special character.
Since table of its contents(集例), we can see the Taoism is how much affect Heo Joon(許浚;the author of Dongeuibogam) to quoten several Taoism`s theory(for example: conduction exercise, cinnabar field therapy etc.). Heo Joon also took a serious view of moral training or practicing own mental attitude or meditation than drug or acupuncture therapy/treatment.
Preferentially, next explanation is studies about Dongeuibogam`s three chapters-about internal organs(Naegyungpyun;內景篇), apperance(Oihyungpyun;外形篇), various diseases(Jabyungpyun;雜病篇)
First, as the chapter about internal organs(Naegyungpyun;內景篇) which is composed of several parts(those parts are written about “Essence;精”, “Spirit;神”, “Qi;氣”, “Blood;血”, “five viscera and six bowels;五臟六腑” has lots of contents for caring or preservation of health(攝生;it means like a life nuturing-養生), Heo Joon said that the life nurturing is more important than drug treatment.(Perhaps, he thought generally that preventive medicine plays the central role in medicine.)
And for the theory of five circuitsand six qi(運氣學) is assigned to the chapter of various diseases(Jabyungpyun;雜病篇), Heo Joon looked at that from new angle-the theory of five circuitsand six qi(運氣學) could be diagnosis of one`s illness.

But above all things, the most special feature of Dongeuibogam(in other words, it can be substituted for Korean Medicine) is just at its composition. Dongeuibogam`s composition is edited by mainly an internal injury. It distinguishes Korean Medecine from Traditional Chinese Medicine which is mainly an external injury.
Actually, as the chapter about internal organs(Naegyungpyun;內景篇) is the head(first) chapter of Dongeuibogam, Heo Joon emphasized the internal organs than the external organs(appearance).
Moreover, Dongeuibogam is different from Chinese medical books by comparing to compiled contents in Hyangyak and materia medica. The chapter of herbal(medicinal) decoction(湯液篇;Tangaekpyun) is for this contents-With regard to the materia medica and fomula(means like prescription or recipe)-Heo Joon adjusted the amount of herbal drugs to korean constitution and excluded unsuitable things by his own clinical experience and comtemporary korean medical books.(Because the most medical books` prescription is for Chinese constitution and climate.) And, he also wrote the popular name in korean alphabet(Hangul) for encouraging people to use Hyangyak(鄕藥;the korean wild herbs which is grown at countryside). In addition to, Dongeuibogam is contained the simple prescription for each symptoms after the disease pattern of each chapter`s part.
After all, since the publication of Dongeuibogam, korea decreased mutual exchange of medical information. This phenomenon is showed that Dongeuibogam became the new source of medicine in korea, also influenced to the several medical books after since then.-like a “Jejoongshinpyeon(濟衆新編;New Edition on Universal Relief)”, “Bangyakhappyeon(方藥合編;Compilation of Formulas and Medicinals)”, “Euijongsonik(醫宗損益;Gains and Losses of Medical Orthodoxy)”, etc.



[Development of Hyangyak and ≪Euibangyoochui≫]

In historical aspect, Hyangyak(鄕藥;the korean wild herbs which is grown at countryside) is one of the most prominent differences that distinguish TKM from TCM. Before Koryo Dynasty, the trend of medicine in Korea has been focused on mimicking that of China. However, due to an excessive preference for Chinese herbs, governmental establishments for medicine set out to emphasize the significance of using peculiar Korean medicine. In fact, it began to be widely known that certain herbs were much more effective than Chinese herbs for specific prescriptions. Herbs such as Chuanxiong rhizome(川芎), dodder(兎絲子) were exported to China, which is a proof for the efficacy of domestic herbs.

Hyangyak's recognition starts in the late Koryo, when the superiority of Korean herbs began to be demonstrated. At the end of 11th century, medicine practitioners believed that any kinds of diseases could be cured with herbs from Korea. They strived to develop traditional medicine based on this historical background, and coined the term “Hyangyak.”

Hyangyak refers to not only wild herbs from countryside, but all herbs grown in mountains, fields, seas, and rivers of Korea. Hyangyak's significance lies in the fact that it serves as the foundation of Korean traditional medicine. It indicates wild herbs indigenous to Korea, being distinct from Chinese herbs or Tang herbs. Based on the theories of Yin Yang and the Five Phases (陰陽五行論), it aids in the development of Korean medicine without imitating Chinese medicine unconditionally. It is a cornerstone for achieving independence in Korean medicine. Since 12th century, the term Hyangyak has been wildly used and the development of traditional medicine has progressed quickly. This is an important achievement as a dispersion of medical practice to the public, along with as a progress of expansion of herbal production and trade.

Various medical books were compiled with the development of Hyangyak. In the beginning, most of them were written by the means of imitating and editing Chinese publications. However, medical books gradually transformed by adopting the method of selecting contents of the prescriptions appropriate for Korean society.

Among numerous medical books on Hyangyak, Hyangyak-gugeubbang(鄕藥集成方) is considered as a representative. Published between 1236-1251 by unknown authors, Hyangyak-gugeubbang is the oldest book of medicine in Korea. It is written in three volumes and a supplement called 方中鄕藥目草部. It follows 太平聖惠方, Biyebackyobang(備豫百要方), Qian-Jin-Yao-Fang(千金要方), and Zhou-Hou-Fang(肘後方); but consists of prescriptions and first aid which does not require pattern identification/ syndrome differentiation and treatment (辨證論治). 方中鄕藥目草部 listed 170 kinds of native domestic herbal medicines, and described their properties according to pharmaceutical theories such as four qi and five flavors(四氣五味). Therefore it serves as an important refercence for studying medical herbs in Koryo Dynasty.

After the establishment of Chosun Dynasty, medicine including Hyangyak makes huge advancement on the basis of government bureaucracy. During Chosun Dynasty, Hyangyak was systemically studied; its collection, cultivation, selection, measurement, and effectiveness were studied. In King Taejo period, 鄕藥濟生集成方 is published, and Hyangyak-gugeubbang is re-published during King Taejong period. Nevertheless, the overall development of medicine is accomplished during King Sejong period.

King Sejong direct efforts to complete Hyangyak(countryside medicinal material) research which has been studied since Kyoro Dynasty. Sended Kim eul hae et al. to Ming dynasty to differentiate Hyangyak between Tang herbs and let doctors accompany them to purchase medicinal material whenever he dispatched ambassador. Hyangyak research in joseon dynasty is at an end as ≪Hyangyakjipseongbang≫ published, which caused the independence of domestic medicinal material, finished in 15th year of sejong.

≪Hyangyakjipseongbang≫, consist of 85 volumes, have much more comprehensive medical system and larger volumes compared to kyoro dynasty's medicinal material texts. By absorbing theory and prescription of major medical texts from Sung, Jin, Yuan, Ming dynasties, ≪Hyangyakjipseongbang≫ extended the application of Hyangyak and straightened up as systematic medicine. Therefore, we call medicine system that integrated in ≪Hyangyakjipseongbang≫ as Hyangyak medicine.

By Joseon dynasty, there were rising interests in plantation, circulation, management of Hyangyak rather than clinical research of it. In addition, sejong had imported medicinal material be cultivated on Jongyakjeon to localize and distinguish domestic medicinal material from chinese medicinal material in order not to prescribe wrong medicinal material.

Though after publication of ≪Hyangyakjipseongbang≫, in korean medical world, Hyangyak was not considered as big issue anymore. It does not mean increasing weight of chinese medicinal material or decline of Hyangyak, but that Hyangyak research, which had been lasted since 11c, reached its peak so that supply and demand of home-grown herbs was almost at its completing stage.

The fact that ≪Sejongsilrokjiriji≫ records much medicinal herbs as local product and ≪Hyangyakchaechuiwolryeong≫ was published and distributed exactly prove it. Also in medical books published afterward, instead of emphasizing Hyangyak, added medicinal herbs-contents as appendix to keep Hyangyak research alive.

Establishing process of korean medicine's identity, which is represented by development of Hyangyak, took a new turn over as ≪Euibangyoochui≫ was issued. ≪Euibangyoochui≫ is the greatest oriental prescription book, completed in Sejong era and published in early years of king Sungjong. This masterpiece synthesized all the medicine from Ming dynasty chinese medicine to Joseon dynasty traditional medicine into 260 volumes.

The significance of this book, however, is in not just publication of new medical encyclopedia, but the fact that it was cornerstone of independent advance of korean medicine. To assimilate oriental medicine which is basically exotic study, these kind of organizations should have been preceded. Intention of compiling ≪Euibangyoochui≫ after organization of Hyangyak by ≪Hyangyakjipseongbang≫ and the fact that king Sejong, who pushed Hyangyak project ahead had ≪Euibangyoochui≫ be written support this idea.

After all, Korean medicine could accumulate masses of information resources by pressing and proofreading of ≪Euibangyoochui≫. And it became good opportunity to establish peculiar korean medicine theory and publish unique medical books.

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