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Stephanie A. Terezakis, MD

• Assistant Professor
• Department of Radiation Oncology and Molecular
• Radiation Sciences
• Johns Hopkins School of Medicine
• Assistant Professor
• Department of Radiation Oncology and
• Molecular Sciences
• Johns Hopkins Hospital
• Baltimore, Maryland

Again juvena herbals cheap npxl 30 caps without a prescription, the time factor is not of importance and careful workmanship produces better results than speed herbs collinsville il order npxl 30caps with amex, although the latter may prove more profitable himalaya herbals 52 npxl 30 caps on-line. But although neither deep abscesses nor diseases of the kidneys nor of the liver nor of other organs situated within the body are visible to the eye bestlife herbals buy 30 caps npxl otc, which is the most satisfactory way of observation herbs used in cooking purchase npxl 30caps online, medicine has none the less found out means by which a diagnosis may be reached herbals for ed cheap npxl 30 caps online. Such means consist of observations on the quality of the voice, whether it be clear or hoarse, on the respiratory rate, whether it be quickened or slowed, and on the constitution of the various fluids which flow from the orifices of the body, taking into account their smell and colour, as well as their thinness or viscosity. By weighing up the significance of these various signs it is possible to deduce of what disease they are the result, what ♦It is possible that something has been lost from the text of this section. Even when nature herself does not produce such signs, they may be revealed by certain harmless measures known to those practised in the science. For instance, a patient may be made to rid himself of phlegm by the administration of certain acid draughts and foods. Thus a visible sign is produced of some underlying disease which could not otherwise be demonstrated to the sight. If a patient be made to walk uphill or to run, abnormalities in respiration will be observed which would not be apparent at rest. By producing sweating in the manner just mentioned the signs of fever can be observed, just as the steam from hot water indi­ cates fire. Substances can be given which, excreted in the urine, or through the skin, reveal the disease better. Then draughts and substances taken by mouth have been discovered, which, producing more heat than the cause of some fever, act on that cause and make the fever flow away, a result which would not happen but for the exhibition of such treatment. But both the methods to be employed and the signs produced differ from case to case. As a result the signs may be difficult for the physician to interpret and then cures are slow and mistrust in the power of the doctor persists. That the science of medicine makes use of principles which can be of real assistance has been shown in this work. But it would not be fair to expect medicine to attempt cures that are all but impossible, nor to be unfailing in its remedies. That medicine can be of value is further demonstrated by the skill of those proficient practitioners whose actions are better proof than their words. It is not that such physicians look down on writers, but they believe that most men are more ready to believe what they see than what they hear. First he must consider the effect of each of the seasons of the year and the differences between them. Secondly he must study the warm and the cold winds, both those which are common to every country and those peculiar to a particular locality. Just as it varies in taste and when weighed, so does its effect on the body vary as well. When, therefore, a physician comes to a district previously unknown to him, he should consider both its situation and its aspect to the winds. The effect of any town upon the health of its popu­ lation varies according as it faces north or south, east or west. Similarly, the nature of the water supply must be considered; is it marshy and soft, hard as it is when it flows from high and rocky ground, or salty with a hardness which is permanent? Then think of the soil, whether it be bare and waterless or thickly covered with vegetation and well-watered; whether in a hollow and stifling, or exposed and cold. Lastly consider the life of the inhabitants them­ selves; are they heavy drinkers and eaters and consequently unable to stand fatigue or, being fond of work and exercise, eat wisely but drink sparely? A physician who understands them well, or at least as well as he can, could not fail to observe what diseases are important in a given locality as well as the nature of the inhabitants in general, when he first comes into a district which was unfamiliar to him. Thus he would not be at a loss to treat the diseases to which the inhabi­ tants are liable, nor would he make mistakes as he would certainly do had he not thought about these things beforehand. Being familiar with the progress of the seasons and the dates of rising and setting of the stars, he could foretell the progress of the year. Thus he would know what changes to expect in the weather and not only would he enjoy good health himself for the most part but he would be very successful in the practice of medicine. If it should be thought that this is more the business of the meteorologist, then learn that astronomy plays a very important part in medicine since the changes of the seasons produce changes in diseases. I shall explain clearly the way in which each of these subjects should be considered. Let us suppose we are dealing with a district which is sheltered from northerly winds but exposed to the warm ones, those, that is, which blow from the quarter between south-east and south-west; and that these are the prevailing winds. Water will be plentiful but it will consist chiefly of brackish surface water, warm in the summer and cold in the winter. The inhabitants of such a place will thus have moist heads full of phlegm, and this, flowing down from the head, is likely to disturb their inner organs. Their constitution will usually be flabby and they tolerate neither food nor drink well. It is a general rule that men with weak heads are not great drinkers because they are particularly liable to hangovers. The women are sickly and liable to vaginal discharges; many of them are sterile, not by nature, but as the result of disease. Children are liable to convulsions and asthma which are regarded as divine visitations and the disease itself as ‘ sacred the men suffer from diarrhoea, dysentery, ague and, in the winter especially, from prolonged fevers. They are also subject to pustular diseases of the skin which are particularly painful at night and also from haemorrhoids. Pleurisy, pneumonia and other acute diseases are rare since such diseases do not flourish in a watery constitution. Such then are the diseases of the country, except that changes in the weather may produce epidemics in addition. Let us now take the case of a district with the opposite situation, one sheltered from the south but with cold prevailing winds from the quarter between north-west and north-east. The inhabitants will therefore be sturdy and lean, tend to constipa­ tion, their bowels being intractable, but their chests will move easily. They will be more troubled with bile than with phlegm; they will have sound and hard heads but suffer frequently from abscesses. Because of this too, and because they are sinewy, abscesses commonly appear on the slightest pretext. Such men eat with good appetites but they drink little; one cannot both eat and drink a great deal at the same time. Ophthalmia occurs and is of long duration tending to become both serious and chronic, and the eyes suppurate at an early stage. These then are the diseases to which the men of such a district are liable; others only if some change in the weather provokes an epidemic. The women suffer largely from barrenness owing to the nature of the water; this is hard, permanently so, and cold. Menstruation, too, does not occur satisfactorily but the periods are small and painful. After parturition they are unable to feed their babies because the flow of milk is dried up by the intractable hardness of the water. The children suffer from dropsy of the testicles while they are young, but this disappears as they grow up. Let us now consider districts which are exposed to winds from the quarter between north-east and south-east, and then those from the west. Those that face east are likely to be healthier than those facing north or south even if such places are only a furlong apart. The water, to the easterly side, must necessarily be clean, sweet-smelling, soft and pleasant. The inhabitants are generally of good and healthy complexion unless they are subject to disease. They have loud and clear voices and if, as is probable, local condi­ tions generally are better, they are of better temperament and intelligence than those exposed to the north. The climate in such a district may be compared with the spring in that there are no extremes of heat and cold. In general, it may be said that they resemble districts of southern aspect except that the women are prolific and give birth easily. Towns that face west and are thus sheltered from easterly winds while the warm winds and those from the south pass them by, must necessarily have a most unhealthy situation. This is because the air holds the early morning mist and such air, mixing with water, takes away its sparkle, for it does not get the sun on it until late in the day. In summer damp breezes blow and cause dew to fall in the early morning, but for the rest of the day the sun, as it declines, burns up the inhabitants. This tends to make them of poor complexion and sickly and they suffer from all the diseases previously mentioned without exception. Their voices are thick and somewhat hoarse on account of the air which tends to be impure and unhealthy. Not even the northerly gales reach such districts to dispel these characteristics. Now I should like to explain what is the effect of different kinds of water, to indicate which are healthy and which unhealthy, and what effects, both good and bad, they may be expected to produce. Stagnant water from marshes and lakes will necessarily be warm, thick and of an unpleasant smell in summer. Those who drink it also have large and firm spleens while their bellies are hard, warm and thin. Their shoulders, the parts about the clavicles and their faces are thin too because their spleens dissolve their flesh. Their spleens remain enlarged summer and winter and, in addition, cases of dropsy are frequent and fatal to a high degree. The reason for this is the occurrence, during the summer, of much dysentery and diarrhoea together with prolonged quartan fevers. Such diseases, when they are of long standing, cause dropsy in people of this type and this proves fatal. The older men suffer from a fever called causus on account of the hardness of their bellies, the women from tumours and leucorrhoea. During lactation, wasting and pains occur and menstruation does not become properly re-established. The children are specially liable to rupture and the men to varicose veins and ulcers of the legs. It is hard; either from the soil containing hot waters, or from iron, copper, silver, gold, sulphur, alum, bitumen or nitre. The water from such ground is bad since it is hard, heating in its effect, difficult to pass and causes constipation. This is sweet and clean and, when taken with wine, but little wine is needed to make a palatable drink. Moreover, it is cool in summer and warm in winter because it comes from very deep springs. I particularly recommend water which flows towards the east, and even more that which flows towards the north-east, since it is very sparkling, sweet­ smelling and light. But there are some constitutions and some diseases which benefit by drinking such water and these I shall proceed to detail. The second best from springs facing the quarter between north-east and north-west, especially the more easterly, and the third from springs between north-west and south-west. The worst is the southern variety, the springs facing between south-west and south-east. These water supplies are worse when the winds are southerly than when they are northerly. A man who is in good and robust health need not distinguish between them, but he may drink whatever is to hand at the moment. But if a sick man wishes to drink what is best for him, he would best regain his health by observing the following rule. If his stomach is hard and liable to become inflamed, the sweetest, lightest and most sparkling water is best for him; but if his stomach is soft, moist and full of phlegm, the hardest and saltiest are best since these will best dry it up. The water that is best for cooking and softest is likely to relax and soften the stomach. Salty water is thought to be a laxative; actually the opposite is the case and permanently hard water tends to make the bowels costive. We now pass from spring water to a consideration of rain water and water from snow. Rain water is very sweet, very light and also very fine and sparkling, since the sun, drawing it up, naturally seizes upon the finest and lightest water, as is proved by the salt which is left behind. The brine is left on account of its thickness and heaviness and becomes salt, but the sun draws up the finest elements because of their lightness. It draws it up not only from ponds, but also from the sea and in fact from any source which contains moisture; and there is nothing that does not contain some. Even from human beings, it draws off the finest and lightest part of the body’s humours. A very good proof of this is seen when a man goes and sits in the sun wearing a cloak. Where sunlight falls on the body, no sweat will be seen, but the part which is shaded or protected by something becomes damp with sweat. This is because the sun draws up the sweat and makes away with it; but where the body is shaded, the sweat remains because the sunlight cannot get at it. If the man goes in the shade, the whole body sweats alike because the sun is no longer on him. Rain water, being composed of a mixture of so many elements, quickly becomes rotten on standing and exhales a foul smell.

To say that they were able to relieve constipation is equivalent to saying that a shotgun may be used as a fly swatter: they purged ruthlessly with the many plant-based purgatives humboldt herbals buy npxl with american express, such as aloes and senna jenith herbals order 30caps npxl mastercard, for every condition imaginable kairali herbals purchase npxl 30caps otc. He receives an unexpected call from the wealthy seemed to care nothing either for his wealth or title herbals supplements proven npxl 30caps. The college’s Phannacopoeia does mention a foxglove tea herbals baikal buy generic npxl from india, or infusion zain herbals proven 30 caps npxl, as a helpful diuretic, meaning a drug to stimulate the kidneys. This shows at least that they were in the right ballpark, since a strengthened heart causes the kidneys to start making urine. Yet medicine as a whole in the nineteenth century lost sight of digitalis as a cardiac drug, using it against tuberculosis and everything else, until London physicians James Mackenzie and Thomas Lewis reintroduced it before the First World War. The physician practis­ ing before the middle of the nineteenth century had nothing against infectious disease, cancer, arthritis, diabetes, asthma, heart attacks, or vaginitis (inflamma­ tion of the vagina). The list of conditions he could not relieve (although he believed that he could) is much longer than those which he could. Arthur Hert zler, the Kansas frontier doctor, said in 1938 of his earlier colleagues, ‘I can scarcely think of a single disease that the doctors actually cured during those early years. Doctors knew how to relieve suffering, set bones, sew up cuts and open boils on small boys. This drawing of the plant appears in a com­ pendium of Aztec history and culture called the Florentine Codex, c. In reality, cin­ chona is effective only against malaria (quinine is one of its constituents) but this was not realized for some time. The great demand for cinchona by Europeans during the period of colonial expansion had important consequences in promoting which synthesized new molecules from coal tar (benzene). After Alexander Wood made it known in 1855 that morphine could be administered with the hypodermic nee­ dle he had perfected, they could be injected directly into the blood stream, bypass­ ing the stomach. The hypodermic syringe and the injectible opioids in the nineteenth-century medical bag became the subject of much mischief, for while they offered undoubted pain relief, they also were highly addictive. The old fam­ ily doctors gave morphine at the drop of a hat, and tales are legion of patients whom these physicians casually addicted. Members of this family, all synthesized in the laboratory, cut pain effectively as well as reducing fever and inflammation. This is part of the larger story of the search for antifever drugs, or antipyretics. In the absence of a germ theory, earlier physicians had directed their attention to bringing down fever rather than to over­ coming the underlying infection. Such efforts went back to experiments with qui­ nine as a general febrifuge, not just an antimalarial drug. But quinine was ineffective against other fevers, and unbeloved among patients because of its bit­ ter taste and side-effects. Since its introduction in 1899, aspirin (acetylsalicylic acid) has been the most popular drug of all time. If the members of the aspirin family had been consumed mainly over-the-counter, bought at the pharmacy without a prescription, they might not figure so prominently in the history of primary care. Yet many doctors themselves Primary Care 135 dispensed aspirin and its relatives, and wrote out prescriptions for them. By 1909, aspirin and the antipyretic phenacetin (another member of the acetanilid family) ranked among the ten items most prescribed by American physicians. The aspirin family had come to symbolize medicine’s new thera­ peutic accomplishments. An enduring problem in primary care is patients who cannot sleep, or are nervous, irritable, depressed, or agitated. The nineteenth-century German chemical industry had presents to offer them as well. In 1869, a foul-tasting hypnotic called chloral hydrate (made by adding water to chloral) came into medical use. Known popularly as a ‘Mickey Finn’, chloral hydrate was in reality a mild sleeping potion, one that starts to lose its efficacy after about the third night. Sulphonal was the first really popular drug of Some of the new drugs intro­ the Bayer Company’s laboratories in Germany, and helped finance research on a duced in the nineteenth century caused severe side further cascade of hypnotics. The poet Dante acid, first synthesized in 1864, and add on several small hydrocarbon sidechains. The barbiturates virtually put an end to all the ear­ addicted to the sedative chlo­ lier hypnotics except for chloral hydrate. In Max bital was introduced in 1912 as Luminal, and has attained epic status in novels Beerbohm’s Quis Custodiet about psychoneurosis among the middle classes. One Canadian family doctor, William Victor Johnston, [Frederick James] Shields and wrote of the interwar years that Luminal, alongside aspirin, morphine, and digi­ I have been talking matters talis, had been ‘indispensable’. What luridly arresting, and are the caused a sensation in primary care, a virtual revolution in the image of the physi­ allies of insomnia. Emil Adolf von Behring and Shibasaburo Kitasato showed that the serum of a horse immunized against diphtheria (using techniques developed at the Pasteur Institute in Paris) could be used to immunize other horses. The introduction of the diphtheria antitoxin sharply upgraded the doctor’s image in the eyes of the public. For the first time, medicine was truly capable of curing an infectious disease that threatened the children of every home in the nation. Apart from the diphtheria antitoxin, however, it would be unwise to exagger­ ate the therapeutic accomplishments of the modern doctor before 1935. Syphilis was treatable with Salvarsan from 1910 (see page 264) but the reality of clinical practice reduced itself more to tonics and laxatives than to finely calibrated doses of Bayer’s pharmaceutical products. In 1869, one observer described the scene at the casualty department of St Bartholomew’s Hospital in London: ‘120 patients were seen by the physician and dismissed in an hour and ten minutes, or at the rate of 35 seconds each. They consist essentially,’ said an anonymous contributor to the Lancet, ‘of purgatives; a mixture of iron, sulphate of magnesia, and quassia [both laxatives], and cod-liver oil, fulfilling the two great indications of all therapeutics elimina­ tion, and the supply of some elements to the blood. He has Opposite: the causative bacil­ never heard of many of the “new-fangled” remedies that are in the case of his lus of diphtheria was isolated young competitor, but he has managed to “get along” these many years without in 1883 by Edwin Klebs. Mathews felt that in time young physicians, too, would discover that all Seven years later, Emil Behring and Shibasaburo they really needed in their bags were drugs to make the patients defaecate and Kitasato developed the first vomit. Horses drugs, 255,000 pounds (115,700 kg) of aloes (a laxative), 113,000 pounds were much used as experi­ (51,250 kg) of jalap (another laxative), 1,400,000 pounds (635,040 kg) of nux mental animals for producing vomica (an emetic), and 13,000 pounds (5,900 kg) o f‘calomel and other mercur­ the blood serum needed for the antitoxin. One such epidemic incision, attempted to cut but his hand vibrated, shook, from the 1890s was recalled by Thomas Shastid in the small went all wobbling around everywhere’. Misanthropus had inadver­ bations and tracheotomies, especially the latter, because tently used the back edge of the blade. I found the boy very ill, the whole back of his throat One night Shastid accompanied a colleague, nicknamed being like white velvet. One must distinguish between innova­ tions that remain the monopoly of a small group of specialists, and those that dif­ fuse widely among general practitioners. The panoply of new technology in primary care that emerged in the late nine­ teenth century (see page 140) was reassuring to the patients, and extended the range of medical diagnosis far beyond what the simple techniques of physical examination permitted. The study was focused on medical economics, but it assumed that a general practitioner would be able competently to determine what the heart was doing in a single surgery visit of half an hour. By contrast the great English heart specialist James Mackenzie had complained just a decade previously about the ‘utmost con­ fusion prevailing as to the significance of the signs detected in the heart’. Diphtheria, a highly the combination of scientifically trained physicians thinking systematically about contagious bacterial infection the mechanisms of disease, together with the persistence of tides of laxatives dis­ whose symptoms include a pensed from big brown jugs, made it inevitable that doctors would become scep­ moderate fever, general tical about the possibilities of drug treatment in general. In the second half of the nineteenth century the hard cough, was often fatal to children. It spread widely in nihilists ruled the roost in academic medicine, teaching generations of medical the eighteenth century There students, quite correctly, that the decoctions and infusions then available in the were also epidemics during formulary were either useless or harmful, that physicians could do relatively little the nineteenth century until to cure disease (although they could relieve suffering with opium), and, by impli­ the development of the anti­ cation, that the real function of medicine was to accumulate scientific information toxin and improved methods of treatment. The term itself is associated with the Viennese academic Joseph Died, a reduced the incidence of the pupil of the famous physician Josef Skoda. Died wrote in 1841: ‘Medicine as a nat­ disease worldwide but epi­ demics still occasionally ural science cannot have the task of inventing panaceas and discovering miracle occur, as recently in the for­ cures that banish death, but instead of discovering the conditions under which mer Soviet Union. Thomas Clifford Allbutt, the distinguished Leeds physi­ X-ray, the stethoscope, and the electrocardiograph. William Macartney, as a house doctor not have this objective, and used the microscope instead to (intern) at Bellevue Hospital in the late 1880s in New York, study specimens. Or one could try to find the bacteria of said with a grateful smile, "Shure, Doctor, that did me a 34 pneumonia, tuberculosis, or bronchitis in samples of sputum. Snickered Daniel Cathell in 1882 of the microscope and the X-ray similar equipment, ‘If, at your office and elsewhere, you In 1895, the Wurzburg physicist Wilhelm Rontgen discov­ make use of instruments of precision. What unwelcome object was in that duced to Germany the region to dampen the normal high note caused by the hol­ whole modern investi­ lowness of the lungs? All of these diseases create areas of dullness, but the Above: the Russian zoologist Elie Metchnikoff with a X-ray would show exactly what was at fault. In the late nineteenth century, his microscopic Burton Wood, in charge of the outpatient department at studies led to the modern science of immunology. Quite quickly, therefore, the measurement of blood pressure the unmusical were bewildered by dissertations on the became standard in primary care. In auscul­ tors at the Massachusetts General Hospital in Boston started tation we were taught to take note of the slightest noting the blood pressure of their patients on admission. Slight weakening of inspi­ the I920s it was customary for British and American general ration at one apex [top of lung] or a roughening of the practitioners to have in their offices the instruments breath sounds or a catchy quality might all be significant required for measuring blood pressure. A wave of electrical current 36 common phrase, "to see for ourselves” crosses the heart from the right side to the left every time it In orthopaedics, for problems like fractures, the X-ray beats. This A knowledge of the blood pressure is useful as a measure­ device required the patient to ment of the work the heart has to do: the higher the arterial place hands and feet in four resistance against the blood being pumped out of the heart, buckets of water (see page the tireder the heart gets. In 1896, the Italian physician Sci 200) and was at first quite pione Riva-Rocci invented a simple device for measuring complicated to operate, blood pressure a rubber bag that went around the arm, although of great useful­ which was then filled with air in order to block the circula­ ness to specialists. By the tion in the brachial artery and determine at what pressure 1930s, however, an Ameri­ the blood was passing through. Bernhard Naunyn, who later became a professor of internal medicine in Germany, remembered of his professors in Berlin in the 1860s: ‘They knew that the healing part of medicine rested upon the discipline’s scientific basis, and that the physician’s compulsion to cure [Drang zutn Heilen] had to be reigned in. In 1844, Harvard’s Jacob Bigelow cautioned medical students against ‘always thinking that you must make your patients worse before they can be better. I believe that much of the medical imposition of the present day is sus­ tained in places where practice has previously been over-heroic, and because mankind are gratified to find that they and their families can get well without the 39 lancet, the vomit, and the blister, indiscriminately applied’. Another Harvard professor in the mid-nineteenth century, Oliver Wendell Holmes, would rescue only opium, wine, and anaesthesia from the formulary. William Osier, Canadian-born professor of medicine at Johns Hopkins University and one of the most influential physicians in the English-speaking world, limited himself in his 1892 textbook to a handful of drugs and said that for many diseases there was no treatment at all. In primary care, the doctrine of therapeutic nihilism was anathema because physicians enjoy the feeling of help­ ing and because patients crave a prescription at the end of the consultation. It was entirely unacceptable that patients should be sent away with the news that medi­ cine was powerless in their case. Kansas doctor Arthur Hertzler summed up the position of the general practitioner around the turn of the century, In some cases I knew, even in the beginning, that my efforts would be futile in the matter of rendering service to anyone. Of course, one left some medicine in case of a recurrence of the trouble; this was largely the bunk, but someone had to pay for the axle grease and just plain advice never was productive of revenue unless fortified by a few pills. It was about as important as the deacon’s ‘Amen’ during the preacher’s sermons —it did no harm and it was an evidence of good faith. His medicines were mainly ‘the bunk’ and he realized that in scientific terms either the patient would recover spontaneously Primary Care 143 from the infectious illness or he would not. In this logical dilemma was born the patient-as-a-person movement, a doctrine that would run through primary care from the 1880s until the Second World War. The patient could not be helped with medicines, although these would be given anyway, but with the psychological support of the doctor. In seeing the patient as ‘a person’ and not just as ‘a case of disease’ the physician was able to approach him in an understanding and sympathetic manner that was in and o f itself therapeutic. It was not that the old-time doc was necessarily a more sensitive and humane individual than his predecessors or his successors, merely that he was therapeutically desperate and realized that he had nothing to give them except such psychological benefits as inherently resided in the consultation. The patient-as-a-person movement originated within the commanding heights of medical science in Europe, but among physicians, whose particular bent was In advocating ‘Nature’s healing, rather than anatomical pathology. In Vienna, Hermann Nothnagel, pro­ healing ways’, some late fessor of medicine after 1882, embodied the new philosophy. As he said in his nineteenth-century doctors 1882 inaugural lecture, ‘I repeat once again, medicine is about treating sick people were rejecting the classic and not diseases’. Many came to believe to the patient’, and fought for their best interests, even at the cost of harsh words that most medicines were with the family doctor. From a German guide Hospital the importance of history-taking in the consultation a key theme in the to domestic medicine by Anna movement as a whole because in taking a long and careful history the doctor has Fischer-Diickelmann (1903). Nothnagel was fond of quoting a saying from an earlier prince of German med­ icine, Christoph Wilhelm Hufeland, to the effect that, ‘Only a truly moral person can become a physician in the truest sense of the term’. Nothnagel, who had a huge consulting practice in the Vienna hotels, prescribed great quantities of the useless medica­ tions of the time, but established close rapport with his patients and was much loved by them. A young American physician, who was sitting in, recalled his words: ‘the physician examines and treats the “patient” and not the “case”. It was this insistence on the human and the humane side of medicine that made the deepest impression on 44 me’, wrote New York neurologist Barney Sachs many years later. Most notably, William Osier embodied these humanistic values, teaching the medical students on rounds at Johns Hopkins University that, the good physician treats the disease but the great physician treats the patient who has the 45 disease’. Farrar who later became a psy­ chiatrist, noted: ‘Osier was instinctively practising psychotherapy without ever having studied it. Physicians in primary care found one aspect of the patient-as-a-person move­ ment of particular interest: the utility of this approach in treating patients whose symptoms were ‘functional’ or ‘psychosomatic’ in other words, symptoms that had arisen in the absence of any organic lesion but were defined by the patient as organic in nature. Such symptoms constituted and constitute today a huge amount of what was seen in primary care: a third or more of all patients. As Francis Weld Peabody, the professor of internal medicine at Harvard University, volunteered in 1927, ‘The successful diagnosis and treatment of these patients.

Yellowness of the skin herbals vs pharmaceuticals generic 30caps npxl otc, tissues and secretions biotique herbals generic 30caps npxl fast delivery, due to the deposition of bile pigments in the blood zordan herbals cheap npxl 30caps free shipping. Either of a pair of organs in the dorsal area of the abdominal cavity which function to excrete waste products and to maintain fluid herbs and uses buy npxl 30 caps visa, electrolyte herbals teas safe during pregnancy order npxl 30 caps without a prescription, and acid-base homeostasis herbs de provence recipes cheapest generic npxl uk. Any of a group of infectious diseases caused by flagellate protozoan parasites of the genus Leishmania and transmitted to man by sandflies of the 331 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) genera Phlebotomus and Lutzomyia. Chronic contagious disease caused by infection with Leprabacillus, characterized by the formation of nodules on the body surface and, in an advanced stage, often producing deformities. A disease of the blood, characterized by a great increase in the number of white blood corpuscles. An acute, usually chronic, disease caused by protozoa of the genus Plasmodium and transmitted by the Anopheles mosquito; characterized by intermittent fever, anemia and debility, and, in its acute form, by chills, high fever and profuse sweating at regular intervals. Disease originally attributed to noxious atmospheric emanations from marshy ground. An acute infectious viral disease, characterized by skin eruptions, high fever and nasal catarrh, and occurring most frequently in childhood. A pre-larval parasitic worm of the family Onchocercidae, found in the vector and in the blood or tissue fluids of the human host. A recurring intensely painful headache, often accompanied by vomiting, giddiness and disturbance of vision. Tiny arachnid (Acari), many of which live as parasites in animals or in prepared foods. Drug or substance used to relieve pain and which induces drowsiness, sleep, stupor or insensibility. The morphologic changes that follow cell death, characterized most frequently by nuclear and also cytoplasmic changes. Sudden severe pains radiating along the course of a nerve, without demonstrable structural changes occurring. An alkaloid derived from the leaves of Pilocarpus jaborandi or Pilocarpus microphyllus and having cholinergic activity. A large number of conditions that include the inflammation or passive congestion of the lungs, resulting in portions of the lung becoming solid. A paste of a plant part or drug applied to a sore or inflamed part of the body, to supply moisture or act as a local stimulant; cataplasm. A chronic inflammatory skin disease characterized by reddish patches covered with white scales. A small elevation filled with pus and situated within or beneath the epidermis or within a pilosebaceous follicle; pimple. To absorb or assimilate a product of the body, such as an exudate or a cellular growth. General term indicating diseases of muscle, tendon, joint, bone or nerve, and resulting in discomfort and disability. A neuralgia radiating from the hip and thigh, through the leg and into the foot, involving the sciatic nerve. Tuberculosis of the lymphatic glands, especially of the neck, in which the glands become enlarged. A priest of the religious practice of certain native peoples who believe that good and evil spirits pervade the world, and can be summoned or heard through inspired priests acting as mediums. Any of various liquid or cream preparations of soap or detergent used to wash the hair and scalp (some are medicated). A severe, eruptive contagious disease marked by chills, high fever, headache and backache. A drug or agent that prevents or relieves spasms or the involuntary and irregular contractions of body muscles. To wrench or twist a ligament or muscle of a joint, especially the ankle or wrist, without dislocating the bones. Inability to produce offspring; the state of being free from living microorganisms; asepsis. Any of various rays of the family Dasyatidae, having a whiplike tail armed with a venomous spine capable of inflicting severe injury. A stimulant of appetite; a drug or substance which promotes the functional activity of the stomach. An abnormal narrowing of the internal passageway within a tubular structure, such as a vessel or duct. A venereal disease characterized by a variety of lesions and caused by Treponema pallidum. A pack or plug made of absorbent material that can be placed in a cavity to absorb blood or other fluid, or to control bleeding. A severe infectious disease caused by Clostridium tetani, characterized by rigidity and spasms of the voluntary muscles. A mycotic disease of the upper digestive tract resulting from infection by the fungus Candida albicans. It occurs especially in children and is characterized by small, whitish spots on the tip and sides of the tongue. A drug that invigorates or generally improves the normal tone of an organ of the patient. A contagious disease of the conjunctiva and cornea of the eye, producing painful sensitivity to strong light, and excessive weeping. A member of the Class Trematoda, which includes the parasitic flukes of man and domestic animals. Infectious disease caused by the tubercle bacillus, attacking all tissues of the body but especially the lungs. Infectious disease caused by bacteria in contaminated food and resulting in fever and intestinal disorders. An interruption of the continuity of a surface, with an inflamed base; any open sore other than a wound. The scar on the abdomen marking the site of former attachment of the umbilical cord in placental mammals. A slit-like tube conveying urine from the internal orifice of the urinary bladder to the external urethral orifice. A transient skin eruption characterized by the appearance of intensely itching wheals or welts; hives or nettle rash. A drug which causes the destruction and expulsion of intestinal worms; anthelmintic. A disorder of pigmentation in which the melanocytes inhibit melanogenesis and eventually disappear, resulting in a patchy loss of pigmentation. To eject the stomach contents through the mouth in a sudden forceful fashion, usually associated with nausea. An infusion used to treat obstructions of the liver and to rid the kidneys and bladder of mucus, grit and sand. Acute infectious disease, usually affecting children, caused by a bacillus, and characterized by catarrh of the respiratory tract and repeated attacks of coughing that end in forced inspiration. Infectious tropical disease caused by Treponema pertenue and characterized by an initial lesion, followed by further multiple lesions of the skin; framboesia. Abdominal Pain; Pothomorphe peltata Renealmia guianensis Anal Pain; Body Aches; Renealmia monosperma Bone Aches; Abdominal Pain Rhizomorpha corynephora Foot Aches and Cramps) Acacia tenuifolia Ruellia tuberosa Adiantum dolosum Aframomum melegueta Scoparia dulcis Astrocaryum vulgare Caesalpinia pulcherrima Senna alata Cyperus odoratus Carica papaya Siparuna guianensis Pariana sp. Croton trinitatis Spondias mombin Protium aracouchini Ficus catappifolia Sterculia cf. Guarea guidonia Sida rhombifolia 341 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Albuminuria Ocimum campechianum Cecropia peltata Amenorrhoea Cyanthillium cinereum Gossypium herbaceum Anodyne Eclipta prostrata Justicia secunda Datura metel Lindernia crustacea Datura stramonium Microtea debilis Amoebic Dysentery (See Drymonia coccinea Peperomia pellucida Dysentery) Iryanthera cf. Tabebuia serratifolia Brosimum guianense Thevetia ahouai Angina Caesalpinia bonduc Caladium cf. Begonia glabra Lantana camara Aluminum Accumulator Chenopodium Lantana camara var. Vochysia guianensis ambrosioides aculeata 342 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Mangifera indica Ocimum sanctum Hibiscus bifurcatus Momordica charantia Phyllanthus amarus Lacmellea aculeata Mora excelsa Phyllanthus carolinensis Mangifera indica Mucuna pruriens subsp. Urvillea ulmacea Passiflora laurifolia niruri Psidium guajava Phyllanthus urinaria Antidiuretic Senna alata Plectranthus amboinicus Ruellia tuberosa Siparuna guianensis Securidaca paniculata Solanum jamaicense Zingiber zerumbet Antidote (Listed separately Spigelia anthelmia under the cause, Antiblennorrhagic (See such as Caladium, Cassava, Anthracoid Erysipelas also Blennorrhagia) Manchineel, Snake, Datura ceratocaula Cecropia peltata or Stingray Poisons) Datura stramonium Costus aff. Lepidium virginicum niruri niruri Mangifera indica Phyllanthus urinaria Phyllanthus urinaria Oxalis barrelieri Securidaca paniculata Ricinus communis Peperomia obtusifolia Zanthoxylum flavum Senna alata Peperomia procumbens Sida acuta Antihaemorrhagic (See Sida glomerata Antiseptic (See also also Bleeding; Sida guianensis Wound Dressing) Bleeding Stancher; Sida rhombifolia Bidens cynapiifolia Haemorrhage) Clidemia dentata Heliotropium indicum Antineuralgic Clidemia hirta Urera caracasana Pothomorphe peltata Cymbopogon citratus Eucalyptus camaldulensis Antihypertensive Antipaludic (See also Gouania striata Persea Americana Antimalarial; Miconia racemosa Malaria; Malarial Fever) Momordica charantia Antileukemic Geissospermum Musa x paradisiaca Picrolemma pseudocoffea argenteum Ocimum sanctum 344 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Ocotea guianensis Agave americana Ayapana triplinervis Pentaclethra macroloba Bonafousia siphilitica Sciadotenia cf. Plectranthus amboinicus Costus scaber cayennensis Swietenia mahagoni Mangifera indica Scoparia dulcis Smilax cordato-ovata Antispasmodic (See also Smilax cuspidata Anuria (See also Urinary Spasmolytic) Smilax pseudosyphilitica Problems) Abelmoschus moschatus Smilax riedeliana Allamanda cathartica Aniba canelilla Smilax schomburgkiana Cynodon dactylon Annona muricata Tephrosia sinapou Aristolochia Tetracera asperula Aperient (See also daemoninoxius Tetracera costata subsp. Laxative) Boerhavia diffusa rotundifolia Ananas comosus Capraria biflora Tetracera tigarea Cynodon dactylon Cedrela odorata Tamarindus indica Chamaesyce hirta Antitumor (See also Cipura paludosa Tumors) Aperitive Clidemia dentata Cecropia surinamensis Catharanthus roseus Clidemia hirta Crotalaria pallida Eleusine indica Curculigo scorzonerifolia Elephantopus scaber Hibiscus sabdariffa Cymbopogon citratus Heliotropium indicum Irlbachia purpurascens Cymbopogon nardus Leonotis nepetaefolia Lecythis longipes Hippeastrum puniceum Mikania congesta Hypoxis decumbens Antitussive (See also Mikania cordifolia Lantana camara var. Coughs) Monnieria trifolia aculeata Allamanda cathartica Physalis pubescens Miconia racemosa Erythrina fusca Piper amalago var. Mora excelsa Hibiscus rosa-sinensis medium Ocimum basilicum Hybanthus calceolaria Quassia amara ‘Minimum’ Ouratea guianensis Schultesia guianensis Ocimum campechianum Peperomia rotundifolia Tinospora crispa Ocimum gratissimum Psychotria poeppigiana Zanthoxylum caribaeum Petiveria alliacea Virola surinamensis Sabicea glabrescens Aphrodisiac Sabicea villosa Antiviral Agent Abuta grandifolia Smilax sp. Croton trinitatis Avicennia germinans Solanum americanum Gossypium barbadense Bauhinia scala-simiae Solanum americanum var. Manihot esculenta Carica papaya nodiflorum Phyllanthus amarus Cocos nucifera Solanum nigrum Phyllanthus carolinensis Dicypellium Solanum oleraceum subsp. Doliocarpus dentatus Xylopia frutescens niruri Faramea lourteigiana Phyllanthus urinaria Hymenaea courbaril Antisyphilitic (See also Hyptis pectinata Syphilis; Antivomitive (See also Licaria cannella Venereal Disease) Vomiting; Vomitive) Montrichardia linifera 345 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Parinari sp. Guatteria ouregou Guarea guidonia Philodendron Guatteria scandens Heliotropium indicum fragrantissimum Lantana camara var. Lantana camara Ptychopetalum olacoides aculeata Mangifera indica Scoparia dulcis Licaria chrysophylla Manicaria saccifera Smilax cordato-ovata Liriodendron tulipifera Pentaclethra macroloba Smilax cuspidata Nectandra sanguinea Peperomia pellucida Smilax pseudosyphilitica Ocimum campechianum Peperomia rotundifolia Smilax riedeliana Plumeria rubra Protium guianense Smilax schomburgkiana Psychotria officinalis Protium heptaphyllum Strychnos cogens Renealmia pyramidale Protium hostmannii Strychnos diaboli Sauvagesia erecta Protium octandrum Strychnos erichsonii Xylopia aromatica Psychotria officinalis Strychnos melinoniana Zanthoxylum Solanum melongena Strychnos mitscherlichii hermaphroditum Sparganophorus Strychnos oiapocensis sparganophorum Trigonia villosa Arrow Poison (See Curare) Trattinnickia burserifolia Xylopia frutescens Xylopia frutescens Zanthoxylum pentandrum Arthritis Zingiber officinale Zea mays Aframomum melegueta Mansoa standleyi Astringent Aphthae Morinda citrifolia Aegle marmelos Abrus precatorius Peperomia obtusifolia Anacardium occidentale Lantana camara var. Pothomorphe peltata Areca catechu aculeata Aspidosperma quebracho Urena lobata Ascaris Worms Boerhavia diffusa Virola sebifera Chenopodium Brunfelsia americana ambrosioides Bucida buceras Apoplexy Byrsonima coriacea Anadenanthera peregrina Asthma (See also Cardiac Byrsonima spicata Asthma) Byrsonima verbascifolia Appetite Stimulant Abrus precatorius Caesalpinia pulcherrima Agave americana Aloe vera Campomanesia aromatica Asplenium serratum Argemone mexicana Campomanesia Carica papaya Aristolochia sp. Chrysobalanus icaco microcarpum Coccoloba uvifera Arm Pains Carica papaya Curatella americana Hedychium coronarium Ceiba pentandra Dipteryx odorata Chamaesyce hirta Eugenia latifolia Aromatic Datura metel Goupia glabra Cordia curassavica Dimorphandra conjugata Heliconia bihai Dicypellium Eclipta prostrata Henriettea succosa caryophyllaceum Erythrina corallodendron Inga bourgoni Eugenia uniflora Guarea cf. Annona muricata Mangifera indica Sparganophorus Calathea elliptica Miconia racemosa aparganophora Leonotis nepetifolia Montrichardia Mimosa pigra arborescens Back Strengthener Oryza sativa Musa x paradisiaca Desmodium adscendens Syzygium cumini Picramnia guianensis Leonotis nepetaefolia Tamarindus indica Protium aracouchini Psidium guajava Bacteriostatic (See Bee Stings (See also Stings) Psidium striatulum Antibacterial Agent) Pouteria melanopoda Rhizophora mangle Rinorea flavescens Baldness (See Hair Loss) Beri-beri Sapindus saponaria Ptychopetalum olacoides Sauvagesia erecta Balsam Sipanea pratensis Caraipa densifolia Bile Cleanser or Thinner Spondias purpurea Clusia rosea (See also Cholagogue) Stachytarpheta Copaifera officinalis Scoparia dulcis jamaicensis Dicypellium Gurania spinulosa Swietenia mahagoni caryophyllaceum Irlbachia alata subsp. Haemorrhage; Bitter niruri Menstruation) Andira inermis Phyllanthus urinaria Cordyline fruticosa Aristolochia sp. Quassia amara Heliotropium indicum Brosimum guianense Sapindus saponaria Pityrogramma Campomanesia aromatica Scoparia dulcis calomelanos Campomanesia Simaba cedron Solanum melongena grandiflora Simaba morettii Terminalia catappa Carapa guianensis Simarouba amara Urera caracasana Casearia glomerata Unxia camphoratum Chlorocardium rodiaei Zanthoxylum pentandrum Bleeding Stancher Clusia rosea Zanthoxylum rhoifolium (Bleeding Stoppage) Couepia guianensis (See also Haemostatic) Coutarea hexandra Black Diarrhoea Calotropis gigantea Coutoubea ramosa Hyptis capitata Cymbopetalum brasiliense Coutoubea spicata Eclipta prostrata Crateva tapia Black Skin Worm Meteoriopsis patula Curtia tenuifolia Passiflora glandulosa Oenocarpus bacaba Goodallia guianensis Piper brownsbergense Pentaclethra macroloba Gouania striata Psychotria ulviformis Pityrogramma Hibiscus sabdariffa calomelanos Irlbachia alata subsp. Bladder Problems alata Abuta rufescens Blennorrhagia (See also Irlbachia caerulescens Caperonia palustris Antiblennorrhagic; Irlbachia purpurascens Carica papaya Syphilitic Blennorrhagia) Licaria chrysophylla Cecropia sciadophylla Costus arabicus Lindernia diffusa Cecropia spp. Costus congestiflorus Liriodendron tulipifera Cocos nucifera Costus scaber Loreya arborescens Costus scaber Humiria balsamifera var. Mimosa pudica Eclipta prostrata balsamifera Monnieria trifolia Eleusine indica Humiria balsamifera var. Moringa pterygosperma Lippia alba floribunda Ouratea guianensis Phyllanthus urinaria Plumeria alba Pachystachys spicata Physalis surinamensis Plumeria rubra Physalis pubescens Remirea maritima Tephrosia sinapou Potalia amara Rhizophora mangle Veronica americana Schultesia guianensis Ruellia tuberosa Ticorea foetida Smilax schomburgkiana Blepharitis (See also Virola caerulea Smilax sp. Eyelid Incrustation) Zanthoxylum caribaeum Waltheria indica Bixa orellana Zea mays Cyperus laxus Bitter Tonic (Bitters) Eugenia uniflora Bleeding (See also Blisters Momordica charantia Antihaemorrhagic; Musa x paradisiaca Phyllanthus amarus Phyllanthus carolinensis Blood Circulation 348 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) (See also Circulatory (See also Hypertension; Clusia nemorosa Problems) Hypotensive) Clusia pana-panari Allium sativum Artocarpus altilis Clusia scrobiculata Siparuna guianensis Bacopa monnieri Endlicheria sp. Vanilla pompona Cocos nucifera Ficus nymphaefolia Gossypium barbadense Gouania blanchetiana Blood Cleanser (Blood Musa x paradisiaca Guarea cf. Caperonia paludosa Syzygium cumini Memora flavida Capsicum frutescens Panopsis sessilifolia Catharanthus roseus Blood in Stool Piper arboreum Chromolaena odorata Cymbopetalum brasiliense Piper gleasonii Croton trinitatus Dalbergia monetaria Vouacapoua americana Cyanthillium cinereum Paullinia dasygonia Desmodium incanum Stigmaphyllon sinuatum Body Cooler (See Coolant) Hymenaea courbaril Hyptis pectinata Blood-loss in Women (See Body Itch Lantana camara also Menstruation) Ageratum conyzoides Momordica charantia Chamaesyce prostrata Peperomia pellucida Chamaesyce thymifolia Body Temperature Phyllanthus amarus Chamaesyce sp. Senna alata niruri Body-Wash Solanum americanum Phyllanthus urinaria Pithecellobium unguis-cati Solanum stramoniifolium Quassia amara Tradescantia zebrina Scoparia dulcis Boils Unxia camphorata Calotropis gigantea Bloody Flux (See also Capraria biflora Blood Clots (Menstrual) Flux) Cissampelos andromorpha (See also Menstruation) Plumeria alba Cissus verticillata Crescentia cujete Heliotropium indicum Blowpipe Poison (See Blood Coagulant Curare) Bone Aches Copaifera guianensis Clusia grandiflora Blowpipe Poison (Non Blood Coolant Curare) Bone Fractures Anacardium occidentale Strychnos cogens Cecropia obtusa Rinorea cf. Senna sophera coriacea Buccal Anaesthetic Lonchocarpus Broken Bones (See Bone Piper oblongifolium heptaphyllus Fractures) Nicotiana tabacum Buccal Dermatoses Peperomia sp. Bronchial Inflammation Inga alata Philodendron hylaeae (See also Bronchitis) Inga alba Philodendron linnaei Byrsonima crassifolia Philodendron scandens Carapa guianensis Buck Sick Philodendron cf. Urospatha sagittifolia Bronchitis (See also balsamifera Bronchial Inflammation) Hyptis mutabilis Bowel Problems (See also Aristolochia Lonchocarpus spp. Pityrogramma Malvaviscus arboreus surinamensis calomelanos Petrea kohautiana Plantago major Prionostemma aspera Breast Tumors Protium heptaphyllum Saccharum officinarum Mandevilla cf. Protium guianense Schlegelia violacea surinamensis Rhynchanthera Sesamum indicum grandiflora Breath Freshener Unxia camphoratum Bush Sores (See also Bush Abelmoschus moschatus Yaws; Yaws) Astrocaryum segregatum Bruises Cecropia peltata Cordia curassavica Calotropis gigantea Clerodendrum thomsoniae Bush Yaws (See also Bush Breathlessness Curcuma longa Sores; Yaws) Cordia nodosa Datura metel Jacaranda copaia Ischnosiphon sp. Datura stramonium Pentaclethra macroloba Philodendron linnaei Eclipta prostrata Vismia macrophylla Pityrogramma 350 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Caladium Poison Antidote Annona muricata Virola sebifera Guadua latifolia Cecropia surinamensis Zingiber officinale Catarrh Calmative Inga bourgoni Annona muricata Cardiovascular Relaxant Syzygium cumini Hyptis capitata Bacopa monnieri Terminalia catappa Indigofera suffruticosa Justicia pectoralis Carib Sick Cathartic Lantana camara Hyptis mutabilis Allamanda cathartica Lantana camara var. Gymnopetalum aculeata Carminative cochinchinense Pachystachys spicata Costus arabicus Mitracarpus sp. Capraria biflora tenuiflorum Cassia acuminata Chest Colds Cinnamomum zeylanicum Catharanthus roseus Opuntia cochenillifera Cnidoscolus urens Chamaesyce hirta Renealmia alpina Dactyloctenium aegyptium Chrysophyllum cainito Sphagneticola trilobata Eleusine indica Citharexylum Eugenia uniflora macrophyllum Chest Conditions (See also Guazuma ulmifolia Citrus sinensis Chest Pain) Heliconia bihai Crescentia cujete Ageratum conyzoides Hibiscus esculentus Leonotis leonurus Gossypium barbadense Momordica Leonotis nepetifolia Lactuca quercina cochinchinensis Mikania congesta Protium guianense Monotagma spicatum Mikania cordifolia Protium heptaphyllum Musa x paradisiaca Mikania micrantha Sloanea sp. Ocotea guianensis Nicotiana tabacum Trattinnickia burserifolia Pachystachys spicata Peperomia pellucida Phyllanthus niruri subsp. Phyllanthus amarus Chest Pain (See also Chest niruri Phyllanthus carolinensis Conditions) Phyllanthus urinaria subsp. Rollinia exsucca Physalis pubescens subincanum Simaba cedron Portulaca oleracea Tibouchina aspera Siparuna guianensis Quassia amara Sterculia cf. Cajanus cajan Cajanus cajan rotundifolia Cecropia obtusa Cardiospermum Cedrela odorata halicacabum Cholagogue (See also Bile Clidemia dentata Cecropia peltata Cleanser or Thinner) Clidemia hirta 352 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Eleutherine bulbosa Ageratum conyzoides Martinella obovata Eperua falcata Aloe vera Montrichardia Euterpe oleracea Anacardium occidentale arborescens Henriettea succosa Ayapana triplinervis Ocimum campechianum Hymenaea courbaril Calotropis gigantea Ocimum gratissimum Miconia racemosa Capsicum frutescens Ocimum sanctum Monstera obliqua Carapa guianensis Opuntia cochenillifera Oenocarpus bacaba Cardiospermum Passiflora foetida Tabebuia serratifolia halicacabum var. Pentaclethra macroloba microcarpum Pityrogramma Cicatrizant of Umbilicus Chamaesyce hirta calomelanos Maprounea guianensis Cinnamomum zeylanicum Pluchea carolinensis Mayna odorata Citharexylum spinosum Pouteria sp. Socratea exorrhiza Clibadium surinamense Prunus myrtifolia Coccinia grandis Renealmia cf. Waltheria indica Clyster Eclipta prostrata Zingiber officinale Manilkara bidentata Eleusine indica Mikania micrantha Eryngium foetidum Colic Eucalyptus camaldulensis Ageratum conyzoides Coffee Substitute Eugenia uniflora Arachis hypogaea Senna hirsuta Euphorbia neriifolia Aristolochia macrota Senna obtusifolia Furcraea foetida Astrocaryum vulgare Senna occidentalis Heliotropium indicum Averrhoa bilimbi Hibiscus bifurcatus Bontia daphnoides Cold Skin Hibiscus esculentus Calycolpus goetheanus Leandra sp. Hyptis atrorubens Capraria biflora Hyptis lanceolata Carica papaya Cold Sweat Irlbachia alata subsp. Colds (See also Chest Kalanchoe pinnata spiralis Colds) Lantana camara Inga gracilifolia Abrus precatorius Lantana camara var. Lantana camara Achyranthes indica aculeata Licaria camara Aframomum melegueta Mansoa alliacea Ocimum campechianum 353 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Petiveria alliacea Contraceptive (See also Phyllanthus amarus Oral Contraceptive) Coolant Phyllanthus urinaria Aloe vera Chamaesyce hirta Portulaca oleracea Anacardium occidentale Cordia curassavica Ricinus communis Aristolochia Cornutia pyramidata Sabicea glabrescens daemoninoxius Peperomia pellucida Sabicea villosa Citrus aurantiifolia Tamarindus indica Stachytarpheta Commelina erecta cayennensis Euterpe oleracea Cordial Stachytarpheta Hibiscus rosa-sinensis Amasonia campestris jamaicensis Mayna odorata Ocimum campechianum Zingiber zerumbet Scoparia dulcis Sauvagesia erecta Stigmaphyllon palmatum Conception Inducer Cosmetic Myrosma cannifolia Contusions Bixa orellana Arrabidaea patellifera Sterculia excelsa Condiment Cordia nodosa Capsicum frutescens Cucumis anguria Coughs (See also Physalis pubescens Dipteryx odorata Antitussive; Bechic; Dipteryx punctata Pectoral; Whooping Cough) Conditioning Cream Lantana camara Abrus precatorius Aloe vera Lomariopsis japurensis Aciotis spp. Aristolochia Bonafousia undulata daemoninoxius Cynodon dactylon Convalescence in Children Aristolochia sp.

For many years I have been telling my students that we always need the whole product instead of the various separated units such as carrot juice herbals wikipedia buy npxl 30caps with mastercard, vegetable juices aasha herbals - cheap npxl 30caps without a prescription, etc zen herbals npxl 30caps with mastercard. There are many needed properties in the fibre also to assist in properly handling the juices herbals for anxiety purchase npxl 30caps with visa. We know from excellent results that carrot juice vaadi herbals pvt ltd order 30 caps npxl visa, celery juice and other vegetable juices are excellent but how much better can they be if left intact and taken as is herbals side effects best npxl 30caps. Can we possibly get as much good and complete nutrition from drinking a dozen carrots without the fibre as we can from properly chewing the whole carrot and eating fewer carrots. Formerly we were told not to use fibre as it might cause a variety of colon troubles. In determining this importance and putting it to use should we go over board with the idea by using such things as wood fiber in bread, (good for termites but not much good for us) or say cereal, or perhaps some other foreign matter in these products or should we use it as it is originally without separating it in the first place. Reminds me of the white bread controversy — tests showed that white bread could not sustain life even though milk and eggs had been added so a variety of vitamins were added — enriched — fortified flour they called it. Then new standards were found or believed to be necessary so more enrich ments were added then extra iron — extra spoilage retardants or 33 preservatives appeared necessary — next extra fiber was found that important. Now after all these things were added just how good was the bread — taking things out and adding other things to replace them. The whole matter could have been prevented by leaving things as they were originally. Now if we can accept the whole procedure as a much needed lesson we can then leave the rest of our food as it is and stop taking extra wheat germ, lecithin, vitamins, minerals, fibre (bran or wood) and many other extras to supplement and enrich a large variety of separated and devitalized products. Another thought by so many people "If a small amount is good: then logic tells them that a lot can do so much more". Something is left out so whatdeficiencies have we created and what about the following side effects. It seems to me we should start all over again from the beginning: start eating things as they are in limited amounts to allow the body to digest and assimilate just the amount it can handle with no excesses. The use of a high protein for weight reducing became a fad and then a predigested protein is creating many serious deficiencies and developed a monster to the point that it was reported that many have died from lack of potassium, and other needed life qualities. This simple idea can and will save us a lot of time, money and useless research to test for possible deficiencies. The ideal purpose of any complete diet is to have all the vitamins, minerals, and nutrients in a readily available form in order to enable the body to function normally and to be free from diseases and other mal functions. Since many people of the world are already handicapped by a multi plicity of diseases, they must first cleanse the body before the right diet can be properly used. Therefore, what is eaten during these respective periods must be harmonious with the natural processes. Soup (homemade, veg etarian, of course) or tomato juice, hot or cold, may be taken with vegetable salad. Note: Recipes for coconut and almond milk, and for a number of dressings, are to be found on the following pages. On other occasions try special dishes such as vegetable stew, various types of brown rice dishes (curried rice, Spanish rice, chop suey and rice), chili beans (made with lima beans or red beans), or any recipe using lentils or garbanzos — but no meat, of course. Vegetarian cutlets, and all similar commercially-produced meat substitute preparations, should be used very, very sparingly, or not at all. An occasional mono diet meal is always beneficial such as brown rice with coconut milk and a little maple syrup only, steamed artichokes only, fresh green corn only, watermelon, strawberries, honeydew. It is very time consuming, costly and does not accomplish the desired results that simplification can. Different types of foods have different requirement in time and abilities to properly digest them. The coconut milk produced in this fashion makes a tasty, nutritious beverage for children or adults in place of animal milk. A number of delicious drinks can be made by using coconut milk and your favorite fresh fruit liquefied together. Stop the blender and push them to the center with a knife several times as they stick to the sides. As liquefier is running add sesame or safflower oil until the oil covers the pulp (approx. Liquefy for 2 minutes and then add warm water until mixture reaches the desired thickness (approx. Push them to the center with a knife several times as they stick to the side as the blender is running. A couple of dill pickles and sweet relish may be added to provide the Thousand Island taste. Add the potato flour as needed if you desire the dressing to be thicker and creamier. Other herbs and spices may be used very delicately instead of the suggested ones to create a variety of dressings. Slowly add potato flour as liquefier is running until desired thickness is achieved. Continue stirring as you add hot water until you have the desired thick ness (approx. These forms of blemishes are not caused by a virus, but are a form of fungus growth feeding on acid elimination in the skin. Use for all insect stings and bites (wasp and mosquito, for example), scratches, small burns, and sores that are slow in healing. Use your finger to put a small amount on the back of the tongue for sore throat or a tickling cough. For those who wish to quite smoking — every time you have the desire for a smoke place — with your finger — a small amount on back of the tongue and you immediately lose your desire to smoke. For infections, irritations, and itching inside the ear dip a Q-tip in the solution and place inside the ear for immediate relief. Camphor and Camphor Cubes When taking a bath in a tub, place 2 camphor cubes in the water. Honey While honey does more harm than good internally (see page 15), it is especially good for many conditions externally. Osage Rub Osage Rub is an excellent commercial product for tired and sore muscles and skin. Place a small amount on one hand (tip the bottle upside down with the palm tight against the opening). Rub the two palms together and then inhale through the nose and mouth for a short time. A small amount of peppermint on the finger and rubbed inside the mouth makes the mouth feel refreshed and cool. Wintergreen the true oil of Wintergreen is superior to the synthetic, so use it if possible. Athletes Foot: Four to five days of frequent use on feet will clear the condition. Chapped Sore Hands: Any fungus condition on hands or other parts of the body, is quickly corrected with straight vinegar. The more frequently these pro ducts are applied, the faster the condition disappears. Sore Throat: Vinegar and water — half and half — is an excellent gargle for sore throat and to cut mucus. Indigestion or Gas: 2 teaspoons of vinegar in a glass of water; may be consumed with the meal or any time afterwards as needed. Use the same amount to stop dysentery or diarrhea — take it every hour until the condition has cleared. However, diarrhea can be very helpful for cleaning and eliminating of surplus toxins from the body. Two tablespoons of vinegar and 2 tablespoons of maple syrup to a quart of water will aid in keeping cut flowers longer. Special Formula for Eye Drops this formula has been used with most excellent results for many years with absolutely no dangerous side effects when coupled with a change of diet, the reflex work and color therapy. Many cases of glaucoma, cataracts, spots, film, and growths of various kinds have completely disappeared. There are a number of books written on eye exercises; their systems help greatly to bring the sight back to normal. Most people would do well to learn and perform exercises to insure the retention of normal vision. Formula: 5 parts (measures) distilled water 2 parts best grade of honey 1 part pure apple cider vinegar (Sterling or other good brand) 4 3 Mix together and store in a bottle. If eyes are in good condition, keep them that way by regular use as no harm can ever come by using it. It has a strong smarting effect for a moment, then the eyes clear and feel very good after each use. All of the different oils and solutions may be added together to make one of the finest massage solutions available. Each ingredient compli ments and aids the other to do a remarkable job for most above condi tions. Wintergreen Oil Mix all together and use straight at any time for a most beneficial and refreshing tonic for the face and skin. The Abuse of Drugs To descend to the bottom of the pit is the hard way to find that this is not the path to the heavenly bliss that one may have heard so much about. Many young people have sincerely sought "instant samadhi" through drugs, only to discover too late it was an abortive route. The many "drug abuse clinics" and "rehabilitation centers", engaged in piecing together the shattered and fragmented lives of our youth, are a symbol of our age. The over-development, manufacture, and sale of these drugs has systematicallycreated a world of unnecessary addiction. It took modern chemistry, medicine, and greed, for profits and power to create a monster of addiction and suffering. The drugs that were used to relieve suffering, created misery and suffering by addiction. Not wanting to be left out, the younger generation has understand ably taken everything and anything they could get their little fingers into and made a big thing of it. Having no more common sense or control than adults, much damage to their bodies and minds has resulted. Crime, loss of property and life, has steadily increased with the increase in the use of these drugs. Getting even, or striking back at our parents and the adult world in general, for their imperfections and lack of understanding is the hard way to prove a point. Must one become involved in the weaknesses and depravity of adult civilization in the entirely justifiable search for freedom? The price we pay for this abuse has reached and gone beyond our ability to pay for and live with it. The development, growth, and manufacture of these useless addictives must be eliminated from our society, if we ever hope to produce a better world to live in. Any possible good that drugs have to offer can easily be duplicated and improved upon by simple and natural methods. If these drugs were not manufactured and distributed by unscrupulous people in the adult world, there would be no possible way our children could procure them. It is the duty of the young and the vital to bring about the needed changes in our society. This creative renewal cannot be accomplished by wallowing in the filth the older generations have created. Drugs do not bring one closer to the Divine or free one from those imaginary shackles. As the effect of the drugs wear off, the old problems are still unsolved and new ones have been added. It is most difficult for the soul to remain healthy while the body is sick with drugs. While the psychic body is out 4 5 of the physical, many adverse conditions can occur. Protective controls are gone, leaving the body wide open to destructive forces or lower spirit entities. Leaving the body under such adverse conditions brings our psychic into an imaginary world of illusion or to the bottom of the pit of utter confusion. Any point there, or in between, can destroy the physical and leave us stranded in the world of confusion which only delays our journey to the higher realms of being. Heaven, God, or the finer things in life are not found in the doping and suppressing of the physical body. Keeping the mind and body free from the degrading effect of drugs gives it a strong incentive to advance more rapidly to the most desired form of living. Medicine has struggled unsuccessfully for over two years for all the right answers as the sick and dying found little cause for respect for those they trusted so hopefully. The Medical way has no resemblance to the natural way of the Universal One for freedom from all diseases. It is all directed auto matically by the divine computer within the mother and the newly developing mortal. The computer requires only the best cooperation of each individual to supply the raw materials designed by nature to fill the need. The ability of the computer is strictly and completely automatic giving complete directions for every part to act in accordance with nature to serve unfaulteringly to every need. It is only when people ignore the simple natural needs of the body and become involved with drugs of any nature — legal or illegal — and a variety of denatured foods with excesses of any kind that people will become sick and crippled. All the above completely eliminates the need for those outlandish expensive man made machines that man has built along with the costly errors of life and death of the humans involved. The high rising costs of man-made products have risen beyond the ability of man to survive any good it may tend to serve such unnatural needs.

Generic 30caps npxl amex. Thyme Herb & its health Benefits.

Common symptoms are irritability greenridge herbals buy 30 caps npxl visa, fatgue verdure herbals npxl 30 caps, slowed movements herbals for weight loss generic npxl 30caps on-line, and changes in sleep and eatng habits herbalshopcom purchase 30 caps npxl visa. One study32 found that 1/3 of study partcipants complained of concentraton and memory problems during interferon treatment herbalsmokeshopcom buy npxl 30caps otc. As mentoned above herbals meds buy npxl 30caps low cost, problems with concentraton and memory can occur because of depression. However, this study found that cognitve complaints were not related to depression prior to or during interferon treatment. For now, litle is known about the potental short and long-term cognitve efects of interferon. It is common to have trouble adjustng to a diagnosis of a long-term medical conditon. Common reactons to being diagnosed with a chronic infectous disease such as hepatts C include: y feeling emotionally numb and in shock y becoming irritable or angry y crying more than usual y not spending time with friends and family y worrying about infecting others y feeling dirty y feeling uncertain about your future y feeling like no one understands y feeling like life is not worth living 314 Copyright © 2008, Caring Ambassadors Program, Inc. If you fnd yourself unable to control how much you are worrying, this may be a sign of an anxiety disorder. If this is the case, it is important to be aware of changes in any of the following, which may signal an anxiety problem: − feeling restless or on edge − becoming tired more quickly than normal − having problems concentrating − feeling more irritable than normal − having headaches, cramps, stiffness, and muscle tension − problems falling or staying asleep Both of these issues (depression and anxiety) may become serious if they contnue for more than a couple of weeks. If this is the case, it is important to talk to someone who can help, such as your healthcare provider. Concerns such as depression, anxiety, and problems with thinking and memory are common. Healthcare providers may not always notce when patents are depressed or anxious, so it may be up to you to tell your healthcare providers if you have any of the symptoms of these disorders (see lists above). Substance abuse is a signifcant issue that should be discussed with your healthcare provider. Hepatts C in patents with psychiatric disease and substance abuse: Screening strategies and comanagement models of care. Addressing tri-morbidity (Hepatts C Psychiatric and Substance Use Disorders): the importance of routne meantal health screening as a component of a co-management model of care. Integrated psychiatric/medical care in a chronic hepatts C clinic: efect on antviral treatment evaluaton and outcomes. Associaton of chronic hepatts C with major depressive disorders: irrespectve of interferon-alpha therapy. Depression and anxiety in patents with hepatts C: prevalence, detecton rates and risk factors. Substance Abuse and the Transmission of Hepatts C Among Persons With Severe Mental Illness. Psychiatric and substance use disorders in individuals with hepatts C: epidemiology and management. Depression, anxiety, post-traumatc stress, and alcohol-related problems among veterans with chronic hepatts C. Natonal Insttutes of Health Consensus Development Conference Statement: Management of Hepatts C. Epidemiology of substance use disorders among persons with chronic mental illnesses. Substance abuse and the transmission of hepatts C among persons with severe mental illness. The prevalence of hepatts C virus infecton in the United States, 1999 through 2002. Comorbid depression among untreated illicit opiate users: results from a multsite Canadian study. Hepatts C virus infecton afects the brain-evidence from psychometric studies and magnetc resonance spectroscopy. Efect of interferon-alpha on cognitve functoning in patents with chronic hepatts C. Caring Ambassadors Hepatitis C Choices: 4th Edition 318 Copyright © 2008, Caring Ambassadors Program, Inc. It is important to be aware that this treatment may also have emotonal and mental health side efects. Approximately 20% to 30% of people undergoing interferon-based therapy for hepatts C experience depression. By being aware of this possibility, you are more likely to recognize the symptoms early, request one of the many antdepressant (or mood stabilizing) medicatons available to treat it, and feel beter for the remainder of the treatment period. People tend to tolerate side efects beter and can identfy them earlier if they know about them in advance, so be sure to discuss these with your healthcare providers untl you are sure you understand them. Caring Ambassadors Hepatitis C Choices: 4th Edition this chapter will primarily focus on depression and its treatment because it is by far the most common psychiatric side efect of pegylated interferon plus ribavirin treatment. In the midst of discussing all of these possible side efects of pegylated interferon plus ribavirin treatment, it is important not to lose sight of the “goal. During pegylated interferon treatment, however, people who have never had a psychiatric disorder may stll experience signifcant depression directly induced by the pegylated interferon. If you have had a prior history of depression or another mood disorder (for example, bipolar disorder), studies vary regarding whether you are at higher risk for depression during interferon-based therapy. One study found that half of those with histories of depression had a recurrence during treatment, and half did not. Second You may hear about results from a variety of research related to interferon or interferon-alfa. But the research that is most pertnent to you is likely to be more recent research about pegylated interferon plus ribavirin, the current standard of care for the treatment of chronic hepatts C. Various methods of evaluaton can sometmes result in confictng and ofen confusing diferences in their conclusions. You are likely to feel more in charge of your treatment if you learn more about it. If your healthcare provider gives you a periodic self-ratng scale as a means of monitoring you for side efects, be sure to take the tme to fll it out accurately. However, if you become aware of feeling more depressed or no longer fnding pleasure in anything, you may recognize these symptoms before your healthcare providers because you have learned to monitor them for yourself and you should take an actve role in getng treatment or requestng a psychiatric evaluaton. Importance of Knowing About Depression and Other Possible Psychiatric Side Effects of Pegylated Interferon Plus Ribavirin Treatment Despite the cautons I just gave you about research related to the psychiatric side efects of interferon-based therapy, these potental psychiatric side efects are stll important to consider for a number of reasons: y There is a 20% to 30% chance that you may experience significant depression during interferon-based therapy, even if you have never been diagnosed with depression before. People with severe psychiatric side efects from interferon-based therapy have sometmes unnecessarily discontnued their treatment because they felt so discouraged about their quality of life during treatment, or so depressed as a result of it. Or it may have been discontnued prematurely in the past by their healthcare providers out of concern that they not get worse. If you have a current psychiatric conditon, or an alcohol or substance use disorder, consider getng a psychiatric evaluaton or enrolling in a substance treatment program to get clean and sober. Caring Ambassadors Hepatitis C Choices: 4th Edition For example, if you have a history of one or more episodes of a “major depressive disorder” that has required antdepressant medicaton in the past, and you are feeling depressed, hopeless, tearful or not fnding pleasure in anything, you should consider consultng with a psychiatrist or asking your healthcare provider to restart antdepressant medicaton. You will likely consider your liver enzymes, your genotype, and the stage of disease in your liver in light of your past treatment history. Among those with comorbid disorders (that is, both psychiatric and substance use disorders), 85% had depression, 71% had anxiety disorders, 43% had postraumatc stress disorder, 42% had psychotc disorders, and 30% had bipolar disorders. You should not accept being told you are ineligible simply because you have a preexistng psychiatric or substance use disorder. If you feel ready not just to start, but to complete the treatment, be sure to let your healthcare providers know, even if they have not yet started that discussion with you. The authors felt this was atributable to the availability of needle exchange programs. They also argue that treatment decisions should be individualized on 322 Copyright © 2008, Caring Ambassadors Program, Inc. However, the presence of other physical side efects did increase the likelihood of early treatment discontnuaton, and they encouraged healthcare providers to address these physical side efects as soon as they were identfed in order to promote higher rates of treatment completon, rather than making a large group ineligible for treatment or allowing early discontnuaton. Another study from San Francisco18 found that among 76 recovering heroin users on methadone, 28% had a sustained viral response and 24% discontnued treatment early. Patents on methadone may contnue on their usual doses with stable chronic liver disease, including advanced cirrhosis. Buprenorphine is another substtuton therapy that may be administered directly by physicians who have received training and certfcaton, in contrast to the highly regulated methadone maintenance treatment programs. However, patents should be warned that atempts to abuse it can cause liver dysfuncton afer sublingual and especially afer intravenous administraton. If you are using intravenous drugs, you are likely to do beter with an organized treatment program, but the hepatts C virus may give you the challenge you need not only to make the decision to stop using, but to stay clean. Disulfram (Antabuse ), monitored Antabuse , or acamprosate 323 Copyright © 2008, Caring Ambassadors Program, Inc. Caring Ambassadors Hepatitis C Choices: 4th Edition (Campral ) can be efectve in helping you maintain sobriety. A 12-step program such as Alcoholics Anonymous is ofen successful in helping people stop drinking. It is also a reminder that you will probably have a beter chance of getng clean and sober with the support and structure a formal substance treatment program. Coinfecton in this very vulnerable populaton was associated with psychiatric illness severity, ongoing drug abuse, poverty, homelessness, incarceraton, urban residence and minority status. You can maximize the chance of a good treatment outcome by remaining clean and sober during treatment. Chapter 21: Mental Health and Hepatitis C Section 2: Mental Health Issues During Interferon-Based Therapy Health-Related Quality of Life and Physical Side Effects of Interferon-Based Therapy Historically, chronic hepatts C had been considered an asymptomatc illness (meaning without signifcant symptoms). Researchers use several standardized measurements to compare the efects of diferent illnesses on the quality of life of people living with them. While the once weekly schedule of pegylated interferon has reduced the intrusion of this treatment in the course of people’s lives, the physical side efects during a lengthy treatment course on pegylated interferon may make some people feel worse before they feel beter. The following are the percentages of some of the physical side efects of pegylated interferon alfa-2a plus ribavirin treatment that were reported from one of the major pegylated interferon treatment studies, involving 1,121 patents at multple sites. Decreased interest in sex can also occur with pegylated interferon treatment, perhaps as a result of a combinaton of the other side efects. For a more detailed discussion of the potental side efects of pegylated interferon treatment, refer to Chapter 8, Western (Allopathic) Medicine. Some experience the treatment itself such as the need for multple medical appointments, getng blood tests, taking or self-administering medicatons, and medicaton side efects as an additonal burden of the illness. Others look to the treatment as a possible salvaton from their illness and consider the demands of that treatment a passing phase on the way to recovery or cure. Caring Ambassadors Hepatitis C Choices: 4th Edition Symptoms that are considered “reactve” or in response to the demands of treatment or the symptoms of the illness are considered “adjustment” issues and usually do not require treatment with psychiatric medicatons. For example, someone who experiences fatgue and decreased interest in sex may beneft more from a few couples sessions with a therapist (who can facilitate communicaton about the efects of the illness on both the patent and the partner) than from a course of antdepressant medicatons. Many people on pegylated interferon plus ribavirin experience signifcant fatgue because they are anemic from the ribavirin. While treatment-related anemia is ofen taken care of by decreasing the ribavirin dose, people who experience fatgue related to anemia will ofen experience more energy and a higher quality of life afer treatment with erythropoietn. This can cause both patents and providers not think as actvely as they could about using treatments to intervene when side efects occur to help people feel beter. You can have an actve role in decreasing the impact of these side efects on the quality of your life by learning about them. In learning about possible side efects, you will be prepared to tell your healthcare providers if they occur. You can request the treatments to minimize any side efects you may experience instead of just trying to accept them as another burden of the illness. In additon, by learning as much as you can about this illness, its treatment, and possible side efects, you may experience improved self-esteem by feeling “empowered” and advocatng for yourself. Knowing more about your situaton may make it more likely that you will fnd ways to feel beter! There are no consistent predictors of who will develop these disorders as side efects of interferon-based therapy, even among those with clear histories of preexistng psychiatric disorders. In a study of people receiving interferon-based therapy who had preexistng psychiatric disorders (but were not in psychiatric care at the beginning of interferon-based treatment), ½ did not require any psychiatric interventon or develop signifcant psychiatric symptoms during the treatment. The only two factors that seemed to be associated with progression to frank psychiatric symptoms during interferon-based therapy were a family history of psychiatric disorders and having more than one psychiatric disorder at baseline. Chapter 21: Mental Health and Hepatitis C Section 2: Mental Health Issues During Interferon-Based Therapy the previously cited study of 1,121 subjects from 81 sites51 found lower rates of depression (20% and 22%) among patents treated with pegylated interferon compared to those treated with standard interferon (30%). This is a partcularly signifcant percentage since the baseline rate of both a history of depression and actve depression was very low for this sample (less than 5%). Notably, psychiatric side efects (mostly events related to depression) were stll the most common reasons for early discontnuaton of treatment. However, not all studies have noted this diference between standard interferon and pegylated interferon. A study conducted in Germany52 compared psychiatric side efects in 48 patents who were treated with standard interferon and 50 patents who were treated with pegylated interferon. They found the rates of depression between the two groups were not statstcally diferent. Notably, while major depressive disorders are consistently found to be twice as common in women as in men in the general populaton, most studies have found that men and women are equally at risk for becoming depressed as a result of the pegylated interferon plus ribavirin treatment. Fortunately, depressive symptoms related to interferon-based therapy respond well to antdepressant medicaton so be sure to consider asking for it — and feel beter. Mania and Irritability on Interferon-Based Therapy A French study53 of 93 patents treated with pegylated interferon-alfa 2b plus ribavirin reported “psychiatric events” or side efects in 32% of their sample. The mood disorders were diagnosed as follows: mania (10%), irritable hypomania (50%) and depressive mixed states (40%). Three patents in that study exhibited classic euphoric manic symptoms and there is another extensive case report of mania that arose during pegylated interferon plus ribavirin treatment.

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