• Title/Summary/Keyword: clinical skills

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The Analysis of Professional Education Needs for the Competencies of Occupational Therapists in Cognitive Rehabilitation: Focusing on the Professors in Occupational Therapy Departments of Universities/Colleges in Korea (작업치료사의 인지재활 직무역량에 대한 교육요구도 분석: 국내 대학 작업치료(학)과 교수자를 중심으로)

  • Hong, Seung-Pyo;Lee, Hee-Ryoung;Han, Dae-Sung;Ju, Yu-Mi;Kim, Young-Geun
    • Therapeutic Science for Rehabilitation
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    • v.12 no.3
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    • pp.45-59
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    • 2023
  • Objective : This study aims to identify the status of education in cognitive rehabilitation (CR) in occupational therapy departments of Korean universities/colleges and to analyze the educational needs for professional competencies. Methods : This study was conducted by distributing a questionnaire to professors. The questionnaire extracted items related to professional competencies from the results of a previous Delphi study. A total of 39 respondents from 32 (51.6%) of 62 universities/colleges were analyzed. The questionnaire analysis was conducted using Excel 2010 and SPSS 18.0 to analyze the Borich requirements and the priority of education through the Locus for focus model. Results : The priority of competency in CR was followed by "clinical reasoning ability to explain cognitive problems from the occupational performance perspective", "ability to manage insurance billing for CR", "ability to establish a CR plan based on outcome evaluation", "ability to perform occupation-oriented CR", and "ability to solve problems that occur during CR evaluation and intervention". In the Locus for focus model, items such as occupation-based cognitive assessment, intervention, and skills for documentation were high priorities for education. Conclusion : This study is expected to reflect educational competencies for CR and establish a plan for CR specialists through continuing education.

Effect of Virtual Reality-based Occupational Therapy Interventions for Disabled Children and Adolescents: A Systematic Review (장애 아동 및 청소년에게 가상현실(VR) 기반 작업치료 중재가 미치는 영향: 체계적 고찰)

  • Kim, Man-Je;Gil, Young-Suk;Kang, Set-Byul;Lee, Jae-Shin
    • The Journal of Korean Academy of Sensory Integration
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    • v.21 no.1
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    • pp.34-46
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    • 2023
  • Objective : The purpose of this study was to systematically analyze the methods by which virtual reality (VR)-based occupational therapy interventions are applied to disabled children and adolescents and to assess their effectiveness. Methods : The RISS, DBpia, KCI, Science Direct, and CINAHL MEDLINE databases were searched for relevant literature from January 2012 to August 2022. The main search terms used were "virtual reality," "work therapy," "youth," "virtual reality," "occupational therapy," "child," and "adolescent." A total of 16 documents were selected for analysis by the 4th stage of the PRISMA flowchart. Results : In the 16 selected studies, VR-based occupational therapy when used with children and adolescents with disabilities and was shown to have meaningful effects. Among the types of cerebral palsy covered in the studies, the most common was hemiplegia, and the evaluation tools used for measurement of the VR effect were daily activities, cognition, exercise technology, social-interaction technology, and visual-perception evaluation. Nintendo wii and Microsoft Kinect produced the VR tools most commonly used to improve motor skills and daily life. Conclusion : The results of this study indicate that VR interventions can be used effectively in clinical practice. In the future, they may assist in the diagnosis of disabled children and adolescents, in helping to select VR tools that are suitable for the purposes of intervention, and in the presentation of specific methods.

Psychosocial Characteristics of Infants with Genital Anomalies and Their Caregivers (생식기 기형을 가진 영유아와 모의 심리 사회적 특성)

  • Lee, Ji-Yeon;Chung, Kyong-Mee;Han, Sang-Won;Jo, Sang Hee;Jung, Hyun Jin;Im, Young Jae
    • Korean Journal of Health Psychology
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    • v.16 no.1
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    • pp.169-187
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    • 2011
  • The present study explored psychosocial characteristics of infants with genital anomalies (GA) and their caregivers against normal controls. Participants were female caregivers and infants between the ages of 6to38months diagnosed with hypospadias(HS;n=103) or cryptorchidism (CR;n=49). Normalcontrols(n=131) were recruited and selected via Internet. Caregivers completed measures on parenting stress, coping style, social support, and infant temperament. Within the GAgroups, HScaregivers reported their greatest parental concerns as infant urination/bodily functioning difficulties whereas CRcaregivers reported worries related to surgical anesthesia issues. Both groups reported concern about their children's potential reproductive problems. Per caregiver report, infants with GA had lower ability to self-soothe. HS infants in particular were perceived as exhibiting greater negative emotion. Compared with controls, HS and CRcaregivers overall employed coping strategies more frequently and had lower interpersonal sensitivity and parental distress. However, HScaregivers emerged as experiencing higher stress when compared to the CRgroup. There were no differences in to tal parenting stress and social support scores between groups. Further, CRcaregivers reported lower levels of family discord than controls. Despite temperament-related differences between infants with GA and normal controls, HS and CRcaregivers reported lower parental distress and greater use of coping skills as compared to controls. Clinical implications are discussed.

The Effects of Case-Based Learning (CBL) on Problem Solving Ability and Academic Self-efficacy in Nursing Students (사례기반학습을 적용한 수업이 간호대학생의 문제해결능력과 학업적 자기효능감에 미치는 효과)

  • Jin Hye Kyung;Yun Mi Jin
    • The Journal of the Convergence on Culture Technology
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    • v.9 no.6
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    • pp.1143-1149
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    • 2023
  • The purpose of this study was to the effects of case-based learning (CBL) on problem solving ability and academic self-efficacy in nursing students and was a quasi-experimental study with a one-group pretest-posttest design. The subjects of this study were 121 grade 4 students, and the data collection period was from Aprill 24 to June 12, 2023. The research procedure was scenario development, preliminary investigation, application of case-based learning classes, and follow-up investigation, and the CBL was conducted for 2 weeks, 50 minutes per week. The general characteristics of the subjects were obtained by frequency, percentage, mean, and standard deviation and the effects of CBL on problem solving ability and academic self-efficacy was tested using a paired t-test. The results of this study showed that nursing students' problem solving ability (t=-5.70, p<.001) and academic self-efficacy (t=-3.25, p<.002) improved after applying CBL compared to before applying it. We suggest the use of case-based learning as a strategy to improve problem-solving skills and academic self-efficacy in nursing education. In the future, follow-up research is needed to verify the effectiveness by developing and applying step-by-step clinical cases at an appropriate level according to the learning content of nursing major subjects by grade.

Effects of Family-Centered Intervention for Children with Autism Spectrum Disorder in South Korea: A Systematic Review - Focusing on Parent Education and Parent Coaching - (국내 자폐스펙트럼장애 아동에 대한 가족 중심 중재 효과: 체계적 고찰 - 부모 교육 및 부모 코칭 중심으로 - )

  • Choi, Yoon-Mi;Yoo, Eun-Young
    • The Journal of Korean Academy of Sensory Integration
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    • v.21 no.3
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    • pp.65-78
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    • 2023
  • Objective : In this study, we aimed to investigate the effectiveness of family-centered intervention conducted with caregivers of children with autism spectrum disorder (ASD) in South Korea through a systematic literature review. Methods : Previous studies published from 2011 to 2021 were searched through RISS, KISS, and DBpia. The search terms applied included "autism spectrum" OR "general developmental disorder" OR "high-functioning autism" OR "Asperger's" AND "parent education" OR "family-centered intervention" OR "parent coaching" OR "parent training" OR "family participation." A total of 11 experimental studies were chosen based on the selection criteria. Results : According to the findings on the general characteristics of the study participants, intervention strategies, and effects of the intervention, it was observed that the majority of children with ASD who participated in the study were preschool-aged, and the majority of participating caregivers were mothers. The effects of family-centered interventions were evident in both children and parents. In children, the most significant effects were observed in interaction and communication skills. In parents, a reduction in parenting stress and an improvement in parenting efficacy were observed. The intervention strategies employed in the study varied, with sensory integration intervention, responsive communication, and interaction-centered intervention being the most commonly used, followed by developmental-centered intervention, positive behavior support (PBS), and parent-mediated intervention based on pivotal response treatment (PRT). Conclusion : The results of this study are significant in that they confirm that family-centered intervention is effective not only in improving the functioning of children with autism spectrum disorder, but also in reducing parenting stress and enhancing parenting efficacy, and provide evidence for clinical use.

Factors Analysis Related to Health Administration Students' Satisfaction on Hospital Practice (보건행정 전공 대학생들의 병원실습 만족도에 영향을 미치는 요인분석)

  • Park, Eun-Young;Jang, Young-Jin;Hong, Jong-Pil
    • Journal of Korean Clinical Health Science
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    • v.5 no.1
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    • pp.825-833
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    • 2017
  • Purpose .This study aims to assess the influence factors on the level of satisfaction with hospital training and to provide basic data for more efficient hospital practice of students' public health administration . Methods . We have conducted a survey on students satisfaction with their hands on practice against 200 students in Busan, Kyeongnam and Kyungbook area, who have completed their practice in public health administration. We have identified the general characteristics of the target respondents, the current training status of the department for the hospital practice and training venue; also analyzed the characteristics composed of the apprentice student's attitude before the practice, satisfaction with the department training program and hospital for practice, as well as their practice at hospital. The general characteristics of the target respondents and clinic practice status at the hospital were measured in percentage and frequency analysis; the average and standard deviations of hospital size were also measured; and the correlations between satisfaction with the department, attitude towards the practice and satisfaction with the hospital were analyzed. Results . Most public health administration students experienced their practice at the hospital after the first semester on the $2^{nd}$year and they have received the foundation training for the practice. The survey allowed multiple responses and the results are as follows: medical terminology 49.5%, medical coordinator 36.7%, Hospital administration 26.5%, Health insurance 17.3%, and medical recording and practice 13.8% respectively. In terms of each individual student's attitude towards the practice at the hospital, the respondents answered as follows: I have completed the obligatory subjects for the practice before the practice 89.5%; I have been fully informed on the hospital for my practice. 74.5%; I responsibly practiced and worked with professionalism and sense of belonging to the hospital as a member of staff 90%; I have actively learned and adopted 95%; My knowledge and skills from the practice was relevant to the theory and practice from my course 83.5%. The findings of satisfaction by size of hospital were in order of a small clinic($3.24{\pm}0.63$), medium sized clinic($3.27{\pm}0.65$), hospital ($3.20{\pm}0.61$), and large sized comprehensive hospital ($2.93{\pm}0.74$). Consequently the satisfaction rate shows no significant difference by size of hospital. In relations between practice attitude and satisfaction with subject, the matter of acquiring information and fully understanding of the hospital for practice before practice(p=0.04), the matter of a sense of belonging and responsibility at hospital during practice(p=0.33). the matter of active adaptation attitude during practice (p=0.42), and the matter of correlations with school curriculum during practice(p=0.00) showed significant results. In relations between practice attitude and satisfaction with the hospital for practice, the matter of acquiring information and fully understanding of the hospital for practice before practice(p=0.01), the matter of a sense of belonging and responsibility at hospital during practice(p=0.04), and the matter of correlations with school curriculum during practice(p=0.00) showed significant results. Conclusion . The most essential subject for the practice in public health administration is medical terminology and there is no significance in satisfaction with the practice by size of hospital. Students were content with the hospital where they can experience as much as possible. Students content with their major show positive attitude towards the practice and so do those content with the hospital. Those with the positive attitude towards the practice show the high correlation of satisfaction with both the major and hospital. As a result, the satisfaction with the major is the significant attribute to the practice in the hospital.

The Characteristics of Pain Coping Strategies in Patients with Chronic Pain by Using Korean Version-Coping Strategies Questionnaire(K-CSQ) (한국판 대처 전략 질문지 (K-CSQ)를 이용한 만성 통증 환자의 통증대처 특성)

  • Song, Ji-Young;Kim, Tae;Yoon, Hyun-Sang;Kim, Chung-Song;Yeom, Tae-Ho
    • Korean Journal of Psychosomatic Medicine
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    • v.10 no.2
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    • pp.110-119
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    • 2002
  • Objectives : Numbers of patients who have chronic pain seem to be increasing in the psychiatric practice. Many investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. Coping strategies appear to be associated with adjustment in chronic pain patients. The objectives of this study were to develop a self-report questionnaire which is the most widely used measures of pain coping strategies, Coping Strategies Questionnaire (CSQ) into Korean version and to study the different coping strategies with which chronic pain patients frequently use when their pain reaches a moderate or greater level of intensity. Methods : One hundred twenty-eight individuals with chronic pain conditions and two hundred fifty-two normal controls were administered the Korean version-Coping Strategies Questionnaire(KCSQ) to assess the frequency of use and perceived effectiveness of a variety of cognitive and behavioral pain coping strategies. We also obtained their clinical features in chronic pain patients. Reliability of the questionnaire were analyzed and evaluated differences of coping strategies between two groups. Results : Data analysis revealed that the questionnaire was internally reliable. Chronic pain patients reported frequent use of a variety of pain coping strategies, such as coping self-statements, praying and hoping, catastrophizing, and increase behavior scales which were higher compared to the normal controls. Conclusion: K-CSQ revealed to be a reliable self-report questionnaire which is useful for the assessment of coping strategies in clinical setting on chronic pain. And analysis of pain coping strategies may be helpful in understanding pain for chronic pain patients. The individual K-CSQ may have greater utility in terms of examining coping, appraisals, and pain adjustment. A consideration of pain coping strategies may allow one to design pain coping skills training interventions so as to fit the individual chronic pain patient. Further research is needed to determine whether cognitive-behavioral intervention designed to decrease maladaptive coping strategies can reduce pain and improve the physical and psycho-social functioning of chronic patients.

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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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Clinical Outcomes of Corrective Surgical Treatment for Esophageal Cancer (식도암의 외과적 근치 절제술에 대한 임상적 고찰)

  • Ryu Se Min;Jo Won Min;Mok Young Jae;Kim Hyun Koo;Cho Yang Hyun;Sohn Young-sang;Kim Hark Jei;Choi Young Ho
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.157-163
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    • 2005
  • Background: Clinical outcomes of esophageal cancer have not been satisfactory in spite of the development of surgical skills and protocols of adjuvant therapy. We analyzed the results of corrective surgical patients for esophageal cancer from January 1992 to July 2002. Material and Method: Among 129 patients with esophageal cancer, this study was performed in 68 patients who received corrective surgery. The ratio of sex was 59 : 9 (male : female) and mean age was $61.07\pm7.36$ years old. Chief complaints of this patients were dysphagia, epigastric pain and weight loss, etc. The locations of esophageal cancer were 4 in upper esophagus, 36 in middle, 20 in lower, 8 in esophagogastric junction. 60 patients had squamous cell cancer and 7 had adenocarcinoma, and 1 had malignant melanoma. Five patients had neoadjuvant chemotherapy. Result: The postoperative stage I, IIA, IIB, III, IV patients were 7, 25, 12, 17 and 7, respectively. The conduit for replacement of esophagus were stomach (62 patients) and colon (6 patients). The neck anastomosis was performed in 28 patients and intrathoracic anastomosis in 40 patients. The technique of anastomosis were hand sewing method (44 patients) and stapling method (24 patients). One of the early complications was anastomosis leakage (3 patients) which had only radiologic leakage that recovered spontaneously. The anastomosis technique had no correlation with postoperative leakage, which stapling method (2 patients) and hand sewing method (1 patient). There were 3 respiratory failures, 6 pneumonia, 1 fulminant hepatitis, 1 bleeding and 1 sepsis. The 2 early postoperative deaths were fulminant hepatitis and sepsis. Among 68 patients, 23 patients had postoperative adjuvant therapy and 55 paitents were followed up. The follow up period was $23.73\pm22.18$ months ($1\~76$ month). There were 5 patients in stage I, 21 in stage 2A, 9 in stage IIB, 15 in stage III and 5 in stage IV. The 1, 3, 5 year survival rates of the patients who could be followed up completely was $58.43\pm6.5\%,\;35.48\pm7.5\%\;and\;18.81\pm7.7\%$, respectively. Statistical analysis showed that long-term survival difference was associated with a stage, T stage, and N stage (p<0.05) but not associated with histology, sex, anastomosis location, tumor location, and pre and postoperative adjuvant therapy. Conclusion: The early diagnosis, aggressive operative resection, and adequate postoperative treatment may have contributed to the observed increase in survival for esophageal cancer patients.

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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