Vegetovascular dystonia (VSD) in men: symptoms and treatment

The diagnosis of vegetative-vascular dystonia in men has recently become especially common. This trend is associated with emotional overload that accompanies businessmen, company owners, responsible employees and others. It is important to recognize the symptoms of the disease in the early stages in order to receive the most effective treatment.

Vegetovascular dystonia is not one of the common diseases, but one of the common diagnoses. True, the popularity of this phrase is observed only in countries that were once part of the USSR. The diagnosis is controversial and doubtful. It does not have its own autonomous syndrome; patients may experience about 10 syndromes and 150 symptoms. In ICD 10, this term is not used, and the disease is classified as a group of somatoform autonomic dysfunctions. The main difference is that the following are excluded for diagnosis:

any relevant physical diseases of organs and systems;
symptoms of body diseases that are clearly provoked by mental disorders.

Causes and symptoms

VSD in men has different symptoms, but they stem from the same reasons. The health of a man with this diagnosis is affected by:

Chronic fatigue.
Overwork.
Insufficient time for sleep and rest.
Irregular working hours.
Stress.
Overload of the body with intellectual work.
Physical fatigue.
Poor nutrition.
Cigarette abuse.
Drinking alcoholic beverages (intoxication).
Inactive lifestyle.
Insufficient exposure to fresh air (lack of oxygen in blood vessels).
Genetic predisposition.

It is impossible to say that VSD appears only in women against the background of hormonal changes, since men after 40 years also experience hormonal changes. Of course, it is not as dramatic as in women, but it is present. In men, testosterone levels decrease, which affects a number of other hormones.

Etiology of the disease

The first signs of the disease are usually detected in boys or in adolescence. Obvious symptoms appear by the age of 25-30. At its core, dystonia is a lack of balance in the functioning of the sympathetic and parasympathetic parts of the nervous system. The main reasons for this imbalance are the following factors:

genetic predisposition;
severe stress or constant psychological overload;
change of climate zone of residence;
diseases of a neurological or somatic nature;
hormonal changes in the body or the appearance of hormonal imbalance;
psychical deviations;
pathologies of the endocrine glands;
injuries or organic lesions of the brain.

Types of VSD and their manifestations

Vegetative-vascular dystonia was called because these disorders are characterized, first of all, by the contraction and dilation of blood vessels, depending on which section of the nervous system is most interested in this in this case.

Therefore, signs of vegetative-vascular dystonia in men may be of the nature of cardiovascular, gastrointestinal, psychoneurological or other diseases. But, as a rule, a thorough examination does not reveal these pathologies in the patient.

General signs of vegetative-vascular dystonia:

fast fatiguability;
dizziness;
rapid pulse;
sweating;
muscle weakness;
surges in blood pressure.

A little history

The symptoms of VSD in men were first described by military doctor Jacob de Costa during the American Civil War. He noticed that young, apparently healthy soldiers suddenly began to experience attacks of dizziness, palpitations and weakness.

A little later, the same symptoms were described in the English army, but, nevertheless, today the International Classification of Diseases (ICD) does not consider VSD a disease. It is rather a syndrome that is characterized by a certain state of the cardiovascular and autonomic nervous system. What happens then?

Symptoms of VSD in men

Treatment tactics for vegetative-vascular dystonia in men are aimed at normalizing the work and rest regime.

If a patient has severe dysfunction, treatment for VSD is prescribed individually, depending on the nature of the dystonia. For nervous agitation or depression, it is recommended to take antidepressants, antipsychotics, tranquilizers, sedatives, and resort to traditional medicine.

When diseases of the cardiovascular system are involved in the pathology, these drugs are taken under the supervision of a doctor.

Antidepressants

This group of drugs includes psychotropic drugs of varying strengths. Popular prescription antidepressants:

Azafen;
Phenelzine;
Isocarboxazid;
Tranylcypromine;
Prozac;
Ludiomil;
Paxil;
Moclobemide.

Mild over-the-counter antidepressants:

Maprotiline;
Fluoxetine;
Deprim.

Neuroleptics

For severe agitation and psychopathic disorders, antipsychotics are used:

Aminazine;
Leponex;
Truxal;
Clopixol;
Triftazin;
Haloperidol;
Moditen;
Eglonil.

But neuroleptics form a syndrome expressed in hyper- or hypokinetic disorders. In this case, signs of apathy or, conversely, anxiety are observed.

Sedatives and tranquilizers

The manifestations of this disease have virtually no gender differences. However, there are a number of features that are characteristic of the male gender.

Vegetative-vascular dystonia is a complex of disorders that manifest themselves in direct dependence on a number of reasons:

heredity;
bad habits (alcohol, cigarettes);
hormonal imbalances;
overwork;
stress;
infection.

Although all causes apply to people of any age, VSD most often occurs in men between the ages of forty and fifty.

In medicine, most doctors believe that problems associated with VSD are formed in youth, since they are directly related to overcoming physical demands. This is manifested both in the concealment of emotions, which affects general emotional fatigue, and in the lack of rest, which is proportional to work.

VSD is characterized by several variants of symptoms, which can be combined with each other and cause increased discomfort not only to the patient, but also to the doctor, who must draw up a treatment plan.

Both parties should take into account the fact that one of the key signs of VSD is the situation when, when examining the internal organ in which the patient feels pain, no pathologies are detected.

The characteristic signs of this disease will be cardiac problems directly related to dysfunction of the cardiovascular system. Their manifestation occurs in the heart area and is expressed in tachycardia, rhythm disturbances and periodic pain.

There is also a disturbance in the respiratory system, which manifests itself in the absence of the ability to take deep breaths or their arbitrary nature. The patient feels short of breath and a feeling of heaviness in the chest.

Less sensitive, but also important, include disturbances in the diadynamics of the body, which is expressed in instability of blood pressure or unhealthy blood circulation; characterized by sudden changes in body temperature and disorders of the gastrointestinal system.

The distinctive symptoms of vegetative vascular dystonia in men, as mentioned above, are present. Similar features also affect neurocircular dystonia, which is a complex of cardiovascular disorders. These include:

Hypertensive type. The symptoms and general condition of the body strongly resemble the presence of hypertension. Throughout the day there is a sharp headache, ringing or noise in the ears, as well as shortness of breath. In addition, anxiety and irritability increase, but appetite decreases.
Hypotonic type. The symptoms of VSD in this case are not very different from hypotension itself. This type of VSD is characterized by selective, pronounced manifestation of the main symptoms, such as drowsiness or dizziness.
Cardiac type. Has a direct effect on the heart, causing pain or periodically slowing the pulse. Also manifests itself in sweating, arrhythmia and other cardiac problems. Here it is especially worth seeking advice from a doctor, since inaction can lead to heart pathologies.
Mixed type. A distinctive feature is a combination of other symptoms. In addition to the fact that the patient experiences pain in the head and heart, sleep disturbances and weather dependence, psycho-emotional disorders, a high level of excitability and panic fear appear as a result of all of the above.

That is why it is necessary to neutralize as many negative factors as possible in youth and not neglect treatment, so that in age all this does not result in VSD.

It was previously said that it is recommended to start treatment in youth, as this can reduce the likelihood of the disease appearing in age or eliminate it altogether. Treatment of the pathology, depending on its manifestations, is carried out using medicinal or non-medicinal methods.

However, it is worth noting that a drug treatment regimen can and should be prescribed only by a specialist who will take into account the characteristics of each organism. The doctor takes into account not only the physical component, because greater priority is given to the psychological state of the person.

If a person develops depression, the doctor prescribes antidepressants, and if he has various phobias, he prescribes anti-anxiety medications. It is complex treatment that can help the body overcome the disease, therefore, in combination with these procedures, symptomatic therapy is carried out.

The essence of therapy is that in case of hypertensive symptoms, the patient is prescribed antihypertensive drugs, in the absence of normal sleep - sleeping pills, and at the first signs of autonomic crises - vascular stabilizers or ganglion blockers.

Treatment of vegetative vascular dystonia in men is accompanied by the following drugs:

Novo-passit - causes sedation;
Persen is a sedative;
Valocormid - causes cardiac effects;
Corvalol - causes a relaxing effect;
Normatens - normalizes sleep;
Vinpocetine - stabilizes blood circulation in the brain;
Azafen - has an anti-anxiety effect;
Seduxen is a tranquilizer;
Propranolol - used for tachycardia;
Diazepam - used to reduce nervous agitation.

Physiotherapy used by the doctor during the treatment process is aimed primarily at normalizing the tone of the vascular muscles. Treatment also affects the stabilization of metabolic processes and blood circulation.

Important! The duration and form of treatment is completely supervised by the doctor until the end of the treatment cycle.

Prevention of vegetative-vascular dystonia

Prevention of VSD includes the following preventive measures:

Eliminate family quarrels and conflicts;
Communicate with the child, find out the causes of his disorders, if any;
Eliminate, as far as possible, the child’s contact with various types of information containing scenes of violence, murder, the occult - films, cartoons, computer games, free uncontrolled access to the Internet.
Eat foods enriched with vitamins and microelements;
Eliminate bad habits - alcohol, smoking;
Do not let various diseases, especially infectious ones, take their course, so that they do not become chronic;
Maintain a work/rest schedule
Do not take uncontrolled medications without consulting a doctor;
Avoid stress. If you work in a job with a high psycho-emotional load, think about whether it is worth it? It may be necessary to change jobs. Health is more important than money!
Try to move more, play sports, ride a bike.

Causes and symptoms

Dystonia has many variants depending on what dysfunction is manifested. Manifestations can be combined into several characteristic groups:

Cardiac signs are associated with dysfunction of the cardiovascular system: pain in the chest in the region of the heart, tachycardia, interruptions in heart rhythm, a feeling of cardiac arrest.
Respiratory signs: increased respiratory rate, inability to take a deep breath, spontaneous deep breaths, a feeling of respiratory failure, a feeling of heaviness in the chest, shortness of breath in the form of attacks during excitement, fear, or falling asleep.
Diadynamic disorders: instability of blood pressure, abnormal blood circulation in tissues.
Violation of thermoregulation: instability of body temperature for no apparent reason (increase from 35°C to 38°C and decrease).
Dyspeptic signs of a disorder of the gastrointestinal system: pain in the abdomen, nausea and vomiting, belching, abnormal stool (diarrhea or constipation).
Disorder of the genital and urinary organs: impaired potency, painful urination, increased frequency of urination.
Psychoneurological signs: increased fatigue, general weakness, irritability, decreased ability to work, absent-mindedness, headaches, sensitivity to climatic changes, sleep disturbance.

The main feature of vegetative-vascular dystonia is the patient’s multiple complaints and the presence of equally diverse symptoms. The most characteristic signs of VSD are various sleep disturbances, the presence of severe respiratory disorders, and frequent headaches.

Often such conditions are accompanied by tremors of the upper extremities, the appearance of edema in different parts of the body, a feeling of heat on the skin of the face, joint pain, and fainting.

Symptoms of vegetative-vascular dystonia in men can vary greatly. Depending on the type of VSD, they may be similar to symptoms of a disease of the cardiovascular, digestive or nervous system.

Types

The diagnosis is made exclusively by a specialist. In the medical record, the diagnosis can be recorded as neurocirculatory dystonia or under other designations. The VSD formulation is not used in Europe or the USA. The name of the form speaks about the problems of the body, namely VSD with hyper- or hypotonic manifestations indicates changes in blood pressure, and cardialgia syndrome indicates pain in the heart or interruptions in its work. The mixed form implies the presence of most symptoms in varying degrees of manifestation. You cannot self-medicate without determining the form of the disease.

Based on the nature of the attacks that complicate the course of vegetative-vascular dystonia, they are divided into: sympathoadrenal, vagoinsular and mixed crises.

Mild crises are characterized by monosymptomatic manifestations, occur with pronounced vegetative changes, and last 10-15 minutes.
Crises of moderate severity have polysymptomatic manifestations, pronounced vegetative changes and last from 15 to 20 minutes.
Severe crises are manifested by polysymptoms, severe vegetative disorders, hyperkinesis, convulsions, attacks lasting more than one hour and post-crisis asthenia for several days.

VSD of hypotonic type

Dystonia of this type is a functional disorder of the ganglion system. It also includes disruptions in the functioning of the myocardium, a decrease in blood pressure, hypotonicity of the capillaries and a decline in the blood supply to organs. The pathological condition in question is associated with the body’s inability to adapt to the current environment, changing conditions, circumstances or relationships. Simply put, hypotonic VSD is an unsuccessful way for the body to overcome a certain stressful situation.

Hypertensive type

Accompanied by the following symptoms:

panic attacks, anxiety and fear;
headaches after overexertion;
elevated blood pressure levels that disappear after rest;
the appearance of “flies” before the eyes;
nausea leading to vomiting, not associated with food intake.

VSD of the hypertensive type differs from hypertension in that no medications are required to normalize blood pressure; you just need to rest for a few minutes and calm down.

VSD of vagotonic type

In addition to the listed symptoms, there are also such manifestations of vegetative abnormalities as:

low blood pressure,
cardiac algia;
swelling under the lower eyelids;
sweating;
respiratory deficiency;
decreased heart rate;
pain in the lower extremities that appears at night;
hypochondria;
dizziness;
increased salivation;
“marbled” leather;
intolerance to stuffiness;
pain in the abdominal area;
nausea, loss of appetite;
obesity, anxiety.

VSD of cardiac type

In the cardiological (as well as in the hypertensive) form of autonomic dysfunction, the diagnosis will most likely show obvious sympathicotonia, that is, functional tension in the work of the sympathetic department of the ANS. A distinctive feature of VSD of the cardiac type is pain in the heart area (stabbing, pressing or burning sensations in the chest area). Signs may resemble those of an angina attack or myocardial infarction. But upon examination, cardiac pathologies are not detected.

Mixed type

If there are observed jumps in blood pressure, it is necessary to be examined, that is, undergo a full course of diagnostic tests. Because it may not be hypertension, or hypotension, or the presence of any pathologies of somatic organs. All this may indicate a mixed type of VSD. As a rule, this type of syndrome is manifested by a decrease in blood pressure in the morning, and in the evening it rises above normal. In addition, pressure can change several times a day from low to high and vice versa.

Most often, patients with VSD of the mixed type complain of several symptoms at once, belonging to different classifications of vegetative-vascular dystonia, therefore, it is often quite problematic to make the correct diagnosis and prescribe treatment. Sometimes symptoms appear in “bundles”, that is, a person simultaneously feels problems of the cardiac, hypertensive and hypotonic types (and some symptoms in these groups overlap), sometimes

VSD of the cardiac type, after a few days or weeks, gives way to VSD of the hypotonic type, and then to VSD of the hypertensive type, forcing the patient to go through “all the circles of hell,” experiencing various unpleasant symptoms over and over again.

Diagnosis of VSD

To diagnose the pathology, the patient is recommended to consult with specialized specialists (neurologist, psychiatrist, cardiologist, endocrinologist). Their research is based on the nature of complaints and symptoms of identified disorders. To clarify the diagnosis, methods are used:

ECG (electrocardiogram) - prescribed for heart pain, feeling of pressure in the chest;
EEG (electroencephalography) - the procedure allows you to see brain activity; it is indicated for patients with sleep disorders, mental disorders, and respiratory dysfunction;
NMR (nuclear magnetic resonance) - using special equipment, a three-dimensional image of the brain is obtained, this makes it possible to determine why a person suffers from headaches, dizziness, and tinnitus;
rheovasography (pulse rhythm) - recommended for high blood pressure;
CT (computed tomography) - used to diagnose changes in organs.

The results obtained will reveal the causes that provoke ANS dysfunction, prevent the disease from progressing, and allow timely and correct treatment to begin.

Since vegetative-vascular dystonia is a whole series of various manifestations and symptoms of various etiologies, the diagnosis of VSD is quite difficult by definition. Doctors do not have special instruments in their arsenal to determine the presence of this syndrome. Therefore, a complete examination of the patient is carried out to exclude certain pathologies and diseases.

The following methods are used:

ECG;
rheovasography;
echocardiography;
Magnetic resonance imaging;
rheoencephalography;
CT scan.

It is very difficult to diagnose VSD, since it manifests itself in various types, and its symptoms may coincide with various diseases of the internal organs. In men, this disease often develops according to the cardiac principle, that is, it begins with the appearance of shortness of breath, rapid pulse, pain in the heart, sudden weakness, and palpitations.

Vegetative-vascular dystonia is a disease, the diagnosis of which presents certain difficulties due to the variety of manifestations of pathology, which often cannot be confirmed by the results of examinations of the patient.

For this reason, the diagnosis of VSD is carried out differentially using a method that allows one to consistently exclude the presence of certain systemic diseases. Usually, this requires consultation with an endocrinologist, cardiologist and neurologist.

An important role is played by clarifying the patient’s medical history, identifying predisposition to autonomic disorders on the part of the parents.

Diagnosing a disease is a meticulous process because the root cause cannot be found by referring to one doctor or procedure. A comprehensive examination of the body and various treatment methods with an appropriate medical approach are required.

Vegetative-vascular dystonia, symptoms and treatment in men are concepts that are closely intertwined.

Due to the range of symptoms, the doctor prescribes treatment. Based on the patient’s complaints, the doctor is obliged to offer him the following types of diagnostics:

Donating blood and urine for analysis.
Determination of blood pressure during the day (Holter method).
Electrocardiogram with and without stress.
Electroencephalography.

These are the main four points of diagnosis that most general practitioners and neurologists use.

Attention! A neuropathologist or neurologist should treat a patient with VSD. If there is a need for a detailed study of the patient’s health, an endocrinologist and a cardiologist can be involved.

If organ pathologies are detected during diagnosis, the doctor will prescribe an ultrasound or MRI.

Treatment of VDS

Typically, the treatment of vegetative-vascular dystonia in both men and women is carried out by a neurologist who can prescribe a set of measures. This includes:

taking medications;
physiotherapy;
diet;
physiotherapy.

Folk remedies, as well as swimming in the pool, a change in environment and normal lifestyle, can provide significant assistance in restoring the body.

Medication

When treating vegetative-vascular dystonia with medications, symptoms are eliminated, depending on the type of syndrome. Attention is paid to the treatment of concomitant diseases, the work of the endocrine and other systems is monitored.

As a rule, potent drugs are not used at the beginning of the development of VSD. Preference is given to natural sedatives, B vitamins and beta blockers.

In cases of exacerbations (crises), medications that regulate the functioning of the heart, stronger psychotropic and sedative drugs are prescribed.

Name of the drug	What is it for?	Possible side effects
Pirocetam	A nootropic drug that has a calming effect on the nervous system. Helps improve blood microcirculation without causing vasodilation.	Headache, decreased concentration, convulsions, hallucinations, nausea, diarrhea, asthenia.
Phenibut	It has a psychostimulating, tranquilizing effect and improves brain function. Reduces headaches, irritability, sleep disturbances.	Nausea, agitation, drowsiness, allergic reactions in case of intolerance to phenibut.
Frenolon	Has a pronounced antipsychotic effect. In small doses it has a calming effect on the central nervous system.	Swelling of the face, insomnia, trembling of limbs; impaired coordination of movements.
Sonapax	Neuroleptic. It has antidepressant, antipsychotic, antiemetic and antipruritic effects.	Excitement, confusion, fainting, diarrhea, vomiting, cutaneous melanosis.
Grandaxin	Tranquilizer. Eliminates various forms of disorders of the autonomic system.	Psychomotor agitation, loss of appetite, jaundice, muscle pain, difficulty breathing.
Vinpocetine	Improves metabolism and blood circulation in the brain, rheological properties of blood. Helps saturate the brain with oxygen.	Tachycardia, increased blood pressure.
Valocordin	It has antispasmodic, sedative, mild hypotensive effects.	Drowsiness, decreased concentration. With long-term use - depression, conjunctivitis, drug dependence.

Folk remedies

Vegetative-vascular dystonia requires an integrated approach to treatment. Since this is a syndrome, that is, a complex of manifestations provoked by an underlying disease, it is first necessary to detect it and begin to treat it. Without this, the fight against VSD will be episodic, symptomatic and will bring only temporary relief to the patient.

Most often, the basis of vegetative-vascular dystonia is a complex of problems associated with the functioning of blood vessels and the heart, so the correct solution would be to strengthen these “weak points” in every possible way. For treatment, the doctor will prescribe medications that improve heart function and strengthen blood vessels, and, if necessary, select blood thinners if there is a threat of thrombosis.

Taking vitamin preparations with minerals, as well as specialized products for blood vessels, for example, Rutin or Ascorutin, will be beneficial. Systematic use of drugs to improve cerebral circulation, for example, based on ginkgo biloba or more complex drugs prescribed by a doctor, will also help.

If blood pressure increases or decreases, the patient may be prescribed specific medications that normalize these indicators.

Physiotherapy and exercise therapy will be of great benefit, but adherence to a clear daily routine and work-rest regime, as well as a proper balanced diet, is of particular importance for patients with this syndrome.

Nutrition for VSD

In order for vegetative-vascular dystonia not to progress and cause problems for a person, it must be combated with comprehensive measures. Proper nutrition plays an important role in this.

There are several ways to answer the question of how to get rid of VSD, and drug therapy is considered one of the main strategies for treating advanced pathology. At the same time, all prescribed medications can be divided into several functional groups aimed at relieving the main symptoms of the disease and returning the functioning of the autonomic nervous system to normal.

Sedatives (calming) drugs

An alternative method of drug therapy for VSD is treatment using folk remedies and recipes. Moreover, in many cases this gentle method is considered the most preferable. All products prepared on the basis of medicinal herbs, according to the method of effect on the body, can be divided into the following groups:

sedatives;
antidepressants;
nootropic action.

Treatment of VSD must begin with determining the cause of the pathology. For this purpose, a comprehensive examination is prescribed, and only after excluding diseases of the internal organs and endocrine glands can therapy for vegetative-vascular dystonia begin.

Treatment includes symptomatic therapy and general recommendations.

Traditional recipes for VSD

To normalize the functioning of the nervous system, you need to know plants that have a calming effect.

Alcohol tinctures

Such plants are considered to be:

Kalina.
Valerian.
Hawthorn.
Motherwort.
Rose hip.
Mint.
Melissa.
Peony.

Any inclusion of traditional medicine in the prescribed treatment should be discussed with your doctor. This should not be forgotten, since some drugs and the main active ingredients of plants may be incompatible.

Infusion of valerian and motherwort

To prepare the product, mix 10 g of dry valerian and motherwort. Pour 200 ml of boiling water over the finished mixture. Leave for 10 minutes, strain. Take a quarter glass 4 times a day. The course of treatment is 1 month.

Berry picking

Combine 40 g of rose hips, 30 g of nettle leaves, 1 tbsp. l. barberry berries, 1 tbsp. l. black currant. Stir and pour 400 ml of boiling water. Leave the mixture in a dark, cool place for 4 hours. Keep the prepared mixture under a closed lid. Strain the mixture. Take half a glass of infusion 3 times before meals.

VSD is not a specific disease that can be cured with one pill, but a complex disruption of the functioning of several organs at once against the background of a nervous disorder. A man needs to solve the problem with a neurologist. Treatment can include either drug therapy or physical therapy.

Possible complications

Vegetative-vascular dystonia can negatively affect the entire body as a whole and cause numerous complications.

Most often, undiagnosed and untreated VSD provokes cardiovascular diseases, provokes problems with the nervous system, and causes persistent insomnia, which is practically untreatable.

The disease negatively affects the respiratory function and the functioning of the gastrointestinal tract, exhausts and depletes the patient, and leads to many negative consequences.

A man's performance and thinking abilities suffer the most due to difficulties with concentration.

All preventive measures require an integrated approach; such an extensive syndrome cannot be cured simply by taking medications and preventing its occurrence solely by the desire not to get sick.

Alternative point of view

Many doctors believe that such a diagnosis does not exist. The alarming thing is that no one has yet decided on the nomenclature of the disease, everyone calls it differently, no one can say exactly how it manifests itself.

Any of the symptoms related to the symptoms of vegetative-vascular dystonia can be found in any person at any period of his life. Not all people in the world can suffer from any disease.

The symptoms of vegetative-vascular dystonia are described very vaguely and in different ways in different sources. Most patients who have been diagnosed with this for years find it difficult to explain that they do not have such a disease, and indeed that such a disease does not exist. Otherwise, a completely logical question arises: what was he treated for all these months or years?

For many doctors, this diagnosis is a “lifeboat” or a “garbage can”, depending on which way you look at it. If a patient has a number of symptoms, but the examination does not reveal any significant organic pathology, it is impossible to tell him that everything is fine.

He came with complaints, something was bothering him, something brought him to the doctor’s office. He simply will not understand the doctor and will decide that he is not competent enough and will go to another doctor, in the hope that he will understand the problem. Therefore, the doctor uses a proven method and writes the diagnosis “vegetative-vascular dystonia” on the card.

Then he prescribes harmless valerian, motherwort, and walks in the evenings under the moon, accompanied by thoughts about something positive. What do we have? And the wolves are fed, and the sheep are safe. The patient is glad that the cause of his problems has been found; fortunately, the reason is trivial, because most of his friends and relatives have vegetative-vascular dystonia.