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The Relation between Collateral Circulation and $^{99m}Tc$-MIBI Heart SPECT (심근경색에서 측부순환 유무에 따른 $^{99m}Tc$-MIBI 심근 SPECT 소견)

  • Kim, Jae-Man;Na, Deug-Young;Park, Eun-Kyung;Yang, Hyung-In;Kim, Deog-Yoon;Kang, Heung-Sun;Choue, Chung-Whee;Kim, Kwon-Sam;Kim, Myung-Shick;Song, Jung-Sang;Bae, Jong-Hoa
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.1
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    • pp.37-43
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    • 1994
  • The coronary collateral vessels have revealed their significance in terms of reduction of infarct size, preservation left ventricular function, and prevention of left ventricular aneurysm in patients with myocardial infarction. The purpose of this study were to evaluated the relation between collateral circulation and $^{99m}Tc$-MIBI Heart SPECT in patient with acute myocardial infarction and their clinical significance. The fifty six MI patients with antegrade TIMI perfusion grade 0 and 1 were studied. The patients were classified into two groups; Group I inclueded 30 patients with grade 2, 3 Collateral flow. Group II inclueded 26 patients with grade 0, 1 Collateral flow. Collateral filling were graded from 0 to 3: 0- none, 1- Filling of side branch only, 2- Partial filling of the epicardial segment, 3- Complete filling of epicardial segment. Clinical variables, left ventricular function, $^{99m}Tc$-MIBI Heart SPECT were analyzed with angiographic finding. Results were following: 1) Collateral visualization was found to be greater in patient with involvement of right coronary artery (RCA). The collateral development site of infarct related artery was RCA 15 cases, left anterior descending artery (LAD) 10 cases, left circumflex artery (LCX) 5 cases, and the collateral circulation from LAD to RCA was 13 cases (40.6%). 2) There was a tendency to be decreased in peak CK activity with group I. 3) The presence of good collateral channels was more frequently $^{99m}Tc$-MIBI reversible perfusion defect (83.4% vs 15.3%, p<0.05). 4) No differences of left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), ejection fraction (EF) were noted between group I and group II. The presence of good collateral channels did affect the frequency of occurrence of $^{99m}Tc$-MIBI reversible perfusion defect.

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Clinical Outcome of Emergency Coronary Artery Bypass Grafting after Failed Percutaneous Transluminal Coronary Angioplasty (경피적 관상동맥 성형술의 실패에 의해 발생한 응급환자의 임상경과)

  • Kim, Do-Kyun;Yoo, Kyung-Jong;Youn, Young-Nam;Yi, Gi-Jong;Lee, Sak;Chang, Byung-Chul;Kang, Meyun-Shick
    • Journal of Chest Surgery
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    • v.40 no.3 s.272
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    • pp.209-214
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    • 2007
  • Background: Failed percutaneous transluminal coronary angioplasty (PTCA) is occasionally required for emergency coronary artery bypass grafting (CABG). The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA. Material and Method: Between May 1988 and May 2005, 5712 patients underwent PTCA, where 84 (1.4%) failed. 27 patients underwent emergency CABG after failed PTCA. The mean age was $63.7{\pm}8.9\;(46{\sim}80)$ years, with 14 male patients (51.9%). Result: All patients underwent emergent surgical revascularization within 6 hours. 22 patients underwent conventional CABG and 5 underwent off-pump CABG. The causes of PTCA failure were coronary obstruction due to new thrombi formation during the procedure (n=4), coronary dissection (n=17), coronary artery rupture (n=3) and 3 due to other causes. The rate of in-hospital operative mortality after emergent operation was 18.5% (5/27). A univariate analysis revealed that patients who died more often had left anterior descending artery disease, a preprocedural shock status, postoperative use of multiple isotropics and postoperative use of intra-aortic balloon pump. The mean follow up duration was $53.6{\pm}63.4$ months. Conclusion: Although PTCA is known to be life saving, there is still a high risk for morbidity and mortality following emergency CABG after failed PTCA, despite the advancement in PTCA techniques. This result will help identify and more effectively treat patients selected for PTCA when emergency CABG is required.

The Feasibility of the DKUH-75 Left Ventricular Assist Device for Acute Cardiogenic Shock in Pigs (돼지의 급성 심인성 쇼크 모델에서 DKUH-75 좌심실보조키의 유용성에 관한 연구)

  • Park, Seong-Sik
    • Journal of Chest Surgery
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    • v.40 no.3 s.272
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    • pp.168-179
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    • 2007
  • Background: The recent trend of an increasing number of patients with acute cardiogenic shock or chronic congestive heart failure following myocardial infarction, as well as the considerable number who can not be weaned from cardiopulmonary bypass after open heart surgery, call for immediate efforts to develop affordable ventricular assist devices that are suitable for the Korean physique. Recently, a pneumatic pulsatile ventricular assist device (VAD), named DKUH-75, has been developed by the Department of Biomedical Engineering, in collaboration with the Department of Thoracic and Cardiovascular Surgery of Dankook University College of Medicine. The feasibility of the DKUH-75 VAD was evaluated on the bases of common hemodynamic variables and echocardiographic measurements in pigs, which are subjected to an acute cardiogenic shock state following myocardial infarction, using a novel coronary artery ligation method employing the ischemic preconditioning concept. Material and Method: Acute cardiogenic shock was induced in 10 Yorkshire Landrace Duroc strain pigs by ligating the left anterior descending coronary artery via an ischemic preconditioning process. The hemodynamic variables were monitored, with epicardial echocardiographic measurements performed before and one hour after the ligation. The DKUH-75 VAD was implanted into 5 pigs one hour after the onset of the shock. The hemodynamic variables and echocardiographic measurements were taken one hour after installation of the VAD. Result: The systolic, diastolic and mean systemic arterial pressures were significantly decreased in all the experimental animals one hour after the ligation. The systolic, diastolic and mean pulmonary arterial pressures were increased (Eds note: this completely contradicts the preceding statement? However, if you mean the non-experimental animals this should be stated?). The left ventricular end diastolic pressure (LVEDP) was increased, but the cardiac index decreased, An increase in the left ventricular end systolic dimension and decreases in the fractional shortening and ejection fraction were observed all animals one hour after the coronary artery ligation. In all 5 of the VAD implanted pigs, the systolic and mean systemic arterial pressures were increased, and the pulmonary arterial pressures decreased one hour after the implantation; the LVEDP decreased, but the cardiac index was significantly increased, In the echocardiographic measurements, the left ventricular end systolic dimension decreased after the implantation of the VAD, but the fractional shortening and ejection fraction significantly increased. Conclusion: Significant improvements in the hemodynamic variables and echocardiographic measurements were observed in the 5 VAD implanted animals one hour after installation, which had been subjected to an acute cardiogenic shock state by ligation of the coronary artery, indicating that the DKUH-75 VAD could help in the recovery of the myocardial function. This suggests that the DKUH-75 VAD is feasible in the short term in relation to an acute cardiogenic shock state due to myocardial infarction.

Arterial Switch Operation in Patients with Intramural Coronary Artery: Early and Mid-term Results

  • Kim, Hyung-Tae;Sung, Si-Chan;Kim, Si-Ho;Chang, Yun-Hee;Ahn, Hyo-Yeong;Lee, Hyoung-Doo
    • Journal of Chest Surgery
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    • v.44 no.2
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    • pp.115-122
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    • 2011
  • Background: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. Materials and Methods: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was $13.4{\pm}10.2$ days (4 to 39 days) and mean body weight was $3.48{\pm}0.33$ kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. Results: There was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was $52.1{\pm}43.0$ months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. Conclusion: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.

Percutaneous Endovascular Stent-graft Treatment for Aortic Disease in High Risk Patients: The Early and Mid-term Results (고위험군의 대동맥류 환자에서 경피적으로 삽입이 가능한 스텐트 그라프트를 이용한 치료: 조기 및 중기성적)

  • Choi, Jin-Ho;Lim, Cheong;Park, Kay-Hyun;Chung, Eui-Suk;Kang, Sung-Gwon;Yoon, Chang-Jin
    • Journal of Chest Surgery
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    • v.41 no.2
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    • pp.239-246
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    • 2008
  • Background: Aortic surgery for high risk patients has high mortality and morbidity rates, and the necessity of performing aortic surgery in cancer patients is questionable because of their short life expectancy. Endovascular repair of aneurysm repair can be considered for high risk patients and cancer patients because it has relatively lower invasiveness and shorter recovery times than aortic surgery does. Especially, percutaneous endovascular stent graft treatment is more useful for high risk patients because it does not require general anesthesia. Material and Method: From July 2003 to September 2007, twelve patients who had inoperable malignancy or who had a high risk of complication because of their combined diseases during aortic surgery underwent endovascular aortic aneurysm repair. he indications for endovascular repair were abdominal aortic aneurysm in 5 patients, descending thoracic aortic aneurysm in 6 patients and acute type B aortic dissection in one patient. The underlying combined disease of these patients were malignancy in 3 patients, respiratory disease in 6 patients, old age with neurologic disease in 6 patients, Behcet's iseae in one patient and chronic renal failure in one patient. Result: Stent grafts were inserted percutaneously in all cases. There were 4 hospital deaths and there were 3 delayed deaths during the follow-up periods. There were no deaths from aortic disease, except one hospital death. There were several complications: a mild cerebrovascular accident occurred in one patient, acute renal failure occurred in 2 patients and ischemic bowel necrosis occurred in one patient. Mild type I endoleak was observed in 2 patients and type II endoleak was observed in a patient after stent graft implantation. Newly developed type I endoleak was observed in a patient during the follow-up period. Conclusion: Percutaneous endovascular stent graft insertion is relatively safe procedure for high risk patients and cancer patients. Yet it seems that its indications and its long term results need to be further researched.

Analysis of Daily Milking Flow in Holstein Dairy Cow Using the LactoCorder (전자식유량계를 활용한 홀스타인 젖소의 비유형질 분석)

  • Cho, Kwang-Hyun;Choi, Jun-Pyo;You, Byung-Wha;Lee, Deuk-Hwan;Kong, Hong-Sik;Park, Kyung-Do;Lee, Hak-Kyo
    • Journal of Animal Science and Technology
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    • v.51 no.4
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    • pp.265-272
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    • 2009
  • A total of 486 milk records were collected from 16 diary farms in Imsil-gun, Jeollabuk-do. Results obtained were as follows: The average 3MG (amount of milk within the first three minute) was 7.44 kg and 55% of total milk yield was produced within 3 min. The average of SPL (% of foam in milk) was 33.93% and the average of MNG (strip yield) was 0.14 kg, which was less than 1% of total milk yield. The averages of HMF (highest milk flow), HMG (maximum milk flow rate in one minute) and DMHG (average milk flow in the main milking phase) were 3.03 kg/min, 2.94 kg/min and 2.05 kg/min, respectively and the average milking speed in Imsil-gun was slower than other regions. The average of tS500(time to reach 0.5 kg/min at beginning) was 0.23min (about 14 seconds) and that of tMGG (duration of the total milking) was 7.75min. The average tMBG (duration of the dry milking phase) was 0.58 min (35 seconds) and that of tMNG (duration of the stripping phase) was 0.42min (14 seconds). The averages of ELHMF (electrical conductivity at highest milk flow) and ELAP (beginning peak level of the electrical conductivity) were 6.81 mS/cm and 7.58 mS/cm, respectively. The average of ELMAX (maximum electrical conductivity) was 7.48 mS/cm and that of ELAD (beginning peak difference of the electrical conductivity) was 0.61 mS/cm. While the total milk yields for DMHG, tMHG (duration of the main milking phase), tPL (duration of the plateau phase), tAB (duration of the descending phase) and tMGG were positively correlated (0.35~0.54), those for tMBG and SPL were negatively correlated (-0.11 and -0.27). As the DMHG increased, tMHG, tPL, tAB, tMGG and SPL decreased. While the cows with higher electrical conductivity at the beginning of milking had less somatic cell counts, cows with higher electrical conductivity after the peak of milk yield had more somatic cell counts. The results of this experiment indicated that through milking based on milking and lactating standards and the regular checking of milking status, the qualities of milk and milk yields could be improved.

Abstracting Services in Korea (한국의 초록서비스에 대하여)

  • Choi Sung-Jin
    • Journal of the Korean Society for Library and Information Science
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    • v.24
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    • pp.9-51
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    • 1993
  • The purpose of this study is twofold: to investigate into general characteristics of the abstracting services in Korea and to discuss general directions of development of the abstracting services in the country. This study is designed to achieve the purpose by gathering and analysing data related to the abstracting journals published in the past ten years and by comparing the results with similar data gathered by the investigator in 1984. The major conclusions made in this study is summarised as follows. (1) Researchers and professionals working in limited numbers of subject fields are benefited by abstracting services of recent achievements in research and development in Korea. Those in most of the fields have essentially no abstracting services of such achievements. Even many researchers and professionals in the limited numbers of the fields that have some elementary abstracting services are not informed of research results in their fields because the abstracting journals are scattered in many narrow subjects and in many cases, the abstracting journals only cover publications in some specific forms and kinds. (2) Abstracting journals of general subjects, which are supposed to be of more or less help to the researchers in the subject fields that have no abstracting journals of their own, have rapidly increased in number in the past ten years. Most of such abstracting journals carry thesis and dissertation abstracts, and the rest those of research papers published in specific places, in specific forms, by specific institutes, and of reports of research projects sponsored by specific foundations. These abstracting journals are not of the kind that comprehensively provide general readers with current awareness of publications of research results in Korea. (3) Most of the abstracting journals existing in Korea are published by institutions of higher education and research institutes, and the rest by commercial publishers, industrial firms, libraries, information centers, government agencies, research foundations, learned societies, etc. Those which publish many titles are small in number and those publish one or two titles are large in number. The former is largely made up of institutions of higher education and research institutes. (4) Ten years ago, there was not a single publishing house that produced abstracting journals. Three commercial publishing houses now produce abstracting journals. As this change occurs, centers of excellence are founded and competitive elements are introduced in abstracting services. This change, in turn, is expected to improve quality of the other abstracting journals in Korea. (5) The abstracting journals published in Korea are classified by type into those of dissertations, research papers, journal articles, patent specifications in that descending order. The fact that Master's and doctoral dissertation abstracts are dominating in Korea is due to the irrational practice of publishing those abstracts at many institutions. (6) Most of the abstracting journals existing in Korea are published by national or government-supported research institutes in order to publicise their own research outputs. Their coverage of literature is normally narrow, and naturally their value to users is limited. (7) The abstracting journals published in Korea increased in number at the rate of $77.8-100\%$ every five years in the past twenty-five years. Most of the abstracting journals that ceased to be published during the period survived for two years. (8) Korean is the desirable language for the abstracting journals designed to be distributed within Korea. About half of the abstracting journals published in Korea is printed in Korean and the other half in foreign languages, and in Korean with foreign languages. All the abstracting journals in foreign languages are printed in English xcept one, which is printed in Japanese. (9) Some twenty percent of the abstracting journals in Korea is published monthly, bimonthly, and quarterly. Others are published annually, biannually, and irregularly. The latter may not function properly as a current-awareness tool due to long intervals between their issues. It is particularly undesirable that about half of the abstracting journals in Korea is published irregularly. Most of the abstracting journals published in Korea are distributed freely to individuals and institutions selected by the publishers. (10) The abstracting journals published by the use of computers increased drastically in the past ten years. The abstracting journals produced by the conventional type-setting method will probably disappear In Korea in another ten years to come. Automation of the production of abstracting journals does not simply mean technical, economic improvement of publishing processes but availability of machine-readable databases that can be used for other purposes, including the generation of other publications and the provision of machine literature searching capabilities. Necessary steps should be taken for this important development that is occurring in the abstracting services in Korea.

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Retrograde Tracer Studies of Tecto-Reticulospinal Pathway and Dorsal Lateral Geniculate Nucleus on GluR1- and GluR4-Immunoreactive Neurons in the Hamster Superior Colliculus (Tecto-reticulospinal pathway (TRS)와 dorsal lateral geniculate nucleus (dLGN)에서 역행성이동추적물질 이용 햄스터 상구에서 GluR1-, GluR4- 면역반응 신경세포 연구)

  • Choi, Jae-Sik;Lee, Jea-Young;Jang, Yu-Jin;Lee, Eun-Shil;Jeon, Chang-Jin
    • Journal of Life Science
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    • v.20 no.1
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    • pp.1-8
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    • 2010
  • We recently reported the distributions of AMPA ($\alpha$-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate) receptor subtypes glutamate receptors (GluR) 1 and GluR4 in the superior colliculi (SC) of hamsters with antibody immunocytochemistry and the effect of enucleation on these distributions. We also compared these labelings to those of calcium-binding proteins calbindin D28K, calretinin, parvalbumin, and GABA. In the present study, we investigated whether the GluR1- and GluR4-immunoreactive (IR) neurons are interneurons or projection neurons by injection of the retrograde tracer horseradish peroxidase (HRP) into one of each major ascending and descending pathways of the SC. HRP injections were made into a tecto-reticulospinal pathway (TRS) and dorsal lateral geniculate nucleus (dLGN). Animals were then allowed to recover and to survive for 48 hr before perfusion. Sections containing retrograde-labeled neurons were then treated for GluR-immunoreactivity. HRP injections proved that only a small population of the GluR1-IR cells project into TRS (1.4%) and dLGN (2.6%). However, a large subpopulation of GluR4-IR cells project into TRS (32.7%). The differential compositions of inter/projection neurons, along with our previous studies on the separate distribution of the GluR subunits, its differential co-localization with calcium-binding proteins and GABA, and differential reactions to enucleations, strongly imply the functional variety of the receptor subunits in visual behavior responses.

Radiation dose Assesment according to the Adaptive Statistical Iterative Reconstruction Technique of Cardiac Computed Tomography(CT) (심장 CT 검사시 ASIR 적용에 따른 선량 평가)

  • Jang, Hyun-Cheol;Kim, Hyun-Ju;Cho, Jae-Hwan
    • The Journal of the Korea Contents Association
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    • v.11 no.5
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    • pp.252-259
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    • 2011
  • To identify the effects of the application of the adaptive statistical iterative reconstruction (ASIR) technique in combination with the other two factors of body mass Index (BMI) and tube potential on radiation dose in cardiac CT. The patient receiving operation the cardiac CT examination was divided four groups into according to kVp.[A group(n=20), Non-ASIR, BMI < 25, 100 kVp; B group(n=20), Non-ASIR, BMI > 25, 120 kVp; C group(n=20), 40% ASIR BMI < 25, 100 kVp; D group(n=20), 40% ASIR, BMI > 25, 120 kVp] After setting up the region of interest in the main artery central part and right coronary artery and left anterior descending artery, the CT number was measured and an average and standard deviation were analyzed. There were A group and the difference which the image noise notes statistically between C. And A group was high so that the noise could note than C group (group A, 494 ${\pm}$ 32 HU; group C, 482 ${\pm}$ 48 HU: P<0.05) In addition, there were B group and the difference noted statistically between D. And B group was high so that the noise could note than D group (group B, 510 ${\pm}$ 45 HU; group D, 480 ${\pm}$ 82 HU: P<0.05). In the qualitative analysis of an image, there was no difference (p>0.05) which a group, B group, C group, and D as to average, A group 4.13${\pm}$0.2, B group 4.18${\pm}$0.1, and C group 4.1${\pm}$0.2 and D group note statistically altogether with 4.15${\pm}$0.1 as a result of making the clinical evaluation according to the coronary artery segments. And the inappropriate image was shown to the diagnosis in all groups. As to the radiation dose, a group 8.6${\pm}$0.9 and B group 14.9${\pm}$0.4 and C group 5.8${\pm}$0.5 and D group are 10.1${\pm}$0.6 mSv.

Studies on the phrases of Yellow Emperor's internal classic(黃帝內經) for the physiology on the spleen and stomach (비위생리(脾胃生理)에 수용(授用)되는 황제내경(黃帝內經) 어구(語句)에 관(關)한 연구(硏究))

  • Won, Jin-Hui
    • The Journal of Korean Medicine
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    • v.16 no.2 s.30
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    • pp.453-489
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    • 1995
  • The research of the phrases related with physiology of stomach and spleen in the contents of Huang Di Nei Jing(黃帝內經) known as the Bible of oriental medicine will make a contribution to a deep understanding of disease of stomach and spleen and a proper clinical diagnosis and treatment of them. In this research of the most appropriate glosses recorded nine kinds of representative medical books including Huang Di Nei Jing Somoon(黃帝內經素問) of Wang Bing(王氷) were picked out: The summaries of the selected contents are as follows: 1. The word 'saliva(涎)' in 'the spleen controls saliva(脾爲涎)' can be viewed as a generic term referring to oral cavity secretion gland as well as the secretion fluid of salivary gland. 2. The phases 'a large reservoir(太倉)', barn organs', 'a reserboir of food stuff', 'a stomach as the market(胃爲之市)', etc mean the function of stomach to receive food(胃主受納). 3. The phase 'generation of five tastes(五味出焉)' means both 'the function of stomach to transform food into chyme(胃主腐熟)' and 'the channelling function of spleen.(脾主運化)' 4. The flowing of the food-Qi(食氣) into stomach brings about spreading Jung(精) into liver and then percolating Jung(精) flow into channel. The channel-Qi(脈氣) flows into lung through channel. As a result, all kinds of channels gather together in lung and Jung(精) is sent into skin and hair. The assembly of Jung(精) with skins and channels moves Qi(氣) into fu-organ and so jung(精) and mental activity(神明) in fu-organ(府) come to be in four organs(四臟). Then if Qi(氣) comes back to power balance unit(權衡) being in the state of equilibrium(權衡以平), the hole of Qi(氣口) comes to determine the matter of life and death through achieving Chun-quan-chi(-寸-關-尺). The above mentioned phrases means the digestion, asorption and transmission of food. When food is taken in stomach, Jung-Qi(精氣) comes to be over flowed upward into spleen, back into lung, finally downward into bladders through water-conduit(水道) controlled by lung. When water- Jung(水精) radiates into whole body with channels of five organs(五臟), both of them fit together with and yin-yang(陰-陽). Therefore, the grasping of the rise and decline of yin-yang(陰C-陽) is necessary to consult patients. The above mentioned phrases is properly viewed to designate the asorption, transmission and excretion of food. 5. Spleen controls flesh(脾之合肉也), the state of spleen is known by human lips, and what this means is that liver plays functions of spread and expansion(肝主疏泄). 6. The phrase 'Jung Jung'((中精)) in 'gallbladder dominates Jung jung(膽主中精)', which in one of the specific expression of 'liver plays functions of spread and expansion(肝主疏泄). 7. It is right that the phase 'The eleven organs in all are determined by gallbladder'(凡十,一臟取決於膽也) is correctly paraphrased as 'only one of ten organs, spleen, is determined by gallbladder'.(凡十,一臟取決於膽也), 8. The small intestine is an organ. which receives the materials digested and sends them out. This means that the function of transforming materials(化物) factually refers to that of separating clearity and blur(泌別淸濁). And it is also thought to have the function of ascending clearity and descending blur(升淸降濁), 9. A large intestine is a transmitting organ(傳導之官) from which a change comes out(變化出焉). the phrase 'change'(變化) in this sentence means both the intake of water and nutrition and the formation procedure of stool through excretion of mucocele.

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