Generally, with more frequent comings and goings than the Dojo, it seems that it was often ex-doctors from the Tenyakuryo (the Bureau of Medicine where medical expertise and special skills were required) who joined jige families as Shinke.
一般に実務官僚たる地下は堂上よりも出入りが頻繁で、特に医療に関する専門知識や特殊技能が求められた典薬寮では、在野の医師が新たに官位を与えられて新家として地下家になる例が他の官職より多かったようである。