변증논치(辨證論治)와 병증변치(病證辨治) 장단점의 비교고찰 - 고혈압과 두통의 예를 중심으로 -

기유종,신선중,한원영,한유창,이선동,Gi, Youjong,Shin, Sunjoong,Han, Wonyoung,Kim, Hyundo,Han, Yoochang,Lee, Sundong 대한예방한의학회 2017 대한예방한의학회지 Vol.21 No.1

Objectives : Comparative review was rendered to evaluate strengths and weaknesses of two common treatment approaches of treatment based on syndrome differentiation and treatment based on syndrome differentiation from disease. A typical symptom of headache from hypertension was chosen for substantial approach of this review. Methods : Pros and cons of two different approaches to disease were evaluated based on literatures and texts focusing treatment based on syndrome differentiation and treatment based on syndrome differentiation from disease. Headache can be correlated with hypertension yet it can be induced by multiple other factors, and headache may/may not accompany hypertension. Hypertension is an example of treatment based on syndrome differentiation from disease and headache can be an example of treatment based on syndrome differentiation. Results : Treatment based on syndrome differentiation can give more autonomy and flexibility in approach to the disease, Intuition, experience, and traditional medical theory can be applied with ease. However, management and eradication of diseases are difficult and standardization of treatment is not easy among practitioners. Treatment based on syndrome differentiation from disease incorporated merits of both eastern and western medicines, achieving more evidence based diagnosis and treatment. Eradication and standardization of disorders are possible with the latter approach. Conclusions : Comparing two systems of treatment based on syndrome differentiation and treatment based on syndrome differentiation from disease with emphasis on hypertension and headache yielded medical values. Treatment based on syndrome differentiation from disease appears to be superior in medical values and effectiveness, but further evaluation and interest are needed to make advancement in Korean traditional medicine.

《傷寒雜病論》의 診斷體系에 關한 硏究

申尙玗,金楨氾 대한동의병리학회 1998 동의생리병리학회지 Vol.12 No.1

《傷寒雜病論》의 診斷體系를 파악하기 위하여 《傷寒論》과 《금궤要略》을 합쳐 仲景의 醫案으로 상정하고, '辨病', '辨證', '辨症徵'의 각도에서 조사하고 살펴보았다. 《傷寒論》과 《금궤要略》의 관계는 外感 傷寒病 전문서와 內傷 雜病 전문서라기 보다는 두 책이 모두 外感 病因을 중시하되 《傷寒論》은 三陰三陽의 定性, 定位적 요소에 맞고 그 傳變규율을 가지는 병을 위주로한 반면, 《금궤要略》은 三陰三陽辨病, 病因辨病, 臨床特徵辨病으로 구분할 수 있고, 辨證방법으로는 六經辨證, 臟腑辨證, 八綱辨證, 病因辨證, 方劑辨證으로 구분할 수 있으며, 病證結合의 유형으로는 제반 辨病과 方劑辨證의 결합, 病因辨病과 六經辨證의 결합, 三陰三陽辨病과 八綱辨證의 결합, 三陰三陽辨病과 臟腑辨證의 결합, 臨床特徵辨病과 八綱辨證의 결합, 辨病위주로 辨證결합, 辨證위주로 辨病결합 등을 들 수 있다. 《傷寒雜病論》의 症徵을 이용한 변치로는 特徵症狀辨證法, 排除辨證法, 對比鑑別法 등을 위주로 하고, 脈診, 舌診, 腹診 모두 病證確診, 病因病耭, 病位病性의 변별에 기여하고 있었다. 《傷寒雜病論》의 진단체계는 辨病과 辨證 및 辨症徵의 다양한 辨治體系들이 유기적으로 연계되어 있으며, 仲景은 이를통해 발전변화하는 병태를 신속하고 정확하게 파악하여 治療하였음을 알 수 있었다. In order to find out the diagnostic system of 《Shang Han Za Bing Lun(傷寒雜病論)》, we combine 《Shang Han Lun(傷寒論)》 with 《Jin Kui Yao Lue(금궤要略)》 and assume it to be clinical charts of Zhang Zhongjing(張仲景). Later, we investigate and consider 《Shang Han Za Bing Lun》 in views of syndrome differentiation(辨證), disease differentiation(辨病) and differentiation of symptoms and signs(辨症徵). The conclusions obtained were summarized as follows. 1. The relation between 《Shang Han Lun》 and 《Jin Kui Yao Lue》 is not special books about febrile disease due to exogenous pathogenic factors and miscellaneous internal diseases due to internal injury. 《Shang Han Lun》 give the first consideration to diseases coming within the category of the triple Yin and triple Yang diseases(三陰三陽病). 《Jin Kui Yao Lue》 put first diseases coming within the unique category. 2. The types of differentiation of diseases(辨病) in 《Shang Han Za Bing Lun》 are divided up differentiation of diseases in accordance with the triple Yin and triple Yang(三陰三陽辨病), etiological differentiation of diseases(病因辨病) and differentiation of diseases according to clinical features(臨床特徵辨病). 3. The types of differentiation of syndromes(辨證) in 《Shang Han Za Bing Lun》 are divided up differentiation of syndromes in accordance with the theory of the six meridians(六經辨證), differentiation of syndromes according to pathological changes of Jang-Bu organs(臟腑辨證), differentiation of pathological conditions in accordance with the eight principal syndromes(八綱辨證), etiological differentiation of syndromes(病因辨證) and differentiation of syndromes according to prescriptions and herbs(方劑辨證). 4. The types of combinations of disease with syndrome(病證結合) in 《Shang Han Za Bing Lun》 are divided up 1) the combination of all disease differentiation with syndrome differentiation according to prescriptions, 2) the combination of etiological disease differentiation with syndrome differentiation in accordance with the theory of the six meridians, 3) the combination of disease differentiation in accordance with the triple Yin and triple Yang with differentiation of pathological conditions in accordance with the eight principal syndromes, 4) the combination of disease differentiation in accordance with the triple Yin and triple Yang with syndrome differentiation according to pathological changes of Jang-Bu organs, 5) the combination of disease differentiation according to clinical features with differentiation of pathological conditions in accordance with the eight principal syndromes, 6) putting first disease differentiation combined with syndrome differentiation, and 7) putting first syndrome differentiation combined with disease differentiation. 5. The types of differentiation of symptoms and signs(辨症徵) in 《Shang Han Za Bing Lun》 are syndrome differentiation according to special symptoms(特徵症狀辨證法), exclusive syndrome differentiation(排除辨證法), and comparative discrimination(對比鑑別法). The Pulse feeling(脈診), the Inspection of the tongue(舌診), the Diagnosis of the abdomen(腹診) all contribute to confirmation of disease/syndrome and discrimination of cause of disease(病因), pathological mechanism(病機), pathological position(病位), pathological characteristics(病性). Based on the above conclusions, the diagnostic system of 《Shang Han Za Bing Lun》 included manifold disease differentiations, syndrome differentiations, differentiations of symptoms and signs, and through these Zhang Zhongjing understanded the growing and changing pathological state of patient very quickly and exactly.

Traditional Chinese medicine diagnostic prediction model for holistic syndrome differentiation based on deep learning

Zhe Chen,Dong Zhang,Chunxiang Liu,Hui Wang,Xinyao Jin,Fengwen Yang,Junhua Zhang 한국한의학연구원 2024 Integrative Medicine Research Vol.13 No.1

Background: With the development of traditional Chinese medicine (TCM) syndrome knowledge accumulation and artificial intelligence (AI), this study proposes a holistic TCM syndrome differentiation model for the classification prediction of multiple TCM syndromes based on deep learning and accelerates the construction of modern foundational TCM equipment. Methods: We searched publicly available TCM guidelines and textbooks for expert knowledge and validated these sources using ten-fold cross-validation. Based on the BERT and CNN models, with the classification constraints from TCM holistic syndrome differentiation, the TCM-BERT-CNN model was constructed, which completes the end-to-end TCM holistic syndrome text classification task through symptom input and syndrome output. We assessed the performance of the model using precision, recall, and F1 scores as evaluation metrics. Results: The TCM-BERT-CNN model had a higher precision (0.926), recall (0.9238), and F1 score (0.9247) than the BERT, TextCNN, LSTM RNN, and LSTM ATTENTION models and achieved superior results in model performance and predictive classification of most TCM syndromes. Symptom feature visualization demonstrated that the TCM-BERT-CNN model can effectively identify the correlation and characteristics of symptoms in different syndromes with a strong correlation, which conforms to the diagnostic characteristics of TCM syndromes. Conclusions: The TCM-BERT-CNN model proposed in this study is in accordance with the TCM diagnostic characteristics of holistic syndrome differentiation and can effectively complete diagnostic prediction tasks for various TCM syndromes. The results of this study provide new insights into the development of deep learning models for holistic syndrome differentiation in TCM. Background: With the development of traditional Chinese medicine (TCM) syndrome knowledge accumulation and artificial intelligence (AI), this study proposes a holistic TCM syndrome differentiation model for the classification prediction of multiple TCM syndromes based on deep learning and accelerates the construction of modern foundational TCM equipment. Methods: We searched publicly available TCM guidelines and textbooks for expert knowledge and validated these sources using ten-fold cross-validation. Based on the BERT and CNN models, with the classification constraints from TCM holistic syndrome differentiation, the TCM-BERT-CNN model was constructed, which completes the end-to-end TCM holistic syndrome text classification task through symptom input and syndrome output. We assessed the performance of the model using precision, recall, and F1 scores as evaluation metrics. Results: The TCM-BERT-CNN model had a higher precision (0.926), recall (0.9238), and F1 score (0.9247) than the BERT, TextCNN, LSTM RNN, and LSTM ATTENTION models and achieved superior results in model performance and predictive classification of most TCM syndromes. Symptom feature visualization demonstrated that the TCM-BERT-CNN model can effectively identify the correlation and characteristics of symptoms in different syndromes with a strong correlation, which conforms to the diagnostic characteristics of TCM syndromes. Conclusions: The TCM-BERT-CNN model proposed in this study is in accordance with the TCM diagnostic characteristics of holistic syndrome differentiation and can effectively complete diagnostic prediction tasks for various TCM syndromes. The results of this study provide new insights into the development of deep learning models for holistic syndrome differentiation in TCM.

윤길영(尹吉榮)의 변증론(辨證論) 변천(變遷) 연구(硏究)에 대한 고찰

김경철 ( Gyeong Cheol Kim ),이해웅 ( Hai Woong Lee ) 대한한의진단학회 2015 大韓韓醫診斷學會誌 Vol.19 No.3

Objectives Syndrome differentiation and treatment (辨證論治) is one of the core theories in Korean medicine and syndrome differentiation (辨證) constitutes a branch of disease diagnosis in Korean medicine. Yoon Gil-Young, one of the modern outstanding scholar of basic medical science in Korean medicine, wrote on basic theories of Korean medicine such as physiology, pathology, formula science, etc. Hereby we will analyze and discuss his works to understand his recognition of historical changes in the syndrome differentiation. Methods We conducted researches into the two works of Yoon Gil-Young`s, which are 『The Clinical Formula Science of Eastern Medicine (東醫臨床方劑學)』 and 『The theory of Four-Constitution Medicine (四象體質醫學論)』. From Yoon`s academic standpoint which connects the basic medical science with the clinical medicine, we analyzed his opinion about syndrome differentiation and its historical changes. Results According to Yoon`s research work on syndrome differentiation and its historical changes, the development of syndrome differentiation, which goes in harmony with the history of Korean medicine, has its deep root in 『 Huangdi`s Internal Classic (黃帝內經)』 and 『Treatise on Cold Damage and Miscellaneous Diseases (傷寒雜病論)』. And through 『Treatise on the Spleen and Stomach (脾胃論)』 and the articles of warm disease (溫病論), the theory of syndrome differentiation became extended to the whole clinical diagnostic field in Korean medicine, finally including the achievements in 『Treasured Mirror of Eastern Medicine (東醫寶鑑)』, 『Longevity and Life Preservation in Eastern Medicine (東醫壽世保元)』. Conclusions Yoon Gil-Young recognized that the system of syndrome differentiation was developed in accordance with the theories from the 『Treatise on Cold Damage and Miscellaneous Diseases』, then the 『Treatise on the Spleen and Stomach』 and the articles of warm disease. The four-constitution medicine in Korea and Koho school in Japan which lays emphasis on abdominal signs also contributed to its development. Syndrome differentiation can be categorized basically into three states of intrinsic cold (本寒), intrinsic deficiency (本虛), intrinsic heat (本熱) according to the deficiency and excess in human body metabolism.

윤길영의 변증체계 고찰

김경철,홍동균,Kim, Gyeong Cheol,Hong, Dong Gyun 대한한의진단학회 2016 大韓韓醫診斷學會誌 Vol.20 No.1

Objectives Syndrome differentiation and treatment (辨證論治) was one of the core theories in Korean medicine and syndrome differentiation (辨證) constitutes a branch of disease diagnosis in Korean medicine. Yoon Gil-Young, one of the modern outstanding scholar of basic medical science in Korean medicine, wrote on basic theories of Korean medicine such as physiology, pathology, formula science, etc. Hereby we will analyze and discuss his works to understand his recognition of historical changes in the syndrome differentiation. Methods We conducted researches into the two works of Yoon Gil-Young's, which are "The Clinical Formula Science of Eastern Medicine (東醫臨床方劑學)" and "The theory of Four-Constitution Medicine (四象體質醫學論)". From Yoon's academic standpoint which connects the basic medical science with the clinical medicine, we analyzed his opinion about the system in the Theory of 'Syndrome Differentiation'. Results According to Yoon's research work on the Theory of 'Syndrome Differentiation', the system of syndrome differentiation, which had its deep root in the theory of Yin and Yang (陰陽) & the theory of abbreviation of the five circuit phases (五運) and the six atomspheric influences (六氣) of the "Huangdi's Internal Classic (黃帝內經)". Conclusions Yoon Gil-Young's theory of differentiation of syndromes and treatment is widespread so much that he studied on the learning field of Traditional Korean Mediciine and ingenious as well. He explain on the main principles of differentiation of syndromes based on "Huang Di Nei Jing" and the system of differentiation of syndromes is composed of Traditional Korean Medical Physiology.

역류성 식도염의 변증과 처방에 관한 문헌적 고찰 - 중국 논문 중심으로 -

최가영,선승호,김병우,이선주,오현석,한인식,고재언,Choi, Ga-Young,Sun, Seung-Ho,Kim, Byoung-Woo,Lee, Sun-Ju,Oh, Hyun-Suk,Han, In-Sik,Ko, Jae-Eon 대한한방내과학회 2011 大韓韓方內科學會誌 Vol.32 No.1

Objectives : This study investigated oriental diagnosis and treatment of reflex esophagitis (RE) such as syndrome differentiation and herbal medicine by reviewing Chinese journals. Methods : A journal search was performed using China National Knowledge Infrastructure (CNKI) from January 2006 to December 2010. The keywords were the various combinations of 'reflex esophagitis', 'Chinese medicine', 'syndrome differentiation', and 'herbal medicine'. All types of journal entries that explained or referred to herbal medicines and definite syndrome differentiations were included. The Types of the journals were randomized clinical trials (RCT), reviews, essays, case series and reports. Vague syndrome differentiations and experimental studies were excluded. Selected journals were extracted and summarized by two researchers independently. Results : 47 Chinese entries were finally selected. 61% of them were case-control trials that had non-randomized, active controlled clinical trials. 36 kinds of syndrome differentiations about RE were investigated. We summarized and divided them into 10 syndrome differentiation groups. 肝胃不和(syndrome of liver qi invading the stomach) in syndrome differentiation, 和胃降逆 (harmonize the stomach and direct qi downward) in method of treatment, and Jwa kum-whan (左金丸) were cited with high frequency in RE. Conclusions : We find that many kinds of syndrome differentiation groups and herbal medicines for reflex esophagitis are used in China, compared with Korea. Further studies will be required about oriental syndrome differentiation and treatment of this disease.

윤길영(尹吉榮)의 병증(病證) 대분류에 대한 고찰

김경철 ( Gyeong Cheol Kim ),이정원 ( Jeong Won Lee ) 대한한의진단학회 2015 大韓韓醫診斷學會誌 Vol.19 No.1

Objectives In order to the review of the Yoon Gil-Young`s theory on the “differentiation of syndromes”, we studied on the his method and system of classification on the “differentiation of syndromes”. Methods We reviewed on 『The Clinical Formula Science Traditional Korean Medicine 東醫臨床方劑學』, 『A study on the Methodology of Traditional Korean Medicine 東醫學의 方法論硏究』 『The theory of SaSang Constitution Medicine 四象體質醫學論』. From a connected standpoint with the basic theory and clinical medicine, considered on the Yoon Gil-Young`s theory of “differentiation of syndromes”. Results Yoon Gil-Young`s theory of differentiation of syndromes and treatment was widespread so much that he studied on the learning field of Traditional Korean Mediciine and ingenious as well. The main principles of differentiation of syndromes was summarized the three representative syndrome-complexes; BON-HER(original deficiency syndrome), BON-HAN(orginal cold excess syndrome), BON-YEOL(original heat excess syndrome). And also the three representative syndrome-complexes was previously carried out the details of differentiation of syndromes and assigned represent prescription one by one. Conclusions As the results, Yoon Gil-Young insisted the system of differentiation of syndromes closely connecting with Traditional Korean Medical physiology, pathology, diagnosis and prescriptions. And therefore he was a frontier of the field of Traditional Korean Medicine.

玄谷 尹吉永의 辨證要綱에 대한 硏究

김경철,신순식,이용태 대한동의병리학회 2003 동의생리병리학회지 Vol.17 No.3

We study on the HYUN-GOG's main principles of Differentiation of Syndromes. HYUN-GOG insisted upon the main principles of Differentiation of Syndromes based on the individual-physiology. The system of Differentiation of Syndromes was composed of the Korean oriental medicine's physiological system. The main principles of Differentiation of Syndromes was mutually explained for the standpoint of eight principal syndromes(differentiation of pathological conditions in accordance with the eight principal syndromes) and the system of Syndrome-complexes based on the physiological system. BON-HER(original deficiency-syndrome), BON-HAN(original cold excess-syndrome), BON-YEOL(original heat excess-syndrome), the three representative syndrome-complexes is previously carried out the details of Differentiation of Syndromes. And the oriental medicine history was rearranged centering around the theory of Differentiation of Syndromes by HYUN-GOG. The theory of Syndrome-complexes was closely connected with prescription by the presentation of the basic organical prescription for the three representative syndrome-complexes.

진전 변증에 관한 문헌적 고찰 - 중국 논문 중심으로 -

선승호,Sun, Seung-Ho 대한한방내과학회 2010 大韓韓方內科學會誌 Vol.31 No.1

Background : It was not enough to apply three kinds of syndrome differentiation in our oriental medical textbook to tremor's treatment according to reports of Korea and traditional medical textbook of China. Objective : To investigate syndrome differentiations by types of diseases related to tremor through Chinese journals review and to suggest adding possible syndrome differentiations. Methods : Literature search was performed using China Academic Journal (CAJ), the search engine of China National Knowledge Infrastructure (CNKI) from January 1994 to December 2009. Searching key words were Chinese characters in combination meaning tremor, paralysis agitans, and syndrome differentiation. We included all types of articles that explained or referred to definite syndrome differentiations. The symptoms and oriental medications by syndrome differentiation in selected articles were extracted and summarized. Results : 56 Chinese journals were ultimately selected. 37 kinds of syndrome differentiations about tremor were investigated, which included dual deficiency of qi and blood (氣血兩虛) quoted 31 times, liver-kidney yin deficiency (肝腎陰虧) 23 times, liver-kidney deficiency (肝腎不足) 21 times, and phlegm-heat stirring wind (痰熱動風) 20 times. 37 kinds of syndrome differentiation could by group into eight types, such as liver-kidney yin deficiency (肝腎陰虧), dual deficiency of qi and blood (氣血兩虛), phlegm-heat stirring wind (痰熱動風), heart deficiency and spirit weakness (心虛神弱), blood stasis due to qi stagnation (氣滯血瘀), sea of marrow deficiency (髓海不足), liver qi depression (肝氣鬱結), and liver yang transforming into wind (肝陽化風). Conclusion : We suggest that the syndrome differentiations of tremor, such as heart deficiency and spirit weakness (心虛神弱), blood stasis due to qi stagnation (氣滯血瘀), sea of marrow deficiency (髓海不足), liver qi depression (肝氣鬱結), and liver yang transforming into wind (肝陽化風), can be added to liver-kidney deficiency (肝腎不足), dual deficiency of qi and blood (氣血兩虛), and phlegm-heat stirring wind (痰熱動風) of the textbook. Further systematic research will be needed on them.

돌발성 난청 치료에 관한 임상적 고찰

하미경,최인화,Ha, Mi-kyung,Choi, In-hwa 대한한방안이비인후피부과학회 2003 한방안이비인후피부과학회지 Vol.16 No.1

Introduction : The causes of sudden sensorineural hearing loss have not been detemined with precision until recently, but viral infections and vascular insufficiencies, such as vascular spasm, occlusion of sludging of erythrocytes were considered as major factors. The treatment has not been determined with precision until recently. It is similar to dizziness(眩暈). sudden dcafncss(暴聾) and congestion-fire deafness(痰火聾) in Oriental Medicine. It is very rare that someone has sudden hearing loss and visit Oriental Medicine Clinic right that time. But we expect if they take a Oriental treatment on thc right time. more effective for their symptom. Subjects : Following conclusions were reached by measuring results of oricntal medical treatments for 40 patients who visited the clinic between January of 2000 and December of 2002, and received treatments continuously for more than 1 months of time. Methods : Among the selected 40 patients. 30 patients belong to Group Ⅰ, which consisted of patients who had already visited a general hospital prior to visiting this clinic, achieved no recovery at all from sudden deafness despite going through more than 5 days of hospitalized treatments of steroidal medications. Group Ⅱ was consisted of 10 patients of sudden deafness who did not experience any steroidal treatments from other hospital prior to the oriental medical treatment. Results and conclusion : According to differentiation of syndrome. among 30 patients of the Group Ⅰ. 21 were categorized as excess syndrome patients and remaining 9 as deficiency syndrome paticnts. Among 10 patients of For Group Ⅱ, 5 were excess syndrome patients and remaining 5 were deficiency syndrome patients. Among Group Ⅰ, recovery ratio of excess syndrome patients was 47.7$\%$ and deficiency syndrome patients was 44.4$\%$ adding up recovery ratio of the group to be 46.1$\%$. Among Group Ⅱ, recovery ratio of excess syndrome patients was 80$\%$ and deficiency syndrome patients was 100$\%$ adding up recovery ratio of the group to be 90$\%$. Oriental medical treatments are generally more effective(90$\%$ recovery ratio) for Sudden Deafness than steroidal treatments. Oriental medical treatments are almost equally effective for both excess syndrome patients and deficiency syndrome patients. However, steroidal treatments for excess syndrom patients(45$\%$ recovery ratio) is much less effective than deficiency syndrome patients(73$\%$ recovery ratio). This indicates that steroidal treatments should be applied selectively to deficiency syndrome patients if applied at all. Even for patients with sudden deafness which hospitalized steroidal treatments did not result in any recovery at all, oriental medical treatments were able to achieve 46.1$\%$ recovery ratio.