homeopathy III: thuja

some study questions on the homeopathic remedy thuja occidentalis.












questions
1. etiology of thuja. †
2. characteristic while answering / speaking... √
3. closely related to which remedy?√
4. two questions to ask thuja patients in an interview.√
5. eccentric or conformist?√
6. similarities to calc carb?√
7. similarity to lycopodium?√
8. role of lying?√
9. hard for thuja to believe what about others?√

10. left or right sided?√
11. worse with what weather?√
12. worse at what time?√
13. worse with which foods?√
14. relationship to smallpox?√
15. skin on the face?√
16. hair?√
17. hair in women?√
18. nasal symptoms?X
19. aversion to which family of veggies?√
20. 3 female genitalia symptoms?√
21. keynote urinary symptom?√
22. prostatic symptoms?√
23. skin conditions?X
24. worse with what weather?√

25. easy dislocation of what in children?√
26. dreams of...√
27. what happens during the course of the night?√
28. sweat?√
29. abdomen feels as if...√
30. worse or better with motion?√
31. worse or better with warmth?√
32. worse or better with open air?√


answers
1. suppression of warts
vaccination
gonorrhea
abuse, mistreatment
2. sentence might dwindle off into a mumble.
3. metorrhinum.
4. 1-- whether they think they are lovable if someone truly knew them inside. 2-- whether they feel attractive.
5. conformist.
6. worse with cold and damp
craves sweets
warts
7. lack of self esteem.
8. very good at lying, may even start to believe their own lies.
9. that they are sincere.

10. left.
11. damp.
12. 1-3PM
13. onions, garlic, tea.
14. thuja is worse after smallpox vaccination.
15. greasy, pale, waxy, acne.
16. greasy, or dry and sticking up.
17. hair growth on the face.
18. thick green catarrh.
19. brassicas.
20. urethral discharge
history of gonorrhea
left ovarian pain.
21. forked urinary stream.
22. dribbling, waking to urinate.
23. warts, especially around anus and horny warts around hands. condylomata.
24. cold and damp.

25. easy dislocation of hip joint in children.
26. falling, dead people.
27. wakes at 3AM and is sleepless.
28. profuse, like onions or honey. only on uncovered parts.
29. animal were alive inside.
30. worse.
31. better.
32. better.

homeopathy III: nat mur

some study questions on the homeopathic remedy natrum muriaticum, homeopathic salt.









questions
mental/emotional...
1. central idea in nat mur?†
2. describe the way a nat mur patient might talk about an emotional experience.√
3. nat mur is a main remedy for which rubric? (ailments from...)
4. in what way does Lot's wife (from the Bible) represent nat mur?√
5. relationship to music?√
6. relationship to crying?√
7. consolation?√
8. "goal in life is to"...√
9. how is nat mur like a "stuck door"?√
10. relationship to sunlight?√
11. characteristic fear?√
12. typical occupations?†
13. how do nat mur patients act when romantically attracted to someone?√
14. what is one thing that can break down the inhibitions of a nat mur patient?√

physical...
15. in which system(s) is retention found for nat mur patients?X√
16. body temperature?√
17. describe the typical nat mur headache. X√√
18. nasal symptoms?X†√√
19. facial features?√
20. typical throat symptom?X√
21. thirsty for what type of drinks?√
22. unique urinary characteristic?√
23. skin features?X√
24. food cravings? (6)XX√
25. food aversions? (4)X√
26. miasm?XX√

answers
1. introversion due to vulnerability to emotional injury.
2. unemotional, objective tone.
3. ailments from disappointed love.
4. dwelling on past disagreeable experiences.
5. very sensitive to music.
6. cries only when alone, but resists crying in general.
7. aggravates.
8. not be hurt, and avoid hurting others.
9. the tendency to keep emotions inward to the point where they burst out in inappropriate ways periodically (hysteria, awkward laughing), similar to the way a stuck door will suddenly burst open after pulling incessantly.
10. bothered by sunlight.
11. fear of robbers.
12. counseling, ministry, social work (sympathy)
13. reserved.
14. alcohol; wine.

15. urinary retention, constipation, amenorrhea.
16. tend to be warm, worse with heat.
17. headache 10am-3pm coming and going with the sun.
18. coryza like raw egg whites. allergic rhinitis symptoms.
19. oily skin, pimples, and herpetic eruptions around lips.
20. lump in throat. related to grief.
21. cold water.
22. can't pee in front of others.
23. eczema, urticaria, herpes.
24. bitter, beer, sour, salt, fish, milk.
25. bread, meat, coffee, tobacco.
26. psoric and syphilitic.

homeopathy III: staphysagria

some study questions on the homeopathic remedy staphysagria...









questions
1. staph is used to treat...
2. etiologies for staphysagria?
3. haughty or humble?
4. emotion seen in later stage of staphyagria?
5. sensitive to...
6. commonality between causticum and staph?
7. confrontations might cause...
8. one patient archetype to consider?
9. worse from suppression of...
10. refined or coarse?
11. keynote of doing what when alone?
12. what type of depression?
13. aggression can be linked to...
14. a remedy for intense...
15. miasm?

16. indicated for any neurological problem brought on by...
17. indicated for what type of children?
18. indicated for complaints following first...
19. first remedy to consider for what bladder condition?
20. indicated for complaints from stretching...
21. staph temperature?
22. worse from letting the mind dwell on...
23. better after? (3)
24. head feels like...
25. head symptoms especially after...
26. hair symptom?
27. eye symptom?
28. mouth symptoms? (2)

29. food cravings?
30. thirst level?
31. colic following what? (3)
32. rectum symptoms?
33. type of GU pain?
34. keynote in honeymoon cystitis?
35. males: impotence after...
36. remedy for psoriasis following...
37. keynote: something about afternoons...
38. perspiration?

answers
1. wounds and scars, wounds that penetrate, wounds that do not heal properly.
2. humiliation, mortification, injury to ego, ailments from physical abuse, ailments from domination.
3. more often humble.
4. anger.
5. rudeness, grief.
6. etiology of repeated grief.
7. physical and emotional spasms, speechlessness.
8. battered women.
9. anger.
10. refined.
11. talking to themselves.
12. resigned sadness, not suicidal.
13. sexuality.
14. sexual fantasies, especially with masturbation.
15. sycotic.

16. suppressed grief or anger.
17. children who become autistic or retarded from slight suppression.
18. coition.
19. honeymoon cystitis.
20. sphincters.
21. not distinct-- either hot or cold.
22. sexual objects.
23. hard pressure, breakfast, warmth.
24. block of wood.
25. sexual excesses, coition.
26. alopecia after grief.
27. long lasting sties on eyelids.
28. tooth decay, apthous ulcers

29. sweets, milk, bread, tobacco.
30. low thirst.
31. anger, cold drinks, or least food or drink.
32. painful hemorrhoids, especially after suppressed anger.
33. stinging, stitching, shooting pain.
34. burning in urethra when not urinating.
35. sexual excess.
36. grief or mortification.
37. aggravated by afternoon naps.
38. profuse, with rotten egg smell.

homeopathy III: mercurius

some study questions about the homeopathic remedy mercurius, which is homeopathically diluted and potentized mercury.









questions
1. kent suggests what about the use of mercury?
2. mercury state can be summed up by which words?XX
3. temperature disposition?√
4. temperature aggravation?√
5. only thing that helps the mercury patient when disturbed by their environment is...√
6. what time of day aggravates?√
7. aggravated by lying on the...√
8. glands?√
9. miasm?√
10. what type of discharges?√
11. quality of discharges?√
12. nervous system symptoms?√
13. tendency towards formation of...√
14. how can acute wounds for mercury be distinguished from aconite / belladonna?√

15. similarity to arsenicum album?√
16. delusional feeling as if...√
17. headache sensation?√
18. headache aggravation?XX
19. appearance of tongue?X√
20. thirst?√
21. what type of taste in the mouth?√
22. mercury can be as important as pulsatilla in which disorder?√
23. mercury is a major remedy for which disorder involving the tongue?√

24. eye symptoms worsened by...√
25. cravings?√
26. food aversions?√
27. PMS characteristics?√
28. lactation?√
29. consider in cases of which STD?√
30. bone involvement?√
31. skin symptoms?√

32. merc-cor indicated for...√
33. merc-iodatum flavum indicated for...√
34. merc-iodatum rubrum indicated for...√

answers
1. not to use more than twice in the winter to treat colds.
2. debility, sluggishness, weakness, oversensitivity.
3. very chilly, but easily overheated.
4. aggravated by the least cold, as well as by heat.
5. lying down and resting.
6. aggravated at night.
7. right side.
8. swollen, inflamed, tender, hardened.
9. syphilitic.
10. profuse, especially saliva and sweat.
11. offensive, acrid.
12. fine tremors, epilepsy, emaciation.
13. pus.
14. both are initially red and inflammed, but mercury then turns to pus formation and is slow in healing.

15. anxious restlessness.
16. he had committed a crime.
17. band around head.
18. worse night and worse in a draft.
19. indented, swollen, flabby.
20. intense thirst for cold drinks.
21. metallic.
22. otitis media.
23. stuttering.

24. heat, radiant heat.
25. bread and butter, alcohol.
26. sweets, diary.
27. anxious restlessness before menses, milk in the breast during menses.
28. mastitis during lactation.
29. syphilis.
30. destructive bone diseases such as osteomyelitis.
31. severe itching, worse from heat of the bed.

32. more intense, excoriating presentations of mercury.
33. sore throat with more inflammation on the right side.
34. sore throat with more inflammation on the left side.

botanical medicine: cardiovascular herbs

this lecture covered the herbs used to treat various cardiovascular conditions. allium sativa, or garlic, is one example; it affects the vascular system by several proposed mechanisms, including stimulating intracellular activity of nitric oxide synthase, which produces nitric oxide, a potent vasodilator. it also works to inhibit the cyclooxygenase enzyme, which produces inflammatory mediators from arachadonic acid- this effect is perhaps more pronounced with raw garlic. on the other hand, the oil produced from steaming garlic is high in sulphur compounds such as diallyl disulfide, which are thought to be antimicrobial and mucolytic. it might be helpful for diabetics by making more insulin available in circulation by competing for insulin binding sites in the liver. finally, garlic is thought to increase NK cells, thereby boosting innate immunity.

angelica sinensis, or dong quai as it is known in chinese medicine (as a blood mover / yin tonic) is another herb useful for cardiovascular conditions. it has vasodilating effects due to nicotinic acid and antispasmodic effects due to ferulic acid, which is thought to have calcium channel blocking effects. it is relaxing for uterine tissue and thus is indicated in some female hormonal conditions such as cramping and dysmenhorrea.

crataegus oxycantha, or hawthorne is an herb that is useful both in acute care as well as long term chronic management of cardiac cases. it has positive inotropic effects (increasing myocardial contractility), stabilizes capillaries via flavonoids, acts as a natural calcium channel blocker via procyanidins (which inhibits phosphodiesterase), and lowers blood pressure by inhibiting ACE and thus aldosterone.

gingko biloba is an herb commonly associated with increased mental clarity, which is thought to be due to increased cerebral artery perfusion. it also has beneficial effects on the vascular system, increasing coronary artery perfusion, enhancing peripheral vasodilation and also acting as an antioxidant via flavonoids and super oxide dismutase. because of its antioxidant effect it can be indicated in cases of hypoxic tissue damage.

one of the few herbs that is indicated specifically for hypotension rather than hypertension is selenicerues grandiflora, or cactus as it is commonly known. it is indicated in cases of weak heart muscle, as in CHF, mitral / aortic insufficiency, and even some arrhythmias. it is used more for functional, rather than organic disorders, and is especially indicated for a sensation of a heavy band in the chest.

a couple herbs with specific applications: leonurus cardiaca is a cardiotonic that is specific for the pelvic area and the vasculature, much like angelica (see above). thus it is used in cases of palpitations associated with pelvic pain, hormonal imbalances, or menstrual complaints. it might also have beta-blocking activity as well as improving blood viscosity. mentha piperita is an herb used specifically when angina occurs after a heavy meal, accompanied by digestive complaints such as gas and bloating. it is in fact part of the "glyconda formula", an eclectic formula used to treat cardiovascular complaints associated with gastrointestinal symptoms.

there are a number of herbs used to treat various pathologies of the peripheral vasculature. yarrow is an astringent that can be applied topically to wounds as well as internally; where it has vasodilatory effects in the peripheral vasculature and vasoconstrictive effects in the uterus. horse chestnuts aids in venous return and is therefore indicated in disorders such as varicose veins, and also has immune modulating effects via lectins. pineapple contains the sulfur-rich bromelain, which is thought to have thrombolytic effects, so much so that it might be used pre-surgery to reduce the risk of clots.

other peripheral vascular herbs: capsella (shepard's purse) is an herb used to stop chronic bleeding, especially uterine bleeding. stone root is a specific for constipation due to vascular engorgement of rectal mucosa and is also specific for congestion of oral, urinary, rectal mucosa. witch hazel is an astringent that can be applied topically or ingested, indicated for pale, engorged, congested tissues. hypericum is better known for its emotionally uplifting effects but also aids in venous stasis and varicosities due to the high flavonoid content. ruscus is in the lily family and contains rescogenins that have vasoconstrictive and anti-inflammatory effects. red clover is more commonly used to for female hormonal balance, but it also has circulatory actions, via the coumarins it contains, which improve blood lipids, reduce inflammation and reduce platelet aggregation. vaccinium, or bilberry contain anthocyanosides which have powerful antioxidant properties, and are stabilizing for capillaries as well. veratrum is an herb that can be used carefully in acute or severe cases of hypertension, indicated in a bounding pulse or flushed face. at higher doses, it acts as an emetic and thus must be used cautiously.

questions...
allium sativa...
1. what compounds does garlic contain that affect vascular endothelium?
2. how does garlic thin blood?
3. raw garlic has more of what effect?
4. which compounds are in garlic oil and result from steam processing?
5. how does garlic affect blood sugar?
6. garlic's effect on the immune system?
7. garlic's effect on inflammation?

angelica sinensis...
8. which family is angelica in? what compound is found in high quantities in this family?
9. antispasmodic effects due to which compound? what does this compound do?
10. vasodilating effects due to which compound?
11. used in chinese medicine for what purpose?

crataegus oxycantha, monogyna...
12. chemical consituents in crataegus?
13. describe the overall effect of hawthorne on the CV system.
14. flavonoids in hawthorne have what effect?
15. indicated for hyper or hypotension?
16. mechanism for lowering blood pressure?
17. mechanism for calcium channel blocking effects?
18. hawthorne berries are high in what compounds in the spring vs. the fall?
19. useful in CHF along with which other nutrient?

ginkgo biloba...
20. increases blood flow to...
21. main active constituent?
22. antioxidant actions via...
23. also used for what conditions due to cerebral perfusion?
24. why indicated for diabetics?

selenicereus grandiflorus...
25. indicated for hyper or hypotension?
26. indicated for functional or organic disorders?
27. specifically indicated for what chest sensation?

leonurus cardiaca...
28. what areas of the body is motherwort specific for?
29. leonurus injections were shown to improve...
30. 2 specific indications for leonurus.

mentha piperita...
31. most indicated for...
32. part of which formula?
33. contraindicated in which patients? why?

peripheral vasculature herbs...
34. yarrow's action in the peripheral vasculature?
35. yarrow's action on the uterus?
36. yarrow's topical effect?
37. horse chestnut's effect on vasculature?
38. [37] attributed to what compound?
39. horse chestnut immune effect via which compounds?
40. pineapple high in which compound?
41. pineapple used pre-surgery for...

more peripheral vasculature herbs...
42. shepard's purse used for...
43. capsella might be contraindicated in pregnancy because of...
44. capsella also contraindicated in people with...
45. stone root specific for which areas?
46. specific GI condition that might benefit from stone root?
47. witch hazel indicated in...
48. hypericum high in which compound?
49. cardiovascular indications of hypericum?
50. mechanism of action for hypericum?
51. what family is ruscus in?
52. active constituents of ruscus? actions?
53. indications for ruscus? affinity for which tissue?

54. active constituent in red clover?
55. effect of [54]?
56. active constituents in vaccinium?
57. effect of [56]?
58. why is bilberry particularly indicate for diabetics?
59. active constituents of veratrum viride?
60. effect of [59]?
61. veratrum effect at high doses?
62. black haw's effect is similar to what other herb?

answers
1. nitric oxide like compounds.
2. by inhibiting platelet aggregation.
3. it is more of a inhibitor.
4. diallyl disulfide and diallyl trisulfide.
5. competes with insulin binding sites on liver, allowing for more insulin to be in circulation, allowing for blood sugar stabilization.
6. increases NK cells.
7. COX inhibitor.

8. umble family, coumarins.
9. ferulic acid; ca-channel blocking effects.
10. nicotinic acid.
11. blood mover and blood builder.

12. flavonoids, tannins, organic acids, sterols, purines, triterpines.
13. normalize blood pressure, positive inotropic activity, diuresis.
14. stabilize capillaries to reduce permeability and fragility.
15. both.
16. inhibits ACE, which leads to a decrease in aldosterone and thus decreased water retention.
17. procyanidins inhibits phosphodiesterase, which breaks down cAMP, leaving higher calcium levels.
18. amines (spring) vs. bioflavonoids.
19. CoQ10.

20. cerebral arteries, carotid arteries.
21. flavonoids; ginkgo heterosides.
22. super oxide dismutase, flavonoids.
23. tinnitus or ear congestion.
24. to increase peripheral perfusion and prevent retinopathy, nephropathy, gangrene, etc.

25. hypotension.
26. functional.
27. band squeezing the chest.

28. pelvis and vasculature.
29. blood viscosity.
30. heart palpitations associated with pelvic pain or hormonal imbalance such as hyperthyroid.
e31. angina that occurs after eating accompanied by digestive symptoms.
32. glyconda.
33. patients with GERD, due to relaxing effects on LES.

34. peripheral vasodilator.
35. promotes constriction of uterine blood vessels.
36. astringent; aids in wound healing.
37. increases venous returns.
38. coumarins.
39. lectins have many immune modulating effects.
40. bromelain.
41. to reduce risk of clotting.

42. to stop chronic bleeding, especially from the uterus.
43. alkaloids.
44. high blood pressure.
45. oral, urinary, rectal mucosa.
46. constipation due to vascular engorgement of rectal mucosa.
47. pale, engorged, congested tissues.
48. hypericin, a bright red flavonoid.
49. venous stasis, varicosities.
50. hypericin and other flavonoids strengthen venous wall integrity, prevent free radical damage and enzymatic breakdown of collagen.
51. lily family.
52. ruscogenins: vasoconstrictive and anti-inflammatory effects.
53. peripheral vasculature, varicosities and hemorrhoids.

54. coumarin.
55. improve blood lipids, reduce inflammation and platelet aggregation.
56. flavonol glycosides-- anthocyanosides.
57. antioxidant and capillary stabilization.
58. because of its specificity for the eyes, fighting the effects of diabetic retinopathy.
59. veratrine.
60. potent hypotensive; circulatory depressant.
61. emesis.
62. cramp bark: uterine relaxant, relaxes peripheral blood vessels.

pharmacology: cardiovascular drugs

the lecture about the conventional medications used to treat cardiac arrhythmias. the electrical conduction system of the heart can be affected in many different ways and there are several classes of drugs, each with a unique mechanism that targets different portions of the cardiac cycle [see questions 4-9]. quinidine is in class Ia, which works to slow the phase 0 depolarization, thereby prolonging action potential and slowing conduction. it is indicated in atrial fibrillation, atrial flutter, and some other arrhythmias, but tends to be avoided due to its high side effect profile; GI upset, cinchonism (a host of symptoms including nausea/vomiting, tinnitus, headache, disorientation), and torsade de pointes (an abnormal heart rhythm normally found in ventricular tachycardia where the peaks and troughs of the Q wave are equidistant from the baseline).

mexiletine is indicated in ventricular arrhythmias and recurrent ventricular tachycardia post-MI. it is class 1b; still a sodium channel blocker like quinidine but acts upon phase 3 repolarization instead of phase 0. side effect include drowsiness, confusion, and pro-arrhythmic potential. flecainide is used for supra-ventricular arrhythmias; arrhythmias that have an origin above the ventricles. the main side effect is its pro-arrhythmic potential; thus it is contraindicated in patients with a history of an MI or ventricular arrhythmia related to an acute ischemic event.

atenolol is a drug in class II anti-arrhythmics, drugs which diminish phase 4 repolarization by acting as beta-adrenergic blockers, thus decreasing sympathetic tone in the myocardium. it is indicated in tachyarrhythmias, a-flutter, a-fib, hypertension, angina, among other conditions, and stabilizes heart rate by the mechanism mentioned above; resulting in decreased automaticity in the various pacemaker cells in the heart. side effects might include drowsiness, bradycardia, dizziness, hypotension.

amiodarone is a typical class III anti-arrhythmic drug, causing a K+ channel blockade that results in prolonged phase 3 repolarization. it is indicated for arrhythmias with a ventricular origin and contains high amounts of iodine, which can cause blue-gray discoloration of the skin as a side effect. other side effects include dizziness / light headedness and pulmonary fibrosis.

the last class of anti arrhythmic, class IV, is represented by verapamil; these are drugs that block calcium channels, resulting in slowed phase 0 depolarization, which results in decreased AV conduction and a slower heart rate. side effects might include flushing, dizziness, hypotension.

there are other drugs that do not fall into the 6 major classes; one such drug is adenosine, which is produced endogenously from the breakdown of ATP. pharmacologically, adenosine has the effect of lengthening the refractory period and decreasing automaticity in the AV node by acting directly on the sinus pacemaker cells and vagal nerve terminals. it is administered by IV and can work as quickly as 15 seconds. it is the drug of choice for patients with PSVT (paroxysmal supraventricular tachycardias).

atropine is a drug derived from the nightshade belladonna which is used in cases of severe bradycardia with hypotension. it works by competitively inhibiting muscarinic acetylcholine receptors, thus blocking parasympathetic activity. thus it can also be used orally to treat diarrhea due to its effect of slowing peristalsis. it is also an effective antidote to organophosphate poisoning; these pesticides work by inhibiting acetylcholinesterase, leaving an abundance of acetylcholine-- while atropine works to block the effects of acetylchoine in the synapse.

digoxin is an anti-arrhythmic derived from the plant digitalis lanata and is classified as a cardiac glycoside. it both increases cardiac contractility as well as lowering conductivity, leading to a more stable, stronger heart beat. it works by inhibiting the Na/K ATPase and allowing for more intracellular influx of Na and Ca, as well as increasing the AV node's sensitivity to vagal stimulation. an overdose can cause "digitalis intoxication" which has a host of symptoms which might include bradycardia, fatigue, nausea, vomiting, blurred vision. digibind is used in such cases, an antibody formulated against digoxin (harvested IgG from sheep that are immunized with digoxin) which forms complexes that can be excreted via the kidneys.

questions
1. what are the five phases of the cardiac rhythm?
2. how does the origin of the arrhythmia correspond with prognosis?
3. common causes of arrhythmias?
4. describe the mechanism for the anti-arrhythmic drug class Ia.
5. describe the mechanism for the anti-arrhythmic drug class Ib.
6. describe the mechanism for the anti-arrhythmic drug class Ic.
7. describe the mechanism for the anti-arrhythmic drug class II.
8. describe the mechanism for the anti-arrhythmic drug class III.
9. describe the mechanism for the anti-arrhythmic drug class IV.

quinidine...
10. what class is quinidine?
11. indications?
12. mechanism of action?
13. side effects?
14. what is cinchonism?
15. what is torsade de pointes?

mexiletine...
16. what class is mexiletine? what is the mechanism?
17. indications?
18. side effects?

flecainide...
19. class? mechanism?
20. indications?
21. side effects?
22. contraindicated for which patients?

atenolol...
23. class?
24. indications?
25. mechanism of action?
26. side effects?

amiodarone...
27. indicated for...
28. mechanism of action?
29. contains high amounts of...
30. [29] results in what side effect?
31. other side effects?

verapamil...
32. which class? mechanism?
33. side effects?

adenosine...
34. drug of choice for which disorder?
35. breakdown product of...
36. mechanism of action?
37. acts directly on...
38. increases vagal tone by...
39. method of administration? onset of action?

atropine...
40. derived from...
41. cardiac use is for treatment of...
42. mechanism of action?
43. oral atropine can be used for...
44. can act as an antidote for...
45. symptoms of organophosphate poisoning?
46. specific antidote for atropine overdose? mechanism?

digoxin...
47. belongs to which family of drugs?
48. derived from which plant?
49. difference between digoxin and digitoxin?
50. mechanism of action?
51. effect on AV node?
52. effect on kidneys?
53. effect on EKG?
54. what is digitalis intoxication?
55. what is digibind?

answers
1. sodium channels open
sodium channels close, potassium channels begin to open
calcium and potassium channels open
calcium channels close
return to resting membrane potential
[Na, Na/K, Ca/K, Ca, return]
2. arrhythmias that originate in the atrias are generally more benign while ventricular arrhythmias are generally fatal within minutes.
3. ischemic damage
electrolyte disturbances
pH imbalance
4. sodium channel blockade: slow phase 0 depolarization-- prolong action potential and slow conduction.
5. sodium channel blockade: shorten phase 3 repolarization and decrease action potential duration by blocking sodium channels.
6. sodium channel blockade: markedly slow phase 0 depolarization.
7. diminish phase 4 repolarization, thus depressing automaticity.
8. prolong phase 3 repolarization without altering phase 0.
9. slow phase 4 depolarization and slow conduction, particularly at the AV node.

10. class Ia.
11. a-flutter, a-fib, AV and ventricular arrhythmias.
12. diminished inward flow of sodium at phase 0 results in decreased automaticity and a longer refractory period.
13. arrhythmias
GI symptoms: nausea, diarrhea, vomiting
cinchonism
torsade de pointes
14. nausea / vomiting
tinnitus
headache / disorientation
psychosis.
15. abnormal rhythm of ventricular tachycardia; peaks and troughs of Q wave are equidistant from baseline.

16. class 1b: blocks open sodium channels and shortens phase 3 repolarization.
17. ventricular arrhythmias, recurrent v-tach post MI.
18. drowsiness, confusion, pro-arrhythmias.

19. class Ic- sodium channel blocker.
20. supraventricular arrhythmias, WPW syndrome.
21. pro-arrhythmic.
22. patients with history of MI or ventricular arrhythmia due to acute ischemic event.

23. class II.
24. tachyarrhythmias
a-flutter, fib
PSVT
hypertension
angina
25. reduced sympathetic myocardial tone.
26. bradycardia, hypotension, fatigue, dizziness.

27. ventricular arrhythmias.
28. potassium channel blockade; prolong phase 3 repolarization.
29. iodine.
30. blue-gray skin discoloration.
31. dizziness, light headedness, pulmonary fibrosis.

32. class IV-- calcium channel blocker, slows phase 0 depolarization resulting in slowed AV conduction.
33. dizziness, flushing, hypotension, headaches.

34. PVST.
35. ATP.
36. prolongs refractory period and decreases automaticity in AV node.
37. sinus pacemaker cells and vagal nerve terminals
38. working between the SA and AV nodes.
39. IV, 15 seconds.

40. belladonna.
41. bradycardia and hypotension.
42. competitive inhibitor of muscarinic AcH receptors; blocks parasympathetic pathway.
43. diarrhea due its effect of slowing peristalsis.
44. pesticides that inhibit acetylcholinesterase.
45. SLUDGE:
salivation, lacrimation, urination, diarrhea, gastric distress, emesis
46. physostigmine; a reversible acetylcholinesterase inhibitor.

47. cardiac glycosides.
48. digoxin lanata.
49. digitoxoin has a longer half life and higher potential for toxicity.
50. inhibits Na/K ATPase, leads to more influx of Na and Ca intracellularly, allowing for higher contractility while decreasing conductivity and thereby stabilizing heart rate.
51. increases sensitivity to vagal stimulation.
52. increases renal perfusion.
53. flattening or inversion of t wave.
54. cardiac symptoms such as bradycardia, heart block
GI symptoms such as N/V, anorexia and diarrhea
eye symptoms such as blurred vision, double vision
55. antibodies specific to digoxin used to clear digoxin from the body after intoxication.

modern living

just read a short article on physorg.com which basically proposes that cancer is a recent evolutionary development, mainly due to the poor diet and pollution that is endemic in industrialized society. reminded me of the first chapter of the neijing; the yellow emperor asking why people in modern times ("modern" being before the 1st century BCE) tended to live much shorter lives than their ancestors.

here's the entire chapter, courtesy of fiveelement.com


Chapter 1: THE UNIVERSAL TRUTH

In ancient times the Yellow Emperor, Huang Di, was known to have been a child prodigy. As he grew he showed himself to be sincere, wise, honest and compassionate. He became very learned and developed keen powers for observing nature. His people recognized him as a natural leader and chose him as their emperor.

During his reign, Huang Di had discussions concerning medicine, health, lifestyle, nutrition, Taoist cosmology with his ministers, including Qi Bo, and others. Their first conversation began with Huang Di asking, “I’ve heard that in the days of old everyone lived one hundred years without showing the usual signs of aging. In our time, however, people age prematurely, living only fifty years. Is this due to a change in the environment, or is it because people have lost the correct way of life?”

Qi Bo replied, “In the past, people practiced the Tao, the Way of Life. They understood the principle of balance as represented by the transformations of the energies of the universe. They formulated exercises to promote energy flow to harmonize themselves with the universe. They ate a balanced diet at regular times, arose and retired at regular hours, avoided overstressing their bodies and minds, and refrained from overindulgence of all kinds. They maintained well-being of body and mind; thus, it is not surprising that they lived over one hundred years.”

“These days, people have changed their way of life. They drink wine as though it were water, indulge excessively in destructive activities, drain their jing - the body’s essence that is stored in the Kidneys - and deplete their qi. They do not know the secret of conserving their energy and vitality. Seeking emotional excitement and momentary pleasures, people disregard the natural rhythm of the universe. They fail to regulate their lifestyle and diet, and sleep improperly. So it is not surprising that they look old at fifty and die soon after.”

“The accomplished ones, of ancient times, advised people how to guard themselves against disease-causing factors. On the mental level, one should remain calm and avoid excessive desires and fantasies, recognizing and maintaining the natural purity and clarity of the mind. When internal energies are able to circulate smoothly and freely, and the energy of the mind is not scattered, but is focused and concentrated, illness and disease can be avoided.”

“Previously, people led a calm and honest existence, detached from undue desire and ambition; they lived with an untainted conscience and without fear. They were active, but never depleted themselves. Because they lived simply, they knew contentment, as reflected in their diet of basic but nourishing foods, and clothing that was appropriate to the season but never luxurious. Since they were happy in their position in life, they did not feel jealousy or greed. They had compassion for others and were helpful and honest, free from destructive habits. They remained unshakable and unswayed by temptations, and they were able to stay centered even when adversity arose. They treated others justly, regardless of their level of intelligence or position.”

Huang Di asked, “I’ve heard of people in ancient times, spoken of as the immortals, who knew the secrets of the universe and held the world in the palm of their hands. They extracted essence from nature and practiced Qi Gong and various stretching and breathing exercises, and visualizations, to integrate body, mind and spirit. They remained undisturbed and thus attained extraordinary levels of accomplishment. Can you tell me about them?”

Qi Bo responded, “The immortals kept their mental energies focused and refined, and harmonized their bodies with the environment. So they did not show typical signs of aging and were able to live beyond their biological limitations.
“Not so long ago there were people known as achieved beings who had true virtue, understood the Way of Life, and were able to adapt to and harmonize with the universe and the seasons. They too were able to keep their mental energy through proper concentration.

“These achieved beings did not live like ordinary humans, who tended to be hard on disease-causing factors. On the mental level, one should remain themselves. They were able to travel freely to different times and places since they were not governed by conventional views of time and space. Their sense of perceptions were supernormal, going far beyond the sight and hearing of ordinary humans. They were also able to preserve their life spans and live in full health, just as the immortals did.

“There was a third type of a person, known as the sage. The sages lived peacefully under Heaven and Earth, following the rhythms of the planet and the universe. They adapted to society without being swayed by fashions and trends. They were free from emotional extremes and lived a balanced, contented existence. Their outward appearance, behavior and thinking did not reflect the conflicting norms of society. the sages appeared busy but were never depleted. Internally they did not overburden themselves. they abided in calmness, recognizing the empty nature of existence. The sages lived over one hundred years because they did not scatter or disperse their energies.

“A fourth type were the natural people who followed the Tao, the Way of Life, and were called naturalists. They lived in accordance with the rhythmic patters of the seasons: Heaven and Earth, moon, sun and stars. They aspired to follow the way of the ancient times, choosing not to lead excessive lifestyles. They, too, lived plainly and and enjoyed long life."

homeopathy III: causticum

study questions for the homeopathic remedy causticum...

questions
1. causticum is prepared from which materials?
2. which acute conditions treated with causticum?
3. causticum burns might have which concomitants?
4. Jeremy Sherr describes causticum as...
5. dry vs. wetness?
6. important neurological remedy for which conditions?
7. some etiologies for causticum?
8. some aggravations for causticum?
9. some ameliorations for causticum?
10. describe the quality of causticum's anxiety.
11. anxiety worse at what time?
12. may have an internal conflict with...
13. describe an archetypal life path for causticum.
14. what is a unique causticum mistake with regards to language?

15. head symptoms?
16. eyes?
17. ears?
18. affinity for which joint in the head?
19. throat conditions?
20. hunger?
21. food cravings / dislikes?
22. rectum?
23. fear of which animals?

answers
1. calcium carbonate and potassium sulfate.
2. scalds / burns-- especially deep ones.
3. urinary frequency / burning, restlessness.
4. old age, a slowing down of life. a person who has worked all day and is weary at the close of the day.
5. more a dry remedy, worse with wetness.
6. weakness and paralysis.
7. ailments from cold exposure (air, water)
overuse or exertion
longstanding grief, fright, worry
8. cold winds
dry weather
coffee
menses
extremes of temperature
9. rainy / damp weather
warmth
heat of the bed
swallowing cold wtaer
10. free floating, vague.
11. twilight.
12. control / self control.
13. young anarchist becomes lawyer.
14. spoonerisms.

15. empty space between the forehead and the brain.
16. heaviness, ptosis, paralysis.
17. abundance of earwax with foul odor.
18. TMJ.
19. loss of voice from laryngeal paralysis.
20. may vanish at the sight of food.
21. cravings for smoked meats / aversion to sweets.
22. tendency towards ineffectual urging, BM's are easier standing up.
23. dogs.

homeopathy III: arsenicum album

some study questions for the homeopathic remedy arsenicum album...

questions
1. describe what is at the core of arsenicum album.
2. dependency on others for...
3. impulse to...
4. relationship to others in terms of power balance?
5. fearful dreams might especially be of...
6. other types of dreams?
7. personal organization?
8. [7] is a manifestation of what?
9. "anger when he spoke of..."
10. five delusions?

11. beyond which level of homeopathic dilution is arsenicum no longer poisonous?
12. similarity to nat mur?
13. similarity to rhus tox?
14. describe the quality of restlessness that arsenicum patients experience.
15. describe the selfishness of arsenicum.
16. they can accumulate...
17. energy level characteristics?
18. suicidal impulses motivated by...
19. sleep disorders around what time?
20. delusions that he will never be...
21. relationship to knifes?
22. appropriate for middle aged women who...
23. anxiety / panic attacks around what time?

24. kids have desire to be...
25. unique aspect of suicidal nature?
26. what miasm does arsenicum belong to?
27. a high potency (10M) is recommended in which special cases?
28. body temperature?
29. desires which foods?
30. thirsty for what?
31. which side is favored?
32. tendency to...
33. discharges are...
34. better or worse from lying?
35. better or worse from seashore?
36. used for fainting from...

37. dry or wet?
38. general appearance?
39. in acute headaches, wants...
40. eyes.
41. HEENT: one of three most common remedies for...
42. colds accompanied by...
43. colds palliation and provocation?
44. feeling of what in the lungs?
45. GI symptoms affect which area of the GI tract?
46. appearance of the tongue?
47. stomach symptoms alleviated by...
48. type of gastroenteritis associated with arsenicum?
49. for which other GI pathology is arsenicum the go to remedy?
50. desires or detests sweets?
51. GU symptoms?

answers
1. insecurity and vulnerability.
2. security.
3. murder.
4. can be dictatorial and demanding.
5. cancer.
6. misfortune, great exertion, danger, accidents.
7. very fastidious.
8. inner insecurity, need for control.
9. her complete recovery.
10. delusions he's offended people
everyone is looking at her
everything she touches is contaminated
body will putrefy
that he murdered someone

11. 6X
12. dreams of robbers
13. restlessness with desire for motion.
14. anxious, weak restlessness.
15. self indulgence.
16. doctors.
17. exaggerated weakness from least effort causes immediate loss of energy.
18. hopelessness and despair.
19. 2-3 AM
20. happy in his own house.
21. afraid to see knives, for fear of what they might do with them.
22. fall to pieces when children leave home.
23. 12-1AM

24. held on to and carried quickly.
25. suicide by setting oneself on fire.
26. syphillis.
27. in someone whose time has come to die but has conflict due to a fear of death.
28. very chilly, yet desires fresh air.
29. sourness, olive oil, hard liquor.
30. sips of warm tea or hot water with lemon.
31. right side.
32. bleed.
33. offensive, acrid, scanty.
34. worse.
35. worse.
36. the slightest cause.

37. dry.
38. thin and wiry, like a racehorse.
39. head cool.
40. burning, inflammation.
41. common cold.
42. chilliness, weakness, fatigue.
43. worse outside, better warm room.
44. smoke.
45. mouth to anus.
46. white, as if painted.
47. warm drinks.
48. viral, with simultaneous vomiting and diarrhea.
49. food poisoning.
50. averse to sweets.
51. swelling and burning.

homeopathy III: lycopodium

some study questions for the remedy lycopodium.

questions
1. what is lycopodium made of?
2. lycopodium especially affects which systems?
3. appearance of lycopodium infants?
4. infants usually suffer from...
5. infants' actions upon waking?

6. physicality vs. mental.
7. describe the lycopodium countenance.
8. body shape?
9. what head symptom is characteristic of lycopodium?

10. underlying mental state is one of...
11. relationship to public speaking?
12. relationship to power and responsibility?
13. consideration for others?
14. intimacy patterns?
15. sexual dysfunctions?
16. does lycopodium enjoy being alone?

17. lycopodium is sensitive to...
18. what time of day aggravates?
19. left or right sided remedy?
20. what type of clothing?
21. temperature disposition?
22. what type of heat ameliorates vs. aggravates?
23. GI symptoms?
24. motion aggravates or ameliorates?

25. headache might be precipitated by...
26. ears?
27. nose?
28. mouth?
29. sore throat is ameliorated and aggravated by...
30. in abdomen-- right sided...
31. urine appearance?
32. urinary symptoms in children?
33. female symptoms-- right sided...
34. aggravated or ameliorated by coition?

35. modalities are similar to which other remedy?
36. extremities-- right sided...

answers
1. inert club moss spores.
2. alimentary tract, GU tract, liver, genitals.
3. wrinkled appearance.
4. colic and constipation.
5. infants are irritable upon waking and immediately demand feeding.

6. lycopodium is more of a mental remedy; these patients are not very physically inclined or athletic.
7. wrinkled, frowning, emaciated.
8. pear shaped; can be emaciated on top and normal / plump on bottom.
9. premature graying of hair.

10. cowardice.
11. dreads public speaking but generally gives exceptional performances.
12. seek power but avoid having responsibility.
13. lyc's might have an "unknowing selfishness", a self-centerdness and self-directed ambition that is oblivious to others' pain or comfort.
14. strong sexual impulses without having true intimacy; one night stands instead of long term relationships.
15. male: impotency or erectile dysfunction. female: inability to achieve orgasm.
16. prefers not to be alone, but wants others to be slightly removed-- wants someone in the next room or house.

17. themselves, to music, to sentiment.
18. 4-8PM.
19. right sided remedy.
20. tight clothing aggravates.
21. chilly, worse cold drinks and food.
22. most heat ameliorates, but cool, fresh air ameliorates.
23. flatulence, easy satiety, gastritis, stomach cancer.
24. restlessness is ameliorated by motion.

25. great hunger.
26. thick otorrhea, otitis media, eczema behind ears.
27. sinusitis with pain at root of the nose, thick yellow discharge with yellow green crusts.
28. dry without thirst.
29. worse with cold drink, better with warm drink.
30. hernia.
31. "red sand in urine".
32. enuresis.
33. ovarian neuralgia
34. aggravated.

35. rhus tox-- better warm, better motion,
36. sciatica.

pharmacology: respiratory drugs

this lecture covered the conventional drugs used to treat respiratory conditions such as asthma. there are several classes of asthma treating drugs, including adrenergic agonists, anti-cholinergics, methylxanthines, etc. which can be grouped into 2 categories: drugs that reduce inflammation, and drugs that relax bronchial smooth muscle. bronchial smooth muscle tone is increased with increased sympathetic activity; epinephrine is a sympathetic neurotransmitter that decreases asthmatic symptoms by this mechanism. since it acts non-selectively, it also acts on beta-1 receptors, causing cardiac symptoms such as palpitations, and on alpha-1 receptors, causing dry mouth and hyperglycemia. in general, the bronchodilating group of asthma drugs are the type used for anaphylaxis / status asthmaticus, while the inflammation reducing drugs are better for longer term, less acute treatments.

then there are drugs that specifically bind to beta-2 agonists, and using the same mechanism above induces dilation of bronchial smooth muscle. these include albuterol, proventil, and salmeterol-- the latter is longer acting and is used more for chronic conditions. these drugs are mainly administered by inhalation, and delivery can be improved by the use of "spacers" which allow for smaller, slower velocity to reach the lungs.

anticholinergics are another class of asthma drugs that act by competitively inhibit the acetylcholine neurotransmitter at muscarinic receptor sites, inducing sympathetic bronchodilation. as opposed to epinephrine or beta-2 agonists, anticholinergics are best used for maintenance as opposed to acute conditions. atrovent and theophylline are two examples of anticholinergics; the former is chemically similar to atropine (from the plant belladonna) and the latter is similar to caffeine.

corticosteroids are also used as asthma treatment when bronchodilators are not effective by themselves. they are potent anti-inflammatories; blocking phospholipase A2, the enzyme which mediates the release of arachidonic acid, the precursor of inflammatory mediators such as leukotrienes and prostaglandins. thus, they decrease the activity of macrophages, eosinophils and t-lymphocytes, as well as decreasing capillary permeability and thus edema systemically (not specific for bronchial tissue). the main danger of corticosteroids is disruption of the body's natural cortisol production via the HPA axis; abrupt discontinuation of corticosteroids might result in an addisonian crisis due to the body's inability to produce ACTH.

corticosteroids also suppress immunity in general, leading to increased susceptibility to infection. one of the side effects of beclovent, an inhaled corticosteroid, is an increased incidence of oral thrush. prednisone is an oral corticosteroid which, compared to inhaled steroids, has more chance of producing systemic side effects, such as hyperglycemia, fat redistribution (same as in cushing's syndrome, a condition of excess cortisol production), osteoporosis, in addition to the potential for the addisonian crisis.

leukotriene inhibitors such as zafirlukast are a newer class of asthma drugs which block leukotriene receptors D4 and E4 in bronchial smooth muscle, thereby reducing inflammation and allowing for bronchodilation. it is also used in the treatment of chronic cases as opposed to anaphylaxis. side effects include headache, Gi upset, possibly increased respiratory infections.

antitussives such as codeine block the medullary centers that are involved in the cough response. the two antitussives that we discussed, codeine and dextramethorphan, are related to morphine: codeine is broken down into morphine while dextramethorphan is a synthetic morphine derivative. besides being addictive, these drugs have other side effects, drowsiness and constipation being among the chief complaints. dextramethorphan is milder than codeine in terms of constipation and and addictive properties.


another major category of respiratory drugs are drugs used to treat allergic rhinitis. antihistamines such as benadryl block histamine H1 receptors and cross the blood brain barrier, causing drowsiness, while medications such as claritin perform the same action while being large enough to not cross the BBB. both cause dryness of mucous membranes and thus are contraindicated in asthma, when a mucolytic (n-acetyl cysteine?) and moistening agent is preferred.

nasal corticosteroids can also be used to depress the inflammatory response locally, such as beconase or rhinocort, although can result in local irritation and nosebleeds, as well as increased susceptibility to nasal candidiasis. nasal alpha agonists are also used to combat allergic rhinitis, such as phenylephrine / afrin, but are highly addicting due to the rebound symptoms that occur as soon as the medication is stopped.

questions
intro...
1. describe the different roles of the autonomic nervous system in terms of bronchoconstriction and bronchodilation.
2. what are the two general mechanisms of action for asthma drugs?
3. epinephrine indications...
4. epinephrine mechanism of action?
5. side effects of epinephrine?
6. method of delivery?

beta-2 agonists...
7. albuterol, proventil mechanism of action?
8. methods of administration and timing of action for each?
9. inhaled administration might be improved by...
10. when is use of salmeterol / serevent indicated?
11. onset and duration of action of salmeterol?
12. side effects of salmeterol?

anticholinergics...
13. anticholinergics are similar in structure to...
14. action of anticholinergics?
15. when are anticholinergics indicated?
16. example of anticholinergic?
17. what is an example of an anticholinergic that has been replaced by beta agonists / corticosteroids?
18. what class of drug does [17] belong to?
19. what other substance is [17] similar to?

corticosteroids...
20. mechanism of action?
21. acute or chronic cases?
22. main side effect?
23. secondary side effects?
24. examples of inhaled corticosteroids?

specific corticosteroids...
25. indication for beclovent?
26. 2 mechanisms of action for beclovent?
27. beclovent's effect on bronchial smooth muscle?
28. oral side effect of inhaled beclovent?
29. indications for prednisone?
30. side effects of prednisone?

leukotriene inhibitors...
31. mechanism of action?
32. two examples?
33. indications for leukotriene inhibitors?
34. zafirlukast used more commonly in which population?
35. side effects?
36. inhibits which other enzyme?

antitussives...
37. mechanism of antitussives?
38. codeine is broken into...
39. side effects?
40. what does the DM in robitussin DM stand for?
41. what class of drug is DM?
42. how do DM antitussives compare to narcotic analgesic tussives in terms of side effects?

antihistamines...
43. MAO of benadryl?
44. benadryl relationship with BBB?
45. why is benadryl contraindicated for asthma?
46. example of a non-drowsy antihistamine?
47. MAO of [46]?
48. how is [46] non-drowsy?
49. common side effect of [46]?

nasal sprays...
50. two examples of nasal corticosteroids?
51. mechanism of action?
52. side effects?
53. two examples of nasal alpha-agonists?
54. most significant side effect?

answers
1. sympathetic= bronchodilation. parasympathetic= bronchoconstriction.
2. bronchodilators and inflammation suppressors.
3. emergent treatment of asthma, status asthmaticus, anaphylaxis.
4. beta-2 adrenergic receptor stimulation leads to increased cAMP levels leads to smooth muscle relaxation and bronchodilation.
5. B-1 agonist effects include tachycardia, anxiety, arrhythmias, palpitations. alpha-1 agonist effects include dry mouth and hyperglycemia.
6. subcutaneous, IV, IM, inhalation, endotracheal tube.

7. beta-2 agonist causes increased cAMP levels resulting in bronchial smooth muscle dilation.
8. periorally-- 30 minutes onset and 4-8 hour duration. inhaled-- 15 mins onset and 2-3 hour duration.
9. spacer which allows for smaller, slower velocity particles.
10. for long term treatment of asthma.
11. 20-30 min onset, 12 hour duration.
12. headache, cough.

13. atropine from belladonna.
14. competitively antagonize AcH at muscarinic receptor sites, resulting in sympathetic bronchodilation.
15. maintenance as opposed to acute cases.
16. ipratropium / atrovent.
17. theophylline.
18. methylxanthine / xanthines bronchodilators.
19. caffiene.

20. inhibition of phospholipase A2 which blocks the release of arachidonic acid, the precursor of inflammatory mediators. also inhibits histamine and kinin activity.
21. chronic.
22. starts to shut off the HPA feedback loop for cortisol production
23. increased susceptibility to infections, hyperglycemia, bone loss, insomnia.
24. beclomethasone / beclovent , vanceril.

25. when asthma can not be controlled by bronchodilators.
26. decreasing activity for inflammatory cells (macrophages, eosinophils, t lymphocytes), decreases capillary permeability.
27. no direct effect on smooth muscle.
28. oral thrush.
29. COPD, worsening asthma.
30. fat redistribution, hyperglycemia / diabetes, osteoporosis, addisonian crisis.

31. blocking leukotriene receptors (E4, D4) in bronchial smooth muscle.
32. zafirlukast / accolate, montelukast / singulair.
33. chronic asthma, prophylaxis.
34. pediatrics.
35. headache, GI upset, increased respiratory infections in older populations.
36. cytochrome p450 enzymes.

37. decreases sensitivity of medullary cough centers.
38. morphine.
39. drowsiness, constipation, GI upset, dependence.
40. dextromethorphan.
41. morphine derivative.
42. DM less addictive, less constipation.

43. blocking H1 receptors.
44. readily crosses BBB.
45. because benadryl will dry and thicken secretions and asthma needs moistening and mucolytics.
46. claritin / loratadine.
47. same as [43].
48. doesn't cross BBB.
49. dry mouth. dryness of mucous membranes.

50. beclomethasome / beconase
budesonide / rhinocort
51. decreases inflammatory mediators in nasal mucosa.
52. irritation, nose bleeds, sore throats, candidiasis.
53. phenylephrine / afrin
oxymetazoline / long acting afrin
54. rhinitis medicosum: rebound effect after taking nasal alpha agonists.

pharmacology: antihypertension drugs

this pharm lecture focused on the conventional medications designed to control blood pressure, of which there are many. the first category is diuretic medications, controlling blood pressure by modifying the kidney's filtration functioning. thiazide diuretics such as hydrodiuril act on the thick ascending loop and early distal tubule to inhibit sodium and chloride reabsorption, thereby increasing water excretion and lowering blood pressure. they also increase calcium and uric acid levels by acting on the proximal tubule. thus, the side effect of thiazide diuretics are hypokalemia, hyponatremia, and hypercalcemia / hyperuricemia. they are commonly used in conjunction with ACE inhibitors and beta blockers.

loop diuretics such as lasix are the most potent of all the types of diuretics and work by blocking the Na/K/Cl cotransporter system in the loop of Henle. they have similar side effects to thiazide diuretics; hypokalemia, hyponatremia, etc. in terms of potency, they are stronger than thiazide diuretics and thus the preferred diuretic in renal disease or hypertensive emergencies.

potassium sparing diuretics such as aldactone inhibit sodium / chloride reabsorption but also promote potassium reabsorption and therefore are sometimes used in conjunction with potassium wasting diuretics such as loop diuretics. it is a direct antagonist to aldosterone. because of the potential for hyperkalemia these medications should be avoided in patients who are taking potassium supplements, or other medications that raise potassium levels such as ACE inhibitors or ARB's.

these diuretics all work by promoting the excretion of fluid from the kidneys, thereby reducing the body's total fluid volume and thus lowering blood pressure. another mechanism that is used to lower blood pressure is via blocking the beta-2 receptors in the heart, which ultimately lowers cardiac output and therefore lowers blood pressure. "beta blockers" such as propanolol are non-specific, meaning they will also affect the beta receptors on peripheral vasculature, causing dilation, as well as the beta receptors on bronchial smooth muscle (the same ones that asthma medications seek to stimulate), causing bronchoconstriction. thus these medications must be used cautiously with patients who have respiratory issues. even the never, "cardio-selective" atenolol which preferentially seeks the beta-2 receptors in the heart also cause non-selective effects at higher doses. all beta blockers can cause CNS depression, sexual dysfunction, and bradycardia-- if acute episodes occur, this can be treated with glucagon, which antagonizes beta blockers' effects between the SA and AV node.

another class of drugs, alpha-1 adrenergic antagonists, block the alpha-1 receptors on peripheral vasculature smooth muscle to cause dilation, which causes a decrease in total peripheral resistance, thus lowering blood pressure. BPH patients might also be benefitted by the relaxation of the bladder neck / prostate. prazosin / minipress is an example, as well as reserpine (which is derived from the alkaloids of rauwolfia).

calcium blockers work by blocking the influx of calcium into smooth muscle cells of the peripheral vasculature as well as cardiac muscle cells, promoting relaxation and dilation, thereby lowering peripheral resistance. they might also have a "negative inotropic effect", which can diminish cardiac output - thus care is needed when administering to patients with CHF or bradycardia. verapamil / isopten is one example, and is indicated for hypertension, CHF, and angina-- in particular, atypical angina due to vasospasm. calcium blockers can be sometimes be used in combination with beta blockers in order to wean a patient off of beta blockers, which have much more severe withdrawal symptoms in the form of rebound hypertension, etc.

there are a couple classes of drugs that work on the renin / angiotensin system- first is the ACE inhibitors (angiotensin converting enzyme inhibitors). as the name suggests, these drugs block the conversion of angiotensin I to angiotensin II, a hormone that facilitates water retention on a large scale in the body. they are particularly effective for diabetics with hypertension due to their actions to counteract diabetic nephropathy by reducing glomerular capillary pressure. ACE inhibitors tend to raise K+ levels, thus one must not use a potassium sparing diuretic in combination, although other diuretics seem to potentiate their actions. the other mechanism that ACE inhibitors have is to prevent the degradation of bradykinins, which leads to a common side effect of a dry cough, since bradykinins stimulate the medullary cough reflex.

other drugs that works with the renin / angiotensin system are angiotensin II receptor blockers such as losartan / cozaar. although the mechanism is different (blocking the receptors as opposed to blocking the conversion of angiotensin II, and no bradykinin involvement) the profile is similar to ACE inhibitors in that they are good for diabetic patients with hypertension, can cause hyperkalemia, and are contraindicated in pregnancy.

questions
introduction...
1. how does "hypertension beget hypertension"?
2. mechanism of thiazide diuretics?
3. indication of thiazide diuretic?
4. thiazide diuretics often used in conjunction with...
5. what occurs at the proximal tubule with thiazide diuretics?
6. thiazide side effects?
7. examples of thiazide diuretics?
8. what supplement in recommended with thiazide diuretics?

loop diuretics...
9. example of loop diuretic?
10. physiological mechanism?
11. side effects of loop diuretics?
12. loop diuretics are the preferred form of diuretics for...
13. loop diuretics can be used to treat what other condition?
14. how do loop diuretics compare in strength to other diuretics?
15. lasix should be avoided in patients with what allergy?

potassium sparing diuretics...
16. example of a PSD?
17. mechanism of action?
18. direct antagonist to...
19. avoid use with patients who are on...

beta blockers...
20. general mechanism of action?
21. if the beta blocker is non selective, what other effects might it have?
22. which beta blockers are selective and which are not?
23. disadvantages to beta blockers?
24. why is abrupt discontinuation not recommended?
25. besides hypertension / cardiac symptoms, what else is propranolol used for?
26. what can be administered to counter the effects of a beta blocker induced acute bradycardia?

alpha-1 adrenergic antagonists...
27. example of an alpha antagonist?
28. mechanism of action?
29. how can these medications additionally benefit patients with BPH?
30. what is an herb that has alpha-1 adrenergic effects?

calcium channel blockers...
31. mechanism of action?
32. what is the "negative inotropic effect"?
33. what is an example?
34. what are the specific indications for [33]?
35. side effects?
36. how do rebound effects compare for calcium vs. beta blockers?

ACE inhibitors...
37. two mechanisms for ACE inhibitors?
38. ACE inhibitors often the drug of choice in treating...
39. least likely of the anti-hypertensives to cause...
40. effect on electrolytes?
41. ACE inhibitors work well in combination with...
42. number one side effect? why?
43. other side effect?
44. pregnancy?

angiotensin II blockers...
45. how does the mechanism differ from ACE inhibitors?
46. example of an AII blocker?

direct vasodilators...
47. mechanism of action?
48. examples of direct vasodilators?
49. side effects for the first example in [48]?
50. side effects for the second example in [48]?

answers
1. prolonged hypertension results in smooth muscle hypertrophy and proliferation in arterioles, which increases total peripheral resistance, thereby raising blood pressure.
2. inhibit sodium and chloride reabsorption in the thick ascending loop and early distal tubule, thereby increasing sodium and water excretion in the urine.
3. mild hypertension with chronic edema.
4. beta blockers and ACE inhibitors.
5. holding back of calcium and uric acid.
6. decreased Na, K, Mg. increased Mg, Ca.
7. hydrochlorthiazide / hydrodiuril.
8. potassium.

9. furosemide / lasix.
10. block the Na/K/Cl cotransporter system in ascending loop of henle.
11. hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hyperglycemia, hyperuricemia.
12. patients with renal disease and hypertensive emergencies.
13. hypocalcemia.
14. generally stronger.
15. sulfonamide allergies.

16. spironolactone / aldactone.
17. inhibits Na/Cl reabsorption while promoting potassium reabsorption.
18. aldosterone.
19. ACE inhibitors, potassium supplements, ARB's.

20. reduce beta-1 receptors in the heart, causing decreased cardiac output.
21. if it affects beta-2 receptors, peripheral vasculature will be dilated and bronchial smooth muscle will constrict.
22. propanolol is non-selective, atenolol is.
23. CNS effects, sexual dysfunction, bradycardia.
24. because of rebound tachycardia / hypertension due to upregulation of beta receptors during the period of medication.
25. stage fright and migraine headache prophylaxis.
26. glucagon-- blocks the beta blocker action between the SA and AV node.

27. prazosin / minipress
28. blockage of alpha-adrenergic sites in peripheral vasculature causes dilation.
29. relaxation of smooth muscle around bladder neck and prostate, allowing urine to pass more easily.
30. rauwolfia alkaloids have peripheral adrenergic blocking effects.

31. blockage of influx of calcium into smooth muscle cells around peripheral vasculature as well as cardiac cells causes dilation, thereby lowering peripheral resistance.
32. a side effect of calcium channel blockers-- decreased cardiac output. thus these medications might be contraindicated for patients with CHF or bradycardia.
33. verapamil / isopten
34. hypertension, angina (especially atypical), CHF
35. flushing, headache, hypotension.
36. calcium blocker rebound effects are much less.

37. 1) block conversion of angiotensin I to angiotensin II. 2) prevent degradation of bradykinins, reducing peripheral vascular resistance.
38. diabetic patients with hypertension.
39. sexual dysfunction in males.
40. tends to increase potassium levels.
41. diuretics.
42. dry irritating cough, due to bradykinin stimulation of the medullary cough reflex.
43. angioedema, especially of tongue and oropharyngeal area.
44. never-- category X.

45. block the angiotensin II receptors, and no involvement of bradykinins.
46. lozartan / cozaar.

47. opening potassium channels in vascular smooth muscle.
48. minoxidil, hydralazine.
49. hirusitism.
50. drug induced lupus syndrome.

pharmacology: antilipidemics

this lecture went into the conventional antilipidemic drugs, indicated when patients have high cholesterol levels (high LDL, low HDL, or high total cholesterol levels). there are five classes of antilipidemic drugs: niacin, fibrates, HMG-CoA reductase inhibitors, bile acid binding resins, and cholesterol absorption blockers. The first category, niacin, is given in the form of Vitamin B3, or alternatively, inositol hexaniacinate (considered safer both in the short and long term). niacin is thought to decrease VLDL production in the liver as well as increase its clearance in the serum.

fibrinates, a class of drugs that are derived from fibric acid, are mainly indicated for high TG levels; their main action is to lower TG levels, while also raising HDL levels. the side effects might include liver damage, gallstones, GI upset, myalgias, and rhabdomyolysis. the main fibrinate is called gembibrate / lopid, and it is contraindicated in patients with preexisting liver or gall bladder problems.

statin drugs are a popular category of antilipidemics that act on the HMG-CoA reductase enzyme, which is the first enzyme in cholesterol synthesis. although statins are effective at lowering cholesterol levels, they are not without side effects, the most common being muscle soreness / weakness, thought to be related to HMG-CoA's involvement in CoQ10 synthesis. a severe side effect is rhabdomyolysis which might lead to acute renal failure in some cases. GI symptoms and erectile dysfunction are two other potential side effects from statins as well. they are contraindicated in patients with liver disease, as well as in pregnancy and lactation, and may interact with fibrinates, anti-fungals, macrolides, protease inhibitors. statins can also be used prophylactically during MI's, strokes, or episodes of unstable angina, especially in DM II patients.

the next class of antilipidemics are bile acid sequestrants, which bind to bile salts and form insoluble complexes which are excreted in the feces. the net effect is cholesterol excretion in the stool and secondarily, lowering of LDL blood levels due to a compensatory upregulation of LDL receptors. questran is an example-- side effects include constipation, bloating, and malabsorption of fat soluble vitamins, folic acid, or other medications.

the last class is cholesterol absorption blockers, which are used in conjunction with statins when their cholesterol lowering actions are insufficient. the main side effect is diarrhea (although myalgias and arthralgias can also occur), requiring patients on these medications to wear dark pants and panty liners when starting these medications. along with bile acid sequestrants, cholesterol absorption blockers are considered category C for pregnancy; underresearched and not recommended.

questions
introduction and niacin...
1. how do change in percentage levels of HDL and LDL affect myocardial infarction risk?
2. what are the five categories of antilipidemics?
3. what does niacin do that is unique among lipid lowering medications?
4. what are the longer term side effects of niacin?
5. two potential MOA's for niacin?
6. what tests might be monitored in patients on niacin?
7. niacin is contraindicated in...
8. what is currently considered the safest form of niacin?

fibrinates...
9. what are the actions of fibrinates?
10. side effects?
11. examples of fibrinates?
12. main indication for fibrinates?
13. contraindicated in...

statin drugs...
14. what is the enzyme blocked by statin drugs? what does it do?
15. most common complaints from statin users?
16. severe potential side effect of statins? what might be a complication?
17. what is a potential mechanism for statins' relationship to rhabdomyolysis?
18. side effects besides [question 15]?
19. contraindications for statin drugs?
20. potential drug interactions?
21. examples of statin drugs?
22. besides cholesterol lowering, what else are statin drugs indicated for?
23. what lab test might be run if rhabdomyolysis is suspected in a patient taking lipitor?
24. lipitor contraindicated in...

bile acid sequestrants...
25. general mechanism of action?
26. how do bile acid sequestrants lower LDL levels?
27. often used in conjunction with...
28. example of bile acid sequestrants?
29. side effect of [question 28]?
30. use in pregnancy?

cholesterol absorption inhibitors...
31. example of a CAI?
32. often used in conjunction with what other class? when?
33. side effect of CAI's?
34. use in pregnancy?

answers
1. 1% increase in HDL decreases MI risk 3-4%. 1% decrease in LDL decreases MI risk 2%.
2. niacin, firates, HMG-CoA reductase inhibitors, bile acid binding resins, cholesterol absorption blockers. [never forget his bad cholesterol]
3. lowers alpha-lipoprotein(a) levels.
4. liver damage
retinal damage
gout
rhabdomyolysis [liver, eye, uric, muscle] [See Ur Life Strength vanish]
5. mainly unknown, but may be related to decreased VLDL synthesis in liver and increased VLDL clearance in plasma.
6. liver function and glucose.
7. DM, liver disease, peptic ulcer disease.
8. inositol hexaniacinate.

9. decrease liver's TG production, increase HDL levels.
10. liver damage / gall stone formation
nausea / diarrhea / GI upset
rhabomyolysis / myalgias
[LV/GB, ST/SP, PC/TB] [wood, earth, fire]
11. gemfibrozol / lopid, fenobibrate / lofibra. [stupid gemstone, lofi fennel]
12. elevated TG levels.
13. pre-existing GB/LV disease.

14. HMG-CoA reductase, the enzyme that catalyzes the first step of cholesterol synthesis.
15. muscle soreness and weakness.
16. rhabdomyolysis which might lead to acute renal failure.
17. HMG-CoA is also involved in CoQ10 production, which is an enzyme involved in oxidative phosphorylation-- ultimately interfering with muscle cell function and contributing to their degeneration.
18. abdominal pain / nausea / diarrhea
headache
erectile dysfunction
19. liver disease, pregnancy, lactation.
20. fibrinates, macrolides, oral antifungals, protease inhibitors. [mac pro: filled with fungus fiber]
21. atorvastin / lipitor
fluvastatin / lescol
lovastatin / mevacor
22. prophylaxis during MI's, stroke, unstable angina, especially in DM II patients.
23. CPK levels.
24. pregnant women-- category X.

25. bind cholesterol and form insoluble complexes which are ultimately excreted.
26. a compensatory mechanism increases the number of LDL receptors, thereby removing LDL from blood.
27. niacin.
28. cholestryramine / questran
29. bloating, constipation, malabsorption of fat soluble vitamins, folic acid.
30. category C; not adequately studied, but recommended to avoid use.

31. ezetimibe / zetia.
32. statins, when they aren't working to lower serum cholesterol.
33. diarrhea, myalgias, arthralgias.
34. category C.

homeopathy III: calc carb

here are some study questions for the remedy we studied this week: calc carb. the remedy is essentially depicted by an overweight, overworked, task oriented person.

questions
1. calc carb is made from...
2. which miasm does calc carb belong to? how does it match the miasm's character?
3. two words that capture the essence of the calc carb state?
4. calc carb's world is seen as a series of never ending...
5. greatest fear is...
6. relationship to insanity?
7. relationship to change?
8. fast or slow?
9. weakness of ...
10. unique language trait?
11. food cravings?

12. one word that describes the physical disposition?
13. temperature disposition?
14. difference of temperature of calc carb children and adults?
15. ability to exercise?
16. better with what form of human contact?
17. time of day that aggravates?
18. how are the joints affected?

19. two body types?
20. head characteristics?
21. headaches from...
22. another prominent symptom related to HEENT?
23. throat symptoms?
24. eyes?
25. ears?
26. type of mucous?
27. mouth?
28. dentition?

29. appetite/thirst?
30. cravings?
31. averse to which foods?
32. BM's?
33. all arthritic pains aggravated by...
34. what do calc carb's do with their feet at night?
35. respiratory symptoms?

36. females: major remedy for...
37. aggravated or ameliorated by coition?
38. sleep is characterized by...
39. wrinkles on face?

40. infants and consolation?
41. kent described a circle of which remedies?

answers
1. inner lining of oyster shell.
2. psora-- a remedy of weakness, insecurity, anxiety.
3. overwhelmed and overexertion.
4. tasks.
5. inability to function, leading to a piling up of work.
6. fear of going insane, but rarely actually insane.
7. aggravated by change.
8. slow.
9. mind.
10. may "confound" words.
11. soft eggs, chalk, dairy products.

12. leucophlegmatic.
13. cold, aggravated by cold.
14. children are generally warmer than adults.
15. worse with any exertion.
16. touching, rubbing, scratching.
17. 1-3pm.
18. low back pain and arthritis.

19. overweight type that gets winded easily. or thin sun laborers with wrinkles on face.
20. perspiration on occiput.
21. eyestrain, overexertion, being chilled.
22. vertigo.
23. swollen glands, sore throat, swollen tonsils.
24. sticky discharge, glandular feeling, blocked tearducts in infants.
25. all types of otitis.
26. thick, yellow.
27. apthae, canker sores, thrush.
28. may be delayed in children.

29. big.
30. sweets, soft eggs, salt, cold drinks, milk, oysters, ice cream, cheese.
31. meat, spicy foods, milk, fat.
32. constipation without urgency, or diarrhea from malabsorption or allergies.
33. cold / damp.
34. put socks on initially then take them off in the middle of the night because their feet are burning hot.
35. tubercular.

36. menorrhagia.
37. aggravated.
38. nightmares, especially in children. insomnia due to thinking about tasks for next day.
39. vertical and horizontal, forms square in lean types.

40. aggravated by consolation.
41. calc carb to lyc to sulphur.

homeopathy III: aurum

the first class of homeopathy III with Dr. Elmore. besides the orientation spiels we went over two case studies that demonstrated key aspects of the homeopathic remedies aurum and nat mur, which are fairly similar. the first case was a 31 year old female that came initially complaining about her allergies, but further questioning revealed deep stress, mainly centering around a dysfunctional marraige--to a man she married almost out of obligation, because he could pay off the massive debt she had accrued. although she couldn't stand him (in fact spent every night outside because she didn't want to be in the house with him), she felt that leaving him would be a betrayal and thus had been living in distress the entire marraige. her current state was one of profound depression to the point of suicidal notions, which she kept from others. she had lost her "inner light", which only came back when thinking about leaving her husband. another poignant aspect of her character was that as a young child, she took care of younger siblings after the mother abandoned the family.

the fastidiousness, emotional insularity and feelings of loyalty and betrayal were all indicative of nat mur, but it was then revealed to the class that this patient also loved the sun, which is decidedly not characteristic of nat mur-- instead, the remedy given to this patient was aurum, which is apparently the leading remedy for patients with suicidal tendencies. aurum patients hold themselves to extremely high standards and have to do things right in all aspects of their lives. the combination of their idealism and suicidal notions (losing the fear of death) makes teenagers the most likely aurum patients. here are some study questions based on Dr. Elmore's readings of aurum:

questions
1. central theme of aurum is...
2. personality type?
3. two remedies that might be confused with aurum?
4. miasm?
5. how does the miasm physically manifest?
6. how does the miasm manifest mentally / emotionally?
7. suicidal thoughts may arise in aurum patients when...

8. occupation ameliorates or aggravates?
9. how much do aurum patients share of their suffering to others?
10. relationship to religion?
11. relationship to death?
12. aurum state might be brought on by loss of...
13. aurum patient can't stand...
14. aurum imagines that... resulting in...
15. relationship to physical pain?

16. relationship to music?
17. what time of day aggravates aurum patients?
18. relationship to sunshine?
19. sleep?

20. nasal symptoms?
21. aurum is a main remedy for which HEENT disorder?
22. eye symptoms?
23. affect on glands?
24. testicles?
25. uterus?
26. chest symptoms?

27. in what particular way are aurum children similar to nat. mur children?
28. relationship to friends?
29. time course of aurum?
30. what are the salts of aurum?

answers
1. depression and loathing of life.
2. perfectionists.
3. nux vomica and natrum muriaticum.
4. syphilitic.
5. destruction of bones and tissue.
6. depression, suicidal thoughts.
7. in a high place or any other precarious situation.

8. ameliorates.
9. nothing; others may not know of their suffering at all.
10. despair of religious salvation -- praying for hours on end.
11. no fear of death, desires death.
12. finances or property.
13. contradiction.
14. he neglected his duty, resulting in guilt.
15. intense pain, causing suicidal thoughts.

16. often ameliorates.
17. sunset to sunrise.
18. desires sunshine.
19. insomnia.

20. boring pain at the root of the nose.
21. mastoiditis.
22. photophobia, corneal ulcers, conjunctivitis, sore / bruised sensation. [look-- PCC]
23. swelling and hypertrophy.
24. swelling and indurated, especially right side.
25. prolapse due to heaviness and congestion of uterus.
26. dyspnea, asthma, angina.

27. easily hurt.
28. few friends, doesn't share much with them.
29. since it is a metal remedy, takes a longer time to act.
30. aurum arsenicum, muriaticum, iodatum, sulphuricum [ars mur iod sul] [aura of siam]

two down, four to go

just did a little redesign on this site and scanning over the entries from the past two years made me think about how fast the time has gone. i'm 1/3 of the way through my education here at NCNM and as expected, it feels like i both got here yesterday and that i've been here for a decade. here are some little tidbits of knowledge i've gleaned over these two years.

• portland is full of coffeeshops, bikers, and naturopathic clinics
• the kidneys are complicated. the liver is complicated. all of our organs are little universes that for the most part, defy our comprehension
• the first two years of studying naturopathy is essentially cramming as much basic science information into one's head as humanly possible
• the most impressive clinicians (to me) are the ones who are flexible with their ideas and able to navigate their body of knowledge with agility
• homeopathy is an impossible thing to represent accurately
• botanical medicine is much more empirical than one might imagine
• there are people in my school that are exceedingly knowledgeable and competent and can compare to some of my best college professors
• there are people in my school that i wouldn't trust to change my toilet paper
• coffee doesn't really help anything, ever
• meditation helps everything, always
• jumping into cold water outside is one of my favorite things to do now
• the onslaught of information in the first two years can suppress the desire to ask questions about material. it's difficult enough to just ingest the material, let alone digest it well and ask an intelligent, probing question.
• spinal adjustments are extremely satisfying to perform
• the "etiology" of the majority of pathological conditions is unknown or poorly elucidated at best, even in conventional textbooks
• doing massage (shiatsu, in my case) has proven to be essential as a supplement for learning about the muscles and bones and rhythms of the body during these two years
• relationships never turn out how you plan them
• my impression so far of what naturopathy aims to be: [naturopathy] = [conventional medical knowledge] + [herbal and energetic modalities] - [symptom suppression techniques]

chinese cosmology III: notebook project

1
this semester we learned about the four "humanity" organs: pericardium, triple burner, gall bladder, and liver. this painting shows the organ clock and the positions of these four organs, starting with pericardium at the rightmost position, representing lunar month 9 and 7-9PM, and ending with liver in the leftmost position, representing lunar month 12 and 1-3AM. each position has an association with an earthly branch, which itself has an association with an element.



earthly branches
pericardium: xu (earth)
triple burner: hai (water)
gall bladder: zi (water)
liver: chou (earth)

the red lines represent the 6 conformation correspondences. pericardium and liver are part of the jueyin wood conformation, while triple burner and gall bladder are part of the shaoyang fire conformation.

each organ is also assigned to a zang fu pairing, which has its own elemental association. thus, each organ is associated with three different elements: 5 element, 6 conformation, and 12 earthly branches. they are as follows:

pericardium: fire / wood / earth
triple burner: fire / fire / water
gall baldder: wood / fire / water
liver: wood / wood / earth

2
the pericardium is full of gate symbolism, which this painting represents. on a physiological level, the pericardium's job is to protect the heart from external pathogens, and its meridian wraps around the heart like a barrier. acupuncture point PC6 is aptly named "the last door before the emperor". the protection that the pericardium provides might be seen as analogous to the blood brain barrier's function in western medicine.

the pericardium's close relationship to the heart is also suggested by its three names: xin bao (the sac around the heart), xin zhu (heart master / that which sees mastership of the heart), and dan zhong (surrendered minister that follows commands that others will not).

on an emotional level, the pericardium is thus involved with romantic relationships, about intimacy. there are two pathologies associated with intimacy that are represented by the red horizontal arrows in the painting. on the one hand, there is the pathology of being closed off to one's emotions and overly intellectual, achieving a Kafka-esque neuroticism in relationships.

on the other hand, there is the pathology of having the gates to one's heart constantly flung open and having no barrier to new and potentially harmful relationships. prostitution is a crystallized example of this pathology. thus the pericardium must be looked at when addressing trauma related to intimacy (as opposed to the bladder, which is more associated with general emotional trauma).

the arrow pointing upwards represents the fact that achieving balance within romantic relationship along the pericardial axis will allow the partners use the relationship in its full potential; as a vehicle for divine connection, an enhanced experience of unity with the universe.

3
the tidal hexagram associated with the pericardium is hexagram 23, the character of which implies, "stripping naked", or "peeling off the peel". the time of day associated with the hexagram is 7-9pm, a time when intimacy between partners occurs; a time for stripping naked. (the theme of intimacy is also depicted in the river zhang, which is made up of two rivers that end up interweaving together)

the time of year, month 9, also has a similar energy; during this time, nature "sheds its clothing", and the leaves on the trees that turned brilliant colors during autumn now start to wither and fall to the ground. during this time nature "has only one goal-- to conserve the life force" and pump everything underground in preparation for the wintertime.

the ninth month is also traditionally the month for marriage, another tie in with the theme of romantic union. one of the pericardium's archetypes is the pure female virgin about to get married, which is on an axis opposite the clock pair of the pericardium, the stomach-- whose archetype is the hormonal, debaucherous teenage male.

4
the stellar constellations associated with the pericardium are also associated with the same themes of intimacy and heart protection. all three refer to spots on a constellation of a dragon-- fang, the breast of the dragon, di, the chest of the dragon, and xin, the heart of the dragon.

the strong connection to the chest and breast within these constellations is indicative of the pericardium's energetic connection to the breasts; breast cancer is oftentimes a pericardium pathology. in fact, hormonal function in women in general can partly be attributed to the pericardium, although some other organs might be more closely associated. uterine fibroids is another example of a hormonally based pathology that is associated with the pericardium.

the character for fang also refers to the ancillary chambers of a house, where sex with concubines with occur. sex therefore has a strong association with the pericardium. incidentally, the animal associated with the pericardium is the dog, whose genitals are used in sex tonics. scorpio, the western counterpart to the pericardium time of year, is also notably associated with strong sexual energy.

5
this painting represents the triple burner's elusive function in the body, which is perhaps the most difficult organ to depict because it basically has no single analogue in simple anatomical terms. in general, triple burner is the function within the body that serves to connect the spaces between cells and organs. accordingly, the painting represents two of the many examples of triple burner manifestations in the body; the lymph channels, draining fluid from the extracellular matrix around cells, and the nervous system, connecting and coordinating all parts of our body to our central command center.

the middle channel represents the river luo, which is the river that is purported to hub together the other rivers (acting similar to the nervous system), as well as a drainage canal for the yellow river (acting similar to the lymph channels)

the triple burner's networking function can be seen in personality traits as well; the person with a triple burner personality is the "networker"-- in a group setting, this person connects everyone to each other and knows everyone. sometimes this function can be pathological and come at the expense of knowing true intimacy, resulting in a charismatic, sociable mask covering up a loneliness that only that person knows.

6
the triple burner is not only involved with connecting on a horizontal level, within one system, but it is also involved in connecting on a vertical, hierachical level. it is in charge of connecting with the universe, the microcosm with the macrocosm. this painting depicts the state that must be realized to achieve this connection; wu wei-- doing without doing, in the flow.

the person in bed represents the time associated with the triple burner, 9-11, a time when nature takes us into sleep, which is the ultimate wu wei state. our bodies are completely relaxed, our breathing gets deep and slow, and we merge with our subconscious, at the very least.

in the middle of the flow is the tidal hexgram associated with the triple burner, hexagram 2. this hexagram is "kun", and its meaning is again "in the flow". it is also a symbol of a grave and related to peaceful awareness of death, that is afforded by the unity of the wu wei state. (a metaphor for the TB function of proper transition / awareness of death is the structure of the pyramids; the long passageways into the pyramids and the elaborate, temple-like interiors suggest a transition with the next realms, rather than a hiding from them.)

the two dots on either side of the flow in the painting represent the stellar constellations wei and ji, which are on either side of the milky way, and also part of the milky way, representing the theme of "in the flow" as well.

7
this painting represents two examples of the relationship between the triple burner and the other organs. the bladder and the triple warmer can both be likened to the roots on a tree, but the bladder is more the large taproot (as it is concerned with circulating energy up the spine in the microcosmic orbit), whereas the triple burner is represented by the root network that connects adjacent plants.

secondly, the kidney and the triple burner can be represented by a battery (or spark plug) and a circuit; the kidney is the central power source and the triple burner provides the channels in which energy can flow. the kidney and triple burner are the pair most closely associated with adrenal function in western medicine. thus some states of adrenal fatigue can be related to these organ networks (although many cases are conflated with thyroid dysfunction).

8
the tidal hexagram of the gall bladder is hexagram 24: fu. it has one yang line under 5 yin lines and represents the energetic momentum at this time of year; yang is returning. the hexagram, when split into two trigrams, also represents thunder under the earth, which is represented by the painting.

the bottom layers of the painting represent the thunderous yang energy deep under the earth. each layer gets progressively more tame, and by the time the surface is reached, the manifestation of what is deep underground is simply rolling hills. the hilly landscape is also reminiscent of gansu province, which the gall bladder's river wei is purported to come from. this province is full of desert like landscapes full of burial mounds that poke up like hills; suggestive of a force about to burst from underneath.

the valleys between the hills in the painting are also suggestive of vertical caves-- caves are an important part of gall bladder symbolism. nature is beginning to come out of the caves during this time of year, out of hibernation. the life force reached the deepest place in the previous month and now is beginning to push back upwards.

9
the gall bladder's emotional function is highly related to decision making; the initial drive that starts a process. people who are unable to make a decision are likely to have a deficiency in the gall bladder network. it is also linked with leadership styles. this painting represents the clock pairs of gall bladder and heart, which form an axis that depicts two styles of leadership. on the one hand, heart leadership is wise, loving, and prioritizes the connection with all members of the group. on the other hand, gall bladder leadership is pushy, about efficiency and organization, and about making decisions rapidly. (the pushy nature of the gall bladder leader is mirrored in part by the gall bladder's physiological function; it serves to move energy in the body and flush out phlegm.)

these two styles are represented by the bamboo leaves- the heart bamboo leaves are falling downwards, representing the more relaxed heart leader and the gall bladder leaves are pushing upwards, representing the wood nature of the gall bladder leadership. bamboo in general might be an archetype for the wood organs, as it is rapidly growing, yet highly flexible. it is also hollow in the middle, which points to the heart function of being an "empty vessel", not having any private agenda as a leader.

another archetype of the gall bladder is the "jihad official". this official has a flag with truth written on it; as the name implies, this truth is often radical or cultish, and the official pursues it with the devotion of a cult leader. thus those who have a tendency to follow charismatic religious leaders or dive into esoteric religious beliefs might be related to gall bladder dysfunction.

10
this painting depicts an old myth about how the months were set in the zhou dynasty; all the animals were lined up on one side of a river and it was determined that the first animal to cross would be assigned to the first month. as the story goes, the rat, in all its cleverness, asked the ox for a ride across, and just as the ox was about to reach the other shore, jumped off and won the contest. the rat thus represents the gall bladder energy of cleverness. incidentally, the gall bladder meridians zig zag along the brain, furthering the mind connection.

the rat and the ox are also the animals for the gall bladder and liver, which are intricately related. if the gall bladder is about the initial push, the liver is about long term endurance. another notable relationship is the gall bladder and the small intestine: both are related to one's internal compass, but the SI has more of a mental, spiritual focus while the gall bladder has more of a visceral nature.

11
in contrast to the triple burner's maxim of "in the flow", the livers energy is decidedly "against the flow", as this painting depicts. hexagram 19 is the tidal hexagram associated with the liver and has two yang lines pushing up against 4 yin lines, and the chinese character means "to advance". the liver thus represents endurance, working for work's sake, without necessarily seeing the light at the end of the tunnel.

the river associated with the liver is the river sheng, which, unlike all the other rivers in china, flows east to west, against gravity. (a side note-- this river is also full of toads, which symbolically represent the liver's detoxifying properties, as toads have mucous membranes on the outside and are highly susceptible to environmental toxicity)

the liver's elemental associations for the five element and six conformation systems are both wood; further exemplifying the quality of pushing against the flow. the energy of the jueyin wood network might represented well by a single blade of grass pushing up towards the sun, bringing water upwards against gravity.

in this painting the liver energy is represented by the single red fish, swimming against the flow of the school of black fish.

12
the endurance that is associated with the liver is a womanly endurance. this painting depicts the symbol for a woman with many complex symbols inside of it, which represent the hormonal reality that renders the female body capable of feats of endurance such as childbirth. the arrow to the right represents the drive to go forward as well as suggesting that this quality might be channeled in males as well, although our physiologies might be different.

however, there is a stronger association with the female archetype than the male with the liver. another connection: the emotion associated with the liver is anger, and the character associated with anger depicts a woman being suppressed-- suggesting that the essence of liver anger is the heart of a suppressed woman, about to burst forth. also, the source of prenatal energy in women is the liver (and the kidneys in men).

xi wang mu is an archetypal liver woman character; a legendary tribal leader who led her tribe with eternal youthfulness and shamanistic wisdom. she was also, according to myth, wore a leopard mask, and howled at the moon-- representing perfectly the physiological qualities of "nu"-- healthy emotional expression.

the ox is yet another symbol of the endurance that liver energy represents; it toils in the fields tirelessly and as the jueyin conformation suggests, works best when pulling against some resistance. as mentioned before, while the gall bladder is important for making initial decisions, the liver is crucial for carrying out plans long term. the liver is therefore also represented by the general, the official in charge who plans and strategizes and delegates orders to the gall bladder's platoon seargent, who then executes the orders on the ground.

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this painting represents some of the energetic functions of the liver in the body. the red drops and flow represents the blood, which the liver has a pivotal role managing. the liver can be likened to a manager in a warehouse of blood, ushering the blood in and out when needed. the three drops of blood in each outlet represent three substances; blood, tears, and hormones (as described above the liver has a close connection with hormones, and tears are an expression of emotional reality made possible by hormones, and contain hormone metabolites as well).

the liver and the pericardium together govern the hormones and blood. jue ni represents a pathological condition of these two organ networks, resulting in blood rushing up in the wrong direction; leading to such conditions as stroke. another organ network that is related to blood flow is the small intestine, which is in charge of all the narrow passageways-- however it is more related to venous, retreating flow, while the liver is related to the pushing, arterial flow.

the overall painting describes another function of the liver, that it is in charge of coursing and draining. the two receiving channels represent the fact that the liver can aid in draining stagnant energy from two areas: the digestive spleen/stomach system, as well as emotional well being, preventing stagnant depressive states. (not depicted by the painting is another physiological function of the liver: the liver contains the hun spirits, which are ethereal spirits that follow the shen and come out in full force during sleep)