The formation or presence of 1 or more ulcers.
(See also prostaglandin drugs.)... prostaglandin
On exposure to cold, the digits turn white due to lack of blood. As sluggish blood flow returns, the digits become blue; when they are warmed and normal blood flow returns, they turn red. During an attack, there is often tingling, numbness, or a burning feeling in the affected fingers or toes. In rare cases, the artery walls gradually thicken, permanently reducing blood flow. Eventually painful ulceration or even gangrene may develop at the tips of the affected digits.
Diagnosis is made from the patient’s history. Treatment involves keeping the hands and feet as warm as possible. Vasodilator drugs or calcium channel blockers may be helpful in severe cases. (See also Raynaud’s phenomenon.)... raynaud’s disease
The main symptom of ulcerative colitis is bloody diarrhoea; and the faeces may also contain mucus. In severe cases, the diarrhoea and bleeding are extensive, and there may be abdominal pain and tenderness, fever, and general malaise. The incidence of attacks varies considerably. Most commonly, the attacks occur at intervals of a few months. However, in some cases, there may be only a single episode.
Ulcerative colitis may lead to anaemia, caused by blood loss. Other complications include a toxic form of megacolon, which may become life-threatening; rashes; aphthous ulcers; arthritis; conjunctivitis; or uveitis. There is also an increased risk of cancer of the colon developing (see colon, cancer of).
A diagnosis is based on examination of the rectum and lower colon (see sigmoidoscopy) or the entire colon (see colonoscopy), or is made by a barium enema (see barium X-ray examination). During sigmoidoscopy or colonoscopy, a biopsy may be performed. Samples of faeces may be taken for laboratory analysis in order to exclude the possibility of infection by bacteria or parasites. Blood tests may also be needed.
Medical treatments of ulcerative colitis include corticosteroid drugs and sulfasalazine and its derivatives. Colectomy may be required for a severe attack that fails to respond to other treatments, or to avoid colonic cancer in those people who are at high risk.... ulcerative colitis
Various processes that can occur include in?ammation, ulceration, infection or tumour. Abdominal disease may be of rapid onset, described as acute, or more long-term when it is termed chronic.
An ‘acute abdomen’ is most commonly caused by peritonitis – in?ammation of the membrane that lines the abdomen. If any structure in the abdomen gets in?amed, peritonitis may result. Causes include injury, in?ammation of the Fallopian tubes (SALPINGITIS), and intestinal disorders such as APPENDICITIS, CROHN’S DISEASE, DIVERTICULITIS or a perforated PEPTIC ULCER. Disorders of the GALLBLADDER or URINARY TRACT may also result in acute abdominal pain.
General symptoms of abdominal disease include:
Pain This is usually ill-de?ned but can be very unpleasant, and is termed visceral pain. Pain is initially felt near the mid line of the abdomen. Generally, abdominal pain felt high up in the mid line originates from the stomach and duodenum. Pain that is felt around the umbilicus arises from the small intestine, appendix and ?rst part of the large bowel, and low mid-line pain comes from the rest of the large bowel. If the diseased organ secondarily in?ames or infects the lining of the abdominal wall – the PERITONEUM – peritonitis occurs and the pain becomes more de?ned and quite severe, with local tenderness over the site of the diseased organ itself. Hence the pain of appendicitis begins as a vague mid-line pain, and only later moves over to the right iliac fossa, when the in?amed appendix has caused localised peritonitis. PERFORATION of one of the hollow organs in the abdomen – for example, a ruptured appendix or a gastric or duodenal ulcer (see STOMACH, DISEASES OF) eroding the wall of the gut – usually causes peritonitis with resulting severe pain.
The character of the pain is also important. It may be constant, as occurs in in?ammatory diseases and infections, or colicky (intermittent) as in intestinal obstruction.
Swelling The commonest cause of abdominal swelling in women is pregnancy. In disease, swelling may be due to the accumulation of trapped intestinal contents within the bowel, the presence of free ?uid (ascites) within the abdomen, or enlargement of one or more of the abdominal organs due to benign causes or tumour.
Constipation is the infrequent or incomplete passage of FAECES; sometimes only ?atus can be passed and, rarely, no bowel movements occur (see main entry for CONSTIPATION). It is often associated with abdominal swelling. In intestinal obstruction, the onset of symptoms is usually rapid with complete constipation and severe, colicky pain. In chronic constipation, the symptoms occur more gradually.
Nausea and vomiting may be due to irritation of the stomach, or to intestinal obstruction when it may be particularly foul and persistent. There are also important non-abdominal causes, such as in response to severe pain or motion sickness.
Diarrhoea is most commonly due to simple and self-limiting infection, such as food poisoning, but may also indicate serious disease, especially if it is persistent or contains blood (see main entry for DIARRHOEA).
Jaundice is a yellow discoloration of the skin and eyes, and may be due to disease in the liver or bile ducts (see main entry for JAUNDICE).
Diagnosis and treatment Abdominal diseases are often di?cult to diagnose because of the multiplicity of the organs contained within the abdomen, their inconstant position and the vagueness of some of the symptoms. Correct diagnosis usually requires experience, often supplemented by specialised investigations such as ULTRASOUND. For this reason sufferers should obtain medical advice at an early stage, particularly if the symptoms are severe, persistent, recurrent, or resistant to simple remedies.... abdomen, diseases of
Habitat: Native to eastern Europe; found in Kashmir and Himachal Pradesh.
English: Marshmallow, Hollyhock.Unani: Khatmi, Gul-Khairu (also equated with Althaea rosea Linn.).Siddha/Tamil: Shemai-tutti.Action: Demulcent, emollient, antitussive (used for cough, bronchitis, gastritis, enteritis and cystitis), antilithic, diuretic.
Key application: (leaf and root) In irritation ofthe oral and pharyngeal mucosa and associated dry cough; in mild inflammation of the gastric mucosa. (German Commission E, ESCOP.) As demulcent. (The British Herbal Pharmacopoeia.) In gastroenteritis, peptic and duodenal ulceration, common and ulcerative colitis. (The British Herbal Compendium.) Topically for varicose veins, skin ulcers, abscesses, cuts, burns.Althaea rosea (L.) Cav., synonym Al- cea rosea L., Hollyhock flower, is used as mucilage for prophylaxis and therapy of diseases and discomforts of the respiratory and gastrointestinal tract and for urinary complaints. (It is included among unapproved herbs by German Commission E.)The root contains starch, mucilage, pectin, flavonoids, phenolic acids, sucrose, tannins and asparagines. Mucilage (18-35%) consists of a number of polysaccharides. Flavonoids include kaempferol, quercetin and diosmetin glucosides. Polyphenolic acids include syringic, caffeic, salcyclic, vanillic and p-coumaric acids.The mucilages have proven biological activity including stimulation of phagocytosis in vitro.The root counters excess stomach acid, peptic ulceration and gastritis.... althaea officinalisHabitat: Wild throughout India, especially in the hill forests of Western and Southern India.
English: Spiny or Thorny Bamboo.Ayurvedic: Vansha, Venu, Kichaka, Trinadhwaj, Shatparvaa, Yavphala. Vanshalochana, Vansharochanaa, Shubhaa, tugaa, Tugaakshiri, Tvak- kshiri (Bamboo-manna). Starch of Curcuma angustifolia Roxb., Zingiberaceae, was recommended a substitute for Vanshalochana (Ayurvedic Formularly of India, Part I, First edn).Unani: Qasab, Tabaashir (Bamboo- manna).Siddha/Tamil: Moongil; Moongilup- pu, (Bambo-manna.)Action: Leaf bud and young shoots—used in dysmenorrhoea; externally in ulcerations. Leaf—em- menagogue, antileprotic, febrifuge, bechic; used in haemoptysis. Stem and leaf—blood purifier (used in leucoderma and inflammatory conditions). Root—poisonous. Burnt root is applied to ringworm, bleeding gums, painful joints. Bark—used for eruptions. Leaf and Bamboo-manna—emmena- gogue. Bamboo-manna—pectoral, expectorant, carminative, cooling, aphrodisiac, tonic (used in debilitating diseases, urinary infections, chest diseases, cough, asthma).
The plant gave cyanogenic glu- coside—taxiphyllin. Bamboo-manna contains silicious crystalline substances.The starch obtained from Maranta arundinacea Linn., Marantaceae, is also used as Bamboo-manna (known as Koovai Kizhangu, Kookaineer and Araroottu Kizangu in Siddha medicine).Dosage: Manna—1-3 g (CCRAS.)... bambusa bambosHin: Akasgaddah;
Mal: Kadamba, KollankovaTam: Akashagarudan, Gollankovai;Tel: Murudonda, NagadondaCorallocarpus is a prostrate or climbing herb distributed in Punjab, Sind, Gujarat, Deccan, Karnataka and Sri Lanka. It is monoecious with large root which is turnip-shaped and slender stem which is grooved, zigzag and glabrous. Tendrils are simple, slender and glabrous. Leaves are sub-orbicular in outline, light green above and pale beneath, deeply cordate at the base, angled or more or less deeply 3-5 lobed. Petiole is long and glabrous. Male flowers are small and arranged at the tip of a straight stiff glabrous peduncle. Calyx is slightly hairy, long and rounded at the base. Corolla is long and greenish yellow. Female flowers are usually solitary with short, stout and glabrous peduncles. Fruit is stalked, long, ellipsoid or ovoid. Seeds are pyriform, turgid, brown and with a whitish corded margin. It is prescribed in later stages of dysentery and old veneral complaints. For external use in chronic rheumatism, it is made into a liniment with cumin seed, onion and castor oil. It is used in case of snakebite where it is administered internally and applied to the bitten part. The root is given in syphilitic rheumatism and later stages of dysentery. The plant is bitter, sweet, alexipharmic and emetic. The root is said to possess alterative and laxative properties (Kirtikar and Basu, 1988). Root contains a bitter principle like Breyonin (Chopra et al, 1980).Agrotechnology: Cucurbits can be successfully grown during January-March and September- December. For the rainfed crop, sowing can also be started after the receipt of the first few showers.Pits of 60cm diameter and 30-45cm depth are to be taken at the desired spacing. Well rotten FYM or vegetable mixture is to be mixed with topsoil in the pit and seeds are to be sown at 4-5/pit. Unhealthy plants are to be removed after 2 weeks and retained 2-3 plants/pit. FYM is to be applied at 20-25t/ha as basal dose along with half dose of N (35kg/ha) and full dose of P (25kg) and K (25kg). The remaining dose of N (35kg) can be applied in 2 equal split doses at fortnightly intervals. During the initial stages of growth, irrigation is to be given at an interval of 3-4 days and at alternate days during flowering and fruiting periods. For trailing cucumber, pumpkin and melon, dried twigs are to be spread on the ground. Bitter gourd, bottle gourd, snake gourd and ash gourd are to be trailed on Pandals. Weeding and raking of the soil are to be conducted at the time of fertilizer application. Earthing up may be done during rainy season. The most dreaded pest of cucurbits is fruit flies which can be controlled by using fruit traps, covering the fruits with polythene, cloth or paper bags, removal and destruction of affected fruits and lastly spraying with Carbaryl or Malathion 0. 2% suspension containing sugar or jaggery at 10g/l at fortnightly intervals after fruit set initiation. During rainy season, downy mildew and mosaic diseases are severe in cucurbits. The former can be checked by spraying Mancozeb 0.2%. The spread of mosaic can be checked by controlling the vectors using Dimethoate or Phosphamidon 0.05% and destruction of affected plants and collateral hosts. Harvesting to be done at least 10 days after insecticide or fungicide application (KAU,1996).... cucurbitsHabitat: Throughout India.
English: Madar (white-flowered), Giant Milk-weed.Ayurvedic: Alarka, Raajaarka, Shvetaarka, Vasuka, Mandaar, Bhaasvanmuula, Dinesh, Prab- haakara, Ravi, Bhaanu, Tapana.Unani: Madaar, Aak.Siddha/Tamil: Erukku.Action: Flowers—stomachic, bechic, antiasthmatic. Milky juice— purgative (gastrointestinal irritant). Roots—used in lupus, tuberculous leprosy, syphilitic ulceration. Leaves—juice poisonous. Used in external swellings. All parts—used against bronchitis and asthma.
The leaf extract showed antitussive activity due to the presence of alkaloids and glycosides. The root contains gly- cosides 0.60-1.42% on dry basis. The latex contains akudarin. Flowers contain beta-amyrin and stigmasterol.Dosage: Milky juice—500 mg; leaf, flower, root bark—3-5 g powder. (CCRAS.)... calotropis giganteaHabitat: In marshy places throughout India up to 200 m.
English: Asiatic Pennywort, Indian Pennywort.Ayurvedic: Manduukaparni, Manduukaparnikaa, Maanduuki, Saraswati, Brahma-manduuki.Siddha/Tamil: Vallaarai.Action: Adaptogen, central nervous system relaxant, peripheral vasodilator, sedative, antibiotic, detoxifier, blood-purifier, laxative, diuretic, emmenagogue. Used as a brain tonic for improving memory and for overcoming mental confusion, stress, fatigue, also used for obstinate skin diseases and leprosy.
Key application: Extracts orally to treat stress-induced stomach and duodenal ulcers; topically to accelerate healing, particularly in cases of chronic postsurgical and post trauma wounds; also to treat second and third degree burns. Patients suffering from venous insufficiency were treated with a titrated extract of the drug. (WHO.)Used in Indian medicine as a brain tonic and sedative. (Indian Herbal Pharmacopoeia.)Major constituents of the plant are: triterpenoid saponins—brahmoside, asiaticoside, thankuniside; alkaloids (hydrocotyline); bitter principles (vel- larin).Brahmoside, present in the plant, is reported to exhibit tranquilizing and anabolic activity. Raw leaves are eaten or plant decoction is drunk to treat hypertension.Asiaticoside, extracted from leaves, gave encouraging results in leprosy. It dissolves the waxy covering of Bacillus leprae. Centelloside has also been found useful in leprosy. Asiaticoside reduced the number tubercular lesions in the liver, lungs, nerve ganglia and spleen in experimental animals. Another derivative of asiaticoside, oxyasi- aticoside, inhibits growth of Tubercle bacillus at a concentration of 0.15 ml/ml Asiaticosides are also hyperglycaemic.The asiatic acid acts against resistant bacteria, particularly Mycobacterium tuberculosis and M. leprae as well as Gram-positive cocci.Asiaticosides elevate blood glucose, triglycerides and cholesterol levels. They seem to decrease blood urea nitrogen and acid phosphatase levels. (Pharmacological findings. Natural Medicines Comprehensive Database, 2007.)Boiled leaves are eaten for urinary tract infections, and unfiltered juice for scrofula and syphilis.Extract of the fresh plant significantly inhibits gastric ulceration by cold restraint stress in rats.In research, using rats, the herb exhibited protective effect against alcohol-induced and aspirin-induced ulcers. (JExp Biol, 2001, Feb, 39(2), 13742.)Dosage: Whole plant—3-6 g (API Vol. IV.)... centella asiaticaHabitat: Native to West Indies and South America. Now distributed in South India, Bengal, Kashmir and Maharashtra in wet places with cultivated lands.
English: Indian Wormseed, Sweet Pigweed, Mexican Tea.Ayurvedic: Sugandh-vaastuuka, Kshetra-vaastuuka.Siddha/Tamil: Kattasambadam.Folk: Khatuaa.Action: Antispasmodic, pectoral, haemostatic, emmenagogue. Employed in treating nervous affections, particularly chorea. Dried herb—anthelmintic against round and hookworms.
Ascaridole, an active constituent of the oil, is highly active against round- worms, hookworms and small, but not large, tapeworms. It is highly toxic and can cause serious side effects.The oil has been found useful in amoebic dysentery and intestinal infections (should be used with caution).Leaves contain kaempferol-7-rham- noside and ambroside.A decoction of the herb is given as an internal haemostatic and the infusion as an enema for intestinal ulceration. The infusion is sudorific and diuretic.The oil exhibits antimicrobial and strong antifungal activity against human pathogenic fungi.... chenopodium ambrosioidesAmong conditions routinely treated are walking disorders in children, injuries to the feet of joggers and athletes, corns, bunions and hammer toes, ulcers and foot infections. Chiropody also has a preventative role which includes inspection of children’s feet and the detection of foot conditions requiring treatment and advice and also foot-health education. The chiropodist is trained to recognise medical conditions which manifest themselves in the feet, such as circulatory disorders, DIABETES MELLITUS and diseases causing ulceration.
The only course of training in the United Kingdom recognised for the purpose of state registration by the Health Professionals Council is the Society of Chiropodists’ three-year full-time course. The course includes instruction and examination in the relevant aspects of anatomy and physiology, local analgesia, medicine and surgery, as well as in podology and therapeutics. The Council holds the register of podiatrists. (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)... chiropody
Many modi?cations have been devised of the basic steroid molecule in an attempt to keep useful therapeutic effects and minimise unwanted side-effects. The main corticosteroid hormones currently available are CORTISONE, HYDROCORTISONE, PREDNISONE, PREDNISOLONE, methyl prednisolone, triamcinolone, dexamethasone, betamethasone, paramethasone and de?azacort.
They are used clinically in three quite distinct circumstances. First they constitute replacement therapy where a patient is unable to produce their own steroids – for example, in adrenocortical insu?ciency or hypopituitarism. In this situation the dose is physiological – namely, the equivalent of the normal adrenal output under similar circumstances – and is not associated with any side-effects. Secondly, steroids are used to depress activity of the adrenal cortex in conditions where this is abnormally high or where the adrenal cortex is producing abnormal hormones, as occurs in some hirsute women.
The third application for corticosteroids is in suppressing the manifestations of disease in a wide variety of in?ammatory and allergic conditions, and in reducing antibody production in a number of AUTOIMMUNE DISORDERS. The in?ammatory reaction is normally part of the body’s defence mechanism and is to be encouraged rather than inhibited. However, in the case of those diseases in which the body’s reaction is disproportionate to the o?ending agent, such that it causes unpleasant symptoms or frank illness, the steroid hormones can inhibit this undesirable response. Although the underlying condition is not cured as a result, it may resolve spontaneously. When corticosteroids are used for their anti-in?ammatory properties, the dose is pharmacological; that is, higher – often much higher – than the normal physiological requirement. Indeed, the necessary dose may exceed the normal maximum output of the healthy adrenal gland, which is about 250–300 mg cortisol per day. When doses of this order are used there are inevitable risks and side-effects: a drug-induced CUSHING’S SYNDROME will result.
Corticosteroid treatment of short duration, as in angioneurotic OEDEMA of the larynx or other allergic crises, may at the same time be life-saving and without signi?cant risk (see URTICARIA). Prolonged therapy of such connective-tissue disorders, such as POLYARTERITIS NODOSA with its attendant hazards, is generally accepted because there are no other agents of therapeutic value. Similarly the absence of alternative medical treatment for such conditions as autoimmune haemolytic ANAEMIA establishes steroid therapy as the treatment of choice which few would dispute. The use of steroids in such chronic conditions as RHEUMATOID ARTHRITIS, ASTHMA and DERMATITIS needs careful assessment and monitoring.
Although there is a risk of ill-effects, these should be set against the misery and danger of unrelieved chronic asthma or the incapacity, frustration and psychological trauma of rheumatoid arthritis. Patients should carry cards giving details of their dosage and possible complications.
The incidence and severity of side-effects are related to the dose and duration of treatment. Prolonged daily treatment with 15 mg of prednisolone, or more, will cause hypercortisonism; less than 10 mg prednisolone a day may be tolerated by most patients inde?nitely. Inhaled steroids rarely produce any ill-e?ect apart from a propensity to oral thrush (CANDIDA infection) unless given in excessive doses.
General side-effects may include weight gain, fat distribution of the cushingoid type, ACNE and HIRSUTISM, AMENORRHOEA, striae and increased bruising tendency. The more serious complications which can occur during long-term treatment include HYPERTENSION, oedema, DIABETES MELLITUS, psychosis, infection, DYSPEPSIA and peptic ulceration, gastrointestinal haemorrhage, adrenal suppression, osteoporosis (see BONE, DISORDERS OF), myopathy (see MUSCLES, DISORDERS OF), sodium retention and potassium depletion.... corticosteroids
Habitat: Evergreen forests of Western Ghats from Konkan southwards and in Goa. Also cultivated in southern districts of Maharashtra and on lower slopes of Nilgiris.
English: Kokam Butter tree, Mangosteen Oil tree.Ayurvedic: Vrkshaamla, Tintidika, Chukra, Amlavrkshak, Kokam, Amsula.Siddha/Tamil: Murgal.Folk: Kokam.Action: Fruit—antiscorbutic, cholagogue, cooling, antibilious, emollient and demulcent. A syrup from the fruit juice is given in bilious affections. Bark—astringent, Oil or Kokam Butter—used for dysentery and diarrhoea with mucus. Applied externally to ulcerations, fissures of lips, chapped skin and skin diseases.
The fruit rind contain a polyiso- prenylated phenolic pigment, garci- nol and its isomer isogarcinol, along with (-)-hydroxycitric acid, cyanidin- 3-glucoside and cyanidin-3-sambubio- side. L-leucine and DNP-L-leucine hy- drochloride have been reported from the leaves.EtOH (50%) extract of aerial parts exhibited semen coagulant and CNS depressant activity.Kokum butter contains fatty acids— palmtic 2.0, stearic 57.5, oleic 39.0, linoleic 1.3 and others 0.2%.Dosage: Fruit—10-20 ml juice; root bark—40-80 ml decoction. (CCRAS.)... garcinia indica2. It is mostly acquired as a result of sexual activity; some cases are caused by simplex type
1. After initial infection the virus lies latent in the dorsal nerve root ganglion (of the spinal cord) which enervates the affected area of the skin. Latent virus is never cured and reactivation results in either a recurrence of symptoms or in asymptomatic shedding of the virus which then infects a sexual partner. Around 30,000 cases of genital herpes are reported annually from clinics dealing with SEXUALLY TRANSMITTED DISEASES (STDS) in England, but there are also many unrecognised (by either patient or doctor) infections. Patients may have a history of painful attacks of ulceration of the genitals for many years before seeking medical advice. All patients with a ?rst episode of the infection should be given oral antiviral treatment, and those who suffer more than six attacks a year should be considered for suppressive antiviral treatment. ACICLOVIR, valaciclovir and famciclovir are all e?ective antiviral drugs. If a woman in the ?nal three months of her pregnancy contracts herpes genitalis, this can have serious consequences for the baby as he or she will be at risk of herpes encephalitis after delivery.... herpes genitalis
Habitat: Cultivated throughout the country, especially found in Assam, Bengal, South India and Andaman Islands.
Ayurvedic: Karkataka, Kaaravella- jalaja.Folk: Kakrol (Maharashtra), Bhat-karelaa, Gulkakraa.Action: Leaf and fruit—used externally for lumbago, ulceration, fracture of bone. Seed—bechic, aperient, emmenagogue, anti- inflammatory, deobstruent. (Used for obstructions of liver and spleen).
The tuberous root contains saponins belonging to the pentacyclic tri- terpene glycoside series. Seeds contain momordica saponins I and II (ester glycosides of gypsogenin and quilla- ic acid respectively), the diterpenoid columbin, oleanolic acid, its derivative momordic acid and bessisterol.The seeds contain the glycoprotein, momorcochin S, which exhibits RNA N-glycosidase activity.... momordica cochinchinensisSeveral diseases and conditions are treated under separate headings. (See APPENDICITIS; CHOLERA; COLITIS; CONSTIPATION; CROHN’S DISEASE; DIARRHOEA; DYSENTERY; ENTERIC FEVER; HAEMORRHOIDS; HERNIA; INFLAMMATORY BOWEL DISEASE (IBD); ILEITIS; INTUSSUSCEPTION; IRRITABLE BOWEL SYNDROME (IBS); PERITONITIS; RECTUM, DISEASES OF; ULCERATIVE COLITIS.)
In?ammation of the outer surface is called peritonitis, a serious disease. That of the inner surface is known generally as enteritis, in?ammation of special parts receiving the names of colitis, appendicitis, irritable bowel syndrome (IBS) and in?ammatory bowel disease (IBD). Enteritis may form the chief symptom of certain infective diseases: for example in typhoid fever (see ENTERIC FEVER), cholera and dysentery. It may be acute, although not connected with any de?nite organism, when, if severe, it is a very serious condition, particularly in young children. Or it may be chronic, especially as the result of dysentery, and then constitutes a less serious if very troublesome complaint.
Perforation of the bowel may take place as the result either of injury or of disease. Stabs and other wounds which penetrate the abdomen may damage the bowel, and severe blows or crushes may tear it without any external wound. Ulceration, as in typhoid fever, or, more rarely, in TUBERCULOSIS, may cause an opening in the bowel-wall also. Again, when the bowel is greatly distended above an obstruction, faecal material may accumulate and produce ulcers, which rupture with the ordinary movements of the bowels. Whatever the cause, the symptoms are much the same.
Symptoms The contents of the bowel pass out through the perforation into the peritoneal cavity, and set up a general peritonitis. In consequence, the abdomen is painful, and after a few hours becomes extremely tender to the touch. The abdomen swells, particularly in its upper part, owing to gas having passed also into the cavity. Fever and vomiting develop and the person passes into a state of circulatory collapse or SHOCK. Such a condition may be fatal if not properly treated.
Treatment All food should be withheld and the patient given intravenous ?uids to resuscitate them and then to maintain their hydration and electrolyte balance. An operation is urgently necessary, the abdomen being opened in the middle line, the perforated portion of bowel found, the perforation stitched up, and appropriate antibiotics given.
Obstruction means a stoppage to the passage down the intestine of partially digested food. Obstruction may be acute, when it comes on suddenly with intense symptoms; or it may be chronic, when the obstructing cause gradually increases and the bowel becomes slowly more narrow until it closes altogether; or subacute, when obstruction comes and goes until it ends in an acute attack. In chronic cases the symptoms are milder in degree and more prolonged.
Causes Obstruction may be due to causes outside the bowel altogether, for example, the pressure of tumours in neighbouring organs, the twisting around the bowel of bands produced by former peritonitis, or even the twisting of a coil of intestine around itself so as to cause a kink in its wall. Chronic causes of the obstruction may exist in the wall of the bowel itself: for example, a tumour, or the contracting scar of an old ulcer. The condition of INTUSSUSCEPTION, where part of the bowel passes inside of the part beneath it, in the same way as one turns the ?nger of a glove outside in, causes obstruction and other symptoms. Bowel within a hernia may become obstructed when the hernia strangulates. Finally some body, such as a concretion, or the stone of some large fruit, or even a mass of hardened faeces, may become jammed within the bowel and stop up its passage.
Symptoms There are four chief symptoms: pain, vomiting, constipation and swelling of the abdomen.
Treatment As a rule the surgeon opens the abdomen, ?nds the obstruction and relieves it or if possible removes it altogether. It may be necessary to form a COLOSTOMY or ILEOSTOMY as a temporary or permanent measure in severe cases.
Tumours are rare in the small intestine and usually benign. They are relatively common in the large intestine and are usually cancerous. The most common site is the rectum. Cancer of the intestine is a disease of older people; it is the second most common cancer (after breast cancer) in women in the United Kingdom, and the third most common (after lung and prostate) in men. Around 25,000 cases of cancer of the large intestine occur in the UK annually, about 65 per cent of which are in the colon. A history of altered bowel habit, in the form of increasing constipation or diarrhoea, or an alternation of these, or of bleeding from the anus, in a middle-aged person is an indication for taking medical advice. If the condition is cancer, then the sooner it is investigated and treated, the better the result.... intestine, diseases of
Action. Inhibits growth of Staphylococcus aureus. Antibiotic.
Uses: Urinary tract infections, boils and internal ulceration. Enteritis, shigella, colitis, osteomyelitis, pneumonia.
Courtesy. Chris Low, Member of the Register of Traditional Chinese Medicine (RTCM), scientific advisor to the Herbal Pharmaceutical Industry; The Chinese Medicine Clinic, Cambridge. ... andrographis
Action. Powerful alterative and antiseptic. Nervine.
Uses: Has a long traditional reputation for ulcerations, chancre, sore throat of syphilis and the chronic nerve dystrophy that follows. An analogue of Goldenseal. Parkinsonism. (Wm A.R. Thomson MD) vSaid to work well with Poke root.
Combined with Skullcap for epilepsy.
Preparation. Tincture: from the bulbous root when plant is in flower. 10 drops in water thrice daily.
Once used in herbal pharmacy. Of historic interest only. ... corydalis
Only a small minority of those exposed to M. leprae develop the disease. The incubation period is 3–5 years or longer. The major clinical manifestations involve skin and nerves: the former range from depigmented, often anaesthetic areas, to massive nodules; nerve involvement ranges from localised nerve swelling(s) to extensive areas of anaesthesia. Advanced nerve destruction gives rise to severe deformities: foot-drop, wrist-drop, claw-foot, extensive ulceration of the extremities with loss of ?ngers and toes, and bone changes. Eye involvement can produce blindness. Laryngeal lesions produce hoarseness and more serious sequelae. The diagnosis is essentially a clinical one; however, skin-smears, histological features and the lepromin skin-test help to con?rm the diagnosis and enable the form of disease to be graded.
Although the World Health Organisation had originally hoped to eliminate leprosy worldwide by 2000, that has proved an unrealistic target. The reason is an absence of basic information. Doctors are unable to diagnose the disorder before a patient starts to show symptoms; meanwhile he or she may have already passed on the infection. Doctors do not know exactly how transmission occurs or how it infects humans – nor do they know at what point a carrier of the bacterium may infect others. The incidence of new infections is still more than 650,000 cases a year or about 4.5 cases per 10,000 people in those countries worst affected by the disease.
Treatment Introduction of the sulphone compound, dapsone, revolutionised management of the disease. More recently, rifampicin and clofazimine have been added as ?rst-line drugs for treatment. Second-line drugs include minocycline, o?oxacin and clarithromycin; a number of regimens incorporating several of these compounds (multi-drug regimens – introduced in 1982) are now widely used. A three-drug regime is recommended for multi-bacillary leprosy and a two-drug one for parcibacillary leprosy. Dapsone resistance is a major problem worldwide, but occurs less commonly when multi-drug regimens are used. Older compounds – ethionamide and prothionamide
– are no longer used because they are severely toxic to the liver. Corticosteroids are sometimes required in patients with ‘reversal reaction’. Supportive therapy includes physiotherapy; both plastic and orthopaedic surgery may be necessary in advanced stages of the disease. Improvement in socio-economic conditions, and widespread use of BCG vaccination are of value as preventive strategies. Early diagnosis and prompt institution of chemotherapy should prevent long-term complications.... leprosy
Habitat: Native of Mediterranean region; grown in Indian gardens.
English: Indian oleander, White oleander.Ayurvedic: Karavira, Viraka, Ashva- maaraka, Hayamaaraka, Gauripush- pa, Divyapushpa, Shatakumbha, Siddhapushpa (white-flowered var.). Raktapushpa, Raktaprasava, Ravipriya (red-flowered var.)Unani: Kaner Safed, Diflaa, Samm-ul-maar, Khar-zaharah.Siddha/Tamil: Arali, Alari, Aatrulari, Karaviram.Action: Root—resolvent and attenuant. A paste of the root is externally applied to haemorrhoids and ulcerations in leprosy. Paste of the root bark and leaves is used in ringworm and other skin diseases. An oil extracted from the root bark is used in skin diseases of scaly nature. Leaves—cardioactive (digitalis-like effect) and diuretic, anti-inflammatory, antifungal, insecticidal. Toxic.
The leaves contain several glyco- sides including glycosides of 8 beta- hydroxy-digitoxigenin. Cardenolide glycosides and pregnanolone glyco- sides have been isolated from roots.The ethanolic extract of the flowers inhibits the growth of dermatophytes.The plant shows antifungal activity against ringworm fungus, Microspo- rum nanum.Dosage: Detoxified leaves—30— 125 mg powder (API, Vol. I); root— 30 mg—125 mg powder (API, Vol. III).... nerium indicumSymptom: black or tarry stools.
Alternatives. Teas: Nettles, Shepherd’s Purse. American Cranesbill. Meadowsweet.
Decoctions: Beth root. Marshmallow root.
Formula. Cranesbill root 2; Echinacea 1; Goldenseal quarter. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). In honey or water, thrice daily before meals.
Diet. 3-day fast.
Vitamins. C. K.
Minerals. Calcium. Iron. Zinc. ... melaena
A gel containing carbenoxolone is used to relieve mouth ulcers.... carbenoxolone
Symptoms When a sensory nerve is injured or diseased, sensation is immediately more or less impaired in the part supplied by the nerve. Ulceration or death of the tissue supplied by the defective nerve may occur. When the nerve in question is a motor one, the muscles governed through it are instantly paralysed. In the latter case, the portion of nerve beyond the injury degenerates and the muscles gradually waste, losing their power of contraction in response to electrical applications. Finally, deformities result and the joints become ?xed. This is particularly noticeable when the ulnar nerve is injured, the hand and ?ngers taking up a claw-like position. The skin may also be affected.
Treatment Damaged or severed (peripheral) nerve ?bres should be sewn together, using microsurgery. Careful realignment of the nerve endings gives the ?bres an excellent chance of regenerating along the right channels. Full recovery is rare but, with regular physiotherapy to keep paralysed muscles in good shape and to prevent their shortening, the patient can expect to obtain a reasonable return of function after a few weeks, with improvement continuing over several months.... nerves, injuries to
Habitat: Cultivated in gardens.
Features ? Stem and leaves reddish, grows up to about twelve inches. Stem quadrangular, slightly hairy. Leaves stalked, oblong-lanceolate, rounded at ends, crenulate at margins, reticulated both sides. Flowers labiate, reddish-purple. Taste, powerfully aromatic.Part used ? Leaves.Action: Aromatic, astringent, tonic, stomachic.
In the treatment of laryngitis, inflammation of throat and tonsils, and ulceration of mouth and throat. The 1 ounce to 1 pint infusion in frequent wineglass doses is given as an internal medicine, the gargle and mouth wash being made as follows ? Pour 1 pint of hot malt vinegar on to 1 ounce of the Red Sage leaves, adding 1/2 pint of cold water.Both Red Sage and the green-leaved variety are extensively used in the kitchen as a flavouring and digestive,Red Sage will also tend to darken grey hair—see "Toilet Recipes."... red sageResearchers are having success in growing human skin in the laboratory for grafting on to people who have been badly burned and have insu?cient intact skin surface to provide an autologous graft (one provided by the recipient of the graft). Other techniques being researched are the use of specially treated shark skin and the production of arti?cial skin.... skin-grafting
Habitat: Kashmir, Himachal Pradesh and Garhwal at 25003,000 m; cultivated in Kashmir and neighbouring regions.
English: Kuth, Costus.Ayurvedic: Kushtha, Kusht, Vaapya, Kaashmira, Gada, Rug, Ruk, Aamaya, Paalaka. (Substitute: Pushkara Muula, Inula racemosa.)Unani: Qust.Siddha/Tamil: Kostum, Kottam.Folk: Sugandha-Kuutth.Action: Root—antispasmodic, expectorant, carminative, astringent, antiseptic. An ingredient of prescriptions for dyspepsia, asthma, cough, chronic rheumatism, skin diseases. Applied locally to wounds and ulcerations. Powdered root, mixed with mustard oil, is applied to scalp in prurigo.
The Ayurvedic Pharmacopoeia of India recommends the root in cough, bronchitis, dyspnoea; erysipelas and gout.The root (containing both the essential oil and alkaloid, saussurine) is used for asthma, particularly of vagotonic type. It produces a definite relaxtion of the bronchioles. The relief obtained is comparable to that of conventional bronchodilators without side effects, like a rise in blood pressure, sweating or headache even on repeated administration.Saussurine depresses parasympa- thetic nervous system. The aminoacid- sesquiterpene adducts, saussureami- nes A, B and C show antiulcer effect. The aqueous extract of the root exhibits antianginal activity.Essential oil inhibits peristalic movement of the gut. It is absorbed from the gastro-intestinal tract and partly excreted by lungs producing an expectorant action and partly by the kidneys producing diuretic effect. (In Western herbal, Kuth essential oil is not prescribed internally.)Kuth roots contain resinoids (6%), and essential oil (1.5%), alkaloid (0.05%) inulin (18%), saussurea lactone (20-25%), a fixed oil and minor constituents like tannin and sugars. Roots obtained from Kashmir are, in general, richer in essential oil content than roots obtained from Garhwal and Nepal. The roots of Punjab variety gave cos- tunolide, dehydrocostuslactone, costic acid, palmitic and linoleic acids, beta- sitosterol and alpha-cyclocostunolide. The Kashmir variety, in addition, gave alantolactone, beta-cyclocostunolide and iso-alantolactone.The essential oil of the roots exhibit strong antiseptic and disinfectant activity against Streptococcus and Staphy- lococcus.Costus speciosus Sm. synonym Banksea speciosa, also known as Kush- tha, is a different herb of Zingiberaceae family. Rhizomes and stems yield dios- genin.Dosage: Root—0.2-1.0 g powder. (API, Vol. I.)... saussurea lappaHabitat: Tropical India up to an altitude of 360 m.
English: Nux vomica.Ayurvedic: Kapilu, Kaakatin- duka, Kaakendu, Kaakapiluka, Vishamushtikaa, Vishamushti, Vishatinduka, Kuchilaa, Ksuchalaa.Unani: Azaraaqi, Kuchlaa.Siddha: Yettikkottai.Action: Nervine tonic and a potent CNS stimulant.
Seeds—used in emotional disorders, insomnia, hysteria, epilepsy, paralytic and neurological affections, retention or nocturnal incontinence of urine, spermatorrhoea, sexual debility and impotence, general exhaustion; as antidote to alcoholism; GIT disorders. Bark—juice given in acute dysentery, diarrhoea and colic. Root—given in intermittent fevers. In Chinese medicine a paste made of Nux vomica seeds is applied topically for treating facial paralysis.Included among unapproved herbs by German Commission E.The Ayurvedic Pharmacopoeia ofIn- dia recommends detoxified seeds in paralysis, facial paralysis, sciatica and impotency.The seeds contain indole alkaloids, the major one is strychnine (approx. 50% of the alkaloids); others include strychnine N-oxide, brucine and its N-oxide, alpha-and beta-colubrine, condylocarpine, diaboline, geissoschi- zine, icajine, isostrychnine, normacu- sine, novacine, pseudobrucine, pseu- do-alpha-colubrine, pseudo-beta-col- ubrine, pseudostrychnine and vom- icine (3-hydro-beta-colubrine). Loga- nin is also present. Pseudostrychnine is non-toxic. The alkaloidal content of the seeds ranges from 1.8 to 5.3%.The leaves contain strychnine and brucine (together 1.6%), strychnine 0.025%; vomicine is the major constituent of leaves. The bark contains 9.9% total alkaloids (brucine 8%, strychnine 1.58%); pseudostrychnine, pseudobrucine and beta-colubrine in small amounts. The roots contain 0.99% alkaloids (brucine 0.28%, strychnine 0.71%).Strychnine, when tested for an- tiulcer activity in shay rat model at a dose of 0.25 mg/kg body weight, complete absence of ulceration was observed which was comparable to cime- tidine. Exhausted Nux-vomica powder at a dose of 20 mg/kg body weight, and brucine at a dose of 0.25 mg/kg body weight gave protection similar to strychnine.Orally, 30-50 mg Nux-vomica (5 mg strychnine) is toxic.Dosage: Detoxified seed—60- 125 mg. (API, Vol. IV.)... strychnos nux-vomicaWithout treatment, noma causes severe ulceration, eventual destruction of the bones around the mouth, and loss of teeth. Healing occurs naturally, but scarring may be severe.
Antibacterial drugs and improved nutrition halt the progress of the disease.... noma
(See also gingivitis, acute ulcerative.)... vincent’s disease
Others appear under their appropriate alphabetical headings: ACNE; ALBINISM; ALOPECIA; ALOPECIA AREATA; APHTHOUS ULCER; BASAL CELL CARCINOMA; BOILS (FURUNCULOSIS); BOWEN’S DISEASE; CALLOSITIES; CANDIDA; CHEILOSIS; CHEIRAPOMPHOLYX; DANDRUFF; DERMATOFIBROMA; DERMATOMYOSITIS; DERMATOPHYTES; DERMOGRAPHISM; ECTHYMA; ERYSIPELAS; ERYTHEMA; ERYTHRASMA; ERYTHRODERMA; ESCHAR; EXANTHEM; FUNGAL AND YEAST INFECTIONS; HAND, FOOT AND MOUTH DISEASE; HERPES GENITALIS; HERPES SIMPLEX; HERPES ZOSTER; IMPETIGO; INTERTRIGO; KELOID; KERATOSIS; LARVA MIGRANS; LICHEN; LUPUS; MADURA FOOT; MELANOMA; MILIARIA; MOLLUSCUM CONTAGIOSUM; MOLE; MYCOSIS FUNGOIDES; NAEVUS; ORF; PEDICULOSIS; PEMPHIGUS; PHOTOCHEMOTHERAPY; PHOTODERMATOSES; PITYRIASIS; PORPHYRIAS; PRURITUS; PSORIASIS; RINGWORM; ROSACEA; SARCOIDOSIS; SCABIES; SCLERODERMA; URTICARIA; VITILIGO; WARTS; XANTHOMATA.
Skin cancer Primary cancer is common and chronic exposure to ultraviolet light is the most important cause. BASAL CELL CARCINOMA is the most common form; squamous cell carcinoma is less common and presents as a growing, usually painless nodule which may ulcerate. Squamous cancer may spread to regional lymph glands and metastasise, unlike basal cell cancer. Occupational exposure to chemical carcinogens may cause squamous carcinoma – for example, cancer from pitch warts or the scrotal carcinoma of chimney sweeps exposed to coal dust in earlier centuries. Squamous carcinoma of the lip is associated with clay-pipe smoking.
Cancer may arise from the population of melanocytes of the skin (see MELANOCYTE; MELANOMA).
Apart from these three most frequent forms of skin cancer, various forms of cancer can arise from cells of the dermis, of which LYMPHOMA is the most important (see also MYCOSIS FUNGOIDES).
Lastly, secondary deposits from internal cancer, particularly from the breast, may metastasise to the skin.
Dermatitis and eczema These are broadly synonymous, and the terms are frequently interchangeable. Eczema is a pattern of in?ammation with many potential causes. Dermatitis is commonly used to suggest an eczema caused by external factors; it is a common pattern of in?ammation of the skin characterised by redness and swelling, vesiculation (see VESICLE), and scaling with intense itching and often exudation (weeping). Fissuring, thickening (licheni?cation – see LICHEN) and secondary bacterial infection may follow. Dermatitis can affect any part of the body. It may be genetically detemined or due to other ‘internal’ factors, such as venous HYPERTENSION in a leg, or stress. Often it is ‘external’ in origin – due to strong irritants or chemical allergens. (See also ALLERGY; ALLERGEN.) ATOPIC DERMATITIS is genetic in origin and usually begins in infancy. It may persist for years, and ASTHMA, allergic RHINITIS and conjunctivitis (see under EYE, DISORDERS OF) – ‘hay fever’ – may be associated. Atopic children tend to have multiple allergies, especially to inhaled allergens such as house-dust mite, cat and dog dander and pollens. Allergy to foods is less common but potentially more dangerous, especially if to nuts, when it can cause acute URTICARIA or even ANAPHYLAXIS. Atopic subjects are particularly prone to persistent and multiple verrucae (see WARTS) and mollusca (see MOLLUSCUM CONTAGIOSUM) and to severe HERPES SIMPLEX infections. (See also ATOPY.)
EXFOLIATE DERMATITIS (PITYRIASIS RUBRA)
Generalised exfoliation and scaling of the skin, commonly with ERYTHEMA. Drugs may cause it, or the disorder may be linked with other skin diseases such as benign dermatoses and lupus erythematosus (see under LUPUS). SUMMER POMPHOLYX is an acute vesicular eczema of the palms and soles recurring every summer. Inhaled allergens are a frequent cause. VENOUS (STASIS) DERMATITIS begins on a lower calf, often in association with PURPURA, swelling and sometimes ulceration. Chronic venous hypertension in the leg, consequent on valvular incompetence in the deep leg veins owing to previous deep vein thrombosis (see VEINS, DISEASES OF), is the usual cause. NEURODERMATITIS A pattern of well-de?ned plaques of licheni?ed eczema particularly seen on the neck, ulnar forearms or sides of the calves in subjects under emotional stress. IRRITANT CONTACT DERMATITIS Most often seen in an industrial setting (occupational dermatitis), it is due to damage by strong chemicals such as cutting oils, cement, detergents and solvents. In almost all cases the hands are most severely affected. ALLERGIC CONTACT DERMATITIS, in contrast, can affect any part of the body depending on the cause – for example, the face (cosmetics), hands (plants, occupational allergens) or soles (rubber boots). Particularly common allergens include metals (nickel and chromate), rubber addititives, and adhesives (epoxy resins).
Treatment Avoidance of irritants and contact allergens, liberal use of EMOLLIENTS, and topical application of corticosteroid creams and ointments (see CORTICOSTEROIDS) are central.... skin, diseases of
The tumours are cancerous, but of a slow-growing type.
If possible, they are removed surgically.
Proton pump inhibitor drugs are given to treat the ulcers.... zollinger–ellison syndrome
Treatment Drying of the feet overnight, where practicable, is the best method of prevention, accompanied by avoidance of constrictive clothing and tight boots, and of prolonged immobility. Frequent rest periods and daily changing of socks also help. The application of silicone grease once a day is another useful preventive measure. In the early stages, treatment consists of rest in bed and warmth; in more severe cases treatment is as for infected tissues and ulceration. ANALGESICS are usually necessary to ease the pain. Technically, smoking should be forbidden, but the adverse psychological effects of this in troops on active service may outweigh its advantages.... trench foot
The drugs used in combination are:
The receptor antagonists, which reduce the output of gastric acid by histamine H2receptor blockade; they include CIMETIDINE, FAMOTIDINE and RANITIDINE.
ANTIBIOTICS to eradicate Helicobacter pylori infection, a major cause of peptic ulceration. They are usually used in combination with one of the PROTON-PUMP INHIBITORS and include clarithomycin, amoxacillin and metronidazole.
BISMUTH chelates.
The prostaglandin analogue misoprostol has antisecretory and protective properties.
Proton-pump inhibitors omeprazole, lansoprazole, pantaprazole and rabeprazole, all of which inhibit gastric-acid secretion by blocking the proton pump enzyme system.... ulcer healing drugs
Habitat: The North Western Himalayas.
English: Himalayan Elm. Slippery Elm is equated with Ulmus fulva.Folk: Hemar, Kitamaara.Action: Bark—astringent, demulcent, emollient, expectorant, diuretic.
The bark contains 0.76% tannins. Ulmus fulva Michx, though known as Indian or Sweet Elm, is an American plant and does not occur in India.Powdered bark of Ulmus fulva gives a mucilage, composed of galactose, 3- methyl galactose, rhamnose and galac- turonic acid residues. As a gruel it is prescribed for patients with gastric or duodenal ulcers. Coarse powdered bark is applied as poultice to burns and skin eruptions.The mucilages cause reflex stimulation of nerve endings in the GI tract and lead to mucous secretion which protects the GI tract against ulceration and excess acidity. (Natural Medicines Comprehensive Database, 2007.)... ulmus wallichianaSymptoms The ?rst, or catarrhal, stage is characterised by mild, but non-speci?c, symptoms of sneezing, conjunctivitis (see under EYE, DISORDERS OF), sore throat, mild fever and cough. Lasting 10–14 days, this stage is the most infectious; unfortunately it is almost impossible to make a de?nite clinical diagnosis, although analysis of a nasal swab may con?rm a suspected case. This is followed by the second, or paroxysmal, stage with irregular bouts of coughing, often prolonged, and typically more severe at night. Each paroxysm consists of a succession of short sharp coughs, increasing in speed and duration, and ending in a deep, crowing inspiration, often with a characteristic ‘whoop’. Vomiting is common after the last paroxysm of a series. Lasting 2–4 weeks, this stage is the most dangerous, with the greatest risk of complications. These may include PNEUMONIA and partial collapse of the lungs, and ?ts may be induced by cerebral ANOXIA. Less severe complications caused by the stress of coughing include minor bleeding around the eyes, ulceration under the tongue, HERNIA and PROLAPSE of the rectum. Mortality is greatest in the ?rst year of life, particularly among neonates – infants up to four weeks old. Nearly all patients with whooping-cough recover after a few weeks, with a lasting IMMUNITY. Very severe cases may leave structural changes in the lungs, such as EMPHYSEMA, with a permanent shortness of breath or liability to ASTHMA.
Treatment Antibiotics, such as ERYTHROMYCIN or TETRACYCLINES, may be helpful if given during the catarrhal stage – largely in preventing spread to brothers and sisters – but are of no use during the paroxysmal stage. Cough suppressants are not always helpful unless given in high (and therefore potentially narcotic) doses, and skilled nursing may be required to maintain nutrition, particularly if the disease is prolonged, with frequent vomiting.... whooping-cough
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
Constituents: coumarins, tannins, flavonoids, phytosterol.
Action: diuretic, hepatic, astringent (mild), haemostatic, vulnerary, cholagogue, Promotes assimilation of food. Bitter tonic.
Uses: weak acid stomach, indigestion, sluggish liver and debility, gall bladder disorders, nosebleed, sore throat, laryngitis (gargle), bed-wetting, incontinence, diarrhoea, to promote flow of gastric juices.
Local: ulceration – to cleanse and heal. Ancient remedy for suppurating sores and wounds.
Preparations: Thrice daily.
Tea: 1 teaspoon to each cup boiling water. Or, as part of Spring Tonic combination: equal parts, Agrimony, Raspberry leaves, Balm and Nettles. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely.
Liquid extract: BHP (1983). 1:1 in 25 per cent alcohol. Dose 15-45 drops (1-3ml). Tincture: BHP (1983). 1:5 in 45 per cent alcohol. Dose 15-60 drops (1-4ml). Tablets. Agrimony (Blackmore’s Labs). ... agrimony
Action. Bactericidal against staphylococcus aureus, streptococcus viridans and five strains of streptococcus mutans – the cause of dental plaque. Antibiotic, Demulcent, Coagulant, Analgesic for mild degree pain. Antiviral.
Astringent, Vitamin B12 precursor, growth stimulator, vulnerary. Contains 18 amino acids and vitamins. Helps eliminate toxic minerals from the body. Neutralises free radicals created by toxic substances.
Uses: An important use: protection against radiation burns. Sunburn. A segment of the fresh leaf rubbed on the skin was a centuries-old sun-screen used by desert Arabs against sunburn, and who regarded the plant as a natural medicine chest. Internal: indigestion, stomach ulceration.
External. Ulceration (leg ulcer, etc.), acne, chapped skin, nappy rash. To allay the itching of dry skin conditions including shingles, eczema, poison ivy and other plant allergies, detergent dermatitis, ulcers on cornea of eye, purulent ophthalmia. Dry scalp, poor hair (shampoo), ringworm. Stretch marks of pregnancy, age lines and liver spots.
Dentistry. “In 12 years of dental practice I have not found any one item which is so versatile for the healing needs of the mouth . . . an ancient plant for modern dentistry”. (Dr B. Wolfe, “Health Consciousness”, Vol 6. No 1) Increasing use as a dental anaesthetic, and for oral infections. Uses include gel on new dentures, rinsing every 4 hours. In canal filling the gel is used as a lubricant.
Combines with Vitamin E for allergies; with Eucalyptus oil for sinus and nasal congestion; with Comfrey for healing of fractures. Combines with Jojoba oil as an invigorating body lotion. Combines with Chamomile or Henna for hair conditioner.
Preparations: Part of fresh leaf cut and thick sap-juice squeezed on affected area for sunburn, burns, injury, wounds. Pulp leaves for use as a poultice for inflamed joints, arthritis. (East Africa). Tablets: Combined with papaya, pineapple, apricot or acerola fruits.
Tincture: 4oz pulped leaf to 8oz Vodka. Shake bottle daily for one week. Filter. Dosage: 1 teaspoon in water, thrice daily, for internal conditions.
Aloe gel. Many preparations on the market contain pure Aloe Vera, cold-pressed to preserve its moisturising and healing properties. Most are free from artificial fragrance and colour being made without lanolin or mineral oil.
Undiluted juice. 1-2 tablespoons (20-40ml) on empty stomach. (Internal) Pregnancy. Not used during. ... aloe vera
Habitat: Throughout North India, rather scarce in South India.
English: Fire-flame Bush, Shiran- jitea.Ayurvedic: Dhaataki, Dhaatri, Kun- jaraa, Taamrapushpi, Bahupushpi, Vahnijwaalaa.Siddha/Tamil: Velakkai.Action: Dried flower—purifies blood, heals ulcers, astringent, prescribed in haemetemesis, erysipelas, dysentery, diarrhoea, menorrhagia, leucorrhoea. Flowers are used in alcohol-based tonics for fermentation (a yeast strain, saccharomyces cerevisiae, has been isolated). Bark—uterine sedative.
The Ayurvedic Pharmacopoeia ofIn- dia recommends the flower in acute diarrhoea, haemorrhages, ulcerations and erysipelas.The dried flowers are powdered and sprinkled over ulcers and wounds. The flowers also enter into an ointment used on pustules of smallpox.In small doses the plant stimulates, while in large doses depresses the central nervous system.The flowers and leaves gave polyphe- nols—ellagic acid, polystachoside and myricetin-3-galactoside. Flowers also gave anthocyanins—pelargonidin- 3,5-diglucoside and cyanidin-3,5-di- glucoside; octacosanol, chrysopha- nol-8-O-beta-D-glucopyranoside and beta-sitosterol. Hecogenin, mesoinos- itol and flavone glycosides—quercetin- 3-rhamnoside, naringenin-7-glucoside and kaempferol, have been reported from flowers.The bark contains C-glucoside, ber- genin.The flowers, leaves and bark contain tannins—24.1, 12-20 and 20-27% respectively. Dimeric hydrolyzable tannins—woodfordins A, B and C, and trimeric tannins woodfordin D and oenothein A and B have been isoalt- ed from dried flowers. A new tannin monomer, isoschimawalin A and five oligomers—woodfordin E, F, G, H and I, have also been isoalted.Oenothein A and B exhibited remarkable host-mediated antitumour activity. Woodfordin C and D also showed antitumour activity. Woodfordin C showed inhibitory activity toward DNA topoisomerase II.Dosage: Flower—3-6 g powder. (API, Vol. I.)English: Pala Indigo Plant.Ayurvedic: Shveta Kutaja. (white- flowered), Punkutaja, Indrayava (seeds).Unani: Inderjao Shireen.Siddha/Tamil: Irum-paalai, Nila- paalai.Action: Bark—antidysenteric. Also used in piles and skin diseases. Seeds—antidysenteric, astringent, febrifuge, anthelmintic. Bark and seeds—prescribed in flatulence and bilious affections.
Pods, without seeds, contain the cycloartanes, cycloartenone and cy- cloeucalenol along with alpha- and beta-amyrin, beta-sitosterol, ursolic acid, oleanolic acid and the terpene, wrightial. The leaves contain beta- amyrin. Stem bark gave beta-amyrin, beta-sitosterol and lupeol.The seeds, leaves and roots have been shown to contain an indigo- yielding glucoside.The flowers gave 3-O-rhamnogluco- side which exhibited significant anti- inflammatory activity in carrageenan- induced hind paw oedema.The bark is commonly used as an adulterant of Kurchi Bark (obtained from Holarrhena antidysenterica).... woodfordia fruticosaAction. Diffusive circulatory stimulant, Deobstruent, Tonic. Astringent (local). Diaphoretic (in hot infusion). Bactericidal, Spermatocidal.
Uses: Mucous colitis, diarrhoea. Congestive catarrhal conditions of mucous membranes. Leucorrhoea, prolapse of the womb. Tuberculosis diathesis. To stimulate a sluggish circulation. Colds and fevers to promote sweating. Nasal polypi (powdered bark snuff). Bleeding from lungs, stomach and bowels. Candidiasis (douche). Leg ulcers (dusting powder). Diphtheria (local application to throat).
An essential ingredient of Dr Thomson’s Composition powder. Combination: with Turkey Rhubarb, Goldenseal, Slippery Elm or Fenugreek seeds for chronic stomach/intestine disorders and irritable bowel syndrome.
Preparations: Thrice daily.
Decoction: 1 teaspoon powdered bark to each cup water; remove vessel when boiling point is reached: dose, quarter to half a cup.
Liquid extract BHP (1983). 1:1 in 45 per cent alcohol: dose, 0.6-2ml. Powdered bark, dose 0.6-2g.
Poultices, powdered bark for ulceration.
Peerless Composition Essence (Potter’s). Ingredient. ... bayberry bark
Symptoms. Vulva or penis swollen and itching. Neuritis of the eye with possible ensuing blindness. A specific disease unrelated to herpes simplex which it resembles. There is no evidence that it is venereal. Basic pathology is inflammation of the veins, arteries and capillaries (Nettles). Thrombosis is possible (Hawthorn).
Treatment. Tea. (1) Nettles. Or (2): place half an ounce Burdock root in 1 pint water; simmer gently 20 minutes: Add 1oz Nettles. Allow to steep for further 15 minutes. Dose: 1 cup thrice daily.
Tablets/capsules. Kelp, Echinacea, Blue Flag.
Tinctures. Combine Echinacea 2; Goldenseal three-quarters; Myrrh quarter. Dose: 1-2 teaspoons in water thrice daily.
Practitioner. Tincture Colchicum BP 1973.
Topical. Bathe with dilute cider vinegar. Cold tea. Garlic ointment. Tea Tree oil diluted many times. Houseleek.
Eyedrops. Goldenseal eyedrops.
Diet. Avoid hot peppery foods, fried foods.
Low-salt. Regular raw food days.
Supplementation. Vitamin E: 500-1000iu daily. Vitamin B-complex. Calcium and Magnesium. Avoid: scented soap, talcum powder, wool (alternatives: cotton briefs, open gusset tights). Information: Bechet’s Syndrome Society, 3 Belgrave Street, Haxby Road, York Y03 7YY. ... bechet’s disease
Prevention is best. Wipe over possible areas with whisky or Vodka following with Oil of St John’s Wort. Bed patients are encouraged to spend at least 2 or 3 hours out of bed daily. Many kinds of bed-care aids exist: inflatable rings, water beds and padded protection. Vitamin C deficiency exists in most cases. Treatment. Herbal antibiotics: Wild Indigo, Myrrh, Milk Thistle, Goldenseal, Echinacea, Marigold. Supportives: Comfrey, Sarsaparilla, Vitamin E.
Tablets/capsules. Goldenseal, Echinacea, Sarsaparilla.
Powders. Parts: Echinacea 2; Goldenseal 1; Liquorice 1. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Tinctures. Wild Indigo 1; Echinacea 2; Goldenseal quarter. 1-2 teaspoons in water 3 times daily. Practitioner. Tincture Echinacea BHP (1983) 20ml; Tincture Goldenseal BPC (1949) 5ml; Tincture Marigold BPC (1934) 10ml. Low alcohol vodka to 100ml. Sig: 5ml (3i) tds aq. cal. AC. (Anonymous) Topical. Early stages: Comfrey poultice or ointment. Marshmallow and Slippery Elm ointment; Oil St John’s Wort, Rue tea. Fresh pulp of Aloe Vera. Later stages: Sunlight soap plaster. Official medicine at the turn of the century used Lassar’s paste or zinc and castor oil ointment which are still effective. Distilled extract of Witch Hazel. For threatened gangrene, skin breakdown with formation of slough: (1) Zinc and Castor oil ointment (or cream) plus a little powdered Myrrh. (2) Cold poultice of Comfrey powder. ... bedsores
Symptoms. Intermittent claudication. Affected parts of the leg are much paler than others, the condition regressing to ulceration and possible gangrene. Inflammation of nerves, veins and arteries may lead to clot formation (thrombosis).
Treatment. Stop smoking. Vasodilator herbs.
Alternatives. Cayenne (minute doses), Bayberry, Lime flowers, Lobelia, Prickly Ash, Wahoo bark, Mistletoe, Skullcap, Cactus.
BHP (1983) recommends: Angelica root, Hawthorn berry, Wild Yam.
Decoction. Formula. Equal parts: Hawthorn, Mistletoe, Valerian. 2 teaspoons to two cups water gently simmered 10 minutes. Dose half-1 cup thrice daily, and when necessary.
Tablets/capsules. Alternatives. Prickly Ash 100mg. Hawthorn 200mg. Wild Yam 200mg. Dosage as on bottles.
Powders. Formula. Equal parts: Hawthorn, Wild Yam, Prickly Ash. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Tinctures. Formula. Equal parts: Bayberry, Hawthorn, Prickly Ash. Dose: 1-2 teaspoons thrice daily. Practitioner. Tincture Gelsemium BPC (1973). 0.3ml (5 drops) when necessary for relief of pain.
Diet. Low fat, low salt, high fibre.
Supplements. Daily. Vitamin E 1000-1500iu. Vitamin B-complex. Magnesium, Calcium.
Exercise. Physiotherapy exercise. From the sitting position raise legs to horizontal; rest for a few minutes. Lie down and raise legs to 45 degrees; rest for a few minutes. Reverse movements resting each time to equalise the circulation. (Brenda Cooke FNIMH) ... buerger’s disease
Constituents: allantoin, pyrrolizidine alkaloids (fresh young leaves and roots), mucilage, phenolic acids, steroidal saponins (root).
Action: astringent-demulcent, haemostatic, vulnerary. Rapid healer of flesh and bones by its property to accelerate mitosis (cell-division). Useful wherever a mucilaginous tissue restorative is required (repairing broken bones and lacerated flesh), especially in combination with Slippery Elm powder which prevents excess fluidity.
Uses: Ulceration anywhere along the gastrointestinal tract; colitis, hiatus hernia.
Bleeding from stomach, throat, bowel, bladder and lungs (haemoptysis) in which it reduces blood clotting time. Once used extensively for tuberculosis (pulmonary and elsewhere). Irritating cough, ‘dry’ lung complaints; pleurisy. Increases expectoration. Should not be given for oedematous conditions of the lungs.
Bones – fractures: to promote formation of a callus; rickets, wasting disease. Skin – varicose ulcers and indolent irritating sores that refuse to heal. Promotes suppuration of boils and gangrene as in diabetes. Bruises. STD skin lesions, internally and externally. Blood sugar control: assists function of the pancreas. Urine: scalding. Rheumatoid arthritis: improvement reported. Malignancy: cases of complete regression of sarcoma and carcinoma recorded. Rodent ulcer, (as a paste).
Preparations: thrice daily.
Tea: dried herb, one heaped teaspoon to each cup; or, 1oz to 1 pint boiling water; infuse 15 minutes, half- 1 cup for no more than 8 weeks.
Tincture (leaf). 1 part to 5 parts alcohol: dose 2.5-5ml. Maximum weekly dosage – 100ml for no more than 8 weeks.
Tincture (root). 1 part to 5 parts alcohol. Maximum weekly dosage – 80ml, for 8 weeks.
(National Institute of Medical Herbalists)
Poultice. A mucilage is prepared from fresh root in a liquidiser or by use of a rolling pin. For sprains, bruises, severe cuts, cleaning-out old ulcers and wounds.
Compress. 3 tablespoons crushed root or powder in 1 pint (500ml) water. Bring to boil; simmer gently 10 minutes. Saturate linen or suitable material and apply. Renew 2-3 times daily as moisture dries off. Ointment. 1 part powder, or liquid extract, to 10 parts base (cooking fat, Vaseline, etc).
Oil (external use). Ingredients: powdered Comfrey root in peanut oil and natural chlorophyll. (Henry Doubleday Research Association)
Notes. Contains trace element germanium, often given for cancer and arthritis. (Dr Uta Sandra Goodman) Helps eliminate toxic minerals. Neutralises free radicals that are created by toxic substances entering the body. Restores the body’s pH balance disturbed by highly acid foods such as meat, dairy products, refined foods and alcohol.
Dr H.E. Kirschner, well-known American physician, reported being called to the bedside of a patient with a huge advanced cancer of the breast. The odour was over-powering and the condition hopeless, but he advised poultices of fresh crushed Comfrey leaves several times daily to the discharging mass. Much to the surprise of all, the vile odour disappeared. The huge sore scaled over and the swelling subsided. Within three weeks the once-malignant sore was covered with a healthy scale and the pain disappeared. Unfortunately, treatment came too late; metastases had appeared in the liver which could not be reached by the poultices.
Claims that Comfrey is a toxic plant are unsubstantiated by a mass of clinical evidence to the contrary. Attempts to equate the effects of its isolated compounds apart from the whole plant yield conflicting results. For thousands of years the plant has been used by ancient and modern civilisations for healing purposes. Risks must be balanced with benefits.
There is a growing body of opinion to support the belief that a herb which has, without ill-effects been used for centuries and capable of producing convincing results is to be recognised as safe and effective.
Experiments reveal that in sufficient doses Comfrey can cause liver disease in laboratory animals. Its risk to humans has been a matter of serious debate since the 1960s, and is still unresolved. Although the overall risk is very low, a restriction has been placed on the plant as a precautionary measure. Fresh Comfrey leaves should not be used as a vegetable which is believed to be a health risk. It is believed that no toxicity has been found in common Comfrey (Symphytum officinale L). No restriction has been placed on use of dried Comfrey leaves as a tea. The debate continues.
It would appear that use of the root of Symphytum officinale may be justified in the treatment of severe bone diseases for which it has achieved a measure of success in the past, such as rickets, Paget’s disease, fractured bones, tuberculosis, etc, its benefits outweighing risks. Few other medicinal plants replenish wasted bone cells with the speed of Comfrey. (external use only) ... comfrey
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