Sept 2606

BOT MED – September 26, 2006 Need to know’s from the monographs: - latin name, family name, part used, constituent (will vary) actions (his exam, not NPLEX)  know circles as well as a few from western/tcm, dosage (unusual dosage, toxicity, important interactions (empirical)  actions & indications should fit together then look at constituents Artemisia Absinthium (wormwood) - bitter, helps with depression, lifts you up to another level Wild Indigo - used as an antiseptic King’s American Dispensatory - eclectic that has been used to create monographs Hoffman CH 21 pg 441 - clear holistic chapter on immune system and immune herbs What is the immune system? - where self meets non self - relationship that allows everything to flourish and be in harmony with it’s neighbors - immunity is about harmony - ex) patient who had a fear of living in a hostile environment  had effects on her immune system – if she was unaware it would not affect her; main problem was her fear, if she conquered this she would have been better - Immunity is proportional to the degree which we are in harmony between ourselves and our environment (nature) - The body responds to positive emotions and positive responses and this can be seen in our humoral immunity  changes can be seen in our immune responses (changes which are being measured in our DNA) - Immunity is the way which we protect ourselves from micro-organisms (pathogenic & non-pathogenic  we are in a symbiotic relationship with these) - Ex) candida albicans  non pathogenic but are becoming pathogenic (in excessive numbers; use anti-fungal/anti-bacterial to kill these organisms) ND’s want to find out where the imbalance began and how to fix it. - How is it that symbiotic plants become pathogenic? Immune system is overload by new chemicals, substances in environment, use of disinfectants, pesticides, anti-microbial, which creates added levels of pathogenesis - Look at PNI higher levels of physical/emotional stress, decreased levels of immunity  polypeptides have a profound effect on how our immune system works (no part of us is separated from any other) How do we use phytotherapy in our immune system? - traditions of herbal use  majority come from TCM 1

- origin was from culture that looked at them as having energetic power Why do we use Herbs for the Immune system? - goal is to support immune system for most balanced and flexible function in both health and disease - Balance = you can develop Abs to pathogenic organism that develops a disease but stops just short so that you don’t become allergic to that pathogen - Ex) ragweed  doesn’t cause disease in a person, but if you have strong allergic rxn it can kill you if you are asthmatic (if you don’t get Tx fast enough); ability on immune system to detect b/w self and non self Terminology Immunostimulants / Immunopotentiators – a herb that will increase the function of the immune system very quickly in a way that will not last. Ex) Echinacea  boosts the immune system but doesn’t trigger immune memory cells, doesn’t create lasting memory of organism, allows you to create better defense, fight the infection and then move on Immunomodulation / Immunoregulation - trying to improve responsiveness of immune system (up-regulate/down-regulate) in a way that can be perpetuated, create optimum function in a way that can be sustained (all of the functions) in a way that doesn’t exhaust the immune system  if you don’t have precision you get allergies and auto-immune diseases Ex) Astragalus – used to treat auto-immune diseases (self-tissue) and allergies Hobbs 1. Deep Immune activation / immunomodulation / immune stimulator – more equivalent to immunomodulation – balancing effect, works against autoimmunity, allergies, can be used indefinitely as long as formula is balanced and monitored (ex. Don’t want to over heat a person with warming herbs) 2. Surface Immune activation stimulation / immunostimulants – local and systemic immunostimulants, anti-microbials & boosting immune function, limiting power of microbe 3. Adaptogenic – has an effect on hormonal systems. Ex) Chinese herbs have effect on KI essence/energy  adrenal function – most useful when immune system is exhausted, more prone to illness, inability to relax 4. Debility or Chronic Fatigue – common problem – How much energy do you have? (scale of 1-10), pts are so tired they just can’t go on 5. Relevance of the herb in question Astragalus m.  1,3,4,5 (useful in treatment of cancer, increases efficacy of western cancer treatment, decreases number of chemotherapy treatments/ frequency) Codonopsis p. 3,4 Ganoderma l. 1,2,3,5

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Case #6 Otitis media – inflammation in response to something (most commonly food allergies – cow’s milk products or wheat)  leads to Eustachian tube being closed. Fluid can no long escape to pharynx. May have difficulty with hearing (a lot of discomfort)  may lead to having a ruptured eardrum. - lymph nodes have become fibrosed (harder) - sign of recurrent infections - obstructed nasal airway, along with accumulations of phlegm - think about probiotics  bowel flora - Astragalus (1st choice) - Codonopsis (2nd Choice) – qi tonic – vitalizing effect, Shen Qi Da Du long - Ganoderma lucidum (3rd choice) super herb, sacred Case #7 - patient was counseled on how to have balance in her life - Borago officinalis (1st choice), supports + attitude, adrenal restorative - Glycyrrhiza (2nd choice), adrenocorticotrophic, antiviral - Schisandra (3rd choice) 5 flavoured herb - Astragalus & Codonopsis  Adaptogens Case #8 - tomb essence = ability to have erections (not enough blood. Atherosclerosis) - impotence doesn’t occur in men who have nocturnal erections - KI essence declines with age as does our ability to pro-create - Need to strengthen KI essence and rejuvenate the adrenals - Panax ginseng (1st choice) - Schisandra (2nd choice) 5 flavoured herb - Withania somnifera (3rd choice) used in Ayurvedic medicine - Eleutherococcus senticosus (4th choice) - Panax notoginseng

BOT MED - October 3, 2006 Biliary & Heptic Herbs (Liver & GB) -

Milk thistle & dandelion (extremely effective in repairing defective LIVER) Liver is the place where lipids are metabolized CHOL & bile acids are important ones as well as EFA Liver is responsible for the formation of bile Unusual organ that is homogenous Organization is done in such a way that every single cell gets blood from hepatic artery and drains both bile and blood This allows liver to regenerate itself if part of it is damaged Transports bilirubin, wastes, toxins and drugs; also produces a variety of proteins (transportation of minerals, conjugation) Herbs are effective for all liver conditions

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ACTIONS OF HEPATIC HERBS: 1) Hepatoprotective: role is to protect & restore the functioning of the individual hepatocyte Ex) Silybum marianum (milk thistle) – principle characteristic - flavoligans - hepatotoxic chemicals: alcohol, peroxidated foods, fungus on plants, toxins - Carbon tetrachloride – toxic to liver 1. Reduce excess of toxins in cells interior 2. Accelerate protein synthesis to regenerate hepatocytes 3. Potentiate phase I & II detoxification pathways (potentiate enzymes for carcinogenic changes) 2) Choleretic: herb which increases the excretion of bile (amount of bile production is increased per hepatocyte), increases body’s ability to detoxify provided that everything else in the body is in order (ie. Bowel is functional) 3) Cholagogue: Stimulates contraction of the gall bladder (bile is stored here); when we have a fatty meal, bile is squirted into the SI to emulsify fats and get them into the portal system (results in more bile) 4) Anti-infective: Need to protect liver against disease, bacterial infection 5) Anti-cancer CONDITIONS THAT CAN BE TREATED: 1. -

Overactive, Overburdened “Toxic” liver: need to eliminate toxic products from the body using the liver (waste material) best way to help organs of elimination is to decrease toxicity foods that are easily digested, put less demand on liver Liver enzymes in blood help with hepatotoxicity, when liver is damaged, there is an increased amount of these enzymes in the blood stream (can be detected in blood tests) Herbs that can improve metabolic rate and efficacy of toxins will be helpful Hep C  make cells more resistant to the virus If the person is willing to eat live-whole foods (organic foods); still metabolizing at the time you eat them; if eaten in moderation reduce the amount of elimination in the body and are very helpful

2. Fatty Liver - condition where liver deposits fat in its own cells; excess of certain type of fat which isn’t good for the body or when ppl eat more CHO than we can burn we lay down fat in the liver - excess CHO reduces the efficiency of the liver

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3. Chronic Hepatitis - chronic inflammation of the liver (liver can’t eliminate so it chronically becomes inflamed) - TCM  heat in the liver; tongue which is more red- in the beginning the edges then the whole tongue eventually  may look like a piece of liver (RED), may have yellow or brownish coat; as you heat body fluids they turn darker  when toxifying orangish coats develops; pt also has a wiry pulse (inflammation or toxicity in some organ) - Longdan (Chinese herb) – increases bile flow 4. Viral Hepatitis - infection Hep B/C which causes damaged to liver & results in cirrhosis (scarring of tissue); results in gangrene of the liver  predisposes liver to cancer (common sequelae) - Licorice excellent herb for this – maintains equilibrium - Cannot detect through enzymes need to take a liver biopsy to detect this 5. Cirrhosis - response to inflammation (ie. From a viral infection, response to alcohol consumption) - use heptaprotective to delay process 6. Cancer of the liver - use to stents to open up pathways (usual Tx) – liver cancer can be controlled - Use of medicinal mushrooms  maintain or reduce tumor size to the point where it is no longer a threat 7. Jaundice - excess bilirubin in the bloodstream; as it builds up in blood person turns yellow - noticed first in sclera of eye; then in face and on skin and ppl become visibly yellow - result of: overload of bilirubin caused by hemolysis (give wrong drug to someone b/c liver can’t cope), obstruction of bile flow (caused by stone or calculus lodged in common bile duct causing bile to back up and bilirubin to be absorbed in blood) 8. Cholecystitis - inflammation of bile duct and GB - can sometimes occlude the bile duct 9. Cholelithiasis - Calculi or stones in the gallbladder (gallstones) - In obstruction of bile duct  do not want increased amounts of bile - If a person has an obstruction of bile ducts they will be in a lot of pain - Pain is relieved as stone is passed 5

- can reduce the size of a gall stone by increasing the flow of bile (regular flow of bile through bile duct and GB) ex) olive oil regulates bile flow 1tbsp /day - gall stone = result of stagnant bile -

don’t use when there is blockage  cholagogues & choleretics

10. Hemorrhoids - Toxicity/ constipation & build up of toxins in the circulatory system around the blood vessels of the anus which leads to inflammation GET CASES FROM SITE!

BOT MED - October 10, 2006 BITTERS & BOWEL REGULATORS Bitter herbs: bitter tasting herbs; tonifying effect on the digestive system ex) Atermesia (wormwood  Chernoble) – extreme negativity attached to herb (bitters in general); Ruta graveolens  extreme negativity – rue the dead; extreme sense of regret that we did something - bitter herbs are essential for normal function - milder bitters (dandelion – leaves); yarrow - bitter drinks  liquers  vermouth (martini) - bitter principles: monoterpenes, irridoids, sesqiterpenes, alkaloids - cause the release of gastrin with stimulates release of pepsin & HCl; which aids with digestion of protein in the stomach - we have over 1000 taste buds in groups of 50 (bitter, sweet, sour, pungent, spicy) - Shisandra has all 5 flavours - Sapid - Bitters also go to the pancrease, GB, SI (pancreatic juice, bile juice) - Stimulation of appetite, raising of the spirit, release of digestive enzymes (digestive stimulant) - Supports the liver in detoxification - Cholegogue – increases bile flow - Angelica arc angelica – sacred herb – excellent herb for digestion - Regulate release of pancreatic hormones – insulin & glucagon - Watch out may have too much insulin if you have bitters (decrease amount of insulin) - Beneficial effects on heart, circulation and consciousness - Gentiana Lutea – tonify consciousness - Contraindications: o Pregnancy: tonics  can improve muscle contraction o Peptic ulcers: increases HCl secretion (burning sensation & exacerbate ulcer condition)

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o GERD: (Gastro-Esophageal Reflex Disease) – problems with acid; acid regurgitation o KI & GB stones: causes spasms o Hiatus Hernia: (top of stomach comes through hiatus in diaphragm caused by pressure  shortening of the esophagus  pulls top of stomach through hiatus. * almost always starts with irritation of the esophagus) pg 499 HOFFMANN list of bitter herbs

GI REGULATORS - laxatives – many words to des - mildest level = depurative: helps combat impurity; helps body detoxify - laxative: increases bowel activity - purgative: something that purges “cleans out” everything in your intestine; empties your stomach ex) cascara segrada “sacred bark” ramnus purshiana – empty digestive tract before setting out on a vision quest; enabled people to go for many days without having a bowel movement (reduction of metabolic activity allows person to go on spiritual quest without disturbance) - cathartic: just one big push – gets rid of whatever is causing the problem Irritable Bowel Syndrome: colon is irritable; more bowel activity then one wants; also at times constipation; has the urge to go but nothing comes out  intestine system that controls the plexus but interferes with digestion - neurological – linked to emotions & stressful situations that upset regulation - not associated with inflammation Inflammatory Bowel Disease: - ulcerative colitis, crohn’s disease, chronically inflamed bowels (does not count b/c removing foods will remove the problem) - in UC & crohn’s removing foods will not resolve the problem - Some people just suffer from sensitivity rxns and not the disorders - State of bowel flora: if it has been upset (antibiotics), may have chronic inflammation which will lead to mucus and blood in the stool  there is more than one way to inflame the bowel Chronic diarrhea – transit time is reduced; difficult for person to resorb water from the stool to turn it into formed stool  results in dehydration; removes electrolytes from the body; lose a lot of your bowel flora Constipation: 1)Increases toxicity, bowel flora changes and becomes over mature and organisms begin to grow; toxins are re-absorbed into blood and you have to process them a second time; 2)like a compost heap  BOWEL FLORA – must have a balance 3) will cause local damage  inflammation in colon & rectum (eating foods that are irritating), possibility of affecting adjacent organs (prostates & uterus  remove toxic stagnation); keep in mind blood flow to digestive system FIBER 7

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shortens transit time; delays gastric emptying (make sure you have sufficient absorption in ST), increases satiety, evens out blood sugar levels, increases weight of the stools, increases microflora in the intestines  everything is being turned into bacteria bodies *good*, increases production of SCFA (short chain FA), decreases serum lipid

LAXATIVES & PURGATIVES 1) retention of fluid, increase bulk and softness (stool isn’t as dry and hard) - osmotic laxatives based on insoluble sugars – lubricate stool 2) works on GI mucosa 3) Antraquinones – herbs which contain chemicals that increase intestinal motility; CI where you don’t want increased muscle contractions (gall stones, kidney stones, pregnancy), reduce transit time and water and salt retention Bulking & swelling agents  pectins & cellulose Insoluble – grains and seed husks, seaweeds, hemicellulose, seaweed – attract water & salt, bind bile & attract pro-biotics Osmotic agents – mannose not absorb, mannose sorbitol non-absorbable (used to sweeten things when ppl don’t want to lose weight) Antra-quinone – Senna (cassia – leaves & pods)  strongest of the laxatives – powerful purgative and cathartic – habiforming – muscles work less and less well Tannins – astringents; have the opposite effect (can make constipation worse- important to realize this) Aloe- aloe vera – 2 plants in one; jelly in leaves = demulcent – laxative due to mucopolysaccharide component; bitter aloes used to prevent nail biting (juice) Excess use of antra-quinone laxatives: Pseudomelanosis – lining of colon & rectum has become pigmented (brown or black); pre-cursor to cancer; discolouration of the urine (orange-red); breast milk can cause symptoms in children Castor Oil: castor bean plant = very poisonous & deadly (red flowers); ricin (extract of castor bean) one of the most potent chemicals  If the oil is extracted properly it is very beneficial as a herbal remedy - amazing remedy when used on the skin: pulls toxins out of the body and promotes healing (scar tissue)  castor oil packs - laxative  works on pancreatic enzymes in body takes ricin and causes water and salt retention – bulking agent; also an increase in peristaltic activity Aperient: like a depurative; very mild laxative Case #18: 8

1) 2) 3) 4)

5) 6)

OA is connected to the emotions; stress Connection with the idea of being overwhelmed- beneficial to do some counseling Digestive  person is not getting nutrients they need, muscles & joints are weak Low self esteem – harder to nourish ourselves – not worthy to be nourished Inflammation from toxins & the gut  produces a lot of toxic by-products (ex. Candida – very toxic – when organisms are dying you feel sick) Toxins are stored in joints CLUE in the case is poor digestive function if diagnosis of OA is correct Menyanthes trifoliate – excellent anti-arthritic, anti-inflamm, bitter, (excellent digestive herb), anti-arthritic 1-4ml/ 3x a day Gentiana Lutea – pure bitter herb (stimulates digestions), treats causes & symptoms; used as a bitter 10 drops in a bit of water sipped (plenty to stimulate digestion); big meal 40 or more drops to restart process of digestion Atemesia vulgaris (good alternative) Centaurium erythraea (good alternative)  good for people with fear of acting also a flower essence, increases person’s confidence in decision making; helps those who have a hard time saying No and try to please others, hard to balance one’s own needs Black cohosh – good for heavy tensive pain (no matter what is causing it); used in rheumatism and arthritis (buck bean, celery seed and black cohosh) pain in lumbar region of the body Filapendula & Glyzzheriza- slows down breakdown of corticosteroids (antiinflammatory) extra herbs

OUTCOMES: Strengthens digestion, better appetite, reversal of OA Case #17: - Laxatives - Hard dry stools – lubrication would be helpful – mucilaginous & slippery (mineral oil = common treatment) - Flax seeds (best when the are ground – rancid though b/c oil is oxidized) & psyllium husks and seeds (can accumulate in colon if not enough water) - Emotional aspect of constipation also quite significant (overwhelmed, child doesn’t know what to do- holds everything in) 1) -

Rhubarb root (Rheum spp.) – treat the symptoms sometimes called elephant ears laxative (antraquinone), Astringent (tannins) habit forming – constipation with long term use gentle purgative useful in young children; constipation when bowel muscles are weak - tea or decoction in small doses (tsp); can add it to grape use to disguise taste 2) Aloe vera gel – demulcent and moistening; do not use aloe juice on child but can use pharmaceutical preparations - softer stools with relief of constipation

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Treating the causes: - check the water intake of the child - check the fiber content of his diet; should be able to eat fiber rich food - check diet in general (could be the cause of the problem) - check the child’s attitude towards their body; are they being given enough privacy?? How much pressure is the child being put under to become toilet trained? - Attitude of the parents Case #19: - folic acid (need it in order to ensure that the neural tube closes properly, want to have it in place during the first few weeks of pregnancy or eat many green leafy vegetables and fruits) - need a laxative avoid antraquinone containing herbs b/c they stimulate muscle contraction and may precipitate a miscarriage - bulk forming & lubricating laxatives also water retaining - also increase insoluble and soluble fiber intake - SIDE EFFECT OF CONSTIPATION during pregnancy: toxicity and hemorrhoids (less room in pelvis, feel need to strain pelvis, can pop a hemorrhoid during bowel movt) 1) Rumex crispus – “yellow duck”; has only a small amount of antraquinones - 1-4 ml of tincture, 3x/day or ½ cup of tea; decoction would also work  treats both cause & symptoms - Organic iron source b/c it is iron rich (Flurodex also good) - Ameliorate constipation - Make sure not to OVERDOSE b/c on antraquinones 2) Aloe vera gel: 1-3 tbsp daily- loosens & moistens stools - Psyllium  insoluble and soluble fibers Case #16 - poor digestion is a sign of odiferous gas  things haven’t been broken down (pancreatic, bile and stomach juices) - putrifies in small intestine (protein & rotten flesh)  smell like dead animal - when eggs are digested sulfurous smell (garlic) - pass gas because things are fermenting - swallowing things prematurely  digestive juices not informed – important in people with no teeth to pre-digest their food (break it town) & swish it around in your mouth before swallowing it (stimulate taste buds) - Bitters will help this patient - digestive process has been slowed down - glutamic HCl helps patient’s digestion as well (weak digestive function associated with Type A blood type)  HCl challenge: eat pills until warm feeling in stomach then back off one pill to assist with digestive function 10

1) Gentiana lutea (Yellow gentian) 2) Atemesia vulgare 3) Centaurium ertythrea 4) Strychnos nux vomica – Therapeutic index is fairly wide; tonic, bitter & nervous system stimulant  dose carefully b/c they may forget the dosage – take precaution* CI – don’t use for hyperacidity 5) Glycerrhiza – good for treating symptoms; gastritis, peptic ulcer, good for GERD Case # 20 - been constipated for 20 years & has never had a spontaneous bowel movement - habituated to cascara (emotionally dependent more than physically) - stick with regimen because it wasn’t doing her any harm - antraquiones irritate colan and cause pseudomelanosis and possibly cancer - talk about water intake, fiber intake & good diet - most likely a psychological dependency - probably would have become more constipated on milder laxatives - possible hyperkalemia - Restore function of the colon - Colon irrigation therapy: running water onto colon through instrument- low pressure system- run water into rectum & goes into colon and when patient is ready remove water – good system for removing fecal matter (can restore tone & rhythmicity w/out getting into psycho-spiritual aspects) / massage colon Recommendations: 1) maintain current regimen 2) talked about what she was on and how they work

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