Introduction

In recent years, the holistic approach to health has been gaining popularity all over the world. The principles of holistic medicine (HM) state that it is necessary to treat not individual organs, but the body as a whole, individually for each person, and it is important not only to preserve his health, but also the vital forces that allow this to happen. These principles are consistent with the philosophy of traditional Oriental medicine (TOM). One of the main tenets of holistic medicine is the personal responsibility of each person for their health, and for medical professionals – identifying the cause of the disease, an individual approach to treatment, a combination of traditional and alternative medicine, and these principles are reflected in the modern approach to a healthy lifestyle.

The purpose of the study: to evaluate the nature of the impact of the combined use of acupuncture and physical therapy for sexual problems.

Оbjectives: Normalization of the energy balance in the genitourinary sphere in men by methods of classical acupuncture and physical therapy, to combine a modern approach to the treatment of sexual problems with the culture of sexual relations of TOM for planning the harmonious development of family and partnership relations.

In the modern world of high technology, the latest types of examinations and methods of their treatment are used, but the problem remains urgent. Sexual disorders in men are very common and have great medical, social and personal significance. When studying the causes of divorce among the population of Prague, 42% of spouses indicated the presence of sexual disorders. Sexual disorders occur in 50% of men over the age of 50 and tend to increase with age, so by the age of 70, 67% of men report this pathology [1].

The main part

The trend of the modern approach to solving many issues, as a rule, is at the junction of sciences or the sublimation of ideas, which can give a new impetus to solving an old problem. We decided to approach this issue philosophically – to combine different methods of therapy and prevention of sexual problems: the "oriental" approach, which has a thousand-year history, based on the practical experience of many generations (acupuncture) and the modern method of medical rehabilitation (physical therapy), widely used in restoring physical health. From the point of view of TOM, a violation of sexual (reproductive function) in men is associated with a violation of the philosophical canons of the Tao, namely its offshoot, Tao–love [2]. The philosophy of "Tao" is the wisdom of nature, understood by the Chinese and transformed into a universal system of harmony of nature, awareness of the power of energy and the number of movements, as the source of all life, through the recipes of prudence and the precise law of conservation of internal resources.

The philosophy of Traditional Chinese medicine (TCM) was formed by the middle of the first millennium BC, based on the conceptual writings of that time: I CHING "The Book of Changes", Tao Te Ching "A Treatise on Tao and Te", Shen-nong's treatise "On the Emperor's Medicines", Nan-ching "Difficult questions of medicine".

Taoism is the philosophy and basis of traditional Chinese medicine (TCM): Tao is the philosophical teaching of Lao Tzu and Zhua Tzu, one of the tenets of which is the rejection of purposeful activity, since nature itself arranges everything, the so–called "concept of doing nothing." "Tao" is also interpreted as perpetual motion - "everything flows and changes," since nothing in nature is at rest. Man, as a part of nature, was presented as a combination of good and evil, which are expressed in his thoughts and actions and are in constant struggle: if the forces of good win, then the soul and body are strengthened, and vice versa, the predominance of evil thoughts and actions adversely affect the health of the body and mental state [2].

Tao nutrition is a diet based on a spiritual understanding of the importance of the quality and quantity of food consumed.

Tao training sometimes brings the body to the complete subordination of the mind and consists in the optimal significance and purposefulness of each movement – nothing superfluous!

This philosophy served the Chinese by enhancing their inner potencies, ensuring good mental and physical longevity, closely related to sexual activity, which is why love and sex were considered by Eastern healers as an important branch of medicine.

However, in the modern world, it is difficult to expect understanding among patients who come to a doctor's appointment, and even more so, following the advice of the TAO philosophy to correct the problem of sexual disorders. Unfortunately, our modern Western mind has not developed any culture on the issue of a harmonious lifestyle and its component – understanding the natural nature of sex in the relationship between men and women. Reflexology therapists often take on the role of filling this gap in knowledge, helping to preserve and direct internal energy in the right direction.

According to the doctors of the ancient East, there is a certain energy in the human body, which they called "Chi", the flow of which circulates through a system of 12 meridians located in symmetrical halves of the human body. A meridian is a conditional formation that unites biologically active points according to the principle of relation to certain organs and has a linear shape.

The energy of "Chi", flowing from one meridian to another at a strictly defined time according to the laws of TCM, forms a vicious circle, which can be represented as a clock face. Every two hours, the energy flow changes its location and activates the next meridian. The organ or system of organs for which this meridian is responsible is at its peak of activity at this time, and the meridian located on the opposite side of the "dial" at this time is experiencing a lack of energy and is resting.

TCM is characterized by the idea of meridians acting as channels for the movement of vital energy "Chi". The meridians are in various relationships with each other and influence each other both positively and destructively, according to the laws of TCM. The occurrence and development of the disease are considered as a result of the struggle between the body's defenses and the disease-causing disorder, as a result of internal causes acting inside the human body [3].

Using TCM methods, the doctor tries to eliminate the causes of the disease, not its symptoms. This approach was formed on the basis of long-term treatment experience and life practice, continuous accumulation of knowledge and repeated repetition. The "Canon of Medicine" defines a place for the basis of medical practice: soul healing, good nutrition, medicines, pleasure, acupuncture and exercises.

TCM includes 6 main methods in its arsenal: the traditional method of treatment (acupuncture and moxibustion), a system of breathing exercises, acupressure, medicinal healing, dietetics, traditional Chinese gymnastics. By mastering reflexotherapy techniques, a doctor can help not only with this problem, but also positively affect the patient's overall health [4].

As for the laws of "Tao" in the ability to conserve a man's energy and use it for many years, this "secret" is known in the East as "control of the preservation of semen and ejaculation," excessive consumption of which leads to the loss of masculinity. In everyday life, people familiar with the Tao control the number of ejaculations in accordance with common sense: they should not be frequent, so as not to lead to exhaustion, but also not be too rare, so as not to feel any discomfort or pressure in the groin area. Everyone makes a conclusion based on training – not every sexual encounter should end with ejaculation. Everyone knows an example from the life of athletes: before a crucial competition, men are contraindicated in sexual intercourse, while women, on the contrary, are recommended, and few people wonder why. The answer has long been given by the founders of TCM: along with the release of the seed, the energy circulating in the closed system is lost – it is transferred to the partner. Even if the patient cannot or does not want to manage their own energy, acupuncture provides an opportunity to channel energy in the right direction, helping to overcome the problem of sexual disorders. However, in order to channel energy, the body must have a certain energy reserve, and if for some reason a person does not have enough of it, then the question arises: how to replenish it? In traditional Chinese practices, herbal medicine or special exercises are often used to replenish the energy balance [5].

In our case, Kegel physical therapy (aimed at strengthening the pelvic floor muscles and improving blood circulation in the pelvis), breathing exercises and physical therapy that trains the cardiovascular system successfully cope with this function [6]. Modern IRT, in addition to the laws of TCM, is based on knowledge of the anatomy and topography, pathogenesis and clinical picture of the disease. The participation of subcortical formations of the brain (hypothalamus, limb, reticular formation and other centers) in the system of vegetative-endocrine regulation of the functions of the genitourinary organs provides a reflex mechanism for its normalization.

In our work, sexual dysfunction was treated in patients with standard examinations who underwent a course of standard therapy, including physiotherapy and pharmacological therapy, but with no apparent success. All patients suffered from sexual disorders in combination with chronic prostatitis, which necessitated additional exposure to relieve the symptoms of this pathology [7].

Chronic prostatitis, in the absence of adequate treatment, can cause complications such as infertility and impotence. Provoking factors are: sedentary work and a sedentary lifestyle, general hypothermia of the body, previous chronic inflammatory diseases, prolonged abstinence and incomplete ejaculation, which contributes to the development of stagnant phenomena in the pelvis [8].

The treatment was performed on an outpatient basis at the 8th City Clinical Hospital in Saratov. A combination of classical IRT (with effects on the corporeal and auricular points) and Kegel exercise therapy, exercises that strengthen the cardiovascular and bronchopulmonary systems, and exercises that strengthen the muscles of the back and extremities were used. Two groups of patients with erectile dysfunction were divided, in accordance with the laws of the TCM, according to the syndromes of "lack or excess of sexual energy": the first group consisted of 15 people aged 21 to 45 years, with a syndrome of lack of energy in the genitourinary sphere (decreased libido, insufficient erectile function, aspermia).

The second group consisted of 8 men, aged 34 to 52 years, with excess energy syndrome (premature ejaculation, increased libido with rapid depletion of erectile function). The treatment consisted of 2 courses of 7-10 acupuncture procedures, lasting from 10 to 30 minutes, 4-5 times a week. A characteristic feature of reflexotherapy in both groups was the condition of complete sexual abstinence within each course.

All patients underwent physical therapy daily during the entire course of therapy on their own on the recommendation of a physical therapy doctor. Physical therapy for men with sexual problems is used as an effective remedy. Physical exercises provide training for certain muscles and have a beneficial effect in many diseases of the genitourinary system [9].

Properly selected exercises stimulate the activity of the central nervous system (especially its sympathetic division), normalize kidney function, improve general and local blood circulation, strengthen the cardiovascular system, eliminate the effects of physical inactivity [10]. Exercises designed to strengthen the oblique and rectus abdominal muscles have a beneficial effect on the condition of the pelvic organs, improve blood circulation, and eliminate signs of erectile dysfunction if it was associated with congestion in the genitourinary system [11].

Kegel exercises were performed after emptying the bladder in a standing position. The tension of the pelvic floor muscles began with 5 seconds, gradually increased to 10, during the workout it is necessary to do 4-5 exercises without holding your breath. For the first few days, the exercises were performed 3-5 times a day, then, with proper feeling of the pelvic floor muscles, they were increased to 10. The patients independently carried out physical activity on large muscle groups, strengthening the back muscles in the form of morning exercises. The physical therapy doctor recommended breathing exercises and exercises to strengthen the cardiovascular system and Kegel exercises. The first few classes were performed in slow motion and with partial load, then the intensity of physical education was gradually increased [12].

In each group, patients were given additional recommendations, taking into account the type of higher nervous activity according to Pavlov (choleric patients were recommended to focus on breathing exercises, melancholic patients on exercises that stimulate the function of the cardiovascular system). When composing prescriptions for acupuncture, the clinically pronounced degree of pathological overexcitation or inhibition was taken into account [13]. Depending on the state of the nervous reaction, methods of inhibition and excitation according to the classical method were used. Special attention in the process of acupuncture was paid to the normalization of the energy balance in the meridian system: correction of the available data on the state of the "syndrome of excess" and "lack" of meridians at the time of therapy was carried out - attention was paid to the symptoms, seemingly unrelated to the underlying pathology (these are diseases of the gastrointestinal tract, bronchopulmonary system, cardiovascularvascular pathology, etc.) [2, 14]. The symptoms of an excess or deficiency of a particular meridian and its associated organ were based primarily on the clinical picture of the disease, and correction for the redistribution of energy flows was carried out according to the basic laws of TCM (Wu-SIN, mother-son, noon-midnight, etc.). The task of a reflexologist was to choose a method of exposure (toning or dispersion of the meridian concerned), the choice of method and formulation of the prescription complex. The combination of acupuncture points in the formulation was selected taking into account this knowledge, the general condition of the patient, the features of the course of the disease and the dynamics of restoring the physiological level of autonomic regulation [15]. Physical therapy was carried out taking into account special medical groups of the health status and was aimed at maintaining the patient's overall energy baggage [10, 16].

As a rule, during the first course of acupuncture, in addition to individually selected schemes, the points of "restorative" action were included: E-36, GI-4, MC-6, TR-5, C-3, C4 C-7, T-20, VB-34, RP-6. The first acupuncture sessions began with exposure to the meridian of the bladder (V29, V33, V53) and the meridian of the stomach (E-32, E-33, E-34), which provided stimulation of the II– IV lumbar segments of the spinal cord, at the level of which the spinal ejaculation center is located [13]. Auricular points (AT) were included in the IRT session, depending on the existing concomitant pathology, and common points were added to them: AT-55 (antistress), AT-51 (sympathetic nervous system), AT-34 (cerebral cortex) [17].

In group 1, with "deficiency syndrome" with manifestations of aspermia, decreased libido, and erectile function, the following acupuncture point toning techniques were used: R-12, R-14, Gi-4, Gi-11, GI-13, RP-4, RP-5, RP-6, J-5, MC-6, E-36, E-40, J-2, F-10, T-4, T-20, in-tan; Auricular points were also included (no more than 2-3 points per session): AT-38 (sacral spine), AT-79 (external genitalia), AT-34 (cortex), AT-51 (sympathetic), AT-119 (anal opening), AT-52 (sciatic nerve), AT-55 (shen-men), AT-22 (endocrine glands), AT-95 (kidney), AT-93 (prostate), AT-13 (adrenal gland). In the 2nd group, with "excess syndrome" – with symptoms of premature ejaculation, increased libido with rapid depletion of erectile function, sedation points were used: V-54, V-57, Gi-4, Gi-11, E-36, E-40, P-7, F-3, F-5, F-10, MC-6, RP-4, J-2 and auricular points were added 2-3 times per session: AT- 28 (pituitary gland); AT- 32(testicle), AT-34 (GM cortex), AT-55(shen-men), AT-33 (forehead), AT-104 (three parts of the trunk), AT-119 (anus), AT-29 (occiput), AT-34 (cortex), AT-79 (external genitalia), AT-93 (prostate gland), AT-95 (kidney).

Therapeutic and general health physical education consisted of physical exertion on large muscle groups, strengthening the muscles of the back and groin muscles. Exercises for the calf and femoral muscles (tightening the heels to the buttocks, spreading and closing bent and straightened limbs, traditional "bicycle", crossing the legs, hip rotation, various squats, bends, rocking) [18], were recommended for patients of the first group with "lack of sexual energy syndrome", which had a positive effect on their well-being and the results of therapy.

The analysis of the treatment results showed a clear therapeutic effectiveness of the combination of classical acupuncture and physical therapy. After the therapy, a positive effect to one degree or another was noted in all patients. At the same time, clinical cure occurred in 15 (65.2%), significant improvement – in 6 (26.1%) and improvement – in 2 (8.7%) patients.

Conclusion

In this way, the clinical effectiveness of the treatment of sexual disorders in men using IRT and physical therapy has shown a positive effect on erectile function and normalization of general somatic problems.

List of abbreviations

PT– physical therapy

TOM – traditional Oriental medicine

TCM – Traditional Chinese medicine

HM – holistic medicine

P – lung meridian

Ig – small intestine meridian

Gi – large intestine meridian

E – stomach meridian

MC – pericardium meridian

V – bladder meridian

R – kidneys meridian

RP – spleen-pancreas meridian

TR – triple energizer meridian

F – liver meridian

J – anterior median meridian

T – posterior median meridian