The role of Korean Medicine in the post-COVID-19 era

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ContentslistsavailableatScienceDirect

Integrative Medicine Research

jou rn al h o m e p a g e :w w w . i m r - j o u r n a l . c o m

Discussion

The role of Korean Medicine in the post-COVID-19 era: an online panel discussion part 2 – basic research and education

Sunju Park

^a

, Dae-Hyun Hahm

^b

, Myungsoo Joo

^c

, Kyongmin Kim

^d

, Sunoh Kwon

^e

, Hoyoung Choi

^f

, Hyangsook Lee

^g,∗

aDepartmentofPreventiveMedicine,CollegeofKoreanMedicine,DaejeonUniversity,Daejeon,SouthKorea

bDepartmentofPhysiology,CollegeofMedicine,KyungHeeUniversity,Seoul,SouthKorea

cDivisionofAppliedMedicine,SchoolofKoreanMedicine,PusanNationalUniversity,Yangsan,SouthKorea

dDepartmentofMicrobiology,SchoolofMedicine,AjouUniversity,SouthKorea

eHerbalMedicineResearchDivision,KoreaInstituteofOrientalMedicine,Daejeon,SouthKorea

fDepartmentofHerbology,CollegeofKoreanMedicine,KyungHeeUniversity,Seoul,SouthKorea

gKoreanMedicineConvergenceResearchInformationCenter,CollegeofKoreanMedicine,KyungHeeUniversity,Seoul,SouthKorea

a r t i c l e i n f o

Articlehistory:

Received5July2020

Receivedinrevisedform16July2020 Accepted16July2020

Keywords:

COVID-19 KoreanMedicine Education

Experimentalresearch Herbalmedicine

a b s t r a c t

Background:ExperiencingdifﬁcultiesandchallengesthoughCOVID-19pandemic,therearevoicesthatit needstobediscussedtoseekdirectionofbasicresearchandcollegeeducationofKoreanMedicine(KM) sothatKMcommunitycanplayasigniﬁcantroleinthefutureinfectiousdiseaseoutbreaks.

Methods:ThispapersummarizestheeditedhighlightsofanonlinevideomeetingbyGooglemeetonMay 19,2020,organizedbytheKoreanMedicineConvergenceResearchInformationCenter.Fiveresearchers specializedinimmunology,microbiology,virology,preventivemedicine,andherbology,respectively, presentedwhatKMcommunityshouldprepareforthefutureacuteinfectiousdiseaseoutbreaksby learningfromthepreviousresearchonantiviraleffectofherbsforcoronavirusandtheexperiencesof thepresentCOVID-19pandemic.

Results:Therearealotofherbsornaturalproductswithpotentialanti-coronaviruseffectsreportedfrom invitroexperimentsanddespitecriticism,manyclinicaltrialsontraditionalherbalmedicineforCOVID- 19arebeingconducted.Inadditiontoestablishingresearchevidence,KMcommunityshouldtrainand producepublichealthprofessionalsamongKoreanMedicineDoctors(KMDs)andofﬁcialparticipation inpublichealthcaresystemshouldbeensuredintermsofregulationandpolicy.NewlydevelopedKM treatmentscanbeinterpretedbytheKMtheoriesandalsoshouldbeallowedbyregulationsforKMDsto utilizethem.

Conclusion:Thepresentonlinediscussionsuggesteddirectionsofbasicresearchforacuteviralinfections diseasesutilizingKMandhowtoenforcerelevanteducationandregulationsinthepost-COVID-19era.

1. Introduction

IncontrasttoKorea’sproactiveresponsestotheCoronavirus Disease2019(COVID-19)pandemic,KoreanMedicine(KM)com- munitywas not abletotake partin anystage of responsesto COVID-19includingtestingorscreening, epidemiologicalinves- tigation, quarantine, treatment or prevention due to various reasonsincludingpoliticalandregulatorybarriers.BecauseKorean

∗ Correspondingauthorat:KoreanMedicineConvergenceResearchInformation Center,CollegeofKoreanMedicine,KyungHeeUniversity,26KyungHeeDae-ro, Dongdaemun-gu,Seoul,SouthKorea.

E-mailaddress:[email protected](H.Lee).

MedicineDoctors(KMDs)hadnowaytoparticipateorvolunteer inanyactivitiesbytheCentralDiseaseControlHeadquarters,the AssociationofKoreanMedicine,byself-help,openeda KMtele- consultation center for COVID-19which wasoperated by KMD volunteers.AsofApril22,2020,approximately20%ofconﬁrmed casesofCOVID-19inKoreawhowereself-isolatedbecausethey couldnotbeadmittedtoahospitalorquarantinefacilityreceived KMtreatmentviaphonecallstoKMteleconsultationcenter.

As experts predict epidemics of infectious diseases will be occurring more often, Korean Medicine Convergence Research InformationCenter(KMCRIC),aKMresearchinformationcenter funded by the Koreangovernment held a series of discussions for KM community to come up with future measures against infectious diseaseoutbreaks.Discussionswereheld onlinewith

https://doi.org/10.1016/j.imr.2020.100488

creativecommons.org/licenses/by-nc-nd/4.0/).

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Table1

InformationofSpeakersinthePresentDiscussion

Speakers(inorderofappearance) Afﬁliation Clinicalexpertiseand/orroleinthediscussion

Prof.HyangsookLee KMCRIC

KyungHeeUniversity

Organizeroftheevent

Prof.Dae-HyunHahm CollegeofMedicine

KyungHeeUniversity

Host

Prof.MyungsooJoo SchoolofKoreanMedicine

PusanNationalUniversity

Immunology/virology

Prof.KyongminKim SchoolofMedicine

AjouUniversity

Virology

Dr.SunohKwon KoreaInstituteofOrientalMedicine Researchonherbalmedicineforinfectiousdiseases

Prof.SunjuPark CollegeofKoreanMedicine

DaejeonUniversity

Preventivemedicine

Prof.HoyoungChoi CollegeofKoreanMedicine

KyungHeeUniversity

Herbology

Fig.1. FlyerofKMCRIConlinepaneldiscussion. KMCRIC,KoreanMedicineConvergenceResearchInformationCenter.

Google meet and this article provides summarized and edited presentationsoftheKMCRIC2ndonlinepaneldiscussionondirec- tionsof basicresearchforviralinfectious diseasesusingherbal medicineandhowtoimproveKMcollegeeducationprogramsfor futureinfectiousdiseaseoutbreaksbythe5expertsinimmunol- ogy,microbiology,virology,preventivemedicine,andherbology (Table1).

2. Onlinepaneldiscussion

Lee:In an ongoing pandemicof COVID-19acrossthe globe, theKMCRIC organizedtwo online paneldiscussions toaddress whatand how topreparein thepost-COVID-19 erain theKM community.¹Followingapreviousonlinepaneldiscussiononclin- icalresearchinKMinpost-COVID-19era,²thisisour2ndonline event wherein we are going to talk about the challenges and directionsforbasicresearchandeducationinKMintheCOVID- 19pandemicand beyond(Fig.1).Below is anedited summary ofpresentationsbyexpertsinimmunology,virology,preventive medicine,andherbologytosuggestwhatbasicresearchoninfec- tious diseases is needed and what further contents should be incorporatedintheuniversityeducationofKM.³

2.1. IntroducingcurrentstatusofbasicresearchonCOVID-19 andpresentingissuesfordiscussion

Joo:In2015,MiddleEastRespiratorySyndrome Coronavirus (MERS-CoV)infectionwasagreatchallengeforus.Thelasttime theMERSepidemicoccurred,themedicalcommunityseemedto functioningreatchaos,butfortunately,thistimetheyseemtobe copingwell.TheKMcommunityisalsocontributingsigniﬁcantly tothestruggleofovercomingCOVID-19.Beforestartingthemain discussion,Iwouldliketodiscussthecurrentsituationbrieﬂyand facilitateadiscussionabouttheroleofKMinbasicresearchand

educationinovercomingapotentialfutureoutbreakofCOVID-19 orsimilarviraldiseases.Thesevereacuterespiratory syndrome coronavirus(SARS-CoV)firstemergedin2002.Beforethat,itwas simplythoughtofasabenignvirus,causingacommoncold.In2002, itwasidentifiedasaviruscausingSARS.Itpeakedmostlyaround April–May,and8000peoplearoundtheworldwereinfected.The casefatalityrate(CFR)was11%,andtherewerethreeconfirmed cases in Korea but no deaths.⁴ In 2015, MERS-CoV,a different speciesof coronavirus,emerged. Itpeaked mostlyaroundMay- July,andthediseasebrokeoutonlyinKorea,where186people wereinfected,withabout20%CFR.⁵Fiveyearslater,lastDecember, SARS-CoV-2emergedforthefirsttime.Unliketheprevioustwo betaviruses,thiscoronavirushasspread worldwide.It causeda pandemic,andasofthe30thofApril,theCFRpredictionintervalis 0.82–9.64%–thelowestendofthecurrentpredictionis0.82%and inlinewithseveralotherestimates.⁶AsIsaidearlier,coronaviruses werenothighlydangerousin thepast.Thispattern changedin thelate2000swhenacoronavirusinfectionstartedcausingSARS.

Therearenospecifictreatmentsorvaccines.Chinareportedthatthe combinationoftraditionalChinesemedicine(TCM)andWestern medicine(WM)andCheongPyeBaeDokdecoction(QingFeiPaiDu- tang in Chinese, Seihaihaidokuto in Japanese) was effective in treatingSARSin2002and influenzalater.Theyreportedthatit wasalsoeffectiveforCOVID-19.InKorea,unfortunately,thereare noreportsofeffectivecoronavirusorinfluenzainfectiontreatment applyingKM.AsofMarch2020,thereareongoingclinicaltrialson about20drugs,mainlyintheU.S.andChina,anditisimpressive thataconsiderablenumberofTCMherbalmedicationsareincluded inthelist.

Todaydiscussiontopicsareasfollows:

•TheneedforbasicresearchoninfectiousdiseasesinKMandits direction;

•TheneedforimprovingtheuniversityeducationofKM.

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TheKMcommunitycouldnotparticipateinpreventionmea- sures related tothe recent outbreak of COVID-19. KMDs were not allowed to participate, but they still contributed a lot to helppatientsovercometheCOVID-19viateleconsultationcenter.⁷ Lookingatthecurrentsituation,Iposequestionslike:“Whyare KoreanpeoplelargelynotinterestedinthatKMDsarenotofﬁcially allowedbythegovernmenttoparticipatein treatingCOVID-19 patients?”,“Whydopeopletalkaboutvaccinesandantiviraltreat- ments, but not about KM treatments?” I think it is, probably, becauseofthecommonnotionthatKMandinfectiousdiseasesare notentirelyrelated.

Therefore,whynotaddressinfectiousdiseasesintermsofKM inthefirstplace?Morespecifically,althoughthereisatreatment forinfectiousdiseasesinKM,Ithinkitwouldbegreatifwedesign andperformastudy,providingguidelinesonaspecifictreatment, effectiveagainstinfluenzavirus,andlikewiseagainstcoronavirus infection.Ithinkitwouldbeessentialiftherewerestudiespre- sentingaspecificKMtreatmentthatiseffectiveforviraldiseases criticaltopublichealth.Then,people’sperspectiveandviewonKM, aswellasthenotionthatKMisirrelevanttoviralinfections,might change.

Second,Ithinkweneedtotakethisopportunitytochangeedu- cationprogramsoninfectiousdiseasesinthecollegesofKM.For one,theproportionof infectiousdiseasesinKMuniversitypro- gramsisnothigh.Ihopetoday’sdiscussionincludesdirectionsfor somebasicresearchthatcanprovidethebasisforKMtreatment forinfectiousdiseases.And,IalsoseetheneedforKMeducationto transformtheconventionalnotionabouttheimportanceofKMin viralinfection.Itwouldbenicetoexchangethoughtswithyouon thesetwotopics.Thankyou.

2.2. Invitroinhibitionofcoronavirusreplicationsbyherbal medicine

Hahm:Thankyouforyourpresentationonthecurrentstatus ofviralinfectiousdiseasesandtheneedforfurtherresearchand educationastopicsfor discussion.Isuggest changingtheorder slightly.NowProf.KyongminKimwillbepresentingtheprevious andongoingbasicresearchonherbalmedicineforcoronavirusﬁrst.

Kim:Inthepast,coronavirusescausingcommoncoldsymp- tomswerenotconsideredimportant.Itbecamehighlycriticalwith the2003SARS,2012MERS,2015KoreanMERS,and2019SARS- CoV-2pandemic.SARS-CoV-2ofthecurrentoutbreak,wasnamed sobecauseitwasmostsimilartoSARS-CoV.Thenameofthedis- easeisCOVID-19,andthenameofthevirusisSARS-CoV-2.⁸This istheviruswiththehighesthomologyandSARSandMERSboth originatedfrombats.

Here is ourdatafrom anin vitroexperiment. We createda cellculture,infecteditwiththevirus,andfoundthatCimicifuga rhizoma, Meliae cortex, Coptidis rhizoma, and Phellodendron cortex inhibit replications of mouse hepatitis virus(MHV) and coronavirus.⁹

Weevaluatedthevirustiterwhereinthebaselineis100,anda decreasebelow10isconsideredeffectiveasanantiviraltreatment.

Asyou cansee,Cimicifugarhizoma, Meliaecortex,Coptidisrhi- zoma,andPhellodendroncortexshowedvaluesmuchlowerthan 10,demonstratingamarkedinhibitionofviralreplicationtothe pointwheretherewasalmostnoRNAexpression.Sophorasub- prostrataradixalsohadanantiviraleffect(≤10,meaningthatit waseffective)andweassumethattheyinhibitRNAbasicallyby inhibitingRNApolymerase,protease,orreplication.⁹

Our2ndpaperwaspublishedin2010.There,wereportedon ourinvitroexperimentswhereinSophoraeradix,Acanthopanacis cortex,Sanguisorbae radix,and Torilisfructusinhibitedreplica- tionofthecoronavirus.Ribavirinisacommonlyuseddrugagainst RNAviruses.We observedthat Sophoraeradix, Acanthopanacis

cortex,Sanguisorbaeradix,andTorilisfructusmarkedlyinhibited replicationof thecoronavirusas much asribavirin. In theend, wecompletedthepaperhypothesizingthatwhileSophoraeradix, Acanthopanaciscortex,andTorilisfructusinhibitRNAdependent RNApolymerasereplication,Sanguisorbaeradixinhibitsviralrepli- cationbyinhibitingnotRNAsynthesisbutlaterstepsoftheviral replication.¹⁰

2.3. Developmentofantiviralagentsfromnaturalproducts

Hahm:Next,IunderstandthatDr.SunohKwonoftheKorea Institute of Oriental Medicine (KIOM) is also conducting basic researchonherbalmedicineforviralinfectiousdiseasesevennow.

Pleasegiveusabriefintroductiontoyourresearch.

Kwon:OurteamusethehumancoronavirusOC43(HCoV-OC43) strainfromthesamebetacoronavirusgeneratoinvestigatethe antiviraleffectsofnaturalproducts.Thesesubstancesarealkaloids fromtherootofStephaniatetrandraS.Moore(Menispermaceae) andotherrelatedspecies.S.tetrandraisknownforanalgesicand anti-inflammatoryeffectsinpatientswitharthritisandedema.¹¹ Wecouldconfirmtheantiviraleffectbyconcentration,usingthe cell-survival rates and the levels of viral M-protein RNA have decreasedpost-treatmentofS.tetrandra.Thereleaseofinflamma- torycytokineshasalsodecreasedpost-treatment.¹²

ResearchersattheUniversityofWisconsindemonstratedina translocationassayusingaMERSpseudovirus,¹³dose-dependent inhibitionofviralgeneexpressionbytetrandrineandfangchino- line,which arethesamecompoundsthatourteamused.These compoundsareknownascalciumchannelblockers,and forthe viralgenetobeexpressed,calciumchannelsmustbeworkingprop- erlytoallowCa²⁺signaling.Accordingtothisstudy,treatmentwith thesecompoundsreducedthesignalingand,thus,inhibitedviral geneexpression.

Atrialoftetrandrinetabletswhichwereusedinourresearch, forCOVID-19treatment,isregisteredatClinicalTrials.gov(https://

www.clinicaltrials.gov/)anditfocusesonreductionofinﬂamma- tions,includingpneumonia,duetotheanti-inﬂammatoryeffectof tetrandrine,ratherthantheantiviraleffectitself.¹⁴

Incontrasttothefindingsabove,recently,articlescriticizing that TCM products whose efficacy and safety have not been sufficiently verified, are being applied in clinical practice and evenexportedtoEurope,werepublishedinNature(https://www.

nature.com/articles/d41586-020-01284-x) and Science (https://

www.sciencemag.org/news/2020/05/unproven-herbal-remedy- against-covid-19-could-fuel-drug-resistant-malaria-scientists)on the same day, May 6th, 2020,^15,16 followed by the newspaper articleintheJoongAngIlboonMay7th,2020,discussingwhether traditionalmedicinehastherapeuticeffectsinCOVID-19treatment andwhetherthereisscientiﬁcevidenceforit(https://news.joins.

com/article/23771276).¹⁷IntheScienceTranslationalMedicineblog byanexpertindrugdiscovery(https://stm.sciencemag.org),the authorcriticizeditisunfortunatethattherearesomanyclinical trialsofTCMtherapyregisteredatClinicalTrials.gov(https://www.

clinicaltrials.gov/).¹⁸

Underthesecircumstances,letmetellyoumyopiniononthe future direction of the development of a preventive treatment basedonKMfornovelandmutantvirusinfections.Withregards toKMforpreventionandtreatmentofnotonlyCOVID-19butalso newmutantviralinfectionsthatmayemergeinthefuture,KMmay havepotentialinincreasingherdimmunityandvaccineadjuvants forpreventionofadverseeffects,onthepreventionside.Onthe treatmentside,ithasthepotentialforpreventingcomplications, providingimmunomodulatorsthatimproveresilienceandthera- peuticsforthemanagementofcomplications.UnlikeChina,Korea israrelyusingKMforinfectiousdiseasemanagement.Inthefuture, weshouldenhancetheresearchinfrastructureand ourcapacity

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Fig.2.SuggestionsforfuturebasicresearchoninfectiousdiseasesutilizingKMbyDr.SunohKwon.

FDA,FoodandDrugAdministration;KM,KoreanMedicine;TCM,TraditionalChineseMedicine.

toobtainscientiﬁc evidenceand quicklyreﬂectit intheclinical practiceguideline, toprovideinformation viapublicpromotion, whilecontinuingtorequesttoincludeKMinthenationalpolicyon infectiousdiseases(Fig.2).

Hahm:Thankyou.AsfarasIknow,Dr.Kwon isaresponsi- ble researcherfor infectious diseaseresearchin KoreaInstitute ofOrientalMedicine,and there arenewﬁndings thathave not beenpublishedyet.That’swhyJoongAngIlbointerviewedhim.He explainedvariousissuesandsuggestedfuturedirectionsaswell.

2.4. ContributionofKMtopublichealthcaresysteminthe post-COVID-19era

Hahm:Next,Prof.ParkwilldiscusshowKMcancontributeto thepublichealthsysteminthefutureviachangesinuniversity educationandinlegalandregulatorybarriers.

Park: Although the KM community has made signiﬁcant progressbyputtingalotofeffortsinthecurrentCOVID-19pan- demic,comparedtothepast,Ihopethatwemakemoreregular andsystematiccontributionstothepublichealthcaresystemin thefuture.DavidQuammen,theauthorof“Spillover:AnimalInfec- tionsandtheNextHumanPandemic,”mentions4thingsthatare essentialtomanaginginfectiousdiseasesin thefuture:science, technology,publichealth,andpolitics.¹⁹Iwouldalsoliketotalk aboutthepublichealthaspect.

IhavebeenthinkingthatnotjusttheeffortsoftheKMcommu- nityalone,butalsothegovernmentandacademiamustcollaborate, inajointeffort,towardsestablishingthebasisandstrengthening ourcapabilities.Intheend,thegoalistodeveloptheroleofKM inmanaginginfectiousdiseasesandsecureourexpertisesothat theKMcommunitycanplayanactiveroleintheinfectiousdisease management.

Ihavedividedthispresentationintothreeparts,i.e.,establishing researchevidence,education,andregulations(Fig.3).Asresearch directionswerealreadyaddressed,Iwouldjustaddtothat;there werecasesinwhichtheKMcommunityhascontributedtoemer- gencysituations,asinarecentteleconsultationcenter.⁷Thinking

back,weneedtoestablishinadvanceadatacollection/utilization systemthatworkseveninemergencies.Ifthereisasystemthatis designedwithanexpertresearcherparticipatingfromearlyonand evaluatedposthocforimprovement,Ithinkthosedatawouldbe usefulinthefuture.Iwillskipthepartaboutclaimsandclaims data utilizationsince it wasexplained wellin the 1st KMCRIC onlinepaneldiscussion.²Othersalsoaddressedtheroleofinfec- tiousdiseaseresearchandaccumulatingrelevantknowledge.As thepresident Moonmentionedinhis3rdinauguralanniversary speechestablishinganationalresearchcenterforinfectiousdis- eases,IhopethattheKMcommunitycantakepartinitaswell.

Andlastly,weshouldcontinuetoexplorewaysfortheKMcom- munitytoparticipateinpublichealthcareandthinkaboutourrole init.

Next,intermsofeducation,studentsofcollegesofKMareedu- catedandtrainedinepidemiologyandmedicalstatistics,butthey arenotwell-awareoftheirimportance,andthus,engagementis ratherlimited.Ithinkweshouldfocusoneducationtoemphasize theimportanceofthesesubjectsandreinforcetheutilizationplan.

Ofcourse,theyarealreadyincludedinthecurriculumandtaught incolleges,butIthinkeducation,relatedtothepublicsector,must alsobereinforced.Studentsshouldfullygraspthecharacteristics androleofpublichealthcareintheirundergraduatestudies,and theirsenseofcommitmenttosocietyshouldbenurturedaswell.

Next,IthinkitisalsoessentialtotrainKMDpublichealthpro- fessionalsandstrengthenthecompetenceandprofessionalizethe KMcommunity.IntermsofupbringingKMDpublichealthprofes- sionals,IhopethatthenumberofprofessionalsinpreventiveKM increases.Also,theyshouldbeallowedtoworkasepidemiological investigatorsbylaw,whichIwillmentionagaininpartaboutreg- ulations.Ialsothinkthateducationoninfectiousdiseasesshould beaddedandreinforcedforKMDsservingthearmyinthepublic healthcenters.

Afterallthesethingsareachieved,theyshouldbesupplemented intermsofregulationandpolicy.TheInfectiousDiseasePreven- tionActandrelatedlawsshouldbeenhanced,and,astheactivities ofepidemiological investigationteamsincrease, theapplication

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Fig.3. Directionsforfutureresearchevidence,education,andregulationsinKMbyprof.SunjuPark. KM,KoreanMedicine;KMD,KoreanMedicineDoctor.

requirementsshouldbemodiﬁedsothatKMDscanapplyaswell.

Next, we shouldcontinue toestablish measuresto expandthe participation of KMDs in publichealthcare, such as increasing recruitmentinnationalandpublichospitals,healthcentersandthe taskforceoninfectiousdiseases.Finally,Ithinktheplanshouldbe expandedtoincludeKMDsinspecializededucationalinstitutions andcreateacurriculumfortrainingpublichealthprofessionalsto strengthentheircompetencesandachieveprofessionalization.

2.5. KMeducationanddevelopmentofherbaltreatmentfor infectiousdiseasesinthepost-COVID-19era

Choi:AccordingtoarecentlypublishedpaperbyLuoetal.,²⁰ thereareabout19medicinalherbs,whicharecommonlyusedto preventCOVID-19.Weknowmostofthem,andsomeofthemare widelyusedinKorea.Whyaren’tthereanynewonesotherthan these?Ifyoulookattheformulaintheguideline/recommendation forCOVID-19,²¹mostoftheprescriptionsarefamiliar,andeven theoneswehavenotheardof,likeCheongGeumGangHwadecoc- tion(QingJinJiangHuo-tanginChinese,SeikinkokatoinJapanese) andCheongPyeBaeDokdecoction(QingFeiPaiDu-tanginChinese, Seihaihaidokutoin Japanese), can bethought of asa combina- tionofcommonlyusedherbsthatweknow.Thereareabout602 differentherbs,accordingtotheKoreanPharmacopoeiaandthe KoreanHerbalPharmacopoeia^22,23and8980accordingtotheChi- neseMateriaMedica.²⁴Amongthem,186kinds,includingEquiseti herbaandPhytolaccaeradix,havealreadybeenreportedtohave antiviraleffects.Ifyoulookatthedefinitionsofherbalmedicine andmedicinalherbs,theyaremostlyofanimal,plant,andthemin- eraloriginandthendried,cutandpurifiedinitsoriginalform.In practice,thereareindeedmanymineral-basedmedicinesbesides plantsandanimalssuchassingleelementminerals ofGoldfoil andsulfur.So,themostimportantthinginthedefinitionofherbal medicineandmedicinalherbisthatitisdefinedbytheprinciples ofKM.Aside fromtheonesusedinthepast, newlydiscovered or developed ones,whetherit bea medicinal herb,an extract, ora singlecomponent, ifit canbeanalyzedbasedontheprin- ciplesofKM,thenitcancertainlybeusedinclinicalpractice.In otherwords,areWesternherbs,plant-basedremediescommonly usedinthelaycommunity,medicinalherbsbecausetheyareall plants?Notreally.Itcanonlybedefinedasmedicinalherbafterit hasbeenanalyzedintermsofKMonthetype,specifications,and drynessordampnesspatternitcanbeusedfor.Therefore,the4

propertiesand5ﬂavorsofherbsarepresentinnotonlynatural products,butallmedicines,eventheoneschemicallysynthesized.

Forexample,manyherbssuchasOlibanum,Myrrha,Styrax,Ben- zonium,CrociStigma,SennaeFolium,PanacisQuinquefoliiRadix, RhinoceriCornu,andDraconisSanguisarenotfromChina.Some wereimportedevenfromAfricatoChinaandareusedasmedicinal herbstoday.Newherbshavebeenestablishedasherbalmedicines overtime,andsimilarly,inKorea,variousherbs,surelyincluding Westernherbs,maybeusedasherbalmedicines.

NowonKMeducation,variouscoursesoninfectiousdiseases shouldbereinforced.Mostimportantly,studentsmustrealizethat the knowledge and training experience acquired through such coursesshouldbepartoftheirworkasKMDsinthefuturesothat theyaremotivatedtostudyhardincolleges.Theywillstudyeven harderatschoolandworkharderaftergraduationifthesetopics arereﬂectedinthenationalexamination.Ifnot,thenIthinkstu- dentswillnotbeaspersistentorinterested,evenifthecoursesare provided.

Researchonherbalmedicinetreatmentisaccomplishedbythe variouseffortsofresearchers,trainedandworkinginthefieldof KM,sothefindingsmustbeappliedinhumanhealthforsure,as wellasKMclinicalpractice.Currently,however,variousresearch findingscannotbeusedinKMclinicalpracticeduetolegalorreg- ulatorybarriers.Forexample,Shinbarotablet(GCSB-5),whichwas developedbytheJasengHospitalofKM,cannotbeusedbyKMDs, andonlyWMdoctorsareallowedtouseit.Whileitisbeneficialfor humanhealth,theKMcommunityisfacingmanydifficulties,asthe resultsofKMcommunity’shardworkandlargeinvestmentarenot permittedtobeappliedtothefieldofKM.FortheCOVID-19,itisa crucialfactorwhetherKMDscanuseresearchfindingsintheirprac- ticetotreatvarioussymptomsoftheCOVID-19.Therefore,research isessential,butIthinklegalandregulatoryimprovementsarealso necessary.

Toconclude,weneedtoreinforceeducationandcourses on infectiousdiseases,andIthink,linkingittotheworkofKMDswill bequitecrucial.IthinkweshouldcreateasysteminwhichKMDs canparticipateinthetreatmentofinfectiousdiseases.Intermsof research,weshouldadviseondevelopingherbalmedicinetreat- mentforinfectiousdiseasesthatcanbeusedbytheKMDsvialegal andregulatoryimprovements.

Hahm:Thankyou.Prof.HoyoungChoigaveusafulllectureon herbalmedicineandthingstobesupplemented,andheexplained thateducationandresearchmustbeexpandedtocoverinfectious

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diseases,butdeﬁnitelythereareregulatorybarrierstobeimproved.

Ithankallthepanelmemberswhopresentedearlier.

Lee: Thank you so much for sharing your valuable experi- encesandopinions.Thereweremanygoodcomments,andnoone expectstheanswerstobefoundinthisoneencounter.Theworldis rapidlychangingamidstmanyotherproblemsandIthinkthemost criticaltaskistoestablishthebasissothatwecanarguefortherole ofKMinacademicsandclinicalpractice,andofKMDsashealth- careprofessionals.Andasprof.Hahmsaid,suchataskshouldbegin witheducation.Ialsobelievethatalthoughtheworkineachﬁeldis different,theevidencefromeachareawilleventuallyaccumulate toestablishthesupportingbackground.Thereshouldstillbemany morediscussionsineachﬁeld,andIhopethatevenmoresound evidencebeestablishedthroughourefforts.Thankyou.

3. Summary

Many in vitroexperiments reported anti-coronaviruseffects oftraditionalherbsornaturalproductsandclinicaltrialsontra- ditionalherbalmedicineforCOVID-19arecurrentlyongoing. In additiontoestablishingresearchevidence,KMcommunityshould train and produce publichealth professionals among KMDs by improvingKMcollegeeducationprogramsandofﬁcialparticipa- tioninpublichealthcare systemshouldbeensured interms of regulationandpolicy.Inthepost-COVID-19era,italsoshouldbe allowedbyregulationsforKMDstoutilizenewlydevelopedherbal medicine/naturalproductsforviralinfectiousdiseasessothatsuch researchandrelevanteducationcanbemotivatedinKMcommu- nity.

Acknowledgments

TheauthorsthankDr.JeeyoungShin,Ms.EunjiKim,andMs.

JooyoungJofortheiradministrativeworkfortheonlinepaneldis- cussionevent.WealsoappreciateDrs.GunwoongKimandGajin Hanfortranscriptionandproofreadingofthemanuscript.

Authorcontribution

Conceptualization:HL.Methodology:HL.DataCuration:SPand HL.Writing –OriginalDraft:SP,D-HH, MJ,KK, SK,HC,and HL.

Writing–Review&Editing:SKandHL.Supervision:HL.Project Administration:HL.FundingAcquisition:HL.

Conﬂictofinterest

Theauthorsdeclarethattheyhavenoconﬂictofinterest.

Funding

ThisworkwassupportedbytheNationalResearchFoundation (NRF)ofKoreafundedbytheKoreangovernment(MinistryofSci- enceandICT,grantno.:NRF-2020R1A6A6017334).

Ethicalstatement

Thisworkdidnot requireanethicalapprovalasit doesnot involveanyhumanoranimalexperiment.

Dataavailability

The full recording of this online panel discussion can beaccessedathttps://www.kmcric.com/education/speciallecture/

viewseminar/42922.

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