Diarrhoea that begins acutely but lasts more than 21 days. The usual enteropathogens are Shigella spp., Salmonella spp., Campylobacter jejuni, Yersinia enterocolitica, Capillaria philippinensis, Cryptosporidium. Giardia can also be a cause.
A steady herbal regime is required including agents which may coax sluggish liver or kidneys into action (Dandelion, Barberry). Sheer physical exhaustion may require Ginseng. For purulent sputum – Boneset, Elecampane, Pleurisy root. To increase resistance – Echinacea. Where due to tuberculosis – Iceland Moss. For blood-streaked mucus – Blood root. For fever – Elderflowers, Yarrow. To conserve cardiac energies – Hawthorn, Motherwort. A profuse sweat affords relief – Elderflowers.
Alternatives. Capsicum, Ephedra, Fenugreek, Garlic, Grindelia, Holy Thistle, Iceland Moss, Lobelia, Mullein, Pleurisy Root, Wild Cherry.
Tea. Formula. Iceland Moss 2; Mullein 1; Wild Cherry bark 1. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily.
Powders. Pleurisy root 2; Echinacea 1; Holy Thistle 1. Pinch Ginger. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.
Tinctures. Formula. Iceland Moss 2; Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 1-2 teaspoons two or more times daily.
Practitioner. Liquid Extract Ephedra BHP (1983), dose 1-3ml. Or: Tincture Ephedra BHP (1983), dose 6-8ml.
Topical. Same as for acute bronchitis.
Note: In a test at Trafford General Hospital, Manchester, blowing-up balloons proved of benefit to those with chronic bronchitis. Fourteen patients were asked to inflate balloons and 14 refrained from doing so. After 8 weeks, the balloon-blowers showed considerable improvement in walking and a sense of well- being. Breathlessness was reduced. Condition of the others was either unchanged or worse. ... bronchitis, chronic
In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.
The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.
Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)
Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.
The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.
Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.
Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:
RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).
marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.
loss of weight.
CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.
bounding pulse with changes in heart rhythm.
OEDEMA of the legs and arms.
decreasing mobility.
Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.
Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.
Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.
Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.
Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)
For a diagnosis of PVS to be made, the state should have continued for more than a prede?ned period, usually one month. Half of patients die within 2–6 months, but some can survive for longer with arti?cial feeding. To assess a person’s level of consciousness, a numerical marking system rated according to various functions – eye opening, motor and verbal responses – has been established called the GLASGOW COMA SCALE.
The ETHICS of keeping patients alive with arti?cial support are controversial. In the UK, a legal ruling is usually needed for arti?cial support to be withdrawn after a diagnosis of PVS has been made. The chances of regaining consciousness after one year are slim and, even if patients do recover, they are usually left with severe neurological disability.
PVS must be distinguished from conditions which appear similar. These include the ‘LOCKED-IN SYNDROME’ which is the result of damage to the brain stem (see BRAIN). Patients with this syndrome are conscious but unable to speak or move except for certain eye movements and blinking. The psychiatric state of CATATONIA is another condition in which the patient retains consciousness and will usually recover.... persistent vegetative state (pvs)
Treatment. BHP (1983) recommends: Meadowsweet, Balm of Gilead, Poke root, Bogbean, Hart’s Tongue fern, Mountain Grape.
Teas: Singly or in combination (equal parts): Chamomile, Bogbean, Nettles, Yarrow. 1-2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup thrice daily before meals.
Tablets/capsules. Blue Flag root, Dandelion root, Poke root, Prickly Ash bark.
Formula. White Poplar bark 2; Black Cohosh half; Poke root quarter; Valerian quarter; Liquorice quarter. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon) (children 5-12 years: 250mg – one 00 capsule or one-sixth teaspoon). Liquid extracts: 1 teaspoon: (children 5-12: 3-10 drops). Tinctures: 2 teaspoons: (children 5-12: 5-20 drops).
Evening Primrose oil. Immune enhancer.
Topical. Hot poultice: Slippery Elm, Mullein or Lobelia.
Diet: Lacto vegetarian. Kelp. Comfrey tea. Molasses. Low fat.
General. Adequate rest, good nursing, gentle manipulation but no massage to inflamed joints. Natural lifestyle. Parental emotional support.
Oily fish. See entry. ... arthritis, juvenile, chronic
Symptoms develop slowly, often over many years. As well as symptoms and signs common to acute forms of leukaemia (see leukaemia, acute), there may be enlargement of the liver and spleen, persistent raised temperature, and night sweats. Diagnosis is by blood tests and a bone marrow biopsy. In many mild cases, no treatment is needed. To treat severe cases, anticancer drugs are given, sometimes with radiotherapy.... leukaemia, chronic lymphocytic
A constant fear is the onset of uraemia caused by accumulation in the blood of waste by-products of protein digestion, therefore the patient should reject meat in favour of fish. Eggs and dairy products taken in strict moderation.
Where urea accumulates in the circulation ‘sustaining’ diuretics are indicated; these favour excretion of solids without forcing the discharge of more urine: including Shepherd’s Purse, Gravel root, or Uva Ursi when an astringent diuretic is needed for a show of blood in the urine. According to the case, other agents in common practice: Dandelion root, Yarrow, Hawthorn, Marigold, Stone root, Hydrangea. Parsley Piert, Buchu, Hawthorn, Golden Rod.
The patient will feel the cold intensely and always be tired. Warm clothing and ample rest are essential. Heart symptoms require treatment with Lily of the Valley or Broom.
This condition should be treated by or in liaison with a qualified medical practitioner.
Treatment. As kidney damage would be established, treatment would be palliative; efforts being to relieve strain and obtain maximum efficiency. There may be days of total bed-rest, raw foods and quiet. Consumption of fluids may not be as abundant as formerly. Soothing herb teas promote well-being and facilitate elimination. Oil of Juniper is avoided.
Efforts should be made to promote a rapid absorption – to restore the balance between the circulation and the lymphatics. For this purpose Mullein is effective. A few grains of Cayenne or drops of Tincture Capsicum enhances action.
Indicated. Antimicrobials, urinary antiseptics, diuretics, anti-hypertensives. For septic conditions add Echinacea.
Of Therapeutic Value. Alfalfa, Broom, Buchu, Couchgrass, Cornsilk, Dandelion, Lime flowers, Marigold, Mullein, Marshmallow, Parsley Piert, Periwinkle (major), Wild Carrot, Water Melon seed tea. Tea. Combine equal parts: Couchgrass, Dandelion, Mullein. 2 teaspoons to each cup boiling water. Infuse 5-15 minutes. 1 cup freely.
Powders. Combine equal parts: Stone root, Hydrangea, Hawthorn. Dose: 500mg (two 00 capsules or one-third teaspoon) 3 or more times daily in water or cup Cornsilk tea. A few grains Cayenne enhances action. Formula. Buchu 2; Mullein 2; Echinacea 1; Senna leaves half. Mix. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or cup Cornsilk tea 3 or more times daily. 2-3 drops Tincture Capsicum to each dose enhances action.
Diffusive stimulant for the lymphatic vessels. Onion milk is an effective potassium-conserving diuretic and diaphoretic. Onions are simmered gently in milk for 2 hours and drunk when thirsty or as desired – a welcome alternative to water. May be eaten uncooked.
Diet. Salt-free, low fat, high protein. Spring water. Raw goat’s milk, potassium broth. Fish oils. Avoid eggs and dairy products. No alcohol.
Supplements. Vitamins A, B-complex, C plus bioflavonoids, B6, D, E, Magnesium, Lecithin. Herbal treatment offers a supportive role. ... bright’s disease (chronic)
Constitutional disturbance: fever, malaise.
Many causes, including: drugs, drinking spirits. Gross mis-use of voice (singing or talking) may produce nodules (warts) on the cords. The smoker has inflammatory changes. Nerve paralysis in the elderly. Carcinoma of the larynx. Voice changes during menstruation are associated with hormonal changes (Agnus Castus). Professional singers, members of choirs benefit from Irish Moss, Iceland Moss, Slippery Elm or Poke root.
Alternatives. Cayenne, Caraway seed, Balm of Gilead, Lungwort, Queen’s Delight, Thyme, Wild Indigo, Marsh Cudweed, Mullein, Marshmallow.
For most infections: Equal parts, Tinctures Goldenseal and Myrrh: 3-5 drops in water 3-4 times daily; use also as a spray or gargle.
Tea. Formula. Equal parts: Mullein, Marshmallow root, Liquorice. 2 teaspoons to each cup water brought to boil; vessel removed on boiling. Drink freely.
Practitioner. Combine equal parts: Senega, Ipecacuanha and Squills (all BP). 5-10 drops thrice daily in water. Also gargle.
Poke root. Reliable standby. Decoction, tablets/capsules. Tincture: dose, 5-10 drops thrice daily in water or honey.
Topical. Aromatherapy. Steam inhalations. Oils: Bergamot, Eucalyptus, Niaouli, Geranium, Lavender, Sandalwood. Any one.
Diet. Slippery Elm gruel. Salt-free. Avoid fried foods.
Supplements. Daily. Vitamin A (7500iu). Vitamin C (1 gram thrice daily).
To prevent voice damage. The voice should not be strained by talking too much, shouting or singing – especially with a cold. Try not to cough or keep clearing the throat but instead, swallow firmly. Do not whisper – it will strain the voice.
A common cause of laryngitis is growth of a nodule, cyst or polyp on the vocal cords. They are visible on use of an endoscope. There are two vocal cords which, in speech, come together and vibrate like a reed in a musical instrument. In formation of a nodule they cannot meet, air escapes and the voice becomes hoarse. Relaxation technique.
Where the condition lasts for more than 4 weeks an ENT specialist should be consulted. ... laryngitis, chronic
Episodes of diarrhoea range in severity and are due to gastroenteritis.
Attention to hygiene, drinking bottled water, and avoiding ice in drinks can prevent a large proportion of episodes.... traveller’s diarrhoea
Causes: alcohol excess, drugs (Paracetamol prescribed for those who cannot tolerate aspirin), autoimmune disease, toxaemia, environmental poisons. Clinically latent forms are common from carbon monoxide poisoning. May lead to cirrhosis.
Symptoms. Jaundice, nausea and vomiting, inertia.
Treatment. Bile must be kept moving.
Alternatives:– Decoction. Formula. Milk Thistle 2; Yellow Dock 1; Boldo 1. 1 heaped teaspoon to each cup water gently simmered 20 minutes. Half-1 cup thrice daily.
Formula. Barberry bark 1; German Chamomile 2. Dose: Liquid Extracts: 2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three capsules or half a teaspoon) thrice daily.
Tablets/capsules. Blue Flag root. Goldenseal.
Astragalus. Popular liver tonic in Chinese medicine. A liver protective in chemotherapy.
Diet. Fat-free. Dandelion coffee. Artichokes. Lecithin.
Supplements. B-vitamins, B12, Zinc.
Treatment by or in liaison with a general medical practitioner. ... liver – hepatitis, chronic
Chronic hepatitis may cause slight tiredness or no symptoms at all.
It is diagnosed by liver biopsy.
Autoimmune hepatitis is treated with corticosteroid drugs and immunosuppressants.
Viral infections often respond to interferon.
In the drug-induced type, withdrawal of the medication can lead to recovery.
For metabolic disturbances, treatment depends on the underlying disorder.... hepatitis, chronic
Possible complications include short stature, anaemia, pleurisy, pericarditis, and enlargement of the liver and spleen. Uveitis may develop, which, if untreated, may damage vision. Rarely, amyloidosis may occur or kidney failure may develop. Diagnosis is based on the symptoms, together with the results of X-rays and blood tests, and is only made if the condition lasts for longer than 3 months.
Treatment may include antirheumatic drugs, corticosteroid drugs, nonsteroidal anti-inflammatory drugs, or aspirin. Splints may be worn to rest inflamed joints and to reduce the risk of deformities. Physiotherapy reduces the risk of muscle wasting and deformities.
The arthritis usually clears up after several years. However, in some children, the condition remains active into adult life.
– kala-azar A form of leishmaniasis that is spread by insects. Kala-azar occurs in parts of Africa, India, the Mediterranean, and South America.... juvenile chronic arthritis
During the chronic phase, symptoms may include fever, night sweats, and weight loss. Visual disturbances, abdominal pain, and priapism may also occur. The symptoms of the more cancerous phase are like those of the acute forms of leukaemia (see leukaemia, acute). The diagnosis is made from blood tests and a bone marrow biopsy. Treatment of the chronic phase includes anticancer drugs. When the disease transforms into the acute phase, treatment is similar to that given for acute leukaemia.... leukaemia, chronic myeloid
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