NMT150 wk 2 (2)

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Questions and Answers

What is the recommended duration for a steam inhalation with essential oils?

20 minutes

5 minutes

10 minutes (correct)

15 minutes

What is the purpose of adding garlic, onion, ginger, thyme, oregano, sage, or mushrooms to soups or stews?

To reduce the calorie intake

To add flavor to the food

To increase the cooking time

To provide herbal support through food (correct)

What is the benefit of using astragalus sticks in the Immune Support Soup?

It is a source of antioxidants

It supports immune modulation and has antiviral properties (correct)

It helps to reduce fever

It provides a source of fiber

What is the purpose of using medicinal mushrooms like Reishi, Chaga, and Cordyceps in preventing recurrence?

To support the immune system and prevent recurrence Signup and view all the answers

What is the recommended consideration when choosing herbal pharmacy for a patient with URTI?

The patient's cultural background, preferences, and level of compliance Signup and view all the answers

What is the primary way in which our relational patterns are established?

In early childhood, as our first perceptual system Signup and view all the answers

What is the potential outcome of recognizing and describing our autonomic states?

Better understanding of our physical and emotional experiences Signup and view all the answers

According to Gabor Maté, what is the common misconception about normality?

Normality equals health Signup and view all the answers

What is the advantage of recognizing our relational patterns?

We can change them to suit our needs Signup and view all the answers

What is the result of cultivating authenticity within ourselves?

Trauma can be healed Signup and view all the answers

What is the primary consideration when choosing a needle for a specific area?

Gauge of the needle Signup and view all the answers

What is the typical cause of sharpness during needling?

Touching a nerve fiber Signup and view all the answers

What should be done immediately after a needle-stick injury?

Inform the teaching assistant or instructor immediately Signup and view all the answers

What is a common cause of a stuck needle?

Movement of the patient causing the needle to trap under or next to structures Signup and view all the answers

What is the first step in managing a fainting episode during needling?

Stop needling and remove all needles Signup and view all the answers

What is the primary function of Blood in the body?

To nourish and moisten the body Signup and view all the answers

What is the characteristic of Qi Deficiency?

Fatigue, insomnia, and poor digestion Signup and view all the answers

What is the result of Blood Stasis?

Coughing up dark, clotted blood Signup and view all the answers

What is the characteristic of Excess Yang?

Feeling hot all day with a red face Signup and view all the answers

What is the result of Qi Stagnation?

Stiffness and heaviness in the limbs Signup and view all the answers

What is one of the basic hygiene practices recommended to prevent the spread of illness?

Washing your hands with soap and water Signup and view all the answers

What is a recommended consideration when using a nasal saline irrigation device?

Using pure sea salt or non-iodized salt Signup and view all the answers

What is a potential benefit of nasal saline irrigation in the treatment of URTI?

Reducing the reliance on medications Signup and view all the answers

What is important to recognize about the origins of nasal saline irrigation?

It has its origins in traditional Ayurvedic practice Signup and view all the answers

What is recommended to prevent the spread of illness when sick?

Staying home and resting Signup and view all the answers

What is a potential side-effect of taking high doses of vitamin C?

GI upset and osmotic diarrhea Signup and view all the answers

What is a recommended consideration when taking zinc supplements?

Take with food to avoid GI upset Signup and view all the answers

What is the recommended daily dose of zinc for adults in the treatment of the common cold?

30-50 mg/day Signup and view all the answers

What is a potential risk associated with taking vitamin C supplements in individuals with a history of kidney stones?

Increased risk of kidney stone formation Signup and view all the answers

What is the role of a healthcare provider when advising patients on nutritional supplements?

Advise on specific products, formulas, and dosages, and screen for potential interactions Signup and view all the answers

What is the primary indication of licorice root for its approval by the German Commission E?

Catarrhs of the upper respiratory tract and gastric or duodenal ulcers Signup and view all the answers

What is the primary action of licorice root that helps in reducing irritation in mucous surfaces?

Demulcent Signup and view all the answers

What is the primary phytochemical responsible for the antiviral effects of licorice root?

Glycyrrhizin Signup and view all the answers

What is the primary caution associated with the use of licorice root in individuals with hypertension?

May raise blood pressure Signup and view all the answers

What is the current limitation of research on the effectiveness of licorice root in respiratory infections?

Limited human research Signup and view all the answers

Which of the following symptoms is characteristic of Spongia Tosta?

Anxiety about heart disease and death Signup and view all the answers

What is the characteristic of Ipecacuanha in relation to cough?

Dry, suffocating cough with no nausea Signup and view all the answers

What is the general characteristic of Ipecacuanha in terms of temperature?

Sensitive to cold and warm weather Signup and view all the answers

What is the characteristic of Ipecacuanha in terms of mental state?

Irritable and intolerant of noise Signup and view all the answers

What is the difference between Ipecacuanha and Antimonium Tartaricum?

Ipecacuanha has more retching and less nausea Signup and view all the answers

What is the primary indication for using amoxicillin and clavulanate in the treatment of Acute Otitis Media?

For treatment failure or recurrence Signup and view all the answers

Which of the following antibiotics is effective against H. influenzae and M. catarrhalis?

Cefuroxime axetil Signup and view all the answers

Why should aspirin not be given to children or teenagers recovering from chickenpox or with flu-like symptoms?

It can lead to Reye syndrome Signup and view all the answers

What is the primary purpose of using analgesics in the treatment of Acute Otitis Media?

To reduce pain Signup and view all the answers

What is the maximum daily dose of acetaminophen recommended for children?

4000 mg/day Signup and view all the answers

Study Notes

URTI – Common Cold

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 and COPD)

Common Cold Symptoms

Typically mild and self-limited
Nasal mucosal erythema and edema
Rhinorrhea and nasal congestion
Sore throat
Cough and sneezing
Headache and low-grade fever
Onset of symptoms usually begins 1-3 days after exposure and can last 7-10 days or persist up to 3 weeks

Botanical Treatment Strategies

Enhance immune system's first and second lines of defense
Choose herbs with tissue and microbial specificity
Relieve common symptoms such as sore throat, congestion, rhinorrhea, etc.
Prevent recurrence

Herbal Actions

Antivirals/antimicrobials
Immune stimulants
Deep immune tonics
Adaptogens
Anti-catarrhals/mucolytics
Expectorants
Diaphoretics
Demulcents
Lymphatics
Anti-inflammatory

Antimicrobial and Immune Stimulant Herbs

Can have a direct effect by attacking the microorganism and/or destroying its cell wall and inhibiting replication
Or an indirect action by preventing viral entry into the cell or stimulating phagocytes, lymphocytes, or other immune cells to attack the pathogen
Many herbal antimicrobials display tissue specificity

Choosing the Right Antimicrobial Herbs

Consider the site of infection
Choose gentle antimicrobial herbs at lower dosing for children, elderly, and those with chronic disease
Consider the specific pathogen
Consider the history of antibiotic use

Materia Medica – Common Cold

Achillea millefolium
Allium sativum
Althea officinalis
Andrographis paniculata
Baptisia tinctoria
Echinacea angustifolia/purpurea
Eleutherococcus senticosus
Eupatorium perfoliatum
Glycyrrhiza glabra
Hydrastis canadensis
Ligusticum porteri
Lomatium dissectum
Mentha piperita
Oleo europaea
Origanum vulgare
Panax ginseng
Phytolacca spp
Sambucus nigra
Salix alba
Thymus vulgaris
Verbascum thapsus
Zingiber officinale

Baptisia tinctoria (Wild Indigo)

Common name: Wild Indigo
Family: Fabaceae
Part used: Root
Main actions: Lymphatic, antimicrobial, immune-stimulant, anti-catarrhal
Main constituents: Polysaccharides (arabinogalactans) and glycoproteins, quinolizidine alkaloids, isoflavones, flavonoids
Indicated in acute infection with excessive mucus production associated with laryngitis, pharyngitis, tonsillitis, rhinitis, and sinusitis

Zingiber officinale (Ginger)

Common name: Ginger
Family: Zingiberaceae
Part used: Rhizome
Main actions: Anti-oxidant, anti-inflammatory, antimicrobial, diaphoretic, carminative, anti-spasmodic
Main constituents: VO (zingiberene), sesquiterpenes, oleoresins (gingerols and shogaols)
Sesquiterpenes have specific anti-viral effects against rhinoviruses and RSV by inhibiting viral attachment and inoculation

Herbal Pharmacy

Echinaceae angustifolia
Baptisia tinctoria
Zingiber officinale
How will these herbs help a common cold?
Pharmacy and posology: What pharmacy will we choose? Which will be our lead herb? Supporting herbs? How will we dose this formula? For how long?

Other Considerations

Herbal lozenges or infusions for symptom relief of sore throat using demulcent herbs
Steam inhalations with Eucalyptus, Thyme, and/or Peppermint essential oils to relieve cough and congestion
Rest, hydration, and nutrition
Food as Medicine: Herbal support through food

Immune Support Soup

Recipe: onion, garlic, olive oil, astragalus, mushrooms, celery, green beans, quinoa, and water

Preventing Recurrence

Long-term considerations of adaptogens and deep immune tonics to support HPA axis and strengthen immune system to prevent recurrence and recover from convalescence
Astragalus membranaceus
Schisandra chinensis
Panax ginseng
Medicinal Mushrooms: Reishi, Chaga, and Cordyceps

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Clean Needle Technique

Clean Needle Technique: techniques designed to reduce the risk of infection of patients, practitioners, and office personnel by killing or reducing the strength of pathogens.
Clean Field: the area prepared to contain the equipment necessary for acupuncture, including the patient's skin around the selected acupuncture points.
Anatomy of a Needle: consists of a handle, root, and body or shaft.

Basic Principles of Clean Needle Technique

Always wash hands three times: before the patient visit, prior to needle insertion, and after removal of needles.
Always use sterilized needles and establish a clean field.
Always immediately isolate used needles.

Setup of Clean Field

Place sterile items on the clean field, such as packaged needles, cotton, and alcohol-soaked cotton.
The clean field is 3-dimensional, and passing non-sterile items over the clean field is not allowed.

Sterile Needles

All pre-packaged needles come sterilized from the manufacturer with expiry dates and method of sterilization indicated.
The shaft of the needle must remain sterile, and if it needs to be rested, it must be placed on a sterile object within the clean field.

Needle Insertion

Wash hands, prepare clean field, and locate the point to be needled.
Cleanse the point with a separate piece of cotton soaked in 70% isopropyl alcohol and allow it to air dry.
Remove the needle from the package, inspect it, and place the tube over the cleansed area.
Give a firm tap to the top of the needle handle, allowing the tip to penetrate the skin.

Precautions to Needling

Avoid deep needling on the posterior neck, chest, hypochondriac region, and back, as it can cause harm to organs, especially the lungs.
Avoid needling near big blood vessels, such as the carotid, jugular, radial, and femoral arteries.
ST 17 and CV 8 are not to be needled.

Normal Sensations or De Qi

Aching, soreness, tingling, distention, heaviness, itching, electrical sensation, and burning are normal sensations during acupuncture.

Abnormal Sensations

Sharpness, spastic contraction of the limbs, convulsions, fainting, and loss of color in the face are abnormal sensations during acupuncture.

Needle Stick Injury Protocol

Inform the instructor or teaching assistant immediately, encourage bleeding from the site, and report the incident.
Both parties should undergo HIV and Hepatitis testing at six weeks, three, six, and twelve months after the incident.

Problems with Needling

Needle stick injury, stuck needle, bent needle, broken needle, fainting, arterial puncture, hematoma, and pneumothorax can occur during acupuncture.

Stuck Needle

Causes: movement of the patient, over-rotation, muscle spasm, or the needle shaft inserted into the tendon.
Management: correct patient position, allow patient to relax, and rotate the needle in the opposite direction.

Bent Needle

Causes: poor technique, strong manipulation, patient position change, or foreign body impaction.
Management: withdraw the needle slowly and gently without twisting, or wiggle the needle gently first and then remove it.

Broken Needle

Causes: poor needle quality, strong manipulation, patient position change, or foreign body impaction.
Management: remain calm, remove the broken portion with forceps or locking hemostats, and if necessary, consider surgical removal.

Fainting

Causes: weak constitution, excess mental tension, over-stressed, severe perspiration, excess hunger, or severe diarrhea or bleeding.
Management: stop needling, remove all needles, lie the patient down, and keep them warm.

Deficiency

Characterized by emptiness of the Upright Qi and the absence of a pathogenic factor
Types of deficiencies:
- Empty Qi: pale face, weak voice, slight sweating, slight shortness of breath, fatigue, loose stools, poor appetite
- Empty Yang: bright pale face, cold limbs, absence of thirst, desire for hot drinks, frequent pale urination
- Empty Yin: heat in the afternoon, dry throat at night, night sweats
- Empty Blood: 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; the stem & leaves would dry up without a root"
Functions:
- Promoting: growth and development
- Warming: maintains warmth
- Defence: protects the body from exterior attacks
- Checking: maintains homeostasis
- Nourishing: Ying Qi or Nutritive Qi
- Qi Hua: function of the organs

Qi Deficiency

Symptoms:
- Fatigue
- Insomnia
- Poor digestion
- Cold hands and feet
- Shortness of breath
- Little to no appetite
- Frequent infections, weak immune system

Stagnation

Symptoms:
- Stiffness, heaviness, numbness or tingling of the limbs
- Migrating pain in the limbs

Blood

Formed from mainly Food Qi
Functions:
- Nourishment and moisture
- Nourishes hair, sinews, bones, and bowels
- Foundation of mental activities; houses the mind
- Circulates with Ying Qi
- Determines menstruation

Blood Deficiency

Symptoms:
- 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

Symptoms:
- Oppression or pain in the chest
- Coughing up dark, clotted blood
- Purple color
- Deep, stabbing pain

Excess

Characterized by the presence of a pathogenic factor
Symptoms:
- Pain worse with pressure
- Pain that is acute in onset
- Irritability, restlessness
- Strong voice

Cold and Heat

Cold: feeling of cold, cold limbs, absence of thirst
Heat: feeling hot, fever, sweating, thirst
Classification of Cold and Heat:
- Full- or Empty-Cold
- Full- or Empty-Heat

Naturopathic Therapeutics - Putting it Together (Week 2)

Learning Objectives

Review and apply week's material through active learning sessions
Collaborate with colleagues and learn from each other's perspectives
Consider preventative care and lifestyle advice for the case
Review considerations for a comprehensive Naturopathic treatment plan
Review regulatory requirements and standards for providing treatment recommendations

Feedback from Week 1

Reflect on last week's experience and how it supported/integrated learning
Discuss desires and expectations for Thursday sessions

Treatment Plan Considerations

3 treatment recommendations (herbs, supplements, etc.)
Nutritional guidance
Lifestyle guidance
Collaborative care/medical guidance
Follow-up considerations
All require informed consent

Must be obtained and documented for every intervention (case history, physical exam/testing, treatments, collecting health information)
Must comply with regional privacy acts and CONO/CNPBC standards

Record Keeping

Must be communicated to the patient and noted in the patient chart to meet regulatory requirements
Must comply with CONO/CNPBC standards for record keeping

Lifestyle, Prevention, and Health Promotion

Basic hygiene for healing and prevention:
- Rest and stay home while sick
- Wash hands with soap and water
- Avoid touching face and eyes with unwashed hands
- Cough into elbow
- Keep up-to-date with vaccinations
- Avoid exposure to tobacco smoke
Nasal saline irrigation (Neti pot):
- Safety considerations: clean device, distilled water, comfortable temperature, and pure sea salt/non-iodized salt or saline mixture
- May help relieve URTI symptoms, reduce viral load, and reduce reliance on medications

Traditional Ayurvedic Practice

Recognize origins and traditional use outside of Naturopathic Medicine and North America
Considerations for holistic use as part of an Ayurvedic practice

Scenario: EB Treatment Suggestions

Work in groups to discuss and design a treatment plan with top 3 EBM treatment suggestions for the case

Nutrition for Immune Support and Healthy Function

Learning objectives include providing nutritional guidance for vitamin C, zinc, and probiotics related 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

Can be accessed through CCNM Library webpage with email login and password
Search database for information on vitamin C in treatment of the common cold

Vitamin C

Consider bowel tolerance with dosing and potential for osmotic diarrhea and GI upset
May precipitate kidney stones for those susceptible (increases risk by 40% in people with a history of oxalate kidney stones)
Important to advise on appropriate and specific product and formula, safe and therapeutic dose, and screen for allergies and potential interactions
Cautions and concerns include potential side-effects, such as GI upset and kidney stones

Zinc and the Common Cold

Important to advise on appropriate and specific product and formula, safe and therapeutic dose, and screen for allergies and potential interactions
Recommended dose: 30-50 mg/day for adults (up to 75 mg in study) for a specific, limited time period to avoid copper deficiency
Take with food to avoid GI upset
Side-effects include GI upset, nausea, and vomiting (N&V)
Do not take at the same time as antibiotics to avoid interference with absorption

Herbs for Colds and Respiratory Infections

American Ginseng: reduces severity and duration of colds
Andrographis: benefits alone and in combination with Eleuthero, with anti-inflammatory and antimicrobial properties
Eleuthero: in vivo studies show antiviral activity, and clinical trials demonstrate effectiveness in combination with Andrographis
English Ivy: safe and effective for coughs
Elder/Flower: numerous studies demonstrate reduced severity and duration of colds
Licorice: in vivo studies show antiviral activity, but limited human research for effectiveness in respiratory infections
Marshmallow: reduces cough alone and in combinations
Thyme: reduces cough in combinations, with antispasmodic and antimicrobial properties
Eucalyptus: reduces cough, with antimicrobial properties
Goldenseal: in vitro studies show significant antiviral activity, but no human trials for colds
Garlic: shows some benefit in clinical trials

Andrographis

Latin: Andrographis paniculata
Family: Acanthaceae
Part: Herb
Main indications: colds, colitis, infectious diarrhea, liver disease, and autoimmune disease
Actions: immunomodulator, antimicrobial, bitter, anti-inflammatory, and emmenogogue
Phytochemicals: diterpene lactones (Andrographolide) and polyphenols (flavonoids)
Safety: contraindicated for gastritis and stomach ulcers, and not recommended for pregnancy and lactation

Siberian Ginseng

Latin: Eleutherococcus senticosus
Family: Araliaceae
Part: root
Drug: Eleuthro radix
Main indications: stress, fatigue, cold, and flu treatment and prevention
Actions: adaptogen, immunostimulant, and immunomodulator
Phytochemicals: unknown
Safety: unknown

Licorice

Latin: European licorice Glycyrrhiza glabra & Chinese licorice Glycyrrhiza uralensis
Family: Fabaceae
Part: root
Drug: Liquiritiae radix
Main indications: respiratory tract infections, inflammation in the GI tract, hepatitis, and cirrhosis of the liver, and adrenal fatigue
Actions: anti-spasmodic, expectorant, antimicrobial, demulcent, adrenal tonic, antiulcer, and hepatoprotective
Phytochemicals: saponins - triterpenoid glycosides (Glycyrrhizin) and flavonoids (Licoflavone)
Safety: contraindicated for high blood pressure, and caution with pregnancy and lactation, hypertension, electrolytes, and medications for the cardiovascular system

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Acute Otitis Media (AOM)

AOM is typically a pediatric condition, but can be caused by both bacteria and viruses, with co-infection being common.
The most common bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Preventative Factors

Vaccination (influenza and S.pneumoniae) can reduce AOM cases.
Public health measures can reduce virus transmission, leading to a decrease in AOM cases.
Avoiding exposure to tobacco smoke and breastfeeding are also preventative factors.

Watchful Waiting

Watchful waiting is applicable in cases with spontaneous resolution, seen in:
- 20% of S.pneumoniae cases
- 50% of H.influenzae cases
- 75% of M.catarrhalis cases
Withhold antibiotic prescriptions for 48 hours in children over 6 months of age with:
- 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
- Parents are capable of recognizing worsening illness with ready access to medical care

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, overcome by doubling the dose of amoxicillin.
H.influenzae and M.catarrhalis produce beta-lactamases, which confer resistance, overcome by using a beta-lactamase inhibitor called clavulanate.
Amoxicillin is considered first-line therapy in the treatment of AOM.
Treatment failure should be considered if symptoms do not improve after 72 hours of treatment.

Alternatives to Amoxicillin

The combination of amoxicillin and clavulanate is typically used for treatment failure or recurrence.
Diarrhea is a common adverse effect of combination therapy.
Cefuroxime axetil and Cefprozil are second-generation cephalosporins, considered second-line agents.
Macrolides (azithromycin and clarithromycin) and lincosamides (clindamycin) are alternative options 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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Learn about the botanical treatment strategy for a common cold, including the selection of anti-microbial herbs, their beneficial actions, and safety concerns. Quiz written by Dr. Fiona Smulders.