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The most commonly used extraction technique is to first isolate the part of the herb that contains the therapeutic material and then soak that part in alcohol or water generic acarbose 50mg without prescription diabetic zucchini bread recipes. Herbal oil is prepared by soaking the dried herb in olive oil or vegetable oil and heating the herb for an extended period of time buy 25 mg acarbose with visa treatment for diabetes. Oils promote the concentration of the therapeutic material and order acarbose 50mg without a prescription diabetes insipidus on mri, if properly stored, extend the therapeutic life of the material for months. They are prepared in a way similar to herbal oils except once the dried herb is soaked in oil, melted wax is mixed with the oil. Once the herb blends with the water, the resulting tea can be stored in the refrigerator for later use as a drink, bath water additive, or applied topically in a compress to the skin. Chaparral tincture, for example, contains important ingredients that cannot be dissolved in water. Tinctures are also a con- venient way to take herbs that does not require kitchen preparation. Disagreeable- tasting herbs can be swallowed more quickly and can be masked with juice. Tinctures are made by soaking fresh or dried herbs in water or alcohol causing the water-soluble and fat-soluble components of the herb to concentrate. Herbal tablets are similar to herbal capsules except the dried, pulverized herb is combined with stabilizers and binders and then compressed into a tablet. A stabilizer is an ingredient that assures that the herb maintains its therapeutic effect. A binder is an ingredient that acts like glue to hold together the powdery mixture of herb and stabilizer. Syrups are made by drying the herb and soaking it in water or oil and then adding a sweetener to the mix. Hazards of Herbal Therapeutics Herbal therapies have a therapeutic effect and are acceptable interventions for diseases and symptoms. However, the lack of standards in manufacturing and lack of oversight by regulatory agencies exposes patients to potential hazards. Pharmaceuticals approved for distribution in the Untied States have under- gone rigorous testing that identifies the purity and concentration of the active ingredient that delivers the therapeutic effect. This also identifies the toxic lev- els that can cause serious and potentially lethal toxic effects. Anyone can sell herbal therapy without having to receive approval from a governmental agency or from the medical community. A major concern is the effect herbal therapy has on the patient who is also tak- ing prescribed medications. A prescriber should always ask what medication the patient is taking and review the patient’s chart before prescribing another medication. For example, a patient who takes cascara—a laxative for constipation—and senna—also a laxative—along with Digoxin—which is used to treat an irregu- lar heart rhythm—can develop a toxicity. For example, comfrey is used as an ointment to relieve swelling that is associated with abrasions and sprains. The herbal dietary supplement ephedra, commonly known as ma huang, is used as an energy boost and for losing weight. Ephedrine and pseudoephedrine are components of ephedra that have a stimulant and bronchodilation effect. How- ever, ephedra has an adverse effect of palpitations—which can result in stroke. Herbal Therapy and the Nursing Process Nurses need to include a discussion about the patient’s use of nonconventional therapeutic agents by name, dosage, frequency, side effects and why the patient is taking this remedy in the nursing assessment. This assessment should include information about all prescription and over-the-counter medications taken by the patient and why the patient is taking these drugs. Herbal medications, over the counter medications, and prescribed medications can combine to create undesir- able results and in some cases can have a toxic and dangerous effect on the patient. After assessing the patient, the nurse considers a nursing diagnosis that is related to herbal therapies. The patient may be unaware of the impact herbal ther- apies have on the patient’s health. The patient may be unaware of how herbal therapies alter the patient’s nutritional balance. The patient might be experiencing nausea, diarrhea, headache, fatigue, and other symptoms that are side effects of herbal therapies. The patient might be experiencing a toxic effect as a result of interactions of herbal therapies with prescribed medications. The patient will verbalize an understanding of the interaction between herbal therapy and conventional therapy. The nurse intervenes by: • Monitoring the patient’s response to conventional and herbal therapy look- ing for adverse side effects. The Do’s and Don’ts About Herbs • Don’t take if pregnant or trying to become pregnant. Make sure that the patient thinks of herbs as medicine that is less potent than conventional medication. However, adverse reactions can occur if conventional medication is taken with herbal therapy. For example, some conventional med- ication may act faster than expected when combined with herbal therapy. The patient should not take any herbal where the following information is not included on the packaging: • Scientific name of the product and the part of the plant used in the preparation • Manufacturer’s name and address • Batch and lot number • Date of manufacture and expiration. It is also a powerful laxative when taken internally and can increase menstrual flow if given in small doses. It is also used in instances where the patient is allergic to daisy or ragweed-like plants. Garlic is also an antibiotic for internal and external treatment of infections and wounds. Ginger is found to relieve nausea and relieves pain, swelling, and stiffness from osteoarthritis and rheumatoid arthritis. Ginkgo has been found useful for treating dementia syndromes, inter- mittent claudication (decreased circulation in the legs), vertigo (dizziness), and tinnitus (ringing in the ears). Red Korean and Chinese Ginseng are used for chronic inflammatory conditions such as arthritis. Hot peppermint tea stimulates circulation, reduces fever, clears congestion, and helps restore energy. Peppermint is also an effec- tive treatment for tension headache when rubbed on the forehead. Some research has shown peppermint to be as effective as Extra-strength Tylenol in relieving headache. Saw Palmetto is also used as an expecto- rant and treatment for colds, asthma, bronchitis, and thyroid deficiency. However, Valerian has an odor of “dirty socks” making it a very low risk for overdose. There have been no reports that frequent use of Valerian leads to habituation and addiction.
Power is neither in- the intention is for clients to actualize their poten- herently good nor evil; however order 25mg acarbose with amex blood glucose high, the form in which tials related to their desire for well-being and bet- power manifests may be viewed as either construc- terment order generic acarbose on-line diabetes symptoms timeline. Barrett (1989) stated that identiﬁes that aspect that is unique to nursing and her theory does not value different forms of power buy 25 mg acarbose free shipping diabetes 2 diet 600 calories, expands nursing practice beyond the traditional but instead recognizes differences in power mani- biomedical model that dominates much of nursing. Barrett’s Power Theory is useful with clients acausal, pandimensional, rhythmical, irreducible, who are experiencing hopelessness, suicidal and unitary context. Unitary pattern-based practice ideation, hypertension and obesity, drug and alco- brings about a new way of thinking and being in hol dependence, grief and loss, self-esteem issues, nursing that distinguishes nursing from other adolescent turmoil, career conﬂicts, marital dis- health-care professionals and offers new and inno- cord, cultural relocation trauma, or the desire to vative ways for clients to reach their desired health make a lifestyle change. To prevent biased responses, the nurse ories have been developed that are useful in should refrain from using the word “power. The Kaleidoscoping is a way of engaging in a mutual scores are documented as part of the client’s pat- process with clients who are in the midst of expe- tern proﬁle and shared with the client during vol- riencing a turbulent life event by mutually ﬂow- untary mutual patterning. Scores are considered ing with turbulent manifestations of patterning as a tentative and relative measure of the ever- (Butcher, 1993). Flow is an intense harmonious in- changing nature of one’s ﬁeld pattern in relation to volvement in the human/environment mutual ﬁeld power. The term “kaleidoscoping” was used be- Instead of focusing on issues of control, the cause it evolves directly from Rogers’ writings and nurse helps the client identify the changes and the conveys the unpredictable continuous ﬂow of pat- direction of change the client desires to make. Rogers client mutually explore choices and options and (1970) explained that the “organization of the liv- identify barriers preventing change, strategies, and ing system is maintained amidst kaleidoscopic al- resources to overcome barriers; the nurse facilitates terations in the patterning of system” (p. For example, asking the questions, “What Life Events is used in conjunction with the do you want? A pattern A wide range of voluntary mutual patterning proﬁle describing the essence of the client’s experi- strategies may be used to enhance knowing par- ences, perceptions, and expressions related to the ticipation in change, including meaningful dia- turbulent life event is constructed and shared with logue, dance/movement/motion, sound, light, the client. Cultivating purpose involves assist- ing clients in identifying goals and developing an Theory of Kaleidoscoping action system. The action system is comprised of in Life’s Turbulence patterning strategies designed to promote harmony Butcher’s (1993) Theory of Kaleidoscoping in Life’s amid adversity and facilitate the actualization of Turbulence was derived from Rogers’ Science of the potential for well-being. Unitary Human Beings, chaos theory (Briggs & In moments of turbulence, clients may want to Peat, 1989; Peat, 1991), and Csikszentmihalyi’s increase their awareness of the complexity of the (1990) Theory of Flow. Creative suspension is a technique that well-being and harmony amid turbulent life events. Guided imagery is human/environmental field characterized by a useful strategy for facilitating creative suspension chaotic and unpredictable change. Any crisis may because it potentially enhances the client’s ability to be viewed as a turbulent event in the life process. Forging the uncertainty of a medical diagnosis, marital dis- resolve is assisting the clients in becoming involved cord, or loss of a loved one. Flow experiences • Love themselves, promote harmonious human/environmental ﬁeld • Identify concerns, patterns. There are a wide range of ﬂow experiences • Give themselves goals, that can be incorporated into the daily activities: • Have conﬁdence and help themselves, and art, music, exercise, reading, gardening, meditation, • Take positive action. The art of kaleidoscoping with turbulence is a mutual creative expression of Research beauty and grace and is a way of enhancing perse- verance through difﬁcult times. As new practice model has been used by the Personalized Nursing theories and health patterning modalities evolve Corporation, an independent, nurse-owned, nurse- from the Science of Unitary Human Beings, there managed company providing outreach nursing remains a need to test the viability and usefulness care to high-risk and active drug users in Detroit, of Rogerian theories and voluntary health pattern- Michigan. With been reviewed in a number of publications a higher sense of well-being, clients are less likely to (Caroselli & Barrett, 1998; Dykeman & Loukissa, continue to engage in high-risk drug-related be- 1993; Fawcett, 2000; Fawcett & Alligood, 2003; haviors. Drug-addicted behaviors are postulated to Malinski, 1986; Phillips, 1989b; Watson, Barrett, be a painful means to experience an awareness of Hastings-Tolsma, Johnson, & Gueldner, 1997). During the pattern manifestation Rather than repeat the reviews of Rogerian re- knowing and appreciation process, clients are asked search, the following section describes current to name a painful experience, are encouraged to “be methodological trends within the Science of in the moment” in a safe place with the experi- Unitary Human Beings to assist researchers inter- ence/feeling, are asked to identify the choices they ested in Rogerian science in making methodologi- usually make during the painful experience, and are cal decisions. Nursing re- Barrett and Caroselli (1998), Barrett, Cowling, search must be grounded in a theoretical per- Carboni, and Butcher (1997), Cowling (1986), spective unique to nursing in order for the Smith & Reeder (1996), and Rawnsley (1994) have research to contribute to the advance of nursing all advocated for the appropriateness of multiple science. Irreducible human/environmental energy ﬁelds sistent with Rogers’ unitary ontology and participa- are the focus of Rogerian inquiry: Energy ﬁelds tory epistemology. Later, Fawcett (1996) also are postulated to constitute the fundamental questioned the congruency between the ontology unit of the living and nonliving. Both human and epistemology of Rogerian science and the as- beings and the environment are understood as sumptions embedded in quantitative research de- dynamic energy ﬁelds that cannot be reduced to signs; like Carboni (1995) and Butcher (1994), she parts. Pattern manifestations are indicators of change: may be more congruent with Rogers’ ontology and Pattern is the distinguishing characteristic of an epistemology. This chapter presents an inclusive view of Pattern manifestations are the source of infor- methodologies. Nevertheless, the researcher needs mation emerging from the human/environmen- to present an argument as to how the design of the tal mutual ﬁeld process and are the only valid study and interpretations of results are congruent reﬂections of the energy ﬁeld. Further- of concern in Rogerian inquiry is conceptualized more, nurses interested in engaging in Rogerian and understood as manifestations of human/ research are encouraged to use, test, and reﬁne the environmental energy mutual process. Pandimensional awareness: Rogerian inquiry sistent with the ontology and epistemology of the recognizes the pandimensional nature of reality. Human instrument is used for pattern knowing and modification of the Criteria of Rogerian and appreciation: The researchers use themselves Inquiry developed by Butcher (1994) and the as the primary pattern-apprehending instru- Characteristics of Operational Rogerian Inquiry ment. The criteria may be ment sensitive to, and which has the ability to a useful guide in designing research investigations interpret and understand, pandimensional po- guided by the Science of Unitary Human Beings. A priori nursing science: All research ﬂows from a appreciation is the process of apprehending in- theoretical perspective. Every step of the inquiry, formation or manifestations of patterning including the type of questions asked, the con- emerging from the human/environmental ﬁeld ceptualization of phenomena of concern, choice mutual process. The process of pattern knowing of research design, selection of participants, se- and appreciation is the same in the research en- lection of instruments, and interpretation of deavor as described earlier in the Rogerian prac- ﬁndings is guided by the science of unitary tice methodology. It is important to note that because of the aware of dynamic unpredictability and contin- incongruency between ontology and episte- uous change and is open to the idea that pat- mology of Rogerian science with assumptions terns in the inquiry process may change in the in quantitative designs, Carboni (1995b) ar- course of the study that may not have been en- gues that the researcher must select qualitative visioned in advance. It is essential that the researcher docu- ods with Rogerian science and argue that the ment and report any design changes. Pattern synthesis: Rogerian science emphasizes hence, both qualitative and quantitative meth- synthesis rather than analysis. The separation of parts is not consistent ence is reﬂected in the nature of questions with Rogers’ notion of integrality and irre- asked and their theoretical conceptualization ducible wholes. However, qualitative designs, the whole emerging from the human/environ- particularly those that have been derived from mental mutual ﬁeld process. Synthesis allows the postulates and principles of the science for creating and viewing a coherent whole. Shared description and shared understanding: the natural settings where the phenomenon of Mutual process is enhanced by including par- inquiry occurs naturally, because the human ticipants in the process of inquiry where possi- ﬁeld is inseparable and in mutual process with ble. Any “manipulation” of participants in the study enhances shared “variables” is inconsistent with mutual process, awareness, understanding, and knowing par- unpredictability, and irreducibility. The researcher and the researcher-into are inte- are the best judges of the authenticity and va- gral: The principle of integrality implies that lidity of their own experiences, perceptions, the researcher is inseparable and in mutual and expressions. Participatory action designs process with the environment and the partici- and focus groups conceptualized within pants in the study.
His teaching specialisms include popular religion in Reformation Europe order acarbose 25mg without a prescription blood glucose 99, crime and society in early modern England buy acarbose toronto diabetes insipidus after surgery, landscape history and the history of European witchcraft discount acarbose on line diabetes prevention activities, and custom and community in nineteenth-century England. Since 2004 he has been a Research Associate at Professor Il-Moo Chang’s laboratory, Natural Products Research Institute, Seoul National University. He is Research Associate at Professor Il-Moo Chang’s laboratory, Seoul National University and is an expert on Sasang Oriental Medicine, which is a unique theory of traditional medicine. She has worked since 1995 as a consultant in the field of African traditional medicines conserva- tion, industrial development and application in formal healthcare. As an honorary research associate in the Department of Botany, University of Cape Town, she publishes regularly on aspects of traditional medicine research. Contributors | xiii Haruki Yamada PhD Haruki Yamada is the Director and a Professor at the Kitasato Institute for Life Sciences, and the Dean of the Graduate School of Infection Control Science, Kitasato University in Japan. He is well known in the field of the scientific elucidation of Kampo medicines, and the bioactive polysaccharides from medicinal herbs. The practitioners include traditional midwives (parteras), herbalists (herbalistos), bone-setters (hueseros) and spiritual healers (curanderos or prayers). Countries in Africa, Asia and Latin America use traditional medicine to help meet some of their primary healthcare needs. In Africa, up to 80% of the population use traditional medicine for primary healthcare. Over one-third of the population in developing countries lack access to essential medicines. The provision of safe and effective traditional medicine therapies could become a critical tool to increase access to healthcare. In this book the term ‘traditional medicine’ is used to describe: Health traditions originating in a particular geographic area or ethnic group and which may also have been adopted and/or modified by communities elsewhere. Disciplines such as aromatherapy, medical herbalism, homoeopathy and others, usually known collectively as complementary and alternative medicine, are described in detail in a companion volume. The distinction between traditional medicine and what is known as folk medicine is not clear cut and the terms are often used interchangeably. Folk medicine may be defined as ‘treatment of ailments outside clinical medicine by remedies and simple measures based on experience and knowledge handed down from generation to generation’. Another simpler definition is ‘the use of home remedies and procedures as handed down by tradition’. In traditional medicine there is usually a formal consultation with a practitioner or healer and such practices may be integrated into a country’s healthcare system, while in folk medicine advice is passed on more informally by a knowledgeable family member or friend and there is generally no such inte- gration. Thus, acupuncture may be considered as being traditional medicine while the use of chicken soup – ‘Jewish penicillin’ – to manage poor health is folk medicine (see Chapter 11). The role of medicines in traditional communities The study of traditional medicines and their manufacture has much to offer to sociocultural studies of many medical systems. Medicines constitute a meeting point of almost any imaginable human interest: material, social, political and emotional. In the context of the family, buying a medicine for a relative can emit a message of love and care. Within a religious context medicines may be seen as gifts to the ailing commu- nity from holy leaders. However, the ability of governments in the developing world to imple- ment the opportunities offered by traditional medicine is, in many instances, beyond their capability. The International Conference on Primary Health Care, meeting in Alma- Ata on 12 September 1978, declared a need for urgent action by all govern- ments, all health and development workers, and the world community to protect and promote the health of all the people of the world. Although traditional medicine has been used for thousands of years and the associated practitioners have made great contributions to human health, it was not until the Alma-Ata Declaration that countries and governments were called upon to include traditional medicine in their primary health systems for the first time, and to recognise the associated practitioners of traditional medicine as a part of the healthcare team, particularly for primary healthcare at the community level. In 2003, the 56th World Health Assembly called on countries to adopt and implement the Strategy. Traditional medicine in practice The following two examples will serve to illustrate studies on the practice of traditional medicine. The first study aimed to highlight the new or lesser known medicinal uses of plant bioresources along with validation of tradi- tional knowledge that is widely used by the tribal communities to cure four common ailments in the Lahaul-Spiti region of western Himalaya. During the ethnobotanical explorations (2002–6), observations on the most common ailments, such as rheumatism, stomach problems, liver and sexual disorders, among the natives of Lahaul-Spiti were recorded. Due to strong belief in the traditional system of medicine, people still prefer to use herbal medicines prescribed by local healers. A total of 58 plant species belonging to 45 genera and 24 families, have been reported from the study area to cure these diseases. Maximum use of plants is reported to cure stomach disorders (29), followed by rheumatism (18), liver problems (15) and sexual ailments (9). Among the plant parts used, leaves were found most widely in herbal preparations (20), followed by flowers (12) and roots (11), respectively. Most of these formula- tions were prescribed in powder form, although juice and decoction forms were also used. Plants with more than one therapeutic use were represented by 24 species; however, 34 species have been reported to be used against a single specific ailment. Validation of observations revealed 38 lesser known or new herbal preparations from 34 plant species, where 15 species were used to cure stomach disorders, 7 for rheumatism, 10 for liver disorders and 6 for sexual problems. Mode of preparation, administration and dosage are discussed along with the family and local names of plants and plant parts used. The questions related to such areas as type and frequency of herbal medicine intake, concomitant herb–pharmaceutical drug use (including herb–antiretroviral drug cotherapy) 6 |Traditional medicine and the perceived effectiveness of herbal medicine. Patterns of traditional herbal medicine use were quite similar between those on antiretroviral therapy and those who received supportive therapy only. When many people from developing countries of the world emigrate, they continue to seek medical advice from traditional practitioners working in their own communities, even in countries where all citizens have free access to good-quality western medicine. It is not surprising that they turn to their own healers, who emigrated before them and practise healthcare much the same as they did in their home countries. Although the main reasons for this are probably cultural and linguistic, the role of mistrust and fear should also be acknowledged. Despite gaining skills that help immigrants improve their socio- economic status and overcome barriers to the mainstream host healthcare system, their health status may still decline as acculturation increases. Thus, increased access to professional medical care may not improve the health of migrants if it comes with the loss of traditional medical knowledge. The ethnic medical systems embrace philosophies very different to those of the west. They are derived from a sensitive awareness of the laws of nature and the order of the universe. Practised according to traditional methods, their aim is to maintain health as well as to restore it. The ideas are complex and require much study to grasp their significance and the nuances of practice. Traditional medical systems are challenging because their theories and practices strike many conventionally trained physicians and researchers as incomprehensible. Should modern medicine dismiss them as unscientific, view them as sources of alternatives hidden in a matrix of superstition or regard them as complementary sciences of medicine?