Yellow Jasmine: Symptoms and Characteristics

Yellow Jasmine

• Associated with muscle aches, soreness, pain, and heaviness
• Characterized by thirstlessness, feelings of being "droopy, dizzy, drowsy, and dull"
• Often accompanied by influenza, mononucleosis, and Chronic Fatigue Syndrome (CFS)
• May exhibit extreme weakness, inability to sit up in bed, and confusion
• May experience body delusions, such as feeling like limbs are detached from the body
• May have canker sores and diarrhea (GI infections)
• Better when indoors, drinking liquids (although may gag on fluids)
• Worse when in cold, open air, walking, or eating solids

Allium Cepa (Red Onion)

• Affinity for mucus membranes (nose, eyes, larynx, bowels)
• Characterized by mental emotions of anxiety and stage fright
• Physical symptoms include:
  • Grogginess, sleepiness, and lethargy, especially in the morning
  • Indifference, dullness, and lack of motivation
  • Absent-mindedness, worsened in the afternoon and by coffee
• Physical complaints:
  • Left-sided or left-to-right neuralgic pains after surgery/amputation/injury
  • Shooting pains following a thin line
• Worse in warm rooms, spring and fall, evenings, and around flowers and cucumber
• Better in fresh air (not too cold) and when consuming onions (may crave)

Botanical Medicine

• Echinacea angustifolia:
  • Treats common cold, flu, and URTIs
  • Actions: immunostimulant, antimicrobial
  • Chemicals: alkylamides, phenolics, polysaccharides
  • Safety: caution with autoimmune disease, safe in pregnancy
• Ginseng (Panax ginseng):
  • Treats stress, fatigue, and cold/flu
  • Actions: adaptogen, immunostimulant, antiviral
  • Chemicals: steroidal saponins, polysaccharides
  • Safety: caution with high blood pressure, safe in pregnancy
• Andrographis paniculata:
  • Treats colds, colitis, and liver disease
  • Actions: immunomodulator, antimicrobial
  • Chemicals: diterpene lactones, flavanoids
  • Safety: contraindicated with stomach/GI ulcers, obstructed gallbladders; not recommended in pregnancy
• Sambucus nigra (European Elder flower):
  • Treats cold and flu
  • Actions: diaphoretic, antiviral, anti-adherence
  • Chemicals: anthocyanin, flavinoids
  • Safety: toxicity causes vomiting/diarrhea
• Other botanicals:
  • Hedera helix (English Ivy leaf): treats cough and acute phlegm
  • Glycyrrhiza glabra (Licorice): treats RTIs, anti-inflammatory, expectorant
  • Althaea officinalis (Marshmallow): treats inflamed mucous membranes, RTIs
  • Eucalyptus globulus (Eucalyptus): treats RTIs, GI tract spasms
  • Baptisia tinctoria (Wild Indigo): treats common cold, lymphatic, anti-microbial, immune stimulant
  • Zingiber officinale (Ginger): treats common cold, antioxidant, anti-inflammatory, antimicrobial, diaphoretic

Best Combination for Colds

• Ginger, Echinacea, and Wild Indigo

Nutrition

• Vitamin C: found in fruits and vegetables, citrus fruits (45 mg/lemon)
• Zinc: found in meats, poultry, seafood, legumes, seeds (33 mg/6 medium oysters)
• Probiotics: found in fermented foods, sauerkraut, kimchi, yogurt, tempeh
• Diet Sources: animal studies show that deficiencies in zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, D, and E can alter immune responses

Glycyrrhiza glabra (Licorice)

• Primary actions: adaptogen, anti-inflammatory, demulcent, antiviral, hypertensive
• Part used: root
• Constituents: triterpene saponins, glycyrrhizin, glycyrrhetinic acid, chalcones
• Indications: ongoing stress, hypotension, asthma, eczema, chronic or acute bronchitis, emphysema, URTI, post-viral cough, stomach ulcers (mostly DGL)
• Cautions/Contraindications: hypertension, pregnancy, lactation, difficult urination, Lyme disease

Considerations

• Malnutrition common among patients with rheumatoid arthritis

• Food allergy: release of IgE antibody, mistaking food for pathogen

• Common food allergies: eggs, milk, fish, shellfish, peanuts, tree nuts, wheat

• Vegan/vegetarian diet: little evidence, but may improve function, joint mobility, and pain in RA### Iron Sources

• Heme iron: derived from hemoglobin and myoglobin, found only in animal products (meat, fish, poultry, oysters, and clams)

• Non-Heme iron: found in meats, beans, dark greens, leafy veggies, dried fruits, blackstrap molasses, and enriched foods (flour, breads, pastas, and cereals)

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

• Most commonly prescribed medications for pain and inflammation
• Make up 5-10% of all medications prescribed each year
• Up to 96% of patients over 65 use NSAIDs in the family practice setting

COX Inhibitors

• Non-specific COX inhibitors: acetylsalicylic Acid (ASA) and ibuprofen
• COX-2 specific inhibitors: celecoxib
• Non-specific COX inhibitors without anti-inflammatory effect: acetaminophen

Acetylsalicylic Acid (ASA)

• Causes irreversible inhibition of COX by covalent bond of acetyl group
• Dosing: 325-650mg Q4H (every 4 hours), maximum 4g/day
• Lasts 6 hours, hits in 1 hour
• Contraindicated in children with viral infections
• GI irritation, ulcers, bleeding, and tinnitus are adverse effects
• High doses can cause hyperventilation, fever, dehydration, metabolic acidosis, and impairment of hemostasis
• Hypersensitivity reactions are uncommon but potentially fatal

Ibuprofen

• Dosing: 200-400mg Q6-8 hours PO, maximum 1200mg/day
• Onset of action: 30-60 minutes, duration of action: 4-6 hours
• Adverse effects include GI irritation, nausea, dyspepsia, bleeding, hepatic toxicity, and renal toxicity

Acetaminophen

• Dosing: 325-650mg Q4H PO, maximum 4g/day
• Onset of action: under 1 hour, duration of action: 4-6 hours
• Little anti-inflammatory effect, may explain analgesic and antipyretic effect
• Risks include rapid absorption from the gut, minimal plasma protein binding, and toxic intermediate formation

Celecoxib

• Dosing: 100mg BID PO or 200mg daily PO for osteoarthritis
• Selective COX-2 inhibitor with potent anti-inflammatory activity without significant GI toxicity
• Increased risk of cardiovascular disease and mortality

Gastroprotection Strategies

• Using COX-2 selective NSAIDs
• Using prostaglandin analogues (e.g., misoprostol)
• Using proton pump inhibitors (e.g., omeprazole)

Homeopathy

• Bryonia alba (white bryony): acts on tendons, ligaments, or connective tissue, causes inflammation and dryness
• Rhus tox (Poison ivy): acts on joints, tendons, and muscles, causes stiffness and skin issues
• Ledum (Marsh tea): acts on acute gouty pain in the ankle and knee

Low Back Pain (Botanical Medicine)

• Same potanicals as joint pain, with exceptions of Corydalis yanhusuo
• Corydalis yanhusuo (yan hou so): analgesic, hepatic, warming, and calminative properties

Nutrition

• Focuses on Vitamin C, Magnesium, Proteolytic enzymes, and Vitamin D
• Vitamin C: increases calcium absorption, strong bones, and healing, risk of deficiency in certain populations

Antibiotics

• Azithromycin: 500 mg PO for one day, then 250 mg PO daily for 4 days for adults; 12 mg/kg PO for 5 days with a maximum daily dose of 500 mg for children.
• Clarithromycin: an alternative for patients who are allergic to penicillin; same adverse effect profile as azithromycin; also available as a suspension; increases the levels of some common drugs like atorvastatin, lovastatin, simvastatin, and prednisone.
• Clarithromycin dosage: 250 mg BID PO for 10 days for adults; 15 mg/kg/day divided BID PO for 10 days with a maximum daily dose of 500 mg for children.
• Lincosamides: interfere with translocation like macrolides but do not inhibit peptidyl transferase; approximately 4 times more likely to cause Clostridium difficile infections compared to other antibiotics; generally bacteriostatic but can be bactericidal at high doses.
• Clindamycin: an alternative for patients who are allergic to penicillin; may be used for treatment in symptomatic patients with multiple, recurrent episodes of pharyngitis; commonly causes diarrhea as an adverse effect.

Glucocorticoids

• Mechanism of action: interact with an intracellular glucocorticoid receptor, then translocate to the nucleus where a large number of gene transcription changes take place.
• Effects:
  • General upregulation of anti-inflammatory mediators and downregulation of inflammatory mediators.
  • Vasoconstrictive effect which reduces delivery of inflammatory mediators and improves erythema.
  • Anti-mitotic effect which inhibits cell proliferation and collagen synthesis.
  • Immunosuppressant effect.
• Adverse effects (topically):
  • Many adverse effects caused by overstimulating glucocorticoid receptors in skin.
  • Stinging or burning sensation.
  • Dermal atrophy Striae.
  • Rosacea.
  • Perioral dermatitis.
  • Acne.
  • Purpura.
  • Increased hair growth.
  • Skin pigment changes.
  • Delayed wound healing.
• Finger tip units (FTP): 1 finger tip ~0.5 g; 5 g should cover two adult hands once spread.

Topical Drug Vehicles

• Types of vehicles:
  • Creams: most used but least effective; preferred because no residue is left; additives can cause irritation.
  • Gel: alcohol-based (can cause stinging); good for hairy areas/oily skin.
  • Lotion: alcohol-based (can cause stinging); good for larger hairy areas/oily skin; evaporates well.
  • Ointment: thick/greasy; least preferred but most effective; emollient effect; no-little irritation.
  • Foam: an aerosolized oil-based formulation; allows for application to hard-to-reach areas; tends to leave a greasy residue.
• Potency: divided into 7 classes; Class 1: highest potency (“super/ultra high class”); Class 2: high; Class 3 – medium-high; Class 4/5 - medium; Class 6/7 – low potency.

Homeopathy

• Urtica urens (dwarf nettle):
  • Skin: itching, burning, and stinging.
  • Swelling/edema < heat.
  • Insect bites, punctured wounds, splinters.
  • Anaphylaxis.
  • No/low thirst.
  • Sudden, rapidly developing complaints.
  • Urticaria/hives with puffy swelling.
• Rhus toxicodendron:
  • Affinities: skin, mucous membranes, fibrous tissue (joints, tendons, sheaths).
  • Itchy skin, red – chicken pox, herpes, psoriasis, urticaria, cellulitis.
  • < at rest (stiffens up), initial movement (but better with continuous motion).
  • COLD DAMP.
  • >heat, HOT BATHS, stretching.
• Sulphur:
  • Skin: itchy < heat, red orifices.
  • Back: slouching, pain standing.
  • Mind: opinionated, critical, independent.
• Graphites:
  • Skin: rough, scars, eruptions, cracks, infections.
  • Digestive organs, eyes.
  • Tendency toward obesity, chilliness, constipation.
  • Mind: dull, slow, timid, reserved, changeable, easily startled.

Botanical Medicine

• Key actions: hepatic, anti-inflammatory.

• Treat RA as you would any condition of immune-mediated inflammation.

• Treat OA or degenerative conditions by promoting circulation.

• More inflammation: favour hepatics.

• More swelling: favour diuretics.

• Feeling of cold in the joints: use cayenne internally and topically.

• Bupleureum chinensis (Chai hu):

  • Primary Actions: hepatic, alterative, anti-inflammatory, hepatoprotective.
  • Part Used: Root.
  • Constituents: Triterpene saponins, sterols, volatile oils, polysaccharides.
  • Daily Therapeutic Dose: Tincture: 6–12 mL (1:5 in 40%); Infusion or Decoction: 3–12 g.
  • Safety: Avoided in cold conditions or constitutions.

• Cayenne:

  • Primary Actions: circulatory, anti-inflammatory, antipyretic.
  • Part Used: dried or powdered fruit.
  • Constituents: Capsaicinoids (capsaicin), steroidal saponins.
  • Daily Therapeutic Dose: Tincture: 1–5 mL (1:5 in 25%); Infusion or Decoction: 1–2 g powder.
  • Indications: Circulatory deficiencies, arthritic conditions, pain relief, depression.

• Curcuma longa (Turmeric):

  • Primary Actions: Anti-inflammatory, mild antimicrobial, carminative, circulatory tonic.
  • Part Used: Root.
  • Constituents: Phenolic antioxidants, curcumin, volatile oils, starches.
  • Daily Therapeutic Dose: Tincture: 8–24 mL (1:5 in 30%); Infusion or Decoction: 8–20 g dried root or powder.
  • Indications: General inflammatory conditions, OA and RA, possibly cancer lesions (topical), stomach ulcers and dyspepsia.

• Ginkgo biloba (Ginkgo):

  • Primary Actions: Circulatory tonic, vasodilator, anti-inflammatory, anticoagulant (as an antiplatelet activator factor [PAF]), nootropic, mild astringent.
  • Part Used: Leaf and fruit.
  • Constituents: Flavonoids, terpenoids, alkylphenols, carbohydrates.
  • Daily Therapeutic Dose: Tincture: 10–20 mL (1:5 in 40%); Infusion or Decoction: 5–10 g dried leaf or powder.
  • Indications: Circulatory deficiencies, memory and cognitive impairment, tinnitus, vertigo, and peripheral vascular disease.### Magnesium Deficiency

• Muscle tremor, spasms, cramps, and tetany

• Chest tightness and shortness of breath

• Palpitations and cardiac arrhythmias

• Anxiety, depression, fatigue, insomnia

• Loss of appetite, nausea, and vomiting

Food Sources of Magnesium

• Barley and brown rice
• Most vegetables, especially green leafies, corn, and carrots
• Seafood and dairy products
• Coffee and tea, cocoa and chocolate

Proteolytic Enzymes

• Effective at reducing inflammation and symptoms related to inflammatory conditions
• Types:
  • Proteinases: protease, bromelain, papain, nattokinase
  • Lipases: lipase
  • Carbohydrases: amylase, lactase, alpha-galactosidase, cellulase

Vitamin D

• Improves absorption of calcium
• Deficiency seen in LBP patients
• Skin production depends on:
  • Length of exposure to the sun
  • Amount of bare skin exposed
  • Season and time of day
  • Level of latitude
  • Degree of pigmentation
  • Age

Recommended Daily Dosages

• Vitamin C: 1000 mg/day
• Magnesium: 400 mg/day
• Proteolytic enzymes:
  • Bromelain: 1,200-2,000 GDU
  • Fungal protease: 100,000-200,000 HUT
  • Nattokinase: 2,000-4,000 FIP
  • Papain: 3,000,000-6,000,000 PU
  • Serrapeptase: 80,000-160,000 SPU
• Vitamin D: 1000 IU/day

Pharmacologic Options

• Acetaminophen and NSAIDs
• GABA derivatives
• Muscle relaxants
• Opioids

GABA Derivatives

• Pregabalin and Gabapentin
• Typically reserved for soft tissue and hyperalgesic pain
• Act centrally
• Not fully understood mod of action
• Similar structure to GABA but do not interact with GABA

Adverse Effects of GABA Derivatives

• Most common: sedation, ataxia, tremor, dizziness, dry mouth, weight gain
• May also cause GI upset, peripheral edema, and vision changes
• Cannot be abruptly discontinued – dose should be tapered over a minimum of 1 week to avoid withdrawal effects

Gabapentin

• Initial dose: 300-400 mg/day PO divided TID
• Can increase at weekly intervals to a maximum of 3600 mg/day divided TID
• Should not be taken with mineral supplements or antacids as this may decrease bioavailability

Pregabalin

• Initial dose: 50-150 mg daily PO divided BID
• May increase weekly by 50-150 mg/day to a maximum of 600 mg/day divided BID
• Does not have any significant interactions and is typically preferred as it is taken twice a day vs three times a day with gabapentin

Muscle Relaxants

• Loosely differentiated into antispasmodics and antispastics
• A very broad term that includes drugs of a number of different drug classes
• All muscle relaxants are not recommended for those over the age of 65

Antispasmodics

• Decrease muscle spasm associated with pain
• Reduce muscle rigidity/spasticity that interferes with therapy or function
• Examples: Methocarbamol and Baclofen

Methocarbamol

• Dosing: 1 g QID PO
• Mechanism of action: dependent on its CNS depressant activity by blocking spinal polysynaptic reflexes, decreasing nerve transmission, and prolonging the refractory period of muscle cells
• Adverse effects: can cause drowsiness, dry mouth, dizziness, fatigue, nausea, and constipation
• Combination with other CNS depressants or opioids can increase the risk of CNS depression

Baclofen

• Dosing: Initial dose: 5 mg TID PO, increase gradually to a maximum of 20 mg TID
• Mechanism of action: a GABA receptor agonist specific for the beta subunit which is primarily expressed on pre- and post-synaptic neurons
• Adverse effects: sedation, muscle weakness, nausea, dizziness, and in rare cases, hepatotoxicity
• Potential additive CNS depression with other drugs like opioids and benzodiazepines

Homeopathy

• Colocynthis: contains cucurbitacin glycosides, affinity for smooth muscles of GI, diarrhea, and peripheral nervous system and cranial nerves
• 5 HTP: 200-400 mg/day, found in turkey, chicken, milk, potatoes, pumpkin, sunflower seeds, turnip and collard greens, and seaweed
• SAM E: showing good results in studies treating depression, 200 mg twice a day up to 400 mg three times a day, ramp up slowly
• B vitamins: important role in anabolic and catabolic cellular processes, may reduce anxiety and depression, and benefit at-risk populations for stress
• Magnesium: deficiency common among depressed patients, 200-600 mg/day
• Vitamin D: reduce risk of depression, but non-strong enough evidence, 1000-2500 IU/day
• Arsenicum Album: intense burning, significant weakness, extreme sensitivity to cold, worse between 12-3 am from cold, better with heat, cannot rest until house is in order

Botanical Medicine (BotMed)

• H.E.M.P formula: Hydrastis (goldenseal), Echinacea (purple cone flower), Myrrh, Phytolacca (Poke Root)
• Hydrastis canadensis (goldenseal):
• Part used: root
• Actions: Antimicrobial, fungal, viral, parasitic, digestive bitter
• Chemicals: isoquinoline alkaloids (berberine, hydrastine)
• Safety: Avoid use with gastric/stomach ulcers, may cause GI irritation, nausea, vomiting, diarrhea
• Echinacea (purple cone flower):
• Part used: root and herb
• Actions: Immunostimulant
• Indications: Strep throat, colds, vaginal candidiasis, UTI
• Chemicals: Phytochemicals (alkylamides, phenolics, polysaccharides)
• Safety: Caution with autoimmunity, safe with pregnancy and difficile colitis

Homeopathy

• Overview of remedies: Allium cepa, Belladonna, Gelsemium sempervirens (24 remedies known to help with URTIs)
• Belladonna (deadly nightshade):
• < means worse or aggravated with heat, fever, redness, throbbing, and burning
• > means better or ameliorated with leaning head against something
• Actions: Brain, head, cardiovascular, fever, appears and disappears suddenly
• Mental emotions: lively, bubbly personality, sudden fits/anger, hallucinate during nightmares, wild eye expression
• Gelsemium sempervirens:
• Gradual onset of complaints
• Actions: Muscular weakness, may see double
• Contraindications: pregnancy, trying to conceive, renal diseases, liver disease, malnutrition, alcoholics

Pharmacology

• Corticosteroids: Two main subclasses
• Glucocorticoids: affect carbohydrate, fat, and protein metabolism, anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive properties
• Mineralocorticoids: involved in electrolyte regulation by modifying renal excretion mechanisms
• Both receptors found in the skin
• Hydrocortisone: backbone provides backbone for all types of corticosteroids
• Fluorinating or esterifying certain carbons in the four-ring backbone can increase potency of TCS

Nutrition and Supplements

• Lacto-ovo-vegetarian diet: avoids meats, allows milk and eggs
• Vegan diet: avoids all products originating from animals
• Fatty acids:
• Omega-3 fatty acids seem to prevent or improve experimental arthritis
• Omega-3 fatty acid supplements for RA have been widely studied
• Fish oil has been shown to reduce joint pain and morning stiffness
• Folate:
• Sources in food: green veggies, mushrooms, legumes, strawberries, oranges
• Common RA medication, methotrexate, destroys folate
• Doctors often prescribe folate supplements for those on this medication
• Iron:
• Anemia is common in patients with chronic inflammatory joint conditions such as RA
• 2 types of iron
• Withania somnifera (Withania):
• Primary Actions: Adaptogen, hypotensive, immune modulator, anti-inflammatory, nootropic
• Constituents: Steroidal lactones (withanolides), alkaloids
• Indications: Fatigue, nervous exhaustion, chronic inflammatory disease, anemia, lowered libido, convalescence, hypothyroid presentations
• Cautions/Contraindications: Considered safe, Preg B, Lact C
• SAM-E, Omega 3 FA, 5 HTP, B vitamins, Magnesium, Vitamin D, Anti-oxidants, Saffron, Turmeric, Mediterranean diet, Probiotics and non-probiotic treatments are also notable for nutrition and mood regulation
• Diet and mood regulation: blood sugar balance, weight management, stimulants, food sensitivities