Podcast
Questions and Answers
What is the recommended amount of essential oil to add to the boiling water for a steam inhalation?
What is the recommended amount of essential oil to add to the boiling water for a steam inhalation?
What is the duration of the steam inhalation process?
What is the duration of the steam inhalation process?
What is the purpose of adding garlic, onion, and ginger to soups or stews?
What is the purpose of adding garlic, onion, and ginger to soups or stews?
What is the role of astragalus in the Immune Support Soup?
What is the role of astragalus in the Immune Support Soup?
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What is the purpose of using medicinal mushrooms like Reishi and Chaga?
What is the purpose of using medicinal mushrooms like Reishi and Chaga?
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What is the importance of considering the patient's cultural background when choosing herbal pharmacy?
What is the importance of considering the patient's cultural background when choosing herbal pharmacy?
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What is the benefit of adding miso to the Immune Support Soup?
What is the benefit of adding miso to the Immune Support Soup?
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What is the role of Schisandra chinensis in preventing recurrence?
What is the role of Schisandra chinensis in preventing recurrence?
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What is the purpose of using Panax ginseng in preventing recurrence?
What is the purpose of using Panax ginseng in preventing recurrence?
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What is the benefit of using Eucalyptus, Thyme, and/or Peppermint essential oils in steam inhalations?
What is the benefit of using Eucalyptus, Thyme, and/or Peppermint essential oils in steam inhalations?
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What is a possible way to experience different relational patterns in life?
What is a possible way to experience different relational patterns in life?
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What is the dominant relational style that most people have?
What is the dominant relational style that most people have?
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What is the good news about our relational patterns?
What is the good news about our relational patterns?
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What is an important skill to cultivate in ourselves and bring to our patients?
What is an important skill to cultivate in ourselves and bring to our patients?
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What is the title of the video featuring Gabor Maté, MD?
What is the title of the video featuring Gabor Maté, MD?
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What is the main topic discussed by Gabor Maté, MD, in the video?
What is the main topic discussed by Gabor Maté, MD, in the video?
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What is the characteristic of a person's default relational style?
What is the characteristic of a person's default relational style?
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What can we experience in different areas of life?
What can we experience in different areas of life?
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What is the adaptation of our nervous system?
What is the adaptation of our nervous system?
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What is the result of tracking autonomic states?
What is the result of tracking autonomic states?
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What is the main precaution when needling on the posterior neck?
What is the main precaution when needling on the posterior neck?
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What is a normal sensation during De Qi?
What is a normal sensation during De Qi?
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What is the correct management of a stuck needle?
What is the correct management of a stuck needle?
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What is a cause of a bent needle?
What is a cause of a bent needle?
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What is the recommended action when a patient is experiencing fainting during needling?
What is the recommended action when a patient is experiencing fainting during needling?
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What is the correct management of an arterial puncture?
What is the correct management of an arterial puncture?
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What is a symptom of fainting during needling?
What is a symptom of fainting during needling?
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Why is it important to use thicker gauge needles for tough, thick areas?
Why is it important to use thicker gauge needles for tough, thick areas?
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What is a consequence of poor management of a stuck or bent needle?
What is a consequence of poor management of a stuck or bent needle?
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Why is it important to consider the needle length and gauge when needling?
Why is it important to consider the needle length and gauge when needling?
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What is the main function of Blood in Traditional Chinese Medicine?
What is the main function of Blood in Traditional Chinese Medicine?
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What is a characteristics of Qi Deficiency?
What is a characteristics of Qi Deficiency?
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What is a symptom of Blood Deficiency?
What is a symptom of Blood Deficiency?
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What is a characteristic of Excess Yang?
What is a characteristic of Excess Yang?
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What is the process by which Food Qi is converted to Blood?
What is the process by which Food Qi is converted to Blood?
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What is characterized by emptiness of the Upright Qi and the absence of a pathogenic factor?
What is characterized by emptiness of the Upright Qi and the absence of a pathogenic factor?
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What is the result of a decrease in Yin?
What is the result of a decrease in Yin?
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What is the function of Qi in the body?
What is the function of Qi in the body?
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What is a characteristic of Empty Yang?
What is a characteristic of Empty Yang?
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What is a symptom of Yang Excess?
What is a symptom of Yang Excess?
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What is one of the basic hygiene practices for healing and prevention?
What is one of the basic hygiene practices for healing and prevention?
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What is the recommended type of water to use for nasal saline irrigation?
What is the recommended type of water to use for nasal saline irrigation?
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What is a potential benefit of nasal saline irrigation?
What is a potential benefit of nasal saline irrigation?
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What is the origin of nasal saline irrigation?
What is the origin of nasal saline irrigation?
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What is a consideration when using nasal saline irrigation as part of an Ayurvedic practice?
What is a consideration when using nasal saline irrigation as part of an Ayurvedic practice?
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What is the primary purpose of obtaining informed consent from patients?
What is the primary purpose of obtaining informed consent from patients?
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What is a key component of a comprehensive Naturopathic treatment plan?
What is a key component of a comprehensive Naturopathic treatment plan?
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Which regulatory requirement is relevant to record keeping in Naturopathic practice?
Which regulatory requirement is relevant to record keeping in Naturopathic practice?
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What is the primary focus of the active learning session in Week 2?
What is the primary focus of the active learning session in Week 2?
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What is the relationship between informed consent and treatment recommendations in Naturopathic practice?
What is the relationship between informed consent and treatment recommendations in Naturopathic practice?
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What is a potential side effect of taking Vitamin C?
What is a potential side effect of taking Vitamin C?
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What is the recommended daily dose of Zinc for adults?
What is the recommended daily dose of Zinc for adults?
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What should be considered when advising patients on Vitamin C supplementation?
What should be considered when advising patients on Vitamin C supplementation?
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Why should Zinc not be taken at the same time as antibiotics?
Why should Zinc not be taken at the same time as antibiotics?
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What is a potential risk of taking Vitamin C supplements for those susceptible to kidney stones?
What is a potential risk of taking Vitamin C supplements for those susceptible to kidney stones?
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What is an important consideration when advising patients on Zinc supplementation?
What is an important consideration when advising patients on Zinc supplementation?
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What is a potential side effect of taking Zinc supplements?
What is a potential side effect of taking Zinc supplements?
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What is the purpose of screening for allergies and potential interactions when advising patients on supplements?
What is the purpose of screening for allergies and potential interactions when advising patients on supplements?
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What is the role of a Naturopathic doctor in advising patients on supplements?
What is the role of a Naturopathic doctor in advising patients on supplements?
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What is the primary goal of treatment in this case presentation?
What is the primary goal of treatment in this case presentation?
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What is the family of the ginseng plant?
What is the family of the ginseng plant?
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What is the main indication of ginseng?
What is the main indication of ginseng?
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What is the action of ginseng as approved by the German Commission E?
What is the action of ginseng as approved by the German Commission E?
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What is the photo courtesy of?
What is the photo courtesy of?
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What is ginseng useful for according to King's American Dispensatory?
What is ginseng useful for according to King's American Dispensatory?
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What are the phytochemicals found in ginseng?
What are the phytochemicals found in ginseng?
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What is the caution for using ginseng?
What is the caution for using ginseng?
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What is the result of various clinical trials of ginseng?
What is the result of various clinical trials of ginseng?
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What is the Latin name of the Korean ginseng?
What is the Latin name of the Korean ginseng?
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What is the drug derived from the root of ginseng?
What is the drug derived from the root of ginseng?
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Which remedy is characterized by persistent nausea and vomiting?
Which remedy is characterized by persistent nausea and vomiting?
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What is a common anxiety feature of Spongia tosta?
What is a common anxiety feature of Spongia tosta?
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What is a key feature of Ipecacuanha's cough?
What is a key feature of Ipecacuanha's cough?
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What is a general characteristic of Ipecacuanha?
What is a general characteristic of Ipecacuanha?
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What is a key mental characteristic of Ipecacuanha?
What is a key mental characteristic of Ipecacuanha?
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What is a characteristic of Ipecacuanha's fever?
What is a characteristic of Ipecacuanha's fever?
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What is a key feature of Spongia tosta's cough?
What is a key feature of Spongia tosta's cough?
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What is a comparison remedy to Ipecacuanha?
What is a comparison remedy to Ipecacuanha?
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What is a general aggravation factor for Ipecacuanha?
What is a general aggravation factor for Ipecacuanha?
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What is a key feature of Ipecacuanha's female issues?
What is a key feature of Ipecacuanha's female issues?
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What is the primary reason for using a combination of amoxicillin and clavulanate?
What is the primary reason for using a combination of amoxicillin and clavulanate?
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Which of the following antibiotics is effective against H.influenzae and M.catarrhalis?
Which of the following antibiotics is effective against H.influenzae and M.catarrhalis?
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What is the recommended treatment for patients with type 1 hypersensitivity reactions to beta-lactam antibiotics?
What is the recommended treatment for patients with type 1 hypersensitivity reactions to beta-lactam antibiotics?
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What is the purpose of using analgesics in AOM treatment?
What is the purpose of using analgesics in AOM treatment?
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What is the recommended dosage of acetaminophen for children?
What is the recommended dosage of acetaminophen for children?
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Why should aspirin not be given to children or teenagers?
Why should aspirin not be given to children or teenagers?
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What is the mechanism of resistance produced by H.influenzae?
What is the mechanism of resistance produced by H.influenzae?
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What is the primary role of antibiotics in AOM treatment?
What is the primary role of antibiotics in AOM treatment?
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What is the effect of antibiotics on pain within the first 24 hours of therapy?
What is the effect of antibiotics on pain within the first 24 hours of therapy?
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Why is clindamycin not effective against H.influenzae or M.catarrhalis?
Why is clindamycin not effective against H.influenzae or M.catarrhalis?
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Study Notes
Upper Respiratory Tract Infection (URTI)
- Involves an infection of the nose, sinuses, pharynx, larynx, and large airways
- Viral causes: rhinovirus (most common), adenovirus, parainfluenza virus, enterovirus, and respiratory syncytial virus (RSV)
- Diagnosis: typically a clinical diagnosis, but nasal and nasopharyngeal swabs/aspirates can be used
- Complications: pneumonia, sinusitis, otitis media, coinfection with bacterial agents, and exacerbation of preexisting medical conditions (asthma & COPD)
Common Cold
- Typically mild and self-limited
- Symptoms: nasal mucosal erythema and edema, rhinorrhea, and nasal congestion, sore throat, cough, and sneezing, headache, and low-grade fever
- Onset of symptoms usually begins one to three days after exposure and can last 7-10 days or persist up to 3 weeks
Botanical Treatment Strategies
- Enhance the immune system's first and second lines of defense
- Choose herbs with tissue and microbial specificity
- Relieve common symptoms such as sore throat, congestion, and rhinorrhea
- Prevent recurrence
Herbal Actions
- Antivirals / antimicrobials
- Immune stimulants
- Deep immune tonics
- Adaptogens
- Anti-catarrhals / mucolytics
- Expectorants
- Diaphoretics
- Demulcents
- Lymphatics
- Anti-inflammatories
Baptisia Tinctoria
- Pharmacy: decoction, tincture, and dried herb
- Actions: anti-microbial, immune stimulant, anti-inflammatory, diaphoretic, and lymphatic
- Safety: can cause nausea, vomiting, anorexia, hypersalivation, tachypnea, tachycardia, and respiratory paralysis with toxic doses internally; contra-indicated in long-term use or high doses, pregnancy, and lactation
Echinacea Angustifolia / Purpurea
- Pharmacy: decoction, tincture, and powdered extract
- Actions: anti-microbial, immunomodulator, immune stimulant, anti-inflammatory, diaphoretic, lymphatic, vulnerary, and anti-catarrhal
- Pharmacology: activates immune response via enhanced granulocyte chemotaxis, macrophage phagocytosis, and increased levels of TNF, IL-1, Ig binding, and neutrophils
- Safety: high doses may cause nausea, throat irritation, and skin irritation; caution in Asteraceae allergy; selectively modulates CYP 3A4 substrates – potential for interactions
Zingiber Officinale (Ginger)
- Pharmacy: infusion, tincture, dry herb, and fresh herb
- Actions: anti-oxidant, anti-inflammatory, anti-microbial, diaphoretic, carminative, and anti-spasmodic
- Pharmacology: sesquiterpenes in ginger have specific anti-viral effects against rhinoviruses and RSV; fresh ginger may stimulate mucosal cells to secrete IFN-β to counter viral infection
- Safety: caution with ulcers, GERD, gallstones, kidney disease, bleeding disorders, and those with sensitive stomachs; additive effect with anticoagulant medication
Herbal Pharmacy
- Herbal selection: Echinacea angustifolia, Baptisia tinctoria, and Zingiber officinale
- Pharmacy and posology: tincture, ratio, and dosage
- How to make an herbal lozenge: using demulcent herbs like Althea officinalis, Glycyrrhiza glabra, Verbascum thapsus, and/or Ulmus fulvus
- Steam inhalations: using Eucalyptus, Thyme, and/or Peppermint essential oils to relieve cough and congestion
Other Considerations
- Rest, hydration, and nutrition
- Food as Medicine: adding garlic, onion, ginger, thyme, oregano, sage, or mushrooms to soups or stews for immune support
- Immune Support Soup recipe
- Preventing recurrence: using adaptogens and deep immune tonics long-term to support HPA axis and strengthen immune system
Adverse Childhood Experiences (ACEs)
- ACEs are strongly associated with 9 of the 10 leading causes of death in the US:
- Heart disease
- Cancer
- Accidents/unintentional injuries
- Chronic lower respiratory disease
- Stroke
- Alzheimer's disease or dementia
- Diabetes
- Kidney disease
- Suicide
Relationship Matters
- Human beings are social creatures, neurologically designed to be in relationships with others
- Social engagement, active listening, and compassionate presence can create a safe space for patients
- The relational experience we can provide to patients can have a significant impact on their health and well-being
Bruce Perry's Reflections
- Human beings are designed to be in relationships with others, which affects our brain and body physiology
- Consistent, predictable, nurturing caregiving can shape our worldview and create a sense of safety and trust
- Inconsistent, unpredictable, chaotic interactions can lead to maladaptive behaviors and a view of the world as unsafe
Attachment and Adaptations of Self
- Secure attachment is the foundation of subconscious perceptual systems
- Secure attachment is associated with:
- Meeting discomfort and distress with reliable, loving care
- Soothing the baby/young child and establishing CNS patterns of trust, security, and comfort
- Predicting lifelong health outcomes (biological, social, psychological)
- Insecure attachment styles include:
- Anxious style: preoccupied with relationships, seeking safety in the presence of others
- Avoidant style: equating intimacy with loss of independence, seeking safety in disconnection
- Disorganized style: no template for safety, resulting in chronic tension between connection and disconnection
The Common Denominator
- Insecure attachment styles are rooted in shame, a belief that one is flawed and unlovable
Your Attachment Style Can Influence
- Your adult relationships and behaviors in relationships
- Your beliefs about yourself
- The way you explain the events of your life
- Your physical health
- Your subconscious triggers
- How you perceive stress, adversity, and challenge
- How you react to and recover from adversity
Relational Tensions vs Relational Security
- Relational security is associated with trust and security in self and others
- Relational tensions can be shifted through conscious awareness and intention
Attending
- Attending is an important skill for cultivating relational security and bringing to our patients
- Tracking autonomic states involves noticing and describing physical/sensory experiences of different states
Authenticity Can Heal Trauma
- Authenticity and connection can be a powerful tool for healing trauma
- Gabor Maté, MD, discusses the underlying causes of physical and emotional suffering and connects them to the pressures of modern-day living
Clean Needle Technique
- Definition: "Use of techniques designed to reduce the risk of infection of patients, practitioners, and office personnel by killing or reducing the strength of pathogens, thereby reducing the chances for contact between the pathogens"
- Includes: Clean Field, Sterile Needles, Universal Precautions, Contraindications, Needle Insertion, Needle Manipulation, and Management of Problems
Anatomy of a Needle
- Consists of: Handle, Root, and Body/Shaft
Clean Field
- Definition: "The area that has been prepared to contain the equipment necessary for acupuncture, in such a way as to protect the sterility of the needles"
- Setup: Use a paper towel or folded gauze pad, place packaged needles, cotton, and alcohol-soaked cotton on the clean field
- Important: The clean field is 3-dimensional, and non-sterile items must not be passed over it
Sterile Needles
- All pre-packaged needles come sterilized from the manufacturer
- Each needle has an expiry date and method of sterilization indicated on the box
- The inside of the bubble package is considered sterile
- Handle the needle shaft carefully to maintain sterility
Universal Precautions
- Assume all patients are infected with HBV or HIV and take non-discriminatory precautions to protect yourself
- Pertains to: Blood, body fluid containing visible blood, semen, vaginal secretions, tissues, CSF, synovial fluid, pleural fluid, peritoneal fluid, and amniotic fluid
Contraindications
- Absolute: alcohol intoxication, exhaustion, severe fear
- Relative: sexual intercourse, overeating, hunger, excessively thirsty, strenuous exercise
Needle Insertion
- Steps:
- Wash hands
- Prepare clean field
- Locate and mark points to be needled
- Cleanse each point with alcohol
- Inspect needle
- Place tube over cleansed area and allow needle tip to fall to the surface of the skin
- Tap the top of the needle handle to penetrate the skin
- Remove tube and ensure needle doesn't fall over
- Gently yet firmly insert the needle to the desired depth
Needle Manipulation
- Techniques: leaving needles in for 15 minutes, tapping and flicking, tonifying methods, holding Channel Qi, and moving Qi
Problems with Needling
- Needle-stick Injury: inform instructor, encourage bleeding from the site, and follow testing protocol
- Stuck Needle: gentle traction, relaxation, or oppositely rotating the needle
- Bent Needle: gentle removal, correcting patient position, and avoiding strong manipulation
- Broken Needle: remain calm, remove broken portion with forceps or locking hemostats, and seek medical attention if necessary
- Fainting: stop needling, lie the patient down, keep them warm, and consider needling GV 26, St 36, Pc 6, and Kd 1 or moxa GV 20, CV 4 or 6
- Arterial Puncture: apply direct pressure with ice, contact emergency services immediately, and allow blood to flow back toward the heart
Types of Needles
- Filiform needle: standard solid needle, comes in different materials (Chinese, Japanese, Korean)
- Ear Tacks: small needles with adhesive backing, used for auricular acupuncture
- Grain Type needles: small needles for sub-cutaneous insertion and covered with tape
Deficiency
- Characterized by emptiness of the Upright Qi and the absence of a pathogenic factor
- Types of deficiencies:
- Qi deficiency: pale face, weak voice, slight sweating, slight shortness of breath, fatigue, loose stools, poor appetite
- Yang deficiency: bright pale face, cold limbs, absence of thirst, desire for hot drinks, frequent pale urination
- Yin deficiency: heat in the afternoon, dry throat at night, night sweats
- Blood deficiency: dull-pale face, pale lips, dry hair, blurred vision, tiredness, poor memory, insomnia, scanty periods
Yin Deficiency
- Decrease in Yin produces heat symptoms
- Symptoms: red cheeks, dry stools, anxiety at night, night sweats, hot flushes, 5 Centre Heat, thirst for cold drinks in sips
Yin Excess
- Excess Yin produces cold symptoms
- Symptoms: abdominal pain better with warmth, dysmenorrhea better with warmth, local pain better with heat, chills
Yang Deficiency
- Decrease of Yang produces cold symptoms
- Symptoms: tired after bowel movement, low libido, edema, fatigue
Yang Excess
- Excess Yang produces heat symptoms
- Symptoms: feeling hot all day, red face, thirst for cold drinks (gulps)
Qi
- Qi is the root of the human body
- Qi functions: promoting, warming, defending, checking, nourishing
- Qi deficiency: fatigue, insomnia, poor digestion, cold hands and feet, shortness of breath, little to no appetite, frequent infections, weak immune system
Stagnation
- If Qi stagnates in the meridians, symptoms include: stiffness, heaviness, numbness or tingling of the limbs, migrating pain in the limbs
Blood
- Formed from Food Qi, which is acted upon by Yuan Qi
- Blood is not complete until it is sent to the Heart, where it is turned red
- Blood functions: nourishment, moisture, circulation with Ying Qi, determining menstruation
- Blood deficiency: long cycles, short luteal phase, scanty menstrual blood, amenorrhea, fatigue, anxiety, insomnia, poor memory, cold hands and feet, abdomen, low back, floaters in eyes, slow recovery, pale
- Blood stasis: oppression or pain in the chest, coughing up dark, clotted blood, purple, deep, stabbing pain
Excess
- Characterized by the presence of a pathogenic factor while Upright Qi is relatively intact and actively fighting against the pathogenic factor
- Symptoms: pain worse with pressure, pain that is acute in onset, irritability, restlessness, strong voice
Naturopathic Therapeutics - Putting it Together
- Learning objectives for this week's session include active learning, collaboration, and applying preventative care and lifestyle advice to the case study.
- Considerations for a comprehensive Naturopathic treatment plan include 3 treatment recommendations, nutritional guidance, lifestyle guidance, collaborative care, medical guidance, and follow-up considerations, all requiring informed consent.
Informed Consent
- Informed consent must be obtained and documented for every intervention, including obtaining case history, performing physical exams/testing, treatments, and collecting health information.
- This is in accordance with regional privacy acts and the CONO Standard on Consent.
Record Keeping
- Accurate record keeping is essential to meet regulatory requirements, as outlined in the CONO Standard for Record Keeping.
- Records must be communicated to the patient and noted in their chart.
Lifestyle, Prevention, and Health Promotion
- Basic hygiene practices for healing and prevention include rest, staying home when sick, washing hands, avoiding touching face and eyes, coughing into elbows, and keeping up-to-date with vaccinations.
- Nasal saline irrigation (Neti pot) can help relieve symptoms of URTI, reduce viral load, and reduce reliance on medications, but requires proper technique and equipment.
- Traditional Ayurvedic practice recognizes the importance of Jala Neti as a holistic practice.
Scenario: Treatment Plan Design
- Work in groups to design a treatment plan for this week's case, considering 3 EBM treatment suggestions that are appropriate for the patient.
- Considerations include treatment recommendations, nutritional guidance, lifestyle guidance, collaborative care, and follow-up considerations, all within the framework of informed consent.
Nutrition for Immune Support and Healthy Function
- Learning objectives for nutritional guidance include considering Vitamin C, Zinc, and Probiotics in relation to case presentation.
Treatment Goals
- Address presenting symptoms and improve patient comfort
- Support full and speedy recovery to return to regular activities
- Patient education
- Monitor and prevent sequelae
Natural Medicines Database
- Vitamin C:
- Data supports use of Vitamin C in treatment of common cold
- Consider bowel tolerance with dosing and potential for osmotic diarrhea and GI upset
- May precipitate kidney stones for those susceptible (40% increased risk with 1 gram/day supplement)
- Zinc:
- 30-50 mg/day for adults (75 mg in study) for specific, limited time period to avoid copper deficiency
- Take with food to avoid GI upset
- GI upset and N&V are most likely side-effects
- Avoid taking at same time as antibiotics to avoid interference with absorption
Our Role/Advice
- Provide appropriate and specific product and formula
- Recommend safe and appropriate therapeutic dose
- Screen for allergies and potential interactions
- Advise on cautions, concerns, and possible side-effects
Colds and Coughs
- Colds and coughs can be treated with herbal medicine, which involves the use of herbal actions to combat the infection.
Herbal Actions
- Immunostimulant: activates the immune system to fight infections
- Diaphoretic: induces sweating to help remove toxins
- Antitussive: soothes and relieves coughs
- Antispasmodic: relaxes smooth muscles to reduce inflammation
- Expectorant: liquefies respiratory secretions to facilitate the expulsion of phlegm and mucous
- Mucolytic: breaks down mucous and loosens thick bronchial secretions
- Demulcent: soothes irritated mucous membranes
- Antimicrobial: destroys or inhibits the growth of microorganisms
- Antiadherence: prevents microorganisms from attaching to and infecting mucous membranes
- Antipyretic: reduces fever
- Lymphatic: promotes the proper functioning of the lymphatic system
Phytochemicals
- Polysaccharides: immunostimulants found in Echinacea, Asian ginseng, Canadian ginseng, and Siberian ginseng
- Alkylamides: immunostimulants found in Echinacea
- Saponins: expectorants found in Ivy, Licorice
- Steroidal saponins: adaptogens, immunomodulators found in Asian ginseng, Canadian ginseng, and Siberian ginseng
- Mucilage: demulcent found in Marshmallow
- Essential oils: antispasmodics found in Thyme, Oregano, and Eucalyptus
- Diterpene lactones: immunomodulators, antispasmodics found in Andrographis
Echinacea
- Main indications: prevents and treats the common cold, flu, and upper respiratory tract infections (URIs), vaginal candidiasis, and urinary tract infections
- Actions: immunostimulant, antimicrobial
- Phytochemicals: alkylamides, phenolics, polysaccharides, glycoproteins, ketoalkenes
- Safety: caution in autoimmune disease, safe in pregnancy and lactation
Ginseng
- Main indications: stress, fatigue, cold and flu treatment and prevention, low immunity
- Actions: adaptogen, immunostimulant, immunomodulator, antiviral, aphrodisiac
- Phytochemicals: steroidal saponins, polysaccharides
- Safety: caution in high blood pressure, Korean ginseng is considered safe in pregnancy and lactation
Homeopathic Remedies for Upper Respiratory Tract Infections
- Dros era: #1 remedy for whooping cough; respiratory illnesses such as laryngitis, bronchitis, and tuberculosis
- Dros era Cough: Tormenting cough with short paroxysms, ringing cough, must hold the chest to cough, inability to cough due to pain
- Dros era Characteristics: < evening, after midnight, after drinking, exertion, singing, smoking; cough after measles; > walking
Rumex Crispus
- Rumex Characteristics: Nervous, restless, sad, and depressed; aversion to mental work
- Rumex Symptoms: Dry tickling cough, copious discharge from mucosa of nose, eyes, and whole respiratory tract
- Rumex Modalities: < cold air, touch or pressure on throat/larynx, temperature changes, morning, and before 11 pm; > drinking, sucking on candy
Spongia
- Spongia Characteristics: Sensitive, anxious, and fearful; "sssh" or "sshh" sound when inhaling
- Spongia Symptoms: Dry, raw, or sore throat, hoarseness, asthmatic cough, and blood circulation problems
- Spongia Modalities: < before midnight, dry cold wind, cold drinks, warm room, and heat; > eating, drinking, warm things, and resting
- Spongia Use in Croup: Bönninghausen used Aconitum, Spongia, and Hepar sulphuris calcareum to cure croup; can be used in alternating order with Aconitum and Hepar
Ipecacuanha
- Ipecacuanha Characteristics: Persistent nausea and vomiting; spasmodic irritation in the chest and stomach
- Ipecacuanha Symptoms: Shortness of breath, gastric disturbances, bright red hemorrhage, and convulsions
- Ipecacuanha Modalities: < warmth, damp warmth, warm room, overeating, and motion; > open air, rest, pressure, and closing the eyes
- Ipecacuanha Mentals: Irritable, contemptuous, anxious during fever and coughing; intolerant to noise, and tranquil after anger
Acute Otitis Media (AOM)
- AOM is typically a pediatric condition, but can also affect adults.
- It can be caused by both bacteria and viruses, and co-infection is common.
- The most common bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Preventative Factors
- Vaccination (influenza and S.pneumoniae) can reduce the risk of AOM.
- Public health measures may reduce virus transmission, leading to a decrease in AOM cases.
- Avoiding exposure to tobacco smoke and breastfeeding can also help prevent AOM.
Watchful Waiting
- Spontaneous resolution is seen in a number of cases caused by the top 3 bacterial pathogens:
- S.pneumoniae: 20%
- H.influenzae: 50%
- M.catarrhalis: 75%
- Withhold antibiotic prescriptions for 48 hours in children over 6 months of age if they have:
- Nonsevere illness (mild pain and fever < 39°C)
- Uncomplicated AOM (no episode in the preceding month, no acute facial nerve palsy, mastoiditis, meningitis, or labyrinthitis)
- No craniofacial abnormalities, immunodeficiencies, cardiac or pulmonary disease, Down syndrome, or history of complicated AOM.
Exceptions
- Infants under 6 weeks of age should be immediately referred to the nearest emergency department.
- Patients aged 6 weeks to 6 months should begin antibiotic therapy immediately.
- Patients with 3 or more episodes in 6 months or 4 or more within a year should begin antibiotic therapy immediately.
Antibiotic Therapy
- Antibiotic resistance is common among the three pathogens.
- S.pneumoniae resistance is due to the alteration of penicillin-binding cell wall proteins, leading to decreased drug affinity.
- This is overcome by doubling the dose of amoxicillin.
- H.influenzae and M.catarrhalis produce beta-lactamases, which confer resistance.
- This is overcome by using a beta-lactamase inhibitor called clavulanate.
- When antibiotics are used, treatment failure should be considered if symptoms do not improve after 72 hours of treatment.
Antibiotic Options
- Amoxicillin is considered first-line therapy in the treatment of AOM.
- The combination of amoxicillin and clavulanate is typically used for treatment failure or recurrence.
- Cefuroxime axetil and Cefprozil are second-generation cephalosporins and have reasonable activity against H.influenzae and M.catarrhalis.
- Azithromycin and Clarithromycin are macrolides and should be reserved for patients with type 1 hypersensitivity reactions to beta-lactam antibiotics.
- Clindamycin is a lincosamide and can be used for patients with type 1 hypersensitivity reactions to beta-lactam antibiotics.
Supportive Therapy
- Antibiotics do not reduce pain within the first 24 hours of therapy and do little in the following days compared to placebo.
- Analgesics are recommended during watchful waiting and with antibiotic therapy.
Analgesics
- Acetaminophen: 10-15 mg/kg every 4-6 hours to a maximum of 75 mg/kg/day and not to exceed 4000 mg/day.
- Ibuprofen: 10 mg/kg every 6-8 hours to a maximum of 40 mg/kg/day and not to exceed 2400 mg/day.
- Aspirin should never be given to children or teenagers recovering from chickenpox or with flu-like symptoms due to the risk of Reye syndrome.
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