• 제목/요약/키워드: Juvenile Rheumatoid Arthritis

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LPS에 의해 자극된 RAW264.7 세포에 대한 계지가출부탕의 항염증활동 (Anti-inflammatory Activities of GyejigaChulBuTang on Lipopolysaccharide-stimulated RAW264.7 Cells)

  • 정민정;이승연;유선애;강경화
    • 대한한방소아과학회지
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    • 제28권3호
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    • pp.47-58
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    • 2014
  • Objectives GyejigaChulBuTang (GCBT) is a prescription used to treat acute and chronic arthritis in Korea, China, and Japan. This study assessed the anti-inflammatory and anti-oxidant activities of GCBT on lipopolysaccharide (LPS)-stimulated RAW264.7 macrophage cells. Methods Raw264.7 cells were pretreated with or without GCBT for 1 hour prior to incubation with LPS. Anti-inflammatory activity of GCBT was evaluated with reference to gene expression and production levels of proinflammatory cytokines ($TNF{\alpha}$, IL-$1{\beta}$, IL-6, GM-CSF and $INF{\gamma}$) and inflammatory mediators (iNOS, COX-2, NO and $PGE_2$). In addition, intracellular ROS generation and signal transduction of MAPK family, PI3K/Akt and $I{\kappa}B{\alpha}/NF{\kappa}B$ was investigated. Results Prior treatment with GCBT inhibited elevation of $TNF{\alpha}$, IL-$1{\beta}$, IL-6, GM-CSF, $INF{\gamma}$, NO and $PGE_2$, together with their cognate mRNAs in a dose-dependent manner. Intracellular ROS contents were similarly reduced. These effects were due to inhibition of LPS-induced phosphorylation of MAPK family, PI3K/Akt and $I{\kappa}B{\alpha}$ as well as nuclear translocation of $NF{\kappa}B$. Conclusions GCBT suppresses pro-inflammatory mediators. GCBT has potential in the treatment of juvenile rheumatoid arthritis associated with inflammation.

연소성 류마티스 관절염의 임상적 고찰 (Clinical observations of juvenile rheumatoid arthritis)

  • 이주훈;유정민;박영서
    • Clinical and Experimental Pediatrics
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    • 제49권4호
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    • pp.424-430
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    • 2006
  • 목 적 : JRA는 소아에서 가장 흔한 결체 조직 질환 중의 하나이고 장, 단기적인 신체장애를 유발하는 중요한 원인이 된다. 저자들은 JRA 환아들의 질병 양상과 경과를 알아보기 위하여 본 연구를 시행하였다. 방 법 : 1990년 8월부터 2004년 11월까지 서울아산병원 소아과를 내원한 59명의 JRA 환아를 대상으로 하였다. 성별, 연령, 유형, 침범 관절, 관절 외 소견, 검사 및 방사선 소견, 치료, 경과 등에 대하여 후향적으로 고찰하였다. 결 과 : 소수 관절형은 32.2%, 다수 관절형은 30.5%, 전신형은 37.3%였다. 남녀비는 1.7 : 1이었으며 평균 발병 연령은 $9.3{\pm}3.7$(1.3-15.9)세이었다. 가장 흔히 침범된 관절은 무릎과 발목, 팔목이었다. 관절 외 소견을 살펴보면 발열, 발진, 근육통, 림프절 비대 등이 있었다. 검사 소견을 살펴보면 백혈구증가증, 빈혈, 혈소판증가증, ESR 상승, CRP 상승 등의 소견을 보였다. 류마토이드 인자, 항핵항체 양성률은 각각 5.3%, 18.0%이었다. 비스테로이드성 소염제(NSAID)가 가장 많이 투여되었으며, 메토트렉세이트 또는 스테로이드를 함께 투여했던 경우가 27.1%였다. 88.1%의 환아에서 장애 후유증 없이 완치되었으며 한 명의 환아에서만 기능성 상태 IV의 장애가 있었다. 폐침범이 동반되었던 한 명의 환아가 사망하였다. 결 론 : 본 연구에서는 균등한 유형별 분포, 남아에서 호발하는 양상, 늦은 발병 연령, 낮은 홍채모양체염 발병률, 그리고 낮은 ANA 양성률을 보였는데 이러한 소견들은 한국에서의 JRA의 소견이며 서양에서의 보고와는 상이한 결과들이다. JRA가 민족과 지역에 따라서 서로 다른 발병양상을 보인다는 점을 시사한다고 생각된다. 앞으로 더 많은 수의 환자들을 대상으로 하는 다기관 협동 연구 및 역학조사가 필요할 것으로 생각된다.

섬유근통 증후군에 대한 문헌고찰 (The Literature Review of FibroMyalgia Syndrome)

  • 김명철;김진상
    • The Journal of Korean Physical Therapy
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    • 제16권4호
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    • pp.23-37
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    • 2004
  • Fibromyalgia syndrome(FMS) is a chronic pain disorder of unknown etiology characterized by widespread musculoskeletal aches and pains, stiffness, and general fatigue, disturbed sleep and sleepiness. Frequently misdiagnosed, FMS is often confused with myofascial pain syndrome, polymyalgia rheumatica, polymyositis, hypothyroidism, metastatic carcinoma, rheumatoid arthritis (RA), juvenile rheumatoid arthritis, chronic fatigue syndrome, or systemic lupus erythematosus, any of which may occur concomitantly with FMS. The management of FMS often begins with a thorough examination and a diagnosis from a physician who is formally trained in tender-point/trigger-point recognition. An initial diagnosis provides reassurance to the patient and often reduces the anxiety and depression patterns associated with FMS. The most common goals in the management of FMS are (1) to break the pain cycle, (2) to restore sleep patterns, and (3) to increase functional activity levels. Because FMS is a multifactorial syndrome, it is likely that the best treatment will encompass multiple strategies. Medication with analgesics and antidepressants and also physiotherapy, are often prescribed and give some relief. The other most effective intervention for long-term management of FS to date is physical exercise. Physical therapists can instruct patients in the use of heat at home (moist hot packs, heating pads, whirlpools, warm showers or baths, and hot pads) to increase local blood flow and to decrease muscle spasm and tension. Also instruct patients in the proper use of cold modalities (ice packs, ice massage, and cool baths) to anesthetize localized areas of pain (tender points) and break the pain cycle. Massage and tender-point massage also may promote muscle relaxation. To date, the two most important interventions for the long-term management of FS are patient education and physical exercise. Lately, is handling FMS and Chronic Fatigue syndrome(CFS) together, becuase FMS and CFS are poorly understood disorders that share similar demographic and clinical characteristics. Because of the clinical similarities between both disorders it was suggested that they share a common pathophysiological mechanism, namely, central nervous system dysfunction.

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Systematic review: agreement between the latent tuberculosis screening tests among patients with rheumatic diseases

  • Pyo, Junhee;Cho, Soo-Kyung;Kim, Dam;Sung, Yoon-Kyoung
    • The Korean journal of internal medicine
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    • 제33권6호
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    • pp.1241-1251
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    • 2018
  • Background/Aims: To estimate the level of agreement and positivity rates of latent tuberculosis infection (LTBI) tests prior to the use of tumor necrosis factor (TNF) inhibitors in relation to underlying rheumatic diseases and endemic tuberculosis levels. Methods: The Ovid-Medline, Embase, and Cochrane Libraries were searched for articles before October 2013 involving LTBI screening in rheumatic patients, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis. Results: In pooled analyses, 5,224 rheumatic patients had undergone both a tuberculin skin test (TST) and an interferon-gamma release assay (IGRA) before TNF inhibitors use. The positivity of TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB (T-SPOT) tests were estimated to be 29%, 17%, and 18%, respectively. The agreement percentage between the TST and QFT-GIT, and between the TST and T-SPOT were 73% and 75%. Populations from low-to-moderate endemic TB presented with slightly less agreement (71% between TST and QFT-GIT, and 74% between TST and T-SPOT) than patients from high endemic countries (73% between TST and QFT-GIT, and 81% between TST and T-SPOT). By underlying disease stratification, a lower level of agreement between TST and QFT-GIT was found among AS (64%) than among JIA (77%) and RA patients (73%). Conclusions: We reaffirm the current evidence for accuracy of LTBI test done by TST and IGRA among rheumatic patients is inconsistent. Our stratified analysis suggests different screening strategies might be needed in clinical settings considering the endemic status in the patient's country of origin and the precise nature of underlying diseases.

소아기 특발성 관절염 환자에서 관절 내 종양형태로 나타난 쌀소체: 증례 보고 (Rice Bodies Presenting as Intra-Articular Masses in Pediatric Idiopathic Arthritis: A Case Report)

  • 김동현;이지혜;정명자;김성희;김지영;김수현;강미진
    • 대한영상의학회지
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    • 제84권3호
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    • pp.731-735
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    • 2023
  • 쌀소체는 성인 류마티스 관절염 환자에서 종종 발생하나 소아의 경우에는 성인에 비해 드물게 발생한다. 저자들은 무릎 통증으로 내원한 11세 여자 환자의 무릎 자기공명영상에서 관절강 내 종괴를 발견하였고 관절경 검사에서 뭉쳐진 쌀소체들을 확인하였다. 소아에서 관절강 내 종괴 형태로 나타난 쌀소체의 자기공명영상 소견을 보고하고자 한다.

류마티스관절염 환자의 원인지각에 관한 질적 연구 (A Qualitative Study on the Acknowledgement of the cause of the illness in the Patients with RA)

  • 은영
    • 근관절건강학회지
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    • 제3권2호
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    • pp.151-165
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    • 1996
  • The purpose of this study is to describe the acknowledgement of the cause of the illness in the patients with RA. I used naturalistic inquiry as a research methodology. The purposive sampling was conducted. 23 subjects who experienced RA, lived in middle-sized city in Korea, and 19 women and 4 men. I collected data using indepth structured interview, "What is the acknowledgement of the cause of the illness?" I used inductive data analysis-such as unitizing and categorizing. This process is used constant comparative method. Summerising the results of this study, the acknowledgement of the cause of the illness are composed of physical constitution, fatalism, the attribution of physical overload, the attribution of stress, the lack of nutrition. The factors which affect the acknowledgement of the cause of the illness are composed of internal factors, external factors, environmental factors. The internal factors are the weakness of the childhood, the illness experience in the family members, juvenile rheumatoid arthritis, personality, lack of nutrition. The external factors are pregnancy, delivery, role burden and conflict, economic problem. The environmental factors are humid condition, abrupt environmental change. It is needed to explaine the coping pattern according to the acknowledgement of the cause of the illness in the next research.

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HLA 제 2 항원계 유전자 다형성(genomic polymorphism)과 질병감수성의 연관 (HLA Class II Variants and Disease Associations)

  • 김세종
    • 대한미생물학회지
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    • 제21권2호
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    • pp.171-179
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    • 1986
  • The HLA class II region encodes a series of polymorphic glycoproteins that form cell surface heterodimers each consisting of one $\alpha$ and one $\beta$ chain. Thess class II molecules are encoded by genes clustered within three loci. DP, DQ, and DR are functfonally implicated as regulatory signals in intercellular communication during the immune resposes. The phenotypic hallmark of the HLA complex is a high degree of structural and functional polymorphism. Detailed analysis. of such polymorphisms should aid in understanding the molecular basis for associations between HLA and diseases. We have used techniques of restriction enzyme fragment analysis by Southern blotting to investigate polymorphisms associated with DQ $\beta$ class II genes on haplotypes expressing the HLA-DR4 and -DQw3 specificities. The endonucleases Hind III and Bam HI were used to identify a specific DQ $\beta$ genomic polymorphism that precisely corrresponds with the reactivity of a monoclonal antibody A-10-83, previously shown to define a serologic split of DQw3. This study identifies two allelic DQ va. riants. DQw3.1 and DQw3.2. We used these specific genotypic markers to investigate the genomic basis of the association of DR4 with insulin-dependent diabetes mellitus(IDDM) and seropositive juvenile rheumatoid arthritis(JRA). The DR4 positive IDDM demonstrate the predominant expression of DQw3.2 and the very rare expression of DQw3.l. However, in haplotype matched siblings from two IDDM families, all of the DR4 positive siblings display a IDDM-associated DQw3.2 allele. Thus, both affected and healthy individuals can carry the same haplotypes and genomic markers, demonstrating that thess specific allelic variants are genetic elements that indicate a increased risk of IDDM but are not in fact disease specific. We contrasted this result with a similar analysis of patients with another DR4-associated disease, JRA. In contrast to the preponderance of the DQw3.2 allele in IDDM, the JRA patients expressed either the DQw3.1 or the DQw3.2 allele and sometimes both, without apparent association with disease expession. The different genomic markers reported here within HLA-DQ region potentially an analysis of HLA-associated function and disease susceptibility.

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소아 세균감염증에서 혈청 procalcitonin의 임상적 유용성 (Clinical Availability of Serum Procalcitonin in Children with Bacterical Infection)

  • 노은정;이소연;이규만;김광남
    • Pediatric Infection and Vaccine
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    • 제17권2호
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    • pp.108-113
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    • 2010
  • 목적: 소아 세균감염증에서 혈청 PCT 수치의 유용성를 알아보기 위하여 세균감염증 환자들의 PCT 수치와 바이러스 감염증 및 비감염성 염증질환인 Juvenile rhematoid arthritis (JRA) 환자들의 PCT 수치를 비교하였다. 또한 PCT 검사의 유용성을 CRP 검사와 비교하여 평가하였다. 방법: 2008년 4월부터 2009년 3월 사이에 소아청소년과에 입원치료 한 환자들 중 세균 감염이 확인된 10명, 바이러스 감염이 확인된 69명과 2007년 8월부터 2009년 7월 사이에 JRA로 입원한 35명의 환아들을 대상으로 후향적으로 조사하였다. 대상 환아들의 PCT와 CRP 수치를 분석하였고, 증상에 따라 추가되었던 배양검사와 바이러스검사 결과들로부터 환자들을 크게 세군감염군(I군)과 바이러스 감염군(II군), 비감염성 염증질환군(III군)으로 분류하여 각 군간의 PCT, CRP 수치를 비교하여 통계적 유의성을 평가하였다. 결과: I, II, III군의 CRP 평균값은 각각 62.07${\pm}$28.97 mg/L, 30.35${\pm}$15.49 mg/L, 17.95${\pm}$11.03 mg/L였고, PCT 평균값은 각각 5.56${\pm}$1.99 ng/mL, 0.24${\pm}$0.76 ng/mL, 0.06${\pm}$1.06 ng/mL로 CRP와 PCT 모두 세 군 사이에 통계적으로 유의한 차이를 보였다(P<0.05). 두 군간의 CRP를 비교하였을 때, I군과 II군 사이에는 통계적으로 유의한 차이를 보였으나(P=0.0057) I과 III, II과 III 사이에서는 유의한 차이를 보이지 않았다(P>0.05). 반면 두 군간의 PCT를 비교하였을 때 I군과 II, I군과 III군 모두 통계적으로 유의한 차이를 보였다(P<0.0001). PCT (Cutoff value=0.5 ng/mL)의 민감도와 특이도, 양성예측도와 음성예측도는 각각 60.0%, 92.3%, 42.9%, 96.0%였으며, CRP (Cutoff value=8 mg/L)의 민감도, 특이도, 양성예측도, 음성예측도는 각각 60.0%, 40.1%, 10.0%. 92.6%였다. 결론: 소아 세균감염 환자에서의 PCT검사는 비세균성 질환과 감별에 있어 CRP에 비해 유용한 검사라 할 수 있을 것이다.

소아기 피부근염의 진단 기준과 자가항체의 진단적 의의 (Association of Diagnostic Criteria and Autoantibodies with Juvenile Dermatomyositis in Newly Diagnosed Children)

  • 신경수;김중곤
    • Clinical and Experimental Pediatrics
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    • 제46권9호
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    • pp.898-902
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    • 2003
  • 목 적 : 소아기 피부근염 환아들의 진단 시 나타나는 임상적 특징과 소아기 피부근염의 진단 기준을 비교하여 조기 진단에 필요한 기준을 제시하고자 하였고, 소아기 피부근염에서 나타나는 자가항체들을 조사하여 진단에 유용한가를 알아보았다. 방 법 : 1985년 3월부터 1999년 3월까지 서울대학교병원 소아과에 내원하여 처음으로 소아기 피부근염으로 진단 받았던 32명의 환아들을 대상으로 성별, 남녀 비, 진단 시 나이, 진단 시 나타난 증상, 근육 효소치, 근전도 및 근육 생검 소견, 면역학적 이상 소견, 자가항체 검사 소견 등에 대한 자료를 의무 기록을 중심으로 후향적인 방법으로 조사하였다. 결 과 : 전체 32명의 환아들 중에서 남아가 8명, 여아가 24명 이었고, 남녀 비는 1 : 3이였다. 진단 시 평균 나이는 남아가 $4.6{\pm}6.9$세, 여아는 $6.9{\pm}7.3$세였고, 여아의 경우에는 진단 시 나이 분포가 2-3세경과 8-9세경에 빈발하였다. 소아기 피부근염의 진단 기준에서 특징적인 발진과 근위부 근육 약화 소견은 32명의 환아들 모두에서 나타났다. 한가지 이상의 근육 효소치의 증가가 있는 경우가 29명으로 90%이었고, 이 중에서 LDH의 증가가 28명(88%)으로 가장 많았다. 근육 생검은 16명(70%)에서 양성 소견이 나타났고, 근전도 검사는 20명(74%)에서 진단 기준에 합당한 소견이 나왔다. 진단 시 나타난 임상 증상들 중에서 근위부 근육의 통증과 압통이 17명(53%), 석회 침착증이 10명(31%)이었고, 연하 곤란(25%), 관절염(25%), 발열(22%) 등의 순으로 나타났다. 진단 시 자가항체로는 항핵항체와 류마티스성 인자를 제외하고는 모두가 음성이었다. 항핵항체는 14명(47%)에서 양성 이었고, 류마티스성 인자(RF)는 2명(7%) 만이 양성이었다. 결 론 : 소아기 피부근염의 진단 기준은 민감도는 높지만 조기 진단을 하기 위해서는 새로운 진단 기준이 필요한 것 같다. 소아기 피부근염에서는 성인에서 나타나는 근염-특이 자가항체의 양성률이 매우 낮아 임상적으로 혹은 검사 상으로 피부근염이 확실할 경우에는 자가항체를 검사하는 것은 의미가 없는 것으로 생각된다.

臨證指南醫案에 나타난 피부외과 질환에 대한 문헌고찰 (A Literature Study of Dermatosurgical Diseases in the ImJeungJiNamUiAn)

  • 조재훈;채병윤;김윤범
    • 한방안이비인후피부과학회지
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    • 제15권2호
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    • pp.271-288
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    • 2002
  • Authors investigated the pathogenesis and treatment of dennatosurgical diseases in the ImJeungJiNamUiAn(臨證指南醫案). 1. The symptoms and diseases of dermatosurgery were as follows; 1) BanSaJinRa(반사진라) : eczema, atopic dermatitis, seborrheic dermatitis, psoriasis, lichen planus, pityriasis rosea, hives, dermographism, angioedema, cholinergic urticaria, urticaria pigmentosa, acne, milium, syringoma, keratosis pilaris, discoid lupus erythematosus, hypersensitivity vasculitis, drug eruption, polymorphic light eruption, rheumatic fever, juvenile rheumatoid arthritis(Still's disease), acute febrile neutrophilic dermatosis(Sweet's syndrome), Paget's disease, folliculitis, viral exanthems, molluscum contagiosum, tinea, tinea versicolor, lymphoma, lymphadenitis, lymphangitis, granuloma annulare, cherry angioma 2) ChangYang(瘡瘍) : acute stage eczema, seborrheic dermatitis, stasis ulcer, intertrigo, xerosis, psoriasis, lichen planus, ichthyosis, pityriasis rosea, rosacea, acne, keratosis pilaris, dyshidrosis, dermatitis herpetiformis, herpes gestationis, bullae in diabetics, pemphigus, lupus erythematosus, fixed drug eruption, erythema multiforme, toxic epidermal necrolysis, toxic shock syndrome, staphylococcal scaled skin syndrome, scarlet fever, folliculitis, impetigo, pyoderma gangrenosum, tinea, candidiasis, scabies, herpes simplex, herpes zoster, chicken pox, Kawasaki syndrome, lipoma, goiter, thyroid nodule, thyroiditis, hyperthyroidism, thyroid cancer, benign breast disorder, breast carcinoma, hepatic abscess, appendicitis, hemorrhoid 3) Yeok(疫) : scarlet fever, chicken pox, measles, rubella, exanthem subitum, erythema infectiosum, Epstein-Barr virus infection, cytomegalovirus infection, hand-foot-mouth disease, Kawasaki disease 4) Han(汗) : hyperhidrosis 2. The pathogenesis and treatment of dermatosurgery were as follows; 1) When the pathogenesis of BalSa(발사), BalJin(發疹), BalLa(발라) and HangJong(項腫) are wind-warm(風溫), exogenous cold with endogenous heat(外寒內熱), wind-damp(風濕), the treatment of evaporation(解表) with Menthae Herba(薄荷), Arctii Fructus(牛蒡子), Forsythiae Fructus(連翹) Mori Cortex(桑白皮), Fritillariae Cirrhosae Bulbus(貝母), Armeniaoae Amarum Semen(杏仁), Ephedrae Herba(麻黃), Cinnamomi Ramulus(桂枝), Curcumae Longae Rhizoma(薑黃), etc can be applied. 2) When the pathogenesis of BuYang(부양), ChangI(瘡痍) and ChangJilGaeSeon(瘡疾疥癬) are wind-heat(風熱), blood fever with wind transformation(血熱風動), wind-damp(風濕), the treatment of wind-dispelling(疏風) with Arctii Fructus(牛蒡子), Schizonepetae Herba(荊芥), Ledebouriellae Radix(防風), Dictamni Radicis Cortex(白鮮皮), Bombyx Batrytioatus(白??), etc can be applied. 3) When the pathogenesis of SaHuHaeSu(사후해수), SaJin(사진), BalJin(發疹), EunJin(은진) and BuYang(부양) are wind-heat(風熱), exogenous cold with endogenous heat(外寒內熱), exogenous warm pathogen with endogenous damp-heat(溫邪外感 濕熱內蘊), warm pathogen's penetration(溫邪內陷), insidious heat's penetration of pericardium(伏熱入包絡), the treatment of Ki-cooling(淸氣) with TongSeongHwan(通聖丸), Praeparatum(豆?), Phyllostachys Folium(竹葉), Mori Cortex(桑白皮), Tetrapanacis Medulla(通草), etc can be applied. 4) When the pathogenesis of JeokBan(적반), BalLa(발라), GuChang(久瘡), GyeolHaek(結核), DamHaek(痰核), Yeong(?), YuJu(流注), Breast Diseases(乳房疾患) and DoHan(盜汗) are stagnancy's injury of Ki and blood(鬱傷氣血), gallbladder fire with stomach damp(膽火胃濕), deficiency of Yin in stomach with Kwolum's check (胃陰虛 厥陰乘), heat's penetration of blood collaterals with disharmony of liver and stomach(熱入血絡 肝胃不和), insidious pathogen in Kwolum(邪伏厥陰), the treatment of mediation(和解) with Prunellae Spica(夏枯草), Chrysanthemi Flos(菊花), Mori Folium (桑葉), Bupleuri Radix(柴胡), Coptidis Rhizoma(黃連), Scutellariae Radix(黃芩), Gardeniae Fructus(梔子), Cyperi Rhizoma(香附子), Toosendan Fructus(川?子), Curcumae Radix(鬱金), Moutan Cortex(牧丹皮), Paeoniae Radix Rubra(赤芍藥), Unoariae Ramulus Et Uncus(釣鉤藤), Cinnamorni Ramulus(桂枝), Paeoniae Radix Alba(白芍藥), Polygoni Multiflori Radix (何首烏), Cannabis Fructus (胡麻子), Ostreae Concha(牡蠣), Zizyphi Spinosae Semen(酸棗仁), Pinelliae Rhizoma(半夏), Poria(백복령). etc can be applied. 5) When the pathogenesis of BanJin(반진), BalLa(발라), ChangI(瘡痍), NamgChang(膿瘡). ChangJilGaeSeon(瘡疾疥癬), ChangYang(瘡瘍), SeoYang(署瘍), NongYang(膿瘍) and GweYang(潰瘍) are wind-damp(風濕), summer heat-damp(暑濕), damp-warm(濕溫), downward flow of damp-heat(濕熱下垂), damp-heat with phlegm transformation(濕熱化痰), gallbladder fire with stomach damp(膽火胃濕), overdose of cold herbs(寒凉之樂 過服), the treatment of damp-resolving(化濕) with Pinelliae Rhizoma(半夏), armeniacae Amarum Semen(杏仁), Arecae Pericarpium(大腹皮), Poria(백복령), Coicis Semen(薏苡仁), Talcum(滑石), Glauberitum(寒水石), Dioscoreae Tokoro Rhizoma(??), Alismatis Rhizoma(澤瀉), Phellodendri Cortex(黃柏), Phaseoli Radiati Semen(?豆皮), Bombycis Excrementum(?沙), Bombyx Batryticatus(白??), Stephaniae Tetrandrae Radix(防己), etc can be applied. 6) When the pathogenesis of ChangPo(瘡泡), hepatic abscess(肝癰) and appendicitis(腸癰) are food poisoning(食物中毒), Ki obstruction & blood stasis in the interior(기비혈어재과), damp-heat stagnation with six Bu organs suspension(濕熱結聚 六腑不通), the treatment of purgation(通下) with DaeHwangMokDanPiTang(大黃牧丹皮湯), Manitis Squama(穿山甲), Curcumae Radix(鬱金), Curcumae Longae Rhizoma(薑黃), Tetrapanacis Medulla(通草), etc can be applied. 7) When the pathogenesis of JeokBan(적반), BanJin(반진), EunJin(은진). BuYang(부양), ChangI(瘡痍), ChangPo(瘡泡), GuChang(久瘡), NongYang(膿瘍), GweYang(潰瘍), Jeong(정), Jeol(癤), YeokRyeo(疫?) and YeokRyeolpDan(疫?入?) are wind-heat stagnation(風熱久未解), blood fever in Yangmyong(陽明血熱), blood fever with transformation(血熱風動), heat's penetration of blood collaterals(熱入血絡). fever in blood(血分有熱), insidious heat in triple energizer(三焦伏熱), pathogen's penetration of pericardium(心包受邪), deficiency of Yong(營虛), epidemic pathogen(感受穢濁), the treatment of Yong & blood-cooling(淸營凉血) with SeoGakJiHwangTang(犀角地黃湯), Scrophulariae Radix(玄參), Salviae Miltiorrhizae Radix(丹參), Angelicae Gigantis Radix(當歸), Polygoni Multiflori Radix(何首烏), Cannabis Fructus(胡麻子), Biotae Semen(柏子仁), Liriopis Tuber(麥門冬), Phaseoli Semen(赤豆皮), Forsythiae Fructus(連翹), SaJin(사진), YangDok(瘍毒) and YeokRyeoIpDan(역려입단) are insidious heat's penetration of pericardium(伏熱入包絡), damp-warm's penetration of blood collaterals(濕溫入血絡), epidemic pathogen's penetration of pericardium(심포감수역려), the treatment of resuscitation(開竅) with JiBoDan(至寶丹), UHwangHwan(牛黃丸), Forsythiae Fructus(連翹), Curcumae Radix(鬱金), Tetrapanacis Medulla(通草), Acori Graminei Rhizoma(石菖蒲), etc can be applied. 9) When the pathogenesis of SaHuSinTong(사후신통), SaHuYeolBuJi(사후열부지), ChangI(瘡痍), YangSon(瘍損) and DoHan(盜汗) are deficiency of Yin in Yangmyong stomach(陽明胃陰虛), deficiency of Yin(陰虛), the treatment of Yin-replenishing(滋陰) with MaekMunDongTang(麥門冬湯), GyeongOkGo(瓊玉膏), Schizandrae Fructus(五味子), Adenophorae Radix(沙參), Lycii Radicis Cortex (地骨皮), Polygonati Odorati Rhizoma(玉竹), Dindrobii Herba(石斛), Paeoniae Radix Alba(白芍藥), Ligustri Lucidi Fructus (女貞子), etc can be applied. 10) When the pathogenesis of RuYang(漏瘍) is endogenous wind in Yang collaterals(陽絡內風), the treatment of endogenous wind-calming(息風) with Mume Fructus(烏梅), Paeoniae Radix Alba (白芍藥), etc be applied. 11) When the pathogenesis of GuChang(久瘡), GweYang(潰瘍), RuYang(漏瘍), ChiChang(痔瘡), JaHan(自汗) and OSimHan(五心汗) are consumption of stomach(胃損), consumption of Ki & blood(氣血耗盡), overexertion of heart vitality(勞傷心神), deficiency of Yong(營虛), deficiency of Wi(衛虛), deficiency of Yang(陽虛), the treatment of Yang-restoring & exhaustion-arresting(回陽固脫) with RijungTang(理中湯), jinMuTang(眞武湯), SaengMaekSaGunjaTang(生脈四君子湯), Astragali Radix (황기), Ledebouriellae Radix(防風), Cinnamomi Ramulus(桂枝), Angelicae Gigantis Radix(當歸), Ostreae Concha(牡蠣), Zanthoxyli Fructus(川椒), Cuscutae Semen(兎絲子), etc can be applied.

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