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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.

Thunder god vine

Thunder god vine (Tripterygium wilfordii) is the English translation of the Chinese name for the perennial plant lei gong teng. The plant grows in the mountains of China, as well as Taiwan and Myanmar (formerly Burma).

It is a deciduous climbing vine that sheds its leaves, and produces white flowers and red fruit with three “wings.” The plant’s leaves, flowers, and outer skin of the root are poisonous.

In fact, honey taken from the plant’s pollen is also poisonous. The root pulp is the non-poisonous part, which is used medicinally. There is a risk of poisoning if the herb is not extracted properly.


The potentially dangerous aspects of this plant are reflected in two of its Chinese folk names, “Walk Seven Steps and Die” and “Intestine-Breaking Plant.” In Asia, the plant is also called “three-wing-nut.”

In ancient China, practitioners carefully extracted the portion of the thunder god vine used for treatment. They gathered roots in the summer or early fall. The poisonous bark was removed and the inner portion of the root was utilized.

In past centuries, this procedure may have involved grinding the root into a powder. The remedy usually was applied topically to the skin, since there was a risk of poisoning if thunder god vine was taken orally.

General use

Use of thunder god vine in traditional Chinese medicine dates back thousand of years. Ancient Chinese practitioners used the root of thunder god vine to treat a range of conditions including rheumatoid arthritis, swelling, skin infections and leprosy, fever, boils, and chills.

However, practitioners were aware that the plant could be deadly. In fact, it was likely used as a murder weapon. Farmers in Asia also used thunder god vine as an insecticide.

In the latter half of the twentieth century, interest again turned to the healing potential of thunder god vine. Research of the remedy included a double-blind trial performed in China during the 1980s. Among the researchers was the physician Xue-Lian Tao, a former post-doctoral fellow at University of Texas Southwestern Medical Branch (UTSMB).

In the study, the scientists and the research subjects (over 2,000 patients) did not know whether participants received the extract or a placebo. Patients reported that the remedy reduced the symptoms of rheumatoid arthritis.

Thunder god vine print

Tao returned to the United States and continued research with Dr. Peter Lipsky, then-director of the Harold C. Simmons Arthritis Center at the University of Texas. Research in the United States focused on finding a safe dosage of thunder god vine and locating the part of the plant that appeared to ease arthritis pain.

Lipsky reported that in 1994 the team evaluated the toxicity of the vine, and found “very little” toxicity, thus reducing the possibility of poisoning. They also saw the potential in the herbal remedy.

During the 1990s, researchers at UTSMB studied the plant’s effectiveness in treating the symptoms of inflammatory conditions such as rheumatoid arthritis (RA). If thunder god vine is proven safe and effective for medical treatment of RA, researchers hope it may also be approved to treat other autoimmune conditions.

These include lupus (a rheumatic condition that affects the skin and tissue, producing symptoms of rash, joint pain, and inflammation) and psoriasis—this inflammatory condition causes portions of the skin to raise, turn red, and scale. By 1998, the research team had developed a root extract from the plant that could be studied for its effectiveness in providing relief of arthritis symptoms.

They named the extract “Texas Ethyl Acetate” (TEA), and applied to the United States Food and Drug Administration (FDA) for permission to test the extract on arthritis patients.

The FDA issued permission for the thunder god vine research using root extract. Studies were done through UTSMB and the National Institutes of Health (NIH). In 1999, Lipsky was named scientific director of NIH’s National Institute of Arthritis and Muscoskeletal and Skin Diseases (NIAMS).

In 2002, NIAMS announced the results of a 20-week study involving 21 rheumatoid arthritis patients. Patients received a high-dose extract, low-dose extract, or a placebo.

After four weeks, rapid improvement in symptoms was reported by 80% of those in the highdose group, and in 40% of low-dose participants. No change was reported by people who took placebos. Lipsky rated the results as promising, saying that the extract slowed down an overactive immune system.

Response to the NIAMS study was generally positive. However, some scientists noted that the test group was small and the trial lasted only 20 weeks. Lipsky announced in 2002 that additional research was planned, using thunder god vine to treat RA and conditions such as lupus.

Prior to the NIAMS study, researchers imported thunder god vine root extract from China, where its medicinal use stretches back thousands of years. In 2002, after news of the NIAMS study was released, it was announced that Phytomedics Inc., a New Jersey biopharmaceutical company, was growing thunder god vine.

Phytomedics Inc. renamed the extract “PMI-001,” and announced plans to develop a botanical drug for the treatment of arthritis. The New Jersey-based company partnered with Pfizer, another pharmaceutical company, to manufacture the drug. As of 2004, the PMI-001 product had not been brought to the FDA.

Preparations

Dried root of thunder god vine

The remedy portion of thunder god vine is the vascular part of the root, the interior section consisting of cells that carry water and food to the plant. The plant interior is dried and cut into pieces for processing.

Thunder god vine is available in the United States, where it has been advertised as a Chinese herb that may offer temporary relief for conditions such as aches, joint pain, colds, fatigue, insomnia, stress, and anxiety.

The herbal remedy has been sold on the Internet, where a California business offers thunder god vine in pill form. The business recommended a daily dosage of two pills taken with warm water.

After UTSMB received approval from the FDA, researchers extracted the active ingredient from the plant. The process involved extracting ethanol and acetate from the root. The extract powder was then packaged into capsules.

According to the Arthritis Foundation, some research participants took a daily dosage of 30 milligrams of thunder god vine extract.

Precautions

As of 2004, no standard safe dosage of thunder god vine had been established. The herb’s use as a diet supplement has not been evaluated for safety or content of the product.

Herbal supplements are not regulated by the FDA; therefore, ordering this product carries risks. The consumer has no assurance about the strength of the dosage or the portion of the plant used to make the supplement.

In the United States, thunder god vine cannot be marketed as a drug until it receives FDA approval, a process that includes evaluation of a product for safety and effectiveness. This preliminary review is not required for herbs marketed as diet supplements. However, the FDA can stop the sale of supplements determined to be unsafe.

The leaves and flowers of thunder god vine are very toxic and may cause death. Extreme caution in purchasing is advised to ascertain that the supplement is a proper extraction made only from the interior of the plant root.

Side effects

Thunder god vine is toxic and could be lethal if not properly extracted.

In the Chinese 1980s double-blind trial, some people experienced diarrhea and related gastrointestinal disturbances. Tao reported that those side effects disappeared as people continued treatment. Moreover, side effects in the NIAMS study were described as “minor.”

According to the Arthritis Foundation, possible side effects of thunder god vine include upset stomach and skin reactions. Men may experience temporary infertility, while women may stop having menstrual periods (amenorrhea).

Interactions

People taking immunosuppressive drugs such as prednisone should not use thunder god vine.

Amalaki (Embelica officinalis)

Triphala, an ancient herbal blend, is one of the most commonly used herbal remedies in the Ayurvedic system of healing. Ayurvedic medicine originated in ancient India, has developed over thousands of years, and is one of the oldest systems of healing.

Thus triphala is one of the longest-used herbal remedies in the world. Triphala, meaning “three fruits,” is made from the fruits of three trees that grow throughout India and the Middle East, including amalaki fruit (Embelica officinalis), bibhitaki fruit (Terminalia belerica), and haritaki fruit (Terminalia chebula).

In preparing triphala, these fruits are dried, ground into powder, and then blended together according to the precise directions of Ayrurvedic tradition. Amalaki fruit, also called amla or Indian gooseberry, is renowned as one of the best rejuvenating herbs in Ayurvedic medicine.


It contains more vitamin C than almost any other fruit, consisting of nearly 3,000 mg of vitamin C per piece. It has been nicknamed the “nurse herb” in India, because of its widespread effectiveness against sickness and its cooling effects on the body.

Haritaki is also considered one of the most useful of Ayurvedic herbs, particularly for its rejuvenating, warming, and balancing effects. Combined with bibhitaki fruit, another tonifying and warming herb, these three compounds are believed to have healing and balancing effects on all three of the principal body types or constitutions (termed doshas) in Ayurvedic medicine. As a balanced formula, triphala can be effectively used by most people and is prescribed for a variety of health conditions.

General Use

amalaki, bibhitaki, and haritaki

Triphala is taken as a general health tonic, useful for all body types and a variety of conditions. It is commonly prescribed to tone and strengthen the digestive system, particularly in cases of weak digestion and constipation. Triphala is a gentle laxative that can be used daily and is not habit-forming, and has no adverse effects on the intestinal flora (the microorganisms that aid digestion).

It is said to improve the function of the stomach and intestines, and is also prescribed for cases of excess stomach acid. Triphala regulates and detoxifies the bowels, improves overall health by increasing the efficiency and absorption of digestion, and reduces gas.

It has a balancing effect on the body’s metabolism, and is prescribed to restore appetite. The herbal compound also helps the body to eliminate excess fat, by improving metabolism. Because of its gentle properties, triphala is recommended as a digestive aid for the elderly and for those with sensitive stomachs.

In addition to restoring the balance of the digestive tract, triphala is used as a blood builder and purifier, and may increase red blood cell count and hemoglobin levels.

Some healers prescribe it for diabetes, for its balancing effect on blood sugar levels. It also has anti-cholesterol and anti-mucus properties in the body. Triphala is believed to strengthen the kidneys and liver, and is prescribed for hepatitis sufferers.

Triphala is a source of vitamin C and is believed to improve the function of the immune system. The herbs in triphala have anti-inflammatory properties. The remedy is prescribed for gout, a form of arthritis caused by excess uric acid in the body, and other inflammatory conditions. Triphala is said to have a calming and tonic effect on the nervous system, and is recommended for Alzheimer’s disease and other degenerative disorders of the nervous system.

Another use for triphala is to strengthen the eyes, particularly in cases of cataracts, glaucoma, and conjunctivitis. It can be used as an eyewash and may reduce soreness and redness in the eyes. Triphala can also be applied topically to the skin to speed the healing of bruises and sunburn.

Preparations

Triphala as powder

Triphala is available as a powder, and in tablets and capsules as well. For those who do not like very strong and bitter tastes, tablets or capsules are recommended. Triphala can be taken daily. As a digestive tonic and laxative, it is best taken in the evening, about two hours after eating, and at least 30 minutes before bedtime.

No food should be eaten for one and a half hours after ingestion. Tablets and capsules can be swallowed, while the powder can be mixed thoroughly in a small amount of cold or warm water. The powder can also be simmered in water and drunk as a medicinal tea.

Individuals should start with small amounts of triphala, a quarter-teaspoon of the powder or one tablet, gradually increasing the dosage until finding the optimal dosage. No more than one teaspoon of the powder or four to six tablets or capsules should be taken per day. The dosage should be reduced in cases of stomach upset or diarrhea.

As triphala is not addictive, it can be taken over long periods of time. It is recommended that every ten weeks, users should stop taking the herbal compound for two to three weeks, to give the body a rest and to maintain the effectiveness of the remedy.

When used as an eyewash, one teaspoon of triphala powder can be added to one cup of boiled and cooled water. The solids should be removed by straining through a dense cloth. The eyewash can be applied to the eyes three times per day. For topical application to the skin, the powder can be mixed with a small amount of water to make an easily applied paste.

Precautions

Triphala is not recommended during pregnancy or nursing, and should not be used with cases of diarrhea and dysentery.

Side Effects

The use of triphala may increase intestinal gas at first, as a possible by-product of the cleansing and detoxification effects in the digestive tract. Loose stools or diarrhea may indicate too high a dosage, and the amount ingested should be reduced.

Interactions

There are no known interactions between triphala and standard Western prescription drugs as of 2004.

Trigger point therapy

Trigger point therapy is a bodywork technique that involves the application of pressure to tender muscle tissue in order to relieve pain and dysfunction in other parts of the body. It may also be called myofascial (myo meaning muscle, fascial meaning connective tissue) trigger point therapy.

Trigger point therapy is sometimes regarded as one of a group of treatment aproaches called neuromuscular therapy or NMT. Myotherapy, developed by Bonnie Prudden, is a related type of trigger point therapy.

Origins

Trigger point therapy was developed by pain experienced in one part of the body is actually caused by an injury or dysfunction in another part of the body.


Ultimately, she mapped what she termed the body’s trigger points and the manner in which pain radiates to the rest of the body. Travell’s work came to national attention when she treated President John F. Kennedy for his back pain.

Trigger points are thought to result from a variety of causes, including birth trauma, hypoglycemia, vitamin B₆ deficiency, food allergies, traumatic injuries, poor posture, skeletal asymmetry, overexertion, or such diseases of the digestive tract as ulcers and irritable bowel syndrome. During times of physical or emotional stress, the points cause muscles to spasm.

Travell’s therapy called for the injection of saline (a salt solution) and procaine (also known as Novocaine, an anesthetic) into the trigger point. Although beneficial in the relief of pain, the injections are a painful procedure for some people.

In the 1970s, Bonnie Prudden, a physical fitness and exercise therapist, found that applying sustained pressure to a trigger point also relieved pain. Prudden developed her techniques over a number of years and called the treatments myotherapy. Myotherapy is beneficial to patients who find that trigger point injections are too painful.

Benefits

Trigger point therapy is said to interrupt the neural signals that cause both the trigger point and the pain. The object is to eliminate pain and to reeducate the muscles into pain-free habits.

In this manner, the swelling and stiffness of neuromuscular pain is reduced, range of motion is increased, and flexibility and coordination are improved. The therapy can also relieve tension and improve circulation.

The list of conditions that benefit from trigger point therapy include arthritis; carpal tunnel syndrome; chronic pain in the back, knees, and shoulders; headaches; menstrual cramps; multiple sclerosis; muscle spasms, tension, and weakness; postoperative pain; sciatica; temporomandibular joint syndrome (TMJ); tendinitis; and whiplash injuries.

Description

Typically, a health care professional refers a patient to a trigger point therapist. The therapist will take a history of injuries suffered, occupations held, and sports played. He or she will ask the individual to describe the pain and its location in detail.

The therapist will then probe the area of the coordinating trigger point. An injection of lidocaine, saline, or other medicines, or probing with a dry needle, may be done. In myotherapy, once the point is found, the therapist will apply sustained pressure using the fingers, knuckles, or elbows for several seconds.

Pain relief is often experienced immediately. Following the injection or pressure treatment, the therapist will then gently stretch the muscles of the trigger point. Finally, a series of exercises is taught to the individual to reeducate the muscles and to prevent the pain from returning.

Workbooks are now available to help patients maximize the benefits of trigger point therapy through self-treatment at home.

trigger point referral pain pattern for the mid back

Preparation

Persons should consult a health care professional before beginning trigger point therapy to insure that the pain is not caused by fracture or disease. In fact, a certified trigger point therapist will not provide services to someone who is not referred by a health care professional.

The therapy is usually conducted on a padded table or treatment chair. The individual should wear comfortable loose-fitting clothing. An ongoing, honest interaction with the therapist will facilitate the sessions.

Treatment sessions can last 30 minutes to an hour. The range of cost is approximately $45–60 per session. Acute pain can be relieved in as little as one session. Chronic pain may require numerous treatments.

Precautions

Persons with infectious diseases, open sores, or recent injuries should wait until they have recovered before beginning trigger point therapy.

Persons taking anticoagulant prescription drugs may experience bruising after trigger point therapy.

Research and general acceptance

Research into the effects of trigger point therapy is sketchy, although the growing acceptance of acupuncture within the mainstream medical community has led to a few recent published studies of trigger point therapy.

Interest in trigger point therapy is growing in Europe and Asia as well as in the United States; one recent study by a group of Japanese researchers reported that trigger point therapy was superior to standard allopathic drugs in relieving the pain of renal colic.

The American Academy of Pain Management (AAPM) reports that studies of trigger point therapy on back pain and headaches have been conducted on groups of fewer than 10 people. The AAPM does, however, recognize trigger point therapy as a valid approach to the management and relief of pain.

In the traditional medical community, trigger point therapy is viewed as a complement to treatment. Patients are referred by a variety of health professionals including psychiatrists, orthopedic surgeons, and anesthesiologists.

Trichomoniasis

Trichomoniasis refers to an infection of the genital and urinary tract. It is the most common sexually transmitted disease, affecting about 120 million women worldwide each year.

Trichomoniasis is caused by a protozoan (the smallest, single-celled members of the animal kingdom). Trichomonas vaginalis is almost always passed through urinary tracts. A woman is most susceptible to infection just after having completed her menstrual period.

Men may carry the organism unknowingly, since infection in men may cause mild or no symptoms. Men may also experience urethral discharge or persistent urethritis. Trichomoniasis is associated with HIV transmission and may be associated with adverse pregnancy outcomes.


Causes and symptoms

Because trichomoniasis is a sexually transmitted disease, it occurs more often in individuals who have multiple sexual partners. The protozoan is passed to an individual by contact within the body fluids of an infected sexual partner. It often occurs simultaneously with other sexually transmitted diseases, especially gonorrhea.

In women, the symptoms of trichomoniasis include an unpleasant vaginal odor, and a heavy, frothy, yellow discharge from the vagina. The genital area (vulva) is often very itchy, and there is frequently pain with urination or with sexual intercourse.

protozoan Trichomonas vaginalis

The labia (lips) of the vagina, the vagina itself, and the cervix (the narrowed, lowest segment of the uterus that extends into the upper part of the vagina) will be bright red and irritated. Women may also experience lower abdominal discomfort.

In men, there may be no symptoms at all. Some men notice a small amount of yellowish discharge from the penis, usually first thing in the morning. There may be some mild discomfort while urinating, testicular pain or tenderness, or lower abdominal pain. Some men infected with trichomoniasis experience persistent urethritis.

The use of antibiotics is a contributing factor to recurrent trichomoniasis in some women because antibiotics affect the balance of bacteria in the vagina, allowing such organisms as T. vaginalis to multiply more rapidly.

Diagnosis

Diagnosis is easily made by taking a sample of the discharge from the woman’s vagina or from the opening of the man’s penis. The sample is put on a slide and viewed under a microscope. The protozoa, which are able to move about, are easily viewed.

Trichomoniasis tends to be underdiagnosed in men because of the relative mildness of symptoms in men and insufficiently sensitive diagnostic tests. The recent introduction of DNA amplification, however, indicates that the incidence of trichomoniasis in men is much higher than was previously thought.

Treatment

Cure of trichomoniasis may be difficult to achieve with alternative treatments. Some practitioners suggest eliminating sweets and carbohydrates from the diet and supplement with antioxidants, including vitamins A, C, and E, and zinc. Naturopaths may recommend treatment with two douches (a wash used inside the vagina), alternating one in the morning and one at bedtime.

One douche contains the herbs calendula (Calendula officinalis), goldenseal (Hydrastis canadensis), and echinacea (Echinacea spp.); the other douche contains plain yogurt with live acidophilus cultures. The herbal douche helps to kill the protozoa while the yogurt reestablishes healthy flora in the vagina. Tea tree oil is another alternative remedy for trichomoniasis.

Acidifying the vagina by douching with boric acid or vinegar may also be useful. Although not a cure, The Gynecological Sourcebook suggests inserting a garlic (Allium sativum) suppository (a peeled whole clove wrapped in gauze) every 12 hours for symptomatic relief.

Other remedies include vaginal suppositories that include the ingredient acidophilus once a day for three days. An alternative medicine practitioner can recommend the correct mixture. A vaginal douche consisting of grapefruit seed extract may also help relieve symptoms.

Allopathic treatment

It is spread through sex

The usual treatment is a single large dose of metronidazole (Flagyl) or split doses over the course of a week. Some sources suggest clotrimazole (Gyne-lotrimin, Mycelex) as an alternative treatment showing a lower cure rate.

Application of Betadine, a concentrated antiseptic solution, is another recommendation, although Betadine is messy, stains, and should not be used by pregnant women. However, the Centers for Disease Control (CDC) states that there are no effective alternatives to therapy with metronidazole available. Topical treatment with metronidazole is not advised.

Individual evaluations are recommended for those who are allergic to metronidazole or who experience treatment-resistant trichomoniasis. Sexual partners of an infected individual must all be treated, to prevent the infection from being passed back and forth. Sexual intercourse should be avoided until all partners are cured.


As of late 2003, the number of cases of metronidazole-resistant trichomoniasis appears to be increasing rapidly. Some success has been reported with the broadspectrum anti-parasitic drug nitazoxanide, but further research needs to be done.

A group of researchers in Thailand is currently investigating the effectiveness of a group of drugs known as bisquaternary quinolinium salt compounds in treating trichomoniasis.

Women who are taking antibiotics for other illnesses should speak to their health care provider about the possibile effects of the medication(s) on the balance of organisms in their vagina.

Expected results

sexually transmitted diseases

Prognosis is excellent (90–95%) with appropriate treatment of the patient and all sexual partners. Without treatment, the infection can remain for a long time, and can be passed to all sexual partners.

Prevention

All sexually transmitted diseases can be prevented by using adequate protection during sexual intercourse. Effective forms of protection include male and female condoms. Other preventive measures are similar to those for other forms of vaginitis, including wearing loose cotton clothing and not using douches, vaginal deodorants, or sprays.