• Title/Summary/Keyword: long-term change

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Late aortic root dilatation and aortic regurgitation in repaired tetralogy of fallot (팔로 4징의 완전 교정술 후 장기 추적 관찰상 나타나는 대동맥근의 확장과 대동맥판 폐쇄부전)

  • Kim, Jeong Eun;Hur, Kyong;Kwon, Hae Sik;Yoo, Byung Won;Choi, Jae Young;Sul, Jun Hee
    • Clinical and Experimental Pediatrics
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    • v.50 no.10
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    • pp.976-981
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    • 2007
  • Purpose : Aortic valve or aortic root (AoRo) replacement is occasionally required because of AoRo dilatation and aortic regurgitation (AR) in repaired tetralogy of Fallot (TOF). We evaluated AoRo size and possible factors associated with its hemodynamic nature in patients with repaired TOF. Methods : We investigated 130 repaired TOF patients more than 15 years of age who followed-up by echocardiography from January 2002 to December 2003. Of 130 patients, we identified 17 patients with AoRo dilatation, which was defined as ratio of expected AoRo size by standard nomogram (AoRo ratio) >1.5 (dilator group), and 113 TOF controls, with AoRo ratio <1.5 (non-dilator group). Results : Mean indexed AoRo size ($mm/m^2$) in the first echo was $24{\pm}3.2$ in the dilator group and $18{\pm}3.4$ in the non-dilator group (P<0.0001). AoRo rate of change (mm/year) from the first to latest echo study was $1.6{\pm}3.8$ in dilator group and $0.05{\pm}1.6$ in the non dilator group (P=0.0021). Patients from the dilator group showed a higher prevalence of pulmonary atresia (P=0.031) and a history of aortopulmonary shunt before repair (P=0.048), moderate to severe AR (P=0.0065), and increased left ventricular end-diastolic dimensions (P=0.003). Conclusions : A subset of patients late after TOF repair may show progressive dilatation of AoRo. To identify and prevent long-term sequelae in this patient group, regular follow-up and speculation about AoRo after TOF repair is recommended.

Surgical Experience of Aortic Root Replacement (대동맥근부치환술의 임상경험)

  • Kim, Hyun-jo;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.30 no.12
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    • pp.1197-1204
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    • 1997
  • Between April 1981 and June 1996, 65 patients had aortic root replacement at our institution. Disease entities were pure aortic annuloectasia in 31 patients(47.7%), Stanford type A aortic dissection with annuloectasia in 8(43.1%), atherosclerotic aneurysm with aortic regurgitation in 4(6.2%), and paravalvular leakage after aortic valve replacement in 2(3.1 %). 34 patients(52.3%) had the clinical stigmata of the Marfan syndrome. The operative procedures were Bentall operation in 61 patients(93.8%); 3 of conventional procedure and 58 of Cabrol's modification, aortic valve-sparing operation in 2(3.1 %), and root replacement with homograft in 2(3.1%). Hospital deaths occurred in 3 patients(4.8%) because of uncontrolled bleeding(1) and bypass weaning failure due to low cardiac output(2), and all had emergency operation with Cabrol's procedure. Postoperative complications developed in 19(29.2%) patients and most of them were transient. Surviving 62 patients have been followed up to cumulative total 315.0 patient-years(mean 60.2 $\pm$42.4 months). Late deaths occurred in 7 patients(11.3%), aneurysmal changes of remaining aorta were detected in 12 patients(19.4%). Actuarial survival rate at 10 years was 72.0 $\pm$ 9.7%, and the subsequent aortic operation-free rate at 10 years was 68.0$\pm$ 8.9% In a multivariate analysis, Marfan syndrome, emergency operation, preoperative dissection, combined arch replacement, and total circulatory arrest emerged as significant risk factors for hospital death or subsequent aortic operation. Over 60 years of age was the only risk factor for late death. Our 16 years'cummulative experience shows that aortic root replacement, mainly by means of Cabrol's procedure, can be applied successfully to variety of aortic root disease. However, long-term follow up will be needed to determine the late result of aortic valve-saving operation and root replacement with homograft. When dissection is present or the distal native aorta is diseased in'Marfan patients, close follow-up is necessary because of the subsequent aneurysmal change of remaining aorta.

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Therapeutic Efficacy of Alendronate for Glucocorticoid Induced Metabolic Bone Disease in Children with Nephrotic Syndrome (신증후군 환아에서 스테로이드 유발 대사성 골질환에 대한 Alendronate의 치료 효과)

  • Lee Ji-Eun;Lee Hyun-Ok;Paik Kyung-Hoon;Lee Suk-Hyang;Jin Dong-Kyu
    • Childhood Kidney Diseases
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    • v.8 no.1
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    • pp.33-42
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    • 2004
  • Purpose : Children with nephrotic syndrome(NS) are under high risk for metabolic bone disease(MBD) as a complication of long-term glucocorticoid therapy. We prospectively evaluated the effect of oral bisphosphonate(alendronate) therapy in children with NS, which has proven efficacy in adult patients with glucocorticoid induced MBD. Methods : Among 58 children with NS, aged 5 to 8 years and haying a disease duration of more than 2 years, 30(51.7%) were enrolled to meet the selection criteria, less than -1.0 Z-scores of lumbar spine bone mineral density(BMD) by dual energy X-ray absorptiometry (DEXA). These 30 children were divided into three groups and each were assigned to receive alendronate, calcitriol, and no-medication, respectively for one year. Lumbar spine BMD was followed up every 6 months and the biochemical indexes were measured before and 1 year after the treatment. There were no significant difference among groups with respect to the average age, the initial BMD, and the cumulative steroid doses. Analysis of the treatment efficacy was done by the % change of BMD and by the changes in Z-scores of lumbar spine BMD. Results : Mean age and disease duration of patients at the initial lumbar spine BMD evaluation was $7.4{\pm}1.7$ years and $2.2{\pm}1.2$ years, respectively. Twenty-three of 30 children(76%) had osteopenia, and seven(23%) had osteoporosis. There was no difference in the biochemical values among the groups, before and 1 year after the treatment(P<0.05). Twenty two children(73.3%) with frequent relapsing or steroid dependant NS had more frequent MBD, compared to the 8 children(26.6%) with infrequent relapsing NS. The one year % changes of BMD were 8.56 in alendronate group, 5.79 in calcitriol group, and 1.9 in no-medication group. The changes in Z-score of lumbar spine BMD increased in the alendronate group and the calcitriol group, but not in the no-medication group. One year % changes of BMD were different among groups(P=0.0002). Significant differences were found between the alendronate and the no-medication group, and between the calcitriol and the no-medication group(P<0.05). There was no difference between the alendronate and the calcitriol group. No serious adverse effect was observed in the alendronate group. Conclusion : Children with NS receiving high dose steroids are under the high risk of BMD and should undergo regular BMD evaluation. Z-score of lumbar spine BMD was a useful parameter in diagnosing low bone mass in children. Alendronate weekly oral therapy was effective and relatively safe in increasing the lumbar spine BMD in children with NS having steroid induced MBD.

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The Effect of Long-term Application of Different Organic Material Sources on Chemical Properties of Upland Soil (유기물원이 다른 퇴비연용이 밭토양의 화학성 변화에 미치는 영향)

  • Kim, Jong-Gu;Lee, Kyeong-Bo;Lee, Sang-Bok;Lee, Deog-Bae;Kim, Seong-Jo
    • Korean Journal of Soil Science and Fertilizer
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    • v.33 no.6
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    • pp.416-431
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    • 2000
  • The objective of this study was to determine the effects of various kinds of composts on the change of soil chemical properties in upland soils. Field experiments were conducted in the loam and sandy loam soils. Various kinds of composts such as poultry manure compost(PMC), cow manure compost(CMC), human excrement sludge(HES), and food industrial sludge compost(FISC) were applied annually at rates of 0, 40, and $80Mg\;ha^{-1}$ to soils grown with soybean and maize plants for 4 years during 1994 to 1997. The results of this study were as follows : The continuous application of human excrement sludge decreased soil pH up to 4.4~5.0, while other compost treatments increased soil pH compared with control plot. The EC increased initially and showed their maximum values at 20days after compost application, and then decreased up to 40 days, thereafter kept a certain level. The available phosphorous accumulated at 0~20cm depth in loam soil, and 0~50cm in sandy loam soil. Annual accumulation rates were 17% higher in sandy loam soil than loam soil. The more compost application rates and times, the higher base saturation percentage increased in upland soils. Four year's application at a rate of $80Mg\;ha^{-1}$ per year increased the base saturation percentage to 87~97% compared with 45% at control plot in the loam soil. While in sandy loam soil only three year's application of same rate increased the base saturation percentage to 81~92% compared with 30.4% at control plot. The average annual increasing rate of base saturation percentage at the same application rates of composts were higher in sandy loam soil by 2.0~3.7 times than in loam soil. The application of compost increased the exchangeable Ca, Mg, and K contents of soils by 2, 2~3, and 3~5 times, respectively, compared with the control. The contents of exchangeable cations were high in surface soil, and decreased with increase of soil depths. In the case of heavy metal content, there were no difference at the application of PMC and CMC but Ni, Fe, Zn, Cu was increased a little when the HES applied, and Ni and Cr was increased application with FISC.

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Spatio-Temporal Changes of Beetles and Moths by Habitat Types in Agricultural Landscapes (농촌경관에서 서식지 유형에 따른 딱정벌레와 나방의 시공간적 변화 양상)

  • Kim, Nang-Hee;Choi, Sei-Woong;Lee, Jae-Seok;Lee, Jaeha;Ahn, Kee-Jeong
    • Korean Journal of Environmental Biology
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    • v.36 no.2
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    • pp.180-189
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    • 2018
  • Agricultural landscapes in Korea comprise a large cultivation area of rice paddies, other crops, and forests which surround the cropland and the farmers' residential village. The forests in this agricultural landscape play important roles as ecological corridors and refuges for plants and animals in this agroecosystem. The present study investigated the spatial and temporal diversity patterns among these components of the agroecosystem to provide baseline data that describes how fauna change in the studies system. Insect sampling was conducted at four sites in two regions, Chungcheong (Ockcheon and Geumsan) and Jeonnam (Younggwang and Haenam), from March to August of 2014, using an UV light trap for moths and five pitfall traps for beetles. Beetles comprised 225 species and 2,457 individuals in 35 families, while moths consisted of 141 species and 403 individuals in 17 families. Beetles showed higher diversity in Chungcheong than Jeonnam, while moths showed no difference in diversity between regions. Forests showed the highest number of species and individuals, followed by orchards and rice paddies. The food preference of beetles showed that forests contained a higher proportion of herbivores, while orchards and rice paddies had a higher proportion of carnivores. Temporal changes in moths in the two regions were synchronous, while those of beetles were nonsynchronous. Moths increased from spring to summer across all habitats, especially in rice paddies during summer. Beetles also increased from spring to summer in orchards and rice paddies, although the beetles in the forests increased in the middle of summer. A detailed and long-term study is needed to reveal the causes of different diversity patterns of taxa among the different habitats within the agroecosystems.

The Analysis and Migration of Bisphenol A Related Compounds from Metal Food Cans (식품용 금속 캔으로부터 비스페놀 A 관련 물질들의 분석 및 이행 연구)

  • Park, Se-Jong;Park, So-Ra;Choi, Jae Chun;Kim, MeeKyung
    • Journal of Food Hygiene and Safety
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    • v.32 no.4
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    • pp.329-335
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    • 2017
  • Analysis method was presented for the simultaneous determination of nine bisphenol A related compounds such as bisphenol A (BPA), phenol, p-tert-butylphenol, bisphenol A diglycidyl ether (BADGE), $BADGE{\cdot}2H_2O$, $BADGE{\cdot}2HCl$, bisphenol F diglycidyl ether (BFDGE), $BFDGE{\cdot}2H_2O$ and $BFDGE{\cdot}2HCl$ migrated from inner coatings of metal food cans by high performance liquid chromatography (HPLC) with fluorescence detection. The method was validated by examining the linearity of calibration curve, the limit of detection (LOD), the limit of quantification (LOQ), recovery and uncertainty. The migration tests of nine BPA related compounds were carried out with four food simulants; deionized water (DW), 4% acetic acid, 50% ethanol and n-heptane. There was not any compound detected in DW, 4% acetic acid and 50% ethanol at $60^{\circ}C$ for 30 min and n-heptane at $25^{\circ}C$ for 60 min. BPA and phenol were migrated into 4% acetic acid and 50% ethanol at $95^{\circ}C$ for 30 min. The concentrations were ranged from 0 to $10.77{\mu}g/L$ of BPA and from 0 to $2.35{\mu}g/L$ of phenol. Canned foodstuffs mostly have long-term shelf life. We investigated migration of nine BPA related compounds according to the variation in storage periods (0~90 days) and temperatures (4, 25 and $60^{\circ}C$). All compounds were not founded during 90 days at $4^{\circ}C$ and $25^{\circ}C$, respectively. However BPA and $BADGE{\cdot}2H_2O$ were founded in DW and 4% acetic acid at $60^{\circ}C$. The migration levels of BPA and $BADGE{\cdot}2H_2O$ were close to the value of LOQ, respectively and did not change significantly as storage period. It was founded from results that the migration of BPA related compounds from metal food cans was controlled to a safe level.

The Outcome of the 6th ICAO Worldwide Air Transport Conference and Fair Competition Policy in International Air Transport (국제항공운송의 최근 동향과 항공운송의 공정경쟁정책 -ICAO 제6차 세계항공운송회의 결과를 중심으로-)

  • Shin, Dong-Chun
    • The Korean Journal of Air & Space Law and Policy
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    • v.28 no.1
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    • pp.97-114
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    • 2013
  • The 6th Worldwide Air Transport Conference was held in Montreal in March 2013 under the auspices of ICAO. This conference, which has been held every ten years, is dealing with virtually every issue of international air transport, and aiming at updating ICAO policy in order to ensure long-term growth of international civil aviation. Last conference which took place in 2003 focused on the liberalization of air transport, and the 6th conference shifted its focus from whether to push for liberalization, to how to implement it. The main agenda items for the 6th conference was liberalization, safeguards, ownership, fair competition, airports and air navigation facilities, charges, and ICAO policy. The liberalization, and in particular progressive liberalization has been a main theme over the past decades. In the process leading to liberalization, there needs to be the expansion of market access, easing regulation on ownership and control of airlines. Furthermore, the provision of enough infrastructure such as airport and air navigation facilities may be contributing factor to remove impediments to liberalization. However, out of concern as for undermining interests of consumer and the weak, when liberalization is proceeding in a sudden and radical manner, there should be safeguards so as to ensure market participation by developing countries, consumer protection, and economical and transparent decision on taxes and charges. Fair competition which differs from promoting competition in the market, is a policy in order to protect the weak players and consumers from monopoly and oligopoly. The Korean delegation submitted 3 WPs (WP/85, 86 and 87) and 1 IP, and presented WPs, at the conference, which were a lot compared with previous occasions. A paradigm shift was emphasized to expedite the process of liberalization at the 6th conference. The reality is that with many previous recommendations to stress the importance of liberalization, and to urge States to change their attitudes, the pace of the liberalization has been very slow and staggering. The liberalization of air transport will contribute to the growth of air transport and related industry, to create new employment, promoting tourism and regional development, and further to facilitating mutual understanding and exchange, which will also lead to making a barrier-free world. In this context, it is expected that the next conference will also evaluate the on-going process of liberalization.

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A Structural Analysis of the Spent Nuclear Fuel Disposal Canister with the Spent Nuclear Fuel Basket Array Change for the Pressurized Water Reactor(PWR) (고준위폐기물 다발의 배열구조변화에 따른 가압경수로(PWR)용 고준위폐기물 처분용기의 구조해석)

  • Kwon, Young-Joo
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.23 no.3
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    • pp.289-301
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    • 2010
  • A structural model of the SNF(spent nuclear fuel) disposal canister for the PWR(pressurized water reactor) for about 10,000 years long term deposition at a 500m deep granitic bedrock repository has been developed through various structural safety evaluations. The SNF disposal baskets of this canister model have the array type of which four square cross section baskets stand parallel to each other and symmetrically with respect to the center of the canister section. However whether this developed structural model of the SNF disposal canister is best is not determinable yet, because the SNF disposal canister with this parallel array has a limitation in shortening the diameter for the weight reduction due to the shortest distance between the outer corner of the square section and the outer shell. Therefore, the structural safety evaluation of the SNF disposal canister with the rotated basket array which is also symmetric with respect to the canister center planes is very necessary. Even though such a canister model has not been found as yet in the literature, the structural analysis of the canister with the rotated basket array for the PWR is required for the comparative study of the structural safety of canister models. Hence, the structural analysis of the canister with the rotated basket array in which each basket is rotated with a certain amount of degrees around the center of the basket itself and arrayed symmetrically with respect to the center planes is carried out in this paper. The structural analysis result shows that the SNF disposal canister with the rotated basket array in which the SNF disposal basket is rotated as 30~35 degrees around the center of the basket itself is structurally more stable than the previously developed SNF disposal canister with the parallel basket array.

The Prognostic role of Electrocardiographic Signs of Cor Pulmonale in Chronic Obstructive Pulmonary Disease (폐성심을 시사하는 심전도 소견 유.무에 따른 만성폐쇄성 폐질환 환자의 예후)

  • Shin, Moo-Chul;Park, Jae-Yong;Bae, Moon-Seob;Bae, Nack-Cheon;Chae, Po-Hee;Kim, Chang-Ho;Jung, Tae-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.6
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    • pp.944-955
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    • 2000
  • Background : In patients with chronic obstructive pulmonary disease(COPD), several factors have been associated with a poor prognosis. These include old age, low $FEV_1$ low diffusing capacity, high alveolar-arterial oxygen pressure difference, and finally cor pulmonale. This study was done to investigate if the ECG signs suggesting cor pulmonale were independent prognostic factors in patients with COPD. Method : We analyzed ECG, pulmonary function data and arterial blood gas values in 61 patients who were admitted through the emergency department with an acute exacerbation of COPD. The ECG signs reflecting cor pulmonale were right strial overloading(RAO), right bundle branch block, right ventricular hypertrophy and low-voltage QRS. The 61 patients were divided into 2 groups ; group I with no ECG signs(n=36) and group II with one or more ECG signs(n=25) suggesting cor, pulmonale. Results : Poor, prognostic factors by univariate analysis were low $FEV_1$, $FEV_1$ % pred., VC % pred., DLco, DLco % pred., $PaO_2$ and $SaO_2$ high $PaCO_2$ presence of ECG signs reflecting cor pulmonale, presence of mental status change, use of mechanical ventilator, and long term use of glucocorticoid. A multivariate analysis indicated that age(risk ratio=1.13, 95% confidence interval 1.05-1.23), DLco % pred. (risk ratio=0,97. 95% confidence interval 0.94-0.99), $PaO_2$ (risk ratio=0.95, 95% confidence interval 0.90-0.99) and RAO(risk ratio=5.27, 95% confidence interval 1.40-19.85) were independent prognostic factors of survival. There was a significant difference in survival between the patients with and without RAO(p=0.038). The survival rates at 1, 2, and 5 years were 94.5%. 81.4%, and 50.0% in patients without RAO and 82.4%, 70.6%, and 27.5% in patients with RAO, respectively. Conclusion : These results suggest that the presence of ECG signs reflecting cor pulmonale is a predictor of survival and that RAO of these ECG signs is a significant independent predictor of survival in patients with COPD.

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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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