• 제목/요약/키워드: Pulse therapy

검색결과 325건 처리시간 0.028초

형장침법 연구 (Study on the Acupuncture in Hyungsang)

  • 강경화;김경철;백근기;이용태
    • 동의생리병리학회지
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    • 제17권5호
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    • pp.1157-1176
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    • 2003
  • The following conclusions are induced from a study on the acupuncture therapy depending on hyungsang of the persons. The study is made on the basis of 'Internal classic (內經)& and &Clinical Lectures by Dr. Jeesan&. The acupuncture originated from the treatment of spasm with numbness in the southern area. The acupuncture is basically a remedy for the exterior disease of meridian but also it can be a cure for the interior disease of Jang and obstinate disease with accurate method. Three mechanisms of acupuncture are described in 'Internal classic'. The first is to make meridian circulate smoothly. The second is to regulate Ki and Hyul. The third is to regulate points through which the meridian-Ki goes in and out smoothly or adversely. There are two ways of acupuncture in 'Internal classic'. One is based on pulse and symptom and the other on the Hyungsang. The former is more generally used therapy, to which depletion method, Asi point method(阿是穴 療法), Inyoung-kigu pulse comparison method (人迎氣口脈法) and method depending on jang-bu disease belong. Acupuncture is done on Su points(輸穴) and back-su point(背兪穴) in case of jang-disease. In case of bu-disease, the treatment is done on Hap points(合穴) and Mo-points(募穴). The latter includes two methods; one according to invariable Hyungsang. And the other to variable Hyungsang. The method of acupuncture according to invariable Hyungsang usually selects Won-points(原穴). Different Hyungsang requires different method of acupuncture; In case of Dam type, the acupuncture is mainly practiced on four-Kwan points with reinforcing and reducing methods achieved by the direction of the needle tip pointing to. In case of Bangkwang type, the acupuncture is usually done on Jungwan(中脘) and Poongyung(豊隆) with reinforcing and reducing methods by means of respiration. In case of female, more effective are the acupoints on the right and lateral parts of the body selected on the basis of five su-points of the twelve meridians matching the heavenly stems and earthly branches. In case of male, more effective are the acupoints on the left, front and rear parts of the eight extra meridians. In case of acupuncture to the person with Hyungsang of five jang and six bu, each person's intrinsic Hyung, color, pulse, must be observed. Because symptoms of jang-bu disease also must be checked up. Acupuncture is done on the Won-points of the meridians related to the jang and bu where the disease starts. The disease of five jang is so obstinate that it requires both of medication and acupuncture for a long time. In case of acupuncture to the person with Hyungsang of animal types, diagnosis is made on the basis of shape, temper, function and color. And the treatment is given on the Won-points of corresponding exterior and interior meridians. For the fish type, the acupuncture is done on the kidney meridian of foot-soyin and the urinary bladder of foot-taiyang. For the bird type, on the heart meridian of hand-soyin, the pericardium meridian of hand-gualyin, and the small intestine meridian of hand-taiyang For the deer type, on the liver meridian of foot-gualyin and the gallbladder meridian of foot-soyang. For the turtle type, on the lung meridian of hand-taiyin and the large intestine meridian of hand-yangmyung.

상한론(傷寒論)과 사상의학(四象醫學)의 병기(病機)에 대한 비교연구(比較硏究) - 동의수세보원(東醫壽世保元) 변증론(辨證論)을 중심(中心)으로 - (A comparative study on between Shanghanlun(傷寒論) and Sa-sang constitutional medicine(四象醫學) in Pathogenesis)

  • 이광영;박찬국
    • 대한한의학원전학회지
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    • 제11권1호
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    • pp.676-718
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    • 1998
  • After a comparative study on between Shanghanlun(傷寒論) and Sa-sang constitutional medicine(四象醫學) in Pathogenesis, I got a conclusion like this. Sa-sang consitutional medicine(四象醫學) changed the directions to the medicine in the center of personality from the medicine in the center of Shanghanlun(傷寒論)'s demonstration, devided the personality of people by the size of Organ system(臟腑) into 4types of Tae-eum, Yo-yang, Tae-yang, Yo-eum(太少陰陽), and explains all the course of physiology, pathology, diagnosis, therapy of the body on the point of constitutional view. Comparing the features of two medicines, Shanghanlun(傷寒論) and Sa-sang constitutional medicine(四象醫學), Shanghanlun(傷寒論) devided the diseases into the three type of eum-yang based on eight principal syndroms(八綱原理), in accordance with evidence of illness, pulse and studied the therapy, Shanghanlun(傷寒論) set up the basis of medicine which is based on overall of symptoms and signg(辨證論治醫學). Sa-sang constitutional medicine(四象醫學) distinguished the image(象) which is devided by the size of inherited Organ system(臟腑), refered to the symptom of diseases(病症) and decided the therapic directions. So Sa-sang constitutional medicine(四象醫學) gave more accuracy to the therapy by subdeviding the process of differenciation of case(辨證) into 2 steps of differenciation of image(辨象) and differenciation of case(辨證). In view of etiologic factor, Shanghanlun(傷寒論) regarded it as a invading of pathogenic factors(邪氣), so Shanghanlun(傷寒論) has the medical theory of pathogenic factors(邪氣). But Sa-sang constitutional medicine(四象醫學) regarded it as a disorder of the genuine energy(正氣)'s movements(升降緩速), so Sa-sang constitutional medicine(四象醫學) has the medical theory putting first of genuine energy(正氣). But Shanghanlun(傷寒論) also recognized the constitutional difference basically and Sa-sang consitutional medicine(四象醫學) devided the constitution into Tae-eum, Yo-yang, Tae-yang, Yo-eum(太少陰陽) and explained the food-air-fluid metabolism(飮食-氣液之氣病證) as cold-hot, cool-warm and devided the the symptom of diseases(病症) into the interior and the exterior(表裏) as the up-down, slow-fast movements of eum-yang and insufficiency and excessiveness is between them. In the end, Sa-sang constitutional medicine(四象醫學) has the theory of eight principal syndroms(八綱原理) faithfully which is the theory of differenciation of case(辨證理論) of Shanghanlun(傷寒論). Therefore Shanghanlun(傷寒論) made a lot of influence on originating Sa-sang constitutional medicine(四象醫學), Sa-sang constitutional medicine(四象醫學) is the theory which is based on existing medical theory including Shanghanlun(傷寒論) and composed the new medical theory to the constitutional point of view. Sa-sang constitutional medicine(四象醫學) enriched the medical theory and developed the clinical medicine so it has the historical value in the medicine.

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해면 정맥동 혈전증(Cavernous Sinus Thrombosis) 치험례 (CAVERNOUS SINUS THROMBOSIS : A CASE REPORT)

  • 장현석;장명진;김용관;김경원
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제17권4호
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    • pp.447-455
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    • 1995
  • Cavernous sinus thrombosis is one of the major complications of abscesses of the maxillofacial region. The initial symptoms of CST are usually pain in the eye and tenderness to pressure. this is associated with high fluctuating fever, chills, rapid pulse, and sweating. Venous obstruction subsequently causes edema of the eyelids, lacrimation, proptosis, chemosis and retinal hemorrhages. Blindness is sometimes an accompaniment of cavernous sinus thrombosis when the infection also involves the orbit. There is also cranial nerve involvement (oculomotor, troclear, abducence) and ophthalmoplegia, diminished or absent corneal reflex, ptosis, and dilation of the pupil occur. The terminal stages bring signs of advanced toxemia and meningitis. Infections of the face can cause a septic thrombosis of the cavernous sinus. Furunculosis and infected hair follicles in the nose are frequent causes. Extractions of maxillary anterior teeth in the presence of acute infection and especially curettage of the sockets under such circumstances can cause this condition. The infection is usually staphylococcal. The inflection may spread directly through the pterygoid plexus of veins and the pterygomaxillary space and then ascend into the sinus or it may spread directly from the pterygopalatine space to the orbit. This is possible because of the absence of valves in the angular, facial, and ophthalmic veins. The treatment is empirical antibiotic therapy followed by specific anbibiotic therapy based on blood or pus culture. The inflection usually involves one side, however, it may easily spread to the opposite side through the circulus sinus. Unless it is treated early, the prognosis is poor even in this doses. Occasionally the antibiotics will not adequately resolve the septic thrombus, and death ensues. the use of anticoagulants to prevent venous thrombosis has been recommended, but the efficacy of such therapy has not been substantiated. Surgical access through eye enucleation has been suggested. We report a case which demonstrates cavernous sinus thrombosis by the infection after the functional neck dissection and the intraoral reconstruction with auriculomastoid fascio-cutaneous island flap.

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초음파가 흰쥐의 좌골신경 압좌손상 후 척수내 Neural Cell Adhesion Molecules의 발현에 미치는 영향 (The Effect of Ultrasound Irradiation on the Neural Cell Adhesion Molecules(NCAM) Expression in Rat Spinal Cord after the Sciatic Nerve Crush Injury)

  • 김현애;한종만
    • The Journal of Korean Physical Therapy
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    • 제19권2호
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    • pp.41-55
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    • 2007
  • Purpose: This study aimed to compare the effect on nerve regeneration of ultrasound irradiation in rats with peripheral nerve injury. Methods: To investigate alterations of the NCAM immunoreactivity in non-crushed part and crushed part of the spinal cord, the unilateral sciatic nerve of the rats were crushed. The expression of NCAM was used as the marked of peripheral nerve regeneration, and also plays an important role in developing nerve system. Experimental animals were sacrificed by perfusion fixation at post-injury 1, 3, 7, 14 days after ultrasound irradiation. The pulsed US was applied at a frequency of 1MHz and a spatial average-temporal average Intensity of 0.5W/of (20% pulse ratio) for 1 mins. The Luxol fast blue-cresyl violet stain were also done to observe the morphological changes. Results: Alteration of NCAM immunoreactivity in the crushed part and the non-crushed part of lower lumbar spinal cord were observed. NCAM-immunoreactivity cells were some increased in the dorsal horn lamina I, III and cell ventral horn at 1 day after unilateral sciatic nerve injury. However, there was not significant difference in the relationship between crushed part and non-crushed part. NCAM-inmmunoreactivity was remarkably increased at 3 days after unilateral sciatic nerve injuryin the gray matter and white matter. NCAM-immunoreactivity was increased in the ventral horn and post horn of experimental crushed part. Also, NCAM-immunoreactivity in large motor neurons in ventral horns lamina VIII, IX were increased at 7 days after unilateral sciatic nerve injury. At 14 days after sciatic nerve crushed injury, there was no significant difference. All group were decreased for 14 days. In the time course of NCAM expression, all groups showed a significant difference at 3day groups(p<0.05). Whereas, CC group was noted a significant difference between 3day and 7 day group respectively. In NCAM expression, there were significantly increased in all group. In the relationship between CNC group and ENC group, significant difference was detected among 3, 7, 14 day group(p<0.05). The difference between CC group and ENC group were noted in all groups(p<0.05). Conclusion: It is consequently suggested that the effects of the ultrasound irradiation may increase the NCAM immunoreactive neurons and glial cell in the spinal cord after unilateral sciatic nerve crushed injury. Therefore, the increased NCAM immunoreactivity in the spinal cord may reflect the neuronal damage and healing process induced by a ultrasound irradiation after peripheral nerve injury in rat.

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가정산소치료의 보험급여 실시 이후 처방 실태: 다기관 조사 -만성기도폐쇄성질환 임상연구센터 제3세부과제 만성기도폐쇄성질환 진료지침 개발/보급 연구- (Long-term Oxygen Therapy for Chronic Respiratory Insufficiency: the Situation in Korea after the Health Insurance Coverage: a Multi-center Korean Survey -Study for the Development and Dissemination of the COPD Guidelines, Clinical Research Center for Chronic Obstructive Airway Disease-)

  • 박명재;유지홍;최천웅;김영균;윤형규;강경호;이승룡;최혜숙;이관호;이진화;임성철;김유일;신동호;김태형;정기석;박용범
    • Tuberculosis and Respiratory Diseases
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    • 제67권2호
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    • pp.88-94
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    • 2009
  • Background: From November 2006, The national health insurance system in the Republic of Korea began to cover prescribed long-term oxygen therapy (LTOT) in patients with chronic respiratory insufficiency. This study examined the current status of LTOT after national health insurance coverage. Methods: Between November 1, 2006 and June 30, 2008, the medical records of patients who were prescribed LTOT by chest physicians were reviewed. The data was collected from 13 university hospitals. Results: 197 patients (131 male and 66 female) were prescribed LTOT. The mean age was 64.3${\pm}$13.0 years. The most common underlying disease was chronic obstructive pulmonary disease (n=103, 52.3%). Chest physicians prescribed LTOT using arterial blood gas analysis or a pulse oxymeter (74.6%), symptoms (14%), or a pulmonary function test (11.2%). The mean oxygen flow rate was 1.56${\pm}$0.68 L/min at rest, 2.08${\pm}$0.91 L/min during exercise or 1.51${\pm}$0.75 L/min during sleep. Most patients (98.3%) used oxygen concentrators. Only 19% of patients used ambulatory oxygen supplies. The oxygen saturation before and after LTOT was 83.18${\pm}$10.48% and 91.64${\pm}$7.1%, respectively. After LTOT, dyspnea improved in 81.2% of patients. The mean duration of LTOT was 16.85${\pm}$6.71 hours/day. The rental cost for the oxygen concentrator and related electricity charges were 48,414${\pm}$15,618 won/month and 40,352${\pm}$36,815 won/month, respectively. Approximately 75% of patients had a regular visit by the company. 5.8% of patients had personal pulse oxymetry. 54.9% of patients had their oxygen saturation checked on each visit hospital. 8% of patients were current smokers. The most common complaint with LTOT was the limitation of daily activity (53%). The most common complaint with oxygen concentrators was noise (41%). Conclusion: The patients showed good compliance with LTOT. However, only a few patients used an ambulatory oxygen device or had their oxygen saturation measured.

아로마 요법이 말기 암 환자의 하지부종에 미치는 영향 - 대조군 연구 (The Effect of Aroma Therapy on Lower Extremity Edema of Terminal Cancer Patients: A Controlled Trial)

  • 김성아;김성주;정주혜;이수영;한명숙;오선희;김세홍
    • Journal of Hospice and Palliative Care
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    • 제12권3호
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    • pp.139-146
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    • 2009
  • 목적: 본 연구에서는 하지 부종이 있는 말기 암 환자에게 아로마 마사지 치료가 부종 정도 및 혈압, 맥박, 체온 등의 생체 징후 변화에 미치는 영향을 관찰함으로써 말기 암 환자의 삶의 질을 향상시킬 수 있는 대체의학적 치료법으로서의 근거를 마련하고자 한다. 방법: 총 36명의 환자(치료군 26명, 대조군 10명)의 환자를 대상으로 아로마 치료군에서는 블랜딩한 오일을 이용하여 대상자의 발가락부터 무릎 위 10 cm까지 경찰, 강찰, 진동기법을 이용하여 약 15${\sim}$20분간 마사지를 시행하였으며 대조군은 순수하게 마사지의 효과만을 알아보기 위해 캐리어 오일만을 이용한 마사지를 아로마 치료군과 동일한 시간과 방법으로 시행하였다. 마사지 시행 전, 마사지 시행 30분 후, 2시간 후, 12시간 후에 전족부(forefoot)와 발목관절의 가장 좁은 부위, 종아리의 가장 넓은 부위에서 둘레를 측정하였고 혈압, 맥박, 체온도 동시에 측정하였다. 결과: 발등(Rt.: P=0.771, Lt.: P=0.371), 발목(Rt.: P=0.580, Lt.: P=0.407), 종아리(Rt.: P=0.666, Lt.: P=0.158)의 둘레의 변화는 아로마 마사지 치료군과 대조군 사이에 통계적으로 유의한 차이를 보이지 않았다. 하지만, 아로마 치료군에서 좌측 발목과 좌측 종아리를 제외한 나머지 부위에서 치료 전과 비교하여 통계적으로 유의하게 부종이 감소하는 결과를 보였으며 발등은 2시간 후에, 우측 발목은 20분 후에, 우측 장딴지는 12시간 후에 가장 많이 감소되었다(P${\le}$0.05). 결론: 결론적으로 아로마 마사지 치료법이 단순 마사지 치료에 비해 하지 부종의 완화에 큰 영향을 주지 못하며 아로마 마사지 치료의 임상적 적용을 위해서는 향후 보다 많은 연구가 필요할 것으로 생각된다.

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기계환기기 이탈의 성공과 관련된 생리적${\cdot}$심리적 요인에 관한 조사 연구 (A Study on the Physiological and Psychological Factors related to Successful Weaning from a Mechanical Ventilator)

  • 김조자;김화순;장연수;김은성
    • 대한간호학회지
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    • 제30권4호
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    • pp.995-1005
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    • 2000
  • This study was performed to identify the physiological and psychological variables related to successful weaning from a mechanical ventilator. The subjects of this study were 22 patients who received mechanical ventilation therapy for more than 3 days in intensive care units. Before the weaning trial, baseline data for following physiologic variables were obtained: spontaneous respiration rate, blood pressure, pulse rate, PaO2, PaCO2, PEEP, static compliance, minute ventilation, tidal volume, rapid shallow breathing index(f/VT), SaO2, PaO2/FiO2 and mean arterial pressure. During spontaneous breathing, physiologic and psychologic variables such as vital signs, ABG, perspiration, chest retraction, paradoxical respiration, dyspnea, anxiety, confidence and efficacy were measured. Successful weaning was defined as sustaining spontaneous respiration over 24 hours after extubation. Weaning failure was defined as the development of more than one of following signs: (1) hypoxemia, (2) CO2 retention or (3) perspiration, tachypnea, chest retraction, tachycardia, arrhythmia, hypotension or hypertension. Subjects (N=18) who successfully weaned from mechanical ventilator were compared with subjects (N=4) who failed. The results are as follows; Eighteen percents of the subjects failed during the weaning trial. Most subjects in the failed group were mechanically ventilated for long-time. This result shows that the success of weaning is more difficult in long-term ventilation patients. In the baseline data that was measured before weaning trial, the mean score of PaO2 in the successfully weaned group was 121mmHg. This is significantly higher than the mean score of PaO2 in the failed group(95mmHg). However, the scores of pH, tidal volume, f/VT, pulse rates, blood pressure, mean airway pressure, SaO2, and PaCO2 were similar between the two groups. Specially the scores of f/VT index as a predominant predictor for successful weaning were not significant (f/VT=44.4) and (f/VT=47). During spontaneous breathing, the scores of dyspnea and anxiety level in the successfully weaned group were less than those of the failed group. On the contrary, the scores of confidence and efficacy in the successful group were greater than those of the failed group. In conclusion, the baseline data that were measured before weaning trial were similar between the both groups, therefore future studies are needed to focus on searching other variables besides physiological parameters related to weaning outcome.

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명대(明代)의 소아과학(小兒科學)에 관(關)한 연구(硏究) (The Medical Study on the Development of Pediatrics in Myeong(明) Dynasty)

  • 박현국;김기욱;이영석
    • 대한한의학원전학회지
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    • 제21권3호
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    • pp.1-25
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    • 2008
  • Myeong(明) Dynasty Period put together clinically various medical theory in Song(宋) Dynasty and Geum-Won(金元) age, organized medical system. They have been developed in theory, which thought of Byeonjeungronchi(辨證論治) more important, and clinical part which included diagnosis, therapy, prevention. In that age reactional medical thought was in fashion because of affect of Ihak(理學), therefore pediatrics have been affected from them. Especially, looking at the symptom of Byeonjeungronchi doctors, Manjeon(萬全), Nobaeksa(魯伯嗣), Wangdaeryun(王大綸), Wanggeungdang(王肯堂), Nuyeong(樓英) had succeed to Jeoneul(錢乙)' the five viscera Byeonjeung(辨證) system. Manjeon advocated Samyuyeosabujokron(三有餘四不足論) about Jangbu(臟腑) and organized the curative principle about Ojangheosil(五臟虛實). Gupyeong(寇平), commented on diagnosis of five viscera and classification of disease of five viscera. Wangdaeryun in the close of Myeong Dynasty Age explained main pulse, pulse of illness in detail according to weakness or strength of five viscera, pathological or physiological features of five viscera and Saenggeuk(生克) relation of Ohaeng(五行) in the book of "Yeongdongryuchwe(嬰童類萃)". Wanggeungdang and Nuyeong had organized system of argument which classified disease as a result of symptom of five viscera. "Yugwajeungchijunseung(幼科證治準繩)" and "Uihakgangmok(醫學綱目) Soabu(小兒部)" had been written by this principle. Nobaeksa had arranged the principle of cure about five viscera and explained method of common use about each organ's disease. Besides, Seolgi(薛己), Janggyeong-ak(張景岳), insisted about Myeongmun(命門) because he thought of Bisin(脾腎) of children and vigor by nature importance. Seolgi had applied and used very well Bojung-ikgitang(補中益氣湯) based on Idongwon(李東垣)'s Biwiseol(脾胃說) and controled and helped spleen and stomach. At the same time, he took a serious view about supplementing children's Sin-gi(腎氣) according to so many spleen and stomach disease was fallen because they couldn't make warm the spirit of Jungju(中州), result of weakening Hwa(火) of Myeongmun. Also Janggyeong-ak took a serious view strengthen of Bisin, so he assorted and used Insam(人蔘) and Buja(附子) to supplement children's weaken energy in kidney Jeonggi(精氣).

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학교 집단 요 검사 이상으로 추적검사 중 전신 홍반 루푸스로 진단된 1예 (Diagnosis of Systemic Lupus Erythematosus During Medical Follow-up After Urinary Screening)

  • 윤소진;송지은;신재일;정일천;이재승;심효섭;정현주
    • Childhood Kidney Diseases
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    • 제12권2호
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    • pp.227-232
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    • 2008
  • 16세 여아가 학교 소변 검사에서 단백뇨와 현미경적 혈뇨가 나타났으며 신생검에서 감염 후 사구체 신염으로 추정되었다. 그러나 단백뇨는 안지오텐신 효소 억제제 치료에도 반응하지 않았다. 6개월 후 경부 림프절염이 나타났고 목 주위 림프절생검에서 아급성 괴사성 림프절염 소견을 보였다. 이후 2개월 후, 환아는 얼굴의 발진과 혈소판 감소증을 보였다. 재 신생검에서 루프스 신염 class IV 소견을 보였다. 환아는 충격 methylprednisolone(500 mg/일) 3일간 정주 후 경구 deflazacort로 유지하였으며, 이와 함께 cyclophosphamide(1 g/$m^2$)를 월 1회 정주 충격 요법을 6회 실시하였다. 이에 본 저자들은 학교 집단 요 검사 이상으로 추적검사 중 전신 홍반 루푸스로 진단이 되었던 증례를 보고하는 바이다.

아유르베다'($\bar{A}yurveda$)에 관한 소고(小考) (A Study on the '$\bar{A}yurveda$')

  • 김기욱;서지영;박현국
    • 동국한의학연구소논문집
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    • 제10권
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    • pp.161-175
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    • 2008
  • The '$\bar{A}yurveda$', Buddhistic medicine, and the present of traditional medicine can be summed up as thus. 1. The '$\bar{A}yurveda$' is a transliteration of the Sanskrit Ayur - veda and is a compound of the words 'Ayus(life)' and 'Veda(knowledge)' and means "The study of life", which means the preservation of health and the understanding and curing of diseases. 2. The '$\bar{A}yurveda$', which originated from ancient experience, was recorded in Sanskrit, which was a theorization of knowledge, and also was written in verses to make memorizing easy, and made medicine the exclusive possession of the Brahmin. The first annotations were 1060 for the "Charaka", 1200 for the "Sushruta", 1150 for the "Ashtanga Sangraha samhita", and 1100 for the "Nidana". The use of various mineral medicines in the "Charaka" or the use of mercury as internal medicine in the "Ashtanga Sangraha samhita", and the palpation of the pulse for diagnosing in the '$\bar{A}yurveda$' and XiZhang' medicine are similar to TCM's pulse diagnostics. The coexistence with Arabian 'Unani' medicine, compromise with western medicine and the reactionism trend restored the '$\bar{A}yurveda$ today. 3. When we look at the present of the education and research of the '$\bar{A}yurveda$', after gaining independence from England, India set up a modern education system of the '$\bar{A}yurveda$' and set it on an equal position with western medicine. According to the 1976 study the '$\bar{A}yurveda$' is taught in a 5 and a half year university curriculum, and the main textbooks are the Charaka - samhita("開羅迦集" - internal medicine), Sushruta-samhita("妙聞集", surgery), Madhavanidana(diagnostics), 3 volumes of Bhavaprakasa(pharmacology internal medicine, mineral medicine}, Rajanighantu (pharmacology), $Vrks\bar{A}yurveda$(plant therapy), Mahabharata(military medicine), Arthasastra(forensic medicine, toxicology) Kamasastra(science of intercourse), etc. in 10 subjects and there are 232227 certified doctors that have graduated from the 95 colleges and passed the exams.

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