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1 Review Article 대한침구의학회지제 32 권제 2 호 (2015 년 6 월 ) : The Acupuncture Vol. 32 No. 2 June 2015 : pissn eissn 견비통의변증에관한문헌고찰 박해인, 이광호 * 상지대학교한의과대학침구의학교실 [Abstract] A Literature Review on Pattern-identification of Shoulder Pain Hae In Park and Kwang Ho Lee * Department of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Sangji University Key words : Shoulder pain; Pattern identification; Oriental medicine; Literature review Objectives : The aim of this study is to summarise -identification of shoulder pain based on the classics of oriental medicine, current literature and domestic papers. Methods : The materials selected were sourced from the classics of oriental medicine, current literature and domestic papers which contained data related to -identification of shoulder pain. The -identifications were compared to determine the similarities, and these were classified. Results : Thirty-five studies were reviewed, and thirty-seven -identifications were collated. These were classified into the following groups: wind-cold-dampness group(n = 8), blood stasis group(n = 3), phlegm group(n = 7), dual deficiency of Qi and blood group(n = 4), deficiency cold group(n = 2), liver-kidney deficiency group(n = 1) and meridian-collateral group(n = 12). Conclusions : On the basis of the classification of -identifications, two groups of -identifications for shoulder pain were suggested. The first group included the -identification associated with a disease-cause, which included the wind-colddampness ( 風寒濕型 ), blood stasis ( 瘀血型 ), phlegm ( 痰飮型 ), Qi-blood deficiency ( 氣血兩虛型 ), deficiency cold ( 虛寒型 ), and liver-kidney deficiency ( 肝腎虧損型 ). The second included the -identification associated with the meridian-collateral, which included the hand greater Yin meridian ( 手太陰經型 ), hand Yang brightness meridian ( 手陽明經型 ), hand lesser Yin meridian ( 手少陰經型 ), hand greater Yang meridian ( 手太陽經型 ), hand reverting Yin meridian ( 手厥陰經型 ), hand lesser Yang meridian ( 手少陽經型 ), and foot greater Yang meridian ( 足太陽經型 ). Received : Revised : Accepted : On-line : Corresponding author : Department of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Sangji University, 80, Sangjidae-gil, Wonju-si, Gangwon-do, , Republic of Korea Tel : redphilips@hanmail.net This is an Open-Access article 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. The Acupuncture is the Journal of Korean Acupuncture & Moxibustion Medicine Society. ( Copyright 2014 KAMMS. Korean Acupuncture & Moxibustion Medicine Society. All rights reserved

2 The Acupuncture Vol. 32 No. 2 June 2015 Ⅰ. 서론 Ⅱ. 방법 견관절은인체에서운동범위가가장큰관절이며근육과인대로지지하고있어쉽게손상될수있는부위로 1), 肩臂痛은견관절을구성하는주위조직에나타나는肩痛과상지臂膊部에연관되어나타나는臂痛을통칭한증상명이다 2,3) 년국내에서, 견비통에해당하는어깨병변 (M75), 견갑대의관절및인대의탈구, 염좌및긴장 (S43) 이병변발생빈도가각각 4순위, 14순위로 4) 임상에서흔하게접하는증상이다. 辨證은望ㆍ聞ㆍ問ㆍ切의四診을통해환자에게서나타나는여러복잡한증상을종합분석하여八綱辨證, 臟腑辨證, 氣血津液辨證, 六淫辨證, 六經辨證, 經絡辨證, 衛氣營血辨證등으로병증을가리는한의학적진단과정으로, 변증에따라그에적합한치료원칙과방법을세워치료하므로 5,6) 변증은치료의기본단계라고할수있다. 견비통의치료는舒筋通絡, 疏通氣血, 祛風散寒化濕을원칙으로하여한약, 침, 뜸, 약침, 부항요법등의다양한방법을응용하는데 7), 이러한치료법은변증이기준이되어야하며현재한의과대학의 鍼灸醫學 7) 교과서에서는견비통에대하여風寒濕, 痰飮, 氣血不足의 3가지병인과陽明經ㆍ太陽經ㆍ少陽經ㆍ太陰經ㆍ少陰經ㆍ厥陰經의 6가지경락으로분류하고太陰經ㆍ陽明少陽經ㆍ太陽經의경락별증상을제시하고있다. 그러나견비통에관한문헌및논문을살펴보면, 병인과관련하여 Cheong et al 8) 은風寒濕痺型ㆍ氣血兩虛型ㆍ肝腎虧損型ㆍ外傷瘀血型의 4가지로분류하였고, Shin et al 9) 은項背肩痛을瘀血로변증하였으며, 경락과관련하여 Song et al 10), Lee et al 11) 은手三陰ㆍ手三陽ㆍ足太陽으로구분하였고, Hur et alo 12) 은手陽明大腸經및手太陰肺經ㆍ手陽明大腸經및手少陽三焦經ㆍ手三陽經및手太陰肺經등의혼합형을제시하는등교과서이외의변증도많았다. 이와같이교과서의변증이견비통을모두포함하기에는부족한면이있고여타문헌에서견비통의변증으로제시하는바가상이한부분이많았다. 이에저자는역대고문헌을바탕으로현대문헌, 국내의임상및문헌고찰논문을살펴견비통의변증체계를정리하고자한다. 1. 연구자료의검색및선정 Hwang et al 13) 의방식을참고하여, 견비통에대한고문헌, 현대문헌, 국내논문중자료를선정하였다. 고문헌은 중국의학사 14) 에소개된의서중의사학적가치가있는의서뿐만아니라의사학적중요도는부족하더라도筋骨과관련된雜病에대해기술한의서들과조선시대의대표적인의서를선별하였다. The Qi의歷代名著選 ( 과 DBneedle 의자료실 ( eedle.com) 에서전산화된원문자료를수집하여 肩, 臂 로내용을검색한후견비통의변증, 병인, 증상에대한내용이있는문헌을위주로선정하였으며단순히견비통의치료혈, 탕약등을나열한경우, 그리고五運六氣와관련된내용은제외하여최종선정된고문헌은 黃帝內經, 類經, 鍼灸甲乙經, 景岳全書, 醫學入門, 鍼灸大成, 醫宗金鑑, 血證論, 醫林改錯, 萬病回春, 東醫寶鑑 의 11종이었다. 현대문헌으로는현재한의과대학의침구의학교과서로쓰고있는 鍼灸醫學 7) 과한국한의학연구소에서전문과목별진단명과진단요건의표준화를목표로연구발행한 한의진단명과진단요건의표준화연구 III 15) 을자료로하였다. 마지막으로국내논문은전통의학정보포털 ( kiom.re.kr), 한국전통지식포탈 ( 과학기술학회마을 ( 국가과학기술정보센터 ( 한국학술정보 ( kstudy.com), 대한침구의학회 ( 에서 견비통, 견통, 견배통, 동결견, 오십견 으로검색수집하였다. 견비통을변증별로분류하거나관련된설명이있고치료시증례가적더라도변증이명확한논문을중심으로선정하였다. 변증없이치료만언급하거나, 변증명만나열하고그에대한설명이없거나, 증례보고및실험연구에서변증을언급하되실제로연구에는적용하지않은논문은제외하였다. 총검색된국내논문은 78편이며, 상기기준을적용하여최종선정된논문은 22편이었다. 2. 변증추출과유사변증군통합 먼저, 선정된자료 35 종에서견비통에관한문장을선별하여팔강변증, 장부변증, 기혈진액변증, 육음변증, 경락 148

3 견비통의변증에관한문헌고찰 변증등의관점에서정리하였고篇이따로있는경우는전체를수록하였다. 그다음단계로, 추출된내용에서변증명을분석하여정리하되, 변증명이없으면장부, 병인, 경락등을임시변증명으로하였고, 經筋失養攣縮痺痛 과같이변증명이두단어이상일때는대표할수있는한단어를변증명으로선택하였다. 마지막단계로, 변증명, 병기, 병인, 증상, 맥진및설진의일치하는정도를살펴유사변증군으로통합하고그증상들을정리하였다 13,16,17). Ⅲ. 결과 1. 변증과관련된내용추출 1) 黃帝內經, 類經, 鍼灸甲乙經 추출한내용이동일하여 3 개문헌을합쳐정리하였다. (1) 手太陰經과관련 經脈篇 : 肺手太陰之脈. 是主肺所生病者. 臑臂內前廉痛厥. 氣盛有餘則肩背痛. 氣虛則肩背痛寒 經筋篇 : 手太陰之筋. 其病當所過者支轉筋痛 (2) 手少陰經과관련 經脈篇 : 心手少陰之脈. 是主心所生病者. 臑臂內後廉痛厥掌中熱痛 經筋篇 : 手少陰之筋. 其病當所過者支轉筋筋痛 (3) 手太陽經과관련 經脈篇 : 小腸手太陽之脈. 是動則病嗌痛頷腫不可以顧肩似拔臑似折. 是主液所生病者耳聾目黃頰腫頸頷肩臑肘臂外後廉痛 經筋篇 : 手太陽之筋. 其病小指支肘內銳骨後廉痛循臂陰入腋下腋下痛腋後廉痛繞肩胛引頸而痛 (4) 足太陽經과관련 繆刺論篇 : 邪客於足太陽之絡令人頭項肩痛 經筋篇 : 足太陽之筋. 脊反折項筋急肩不擧腋支缺盆中紐痛不可左右搖 (5) 手陽明經과관련 經脈篇 : 大腸手陽明之脈. 是主津液所生病者. 肩前臑痛大指次指痛不用 經筋篇 : 手陽明之筋. 其病當所過者支痛及轉筋肩不擧 頸不可左右視 (6) 手厥陰經과관련 經脈篇 : 心主手厥陰心包絡之脈. 是動則病手心熱臂肘攣急 經筋篇 : 手厥陰之筋. 其病當所過者支轉筋 (7) 手少陽經과관련 經脈篇 : 三焦手少陽之脈. 是主氣所生病者. 肩臑肘臂外皆痛小指次指不用 繆刺論篇 : 邪客於手少陽之絡. 臂外廉痛手不及頭 經筋篇 : 手少陽之筋. 其病當所過者支轉筋 (8) 肺와관련 藏氣法時論篇 : 肺病者喘咳逆氣肩背痛. 五邪篇 : 邪在肺則病皮膚痛寒熱上氣喘汗出咳動肩背 (9) 心과관련藏氣法時論篇 : 心病者胸中痛脅支滿脅下痛膺背肩甲間痛兩臂內痛 (10) 脾와관련咳論篇 : 脾咳之狀咳則右脅下痛陰陰引肩背 (11) 腎과관련五邪篇 : 邪在腎則病骨痛陰痹. 陰痺者按之而不得腹脹腰痛大便難肩背頸項痛時眩 (12) 西風 ( 秋氣 ) 와관련 金匱真言論篇 : 西風生於秋病在肺俞在肩背. 秋氣者病在肩背 2) 醫學入門 (1) 脾와관련 丹溪朱先生雜病纂要 : 肝勞盡力謀慮則筋骨拘攣極則頭目昏眩. 脾勞意外過思則脹滿少食極則吐瀉肉削四肢倦怠關節肩背強痛 咳嗽 : 思傷脾咳右脅引肩背痛甚則不可以動 (2) 痰과관련 丹溪朱先生雜病纂要 : 若因飲酒乾嘔噯臂脅痛又名酒痰 雜病用藥賦 : 墜痰丸. 治心腹走注刺痛及氣痰風痰. 或肩背兩手十指麻木或氣塞胸中一切痰証神效 雜病用藥賦 : 治中脘停伏痰飲以致臂痛不能擧左右時複轉移 痛風 : 濕痰橫行手臂痛 149

4 The Acupuncture Vol. 32 No. 2 June 2015 (3) 氣血凝滯와관련雜病 : 治氣血凝滯經絡以致臂痛不擧及諸痛 (4) 食積과관련痛風 : 肩背痛因食積者單龜板為丸薑湯下 (5) 風ㆍ寒ㆍ濕ㆍ熱과관련 痛風 : 風中肩背太陽氣鬱不可回顧或肺氣鬱熱 痺風 : 上多風濕下寒濕. 大概風濕多侵乎上肩背麻木手腕硬痛 傷寒用藥賦 : 風濕腫痛勝濕表以麻杏四般羌活勝濕湯. 肩背痛不可回顧此手太陽經氣鬱不行 雜病 : 通氣防風湯. 治風濕臂痛 雜病 : 治濕熱為病肢節煩疼肩背沉重 3) 鍼灸大成 (1) 手太陰經과관련 十二經脈歌 : 手太陰肺中焦生 所生病者. 臑臂之內前廉痛. 虛氣肩背痛而寒 十二經病井榮俞經合補瀉虛實 : 手太陰肺經. 所生病. 臑臂內前廉痛掌中熱氣盛有餘則肩背痛風寒汗出中風. 虛則肩背痛寒 十二經治症主客原絡圖 : 肺之主大腸客. 肩內前廉兩乳疼 (2) 手陽明經과관련 十二經脈歌 : 陽明之脈手大腸. 所生病者. 肩前臑外痛相仍 十二經病井榮俞經合補瀉虛實 : 手陽明大腸經. 所生病. 肩前臑痛 十二經治症主客原絡圖 : 大腸主肺之客. 喉痺肩前痛莫當 十二經筋 : 手陽明之筋. 肩不擧頸不可左右視 手陽明大腸經穴歌 : 肩中熱頭不可回顧肩臂疼痛臂無力手不能回頭攣急 (3) 手少陰經과관련 十二經脈歌 : 手少陰脈. 所生臑痛目如金臂之內後廉痛 十二經病井榮俞經合補瀉虛實 : 手少陰心經. 所生病. 臑臂內後廉痛厥 十二經治症主客原絡圖 : 真心主小腸客. 臂疼兮掌發熱 (4) 手太陽經과관련 十二經脈歌 : 手太陽經小腸脈. 是動則病. 肩如技兮臑似折. 所生病主肩臑痛耳聾目黃腫腮頰肘臂之外後廉痛 十二經病井榮俞經合補瀉虛實 : 手太陽小腸經. 是動病. 肩似拔臑似折. 所生病. 頸賌肩臑肘臂外後廉痛 十二經治症主客原絡圖 : 小腸主真心客. 頰腫肩疼兩臂旁項頸強疼難轉側. 肩似拔兮臑似折. 臑肘臂外後廉痛 十二經筋 : 手太陽之筋. 循臂陰入腋下腋下痛腋後廉痛遶肩胛引頸而痛 (5) 手厥陰經과관련 十二經脈歌 : 手厥陰心主. 是動則病手心熱肘臂攣急腋下腫 十二經病井榮俞經合補瀉虛實 : 手厥陰心包絡經. 是動病. 手心熱肘臂攣痛 十二經治症主客原絡圖 : 包絡主三焦客. 包絡為病手攣急臂不能伸痛如屈 (6) 手少陽經과관련 十二經脈歌 : 手經少陽三焦脈. 生病者. 肩臑臂肘外皆疼小指次指亦如廢 十二經病井榮俞經合補瀉虛實 : 手少陽三焦經. 所生病. 耳後肩臑肘臂外皆痛 十二經治症主客原絡圖 : 三焦主包絡客. 肩背風生膊肘 (7) 足太陽經과관련 十二經筋 : 足太陽之筋. 項筋急肩不擧 繆刺論 : 邪客於足太陽之絡令人頭項肩痛 (8) 脾와관련刺欬論 : 脾欬之狀欬則右胠下痛陰陰引肩背 (9) 風, 寒濕과관련 玉龍歌楊繼洲註解 : 肩背風氣連臂疼 玉龍歌楊繼洲註解 : 肩端紅腫痛難富寒濕相爭氣血狂 (10) 痰飮과관련 治症總要 : 亦有痰飲停滯胸膈賊風串入腦戶偏正頭風發來連臂內痛成手足沉冷久而不治變為癱瘓 醫案 : 患痰火熾盛手臂難伸. 多是濕痰流注經絡之中. 以理其本則痰氣可清而手臂能舉矣 (11) 治症總要第三十九 - 四十四 第三十九手臂麻木不仁問曰 : 此症從何而得? 答曰 : 皆因寒濕相搏氣血凝滯 第四十手臂冷風痠痛問曰 : 此症從何而得? 答曰 : 寒邪之氣流入經絡夜臥涼枕竹簞漆凳冷處睡著不知風濕流入經絡 第四十一手臂紅腫疼痛 150

5 견비통의변증에관한문헌고찰 問曰 : 此症緣何而得? 答曰 : 氣血壅滯流而不散閉塞經絡不通故得此症復刺後穴 第四十二手臂紅腫, 及疽問曰 : 此症緣何而得? 答曰 : 血氣壅滯皮膚瘙癢用熱湯泡洗而傷紅腫故得此症久而不治變成手背疽 第四十三手臂拘攣, 兩手筋緊不開問曰 : 此症從何而得? 答曰 : 皆因濕氣處臥暑月夜行風濕相搏或酒醉行房之後露天而臥 第四十四肩背紅腫疼痛問曰 : 此症從何而得? 答曰 : 皆因腠理不密風邪串入皮膚寒邪相搏血氣凝滯 4) 景岳全書 (1) 足太陽經과관련 痙證 : 足太陽之筋病脊反折項筋急肩不擧 三陽陰證辨 : 足太陽膀胱經病. 腰脊強肩背痛. 若肩背畏寒. 皆太陽合少陰之陰證也 (2) 手太陰經과관련寒熱 : 肺所生病者. 臑臂內前廉痛厥. 氣盛有餘則肩背痛. 氣虛則肩背痛寒 (3) 手少陰經과관련寒熱 : 心所生病者. 臑臂內後廉痛厥 (4) 肺와관련 欬嗽 : 肺病者喘欬逆氣肩背痛 汗證 : 臟氣法時論曰肺病者肩背痛汗出 (5) 脾와관련欬嗽 : 脾欬之狀欬則右胠下痛陰陰引肩背 (6) 腎과관련風痹 : 邪在腎則病骨痛陰痺. 陰痺者按之而不得腹脹腰痛大便難肩背頸項痛時眩 (7) 三焦와관련和陣 : 流氣飲子治三焦氣壅五臟不和胸膈痞滿肩背攻痛嘔吐氣喘痰盛浮腫等證 (8) 風, 風寒濕, 濕熱과관련 諸風 : 風從北方來名曰大剛風其傷人也內舍於腎外在於骨與肩背之膂筋其氣主為寒也 諸風 : 西風生於秋病在肺俞在肩背. 秋氣者病在肩背 諸風 : 夫風之為病當半身不遂或但臂不遂者 風痹 : 所謂痺者各以其時重感於風寒濕之氣也 寒陳 : 東垣當歸拈痛湯. 治濕熱為病肢節煩疼肩背沉重 (9) 痰, 痰熱과관련 和陣 : 茯苓丸百十四. 治人有臂痛手足不能擧或時左右轉移此伏痰在內. 但治其痰則臂痛自止. 累有人為痰所苦夜間兩臂常覺抽掣 攻陳 : 七聖丸. 治風氣壅盛痰熱結搏. 肩背拘急 (10) 기타 痘瘡上 : 毒歸五臟證有不同當詳辨也. 毒歸於肺則爲欬爲喘爲癢爲衄血爲瘡乾燥皺揭爲肩臂痛 瘟疫 : 大頭瘟者以天行邪毒客於三陽之經所以憎寒發熱頭目頸項或咽喉俱腫甚至腮面紅赤肩背斑腫狀如蝦蟆故又名爲蝦蟆瘟 5) 醫宗金鑑 風濕과관련한肩背總括 : 通氣太陽肩背痛羌獨草蔓防芎, 氣滯加木陳香附, 氣虛升柴參同, 血虛當歸白芍藥, 血瘀薑黃五靈紅, 風加靈仙濕二朮, 研送白丸治痰凝. ( 注 ) 李杲羌活勝濕湯又名通氣防風湯治太陽經風濕肩背痛, 即羌活獨活本甘草蔓荊子防風川芎也 6) 血證論 瘀血과관련한吐血 : 二消瘀血. 審係血瘀上蕉, 則見胸背肩膊疼痛麻木逆滿等證 7) 醫林改錯 瘀血과관련한痺症有瘀血說 : 凡肩痛臂痛腰疼腿疼或周身疼痛總名曰痺症. 明知受風寒有溫熱發散藥不愈. 云 : 病在皮脈易於為功, 病在筋骨實難見效. 因不思風寒濕熱入皮膚何處作痛. 入於氣管痛必流走, 入於血管痛不移處. 如論虛弱是因病而致虛非因虛而致病. 總滋陰外受之邪歸於何處. 總逐風寒去濕熱已凝之血更不能活. 如水遇風寒凝結成冰冰成風寒已散. 明此義治痺症何難 8) 萬病回春 (1) 手陽明經과관련十二經脈歌 : 手陽明大腸經脈歌. 所生病. 肩前外痛相仍 (2) 手少陰經과관련十二經脈歌 : 手少陰心經脈歌. 所生病. 脅臂之內後廉痛 151

6 The Acupuncture Vol. 32 No. 2 June 2015 (3) 手太陽經과관련十二經脈歌 : 手太陽小腸經脈歌. 是動則病. 肩如拔兮似折. 所生病兮主肩. 肘臂之外後廉痛 (4) 手厥陰經과관련十二經脈歌 : 手厥陰心包絡經脈歌. 是動則病. 肘臂攣急腋下腫 (5) 手少陽經과관련十二經脈歌 : 手少陽三焦經脈歌. 所生病. 肩肘臂外皆疼 (6) 手太陰經과관련十二經脈歌 : 手太陰肺經脈歌. 是動則病. 兩手交瞀為臂厥. 所生病臂之內前痛. 氣虛肩背痛而寒 痰飮多爲臂痛 : 臂痛或麻木或戰掉皆痰飮所作二陳湯方見痰飮呑下靑州白元子 (3) 風寒濕과관련肩臂病因 : 臂爲風ㆍ寒ㆍ濕所搏或睡後手在被外爲寒邪所襲, 遂令臂痛或乳婦以臂枕兒傷於風寒亦致臂痛寒痛宜五積散方見寒門, 風痛宜烏藥順氣散, 濕痛宜蠲痺湯方並見風門加蒼朮酒防己 ( 醫鑒 ) (4) 經絡과관련臂痛有六道經絡 : 當以兩于伸直其臂貼身垂下大指居前小指居後而定之則其臂臑之前廉痛屬陽明經, 後廉痛屬太陽經, 外廉痛屬少陽經, 內廉痛屬厥陰經, 內前廉痛屬太陰經, 內後廉痛屬少陰經, 視其何經而用鍼藥治之也 ( 東垣 ) (7) 痰과관련 背痛 : 肩背痛沉而滑者痰痛. 肩背痛不能回顧者太陽氣鬱而不行也 痰飲 : 痰之為病難明. 或手足麻痺臂痛狀若風濕 臂痛 : 臂痛者因濕痰橫行經絡也 (8) 風寒濕, 濕熱과관련 臂痛 : 臂痛者因風寒濕所搏也. 或睡後手在被外為寒邪所襲遂令臂痛及婦人以臂枕而傷於風寒而致臂痛 脚氣 : 治濕熱腳氣為病四肢骨節煩疼肩背沉重 (9) 血氣, 風濕, 痰火와관련痛風 : 痛風者遍身骨節走注疼痛也. 謂之白虎歷節風都是血氣風濕痰火皆令作痛. 手臂痛加薄桂 9) 東醫寶鑑 (1) 臟腑와관련肩臂病因 : 靈樞 曰 心肺有邪其氣流于兩肘 (2) 痰飮과관련 肩臂病因 : 酒家之癖多爲項腫臂痛. 盖熱在上焦不能淸利故醞釀日久生痰涎聚飮氣流走於項臂之間不腫則痛耳 ( 直指 ) 痰飮多爲臂痛 : 凡人忽患胸背手脚腰胯隱痛不可忍連筋骨牽引釣痛坐臥不寧時時走易不定意謂是風證或疑是癰疽皆非也. 此乃痰涎伏在心膈上下變爲此疾 ( 集要 ) 痰飮多爲臂痛 : 治臂痛不能擧或左右時復轉移由伏痰在中脘停滯脾氣不得流行上與氣搏四肢屬脾滯而氣不升故上行攻臂其脈沈細者是也. 氣實者控涎丹方見痰飮最效, 宜用半硝丸消痰茯笭丸 ( 入門 ) 10) 鍼灸醫學 7) (1) 風寒濕 東醫寶鑑 을인용 : 臂爲風寒濕所搏或睡後手在被外爲寒邪所襲遂令臂痛或乳婦以臂枕兒傷於風寒亦致臂痛 증상 : 견관절통증과운동장애 ( 일반적 ) 팔이風寒濕의침범을받으면통증이더욱심해짐風勝者多傷於筋肩痛可牽涉項背手指寒盛者多傷於骨肩痛較劇深按乃得得熱則舒濕盛者多傷於肉肩痛固定不移局部腫脹拒按 (2) 痰飮 東醫寶鑑 을인용 : 酒家之癖多爲項腫臂痛. 盖熱在上焦不能淸利故醞釀日久生痰涎聚飮氣流走於項臂之間不腫則痛耳. 治臂痛不能擧或左右時復轉移由伏痰在中脘停滯脾氣不得流行上與氣搏四肢屬脾滯而氣不升故上行攻臂其脈沈細者是也 증상 : 견관절통증과운동장애 ( 일반적 ) 팔을들지못할만큼아프거나통증이좌우팔로왔다갔다하며脈은沈細함 (3) 氣血不足 類經圖翼 을인용 : 凡人肩冷臂痛者每遇風寒肩上多冷或日須熱撫摩夜須多被擁蓋庶可支持此以陽氣不足氣血衰少而然 須灸肩二穴方免此患 증상 : 견관절통증과운동장애 ( 일반적 ) (4) 經絡과관련 太陰經 : 어깨앞쪽中府穴에통증이있고팔을뒤로신전시통증이심해짐 152

7 견비통의변증에관한문헌고찰 陽明少陽經 : 어깨외측肩髃ㆍ肩髎穴과삼각근에압통이있으며외전시통증이심해짐 太陽經 : 어깨뒤쪽天宗穴에통증이있고내전시통증이심해짐 陽明經 ( 前廉痛 ) ㆍ太陽經 ( 後廉痛 ) ㆍ少陽經 ( 外廉痛 ) ㆍ太陰經 ( 內前廉痛 ) ㆍ少陰經 ( 內後廉痛 ) ㆍ厥陰經 ( 內廉痛 ) 11) 한의진단명과진단요건의표준화연구 (Ⅲ) 15) (1) 肩痛의변증지표 1 風寒 감별증 : 痛症이比較的輕하고病程이짧음. 疼痛의樣相은鈍痛隱痛을나타냄. 肩部冷感 전신증 : 風寒濕의邪를感受하여일어남 설맥 : 舌苔白, 脈浮 2 痰濕 감별증 : 肩部및周圍筋肉疼痛이激烈. 病程이길다. 初期에는肩關節이正常이나激甚한疼痛으로인해運動不能動則疼痛增加 전신증 : 痰濕이長期間筋肉사이에停滯하게되면심한疼痛뿐만아니라氣血도虛해진다. 虛汗短氣易勞易感冒등의氣虛症狀 설맥 : 舌質淡苔白, 脈弦, 脈細 3 瘀血 감별증 : 局部의腫脹壓痛이있다. 疼痛의性質은刺痛으로서上肢의運動障碍를동반 전신증 : 晝輕夜重 설맥 : 脈細澁 (2) 肩不擧의변증지표 1 風寒 감별증 : 多見于此病各期, 肩臂困痛, 感風寒之邪疼痛增劇, 得溫則痛減, 肩關節活動輕度受限 전신증 : 頭暈, 耳嗚, 畏風畏冷 설맥 : 舌質淡, 脈弦或浮 2 瘀血 감별증 : 肩部疼痛或腫脹, 痛以夜間爲重, 肩關節活動受限 전신증 : 肩痛과동시에患側의手指腫脹手指屈伸不能甚則入眠難 설맥 : 舌質有瘀斑, 苔白或薄黃, 脈弦或細澁 3 氣虛 감별증 : 病後期에다발, 肩部酸痛勞累痛劇, 肩關節活動受限 전신증 : 氣短懶言, 四肢無力 설맥 : 舌質淡, 苔白, 脈沈弱 4 血虛 감별증 : 病後期에다발, 肩部酸痛勞累痛劇, 肩關節活動受限 전신증 : 頭暈眼花, 心悸, 耳鳴 설맥 : 舌質淡, 苔白, 脈細弱 (3) 肩臂痛의변증지표 1 痰飮 감별증 : 臂痛肢腫, 膚微腫, 痛不能擧, 或左右時復轉 전신증 : 眩暈, 惡心, 胸悶, 便軟, 口不渴 설맥 : 舌苔膩, 脈沈濡 2 寒 감별증 : 疼痛較重, 局部膚冷, 肩臂部筋脈收引 전신증 : 腹嗚, 少便淸, 口淡 설맥 : 舌苔白滑脈沈 3 風 감별증 : 疼痛走時下時上 설맥 : 脈滑 4 氣血兩虛 감별증 : 上肢酸痛痠麻感爲主, 疲勞漏籍時痛症增加休息時痛症減少, 病程이長期 전신증 : 疲勞, 肌肉萎縮, 肢體無力感, 皮膚不華, 頭量, 目眩, 食慾不振 설맥 : 脈沈細無力, 舌質淡 5 打撲瘀血 감별증 : 肩臂痛局部腫痛, 夜間尤甚, 痛處가一定, 皮膚가靑紫色을띔, 骨節ㆍ脫臼ㆍ打撲의經歷이있음 전신증 : 局部皮膚知覺麻痺 설맥 : 脈澁弦, 舌質靑紫或瘀点 (4) 肩關節周圍炎의변증지표 1 風寒濕 감별증 : 肩部串痛, 偶風寒痛增, 得溫痛緩, 畏風惡寒, 或肩部有沈重感 설맥 : 舌質淡, 苔薄白或膩, 脈弦滑或緊 153

8 The Acupuncture Vol. 32 No. 2 June 瘀血 감별증 : 肩部腫脹, 疼痛拒按, 夜間尤甚 설맥 : 舌質暗紅或有瘀斑, 苔白或薄黃, 脈弦或細澁 2 虛寒 감별증 : 肩部酸脹, 勞損後疼痛加重, 遇寒痛劇, 得溫痛緩 설맥 : 舌質淡, 苔薄白, 脈沈細無力 3 氣血兩虛 감별증 : 肩部酸痛, 勞累後痛加重, 頭暈目眩, 氣短懶言, 心悸失眼, 四肢乏力 설맥 : 舌質淡, 苔少或白, 脈細弱或沈 (5) 肩關節部捻挫의변증지표 1 氣滯血瘀 감별증 : 局部腫脹, 疼痛拒按, 機能의制限 전신증 : 瘀血斑이나타남 설맥 : 舌質暗或有瘀斑, 苔白或薄黃, 脈弦或細澁 (8) 肩關節滑囊炎의변증지표 1 瘀血 감별증 : 初期에흔히나타남. 局部腫脹, 疼痛拒按夜間疼痛더욱뚜렷. 局部에波動感있는腫塊觸知 설맥 : 舌質暗紅, 苔薄黃, 脈弦 2 虛寒 감별증 : 後期에주로나타남. 局部酸脹疼痛, 勞界後疼痛加重, 畏寒喜溫, 神疲乏力, 부드러운腫塊觸之 설맥 : 舌質淡苔薄白, 脈沈細 2 風寒濕 감별증 : 後期에主로나타난다. 肩部酸脹痛, 沈重感, 遇風寒則疼痛加重, 得溫則疼痛輕減 설맥 : 舌質淡, 苔薄白或膩, 脈緊 (6) 上腕二頭筋筋腱炎의변증지표 1 寒濕 감별증 : 肩部腫脹, 重着感, 遇寒痛增, 得溫痛緩或兼有畏寒 설맥 : 舌質淡紅, 苔白或膩, 脈弦滑 2 瘀血 감별증 : 초기에흔히나타남. 肩部疼痛은비교적局限되어있고夜間에더甚하며壓痛이뚜렷한데硬結을觸知할수있고활동시摩擦音이있음 설맥 : 舌質暗紅或有瘀斑, 脈弦或細澁 3 氣血兩虛 감별증 : 後期에많고肩部酸痛, 勞動後疼痛加重, 皮膚色蒼白 전신증 : 頭暈心悸, 肌肉養縮 설맥 : 舌質淡苔白, 脈沈細有力 (7) 棘上筋腱炎의변증지표 1 瘀血 감별증 : 肩部疼痛腫脹, 夜間尤甚, 痛處固定, 拒按, 肩部活動時摩擦音 설맥 : 舌質暗紅或有瘀斑, 苔白或薄黃, 脈弦或細澁 12) Kim 2) (1) 病因에따른변증 1 急性 ( 風寒濕의外因 ) 특징 : 돌연히발생 증상 : 肩關節部의紅腫疼痛而拒按, 惡寒發熱수반, 오후및야간에심한통증 설맥 : 脈浮數, 舌苔白薄或黃 2 慢性 ( 痰飮의內因 ) 특징 : 급성병에서이행되는것외에병이서서히발생 증상 : 局部는無紅腫이나혹浮腫이있기도함, 患部는喜熱이라加溫하면痛減, 按則冷麻, 수개월내지수년계속되는경우도있음 설맥 : 舌苔의변화는없고脈沈細혹은無變化. (2) 經脈에따른변증 1 大腸經型症증상 : 肩前與上臂에作痛하며食指疼痛而不能運動 2 小腸經型症증상 : 肩痛이잡아빼듯아프고上臂痛은折斷樣痛이며혹은頸項難轉側不能回顧, 肩臑肘臂部의外側後緣으로疼痛 3 三焦經型症증상 : 肩臑肘臂外部의外緣으로疼痛, 無名指不能運用 4 心經型症증상 : 發臂厥症, 上臂에서下臂內側後緣으로疼痛, 患部厥冷, 掌心은반대로發熱而灼痛 154

9 견비통의변증에관한문헌고찰 5 心包經型症증상 : 臂肘攣急및腋腫이있으며手心熱 病程이오래된경우肌肉이痿縮, 潤氣가없고疲勞 설맥 : 脈沈細無力 6 肺經型症증상 : 臂厥, 臑臂部內側前緣으로疼痛및厥冷이있고혹手掌心에發熱 (3) 肩臂痛을유발하는원인에따른분류肩部位疾患, 頸椎關節疾患, 心肺疾患으로구분 13) Kim 18) 의經絡ㆍ經筋에따른변증 1 肺ㆍ大腸經型 : 肩臂痛및運動制限이肩臂部前面에나타남 2 心包ㆍ三焦經型 : 肩臂痛및運動制限이肩臂部中面에나타남 3 心ㆍ小腸經型 : 肩臂痛및運動制限이肩臂部後面에나타남 4 膀胱經型 : 肩臂痛및運動制限이肩胛背部에나타남 14) Chae et al 19) 의病因에따른변증 1 氣血凝滯肩臂痛증상 : 疼痛, 膨脹感, 외부로腫形이생기지않고自覺疼痛의범위가넓고일정하지않으며體表에분명한압통감이나타나지않음 2 打撲ㆍ瘀血肩臂痛증상 : 不通則痛하여항상疼血 ( 血溢脈外하여발생한局所 離經 의血液停滯된것 ) 이있는곳에痛處固定, 靑紫色腫脹 3 頸椎性肩臂痛증상 : 경추의질환으로인하여초래된견비통 15) Cheong et al 8) 의病因에따른변증 1 風寒濕痺型 특징 : 임상적으로제일많은유형. 肩部가風ㆍ寒ㆍ濕邪에感하거나寒濕之邪氣가經脈分肉之中에入하여氣血 이凝滯되어발병 증상 : 肩部寒凉感, 遇濕冷時疼痛加重, 得暖則輕 2 氣血兩虛型 특징 : 過勞혹은失血過多等으로氣血虧損, 運行無力하여발병 증상 : 疲勞累積時痛症이甚하고, 休息時痛症이輕減, 3 肝腎虧損型 특징 : 年老또는體虛한데病程이오래된경우혹은房事過度로肝腎損傷時에腎精虧損, 肝血不足하여발병 증상 : 肩關節周圍一般症狀, 疼痛, 頭暈, 目眩, 耳鳴, 腰搐. 설맥 : 舌質微紅, 脈細弱 4 外傷瘀血型 특징 : 骨折, 脫臼, 打撲等外傷에의해발병 증상 : 痛處固定, 極烈, 刺痛感, 피부가靑紫色 설맥 : 脈澁, 舌質靑紫或은瘀点 16) Shin et al 9) 의項背肩痛을瘀血로변증 증상 : 固定性疼痛, 或痛處腫塊, 日輕夜重, 附缸施術時瘀斑이생기는등특징적인瘀血症狀을나타냄 17) Park et al 20) 의病因에따른변증 1 風寒外襲증상 : 肩部疼痛, 肩部漫痛, 日輕夜重, 活動受限, 遇寒加重, 得熱痛減, 擧臂, 外轉및旋轉運動時疼痛加重. 2 經筋失養攣縮痺痛증상 : 肩痛經久不愈, 經筋失養, 肌肉萎縮, 經筋攣縮而軟短, 故擧臂不及頭, 後旋不及背, 痠痛乏力, 肩部活動受限, 痠痛無力, 遇寒加重, 得熱痛減. 18) Lee et al 21) 의肩臂痛이나타나는經脈에따른변증 1 陽明經 ( 臂臑의前廉 ) 2 太陽經 ( 後廉 ) 3 少陽經 ( 外廉 ) 4 厥陰經 ( 內廉 ) 5 太陰經 ( 內前廉 ) 6 少陰經 ( 內後廉 ) 19) Song et al 10) 의肩臂痛이나타나는經脈ㆍ經筋에따른변증 手三陰ㆍ手三陽ㆍ足太陽으로구분 155

10 The Acupuncture Vol. 32 No. 2 June ) Lee et al 11) 의肩臂痛이나타나는經脈ㆍ經筋에따른변증 手三陰ㆍ手三陽ㆍ足太陽으로구분 21) Lee et al 22) 의주된통증부위에따른經絡流走別변증 1 陽明經型 ( 大腸經 ) 2 太陽經型 ( 小腸經 ) 3 少陽經型 ( 三焦經 ) 22) Park et al 23) (1) Cheong et al 8) 의변증을따름 風寒濕痺型ㆍ氣血兩虛型ㆍ肝腎虧損型ㆍ外傷瘀血型으로구분 (2) 肩臂痛이나타나는經絡ㆍ經筋에따른변증手三陰, 手三陽, 足太陽으로구분 23) Heo et al 24) 의중풍후유증으로인한견비통을風寒濕으로변증 中風偏麻痺患者의肩臂痛은편마비측의氣血沮滯로風ㆍ寒ㆍ濕의邪氣를유발하여통증이발생한다고하여祛風濕하는생강약침을사용 24) Kim 25) 의肩臂痛이나타나는經絡에따른변증 1 手陽明 ( 前 ) 2 手少陽 ( 中 ) 3 手太陽 ( 後 ) 25) Shin et al 26) 의중풍후유증환자의견통을風寒濕으로변증 中風後遺症患者의肩臂痛양상은어깨가쑤시고, 씨리고, 저리고욱신거림인데이러한통증양상은風寒濕의侵襲으로氣血凝滯된상태라고하여溫經止痛祛風濕通絡하는川芎桂枝湯을사용 26) Hur et al 12) 의肩臂痛이나타나는經絡에따른변증手陽明大腸經, 手陽明大腸經및手太陰肺經ㆍ手陽明大腸經및手少陽三焦經ㆍ手三陽經ㆍ手三陽經및手太陰肺經으로분류하여혼합형도제시 27) Lee et al 27) 의肩臂痛이나타나는經絡에따른변증 1 陽明經 ( 肩臑의前廉 ) 2 太陽經 ( 後廉 ) 3 少陽經 ( 外廉 ) 4 厥陰經 ( 內廉 ) 5 太陰經 ( 內前廉 ) 6 少陰經 ( 內後廉 ) 28) Lee et al 28) 의肩臂痛이나타나는經絡流走別변증 1 陽明經型 ( 주된통증이大腸經에있음 ) 2 太陽經型 ( 小腸經 ) 3 少陽經型 ( 三焦經 ) 29) Kim et al 29) 의血瘀證으로변증 석회화건염의증상이自發痛, 刺痛, 壓痛, 肩髃, 肩髎穴주위로痛處固定, 능동운동시도시극심한통증, 수동거상시에도극심한통증으로肘屈 90 상태에서체간에고정시킨상태를유지하고脈弦, 舌質暗紫, 黃白苔하여氣血阻滯로인한血瘀證으로변증 30) Ahn et al 30) 의經筋에따른변증 12 경근이론에따라어깨를手足太陽經筋, 手少陽經筋, 手陽明經筋으로구분하고가장운동이안되는경근중택하여치료 31) Park et al 31) 의痰飮ㆍ瘀血로변증 상부관절와순파열로인한견비통이마찰또는압박에의해氣血阻滯되어병리적인산물인痰飮과瘀血이발생한것이라고하여臂痛不能擧에活血通經, 行己止痛, 順氣去痰하는加味舒經湯을사용 32) Kwon et al 32) 의瘀血로변증 오십견의통증양상이야간에심해지고바늘로찌르는것과같아, 어혈의증상과일치하다고여겨瘀血로변증 33) Jeong et al 33) 의瘀血로변증 회전근개파열로수술한환자의견비통에대하여운동중극심한통증이발생하였다는외상의병력과회전근개파열및재파열로 2차례수술했다는점을감안하여瘀血로변증 156

11 견비통의변증에관한문헌고찰 2. 변증추출 선정된자료에서변증명, 임시변증명, 그외견비통과관련된특징을추출하여정리하였다 (Table 1). 추출된변증명및임시변증명을살펴보면風寒濕, 西風, 風, 寒, 風寒, 寒濕, 風濕, 濕熱, 瘀血, 外傷瘀血, 氣血凝滯, 痰飮, 痰火, 痰熱, 酒痰, 氣痰, 風痰, 濕痰, 氣虛, 血虛, 氣血兩虛, 經筋失養, 氣血不足, 虛寒, 肝腎虧損型, 手太陰經, 手陽明經, 手少陰經, 手太陽經, 手厥陰經, 手少陽經, 足太陽經, 陽明少陽經, 肺ㆍ大腸經型, 心包ㆍ三焦經型, 心ㆍ小腸經型, 手三陽經및手太陰肺經등총 37종의변증명을추출하였다. 3. 유사변증군통합 정리된 37 종의변증에서변증명, 병인, 증상등을검토하여표현은다르지만의미상유사하다고판단되는변증을묶어대표성을띨만한변증으로통합하였다 (Fig. 1). 그결과風寒濕型ㆍ瘀血型ㆍ痰飮型ㆍ氣血兩虛型ㆍ虛寒型ㆍ肝腎虧損型의 6가지로분류하였고, 근골격계질환임을고려하여경락에따라手太陰經型ㆍ手陽明經型ㆍ手少陰經型ㆍ手太陽經型ㆍ手厥陰經型ㆍ手少陽經型ㆍ足太陽經型의 7가지를따로분류하였으며, 해당하는증상중중복되는것은정리하여요약하였다 (Table 2, 3). Six excesses identification Wind-cold-dampness, wind-cold, wind, western wind, cold, cold-danpness, wind-dampness, dampness-heat. Wind-cold-dampness Qi-bloodfluid-humor identification Eight principle identification Visceral identification Meridian collateral identification Static blood, external damage-static blood, Qi and blood stagnation Phlegm-retained fluid, phlegm-fire, phlegm-heat, liquor-phlegm, Qi-phlegm, wind-phlegm, dampness-phlegm Qi deficiency, blood deficiency, dual deficiency of Qi and blood, meridian sinew dystrophy Deficiency clod, lock of Qi and blood * Liver-kidney deficiency Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian, Yang brightness hand lesser Yang meridian, lung large intestine meridian, pericardium triple energizers meridian, heart small intestine meridian, three Yang meridians of the handㆍhand greater Yin meridian. Blood stasis Phlegm Qi-blood deficiency Deficiency cold Liver-kidney deficiency Hand greater Yin meridian Hand Yang brightness meridian Hand lesser Yin meridian Hand greater Yang meridian Hand reverting Yin meridian Hand lesser Yang meridian Foot greater Yang meridian Disease cause Meridian collateral Fig. 1. Summary of -identification Because symptoms from lack of Qi and blood* in The Acupuncture and Moxibustion Medicine 7) are similar to that of deficiency cold, we made lack of Qi and blood belong to deficiency cold

12 Table 1. The Characteristics of Data No Reference Disease cause Meridian-collateral / meridian sinew Others Huangdi s internal classic Classified classic A-b classic of acupuncture and moxibustion Introduction to medicine Complete compendium of acupuncture and moxibustion Complete works of jingyue The golden mirror of medicine Treatise on blood s /syndromes Correction of Errors in Medical Classics Western wind 1. Wind, cold, dampness, heat(wind, wind-dampness, dampness-heat) 2. Phlegm(liquor-phlegm, Qi-phlegm, wind-phlegm, dampness-phlegm) 3. Qi and blood stagnation 1. Wind, cold, dampness(wind, cold, cold-dampness, wind-dampness) 2. Phlegm(phlegm-retained fluid, phlegm-fire, dampness-phlegm) 3. Qi and blood stagnation 1. Wind, cold, dampness, heat(wind, western wind, wind-cold-dampness, dampness-heat) 2. Phlegm(phlegm, phlegm-heat) Wind-dampness Static blood(static blood in upper energizer) Static blood(blood coagulation because of wind, cold, dampness, heat) Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian Hand greater Yin meridian, hand lesser Yin meridian, foot greater Yang meridian Viscera and bowels disease(lung disease, heart disease, spleen cough, Yin impediment) 1. Viscera and bowels disease(spleen overexertion, spleen cough) 2. Food accumulation Viscera and bowels disease(spleen cough) 1. Viscera and bowels disease(lung disease, spleen cough, Yin impediment, Qi stagnation in upper energizer) 2. Smallpox 3. Erysipelas facialis

13 Recovery from All Ailments 1. Wind, cold, dampness, heat(wind-cold-dampness, dampness-heat, wind-dampness) 2. Phlegm(phlegm, dampness-phlegm, phlegm-fire) Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian 9 Treasured Mirror of Eastern Medicine 1. Wind-cold-dampness 2. Phlegm-retained fluid Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian The Acupuncture and Moxibustion Medicine 7) Standardization and unification of the terms and conditions used for diagnosis in oriental medicine(iii) 15) 1. Wind-cold-dampness 2. Phlegm-retained fluid 3. Lack of Qi and blood 1. Wind, cold, dampness(wind, cold, wind-cold, wind-cold-dampness) 2. Phlegm(phlegm-dampness, phlegm-retained fluid) 3. Static blood(external damage-static blood, blood stasis due to Qi stagnation) 4. Qi deficiency, blood deficiency, dual deficiency of Qi and blood 5. Deficiency cold 1. Greater Yin meridian, Yang brightness-lesser Yang meridian, greater Yang meridian 2. Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian 12 Kim 2) 1. Wind-cold-dampness 2. Phlegm-retained fluid Lung meridian, heart meridian, pericardium meridian, large intestine meridian, small intestine meridian, triple energizer meridian 13 Kim 18) meridian, heart ㆍ small intestine meridian, bladder Lung ㆍ large intestine meridian, pericardium ㆍ triple energizer meridian 14 Chae et al 19) 1. Qi and blood stagnation 2. External damage ㆍ static blood 1. Wind-cold-dampness impediment 15 Cheong et al 8) 2. Dual deficiency of Qi and blood 3. Liver-kidney deficiency 4. External damage-static blood Viscera and bowels disease(pathogen in heart-lung) 1. Viscera and bowels disease (heart-lung disease) 2. Cervical joint disease Cervical shoulder pain 8

14 16 Shin et al 9) Static blood 17 Park et al 20) 1. Wind-cold assailing the exterior 2. Meridian sinew dystrophy 18 Lee et al 21) Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian Hand greater Yin meridian, hand Yang brightness meridian, hand 19 Song et al 10) lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian Hand greater Yin meridian, hand Yang brightness meridian, hand 20 Lee et al 11) lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian 21 Lee et al 22) Yang brightness meridian, greater Yang meridian, lesser Yang meridian Hand greater Yin meridian, hand Yang brightness meridian, hand 22 Park et al 23) Following the -identifications of Cheong et al 8) lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian 23 Heo et al 24) Wind-cold-dampness 24 Kim 25) 26 Hur et al 12) Hand Yang brightness meridian, hand greater Yang meridian, hand lesser Yang meridian 25 Shin et al 26) Wind-cold-dampness triple energizer meridian, three Yang meridians of the hand, three Yang Large intestine meridian, large intestine ㆍ lung meridian, large intestine ㆍ meridians of the hand ㆍ lung meridian 27 Lee et al 27) Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian 28 Lee et al 28) Yang brightness meridian, greater Yang meridian, lesser Yang meridian 29 Kim et al 29) Blood stasis syndrome 30 Ahn et al 30) Hand and foot greater Yang meridian sinews, hand lesser Yang meridian sinews, hand Yang brightness meridian sinews 31 Park et al 31) Phlegm-retained fluid ㆍ static blood 32 Kwon et al 32) Static blood 33 Jeong et al 33) Static blood

15 Table 2. Summary of Pattern-identification Associated with a Disease Cause No 1 2 Pattern identification Wind-colddampness Blood stasis 3 Phlegm 4 5 Qi-blood deficiency Deficiency cold Symptoms References Sudden occurrence. When lieing on the humid place, sleeping in the cold place, having sex while he drunk. Short-term disease duration. 1, 2, 3, 4, 5, Mild pain, blunt pain, dull pain. The pain gets worse when the weather is cold, where as better when warm weather. Getting better 6, 7, 10, 11, during the day, getting worse during the night. 12, 13, 14, Cold sensation around the shoulder, refusing to be touched due to red-swelling-pain of the shoulder, feeling sunken and heavy, mild 17, 19, 24, limitation of range of motion(rom) of the shoulder, unable to rotate head due to should and back pain. Fear of wind, aversion to cold. 25, 27 Pale red tongue. White or white thin or slimy fur. Floating or string-like slippery or tight pulse. Injury like fracture, luxation, external damage. Frequent occurrence at the initial stage of disease. Shoulder pain, oppressive pain, fixed sore spot, stabbing pain, refusing to be touched due to pain, getting worse at the night. Swelling, induration, limitation of ROM of the shoulder, friction sound. Partial sensory paralysis, affected side hand flexion-extension disorder due to swelling. If severe, difficult to sleep. Dark red or purpura tongue. White or yellow thin fur. String-like or fine rough pulse. Long-term disease duration. Pain in the arm with swelling, a little edema of the skin, unable to raise arm. The pain gets worse when he move his shoulder, dragging pain, discomfort while either sitting or lieing, moving place to place of the pain. Sometimes numbness of the shoulder, back, both hand or numbness of the hand and foot. Dizziness, nausea, oppression in the chest, sloppy stool, not thirsty. Pale tongue. White or slimy fur. Sunken soggy or sunken fine pulse. Overwork or excessive bleeding. Frequent occurrence at the end stage of disease. Long-term disease duration. Mainly aching pain, aching numbness. Getting worse when fatigue, getting better when rest. Prolonged healing. Fatigue, powerlessness, muscle and skin dystrophy, dizziness, dizzy vision, anorexia, shortness of breath, being tired of speaking, palpitations, tinnitus, pale complexion. Pale tongue. White fur. sunken weak or fine weak pulse. Frequent occurrence at the end stage of disease. Partially aching, distending, cold pain. Getting worse after overwork. Severe pain when the weather is cold. Feeling hot during the day where as dyring the night, lassitude of spirit, lack of strength. Pale tongue. White thin fur. Sunken fine pulse lacking of strength. 4, 5, 8, 9, 13, 16, 17, 18, 24, 31, 33, 34, 35 4, 5, 6, 10, 11, 12, 13, 14, 31 13, 17, 19, 24 12, 13

16 Liver-kidney deficiency Old age, physically weak. Long-term disease duration. Insufficient essence and blood of the liver and kidney because of excessive sexual intercourse Pain aroud the shoulder joint. Dizziness, dizzy vision, tinnitus, lumbar convulsions. Reddish tongue. Fine weak pulse. References : these are the number of the order in which they are described in table 1. 17, 24 Table 3. Summary of Pattern-identification Associated with the Meridian-collateral No Pattern identification Symptoms References Hand greater Yin meridian Hand reverting Yin meridian Hand lesser Yin meridian Hand greater Yang meridian Hand lesser Yang meridian Hand Yang brightness meridian Foot greater Yang meridian Pain in the anteromedial arm. Shoulder-back pain when Qi excession, shoulder-back cold pain when Qi deficiency. Arm cramp when disease deteriorates. Arm spasm, axillary swelling. Unable to expand the arm. Arm cramp when disease deteriorates. Pain and reversal cold in the posteromedial arm. Arm cramp with pain when disease deteriorates. Severe pain in the posterolateral shoulder and arm. Pain in the axilla and posterior axilla. Pain from the scapula to the neck, unable to rotate head. Pain in the lateral shoulder and arm, unable to raise hand. Arm cramp when disease deteriorates. Pain in the anterior shoulder and arm. Occuring of pain with cramp and unabling to raise shoulder or to rotate head when disease deteriorates. Headache with neck and shoulder pain, neck and spine stiffness, axillary and supraclavicular pain. References : these are the number of the order in which they are described in table 1. 1, 2, 3, 5, 6, 10, 11, 12, 14, 15, 20, 21, 22, 24, 28, 29 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 24, 29 1, 2, 3, 5, 6, 10, 11, 12, 14, 15, 20, 21, 22, 24, 29 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 23, 24, 26, 28, 29, 30, 32 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 23, 24, 26, 28, 29, 30, 32 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 23, 24, 26, 28, 29, 30, 32 1, 2, 3, 5, 6, 15, 20, 21, 22, 24, 32 6

17 견비통의변증에관한문헌고찰 Ⅳ. 고찰 어깨는견갑흉곽관절 (scapulothoracic joint), 관절와상완관절 ( 견관절, glenohumeral joint), 흉쇄관절 (sternoclavicular joint), 견봉쇄골관절 (acromioclavicular joint) 의복합적인구조로이루어져있고상지를척추, 흉벽에연결시키면서관절및근육의유기적인작용으로팔을움직이는역할을하는등 34) 어깨와상완부, 경ㆍ흉추부, 흉부는서로연결되어여러근육및구조물을공유하고있다. 그러므로어깨란단순히견관절만을의미하는것은아니며상완부, 경ㆍ흉추부, 흉부에서견관절과인접하여어깨를구성하고견관절의움직임에관여하는구조물들까지포함한다. 견비통은어깨인肩과아래팔인臂에나타나는통증을이르는증상명으로, 용어를풀어서정리하면견관절과그인접한상지부, 배부, 흉부에나타나는제반통증이라고할수있다 2,18,19,35). 따라서견비통은견관절자체의문제, 경추의문제등의근ㆍ골격계질환에서발생하는견비통뿐만아니라협심증에서왼쪽어깨나양팔의내측면을따라통증이방사되는것 36) 과같이내장질환에서부수적으로나타나는견비통, 痘瘡, 大頭瘟등에서병발되는견비통등을모두포함하는폭넓은개념이다. 그러나내부장기의반사반응에의해견비통이나타나는것은주원인이되는내부장기에초점을맞춰치료가시행되어야하고마찬가지로두창, 대두온등에서나타나는견비통또한주증상이아닌부수적으로수반되는증상이라고판단하여본논문에서는견비통을주증상으로하는근ㆍ골격계질환에대하여변증을정리하고자한다. 견비통치료시한약, 침구치료, 약침치료, 부항요법등을응용할수있는데, 한약치료시風ㆍ寒ㆍ濕의사기에따라烏藥順氣散, 五積散, 蠲痺湯을쓰고담음에는二陳湯을쓰는것과같이병인에따라처방을하고 7,31), 침구치료시에는혈자리의주치, 혈성을응용한취혈법뿐만아니라견비부를유주하는경락에따른취혈법을많이사용한다 7,21). 약침치료시에도마찬가지로적합한혈자리를선택하여소염진통작용, 혈액순환촉진작용이있는봉약침을쓸수있고活血化瘀, 通絡止痛하는홍화약침, 祛風濕하는생강약침등과같이병인에따른약침처방이가능하다 37,38). 부항요법은대개압통점 ( 아시혈 ) 에응용하여통증부위를舒筋活絡하고그외에도피내침, 전침을통증부위에응용하기도한다 7). 이러한치료들은변증이바탕이되어야하며, 견비통의변증과관련된자료를살펴본결과팔강변증, 장부변증, 기혈진액변증, 육음변증을사용하여그병인에따라치료하고경락변증을응용하여증상이나타나는경락과경근에따라치료하였음을알수있었다. 견비통치료시, 특히 한약, 침구치료, 약침치료에서병인에따른변증, 경락과경근에따른변증을복합적으로운용하여두가지모두중요하다고판단하였고, 현재의 鍼灸醫學 7) 교과서에서각각병인과경락에따라분류한점을참고하여견비통변증을크게 2가지로구분하고그안에서다시정리하였다. 본논문에서정리한견비통에관한변증은총 37 종이었으며, 병인과관련하여風寒濕型ㆍ瘀血型ㆍ痰飮型ㆍ氣虛血虛型ㆍ虛寒型ㆍ肝腎虧損型의 6가지변증으로구분하였고경락과관련하여手太陰經型ㆍ手陽明經型ㆍ手少陰經型ㆍ手太陽經型ㆍ手厥陰經型ㆍ手少陽經型ㆍ足太陽經型의 7가지변증으로나누었다. 風寒濕型을살펴보면, 風寒濕, 西風, 風, 寒, 風寒, 寒濕, 風濕, 濕熱등비슷한변증명, 임시변증명, 증상들을기준으로묶었고濕氣處臥, 冷處睡著등에발병하는점, 그리고寒邪, 風中, 侵, 襲, 流入經絡등의표현을고려하면外感邪氣에의한것으로사료되며대표성을띨만한風寒濕型으로이름하였다. 이러한변증은선정된 35 가지의자료중 17가지의문헌에서제시되었고특히고문헌 11가지중 9가지에서언급되어중요한변증이라사료된다. 醫學入門, 景岳全書, 萬病回春 에서濕熱이병인이되어나타나는견비통을언급하였는데, 단순히 肢節煩疼, 肩背沉重 의증상만을제시하고그병기에대한설명이없고다른자료에서도공통되는부분이없어변증에서제외하였다. 風寒濕型은발병당시습한곳, 추운곳, 야외에서자는등외부환경에의노출이있고통증이비교적가벼우나風ㆍ寒ㆍ濕을만나면증상이악화되며사기가아직체표에있어脈浮한특징이있다. 또한風性견비통은동통이위아래로이동하고項背, 手指까지당길수있으며, 寒性견비통은동통이비교적강하며피부가차갑고따뜻하게하면증상이경감되고, 濕性견비통은통증부위가고정되고국소부위에종창이있어만지는것을싫어하는등7,15 勝한사기에따라특정증상이두드러질수있으며발병시의상황, 병인, 증상의경중을살펴風濕, 寒濕등의다양한변증표현이가능할것으로사료된다. 瘀血, 外傷瘀血, 氣血凝滯는瘀血型으로통합하였다. 氣血凝滯 와 外傷瘀血 은엄밀히따지면뜻하는바가다르지만 氣血凝滯 는모든병인에서나타날일종의병리적상태라고판단하였고, 그표현을 醫學入門, 鍼灸大成, 한의진단명과진단요건의표준화연구 (Ⅲ) 15) 에서찾아볼수있는데, 한의진단명과진단요건의표준화연구 (Ⅲ) 15) 에서는瘀血이 7회, 氣血凝滯가 1회언급되고氣血凝滯의증상, 설진, 맥진등이瘀血의내용과일치하여대표변증명을瘀血로통일하였다. 鍼灸大成 에서는주리가치밀하지못해風寒邪가流入, 相搏하여기혈응체되고紅腫疼痛이 163

18 The Acupuncture Vol. 32 No. 2 June 2015 나타난다고하였는데이는 醫林改錯 에서설명하는 痺症有瘀血說 과유사하다고사료되어瘀血型에포함시켰고, 醫學入門 에서 氣血凝滯經絡以致臂痛不擧 라고한것은견비통의일반증상, 즉통증으로나타나는운동제한이라고판단하여증상에포함시켰다. 瘀血型은선정된 35 가지의자료중 13가지문헌에서제시되었고골절, 탈구, 타박등의외상이자주발생하는근ㆍ골격계질환에서는반드시필요한변증이라고사료된다. 瘀血型견비통은외상과거력이있고병증의초기에자주보이는유형으로통증부위가고정되어한부위가바늘로찌르듯이아프고통증으로인하여만지는것을싫어하는데이러한증상들이밤에더심한경향이있으며舌質暗紅或有瘀斑하는특징적인설진을나타낸다. 痰飮, 痰火, 痰熱, 酒痰, 氣痰, 風痰, 濕痰은변증명표현은다양하나그증상과설진, 맥진이비슷하여대표할만한痰飮型으로통합하였고, 선정된자료중 9가지의문헌에서제시되며그횟수가많지는않지만다양한변증명으로수차례언급되고 鍼灸醫學 7) 교과서에견비통병인으로인용되고있으므로이변증도포함되어야한다고판단하였다. 痰飮型견비통의증상들을살펴보면肩ㆍ肩背에관한내용도있지만대부분臂痛에대한내용이고고문헌에서더욱그러하였다. 목덜미옆, 결분의위를肩이라하고, 肩의아래에서臂의위를臑라고하며, 肘의아래에서掌의위를臂라고하여, 臂는아래팔에해당하지만, 臂痛에관하여臂痛不能擧라하고담음이項臂之間에유입되어통증이나타난다고하였으니견관절운동장애를동반한아래팔통증으로해석할수있다. 또한담음은脾가마시는것을제대로傳化하지못하여생기는병리적물질로유주하는성질이있어담음이정체되는곳에병증을일으킨다 39). 痰飮型은통증이극렬하여참을수없고통증으로팔을들수없으며주위의연결된근골까지통증이나타나는데이러한통증은때때로이동하는경향이있고담음이유주하는곳에따라眩暈, 惡心, 胸悶등의증상이있을수있다. 氣虛, 血虛, 氣血兩虛, 經筋失養은선정된자료중 3개의문헌에서등장하여비록그횟수는적으나, 한의진단명과진단요건의표준화연구 (Ⅲ) 15) 에서각상병마다상세하게다뤄 7회언급되고, 風寒濕型ㆍ瘀血型ㆍ痰飮型은실증에해당하므로허증의변증도필요하다고판단하여포함시켰다. 氣와血은불가분의관계로그변증에서중복되는점이많아氣血兩虛型으로통합하여정리하였고經筋失養攣縮痺痛또한증상과병기가비슷하다고판단되어氣血兩虛型에포함시켰다. 氣血兩虛型견비통은과로, 실혈과다시에발병하고병의후기에나타나는변증으로이때의견비통은피로누적시심해지고휴식시통증이감소하며오래 도록낫지않는경향이있다. 또한疲勞, 無力感, 肌肉萎縮, 皮膚不華등의전신증상을수반하기도한다. 虛寒의변증은 한의진단명과진단요건의표준화연구 (Ⅲ) 15) 에서 2회등장하는데, 氣血兩虛型과비슷한허증의증상을보이나 遇寒痛劇得溫痛緩 의특징적인증상표현을고려하여虛寒型으로분리하여정리하였다. 또한 鍼灸醫學 7) 에서 類經圖翼 의 肩冷臂痛者每遇風寒肩上多冷或日須熱撫摩夜須多被擁蓋庶可支持此以陽氣不足氣血衰少而然 을인용하여氣血不足이라고명명하였으나, 낮에는뜨거운것으로문지르고밤에는이불을많이덮는등, 그증상이氣血兩虛型보다虛寒型에가깝다고판단되어虛寒型에포함시켰다. 肝腎虧損型은 Cheong et al 8) 이중국의임상보고를바탕으로제시한것으로선정된자료중 2회언급되어그인용횟수가적지만肝主筋, 腎主骨하여근ㆍ골격계질환에서는중요한변증이라고판단하여포함시켰다. 또한이변증은頭暈, 目眩, 耳鳴과같은허증의전신증상이나타나고舌質微紅, 脈細弱의설진과맥진을보인다는점에서氣血兩虛型과비슷하나병기에서腎精虧損, 肝血不足으로다르고특징적으로腰搐과같은신허증상을보이기에개별변증으로정리하였다. 견비통에대하여경락과경근에따른증상, 치법을제시하는자료들이많았고, 맥진, 설진에관한내용이없다는단점이있지만취혈할때에통증및기타증상이나타나는경락과경근을기준으로변증하여혈자리를선정하거나순경취혈, 접경취혈등의방법을응용할수있는데 10,11,22,25,40), 이는간단하고임상에서쉽게응용할수있다는장점이있어경락과경근에따른변증또한중요하다고판단하였다. 경락은기혈을운행시켜신체를자양하고근골, 관절이제기능을할수있도록하고, 경근은경락에의해자양된기육, 근막, 근건, 인대등의연부조직이포함된것으로경근의병후에서 其病當所過者支轉筋 이라고하여경락병, 경근병은해당경락의문제또는경근의이상으로발생한疼痛, 痹症, 牽引, 拘攣, 弛緩, 强直, 搐搦등의연부조직질환이라고할수있다 10,41). 이러한경락, 경근, 견비통의상관관계를고려하여경락과경근에따른변증을견비통의변증에포함시켰다. 鍼灸醫學 7) 교과서에서는 경락별증상 에서太陰經ㆍ陽明少陽經ㆍ太陽經을제시하고 경락의소속에따른치료법 에서太陰經ㆍ厥陰經ㆍ少陰經ㆍ太陽經ㆍ少陽經ㆍ陽明經을제시하였는데, 선정된자료를정리하면, 견비부를유주하는경락과경근은手太陰ㆍ手厥陰ㆍ手少陰ㆍ手太陽ㆍ手少陽ㆍ手陽明ㆍ足太陽의 7가지이고증상이둘이상의경락과경근 164

19 견비통의변증에관한문헌고찰 에나타날때에陽明少陽經型 7) 과같이혼합변증이가능하다고사료된다. 각경락과경근이지나는부위를살펴보면, 手太陰은수궐음과수소음의앞에해당하는견비부의안쪽, 앞쪽 ( 內前廉 ) 을거쳐겨드랑이아래 ( 腋下 ), 견봉 ( 肩前髃 ), 쇄골근처 ( 缺盆 ) 를지나간다. 手厥陰은수태음과수소음사이인견비부의안쪽 ( 內廉 ), 겨드랑이 ( 腋 ) 로지나가고手少陰은수태음과수궐음의뒤쪽인견비부의안쪽, 뒤쪽 ( 內後廉 ) 과겨드랑이아래 ( 腋下 ) 를지나간다. 手太陽은견비부의바깥쪽, 뒤쪽 ( 外後廉 ) 과어깨뼈 ( 肩胛 ), 어깨위 ( 肩上 ), 쇄골근처 ( 缺盆 ) 를지나고手少陽은견비부의바깥쪽 ( 外廉 ), 어깨 ( 肩 ), 쇄골근처 ( 缺盆 ) 를지나며手陽明은견비부의바깥쪽, 앞쪽 ( 外前廉 ) 과견봉의앞쪽 ( 髃骨之前廉 ), 쇄골근처 ( 缺盆 ) 을지나간다. 足太陽은유일하게足經으로본래머리, 경추, 흉추, 요추, 하지의뒷면을유주하며상지로는지나지않으나 下項循肩髆內挾脊, 從髆內左右下貫胛挾脊內 41) 하여어깻죽지 ( 肩髆 ) 를척추에연결하는역할을하여견관절의운동과지지에관여할것으로판단하여포함시켰다. 경락과경근에따른변증시에문헌들에서언급된증상외에도상기한바와같이그유주하는부위를살핀다면변증에더욱도움이될것으로사료되며명칭의간략화를위하여경락에따른변증이라고이름하였다. 비록본문에서는견비통의변증을정리할때에내장질환, 두창, 대두온등은제외하였으나그것과는별도로 Kim 2) 이심폐질환에수반되는견비통에대하여소속경락에서취혈하여치료하는것에착안하여경락변증을응용하여내장질환뿐만아니라두창, 대두온등에서부수적으로나타나는견비통의통증을제어하는방법은유용할것으로사료된다. 본논문은옛문헌을근간으로현재쓰이고있는견비통의변증을살펴보기위하여고문헌, 현대문헌, 국내논문등다각도로자료를고찰하였고이과정에서여러경로로자료를수집하였으나수집된고문헌만으로역대문헌을대표하지못할수있고원문검색중에서도누락된부분이있을수있었다고생각된다. 또한국내의문헌고찰논문뿐만아니라임상논문을함께살펴한의학계에서실제로쓰이는변증을살펴보고자했으나선정된논문대부분이임상적고찰, 증례보고였다는한계가있다. 추후본논문의변증에대하여전문가적인토론과합의, 그리고임상에서의적용, 검증, 보완의작업이필요할것으로사료되며향후표준화된변증체계설립과견비통에대한연구및임상에서의견비통진료시에도움이되었으면하는바이다. Ⅴ. 결론 기존의 鍼灸醫學 교과서에기재된변증만으로견비통을모두대변하기에는부족한면이있고여타문헌에서제시하는견비통의변증은상이한부분이많았다. 이에견비통의변증에관한문헌을다각도로고찰하였고기존의변증을보완하여다음과같이제안하는바이다. 1. 견비통의변증을크게병인과관련된변증, 경락에따른변증으로정리하였다. 2. 병인과관련된변증은風寒濕型ㆍ瘀血型ㆍ痰飮型ㆍ氣血兩虛型ㆍ虛寒型ㆍ肝腎虧損型의 6가지로구분하였다. 3. 경락에따른변증은手太陰經型ㆍ手陽明經型ㆍ手少陰經型ㆍ手太陽經型ㆍ手厥陰經型ㆍ手少陽經型ㆍ足太陽經型의 7가지로나누었다. Ⅵ. References 1. Sin HJ, Yoon IJ, Oh MS. Consideration of literatures on the treatment of pain in shoulder and arm based on oriental medicine. The J of Daejeon Oriental Medicine ; 16(1) : Kim KS. Clinical study of acupuncture and moxibustion treatment on shoulder pain. The J of Korean Medicine ; 5(1) : Kim DC, Kim GS, Ahn CB. Clinical study on pain of shoulder and arm. The J of Korean Medicine ; 8(2) : National Health Insurance Service. Health insurance statistics 2012 [Internet]. Seoul ; [cited 2014 April 20]. available from : stathtml.do?orgid=350&tblid=dt_35001_a8021&v w_cd=&list_id=&scrid=&seqno=&lang_mode=ko&o bj_var_id=&itm_id=&conn_path=k1&path= 5. Oriental Medicine Dictionary Compilation Committee. Oriental medicine dictionary. Seoul : Jeongdam : Lee BG, Park YB, Kim TH. Korean medicine diagnosis. Gyeonggi : Seongbosa : The Acupuncture and Moxibustion Medicine Society. The acupuncture and moxibustion medicine

20 The Acupuncture Vol. 32 No. 2 June 2015 Gyeonggi : Jipmoondang : , 342-7, Cheong SH, Lee JS, Kim SS, Shin HD. Current tendency for herb-medication of the frozen shoulder. The J of Korean Medicine ; 10(2) : Shin WW, Kim SH, Song HJ. Clinical study of 3700 patients with cervical and shoulder pain: static blood pigmentation by cupping therapy. The J of Daejeon Oriental Medicine ; 6(2) : Song IG, Kim GS, Lee SD. A study of similarities between VDT syndrome and Kyunbitong(Jianbeitong, 肩臂痛 ) on the ground of medical records. The Acupuncture ; 18(2) : Lee TH, Chang SY, Kim HJ et al. The comparison of effectiveness between Shunjing-quxue needling and Jiejing-quxue needling on shoulder pain patient. The Acupuncture ; 22(6) : Hur B, Yim YK. Study on clinical effects of indirect moxibustion at Geogol(LI 16) on the shoulder pain. The J of Daejeon Oriental Medicine ; 16(2) : Hwang JS, Kim KH. The study on the books of oriental medicine which deal with variation in diagnosis on the neck and nuchal pain. The Acupuncture ; 24(2) : Kim GU. Historiography of Chinese medicine. Seoul : Daesung Publishing Company : Korea Institute of Oriental Medicine. Standardization and unification of the terms and conditions used for diagnosis in oriental medicine Ⅲ. Editions of the Korea Institute of Oriental Medicine ; 3(1) : Sun SH. Literature review on syndrome differentiation of tremor, focusing on Chinese journals. The J of Internal Korean Medicine ; 31(1) : Oh HS, Han IS, Lee DS et al. Literature review on syndrome differentiation and herbal medicine of Sjogren s syndrome: focusing on chinese traditional medicine's journals. Korean J of Oriental Physiology and Pathology ; 27(5) : Kim GS. The study of oriental and occidental medicine on the type categorization of shoulder and arm pain and acupuncture therapy. The Acupuncture ; 2(1) : Chae WS, Lee IK, Lee BY. Clinical study on 44 patients with pain of shoulder and arm. The Journal of Korean Medicine ; 8(2) : Park KH, Lee BR. Philological study on etiology and pathogenesis of neuralgia in the shoulder and the arm, and its acupuncture points for treatment. The J of Daejeon Oriental Medicine ; 8(1) : Lee HY, Lee BB. Literatual study on acupuncture treatment of shoulder pain. The Acupuncture ; 16(3) : Lee HY, Kim SH, Heo JE et al. Clinical study about acupuncture and moxibustion treatment according to the different type of the meridian pathways of the patients who have shoulder pain. Korean Journal of Acupuncture ; 23(4) : Park KH, Lee H. Consideration of literatures on the treatment of pain in shoulder and arm based on oriental medicine and western medicine. The J of Daejeon Oriental Medicine ; 15(1) : Heo SW, Kwon MJ, Kim HG et al. Clinical study on effect of ginger herbal acupuncture therapy on shoulder pain of paralytic patients. The Acupuncture ; 23(5) : Kim YI. Comparison study acupuncture treatment with acupuncture & moxibustion combined treatment for frozen shoulder patients. The J of Daejeon Oriental Medicine ; 15(2) : Shin WY, Hyun JO, Choi EY et al. 3 case reports of Cheongungkyeoji-tang for post-stroke patients with shoulder pain. The J of Korean Medicine ; 27(4) : Lee JS, Song KH, Lee SN et al. Clinical study of different effect between trigger point needling and remote acupuncture point needling on shoulder pain patient. The Acupuncture ; 24(5) : Lee HY, Youn HM, Kim WI. Clinical study about shoulder pain by oriental medical treatment and 166

21 견비통의변증에관한문헌고찰 oriental-western medical treatment. The J of Korean Institute of Pharmacopuncture ; 11(2) : Kim SH, Ko KM, Lee YK et al. A case report of the patient with calcified tendinitis treated by oriental medicine. The J of the Association of Spine & Joint Korean Medicine ; 5(1) : Ahn MS, Park JS, Jung JH et al. A case report of frozen shoulder with muscular acupuncture and muscle energy technique. The J of Korea Chuna Manual Medicine for Spine & Nerves ; 4(2) : Park SH, Ro HR. The case report of prescribing Kamiseokyong-tang(nam) for the two patients with superior labral anterior posterior lesion. The J of Korea Chuna Manual Medicine for Spine & Nerves ; 6(1) : Kwon SA, Lee JW, Kim MJ et al. A study of blood stasis for frozen shoulder using blood stasis questionnaires(bspq) and the relationship of pain, shoulder range of motion and BSPQ score. The Acupuncture ; 28(4) : Jeong JY, Kim JH, Song CH et al. 1 case of shoulder pain treated with oriental treatment including pharmacopuncture in rotator cuff sur- gery. The Acupuncture ; 29(6) : The Korean Orthopaedic Association. Orthopaedics 1. Seoul : Choisin Medical Books : Chang IK. Bibliographical studies on the upper extremity pain. The J of Korean Medicine ; 2(1) : The Society of Internal Korean Medicine of Circulatory System. Internal Korean medicine of circulatory system. Seoul : Koonja : Korean Pharmacopuncture Institute. Pharmacopuncturology. Seoul : Elsevier Korea : Jeong DH, Ahn HJ, Hwang KS et al. Clinical study on effect of carthmi-flos herbal acupuncture therapy on shoulder pain. The Acupuncture ; 19(6) : Heo J. Donguibogam. Gyeongsangnam-do : Donguibogam Publishing Company : , Won SH, Kwon GR. The literatual study about frozen shoulder. The J of Korean Institute of Pharmacopuncture ; 2(1) : Meridian & Acupoints Compilation Committee Of Korean Orienal Medical Colleges. Principles of meridians & acupoints: a guidebook for college students. Wonju : Yibang Medical Book Center : 20-30, 70-72,

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