Modern aspects of channel diagnostics

Dr. Igor V. BOITSOV M.D..

MODERN ASPECTS OF CHANNEL DIAGNOSTICS

ELECTROPUNCTURAL DIAGNOSTICS:
MAIN TRENDS OF APPLICATION

The number of physicians using methods of traditional Chinese medicine has significantly increased since techniques of instrumental acupunctural diagnostics were developed and introduced into modern medical practice. The punctural diagnostics or, in other words, the diagnostics of acupunctural points and their status is a great support for those who resort to traditional Chinese medicine for diagnosing and therapy planning as well as for assessing treatment results. Special preference among various methods of punctural diagnostics is given to measurements of skin electric parameters, i.e. to methods of electropunctural diagnostics. Methods of electropunctural diagnostics (EPD) began to be widely introduced into the public health care in 80-90ies of the 20th century. The most acknowledged among all suggested varieties of EPD are the methods of R.Voll and Y. Nakatani. Their success is based on reliable normative scales developed by the authors, the approach which, in the end, always leads to high quality diagnostics.

What these two methods have in common is the assessment of such a diagnostic criterion as skin electroconductivity but, in fact, they are two independent trends of EPD. The main difference between them consists in using different parameters of electrical current for electropunctural testing. Basing on these parameters the authors determined certain conditions for diagnostic procedures and developed specific normative scales and rules of interpreting the obtained results.

While doing his research R.Voll empirically came to the conclusion that electric current parameters used  for diagnosing the status of biologically active points (BAP) must be 2-3 V(voltage) and about 15 mkA (current strength) [8]. Besides, to make the diagnostic reliable, the active electrode must be placed strictly on a point projection, that is why the electrode is designed as a metal rod 3 mm in diameter. If this rod exercises pressure on the skin with a varying force, the skin electrical resistance will naturally change depending on the intensity of this pressure. Hence, the pressing force in this method must be strictly regulated for the sake of obtaining reliable values but in practice it is determined subjectively by the physician who carries out the procedure. Proceeding from the testing current parameters and conditions of the testing procedure R. Voll developed a corresponding scale for interpreting the obtained results. The current strength values within 5,5 - 7, 0 mkA are considered normal for any testing point and they correspond to 50 - 60 units on Voll’s scale [8].

The main peculiarity of Voll’s method in the interpretation of the results consists in the author’s postulate that electrophysiological properties of a point do not reflect the condition of the whole organ or the whole functional system but refer only to its certain, strictly determined part (thus, for example, judging by the state of certain points on the stomach channel one can determine the state of the esophagus, stomach body, pylorus, peritoneum, etc.). A special role of R. Voll as a researcher consists in his proof of the fact that classical Chinese channels really have their representation on the skin surface since all the points for determining the state of a functional system lie on a certain channel corresponding to this system.

Recently there have appeared some diagnostic complexes which, for the sake of reducing a point exposure to an EPD procedure, suggest using the testing current lower than that in Voll’s method, i.e. 2-4 mkA. However, actual practice implies that one cannot reduce the testing current up to such small values because the results in the case will more and more depend on a great number of artifacts appearing in the course of testing and, if the measurements are repeated in the same patient under the same conditions 10-15 minutes later, different diagnostic conclusions will be obtained.

Basing on extensive  empirical data of his research Nakatani worked out his own method of EPD and convincingly substantiated the application of  testing current parameters of 12 V(voltage) and 200 mkA (current strength)  for diagnostic purposes in order to asses the so-called “viscero-cutaneous sympathetic reflex” [4,6]. Nowadays this method is recognized all over the world and is the most popular not only with specialists in acupuncture but also with general practitioners. To achieve his goal Nakatani suggested that not points but biologically active zones should be tested. Hence the diameter of the active electrode according to Nakatani’s method makes up 10 mm and its metal contact is placed inside an ebonite cup where some cotton wool soaked with NaCl has been put before the testing procedure. In this case there is no direct contact of the active metal electrode with the skin, the effects of the skin polarization are reduced and the testing current is, through the soaked cotton wool, uniformly applied to the skin over the whole surface of the testing electrode cup. During the diagnostic procedure the nerve endings in the skin are exposed to the testing current and segmentary irritation from afferent vegetative nerve endings is transmitted via intercalary neurons to efferent sympathetic vegetative neurons. The excitement of the latter results in changing of vegetative regulation processes in the skin under the active electrode. The changed vegetative regulation of the skin is responsible for the alteration of  skin electrophysiological properties and, as a rule, leads to the decrease of  electrical resistance and to the increase of  electroconductivity of the given skin area.

The skin in the areas of the 12 symmetrical representative zones belonging to certain dermatomes or, to be more precise, to the segmentary vegetative apparatus innervating this or that dermatome, is variously susceptible to Nakatani’s signal in a normally functioning organism that is why the electroconductivity in these skin areas changes differently. Having revealed this peculiarity, Nakatani developed his scales for interpreting electroconductivity values of each dermatome and created standard, the so-called “ryodoraku” charts [4,6]. Since the vegetative regulation is normally variable, the “ryodoraku” scales reflect an empirically revealed intensity of response for each dermatome (fig.1). If the response of each dermatome yielded its theoretical maximum, the resulting picture would be as follows: the peak response would be registered for the three heaters channel and the large intestine channel whereas the current strength in the case would be equal to the short circuit current of 200 mkA. This value would make up about 190 mkA for the lung channel, 170 mkA for the pericardium and the small intestine channels, 160 mkA for the pancreas and kidney channels, 150 mkA, for the urinary bladder channel and about 140 mkA for the heart and stomach channels. The liver and gall bladder channels are the last in this list: the peak value of current strength in these skin areas would be no more than 130 mkA with the testing current of 200 mkA , the voltage of 12 V and the signal duration of 3 sec. Practical experience shows the correctness of these values for all skin types independent of the race of the tested.

 

Thus, according to Nakatani’s data each dermatome has its own scale for interpreting electroconductivity values of the skin. Besides, specific intervals of normal values are determined for each testing procedure depending on an average value derived from all obtained figures of electroconductivity values. As it is shown in fig.1, equal  values of current strength (for example of 100 mkA) lie on different levels of the interpretation scales in accordance with  the response intensity of the corresponding dermatomes which is empirically set for a normally functioning organism. Such equal values obtained by testing can be normal for some dermatomes, but excessive or insufficient for others. And this fact makes the main difference in the interpretation of values when compared with Voll’s method of BAP testing with light testing current. In the latter case equal electroconductivity values of a certain point are equally assessed being compared to standard values of a norm interval (50-65 units on Voll’s scale) [8].

So testing current used in Nakatani’s method is heavy enough to provoke a response in the segmentary sympathetic vegetative apparatus. This method is based on the analysis of the intensity of vegetative reactions in dermatomes in response to a standard testing signal and of the correlations of these reactions. The author’s approach to the assessment of the results consists in estimating the dermatome vegetative regulation which correlates with the vegetative regulation of the corresponding functional systems according to the doctrine of the oriental medicine about the localization of external branches of classical Chinese channels [1].

All the above-mentioned makes it clear that a standard “ryodoraku” chart cannot be used for interpreting electroconductivity values obtained by testing with other currents than those used in Nakatani’s method. Any other testing currents may provoke an unpredictable reaction in the skin and naturally special scales and interpretation rules must be developed for such cases. Unfortunately, many designers of EPD-devices reduce voltage and strength of the testing current simultaneously referring to Nakatani’s method in the title of such devices. One cannot agree with the designers of the diagnostic systems who suggest that other current parameters should be used as a testing signal for various channels and simultaneously take peak values of the current strength from “ryodoraku” scales (fig.1). Such approach violates the main principle of Nakatani’s diagnostics – to asses how the values of the sympathetic response reaction in dermatomes correlate with the same standard testing signal while the peak values of the current strength in “ryodoraku” scales reflect an empirically set intensity of such reactions for a normally functioning organism.

The opponents of Nakatani’s method put forward rather equivocal arguments. On the one hand, they are against using the testing current parameters of 12 V and 200 mkA which, in their view, are unacceptable for diagnostic purposes. On the other hand, they point out that by this method it is impossible to repeat a testing procedure earlier than in 24 hours. To prove their first argument they refer to the data from medical literature about adverse reactions which develop even when the acupuncture points are exposed to a much lighter current of 10-20 mkA. These reactions can include nausea, dizziness, cardiac and breathing arrhythmia, falling or rising blood pressure and general weakness in some patients. But it is well-known that such vegetative reactions, although rarely, can be observed in some patients, especially men, because of a common fear for any treatment procedure, for example an ordinary injection. This is also true for acupuncture since this method of treatment is new for most patients. In my acupuncture practice there was only one case of a patient fainting while I was searching the necessary point  slightly pressing the skin with a usual metal probe, but none of my other patients examined by Nakatani’s method (and their number exceeds 1000)  experienced the above mentioned adverse reactions,  even  the mildest ones.

Table
Electrophysiological properties of some points and their correlation with changes in organs and systems according to R.Voll

Points to be tested

Correlation with changes in the organism

LU.9

Trachea

PC.7

Coronary vessels

HT.7

Left and right branch of His bundle

SI.3

Right – descending part of the duodenum  
Left – bend between the duodenum and the empty intestine

SI.4

Right – upper horizontal part of the duodenum
Left – descending part of the duodenum

SI.5

Vertebral column, cervical part

TH.3

Hypophysis, epiphysis,

TH.4

Practically coincides with the point “Degeneration of the head organs ”

LI.3

Right – ascending part of the large intestine
Links – bend of the  large intestine

LI.4

Right – the blind gut 
Left – left part of the transverse colon

LI.5

No correlation

SP.3

Right – carbohydrate metabolism, amylase and maltase production
Left – function of the red pulp of the spleen

LR.3

Perivascular and periportal filed of the liver

KI.3

Glomeruli, convoluted tubules of the kidneys

KI.4

Medium and lower rectal  plexus

BL.64

Women – the ovary, the epoophoron, the fallopian tube
Men – spermatic cords, the epididymus

BL.65

Women – the vagina, urethra, uterus, broad ligament of the uterus
Men – the prostate, penis, urethra, seminal vesicles, tubercles

GB.40

No correlation

GB.41

Lobous ducts of the right lobes of the liver

ST.42

The  right and left  upper part of the esophagus

ST.43

The stomach path , the ascending part of the angular notch

The second argument of Nakatani’s opponents about the impossibility of a repeated testing earlier than in 24 hours does not correspond to the truth. The skin area which has been exposed to testing current and which electrophysiological properties have been altered naturally needs some time for restoring its initial values. But the period for restoring takes from 1 to 5 minutes and the time interval between any two repeated measurements makes up 10-15 minutes, so in this period of time the main correlations of electroconductivity values in dermatomes will be restored. Besides, Nakatani’s method is not used for the analysis of absolute current values as they are but estimates their correlations and this is a more stable index with regard to the repetition of testing results if compared to absolute values of electroconductivity in a living organism.

Summing up we single out the following main trends of electropunctural diagnostics:

  1. Testing of skin electrophysiological properties in the area of biologically active points. One should take into consideration that electrophysiological properties of a BAP do not reflect the condition of the whole functional system but refer only to its certain part. To test these properties one should apply light current which parameters determined by R. Voll which are equal to15 mkA (current strength) and 1-3 V (voltage)
  2. Testing of the dermatome vegetative regulation and comparing of the obtained characteristics with the vegetative regulation of the functional systems and the condition of the corresponding classical channels. The testing current used for the purpose must be heavy enough to provoke a response reaction in the segmentary vegetative apparatus. The current parameters are empirically set by Nakatani and make up 200 mkA (current strength) and 12 V (voltage). We call this diagnostic trend ”segmentary neurofunctional diagnostics” and it will be later discussed here in detail. First of all we theoretically substantiate the application of the segmentary neurofunctional diagnostics and its methods for determining the functional condition of the channel system in the human body.

Fig.1 Standard Y. Nakatani’s chart (schematic picture)

 

SEGMENTARY NEUROFUNCTIONAL DIAGNOSTIC AS A METHOD FOR TESTING
THE CONDITION OF THE CHANNEL SYSTEM

The proposed term “segmentary neurofunctional diagnostics” comprises diagnostic methods allowing us to test the ability of the segmentary vegetative apparatus to realize the vegetotrophic regulation.
According to traditional Chinese medicine the diagnostic of the so-called “vital energy” circulation through the human body always precedes the therapy. The method and the place of an acupunctural exposure have always been determined by the character of disturbance in the YING –YANG balance [3,5,7]. The most informative method of acupunctural diagnostics in traditional Chinese medicine consists in examination of the pulse in the radial points of the upper extremities. The main principles of the pulse diagnostics determining the disturbance levels of the YING-YANG balance are discussed below.

First it is stated if there is a reduction or an amplification of all superficial or deep pulses in the both upper extremities which feature is characteristic of general surplus or deficiency of the vital energy in the human body. It is the so-called first level of disturbance – the level of “the general energy of the human body”.
The main distinction of the second level of disturbance in the balance of the general YING and the general YANG is the difference between superficial and deep pulses. The following types of disturbance are to be singled out: 1) surplus of the general YANG and relative deficiency of the general YING (amplification of superficial pulses which prevail over the deep ones); 2) deficiency of the general YING with relative surplus of the general YANG  (reduction of deep pulses and prevailing of the superficial ones); 3) surplus of the general YING with relative deficiency of the general YANG (amplification of deep pulses which prevail over the superficial ones) ; 4) deficiency of the general YANG and relative surplus of the general YING  (reduction of superficial pulses and prevailing of the deep ones).

Characteristic of the third level is quadrant disturbance of the YING-YANG-balance, in other words this level includes various types of surplus and deficiency of YING and YANG of the upper extremities and YING- and YANG of the lower extremities. Pulse diagnostics reveals disturbance typical for such pulse changes, for example prevailing of superficial pulses in position I and III on the right arm and in position I on the left arm speaks for YANG-surplus of the arms whereas prevailing of deep pulses in position II on the right and left arms and in position III on the left arms speaks for YING-surplus of the lower extremities.

But there are more often such cases when the disturbance of the YING -YANG balance does not refer to the whole channel system but involves separate channels and that is the fourth level of disturbance, so in this case the pulse diagnostics requires the highest mastery. It takes years under the guidance of an experienced teacher to learn revealing and correctly interpreting single changes of the pulse wave in certain positions in order to be able to constantly compare your own subjective perceptions of patients’ pulse beatings with the perceptions of your teacher.

It is practically impossible for western specialists to master the pulse diagnostics that is why they use instrumental methods of channel system diagnostics for conducting efficient acupuncture therapy. Of many instrumental methods of acupunctural diagnostics we have singled out two main trends for measuring the electrical parameters of the skin. The aim of the fist trend is to diagnose electrophysiological properties of the skin in the area of acupuncture points and to compare these properties with the state of certain parts of the inner organs. This trend does not solve any problems of channel diagnostics. A vivid example of this trend is EPD by Voll’s method. Below we will apply the term “electropunctural diagnostics”, i.e. diagnosing the condition of acupuncture points, namely to this trend. To investigate the condition of the channel system in modern medical practice it is preferable to use methods of the segmentary neurofunctional diagnostics. One of the varieties of this diagnostics is “ryodoraku” diagnostics (Nakatani’s method).   

Segmentary neurofunctional diagnostics consists in determining the degree of vegetative regulation of the inner organs on a basis of changes in activity of segmentary vegetative neurons in response to a slight stimulation of the skin surface in distal parts of the extremities with a standard electric impulse. In other words, the interpretation of the obtained values implies correlation between the vegetative regulation of the skin in the area of certain dermatomes and the vegetative regulation of the inner organs. The segmentary vegetative apparatus includes vegetative neurons of the spinal cord and neurons of paravertebral, prevertebral and spinal ganglia which were formed in the process of embryogenesis. In our opinion, testing of the morphofunctional system activity from the standpoint of the segmentary vegetotrophical regulation is, in fact, the main method of diagnosing functional systems in terms of traditional Chinese medicine.

According to theoretical postulates of traditional Chinese medicine a functional system includes the following constituent parts: a ZANG- or a FU- organ, an outer and an inner run of a channel, a musculotendinous channel of the same name and collateral branches connecting all constituents of a functional system into a single whole. If any of the functional systems is pathological, all its constituent parts also suffer. Modern neurophysiology regards the segmentary vegetative apparatus (fig.2) as a unifying ground for all constituent parts of a morphofunctional system (MFS). In this apparatus vegetative neurons of a certain segmentary level (neurotome) control, in terms of vegetotrophic regulation, the corresponding splanchnotome (i.e. an inner organ of a morphofunctional system:  a ZANG or  FU-organ according to Chinese traditional medicine), the dermatome (i.e. representation of the given morphofunctional system on the skin  - an outer run of a channel), the myotome and the sclerotome (a musculotendinous group of a MFS or a musculotendinous channel of the same name in terms of traditional Chinese medicine). The inner run of a channel is made up of neuron processes which being a part of the nerve trunk and of conduction trunks provide for the integrity of the whole MFS and its interrelations with other systems. In the process of embryogenesis all constituent parts of a MFS turned out to be interrelated through a common initial innervation which persists when organs and tissues shift because of a simultaneous growth of conductors. It means that basic theoretical postulates of traditional Chinese medicine about functional systems, ZANG- and FU-organs and related channels by no means contradict to modern knowledge of anatomy and neurophysiology. Besides, the given model of the conformity between a functional system according to traditional Chinese medicine and modern ideas about the MFS do not deny morphological and functional reality of the channel system. In our view, such notion as “channel energy” means an electromagnetic constituent of all electrical and biochemical processes in the body. This constituent has various frequency parameters and is exposed to the influence of an outer magnetic field.  

So the segmentary neurofunctional diagnostics uses the principle of organizing the functional system on a basis of theoretical postulates of traditional Chinese medicine and modern scientific data. The diagnostic procedure can be described as follows (fig. 3). Step I: the active electrode is placed onto the skin in the area of some dermatome and via it the skin nervous receptors and the subcutaneous tissue are irritated with electrical current (the advantage of electrical current as an irritator lies in an easy standardization of its parameters such as voltage, current strength, time and area of exposure). Step II: As a result of the irritation a local depolarizing potential is produced in the terminal nervous receptors. Step III: under the influence of a sufficiently powerful irritator the depolarizing potential reaches its critical level and is transformed into a nervous impulse which is transmitted to neurons via vegetative afferent fibers. Step IV:  activity of the vegetative neuron apparatus on the corresponding segmentary level is changed, the character of these changes depends on the functional state of neurons prior to the irritation. Step V: the reaction of the neuron apparatus in response to irritation changes the vegetative regulation of the skin under the active electrode. Step VI: electrophysiological properties of the skin in this area, in particular its electrical resistance, are also changed. Step VII: electroconductivity of the skin under the active electrode is measured by the investigator and, after the representation zones of all dermatomes are tested, the results are interpreted with regard to normative values for a response reaction of the vegetative neuron apparatus on various segmentary levels. 

According to the results of diagnostic investigation one makes a conclusion about the functional activity of higher supersegmentary centers of the nervous system and this is the level of the general tonus of the human body. Increasing or decreasing response reactions of all segments point out to rising or lowering of the general tonus of the organism. If you analyze the clinical picture of this type of disturbance, it will be identical to the picture observed in a patient with increasing or decreasing of ”the general energy of the organism” according to traditional Chinese medicine.    

It follows a general analysis of the values obtained from the dermatomes which correspond to YING and YANG channels – the second level of disturbance. If response reactions from outer dermatomes prevail over reactions from the inner surface of the extremities, the clinical picture of the patient will demonstrate the prevalence of the symptoms which point to excessive activity of the sympathetic part of the vegetative nervous system, and it corresponds to the syndrome of the excessive general YANG according to traditional Chinese medicine. And on the contrary, if response reactions from inner surfaces of the extremities prevail, the clinical picture of the patient will demonstrate the prevalence of the symptoms which point to excessive activity of the parasympathetic part of the vegetative nervous system and it corresponds to the syndrome of the excessive general YING according to traditional Chinese medicine. On the second level you analyze the correlation of activities in the sympathetic and parasympathetic parts of the vegetative nervous system and these activities are determined by the activities of the corresponding neurons in medulla oblongata and medulla spinalis. Simultaneously you can differentiate absolute or relative sympathicotonia and absolute or relative parasympathicotonia. 

On the third level a comparative analysis of the conductivity on the outer and inner surfaces of the extremities is conducted. The disturbance of conductivity on this level is determined by activity changes in neurons of the whole series of segments and according to traditional Chinese medicine is associated with the balance disturbance between YANG and YING of the upper extremities and YANG and YING of the lower extremities. In neurological practice such disturbance is caused by affection of the brain or spinal cord as well as of the nervous plexuses.

On the fourth level the disturbance in the activity of the neuron apparatus of separate segments (neurotome) is analyzed. Such disturbance influences the corresponding morphofunctional systems, namely in the inner organs (splanchnotome), in the skin and subcutaneous tissue (dermatome), in the muscles and tendons (myotome and sclerotome), in the fascias and vessels (sclerotome) and in the conductive ways (a part of the neurotome). This level of disturbance corresponds to changes of activity in separate channels which according to traditional Chinese medicine correlates with the activity of the related functional systems.

So in order to know the general condition of morphofunctional systems or the condition of the channels as their constituent parts western specialists of acupuncture resort to methods of segmentary neurofunctional diagnostics (SNFD). The principle of segmentary neurofunctional diagnostics fully corresponds to traditions of diagnostic search in the ancient oriental medicine and this type of diagnostic investigation gives a rather full picture of a patient’s state on all levels of possible disturbance.

Below we discuss in detail the most used methods of segmentary neurofunctional diagnostics.

Fig. 2. Main constituent parts of a morphofunctional system

Fig. 3 Scheme of segmentary neurofunctional diagnostics

 

CHARACTERISTICS OF SEGMENTARY NEUROFUNCTIONAL DIAGNOSTIC METHODS

Since the skin is more accessible for investigation than the inner systems of the body the most applied methods of segmentary neurofunctional diagnostics are those which use cutaneous segments (dermatomes) for diagnosing the functional condition of the segmentary vegetative apparatus. The general scheme of such testing is given in fig. 3

Qualitative and quantitative parameters of the response reaction depend on the physiological condition of all participants of the reflex arch, but first of all, on the functional activity of segmentary efferent vegetative neurons.

The following interpretation of diagnostic results, or parameters of the reflex response reaction, is carried out as follows:

  1. Medical doctors interpret the results in the context of functional activity of the inner organs and systems of the body on a basis of the unity of splanchotomes (segmentary vegetative regulation in visceral systems) and dermatomes (skin segments);
  2. Surgeons assess the character of vegetative regulation of the skin grafts for further transplantation or on the sites of surgical incisions;  
  3. Doctors in sport medicine analyze the segmentary vegetative reaction for the assessment of the musculotendinous groups of morphofunctional systems (sclero-myotomes);
  4. Specialists in cosmetic dermatology compare the vegetative regulation of the dermatomes and the outward appearance of the corresponding skin areas;
  5. Specialists of traditional Chinese medicine make correlations between the obtained vegetative characteristics and the condition of the patient’s channel system.

Common for all methods of segmentary neurofunctional diagnostics is the determination of the vegetative regulation character for inner organs, musculotendinous apparatus and integument on a basis of assessing the excitement of the neurons of the segmentary part of the autonomic nervous system on the background of low-intensity stimulation of nerve receptors in the skin segments.

Electrical current is usually used as an irritator for the conduction of such investigations, rarely it can be a thermal source.

 In the first half of the 20th century Doctor Akabane was the first to suggested warming-up with an absinth cigarette of certain zones on the distal phalanges of the fingers and toes in order to determine the threshold of pain sensitivity [2]. According to the findings the time period from the beginning of the warming up to the appearance of an intense burning sensation in symmetrical zones of the right and left extremities is assessed.  If there is a great difference in time, the conclusion is made that one of the conjugated Chinese channels corresponding to the given skin segment is in the state of disturbance of the right-left balance or, in other words, one of the symmetrical channels is excited and the other is depressed. At present this principle is still used in medical practice and it is known as the method of thermoalgometry. Nowadays a thermal diode is used instead of an absinth cigarette and the process of testing is automated so that the patient himself registers the moment of pain sensation by pressing the button. The range of segments in use is also expanded. Included into the range are not only those segments which correspond to the Chinese channels but also the channels which were discovered by Doctor R. Voll.  However, the criterion for the final assessment remains the patient’s subjective answer whether it hurts. There cannon be any objective parameters since we cannot foresee how the patient’s threshold of pain sensitivity will change in the process of testing and after, for example, the fifth, the tenth or after twentieth sudden painful irritation. Vegetative findings which unpredictably change in the process of diagnostics cannot be objectively assessed either. Besides, this diagnostic procedure cannot be applied to children, mentally ill patients, in cases of spinal disturbance, radiculopathy, distal polyneuropathy and the like.

Among other methods of segmentary neurofunctional diagnostics the “ryodoraku” method is most frequently used. This method was suggested by a Japan doctor Nakatani in the middle of the last century. Electric current is used in the method as an irritator and, what is very important the power of irritation never exceeds the threshold of the patient’s subjective perceptions. Thus, the patient does not perceive any irritation during the procedure of testing and the response reaction of the efferent neurons is assessed in the context of changing electroconductivity of the skin under the active electrode. The procedure is not complicated from the technical point of view. When the test is over, normative parameters for each dermatome are calculated and the obtained results are compared with these parameters. If the general tonus of the body is normal and the sympathetic and parasympathetic systems  are well-balanced and, besides, if there are no specific quadrant disturbance of conductivity in the extremities, the measured parameter lying within the range of the norm points out that the vegetative regulation of the given skin area is normal. It also means that all the constituent parts of the corresponding morphofunctional system (the dermatome, myotome, sclerotome, osteotome, splanchnotome) are also normally provided in the context of vegetotrophic regulation. If a measured parameter of any dermatome is higher or lower than the normative range, it speaks for an increased or deficient vegetotrophic provision of the given MFS.

It goes without saying that this test outperforms the thermoalgometry, first of all in the objectivity of the measurements which do not depend on the patient’s mood. However, this method also has its drawbacks which will be discussed later when we introduce the fundamentals of the next method of the segmentary neurofunctional diagnostics.

Thus, the next, third method of segmentary neurofunctional diagnostics is the author’s method of “dynamic segmentary diagnostics” or, as we call it, the DSD- test.

As an irritator we use electrical current with voltage of 6-21 V and current strength of 150-250 mkA  (when the electrodes are closed).The intensity of irritation of the skin receptors does not reach the threshold of the patient’s subjective perceptions.

The testing procedure consists of the following steps:

Step I: nerve receptors of the representative zone in the skin segment are excited with an irritating signal of low intensity.
Step II: the strength of irritation gradually increases and reaches the maximum level at the moment of the peak response reaction.
Step III: Dynamic changes of skin electroconductivity under the active electrode are constantly followed. The diagram of these changes is shown in fig.4. As nerve receptors in the skin are irritated, the electroconductivity begins to grow and reaches its peak values in the time period t1, which is equal to 7-50 sec, i.e. a further irritation of the skin does not lead to an increase of a response reaction from segmentary vegetative neurons. If the skin nerve receptors are further irritated, in a certain period of time t2, which is equal to 1-2 min, the activity of the neuron apparatus begins to fall. It is depressed and the skin electroconductivity under the active electrode decreases to its initial values in the period of time t3, which is equal to 3-10 min.

So in the process of testing the following phases are singled out: phase I - excitement of the neuron group (fig. 4), phase II – stabilization or ‘plateau” (fig. 4) and phase III - depression of neurons (fig.4). To spare time, the testing in medical practice is conducted till the moment of stabilization of skin electroconductivity parameters on their peak values is reached, i.e. till the moment of reaching “plateau”. That is why if you use the programmed apparatus complex “POINT”, the DSD-test procedure of the all 24 skin grafts will, as rule, make up 10-15 minutes.

The interpretation of diagnostic results consists in calculating and estimating the general index of the body tonus, parameters of the balance between the sympathetic and parasympathetic systems and skin electroconductivity parameters of the upper and lower extremities, as well as parameters of a reflex response reaction of certain morphofunctional systems – the parameter of vegetative provision of activities (VPA-parameter) and the parameter of vegetative reactivity (VR-parameter).

The VPA –parameter denotes those peak values of skin electroconductivity which have been measured while testing a dermatome and they are electroconductivity values of the “plateau” phase. Fig.5 demonstrates diagrams of the systems with the VPA parameters which can be normal (“B”), elevated (“A”), or decreased (“C”).

The VR parameter is calculated according to the formula:

                      Imax
VRi
= 0,9 ki  ------    ,
                       t0,9
         where VRi – VR -parameter;
          Imax – current strength for reaching the “plateau”;
          t0,9 – time during which the current strength increased to 0,9 х Imax;
          ki –   segmentary level factor

Fig.6 demonstrates diagrams of the systems with a normal VPA parameter but with different vegetative reactivity (VR) which can be normal (“B”), elevated (“A”), or decreased (“C”).

Fig. 4  Phases of the neuron apparatus response reaction during DSD-testing (explained in the text)

Fig. 5 Various changes of the parameter of vegetative provision of activities for a MFS during DSD -testing (explained in the text)

Fig. 6  Various changes of vegetative reactivity parameter during DSD -testing (explained in the text)

Fig. 7 Variants of interpretation of an elevated “ryodoraku” parameter (explained in the text)

Thus using the results of the dynamic segmentary diagnostics the physician can obtain objective data about vegetotrophic regulation of morphofunctional systems and of the whole body in general. Besides DSD-testing avoids the main drawbacks of the “ryodoraku” test which are as follows

In the first place, when the investigator measures an elevated electroconductivity parameter by Nakatani’s method he cannot determine what has caused such an elevation of  skin electroconductivity and cannot decide whether the morphofunctional system is overloaded and requires an elevated vegetative provision (fig. 7 “A”), or   whether the system simply has an elevated vegetative reactivity (fig. 7”B”).

In the second place, when the investigator obtains a decreased parameter in the “ryodoraku” test, he cannot determine what has caused such a reduction of skin electroconductivity and cannot decide, whether the morphofunctional system is really depressed and the parameter of vegetative provision of MFS- activities is decreased (fig. 8 “A”), or   whether only the vegetative reactivity of the system is reduced (fig. 8”B”).

In the third place, when the investigator obtains a normal parameter in the “ryodoraku” test he cannot foresee how this parameter will behave when skin receptors are further irritated. The investigator does not know, whether this parameter will further increase and then stabilize on some normal values (then the vegetotrophic provision of the system is normal - fig.9, ‘C’), or whether after a normal answer to low - intensity irritation the segmentary neuron group will be exhausted by further irritation (fig.9, ‘B’) or, on the contrary, extremely excited (fig.9, ‘А’). In this case the electroconductivity parameter on the plateau phase will be abnormal which points to an obscure or compensated pathology of the given MFS.

Fig .8  Interpretation variants of a decreased “ryodoraku” parameter (explained in the text)

Fig. 9 Interpretation variants of a normal “ryodoraku” parameter (explained in the text)

In conclusion, if we compare two main trends of diagnostic search based on electrical parameters of the skin such as electropunctural diagnostics and segmentary neurofunctional diagnostics it can be stated that the latter can be used to test the activity of the human channel system. Moreover, among the varieties of the segmentary neurofunctional diagnostics the dynamic variety or the dynamic segmentary diagnostic is the most reliable and informative method.

 

The basic literature:

1. Anatomical Atlas Of Chinese Acupuncture Points. Shandong, 1988

2. Akabane K. Method of Hinaishin. - Tokyo, 1956.
3. Chinese Acupuncture And Moxibustion. Beijing, 1987.
4. Hyodo M. Ryodoraku Treatment. Osaka, Japan, 1985.
5. Inoue K. Clinical Pulse Diagnosis In Oriental Medicine. Tokyo, 1965.
6. Nakatani Y., Yamashyta K.  Ryodoraku Akupunkture. Japan. Tokyo. 1977
7. Sun Xue Quan. Applied Chinese Acupuncture For Clinical Practioners, Shandong, 1985.
8. Voll R. Topographische Lage der Messpunkte der Elek­troakupunktur. Textband I,II,III - Aufl. Uelzen, 1976.

Комплексная терапия заболеваний позвоночника

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