Ayurveda the Science of Life
Herbal remedies, dietary supplements, and seizures. Epilepsia 2003 44(2) 228-235. 3. Spinella M. Herbal medicines and epilepsy the potential for benefit and adverse effects. Epilepsy Behav 2001 2 524-532. 8. PDA for Herbal Medicine, 2nd ed. Montvale, NJ Medical Economics Co., 2000. 16. Narita Y, Satowa H, Kokubu T, et al. Treatment of epileptic patients with the Chinese herbal medicine saiko-keishi-to (SK). IRCS Med Sci 1982 10 88-89.
Various Ayurvedic treatment modalities that include strong elimination and alleviation therapies, depending upon specific requirements, are useful for epilepsy patients. When epilepsy is associated with extrinsic factors, then mantras (hymns) have been recommended. The physician is advised to first take steps to awaken the heart channels and unblock the mind blocked by the dosas through drastic emesis (Vatika Apasmara), enema (Paittika Apasmara), and purgatives (Slaismika Apasmara). Drug formulations are recommended only after the patient has been cleansed by all means and consoled Similar to traditional Chinese herbal medicine (TCHM), Ayurvedic medicine has been practiced for millennia. The practice includes not only medicinal and dietary treatments but also commonsense behavioral prescriptions such as, Patients with epilepsy should avoid being in places where a seizure could result in injury (1). As with TCHM, many of the compounds used are likely to be pharmacologically active...
Abundant references to all aspects of epilepsy can be found in the Ayurvedic literature, including symptomology, etiology, diagnosis, and treatment. The eighth chapter of Nidanasthana (diagnosis) and tenth chapter of Chikitsasthana (treatment) of the Caraka Samhita are devoted exclusively to epilepsy (2). In Ayurvedic literature, the diseases of the head, nervous system, and mental afflictions are well classified and their treatment is given in detail. Convulsions (akshepaka), apoplectic fits (apatantraka), and hysterical fits (daruna apatantraka) are a few of the important nervous system disorders mentioned (1). The discussion of epilepsy in Ayurvedic literature is summarized below.
The chief source of ancient Indian Aryan culture and medicine is the four Vedas. The exact source and date of origin of the Vedas has always been a debatable issue, but according to Indian traditions, the Vedas were revealed to the sages by Brahma (the creator) approximately six thousand years before the Christian era. Most Western scholars believe that the oldest of the four Vedas was compiled during the second millennium b.c. The word Ayurveda (in Sanskrit Ayu means life, and Veda, to know ) has traditionally been equated with the ancient Indian system of medicine. Although Ayurveda means the knowledge of life, by which the nature of life is understood and thus life is prolonged, this word does not appear in the Vedic texts. Most likely, traditional Vedic medicine flourished for several centuries before it was handed down orally from the master to the pupil. Much later, traditional Hindu medicine became synonymous with Ayurveda. Unfortunately, the text of Ayurveda is not available...
There are few published studies of herbal medicine as a pediatric therapy, despite the general popularity of herbal remedies (9) and the likelihood that many are given to children in the home. The only two existing studies that were randomized, double-blinded controlled trials were conducted by Sarrell and colleagues to evaluate a naturopathic herbal extract (NHE) for ear pain associated with acute otitis media (AOM) (55,56). Although well designed, both studies excluded children younger than 5 years of age despite AOM being the most common complaint in ages 2-3 years. Sarrell et al. excluded these children because younger children are not able to report pain clearly and accurately. should be considered a possibly efficacious treatment for AOM-related ear pain in children. Other herbal remedies should be subjected to similar trials.
Complete online patient data, including traditional medical chart information and clinical images, are essential to providing good health care. Information must be available at any location and any time that the patient needs care. A complete multimedia patient record allows health care networks to provide care seamlessly, without repeating studies and delaying treatment.
Ayurveda classifies epilepsy into four types, individually originating in the disordered states of the three dosas (humors) Vatika Apasmara, Paittika Apasmara, and Slaismika Apasmara, or all combined. The fourth type, the Sannipatika form of the disease, is caused by the simultaneous vitiation of all three dosas and is incurable however, it is open to palliative measures. An unusual feature of all four types of epilepsy is the sudden manifestation of violent symptoms without any warning and also the sudden disappearance of symptoms without treatment (2,4).
Prior scientific assertions of the genetic domination of behavior have not stood the test of time. In 1865 Galton published two papers in MacMillan's Magazine titled Hereditary Talent and Character. Galton began part two of his article by stating I have shown, in my previous paper, that intellectual capacity is so largely transmitted by descent that, out of every hundred sons of men distinguished in the open professions, no less than eight are found to have rivaled their fathers in eminence. It must be remembered that success of this kind implies the simultaneous inheritance of many points of character, in addition to mere intellectual capacity. A man must inherit good health, a love of mental work, a strong purpose, and considerable ambition in order to achieve successes of the high order of which we are speaking (Galton 1865, 318).
Before we look at what you can do when your kidneys start to fail, it's a good idea to review the basics on how the kidneys work in the body. With this knowledge, you will get a better understanding of why the kidneys are so important in the functioning of your body and the extent of the damage that can occur to your health if things do go wrong.
Traditional Chinese medicine (TCM) is the study of human physiology and pathology, and the prevention, diagnosis, and treatment of human diseases. It is a system that consists of the clinical and theoretical investigation of the physiology and pathology of organs and functions. Current TCM practice is based on the cosmologic principles of Chinese philosophy, including holism, differentiation, yin yang, and the five elements. Herbal medicine, acupuncture, and moxibustion are the treatment methods employed in TCM, in order of frequency. TCM has a more than 2,500-year history consisting of the development of major theories and clinical investigations that have been carried out by generations of practitioners and investigators. The theoretical basis for TCM is beyond the scope of this chapter. A detailed discussion may be found in the work of Bensky, et al. (1-3).
CA Therapeutic Research Faculty, 2005, pp. 82-83. Kaplan GP. Ayurvedic medicine. In Oken BS, ed. Complementary Therapies in Neurology. London Parthenon Publishing, 2004, pp. 145-158. Manyam BV Ayurvedic approach to neurologic illness. In Weintraub MI, Micozzi MS, eds. Alternative and Complementary Treatment in Neurologic Illness. New York Churchill Livingstone. 2001, pp. 68-74. Pai S, Shanbhag V, Archarya S. Ayurvedic medicine. In Kligler B, Lee R, eds. Integrative Medicine Principles for Practice. New York McGraw-Hill, 2004, pp. 219-240. Agarwal R, Diwanay S, Patki P, et al. Studies on immunomodulatory activity of Withania somnifera (Ashwagandha) extracts in experimental immune inflammation. J Ethnopharmacol 1999 67 27-35. Saper RB, Kales SN, Paquin J, et al. Heavy metal content of Ayurvedic herbal medicine products. JAMA 2004 292 2868-2873. Ziauddin M, Phansalkar N, Patki P, et al. Studies on the immunomodulatory effects of Ashwagandha. J Ethnopharmacol 1996 50 69-76.
The HRQL scoring systems provide utility (preference) scores on a generic scale where dead 0.00 and perfect health 1.00. HUI scores meet or exceed the criteria for calculating quality-adjusted life years (QALY), and the requirements of published guidelines for economic evaluations of pharmaceutical and other health care services. The health status classification and HRQL scoring systems are generic in terms of applying to all people age 5 years and older in both clinical and general populations. A health-status classification system based on HUI2 and HUI3 suitable for children 3 to 5 years of age is under development.
A 59-yr-old man presented with the diagnosis of type 2 diabetes. He was in good health until 5 yr ago when he presented to the emergency room (ER) with an episode of chest pain and numbness in his jaw that occurred as he was walking up stairs. He was admitted to the hospital, and although an acute myocardial infarction (MI) was ruled out, an exercise stress test was positive. Coronary angiography revealed triple-vessel disease, and a coronary bypass operation was performed. Risk factors for coronary disease included the following family history his father died of an MI at age 52, mild hypertension -145 88, cigarette smoking 1 pack per day x 20 yr. He works as a bus driver and is 5 ft 9 in and 180 lbs. A lipid profile taken 2 mo postoperatively was as follows cholesterol 250 mg dL, triglyceride 180 mg dL, HDL 30 mg dL, and LDL 184 mg dL. Liver, renal, and thyroid functions were normal.
Many commonly used herbs may stimulate the immune system (see Table 23.2). Echinacea is the most well known of these herbs. Some other herbs in this category are among the most popular herbs in the United States, including alfalfa, Asian ginseng, astragalus, cat's claw, garlic, saw palmetto, and Siberian ginseng. Other immune-stimulating herbs may be found in this book in the chapters on Asian herbal medicine and Ayurvedic medicine. For people with MS, the use of one rather uncommon herb, woody nightshade stem, is specifically discouraged in The German Commission E Monographs, an authoritative text on herbal medicine 3 . It is not clear if
Conclusive evidence that lowering hsCRP levels leads to a reduction in clinical cardiovascular events in primary prevention settings is not available. Nevertheless, many behavioral and pharmacological interventions that reduce cardiovascular event rates are associated with lower hsCRP levels. Behavioral interventions in this category include smoking cessation, weight loss, increased physical activity, and dietary modification (see ref. 6 for a review). Pharmacological interventions are reviewed in the following sections. Because a patient's compliance with recommended interventions depends in part on his or her perception of absolute disease risk and because the addition of hsCRP testing to existing risk algorithms provides an improved prediction tool, a major rationale for hsCRP screening is to help motivate at-risk individuals to adopt healthier lifestyles and to comply with prescribed drug therapies.
There is a long tradition of the use of honey in wound healing. Medical literature from ancient Egypt and Greece as well as the Ayurvedic traditions of India have described the use of honey alone or in combination with other substances as a wound healing agent (43). These traditional applications of honey have evolved into current evidence-based practices in which honey is used as a therapeutic agent to modulate wound healing in a multifactorial way. It promotes debridement, kills bacteria, creates a moist healing environment, and appears to actively promote healing (44).
The importance of the eye and its function is sometimes underrated, but a consideration of the part played by vision in our consciousness makes us soon realise its value. If we think of dreams, memories, photographs and almost anything in our daily existence, it is difficult to express them without visual references. After a little careful consideration of the meaning of blindness, it is easy to sense the rational and irrational fears that our patients present to us in the clinic. Nevertheless, in a modern European community the effects of blindness are not so apparent as in former years, and blind people tapping their way about the street or begging for food are less in evidence to remind us of the deprivation that they suffer. This is due to the effective application of preventive medicine and the efficacy of modern surgical techniques. However, in the western world we have a new and increasing problem related to the increasing
Little is known of the prevalence of the use of herbal medicine for pain among Canadian First Nations peoples. The compounding of herbal preparations is not regulated under the Natural Health Products regulations. The use of healing rituals such as sweat lodges, smudging, pipe smoking, the use of song, sun dances and prayer, the concept of the medicine wheel , and herbs such as sage, sweetgrass and cedar have all been described. It is interesting to note that the use of herbs such as echinacea, goldenseal, St John, s Wort, and evening primrose by First Nations healers is also increasingly receiving interest from a wider population. It is clear that within First Nations cultures and, increasingly, within Western society, indigenous healers are given a credibility that goes beyond our current
The table below gives you an estimate of the amount of supplies you will need according to the number of people in your area. To find the amounts needed for each item, look in the column under the approximate population of your catchment area to the nearest 5000. You may add several columns (e.g. if your health facility serves 35 000 people, add the amounts in the 10 000 and 5000 columns to those in the 20 000 column). Write the amount needed at your health facility in the empty column on the right. On the basis of drug resistance in your area, choose only one of the antimicrobial.
It should now be clear that the major issue, the major concern, the major variable in all of these discussions about the ethics and social consequences of genetic disclosure is not whether information is disclosed, but the character of the social milieu into which that disclosure is disseminated. And the width and band of that social milieu is critical, from nation to culture to region to family unit. One family environment (or nation-state) may be safe and supportive for a child with Down syndrome, another quite hostile. It is not so much the disclosure that should occupy the focus of our analysis, but the context of that disclosure. As we have seen, under the highly commendable and politically safe banner of prospectively bringing greater health, molecular biologists assume that what they are doing will ultimately come down on the side of increasing public health (Hood 1992 Gilbert 1992).
Borchers AT, Hackman RM, Keen CL, et al. Complementary medicine A review of immunomodulatory effects of Chinese herbal medicines. Am J Clin Nutrition 1997 66 1303-1312. Chan TYK, Critchley JAJH. Usage and adverse effects of Chinese herbal medicines. Human Exp Toxicol 1996 15 5-12. Zhang L-H, Huang Y, Wang L-W, et al. Several compounds from Chinese traditional and herbal medicine as immunomodulators. Phytother Res 1995 9 315-322.
The current management of MetS reflects two major considerations (1) promotion of healthy lifestyle changes to ameliorate the root environmental causes and (2) the therapeutic approaches to manage the individual components of MetS. Healthy lifestyle promotion includes (1) dietary changes in terms of moderating calorie intake to achieve a 5-10 loss of body weight in the first year and changing dietary composition (2) increasing physical activity and (3) changes in dietary composition to lower intake of saturated fats, trans fats and cholesterol, and include carbohydrates with a low glycemic index and high content of soluble fiber.
The use of complementary and alternative medications (CAM) in the United States has skyrocketed in the past decade. A 1998 study in the Journal of the American Medical Association estimated that the use of herbal medications increased from 2.5 to 12.1 in the adult population between 1990 and 1997, and that 18 of all prescription drug users were also taking herbal remedies or high-dose vitamins (1). The clinical benefit of CAM is largely unproven, because of a paucity of rigorous clinical trials evaluating safety and efficacy. Patients tend to underreport their use of alternative medicines to physicians, and physicians may discount their significance even when their use is presented. Substantial risks, however, are associated with the use of these interventions. These risks involve the direct toxicities of the alternative preparations as related to their intended ingredients, possible adulteration by other compounds, and interactions that we call herb-drug interactions. Herb-drug...
No large published clinical studies have specifically investigated the effect of Ayurveda on MS or its symptoms. Some components of Ayurveda have been investigated individually. These include massage, meditation, and yoga, all of which are discussed elsewhere in this book. These therapies may be helpful for some symptoms that occur with MS, including fatigue, spasticity, pain, depression, and anxiety. Ashwagandha, the Ayurvedic supplement sometimes recommended for MS, has been studied mainly in scientific and animal studies. In these studies, ashwagandha has been shown to stimulate the immune system. It also may produce sedating effects. Ashwagandha has not been studied in clinical trials in MS as a result, it is not known if it has any therapeutic effects in MS. Some research has evaluated Ayurvedic supplements for other conditions. One small study found that the herb Phyllanthus was an effective therapy for liver inflammation subsequent studies did not find beneficial effects. For...
In addition to physical activity promoting health and well-being during treatment, there may be implications for long-term health, as adolescence is an important time for adopting healthy practices including preferences for activity or inactivity 25 , which may impact on future fitness, obesity, bone density, and cardiovascular disease. This is particularly important for adult survivors of cancer who are at risk for multiple health problems.
Receptive to particular treatment regimens, has stimulated debate about whether it is possible or desirable to create therapies targeted to the individual and if such efforts will re-inscribe race as a relevant biological category.8 Another similar breed of genetics, called nutrigenomics, has already emerged, which promises to identify genetic variants linked to particular body types and health needs and thereby help clients make better health and lifestyle decisions. Sciona, Inc. offers a nutrigenetic test called Cellf to discover The Science of You. The Cellf Report, which is sent to the client after she buys a kit at a retail outlet and sends a cheek swab and payment to the company, explains which gene variations you have, what effects they may have on your health, and what specific amounts of food, nutrients, supplements, and exercise may help tailor-made and written just for you. 9 Pre-implantation genetic diagnosis, which allows couples to genetically test an embryo created...
The more we understand the biochemical pathways behind disease, the more we understand the biochemical pathways behind healthy functioning. Further, as research and technology improve our ability to design effective medications, we gain important insights into what diet and nutrition provide for maintaining good health. Our knowledge of the neurochemical basis behind epilepsy is growing, but we must translate and supplement this with information about how epilepsy impacts the body's use of specific nutrients. Amino acids, vitamins, and minerals are essential components of daily metabolism, and may be affected to varying degrees by epilepsy. Studies are beginning to look at both the preventative and therapeutic roles nutrition can play in the treatment of epilepsy. Because of the broad spectrum of causes for epilepsy, treatments must be chosen carefully, and the findings of one particular study may not apply to all people with epilepsy.
In 1977, scientists were able to use gene therapy techniques to deliver a gene into the cells of mammals. American doctor W. French Anderson performed one of the first studies of gene therapy in humans in 1990 on a four-year-old girl who had a rare genetic immune system disorder called severe combined immunodeficiency (SCID). The immune system fights off infections from bacteria and viruses, and the disorder made it difficult for her body to stay healthy. Anderson and his team genetically altered her white blood cells and then returned them to her body. The new white blood cells strengthened the girl's immune system and made it possible for her to survive.
One of the promising concepts for improving health care utilizing the considerable knowledge gained in the past century is personalized medicine or individualized medicine. Basically, the promise is that therapeutic efficacy can be maximized while minimizing side effects if treatments are designed according to the relevant genotype and phenotype information of the individual (1). Another aspect of personalized medicine is monitoring the evolution of the disease (including the effects of treatment and changes of the disease target itself) and adjusting further therapy accordingly. In order to obtain the relevant information of the individual and monitor the disease evolution, appropriate diagnostic methods need to be applied. Therefore, the approach of utilizing relevant diagnostic information to guide therapy (known as theranostics) has become an essential component of personalized medicine.
The table below gives you an estimate of the amount of supplies you will need according to the number of people in your area. To find the amounts needed for each item, look in the column under the approximate population of your catchment area to the nearest 5000. You may add several columns (e.g. if your health facility serves 35 000 people, add the amounts in the 10 000 and 5000 columns to those in the 20 000 column). Write the amount needed at your health facility in the empty column on the right.
According to a recent national survey, 50 or more of patients who report severe depression have used complementary and alternative therapies in an attempt to alleviate symptoms (Kessler et al. 2001). These approaches include cognitive techniques such as relaxation and biofeedback, oral medications such as herbal medicine and homeopathy, physical treatments such as massage and chiropractic, and other approaches such as spiritual healing and dietary modification. Most persons using these approaches also seek treatment professionally (e.g., by a psychiatrist, psychologist, or general physician), which provides an opportunity to assess for possible adverse effects of combining alternative therapies with pharmacotherapies (e.g., mild serotonin syndrome from mixing St. John's wort and SSRIs). Clinicians need to inquire about the use of complementary and alternative approaches, become familiar with current data on efficacy, and inform patients of any potential known risks. A recent...
Herbs may contain chemicals that have harmful effects. For example, the lily-of-the-valley plant contains potent heart toxins. Some herbs, such as chaparral and comfrey (or contaminants mixed in with the herbs), have been associated with a severe liver toxicity that has led to death or the need for liver transplantation. An example of a tragic case of liver injury was described in February 1999. A 28-year-old man with mild MS was treating his disease with zinc and two herbal medicines, scullcap and pau d'arco. He developed severe liver injury and died. The liver injury was believed to be due to a chemical contaminant in the scullcap.
Aromatherapy may be obtained from a practitioner or may be self-administered. It is sometimes combined with herbal medicine or traditional Chinese medicine. Aromatherapy may be provided on an individual basis or as informational classes. Individual sessions typically cost 60 to 80 and last about 60 minutes. Classes cost about 30 for 60 to 120 minutes.
For millennia mankind has sought relief from pain by using medicines. Ancient texts refer to the use of many herbal remedies for pain. In the first century Emperor Claudius' personal physician recorded detailed instructions on the preparation of opium and Galen recommended the juice of the poppy for the relief of pain in older persons. Cannabis was a remedy with known pain relieving effects in use in Ancient China 1 , Persia, India, Egypt, Greece and Rome. The bark of the willow (from which aspirin is derived) was one of the many herbal remedies used by Sumerian, Egyptian, Greek and Roman physicians. In Hippocratic writings it was praised for combating the pains of childbirth and fever 1 .
After 1789 the French Revolution gave hygiene a new political status. Revolutionary French hygienists enthusiastically followed the plan of rational medicine set by the philosophes, and used hygiene and preventive medicine as a stick with which to beat the forces of conservatism. Revolutionary hygiene progressed from being a lengthy article in the Encyclop die m thodique in the 1780s to becoming officially adopted as one of the rights of the healthy citizen, and one of the duties of the state, by the National Convention's Committee on Salubrity in 1793. Behind the scenes public hygiene had been a long time maturing. Plague deaths
Bleeding within neoplasm mimicking a stroke. A 59-year-old man, in good health, suddenly collapsed. A few hours later, he was lethargic, his left side was paralyzed, a mild right ptosis was present, and the right pupil was slightly larger than the left, indicating incipient transtentorial uncal herniation. Three days later, he died. His medical history was significant for excision of a cutaneous melanoma 9 years earlier. A noncontrast CT scan of the head shows (A) a large right frontal and (B) a small right occipital hyperdense lesion surrounded by hypodense edema with mass effect. The brain shows (C) circumscribed hemor-rhagic lesions corresponding to the large frontal and the small occipital lesions shown on the CT scan, and also a third small parietal lesion histologically, all melanomas.
This survey asks for your views about your health This Information will be summarized in your medical record and will help your doctors keep track of how you feel and how well you are able to do your usual activities. 1. In general, would you say your health is (circle one number) 2. Compared to one year ago, how would you rale your health In general now (circle one number) The following questions are about activities you might do during a typical day. Does your health limit you in these acllvllles If so, how much (circle one number on each line)
The ego psychologists were especially interested in the functioning of the ego and emphasized the importance of adaptation (Hartmann, 1958, 1964). Ego psychology set out to elaborate the various aspects of healthy functioning or ego-adaptive capacity. This aspect of psychodynamic theory was expanded by Horner (1994, 1995) and is an extremely valuable component of psychodynamic assessment, especially when conducting brief dynamic therapy.
In the industrialized countries diets have changed remarkably over the past 100 years. This dietary shift, combined with an increasingly sedentary lifestyle, is a major cause of many common diseases-heart disease, osteoporosis, tooth decay, high blood pressure, and diabetes. These disorders, so prevalent now, were rare before the 20th century. For thousands of years, humans adapted to and thrived on a diet radically different from today's diet.19,20 Looking at the diet of our ancestors provides an insight into what foods and nutrients humans were genetically designed to consume for good health.
Good health late in life depends largely on avoiding the major degenerative diseases associated with getting old. These common disorders greatly accelerate the aging process -preventing these conditions would allow many to live a healthy life well past the age of 100. (A detailed discussion of the nutritional prevention and treatment of each of these important disorders can be found in later sections. Cancer. The chances of getting cancer double every 10 years after the age of 50. The accumulated effects of poor nutrition and exposure to cancer-causing substances in the environment weaken the immune system and impair DNA repair mechanisms - making cancer more likely in lateryears. It is estimated that about 30-50 of all cancers are due to dietary factors.7 Proper eating habits, antioxi-dant supplementation, and a healthy lifestyle can dramatically reduce risk of cancer.
Recently, herbs were found in a pouch worn by a 5,200-year-old prehistoric frozen mummy ( Oetzi ) found in Northern Italy he is now on display in Bolzano, Italy. The first official compilation of herbal treatments was ordered by the King of Sumeria in 2000 b.c. and consisted of 250 substances. The ancient Greeks and Romans also produced written texts on herbal medicine, such as the Roman De Materia Medica from the first century a.d.
In general, how would you say your health is yourself your school work your ability to play sports your friendships the things you can do the way you get along with others your body and your looks the way you seem to feel most of the time the way you get along with your family the way life seems to be for you your ability to be a friend to others the way others seem to feel about you your ability to talk with others your health in general Compared to one year ago, how would you rate your health now How often has your health or behavior - limited the types of activities you could do as a
Put simply, each person has unique nutritional requirements. Depending on one's individual genetic makeup, striking variability can exist in the body's biochemistry. A nutrient intake sufficient for one person may be inadequate for another. For example, 2 mg day of vitamin B6 is adequate for good health in most people, yet some individuals with inherited defects in vitamin B6 metabolism need up to 30 to 100 times this amount.25 The absorption and daily requirement for calcium can vary four- to fivefold among healthy middle-aged women.26 Normal plasma concentrations for 1,25 (OH)2 vitamin D (the activated form of the vitamin) vary between 15 and 45 pg ml in healthy adults.9 In the 10 of the population who are heterozygous for the hemochromatosis gene (see pp. 68), dietary iron intakes that normally maintain health may be toxic in the long-term.27
The concern that to optimize all of the efficacy and ADMET parameters within a single molecule might be difficult, if not impossible, to achieve on a routine basis even when prodrug strategies are relied upon to address absorption and distribution properties was raised within the prior discussion about drug distribution. Alternatively, the use of two or more molecules that might work together as a team also presents itself as a possibility toward potentially achieving such a multiparameter optimized profile. That some herbal remedies appear to demonstrate greater benefits as their mixtures than as their isolated components adds to this intriguing possibility and thus prompts a brief consideration of this topic. Although today's trend in the US to self-administer herbal remedies and preventatives is admittedly driven
In a case reported by Chrisomalis et al.,75 a 30-year-old woman with CLL experienced repeated infections during pregnancy that were treated successfully with antibiotics. She was not treated for the CLL, as she was asymptomatic. In addition to her bone marrow, the intervillous spaces of the placenta were filled with mature-appearing lymphocytes consistent with CLL. The patient delivered a healthy newborn, and the patient and baby remained in good health 1 year after delivery.75 Welsh et al.76 reported a 22-year-old patient with CLL diagnosed at 35 weeks gestation with a WBC count of 45,400 L. She delivered a healthy infant at term. Four months following delivery, her WBC count decreased to 10,300 L without therapy. She continued to have a high percentage of monoclonal lymphocytes, but the absolute number decreased. The authors concluded that this represents an apparent spontaneous clinical but not clonal regression.76
Expected to grow as a larger percentage of the population develops obesity and diabetes. As a result of lifestyle changes, primarily in reduced smoking, improved diet and exercise, more aggressive preventive medicine, as well as modern improvements in detection, diagnosis, and treatment, the mortality rates from CHD in both men and women are significantly decreasing in western Europe and the US. Nevertheless, despite these improvements, nearly 25-30 of patients in the US still die within a year of their first heart attack.3 In contrast, from 1990 to 2002 the most dramatic and rapid increases in both CHD incidence and mortality have occurred in developing countries such as Russia, China, India, and the countries of Eastern Europe. Proportionate increases of smaller magnitude have also been observed in South America and Africa.3 While previously considered a disease attributed to the sedentary lifestyle and fatty diets of modern American and western cultures, more than 75 of deaths...
What happened when Myriad tried to expand its version of BRCA-testing services to Britain and the rest of Europe Would Myriad's technology and way of structuring the identities of clients and health-care professionals be neatly transferable to the British context And how would the British government, British scientists, British clinicians, and British patients respond to Myriad's attempt to insinuate its approach to BRCA testing into their institutions Would they be able to accept Myriad's definition of a good health outcome, or would they remain loyal to the British approach system encompassing the clinical and technical dimensions of the test, particular roles for testing system participants such as clients and health-care professionals, and specific definitions of a good health outcome into a cultural context that differed greatly from the one in which it had been built.
There are five components of traditional Chinese medicine. In addition to acupuncture, they include traditional Chinese herbs, diet and nutrition, exercise, stress reduction and counseling, and massage. T'ai chi, which is discussed elsewhere in this book, is also a component of traditional Chinese medicine. This chapter discusses acupuncture as well as two types of herbal medicine Asian herbal medicine and Asian proprietary (or patent) medicine.
Hospitalised AIDS patients, who take in only 70 of resting energy expenditure (REE) needs and 65 of protein needs, excluding the extra needs resulting from the hypermetabolism associated with fever, acute infections, and physical activity. Dietetic deficits in protein and calorie consumption interfere with the natural course of the main disease, emphasising subjective symptoms such as sickness, asthenia, anorexia, emesis, and constipation, which in turn interfere with feeding. A close relationship exists between susceptibility to infectious diseases and nutritional status regular nutrition and general good health make individuals more resistant to infections. Similarly, anergy to cutaneous tests (PPD, candidin, DNCB, etc.) is closely related to body-weight insufficiency and hypoalbuminaemia. The pre-surgical correction of denutrition reduces the incidence of post-surgical infectious complications, favouring the healing of the wounds and a quicker return to health 18-20 .
Older adults' perceptions of their health have been linked to a variety of objective health outcomes, including mortality. Depression affects subjective health concerns, as do certain personality traits. Neuroticism is inversely associated with self-perceptions of good health, whereas extraversion is positively associated in a recent study, these associations were stronger among persons age 75 and older than among persons in their 60s and early 70s (Du-berstein et al. 2003). This same study found that openness to experience correlated with higher functional status throughout the late-life age range.
However, in addition to the importance of controlling the total amount of dietary energy, food choices should be directed towards a balanced distribution of energy among nutrient sources. Epidemiological and experimental studies have led to the establishment of correct energy distribution among carbohydrates, fats, and protein, in order to prevent the onset of chronic diseases and to assure the maintenance of a good nutritional and health status. In this view, in the USA, more than 20 years ago, a Senate Select Committee stated that the energy distribution compatible with good health and that should be reached by the American population (dietary goals) should consist of 58 of energy from carbohydrates, 30 from fats, and 12 from proteins. Among carbohydrates, 15 of calories should derive from sugars and 40-50 from complex carbohydrates, while, among fats, 10 of calories should come from saturated fats and 20 from unsaturated fats 13 .
John's wort, a herbal remedy and a widely used antidepressant, has not been subjected to the rigorous clinical testing that most drug candidates currently in development receive. A number of case reports have demonstrated drug-drug interactions between St. John's wort and various drugs that are CYP3A4 substrates 91,92 . In women St. John's wort increased the clearance of oral contraceptives, which led to decreased circulating sex steroid levels and the loss of contraceptive efficacy 93 . Co-administration of St. John's wort also reduces the blood levels of HIV protease inhibitors and immunosuppressant drugs 94,95 . Recently Kliewer and colleagues demonstrated that these St. John's wort related drug interactions are due to activation of human PXR and subsequent induction of CYP3A4 expression 96 . Another example is paclitaxel, which is a widely used antineoplastic agent, an efficient human PXR activator, and a substrate of CYP3A4 and CYP2C8. The therapeutic efficacy of this drug...
These next questions ask about how your health affects your work. These next questions ask about how your health affects your work. 33. Work for short periods of time or take frequent rests because of your health 36. Work at your usual job, but with some changes because of your health (for example, use special equipment, trade tasks with other workers) 37. Fear losing your job because of your health
In most Ayurvedic texts, epilepsy is mentioned as Apasmara (or Apasmrti) and classified as a mental disease. As implied by its name, it involves partial or total loss of cognition (memory and sense-perception). Epilepsy (Apasmara), like several psychatric illnesses (Unmada), is attributed to humoral derangement. The original cause of such derangement lies in wrong conduct (mithyacara) and improper gratification of senses. The bodily humors deranged by such conduct gradually invade the sense-carrying channels of the body, causing loss of consciousness due to the gradual accumulation of tamas (inertia) inside the channels. Unusual physical activity in the shape of involuntary writhing, groaning, contortions of the limbs, and uncontrolled movements of the eyes are caused by the abnormal accumulation of rajas (potential energy) in other channels (4).
This group of questions refers to many types of physical and social activities. We would like to know how difficult it was for you to do each of these activities, on the average, during the past month. By difficult, we mean how hard it was or how much physical effort it took to do the activity because of your health. Circle the number f you usually had no difficulty doing it f you usually had some difficulty doing it f you usually had much difficulty doing it f you usually did not do the activity because of your health or f you usually did not do the activity for other reasons. f you usually had no difficulty doing it f you usually had some difficulty doing it f you usually had much difficulty doing it f you usually did not do the activity because of your health or f you usually did not do the activity for other reasons. 15. Are you unable to do certain kinds or amounts of work, housework, or schoolwork because of your health 16. Does your health keep you from working at a job, doing...
Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven Yale University Press, 1923), 30. Winslow was a forceful US campaigner Arthur Newsholme was a key figure in the United Kingdom see John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885-1935 (Cambridge Cambridge University Press, 1997) Newsholme, Evolution of Preventive Medicine (London Baliere, 1927). On public health nursing, see Christopher Maggs, 'A General History of Nursing 1800-1900', in Bynum and Porter (eds.), Companion Encyclopedia of the History of Medicine, ii and Maggs (ed.), Nursing History The State of the Art (London Croom Helm, 1987). On hygiene advertising and industry-led hygiene initiatives, see Nancy Tomes, The Gospel of Germs Men, Women and the Microbe in American Life (Cambridge, Mass. Harvard University Press, 1998), 117-23, 247-52, and Juliann Sivulka, Stronger than Dirt A Cultural History of Advertising Personal Hygiene in North America (Amherst, NY Humanity...
In clinical medicine today there is a growing demand for adequate proof of the efficacy of this or that form of treatment. Often proof can come only by means of a collection of records of clinical trials devised on such a scale and in such a form that statistically reliable conclusions can be drawn from them. However great may be our aversion to figures, we cannot escape the conclusion that the solution of most of the problems of clinical or preventive medicine must ultimately depend on them (30).
Caffeine is perhaps the most commonly used stimulant in the world. Several plants produce caffeine and theophylline and theobromine, which are close relatives of caffeine. Most people readily know that coffee (Coffea arabica and C. robusta) and tea (Camellia sinensis) have caffeine in them, but several other herbal medicines also contain caffeine. Cocoa (Theobroma cacao) is the main ingredient in chocolate-flavored foods, from candy bars to hot cocoa. There are usually 20 to 60 milligrams of caffeine in an average chocolate bar (200 grams of chocolate). That isn't a lot of caffeine, but eating several pieces of chocolate, particularly dark chocolate, can add up to a significant amount. It also takes the body several hours to process caffeine, so eating several pieces throughout a day can have a cumulative effect. Cocoa also has higher amounts of theobromine in it, which acts in a manner similar to caffeine.
The most popular herb sales in the United States include Echinacea (10 ), garlic (10 ), goldenseal* (7 ), ginseng (6 ), Ginkgo (4.5 ), and saw palmetto (4.4 ). * Goldenseal is often used illicitly in unsuccessful attempts to disguise urinary marijuana (THC) metabolites. There are no toxicologic databases on herbal and vitamin toxicity in the United States. In Hong Kong, herbal medicine toxicity accounts for less than 1 of all acute hospital admissions, and Western medicine toxicity and drug-drug interactions account for 4.4 of all acute hospital admissions. Fatalities have resulted from megadoses of the fat-soluble and lipophilic (stored in liver and brain) vitamins A, D, and E and therapeutic (homeopathic) doses of niacin and tryptophan.
One of the more popular forms in the United States is hatha yoga. Three main components of yoga are breathing, movement, and posture. A series of body postures and movements, known as asanas, are performed. Deep, slow breathing is done in conjunction with the body movements. Specific breathing exercises, referred to as pranayama, also are done. Different types of yoga have different levels of exercise intensity and posture difficulty. In addition to these physical activities, yoga may include meditation, ethical guidelines, and diet recommendations.
Two Asian herbal mixtures of the same nine herbs have been reported to have similar antiepileptic efficacy Japanese sho-saiko-to (or saiko-keishi-to) and Chinese chai-hu-keui-chi-tang (bupleurum-cinnamon combination) (14). These are composed of Bupleurum falcatum (thorowax) root, Paeonia lactiflora (peony) root, Pinellia ternata (ban xia) rhizome, Cinnamomum cassia (cassia) bark, Zingiber officinale (ginger) rhizome, Zizyphus jujuba (jujube) fruit, Panax ginseng (Asian ginseng) root, Scutellaria baicalensis (scullcap) root, and Glycyrrhiza uralensis (licorice, gan cao) rhizome in differing ratios (14). Animal studies show that this herbal mixture may prevent seizures by inhibiting the effects of calcium or by affecting cyclic nucleotides in nerve cells (15). A similar mechanism may explain the antiepileptic affect of Coleus forskohlii, an important herb in the Ayurvedic treatment of epilepsy (14). Some human studies on these Oriental herbal mixtures have been reported, but some are...
On the basis of current evidence, acupuncture and Asian herbal medicine, both of which are components of traditional Chinese medicine (TCM), should be approached differently by people with MS. Acupuncture is of low risk, is possibly beneficial, and may be a reasonable treatment option for some people with MS. In contrast, Asian herbal medicine should be considered with caution by people with MS, especially for use on a long-term basis. Reports of treatment benefits using this therapy cannot be fully evaluated because of the lack of published information in English. Some herbs may be toxic or may stimulate the immune system, and the safety of long-term treatment has not generally been established.
The reasons why people with MS pursue CAM are as varied as the different CAM modalities used. Curing MS is not a frequently cited reason for using CAM. Common reasons include decreasing the severity of MS-associated symptoms, increasing control, improving health, and using a method that accounts for the interrelation of mind, body, and spirit. Some people are drawn to CAM because of the lack of effectiveness of conventional medications and anecdotal reports of benefits or recommendations from friends, relatives, or physicians (5,8,12). One study of CAM use in people with MS and other chronic diseases concluded that CAM was an important component for self-care and was not generally embraced as a rejection of conventional medicine or an unrealistic search for a cure (15).
Blue cohosh (Caulophyllum thalictroides) is used as an anticonvulsant, to increase menstrual flow, and to induce labor. A national survey of the certified nurse-midwives who endorse herbal medicine use found that 65 used it in labor. The active agent, methyl-cytisine, is similar to but less potent than nicotine. Synonyms for blue cohosh are blue ginseng, caulophyllum, papoose toot, squawroot, and yellow ginseng. Common trade The simple answer is that none are proven to work for epilepsy. Doubleblind studies find that placebos can significantly reduce seizures in up to 25 to 30 of epilepsy patients. Thus, it would be remarkable if small studies of any substance did not show some effectiveness, but what is the evidence Drs. Conry and Pearl take a hard and close look at the evidence. Their review of the published literature reveals that the risks might actually outweigh the benefits, but that, ultimately, we are working with very limited information. The jury is out. It is leaning away...
The use of IA-HA is now recommended in the guidelines for treating knee OA published by the American College of Rheumatology (24) and the European Union of Leagues Against Rheumatic Disease (25). The most comprehensive systematic review of randomized clinical trials (RCTs) evaluating IA-HA for the treatment of knee OA was recently published in the Cochrane Library of evidence-based medicine (26). The Cochrane review identified 63 RCTs of IA-HA, of which 37 compared IA-HA to intra-articular saline or another control (placebo) intra-articular procedure. The review concluded that the benefit of IA-HA was statistically significant and clinically important. Several other systematic reviews of IA-HA published in medical journals drew similar conclusions (27,28) though in one, the clinical importance of the benefit was considered no better than the clinical benefit of nonsteroidal anti-inflammatory drugs (NSAIDs) over acetaminophen (28). Several randomized pragmatic trials have evaluated the...
Oxindole CDK inhibitors related to the pan-kinase inhibitor indirubin 56 isolated from Chinese herbal medicine 117,118 have been reported by several companies Sugen (now Pfizer) 119,120 (57), Hoffman La Roche 121 (58), Boehringer Ingelheim 122 (59), and GlaxoSmithKline 123 (60). Many of these analogs were very potent inhibitors of the CDKs and exhibited excellent anti-proliferative activity against tumor cell lines. The series from GlaxoSmithKline 123 is selected here to exemplify this class of inhibitor and illustrate how, through the use of X-ray crystallography, modeling, and SAR studies, activity and selectivity were optimized.
Marijuana has been used since antiquity, and it can be found in numerous ancient texts. The oldest known reference to marijuana is in a 15th-century B.C. Chinese text on herbal remedy (Walton, 1938). Also, Assyrian cuneiform tablets from 650 B.C. that contain references to people smoking marijuana are generally regarded as obvious copies of much older texts, according to Walton. Although archeological findings in Berlin, Germany, suggest that marijuana was in Western Europe by 500 B.C., an exact date or extent of use is unknown. However, hemp-based clothing was widespread in central and southern Italy, and the intoxicating effects of marijuana were also recorded in Renaissance texts. In Europe, it was quite popular in 19th-century high society. In the United States, in the beginning of this century, it was popular principally in the West and was mostly associated with ethnic groups and jazz musicians. Marijuana's social stigma, epitomized in the now-popular classic cult film Reefer...
Overall, Myriad characterized BRCA testing as an unprecedented technology that could improve the lives and health care of women and was distinct from other risk-assessment services that had previously been available. Furthermore, it could be offered without specialist care or counseling, because the laboratory analysis itself identified specific risks and could trigger certain treatment recommendations. As the company promoted its novel technology, which identified new risks and disease and could also direct clients to new treatments, it also articulated a specific definition of a good health outcome to identify and treat mutation-positive individuals. The company argued that this identification process was useful not only because knowing one's mutation status would provide peace of mind but also because a variety of clinical management options were available for this newly identified class of at-risk individuals. As we will see, however, this goal was quite different from the one...
Every patient should be asked about his her smoking status during each visit consultation. As the guidelines stipulate, the physician then advises the patient to quit smoking with a clear ( It is important for you to quit smoking now, and I can help you. Cutting down while you are ill is not enough. ) and strong statement ( As your physician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you. ). The advice should also be personalized for the patient, highlighting his her particular situation. For example, the advice may be tied to the patient's health ( Your smoking is not only prolonging your cough, it is putting you also at risk for long-term respiratory problems, such as chronic bronchitis or emphysema. ) or the impact smoking might have on children ( You are putting your children at risk of asthma, ear infections and other diseases by exposing them to second-hand smoke...
Padma 28, also known as Badmaev 28 and Gabyr-Nirynga, is a complex mixture of herbs sometimes recommended for MS. This herbal combination was developed in the late nineteenth century in the Buryat region of the Russian Empire by two physicians, Sul-Tim-Badma and Zham-Saram-Badma, also known as Dr. Alexander Badmaev and Dr. Peter Badmaev. The practices of these physicians were influenced by traditions of Ayurvedic and Tibetan medicine. Padma 28 is taken by mouth and contains more than 20 different herbs and calcium. It appears to have antioxidant effects and may mildly decrease immune system activity.
Although clinical measurements of functional status were often used for the elderly, clinicians and researchers paid little or no attention to early non-clinical publications by psychologists, which described surveys using indices to appraise happiness and psychological well-being. One study, in 1953, used objective measures that included good health, financial security, hobbies and interests, friends, living with one's spouse, age, and sex. Another study, in 1961, used subjective measures expressed as a life satisfaction scale and two smaller life satisfaction indexes. As a specific concept, the term quality of life (rather than quality of survival) seems to have entered the medical literature in a 1966 article about medically indigent patients receiving hemodialysis. After noting that the post dialysis medical problems included sepsis and cannula clotting, the authors concluded that, while an effective degree of life prolongation was obtained for some of these patients, for most,...
This group of questions refers to many types of physical and social activities. We would like to know how difficult it was for you to do each of these activities, on the average, during the past month. By difficult, we mean how hard it was or how much physical effort it took to do the activity because of your health. Circle the number 1 if you usually did not do the activity because of your health or 0 if you usually did not do the activity for other reasons.
A functional drink can be defined as one that offers the consumer additional perceived benefits besides its primary function, which is hydration - the maintenance of body fluid at a suitable level. The benefits are usually directed towards some aspect of maintaining good health or coping with the pressures of modern lifestyles. A range of functional ingredients, including herbal extracts, is available to the formulator of functional drinks.
Self-sufficient, not self-sufficient and institutionalised 30 . Besides, nutritional examination in a selected healthy elderly population would not show variations in dietary patterns in fact, they try to maintain the food habits because of a reduction of the adaptation capacity with age 31 . Elderly people's associations with food are more emotional than those of younger adults for some, food intake is the main event in the course of the day, often providing the only possibility of social contact 31 . The elderly have repeatedly been told that good food means good health 31 . So, the elderly may eat simply because they know they have to, even if they do not feel like eating, or they may eat because the food is delivered and throwing it away would be wasteful 32 .
The new universities fed the early medieval 'Romanesque' enthusiasm for literacy, culture, and self-improvement. The message of the health-conscious regimen was strongly promoted by the new university-trained medici, supported by Romano-Islamic classical scholarship such as that of the comprehensive, easy-to-memorize, four-volume Canon of Medicine by Ibn Sina (Avicenna 980-1037). The physicians were eager to get classical preventive medicine on board alongside their other 'cures', and profited well from it their personally tailored regimens and consilia (letters of advice) were available to anyone who could afford them. Throughout Europe there were growing numbers of manuscript tracts and volumes for general readers on all subjects religious and secular and roughly 3 to 4 per cent of these were medical works.16 Evidently one had to be 'wise in science' at court. Encyclopedic 'books of secrets' (such as the famous Aristotle's Secrets) could be read or memorized in short bursts, as well...
The ubiquitous expression of annexins means that they are superficially unattractive targets for drug development. Recently however it has been shown that Withaferin A, a steroidal lactone derived from Indian Ginseng which has been widely used in traditional Indian medicine, specifically binds to annexin 2 and has dramatic effects on cancer cell lines by modifying their actin cytoskeleton (Falsey et al., 2006). It is cytotoxic to cancer cell lines and is thought to alter the actin binding properties of annexin 2. Derivatives of this compound are finding uses as markers for angiogenesis and the compound itself has potent anti-angiogenic properties (Yokota et al., 2006 Mohan et al., 2004). This is congruent with the observation that the annexin 2 knockout mouse is incapable of pathological neo-angiogenesis, and with the proposed role of annexin 2 in the migration of new blood vessels (via tissue plasminogen activator, plasminogen and matrix metallo-proteinases MMPs) (Ling et al., 2004).
In the 1960s and 1970s naturism and wealth coincided on the warm and sunny Pacific coast of California, and produced a luxurious 'New Age' theology of body culture that ultimately became the 'well-being sector'. 'Hippie' teenagers who grew up in the 1970s and 1980s formed the core group of affluent health enthusiasts who rediscovered multicultural medicine in the 1980s and 1990s and in the United States, where personal health insurance was expensive or simply not affordable, and individual preventive health care strategies were even more essential, New Age holism was rapidly adopted and massmarketed as a new moral 'wellness' crusade 'Your health is your responsibility don't just sit there, do something,' as one American best-seller energetically put it.45
Many survivors are at risk of obesity, low bone density, and have poor body image. A healthy lifestyle involving exercise may be a first step toward minimizing these late effects of cancer. Participation in sports activities among survivors seems to be similar to the general population. Survivors who participate in sports were more likely to report having access to health insurance and medical care by a local physician, although there were no differences based on age, race, socioeconomic status, body mass index, time since diagnosis, length of treatment, and time since completed treatment 30 . Males were found to exercise more than females, a difference typically also found in the general population.
editation is a type of mind-body therapy, a class of therapies that also includes biofeedback, hypnosis, and guided imagery. For thousands of years, meditation has been practiced in some form, especially in the context of religious practice. Also, meditation is one of several components of some complementary and alternative medicine (CAM) therapies, including Ayurveda (which uses transcendental meditation or TM) and traditional Chinese medicine.
'The cleanliness of the rest of your person, which, by the way, will conduce greatly to your health, I refer from time to time to the bagnio,' remarked Chesterfield casually, but not urgently.9 He might have known better than to send his son to France with that advice or perhaps he assumed that French aristocratic males merely looked on while their womenfolk bathed and sluiced. In France the aristocratic tendre for cosmetic cleanliness that had developed during the seventeenth century had reached a new peak of perfection by the eighteenth century. It had virtually become a symbol of their class. The cultic aspects of the boudoir came from the French royal ritual of the levee, the morning toilette conducted in the royal bedroom suite with an audience of kin, intimate friends, and favoured counsellors, an old custom of monarchs that had been perfected by Louis XIV, and which spread throughout the French nobility a new and highly favoured grooming pleasure zone, full of objets d'art.10...
Thirty years have passed since the PGA suture was first used in hospitals. Safety is the most important factor to be considered for medical materials directly applied to the human body, and this is particularly true of the degradable and absorbable biomaterials which are most commonly indwelled in the human body. Most of the degradable and absorbable biomaterials described in this chapter are designed as substitutes for the currently used materials in hopes of securing better quality of life (QOL). Since no other materials can substitute for degradable and absorbable biomaterials, their safety must be thoroughly examined. Because time is required for this, it will take some time for these materials to become clinically available on a large scale. We all hope to live a healthy life without excessive assistance. The degradable and absorbable biomaterials are being developed for this purpose, and they will soon become indispensable for reconstruction and as scaffolds in regenerative...
In the setting of a poor functional age, serious comor-bid medical conditions, and particularly patient preference, less intensive chemotherapy or aggressive supportive care may be more appropriate treatment options. Drugs such as hydroxyurea (generally given in doses of 500-3000 mg day, adjusted to the degree of leukocytosis and or treatment-related thrombocytopenia) and low-dose ara-C (at a dose of 10 mg m2) are well tolerated and will reduce leukocytosis for a period of time, though neither will impact survival.96 We use the phrase aggressive supportive care to emphasize that symptoms will be treated vigorously and to distinguish this modality from hospice. Blood and platelet transfusions should be administered to alleviate symptoms stemming from anemia and thrombocytopenia, and antibiotics initiated when appropriate. In addition, integrative therapies such as Reike, therapeutic touch, and herbal medicines may be used by the willing patient. These latter interventions often can be...
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