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Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study

  • Takeshi Okamoto;Takashi Sasaki;Tsuyoshi Takeda;Tatsuki Hirai;Takahiro Ishitsuka;Manabu Yamada;Hiroki Nakagawa;Takafumi Mie;Takaaki Furukawa;Akiyoshi Kasuga;Masato Ozaka;Naoki Sasahira
    • Clinical Endoscopy
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    • v.57 no.4
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    • pp.515-526
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    • 2024
  • Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions: No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

The Effects of Korean Seaweeds on In vitro Ruminal Fermentation Characteristics and Methane Production (국내 자생 해조류 첨가가 in vitro 반추위 발효 성상 및 메탄 발생량에 미치는 영향)

  • Kim, Byul;Wi, Jisoo;Lee, Yookyung;Kim, Hyunsang;Seong, Pilnam;Lee, Sungdae;Hwang, Ilki;Kim, Hyunchul;Lee, Seongshin
    • Korean Journal of Organic Agriculture
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    • v.32 no.3
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    • pp.277-288
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    • 2024
  • The present study was conducted to investigate the effects of seaweeds on in vitro ruminal fermentation characteristics and methane gas production. Five seaweeds (Dictyota dichotoma, DD; Chrysymenia wrightii Yamada, CW; Codium fragile, CF; Sargassum fusiforme, SF; Gracilaria vermiculophylla, GV) were obtained from National Institute of Fisheries Science (NIFS) in South Korea. The ruminal fluids were collected from 3 rumen-cannulated Hanwoo steers (average 12-months-old). The buffered ruminal fluids (50 mL) were incubated with substrates (0.4 g of concentrate and 0.1 g of rice straw in dry matter basis) and seaweeds (5% of substrates) at 39℃ for 24 and 48 hours. The total gas and methane production of all treatments incubated for 24 hours were not affected by the seaweed. However, methane production (mL/g of digested dry matter) in the CW and CF treatments incubated for 48 hours was decreased compared to control (p<0.05). Additionally, the ruminal pH of all treatments incubated for 24 and 48 hours was lower than control (p<0.05). There was no signigicant difference in total VFA concentration at 24 hours of incubation, but it was higher in the CF treatment at 48 hours of incubation (p<0.05). The dry matter digestibility of all treatments incubated for 24 and 48 hours were not affected by the seaweed. In conclusion, Codium fragile reduced in vitro methane production without negative effects on rumen fermentation characteristics.

Lack of Associations between Genetic Polymorphisms in GSTM1, GSTT1 and GSTP1 and Pancreatic Cancer Risk: A Multi-Institutional Case-Control Study in Japan

  • Yamada, Ikuhiro;Matsuyama, Masato;Ozaka, Masato;Inoue, Dai;Muramatsu, Yusuke;Ishii, Hiroshi;Junko, Ueda;Ueno, Makoto;Egawa, Naoto;Nakao, Haruhisa;Mori, Mitsuru;Matsuo, Keitaro;Nishiyama, Takeshi;Ohkawa, Shinichi;Hosono, Satoyo;Wakai, Kenji;Nakamura, Kozue;Tamakoshi, Akiko;Kuruma, Sawako;Nojima, Masanori;Takahashi, Mami;Shimada, Kazuaki;Yagyu, Kiyoko;Kikuchi, Shogo;Lin, Yingsong
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.1
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    • pp.391-395
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    • 2014
  • Background: We aimed to evaluate the role of genetic polymorphisms in tobacco carcinogen-metabolizing genes and their interactions with smoking in a hospital-based case-control study of Japanese subjects. Materials and Methods: We examine the associations of pancreatic cancer risk with genetic polymorphisms in GSTM1, GSTT1 and GSTP1, phase II enzymes that catalyze the conjugation of toxic and carcinogenic electrophilic molecules. The study population consisted of 360 patients and 400 control subjects, who were recruited from several medical facilities in Japan. Unconditional logistic regression methods were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between genotypes and pancreatic cancer risk. Results: Among the control subjects, the prevalence of the GSTM1-null genotype and the GSTT1-null genotype was approximately 56% and 48%, respectively. Cases and controls were comparable in terms of GSTM1 and GSTT1 genotype distributions. Neither of the deleted polymorphisms in GSTM1 and GSTT1 was associated with the risk of pancreatic cancer, with an age- and sex-adjusted OR of 0.99 (95%CI: 0.74-1.32) for the GSTM1-null genotype, and 0.98 (95%CI: 0.73-1.31) for the GSTT1-null genotype. The OR was 0.97 (95%CI: 0.64-1.47) for individuals with the GSTM1 and GSTT1-null genotypes compared with those with the GSTM1 and GSTT1- present genotypes. No synergistic effects of smoking or GST genotypes were observed. Conclusions: Our results indicate no overall association between the GSTM1 and GSTT1 deletion polymorphisms and pancreatic cancer risk in the Japanese subjects in our study.

A Clinical Study of Protruding Lesions That Arise at the Scar of an Endoscopic Mucosal Resection for an Early Gastric Carcinoma and a Gastric Flat Adenoma (위 편평선종 및 조기위암에서 내시경적 점막절제술 후 절제부위에서 발생한 융기형 병변에 관한 임상적 고찰)

  • Cheon Young Koog;Ryu Chang Beom;Ko Bong Min;Kim Jin Oh;Cho Joo Young;Lee Joon Seong;Lee Moon Sung;Jin So Young;Shim Chan Sup
    • Journal of Gastric Cancer
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    • v.1 no.1
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    • pp.55-59
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    • 2001
  • Purpose: Several studies of an endoscopic mucosal resection(EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. Materials and Methods: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). Results: 1. The mean duration until detection of the protruding lesion was 8.9 months ($1.5\∼27$). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs ($3.6\%$) and from 15 of 73 gastric flat adenomas ($20.5\%$). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients ($81.7\%$) who developed a protruding lesion than in those ($51.8\%$) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. Conclusions: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.

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The Significance of Small Polyp of Colon in Koreans (한국인에 있어서 대장의 작은 용종의 의의)

  • Kwon, Soon-Uk;Lee, Eun-Ju;Eun, Jong-Ryul;Choi, Sun-Taek;Lee, Hak-Jun;Jang, Byeong-Ik;Kim, Tac-Nyeun;Chung, Moon-Kwan
    • Journal of Yeungnam Medical Science
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    • v.17 no.1
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    • pp.39-48
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    • 2000
  • Background: There arc two theories in the development of colon cancer. One is the adenoma-carcinoma sequence theory and the other is the de novo cancer theory. Western countries believe in the adenoma-carcinoma sequence theory, however there are many recent reports from, Japan about cancers developing from small adenomas. Methods: The present study analyzed 408 polyps from 508 cases that were taken by colonoscopic polypectomy at the Department of internal Medicine, Yeungnam University Hospital. Results: The percentage of patients who had a polyp was 41.3% (210 cases out of 526 cases), and the peak incidence was noted in patients in their 50s and 60s, There was no difference between the sexes, but we noted significant increase in the incidence of polyps in patients over the age of thirty. We found 395 polyps below 1cm and 13 polyps above 1cm. Among 408 polyps, 5 cases were cancerous polyps and 3 cases showed polyp size of less than 1cm each. The first case was a polyp of 0.4cm in size with elevated mucosa at the ascending colon. The second was 0.5cm in size with round elevation and hyperemic mucosa in the rectum. The third was 0.6cm in size with tubular elevation at the hepatic flexure. Conclusions: Colon polyp is a common disease in Koreans, Even small polyps can have cancer tissue, which should be removed if discovered during colonoscopy. We believe that not all colon cancer originates in the manner described by the adenoma-carcinoma sequence theory. However further studies with a larger sample population arc needed to determine the exact role of colon polyps in the development of colon cancer.

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A Study on the ' Zhe Zhong Pai'(折衷派) of the Traditional Medicine of Japan (일본(日本) 의학(醫學)의 '절충파(折衷派)'에 관(關)한 연구(硏究))

  • Park, Hyun-Kuk;Kim, Ki-Wook
    • The Journal of Dong Guk Oriental Medicine
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    • v.10
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    • pp.41-61
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    • 2008
  • The outline and characteristics of the important doctors of the 'Zhe Zhong Pai'(折衷派) are as follows. Part 1. In the late Edo(江戶) period The 'Zhe Zhong Pai', which tried to take the theory and clinical treatment of the 'Hou Shi Pai (後世派)' and the 'Gu Fang Pai(古方派)' and get their strong points to make treatments perfect, appeared. Their point was 'The main part is the art of the ancients, The latter prescriptions are to be used'(以古法爲主, 後世方爲用) and the "Shang Han Lun(傷寒論)" was revered for its treatments but in actual use it was not kept at that. As mentioned above The 'Zhe Zhong Pai' viewed treatments as the base, which was the view of most doctors in the Edo period. However, the reason the 'Zhe Zhong Pai' is not valued as much as the 'Gu Fang Pai' by medical history books in Japan is because the 'Zhe Zhong Pai' does not have the substantiation or uniqueness of the 'Gu Fang Pai', and also because the view of 'gather as well as store up'(兼收並蓄) was the same as the 'Kao Zheng Pai'. Moreover, the 'compromise'(折衷) point of view was from taking in both Chinese and western medical knowledge systems(漢蘭折衷). Generally the pioneer of the 'Zhe Zhong Pai' is seen as Mochizuki Rokumon(望月鹿門) and after that was Fukui Futei(福井楓亭), Wadato Kaku(和田東郭), Yamada Seichin(山田正珍) and Taki Motohiro(多紀元簡). Part 2. The lives of Wada Tokaku(和田東郭), Nakagame Kinkei(中神琴溪), Nei Teng Xi Zhe(內藤希哲), the important doctors of the 'Zhe Zhong Pai', are as follows. First Wada Tokaku(和田東郭, 1743-1803) was born when the 'Hou Shi Pai' was already declining and the 'Gu Fang Pai' was flourishing and learned medicine from a 'Hou Shi Pai' doctor, Hu Tian Xu Shan(戶田旭山) and a 'Gu Fang Pai' doctor, Yoshimasu Todo(吉益東洞). He was not hindered by 'the old ways(古方)' and did not lean towards 'the new ways(後世方)' and formed a way of compromise that 'looked at hardness and softness as the same'(剛柔相摩) by setting 'the cure of the disease' as the base, and said that to cure diseases 'the old way' must be used, but 'the new way' was necessary to supplement its shortcomings. His works include "Dao Shui Suo Yan(導水瑣言)", "Jiao Chiang Fang Yi Je(蕉窗方意解)" and "Yi Xue Sho(醫學說)". Second. Nakagame Kinkei(中神琴溪, 1744-1833) was famous for leaving Yoshimasu Todo(吉益東洞) and changing to the 'Zhe Zhong Pai', and in his early years used qing fen(輕粉) to cure geisha(妓女) of syphilis. His argument was "the "Shang Han Lun" must be revered but needs to be adapted", "Zhong Jing can be made into a follower but I cannot become his follower", "the later medical texts such as "Ru Men Shi Qin(儒門事親)" should only be used for its prescriptions and not its theories". His works include "Shang Han Lun Yue Yan(傷寒論約言)". Third, Nei Teng Xi Zhe(內藤希哲, 1701-1735) learned medicine from Qing Shui Xian Sheng(淸水先生) and went out to Edo. In his book "Yi Jing Jie Huo Lun(醫經解惑論)" he tells of how he went from 'learning'(學) to 'skepticism'(惑) and how skepticism made him learn in 'the six skepticisms'(六惑). In the latter years Xi Zhe(希哲) combines the "Shen Nong Ben Cao Jing(神農本草經)", the main text for herbal medicine, "Ming Tang Jing(明堂經)" of accupuncture, basic theory texts "Huang Dui Nei Jing(皇帝內經)" and "Nan Jing(難經)" with the "Shang Han Za Bing Lun", a book that the 'Gu Fang Pai' saw as opposing to the rest, and became 'an expert of five scriptures'(五經一貫). Part 3. Asada Showhaku(淺田宗伯, 1815-1894) started medicine at Zhong Cun Zhong Zong(中村中倧) and learned 'the old way'(古方) from Yoshimasu Todo and got experience through Ouan Yue(川越) and Fu Jing(福井) and received teachings in texts, history and Wang Yangmin's principles(陽明學) fmm famous teachers. Showhaku(倧伯) meets a medical official of the makufu(幕府), Ben Kang Zong Yuan(本康宗圓), and receives help from the 3 great doctors of the Edo period, Taki Motokato(多紀元堅), Xiao Dao Xue Gu(小島學古) and Xi Duo Cun Kao(喜多村栲窻) and further develops his arts. At 47 he diagnoses the general Jia Mao(家茂) with 'heart failure from beriberi'(脚氣衡心) and becomes a Zheng Shi(徵土), at 51 he cures a minister from France and received a present from Napoleon, at 65 he becomes the court physician and saves Ming Gong(明宮) Jia Ren Qn Wang(嘉仁親王, later the 大正天皇) from bodily convulsions and becomes 'the vassal of merit who saved the national polity(國體)' At the 7th year of the Meiji(明治) he becomes the 2nd owner of Wen Zhi She(溫知社) and takes part in the 'kampo continuation movement'. In his latter years he saw 14000 patients a year, so we can estimate the qualjty and quantity of his clinical skills. Showhaku(宗伯) wrote over 80 books including the "Ju Chuang Shu Ying(橘窻書影)", "Wu Wu Yao Shi Fang Han(勿誤藥室方函)", "Shang Han Biang Shu(傷寒辨術)", "Jing Qi Shen Lun(精氣神論)", "Hunag Guo Ming Yi Chuan(皇國名醫傳)" and the "Xian Jhe Yi Hua(先哲醫話)". Especially in the "Ju Chuang Shu Ying(橘窻書影) he says "the old theories are the main, and the new prescriptions are to be used"(以古法爲主, 後世方爲用), stating the 'Zhe Zhong Pai' way of thinking, In the first volume of "Shang Han Biang Shu(傷寒辨術)" and "Za Bing Lun Shi(雜病論識)", 'Zong Ping'(總評), He discerns the parts that are not Zhang Zhong Jing's writings and emphasizes his theories and practical uses.

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Studies on the ${\beta}-Tyrosinase$ -Part 2. On the Synthesis of Halo-tyrosine by ${\beta}-Tyrosinase$- (${\beta}-Tyrosinase$에 관한 연구 -제2보 ${\beta}-Tyrosinase$에 의한 Halogen화(化) Tyrosine의 합성(合成)-)

  • Kim, Chan-Jo;Nagasawa, Toru;Tani, Yoshiki;Yamada, Hideaki
    • Applied Biological Chemistry
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    • v.22 no.4
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    • pp.198-209
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    • 1979
  • L-Tyrosine, 2-chloro-L-tyrosine, 2-bromo-L-tyrosine, and 2-iodo-L-tyrosine were synthesized by ${\beta}-tyrosinase$ obtained from cells of Escherichia intermedia A-21, through the reversal of the ${\alpha},{\beta}-elimination$ reaction, and their molecular structures were analyzed by element analysis, NMR spectroscopy, mass spectrometry and IR spectroscopy. Rates of synthesis and hydrolysis of halogenated tyrosines by ${\beta}-tyrosinase$, inhibition of the enzyme activity by halogenated phenols, and effects of addition of m-bromophenol on the synthesis of 2-bromotyrosine were determined. The results obtained were as follows: 1) In the synthesis of halogenated tyrosines, the yield of 2-chlorotyrosine from m-chlorophenol were approximately 15 per cent, that of 2-bromotyrosine from m-bromophenol 13.8 per cent, and that of 2-iodotyrosine from m-iodophenol 9.8 per cent. 2) Rate of synthesis of halogenated tyrosines by ${\beta}-tyrosinase$ was slower than that of tyrosine and the rates were decreased in the order of chlorine, bromine and iodine, that is, by increasing the atomic radius. Relative rate of 2-chlorotyrosine synthesis was determined to be 28.2, that of 2-bromotyrosine to be 8.13, and that of 2-iodotyrosine to be 0.98, respectively, against 100 of tyrosine. However 3-iodotyrosine was not synthesized by the enzyme. 3) The relative rate of 2-chlorotyrosine hydrolysis by ${\beta}-tyrosinase$ was 70.7, that of 2-bromotyrosine was 39.0, and that of 2-iodotyrosine was 12.6 against 100 of tyrosine, respectively. The rate of hydrolysis appeared to be decreased in the order of chlorine, bromine and iodine, that is, by increasing the atomic radius or by decreasing the electronegativity. But 3-iodotyrosine was not hydrolyzed by the enzyme. 4) The activity of ${\beta}-tyrosinase$ was inhibited by phenol markedly. Of the halogenated phenols, o-, or m-chlorophenol and o-bromophenol gave marked inhibition on the enzyme action, however inhibition by iodophenol was not strong. Plotting by Lineweaver-Burk method, a mixed-type inhibition by m-chlorophenol was observed and its Ki value was found to be $5.46{\times}10^{-4}M$. 5) During the synthesizing reaction of 2-bromotyrosine by the enzyme, sequential addition of substrate which was m-bromophenol with time intervals and in a small amount resulted in better yield of the product. 6) The halogenated tyrosines which were produced by ${\beta}-tyrosinase$ from pyruvate, ammonia and m-halogenated phenols were analysed to determine their molecular structures by element analysis, NMR spectroscopy, mass spectrometry, and IR spectroscopy. The result indicated that they were 2-chloro-L-tyrosine, 2-bromo-L-tyrosine, and 2-iodo-L-tyrosine, respectively.

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A Study on the 'Zhe Zhong Pai'(折衷派) of the Traditional Medicine of Japan (일본(日本) 의학醫學의 '절충파(折衷派)'에 관(關)한 연구(硏究))

  • Park, Hyun-Kuk;Kim, Ki-Wook
    • Journal of Korean Medical classics
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    • v.20 no.3
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    • pp.121-141
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    • 2007
  • The outline and characteristics of the important doctors of the 'Zhe Zhong Pai'(折衷派) are as follows. Part 1. In the late Edo(江戶) period The 'Zhe Zhong Pai', which tried to take the theory and clinical treatment of the 'Hou Shi Pai (後世派)' and the 'Gu Fang Pai (古方派)' and get their strong points to make treatments perfect, appeared. Their point was 'The main part is the art of the ancients, The latter prescriptions are to be used'(以古法爲主, 後世方爲用) and the "Shang Han Lun(傷寒論)" was revered for its treatments but in actual use it was not kept at that. As mentioned above The 'Zhe Zhong Pai ' viewed treatments as the base, which was the view of most doctors in the Edo period, However, the reason the 'Zhe Zhong Pai' is not valued as much as the 'Gu Fang Pai' by medical history books in Japan is because the 'Zhe Zhong Pai' does not have the substantiation or uniqueness of the 'Gu Fang Pai', and also because the view of 'gather as well as store up' was the same as the 'Kao Zheng Pai', Moreover, the 'compromise'(折衷) point of view was from taking in both Chinese and western medical knowledge systems(漢蘭折衷), Generally the pioneer of the 'Zhe Zhong Pai' is seen as Mochizuki Rokumon(望月鹿門) and after that was Fukui Futei(福井楓亭), Wadato Kaku(和田東郭), Yamada Seichin(山田正珍) and Taki Motohiro(多紀元簡), Part 2. The lives of Wada Tokaku(和田東郭), Nakagame Kinkei(中神琴溪), Nei Teng Xi Zhe(內藤希哲), the important doctors of the 'Zhe Zhong Pai', are as follows First. Wada Tokaku(和田東郭, 1743-1803) was born when the 'Hou Shi Pai' was already declining and the 'Gu Fang Pai' was flourishing and learned medicine from a 'Hou Shi Pai' doctor, Hu Tian Xu Shan(戶田旭山) and a 'Gu Fang Pai' doctor, Yoshimasu Todo(吉益東洞). He was not hindered by 'the old ways(古方), and did not lean towards 'the new ways(後世方)' and formed a way of compromise that 'looked at hardness and softness as the same'(剛柔相摩) by setting 'the cure of the disease' as the base, and said that to cure diseases 'the old way' must be used, but 'the new way' was necessary to supplement its shortcomings. His works include "Dao Shui Suo Yan", "Jiao Chiang Fang Yi Je" and "Yi Xue Sho(醫學說)" Second. Nakagame Kinkei(中神琴溪, 1744-1833) was famous for leaving Yoshirnasu Todo(吉益東洞) and changing to the 'Zhe Zhong Pai', and in his early years used qing fen(輕粉) to cure geisha(妓女) of syphilis. His argument was "the "Shang Han Lun" must be revered but needs to be adapted", "Zhong jing can be made into a follower but I cannot become his follower", "the later medical texts such as "Ru Men Shi Qin(儒門事親)" should only be used for its prescriptions and not its theories". His works include "Shang Han Lun Yue Yan(傷寒論約言) Third. Nei Teng Xi Zhe(內藤希哲, 1701-1735) learned medicine from Qing Shui Xian Sheng(淸水先生) and went out to Edo. In his book "Yi Jing Jie Huo Lun(醫經解惑論)" he tells of how he went from 'learning'(學) to 'skepticism'(惑) and how skepticism made him learn in 'the six skepticisms'(六惑). In the latter years Xi Zhe(希哲) combines the "Shen Nong Ben Cao jing(神農本草經)", the main text for herbal medicine, "Ming Tang jing(明堂經)" of accupuncture, basic theory texts "Huang Dui Nei jing(黃帝內徑)" and "Nan jing(難經)" with the "Shang Han Za Bing Lun", a book that the 'Gu Fang Pai' saw as opposing to the rest, and became 'an expert of five scriptures'(五經一貫). Part 3. Asada Showhaku(淺田宗伯, 1815-1894) started medicine at Zhong Cun Zhong(中村中倧) and learned 'the old way'(古方) from Yoshirnasu Todo and got experience through Chuan Yue(川越) and Fu jing(福井) and received teachings in texts, history and Wang Yangmin's principles(陽明學) from famous teachers. Showhaku(宗伯) meets a medical official of the makufu(幕府), Ben Kang Zong Yuan(本康宗圓), and recieves help from the 3 great doctors of the Edo period, Taki Motokato(多紀元堅), Xiao Dao Xue GU(小島學古) and Xi Duo Cun Kao Chuang and further develops his arts. At 47 he diagnoses the general Jia Mao(家茂) with 'heart failure from beriberi'(脚氣衝心) and becomes a Zheng Shi(徵I), at 51 he cures a minister from France and received a present from Napoleon, at 65 he becomes the court physician and saves Ming Gong(明宮) jia Ren Qn Wang(嘉仁親王, later the 大正犬皇) from bodily convulsions and becomes 'the vassal of merit who saved the national polity(國體)' At the 7th year of the Meiji(明治) he becomes the 2nd owner of Wen Zhi She(溫知社) and takes part in the 'kampo continuation movement'. In his latter years he saw 14000 patients a year, so we can estimate the quality and quantity of his clinical skills Showhaku(宗伯) wrote over 80 books including the "Ju Chuang Shu Ying(橘窓書影)", "WU Wu Yao Shi Fang Han(勿誤藥室方函)", "Shang Han Biang Shu(傷寒辨術)", "jing Qi Shen Lun(精氣神論)", "Hunag Guo Ming Yi Chuan(皇國名醫傳)" and the "Xian Jhe Yi Hua(先哲醫話)". Especially in the "Ju Chuang Shu Ying(橘窓書影)" he says "the old theories are the main, and the new prescriptions are to be used"(以古法爲主, 後世方爲用), stating the 'Zhe Zhong Pai' way of thinking. In the first volume of "Shung Han Biang Shu(傷寒辨術) and "Za Bing Lun Shi(雜病論識)", 'Zong Ping'(總評), He discerns the parts that are not Zhang Zhong Jing's writings and emphasizes his theories and practical uses.

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9 Provinces and 5 Secondary Capitals, Myeong-ju(Haseo-ju) - Revolve Around Urban Structure - (구주오소경과 명주(하서주) - 그 도시구조를 중심으로 -)

  • Takahumi, Yamada
    • Korean Journal of Heritage: History & Science
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    • v.45 no.2
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    • pp.20-37
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    • 2012
  • After withdrawal of military troops of Chinese Tang dynasty in the 18th year of King Moon-moo's reign(678), the Silla Kingdom had actually unified the Korean peninsula and had divided the territory into 9 states benchmarking the China's local administrations adjustment system. He had established local administrative units by deploying secondary capitals, counties and prefectures in the nine states. The so-called "9 Provinces and 5 Secondary capitals" are what constitutes the local administrations system. The provinces can be compared to current provinces of the Republic of Korea(hereinafter Korea), and secondary capitals to megalopolises. According to a chapter of the Samkuksaki(三?史記) which had recorded the achievements of king Kyoungdeok in December in his 16th year on the throne(757), the local administrative units had amounted to 5 secondary capitals, 117 counties and 293 prefectures. There are still lots of ambiguous points since there have never been any consultation on locations of provinces and secondary capitals' castles, and on structures of cities because the researches for local cities inside the 9 Provinces and 5 Secondary capitals in the Unified Silla Kingdom has been conducted centering on the historic literatures only. The research for restoring structures of cities seen from an archeological perspective are limited to the studies of Taewoo Park("A study on the local cities in the Unified Kingdom Age" 1987) and that of the author("A study on the restoration of planned cities for the Unified Silla Kingdom in terms of the structures and realities of the castles in the 9 Provinces and 5 Secondary capitals" 2009). The Gangneung city of Gangwon province was originally called Haseoryang(河西良) of the Gogureo Kingdom as an ancient nation of Ye(濊). According to "Samkuksaki", it had evolved from Haseoju(河西州) to a secondary capitals in the 8th year of King Seonduk(639). Afterwards, it had been renamed as Myeongju(溟洲) in the 16th year of King Kyoungduk(757), and then several other names were given to it after Goryo dynasty. Taewoo Park claims that it is being defined as a sanctuary remaining in Myoungjudong because of the vestige of bare castle, and this cannot be ascertained due to the on-going urbanization processes. Also, the Kwandong university authority is suggesting an opinion of regarding Myeongju mountain castle located 3 Kms southwest of the center of Gangwon city as commanding post for the pertinent state. The author has restored the pertinent area into a city composed of villages within a lattice framework like Silla Keumkyoung and many other cities. The structure is depicted next. The downtown of Gangneung is situated on a flat terrain at the west bank of Namdaecheon stream flowing southwest to northeast along the inner area of the city. Though there isn't any hill comparatively higher than others in the vicinity, hills are continuously linked east to west along the northern area of the downtown, and the maximum width of flat terrain is about 1 Km and is not so large. Currently, urbanization is being proceeded into the inner portion of Gangneung city, the lands in all directions from the hub of Gangneung station have been readjusted, and thus previous land-zoning program is almost nullified. However, referring to the topographic chart drawn at the time of Japanese colonial rule, it can be validated that land-zoning program to accord the lattice framework with the length of its one side equaling to 190m leaves its vestige about 0.8Km northwest to southeast and about 1.7Km northeast to southwest of the vicinity of Okcheondong, Imdangdong, Geumhakdong, Myeongjudong, and etcetera which comprize the hub of the downtown. The land-zoning vestige within the lattice framework, compared to other cases related with the '9 states and 5 secondary capitals', is very much likely to be that of the Unified Silla Kingdom. That the length of a side of a lattice framework is 190m as opposed to that of Silla Geumkyoung and other cities with their 140m or 160m long sides is a single survey item in the future. The baseline direction for zoning the lands is tilting approximately 37.5 degrees west of northwest to southeast axis in accordance with the topographic features. It seems that this phenomenon takes place because of the direction of Namdaecheon and the geographic constraints of the hills in the north. Reviewing minimally, a rectangular size of zoned land by 4 Pangs(坊) on the northwest to southeast side multiplied by 7 Pangs(坊) on the northeast to southwest side had been restored within a lattice framework. Otherwise, considering the extent of expansion of the existing zoned lands in the lattice framework and one more Pang(坊) being added to each side, it is likely that the size could have been with 5 Pangs(坊) on the northwest to southeast side multiplied by 8 Pangs(坊) on the northeast to southwest side(950 M on the northwest to southeast side multiplied by 1,520m on the northeast to southwest side). The overall shape is rectangle, but land-zoning programs reminiscent of rebuilt roads(red phoenix road) like Jang-an castle(長安城) of Chinese Tang dynasty or Pyoungseong castle(平城城) in Japan is not to be validated. There are some historic items among the roof tiles and earthen wares excavated at local administrative office sites or Gangneung's town castle in Joseon dynasty inside the area assumed to be containing municipal vestiges even though archeological survey for the vestige of Myeongju has not been made yet, and these items deserve dating back to the Unified Silla Kingdom age. Also, all of the construction sites at local administrative authorities of the Joseon dynasty are showing large degrees of slant in the azimuth. This is a circumstantial evidence indicating the fact that the inherited land-zoning programs to be seen in Gangneung in terms of the lattice framework had ever existed in the past. Also, the author does not decline that Myeongju mountain castle had once been the commanding post when reviewing the roof tiles at the edge of eaves in this stronghold. The ancient municipal castles in the Korean peninsula are composed of castles on the flat terrain as well as hilly areas and the cluster of strongholds like Myounghwal, Namhan, Seohyoung mountain castles built around municipal castle of Geumkyoung based on a lattice framework program. Considering that mountain castles are spread in the vicinity of municipal vestiges in other cities other than the 9 states and 5 secondary capitals, it is estimated that Myeongju was assuming the function of commanding post incorporating cities on the flat terrain and castles on the hills.