NMT150 wk 4

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary function of anti-inflammatory herbal constituents?

To inhibit the production of herbal alteratives and hepatics

To regulate inflammatory cytokine and interleukin production (correct)

To stimulate cyclo-oxygenase and lipoxygenase enzymes

To detoxify the body using herbal alteratives and hepatics

What is the benefit of using herbal alteratives and hepatics in chronic inflammatory conditions?

To reduce the production of inflammatory cytokine and interleukin

To inhibit the production of herbal alteratives and hepatics

To stimulate cyclo-oxygenase and lipoxygenase enzymes

To detoxify the body and alleviate inflammation (correct)

How can herbs be used to alleviate pain and inflammation in the MSK system?

Through surgical intervention

Only through internal consumption

Only through topical application

Through both internal and topical application (correct)

Which of the following herbs has been studied for its anti-inflammatory properties in the treatment of osteoarthritis?

All of the above Signup and view all the answers

What is the role of cyclo-oxygenase and lipoxygenase enzymes in inflammation?

To facilitate inflammation through the production of pro-inflammatory mediators Signup and view all the answers

What is the manifestation of the Heart in the body?

Complexion Signup and view all the answers

What is the relationship between the Small Intestine and the Bladder?

They have a direct functional relationship, influencing urinary function Signup and view all the answers

What is the function of the Small Intestine in relation to food and drink?

It receives and transforms food and drink from the Stomach Signup and view all the answers

What is the effect of Heart Qi Deficiency on sweat?

It causes spontaneous sweating Signup and view all the answers

What is the role of the Small Intestine in mental clarity and judgment?

It helps to distinguish between options to make decisions Signup and view all the answers

What is the primary benefit of incorporating exercise in the treatment plan for patients with osteoarthritis?

Reduce pain and stiffness Signup and view all the answers

What is the recommended approach to exercise for patients with osteoarthritis?

Low-impact exercises with a focus on range-of-motion, strengthening, and aerobic exercises Signup and view all the answers

What is the benefit of hydrotherapy in the treatment of rheumatoid arthritis?

Reduces inflammation and improves mood Signup and view all the answers

What is the recommended temperature application for an acutely inflamed joint?

Cold application to reduce pain and inflammation Signup and view all the answers

What is the benefit of tai chi in the treatment of osteoarthritis of the knee?

Reduces symptoms of pain and improves mood Signup and view all the answers

Which of the following vitamins is also known as Cobalamin?

Vitamin B12 Signup and view all the answers

What is the title of the book written by Katz?

Nutrition in Clinical Practice Signup and view all the answers

Which of the following is a systematic review of the literature on the prevalence and outcomes of anemia in rheumatoid arthritis?

The American Journal of Medicine Signup and view all the answers

What is the title of the journal that published an article on the effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment?

Rheumatology International Signup and view all the answers

Which of the following is a source cited in the references?

Center for Disease Control and Prevention Signup and view all the answers

What is the primary action of Curcuma longa (Turmeric)?

Anti-inflammatory Signup and view all the answers

What is the closest substitute for Ginkgo biloba (Ginkgo)?

Harpagophytum procumbens Signup and view all the answers

What is the part used for Curcuma longa (Turmeric)?

Root Signup and view all the answers

What is the recommended daily therapeutic dose of Curcuma longa (Turmeric) in infusion or decoction?

1-2 g powder Signup and view all the answers

What is the action of Ginkgo biloba (Ginkgo) related to blood clotting?

Anticoagulant Signup and view all the answers

Which of the following remedies is characterized by a lack of internal heat but pains better by cold application?

Ledum Signup and view all the answers

What is the peculiar characteristic of the tongue in Rhus Tox?

Triangular red tip Signup and view all the answers

Which of the following remedies is known for its shooting pains in the foot and limbs?

Ledum Signup and view all the answers

Which of the following remedies is worse from continued motion?

Rhus Tox Signup and view all the answers

Which of the following remedies is known for its superstitious and ritualistic behavior?

RHUS TOX-AFFINITY Signup and view all the answers

What is the mechanism of action of ASA on COX enzymes?

Irreversible inhibition through covalent bonding Signup and view all the answers

What is the primary concern for patients taking Celecoxib?

Cardiovascular disease and mortality Signup and view all the answers

What is the primary mechanism of acetaminophen's analgesic and antipyretic effects?

Affinity for COX-3 Signup and view all the answers

What is the optimal strategy for reducing the risk of GI bleeding in patients taking NSAIDs?

All of the above Signup and view all the answers

What is the primary contraindication for ASA use in children?

Viral infections Signup and view all the answers

Study Notes

Botanical Treatment Strategy for Inflammation in the Musculoskeletal System

Find and treat the underlying cause of inflammation, which may include toxicity, overuse, irritation, or infection
Reduce inflammation
Alleviate pain
Restore damaged connective tissue
Improve mobility and range of motion

Herbal Actions for Joint Pain and Inflammation

Alteratives and hepatics: support metabolism and elimination, with a cleansing effect on the body
Anti-rheumatics: help reduce or resolve symptoms of musculoskeletal disease
Anti-inflammatories: modulate inflammation
Anodynes/analgesics: alleviate pain
Connective tissue tonics: strengthen and repair damaged connective tissue
Diuretics: remove waste, such as uric acid
Rubefacients and circulatory stimulants: promote circulation and delivery of healing factors

Herbal Anti-Inflammatories

Reduce or resolve inappropriate inflammation
Can have a general action or be tissue-specific, such as turmeric, licorice, hawthorn, and devil's claw

Mechanism of Action of Herbal Anti-Inflammatories

Provide a demulcent or emollient action on inflamed tissues
Inhibit cyclo-oxygenase and lipoxygenase enzymes to reduce inflammatory prostaglandin and leukotriene production
Regulate inflammatory cytokine and interleukin production
Detoxify the body to reduce toxic load and restore tissue function

Anti-Inflammatory Constituents

Resins: anti-inflammatory, rubefacient (e.g., turmeric, devil's claw, frankincense)
Salicylates: anti-inflammatory, analgesic, antipyretic (e.g., white willow, wintergreen)
Volatile oils: anti-inflammatory, antimicrobial, rubefacient (e.g., turmeric, ginger)
Saponins: anti-inflammatory, adaptogen, immunomodulator (e.g., licorice, wild yam)
Mucilage: anti-inflammatory, demulcent, emollient, vulnerary (e.g., marshmallow, slippery elm)
Sulphur: anti-inflammatory, anti-microbial, rubefacient (e.g., garlic, onion, mustard)
Flavonoids: anti-inflammatory, anti-oxidant, anti-allergy (e.g., turmeric, licorice)
Iridoid glycosides: anti-inflammatory (e.g., devil's claw)

Materia Medica for Joint Pain and Inflammation

Arnica montana (topical)
Boswellia serrata
Capsicum frutescens (topical)
Cichorium intybus
Curcuma longa
Dioscorea villosa
Harpagophytum procumbens
Olea europaea
Rosa canina
Salix alba
Symphytum officinale (topical)
Uncaria tomentosa/guianensis
Urtica dioica
Zingiber officinale

Harpagophytum Procumbens (Devil's Claw)

Common name: devil's claw
Family: Pedaliaceae
Parts used: tuber (secondary roots)
Main constituents: iridoid glycosides (harpagosides), flavonoids
Main indications: arthritis (rheumatoid and osteoarthritis), tendonitis, musculoskeletal degenerative disease
Main actions: significant anti-inflammatory action, anti-oxidant, anti-rheumatic, analgesic
Safety concerns: high doses may cause transient mild GIT disturbance, headaches, conjunctivitis, tinnitus, tachycardia, rhinitis; use caution with anxiety, peptic ulcers, gallstones, Hx asthma, bleeding disorders, CHF, HTN, heart disease; CI in pregnancy and lactation

Curcuma Longa (Turmeric)

Common name: turmeric
Family: Zingiberaceae
Parts used: rhizome
Main constituents: curcuminoids (curcumin), volatile oils (zingiberene, turmerone), resins
Main indications: rheumatic disorders (arthritis), cardiovascular disease by lowering cholesterol and TG, IBD
Main actions: significant anti-inflammatory action via downregulation of COX-2, LOX, and inducible nitric oxide enzymes, hepatoprotectant, hypolipidemic

Topical Considerations

Arnica montana
Capsicum frutescens
Curcuma longa
Symphytum officinale
Urtica dioica
Viburnum spp.
Zingiber officinale
Castor oil
Rosemary, wintergreen, peppermint, eucalyptus essential oils

TCM Heart Functions

The Heart governs Blood and is responsible for its transformation from Gu-Qi into Blood.
The Heart controls the circulation of Blood and the state of the Blood vessels.
If the Heart Qi is strong, the Blood vessels will be in a good state, and the pulse will be full and regular.
The Heart is reflected in the complexion, and its state can affect the distribution of Blood throughout the body.
The Heart houses the Mind (Shen), which includes mental faculties, and is related to the mental and spiritual aspects of a human being.
The Heart is responsible for mental activity, consciousness, emotional state, memory, thinking, and sleep.
A strong Heart and abundant Blood lead to a normal mental activity, a balanced emotional life, clear consciousness, good memory, keen thinking, and good sleep.
The Heart is related to Joy, and excessive excitement or craving can injure the Heart.
The Heart opens into the tongue, controlling its color, form, and appearance, and affects speech.
The Heart controls sweat, and its Qi Deficiency can cause spontaneous sweating, while a Yin Deficiency can cause night sweating.

TCM Small Intestine Functions

The Small Intestine controls receiving and transforming food and drink from the Stomach.
It separates the 'clean' (reusable) part from the 'dirty' part, and the 'clean' part is transported by the Spleen to nourish the body.
The Small Intestine has a direct functional relation with the Bladder and influences urinary function.
It separates fluids, further processing the 'dirty' fluids from the Stomach into a 'clean' part for excretion as urine and a 'dirty' part for excretion in the stools.
The Small Intestine influences mental clarity and judgment, helping to distinguish options clearly in order to come to a decision.

Treatment Notebook

A Treatment Notebook is a way to gather information in a case-based approach for easy access in practice.
It should be started while learning about each case every week and will be beneficial for future practice as a Naturopathic Doctor (ND).

Components of a Treatment Notebook

Pathophysiology of disease
Signs and symptoms (SSx) of the disease
Etiology, epidemiology, risk factors, and prognosis
Differential diagnosis (DDx)
Workup/labs
Treatment Options:
- Nutrition
- Homeopathy
- Nutraceuticals
- Counselling
- Lifestyle
- Physical medicine / manipulation
- TCM/Acupuncture
- Prescription medications
- Botanical medicine
- Injection / IV therapy

Examples of Treatment Notebooks

Medscape (https://reference.medscape.com/)
ND Assist (https://www.nhpassist.com/database)

Exercise, Hydrotherapy, and Tai Chi for Arthritis

Benefits of Exercise

Improve health and fitness while not injuring joints
Strengthen muscles around joints
Reduce pain and stiffness
Help maintain bone strength
Increase energy and improve mood
Make it easier to sleep well
Help control weight
Improve balance

The "Right Kind" of Exercise

Low impact (e.g., walking, recumbent cycling, exercising in water)
Focus on range-of-motion, strengthening, and aerobic exercises
Go slow, move gently, and mindfully
Use heat before exercise and consider ice afterwards if joints are inflamed or swollen

Benefits of Exercise for Osteoarthritis

Long-term walking and resistance-training programs slow functional decline
Regular walking reduces levels of fatigue associated with RA

Benefits of Hydrotherapy

Application of heat relieves joint pain and stiffness caused by RA and OA
Cold is preferable for treatment of an acutely inflamed joint to help decrease pain and inflammation
Hydrotherapy and water aerobics reduce RA symptoms of pain and joint tenderness while relieving tension and improving mood

Heat Application Methods for Hydrotherapy

Fomentation / Hot compress
Moist hot packs
A hot shower
Spas
Ultrasonography
Diathermy

Benefits of Tai Chi

Tai chi is a potentially effective treatment for pain associated with osteoarthritis of the knee
Tai Chi reduces pain in people with RA by 2.15 points on a scale of 0 to 10

Inflammatory Joint Conditions

Malnutrition is common among patients with rheumatoid arthritis (RA), occurring in 26% of patients, and its severity increases with disease severity.
Treatment goals for RA include addressing presenting symptoms, supporting full recovery, patient education, and monitoring and preventing complications.

Food Allergy and Sensitivity

Food allergy occurs when the immune system mistakes a protein in food as harmful, releasing immunoglobulin E (IgE) and triggering symptoms such as abdominal pain, hives, or tingling in the mouth.
Common food allergies include eggs, milk, fish, shellfish, peanuts, tree nuts, wheat, and soy.
Food sensitivity is more common than food allergy and is harder to track, with symptoms such as cramps, bloating, and diarrhea that may not appear immediately.
One-third of people with RA report that certain foods worsen their symptoms, with red meat and dairy known to trigger inflammation.

Special Diets

The Mediterranean diet has been shown to reduce pain and improve physical function in people with RA.
The Mediterranean diet is a plant-based diet that emphasizes the intake of foods such as olive oil, fish, and moderate amounts of red wine.
Key components of the Mediterranean diet include eating primarily plant-based foods, replacing butter with healthy fats, using herbs and spices instead of salt, and eating fish and poultry at least twice a week.
A small study found that a low-fat vegan diet improved RA joint pain, stiffness, and swelling, but there is not enough evidence to justify recommending a vegan diet for everyone with RA.

Supplements to Consider

Fatty acids, particularly omega-3 fatty acids found in fish oil, have been shown to reduce joint pain and morning stiffness in RA.
Folate supplements are recommended for people taking methotrexate, a common RA medication, as it can destroy folate.
Iron supplements are recommended for people with anemia, which is common in patients with chronic inflammatory joint conditions such as RA.

Summary

Key points for nutritional guidance in RA include considering food allergy and sensitivity, special diets such as the Mediterranean diet, and supplements such as fatty acids, folate, and iron.

Case Study

Clara M, a 49-year-old woman with RA, should take folate (5mg folic acid) supplements to counteract the effects of methotrexate on folate levels.

Outcome Measures

Increase pain-free range of motion
Improve pain in joints
Prevent progression to physical degeneration

Relevant Botanical Actions to Consider

Anti-inflammatory
Hepatic
Alterative
Diuretic
Circulatory tonic
Analgesic
Adaptogen

Featured Herbs by Botanical Action

Alterative

Nettle leaf (Urtica dioica folia)
Dandelion leaf (Taraxacum officinale)
Yarrow (Achillea millefolium)
Berberis vulgaris (Barberry)
Bupleurum sinensis (Bupleurum)
Glycyrrhiza glabra (Licorice)

Anti-inflammatory

Turmeric (Curcuma longa)
Devil's claw (Harpagophytum procumbens)
Frankincense (Boswellia serrata)
Polygonum cuspidatum (Japaneses knotweed)
Cat's claw (Uncaria tomentosa)
Polygonatum biflorum (Solomon's seal)

Analgesic

Kava kava (Piper methysticum)
Cannabis (Cannabis indica)
Cayenne (Capsicum annua)
Valerian (Valeriana officinalis)
Jamaican dogwood (Piscidia piscipula)
Wild lettuce (Lactuca virosa)

Adaptogen

Ganoderma spp. (Reishi, Ling zhi)
Cordyceps sinensis (Cordyceps)
Innonotus obliqus (Chaga)
Codonopsis pilosula (Dan shen)
Astragalus membranaceus (Huang qi)
Panax quinquefolia (NA ginseng)

Herb Selection

Formula: Polygonum cuspidatum 30, Harpagophytum procumbens 20, Gingko biloba 30, Actea racemosa 10, Curcuma longa 10
Dosage: Tincture or powder: 1 to 2 tablespoons (15–30 mL) a day, ideally in a mug of warm water between meals
Cautions and Contraindications: Ginkgo may cause mild stomach discomfort and, occasionally, headaches

Other Effective Therapies

Contrasting hydrotherapy
Inclusion of healthy fats and oils
Ensuring appropriate amounts of protein

Botanicals in Joint Pain

Boswellia serrata (Frankincense)

Primary Actions: Antimicrobial, anti-inflammatory, astringent
Constituents: Resins, boswellic acid, volatile oils
Indications: Inflammatory joint conditions, IBD, topical antimicrobial
Cautions and Contraindications: Considered safe, though not generally taken internally in large amounts
Daily Therapeutic Dose: Tincture: 2–4 mL (1:5 in 90%), Infusion or Decoction: 300–3000 mg

Capsicum frutescens (Cayenne)

Primary Actions: Stimulant, circulatory tonic, rubefacient, sialagogue, libido tonic
Constituents: Capsaicinoids (capsaicin), steroidal saponins
Indications: Circulatory deficiencies, arthritic conditions, pain relief, depression
Cautions and Contraindications: Non-toxic, but large doses will cause sweating and possible syncope
Daily Therapeutic Dose: Tincture: 1–5 mL (1:5 in 25%), Infusion or Decoction: 1–2 g powder

Curcuma longa (Turmeric)

Primary Actions: Anti-inflammatory, mild antimicrobial, carminative, circulatory tonic
Constituents: Phenolic antioxidants, curcumin, volatile oils, starches
Indications: General inflammatory conditions, OA and RA, possibly cancer lesions (topical), stomach ulcers and dyspepsia
Cautions and Contraindications: Broadly considered safe, though acts as a mild inhibitor of phase I and inducer of phase II liver conjugation
Daily Therapeutic Dose: Tincture: 8–24 mL (1:5 in 30%), Infusion or Decoction: 8–20 g dried root or powder

Rheumatoid Arthritis Symptoms

Tender, warm, swollen joints
Joint stiffness that is worse in the mornings and after inactivity
Fatigue, fever, and loss of appetite
Early stages affect smaller joints, particularly finger and toe joints
Symptoms often spread to wrists, knees, ankles, elbows, hips, and shoulders
Symptoms usually occur in the same joints on both sides of the body

Remedies for Knee Pain

Bryonia: White Bryony
Rhus Toxicodendron: Poison Oak
Ledum: Marsh Tea

Bryonia

Acts on serous membranes and organs they contain
Tendons, ligaments, or connective tissue
Joint and muscle pain and stiffness, worse with any motion
Aggravation: slightest motion, heat (except local heat)
Amelioration: rest, strong pressure, lying on painful side, sweating
Concomitants: strong thirst, irritability, business thoughts, attempt to achieve absolute immobility

Rhus Toxicodendron

Joint/tendon/muscle ailments with stiffness and pain
Affinity: skin, blood, mucous membranes, glands, nerves
Worse from: continued motion, heat, warm drinks, rubbing, change of position
Generalities: aversion to certain foods, desires certain foods, worse from certain foods
Mental picture: restless, busy, superstitious, ritualistic, or compulsive behavior

Ledum

Lack of internal heat, but pains better with cold application
Gouty joints, pains from the feet upward (ascending pains)
Rheumatism alternating with hemoptysis
Worse from: heat, night in bed, motion, covering inflamed parts
Better from: cold, soaking in cold water
Characteristics: shooting pains in foot, limbs, small joints; ankles easily sprain

Differential Diagnosis

Bryonia: rheumatism with excruciating, stitching pain
Rhus Toxicodendron: main remedy in rheumatism
Ledum: acute gouty pain of the knee, ankles swollen, shoulders, ball of great toe

NON-OPIOID ANALGESICS AND ANTI-INFLAMMATORIES

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

NSAIDs are one of the most commonly prescribed medications for pain and inflammation.
They make up 5-10% of all medications prescribed each year.
Up to 96% of patients over the age of 65 use NSAIDs in the family practice setting.

MECHANISM OF ACTION

COX-2 prostaglandins are inflammatory and participate in inflammatory responses which can produce pain.
COX-1 inhibition leads to ulcers and increases the risk for major GI bleeds.
COX-2 inhibition is desirable for anti-inflammatory effects.

ACETYLSALICYLIC ACID (ASA)

ASA causes irreversible inhibition of COX by covalently bonding its acetyl group to the active binding site of COX.
ASA has a short plasma half-life as it is rapidly hydrolyzed to salicylic acid by plasma esterase.
Eliminated in the urine after conjugation (primarily to glycine).
Rate of excretion is affected by urine pH.
Contraindicated in children with viral infections.
Adverse effects: GI irritation/ulcers/bleeding, tinnitus, high doses can cause hyperventilation, fever, dehydration, metabolic acidosis, impairment of hemostasis, and hypersensitivity reactions.

IBUPROFEN

Adverse effects: GI irritation, nausea, dyspepsia, bleeding, hepatic toxicity, and renal toxicity including acute renal failure if dehydration occurs.

ACETAMINOPHEN

Little effect on COX-1 or COX-2, but has affinity for COX-3, which may explain its analgesic and antipyretic effect.
Rapidly absorbed from the gut, with minimal plasma protein binding, and widely distributed to peripheral tissue and the CNS.
Toxic intermediate formed with CYP1A2, 2E1, 3A isoenzymes, normally conjugated with glutathione and renally excreted.
Glutathione depletion can lead to hepatic necrosis.

CELECOXIB

Selective COX-2 inhibitor with potent anti-inflammatory activity without significant GI toxicity.
Increased risk of cardiovascular disease and mortality.
Does not inhibit platelet aggregation.

GASTROPROTECTION

Risk factors for major GI bleeding: increased age, concomitant use of systemic corticosteroids or warfarin, and history of GI bleeding or peptic ulcer disease.
Strategies to reduce serious adverse effects: using COX-2 selective NSAIDs, prostaglandin analogues (e.g., misoprostol), and proton pump inhibitors (e.g., omeprazole).

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Learn about the botanical treatment strategies for inflammation in the musculoskeletal system and identify herbal actions beneficial for joint pain and inflammation.