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What is the recommended duration for a steam inhalation with essential oils?
What is the purpose of adding garlic, onion, ginger, thyme, oregano, sage, or mushrooms to soups or stews?
What is the benefit of using astragalus sticks in the Immune Support Soup?
What is the purpose of using medicinal mushrooms like Reishi, Chaga, and Cordyceps in preventing recurrence?
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What is the recommended consideration when choosing herbal pharmacy for a patient with URTI?
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What is the primary way in which our relational patterns are established?
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What is the potential outcome of recognizing and describing our autonomic states?
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According to Gabor Maté, what is the common misconception about normality?
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What is the advantage of recognizing our relational patterns?
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What is the result of cultivating authenticity within ourselves?
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What is the primary consideration when choosing a needle for a specific area?
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What is the typical cause of sharpness during needling?
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What should be done immediately after a needle-stick injury?
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What is a common cause of a stuck needle?
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What is the first step in managing a fainting episode during needling?
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What is the primary function of Blood in the body?
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What is the characteristic of Qi Deficiency?
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What is the result of Blood Stasis?
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What is the characteristic of Excess Yang?
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What is the result of Qi Stagnation?
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What is one of the basic hygiene practices recommended to prevent the spread of illness?
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What is a recommended consideration when using a nasal saline irrigation device?
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What is a potential benefit of nasal saline irrigation in the treatment of URTI?
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What is important to recognize about the origins of nasal saline irrigation?
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What is recommended to prevent the spread of illness when sick?
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What is a potential side-effect of taking high doses of vitamin C?
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What is a recommended consideration when taking zinc supplements?
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What is the recommended daily dose of zinc for adults in the treatment of the common cold?
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What is a potential risk associated with taking vitamin C supplements in individuals with a history of kidney stones?
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What is the role of a healthcare provider when advising patients on nutritional supplements?
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What is the primary indication of licorice root for its approval by the German Commission E?
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What is the primary action of licorice root that helps in reducing irritation in mucous surfaces?
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What is the primary phytochemical responsible for the antiviral effects of licorice root?
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What is the primary caution associated with the use of licorice root in individuals with hypertension?
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What is the current limitation of research on the effectiveness of licorice root in respiratory infections?
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Which of the following symptoms is characteristic of Spongia Tosta?
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What is the characteristic of Ipecacuanha in relation to cough?
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What is the general characteristic of Ipecacuanha in terms of temperature?
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What is the characteristic of Ipecacuanha in terms of mental state?
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What is the difference between Ipecacuanha and Antimonium Tartaricum?
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What is the primary indication for using amoxicillin and clavulanate in the treatment of Acute Otitis Media?
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Which of the following antibiotics is effective against H. influenzae and M. catarrhalis?
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Why should aspirin not be given to children or teenagers recovering from chickenpox or with flu-like symptoms?
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What is the primary purpose of using analgesics in the treatment of Acute Otitis Media?
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What is the maximum daily dose of acetaminophen recommended for children?
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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
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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Description
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.
