TCM Final Exam Review PDF

TCM o Acupuncture and Chinese herbal remedies – back 2200 years o Shang Dynasty - archeological findings of acu & bones with medical problems engraved o Huang Di Nei Jing (The Yellow Emperor’s Inner Classic) – earliest written record o Five Elements (Xu Wing) o Book of Changes (Yi Jing)– earliest re...

TCM o Acupuncture and Chinese herbal remedies – back 2200 years o Shang Dynasty - archeological findings of acu & bones with medical problems engraved o Huang Di Nei Jing (The Yellow Emperor’s Inner Classic) – earliest written record o Five Elements (Xu Wing) o Book of Changes (Yi Jing)– earliest reference to yin and yang o Han Dynasty– yin and yang, five elements, channel theory, pharmacopeia o Medical classics that laid foundations for TCM YIN YIN E/D YIN EXCESS Material, matter Produces form, grows, nourishes Contraction/descend, below Female, feminine Cloud, shade, (-) electrical charge Cooling/cold/water Provides space for rest Substance that is moved Creates space for conception Heavy, obscured/Earth, night Down and in movement Autumn and Winter Lower body, interior, abdomen Acupuncture – traditional, auricular, electro-stim, Cupping, Botanical – plant, mineral, animal, Moxibustion, Massage (Tui Na), Nutrition, Bleeding technique, Gua Sha, Tai Chi and Qi Gong 4 aspects of yin/yang o Opposition – Y&Y are opposite and always changing; never 50/50 o Interdependence – cannot exist without the other o Mutual consumption – too much of one will deplete the other o Inter-transformation – Y&Y transform into one another; in cycles YANG Cold symptoms Local pain better w heat Heat symptoms Dry stools Abdo pain, dysmenorrhea better with warmth Chills YIN DEFICIENCY Red cheeks, hot flushes, 5 centre heat Night anxiety sweats Thirst for cold drinks (sips) Immaterial Produces energy, generates Expansion, Rising, above Sun, positive electrical charge Transforms/moves Protects/holds Spark for conception Male Hot/fire/warming Light, radiant/Heaven, day Up and out movement YANG E/D YANG EXCESS Hot all day Red face Thirst for cold drinks (gulps) YANG DEFICIENCY Cold symptoms Low libido Fatigue, tired after bowel movement Edema Spring and Summer Upper body, exterior, back Tongue a) Body colour - condition of yin organs, blood, and nutritive Qi. True condition of the body irrespective of temporary conditions (ex. physical exertion or emotions) b) Body shape - Features can include: physical contours of the tongue, consistency, texture, mobility. Thin or swollen/Long or short/Cracks – major and minor c) Tongue coating - Physiological by-product of stomach digestion; tips of papillae d) Tongue moisture - Indication of the body’s fluids - dry, moist, wet e) Spirit/Shen Normal = pale, red and fresh, supple, not cracked, no tremble/quiver, not swollen/thin. thin white coat. slightly moist, radiant, brilliant Pulse Pulse diagnosis→ balance of the body (state of Qi, blood, YY, constitution, organs) Speed – below 60bpm or over 90bpm Rhythm – regular or irregular Size – long, short Width – thin, thready, thick Shape – wiry, soft, tense Quality – choppy, rushing, slippery - Fast, thin– Yin deficiency Deep, slow, weak– Yang deficiency Floating– ext pathogen, wind cold pathogen Superficial– potentially wind heat pathogen Slow – cold pathogen Full-tight-deep – full-cold Weak-slow-deep – empty-cold Rapid – heat pathogen, summer heat pathogen Full-rapid-overflowing – full-heat Floating-rapid-empty – empty-heat Slippery – dampness pathogen WOOD - Bent/straight/ workable/solid - Direction: expand. - Season: spring - Organs: liver, GB. - Secretion: tears. - Emotions: anger, jealousy - Flavour: sour. - Sense: vision EARTH sow, grow, reap, nutrition Direction: central. Season: last 18 days. Organs: spleen, stomach. Secretion: saliva. Emotions: pensiveness, overthinking. - Flavour: sweet. - Sense: taste - - No coating – Yin deficiency Damp coating – potentially Yang deficiency Bright heat colour (pink/red) – greater Yin deficiency Dull heat colour (paler red) – less Yin deficiency White coating with bluish/purple – cold pathogen Full cold – thick white coating Empty cold – thin white coating Yellow coating or red tongue body – heat pathogen Sticky coat or swollen – dampness pathogen Dry tongue – dryness pathogen Red on sides and tip – summer heat pathogen Quiver, stiff, deviation – wind pathogen Pale – blood deficiency Dark red/purple – blood stasis Yang deficiency Tongue - Coating depends on accumulation of dampness, pale. Pulse: deep, slow, weak Yin deficiency Tongue - absence of coating, pale. Greater deficiency= brighter heat; pink/red. Less deficiency = duller heat; more pale. Pulse: fast, thin 5 Elements and Corresponding TCM Organs History of the 5 Elements - Aristotle – 4 elements and conflict between them. 5 Elements originated in the Zhou Dynasty (1000-770 BC). Used for government and power. fell off around 100 AD. Song Dynasty – regained status and incorporated into mainstream medicine 5 Elements: used to explain organ properties, relationship, pathological changes METAL - Mouldable, solid. - Direction: contract - Season: winter. - Organs: lungs, LI - Secretion: mucous - Emotions: sad, grief - Flavour: pungent. - Sense: smell WATER - moisten down, fluid - Direction: down - Season: winter. - Organs: kidney, UB - Secretion: urine - Emotions: fear and shock. - Flavour: salty. - Sense: hearing FIRE - flares up, combustible, warm - Direction: up - Season: summer - Organs: heart, SI; pericardium and SJ - Secretion: sweat. - Emotions: joy, anxiety. - Flavour: bitter. - Sense: speech and taste Generating, Controlling and Insulting Cycles Generating cycles: relationship bw each element, creation/nourishment. Mother always creates Child Wood creates Fire from burning. Fire creates Earth from ashes. Earth creates Metal by hardening. Metal creates Water by containing. Water creates Wood by nourishing Controlling cycle: each element is controlled by another element to maintain balance. Controller excess = pathology in the controlled. Controller deficiency =pathology in the controller. Wood controls Earth by covering. Fire controls Metal by melting. Earth controls Water by damming. Metal controls Wood by cutting. Water controls Fire by extinguishing Insulting cycle: element “back-lashes” controller; occurs when the controller is relatively weaker than the controlled Wood insults Metal. Fire insults Water. Earth insults Wood (liver). Metal insults Fire. Water insults Earth 5 Element Pathology and Correspondences When an element is deficient: a) Fail to nourish the child on the generating cycle b) Allow an insult to occur on itself by creating a excess in the controlling cycle (Yin deficiency and heat symptoms) When an element is in excess: a) Draw excessively from the mother b) Over-act on the controlling cycle (Yang excess causing dry symptoms TCM Organs TW/San Jiao: organ system - regulating movement/distribution of fluids and energy (Qi) throughout the body Upper burner (Shang Jiao)→mist; lungs, heart Middle burner (Zhong Jiao)→maceration chamber; stomach, spleen, liver, GB Lower burner (Xia Jiao)→draining ditch; LI, SI, bladder, kidney 8 Principles and 6 Pathogenic Factors Pattern differentiation – ways to look at the whole picture and determine treatable patterns 1. The 8 Principles – yin-yang, heat-cold, internal-external, excess-deficiency 2. The 5 Elements – controlling, generating, insulting cycles 3. The Vital Substances – Qi, blood, body fluids, essence 4. The Zhang-Fu Organs – 5 Yin and 6 Yang organs and 6 extraordinary organs 5. Pathogenic Factors – wind, cold, heat/fire, dampness, dryness, summer-heat 6. The 6 Stages – Tai Yang, Yang Ming, Shao Yang, Tai Yin, Shao Yin, Jue Yin 7. The 4 Levels – Wei, Qi, Ying, Blood 8. 3 Jiao (Burners) – upper, middle, and lower Jiao 9. The Meridians Causes of disease –internal (often from stress and emotional problems that can damage individual organ systems leading to lack of functioning) or external (pathogens that attack the body from the outside (ex. diet, drugs, alcohol) 6 Pathogenic Factors Wind - Used as source for other factors to enter; moves around, arises quickly and changes rapidly. Lungs affected first (yang) - Tremors, convulsions, stiff/rigid muscles, paralysis, pain moves from joint to joint. quiver, stiff, deviation of tongue - Wind Cold DDX- Aversion to cold/wind. Sneezing, chills, coughing and runny nose white discharge. stiffness and aches. Pulses –floating; tongue – no change from normal - Wind Heat DDX- Aversion to heat/wind. Fever, sneezing, cough with yellow discharge and runny nose yellow mucus, itchy/sore throat, swollen tonsils, red back of throat. Pulses –superficial; tongue – no change from normal - Internal wind – liver affected. Tremors, tics, itchy. Severe dizziness, vertigo, convulsions, unconsciousness, hemiplegia. Deviation of mouth/tongue Cold - Contracts and congeals. Clear discharge. Sleepiness, severe local pain improved by heat, craves warmth, aversion to cold and feels cold, (injures yang) pale complexion, lack of thirst, loose stool. Day or night - Pulse – slow; White coat, blue purple tongue Heat - Potential to generate Wind when severe. Blazes upwards. Drying, high fever, desires cold, aversion to heat, heat sensation, redness. (yang) Constipation/foul-smelling diarrhea. bleeding – cough, vomit, nose, gums, urine, stool, skin. Scanty/dark yellow urine. Affects mind, restlessness, irritability. - Rapid anything – pulse/breathing rate; tongue – yellow coating or red tongue body Dampness - Excess of Yin. From damp environments, lack of movement. Sticky and difficult to get rid of; heavy and slow. Feeling of heaviness, pain, (yin excess) swollen, oozing. No appetite, bloating, made worse with food. Cloudiness of discharges. Pulse – slippery; tongue – sticky coat and/or fat, swollen wet tongue Dryness - Internal dryness without heat signs or symptoms (yin deficiency) - From dry and/or hot weather, internal heat, dry warm foods/herbs, lack of fluid, not enough fruits/veggies, salty processed food. Symptoms are dry Summer heat st - only in summer and usually 1 aid situations. Heat stroke, combination of heat and damp. Aversion to heat, sweating, headache, thirst (yang) (none if severe), feeling of heaviness, dry lips, scanty dark urine, irritability, delirium, slurred speech and unconsciousness - Pulse – rapid; Tongue red on sides/tip The 8 Principles: framework to assess and categorize a patient’s condition; divided into four pairs with two opposing principles Exterior and interior Exterior - skin, muscles and channels – including the space between skin and muscles where Wei Qi and sweat are located (area where invasion by external pathogenic factors enter first). Patterns→aversion to cold, fever, aching body, stiff neck and a floating pulse Interior- Internal organs may have arisen from an exterior pathogen but considered interior once penetrated. Patterns→internal organ patterns Heat and cold Heat –hot, fever, sweating, thirst. Empty vs. full-heat – dependent on if it is a manifestation of excess Yang or if Yang is relatively in excess Cold –cold, cold limbs, absence of thirst. Empty vs. full-cold – depends on Yin, if it is in excess or relative excess of Yang Excess and deficiency Excess - presence of a pathogen while Upright Qi is intact and fighting against the pathogen. Pain worse w pressure/acute. Irritability, restlessness. Strong voice Deficiency- emptiness of the Upright Qi, pathogen absent Empty Qi→pale face, weak voice, slight sweating, slight SOB, fatigue, loose stools, poor appetite Empty Yang→bright pale face, cold limbs, no thirst, desire for hot drinks, frequent pale urination Empty Yin→ afternoon heat, night dry throat, sweats Empty Blood→dull-pale face, lips, dry hair, blurry vision, tired, bad memory, insomnia, scanty periods Vital Substances Qi (YANG) Qi: root of human body; Promote growth and development, Warming, Defence – Wei Qi protects from exterior attacks, Checking – maintaining homeostasis, Nourishing – Ying Qi or Nutritive Qi, Qi Hua – function of the organs (ex. lung Qi) Yuan Qi (original) o Rooted in kidneys→transported through body by San Jiao o Greater Yuan Qi = greater Zang-Fu activity o Inherited from pre-heaven essence; supplemented and nourished by food essence o Depleted by excess activity/lack of rest, long illness. Increased ejac/preg Food Qi (fu chi) o Grains of Qi; first stage in transformation of food into Qi o Food rotted/ripened→spleen transforms to Food Qi (unuseable)→rise to lungs, combines with air to form Zong Qi o Food Qi goes to heart→transformed to blood Zong Qi (gathering) o Formed from interaction between Food Qi and air; related to function of heart and lungs o Assists heart & lungs to push Qi and blood to limbs; gathers in throat and assists in speech o Zhen Qi = last stage of Qi transformation; Zong Qi transformed into True Qi (2 forms of Ying Qi and Wei Qi) Ying Qi (nutritive) o A refined Qi made from food (extracted by the spleen and stomach), air and Yuan Qi o Nourishes internal organs; closely related to blood that flows in the channels and blood vessels Wei Qi (defensive) o Defends external pathogens, protects muscular surface, controls pores, moistens skin/hair, adjusts body temp o Warms up Zang-Fu organs Zang-Fu (organ) Qi o Function of the organs o Zang organs – Yin organs – solid organs; Fu organs – Yang organs – hollow organs Other Qi Meridian Qi and Zhong Qi (middle) Blood (YIN) Made from Food Qi from spleen/stomach→rise to chest→acted on by Yuan Qi→blood→not complete until sent to Heart Functions: Nourish and moisture – movement of eyes and limbs, nourishes hair, sinews, bones, and bowels. Foundation of mental activities – houses the mind. Circulates with Ying Qi. Determines menstruation. Heart governs blood, Spleen makes blood & supports keeping blood in its place, Liver stores blood Qi = commander of blood (moves it) ; blood = mother of Qi (gives body nutritional substance) Body fluids Sweat, saliva, urine, tears, digestive juices. To moisten skin, muscles, organs, mucous, membranes and orifices Jin – thin: Circulate with defensive Qi, Controlled by lung, Clear and watery; on mucous membranes, skin. Warms and nourishes muscles, moisten skin, is fluid portion of blood Ye – thick: Circulate with nutritive Qi, Controlled by spleen and kidney, viscous; in bowels, brain, bones. Lubricates joints, bone marrow and CSF Fluid metabolism In stomach fluids are churned/separated→spleen further separates→ascends pure to lung and descends the impure to SI→SI further purifies, sends pure to stomach/spleen and impure to LI or bladder →lungs send most refined to skin and less refined to kidneys→kidneys send steam to lungs to moisten Shen (mind): closely related to the heart; responsible for many different mental activities No physical nature; broader concept that allows mind body connection (considered a spirit) Functions: Consciousness, Thinking, memory, Insight, Cognition, Sleep, Intelligence, Wisdom, Ideas, Affections, Feelings, Senses Essence primary substance for growth and development. Prenatal essence (from parents; nourishes embryo, creates individuality), Postnatal essence (from food/fluids eaten; easiest to change/improve). Jing = primary substance for growth and development. 8-year essence cycle for MEN - 8 years – essence is full; hair grown, teeth change - 16 years – essence abund; Water of Heaven, Jing Qi, YY harmony, fertile - 24 years – Jing (essence) plateaus; tendons and bones are strong, wisdom teeth come in, peak of growth - 32 years – tendons and bones at strongest; flesh is full and strong - 40 years – essence is weakened; hair falls out, teeth are loose - 48 years – the Yang Qi is exhausted, face darkens, hair whitens - 56 years – liver/kidney weak, tendons can’t move, Dew used up, little semen, looks/body are at end - 64 years – hair and teeth are gone 7-year essence cycle for WOMEN - 7 years – essence is ascendent; hair grows, teeth changes - 14 years – Dew of Heaven, Conception Meridian, Penetrating Extra Meridian is full, menses, conceive - 21 years – essence plateaus; wisdom teeth come in, growth at its peak - 28 years – tendons, bones strong, hair peak, body is strong - 35 years – Yang Brightness Meridian weakens, face darken, hair falls out - 42 years – 3 Yang Meridians are weak in the face, face dark, hair white - 49 years – Conception Meridian is deficient, the Penetrating Extra Meridian is exhausted, Water of Heaven is dried up, Earth Road (menses) is not open, weakness and infertility set in 5 Shu and Point Classifications Points can be classified by: location on a meridian or action of the point Selecting points depends on the goal of the treatment (solve problem or mediate symptoms) 5 Shu points (WELL – SPRING – STREAM – RIVER -SEA): transporting points; between fingertipselbows or toe tips-knee o Y&Y meridians have 5 Shu points; representing dynamic areas of change where Qi is abundantly stored o Larger bodies of energy as you move from tips to the knee or elbow o Superficialness of “well” points = attacked by external pathogen, accessible = acute/quick benefit from these points o Deepness of “sea” points can be used for more long-term effects; will take longer but will last Well points 1. 2. 3. 4. 5. acupuncture Pain management via opioid peptide – “gait theory”; release intrinsic hormones from brain Muscle length changes – contract muscles via trigger points; send brain to stop signals Neurological inhibition – inhibit stimulation Inflammatory modulation – increase/decrease inflammatory mediators Neurophysiological effects mediated by a variety of areas in the brain (fMRI studies) Acupuncture in neurological conditions o Local – A-delta, C-fibres and group II/III fibres o Segmental – dorsal horn o Extra-segmental and central regulatory – brainstem, limbic, endocrine, ANS o Myofascial trigger points – pain relief via nociceptor inhibition 6.Meridian flow theory: interconnectedness of body & organs; pathways/channels Qi (energy) flows in. Move from greater yin to greater yang with path of least resistance; lesser yin and yang areas are intermediaries and make the transition more gradual Anatomical position: arms abd, elbows flexed 90 degrees, hands up. TOP of body=more YANG YIN: Front, Lower body, Leg, head, convergence, and transitional areas (ex. elbows and wrist = conversion areas and hands and feet are transition areas) YANG: Back, upper body, arms, hands Location: fingertips or corner of nailbed Highest energetic ability for change within the body; change between Y & Y; outward movement of Qi Use: severe acute situations (eliminate pathogenic factors quickly). Can be bled to clear excess heat rapidly Spring Located between the fingertips and the wrist or ankle Powerful and dynamic points Capable of quick change within the body Uses: to clear heat (Good for external pathogenic heat like Wind-heat). Can use moxa here to tonify fire or heat Stream “source” points Location: near or at wrists and ankles Wei Qi gathers here; prevent external pathogens from traveling deeper into meridian Uses: joint, muscle, and tendon pain from dampness River points Location: between wrist + elbow or ankle + knee Qi wider and deeper Uses: treating cough, asthma, and respiratory conditions (especially with Yin channels). Can use moxa on Yang channels to strengthen weak yang or fire Sea “earth” points o Location: near or at elbow or knee o Qi flow slow and directed inward o Uses: chronic diseases; especially on Yang channels. Stomach issues, cooling effect for skin rashes, organ problems Source points: larger points in TCM that contain Original or Yuan- source Qi; all 12 meridians have a source point Actions – YIN meridians i. Tonify deficiencies ii. Balance Yin and Yang iii. Reduce excess iv. Regulate emotions o o o o o o o o o o o o o Actions – YANG meridians i. Mainly to reduce excess conditions ii. Some used to tonify deficiencies Xi-Cleft points: accumulation points o Located between fingers + elbows or toes + knees (exception: St 34 which is above the knee) ▪ Over a crevice/cleft in bone along the channel = pooled Qi o Qi gathers here and can be used for acute excess conditions and treat acute pain (which is often treated as obstruction or stagnation) o May not result in long-term effects or be effective in treating chronic conditions Triple warmer: major source point for tonifying Original Qi; since TQ is used to transport and move Original Qi ascending from between the kidneys Window of the sky points: Window of the Heavens, Celestial-Window points, “tian or pinyin”; balances mindbody connection o Used to treat psychological disorders (ex. emotional concerns, grounding) o Located mainly on the neck – susceptible area of disconnection between the head (mind) and the body o Balance Yin in the lower body and excess Yang in the upper body Command points: profound effects on certain areas of the body; affinity towards certain areas o Qi and blood directed towards but nonspecific (i.e. does not tonify or sedate but will send Qi/blood towards) o Can be used with other points Influential points: gathering points; affinity for certain tissues o Only a balancing effect; still not specific enough to tonify or sedate directly NUT Global Nutrition Crisis (-) Interest in Nutrition for Population – post WW2 (+) Health Care Cost (-) National Security (-) Nutritional Science (+) 60s/70s Dietary Advice (-) Improving Nutrition Practise Discovery of Vitamin C (ascorbic acid) / its benefits Nutrition focus in the 1980s/90s Modern Conclusions Future Developments Canada’s Food Guide (2020) Principles Nutrition in Healthcare - Poor diets (deficiency or excess) - Double Burden: Food and diet “double- edged sword” disparities – undernutrition in developing countries, over nutrition in wealthy countries - In times of crisis government had to intervene w basic model of Canada’s first food guide - Much more nutrition research was emerging - Impact of Malnutrition on the Population - Nutrition assessment - Future Research for Measuring Food Sensitivities/Intolerances Increasing costs associated with treating preventable chronic illness (DM, HTN, cancer) Climate change = loss of crops = less accessible food = higher $$ of groceries Lack of nutrient access = Increase in chronic illness = decrease in country’s social stability More research in nutrition= foundation for policy change = increase health of population Nutrition approaches = reductionist (only divided into input/output of calories) Dangerous calculation method - does not include nutrient density / quality, holistic factors Increase research & reputable data and knowledge Implementing policy based on emerging credible research Discovered (1932) Research emerged; helps build collagen, connective tissue and bones Cofactor for many chemical rxtns in the body (IAA metabolism) Antioxidant (donates e- to reduce molecules, less harmful state) highlight food as medicine Link between poor nutrition and chronic diseases (DM, hypertension) At this time, their solution was to reduce carbs, increase protein rich foods Low success in reducing chronic disease (didn’t include nutrient density/exercise) Best to eat wide range of high quality, nutrient-dense foods Increase - fish, nuts, F & V, whole grains, Limit – refined grains, sugars, processed meats Nutrient interactions (increase the bioavailability, when eaten together) Diet and microbiome (we are born with “normal” bacteria in the gut. As we age, food Δ fxn Effects of diet composition > counting calories; nurture > nature influences our nutrition Accessibility – when prescribing nutrition support, consider cost, cultural, social preferences Regulations – i.e. sugar tax Daily food – vegetables, fruits, whole grains, proteins, legumes, soy, nuts, seeds, fish, lean red meat Low fat milk and yogurt, UFA should replace Fas Nutritious foods to eat regularly – fresh, frozen, canned, dried Socialization while eating is a key factor for health – SYN state, mindful eating Daily physical activity recommended Limit ingestion of Trans Fats (increases risk of CVD and high cholesterol) –created by altering hydrogen bonds of oils, harder to digest, more inflammatory Create public awareness on costs of chronic illness, the impact on society / economy, how proper nutrition / lifestyle can improve health As an ND – be an educator / role model for proper nutrition and lifestyle to others, organizing community health nutrition programs, advise good NUT practise to policy makers 20-50% of people are malnourished / high risk (globally) Improper nutrition = weight mgmt, nutrient deficiencies (Fe, B12, Vit D deficiency), poor immunity, muscle weakness, digestive disorders Early Nutrition Assmt = potential risk factors that may negatively affect overall health Implementing proper nutrient plans = support patient nutritional status Fecal assays: targeting tryptase, eosinophile cationic protein, calprotectin Evaluating real-time microscopic changes to gut mucosa Gluten free diets DRI: Dietary Reference Intake - number of vitamins, minerals, other substances we need such as fibre – to not only PREVENT deficiencies, but to also lower the risk of chronic disease. Measurements include: 1. 2. 3. 4. 5. Estimated Average Requirement (EAR) - Calculated by the amount of a nutrient that is estimated to meet the requirements of HALF (50%) of all healthy people in a specific age/gender group (not most accurate) Recommended Dietary Allowance (RDA) - Average daily dietary intake that is sufficient to meet the requirement of almost all (97-98%) healthy people (calculated from EAR) Adequate Intake (AI) - Determine the amount of a nutrient eaten by a group of healthy people which would assume an adequate level to promote health in a sample population. Only established when EAR/RDA can’t be calculated) Tolerable Upper Intake Level (UL) - max amount of a nutrient that you can consume. Acceptable Macronutrient Distribution Range (AMDR) - % range of macros intake associated with reduced risk of chronic disease, while providing adequate intakes of essential nutrients prospective observational study is the best evidence Vitamins that Need a Prescription in Ontario - ATP - CaCl (IV) - Ca gluconate (IV) - Colchicine botanical - Dextrose injection - Folic acid >1mg - L-tryptophan >220mg - Levocarnitine - Nitroglycerin - Pilocarpine botanical - Podophyllotoxin botanical - Vitamin K1, K2 >0.12mg - Yohimbine Folic acid Vitamin B12 Niacin B3 Selenium (Micronutrient) Chromium Zinc Protein *variable Essential Fatty Acids Lipoproteins Polyunsaturated Fatty Acids (PUFA) Fibre Mediterranean Diet $$ Vegetarian diet Vegan diet Vitamins B vitamins Minerals Necessary for rapidly dividing cells, growth, NS development; In pregnancy, supplement with folic acid + B12 (cofactors) Deficiency: spina bifida to babies developing in utero Contradicted in: cancer patients – bc folic acid promotes rapidly dividing cells ONLY found in animal products (vegetarians / vegans must supplement with it to meet DRIs) Need 2.4ug daily (small amt) Cobalt constituent gives it the “red” colour First discovered in liver extracts (storage area, 3 months). Enhance bioavailability (B12 + folate together) Tryptophan (protein) converts to B3 Discovered that alkalization of corn > releases Niacin (helped with global deficiencies of this nutrient) 4 Ds of Niacin Deficiency (Pellagra) Dermatitis, Diarrhea, Dementia, Death Essential for Activation of Vitamin E Dietary Source – Brazil nuts Healthy thyroid functioning, healthy liver detox Essential for Glucose Metabolism, a cofactor for insulin (make insulin more effective when processing glucose) Dietary source – grapes. Can help with DM Plant foods rich in calcium or bone metals (Calcium, copper, soy) all compete with zinc for absorption in the bloodstream NOT a common deficiency (since it is abundant in nearly all food types) Essential for fertility, sperm production ✓ Building a healthy skin barrier Multiple AA’s are required to synthesize a protein structure, need a variety of protein sources (and therefore AA’s) Different requirements based on age, gender, activity level, necessary for immunity – building antibodies Deficiency causes: high bad cholesterol and IHD (Ischemic Heart Disease). Severe is rare – weakness, blurred vision, scaly dermatitis. Relative deficiency is common; FAs compete with each other in biochemical pathways - UFAs essential for skin health and growth; quality > quantity - Sourced from supplements (ethyl ester > triglycerides), Krill Oil (has EPA & DHA) 1)Linoleic Acid (Omega 6) 2)Alpha Linoleic Acid (Omega 3FA): precursor to EPA & DHA (Skin healthy) - EPA: anti-inflammatory, anti-thrombotic, hypolipidemic || DHA: development of functioning CNS and retina - Oxidation of EFA —> longer Highly-UFAs (eicosanoids - cell membrane) 1) Prostaglandins - Regulate inflammation, vasoconst, platelet agg., hormones, cell growth, eye pressure, fever, glomerular Filtration Rate 2) Thromboxones - Vasoconstrictive (alertness), hypertensive (healthy), platelet aggregation 3) Leukotrienes - Immunity; inflammation in asthma, allergies, anaphylaxis. Respiratory; bronchoconstriction (prevent patho), increases mucus - Fats are NOT soluble, to make fats soluble in blood, we MUST combine them with proteins - HDL (higher concentration of protein) is more water soluble, easier to move through the bloodstream - We need an appropriate ratio of BOTH HDL and LDL to be within an optimal range - Big dietary source = fish (has more Omega-3s>plants, more anti- inflammatory) - Plants have higher ratio omega6:omega3 (more inflammatory) - Helps to prevent heart disease and cholesterol concerns - Dietary sources – whole grains, whole foods, vegetables - Poor fibre intake = poor colon health, lazy colon, unable to excrete harmful bacteria efficiently, sits in the body - Link between poor dietary fibre intake and high LDL, colon cancer, type 2 diabetes - Improves transit time of food, allowing bad bacteria’s to leave our body efficiently - Goals = prevent CVD, cancers, cognitive decline, type II DM - Food principles – seasonal grown, fresh F&V, beans, nuts, seafood, conscious of where fish is coming from - Preventative healthcare, less costs associated with treatment - Poultry and dairy should be grass fed (less inflammation in animals' diet, when we eat them) - V&F, milk and dairy, nuts, NO – meat, fish - F&V - at least 5 servings/day (fibre, antioxidant source) Fats – should be unsaturated - Increased risk of iron / B12 deficiency - Need to eat a variety of foods to enhance nutrient density, complimentary food absorption - Milk / dairy = protein, calcium, vitamin A, B12, Eggs = animal protein, Vit B12 - ONLY plants and nuts NO – animal products - Minimum 5 servings F&V / day - Certain CVD can be reversed with vegan diet (alongside meds) - Vitamin D / Calcium from dark green leafy veg, fortified soy products, pulses, sesame seeds, tahini, dried fruits - Iron sources = whole bread, iron fortified cereals, nuts, dried fruits - Fats – high quality veg oils - Benefits – protection from CVD, certain types of cancer, managing DM II, weight loss - Vitamins – organic molecule necessary in small quantities for healthy metabolism A) Water soluble (C, B) - excreted by kidneys, harder to OD B) Fat soluble (ADEK)- stored in fat, metabolized by liver, not excreted by kidneys. Eat with fatty meals to increase absorption - Cofactors to help convert inactive proteins, necessary to activate vital proteins (enzymes, hormones, etc) - Energy Releasing —Thiamin, Riboflavin, Niacin, Pantothenic Acid, B6, Biotin - Hematopoietic (responsible for RBC/WBC formation) -Pantothenic Acid, B6, Folate, B12 - Macrominerals – Ca, Mg, Ph, K, Na, Chorine -Maintains bone and CT health, electrolyte balance, muscle and nerve action potential - Microminerals- Iron, Copper, Zinc, Selenium, Chromium, Iodine, Manganese, Molybdenum, Fluoride, Boron, Silicon, Vanadium - Needed in much smaller quantities, still essential for health - Blood building, hemoglobin syntheses (Fe), thyroid Fx (iodine, selenium), glucose Metabolism (Chromium, vanadium), bone, connective tissue (boron, silicon) Carbohydrate - Makes Glycogen, Deoxyribose, Glycolipids - Digested to monosaccharides (glucose, galactose, fructose) - During Resting State: -Insulin receptor required for glucose to bind to cell, enter fat/resting skeletal/liver cells - During exercise: -Insulin not required for cells to use glucose (diabetic should exercise to become LESS dependent on insulin, process glucose for regular metabolic activities) - Imbalance of Glucose: DM (I or II), IHD, HTSN, Renal dysfunction / failure, stroke, peripheral neuropathy Lipids - Cell Membrane Functioning, Energy Metabolism, Fuel - Signal Transduction - Delay aging, neurogenerative diseases Prostaglandins (from Arachidonic FA) - Regulate inflammation - Vasoconstriction / platelet aggregation - Regulate hormones, cell growth, eye pressure, fever, glomerular filtration rate Lipoproteins: - Requires hydrophilic protein coat to be able to transport - LDL (Pro-Atherogenic): [fat] = or > [protein] - HDL (Anti-Atherogenic): [protein] > [fat] - Need BOTH Apolipoproteins: - Proteins that bind lipids to form lipoproteins - Structural role, ligands as lipoprotein receptors, guide lipoprotein formation, Activators / Inhibitors of enzymes for lipoprotein metabolism - GOOD Inflammation (within range) = regulate blood flow, increases heat to area to help fight bacteria / infections - Metabolism – fat circulating between liver, lymph and blood Protein - Growth, development - Synthesis of hormones, enzymes -Build DNA / RNA structure, muscles - Maintain pH, body fluids, Immunity - Lipid metabolism (lipoprotein complex) - Energy - Protein ingested —> converted to aa’s 1)Anabolism 2)Catabolism 3)Excess discharged – in urine as ammonia or skin as sweat Microbiome - Microbiome Bacteria + Non-friendly bacteria = should be in healthy BALANCE - Mouth/Pharynx/Respiratory System/Urogenital Tract/ Stomach/ SI / LI/Bowels (digestion / absorption) - Cancer prevention/ Weight flux/Immune function/Metabolism Regulator - Firmicutes (main types)/Bacteroides/Actinobacteria - Must balance coordination between 3 cell groups: 1)Gut Microbiota – secretes chemicals —> epithelia (gut lining) 2)Epithelial Cells – connects to —> immune cells (under gut lining) 3)Immune Cells - What you eat = reflected in growth / suppression of microbiome - Genetics = determines the types of nutrients each microbiota needs - Inflammation = what we eat will put our microbiome into either an anti or pro-inflammatory state. Highly refined/ artificial sugars = increases risk of chronic disease (not digesting food/eliminating wastes optimally) - Anti-Inflammatory Foods = high fibre foods, prebiotics, dark leafy veg - Essential Nutrients (Prebiotics required to FEED probiotic foods) : SCFA, Peptides, Polysaccharides, Linoleic Acid (Omega 6) - Dysregulation = dysbiosis = Pro-Inflammatory State - Dysbiosis (increased bad bacteria, eats away at GOOD bacteria), DECREASED gut DIVERSITY = increased risk of health - Lack of Diversity can cause: 1)Dysregulation of microbiome 2) Useful Bacteria do NOT find their essential nutrients to thrive 3) Impaired ability to absorb good nutrition in body - Influencing Factors: Exercise, Lifestyle, Genetics, Environment, Antibiotics, Probiotics, Prebiotics, Diet, Fecal transplant Food Intolerances - Non-immune mediated responses / reactions to foods (25% of IBS patients) - Can take time to see reactions Clinical diagnosis: o monitor associated bowel changes / discomfort after certain types / foods o Lab Testing – IgG food sensitivity testing (minimal efficacy – not evidence- based) 1)Food elimination diet - Eliminating foods that can trigger inflammation = improved microbiome quality and quantity = reduces inflammation / symptoms - Typical example = discontinue most inflammatory foods (wheat, dairy, eggs for 3 mo) - Not evidence based 2)Low-FODMAP Diet - Exclusion of FODMAP foods for 6-8 weeks, slowly reintroduce them - HIGH FODMAP Foods = short chain carbs (fermented by gut bacteria, converted to methane / H2 gases which are poorly absorbed) - Classic symptoms = bloating, gas, abdominal discomfort, food intolerance symptoms - Advantages: better tolerated than elimination diet, more evidence-based than IgG OR elimination diet plans Food Allergies - Common Allergies :Nuts, eggs, shellfish IBS - Abdominal pains / colic / discomfort that are not Immediate allergic response associated with an - GI symptoms: severe pain, gases, organic disease bloating, burping - Minimum 2 of - Skin rash: (hives, urticaria like rash) these criteria: purpura, pamphlets - Related to - Joint pain / arthritis defecation - Respiratory symptoms: allergic rhinitis - Associated with a or asthma change in stool - Rare – anaphylaxis frequency - Associated with a Testing change in stool - Lab Testing: Ig E antibody titer is consistency high in these pts - Skin prick test BOT Botanical medicine: oldest form of therapy; based on Vital Force and relationship between plants, humans and planet “planetary wholeness” Biophilia: innate feeling or emotion for all living forms and systems; activated through relationship and experiences with nature History of Herbal Medicine Earliest records of therapeutic use of plants – Sumerian tablets (3000 BCE) followed by Ebers papyrus (1500 BCE) in Ancient Egypt o Herbal medicine practice 60,000 years ago in Iraq and 8000 years ago in China o Ancient herbal practices include: Ayurvedic Medicine, Traditional Chinese Medicine, African Traditional Medicine, Ancient Egyptian Medicine, First Nation Traditional Medicine, Arabic/Sumerian Medicine, Persian/Iranian Medicine, Greco-Roman Medicine Greco-Roman Roots Humoral Medical Theory – developed by Hippocrates and Aristotle; first European medical theoretical system Galen – surgeon to make humoral medicine the cornerstone of medicine in Europe for the next 1500 years Greco-Roman medicine integrated with Persian, Indian and Arabic practices by Ibn-Sina into the book The Canon of Medicine in 1000 AD Element Quality Humor Fire Choler (yellow bile) Hot Exc: Tingling, burning, itching, jaundice, flushing, redness - Stimulating, cayenne Def: Ingestion, bloating, loss of drive Temperament Choleric Argumentative, angry, restless, decisive, hard-working Air Dry - Toning, witch hazel Blood Exc: nervous, indigestion, mania, headaches Def: atrophy, fatigue Sanguine Socialable, talkative, playful, happy, impulsive, courageous Water Damp - Relaxing, Labelia Phlegm Exc: lung infection, bloat, loose stool Def: constipation, dry skin Phlegmatic Lethargic, passive, loyal, calm, adaptable Earth Cold - Sedating, valerian Black Bile Exc: insomnia, depression, weak digestion Def: impulsiveness, lack of focus Melancholic Moody, somber, worried, pessimistic, artistic, idealistic Historical herbal texts: Hippocrates (468-377 BC) – “Father of Medicine” wrote Hippocratic Corpus (300 plants) Dioscorides (50-70 AD) – doctor to the Roman Armies; wrote De Materia Medica (600 plants); remained key reference Early American Naturopaths Samuel Thomson (1769-1843) o Travelling physician using hydrotherapy and herbs; knowledge came from Indigenous peoples o Thompsonian movement (The Friendly Botanical Society) th Eclectic medicine – 20 century o Blending old/new theories – understand the body and herbs to treat. Ellingwood and Felter helped to publish Eclectic Materia Medicas Suppression of biophilia in medicine – 1906-1928 The Dawn of Chemical Pharmacology Paracelsus (1493-1541) o German-Swiss physician and alchemist – founder of chemical pharmacology. Believed medicinal action of each plant depends on its active principle o Arcana: meant getting to the pure chemical part of the plant; isolating it thought to be more effective and powerful while being safe o Doctrine of signatures: concept that plants contain visible including colour, form, place of growth, resemblance to human organs o Attacking use of plant medicines – dangerous, unscientific, wild and unpredictable o AMA licences to practice medicine based on achieving standards; away from herbal practices botanicals, eclectic, Thomsonian schools had closed Nicholas Culpeper (1616-1654) o English herbalist, apothecary and astrologist known for providing cheap and readily available health care to the poor o Translated Latin herbal pharmacopeia to English = English Physician – which made its way to North America and integrated Energetic Western Herbal Medicine Herbal constituents: “active ingredients”; one plant can have hundreds and there can be primary or secondary constituents Herbal actions: the effect an herb and its constituents have on the body Herbal energetics: describe how herbs and body interact; fine tune herbal selection for formulation Four qualities Hot – stimulating, warm Cold – sedating, cooling, relaxing Damp – moistening, demulcent Dry – astringent, drying Six tissue states: a) Excitation b) Depression c) Stagnation d) Atrophy e) Laxity f) Constriction Description Helpful to oppose Heat-excitation - Increased tissue function, overproduction, “hyper” conditions, Anxiety, irritability, restlessness - Red, swollen, tender, hot tissues, itching, burning, bleeding, inflammation - Tongue – red, yellow coat || Pulse – rapid, bounding Cooling, sedating, moistening Cold-depression - Lack of stimulation, insufficient tissue function, “hypo” conditions, Cloudy thinking, depression, lethargy - Poor circulation, cold, easy bruising, slow heal, dull or throb pain, slow digestion, constipation - Tongue - purple/blue with no coat or thick coat || Pulse – deep and slow Stimulating, warming, aromatic Damp-laxity - Lack tone, can’t hold fluid, mucus, diarrhea, saliva, sweat/ prolapsed organs, pale, cool, moist skin and mucosa - Tongue – moist, foam or streamers on sides || Pulse – full, non-resistant (floppy) Dryness, astringent Damp-stagnation - Hold excess fluid, improper assimilation of nutrients, swollen, weak, inactive tissues, thick/sticky/yellow mucous - Poor waste excretion, constipation, infrequent sweat/urine, poor liver function, sluggish, dullness and fatigue - Tongue – thick, floppy || Pulse – dull, slow Stimulating, detoxification, bitters, hepatics Dry-atrophy - Dry tissues, skin and mucosa (itchy), craves fluids, chronic constipation. Nervous exhaustion, poor memory Moistening, demulcent, and focus nutritive herbs - Tongue – dry, narrow Tense-constriction - Tension or spasm in tissues, rigid muscles, tension, digestive spasm or cramping - Feeling anxious or high strung, unable to relax, irregular or changing symptoms - Tongue – quivering || Pulse – wiry, tense Relaxants, antispasmodics, nervines, aromatics, diaphoretics Parts of Herbal Plants A. Aerial parts o When: spring to late summer when herb flowers o How: pick petals or whole flowers/leaves o Processing: dry herbs on rack or tie bunches to hang; wait until crunchy to store o Storage: air-tight out of light; keep for ~1 year B. Roots o When: autumn as nutrients settle downwards o How: roots after 1 year of growth; replant crown just below stem o Processing: wash/scrub root and peel off outer layer; cut and dry o Storage: up to 2 years in air-tight containers in cool/dark place C. Bark o When: early spring, sap rises; autumn, sap settles o How: collect from branches or saplings that are at least 2 years old pruning them in long stripes; never harvest bark from main trunk or ring o Processing: strip with knife; cut into pieces and dry o Storage: up to 2 years air-tight, cool/dark place D. Fruit and seed o When: summer to autumn (when ripe) o How: pick when fruit and seeds are ripe; some gathered when fresh and green o Processing: slice; lay out in single layers to dry o Storage: up to 2 years air-tight, cool/dark place Infused Oil Herbs steeped in warm or cold oil; can be used topically or internally via cooking - Carrier oil options include: olive, almond, coconut, shea butter, sunflower, castor, grapeseed ( 6-12 mo) Powders, capsules, tablets Powdered herbs stirred into food and drinks, encapsulated or pressed into tablets (standard) Posology Considerations a) Empty stomach – cleanse, detox; best for internal herbs b) Before a meal – nervous conditions, help digestion c) After a meal – for indigestion and gas d) Taken with food – to lower the strength of preparation Monograph structure: 1. Picture of plant 2. Latin name, common name and family name 3. Part used 4. Constituents and actions 5. Pharmacology: Medicinal uses/indications 6. Pharmacy and posology 7. Contraindications, cautions, toxicity concerns, Interactions 8. Optional: energetics, taste, folklore Tincture Herbs steeped in alcohol or vinegar; alcohol better at extracting most constituents and is a preservative o Folk Method –40% alcohol and stored for 4-6 weeks o Maceration method - identify herb material to liquid ratio and percentage of alcohol required (ex. 1:5 in 40%) o Percolation – moving alcohol through powdered herb slowly, letting the solvent drip through a container (2yrs) ▪ Benefits = fast processing (1-2 days), more concentrated ▪ Drawbacks = special equipment, fresh low mucilage plants Liniment Alcohol/vinegar tincture applied directly to skin (2 tincture:1 oil/ alcohol) o Muscular use – only apply to unbroken skin o Usually contains anodyne and rubefacient herbs in oil or alcohol; applied with friction Glycerite Herbs steeped in glycerine (1 year) Infusion Water-based - nonwoody herbs steeped in water (24h, refrigerated) Decoction Woody herbs simmered in water - More heat and time needed than infusion (48h, refrigerated) Inhalation Infusion or decoction is inhaled as steam; delivers constituents right into respiratory tract Bath Strong infusion or decoction is added to bath water; skin, genital/anal use Poultice Apply fresh, dried or powdered herb directly to the body - Used for skin irritation/damage, muscle pain/strain and inflammation (infection) - Hot or cold Salve Beeswax or thickener is to oil to produce a solid product to apply to skin (vulnerary, emollients) - Occlusive,protective (6-12 mo) Compress Infusion/decoction applied to skin with a soaked cloth; use for skin, muscle and inflammation - Warm or cool; contain vulneraries, astringents, rubefacients, circulatory stimulants Lozenges and pastilles Treat mucous membranes; demulcents, soothing expectorant, or antimicrobial. Contain finely powdered herbs Creams and lotions Emulsions of oil & water with medicinal phases being in either base - Absorbed into body - Work on surface of skin Vinegars, oxymels and honey, syrups Vinegars – promote digestion, support liver health - 4% acetic acid = extract fat- soluble constituents - Useful for no alcohol use – but does not keep as long Oxymel –honey is added; can infuse honey directly Herbal syrups – saturated sugar/honey in water (sugar=preservative, water=strong infusion/decoction) - Help absorption/effect of medicines, act as CHO Phytochemistry Primary metabolites: fundamental to the life of the plant (ex. protein, lipid, chlorophyll) Secondary metabolites: not fundamental to sustain life but serve functions within the plant; r plant constituents. For protection, interactions with other species, fragrance, colour, structure Constituent classifications a) Carbohydrates – inulin, arabinogalactans, beta-glucans, gum, mucilage b) Lipids - alkamides, fatty acids c) Phenolics – salicylic acid, coumarins, flavonoids, isoflavones, lignans, quinones, tannins d) Terpenoids – volatile oils, resins, saponins, phytosterols, carotenoids, cardiac glycosides, iridoids e) Alkaloids – isoquinoline, pyrrolizidine Glycosides - 2 molecules attached via glycosidic bond – glycone (sugar unit) and aglycone (any compound) - Phenolic glycosides – sugar attached to phenolic compound; typically, aglycone is active component and the sugar unit helps make them more water soluble. Need 25-60% solvent Considerations for herbal ethics and safety a) Social and environmental impact b) Cultural sensitivity and patient autonomy c) Quality and sourcing d) Toxicity, allergy and contradictions o Depends on: Dose, Time of exposure, Susceptibility of tissues and body metabolism, Re-generative, elimination and spare capacity of tissues or organs, The herb and the person o Allergies – whole plant or plant family o Contraindications e) Herb-drug and herb-herb interactions Herb-drug interactions Additive effects – same effects (ex. gingko with anticoagulant medications) Counteracting effects – opposing effects (ex. stimulant herbs with sedative medications) Changes in the way a substance is absorbed in the GI tract (ex. tannins and mucilage) Changes in the way a substance is metabolized and excreted (ex. grapefruit, SJW) Herb-herb interactions Bitter and pungent herbs can enhance absorption and assimilation of other herbs Tannins may reduce absorption of other constituents (particularly alkaloids) via precipitation Constituent solubility o Water-based solutions→ extract water soluble constituents like mucilage, polysaccharides and tannins o Fat-based solutions→ extract fat-soluble constituents like alkaloids, resins, volatile oils o Influences: Structure, size, polarity, functional groups, synergistic/companion compound content, solvent temp, plant matrix, type of solvent, solution pH 1. 2. 3. 4. 5. 6. MUCILIAGE: group of polysaccharides that form a gel-like consistency when combined with water Actions: demulcent, emollient, anti-inflammatory, vulnerary, bulking laxative, soothing expectorant, anti-spasmodic Emollients: softens and soothes the skin (for topical use only). Form a protective skin barrier + moisten inflammation, irritation, burn. Applied as a gel, salve, cream, lotion/poultice Herb examples: Aloe gel, Plantain, Chickweed, Comfrey Demulcents: soothe and protect irritated/inflamed internal tissue. Cooling, soothing and relaxing to the GI, respiratory and genitourinary tracts Herbs for the GI: Marshmallow, Licorice, Slippery Elm Herbs for soothing respiratory tract: Mullein, Coltsfoot Herbs for soothing genitourinary tract: Corn silk Vulnerary: helps healing wounds. Used both topically and internally. Promotes granular tissue laydown to form scab/eschar sooner. Allantoin is another constituent having action found in comfrey and plantain Herbal examples: Calendula, Comfrey, Plantain Bulking Laxatives: mucilage pulls water into colon to soften,bulk to stool Herbal Examples: Aloe gel, Psyllium seed, Flax seed, Marshmallow root Soothing Expectorant: removes excess mucous from lungs/soothes irritated lung tissue. Helps dry sticky mucous that is difficult to cough up. Helps unproductive and irritable coughs. Relax bronchial tissues + loosen mucous Herbal Examples: Plantain, Coltsfoot, Mullein COUMARINS: glycosidic form, vanilla odour; derivatives of hydroxycoumarins, furanocoumarins and pyranocoumarins Actions: anti-inflammatory, antimicrobial, antispasmodic and edema-modifiers Safety: anticoagulant effect only after fermentation, photosensitivity rashes Herbal examples: Horse chestnut, Red clover FLAVONOIDS: “biological response modifiers”, carbon skeleton with 2 substituted benzene rings; found in leaves, fruits and flower Actions: antioxidant, anti-spasmodic, anti-inflammatory, vascular tonic, liver-protection, anti-allergic, anti-viral/cancer 1. Antioxidant: redox regulators (transfer of electrons). Reduce oxidative damage caused by ROS. Inhibits reduction of dehydroascorbic acid via glutathione by acting as H+ donors allowing resonance stabilization allowing damaging molecules to be unreactive. Slows aging of cells Herbal Examples: Colourful fruits and veggies, Turmeric, Hawthron, Green tea, Reishi 2. Antispasmodics/ Spasmoltyics: prevent spasms/cramping of muscles o Nervine relaxants and carminatives. Salicylates, alkaloids, volatile oils also have this action Herbal examples: Hops, Chamomile, Peppermint, Cramp Bark, Ginger LIGNANS: polyphenolic indigestible plant fibers, metabolized by microbiota Actions: phytoestrogenic, antiox, reduce cholesterol, nephron, hepatoprotective Herbal examples: milk thistle, schisandra, flax seeds ANTHRAQUINONES: largest subgroup of quinones; yellow-brown pigments mainly occurring as glycosides Actions: stimulant laxative effects (dose and bowel flora dependent) via local action with little absorption Safety: pregnancy contradiction, adverse effects – acute intestinal pain/cramping, long term use – dependence, electrolyte imbalance, dehydration, interfere with absorption, Caution in acute IBS/IBD, children under 12, abdo pain, Herbal examples: cascara, senna, aloe latex, turkey rhubarb TANNINS: toning and tightening effect due to ability to precipitate proteins and reduce sections; found in shed parts of plants Actions: astringent, antimicrobial, hemostatic, vulnerary, anti-diarrhetic, dry up secretions Safety: constipation, iron deficiency and malnutrition, not with other med/supps, rich in hydrolyzable tannins should be reserved for topical use only (hepatoxic) 1. Condensed: pre-flavonoids Green / Black Tea; Red Raspberry leaf; White Willow 2. Hydrolysable: use caution Horsechestnut, WitchHazel, Bearberry, Arctostaphylos 3. Organ specific: o Gastrointestinal Tract Meadowsweet, Green / Black Tea o Kidney Horsetail, Bearberry o Lungs Plantain o Cardiovascular System Horsechestnut, Yarrow, Blueberry o Female Reproductive System Shepard’s Purse, Red Raspberry o Skin & Connective Tissue Horsechestnut, Witch Hazel ** Astringent: binding, tightening, drying, reduce mucous membrane irritation + improve membrane integrity, vulnerary effect Herbal Examples: Yarrow, Meadowsweet, Witch Hazel, Red Raspberry Leaf BITTERS: digestive stimulant; many constituents Actions: hepatic alterative, appetite, detoxification of liver, regulates BS, stimulates PNS, mild laxative, stimulates bile, acid and digestive enzymes Safety: avoid with IBD, diarrhea, pregnancy, kidney stones, acute GB disease, reflux 1. Hepatics – cholagogues and choleretics; supports liver cells and aid in digestion of food and fats o Cholagogues – stimulate the flow of bile from liver and gallbladder o Choleretics – increase volume of bile produced by liver o Hepatoprotective – turmeric o Hepatotrophroestorative – milk thistle 2. Alteratives - restore proper nutrition, function of the body. Blood cleansers– lymphatic, GI, urinary and skin systems Herbal examples: Burdock, Yellow Dock, Cleavers, Dandelion root, Stinging Nettle tops, Red Clover SAPONINS: “soap-like” based on a steroid or triterpene fat-soluble base joined with water-soluble sugar molecule Actions: adaptogen, anti-inflammatory, stimulating expectorant, anticatarrhal. Immunomodulator, diuretic, anti-spasmodic, aphrodisiac, antioxidant, emmenagogue, cardiac stimulant, hormone modulating, hepatoprotective Herbal examples: Wild Yam, Licorice, Ginseng SALICYLATES: ease pain + reduce inflammation; group of simple phenolics = salicin + methyl salicylate + salicylic acid Actions: anti-inflammatory, analgesic, anti-pyretic/febrifuge, anti-septic Safety: high doses can be toxic (hearing loss in zinc-deficient people), salicylism, avoid if allergic 2. Anti-inflammatory: modulate inflammation (suppress or promote). Supports and balances cytokines, interleukins, prostaglandins, leukotriene etc. 3. Analgesic: soothe and relieve pain. Usually salicylate, alkaloid and resin constituents; used in low doses for long periods. Lessen neural sensitivity within NS via: Sodium dependent channel inhibition to reduce AP transduction along nerve fibres & Stimulate and deplete Substance P Herbal Examples: Cayenne, California Poppy, Cramp Bark, White Willow 4. Anti-Pyretic/Febrifuge: control/reduce fever Herbal Examples: Meadowsweet, Peppermint, White Willow VOLATILE OILS: aromatic herbs; complex mixture of compounds Actions: carminatives, rubefacients, nervine stimulants, nervine relaxants, antimicrobial, immune stimulants, anti-inflammatory Resin actions: anti-inflammatory, antimicrobial, expectorant, rubefacient Safety concerns: Internal use can cause salivation, perspiration, peristalsis, stimulate heart muscle contraction. Essential oils (EO) – not internally (contradicted in pregnancy), caution with topical EO 1. Carminatives: ease and promote digestive function. Soothe gut wall and remove gas. Stimulate and relax muscle tissues of intestines Herbal Examples: Fennel, Chamomile, Lemon Balm 2. Rubefacients: dilate BV and mildly stimulate tissue. Cleanse and nourishes affected tissue via improved blood and lymphatic flow. Draws blood from deeper parts of body into skin to benefit organs Herbal Examples: Mustard seed, Cayenne, Castor Oil, Onion & Garlic 3. Nervine relaxants: beneficial effect upon the nervous system, ease physical and psychological tension in cases of restlessness and anxiety (high dose = sedative) Herbal examples: Lavender, Passionflower, Lemon Balm 4. Nervine stimulants: stimulates the nervous system in cases of mental fatigue Herbal examples: Peppermint, Orange EO, Caffeine 5. Nervine tonics: strengthen and feed the nervous system in cases of nervous debility and exhaustion Herbal examples: Oat tops, St. John’s Wort, Gotu Kola 6. Immune stimulants/antimicrobials: directly against bacteria or virus and stimulate innate immunological defenses Herbal examples: Tea tree oil, Oil of oregano, Echinacea, Old Man’s Beard ALKALOIDS: containing nitrogen-bearing molecule; found in flowering plants Actions: anti-spasmodic, analgesic, anti-arrhythmic, anti-bacterial, anti-cancer, nervine stimulant, vasodilatory, psychotropic/hallucinogenic Safety: potentially toxic, adhere to max weekly and daily doses, contradicted in pregnancy and lactation 1. Indole: Passionflower, Peyote 2. Isoquinoline: Corydalis, California Poppy, Oregon Grape, Goldenseal 3. Purine: Coffee, Tea Herbal examples: Deadly Nightshade, Goldenseal, Oregon Grape, Lobelia, Borage, Comfrey, Coffee, Green tea, Chocolate