Dyspnoea Health Dictionary

Breathlessness, or dyspnoea, may be due to any condition which renders the blood de?cient in oxygen, and which therefore produces excessive involuntary e?orts to gain more air. Exercise is a natural cause, and acute anxiety may provoke breathlessness in otherwise healthy people. Deprivation of oxygen – for example, in a building ?re – will also cause the victim to raise his or her breathing rate. Disorders of the lung may diminish the area available for breathing – for example, ASTHMA, PNEUMONIA, TUBERCULOSIS, EMPHYSEMA, BRONCHITIS, collections of ?uid in the pleural cavities, and pressure caused by a TUMOUR or ANEURYSM.

Pleurisy causes short, rapid breathing to avoid the pain of deep inspiration.

Narrowing of the air passages may produce sudden and alarming attacks of di?cult breathing, especially among children – for example, in CROUP, asthma and DIPHTHERIA.

Most cardiac disorders (see HEART, DISEASES OF) cause breathlessness, especially when the person undergoes any special exertion.

Anaemia is a frequent cause.

Obesity is often associated with shortness of breath. Mountain climbing may cause breathlessness

because, as altitude increases, the amount of oxygen in the air falls (see ALTITUDE SICKNESS). (See also LUNGS and RESPIRATION.)... breathlessness

Nees.

Synonym: A. zeylanica Medic. Justicia adhatoda Linn.

Family: Acanthaceae.

Habitat: Throughout India, up to an altitude of 1,300 m.

English: Malabar Nut, Vasaca.

Ayurvedic: Vaasaa, Vaasaka, Vaasikaa, Simhaasya, Simhaparni, Simhavadanaa, Vaajidanta, Vrisha, Aataruushaka.

Unani: Arusaa.

Siddha/Tamil: Aadaathodai.

Folk: Vasaakaa.

Action: Expectorant (used in bronchial, asthmatic and pulmonary affections), antispasmodic, febrifuge.

Key application: As bronchodilatory, expectorant. (Indian Herbal Pharmacopoeia.) The Ayurvedic Pharmacopoeia of India indicates its use in dyspnoea.

The chief quinazoline alkaloid vas- icine is reported in all parts of the plant, the highest being in inflorescence. It is a bitter bronchodilator, respiratory stimulant, hypotensive, cardiac depressant, uterotonic and aborti- facient. An aqueous solution of va- sicinone hydrochloride, when studied in mice and dogs, was found to potentiate the bronchodilatory activity of aminophylline, also that of isopre- naline. Vasicinone exhibited smooth- muscle-relaxant properties of airways.

Alkaloids present in the plant showed significant protection against allergin-induced bronchial obstruction in guinea pigs.

The leaves are found to activate the digestive enzyme trypsin.

An extract of the leaves showed significant antifungal activity against ringworm.

Adhatoda beddomei C.B. Clarke, found in Kerala, is considered to be more powerful and active than A. vasi- ca. Fresh leaf juice is used in haemoptysis and menorrhagia, also as an antiasthmatic.

Jacobinia tinctoria Henl. is equated with the red-flowered var. of Vaasaa.

Dosage: Leaf—10-20 ml juice. Dried leaves—10-20 g for deoction. Root—3-6 g powder. (API Vols. I, IV)... adhatoda vasica

Linn.

Family: Liliaceae; Alliaceae.

Habitat: Cultivated as an annual all over the country. The most important onion-growing states are Maharashtra, Tamil Nadu, Andhra Pradesh., Karnataka and Madhya Pradesh.

English: Onion.

Ayurvedic: Palaandu, Durgandh.

Unani: Piyaaz.

Siddha/Tamil: Venkaayam.

Action: Antibiotic, antibacterial, antisclerotic, anticoagulant, anti-inflammatory, antiasthmatic, expectorant, carminative, anti- spasmodic, diuretic, hypotensive, antidiabetic.

Key application: For the prevention of atherosclerosis (German Commission E) and age-dependent changes in the blood vessels, and loss of appetite (WHO).

The official onion bulb of the Pharmacopoeia of the People's Republic of China is a different species, Allium macrostemon Bge., than that of the German Commission E monographs, A. cepa. Chinese onion is used for cough, dyspnoea, angina pectoris and dysentery.

Scallions or Spring Onion of Chinese medicine are equated with Allium fistulosum.

Onion bulbs contain a volatile oil with sulphurous constituents, including allylpropyldisulphide; sulphur- containing compounds, including al- licin, alliin; flavonoids; phenolic acids and sterols.

Hypoglycaemic activity of the onion is attributed to the allylpropyldisul- phide and allicin. Diphenylamine, isolated from mature bulbs, also exhibits potent antihyperglycaemic activity.

Alliin and allicin have an inhibitory effect on platelet aggregation. Antibiotic activity is due mainly to alli-cin.

Regular use of onion (50 g/day) reduces insulin requirement of a diabetic patient from 40 to 20 units a day.

Thiosulphinates, isolated from onion juice, exhibited antiasthmatic activity in vivo.

Dosage: Juice of bulb—10-20 ml. (CCRAS.)... allium cepa

In?ammation of the alveoli (see ALVEOLUS) of the lungs caused by an allergic reaction. When the in?ammation is caused by infection it is called PNEUMONIA, and when by a chemical or physical agent it is called pneumonitis. It may be associated with systemic sclerosis or RHEUMATOID ARTHRITIS.

Extrinsic allergic alveolitis is the condition induced by the lungs becoming allergic (see ALLERGY) to various factors or substances. It includes BAGASSOSIS, FARMER’S LUNG and BUDGERIGAR-FANCIER’S LUNG, and is characterised by the onset of shortness of breath, tightness of the chest, cough and fever. The onset may be sudden or gradual. Treatment consists of removal of the affected individual from the o?ending material to which he or she has become allergic. CORTICOSTEROIDS give temporary relief.

Fibrosing alveolitis In this disease there is di?use FIBROSIS of the walls of the alveoli of the lungs. This causes loss of lung volume with both forced expiratory volume and vital capacity affected, but the ratio between them remaining normal. The patient complains of cough and progressive DYSPNOEA. Typically the patient will be cyanosed (blue – see CYANOSIS), clubbed (see CLUBBING), and have crackles in the mid- and lower-lung ?elds. Blood gases will reveal HYPOXIA and, in early disease, hypocapnia (de?ciency of carbon dioxide in the blood due to hyperventilation). There is an association with RHEUMATOID ARTHRITIS (about one-eighth of cases), systemic lupus erythematosus (see under LUPUS), and systemic SCLEROSIS. Certain drugs – for example, bleomycin, busulphan and hexamethonium – may also cause this condition, as may high concentrations of oxygen, and inhalation of CADMIUM fumes.... alveolitis

An alkaloid (see ALKALOIDS) structurally similar to CAFFEINE, and found in small amounts in tea. Its main use is for the relief of BRONCHOSPASM, where beta-2 adrenoceptor stimulants have failed. It is given intravenously in combination with the stabilising agent ethylenediamine (as aminophylline) for the treatment of severe ASTHMA or paroxysmal nocturnal DYSPNOEA. Formerly used in the treatment of left ventricular failure, it has been largely superseded by more e?ective DIURETICS. When indicated, aminophylline should be given by very slow intravenous injection; acute overdose may cause convulsions and cardiac ARRHYTHMIA.... theophylline

(Ait.) R.Br.

Family: Asclepiadaceae.

Habitat: An evergreen shrub distributed in West and Central India.

English: Swallow-Wart, Milk Weed, (purple-flowered), King's Crown.

Ayurvedic: Alarka, Surya, Su- uryaahvya, Vikirna, Vasuka, Tapana, Tuulaphala, Kshirparna, Arkaparna, Aasphota.

Unani: Aakh, Madaar, Ashar.

Siddha/Tamil: Vellerukku, Erukku.

Action: The plant is used against bronchial asthma (especially flowers with black pepper). Leaves—used for treating chronic cases of dyspepsia, flatulence, constipation and mucus in stool. Seed oil— geriatric and tonic. Leaves, flowers and root-bark oil—antimicrobial (maximum activity in leaves). The Ayurvedic Pharmacopoeia of India indicated the use of the root and leaf in asthma and dyspnoea; stem bark in diseases of the spleen.

Root bark contains benzoylline- olone and benzolisolineolone. Root, stem and leaves, also latex contain beta-amyrin. Flowers contain evanidin 3-rhamnoglucoside. The plant contains a cardenolide, proceragenin, an antibacterial principle.

The latex is given for treating epilepsy, also in painful, joints and swellings. The latex exhibited anti-inflammatory activity in carrageenan-and formalin- induced rat paw oedema model.

The herb can alter menstrual cycle and temporarily inhibit ovulation. Cardiac glycosides may be additive when combined with Digoxin. (Sharon M. Herr.)

Dosage: Leaf—250-750 mg powder; root—1-3 g for decoction (API Vol. I); stem bark—0.5-1 g powder (API Vol. III). Milky juice—500 mg to 1 g (CCRAS.)

Action: Anti-inflammatory. Root— hypocholesterolaemic. Poisonous to human beings in mature stages.

The flowers contain flavonoids, 7- rhamnosides, 3-glucosides and 3-glu- co-7-rhamnosides of kaempferol and quercetin. Roots gave triterpenoid glycosides, which decreased serum cholesterol and total protein and increased blood sugar equivalent to bu- tadione in rats.

EtOH (50%) extract of the plant exhibits CNS depressant and hypotensive activity in rat.... calotropis procera

(Linn.) Moon.

Family: Verbenaceae.

Habitat: A shrub distributed throughout the country, especially common in Assam and Bengal.

English: Blue-flowered Glory tree, Beetle Killer.

Ayurvedic: Bhaargi, Bhaaran- gi, Angaarvalli, Phanji, Braah- manyashtikaa, Kharshaak, Padma, Bhragubhavaa, Brahmayashtikaa.

Siddha/Tamil: Kandoorbarangi (root), cherutekku.

Action: Root—Antiasthmatic, antihistaminic, antispasmodic, antitussive carminative, febrifuge. Leaf—febrifuge.

The Ayurvedic Pharmacopoeia of India indicated the use of the dried roots in cough, bronchitis, dyspnoea, chest diseases and sinusitis.

The bark contains triterpenoids— serratagenic, oleanolic and queretaric acids; leaves contain alpha-spinasterol and flavonoids, including luteolin, api- genin, baicalein, scutellarein, phenolic acids—caffeic and ferulic acids.

EtOH (50%) extract of the plant exhibited hypotensive and spasmolytic activity. Polyhydric property on isolated guinea pig ileum. Antiasthmatic effect was also observed pharmacologically.

Dosage: Root—3-6 g powder; 1020 g for decoction. (API Vol. III.)... clerodendrum serratum

n. the alternation of active inhalation (or inspiration) of air into the lungs through the mouth or nose with the passive exhalation (or expiration) of the air. During inhalation the *diaphragm and *intercostal muscles contract, which enlarges the chest cavity and draws air into the lungs. Relaxation of these muscles forces air out of the lungs at exhalation. (See illustration.) Breathing is part of *respiration and is sometimes called external respiration. There are many types of breathing in which the rhythm, rate, or character is abnormal. See also apnoea; bronchospasm; Cheyne–Stokes respiration; dyspnoea; stridor.... breathing

combining form denoting a condition of breathing. Example: dyspnoea (breathlessness).... pnoea

a rare complication of pregnancy, occurring from the sixth month of pregnancy until six months postnatally (usually within six weeks of delivery). It can follow pre-eclampsia. It is characterized by palpitations, dyspnoea, oedema (peripheral and central), and impaired exercise tolerance. The diagnosis is confirmed on echocardiography. It has a high mortality and morbidity. Treatment of heart failure, anticoagulation, and in some cases immunosuppressant therapy is required; in some cases heart transplantation may be considered.... puerperal cardiomyopathy

W. & A.

Synonym: C. cordifolia Cogn. Cephalandra indica Naud.

Family: Cucurbitaceae.

Habitat: Cultivated in Assam, West Bengal, Bihar, Orissa, Maharashtra, Andhra Pradesh, Tamil Nadu; wild in many parts of India.

English: Ivy-Gourd.

Ayurvedic: Bimbi, Tundi, Tundikaa, Tundikeri, Kunduru, Raktaphala, Piluparni, Dantchhadaa.

Unani: Kanduri.

Siddha/Tamil: Kovvai.

Action: Carminative, antipyretic, galactagogue. Powder of root is taken with water to stop vomiting. Juice of leaves—antispasmodic and expectorant. Applied externally in eruptions of the skin. Root— antiprotozoal. Fruit, leaf and root— antidiabetic. Various plant parts are used in slow pulse and convulsions, also against infective hepatitis.

The Ayurvedic Pharmacopoeia ofIn- dia recommends the whole plant for oedema, anaemia, disorders due to vitiated blood, cough and dyspnoea.

The fruit yielded beta-amyrin and its acetate, lupeol and cucurbitacin B.

Dosage: Whole plant—3-6 g powder; 5-10 ml juice. (API Vol. III.)... coccinia indica

Cyanide inhibits cellular RESPIRATION by binding rapidly and reversibly with the ENZYME, cytochrome oxidase. E?ects of poisoning are due to tissue HYPOXIA. Cyanide is toxic by inhalation, ingestion and prolonged skin contact, and acts extremely quickly once absorbed. Following inhalation of hydrogen cyanide gas, death can occur within minutes. Ingestion of inorganic cyanide salts may produce symptoms within 10 minutes, again proceeding rapidly to death. On a full stomach, effects may be delayed for an hour or more. Signs of cyanide poisoning are headache, dizziness, vomiting, weakness, ATAXIA, HYPERVENTILATION, DYSPNOEA, HYPOTENSION and collapse. Loss of vision and hearing may occur, then COMA and CONVULSIONS. Other features include cardiac ARRHYTHMIA and PULMONARY OEDEMA. Patients may have a lactic ACIDOSIS. Their arterial oxygen tension is likely to be normal, but their venous oxygen tension high and similar to that of arterial blood.

Treatment Administration of oxygen when available is the most important ?rst-aid management. Rescuers should be trained, must not put themselves at risk, and should use protective clothing and breathing apparatus. In unconscious victims, establish a clear airway and give 100 per cent oxygen. If breathing stops and oxygen is unavailable, initiate expired-air resuscitation. If cyanide salts were ingested, mouth-to-mouth contact must be avoided and a mask with a one-way valve employed instead. Some commercially available ?rst-aid kits contain AMYL NITRATE as an antidote which may be employed if oxygen is unavailable.

Once in hospital, or if a trained physician is on the scene, then antidotes may be administered. There are several di?erent intravenous antidotes that may be used either alone or in combination. In mild to moderate cases, sodium thiosulphate is usually given. In more severe cases either dicobalt edetate or sodium nitrite may be used, followed by sodium thio-sulphate. Some of these (e.g. dicobalt edetate) should be given only where diagnosis is certain, otherwise serious adverse reations or toxicity due to the antidotes may occur.... cyanide poisoning

Linn. f.

Habitat: Native to China; now grown in Himachal Pradesh, Kumaon, the Nilgiris and West Bengal for edible fruits.

English: Japanese Persimmon.

Ayurvedic: Tinduka (var.).

Action: Hypotensive, hepatopro- tective, antidote to poisons and bacterial toxins. Calyx and peduncle of fruit—used in the treatment of cough and dyspnoea. Roasted seeds—used as a substitute for coffee.

The fruit, in addition to sugars, glucose, fructose, ascorbic acid, citric acid, contains (% of fresh weight) 0.20-1.41 tannins, 0.21-10.07 total pectins, 0.67 pentosans and 0.16-0.25 polyphenols. The fruit also contains 2.4 mg/100 g carotenoids; carotene expressed as vitamin A 2200-2600 IU. The carote- noids identified in the pulp include cryptoxanthine, zeaxanthin, antherax- anthin, lycopene and beta-carotene. (Many carotenoids originally present in the fruit decompose during ripening.

The fruit pulp is an antidote to bacterial toxins and is used in the preparation of a vaccine for pertussis.

Condensed tannins from the fruits effectively inhibited 2-nitrofluorene mutagen.

The immature leaves contain a ster- oidal saponin, lignin and phenolic compounds. Eugenol and dihydroac- tinidiolide are reported from fresh leaves.

The leaves are reported to exhibit hepatoprotective activity. Leaves also contain hypotensive principles. Astra- galin and isoquercitrin have been isolated from leaves.... diospyros kaki

A clinical state arising from invasive colo-rectal disease; it is accompanied by abdominal colic, diarrhoea, and passage of blood/mucus in the stool. Although the two major forms are caused by Shigella spp. (bacillary dysentery) and Entamoeba histolytica (amoebic dysentery), other organisms including entero-haemorrhagic Escherichia coli (serotypes 0157:H7 and 026:H11) and Campylobacter spp. are also relevant. Other causes of dysentery include Balantidium coli and that caused by schistosomiasis (bilharzia) – Schistosoma mansoni and S. japonicum infection.

Shigellosis This form is usually caused by Shigella dysenteriae-1 (Shiga’s bacillus), Shigella ?exneri, Shigella boydii, and Shigella sonnei; the latter is the most benign and occurs in temperate climates also. It is transmitted by food and water contamination, by direct contact, and by ?ies; the organisms thrive in the presence of overcrowding and insanitary conditions. The incubation is between one and seven days, and the severity of the illness depends on the strain responsible. Duration of illness varies from a few days to two weeks and can be particularly severe in young, old, and malnourished individuals. Complications include perforation and haemorrhage from the colo-rectum, the haemolytic uraemic syndrome (which includes renal failure), and REITER’S SYNDROME. Diagnosis is dependent on demonstration of Shigella in (a) faecal sample(s) – before or usually after culture.

If dehydration is present, this should be treated accordingly, usually with an oral rehydration technique. Shigella is eradicated by antibiotics such as trimethoprimsulphamethoxazole, trimethoprim, ampicillin, and amoxycillin. Recently, a widespread resistance to many antibiotics has developed, especially in Asia and southern America, where the agent of choice is now a quinolone compound, for example, cipro?oxacin; nalidixic acid is also e?ective. Prevention depends on improved hygiene and sanitation, careful protection of food from ?ies, ?y destruction, and garbage disposal. A Shigella carrier must not be allowed to handle food.

Entamoeba histolytica infection Most cases occur in the tropics and subtropics. Dysentery may be accompanied by weight loss, anaemia, and occasionally DYSPNOEA. E. histolytica contaminates food (e.g. uncooked vegetables) or drinking water. After ingestion of the cyst-stage, and following the action of digestive enzymes, the motile trophozoite emerges in the colon causing local invasive disease (amoebic colitis). On entering the portal system, these organisms may gain access to the liver, causing invasive hepatic disease (amoebic liver ‘abscess’). Other sites of ‘abscess’ formation include the lungs (usually right) and brain. In the colo-rectum an amoeboma may be di?cult to di?erentiate from a carcinoma. Clinical symptoms usually occur within a week, but can be delayed for months, or even years; onset may be acute – as for Shigella spp. infection. Perforation, colo-rectal haemorrhage, and appendicitis are unusual complications. Diagnosis is by demonstration of E. histolytica trophozoites in a fresh faecal sample; other amoebae affecting humans do not invade tissues. Research techniques can be used to di?erentiate between pathogenic (E. dysenteriae) and non-pathogenic strains (E. dispar). Alternatively, several serological tests are of value in diagnosis, but only in the presence of invasive disease.

Treatment consists of one of the 5nitroimidazole compounds – metronidazole, tinidazole, and ornidazole; alcohol avoidance is important during their administration. A ?ve- to ten-day course should be followed by diloxanide furoate for ten days. Other compounds – emetine, chloroquine, iodoquinol, and paromomycin – are now rarely used. Invasive disease involving the liver or other organ(s) usually responds favourably to a similar regimen; aspiration of a liver ‘abscess’ is now rarely indicated, as controlled trials have indicated a similar resolution rate whether this technique is used or not, provided a 5-nitroimidazole compound is administered.... dysentery

Linn.

Synonym: O. tenuiflorum Linn.

Family: Labiatae; Lamiaceae.

Habitat: Throughout India; grown in houses, gardens and temples.

English: Holy Basil, Sacred Basil.

Ayurvedic: Tulasi, Surasaa, Surasa, Bhuutaghni, Suravalli, Sulabhaa, Manjarikaa, Bahumanjari, Deva- dundubhi, Apet-raakshasi, Shuu- laghni, Graamya, Sulabhaa.

Unani: Tulasi.

Siddha/Tamil: Tulasi, Nalla-Tulasi.

Action: Leaf—carminative, stomachic, antispasmodic, antiasthmatic, antirheumatic, expectorant, stimulant, hepatoprotective, antiperiodic, antipyretic and diaphoretic. Seed— used in genitourinary diseases. Root—antimalarial. Plant—adap- togenic, antistress. Essential oil— antibacterial, antifungal.

The Ayurvedic Pharmacopoeia of India recommends the use of the leaf and seed in rhinitis and influenza; the seed in psychological disorders, including fear-psychosis and obsessions.

Major components of the essential oil are eugenol, carvacrol, nerol and eugenolmethylether. Leaves have been reported to contain ursolic acid, api- genin, luteolin, apigenin-7-O-glucu- ronide, luteolin-7-O-glucuronide, orientin and molludistin.

Ursolic acid, isolated from leaves, exhibited significant protection of mast cell membrane by preventing granulation and decreased histamine release. The ethanolic extract (50%) of fresh leaves, volatile oil from fresh leaves and fixed oil from seeds showed antiasth- matic activity and significantly protected guinea-pigs against histamine and dyspnoea. They also showed anti- inflammatory activity against carrage- enan-, serotonin-, histamine- and PGE-2-induced inflammation and inhibited hind paw oedema in rats.

The ethanol extract (90%) of the leaves showed hepatoprotective effect against paracetamol-induced liver damage.

The plant extract exhibited antiul- cerogenic property against experimental ulcers.

Oral administration of alcoholic extract of leaves lowers blood sugar level in normal, glucose-fed hyperglycaemic and streptozotocin-induced diabetic rats. The activity of the extract was 91.55 and 70.43% of that of tolbutamide in normal and diabetic rats respectively.

Administration of the juice of the plant affected a significant reduction in the size of urinary brushite crystals.

A study of methanol extract and aqueous suspension of the leaves showed immunostimulation of humoral immunologic response in albino rats indicating the adaptogenic action of the plant.

Dosage: Seed—1-2 g powder (API, Vol. IV); plant—50-10 ml infusion (CCRAS.).... ocimum sanctum

Gymnema sylvestre

Asclepiadaceae

San: Mesasrngi, Madhunasini;

Hin: Gudmar, Merasimgi;

Ben: Merasingi;

Mal: Chakkarakolli, Madhunasini;

Tam: Sirukurumkay, Sakkaraikkolli;

Kan: Kadhasige;

Tel: Podapatra; Mar: Kavali

Importance: Gymnema, Australian Cowplant, Small Indian Ipecacuanha or Periploca of the woods is a woody climber. It is reported to cure cough, dyspnoea, ulcers, pitta, kapha and pain in the eyes. The plant is useful in inflammations, hepatosplenomegaly, dyspepsia, constipation, jaundice, haemorrhoids, strangury, renal and vesical calculi, helminthiasis, cardiopathy, cough, asthma, bronchitis, intermittent fever, amenorrhoea, conjuctivitis and leucoderma. The fresh leaves when chewed have the remarkable property of paralysing the sense of taste for sweet and bitter substance for some time (Warrier et al, 1995). The drug is described as a destroyer of madhumeha (glycosuria) and other urinary disorders. Root has long been reputed as a remedy for snakebite. Leaves triturated and mixed with castor oil are applied to swollen glands and enlargement of internal viscera as the liver and spleen (Nadkarni, 1954). The drug is used to strengthen the function of heart, cure jaundice, piles, urinary calculi, difficult micturition and intermittent fevers (Sharma,1983). The drug enters into the composition of preparations like Ayaskrti, Varunadi kasaya, Varunadighrtam, Mahakalyanakaghrtam, etc. They suppress the activity of taste of tongue for sweet taste and for this reason it was considered that it destroys sugar, hence the name Madhunashini or Gurmar and has been prescribed as an anti-diabetic. The crude drug as well as its dried aqueous extract is mainly used in bronchial troubles.

Distribution: It is a tropical climber. It mainly grows in Western Ghats, Konkan, Tamil Nadu and some parts of Bihar. The plant is cultivated in plains of India but the drug is mainly important from Afghanistan and Iran.

Botany: Gymnema sylvestre (Retz.)R. Br. syn. Asclepias germinata Roxb. belonging to the family Asclepiadaceae is a large, woody much branched climber with pubescent young parts. Leaves are simple, opposite, elliptic or ovate, more or less pubescent on both sides, base rounded or cordate. Flowers are small, yellow and arranged in umbellate cymes. Fruits are slender and follicles are upto 7.5cm long (Warrier et al, 1995).

Two allied species, G. hirsutum found in Bundelkh and Bihar and Western Ghats and G. montanum growing wild in Eastern Ghats and Konkan are also used for the same purpose and are also called “Gurmar” (Thakur et al, 1989).

Agrotechnology: The plant can be propagated both by seeds and stem cuttings. Seedlings are to be raised in polybags. Pits of size 50cm cube are to be taken, filled with 10kg dried cowdung or FYM and covered with topsoil. On these pits about 3-4 months old seedlings are to be transplanted from polybags. Trailing can be facilitated by erecting poles and tying the plants to the poles. The plant will attain good spread within one year. Regular weeding, irrigation and organic manure application are beneficial. The plant is not attacked by any serious pests or diseases. Leaves can be collected from the first year onwards at an internal of one week. This can be continued for 10-12 years. Fresh or dried leaves can be marketed (Prasad et al, 1997).

Properties and activity: Nonacosane and hentriacontane were isolated from the hexane extract of leaves. An attempt to isolate nitrogenous compounds led to the isolation of amino acids such as leucine, iso-leucine, valine, allanine and - amynobutyric acid. Isolation of trimethyl amine oxide was of particular interest. An alkaloid gynamine which is a trace constituent was isolated and identified (Sinsheimer et al, 1967). Antisweet constituent of the leaves has been found to be a mixture of triterpene saponins. These have been designated as gymnemic acids A,B,C and D which have the gymnemagenin and gymnestrogenins as the aglycones of gymnemic acid A and B and gymnemic acid C and D respectively. These are hexahydroxy triterpenes the latter being partially acylated. The sugar residues are glucuronic acid and galacturonic acid while ferulic and angelic acids have been attached as the carboxylic acid.

Chewing of leaves reduces sensitivity to sweet substances. Effects of gymnema extracts had been variable. While verifying the effect of G. sylvestre leaves on detoxification of snake venom, it has been reported that a toxic component of venom ATP and gymnemate bind at the same site inhibiting venom ATP-ase. The active principles which have been identified as glycosides (7 gymnemic acids) suggest that the topical and selective anaesthetic effect of the plant might result from the competition of the receptor sites between glycosides and the sweet substances (Warren et al, 1969). The leaves are antidiabetic and insulinotropic. Gymnemic acid is antiviral. The plant is bitter, astringent, acrid, thermogenic, antiinflammatory, anodyne, digestive, liver tonic, emetic, diuretic, stomachic, stimulant, anthelmintic, alexipharmic, laxative, cardiotonic, expectorant, antipyretic and uterine tonic.... gymnema

Linn.

Leonotis nepetaefolia (L.) R. Br.

Family: Labiatae; Lamiaceae.

Habitat: Throughout the warmer parts of India.

Ayurvedic: Granthiparni, Kaaka- puchha.

Folk: Gathivan, Deepamaal (Maharashtra).

Action: Leaves—spasmolytic. Ash of flower head—applied to burns and scalds, in ringworm and other skin diseases.

The Ayurvedic Pharmacopoeia ofIn- dia recommends the root in cough, bronchitis and dyspnoea.

The root contains n-octacosanol, n-octacosanoic acid, quercetin, 4,6,7- trimethoxy-5-methylchromene-2-one, campesterol and beta-sitosterol-beta- D-glucopyranoside.

The plant contains 4,6,7-trimethoxy- 5-methyl-chromene-2-one.

The leaves contain neptaefolin, nep- taefuran, neptaefuranol, neptaefolinol, leonitin, neptaefolinin and (-)-55, 6- octadecadienoic acid.

The seed oil contains oleic, linoleic, palmitic and stearic acids. The fatty

Family: Labiatae; Lamiaceae.

Habitat: Native to Europe; also distributed in Himalayas from Kashmir to Kumaon.

English: Common Motherwort, Lion's Tail.

Unani: Baranjaasif. (Also equated with Artemesia vulgaris Linn; and Achillea millifolium Linn.)

Action: Stomachic, laxative, antispasmodic, diaphoretic, em- menagogue (used in absent or painful menstruation, premenstrual tension, menopausal flushes). Hypnotic, sedative. Used as a cardiac tonic. (Studies in China have shown that Motherwort extracts show antiplatelet aggregation actions and decrease the levels of blood lipids.)

Key application: In nervous cardiac disorders and as adjuvant for thyroid hyperfunction. (German Commission E.) As antispasmodic. (The British Herbal Pharmacopoeia.) The British Herbal Compendium indicated its use for patients who have neuropathic cardiac disorders and cardiac complaints of nervous origin.

The plant contains diterpene bitter principles, iridoid monoterpenes, flavonoids including rutin and querci- trin, leonurin, betaine, caffeic acid derivatives, tannins and traces of a volatile oil.

The herb is a slow acting adjuvant in functional and neurogenic heart diseases. Its sedative and spasmolytic properties combine well with Valeriana officinalis or other cardioactive substances.

The herb contains several components with sedative effects—alpha- pinene, benzaldehyde, caryophyllene, limonene and oleanolic acid. (Sharon M. Herr.)

Habitat: Western Europe. Seeds are imported into India from Persia.

English: Pepper-Grass.

Unani: Bazr-ul-khumkhum, Todari (white var.).

Action: Seeds—blood purifier; prescribed in bronchitis.

The fatty acid of the oil are: oleic 12.9, linoleic 47.87, linolenic 5.43, erucic 31.97, stearic 0.54 and palmitic 1.22%.

The seed mucilage on hydrolysis gave galactose, arabinose, rhamnose and galacturonic acid.

Flowering tops and seeds contain a bitter principle, lepidin.

The plant yield a sulphur-containing volatile oil.... leonurus cardiaca

R. Br.

Synonym: P. morindaefolia R. Br. ex Wt.

Family: Nyctaginaceae.

Habitat: Cultivated in gardens in Chennai and other places near the sea on both east and west coasts.

English: Lettuce tree.

Siddha/Tamil: Chandi keerai, Leechai kottai keerai, Nachu Kottai keerai.

Action: Fresh leaf—diuretic, used in inflammations (of elephantoid nature in legs and other parts). Root—purgative.

The plant gave octacosanol, beta- sitosterol, alpha-spinasterol, beta-si- tosterol-b eta-D-glucopyranoside, dul- citol and quercetin.

Karkata, Karkataakhya, Kuli- rashringaaya, Kuliravishaanikaa, Vakraa, Vishaani. Ajashringi (also equated with Gymnema sylvestre).

Unani: Kaakraasingi, Kakar.

Siddha/Tamil: Karkatagasingi.

Action: Gall—astringent, expectorant, antiasthmatic, antidysenteric, styptic.

Key application: In cough, bronchitis and dyspnoea. (The Ayurvedic Pharmacopoeia of India.)

The tetracyclic triterpenes, pistaci- gerrimones A, B and C have been isolated from the galls produced on the leaves.

Alpha-pinene 21.8, beta-pinene 16.2, alpha-phellandrene 15.5 and delta-carene 11% are major constituents of the essential oil extracted from galls. The oil is reported to exhibit CNS- depressant, antispasmodic, carminative and antibacterial, antiprotozoal, antiamoebic, anthelmintic activities.

Dosage: Gall—3-6 g powder. (API, Vol. I.)... pisonia grandis

Bennett.

Family: Simaroubaceae.

Habitat: Garhwal, Himachal Pradesh and Kulu.

English: Quassia (substitute for P excelsa Lindtl).

Ayurvedic: Bhurangi, Nimbi. (Clerodendrum serratum and its related species represent Bhaargi or Bhaarangi.)

Folk: Nimatotaa.

Action: Wood—a non-astringent bitter tonic and stomachic, amoe- bicidal, anthelmintic (used as enema), insect repellent. Used as a supporting medicine for temporary relief in cirrhosis of liver.

Many indole alkaloids of beta-car- boline, canthin-6-one and beta-carbo- line dimer type, have been isolated from the wood. These are reported to increase the blood flow rate in the intestine and stomach of rabbit; also exhibited antiviral activity on Herpes simplex virus.

Nigaki lactone and methylnigaki- none, isolated from the wood, showed antigastric ulcer activity in rats. The extract of the wood is reported to prevent the secretion of gastric juice in a dose-dependent manner in rats. The extract also showed the same effects on rats having aspirin-induced gastric ulcer.

Family: Scrophulariaceae.

Habitat: The alpine Himalayas from Kashmir to Sikkim.

English: Picrorhiza.

Ayurvedic: Katukaa, Katurohini, Kattarohini, Katuki, Katukikaa, Krishnabhedaa, Kaandaruhaa, Matsyashakalaa, Chakraangi, Shat- parvaa, Arishta, Ashokarohinya, Shakuldaani.

Unani: Kutki, Kharbaq-e-Hindi.

Siddha/Tamil: Kaduguragini.

Action: Root—stomachic, antidiar- rhoeal, cholagogue, hepatoprotec- tive. Used in hepatitis, chronic dysentery, amoebiasis.

Key application: In jaundice, intermittent fever, dyspnoea and skin diseases. (The Ayurvedic Pharmacopoeia ofIndia.)

The roots yield a glycosidal bitter principle, kutkin, found to be a mixture of two iridoid glycosides, picro- side I and kutkoside. Also obtained were D-mannitol, kutkiol, kutkisterol and a ketone (identical with apocynin).

Kutkin exhibited hepatoprotective activity in CCl4-induced toxic rats.

Picroliv, a standardized fraction from the alcoholic extract of the root and rhizome, containing 55-60% of a mixture of picroside I and kutkoside (1:15) showed dose-dependent protective activity on isolated hepatocytes in vitro against thiocetamide-induced hepatic damage in rat and was found to be more potent than Silymarin, a known hepatoprotective agent. Pi- croliv is reported to show protective effect against rifampicin-induced hep- atotoxicity in rats. It also exerts hy- polipidaemic effect in normal, triton- treated and cholesterol-fed rats.

Kutkin, picroside I and kutkoside exhibit anti-inflammatory property.

The phenolic glycoside, androsin, isolated from the plant, prevents allergen and platelet activating factor- induced bronchial obstruction in guinea-pigs in vitro.

Cucurbitacin glycosides, isolated from the root, exhibit liver protective, tumour inhibitory and anti-inflammatory activity.

Dosage: Root—1-3 g; 3-6 g as purgative. (CCRAS.)... picrasma quassioides

Schott.

Family: Araceae.

Habitat: Tropical Himalayas, Bengal, southwards to Andhra Pradesh and the Andamans.

Ayurvedic: Gajakrishna, Hastipip- pali, Gajapippali (also equated with Piper chaba).

Siddha/Tamil: Anaitippili.

Action: Fruits—stimulant, carminative, diaphoretic, anthelmintic, antidiarrhoeal. Decoction is used as an expectorant in asthma. Fruits and shoots—hypoglycaemic. Fruit pulp—applied externally in rheumatism.

The Ayurvedic Pharmacopoeia of India recommends dried pieces of mature female spadix in dyspnoea. (Gajapip- pali is wrongly equated with male or female inflorescence of Borassus flabel- lifer Linn.)

The fruits contain two glycosidic substances—scindapsin A and B, which on hydrolysis yield the aglu- cons, scindapsinidine A and B. Free sugars, rhamnose, fructose, glucose and xylose together with some di-and trisaccharides have been identified in the plant.

Dosage: Dried pieces of mature female spadix—2-3 g for infusion. (API, Vol. II.)... scindapsus officinalis

Linn.

Family: Cruciferae; Brassicaceae.

Habitat: Cultivated in Uttar Pradesh, Punjab, Maharashtra and Gujarat.

English: Radish.

Ayurvedic: Muulaka, Laghu- muulaka, Muulakapotikaa, Visra, Shaaleya, Marusambhava. Pods— Sungraa, Singri, Mungraa.

Unani: Muuli, Turb Fajal.

Siddha/Tamil: Mullangi.

Action: Radish—preparations are used in liver, gallbladder and urinary complaints. Green leaves— diuretic and carminative. Seeds— diuretic, purgative, expectorant.

A decoction of dry radish is given orally in piles. Extract of the dry root is given for hiccough, influenza, dysentery, colic and urinary troubles.

Key application: In peptic disorders, especially those related to dyskinesia of the bile ducts; and in catarrhs of the upper respiratory tract. (German Commission E.)

The Ayurvedic Pharmacopoeia of India recommends the juice of the whole plant in sinusitis; juice of the root in diseases of the throat and sinusitis; and the seed in amenorrhoea, cough and dyspnoea.

The fleshy root and seeds contain trans-4-methyl-thiobutenyl isothio- cyanate glucoside (the pungent principle), cyanidin-5-glucoside-3-sophoro- side, pelargonidin diglycoside, cyani- din diglycoside, 5-methyl-L-cysteine- sulphoxide (methiin), steroidal sa- pogenins and sulphorophene.

The enzymes present in the radish are phosphatase, catalase, sucrase, amylase, alcohol dehydrogenase and pyruvic carboxylase.

Radish contains caffeic acid and fer- ulic acid which exhibit hepatoprotec- tive and choleretic properties. It contains choline which prevents deposition of fat in liver. Amino acids, or- nithine, citrulline, arginine, glutamic acid and asparatic acid remove toxins from the body and urea acumulation.

Radish is a good source of ascorbic acid (15-40 mg/100 g), trace elements include aluminium, barium, lithium, manganese, silicon, titanium, also iodine (upto 18 mcg/100 g) and ascor- bigen.

Roots, leaves, flowers and pods are active against Gram-positive bacteria.

The seeds are reported to contain a broad spectrum antibiotic, machro- lysin, specific against Mycobacterium tuberculosis. Raphanin, extracted from the seeds, is active against Grampositive and Gram-negative bacteria.

A purified basic protein, homologous to nonspecific lipid transfer proteins, from seeds showed antifungal activity.

Raphanus caudatus Linn., synonym R. sativus var. caudatus, is known as Rat-Tail Radish.

A native to Java, it is cultivated in northern and western India. The root is not used; pods, purple or violet in colour, are consumed for properties attributed to Raphanus sp. These are known as Mungraa or Sungraa.

Dosage: Whole plant-20-40 ml juice; root—15-30 ml juice. (API, Vol. II.) Seed—1-3 g powder. (API, Vol. III.)... raphanus sativus

Desv.

Synonym: Hedysarum pictum Jacq.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout India, in dry grasslands. Ayurvedic: Prishniparni, Prithak- parni, Simhapushpi, Kalashi, Dhaavani, Guhaa, Chitraparni.

Siddha/Tamil: Oripai.

Action: Root—prescribed for cough, chills and fevers. Leaves—antiseptic, used for urinary discharges and genitourinary infections.

The Ayurvedic Pharmacopoeia of India recommends a decoction of whole plant in alcoholism, insanity, psychosis; cough, bronchitis, dyspnoea; diseases due to vitiated blood; gout; bleeding piles; blood dysentery, acute diarrhoea.

The plant is credited with fracture- healing properties. Its total extract exhibits better and quicker healing of fractures in experimental animals due to early accumulation of phosphorus and more deposition of calcium.

Dosage: Whole plant—20-50 g powder for decoction. (API, Vol. IV.)... uraria picta

Linn.

Family: Vitaceae.

Habitat: A woody, shrubby vine, cultivated in Punjab, Rajasthan, Delhi, Uttar Pradesh Maharashtra, Karnataka, Andhra Pradesh and Tamil Nadu for edible fruits.

English: Wine Grape, European Grape. (Chinese: P'u-t'ao.)

Ayurvedic: Draakshaa, Go-stani, Mrdvikaa. Dehydrated fruit— Daakh, Munnakaa, Kishmish.

Unani: Angoor. Dehydrated fruit—Daakh, Maweez, Zabeeb, Munaqqaa, Kishmish.

Siddha: Draksha.

Action: Dried fruits, seedless— nourishing and invigorating. Used in prescriptions for cough, respiratory tract catarrh, subacute cases of enlarged liver and spleen; and in alcohol-based tonics (Aasavs).

The Ayurvedic Pharmacopoeia ofIn- dia recommends dried mature fruits (5-10 g) in anaemia, jaundice, dyspepsia, constipation, haemorrhagic diseases, gout, cough, dyspnoea, and alcoholism.

Grape vine contains flavonoids, tannins, tartrates, inositol, carotenes, cho- line and sugars. The fruit contains tar- taric and malic acids, sugars, pectin, tannin, flavone glycosides, vitamins A, B1, B2, C and minerals; anthocyanins in red leaves and red grapes. Antho- cyanins reduce capillary permeability. Red leaves are astringent and anti- inflammatory; an infusion is used for diarrhoea, heavy menstrual bleeding and uterine haemorrhage; also in the treatment of varicose veins and haemorrhoids.

Oligomeric proanthocyanidin extract of the seed is used in atherosclerosis due to its free radical scavenging ability, also in venous insufficiency, night vision, oedema due to injury and post surgery oedema.

Proanthocyanidin extract decreased hepatotoxicity of acetaminophen in mice. Grape polyphenols, extracted from skin and seeds decreased hepatic injury from alcohol, but had no effect on ethanol-induced lipid changes in rats. (Sharon M. Herr.)

Dosage: Dried mature fruits—5-10 g. (API, Vol. III.)... vitis vinifera

(Decne) Sch.-Bip.

Synonym: S. costus (Falc.) Lipsch.

Family: Compositae; Asteraceae.

Habitat: Kashmir, Himachal Pradesh and Garhwal at 25003,000 m; cultivated in Kashmir and neighbouring regions.

English: Kuth, Costus.

Ayurvedic: Kushtha, Kusht, Vaapya, Kaashmira, Gada, Rug, Ruk, Aamaya, Paalaka. (Substitute: Pushkara Muula, Inula racemosa.)

Unani: Qust.

Siddha/Tamil: Kostum, Kottam.

Folk: Sugandha-Kuutth.

Action: Root—antispasmodic, expectorant, carminative, astringent, antiseptic. An ingredient of prescriptions for dyspepsia, asthma, cough, chronic rheumatism, skin diseases. Applied locally to wounds and ulcerations. Powdered root, mixed with mustard oil, is applied to scalp in prurigo.

The Ayurvedic Pharmacopoeia of India recommends the root in cough, bronchitis, dyspnoea; erysipelas and gout.

The root (containing both the essential oil and alkaloid, saussurine) is used for asthma, particularly of vagotonic type. It produces a definite relaxtion of the bronchioles. The relief obtained is comparable to that of conventional bronchodilators without side effects, like a rise in blood pressure, sweating or headache even on repeated administration.

Saussurine depresses parasympa- thetic nervous system. The aminoacid- sesquiterpene adducts, saussureami- nes A, B and C show antiulcer effect. The aqueous extract of the root exhibits antianginal activity.

Essential oil inhibits peristalic movement of the gut. It is absorbed from the gastro-intestinal tract and partly excreted by lungs producing an expectorant action and partly by the kidneys producing diuretic effect. (In Western herbal, Kuth essential oil is not prescribed internally.)

Kuth roots contain resinoids (6%), and essential oil (1.5%), alkaloid (0.05%) inulin (18%), saussurea lactone (20-25%), a fixed oil and minor constituents like tannin and sugars. Roots obtained from Kashmir are, in general, richer in essential oil content than roots obtained from Garhwal and Nepal. The roots of Punjab variety gave cos- tunolide, dehydrocostuslactone, costic acid, palmitic and linoleic acids, beta- sitosterol and alpha-cyclocostunolide. The Kashmir variety, in addition, gave alantolactone, beta-cyclocostunolide and iso-alantolactone.

The essential oil of the roots exhibit strong antiseptic and disinfectant activity against Streptococcus and Staphy- lococcus.

Costus speciosus Sm. synonym Banksea speciosa, also known as Kush- tha, is a different herb of Zingiberaceae family. Rhizomes and stems yield dios- genin.

Dosage: Root—0.2-1.0 g powder. (API, Vol. I.)... saussurea lappa

DC.

Synonym: Z. alatum Roxb. Z. var. planispinum Sieb. & Zucc.

Family: Rutaceae.

Habitat: Jammu & Kashmir and Garhwal.

English: Toothache tree, Indian Prickly Ash.

Ayurvedic: Tumburu (fruit). Tejabala, Tejaswani, Tejohva, Tejovati (stem bark).

Unani: Faaghir, Kabaab-e- Khandaan.

Siddha: Tejyovathi.

Folk: Nepaali Dhaniyaa.

Action: Stem bark—used in cough, dyspnoea, hiccup, stomatitis, rheumatism. (The Ayurvedic Pharmacopoeia of India.) Stems and thorns—hypoglycaemic. Bark— used for cleaning teeth, also for treating diarrhoea. Fruits, seeds, bark—carminative, antispasmodic, anthelmintic. Fruits and seeds— used as a tonic in fever, dyspepsia and skin diseases. Essential oil of the fruit—antibacterial, antifungal and deodorant. Used in tooth powders.

The essential oil from dried fruits contains linalool (64.1%), linalyl acetate, citral, geraniol methyl cinna- mate, limonene and sabinene.

Dried bark and branches contain lignans—sesamin, fargesin, eudesmin; a lactone pulviatide; dictamine, 8- hydroxydictamine and gamma-faga- rine; magnoflorine and xanthoplanine. The root contains magnoflorine, xan- thoplanine, skimmianine, dictamine and gamma-fagarine. Seeds contain flavonoids tambulin and tambulol.

Dosage: Stem bark—10-20g for decoction; fruit—3-4 g. (API, Vol. II; Vol. IV.)... zanthoxylum armatum

Rosc.

Family: Zingiberaceae.

Habitat: Native to Southeast Asia; now cultivated mainly in Kerala, Andhra Pradesh, Uttar Pradesh, West Bengal, Maharashtra.

English: Ginger.

Ayurvedic: Fresh rhizome— Aardraka, Aadrikaa, Shrngibera, shrngavera, Katubhadra. Dried rhi- zome—Shunthi, Naagara, Naagaraa, Naagaraka, Aushadha, Mahaushad- ha, Vishvaa, Vishvabheshaja, Vishvaaushadha.

Unani: Fresh rhizome—Zanjabeel- e-Ratab, Al-Zanjabeel. Dried rhizome—zanjabeel, Zanjabeel-e- yaabis.

Siddha: Fresh rhizome—Inji, Allam, Lokottai. Dried rhizome— chukku, Sunthi.

Action: Rhizome—antiemetic, antiflatulent, hypocholesterolaemic, anti-inflammatory, antispasmodic, expectorant, circulatory stimulant, diaphoretic, increases bioavailabil- ity of prescription drugs. Used for irritable bowel and diarrhoea, colds and influenza. Showed encouraging results in migraine and cluster headache (J Ethnophar- macol, 1990, 29, 267-273; Aust J Med Herbalism, 1995, 7/3, 6978; Natural Medicines Comprehensive Database, 2007.) The Ayurvedic Pharmacopoeia of India recommends dried rhizomes in dyspepsia, loss of appetite, tympanitis, anaemia, rheumatism, cough and dyspnoea; fresh rhizomes in constipation, colic, oedema and throat infections.

Key application: For dyspepsia and prevention of motion sickness (German Commission E); vomiting of pregnancy, anorexia, bronchitis and rheumatic complaints (The British Herbal Compendium); as a post-operative antiemetic. (ESCOP).

The rhizome contains an essential oil containing monoterpenes, mainly geranial and neral; and sesquiterpenes, mainly beta-sesquiphellandrene, beta- bisabolene, ar-curcumene and alpha- zingiberene; pungent principles, consisting of gingerols, shogaols and related phenolic ketone derivatives. Other constituents include diarylheptenones, diterpenes, gingesulphonic acid and monoacyldigalactosyl glycerols.

Gingerol and shogaol have been shown to suppress gastric contractions. Both fresh and dried rhizomes suppress gastric secretion and reduce vomiting. Gingerol and shogaol have gained importance due to their sedative, anti-inflammatory, antipyretic, analgesic, hypotensive and hepatopro- tective activities.

Cardiotonic effects of ginger has been attributed to 6-and 8-shagaols and gingerols. (Antithrombotic effects remain unconfirmed.) Antimigraine effect is due to ginger's ability to decrease platelet aggregation. It also acts as a potent inhibitor of prostaglandins which enhance release of substance P from trigeminal fibers. (PDR, 2004.)

Indian ginger is considered only second to Jamaican in quality.

There are three main types of Indian ginger—Cochin ginger (light brown or yellowish grey; Calicut ginger from Malabar (orange or reddish brown, resembling African ginger) and Kolkata ginger (greyish brown to greyish blue).... zingiber officinale

severe difficulty in achieving adequate oxygenation in spite of significant efforts to breathe: it is usually associated with increased *respiratory rate and the use of *accessory muscles in the chest wall. It can occur in both obstructive and nonobstructive lung conditions. See adult respiratory distress syndrome; airway obstruction; dyspnoea; respiratory distress syndrome; stridor.

respiratory distress syndrome (RDS; hyaline membrane disease) the condition of a newborn infant in which the lungs are imperfectly expanded. Initial inflation and normal expansion of the lungs requires the presence of a substance (*surfactant) that reduces the surface tension of the air sacs (alveoli) and prevents collapse of the small airways. Without surfactant the airways collapse, leading to inefficient and ‘stiff’ lungs. The condition is most common and serious among preterm infants, in whom surfactant may be deficient. It lasts 5–10 days, with worsening on days 2–3. Breathing is rapid, laboured, and shallow, and microscopic examinations of lung tissue in fatal cases has revealed the presence of *hyalin material in the collapsed air sacs. The condition is treated by careful nursing, intravenous fluids, and oxygen, with or without positive-pressure ventilation (see noninvasive ventilation). Early surfactant replacement therapy has been shown to reduce the severity of RDS and when given prophylactically it has been demonstrated to improve clinical outcome. See also adult respiratory distress syndrome.... respiratory distress