Nabilone — Clinical Experience at the James Paget Hospital

The dose per capsule is 1 mg but we found that this could be excessive for some patients. Therefore, some were started at 0.25 mg by opening the capsule and dividing the resultant powder into four. The initial time for nabilone use has been at night to reduce the potential discomfort of any side effects. Once the patient’s confidence has been developed, the dosage has been increased where appropriate. Those patients who have benefited from nabilone have been through a period of discontinuation to help evaluate the benefits of this drug. The age range of the 43 patients who have used nabilone is from 25–82 years with 75% between the ages of 30 and 50. More women than men were treated, mainly reflecting a large sex difference in the group with multiple sclerosis. The diagnoses of the patients were categorised into 6 groups as the most convenient method of presenting the information from such an heterogeneous group. No attempt has been made to do anything more than describe the effects of using nabilone on each individual patient and thereby evaluate whether it might be of value in pain control. Multiple Sclerosis Multiple Sclerosis is characterised by widespread and varied damage to the central nervous Read more […]

Citrus in Traditional Medicine

Citrus in traditional Asiatic medicine In a comparative study of the use of herbal drugs in the traditional medicines of India and Europe, Pun () found a marked similarity between the drugs used in the two continents. He attributed this not only to the similarity of the vegetation in the two areas, but also to the influence that traditional Indian medicine, in particular the Atherveda, one of the most ancient repositories of human knowledge, had on Egypt, Greece and Rome. He listed the principal uses of a small number of these drugs, including bitter orange peel, which in India is used as an aromatic, stomachic, tonic, astringent and carminative agent, and lemon, which is used as a flavouring and for its carminative and stomachic effects. In the Valmiki-Ramayana, written after the Vedas and one of the most sacred of all religious books which enumerates the virtues of the medicinal plants that Lord Rama (Vishnu) met during his fourteen-year journey around different parts of India, Karnick and Hocking () identified and listed fifty of these drugs with their use as described in the Ayurvedica (or native Indian) system of medicine. The immature fruit of Citrus aurantifolia (Christm) Swingle was used as an fortifier, Read more […]

Sweet Violet (Viola Odorata)

Family: Violaceae Part used: aerial parts There are over 90 Viola species in Europe. The Flora of Turkey gives 20 Viola species, including Viola odorata and Viola tricolor. Viola odorata L. is a low-growing perennial with a stout rootstock found in hedgerows, rough land and margins of woodlands. It is native to Europe south of the Alps and west into France, but has naturalized in more northern areas because of widespread cultivation. The stalked leaves arise in a rosette from the sturdy rootstock and are heart-shaped and hairy with an oval stipule. The fragrant, five-petalled dark violet or white flowers occur in spring and it may flower again in early autumn. The leafless flower stalks curve sharply so that the flower hangs down. The lowest petal has a prominent nectar-filled spur and the five sepals have basal appendages. The small seeds form in a three-valved capsule and it also spreads by long creeping stolons. Other species used Parma violets are cultivated for cut flowers and for their fragrance. The leaves are shiny green and the flowers are double. A study of six specimens cultivated in France and 31 wild Viola species found that Parma violets are cultivars of Viola alba. Parma violets are tender and Read more […]

Sweet Violet: Echoes, Changes And Additions

With the medieval herbals there are echoes, changes and additions. Macer writes of ‘vyolet’ as cold in the first degree, moist in the second; how it is good for sore, swollen or ‘blasted’ eyes, the root being stamped with myrrh and saffron – no distinction here between the purple and the yellow; for head wounds a plaster of the leaves stamped with honey and vinegar – is this a version of ‘when the head burns’?; and as a foot bath and a binding for the temples for poor sleep due to sickness, ‘and ye shall sleep well by the Grace of God’. The Old English Herbarium carries two uses: for fresh or old wounds (not just the head this time), swellings and calluses, the leaves are applied with lard. Then violet’s use for constipation is introduced; take the flowers mixed with honey and soaked in very good wine to relieve the constipation. Hildegard records a number of uses. She begins with use of the oil for the eyes, against fogginess of the eyes. She gives a recipe for this oil ‘take good oil and make it boil in a new pot, either in the sun or over a fire. When it boils, put violets in so that it becomes thickened. Put this in a glass vessel and save it. At night put this unguent around the eyelids and eyes. Although it Read more […]

Sweet Violet: More Modern Application And Cancer

The plant does not appear in Cook or Ellingwood in the USA. The National Botanic Pharmacopoeia summarizes the view in the early part of the 20th century. Inflammation of the eyes, sleeplessness, pleurisy, jaundice and quinsy ‘are but a few of the ailments for which it was held potent’. The general assessment in this herbal is not encouraging; ‘it is still found in the pharmacopoeias though many of the virtues ascribed to it in the Middle Ages have not stood the test of time and greater experience’. This might be a rather severe judgement, particularly given the narrow range of application mode and lack of emphasis or perhaps sufficient appreciation of its broader cooling properties within its earlier context. Its reputation as an anti cancer herb is explored in Potter’s Bulletin of May 1902, cited by the National Botanic Pharmacopoeia, recording the case of a 67-year-old lady whose malignant throat tumour was cleared in 14 days on use of this herb. They suggest a handful of fresh green violet leaves infused in 1 pint of boiling water covered for 12 hours; this is strained and warmed; then a piece of lint, soaked in this infusion, is placed ‘where the malady is’, covered with oilskin or flannel and changed when dry or Read more […]

Chronic Pelvic Pain

Chronic pelvic pain (CPP) is defined as pelvic pain lasting more than 6 months. Some authors add the additional criteria that the pain be noncyclic. It is one of the most common presenting complaints in gynecologic practice, affecting as many as one in seven American women. Chronic pelvic pain comprises up to 10% of outpatient gynecologic visits, accounts for 20% of laparoscopies, and results in 12% (75,000 / year) of all hysterectomies performed annually in the United States. Estimated annual direct medical costs for outpatient visits for chronic pelvic pain in the United States among women 18 to 50 years old is estimated to be $881.5 million. It is often an extremely frustrating condition for both patient and care provider because in many cases an etiology cannot be identified and there is no apparent pathology. Treatment of presumed underlying conditions is frequently ineffective, and the “pain itself becomes the illness.” Because the cause often cannot be identified, chronic pelvic pain is frequently attributed to psychogenic causes. Although these may play a role in chronic pelvic pain for some women with lack of an identifiable cause, this does not necessarily equate with a psychosomatic origin for this complaint. Common Read more […]

Chronic Pelvic Pain: Additional Therapies

Muscle Relaxation and Re-education, Biofeedback, and Electrical Stimulation Muscle tension in the pelvis, hips, and lower back may be caused by, or lead to CPP. Helping a woman to identify and relax tension, become aware of and adjust her body mechanics and standing and sitting posture, and wear appropriate shoes to minimize postural problems can help to reduce pain caused by structural imbalances. Pelvic relaxation training techniques should be taught and practiced regularly. Much of this can be done at home, but physical therapy can be helpful if there is limited joint movement or muscular problems. Prolonged sitting or standing can aggravate CPP, so patients may need suggestions and supportive counseling for modifying jobs or activities that require positions that exacerbate the problem. Exercises such as running or high-impact aerobics also may be aggravating, and should be replaced with gentler, relaxing forms of exercise, for example, walking, tai chi, yoga, or dance. Physical therapy for the treatment of musculoskeletal problems or postural problems can be beneficial for women with CPP. Biofeedback machines can be effective in helping women to identify and improve the effectiveness of pelvic muscle relaxation Read more […]

Nervous Affections

There are writers other than Grieve who consider mugwort a nervine. Ibn Sina records the benefit of artemisia in headache due to a cold cause and in nasal catarrh while the Salernitan herbal, reflecting Arabic influences, recommends a hot opiate taken with a decoction of artemisia for migraine. Bauhin cites the empiric Wirtemberg, who guarantees relieving within an hour a headache due to cold by washing the head with a decoction of mugwort in wine, then laying on the hot leaves. This is a version of a cure for migraine from Arnold de Villanova, Bauhin points out, mentioning also that mugwort in wine or lavender water can be used in cases of paralysis. Other uses in Bauhin’s day include inducing sleep, treating scabs on the head, clearing jaundice and preventing dropsy, and reversing prolapse of the anus. In this last case, the anus is first fumigated with myrrh Commiphora molmol and colophonia before a hot poultice of mugwort cooked in red wine is applied. Quincy classifies uterine medicines under nervous simples, where these ‘hysterics’ must be differentiated from carminatives and from cephalics and cordials, now under one heading for ‘what is cordial must be cephalic as the head hath a principal share in agreeable Read more […]

Ricinus communis

Ricinus communis L. (Euphorbiaceae) Castor Oil Plant, Castor Bean Ricinus communis L. is an erect herb, growing up to 3.6 m high, having pinkish succulent stem and large alternate palmate leaves that are green or reddish brown. Leaves are lobed, consisting of 6-8 radiating leaflets with serrated edges and prominent central veins. Flowers are green, pink or red and inconspicuous, with no petals. The fruits are capsular, with three lobes, prickly and green, containing three seeds. Origin Native to Africa, naturalised throughout tropics and subtropics. Phytoconstituents Ricin, ricinoleic acid, ricinine, p-coumaric acid, ferulic acid, o-coumaric acids, syringic acid, cinnamic acids, stigmasterol, fucosterol and others. Traditional Medicinal Uses Its leaf poultice is applied to boils and sores in India; to treat headaches and fever in Hawaii. The leaves and roots are used in a decoction for anal prolapse, arthritis, constipation, facial palsy, lymphadenopathy, strabismus, uteral prolapse, cough, and also as a discutient and expectorant. The heated leaves are applied to gout and swellings as well. The leaves and oil are used for dermatological purposes in Nigeria. Its seeds are used to treat abscesses and skin eruptions, Read more […]

Arctium lappa

Family: Asteraceae Part used: root, seed, leaf Arctium lappa L. is a robust biennial, found throughout Europe on roadsides, verges and scrub land. The Flora of Turkey gives three Arctium species, not including Arctium lappa but including Arctium minus. Stout, downy, striated, branched stems (to 1 m) bear alternate, entire leaves which are large (to 50 cm long) and wide with a heart-shaped base and white down underneath. The petioles (leaf-stalks) are solid. The spherical, purple flowerheads are stalked and surrounded by dense clusters of scale-like hooked bracts. The egg-shaped seeds are achenes and surrounded by a pappus of yellowish free hairs and characteristic stiff hooked scales derived from the bracts. The ribbed seeds are dispersed by animals as the scales stick firmly to fur. Lesser burdock Arctium minus Bernh. is very similar but smaller (to 50 cm). Basal leaves are smaller and narrower with hollow leaf stalks. The purple flowerheads occur in clusters and project beyond the surrounding spiny bracts. The seed is not ribbed. Arctium minus has three subspecies and a fertile cross with Arctium lappa and there are many variants. The photographed specimen may be a cross as it as over 1 m tall but had hollow Read more […]