• Title/Summary/Keyword: deficiency in the heart

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A Study on the Blood-Letting Therapy in Elementary Questions (("황제내경소문(黃帝內經素問)" 중(中) 사혈(瀉血)에 관한 연구(硏究))

  • Lee, Jun-Geun
    • Journal of the Korean Institute of Oriental Medical Informatics
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    • v.14 no.1
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    • pp.19-42
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    • 2008
  • Blood-Letting Therapy is a rational and ecological medical treatment by which we can heal most of the diseases by removing the static blood which precipitates in the blood vessel and blocks the flowing of blood. And the static blood is the generic term for the injurious, bad, dead and precipitated blood which is blocked the capillary vessel. The Yellow Emperor's Canon of Internal Medicine says that "the patient is treated with drugs internally and stone acupuncture externally. "In the old texts, the blood-letting therapy is mentioned as blood-letting, network vessel pricking, bloodletting, pricking, and arousing pulses etc and it is noted down as the method of network vessel pricking in 'On the Application of Needles' of Spiritual Pivot. Nine-pricking therapy, twelve-pricking therapy and five-pricking therapy are recorded in the methods of network vessel pricking and among them, the method of squeezing blood after pricking the affected part is explained as the network vessel pricking. There are four methods of network vessel pricking, pricking, picking, cluster needling and scatter-pricking and they are fluidly applied to the various symptoms of diseases. In 'On Discriminative Treating for Patients of Different Regions' in Elementary Questions, Ki-baek emphasizes "most of the local people, there are black in skin and loose in striate, and their diseases are mostly of carbuncle kind. It is suitable to treat the disease with stone therapy to prick with stone, so the stone therapy is transmitted from the east. "And in 'On the Corresponding Relation Between the Eum and Yang of Man and All Things' in Elementary Questions, when the Emperor asked Ki-Back, he answered "sthenia means the sthenia of evil, and deficiency means the deficiency of healthy energy. When the blood is sthenic, the evil should be discharged by pricking when out letting the blood; deficiency of vital energy is the asthenia of channels and network vessels, so the energy should drain from the channel which is not deficient, to replenish. "And in this case we can use the methods of 'Breaking out the static bloods', 'driving out the static bloods', blood-letting'. With this we can infer that the blood-letting therapy is made use of the important medical treatments from the ancient times. Especially in referring to the principles of treatment in The Yellow Emperor's Canon of Internal Medicine, it mostly alluded to acupuncture therapies and only eleven times to medicinal treatments. This is to verify that the blood-letting therapy formed the foundation of the medical art. In Dong's Therapy of Acupuncture-Moxibustion and Bloodletting, Dong Kyeong-Chang gave emphasis on the points that there must be extravasated bloods without exception in the serious illnesses which is old, unnatural, accompanying acute pains and so we can revive our body‘s sprit by circulating 'gi' and static blood piled up in the network vessel, regulating the weakness and strength, and controling the disharmony of the internal organs. The blood-letting therapy has effect on the orifice in emergency, such as fore draining, freeing network vessels, harmonizing gi and blood, relieving pain, dispersing swelling and concretion, sedation, resolving toxin as well as strengthening the heart, relieving itching. So it has distinguished effect on all kinds of medical treatment to the modern people. But by the change of social customs and the confucianism of confucius - it is widely spread on the period of North and South Dynasties, 'Wi' and 'Jin' in china and the period of the Three States in korea - The blood-letting therapy which was regarded as the most important medicinal treatment withered rapidly. And Confucius accentuated the importance of our body and all its members, loyalty and filial piety and banned any damage of our body under no circumstances. As a result of it, the therapy of blood-letting had a rapid decrease and barely kept itself in existence in both countries. What is worse, at the period of Japanese colonial rule of korea and our nation's founding of early stage, it has been withered by the high-handed policy to change Oriental Medicine into modern medical science. So the therapy of blood-letting barely kept itself in existence in some Buddhist temples. Another case, it has handed down as a old-fashioned quick fix in folk remedies. But all kinds of the contamination of heavy metals and the misuses of antibiotics are widely spread nowadays, which increased diseases of adult people and incurable diseases as modern society unavoidably made its way into a highly industrial society. To make us more miserable, the western medical science - the antibiotics and surgical operation medical science - already reveals itself into a limit. The necessity of a new medical science which can give a security to the patients who are suffering from the diseases of adult people and the incurable diseases is especially come into the force nowadays. In view of the results after bibliographically studying on the blood-letting Therapy in Elementary Questions of the Yellow Emperor's Canon of Internal Medicine, the blood-letting therapy has acted for the important Oriental medicinal science and has been clarified the prominent effects on the diseases of adult people and the incurable diseases. So it is regarded as an appropriate thing that we lay out a determined theory of the blood-letting therapy and of course prevent the unwanted side effects from inappropriate medicinal treatments, and make full use of clinic by elevating the curative value and that we win back our self-respect of medical treatment which is dominated from the western medical science and ultimately contribute to national medical welfare.

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Reliability and Validity Analysis of the Instrument of Oriental Medical Evaluation for Hwa-Byung (화병 한의 평가도구의 신뢰도, 타당도 평가)

  • Lee, Hun-Soo;Choi, Woo-Chang;Yu, Yun-Seon;Kang, Wee-Chang;Jung, In-Chul
    • Journal of Oriental Neuropsychiatry
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    • v.25 no.4
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    • pp.351-358
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    • 2014
  • Objectives: This study was performed to evaluate the reliability and validity of the instrument of oriental medical evaluation for Hwa-byung. Methods: 97 participants diagnosed with Hwa-byung divided into 5 pattern identifications by the instrument on pattern identifications for Hwa-byung were tested by the instrument of oriental medical evaluation for Hwa-byung twice a week. Results: The intraclass correlation coefficient of the test-retest analysis of oriental medical evaluation for Hwa-byung had over moderate agreement. The intraclass correlation coefficient of test-retest analysis of evaluation index of symptoms had moderate agreement for the total symptoms, and fair agreement for the physical and mental symptoms. The validity analysis of the instrument represented a positive correlation in the pattern identification of stagnation of liver Gi, malfunction of gallbladder due to phlegm stagnation, and disharmony between heart and kidneys. Conclusions: The results showed that the reliability analysis of the instrument of oriental medical evaluation for Hwa-byung showed over moderate agreement, and validity analysis represented a positive correlation except for the pattern identification of flare-up of liver fire and deficiency of both Gi and blood.

Wernicke's encephalopathy in a child with high dose thiamine therapy

  • Park, So Won;Yi, Yoon Young;Han, Jung Woo;Kim, Heung Dong;Lee, Joon Soo;Kang, Hoon-Chul
    • Clinical and Experimental Pediatrics
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    • v.57 no.11
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    • pp.496-499
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    • 2014
  • Wernicke's encephalopathy is an acute neurological disorder characterized by mental confusion, oculomotor dysfunction, and ataxia. It has been reported in individuals with alcohol dependence, hyperemesis gravidarum, and prolonged parenteral nutrition without vitamin supplementation. Here we present the case of a 13-year-old male patient with neuroblastoma and a history of poor oral intake and nausea for 3 months. After admission, he showed gait disturbances, nystagmus, and excessive dizziness; his mental state, however, indicated he was alert, which did not fit the classical triad of Wernicke's encephalopathy. A diagnosis of Wernicke's encephalopathy was made only after brain magnetic resonance imaging and serum thiamine level analyses were performed. The patient's symptoms remained after 5 days of treatment with 100-mg thiamine once daily; thus, we increased the dosage to 500 mg 3 times daily, 1,500 mg per day. His symptoms then improved after 20 days of replacement therapy. This case report describes a pediatric patient who was promptly diagnosed with Wernicke's encephalopathy, despite only 2 suspicious symptoms, and who completely recovered after high doses of thiamine were given intravenously.

Vasopressin in Young Patients with Congenital Heart Defects for Postoperative Vasodilatory Shock (선천성 심장병 수술 후 발생한 혈관확장성 쇼크에 대한 바소프레신의 치료)

  • 황여주;안영찬;전양빈;이재웅;박철현;박국양;한미영;이창하
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.504-510
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    • 2004
  • Background: Vasodilatory shock after cardiac surgery may result from the vasopressin deficiency following cardio-pulmonary bypass and sepsis, which did not respond to usual intravenous inotropes. In contrast to the adult patients, the effectiveness of vasopressin for vasodilatory shock in children has not been known well and so we reviewed our experience of vasopressin therapy in the small babies with a cardiac disease. Material and Method: Between February and August 2003, intravenous vasopressin was administrated in 6 patients for vasodilatory shock despite being supported on intravenous inotropes after cardiac surgery. Median age at operation was 25 days old (ranges; 2∼41 days) and median body weight was 2,870 grams (ranges; 900∼3,530 grams). Preoperative diag-noses were complete transposition of the great arteries in 2 patients, hypoplastic left heart syndrome in 1, Fallot type double-outlet right ventricle in 1, aortic coarctation with severe atrioventricular valve regurgitation in 1, and total anomalous pulmonary venous return in 1. Total repair and palliative repair were undertaken in each 3 patient. Result: Most patients showed vasodilatory shock not responding to the inotropes and required the vasopressin therapy within 24 hours after cardiac surgery and its readministration for septic shock. The dosing range for vasopressin was 0.0002∼0.008 unit/kg/minute with a median total time of its administration of 59 hours (ranges; 26∼140 hours). Systolic blood pressure before, 1 hour, and 6 hours after its administration were 42.7$\pm$7.4 mmHg, 53.7$\pm$11.4 mmHg, and 56.3$\pm$13.4 mmHg, respectively, which shows a significant increase in systolic blood pressure (systolic pressure 1hour and 6 hours after the administration compared to before the administration; p=0.042 in all). Inotropic indexes before, 6 hour, and 12 hours after its administration were 32.3$\pm$7.2, 21.0$\pm$8.4, and 21.2$\pm$8.9, respectively, which reveals a significant decrease in inotropic index (inotropic indexes 6 hour and 12 hours after the administration compared to before the administration; p=0.027 in all). Significant metabolic acidosis and decreased urine output related to systemic hypoperfusion were not found after vasopressin admin- istration. Conclusion: In young children suffering from vasodilatory shock not responding to common inotropes despite normal ventricular contractility, intravenous vasopressin reveals to be an effective vasoconstrictor to increase systolic blood pressure and to mitigate the complications related to higher doses of inotropes.

The Assessment for Nutrient Intakes of Korean Patients with Heart Failure (우리나라 일부 심부전 환자의 영양소 섭취량 평가 연구)

  • Lee, Hye-Ran;Kang, Bo-Rum;Chung, Hye-Kyung;Do, Hyun-Joo;Shim, Jee-Seon;Bae, Soon-Hwa;Kang, Seok-Min;Shin, Min-Jeong
    • Journal of Nutrition and Health
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    • v.43 no.3
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    • pp.224-232
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    • 2010
  • The prevalence of heart failure (HF) is increasing globally and growing evidence has shown that dietary factors play an important role in preventing and improving prognosis of HF. However, little data on nutrient intake in Korean HF patients which are available to develop dietary guidelines for HF. The aims of this study were to estimate nutrient intake in 78 HF patients and evaluate whether the estimated nutrient intake is appropriate compared to dietary reference intake for Koreans. Data are presented as the ratio of actual intake and estimated average requirement (EAR) for each nutrient. The result showed that the average nutrient intakes including total energy and protein met EAR in total patients. However, the deficiencies in mineral and vitamin intakes were found. Moreover, the proportion of subjects with lower intake than EAR was substantial. The results showed that the proportion of male HF patients with inferior intakes to EAR in calcium, potassium (compared to adequate intake: AI), folate and vitamin $B_{12}$ were 38%, 79%, 38%, and 65%, respectively. Also, the proportion of female HF patients with inferior intakes to EAR in calcium, potassium (compared to AI), folate and vitamin $B_{12}$ were 35%, 88%, 38% and 40%, respectively. In particular, the elderly with HF ($\geq$ 70 yrs, n = 28) showed more serious deficiencies in calcium, potassium (compared to AI), folate and vitamin $B_{12}$. In summary, the intakes of potassium, calcium, folate, and vitamin B12 were not sufficient to meet EAR in HF patients. Furthermore, the proportions of subjects with lower intake than EAR in these nutrients were substantial, raising the possibility that these micronutrients may be involved in the pathogenesis of HF. Practical dietary guideline for HF patients is needed to improve prognosis of HF.

Evaluation on Toxicity of Habitual dose of Extract of Rheum Palmatum through Single Blinded Pilot Study (단일맹검시험을 통한 대황(大黃) 상용량(常用量)의 독성작용 평가)

  • Kwon, Hyork;Chi, Gyoo-Yong;Eom, Hyun-Sup
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.24 no.3
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    • pp.390-400
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    • 2010
  • This study is aimed to test physiological and hematological actions of Rheum palmatum through clinical pilot study optimized for usual oriental medicine prescription. Thirty-one cases were finally collected and the sample extract 100 $m{\ell}$ of Rheum palmatum (ERP) was administered two times in a day during 3 days and checked with blood CBC test, urinalysis, liver function test, abdominal X-ray as well as general diagnostic process of oriental medicine; pattern identification, assessment of shapes and constitution. The total toxic effective rate of ERP was 9.68% in 3 cases of the whole in case of consistent uneasy state in the subjective symptomatic assessment and aggravation of blood and urine examination. The relevant diagnostic factors were so-eum constitution and essence type subject, carapaces species, lung type in the aspect of Jisan shape theory. On the other hand, the positive effective rate of ERP was 29.03% manifesting improvement of vital signs or present illness and no abnormal changes of blood chemistry and urinalysis and simple abdomen radiology. The relevant diagnostic factors were tae-eum constitution, energy type subject, aves species, heart and liver type in Jisan's shape theory. And the other cases were manifesting no specific change through the administration of ERP. The ratio of the numbers of decrease and increase was 44:5 in the tenderness and hardness of abdominal palpation. But if the pattern identification doesn't comply with the aim of rhubarb application despite of constipation and abdominal pain, the tendeness and biochemical report was shown in abnormal change. The mean number of diarrhea by ERP was $16.77{\pm}6.95$ during 3 days after administration, and the frequent areas of abdominal pain were lower>middle>upper in order, and it meant the target site of ERP too. Besides, the toxic reaction against ERP was expressed highly in case of decrease in blood cell count and hemoglobin, hematocrit having blood deficiency syndrome. Likewise, the toxicity of ERP was influenced by pattern identification manifesting present disease condition and diagnostic factors of four constitutions, Jisan's shape theory collaterally. In conclusion, evaluation of herbal toxicity in order for using as a clinical guideline, various diagnostic pattern information and shape features like the above should be studied together with other pharmacologic toxicology test for the future.

A Study on the Dizziness of Huangdi's Internal Classic $\ll$黃帝內經$\gg$ ($\ll$소문.영추(素問.靈樞)$\gg$에 나타난 현훈(眩暈)에 대한 연구(硏究))

  • Tark, Myoung-Rim;Kang, Na-Ru;Ko, Woo-Shin;Yoon, Hwa-Jung
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.24 no.1
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    • pp.142-170
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    • 2011
  • Objective : The purpose of this study is to investigate dizziness of Plain Questions $\ll$素問$\gg$ and Miraculous Pivot $\ll$靈樞$\gg$. Methods : We conducted a study on the original text paragraphs of Internal Classic $\ll$內經$\gg$ containing the dizziness and analysis of Yang, Ma, Zhang, Wang etc. We drew a parallel between dizziness from Internal Classic $\ll$內經$\gg$and matching diagnoses from western medicine. Results : The results were as follows. 1. Dizziness in Ok Ki Jin Jiang Ron <玉機眞藏論> and Pyo Bon Byeong Jeon Ron <標本病傳論> had relation to liver and was similar to dizziness caused by tension, hypertension, anemia and cerebrovascular accident etc. in western medicine. 2. Dizziness in Ja Yeol<刺熱>, O Sa<五邪> and Hai Ron<海論> had relation to kidney and was similar to dizziness caused by aging and peripheral vertigo concurrent with tinnitus and difficulty in hearing in western medicine. 3. Dizziness in O Sa<五邪> had relation to heart(pericardium) and was similar to dizziness caused by cardiac output loss and psychogenic dizziness in western medicine. 4. In Internal Classic $\ll$內經$\gg$ the main etiology of dizziness was infirmity(虛), which were Qi(氣) of the upper portion of the body being insufficient(上氣不足), blood depletion(血枯), deficiency of marrow-reservoir(髓海不足) etc. 5. In Dae Hok Ron<大惑論> etiology and pathogenesis of dizziness were mentioned and dizziness was similar to dizziness caused by eye disorder, psychogenic dizziness and central dizziness in western medicine. 6. In Internal Classic $\ll$內經$\gg$ the meridian of acupuncture points which was used much for dizziness was Bladder Meridian. Aqupunture points used in treatment of dizziness were Ch'onju(天柱), Kollyun(崑崙), Taejo, Chok-t'ongkok(足通谷) etc. Conclusion : We found out etiology, pathogenesis, treatments of dizziness in Internal Classic $\ll$內經$\gg$. Further we compared with western medicine to develop better understanding of dizziness.

Methods of The Promoting Blood Circulation and Removing Blood Stasis by Wang Cheong-Im (왕청임(王淸任)의 활혈거어법(活血祛瘀法))

  • Kim Hya-Sung;Jung Seung-Woo;Lee Jong-Il;Kwon Dong-Yeul
    • Herbal Formula Science
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    • v.12 no.2
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    • pp.47-55
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    • 2004
  • Wang Cheong-Im(1768-1831) in the Ching dynasty conducted the therapy of blood statis syndrome using the methods for promoting blood circulation and removing blood statis in accordance with the description in the book Uirimgaechak(醫林改錯). Thus, this study examined his methods for promoting blood circulation and removing blood statis, therapy of blood statis syndrome and mechanism of function. Since the blood statis symptoms varied on the parts where the blood statis were occurred, the therapy for promoting blood circulation and removing blood statis applied different treatments and drugs depending on the symptoms. The therapy also valued much of qi and blood. Qi is important to the human body so that the therapy replenished qi and simultaneously promoted the blood circulation as mainly focusing on the regulation of the qi flow. Moreover, the therapy adjusted the level of removing blood circulation and rate of replenishing qi. The degree of prescription and drug was differentiated in treating a variety of blood statis because of the difference in the seriousness and characteristics of blood circulation, amount and application of drug and combination of drugs. The therapy was careful about the regulation of qi for the replenishment of qi and the nurishment of blood for the promotion of blood circulation. If the blood circulation was blocked, the blood statis was formed. Accordingly, the phlegm and the blood statis were closely related. Then, the phlegm and blood statis were simultaneously treated. The therapy divided the properties of blood statis into the stagnant excess syndrome, the stagnant deficiency syndrome, the stagnant cold syndrome and the stagnant heat syndrome and treated the patients suitable for each symptom. The function of mechanism in the treatment using the methods for promoting blood circulation and removing blood statis was divided into the stagnation of blood and interruption in blood circulation. The therapy laid stress on promoting blood circulation and removing blood circulation. With such emphasis, the therapy facilitated the circulation in the bloood vessel, prevented the coagulation of blood, removed the blood statis and promoted the metabolism. Then, the physiological function and pathological change internal organs were improved. Furthermore, the therapy strengtened the heart and promoted the blood circulation by improving the systemic blood circulation. Moreover, the therapy facilitated the micro-circulation by adjusting the balance of body.

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Current Status of Systems Biology in Traditional Chinese medicine - in regards to influences to Korean Medicine (최근 중의학에서 시스템생물학의 발전 현황 - 한의학에 미치는 영향 및 시사점을 중심으로 -)

  • Lee, Seungeun;Lee, Sundong
    • Journal of Society of Preventive Korean Medicine
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    • v.21 no.2
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    • pp.1-13
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    • 2017
  • Objectives : This paper serves to explore current trends of systems biology in Traditional Chinese Medicine (TCM) and examine how it may influence the Traditional Korean medicine. Methods : Literature review method was collectively used to classify Introduction to systems biology, diagnosis and syndrome classification of systems biology in TCM perspective, physiotherapy including acupuncture, herbs and formula functions, TCM systems biology, and directions of academic development. Results : The term 'Systems biology' is coined as a combination of systems science and biology. It is a field of study that tries to understand living organism by establishing a theory based on an ideal model that analyzes and predicts the desired output with understanding of interrelationships and dynamics between variables. Systems biology has an integrated and multi-dimensional nature that observes the interaction among the elements constructing the network. The current state of systems biology in TCM is categorized into 4 parts: diagnosis and syndrome, physical therapy, herbs and formulas and academic development of TCM systems biology and its technology. Diagnosis and syndrome field is focusing on developing TCM into personalized medicine by clarifying Kidney yin deficiency patterns and metabolic differences among five patterns of diabetes and analyzing plasma metabolism and biomarkers of coronary heart disease patients. In the field of physical therapy such as acupuncture and moxibustion, researchers discovered the effect of stimulating acupoint ST40 on gene expression and the effects of acupuncture on treating functional dyspepsia and acute ischemic stroke. Herbs and formulas were analyzed with TCM network pharmacology. The therapeutic mechanisms of Si Wu Tang and its series formulas are explained by identifying potential active substances, targets and mechanism of action, including metabolic pathways of amino acid and fatty acid. For the academic development of TCM systems biology and its technology, it is necessary to integrate massive database, integrate pharmacokinetics and pharmacodynamics, as well as systems biology. It is also essential to establish a platform to maximize herbal treatment through accumulation of research data and diseases-specific, or drug-specific network combined with clinical experiences, and identify functions and roles of molecules in herbs and conduct animal-based studies within TCM frame. So far, few literature reviews exist for systems biology in traditional Korean medicine and they merely re-examine known efficacies of simple substances, herbs and formulas. For the future, it is necessary to identify specific mechanisms of working agents and targets to maximize the effects of traditional medicine modalities. Conclusions : Systems biology is widely accepted and studied in TCM and already advanced into a field known as 'TCM systems biology', which calls for the study of incorporating TCM and systems biology. It is time for traditional Korean medicine to acknowledge the importance of systems biology and present scientific basis of traditional medicine and establish the principles of diagnosis, prevention and treatment of diseases. By doing so, traditional Korean medicine would be innovated and further developed into a personalized medicine.

Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA)

  • Shin, Youn Ho;Yu, Jinho;Kim, Kyung Won;Ahn, Kangmo;Hong, Seo-Ah;Lee, Eun;Yang, Song-I;Jung, Young-Ho;Kim, Hyung Young;Seo, Ju-Hee;Kwon, Ji-Won;Kim, Byoung-Ju;Kim, Hyo-Bin;Shim, Jung Yeon;Kim, Woo Kyung;Song, Dae Jin;Lee, So-Yeon;Lee, Soo Young;Jang, Gwang Cheon;Suh, Dong In;Yang, Hyeon-Jong;Kim, Bong Sung;Hong, Soo-Jong
    • Clinical and Experimental Pediatrics
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    • v.56 no.10
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    • pp.439-445
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    • 2013
  • Purpose: Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort. Methods: The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia. Results: The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of ${\geq}75.0$ nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004). Conclusion: The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.