The Circulatory System

Anatomy and Physiology
The heart pumps blood from the body to the lungs to become oxygenated which goes round the body where the oxygen is used then brought back to the heart to repeat the process.
The left side of the heart has the largest muscle because it pumps blood to the extremities (as symbolised by the stick man on the diagram) through the aorta. It comes from the body through the superior vena cava and to the lungs via the pulmonary artery.

Arteries and veins have different anatomy for their different purposes. Arteries carry blood from the heart to the body which requires a thicker vessel wall to handle the high pressure of blood from the heart. Veins carry blood from the extremities back to the heart. They have valves to prevent blood from flowing backwards and thinner vessel walls than arteries do.

Physical assessment of the Cardiovascular System
Observations
Clubbing and splinter haemorrhaging may indicate infective endocarditis but there are other things associated with clubbing which are more common in other body system diseases. Cyanosis of the lips and tongue may indicate; shock, a cold environment or heart failure.

Jugular Venous Pressure
The JVP should be between 3 and 4 cm. This is a rough measure of the pressure of the jugular vein. If it is raised this can indicate constrictive pericarditis, cardiac tamponade, renal disease, excessive fluids or superior vena cava obstruction.

Inspection
Inspect the chest for kyphoscliosis, obvious scars which may indicate a pacemaker, a bulge indicating cardiac enlagment and abdominal pulsations (a lack of which may indicate an abdominal aortic aneurysm).

Palpation
Palpate for the 4 areas and the apex. Feel for heaves which may indicate right ventricular or left atrial enlargement. Also feel for thrills which indicate a palpable murmur. If the apex beat cannot be found this is usually due to obesity but can also indicate; emphysema, pericardial or pleural effusion.

Auscultation
Auscultate the 4 areas for murmurs caused by things like; a stenotic valve or regurgitation.

Cardiovascular pathologies
Ischemic heart disease
Atherosclerosis is the hardening of an artery’s inner wall caused by a plaque. Arteriosclerosis is a more general term used to describe any hardening of the artery inner wall including loss of elasticity by any cause. It is generally thought that atherosclerosis is made of an adipose plaque but in fact the plaque is made up of white blood cells which have gathered in the area of damage to the endothelial wall which has become saturated with red blood cells, fat and other cells. This collection of cells and fat create an inflammatory response whereby the body tries to protect itself from what seems to be a hostile cell by bringing in macrophages/ antibodies to fight. These are found in white blood cells and are what create the plaque, as mentioned above.

Smoking, obesity, diabetes, and hypertension can all contribute and sometimes cause atherosclerosis. Obesity, smoking and diabetes are associated with hypercholesterolemia which will influence the pathology above. Hypertension increases the pressure of the blood in the arteries and this in itself can sometimes cause damage to the endothelial wall.

It can occur from child hood and culminate in a trans ischaemic attach (stroke) or myocardial infarction (heart attack) later in life; usually around the middle ages. A change in diet and lifestyle is usually the best way to prevent this from happening as it is not symptomatic until another pathology occurs as a result. For example, the plaque can cause a blockage of the artery thereby cutting off the circulation to parts of the body and causing cell death through starvation of oxygen. This is how strokes and heart attacks occur, each area, either heart or brain, has been starved of oxygen.

Trans ischemic attack/ Stroke is otherwise known as a “brain attack” these can be deadly. They occur when either a part of a blood clot elsewhere in the body breaks off and blocks an artery in the brain (embolic stroke) or a blood clot occurs in the brain itself (thrombotic stroke). Sometimes the pressure in these blockages is too much and can haemorrhage bursting the artery walls and leaking into the brain (a simple hemorrhagic stroke) or the cerebrospinal fluid (subarachnoid haemorrhage). Other causes include arteritis (inflammation of the arteries), mass lesions (such as tumours). In children causes are usually different such as; congenital heart disease, drug abuse, clotting disorders, CNS (central nervous system) infection, neurofibromatosis, vasculitis, fibromuscular dysplasia, Marfan disease, tuberous sclerosis and tumours.

TIAs are acute and usually have happened before a health professional sees the patient. Symptoms are signs which occur after are speech difficulties, movement difficulties (usually affecting gait) and memory.

Myocardial Infarction/ Heart attack occurs when the blood supply is prevented from getting to the myocardium starving it of oxygen (hypoxia) resulting in cell death (necrosis). The symptoms usually present as a feeling of chest tightness and a sharp pain running down the left arm and up the neck up to the jaw. These can result in death. Usually a person at risk does not know they are until the myocardial infarction occurs. Blood thinners are the orthodox treatment to prevent this from happening however; these do leave the person at risk of severe bleeding.

Right/Left heart failure is brought about when the muscle of the heart can no longer fully pump as it once did. Left heart failure is the most common. This results in an accumulation of blood in the ventricle putting more pressure on the heart. Eventually it can spill over back into the lungs, as can be seen in the diagram above. Right heart failure gives a far wider ranging set of problems because blood backs up into the extremities. Oedema around the ankles is one of the most obvious symptoms of this. In both cases, if it is left untreated it can result in death. However, heart failure is not an acute problem the process usually happens over a long time period so it is possible to catch it before death occurs.

Angina is caused by ischemia (lack of blood supply resulting in hypoxia) to the heart muscle. This results in a severe pain as described for a myocardial infarction. Usually it is caused by either an embolism or spasm of the artery.

Arteritis is inflammation of an artery.

Vasculitis is inflammation of a blood vessel.

Peripheral vascular disease

Chronic and acute lower limb ischemia occur when the blood supply to the lower limbs are cut off by an embolism (break off of a blood clot) or a thrombus (break off from a plaque). Acute sufferers will complain of pain, paleness, paresthesia (a sensation of tingling, pricking and numbness) and paralysis. Chronic sufferers will complain of severe cramp on exercise and intermittent claudication (attacks of lameness and pain when walking).

Aneurysm is used to describe an artery which has thinning walls. This can sometimes rupture. Until they rupture the condition is asymptomatic (there are no symptoms). Abdominal aortic aneurysms can be deadly they cause severe pain, hypotension, tachycardia, profound anaemia and sudden death.

Raynaud’s disease is caused when constriction of the blood vessels prevents a full blood supply to the fingers (sometimes the toes). It is aggravated by cold weather and made better with warmth. When it is particularly chronic fingers can be lost to the disease.

Buerger’s disease occurs in young men who smoke. It seems to be caused by arteritis and sometimes vasculitis resulting in atherosclerosis leading to severe claudication and pain on rest leading to gangrene.

Peripheral Venous disease

Varicose veins occur when the vein becomes dilated these can usually be clearly seen on the leg and often cause pain to the patient.

Venous thrombosis is a general term used for thrombosis (blood clot) of any vein. Deep vein thrombosis is one such example. These usually occur after an injury to the vein or large periods of inactivity.

Valvular heart disease refers to diseases which affect the valves of the heart. Namely stenosis (hardening) of the valve or regurgitation which can occur after stenosis. These are called:
- Aortic stenosis
- Aortic regurgitation
- Mitral stenosis
- Mitral regurgitation
- Tricuspid stenosis
- Tricuspid regurgitation
- Pulmonary stenosis
- Pulmonary regurgitation

Cardiomyopathy, meaning a disease of the cardiac muscle, is a title used to classify a group of diseases. They are subdivided by their presentation into; dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy.
All the information in this paper was found in Kumar and Clarks (2002) section on cardiovascular disease.

Herbs for the Heart
These herbs are listed here for their affinity to the heart however, they do not just work on the circulatory system, and they are far more complex than this. Below is the use of each herb in relation to the circulatory system only.
Achillea millefolium this herb helps bring blood to the peripheries and promotes sweating
Cinammomum zeylanicum this herb opens the arteries allowing blood to flow more freely in cases of tension
Crataegus lavaegata this herb strengthens the heart muscle and can be used for hypertension and hypotension alike
Leonurus cardiac this is another herb which strengthens the heart but is traditionally used in high blood pressure, not low
Rosmarianus officianlis this herb increases circulation to the peripheries as well and has an affinity to the brain thus helping with headaches caused by poor circulation from stress (which causes constriction and prevents blood flow)
Zingiber officinalis is a hot herb, as is Rosmarianus, it helps bring blood to the peripheries and prevents sweating like Achillea does.

The Respiratory System

Anatomy and Physiology

Physical Examination
Inspection
Inspect the mental alertness of the patient. Is there blueness in the face (cyanosis) or breathlessness at rest? Is the patient using accessory muscles to breathe? Is there any clear deformities or scars and is there equal movement of the chest on each side?

Palpation and percussion
The chest can be palpated for broken ribs but this is rarely seen by a herbalist. The chest expension should be noted through palpation. Check the trachea position as it moves away from a pneumothorax and toward a collapsed lung. Also, palpate the lymph nodes; if enlarged lymph is found in the supraclavicular area it may indicate bronchial carcinoma. if dullness is discovered on percussion pneumonia, lung collapse, fibrosis or pleural effusion may be present. If hyperresonance is discovered a pneumothorax may be the cause.

Auscultation
The lungs must be listened to on normal breathe sounds as well as whispering and spoken voice if necessary. If a wheeze is heard this may indicate asthma or COPD. If crackles are heard there may be airflow limitation as in oedema, fibrosis and bronchiectasis. A pleural rub can be heard when there is inflammation and roughening of the pleural surface, this is also painful for the patient. When the lung is consolidated high pitches are extenuated and low pitches are very difficult to hear, whereas, when there is fluid on the lungs almost no low pitches can be heard.
A peak flow test is useful to assess the abilities for the lungs to take in oxygen it also gives an idea of consolidation, fluid in the lungs or constriction of the alveoli or bronchioles.

Respiratory Diseases
Rhinitis/ Hayfever is an inflammation due to irritation of the mucous membrane in the nasal passage.

Bronchitis is inflammation of the bronchioles. Usually this is caused by a virus. It results in an irritating dry cough followed by chest tightness, wheezing and shortness of breath (SOB). The cough eventually becomes productive with yellow or green sputum. Sometimes it is accompanied by a mild fever and usually it is resolved within 4-8 days.

COPD is a set of diseases which are characterised by obstruction to normal breathing. Usually they are caused by the inhalation of toxins which results in sputum and wheezing with breathlessness. It is aggravated by cold, foggy weather and atmospheric pollution. The lungs are hyperinflated which means the liver and heart can no longer be percussed for. It can lead to respiratory failure characterised by hypoxia and hypercapnea.

Bronchiectasis (a COPD) occurs when the alveoli and bronchi are abnormally dilated which gives them a more likely chance that they will collapse. Before this happens they produce large quantities of sputum which obstructs air flow. The sputum leads to a high chance of recurrent infections and gives a chronic productive cough. Halitosis, malaise, pneumonia and clubbing of the fingers can be observed.

Cystic fibrosis is hereditary and occurs in the lungs and the pancreas. It affects the pancreas by creating scarring and cysts which is what the name refers to. In the lungs it creates very thick (viscose) and sticky (tenacious) sputum. This increases the chances of infection. Sinusitis, breathlessness and haemoptysis are sometimes seen.

Pneumonia is usually caused by viruses or bacteria creating inflammation in the lungs. This leads to sputum production and a productive cough. Chest pain, fever, difficulty breathing are also seen.

Tuberculosis is an infectious disease which can infect other organs but is most commonly seen in the lungs. It presents with a chronic cough, blood tinged sputum, fever, night sweats, chest pain, and weight loss.

Bronchial carcinomas can cause chest pain, discomfort but more commonly they show no symptoms. However, it may be possible to feel raised lymph nodes in the supraclavicular area.

Pleurisy is pain arising from any disease of the pleura caused by inflammation.
Pleural effusion is fluid in the pleural cavity.

Pneumothorax occurs when air seeps into the pleural cavity. As the pleura expands with the air it pushes the lung over to the other side creating tracheal deviation away from the pneumothorax. It causes pressure which can be painful and fainting. It can also cause shortness of breathe and eventually cardiac arrest. In serious cases the lung may collapse under the growing pressure from the air. On auscultation a lack of breathe sound will be heard. Urgent intervention is needed.

Emphysema (a COPD) is caused by localised inflammation which leads to septal degradation. It is similar to bronchiectasis, another COPD.

Respiratory Herbs
Inula helenium is a strong expectorant which steadily dissolves thick green mucous to a much thinner and clearer consistency so it can be coughed up.
Thymus vulgaris is an anti-viral herb used when bacteria causes infections.
Glycyrrhiza glabra can be used to soothe the respiratory tract and helps dissolve sputum and is an expectorant. It is particularly useful in asthma.
Tussilago farfara is an expectorant which helps for those with congestive coughs.

The Musculoskeletal System

Anatomy and Physiology
The musculoskeletal system is a combination of the skeletal and muscular system as one could not function without the other. It gives us our movement and provides us with support. Although each joint appears the same the anatomy of each is very similar. There are 5 different types of joints as seen below; ball and socket, hinge, saddle, pivot and gliding. The knee joint, seen above, is a ball and socket joint.

Musculoskeletal Pathologies
Some of the most common musculoskeletal problems are those of arthritis. There are many types some of which are listed below.

Osteoarthritis is an inflammation of the joint which occurs after years of wear and tear. The activity wears down the synovial fluid and eventually the bones rub together. This causes inflammation and pain which gets worse as the day goes on. It usually occurs in an isolated joint.

Rheumatoid arthritis has similar symptoms but is symmetrical and usually presents with stiffness on rising which gets better during the day. It is an autoimmune response with an unknown cause however it does seem to run in families.

Reactive arthritis has similar symptoms to rheumatoid arthritis however; it is caused by a reaction to some kind of infection. It seems to affect the eyes causing conjunctivitis, urethritis (inflammation and irritation of the urethra).

Septic arthritis is cause by a purulent invasion of an infection and, again, has similar affects to the other arthritis. The only sure fire way to diagnose them precisely is usually further testing by the GP.

Gout (a form of crystal arthritis) is caused by uric acid crystals in the joints, tendons and surrounding tissue. It is characterised by acute flare ups of inflammation and pain.

Osteomyelitis is infection and inflammation of the bone marrow. It is usually caused by staphalaucoccus or salmonella. It presents with a fever, edema, tenderness to touch, and warmth.

Osteoporosis is a fragility of bones caused by a loss of bone density usually occurring after menopause.

Rhabdomyolysis usually occurs after injury and causes a breakdown of muscle fibres. This presents with weakness, pain, tenderness and edema as the muscles can not sufficiently move fluids around the body anymore.

Carpal tunnel syndrome is a pain, tingling and numbness in the hands. This happens because the carpal tunnel in the wrist pinches on the nerve.

Nerve entrapment causes pain, numbness, tingling and muscle weakness. Usually it is caused by a slipped disc in the spine (vertabrea).

Dupuytrens contracture is a contracture of the underlying palmar fascia in the hand. Sometimes it is a sign of lvier failure. It is not a painful condition but it is restrictive to the movement of the hand.

Ankylosing spondylitis is a bend in the spine which causes chronic pain and stiffness.

Fibromyalgia is generalised muscle pain. It can be associated with fatigue, sleep disturbance, joint stiffness, associated with depression and anxiety.

Systemic lupus erythamatous (SLE) is an autoimmune condition which affects the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system. Flare ups bring fever, malaise, joint pain, myalgias (muscle pains) and fatigue.

Paget’s disease of the bone is characterised by enlarged and deformed bones. It causes bone pain, arthritis, deformities, fractures, headaches, hearing loss, paralysis, teeth may spread intraorally and chalk stick fractures may appear. It has genetic and viral causes.

M/S Herbs
Chamomilla recutita is an anti-inflammatory.
Sympthytum officinale root is used to knit bones together as is rarely used internally for any other reason as it contains pyrollizidine alkaloids which have been shown to cause liver damage in large quantities (in rats, intravenously).
Hypericum perforatum is a nervine and therefore helps with nerve pains.
Curcuma longa is a powerful anti-inflammatory, usually used to treat the gastro-intestinal tract inflammations but can be used for other locations of inflammation as well.

The Immune System

Anatomy and Physiology
The immune system is vital to our ability to fight off parasites, infections and viruses. It changes and develops new anti-bodies with each new substance we come into contact with; this is called ‘aquired immunity’. It is made up of the lymphatic system, white blood cells, thymus (which excretes t-lymphocytes), spleen and the tonsils which is not shown on the diagram above, it too produces t-lymphocytes. (Springhouse Publishing, 2002)
There are three different types of immune problems:
• Immunodeficiencies e.g. HIV
• Autoimmunities e.g. rheumatoid arthritis and SLE
• Hypersensitivity e.g. atopic conditions (eczema, rhinitis and asthma)

Immune System Pathologies
HIV (human immunodeficiency virus) is a virus which leads to the immune system failing. This happens in 4 stages:
- Incubation which is asymptomatic and lasts 2-4 weeks
- Acute infection which has similar sings to a cold; fever, lymphadenopathy, pharyngitis, rash, myalgia, fatigue, mouth, oesophagus sores, hepatosplenomegaly (liver and spleen enlargement) and nausea and vomiting. This lasts up to 28 days.
- Latency shows few or no symptoms and lasts from 2 – 20 weeks and over
- AIDS eventually occurs giving symptoms of opportunistic infections which the patient contracts

Atopic conditions include asthma, eczema and rhinitis (hayfever). These conditions are due to a hypersensitive reaction of the immune system to foreign substances. The body reacts as though the allergen is pathogenic in nature although it is not. Often all three of these occur during a persons life and they are often more likely to have food sensitivities as well such as celiac disease. Anaphylaxis is an extreme reaction to an allergen which can lead to death.

Systemic Lupus Erythematosus (SLE) is an autoimmune reaction. It may effect the joints, skin, kidneys, blood cells, heart or lugns. It may cause a butterfly rash on the face as in figure 2, fatigue, loss of appetite, low-grade fever, photosensitivity, mouth ulcers, pleurisy, pericarditis, arthritis, myalgia and poor peripheral circulation.

Rheumatoid arthritis is another autoimmune disease covered in the musculoskeletal system.

Myasthenia gravis is an autoimmune disease affecting the neuromuscular system resulting in progressive muscle weakness.

Herbs for the Immune System
Echinacea purpurea and angustifolia both help increase white blood cell count thereby increasing the resilience of the immune system. This helps when treating viruses and infections but can aggravate autoimmune diseases.
Thymus vulgaris is an excellent anti-viral which will help kill viruses without increasing the bodies resilience to deal with the pathogen itself. Most herbs high in volatile oils make good anti-virals.
Symphytum officinale fol. Is good as an anti-inflammatory for the bones.
Hypericum perforatum is another anti-inflammatory good for the nerves.
Chamomilla recutita and Calendula officinalis are both good anti-inflammatories as well.

Cherry syrup

How to make cherry syrup

This syrup is a good way to treat coughs especially when added with other herbs specific to the ailment at the time e.g. Echinacea to boost immunity, Elderflowers to break a fever or Thyme to kill a virus in it's tracks.

You will need:
Some cherries (washed and without stalks)
Sugar
Water
A saucepan
Empty bottles
A funnel
A jam strainer or muslin cloth

I used a recipe off my friend Karen at Sensory Solutions who uses Mrs.Grieves age old trick of a pound of sugar to a pint of water. The more water you use the more syrup you make but ideally you'd have at least a pound of cherries to your pint of water as well.

1. Wash your cherries in a collander.

2. Put your sugar in the water with the cherries a bring to the boil.
3. Keep it moving until the sugar has dissolved.
4. You may wish to start squishing the cherries against the side at this point.
5. Leave until the water has gone dark red/black or boil down to the amount you wish
6. Strain into a jug and allow to cool, composting the left over cherry skin and stone. Once cool transfer to bottles. I recommend you use glass bottles or plastic ones which havnt been used before. I tried reusing a bottle which had had thyme and liquorice syrup in and it contaminated the entire thing (not necessarilly a bad thing though!).

The Endocrine System

Anatomy and Physiology

The endocrine system is made of 7 glands; the thyroid, pituitary, pineal, thymus, adrenal, pancreas and gonads (testes and ovaries). The hypothalamus is a part of the brain which connects the endocrine system to the nervous system and produces hormones which trigger the anterior piruitary gland to produce its hormones. The pineal gland produces melatonin and is sometimes referred to as the ‘third eye’. It responds to sun light through the eyes and governs our mood and sleep patterns. The pituitary releases ADH which helps control growth, blood pressure, some parts of pregnancy, childbirth, breast milk production, sex organ functions, thyroid function, metabolism of food, osmosis rates and temperature. The thyroid produces thyrotoxine (T4) and triiodothyronine (T3). It regulates the rate of metabolism and growth. The thymus releases t-lympocytes which are critical to the adaptive immune system which protects us so much in life.The adrenals release adrenalie, cortisole, aldosterone, noradrenalise and androgens. These give us our fight or flight response. The pancreas creates insulin, glucagon and somatostatin which help control our blood-glucose levels. This is the primary endocrine gland involved in diabetes. The female gonads produce oestrogen and progesterone. The male gonads produce testosterone.

Endocrine Pathologies
Hyperthyroidism is caused by over-production of hormones from the thyroid. This results in high growth rates, diarrhoea, weight loss, anxiety, hyperactivity, apathy, depression, polyuria (having to wee frequently), polydipsia (excessive thirst), delirium, tremor, palpitations, arrhythmias, shortness of breath, loss of libido, nausea and vomiting.
Hypothyroidism is essentially the opposite of hyperthyroidism. It can result in hypotonia (low muscle tone), depression, muscle cramps, goitre, carpal tunnel syndrome, paleness, dry and itchy skin, osteoporosis, weight gain (as metabolism slows), constipation, bradycardia, thin brittle hair and an intolerance to the cold.
Cushing’s syndrome is caused by an over production of corticosterois from the adrenals (or sometimes from over-use of topical steroids) and results in abdominal striae, weight gain, ‘moon face’, fatigue, weakness, loss of libido and high blood pressure.
Addison’s disease is essentially the opposite of Cushing’s syndrome as it is due to an under-production of adrenal hormones resulting in muscle weakness, abdominal pain, low blood pressure, weight loss, dizzy spells, vomiting, dehydration and tiredness.
Diabetes can either result from an inability of the pancreas to create enough insulin or a resistance of the body to the insulin that is being produced. This results in an inability to balance sugar levels in the body. It usually produces symptoms of polydipsia (frequent thirst), polyuria (frequent urination), high blood pressure, weight loss in severe cases, weight gain more commonly, pitting oedema in the ankles and dry skin.

Endocrine Herbs
Borago officinalis can be used to replenish the adrenals.
Glycyhhriza glabra is an adaptogens which means it helps to regulate our response to stress and replenishes the adrenals. It can be used to treat Addison’s disease.

The Female Reproductive System

Anatomy and physiology
The gynaecological system of a female is largely governed by the hormones which come from the endocrine system. The female reproductive system is far more complicated than the males because it has a monthly cycle. In this cycle (governed by hormones) a follicle matures in the ovary and is released into the fallopian tube waiting for fertilisation from a sperm. If this does not happen the endometrium breaks down as it is not needed to feed the egg thereby causing menstruation. Follicle stimulating hormone (FSH) comes from the pituitary and matures the follicle it is released when a peak in oestrogen occurs. The egg leaves the ovary and leaves behind what is called a corpus luteum. Lutenising hormone is released from the pituitary and either helps to maintain a healthy environment for a foetus or turns the left-over follicle into a corpus luteum. The corpus luteum then releases progesterone which lowers the amount of oestrogen leading to menstruation. During menstruation the levels of hormone are at their lowest and this triggers the hypothalamus to release gonadotropin releasing hormone which stimulates the pituitary to release FSH and LH and the cycle starts again.

Gynaecological Pathologies
Ectopic pregnancies are foetuses which start maturing outside of the uterus, usually in the fallopian tubes but it can be elsewhere. It can lead to spotting, pain in the abdomen, dysuria (pain on weeing) and pain of defacation.
Poly cystic ovarian syndrome (PCOS) is fairly common and refers to multiple cysts which are formed on the ovaries. These are usually discovered with an ultrasound scan. Usually cyst means an empty sac, in this case it actually refers to immature follicles which have not developed or disappeared with the hormone cycle. It leads to an over-production of progesterone as this is what a corpus luteum produces and gives symptoms such as; hirsutism (manly hair growth patterns), irregular periods or ammenorreha (lack of periods) and infertility.
Endometriosis is when endometrial tissue flourishes outside of the womb. Despite being far from the womb it is still activated by hormones and sheds every month. This can create monthly bleeding in strange places. It leads to painful periods (dysmennorhea), painful sex (dyspareunia), dysuria, infertility and sometimes vertigo.
Adenomyosis is ectopic endometrial tissue within the womb muscle. It causes dysmenorrhea and menorrhagia.
Fibroids are a type of tumour sometimes called uterine myomas. They can cause menorrhagia (heavy periods), dysmenorrhea, abdominal discomfort, painful defacation, back ache, fever, nausea and vomiting.
Salpingitis is inflammation (usually caused by infection) of the fallopian tubes. It causes a change of smell and colour of the cervical fluid, creates pain during ovulation (as the egg passes through the fallopian tube), dyspareunia, abdominal pain, lower back pain, fever and nausea and vomiting.
Pelvic inflammatory disease (PID) is used to describe inflammation of any of the reproductive organs, uterus, ovaries, fallopian tubes etc. It is characterised by a fever, lower abdomen pain, dyspareumia, irregular menstruation, and a change to cervical discharge.
Ashmerman’s syndrome is an acquired uterine condition. In this condition the front and back walls of the uterus adhere to one another. These adhesions can be thick, thin, confluent or spotty. It may result in symptoms such as amenorrhoea, dysmenorrhoea without bleeding as menses occur but blood can not flow out of the uterus. Often it is caused as a result of a D&C.

Gynaecological Herbs
Rubus idaeus is a uterine tonic used to tone the uterine muscle in pregnancy.
Vitex agnus castus is an oestrogenic regulator commonly used in menopause.
Alchemilla vulgaris is a uterine tonic similar to Rubus idaeus.
Dioscorea villosa is antispasmodic and contains phyto-oestrogens and therefore is used to treat oestrogen related problems. It is als anti inflammatory and therefore used to treat salpingitis and PID.
Salvia officinalis is commonly used to treat hot flushes in the menopause because it is so cooling. Rosa damascene is another nice one for that.

The Nervous System

Anatomy and physiology
The nervous system is made up of neurons which pass messages electrically through the brain, spine and peripheral nervous system. The central nervous system (CNS) is compromised of the brain and spinal cord. The peripheral nervous system (PNS) is made of any nerves which branch out from that toward the peripheries. The nervous system has 3 main functional divisions; motor, sensory and reflexive. The motor pathway receives and sends messages which give us control over our movement. In a physical exam this is tested via co-ordination tests and palpation for muscle bulk and tone. The sensory pathway sends and receives sensations. Pain, temperature and crude touch travel up the spinothalamic tract and the posterior column takes vibration, soft touch and position sense. The sensory pathway is tested by touching the patient with soft objects, painful ones and vibrating ones whilst their eyes are closed. They are also given objects to describe by feeling them in their hands and numbers are written on the hand using something with a point (stereognosis). The reflexes by-pass the brain and travel through a reflex arc. They are tested by tapping the reflexive tendon with a patella hammer.

Physical examination
It is best with this exam to perform it firstly on the top half of the body and then the lower half after. This prevents the patient from having to completely remove their clothes at any given point. There are 4 parts to this examination; motor, sensory, co-ordination and reflexes.

Begin by observing the patients gait. Have them walk up and down the room normally then on their heels followed by their toes then small steps touching the heel to the toe each time (pigeon steps). Have the patient hop on one leg then crouch on one leg (perform on both sides and make sure you can catch any falls).

Have the patient remove their top if you cannot see their arms and shoulders. Feel for bulk in the hands arms and shoulders a loss of muscle bulk may be due to polio, paralysis or injury. Move the arm around feeling for tone hypertonia (high tone) may indicate an upper motor neuron lesion, hyperthyroidism or amphetamine use. Hypotonia (low tone) may indicate a low motor neuron lesion or hypothyroidism. Test the strength of each muscle groups, fingers (grip, thumb opposition and finger abduction), wrists, bicep, tricep, abduction & adduction of arms, shrug the shoulders and turn the head. All of these must be performed against resistance and one must try to overcome the strength of the patient and push them to their limits or else it is very difficult to observe any asymmetry in muscle strength.

The peripheral senses are tested by touching the patient on certain dermatomes with a soft thing or a sharp thing, the patient has their eyes closed and must identify the sensation. If there is a problem feeling these one must perform a hot or cold test (temperature). Ask the patient to close their eyes and place a vibrating tuning fork on their thumb knuckle (or big toe) and ask them to identify the sensation. If this is achieved most distally it is not necessary to go more proximal. A common cause of sensation loss is glove and stocking syndrome caused by alcoholism or diabetes this spreads evenly up the arm from the peripheries toward the heart. If the patient can feel pain and temperature their spinothalamic tract is intact and if they feel vibration and soft touch their posterior column is unaffected. It is hard to say what may cause damage to these columns so it is best to describe harm as a ‘lesion’ to these areas so I specialist can make a diagnosis. Position sense is tested by moving the fingers (or toes) up and down with the patients eyes closed; this is disturbed in posterior column lesions. Then place an object in the patients hand to identify followed by writing a number in the patient hands with a pointed object; this is difficult for those with glove and stocking syndrome, co-ordination difficulties such as Parkinson’s, or numbness caused by stroke, trauma, alcoholism or multiple sclerosis.

To test co-ordination in the upper body ask the patient to rapidly turn their hands over on their lap. When a patient cannot do this it is called dysdiadochokinesis (lack of co-ordination) and can indicate cerebellar disease. Have them touch their nose then your finger as quickly as possible then begin to move your finger so they have to stretch to reach it (this is the only way an intentional tremor is noticed; a sign of multiple sclerosis and Wilsons disease). Have the patient stand up with their feet together and eyes closed for at least 30 seconds (this is called Romberg’s test) a positive one i.e. falling over or uneasiness indicates a loss of position sense. Follow this by having the patient stand with their hands out and palms up watching they do not drift from one point, then push the hands down and see if the patient corrects their position correctly (this is called pronator drift).

There are 3 reflexes for both the upper and the lower part of the nervous system exam. For the upper body there is the ulnar, bicep and tricep reflexes and for the lower there is the knee, ankle and plantar reflexes. Hyperreflexia can indicate hyperthyroidism, brain damage through amphetamine use, upper motor neuron damage, multiple sclerosis and alcoholism. Hyporeflexia is quite normal but can indicate hypothyroidism, lower motor neuron damage, guillaine-barre syndrome, polio. Pendular reflexes may indicate cerebellar disease.

Nervous System Pathologies
Alcoholism (the bodies dependence on alcohol) can cause great damage including liver failure, liver cirrhosis, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, chronic gastritis, diabetes (type 2), anaemia, cancer (mouth, trachea and oesophagus), ataxia (loss of balance), cravings, panic, anxiety, psychosis, hallucinations, delusions and sleep disorders.
Stroke is caused by an embolism which stops blood supply to some part of the brain. It causes different symptoms depending where in the brain is being affected. It may produce pronator drift, face weakness, abnormal speech, sometimes numbness, reduction in sensory or vibratory sensation, loss of coordination and it may affect the senses.

Parkinson’s is a degenerative disease affecting the central nervous system. It is due to an under activity of the basal ganglia stimulating the motor cortex and under production of dopamine. It can cause cogwheel rigidity, a resting tremor (pill rolling), bradykinesia, akinesia, postural instability and small steps when walking.

Meningitis is inflammation of the brain meninges caused by infection. It causes a severe headache, nuchal rigidity, high fever, photophobia (sensitivity to light), phonophobia (sensitivity to sound) and a rash. A positive Brudzinsky or Kernig’s sign (painful rigid raising of either the head or legs when the opposite is raised) may indicate meningitis.
Multiple sclerosis (MS) is caused by demyelination and scarring of the myelin sheaths surrounding the axons in the brain and spinal cord. It causes fatigue, cognitive impairment, depression, mood swings, nystagmus, optic neuritis, diplopia, dysarthia, dysphagia, muscle weakness, spasms, constipation, diarrhoea, and constipation, frequency of urination or retention of urine.
Epilepsy is characterised by seizures caused by synchronous neuronal activity in the brain. Usually it is seen in young children or patients over 65.
Myasthenia Gravis has a prevalence of 4 in 100,000 and is twice as prevalent in women as men. The cause is unknown. It presents with fatigability, proximal limb muscles, extra ocular muscles, mastication, speech and facial expression muscles are the first to become affected.

Depression is theorised to be caused by low levels of 5-HT (serotonin); a neurotransmitter. In the case of SAD (seasonal affective disorder) this is caused by low levels of melatonin (a hormone) being produced by the pineal gland which helps trigger serotonin. Serotonin does not just govern our mood either, it also is found in the GIT where it contributes to our rate of bowel movements, nausea and vomiting reflexes. This is probably why appetite alters with depression. It may cause anorexia, weight gain, and weight loss, loss of libido, insomnia, fatigue and low mood.

Herbs for the Nervous System
Centella asciatica has an affinity for the brain as does Gingko biloba.
Hypericum perforatum is well known for its affects of serotonin levels.
Zingiber officinalis is a less well known herb for its affect on serotonin but this may be the mechanism by which it helps in nausea and vomiting in pregnancy.

The Digestive System

Anatomy and Physiology
The digestive system is made up of the gastro-intestinal tract which is a continuous tract from mouth to rectum. It consists of mouth, oesophagus, stomach, small intestine, large intestine and rectum. It also has 3 accessory organs which take products from the circulation surrounding the GIT to the liver where it is filtered and excreted in the form of bile back into the GIT.

Food is broken down by the stomach and absorbed by the intestines.
Substances pass through the intestine walls into the circulation which goes via the liver back to the heart. Bile is created when the liver filters this supply of blood. It is then stored in the gallbladder to be excreted into the intestines later. The sphincter of oddi governs when this bile is excreted. The pancreas uses the same duct as the bile does to excrete digestive enzymes into the intestines. It also excretes hormones; this will be covered in the endocrine system section.

Physical Examination
In each examination one must always begin by observing the patient. Look at the creases on their palm for pink lines, if these are pale it can indicate poor peripheral circulation or anaemia. If the palm is particularly red it may indicate liver failure. If the patient has yellow skin this is jaundice and may indicate liver problems such as cirrhosis and liver failure. You may also notice spider naevi which will indicate the same things but is usually ignored by physicians unless there are at least 5 of them on the body. Then look at the nails for Terry’s nail (a sign of liver cirrhosis), clubbing (a sign of irritable bowel diseases) and splinter haemorrhaging. Then move to the face looking at the patient sclera (pull down the eyes for this) if it is particularly pale this may indicate anaemia as will ankylosing stomatitis in the corners of the mouth. Yellow conjunctivae also indicates cirrhosis and jaundice. Look at the patients mouth for ulcers (may indicate crohn’s disease), healthy teeth (bad dentures will make digestion harder) and fillings (possible cause of mercury poisoning).

Before beginning ask the patient if they need to wee or are on their period or pregnant if a woman. Ask the patient to lay back on the bed and pull their shirt up to either their bra line (if a woman) or just high enough so the entire abdomen is uncovered this may involve rolling the trousers down over the hips. Usually one would palpate, percuss then auscultate but in the case of the abdominal examination this occurs in reverse due to not wanting to move the contents of the bowel or cause unnecessary pain. Firstly observe the abdomen for striae (child bearing, cushing’s syndrome or steroids can cause this), distension caused by the 6 f’s (fat, flatus, faeces, foetus, fluid, fibroids), scars (perhaps from an appendectomy), and look across the abdomen surface to observe a healthy abdominal aortic pulsation. Then listen to the abdomen for normal bowel movements. Percuss the 9 areas listening for the dullness of a bolus or a sign of pathology. Then lightly palpate to locate any areas of tenderness. Deeply palpate the same areas to feel for masses which may be the source of pain. Then move on to finding the accessory organs.

Firstly, percuss for the liver from the hip upwards as this is where the liver will expand to when enlarged. Then palpate for the liver. A healthy liver should sit about the ribs and be very difficult to feel. An unhealthy one may be hard and enlarged and usually painful. This indicates hepatitis, cirrhosis and liver failure.

Secondly, percuss diagonally from the belly button to the spleen as this is where it will expand to. Then ask the patient to breathe in and percuss then ask them to breathe out and percuss again. There should be no change in tympany. If there is the spleen may be enlarged (splenomegaly).

Lastly, palpate for the kidneys by placing your hands over them and then on their in breathe push down briskly to the back of the patient and try to grab the kidney. When they breathe out it should slip away from your hand. (This is very difficult and usually uncomfortable for the patient).

Shifting dullness is a special test for ascites. One must have the patient lie supine (flat) and percuss outwards from the belly button outwards and towards the feet as if they were sun rays. Listen for when the sound changes, this is the current level of fluid (inaudible in a normal person usually). Then have them turn to one side to the fluid settles on one side then percuss again from the bottom up (from one side of the body to the other). In a healthy person the level of fluid won’t have changed much but in someone with ascites it would change and the higher it is the more fluid there is. You would usually be able to observe distension in these patients.

Digestive System Pathologies
Irritable bowel syndrome is a collection of symptoms which have been identified to occur frequently without any known organic cause. It can be characterised by diarrhoea or constipation alike.

Crohns disease (IBD) is a form of irritable bowel disease. This has similar symptoms as irritable bowel syndrome but the pain is usually localised to the area which is ulcerated. The ulcers can occur at any point in the gastro intestinal tract from mouth to rectum. However, ulcers that occur in the stomach are usually called peptic (meaning stomach) ulcers.

Ulcerative colitis (IBD) is similar to crohns disease but the ulceration of the GIT spreads continuously from the rectum up toward the mouth. The pain corresponds with this pattern.

Diverticulitis (IBD) is another form of irritable bowel disease. It is characterised by many diverticular which have become inflamed. Before this occurs you can have diverticular disease (multiple diverticular or diverticulosis) without any symptoms or problems caused by it.

Hiatal hernia occurs when a defect in the diaphragm allows the stomach to push up past it. This has almost identical symptoms to GERD and usually is only diagnosed accidently when a barium swallow test is done.

Gastric reflux (GERD) is when gastric juices from the stomach make its way back up the oesophagus which causes a burning sensation as it goes.
Appendicitis is inflammation of the appendix, the exact cause is unknown but it can cause severe pain and as the function of the appendix is unknown (or has none depending who you talk to) it is usually removed (appendectomy) to treat the pain.
Cancers of the GIT make up 20% of all cancers diagnosed and should therefore always be ruled out when treating someone with GIT complaints.
Cirrhosis of the liver occurs after serious hepatic cells die (necrosis). Then they can not perform their function and give rise to symptoms like jaundice, spider naevi, abdominal distension, itching, nosebleeds, fluid in the lungs, mental changes, dry skin and liver enlargement (hepatomegaly).
Heptatits is inflammation of the liver, in this case cell death occurs due to an organic cause, usually an infection. This gives rise to similar symptoms as cirrhosis.
Gall stones are formed cholesterol and if large enough are operated on but often they are passed naturally but painfully by the patient whilst weeing.
Pancreatitis is inflammation of the pancreas which usually occurs as a result of gall stones as well. They are usually caught in the common bile duct or just before the sphincter of oddi in this case.
Cholecystitis is inflammation of the gall bladder usually occurring when gall stones get caught in the cystic duct.
Candida albicans is a fungus which always lives in our guts but if we change the environment in our gut by eating too much sugar, taking oral contraceptives, taking recreational drugs or antibiotics we disturb the balance of micro flora and give candida a chance to proliferate. When this happens it can cause gas, bloating, indigestion, mental confusion, heart burn, nausea, constipation or diarrhoea, mood swings, sugar cravings, depression, fatigue, pre-menstrual syndrome and low immunity.
Giardia is a parasite. It lives in the small intestine and causes symptoms of diarrhoea, fatigue, excessive gas, abdominal pain, bloating, nausea, low appetite, possibly vomiting and weight loss.

Herbs for the Digestive System
Plantago psyllium; this acts as a bulking agent for those with diarrhoea.
Althea officinalis: this is a mucilaginous herb which coats the digestive tract and soothes it in the case of IBS and IBD
Glycyrrhiza glabra; this too is mucilagenous
Chamomilla recutita; this herb helps promote good gut bacteria after having had a serious viral infection e.g. giardia
Curcuma longa; this also helps promote good bacteria in the gut.
Cinamommum zeylanicum; almost all the spices from India help with ailments such as wind, gut dysbiosis.
Zingiber officinalis; this helps the GIT through the promotion of serotonin in the gut
Silybum marianum; this herb helps liver cells regenerate faster, this is known as a liver tonic
Taraxacum officinalis radix; this is a liver tonic as well
Calendula officinalis; this is not specific to the GIT but it promotes healing of tissue and can be helpful in cases of IBD

Skin

The skin is made of the:
• Epidermis; which prevents skin shedding
• Basement membrane zone; which attaches the epidermis to the dermis firmly
• Dermis; which hosts sweat glands, nerves, hair and nails
• Subcutaneous layer; which provides insulation and stores lipids
(Clark & Kumar, 2002)

Relatively little is understood about the pathology of the skin when compared with other organs.

However, with the holistic perspective much improvement has been made with skin problems to resolve the issue. The skin is our largest organ as it covers our entire body. Most think of it as merely a cover to our other body systems holding it all in place and making sure we don’t leak (apart from at the appropriate places). However, it is far more complex than that. Skin has many nerves in which allows us to feel which gives us the ability to handle objects better and also to warn us if we are touching something harmful to us. It allows us to alter our body temperature through a complex system of sweat glands, hair and blood flow. Through this sweating system it also allows us to excrete toxins. (Gascoigne, 2001)

This concept of the skin being an excretory organ is what allows the holistic practitioner to help so much in skin conditions. Often, when a person suffers bouts of eczema it is due to stress. Stress causes liver heat which tries to relieve itself by making its way to the surface; this can create dandruff, psoriasis, eczema etc. It can be widespread and very difficult to relieve. Often it is red and dry and sometimes itchy.

When taking a patient who has a skin problem answers to the following questions should be obtained:
- How long has the rash been there?
- Where are the lesions found?
- What are the patients symptoms?
- Is there any family history of skin problems?
- What drug/allergies does the patient have?
- What is their past medical history?
- Does anything make it worse?
- Does anything make it better?
- Have they had any previous skin treatments?
(Clark & Kumar, 2002)

It is important to look at the rash but also it must be felt including the hair skin and nails. If possible, pictures can be useful to monitor the improvement of the rash.

References
Gascoigne, S (2001) The Clinical Medicine Guide: A Holistic Perspective. Ireland: Jigme Press.
Clark and Kumar (2002) Clinical Medicine. London: Elsevier