Medikal Akupunktur - Yeni Tıp Dergisi

E. Horosanlı ve ark.Yeni Tp Dergisi 2008;25: 70-75bilateral cerebellum, sol superior frontal gyrus vesa medial ve inferior frontal gyrus bölgelerindeaktivasyon gözlemlemilerdir 26 . Deiik görüntülemeçalmalar akut ve kronik arda ayn yaplarnaktive olduunu göstermitir 27-29 .“Kap kontrol teorisini” ortaya koyan Melzacktarafndan 90’l yllarda, ar oluumunda beyninçok önemli dinamik rolünün olduu ve bugünekadar bildiklerimizin, ar oluumunun sadece birksmn oluturduu ileri sürülmektedir 30 . Dahasonralar ise Melzack “Nöromatriks” teorisinitanmlam, buna göre; vücudun algsn ve arhissedilmesini salayan nöronlardan oluanNöromatriks beyinde önceden genetik olarakyaplanmtr, daha sonra somotosensoryal inputlarla,deneyimlerle ekillenmekte ve böylelikle kiininnöral imzas ortaya çkmaktadr 31,32 .Akupunktur ile aktive edilen bütün yaplarnosiseptif sistem ile ilgilidir ve Melzack tarafndantanmlanan “Nöromatriks” konseptinde önemli roloynamaktadr. Bu konsepte göre, akupunktur arnöromatriksinde çelikili mesajlarla dengesinibozar ve böylece arnn alglanmas modifiye edilir 33 .Çalmalarn büyük çounluu akupunkturunanaljezik etkisi ve endojen opioidlerin rolü üzerindeyounlamtr. Ancak bununla birlikte akupunkturstimulasyonu, nörohormonlar ve nörotransmitterlerinsalnmnda artma ve kan akmnn santral veperiferik regulasyonunda deimeyi içeren oldukçageni spektrumda sistemik cevaplar da oluturur.Ayrca baklk sistemi üzerindeki etkileri ve sinirrejenerasyonunu hzlandrmas ile ilgili birçok çalmamevcuttur 7 .Akupunktur ine stimulasyonu, hem mast hücrelerindensalnan histamin, proinflamatuar sitokinler(IL-1, IL-6, TNF-) ve dier vazoaktif aminler hemde nosiseptif sistem (A ve C lifleri) araclylaHipotalamo-Hipofizer-Adrenal Aks aktive ederekendojen steroidlerin (Sürrenal Korteks) ve IL-10,IFN- gibi antienflamatuar sitokinlerin (Lenfosit)salglanmasn arttrr. Ayrca lökosit says daartar. Sonuç olarak bütün bunlar akupunkturunantienflamatuvar ve otoimmün etkisini oluturur 34 .Hipotalamo-Hipofizer aks aktivasyonu sonucuortaya çkan nörohormonlar ve nörotransmitterler,akupunkturun dier sistemik etkilerinin (homeostasis,sedasyon ve psikolojik) temelini oluturur 7,35 .REFERANSLAR1. Chernyak GV, Sessler DI. Perioperative Acupuncture and RelatedTechniques. Anesthesiology 2005;102: 1031-78.2. Chapman CR, Gunn C C . Acupuncture. In: Bonica JJ (ed) TheManagement of Pain. 2nd edition. Philadelphia: Lea & Febiger; 1990, 1805-21.3. Cheng Xinnong (ed). Chinese Acupuncture and Moxibustion. 1stedition. Beijing: Foreign Language Press; 1987, 1-108.4. Gunn C C. Acupuncture in context. In: Filshie J, White A (eds)Medical Acupuncture. 1st edition. Toronto: Churchill Livingstone; 1998, 11-16.5. Zhang Enqin (ed). Chinese Acupuncture and Moxibustion. 3rdedition. Shangai: Publishing House of Shangai College of TraditionalChinese Medicine 1990, 4-50.6. 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Pain Pharmacology. In: Dolin SJ,Padfield NL, editors. Pain medicine manual. 2nd ed. Edinburg: Butterworth-Heinemann 2004; 21-835. Chen YS, Yao CH, Chen TH, Lin JG, Hsieh CL, Lin CC, et al. Effect ofacupuncture stimulation on peripheral nerve regeneration using siliconerubber chambers. Am J Chin Med 2001;29: 377–85.Yazma adresi:Dr. Burhanettin USTAFatih Üniversitesi Tp Fakültesi, Betepe-Ankarae-mail: drbusta@yahoo.comYayna kabul tarihi: 30.04.20087575