• Title/Summary/Keyword: head and neck

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CT Simulation Technique for Craniospinal Irradiation in Supine Position (전산화단층촬영모의치료장치를 이용한 배와위 두개척수 방사선치료 계획)

  • Lee, Suk;Kim, Yong-Bae;Kwon, Soo-Il;Chu, Sung-Sil;Suh, Chang-Ok
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.165-171
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    • 2002
  • Purpose : In order to perform craniospinal irradiation (CSI) in the supine position on patients who are unable to lie in the prone position, a new simulation technique using a CT simulator was developed and its availability was evaluated. Materials and Method : A CT simulator and a 3-D conformal treatment planning system were used to develop CSI in the supine position. The head and neck were immobilized with a thermoplastic mask in the supine position and the entire body was immobilized with a Vac-Loc. A volumetrie image was then obtained using the CT simulator. In order to improve the reproducibility of the patients' setup, datum lines and points were marked on the head and the body. Virtual fluoroscopy was peformed with the removal of visual obstacles such as the treatment table or the immobilization devices. After the virtual simulation, the treatment isocenters of each field were marked on the body and the immobilization devices at the conventional simulation room. Each treatment field was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR)/digitally composite radiography (DCR) images from the virtual simulation. The port verification films from the first treatment were also compared with the DRR/DCR images for a geometrical verification. Results : CSI in the supine position was successfully peformed in 9 patients. It required less than 20 minutes to construct the immobilization device and to obtain the whole body volumetric images. This made it possible to not only reduce the patients' inconvenience, but also to eliminate the position change variables during the long conventional simulation process. In addition, by obtaining the CT volumetric image, critical organs, such as the eyeballs and spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. The differences between the DRRs and the portal films were less than 3 mm in the vertebral contour. Conclusion : CSI in the supine position is feasible in patients who cannot lie on prone position, such as pediatric patienta under the age of 4 years, patients with a poor general condition, or patients with a tracheostomy.

A Study of the Dried-lacquer Amitabha Buddha Statue from Simhyangsa Temple (심향사 극락전 협저 아미타불의 제작기법에 관한 연구)

  • Jeong, Ji-Yeon;Motoya, Myochin
    • Korean Journal of Heritage: History & Science
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    • v.47 no.1
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    • pp.134-151
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    • 2014
  • This paper deals with a review of the structure and production techniques of the Dried-lacquer Amitabha Buddha statue enshrined in Geungnakjeon Hall of Simhyangsa Temple, located in Daeho-dong, Naju-si, Jeollanam-do, Korea. To achieve this goal, X-ray date and two rounds of field research were performed. The data collected were reviewed, and a sample peeled off from the damaged part was analyzed to investigate the structure and material of the background layer. The results revealed that the Simhyangsa Temple Buddha statue was an almost empty Dried-lacquer(Hyeopjeo) Buddha statue where wood core had not been framed and inserted in the statue. It was thus observed that considering that the clothes wrinkles clearly remained, the same one as the irregularity of the outer clothes wrinkles, the Dried-lacquer layer was lifted made in an almost complete shape in the process of forming the clay figure as the origin form. The statue was found to be diagonally incised from the top of the head to the back of the neck to remove the clay and wood core. But in other sites, no incision was confirmed. It was observed that on the site of the head where the incision was made, an adhesives(lacquer or paste) was used. In addition, the black eyes were impacted with beads and the ears, hands, bands, and knots were made of wood. These features are identically shown in the Dried-lacquer Amitabha Buddha statue from Seonguksa Temple, known as a work of the late Goryeo dynasty; the Seated Dried-lacquer Buddha statue in Okura Museum of Art in Tokyo, Japan; the Seated Dried-lacquer Amitabha Buddha statue from Jungnimsa Temple, know as a work of the early Joseon dynasty; and the Seated Vairocana Buddha statue in Bulhoesa Temple, the Seated Dried-lacquer Amitabha Buddha and the Seated Dried-lacquer Buddha statue from Silsangsa Temple. The analysis of the back layer demonstrated that the ground layer and the red lacquer were the production of the time. In particular, the bone ash used for the ground layer was also coated for the ground layer of Buddha statues as well as for the production of the lacquerware during the Goryeo dynasty. It was also found that gold mending was conducted more than twice even in modern times and that the layer of the production time was well preserved despite gold mending several times.

Effects of Recombinant Human Epidermal Growth Factor (rhEGF) on Experimental Radiation-Induced Oral Mucositis in Rats (Rat의 방사선 조사성 구내염에 대한 Recombinant Human Epidermal Growth Factor (rhEGF)의 효과)

  • Jung Kwon-Il;Kim Sun-Hee;Moon Soo-Young;Kim Yeon-Wha;Hong Joon-Pio;Kim Hyun-Sook;Lee Sang-Wook
    • Radiation Oncology Journal
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    • v.24 no.1
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    • pp.67-76
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    • 2006
  • Purpose: Oral mucositis is a common toxicity of radiation or chemotherapy, which is used a treatment for head and neck cancer. We investigated effects of recombinant human epidermal growth factor (rhEGF) on radiation-induced oral mucositis in rat model. Materials and Methods: Spraque-Dawley rats (7 per group) exposed to a single dose of 25 Gy (day 0) on their head, except for one group, were randomly divided into un-treated, vehicle-treated, and two rhEGF-treated groups. Rats were topically applied with rhEGF (15 or $30{\mu}g/oral$ cavity/day) or vehicle to their oral mucosa. Survival rate of rats, weight changes, and food intakes were examined from day 0 to 18 after radiation. Histology study was performed from oral mucosa of rats at day 7 and 18 after radiation. Results: rhEGF-treated groups (15 or $30{\mu}g/oral$) showed all survival rate 33%, whereas un-treated and vehicle-treated groups showed all survival rate 0% at the end of experiment. rhEGF-treated groups statistically had less weight loss compared to vehicle-treated group from day 2 to 7 after radiation. Food intake of rats with rhEGF treatment turned to increase at day 14 after radiation. At 7 day after radiation, un-treated and vehicle-treated groups showed severe pseudomembraneous or ulcerative oral mucositis. On the other hand, rhEGF-treated groups had no more than cellular swelling and degeneration of epidermal cells in oral mucosa of rats. Conclusion: These results suggest that rhEGF has significantly positive effects on radiation-induced oral mucositis in rats. rhEGF display a therapeutic potential on a clinical level.

Patient Setup Aid with Wireless CCTV System in Radiation Therapy (무선 CCTV 시스템을 이용한 환자 고정 보조기술의 개발)

  • Park, Yang-Kyun;Ha, Sung-Whan;Ye, Sung-Joon;Cho, Woong;Park, Jong-Min;Park, Suk-Won;Huh, Soon-Nyung
    • Radiation Oncology Journal
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    • v.24 no.4
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    • pp.300-308
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    • 2006
  • $\underline{Purpose}$: To develop a wireless CCTV system in semi-beam's eye view (BEV) to monitor daily patient setup in radiation therapy. $\underline{Materials\;and\;Methods}$: In order to get patient images in semi-BEV, CCTV cameras are installed in a custom-made acrylic applicator below the treatment head of a linear accelerator. The images from the cameras are transmitted via radio frequency signal (${\sim}2.4\;GHz$ and 10 mW RF output). An expected problem with this system is radio frequency interference, which is solved utilizing RF shielding with Cu foils and median filtering software. The images are analyzed by our custom-made software. In the software, three anatomical landmarks in the patient surface are indicated by a user, then automatically the 3 dimensional structures are obtained and registered by utilizing a localization procedure consisting mainly of stereo matching algorithm and Gauss-Newton optimization. This algorithm is applied to phantom images to investigate the setup accuracy. Respiratory gating system is also researched with real-time image processing. A line-laser marker projected on a patient's surface is extracted by binary image processing and the breath pattern is calculated and displayed in real-time. $\underline{Results}$: More than 80% of the camera noises from the linear accelerator are eliminated by wrapping the camera with copper foils. The accuracy of the localization procedure is found to be on the order of $1.5{\pm}0.7\;mm$ with a point phantom and sub-millimeters and degrees with a custom-made head/neck phantom. With line-laser marker, real-time respiratory monitoring is possible in the delay time of ${\sim}0.17\;sec$. $\underline{Conclusion}$: The wireless CCTV camera system is the novel tool which can monitor daily patient setups. The feasibility of respiratory gating system with the wireless CCTV is hopeful.

두경부암의 6MV 광자선 치료 시 표면선량 증가를 위한 Spoiler의 유용성 평가

  • 이강혁;김원택;이화중;김대영
    • The Journal of Korean Society for Radiation Therapy
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    • v.14 no.1
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    • pp.41-47
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    • 2002
  • 1.목적 두경부암(head and neck Ca)과 쇄골상부(Supraclavicular)에 6MV 광자선으로 치료 시 치료부위(Target volume)가 피부에서 대략 $1^{\sim}2mm$정도 깊이에 위치할 경우, 6MV 광자선의 선량분포는 표면선량이 낮아서 치료에 적합하지 않기 때문에 Bolus와 같이 사용하지만 Skin Sparing(피부보호)효과의 손실로 피부의 손상이 발생할 수 있다. 이러한 이유로 피부의 보호와 치료 시 표면선량의 증가를 위해 Spoiler(산란판)를 제작하여 측정 후 그 특성을 이해하고 선량의 분포를 통하여 Bolus와 비교한 후에 Spoiler의 유용성에 대해 평가하고자 하였다. 2.방법 Siemens사 선형가속기(PRIMUS)의 6MV 광자선을 사용하여 Spoiler의 사용여부 및 Spoiler의 사용 시에는 조사면의 크기를 $5{\times}5,\;7{\times}7,\;10{\times}10,\;15{\times}15,\;20{\times}20cm^2$로 하고 Spoiler와 표면과의 거리는 6, 10, 15cm로 바꾸어 가면서 물팬톰(PTW. 독일)을 이용해 깊이와 측방에 따른 선량분포를 Markus 전리함(PTW. 독일)으로 측정하였으며 전리함의 방수를 위해 씌어진 방수 캡 때문에 표면선량을 별도의 고형 팬톰으로 측정하였다. 표면의 측정선량은 전리함의 측면 벽 등에 의한 선량 측정치의 증가 현상으로 과 반응을 보였으며 이를 교정하였다. 그리고 측정된 데이터를 치료계획 시스템(Pinnacle 6.0m)으로 비교, 분석하였다. 3.결과 Spoiler의 사용 시 3cm깊이 측정선량 백분율과 Spoiler를 사용하지 않은 해당 치료 조사면의 3cm깊이 선량의 백분율에 일치하도록 하여 가상의 치료 깊이인 2mm에서 측정값을 비교하여 본 결과 조사면 $5{\times}5,\;10{\times}10,\;20{\times}20cm^2$에서 OPEN시 62, 64, $70\%$, Bolus는 97, 97, $99\%$로 Spoiler의 사용 시 표면과의 거리가 6cm에서 82, 98, $103\%$, 10cm에는 72, 89, $101\%$, 15m에 65, 79, $96\%$로 나타났으며 표면에서의 측정값을 비교하여 본 결과 OPEN시 11, 17, $27\%$, Bolus는 84, 84, $86\%$, Spoiler의 사용 시 6cm에서 40, 71, $93\%$, 10cm에는 25, 50, $81\%$, 15cm에 18, 36, $67\%$를 나타내었다. 또한 3m깊이에서의 측방 선량분포에서 Spoiler의 거리변화(6, 10cm)는 심부선량의 변화에 영향을 주지 않는 것으로 확인할 수 있었다. 그리고 위의 실험측정치를 치료계획 시스템에 입력하여 선량분포를 확인한 결과 Spoiler를 사용하는 경우 OPEN에 비해 선량분포 영역을 표면으로 끌어 올릴 수 있으며 Bolus 보다 피부 보호효과는 어느 정도 유지가 되는 것을 보여주었다. 4.결론 이와 같이 Spoiler는 Bolus와 비교하여 6MV 광자선의 build up 영역을 표면으로 증가시키는 동시에 Skin Sparing(피부보호)효과를 유지할 수 있으며 두경부암의 치료에서 Spoiler의 사용이 가능한 조건으로는 조사면이 $5{\times}5cm^2$에서 Spoiler와 표면과의 거리가 6cm일 때, $7{\times}7cm^2$에서 6cm, 10cm였고 $10{\times}10cm^2$는 10cm, 15cm로, $15{\times}15cm^2$는 15cm의 간격으로 평가되었다. 또한 $20{\times}20cm^2$의 조사면, Spoiler가 6cm 간격 인 경우 Bolus를 사용한 것 보다 더욱 높은 표면선량을 나타내었다. 그러나 Spoiler와 표면간의 거리를 다르게 함으로써 깊이에 따라 선량분포를 다양하게 나타낼 수 있기 때문에 표면선량의 증가와 피부의 보호를 위해 환자의 피부 두께, 실제 치료 부위의 깊이 등을 고려한다면 Spoiler를 사용하는 것이 bolus를 사용하는 것보다 더 유용하게 적용할 수 있을 것으로 사료된다.

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The Effect of Optokinetic Stimulation with Smooth Pursuit Eye Movement to Chronic Hemispatial Neglect: A Pilot Study (완곡 추적 안구운동을 동반한 시운동자극이 만성 편측무시에 미치는 영향 : 예비연구)

  • Shin, Jae-Yong;Yoo, Eun-Young
    • Therapeutic Science for Rehabilitation
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    • v.5 no.2
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    • pp.81-92
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    • 2016
  • Objective: This study aim is to identify whether 30minutes optokinetic stimulation(OKS) with smooth pursuit eye movement can alleviate chronic hemispatial neglect. Methods: We applied optokinetic stimulation with smooth pursuit eye movement to 2 chronic hemispatial neglect patients. experimental duration was total 4weeks - 1week baseline, 2weeks OKS intervention, 1week 2nd. baseline. The intervention was 10 OKS sessions (30min each, 1session daily, from Monday to Friday) over a period of 2weeks. The neglect test carried out 3 times a week every other day. The OKS was provided on the screen when patient sat in front of the screen(13.5 inch). The OKS video that the 24 yellow squares moving coherently from the right to the left side. Patients were instructed to perform smooth pursuit eye movement without head and neck movement. Results: As a result of the OKS for 2weeks, the degree of neglect trends to decrease on both 2 cases compared to baseline A. The degree of the neglect of subject 1 tended to increase the at the baseline A. In contrast, the subject 2 showed that tendency that the degree of the neglect declined additionally at the baseline A. Conclusions: We identified that 30 minutes optokinetic stimulation with sooth pursuit eye movement is effective intervention method for chronic hemispatial neglect.

The Effect of Smooth Pursuit Eye Movement Using Portable Device to Chronic Hemispatial Neglect: A Pilot Study (휴대용 디바이스를 이용한 완곡추적 안구운동이 만성 편측무시에 미치는 영향: 예비연구)

  • Shin, Jae-Yong
    • Therapeutic Science for Rehabilitation
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    • v.6 no.1
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    • pp.71-83
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    • 2017
  • Objective : This study aim is to identify whether smooth pursuit eye movement(SPEM) using portable device can alleviate chronic hemispatial neglect. Methods : We applied smooth pursuit eye movement to one chronic hemispatial neglect patient. Experimental duration was total 4weeks - 1week baseline, 2weeks SPEM intervention, 1week 2nd. baseline. The intervention was 10 SPEM sessions (30min each, 1session daily, from Monday to Friday) over a period of 2weeks. The neglect test carried out 5 times a week. The SPEM was provided on the screen when patient sat in front of the screen(8.4 inch tablet pc, distance 40cm). The SPEM video that the 24 yellow squares moving coherently from the right to the left side. Patients were instructed to perform smooth pursuit eye movement without head and neck movement. Results : As a result of the SPEM for 2weeks, the degree of neglect tended to decrease compared to baseline A. The degree of the LBT tended to increase the at the baseline A'. In contrast, the SCT showed that tendency which the degree of the neglect maintained at the baseline A'. Conclusion : We identified that SPEM using portable device is effective intervention method for chronic hemispatial neglect.

The Effects of Diltiazem and Pentoxifylline on Apoptosis of Irradiated Rat Salivary Gland (흰쥐 침샘의 방사선조사시 Apoptosis에 대한 Diltiazem과 Pentoxifylline의 효과)

  • Yang, Kwang-Mo;Suh, Hyun-Suk
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.367-375
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    • 1998
  • Purpose : Xerostomia is a complication met by almost all patients who have radiotherapy for cancers of head and neck. Many studies for prevention of xerostomia will be necessary. Radiation-induced acute response of salivary glands has been defined as interphase death or apoptosis. Increased intracellular calcium level have an important role in radiation-induced apoptosis. Calcium channel blocker may prevent radiation-induced apoptosis of salivary glands. This study was designed to evaluate the effectiveness of diltiazem known as calcium channel blocker and pentoxifylline with inhibition of inflammatory response on the apoptosis as an acute response of radiation in rat salivary glands. Materials and Methods : Sprague-Dawley rats with about body weight 200-250 g were divided into 5 study groups : control, radiation alone, diltiazem with radiation, pentoxifylline with radiation, and diltiazem and pentoxifylline with radiation. The diltiazen and pentoxifylline were injected intraperitoneally 20 mg/kg and 50 mg/kg, 30 and 20 mimute before irradiation. respectively. Irradiation was given with a 4 MV linear accelerator. The 1600 cGy of radiation was delivered in a single fraction through a single anterior portal encompassing the entire neck. After 24 h of irradiation, rats were sacrificed and parotid and submandibular glands were removed and stained with hematoxylin and eosin. The quantification of apoptosis was performed by microscopic examination of stained tissue sections at a magnification of 200X and the percentage of apoptotic cell was calculated. Results : On parotid glands, the percentage of apoptosis by radiation alone, diltiazem with radiation, pentoxifylline with radiation, and diltiazem and pentoxifylline with radiation were 1.72$\%$ (8.35/486), 0.64$\%$ (2.9/453), 0.23$\%$ (1.2/516), and 0.28$\%$ (1.1/399), respectively. The apoptosis was markedly reduced in the groups receiving drugs compared with groups receivinge, radiation alone (p<0.05). In serous cell of submandibular glands, the percentages of apoptosis of radiation alone, diltiazem with radiation, pentoxifylline with radiation, and diltiazem and pentoxifylline with radiation were 1.94$\%$ (l1/567), 0.34$\%$ (1.9/554), 0.28$\%$ (1.8/637), and 0.22$\%$ (1.3/601), respectively. In the mucus cell of submandibular glands, the percentages of apoptosis were 0.92$\%$ (5.1/552), 0.41$\%$ (2.5/612), 0.29$\%$ (1.3/455), and 0.18$\%$ (1.0/562), respectively. The apoptosis was markedly reduced in the serous glands (p<0.05), but there was no difference in development of apoptosis in each group of mucus gland. Conclusion : These results suggest that radiation-induced apoptosis of serous cells of salivary glands may be decreased by diltiazem and pentoxifylline administration.

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Studies on the Estimation of Growth Pattern Cut-up Parts in Four Broiler Strain in Growing Body Weight (육용계에 있어서 계통간 산육능력 및 체중증가에 따른 각 부위별 증가양상 추정에 관한 연구)

  • 양봉국;조병욱
    • Korean Journal of Poultry Science
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    • v.17 no.3
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    • pp.141-156
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    • 1990
  • The experiments were conducted to investigate the possibility of improving the effectiveness of the existing method to estimate the edible meat weight in the live broiler chicken. A total of 360 birds, five male and female chicks from each line were sacrificed at Trial 1 (body weight 900-1, 000g), Trial 2 (body weight 1.200-1, 400g), Trial 3(body weight 1, 600-1, 700), and Trial 4(body weight 2, 000g) in order to measure the body weight, edible meat weight of breast, thigh and drumsticks, and various components of body weight. Each line was reared at the Poultry Breeding Farm, Seoul National University from the second of july, 1987 to the thirteenth of September, 1987. The results obtained from this study were summarized as follows : 1. The average body weights of each line( H. T, M, A) were $2150.5\pm$34.9, $2133.0\pm$26.2, $1960.0\pm$23.1, and $2319.3\pm$27.9, respectively. at 7 weeks of age. The feed to body weight eain ratio for each line chicks was 2.55, 2.13, 2.08, and 2.03, respectively, for 0 to 7 weeks of age. The viability of each line was 99.7. 99.7, 100.0, and 100.0%, respectively, for 0 to 7 weeks of age.01 was noticed that A Line chicks grow significantly heavier than did T, H, M line chic ks from 0 to 7 weeks of age. The regression coefficients of growth curves from each line chicks were bA=1.015, bH=0.265, bM=0.950 and bT=0.242, respectively. 2. Among the body weight components, the feather. abdominal fat, breast, and thigh and drumsticks increased in their weight percentage as the birds grew older, while neck. head, giblets and inedible viscera decreased. No difference wat apparent in shank, wings and hack. 3. The weight percentages of breast in edible part for each line thicks were 19.2, 19.0, 19.9 and 19.0% at Trial 4, respectively. The weight percentages of thigh and drumsticks in edible part for each line chicks were 23.1, 23.3, 22.8, and 23.0% at Trial 4. respective1y. 4. The values for the percentage meat yield from breast were 77.2. 78.9 73.5 and 74.8% at Trial 4 in H, T, M and A Line chicks. respectively. For thigh and drumstick, the values of 80.3, 78.4. 79.7 and 80.2% were obtained. These data indicate that the percentage meat yield increase as the birds grow older. 5. The correlation coefficients between body weight and blood. head, shanks. breast. thigh-drumstick were high. The degree if correlation between abdominal fat(%) and percentage of edible meat were extremely low at all times, but those between abdominal fat (%) and inedible viscera were significantly high.

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The essay of Bijeung by chinese doctors in 20th century - Study of - (20세기(世紀) 중의사(中醫師)들의 비증(痺證)에 대(對)한 논술(論述) 연구(硏究) - 《비증전집(痺證專輯)》 에 대(對)한 연구(硏究) I -)

  • Kim, Myung Wook;Oh, Min Suk
    • Journal of Haehwa Medicine
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    • v.9 no.1
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    • pp.547-594
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    • 2000
  • I. Introduction The essence of Oriental medicine consists of ancient books, experienced doctors and succeeded skills of common society. Many famous doctors studied medical science by their fathers or teachers. So the history of medical science is long. $\ll$DangDaeMyeongIImJeungJeongHwa(當代名醫臨證精華)$\gg$ written by SaWoogWang(史宇廣) and DanSeoGeon(單書健) has many medical experience of famous doctors. So it has important historical value. Bi(痺) means blocking. BiJeung is one kind of symptoms making muscles, bones and jonts feel pain, numbness or edema. For example it can be gout or SLE etc. So I studied ${\ll}BiJeungJuJip{\gg}$. II. Final Decision Following decisions of Chinese doctors of 20th century are as follows ; 1. JuYangChun(朱良春) emphasized on IkSinJangDok(益腎壯督) to treat BiJeong. And he devided WanBi(頑痺) as PungHanSeup(風寒濕), DamEo(痰瘀), YeolDok(熱毒), SinHeo(腎虛). He used insects for medicine. 2. ChoSuDoek(焦樹德) introduced past prescription. He used ChiBiTang(治痺湯) to treat HaengBi(行痺), TongBi(痛痺), ChakBi(着痺). He insisted that Han(寒; coldness) and Seup(濕; dampness) be Eum(陰) and Pung(風; wind) can change his character to be Eum. After all BiJeung is usually EumJeung. So he used GaeJi(桂枝) and BuJa(附子). By the way he used ChungYeolSanBiTang(淸熱散痺湯) for YeolBi, BoSinGeoHanChiWangTang SaBok(王士福) emphasized on the importance of medicine. He introduced many treatments like CheongYeol(情熱) for YeolBi and YiO(二烏) for HanBi. And he divided BiJeung period for three steps. At 1st step, we must use GeoSa(祛邪), at 2nd step, we must use BuJeong(扶正) and at 3rd step, we must use BoHyeol(補血), he insisted. And he introduced many herbs to treat BiJeung. 4. JeongGwangJeok(丁光迪) said that GaeJi(桂枝), MaHwang(麻黃), OYak(烏蘖) and BuJa(附子) are very important for TongRak(通絡). And pain usually results from Han(寒), so he liked to use hot-character herbs. 5. MaGi(馬志) insisted that BiJeung usually result from ChilJeong(七情). And he liked to use insects for treatment of BiJeung. 6. WeolSeokMu(越錫武) introduced 8 kinds of treatments and divided BiJeung period. Also he divided BeJeung for PungBi(風痺), HanBi(寒痺) and SeupBi(濕痺). 7. SeoGeaHam(徐季含) observed many patients and concluded that 86.7% of BiJeung is HeuJeung(虛症). 8. YuJiMyeong(劉志明) said that YeolBi is important and CheongYeol is also important. So he emphasized on DangGyuiJeomTongTang(當歸拈痛湯) and SeonBiTang(宣痺湯). 9. WangLiChu(汪履秋) studied cause of WanBi. Internal cause is GiHyeolHeo(氣血虛) and GanSinHeo(肝腎虛) and external cause is SaGi(邪氣) he insisted. 10. WangSaSang(王士相) said that YeolBi can be SeupYeolBi or EumHeuYeolBi(陰虛熱痺) and HanSeupBi(寒濕痺) is rare. He use WooBangJaSan(牛蒡子散) and BangPungHwan(防風丸) for SeupYeolBi, DangGyuiSaYeokTang(當歸四逆湯) for HanSeupBi. 11. JinTaekGang(陳澤江) treated YeolBi with BaekHoGaGyeJiTang(自虎加桂枝湯) and SaMyoSan(四妙散). If they don't have effect, he tried to cure BiJeung step by step. And he used e term of GeunBi(筋痺) and BangGiMogwaEIInTang(防己木瓜薏苡仁湯) was good for GeunBi. 12. MaSeoJeong(麻瑞亭) said that PungSeupYeokJeul(風濕歷節) is BiJeung and it is related to GanBinSin(肝脾腎; liver, Spleen, Kindey). And he emphasized on balance WiGi(衛氣) and YoungHeul(營血). 13. SaJeJu(史濟桂) said that GeunGolBi(筋骨痺) is similar to arthritis and sometimes called ChakBi. And SinBi(腎痺) is terminal stage of ChakBi, he said. He also used insects for treatment. 14. JeongJeNam(丁濟南) tried to cure SLE and used GyeJi, CheonCho(川椒), SinGeunCho(伸筋草), SunRyeongBi(仙靈脾), HyconSam(玄蔘) and GamCho(甘草). 15. JinGYungHwa(陳景和) emphasized on diagnosis of tongue. If the color of tongue is blue, it usually has EoHyeol(瘀血), for example. And he also used insects. 16. JuSongI(朱松毅) tried to devide YeolBi with OnByeong(溫病), Wi(衛), Gi(氣) and Hyeol(血). 17. RuDaBong(蔞多峰) said that JyeongHeo(正虛), OiSa(外邪) and EoHyeol are closely related. And he explained BiJeung by deviding the body into the part, for example head, neck, shoulder, waist, upper limb and lower limb. 18. YuMuBo(劉茂甫) defined PungHanSyubBi as chronic stage and YeolBi as acute stage.

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