The main treatment methods of traditional Korean medicine includes acupuncture, moxibustion, cupping, herbal medicine and manual therapy.1) North and South Korea share the same traditional Korean medicine system, which is very similar to traditional medicine being practiced in China and Japan. The name of traditional Korean medicine in North Korea is “Koryo Medicine,” deriving from the ancient dynasty “Koryo”, which is also where the country name ”Korea“ originates from. North Korea changed the name to Koryo medicine in 1993 to emphasize the regime’s governing ideology, “Juche”, which seeks to indoctrinate self-reliance within the nation.2)

South Korea, the United States, and the United Nations have currently imposed extensive economic sanctions against North Korea. These sanctions made supplying products or conducting economic activities became difficult within North Korea.3) The difficulty of purchasing imported medicines and medical supplies meant North Korea had to increase the use of Koryo medicine to maintain its national health care system.4) This is also in line with the economic policies of the Kim Jong Un regime, characterized by “localization policy” which encourages the consumption of locally produced or sourced products.5) Koryo medicine in North Korea accounts for 30–40% at the largest hospital-level treatments, 40–60% at the local level, and 70% at primary care.6) In primary medical services, Koryo medicine is provided alongside conventional drugs with the majority consisting of traditional therapies such as acupuncture and moxibustion, but also covers internal and surgical diseases.7) Koryo medicine research in North Korea is conducted by the Koryo Medical Research Institute (KMRI) under the Ministry of Health. Besides KMRI, institutions that conduct traditional medical research in North Korea are the Institute of Pharmacology and Natural Material under KMRI, the Koryo Pharmaceutical Technology Center, traditional Korean medicine departments of all medical schools, Special Hospital for Koryo Medicine, and other various medical institutions.7)

Despite its importance in North Korea, there is very little information on Koryo medicine, especially after the collapse of inter-Korean relations when all forms of exchange with North Korea ceased. Due to the difficulty of acquiring information, bibliographic analysis of North Korean academic journals can be used to analyze North Korean society and its characteristics.8)

While North Korean medical journals have been analyzed in the field of internal medicine8), dentistry9,10), pharmaceutical11), and oncology12), the Koryo medicine has never been analyzed using North Korean journals. However, identifying North Korea’s research trend is challenging due to the lack of accessible research data. Nevertheless, North Korea’s clinical research trends in using Koryo medicine can be identified through publications such as Rodong Sinmun or Koryo Medicine. This paper seeks to examine the types and trends of clinical research being conducted in North Korea using Koryo medicine to identify which disease and treatment is considered significant in North Korea.

This study conducted frequency analysis of Koryo Medicine articles to show the research trends and use of Koryo medicine in North Korea. This study is significant as it identified North Korea’s clinical research trends on traditional medicine using Koryo Medicine. This study provides insight on the utilization of Koryo medicine thru the bibliographic analysis of Koryo Medicine.Table 5Table 6

In Koryo Medicine, clinical research on determining the effect of treatment was very frequent (65.6%). Other than clinical research, most of the research was basic research, such as in vitro and in vivo research on the effects of traditional North Korean medicine. Although research on classical medical literatures is an important part of traditional medical research in East Asian countries, it was difficult to find such research within Koryo Medicine. However, because the analysis only used articles from Koryo Medicine, it does not cover all the research related to traditional North Korean medicine, so it is difficult to draw a conclusive explanation on why old document research is scarce in North Korea.

Among clinical research articles, research using herbal medicine was most common, accounting for 17.69% of the total. Herbal medicine, along with acupuncture, moxibustion, and cupping, is one of the most commonly used traditional medical treatments. However, the active clinical research on herbal medicine seems to be affected by North Korea's domestic situation. North Korea Economic sanctions imposed on North Korea make it difficult for Western medicine to accessible and affordable, which is why Koryo medicine is used as a replacement for Western medicine6). Due to the increased importance of herbal medicine/preparation, North Korea enacted the “Herbal Medicine Law”, which emphasized the preservation and production of herbal resources (“Herbal Medicine Law”). Rodong Sinmun, the official newspaper for the Worker’s Party of Korea, frequently promotes the production of Koryo medicine production institute and its performance. Also, research on herbal medicine/preparations has become more active as a means to achieve ‘independent economy’ which is an important characteristic of the Kim Jung-Un regime.

In Koryo Medicine, the number of clinical research involving “musculoskeletal and connective tissue diseases” is not high, accounting for only 17.15%. In South Korea, however, the proportion of clinical research on “musculoskeletal and connective tissue diseases” is high, accounting for half of the 10 most commonly treated diseases in Korean medical services (Health Insurance Review and Assessment Service, 2018). This is because traditional Korean medical services in South Korea are mainly provided through acupuncture, so the proportion of musculoskeletal disease treatment, which is widely known to be treated with acupuncture, has increased. This has led to an increase in the clinical research of using acupuncture and the treatment of musculoskeletal diseases using Koryo medicine. In contrast, Koryo medicine research in North Korea does not focus on musculoskeletal diseases but focuses on internal diseases such as digestive system diseases, genitourinary system diseases, and circulatory system diseases. This was also shown in the results of this study in the frequency of Koryo medicine treatment by disease type.

In 2016, diseases with the highest DALY (Disability Adjusted Life Year) in North Korea were stroke, ischemic heart disease, chronic obstructive pulmonary disease, trachea·bronchus· lung cancers, and tuberculosis (WHO). However, in traditional medicine literature, the most researched diseases were related to the ‘digestive system.’ The specific disease mentioned in the literature included gastritis, gastric ulcer, colitis, and irritable bowel syndrome. This indicates that North Korea uses traditional medicine to provide primary medical care. However, further research is required to identify why ‘digestive system diseases’ in particular are so prevalent in existing literature.

There is a wealth of clinical Koryo medicine research conducted in tandem with conventional drugs, especially in acupuncture. There were many clinical research that combined Western medical treatments, especially herbal acupuncture studies. In North Korea, traditional medicine is generally used in tandem with Western medicine in order to enhance the effect, or decrease adverse effects of Western medicine16). The simultaneous use of traditional and Western medicine is because North Korea's healthcare system, like China, does not differentiate the scope of licensed practices between Western and traditional medical doctors. Hence, there is no regulatory barriers on an institutional level hindering the addition of both Western and traditional medicinal ingredients to herbal acupuncture.

This study has the following limitations. First, due to the lack of a North Korean research literature search engine, only Koryo Medicine was used as the data source to represent traditional North Korean medicine journals.

Since this study analyzed only the Koryo Medicine, it lacks analysis of additional journals that contain traditional medicine as well as other traditional medicine research that has not been published. For example, other traditional North Korean medical journals such as Chosun Medicine, Chosun Pharmacy, Preventative Medicine all contain Koryo medicine research, but these these were not analyzed in this study. Yet, the analysis indicates that although traditional medicine is gaining importance in North Korea, its primary function seems to be limited to chronic and mild disease treatment. This is similar to how traditional medicine is applied in East Asian countries such as China, Japan, Taiwan, etc. Secondly, the types of research conducted in Koryo Medicine differs from research in South Korea. For example, typical research topics in South Korea such as historical research, discovery, and interpretation of old documents, and social research related to Koryo medicine are not dealt with as often as clinical research and basic research in North Korea. Third, two Koryo medicine doctors classified disease written in North Korean vernacular language by its disease and treatment method according to KCD classification, but this method of the included articles did not provide enough details. Since Korean and North Korean language is different, some diseases might have been incorrectly classified. Finally, due to the lack of information on the external situation in North Korea, it was difficult to review the results of the study. Despite these limitations, this study could provide a deeper understanding of the current traditional medicine research trend in North Korea by analyzing one of the Korean medical journals focused on traditional North Korean medicine.

This research conducted a bibliographic analysis of Koryo Medicine original and reviewed articles to identify the current trend of traditional North Korean medicine. The original articles were comprised of an introduction, research topics and methods, research results, conclusions, and references were generally about 1–2 pages long with 1–2 authors. Analysis of this data identified the main diseases, treatment methods, and integration with conventional drugs13,14,15) within the clinical research field of North Korea. It also presented Koryo medicine research and its use in North Korea. As a country actively using Koryo medicine, the study of Koryo Medicine in North Korea will become an interesting field of global traditional medicine and complementary medicine research.