We learnt about many different ways in diagnosing a patient. However, theories and actual pratice sometimes do not match. So we asked for an interview with professor Baek Yu Sang who pratices medicine at Baek Suk KM clinic about his experiences and some difficulties. Professor Baek graduated from Kyung Hee college of KM and is a professor of the Medical Classics department at the same school.

Q : When you inspect your patients what do you mainly use among the Four examinations(Looking, Listening and Smelling, Asking, and Touching)?

A : I use all of them. Only, the voice and smells are difficult to distinguish.

Q : How can we examine patients who wear perfume or had a plastic surgery?

A : It is hard to diagnose, but it doesn`t matter because we can ask them.

Q : Is there a difference between the examination of the Easterners and of the Westerners?

A : I think there isn`t a big difference. (I don`t know exactly since I haven`t examined the foreigners that much). When we take a pulse we consider the patient`s individual physical constitution, and strength, so it won`t be a big problem.

Q : Is it important to know the physical constitution when you diagnose?

A : Sure it is. It`s very important to understand the constitution let alone the Four Examinations. You would know the constitution by the disease of a person, or by the prominent characteristics when you examine.

Q : What is the O-ring test?

A : That`s not a traditional examination, but it has been proved through experience. Put food or medicine on your one hand, and make an O with thumb and index finger of the other hand. Then, your doctor measures the force of the fingers. With the O-ring test we can figure out the patient`s constitution. Also we can tell whether the Ki of the medicine suits for the patient or not.

Q : How is the way of diagnosis related with theories?

A : The method of the diagnosis is one field of the medical science, and it has many theories. The difference of the diagnosis means the difference of the theoretical basis. There are many theories in Korean Medicine, so diagnosis is interpreted differently by different theories. For example when you take the Floating pulse, diagnoses of Shang Han Lun(傷寒論)and of Sasang Constitutional Medicine(四象醫學) are different. Thus, you must study the theories like Shang Han Lun and Sasang Constitutional Medicine to make a diagnosis based on the information you collect.

Q : It is said that there is a lot of difference between the diagnosis and the actual clinical case in the Western Medicine. How about in Korean Medicine?

A : Western Medicine is the science of set standards. Through observation individual cases have been classified. On the other hand Korean Medicine is not set but "flexible". "Flexible" means that Korean Medicine doctor makes a diagnosis of a patient's illness by distinguishing Eum and Yang , Deficiency and Excessiveness. There is no fixed standards and everything is entirely up to the doctor. That's why a diagnosis pointing to one side can change into another.

Q : Is there a difference between the method of diagnosis before the modern age and now?

A : I think there isn't a big difference between the two. New ways of diagnosis just appeared. For example, there is a medical appliance named "pulse diagnostic apparatus". It was thought to replace the function of diagnosis which were done before by doctor's five senses. But we cannot be sure of its effectiveness yet. So we can only use to get insurance money from the national health service. There are various physical constitution discerning appliances out in the market. The most widely used method is the O-ring test. Methods using acupuncture and medication are also in use nowadays.

Q : When we take a pulse, can we distinguish all the 28 types of pulse?

A : Without much experience, we can only discern the Floating pulse, Sinking pulse, Slow pulse, and Rapid pulse. Pulse taking requires training, great experience, and sensitivity. Only an expert can feel all of them. I`m now practicing to reach the stage of expert. Through training and taking a pulse as often as possible, you would become sensitive and diagnose illness exactly. To be an expert, it`s necessary to take pulse of your own, and of the others whenever possible.

Q : Is there a particular patient you remember?

A : There was an old man who I could not feel the pulse. Especially his left hand pulse was very weak. Later on I found out that he had been distressed greatly and was mentally suppressed for a long time. When someone's pulse is very weak there might be a chance that the patient has a mental problem along with a physical one.

Q : Is there anything else you want to emphasize?

A : It is most important to make lots of conversation with the patient because communication is crucial in treatment. Surprisingly, often patients do not recognize their present condition. They might not think that they are ill. For example, person with insomnia might not realize their symptoms and they might not mention it to the doctor. So to make it precise doctors should ask detail questions like,

"Do you sleep well?" "How long do you sleep?" "When do you go to bed and get up in the morning?" "How often do you wake up during night?"

If you ask many detailed questions you can figure out that he or she has Insomnia. Also during conversation depending on one's tone, speed, loudness and expressions you can find out the patient's characteristics.

Q : Can Korean Medicine doctors use X-ray or MRI in their processof diagnose?

A : They diagnose using MRI especially when diagnosing Palsy using MRI. We decide which part of the blood vessel has been ruptured and find out where the thrombus and bleeding occurred. However, Korean Medicine doctors do not have the legal rights for that. Orders can be made only if you have both licenses to Korean and Western Medicine. So KM doctors are requesting for a license in order to get an access to these appliances. However, diagnosis can be done using these appliances but prescription and therapy are done by traditional methods.

Q : What is you opinion about diagnosing in Western Medicine and treating in KM?

A : In the 80's and 90's, some of the Korean Medicine Doctors (KMD) Insisted the popularization, scientification and objectification of Korean Medicine. That is, to follow the formalized Western Medicine's diagnosis and systemize the according Korean medical remedies. This plan is still in process, but there is doubt in whether this method is truly a possible one.

On the other hand, some KMDs say this method is impossible considering the characteristics of Korean Medicine. They believe that for Korean Medicine to survive, they should maintain its original form. Furthermore, they say that their roots being so different, Korean Medicine and Western Medicine cannot combine.

Q : What do you think about the "3rd Medicine"?

A : The current situation is like this: it is still on trial, but so far there is a huge gap between KM and WM leading to very much confusion. Formerly when the idea of unifying medical system was proposed, it was rather concentrated on the 'WM' ways. The idea was that: they would make a category of non-curable disease in western medical field and commit it to KM. Which meant that KM would become merely a department in WM. The attempt to use a piece of Korean medical knowledge without knowing the whole is very unreasonable. If one should speak about the combination of the two, at least he or she should learn about each 1:1. Arguing about the 3rd Medicine without full knowledge of the two medicines is an hollow attempt. So, with the current situation, it is against all reason to create a "3rd" medicine.

One more thing I want to emphasize is that all studies must go side by side with reality. That is, if there is a good diagnosis which also proves well in clinic, it should be developed and used more widely. A study cannot merely live on its image. It can only survive based on ability and depth of knowledge.