| · Almost 70% of the people use Koryo traditional medicine at the PHC level in DPR Korea. · Koryo traditional medicine along with allopathic medicines are fully integrated into every level of the health system. It is an example of traditional medicine supplementing allopathic medicines in ensuring well-being. · All medical practitioners in DPR Korea are trained and qualified to practice both Koryo traditional and allopathic medicine. |
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More than 80% of the world’s population in over 170 of WHO’s 194 Member States currently use some form of traditional medicine, such as herbal medicine, yoga, Ayurveda, acupuncture and acupressure, and indigenous therapies. For many, traditional medicine is the first port of call, and practitioners of traditional medicine have played an important role in treating chronic illnesses.
While the use and recognition of the role of traditional medicine in primary health care (PHC) and universal health care (UHC) have been growing, the Democratic People’s Republic of Korea (DPR Korea), which has a long history of using traditional medicine, is one of the leaders in integrating traditional medicine with allopathic treatments to provide care and promote health and well-being.
Almost 70% of the population in DPR Korea use Koryo traditional medicine at the PHC level while about 30–40% use it at the central level and 40–60% at the county level.
Some of the common health conditions managed with traditional medicine in DPR Korea include bone and joint disorders, cardiovascular diseases, neurological disorders (paralysis, cerebral palsy), metabolic disorders (diabetes, gout), gastrointestinal disorders, respiratory disorders (asthma, cold), skin disorders, gynaecological disorders (menstrual abnormality), mental and psychological disorders.
Koryo system – a long history of healing and care
The Koryo system of traditional medicine is more than 5000 years old and traces its roots to 3000 BC. These traditional medicines and practices have been preserved, organized and modernized during the past several decades, and have been fully integrated into the national health-care delivery systems from the central to the most peripheral administrative levels in DPR Korea.
Koryo medicine evolved through three distinct periods between the 15th and 17th centuries and has been carefully documented in three publications of immense significance, which capture its development and use.
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Hyangyakjipsongbang (COMPENDIUM OF PRESCRIPTIONS FROM THE COUNTRYSIDE) is a medical classic published by Ro Jung Rye a famous Koryo medical doctor in 1433. It describes 10 706 herbal prescriptions for 959 diseases and 694 kinds of domestic herbal materials that can be used in their treatment.
The Uibangruichi (CLASSIFIED ASSEMBLAGE OF MEDICAL PRESCRIPTIONS) in 266 volumes was published by Kim Rye Mong in 1477. It is a comprehensive compilation of successes achieved in the development of Koryo traditional medicine up to the beginning of 15th century, and was well known as a medical encyclopedia worldwide at that time.
Tonguibogam (TREASURED MIRROR IN EASTERN MEDICINE), was published by Ho Jun, a famous Koryo medical doctor, in 1611. It comprises a total of 25 volumes and describes Koryo medical therapeutic methods for all diseases of the body. It lists 1400 kinds of domestic herbal medicines and continues to play a crucial role in the development of traditional medicine even today.
Combining ancient wisdom with modern science
While the Koryo system of traditional medicine has been in use for over 5000 years, sustained support since 1945 from the government to integrate the allopathic and traditional systems of medicine enabled the modernization and integration of traditional medicine with the national health-care delivery system in the 1970s.
All medical practitioners in DPR Korea are trained and qualified to practise both Koryo traditional and allopathic medicine. People can opt to access both or either allopathic or traditional medicine. Both systems of care are offered at all levels of the health system, including the central, provincial, county and Ri or village level, the most peripheral administrative level.
Acupuncture, chiropractic and naturopathy are used by 20–39% of the population while 40–59% of the population use herbal medicines.
A doctor provides Koryo medical treatment to a patient in DPR Korea (Source: Ministry of Public Health, DPR Korea)
To generate awareness about traditional medicines, since the 1980s, a number of publications on self-health care have been developed to inform people about the benefits and uses of traditional medicine. Several TV programmes highlighting the uses of traditional medicines are also broadcast to inform people.
The household doctors
The backbone of the health system in DPR Korea is the household doctor system. At every primary health centre level, there is at least one doctor who caters to around 135 households in their catchment area. This allows DPR Korea to provide comprehensive health-care coverage to the entire population.
Typically, the doctors stay at the primary health centre during the first half of the day to attend to patients. In the afternoon, they undertake home visits as per their duty schedule to provide medical consultation, health education and other community duties. In case patients need specialized treatment, they are referred to the district-/county-level hospital or to the central or 20 provincial Koryo traditional medicine hospitals, depending on the ailment and needs of the patient.
As some patients are unable to visit a primary health centre due to injuries, infirmity or health conditions, home visits by the household doctors play a crucial role in ensuring care. The doctors also screen patients for any underlying health conditions and suggest timely remedial action.
Training, education and research
In DPR Korea, those opting to major in allopathic medicine must compulsorily take courses in traditional medicine and vice versa. This ensures that medical practitioners are aware of and can utilize both systems of medicine.
Students can enrol in 13 medical universities located at the central and provincial levels and one Koryo traditional medicine pharmaceutical university. Each medical university has a Koryo traditional medicine faculty where Koryo traditional medicine is taught. Basic theories of Koryo medicine such as acupuncture, herbal prescriptions, internal medicine, surgery, gynaecology, paediatrics, etc. are all taught along with modern medical subjects such as anatomy, physiology, pathology, internal medicine, surgery, etc.
This enables doctors to diagnose and treat with both modern allopathic medicine for specific conditions as well as Koryo traditional medicine since referral between both systems is facilitated.
A doctor in Koryo medicine undertakes scientific research of the functional status of the body through investigation of ear acupressure points (Source: Ministry of Public Health, DPR Korea)
To guide and build on research and training, the Academy of Koryo Medical Science in Pyongyang serves as a scientific research and therapeutic and preventive institution at the central level. There are also 28 research institutions for Koryo medicine in DPR Korea.
As the leading research institute for traditional medicine and practice, the Academy plays the lead role in standardizing the manufacturing process of extracts from herbal materials to improve dosage formulation and improve the quality of herbal medicines.
Some of the areas of focused research include studies on the development of anticancer drugs, cardiovascular diseases such as arteriosclerosis and angina pectoris, respiratory diseases such as bronchial asthma, obesity, diabetes and other metabolic disorders, and basic studies on acupuncture therapeutic mechanisms for various bone and joint and spinal disorders, and on different kinds of composition of the human body. Based on the findings of the research, the Ministry of Public Health issues treatment guidelines on a regular basis and integrates health-care services into the health-care delivery system.
The Academy has also developed materials such as a chart of the meridian nerves, manuals on acupuncture, moxibustion and manual therapy, therapeutic methods of disk herniation according to Koryo traditional medicine, preparations from hawthorn leaves and their clinical effects. These have been offered as part of international collaborative efforts and examples of the research being conducted in traditional medicine in DPR Korea.
The Koryo Medical Science Academy was also designated as a WHO Collaborating centre between 1988 and 2004, and carried out two WHO projects, published annual reports on Koryo traditional medicine.
Safety and regulation
To ensure the safety, standardization, efficacy and quality of traditional medicines, DPR Korea follows the same stringent standards and regulations for production and use of traditional medicines as are followed for allopathic medicines.
To practise traditional medicine in DPR Korea, a license is a must, which is provided by the government. There are also national-level regulations on indigenous traditional medicine and acupuncture providers, chiropractic and herbal medicine providers, and providers of naturopathic medicine.
Koryo medicines and herbal extracts (Source: Ministry of Public Health, DPR Korea)
“Ensuring the safety, regulation, and standardization of traditional medicine and practices is a crucial step towards building confidence and integrating their application in mainstream medical care to tap their full potential,” said Mr Manoj Jhalani, Director, Department of Health Systems Development at the WHO Regional Office.
The same regulations and safety standards followed for conventional pharmaceuticals are also followed for herbal medicines.
Herbal medicines are regulated as prescription and non-prescription medicines, dietary supplements, health foods and general food products. They are sold with medical, health, and nutrient content details.
Sustainable manufacturing process
As of 2022, there were 671 herbal medicines registered with the authorities for production. Out of these, 28 products are included in the national essential drugs list and are being widely used for public health care. These Koryo medicines are manufactured at 210 factories, which are overseen by the Production and Management Bureau of the Ministry of Public Health.
Regular inspections are carried out by the authorities at the manufacturing plants and laboratories, and samples are regularly tested. Most of the raw materials are locally produced. There are also 160 management centres for sourcing raw materials.
Challenges and the road ahead
DPR Korea has a substantial network of well-regulated health facilities but, despite this, movement of patients and people between health facilities poses a challenge as it is often hampered by a range of barriers such as mountainous terrain and communications systems. The country is also prone to extreme weather and natural catastrophes in the form of floods and droughts, which pose a threat to public health and access to health services.
External geopolitical factors and international economic sanctions have challenged economic development in the country and impacted the health system. Securing operational finance for ensuring quality medical equipment, planning and human resources are needed to strengthen the health system.
The country has an ageing and highly urbanized population and noncommunicable diseases account for an increasing burden of morbidity and mortality. This is especially the case with cerebrovascular and cardiovascular diseases as well as cancers and respiratory illnesses.
The COVID-19 pandemic has highlighted gaps in health coverage by health systems across the world. Traditional medicines and practices can play a vital role in helping to plug these gaps, help in faster recovery and provide avenues of research into new therapies to counter and deal with emerging health threats and emergencies.
With decades of research and development of traditional medicine, DPR Korea has already established a lead in harnessing the potential of traditional medicine. Combined with its long-standing pledge to universal and free health care supported by household doctors at the PHC level, it has set the benchmark for the successful integration of traditional and allopathic systems of medicine towards improving people’s health and well-being.