Week 2 notes.docx

**Botanical medicine** **Wild indigo** - **Latin name:** Baptisia tinctoria - **Family:** Fabaceae - **Part used:** root - **Actions:** lymphatic, anti-microbial, immune-stimulant, anti-catarrhal - **Constituent:** polysaccharides & glycoproteins, quinolizidine alkaloids, iso...

**Botanical medicine** **Wild indigo** - **Latin name:** Baptisia tinctoria - **Family:** Fabaceae - **Part used:** root - **Actions:** lymphatic, anti-microbial, immune-stimulant, anti-catarrhal - **Constituent:** polysaccharides & glycoproteins, quinolizidine alkaloids, isoflavones, flavonoids. - **Pharmacology:** polysaccharides & glycoproteins stimulate the immune system. By increasing the number of WBCs and improving endogenous defense mechanisms. Stimulates lymphocyte DNA synthesis and antibody production. Indicated in acute infection with excessive mucus production associated with laryngitis, pharyngitis, tonsilitis, rhinitis and sinusitis. Has been shown to substantially reduce time to improvement in common cold in combination with Echinacea and Thuja. - **Dosage:** decoction: 1tbsp/cup, simmered 15 mins, 1 cup TID. Tincture (1:5. 60%): 1-3ml TID, max 60ml/week. Dried herb: 1g TID. - **Adverse effects:** nausea, vomiting, anorexia, hypersalivation, tachypnea, tachycardia, respiratory paralysis with toxic doses internally. - **Contradictions:** long term use of high doses; preg/lactation. **Ginger** - **Latin name:** Zingiber Officinale - **Family:** Zingiberaceae - **Part used:** rhizome - **Actions:** antioxidant, anti-inflammatory, anti-microbial, diaphoretic, carminative, anti-spasmodic. - **Constituents:** VO (zingiberene), sesquiterpenes, oleoresins (gingerols & shogaols). - **Pharmacology:** sesquiterpenes have specific anti-viral effects against rhinoviruses and RSV by inhibiting viral attachment and inoculation. Fresh ginger may stimulate mucosal cells to secrete IFN-beta to counter viral infection. Oleoresins help reduce pain, suppress coughing and modulate fever. - **Dosage:** infusion: 1g/cup, 1cup TID Tincture (1:5, 90%): 1.5-3ml TID, max 60ml/wk. Dry herb: 1-10g in divided doses. Fresh herb: 5g QD. Contradictions: caution with ulcers, GERD, gallstones, kidney disease, bleeding disorders, and those with sensitive stomachs. Additive effect with anticoagulant medication. **Herbal actions** A table with text on it Description automatically generated **Echinacea ** - **Latin:** Echinacea purpurea/angustifolia/pallida  - Plant part**:** Root and herb - **Indications:** prevent and treat common cold, flu, URTIs, vaginal candidiasis, UTIs   - **Actions :** Immunostimulant, antimicrobial (alkylamides, phenolics, polysaccharides)  - **Contraindications:** Caution in auto-immune disease, safe in preg and lact - **Side Effects: /** - **Research:** German Commission E  - Echinacea purpurea herb (Approved) - Supportive therapy for colds and chronic infections of the respiratory tract and lower urinary tract. - Echinacea pallida root - (Approved) Supportive therapy for influenza-like infections.   - *Note: Echinacea angustifolia herb and root & Echinacea pallida herb are UNAPPROVED because of lack of clinical trials for the specific plant parts.* - Clinical trial (2021): Echinacea purpurea (combo of root and herb) helped prevent respiratory tract infections and reduced associated antibiotic usage in children. **Ginseng** - **Latin:** Asian "Korean" Ginseng: *Panax ginseng* & Canadian ginseng : *Panax quinquefolius* (Araliaceae family) (Drug : Ginseng radix)  - Plant part**:** Root  - **Indications:** Stress, fatigue, cold/flu treat and prevent, low immunity   - King's American: loss of appetite, weak stomach, laryngitis, bronchitis - **Actions:** adaptogen, immunostimulant, immunomodulator, antiviral, aphrodisiac (Steroidal saponins, Polysaccharides)  - **Contraindications:** Caution: High blood pressure, Korean ginseng safe in preg and lact  - **Side Effects: /** - **Research:** German Commission E approved for fatigue and debility  - Review (2021): Various clinical trials of ginseng have exhibited a reduction in repeated colds and the flu **Andrographis ** - **Latin:** *Andrographis paniculata * - Plant part**:** Herb - **Indications:** Colds, Colitis/infectious diarrhea, Liver disease, autoimmune disease  - **Actions:** Immunomodulator, Antimicrobial, Bitter ("King of the Bitters"), Anti-inflammatory emmenagogue (Diterpene lactones = andrographolide, Polyphenols/flavonoids)  - **Contraindications:** Gastritis & stomach ulcers, obstructed gallbladder, not recommended/unknown in preg and lact   - **Side Effects:** May cause GI irritation -\> nausea, vomiting, diarrhea  - **Research:** Clinical trial (2009): Andrographis twice as effective as placebo in reducing symptoms and duration of URTI  **Siberian Ginseng ** - **Latin:** *Eleutherococcus senticosus* (Araliaceae family) (drug: eleuthero radix)  - Plant part**:** root  - **Indications:** Stress, Fatigue, treat/prevent cold and flu  - **Actions:** Adaptogen, Immunistimulat, immunomodulator, antiviral (Steroidal saponins (modulates corticosteroids) - eleutheroside A)  - **Contraindications:** Caution in high blood pressure, likely safe in preg and lact. - **Side Effects: / ** - **Research:** German Commission E approved as a tonic in times of fatigue and debility and convalescence  - In vivo: Eleutherococcus senticosus roots inhibited the productive replication of human rhinovirus (HRV), respiratory syncytial virus (RSV) and influenza A virus  - Clinical trial (2004): Eleutherococcus and Andrographis combo more effective than an Echinacea formula (with zinc, vitamins & astragalus) - Clinical trial: Eleutherococcus and Andrographis reduced the recovery duration of patients by 21% and significantly relieves the severity of typical URTI **Elderflower** - **Latin:** European: *Sambucus nigra,* Canadian: *Sambucus canadensis* (Caprifoliaceae family) (Drug: sambuci flos, elderflower)  - Plant part**:** flower and berries  - **Indications:** Cold and flu  - King's American: crusts on epidermis, skin affections  - **Actions:** Diaphoretic (sweating), Antiviral, Anti-Adherence (can't stick to cells), antirheumatic, diuretic, anti-inflammatory (Anthocyanin, flavonoids, tannins, ascorbic acid, cyanogenic glycoside in unripe)  - **Contraindications:** unknown in preg and lact  - **Side Effects:** flower and berries are safe, leaf bark and unripe fruit may cause severe vomiting and diarrhea  - **Research:** German Commission E approved for colds  - META-ANALYSIS: Elderberry supplementation significantly reduced the duration of upper respiratory symptoms compared to placebo.  **English Ivy Leaf** - **Latin:** Hedera helix (Araliaceae family) (Drug: hederae helicis folium)  - Plant part**:** leaf - **Indications: ** cough, acute/chronic respiratory inflammation and phlegm - King's American: pulmonary affections  - **Actions:** Expectorant, antitussive antispasmodic, antimicrobial (Saponins - hederacoside C)  - **Contraindications:** Generally safe, short term during pregnancy  - **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 for chronic inflammatory bronchial conditions  - Systematic review: All studies concluded that ivy leaf extract is an effective and safe option for the treatment of cough due to URTIs and bronchitis.  **Licorice ** - **Latin:** European licorice: *Glycyrrhiza glabra* & Chinese licorice: *Glycyrrhiza uralensis* (Family: Fabaceae) (Drug : Liquiritiae radix)  - Plant part**:** Root  - **Indications:** Respiratory tract infections, GI tract inflammation, Hepatitis/cirrhosis of liver, adrenal fatigue  - King's American: lessen irritation of mucous surfaces, coughs  - **Actions:** antispasmodic, expectorant, antimicrobial, demulcent, adrenal tonic, antiulcer, hepatoprotective (Saponins - Glycyrrhizin, Flavonoids - licoflavone)  - **Contraindications:** High blood pressure (Hypertension - can raise BP, caution with cardiovascular meds), caution in preg and lact (may be unsafe)  - **Side Effects: can cause potassium loss** - **Research:** German commission E approved for URTIs and gastric ulcers  - Review (2022). In vivo studies show antiviral effects but limited human research for licorice's effectiveness in respiratory infections. **Marshmallow ** - **Latin:** *Althaea officinalis* (Malvaceae family) (Drug: Althaeae radix & Althaeae folium)  - Plant part**:** root and flower  - **Indications:** inflamed mucous membranes, respiratory tract infections, inflammation in GI tract, UTIs  - King's American: diseases of mucous tissues, as hoarseness, catarrh, pneumonia  - **Actions :** Demulcent, Antitussive (Mucilage, Flavonoids)  - **Contraindications:** unknown in preg and lact - **Side Effects:** may delay drug absorption  - **Research:** German Commission E approved for irritation of oral and pharyngeal mucosa associated dry cough  - Review: Marshmallow alone reduced cough but combinations (Zataria multiflora, Zingiber officinalis, or Helix hedera) increased the efficacy. **Eucalyptus ** - **Latin:** *Eucalyptus globulus* (Myristicaceae family)  - Plant part**:** essential oil  - **Indications:** Respiratory tract infections, GI tract spasms  - King's American: catarrhal states of the broncho-pulmonary tract  - **Actions :** Antitussive, Expectorant, Antimicrobial, Carminative (Essential oils - monoterpenoids - eucalyptol)  - **Contraindications:** unknown in preg and lact - **Side Effects:** Pure eucalyptus essential oil can be irritating but considered safe - avoid pure essential oil  - **Research:** German Commission E approved for catarrhs of the respiratory tract  - In vitro (2013):  Essential oils found in peppermint and eucalyptus are antitussive - Meta-Analysis (2022):  Eucalyptus is safe, but efficacy considered minimal.  **HERB** **RESEARCH** **DETAILS** ------------ ----------------- ---------------------------------------------- Thyme Clinical trials Reduce in combos. In vitro antispasmodic. Eucalypus Clinical trials Reduce cough.  In vitro some antimicrobial. Goldenseal In vitro Berberine has significant antiviral activity Garlic Clinical trials Shows some benefits. **Health psychology** **Relational experience:** social engagement, active listening and compassionate presence **Attachment** Meeting discomfort and distress with reliable, loving care so as to soothe the baby/young child and establish CNS patterns of trust, security and comfort. Not just about one behaviour, but about providing consistent and kind response that regulates and entrains emotional health and a healthy stress system. **Insecure attachment styles** Anxious Avoidant Disorganized ---------------------------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- Safety in the presence of another. "I'm not ok you're ok". **Sympathetic** Safety in disconnection from others. I'm ok, you're not ok. **Dorsal vagal** No template for safety, chronic tension between connection and disconnection. "I'm not ok, you're not ok, but I want you anyway". **Freeze** High dependence + low avoidance Low dependence + high avoidance High dependence + high avoidance **TCM** **Basic principles of acupuncture** Always wash hands 3 times - Before patient visit - Prior to needle insertion - After removal of needles Always use sterilized needles Always establish a clean field Always immediately isolate used needles **Contradictions** Absolute Relative --------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- Alcohol intoxication. Exhaustion. Severe fear (hard to control after tx but do not treat anyone suffering from it before) Sexual intercourse. Overeating. Hunger. Excessively thirsty. Strenuous exercise. **Clean needle technique** Abnormal sensations - Sharpness (usually due to needle point touching in a sensitive layer like fascia, vessels or nerve fibers) - Spastic contraction of the limbs - Convulsions - Fainting - Loss of color in the face Needle manipulation, various ways to stimulate Qi or cause De Qi - Leaving the needle in for 15 mins - Tapping and flicking - Tonifying methods - Holding channel Qi: manipulating at certain times - Moving Qi: usually by tapping or pressing along the meridian adjacent to the point needled. **Problems** Needle stick injury protocol: - Inform TA or instructor immediately. - Encourage bleeding from site. - Both parties must give a full report of the incident to the instructor. - The injured party must be accompanied to the ER for HIV and hepatitis testing (at 6 wks, 3, 6, and 12 months after the incident). - Host party is encouraged to test for HIV and hepatitis, not required but strongly urged to disclose the information. +-----------------------+-----------------------+-----------------------+ | Incident | Cause | Management | +=======================+=======================+=======================+ | Stuck needle. | Movement of the | Correct patient | | | patient. | position. | | Very hard to rotate, | | | | twist lift or thrust. | Too strong of a | Allow patient to | | | stimulation or | relax or message | | | over-rotation in one | areas adjacent to the | | | direction. | point to relieve | | | | tension. | | | The needle shaft was | | | | inserted into the | In over rotation, | | | tendon and rotated | rotate the needle in | | | with a large angle. | the opposite | | | | direction and shake | | | | left and right gently | | | | to loosen it. | +-----------------------+-----------------------+-----------------------+ | Bent needle. Shaft of | Poor technique. | With slightly bends | | the needle is bent | | of the shaft, | | while in the patient | Strong manipulation. | withdrawal of the | | | | needle, slowly and | | | Patient position has | gently without | | | changed. | twisting. | | | | | | | Handle bending from | With large bends, the | | | foreign body or | needle should be | | | structure. | wiggled gently first | | | | then removed | | | Poor management of a | according to the bent | | | stuck needle. | angle. | | | | | | | | With multiple bends, | | | | the needle must be | | | | slowly removed | | | | following the bends | | | | of the needle. | | | | | | | | Correct patient | | | | position. | +-----------------------+-----------------------+-----------------------+ | Broken needle. Either | Poor needle quality. | Remain calm and ask | | broken outside of the | | patient to remain | | skin or within the | Too strong | calm and have them | | skin. | manipulation. | remain in their | | | | position. | | | Patient position | | | | changed. | If the broken portion | | | | is above the skin, | | | Foreign body | remove it with | | | impaction of the | forceps or locking | | | needle. | hemostats. | | | | | | | Poor management of a | If it's at or near | | | bent or stuck needle. | skin, gently press | | | | down with your index | | | Sudden violent | finger and thumb and | | | electrical | remove the broken | | | stimulation during | fragment with forceps | | | electro-acu. | or locking hemostats. | | | | | | | | If the broken portion | | | | cannot be removed and | | | | is near an important | | | | area of the body, | | | | x-ray or surgical | | | | removal will be | | | | required. | | | | | | | | In non-important | | | | areas, the broken | | | | portion can be left | | | | in but checked on | | | | periodically. | +-----------------------+-----------------------+-----------------------+ | Fainting | Week constitution, | Stop needling and | | | excess mental | remove all needles. | | | tension, | | | | overstressed. | Lie patient down with | | | | feet higher than | | | Severe perspiration, | head. | | | excess hunger, severe | | | | diarrhea or bleeding. | Keep patient warm | | | | either passively or | | | Incorrect position or | with tea or water. | | | strong manipulation. | | | | | For more severe | | | | cases, needle | | | | anti-fainting points | | | | (too many, check | | | | slides). | | | | | | | | Recovery usually | | | | takes 0.5-1 hr. | | | | | | | | If things keep | | | | escalating, send them | | | | to ER. | +-----------------------+-----------------------+-----------------------+ | Arterial puncture | Puncture of an artery | Apply direct pressure | | | which causes the | with ice for 5 mins | | | blood under pressure | for small arteries. | | | to be ejected from | | | | the puncture site. | Contact ER for large | | | | arteries. | | | | | | | | Depending on | | | | location, try to let | | | | blood flow back to | | | | the heart. | +-----------------------+-----------------------+-----------------------+ | Hematoma. | Small blood vessels | Self-limiting. | | | are punctured. | | | Bruising or swelling | | Cold compress | | around the punctured | Hooked tip of the | followed later by a | | area after removal of | needle causes | hot compress or moa | | the needle. | bleeding. | or gentle massage. | | | | | | | | Bleeding cupping to | | | | remove stagnation. | +-----------------------+-----------------------+-----------------------+ | Pneumothorax. | Deep needling in the | Place patient in | | | chest, back or | lateral recumbent | | Puncturing the lung | shoulder area. | position. | | causing chest pain, | | | | stuffy feeling in the | Incorrect angulation. | Mild cases will heal | | chest, SOB. | | in 1-2 wks and | | | | patient should be | | | | monitored. | | | | | | | | Severe cases call | | | | 911. | +-----------------------+-----------------------+-----------------------+ **Deficiency** Yin deficiency Yin excess Yang deficiency Yang excess -------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ --------------------------------------------------------- ----------------------------------------------------------------- Red cheeks, dry stool, anxiety at night, night sweats, hot flushes, 5 center heat, thirst for cold drinks in sips. Abdominal pain, dysmenorrhea, local pain, chills. All can be relieved with warmth. Tired after bowel movement, low libido, edema, fatigue. Feeling hot all day, red face, thirst for cold drinks in gulps. **Qi** Deficiency: Fatigue, insomnia, poor digestion, cold hands and feet, shortness of breath, little to no appetite, frequent infections, weak immune system. Functions: - Promoting: growth and development - Warming: readjusting Qi - Defence: Wei Qi - Checking: maintains homeostasis - Nourishing: Ying Qi or Nutritive Qi - Qi Hua: function of the organs (lung Qi = lung function) Stagnation: stiffness, heaviness, numbness, or tingling of the limbs in the affected regions, or migrating pain in the limbs. **Blood** Food Qi from spleen and stomach acted upon yuan Qi in the chest sent to heart and turned red (complete blood). "Heart governs blood" Functions: - Nourishment and moisture: movement of eyes and 4 limbs - Nourishes hair, sinews, bones and bowels - Foundation of mental activities, houses the mind - Circulates with Ying Qi - Determines menstruation Deficiency: - Long cycles short luteal phase - Scanty menstrual blood, amenorrhea - Fatigue, anxiety, insomnia, poor memory - Cold hands and feet, abdomen, low back - Floaters in eyes, slow recovery - Pale Blood stasis: - Oppression or pain in the chest - Coughing up dark, clotted blood - Purple - Deep, stabbing pain **Heat and cold** +-----------------------+-----------------------+-----------------------+ | Cold | Heat | Dampness | +=======================+=======================+=======================+ | Feeling of cold. | Feeling hot, fever. | Excess of Yin. | | | | | | Cold limbs. | Sweating. | From damp | | | | environment. | | Absence of thirst. | Thirst. | | | | | Lack of movement. | | Full or empty cold | Empty or full heat | | | depends on if Yin is | depends on if Yang is | Sticky and difficult | | in excess or relative | excess or only | to get rid of. | | excess of Yang. | relatively excess of | | | | Yin. | Heavy and slow. | | | | | | | | Feeling of heaviness, | | | | pain or anything | | | | worse with damp. | | | | | | | | Anything swollen | | | | and/or oozing. | | | | | | | | No appetite, | | | | bloating, made worse | | | | with food. | | | | | | | | Cloudiness of | | | | discharges. | | | | | | | | Slippery pulses. | | | | | | | | Tongue: sticky coat | | | | and/or fat, swollen. | +-----------------------+-----------------------+-----------------------+ A blue and white medical chart Description automatically generated with medium confidence **Nutrition** **Zinc** - 30-50mg day for adults - Take w/ food - GI upset likely side effect - Don\'t take same time as antibiotics to avoid interference - Eg. meat, legumes **Probiotics** - Potential GI upset, likely dose-independent - Change in stool habits - Caution selection w/ dairy allergy - Help prevent side effects of antibiotics - Help resolve infection - Help prevent infections - Eg. fermented foods **Recurrent Acute Otitis Media** - Could be related to inflammatory state due to incorrect diet  - Traditional Mediterranean diet (TMD) as treatment for RAOM - **High Fat Diet** - Assoc. w/ obesite & otitis media with effusion  - Assoc. w/ OME  **Homeopathy** **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  **Pharmacology** **Acute otitis media** The most common bacterial pathogens are streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Preventive factors: - Vaccination as viral URTI often precede AOM - Public health measure may reduce virus transmission - Avoiding exposure to tobacco smoke - Breastfeeding **Watchful waiting** Withhold antibiotic prescriptions for 48 hrs in children over 6 months provided they have: - Nonsevere fever (\