Under the term sympathetic nervous system is understood a specific segment (department) autonomic nervous system... Its structure is characterized by some segmentation. This department belongs to the trophic. Its tasks are to supply organs with nutrients, if necessary, increase the rate of oxidative processes, improve respiration, and create conditions for the supply of more oxygen to the muscles. In addition, an important task is to accelerate the work of the heart, if necessary.

Lecture for doctors "Sympathetic nervous system". The autonomic nervous system is divided into sympathetic and parasympathetic parts. The sympathetic part of the nervous system includes:

• lateral intermediate substance in the lateral columns of the spinal cord;
• sympathetic nerve fibers and nerves running from the cells of the lateral intermediate substance to the nodes of the sympathetic and autonomic plexuses of the abdominal cavity of the pelvis;
• the sympathetic trunk, the connecting nerves that connect the spinal nerves to the sympathetic trunk;
• nodes of the autonomic nerve plexus;
• the nerves that travel from these plexuses to the organs;
• sympathetic fibers.

VEGETATIVE NERVOUS SYSTEM

The vegetative (autonomic) nervous system regulates all internal processes of the body: the functions of internal organs and systems, glands, blood and lymphatic vessels, smooth and partially striated muscles, sensory organs (Fig. 6.1). It provides homeostasis for the body, i.e. the relative dynamic constancy of the internal environment and the stability of its basic physiological functions (blood circulation, respiration, digestion, thermoregulation, metabolism, excretion, reproduction, etc.). In addition, the autonomic nervous system performs an adaptive-trophic function - the regulation of metabolism in relation to environmental conditions.

The term "autonomic nervous system" reflects the control of the body's involuntary functions. The autonomic nervous system is dependent on the higher centers of the nervous system. There is a close anatomical and functional relationship between the autonomic and somatic parts of the nervous system. The autonomic nerve conductors pass through the cranial and spinal nerves. The main morphological unit of the autonomic nervous system, like the somatic one, is the neuron, and the main functional unit is the reflex arc. The autonomic nervous system has a central (cells and fibers located in the brain and spinal cord) and peripheral (all other formations) sections. There are also sympathetic and parasympathetic parts. Their main difference lies in the features of functional innervation and is determined by the attitude to the means that affect the autonomic nervous system. The sympathetic part is excited by adrenaline, and the parasympathetic part is excited by acetylcholine. Ergotamine has an inhibitory effect on the sympathetic part, and atropine - on the parasympathetic.

6.1. Sympathetic division of the autonomic nervous system

Central formations are located in the cerebral cortex, hypothalamic nuclei, brain stem, in the reticular formation, as well as in the spinal cord (in the lateral horns). Cortical representation is not well understood. From the cells of the lateral horns of the spinal cord at the level from C VIII to L V, peripheral formations of the sympathetic section begin. The axons of these cells pass as part of the anterior roots and, having separated from them, form a connecting branch that approaches the nodes of the sympathetic trunk. This is where some of the fibers end. From the cells of the nodes of the sympathetic trunk, the axons of the second neurons begin, which again approach the spinal nerves and end in the corresponding segments. Fibers that pass through the nodes of the sympathetic trunk, without interruption, approach the intermediate nodes located between the innervated organ and the spinal cord. Axons of second neurons begin from the intermediate nodes, heading to the innervated organs.

Figure: 6.1.

1 - cortex of the frontal lobe of the large brain; 2 - hypothalamus; 3 - ciliary node; 4 - wing-palatine node; 5 - submandibular and sublingual nodes; 6 - ear node; 7 - upper cervical sympathetic node; 8 - large visceral nerve; 9 - internal knot; 10 - celiac plexus; 11 - celiac nodes; 12 - small visceral nerve; 12a - lower visceral nerve; 13 - the superior mesenteric plexus; 14 - the lower mesenteric plexus; 15 - aortic plexus; 16 - sympathetic fibers to the anterior branches of the lumbar and sacral nerves for the vessels of the legs; 17 - pelvic nerve; 18 - hypogastric plexus; 19 - ciliary muscle; 20 - the sphincter of the pupil; 21 - pupil dilator; 22 - lacrimal gland; 23 - glands of the mucous membrane of the nasal cavity; 24 - submandibular gland; 25 - sublingual gland; 26 - parotid gland; 27 - heart; 28 - thyroid gland; 29 - larynx; 30 - muscles of the trachea and bronchi; 31 - lung; 32 - stomach; 33 - liver; 34 - pancreas; 35 - adrenal gland; 36 - spleen; 37 - kidney; 38 - large intestine; 39 - small intestine; 40 - detrusor of the bladder (muscle that expels urine); 41 - sphincter of the urinary bladder; 42 - sex glands; 43 - genitals; III, XIII, IX, X - cranial nerves

The sympathetic trunk is located along the lateral surface of the spine and has 24 pairs of sympathetic nodes: 3 cervical, 12 thoracic, 5 lumbar, 4 sacral. From the axons of the cells of the upper cervical sympathetic node, the sympathetic plexus of the carotid artery is formed, from the lower - the upper cardiac nerve, which forms the sympathetic plexus in the heart. The aorta, lungs, bronchi, abdominal organs are innervated from the thoracic nodes, and the pelvic organs from the lumbar nodes.

6.2. Parasympathetic division of the autonomic nervous system

Its formations begin from the cerebral cortex, although the cortical representation, as well as the sympathetic part, has not been sufficiently clarified (mainly the limbic-reticular complex). The mesencephalic and bulbar regions are distinguished in the brain and the sacral - in the spinal cord. The mesencephalic section includes the nuclei of the cranial nerves: III pair - the accessory nucleus of Yakubovich (paired, small-cell), which innervates the muscle that narrows the pupil; the nucleus of Perlia (unpaired small cell) innervates the ciliary muscle involved in accommodation. The bulbar section is made up of the upper and lower salivary nuclei (pairs VII and IX); X pair - vegetative nucleus, innervating heart, bronchi, gastrointestinal tract,

his digestive glands, other internal organs. The sacral section is represented by cells in the S II -S IV segments, the axons of which form the pelvic nerve, which innervates the urogenital organs and the rectum (Fig. 6.1).

All organs are influenced by both the sympathetic and parasympathetic parts of the autonomic nervous system, with the exception of the vessels, sweat glands and the adrenal medulla, which have only sympathetic innervation. The parasympathetic division is more ancient. As a result of its activity, stable states of organs and conditions for creating reserves of energy substrates are created. The sympathetic part changes these states (i.e., the functional ability of the organs) in relation to the function performed. Both parts work closely together. Under certain conditions, a functional predominance of one part over another is possible. In the case of a predominance of the tone of the parasympathetic part, a state of parasympatotonia develops, the sympathetic part - sympathotonia. Parasympathotonia is characteristic of the state of sleep, sympathotonia - for affective states (fear, anger, etc.).

In clinical conditions, conditions are possible in which the activity of individual organs or systems of the body is disrupted as a result of the predominance of the tone of one of the parts of the autonomic nervous system. Parasympathotonic manifestations accompany bronchial asthma, urticaria, Quincke's edema, vasomotor rhinitis, motion sickness; sympathotonic - vascular spasm in the form of Raynaud's syndrome, migraine, transient form of hypertension, vascular crises in hypothalamic syndrome, ganglionic lesions, panic attacks. The integration of autonomic and somatic functions is carried out by the cerebral cortex, hypothalamus and reticular formation.

6.3. Limbic-reticular complex

All activity of the autonomic nervous system is controlled and regulated by the cortical divisions of the nervous system (frontal cortex, parahippocampal and cingulate gyrus). The limbic system is the center of emotion regulation and the neural substrate for long-term memory. The rhythm of sleep and wakefulness is also regulated by the limbic system.

Figure: 6.2.Limbic system. 1 - corpus callosum; 2 - vault; 3 - belt; 4 - posterior thalamus; 5 - isthmus of the cingulate gyrus; 6 - III ventricle; 7 - mastoid; 8 - bridge; 9 - lower longitudinal bundle; 10 - border; 11 - gyrus of the hippocampus; 12 - hook; 13 - orbital surface of the frontal pole; 14 - hooked bundle; 15 - cross connection of the amygdala; 16 - anterior commissure; 17 - anterior thalamus; 18 - cingulate gyrus

The limbic system (Fig. 6.2) is understood as a series of closely interconnected cortical and subcortical structures that have common development and functions. It also includes the formations of the olfactory tract located at the base of the brain, the transparent septum, the vaulted gyrus, the cortex of the posterior orbital surface of the frontal lobe, the hippocampus, the dentate gyrus. The subcortical structures of the limbic system include the caudate nucleus, shell, amygdala, anterior thalamic tubercle, hypothalamus, and frenulum nucleus. The limbic system includes a complex interlacing of the ascending and descending pathways, intimately connected with the reticular formation.

Irritation of the limbic system leads to the mobilization of both sympathetic and parasympathetic mechanisms, which has corresponding autonomic manifestations. A pronounced vegetative effect occurs with irritation of the anterior limbic system, in particular the orbital cortex, amygdala and cingulate gyrus. At the same time, there are changes in salivation, respiratory rate, increased intestinal motility, urination, defecation, etc.

Of particular importance in the functioning of the autonomic nervous system is the hypothalamus, which regulates the functions of the sympathetic and parasympathetic systems. In addition, the hypothalamus realizes the interaction of the nervous and endocrine, the integration of somatic and autonomic activity. The hypothalamus contains specific and non-specific nuclei. Specific nuclei produce hormones (vasopressin, oxytocin) and releasing factors that regulate the secretion of hormones by the anterior pituitary gland.

Sympathetic fibers that innervate the face, head and neck start from cells located in the lateral horns of the spinal cord (C VIII -Th III). Most of the fibers are interrupted in the upper cervical sympathetic node, and a smaller part is directed to the external and internal carotid arteries and forms periarterial sympathetic plexuses on them. They are joined by postganglionic fibers coming from the middle and lower cervical sympathetic nodes. In small nodules (cell clusters) located in the periarterial plexuses of the branches of the external carotid artery, fibers that are not interrupted in the nodes of the sympathetic trunk end. The rest of the fibers are interrupted in the facial ganglia: ciliary, pterygopalatine, sublingual, submandibular and ear. Postganglionic fibers from these nodes, as well as fibers from the cells of the upper and other cervical sympathetic nodes, go to the tissues of the face and head, partly as part of the cranial nerves (Fig. 6.3).

Afferent sympathetic fibers from the head and neck are directed to the periarterial plexuses of the branches of the common carotid artery, pass through the cervical nodes of the sympathetic trunk, partially in contact with their cells, and through the connecting branches approach the spinal nodes, closing the reflex arc.

Parasympathetic fibers are formed by the axons of the stem parasympathetic nuclei and are directed mainly to the five vegetative ganglia of the face, in which they are interrupted. A smaller part of the fibers is directed to the parasympathetic accumulations of cells of the periarterial plexuses, where they are also interrupted, and postganglionic fibers are part of the cranial nerves or periarterial plexuses. In the parasympathetic part there are also afferent fibers that go in the vagus nerve system and are directed to the sensitive nuclei of the brain stem. The anterior and middle sections of the hypothalamic region, through the sympathetic and parasympathetic conductors, affect the function of the predominantly ipsilateral salivary glands.

6.5. Vegetative innervation of the eye

Sympathetic innervation.Sympathetic neurons are located in the lateral horns of segments C VIII-Th III of the spinal cord (centrun ciliospinale).

Figure: 6.3.

1 - posterior central nucleus of the oculomotor nerve; 2 - accessory nucleus of the oculomotor nerve (nucleus of Yakubovich-Edinger-Westphal); 3 - the oculomotor nerve; 4 - the nasal branch from the optic nerve; 5 - ciliary node; 6 - short ciliary nerves; 7 - the sphincter of the pupil; 8 - pupil dilator; 9 - ciliary muscle; 10 - internal carotid artery; 11 - sleepy plexus; 12 - deep stony nerve; 13 - upper salivary nucleus; 14 - intermediate nerve; 15 - knee knot; 16 - large stony nerve; 17 - pterygopalatine node; 18 - maxillary nerve (II branch of the trigeminal nerve); 19 - zygomatic nerve; 20 - lacrimal gland; 21 - mucous membranes of the nose and palate; 22 - knee-drum nerve; 23 - auricular nerve; 24 - middle meningeal artery; 25 - parotid gland; 26 - ear node; 27 - small stony nerve; 28 - tympanic plexus; 29 - auditory tube; 30 - single path; 31 - lower salivary nucleus; 32 - drum string; 33 - tympanic nerve; 34 - lingual nerve (from the mandibular nerve - III branch of the trigeminal nerve); 35 - taste fibers to the front 2/3 of the tongue; 36 - sublingual gland; 37 - submandibular gland; 38 - submandibular node; 39 - facial artery; 40 - upper cervical sympathetic node; 41 - cells of the lateral horn ThI-ThII; 42 - lower node of the glossopharyngeal nerve; 43 - sympathetic fibers to the plexuses of the internal carotid and middle meningeal arteries; 44 - innervation of the face and scalp. III, VII, IX - cranial nerves. Parasympathetic fibers are indicated in green, sympathetic fibers in red, sensitive fibers in blue

The processes of these neurons, forming preganglionic fibers, leave the spinal cord together with the anterior roots, as part of the white connecting branches, enter the sympathetic trunk and, without interruption, pass through the overlying nodes, ending in the cells of the superior cervical sympathetic plexus. Postganglionic fibers of this node accompany the internal carotid artery, braiding its wall, penetrate into the cranial cavity, where they connect with the I branch of the trigeminal nerve, penetrate into the orbital cavity and end in the muscle that dilates the pupil (m. dilatator pupillae).

Sympathetic fibers also innervate other structures of the eye: the tarsal muscles that widen the palpebral fissure, the orbital muscle of the eye, as well as some structures of the face - the sweat glands of the face, smooth muscles of the face and blood vessels.

Parasympathetic innervation.The preganglionic parasympathetic neuron lies in the accessory nucleus of the oculomotor nerve. As part of the latter, it leaves the brain stem and reaches the ciliated node (ganglion ciliare),where it switches to postganglionic cells. From there, some of the fibers are sent to the muscle that constricts the pupil. (m. sphincter pupillae),and the other part is involved in providing accommodation.

Violation of the autonomic innervation of the eye.The defeat of sympathetic formations causes Bernard-Horner syndrome (Fig. 6.4) with constriction of the pupil (miosis), narrowing of the palpebral fissure (ptosis), retraction of the eyeball (enophthalmos). The development of homolateral anhidrosis, conjunctival hyperemia, depigmentation of the iris are also possible.

The development of the Bernard-Horner syndrome is possible with the localization of the lesion at a different level - the involvement of the posterior longitudinal bundle, the pathways to the muscle that dilates the pupil. The congenital variant of the syndrome is more often associated with a birth injury with damage to the brachial plexus.

When sympathetic fibers are irritated, a syndrome occurs that is the opposite of Bernard-Horner's syndrome (Purfour du Petit) - dilation of the palpebral fissure and pupil (mydriasis), exophthalmos.

6.6. Autonomic innervation of the bladder

Regulation of the activity of the bladder is carried out by the sympathetic and parasympathetic divisions of the autonomic nervous system (Fig. 6.5) and includes urinary retention and emptying of the bladder. Normally, retention mechanisms are more activated, which

Figure: 6.4.Right-sided Bernard-Horner syndrome. Ptosis, miosis, enophthalmos

is carried out as a result of the activation of sympathetic innervation and blockade of the parasympathetic signal at the level of segments L I-L II of the spinal cord, while the activity of the detrusor is suppressed and the tone of the muscles of the internal sphincter of the bladder increases.

Regulation of the act of urination occurs upon activation

parasympathetic center at the level of S II -S IV and the center of urination in the pons of the brain (Fig. 6.6). Descending efferent signals send signals that provide relaxation of the external sphincter, suppress sympathetic activity, remove the block of conduction along parasympathetic fibers, and stimulate the parasympathetic center. The consequence of this is the contraction of the detrusor and the relaxation of the sphincters. This mechanism is under the control of the cerebral cortex; the reticular formation, the limbic system, and the frontal lobes of the cerebral hemispheres are involved in regulation.

Arbitrary stopping of urination occurs when a command arrives from the cerebral cortex to the urination centers in the brainstem and sacral spinal cord, which leads to a contraction of the external and internal sphincters of the pelvic floor muscles and periurethral striated muscles.

The defeat of the parasympathetic centers of the sacral region, the autonomic nerves emanating from it, is accompanied by the development of urinary retention. It can also occur when the spinal cord is damaged (trauma, tumor, etc.) at a level above the sympathetic centers (Th XI -L II). Partial damage to the spinal cord above the level of the autonomic centers can lead to the development of an urge to urinate. With the defeat of the spinal sympathetic center (Th XI - L II), true urinary incontinence occurs.

Research methodology.There are numerous clinical and laboratory methods for studying the autonomic nervous system, their choice is determined by the task and conditions of the study. However, in all cases, it is necessary to take into account the initial vegetative tone and the level of fluctuations relative to the background value. The higher the initial level, the less the response will be in functional tests. In some cases, even a paradoxical reaction is possible. Research beam

Figure: 6.5.

1 - cerebral cortex; 2 - fibers providing voluntary control over the emptying of the bladder; 3 - fibers of pain and temperature sensitivity; 4 - cross section of the spinal cord (Th IX -L II for sensory fibers, Th XI -L II for motor fibers); 5 - sympathetic chain (Th XI -L II); 6 - sympathetic chain (Th IX -L II); 7 - cross section of the spinal cord (segments S II -S IV); 8 - sacral (unpaired) node; 9 - genital plexus; 10 - pelvic visceral nerves;

11- hypogastric nerve; 12 - lower hypogastric plexus; 13 - genital nerve; 14 - external sphincter of the urinary bladder; 15 - detrusor of the bladder; 16 - internal sphincter of the bladder

Figure: 6.6.

it is better to do it in the morning on an empty stomach or 2 hours after eating, at the same time, at least 3 times. The minimum value of the received data is taken as the initial value.

The main clinical manifestations of the predominance of the sympathetic and parasympathetic systems are presented in table. 6.1.

To assess the vegetative tone, it is possible to carry out tests with the influence of pharmacological agents or physical factors. Solutions of epinephrine, insulin, mezaton, pilocarpine, atropine, histamine, etc. are used as pharmacological agents.

Cold test.In the supine position, the heart rate is calculated and the blood pressure is measured. After that, the hand of the other hand is immersed in cold water (4 ° C) for 1 min, then the hand is taken out of the water and blood pressure and pulse are recorded every minute until returning to the initial level. Normally, this happens after 2-3 minutes. With an increase in blood pressure by more than 20 mm Hg. Art. the reaction is considered pronounced sympathetic, less than 10 mm Hg. Art. - moderate sympathetic, and with a decrease in blood pressure - parasympathetic.

Ophthalmic reflex (Danini-Ashnera).When pressing on the eyeballs in healthy people, the heart rate slows down by 6-12 per minute. If the heart rate decreases by 12-16 per minute, this is regarded as a sharp increase in the tone of the parasympathetic part. The absence of a decrease or increase in heart rate by 2-4 per minute indicates an increase in the excitability of the sympathetic department.

Solar reflex.The patient lies on his back, and the examiner presses his hand on the upper abdomen until a pulsation of the abdominal aorta is felt. After 20-30 seconds, the heart rate slows down in healthy people by 4-12 per minute. Changes in cardiac activity are assessed in the same way as when evoking the ocular reflex.

Orthoclinostatic reflex.In a patient lying on his back, the heart rate is calculated, and then offered to stand up quickly (orthostatic test). When moving from a horizontal position to a vertical position, the heart rate increases by 12 per minute with an increase in blood pressure by 20 mm Hg. Art. When the patient moves to a horizontal position, the pulse and blood pressure return to their original values \u200b\u200bwithin 3 minutes (clinostatic test). The degree of pulse acceleration during the orthostatic test is an indicator of the excitability of the sympathetic division of the autonomic nervous system. A significant slowdown in the pulse with a clinostatic test indicates an increase in the excitability of the parasympathetic department.

Table 6.1.

Continuation of table 6.1.

Test with adrenaline.In a healthy person, subcutaneous injection of 1 ml of 0.1% adrenaline solution after 10 minutes causes blanching of the skin, increased blood pressure, increased heart rate and increased blood glucose levels. If such changes occur faster and are more pronounced, then the tone of the sympathetic innervation is increased.

Skin test with adrenaline.A drop of 0.1% adrenaline solution is applied to the skin injection site with a needle. In a healthy person, blanching occurs in such an area with a pink corolla around.

Atropine test.Subcutaneous injection of 1 ml of 0.1% atropine solution in a healthy person causes dry mouth, decreased sweating, increased heart rate and dilated pupils. With an increase in the tone of the parasympathetic part, all reactions to the introduction of atropine are weakened, therefore the test can be one of the indicators of the state of the parasympathetic part.

To assess the state of the functions of segmental vegetative formations, the following tests can be used.

Dermographism.Mechanical irritation is applied to the skin (with the handle of a hammer, the blunt end of a pin). A local reaction occurs as an axon reflex. At the site of irritation, a red stripe appears, the width of which depends on the state of the autonomic nervous system. With an increase in sympathetic tone, the strip is white (white dermographism). Wide bands of red dermographism, a band that rises above the skin (elevated dermographism), indicate an increase in the tone of the parasympathetic nervous system.

For topical diagnostics, reflex dermographism is used, which causes irritation with a sharp object (carried over the skin with the tip of a needle). A strip with uneven scalloped edges appears. Reflex dermographism is a spinal reflex. It disappears in the corresponding zones of innervation with damage to the posterior roots, segments of the spinal cord, anterior roots and spinal nerves at the level of the lesion, but remains above and below the affected area.

Pupillary reflexes.The direct and friendly reaction of the pupils to light, the reaction to convergence, accommodation and pain (dilation of the pupils with an injection, pinching and other irritations of any part of the body) are determined.

Pilomotor reflexcaused by pinching or by applying a cold object (test tube with cold water) or coolant (cotton wool soaked in ether) to the skin of the shoulder girdle or the back of the head. On the half of the chest with the same name, "goose bumps" appear as a result of the contraction of smooth hair muscles. The reflex arc closes in the lateral horns of the spinal cord, passes through the anterior roots and the sympathetic trunk.

Acetylsalicylic acid test.After taking 1 g of acetylsalicylic acid, diffuse sweating appears. If the hypothalamic region is affected, its asymmetry is possible. With damage to the lateral horns or anterior roots of the spinal cord, sweating is impaired in the innervation zone of the affected segments. With a lesion of the spinal cord diameter, taking acetylsalicylic acid causes sweating only above the site of the lesion.

Pilocarpine test.The patient is injected subcutaneously with 1 ml of 1% solution of pilocarpine hydrochloride. As a result of irritation of the postganglionic fibers going to the sweat glands, sweating increases.

It should be borne in mind that pilocarpine excites peripheral M-cholinergic receptors, causing increased secretion of the digestive and bronchial glands, narrowing of the pupils, increased tone of smooth muscles of the bronchi, intestines, gall and bladder, uterus, but the strongest effect of pilocarpine has on sweating. If the lateral horns of the spinal cord or its anterior roots are damaged in the corresponding area of \u200b\u200bthe skin after taking acetylsalicylic acid, perspiration does not occur, and the administration of pilocarpine causes sweating, since the postganglionic fibers that react to this drug remain intact.

Light bath.Warming the patient causes sweating. This is a spinal reflex similar to the pilomotor reflex. The defeat of the sympathetic trunk completely eliminates perspiration after the use of pilocarpine, acetylsalicylic acid and warming the body.

Skin thermometry.Skin temperature is examined using electrothermometers. Skin temperature reflects the state of blood supply to the skin, which is an important indicator of autonomic innervation. Areas of hyper-, normo- and hypothermia are determined. The difference in skin temperature of 0.5 ° C in symmetrical areas indicates a violation of autonomic innervation.

Electroencephalography is used to study the autonomic nervous system. The method makes it possible to judge the functional state of the synchronizing and desynchronizing systems of the brain during the transition from wakefulness to sleep.

There is a close connection between the autonomic nervous system and the emotional state of a person, therefore, the psychological status of the subject is studied. To do this, use special sets of psychological tests, the method of experimental psychological testing.

6.7. Clinical manifestations of lesions of the autonomic nervous system

With dysfunction of the autonomic nervous system, a variety of disorders occur. Violations of its regulatory functions are periodic and paroxysmal. Most pathological processes do not lead to the loss of certain functions, but to irritation, i.e. to increased excitability of central and peripheral structures. On-

collapse in some parts of the autonomic nervous system can spread to others (repercussion). The nature and severity of symptoms are largely determined by the level of damage to the autonomic nervous system.

Damage to the cerebral cortex, especially the limbic-reticular complex, can lead to the development of autonomic, trophic, emotional disorders. They can be caused by infectious diseases, injuries of the nervous system, intoxication. Patients become irritable, quick-tempered, quickly depleted, they have hyperhidrosis, instability of vascular reactions, fluctuations in blood pressure, pulse. Irritation of the limbic system leads to the development of paroxysms of pronounced vegetative-visceral disorders (cardiac, gastrointestinal, etc.). Psychovegetative disorders are observed, including emotional disorders (anxiety, anxiety, depression, asthenia) and generalized vegetative reactions.

With damage to the hypothalamic region (Fig. 6.7) (tumor, inflammatory processes, circulatory disorders, intoxication, trauma), vegetative-trophic disorders can occur: disturbances in the rhythm of sleep and wakefulness, thermoregulation disorder (hyper- and hypothermia), ulceration in the gastric mucosa, the lower part of the esophagus, acute perforations of the esophagus, duodenum and stomach, as well as endocrine disorders: diabetes insipidus, adiposogenital obesity, impotence.

Damage to the vegetative formations of the spinal cord with segmental disorders and disorders localized below the level of the pathological process

Patients may have vasomotor disorders (hypotension), sweating and pelvic function disorders. With segmental disorders in the relevant areas, trophic changes are noted: increased dryness of the skin, local hypertrichosis or local hair loss, trophic ulcers and osteoarthropathies.

With the defeat of the nodes of the sympathetic trunk, similar clinical manifestations occur, especially pronounced with the involvement of the cervical nodes. There is a violation of sweating and a disorder of pilomotor reactions, hyperemia and an increase in the temperature of the skin of the face and neck; due to a decrease in the tone of the muscles of the larynx, hoarseness and even complete aphonia may occur; Bernard-Horner syndrome.

Figure: 6.7.

1 - damage to the lateral zone (increased drowsiness, chills, increased pilomotor reflexes, pupillary constriction, hypothermia, low blood pressure); 2 - damage to the central zone (violation of thermoregulation, hyperthermia); 3 - damage to the supraoptic nucleus (impaired secretion of antidiuretic hormone, diabetes insipidus); 4 - damage to the central nuclei (pulmonary edema and gastric erosion); 5 - damage to the paraventricular nucleus (adipsia); 6 - damage to the anteromedial zone (increased appetite and impaired behavior)

The defeat of the peripheral parts of the autonomic nervous system is accompanied by a number of characteristic symptoms. Most often there is a kind of pain syndrome - sympathetic. The pains are burning, pressing, bursting, tend to gradually spread beyond the area of \u200b\u200bprimary localization. Pain is provoked and aggravated by changes in barometric pressure and ambient temperature. Changes in the color of the skin are possible due to spasm or expansion of peripheral vessels: paleness, redness or cyanoticity, changes in sweating and skin temperature.

Autonomic disorders can occur with damage to the cranial nerves (especially the trigeminal), as well as the median, sciatic, etc. The defeat of the autonomic ganglia of the face and oral cavity causes burning pain in the innervation zone related to this ganglion, paroxysm, hyperemia, increased sweating, in case defeat of the submandibular and sublingual nodes - an increase in salivation.

The autonomic (autonomic) nervous system is involved in the regulation of unconscious actions in the body, which is responsible for human growth, normalization of blood circulation, and the expenditure of energy produced in the lungs and intestines. It also has a direct relationship with the state of the heart rate. It is divided into two components responsible for polar actions, one works with activation processes, the other with their inhibition.

Definition

The parasympathetic nervous system, being one of the components of the autonomous system, ensures the function of respiration, regulation of the heartbeat, dilation of blood vessels, control of digestive processes, as well as the activation of other equally important mechanisms.

This system works to relax the body, restoring balance after physical or emotional stress.

At an unconscious level, with her participation, muscle tone decreases, pulse normalizes, vascular walls narrow. Acetylcholine acts as a mediator of the parasympathetic system, acting opposite to adrenaline.

Parasympathetic centers occupy the space of the brain and spinal cord, this contributes to the fastest transmission of impulses that serve to regulate the performance of internal organs and systems. Each of the nerve impulses is responsible for a specific part of the body that responds to its stimulation.

The peri-motor, facial, vagus, glossopharyngeal and pelvic visceral nerves are referred to as parasympathetic nerves. Nerve fibers perform local functions, uniting with each other, such as those that are part of the parasympathetic system of the plexus of the intramural nervous system, localized mainly in the parts of the digestive tract. These include plexuses:

• musculo-intestinal, located between the longitudinal and annular muscles of the digestive tube;
• submucosal, growing into a network of glands and villi.

The location of the parasympathetic nerve plexuses determines the area of \u200b\u200bresponsibility of the system department. For example, the plexuses in the pelvic region are engaged in physical activity. Located in the digestive tract, they are responsible for how gastric juice is secreted and intestinal peristalsis works.

In addition to the hypothalamus and pineal gland, parasympathetic centers are localized in the nerve nuclei of the occipital zone, lumbar, celiac and thoracic plexuses. The centers located in the cardiac plexus are responsible for myocardial tremors. Parasympathetic fibers, starting in the midbrain, are a constituent part of the oculomotor nerve. Their effects on the smooth muscles of the eye, lead to constriction of the pupil and affect the ciliary (accommodative) muscle.

The petrosal, glossopharyngeal nerves and the nerve tympanic are based on parasympathetic fibers and affect the lacrimal, salivary, parotid, and nasal and palate glands.

The fibers that are the bulk of the vagus nerve are also parasympathetic. They are involved in regulating the work of all internal organs of the chest and abdominal cavity, with the exception of the pelvic area.

There are also parasympathetic agents in the sacral spine. The paired pelvic nerve, for example, is actively involved in the formation of the hypogastric plexus and is involved in the innervation of the bladder, internal genital organs and the lower colon.

Functions

The task of this system is the functioning of all parts of the body at rest. First of all, this means that there is an active relaxation and recovery of the body after any stress, be it physical or emotional. For this, an effect is made on the tone of smooth muscles and an effect is exerted on the circulatory system and the work of the heart, in particular, on:

• normalization of blood pressure and blood circulation;
• permeability and vasodilation;
• contraction of the myocardium;
• slow heartbeat;
• restoration of optimal blood glucose levels.

Performing an important task of cleansing the body includes adjusting the processes of sneezing, coughing and vomiting, as well as regulating the emptying of the gall and bladder and defecation by relaxing the sphincters.

Also affected are:

• internal secretion of individual glands, including salivation, lacrimation;
• stimulation of food digestion;
• sexual arousal;
• constriction of the pupils, relieving tension from the optic nerve;
• restoration of calm breathing due to narrowing of the bronchi;
• decrease in the speed of transmission of nerve impulses.

In other words, the front of the parasympathetic system covers many parts of the body, but not all. The list of exclusions includes, for example, smooth muscle membranes of blood vessels, ureters, smooth muscle of the spleen.

The parasympathetic department is responsible for the non-stop operation of such systems as: cardiovascular, genitourinary and digestive.

In addition, the liver, thyroid, kidneys and pancreas are affected. The parasympathetic system has many different functions, the performance of which provides a complex effect on the body.

Interaction of VNS departments

The process of the autonomic system is directly related to the receipt of response impulses from the brain centers, leading to the regulation of the tone of the vessels used to move blood and lymph through the body. The close connection of the parasympathetic divisions is due to the fact that one works with the tension of the body as a whole and its organs in particular, and the other - with their relaxation. This means that the functioning of departments depends on the smooth operation of each other.

Comparison of the two departments shows an obvious difference between them, associated with the opposite direction of their impact. The sympathetic division deals with the awakening of the body, the response to stress and the emotional response, that is, the activation of internal organs, while the phase of the parasympathetic nervous system is associated with the inhibition of these phenomena, including relaxation after physical and emotional stress, in order to restore the normal state of the body. In this regard, there is also a difference in the mediators that carry out the movement of nerve impulses along the synapses.

The sympathetic system uses norepinephrine, the parasympathetic system uses acetylcholine.

There is also a difference in the remoteness of the ganglia: the sympathetic are based at a distance, and the localization of the parasympathetic are predominantly intramural nodules in the walls of the controlled organs. A lot of short postganglionic fibers are directed from the cells of these nodes deep into the organ.

The joint work of the components of the vegetative system underlies the clear work of organs that respond to any changes that happen to the body, and adapt their activities to new conditions. If the balance in the joint work of these systems fails, treatment is necessary.

Anatomy of the innervation of the autonomic nervous system. Systems: sympathetic (red) and parasympathetic (blue)

The part of the autonomic nervous system associated with and functionally opposed to the sympathetic nervous system. In the parasympathetic nervous system, the ganglia (nerve nodes) are located directly in the organs or on the approaches to them, therefore the preganglionic fibers are long, and the postganglionic fibers are short. The term parasympathetic - that is, near-sympathetic was proposed by D. N. Langley in the late XIX - early XX century.

Embryology

The embryonic source for the parasympathetic system is the ganglion plate. Parasympathetic head nodes are formed by cell migration from the midbrain and medulla oblongata. Peripheral parasympathetic ganglia of the alimentary canal originate from two sections of the ganglionic plate - "vagal" and lumbosacral.

Anatomy and morphology

In mammals, the central and peripheral divisions are distinguished in the parasympathetic nervous system. The central includes the nuclei of the brain and the sacral spinal cord.

The bulk of parasympathetic nodes are small ganglia, diffusely scattered in the thickness or on the surface of internal organs. The parasympathetic system is characterized by the presence of long processes in preganglionic neurons and extremely short ones in postganglionic ones.

The head section is subdivided into the middle and medullary parts. The midbrain part is represented by the Edinger-Westphal nucleus, located near the anterior hillocks of the quadruple at the bottom of the Sylvian aqueduct. The medullary oblongata includes the nuclei of the VII, IX, X cranial nerves.

Preganglionic fibers from the Edinger-Westphal nucleus exit as part of the oculomotor nerve, and end on the effector cells of the ciliary ganglion ( gangl. ciliare). Postganlionic fibers enter the eyeball and go to the accommodative muscle and the sphincter of the pupil.

VII (facial) nerve also carries a parasympathetic component. Through the submandibular ganglion, it innervates the submandibular and sublingual salivary glands, and switching in the pterygopalatine ganglion - the lacrimal glands and nasal mucosa.

The fibers of the parasympathetic system are also part of the IX (glossopharyngeal) nerve. Through the parotid ganglion, it innervates the parotid salivary glands.

The main parasympathetic nerve is the vagus nerve ( N. vagus), which, along with afferent and efferent parasympathetic fibers, includes sensory and motor somatic, and efferent sympathetic fibers. It innervates almost all internal organs up to the colon.

The nuclei of the spinal center are located in the region of the II-IV sacral segments, in the lateral horns of the gray matter of the spinal cord. They are responsible for the innervation of the colon and pelvic organs.

Physiology

Predominantly the neurons of the parasympathetic nervous system are cholinergic. Although it is known that, along with the main mediator, postganglionic axons simultaneously release peptides (for example, vasoactive intestinal peptide (VIP)). In addition, in birds in the ciliary ganglion, along with chemical transmission, electrical transmission is also present. It is known that parasympathetic stimulation in some organs causes an inhibitory effect, in others - an exciting response. In any case, the action of the parasympathetic system is opposite to that of the sympathetic (the exception is the action on the salivary glands, where both the sympathetic and parasympathetic nervous systems cause the activation of the glands).

The parasympathetic nervous system innervates the iris, lacrimal gland, submandibular and sublingual glands, parotid gland, lungs and bronchi, heart (decrease in heart rate and strength), esophagus, stomach, large and small intestine (increased secretion of glandular cells). Narrows the pupil, enhances the secretion of the sebaceous and other glands, narrows the coronary vessels, improves peristalsis. The parasympathetic nervous system does not innervate the sweat glands and vessels of the extremities.

see also

Literature

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See what the "Parasympathetic nervous system" is in other dictionaries:

PARASYMPATHIC NERVOUS SYSTEM - see Vegetative n. from. Big psychological dictionary. M .: Prime EUROZNAK. Ed. B.G. Meshcheryakova, acad. V.P. Zinchenko. 2003. The parasympathetic nervous system ... Big psychological encyclopedia

PARASYMPATHIC NERVOUS SYSTEM, one of the two parts of the AUTONOMOUS NERVOUS SYSTEM, the second part is the SYMPATHIC NERVOUS SYSTEM. They are both involved in the work of SMOOTH MUSCLES. The parasympathetic nervous system controls muscles that ... ... Scientific and technical encyclopedic dictionary

Big Encyclopedic Dictionary

- (from steam ... and Greek sympathes sensitive, susceptible to influence), part of the autonomic nervous system, ganglia to the swarm are located in the immediate vicinity. proximity to the innervated organs or in their wall. In mammals P. n. from. consists of… … Biological encyclopedic dictionary

PARASYMPATHIC NERVOUS SYSTEM - PARASYMPATIC NERVOUS SYSTEM, see Autonomic nervous system ... Big medical encyclopedia

Part of the autonomic nervous system, including: nerve cells of the medulla oblongata, midbrain and sacral spinal cord, the processes of which are directed to the internal organs; nerve ganglia (nodes) in internal organs and on their ... ... encyclopedic Dictionary

Parasympathetic nervous system - (parasympathetic nervous system) - a group of nerve centers and fibers of the autonomic nervous system, providing, along with the sympathetic nervous system, the normal functioning of internal organs. The parasympathetic nervous system slows down ... Encyclopedic Dictionary of Psychology and Pedagogy

A part of the autonomic nervous system (see Autonomic nervous system), the ganglia of which are located in the immediate vicinity of the innervated organs or in them. P. centers of n. from. are located in the middle and medulla oblongata ... ... Great Soviet Encyclopedia

- (see a couple ...) a part of the autonomic nervous system involved in the regulation of the activity of internal organs (slows down the heartbeat, stimulates the separation of digestive juices, etc.), activates the processes of accumulation of energy and substances cf. ... ... Dictionary of foreign words of the Russian language

PARASYMPATHIC NERVOUS SYSTEM - see the Autonomic nervous system ... Veterinary encyclopedic dictionary

According to the morphofunctional classification, the nervous system is divided into: somaticand vegetative.

Somatic nervous systemprovides the perception of irritations and the implementation of motor reactions of the body as a whole with the participation of skeletal muscles.

Autonomic nervous system (ANS) innervates all internal organs (cardiovascular system, digestion, respiration, genitals, secretions, etc.), smooth muscles of hollow organs, regulates metabolic processes, growth and reproduction

Autonomic (autonomic) nervous system regulates the functions of the body regardless of the will of the person.

The parasympathetic nervous system is the peripheral part of the autonomic nervous system, responsible for maintaining the constancy of the internal environment of the body.

The parasympathetic nervous system consists of:

From the cranial section, in which the preganglionic fibers leave the median and rhomboid brain as part of several cranial nerves; and

From the sacral section, in which the preganglionic fibers leave the spinal cord as part of its ventral roots.

The parasympathetic nervous system inhibits work of the heart, dilates some blood vessels.

The sympathetic nervous system is a peripheral part of the autonomic nervous system that mobilizes the body's resources for urgent work.

The sympathetic nervous system stimulates the heart, constricts blood vessels and enhances skeletal muscle performance.

The sympathetic nervous system is represented by:

Gray matter of the lateral horns of the spinal cord;

Two symmetrical sympathetic trunks with their ganglia;

Inter-nodal and connecting branches; and

Branches and ganglia involved in the formation of nerve plexuses.

All vegetative NS consists of: parasympathetic and sympathetic divisions. Both of these departments innervate the same organs, often exerting the opposite effect on them.

The neurotransmitter acetylcholine is released by the endings of the parasympathetic part of the autonomic NS.

Parasympathetic division of the autonomic NSregulates the work of internal organs at rest. Its activation contributes to a decrease in the frequency and strength of heart contractions, a decrease in blood pressure, an increase in both motor and secretory activity of the digestive tract.

The endings of the sympathetic fibers secrete norepinephrine and adrenaline as mediators.

Sympathetic division of the autonomic NA increases its activity if necessarymobilization of body resources. The frequency and strength of heart contractions increase, the lumen of blood vessels narrows, blood pressure rises, the motor and secretory activity of the digestive system is inhibited.

The nature of the interaction between the sympathetic and parasympathetic parts of the nervous system

1. Each of the divisions of the autonomic nervous system can exert an exciting or inhibitory effect on one or another organ. For example, under the influence of sympathetic nerves, the heartbeat increases, but the intensity of intestinal motility decreases. Under the influence of the parasympathetic department, the heart rate decreases, but the activity of the digestive glands increases.

2. If any organ is innervated by both parts of the autonomic nervous system, then their action is usually exactly the opposite. For example, the sympathetic section enhances the contractions of the heart, and the parasympathetic one weakens; the parasympathetic increases the secretion of the pancreas, while the sympathetic decreases. But there are exceptions. So, the secretory nerves for the salivary glands are parasympathetic, while the sympathetic nerves do not inhibit salivation, but cause the release of a small amount of thick viscous saliva.

3. For some organs, either sympathetic or parasympathetic nerves are predominantly suitable. For example, sympathetic nerves go to the kidneys, spleen, sweat glands, and mainly parasympathetic nerves to the bladder.

4. The activity of some organs is controlled by only one part of the nervous system - the sympathetic. For example: when the sympathetic part is activated, sweating increases, but when the parasympathetic part is activated, it does not change, the sympathetic fibers increase the contraction of the smooth muscles that raise the hair, and the parasympathetic ones do not change. Under the influence of the sympathetic part of the nervous system, the activity of some processes and functions can change: blood coagulation is accelerated, metabolism occurs more intensively, and mental activity increases.

Sympathetic nervous system reactions

The sympathetic nervous system, depending on the nature and strength of the stimuli, responds either with the simultaneous activation of all of its departments, or with reflex responses of individual parts. Simultaneous activation of the entire sympathetic nervous system is most often observed when the hypothalamus is activated (fright, fear, unbearable pain). The result of this widespread body-wide response is the stress response. In other cases, reflexively and with involvement of the spinal cord, certain parts of the sympathetic nervous system are activated.

The simultaneous activation of most parts of the sympathetic system helps the body to perform unusually large muscle work. This is facilitated by an increase in blood pressure, blood flow in working muscles (with a simultaneous decrease in blood flow in the gastrointestinal tract and kidneys), an increase in the metabolic rate, glucose concentration in blood plasma, the breakdown of glycogen in the liver and muscles, muscle strength, mental performance, blood coagulation rate ... The sympathetic nervous system is highly excited in many emotional states. In a state of rage, the hypothalamus is stimulated. Signals are transmitted through the reticular formation of the brain stem to the spinal cord and cause massive sympathetic discharge; all of the above reactions are triggered immediately. This reaction is called the sympathetic anxiety response, or the fight or flight response. an instant decision is required - stay and fight or flee.

Examples of reflexes in the sympathetic nervous system are:

- expansion of blood vessels with local muscle contraction;
- sweating when the local area of \u200b\u200bthe skin is heated.

The modified sympathetic ganglion is the adrenal medulla. It produces the hormones adrenaline and norepinephrine, the points of application of which are the same target organs as for the sympathetic part of the nervous system. The action of hormones in the adrenal medulla is more pronounced than in the sympathetic division.

Parasympathetic system responses

The parasympathetic system carries out local and more specific control of the functions of the effector (executive) organs. For example, parasympathetic cardiovascular reflexes usually act only on the heart, increasing or decreasing the heart rate. Other parasympathetic reflexes act in the same way, causing, for example, salivation or secretion of gastric juice. The emptying reflex of the rectum does not cause any changes over a significant length of the colon.

Differences in the influence of the sympathetic and parasympathetic divisions of the autonomic nervous system are due to the peculiarities of their organization. Sympathetic postganglionic neurons have an extensive area of \u200b\u200binnervation, and therefore their excitation usually leads to generalized (broad-acting) reactions. The general effect of the influence of the sympathetic section is to inhibit the activity of most internal organs and stimulate the heart and skeletal muscles, i.e. in preparing the body for behavior such as "fight" or "flight". Parasympathetic postganglionic neurons are located in the organs themselves, innervate limited areas, and therefore have a local regulatory effect. In general, the function of the parasympathetic department is to regulate processes that ensure the restoration of body functions after vigorous activity.

The nervous system is a kind of apparatus that connects all organs, creates a relationship between their functions, which guarantees the smooth operation of the human body as a whole. The main element of this complex mechanism is the neuron - the smallest structure that exchanges impulses with other neurons.

The main vegetative processes in the body

The anatomical differences between the sympathetic and parasympathetic nervous systems lie in the location of the neural cell bodies - those belonging to the SNS are located in the spinal cord of the thoracic and lumbar vertebrae, and those belonging to the PNS section are grouped in the medulla oblongata and the sacral regions of the spinal cord. The second neural chain is located outside the central nervous system, it forms ganglia in close proximity to the spine.

The role of the metasympathetic division

The sympathetic and parasympathetic parts of the nervous system have a fundamental effect on the functioning of most internal organs through the so-called vagus nerve. If we compare the rates of impulse transmission of the central and vegetative systems, the latter is significantly inferior. The unifying SNS and PNS can be called the metasympathetic section - this area is located on the walls of organs. Thus, all internal processes of the human body are controlled due to the well-established work of vegetative structures.

The principle of work of vegetative departments

The functions of the sympathetic and parasympathetic nervous systems cannot be classified as interchangeable. Both sections supply neurons to the same tissues, creating an unbreakable connection with the central nervous system, but they can have a completely opposite effect. The table below will help you to clearly verify this:

Organs and systems	Sympathetic system	Parasympathetic system
Pupils	expand	narrow down
Salivary glands	causes a small amount of thick liquid	intense production of watery secretions
Lacrimal glands	does not affect	causes increased production of secretion
Contractility of the heart muscle, rhythm	provokes an increase in heart rate, intensifies contractions	weakens, lowers heart rate
Vessels and blood circulation	is responsible for narrowing the arteries and increasing blood pressure	practically does not affect
Respiratory organs	helps to strengthen, expand the lumen of the bronchi	narrows the lumen of the bronchi, there is a decrease in breathing
Musculature	tones	relaxes
Sweat glands	activates the production of sweat	does not affect
The work of the digestive tract and digestive organs	inhibits mobility	activates mobility
Sphincters	activates	slows down
Adrenal glands and endocrine system	production of adrenaline and norepinephrine	does not affect
Genitals	responsible for ejaculation	responsible for erection

Sympathicotonia - disorders of the sympathetic system

The sympathetic and parasympathetic divisions of the nervous system are in an equal position, without the predominance of one over the other. In other cases, sympathicotonia and vagotonia develop, which is manifested by increased excitability. If we are talking about the predominance of the sympathetic department over the parasympathetic, then signs of pathology will be:

• feverish condition;
• heart palpitations;
• numbness and tingling in the tissues;
• irritability and apathy;
• increased appetite;
• thoughts about death;
• distraction;
• decrease in salivation;
• headache.

Disorder of the parasympathetic system - vagotonia

If, against the background of weak activity of the sympathetic department, parasympathetic processes are activated, then the person will feel:

• increased sweating;
• lowering blood pressure;
• change in heart rate;
• short-term loss of consciousness;
• increased salivation;
• fatigue;
• indecision.

What is the difference between SNS and PNS?

The main difference between the sympathetic nervous system and the parasympathetic nervous system is its ability to increase the body's capabilities in case of a sudden need. This department is a unique vegetative structure that, in an emergency, gathers together all available resources and helps a person cope with a task that is almost on the verge of his capabilities.

The functions of the sympathetic and parasympathetic nervous systems are aimed at maintaining the natural functioning of internal organs, even in critical situations for the body. The increased activity of the SNS and PNS helps to overcome various stressful circumstances:

• excessive physical activity;
• psychoemotional disorders;
• complex diseases and inflammation;
• metabolic disorders;
• development of diabetes mellitus.

With emotional upheavals, the autonomic nervous system begins to work more actively in a person. The sympathetic and parasympathetic divisions enhance the action of neurons and strengthen the connections between nerve fibers. If the main task of the PNS is to restore normal self-regulation and protective functions of the body, then the action of the SNS is aimed at improving the production of adrenaline by the adrenal glands. This hormonal substance helps a person to cope with a sudden increase in stress, it is easier to endure dramatic events. After the sympathetic and parasympathetic parts of the autonomic nervous system have used up possible resources, the body will need rest. To fully recover, a person will need 7-8 hours of sleep a night.

Unlike the sympathetic nervous system, the parasympathetic and metasympathetic autonomic divisions have a slightly different purpose associated with maintaining the body's functions in peace. The PNS works differently by lowering the heart rate and the strength of the muscle contractions. Thanks to the parasympathetic component of the autonomic system, digestion is stimulated, including with insufficient glucose levels, protective reflexes (vomiting, sneezing, diarrhea, coughing) are triggered, aimed at freeing the body from harmful and foreign elements.

What to do if there are disorders of the vegetative system?

Noticing the slightest disturbances in the functionality of the sympathetic and parasympathetic divisions of the autonomic nervous system, you should consult a doctor. In advanced cases, violations lead to neurasthenia, gastrointestinal ulcers, hypertension. Medication should be prescribed only by a qualified neurologist, but the patient is required to eliminate any factors that excite the sympathetic and parasympathetic nervous system, including physical exertion, psycho-emotional upheavals, experiences, fears and fears.

In order to establish vegetative processes in the body, it is advisable to take care of a cozy home atmosphere and receive only positive emotions. In addition to the above, physiotherapy, breathing exercises, yoga, swimming should also be included. This helps to relieve the general tone and relaxation.