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신장(腎), 뼈(骨), 치아(齒)의 관계에 대한 동서의학적 고찰

A Study of the Relationship Between Kidneys, Bones, and Teeth in Eastern-Western Medicine

  • 이은비 (대전대학교 한의과대학) ;
  • 한상윤 (대전대학교 한의과대학)
  • Eun Bi Lee (College of Korean Medicine, Daejeon University) ;
  • Sang Yun Han (College of Korean Medicine, Daejeon University)
  • 투고 : 2024.09.30
  • 심사 : 2024.10.28
  • 발행 : 2024.10.25

초록

Bones and teeth impact quality of life and serve as important indicators of overall health, and diseases such as osteoporosis and periodontitis are emerging as increasingly significant health issues in aging societies. In traditional Korean medicine(TKM), bones and teeth are classified under the kidneys, explaining their interrelationship, and biomedical studies have been published on this connection. This study aims to compare the perspectives of TKM and biomedicine on the relationship between the kidneys, bones, and teeth, focusing on similarities between the two disciplines. The fact that the kidneys produce active vitamin D, which contributes to skeletal formation, and that sex hormones, which influence the lifespan of osteoclasts and osteoblasts, resemble the role of the kidneys(腎) in TKM, which are associated with growth and reproduction, aligns with the TKM concept that "the kidneys govern the bones" (腎主骨). Furthermore, the histological similarity between bones and teeth, as well as the metabolic parallels involving osteoclast metabolism, retinoic acid metabolism, and vitamin D, support the idea that "teeth are the surplus of bones" (齒者骨之餘). In addition to the kidneys acting on the shared pathways of bones and teeth, the pathological link between kidney deficiency(腎虛) and dental diseases-caused by aging, overwork, or congenital deficiencies-explains the concept that "the kidneys govern the teeth"(腎主齒). This study contributes to an integrated understanding of both disciplines by comparing the TKM concept with biomedical explanations concerning the kidneys, bones, and teeth. Through this approach, it can be demonstrated that TKM concepts remain valid in modern contexts, while also suggesting the potential to explain less clearly understood TKM theories in this manner.

키워드

과제정보

본 연구의 진행에 있어 도움을 준 대전대학교 한의과대학 김찬 학생에게 고마움을 전한다.

참고문헌

  1. Kim Y, Kim J, Cho D. Gender Difference in Osteoporosis Prevalence, Awareness and Treatment: Based on the Korea National Health and Nutrition Examination Survey 2008~2011. JKAN. 2015;45(2):293-305.
  2. Han DH, Lee HJ, Lim S. Smoking induced heavy metals and periodontitis: findings from the Korea National Health and Nutrition Examination Surveys 2008-2010. Journal of Clinical Periodontology. 2013;40(9):850-8.
  3. KDCA. 2022 Korea National Health and Nutrition Examination Survey(KNHANES) Division of Health and Nutrition Survey Analysis, Bureau of Chronic Disease Prevention, Korea Disease Control and Prevention Agency (KDCA); 2023.
  4. Schools NPPoKM. Physiology of Korean Medicine. Jipmoondang: DG Lim; 2016.
  5. Park J, Han Y. A Study on the relationship between Shin(腎) with Thyroid. JIKM. 1997;18(2):305-31.
  6. Park MS, Cho J, Hur W, Yoo H. A Review on "Kidney" Functional System in Korean Medicine : From the Perspective of Molecular Physiology. Journal of Physiology & Pathology in Korean Medicine. 2022;36(5):169-74.
  7. Ju D, Liu M, Zhao H, Wang J. Mechanisms of "kidney governing bones" theory in traditional Chinese medicine. Frontiers of Medicine. 2014;8(3):389-93.
  8. Zhu H, Liu Q, Li W, Huang S, Zhang B, Wang Y. Biological Deciphering of the "Kidney Governing Bones" Theory in Traditional Chinese Medicine. Evid Based Complement Alternat Med. 2022;2022:1685052.
  9. Lee H, Oh M. Effects of Jeopgolsan (JGS) Extract on Fracture Healing. JKM. 2018;28(1).
  10. Kwak I, Yoon C, Jung J. A Literature Study of the Teeth. JIKM. 1995;16(2):146-77.
  11. Kim N-Y, Kim J-E, Choi C-H, Chung K-H. Association between chronic kidney disease and tooth loss in elderly Koreans: The Korea National Health and Nutrition Examination Survey 2016-2018. Journal of Korean Academy of Oral Health. 2023;47(4):202-6.
  12. Lee E-S, Do K-Y. Relationship between Periodontal Disease and Chronic Kidney Disease: A Systematic Review of Cohort Studies. Journal of Dental Hygiene Science. 2017;17(2):160-7.
  13. Shin HS. Number of existing permanent teeth is associated with chronic kidney disease in the elderly Korean population. Korean J Intern Med. 2018;33(6):1150-9.
  14. Choi HM, Han K, Park YG, Park JB. Associations between the number of natural teeth and renal dysfunction. Medicine (Baltimore). 2016;95(34):e4681.
  15. Fisher MA, Taylor GW. A prediction model for chronic kidney disease includes periodontal disease. J Periodontol. 2009;80(1):16-23.
  16. Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International. 2006;69(11):1945-53.
  17. Kwon YJ. Osteoporosis in Patients with Chronic Kidney Disease. The Korean Journal of Medicine. 2020;95(2):89-94.
  18. MEDICLASSICS [internet]. Korea Institute of Oriental Medicine. [2014] [cited 2024 October 30]. Available from: https://www.mediclassics.kr/.
  19. Kim JYM. Diagnosis of Osteoporosis. KHS. 2011;23(2):108-15.
  20. Choi BH, Kim SM. Report on the Crosstabulation Analysis about Bone Mineral Density Test of Workers. JPPKM. 2009;23(6):1508-12.
  21. Kang S, Park Y, Ahn H. The bibliographical studies on the acupuncture treatment of the osteoporosis. The Journal of Korean Acupuncture & Moxibustion Society. 1995;15(2):171-89.
  22. Won J, Han D, Nam S, Kil B, Kim D. Effect of Herbal Medicine on Osteoporosis: A Review of Animal Experiment, Clinical Studies Published in Korea and Overseas. JKM. 2021;31(3).
  23. Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev. 2016;96(1):365-408.
  24. Ralston SH. Bone structure and metabolism. Medicine. 2009;37(9):469-74.
  25. Kousteni S, Bellido T, Plotkin LI, O'Brien CA, Bodenner DL, Han L, et al. Nongenotropic, Sex-Nonspecific Signaling through the Estrogen or Androgen Receptors: Dissociation from Transcriptional Activity. Cell. 2001;104(5):719-30.
  26. Sibilia V, Bottai D, Maggi R, Pagani F, Chiaramonte R, Giannandrea D, et al. Sex Steroid Regulation of Oxidative Stress in Bone Cells: An In Vitro Study. International Journal of Environmental Research and Public Health. 2021;18(22):12168.
  27. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80(6 Suppl):1689S-96S.
  28. Bland R, Walker EA, Hughes SV, Stewart PM, Hewison M. Constitutive expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in a transformed human proximal tubule cell line: evidence for direct regulation of vitamin D metabolism by calcium. Endocrinology. 1999;140(5):2027-34.
  29. Moe SM, Drueke TB. Management of secondary hyperparathyroidism: the importance and the challenge of controlling parathyroid hormone levels without elevating calcium, phosphorus, and calcium-phosphorus product. Am J Nephrol. 2003;23(6):369-79.
  30. Naylor KL, McArthur E, Leslie WD, Fraser L-A, Jamal SA, Cadarette SM, et al. The three-year incidence of fracture in chronic kidney disease. Kidney International. 2014;86(4):810-8.
  31. Nickolas TL, McMahon DJ, Shane E. Relationship between moderate to severe kidney disease and hip fracture in the United States. J Am Soc Nephrol. 2006;17(11):3223-32.
  32. Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, et al. Endogenous Hormones and the Risk of Hip and Vertebral Fractures among Older Women. New England Journal of Medicine. 1998;339(11):733-8.
  33. Lips P, Netelenbos JC, Jongen MJM, van Ginkel FC, Althuis AL, van Schaik CL, et al. Histomorphometric profile and vitamin d status in patients with femoral neck fracture. Metabolic Bone Disease and Related Research. 1982;4(2):85-93.
  34. Won J, Choi Y, Lee B, Lee H. Improvement of Low Bone Mineral Density Treated with Jeopgol-tang in a Middle-Aged Man: A Case Report. JKM. 2021;42(2):90-7.
  35. Kim Y, Kang J, Kwak K, Lee H. Observation of Correlation between Deficiency Syndrome of Kidney and Bone Mineral Density in Osteoporosis Patients. Korean Journal of Acupuncture. 2014;31(3):99-107.
  36. Choi H, Choi J. Diagrammatic Representation of Pathophysiology in Korean Medicine. Jipmoondang: DG Lim; 2014.
  37. Peper JS, Brouwer RM, van Leeuwen M, Schnack HG, Boomsma DI, Kahn RS, et al. HPG-axis hormones during puberty: a study on the association with hypothalamic and pituitary volumes. Psychoneuroendocrinology. 2010;35(1):133-40.
  38. Cauley JA. Estrogen and bone health in men and women. Steroids. 2015;99(Pt A):11-5.
  39. Leder BZ, LeBlanc KM, Schoenfeld DA, Eastell R, Finkelstein JS. Differential Effects of Androgens and Estrogens on Bone Turnover in Normal Men. The Journal of Clinical Endocrinology & Metabolism. 2003;88(1):204-10.
  40. Pederson L, Kremer M, Judd J, Pascoe D, Spelsberg TC, Riggs BL, et al. Androgens regulate bone resorption activity of isolated osteoclasts in vitro. Proceedings of the National Academy of Sciences. 1999;96(2):505-10.
  41. Wehbeh L, Dobs AS. Opioids and the Hypothalamic-Pituitary-Gonadal (HPG) Axis. J Clin Endocrinol Metab. 2020;105(9).
  42. Antony T, Alzaharani SY, El-Ghaiesh SH. Opioid-induced hypogonadism: Pathophysiology, clinical and therapeutics review. Clin Exp Pharmacol Physiol. 2020;47(5):741-50.
  43. Gotthardt F, Huber C, Thierfelder C, Grize L, Kraenzlin M, Scheidegger C, et al. Bone mineral density and its determinants in men with opioid dependence. J Bone Miner Metab. 2017;35(1):99-107.
  44. Dwyer AA, Quinton R. Anatomy and physiology of the hypothalamic-pituitary-gonadal (HPG) axis. Advanced Practice in Endocrinology Nursing. 2019:839-52.
  45. Kim E, Seong W, Song K. Syudy on Chungye Relavant to Menstration Starting and Pause Compared by Oriental and Western Medicine. JKOM. 1996;17(2).
  46. Wang M, Cha N. An approach of Eastern Nursing Science for Regimen on the Oldman. EWNRI. 2002;7(1):7-17.
  47. Shin S, Kim J. An Integrative Understanding of Two Views on Teeth - Focusing on Relation between Kidney and Yangming. JKMC. 2019;32(1):117-31.
  48. Kim S-Y, Oh J, Hong J, Park SK, Park H-J. A Comparison Study of Acupuncture Points Selection between Classics of Traditional Medicine and Clinical Trials in Dental Disorders. Korean Journal of Acupuncture. 2013;30(4):201-11.
  49. Kwak I, Un C, Jenog J. A Literature Review on Teeth. JIKM. 1995;16(2):146-77.
  50. Park B, Lee E. A Study on Clinical treatments of Oriental Medicine for dental diseases. JKMR. 1998;8(2):297-314.
  51. Xie Y, Chen S, Sheng L, Sun Y, Liu S. A New Landscape of Human Dental Aging: Causes, Consequences, and Intervention Avenues. Aging Dis. 2023;14(4):1123-44.
  52. Walker WB. The Oral Cavity and Associated Structures. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. Boston: Butterworths Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.; 1990.
  53. Goldberg M, Kulkarni AB, Young M, Boskey A. Dentin: Structure, Composition and Mineralization: The role of dentin ECM in dentin formation and mineralization. Frontiers in bioscience (Elite edition).3:711.
  54. Tjaderhane L, Carrilho MR, Breschi L, Tay FR, Pashley DH. Dentin basic structure and composition-an overview. Endodontic Topics. 2009;20(1):3-29.
  55. Murata M. Collagen biology for bone regenerative surgery. jkaoms. 2012;38(6):321-5.
  56. Kim Y, Um I. Autogenous tooth bone graft material. JDIR. 2014;33(1):12-7.
  57. Gama A, Navet B, Vargas JW, Castaneda B, Lezot F. Bone resorption: an actor of dental and periodontal development? Frontiers in Physiology. 2015;6:319.
  58. Walsh MC, Choi Y. Biology of the RANKL-RANK-OPG system in immunity, bone, and beyond. Frontiers in immunology. 2014;5:511.
  59. Lin J, Callon K, Lin C, Bava U, Zheng M, Reid I, et al. Alteration of bone cell function by RANKL and OPG in different in vitro models. European journal of clinical investigation. 2007;37(5):407-15.
  60. Kim M, Kim H, Kim I, Kim S. Expression of RANKL and OPG in the Developing Teeth of the Postnatal Rat. ABA. 2005;18(3):207-15.
  61. Dobnig H, Hofbauer L, Viereck V, Obermayer-Pietsch B, Fahrleitner-Pammer A. Changes in the RANK ligand/osteoprotegerin system are correlated to changes in bone mineral density in bisphosphonate-treated osteoporotic patients. Osteoporosis international. 2006;17:693-703.
  62. Choi H. Mode of Action of Bisphosphonates and Clinical Implication. OSTEOPOROSIS. 2008;6(2):63-70.
  63. Kim H, Chung J, Kim S. Bisphosphonate and the Eruption of Developing Teeth: Its Effects and Mechanism. ABA. 2006;19(1):73-83.
  64. Hu L, Lind T, Sundqvist A, Jacobson A, Melhus H. Retinoic acid increases proliferation of human osteoclast progenitors and inhibits RANKL-stimulated osteoclast differentiation by suppressing RANK. PloS one. 2010;5(10):e13305.
  65. Berkovitz B, Maden M. The distribution of cellular retinoic acid-binding protein I (CRABPI) and cellular retinol-binding protein I (CRBPI) during molar tooth development and eruption in the rat. Connective tissue research. 1995;32(1-4):191-9.
  66. Kim J, Cho S. Aldh1a2 is a maker of dental follicle in tooth germs at cap stage. KJOA. 2016;37(1):37-42.
  67. Liu J, Huang F, He HW. Melatonin effects on hard tissues: bone and tooth. Int J Mol Sci. 2013;14(5):10063-74.
  68. Roth JA, Kim BG, Lin WL, Cho MI. Melatonin promotes osteoblast differentiation and bone formation. J Biol Chem. 1999;274(31):22041-7.
  69. MacDonald IJ, Tsai HC, Chang AC, Huang CC, Yang SF, Tang CH. Melatonin Inhibits Osteoclastogenesis and Osteolytic Bone Metastasis: Implications for Osteoporosis. Int J Mol Sci. 2021;22(17).
  70. Ladizesky MG, Boggio V, Albornoz LE, Castrillon PO, Mautalen C, Cardinali DP. Melatonin increases oestradiol-induced bone formation in ovariectomized rats. J Pineal Res. 2003;34(2):143-51.
  71. Kumasaka S, Shimozuma M, Kawamoto T, Mishima K, Tokuyama R, Kamiya Y, et al. Possible involvement of melatonin in tooth development: expression of melatonin 1a receptor in human and mouse tooth germs. Histochemistry and Cell Biology. 2010;133(5):577-84.
  72. Ohtsuka-Isoya M, Hayashi H, Shinoda H. Effect of suprachiasmatic nucleus lesion on circadian dentin increment in rats. Am J Physiol Regul Integr Comp Physiol. 2001;280(5):R1364-70.
  73. Klejna K, Naumnik B, Gasowska K, Mysliwiec M. OPG/RANK/RANKL signaling system and its significance in nephrology. Folia Histochem Cytobiol. 2009;47(2):199-206.
  74. Uwitonze AM, Murererehe J, Ineza MC, Harelimana EI, Nsabimana U, Uwambaye P, et al. Effects of vitamin D status on oral health. The Journal of Steroid Biochemistry and Molecular Biology. 2018;175:190-4.
  75. Youssef DA, Miller CWT, El-Abbassi AM, Cutchins DC, Cutchins C, Grant WB, et al. Antimicrobial implications of vitamin D. Dermato-Endocrinology. 2011;3(4):220-9.
  76. Dietrich T, Nunn M, Dawson-Hughes B, Bischoff-Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation2. The American Journal of Clinical Nutrition. 2005;82(3):575-80.
  77. Hussein AS, Rosli RA, Ramle RS, Khor GH. The impact of vitamin D deficiency on caries, periodontitis, and oral cancer: A systematic review. The Saudi Dental Journal. 2024;36(7):970-9.
  78. Chen A, Liu Y, Lu Y, Lee K, He JC. Disparate roles of retinoid acid signaling molecules in kidney disease. American Journal of Physiology-Renal Physiology. 2021;320(5):F683-F92.
  79. Henze A, Frey SK, Raila J, Tepel M, Scholze A, Pfeiffer AF, et al. Evidence that kidney function but not type 2 diabetes determines retinol-binding protein 4 serum levels. Diabetes. 2008;57(12):3323-6.
  80. Penniston KL, Tanumihardjo SA. The acute and chronic toxic effects of vitamin A1234. The American Journal of Clinical Nutrition. 2006;83(2):191-201.
  81. Yadav AS, Isoherranen N, Rubinow KB. Vitamin A homeostasis and cardiometabolic disease in humans: lost in translation? Journal of Molecular Endocrinology. 2022;69(3):R95-R108.
  82. Textbooks TCftCoKMP. Korean Medical Pathology. Hanui Munhwasa: JB Kim; 2020.
  83. Beck JD, Slade G, Offenbacher S. Oral disease, cardiovascular disease and systemic inflammation. Periodontology 2000. 2000;23(1).
  84. Ebersole JL, Cappelli D. Acute-phase reactants in infections and inflammatory diseases. Periodontology 2000. 2000;23(1).
  85. Sharma P, Fenton A, Dias IH, Heaton B, Brown CL, Sidhu A, et al. Oxidative stress links periodontal inflammation and renal function. Journal of Clinical Periodontology. 2021;48(3):357-67.
  86. Kim C, Ahn Y, Ahn S, Doo H. The Effects of Palmijihwang-hwan (Baweidehuang-wan) and Obaeja (Galla Rhois) on Proliferation Activity of Alkaline Phosphatase and the Synthetic Ability of Protein in Osteoblast-like Cell Lines and Periodontal Ligament Fibroblasts. JKM. 2003;24(3):35-44.
  87. Carra MC, Schmitt A, Thomas F, Danchin N, Pannier B, Bouchard P. Sleep disorders and oral health: a cross-sectional study. Clinical oral investigations. 2017;21:975-83.
  88. Romandini M, Gioco G, Perfetti G, Deli G, Staderini E, Lafori A. The association between periodontitis and sleep duration. Journal of clinical periodontology. 2017;44(5):490-501.
  89. Han DH, Kim MS, Kim S, Yoo JW, Shen JJ. Sleep time and duration are associated with periodontitis in a representative sample of Koreans. Journal of Periodontology. 2022;93(2):210-9.
  90. Alqaderi H, Goodson JM, Agaku I. Association between sleep and severe periodontitis in a nationally representative adult US population. Journal of periodontology. 2020;91(6):767-74.
  91. D'aiuto F, Nibali L, Parkar M, Patel K, Suvan J, Donos N. Oxidative stress, systemic inflammation, and severe periodontitis. Journal of dental research. 2010;89(11):1241-6.
  92. Chang H, Perkins MH, Novaes LS, Qian F, Zhang T, Neckel PH, et al. Stress-sensitive neural circuits change the gut microbiome via duodenal glands. Cell.
  93. Goyal S, Gupta G, Thomas B, Bhat KM, Bhat GS. Stress and periodontal disease: The link and logic!! Ind Psychiatry J. 2013;22(1):4-11.
  94. Jeon C. Study of Growth Disturbance and Endocrine, in the view of Oriental Medicine. JKPM. 2001;15(1):105-15.
  95. Son H, Kang S, Lee H. An Convergence Analysis of the Effect of Growth Hormone Deficiency on the Development of Teeth in short stature Children. Journal of the Korea Convergence Society. 2021;12(6):39-47.
  96. Mahesh S, Kaskel F. Growth hormone axis in chronic kidney disease. Pediatric Nephrology. 2008;23(1):41-8.