Parameter Health Dictionary

Buch.-Ham.

Synonym: C. magna (Lour.) DC.

Family: Capparidaceae.

Habitat: Wild as well as cultivated in gardens all over India.

Ayurvedic: Varuna, Varana, Barnaa, Setu, Ashmarighna, Kumaarak, Tiktashaaka.

Unani: Baranaa.

Siddha/Tamil: Maavilingam.

Action: Bark—diuretic (finds application in urinary disorders, including urolithiasis, prostatic hypertrophy, neurogenic bladder and urinary infections; uterine and gastro-intestinal problems). Juice of the bark is given to women after childbirth. Extract of root bark, mixed with honey, is applied to scrofulous enlargements of glands. Whole plant powder—cholinergic in smooth muscles including urinary bladder.

Key application: As antiurolithiatic. (Indian Herbal Pharmacopoeia.)

The antiurolithic activity of the stem-bark is attributed to the presence of lupeol. Lupeol not only prevented the formation of vesical calculi, but also reduced the size of the preformed stones in the kidneys of calculogenic rats. It also reversed the biochemical parameters in urine, blood and serum towards normal.

The stem bark also exhibit anti- inflammatory activity, and is reported to stimulate bile secretion, appetite and bowel movement.

Dosage: Stem bark—20-30 g for decoction. (API Vol. I.)... crataeva nurvala

A formal statement or procedure within an institution (notably government) which defines goals, priorities and the parameters for action in response to health needs, within the context of available resources.... health policy

The softening of bone mass and the widening of the bone canals. This occurs with both age and diminished physical activity. Since women live longer, they are more likely to show such signs. (WARNING! Tirade Ahead!) There is little doubt that the condition is increasing among American women, and is starting to show itself at an earlier age. This is called “improved diagnostic methods” (harumph). The statistics that show the rise to be strongest in women that have used steroid hormone therapies in their earlier years seems to have escaped the notice of current Medical Conventional Wisdom. This states that ALL women need medical care against osteoporosis going into menopause, and the primary treatment is...steroid hormones (this year, at least). I know this may sound smarmy, coming from some long-in-the-tooth hippy male, but I would be far more impressed if SERIOUS attention was given to carefully defining the parameters of a woman’s risks. The road of medicine is strewn with four decades of well-intended universal hormone approaches to women’s health...embarrassedly forgotten. The idea of universal HRT for a whole generation of menopausal women seems like a frightening experiment in medical fascism and band-wagon hubris. There is no attention given as to WHY our future elders are suddenly stricken with a medical problem. Were birth-control pills, made up of synthetic digestion-proof steroid analogues, a major cause? Has our food become simply inadequate and over-pocessed? Have the decades of exposure by women to xeno-estrogens that are derived from degraded insecticides had more effect than the ones claimed by environmental watch-dog groups...the rise in breast and prostate cancer, the halving of the sperm count in Caucasian males and little-dicked alligators reported from Florida? Is the synthetic flavor in that pink bubble gum to blame? Perhaps its the fumes released from the early Barbies? FDS? There must be some reason, but the present medical answer is only HRT and (if politics allow) Jane Fonda tapes.... osteoporosis

Documented verification of the appropriateness of critical process parameters, operating ranges and system reproducibility over an appropriate time period... performance- qualification

The tendency for the estimated magnitude of a parameter (e.g. based upon the average of a sample of observations of a treatment or intervention effect) to deviate randomly from the true magnitude of that parameter. Random variation is independent of the effects of systematic biases. In general, the larger the sample size, the lower the random variation of the estimate of a parameter. As random variation decreases, precision increases.... random variation / random error

(in statistics) a range of values for a parameter of interest that is estimated to contain the true value of the parameter within a given probability. For example, with a 95% confidence interval the parameter value will lie in this interval 95 times out of every 100.... confidence interval

(CRL) the longest measurement of the fetus from end to end. Measurement of the CRL of the embryo in the first trimester has been shown to be the most accurate parameter for assessment of gestational age; the measurement is less accurate at the end of the first trimester because of fetal flexion.... crown–rump length

(EWS) a system to detect deteriorating patients on the ward. Certain physical parameters are accorded scores: the higher the scores for individual patients, the greater the deterioration in their condition. Parameters scored include blood pressure, respiratory rate, pulse rate, blood oxygen saturation, and level of consciousness. Adjustments can be made for increased age.... early warning system

n. a record of measurements of various bodily parameters during sleep. It is used in the diagnosis of sleep disorders, such as *obstructive sleep apnoea.... polysomnograph

Within most cultures, care of the sick is seen as entailing special duties, codi?ed as a set of moral standards governing professional practice. Although these duties have been stated and interpreted in di?ering ways, a common factor is the awareness of an imbalance of power between doctor and patient and an acknowledgement of the vulnerability of the sick person. A function of medical ethics is to counteract this inevitable power imbalance by encouraging doctors to act in the best interests of their patients, refrain from taking advantage of those in their care, and use their skills in a manner which preserves the honour of their profession. It has always been accepted, however, that doctors cannot use their knowledge indiscriminately to ful?l patients’ wishes. The deliberate ending of life, for example, even at a patient’s request, has usually been seen as alien to the shared values inherent in medical ethics. It is, however, symptomatic of changing concepts of ethics and of the growing power of patient choice that legal challenges have been mounted in several countries to the prohibition of EUTHANASIA. Thus ethics can be seen as regulating individual doctor-patient relationships, integrating doctors within a moral community of their professional peers and re?ecting societal demands for change.

Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.

Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.

A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.

Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.

An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.

The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.

In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics

The previous subject is obviously an endless one, but as this is the glossary of an herbal nature, let me assure you, virtually no plants have a direct steroid hormone-mimicking effect. There are a few notable exceptions with limited application, like Cimicifuga and Licorice. Plant steroids are usually called phytosterols, and, when they have any hormonal effect at all, it is usually to interfere with human hormone functions. Beta sitosterol, found in lots of food, interferes with the ability to absorb cholesterol from the diet. Corn oil and legumes are two well-endowed sources that can help lower cholesterol absorption. This is of only limited value, however, since cholesterol is readily manufactured in the body, and elevated cholesterol in the blood is often the result of internal hormone and neurologic stimulus, not the diet. Cannabis can act to interfere with androgenic hormones, and Taraxacum phytosterols can both block the synthesis of some new cholesterol by the liver and increase the excretion of cholesterol as bile acids; but other than that, plants offer little direct hormonal implication. The first method discovered for synthesizing pharmaceutical hormones used a saponin, diosgenin, and a five-step chemical degradation, to get to progesterone, and another, using stigmasterol and bacterial culturing, to get to cortisol. These were chemical procedures that have nothing to do with human synthesis of such hormones, and the plants used for the starting materials-Mexican Wild Yam, Agave, and Soy were nothing more than commercially feasible sources of compounds widely distributed in the plant kingdom. A clever biochemist could obtain testosterone from potato sterols, but no one would be likely to make the leap of faith that eating potatoes makes you manly (or less womanly), and there is no reason to presume that Wild Yam (Dioscorea) has any progesterone effects in humans. First, the method of synthesis from diosgenin to progesterone has nothing to do with human synthesis of the corpus luteum hormone; second, oral progesterone has virtually no effect since it is rapidly digested; and third, orally active synthetic progesterones such as norethindrone are test-tube born, and never saw a Wild Yam. The only “precursor” the ovaries, testes and adrenal cortices EVER need (and the ONLY one that they can use if synthesizing from scratch) is something almost NONE of us ever run out of...Low Density Cholesterol. Unless you are grimly fasting, anorectic, alcoholic, seriously ill or training for a triathlon, you only need blood to make steroid hormones from. If hormones are off, it isn’t from any lack of building materials...and any product claiming to supply “precursors” better contain lard or butter (they don’t)...or they are profoundly mistaken, or worse. The recent gaggle of “Wild Yam” creams actually do contain some Wild Yam. (Dioscorea villosa, NOT even the old plant source of diosgenin, D. mexicana...if you are going to make these mistakes, at least get the PLANT right) This is a useful and once widely used antispasmodic herb...I have had great success using it for my three separate bouts with kidney stones...until I learned to drink more water and alkalizing teas and NEVER stay in a hot tub for three hours. What these various Wild Yam creams DO contain, is Natural Progesterone. Although this is inactive orally (oral progesterone is really a synthetic relative of testosterone), it IS active when injected...or, to a lesser degree, when applied topically. This is pharmaceutical progesterone, synthesized from stigmasterol, an inexpensive (soy-bean oil) starting substance, and, although it is identical to ovarian progesterone, it is a completely manufactured pharmaceutical. Taking advantage of an FDA loophole (to them this is only a cosmetic use...they have the misguided belief that it is not bioactive topically), coupled with some rather convincing (if irregular) studies showing the anti-osteoporotic value of topical progesterone for SOME women, a dozen or so manufacturers are marketing synthetic Natural Progesterone for topical use, yet inferring that Wild Yam is what’s doing good. I am not taking issue with the use of topical progesterone. It takes advantage of the natural slow release into the bloodstream of ANY steroid hormones that have been absorbed into subcutaneous adipose tissue. It enters the blood from general circulation the same way normal extra-ovarian estradiol is released, and this is philosophically (and physiologically) preferable to oral steroids, cagily constructed to blast on through the liver before it can break them down. This causes the liver to react FIRST to the hormones, instead of, if the source is general circulation, LAST. My objection is both moral and herbal: the user may believe hormonal effects are “natural”, the Wild Yam somehow supplying “precursors” her body can use if needed, rejected if not. This implies self-empowerment, the honoring of a woman’s metabolic choice...something often lacking in medicine. This is a cheat. The creams supply a steady source of pharmaceutical hormone (no precursor here) , but they are being SOLD as if the benefits alone come from the Wild Yam extract, seemingly formulated with the intent of having Wild Yam the most abundant substance so it can be listed first in the list of constituents. I have even seen the pharmaceutical Natural Progesterone labeled as “Wild Yam Progesterone” or “Wild Yam Estrogen precursor” or, with utter fraud, “Wild Yam Hormone”. To my knowledge, the use of Mexican Yam for its saponins ceased to be important by the early 1960’s, with other processes for synthesizing steroids proving to be cheaper and more reliable. I have been unable to find ANY manufacturer of progesterone that has used the old Marker Degradation Method and/or diosgenin (from whatever Dioscorea) within the last twenty years. Just think of it as a low-tech, non invasive and non-prescription source of progesterone, applied topically and having a slow release of moderate amounts of the hormone. Read some of the reputable monographs on its use, make your choice based solely on the presence of the synthetic hormone, and use it or don’t. It has helped some women indefinitely, for others it helped various symptoms for a month or two and then stopped working, for still other women I have spoken with it caused unpleasant symptoms until they ceased its use. Since marketing a product means selling as much as possible and (understandably) presenting only the product’s positive aspects, it would be better to try and find the parameters of “use” or “don’t use” from articles, monographs, and best of all, other women who have used it. Then ask them again in a month or two and see if their personal evaluation has changed. If you have some bad uterine cramps, however, feel free to try some Wild Yam itself...it often helps. Unless there is organic disease, hormones are off is because the whole body is making the wrong choices in the hormones it does or doesn’t make. It’s a constitutional or metabolic or dietary or life-stress problem, not something akin to a lack of essential amino acids or essential fatty acids that will clear up if only you supply some mythic plant-derived “precursor”. End of tirade.... steroids, plant

(Roxb.) W. & A.

Family: Combretaceae.

Habitat: Throughout the greater part of India, also grown as an avenue tree.

English: Arjun Terminalia.

Ayurvedic: Arjuna, Dhananjaya, Kaakubha, Kakubha, Aartagala, Indravriksha, Paartha, Virataru, Viravriksha.

Unani: Arjun

Siddha: Marudam.

Action: Bark—used as a cardiopro- tective and cardiotonic in angina and poor coronary circulation; as a diuretic in cirrhosis of liver and for symptomatic relief in hypertension; externally in skin diseases, herpes and leukoderma. Powdered bark is prescribed with milk in fractures and contusions with excessive ec- chymosis, also in urinary discharges and strangury. Fruit—deobstruent.

The Ayurvedic Pharmacopoeia ofIn- dia recommends the powder of the stembark in emaciation, chest diseases, cardiac disorders, lipid imbalances and polyuria.

The bark extract contains acids (ar- junolic acid, terminic acid), glyco- sides (arjunetin, arjunosides I-IV), and strong antioxidants—flavones, tannins, oligomeric proanthocyani- dins.

The bark extract (500 mg every 8 h) given to (58 male) patients with stable angina with provocable ischemia on treadmill exercise, led to improvement in clinical and treadmill exercise parameters as compared to placebo therapy.

These benefits were similar to those observed with isosorbide mononitrate (40 mg/day). (Indian Heart J. 2002, 54(4), 441.)

Arjunolic acid exhibited significant cardiac protection in isoproterenol- induced myocardial necrosis in rats.

T (Mol Cell Biochem, 2001, 224 (1-2), 135-42.) A study demonstrated that the alcoholic extract of Terminalia arjuna bark augmented endogenous antioxi- dant compounds of the rat heart and prevented from isoproterenol-induced myocardial ischemic reperfusion injury. (Life Sci. 2003, 73 (21), 27272739.) Cardiac lipid peroxidation in male Wistar rats was reduced by 38.8% ± 2.6% at a dose of 90 mg/kg, in a study based on aqueous freeze-dried extract ofthebark. (PhytotherRes. 2001,15(6), 510-23.)

Oral administration of bark powder (400 mg/kg body weight) for 10 days produced significant increase in circulating histamine, a little increase in 5-HT, catecholamines and HDL cholesterol, and decrease in total lipid, triglycerides and total cholesterol in normal rats.

Casuarinin, a hydrolyzable tannin, isolated from the bark, exhibited antiherpes virus activity by inhibiting viral attachment and penetration. 50% ethanolic extract of the bark exhibited significant increase in the tensile of the incision wounds.

Dosage: Stembark—3-6 g powder. (API, Vol. II.)... terminalia arjuna