정신과의사 및 한의사들의 홧병에 대한 개념

The Concept of Hwabyung of Korean Psychiatrists and Herb Physicians

The answers to 29-item questionnaire on so-called “hwabyung”, from 265 Korean psychiatrists and 32 Korean herb physicians working as professors in Chinese medical schools, were analysed and compared. Psychiatrists reported that the incidence of hwabyung was 3 to 10 % in the general population and was more frequently found in women, in middle and mid-late age groups, in low educational and economic classes, and in rural areas. Most psychiatrists thought of hwabyung as being a psychogenic disorder which was usually caused by familial problems, financial loss or poverty and patient’ personality problems. Frequent familial problems include conflicts due to husbands* misconducts, conflicts between housewieves and mother-in-laws and conflicts between parents and children. From these etiological factors, discontent, frustration, mortification, anger and resentment develop. However, the patients have to repetitively repress or suppress their negative emotional reactions for a long period or undergo partial somatization before the symptom develop. This results in incompletely suppressed anger and resentment and depressive syndromes such as depressve moods, regret, pessimism and feeling of worthlessness. Somatic symptoms are also characteristic. The most common and typical symptoms are something pushing-up in chest, chest oppression, heat or hot feeling of body, epigastric mass and palpitation. According DSM-III criteria, many psychiatrists diagnosed hwabyung patients as having somatization disorders, neurotic depression ( dysthymic disorder) and generalized anxiety disorders. Most psychiatrists recommended interactive psychiatric treatment including psychotherapy, drug therapy and family therapy and thought that hwabyung was a chronic disorder but that the prognosis was good. Many psychiatrists were reluctant to accept the possibility that hwabyung could be a clinical entity but accepted that it could be a culture-bound syndrome in Korea. Most of the Korean herb physicians had opinions similar to those of psychiatrists in respect to incidence in sex and age, psychogenecity, etiological background, symptoms and clinical course. However, they thought the incidence of hwabyung was 20〜 50% in the general population and that it occured more frequently in high educational and economic classes. Many of the herb physician related hwa(fire), a unique concept in old Chinese medicine, as the major etiological factors. Their diagnosis and recommendation for treatment varied so greatly that it seemed their concept of hwabyung was not clearly established. More herb physicians accepted that hwabyung could be a clinical entity but were reluctant to accept that it could be a culture-bound syndrome in Korea.