성인 만성 아토피 피부염 환자의 삶의 질과 한방 치료비용에 대한 고찰

김남권,오용열,서은성,이동효,Kim, Nam-Kwen,Oh, Yong-Leol,Seo, Eun-Sung,Lee, Dong-Hyo 대한한방안이비인후피부과학회 2010 한방안이비인후피부과학회지 Vol.23 No.1

Objective : The aim of this study is to assess the impact of chronic atopic dermatitis (AD) on quality of life (QoL) as well as the economic burden associated with oriental medical treatment on adult patients with chronic AD in Korea. Methods : The EQ-5D health states, existence and duration of AD in the 2007 National Health and Nutrition Examination Survey (NHANES) were used to obtain the study subjects. A questionnaire including the questions on direct medical and direct non-medical costs associated with oriental medical treatment for adult patients with AD was specifically designed. Twenty-nine, members of the Korean Oriental Medical Ophthalmology, Otolaryngology and Dermatology Society (KOMOODS), completed the questionnaires. Results : The incidence of AD was around 3.09% in 2007 NHANES (sample survey, n=2981). Three months and above in duration of disease was 1.35%. The QoL data revealed as follows: 0.932 in non-chronic AD, 0.916 in chronic AD, and 0.908 in non-AD. We also stratified our analysis by age. The QoL data in 40's was statistically significant (P<0.023). But, no significant differences were reported in 20's, 30's, and 50's. The total direct medical costs of oriental medical treatment for AD was about 2,560,717 Won, and total direct non-medical costs was about 605,125 Won in a year. Conclusions : This study might be applied to find the evidence of economic evaluation in oriental medicine for AD. More rigorous studies are warranted.

乾癬에 對한 東.西醫 文獻的 硏究

김남권,황충연,임규상,Kim, Nam-Kwen,Hwang, Chung-yeon,Lim, Gye-sang 대한한방안이비인후피부과학회 1999 한방안이비인후피부과학회지 Vol.12 No.1

Psoriasis is the recurrent disease of skin and till now its mechanism, pathogenesis and treatment are not clearly discovered. So, like these papers, we must investigate more safety and effective treatment of psoriasis. And I obtained the following condusions from the Oriental and Occidental bibliographic investigation. 1. In Oriental medicine. Baikbi, Pungsun, Eunselbyong, Songpisun, Baikselpung were the other names of Psoriasis. 2. In Occidental medicine, genetic factors, aggravation and inducible factors, biochemical factors, immunologic factors, disorder of epidermal kinetics, vascular malformation of dermis were cosidered to the pathogenic factors of psoriasis. 3. In Oriental medicine, the pathogenic factors of psoriasis were divided two parts. One is exogenous pathogenic factors which including the blood-heat, blood dryness, blood stasis, deficiency of liver and kidney, inharmony of impulsive and appointed pulsation, deficiency of blood. The other is exogenous pathogenic factors which including the wind-evil, wind-wetness, wind-heat, wind-cold, wetness-heat, cold-wetness, heat-evil. 4. In Occidental medicine, external applicative medicine, internal medicine, ultraviolet therapy, ultraviolet - external applicative medicine compound therapy and etc. were used the therapy of psoriasis. 5. In Oriental medicine, clean away heat and cooling blood, aliment the blood and moisturize, activating blood and expelling blood stasis, harmonize and invigorate the liver and kidney, invigorate the kidney, aliment the blood and moisturize the skin, aliment the blood and expelling the wind, expelling the wind and wetness, clean away heat and expelling wind, expelling the wind and scatter the cold, clean away heat and expelling the wetness, heat up the meridian and scatter the cold, clean away heat and remove the toxin and etc. were used the method of internal therapy of psoriasis. 6. Until Qing dynasty, wind expelling effective prescriptions like Bangpungtongsungsan, Sopungsan. Supungsunkisan and etc. were used and recently Yanghyelgeupungtang, Hwalhyelgeupungtang, Samultanggagam and etc. were used the internal therapy of psoriasis. 7. In the external therapy of psoriasis, Yuhonggo, Pungyugo, Sekryupiyeongo were used the plaster therapy and Folium Rerillae, Camphora, Fructus, Xanthii, Herba Spirodelae compound prescription were used the cleansing therapy, Okgisan, Chiunsan, Galmyogo, Hobunsan, Muisan, Madugo, Jeyugohengin were used the rubbing skin therapy. Rangdok Radix Aconiti, Bijeonilchoalkwang were used the attaching therapy, the extract of Rhizoma Et Radix Veratri was used the spreading pouder therapy. 8. In the acupuncture therapy of psoriasis, the Jelgol, chok Samni(S36), Kansa(P5), Haegye(S41), Wijung(B40) and etc. were used the acupuncture point, and the angle of helix incision threapy that disinfect and cut the angle of helix and plaster the Semen Glycine and Squama Manitis were used.

이명증에 대한 보중익기탕과 반하백출천마탕의 비용효과 분석 연구

김남권,오용열,서은성,이동효,Kim, Nam-Kwen,Oh, Yong-Leol,Seo, Eun-Sung,Lee, Dong-Hyo 대한한방안이비인후피부과학회 2010 한방안이비인후피부과학회지 Vol.23 No.1

Background : Bojungikgitang(BJT) and Banhabaekchulchonmatang(BBT) are known to treat the tinnitus patients, which were registered Korean National Health Insurance coverage lists. Objective : Few studies have evaluated economic benefits of both herbal medicines. This research is to investigate the cost-effectiveness of Bojungikgitang(BJT) and Banhabaekchulchonmatang(BBT) in chronic tinnitus patients over nineteen years old. Method : We built the decision tree model of chronic tinnitus and executed the deterministic analysis and threshold sensitivity analysis based on randomized clinical trial. Effectiveness was measured in quality-adjusted life-years(QALYs), and costs were in 2009 KRW(South Korean Currency). The perspective is societal, time horizon is 10 weeks, and Korean willingness to pay threshold is assumed to 20,000,000KRW. Results : In the base case analysis, BJT treatment resulted is better outcomes as low cost, so BJT is dominant medicine and BBT is dominated. But both cost per QALYs (BJT is 3,120,339KWN per QALY, BBT is 3,505,780KWN per QALY) are lower than the threshold, that could be covered by Korean National Health Insurance(KNHI). Conclusion : This study results showed that BJT was more cost-effective than BBT treating tinnitus patients for 10 weeks, and the cost per QALYs of both alternatives were lower than Korean national threshold.

口眼와斜의 原因과 男左女右에 對한 文獻的 硏究

김남권,황충연,임규상,Kim, Nam-Kwen,Hwang, Chung-Yeon,Lim, Gyu-Sang 대한한방안이비인후피부과학회 1996 한방안이비인후피부과학회지 Vol.9 No.1

龍膽瀉肝湯의 抗바이러스 活性 및 免疫反應에 對한 實驗的 考察

김남권,김종한,임규상,황충연,Kim, Nam-Kwen,Kim, Jong-han,Lim, Gyu-sang,Hwang, Choong-yeon 대한한방안이비인후피부과학회 1998 한방안이비인후피부과학회지 Vol.11 No.1

During the last few years, nitric oxide(NO) as a potent macrophage-derived effector molecule against a variety of bacteria, parasites, and tumors has received increasing attention. More recent studies suggest that NO also has antiviral effects in both murine and human cells. The objective of the current study was to determine the effect of Yongdamsagantang(YST) on the production of NO. Stimulation of mouse peritoneal macrophages with YST after the treatment of recombinant $interferon-{\gammer}(rlFN-{\gammer})$ resulted in the increased NO synthesis. YST had no effect on NO synthesis by itself. When YST was used in combination with $rIFN-{\gammer}$, there was a marked cooperative induction of NO synthesis in a dose-dependent manner. The optimal effect of YST on NO synthesis was shown 6 hour after treatment with $rIFN-{\gammer}$. This increase in NO synthesis was reflected as increased amount of inducible NO synthase(iNOS) protein. NO production was inhibited by $N^G-monomethyl-L-arginine$. The increased production of NO from $rIFN-{\gammer}$ plus YST-stimulated cells was decreased by the treatment with staurosporin. In addition, synergy between $rIFN-{\gammer}$ and YST was mainly dependent on YST-induced tumor necrosis $factor-{\alpha}(TNF-{\alpha})$ secretion. These results suggest that the capacity of YST to increase NO production from $rIFN-{\alpha}-primed$ mouse peritoneal macrophages is the result of YST-induced $TNF-{\alpha}$ secretion.

알레르기성 鼻炎 患者에 對한 臨床的 考察

김남권,임규상,황충연,Kim, Nam-Kwen,Lim, Gyu-Sang,Hwang, Choong-Yeon 대한한방안이비인후피부과학회 1997 한방안이비인후피부과학회지 Vol.10 No.1

The author analyzed 46 cases of allergic rhinitis patients, who were treated in the Kwang-ju Oriental Medical Hospital of Wonkwang University from January 1997 to April 1996. I've examined the 46 cases in the view of age and sex distribution, seasonal distribution, distribution of the job, duration of the disease, past history, family history, distribution of complicated signs, the degree of recovery about the total patient, the relationship of the ages and the remedial value, the relationship of the duration of disease and the remedial value. The following results are obtained. 1. The ratio of under teenagers was $32.61\%$(15 cases), teenagers was $30.43\%$(11 cases), 2th decade was $17.39\%$(8 cases), 3th decade was $17.39\%$(8 cases), 4th decade was $4.35\%$(2 cases), 5th decade was $2.17\%$(1 case), over sixty was $2.17\%$(1 case). 2. The ratio of the male was $58.70\%$(27 cases) and femal was $41.30\%$(19 cases). 3. The ratio of spring was $21.74\%$(10 cases), summer was $8.70\%$(4 cases), fall was $43.48\%$(20 cases), winter was $43.48\%$(20 cases) and unknown was $10.87\%$(5 cases). 4. The ratio of the students was $45.65\%$(21 cases), house-wives was $15.22\%$(7 cases), office men was $10.87\%$(5 cases), farmers was $4.35\%$(2 cases), driver was $2.17\%$(1 case) and unemployed was $21.74\%$(10 cases). 5. The ratio of the under six months was $8.70\%$(4 cases), under 1 year was $17.39\%$(8 cases), under 3 years was $32.60\%$(15 cases), over 3 years was $41.31\%$(19 cases). 6. The ratio of atopic dermatitis was $32.61\%$(15 cases), allergic dermatitis was $21,74\%$(10 cases), the asthma was $17.39\%$(8 cases), digestion disorder was $6.52\%$(3 cases) and etc. 7. The ratio of paternal line was $21.74\%$(10 cases), maternal line was $13.04\%$(6 cases), paternal and maternal lines was $4.35\%$(2 cases), brother or sisters was $13.04\%$(6 cases) and non-significant was $47.83\%$(22 cases). 8. The ratio of sneezing was $100\%$(46 cases) , nasal discharge was $100\%$(46 cases), nasal obstruction was $86.96\%$(40 cases), pruritus was $45.65\%$(21 cases), headache was $13.04\%$(6 cases), asthma was $10.87\%$(5 cases), digestion disorder was $6.52\%$(3 cases), light phovia was $6.52\%$(3 cases), tears was $4.35\%$(2 cases), nosebreeding was $2.17\%$(1 case). 9. The total remedial value of the 46 patients was revealed $52.17\%$. 10. The remedial value of under teenagers, teenagers were higher than the total remedial value($52.17\%$). 11. The remedial value of under 6 months, under 1 year were higher than the total remedial value($52.17\%$). These results demonstrated that in the point of remedial view, the patients who were younger and shorter of the duration of disease, would be well recovered.

통년성 알레르기 비염의 변증 도구 개발을 위한 전문가 집단 설문조사 연구

김남권,이동효,최인화,고성규,Kim, Nam-Kwen,Lee, Dong-Hyo,Choi, In-Hwa,Ko, Seong-Gyu 대한한방안이비인후피부과학회 2013 한방안이비인후피부과학회지 Vol.26 No.2

Background : According to the rising cases of clinical researches with Traditional Korean Medicine for persistent allergic rhinitis patients, the need for developing and applying Pattern diagnosis instrument has been increasing. Objective : This study was done to investigate and pragmatize the Pattern diagnosis instrument for persistent allergic rhinitis patients launched by KFDA in 2008. Methods : Data was collected by structured survey papers from Korean Medicine doctors participate in the Conference of The Korean Oriental Medical Ophthalmology & Otolaryngology & Dermatology Society in October 2012. We investigated their representative Patterns(변증) of every questions and used the mean results for assuming agreement rates. The importance order of 8 symptom domains for considering Pattern diagnostic steps were also asked and analyzed for inducing importance rates. Finally based on above two results, we developed weight points of each questions by multiplying agrement percents with importance rates. Results : 50 Korean medicine doctors described the informed consent and survey papers. Response agreement rates of each questions of Pattern diagnosis instruments were analyzed and described in Table 2. Comparing the survey results with diagnostic references, matched percent of 肺胃熱 was the 87.9%, 肺氣虛寒 was 62.5%, 肺脾氣虛 was 62.5% and 腎元虧虛 was 50%. Mean importance rates of rhinorrhea was 7.28, otoscope diagnosis 5.12, obstruction 5.04, sneeze 4.82, symptom duration 4.63, other body condition 3.54, tongue diagnosis 3.02, nasal pruritus 2.86, accordingly. Final importance rates of each questions were assumed, and the range of them was from 1.60 to 4.72, which were listed in Table 5. Conclusion : These results might provide the rational backgrounds and practical methods for developing and utilizing methods of Pattern diagnosis questionnaire for perennial allergic rhinitis.

통년성 알레르기 비염의 표준 치료 모델 개발 : 실용임상연구 프로토콜 개발을 위한 기초 연구

김남권,이동효,서은성,최은지,장보형,최인화,고성규,Kim, Nam-Kwen,Lee, Dong-Hyo,Seo, Eun-Sung,Choi, Eun-Ji,Jang, Bo-Hyeong,Choi, In-Hwa,Ko, Seong-Gyu 대한예방한의학회 2013 대한예방한의학회지 Vol.17 No.3

Objective : This study was done to define the treatment protocol of Traditional Korean Medicine for persistent allergic rhinitis, which might be necessary for conducting PRCT study. Methods : Data were collected by questionnaire from Korean Medicine doctors participated in the Conference of The Korean Oriental Medical Ophthalmology & Otolaryngology & Dermatology Society in October 2012. We investigated their treatment procedures for persistent allergic rhinitis in ordinary clinical settings. Their treatment patterns including annual treatment period, frequencies and treatment times were also investigated. Finally, we combined the national insurance covered or out-of-pocket treatments as treatment packages according to the response rates of each contents, and displayed them as treatment protocols for PRCT study. Results : 50 Korean medicine doctors described the informed consent and questionnaire. Response rates of each treatment procedure were listed in Table 2 to Table 5. Treatment periods, frequencies and treatment time of each visit were listed in Table 6. Finally, treatment packages which would be defined for PRCT were listed in Table 7 as treatment package 1(response rates were over 50%), package 2(response rates were over 25%), package 3(response rates were over10%). Conclusion : These results provide the rational background and preliminary sources of defining treatment packages for developing PRCT protocols.

升麻葛根湯加味方이 마우스의 抗 ALLERGY 및 免疫反應에 미치는 影響

김남권,황충연,임규상,Kim, Nam-Kwen,Hwang, Chung-Yeon,Lim, Gyu-Sang 대한한방안이비인후피부과학회 1995 한방안이비인후피부과학회지 Vol.8 No.1

Seungmagalgeuntang-gamibang has long been known to have anti-allergic effect. However, the mechanism of action of Seungmagalgeuntang-gamibang is not well investigated. The author analysed the effects of Seungmagalgeuntang-gamibang on the vascular permeability, delayed-type and contact hypersensitivities, and phagocytic function, the results obtained are as follows: 1. Administration of Seungmagalgeungtang-gamibang decreased the vascular permeability induced by serotonin in the mouse. 2. Administration of Seungmagalgeuntang-gamibang decreased the vascular permeability induced by histamine without statistical significant. 3. Administration of Seungmagalgeuntang-gamibang decreased the delayed-type hypersensitivity induced by sheep red blood cells. 4. Administration of Seungmagalgeungtang-gamibang decreased the contact hypersensitivity induced by dinitrochlorobenzene. 5. Seungmagalgeungtang-gamibang increased the phagocytic-activities of macrophages in vitro and in vivo. 6. Seungmagalgeungtang-gamibang enhanced the formation of reactive oxygen intermediates in vitro and in vivo. The above results demonstrate that Seungmagalgeuntang-gamibang suppresses the hypersensitivity reactions with increasing the phagocytic functions and formations of reactive oxygen intermediates from macrophages.

뇌졸중 환자의 기대여명과 삶의 질, QALY에 대한 연구

김남권,이동효,조가원,서은성,Kim, Nam-Kwen,Lee, Dong-Hyo,Jo, Ga-Won,Seo, Eun-Sung 대한예방한의학회 2012 대한예방한의학회지 Vol.16 No.3

Objective : Only a few studies have investigated the life expectance and health related quality of life (HRQOL) about stroke patients. The purpose of this study is to analyze the life expectancy, preference based quality of life(QOL) and quality adjusted life years(QALYs) of stroke patients. Methods : We used data of 10,533 adults from 4th Korean national health and nutritional examination survey 2009 for evaluating HRQOL of stroke patients. We also analyzed the life expectancy for stroke patients using life table from national public health data. Finally we calculated the QALYs with and without stroke conditions and assumed the difference of QALYs. Results : The mean age of stroke patients was assumed to be 65. Lower income and less educated groups were prone to be exposed to the stroke conditions. Common comorbidities of stroke patients were ischemic heart attack, hypertension, diabetes and hyperlipidemia. The proportions of participants who reported problems in each of the five EQ-5D dimensions increased significantly at chronic stroke group. Participants with chronic stroke conditions had an almost 6-fold higher risk of impaired health utility(the lowest quartile of EQ-5D utility score) compared with non stroke participants, after adjustment of age, gender, income, education, comorbidity variables. The differences of life expectancy and QALYs between non-stroke and stroke group from the age of 65 till death were assumed to be 0.767 year and 3.103 QALYs. Conclusions : Although the authors analyzed the affecting factors of QOL and assumed the differences of life expectance and QALYs about stroke patients using domestic national data and statistic references, well designed cohort studies should be needed to prove the causal effects of affecting factors and to assume more correct QALY differences.