Sodium chloride waters very widespread in nature and easily prepared artificially. Artificial baths are prepared by dissolving required amount table salt in fresh water. Based on their chemical composition, the following varieties are distinguished:
- sodium chloride, less often calcium-sodium with mineralization from 2 to 35 g/l;
- sodium chloride and calcium-sodium brines with mineralization from 35 to 350 g/l
- calcium-sodium chloride, less often calcium-magnesium ultra-strong brines with mineralization from 350 g/l to 600 g/l.
The clinical and physiological effect of water depends on the salt concentration. There are waters of weak (10-20 g/l), medium (20-40 g/l) and high (40-80-100 g/l) concentrations.
Study of physiological and therapeutic effects sodium chloride baths showed that the minimum concentration at which the specific effect of baths begins to manifest itself is 10 g/l. At a concentration of 20-40 g/l, the effect is clear; when the concentration increases to 60-80 g/l, negative reactions from the cardiovascular system often appear.
Mechanism of action
The main mechanism of action of these baths is the deposition of mineral salts on the skin and the formation of the so-called “salt cloak”, which is a source of respiratory irritation of receptors and a reflex effect on functional systems. Skin irritation caused by dissolved bath salts is manifested by a variety of sensations, ranging from a slight tingling sensation to an intense burning sensation and redness of the skin. A number of morphological changes are formed in various layers of the skin (thickening of the stratum corneum, proliferation of the germ layer, intercellular edema, an increase in the number of fibrocytes and elastic fibers and a decrease in histiocytes), the intensity of which depends on the concentration and number of procedures.
The presence of a “salt cloak” on the skin determines the characteristics of heat exchange in sodium chloride baths, which is characterized by greater heating of the body than in fresh and other mineral baths. An increase in body temperature causes a compensatory vasodilator reaction, increasing oxygen absorption. An increase in cutaneous blood circulation is accompanied by the release of deposited blood, an increase in the volume of circulating blood and the flow of venous blood to the heart.
Use for diseases
Sodium chloride baths increase the tone of the peripheral veins and promote the outflow of venous blood from the periphery to the heart. These changes in hemodynamics depend on the temperature and concentration of salts in the bath: when the concentration increases to 60 g/l and the temperature to 38-40°C, a pronounced load on the heart and a weakening of the vagotonic effect are observed. Changes in the microcirculatory system of blood circulation are characterized by a decrease in blood viscosity, aggregation and adhesive ability of platelets, and an increase in muscle and subcutaneous blood flow.
A number of clinical studies have established the normalizing effect of baths on blood pressure. A study of the effect of sodium chloride baths on the sympathetic-adrenal system led to the conclusion that as the concentration increases, their activating effect on the functional state of the sympathetic part of the autonomic nervous system increases; baths with a concentration of 60 g/l and higher increase the level of aldosterone and renin.
The stimulating effect of high concentration sodium chloride baths on the pituitary-adrenal system is one of the determining factors in the anti-inflammatory and desensitizing effect of this type of therapy.
Sodium chloride baths improve all types of metabolism, accumulating energy resources in tissues due to an increase in high-energy phosphorus compounds. Irritation of the skin receptor apparatus causes the emergence of a unique biopotential in the form of rhythmic impulses with different frequencies and amplitudes. which is replaced by prolonged braking.
This appears to be responsible for the analgesic effect sodium chloride baths. Electrophysiological studies confirmed the predominance of inhibition processes that occurs reflexively in the central nervous system. Clinically this was confirmed by a pronounced analgesic and sedative effect.
Indications, contraindications and treatment methods
Numerous clinical studies have shown the significant anti-inflammatory, analgesic properties of sodium chloride baths that improve the reactivity of the immune and cardiovascular systems, which determines their advantages when prescribed to patients with dystrophic and inflammatory processes, polyneuritis, functional insufficiency of the endocrine glands, and with the initial manifestations of obliterating vascular diseases of the extremities, varicose veins, hypertension.
Contraindications: common for balneotherapy, increased skin sensitivity to salt.
Treatment method
Sodium chloride baths are usually prescribed: initially with low mineralization and indifferent temperature, gradually moving to more concentrated and hotter ones.
Water mineralization ranges from 10 to 80 g/l, temperature - 35-38 ° C; baths are prescribed 3-4 times a week, 12-18 baths per course.
Baths with a concentration of 60 g/l cause an increase in high-energy phosphorus compounds in the tissues of the heart, liver, and skeletal muscles, which indicates stimulation of the synthesis of ATP and creatine phosphate and the accumulation of resources in the tissues of these organs. Destructive changes in the skin can be a consequence of an overdose of not only excess concentration, but also the frequency of procedures.
What are the benefits of sodium chloride baths?
The study of the physiological and therapeutic effects of chloride and sodium baths made it possible to establish that the minimum concentration at which the specific effect of sodium chloride water begins to manifest itself when applied externally is 10 g/l. At 20 - 40 g/l, its effect becomes absolutely clear, and when this indicator increases above 40 g/l, and especially at 60 - 80 g/l, negative reactions often begin to occur on the part of the cardiovascular, nervous and other body systems .
It has now been established that sodium chloride baths, with adequate methods and dosages, have a regulatory effect on the functional state of the central nervous system, cause immunological changes in the body, significantly change the course of metabolic processes, etc. Their analgesic, anti-inflammatory and desensitizing effect has been revealed in patients with degenerative and other joint lesions. Sodium chloride baths have a beneficial effect on the functional state of the cardiovascular system of patients with neurocirculatory dystonia of the hypotonic type, arterial hypertension, and rheumatic heart defects. The positive effect of these baths on a number of indicators of the functional state of the central nervous system and hemodynamics is more pronounced compared to the carbon dioxide, radon and sulfate baths widely used in the treatment of such patients.
How to take sodium chloride baths?
The duration of sodium chloride baths at a temperature of 35 - 38 ° C is 10 - 20 minutes (every other day); 12 - 15 baths are prescribed per course of treatment.
These baths are indicated for:
Diseases of the cardiovascular system (initial manifestations of atherosclerosis, cardiosclerosis, myocardial and atherosclerotic sclerosis, myocardial dystrophy, rheumatic heart disease in adults and children in the first stage of process activity with circulatory failure stages 1-11, hypertension stages I and II, hypotensive disease , obliterating vascular diseases of the extremities, varicose veins and postthrombotic syndrome);
Diseases of the organs of support and movement (arthritis and polyarthritis of non-tuberculous origin);
Diseases of the spine (spondylosis, spondyloarthrosis, spondyloarthritis);
Diseases and consequences of traumatic injuries to bones, muscles, tendons;
Diseases of the central (consequence of spinal cord injuries, consequences of polio) and peripheral nervous system (plexitis, radiculitis, polyradiculitis);
Chronic inflammatory diseases of the female genital organs, functional ovarian failure;
Some skin diseases (psoriasis, neurodermatitis).
Balneotherapy - This medicinal use mineral waters. It is based on the external use of natural and artificially prepared mineral waters. Balneotherapy also includes the internal use of mineral waters.
^ SODIUM CHLORIDE BATHS - therapeutic effect on a patient immersed in sodium chloride mineral water.
PHYSICAL CHARACTERISTICS. The mineralization of natural sodium chloride waters ranges from 2 to 60 g/l and higher. Based on their chemical composition and salt content, they are divided into the following types:
1. Sodium chloride, less often calcium-sodium waters with a mineralization of 2-35 g/l.
2. Sodium chloride and calcium-sodium brines with a mineralization of 35-350 g/l.
3. Sodium chloride and calcium-sodium, less often calcium-magnesium ultra-strong brine with a mineralization of 350-600 g/l.
For medicinal purposes, waters of low (up to 5 g/l), medium (5-15 g/l), and high (15-35 g/l) mineralization are used.
DEVICES. The procedures are carried out in a bathtub or two- or four-chamber baths.
^ MECHANISM OF ACTION OF THE FACTOR.Physico-chemical effects. Salts partially penetrate the skin and are deposited on it in the form of a “salt cloak,” irritating skin receptors. The heat flow into the body from a sodium chloride bath is 1.5 times higher than from fresh water.
^ Physiological effects . The “salt cloak” persists after baths and is a source of long-term influence on nerve endings in the skin and a reflex effect on body systems. Sodium chloride penetrates into the internal environment of the body in small quantities, so its biological effect can hardly be taken into account. However, salt baths still indirectly affect the functions of a number of organs and systems.
Salts cause functional disorders in the receptor apparatus of the skin - primary short-term excitation is replaced by long-term inhibition. Reflex changes in the central nervous system and hypothalamus consist of an increase in inhibition processes and a predominance of parasympathetic activity of the hypothalamus. In clinical observations, a pronounced analgesic and sedative effect is noted. The formation of a “salt cloak” on the skin reduces the evaporation of water from the skin, which leads to a change in the function of the physiological thermoregulation system. The distinctive effect of sodium baths on heat exchange is the greater heating of the body than when taking sodium baths. tap water or gas (carbon dioxide, hydrogen sulfide and radon). An increase in core body temperature causes a compensatory vasodilator response, an increase in oxygen absorption, and an increase in the functional activity of the hypothalamus, adrenal cortex and sympathoadrenal system.
Baths with a low concentration of salts (10-20 g/l) are characterized by a gradual increase in the stimulating effect on the sympathoadrenal system, starting from the first procedures and reaching a maximum towards the end of the course of treatment. At higher concentrations of salts in water, a pronounced stimulating effect is observed. Heat expands the superficial vessels of the skin and increases blood flow by 1.2 times. BAS (prostaglandins, bradykinin, etc.) and local neuroreflex reactions play a significant role in the formation of hyperemia. Moreover, after a course of such baths, the content of biologically active substances in patients decreases. Decreasing increased level markers of inflammation.
Sodium chloride water, through its effect on the activity of the sympathoadrenal system and the adrenal cortex, enhances the synthesis of catecholamines, which leads to increased oxidative phosphorylation and an increase in the number of macroergs in tissues.
In addition to the general reflex effect caused by the chemical composition of water, in the mechanism of action of salt baths there are also local functional changes in the receptor apparatus of the skin itself, in cellular elements and blood vessels. Baths of medium concentration increase the excitability of the central nervous system and the activity of the endocrine apparatus (pituitary gland, adrenal glands, thyroid gland), cause immunocorrection, and change tissue trophism.
The autonomic nervous system responds to salt baths by increasing parasympathetic tone, increasing blood circulation and diuresis. Thermal and chemical irritation of the skin, activation of thermoregulation mechanisms cause a reflex reaction in the form of dilation of peripheral vessels (compensatory reaction due to increased body temperature, trace effect). An increase in skin blood circulation is accompanied by the release of deposited blood and an increase in the volume of circulating blood. Sodium chloride baths, more significantly than fresh and gas baths, increase the tone of the peripheral veins and promote the outflow of venous blood from the periphery to the heart, which leads to an increase in venous return, increasing cardiac output (Starling mechanism). An increase in the tone of venous vessels under the action of a sodium chloride bath can be associated with an increase in the activity of sympathetic influences on the cardiovascular system.
^ Therapeutic effects : vasodilator, metabolic, immunostimulating, anti-inflammatory, secretory, antispastic.
INDICATIONS. Sodium chloride baths are indicated for syndromes: hyperergic inflammatory, dysalgic with reduced sensitivity, neurotic against the background of excitement, dishormonal with a predominance of stress-limiting hormones, immunopathies with allergic or immunodeficiency conditions), dysplastic, dystrophic by hypotype.
Diseases: inflammatory in subacute and chronic stages (adnexitis, bronchitis, pancreatitis, etc.), diseases of the cardiovascular system (neurocirculatory dystonia, stage I-II hypertension, chronic venous insufficiency, Raynaud’s disease, musculoskeletal system (polyarthritis, damage to ligaments, tendons, bones, deforming osteoarthritis), nervous system (plexitis, radiculitis), skin (psoriasis, neurodermatitis, scleroderma), hypothyroidism, stage I-II obesity, gout, vibration disease.
syndromes: infectious, hypoergic inflammatory, dysalgic with increased and inverted sensitivity, neurotic due to depression, dishormonal with a predominance of stress-inducing hormones, as well as organ failure (cardiac, vascular, respiratory, renal, hepatic, gastrointestinal and endocrine dysfunction, encephalomyelopathy, arthropathy, dermopathy) in the stage of decompensation, wound.
Diseases: inflammatory diseases in the acute stage, autonomic polyneuropathy, thrombophlebitis, hypothyroidism.
METHOD AND TECHNIQUE FOR CARRYING OUT THE PROCEDURE. Use artificially prepared baths, the sodium chloride content of which is 10-40 g/l, and the water temperature is from 35-38°C.
DOSAGE. The dosage of baths is determined by the concentration of dissolved sodium chloride, the temperature of the water, its volume and the duration of the procedure. The duration of the procedures, which are carried out with a break after 1-2 days, is 10-20 minutes.
^ PHYSIOTHERAPEUTIC RECIPCE
Diagnosis: Neurocirculatory dystonia of cardiac type.
Rp: Sodium chloride bath, with a concentration of 20 g/l, 35 o C, 10 minutes, every other day, No. 15.
^ IODINE-BROMINE BATHS - therapeutic effect on a patient immersed in iodine-bromine mineral water.
PHYSICAL CHARACTERISTICS. In nature, iodine and bromine ions are more often found in sodium chloride mineral waters. The iodine content is not less than 10 mg/l and bromine - 25 mg/l. Iodine-bromine baths contain iodine in ionic form in the form of iodides, the transition of which to molecular form is accompanied by a significantly greater intake from water into the patient’s body, which significantly increases the effectiveness of such procedures. Eat various ways the transition of iodine into a molecular form, for example, storing water with access to light and air, passing an electric current through it, oxidation.
DEVICES. The procedure is carried out in a bath.
^ MECHANISM OF ACTION OF THE FACTOR.Physico-chemical effects. The penetration of iodine and bromine ions through the skin depends on many circumstances: the mineral composition of water, its temperature, etc. During the procedure (10 minutes), 140-190 mcg of iodine and 0.28-0.3 mg of bromine penetrate into the body through the skin, which selectively accumulate in the thyroid gland, pituitary gland and hypothalamus. It is known that iodine is a component of the thyroid hormone - thyroxine, and bromine is contained in the pituitary gland tissue. One of the leading factors that influence the penetration of biologically active components of iodine-bromine mineral waters through human skin is kitchen salt.
Among the possible mechanisms of action of sodium chloride on transmembrane ion transport, a decrease in the activity of ions with an increase in the ionic strength of the solution and the formation of ion pairs with varying degrees of charge compensation and sizes, and, consequently, with unequal mobility, is of great importance. In a pair of sodium-iodine and sodium-bromine ions, the ion charges are compensated to a greater extent, and the size of such pairs is smaller than that of sodium-chlorine ions, since the hydration energy decreases in the series chlorine > bromine > iodine. Therefore, sodium-bromine and sodium-iodine ion pairs, under certain conditions, have a transmembrane diffusion (but not active transport) advantage comparable to the sodium-chlorine pair. Increasing the mineralization of water in an iodine-bromine bath from 6 g/l to 24 g/l doubles the deposition of iodine on the skin. Under other equal conditions, the movement of water can increase the deposition of iodine on the skin by 5 times, while a 7-fold increase in the volume of water without stirring it by 1.6 times. Established changes in the ability of the thyroid gland to concentrate and fixate iodine ions, the direction of which is directly dependent on the concentration of salts in water: iodine-bromine baths with low mineralization increase the ability of the thyroid gland to concentrate and fix iodine ions. Baths with highly mineralized water block the thyroid gland's ability to accumulate iodine. Fresh water baths do little to change the function of the thyroid gland.
^ Physiological effects . Iodine and bromine excite vascular chemoreceptors, reduce muscle tone, blood pressure, heart rate, increase the stroke volume of the heart, the volume of circulating blood, enhance inhibitory processes in the central nervous system, and reduce the manifestations of vegetative-trophic disorders.
By entering the structure of thyroxine and triiodothyronine, iodine ions restore basic metabolism in the body, stimulate protein synthesis and the oxidation of carbohydrates and lipids. The lipotropic effect of iodine-bromine baths is more pronounced in contrast to chloride and fresh baths.
Systematic use of iodine-bromine baths with diluted mineral water (mineralization more than 20 g/l) causes morphological signs of hyperfunction of the thyroid gland, an increase in basophilic cells in the anterior part of the pituitary gland and hypertrophy of the adrenal cortex. There is an improvement in the morphofunctional state of the myocardium and a decrease in the morphological signs of atherosclerosis in the vessels, which indicates the specific inhibitory effect of iodine and bromine on the signs of atherosclerosis. Course use of iodine-bromine baths normalizes the level of 11-OX in the blood. They increase the fibrinolytic activity of the blood, which is suppressed in atherosclerosis, reduce its coagulation properties and stimulate the formation of antibodies. Under the influence of iodine-bromine water, a decrease in platelet aggregation ability is observed, and it is more pronounced than the normalization of coagulation homeostasis indicators. After a course of baths, an increase in the content of free heparin in the blood is noted.
The presence of iodine and bromine ions in mineral water determines the specific features of the effect of baths on the hemostatic system. This is realized through a change in the functional state of endocrine and nervous regulation. The influence of iodine and bromine as biologically active substances on the state of hemostasis through the nervous and endocrine systems is largely antagonistic.
Iodine-bromine baths, increasing blood circulation and changing the function of the endocrine glands, have an anti-inflammatory effect and reduce autoimmune disorders. These aspects of action served as the basis for the use of iodine-bromine baths for inflammatory diseases. Accumulating at the site of inflammation in the lungs, iodine ions inhibit alteration and exudation and stimulate reparative regeneration processes. The anti-inflammatory effect of iodine-bromine baths is due to the pronounced affinity of iodine for bone and cartilage tissue, as well as the resorption effect, which is achieved due to vasodilation, active redistribution of blood and regulation of local blood circulation.
Penetrating through the blood-brain barrier, iodine ions inhibit excitation processes in the cerebral cortex and weaken pathological temporary connections in patients with psychosis and neurasthenia, and accelerate the synthesis of releasing factors of the hypothalamus and tropic hormones of the pituitary gland. The most characteristic property of iodine-bromine baths is the effect on the nervous system, which is expressed by an increase in the threshold of pain sensitivity, increased inhibition processes in the central nervous system, an analgesic and sedative clinical effect. By blocking the ionic permeability of voltage-dependent ion channels of the peripheral nerve conductors of the skin, iodine ions cause a decrease in pain and tactile sensitivity in patients, and have a desensitizing, bacteriostatic and bactericidal effect.
Iodine-bromine baths reduce the tone of arterial vessels and increase the tone of veins, increase venous blood flow to the heart and cardiac output.
^ Therapeutic effects : stress-limiting, anti-inflammatory, reparative-regenerative, metabolic, sedative, bacteriostatic, bactericidal, hyposensitizing, immunocorrective, secretory, hypotensive, analgesic.
INDICATIONS. Iodine-bromine baths are indicated for syndromes: hyperergic inflammatory dysalgic with increased and inverted sensitivity, neurotic against a background of excitement, dishormonal with a predominance of stress-inducing hormones, immunopathy with allergic or immunodeficiency conditions, dysplastic and dystrophic in the hypertype.
Diseases: chronic inflammatory, angina pectoris FC I and II, atherosclerotic and post-infarction cardiosclerosis (10 weeks after myocardial infarction), hypertension stage I-II, polyneuropathy, psychosis, schizophrenia, neurasthenia, eczema, neurodermatitis, cerebral atherosclerosis, Raynaud's disease, endocrine forms of female infertility (with the exception of thyrotoxicosis), osteoarthritis.
CONTRAINDICATIONS. On a par with general syndromes: infectious with a pyretic reaction, hypoergic inflammatory, neurotic against a background of depression, dyshormonal with a predominance of stress-limiting hormones, edematous, as well as organ failure (cardiac, vascular, respiratory, renal, hepatic, gastrointestinal and endocrine dysfunction, encephalomyelopathy, arthropathy, dermopathy ) in the stage of decompensation, dysplastic and dystrophic hypotype, wound.
Diseases: inflammatory in the acute stage, iodine intolerance, severe forms of diabetes mellitus and thyrotoxicosis, pituitary obesity, gout, hypothyroidism.
METHOD AND TECHNIQUE FOR CARRYING OUT THE PROCEDURE. To prepare an artificial bath with a capacity of 200 liters, add 2 kg of sea or kitchen salt, 25 g of potassium bromide and 10 g of sodium iodide to fresh water. It is advisable to immediately prepare a solution for 10 baths; to do this, dissolve 250 g of potassium bromide and 100 g of sodium iodide in 1 liter of cold water. After dissolving the salt in fresh water, add 100 ml of this solution. The solution is stored in a dark glass container with a stopper. Before the procedure, a concentrated mother solution is poured into the bath. Then add cold fresh water until the desired temperature and bath volume are achieved. After this, the patient is carefully immersed in the bath to the level of the nipples. After the bath, the patient wets the body with a towel, wraps himself in a sheet and rests for 20-30 minutes.
DOSAGE. To carry out the procedure, use mineral water at 35-37°C, the content of iodine ions is not lower than 10 ml/l, and bromine ions - 25 mg/l. The duration of the procedures with a break every other day or two is 10-15 minutes, the course of treatment is 10-15 baths.
^ PHYSIOTHERAPEUTIC RECIPCE
Diagnosis: IHD: atherosclerotic cardiosclerosis, CH1.
Rp: Iodine-bromine bath, 25 mg/l potassium bromide and 10 mg/l sodium iodide, 35 o C, 10 min, every other day, No. 10
^ HYDROGEN SULFIDE BATHS - therapeutic effect on a patient immersed in hydrogen sulfide mineral water.
PHYSICAL CHARACTERISTICS. Hydrogen sulfide waters include waters that contain sulfides in the form of molecular (H 2 S 2) or hydroxyl ions (HS -). Depending on the content of sulfides (total hydrogen sulfide), natural waters are divided into weak (0.3-1.5 mmol/l, or 10-50 mg/l), medium (1.5-3 mol/l, or 50-100 mg/l), strong (3-7.5 mmol/l, or 100-250 mmol/l) and very strong (7.5-12 mmol/l, or 250-400 mg/l). In clinical practice, water of medium concentration, more than 10 mg/l of total hydrogen sulfide, is more often used. The ionic composition of hydrogen sulfide waters is determined by the hydrogeological features of their deposit and includes hydrosulfite ions, bicarbonates, sulfates and chloride. Most natural hydrogen sulfide mineral waters (temperature 35-37°C) have medium and high mineralization (10-40 g/l). Ukrainian resorts with sulfide waters: Lyuben-Veliky, Nemirov, Sinyak, Cherche.
DEVICES. The procedures are carried out in a bathtub in a separate room with good ventilation.
^ MECHANISM OF ACTION OF THE FACTOR.Physico-chemical effects. The free hydrogen sulfide present in water is split into hydrogen ions, hydrosulfidiones and sulfur. Hydrogen sulfide actively penetrates the body through intact skin, mucous membranes and the upper respiratory tract. Hydrogen sulfide, as a strong reducing agent, converts disulfide groups of proteins and enzymes into sulfhydryl groups and acts as a natural antioxidant. As a result, the activity of the pentose cycle and the synthesis of low-density lipoproteins are reduced, and glycolysis is activated.
^ Physiological effects . The main active principle of the use of sulfide baths, in addition to their thermal and hydrostatic factors, is free hydrogen sulfide and hydrosulfide ions. By irritating sensitive nerve endings in the skin and mucous membranes of the respiratory tract, hydrogen sulfide causes reflex reactions of the vasomotor nerves, thereby changing the tone of the skin vessels. At the same time, histamine-like substances are released and participate in this regulation. In addition, penetrating through the skin and mucous membranes of the respiratory tract into the blood, hydrogen sulfide affects the internal environment of the body. Hydrogen sulfide circulating in the blood quickly undergoes oxidation with the participation of the liver. Oxidation products are excreted by the kidneys, therefore, for diseases of the liver and kidneys, sulfide balneotherapy is not carried out, since complications from these organs are possible.
Hydrogen sulfide and its oxidation products circulating in the blood, as well as vasoactive substances (histamine, serotonin, etc.) act on the chemoreceptors of the vessels of the sinocarotid and aortic zones (excites), affecting vascular tone, blood pressure and heart regulation.
Sulfide baths help normalize the disturbed functional state of the central nervous system, enhancing inhibition processes in it and balancing nervous processes, the functional state of the hypothalamus changes (the parasympathetic influence increases) and the vagotonic nature of reactions to the first procedures predominates. Reflexes from carotid chemoreceptors lead to contraction of the spleen and the release of red blood cells into the general circulatory system, and activate the secretion of corticosteroids by the adrenal medulla. This leads to hyperglycemia and increased levels of immunoglobulins E and G, as well as increased glomerular filtration and diuresis.
Mostly hydrogen sulfide molecules penetrate into the body from water, which is subsequently oxidized to sulfates and sulfides. Molecules enter the bloodstream and cerebrospinal fluid through the skin. When oxidized, they form free sulfur and sulfides in tissues, which, by blocking iron-containing enzymes (cytochrome oxidase, lipase, etc.), inhibit the rate of oxidative phosphorylation in tissues. Hydrogen sulfide reduces platelet aggregation ability and blood viscosity. Due to the activation of polymorphonuclear leukocytes, hydrogen sulfide stimulates reparative regeneration in tissues and streamlines the structure of collagen fibers in scars. The metabolism of proteins and amino acids that contain sulfgyryl groups is enhanced. Mineral waters that contain sulfur have a positive effect on cartilage metabolism. The content of biologically and vasoactive substances in the blood increases, which determine the humoral link in the regulation of the basic physiological functions of the body. The number of active capillaries increases, metabolic processes at the cellular and tissue levels accelerate, and microcirculation improves.
Dilatation of skin vessels with redistribution of blood, a decrease in arteriolar tone is accompanied by a decrease in peripheral vascular resistance, a decrease in blood pressure and an increase in cardiac output. This is also facilitated by an increased flow of venous blood to the right heart due to an increase in the amount of circulating blood (the release of deposited blood due to its movement into the dilated vessels of the skin). Heart filling improves. This effect of sulfide baths on the heart, which is regularly repeated during the course of treatment, is considered as a training effect and serves as the basis for their use in the treatment of the initial stage of heart failure (adaptation therapy).
In the hypokinetic variant of blood circulation, hemodynamic restoration occurs due to a decrease in increased peripheral resistance under the influence of baths with a concentration of 75-100-150 mg/l. At the same time, there is an improvement in the contractile function of the myocardium, as evidenced by an improvement in the phase structure of left ventricular systole.
Restoration of hemodynamics in the hyperkinetic variant occurs due to a decrease in the increased SV, and only under the influence of baths with a low concentration of hydrogen sulfide 25-50-75 mg/l. Sulfide baths with a higher (100-150 mg/l) concentration of hydrogen sulfide either do not reduce the CV or increase it even more.
Hydrogen sulfide baths promote the intensification of carbohydrate metabolism, which leads to a decrease in hyperglycemia in patients with diabetes, activate the reserves of catecholamine biosynthesis and help restore the impaired (mainly reduced) functional state of the sympathoadrenal system and glucocorticoid function of the adrenal glands. Sulfide baths (100-150 mg/l) increase the iodine absorption function of the thyroid gland, activate the reduced estrogenic function of the ovaries, and restore the disrupted menstrual cycle.
^ Therapeutic effects : reparative-regenerative, metabolic (glycolytic and lipolytic), immunomodulatory, secretory, stress-inducing, thrombocoagulating (primary), proinflammatory (primary), tonic, cardiotonic, analgesic.
INDICATIONS. Hydrogen sulfide baths are indicated for the following main reasons: syndromes: hypoergic inflammatory, dysalgic with increased, decreased and inverted sensitivity, neurotic against the background of depression, dyskinetic and dystonic, as well as organ failure (cardiac, vascular, arthropathy) in the compensation stage, dysplastic and dystrophic.
Diseases: chronic inflammatory, angina pectoris FC I-II, pathology of the peripheral nervous system and joints with hyporeactivity of the body (neuralgia, polyneuritis, radiculitis, myelitis, encephalitis, neurasthenia, cerebroasthenia, polyarthritis, spondylosis, osteochondropathy, osteoarthritis), Raynaud's disease, obliterating endarteritis, varicose veins, vibration disease, tubal infertility, chronic poisoning with salts of heavy metals.
CONTRAINDICATIONS. On a par with general syndromes: infectious, hyperergic inflammatory, neurotic against a background of excitement, dyshormonal with a predominance of stress-inducing hormones, immunopathy with allergic conditions, organ failure (cardiac, vascular, respiratory, renal, hepatic, gastrointestinal and endocrine dysfunction, encephalomyelopathy, arthropathy, dermopathy) in the stage of decompensation, wounded.
Diseases: inflammatory in the acute stage, angina pectoris III-IV FC, diseases of the kidneys, liver and biliary tract and bronchopulmonary system, toxic-allergic reactions to hydrogen sulfide, vegetative-vascular dysfunction, severe dysfunction of the pelvic organs, arachnoiditis, tendency to thrombosis, gastric ulcer in the acute stage .
DOSAGE. The dosage of baths is carried out by the concentration of hydrogen sulfide, as well as the temperature of the water, its volume and the duration of the procedure. The duration of the procedures, which are carried out with a break every other day or two, is 8-12 minutes, the course of treatment is 12-14 baths.
^ PHYSIOTHERAPEUTIC RECIPCE
Diagnosis: Raynaud's disease.
Rp: Hydrogen sulfide bath with a concentration of 75 mg/l, 36 o C, 15 minutes, every other day, No. 12.
RADON BATHS - therapeutic effect on a patient immersed in radon mineral water. Recently, other types of radon therapy have found application: air-radon or “dry radon baths”, devoid of the action of water, but retaining the specific effect of alpha radiation. Pararadon procedures (“baths”) are natural radon steam from wells, cracks in rocks or mine workings. The peculiarities of their action consist not only in the elimination of hydrostatic influence, but also in the higher accumulation of radon in internal organs due to the high temperature of the vapor-air environment (44-46 0 C).
PHYSICAL CHARACTERISTICS. The main active factor in a radon bath is the dissolved inert gas radon (Rn), the decay of which is accompanied by alpha radiation (radon half-life is 3.823 days). For therapeutic effects, mineral water is used, which contains radon and its daughter decay products - polonium (Po), lead (Pb), bismuth (Bi). Moreover, radon daughter products (DPR) are an active agent to a much greater extent than radon itself. The DPR part accounts for from 70% (with water baths) to 97% (with air baths) absorbed radiation energy. The half-life of radon radioisotopes ranges from several to 26 minutes. The volumetric activity of radon in water must exceed 37 Bq/l.
Most natural radon mineral waters have low mineralization (below 2 g/l) and contain, in addition to radon, various gases and minerals. The water temperature of radon baths is 34-36 0 C. Natural and artificially prepared radon baths are used for medicinal purposes. The concentration of radon in baths is determined by the unit of activity - the curie, corresponding to the activity of any radioactive isotope in which 37 billion decays occur in 1 s. Today, a new unit of activity is being introduced according to the international system (SI) - becquerel (BC) 1 nCi = 37 BC. Natural waters divided into waters with low (0.2-1.5 kBq/l, or 5-40 nCi/l), medium (1.5-7.4 kBq/l, or 40-200 nCi/l) and high ( more for 7.5 kBq/l, or 200 nCi/l) radon concentration.
DEVICES. The procedures are carried out in a bathtub installed in a separate room with good ventilation.
^ MECHANISM OF ACTION OF THE FACTOR.Physico-chemical effects. When the stratum corneum is irradiated, radiolysis products (radiotoxins) are formed, which can penetrate into the deeper layers of the skin (dermis). Radiotoxins disrupt the processes of glycolysis and oxidative phosphorylation and thereby affect cell functions. Radon alpha radiation causes ionization of protein and water molecules in the dermis and the formation of reactive oxygen species. During the procedure, up to 0.27% radon penetrates the body through the skin, which creates a high concentration of ionization products in the tissues of internal organs. A so-called radioactive coating settles on the skin, which continues to act after the bath. The skin has a kind of barrier layer that prevents the transport of radon. It not only significantly limits the entry of radon into the body, but also slows down its reverse elimination. This layer appears to be composed of phospholipid molecules, which are known to be in liquid crystalline form.
^ Physiological effects . Changes in cellular metabolism are accompanied by the release of biologically active substances, which in turn serve as a source of afferent impulses and many reactions of the body. Irritation of numerous nerve endings in the skin by alpha radiation reduces the threshold of their sensitivity. Due to internal radiation, the sensitivity threshold of nerve endings in organs changes. A decrease in alpha and beta adrenergic sensitivity under the influence of drinking radon water and baths (trace effect) has been established.
Radon baths also reduce sensitivity to angiotensin and norepinephrine. The products of protein radiolysis, like protein products of photodestruction, come into contact with sensitized T-helper lymphocytes and stimulate the release of cytokines. As a result, the synthesis of neutral proteases, biologically active substances and Ig by tissue histiocytes (macrophages) and polymorphonuclear granulocytes is enhanced. The induction of immune processes in the skin is also potentiated by lipid peroxidation products, which activate the differentiation of T- and B-lymphocytes with the production of immunoglobulins. The primary phase of radon therapy is characterized by a stress-inducing orientation and immunosuppression. Subsequently, restoration of moderately impaired immune functions is observed. But in the case of deeper breakdowns in the homeostasis of immunoregulatory cells, radon therapy can intensify existing disorders and lead to an exacerbation of the disease.
In the hyperkinetic version, hemodynamic restoration occurs under the influence of baths with a radon concentration of 40-80 nCi/l, in the hypokinetic version - 40 nCi/l. Restoration of hemodynamics in the hyperkinetic variant (decrease in cardiac output) can be associated with a decrease in sympathetic influences on the cardiovascular system. This situation was confirmed by a decrease in clinical signs of hypersympathicotonia and a decrease in the daily excretion of catecholamines and their precursors, which was increased before treatment, under the influence of baths at concentrations of 40 and 80 nCi/l.
Restoration of hemodynamics (increase in cardiac output) in hypokinetic circulation occurs due to a decrease in peripheral resistance under the influence of baths with concentrations of 40 and 120 nCi/l (baths with 40 nCi/l are more favorable). An increase in cardiac output is also due to an increase in venous blood flow to the heart and an increase in venous tone only at a given radon concentration. At the same time, an increase in dopamine excretion is observed, which is significant only at a radon bath concentration of 40 nCi/l.
When applied externally (during bathing - the primary effect), the concentration of catecholamines in various tissues increases. An increase in their level is observed in the adrenal glands with internal use(drinking) radon water.
One of the main mechanisms of action of alpha radiation from radon baths is the effect on the nervous system at all its levels. After a course of radon baths with a concentration of 40-120 nCi/l, the increased excretion of adrenaline and dopamine decreases while the clinical and hemodynamic signs of hypersympathicotonia decrease. Radon alpha radiation significantly reduces the conductivity of nerve fibers, which leads to a decrease in pain sensitivity of the skin, a decrease in sympathetic tone and an increase in the parasympathetic parts of the autonomic nervous system.
The influence of alpha radiation on the body is realized both directly on the cells and tissues of organs, and indirectly through the centers of neuroendocrine regulation. There is a stimulating effect of radon baths on the function of the corpus luteum, which is often reduced in patients with hypertension. IN early period menopause (menopause lasting up to 1 year) under the influence of treatment with radon baths is noted more favorable course than in patients with long-term (from 2 to 14 years) menopause. It is expressed by a decrease in the increased excretion of estrone and an increase in estriol due to the accelerated transition of estrone to estriol. This significantly distinguishes the effect of radon baths from sulfide and carbon dioxide baths, the action of which leads to favorable changes in estrogen metabolism only in patients in the late period of menopause.
A stimulating effect of radon baths on the activity of tissue lipolytic enzymes in atherosclerosis is observed, hypercholesterolemia in patients with coronary artery disease and hypertension is reduced when treated at resorts with radon waters. The use of natural or artificial radon baths in patients with exogenous obesity leads to an increase in tolerance to carbohydrates, a decrease in the level of uric acid in the blood and an increase in its excretion in the urine in patients with gout.
^ Therapeutic effects : reparative and regenerative, metabolic (glycolytic and lipolytic), immunostimulating, antispastic, analgesic, stress-inducing.
INDICATIONS. Radon baths are indicated for the following main reasons: syndromes: hypoergic inflammatory, dysalgic with increased, inverted sensitivity, neurotic against the background of excitement, dishormonal with a predominance of stress-limiting hormones, immunopathies with immunodeficiency states, dysplastic and dystrophic.
Diseases: chronic inflammatory, cardiovascular pathology (angina pectoris I-III FC, myocardial dystrophy, myocardial, atherosclerotic, post-infarction cardiosclerosis, stage I-II hypertension, varicose veins), musculoskeletal (arthritis, osteomyelitis, bone fractures with delayed consolidation during hyporeactivity of the body, osteoarthritis, spondylitis) and nervous systems (neuralgia, neuritis, radiculitis, plexitis, neurasthenia, sleep disturbance, consequences of brain injury), skin (neurodermatitis, psoriasis, scleroderma), keloid scars, trophic ulcers, gout, diabetes mellitus, obesity of II-III degree, diffuse toxic goiter of I-II degree, uterine fibroids (size up to 12 weeks of pregnancy), endometriosis.
CONTRAINDICATIONS. On a par with general syndromes: infectious with a pyretic reaction, hyperergic inflammatory, neurotic against the background of depression, dyshormonal with a predominance of stress-inducing hormones, organ failure (cardiac, vascular, respiratory, renal, hepatic, gastrointestinal and endocrine dysfunction, encephalomyelopathy, arthropathy, dermopathy) in the stage decompensation, wound.
Diseases: inflammatory in the acute stage, poor tolerance to radon mineral water, professional contacts with ionizing radiation, ovarian hypofunction of neuroendocrine origin, pregnancy, uterine fibroids (over 12 weeks of pregnancy), lymphopenia, radiation sickness, severe neurosis, autonomic dysfunction, angina pectoris IV FC, hyperthyroidism stage III.
METHOD AND TECHNIQUE FOR CARRYING OUT THE PROCEDURE. An artificial radon bath is prepared by pouring and stirring a portion (100 ml) of a concentrated radon solution into fresh bath water (200 l) at a given temperature. The patient is immersed in the bath to the level of the nipples. After the bath, the patient dries the skin with a towel (without rubbing), which helps preserve the daughter products of radon decay on the skin, and rests for 30-60 minutes.
DOSAGE. The dosage of baths is determined by the duration of the procedure, the radioactivity of radon, as well as the temperature of the water and its volume. Artificially prepared water is prescribed to adults at a concentration of 40-80 nCi/l, to children - 20 nCi/l. The duration of the baths, which are carried out daily or every other day, is 12-15 minutes, the course of treatment is 10-15 baths.
^ PHYSIOTHERAPEUTIC RECIPCE
Diagnosis: Common osteochondrosis.
Rp: Radon bath, 80 nCi/l, 36 o C, 10 min, every other day No. 10.
INTESTINAL WASH - Irrigation of the walls of the large intestine with liquid.
PHYSICAL CHARACTERISTICS. For intestinal lavage, use fresh water with a decoction of herbs (chamomile, etc.), a solution of medicinal substances, mineral water (saline solution of kitchen salt, Epsom salt, Carlsbad salt, magnesium sulfate) or acidic mineral water with a mineralization of 2-8 g/dm 3 with a temperature 37-39°C.
APPARATUS. Couch for gastrointestinal irrigation with a dosing tank, APKP-760 (underwater intestinal lavage device), AKP (intestinal lavage device) and AMOC (intestinal monitoring device), hydrocolon.
^ MECHANISM OF ACTION OF THE FACTOR.Physico-chemical effects. The injected fluid penetrates to the ileocecal valve and loosens the intestinal contents, which are then excreted with fluid from the colon. The liquid also cleanses the intestinal walls from rejected epithelial cells, mucus, waste, toxins, excreta and putrefactive aerobic bacteria. The washing liquid restores the normal ratio of intestinal microflora microorganisms that break down the nutrients of chyme and synthesize B vitamins.
^ Physiological effects . An increase in fluid pressure in the rectum to 4-5 kPa causes irritation of the mechanoreceptors of the submucosal layer, leading to the formation of afferent impulse flows that excite the defecation center located in the transverse segments of the spinal cord. The tone of the muscular internal sphincter increases, the tone of the external anal sphincter weakens and defecation occurs. In this case, there is an increase in respiratory rate, heart rate (by 10-20 beats/min), as well as an increase in blood pressure (systolic by 50-60 mm Hg, diastolic by 10-20 mm Hg), the volume of circulating blood increases. Due to the absorption of a certain amount of water, diuresis increases. Intestinal lavage increases local blood flow to the colon mucosa and restores the absorption of gases and minerals into the blood that is impaired due to illness. The flushing liquid reduces inflammation and corrects metabolic disorders in the interstitium, restores motility and secretion of the intestinal mucosa, and normalizes immunity.
^ Therapeutic effects : defecation, detoxification, metabolic, kinetic, diuretic, hyposensitizing, immunocorrective.
INDICATIONS. Before prescribing intestinal lavage, clinical and laboratory examinations of the rectum and pelvic organs are carried out (review by a proctologist and gynecologist, sigmoidoscopy, irrigoscopy, fecal occult blood test). Intestinal lavage is indicated for the following syndromes : hyper- and hypoergic inflammatory, dysalgic with reduced and inverted sensitivity, immunopathies with allergic or immunodeficiency conditions, dyskinetic and dystonic in hyper- or hypotype.
Diseases: chronic colitis, chronic constipation, chronic gastritis, liver and biliary tract disease, gout, diabetes, diathesis, obesity.
CONTRAINDICATIONS. In addition to absolute ones, when syndromes: infectious inflammatory, dysalgic with increased sensitivity, edematous, as well as organ failure (cardiac, vascular, respiratory, renal, hepatic, gastrointestinal and endocrine dysfunction) in the stage of decompensation, wound.
METHOD AND TECHNIQUE FOR CARRYING OUT THE PROCEDURE. Before the procedure, the patient empties the intestines and bladder, it is advisable to give enemas. The flushing liquid is introduced into the colon under a pressure of 12-15 kPa in portions that increase from 0.5 to 1.5 liters. The total volume of water is up to 10 liters. Irrigation water is administered through a sterile rectal tube with a tip lubricated with petroleum jelly and connected to the irrigation reservoir system. The rubber tip is inserted to a depth of 15-20 cm. The flushing liquid is introduced in portions using a tap. When there is an urge to defecate, they expel it along with feces into the sewer.
DOSAGE. The dosage is carried out by the pressure of the washing liquid, its volume and the number of washes. Washing is carried out 1-2 times a week. The course of treatment is 6 procedures.
^ PHYSIOTHERAPEUTIC RECIPCE
Diagnosis: Chronic non-infectious catarrhal colitis, inactive phase.
Rp: Intestinal lavage with chamomile decoction, water temperature 37 0 C, from 0.5 to 1.5 l, total volume up to 10 l, after two days, No. 5.
^ TAKING MINERAL WATER INSIDE. The use of drinking mineral waters has become widespread for diseases of the digestive system, urinary and endocrine systems, and metabolic pathologies.
PHYSICAL CHARACTERISTICS. For drinking treatment, mainly waters of low and medium mineralization are used (2-5 and 5-15 g/l). Waters with mineralization less than 2 g/l are considered medicinal if they contain any specific components, for example organic substances, in increased quantities. The temperature of drinking mineral waters varies widely: cold waters - below 20 0 C, warm (subthermal) - 20-35 0 C, hot (thermal) - 35-42 0 C, very hot (hyperthermal) - above 42 0 C. For oral administration, warm and hot waters are often used. The acidity and alkalinity of water is important. There are strongly acidic (pH 8.5). Slightly alkaline waters are used more often. The weakly acidic reaction of mineral waters can be converted into a slightly alkaline reaction by heating the water, when part of the carbon dioxide is released from it.
Physiological and therapeutic effect depends on chemical composition mineral water. It is the ionic composition that determines the type and name of water.
An assessment of the properties of mineral water must begin with a consideration of the geological layers where the water is formed. In this regard, flint, calcareous, ferruginous, quartz and other waters are of great interest. For example, water deposits in the Zborovsky district of the Ternopil region have unique geological and geophysical properties. While drilling the well, rock layers were revealed: loam, calcareous clay, limestone, clay with layers of sand and clay, chalk with silicon. These layers are involved in the formation of water containing calcium, silicon, iron, iodine, etc. A deficiency of these microelements is observed in patients with the vagoinsular type of autonomic dysfunction.
The reserves of sodium and magnesium in the salt deposits of ancient seas create unique waters containing sodium, magnesium, potassium, copper, fluorine, zinc, phosphorus, molybdenum, manganese, vanadium, and chromium. Deficiency of these micro- and macroelements is observed in patients with sympathoadrenal dysfunction. The uniqueness of such water deposits makes it possible to introduce new type in the classification of mineral waters - health-improving (along with medicinal and table waters). The concept of “adaptation” is introduced for the first time " water, the action of which is aimed at correcting homeostasis in the patient’s body. The intake of this water is determined by the leading syndrome and deficiency of macro- and microelements, their action in conditions of impaired autonomic tone, hormonal balance, immune status and metabolism.
^ MECHANISM OF ACTION OF THE FACTOR.Physico-chemical effects. Ions of sodium, potassium, calcium, magnesium, bicarbonates, sulfates are involved in the most complex physical and chemical processes, in maintaining acid-base balance. Hydrocarbonate waters, filling the lack of blood carbonate, increase the body's alkaline reserves, neutralize the acidic secretions of the stomach, reducing the number of hydrogen ions. Chlorine anions are the initial substrate for the formation of hydrochloric acid in gastric juice. Sulfates inhibit acid formation in the stomach and improve the physicochemical properties of bile. Magnesium salts catalyze the function of a number of enzymes (trypsin, erypsin). Sodium and potassium regulate metabolism and osmotic pressure in tissues.
^ Physiological effects . Drinking mineral waters dilute pathological mucus in the digestive canal and urinary tract, thereby facilitating its removal from these organs. Hydrocarbonate water inhibits the level of acid formation in the stomach. Reacting with gastric juice, bicarbonates form carbon dioxide. Neutralization of acidic gastric secretions helps reduce gastrin production. Ions chlorine are the initial substrate for the formation of hydrochloric acid, enhance gastric motility, stimulate pancreatic secretion, and the formation of intestinal enzymes. Sulfate sodium and magnesium salts, by restoring the function of hepatocytes, have a beneficial effect on the functional state of the liver, increase choleresis, improve physicochemical characteristics bile. Waters that contain sulfates, irritate the intestinal mucosa, enhance peristalsis and secretion, and have a laxative effect. Ions sodium, potassium enhance the tone and motor function of the stomach and intestines.
In the case of reduced acidity, ingested mineral water of a complex chemical composition irritates the chemoreceptors of the gastric mucosa and reflexively excites the vagus nerve, which is the secretory nerve of the stomach. The release of gastrin, acid formation and gastric motility are enhanced. Gastrin increases protein synthesis in the gastric mucosa, enhances microcirculation, which leads to improved tissue trophism. Stimulation of the activity of acid-producing glands is not observed only in patients with deep atrophy of the gastric mucosa, the glandular apparatus of which is not capable of producing hydrochloric acid.
In hyperacid conditions, mineral waters help stimulate secretin and pancreozymin, which increases the alkalinity of the duodenal cavity and inhibits gastric secretion of hydrochloric acid.
The functional state of the liver improves, first of all, due to improved blood circulation in it. An increase in the intensity of hepatic blood flow and a decrease in tissue hypoxia are associated with the action of gastrin, the release of which is stimulated by mineral water. The function of the pancreas improves, the content of bicarbonates and enzymes in pancreatic juice increases.
Fluorine normalizes mineral composition with severe osteoporosis. Patients constantly receiving glucocorticoid hormones (the latter are known to cause magnesium deficiency in the body) should take water with plenty of magnesium. Against the background of such mineral water, magnesium-calcium and phosphouresis increase, parathyroid hormone secretion decreases, and the level of magnesium in the serum increases, which ultimately improves the course of the disease. Sulfate anion , which is contained in mineral water, is included in the exchange of connective and cartilage tissue. The process of sulfate assimilation in chondrocytes is observed within an hour after drinking water, and the cation combined with sulfate has a great influence on intracellular fixation and the rate of sulfur absorption.
Mineral waters increase the excretion of uric acid by the kidneys due to the diuretic effect and inhibition of urate reabsorption in the tubules. Carbon dioxide hydrocarbonate and sulfate sodium waters increase the alkalinity of urine and have a diuretic effect, especially waters of low mineralization with a pH above 7.1. Calcium and magnesium sulfate waters also contribute to the removal of urea (90%) and chlorine (87%).
A risk factor for the formation of calcium oxalate stones is a deficiency of magnesium in the body, so water with a high magnesium content can be successfully used to eliminate disorders of mineral metabolism. Hydrocarbonate and sulfate waters have litholytic properties, prevent agglutination of urinary crystals, and stimulate peristalsis of the urinary tract. For uraturia, it is more justified to use sodium bicarbonate waters, and for oxalaturia, calcium sulfate waters. Calcium ions form insoluble compounds with oxalic acid, which ultimately helps remove oxalates from the body and prevent relapses of urolithiasis. Sulfate-magnesium waters also suppress oxaluria and normalize mineral metabolism.
The destruction of oxalate and urate stones in the kidneys is caused by the use of bicarbonate water, which increases the content of citrates in the urine, causing an increase in alkalinity.
^ In healing waters Microelements, which are important for the correction of water-electrolyte and functional disorders that accompany the leading pathogenetic syndrome, become important.
^ Therapeutic effects : when consumed internally, mineral waters have an anti-inflammatory, antispasmodic, analgesic effect, normalize the secretory and motor functions of the stomach and intestines, help normalize bile formation and excretion, and increase diuresis.
INDICATIONS. Ingestion of mineral water is indicated for syndromes: hyper- and hypoergic inflammatory, dishormonal with a predominance of stress-inducing or stress-limiting hormones, immunopathies with allergic or immunodeficiency conditions, dyskinetic and dystonic in hyper- or hypotype.
Diseases: digestive organs (diseases of the esophagus, stomach, peptic ulcer, intestinal diseases outside the acute phase; diseases of the liver and biliary tract, chronic pancreatitis without a tendency to frequent exacerbation, diseases of the operated stomach); genitourinary system (chronic pyelonephritis without symptomatic hypertension, chronic cystitis, urolithiasis, condition after surgery to remove stones); metabolic diseases (obesity, diabetes, mineral metabolism disorders).
At dysneurotic syndrome, vagotonics are prescribed healing waters that have a stimulating effect on the central nervous system (for example, Zborovskaya “Tonus”). It contains trace elements of calcium, iron, iodine, selenium, sulfur. For sympathotonics, sedative waters containing microelements are indicated - magnesium, potassium, sodium, phosphorus, copper, zinc, manganese, which have an inhibitory effect on the central nervous system (for example, Zborovskaya “Relax.”)
At dishormonal syndrome with a predominance of synthetic processes, tonic water is indicated, which activates the sympathoadrenal system and the processes of glucose breakdown (calcium, iron, iodine, sulfur, etc.). For dishormonal syndrome with a predominance of catabolic processes, water is prescribed that contains zinc, molybdenum, vanadium and other trace elements that activate insulin and other synthetic hormones, as well as the processes of glucose absorption.
At dysimmune allergic type syndrome, desensitizing waters (contain calcium, iodine, iron) are indicated. For immunosuppression, immunomodulators (magnesium, potassium, etc.) are indicated.
At dysmetabolic syndrome with alkalosis disorders, the use of slightly acidic waters is justified; in case of metabolism with acidosis, alkaline waters are indicated. The weakly acidic reaction of mineral waters can be converted into a slightly alkaline reaction by heating the water. Some carbon dioxide is released from the water.
CONTRAINDICATIONS. In addition to the general syndromes: infectious with a pyretic reaction, dysalgic with increased sensitivity, edematous, organ failure (cardiac, vascular, respiratory, renal, hepatic, gastrointestinal and endocrine dysfunction, encephalomyelopathy, arthropathy, dermopathy) in the stage of decompensation.
Diseases: chronic stomach and intestinal problems, which are accompanied by frequent vomiting, diarrhea, bleeding, severe pain, severe digestive disorders; diseases with a pronounced impairment of the motor-evacuation function of the stomach and intestines, narrowing of the esophagus, abdominal adhesions; rigid gastritis; peptic ulcer of the stomach, complicated by stenosis, penetration, all forms of jaundice, cirrhosis of the liver; viral hepatitis; cholelithiasis with frequent attacks; chronic dysentery; urolithiasis disease; urological diseases (cystitis, prostatitis) in the acute stage. Contraindications for treating patients with gout at drinking resorts include frequent renal colic with the passage of multiple stones, impaired outflow of urine from the kidneys, increased concentrations of urea and creatinine in the blood (above 10 mmol/l and 200 µmol/l, respectively).
METHOD AND TECHNIQUE OF VACATION PROCEDURES. Highlight following methods internal use of mineral waters:
1. Drinking treatment.
2. Transduodenal intestinal lavage.
3. Tubage (probeless probing).
4. Gastric lavage and irrigation.
5. Rectal method of administration, intestinal lavage, microenemas with mineral water.
Method of drinking treatment. Drinking treatment is carried out directly at the source or bottled mineral water is used. It is recommended to drink mineral water directly near the pump room while walking, which promotes better absorption of mineral water. Water should be drunk slowly, in small sips.
At transduodenal lavages intestines, mineral water passes through the stomach and directly enters the duodenum, which provides the opportunity to influence the intestinal mucosa with water at the required temperature. The probe inserted into the duodenum is connected to a 3-4 liter vessel with mineral water.
^ Probeless sensing carried out with low- or medium-mineralized waters with the addition of cholekinetic agents (xylitol, sorbitol) to the first portion and the use of a heating pad.
^ Gastric lavage carried out using a thick gastric tube. For irrigation, a special probe is inserted into the patient's stomach, which consists of two thin probes. The procedure is performed in a lying position on the right side. From one tube, warm mineral water is injected into the stomach and at the same speed through another tube it is poured into the pelvis.
At intestinal lavages mineral water is introduced into the intestines and removed simultaneously according to the principle of a siphon. A rubber tube is inserted into the rectum, one end of which is connected to a funnel. Mineral water is poured up to 1 liter, then the funnel is lowered to the floor and the water is removed. During 1 procedure, 3-5 infusions are performed.
DOSAGE. The dosage is determined by the temperature of the mineral water: the water is drunk warm for diseases of the liver, biliary tract, diarrhea, spastic constipation, hyperacid gastritis; cool mineral water is used for hypoacid conditions. A single dose of mineral water with low and medium mineralization is determined at the rate of 2-3 ml per 1 kg of body weight. When taking waters of low mineralization, a single dose is prescribed at the rate of 4-4.5 ml per 1 kg of patient’s body weight. In hyperacid conditions, water is taken 1-1.5 hours before meals, in hypoacid conditions - 10-15 minutes before meals. Water is taken 3 times a day for 30 days. For hyperacid conditions, take hydrocarbonate (alkaline), hypoacid - salty (acidic), diseases of the biliary tract - sulfate, kidney - depending on the pH of the urine (for acidic - alkaline, for alkaline - acidic, up to 1000-1200 ml/day).
Health-improving (adaptation) waters are dosed according to the type of disorder and leading syndrome. Vagotonics should use water in limited quantities due to the tendency to edema. Sympathotonics should increase the amount of prescribed water.
^ PHYSIOTHERAPEUTIC RECIPCE
Diagnosis: Chronic superficial gastritis with increased secretory activity.
Rp: Drinking method of using mineral water, 2 ml/kg body weight, water temperature 38 o C, one hour before meals, daily, 3 times a day, 30 days.
Sodium chloride baths - the most common type of mineral water, the source of which is the sea, estuaries, salt lakes and underground springs. They make up the bulk of terrestrial animals and occupy more than 70% of the globe.
Waters are distinguished:
- sodium chloride (less commonly calcium-sodium) with mineralization from 2 to 35 g/dm 3;
- sodium chloride and calcium-sodium brines with mineralization from 35 to 350 g/dm 3 ;
- chloride calcium-sodium, calcium, less often calcium-magnesium ultra-strong brines with mineralization from 350 to 600 g/dm 3.
The thermal effect of sodium chloride water is more pronounced than that of fresh water. The heat flow into the body from such a bath is 1.5 times higher than from a fresh one at the same temperature. The absorbed heat causes the superficial vessels of the skin to dilate and increases its blood flow 1.2 times more than fresh water. In the formation of hyperemia, biologically active substances released under the action of sodium chloride water (prostaglandins, bradykinin, etc.) and local neuroreflex reactions play a significant role. In such baths, heat transfer through evaporation is significantly reduced.
The high osmotic pressure created by sodium chloride water causes dehydration of the skin, which significantly changes the physicochemical properties of the cellular elements of the skin and the receptors embedded in it. With changes in the ionic microenvironment, the excitability and conductivity of the nerve conductors of the skin decreases, and tactile and pain sensitivity decreases. This effect is also observed after taking a bath, since sodium chloride, crystallizing, leaves a thin salt shell (“salt cloak”) on the skin.
In balneotherapeutic terms (but in terms of clinical and physiological action), from the wide range of sodium chloride waters existing in nature, water with a mineralization not exceeding 80 g/dm 3 is used for medicinal purposes. In this case, sodium chloride waters in the range from 10 g/dm 3 (threshold concentration) to 80 g/dm 3 are divided into three groups: low concentration water - from 10 to 20 g/dm 3; medium concentration - from 20 to 40 g/dm 3 dm 3 and high concentration - from 40 to 80 g/dm 3; Below the upper limit, the onset of damaging effects can be observed in animal skin tissues. Water with an average concentration of 20-40 g/dm3 can be considered optimal for most diseases. Of the range of these concentrations in practice, the most commonly used is 30 g/dm3.
Sodium chloride baths have an anti-inflammatory and desensitizing, and as a result, analgesic effect for patients with degenerative and other joint lesions as a result of the stimulating effect of baths on function various organs and systems and their beneficial effects on adaptive mechanisms and mechanisms of sanogenesis. Sodium chloride baths have a beneficial effect on the functional state of the cardiovascular system in patients with neurocirculatory dystonia of hypotonic type, hypertension, rheumatic heart disease in adults and children, etc. The positive effect of these baths on a number of indicators of the functional state of the central nervous system and hemodynamics (REG, oscillography) is much more pronounced compared to the widely used carbon dioxide, radon and sulfide baths.
Treatment with sodium chloride baths helps to increase the systolic volume of the heart and reduce total peripheral resistance. In this case, the majority of patients do not experience pronounced changes in intracardiac hemodynamics according to the phase structure of the cardiac cycle, as well as changes in the function of automaticity, excitability or conductivity of the myocardium. In patients with chronic venous insufficiency, baths reduce blood clotting ability, helping to increase the function of the anticoagulation system.
Therapeutic effects - analgesic, vasodilator, metabolic, immunostimulating, anti-inflammatory, secretory and coagulocorrecting.
Indications - diseases of the cardiovascular system (neurocirculatory dystonia of cardiac and hypertensive types, hypertension I-II stages, rheumatic heart defects, initial symptoms of atherosclerosis, chronic venous insufficiency, post-thrombotic and varicose veins, Raynaud's disease), diseases of the musculoskeletal system (rheumatic and infectious-allergic polyarthritis, damage to ligaments, tendons, bones, deforming osteoarthritis), diseases and consequences of damage to the peripheral nervous system (plexitis, radiculitis), chronic inflammatory diseases of the female genital organs, skin diseases (psoriasis, neurodermatitis, scleroderma), chronic pyelonephritis without exacerbation, chronic pancreatitis, hypothyroidism, obesity I-II degrees, gout, vibration disease.
Contraindications - autonomic polyneuropathy, thrombophlebitis in the initial stage, chronic renal failure II-III stages.
Natural springs are numerous and varied. Among the resorts with such oxen: Staraya Russa, Usolye (Russia), Odessa, Mirgorod, Morshyn, Slavyansk (Ukraine), Druskininkai (Lithuania), Salsomaggiore Terme, Ischia (Italy), Wiesbaden (Germany), Glenwood Spring (USA) , Atami (Japan), etc. The mineralization of natural sodium chloride waters ranges from 2 to 35 g/dm 3 and higher. They are also used in numerous hydropathic clinics opened in the areas of boreholes. For medicinal purposes, concentrated sea water from estuaries or salt lakes is used (brine baths). In addition, sodium chloride water is easy to prepare artificially.
Artificial baths prepared in a concentration of 10-40 g/dm3. To prepare baths, pour 3-5 kg of table salt into a canvas bag or a special sieve. The bag is hung on a tap and hot water is passed through it until the salt is completely dissolved; The sieve is placed in the bath under running water.
Methodology. Baths from natural and artificially prepared sodium chloride water at a temperature of 35-38 ° C are carried out for a duration of 10 to 20 minutes, every other day. Course 12-15 baths. Before carrying out the bath, cold fresh water is poured into a container with a hot sodium chloride solution until the desired temperature is obtained. The patient is immersed in the bath to the level of the nipples. After the bath, the patient wets the body with a towel (without rubbing), wraps the body in a sheet and rests for 15-20 minutes. Along with baths, sodium chloride waters are used for vaginal irrigation, washing, and rinsing.
Sodium chloride baths are combined with gas (oxygen, nitrogen), mineral (iodine-bromine), mineral gas (,) and.
4430 0
Methodology (Vagramyan A.G., 1987; Kasyanova I.M., 1993; Vogolyubov V.M. et al., 1997; Klemenkov S.V. et al., 1999; Klemenkov S.V. et al., 2000 )
Mineral waters containing at least 10 mg/dm3 and bromine at least 25 mg/dm3 are classified as iodine-bromine waters.Pure iodine-bromine waters do not exist in nature.
Iodine and bromine ions, along with other trace elements, are most often found in sodium chloride waters.
Iodine-bromine waters are widespread in our country in the Urals and Siberia (Valabanova I.A., 1984). In the waters of open seas and oceans, the bromine content is determined from 63 to 74 mg/dm3. Sodium chloride waters containing iodine always contain bromine. At the same time, bromine can be contained in these waters without iodine. Depending on the predominance of iodine or bromine in sodium chloride water, the names iodine-bromine, bromiodine, and bromine waters can be found in the literature (Olefirenko V.T., 1986).
For cooking artificial baths The composition (in terms of chlorine, bromine and iodine content) of natural mineral water of the Khadyzhensk resort is taken as a basis. 250 g of potassium bromide (sodium) and 100 g of sodium iodide are dissolved in 1 liter of water.
The maximum shelf life of the solution should not exceed 7 days. A freshly prepared solution (100 ml) is poured from a dark vessel into a bath with 200 liters of fresh water at the required temperature, in which 2 kg of table salt (sodium chloride) are previously dissolved.
Baths at a temperature of 35-37 °C, duration 810 minutes. carried out every other day or 2 days in a row with rest on the 3rd day. A total of 12-15 baths per course of treatment. When treated with natural chloride sodium iodide-bromine waters, their mineralization should not exceed 30 g/dm3 (Sorokina E.I., 1989). After the bath, the patient dries the body with a towel (without rubbing), wraps itself in a sheet and rests for 20-30 minutes.
Therapeutic effect
During the procedure, 140-190 mcg of iodine and 0.28-0.3 mg of bromine penetrate into the body through the skin, which, entering the bloodstream, selectively accumulate in the thyroid gland (I-), pituitary gland and hypothalamus (Br-). Iodine ions, entering the follicles of the thyroid gland through active transport, form organic substances (adducts) and physiologically active thyroid hormones - thyroxine and triiodothyronine, restore the basal metabolism in the body. They stimulate the oxidation of carbohydrates and lipids, which leads to an increase in high-density lipoproteins in the blood and normalization of its lipid spectrum.In addition, iodine ions increase the fibrinolytic activity of the blood, which is suppressed during atherosclerosis, and reduce its coagulation properties (Vogolyubov V.M. et al., 1997). M.T. Kudaev et al. (2003) it was proven that balneotherapy with iodine-bromine baths at the Caspian sanatorium (Republic of Dagestan) had a positive effect on cholesterol metabolism, blood pressure and thrombogenic potential of the blood in patients with angina pectoris class 1-2.
Bromine ions, penetrating into the brain, change the ratio of inhibitory-excitatory processes in the cerebral cortex towards increased inhibition (sedative effect) and accelerate the synthesis of releasing factors of the hypothalamus and tropic hormones of the pituitary gland. Results of the study by V.F. Kazakova et al. (1994, 1998) showed that the use of baths with sodium chloride bromine water in the Volzhsky Utes sanatorium in IVS patients leads to a decrease in the severity of risk factors for coronary atherosclerosis, multidirectional changes in the level of immunoglobulins and the hormonal spectrum of the blood.
In patients with IVS, after a course of treatment with sodium chloride iodine-bromine baths, along with the antianginal effect, there is an effect on systemic hemodynamics - a decrease in blood pressure and PSS is accompanied by a decrease in the tone of arterial vessels and an increase in the tone of venous vessels.
The latter increases venous blood flow to the heart and cardiac output. There is a slight decrease in heart rate. Specific to sodium chloride waters (regardless of the presence of iodine or bromine in them) is their significant positive effect on the MC in the form of improving blood rheology, reducing blood clotting, increasing fibrinolytic activity, reducing the adhesive-aggregation activity of platelets, and reducing the content of cholesterol and beta. lipoproteins.
According to A.S. Makarkina (1996), S.V. Klemenkova et al. (2000) and O.B. Davydova et al. (1996) a course of artificial general sodium chloride iodide-bromine baths with a mineralization of 20 g/dm3 in patients with IVS with stable angina FC 1 and 2 gives a pronounced antiarrhythmic effect.
At the same time, the average number of ventricular arrhythmias of class 1-4a according to V. Laun decreases per day by 63.0%, supraventricular extrasystoles - by 97.1%. The antiarrhythmic effect of general iodine-bromine baths in patients with coronary heart disease correlates with a decrease in the manifestations of painful and “silent” myocardial ischemia; it is also due to a decrease in parasympathetic influences on the heart.
General iodine-bromine baths give a pronounced training effect in patients with stable angina FC 1 and 2 with extrasystole, which is manifested by an increase in the level of physical performance and coronary reserve of the heart. In case of stable angina pectoris FC 2 and ventricular arrhythmias of class 4B according to V. Laun, iodide-bromine baths are contraindicated because they lead to deterioration of coronary blood supply.
Indications
Sodium chloride iodine-bromine baths are indicated for patients with stable angina pectoris of 1-2 FC, including the presence of 1-2 degree hepatitis, post-infarction cardiosclerosis (1 year or more after the onset of the disease) with extrasystoles and heart failure no higher than 1 stage. in the absence of prognostically unfavorable cardiac rhythm and conduction disturbances.Contraindications
Sodium chloride baths
Methodology (Olefirenko V.T., 1986; Sorokina E.I., 1989; Vogolyubov V.M. et al., 1997; Davydova O.V. et al., 1997; Ponomarenko G.G., 1999; Klemenkov S. S.V. et al., 1999; S.V. Klemenkov et al., 2000; S.V. Klemenkov et al., 2003; O.V. Davydova et al., 2006)
Baths from natural and artificially prepared sodium chloride water at a temperature of 35-37 ° C are carried out for 8-10 minutes, every other day or 2 days in a row with a break on the 3rd day. The total mineralization in the bath should not exceed 30 g/dm3. A total of 10-12 baths per course of treatment.To prepare artificial CNV, table salt (lake or sea salt) (3-5 kg) is poured into a canvas bag, or even better, into a special sieve, which is placed in a bath under running hot water. As the salt dissolves, add it to the bath cold water to the required temperature (3537 °C).
Therapeutic effect
The thermal effect of sodium chloride water is more pronounced than that of fresh water. The heat flow into the body from such a bath is 1.5 times higher than from a fresh bath of the same temperature. The absorbed heat causes the superficial vessels of the skin to dilate and increases its blood flow 1.2 times more than fresh water.A significant role in the formation of hyperemia is played by biologically active substances released under the action of sodium chloride water (prostaglandins, bradykinin, etc.) and local neuro-reflex reactions. In such baths, heat transfer through evaporation is significantly reduced.
The high osmotic pressure created by sodium chloride water causes dehydration of the skin, which significantly changes the physicochemical properties of the cellular elements of the skin and the receptors embedded in it. This leads to a decrease in the excitability and conductivity of the nerve conductors of the skin and a decrease in tactile and pain sensitivity and continues after taking a bath, since sodium chloride, crystallizing, leaves a thin salt shell (“salt cloak”) on the skin.
Due to the deformation of heat-sensitive skin structures in sodium chloride water, the effect of the thermal factor is enhanced. Dehydration of surface tissues promotes the release of fluid from the interstitium into the capillary bed, activation of factors of the anticoagulation system of the blood and a decrease in the adhesive-aggregation activity of platelets.
Despite the decrease in blood pressure and total heart rate, the phase structure of the cardiac cycle and the properties of the myocardium do not change significantly, and there is no dynamics in heart rate. Under the influence of CNV treatment, the tone of the peripheral veins increases and the clinical manifestations of orthostatic hypotension decrease.
Valneotherapy with sodium chloride water in patients with hepatitis B and IVS normalizes the activity of the sympathetic-adrenal system and the adrenal cortex, enhances the synthesis of catecholamines in the adrenal glands and reduces the reabsorption of sodium ions from primary urine, which contributes to an increase in diuresis. With an increase in the concentration of sodium chloride, the vagotonic effect of baths decreases and the activating effect on the sympathetic part of the autonomic nervous system increases.
According to N.V. Lvovoy et al. (2000) with a combination of hepatitis B and IVS, greater treatment effectiveness is observed when using baths with a sodium chloride concentration of 40 g/dm3, rather than 20 g/dm3, which was confirmed by their more pronounced effect on pain, 24-hour ECG monitoring, physical performance, parameters central and peripheral hemodynamics.
The limitation of the use of this concentration of baths is, according to the authors, the crisis course of hepatitis B, the tendency to hypersympathicotonia, i.e. in this form of combined cardiovascular pathology, the leading factor in determining the indications is the course of hepatitis B.
According to N.F. Chashchina (1998), S.V. Klemenkova et al. (1999, 2000, 2003) a course of general sodium chloride baths with a mineralization of 20 g/dm3 in patients with IVS with stable angina FC 1 and 2 gives a pronounced antiarrhythmic effect. At the same time, the average number of ventricular arrhythmias of class 1-4a according to V. Laun decreases per day by 49.9%, supraventricular extrasystoles - by 57.5%.
The antiarrhythmic effect of common CNVs in patients with coronary heart disease correlates with a decrease in the manifestations of painful and “silent” myocardial ischemia. General sodium chloride baths give a pronounced training effect in patients with stable angina FC 1 and 2 with extrasystole, which is manifested by an increase in the level of physical performance and coronary reserve of the heart.
In case of stable angina pectoris FC 2 and ventricular arrhythmias of class 4b according to V. Laun, general CNVs are contraindicated because they lead to deterioration of coronary blood supply. Similar results were obtained by N.N. Shlomov (2003), who successfully used complex therapy using low-frequency variable in patients with stable angina with rhythm disturbances magnetic field
and CNV.
Indications
Sodium chloride baths are indicated for patients with stable angina pectoris 1-2 FC, including the presence of hepatitis 1-2 degrees, post-infarction cardiosclerosis (1 year or more after the onset of the disease) with extrasystoles and heart failure no higher than 1 level. in the absence of prognostically unfavorable cardiac rhythm and conduction disturbances.Contraindications
Stable angina FC 3-4. Unstable angina. Circulatory failure grade 2-3. Prognostically unfavorable disturbances of cardiac rhythm and conduction. Paroxysmal heart rhythm disturbances. Atrial fibrillation. Cardiac asthma. Cardiac aneurysm.S.G. Abramovich, N.A. Kholmogorov, A.A. Fedotchenko