What Do Constitution Prescription and Temperament Analysis Attend to First? The Therapeutic Focus of Sasang Neuropsychiatry as Seen Through Two Clinical Texts

Method — Narrative review. No formal quality appraisal (such as GRADE) was performed.

• Sources searched: PubMed (E-utilities), KCI (Journal of Oriental Neuropsychiatry), the Korean Medicine Classics Database (mediclassics.kr; the 1901 Sinchuk edition of 東醫壽世保元, Dongui Suse Bowon), and the Sasang medicine corpus of the clinic library (the clinical volume of Saeroseun Sasang Uihak, Sasang Simhak, and the lectures and case records of Taeyul)
• Search date: 2026-09-27
• PubMed search string (to identify trials of constitution-specific treatment): (Sasang[tiab] OR "constitutional medicine"[tiab] OR "Sasang constitution"[tiab]) AND (random*[tiab] OR "clinical trial"[pt]) AND (depress*[tiab] OR anxiety[tiab] OR insomnia[tiab] OR panic[tiab] OR "hwa-byung"[tiab] OR hwabyung[tiab] OR psychiatr*[tiab] OR mental[tiab]) → 1 record, excluded because its subject was gynecological
• Inclusion criteria: literature that addresses Sasang constitution together with mental health, or that reports on the actual practice of neuropsychiatric care in Korean medicine. Korean dissertations, conference abstracts, and an exhaustive KCI search were not included.

1. Summary

This paper selects two clinical texts on neuropsychiatric treatment in Sasang constitutional medicine and compares them as representatives of the constitution-prescription approach and the temperament-analysis approach (Sasang Simhak). The first is the clinical volume of Ryu Ju-yeol's Saeroseun Sasang Uihak (Sasang Medicine, Newly Written). It classifies depression, anxiety, and insomnia by 臟腑辨證, jangbu byeonjeung—pattern identification according to the functional state of the visceral organ systems—and assigns to each pattern a formula for each of the four constitutions. The second comprises 四象心學 Sasang Simhak (Kang Yong-hyuk, 2010) and the case records of Taeyul (太栗, Kim Do-sun). These works superimpose the theory of 性情, seongjeong—innate nature and emotional disposition—found in Dongui Suse Bowon onto Jung's analytical psychology, and place clinical interviewing and self-analysis at the center of treatment. Constitution serves a different function in each body of work. In the former, constitution is a coordinate for selecting a prescription, and the mind is an object observed through symptoms. In the latter, constitution is a framework for reading seongjeong and interpersonal relationships. Contemporary studies have reported associations between Sasang constitution and both temperament and depressive symptoms, but evidence for the efficacy of constitution-tailored treatment remains limited. The contribution of this paper lies not in fixing the respective domains of the two approaches, but in showing how the focus of treatment differs between them and in formulating verification questions that an integration of the two would need to answer.

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2. Context of the Question

Dongui Suse Bowon, the 1894 treatise in which Yi Je-ma (李濟馬) founded Sasang constitutional medicine, places its discourses on human nature and destiny (性命論, Seongmyeongnon), on the four beginnings (四端論, Sadanron), and on expansion and fulfillment (擴充論, Hwakchungnon) before its discussion of disease patterns. In these chapters it explains the relative sizes of the visceral organs in each of the four constitutions—the 臟局, janguk, or visceral configuration—as the result of an imbalance among joy, anger, sorrow, and pleasure (喜怒哀樂). Judged by this structure alone, neuropsychiatric disorders such as depression and anxiety fall within a domain that Sasang medicine can address in the language of its own founding text.

Clinical practice presents a somewhat different picture. A 2024 survey of 864 Korean medicine doctors found that nearly all used acupuncture (95.4%) and herbal medicine (94.0%) in treating hwa-byung (a Korean culture-bound anger syndrome), whereas only about one in four used the mind–body interventions (26.2%) and psychotherapy (21.3%) recommended by the clinical practice guideline. According to national health insurance data, the number of patients receiving Korean medicine care for depression fell by 40.37%, from 3,607 in 2012 to 2,151 in 2021, while the number receiving conventional medical care rose by 49.32% over the same period. Neither of these investigations considered Sasang constitution separately.

This raises the question of what focus neuropsychiatric treatment has been designed around within Sasang medicine itself. This paper approaches the question by setting side by side two clinical texts of clearly different character. The two texts are not taken to represent the whole of Sasang clinical practice. Rather, they are read as cases that bring the two foci into sharp relief.

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3. What the Literature Says

1. The Starting Point in the Classic: Imbalanced Temperament Shapes the Visceral Configuration

The Sadanron chapter of Dongui Suse Bowon explains the relative sizes of the viscera in the four constitutions by an imbalance between 性, seong—the innate nature, which in Yi Je-ma's usage refers to the emotions as they arise in response to the wider world—and 情, jeong—the emotions as they arise in response to personal affairs.

太陽人, 哀性遠散, 而怒情促急, 哀性遠散, 則氣注肺, 而肺益盛, 怒情促急, 則氣激肝, 而肝益削, 太陽之臟局, 所以成形於肺大肝小也.

In the Taeyangin, the sorrow-nature disperses far and the anger-emotion is hurried and urgent. When the sorrow-nature disperses far, qi pours into the lung and the lung grows ever more exuberant; when the anger-emotion is hurried and urgent, qi strikes the liver and the liver is ever more diminished. This is why the visceral configuration of the Taeyang type takes the form of a large lung and a small liver.

— 『東醫壽世保元』 Dongui Suse Bowon, Sadanron [2-10] (mediclassics.kr/books/182/volume/1#content_50)

The same article continues with an identical structure for the Soyangin, Taeeumin, and Soeumin types. On this premise, Yi Je-ma recorded separately, for each constitution, the emotions against which it must guard.

太陽人, 有暴怒深哀, 不可不戒, 少陽人, 有暴哀深怒, 不可不戒. 太陰人, 有浪樂深喜, 不可不戒, 少陰人, 有浪喜深樂, 不可不戒.

The Taeyangin is prone to violent anger and deep sorrow, and must guard against them; the Soyangin is prone to violent sorrow and deep anger, and must guard against them. The Taeeumin is prone to unrestrained pleasure and deep joy, and must guard against them; the Soeumin is prone to unrestrained joy and deep pleasure, and must guard against them.

— Dongui Suse Bowon, Sadanron [2-18] (mediclassics.kr/books/182/volume/1#content_58)

As to why emotions arise in an imbalanced manner, the text answers in the language of self-cultivation.

天下喜怒哀樂之暴動浪動者, 都出於行身不誠, 而知人不明也.

All violent and unrestrained stirrings of joy, anger, sorrow, and pleasure in the world arise from conducting oneself without sincerity and from a lack of clarity in understanding others.

— Dongui Suse Bowon, Sadanron [2-20] (mediclassics.kr/books/182/volume/1#content_60)

What this article explains is the violent stirring (暴動, pokdong) and unrestrained stirring (浪動, nangdong) of joy, anger, sorrow, and pleasure; it does not speak to the causes of mental disorders as defined in contemporary diagnostic systems. This paper therefore reads the article not as a theory of etiology but as an expression of the classic's view that emotional regulation is a task of self-reflection and of understanding others. It cannot be used as grounds for attributing a mental disorder to a patient's conduct or perception.

2. The Classic's Account of Disease: How a Habitual Mind Progresses to Serious Illness

In the chapter 四象人辨證論, Sasangin Byeonjeungnon (Discourse on Differentiating the Four Types), Yi Je-ma records for each constitution the mind it constantly harbors—恒心, hangsim (the habitual mind)—and shows in stages which disease pattern results when that mind deepens.

太陰人, 恒有怯心, 怯心寧靜, 則居之安, 資之深, 而造於道也, 怯心益多, 則放心桎梏, 而物化之也, 若怯心, 至於怕心, 則大病, 作而怔忡也, 怔忡者, 太陰人病之重證也.

The Taeeumin constantly harbors a timid mind. When the timid mind is settled and tranquil, he dwells in ease, accumulates his resources deeply, and advances toward the Way; when the timid mind grows greater, his mind is fettered and he is swayed by external things. If the timid mind reaches the point of a dreading mind, a grave illness arises in the form of palpitation with fright; this palpitation is the serious pattern among the illnesses of the Taeeumin.

— Dongui Suse Bowon, Sasangin Byeonjeungnon [17-11] (mediclassics.kr/books/182/volume/4#content_236)

少陽人, 恒有懼心, … 若懼心, 至於恐心, 則大病, 作而健忘也, 健忘者, 少陽人病之險證也.

The Soyangin constantly harbors a fearful mind … If the fearful mind reaches the point of a terrified mind, a grave illness arises in the form of forgetfulness; this forgetfulness is the dangerous pattern among the illnesses of the Soyangin.

— Dongui Suse Bowon, Sasangin Byeonjeungnon [17-12] (mediclassics.kr/books/182/volume/4#content_237)

少陰人, 恒有不安定之心, 不安定之心寧靜, 則脾氣, 卽活也, 太陽人, 恒有急迫之心, 急迫之心寧靜, 則肝血, 卽和也.

The Soeumin constantly harbors an unsettled mind; when the unsettled mind is settled and tranquil, the spleen qi immediately becomes vigorous. The Taeyangin constantly harbors an impatient mind; when the impatient mind is settled and tranquil, the liver blood immediately becomes harmonious.

— Dongui Suse Bowon, Sasangin Byeonjeungnon [17-13] (mediclassics.kr/books/182/volume/4#content_238)

These three articles lay out, in sequence, the ordinary habitual mind (怯心, geopsim, the timid mind; 懼心, gusim, the fearful mind; 不安定之心, buranjeong ji sim, the unsettled mind; and 急迫之心, geuppak ji sim, the impatient mind), the stage at which that mind has deepened (怕心, pasim, the dreading mind; 恐心, gongsim, the terrified mind), and the disease pattern at the end of the progression (怔忡, jeongchung—palpitation accompanied by fright and anxiety; 健忘, geonmang—forgetfulness). The direction of recovery is given as 寧靜, yeongjeong—settledness and tranquility—and [17-13] links it directly to the harmonization of the spleen qi (脾氣, bigi) and the liver blood (肝血, ganhyeol). Within the classic, change in the mind and change in the body lie on a single pathway.

3. The Constitution-Prescription Approach: Matching Visceral Pattern Identification to Formulas for the Four Constitutions

The neuropsychiatry chapter in the clinical volume of Ryu Ju-yeol's Saeroseun Sasang Uihak covers psychoneurosis, insomnia, and obsessive-compulsive symptoms; anxiety disorders; periodic psychosis; mood disorders; and organic mental disorders. Each condition is divided into jangbu byeonjeung patterns such as liver qi stagnation (肝氣鬱結證), liver stagnation with phlegm retention (肝鬱痰滯證), dual deficiency of the heart and spleen (心脾兩虛證), and heart–gallbladder qi deficiency (心膽氣虛證), and each pattern is matched with a formula for the Taeeumin, Soyangin, Taeyangin, and Soeumin types. For example, for the spleen qi deficiency pattern (脾氣虛證) of mood disorder—a depression in which everything feels burdensome, the patient is listless, appetite is poor, and sleep is excessive—the text specifies the treatment principle of strengthening the spleen and boosting qi (健脾益氣) and, under it, prescribes Uiiin-geonbi-tang (薏苡仁健脾湯) for the Taeeumin, Hongmaek-geonbi-tang (紅麥健脾湯) for the Soyangin, and Gyomaek-geonbi-tang (蕎麥健脾湯) for the Taeyangin.

The distinguishing feature of this text is the explicitness of its prescription-selection process. Because the key points for pattern identification are written in the language of symptoms, it is clear which clinical findings lead to which formula. Whether different Korean medicine doctors would reach the same judgment for the same patient, however, could only be established with separate inter-rater agreement data. The management guidance is also concrete. The textbook recommends hospitalization when there is a history of suicide attempts or severe mania, and advises that lifestyle guidance be given to the patient in writing, specifying times for waking, meals, and walking. With regard to psychiatric medications the patient is already taking, it stresses the danger of discontinuing them without supervision and describes a gradual taper. This is what the textbook states. In current practice, the principle is that any adjustment of medication is made in consultation with the prescribing psychiatric team.

What this paper focuses on is how the diagnostic axis is constructed. In this chapter, the seongjeong terms of Dongui Suse Bowon (joy, anger, sorrow, and pleasure; 喜·怒·哀·樂) are not used as diagnostic criteria, and the word "interview" does not appear at all (based on a full-text search of the chapter). This does not mean that seongjeong is excluded from constitution-prescription practice as a whole. It means that, in this text, constitution functions as a coordinate for selecting a prescription and the mind functions as an object observed through symptoms.

4. The Temperament-Analysis Approach: Sasang Simhak

Kang Yong-hyuk's Sasang Simhak (2010) defines this approach as follows.

Sasang Simhak (四象心學) is a science of temperament analysis within the field of Korean medical neuropsychiatry, grounded in the Sasang medicine of Dongmu Yi Je-ma and the analytical psychology of Carl Gustav Jung.

— Kang Yong-hyuk, Sasang Simhak (四象心學), Daeseong Uihaksa, 2010

The same book positions itself as "differing somewhat from the prevailing atmosphere of the existing Sasang medicine community, whose main concerns are constitutional classification and medication, in that it centers on self-analysis and on inquiry into the psychiatric domain." The system is described as having been first proposed by Taeyul, a doctor of Korean medical neuropsychiatry, in his 1993 "Dongui Simhak Chogo" (A First Draft of Eastern Medical Psychology), and as having been handed down to junior Korean medicine doctors through apprenticeship over some twenty years. Although long-term clinical transmission and an accumulation of cases exist, this paper found, within its search scope, no data in which the procedures and outcomes had been verified externally.

Its view of treatment warns against turning the four constitutions into a manual. Yi Je-ma's classification of the four types is regarded as "merely a broad-framework distinction of the fact that innate seongjeong differs in four ways," and not as implying that a single, identical treatment exists for everyone with the same disposition. The primary goal at the medical level is to help patients understand the imbalance of their own body and mind, and the approach also requires self-analysis on the part of the clinician who conducts the analysis.

One of Taeyul's case records illustrates how the method is applied. A 1996 case record describes a 23-year-old woman who had experienced auditory hallucinations for five years. The diagnosis given in the record is "simple-type schizophrenia." For this patient, Taeyul drew up a three-year plan that began with weekly interviews and later tapered to one interview every two weeks. Judging that causal analysis would be dangerous while the ego remained immature, he set ego strengthening as the goal, and he assessed the constitution of each parent together with the family dynamics. This is a single case, and the plan does not indicate the typical duration of treatment in this approach.

5. The Position of Contemporary Research: Associations Have Been Reported, but Evidence for Tailored Treatment Is Limited

Associations between Sasang constitution and psychological characteristics have been reported across a range of instruments and samples. The Sasang Personality Questionnaire (SPQ) showed an internal consistency of .817 and a test–retest reliability of .837 in a sample of 245 participants, with scores increasing in the order Soeumin (24.43), Taeeumin (27.33), and Soyangin (30.90). In a temperament assessment of 97 adult patients, Soeumin participants scored higher on harm avoidance than Soyangin participants (44.64 vs 35.16, P=.003). In a cross-sectional survey of 653 community residents, Soeumin individuals were more likely than Soyangin individuals to fall into the group with depressive symptoms as defined by the CES-D (adjusted odds ratio 2.907, 95% CI 1.379–6.144). This is a prevalence association at a single time point, not a result from tracking the risk of developing depression. In a heart rate variability study of 399 healthy adults, indices in the Soeumin group differed from those in the non-Soeumin group (lower LF/HF, P=.002). The investigators interpreted this as vulnerability to stress, while noting that the participants had no related clinical problems. A literature analysis pooling 33 Korean SPQ studies (15,085 participants) reported the same order of scores.

On the treatment side, the evidence is limited. There are examples of constitutional instruments being used for assessment, such as the report that the SPQ subscales explained 26.0% of psychological symptoms in 118 patients with hwa-byung. However, the PubMed search conducted for this paper identified no randomized controlled trial that allocated different treatments by constitution and compared them. Even among herbal medicine trials that did not take constitution into account, a double-blind, placebo-controlled trial of Bunsimgi-eum (分心氣飮)—a formula for 七情傷, chiljeongsang, or injury by the seven emotions—in hwa-byung found that both groups improved but that the between-group difference was not significant. With respect to mind–body interventions, a systematic review of nine hwa-byung studies reported that art therapy improved scores on the Hwa-byung Scale (mean difference −7.74, 95% CI −9.81–−5.66), while also pointing out methodological weaknesses such as the absence of assessor blinding.

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4. Cross-Reading

The difference between the two texts lies less in their tools than in what each attends to first.

Because contemporary research belongs to neither approach, it is summarized separately.

Taeyul divided disease groups into levels: disorders whose cause is to be removed by surgery or new drugs belong to the level of the physical substrate (物, mul); disorders to be regulated by herbal medicine, diet, and lifestyle belong to the level of the body (身, sin); and disorders to be harmonized through psychoanalysis or interviewing belong to the level of the mind (心, sim). This paper adopts that clinical classification as its interpretive framework. Viewed through this framework, the constitution-prescription approach attends primarily to the bodily state, and the temperament-analysis approach attends primarily to seongjeong and to patterns of relationship. Neither is confined to a single level. Herbal medicines are prescribed with symptoms of the mind in view, and interviewing also addresses bodily symptoms. Just as articles [17-11]–[17-13] of the classic trace a single pathway from geopsim to jeongchung, and from the settling of buranjeong ji sim to the invigoration of bigi, the two foci are continuous within a single patient.

The association of Soeumin constitution with harm avoidance and depressive symptoms in contemporary research resembles, in its explanatory structure, the classic's buranjeong ji sim. This is a similarity between two descriptions that differ in their objects of observation and in their systems of measurement; it does not demonstrate that they describe the same phenomenon.

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5. What Remains Unknown

Within the search scope of this paper, no study was found that evaluated the efficacy of a treatment combining the two foci. The records of Sasang Simhak survive through apprenticeship-based transmission and online postings, so its procedures and outcome indicators have not been standardized. Nor was any work found that has translated the classic's stages of hangsim (geopsim → pasim → jeongchung) into scales currently in use. The SPQ and temperament inventories measure ordinary tendencies, but they do not measure the stage at which that habitual mind passes over into illness.

The verification questions to be addressed in subsequent papers in this series are as follows.

1. Can the interview and diary-analysis procedures of Taeyul's Sasang Simhak be reconstructed in terms of stages and outputs? (Part 2)
2. What intervention hypotheses can be derived from the description of personality pathology concerning 鄙薄貪懦, bibak-tamna—the four vices of meanness, frivolity, greed, and cowardice that Yi Je-ma attributes to the four types? (Part 3)
3. Can the stages of hangsim be translated into measurable items?
4. By what design can the additional effect of a combined procedure—chejilbang medication supplemented by seongjeong-focused interviewing—be tested? (Part 4, protocol)
5. How should criteria for collaborative care with psychiatry be formalized for patients who are taking psychiatric medication?

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6. Source Citation Cards

In each card, "Text verified" records the extent to which this paper actually checked the source, and "Study type" records the kind of literature. Because no formal quality appraisal was conducted, no certainty-of-evidence grades were assigned.

Source 1 [KM]

• Source: 『東醫壽世保元』 Dongui Suse Bowon, 1901 Sinchuk edition, Sadanron [2-10], [2-18], [2-20]
• Author/Era: Yi Je-ma, Joseon dynasty (1901 Sinchuk edition)
• MEDICLASSICS: mediclassics.kr/books/182/volume/1#content_50 · #content_58 · #content_60
• Text verified: Direct comparison with the original text | Study type: Classical text
• Key point: Imbalance of seongjeong shapes the visceral configuration, and the violent and unrestrained stirring of joy, anger, sorrow, and pleasure is explained as a task of self-cultivation.

Source 2 [KM]

• Source: Dongui Suse Bowon, 1901 Sinchuk edition, Sasangin Byeonjeungnon [17-11]–[17-13]
• Author/Era: Yi Je-ma, Joseon dynasty (1901 Sinchuk edition)
• MEDICLASSICS: mediclassics.kr/books/182/volume/4#content_236 · #content_237 · #content_238
• Text verified: Direct comparison with the original text | Study type: Classical text
• Key point: When the constitution-specific hangsim deepens, it becomes a serious pattern such as jeongchung or geonmang; when it is settled, visceral function is harmonized.

Source 3 [KM]

• Source: Saeroseun Sasang Uihak (『새로쓴 四象醫學』), clinical volume, neuropsychiatry chapter
• Author/Year: Ryu Ju-yeol, 2013
• Text verified: Full text (clinic library corpus) | Study type: Clinical textbook
• Key point: Matching of jangbu byeonjeung patterns to formulas for the four constitutions; management guidance including hospitalization criteria and lifestyle instruction.

Source 4 [KM]

• Source: Sasang Simhak (『四象心學』)
• Author/Year: Kang Yong-hyuk, Daeseong Uihaksa, 2010
• Text verified: Full text (clinic library corpus) | Study type: School textbook
• Key point: A science of temperament analysis combining Sasang medicine with analytical psychology; caution against manualization; self-analysis by the therapist.

Source 5 [KM]

• Source: Taeyul (Kim Do-sun), "Sasang Simhak: Simple-Type Schizophrenia, Case I" (posted on Mandala Seowon, #1272), 1996
• Text verified: Full text (transcription of a scanned copy) | Study type: Single case record
• Key point: Classification into the levels of mul, sin, and sim; a three-year interview plan tapering from weekly to once every two weeks; ego strengthening as the goal.

Source 6 [WM]

• Source: Development and validation of a personality assessment instrument for traditional Korean medicine: Sasang Personality Questionnaire
• Author/Year: Chae H et al., 2012, Evid Based Complement Alternat Med (PMID 22567034)
• Text verified: Abstract | Study type: Instrument development and validation
• Key point: 245 participants; α=.817; test–retest r=.837; order Soeum < Taeeum < Soyang.

Source 7 [WM]

• Source: Temperament and character profiles of Sasang typology in an adult clinical sample
• Author/Year: Park SH et al., 2011, Evid Based Complement Alternat Med (PMID 19380352)
• Text verified: Abstract | Study type: Cross-sectional study
• Key point: 97 participants; harm avoidance 44.64 in Soeumin vs 35.16 in Soyangin (P=.003).

Source 8 [WM]

• Source: Sasang Constitution May Act as a Risk Factor for Depressive Symptoms — A Survey for Local Residence
• Author/Year: Kim Y, Jang E, 2022, Healthcare (Basel) (PMID 36011205)
• Text verified: Abstract | Study type: Cross-sectional survey
• Key point: 653 participants; membership in the CES-D depressive-symptom group; Soeumin vs Soyangin adjusted OR 2.907 (1.379–6.144); unadjusted OR 2.315.

Source 9 [WM]

• Source: Heart rate variability in middle-aged adults: Use of Sasang typology to distinguish individuals susceptible to stress
• Author/Year: Oh H et al., 2019, Medicine (Baltimore) (PMID 31689836)
• Text verified: Abstract | Study type: Cross-sectional study (healthy adults)
• Key point: 399 participants; higher nHF and lower LF/HF in Soeumin. No accompanying clinical problems.

Source 10 [WM]

• Source: Biopsychological pattern underlying the psychosomatic symptoms of patients with Hwabyung from a universal perspective
• Author/Year: Chae H et al., 2025, Biopsychosoc Med (PMID 41163073)
• Text verified: Abstract | Study type: Cross-sectional study
• Key point: 118 participants; the SPQ explained 26.0% of psychological symptoms and 14.3% of somatic symptoms of hwa-byung.

Source 11 [WM]

• Source: A systematic literature analysis of the use of the Sasang Personality Questionnaire (SPQ) in Korean medicine (사상성격검사(SPQ)의 한의학적 활용 현황에 대한 체계적 문헌 분석)
• Author/Year: Kim MS (Min Seong Kim) et al., 2021, Journal of Oriental Neuropsychiatry (『동의신경정신과학회지』) 32(3):167–184
• Text verified: Abstract | Study type: Literature analysis
• Key point: 33 studies; 15,085 participants; SPQ total score Soeum < Taeeum < Soyang.

Source 12 [WM]

• Source: Development of digital therapeutics in Hwa-byung treatment: exploring innovation potential in Korean medicine through practitioner survey
• Author/Year: Kwon CY, Front Med (Lausanne), published 15 January 2025 (eCollection 2024; 11:1512337) (PMID 39882515)
• Text verified: Abstract | Study type: Questionnaire survey (August–September 2024)
• Key point: 864 Korean medicine doctors; acupuncture 95.4% and herbal medicine 94.0% vs mind–body interventions 26.2% and psychotherapy 21.3%.

Source 13 [WM]

• Source: Gap between the Scientificization and Utilization of Korean Medicine for Depressive Disorder in South Korea
• Author/Year: Kwon CY, 2022, J Clin Med (PMID 36498597)
• Text verified: Abstract | Study type: Claims data analysis
• Key point: Patients receiving Korean medicine care for depression: 3,607 (2012) → 2,151 (2021), −40.37%; conventional medical care +49.32%.

Source 14 [WM]

• Source: The effect of Bunsimgi-eum on Hwa-byung: randomized, double blind, placebo controlled trial
• Author/Year: Kim SH et al., 2012, J Ethnopharmacol (PMID 23026303)
• Text verified: Abstract | Study type: RCT
• Key point: Within-group improvement; no significant between-group difference.

Source 15 [WM]

• Source: Effectiveness of mind-body medicine for Hwa-Byung: A systematic review of interventional studies
• Author/Year: Kwon CY, Lee B, 2024, Complement Ther Med (PMID 38185401)
• Text verified: Abstract | Study type: Systematic review and meta-analysis
• Key point: 9 studies; art therapy HB-S MD −7.74 (−9.81–−5.66); methodological weaknesses.

Source 16 [Author's prior work]

• Source: A contemporary reinterpretation of bibak-tamna (鄙薄貪懦): a structural analogy analysis of the Sasang Simhak theory of personality pathology and DSM-5 personality disorders
• Author/Year: Choi Jang-hyuk, 2026, Sowonjae (sowonjae.dongjedang.com/post/2026-03-31-bibaktamna-dsm5-reinterpretation-v5/)
• Study type: Theoretical comparative study
• Key point: The theoretical axis of the Sasang Simhak theory of personality pathology; to be extended to the stage of intervention in Part 3.

Source 17 [Author's prior work]

• Source: A structural comparison of 心地淸濁, simji cheongtak (the clarity and turbidity of the mind-ground), and individuation
• Author/Year: Choi Jang-hyuk, 2026, Sowonjae (sowonjae.dongjedang.com/post/2026-04-01-simji-cheongtak-individuation/)
• Study type: Theoretical comparative study
• Key point: A comparison of Yi Je-ma's theory of self-cultivation and Jung's individuation as models of personality integration.

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Choi Jang-hyuk | Doctor of Korean Medicine · Director, Dongjedang Korean Medicine Clinic · Method: narrative literature review (cross-reading of PubMed, KCI, the Korean Medicine Classics Database, and the clinic library corpus)