Acupuncture Health Dictionary

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (International Association for the Study of Pain, 1979). Pain is perceived in the cerebral cortex (see BRAIN) and is always subjective. Sometimes sensations that would usually be benign can be perceived as painful – for example, allodynia (extreme tenderness of the skin) or dysaesthesia (unpleasant skin sensations resulting from partial damage to sensory nerve ?bres, as in herpes zoster, or shingles).

Acute pain is caused by internal or external injury or disease. It warns the individual that harm or damage is occurring and stimulates them to take avoiding or protective action. With e?ective treatment of disease or injury and/or the natural healing process, the pain resolves – although some acute pain syndromes may develop into chronic pain (see below). Stimuli which are su?ciently intense potentially to damage tissue will cause the stimulation of speci?c receptors known as NOCICEPTORS. Damage to tissues releases substances which stimulate the nociceptors. On the surface of the body there is a high density of nociceptors, and each area of the body is supplied by nerves from a particular spinal segment or level: this allows the brain to localise the source of the pain accurately. Pain from internal structures and organs is more di?cult to localise and is often felt in some more super?cial structure. For example, irritation of the DIAPHRAGM is often felt as pain in the shoulder, as the nerves from both structures enter the SPINAL CORD at the same level (often the structures have developed from the same parts of the embryo). This is known as referred pain.

The impulses from nociceptors travel along nerves to the spinal cord. Within this there is modulation of the pain ‘messages’ by other incoming sensory modalities, as well as descending input from the brain (Melzack and Walls’ gate-control theory). This involves morphine-like molecules (the ENDORPHINS and ENKEPHALINS) amongst many other pain-transmitting and pain-modulating substances. The modi?ed input then passes up the spinal cord through the thalamus to the cerebral cortex. Thus the amount of pain ‘felt’ may be altered by the emotional state of the individual and by other incoming sensations. Once pain is perceived, then ‘action’ is taken; this involves withdrawal of the area being damaged, vocalisation, AUTONOMIC NERVOUS SYSTEM response and examination of the painful area. Analysis of the event using memory will occur and appropriate action be taken to reduce pain and treat the damage.

Chronic pain may be de?ned in several ways: for example, pain resistant to one month’s treatment, or pain persisting one month beyond the usual course of an acute illness or injury. Some doctors may also arbitrarily choose the ?gure of six months. Chronic pain di?ers from acute pain: the physiological response is di?erent and pain may either be caused by stimuli which do not usually cause the perception of pain, or may arise within nerves or the central nervous system with no apparent external stimulation. It seldom has a physiological protective function in the way acute pain has. Also, chronic pain may be self-perpetuating: if individuals gain a psychological advantage from having pain, they may continue to do so (e.g. gaining attention from family or health professionals, etc.). The nervous system itself alters when pain is long-standing in such a way that it becomes more sensitive to painful inputs and tends to perpetuate the pain.

Treatment The treatment of pain depends upon its nature and cause. Acute pain is generally treated by curing the underlying complaint and prescribing ANALGESICS or using local anaesthetic techniques (see ANAESTHESIA – Local anaesthetics). Many hospitals now have acute pain teams for the management of postoperative and other types of acute pain; chronic pain is often treated in pain clinics. Those involved may include doctors (in Britain, usually anaesthetists), nurses, psychologists and psychiatrists, physiotherapists and complementary therapists. Patients are usually referred from other hospital specialists (although some may be referred by GPs). They will usually have been given a diagnosis and exhausted the medical and surgical treatment of their underlying condition.

All the usual analgesics may be employed, and opioids are often used in the terminal treatment of cancer pain.

ANTICONVULSANTS and ANTIDEPRESSANT DRUGS are also used because they alter the transmission of pain within the central nervous system and may actually treat the chronic pain syndrome.

Many local anaesthetic techniques are used. Myofascial pain – pain affecting muscles and connective tissues – is treated by the injection of local anaesthetic into tender spots, and nerves may be blocked either as a diagnostic procedure or by way of treatment. Epidural anaesthetic injections are also used in the same way, and all these treatments may be repeated at intervals over many months in an attempt to cure or at least reduce the pain. For intractable pain, nerves are sometimes destroyed using injections of alcohol or PHENOL or by applying CRYOTHERAPY or radiofrequency waves. Intractable or terminal pain may be treated by destroying nerves surgically, and, rarely, the pain pathways within the spinal cord are severed by cordotomy (though this is generally only used in terminal care).

ACUPUNCTURE and TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) are used for a variety of pain syndromes, particularly myofascial or musculoskeletal pain. It is thought that they work by increasing the release of endorphins and enkephalins (see above). It is possible to implant electrodes within the epidural space to stimulate directly the nerves as they traverse this space before passing into the spinal cord.

Physiotherapy is often used, particularly in the treatment of chronic backache, where pain may be reduced by improving posture and strengthening muscles with careful exercises. Relaxation techniques and psychotherapy are also used both to treat chronic pain and to help patients cope better with their disability.

Some types of chronic pain are caused by injury to sympathetic nerves or may be relieved by interrupting conduction in sympathetic nerves. This may be done in several ways. The nerves may be blocked using local anaesthetic or permanently destroyed using alcohol, phenol or by surgery.

Many of these techniques may be used in the management of cancer pain. Opioid drugs are often used by a variety of routes and methods, and management of these patients concentrates on the control of symptoms and on providing a good quality of life.... pain

A group of therapies, often described as “alternative”, which are now increasingly used to complement or to act as an alternative to conventional medicine. They fall into 3 broad categories: touch and movement (as in acupuncture, massage, and reflexology); medicinal (as in naturopathy, homeopathy. and Chinese medicine); and psychological (as in biofeedback, hypnotherapy, and meditation).... complementary medicine

This is the title used for a diverse group of health-related therapies and disciplines which are not considered to be a part of mainstream medical care. Other terms sometimes used to describe them include ‘natural medicine’, ‘nonconventional medicine’ and ‘holistic medicine’. CAM embraces those therapies which may either be provided alongside conventional medicine (complementary) or which may, in the view of their practitioners, act as a substitute for it. Alternative disciplines purport to provide diagnostic information as well as o?ering therapy. However, there is a move now to integrate CAM with orthodox medicine and this view is supported by the Foundation for Integrated Medicine in the UK in its report, A way forward for the next ?ve years? – A discussion paper (1997).

The University of Exeter Centre for Complementary Health Studies report, published in 2000, estimated that there are probably more than 60,000 practitioners of complementary and alternative medicine in the UK. In addition there are about 9,300 therapist members of organisations representing practitioners who have statutory quali?cations, including doctors, nurses (see NURSING), midwives, osteopaths and physiotherapists; chiropractors became fully regulated by statute in June 2001. There are likely to be many thousands more health sta? with an active interest or involvement in the practice of complementary medicine – for example, the 10,000 members of the Royal College of Nursing’s Complementary Therapy Forum. It is possible that up to 20,000 statutory health professionals regularly practise some form of complementary medicine including half of all general practices providing access to CAMs – most commonly manipulation therapies. The report from the Centre at Exeter University estimates that up to 5 million patients consulted a practitioner specialising in complementary and alternative medicine in 1999. Surveys of users of complementary and alternative practitioners show a relatively high satisfaction rating and it is likely that many patients will go on to use such therapists over an extended period. The Exeter Centre estimates that, with the increments of the last two years, up to 15–20 million people, possibly 33 per cent of the population of the country, have now sought such treatment.

The 1998 meeting of the British Medical Association (BMA) agreed to ‘investigate the scienti?c basis and e?cacy of acupuncture and the quality of training and standards of con?dence in its practitioners’. In the resulting report (July 2000) the BMA recommended that guidelines on CAM use for general practitioners, complementary medicine practitioners and patients were urgently needed, and that the Department of Health should select key CAM therapies, including acupuncture, for appraisal by the National Institute for Clinical Medicine (NICE). The BMA also reiterated its earlier recommendation that the main CAM therapies, including acupuncture, should be included in familiarisation courses on CAM provided within medical schools, and that accredited postgraduate education should be provided to inform GPs and other clinicians about the possible bene?ts of CAM for patients.... complementary and alternative medicine (cam)

As spinal chord nerves branch out into the body, some segments fan out across the skin; these are the nerves that monitor the surface and are the source of senses of touch, pain, hot, cold and distension. All this information is funneled back in and up to the brain, which learned early on to correlate WHAT information comes from WHERE. Think of the brain as the CPU, with the spinal chord nerves uploading raw binary data; the brain has to make a running program out of this. It must form a three-dimensional hologram or homunculus from the linear input, and retranslate it outwards as binary data. The surface of the forearm, as an example, has sensory input gathered from several different and very separate spinal chord nerves. The brain will origami-fold these separate data streams into FOREARM. If you were to inject novacaine into the base of the left first sacral nerve (LS1), you would find that a whole section of skin became numb. So well defined a section that you could outline in charcoal the demarcation between sensation and numbness. This section would be a long oval of of numbness around the left buttock, under to the groin, perhaps part of the thigh...and the left heel. That spinal nerve is solely responsible for carrying sensation from that zone of skin...that dermatome; your brain mixes all the dermatomes together to get a working hologram of your total skin surface. That particular nerve also brings and sends information about the uterus, abdominal wall and pelvic floor. If you are a woman suffering pelvic heaviness and suppressed menses, a hot footbath might be enough S1 (heel dermatome) stimulation to cross-talk over to the referred S1 pelvic functions...and heat up the stuck uterus. Much of acupuncture, Jinshinjitsu, and zone and reflex therapy (not to mention Rolfing) uses various aspects of this dermatome crossover phenomena (by whatever name) and zone counterirritation was widely used in American standard medicine up until...penicillin. It was still being described in clinical manuals as late as 1956, although with the mention that it was only used infrequently and a “mechanism not understood” disclaimer.... dermatomes

Peptides (see PEPTIDE) produced in the brain which have a pain-relieving action; hence their alternative name of opiate peptides. Their name is derived from endogenous MORPHINE. They have been de?ned as endogenous opiates or any naturally occurring substances in the brain with pharmacological actions resembling opiate alkaloids such as morphine. There is some evidence that the pain-relieving action of ACUPUNCTURE may be due to the release of these opiate peptides. It has also been suggested that they may have an antipsychotic action and therefore be of value in the treatment of major psychotic illnesses such as SCHIZOPHRENIA.... endorphins

A method of electrical stimulation that is being used for the relief of PAIN, including that of MIGRAINE, NEURALGIA and phantom limbs (see AMPUTATION). Known as TENS, its mode of action appears to have some resemblance to that of ACUPUNCTURE. Several controlled trials suggest that it provides at least a modicum of relief of pain after operations, thereby reducing the amount of ANALGESICS that may be called for.... transcutaneous electrical nerve stimulation (tens)

Acquired Immune Deficiency Syndrome. Infection by HIV virus may lead to AIDS, but is believed to be not the sole cause of the disease. It strikes by ravaging the body’s defence system, destroying natural immunity by invading the white blood cells and producing an excess of ‘suppressant’ cells. It savages the very cells that under normal circumstances would defend the body against the virus. Notifiable disease. Hospitalisation. AIDS does not kill. By lacking an effective body defence system a person usually dies from another infection such as a rare kind of pneumonia. There are long-term patients, more than ten years after infection with HIV who have not developed AIDS. There are some people on whom the virus appears to be ineffective. The HIV virus is transmitted by infected body fluids, e.g. semen, blood or by transfusion.

A number of co-factors are necessary for AIDS to develop: diet, environment, immoral lifestyle, drugs, etc also dispose to the disease which, when eliminated, suggest that AIDS needs not be fatal. However, there is no known cure. Smoking hastens onset. Causes include needle-sharing and sexual contacts. Also known as the ‘Gay Plague’ it can be transmitted from one member of the family to another non-sexual contact.

The virus kills off cells in the brain by inflammation, thus disposing to dementia.

Symptoms. Onset: brief fever with swollen glands. “Feeling mildly unwell”. This may pass off without incident until recurrence with persistent diarrhoea, night sweats, tender swollen lymph nodes, cough and shortness of breath. There follows weight loss, oral candida. Diagnosis is confirmed by appearance of ugly skin lesions known as Kaposi’s sarcoma – a malignant disease. First indication is the appearance of dark purple spots on the body followed by fungoid growths on mouth and throat.

While some cases of STDs have been effectively treated with phytotherapy, there is evidence to suggest it may be beneficial for a number of reasons. Whatever the treatment, frequent blood counts to monitor T-4 cells (an important part of the immune system) are necessary. While a phytotherapeutic regime may not cure, it is possible for patients to report feeling better emotionally and physically and to avoid some accompanying infections (candida etc).

Treatment. Without a blood test many HIV positives may remain ignorant of their condition for many years. STD clinics offer free testing and confidential counselling.

Modern phytotherapeutic treatment:–

1. Anti-virals. See entry.

2. Enhance immune function.

3. Nutrition: diet, food supplements.

4. Psychological counselling.

To strengthen body defences: Garlic, Echinacea, Lapacho, Sage, Chlorella, Reisha Mushroom, Shiitake Mushroom. Of primary importance is Liquorice: 2-4 grams daily.

Upper respiratory infection: Pleurisy root, Elecampane.

Liver breakdown: Blue Flag root, Milk Thistle, Goldenseal.

Diarrhoea: Bayberry, Mountain Grape, American Cranesbill, Slippery Elm, lactobacillus acidophilus.

Prostatitis: Saw Palmetto, Goldenrod, Echinacea.

Skin lesions: External:– Comfrey, Calendula or Aloe Vera cream.

To help prevent dementia: a common destructive symptom of the disease: agents rich in minerals – Alfalfa, Irish Moss, Ginkgo, St John’s Wort, Calcium supplements.

Nervous collapse: Gotu Kola, Siberian Ginseng, Oats, Damiana.

Ear Inflammation: Echinacea. External – Mullein ear drops.

With candida: Lapacho tea. Garlic inhibits candida.

Anal fissure: Comfrey cream or Aloe Vera gel (external).

Practitioner: Formula. Liquid extract Echinacea 30ml (viral infection) . . . Liquid extract Poke root 10ml (lymphatic system) . . . Liquid extract Blue Flag root 10ml (liver stimulant) . . . Tincture Goldenseal 2ml (inflamed mucous membranes) . . . Liquid extract Guaiacum 1ml (blood enricher) . . . Decoction of Sarsaparilla to 100ml. Sig: 5ml (3i) aq cal pc.

Gargle for sore throat: 5-10 drops Liquid extract or Tincture Echinacea to glass water, as freely as desired.

Abdominal Castor oil packs: claimed to enhance immune system.

Chinese medicine: Huang Qi (astragalus root).

Urethral and vaginal irrigation: 2 drops Tea Tree oil in strong decoction Marshmallow root: 2oz to 2 pints water. Inject warm.

Diet. Vitamin C-rich foods, Lecithin, Egg Yolk, Slippery Elm gruel, Red Beet root, Artichokes. Garlic is particularly indicated as an anti-infective.

Nutrition. Vitamin A is known to increase resistance by strengthening the cell membrane; preferably taken as beta carotene 300,000iu daily as massive doses of Vitamin A can be toxic. Amino acid – Glutathione: Garlic’s L-cysteine relates.

Vitamin C. “The virus is inactivated by this vitamin. Saturating cells infected with the HIV virus with the vitamin results in 99 per cent inactivation of the virus. The vitamin is an anti-viral and immune system modulator without unwanted side-effects. The ascorbate, when added to HIV cells, substantially reduced the virus’s activity without harming the cells at specific concentrations. Patients taking large doses report marked improvement in their condition. Minimum daily oral dose: 10 grams.” (Linus Pauling Institute, Science and Medicine, Palo Alto, California, USA)

Periwinkle. An anti-AIDS compound has been detected in the Madagascan Periwinkle (Catharanthus roseus), at the Chelsea Physic Garden.

Mulberry. The black Mulberry appears to inhibit the AIDS virus.

Hyssop. An AIDS patient improved to a point where ulcers were healed, blood infection eliminated, and Kaposi’s sarcoma started to clear when her mother gave her a traditional Jamaican tea made from Hyssop, Blessed Thistle and Senna. From test-tube research doctors found that Hyssopus officinalis could be effective in treatment of HIV/AIDS. (Medical Journal Antiviral Research, 1990, 14, 323-37) Circumcision. Studies have shown that uncircumcised African men were more than five to eight times more likely to contract AIDS than were circumcised men; life of the virus being short-lived in a dry environment. (Epidemiologist Thomas Quinn, in Science Magazine)

Study. A group of 13 HIV and AIDS patients received 200mg capsules daily of a combination of Chelidonium (Greater Celandine) 175mg; Sanguinaria (Blood root) 5mg; and Slippery Elm (Ulmus fulva) 20mg. More than half the patients enjoyed increased energy and improved immune function with reduction in both size and tenderness of lymph nodes. (D’Adamo P. ‘Chelidonium and Sanguinaria alkaloids as anti-HIV therapy. Journal of Naturopathic Medicine (USA) 3.31-34 1992)

Bastyr College of Naturopathy, Seattle, MA, USA. During 1991 the College carried out a study which claimed that a combination of natural therapies including nutrition, supplements, herbal medicine, hydrotherapy and counselling had successfully inhibited HIV and other viral activity in all patients in controlled trials lasting a year.

Patients chosen for the trial were HIV positive, not on anti-viral drugs and showing symptoms of a compromised immune system, but without frank AIDS (generally taken to be indicated by Karposi’s sarcoma and/or PCP-pneumocystitis carinii pneumonia).

Symptoms included: Lymphadenopathy in at least two sites, oral thrush, chronic diarrhoea, chronic sinusitis, leukoplakia, herpes, night sweats and fatigue.

Assessment was subjective and objective (including T-cell ratio tests). The patients did better than comparable groups in published trials using AZT.

Treatment was naturopathic and herbal. Patients receiving homoeopathy and acupuncture did not do as well as those receiving herbs.

Best results with herbs were: Liquorice (1g powder thrice daily); St John’s Wort (Yerba prima tablets, 3, on two days a week only). Patients reported a great increase in the sense of well-being on St John’s Wort. An equivalent dose of fresh plant tincture would be 10ml. The tincture should be of a good red colour. The College did not use Echinacea, which would stimulate the central immune system and which would therefore be contra-indicated.

Supplements given daily. Calcium ascorbate 3g+ (to bowel tolerance). Beta-carotene 300,000iu. Thymus gland extract tablets 6. Zinc 60mg (with some Copper). B-vitamins and EFAs.

To control specific symptoms: most useful herbs were: Tea Tree oil for fungal infections; Goldenseal and Gentian as bitters. Ephedra and Eyebright for sinusitis. Carob drinks for non-specific enteritis. Vitamin B12 and topical Liquorice for shingles.

Counselling and regular massage were used to maintain a positive spirit. Studies show all long term HIV positive survivors have a positive attitude and constantly work at empowering themselves.

Results showed significant improvements in symptoms suffered by HIV patients despite a slow deterioration in blood status. Methods used in the study had dramatically reduced mortality and morbidity. A conclusion was reached that AIDS may not be curable but it could be manageable. (Reported by Christopher Hedley MNIMH, London NW1 8JD, in Greenfiles Herbal Journal) ... aids

Environmental medicine. Treatment of allergies by natural medicines. The science that endeavours to bridge physics and chemistry; including such disciplines as homoeopathy, acupuncture, herbalism, etc. ... clinical ecology

In?ammation of the LIVER which damages liver cells and may ultimately kill them. Acute injury of the liver is usually followed by complete recovery, but prolonged in?ammation after injury may result in FIBROSIS and CIRRHOSIS. Excluding trauma, hepatitis has several causes:

Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.

Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.

WILSON’S DISEASE.

Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).

Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.

Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.

Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.

Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.

•Hepatitis A virus (HAV) is an ENTEROVIRUS

which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.

Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.

Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.

Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.

Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic

viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.

As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.

Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around

0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).

Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:

Parenteral drug abusers.

Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.

Men who have sex with men.

Patients undergoing regular haemodialysis.

Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis

A derivative of acupuncture in which pressure is applied instead of needles.... acupressure

Traditional Chinese medicine is generally based on the theory that a universal life-force, called chi, manifests itself in the body as 2 complementary qualities that are known as yin and yang.

According to this belief, vigorous yang and restraining yin must be in balance, and the chi must flow evenly for good health.

Treatments for illness aim to restore the yin-yang balance and normalize the flow of chi using techniques such as Chinese herbal medicine, acupressure, acupuncture, and t’ai chi.... chinese medicine

The external use of essential oils from seeds, resins, herbs, barks and spices for relaxant purposes.

Plant essences give plants their scent and were known to the ancient civilisations of Egypt and Greece as the ‘vital force’ or spirit of the plant. They were used for inhalation, rubbing on the skin or as a healthful addition to baths and foot-baths. The art is complementary to phytotherapy, acupuncture and other systems of alternative medicine.

The aromatherapist uses oils individually or in blends of different oils. The natural concentrated oil is usually diluted by adding a vegetable oil before direct application to the skin. A massage oil usually comprises 6 drops essential oil to 10ml (2 teaspoons) carrier oil – Almond, Peanut or other vegetable oil.

The skin is known to be an integral part of the immune system. T-cells are scattered throughout, primarily in the epidermis or outer layer. It has been demonstrated that oils rubbed on the skin are readily absorbed and borne to distant organs in the body via the bloodstream to soothe, relax and heal. Some oils should not be used during pregnancy or lactation.

An oil may be used as a natural perfume. As a bath oil, 5-6 drops of a favourite oil may be added to bathwater. Oils freshen a room; stimulate or relax as desired when added to water on a warm radiator. Oils are never used on the skin undiluted.

The aromatherapist never uses essential oils internally. Other carrier oils may be used: Sesame seed, Sunflower seed, Apricot kernel and Wheatgerm. Usual methods of applying essential oils: massage, inhalation and baths. When adding oils to baths water should not be too hot which causes oils to evaporate.

Remedies absorbed into the body via the skin avoid metabolism by the liver as when taken by mouth.

When the therapy was used in a geriatric ward in Oxford drug expenditure on laxatives and night sedatives fell. It was reported to have given profoundly deaf patients, many of whom had multiple sensory deficits, tranquillity. The results of a randomised trial in patients on an intensive care unit showed significantly greater psychological improvement (as demonstrated with anxiety and mood rating scales) in those given aromatherapy (1 per cent Lavender and Grapeseed oil) over those massaged with Grapeseed oil only or those prescribed rest alone. (The Lancet 1990 336 (8723) 1120)

The governing body of the therapy in the UK is the Aromatherapy Organisations Council (AOC) which represents the majority of professional practitioners. Enquiries: AOC, 3 Latymer Close, Braybrooke, Market Harborough. Leicester LE16 8LN. Tel/Fax 01858 434242. ... aromatherapy

A General Medical Council style organisation with a single Register, common ethics and disciplinary procedures for its members. To promote high standards of education, qualification and treatment; to preserve the patient’s freedom of choice.

Founder groups: The National Institute of Medical Herbalists, College of Osteopaths, British Naturopathic and Osteopathic Association, The British Chiropractic Association, The Society of Homoeopaths, The British Acupuncture Association, The Traditional Acupuncture Society and the Register of Traditional Chinese Medicine.

Objects: to provide vital unified representation to contest adverse legislation; to promote the interests of those seeking alternative treatments; to maintain standards of competent primary health care; to protect the practice of alternative medicine if Common Law is encroached upon. The Council prefers to work in harmony with the orthodox profession in which sense it is complementary. Council’s first chairman: Simon Mills, FNIMH. Address: 10 Belgrave Square, London SW1X BPH. ... council for complementary and alternative medicine

(Metatarsalgia)

Causes: foot-strain, deformity, osteoporosis, high heels throwing the body out of its normal posture, tight shoes.

Feet are often painful because one or more of the bones are out of alignment and which may be adjusted by simple osteopathy. The process can be assisted by foot-baths of Chamomile flowers, Arnica flowers, or Comfrey to relax muscles and tendons.

Alternatives. Alfalfa, Chaparral, Ligvites, Prickly Ash.

Topical. Aromatherapy. (Sensitive feet) Oils of Pine, Eucalyptus or Thyme – 6 drops, any one, to 2 teaspoons Almond oil. Warm. Massage into foot and wrap round with damp hot towel.

General. Acupuncture. Shoes should be bought in the afternoon, particularly if feet swell during the day. Shoes that fit well in the morning may have become too tight by tea-time. ... feet – pain in

A form of treatment, often used in conjunction with acupuncture, in which a cone of wormwood leaves (moxa) or certain other plant materials is burned just above the skin to relieve internal pain.... moxibustion

The treatment of pain, usually with analgesic drugs. Paracetamol, aspirin and codeine are the most widely used drugs in this group. Pain accompanied by inflammation is often alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs). Severe pain may require treatment with opioids, such as morphine.

Other methods of pain relief include massage, ice-packs, poultices, TENS, acupuncture, or hypnosis. Surgery to destroy pain-transmitting nerves (as in a cordotomy) is occasionally performed when other treatments fail.... pain relief

Pain affecting the back, often restricting movement. The pain usually lasts for only a week or so but can recur in some people. Rarely, persistent back pain causes long-term disability.

Back pain is usually caused by minor damage to the ligaments and muscles in the back. The lower back is especially vulnerable to these problems because it supports most of the body’s weight and is under continual stress from movements such as bending, twisting, and stretching. Less commonly, lower back pain may result from an underlying disorder such as a prolapsed intervertebral disc (see disc prolapse) in the spine.

In most cases, back pain can be treated with over-the-counter painkillers (see analgesic drugs) such as aspirin and related drugs, nonsteroidal antiinflammatory drugs, or muscle-relaxant drugs. If the pain persists, a heat pad, a wrapped hot-water bottle or, sometimes, an ice-pack, may provide additional relief. Generally, it is advisable to remain as active as the pain permits. People whose pain worsens or is still too severe to allow normal movement after several days should consult a doctor for medical tests.

Investigations for back pain, such as X-rays, CT scanning, or MRI, sometimes reveal abnormalities, such as disc prolapse, that require surgical treatment and can be treated by a microdiscectomy.

Other treatments for back pain include acupuncture, spinal injection, exercise, or spinal manipulation.... back pain

Artemisia vulgaris

FAMILY: Asteraceae (Compositae)

SYNONYMS: Armoise, wild wormwood, felon herb, St John’s plant.

GENERAL DESCRIPTION: An erect, much-branched, perennial herb up to 1.5 metres high, with purplish stems, dark green divided leaves which are downy white beneath, and numerous small reddish-brown or yellow flowers.

DISTRIBUTION: Believed to have originated in eastern Europe and western Asia; now found in temperate zones all over the world. The oil is produced in southern France, Morocco, Germany, Hungary, India, China and Japan.

OTHER SPECIES: There are many different species in the Artemisia group (see Botanical Classification), which includes wormwood and tarragon. There are also several different types of mugwort such as the great mugwort (A. arborescens) and the Chinese mugwort (A. moxa and A. sinensis) which are both used to make ‘moxa’ in Japan, containing mainly borneol.

HERBAL/FOLK TRADITION: In Europe, the herb has been associated with superstition and witchcraft, and was seen as a protective charm against evil and danger. It is said that St John the Baptist wore a girdle of the leaves in the wilderness. It was also seen as a woman’s plant, used as a womb tonic, for painful or delayed menstruation and as a treatment for hysteria and epilepsy. It was also used to expel worms, control fever and as a digestive remedy.

In the East the white fluffy underside of the leaves is used for moxibustion, a process often combined with acupuncture, in which the compressed dried herb is burned over a certain point in the body to stimulate it with heat. Moxa was also used in Europe to relieve gout and rheumatism. It is current in the British Herbal Pharmacopoeia as a specific for amenorrhoea and dysmenorrhoea.

ACTIONS: Anthelmintic, antispasmodic, carminative, choleretic, diaphoretic, diuretic, emmenagogue, nervine, orexigenic, stimulant, stomachic, tonic (uterine, womb), vermifuge.

EXTRACTION: Essential oil by steam distillation from the leaves and flowering tops.

CHARACTERISTICS: A colourless or pale yellow liquid with a powerful camphoraceous, bitter-sweet, herbaceous odour. It blends well with oakmoss, patchouli, rosemary, lavandin, pine, sage, clary sage and cedarwood.

PRINCIPAL CONSTITUENTS: Thujone, cineol, pinenes and dihydromatricaria ester, among others.

SAFETY DATA: Oral toxin, due to high thujone content. Abortifacient.

AROMATHERAPY/HOME: USE None. ‘It should not be used in therapy either internally or externally.’.

OTHER USES: Used as a fragrance component in soaps, colognes and perfumes. Limited use in flavouring due to toxic levels of thujone.... mugwort