Byung-Hee Koh, Ph.D., KMD (Korea)
In modern western science, the humanities and social sciences are separated from the natural sciences. However, new interpretations should be explored based on holistic concepts and the principles of wholeness found in eastern nature. Examples of the latter from Korea include Lee Je Ma’s Sasang Constitutional Medicine(SCM). We aimed to examine the features and problems associated with SCM, as well as approaches to these problems.
Sasang constitutional medicine suggests that an individual’s constitution is determined congenitally, and the body and mind need to be considered simultaneously when treating disease. And SCM thinks that individuality is important in clinical practice even in social relationship. SCM needs to develop for objective diagnoses, and basic research needs to be conducted in parallel such as study of the Confucian classics and neo-confucianism. Expanding the scope of patient-centric academic exchange has been raised as an important issue to exchange with Western medicine and so on. SCM can be the medicine that places humanity at the center, and its mentality could apply to preventive medicine and personalized medicine. So it has positive influence on construction of a healthy society and improvement of healthcare worldwide.
Ⅰ. Sasang Constitutional Medicine in the 21st Century
Interest in eastern medicine has recently grown, following the realization that traditional Korean medicine can compensate for some of the shortcomings of medicine based on science and technology that is rooted entirely in western natural science. In modern western science, the humanities and social sciences are separated from the natural sciences. However, new interpretations should be explored through a convergent approach based on holistic concepts and the principles of wholeness found in eastern nature. Examples of the latter from Korea include Heo Jun’s Dongui Bogam and Lee Je Ma’s Sasang Constitutional Medicine1. The texts underlying these approaches break free of the abstract, conceptual aspects of medicine that had been introduced from China until that time. They have been studied by numerous scholars from various perspectives, enabling practical application in clinical medicine, including physiology, pathology, diagnosis, and treatment. In the future, it will be necessary to continue developing and innovating traditional Korean medicine as it adapts to the age of globalization. To this end, we aimed to examine the features and problems associated with Sasang constitutional medicine, as well as approaches to these problems.
Ⅱ. Features of Sasang Constitutional Medicine2
– 1. Hereditary medicine (稟受醫學)
Pumsu (稟受) refers to the idea that an individual’s constitution is determined congenitally, wherein individuals inherit features from their parents and grandparents, including appearance, character, and even disease-related tendencies. In terms of established information relating to this idea, blood type is known to be passed down from parents to their children according to certain rules. Furthermore, children of individuals with high blood pressure or who experience stroke often have the similar conditions themselves. Moreover, children of individuals with poor digestion have a higher incidence of digestion problems, and a genetic influence has been demonstrated for color blindness, hemophilia, and mental health disorders. Based on such evidence, pumsu is considered to be fully worthy of consideration in medicine.
– 2. Psychosomatic (mind-body) medicine(心身醫學)
Until now, medicine has mostly only considered treatment of parts of the patient’s body that can be observed via our eyes and other sensory organs. However, there is increasing recognition that an individual consists of both a body and a mind, the existence of both of which are required to differentiate them from inanimate objects. Therefore, the body and mind need to be considered simultaneously when treating disease.
The mind is not a part of the physical body, but forms an equal part of our being. Thus, is also plays an important role in the development of disease, and is heavily involved in the formation of constitution. In western medicine too, similar theories have emerged at the beginning of the 20th Century, and have recently received a lot of attention. However, the fact that these ideas and the recognition of the equal importance and mutual influence of the body and mind only developed at the end of the 19th Century but were previously unimaginable in western medicine, reaffirms the remarkable sagacity (慧智) of Lee Je Ma.
– 3. Constitutional medicine (體質醫學)
Constitution is the idea that, in terms of treatment, individuals display different characteristics according to their physical constitution, and so these differences need to be taken into account by applying different treatment approaches for different patients, even for the same disease. Essentially, this principle highlights the importance of individuality. Patient individuality and heterogeneity is a difficulty often experienced by many doctors in clinical practice.
For example, there may be two drugs, A and B that can be used to treat the same disease. However, there may be some patients who recover when treated with A, but other patients who only see an effect from B and not from A. Furthermore, there may even be patients who can only be treated with drug C, rather than A or B. In such cases, one can consider whether the issue arises because of differences in the drugs’ mechanisms of action, or due to the individuality of the patients, or some combination of the two.
Lee Je Ma recognized that this situation arises due to differences in constitution. He further considered that, in addition to medication, people will likely have different needs and responses to nutrition resulting from their constitution. Furthermore, allergies, which are frequently discussed in western medicine, can also be considered related to constitutional factors.
– 4. Social medicine (社會醫學)3
Within our social lives, we find relating to some people relatively comfortable, while relating of others is very burdensome. If we were to approach other people with an understanding of constitutional characteristics, we might gain better insight into the other’s traits, which would render personal relationships more comfortable and, in the workplace, may also enable more efficient pursuit of business. Moreover, understanding the characteristics of a workplace or job would enable better choices by considering one’s own constitutional traits. From the perspective of management, accounting for the traits of employees in human resources could be very helpful. Given that personality type tests, such as the MBTI used in the west, we think it will be possible to develop methods suited to our sensibilities.
This is suggested in Dongui Suse Bowon’s Gwangje-seol (廣濟說), which contains the following statement: “the most common disease in this world is to covet and envy the wisdom and ability of others. The finest medicine for this disease is to love their wisdom and find pleasure in good deeds.” (Journal of Sasang Constitutional Medicine. 2018. Mar, 30(1): 1-6, DOI: http://dx.doi.org/10.7730/JSCM.2018.30.1.1, Copyright @ 2018, The Society Of Sasang Constitutional Medicine)
Ⅲ. Challenges for Sasang constitutional medicine4
– 1. Objective diagnoses3
In modern SCM, efforts to provide objective care are highly valued, with the application in clinical practice of self-report questionnaires (QSCC; Questionnaire for Sasang Constitution Classification), body type tests, facial anthropometry, voice spectrography (聲紋), fingerprints (指紋), pulse diagnosis (脈診), and food or drug reaction surveys, rather than using subjective methods that depend on past experience. To develop objective diagnostic signs from those typically used in Korean medicine, research investigating neurometer tests, biofunctional diagnosis, and pulse diagnosis need to be developed in a more objective, practical direction in the future.
– 2. Research on the relationship between Eastern philosophy and medicine
Generally, traditional Korean medicine possesses traits of Taoist (道家) Huang Lao thought (黃老學), but study of SCM is inseparable from the study of the Confucian classics (經學) and neo-confuciansim. Thus, an understanding of the philosophical background is required, and even from a medical perspective there is some inherent confusion of concepts. For this reason, basic research needs to be conducted in parallel, so that the concepts behind individual theories can be properly understood and practically applied.
