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J Acupunct Res > Volume 33(2); 2016 > Article
Kim, Han, Lee, Yang, and Chae: Systematic Review of Traditional Korean Emergency Medicine※

Abstract

Objectives:

Traditional Korean Emergency Medicine (EM) has been developing for thousands of years, however its value was not properly considered after 19th century modernization. The purpose of this study was to review the current status of EM in Korean Medicine and suggest methods for improvement.

Methods:

We performed systematic reviews of the definition, current medical system, and educational curriculum of EM in Western Medicine, traditional Korean and Chinese Medicine, and integrated Western and traditional Chinese medicine with the use of medical classics and text books. We also analyzed the trends in published research articles to discuss the current situation in the field of traditional Korean EM, and to provide methods for its establishment and development with traditional Korean medicine.

Results:

The definition of EM as a treatment of acute disease shares common understanding among traditional Korean, Chinese, and Western medicine. We presented descriptions of EM in many medical classics, however current law and EM service does not include these. As for the review of publications during the last 20 years, we found 21 articles in several fields that confirmed the need for more investigation.

Conclusion:

Traditional Korean EM has a long history and clinical experiences that can be found in medical classics, textbooks and research articles. There is an urgent need for more studies on traditional Korean EM as an emergency medical service system, and in terms of educational curriculum and related policies to improve Evidence-Based teaching.

Notes

This work was supported by a 2-Year Research Grant of Pusan National University

Fig. 1
Flow diagram for database search in this study
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Fig. 2
Published articles in Traditional Korean emergency medicine from 1995 to 2015
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Table 1
The definition of Emergency Medicine and its related descriptions in medical classics
Medical classics Topics Descriptions
Yellow emperor’s internal medicine6) High fever and heart disease This chapter (Discussions on Fever) systematically discussed the definition, pathology, epidemiology, treatment and prevention of the febrile diseases, and provided new ways for clinical studies of external febrile diseases.
The chapter (Discussion on Syncope) has descriptions on heart disease which shows the clinical features of cyanosis in hand and feet (that can induce sudden death. The pain of heart disease is similar to that of sudden heartache or myocardial infarction.
Important Strategies from Golden Chest10) CPR It has described clinical experience similar to the chest compression of CPR(cardiopulmonary resuscitation).
Formulas kept in Hand11) Emergency medicine It has previous clinical experiences on emergency situations, such as heart attack, sudden abdominal pain, acute gastroenteritis, toxicosis, food poisoning and other acute diseases in internal medicine, orthopedics and surgery, pediatrics and OB&GY. It provides detailed descriptions on pathology, diagnosis, symptoms and treatments.
Principles and Practice of Eastern Medicine6) Emergency medicine It showed ten cases of emergency situations and treatments, such as acute gastroenteritis, airway obstruction, bleeding, toxicosis, asphyxia, hernia, obstructed labor and others.
Categorical Collection of Medical Records12) Emergency treatment It has emergency treatments and medications for five situations, including hit by collapsed walls, unconsciousness by nightmare, and death by hanging, drowning or child birth.
Introduction to Medicine13) Emergency medications It has descriptions on multi-potent detoxification drug for emergency situation.
Table 2
Comparison of Definition, Education and System about Emergency
Traditional Korean medicine Western medicine Traditional Chinese medicine Integration of Western and Traditional Chinese Medicine
Definition of emergency medicine Acute or severe diseases threatening the life and health. Critical conditions with Imminent onset and rapid changes of the situations53). Critical conditions require imminent aid or care to prevent life threatening situation or life-long disabilities26). Sudden death or disease by fever, loss of consciousness or pains35). Caring patients with acute disease or hurt requires urgent diagnosis and treatment35).
First Aid Korean Medicine emergency treatment on shock, syncope, angina pectoris, myocardial infarction, heart attack, stroke and seizure with acupuncture and others54). CPR, medication, transfusion and others after clinical examination on vital signs and emergency situations34). Emergency treatments as combination of Western and traditional Chinese medicine. It can provide services for poisoning, respiratory diseases, heart disease and others with acupuncture, medication and fluid injections35).
Rescue & Transportation Lack of guideline or manual for emergency treatment, and Emergency Medical System(EMS) was not established. EMS system in collaboration with 119 and hospitals. Provided with emergency treatment manuals for teaching general public. Fully equipped with an EMS.
Visit to the emergency room Absence of Emergency Medical Institutions which are designated by Emergency Medical Service Act. Emergency Rooms of Korean Medicine hospitals are maintained as night time clinics. Emergency Medical Institutions designated by the Emergency Medical Service Act. National, regional, local and specialized Emergency Medical Centers are working in collaboration Doctors of traditional Chinese and Western medicine work together in Emergency Room. The traditional Chinese Emergency Medicine is actively used.
Educational institutes Eleven Universities and one Graduate School of Korean Medicine College of Medicine, Seoul National University Tianjin University of Traditional Chinese Medicine
Curriculums The names are First Aid, Emergency Medicine, clinical diagnostics and treatment in Western medicine, and Collaborative treatment in Korean and Western medicine-EM Emergency Medicine Surgery of Western Medicine Emergency Medicine in Integration of Western and Traditional Chinese medicine
Credits and practice 1.6 credits(average). Clinical practice was established depends on each institute. 3 credits with classes for clinical practice.
Clinical specialist Absence of clinical specialist for Korean Emergency Medicine. Clinical specialist for Emergency Medicine.
Table 3
Applications of traditional Korean medical first aid in accordance with the step-by-step classification of emergency situation17)
Areas Stage of emergency The applicable Traditional Korean medical first aid
Paramedics or Emergency medical technicians locus of accident
Transportation
The prepared protocols of acupuncture treatment as first aids
Doctors (Emergency medicine specialist) Hospital Professional treatment with herbs and acupuncture Evidence-Based guideline for pre-defined symptoms.
Table 4
Article on Traditional Korean Emergency Medicine
Category Article Journal year Sample size Critical Result
Clinical Analysis of Musculoskeletal Patients Who Visited the Emergency Room of an Oriental Medicine Hospital55) The Journal of Korea CHUNA Manual Medicine for spine & nerves 2009 551 Total patients, the male to female ration was almost same. The majority of patients visited the emergency room within 24hours of onset. The patients were categorized as lumbar sprain 66.06 %, cervical sprain 16.25 %, and ankle sprain 9.04 %.
Musculoskeletal disease Clinical Analysis of 1,472 Musculoskeletal Patients Who Visited Emergency Room of Oriental Medicine Hospital48) The Journal of Korean Acupuncture & Moxibustion Society 2010 1472 Total patients, the male to female ration was almost same and people in their 30s were the peak age group. Low back pain, cervical pain and ankle pain was the most frequent, in this order.
The Cervical SpineNCurvature of Posterior Neck Pain Patients Who Visited Emergency Room After Whiplash Injury by Traffic Accident56) The Journal of Korea CHUNA Manual Medicine for spine & nerves 2011 102 Whiplash injury tends to make hypolordosis or straight. And female has more vulnerable curvature than male in whiplash injury
Effects of Pyung-Hyung acupuncture on low back pain patients in a Korean Medicine hospital emergency room57) The Journal of the spine and joint Korean Medicine 2012 21 Pyung-Hyung acupuncture could be used for relieving symptoms related with acute sprain and strain of lumbar spine.
A Descriptive Analysis of 199 Marathon Participants with Acute Sport Injuries Treated by Acupuncture in the Prehospital Setting36) The Journal of Korean Acupuncture & Moxibustion Society 2013 199 The main intervention was manual acupuncture with vigorous stimulation technique. Most treated symptoms were lower extremity pain(77 %) knee pain was the most frequently recorded symptoms following the ankle pain.
Effects of Acupuncture on Acute Musculoskeletal Pain Transferred from Emergency Department: Case Report47) The Journal of Korean Acupuncture & Moxibustion Society 2013 3 The Acupuncture was effective for immediate pain reduction in patients with severe acute musculoskeletal pain transferred from Emergency Department.
A Research of Trend Differences by Sex: The Patients Who Visited the Emergency Room of Spine Specialty Korean Medicine Hospital50) The Journal of Sports Korean Medicine 2014 329 Chief Complaints is significantly associated with sex. Low Back Pain takes up more proportion at Male group, compared with Neck pain and Joint pain is likely to occur in Female group.
A Retrospective Clinical Analysis of 1,485 Patients Who Visited the Emergency Room of Korean Medical Hospital with Musculoskeletal Disorders20) The Journal of Korean Acupuncture & Moxibustion Society 2015 1485 The most symptom site was the low back, followed by ankle and neck. The most frequently used treatment method was acupuncture.

A Clinical study on the pediatric patients who visited Emergency Room of Oriental Medical Hospital58) The Journal of Korean Oriental Pediatrics 2003 135 Systemic divisions of the major problems in pediatrics were the digestive diseases(541 %) and nervous also mental disease followed. Most common medical care is venesection.(17.8 %)
A Clinical Study of the Pediatric Patients Who Visited in Emergency Room of Oriental Medical Hospital49) The Journal of Korean Oriental Pediatrics 2007 281 Systemic divisions of the major problems in pediatrics were the digestive symptoms(44.5 %) and nervous symptoms, respiratory symptoms, musculoskeletal symptoms, dermatological symptoms, cardiovascular symptoms and others followed.

Pediatric disease Clinical Study of the Pediatric Patients Who Had Visited Emergency Room(ER) at Oriental Medical Hospital59) The Journal of Korean Oriental Pediatrics 2010 371 The major problems of hospitalization were digestive symptoms and nervous symptoms. Acupuncture and herbal medication treatment were the most common medical treatments.
A Clinical Study of the Pediatric Patients Who Had Visited Emergency Room(ER)21) The Journal of Korean Oriental Pediatrics 2014 334 A serious illness was not the most common reason for the ER visit among the pediatric patients. The major problems of hospitalization were digestive symptoms and nervous symptoms. Acupuncture and herbal medication treatment were the most common medical treatments

Circulatory disease Clinical study of the blood pressure change in cerebral infarction patients who were treated with oriental medical emergency care37) The Journal of Traditional Korean Medicine 1997 53 In acute cerebral infarction patients with hypertension whose blood pressure while receiving the treatment of Korean medicine is a significant fall in the onset of a week. After the first week the patients showed a stable pattern in the normal range.
Effects of Systemic And Ear Acupuncture on High Blood Pressure Control16) Korean journal of oriental physiology & pathology 2001 15 There was no therapeutic superiority of systemic or ear acupuncture on high blood pressure control to non-acupuncture group.

Psychiatric disease A Clinical Study and an analysis of Symptom Check List-90-Revision on Psychiatric Patients Visiting the Emergency Room in an Oriental Medicine Hospital60) The Journal of Oriental Neuropsychiatry 2003 20 The most frequent cause of illness was stress in occupation and overwork. The greater part of patients came to hospital in 12 hours after an attack. In chief problem somatic symptoms such as headache, dizziness, numbness and chest discomfort were most frequent. After treatment, most of symptoms were improved. Psychiatric traits by SCL-90-R correlated with somatization and anxiety.

ENT disease Oriental Medical Therapy for Sudden ensorineural Hearing Loss61) The Journal of Korean Oriental Medicine 2009 19 9 patients showed effectiveness in improving both hearing level and speech discrimination, 6 patinets showed effectiveness only on speech discrimination and 4 patients showed no therapeutic effect in 19 patients of sudden sensorineural hearing loss.
A Clinical Analysis on the Patients of Orient - Medical Therapies in Emergency Department38) Journal of the Korean Society of Emergency Medicine 1997 427 In the leading causes for visit to orient-medical therapy, cardiovascular disease ranked at the top, followed by injury gastrointestinal disease and respiratory disease in decreasing order of frequency.

Systemic approach The Statistical Study of 1,278 Patients Visited Oriental Medical Hospital Emergency Room22) The Journal of Oriental Rehabilitation Medicine 2002 1278 In distribution of Patients, male, 30s, Sunday were most common. In distribution of diseases, The most was head and musculoskeletal disease(53.9 %), followed by central nerve system, digestive disease.
The Statistical Study of 2,485 Patients Visited Oriental Medical Hospital Emergency Room18) The Journal of Oriental Rehabilitation Medicine 2002 2485 In distribution of disease, circulatory disease was most common, and followed by musculoskeletal disease. In distribution of treatment, acupuncture and herb med were 61 4 %, acupuncture was 22 6 %, acupuncture, herb med and negative were 39 %, herb med was 02 %, teaching and rest were 11 8 %..
Clinical Analysis of Patients Who Visited the Emergency Room of an Oriental Medical Center40) The Journal of Korean Medicine 2007 2674 The patients were categorized as follows: neurological diseases, musculoskeletal diseases, internal medical diseases psychiatric and related diseases, in this order. The average transit time was about 1hour 30 minutes. Admission rate was 48 % and the rate of admission to the intensive care unit (ICU) was 5 % of total visiting patients.
Single Hospital-based Clinical Analysis of 1,119 Patients visited Oriental Medical Hospital Emergency Room19) The Journal of Korean Oriental Internal Medicine 2012 1119 In distribution of gender, the rate of females (55.9 %) was higher than that of male. Most of the patients visited the Korean Medical Hospital emergency room between 11:00 and 23:00, Sunday, December. The patient were grouped as Neurological disease 58.9 %, musculoskeletal disease, internal medical medicine and others, in this order.
Table 5
Application of Traditional Korean Medicine in emergency situations which was listed as Enforcement Regulations of Emergency Medical Service Act Article 2 No. 1. Appendix 1
Category Descriptions Application of traditional Korean medicine
Psychiatric disease Acute consciousness disorder, acute neurological abnormalities, and head injury with consciousness disorders or vomiting There are prescriptions can be used in sudden immobility, which can’t move their body, eye lid and mouth however wakes up from dizziness and unconsciousness6).
Emergency symptoms Cardiovascular disease Symptoms requiring cardiopulmonary resuscitation(CPR), acute dyspnea, and acute chest pain from heart disease, palpitation, abnormality of heartbeat and shock. Saving someone who hang themselves. Lay flat and extend the leg. Push patient’s chest frequently and massage patient’s leg and feet. This is similar to the CPR of now days10).
Toxification and metabolic disease Severe dehydration, overdose or addiction to drug, alcohol or other substances, acute disturbances of metabolism(hepatic or renal failure, diabetes and others) Do not drink the herbal decoction for detoxification in hot. And if you are not sure about the time of toxification, drink herbal extracts10).
If the disease is on upper Triple Energizer, let that vomit. If the disease is on lower Triple Energizer, let down with diarrhea. Using liquorices, green beans and decoration can solve all the poisoning6).
You should use induced vomiting, warming the body, cucumber juice, and Puerariae juice when toxified with alcoholic drinks. Inserting ice to mouth and anus might useful for that6).
Surgical department Acute abdominal symptom requiring laparotomy, extensive burns, penetrating wound, open or multiple fracture, vertebral fracture in the femoral region, vascular damage requiring extremity cutting, emergency surgery needs general anesthesia, and multiple trauma Damage on abdomen and intestine. If the intestine is cut by the steel, you should suture with thread soaked with herbs as soon as possible and push into abdomen. If there are no cuts with intestine, just wash it before pushing that into the abdomen. You should not stitch outer skin, since the outer skin should be regenerated by itself. The anuria and hardened stool should prevented6).
Drug for homeostasis and regeneration of skin. Widely spread air bladder of salted fish on the wound and wrap with cloth. Put the mint leaves and wash the wound once a day in summer6).
Bleedings Continued hemoptysis, hemorrhage without hemostasis, and acute gastrointestinal bleeding How to stop the nose bleeding place ten times folded paper soaked with cold water on the forehead and iron until drying one or two layers6). There are several prescriptions for stopping different types of nose bleedings6).
Ophthalmic disease Damage on eye and acute loss of vision from chemicals When there are dust inside the eye, make aggregate and take it out gently with cotton ball6).
If the sight is ambiguous, it came from exhaust from works. Qi-deficiency can be treated with prescription with ginseng and heat from Yin-deficiency can be controlled with others6).
Allergenic responses Allergic reactions accompanied with facial edema The face and body has no bloody pus painful and itchy sensations and can be changed into fixed ones if prolonged and spreads to the calf. Spontaneous use of fish chicken, leek, onion and others would be useful6).
Pediatric disease Convulsive disorders in children If the children have problems with moving limbs, convulsion from surprise, or epilepsy from breathing changes, use prescription. The convulsive problems can be divided into several types, and the seizure can be solved by dissolving the blockage in qi circulation12). Use prescription with boiled water of mint and ginger6).
Psychiatric disease Mental disorder can harm self or others Crazy person can climb up to the roof with loose hair, shout loudly, and tries to kill person since there are severely blocked phlegm and gathered fire6). Several prescriptions might be suggested6). Inducing diarrhea might be useful6).

Equivalent to emergency symptoms Neurologic disease Consciousness disorder and dizziness Dizziness which can be seen before the CVA might come from the deficiency of upper Triple Burner. One prescription can be used for bright skin, and others for dark sin patient6). If the sticky phlegm is, on the upper Triple Burner, you can remove that by using herbal prescription6). The vertigo can be divided into several types6).
Cardiovascular disease Dyspnea and hyperventilation As for treatment of dead-like syncope from qi blockage, use herbal powder to nostrils and attaching herb powder under the tongue10).
Surgical disease Burns, acute abdominal symptoms, fracture, trauma and dislocation for emergency surgery, and dysuria When bones were smashed into pieces, use anesthetics and trim the ends not to disturb the flesh, or take the broken small bones out to prevent fostering. Wash the wounds with herbs for preventing bad smell6). As for the broken bones, apply melted drug and fix with wooden sticks. External medications and internal medications might be useful6).
Bleedings Vascular injury Refer to related emergency symptoms of bleeding.
Pediatric disease Conversion and fever over than 38 degree in children. The fever in child can be classified into various conditions. There are several prescriptions can be used6).
In case of labor problems, practice three or four times of acupuncture and rub a salt in. Difficult labor can be solved by rubbing children’s foot and mother’s abdomen6).
Obstetrics and Gynecology Symptoms needs gynecological examination or treatment from childbirth or sexual violence If the placenta does not comes out, cut the umbilical cord to stop the blood reflux. The rest of placenta would come out later if the mother keep the mind in peace. Use prescriptions if needed6).
Bleeding after childbirth would be treated with herbal prescription, and other prescription can be suggested.
Bleeding after the abortion, prescriptions might be useful6).
Damages from foreign materials Patients requiring removal of foreign bodies in the ear, eye, nose, anus, and others. Bugs or insects inside the ear; Produce sound with face two knives in front of the ear, apply oils outside the ear, block the ear canal with peach leaves, blow with bamboo pipe when needed6). If the bug does not come out from the ear, using a cord with glue can pull that out. When something enters the ear and does not out, using chordal with glue can pull out it, slowly6).

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