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1 한방안이비인후피부과학회지제 28 권제 3 호 (2015 년 8 월 ) J Korean Med Ophthalmol Otolaryngol Dermatol 2015;28(3): pissn eissn Case Report / 증례한약과압출치료에병행한황련해독탕약침의여드름치료 22례임상보고 김혜윤 1) 홍석훈 2) 박인해 2) 신선호 3) 권영미 4) 1) 전주피브로한의원 2) 원광대학교한의과대학안비인후피부과학교실 3) 원광대학교한의과대학내과학교실 4) 원광대학교한의과대학진단방사선과학교실 Twenty-two Case of Acne Treated by Hwangryunhaedok-tang Pharmacopuncture Therapy Combined with Herbal Medicine and Extrusion Hye-Yoon Kim 1) Seok-Hoon Hong 2) In-Hae Park 2) Sun-Ho Shin 3) Young-Mi Kwon 4) 1) Jeonju Pibro Korean Medicine Clinic 2) Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Won-kwang University 3) Department of Internal Medicine of Korean Medicine, College of Korean Medicine, Won-kwang University 4) Department of Diagnostic Radiology, College of Korean Medicine, Won-kwang University Abstract Objectives : The objective of this study was to evaluate the effect of Herbal medicine, extrusion and Hwangryunhaedok-tang Pharmacopuncture therapy for treating Sil-Yol(Excess heat) type acne. Methods : Total of 22 patients with Sil-Yol(Excess heat) type acne were treated with the Herbal medicine(chungsangbangpoong-tang, Yangkyuksanwha-tang, Hwalhyeolsano-tang, Galgeunhaegi-tang, Daeshihotang) and weekly Hwangryunhaedok-tang Pharmacopuncture & extrusion therpay. By the standardized photography before and after treatment, KASG and survey for patient`s satisfaction, we checked effect of Herbal medicine and Hwangryunhaedok-tang Pharmacopuncture therapy for treating acne. c 2015 the Society of Korean Medicine Ophthalmology & Otolaryngology & Dermatology This is an Open Access journal distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 114
2 김혜윤외 4 인 : 한약과압출치료에병행한황련해독탕약침의여드름치료 22 례임상보고 Results : 1. In 22 patients who underwent the Herbal medicine, extrusion and Hwangryunhaedok-tang Pharmacopuncture therapy, there was an significant improvement in KASG. Mean value of KAGS before treatment is 3.59±0.80, mean value of KAGS after treatment is 1.95± The responses to the survey for satisfaction revealed that 5 patients were very satisfied with their outcomes, 11 patients were satisfied, 5 patients were somewhat satisfied, 1 patient was dissatisfied. Conclusion : In Korean medicine, Herbal medicine and Hwangryunhaedok-tang Pharmacopuncture therpay might be effective method for treating Sil-Yol(Excess heat) type acne. Key words : Acne; Pharmacopuncture; Hwangryunhaedok-tang Ⅰ. 서론 여드름은털피지샘단위 (pilosebaceous unit) 의만성염증질환으로면포, 구진, 고름물집, 결절, 거짓낭등의다양한병변이피지분비가많은부위인얼굴이나목, 등, 어깨, 가슴에호발한다 1). 여드름의형태는심상성여드름, 화농성여드름, 응괴성여드름, 켈로이드성여드름, 전격성여드름, 신생아여드름, 월경전여드름, 스테로이드성여드름이있으며 2), 심상성여드름이가장흔한형태의여드름으로서일반적인여드름을지칭한다 3). 2005년미국의통계에따르면보통여드름 ( 심상성여드름, acne vulgaris) 은피부과내원환자의약 11.3% 에해당하는가장흔한질환이다 4). 여드름중에서도특히안면부에발생하는여드름은환자에게부정적인정신사회적영향을미쳐삶의질을저하시킬수있다. 현대의학에서여드름의치료는다양한방식으로이루어지고있다. 국소치료제는국소항생제, 국소레티노이드제등이있으며등이있으며전신적인치료약제에는경구용 isotretinoin과 minocycline 등의항생제및 estrogen, glucocorticoids 등의호르몬제가있다 5). 그외여드름압출법, 피부박피술 ( 필링 ), 광선치료, 광역동치료등이여드름치료를위해사용된다 3). Corresponding author : Kim Hye-yoon, Jeonju Pibro Korean Medicine Clinic, Ongoeulro 22, Jeonju city, Jeonbuk, South Korea. (Tel : , hbyooni@hanmail.net) Recieved 2015/7/4 Revised 2015/8/2 Accepted 2015/8/9 한의학문헌에서여드름은痤瘡, 面疱, 肺風粉刺등의다양한명칭으로나타나며 6), 병인병기적측면에서肺熱血熱型, 脾胃濕熱型, 熱毒熾盛型, 血瘀痰凝型, 陰虛血熱型, 衝任不調型으로크게변증할수있다 7). 여드름치료에관한국내한의학계의선행연구중임상논문으로는淸上防風湯 8-10), 補中益氣湯 11), 黃連解毒湯 12) 13), 六味地黃湯등의내복약과面疱散 14), 古方및舍岩鍼 15), 苦蔘추출물을함유한화장수 16), 자동미세침 17), 樺皮추출물복합제화장품 18) 등을활용한외치요법의효과를보고한연구가있다. 실험논문으로는淸上防風湯 19), 升麻胃風湯 20), 魚腥草 21), 玄胡索 22), 顚倒散 23), 枇杷淸肺飮 24), 如意金黃散 25), 連翹敗毒散 26), 27) 硫黃등을이용한연구가있다. 이처럼내복약, 외용제, 침술등다양한한의학적방식을시도한여드름치료연구가보고되었으나아직약침요법을응용한여드름치료연구는없었다. 최 28) 와이 29) 의임상보고에따르면여드름을주소로내원한환자중 70% 이상이實熱型에속하였다고하였으며, 기존여드름의한의학치료와관련한연구도대부분實熱型여드름에사용되는단미재및복합처방과관련되어있다. 이에저자는여드름치료에서상당수를차지하는實熱型여드름환자에게淸熱燥濕, 淸心除煩, 瀉火解毒작용을하며, 항염효과를가지는황련해독탕약침을한약치료및압출치료와병행하여적용후유의한효과를얻었기에이를보고하는바이다. 115
3 한방안이비인후피부과학회지제 28 권제 3 호 (2015 년 8 월 ) Ⅱ. 대상및방법 1. 대상 2013년 1월부터 2013년 12월까지전주피브로한의원에여드름을주소로내원한환자중다음의조건을만족하는 22명의환자를대상으로진료기록을후향적검토하였다. 1) 내원한환자의여드름의형태, 발병일, 현병력, 유발요인, 호발부위및소화, 대소변상태, 맥진등望聞問切후 韓醫皮膚外科學 에기재된여드름변증분류 7) (Table 1) 에따라변증한결과實熱型 ( 肺熱血熱, 脾胃績熱, 熱毒熾盛 ) 으로분류되는여드름환자 2) 치료종결까지주 1회간격으로꾸준히내원한환자 3) 본임상관찰의의의와절차에대해설명하여충분히인지하고임상자료사용동의서를작성한환자 4) 여드름외질환으로한약혹은양약을복용중이거나기타치료를받았던환자를제외하였다. 2. 치료방법 1) 약물치료진찰결과에따라淸上防風湯, 凉隔散火湯, 活血散瘀湯, 葛根解肌湯, 大柴胡湯을처방하였다. 모든탕약은 20첩을 120cc씩 30포씩전탕하였고, 치료기간동안매일 1일 3회, 1회 1포씩, 식후 1시간에복용할수있도록열흘단위로처방하였다. 각처방의약물구성은아래와같으며, 1첩분량을기준으로기재하였다. 淸上防風湯, : 防風 4g, 白芷, 連翹, 桔梗, 黃芩, 川芎 3g, 荊芥, 梔子, 黃蓮, 枳殼, 薄荷 2g, 甘草 1g. 凉隔散火湯, : 生地黃, 忍冬藤, 連翹 8g, 梔子, 薄荷, 知母, 石膏, 荊芥, 防風 4g. 活血散瘀湯 : 大黃, 桃仁, 當歸尾, 赤芍藥 8g, 川芎, 蘇木 6g, 牧丹皮, 瓜蔞仁, 枳殼 4g, 檳榔 2g. 葛根解肌湯 : 葛根, 柴胡, 黃芩, 赤芍藥, 羌活, 石膏, 升麻, 白芷, 桔梗 4g, 甘草 2g, 生薑 6g, 大棗 4g. 大柴胡湯 : 柴胡 16g, 白芍藥, 黃芩 10g, 大黃 8g, 枳實 6g, 半夏 4g, 生薑 6g, 大棗 4g. 2) 압출및약침치료안면전체를보릭솜으로닦은후, 23G needle과여드름압출기를사용하여면포와고름을제거하였다. 이후황련해독탕약침 1cc를 26G needle 에 1cc담은후여드름이집중된부위에한부위당 0.1cc정도씩천자하여나누어주입하였다. 시술후스피루리나모델링 ( 세라덤 ( 주 )) 을안면부전체에도포하여피부를진정시켰다. 주 1회내원하게하여상기시술을시행하였다. 3. 평가방법 1) 임상사진및 KAGS 를통한치료효과평가치료전후촬영한임상사진및환자의상태를근거로하여동일한한의사한명이한국형여드름중증도시스템 (Korean Acne Grading System) 28) 에따라평가하였다 (Table 2). 2) 환자만족도평가치료후환자들에게설문지를통하여치료효과에대해매우만족, 만족, 보통, 불만족, 매우불만족의다섯문항으로주관적인평가를하게하였다. 4. 통계분석시술후호전유무를확인하기위해 SPSS Statistics 21.0 을이용하여조사결과를통계처리하였다. Paired-samples t-test를통해치료효과의유의성을검정하였다. 통계분석을위한유의수준은 p-value<0.05에서검정하였고측정값은평균값 ± 표준편차로나타내었다. 116
4 김혜윤외 4 인 : 한약과압출치료에병행한황련해독탕약침의여드름치료 22 례임상보고 Ⅲ. 결과 1. 성별및연령별분포여드름치료를받은총 22명의환자중남성이 2 명, 여성이 22명이었다. 연령별분포는 10-19세 11명, 20-29세 9명, 30-39세 2명으로평균연령은 21.45± 5.61세였다 (Table 3). 2. 처방분류望聞問切한변증결과에따라치료기간동안투약되는탕약처방을달리하였는데, 淸上防風湯 10명, 凉隔散火湯 4명, 活血散瘀湯 4명, 葛根解肌湯 2명, 大柴胡湯 2명순으로처방되었다. Table 1. Major Symptoms of Acne Following Each Pattern Pattern diagnosis of acne 肺熱血熱型 Lung and blood heat pattern Major Symptoms Papular acne that is smaller, painful with itching, burning and scattered around face. White head / Black head. Thin yellow tongue fur. Rapid Floating Pulse. 脾胃積熱型 Spleen and stomach heat stagnation pattern 熱毒熾盛型 Flush of fever pattern 血瘀痰凝型 Blood and phlegm stasis pattern 陰虛血熱型 Yin-deficiency blood heat pattern 衝任不調型 Disharmony of the thoroughfare and conception vessels pattern Papular acne that is painful with itching, scattered around face. Facial blushing. Get worse due to heat. Lose appetite and dyspepsia. Stomach is bloated. Constipation. Slimy yellow tongue fur. Slippery rapid pulse. Papular and purulent acne. Blushing around lesion. Pain on acne lesion. Pigmentation and hypotrophic scars occurred after pustules removed. Dry mouth and yellow tongue fur. Rapid pulse. Papular, nodular or cystic with pus. Lesion with dark color is hard, painful. Leave scars, pimples and pigmentation. Dark red tongue. Fine rapid or stringlike pulse. Mixture of new and old papular acne with dark red color. Continue for a long time after youth. Pale tongue. Slimy tongue fur. Soggy rapid pulse. Mentrual cycle effect on severity of acne. Skin symptoms become severe before mentruation. Red tongue. Slimy tongue fur. Rapid floating pulse. 117
5 한방안이비인후피부과학회지제 28 권제 3 호 (2015 년 8 월 ) Table 2. Korean Acne Grading System Grade Grade 1 papules 10 Grade 2 papules Grade 3 Grade 4 Grade 5 Grade 6 papules 31 nodules 10 Description nodules ± mild ongoing scars Table 3. Sex and Age Distribution nodules ± moderate ongoing scars nodules 31 ± severe ongoing scars ± sinus tract Age / Sex Male Female Total years old Total Table 4. Treatment Period Period(weeks) 3. 치료기간 Case Total 22 치료시작부터종결까지기간을관찰한바최단 5 주에서최장 19주까지분포하였다. 평균치료기간은 10.86±3.59주였다 (Table 4). 4. 치료효과 1) 임상사진및 KAGS 를통한치료효과평가임상사진과환자의상태를근거로동일한한의사한명이평가한 KAGS 등급을치료전후비교하였을때총 22명의환자모두등급의개선을보였다. 치료전평균 KAGS 등급은 3.59±0.80였고치료후평균 KAGS 등급은 1.95±65 로유의한호전을보였다 (p<0.001)(table 5, Fig. 1-8). 성별에따른평균 KAGS 등급은남성이치료전 4.0±0.0에서치료후 2.0±0.0으로여성이치료전 3.55±0.83에서치료후 1.95±0.69 로감소하여, 모든성별에서유의한감소를보였다 (p<0.001). 연령에따른평균 KAGS 등급은 10-19세환자군이치료전 3.64±0.67에서치료후 2.09±0.79로 세환자군이치료전 3.44±1.01에서치료후 1.78± 0.67로 30-30세환자군이치료전 4.0±0.0에서치료후 2.0±0.0으로감소하여, 모든연령대에서유의한감소를보였다 (p<0.001). 치료기간에따른평균 KAGS 등급은 1-5주치료환자군이치료전 4.0±0.0에서치료후 2.0±0.0으로 6-10주치료환자군이치료전 3.44±1.01 에서치료후 2.1±0.57로 11-15주치료환자군이치료전 3.6±0.70에서치료후 2.1±0.57로 16-20주치료환자군이치료전 4.0±0.0 에서치료후 2.5±0.70으로감소하여, 모든치료기간에서유의한감소를보였다 (p<0.001)(table 6). 2) 환자만족도평가치료종료후환자들에게치료효과에대한만족도를평가하도록설문을진행하였다. 총 22명중매우만족 5명, 만족 11명, 보통 5명, 불만족 1명, 매우불만족 0명으로각각답하였다 (Table 7). 118
6 김혜윤외 4 인 : 한약과압출치료에병행한황련해독탕약침의여드름치료 22 례임상보고 Fig. 1. Before and After Treatment Fig. 4. Before and After Treatment Fig. 2. Before and After Treatment Fig. 5. Before and After Treatment Fig. 3. Before and After Treatment Fig. 6. Before and After Treatment 119
7 한방안이비인후피부과학회지제 28 권제 3 호 (2015 년 8 월 ) Table 5. Change of KAGS Before and After Treatment Name Sex Age Treatment period KAGS (weeks) before treatment after treatment K F K M K F K F K F K F K F K F K F P F A F O F O F Y F L F L M J F J F C F C F H F H F Mean Value 10.86± ± ±65 Table 6. Mean Value of KAGS along to Sex, Age, Treatment Period Sex Age (years old) Treatment period (weeks) Mean value of KAGS Before treatment After treatment Male 4.0± ±0.0 Female 3.55± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±
8 김혜윤외 4 인 : 한약과압출치료에병행한황련해독탕약침의여드름치료 22 례임상보고 Table 7. Patient`s Satisfaction of Treatment Effect Patient`s Satisfaction Level Case Very Satisfied 5 Satisfied 11 Somewhat Satisfied 5 Dissatisfied 1 Very Dissatisfied 0 Total 22 Ⅳ. 고찰및결론여드름은털피지샘단위 (pilosebaceous unit) 의만성염증질환으로면포, 구진, 농포, 결절및낭을형성하는것을특징으로한다. 병인론적측면에서여드름은모낭벽의이상각화, 호르몬의변화와피지분비의증가및 Propionibacterium acnes 등의여러요인이작용하여발생하는것으로알려져있다 31). 현대의학의여드름치료는피지분비조절, 털집과다각질화교정, P. acnes의집락수감소와염증반응억제를기본원칙으로하며, 크게국소치료에반응이없는여드름과흉터를남길정도의중증, 고증의여드름은경구치료제투여에의한전신치료가이루어져야한다 3). 국소요법으로는약용비누, 각질용해제, Benzoyl peroxide, Retinoic anid, 국소도포용항생제, 압출요법, 부신피질호르몬의병변내주사가있으며, 전신요법으로는항생제, 레티노이드, 호르몬제, Zinc sulfate 등이사용된다 32). 그외피부박피술, 광치료, 레이저치료, 고주파치료기, 냉동치료, 전기소작술, 전기열분해술등의외과적시술법도여드름치료에응용되고있다. 한의학적인관점에서여드름은痤瘡, 面疱, 肺風粉刺등이현대적인의미의여드름과가장유사하다. 여드름의병인병기는다양한한의학문헌에기재되어있는데, 정등 33) 의보고에서여드름과관련한 17편의국내외한의학논문을분석한결과크게風熱型, 濕熱 型, 痰瘀型, 衝任不調型의 4가지변증유형으로분류한바있다. 여드름을주소로내원한환자의변증분류를보고한연구중최 28) 는 31명중약 71% 인 22명의환자가實熱型 ( 肺熱血熱, 腸胃濕熱 ) 에해당하였다고보고한바있으며, 이 29) 는 54명중약 72.2% 인 39 명의환자가實熱型 (( 肺經風熱, 脾胃濕熱 ) 에속하였다고보고하였다. 여드름치료에관한국내한의학계의임상논문으로는淸上防風湯 8-10), 補中益氣湯 11), 黃連解毒湯 12), 六 13) 味地黃湯등의내복약과面疱散 14), 古方및舍岩鍼 15), 苦蔘추출물을함유한화장수 16), 자동미세침 17), 樺皮추출물복합제화장품 18) 등을활용한외치요법의효과를보고한연구가있다. 실험논문으로는淸上防風湯 19), 升麻胃風湯 20), 魚腥草 21), 玄胡索 22), 顚倒散 23), 枇杷淸肺飮 24), 如意金黃散 25), 連翹敗毒散 26), 硫黃 27) 등을이용한연구가있다. 상기연구에사용된단미재와처방중補中益氣湯, 六味地黃湯을제외한약물은대개실증의여드름에적용가능한것이다. 이처럼여드름환자중風熱, 血熱, 濕熱등의實熱型의여드름환자가많은수를차지할것으로생각되며, 대부분의한의학적여드름치료연구도實熱型여드름에집중되어있다. 황련해독탕은 肘後備急方 34) 에처음언급되었으며, 淸火濕熱, 瀉火解毒의대표적인처방으로황금, 황련, 황백, 치자로구성되어있다. 황금이上焦의肺火를瀉하고황련이中焦의脾火를瀉하며황백이下焦의腎火를瀉하고치자가三焦의火를瀉하여소변으로出하게한다 12). 이와같은작용을통해일체의實熱火毒으로인한병증에사용될수있다. 또한현대의학적인관점에서황련해독탕은 TNF-α, PGE 2, IL-1β, IL-6 등전염증성사이토카인생성을억제시킴으로써항염작용을가지며 35-39), 혈청 IgE 농도를낮추어항알레르기 40-43) 작용을하여다양한임상분야에응용되고있다. 황련해독탕약침은경락학설의원리에의해황련해독탕구성약물을달여서나온증류액을모아냉각시 121
9 한방안이비인후피부과학회지제 28 권제 3 호 (2015 년 8 월 ) 킨후여과과정과 ph 조절과정등을거쳐고압멸균뒤사용하는데, 유관한혈위, 압통점혹은체표의촉진으로얻어진양성반응점에주입하여자침과약물작용을통하여생체의기능을조정하고병리상태를개선시키는데사용한다 44). 황련해독탕약침을응용한연구중전염증성사이토카인생성및히스타민방출억제작용과혈중 IgE 농도의강하작용을통한한포진 45), 아토피피부염 46), 장미색비강진 47), 대상포진 48) 지루성피부염 49) 등의피부질환관련연구가다수있으나, 흔한피부질환중하나인여드름에적용된예는보고된바가없었다. 이에저자는여드름이발생한부위에황련해독탕약침액을주입하여직접적인항염작용을유도하는동시에한의학적관점에서實熱火毒으로변증분류되는여드름에淸火濕熱, 瀉火解毒의치료효과를확인하고자하였다. 본연구에서는 2013년 1월부터 2013년 12월까지전주피브로한의원에여드름을주소로내원한환자중望聞問切을통하여實熱型으로분류되는여드름환자중약물치료와황련해독탕약침치료를시행한 22명의환자의진료기록을후향적으로검토하여치료효과를관찰하였다. 변증평가는 韓醫皮膚外科學 의여드름변증분류를토대로이루어졌으며, 肺熱血熱型, 脾胃積熱型, 熱毒熾盛形을實熱型여드름으로분류하였다. 肺熱血熱型, 脾胃積熱形은대개안면부의구진이少數, 散在한다. 肺熱血熱型은흔히심상성여드름으로분류되고脾胃積熱型은주사형여드름으로분류되는데, 현대사회에서는인스턴트식품, 빵, 면종류의음식을과다섭취하여脾胃積熱型환자가많은수를차지할것으로생각된다. 熱毒熾盛型은구진과농포가중심이되며농포제거후흉터를남기기쉽고舌苔黃燥, 脈數하다 7). 三焦의實火를치료하는황련해독탕은이러한제반實熱證에모두적용가능한대표적인방제이므로實熱型여드름의변증을세분화하지않고모든환자군에황련해독탕약침을사용하여치료하였다. 변증분류후風熱, 濕熱, 血熱등에적용할수있는淸上防風湯, 凉隔散火湯, 活血散瘀湯, 葛根解肌湯, 大柴胡湯을환자의제반증상에맞추어처방하였으며, 주 1회씩면포를압출한후여드름이집중된부위에황련해독탕약침을주입하였다. 치료전과치료종결후촬영한사진과환자의상태를근거로동일한한명의한의사가 KAGS 평가도구를이용해치료전후의등급을분류하였다. 또한환자가주관적으로치료효과에대한만족도를평가하게하였다. KAGS 등급을치료전후비교하였을때총 22명의환자모두등급의개선을보였다. 치료전평균 KAGS 등급은 3.59±0.80였고치료후평균 KAGS 등급은 1.95±65 로유의한호전을보였다. 또한모든성별, 연령별, 치료기간에따른평균 KAGS 등급도유의한호전을보였다. 환자의만족도평가에서는총 22명중약 72.7% 에해당하는 16명이치료효과에매우만족및만족으로답하여비교적높은만족도를보였다. 보통과불만족에각각 5명과 1명이답하였으며, 매우불만족하다고답한환자는없었다. 위와같은결과를고려할때한약치료및압출치료에병행한황련해독탕약침치료가여드름환자중다수를차지하는實熱型여드름에효과가있을것으로생각된다. 다만황련해독탕약침외다른한방치료를적용한기존의여드름증례보고와환자군의수, 총치료기간, 치료시작시점에서환자군의나이, 성별, 여드름의중증도, 변증분류등이다른관계로치료효과의직접적인비교가어려운점에서아쉬움이남는다. 또한한약및압출치료등다른병행치료의영향성을배제하지못하여황련해독탕약침단독의치료효과를확인하지못한점에서한계가있었다. 황련해독탕약침을여드름치료에보다적극적으로활용하기위하여향후대조군설정을통한실험연구및임상보고가필요할것으로사료된다. 122
10 김혜윤외 4 인 : 한약과압출치료에병행한황련해독탕약침의여드름치료 22 례임상보고 References 1. Korean Dermatological Association. Dermatology. 5th. Seoul:RMGP. 2008; Jung JY, Ha CM. Primary Care of Skin Disease. 1st. Chungbuk:MDWORLD. 2006; Joo HA. A Literature Study about Comparison of Eastern-Western Medicine on the Acne. Dept. of Korean Medicine, Graduate School of Wonkwang University, Korea. 4.Tosti A, Padova MD, Beer K. Acne Scar-Classification and treatment. Seoul:Gabon Medical Book, Inc. 2010: Cunliffe WJ, can de Kerkhof, Caputo R, Cavicchini S, Cooper A, Fyarand OL, et al. Roaccutane treatment guidelines:results of an international survey. Dermatology. 1997;194: Kim CH. The Bibliographical Studies on the Acne. The Kyung Hee University Oriental Med J. 1984;7(1): Text of Traditional Korean Dermatology & Surgery. Busan:Sunwoo. 2007; Lim JH, Oh EY, Jee SY. A Clinical Report about the Effect of Chungsangbangpungtang on Acne. J Korean Med Ophthalmol Otolaryngol Dermatol. 2003;16(2): Hwang-Bo M, Hwang SY, Cho WJ, Jee SY, Lee SK. Three Cases of Acne. J Korean Med Ophthalmol Otolaryngol Dermatol. 2006;19(3): Kim JH, Yoo DY. A Case Report of Acne Vulgaris Patient Treated with Cheongsangbangpungtang. Thesis Collention of Daejeon University, Institute of Korean Medicine. 2013;22(1): Lee JA, Hong SU. A Clinical Study about the Effect of Bojoongikki-tang on Acne. J Korean Med Ophthalmol Otolaryngol Dermatol. 2008; 21(2): Oh CS, Kim MS, Kim I, Kim HY, Park SI, Choi SI, et al. Acne Treatment Case with Hwangryeonhaedok-tang. J Korean Med Ophthalmol Otolaryngol Dermatol. 2009;22(3): Lee YS, Yoon JY, Han JK, Kim YH. A Case Study about the Effect of Yukmijihwangtang Gamibang and comedon extraction on Male Acne. Thesis Collention of Daejeon University, Institute of Korean Medicine. 2011;20(1): Kim JS, Kim GJ. The Clinical Observation of 8 Cases of Acnes Disease. J of Korean Med Ophthalmology Otolaryngology Dermatol. 2001;14(1): Kim HY, Sung EJ, Yun CS, Yun C, An MS, Kim HY, et al. One Case Report of Inflammatory Acne Treated wit the Ko-Bang and the Sa-Am Acupuncture. J Korean Med Ophthalmol Otolaryngol Dermatol. 2008;21(3): Baek SC, Jo EH, Menderel M, Park MC. Effect of Sophorae Radix-Skin Lotion on Acne. J Korean Med Ophthalmol Otolaryngol Dermatol. 2011;24(1): Seong EJ, Jo EH, Park MC. A Clinical Report on the Acne Treatment with AMTS. J Korean Med Ophthalmol Otolaryngol Dermatol. 2010;23(3): Park SY, Na CS, Jeong WC, Lee JC. A 123
11 한방안이비인후피부과학회지제 28 권제 3 호 (2015 년 8 월 ) Clinical Study for Effect of Herbal Cosmetics Containing Cortex Betulae Platyphyllae Extract Complex on Acne. J Korean Med Ophthalmol Otolaryngol Dermatol. 2013;26(3): Hong SH, Roh SS. The Study on the Effect of Chungsangbangpungtang and Lonicerae Flos, Coicis Semen(CBTLC) on Acnes. J Korean Med Ophthalmol Otolaryngol Dermatol. 2002;15(1): Seo HS. Stidoes on the Effects of Gami- Shengmayuipung-tang on Acnes. J Korean Oriental Med. 2005;26(1): Jeon OD, Seo HS. The Effects of Houttuyniae Herba Extract on the Activity of Antibacteria, Anti-inflammation and Acti-oxidation. J of Korean Institutue of Herbal- Acupuncture. 2008;11(1): Lee JR, Park SJ, Kim YW, Cho IJ, Byun SH, Kim SC. Comparison of Antimicrobial Effects of Corydalis Tuber and Processed Corydalis Tuber against Propionibacterium acnes. J Korean Med Ophthalmol Otolaryngol Dermatol. 2011;24(3): Choi KH, Seo HS. The Effects of Jeondo-san on Anti-Inflammation and Anti-Propionibacterium Acnes. J Korean Med Ophthalmol Otolaryngol Dermatol. 2007;20(2): Yim HS, Chae BY. The Experimental Study of Gagambipachungpe-Eum on Acne. J Korean Med Ophthalmol Otolaryngol Dermatol. 2000;13(1): Yoo JG, Seo HS. The Effects of Yeouigeumhwang-san on Anti-Inflammation and Anti-Propionibacterium Acnes. J Korean Med Ophthalmol Otolaryngol Dermatol. 2007;23 (2): Kim SB, Kim KJ. Effect of the Addition Temperament Drugs of Yeongyopaedock-san on Acne in the State of Inflammation. J Korean Med Ophthalmol Otolaryngol Dermatol. 2002;15(1): Lee SY, Seo HS. The Effects of Sulfur extract on Anti-Inflammation and Anti-Propionibacterium Acnes. J Korean Med Ophthalmol Otolaryngol Dermatol ;20(2): Choi IH. A Clinical Study of Recurrent Acne in the Oriental Medicine. J Korean Med Ophthalmol Otolaryngol Dermatol. 2000;13 (2): Rhee SH. The Clinical Classification as Identify of Symptoms about 54 Cases of Patients with Acne. J of Korean Med Institute of Dermatology & Aesthetics. 2005;1(1): Sung KJ, Rho YS, Choi EH, Oh JJ, Lee JH, Kim SW, et al. Korean Acne Grading System. Korean J of Dermatol. 2004;42(10): Park YK, An SK, Lee SH. Common Skin Disease. 1st. Seoul;KOMB. 1993: Kang WH. Atlas of Skin Disease. 2nd. Seoul:Hanmi Medical Publishing Co. 2006: Jeong WY, Hong EG, Shin JH, Kim YB, Nam HJ, Kim KS, et al. A Study on the Major Symptoms by Each Pattern of Acne Vulgaris. J Korean Med Ophthalmol Otolaryngol Dermatol. 2014;27(4); Gehong. ZhouhoubeiJifang. Shanghai:People`s Health Publishing. 1996: Lee JA, Ha HK, Jung DY, Lee HY, Lee JK, Huang DS, et al. Comparative Study of 25 Herbal Formulas on Anti-Inflammatory Effect. 124
12 김혜윤외 4 인 : 한약과압출치료에병행한황련해독탕약침의여드름치료 22 례임상보고 The J of Oriental Obstetrics&Gynecology. 2010;23(3): Yang HJ, Joo HA, Back SC, Park JS, Hong SH. Anti-inflammatory Effects of Hwangnyeonhaedok-tang and Fermented Hwangnyeonhaedok-tang. J Korean Med Ophthalmol Otolaryngol Dermatol. 2011;24(2): Ki HP, Jang SI, Yun YG. Ameliorative Effects of Hwangnyeonhaedok-tang on Atopic Dermatitis. J of the Korean Med Society for the Herbal Foumula Study. 2013;21(1): Kim JH, Shin HK. Analysis of Biological Experiments on the Anti-inflammatory and Antipyretic Effects of Hwangryeonhaedok-tang. The J of Korean Oriental Med. 2012;33(4): Cho JY, Kim YJ, Kim EJ, Lee SD, Kim KS. The Effects of Hwangryunhaedok-tang Pharmacopunture by the Anti-InflammatoryAction of Suppression of inos Produntion on Mice with Allergin Rhinitis. The J of Korean Acupuncture & Moxibustion Society. 2012; 29(1): Kim BA, Yang JC, Park CI. Effect of Hwangryunhaedok-tang Extracts on DNCBinduced Allergic Contact Dermatitis. Kor. J. Herbology. 2009;24(2): Lee KH, Shin YW, Kim DH. Effect of Hwangryunhaedoktang on Contact Hypersensitivity and Passive Cutaneous Hypoersensitivity in Mice. J of Applied Pharmacology. 2004;12(2): Kim HM. Antiallegy Drugs from Oriental Medicines. International J of Oriental Med. 2000;1(1): Kang YH, Kim JT, Kim SA. The Effects of Hangryunhaedocktang on Allerfic Contact Dermatitis Based on the Morphological Changes in Epidermal Damage in Mice. Korean J. Orient. Int. Med. 2004;25(3): Korean Acupuncture and Moxibustion Society. The Acupunture and Moxibustion. v3. Seoul;Jipmoon. 1994: Shin SH, Yun JM, Heo JE, Ko WS, Yoon HJ. A Case Study on Steroid Rebound Phenomenon after Steroids Treatment for Pompholy. J Korean Med Ophthalmol Otolaryngol Dermatol. 2014;27(3): Lee DJ, Kwon K, Sun SH, Seo HS. Koposi`s Varicelliform Eruption in Atopic Dermatitis Treated with Korean Medicine. J of Pharmacopuncture. 2014;17(2): Jung MY, Kim MJ, Kim DS, Park YH, Kim JH, Park SY, et al. Pityrasis Rosea: Report of 1 Case Treated by Oriental Medicine. J Korean Med Ophthalmol Otolaryngol Dermatol. 2007;20(3): Huh YS, Park SE, Kim CH, Han D. Two Cases of Herpes Zoster, treated with Hwangryunhaedoktang Herbal Acupuncture. J Korean Med Ophthalmol Otolaryngol Dermatol. 2007;20(2): Hong CH. Two cases of Seborrheic Dermatitis Treated by Hwangryunhaedok-tang Pharmacopunture Therapy. J Korean Med Ophthalmol Otolaryngol Dermatol. 2012;25(2):
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