By studying the portions and layers(分部), left and right, superior and inferior, location of yin and yang, and beginning and end of diseases of skin, which is the core point of the theory of cutaneous region(皮部論) in "Naejing(內經)", in the physiological and pathological perspective, based on opinion of historic memorial doctors, arrived to the conclusion as below. Cutaneous region means not only the distribution of three yin and three yang(三陰三陽) of the surface, but also inside and outside, shallowness and depth, and it is the system which unites meridians, networks, and vessels. It is divided into portions and layers. The origin and beginning of diseases and the rule of favorable pattern and unfavorable pattern can be known through it. The portion of skin is not only the area that meridian vessels belongs to skin, but also the area that activation of twelve meridian vessels are expressed in the surface. The layer of skin is consisted in order of skin-tertiary collateral vessel-collateral vessel-meridian vessel-bone. In "Naejing", there are two preconditions to divide three yin and three yang into yin and yang. The first is standing while looking the south, and second is the quotation "outside is side of yang(外者爲陽 內者爲陰)." According to this preconditions, yang of outside of yang brightness, lesser yang, and greater yang is the whole body, except inside of hand and foot which yin of lesser yin, pericardium, and greater yin. Superior and inferior of the portions and the layers is designated as hand and foot, theological basis of which superior and inferior work in same diagnostic method can be found in the root and the basis(標本) and the origin and the insertion(根結). In conclusion, cutaneous region not only manages layer of the skin, but also it is divided into layers and portions, so it has close relations between meridian vessels and collateral vessels. The in-depth study of cutaneous region and meridians should be progress, in order to practice of diagnosis and acupuncture and moxibustion more.
Through a consideration of the contralateral collateral needling(繆刺) from "Neijing", the conclusions are as follows. The contralateral collateral needing is defined as a disordered state, and also as the pricking bloodletting method. Unlike the seasonal deficiency pathogen(虛邪), which are affected by the four seasons, the subject of the contralateral collateral needling is the extra pathogen(奇邪), which is the cause of the extra disease(奇病), therefore the treatment should be different from the general. The contralateral collateral needling is generally used when a pain is generated from the veins(絡) by an external pathogen(邪). However, it can be used as the treatment for an emotional disorder, such as flight or sorrow, or a body constituent(身形) disorder caused by internal parts of the five viscera. Although the contralateral collateral needling(繆刺) and the contralateral meridian needling(巨刺) share the left and right cross treatment(右取左, 左取右) in common, but they are different in every aspect, as the causes, transmutation, location, and feature of disease, relation of qi and blood, and location and method of needling(刺鍼). The medical procedure of the contralateral collateral needling is collateral needling(刺絡) the parts of blood collaterals(血絡) or bruising(痏) well points(井穴) of the end of the both sides of limbs, and using the left and right cross treatment when the former methods are not making any progress. The symptoms of contralateral collateral needling are head, chest, and abdomen pains, and they are treated at the end of the limbs. The bloodletting method(刺絡法), extracting a little amount of blood at well points or blood collaterals, or the collateral vessel pricking therapy(瀉血法), extracting a lot of blood by using cupping(附缸), for example, are contemporary successions of the collateral needling(絡刺), the leopard-spot needling(豹文刺), and the contralateral collateral needling.
Objectives : The capillary destruction has frequently been used to treat telangiectasia in Korean Medicine. The objective of this study was to review of related literature concerning the capillary destruction as treatment for telangiectasia, and to discuss the clinical application of medical devices in accordance with the principles of Korean Medicine. Methods and Results : An extensive traditional literature including Huangdi Neijing were reviewed for identification of relevant evidence for treating telangiectasia. The telangiectasia is simply defined as a dilated, superficial blood vessel. It is called as the tertiary collateral vessel, superficial collateral vessel or Hyulrak(small superficial collateral vessel). The telangiectasia could be due to disturbances in the circulation of qi and blood. According to Huangdi Neijing, one of the oldest traditional literature published in 4th century B.C. through the first century A.D., it is needed to get rid of the vessel by the capillary destruction for treating telangiectasia using lance needle, shear needle, stiletto needle or moxibustion. Several studies have examined that intense pulsed light or laser as new therapeutic tools could have an sufficiently impact on aspects of improving the effectiveness of the capillary destruction. Conclusions : The capillary destruction for the treatment of telangiectasia has been used since two thousand years ago. We suggested that medical devices, such as intense pulsed light or laser, should be used to treat telangiectasia as a safe and convenient intervention in clinical practice of Korean Medicine.
Kim, Dong-Hui;Jeong, Chang-Hyun;Jang, Woo-Chang;Lyu, Jeong-Ah;Baik, You-Sang
Journal of Korean Medical classics
/
v.25
no.1
/
pp.89-115
/
2012
Objective : Blood disease is common these days due to modern man's excessiveness in Yang heat (陽熱) and vulnerability of the Eum blood(陰血). This exposes them to warmheat/ dampness-heat diseases, where pathogenic heat easily penetrates the blood dimension(血分) creating stagnated blood(瘀血). Consequently, pathogenic symptoms in the collateral vessels increase, making it crucial to understand the pathogenic mechanism of the disease. Method : This paper examines the condition and region of the collateral vessel diseases(CVD) according to the blood diseases of Onbyeong, by analyzing each prescription's matching symptom. The disease in question in this paper is 'stagnated blood fixated in the collateral vessels'. Therefore diseases with stagnated blood in the Yang collaterals and Viscera collaterals or viscera themselves from the chapter of "On-Yeok-Ron(溫疫論)", and < Dry Blood-DaeWhangJaChungWhan(大黃蟅蟲丸) > chapter of "Geum-Gue-Yo-Rak(金匱要略)", were examined respectively. Result & Conclusion : The process of CVD according to the blood diseases of Onbyeong can be summarized as follows. First, bleeding in the Yang and Bowel collaterals, then stagnation in the Yang and Bowel collaterals, and finally stagnation in the viscera collaterals or Liver itself. The refractory nature of blood stagnation symptoms of the collateral vessels is mainly due to the characteristics of the collateral vessel itself. In structure, they are very narrow and small, situated at the most terminal part of the body where it is difficult for the Jeong Gi(精氣) to reach. Also, as they are symptomatic of degeneration of Jeong Gi, the root of the disease is very deep. Therefore to resolve blood stagnation in the cases of Ju-Gaek-Gyo and Dry Blood, general approaches using 'Gi communication(行氣)' or 'Blood vitalizing(活血)' medicinals will not suffice. Special medicinals such as crustacean and insects need to be appropriately applied.
We have recently reported the development of a high efficiency expression vector, pCK, which can drive a high level of gene expression in mouse skeletal muscle. In this study, we tested the therapeutic potential of pCK expressing human VEGF165, pCK-VEGF in the rabbit ischemic hind limb model. To determine the optimal dose of plasmid DNA, various concentrations of pCK-CAT were injected into the muscle of a rabbit hind limb and the levels of CAT activity were determined. It was found that the expression level of the exogenously added gene became stable between 250 and 1,000 $\mu$g. Based on this result, we tested whether intramuscular transfer of 500$\mu$g of pCK-VEGF could actually modulate collateral vessel development in a rabbit ischemic hind limb model. It was found that relative to the control group injected with the pCK lacking the VEGF sequence, single intramuscular doses (500$\mu$g) of pCK-VEGF produced statistically significant augmentation of collateral vessels as determined by the angiographic vessel count, maximal blood flow by Doppler flowmeter and the number of capillaries by histology. These results suggest that a single 500$\mu$g-delivery of pCK-VEGF is potent enough to induce sufficient angiogenic activity and achieve therapeutic benefit on this rabbit model.
UCP 600 approved at the Banking Commission Meeting of ICC at the end of October, 2006 comes into effect from July 1, 2007. The main revision of the UCP 600 concerning the sea transport document are as follows. First, if the bill of lading contains an on-board-notation, with the date of shipment, the date stated in the on-board-notation will be deemed the date of shipment. Secondly, phrases "on its face" and "otherwise authenticated" should be eliminated. Thirdly, when an agent signs for or signs on behalf of the master, there is no longer a need for the name of master to be quoted. Fourthly, the terminology "loading on-board or shipped on a named vessel" is changed to "shipped on-board a named vessel." Fifthly, phrases "the rejection of the documents transported only by sail" is removed. Finally, new rule in UCP is the signing of a charter party bill of lading by the charterer or a named agent on behalf of the charterer. My assessment of the revision in UCP 600 is as follows: Because a freight forwarder transport document is a weaker form than a liner bill of lading as collateral, banks may need a secure measure as to protect themselves from such a weak collateral effect. we recognize that Such a weak collateral effect stemmed from the elimination of rules in UCP 500 article 30, and the admission of transport documents issued by the freight forwarder as long as any one besides carrier, shipper, and charterer satisfies the requirements of transport document clauses in UCP 600. Finally, I hope the Commentary on UCP 600 will serve to explain the ambiguities remaining in the new rules.
We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.
This case report described a single case of adult stoke patient due to Moyamoya disease through long-term follow-up observation, which included his demographics, brain images, and change of motor function and functional activities. The subject was the 54-year-old male diagnosed with left hemiparesis from a stroke due to multifocal encephalomalacia in both hemispheres. At the time of the stroke attack, he took brain surgery intervention including external ventricular drain. Physical and occupational therapy for stroke rehabilitation were admitted including muscle strengthening exercises, functional activity/ADL training, neurofacilitative techniques with bobath or proprioceptive neuromuscular facilitation concepts, and compensatory strategy. Patient's MRI showed that right frontal lobe, right peri-ventricular area, left parietal, and left occipital lobes were damaged, and MRA showed that abnormal collateral vessel was richly developed in both hemispheres by occlusion of proximal internal carotid arteries in both sides. His motor strength was improved from poor to good grade in all of upper and lower limb motions, that MBC was improved from stage 1 to stage 5. In FAC and barthel index, at the initial evaluation, he could not perform any functional movement, but his FAC and barthel index were on 3 and 14 points at present, respectively. During long-term follow-up for approximately 4 years, the subject's functional motor ability was improved, as similar with recovery progression of usual stroke patient. We believe that this single case report will provide clinical information and concern regarding Moyamoya disease with physical therapist, in terms of such as epidemiology, pathogenesis, diagnostic procedures, clinical features, recovery process, and prognosis.
Objectives : This paper studied the different disease sites according to Yin and Yang deviation and the principal to applying the Five Shu Points acupuncture method to these sites of the Yin-Yang needling method as explained in the Shouyaogangrou chapter of the Lingshu. Methods : Of the seasonal needling method in the Neijing, the principle to managing the Five Shu Points and indications of each point were examined. Next, clinical applications of the Five Shu Points were analyzed. Descriptions of clinical expression were collected and examined to understand the underlying pattern. Results : If we connect the disease sites of the Yin-Yang needling method to the Five Shu Points needling method according to the seasonal changes, the Yang of Yin connects to Spring, Yin of Yang to Summer, Yang of Yang to Autumn, and Yin of Yin to Winter. Of the needling site, the collateral vessel is the collateral vessel of Spring, 'Meridian of Yin' is the meridian of the Yin domain or the meridian points of the Yin meridian. 'He of Yang' is the He point of the Yang meridian, and the Yin Xing and Shu are the Xing and Shu points of the Yin meridian. Upon examining cases in the Neijing where the Five Shu Points were applied, it could be found that the Xing and Shu points of the Yin meridian were used together, while the He point of the Yang meridian was used to eliminate Yang pathogen or to stimulate Yang qi, which matches the Yin-Yang needling method of the Shouyaogangrou chapter of the Lingshu. Conclusions : The Yin and Yang of the needling sites from the Yin-Yang needling method in the Shouyaogangrou chapter of the Lingshu refers to the Yin and Yang meridians, or the Yin and Yang domains. In the context of disease site description, the former Yin and Yang describes a spatial aspect, while the latter Yin and Yang refers to the vicissitudes of qi according to temporal change.
Objectives: This study was carried out to concrete the concept of Hand Gworeum Skin referred in Suwen of Huangdi Neijing. Methods: The Hand Gworeum Meridian was labeled with latex in the body surface of the cadaver, subsequently dissecting a superficial fascia and muscular layer in order to observe internal structures. Results: Skin histologically encompasses a common integument and a immediately below superficial fascia, this study established the skin boundary with adjacent structures such as relative muscle, tendon as its compass. The realm of the Hand Gworeum Skin is as follows: The skin close to the nipple on the 4th intercostal space, the interceps of biceps brachii muscle, the cubital surface at ulnad of bicipital aponeurosis, the anterior surface of the forearm, between flexor carpi radialis and palmaris longus(from wrist crease to 5chon above), the palm between the 3rd and 4th metacarpals on the cross part with the palm crease, the radiod from the middle finger nail(or the end of middle finger). The realm of the Hand Gworeum Skin is situated on between Hand Taeeum Skin and Hand Soeum Skin in front of arm. Conclusion: The realm of Hand Gworeum Skin from the anatomical viewpoint seems to be the skin area outside the superficial fascia or the muscle involved in the pathway of the Hand Gworeum Meridian vessel, Collateral Meridian vessel, and Meridian muscle, being considered adjacent vessels or nerves at the same time.
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