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Does psychological testing help to predict the response to acupuncture or massage/relaxation therapy in patients presenting to a general neurology clinic with headache? An open study comparing manual therapy with the use of cold packs in the treatment of posttraumatic headache Cephalalgia 1990; 10: 241–50 82 cheap 600 mg zyvox overnight delivery bacteria 365 days plague inc. Use of complementary and alternative treatments by individuals with fibromyalgia syndrome cheap 600 mg zyvox with amex infection rate calculation. The use of vibrotherapy to prevent suppurative- inflammatory complications in mandibular fractures. External stimuli in the form of vibratory massage after heart or lung transplantation. The clinical evaluation of conservative treatment in patients with the thoracic outlet syndrome. The efficacy of psychosocial approaches to behavior disorders in dementia: a systematic literature review. Therapeutic benefit of touch-massage in the overall management of demented elderly. Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review Complement Ther Med 2000; 8:97–105 100. Use of alternative health therapies by people with multiple sclerosis: an exploratory study. Am J Forensic Med Pathol 1999; 20:354–6 6 Acupuncture and traditional Chinese medicine Yuan-Chi Lin Complementary Therapies in Neurology: An Evidence-Based Approach Edited by Barry S. Oken ISBN 1-84214-200-3 Copyright © 2004 by The Parthenon Publishing Group, London INTRODUCTION The history of traditional Chinese medicine and acupuncture can be traced back 2000 to 3000 years. In Shi Jing (Book of Poems), a collection of verse compiled in the 12th century BC, a number of herbs are mentioned. In Shy Ji (Records of Historian) written 104–91 BC, it is recounted that the technique of pulse taking and acupuncture was developed. Acupuncture is one of the treatment modalities within comprehensive traditional Chinese medicine. Needles of flint, bamboo and bone from the Neolithic period suggest that acupuncture existed long before the discovery of metal. The acupuncture treatment is performed by inserting special hair-thin needles into the skin at specific sites, known as acupuncture points, for desired therapeutic and preventive purposes. Acupuncture can be effective in the treatment of mental as well as physical illnesses. Moxibustion, the burning of moxa (Artemisia vulgaris) over the acupuncture points, can also be used for the treatment of various illnesses. There were other situations, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome and asthma, in which acupuncture may be useful as an adjunct or an acceptable alternative treatment, or one that might be included in a comprehensive management program. This chapter provides a practical and theoretical Acupuncture and traditional Chinese medicine 135 understanding of traditional Chinese medicine and acupuncture, emphasizing its efficacy in various neurological diseases. The training and licensing requirements for acupuncturists and potential risks of acupuncture are also addressed. TRADITIONAL CHINESE MEDICINE The use of traditional Chinese medicine and acupuncture can be traced back to Neolithic times. Archeological vestiges exist which testify to the antiquity of its practice, although the practice was first passed on as an oral tradition. This work was composed as a dialogue between the Yellow Emperor and his minister, Chi-Po. There are two depictions of sessions within the text, Su Wen (Common Questions) and Ling Shu (Direction of Soul/Spirit). Within traditional Chinese medicine, sharp distinctions are not made between the physical, psychological and synthetic. This contrasts with Western biomedical science, which tends to be reductionistic in its attempts to trace a linear cause-and-effect chain of events to a single identifiable etiology. In the traditional Chinese medicine framework, illness is understood as an overall pattern of a multiple of physical, psychological and environmental factors. The theoretical basis of traditional Chinese medicine stems from a system of metaphysics that focuses on the balance between two opposing forces: Yin and Yang. They can transform into each other, and are natural phenomena that also exist within the body. Yin is present in the qualities of cold, rest, passivity, dark, inward, decrease and female.

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Factors pharmacological response; problems of absorption are such as sex cheap zyvox 600mg antimicrobial lock solutions, age zyvox 600mg with mastercard infection jobs indeed, edema, pregnancy, and body fat can in- circumvented because the entire quantity of drug enters fluence the volume of these various compartments. The pharmacokinetic concept of vol- A serious disadvantage of intravenous drug admin- ume of distribution (a derived parameter that relates istration becomes clearly apparent when an overdose the amount of drug in the body to the plasma concen- is inadvertently given: Neither can the drug be re- tration) is discussed more fully in Chapter 5. Other disadvan- tages include the possibilities of embolism (particu- larly if an insoluble drug is given), introduction of BINDING OF DRUGS TO PLASMA bacteria, and when this route is used for prolonged pe- PROTEINS riods, subcutaneous tissue infiltration. The possible in- troduction of the human immunodeficiency virus Most drugs found in the vascular compartment are (HIV) is a well-known consequence of intravenous bound reversibly with one or more of the macromole- drug administration in addicts who use contaminated cules in plasma. Many highly al- ion and in dynamic equilibrium, according to the law of bumin-bound drugs are poorly soluble in water, and for mass action. Since only the unbound (or free) drug dif- such drugs, binding to hydrophobic sites on albumin is fuses through the capillary walls, extensive binding may often important. The magnitude of of an acidic drug are bound per albumin molecule, this decrease is directly proportional to the fraction of whereas basic, positively charged drugs are more drug bound to plasma protein. As drug nonspecific; that is, many drugs may interact with the dosage increases, eventually the binding capacity of the same binding site. A drug with a higher affinity may dis- protein becomes saturated and any additional drug will place a drug with weaker affinity. However, in practice, changes in protein bind- culation, thereby slowing the rate of transfer across the ing result in clinically significant effects for only a lim- capillary. Thus, binding poalbuminemia, uremia, hyperbilirubinemia) have been does not prevent the drug from reaching its site of ac- associated with changes in plasma protein binding of tion but only retards the rate at which this occurs. For example, in uremic patients the plasma pro- Extensive plasma protein binding may prolong drug tein binding of certain acidic drugs (e. Drugs that are Lipoproteins highly bound to plasma proteins may distribute less widely because they remain trapped in the peripheral vas- Drugs that bind to lipoproteins do so by dissolving in culature, since the plasma proteins themselves cannot tra- the lipid portion of the lipoprotein core. The binding 30 I GENERAL PRINCIPLES OF PHARMACOLOGY capacity of individual lipoproteins generally depends (e. The lung receives the entire cardiac out- the drug first binding to a number of sites on the protein put; therefore, drug distribution into it is very moiety and then dissolving in the lipid phase. However, some nonbasic psychotherapeutic drugs chlorpromazine, imipramine, amines, such as the herbicide paraquat, also spiroperidol, and nortriptyline, is becoming apparent. Although bone is a relatively inert tissue, certain physiological and pathological conditions, such it can accumulate such substances as tetracy- as injury, stress, surgery, trauma, rheumatoid arthritis, clines, lead, strontium, and the antitumor agent and celiac disease. These substances may accumulate in bone by absorption onto the bone crystal sur- face and eventually be incorporated into the crystal lattice. Tetracycline deposition during SELECTIVE ACCUMULATION OF DRUGS odontogenesis may lead to a permanent yel- Drugs will not always be uniformly distributed to and low-brown discoloration of teeth, dysplasia, retained by body tissues. Lead can substi- drugs will be either considerably higher or considerably tute for calcium in the bone crystal lattice, re- lower in particular tissues than could be predicted on sulting in bone brittleness. This obser- reservoir for the slow release of toxic sub- vation is demonstrated in the following examples: stances, such as lead and cisplatin. Since the kidneys receive 20 to 25% of the cardiac output, they will be exposed to a rel- PHYSIOLOGICAL BARRIERS TO DRUG atively large amount of any systemically admin- DISTRIBUTION istered drug. The kidney also contains a protein, metallothionein, that has a high affinity for Blood-Brain Barrier metals. Several drugs have an affinity for the reti- cells is much less permeable to water-soluble drugs than nal pigment melanin and thus may accumulate is the membrane between plasma and other tissues. Chlorpromazine and other phe- Thus, the transfer of drugs into the brain is regulated by nothiazines bind to melanin and accumulate in the blood-brain barrier. To gain access to the brain from the uveal tract, where they may cause retino- the capillary circulation, drugs must pass through cells toxicity. Only drugs that have a high can be approximately 100 times that found in lipid–water partition coefficient can penetrate the the liver. Drugs with extremely high lipid–water Drugs that are partially ionized and only moderately partition coefficients have a tendency to accu- lipid soluble will penetrate at considerably slower rates.

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Left Right Both Pleaseanswer thefollowing questionsregarding theshoulder for whichyouhavebeen evaluated or treated discount zyvox 600 mg on-line virus 4 year old dies. Considering all the ways that your shoulder affects you order zyvox 600mg amex antibiotics for dogs lyme disease, mark X on the scale below for how well you are doing Very poorly _______________________________________________ Very well The following questions refer to pain. During the past month, how would you describe the usual pain in your shoulder at rest? During the past month, how would you describe the usual pain in your shoulder during activities? During the past month, how often did the pain in your shoulder make it difficult for you to sleep at night? A) Every day B) Several days per week C) One day per week D) Less than 1day per week E) Never 5. A) Every day B) Several days per week C) One day per week D) Less than 1day per week E) Never a 19. Considering all the ways you use your shoulder during daily personal and household activities (i. A) Very severe limitation; unable B) Severe limitation C) Moderate limitation D) Mild limitation E) No limitation Questions 7±11: During the past month, how much difficulty have you had in each of the following activities due to your shoulder? A) Unable B) Severe difficulty C) Moderate difficulty D) Mild difficulty E) No difficulty 8. Combing or brushing A) Unable B) Severe difficulty C) Moderate difficulty D) Mild difficulty E) No difficulty 9. Reaching shelves that are above your head A) Unable B) Severe difficulty C) Moderate difficulty D) Mild difficulty E) No difficulty 10. Scratching or washing your lower back with your hand A) Unable B) Severe difficulty C) Moderate difficulty D) Mild difficulty E) No difficulty 11. A) Unable B) Severe difficulty C) Moderate difficulty D) Mild difficulty E) No difficulty 256 19 Scores Table 22 (continued) The following questions refer to recreational or athletic activities. Considering all the ways you use your shoulder during recreational or athletic activities (i. A) Very severe limitation; unable B) Severe limitation C) Moderate limitation D) Mild limitation E) No limitation 13. During the past month, how much difficulty have you had throwing a ball overhand or serving in tennis due to your shoulder? A) Unable B) Severe difficulty C) Moderate difficulty D) Mild difficulty E) No difficulty 14. List one activity (recreational or athletic) that you particularly enjoy and then select the degree of limitation you have, if any, due to your shoulder. Activity _________________ A) Unable B) Severe limitation C) Moderate limitation D) Mild limitation E) No limitation The following questions refer to work. A) Paid work (list type) _______________ B) Housework C) Schoolwork D) Unemployed E) Disabled due to your shoulder F) Disabled secondary to other causes G) Retired If you answered D, E, F, or G to the above question, please skip questions 16±19 and go on to question 20. During the past month, how often were you unable to do any of your usual work because of your shoulder? A) All days B) Several days per week C) One day per week D) Less than 1day per week E) Never 17. During the past month, on the days that you did work, how often were you unable to do your work as carefully or as efficiently as you would like because of your shoulder? A) All days B) Several days per week C) One day per week D) Less than 1day per week E) Never 18. During the past month, on the days that you did work, how often did you ha- ve to work a shorter day because of your shoulder? A) All days B) Several days per week C) One day per week D) Less than 1day per week E) Never 19. During the past month, on the days that you did work, how often did you ha- ve to change the way that your usual work is done because of your shoulder? A) All days B) Several days per week C) One day per week D) Less than 1day per week E) Never The following questions refer to satisfaction and areas for improvement. During the past month, how would you rate your overall degree of satisfacti- on with your shoulder?

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Symptoms often associated sessive-compulsive disorder buy 600 mg zyvox with mastercard antibiotics and dairy, and several phobias effective zyvox 600mg antibiotics qid, in- with acute alcohol intoxication include increase in self- cluding agoraphobia. Because the SSRIs are less toxic confidence, loss of inhibitions, euphoria, and loss of judg- than the tricyclic antidepressants, their use in the treat- ment. With increasing doses motor and intellectual im- ment of anxiety is safer and less likely to produce seri- pairment become prominent. A 21-year-old man is a full-time college student would relieve his symptoms without making him who also works 25 hours per week. He (A) Alprazolam says he is tired most of the time and has trouble (B) Zephalon concentrating on his studies. Which of the following (C) Chloral hydrate drugs would be the most appropriate initial phar- (D) Propranolol macologic treatment for his anxiety? Zolpidem is effective at relieving sleep-onset in- usually takes her 2 or more hours to fall asleep at somnia. Which of the following drugs would help re- sleep, although each would be expected to produce lieve her sleep disturbance while being least disrup- more disruption of sleep rhythm than would zolpi- tive to REM sleep? Midazolam, like all benzodiazepines given in (B) Chloral hydrate sufficient dose, has the capacity to produce antero- (C) Zolpidem grade amnesia. It is also available in an injectable (D) Amobarbital form and frequently is used as an anesthetic agent (E) Hydroxyzine during short procedures. Chlordiazepoxide, through its metabolites, has a colonoscopy that will take approximately 20 min- relatively long biological half-life. Which of the following drugs would be most many of the severe symptoms of acute alcohol with- likely to produce the desired anesthesia and antero- drawal. The other agents have (A) Buspirone sedative properties and could potentially suppress (B) Zephalon alcohol withdrawal but each has a much shorter bi- (C) Midazolam ological half-life than chlordiazepoxide. As a -adrenoceptor blocker, propranolol can (E) Hydroxyzine relieve many of the symptoms of stage fright. A 33-year-old woman has a 15-year history of alco- this use it can be taken once a few hours before the hol abuse. Which of SUPPLEMENTAL READING the following drugs would most effectively and safely Yuan R, Flockhart DA, and Balian JD. Anxiety disorders: A re- accompany his stage fright were so intense that he view of tricyclic antidepressants and selective sero- was unable to complete his presentation. She re- to sleep well is probably the result of anxiety caused ports that although she is exhausted at bedtime, she by several stresses in her life. She is a recent college typically cannot fall asleep for at least an hour or graduate, has a new job, and has moved to a new two. The sleep loss and her supervisors think she is “dumb” because she has anxiety are usually of relatively short duration. After falling to sleep, Zolpidem has a quick onset and a half-life of ap- she sometimes wakes an hour or more before her proximately 2. If taken at bedtime, it should alarm goes off, usually thinking about her dumb allow her to fall asleep quickly and sleep though mistakes. Its elimination is fast proximately 5 months ago, when she was studying enough that it should not produce residual drowsi- for final examinations in her senior year of college. Sonsalla DRUG LIST GENERIC NAME PAGE GENERIC NAME PAGE Amantadine 370 Pergolide 369 Benztropine 370 Pramipexole 369 Biperiden 370 Procyclidine 370 Bromocriptine 369 Rivastigmine 371 Carbidopa 368 Ropinirole 369 Donepezil 371 Selegiline 369 Entacapone 370 Tacrine 371 Galanthamine 371 Tolcapone 370 Levodopa 367 Trihexyphenidyl 370 Neurodegenerative diseases are a group of disor- normal movements resulting from the loss of a specific ders characterized by neuronal loss and generally an ac- subset of striatal neurons; (4) amyotrophic lateral scle- cumulation of insoluble intracellular or extracellular rosis (ALS), in which progressive weakness and muscle material in certain brain regions. Most neurodegenera- atrophy are due to degeneration of spinal, bulbar, and tive disorders are of unknown etiology, affect the eld- cortical neurons. How- forms of these disorders; however, most are sporadic oc- ever, drugs used in the treatment of neurodegenerative currences (idiopathic) with genetic predisposition, envi- disorders only treat symptoms and do not cure or alter ronmental factors, and aging contributing as risk factors. It generally affects the elderly scribed as jerky resistance that has been likened to the and is estimated to afflict more than 1% of individuals movement of a cogwheel (cogwheel rigidity), is also an over the age of 65. Bradykinesia, an ial forms of parkinsonism with an autosomal dominant extreme slowness of movement, is the most disabling pattern of inheritance. These genes encode kinesia results in a typical stooped posture when the for -synuclein, a protein found in abundance in vesi- person is standing or walking and a characteristic cles and synaptic regions, and for parkin and ubiquitin shuffling gait marked by the absence of normal arm- carboxy-terminal hydroxylase, both of which are in- swinging movements.

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