Habitat: The Mediteranean region, Europe and Asia.
English: Borage, Cow's Tongue Plant.Unani: Gaozabaan (Onosma bracteatum Wall. has also been equated with Gaozabaan).Action: Fresh herb (compounded with water)—refreshing, restorative and nervine tonic. Leaves and flowers—diuretic, febrifuge, expectorant, demulcent, emollient; promote the activity of kidneys; alleviate pulmonary affections.
The drug strengthens adrenal glands and is given for stress, mental exhau- sion and depression; provides support to stomach and intestines in cases of infection and toxicity. Used as a tonic to counteract the lingering effects of steroid therapy. Seeds relieve irritable bowel syndrome and regulate menstruation.The leaves contain lycopsamine and supindine viridiflorate as the predominant unsaturated pyrrolizidine alkaloids. Due to low concentration of these alkaloids Borage is not toxic.The drug contains potassium and calcium, combined with mineral acids. The fresh juice affords 30%, the dried herb 3% of nitrate of potash. The stems and leaves supply much saline mucilage. These saline qualities are mainly responsible for the wholesome invigorating properties of Borage.Borage imparts pleasant flavour and cooling effect to beverages. In India, squashes and syrups, sold during summer, contain Borage extract.Borage contains ascorbic acid (38 mg/100 g). Flowers contain cholin, glucose, fructose, amino acids, tannin (about 3%). Seeds contain protein (20.9%) and an oil (38.3%). The seed oil is one of the important sources of gamma-linoleic acid and linoleic acid. Borage oil, combined with Evening Primrose oil, is used in hypercholes- terolaemia.Borage seed oil is used for rheumatoid arthritis, atopic eczema, infantile seborrhoeic dermatitis, neurodermati- tis, also for PMS and for preventing heart disease and stroke. Only UPA (unsaturated pyrrolizidine alkaloids) free oil is given internally.Listed by German Commission E among unapproved herbs.It has been suggested that borage not be used with drugs known to lower the seizure threshold such as tricyclic an- tidepressants and phenothiazines due to GLA content (only borage seed oil contains significant amounts of GLA). (Francis Brinker.)... borago officinalisCardeah, Cardia, Cardiah... cardea
Habitat: British and European hedge plant, met with in the temperate Himalayas of Kashmir and Himachal Pradesh at an altitude of 1,800-3,000 m. (The plant does not thrive in the plains of India.)
English: English Hawthorn.Folk: Ring, Ringo, Pingyat, Phindak, Ban Sanjli (Punjab hills).Action: Coronary vasodilator (strengthens heart muscle without increasing the beat in coronary arteries), antispasmodic, antihypertensive, sedative to nervous system, diuretic.
Key application: In cases of cardiac insufficiency Stage II as defined by NYHA (New York Heart Association). An improvement of subjective findings as well as an increase in cardiac work tolerance, a decrease in pressure/heart rate product, an increase in the ejection fraction and a rise in the anaerobic threshold have been established in human pharmacological studies. (German Commission E, WHO.)The active principles include oligo- meric procyanidins and flavonoids.The drug is official in Homoeopathic Pharmacopoeia of India.Contraindicated in low blood pressure, chest pain, bleeding disorders. The herb may interfere with therapeutic effect of cardiac drugs. (Sharon M. Herr.) Preparations based on hydroal- coholic extracts of Crataegus monogy- na or C. laevigata are used as Hawthorn in the Western herbal.... crataegeus oxyacanthaExamination of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magni?cation.
Tuning-fork or Rinne tests are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating fork is audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to di?erentiate between conductive and nerve deafness.
Hearing tests are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The intensity of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing, at that frequency, through air and bone respectively. It may be necessary to play a masking noise into the opposite ear to prevent that ear from hearing the tones, enabling each ear to be tested independently.
General symptoms The following are some of the chief symptoms of ear disease: DEAFNESS (see DEAFNESS). EARACHE is most commonly due to acute in?ammation of the middle ear. Perceived pain in this region may be referred from other areas, such as the earache commonly experienced after tonsillectomy (removal of the TONSILS) or that caused by carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause. TINNITUS or ringing in the ear often accompanies deafness, but is sometimes the only symptom of ear disease. Even normal people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. The intensity of the tinnitis usually ?uctuates, sometimes disappearing altogether. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness. The symptom seems to originate in the brain’s subcortical regions, high in the central nervous system. It may be a symptom of general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse, and may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitis, but unfortunately in many cases the noises persist. Management involves psychological techniques and initially an explanation of the mechanism and reassurance that tinnitus does not signify brain disease, or an impending STROKE, may help the person. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.
Diseases of the external ear
WAX (cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitis and sometimes disturbance of balance. Wax can sometimes be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected. FOREIGN BODIES such as peas, beads or buttons may be found in the external ear canal, especially in children who have usually introduced them themselves. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are ?rst instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove some foreign bodies, but often removal by a specialist using suitable instrumentation and an operating microscope is required. In children, a general anaesthetic may be needed. ACUTE OTITIS EXTERNA may be a di?use in?ammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment should be local, using magnesium sulphate paste or glycerine and 10-per-cent ichthaminol. Topical antibiotic drops can be used and sometimes antibiotics by mouth are necessary, especially if infection is acute. Clotrimazole drops are a useful antifungal treatment. Analgesics and locally applied warmth should relieve the pain.
CHRONIC OTITIS EXTERNA producing pain and discharge, can be caused by eczema, seborrhoeic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, and the chronic disorder may be the result of swimming or use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments. TUMOURS of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, said to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to ?ll the ear canal, but may shrink considerably after treatment of the associated infection.
Diseases of the middle ear
OTITIS MEDIA or infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses. It may follow a cold, tonsillitis or sinusitis, and may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Primarily it is a disease of children, with as many as 1.5 million cases occurring in Britain every year. Pain may be intense and throbbing or sharp in character. The condition is accompanied by deafness, fever and often TINNITUS.
In infants, crying may be the only sign that something is wrong – though this is usually accompanied by some localising manifestation such as rubbing or pulling at the ear. Examination of the ear usually reveals redness, and sometimes bulging, of the ear drum. In the early stages there is no discharge, but in the later stages there may be a discharge from perforation of the ear drum as a result of the pressure created in the middle ear by the accumulated pus. This is usually accompanied by an immediate reduction in pain.
Treatment consists of the immediate administration of an antibiotic, usually one of the penicillins (e.g. amoxicillin). In the majority of cases no further treatment is required, but if this does not quickly bring relief then it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear. When otitis media is treated immediately with su?cient dosage of the appropriate antibiotic, the chances of any permanent damage to the ear or to hearing are reduced to a negligible degree, as is the risk of any complications such as mastoiditis (discussed later in this section). CHRONIC OTITIS MEDIA WITH EFFUSION or glue ear, is the most common in?ammatory condition of the middle ear in children, to the extent that one in four children in the UK entering school has had an episode of ‘glue ear’. It is characterised by a persistent sticky ?uid in the middle ear (hence the name); this causes a conductive-type deafness. It may be associated with enlarged adenoids (see NOSE, DISORDERS OF) which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the ?uid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of grommets (ventilation tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is less popular than it was a decade or so ago. MASTOIDITIS is a serious complication of in?ammation of the middle ear, the incidence of which has been dramatically reduced by the introduction of antibiotics. In?ammation in this cavity usually arises by direct spread of acute or chronic in?ammation from the middle ear. The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. The management of this condition in the ?rst instance is with antibiotics, usually given intravenously; however, if the condition fails to improve, surgical treatment is necessary. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.
Diseases of the inner ear
MENIÈRE’S DISEASE is a common idiopathic disorder of ENDOLYMPH control in the semicircular canals (see EAR), characterised by the triad of episodic VERTIGO with deafness and tinnitus. The cause is unknown and usually one ear only is affected at ?rst, but eventually the opposite ear is affected in approximately 50 per cent of cases. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures. OTOSCLEROSIS A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200; it customarily occurs early in adult life. An overgrowth of bone ?xes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.
Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)... ear, diseases of
Agnus Castus and Helonias are believed to encourage production of endorphins thus improving a sense of well-being in menopausal women. ... endorphins
NICE – its Scottish equivalent is the Scottish Health Technology Assessment Centre – has three main functions:
appraisal of new and existing technologies.
development of clinical guidelines.
promotion of clinical audit and con?dential inquiries. Central to its task is public concern about ‘postcode prescribing’ – that is, di?erent availability of health care according to geography.
In 2003 the World Health Organisation appraised NICE. Amongst its recomendations were that there should be greater consistency in the methods used for appraisal and the way in which results and decisions were reported. WHO was concerned about the need for transparency about the con?ict between NICE’s use of manufacturers’ commercial evidence in con?dence, and believed there should be greater de?nition of justi?cation for ‘threshold’ levels for cost-e?ectiveness in the Centre’s judgement of what represents value for money.
In all, WHO was congratulatory – but questions remain about the practical value and imlementation of NICE guidelines.... national institute for clinical excellence (nice)
The resting level of spontaneous neuronal activity in the hearing system is only just below that at which sound enters a person’s consciousness – a consequence of the ?ne-tuning of normal hearing; so it is not, perhaps, surprising that normally ‘unheard’ neuronal activity becomes audible. If a patient suffers sensorineural deafness, the body may ‘reset’ the awareness threshold of neural activity, with the brain attempting greater sensitivity in an e?ort to overcome the deafness. The condition has a strong emotional element and its management calls for a psychological approach to help sufferers cope with what are, in e?ect, physically untreatable symptoms. They should be reassured that tinnitus is not a signal of an impending stroke or of a disorder of the brain. COGNITIVE BEHAVIOUR THERAPY can be valuable in coping with the unwanted noise. Traditionally, masking sounds, generated by an electrical device in the ear, were used to help tinnitus sufferers by, in e?ect, making the tinnitus inaudible. Even with the introduction of psychological retraining treatment, these maskers may still be helpful; the masking-noise volume, however, should be kept as low as possible or it will interfere with the retraining process. For patients with very troublesome tinnitus, lengthy counselling and retraining courses may be required. Surgery is not recommended.
Under the auspices of the Royal National Institute for Deaf People, the RNID Tinnitus Helpline has been established. Calls are charged at local rates. (See also MENIÈRE’S DISEASE.)... tinnitus
Where emotional and mental stress is caused by adrenal exhaustion the herb Pulsatilla exerts a positive influence. Other adrenal stimulants:– Sarsaparilla, Ginseng, Gotu Kola, Borage. Night cap to relax: cup of Balm tea.
As many of its symptoms are indistinguishable from caffeinism, coffee and strong tea should be avoided. Hypoglycaemia predisposes. Stop smoking. A dog makes an ideal companion for an agoraphobic, providing an impetus to get across the threshold.
Supplements: Vitamin B-complex, B1, B6, C, E.
Minerals: Calcium, Magnesium, Zinc.
Aromatherapy: 6 drops Roman Chamomile oil on cotton wool for use a nosegay. ... agoraphobia
Varicose veins are dilated tortuous veins occurring in about 15 per cent of adults – women more than men. They most commonly occur in the legs but may also occur in the anal canal (HAEMORRHOIDS) and in the oesophagus (due to liver disease).
Normally blood ?ows from the subcutaneous tissues to the super?cial veins which drain via perforating veins into the deep veins of the leg. This ?ow, back towards the heart, is aided by valves within the veins. When these valves fail, increased pressure is exerted on the blood vessels leading to dilatations known as varicose veins.
Treatment is needed to prevent complications such as ulceration and bleeding, or for
cosmetic purposes. Treatment alternatives include injection with sclerosing agents to obliterate the lumen of the veins (sclerotherapy), or surgery; in the elderly or un?t, an elastic stocking may su?ce. One operation is the Trendelenburg operation in which the saphenous vein is disconnected from the femoral vein and individual varicose veins are avulsed. (See also VASCULITIS.)
Thrombosis Thrombosis occurs when blood, which is normally a liquid, clots within the vein to form a semisolid thrombus (clot). This occurs through a combination of reduced blood ?ow and hypercoagulability (a reduced threshold for clotting). The most common site for this to occur is in the deep veins of the leg, where it is known as a deep-vein thrombosis (DVT).
Predisposing factors include immobility (leading to reduced blood ?ow), such as during long journeys (e.g. plane ?ights) where there is little opportunity to stretch one’s legs; surgery (leading to temporary post-operative immobility and hypercoagulability of blood); oestrogen administration (low-dose oestrogen oral contraceptives carry a very low relative risk); and several medical illnesses such as heart failure, stroke and malignancy.
Deep-vein thrombosis presents as a tender, warm, red swelling of the calf. Diagnosis may be con?rmed by venogram (an X-ray taken following injection of contrast medium into the foot veins) or by ultrasound scanning looking for ?ow within the veins.
Prevention is important. This is why patients are mobilised and/or given leg exercises very soon after an operation, even major surgery. People should avoid sitting for long periods, particularly if the edge of the seat is hard, thus impeding venous return from the legs. Car drivers should stop regularly on a long journey and walk around; airline travellers should, where possible, walk round the aisle(s) and also exercise and massage their leg muscles, as well as drinking ample non-alcoholic ?uids.
Diagnosis and treatment are important because there is a risk that the clotted blood within the vein becomes dislodged and travels up the venous system to become lodged in the pulmonary arteries. This is known as PULMONARY EMBOLISM.
Treatment is directed at thinning the blood with ANTICOAGULANTS, initially with heparin and subsequently with WARFARIN for a period of time while the clot resolves.
Blocked super?cial veins are described as super?cial thrombophlebitis, which produces in?ammation over the vein. It responds to antiin?ammatory analgesics. Occasionally heparin and ANTIBIOTICS are required to treat associated thrombosis and infection.... veins, diseases of
An audiometer (an electrical instrument) is used to test an individual’s ability to hear sounds at different frequencies and volumes. The lowest level at which a person can hear and repeat words (the speech reception threshold) is tested, as is the ability to hear words clearly (speech discrimination). The type of hearing loss (see deafness) is determined by holding a tuning fork to different parts of the ear.... hearing tests
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