Three plural medical systems in East Asia: interpenetrative pluralism in China, exclusionary pluralism in Korea and subjugatory pluralism in Japan

Amid persistent interest in and concerns about traditional, complementary and alternative medicine (TCAM) in low-, middle- and high-income countries, the global community of healthcare is in need of learning ways to institutionalize TCAM with biomedicine. By investigating how traditional East Asian medicine (TEAM), one of the most popular forms of TCAM in the world, is institutionalized in China, Korea and Japan, this study finds three different ways of instituting a plural medical system in which TCAM and biomedicine intersect with each other. In the interpenetrative pluralism in China and the exclusionary pluralism in Korea, TEAM and biomedicine are institutionalized as independent and equivalent systems of medical practices. However, TEAM and biomedicine are conditioned to cross over into each other unconditionally in practice in the former, whereas the two exclude each other very strictly in the latter. In the subjugatory pluralism in Japan, the crisscrossing of TEAM and biomedicine is allowed, yet in an asymmetrical way whereby the practice of TEAM is dependent upon and subordinated into biomedicine. The practice of various TEAM modalities is overseen by TEAM doctors, biomedicine doctors or integrative TEAM-biomedicine doctors in interpenetrative pluralism, by TEAM doctors only in exclusionary pluralism, and by biomedicine doctors only in subjugatory pluralism. These varying characteristics demonstrate a variety of plural medical systems. They also provide useful cues in accounting for the varying behaviours of medical service providers and users who encounter TCAM as well as biomedicine in their everyday practices. In addition, the growing literature about the outcomes of TCAM and plural medical systems can take advantage of these findings.