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Urinary incontinence is unintentional loss of urine that is sufficient enough in frequency and amount to cause physical and/or emotional distress in the person experiencing it.

Approximately 13 million Americans suffer from urinary incontinence. Women are affected by the disorder more frequently than are men; one in 10 women under age 65 suffers from urinary incontinence.

A study published in late 2002 found that between 21% and 29% of adult women in the workforce reported at least one potongan of urinary incontinence each month. Older Americans, too, are more prone to the condition. Twenty percent of Americans over age 65 are incontinent. In general, the condition is underrecognized and undertreated.


There are five major categories of urinary incontinence: overflow, stress, urge, functional, and reflex:

• Overflow incontinence. Overflow incontinence is caused by bladder dysfunction. Individuals with this type of incontinence have an obstruction to the bladder or urethra, or a bladder that doesn’t contract properly. As a result, their bladders do not empty completely, and they have problems with frequent urine leakage.
• Stress incontinence. Stress incontinence occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (i.e., during exercise, sexual activity, sneezing, coughing, laughing, or hugging).
• Urge incontinence. Urge incontinence occurs when a person feels a sudden need to urinate and cannot control the urge to do so. As a consequence, urine is involuntarily lost before the individual can get to the toilet.
• Functional incontinence. Individuals who have control over their own urination and have a fully functioning urinary tract, but cannot make it to the bathroom in time due to a physical or cognitive disability, are functionally incontinent. These individuals may suffer from arthritis, Parkinson’s disease, multiple sclerosis,or Alzheimer’s disease.
• Reflex incontinence. Individuals with reflex incontinence lose control of their bladder without warning. They typically suffer from neurological impairment.

In some cases, an individual may develop short-term or acute incontinence. Acute incontinence may occur as a symptom or byproduct of illness, as a side effect of medication, or as a result of dietary intake. The condition is typically easily resolved once the cause is determined and addressed.

Causes and symptoms

Urinary incontinence can be caused by a wide variety of physical conditions, including:

• Childbirth. Childbirth can stretch the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence.
• Dysfunction of the bladder and/or the urinary sphincter. In a continent individual, as the bladder contracts, the outlet that releases urine into the urethra (bladder sphincter) opens and urine exits the body. In individuals with overflow incontinence, bladder contractions and dilation of the sphincter do not occur at the same time.
• Enlarged prostate. In men, an enlarged prostate gland can obstruct the bladder, causing overflow incontinence.
• Hysterectomy or other gynecological surgery. Any surgery involving the urogenital tract runs the risk of damaging or weakening the pelvic muscles and causing incontinence.
• Menopause. The absence of estrogen in the postmenopausal woman can cause the bladder to drop, or prolapse.
• Neurological conditions. The nervous system sends signals to the bladder telling it when to start and stop emptying. When the nervous system is impaired, incontinence may result. Neurological conditions such as multiple sclerosis, stroke, spinal cord injuries, or a brain tumor may cause the bladder to contract involuntarily, expelling urine without warning, or to cease contractions completely, causing urinary retention.
• Obesity. Persons who are overweight have undue pressure placed on their bladder and surrounding muscles.
• Obstruction. A blockage at the bladder outlet may permit only small amounts of urine to pass, resulting in urine retention and subsequent overflow incontinence. Tumors, calculi, and scar tissue can all block the flow of urine. A urethral stricture, or narrow urethra caused by scarring or inflammation, may also result in urine retention.

Acute incontinence is a temporary condition caused by a number of factors, including:

• Bladder irritants. Substances in the urine that irritate the bladder may cause the bladder muscle to malfunction. The presence of a urinary tract infection and the ingestion of excess caffeine can act as irritants. Highly concentrated urine resulting from low fluid intake may also irritate the bladder.
• Constipation. Constipation can cause incontinence in some individuals. Stool that isn’t passed presses against the bladder and urethra, triggering urine leakage.
• Illness or disease. Diabetes can greatly increase urine volume, making some individuals prone to incontinence. Other illnesses may temporarily impair the ability to recognize and control the urge to urinate, or to reach the toilet in time to do so.
• Medications and alcohol. Medications that sedate, such as tranquilizers and sleeping pills, can interfere with the proper functioning of the urethral nerves and bladder. Both sedatives and alcohol can also impair an individual’s ability to recognize the need to urinate, and act on that need in a timely manner. Other medications such as diuretics, muscle relaxants, and blood pressure medication can also affect bladder function.
• Surgery. Men who undergo prostate surgery can suffer from temporary stress incontinence as a result of damage to the urethral outlet.

Diagnosis

Urinary incontinence may be diagnosed by a general practitioner, urologist, or gynecologist. If the patient is over age 65, a gerontologist may diagnose and treat the condition.

A thorough medical history and physical examination is typically performed, along with specific diagnostic testing to determine the cause of the incontinence. Diagnostic testing may include x rays, ultrasound, urine tests, and a physical examination of the pelvis.

It may also include a series of exams that measure bladder pressure and capacity and the urinary flow (urodynamic testing). The patient may also be asked to keep a diary to record urine output, frequency, and any episodes of incontinence over a period of several days or a week.

Treatment

Adjusting dietary habits and avoiding acidic and spicy foods, alcohol, caffeine, and other bladder irritants can help to prevent urinary leaking. The patient should eat recommended amounts of whole grains, fruits, and vegetables to avoid constipation.

Bladder training, used to treat urge incontinence, can also be a useful treatment tool. The technique involves placing a patient on a toileting schedule. The time interval between urination is then gradually increased until an acceptable time period between bathroom breaks is consistently achieved.

Therapies designed to strengthen the pelvic muscles are also recommended for the treatment of urinary incontinence. Pelvic toning exercises, known as Kegel or PC muscle exercises, can alleviate stress incontinence in both men and women. These exercises involve repeatedly tightening the muscles of the pelvic floor.

Biofeedback techniques can teach incontinent patients to control the urge to urinate. Biofeedback uses sensors to monitor temperature and muscle contractions in the vagina to help incontinent patients learn to increase their control over the pelvic muscles.

An infusion, or tea, of horsetail (Equisetum arvense), agrimony (Agrimonia eupatoria), and sweet sumac (Rhus aromatica) may be prescribed by an herbalist or naturopath to treat stress and urge incontinence. These herbs are natural astringents and encourage toning of the digestive and urinary tracts.

Other herbs, such as urtica or stinging nettle (Urtica urens), plantain (Plantago major), or maize (Zea mays) may be helpful. Homeopathic remedies may include pulsatilla and causticum. Chinese herbalists might recommend golden lock tea, a mixture of several herbs that helps the body retain fluids.

Urinary incontinence infographic

Allopathic treatment

There are numerous invasive and noninvasive treatment options for urinary incontinence:

• Behavior modification therapy. Behavior modification is a psychological approach to the treatment of urinary incontinence in which patients gradually increase the length of the time interval between voidings and “retrain” the bladder in other ways. It is reported to be highly effective in treating urge incontinence.
• Collagen injections. Collagen injected in the tissue surrounding the urethra can provide urethral support for women suffering from stress incontinence.
• External occlusive devices. A new single-use disposable urethral cap is available without a prescription as of late 2002 for women suffering from stress urinary incontinence. The cap is noninvasive and appears to be quite effective in managing incontinence.
• Inflatable urethral insert. Sold under the tradename Reliance, this disposable incontinence balloon for women is inserted into the urethra and inflated to prevent urine leakage.
• Intermittent urinary catheterization. This procedure involves the The periodic insertion of a catheter into a patient’s bladder to drain urine from the bladder into an attached bag or container.
• Medication. Estrogen hormone replacement therapy can help improve pelvic muscle tone in postmenopausal women. Other medications, including flurbiprofen, capsaicin and botulinum toxin, are sometimes prescribed to relax the bladder muscles or to tighten the urethral sphincter. As of late 2002, newer medications for the treatment of urinary incontinence are undergoing clinical trials. One of these drugs, duloxetine, differs from present medications in targeting the central nervous system’s control of the urge to urinate rather than the smooth muscle of the bladder itself.
• Perineal stimulation. Perineal stimulation is used to treat stress incontinence. The treatment uses a probe to deliver a painless electrical current to the perineal area muscles. The current tones the muscle by contracting it.
• Permanent catheterization. A permanent, or indwelling, catheter may be prescribed for chronic incontinence that doesn’t respond to other treatments.
• Sacral nerve stimulation (SNS). Also known as sacral neuromodulation, SNS is a procedure in which a surgeon implants a device that sends continuous stimulation to the sacral nerves that control the urinary sphincter. The FDA approved sacral nerve stimulation for the treatment of urinary urge incontinence in 1997 and for urinary frequency in 1999.
• Surgery. Bladder neck suspension surgery is used to correct female urinary stress incontinence. Bladder enlargement surgery may be recommended to treat incontinent men and women with unusually small bladders.
• Urinary sphincter implant. An artificial urinary sphincter may be used to treat incontinence in men and women with urinary sphincter impairment.
• Vaginal inserts. Devices constructed of silicone or other pliable materials can be inserted into a woman’s vagina to support the urethra.

Expected results

Left untreated, incontinence can cause physical and emotional upheaval. Individuals with long-term incontinence suffer from urinary tract infections, and skin rashes and sores. Incontinence can also affect their self-esteem and cause depression and social withdrawal.

They frequently stop participating in physical activities they once enjoyed because of the risk of embarrassing “accidents.” However, with the wide variety of treatment options for incontinence available today, the prognosis for incontinent patients is promising. If incontinence cannot be stopped, it can be improved in the majority of cases.

Prevention

Women who are pregnant or who have gone through childbirth can reduce their risk for stress incontinence by strengthening their perineal area muscles with Kegel exercises. Men who have undergone prostate surgery may also benefit from pelvic muscle exercises. Men and women should consult with their doctor before initiating any type of exercise program.

Unani-tibbi

Unani-tibbi denotes Arabic or Islamic medicine, also known as prophetic medicine. It traditionally makes use of a variety of techniques including diet, herbal treatments, manipulative therapies, and surgery. Unani-tibbi is a complete system, encompassing all aspects and all fields of medical care, from nutrition and hygiene to psychiatric treatment.

Origins

The name unani-tibbi is something of a misnomer, as literally translated from the Arabic, it means Greek medicine. This is because the early Arab physicians took their basic knowledge from the Greeks.

At the time, Greek medical knowledge was the best to be had, particularly from Galen, the renowned second-century Greek physician who treated the gladiators and Emperor Marcus Aurelius.


However, from that point onwards, Islamic medical scholars were responsible for many developments and advancements that, at the time, placed Arabic medicine firmly in the vanguard of medical science.

There followed a steady stream of Muslim medical scholars, who not only upheld the high standards that came to be known of unani-tibbi, but carried on adding to and improving the basic pool of knowledge.

Some notable scholars of the science of unani-tibbi include:

• Al Tabbari (838–870)
• Al Razi (Rhazes) (841–926)
• Al Zahrawi (930–1013)
• Ibn Al Haitham (960–1040)
• Ibn Sina (Avicenna), (980–1037)
• Ibn Al Nafees (1213–1288)
• Ibn Khaldun (1332–1395)

Medical innovations introduced by unani-tibbi physicians included:

• Avicenna was the first to describe meningitis, so accurately and in such detail, that it has scarcely required additions after 1,000 years.
• Avicenna was the first to describe intubation (surgical procedure to facilitate breathing)—Western physicians began to use this method at the end of the eighteenth century.
• The use of plaster of Paris for fractures by the Arabs was standard practice—it was “rediscovered” in the West in 1852.
• Surgery was used by the Arabs to correct cataracts.
• Ibn Al Nafees discovered pulmonary blood circulation.
• A strict system of licensing for medical practitioners was introduced in Baghdad in 931, which included taking the Hippocratic oath, and specific periods of training for doctors.
• There was a system of inspection of drugs and pharmaceuticals—the equivalent of the Federal Drug Administration (FDA)—in Baghdad 1,000 years ago.
• The European system of medicine was based on the Arabic system, and even as recently as the early nineteenth century, students at the Sorbonne had to read the canon of Avicenna as a condition to graduating.
• Unani-tibbi hospitals were, from the beginning, free to all without discrimination on the basis of religion, sex, ethnicity, or social status.
• Their hospitals allocated different wards for each classification of disease.
• Hospitals had unlimited water supplies and bathing facilities.
• Before the advent of the printing press, there were extensive handwritten libraries in Baghdad, (80,000 volumes), Cordova, (600,000 volumes), Cairo, (two million volumes), and Tripoli, (three million volumes).
• All Unani-tibbi hospitals kept patient records.
• A hospital was established for lepers.
• In 830, nurses were brought from Sudan to work in the Qayrawan hospital in Tunisia.
• A system of fountain-cooled air was devised for the comfort of patients suffering from fever.
• Avicenna described the contamination of the body by “foreign bodies” prior to infection, and Ibn Khatima also described how “minute bodies” enter the body and cause disease—well in advance of Pasteur’s discovery of microbes.
• Al Razi was the first to describe smallpox and measles. He was accurate to such a degree that nothing has been added since.
• Avicenna described tuberculosis as being a communicable disease.
• Avicenna devised the concept of anesthetics. The Arabs developed a “soporific sponge,” (impregnated with aromatics and narcotics and held under the patient’s nose), which preceded modern anesthesia.
• The Arab surgeon, Al Zahrawi was the first to describe hemophilia.
• Al Zahrawi was also the first surgeon in history to use cotton, which is an Arabic word, as surgical dressings for the control of hemorrhage.
• Avicenna accurately described surgical treatment of cancer, saying that the excision must be radical and remove all diseased tissue, including amputation and the removal of veins running in the direction of the tumor. He also recommended cautery of the area if needed. This observation is relevant even today.
• Avicenna, Al Razi, and others formed a medical association for the purpose of holding conferences so that the latest developments and advancements in the field of medicine could be debated and passed on to others.

Benefits

What began as an advanced medical system that set world standards, has now come to be regarded as a system of folk medicine. This decline coincided with the decline of the Islamic Empire and the dissolution of the caliphate (spiritual head of Islam), as these were directly responsible for the direction and impetus of Islamic scientific scholars in all fields.

Unani-tibbi practitioners still treat people with herbal remedies and manipulation, for a variety of illnesses. In the Islamic world, many of the poorer people who cannot afford allopathic medicine still resort to this traditional medicine.

There are also people who prefer unani-tibbi to allopathic medicine, as indeed, the traditional unani-tibbi remedies do not bring with them the side effects commonly experienced with allopathic drugs.

Description

Similar to Greek humoral theory, unani-tibbi considers the whole human being, spiritual, emotional, and physical. Basic to the theory is the concept of the “four humors.” These are Dum (blood), Bulghum (phlegm), Sufra (yellow bile), and Sauda (black bile). Each is further categorized as being hot and moist (blood), cold and moist (phlegm), hot and dry (yellow bile), and cold and dry (black bile).

Every individual has his/her own unique profile of humors, which must be maintained in harmony to preserve health. If the body becomes weak, and this harmony is disrupted, a physician can be called upon to help restore the balance.

This restoration may be done using correct diet and nutrition and/or the unani-tibbi system of botanical therapy, cupping, bleeding, manipulation, and massage, among others, as treatments for all disease and ailments. Herbs or substances used to treat a patient will be matched to his humor type.

Unani-tibbi employs a detailed system of diagnosis, including observation of urine and stools, palpation of the body and pulse, and observation of the skin and eyes.

It also employs a system of prophylactics in order to preserve health and ward off disease. This includes the adherance to strict hygiene rules, protection of air, food and water from contamination or pollution, sufficient rest and exercise, and attention to spiritual needs. Certain herbs are also taken on a prophylactic basis, such as black cumin and sage.

In general, unani-tibbi treatment is not expensive, and it is certainly less expensive than allopathic medicine. However, charges vary according to area and practitioner. Fees should be discussed with a practitioner before treatment begins.

Preparations

Remedies are often provided by the practitioner or are obtained from a specialized herbalist. The ingredients are mainly herbs and honey. It must be noted that the honey used will be raw and unadulterated, rather than the type found in supermarkets, which is usually heat-treated.

A famous and widely used medicinal herb is black cumin (Nigella sativa), also known as Hab Al Baraka in Arabic, which means blessed seed. Black cumin has been cultivated since Assyrian times and it is beneficial for a very long list of ailments.

It is widely mixed with other herbs for greater beneficial effect and is said to strengthen the immune system when taken over a period of time. Research has proved that it has the ability to slow the division of cancer cells.

Precautions

The achievements of the unani-tibbi practitioners of today bear little resemblance to those of their illustrious predecessors, and some of those claiming to practice traditional medicine are woefully ill-equipped to practice.

However, many Arab and Muslim doctors, after qualifying in allopathic medicine, are still treating their patients with traditional remedies and are taking the trouble to educate themselves in this ancient art.

In India, where Islamic medicine is primarily known as unani-tibbi, the government has set up a Central Council for Research in Unani Medicine (CCRUM), which also has a licensing system for these traditional practitioners.

In the Arab countries, it is known as tibb-nabawi, or prophetic medicine, and mainly utilizes herbal remedies, honey, and other bee products.

Side effects

There are no known side effects of this form of treatment.

Research and general acceptance

The herbal remedies employed by unani-tibbi are chosen for their non-toxicity and absence of side effects.

Although unani-tibbi has not been the subject of a great deal of research by modern-day scientists, it still enjoys great popularity in Muslim countries. The records left by Islamic medical scholars become more remarkable in the light of modern medicine, when their achievements and theories still hold their own next to the latest in medical technology.

The CCRUM in India is conducting research into aspects of unani-tibbi that are likely to be of particular benefit to modern society. To cite one example, an examination of the substances that were originally used as safe forms of contraception, with none of the side effects of present-day chemical contraception.

Training and certification

There are two classifications of practitioners of unani-tibbi. There are the simple folk practitioners, dispensers of herbal remedies and so on, and the highly qualified doctors and scholars who are still conducting research.

Research is currently being conducted at the King Abdul Azeez University in Riyadh, Saudi Arabia, and the Sultan Qaboos University in Oman, among others, into the efficacy of traditional herbal remedies.

The CCRUM in India issues licenses to unani-tibbi practitioners and provides funds for research.

Digestive Ulcers

An ulcer is an eroded area of skin or mucous membrane. In common usage, however, ulcer usually refers to disorders in the upper digestive tract. The terms ulcer, gastric ulcer, and peptic ulcer are often used interchangeably.

Peptic ulcers can develop in the lower part of the esophagus, the stomach, the first part of the small intestine (the duodenum), and the second part of the small intestine (the jejunum).

It is estimated that 2% of the adult population in the United States has active digestive ulcers, and that about 10% will develop ulcers at some point in their lives. There are about 500,000 new cases in the United States every year, with as many as 4 million recurrences. The male/female ratio for digestive ulcers is 3:1.


The most common forms of digestive ulcer are duodenal and gastric. About 80% of all digestive ulcers are duodenal ulcers. This type of ulcer may strike people in any age group but is most common in males between the ages of 20 and 45. The incidence of duodenal ulcers has dropped over the past 30 years. Gastric ulcers account for about 16% of digestive ulcers.

They are most common in males between the ages of 55 and 70. The most common cause of gastric ulcers is the use of nonsteroidal anti-inflammatory drugs, or NSAIDs. The current widespread use of NSAIDs is thought to explain why the incidence of gastric ulcers in the United States is rising.

Causes and symptoms

Causes of ulcers

There are three major causes of digestive ulcers: infection; certain medications; and disorders that cause oversecretion of stomach juices.

HELICOBACTER PYLORI INFECTION. Helicobacter pylori is a bacterium that lives in the mucous tissues that line the digestive tract. Infection with H. pylori is the most common cause of duodenal ulcers. About 95% of patients with duodenal ulcers are infected with H. pylori, as opposed to only 70% of patients with gastric ulcers. USE OF NONSTEROIDAL ANTI-INFLAMMATORY

DRUGS (NSAIDS). Nonsteroidal anti-inflammatory drugs, or NSAIDs, are painkillers that many people use for headaches, sore muscles, arthritis, and menstrual cramps. Many NSAIDs are available without prescriptions. Common NSAIDs include aspirin, ibuprofen (Advil, Motrin), flurbiprofen (Ansaid, Ocufen), ketoprofen (Orudis), and indomethacin (Indacin).

Chronic NSAID users have 40 times the risk of developing a gastric ulcer as nonusers. Users are also three times more likely than nonusers to develop bleeding or fatal complications of ulcers. Aspirin is the most likely NSAID to cause ulcers.

Other Risk Factors

• Hypersecretory syndromes, including Zollinger-Ellison syndrome, secrete excessive amounts of digestive juices into the digestive tract. Fewer than 5% of digestive ulcers are due to these disorders.
• Smoking increases a patient’s chance of developing an ulcer, decreases the body’s response to therapy, and increases the chances of dying from complications.
• Blood type. Persons with type A blood are more likely to have gastric ulcers, while those with type O are more likely to develop duodenal ulcers.
• Attitudes toward stress, rather than the presence of stress, puts one at risk for ulcers.
• Having a critical illness. Patients who are very sick are at increased risk of developing stress-related ulcers.

The consumption of high-fat or spicy foods is not a significant risk factor.

Symptoms

Not all digestive ulcers produce symptoms; as many as 20% of ulcer patients have so-called painless or silent ulcers. Silent ulcers occur most frequently in the elderly and in chronic NSAID users.

The symptoms of gastric ulcers include feelings of indigestion and heartburn, weight loss, and repeated episodes of gastrointestinal bleeding. Ulcer pain is often described as gnawing, dull, aching, or resembling hunger pangs. The patient may be nauseated and suffer loss of appetite.

About 30% of patients with gastric ulcers are awakened by pain at night. Many patients have periods of chronic ulcer pain alternating with symptom-free periods that last for several weeks or months. This characteristic is called periodicity.

The symptoms of duodenal ulcers include heartburn, stomach pain relieved by eating or taking antacids, weight gain, and a burning sensation at the back of the throat. The patient is most likely to feel discomfort two to four hours after meals, or after having citrus juice, coffee, or aspirin.

About 50% of patients with duodenal ulcers awake during the night with pain, usually between midnight and 3 A.M. A regular pattern of ulcer pain associated with certain periods of day or night or a time interval after meals is called rhythmicity.

Foods that make ulcers worse

Complications

Between 10%–20% of peptic ulcer patients develop complications at some time during the course of their illness. All of these are potentially serious conditions. Complications are not always preceded by diagnosis of or treatment for ulcers; as many as 60% of patients with complications have not had prior symptoms.

Bleeding is the most common complication of ulcers. It may result in anemia, vomiting blood, or the passage of bright red blood through the rectum. The mortality rate from ulcer hemorrhage is 6-10%.

About 5% of ulcer patients develop perforations, which are holes through which the stomach contents can leak out into the abdominal cavity. The incidence of perforation is rising because of the increased use of NSAIDs, particularly among the elderly.

The signs of an ulcer perforation are severe pain, fever, and tenderness when the doctor touches the abdomen. Most cases of perforation require emergency surgery. The mortality rate is about 5%.

Ulcer penetration is a complication in which the ulcer erodes through the intestinal wall without digestive fluid leaking into the abdomen. Instead, the ulcer penetrates into an adjoining organ, such as the pancreas or liver. The signs of penetration are more severe pain without rhythmicity or periodicity, and the spread of the pain to the lower back.

Obstruction of the stomach outlet occurs in about 2% of ulcer patients. It is caused by swelling or scar tissue formation that narrows the opening between the stomach and the duodenum (the pylorus). Over 90% of patients with obstruction have recurrent vomiting of partly digested or undigested food; 20% are seriously dehydrated.

Diagnosis

Physical examination and patient history

The diagnosis of peptic ulcers is rarely made on the basis of a physical examination alone. The only significant finding may be mild soreness in the area over the stomach when the doctor presses (palpates) it. The doctor is more likely to suspect an ulcer if the patient has one or more of the following risk factors:

• member of the male sex
• age over 45
• recent weight loss, bleeding, recurrent vomiting, jaundice, back pain, or anemia
• history of using aspirin or other NSAIDs
• history of heavy smoking
• family history of ulcers or stomach cancer

Endoscopy and imaging studies

An endoscopy is considered the best procedure for diagnosing ulcers and taking tissue samples. An endoscope is a slender tube-shaped instrument used to view the tissues lining the stomach and duodenum. If the ulcer is in the stomach, then a tissue sample will be taken because 3-5% of gastric ulcers are cancerous.

Duodenal ulcers are rarely cancerous. Radiological studies are sometimes used instead of endoscopy because they are less expensive, more comfortable for the patient, and are 85% accurate in detecting cancer.

Laboratory tests

Blood tests usually give normal results in ulcer patients without complications. They are useful, however, in evaluating anemia from a bleeding ulcer or a high white cell count from perforation or penetration. Serum gastrin levels can be used to screen for Zollinger-Ellison syndrome.

It is important to test for H. pylori because almost all ulcer patients who are not taking NSAIDs are infected. Noninvasive tests include blood tests for immune response and a breath test. In the breath test, the patient is given an oral dose of radiolabeled urea.

If H. pylori is present, it will react with the urea and the patient will exhale radiolabeled carbon dioxide. Invasive tests for H. pylori include tissue biopsies and cultures performed from fluid obtained by endoscopy.

Treatment

Alternative treatments can relieve symptoms and promote healing of ulcers. A primary goal of these treatments is to rebalance the stomach’s hydrochloric acid output and to enhance the mucosal lining of the stomach.

Food allergies have been considered a major cause of stomach ulcers. An elimination/challenge diet can help identify the allergenic food(s) and continued elimination of these foods can assist in healing the ulcer.

Ulcer patients should avoid aspirin, stop smoking, avoid antacids, and reduce stress. Dietary changes include avoidance of sugar, caffeine, and alcohol, and reducing milk intake.

Supplements

Dietary supplements that help to control ulcer symptoms include:

• vitamin A
• B-complex vitamins
• vitamin C
• vitamin E
• glutamine
• rice bran oil (gamma oryzanol)
• selenium
• deglycyrrhizinated licorice (DGL)
• zinc picolinate

Herbals

Botanical medicine offers the following remedies that may help treat ulcers:

• Bilberry (Vaccinium myrtillus): heals ulcers.
• Cabbage: heals ulcers.
• Calendula (Calendula officinalis): heals duodenal ulcers.
• Chamomile tea: speeds healing, reduces mucosal reaction, reduces stress, and lessens gas.
• Comfrey (Symphytum officinale) root: soothes the stomach, lessens bleeding, and speeds healing, however, the patient must take caution, in that prolonged or excessive use can be harmful to the liver.
• Geranium (Pelargonium odoratissimum): lessens bleeding.
• Licorice (Glycyrrhiza glabra): heals ulcers.
• Marsh mallow (Althaea officinalis) root: soothes the stomach.
• Meadowsweet: soothes the stomach.
• Plantain (Plantago major): soothes the stomach.
• Slippery elm (Ulmus fulva): lessens bleeding and heals mucous membrane.
• Wheat grass (Triticum aestivum): heals ulcers.

Chinese medicines

Chinese herbal treatment principles are based upon specific groups of symptoms. Chinese patent medicines are also based upon specific symptoms and include:

• Wu Bei San (cuttlefish bone and fritillaria): acid reflux and bleeding
• Wu Shao San (cuttlefish bone and paeonia): acid reflux and bleeding
• Liang Fu Wan (galangal and cyperus pill): pain
• 204 Wei Tong Pian (204 epigastric pain tablet): pain, acid reflux, and bleeding
• Xi Lei San (tin-like powder): ulcer with tarry stool

Other treatments

Other treatments for ulcers are:

• Essence therapy. Dandelion essence can help reduce tension, and pink yarrow essence can help the patient distinguish between his or her problems and those of others.
• Reflexology. For ulcers, the practitioner work the solar plexus and stomach points on the feet and the solar plexus, stomach, and top of shoulder points on the hands.
• Biofeedback. Thermal biofeedback can help protect and heal the stomach.
• Sound therapy. Music with a slow, steady beat can promote relaxation and reduce stress.
• Ayurveda. Ayurvedic treatment is individualized to each patient but common ulcer remedies include: aloe vera natural gel, arrowroot powder with hot milk, and tea prepared from cumin, coriander, and fennel seeds.
• Acupuncture. Ulcers can be treated using target points for stress, anxiety, and stomach problems.
• Relaxation techniques. Stress reduction and involvement in stress management programs may help relieve ulcer symptoms.

Allopathic treatment

Medications

Most drugs that are used to treat ulcers work by either lowering the rate of stomach acid secretion or protecting the mucous tissues that line the digestive tract.

Medications that lower the rate of stomach acid secretions fall into two major categories: proton pump inhibitors and H2 receptor antagonists.

The proton pump inhibitors, which have been in use since the early 1990s, include omeprazole (Prilosec) and lansoprazole (Prevacid). The H2 receptor antagonists include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid).

Drugs that protect the stomach tissues are sucralfate (Carafate), bismuth preparations, and misoprostol (Cytotec).

Most doctors presently recommend treatment to eliminate H. pylori to prevent ulcer recurrences. Without such treatment, ulcers recur at the rate of 80% per year.

The drug combination used to eliminate the bacterium is tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol). Eradication is not always successful, however, for reasons that are unclear.

Surgery

Surgical treatment of ulcers is generally used only for complications and suspected cancer. The introduction of a newer technique for repairing perforated ulcers using a laparoscope rather than opening the patient’s abdomen may reduce some of the risks associated with surgical treatment of ulcers.

The most common surgical procedures are vagotomies, in which the connections of the vagus nerve to the stomach are cut to reduce acid secretion; and antrectomies, which involve the removal of part of the stomach.

Expected results

The prognosis for recovery from ulcers is good for most patients. Very few ulcers fail to respond to the medications that are currently used to treat them. Recurrences can be cut to 5% by eradication of H. pylori. Most patients who develop complications recover without problems even when emergency surgery is necessary.

Prevention

Strategies for the prevention of ulcers or their recurrence include the following:

• giving misoprostol to patients who must take NSAIDs
• participating in integrated stress management programs
• avoiding unnecessary use of aspirin and NSAIDs
• improving the nutritional status of critically ill patients
• quitting smoking
• cutting down on alcohol, tea, coffee, and sodas containing caffeine
• eating high-fiber foods

Turmeric

Turmeric is a member of the Curcuma botanical group, which is part of the ginger family of herbs, the Zingiberaceae. Its botanical name is Curcuma longa.

Turmeric is widely grown both as a kitchen spice and for its medicinal uses. Two closely related plants, Curcuma petolata and Curcuma roscoeana, are natives of Cambodia and are grown for their decorative foliage and blossoms.

All curcumas are perennial plants native to southern Asia. They grow in warm, humid climates and thrive only in temperatures above 60°F (29.8°C). India, Sri Lanka, the East Indies, Fiji, and Queensland (Australia) all have climates that are conducive to growing turmeric.


The turmeric plant is identifiable by both its characteristic tuberous root and the leaves that extend upward from erect, thick stems arising from the root. Turmeric root is actually a fleshy oblong tuber 2–3 in (5–10 cm) in length, and close to 1 in (2.54 cm) wide.

It is tapered at each end, and its exterior can be yellow, tan, or olivegreen in color. The interior of the root is hard, firm, and either orange-brown or deeply rust-colored, with transverse resinous parallel rings.

M. Grieve, in A Modern Herbal, states that the root is dense and breaks into a powder that is lemon yellow in color. Turmeric root has a fragrant aroma and a somewhat bitter, peppery, biting taste reminiscent of ginger. When eaten, it colors the saliva yellow and leaves a warm sensation in the mouth.

The root contains a bitter volatile oil, brown coloring matter, gum, starch, calcium chloride, woody fiber and a yellowish coloring material that is known as cucurmin. In addition to the root, the turmeric plant produces rhizomes, which are underground stems growing parallel to the ground that produce roots below and new shoots from their upper surface.

Turmeric rhizomes have also been used for medicinal purposes. The plant’s leaves are divided, lance-shaped and narrower at each end. They are close to 2 ft (61 cm), lustrous and deep green. The flowers arise from those leaves, and are a pale yellow color, growing in groupings of three to five.

General use

Harvested turmeric

Powdered turmeric root is perhaps best known as a popular spice, frequntly used in Eastern cooking. It is an ingredient of curry powders, and is also used to give mustard its characteristic color. It is sometimes used as a substitute for saffron.

The addition of turmeric to such oils as olive or sesame oil extends their shelf life due to its antioxidant properties. In addition, some orange and lemon drinks are now colored with turmeric, which is considered safer than artificial colorings derived from coal tar.

The powdered root of turmeric has been used for making a deep yellow dye for fabrics for hundreds of years, though it does not produce an enduring color-fast tint. It is also used as a coloring for medicines at times.

A less familiar use of turmeric is in chemistry, in the making of papers to test for alkaline solutions. White paper soaked in a tincture of turmeric turns reddish-brown and dries to a violet color when an alkaline solution is added.

Though its use in Western herbal medicine has declined over the years, turmeric has long been used and continues in use in Eastern medicine, both Oriental herbal medicine and Ayurveda, the traditional system of medicine from India.

R.C. Srimal, in Turmeric: A Brief Review of Medicinal Properties, describes the herb as having the ability to protect the liver against toxic substances, especially such heavy metals as lead; to prevent the formation of gallstones or decrease the size of stones already formed; and to increase the flow of bile.

Some studies have demonstrated that turmeric exhibits anti-inflammatory properties that are useful in the treatment of both osteoarthritis and rheumatoid arthritis. Alcohol extracts of turmeric have been found to reduce blood sugar, which could eventually affect the treatment of diabetes.

Turmeric field

In addiion, clinical trials in China have demonstrated that simply using turmeric as a food seasoning can reduce serum cholesterol levels. The World Health Organization has recommended the use of this spice.

A substance known as a lipopolysaccharide isolated from the turmeric root has shown a capacity to stimulate and increase the activity of the immune system. In addition, research has shown turmeric to be effective in destroying gram-positive salmonella bacteria in vitro. Turmeric also demonstrates antifungal properties.

Turmeric has long been used as an Eastern folk remedy for eye discharges and as a cooling, soothing skin lotion. In Chinese herbal medicine, under the name of jiang huang, the turmeric rhizome is used in many different formulas as an anti-inflammatory pain reliever, especially for shoulder pain.

It is believed to invigorate and improve the movement of blood and stimulate menstruation. The turmeric tuber, which is called yu jin in Chinese medicine, also has many important uses. It is given for jaundice, pain in the liver area, agitation, and insomnia.

The cucurmin found in turmeric is being studied as a possible treatment to prevent cancer. Cucurmin appears to lower the rate of genetic mutations in experimental animals.

It has also been shown to induce apoptosis, or cell self-destruction, in leukemia cells. In addition, recent studies done on tissue samples from the human digestive tract indicate that cucurmin may help to prevent colon cancer.

Preparations

A lot of turmeric

Turmeric root is cleaned, boiled, and dried in the oven before being powdered. This pulverized root can then be dissolved in either water or alcohol. It is usually dissolved in boiling alcohol and filtered to make a medicinal tincture.

In India and Pakistan, turmeric is dissolved in water for use as an eyewash, and in milk to make a soothing skin lotion.

Precautions

Practitioners of Chinese herbal medicine advise against using turmeric during pregnancy.

Side effects

Like other anti-inflammatory agents, turmeric has been found to contribute to the formation of stomach ulcers.

Tuberculosis

Tuberculosis (TB) is a contagious and potentially fatal disease that can affect almost any part of the body but manifests mainly as an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or Mycobacterium tuberculosis. TB infection can either be acute and short-lived or chronic and long-term.

Although TB can be prevented, treated, and cured with proper treatment and medications, scientists have never been able to eliminate it entirely. The organism that causes tuberculosis, popularly known as consumption, was discovered in 1882.

Because antibiotics were unknown, the only means of controlling the spread of infection was to isolate patients in private sanatoria or hospitals limited to patients with TB—a practice that continues to this day in many countries. TB spread very quickly and was a leading cause of death in Europe.


At the turn of the twentieth century more than 80% of the people in the United States were infected before age 20, and tuberculosis was the single most common cause of death. Streptomycin was developed in the early 1940s and was the first antibiotic effective against the disease.

The number of cases declined until the mid- to late-1980s, when overcrowding, homelessness, immigration, decline in public health inspections, decline in funding, and the AIDS epidemic caused a slight resurgence of the disease. The increase in TB in the United States peaked in 1992, and new cases reported in the United States continue to decrease as of 2004.

Yet the number of cases in foreign-born individuals is rising, and the number of deaths from TB has been rising, making TB a leading cause of death from infection throughout the world. It is estimated that in the next 10 years 90 million new cases of TB will be reported, with the result of 30 million deaths, or about 3 million deaths per year.

Several demographic groups are at a higher risk of contracting tuberculosis. Tuberculosis is more common in elderly persons. More than one-fourth of the nearly 23,000 cases of TB in the United States in 1995 were reported in people above age 65. TB also is more common in populations where people live under conditions that promote infection, such as homelessness and injection drug use.

In the late 1990s, two-thirds of all cases of TB in the United States affected African Americans, Hispanics, Asians, and persons from the Pacific Islands. Finally, the high risk of TB includes people who have a depressed immune system.

High-risk groups include alcoholics, people suffering from malnutrition, diabetics, and AIDS patients — and those infected by human immunodeficiency virus (HIV) — who have not yet developed clinical signs of AIDS. TB is the number one killer of women of childbearing age worldwide. In poor countries, women with TB often don’t know they have the disease until symptoms become severe.

As of late 2002, TB is a major health dilema in certain immigrant communities, such as the Vietnamese in southern California. One team of public health experts in North Carolina maintains that treatment for tuberculosis is the most pressing healthcare need of recent immigrants to the United States.

In some cases, the vulnerability of immigrants to tuberculosis is increased by occupational exposure, as a recent outbreak of TB among Mexican poultry farm workers in Delaware indicates. Other public health experts are recommending tuberculosis screening at the primary care level for all new immigrants and refugees.

Tuberculosis infographic

Causes and symptoms

Transmission

Tuberculosis spreads by droplet infection, in which a person breathes in the bacilli released into the air when a TB patient exhales, coughs, or sneezes.

However, TB is not considered highly contagious compared to other infectious diseases. Only about one in three people who have close contact with a TB patient, and fewer than 15% of more remote contacts, are likely to become infected.

Unlike many other infections, TB is not passed on by contact with a patient’s clothing, bed linens, or dishes and cooking utensils. Yet if a woman is pregnant, her fetus may contract TB through blood or by inhaling or swallowing the bacilli present in the amniotic fluid.

Once inhaled, water in the droplets evaporates and the tubercle bacilli may reach the small breathing sacs in the lungs (the alveoli), then spread through the lymph vessels to nearby lymph nodes. Sometimes the bacilli move through blood vessels to distant organs.

At this point they may either remain alive but inactive (quiescent), or they may cause active disease. The likelihood of acquiring the disease increases with the concentration of bacilli in the air, and the seriousness of the disease is determined by the number of bacteria with which a patient is infected.

Ninety percent of patients who harbor M. tuberculosis do not develop symptoms or physical evidence of the disease, and their x rays remain negative. They are not contagious; however, these individuals may get sick at a later date and then pass on TB to others.

Though it is impossible to predict whether a person’s disease will become active, researchers surmise that more than 90% of cases of active tuberculosis come from this pool of people. An estimated 5% of infected persons get sick within 12-24 months of being infected.

Another 5% heal initially but, after years or decades, develop active tuberculosis. This form of the disease is called reactivation TB, or post-primary disease. On rare occasions a previously infected person gets sick again after a second exposure to the tubercle bacillus.

Pulmonary tuberculosis

Pulmonary tuberculosis is TB that affects the lungs, and represents about 85% of new cases diagnosed. It usually presents with a cough, which may or may not produce sputum. In time, more sputum is produced that is streaked with blood.

The cough may be present for weeks or months and may be accompanied by chest pain and shortness of breath. Persons with pulmonary TB often run a low-grade fever and suffer from night-sweats. The patient often loses interest in food and may lose weight.

If the infection allows air to escape from the lungs into the chest cavity (pneumothorax) or if fluid collects in the pleural space (pleural effusion), the patient may have difficulty breathing. The TB bacilli may travel from the lungs to lymph nodes in the sides and back of the neck. Infection in these areas can break through the skin and discharge pus.

Extrapulmonary tuberculosis

Although the lungs are the major site of damage caused by tuberculosis, many other organs and tissues in the body may be affected. About 15% of newly diagnosed cases of TB are extrapulmonary, with a higher proportion of these being HIV-infected persons. The usual progression of the disease is to begin in the lungs and spread to locations outside the lungs (extrapulmonary sites).

In some cases, however, the first sign of disease appears outside the lungs. The many tissues or organs that tuberculosis may affect include:

• Bones. TB is particularly likely to attack the spine and the ends of the long bones.
• Kidneys. Along with the bones, the kidneys are probably the most common site of extrapulmonary TB. There may, however, be few symptoms even though part of a kidney is destroyed.
• Female reproductive organs. The ovaries in women may be infected; TB can spread from them to the peritoneum, which is the membrane lining the abdominal cavity.
• Abdominal cavity. Tuberculous peritonitis may cause pain ranging from the mild discomfort of stomach cramps to intense pain that may mimic the symptoms of appendicitis.
• Joints. Tubercular infection of joints causes a form of arthritis that most often affects the hips and knees.
• Meninges. The meninges are tissues that cover the brain and the spinal cord. Infection of the meninges by the TB bacillus causes tuberculous meningitis, a condition that is most common in young children and the elderly. It is extremely dangerous. Patients develop headaches, become drowsy, and eventually comatose. Permanent brain damage can result without prompt treatment.
• Skin, intestines, adrenal glands, and blood vessels. All these parts of the body can be infected by M. tuberculosis. Infection of the wall of the body’s main artery (the aorta), can cause it to rupture with catastrophic results. Tuberculous pericarditis occurs when the membrane surrounding the heart (the pericardium) is infected and fills up with fluid that interferes with the heart’s ability to pump blood.
• Miliary tuberculosis. Miliary TB is a life-threatening condition that occurs when large numbers of tubercle bacilli spread throughout the body. Huge numbers of tiny tubercular lesions develop that cause marked weakness and weight loss, severe anemia, and gradual wasting of the body.

Diagnosis

TB is diagnosed through laboratory test results. The standard test for tuberculosis infection, the tuberculin skin test, detects the presence of infection, not of active TB. Skin testing has been done for more than 100 years. In this process, tuberculin is an extract prepared from cultures of M. tuberculosis.

It contains substances belonging to the bacillus (antigens) to which an infected person has been sensitized. When tuberculin is injected into the skin of an infected person, the area around the injection becomes hard, swollen, and red within one to three days.

Today skin tests utilize a substance called purified protein derivative (PPD) that has a standard chemical composition and is therefore a good measure of the presence of tubercular infection.

The PPD test, also called the Mantoux test, is not always 100% accurate; it can produce false positive as well as false negative results. The test may indicate that some people who have a skin reaction are not infected (false positive) and that some who do not react are in fact infected (false negative).

The PPD test is, however, useful as a screener and can be used on people who have had a suspicious chest x ray, on those who have had close contact with a TB patient, and persons who come from a country where TB is common.

Because of the multiple and varied symptoms of TB, diagnosis on the basis of external symptoms is not always possible. TB is often discovered by an aneh chest x ray or other test result rather than by a claim of physical discomfort by the patient. After an irregular x ray, a PPD test is always done to show whether the patient has been infected.

To verify the test results, the physician obtains a sample of sputum or a tissue sample (biopsy) for culture. In cases where other areas of the body might be infected, such as the kidney or the brain, body fluids other than sputum (urine or spinal fluid, for example) can be used for culture.

One important new advance in the diagnosis of TB is the use of molecular techniques to speed the diagnostic process as well as improve its accuracy. As of late 2002, four molecular techniques are increasingly used in laboratories around the world.

They include polymerase chain reaction to detect mycobacterial DNA in patient specimens; nucleic acid probes to identify mycobacteria in culture; restriction fragment length polymorphism analysis to compare different strains of TB for epidemiological studies; and genetic-based susceptibility testing to identify drug-resistant strains of mycobacteria.

Treatment

Because of the nature of tuberculosis, the disease should never be treated by alternative methods alone. Alternative treatments can help support healing, but treatment of TB must include drugs and will require the care of a physician. Any alternative treatments should be discussed with a medical practitioner before they are applied.

Supportive treatments include:

• Diet. Nutritionists recommend a whole food diet including raw foods, fluids, and particularly pears and pear products (pear juice, pear sauce), since pears may help heal the lungs. Other helpful foods include fenugreek, alfalfa sprouts, garlic, pomegranate, and yogurt or kefir. Four tablespoons of pureed steamed asparagus at breakfast and dinner taken for a few months may also be helpful.
• Nutritional therapy. Nutritionists may recommend one or many of the following vitamins and minerals: vitamin A at 300,000 IU for the first three days, 200,000 IU for the next two days, then 50,000 IU for several weeks; beta-carotene at 25,000-50,000 IU; vitamin E at up to 1,000 IU daily unless the patient is a premenopausal woman with premenstrual symptoms; lipotrophic formula (one daily); deglycerolized licorice; citrus seed extract; vitamin C; lung glandular; essential fatty acids; vitamin B complex; multiminerals; and zinc.
• Herb therapy may use the tinctures of echinacea, elecampane, and mullein taken three times per day, along with three garlic capsules three times per day.
• Hydrotherapy may be used up to five times weekly. Dr. Benedict Lust, the founder of naturopathy, supposedly cured himself of tuberculosis by using hydrotherapy.
• Juice therapy. Raw potato juice, may be taken three times daily with equal parts of carrot juice plus one teaspoon of olive or almond oil, one teaspoon of honey, beaten until it foams. Before using the potato juice, starch should be allowed to settle from the juice.
• Topical treatment may use eucalyptus oil packs, grape packs or grain alcohol packs.

Professional practitioners may also treat tuberculosis using cell therapy, magnetic field therapy, or traditional Chinese medicine. Fasting may be undertaken, but only with a doctor’s supervision.

Allopathic treatment

Drug therapy

Five drugs are most commonly used today to treat tuberculosis: isoniazid (INH), rifampin, pyrazinamide, streptomycin, and ethambutol. Of the five medications, INH is the most frequently used drug for both treatment and prevention. The first three drugs may be given in the same capsule to minimize and treat active TB the number of pills in the dosage.

As of 1998, many patients are given INH and rifampin together for six months, with pyrazinamide added for the first two months. Hospitalization is rarely necessary because many patients are no longer infectious after about two weeks of combination treatment. A physician must monitor side effects and conduct monthly sputum tests.

In 2002, the Centers for Disease Control (CDC) worked with medical organizations to release new guidelines that better individualize the drug regimens received by TB patients depending on their disease symptoms and severity. Many can now receive once-weekly doses of rifapentine in the continuation phase of treatment.

The first large scale trial of a new agent to treat TB began in 2002. The promising new drug, called moxifloxacin, may mean a shorter treatment course for TB sufferers in the near future.

It will also be tested in combination with rifapentine, and researchers believe that using the drugs together will mean a less frequent dosing schedule for patients.

Drug resistance has become a dilema in treating TB. When patients do not take medication properly or for long enough periods of time, the TB organisms may become drug resistant. This makes the patient vulnerable to further infection and allows the TB organism to develop resistance.

Surgery

Surgical treatment of TB may be used if medications are ineffective. There are three surgical treatments for pulmonary TB: pneumothorax, in which air is introduced into the chest to collapse the lung; thoracoplasty, in which one or more ribs are removed; and removal of a diseased lung, in whole or in part. It is possible for patients to survive with one healthy lung.

Expected results

The prognosis for recovery from TB is good for most patients, if the disease is diagnosed early and given prompt treatment with appropriate medications on a long-term regimen.

According to a 2002 Johns Hopkins study, most patients in the United States who die of TB are older—average age 62— and suffer from such underlying diseases as diabetes and kidney failure.

Modern surgical methods are usually effective when necessary. Miliary tuberculosis is still fatal in many cases but is rarely seen today in developed countries.

Even in cases in which the bacillus proves resistant to all of the commonly used medications, other seldom-used drugs may be tried because the tubercle bacilli have not yet developed resistance to them.

Prevention

Vaccination is widely used as a prevention measure for TB. A vaccine called BCG (Bacillus Calmette-Guérin, named after its French developers) is made from a weakened mycobacterium that infects cattle.

Vaccination with BCG does not prevent infection, but it does strengthen the immune system of first-time TB patients. As a result, serious complications are less likely to develop. BCG is used more widely in developing countries than in the United States.

Though the vaccine has been proven beneficial and fairly safe, its use is still controversial. It is not clear whether the vaccine’s effectiveness depends on the population in which it is used or on variations in its formulation. Recently, efforts have been focused on developing a new vaccine.

Generally, prevention focuses on the prevention of transmission, skin-testing high-risk persons and providing preventive drug therapy to people at risk.

Measures such as avoidance of overcrowded and unsanitary conditions are necessary aspects of prevention. Hospital emergency rooms and similar locations can be treated with ultraviolet light, which has an antibacterial effect.

INH is also given to prevent TB, and decreases the incidence of TB by about 60% over the life of the patient. INH is effective when taken daily for 6 to 12 months by people in high-risk categories who are under 35 years of age.

About 1% of patients in preventive treatment develop toxicity. Because INH carries the risk of side effects (liver inflammation, nerve damage, changes in mood and behavior), it is important for its use to be monitored and to give it only to persons at special risk.

Unfortunately, failure of TB patients to complete the full course of their drugs adds to TB incidence and encourages development of drug-resistant strains of the disease.

As scientists try to develop drugs that require shorter courses, physicians must work with patients to encourage compliance with their treatments. Even if symptoms go away, patients often have to continue their drug treatment for six months to be sure to stop the spread of their TB infection to others.

Tibetan Medecine - chakras and energy channels

Tibetan medicine differs from allopathic medicine in that it has no concept of illness as such, but rather the concept is of disharmony of the organism. Accordingly, this system of medicine, like many alternative therapies, seeks to achieve a harmony of the self.

Medicine is one of five branches of Tibetan science, and is known to the Tibetans as gSoba Rig-pa—the science of healing.

The Tibetan pharmacopoeia utilizes many different elements in the treatment of disease, such as trees, rocks, resins, soil, precious metals, sap, and so on, but like Chinese medicine, to which it is related, it mainly relies on herbs for treatment.


Origins

Tibetan medicine, like its relative Chinese medicine, is an ancient art that has become associated with many legends and is surrounded by a cloud of mysticism. Although Tibetan culture is more recent, Tibetan medical practices can be traced back over 2,500 years. It is now practiced in secret or by those in exile since Communist rule has suppressed it in its country of origin.

The treatise of Tibetan medicine, which can be described as a manual compiled over thousands of years, is called the Chzud-shi. In addition to the medical theory, this manual also incorporates the Tibetan pharmacopoeia.

Medicine Buddha with healing herbs

Benefits

Tibetan medicine has been particularly successful at treating chronic conditions such as rheumatism, arthritis, ulcers, digestive problems, asthma, hepatitis, eczema, liver disorders, sinus problems, emotional disorders and nervous system problems. Like many alternative therapies, it is a holistic therapy that treats the whole person and encourages a healthy way of life that will promote well-being at all levels.

Description

Harmony and the balance of all aspects of the human organism are the concepts that form the basis for Tibetan medicine. The three elements that must be kept in harmony are known collectively as the Nyipa sum, and they are rLung, mKhris-pa, and Bad-kan.

It is said that the Tibetan words describing their medicine are very difficult to translate, rather an explanation of the meaning is attempted. Desire, hatred, and delusion are considered to be very harmful influences affecting this harmony, and illustrate the close connection between the Tibetan medical art and Buddhist teachings.

rLung is considered to be a “subtle flow of energy” that is most closely connected with the “air” element. However, since all five elements; earth, water, fire, air and space, in addition to the concepts of heat and cold play a complex role in the health of the individual, this is no simple matter. All elements and aspects are held to be interdependent.

Types of rLung:

• Srog-’dzin (life-grasping rLung). Located in the brain, this energy governs swallowing of food, breathing, spitting, sneezing, and the clearing and steadying of the mind.
• Gyen-rgyu (rLung moving upwards). Located in the chest, it governs speech, physical vigor, general health, and appearance of skin.
• Khyab-byed (all pervading rLung). Located in the stomach, it governs digestion, metabolism, and the seven physical sustainers referred to as lus-zung dhun.
• Thur-sel (downward cleansing rLung). Located in the rectum, it governs the elimination of waste products and reproductive fluids in addition to the birth process (for women).

Types of mKhris-pa:

• mKhris-pa is the heat of human nature, related to fire, described as oily, sharp, hot, light, pungent and moist. Its major function is to balance body temperatures. It governs hunger and thirst, and regulates skin condition. There are five types of mKhris-pa:
• Ju-byed. This is located between the stomach and the intestine. Governs digestion and assimilation, providing heat and energy.
• SGrub-byed. Located in the heart. Responsible for anger, aggression, and hatred, and is considered to lead to desire, achievement, and ambition.
• mDangs-sgur. Located in the liver, it is responsible for maintaining and promoting color and essential components of blood.
• mThong-byed. Located in the eye, it governs vision.
• mDog-sel. Located in the skin, it governs skin appearance and texture.

Types of Bad-kan:

• rTen-byed (supporting Bad-kan). Located in the chest, plays a supporting role to the other four types of Bad-kan.
• Myag-byed (mixing Bad-kan). Located in the upper half of the body. Mixes nutrients (liquids and solids).
• Myong-byed (experiencing Bad-kan). Located in the tongue, governs experience of taste.
• Tsim-byed (satisfaction Bad-kan). Located in the head. Governs the five senses and responsible for heightening their power.
• Byor-byed (joining Bad-kan). Located in the joints, it is considered responsible for their flexibility.

Old Tibetan Medicine painting of anatomy

When these components of Nyipa sum are balanced, the seven bodily sustainers will also be in harmony. They are essential nutrients, blood, muscle tissue, fat, bone, marrow, and reproductive fluids.

Diagnosis

A practitioner of Tibetan medicine will employ several diagnostic tools. Chief of these is a very complicated system of pulse reading, which involves 13 different positions with a possibility of over 300 different readings.

This is similar to traditional Chinese medicine and Ayurvedic medicine. The pulse is likened to a messenger between doctor and patient. For this diagnosis to be effective, it is necessary for the patient to be rested and relaxed.

Another tool of diagnosis is observation, which consists of urinalysis and examining the tongue. To examine the urine, a physician will assess the color, vapor, odor, bubbles, sediments, and albumin content. The color of urine is determined by food and drink, the seasons, and whatever diseases the patient suffers from.

The selesai tool of diagnosis is questioning. The physician will ask specific questions of his patient, and will include such questions as how and when the illness started, where pain is felt, and if the condition is affected by foods eaten.

Treatment

Treatment is divided into four categories, which are dietary advice, lifestyle recommendations, the prescription of medicine, and if necessary, surgical procedures, according to the type of patient.

Treatment proceeds in this order according to the seriousness of the disorder. For example, minor problems are considered to need merely a reassessment of dietary habits, but only in the most serious cases will surgery be considered.

Preparations

A Tibetan physician prescribes medicines and recommends surgery as a last resort. When it is necessary, the prescription is likely to be made up from certain herbs in the form of a decoction, powder, or pills. The prescription will be made up at one of the branches of the Tibetan Medical Institute specifically for each patient.

Precautions

The qualifications of any Tibetan physician should be checked before treatment proceeds.

Side effects

As a natural therapy, Tibetan medicine, if administered correctly, is not known to be associated with any side effects. According to the primary Tibetan medical treatise, one of the criteria for medical prescriptions is that they should be absolutely harmless.

Research and general acceptance

The Tibetan system of medicine has roots in medical practices over 2,500 years old, so it can be considered well researched. Despite the Communist crackdown in Tibet, and the oppression and persecution of their physicians, the Tibetan people still prefer to seek the advice of a traditional physician rather than take advantage of “new” systems of medicine.

In 1994, the Natural Medicine Research Unit, (NMRU) of Hadassah University Hospital in Jerusalem began a double-blind randomized clinical trial of Tibetan herbal formulas which had been on sale in Switzerland for more than seventeen years. Previous trials had already demonstrated the harmlessness of these formulas. The aim of the unit is to compile a database of Tibetan formulas.

The father of Tibetan Medicine, Yuthok sitting in mandala

Training and certification

The headquarters of the main Tibetan medical institute is now in Dharamsala in northern India. Tibetan medicines are also manufactured there. The minimum period of training for a Tibetan physician is seven years.

The first five years mainly consist of theoretical training, and for the sixth and seventh years, medical students are sent for a period of practical training under a senior physician at one of the Institute’s branches, of which there are over 30 in India and Nepal.

Thyme

Thyme (Thymus vulgaris L.), known as garden thyme, and T. serpyllum, known as creeping thyme, mother of thyme, wild thyme, and mountain thyme, are two similarly beneficial evergreen shrubs of the Lamiaceae or mint family.

The aromatic thyme is a perennial native of southern Europe and the western Mediterranean. Thyme is extensively cultivated, both commercially and in home gardens, as a culinary and medicinal herb. There are hundreds of species of thyme.

Garden thyme grows from a woody, fibrous root to produce thin, erect, stems up to 15 in (38 cm) high. It is most commonly cultivated for its culinary uses. Wild thyme is found growing on heaths, in sheep pastures, and mountainous areas in temperate regions.


It was probably introduced to North America by European colonists, and has escaped cultivation. Wild thyme produces long, lowlying, sprawling and creeping stems. This habit inspired the designation serpyllum referring to the serpent-like growth of the species.

Thyme has tiny narrow gray-green leaves that grow in opposite pairs on the square woody stems. The edges of the stalkless, and slightly hairy leaves are rolled inward. The blossoms may be white to rose-colored or a blue to purple hue, depending on the species and variety. Flowers are tiny and tubular and grow in terminal clusters up to 6 in (15.2 cm) long.

Flowering time is mid-summer. Seeds are minuscule and abundant. Thyme thrives in sunny locations on dry stony banks and heaths. The aromatic herb attracts bees that produce a uniquely flavored honey from the herb. It also acts to repel whiteflies.

Thyme print

Thyme has been known since ancient times for its magical, culinary, and medicinal virtues. Tradition held that an infusion of thyme taken as a tea on midsummer’s eve would enable one to see the fairies dancing.

Young women wore a corsage of blossoming thyme to signal their availability for romance. The generic name may have been inspired by one of thyme’s traditional attributes.

Greek folk herbalists believed that thyme would impart courage (thumus in Greek) to those who used the herb, particularly soldiers. Greek men particularly liked the pungent scent of thyme and would rub the herb on their chests.

The Romans believed that adding thyme to bath water would impart energy. They also included thyme in bedding to chase melancholy and to prevent nightmares. The strong scent of thyme was employed as a moth repellent, and burned as fumigating incense.

The philosopher-herbalist Pliny the Elder recommended burning the dried herb in the house to “put to flight all venomous creatures.” In the kitchen thyme has been used for centuries to season sauces, soups, stuffing, and soups. Thyme has long been recognized for its antiseptic properties.

The Egyptians used the herb in formulas for embalming the dead. The herb was among those burned in sickrooms to help stop the spread of disease. Oil of thyme was used on surgical dressings and in times of war as recently as World War I, to treat battle wounds.

General use

The fresh and dried leaf, and the essential oil extracted from the fresh flowering herb, are medicinally potent. Thyme is one of the most versatile herbs for use in home remedies. It is aromatic, antiseptic, diaphoretic (increases perspiration), analgesic, antispasmodic, and diuretic.

It acts as an emmenagogue (brings on the menstrual discharge), carminative (expels gas), and stimulant. Thyme’s essential oil contains a crystalline phenol known as thymol, a powerful and proven antibiotic and disinfectant that enhances the immune system and fights infection.

The aromatic and medicinal strength of the essential oil varies with the species harvested. The essential oil exerts a swift and effective action against bacteria. With external application, the essential oil is especially good for maintaining the health of the teeth and gums and relieving toothache.

An ointment made with the essential oil is used to disinfect cuts and wounds, and is effective against the fungi that cause athletes’ foot. As a massage oil, thyme can relieve rheumatism, gout, and sciatica (pain along the course of a sciatic nerve, especially in the back of the thigh).

As an ingredient in a lotion used as a chest rub, thyme will help break up catarrh (inflammation of the mucous membrane) of the upper respiratory tract. A strong decoction of the leaves and flowers, added to the bath water, will stimulate circulation. When used as a hair rinse, combined with a scalp massage, the herb decoction may help to prevent hair loss.

Taken internally as an infusion or syrup, thyme is an effective remedy for ailments of the respiratory, digestive, and genitourinary systems. The herb relaxes the bronchial muscles, helping to quell dry coughs.

The warm infusion can relieve migraine headache, colic, and flatulence, promote perspiration, and expel worms. A strong decoction, sweetened with honey, is good for easing the spasms of whooping cough and expelling catarrh. The infused herb can be used as a gargle for sore throat.

Taken warm, thyme tea will bring relief for menstrual pain, and relieve diarrhea. Thyme has an antioxidant effect and is a good tonic and digestive tea. The phytochemicals (plant chemicals) in thyme include tannins, bitters, essential oil, terpenes, flavonoids, and saponins.

Preparations

Dried thyme

The aerial parts of thyme can be harvested before and during flowering. The leaves should be removed from the woody stems and placed in single layers on a paper-lined tray in a warm airy room out of direct sunlight, or hung to dry in bunches in a shady location. The dried leaf should be stored in dark glass, tightly sealed, and clearly labeled containers. Thyme can also be frozen for later use.

Infusion: Two ounces of fresh thyme leaf (less if dried) are placed in a warmed glass container, and 2.5 cups of fresh nonchlorinated boiling water are added to the herbs. Twice as much herb is used in preparing an infusion for use as a gargle or bath additive.

The tea should be covered and infused from 10-30 minutes, depending on the strength desired. After straining, the prepared tea will store for about two days in the refrigerator. Thyme tea may be enjoyed by the cupful as a tonic beverage taken after meals up to three times a day.

Tincture: Four ounces of finely-cut fresh or powdered dry herb are combined with 1 pt of brandy, gin, or vodka in a glass container. There should be enough alcohol to cover the plant parts and have a 50:50 ratio of alcohol to water.

The mixture is stored away from light for about two weeks, and needs to be shaken several times each day. The mixture is strained and then stored in a tightly-capped, dark glass bottle. A standard dose is onehalf to one teaspoon of the tincture, taken in hot water, up to three times a day.

Essential oil: Commercial extracts of essential oil of thyme are available. These are not to be taken internally. The essential oil must be diluted in water or vegetable oil, such as almond or sunflower oil, before applying to minimize the toxicity.

The oil contains thymol, a component in many commercially available antiseptics, mouthwash, toothpaste, and gargle preparations. It is antibacterial and antifungal.

Precautions

Thyme oil benefit

Very small amounts of thyme used in culinary preparations are generally safe. In large amounts, thyme acts as a uterine stimulant. Pregnant women should not use the herb, tincture, or essential oil of thyme.

Excessive use of undiluted essential oil is toxic. If the oil is ingested, it may cause gastrointestinal distress such as diarrhea, nausea, and vomiting. Other adverse toxic effects may include headache, muscular weakness, and dizziness.

The oil of thyme may act to slow the heartbeat, depress respiration, and lower body temperature. Applied externally in undiluted form the essential oil may cause skin irritation. The oil should be diluted before use.

Side effects

The U. S. Food and Drug Administration (FDA) has rated thyme as “food safe.” The PDR For Herbal Medicine lists “No health hazards or side effects” when the herb is properly administered in designated therapeutic dosages.