NMT150 Practice Qs

Cardio System

• Fevers: acute, appear and disappear suddenly
• Mind: lively, fits/tantrums, hide from hallucinations during fevers/nightmares, wild expression, dilated pupils, glassy eyes when sick

Gelsemium Sempervirens

• Gradual onset of complaints
• Muscular weakness
• Muscle aches, soreness, pain, heaviness
• Thirstless
• Dizzy, drowsy (flu, mono)
• Modalities:
  • Better: open air, closing eyes, bending forward
  • Worse: heat, damp weather, before thunder, from bad news or excitement
• Mental symptoms:
  • Stage fright/exam funk
  • Timid in public
  • Act bravely or bold to fight inner fear

Materia Medica

• Symptoms strongly associated with trends and features frequently seen in a remedy
• Can include characteristic symptoms and affinities of a remedy or be common
• Usually accented with CAPITAL LETTERS, bold letters, italics, or color

URTI Remedies

• Spongia tosta - roasted sponge
  • Barking seal cough, like a saw, sibilant (SHHH or SSSS)
  • Spasmodic/short cough (hoarseness, asthmatic, won't stop)
  • Suffocation sensation (throat constricted, raw, or sore)
  • Dry airways
  • Glands/cervical nodes inflamed
  • Weak sensation in chest
  • Heart pains/palpitations, valvular insufficiencies
  • Blood circulation problems
  • Worse: before midnight, dry cold wind, cold drinks, heat
  • Better: eating, drinking, warm things, resting
  • Mind: fear, wakes at night startled, sensitive, alternating moods, anxiety about heart disease/suffocation
• Drosera rotundifolia - common sundew
  • #1 remedy for whooping cough
  • Respiratory illness (Laryngitis, bronchitis, tuberculosis)
  • Tormenting cough (short and ringing cough)
  • Paroxysms (attacks/fits) that follow one another quickly
  • Holding the chest to cough
  • Hot face, cold hands
  • Inability to cough due to pain
  • Worse: in the evening and after midnight-2am, lying down, after drinking, exertion, singing, smoking, measles, heat, talking, laughing
  • Better: walking, open air, pressure, sitting up
  • Mind: suspicious of others, easily angered, restless, fears being alone
• Rumex crispus - yellow dock
  • Dry, tickling cough
  • Cough ends with sneeze
  • Cough in temperature changes
  • Skin itch in cool air (or sensitive to cold air)
  • Copious discharge from mucosa of nose, eyes, resp tract
  • Worse: cold air (inhale, laugh, talking), touch/pressure on throat, temp changes, motion, morning, before 11pm
  • Better: drinking, sucking on candy
  • Mind: nervous in evening/night, restless, sad/depressed, aversion to mental work, fear of misfortune
• Ipecacuanha - ipecac
  • Persistent nausea/vomiting
  • Spasmodic irritation in chest/stomach (vagus n.)
  • Shortness of breath
  • Gastric disturbances (nausea)
  • Bright red hemorrhage (rapidly clotting)
  • Fevers/infections (from epilepsy, whooping cough, indigestion, menstruation)
  • Vomiting with sensation as if all bones in body are being torn to pieces
  • Violent, spasmodic, suffocating cough (at 7pm) which brings on vomiting or nausea
  • Thirstless
  • Vomiting before or during menses, large clots, miscarriage, labor, pregnancy/placenta issues
  • Worse: warmth/damp warmth, overeating (rich foods), heat and cold, vomiting, motion, lying down
  • Better: open air, rest, pressure, closing eyes, cough better with cold drinks, rest
  • Mind: irritable, contempt for everything when irritated, impatient, anxiety during fever/coughing, many desires but can't express them (hard to please), intolerant to noise, tranquil after anger, anorexia and hypochondria with epigastric tension/constipation

Derm Remedies

• Urtica Urens - Dwarf nettle
  • Itching, burning, stinging skin
  • Burns/scalds
  • Insect bites/stings
  • Allergic rxn after shellfish
  • Disturbances in lactation (swelling, burning)
  • Rheumatism (RA) and Uric acid diathesis (gout, kidney stones)
  • Worse: cold bathing, cold/damp air, snow, touch
  • Better: /
  • Mind: /
• Apis mellifica - mellifera
  • Swelling/edema
  • Stinging, burning pains, hives w puffy swelling
  • Insect bites, puncture wounds, splinters
  • Anaphylaxis
  • No/low thirst
  • Worse: night, heat, touch, right side
  • Better: cold applications, cold water
  • Mind: rapidly developing complaints, passionate, busy (like a bee), restless, awkward/clumsy, irritable, jealous/grief, fear of birds, indifference/apathy, weepy
• Rhus toxicodendron
  • Affinities - skin, mucous membranes, fibroid tissue (joints, tendons), aponeurosis
  • Stiffness and pain
  • RA
  • Itchy, red skin (chicken pox, herpes, psoriasis, urticaria, cellulitis)
  • Worse: at rest (stiff, restless), initial movement, cold damp
  • Better: heat, hot bath, stretching, continuous motion
  • Mind: busy, restless, dreams of travel, work, superstitious or ritualistic behavior
• Sulfur
  • Itchy, red orifices
  • Dry skin, warts, blisters, dry nails
  • Slouches, hot in bed (uncovers feet)
  • Unkempt appearance
  • Cat-nap sleepy
  • Eating at night
  • More thirsty than hungry (not hungry in morning)
  • Worse: pain from standing, heat, weather changes, baths, morning (diarrhea), night, left side
  • Better: dry weather, motion, lying on right side
  • Mind: opinionated, critical, independent, nervous, quick-tempered, argues ideas, speculates, high confidence / full of themselves, hard to get up in morning, fear of heights, anxiety/guilt
• Graphites
  • Thick, Rough skin, scars, eruptions (at bends of skin), cracks/fissures, infections (fungal), keloids
  • Oozing sticky honey-like discharge
  • Eczema, psoriasis, herpes
  • Affinity for skin (folds), digestive organs, eyes
  • Tendency toward obesity, chilliness, constipation
  • Stomach disorders, pain worse with milk/eating
  • Constipation, chronic during/before menses
  • Anemia (pale mucosa, red face)
  • Menstrual issues, menopause
  • Photophobia, blepharitis
  • Alopecia at vertex or sides of head
  • Better: in dark, wrapped up
  • Worse: warmth, night, after menstruation
  • Mind: dull, slow, timid, reserved, changeable, easily startled, indecisive insecure, easily offended, fidgety, fear of something bad happening

Joint Pain Remedies

• Bryonia alba (white bryony)
  • Bryonia toxicity - glycosides have cytotoxic effect -> intense dryness of mucous membrane, respiratory and digestive mucosa
  • Affinity for serous membranes and tendons, ligaments, CT
  • Good for inflammation, dryness, exudation, joint pain and muscle stiffness
  • "Stitching" pain - averse to being examined or moved
  • Thirst for lots of water (extreme thirst)
  • Doesn't want to move
  • Large, hard stools
  • Better: rest, strong pressure, lying on painful side, sweating
  • Worse: any motion, heat (except local)
  • Mind: irritability, wants to be left alone, busy thoughts
• Rhus tox
  • Joint/tendon/muscle ailments with stiffness and pain
  • Skin (last week)
  • Blood and mucous membranes, glands, nerves (sciatic)
  • Aversion to alcohol, meat, oysters, soup
  • Desire for milk, beer, cold drinks, oysters, sweets, tonics
  • Red triangular tip of tongue
  • Better: continued motion, heat, warm drinks and food, milk rubbing, change of position, lying on hard surface
  • Worse: wet, cold air, washing, draft when wet/sweaty, beginning motion

Antibiotic Stewardship

• Antibiotic stewardship is essential to prevent antibiotic resistance.

Mechanisms of Antibiotic Resistance

• Bacteria may develop resistance to antibiotics through various mechanisms.
• Antibiotic resistance can lead to urgent threats, concerning threats, and watch list threats.

Classification of Antibiotics

• Antibiotics can be classified into three main categories based on their antimicrobial spectrum:
  • Narrow: Active against a single species or limited group of pathogens.
  • Broad: Active against a wide range of pathogens.
  • Extended: In between narrow and broad spectrum.

Antibiotic Examples

• Penicillin V:
  • Narrow spectrum antibiotic.
  • Oral suspension.
  • Adverse effects: GI upset, nausea, vomiting, diarrhea, and rash.
  • Rare cases: can cause anaphylaxis.
  • Target: Group A streptococcus pharyngitis.
  • Dosage: > 27 kg: 300 mg TID or 600 mg BID for 10 days.

Antibiotic Resistance Threats

• Urgent threats:
  • Carbapenem-resistant Acinetobacter.
  • C.auris.
  • C.difficile.
  • CRE.
  • N.gonorrhoeae.
• Concerning threats:
  • Erythromycin-resistant group A Streptococcus.
  • Clindamycin-resistant group B Streptococcus.
• Watch list:
  • Azole-resistant A. fumigatus.
  • Drug-resistant M. genitalium.
  • Drug-resistant B. pertussis.

Botanical Medicine

Wild Indigo

• Latin name: Baptisia tinctoria
• Family: Fabaceae
• Part used: Root
• Actions: Lymphatic, anti-microbial, immune-stimulant, anti-catarrhal
• Constituents: Polysaccharides, glycoproteins, quinolizidine alkaloids, isoflavones, flavonoids
• Pharmacology: Stimulates immune system, increases WBCs, improves endogenous defense mechanisms
• Indications: Acute infections with excessive mucus production, e.g., laryngitis, pharyngitis, tonsillitis, rhinitis, and sinusitis
• Dosage: Decoction, tincture, or dried herb
• Adverse effects: Nausea, vomiting, anorexia, hypersalivation, tachypnea, tachycardia, respiratory paralysis (toxic doses)
• Contraindications: Long-term use of high doses, pregnancy, and lactation

Ginger

• Latin name: Zingiber officinale
• Family: Zingiberaceae
• Part used: Rhizome
• Actions: Antioxidant, anti-inflammatory, anti-microbial, diaphoretic, carminative, anti-spasmodic
• Constituents: Volatile oils (zingiberene), sesquiterpenes, oleoresins (gingerols and shogaols)
• Pharmacology: Sesquiterpenes have anti-viral effects against rhinoviruses and RSV; oleoresins help reduce pain, suppress coughing, and modulate fever
• Dosage: Infusion, tincture, or dried herb
• Indications: Various conditions, including nausea and respiratory infections

Traditional Chinese Medicine (TCM)

Basic Principles of Acupuncture

• Always wash hands 3 times: before patient visit, prior to needle insertion, and after removal of needles
• Always use sterilized needles
• Always establish a clean field
• Always immediately isolate used needles

Contradictions

• Absolute: alcohol intoxication, exhaustion, severe fear
• Relative: sexual intercourse, overeating, hunger, excessive thirst, strenuous exercise

Clean Needle Technique

• Abnormal sensations: sharpness, spastic contraction of limbs, convulsions, fainting, loss of color in the face
• Needle manipulation: various ways to stimulate Qi or cause De Qi, e.g., leaving the needle in for 15 minutes, tapping and flicking, tonifying methods, holding channel Qi, and moving Qi

Problems

• Needle stick injury protocol: inform TA or instructor immediately, encourage bleeding from the site, and both parties must give a full report of the incident to the instructor

Elderflower

• Latin name: European (Sambucus nigra), Canadian (Sambucus canadensis)
• Family: Caprifoliaceae
• Part used: Flower and berries
• Actions: Diaphoretic, antiviral, anti-adherence, antirheumatic, diuretic, anti-inflammatory
• Constituents: Anthocyanin, flavonoids, tannins, ascorbic acid, cyanogenic glycoside (in unripe)
• Indications: Cold and flu, crusts on epidermis, skin affections
• Contraindications: Unknown in pregnancy and lactation
• Side effects: Flower and berries are safe, but leaf, bark, and unripe fruit may cause severe vomiting and diarrhea
• Research: German Commission E approved for colds, and meta-analysis showed significant reduction in upper respiratory symptoms compared to placebo

English Ivy Leaf

• Latin name: Hedera helix
• Family: Araliaceae
• Part used: Leaf
• Actions: Expectorant, antitussive, antispasmodic, antimicrobial
• Constituents: Saponins (hederacoside C)
• Indications: Cough, acute/chronic respiratory inflammation, and phlegm
• Contraindications: Generally safe, but short-term use during pregnancy is recommended
• Side effects: Toxicity - high amounts can cause irritation of GI tract, nausea, and vomiting
• Research: German Commission E approved for treatment of catarrhs and respiratory passages, and systematic review concluded that ivy leaf extract is effective and safe for treating cough due to URTIs and bronchitis

Licorice

• Latin name: European (Glycyrrhiza glabra), Chinese (Glycyrrhiza uralensis)
• Family: Fabaceae
• Part used: Root
• Actions: Antispasmodic, expectorant, antimicrobial, demulcent, adrenal tonic, antiulcer, hepatoprotective
• Constituents: Saponins (glycyrrhizin), flavonoids (licoflavone)
• Indications: Respiratory tract infections, GI tract inflammation, hepatitis/cirrhosis of liver, adrenal fatigue
• Contraindications: High blood pressure (hypertension), caution in pregnancy and lactation
• Side effects: Can cause potassium loss
• Research: German Commission E approved for URTIs and gastric ulcers, and review (2022) showed its effectiveness in various conditions

Botanical Medicine

Treatment Strategies

• Emollients
• Vulneraries
• Antimicrobials / Antiseptics
• Anti-inflammatories
• Antipruritics
• Lymphatics
• Astringents
• Connective tissue tonics

Calendula / Marigold

• Latin name: Calendula officinalis (Asteraceae family)
• Plant part used: Flowerheads and petals (infusion and tincture for internal, ointments and poultices for external)
• Indications: Local skin problems, rash, eczema, psoriasis, abrasions
• Actions: Antimicrobial, lymphatic, antiseptic, anti-inflammatory, vulnerary, demulcent, emollient
• Stimulates drainage of enlarged and inflamed lymph nodes
• Stimulates granulation tissue
• Contraindications: Generally safe, caution in asteraceae family allergy
• Side effects: Caution in asteraceae family allergy

Gotu Kola

• Latin name: Centella asiatica (Apiaceae family)
• Plant part used: Aerial parts (infusion, tincture, and standardized extracts for internal use, topical: creams, ointments, and poultices applied BID or PRN)
• Indications: Speeds up skin collagen formation and angiogenesis, increases antioxidant levels within wound in early stages of tissue repair
• Actions: Anti-inflammatory, connective tissue builder, vulnerary, adaptogen, nervine tonic, anti-allergy
• Asiaticosides increase vascularization of connective tissue and the formation of structural glycosaminoglycans
• Constituents: Saponins, flavonoids, alkaloids
• Contraindications: Don't use in pregnancy and lactation, liver disease
• Side effects: Internal use - GI upset, contact dermatitis, sedation, headaches, interacts with anti-diabetics, antihyperlipidemics, CNS depressants, and vasodilators

Plantain

• Latin name: Plantago lanceolata & major (Plantaginaceae family)
• Plant part used: Leaves
• Indications: Wound healing
• Actions: Antimicrobial, lymphatic, anti-inflammatory, astringent, anti-hemorrhagic, emollient, vulnerary, connective tissue tonic, antipruritic
• Allantoin promotes cell proliferation and induces transition of fibroblasts to increase tensile strength of connective tissue
• Constituents: Mucilage, tannins, flavonoids, resins, alkaloids, saponins, minerals Zn, K, Mg, P
• Contraindications: Generally safe
• Side effects: High doses internally - laxative

German Chamomile

• Latin name: Matricaria recutita (Asteraceae family)
• Plant part used: Flower heads (infusion and tincture for internal, ointments, baths, poultices external)
• Indications: Dermatological conditions
• Actions: Anti-inflammatory, vulnerary, nervine sedative, emollient, antimicrobial
• Constituents: Volatile oils, flavonoids, sesquiterpene lactones, salicylic acid, mucilage
• Contraindications: Generally safe, caution in asteraceae allergy
• Side effects: May cause contact dermatitis in cases of allergy or sensitivity

Burdock

• Latin name: Arctium lappa
• Primary actions: Alterative, hepatic, mild laxative, mild adaptogen
• Constituents: Lignans, carbohydrates, inulin
• Indications: Hepatic congestion, sluggish bowels, acne, eczema, and other skin conditions, IBS, type II diabetes, nausea
• Cautions/contraindications: Considered safe, even nutritious
• Part used: Root
• Daily therapeutic dose: Tincture - 9-18 mL (1:5 in 30%), infusion or decoction - 2-12 g root
• Pairs well with: Zingiber officinalis for nausea of deficient stomach

Barberry

• Latin name: Berberis vulgaris
• Plant part used: Root
• Indications: General infections, GI infections, hepatic/gallbladder conditions, constipation, type 2 diabetes, PCOS, any inflammatory skin condition
• Actions: Hepatic, cholagogue, antimicrobial, bitter, anti-inflammatory, alterative, endocrine modulator (insulin)
• Constituents: Isoquinoline alkaloids
• Contraindications: Avoid during pregnancy and lactation
• Side effects: /
• Research: Regulation of blood sugar

Coptis / Goldenthread

• Latin name: Coptis sinensis
• Plant part used: Root
• Indications: Chronic or acute skin characterized by inflammation, acute GI infections, chronic sinusitis, hepatitis
• Actions: Antimicrobial, anti-inflammatory, hepatic, bitter
• Constituents: Isoquinoline alkaloids
• Contraindications: Avoid during pregnancy and lactation, non-toxic but very strongly bitter, not used for more than 3 weeks
• Side effects: /
• Research: /

Yellow Dock

• Latin name: Rumex crispus
• Plant part used: Root
• Indications: Chronic skin conditions, constipation, convalescence
• Actions: Alterative, laxative, hepatic, astringent, mild adaptogen, blood purifier and builder
• Contraindications: Not to be eaten fresh, not in pregnancy and lactation
• Side effects: /
• Research: /

Red Clover

• Latin name: Trifolium pratense
• Plant part used: Flowers, aerial parts
• Indications: Skin conditions, PCOS, irregular menses, menopausal hot flashes
• Actions: Alterative, lymphatic, mild female endocrine modulator
• Contraindications: May interact with anticoagulants
• Side effects: /
• Research: /

Topical Herbal Pharmacy for Skin Rash

• Ointments (salves) - semi-solid base of oil and beeswax, fats soften at skin temperature making material available to the skin### Lung Deficiencies
• Lung Qi Deficiency:
  • Caused by chronic cough or asthma, insufficiency of Qi production
  • Symptoms: feeble cough, shortness of breath, low and/or hoarse voice, fatigue, spontaneous sweating, dizziness, aversion to cold, pale face, watery or thin/clear sputum, catching colds easily
  • Tongue: pale, thin white coating
  • Pulse: weak or empty pulses, especially right cun position
• Lung Yin Deficiency:
  • Caused by prolonged cough, heat disorders that injure the lung
  • Symptoms: dry cough, dry mouth and throat, afternoon fever, malar flush, night sweats, heat sensation in the five centers
  • Tongue: red body with a dry coat or little coating and maybe cracks or peeling
  • Pulse: rapid and thready
• Lung Dryness:
  • Caused by pathogenic dryness (stomach yin deficiency)
  • Symptoms: dry cough, little sputum, chest pain, dry skin, thirst, hoarse voice
  • Tongue: dry with thin coating
  • Pulse: rapid and thready
• Lung Cold:
  • Caused by pathogenic cold in the lung
  • Symptoms: cough, asthma, thin white sputum, absence of thirst, runny nose with clear mucus, fever, headache and body aches
  • Tongue: white coat, pale body
  • Pulse: slow, strong and tight
• Lung Heat:
  • Caused by pathogenic heat in the lung
  • Symptoms: cough, asthma, yellow sticky sputum, thirst, sore throat, chest pain, yellow purulent sputum with blood
  • Tongue: red body and thing, yellow coat
  • Pulse: rapid and strong
• Phlegm Damp Retention:
  • Caused by pathogenic wind, cold, and damp
  • Symptoms: cough with frothy or white sticky sputum, stuffiness and fullness in the chest, gurgling sound with sputum in the chest, shortness of breath
  • Tongue: pale with white sticky coating
  • Pulse: wiry, slippery, and strong
• Invasion by Wind-Water:
  • Caused by wind cold and damp
  • Symptoms: sudden swelling of the eyes, bright-shiny complexion, scanty and pale urine, aversion to wind, fever, cough, breathlessness
  • Tongue: sticky white coating
  • Pulse: floating and slippery
• Cold Phlegm in Lungs:
  • Caused by repeated wind-cold invasions, excessive consumption of raw, cold, or diary
  • Symptoms: cough with white watery sputum, feeling of cold in the chest, dizziness, heaviness in the chest, tongue: swollen and wet with sticky white coating
  • Pulse: slow, slippery, and strong
• Dry Phlegm in Lungs:
  • Caused by excessive consumption of greasy and dairy
  • Symptoms: dry cough, difficult to expectorate, SOB, heavy feeling in the chest and head, dry throat, wheezing, pasty-dry complexion
  • Tongue: swollen with dry, sticky coating
  • Pulse: fine and slippery

Large Intestine Function

• Controls passage and conduction
• Stool formation
• Qi goes downward, stagnation of Qi causes distention and constipation
• Mental aspect of letting go, not dwelling on the past, LI points can calm the mind

Large Intestine Deficiencies

• LI Damp Heat:
  • Caused by excessive consumption of hot and greasy food, pathogenic summer heat, damp, and heat
  • Symptoms: abdominal pain, tenesmus, blood and mucus in the stools, burning sensation in the anus, diarrhea with yellow watery stools
  • Tongue: red body with yellow, sticky coating
  • Pulse: rapid, slippery, and strong
• LI Heat Consumption of Fluid:
  • Caused by excessive consumption of hot foods, lamb, beef, and alcohol
  • Symptoms: constipation with dry stools, burning sensation in the mouth, dark, scanty urine
  • Tongue: red body with thick yellow or brown dry coat
  • Pulse: full and rapid
• Cold Invading LI:
  • Caused by chronic exposure to cold weather, sitting on cold, wet surfaces for long periods
  • Symptoms: sudden abdominal pain, diarrhea with pain, feeling of cold in the abdomen
  • Tongue: thick white coating
  • Pulse: deep, wiry, slow, and strong
• LI Dryness:
  • Caused by blood or yin deficiency, elderly, women after a delivery, late stages of febrile disease
  • Symptoms: dry stools, constipation, dry mouth and throat, yellow, scanty urine
  • Tongue: dry, red or pale body without coating
  • Pulse: thready
• LI Qi Stagnation:
  • Caused by irregular eating habits, frustration, anger
  • Symptoms: abdominal distention and pain, constipation with bitty stools, irritability
  • Tongue: normal to slight red sides
  • Pulse: wiry on both chi positions
• LI Collapse:
  • Caused by spleen and stomach deficiency, excessive physical work
  • Symptoms: chronic diarrhea, anal prolapse, hemorrhoids, fatigue after bowel movements, cold limbs
  • Tongue: pale
  • Pulse: deep, fine, weak

Pharmacology

• Corticosteroids:
  • Expressed in the skin
  • Glucocorticoids: affect carbohydrate, fat, and protein metabolism, anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstrictive
  • Mineralocorticoids: primarily involved in electrolyte regulation
• Topical Corticosteroids:
  • Basic structure: hydrocortisone backbone
  • Increase potency of TCS by fluorinating or esterifying certain carbons in the four-ring backbone
• Mechanism of Action:
  • Once absorbed, TCS interacts with an intracellular glucocorticoid receptor
  • The complex then translocates to the nucleus where a large number of gene transcription changes take place
  • Upregulation of anti-inflammatory mediators, downregulation of inflammatory mediators