Prior authorization Health Dictionary

Prior Authorization: From 1 Different Sources


A requirement imposed by a third party payer under many systems of utilization review in which a provider must justify, before a peer review committee, insurance company representative or state agent, the need to deliver a particular service to a person before actually providing the service in order to receive reimbursement.
Health Source: Community Health
Author: Health Dictionary

Blood Bank

A department in which blood products are prepared, stored, and tested prior to transfusion into patients.... blood bank

Clinical Trial

A controlled research study of the safety and effectiveness of drugs, devices or techniques that occurs in four phases, starting with the enrolment of a small number of people, to the later stages in which thousands of people are involved prior to approval by the licensing authorities (for example, the Food and Drug Administration).... clinical trial

Admitting Privileges

The authorization given by a health care organization’s governing body to medical practitioners and, in some cases, other professionals who request the privilege of admitting and/or treating patients. Privileges are based on a provider’s licence, training, experience and education.... admitting privileges

Advance Care Planning

Planning in advance for decisions that may have to be made prior to incapability or at the end of life. People may choose to do this planning formally, by means of advance directives, or informally, through discussions with family members, friends and health care and social service providers, or a combination of both methods.... advance care planning

Ajo

Garlic (Allium sativum).

Plant Part Used: Bulb.

Dominican Medicinal Uses: The bulb is traditionally ingested raw for high blood pressure, upper-respiratory infection, common cold, flu-like symptoms and cough, and the alcohol extract is taken internally for sinusitis. The bulb skins are traditionally prepared as a tea and taken internally for indigestion and gastro-intestinal complaints.

Safety: The bulb is generally regarded as safe for human consumption. Reported adverse effects include skin burns due to topical application (especially in children with prolonged exposure). Adverse effects associated with internal use include halitosis, body odor, gastrointestinal irritation, constipation, headache, nausea, fatigue and vertigo.

Contraindications: Not to be taken at therapeutic doses for 10 days prior to surgery due to antiplatelet activity and risk of excessive bleeding. The bulb is contraindicated during lactation.

Drug Interactions: Chlorzoxazone: garlic may reduce drug metabolism. Indomethacin and NSAIDs: risk of excessive bleeding. Protease inhibitors: reduced blood levels. Drugs metabolized by cytochrome P450 2E1: garlic may inhibit efficacy. Forskilin: garlic may potentiate antiplatelet activity.

Clinical Data: The following effects have been investigated in human clinical trials: treatment of atherosclerosis, common cold, coronary artery disease, hyperlipidemia, hypertension and unstable angina pectoris.

Laboratory & Preclinical Data: The following biological activities have been investigated in laboratory and preclinical studies (in vitro or animal models): antibacterial, anticarcinogenic, antifungal, antihypertensive, antineoplastic, antinociceptive, antioxidant, anti-platelet-aggregant, antithrombic, antiviral and immune enhancing.... ajo

Allium Sativum

Linn.

Family: Liliaceae, Alliaceae.

Habitat: Native to Central Asia. Cultivated all over India.

English: Garlic.

Ayurvedic: Lashuna, Rasona, Yavaneshta, Ugragandha, Ma- haushadh, Arishta.

Unani: Seer, Lahsun.

Siddha/Tamil: Ullippoondu, Vellaip- pondu.

Action: Antibiotic, bacteriostatic, fungicide, anthelmintic, antithrom- bic, hypotensive, hypoglycaemic, hypocholesterolaemic. Also used for upper respiratory tract infections and catarrhal conditions.

Key application: As a supportive to dietary measures for elevated levels of lipids in blood; as a preventive measure for age-dependent vascular changes. (German Commission E, ESCOP, WHO, The British Herbal Pharmacopoeia.) Also as an antimicrobial. (The British Herbal Pharmacopoeia). Garlic has been shown to be effective in respiratory infections and catarrhal conditions. (The British Herbal Compendium.)

The Ayurvedic Pharmacopoeia ofIn- dia indicates the use of the bulb as a brain tonic in epilepsy and psychic disorders.

Heavy consumption of garlic prior to surgery led to increased clotting time or reduced platelet aggregation (in human case reports). Garlic tablets at a dose of 400 mg twice daily for 12 weeks reduced platelet aggregation 59% compared with placebo in 80 patients (in human clinical study). (Francis Brinker.)

Garlic cloves are high in sulphur- containing amino acids known as al- liin (no taste, no smell, no medicinal action). With crushing or chewing alli- in comes into contact with the enzyme alliinase. Alliinase, in less than 6 s, transforms alliin into allicin (strongly medicinal), which breaks down into a number of sulphur compounds including ajoene, vinyldithin and diallyl disulfide, and trisulfide. The antibiotic effect is attributed to allicin; hypogly- caemic effect to allicin and allylpro- phyldisulphide (also to S-allyl cysteine sulfoxide); anticarcinogenic activity to diallyl monosulfide; platelet aggregation inhibitory effect to diallyl-di- and tri-sulphides. Ajoene inactivated human gastric lipase, which is involved in digestion and absorption of dietary fats.

Diallyltetra, penta-, hexa- and hep- tasulphides are potential antioxidants.

Allium leptophyllum Wall. is equated with Vana Lashuna, Jangali Lahsun.

Dosage: Bulb—3 g (API Vol. III.)... allium sativum

Alternative Medical System

A complete system of theory and practices that has evolved independently of, and often prior to, the conventional biological approach. Many are traditional systems of medicine that are practised by individual cultures throughout the world. Traditional Oriental medicine and Ayurveda, India’s traditional system of medicine, are two examples.... alternative medical system

Chocolate

(Cocoa, milk chocolate, sweet chocolate)

Nutritional Profile Energy value (calories per serving): Moderate Protein: Low (cocoa powder) High (chocolate) Fat: Moderate Saturated fat: High Cholesterol: None Carbohydrates: Low (chocolate) High (cocoa powder) Fiber: Moderate (chocolate) High (cocoa powder) Sodium: Moderate Major vitamin contribution: B vitamins Major mineral contribution: Calcium, iron, copper

About the Nutrients in This Food Cocoa beans are high-carbohydrate, high-protein food, with less dietary fiber and more fat than all other beans, excepting soy beans. The cocoa bean’s dietary fiber includes pectins and gums. Its proteins are limited in the essential amino acids lysine and isoleucine. Cocoa butter, the fat in cocoa beans, is the second most highly saturated vegetable fat (coconut oil is number one), but it has two redeeming nutritional qualities. First, it rarely turns rancid. Second, it melts at 95°F, the temperature of the human tongue. Cocoa butter has no cholesterol; neither does plain cocoa powder or plain dark chocolate. Cocoa beans have B vitamins (thiamine, riboflavin, niacin) plus min- erals (iron, magnesium, potassium, phosphorus, and copper). All chocolate candy is made from chocolate liquor, a thick paste pro- duce by roasting and grinding cocoa beans. Dark (sweet) chocolate is made of chocolate liquor, cocoa butter, and sugar. Milk chocolate is made of choc- olate liquor, cocoa butter, sugar, milk or milk powder, and vanilla. White * These values apply to plain cocoa powder and plain unsweetened chocolate. Add- ing other foods, such as milk or sugar, changes these values. For example, there is no cholesterol in plain bitter chocolate, but there is cholesterol in milk chocolate. chocolate is made of cocoa butter, sugar, and milk powder. Baking chocolate is unsweetened dark chocolate. The most prominent nutrient in chocolate is its fat. Fat Content in One Ounce of Chocolate

Saturated fat (g) Monounsaturated fat (g) Polyunsaturated fat (g) Cholesterol (mg)
Dark (sweet)
chocolate 5.6 3.2 0.3 0
Milk chocolate 5.9 4.5 0.4 6.6
Baking chocolate 9 5.6 0.3 0
White chocolate 5.5 2.6 0.3 0
  Source: USDA Nut rient Data Laborator y. Nat ional Nut rient Database for Standard Reference. Available online. UR L : http://w w w.nal.usda.gov/fnic/foodcomp/search /. Because chocolate is made from a bean, it also contains dietary fiber and measurable amounts of certain minerals. For example, one ounce of dark chocolate, the most nutritious “eating” chocolate, has 1.6 g dietary fiber, 0.78 mg iron (4 percent of the R DA for a woman, 10 percent of the R DA for a man), 32 mg magnesium (11 percent of the R DA for a woman, 8 percent of the R DA for a man), and .43 mg zinc (5 percent of the R DA for a woman, 4 percent of the R DA for a man). Cocoa beans, cocoa, and chocolate contain caffeine, the muscle stimulant theobro- mine, and the mood-altering chemicals phenylethylalanine and anandamide (see below).

The Most Nutritious Way to Serve This Food With low-fat milk to complete the proteins without adding saturated fat and cholesterol. NOTE : Both cocoa and chocolate contain oxalic acid, which binds with calcium to form cal- cium oxalate, an insoluble compound, but milk has so much calcium that the small amount bound to cocoa and chocolate hardly matters. Chocolate skim milk is a source of calcium.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-calcium and low-oxalate diet (to prevent the formation of calcium oxalate kidney stones) Low-calorie diet Low-carbohydrate diet Low-fat diet Low-fat, controlled-cholesterol diet (milk chocolates) Low-fiber diet Potassium-regulated (low-potassium) diet

Buying This Food Look for: Tightly sealed boxes or bars. When you open a box of chocolates or unwrap a candy bar, the chocolate should be glossy and shiny. Chocolate that looks dull may be stale, or it may be inexpensively made candy without enough cocoa butter to make it gleam and give it the rich creamy mouthfeel we associate with the best chocolate. (Fine chocolate melts evenly on the tongue.) Chocolate should also smell fresh, not dry and powdery, and when you break a bar or piece of chocolate it should break cleanly, not crumble. One exception: If you have stored a bar of chocolate in the refrigerator, it may splinter if you break it without bringing it to room temperature first.

Storing This Food Store chocolate at a constant temperature, preferably below 78°F. At higher temperatures, the fat in the chocolate will rise to the surface and, when the chocolate is cooled, the fat will solidif y into a whitish powdery bloom. Bloom is unsightly but doesn’t change the chocolate’s taste or nutritional value. To get rid of bloom, melt the chocolate. The chocolate will turn dark, rich brown again when its fat recombines with the other ingredients. Chocolate with bloom makes a perfectly satisfactory chocolate sauce. Dark chocolate (bitter chocolate, semisweet chocolate) ages for at least six months after it is made, as its flavor becomes deeper and more intense. Wrapped tightly and stored in a cool, dry cabinet, it can stay fresh for a year or more. Milk chocolate ages only for about a month after it is made and holds its peak flavor for about three to six months, depending on how carefully it is stored. Plain cocoa, with no added milk powder or sugar, will stay fresh for up to a year if you keep it tightly sealed and cool.

What Happens When You Cook This Food Chocolate burns easily. To melt it without mishap, stir the chocolate in a bowl over a pot of hot water or in the top of a double boiler or put the chocolate in a covered dish and melt it in the microwave (which does not get as hot as a pot on the store). Simple chemistry dictates that chocolate cakes be leavened with baking soda rather than baking powder. Chocolate is so acidic that it will upset the delicate balance of acid (cream of tartar) and base (alkali = sodium bicarbonate = baking soda) in baking powder. But it is not acidic enough to balance plain sodium bicarbonate. That’s why we add an acidic sour-milk product such as buttermilk or sour cream or yogurt to a chocolate cake. Without the sour milk, the batter would be so basic that the chocolate would look red, not brown, and taste very bitter.

How Other Kinds of Processing Affect This Food Freezing. Chocolate freezes and thaws well. Pack it in a moistureproof container and defrost it in the same package to let it reabsorb moisture it gave off while frozen.

Medical Uses and/or Benefits Mood elevator. Chocolate’s reputation for making people feel good is based not only on its caffeine content—19 mg caffeine per ounce of dark (sweet) chocolate, which is one-third the amount of caffeine in a five-ounce cup of brewed coffee—but also on its naturally occurring mood altering chemicals phenylethylalanine and anandamide. Phenylethylalanine is found in the blood of people in love. Anandamide stimulates areas of your brain also affected by the active ingredients in marijuana. (NOTE : As noted by the researchers at the Neurosci- ences Institute in San Diego who identified anandamide in chocolate in 1996, to get even the faintest hint of marijuana-like effects from chocolate you would have to eat more than 25 pounds of the candy all at once.) Possible heart health benefits. Chocolate is rich in catechins, the antioxidant chemicals that give tea its reputation as a heart-protective anticancer beverage (see tea). In addition, a series of studies beginning with those at the USDA Agricultural Research Center in Peoria, Illinois, suggest that consuming foods rich in stearic acid like chocolate may reduce rather than raise the risk of a blood clot leading to a heart attack. Possible slowing of the aging process. Chocolate is a relatively good source of copper, a mineral that may play a role in slowing the aging process by decreasing the incidence of “protein glycation,” a reaction in which sugar molecules ( gly = sugar) hook up with protein molecules in the bloodstream, twisting the protein molecules out of shape and rendering them unusable. This can lead to bone loss, rising cholesterol, cardiac abnormalities, and a slew of other unpleasantries. In people with diabetes, excess protein glycation may be one factor involved in complications such as loss of vision. Ordinarily, increased protein glyca- tion is age-related. But at the USDA Grand Forks Human Nutrition Research Center in North Dakota, agricultural research scientist Jack T. Saari has found that rats on copper-deficient diets experience more protein glycation at any age than other rats. A recent USDA survey of American eating patterns says that most of us get about 1.2 mg copper a day, considerably less than the Estimated Safe and Adequate Daily Dietary Intake (ESADDI) or 1.5 mg to 3 mg a day. Vegetarians are less likely to be copper deficient because, as Saari notes, the foods highest in copper are whole grains, nuts, seeds, and beans, including the cocoa bean. One ounce of dark chocolate has .25 mg copper (8 –17 percent of the ESADDI).

Adverse Effects Associated with This Food Possible loss of bone density. In 2008, a team of Australian researchers at Royal Perth Hos- pital, and Sir Charles Gairdner Hospital published a report in the American Journal of Clinical Nutrition suggesting that women who consume chocolate daily had 3.1 percent lower bone density than women who consume chocolate no more than once a week. No explanation for the reaction was proposed; the finding remains to be confirmed. Possible increase in the risk of heart disease. Cocoa beans, cocoa powder, and plain dark chocolate are high in saturated fats. Milk chocolate is high in saturated fats and cholesterol. Eating foods high in saturated fats and cholesterol increases the amount of cholesterol in your blood and raises your risk of heart disease. NOTE : Plain cocoa powder and plain dark chocolate may be exceptions to this rule. In studies at the USDA Agricultural Research Center in Peoria, Illinois, volunteers who consumed foods high in stearic acid, the saturated fat in cocoa beans, cocoa powder, and chocolate, had a lower risk of blood clots. In addition, chocolate is high in flavonoids, the antioxidant chemicals that give red wine its heart-healthy reputation. Mild jitters. There is less caffeine in chocolate than in an equal size serving of coffee: A five- ounce cup of drip-brewed coffee has 110 to 150 mg caffeine; a five-ounce cup of cocoa made with a tablespoon of plain cocoa powder ( 1/3 oz.) has about 18 mg caffeine. Nonetheless, people who are very sensitive to caffeine may find even these small amounts problematic. Allergic reaction. According to the Merck Manual, chocolate is one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach.* The others are berries (blackberries, blueberries, raspberries, strawberries), corn, eggs, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated food, such as cocoa or chocolate, while you are taking an M AO inhibitor, the result may be a hypertensive crisis. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal gland, secretes adrenalin, which the body converts to VM A (vanillylmandelic acid). VM A is excreted in urine, and, until recently, the test for this tumor measured the level of VM A in the urine. In the past, chocolate and cocoa, both of which contain VM A, were eliminated from the patient’s diet prior to the test lest they elevate the level of VM A in the urine and produce a false-positive result. Today, more finely drawn tests usually make this unnecessary. * The evidence link ing chocolate to allergic or migraine headaches is inconsistent. In some people, phenylet hylamine (PEA) seems to cause headaches similar to t hose induced by t yramine, anot her pressor amine. The PEA-induced headache is unusual in t hat it is a delayed react ion t hat usually occurs 12 or more hours after t he chocolate is eaten.... chocolate

Embryo

The FETUS in the womb prior to the end of the second month.... embryo

Etomidate

An intravenous agent for inducing general ANAESTHESIA prior to surgery or other procedures that require patients to be unconscious. When the drug is injected intravenously, pain sometimes occurs, but this can be minimised by premedication with an opioid analgesic (see ANALGESICS).... etomidate

Anís De Estrella

Chinese star anise (Illicium verum).

Plant Part Used: Fruit, seed.

Dominican Medicinal Uses: The fruits or seeds are traditionally prepared as a decoction and taken orally for flatulence, headache, indigestion, stomach ache, upper respiratory tract infection and cleansing the intestines.

Safety: The fruit is generally considered safe for human consumption in small amounts and is widely used as a culinary spice. When taken in excessive quantities, isolated compounds from the fruit have shown neurotoxic effects in animal studies. Caution is advised due to possible adulteration with the highly poisonous look-alike, Japanese star anise (Illicium anisatum).

Contraindications: Avoid use in small children due to potential contamination with misidentified toxic look-alike. Caution and avoidance is advised in patients with a history of convulsive disorders including epilepsy due to case reports of seizures associated with internal use of the tea. Caution advised in patients prior to surgery due to potential risk of increased bleeding.

Drug Interactions: Anticoagulants, antiplatelet medications and NSAIDS: based on animal studies in mice, star anise increases cytochrome P450 dependent 7-ethoxycoumarin O-deethylase activity which may affect the metabolism of these drugs.

Clinical Data: No human clinical trials evaluating this plant species have been identified in the available literature.

Laboratory & Preclinical Data: The following biological activities of this plant have been demonstrated in laboratory and preclinical studies using in vitro or animal models: antiangiogenic, antibacterial, antimicrobial, insecticidal, neurotropic and sepsis prevention.

* See entry for Anís de estrella in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... anís de estrella

Clinical Trials

(See EVIDENCE-BASED MEDICINE.) Clinical trials aim to evaluate the relative effects of di?erent health-care interventions. They are based on the idea that there must a fair comparison of the alternatives in order to know which is better. Threats to a fair comparison include the play of chance and bias, both of which can cause people to draw the wrong conclusions about how e?ective a treatment or procedure is.

An appreciation of the need to account for chance and bias has led to development of methods where new treatments are compared to either a PLACEBO or to the standard treatment (or both) in a controlled, randomised clinical trial. ‘Controlled’ means that there is a comparison group of patients not receiving the test intervention, and ‘randomised’ implies that patients have been assigned to one or other treatment group entirely by chance and not because of their doctor’s preference. If possible, trials are ‘double-blind’ – that is, neither the patient nor the investigator knows who is receiving which intervention until after the trial is over. All such trials must follow proper ethical standards with the procedure fully explained to patients and their consent obtained.

The conduct, e?ectiveness and duplication of clinical trials have long been subjects of debate. Apart from occasional discoveries of deliberately fraudulent research (see RESEARCH FRAUD AND MISCONDUCT), the structure of some trials are unsatisfactory, statistical analyses are sometimes disputed and major problems have been the – usually unwitting – duplication of trials and non-publication of some trials, restricting access to their ?ndings. Duplication occurs because no formal international mechanism exists to enable research workers to discover whether a clinical trial they are planning is already underway elsewhere or has been completed but never published, perhaps because the results were negative, or no journal was willing to publish it, or the authors or funding authorities decided not to submit it for publication.

In the mid 1980s a proposal was made for an international register of clinical trials. In 1991 the NHS launched a research and development initiative and, liaising with the COCHRANE COLLABORATION, set out to collect systematically data from published randomised clinical trials. In 1994 the NHS set up a Centre for Reviews and Dissemination which, among other responsibilities, maintains a database of research reviews to provide NHS sta? with relevant information.

These e?orts are hampered by availability of information about trials in progress and unpublished completed trials. With a view to improving accessibility of relevant information, the publishers of Current Science, in 1998, launched an online metaregister of ongoing randomised controlled trials.

Subsequently, in October 1999, the editors of the British Medical Journal and the Lancet argued that the case for an international register of all clinical trials prior to their launch was unanswerable. ‘The public’, they said, ‘has the right to know what research is being funded. Researchers and research funders don’t want to waste resources repeating trials already underway.’ Given the widening recognition of the importance to patients and doctors of the practice of EVIDENCE-BASED MEDICINE, the easy availability of information on planned, ongoing and completed clinical trials is vital. The register was ?nally set up in 2005.... clinical trials

Indian Bdellium

Commiphora mukul

Burseraceae

San: Gugulu, Mahisaksah, Koushikaha, Devadhupa

Hin: Gugal Mal:Gulgulu Tam,

Tel: Gukkulu

Kan: Guggul

Ben: Guggul

Importance: Indian bdellium is a small, armed, deciduous tree from the bark of which gets an aromatic gum resin, the ‘Guggul’ of commerce. It is a versatile indigenous drug claimed by ayurvedists to be highly effective in the treatment of rheumatism, obesity, neurological and urinary disorders, tonsillitis, arthritis and a few other diseases. The fumes from burning guggul are recommended in hay- fever, chronic bronchitis and phytises.

The price of guggulu gum has increased ten fold in ten years or so, indicating the increase in its use as well as decrease in natural plant stand. It has been listed as a threatened plant by Botanical Survey of India (Dalal, 1995) and is included in the Red Data Book (IUCN) and over exploited species in the country (Billare,1989).

Distribution: The center of origin of Commiphora spp. is believed to be Africa and Asia. It is a widely adapted plant well distributed in arid regions of Africa (Somalia, Kenya and Ethiopia in north east and Madagascar, Zimbabwe, Botswana, Zaire in south west Africa), Arabian peninsula (Yemen, Saudi Arabia and Oman). Different species of Commiphora are distributed in Rajasthan, Gujarat, Maharashtra and Karnataka states of India and Sind and Baluchistan provinces of Pakistan (Tajuddin et al, 1994). In India, the main commercial source of gum guggul is Rajasthan and Gujarat.

Botany: The genus Commiphora of family Burseraceae comprises about 185 species. Most of them occur in Africa, Saudi Arabia and adjoining countries. In India only four species have been reported. They are C. mukul(Hook. ex Stocks) Engl. syn. Balsamodendron mukul (Hook. ex Stocks), C. wightii (Arnott) Bhandari, C.stocksiana Engl., C. berryi and C.agallocha Engl.

In early studies about the flora of India, the ‘guggul’ plant was known as Commiphora mukul(Hook. ex Stocks) Engl. or Balsamodendron mukul (Hook. ex Stocks). It was renamed as C. roxburghii by Santapau in 1962. According to Bhandari the correct Latin name of the species is C. wightii(Arnott) Bhandari, since the specific name ‘wightii’ was published in 1839, prior to ‘roxburghi’ in 1848 (Dalal and Patel, 1995).

C. mukul is a small tree upto 3-4m height with spinescent branching. Stem is brownish or pale yellow with ash colored bark peeling off in flakes. Young parts are glandular and pubescent. Leaves are alternate, 1-3 foliate, obovate, leathery and serrate (sometimes only towards the apex). Lateral leaflets when present only less than half the size of the terminal ones. Flowers small, brownish red, with short pedicel seen in fascicles of 2-3. Calyx campanulate, glandular, hairy and 4-5 lobed. Corolla with brownish red, broadly linear petals reflexed at apex. Stamens 8-10, alternatively long and short. Ovary oblong, ovoid and stigma bifid. Fruit is a drupe and red when ripe, ovate in shape with 2-3 celled stones. The chromosome number 2n= 26 (Warrier et al, 1994; Tajuddin et al, 1994).

Agrotechnology: Guggal being a plant of arid zone thrives well in arid- subtropical to tropical climate.

The rainfall may average between 100mm and 500mm while air temperature may vary between 40 C in summer and 3 C during winter. Maximum relative humidity prevails during rainy season (83% in the morning and 48% in the evening).Wind velocity remains between 20-25 km/hour during the year is good. Though they prefer hard gypseous soil, they are found over sandy to silt loam soils, poor in organic matter but rich in several other minerals in arid tracks of western India (Tajuddin et al, 1994).

Plants are propagated both by vegetatively and seeds. Plants are best raised from stem cuttings from the semi woody (old) branch. For this purpose one metre long woody stem of 10mm thickness is selected and the cut end is treated with IBA or NAA and planted in a well manured nursery bed during June-July months; the beds should be given light irrigation periodically. The cuttings initiate sprouting in 10-15 days and grow into good green sprout in 10-12 months. These rooted plants are suitable for planting in the fields during the next rainy season. The cuttings give 80-94% sprouting usually. Air layering has also been successfully attempted and protocol for meristem culture is available in literature. Seed germination is very poor (5%) but seedling produce healthier plants which withstand high velocity winds.

The rooted cuttings are planted in a well laid-out fields during rainy season. Pits of size 0.5m cube are dug out at 3-4 m spacing in rows and given FYM and filler soil of the pit is treated with BHC (10%) or aldrin (5%) to protect the new plants from white ants damage. Fertilizer trials have shown little response except due to low level of N fertilization. Removal of side branches and low level of irrigation supports a good growth of these plants. The plantation does not require much weeding and hoeing. But the soil around the bushes be pulverised twice in a year to increase their growth and given urea or ammonium sulphate at 25- 50g per bush at a time and irrigated. Dalal et al (1989) reported that cercospora leaf spot was noticed on all the cultures. Bacterial leaf blight was also noticed to attack the cultures. A leaf eating caterpillar (Euproctis lanata Walker) attack guggal, though not seriously. White fly (Bemisia tabaci) is observed to suck sap of leaves and such leaves become yellowish and eventually drop. These can be effectively controlled by using suitable insecticide.

Stem or branch having maximum diameter of about 5cm at place of incision, irrespective of age is tapped. The necrotic patch on the bark is peeled off with a sharp knife and Bordeaux paste is applied to the exposed (peeled off) surface of the stem or branch. A prick chisel of about 3cm width is used to make bark- deep incisions and while incising the bark, the chisel is held at an acute angle so that scooped suspension present on the body of the chisel flows towards the blade of the chisel and a small quantity of suspension flows inside the incised bark. If tapping is successful, gum exudation ensures after about 15-20 days from the date of incision and continues for nearly 30-45 days. The exuded gum slides down the stem or branch, and eventually drops on the ground and gets soiled. A piece of polythene sheet can be pouched around the place of incision to collect gum. Alternatively, a polythene sheet can be spread on the ground to collect exuded gum. A maximum of about 500g of gum has been obtained from a plant (Dalal, 1995).

Post harvest technology: The best grade of guggul is collected from thick branches of tree. These lumps of guggul are translucent. Second grade guggul is usually mixed with bark, sand and is dull coloured guggul. Third grade guggul is usually collected from the ground which is mixed with sand, stones and other foreign matter. The final grading is done after getting cleansed material. Inferior grades are improved by sprinkling castor oil over the heaps of the guggul which impart it a shining appearance (Tajuddin et al, 1994).

Properties and activity: The gum resin contains guggul sterons Z and E, guggul sterols I-V, two diterpenoids- a terpene hydrocarbon named cembreneA and a diterpene alcohol- mukulol, -camphrone and cembrene, long chain aliphatic tetrols- octadecan-1,2,3,4-tetrol, eicosan-1,2,3,4-tetrol and nonadecan-1,2,3,4-tetrol. Major components from essential oil of gum resin are myrcene and dimyrcene. Plant without leaves, flowers and fruits contains myricyl alcohol, -sitosterol and fifteen aminoacids. Flowers contain quercetin and its glycosides as major flavonoid components, other constituents being ellagic acid and pelargonidin glucoside (Patil et al, 1972; Purushothaman and Chandrasekharan, 1976).

The gum resin is bitter, acrid, astringent, thermogenic, aromatic, expectorant, digestive, anthelmintic, antiinflammatory, anodyne, antiseptic, demulcent, carminative, emmenagogue, haematinic, diuretic, lithontriptic, rejuvenating and general tonic. Guggulipid is hypocholesteremic (Husain et al, 1992; Warrier et al, 1994).... indian bdellium

Pre-existing Condition

A term normally used for a condition developed prior to applying for a health insurance policy. Some policies exclude coverage of such conditions for a period of time or indefinitely.... pre-existing condition

Prospective Payment System

A system whereby reimbursement rates are set for a given period of time prior to the circumstances giving rise to actual reimbursement claims.... prospective payment system

Single Point Of Entry

A local or regional access point where older persons receive information, assessment of needs, care planning, referrals to health and social services and, in some systems, authorization of services for home care, community-based care or residential care facilities.... single point of entry

Alprostadil

A prostaglandin drug used, prior to surgery, to minimize the effects of congenital heart defects in newborn babies. Alprostadil is also used as a treatment for impotence. It is administered by self-injection into the penis or as a gel introduced into the urethra to produce an erection.... alprostadil

Neomycin

An antibiotic drug used in the treatment of ear, eye, and skin infections, often in combination with other drugs. Neomycin is sometimes given to prevent infection of the intestine prior to surgery. Possible adverse effects include rash and itching.... neomycin

Asparagus

Asparagus racemosus

Liliaceae

San, Mar, Hin, Mal: Satavari;

Ben: Shatamuli,

Guj: Ekalkanto,

Tel: Pilligadalu, Philithaga

Tam: Ammaikodi, Kilwari,

Kan: Aheruballi, Ori: Manajolo

Importance: Asparagus is a climbing undershrub with widespread applications as diuretic, cooling agent and an excellent safe herbal medicine for ante-natal care. It is useful in nervous disorders, dyspepsia, diarrhoea, tumours, inflammations, vitiated conditions of vata and pitta, burning sensation, hyperdipsia, ophthalmopathy, nephropathy, hepatopathy, strangury, scalding of urine, throat infections, tuberculosis, cough, bronchitis, gleet, gonorrhoea, leucorrhoea, leprosy, epilepsy, fatigue, hyperacidity, colic haemorrhoids, hypertension, abortion, agalactia, cardiac and general debility (Warrier et al, 1993).

Shatavari is described in Rigveda and Atharvaveda. In Ayurvedic classics it is prescribed as a cooling agent and uterine tonic. It is the main ingredient in ayurvedic medicines like shatavari gulam and shatavari ghrtam. Besides quenching thirst, its root juice helps in cooling down the body from summer heat, curing hyper-acidity and peptic ulcer. It contains good amount of mucilage which soothes the inner cavity of stomach. It relieves burning sensation while passing urine and is used in urinary tract infections. It contains an anticancer agent asparagin which is useful against leukaemia. It also contains active antioxytocic saponins which have got antispasmodic effect and specific action on uterine musculature. It is very good relaxant to uterine muscles, especially during pregnancy and is used to prevent abortion and pre-term labour on the place of progesterone preparations. Its powder boiled with milk is generally used to prevent abortion. It increases milk production in cows and buffaloes. Its preparations in milk helps in increasing breast milk in lactating women. Its proper use helps in avoiding excessive blood loss during periods. It clears out infections and abnormalities of uterine cavity and hence it is used to rectify infertility in women. The leaves are used to prepare toilet soaps. The plant has also ornamental value both for indoor and out door decorations (Syamala, 1997).

Distribution: The plant is found wild in tropical and subtropical India including Andaman and Nicobar Islands. It is distributed from mean sea level upto 1500m in the Himalayas from Kashmi r eastwards. The crop is cultivated in Kerala, Tamil Nadu, Andhra Predesh and northern states in India. However, most of the requirement of the industry is met through wild collections from forests. It is also grown in gardens.

Botany: Satavari, Asparagus racemosus Willd. belongs to the lily family, Liliaceae. Asparagus adscendens Roxb., A. filicinus Lam., A. gonoclados Baker, A. officinalis Linn. and A. sarmentosus Willd. are the other important medicinal plant species of the genus. A. racemosus Willd. is an armed climbing undershrub with woody terete stems and recurved or rarely straight spines. The tuberous succulent roots are 30cm to 100cm or more in length, fascicled at the stem base, smooth tapering at both ends. Young stems are very delicate, brittle and smooth. Leaves are reduced to minute chaffy scales and spines; cladodes triquetrous, curved in tufts of 2-6. Flowers are white fragrant in simple or branched recemes on the naked nodes of the main shoots or in the axils of the thorns. Fruits are globular or obscurely 3-lobed, pulpy berries, purplish black when ripe; seeds with hard and brittle testa.

Agrotechnology: The plant comes up well under a wide range of tropical and subtropical climate. Fertile moist sandy loam soils are ideal for its cultivation though it grows in a wide range of soils. Better root development is observed in soils in increased proportion of sand. However, a decline in the yield of the crop is noticed in soils containing previous year’s residue of the roots. Asparagus plant is best grown from its tuberous roots even though it can be successfully propagated through seeds. Since root tubers are of commercial value seed propagation provides economic advantage to the farmers. Seeds usually start germinating after 40 days and average germination is 70% (Tewari and Misra, 1996).

For the cultivation of the crop, the land is ploughed well with pre-monsoon showers and seed nurseries are raised on seed beds of approximately 1m width, 15cm height and suitable length. Seed nursery should be irrigated regularly and kept weed free. With the onset of monsoon in June-July the main field is ploughed thoroughly and pits of size 30cm cube are dug at a spacing of 60-100cm. Tiwari and Misra (1996) have reported that irrespective of more number of roots and higher fresh weight per plant under wider spacings, the per hectare yields were highest in the closer spacing of 30cm x 30cm. The pit is filled with a mixture of top soil and well decomposed FYM or compost applied at 10 - 15 t/ha and the seedlings are transplanted. Application of N, P2O5 and K2O at 60:30:30 kg/ha increases the root yield. Regular irrigation and weeding are required to realize higher yields. Standards are to be provided for training the plant (Sharma et al, 1992). Few pests and diseases are observed on this crop. Harvesting the crop after two years provided higher root yield than annual harvests in pots as well as in field experiments. Irrigating the field prior to harvest enables easy harvesting of the root tubers. The average yield is 10 - 15 t/ha of fresh root tubers though yields over 60t/ha have been reported.

Properties and activity: Asparagus roots contain protein 22%, fat 6.2%, Carbohydrate 3.2%, Vitamin B 0.36%, Vitamin C 0.04% and traces of Vitamin A. It contains several alkaloids. Alcoholic extract yields asparagin- an anticancer agent. It also contains a number of antioxytocic saponins, viz. Shatavarisn - I to IV (Syamala, 1997). Leaves contain rutin, diosgenin and a flavonoid glycoside identified as quercetin - 3 - glucuronide. Flowers contain quercetin hyperoside and rutin. Fruits contain glycosides of quercetin, rutin and hyperoside while fully ripe fruits contain cyanidin - 3 - galactoside and cyanidin - 3 - glucorhamnoside.

Root is demulcent, diuretic, aphrodisiac, tonic, alterative, antiseptic, antidiarrhoeal, glalctogogue and antispasmodic. Aerial part is spasmolytic, antiarrhythmic and anticancer. Bark is antibacterial and antifungal.... asparagus

Optic Atrophy

A shrinkage or wasting of the optic nerve fibres due to disease or injury to the optic nerve, resulting in partial or complete loss of vision.

Optic atrophy may occur without prior signs of nerve disease, such as inflammation.... optic atrophy

Prostaglandin Drugs

Synthetically produced prostaglandins.

Dinoprostone is used with oxytocin for induction of labour.

Gemeprost softens and helps to dilate the cervix prior to inducing an abortion.

Alprostadil is used to treat newborn infants awaiting surgery for some congenital heart diseases.... prostaglandin drugs

Contraception

A means of avoiding pregnancy despite sexual activity. There is no ideal contraceptive, and the choice of method depends on balancing considerations of safety, e?ectiveness and acceptability. The best choice for any couple will depend on their ages and personal circumstances and may well vary with time. Contraceptive techniques can be classi?ed in various ways, but one of the most useful is into ‘barrier’ and ‘non-barrier’ methods.

Barrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.

Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.

SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.

These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.

INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.

The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.

Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.

HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.

In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... contraception

Disinfection

Killing of infectious agents outside the body by chemical or physical means directly applied. 1. Concurrent disinfection is the application of disinfective measures as soon as possible after the discharge of infectious material from the body of an infected person, or after the soiling of articles with such infectious discharges. All personal contact with such discharges or articles being prevented prior to such disinfection. 2. Terminal disinfection is application of disinfective measures after the patient has been removed by death or to a hospital, or has ceased to be a source of infection, or after isolation practices have been discontinued. Terminal disinfection is rarely practised; terminal cleaning generally suffices along with airing and sunning of rooms, furniture and bedding. It is necessary only for diseases spread by indirect contact; steam sterilisation of bedding was considered desirable after smallpox (now eradicated).... disinfection

Drug Interactions

Many patients are on several prescribed drugs, and numerous medicines are available over the counter, so the potential for drug interaction is large. A drug may interact with another by inhibiting its action, potentiating its action, or by simple summation of effects.

The interaction may take place:

(1) Prior to absorption or administration – for example, antacids bind tetracycline in the gut and prevent absorption.

(2) By interfering with protein binding – one drug may displace another from binding sites on plasma proteins. The action of the displaced drug will be increased because more drug is now available; for example, anticoagulants are displaced by analgesics.

(3) During metabolism or excretion of the drug – some drugs increase or decrease the activity of liver enzymes which metabolise drugs, thus affecting their rate of destruction; for example, barbiturates, nicotine, and alcohol all activate hepatic enzymes. Altering the pH of urine will affect the excretion of drugs via the kidney.

(4) At the drug receptor – one drug may displace another at the receptor, affecting its e?cacy or duration of action.... drug interactions

Enema

Introduction of ?uid into the RECTUM via the

Percutaneous nephroscope used for examining the interior of the kidney. It is passed into the pelvis of the kidney through a track from the surface of the skin. (The track is made with a needle and guide wire.) Instruments can be passed through the nephroscope under direct vision to remove calculi.

ANUS. Enemas may be given to clear the intestine of faeces prior to intestinal surgery or to relieve severe constipation. They may also be used to give barium for diagnostic X-rays as well as drugs such as CORTICOSTEROIDS, used to treat ULCERATIVE COLITIS. The patient is placed on his or her side with a support under the hips. A catheter (see CATHETERS) with a lubricated end is inserted into the rectum and warmed enema ?uid gently injected. Disposable enemas and miniature enemas, which can be self-administered, are widely used; they contain preprepared solution.... enema

Palate, Malformations Of

The commonest deformity of the PALATE is cleft palate, which is a result of faulty embryonic development in which the two sides of the palate fail to fuse or only fuse in part. If the cleft extends the full length with bilateral clefts at the front of the MAXILLA, it may be accompanied by a cleft lip (also called hare-lip) and disruption in the development of the front teeth. About 1 in 500 babies is born with a cleft lip and 1 in 1,000 has a cleft palate. If the parents are affected, the risk is three times that of the normal population; if one child has a deformity, the risk for a subsequent child is higher. Associated abnormalities include tongue tie, malpositioning of the MANDIBLE and ?uid in the middle EAR.

Cleft palate and hare-lip should be recti?ed by operation, because both are a serious drawback to feeding in early life – while later, harelip is a great dis?gurement, and the voice may be affected. The lip may be dealt with at any time from the neonatal period to a few weeks, depending on the individual surgeon’s view of when the best result is likely to be achieved. Prior to operation, special techniques may be necessary to ensure adequate feeding such as the use of special teats in formula-fed babies. The closure of a large cleft in the palate is a more formidable operation and is better performed when the face has grown somewhat, perhaps at 6–12 months. The operations performed vary greatly in details, but all consist in paring the edges of the gap and drawing the soft parts together across it.

Further operations may be required over the years to improve the appearance of the nose and lip, to make sure that teeth are even, and to improve speech.

Parents of such children can obtain help and advice from the Cleft Lip and Palate Association (CLAPA).... palate, malformations of

Sodium Picosulfate

A stimulant laxative drug used to treat constipation and to empty the bowel prior to procedures such as X-ray, endoscopy, and surgery on the intestines. Side effects may include abdominal cramps and diarrhoea. The drug should be avoided in cases of intestinal obstruction.... sodium picosulfate

Arteriography

n. imaging of arteries (see angiography). The major roles of arteriography are to demonstrate the site and extent of atherosclerotic narrowing or occlusion, especially in the coronary arteries (see coronary angiography) and leg arteries (peripheral arteriography), and to demonstrate the anatomy of aneurysms within the skull (carotid and vertebral arteriography). This technique is also used to image a bleeding vessel prior to blocking it (see embolization).... arteriography

Asa Classification

a widely used classification for grading patients’ fitness for surgery prior to the operation. It was developed by the American Society of Anesthesia (ASA), but is now used worldwide. Patients are assigned grades between 1 and 6.... asa classification

Clamp

n. a surgical instrument designed to compress a structure, such as a blood vessel or the intestine (see illustration). A variety of clamps have been designed for specific surgical procedures. Blood-vessel (atraumatic) clamps are used to stop bleeding from the cut vessels and are designed not to damage the arterial wall. Intestinal clamps prevent the intestinal contents from leaking into the abdominal cavity during operations on the intestines and are designed either not to damage the intestinal wall (noncrushing clamps) or to close the open end (crushing clamps) prior to excising and suturing the intestine to create an anastomosis.... clamp

Skullcap Tea Health Benefits

Skullcap tea gets its name from the perennial herb shaped like a human skull, native to North America. Skullcap tea has been used for centuries as a natural and effective sedative and nerve tonic which relieves fear, anxiety and promotes relaxation. Skullcap Tea Brewing Skullcap teabrewing should be made with water that is not too hot, because otherwise it will spoil the tea and its benefits will not be fully enjoyed. The infusion will last three to five minutes. Skullcap tea has a pleasant taste which will make you perceive it less like a medicinal sleeping aid. Skullcap Tea Health Benefits Skullcap tea has a wide range ofbeneficial effects on the human body. It has been used as a sedative for centuries and nowadays been proven effective as a cure for insomnia, anxiety and headaches. Skullcap tea has a calming effect which soothes stress, muscle spasms, menstrual cramps and other problems that require the use of a remedy with sedative properties. Skullcap tea consumption may also be useful as a complimentary treatment method for more serious illnesses such as bladder and liver cancer, asthma, arthritis, gout or allergies. Research suggests that the tea could be beneficial for the prevention of heart diseases and strokes as well. Skullcap Tea Side Effects Excessive Skullcap tea intake may lead to unpleasantside effects such as irregular heartbeat, mental confusion, slow responsiveness to stimuli and even seizures. Skullcap tea should not be consumed with other with other medications that have the same relaxing effects because it may enhance their sedation properties and it is not recommended for pregnant or nursing women. Patients suffering from spleen, liver or stomach problems and diabetics should avoid Skullcap tea. It is advisable to consult a doctor prior to adding skullcap tea to your dietary plan. Sleep is essential for the well-being of our body. Drinking Skullcap tea nightly before bed when you feel the need of easing your mind or calming your nerves will work miracles. You will turn off your brain and enjoy a good night’s sleep!... skullcap tea health benefits

Almond Oil

Amygdala dulcis (sweet almonds). A fixed oil expressed from Prunus amygdalus without the aid of heat. Contains 45 per cent fixed oil and about 20 per cent protein and an enzyme, emulsin. Demulcent. Nutritive. Emulsifying agent. Used internally as a laxative, or externally as a massage oil. A nourishing skin cream is made by whisking Almond oil 2; Beeswax 1; and Aloe Vera 1; in a mixer. “Oil of Almonds makes smooth the hands and face of delicate persons, and cleanses the skin from spots and pimples” (John Gerard)

Oil is injected into the meatus for softening ear wax prior to removal. A good vehicle for Vitamins A, D and E in cosmetic lotions. Excellent base for ointments, together with Agar-Agar.

Sweet almonds have been used as food since ancient times, being a source of fats, iron, calcium, potassium, phosphorus, copper and zinc. Used widely in Aromatherapy. ... almond oil

Chelation

From the Greek ‘chele’ meaning to claw or grip. Deposits of cholesterol and by-products of free radical activity may cause arteries to become brittle and block circulation. Chelation offers an internal ‘house cleaning’ whereby such deposits and metals are freed into the circulation for elimination from the body.

Chelation is increasingly used as an alternative to by-pass surgery for coronary disease, significantly improving the coronary circulation. Reportedly of value for improved kidney function, decreased insulin requirement for diabetes, to reduce prostate obstruction, restore near-normal breathing pattern in emphysema and to bring relief in arthritis. Specific herbs act as bonding agents to metals in blood vessel plague prior to expulsion via the kidneys and bowel.

Conventional medical chelation therapy consists of an intravenous drip of a synthetic amino acid, EDTA (ethylene diamine tetra-acetic acid) which leeches from the tissues toxic metals (lead, mercury etc) prior to elimination. Cholesterol and fats are dissolved and metabolised by the liver, and metals are excreted by the kidneys.

Supportive aid to primary treatment. Combine tinctures: Hawthorn 2; Lily of the Valley 1; Capsicum quarter. Dose: 15-60 drops in water thrice daily.

Saponin-containing herbs, by their detergent action act as binding agents to leech metals, plague etc from blood vessels and the intestinal canal.

Diet. Guar gum preparations. Low salt. Fish oils or oily fish.

Supplements. Vitamins A, C, D (Cod Liver oil), B-complex, especially Vitamin B12, biotin, PABA, chromium, selenium, zinc, methionine, superoxide dismutase, magnesium.

Information. The Arterial Disease Clinic: tel: 0942 676617. ... chelation

Colostrum

n. the first secretion from the breast, occurring shortly after, or sometimes before, birth prior to the secretion of true milk. It is a relatively clear fluid containing serum, white blood cells, and protective antibodies.... colostrum

Cordocentesis

n. the removal of a sample of fetal blood by inserting a fine hollow needle through the abdominal wall of a pregnant woman, under ultrasound guidance, into the umbilical vein. Cordocentesis is most commonly performed for confirmation of fetal *packed cell volume prior to intrauterine transfusion in cases of haemolytic disease of the newborn or for confirmation of infection in the fetus. See also fetal blood sampling.... cordocentesis

Crenation

n. an abnormal appearance of red blood cells seen under a microscope, in which the normally smooth cell margins appear crinkly or irregular. Crenation may be a feature of certain blood disorders, but most commonly occurs as a result of prolonged storage of a blood specimen prior to preparation of a blood film. See also burr cell.... crenation

Diabetic Holiday Foot Syndrome

a condition in which patients with diabetic sensory polyneuropathy (see diabetic neuropathy) suffer significant trauma to their insensate feet through holiday activities. These may include walking on hot flagstones or sand and wearing ill-fitting shoes. The condition may be prevented with prior education and advice and by maintaining safe footcare practices.... diabetic holiday foot syndrome

Cancer

An invasive growth which gradually emerges into life and, undisciplined, eats its way into neighbouring tissues. Malignancy is the growth of abnormal cells with the ability to form a primary lesion from which cells may be bloodborne to other parts of the body (metastasis). Growth usually follows the line of the lymph vessels (Violet leaves have an affinity for lymph vessels).

Course of the disease is unpredictable, cases surviving for many years on primary or supportive herbal treatment. Suspected malignancy should be referred to modern hospital treatment immediately. Early detection is vital.

Common signs calling attention are: (1) Unusual bleeding or discharge. (2) Tired feeling all the time. (3) Thickening or lump in breast or elsewhere. (4) Sudden change in hair texture and colour. (5) Irritable cough or hoarseness. (6) Extreme mental depression. (7) Obvious change in a mole or wart. (8) Muscle weakness and cramps. (9) A sore that does not heal. (10) Change in bowel or bladder habit. (11) Sudden weakness of the eyes. (12) Difficulties in swallowing; indigestion. (13) Excess wind in stomach or bowel.

Tumour-killing effect of chemotherapy may be intensified and side-effects minimised (loss of weight, and of white blood cells) when certain neoplastic herbs are prescribed. Cytotoxic drugs inhibit the ability of Vitamin C to stimulate the body’s defences. Herbs enhance the body’s self-healing ability to eliminate. An inoperable cancer would appear to be good grounds for herbal medication which often relieves pain and preserves a man’s dignity in his hour of extremity.

A series of medical trials in Finland revealed that terminal cases had 12 per cent lower mean serum selenium concentration than controls. Other similar trials point to the need for selenium supplements. Those with both low selenium and low Vitamin E levels are especially at risk.

See: GERSON CANCER THERAPY.

Exercise. High levels of fitness are associated with lower death rates. (American study)

Plants with a special reference to cancer include: Blue Flag, Burdock, Clivers, Condurango, Echinacea, Guaiacum, Houseleek, Poke root. There are many more referred to in medical literature.

Poke Root. John Bartram reported in the late 18th century that from his experience among the Mohawk Indians, Poke root (Phytolacca decandra) was a “cure” for cancer. (American Indian Medicine, Virgil J. Vogel)

Blood Root. For internal or external bleeding of cancer.

Calendula (Marigold). For the same purpose.

Mistletoe. Dr Alfred Vogel advises an extract of the plant (Loranthus europaeus) as grown on the Oak tree: dose: 10-15 drops.

Almonds. Edgar Cayce, Virginia Beach, USA, with some successes to his credit, advised eating three almonds a day to counter any tendency towards the disease.

Laetrile. From Apricot kernels that contain cyanogenic glucosides. Though competent physicians have reported positive results in some terminal cases without prior surgery or radiation, the remedy has been withdrawn from general practice because of possible toxicity.

Much needless suffering may be incurred because of out-moded resistance of doctors and governments against prescribing morphine early in cancer patients. It is estimated that 50-80 per cent of patients do not receive satisfactory pain-relief because doctors fear tolerance of the drug would increase, necessitating a higher dosage. From the beginning of time the Opium Poppy has been the most effective analgesic for the terminal condition. Morphine is a respiratory depressant and some authorities believe it should be given before the final stages in continuous doses for adequate pain control. Risks must be balanced with benefits. Dangerous in asthmatics.

Way of Life. Herbal medication of malignant disease involves the patient with his treatment. Here is something he or she can do to regain some control over their life. It can give them the satisfaction of knowing that in some way they are ‘fighting back’ thus influencing the quality of life and a sense of well- being.

If improvement in cancer is not possible maybe the condition can be stabilised and the patient helped to cope with the very unpleasant side-effects of chemotherapy and radiation. Thus, may be restored the body’s natural balance and a possible extension of lifespan.

For this, patients and practitioners may need information and support. That is why suggestions for malignant disease are included in this book. Moreover, well-meaning friends and relatives may exert pressure on the patient ‘to leave no stone unturned’ in search of a cure. Thus every possible secondary treatment should be considered since any one may prove to contribute towards recovery. It is hoped that this book will invite a therapeutic alliance with members of the medical profession as well as with other practitioners.

Macmillan nurses help alleviate physical pain and the psychological distress that can accompany this illness. They are trained to help people with cancer and their families fight cancer with more than medicine.

All forms of cancer should be treated by or in liaison with a qualified medical practitioner or an oncologist. ... cancer

Exsanguination

n. 1. depriving the body of blood; for example, as a result of an accident causing severe bleeding or – very rarely – through uncontrollable bleeding during a surgical operation. 2. a technique for providing a bloodless field to facilitate delicate or haemorrhagic operative procedures. 3. the removal of blood from a part (usually a limb) prior to stopping the inflow of blood (by tourniquet). —exsanguinate vb.... exsanguination

Germinal Vesicle

the nucleus of a mature *oocyte, prior to fertilization. It is considerably larger than the nucleus of other cells.... germinal vesicle

Graafian Follicle

a mature follicle in the ovary prior to ovulation, containing a large fluid-filled cavity that distends the surface of the ovary. The *oocyte develops inside the follicle, attached to one side. [R. de Graaf (1641–73), Dutch physician and anatomist]... graafian follicle

Heaf Test

a skin test to determine whether or not an individual is immune to tuberculosis, carried out prior to vaccination. A spring-loaded gun mounted with very short needles produces a circle of six punctures in the forearm through which *tuberculin is introduced. If the test is positive a reaction causes the skin to become red and raised, indicating that the individual is immune. If the test is negative a vaccine (*BCG) should be given. [F. R. G. Heaf (20th century), British physician]... heaf test

Artificial Insemination

A form of assisted conception in which semen is introduced artificially into the uterus, instead of by sexual intercourse, with the aim of inducing pregnancy.

There are 2 types of artificial insemination: , artificial insemination with the semen of the woman’s male partner; and , insemination with a donor’s sperm. is usually used for couples who are unable to have intercourse, or if the man has a low sperm count or a low volume of ejaculate. It is also used when semen has been stored from a man prior to treatment (such as chemotherapy) that has made him sterile. is available to couples if the man is infertile or is a carrier of a genetic disease. It may also be used by a woman who wants children but has no male partner.

Insemination is timed to coincide with natural ovulation or may be combined with treatment to stimulate ovulation.... artificial insemination

Athetosis

A disorder of the nervous system that is characterized by slow, writhing, involuntary movements, most often of the face, head, neck, and limbs. These movements commonly include facial grimacing, with contortions of the mouth. There may also be difficulty in balancing and walking. Athetosis tends to be combined with chorea (jerky involuntary movements). Both athetosis and chorea arise from damage to the basal ganglia, clusters of nerve cells in the brain that control movement. Causes of athetosis include brain damage prior to or at birth (see cerebral palsy), encephalitis (brain infection), degenerative disorders such as Huntington’s disease, or as a side effect of phenothiazine drugs or levodopa.... athetosis

Barium Enema

a radiological technique used to diagnose conditions of the large bowel using the combination of X-ray imaging and radiopaque contrast (barium sulphate). Prior bowel cleansing is usually required with a colonic cleansing preparation. A large-bore tube with a balloon is inserted into the rectum and through this the barium is delivered to the caecum. The balloon is inflated in the rectum to prevent leakage of barium outside. In *double contrast studies, air is passed through the catheter to distend the colon. A series of radiographs are taken after barium has coated the colon, and the patient may be asked to change position to ensure that the whole bowel is delineated. Barium enema is used to identify colonic polyps, colorectal cancer, and diverticular disease. However, its role has been largely taken over by *colonoscopy which enables additional mucosal sampling and therapeutic intervention.... barium enema

Hospital

n. an institution providing medical or psychiatric care and treatment of patients. Such care may be residential (in-patient), including the care of patients for a whole day and their return home at night (day care). Out-patient services include consultation with specialists by prior appointment, X-rays, laboratory tests, physiotherapy, and accident and emergency services for those requiring urgent care. Most health districts have a district general hospital (DGH), which provides sufficient basic services for the population of the district. Some larger hospitals have resources that are more highly specialized, to meet the needs of a wider population, providing so-called regional or supraregional (national) services. Such hospitals often provide training for medical students (teaching or university hospitals) and for postgraduate education. Some smaller hospitals – known as community hospitals – may be staffed by general practitioners and are intended for people for whom home care is not practicable on social grounds. Within the NHS, individual hospitals or groups of hospitals are generally part of *foundation trusts, deriving their income largely from contracts with *clinical commissioning groups. There are also around 400 private hospitals in the UK, which operate outside of the NHS, though some are contracted to provide some NHS services.... hospital

Immunity

n. the body’s ability to resist infection, afforded by the presence of circulating *antibodies and white blood cells. Healthy individuals protect themselves by means of physical barriers, phagocytic cells, *natural killer cells, and various blood-borne molecules. All of these mechanisms are present prior to exposure to infectious agents and are part of natural (or innate) immunity. Antibodies are manufactured specifically to deal with the antigens associated with different diseases as they are encountered. Active immunity arises when the body’s own cells produce, and remain able to produce, appropriate antibodies following an attack of a disease or deliberate stimulation (see immunization). Passive immunity, which is only short-lived, is provided by injecting ready-made antibodies in *antiserum taken from another person or an animal already immune. Babies have passive immunity, conferred by antibodies from the maternal blood and *colostrum, to common diseases for several weeks after birth. See also immune response.... immunity

Induction

n. 1. (in obstetrics) the starting of labour by artificial means. It is carried out using such drugs as *prostaglandins to prime the cervix and/or *amniotomy prior to synthetic *oxytocin (Syntocinon), which stimulate uterine contractions. Induction of labour is carried out if the wellbeing or life of mother or child is threatened by continuance of the pregnancy. 2. (in anaesthesia) initiation of *anaesthesia. General anaesthesia is usually induced by the intravenous injection of short-acting *anaesthetics, e.g. thiopental.... induction

Overtube

n. a semirigid plastic tube (25–45 cm long) designed to fit over the shaft of an *endoscope in order to minimize the risk of trauma. It can be used with a *gastroscope, *cholangioscope, *enteroscope, or colonoscope (see colonoscopy). An overtube is placed over the shaft of an endoscope prior to its insertion; once the endoscope is in the desired place, the overtube is lubricated and slid into position over the shaft. It is commonly used in combination with a gastroscope for the removal of ingested foreign bodies (especially those with sharp or serrated edges that may cause significant trauma as they are being extracted).... overtube

Percutaneous Transhepatic Cholangiopancreatography

imaging of the bile duct and pancreatic duct. A catheter is carefully manipulated into the ducts via direct puncture through the abdomen under radiological guidance. Contrast material is flushed through the catheter to delineate the ducts (see also cholangiography). This procedure is often performed in cases of obstructive jaundice prior to insertion of a biliary drain or stent when *ERCP is not possible.... percutaneous transhepatic cholangiopancreatography

Lumbar Puncture

a procedure performed under local anaesthetic in which cerebrospinal fluid is withdrawn by means of a hollow needle inserted into the *subarachnoid space in the region of the lower back (usually between the third and fourth lumbar vertebrae). The fluid obtained is examined for diagnosis of meningitis, multiple sclerosis, and various other disorders of the brain and spinal cord. Lumbar puncture may also be performed to inject agents into the subarachnoid space. The procedure is usually without risk to the patient, but in patients with raised intracranial pressure it may be hazardous. CT and MRI scanning prior to lumbar puncture have greatly reduced the risk of performing the test in patients with unsuspected raised intracranial pressure. The commonest side-effect of the procedure is a headache that is worse on standing and reduces on lying down (*intracranial hypotension headache). See also Queckenstedt test.... lumbar puncture

Pprom

preterm prelabour (or premature) rupture of membranes: spontaneous rupture of fetal membranes prior to 37 weeks gestation in the absence of regular painful contractions. This can be monitored for any signs of infection (*chorioamnionitis). Compare PROM.... pprom

Prime

vb. (in chemotherapy) to administer small doses of a *cytotoxic drug prior to high-dose chemotherapy and/or radiotherapy. This causes proliferation of the primitive bone marrow cells and aids subsequent regeneration of the bone marrow.... prime

Prom

prelabour (or premature) rupture of membranes: spontaneous rupture of membranes prior to the onset of labour. The majority of women who demonstrate this phenomenon will go into active labour spontaneously within the following 48 hours. Compare PPROM.... prom

Quality Of Life

a measure of a person’s wellbeing that is relevant in two ways in medical ethics. (1) The experience, burden, and effects of disease as opposed to its duration are often invoked in debates about *abortion, *assisted suicide, *euthanasia, and the withholding or withdrawal of medical treatment. The criteria for determining another person’s wellbeing are complex and contested, and some argue that competent adults are the best judges of their own quality of life. (2) The formal evaluation of losses and gains is employed to determine who will benefit most from a treatment and, on this basis, who should receive priority where resources are scarce. In such cases a calculation of quality-adjusted life years (QALYs) is made, rather than a simpler estimate of how long a successfully treated patient can expect to live. Each expected year of full health is scored 1, each expected year with various degrees of illness or disability less than 1, and death 0. Research priorities are often made on the basis of a related metric, *disability-adjusted life years (DALYs), which seeks to minimize the burden of disease. Both metrics have been criticized for discriminating against those with prior medical conditions, which lower their baseline score, and the elderly, whose longevity is short. See also need.... quality of life

Q Wave

the downward deflection on an *electrocardiogram that indicates the beginning of ventricular depolarization. An abnormally deep and wide Q wave is an indication of prior heart muscle damage due to heart attack.... q wave

Replantation

n. 1. the reattachment of severed limbs (or parts of limbs) and other body parts (e.g. the nose) using *microsurgery to rejoin nerves and vessels. 2. (reimplantation) (in dentistry) the reinsertion of a tooth into its socket after its accidental or deliberate removal. The prognosis for the tooth is improved if the tooth is not allowed to dry out prior to reimplantation. —replant vb.... replantation

Rest Pain

pain without prior exertion, usually experienced in the feet or chest (*angina pectoris), that indicates an extreme degree of *ischaemia.... rest pain

Sarcoma Botryoides

the most common tumour of the cervix and vagina in children and adolescents under the age of 16; 90% occur in children under five years. Symptoms are vaginal bleeding and a bloody discharge; in young girls the tumour may protrude from the cervix. It is a highly malignant *rhabdomyosarcoma with the appearance of a bunch of grapes. Treatment is with triple chemotherapy with or without radiotherapy prior to hysterectomy and vaginectomy.... sarcoma botryoides

Spatulation

n. the technique of widening the orifice of an anatomical tube prior to joining it up, which makes the join more secure and less prone to narrowing.... spatulation

Suppository

n. a medicinal preparation in solid form suitable for insertion into the rectum, vagina, or urethra. Rectal suppositories may contain simple lubricants (e.g. glycerin); drugs that act locally in the rectum or anus (e.g. corticosteroids, local anaesthetics); or drugs that are absorbed and act at other sites (e.g. analgesics, such as diclofenac). Vaginal suppositories are used in the treatment of some gynaecological disorders (see pessary). Urethral suppositories contain antibiotics, local anaesthetics (prior to a procedure), or medication used in the treatment of erectile dysfunction.... suppository

Talc

n. a soft white powder, consisting of magnesium silicate, used in dusting powders and skin applications. Talc used to dust surgical rubber gloves causes irritation of serous membranes, resulting in adhesions, if not washed off prior to an operation.... talc

Ureterolysis

n. an operation to free one or both ureters from surrounding abnormal adhesions or fibrous tissue (e.g. retroperitoneal fibrosis). It may also be performed prior to pelvic surgery to avoid intraoperative ureteric injury.... ureterolysis

Veress Needle

a surgical needle used prior to *laparoscopy to gain access to the peritoneal cavity and allow insufflation of carbon dioxide (*pneumoperitoneum) before the insertion of a sharp *trocar. It has an outer cutting sheath and an inner spring-loaded gas-transmitting safety sheath and is inserted into the abdomen either in the midsagittal plane at the lower margin or base of the umbilicus or at *Palmer’s point. [J. Veress (20th century), Hungarian surgeon]... veress needle

Xeroradiography

n. a type of X-ray imaging in which a picture of the body is recorded on paper rather than on film. A plate of selenium, which rests on a thin layer of aluminium oxide, is charged uniformly by passing it in front of a scorotron. As X-ray photons impinge on this, charges diffuse out in proportion to the energy content of the X-ray. An imprint is formed by the charge distribution on the plate, which attracts toner particles and is transferred to reusable paper plates. Unlike conventional X-ray imaging, xeroradiography does not require photographic developers. The technique does, however, require more radiation exposure. It was widely used in mammography prior to the advent of digital mammography.... xeroradiography

Citronella

Cymbopogon nardus

FAMILY: Poaceae (Gramineae)

SYNONYMS: Andropogon nardus, Sri Lanka citronella, Lenabatu citronella.

GENERAL DESCRIPTION: A tall, aromatic, perennial grass, which has derived from the wild-growing ‘managrass’ found in Sri Lanka.

DISTRIBUTION: Native to Sri Lanka, now extensively cultivated on the southernmost tip of the country.

OTHER SPECIES: An important essential oil is also produced on a large scale from the Java or Maha Pengiri citronella (C. winterianus). This variety is cultivated in the tropics worldwide, especially in Java, Vietnam, Africa, Argentina and Central America. There are many other related species of scented grasses.

HERBAL/FOLK TRADITION: The leaves of citronella are used for their aromatic and medicinal value in many cultures, for fever, intestinal parasites, digestive and menstrual problems, as a stimulant and an insect repellent. It is used in Chinese traditional medicine for rheumatic pain.

ACTIONS: Antiseptic, antispasmodic, bactericidal, deodorant, diaphoretic, diuretic, emmenagogue, febrifuge, fungicidal, insecticide, stomachic, tonic, vermifuge.

EXTRACTION: Essential oil by steam distillation of the fresh, part-dried or dried grass. (The Java citronella yields twice as much oil as the Sri Lanka type.)

CHARACTERISTICS: A yellowy-brown, mobile liquid with a fresh, powerful, lemony scent. The Java oil is colourless to pale yellow with a fresh, woody-sweet fragrance; it is considered of superior quality in perfumery work. It blends well with geranium, lemon, bergamot, orange, cedarwood and pine.

PRINCIPAL CONSTITUENTS: Mainly geraniol (up to 45 per cent in the Java oil), citronella (up to 50 per cent in the Java oil) with geranyl acetate, limonene and camphene, among others. The Sri Lanka variety contains more monoterpene hydrocarbons.

SAFETY DATA: Non-toxic, non-irritant; may cause dermatitis in some individuals. Avoid during pregnancy.

AROMATHERAPY/HOME: USE

Skin Care: Excessive perspiration, oily skin, insect repellant. ‘Mixed with cedarwood oil Virginia, it has been a popular remedy against mosquito attacks for many years prior to the appearance of DDT and other modern insecticides.’.

Immune System: Colds, ’flu, minor infections.

Nervous System: Fatigue, headaches, migraine, neuralgia.

OTHER USES: Extensively used in soaps, detergents, household goods and industrial perfumes. Employed in insect repellent formulations against moths, ants, fleas, etc, for use in the home and in the garden The Sri Lanka oil is used in most major food categories, including alcoholic and soft drinks. The Java oil is used as the starting material for the isolation of natural geraniol and citronellal.... citronella

Oakmoss

Evernia prunastri

FAMILY: Usneaceae

SYNONYMS: Mousse de chene, treemoss.

GENERAL DESCRIPTION: A light green lichen found growing primarily on oak trees, but sometimes other species.

DISTRIBUTION: The oak (Quercus robur) is indigenous to Europe and North America; the lichen is collected all over central and southern Europe, especially France, Yugoslavia, Hungary, Greece, and also Morocco and Algeria. The aromatic materials are prepared mainly in France, but also in the USA, Bulgaria and Yugoslavia.

OTHER SPECIES: There are many varieties of lichen used for their aromatic qualities, the most common being E. furfuracea and Usnea barbata which are frequently gathered from spruce and pine trees, and are known as fir moss or tree moss in Europe, but in the USA are also called oakmoss. However they are less refined than the ‘true’ oakmoss. Other species include Sticta pulmonaceae or Lobaria pulmonaria, Usnea ceratina, and some members of the Ramalina, Alectoria and Parmelia groups.

HERBAL/FOLK TRADITION: Sticta pulmonaceae, a greeny-brown lichen also found growing on oak trees and frequently harvested along with E. prunastri, is also called oak lungs, lung moss, lungwort or ‘lungs of oak’ by the North American Indians who use it for respiratory complaints and for treating wounds. It is called lobaria in the British Herbal Pharmacopoeia and is used for asthma, bronchitis and coughs in children.

Many types of lichen, especially the Parmelia group, are used as vegetable dyes.

ACTIONS: Antiseptic, demulcent, expectorant, fixative.

EXTRACTION: A range of products is produced: a concrete and an absolute by solvent extraction from the lichen which has often been soaked in lukewarm water prior to extraction; an absolute oil by vacuum distillation of the concrete; resins and resinoids by alcohol extraction of the raw material. Most important of these products is the absolute.

CHARACTERISTICS: 1. The absolute is a dark green or brown, very viscous liquid with an extremely tenacious, earthy-mossy odour and a leatherlike undertone. 2. The absolute oil is a pale yellow or olive viscous liquid with a dry earthy, barklike odour, quite true to nature. 3. The concrete, resin and resinoids are a very dark-coloured semi-solid or solid mass with a heavy, rich-earthy, extremely tenacious odour. They have a high fixative value and blend with virtually all other oils: they are extensively used in perfumery to lend body and rich natural undertones to all perfume types.

PRINCIPAL CONSTITUENTS: Crystalline matter of so-called ‘lichen acids’: mainly evernic acid, d-usnic acid, some atranorine and chloratronorine.

SAFETY DATA: Extensively compounded or ‘bouquetted’ by cutting or adulteration with other lichen or synthetic perfume materials.

AROMATHERAPY/HOME: USE As a fixative.

OTHER USES: The concrete is used primarily in soaps; the absolute is the most versatile and is used in all perfume types (oriental, moss, fougère, new-mown hay, floral, colognes, aftershaves, etc.). The absolute oil is used in high-class perfumes. The resins and resinoids, which have a poor solubility, are used in soaps, hair preparations, industrial perfumes and low cost products.... oakmoss

Orris

Iris pallida

FAMILY: Iridaceae

SYNONYMS: Orris root, iris, flag iris, pale iris, orris butter (oil).

GENERAL DESCRIPTION: A decorative perennial plant up to 1.5 metres high, with sword-shaped leaves, a creeping fleshy rootstock and delicate, highly scented, pale blue flowers.

DISTRIBUTION: Native to the eastern Mediterranean region; also found in northern India and North Africa. Most commercial orris is produced in Italy where it grows wild. The oil is mainly produced in France and Morocco and to lesser extent in Italy and the USA.

OTHER SPECIES: There are many species of iris; cultivation has also produced further types. In Italy the pale iris (I. pallida) is collected indiscriminately with the Florentine orris (I. florentina) which has white flowers tinged with pale blue, and the common or German iris (I. germanica) which has deep purple flowers with a yellow beard. Other species which have been used medicinally include the American blue flag (I. versicolor), and the yellow flag iris (I. pseudacorus).

HERBAL/FOLK TRADITION: In ancient Greece and Rome orris root was used extensively in perfumery, and its medicinal qualities were held in high esteem by Dioscorides. The juice of the root was used for cosmetic purposes, and the root bruised in wine was employed for dropsy, bronchitis, coughs, hoarseness, chronic diarrhoea and congested headaches. In Russia the root was used to make a tonic drink with honey and ginger.

Iris is little used medicinally these days, but it still appears in the British Herbal Pharmacopoeia as being formerly used in upper respiratory catarrh, coughs, and for diarrhoea in infants.

ACTIONS: Dried Root – antidiarrhoeal, demulcent, expectorant. Fresh Root – diuretic, cathartic, emetic.

EXTRACTION: 1. An essential oil (often called a ‘concrete’) by steam distillation from the rhizomes which have been peeled, washed, dried and pulverized. The rhizomes must be stored for a minimum of three years prior to extraction otherwise they have virtually no scent! 2. An absolute produced by alkali washing in ethyl ether solution to remove the myristic acid from the ‘concrete’ oil. 3. A resin or resinoid by alcohol extraction from the peeled rhizomes.

CHARACTERISTICS: 1. The oil solidifies at room temperature to a cream-coloured mass with a woody, violet-like scent and a soft, floral-fruity undertone. 2. The absolute is a water-white or pale yellow oily liquid with a delicate, sweet, floral-woody odour. 3. The resin is a brown or dark orange viscous mass with a deep, woody sweet, tobacco-like scent – very tenacious.

Orris blends well with cedarwood, sandalwood, vetiver, cypress, mimosa, labdanum, bergamot, clary sage, rose, violet and other florals.

PRINCIPAL CONSTITUENTS: Myristic acid, an odourless substance which makes the ‘oil’ solid (85–90 per cent), alpha-irone and oleic acid.

SAFETY DATA: The fresh root causes nausea and vomiting in large doses. The oil and absolute are much adulterated or synthetic – ‘true’ orris absolute is three times the price of jasmine.

AROMATHERAPY/HOME: USE None. However, the powdered orris, which is a common article, may be used as a dry shampoo, a body powder, a fixative for pot pourris, and to scent linen.

OTHER USES: The powder is used to scent dentifrices, toothpowders, etc. The resin is used in soaps, colognes and perfumes; the absolute and ‘concrete’ oil are reserved for high-class perfumery work. Occasionally used on the Continent for confectionery and fruit flavours.... orris




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