『景岳全書·雜證模』에 수록된 董某氏 노인 요통의 의학 진단과 辨證에 대한 연구

Medical Diagnosis and Pattern Differentiation of Geriatric Lower Back Pain of a Mr. Dong in the Jingyuequanshu·Zazhengmo(景岳全書·雜證模)

Objectives : This study discusses the medical diagnosis and pattern differentiation of geriatric lower back pain in the case study of a Mr. Dong, listed in the Zazhengmo chapter of the Jingyueqyanshu. Methods : First, standards for CP(Clinical Presentation) and DDx(Differential diagnosis) were extracted from the case study. Next, the extracted information was restructured according to the form of contemporary medical records, from which the medical condition of the lower back pain was assumed. Lastly, Zhangjiebin’s pattern differentiation was evaluated based on examination of previous studies on excess pattern lower back pain. Results : Using clinical expression from the case study of geriatric lower back pain of Mr. Dong as key evidence, the medical diagnosis for lower back pain was assumed to be ‘radiating pain due to intestinal disease’, while the diagnosis for dysfunctional urination could be narrowed down to either ‘infection’ or ‘hormone-related.’ A common cause of the two assumptions was nephropyelitis. Clinical symptoms of acute nephropyelitis is pain in the CVA(Costovertebral Angle), pain during urination, and feeling of residual urine among others. The fact that it is often preceded by urethritis or bladder infection supports this assumption. Zhangjiebin diagnosed Mr.Dong’s lower back pain as dampness-heat in the Bladder or Bladder Channel, or the Taiyang Channel. Based on the aforementioned medical diagnosis and previous studies in excess pattern lower back pain, this case could be re-evaluated as ‘excess pattern which started in the Taiyang Channel that transitioned to the Kidneys through the Bladder Channel.’ Conclusions : The case study of Mr. Dong shows that while Kidney related lower back pain is often times deficient in nature, Zhangjiebin treated a fair number Kidney excess pattern cases. His pattern differentiation results should be interpreted more flexibly.