한의 임상 복진법 - 전문가 의견을 바탕으로 -

김금지,전혜진,고석재,박재우,Kim, Keumji,Jeon, Hye-jin,Ko, Seok-jae,Park, Jae-Woo 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.6

Objectives: The purpose of this study was to investigate the opinions of experts on abdominal examinations in Korean Medicine included in the curriculum of the College of Korean Medicine. Methods: Among Korean doctors, 14 experts on abdominal examinations were interviewed; the experts included 9 professors of Korean internal medicine, 1 expert in diagnostics of Korean Medicine, 1 primary care Korean medicine doctor, and 3 executives of a (former) Korean association of the abdomen. The interview consisted of questions regarding recognition of the clinical importance of abdominal examinations, how to perform abdominal examinations, the most frequent abdominal examination findings encountered in clinical practice, and the definition of some of the abdominal examination findings. Results: Most interviewees recognized abdominal examinations as important and used them in clinical practice. Opinions on additions and corrections were collected regarding observation items, posture, method, and order during abdominal examinations. Abdominal examination findings that were common clinically were abdominal fullness (腹滿), epigastric stuffness (心下痞鞕), abdominal tenderness, epigastric fullness (心下滿), and rib distention (胸脇苦滿). The answers to the question related to the definitions of abdominal examination findings included consent and supplementary opinions regarding definitions of deficiency-excess, cold-heat, abdominal tenderness, tension of abdominal muscles, succession sounds, and borborygmus; these were mainly selected based on abdominal symptoms that are highly quantifiable. Conclusions: In the future, based on the results of this study, additional research related to the drafting of a standard abdominal examination in Korean medicine should be conducted to provide an opportunity to increase the reliability of Korean medicine diagnosis.

복진(腹診)에 대한 국내 연구동향 분석 및 연구방향 제안

김지혜(Jihye Kim),박정환(Jeong Hwan Park),김근호(Keun Ho Kim) 대한한의학회 2016 대한한의학회지 Vol.37 No.3

한의복진법의 정량화를 위한 탐색적 임상연구 - 한의 복진기기 개발을 위한 예비 연구 -

이재홍,김상진,고석재,박재우,Lee, Jae-hong,Kim, Sang-jin,Ko, Seok-jae,Park, Jae-woo 대한한방내과학회 2016 大韓韓方內科學會誌 Vol.37 No.6

Objectives: This exploratory trial evaluated the possibility of quantitatively measuring several aspects during the "abdominal examination" of traditional Korean medicine. The main results of this study will be used to develop a new diagnostic device for abdominal examinations. Methods: Fifteen healthy volunteers were recruited for this study. Three certified Korean medical doctors assessed the existence of pressure pain, the elasticity of the abdominal muscle, and the tonus at CV12 as gold standards. Then, 2 well-trained investigators measured the pressure pain threshold (PPT), the indentation depth of a bar, and repelling force by pressing CV12. Each investigator measured the above 3 variables 2 times at 1 min intervals using a modified digital algometer. Reliability and validity tests of the 3 variables were performed. Results: There were statistically significant coefficients of intraclass correlation on the 3 variables both between and within the investigators (P<0.001). Also, PPT and repelling force showed statistically significant high sensitivity and specificity in a ROC curve. However, the indentation depth of the bar presented relatively low sensitivity. Conclusions: This new diagnostic method using a modified digital algometer could be a useful tool for quantitative measurement in "abdominal examinations". However, future rigorous clinical studies with a large population will be needed for the verification of its usefulness.

국내 일부지역의 식도암 발생 위험요인과 관련된 요인

이성란 사단법인 인문사회과학기술융합학회 2016 예술인문사회융합멀티미디어논문지 Vol.6 No.11

This study was attempted to identify the factors influencing on esophageal cancer incidence of local area in Korea. A total of 76 incident cases of esophageal cancer admitted to the department of internal medicine in a general hospital form December 1, 2015 to January 31, 2016 were compared with 76 matched controls admitted to same hospital in same period. Factors associated with general characteristics and medical behaviors were performed using Chi-square test. Odds ratio between risk factors of esophageal cancer were analyzed using multiple logistic regression analysis, Major findings are as follows. Firstly, for family history, case groups who have family history were significantly higher than control group(X2=1.67, p<.05). Secondly, case group who have hypertension were significantly higher than control group(X2=2.96, p<.05). Thirdly, for gender, men were significantly higher 3.12 times than women in risk factor of esophageal cancer(OR=3.12, 95% Cl=1.57-8.64). Fourthly, through the logisticregression, it were statistically associated factors with esophageal cancer in subjects who were abdominal obesity, diabetes mellitus, current smoking(p<.05). Based on this study, for effective prevention of the esophageal cancer, it is required to education and screening examination. 본 연구는 국내 일부지역의 식도암 발생 위험요인과 관련된 요인을 규명하기 위해 수행하였다. 자료는 2015년 12월 1일부터 2016년 1월 31일까지 서울지역에 소재한 종합병원 내과에 내원한 환자군 76명, 대조군 76명을 대상으로 시행하였다. 연구대상자의 일반적인 특성과 의료행태와 관련된 요인은 Chi-square test를 시행하였다. 식도암 위험요인간의 교치비를 구하기 위해 multiple logistic regression analysis를 사용하였다. 연구결과는 다음과 같다. 첫째, 가족력을 보면 가족력이 있는 경우 환자군이 60.6%로 대조군의 39.4% 보다 유의하게 높게 나타났다(X2=1.67, p<.05). 둘째, 고혈압여부는 고혈압이 있는 경우 환자군은 67.3% 대조군은 32.7%로 환자군이 대조군보다 유의하게 높은 분포를 보였다(X2=2.96, p<.05). 셋째, 성별은 여성에 비해 남성에서 식도암의 위험요인이 4.28배 유의하게 높게 나타났다(OR=3.12, 95% Cl=1.57-8.64) 넷째, 남성, 현재흡연을 할수록, 당뇨병과 복부비만이 있는 경우 식도암 위험요인이 유의하게 나타났다(p<.05). 이러한 결과를 토대로 식도암의 효과적인 예방은 교육 및 검진이 요구된다고 본다.

초음파 결합형 압통계를 활용한 압통시 소화불량 환자와 건강인의 복강내 조직 변화 비교: 비무작위 대조군 예비 임상시험

임진웅,정태성,정호석,강선이,최창민,김동웅 대한예방한의학회 2023 대한예방한의학회지 Vol.27 No.1

Objectives : The aim of this study was to evaluate the differences in the abdominal cavity between functional dyspepsia patients and healthy people using an algometer combined with an ultrasound device. Methods : A non-randomized, controlled, pilot trial was conducted. Thirty patients in the experimental group and fifteen participants in the control group were recruited. We collected demographical data, and measured abdominal circumference, height of the body cavity, subcutaneous fat thickness, visual analogue scale of dyspepsia symptoms in the experimental group, depth of algometer and pressure of algometer when pressure pain occurred, and the whole ultrasonic image from the beginning of pressurization to the time when pressure pain occurred. The measurements were carried out twice with the duration of 1 week. Generalized linear regression was conducted to adjust baseline characteristics. Results : A total of 45 participants (30 in experimental group, 15 in control group) were recruited and finished the trial. Females were recruited more in the experimental group than in the control group and it was statistically significant. The difference in thickness of abdominal cavity between a second before the pressure pain and at the time when pressure pain occurred was statistically significant on 1st visit, and other measurements were not statistically significant. From the results of the regression analysis, the difference between two groups was statistically significant in the differences in the thickness of stomach and up to abdominal aorta on 1st visit, and the thickness of stomach on 2nd visit, and other measurements were not statistically different. Conclusions : According to the results, there were not statistically significant differences in abdominal examination when pressure pain occurred between dyspepsia patients and healthy people. Further studies are warranted to assess the abdominal examination using devices including algometer and ultrasound devices, regarding the results of the present study.

비외상성 복통을 주소로 응급의료센터에 내원한 젊은 여성 환자의 급성 복증 감별에 있어서 이학적 및 검사실 인자들에 대한 다변량 분석

이창재,정태녕,임득호,진수근,김옥준,최성욱,김의중,조윤경 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.6

Purpose: One of the most challenging groups of patients to diagnose that visit an emergency department (ED) is the female with acute abdominal pain. The causes of acute abdominal pain range from minor, self-limiting conditions to life-threatening disorders. Differential diagnosis for these patients is extensive and frequently requires multiple examinations and tests. This study analyzed the effectiveness of surgical abdomen detection using various physical examination and clinical laboratory methods, for young women reporting non-traumatic abdominal pain. Methods: This study reviewed computed tomography (CT)reports for 232 women, aged 21~35 years old, who visited our ED for nontraumatic abdominal pain from July 2009 to June 2010. Bivariate analyses relating physical and laboratory methods used to detect surgical abdomen were conducted. A multivariate logistic regression model was then derived,with all variables in the final model significant at p<0.05. Results: The number of patients who required surgical intervention was 88, while the number who did not require surgery was 144. Significant predictive methods for identifying surgical abdomen were maximal tenderness site (p=0.019), rebound tenderness (p=0.037), white blood cell count (p=0.012) and urine blood (p=0.037). The bootstrap result was identical in 1000 samples with a 95% confidence interval. Conclusion: Maximal tenderness site, rebound tenderness,and results indicating leukocytosis and hematuria were found to be independently valid factors for detection of surgical abdomen in young women evaluated in our ED due for nontraumatic abdominal pain.

한의 복진 정량화 연구 - 기능성 소화불량 환자의 복냉 진단을 중심으로 -

이재홍,조수호,고석재,김진성,박재우,Lee, Jae-hong,Cho, Soo-ho,Ko, Seok-jae,Kim, Jin-sung,Park, Jae-woo 대한한방내과학회 2018 大韓韓方內科學會誌 Vol.39 No.4

Objective: This study was designed to investigate the possibility of quantification of the diagnosis of abdominal coldness (AC) in patients with functional dyspepsia (FD). Methods: Forty-four patients with FD were enrolled in this study. Three Korean medicine doctors each randomly examined all abdomens. Diagnosis of AC was made by consensus of at least two of the doctors. Body temperature (oral by digital oral thermometer) and skin temperature (by digital infrared thermal imaging [DITI]) were measured, followed by administration of the Cold and Heat questionnaire (CHQ) and the Instrument of Pattern Identification for Functional Dyspepsia (IPIFD). Results: Of the 44 patients with FD, 22 were assigned to the AC group and 22 to the non-AC group. The concordance rate of diagnosis among the three doctors was 63.6% (28/44), with a ${\kappa}$ of 0.504, indicating means moderate agreement). Neither the oral nor the skin temperatures showed statistically significant differences between the AC and non-AC groups. However, the CHQ scores and 'Simultaneous Occurrence of Cold and Heat Syndromes pattern' scores of the IPIFD were higher in AC group and showed statistically significant differences (p=0.010 and 0.009). Conclusions: This is the first study conducting quantitative measurements of abdominal coldness in patients with FD. Although oral and skin temperature showed no statistical significance between AC and non-AC groups, the concordance rate of diagnosis of AC among the three Korean Medicine doctors was moderate. The CHQ scores and 'Simultaneous Occurrence of Cold and Heat Syndromes pattern' scores of the IPIFD also suggest that diagnosis of AC is relevant to cold and heat patterns, and these questionnaires could be utilized as supportive data for the diagnosis of AC. Further studies should be conducted for the purpose of quantifying and standardizing abdominal examinations in Korean Medicine.

한의 복합치료로 호전된 불응성 위식도역류질환 (PPI-refractory GERD) 환자 1례 - 복진소견 평가를 중심으로 -

이재홍,조수호,고석재,박재우,Lee, Jae-hong,Cho, Soo-ho,Ko, Seok-jae,Park, Jae-woo 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.5

This case report describes a 60-year-old man who had reflux symptoms despite treatment with proton pump inhibitors (PPIs). Korean traditional medicine, including a herbal prescription, acupuncture, and moxibustion was administered to the patient during his 19 days of hospitalization. The visual analogue scale (VAS), gastrointestinal scale (GIS), and gastrointestinal symptom rating scale (GSRS) scores were assessed on the dates of admission and discharge. An abdominal examination, which is one of the Korean medicine diagnostic tools, was performed every day to evaluate the treatment progress. During the treatment, the improvement of symptoms was clinically correlated with abdominal examination outcomes. We suggest that administration of traditional Korean Medicine on PPI-refractory GERD patients could be effective and we recommend utilization of the abdominal examination as an assessment tool for Korean Medicine treatment.

Development of a patient-report pressure algometer for the quantification of abdominal examination

고석재,Keun Ho Kim,Sanghun Lee,임미홍,박재우 한국한의학연구원 2021 Integrative Medicine Research Vol.10 No.4

Background Abdominal examination (AE), one of the primary diagnostic tools used in traditional Korean medicine (TKM), has a limitation of being subjective due to depending on individual practitioner's experience. Therefore, we devised a novel patient-report pressure algometer (PA) and performed a clinical trial to investigate its validity. Methods In total, 44 participants with functional dyspepsia and 44 healthy participants completed the study. The participants were allocated into one of two groups according to the existence of abdominal stiffness at 5 acupoints or abdominal tenderness at 12 acupoints diagnosed by TKM doctors. The pressure depth and pressure pain threshold (PPT) were evaluated using the PA at the same acupoints. We assessed the validity (sensitivity and specificity) of PA and calculated the area under the curve (AUC) and optimal cutoff value of the test variables (pressure depth and PPT) to criterion standards (abdominal stiffness and tenderness). Results Pressure depth and PPT assessed by PA showed high sensitivity and specificity in diagnosing abdominal stiffness and tenderness. The validity at CV-14 of diagnosing abdominal tenderness with PPT by PA had a sensitivity of 73.1%, specificity of 77.8%, and an AUC of 0.807 with a P value of < 0.001. Conclusion This study may provide evidence of standardization and quantification of AE through PA.

건강검진에서 지방간 진단의 상복부초음파검사와 간 Hounsfield Units 측정값과의 정확성 분석

오왕균(Wang Kyun Oh),김상현(Sang Hyun Kim) 대한방사선과학회(구 대한방사선기술학회) 2017 방사선기술과학 Vol.40 No.2

상복부초음파검사에서 간실질의 에코 음영증가와 불명확한 혈관경계 등으로 지방간을 진단하는데, 여러 연구들에 의하면 지방간 진단에 84∼95%의 특이도와 60∼90%의 민감도를 가지나 결과가 검사자에 의존적이어서 차이가 있을 수 있고 지방의 침윤 상태의 정량적인 측정이 불가능하다. 건강검진의 상복부초음파검사와 흉부 전산화단층촬영(computed tomography; CT) 검사를 같은 날에 시행한 수검자중 초음파검사에서 지방간을 진단 받은 환자의 흉부 전산화단층촬영 영상에서 간(Liver) Hounsfield Units(HU)를 측정하여 지방간 진단의 정확성을 연관분석 하고자 하였다. 연구대상 수검자 720명 중 가정의학과 전문의에게 검사를 받고 지방간 판정을 받은 자는 448명으로 62.2%였다. 지방간 판정자의 CT영상에서 간 HU를 측정한 결과 40 HU 이하의 측정값은 720명 중 175명으로 24.3%이며, 초음파에서 진단 받은 448명에 175명 중 173명이 포함되어 98.9%가 일치하였다. 이는 지방간을 초음파로 진단 시 검사자의 주관적 경험과 능력이 병변을 진단하는데 크게 영향을 미친 것으로 생각되며 검진 CT검사에서 간 HU를 측정하여 40 HU 이하는 영상저장을 통하여 지방간 진단 시 참고자료로 활용될 수 있을 것으로 사료된다. In abdominal Ultrasonography, the fatty liver is diagnosed through hepatic parenchymal echo increased parenchymal density and unclear blood vessel boundary, and according to many studies, abdominal Ultrasonography has 60∼90% of sensitivity and 84∼95% of specificity in diagnosis of fatty liver, but the result of Ultrasonography is dependent on operators, so there can be difference among operators, and quantitative measurement of fatty infiltration is impossible. Among examinees who same day received abdominal Ultrasonography and chest computed tomography (CT), patients who were diagnosed with a fatty liver in the Ultrasonography were measured with liver Hounsfield Units (HU) of chest CT imaging to analyze the accuracy of the fatty liver diagnosis. Among 720 subject examinees, those who were diagnosed with a fatty liver through abdominal Ultrasonography by family physicians were 448, which is 62.2%. The result of Liver HU measurement in the chest CT imaging of those who were diagnosed with a fatty liver showed that 175 out of 720 had the measured value of less than 40 HU, which is 24.3%, and 173 were included to the 175 among 448 who were diagnosed through Ultrasonography, so 98.9% corresponded. This indicates that the operators subjective ability has a great impact on diagnosis of lesion in Ultrasonography diagnosis of a fatty liver, and that in check up chest CT, under 40 HU in the measurement of Liver HU can be used for reference materials in diagnosis of a fatty liver.