Respiratory disorders
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RESPIRATORY DISORDERS. The respiratory system. Nose H+M Larynx M+H Lungs H+D The upper respiratory tract includes: the nose & nasal cavities, the paranasal sinuses, the pharynx and the larynx The lower respiratory tract includes: the trachea and the lungs (bronchi, bronchioles and alveoli).

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RESPIRATORY DISORDERS

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Respiratory disorders

RESPIRATORY DISORDERS


The respiratory system

The respiratory system

  • Nose H+M

  • Larynx M+H

  • Lungs H+D

  • The upper respiratory tract includes: the nose & nasal cavities, the paranasal sinuses, the pharynx and the larynx

  • The lower respiratory tract includes: the trachea and the lungs (bronchi, bronchioles and alveoli)


The respiratory system1

THE RESPIRATORY SYSTEM

  • The temperament of the respiratory system ensures that:

  • The air breathed in from the external environment is cleared of harmful or irritant material-dust particles, pollen, fungal spores and bacteria.

  • The temperature of the incoming air is close to that of the respiratory tract, so preventing shock.

  • The humidity of the incoming air is adjusted in order to prevent dehydration of the body.


Respiratory disorders

Humans possess a number of paranasal sinuses, divided into subgroups that are named according to the bones within which the sinuses lie:

the maxillary sinuses, also called the maxillary antra and the largest of the paranasal sinuses, are under the eyes, in the maxillary bones.

the frontal sinuses, superior to the eyes, in the frontal bone, which forms the hard part of the forehead.

the ethmoid sinuses, which are formed from several discrete air cells within the ethmoid bone between the nose and the eyes.

the sphenoid sinuses, in the sphenoid bone at the centre of the skull base under the pituitary gland.


Respiratory disorders

Paranasal sinuses


Respiratory disorders

  • THE PARANASAL SINUSES

  • a sinus is an air filled cavity in the bone. The paranasal sinuses are the four pairs of sinuses within the bones of the face and skull. They are situated near the nasal cavities or the ears.


Paranasal sinuses

Paranasal sinuses

  • They have four main functions:

  • To lighten the bones of the skull

  • To secrete mucus into the nasal passages

  • To act as speech resonators, giving a warm rich tone

  • To act as thermal insulators, so preventing cold inhaled air cooling surrounding structures.


Paranasal sinuses1

Paranasal sinuses

  • also lined with a mucous membrane which contains goblet cells

  • Inflammation of the sinuses causes the mucous membrane to swell, so blocking the ostia (narrow passage or duct that connects the each sinus to the nasal cavities). This in turn prevents fluid from draining into the nasal cavity. This leads to blocked sinuses, a common disorder of the upper respiratory tract


Respiratory disorders

Paranasal sinuses


Respiratory disorders

  • THE NOSE (H+M)

  • Organ of smell

  • Acts to warm, moisten and filter incoming air before it enters the lung

  • internal nose made up of nostrils & nasal cavities.

  • The nasal cavities are separated from one another by the nasal septum, a vertical plate.


The nose

The nose

  • The nasal septum and the inside walls of the nasal cavities are covered with a very delicate mucous membrane.

  • This receives blood supply from a capillary network of blood vessels. This is prone to physical damage such as nose bleeds.

  • the nasal lining also contains a large number of goblet cells which secrete an excess of viscous fluid when inflamed or infected. (e.g. cold or flu)


The tonsils

THE TONSILS

  • Plays a relatively minor role in the immune system’s defence of the body against infection caused by bacteria, viruses and fungi.

  • Two pairs of lymphoid organs are found in the oropharynx:

  • Palatine tonsils- situated behind and below the fauces; these are the ones which are sometimes removed surgically.

  • Lingual tonsils- found at the base of the tongue.

  • Another pair of lymphoid organs are found in the nasopharynx:

    c) Nasopharyngeal tonsils- more familiar referred to as adenoids.


Respiratory disorders

  • THE PHARYNX

  • the pharynx or throat is a muscular tube, extending from the base of the skull to the top of the oesophagus.

  • it serves as a passageway for both the respiratory & digestive tracts.

  • The pharynx carries air to & from the lungs via the trachea, & food and drink via the oesophagus and into the stomach. It is lined with a mucous membrane.


The pharynx

The pharynx

  • divided into three distinct sections:

  • The nasopharynx (upper section)- this lies just behind the opening of the throat. The nasopharynx has two openings linking the ears (the eustachian tubes)

  • The middle section; opposite the mouth is the oropharynx. This single opening linking with mouth is called the fauces.

  • The lower section is the laryngo-pharynx & this opens both the larynx and the oesophagus.


The larynx

The larynx

  • The larynx , commonly called the "voice box," is a tube shaped structure comprised of a complex system of muscle, cartilage, and connective tissue.


Respiratory disorders

THE LARYNX

 The larynx is suspended from the hyoid bone, which is significant in that it is the only bone in the body that does not articulate with any other bone.  The framework of the larynx is composed of three unpaired and three paired cartilages.  The thyroid cartilage is the largest of the unpaired cartilages, and resembles a shield in shape.  The most anterior portion of this cartilage is very prominent in some men, and is commonly referred to as an "Adam's apple."  The second unpaired cartilage is the cricoid cartilage, whose shape is often described as a "signet ring."  The third unpaired cartilage is the epiglottis, which is shaped like a leaf.  The attachment of the epiglottis allows it to invert, an action which helps to direct food and liquid into the oesophagus and to protect the vocal cords and airway during swallowing.Voice production is a complex action, and involves practically all systems of the body.  Voice production begins with respiration (breathing).  Air is inhaled as the diaphragm (the large, horizontal muscle below the lungs) lowers.  The volume of the lungs expands and air rushes in to fill this space.  We exhale as the muscles of the rib cage lower and the diaphragm raises, essentially squeezing the air out.  


Respiratory disorders

THE TRACHEA

The trachea, or windpipe, is the bony tube that connects the nose and mouth to the lungs, and is an important part of the vertebrate respiratory system. When an individual breathes in, air flows into the lungs for respiration through the windpipe. Because of its primary function, any damage incurred to the trachea is potentially life-threatening.


The trachea

The trachea

  • The trachea is made up of strong fibrous elastic (hyaline ) tissue, in which are embedded several C-shaped cartilage rings, making it semi-rigid so keeping it open and resistant to collapse.

  • The trachea divides into two branches at the level of the sternum:

  • the left bronchus and the right bronchus. This division takes place at a point called the carina.


Respiratory disorders

  • BRONCHI AND BRONCHIOLES

  • The bronchi are the airways after the trachea which carry air to and from the lungs

  • the two bronchi have a structure similar to the trachea, but with the cartilage dispersed throughout the tubes, rather than in the form of rings.

  • The bronchi are very flexible and elastic & lined with mucous glands.

  • There also a large number of smooth muscle fibres present which allow changes to occur in the diameter of the bronchi.


Bronchi and bronchioles

Bronchi and bronchioles

  • the right bronchus is alot wider than the left one & more vertical.

  • The bronchi are lined with a special type of epithelium cells.

  • the bronchi divide repeatedly (as much as 20 times) forming smaller and smaller airways.

  • As they become smaller, the amount of cartilage decreases.

  • each bronchus divides into three small airways, called secondary or lobar bronchi.

  • Each of these goes to a specific lobe of the lung.

  • This repeated subdivision of the airways is called the bronchial or respiratory tree.


Bronchi and bronchioles1

Bronchi and bronchioles

  • when the airways reach a diameter of around 1millimeter, they are known as bronchioles.

  • further division of the bronchial tree leads to the terminal bronchioles.

  • These in turn subdivide into a large number of the smallest and finest air passages, the respiratory bronchioles. These develop into the alveolar ducts


Respiratory disorders

  • THE LUNGS (H+D)

  • The primary bronchi and the pulmonary blood vessels enter the lungs through an opening in the surface of the lung called the hilum.

  • The two lungs are the principle organs of respiration.

  • They are cone-shaped organs, occupying most of the thoracic cavity.

  • The lung tissue is soft and spongy, and has a great elasticity.

  • In children the lungs are pink in colour but with age they become darker and mottled as they are exposed to dust and chemicals in the environment.


The lungs

The lungs

  • Each lung has:

  • An apex-which projects up into the base of the neck behind the clavicle

  • A base- with a concave surface, which rests on the diaphragm, the main respiratory muscle

  • A mediastinal surface- which rests against the various structures situated in the mediastinum. This is the central cavity between the two lungs. It holds the heart, the pulmonary blood vessels, various nerves and several lymph glands.

  • The lungs are enclosed in a continuous double membranous sac called the pleural sac.


Chronic cough

CHRONIC COUGH

  • A cough that lasts for longer than 4-8 weeks is prolonged

  • TB OR NOT TB?

  • Consider a chest x-ray

  • The following differential diagnosis will be considered:

    Less than 3 weeks

  • Viral cold

  • Hay fever

  • Sinusitis

    More than 4 weeks and normal chest x-ray (non-smoker)

  • Post nasal drip

  • Asthma

  • COPD

  • ACE-inhibitors


Chronic cough1

CHRONIC COUGH

Dyspnoea/ dry cough with abnormal chest x-ray

  • Left ventricular failure

  • HIV

  • Asthma

  • Alveolitis

  • Pleural disease

  • Pleural effusion

    Wet cough with foul smelling sputum

  • Bronchiectasis

  • Lung abscess

  • Chronic bronchitis


Coughs pertussis

COUGHS (pertussis)

  • A dry cough is associated with a H+D frame, Pathway 1

  • A wet cough is associated with a M+H frame, Pathway 2

  • A cough is a self-protection mechanism which exists to clear the unwanted secretions and toxins from the lungs.

  • A cough may be the symptom of many disorders linked with the respiratory system i.e. Asthma, hay fever, cold, flu, pneumonia, pleurisy, TB, bronchitis, laryngitis, tonsillitis and occasionally organ related disorders such as the heart or liver.

  • Generally there are two main types of coughs- dry (non-productive) cough and wet (productive) cough.

    Discuss treatment in terms of the Tibb philosophy


Pneumonia

PNEUMONIA

  • Infection of the lung tissue including the alveolar spaces and interstitial tissue.

  • Pneumonia: Inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.

  • Classification includes:

  • Community acquired

  • Nosocomial

  • Aspiration

  • Immunocompromised


Pneumonia1

PNEUMONIA

Signs of pneumonia

  • Tachypnoea

  • Fever (however, fever may not be present in 30% of patients)

  • Herpes labialis (pneumococcus)

  • Consolidation (dull to percussion, increased viral load, bronchial breathing)

  • Nasal flaring

    Tests and treatment

  • Chest X-ray if indicated

  • Fluids, rest, antibiotics and hospitalization.

    Bronchopneumonia-this is a multifocal process involves the terminal bronchioles, which spreads segmentally causing patchy consolidation.


Respiratory disorders

CHRONIC PNEUMONIA


Lobar pneumonia

LOBAR PNEUMONIA

CLINICAL FEATURES

  • Fever, rigors, pleuritic pain and cough with rust-coloured sputum

  • Tachypnoea, intercostal recession, flaring

  • Initially decreased air entry and creps on affected side may be present


Lobar pneumonia1

LOBAR PNEUMONIA

Later the classical signs of consolidation appear

  • Bronchial breathing

  • Increased vocal resonance

  • Dullness on percussion

  • A pleural friction rub may occasionally be heard

  • During resolution, the signs of consolidation are replaced by creps

  • However, in elderly patients or patients with lowered resistance such as diabetes or AIDS, the clinical picture will be less obvious.

    Suspect Pneumonia in any adult with a cough, raised respiratory rate,

    Pleuritic chest pain and who is ill, even though no chest signs are found

    on examination.


Respiratory disorders

LOBAR PNEUMONIA


Respiratory disorders

LOBAR PNEUMONIA


Bronchopneumonia

BRONCHOPNEUMONIA

CLINICAL FEATURES

The patient will be ill with:

  • Tachypnoea

  • Intercostal recession

  • Grunting

  • Tachycardia

  • Later scattered crepitations and wheezes appear, affecting one or more lobes

  • In adults diagnosis is suggested by early production of infected sputum, coarse crepitations and rhonchi

  • The presence of a cough in a neonate, even in the absence of other physical signs, is sufficient evidence to diagnose bronchopneumonia.


Bronchopneumonia1

Bronchopneumonia

In small infants, less than 2 months old, clinical features may be minimal.

Bronchopneumonia should be suspected if there are any of the following:

  • A productive cough on history or examination

  • Any evidence of dyspnoea or grunting

  • Respiratory rate above 60/min

  • recession


Bronchopneumonia2

BRONCHOPNEUMONIA

Other causes of a raised respiratory rate in children

High temperature

  • Check this by reducing the temperature

  • If the respiratory rate now drops, it was only due to pyrexia

    Acidosis (An abnormally high level of acid in the blood because the lungs are not working well)

  • This occurs particularly if the child has been given aspirin

  • This may have been given as aspirin or aspirin in another tablet e.g. Compral, Grandpa

  • Ask the escort about this

  • REFER

    Crying or exercise

  • This will also raise the respiratory rate

  • Recheck the respiratory rate when the child is quiet.


Bronchopneumonia3

BRONCHOPNEUMONIA

In infants 2-12 months

  • Chest signs are uncommon

  • The diagnosis of bronchopneumonia is suggested if

  • The respiratory rate is above 50/min

  • There is evidence of dyspnoea or recession

  • Flaring nostrils

    In small children 1-5 years

  • The diagnosis is often made if only a few of the above features are present. The following features are important

  • ill child

  • Fever

  • Dyspnoea and flaring

  • Respiratory rate above 40/min


Respiratory disorders

Bilateral bronchopneumonia


Bronchitis

BRONCHITIS

  • Bronchitis is a C+D to D+H imbalance. Pathologically it is the inflammation of the bronchi, the respiratory tubes that lead to the lungs.

  • There are two types of bronchitis, acute or chronic.

  • Acute bronchitis is usually caused by a sudden exposure to Cold weather/environment, excessive intake of C+D food & drink, dairy products, wheat products especially refined flour products and a sudden change in temperature from hot to cold or cold to hot.


Bronchitis1

Bronchitis

  • Chronic bronchitis results from frequent irritation of the lungs, such as from exposure to cigarette smoke or other noxious fumes, unhealthy environments, cold and dust etc.

  • As chronic bronchitis diminishes the exchange of oxygen and carbon dioxide in the lungs, the heart works harder in an attempt to compensate.

  • Over time, this can lead to pulmonary hypertension, enlargement of the heart and ultimately heart failure.

  • Usually a viral infection that does not require antibiotic therapy.

  • Bronchitis and pneumonia are often impossible to distinguish clinically.


Bronchitis2

Bronchitis

  • Antibiotics should be considered if:

  • The patient’s general condition is impaired or worsening

  • Fever continues for more than 1 week

  • Fever starts again after already having settled

  • The patient is immunocompromised.


Bronchitis3

BRONCHITIS

  • Cough is the most commonly observed symptom of acute bronchitis

  • Most patients have a cough for less than two weeks; however, 26% are still coughing after two weeks, and a few cough for six to eight weeks.

    SYMPTOMS

  • Cough

  • Sputum may be clear, white, yellow, green or even tinged with blood

  • Retrosternal discomfort (burning sensation due to “rawness” of bronchioles

  • sensation of tightness

  • Dyspnoea & wheezing

  • Symptoms may vary & may not all be present

    SIGNS

  • Fever

  • Not usually very ill patient

  • Coarse crackles which clear with coughing

  • Chest may be clear

    Discuss treatment as group discussion from TIBB perspective


Respiratory disorders

Bronchitis is a condition defined as the inflammation of the bronchi which results in persistent cough that produces considerable quantities of sputum. A respiratory infection such as a cold is the initial stage of the development of bronchitis. Bronchitis usually disappears within a few days without lasting effects in most people, however the coughs due to bronchitis can continue for up to three weeks or more.

Viruses such as corona virus, adenovirus, or a rhinovirus, that attack the lining of the bronchial tree is one of the major causes of bronchitis. Swelling occurs and more mucus is produced when the body tries to fight back the infection causing virus. Bacteria and fungus are considered to be one of the other causes of bronchitis, but newer research shows that bacterial and fungal infection are much less common in bronchitis.

Aromatherapy is one of the widely used bronchitis natural remedy which involve inhaling the eucalyptus oil that provides some relief from the inflamed lungs. Cayenne pepper is one of the other best bronchitis natural remedies which helps break up the congestion and help you get quicker relief. One of the other natural remedies for bronchitis is a tea prepared by mixing both garlic and ginger which when taken for three to four times a day helps cure the symptoms effectively.

A tea made from an herb called creosote bush is one of the natural remedy for bronchitis widely used to cure bronchitis and other respiratory problems. A tea prepared from an herb called pleurisy root is widely used for phlegm removal. An herb called coltsfoot is also considered as natural treatment for bronchitis that has expectorant properties stimulates the microscopic hairs that move mucus out of the airways and suppresses production of a protein that triggers spasms in the bronchus

One of the other natural treatment for bronchitis that help soothe the throat and stop the muscle spasms that trigger coughs is a herb called mullien having expectorant properties. Massaging the chest and back with a vegetable oil or massage oil is one of the other best bronchitis natural treatment that helps break up congestion in the lungs. Taking more supplements of vitamins A and C are best remedies that helps heal the inflammation of the bronchial tubes


Respiratory disorders

alternative remedies for Bronchitis


Asthma

ASTHMA

An airway disease characterised by:

  • Reversible obstruction

  • Inflammation

  • Increased sensitivity to irritants

    SYMPTOMS AND SIGNS OF ASTHMA

    DYSPNOEA

  • In the morning and during the night

  • After exercise (especially in cold weather)

  • In association with upper respiratory tract infections

  • In association with exposure to allergens such as pollen and animal dust

    WHEEZING

  • Simultaneously with dyspnoea

    PROLONGED COUGH

  • In the morning and late at night

  • In association with irritating factors

  • Cough may be dry, but often clear mucous is excreted


Asthma1

ASTHMA

COMMON ASTHMA TRIGGERS

A- ALLERGY (pollen, dander)

S- SPORT (exercise, play)

T- TEMPERATURE (cold, wet, windy)

H- HEREDITY

M- MICROBIOLOGY (bugs)

A- ANXIETY (stress, worries etc)


Respiratory disorders

STAGING OF CHRONIC ASTHMA

TREATMENT DEPENDS ON STAGING


Respiratory disorders

Bronchospasm inflammation

TIGHT CHEST PHLEGM

Use reliever use preventer

(asthavent,berotec,venteze) (inflammide,budeflam, beclate)

USE AS NEEDED USE EVERYDAY

Opens chest clears phlegm


Respiratory disorders

  • WARNING SIGNS THAT ASTHMA IS GETTING WORSE!!!

  • INCREASING SHORTNESS OF BREATH WORSENING COUGH AT NIGHT

  • NEED TO USE RELIEVER (asthavent, berotec, venteze) MORE OFTEN

  • RELIEVER NOT HELPING

  • ASTHMA WORSENS WITH EXERCISE

  • INCREASING PHLEGM ON CHEST


Phlegmatic asthma

PHLEGMATIC ASTHMA

  • M+H to C+M imbalance due to excess phlegmatic humour, Pathway 2

  • This type of Asthma is a phlegmatic condition due to a M+H to C+M imbalance that causes obstruction of the airways.


Phlegmatic asthma1

Phlegmatic Asthma

CAUSES & RISK FACTORS

  • Asthma in children is highly associated with Phlegmatic/Sanguinous dominant types

  • Genetic factors that make a child susceptible to environmental triggers, such as infections, dietary patterns, air pollution and allergens.

  • Early lung development, particularly having smaller lungs

  • Diet

  • Environment

  • Conventional & synthetic drugs for asthma put a suppressive affect on the lungs and patient becomes dependent and in the long run patient doesn’t even respond to the treatment.

  • Low oxygenated and improper ventilated houses where children are spending more time watching television, playing video games or using the computer.

  • Not having been breastfed, which leads to nutrient deficiencies which protects against inflammation and infection.

  • Early recurrent respiratory infections

  • Exercise-induced Asthma is a limited form of the condition where exercise triggers coughing, wheezing, or dyspnoea because of the increase in heat which leads towards irritation of the mucous membrane to produce more mucous or the low functional capacity of the lungs can lead towards a spasm like condition in the airways.

  • Food additives and preservatives, air pollution, tobacco smoke, perfume, chemicals such as rugs, cleaning supplies, paints, solvents, allergens such as pet dander, pollen, dust mites and mould can trigger the condition.

    Typical symptoms of an attack of this type of asthma are coughing, wheezing, a feeling of tightness in the chest and difficulty breathing.


Phlegmatic asthma2

Phlegmatic Asthma

Phlegmatic Asthma

Asthma due to excessive phlegmatic humour (Moist & Hot and Cold & Moist) explain about the phlegmatic humour and its production, concoction, elimination and other techniques.

The main objective of this treatment is to overcome the moistness due to the excessive phlegmatic humour by:

Concoction and elimination of the phlegmatic humour with the help of medication, dietary changes, home remedies,

massage and cupping

Medication: Medication can be prescribed as the following:

Regular medication: these medication must be given to the patient until the recovery

Septogard tablets/syrup1-2 tablets/1-2 teaspoon , Tibb- Asthma syrup 1-3 teaspoon, Black seed honey/Capsules 1 teaspoon/1capsule. 2-3 times a day ½ hour before meals.

While following the above treatment , after every 5 days give the following eliminative medication for 2 days in a week:.

For adults: Phlemnil 2 tablets, Regulax ¼ to ½ tablets preferably bedtime.

For children: Phlemnil ½ to 1 tablet, Hamdardghutti 1 tsp. preferably bedtime.

After recovery give the maintenance medication for 15 days:

Septogard tablets/syrup 2 tablets/2 teaspoon, Black seed honey/Capsules 1-2 teaspoon/1capsule, once a day;

and

For the elimination of phlegm continue once every 5 days:

For adults: Phlemnil 2 tablets, Regulax ¼ to ½ tablet preferably bedtime.

For children: Phlemnil ½ to 1 tablet, Hamdardghutti 1 tsp. preferably bedtime.


Phegmatic asthma

Phegmatic Asthma

  • dietary changes- follow the diet Avoid all the cold things and dairy products, cold drinks and juices.

  • Home remedies – such as

  • Cinnamon, cloves, fenugreek and ajmo tea, take all the ingredients in equal quantity and crush it into powder, 1 teaspoon of the powder mix in 1cup boiling water for 15 minutes and then drink warm 2-3 times a day. or

  • ‘Hakim healing soup’, 1-3 cups per day.

  • massage – Black seed Rub/ Black seed winter oil. Give a massage on the chest and on the back while the patient is in the clinic and advice to do it once or twice a day. The massage should be stimulant and strong.

  • cupping –

  • Start with dry cupping and after a week or 2 weeks follow a wet cupping.

  • Cupping can be done after the massage.

  • Cupping points (TH1, TH2, TH4, B3, B4, B6)

  • Apply dry cupping for 5-10 minutes.

  • Then bleed TH1, TH2, B3, B4 or B6.

  • Emesis- In infants and children sometimes vomiting start because of the overload of phlegm. Explain the patient not to worry about this because this is a natural way of elimination.


Phlegmatic asthma3

Phlegmatic Asthma

  • Activate and strengthen the lungs with the help of home remedies, massage, cupping, breathing and physical exercise.

  • Home remedies – such as Cinnamon, cloves, fenugreek and ajmo tea, or Hakim healing soup. After the recovery patient should carry on this least 15 days

  • Massage – Black seed Rub/ Black seed winter oil/ Black seed pure oil followed by cupping.

  • Cupping – follow the dry/wet cupping every month for 3 months.

  • breathing and physical exercises – deep breathing exercises along with brisk walk and jogging should be started gradually and done regularly.

  • Avoiding the further recurrence and production of phlegm with dietary changes, climatic and weather, home remedies, cupping, breathing and physical exercises and elimination.

  • dietary changes – avoid cold thing and excessive intake of fizzy drinks and dairy, especially in cold and rainy weather and after sunset to sunrise.

  • climatic and weather amendments – avoid exposure to cold and rainy season.

  • Home remedies – follow when the weather is cold and rainy.

  • Cupping – follow the dry/wet cupping every 3 months.

  • breathing and physical exercises – regular deep breathing exercises along with brisk walk and jogging.

  • Elimination should carry on once or twice a month –

  • For adults: Phlemnil 2 tablets, Regulax ¼ to ½ tablet preferably bedtime.

  • For children: Phlemnil ½ to 1 tablet, Hamdardghutti 1 tsp. preferably bedtime.


Melancholic asthma

MELANCHOLIC ASTHMA

  • This type of asthma is linked to the C+D or Melancholic imbalance, pathway 2

  • Broncho-constriction develops as a result o shrinkage in the airways of the lungs. The net response is that the patient does not get enough air. Sometimes this asthma is linked to C+D conditions and frequently develops after exercise.

  • The main symptoms are a marked difficulty in breathing.

  • In most cases mucous or phlegm expectoration are absent and coughing is rare.


Melancholic asthma1

Melancholic Asthma

  • MELANCHOLIC ASTHMA

  • Asthma due to excessive hard, thick abnormal phlegmatic humour

  • (Cold & Dry), explain the patient about the abnormal phlegmatic humour and its melancholic nature, production, concoction, elimination and other techniques.

  • The main objective of this treatment is to overcome the Cold and Dryness due to the abnormal phlegmatic humour by:

  • Concoction and elimination of the abnormal phlegmatic humour with the help of medication, dietary changes, home remedies, massage and cupping:

  • Medication: Medication can be prescribed as the following:

    • Regular medication: these medication must be given to the patient until the recovery

  • Septogard tablets/syrup1-2 tablets/1-2 teaspoon , Tibb- Asthma syrup 1-3 teaspoon, Black seed honey/Capsules 1 teaspoon/1capsule. 2-3 times a day ½ hour before meals.

    • While following the above treatment , after every 5 days give the following eliminative medication for 2 days in a week:.

  • For adults: Melanpurg 1-2 tablets, Laxotabs 2 tablets preferably bedtime.

  • For children: Melanpurg ½ -1 tablet, Hamdardghutti 1 tsp. preferably bedtime.

    • After recovery give the maintenance medication for 15 days:

  • Septogard tablets/syrup 2 tablets/2 teaspoon, Black seed honey/Capsules 1-2 teaspoon/1capsule, once a day;

  • and for the elimination of abnormal phlegm continue with

  • For adults: Melanpurg 1-2 tablets, Laxotabs 2 tablets preferably bedtime.

  • For children: Melanpurg ½ -1 tablet, Hamdardghutti 1 tsp. preferably bedtime.


  • Melancholic asthma2

    Melancholic Asthma

    • dietary changes- follow the diet Avoid all the cold and dry especially sour things, cold drinks and juices.

    • home remedies – such as Cinnamon, cloves, fenugreek and ajmo tea, take all the ingredients in equal quantity and crush it into powder, 1 teaspoon of the powder mix in 1cup boiling water for 15 minutes and then drink warm 2-3 times a day or ‘Hakim healing soup’, 1-3 cups per day.

    • massage – Black seed Rub/ Black seed winter oil. Give a massage on the chest and on the back while the patient is in the clinic and advise to do it once or twice a day. The massage should be stimulating and strong.

    • cupping – Start with dry cupping and after a week or 2 weeks follow with a wet cupping.

    • Cupping can be done after the massage.

    • Cupping points (TH1, TH2, TH4, B3, B4, B6)

    • Apply dry cupping for 5-10 minutes.

    • Then bleed TH1, TH2, B3, B4 or B6.


    Melancholic asthma3

    Melancholic Asthma

    • Activate and strengthen the lungs with the help of home remedies, massage, cupping, breathing and physical exercise.

    • home remedies – such as Cinnamon, cloves, fenugreek and ajmo tea, or Hakim healing soup. After the recovery patient should carry on this least 15 days

    • Massage – Black seed Rub/ Black seed winter oil/ Black seed pure oil followed by cupping.

    • Cupping – follow the dry/wet cupping every month for 3 months.

    • breathing and physical exercises – deep breathing exercises along with brisk walk and jogging should be started gradually and done regularly.

    • Avoiding the further recurrence and production of phlegm with dietary changes, climatic and weather, home remedies, cupping, breathing and physical exercises and elimination.

    • dietary changes – avoid cold and dry things especially sour things and excessive intake of fizzy drinks and dairy, especially in cold and rainy weather and after sunset to sunrise.

    • climatic and weather amendments – avoid exposure to cold and rainy season.

    • home remedies – follow when the weather is cold and rainy.

    • Cupping – follow the dry/wet cupping every 3 months.

    • breathing and physical exercises – regular deep breathing exercises along with brisk walk and jogging.

    • Elimination should carry on once or twice a month –

    • For adults: Melanpurg 1-2 tablets, Laxotabs 2 tablets preferably bedtime.

    • For children: Melanpurg ½ -1 tablet, Hamdardghutti 1 tsp. preferably bedtime.


    Emphysema

    EMPHYSEMA

    • C+M to C+D imbalance due to excess Phlegmatic/Melancholic humour, pathway 2

    • Emphysema is a form of chronic obstructive pulmonary disease (COPD) caused by a loss of elasticity and dilation of the lung tissue. This loss of elasticity is as a result of increased dryness of hardened phlegmatic humour (C+M to C+D).

    • A person with emphysema cannot exhale without great effort.

    • Stale air remains trapped in the lungs, preventing the needed exchange of oxygen and carbon dioxide.

    • Results from frequent irritation of the lungs, such as that arising from exposure to cigarette smoke or other noxious fumes, an unhealthy environment, cold and domestic or occupational dust.

    • The most common symptom is severe, long, lasting breathlessness, followed by coughing. This typically develops during exertion, no matter how slight.

      Discuss treatment in terms of Tibb philosophy


    Emphysema1

    EMPHYSEMA

    AVOIDANCE OF THE FOLLOWING IS ADVISED

    • All contact with tobacco products. Tobacco smoke is the single most dangerous influence an emphysema patient can encounter.

    • The use of gas stoves.

    • Electric stoves are better tolerated by the patient

    • Furry or feathered house pets and animals

    • Fried and greasy foods. Dairy products (especially cheese), processed foods, junk foods and white flour products.

    • These can cause excess mucous to be formed in the GIT, lungs, nasal sinuses and nasal cavity.

    • Perfume, scents, soaps and anything containing fragrances

    • Encourage the patient to avoid hot, humid climates

    • Get plenty of fresh air. Avoid air pollution and working in a dirty, dusty, or toxic environment.


    Emphysema2

    Emphysema

    Deep breathing exercise of emphysema

    • The patient should carry out this exercise early in the morning and late afternoon.

    • Sit on a chair with a straight spine

    • The right index finger should close the left nostril

    • A long, deep breath in through the right nostril

    • Hold for as long as possible before releasing

    • Next, the right nostril should be closed with the right thumb, and then breathe out through the left nostril forcefully.

    • This is one complete breath. Repeat the same motion, starting with the opposite nostril for at least 15-25 breaths twice daily

    • After completing this exercise, rest for at least 5 minutes in the same position.

      Discuss treatment in terms of the Tibb philosophy


    Obstructive sleep apnoea

    OBSTRUCTIVE SLEEP APNOEA

    • M+H frame due to excess Phlegmatic humour, Pathway 2

    • This condition develops from an accumulation of the excessive moistness/phlegmatic humour in the throat and larynx area.

    • The tone of the muscles linked to these areas have become weak and lost proper tone, and during sleep this situation can lead towards upper respiratory obstruction.

    • The common symptom is excessive and severe snoring.


    Tuberculosis

    TUBERCULOSIS

    • D+H frame due to abnormal Bilious humour, Pathway 2

    • Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and often deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and even the skin. Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti also cause tuberculosis, but these species are less common.

    • Tuberculosis is spread through the air, when people who have the disease cough, sneeze or spit. One third of the world's current population have been infected with M. tuberculosis, and new infections occur at a rate of one per second.[1] However, most of these cases will not develop the full-blown disease; asymptomatic, latent infection is most common. About one in ten of these latent infections will eventually progress to active disease, which, if left untreated, kills more than half of its victims. In 2004, mortality and morbidity statistics included 14.6 million chronic active cases, 8.9 million new cases, and 1.6 million deaths, mostly in developing countries.[1] In addition, a rising number of people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse, or AIDS.


    Symptoms of tb

    Symptoms of TB

    The typical symptoms of tuberculosis are a chronic cough with

    blood-tinged sputum, fever, night sweats and weight loss.

    Infection of other organs cause a wide range of symptoms.

    The diagnosis relies on radiology (commonly chest X-rays), a

    tuberculin skin test, blood tests, as well as microscopic

    examination and microbiological culture of bodily fluids.

    Tuberculosis treatment is difficult and requires long courses of

    multiple antibiotics. Contacts are also screened and treated if

    necessary. Antibiotic resistance is a growing problem in

    (extensively) multi-drug-resistant tuberculosis. Prevention

    relies on screening programs and vaccination, usually with

    Bacillus Calmette-Guérin (BCG vaccine).


    Tuberculosis1

    TUBERCULOSIS

    • When the disease becomes active, 75% of the cases are pulmonary TB. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily.[1]

    • In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB. This occurs more commonly in immunosuppressed persons and young children. Extrapulmonary infection sites include the pleura, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints in Pott's disease of the spine. An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Although extrapulmonary TB is not contagious, it may co-exist with pulmonary TB, which is contagious.

    • When people suffering from active pulmonary TB cough, sneeze, speak, or spit, they expel infectious aerosol droplets 0.5 to 5 µm in diameter. A single sneeze can release up to 40,000 droplets.[16] Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low and the inhalation of just a single bacterium can cause a new infection.[17]


    Tuberculosis2

    TUBERCULOSIS

    • People with prolonged, frequent, or intense contact are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis can infect 10–15 other people per year.[1] Others at risk include people in areas where TB is common, people who inject drugs using unsanitary needles, residents and employees of high-risk congregate settings, medically under-served and low-income populations, high-risk racial or ethnic minority populations, children exposed to adults in high-risk categories, patients immunocompromised by conditions such as HIV/AIDS, people who take immunosuppressant drugs, and health care workers serving these high-risk clients.[18]

    • Transmission can only occur from people with active — not latent — TB. The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the virulence of the M. tuberculosis strain.[5] The chain of transmission can, therefore, be broken by isolating patients with active disease and starting effective anti-tuberculosis therapy. After two weeks of such treatment, people with non-resistant active TB generally cease to be contagious. If someone does become infected, then it will take at least 21 days, or three to four weeks, before the newly infected person can transmit the disease to others.[19] TB can also be transmitted by eating meat infected with TB. Mycobacterium bovis causes TB in cattle.


    Diagnosis of tb

    DIAGNOSIS OF TB

    • Tuberculosis can be a difficult disease to diagnose, mainly due to the difficulty in culturing this slow-growing organism in the laboratory (4–12 weeks for blood culture). A complete medical evaluation for TB must include a medical history, a chest X-ray, and a physical examination. Tuberculosis radiology is used in the diagnosis of TB. It may also include a tuberculin skin test, a serological test, microbiological smears and cultures. The interpretation of the tuberculin skin test depends upon the person's risk factors for infection and progression to TB disease, such as exposure to other cases of TB or immuno-suppression.[5]

    • Currently, latent infection is diagnosed in a non-immunized person by a tuberculin skin test, which yields a delayed hypersensitivity type response to an extract made from M. tuberculosis. Those immunized for TB or with past-cleared infection will respond with delayed hypersensitivity parallel to those currently in a state of infection, so the test must be used with caution, particularly with regard to persons from countries where TB immunization is common.[27] New TB tests are being developed that offer the hope of cheap, fast and more accurate TB testing. These use polymerase chain reaction detection of bacterial DNA and antibody assays to detect the release of interferon gamma in response to mycobacteria.[28] These tests are not affected by immunization, so generate fewer false positive results.[29] Rapid and inexpensive diagnosis will be particularly valuable in the developing world.


    Respiratory disorders

    Mantoux Tuberculin skin test


    Respiratory disorders

    TB under a microscope

    Chest x-ray


    Respiratory disorders

    tuberculosis


    Pleurisy

    PLEURISY

    • Pleurisy is located in the Hot & Moist to Moist & Hot frames, and characterized by excess or imbalanced phlegmatic humour.

    • As pleurisy is an acute disorder, it is located mostly on Pathway 1.

    • The pleura are the serous membranes that line the inside of the chest cavity and cover the lungs.

    • The membranes have a smooth, moistened surface which allow then to slide over each other.

    • Pleurisy (also termed pleuritis) means inflammation of these membranes.

    • Depending on its original cause, pleurisy can be associated with an accumulation of fluid in the space between the lungs and chest wall called a pleural effusion, or it can be dry pleurisy, which has no fluid accumulation.

    • This disorder affects both male and female in all age groups.


    Pleurisy1

    Pleurisy

    Causes and risk factors

    • Pleurisy can arise from a variety of reasons. The main ones are:

    • Injury to the chest, especially from a fractured rib or knife wound, or as a consequence of radiation therapy.

    • Lower respiratory tract infection, especially following pneumonia, bronchitis and tuberculosis.

    • System diseases, such as systemic lupus erythematosus (lupus), rheumatic fever, rheumatoid arthritis.

    • Diseases of the lung, such as lung cancer, pneumothorax, and as a result of a pulmonary embolism.

    • Other factors which may play a part in the onset of pleurisy are:

    • Diet – an excessive intake of predominantly Hot & Moist to Cold & Moist foods, such as dairy foods.

    • Environmental factors – exposure to humid or rainy, cold and moist weather, especially in winter, and from improperly set air-conditioning.


    Respiratory disorders

    Diagnosis was TB type pleurisy


    Pleurisy2

    PLEURISY

    Clinical features of pleurisy

    • The predominant symptom of pleurisy is stabbing chest pain.

    • The onset of pleurisy is usually signaled by sudden chest pain, which may be mild, but is usually severe.

    • The pain is present with each breath, when the sufferer moves, and intense when coughing or sneezing.

    • Other signs and symptoms are related to the severe pain experienced:

    • Shallow, rapid and difficult breathing

    • Headache

    • Loss of appetite

    • Weakness and fatigue

    • A dry cough

    • Rapid heart beat (tachycardia)

    • Auscultation of the chest may reveal pleural frictional rub, a typical sound heard in pleurisy patients.


    Pleurisy3

    PLEURISY

    Treatment of pleurisy

    • As this condition is associated with the frame of Hot & Moist to Moist & Hot, treatment involving Governing Factors will be along the same lines as the management of other acute disorders that fall into the Hot & Moist to Moist & Hot frame.

    • The treatment frames will include: Cold & Dry, Dry & Hot and Hot & Dry.

    • Additional advice to the patient would include:

    • Consumption of food which consists ofCold & Dry (30-40%) and Hot & Dry (50-60%) items.

    • Avoidance of the following is advised:

    • Smoking and passive smoking.

      Tibb medication for pleurisy

    • Septogard(tablets and syrup).

    • Chesteez(syrup).

    • Joshina (granules).

    • Livotibb(tablets).


    Pleural effusion

    PLEURAL EFFUSION

    • Pleural effusion is located in the Moist & Hot to Hot & Moist frames, and characterized by excess or abnormal phlegmatic humour, plus a structural imbalance.

    • As pleural effusion is a chronic disorder, it is located on Pathway 2.

    • A pleural effusion is accumulation of fluid in the pleural space around the lungs.

    • The pleura are thin membranes that enclose the lungs and line the inside of the chest cavity.

    • The 'pleural space' describes the small space between the inner (visceral) and outer(parietal) layer of pleura, which normally contains a small volume of lubricating pleural fluid which allows the lungs to expand without friction.

    • This fluid is constantly being formed through leakage of fluid from nearby capillaries and then re-absorbed by the body's lymphatic system.

    • With a pleural effusion, an imbalance between production and re-absorption of pleural fluid leads to excess fluid building up in the pleural space.

    • As much as 1500 ml of excess fluid may form in the pleural space.


    Pleural effusion1

    PLEURAL EFFUSION

    Causes and risk factors

    • Most underlying causes of pleural effusion are linked to Moist & Hot to Hot & Moist qualitative frames. However, anything that causes an imbalance between production and re-absorption of pleural fluid can lead to the onset of pleural effusion.

    • Transudative pleural effusions, which have low protein levels, usually form as a result of excessive capillary fluid leakage into the pleural space. The main clinical disorders leading to transudative pleural effusions are:

    • Congestive heart failure

    • The nephrotic syndrome

    • Cirrhosis of the liver

    • Pulmonary embolism

    • Hypothyroidism

    • Exudative effusions, which have high protein levels, are often more serious than transudative effusions. They are formed as a result of inflammation of the pleura, which might happen for example in lung disease or as a consequence of radiation therapy. The main clinical disorders leading to exudative effusions are:

    • Pneumonia

    • Lung or other, cancers

    • Inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus

    • Pulmonary embolism

    • Asbestosis

    • Tuberculosis


    Pleural effusion2

    PLEURAL EFFUSION

    Clinical features of pleural effusion

    • Clinical findings associated with pleural effusions may occur when the fluid volume exceeds 500 ml. These include diminished breath sounds, dullness to percussion, vocal vibrations or tremor during breathing (fremitus), and occasionally evidence of a pleural friction rub. The most common symptoms of pleural effusion are:

    • Shortness of breath

    • Chest pain, usually a sharp pain that is worse with cough or deep breaths

    • Cough

    • Hiccups

    • Rapid and difficult breathing (dyspnoea)

    • A sensation of pressure in the chest

    • Chest pain may occur even with little fluid formation, as it is related to the intense inflammation of the pleural surfaces.

    • Chest pressure usually does not manifest until the effusion volume is moderate (500 to 1500 ml) to large (>1500 ml).

    • Dyspnoea rarely occurs with small effusions, unless pleurisy is also present.

    • Often the patient will not experience dyspnoea until the effusion is massive, as revealed by chest x-ray.

    • Cough is usually related to the lungs’ failure to expand (atelectasis), which to some degree accompanies all pleural effusions.

    • In contrast to pneumonia, crackles are not heard with an isolated pleural effusion.


    Pleural effusion3

    PLEURAL EFFUSION

    Treatment of pleural effusion

    • As this condition is associated with a structural imbalance, treatment will be mainly symptomatic or palliative, depending on the cause of the illness.

    • Treatment involving the Governing Factors will be along the same lines as the management of other Pathway 1 disorders that fall into the Moist & Hot to Hot & Moist frame.

    • The treatment frames will include: Cold & Moist, Cold & dry and Dry & Hot.

      Tibb medication for pleural effusion

    • Tibb-Renotone(tablets and syrup).

    • Livotibb(tablets and syrup).

    • Rumaflam(tablets).


    Respiratory disorders

    Chest x-ray of pleural effusion


    Pneumothorax

    PNEUMOTHORAX

    • Pneumothorax is located in the Dry & Hot to Hot & Dry qualitative frames, and characterized by excess or abnormal bilious humour, plus a structural imbalance.

    • Primary pneumothorax is an acute disorder, so is located on Pathway 1.

    • Secondary pneumothorax is a chronic disorder, so is located on Pathway 2.


    Respiratory disorders

    • Pneumothorax is the abnormal appearance of substantial amounts of air in the pleural cavity, between the two membranous layers that line the inside of the chest wall and cover the lungs.

    • This build-up of air exerts pressure, and causes the lung(s) to collapse.

    • A spontaneous pneumothorax, also referred to as a primary pneumothorax, occurs for no known cause.

    • Traumatic pneumothorax is the result of injury to the chest. A secondary (termed complicated) pneumothorax occurs as a result of an underlying disorder, such as lung disease.

    • Tension pneumothorax occurs when air can enter the pleural cavity when the patient breathes in, but does not escape on breathing out.

    • Persons of any age and either sex can succumb to this serious disorder.

    • For some reason it is most common in tall, thin men between 20 and 40 years of age.


    Pneumothorax1

    PNEUMOTHORAX

    Causes and risk factors

    • The usual causes of pneumothorax are penetrating injuries from, say, a knife or bullet, or from a fractured rib. Rupture of the lungs’ alveolar sacs as a result of lung diseases such as bronchial asthma, tuberculosis, emphysema, cystic fibrosis, and the formation of an abscess. Medical procedures, such as removal of fluid from the pleural cavity with a needle (thoracentesis) or a lung biopsy or may be deliberately induced in order to collapse the lung, maybe to treat tuberculosis.

    • The risk of developing pneumothorax is higher for:

    • Cigarette smokers

    • Persons taking antibiotics improperly or to excess

    • Persons taking 3rd and 4th order herbal medications

    • Regular travelers on high altitude flights

    • People undergoing surgery on the chest

    • People applying Governing Factors which lead to a severe Hot & Dry imbalance, which can initiate inflammation in the lungs, are also more prone to pneumothorax.


    Pneumothorax2

    PNEUMOTHORAX

    Clinical features of pneumothorax

    • The main symptoms of a collapsed lung resulting from pneumothorax are:

    • Sudden shortness of breath

    • Painful breathing

    • Sharp chest pain, often on one side

    • Chest tightness

    • Dry, hacking or barking cough

    • The following signs can indicate a collapsed lung:

    • Low blood pressure

    • Rapid heart rate

    • Low levels of blood oxygen

    • Loss of normal breath sounds where the lung is deflated

    • A hollow sound when part of the chest is percussed

    • A shift in the normal location of heart sounds

    • Symptoms of a tension pneumothorax are similar, and include:

    • A bluish tinge to the skin, due to lack of oxygen

    • Engorgement of the neck veins

    • Low blood pressure or sometimes shock in severe cases

    • A chest X-ray is the best way to confirm that that a lung has collapsed. The X-ray will show the affected lung as a dark area in the chest. A computed tomography (CT) scan may be needed in some cases to find a small collapsed area of a lung, or for people with co-existing extensive lung disease.


    Pneumothorax3

    PNEUMOTHORAX

    Treatment of pneumothorax

    • As this disorder is associated with the structural imbalance, treatment will be according to the identified cause of the illness. Treatment involving the Governing Factors will be along the same lines as the management of other disorders that also fall into the Dry & Hot to Hot & Dry frame.

    • The treatment frames will include: Hot & Moist, Moist & Hot and Cold & Moist.

      Tibb medication for pneumothorax

    • Tibb-Kofclear (syrup).

    • Tibb-Asthma (syrup).

    • Livotibb (tablets and syrup).

    • Coronary Care (tablets).


    Respiratory disorders

    Tension pneumothorax


    Respiratory disorders

    pneumothorax


    Case study

    CASE STUDY

    Mrs Q is 25 years old who presents with a persistent cough for the past month. She smokes at least 20

    cigarettes a day. She wants to stop but is having difficulty and previous attempts have been

    unsuccessful. She works in a factory and experiences the occasional wheeze but uses her sister’s pump

    which normally alleviates the problem temporarily. She constantly feels tired and has noticed weight

    loss over the past month.

    What is the diagnosis of this condition and which pathway and qualitative frame does it fall into? (2)

    List 3 hazards as well as 3 withdrawal symptoms of smoking (3)

    Mention a few other symptoms that may also be present in this particular disease (3)

    Which further tests would you insist upon? (2)

    Which treatment strategy would you recommend in terms of governing factors and regimental

    therapies? (6)

    Would you recommend Tibb meds for this patient and why? (4)

    Outline the clinical features of tongue and pulse diagnosis (5)

    TOTAL 25


    Case study memo

    Case study memo

    • MEMO OF CASE STUDY: RESPIRATORY SYSTEM

    • QUESTION 1

    • TB/Tuberculosis, Pathway 2, D+H (abnormal Bilious humour)

    • QUESTION 2

    • Hazards:

    • Cancer of the lungs, throat, oesophagus

    • Asthma

    • Emphysema

    • Chronic bronchitis

    • SOB

    • Withdrawal symptoms:

    • Headache

    • Cravings

    • Anxiety

    • Sweating

    • Nausea

    • Tingling in hands and feet

    • Mental confusion

    • QUESTION 3

    • Night sweats

    • Blood stained sputum (coughing up)

    • Flu-like symptoms

    • SOB

    • QUETSION 4

    • Sputum test

    • Chest X-ray


    Case study memo1

    Case study memo

    • QUESTION 5

    • Treatment frames include D+H, H+M, M+H, and C+ M

    • Diet advice

    • Avoid food that fall within the H+D frames

    • Increase water intake, at least 8 glasses per day

    • Switch to a high fiber diet

    • Avoid foods that are high in saturated fat

    • Include fresh fruit and vegetables in the diet

    • Sleep patterns

    • Sufficient rest encouraged, the patient should be getting at least 8 hours of sleep

    • Environmental air and breathing

    • Strive for a well-ventilated environment

    • Elimination

    • Keeping the colon clean is vital

    • Increase in water consumption aids in the cleansing process of the colon by facilitating the elimination of waste products.

    • A high fiber diet with increased amounts of roughage is beneficial

    • Emotions

    • Encourage a stress free living environment

    • Emotions like anger increases the Bilious humour hence aggravating the condition

    • Cupping

    • Cupping is very beneficial for this particular disorder. Cupping sites include: TH4, B3, B4,

    • QUESTION 6

    • Yes Tibb meds will definitely be recommended.

    • Kofcare syrup (H+M)-soothing properties, for coughing

    • Tibb-expectorant (H+M)

    • Livotibb (M+H)-liver tonic, restores damaged hepatic cells

    • Septogard- natural antibiotic

    • QUESTION 7

    • Tongue: dry, blood stasis in the lung region, thick yellow coating

    • Pulse: superficial, thin, long, strong, fast, and hard


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