From Big Medical Encyclopedia

ACUPUNCTURE (synonym, acupuncture, acupuncture, chzhen-tszyu-therapy) — one of methods of reflex therapy consisting in impact on functions of an organism with the medical purpose various on force, character and duration of the irritations put in certain dot zones of a body surface. Method I. exists apprx. 5000 years. Its homeland — China.

Fig. 1. Bronze model of a figure of the person with more than 600 «points» put on it for acupuncture (Wang Wei-and, 1027).

The big merit in development of a method belongs to national Aesculapians, the found empirical way on a body of the person certain zones or points which irritation pricks or cauterization led to disappearance of a number of the painful phenomena. For acupuncture (chzhen) in the ancient time used the acute ends of stones — stone needles (byan-sha), for cauterization (Jiu) — lumps of the smoldering wormwood. Since chzhen and Jiu are carried out often at the same time or consistently to the same points, the method is considered as uniform and received the name «chzhen-tszyu-therapy». In a classical canon of the Chinese traditional medicine «Huandi-ney-tszin» (3 century BC) 9 forms of metal needles, technique and the equipment chzhen and Jiu, indications and contraindications to their use are described. In 11 century the first «Atlas of points» appears (Wang Wei-and, 1026), on a basis to-rogo in 1027 the bronze model of a figure of the person with more than 600 points (fig. 1) known during this period put on it is cast. Blossoming of a method continues up to 17 century, and then it ceases to be used almost. Again address chzhen-tszyu-therapy in China in 20 century 1955 the in-t of chzhen-tszyu-therapy is created research; studying of this method is introduced in the program of medical in-comrade for the first time. In Japan, Vietnam, Korea, Mongolia, India And. is widely adopted in 6 — 11 centuries. To Europe a method I. and cauterizations (chzhen-tszyu) got in 17 century and received the names «acupuncture» and «moxa» (cauterization, Jiu). More wide spread occurance in a number of the European countries, especially in France, the acupuncture receives in 19 century. Further development of this method in France happens in 20 — the 40th are 20 century, and in many countries of Europe, Asia and Latin America in 60 — the 70th. The international and national associations of acupuncture are created, monographs and the managements are published, there are special magazines, the international and national congresses are convoked. In the Russian literature 19 and the beginnings of 20 century were available P. Charukovsky's works (1828), A. A. Tatarinova (1853), P. A. Korniyevsky (1863, 1878), V. V. Korsakov (1928), A. Ya. Violina (1903), etc., devoted to a question I.; systematic studying and use of this method in the USSR began since 1957 at the initiative of M3 of the USSR. Big contribution to development And. N. I. Grashchenkov, I. I. Rusetsky, B brought. G. Vogralik, E. D. Tykochinskaya, M. K. Usova. Studying to lay down. use and training of specialists on And. carried out in specially organized M3 of the USSR two laboratories (in Moscow and Leningrad), at departments of nervous diseases of in-t of improvement of doctors (in Moscow and Kazan) and at department of hospital therapy Gorky medical in-that. In 1973 in Leningrad the All-Union scientific and methodical center of acupuncture is organized. The method received broad practical application, in hundreds to lay down. - professional, institutions of various cities and the republics I. V offices of 1976 in Moscow are created it is organized Central research by in-t of reflexotherapy to which functions of the all-Union scientific and methodical center of acupuncture are assigned.

In 1977 in the Moscow, Leningrad and Kazan in-t of improvement of doctors departments of reflexotherapy are organized. Method I. it continues to be studied, its further justification is necessary; its use is authorized only to the doctors who received special preparation.

Fig. 2. Eagles used to acupuncture.

Essence of a method I. consists in reflex impact on functions of an organism with to lay down. the purpose the irritations, various on force, character and duration, put in strictly certain dot zones located in skin and the subject tissues of the head, person, trunk and extremities. The irritation is carried out or by means of the thinnest metal needles entered by means of certain techniques on various depth (acupuncture, chzhen, acupuncture), or by warming up or cauterization by the smoldering wormwood (cauterization, Jiu, a moxa). Preferential fine needles to dia are used. 0,2 — 0,3 mm thanks to what there is the minimum disturbance of integrity of fabric and are absent sensation of pain. For giving of bigger flexibility, elasticity and the data to them to a minimum of oxidation level they are made of alloys of silver, gold or the premiums of stainless steel (nichrom). The needle consists of the handle and a core which shall be manufactured of an integral piece of a metal wire that prevents danger of an otlom of the handle from a core at introduction and, especially, during removal of a needle from fabrics. Length of needles is various: from 1 to 15 cm (fig. 2). For drawing superficial irritations there are so-called skin needles consisting of a bunch of 8 — 10 short needles connected together with the acute ends attached to the long handle of a round form. If it is necessary to leave needles in fabrics for a long time, then use the special needles of the T-shaped form made of alloy of gold. Depth of introduction of needles to fabrics is various depending on an anatomic arrangement of a zone, the constitution, gender and age of the patient, and also from extent of development of fatty and muscular layers.

Most widely apply specially processed wormwood to cauterization, at decay the cut arises intensive heat. In the past from densely pressed wormwood cones of various size were produced; they were imposed on certain points of skin. At decay of a wormwood on skin quite often there were burns, up to bulging therefore began to use wormwood cigarettes, to-rymi actually carry out not cauterization, but warming up. Decay of wormwood cigarettes and cones gives is long the remaining smoke therefore their use demands well aired rooms.

Fig. 3. Approximate topography of biologically active sites on a body surface: 1 — an anterior aspect; 2 — behind.

At the heart of a method I. impact on zones or points (fig. 3) — acupuncture, or the biologically active sites (BAS) lies. Total number of the points located on all skin surface reaches 693, their vast majority is known from an extreme antiquity. In east traditional medicine there are empirical principles of distribution of points on «channels», or «meridians». On the surface of skin there pass 14 «meridians» on which all points are located; 12 of 14 «meridians» carry conditional names of internals, and 2 — front and back median «meridians» — received the name on an arrangement. Points have a certain anatomo-topographical arrangement: 55 points — unary, are located on the centerline of the head, person, a front and back surface of a trunk; the others — 638 — steam rooms, are located on symmetric lines and areas of the head, person, extremities and trunks. All these points are not so much skin how many a skin projection of the nervous elements put in the subject fabrics at a depth from several millimeters to several centimeters. On a location they can be subdivided on skin and nervous, muscular and tendinous and nervous and neurovascular. As a result of the researches conducted as at us in the country, and abroad it is established that, unlike surrounding sites of skin, in points of influence lower electroskin resistance (EX-) and higher electric potential. The design of electronic devices for search and indication of points by definition EX-is based on this principle. At introduction to points of needles on a certain depth there is scale of peculiar feelings: ache, raspiraniye, pressure, numbness, heat, feeling of passing of electric current. These feelings are so specific that can serve as criterion for evaluation of accuracy of hit and correctness of drawing the corresponding influence. Data of a number of researches allow to consider acupuncture points of influence as microzones of the maximum concentration of nervous receptors of skin, vessels, muscles of sinews. However the nature of these points, their bonds with a nervous system and the functional changes happening in points under the influence of external influences remain still obscure. On an orientation of action and innervatsionny bonds of a point can be conditionally divided: 1) on points of a systemic effect which irritation exerts reflex impact on a functional condition of c. N of page; 2) on the segmented points located in the field of the skin metameres corresponding to a zone of an innervation of certain segments of a spinal cord, impact on which exerts segmentary-reflex impact on the bodies innervatsionno connected with these segments; 3) on the spinal points located on vertebralny and juxtaspinal lines according to the place of an exit of nervous roots and vegetative fibers; 4) on the regional points located in a zone of a projection to skin of certain bodies — Zakharyin's zones — Geda (see. Zakharyina — Geda of a zone ); 5) the local points intended preferential for impact on the subject fabrics (muscles, vessels, ligaments, joints).

Distinguish two main techniques And. — brake and exciting. Each of them has strong and weak option. At a brake technique of a needle enter slow rotary motions on depth from 1 to 12 cm (depending on a location of a point), causing the gradual accruing, intensive, preferential painless irritation which is followed by emergence of scale of the described feelings irradiating on considerable distance from an injection site of a needle. At the first, stronger option of a needle leave in fabrics for 30 — 60 min. and more, at the same time no more than in 4 — 6 points. At the second, weaker option influence continues from 20 to 30 min., intensity of irritation weaker with less expressed irradiation of feelings.

At an exciting technique the irritation superficial, strong, bystry, is put consistently in considerable number (8 — 10) of points and is followed by emergence of slight pain and feeling of passing of electric current. At the first option influence is made preferential by means of one needle entered by the punktiruyushchy movements into skin and hypodermic cellulose on depth no more than 0,3 — 0,6 cm lasting from several seconds up to 1 — 2 min. At the second option influence is made by 2 — 3 needles entered consistently into 4 — 6 points, needles leave in fabrics from 3 to 5 min. Reaction from various systems of an organism to influence by brake and exciting techniques is various since irritations differ not only on force, character and duration, but are addressed in various structures of a nervous system. The afferent impulses arising at the same time are heterogeneous. The local specific impulses extending on projective sensitive ways which come to thalamic transfer kernels and to somato-visceral areas of bark where there are centers of excitement are more characteristic of an exciting technique. The afferent impulses arising at a brake technique have diffusion, nonspecific character, extending tsentrostremitelno on multisinaptichesky and medlennoprovodyashchy ways to somato-visceral structures at the spinal, trunk, subcrustal and cortical levels, causing a number of local, segmented and general reactions. An important role in formation of responses on And. belongs reticular formation (see), to a hypothalamus (see) and to nonspecific department of a thalamus, than, apparently, broad range also speaks to lay down. actions of this method.

And. — the perspective method of reflex therapy, to-rogo is the cornerstone interaction of three main factors: a way and localization of influence, and also an initial functional background on which the irritation during the carrying out acupuncture falls. The choice of a technique is defined by character funkts, disturbances and problems of treatment. At increase in functions of various systems (pains, spasms, spasms) the brake technique is applied, at decrease in functions (paralyzes, paresis, an atony) — an exciting technique. Great value for efficiency And. has the choice of points of influence and their combination correct, adequate to a condition of the patient. During the carrying out And. also dynamics of a course of a disease is considered and depending on it the technique, a dosage, intervals between separate procedures, total number of procedures during a course and intervals between courses vary. Many methods of acupuncture for the present have empirical character and demand more strict scientific justification.

Advantages of a method: 1) simplicity of the equipment and the expressed efficiency at many funkts, diseases and pain syndromes (gives the chance to use And. for an analgesia at surgical interventions and postoperative pains); 2) lack of side negative reactions (in particular, allergic); 3) lack of need for use of pharmaceuticals.

The main indications for use of acupuncture: pain syndromes of various origin; diseases of a peripheral nervous system with a pain syndrome and motive disturbances (radiculitis, neuritis, neuralgia); postoperative pains and anesthesia at surgical interventions; allergic diseases (bronchial asthma, vasculomotor rhinitis, neurodermatitis); diseases of century of N of page (with vascular, trophic and secretory disorders); funkts, diseases of a nervous system with various patol, syndromes, and also system neurosises (in particular, separate forms of sexual neurosises).

Main contraindications: state after a heart attack; acute hyperphrenia; ebrietas; pregnancy (second half); acute infectious diseases; malignant new growths.

Aurikuloterapiya (an aurikulopunktur, Ayr-chzhen-lyao) — influence And. on certain active zones of an auricle, a cut allegedly causes the directed reflex reactions rendering therapeutic effect at diseases of internals, a nervous system. Lech. action of an aurikuloterapiya, perhaps, is caused by abundance of nervous bonds of an auricle through systems of cranial and somatic cervical nerves with the bulbar, thalamic, hypothalamic centers of a brain. Still in «Huangdi neytszin» it was claimed that an ear — the part connected with all organism including and with internals, by means of «channels» (tszin-May). The big contribution to development of an aurikuloterapiya was made by P. Nogier. However justification of a method, check of its efficiency demands further researches.

Fig. 4. Topography of biologically active sites in an auricle used at acupuncture on which certain parts of a body are allegedly projected.

In the figure 4 the topography of points and zones in an auricle on which certain parts of a body are allegedly projected is presented. Points on an auricle are located strictly naturally. The name is given to them in connection with their functional purpose: e.g., a point of heart, liver, the point regulating breath, a hypotensive point, etc. Some points are called on a disease, a cut treat by impact on this point — a point of hepatitis, cirrhosis; some kept traditional Chinese names — «thaw-yan» (sun), «shen-myn» (a gate of spirit). On observations of some authors at a disease of internals in the corresponding points of an auricle allegedly there is pain, rash, hillocks, ulcerations is more rare. It is established that active sites are characterized by the low resistance to a direct current, higher electric potential, the increased morbidity. At inflammatory processes, pain syndromes in the field of active sites indicators of conductivity sharply increase.

A technique and technology of introduction of needles at an aurikuloterapiya the same, as during the carrying out And. in other points of a body, but a needle apply only short; microneedles are used. The devices helping to find quickly and precisely BAHT on an auricle at the patient on the basis of measurement EX-are created.

The aurikuloterapiya at allergic diseases, disorders of functions of internals, pain syndromes, eye diseases is applied, an idiopathic hypertensia, bronchial asthma and other sufferings. Aurikuloterapiya, and also electropuncture of an ear are applied as a component of a balanced anesthesia at some operative measures, and also to mitigation of a pain syndrome in the postoperative period. Scientific development of indications and contraindications continues.

An electropuncture — influence by electric current on biologically active sites of skin of the person; represents to lay down. method of punktatsionny (dot) reflexotherapy. The electropuncture is made by means of the special devices allowing to run for quick search BAHT, to render on them to lay down. influence and also to study them biophysical, parameters are normal also of pathology, depending on funkts, a condition of an organism in general, separate bodies and systems. At the heart of diagnostic and to lay down. uses of an electropuncture lie the electric properties BAHT which are characterized by change EX-(decrease or increase), unlike surrounding sites of skin. Impact of an electropuncture on an organism is carried out in the reflex way.

The therapeutic effect of an electropuncture is based on an interconnection of electric characteristics BAHT (electric resistance of skin, its symmetry or asymmetry, etc.) with features funkts, conditions of the central and peripheral parts of the nervous system.

Fig. 5. The device for an electropuncture and an elektroigloanalgeziya «Elite-4 Electronics»: 1 — the instrument assembly; 2 — the probe with light indication for search electrically active sites (active electrode); 3 — the clip in the form of a bracelet fixed on a brush (a passive electrode).

Depending on indications and the purposes apply the following types of electric current to an electropuncture: direct, continuous current of low tension (galvanic); an impulse direct current of low tension, and also diadynamic current (Bernard's current), alternating current — low tension (sinusoidal), the high tension, high frequency (diathermy); electromagnetic field of the high frequency (UVCh). For an electropuncture special devices (fig. 5) allowing to run for search and detection of B of AT, diagnosis of a state BAHT, impact on BAHT for the purpose of normalization of their electric characteristics are used.

The electropuncture has the following features: 1) impact on B of AT is made by very small currents (several tens or hundreds of microamperes), in size close to biocurrents of an organism; 2) in comparison with traditional And. and impact on BAHT is made by cauterization without damage of fabrics.

Lech. influence of an electropuncture provides: spasmolysis of smooth muscles of blood vessels, hollow bodies, thin and thick guts, etc.; normalization of electric ratios in fabrics, change of intracellular colloid structure with a tendency to normalization patholologically the changed permeability.

A kind of an electropuncture is the elektroiglopuiktura — impact on BAHT electric current through the needles entered into fabrics.

Indications and contraindications for use of an electropuncture generally the same, as for acupuncture.

By means of an elektroiglopunktura it is possible to make anesthesia (an analgesia, an electroanalgesia) in surgery, traumatology, anesthesiology, stomatology, etc. In all cases it is necessary to consider specific features of each patient.

The electropuncture gives the encouraging effect at a number of diseases, however demands further researches with tselyo justifications of a method and identification of the most adequate parameters of electrostimulation, development of more reliable methods and devices.

See also Reflexotherapy , Segmentary-reflex therapy .

Bibliography: Vogralik V. G. Bases of the Chinese medical method chzhen-tszyu, Gorky, 1961, bibliogr.; Acupuncture, under the editorship of V. G. Vogralik, Gorky, 1974; Makarova L. A. A neurophysiological research of the segmented device of a spinal cord at postinsultny patients with a spastic hemiparesis, Works Leningr, nauch. - issled. in-that psikhonevrol., t. 62, page 13, 1972, bibliogr.; T and beev and D. M. and Klimenko of L. M. Ukhoigloterapiya, Kazan, 1976; T y to about the h and N with to and I am E. D. Igloterapiya at diseases of a peripheral nervous system, L., 1972; Usova M. K. and M about r about x about in S. A. The quick reference guide on acupuncture and cauterization, M., 1974, bibliogr.; C and at - l I to V. N., etc. Anesthesia by acupuncture in anasteziologichesky practice, Medical ref. zhurn., section 4, No. 8, page 1, 1976; H at L I am a N, the Guide to modern chzhen-tszyu-therapy, the lane with ki-taysk., M., 1959; L a n z an U. Agopuntura classica, v. 1, Torino, 1976; Mann F. Acupuncture, N. Y., 1973, bibliogr.

E. D. Tykochinskaya; V. S. Goydenko (aurikuloterapiya and electropuncture).