AKUPUNKTURA I PSIHIJATRIJA

AKUPUNKTURA I PSIHIJATRIJA

Maravic, G., Deura, M., Milovanovic, S.

Akupunktura je starokineski naCin leeenja bolesti ubadanjemigala u odredjene taeke na koii ideo je tradicionalne kineskemedicine (TKM). TKM je zasnovana na principima kineske iilozofije, a, pored toga, razvila je i sopstveno ucenje 0 funkcionisanju organa i 0 faktorima koji remete to funkcionisanje.Mentalne aktivnosti se u TKM shvataju kao vrsta iizioloskefunkcije organa i pripisuju se srcu, jetri i bubrezima dok semozak u ovom smislu ne razmatra. Mentalna obolenja seshvataju kao obolenja ovih organa i Ieee se po istim principimakao i telesna. RazliCite emocije se pripisuju razliCitim organima injihova preteranost tnoie biti i uzrok i posledica bolestiodqoverejuceq organa. Objasnjenja, dijagnostieke i terapijskeprocedure, iako izgledaju neobicno, predstav/jaju potpun idosledan sistem i mogu se uspesno koristiti. Akupunktura jenasla primenu i u zapadnoj medicini, a psihijatrija je jedno odpo/ja koja nude moqucnosti za njeno koristenje.

Kljucne rec;: akupunktura, psihijatrija.

Akupunktura je starokineska metoda lecenja pornocu igala koje sezabadaju u odredjene tacks na kozi. Ona je dec tradicionalne kineskemedicine (TKM) koja je, prema najstarijim zapisima, stara pet hiljada

godina. TKM je zasnovana na temeljima drevne kineske filozofije i kulture.Kineska filozofija, u principu polazi od stava 0 jedisntvu makrokosmosa imikrokosmosa. To znaci da se ista pravila i zakonitosti mogu primeniti i nacitavu prirodu, i na pojedinacne pojave, i da mogu posluziti kao sredstvo zanjihovo tumacenje i predvidjanje. Izuzetak od ovoga nije ni funkcionisanjecovekovog tela, kako u zdravlju, tako i u bolesti. Osnovni principi koji postojekako u Citavom kosmosu, tako i na nivou tela, pa i pojedninh njegovih delova,su jin i jang (yin i yang). lako misticnoq prizvuka, ovi principi izrazavaju

ENGRAMI 22 (2000) 1 65


odnose dualiteta pojava sa kojima se svakodnevno srecerno, poput dana inoci, rnuskoq i zenskog, dobra i zla i svega ostalog. Najprostije receno, jin ijang predstavljaju odnose izmedju suprotnih parova istorodnih pojava. Principjin/jang se smatra osnovnom silom kojoj se podvrgavaju stvari, i u kineskojkulturi je razradjen u raznim oblastima pa i u medicini. Medjuodnos jina ijanga obezbedjuje promene, odnosno kretanje, a ovo kretanje se odigravaposredstvom energije koja se naziva Ci (qi). Ci je u stalnom kretanju i onornoqucava kretanje drugih stvari. Kao sto postoji u prirodi, on postoji i uIjudskom telu, i to u nekoliko oblika, pokrece organe i vrsi druge funkcije itako obezbedjuje vitalitet organizma. U TKM terapija je konceptualizovanakao postupci koji velikim delom deluju neposredno na ci organizma i na tajnaCin ostvaruju ozdravljenje, kao sto i bolest u velikom delu predstavljaporernecaj ove energije. Ovaj koncept, oCigledno, je tesko shvatljiv, i to nesamo "zapadnom umu", vee i Kinezima na prvim godinama studija tradicionalne medicine, koji imaju probleme sa njegovim usvajanjem.

Iz ucenja 0 jinu i jangu proistice Zakon pet elemenata. Pet elemenata(drvo, vatra, zemlja, metal, voda) simbolisu pet kategorija stvari i njihovemedjusobne odnose stimulacije, slabljenja iii kocenja, U ove kategorije semogu svrstavati najrazliCitiji modaliteti pojava i tako prikazati odnosi tih modalitta na nacin koji ima odredjeni smisao. Na primer, emocija koja odgovaravodi je strah, a emocija koja odgovara vatri je radost, i kao sto voda gasivatru, tako i strah gusi radost. Ovakvi odnosi analogije se primenjuju namodalite najrazlicitijih pojava (qodisnja doba, strane sveta, organe tela,osecanja, kao sto je dato u primeru i mnoge druge stvari), i koriste se umedicini, kako u dijagnostici, odrazavajuci funkcionisanje organa, tako i uterapiji, procenjujuCi koji agens deluje na koji patoloski faktor u cilju otklanjanja bolesti.

Sazeto receno, iste sile koje odrzavaju makrokosmos iii prirodu postoje i ucoveku i podlezu istim zakonitostima. Pored ovih opstih principa, koji se pokineskoj filozofiji (taoistickoj, precciznije), mogu primeniti na sve pojave, TKMje razvila i specificnija ucenja koja se ticu anatomije, fiziologije i patofiziologije, a koja su takodje uklopiva u ranije navedeno. Svaki deo tela iii organ imasvoj jin i jang. Na primer, gornji delovi tela, leva strana i ledja su jang,suprotno ovome je jin, sest parova organa su u medjusobnom odnosu petelemenata itd.

Kineska anatomija i fiziologija su prilicno bliske i podela organa u TKM,koja je druqacija od nase podele, kao da razvrstava pre svega funkcije koje supretpostavljene pojedinim organima. Jedna od razlika u naCinu razrnisljanjaistocnoq i zapadnog sveta, koja se ogleda i u medicini, je to sto smo mi sklonida po svaku cenu trazimo materijalnu osnovu neke pojave (anatomsku, histolosku, molekularnu), odnosno proucavamo gradju i za nju onda vezujemoneku funkciju, dok se na Istoku primarno proucava funkcija i njene zakonitosti(cesto data kroz apstraktne pojmove poput jina i janga, energije i drugoga), amaterijalna osnova se uzima u obzir onoliko koliko je potrebno za ustanovljavanje, odnosno opis, ovih zakonitosti, a na kao nesto vazno per se.Kineska anatomija nam, kao sto cerno videti, zato izgleda nerazradjena i

66 ENGRAMI 22 (2000) 1


trivijalna, a fiziologija netacna: organima se pripisuju funkcije za koje znamoda ih oni nemaju. Medjutim, kada se "kineski" opis funkcionisanja organizmauzme za sebe on predstavlja zaokruzenu i skladnu celinu, pri tom razvijenu donepojmljivo minucioznih detalja (npr. tame gde mi pipamo puis arterije radialis, TKM razlikuje tri mesta za palpaciju, od kojih se svako moze palpirati sajacim iii slabijim pritiskom dajuCi razliCite informacije, koje se razlikuju i uzavisnosti koja je ruka u pitanju). Kada se uzmu kao celina, i tumacenja irazultati prakse TKM, i pored velike neobicnosti pocetnih pretpostavki (kojekod obrazovanog coveka stvaraju dodatni otpor svojim misticnirn i magijskimprizvukom) stvaraju utisak da tu "ima neceqa".

Kao sto je receno, pojmovi organa su vise pojmovi funkcija nego pojmovianatomskih entiteta. Organi su vise definisani time sta rade, nego time sto sujedinice gradje. Najprostije receno, pojmovi organa u zapadnoj i kineskojmedicini nemaju isto znacenje. I funkcije organa su u kineskoj medicini sasvimosobite, ali, porernecaji ovih funkcija rezultiraju simptomima koji su i namaveoma poznta.

TKM poznaje dvanaest osnovnih organa koji cine sest parova. U svakomparu jedan organ je solidan i pripada dzang (zang) organima, iii jin organima,a drugi je supalj i pripada fu (fu) organima iii jang organima (u zagradi je datalatinicna transkripcija kineskog znaka koji ima odqovarajuce znacenje). Jinorgani su pluca, slezina, perikard, srce, jetra i bubreg, a odqovarajuci jangorgani po istom redosledu su debelo crevo, zeludac, trodelni qrejac (ovo nepostoji kao organ u nasoj anatomiji, a odgovaralo bi celomskoj duplji), tankacrevo, zucna kesa i mokracna besika.U principu, puni organi stvaraju hranljivematerije a suplji ih skladiste, ali tu postoji mnogo znacajnih varijacija.

Funkcije organa u TKM se razlikuju, kao sto je receno od funkcija kako ihdefinise nasa medicina, mada postoje i znacajne slicnosti, Pluca, recimo, sluzeza respiraciju, ali imaju i imunu funckiju. Siezina ima veze sa hemostatskomfunkcijom, ali i sa funkcijom varenja, kao i sa sprecavanjern prolapsa i ptozeorgana (istina, "kinseski" koncept slezine bi odgovarao i nasern pankreasu, ane samo slezini). Siezina bi bila zaduzena za proizvodnju cija, Bubreg requlisemetabolizam vode, ali i reprodukciju i rast (znaCi, ima endokrinu funkciju),utice na formiranje kostiju, stvara ci. Srce, pored funkcije u cirkulaciji, predstavlja centralni organ koji rukovodi mentalnim aktivnostima.

Teorija dzang-fu organa je povezana i sa mentalnim aktivnostima i dajesve ostale funkcije ovih organa u jedinstvu sa psihickim, tj. psihicko razmatrakao jednu od njihovih funkcija. Dok savremeno naucno shvatanje povezujepsihicki zivot, odnosno mentalne funkcije, sa funkcionisanjem mozga, tradicionalna kineska medicina ga povezuje sa funkcijama ovih organa. Razlikuje sepet osnovnih emocija i svaka od njih pripada nekom organu: Ijutnja jetri,radost srcu, razrnisljanje (shvaceno je kao emocija!) slezini, tuga plucirna, astrah bubregu. Kao sto svi organi pripadaju po jednom od pet elemenata,ostvarujuCi odgovarajuCi medjusobni odnos, isto vazi i za pripadajuce emocije,koje se medjusobno odnose na isti naCin. Ovo je osnovna podela emocija, dokpsihopatologija obuhvata znatno slozenije tumacenje porernecaja funkcija organa, koje se u sustini ne razlikuje od definisanja telesnih obolenja.

ENGRAMI 22 (2000) 1 67


Srce je, kao 5tO je i receno, povezano sa duhovnim aktivnostima coveka.Za srce TKM tvrdi da je "kuca covekove misli''. Duhovne aktivnosti su u vezi saradom srca. Ako je srce u redu covek je raspolozen. Ako nije u redu, mogu sejaviti nesanica, povecano spavanje, promenljivo raspolozenje, Psihicke bolestisu po TKM velikim delom bolesti srca. Srce je povezano sa osecanjern radosti idobro raspolozenje na njega utice povoljno, ali mu u prevelikoj meri skodi.Ovde se mogu zapaziti neke paralele sa zapadnom medicinom, pocev od togada je anksioznost pracena tahikardijom i palpitacijama, preko lecenja psihijatrijskih obolenja kardioloskirn lekovima do izuzetno sirokoq polja psihosomatike, koja se tice i kardiovaskularnog sistema. Perikard se razmatra kao organslican po funkciji srcu, pa se tako shvata i u odnosu na dusevni zivot.

Jetra, pored ostalih funkcija, ima i funkciju koja se tradicionalno zove"vladanje slobodnim tokom cija", Najprostije receno, ona ornoqucuje dazivotna energija kruzi organizmom !1a odgovarajuCi naCin, sto se naroCitoodnosi na energiju zeluca i slezine. Cesta neraspolozenost i razdrazljivost seoznacava kao nepravilnost vladanja slobodnim tokom, a rnoze se javiti i gubitak apetita. Dijareja kod nervoze i Ijutnje povezana je, takodje, sa ovim stanjem U svim ovim slucajevima. razdrazljivost preko jetre deluje na slezinu, i,kako kaze TKM, potrebno je leCiti jetru, u stanjima koja bismo mi nazvalidistimijom iii, mozda, anksiodpresivnoscu. Potrebna je normaIna funkcija jetrei za to da srce funkcioni5e normalno. Kada jetra radi dobro, odnosno, kada jekretanje cija i krvi harrnonicno, covek je raspolozen. Kod porernecaja funkcijajetre, covek se lako sneveseli, postane razdrazljiv, nervozan, Ijut. Za kinesekoglekara ovi simptomi ce biti razlog za sumnju da je covek bolestan, i pri tome ihnece shvatati kao specificno psihijatrijske, vee kao telsesne, dok se kod veselogi stabilnog raspolozenja kaze da je funkcija slobodnog toka normalna.

Jetra je povezana sa osecanjern Ijutnje. Ako je ono isuvi5e cesto i intezivno, rnoze uticati na funkciju jetre. Kao 5tO svaka stvar ima svoj jin i jang, istovazi i za jetru, a Ijutnja je povecanje janga. U visku janga, covek je razdrazljiv,nervozan i tada treba leciti jetru. U TKM postoji dijagnoza "vatra jetre napadazeludac". To znaci da dugotrajni obuzdavani bes dovodi do promene u funkcijijetre (lIzastoj Cija koji se pretvara u vatru") koja onda uticu na zeludac, manifestujuci se bolom i porernecajem kretanja energije zeluca, koja se, umestonanize, 5tO joj je po TKM normalan tok, krece navi5e, izazivajuCi mucninu ipodrigivanje. Ova klinicka slika odgovara gastririsu i ulkusnoj boesti kod nas, au njenoj patogenezi i nasa medicina smatra da Ijutnja ima znacajno mesto.

Bubregu odgovara emocija straha. Kod deficita cija bubrega, covek se, poTKM lako uplasi, a ucestalost ove emocije moze uticati na funkciju bubrega.Zanimljivo je da se kicmena rnozdina i mozak shvataju kao organi direktnozavisni od bubrega, a starost se povezuje sa smanjenjem vitalnosti bubrega,pa su onda i promene CNS pri starenju posledica tog procesa. 0 vezi bubregai straha mozemo se podsetiti Cinjenice da je anksioznost, ponekad, pracenacestim pozivima na mokrenje.

Pluca se povezuju sa osecanjern tuge. Cesto uzdisanje u TKM oznacavazastoj ci energije.

68 ENGRAMI 22 (2000) 1


Krv se u TKM definise donekle druqadje nego kod nas. Izmedju ostalog,ona se smatra materijalnom bazom uma, a porernecaji krvi (koji su druqacijiod onih koje definise nasa hematologija, mada postoje i izvesne paralele) semanifestuju nesanciom, anksioznoscu. konfuznoscu do kome, porernecajemsenzibiliteta i eula. Ovo bi se moglo povezati sa znacajem ishtane CNS koja seostvaruje putem krvi i tako donekle pomiriti sa nasirn shvatanjem. Takodje,zanimljivo je da anemija, srcana obolenja i anksioznosti mogu biti prisutni iistovremeno, iii biti predemt diferencijalne dijagnostike zbog slicnih simptoma(malaksalost, palpitacije, napetost) tako da i u nasoj medicini imamo slucajmedjuzavisnosti sicnih elemenata koji se javlja i u kineskoj.

Mozak pripada, po TKM takozvanim "ekstra" organima (zajedno sakicmenom rnozdinorn, srzi kostiju, krvnim sudovima, matericom i, ovdeponovo ubrojanom zucnorn kesom, prema tradicionalnoj podeli). U starimknjigama TKM 0 njemu se govori vrlo malo. Mozak je, kao sto smo rekli,povezan sa funkcijom bubrega i na neki nazin se shvata ko vrsta kostne srZi.Danasnja kineska medicina posvecuje odredjeni znacaj mozgu, sto je,verovatno, posledica kontakta sa zapadom, medjutim, bolesti nervnogsistema, pa i psihijatrijske bolesti, definisane su u okviru patologije onih dvanaest osnovnih organa, iii druqacije, shvataju se kao bolesti tih organa pa se iIeee kao ti organi.

Sazeto receno, celokupna funkcija CNS koju mi poznajemo, u TKM zavisiod aktivnosti srca (mentaIna aktivnost, emocionaln stanja), jetre (delirnicnoemocionalnost, uticaj na protok krvi) i bubrega (razvoj struktura CNS i njihovoodrzavanje).

Jos jednom rnozerno pobrojati organe i psihopatoloska stanja povezanasa njihovom disfunkcijom.

o Srce: anksioznost, depresivnost, manija, poremeceji pemcenje, nesanica, hipersomnija, poremece]!svesti, koma.

o Jetra: depresivnost, rezdreiljivost.

o Bubreg: degenerativne bolesti eNS, demencija, oligo frenija, stereckepromene.

o Perikard: anksiozna stanja, psihogena impotencija, neurovegetativnesmetnje.

Pored patofiziologije organa, TKM razmatra i etioloske faktore. Podelaetioloskih faktora u TKM je druqacija nego na Zapadu, mada se ovde moguzapaziti neke nepotpune paralele. Dijaqnosticke kategorije iskazane ovimsistemom i terminologijom izgledaju cudno i primitivno. Takodje, ne moze seuspostaviti direktna paralela izmedju istocnih i zapadnih kategorija tako dajedna kategorija TKM moze obuhvatati vise sasvim raznorodnih zapadnihkategorija i obrnuto: u onome sto se na Zapadu smatra jednim nozoloskimentitetom TKM razlikuje prilicno razliCita patolosla stanja. Ipak, kineska nozologija predstavlja potpun sistem, iskazan jezikom kineske patofiziologije ioperativan je sa stanovista odluke 0 vrsti terapije koja ce se primeniti.

ENGRAMI 22 (2000) 1 69


Etioloski faktori obuhvataju sest kategorija (egzogeni faktori, "sedamemocija", zarazni agensi, faktori vezani za naCin zivota, patoloske tecnosti izastoj krvi, i mehanicka trauma). Ne ulazeci detaljnije u ovu podelu, mozernoizdvojiti "sedam emocija" shvacenih kao etioloski faktor. One nisu stetne svedok nisu preterane, a onda izazivaju bolest. Tih sedam emocija su radost,Ijutnja, tuga, bol, zarnisljenost, strah i uzas, i one odgovaraju organima naslican nacin kao kod odnosa Pet elemenata: radost odgovara srcu, Ijutnja jetri,tuga i bol plucima, zarnisljenost slezini i uzas bubregu.

Kao sto je kod pojedinih organa pomenuto, patologija organa rnozedovesti do stanja odredjene emocije i obrnuto, dugo stanje intenzivne emocijemoze izazvati ostecenje odqovarajuceq organa. Ovde postoji slicnost sa nasimpsihosomatskim konceptom, ali, nepotpuna: mnoge bolesti koje mi smatramopsihosomatskim po TKM nastaju dejstvom nekog drugog etioloskoq faktora.Takodje, teorija psihosomatskih bolesti je dosta obimna, i ne obuhvata prosturelaciju postojanja emocije i posledicne pojave bolesti. Isto tako, ovde vidimoda one sto kod nas obradjuje psihijatrijska propedevtika, u TKM predstavljanesto potpuno ekvivalentno telesnom simptomu, ako shvatimo da obolenjeodredjenog organa izaziva odredjenu emociju.

Osnovni organi imaju prezentaciju na povrsini tela u obliku energetskihkanala, iii meridijana, koji se smatraju mestima kruzenja energije tih organa.koja u svom toku jednim delom dolazi do povrsine tela. Tacke su najosetljivijamesta na kanalima i na njih se terapijski deluje. Odabir tacaka zavisi od vrsteobolelog organa i patoloskoq procesa. Kako se psihicka obolenja mogu shvatiti kao obolenja razlicitlh organa, to se u skladu sa time odabiraju kanali Cijese tacke ubadaju. Koriste se tacke na kanalu bubrega, jetre, mokracne besike(ovo zato sto taj kanal ima tacke u kojima se prezentuju svi organi), srca iperikarda. Kanal mokracne besike se na ledjima grana u dva toka od kojih jejedan postavljen medijalno a druqi lateralno. Na medijalnom se nalaze tackekoje prestavljaju organe, a na lateralonm se nalaze tacke za koje se smatra dadeluju na emocije koje odgovaraju organu u nivou Cije se tacke nalaze.

Dijagnostika bolesti u TKM se obavlja inspekcijom, slusanjern i mirisanjem,anamnezom i palpacijom. Pri tome, ovi postupci se razlikuju od onih u zapadnoj medicini, a anamneza, toliko bitna kod nas, na neki naCin se smatradrugorazrednom metodom, a lekar koji postavlja previse pitanja losirnlekarom. Od lekara se ocekuje da metodama fizickoq pregleda (posmatranjejezika, pipanje pulsa itd.) dodje do relevantnih podataka i dijagnoze, stotakodje ilustruje primarnost, iii barem jednakost, telesnog aspekta u odnosuna psihicki,

Akupunktura je inspirisala mnoga istrazivanja na Zapadu, od kojih su nekadovela do zancajnih rezultata, poput otkrica endogenih opioida. Zapadnafiziologija nastoji da da objasnjenja i tumacen]a dejstva akupunkture, a velikideo tih efekata ide kroz razne nacine uticaja na svim nivoima eNS.

Terapija akupunkturom se obavja ubadanjem igala u odredjene tacke.Razlidte tacke imaju razlicite funkcije i u zavisnosti od prethodne dijagnostike

70 ENGRAMI 22 (2000) 1


se vrsi njihov izbor. Ovo vazi za sva stanja, pa i za ona pracena psihickimtegobama.

Evo opsteq pregleda indikacija tretmana odredjenih kanala u razlicitirnstanjima.

o Meridijan pluce (P): nesanica, psihicka iscrp/jenost, tuga, razdrailjivost,anksioznost.

o Meridijen debelog creva (lC): rezdreiljivost i preosetljivost, deprestje ipotistenost, gubitak samopouzdanja, gubitak vo/je.

o Meridijan ieluce (G): tuga, nespokojstvo, depresija, briinost, gubitakiivotne radosti, mrzovoljnost, psihofizicka iscrp/jenost.

o Meridijan slezine (LP): hipohondrijaza.

o Meridijan srca (C): psihosomatske bolesti, naroCito hipertireoza, ank-sioznost, neodlucnost, tuga, depresija.

o Meridijan tankog creva (IT): apatija, astenija, agitacija.

o Meridijan bubrega (R): slabost pamcenja, strah, nesanica, zbunjenost.

o Meridijan mokrecne beiik« (VU): ekscitabilnost, opsesija, agitacija,preterana tuga, neurovegetativna distonija, psihosomatska obolenja.

n Meridijan perikarda (PC): impotencija, frigidnost, razdraz/jivost, nesanica zbog polne prenedreienosti.

o Meridijan trostrukog grejaca (TR): strah, tuga, anksioznost, apatija,agitacija, somnolencija.

o Meridijan jetre (H): kolericnost, nezadovoljstvo, Ijubomora,preosetljivost, strah, anksioznost, neurastenija.

o Meridijan zucne kese (VF): nedostatak poverenja u samog sebe, nedostatak odveinosti, strah od neuspeha, depresija, preterana tuga.

Na jedan organ se ne deluje samo preko meridijana koji nosi njegovo ime,vee po odredjenim zakonitostima i preko drugih kanala, i to kako djstvom naorgan, tako i dejstvom na patoloski faktor. Takodje, akupunktura ima"uravnotezujuce" dejstvo, pa se cesto i za suprotne stvari preporucuje tretmanistog meridijana. Medutim, za odgovarajuCi odabir tacaka koje ce se koristiti,potrebno je preciznije definisanje stanja i poznavanje specificnoq karakteratacaka.(Postoji vise nacina obelezavanja meridijana, a ovde se koristi Medjunarodna standardizacija nomenklature svekineske asocijacije akupunkture. Zaobelezavanje tacaka koristimo simbol kanala i broj tacke na kanalu, npr 1(4znaci cetvrta tacka na kanalu debelog creva. Tradicionalno, tacke seobelezavaju imenima, pa je naziv 1(4 "Hegu", i to je, inace, poznata tacka kojase nalazi izmedju prve i druge metakarpalne kosti, na dorzalnoj strani sake).

Neke od znacajnijih tacaka koje utlcu na psihicke tegobe su:

o C7, Shenmen, na pregibu sake, izmedju ulne i pisiformne kosti.

ENGRAMI 22 (2000) 1 71


[] LP6, Sanyinqiao, tri palca iznad unutrasnjeg maleolusa na zadnjoj ivicitibije.

[] Pc6, Neiguan, tri palca iznad pregiba sake, izmedju tetiva m. palmarislongus i m. flexor carpi radialis.

[] DM20, Baihui je naziv teck», a nalazi se na kanalu Dumai, koji prolazimedijalnom linijom pozadi i koji ne pripada ni jednom organu posebno, a tacka je na vrhu glave, na sredini linije koja povezuje vrhoveusnih sko/jki.

Pored ovih tacaka, u terapiji se, zavisno od obolenja koriste i druge tacke,a odabir tacaka podleze relativno strogim zakonitostima.

Pored sistema korporalne akupunkture, koji se ovde opisuje, i obuhvatasistema tacaka na svim delovima tela, postoje i tzv. mikrosistemi, kojiobuhvataju sisteme tacaka koji reprezentuju Citav organizam, ali se ti sisteminalaze u okviru pojedinih anatomskih celina na telu. Najpoznatija je aurikuloakupunktura, koja obuhvata tacke na usnoj skoljci i skalp akupunktura, kojaobuhvata linije ("zone") na kapilicijumu u koje se tangencijalno zabadaju igle.Principi odabira mesta aplikacije su slicni kao u korporalnoj akupunkturi.

Skalp akupunktura poznaje Psihoafektivnu zonu koja se koristi kod izmenjenih afektivnih reakcija i Zonu kontrole dusevnih bolesti, koja se koristi kodpsihoza, a u lecenju psihijatrijskih bolesti (depresija, neurastenija, pseudoneurastenija, psihomotorna retardacija, nocno mokrenje, impotencija i frigidnost)se koriste i druge zone.

Postoji relativno dosta naCina za tretman obolenja koja se manifestujupsihijatrijskom simptomatologijom. Naravno, cak i u Kini, oni se koriste uzneophodnu kriticnost, U lecenju psihoza, iako i za njih postoje odqovarajuceprocedure, ne mozerno se osloniti na akupunkturu, mada je Kinezi koriste kodkatatonije. Kod afektivnih porernecaja, vazi ista stvar, a razradjena farmakoterapija koju koristimo, rnoze se i ovde, i kod psihoza smatrati jedinomadekvatnom vrstom tretmana, iako bi se mogle sprovesti studije 0 adjuvantnim efektima akupunkture i u ovim stanjima. U nepsihoticnim poremecajirnaakupunktura bi mogla imati vecu ulogu, iako se primenjuje sarno sporadicno,a u odredjenim slucajevima bi, vervatno, mogla biti srecna alternativa psihofarmakoterapiji (npr. benzodiazepinima), koja se, narocito u ambulantnim uslovima, lako otima kontroli. Napokon, akupunktura bi se mogla koristiti i ukombinaciji sa uobicajenim postupcima psihijatrijskog lecenja, makarshvacena kao sredstvo nespecificne regulacije autonomnog nervnog sistema,sto bi je cinilo podesnom za lecenje psihosomatskih obolenja i anksioznihstanja. Treba pomenuti i bolesti zavisnosti koje su narocito zahvalna indikacijaza akupunkturu, pa se ona koristi u njihovom lecenju.

Siroko indikaciono podrucje akupunkture, koje proistice iz velikog brojakombinacija tacaka koje su precizno odredjene za razidta bolesna stanja, injena efikasnost, pobudjuju paznju na Zapadu unazad stotinak godina,da bipunu naucnu afirmaciju akupunktura stekla poslednjih decenija. Indikacijeprimene je nasla u razlicitirn granama medicine, a psihijatrija je jedna odoblasti koja, takodje, pruza moqucnosti za njeno koriscenje.

72 ENGRAMI 22 (2000) 1


Literatura

1. China Pictorial Publications. TCM Marches Towards the World. New StarPress, Beijing, 1994.

2. Cstovic E. Akupunktura. SNL, Zagreb, 1989.

3. Ferkovic M., TepetovicM. Akupunktura. Skolska knjiga, Zagreb, 1990.

4. Hajder D., Djukic V. Akupunktura i laseri. lRl, Zemun, 1993.

5. Kaplan H.I., Sadock B.l., Grebb l.A. Synopsis of Psychiatry. Williams andWilkins, Baltimore, 1994.

6. Mitovenovk: D. Klinicka psihofarmakologija. Rednkke stempe i Barex, Beograd, 1999.

7. Skokljev A. Aurikuo akupunktura. Sportska knjiga, Beograd, 1985.

8. Skokljev A. Topografsko-anatomska karta akupunkturnih tacaka i kanala.Neucn« knjiga, Beograd, 1986.

9. Skokljev A. Akupunkturologija. Naucna knjiga, Beograd, 1987.

Maravic Goran, psihijatar; Dispanzer za menta/no zdravlje, Domzdravlja "Zemun"

Deura Maja, specijalista fizika/ne medicine i rehabi/itacije

Milovanovic Srd'an, mr sci. med., specija/ista psihijatrije, asistentMedicinskog faku/teta u Beogradu, Centar za parcija/nu hospitalizaciju, /nsitut za psihijatriju KCS

ENGRAMI 22 (2000) 1 73

.m~VLJEl u PSIHIJATRIJILeskovac

TRANE)('J(hlorazepat). anksiolitik

ADUMB~

(oksazepam)anksiolitik

~OA'Jell, ~~//)

'Ib/epr,~'O/.

IIZDRAVLJEILeskovacFarmaceutlko hemijlka industrijaV1&Jkova 199, 18000 LeskovactelefoDi 018/41-884, 56-711

ACUPUNCTURE AND PSYCHIATRY

Maravic,G., Deura,M., Milovanovic,S.,

Acupuncture is an ancient chinese method of healing by pricking needles in certain points on the skin and it is a part oftraditional chinese medicine (TCM). rCM is based on principlesof chinese philosophy and also, it develops its own theory oforgans functioning and its disturbing factors. Mental activitiesin rCM are recognized as a sort of physiological organ functions and they are attributed to heart liver and kidney, whilebrain is not considered in that way: Mental diseases are supposed to be diseases of these organs and they are treatedaccording to the same principles as somatic disorders. Differentemotions are attributed to different organs and, in excess, theycould be either cause or consequence of disorder of particularorgan. Explanations, diagnostic and therapeutic procedures inrCM, although seem odd, represent a complete and consistentsystem and they could be successfully used. Acupuncture hasfound its application even in modern western medicine, andpsychiatry is one of fields offering possibilities for its use.

Key words: acupuncture, psychiatry

Acupuncture is an ancient chinese healing method, using needles that arepricked in certain points of the skin. It is a part of traditional chinesemedicine, which is, according to the oldest records, five thousand years

old .Traditional Chinese Medicine is based on principles of ancient chinesephilosophy and culture. Chinese philosophy, in general, has an initial attitudeof unity of macro and micro cosmos. This means that same rules and legislations could be applied to whole nature and single phenomena as well, andthey could be used for their explanation and prediction. Functioning of human body in health and in illness is not an exception to that. Basic principleswhich exist in entire universe, in the body, and at the level of its parts, are yin

ENGRAMI 22 (2000) 1 75

Maravic,G., Deura,M., Miiovanovic,S.,

and yang. Although having a misterious connotation, those principles expressrelations of phenomena duality well known in every day life like day andnight, male and female, good and evil and everything else. Simply, yin andyang represent relations between opposite pairs of the same phenomenon.Yin / yang principle is supposed to be a basic force to which things aresubjected. In chinese culture it is worked out in details, in many fields, including medicine. Relation between yin and yang provides changes, motion, andthis motion is realized through energy called "qi", Qi is in continuous moving,providing other things to move. Like in nature, it exists in human body,turning organs to function and having some other functions as well, allowingorganism's vitality. In TCM, the therapy is conceptualized as procedures whichsignificantly directly affect qi, bringing health in that way. Illness, very often,means disorder of this energy. This concept is obviously difficult to understand, not just to a "western mind" but also to chinese medical students who,during the first grade of studies, have problems in becoming familiar with it .

Principle of Pentaism follows yin/yang theory. Pentaism describes five elements (wood, fire, ground, metal and water) symbolizing five categories andtheir mutual relations of strengthening, weakening and stopping. These categories could be applied to most different modalities of things, showing relations between them which make certain sense. For instance, emotion whichcorresponds to element of water is fear, and the one corresponding to fire isjoy, so, as the water extinguishes fire, the fear prevents joy. These analogiesare applied to modalities of various phenomena (seasons, cardinal points,organs of body, feelings as in the example and everything else). They are usedin medicine, in diagnostic - reflecting organs functions and in therapy, with aview to evaluate which agent will be effective towards certain pathologicalfactor.

In shortest, same forces which exist in macrocosms or in nature exist inhuman body and they are subordinated to same rules. Beside these generalprinciples which, according to chinese philosophy (more precisely - Taoist),could be applied to all phenomena, TCM has developed more specific theoriesregarding anatomy, physiology and pathophysiology, also compatible withthe above mentioned. Each part of the body and each organ have their ownyin and yang : upper parts of body- left side and back are yang, whileopposite is yin. Six pairs of organs (below in text) are in mutual relations withthe five elements etc.

Chinese anatomy and physiology are rather close. Division of organs inTCM, which is different than ours, seems to classify primarily the functionswhich are attributed to each organ. Among other things, the difference inway of thinking between the eastern and western worlds, which is also beingreflected in medicine, is that we incline to search for material basis (anatomic,histological, molecular). Namely, we study structure, and then connect it tosome function, while in the East function is primarily observed and somesystem in it is being established (often given through abstract terms like yinand yang, energy etc.), and the material basis is essential as much as it isneeded for establishing and description of this system, and not being impor-

76 ENGRAMI 22 (2000) 1

ACUPUNCTURE AND PSYCIATRY

tant for itself alone. For this reason, as we shall see, the chinese anatomyseems to us to be undeveloped and naive, while physiology is incorrect: toorgans are attributed functions which they don't have. Nevertheless, when"chinese" description of functioning of organism is being studied by itself, itrepresents a complete and coherent system, at the same time is developed upto incomprehensibly sophisticated details (e.g. in place of palpation of arteryradialis, chinese medicine discriminates three locations for palpation, eachone having a possibilty to be palpated with higher or lower pressure, providing different information which additionally differs depending on arm - beingleft or right).When considering in total, the theory and results of this traditional medicine, in spite of its pretty unusual initial presumptions (which athighly educated people induce additional resistance by its mystic and magicsound), give impression that there is some hidden logic in it. As it is abovementioned, the organs are more concepts of functions than anatomical entities. The organs are more defined by things they do than by being units ofstructure.

Simply, terms of organs in western medicine and TCM do not have thesame meaning. Although functions of organs in TCM are exotic, disorders ofthese functions result in symptoms which, even to us, are quite known.

TCM recognizes twelve basic organs which form six pairs. In every pair,each organ is solid and belongs to so called "lang" organs, or yin organs,while the other is hollow and belongs to "Fu", or yang organs. Yin organs arelungs, spleen, pericard, liver and kidney, and corresponding yang organs areaccordingly: large intestine, stomach, triple warmer (it does not exist in ourmedicine as an organ and could be understood as a coelom cavity), smallintestine, gall bladder and urinary bladder. Basically, solid organs producenutrients and hollow organs store them but there are many significant variations to this rule.

Functions IOfsorqans in TCM are different than functions defined by ourmedicine, as it was said above, although there are many similarities. Lungs,for example, take part in respiration but also perform role in immunity. Spleenis connected to hemostasis but to digestion as well, and it prevents a prolapseof organs ( in fact the chinese concept of spleen includes pancreas, and notjust spleen). Spleen produces qi. Kidney controls a metabolism of water, butalso reproduction and growth (meaning it has an endocrine function), influences development of bones and produces qi. Heart, beside a role in circulation, represents the central organ which conducts mental activities.

Theory of "lang-fu" organs is related to mental activities and describesthem together with other functions of those organs,namely, it considers psychic function as one their functions. Modern approach attributes mental activities to brain functioning and TCM attributes it to functions of all organs.Five basic emotions are distinguished and each one is connected to certainorgan. Anger is attributed to liver, joy to heart, thinking (even it is recognizedas an emotion) to spleen, sorrow to lungs and fear to kidneys. As every organbelongs to one of five elements and realize defined mutual relations, thesame is applicable to corresponding emotions. This is a basic classification of

ENGRAMI 22 (2000) 1 77


emotions and psychopathology and includes more complex explanations ofdisorders in organs functioning which are not basically different then those insomatic disorders.

Heart is, as we have already mentioned, connected to person's mentalactivity. For heart, TCM claims to be II home of men's mind", Mental activitiesare in relation to functioning of heart, and if with the organ everything is inorder, man is in a good mood. If something is wrong, sleeplessness, frequentmood changes or increased sleep could be the result. Psychiatric illnesses,according to TCM, are in significant part heart diseases. Heart is connected toemotional joy and good mood has a good influence on it, but in excessiveextent is harmful. Some parallels to the western medicine could be observed,such as a fact that anxiety is followed by a tachicardia and palpitation. Certainpsychiatric diseases are cured with cardiologic drugs and psychosomaticmedicine is related to cardiovascular system as well. Pericard is an organdescribed as similar to heart, so his role in mental life is approximately thesame.

Liver, among other functions, has a traditionally called II managing freeflow of qi function. Simply, it enables life energy to circulate throughoutorganism in proper way which specially refers to energy of spleen and stomach. Often state of indisposition and irritability are noticed as an irregularityof "rnanaqinq free flow", and a loss of appetite could be also present. Diarrheain states of nervousness and anger is related to this irregularity and, in allcases, the irritability through liver affects spleen, and as TCM says, liver shouldbe cured in those cases which we would diagnose as dysthimia or maybe asanxiodepresivity. For normal heart functioning, normal function of liver is alsorequired. When liver works well, which means the flow of qi and blood is in aharmony,a man is in a good mood. As we saw in liver function disorders oneeasily turns indisposed, irritable, nervous and angry. For chinese physician,these symptoms will be a reason to suspect that the person is ill, and at thesame time, he will not address them as specifically psychiatric symptoms butas well as somatic ones, and if person is in a good and stable mood he willsay that the function of "free flow" is normal.

Liver is related to emotion of anger. If this emotion is too frequent andtoo intense it could affect liver functioning. As everything has its yin andyang, the liver has that also, and the anger is increased yang. In excess ofyang, one is irritable, nervous and the treatment of liver is needed. In TCM,there is a diagnosis "fire of liver affects stomach", It means that a rage suppressed for longer time leads to changes in liver functioning (llblock of qiturns to fire'Tthat affects stomach causing pain and disorder in flow of energyof stomach, which instead of going downwards, accordingly to TCM's normaldirection, goes upwards provoking a feeling of sickness and belching. Thisclinical manifestations refer to gastritis and ulcer disease in our medicine andin their pathogenesis, our medicine also considers anger to be of a significantimportance.

Kidney corresponds to emotion of fear. According to TCM in kidney qideficit, one easily becomes frightened and if this emotion is frequent, it could

78 ENGRAMI 22 (2000) 1


influence kidney's function. An interesting fact is that spinal cord and brain inTCM are discussed as organs directly dependent on kidney, and aging isrelated to decreased kidney's vitality, so the changes in CNS during aging area consequence of the same decrease. Regarding connection between kidneyand fear, we could recall a fact that the anxiety is sometimes followed withfrequent urge to urinate.

Lungs are connected to feeling f sorrow. Frequent sighing in TCM indicates a qi block.

In TCM blood is defined differently than here. Among other things, it issupposed to be the material basis of mind, and blood disorders (which aredifferent than those described in our hematology, although there are someparallels) are manifested by sleeplessness, anxiety, confusion to coma, impairment of sensitivity and senses. This could be related to significant role ofblood in providing CNS nutrition and with a view to reconcile this point withour way of understanding.

Also, there is a necessity to stress that the anemia, heart disease andanxiety could be present at the same time or considered as diseases in differential diagnosis due to similar symptoms (exhaustion, palpitation, anxiety), soin our medicine similar relation occurs between the same elements as it is thecase with the chinese medicine.

Brain, according to chinese physiology and anatomy, belongs to so called"extra organs" (along with spinal cord, bone marrow, blood vessels, womband here again included gold bladder, following traditional classification).Brain was rarely a topic in ancient books of TCM. Brain, as we have alreadysaid, is connected to kidney's function and in some way is supposed to be akind of bone marrow. Nowadays, chinese medicine attributes some significance to brain, which is probably a consequence of a contact with westernworld, however, diseases of nervous system, meaning the psychiatric diseasesas well, are defined in terms of pathology of those twelve basic organs, or toput it in another way, they are considered to be diseases of these organs, sothat they are cured the same way.

In shortest, a whole functioning of CNS in TCM, known by us, depends onactivity of heart (mental activity, emotional states), liver (partly emotionallife,liver influences a blood flow) and kidneys (development and maintainingof CNS structures).

Once again, we could count organs and psychopathologic states connected to their dysfunction.

Heart anxiety, depressions, mania, memory problems, sleeplessness, hypersomnia, disorders of consciousness, coma.

o Liver: depression, irritability,

o Kidney : degenerative eNS diseases, dementia, oligophrenia, changesin elderly.

ENGRAMI 22 (2000) 1 79


D Pericard : anxiety states, neurovegetative disturbances, psychogenicimpotence.

Beside pathophysiology of organs, TCM considers etiologic factors. Classification of etiologic factors in TCM is different than in western medicine,although we could notice some incomplete parallels. Diagnostic categoriesexpressed by this system and terminology seem to be odd and primitive. Atthe same time, a strict parallel between "eastern" and "western" categoriescould not be established, so one category of TCM may encompass the entirelydifferent western categories and vice versa: what is in the West considered asone of nosological entity, in TCM is regonised as few states, quite differentone from another. However, chinese nosiology presents a complete system,expressed in terms of chinese pathofisiology and operative, from the point ofdecision making, regarding a choice of therapy.

Etiologic factors comprise six categories (exogenous factors "seven emotions", infective agents, factors connected to life style, pathological liquidsand blood stopping and mechanical trauma). Not discussing details of thisdivision, we could focus on seven emotions. They are not harmful if not inexcess, otherwise they cause illness. This seven emotions are : joy, anger,sorrow, pain, thoughtfulness, fear and horror. They correspond to organs insimilar way as described in principle of Tentaism: joy to heart, anger to liver,sorrow and pain to lungs, thoughtfulness to spleen and horror to kidney. Aswe have already mentioned, while describing organs, pathology of organ maylead to a certain emotion and reversely- a prolonged duration of intensiveemotion could cause damage of particular organ. There is a certain similaritybetween that and our psychosomatic concept but not entirely: many diseases,on our behalf considered as psychosomatic, according to TCM are caused bysome other etiologic factor and not by emotions. Also, a theory of psychosomatic diseases is considerably extensive, searching for something more thansimple relation between emotion and accurance of illness. On the other hand,phenomenon elaborated as a typical science and symptom in psychiatry inTCM represent something completely equivalent to body symptoms, if werealize that disease of certain organ causes the certain emotion.

Basic organs have their presentation on the body surface, in form ofenergy channels or meridians, which are considered to be place where energyof the organ, during its flow, partly reaches body surface. The most sensitiveparts of channels are acupuncture points and they are places of therapeuticaction. Selection of points depends on affected organ and a specific pathological process. As mental diseases are supposed to be disorders of variousorgans, according to this, selection of channels where points are treated isdone. Points on channels of kidney, liver, urinary bladder (the later is due to afact that this channel contains point of presentation for each other organ),heart and pericard are being used. Urinary bladder channel branches at theback, with two flows, medial and lateral one. On the medial one- there arepoints which represent organs while, at the same level, on the lateral thereare points which are considered to influence emotion related to certain organ.

80 ENGRAMI 22 (2000) 1


Diagnosis in TCM is made by inspection, listening and smelling, throughinterview and palpation. These procedures are different than those in western

umedicine. History of present illness provided .by interview, so.irnportant in ourmedicineTCM is considered to be the second grade method and a physicianwho poses a lot of questions is not a good one. It is expected that a doctor,by methods of physical examination (observing tongue, pulse palpation etc.),reaches relevant information and diagnosis. This also illustrates a primarity orat least the same importance of physical aspect comparing to the psychological one.

Acupuncture inspired many researches on the West, and some of themhad achieved significant results such as discovery of endogenous opioids.Western physiology endeavored to give explanation and interpretation effectsof acupuncture, and a majority of these effects realize at different CNS levels.

Acupuncture therapy is performed by pricking of needles in certainpoints. Different points have different function and depending on previousdiagnosis their choice is made. It is so in all cases as well as in those joint topsychiatric symptoms.

Here is presented a general review of indications for treatment of certainchannels in various states.

o Lung meridian (P):sleeplessness, psychic exhaustion, sorrow, irritability,anxiety

o Large intestine meridian (lC): irritability, hypersensitivity, depression,digestion, I oss of self-confidence, lack of will

o Spleen meridian (LP): hypochondriasis

o Stomach meridian(G):sorrow, restlessness, depression, worriness, lossof lifejoy, moroseness, psychofisical exhaustion

o Heart meridian (C): psychosomatic diseases, especially hyperthyreosis,anxiety, indecisiveness, sorrow depression.

o Small intestine meridian (IT): apathy, asthenia, agitation.

o Kidney meridian (R): memory impairment, fear, sleeplessness, perplexity

o Urinary bladder meridian(VU): excitability, obsession, agitation, excessive sorrow, neurovegetative distonya, psychosomatic diseases.

o Pericard meridian (Pc): impotence, frigidity, irritability, sleeplessnessdue to sexual overexcitation.

o Triple warmer meridian(TR):fear, sorrow, anxiety, apathy, agitation,somnolence.

oLiver meridian(H): being choleric, discontent, jealousy, hypersensitivity,fear, anxiety, neurasthenia.

ENGRAMI 22 (2000) 1 81


D Gold bladder meridian(VF): lack of self-confidence, lack of courage,fear of failure, depression, excessive sorrow.

Each organ is influenced not just through meridian with its name, butaccordingly to certain rules, through other channels, in two ways, first onedirectly influencing the organ, and the second- influencing a pathologicalfactor as well. Acupuncture has balancing action, so, very often, for theopposite states treatment of the same meridian is proposed.

However, for adequate choice of treated point, it is needed to moreprecisely define a disorder and to be acquainted with specific point's characteristics.

There are few systems for meridian marking and here the internationalstandardization of AIIChine acupuncture association nomenclature is used. Formarking points we use symbol of channel and number of point on the channel, e.g. IC4 is the forth point on the large intestine channel. Traditionallypoints are marked by names, so IC4 is Hegu, a very known point locatedbetween the first and the second metacarpal bone on dorsal hand side.

Some of important points, which concern mental complaints are:

D e7, Shenmen, on the joint of hand, between ulna and pisiforme bone.

D LP6, Sanyinqiao, three inches above medial maleolus on posterioredge of tibia.

D Pc6, Neiguan, three inches above joint of hand between tendons ofmuscles palmaris longus and flexor carpi radialis.

D DM20, Baihui, belongs to meridian Dumai, located on medial line, onthe back and does not belong to any particular organ. Point is on thetop of the head, on crossing of medial line and one connecting tops ofears.

Along with this, depending on illness, other points are used in therapy,and a choice follows relatively strict rules.

Beside system of corporal acupuncture, above described, which includespoints in the whole body, there are also so called microsystems. They includesystems of points representing whole organism, but, these systems are located on limited parts of body. The most known is auriculo acupunture whichencompasses points on auricle, and scalp acupuncture, which encompasseslines ("zones") at capillitium, in which needles are pricked parallelly to skinsurface. Principle of choice where to apply needles are similar to those incorporal acupuncture.

Scalp acupuncture recognizes Psychoafective zone which is used inchanges of affective reactions, and Mental diseases control zone, used inpsychoses. In a treatment of psychiatric diseases (depression, neurasthenia,pseudodementia, psychomotor retardation, enuresis, impotence, frigidity)other zones are used as well.

82 ENGRAMI 22 (2000) 1


There are many ways to treat diseases with psychiatric symptoms. Ofcourse, even in China, they are used critically. Although proposed receipts(lists of points to treat) exist, in treatment of psychoses acupuncture is notreliable, but in China it is used to treat catatonia. In affective disorders is thesame, and worked out therapy, used by us both for psychoses and affectivedisorders, could be considered as the only adequate way of treatment (however, studies of adjuvante effects of acupuncture in this states could be conducted). In non-psychotic disorders acupuncture could play more importantrole, although it is applied sporadically, and in some cases it could be advantageous alternative to psychopharmacotherapy (benzodiazepines, for instance) which, especially in outpatients, easy becomes out of control.

Finally, acupuncture could be used along with conventional procedures ofpsychiatric treatment, recognized at least as mean of non-specific regulationof autonomous nervous system, and so be suitable for treatment of psychosomatic disorders and anxiety states. Substance-related disorders should bementioned as particularly grateful indication for acupuncture, so that theacupuncture is used for their treatment also.

Wide range of indications for acupuncture, which rises from large number of combinations of points, destinated to various pathological states,along with its effectiveness, draws attention of West for about hundred years,and in past decades, acupuncture gained entire scientific affirmation. Indications for application of acupuncture exist in numerous branches of medicine,and psychiatry is one of the fields offering possibilities for its use.

ENGRAMI 22 (2000) 1 83

Maravic,G., Deura,M., Miiovanovic,S.,

References

1. China Pictorial Publications. TCM Marches Towards the World. New StarPress, Beijing, 1994.

2. Catovic E. Akupunktura. SNL, Zagreb, 1989.

3. Ferkovic M., TapalovicM. Akupunktura. Skolska knjiga, Zagreb, 1990.

4. Hajder D., Djukic V. Akupunktura i laseri. lRl, Zemun, 1993.

5. Kaplan H.I., Sadock B.l., Grebb l.A. Synopsis of Psychiatry. Williams andWilkins, Baltimore, 1994.

6. Milovanovic D. Klinicka psihofarmakologija. Radnicka stempe i Barex, Beograd, 1999.

7. Skokljev A. Aurikuo akupunktura. Sportska knjiga, Beograd, 1985.

8. Skokljev A. Topografsko-anatomska karta akupunkturnih tacaka i kanala.Neucne knjiga, Beograd, 1986.

9. Skokljev A. Akupunkturologija. Neucne knjiga, Beograd, 1987.

Maravic Goran, Psychiatrist, Mental Health Ward, Outpatient Hospita/llZemunll

Deura Maja, Specialist for Physical Medicine and Rehabilitation

Milovanovic Sr4an, M.D., M.A., Psychiatrist, Assistent lecturer ofpsychiatry Professor of Psychiatry, Belgrade, Univerisity School ofMedicine, Institute for Psychiatry Clinical Center of Serbia

84 ENGRAMI 22 (2000) 1

Documents

AKUPUNKTURA I PSIHIJATRIJA