Clinical reasoning in traditional medicine exemplified by the clinical encounter of Korean medicine: a narrative review

Abstract

Background: Clinical reasoning is generally defined to be a way of thinking for diagnostic or therapeutic decision making in clinical practice. Different cognitive models have been proposed for the clinical reasoning which takes place during the clinical encounter with a patient. This may have similarities with similar approaches used in Traditional Korean Medicine (TKM). Jinchal, the clinical encounter, has specific features in TKM and different Jinchal processes are closely related to several underlying cognitive models in clinical reasoning. It is a necessary process to see the patient, but in TKM, the method has a characteristic aspect and emphasis is placed on importance.

Methods: Experts consensus were reached through panel discussion. Narrative description on the concept of clinical reasoning and explanation on Jinchal process in TKM were suggested.

Results: This article analyses the Jinchal process using theoretical concepts from four authentic KM schools of clinical reasoning which are currently used in contemporary practice.

Conclusion: Future research should focus on the similarities and differences in understanding clinical reasoning in KM as well as the broader field of traditional East Asian Medicine.

Keywords: Clinical encounter; Clinical reasoning; Jinchal; Theoretical models; Traditional Korean medicine and narrative review.

Fig. 1

An example of hypothetico-deductive reasoning process when diagnosing common cold in traditional Chinese medicine. This is an example case of hypothetico-deductive reasoning process which can be observed during the diagnosis of common cold in traditional Chinese medicine.

Fig. 2

Jinchal process in the Pattern Identification system. Jinchal process in the Pattern Identification system is considered to be the most basic procedure of the diagnosis in Korean Medicine. The circled portion of the figure is the specific point of this clinical reasoning system.

Fig. 3

Jinchal process in the Decoction-Pattern system. Specific features of clinical reasoning in Decoction-Pattern system is decided by the decision procedure of decoction based on the Shanghanlun text. The circled portion of the figure is the specific point of this clinical reasoning system.

Fig. 4

Jinchal process in the Condition-Decoction system. Specific features of clinical reasoning in Condition-Decoction system is to find most appropriate pattern and decoction based on the patient’s chief complaint. The circled portion of the figure is the specific point of this clinical reasoning system.

Fig. 5

Jinchal process in the Sasang constitutional medicine system. Specific features of clinical reasoning in Sasang constitutional medicine system is to define a person’s constitution first and clinical reasoning proceeds based on the constitution. The circled portion of the figure is the specific point of this clinical reasoning system.