Ritonavir

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Joanna Chikwe, MD

  • Assistant Professor
  • Department of Cardiothoracic Surgery
  • Mount Sinai Medical Center
  • New York, New York

Bacterial (Bacillus cereus) and yeast contamination have been detected in commercial supplies of dried flowers (Martins et al symptoms 5 weeks pregnant generic ritonavir 250mg online. Proper storage is important because heat and moisture may decrease the therapeutic action of this plant (List and Horhammer 1979) treatment borderline personality disorder buy cheap ritonavir on-line. In European herbal medicine medicine 3604 pill cheap ritonavir line, this plant has been used since medieval times as a diaphoretic (to promote perspiration) and as both a nervine (tranquilizer) and a stimulant medicine werx order discount ritonavir online. It has also been used to treat headaches medicine dictionary pill identification order genuine ritonavir online, indigestion symptoms pink eye generic 250 mg ritonavir visa, hysteria, diarrhea and epilepsy (Foster and Tyler 1999). Major chemical constituents of the leaf include: flavonoids: tiliroside, kempferol-3,7 dirhamnoside, kempferol-3-O-glucoside-7-O-rhamnoside, linarine, quercetin-3,7-di-O-rhamnoside, quercetin-3-O-glucoside-7-O-rhamnoside; tannins and mucilage. The flower contains: afzelin, astragalin, hyperoside, isoquercitrin, kempferitrin, quercitrin, tiliroside, quercetin-3-O-glucoside-7-O-rhamnoside, kempferol-3-O-rhamnoside, kempferol-3-O-glucoside-7-O-rhamnoside, quercetrin-rhamnoxyloside, rutin; hydroxycoumarins: calycanthoside, aesculin; caffeic acid derivatives: chlorogenic acid; mucilage; tannins; and volatile oil: linalool, germacrene, geraniol, 1,8-cineole, 2-phenyl ethanol, phenyl ethyl benzoate and alkanes (Gruenwald et al. Indications and Usage: Flowers are approved by the Commission E for the treatment of cough and bronchitis (Blumenthal et al. Dried flowers are available in crushed or powdered form and administered as a tea. To prepare a tea, infuse 2 g herb (1 heaping teaspoonful) in 1 cup hot water and steep for 5-10 minutes. Activity/Effect Preparation Design & Model Results Reference Antigenotoxic Infusion of Tilia In vitro: hydrogen Active; desmutagenic; Romero cordata peroxide used as detoxified the mutagen Jimenez et al. Pharmacological evaluation of the anxiolytic and sedative effects of Tilia americana L. Comparative immunomodulatory effect of scopoletin on tumoral and normal lymphocytes. Evaluation of microbiological quality of medicinal plants used in natural infusions. Hepatoprotective principles from the flowers of Tilia argentea (linden): structure requirements of tiliroside and mechanisms of action. Evidence for bioadhesive effects of polysaccharides and polysaccharide containing herbs in an ex vivo bioadhesion assay on buccal membranes. Flavonoids with antinociceptive and anti-inflammatory activities from the leaves of Tilia argentea (silver linden). Isolation of pharmacologically active benzodiazepine receptor ligands from Tilia tomentosa (Tiliaceae). Traditional Preparation: Timacle root is often added to herbal mixtures or tinctures (botellas) and strong infusions or decoctions (tisanas) in combination with other roots and herbs; these herbal preparations may be used to treat a variety of ailments. Traditional Uses: In the Dominican Republic, this plant is attributed the following therapeutic properties: astringent, diuretic and emetic. Availability: Timacle can sometimes be purchased from botanicas that specialize in selling Caribbean medicinal plants. Flowers are yellow and grow in small clusters; petals are fused at the base to form a funnel-like shape, are marked by reddish lines on the outer surface and open at the end into 5 triangular lobes resembling a star. Fruits are fleshy, nearly circular, flattened drupes that turn from green to white when ripe (Acevedo-Rodriguez 1996). Animal Toxicity Studies: Toxicity studies in mice using the aqueous decoction of the root (1-5 g/kg) did not result in any fatalities (Saravia 1992). In mice, the ethanolic extract of the root showed hypoactivity but did not cause death when administered as a single oral dose (up to 2000 mg/kg) nor did it show signs of liver monooxygenase activity alteration. Intraperitoneal and subcutaneous administration of ethanolic root extracts showed significantly greater toxicity. In chronic toxicity tests, gavage administration of the ethanolic root extract for 14 days did not result in any deaths. In mutagenicity studies using the Salmonella/microsome assay, the ethanolic extract did not show mutagenic effects. Overall, when administered orally to mice, ethanolic extracts of the root were not mutagenic and presented a low acute and subacute toxicity (Gazda et al. The following compounds have been identified in the root: alkaloids, methyl salicylate and tannins (Duke 1992). Merilactone (a C-19 metabolite from methanol root extract) is a novel nor-seco-primaraine chemical structure that was recently isolated (Borges-Argaez et al. This classification is based on its most frequently reported use in the Caribbean as a remedy for the treatment of urethritis and ganglial inflammation of the groin (Germosen-Robineau 1995). Laboratory and Preclinical Data: Chiococca alba Activity/Effect Preparation Design & Model Results Reference Antibacterial Ethanolic extract of In vitro: Bacillus Demonstrated slight Le Grand & root subtilis antibacterial activity Wondergem 1986 Anti Ethanolic extract of In vivo Demonstrated anti Schapoval et inflammatory leaves inflammatory activity al. Antigonorrhoeal activity of plants used in Guatemala for the treatment of sexually transmitted diseases. Activites antimicrobiennes et etudes bibliographiques de la toxicologie de dix plantes medicinales de la caraibe. Traditional Preparation: An infusion or decoction of the leaves or aerial parts is used for treating digestive and gastrointestinal disorders, cough and upper or lower respiratory tract infections. Traditional Uses: the leaves are added to baths for skin disorders and spiritual purposes. Availability: As a popular culinary seasoning tomillo herb (usually dried but sometimes fresh) can be found at most grocery stores and supermarkets and is also sold at many botanicas in New York City. Leaves are small, dark green and arranged in opposite pairs along stems; they are linear to narrowly oval in shape, covered with glandular dots and slightly hairy on the underside. This plant is highly aromatic with a sharp, musky-camphor-like odor (Bailey Hortorium Staff 1976). Distribution: Originally native to the western Mediterranean, this popular culinary herb is cultivated in diverse temperate regions around the world (Bailey Hortorium Staff 1976). When administered appropriately, there are no known health hazards or negative side effects associated with its therapeutic use, except for a low potential for allergic reaction (Gruenwald et al. Few cases of hypersensitivity 416 to tomillo have been reported; however, cross-sensitivity to plants belonging to the mint (Lamiaceae) family has been observed in clinical settings and laboratory research (Benito et al. Animal Toxicity Studies: In an animal study involving rats fed a diet containing 2% or 10% Thymus vulgaris leaves, no evidence of toxicity was observed (Haroun et al. Contraindications: Contraindicated during pregnancy due to demonstrated effects as an emmenagogue. Caution advised in patients with acute inflammation of the urinary tract or gastrointestinal tract due to the potentially irritating effects of this herb on mucosa of the renal, urinary and gastrointestinal tracts. Patients with extensive skin injuries, acute dermatological conditions, high fevers, severe infectious diseases, heart conditions or hypertonia should avoid whole-body baths except when approved by a physician (Gruenwald et al. Indications and Usage: this herb has been approved by the Commission E for the treatment of cough and bronchitis (Blumenthal et al. This herb can be prepared as dried leaves, powdered herb, tea, infusion, bath, tincture, oil or liquid extract. For a bath, add 500 g herb to 4 liters boiling water, filter, then add to bath water or add 0. Relaxant effect of Thymus vulgaris on guinea-pig tracheal chains and its possible mechanism(s). Open trial to assess aspects of safety and efficacy of a combined herbal cough syrup with ivy and thyme. Isolation and structure elucidation of radical scavengers from Thymus vulgaris leaves. Effects of selected plant essential oils on the growth and development of mouse preimplantation embryos in vivo. Potentiation of antifungal action of amphotericin B by essential oil from Thymus vulgaris. Evaluation of the non-inferiority of a fixed combination of thyme fluid and primrose root extract in comparison to a fixed combination of thyme fluid extract and primrose root tincture in patients with acute bronchitis. Effect of feeding Cuminum cyminum fruits, Thymus vulgaris leaves or their mixture to rats. Antibacterial effects of commercial essential oils over locally prevalent pathogenic strains in Mexico. In vitro acetylcholinesterase inhibitory properties of thymol, carvacrol and their derivatives thymoquinone and thymohydroquinone. Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. The effects of essential oils and aqueous tea infusions of oregano (Origanum vulgare L. In vitro inhibition of drug-resistant and drug-sensitive strains of Mycobacterium tuberculosis by ethnobotanically selected South African plants. Antispasmodic activity of Thymus vulgaris extract on the isolated guinea-pig trachea: discrimination between drug and ethanol effects. In vitro effects of essential oils and isolated mono and sesquiterpenes on Leishmania major and Trypanosoma brucei. Antiviral effect of aqueous extracts from species of the Lamiaceae family against Herpes simplex virus type 1 and type 2 in vitro. Therapeutic approach to dermatophytoses by essential oils of some Moroccan aromatic plants. Susceptibility of drug-resistant clinical herpes simplex virus type 1 strains to essential oils of ginger, thyme, hyssop and sandalwood. In-vitro anti-inflammatory effect of Eucalyptus globulus and Thymus vulgaris: nitric oxide inhibition in J774A. A preliminary study investigating the effect of the application of some essential oils on the in vitro proliferation of Dermatophilus congolensis. Although the common name toronja may be used to refer to more than one species (C. Traditional Preparation: this remedy, which is attributed acidic and sour properties, is typically administered raw as a juice or eaten as a fruit. Traditional Uses: For some digestive disorders, aloe vera (sabila) is also used as a laxative in combination with grapefruit juice. Availability: Citrus paradisi is typically available at grocery stores and fruit stands in the United States, and its closely-related ancestor, Citrus grandis, is also sold but less popular. Leaves are oval, dark green, thick and leathery with wavy margins, glandular dots, a characteristic pungent odor when crushed and broadly winged leaf-stems. Fruits are round and occur in dense clusters, have light yellow to yellow-orange skin and contain numerous seeds and tart, succulent yellow to pink pulp. Fruit color, size, seed-content and sweetness vary between cultivars (Bailey Hortorium Staff 1976). Distribution: Native to China and southeast Asia, this plant is cultivated in tropical, subtropical and warm temperate regions (Bailey Hortorium Staff 1976). Grapefruit juice has been shown to interact with nifedipine in rats (Uesawa & Mohri 2005b). Drugs that have been shown to interact with this fruit juice by increasing their bioavailability include: cyclosporine (human clinical trials; Grenier et al. Swine co administered a decoction of the fruit pericarps and cyclosporine showed acute toxicity; therefore, blood levels should be monitored in patients concomitantly both these substances (Hou et al. Honey co ingested with a decoction of the fruit pericarps reduces the naringin and naringenin absorption from this plant and may reduce its potency (Hou et al. In laboratory and preclinical studies, the following activity has been reported: acetylcholinesterase inhibition, antiasthmatic, anticancer, antioxidant, antiplatelet, antitussive, anti-ulcer, chemopreventive, cytoprotective, expectorant, gastroprotective, hypocholesterolemic, inhibition of dihydropyridine oxidation and aflatoxin B1 activation and osteoporosis modulating (see Clinical Data and Laboratory and Preclinical Data tables below). An epidemiological study has shown an association between consumption of citrus peels (which have a high d-limonene content) and reduced risk of squamous cell skin cancer (Hakim et al. Other flavonoids include neohesperidin, hesperidin, narirutin and quercetin (Ho et al. Volatile constituents of the essential oil include: ethyl acetate, methyl butyrate, ethyl butyrate, limonene, octanal, cis-3-hexenol, cis linalool oxide, trans-linalool oxide, linalool, terpinen-4-ol, alpha-terpineol and nootkatone (Pino et al. Pomelo (Citrus grandis) has a similar chemical composition and also contains furanocoumarins including bergamottin, bergaptol and 6,7dihydroxybergamottin (Uesawa & Mohri 2005a) and coumarins xanthyletin, xanthoxyltein and suberosin (Teng et al. Indications and Usage: No dosage information available except for its traditional and nutritional use. Hortus Third: A Concise Dictionary of Plants Cultivated in the United States and Canada. Prevention of toxin-induced cytoskeletal disruption and apoptotic liver cell death by the grapefruit flavonoid, naringin. The effects of grapefruit pectin on patients at risk for coronary heart disease without altering diet or lifestyle. Pomelo-induced increase in the blood level of tacrolimus in a renal transplant patient. The effects of grapefruit on weight and insulin resistance: relationship to the metabolic syndrome. Fresh Israeli jaffa sweetie juice consumption improves lipid metabolism and increases antioxidant capacity in hypercholesterolemic patients suffering from coronary artery disease: studies in vitro and in humans and positive changes in albumin and fibrinogen fractions. Pomelo juice, but not cranberry juice, affects the pharmacokinetic of cyclosporine in humans. In vitro inhibition of diydropyridine oxidation and aflatoxin B1 activation in human liver microsomes by naringenin and other flavonoids. Citrus peel use is associated with reduced risk of squamous cell carcinoma of the skin. Acute intoxication of cyclosporine caused by coadministration of decoctions of the fruits of Citrus aurantium and the pericarps of Citrus grandis. Effect of honey on naringin absorption from a decoction of the pericarps of Citrus grandis.

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The wood has a fairly uniform texture and palachians of Pennsylvania medicine gustav klimt purchase on line ritonavir, very good machining properties treatment 1st degree burns buy generic ritonavir 250mg on line. It is moderately heavy symptoms anxiety ritonavir 250 mg online, Virginia medications and breastfeeding ritonavir 250mg otc, and North Carolina strong medicine woman cheap ritonavir 250 mg otc, stiff medicine dosage chart discount ritonavir online, and moderately hard, with high shock resis westward to Kansas, Okla tance. Other uses include as aspen (Populus), basswood (Tilia), and sapwood of burial caskets, wooden ware, novelties, patterns, and yellow-poplar (Liriodendron tulipifera). The white sapwood of buckeye merges gradually into the Chestnut, American creamy or yellowish white heartwood. The wood is uniform in texture, generally straight grained, light in weight, soft, American chestnut (Castaand low in shock resistance. It is rated low on machinability nea dentata) is also known such as shaping, mortising, boring, and turning. Before this species was attacked by Buckeye is suitable for pulping for paper; in lumber form, a blight in the 1920s, it grew it has been used principally for furniture, boxes and crates, in commercial quantities food containers, wooden ware, novelties, and planing mill from New England to north products. Practically all Butternut standing chestnut has been killed by blight, and most sup plies of the lumber come from salvaged timbers. Its southern range extends into northeast the heartwood of chestnut is grayish brown or brown and ern Arkansas and eastward darkens with age. American elm is threatened ately light in weight, moderately hard, moderately low in by two diseases, Dutch Elm disease and phloem necrosis, strength, moderately low in resistance to shock, and low in which have killed hundreds of thousands of trees. Sapwood of elm is nearly white and heartwood light brown, Chestnut was once used for fooring, poles, railroad cross often tinged with red. Elm may be divided into two general ties, furniture, caskets, boxes, shingles, crates, and core classes, soft and hard, based on the weight and strength of stock for veneer panels. Cottonwood includes sev eral species of the genus Historically, elm lumber was used for boxes, baskets, Populus. Most important are crates, slack cooperage, furniture, agricultural supplies and eastern cottonwood (P. Today, elm lumber and veneer are used known as Carolina poplar mostly for furniture and decorative panels. Greatest production lumber known in the trade of lumber is in the Southern and Central States. Hackberry tonwood grows on the West Coast and in western Montana, grows east of the Great northern Idaho, and western Nevada. Balsam poplar grows Plains from Alabama, Geor from Alaska across Canada and in the northern Great Lakes gia, Arkansas, and Oklaho States. Sugar the heartwood of cottonwood is grayish white to light berry overlaps the southern part of the hackberry range and brown. The sapwood is whitish and merges gradually with grows throughout the Southern and South Atlantic States. The wood is comparatively uniform in tex Sapwood of both species varies from pale yellow to green ture and generally straight grained. Eastern cottonwood is moderately low in bending the wood resembles elm in structure. Hackberry lumber is and compressive strength, moderately stiff, moderately soft, moderately heavy. It is moderately strong in bending, mod and moderately low in ability to resist shock. Most strength erately weak in compression parallel to grain, moderately properties of black cottonwood are slightly lower than those hard to very hard, and high in shock resistance, but low in of eastern cottonwood. Most hackberry is cut into lumber; small amounts are used for furniture parts, dimension stock, and veneer. Cottonwood is used principally for lumber, veneer, pulp Hickory (Pecan Hickory Group) wood, excelsior, and fuel. Species of the pecan hick ory group include bitternut Elm hickory (Carya cordiforSix species of elm grow mis), pecan hickory in the eastern United (C. The sapwood of this group is white or nearly white and rel When available, honeylocust is primarily used locally for atively wide. Heavy pecan hickory is used for tool and implement Locust, Black handles and fooring. Black locust (Robinia Many higher grade logs are sliced to provide veneer for fur pseudoacacia) is some niture and decorative paneling. Hickory (True Hickory Group) this species grows from Pennsylvania along the True hickories are found Appalachian Mountains throughout the eastern half to northern Georgia and of the United States. It is also native species most important to western Arkansas and commercially are shagbark southern Missouri. The greatest production of black locust (Carya ovata), pignut timber is in Tennessee, Kentucky, West Virginia, and (C. The heartwood, of the true hickories for all uses is in the Middle Atlantic when freshly cut, varies from greenish yellow to dark and Central States, with the Southern and South Atlantic brown. Black locust is very heavy, very hard, very resistant States rapidly expanding to handle nearly half of all hickory to shock, and very strong and stiff. The sapwood of the true hickory group is white and usu Black locust is used for round, hewn, or split mine timbers ally quite wide, except in old, slow-growing trees. The as well as fence posts, poles, railroad crossties, stakes, and heartwood is reddish. Historically, black locust was important for the manufacture For some purposes, both rings per centimeter (or inch) and of insulator pins and wooden pegs used in the construction weight are limiting factors where strength is important. It is also used for lad der rungs, athletic goods, agricultural implements, dowels, Magnolia gymnasium apparatuses, poles, and furniture. Lower grade Commercial magnolia hickory is not suitable for the special uses of high quality consists of three species: hickory because of knottiness or other growth features and southern magnolia (Maglow density. However, the lower grade is useful for pallets nolia grandifora), sweet and similar items. Other Honeylocust names for southern the wood of honeylocust magnolia are evergreen (Gleditsia triacanthos) has magnolia, big laurel, and bull bay. The lumber produced by all three such as attractive fgure species is simply called magnolia. The natural range of and color, hardness, and sweetbay extends along the Atlantic and Gulf Coasts from strength, but it is little used Long Island to Texas, and that of southern magnolia ex because of its scarcity. Cucumbertree grows species is found most com from the Appalachians to the Ozarks northward to Ohio. Sapwood of southern magnolia is yellowish white, and Sapwood is generally wide and yellowish, in contrast to the heartwood is light to dark brown with a tinge of yellow or light red to reddish-brown heartwood. Heartwood of soft maple is somewhat lighter in ately low in shrinkage, moderately low in bending and com color than the sapwood and somewhat wider. The wood of pressive strength, moderately hard and stiff, and moderately soft maple, primarily silver and red maple, resembles that high in shock resistance. Sweetbay is much like southern of hard maple but is not as heavy, hard, and strong. The wood of cucumbertree is similar to that of Soft maple is used for railroad crossties, boxes, pallets, yellow-poplar (L. Oak, Live Magnolia lumber is used principally in the manufacture of See Oak (Tropical) furniture, boxes, pallets, venetian blinds, sashes, doors, ve Oak (Red Oak Group) neer, and millwork. Hard maple includes the principal species are sugar maple (Acer sacnorthern red (Quercus rucharum) and black maple bra), scarlet (Q. The sapwood is nearly white and roughly 2 to 5 cm (1 to the heartwood is usually light reddish brown but some 2 in. The sapwood is commonly white Sawn lumber of the red oak group cannot be separated by with a slight reddish-brown tinge. The open pores of red oak make straight, but birdseye, curly, or fddleback grain is often se this species group unsuitable for tight cooperage, unless the lected for furniture or novelty items. Quartersawn lumber of the oaks is distinguished by its broad and conspicuous Hard maple is used principally for lumber and veneer. Rapidly grown second large proportion is manufactured into fooring, furniture, growth wood is generally harder and tougher than fner cabinets, cutting boards and blocks, pianos, billiard cues, textured old-growth wood. The red oaks have fairly high handles, novelties, bowling alleys, dance and gymnasium shrinkage upon drying. The red oaks are primarily cut into lumber, railroad cross Maple (Soft Maple Group) ties, mine timbers, fence posts, veneer, pulpwood, and Soft maple includes silver fuelwood. Ties, mine timbers, and fence posts require pre maple (Acer sacchariservative treatment for satisfactory service. Red oak lumber num), red maple is remanufactured into fooring, furniture, general millwork, (A. Silver maple is also Oak (White Oak Group) known as white, river, water, and swamp maple; White oak lumber comes red maple as soft, water, scarlet, white, and swamp maple; chiefy from the South, boxelder as ash-leaved, three-leaved, and cut-leaved maple; South Atlantic, and Cen and bigleaf maple as Oregon maple. Soft maple is found in tral States, including the the eastern United States except for bigleaf maple, which southern Appalachian comes from the Pacifc Coast. The most important western oak species, Or type stripe that is desirable for interior woodwork and egon white oak (Q. It is moderately strong, moderately stiff, and moderately high the sapwood of the white oaks is nearly white and roughly in shock resistance. Heartwood pores are usually plugged with Sweetgum is used principally for lumber, veneer, plywood, tyloses, which tend to make the wood impenetrable to liq slack cooperage, railroad crossties, fuel, pulpwood, boxes uids. Consequently, most white oaks are suitable for tight and crates, furniture, interior moulding, and millwork. High-quality white oak is es Maine to Nebraska, pecially sought for tight cooperage. An important use of southward to Texas, and white oak is for planking and bent parts of ships and boats; eastward to Florida. White oak is also used for furniture, fooring, pallets, agri the heartwood of sycamore is reddish brown; the sapwood cultural implements, railroad cars, truck foors, furniture, is light in color and from 4 to 8 cm (2 to 3 in. It is moderately heavy, moderately Sassafras hard, moderately stiff, moderately strong, and it has good Sassafras (Sassafras albishock resistance. Sassafras ber is used for furniture, boxes (particularly small food is easily confused with containers), pallets, fooring, handles, and butcher blocks. Sapwood is light yellow, and heartwood varies from dull grayish brown Tanoak to dark brown, sometimes with a reddish tinge. The wood is moderately densiforus) is also heavy, moderately hard, moderately weak in bending and known as tanbark-oak endwise compression, quite high in shock resistance, and because high-grade tan resistant to decay. Locally, sassafras is used for fence posts and species is found from rails and for general millwork. Sweetgum (Liquidambar Sapwood of tanoak is light reddish brown when frst cut and styracifua) grows from turns darker with age to become almost indistinguishable southwestern Connecticut from heartwood, which also ages to dark reddish brown. Except for compression per and southward to the Gulf pendicular to grain, the wood has roughly the same strength Coast. Tanoak has higher is produced in the South shrinkage during drying than does white oak, and it has a ern and South Atlantic tendency to collapse during drying. Black walnut is normally Because of its hardness and abrasion resistance, tanoak is straight grained, easily worked with tools, and stable in use. It is heavy, hard, strong, and stiff, and has good resistance It is also suitable for industrial applications such as truck to shock. The wood has been manufactured into Because of its good properties and interesting grain pattern, baseball bats with good results, and it is also suitable for black walnut is much valued for furniture, architectural veneer, both decorative and industrial, and for high quality woodwork, and decorative panels. Tupelo Willow, Black the tupelo group in Black willow (Salix nigcludes water (Nyssa ra) is the most aquatica), black (N. All except black tupelo grow principally reddish brown and frequently contains darker streaks. Wood of the different tupelo species is quite similar in ap It has moderately high shrinkage. The heartwood is light brownish Black willow is principally cut into lumber, which is then gray and merges gradually into the lighter-colored sapwood, remanufactured into boxes, pallets, crates, caskets, and fur which is generally many centimeters wide. Small amounts have been used for slack cooperage, fne, uniform texture and interlocked grain. Tupelo wood is veneer, excelsior, charcoal, pulpwood, artifcial limbs, and moderately heavy, moderately strong, moderately hard and fence posts. Buttresses of trees growing in swamps or fooded areas contain wood that Yellow-Poplar is much lighter in weight than that from upper portions of Yellow-poplar (Lirithe same trees. Because of interlocked grain, tupelo lumber odendron tulipifera) is requires care in drying. Yellow Black walnut (Juglans poplar grows from Con nigra) ranges from Ver necticut and New York southward to Florida and westward mont to the Great Plains to Missouri. The greatest commercial production of yellow and southward into Loui poplar lumber is in the South and Southeast. About Yellow-poplar sapwood is white and frequently several cen three-quarters of walnut timeters wide. The heartwood is yellowish brown, some wood is grown in the times streaked with purple, green, black, blue, or red. The wood has moderately high shrinkage when dried from Douglas-fr (Pseua green condition, but it is not diffcult to dry and is stable dotsuga menziesii) is after drying.

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Negative controls are those that show the effect of the absence of the suspected cause agent medications hair loss generic 250mg ritonavir overnight delivery. Positive controls show what happens if another medications given for adhd purchase generic ritonavir online, established cause is present but not our new suspect treatment hypothyroidism buy cheap ritonavir on-line. Independent variables are those that are influenced by the experiment (time medicine 9 minutes cheap ritonavir, weather medicine used to treat bv cheap 250mg ritonavir visa, etc medicine 503 buy ritonavir with a mastercard. Measurement Precise, quantitative measurements using accurate instruments make our observations more reliable and make it possible for others to check our scientific accuracy. Theories Explanations that apply to a broad range of observations are called theories. Reporting Careful records of our research findings including related research by prior investigations, our experimental design, observed measurements, and the reasoning used to interpret them allow others to learn and, if they want, to repeat our experiment. Produced in collaboration with the Ethiopia Public Health Training Initiative, the Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. The Center has not only supported the team financially, but also stood behind it firmly throughout the entire period of this experience. Thus Carter Center has become the pioneer in the field of preparing teaching material and also in training a team of authors for future endeavors of the kind. In addition, the task would have been impossible without the directing of the Federal Democratic Republic of Ethiopia, Ministry of Education. It is also not out of place to thank the administration of Gondar University, Debub University and Jimma University for extending cooperation whenever it was needed. D) Associate professor of Biochemistry, Medical Faculty, Addis Ababa University and Ato. Daniel Seifu, Lecturer of Medical Biochemistry, Medical Faculty, Addis Ababa University for their highly professional editing and most helpful comments about many aspects of the text. Contemporary Biochemistry plays a crucial role in the Medical field, be it metabolic pathways, storage diseases, mechanism action of varied biomolecules or inter and intra cellular communications. A lecture note on Medical biochemistry integrates and summarizes the essentials of the core subject. Topics are carefully selected to cover the essential areas of the subject for graduate level of Health sciences. Conformation of biomolecules, structure and their relationship to biological activity 2. Molecular events in gene expression and regulation Enzymes: Body proteins perform a large number of functions. They direct the metabolic events and exhibit specificity toward substrates, regulate the entire metabolism. Thus, they play key role in the degradation and synthesis of nutrients, biomolecules etc. They assist to know damaged tissues, the extent of tissue damage, helps to monitor the course of the disease and used as a therapeutic means of diagnosing a vast array of diseases. Proteins are the molecular instruments in which genetic information is expressed, Hormones, Antibodies, transporters, the lens protein, the architectural framework of our tissues and a myriad of substances having distinct biological activities are derived. The type, nature and number of amino acids impart characteristic properties to the proteins. Acid base properties of amino acids are important to the individual physical and chemical nature of vi the protein. The structural organization of proteins could be primary, secondary, tertiary and quaternary. The unfolding and disorganization of the proteins results in denaturation, the process is mostly irreversible. Many amino acid derived peptides are of biological importance and special products formed from them are of critical importance to the body. They contain more than one hydroxyl group (polyhydric) In addition to aldehyde or ketone group. Carbohydrates can be classified in to Monosaccharide, disaccharide, and polysaccharides. Mono is the smallest sugar unit, disaccharide is made up of two monosaccharides joined by glycosidic linkages. Serve as cell membrane components and mediate some forms of communication between cells. The failure of Galactose and fructose metabolism due to deficient enzymes leads to turbidity of lens proteins (Cataract). People suffer from Diabetes if the insulin hormone is less or not functioning well, such people are prone to atherosclerosis, vascular diseases, and renal failure. Integrative Metabolism and Bioenergetics Oxygen is utilized for the conversion of glucose to pyruvate. The main breakdown product of pyruvate is acetyl CoA, which is the common intermediate in the energy metabolism of carbohydrates, lipid and amino acids. It enters central metabolic pathway, the Citric acid cycle in the mitochondrial matrix. Lipids are water insoluble, but can be extracted with non-polar solvents like Benzene, methanol, or ether. Some lipids act as storage molecules for example triglycerides stored in adipose tissue. Transport forms of lipids (Lipoproteins),are present in combination with proteins Building blocks of lipids are fatty acids. Some lipids like cholesterol lack fatty acids but are potentially related to them. Lipids are constituents of cell membrane and act as hydrophobic barrier that permits the entry/exit of certain molecules. Break down of fatty acid produce energy, excessive breakdown cause ketosis, ketoacidosis, coma and death. Such information is applied in the treatment of patients with high cholesterol levels. Vitamins and Minerals They are organic compounds required in small quantities for the functioning of the body. Generally they are responsible for the maintenance of health and prevention of chronic diseases. A third group includes trace elements, which are required in small amounts for example Fe, I, Zn, etc. The metabolic role and deficiency disorders are important for the students of health sciences. Vitamins and trace elements are particularly important for patients with gastrointestinal disorders, who are fed on artificial diets or parenteral nutrition. Hormones are synthesized in one tissue, secreted in to blood, transported as mobile messengers. They increase the rate of chemical reactions taking place within living cells with out changing themselves. Depending on the presence and absence of a non protein component with the enzyme enzymes can exist as, simple enzyme or holoenzyme 1. Simple enzyme: It is made up of only protein molecules not bound to any non proteins. I If this cofactor is an organic compound it is called a coenzyme and if it is an inorganic 2+ 2+ 2+ groups it is called activator. One molecule of coenzyme is able to convert a large number of substrate molecules with the help of enzyme. Metal-activated enzymes-form only loose and easily dissociable complexes with the metal and can easily release the metal without denaturation. Metalloenzymes hold the metal tightly on the molecule and do not release it even during extensive purification. Promoting the formation of the enzyme-substrate complex (Example: Enolase and carboxypeptidase A. Acting as electron donors or acceptors (Example: Fe-S proteins and cytochromes) d. Active site Enzyme molecules contain a special pocket or cleft called the active site. The active site contains amino acid chains that create a three-dimensional surface complementary to the substrate. For the combination with substrate, each enzyme is said to possess one or more active sites where the substrate can be taken up. Catalytic efficiency/ Enzyme turnover number 3 8 Most enzyme catalyzed reactions are highly efficient proceeding from 10 to 10 times faster than uncatalyzed reactions. Typically each enzyme molecule is capable of transforming 100 to 1000 substrate molecule in to product each second. Enzyme turn over number refers to the amount of substrate converted per unit time (carbonic anhydrase is the fastest enzyme). Absolute specificity: this means one enzyme catalyzes or acts on only one substrate. Stereo specificity some enzymes are specific to only one isomer even if the compound is one type of molecule: For example: glucose oxidase catalyzes the oxidation of D-glucose but not D glucose, and arginase catalyzes the hydrolysis of L-arginine but not D-arginine. Bond Specificity * Enzymes that are specific for a bond or linkage such as ester, peptide or glycosidic belong to this group Examples: 1. Regulation Enzyme activity can be regulated that is, enzyme can be, activated or inhibited so that the rate of product formation responds to the needs of the cell. Zymogens (inactive form of enzyme) Some enzymes are produced in nature in an inactive form which can be activated when they are required. Many of the digestive enzymes and enzymes concerned with blood coagulation are in this group Examples: Pepsinogen this zymogen is from gastric juice. When required Pepsinogen converts to Pepsin Trypsinogen this zymogen is found in the pancreatic juice, and when it is required gets converted to trypsin. Isoenzymes (Isozymes) these are enzymes having similar catalytic activity, act on the same substrate and produces the same product but originated at different site and exhibiting different physical and chemical characteristics such as electrophoretic mobilities, amino acid composition and immunological behavior. The international union of Biochemistry and Molecular Biology developed a system of nomenclature on which enzymes are divided in to six major classes, each with numerous sub groups. Each enzyme is characterized by a code number comprising four digits separated by points. The four digits characterize class, sub-class, sub-sub-class, and serial number of a particular enzyme. Transferases: Enzymes catalyzing a transfer of a group other than hydrogen (methyl, acyl, amino or phosphate groups) Example: Enzymes catalyzing transfer of phosphorus containing groups. Hydrolases: Enzymes catalyzing hydrolysis of ester, ether, peptido, glycosyl, acid-anhydride, C-C, C-halide, or P-N-bonds by utilizing water. Lyases: Enzymes that catalyze removal of groups from substances by mechanisms other than hydrolysis, leaving double bonds. Isomerases: Includes all enzymes catalyzing interconversion of optical, geometric, or positional isomers. Example: Enzymes catalyzing interconversion of aldose and ketoses D Glyceraldehyde-3 phosphate ketoisomerase (triosephosphate isomerase) D Glyceraldehyde-3phosphate Dihydroxyacetone phosphate. Lock: Key model of enzyme action implies that the active site of the enzyme is complementary in shape to that of its substrate, i. Figure: Models of enzyme substrate interactions Mechanism of Enzyme Action (1913) Michaels and Menten have proposed a hypothesis for enzyme action, which is most acceptable. Enzyme once dissociated from the complex is free to combine with another molecule of substrate and form product in a similar way. The transition state is the top of the energy barrier separating the reactants and products. The rate of a given reaction will vary directly as the number of reactant molecules in the transition state. The energy of activation is the amount of energy required to bring all the molecules in 1 gram-mole of a substrate at a given temperate to the transition state A rise in temperature, by increasing thermal motion and energy, causes an increase in the number of molecules on the transition state and thus accelerates a chemical reaction. The enzyme combines transiently with the substrate to produce a transient state having c lower energy of activation than that of substrate alone. Once the products are formed, the enzyme (or catalyst) is free or regenerated to combine with another molecule of the substrate and repeat the process. Activation energy is defined as the energy required to convert all molecules in one mole of reacting substance from the ground state to the transition state. Temperature Starting from low temperature as the temperature increases to certain degree the activity of the enzyme increases because the temperature increase the total energy of the chemical system. Above this the reaction rate decreases sharply, mainly due to denaturation of the enzyme by heat. The temperature at which an enzyme shows maximum activity is known as the optimum temperature for the enzyme. For most body enzymes the optimum 0 temperature is around 37 c, which is body temperature. First, the catalytic process usually requires that the enzyme and substrate have specific chemical groups in an ionized or unionized sate in order to interact.

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Rabdosia (dong ling cao) symptoms 4dp3dt buy generic ritonavir 250 mg line, barbed skullcap (ban zhi lian) symptoms jaw pain and headache buy 250 mg ritonavir visa, old enlandia (bai hua she she cao) medicine 018 250mg ritonavir fast delivery, isatis (da qing ye) medications for anxiety cheap ritonavir 250mg amex, moutan (mu dan pi) symptoms gout order ritonavir 250mg without prescription, zedoary (e zhu) medicine etodolac ritonavir 250mg for sale, and amber (hu po) are used in traditional Chinese herbal medicine to treat cancer and tumors. According to modern research, saw palmetto reduces inflammation and supports prostate health. Based on Rehmannia Six Formula (Liu Wei Di Huang Wan), a kidney yin tonic, this formula is used specifically to address yin deficiency with fire, internal heat, or bone-steaming heat. It is excellent for feelings of burn out or exhaustion with heat, and is one of the most commonly used formulas for controlling hot flashes. Indications Back pain Night sweats Dizziness or vertigo Palms and soles, hot Face, red Pain, in back or at midline Fever, low grade, afternoon, or Premature ejaculation tidal Restlessness Hot flashes Spontaneous seminal emission Hyperthyroidism Toothache, from deficiency fire Insomnia Throat, sore and dry Impotence Urinary difficulty Tongue: Dry, red or red sides, glossy. If heat signs are not present, use Rehmannia Six Formula or True Yin Formula instead. Heat in the blood can cause bleeding disorders such as nosebleed, vomiting blood, or blood in the urine and stools, and various types of skin rashes. Rehmannia Cool Blood Formula can also be used to destroy bacteria that has entered the blood. Indications Blood in stool or urine Mania Boils Mouth sores Carbuncles Nosebleed Chicken pox Psoriasis Delirium Restlessness Eczema Skin rash, red with intense itching Heat, aversion to Sores, painful Hives Stools, dry Incoherent speech Thirst, with no desire to swallow Irritability Throat, sore or dry Itching Urine, yellow or scanty Tongue: Red or purplish, with thin, yellow, or white coating. By sup plementing the yin of the kidney and liver, this formula helps to support the root yin of the whole body. Originally from a pediatric text, Rehmannia Six Formula was developed to treat children with slow development or failure to thrive. Thus, it is a well-balanced formula, appropriate for long-term use to build yin and drain deficiency fire. Ingredients Rehmanniae Radix Preparata (Rehmannia, cured / Shu Di Huang) 32% Corni Fructus (Asiatic Dogwood Fruit, Asiatic Cornel / Shan Zhu Yu) 16% Dioscoreae Rhizoma (Chinese Yam / Shan Yao) 16% Moutan Cortex (Tree Peony / Mu Dan Pi) 12% Poria (Poria, Hoelen, Tuckahoe / Fu Ling) 12% Alismatis Rhizoma (Asian Water Plantain / Ze Xie) 12% Chinese Medical Actions Supplements yin, nourishes kidneys and liver, builds and stabilizes essence. Indications Back (lower), weak and sore Menopause, premature Children, slow development in Night sweats Constitution, delicate Nocturnal emissions Diabetes mellitus Palms and soles, hot Dizziness or vertigo Premature ejaculation Dry mouth or throat (chronic) Ringing in the ear Fatigue Tidal fever Hearing loss Urinary tract infection, chronic Impotence Vision blurred Knees weak Tongue: Red, with thin coating, dry. Contraindications: Rehmannia Six Formula should be used with caution in cases where the patient has weak digestion, loose stools due to spleen deficien cy, or a white, greasy tongue coating. It is a major formula for treating a decline in the various basic desires and appetites that are the conventional hallmarks of vitality, specif cally, loss of interest in food and sex. It is commonly used to treat impotence, premature ejaculation, and diminishing hearing and/or eyesight, as well as chronic fatigue. Ingredients Dioscoreae Rhizoma (Chinese Yam / Shan Yao) 10% Cyathulae Radix (Cyathula Root / Chuan Niu Xi) 9% Cistanches Herba (Broomrape / Rou Cong Rong) 8% Corni Fructus (Asiatic Dogwood Fruit, Asiatic Cornel / Shan Zhu Yu) 7% Lycii Fructus (Lycium Fruit / Gou Qi Zi) 7% Poria (Poria, Hoelen, Tuckahoe / Fu Ling) 7% Morindae Ofcinalis Radix (Morinda / Ba Ji Tian) 6. Indications Abdomen, cold Impotence Aging, premature Libido, low Appetite, loss of Night sweats Back, heavy feeling in Spontaneous seminal emission Ejaculation, premature Teeth, loosening Emaciation Vaginal discharge, white Fatigue, chronic Vision, decline of Hearing loss Weight loss, unintended Tongue: Pale or normal. This formula is best applied when spleen qi deficiency is secondary to the accumulation of damp. The spleen is easily susceptible to the encumbrance of damp from the occasional overindulgence in food or alcohol, or from the long-standing habit of an improper diet. This causes the spleen to become compromised in its transportation and transformation function, leading to damp stagnation with pain, indigestion, bloating and abdominal discomfort after meals, chronic loose or irregular stools, irregular appetite, dulling of taste, and lethargy. The traditional formula has been modified to include coix (yi yi ren), poria (fu ling), and amomum (sha ren) to help disinhibit dampness and support the spleen, immature bitter orange (zhi shi) and hawthorn (shan zha) to disperse digestive stagnation, and vladimiria (chuan mu xiang) to pro mote the downward flow of qi through the digestive tract and relieve abdomi nal distension. Codonopsis (dang shen) is included to supplement the qi of the spleen and stomach. This formula can be helpful in patients on a weight loss regimen who are experiencing damp encumbrance. Often, these patients will have such an overwhelming amount of dampness that it is necessary to use this formula initially before the root conditions can be addressed. This is a drying formula and should not be used with those who are severely yin or blood deficient unless coupled with an appropriate formula. Note: this formula is best applied in the short term to overcome damp encumbrance. This version has been modified with biota (bai zi ren) to nourish the heart and calm the spirit; longan (long yan rou) to supplement the heart and spleen, nourish the blood, and calm the spirit; and mimosa (he huan hua) to calm the spirit. The state of the shen (spirit) is responsible for the quantity and quality of sleep. A pattern of chronic sleeplessness leads to a defi ciency of heart blood and yin. As the deficiency becomes more pronounced, it becomes increasingly more difficult to sleep. Restful Sleep Formula helps to break this cycle and restore normal sleep patterns. This is an excellent formula for insomnia in older patients with chronic deficiency patterns. Ingredients Platycladi Semen (Oriental Arborvitae Seed, Biota Seed / Bai Zi Ren) 20% Longan Arillis (Longan Fruit / Long Yan Rou) 13% Albiziae Flos (Mimosa Tree Flower, Silk Tree Flower / He Huan Hua) 13% Ophiopogonis Radix (Ophiopogon Tuber / Mai Men Dong) 10% Jujubae Fructus (Jujube Date, red / Hong Zao, Da Zao) 9% Rehmanniae Radix (Rehmannia, unprocessed / Sheng Di Huang) 9% Glycyrrhizae Radix Preparata (Chinese Licorice Root, honey-fried / Zhi Gan Cao) 8% Ginseng Radix (Asian Ginseng Root / Ren Shen) 6% Zingiberis Rhizoma Recens (Ginger, fresh / Sheng Jiang) 6% Cinnamomi Ramulus (Cassia Twig, Chinese Cinnamon / Gui Zhi) 6% Chinese Medical Actions Supplements qi and heart blood, calms the spirit, clears heat, aids sleep. Indications Appetite, poor Insomnia Complexion, pale Memory, poor Constipation, with dry stool Palpitations Fatigue, from sleeplessness Sleep, restless or disturbed Tongue: Pale. Note: this formula should be taken consistently over a period of time to address deficiency of qi and heart blood created by a pattern of sleeplessness. It will be important to address other possible causes for insomnia, such as pain or other patterns of disharmony. Most formulas designed to treat pain primarily use herbs that regulate and invigorate qi and blood. Restorative Formula differs in that it not only moves blood and qi, but also focuses on supplementing qi, blood, yin, and yang. This makes it ideal for patients whose presentation is more related to deficiency than stasis. The balanced nature of the formula allows it to transform damp without damaging yin, thus making it ideal as a general tonic for aging patients. Indications Arthritis Limbs, tired or aching Chronic pain in the elderly or in Nerve pain patients weakened by illness Pain in the muscles, tendons, Fibromyalgia and joints Tongue: Pale, with a thin, white coating, or small and dark red. The original formulation is a modification of Sheng Mai Formula, which is for restoring the pulse after prolonged or severe illness. Instead of ophiopogon (mai men dong), Restore the Lung Formula contains prepared rehmannia (shu di huang) because the emphasis is not so much on moistening as it is on restoring a strong relationship between lung and kidney. The source formula includes mulberry bark (sang bai pi) and aster (zi wan) to relieve cough. Ingredients Astragali Radix (Astragalus / Huang Qi) 20% Rehmanniae Radix Preparata (Rehmannia, cured / Shu Di Huang) 20% Codonopsis Radix (Codonopsis / Dang Shen) 15% Mori Cortex (White Mulberry Root Bark / Sang Bai Pi) 15% Asteris Radix (Tartarian Aster Root / Zi Wan) 12% Platycodi Radix (Platycodon Root, Balloon Flower Root / Jie Geng) 10% Schisandrae Fructus (Northern Schisandra Fruit / Wu Wei Zi) 8% Chinese Medical Actions Revitalizes lung qi, harmonizes lung and kidney, resolves phlegm, relieves cough. Indications Bronchitis, chronic or post-acute Shortness of breath Cough, chronic (dry or phlegmatic) Sweating, spontaneous Fatigue Tongue: Pale, may be slightly red at tip. Note: the application of this formula is similar to that of Lily Preserve Metal Formula. The main difference is that Lily Preserve Metal Formula restores the lung that has sustained damage primarily to its fluids; Restore the Lung Formula revitalizes the lung qi that has been depleted. The original formula emphasizes the promotion of blood flow and the balancing of the heart. To the basic formula, the traditional Six Gentlemen Formula (Liu Jun Zi Wan) has been added to support the general vitality, which is often diminished in chronic depression. When appropriate, this formula can be useful for patients who are undergoing psychotherapy, as it helps lighten and free the emotions while providing support. In cases of blood deficiency, use Peaceful Spirit Formula or Ginseng Nourishing Formula. This formula combines several potent, blood-stanching herbs to treat bleeding from internal disorders or from external trauma. Ingredients Notoginseng Radix (Tienqi Ginseng, Pseudoginseng / San Qi, Tian Qi) 45% Agrimoniae Herba (Agrimony / Xian He Cao) 20% Celosiae Cristatae Flos (Cockscomb Flower / Ji Guan Hua) 15% Imperatae Rhizoma (Imperata Rhizome / Bai Mao Gen) 10% Platycladi Cacumen (Oriental Arborvitae Leaf and Stem / Ce Bai Ye) 10% Chinese Medical Actions Stops bleeding, dispels blood stasis. Note: For bleeding from a constitutional imbalance, it may be appropriate to combine with a formula to treat the root disorder. For example, bleeding due to heat in the blood can be addressed with Rehmannia Cool Blood Formula. Qi deficiency bleeding can be addressed by using San Qi Formula with Ginseng & Astragalus Formula. Bleeding from blood-heat (especially uter ine bleeding) precipitated by liver qi stagnation can be treated by combining San Qi Formula with Free & Easy Wanderer Plus. It is useful for patients with kidney deficiency who also have weak spleen yang and lack the digestive fire to process kidney tonics alone. Indications Abdomen, cold sensation in Impotence Appetite, loss of Lassitude Cold hands and feet Menstruation, prolonged Cold, sensitivity to Urinary incontinence Complexion, pale Urination, excessive Cough with white sputum Vaginal discharge, white or clear Diarrhea Weak limbs Dizziness Weakness, generalized Fatigue Tongue: Pale, may be swollen. The traditional formula upon which this tablet is based treats a broad range of symptoms that result from deficient kidney yin and essence (jing), and deficient liver blood and yin. The Chinese name of this formula can be translated as Seven Treasures Elixir for Beautiful Hair. The formula presented here has been modified with drynaria (gu sui bu) to further supplement the kidney and liver, red peony (chi shao) to cool and invigorate blood, and licorice root (gan cao) to harmonize and supplement qi. Ingredients Polygoni Multiflori Radix Preparata (Fo-Ti / Zhi He Shou Wu) 20% Drynariae Rhizoma (Drynaria Rhizome / Gu Sui Bu) 12% Lycii Fructus (Lycium Fruit, Chinese Wolfberry / Gou Qi Zi) 11% Achyranthis Bidentatae Radix (Achyranthes / Huai Niu Xi) 10% Angelicae Sinensis Radix (Dong Quai Root, Tang Kuei / Dang Gui) 10% Cuscutae Semen (Chinese Dodder Seed, Chinese Cuscuta / Tu Si Zi) 10% Psoraleae Fructus (Psoralea Fruit / Bu Gu Zhi) 10% Poria (Poria, Hoelen, Tuckahoe / Fu Ling) 8% Paeoniae Radix, rubra (Chinese Peony, red / Chi Shao) 6% Glycyrrhizae Radix (Chinese Licorice Root / Gan Cao) 3% Chinese Medical Actions Replenishes yin and essence (jing) of the kidney, nourishes liver blood and yin, supports kidney yang. Indications Back (lower), weak and sore Knees, weak and sore Hair, premature graying Nocturnal emissions Hair loss or thinning Thirst Infertility from kidney deficiency Vaginal discharge, profuse Tongue: Pale, thin, shiny, or lacking a tongue coating. Contraindications: Use with caution with patients who have a thick tongue coating or loose stools. It is used for injury to the yin from summer heat or in cases of chronic weakness caused by lung qi or yin deficiency. It can also be used after trauma or shock, or whenever the pulse has become remarkably deficient after an external invasion. Today, this formula is also frequently used to treat a wide range of cardiovascular conditons. Pulse: Weak and rapid, or weak and thin, or large and scattered Contraindications: Do not use with a high fever, in initial stages of summer flu, or with unresolved conditions from external pathogenic factors. Ingredients Cyperi Rhizoma (Cyperus, Nut Grass / Xiang Fu) 10% Paeoniae Radix, alba (Chinese Peony, white / Bai Shao) 10% Bupleuri Radix (Bupleurum Root / Chai Hu) 8% Crataegi Fructus (Chinese Hawthorn Fruit / Shan Zha) 8% Aurantii Fructus (Bitter Orange / Zhi Ke) 7% Amomi Fructus (Amomi Fruit / Sha Ren) 7% Citri Reticulatae viride Pericarpium (Tangerine Peel, green / Qing Pi) 6% Citri Reticulatae Pericarpium (Tangerine Peel / Chen Pi) 6% Magnoliae Officinalis Cortex (Magnolia Bark / Hou Po) 6% Curcumae Radix (Turmeric, Curcuma Tuber / Yu Jin) 6% Amomi Fructus Rotundus (Chinese Cardamom / Bai Dou Kou) 6% Vladimiria Radix (Vladimiria Root / Chuan Mu Xiang) 6% Citri Sarcodactylis Fructus (Fresh-Finger Citron Fruit / Fo Shou) 5% Glycyrrhizae Radix (Chinese Licorice Root / Gan Cao) 4% Curcumae Longae Rhizoma (Turmeric Rhizome / Jiang Huang) 3% Zingiberis Rhizoma Recens (Ginger, fresh / Sheng Jiang) 2% Chinese Medical Actions Soothes the liver, regulates the stomach, moves qi, breaks up stagnation, dries dampness, and transforms phlegm. Indications Abdominal distension or bloating Hiccough Abdominal pain Hypoglycemia Acid regurgitation Hypochondriac pain Appetite, poor Indigestion Bitter or sour taste in mouth Intestinal cramping Belching Irritable Bowel Syndrome Digestion, poor Stomachache Flatulence Stools, erratic Heartburn Vomiting Hepatitis Tongue: Normal, or with a thin, greasy coating. Because it clears both deep-lying and superficial heat and includes substances that unblock all of the major pathways out of the body: it vents the upper body and releases excess heat, wind, and dampness to the exterior, it unblocks the bowel, and disinhibits urination. The two most common patterns are 1) an exterior heat pathogen that has penetrated to the interior without leaving the exterior, and 2) an exterior heat pattern that attacks where there is a preexisting internal heat pattern. The most common applications today are the resolution of heat-type influenza and acute, hot skin disorders. The formula is balanced between purgative/heat-clearing substances and exterior-releasing substances. Ingredients Glycyrrhizae Radix (Chinese Licorice Root / Gan Cao) 21% Alismatis Rhizoma (Asian Water Plantain / Ze Xie) 12% Platycodi Radix (Platycodon Root, Balloon Flower Root / Jie Geng) 10% Malvae Semen (Malva Seed, Whorled Mallow Fruit / Dong Kui Zi) 10% Scutellariae Radix (Chinese Skullcap, Scute / Huang Qin) 8% Saposhnikoviae Radix (Siler / Fang Feng) 4% Rhei Radix et Rhizoma (Chinese Rhubarb / Da Huang) 4% Menthae Haplocalysis Herba (Chinese Mint / Bo He) 4% Forsythiae Fructus (Forsythia / Lian Qiao) 4% Schizonepetae Herba (Schizonepeta / Jing Jie) 4% Anemarrhenae Rhizoma (Anemarrhena Rhizome / Zhi Mu) 4% Chuanxiong Rhizoma (Ligusticum Wallichii Rhizome / Chuan Xiong) 3% Angelicae Sinensis Radix (Dong Quai Root, Tang Kuei / Dang Gui) 3% Paeoniae Radix, alba (Chinese Peony, white / Bai Shao) 3% Atractylodis Macrocephalae Rhizoma (White Atractylodes Rhizome/ Bai Zhu) 2% Gardeniae Fructus (Gardenia Fruit / Shan Zhi Zi) 2% Zingiberis Rhizoma Recens (Ginger, fresh / Sheng Jiang) 2% Chinese Medical Actions Expels exogenous wind-heat, drains heat from the interior, supplements qi and blood. Indications Acne Hives Bitter taste in mouth Itching Boils, carbuncles Infection, viral Bronchitis, acute Influenza Common cold, with high fever Sinus infections, with fever Conjunctivitis Skin rashes, hot Constipation Sores, red, hot Cough Sties Eyes, red and painful Throat, sore Fever Urination, dark, rough, or inhibited 108 Hemorrhoids or rectal bleeding Warts, flat Tongue: Red at tip, with yellow coating. Pulse: Rapid and flooding, rapid and wiry, or rapid and rolling Contraindications: this formula is designed for acute conditions and is con traindicated for long-term use. Note: In respiratory disorders with no exterior heat signs, such as simul taneous chills and fever, or aversion to wind or cold, Mulberry & Lycium Formula may be a more appropriate strategy. It is a combination of the Four Gentleman Formula (Si Jun Zi Tang) for spleen qi deficiency with Citrus and Pinellia Formula or Two-Cured Decoction, a formula to dry dampness, transform phlegm and rectify the qi. Indications Acid regurgitation Fatigue Appetite, loss of Mental disorders from phlegm Cough with thin white sputum Nausea Diarrhea Nervous exhaustion Digestion, weak Shortness of breath Dizziness Vomiting Tongue: Pale, slightly swollen. Contraindications: the overuse of this formula can lead to dry mouth and excessive thirst. Unless used in conjunction with another appropriate formula, this formula should not be used in cases where there is deficiency heat, high fever, or irritability, thirst, and constipation. Since chronic blood stasis usually presents with qi stagnation, phlegm nodulation, heat-toxin, and/ or spleen/kidney deficiency, this formula addresses each of these. Ingredients Salviae Miltiorrhizae Radix (Chinese Salvia Root / Dan Shen) 10% Astragali Radix (Astragalus / Huang Qi) 9% Sargentodoxae Caulis (Sargentodoxa / Hong Teng) 8% Cyperi Rhizoma (Cyperus, Nut Grass / Xiang Fu) 8% Patriniae Herba (Patrinia, Snow Thistle / Bai Jiang Cao) 8% Angelicae Sinensis Radix (Dong Quai Root, Tang Kuei / Dang Gui) 8% Myrrha (Myrrh / Mo Yao) 8% Sparganii Rhizoma (Sparganium, Bur Reed Rhizome / San Leng) 8% Curcumae Rhizoma (Zedoary Rhizome / E Zhu) 8% Prunellae Spica (Heal All Spike, Self-Heal Spike / Xia Ku Cao) 6% Gleditsiae Spina (Gleditsia Thorn / Zao Jiao Ci) 6% Chuanxiong Rhizoma (Ligusticum Wallichii Rhizome / Chuan Xiong) 4% Cinnamomi Cortex (Cassia Bark, Chinese Cinnamon / Rou Gui) 3% Bupleuri Radix (Bupleurum Root / Chai Hu) 3% Cimicifugae Rhizoma (Chinese Cimicifuga Rhizome / Sheng Ma) 3% Chinese Medical Actions Moves blood, regulates qi, eliminates dampness, transforms stasis, disperses nodules, clears heat-toxin, alleviates pain, supports the spleen and kidneys. Indications Abdominal pain, lower Menstrual pain Amenorrhea Menstruation, irregular Constipation Ovarian cysts Endometriosis Pelvic Inflammatory Disease Endometritis Prostatitis, chronic, w/blood stasis Fibromyalgia w/blood stasis Sexual dysfunction, male, Infertility w/blood stasis w/blood stasis and damp-heat Menopausal symptoms Uterine bleeding, dysfunctional Tongue: Purple or dark red, with dark or purple spots. Do not use in cases with heavy menstrual bleeding or any active hemorrhagic disorder. This modification of Harmony-Preserving Pills (Bao He Wan) is intended to treat acute upset of the digestive tract with belching, acid reflux, a full feeling in the stomach, bloating, nausea, a foul taste in the mouth, abdominal cramping, diarrhea, or constipation. Whether from overeating, poor food combining, weak digestion, or other factors such as emotional upset, acute gastric distress is often char acterized by stagnation of qi and food and counterflow of stomach qi. This formula can relieve the discomfort of overeating and the stagnation of damp heat associated with hangover from drinking too much alcohol. Ingredients Crataegi Fructus (Chinese Hawthorn Fruit / Shan Zha) 18% Paeoniae Radix, alba (Chinese Peony, white / Bai Shao) 12% Massa Fermentata (Fermented Leaven / Shen Qu) 12% Forsythiae Fructus (Forsythia / Lian Qiao) 12% Pinelliae Rhizoma Preparatum (Pinellia, ginger-cured / Zhi Ban Xia) 10% Poria (Poria, Hoelen, Tuckahoe / Fu Ling) 10% Citri Reticulatae Pericarpium (Tangerine Peel / Chen Pi) 7% Toosendan Fructus (Melia Fruit / Chuan Lian Zi) 5% Zingiberis Rhizoma Recens (Ginger, fresh / Sheng Jiang) 5% Raphani Semen (Radish Seed / Lai Fu Zi) 5% Coptidis Rhizoma (Coptis / Huang Lian) 4% Chinese Medical Actions Disperses accumulation and stagnation of food, clears heat, directs qi down ward, rectifies qi flow, harmonizes the stomach and intestines.

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