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Establishing a therapeutic rationale during treatment
1 Establishing a therapeutic rationale during treatment Chapter Objectives 1. Introduce common cardiovascular disease conditions in integrative cardiovascular Chinese medicine through the acute, chronic, recovery, and prevention stages of cardiovascular disease conditions. 2. Introduce the purpose of treatment. 3. Indicate whether herbal formulas could be the only treatment. 4. Indicate whether the integration of herbs, nutrition, and pharmaceutical drugs could be used in treatment. 5. Indicate whether pharmaceutical drugs are the only preferred method of treatment.
This chapter discusses the health factors and the purpose and possible effectiveness of isolated and integrative treatment through each stage.
Acute stage
Condition
Purpose of treatment
Hypertension
Stabilizing the patient back to normal blood pressure levels or regular life from a painful event or condition that raised the blood pressure
Herbal formula treatment only
Integrative herbs and drugs
Medical Empathy, Pharmacological Systems, and Treatment Strategies in Integrative Cardiovascular Chinese Medicine. https://doi.org/10.1016/B978-0-12-817574-3.00001-1 Copyright © 2020 Elsevier Inc. All rights reserved.
Pharmaceutical drugs only
3
4
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Purpose of treatment
Arrhythmia
Reversing arrhythmia symptoms during or after a temporary non-life-threatening illness
Hyperlipidemia Stimulating the body's natural ability to digest fats; utilization and distribution of fats for normal body functions that require fats Breaking up the clotted blood or Peripheral removal or foreign obstruction vascular within the affected vessel disease Atherosclerosis Vessel and endothelial protection, control or elimination of vessel inflammation, control or elimination of the fatty streak of the lipid layer Prophylaxis due to borderline diagnosis due to very high cholesterol levels plus age and weight with other steadily developing cardiovascular symptoms Diabetes Control of temporary blood sugar elevation or drop that has caused reversible adverse symptoms, stimulating the body's natural ability to metabolize sugars for normal body functions that require sugars Diuretics Patient experiences a stressor or the effects of an illness that raises blood pressure, causes exhaustion or physical strain, breathing difficulty, and lower body edema
Herbal formula treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Chronic Stage
Condition
Purpose of treatment
Hypertension
Stabilizing the uncontrolled stage 2 blood pressure levels when high blood pressure can affect the eyes, overall well-being, aldosterone production, and lifethreatening circulation to the brain and the kidneys. There can be suspected pheochromocytoma and bilateral renal artery stenosis or stenosis found in one or both kidneys. Patients at the chronic stage and taking nitrates for confirmed diagnoses will have a prior history of serious noncompliance. They may likely not be indicated for Chinese herbal medicine and nutritional supplements, especially vitamin C and cysteine. The effectiveness is still subjective to findings in lab studies, disease stage, body constitution, and overall prognosis. None will have satisfactory clinical effects of much significance over the long term because concentric remodeling in confirmed and advancing diseases states does not present reversal. Pharmacodynamics of nitrates can increase blood pressure and the likelihood of anginal chest pains and emergency events if
Herbal formula Treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
5
6
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Arrhythmia
Hyperlipidemia
Peripheral vascular disease
Purpose of treatment interacted with other ingested pharmaceutical drugs or Chinese herbal medications. Men are especially affected as certain blood pressure medications, with side effects that enhance experiences during sexual encounters, can experience excessively dangerous drops in blood pressure, which can be fatal. Clinical management of advancing heart failure with coronary artery disease and metabolic syndrome as causative factors involves disease surveillance, balancing health factors within subjective yet acceptable ranges. Sustaining normal rhythm to prevent asystole and sudden death Patients have vascular disease and high cholesterol levels, both of which are risk factors for atherosclerosis, myocardial infarction, stroke, and heart disease. They may be on a combination of statins and other cardiovascular drugs to reduce cholesterol levels and chances of mortality Prophylaxis against potential lifethreatening events. These types of patients may have a history
Herbal formula Treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Atherosclerosis
of gait problems when walking, pain in the legs at rest or while sleeping, and circulation problems that may be severe enough to cause blood clots under the skin surface, which result in ulceration after bursting. Underlying health conditions can include atrial fibrillation, problems with the heart valves, and possible recent heart attack/myocardial infarction. Patients at risk of life-threatening symptoms associated with atherosclerosis should be treated only with western medicine methods and approaches. One main reason is for diagnostic and follow-up monitoring of sudden death. Another reason is because patients indicated for blood thinners have an increased risk of bleeding and must use caution in diet and lifestyle, and many herbal formulations will enhance the effects of the drug to dangerous levels. For many patients, medication and lifestyle changes can reduce the health risk and may help them become indicated for the benefits of nutritional supplements and herbal medicines in the future. Prophylaxis due to diagnosis of very high cholesterol levels plus age and weight, other steadily developing cardiovascular symptoms, positive stress test, and percutaneous intervention (PCI) result of 50% or more occlusion
7
8
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Purpose of treatment
Diabetes
Confirmed diabetes diagnosis, patients can present with at least two other common occurrences concerning glycemic levels. The first is diabetic dermopathy. This condition involves the skin, and complaints range from itchiness, flakiness, and acanthosis nigricans of the neck, back, arm pits, elbows, knuckles, and knees to hemorrhage and erosion ulcers that are often complicated by fungal and bacterial infections. The second is hypoglycemia. This happens in patients who are using injected or oral insulin and can occur in patients with diabetes for a variety of reasons including insulin resistance and lack of insulin production. Treatment strategy must include the type and stage of the diabetes and body constitution. Patients should understand proper timing, such as how to predict peak action of insulin when indicated snacks, meals, herbs, and nutritional supplements can be integrated with oral or injected pharmaceutical drugs. Patients with chronic and confirmed diabetes type 1 and 2 frequently
Herbal formula Treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Diuretics
monitor for several complications including diabetic ketoacidosis (DKA). DKA is preventable but when it does occur symptoms are typically dehydration with elevated glucose levels. They are hospitalized to rehydrate, restore electrolytes, and bring elevated glucose levels under control and stabilized. For patients with uncontrollable diabetes, those who are noncompliant, with DKA or kidney disease, herbs and nutrients may mostly likely be prohibited due to monitoring of a restricted diet, and pharmaceutical drug therapy is required. Heart failure and or kidney failure impending or diagnosed, which compromises overall well-being or threatens life Some patients may need to live on a fluid restriction, including drinks and food, of a minimum of 1 L up to a maximum of 2 L daily. Some patients may need to live on a salt restriction to assist with the desire to drink more fluids.
9
10
Chapter 1 Establishing a therapeutic rationale during treatment
Recovery Stage
Condition Hypertension
Purpose of Treatment
Implementing a strategy to reduce the effects of hypertension, which includes adopting a sustainable lifestyle, earlier blood pressure detection, and understanding of appropriate treatment hierarchies from prevention to surgical intervention leading toward mortality During the recovery stage, when a patient is weaning off of calcium channel blocker (CCB) drug therapy to herbal formulas for hypertension, patients often adopting a lifestyle that improves health. Food and nutritional choices in the diet must exclude pomelo and grapefruit whole or in juices. These products interfere with the pharmacodynamics of the medication, potentially causing harm due to accumulation of unmetabolized drug within the body. It is advised to give a time window of at least 4 h between consuming grapefruit and ingesting CCBs. Reducing diastolic blood pressure in increments of 2 mmHg to help decrease the risk of stroke by 15% and the risk of coronary heart disease by 6% Hyperlipidemia Patients have vascular disease and high cholesterol levels, both of which are risk factors for atherosclerosis, myocardial infarction, stroke, and heart disease. They may be on a combination of statins and other cardiovascular drugs to reduce cholesterol levels and chances of mortality. To help with male virility, leg swelling, back pain, and overall energy. Practitioners may
Herbal formula Integrative Treatment Herbs and Pharmaceutical Only Drugs Drugs Only
Chapter 1 Establishing a therapeutic rationale during treatment
find, among other therapeutic principles, that the traditional Chinese medicine differentiations of blood deficiency and stagnation are obvious. Assisting the patient by balancing yin and yang, qi, and building blood will help them notice marked positive differences in their well-being over time. Atherosclerosis Assisting patients who are at a lower risk due to lipid imbalances and obesity yet are not indicated for drug therapy, and those not indicated for statin therapy may benefit from natural medicine for prevention. Patients who become stabilized after treatment using western medicine methods and approaches may be indicated for natural medicine in the recovery stages. These patients may also notice immune benefits of natural remedies for bacterial and viral infections and herbal medicines that help build energy and wellbeing after illness. Laboratory studies would continue to monitor progress, especially for patients still at risk of adverse health chances due to heart or vessel injuries during the chronic stages. Some patients who are under the care of western medicine physicians may be cleared to introduce natural aspects to treatment with extreme caution and monitoring, such as CoQ10, potassium, and Chinese herbal medicine formulas. These choices should coincide with and be subjective to needs seen in clinical management. Use caution with modifying formulas with herbs, kushen, milk weed, lily of the valley, hawthorn, mao di huang, shu di huang, sheng di huang, and other cardiotonic herbs with glycosides as part of plant or natural substance constituents. Peripheral vascular disease
11
12
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Diabetes
Purpose of Treatment Prophylaxis due to diagnosis of very high cholesterol levels plus age and weight, other steadily developing cardiovascular symptoms, positive stress test, and PCI result of 50% or less occlusion When weaning from nitrates to a modified lifestyle that may involve the use of other medications. When indicated, alternate Chinese medicine formula(s) that recover after illness with pharmaceutical drugs. Administer within 3 h before or after pharmaceutical drug doses. To help the body utilize and regulate normal use of glucose in the blood, normal lipid accumulation and metabolism, and sufficient blood content and levels. Single or simple herb combinations and nutritional supplementation can be used in daily health tonics, short-term regimens, and culinary use to enhance dietary practices. Understanding of the body constitution and proper timing is important. Patients must be educated on how to predict peak action of insulin and other symptoms and be guided about how to create a lifestyle to remain literate and proactive. Monitored through tapering down of prescribed pharmaceutical drugs. It is important to educate them about properly utilizing food and medicine. They should be educated about snacks and meals, and when and how to integrate single or simple herb combinations and nutritional supplements with oral or injected pharmaceutical drugs. Continue a TCM formula that recovers after illness and within 2 weeks after weaning
Herbal formula Integrative Treatment Herbs and Pharmaceutical Only Drugs Drugs Only
Chapter 1 Establishing a therapeutic rationale during treatment
Diuretics
13
from nitrates and pharmaceutical drugs; and incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Continue a TCM formula that recovers after illness and within 2 weeks after weaning from nitrates and pharmaceutical drugs; and incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Patient experiences a stressor or the effects of an illness that raises blood pressure; or causes exhaustion from physical strain, breathing difficulty, and lower body edema. Some patients may need to live on a fluid restriction, including drinks and food, of a minimum of 1 L up to a maximum of 2 L daily. Some patients may need to live on a salt restriction to assist with the desire to drink more fluids.
Prevention Stage
Condition
Purpose of treatment
Hypertension
Implementing a strategy to reduce the effects of hypertension, which includes adopting a sustainable lifestyle, earlier blood pressure detection, and understanding of appropriate treatment hierarchies from prevention to surgical intervention leading toward mortality. Reducing diastolic blood pressure in increments of 2 mmHg to help decrease the risk of stroke by 15% and the risk of coronary heart disease by 6%. Those groups include patients with a family history of hypertension, obesity, and
Herbal formula Integrative treatment herbs and Pharmaceutical only drugs drugs only
14
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Hyperlipidemia
Peripheral vascular disease
Atherosclerosis
Purpose of treatment weight gain with physical inactivity; excessive consumption of sugar, sodium, and alcohol; multigenerational American citizens with a black (African) ancestry; and physical inactivity. Patients have vascular disease and high cholesterol levels, both of which are risk factors for atherosclerosis, myocardial infarction, stroke, and heart disease. They may be on a combination of statins and other cardiovascular drugs to reduce cholesterol levels and chances of mortality. To help with male virility, leg swelling, back pain, and overall energy. Practitioners may find among other therapeutic principles that the TCM differentiations of blood deficiency and stagnation are obvious. Assisting the patient by balancing yin and yang, qi, and building blood will help them to notice marked positive differences in their well-being over time. Assisting patients who are at a lower risk due to lipid imbalances and obesity yet are not indicated for drug therapy, and those not indicated for statin therapy may benefit from natural medicine for prevention. Patients who become stabilized after treatment using western medicine methods and approaches may be indicated for natural medicine in the recovery stages. These patients may also notice immune benefits of natural remedies for bacterial and viral infections and herbal medicines that help build
Herbal formula Integrative treatment herbs and Pharmaceutical only drugs drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Diabetes
energy and well-being after illness. Laboratory studies would continue to monitor progress, especially for patients still at risk of adverse health chances due to heart or vessel injuries during the chronic stages. Some patients who are under the care of western medicine physicians may be cleared to introduce natural aspects to treatment with extreme caution and monitoring, such as CoQ10, potassium, and Chinese herbal medicine formulas. These choices should coincide with and be subjective to needs seen in clinical management. Use caution with modifying formulas with herbs, kushen, milk weed, lily of the valley, hawthorn, mao di huang, shu di huang, sheng di huang, and other cardiotonic herbs with glycosides as part of plant or natural substance constituents. Prophylaxis due to diagnosis of very high cholesterol levels plus age and weight, other steadily developing cardiovascular symptoms, positive stress test, and PCI result of 50% or less occlusion When weaning from nitrates to a modified lifestyle that may involve the use of other medications. When indicated, alternate Chinese medicine formula(s) that recover after illness with pharmaceutical drugs. Administer within 3 h before or after pharmaceutical drug doses. To help the body utilize and regulate normal use of glucose in the blood, normal lipid accumulation and metabolism, sufficient blood content and levels. Single or simple herb combinations and nutritional supplementation can be used in daily health tonics, short-term regimens, and culinary use to enhance dietary practices. Understanding of the body constitution and proper timing is important. Patients must be educated on how to predict peak action of insulin and other symptoms and be guided about how to create a lifestyle to remain literate and proactive.
15
16
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Diuretics
Purpose of treatment Monitored through tapering down of prescribed pharmaceutical drugs. It is important to educate them about properly utilizing food and medicine. They should be educated about snacks and meals, and when and how to integrate single or simple herb combinations and nutritional supplements with oral or injected pharmaceutical drugs. Continue a TCM formula that recovers after illness and within 2 weeks after weaning from nitrates and pharmaceutical drugs; incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Continue a TCM formula that recovers after illness and within 2 weeks after weaning from nitrates and pharmaceutical drugs, incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Patient experiences a stressor or the effects of an illness that raises the blood pressure, causes exhaustion from physical strain, breathing difficulty, and lower body edema. Some patients may need to live on a fluid restriction, including drinks and food, of a minimum of 1 L up to a maximum of 2 L daily. Some patients may need to live on a salt restriction to assist with the desire to drink more fluids Patients should monitor weight daily before meals. Concern is for weight gain or loss of more than 3 lb daily or 5 lb weekly.
Herbal formula Integrative treatment herbs and Pharmaceutical only drugs drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Further Reading Altschul DM, Wraw C, Der G, Gale CR, Deary IJ. Hypertension development by midlife and the roles of premorbid cognitive function, sex, and their interaction. Hypertension. 2019;73(4):812e819. https://doi.org/10.1161/ HYPERTENSIONAHA.118.12164. Bosu WK, Aheto JMK, Zucchelli E, Reilly ST. Determinants of systemic hypertension in older adults in Africa: a systematic review. BMC Cardiovasc Disord. 2019;19(1):173. https://doi.org/10.1186/s12872-019-1147-7. Published 2019 Jul 22. Bosu WK, Reilly ST, Aheto JMK, Zucchelli E. Hypertension in older adults in Africa: a systematic review and meta-analysis. PLoS One. 2019;14(4): e0214934. https://doi.org/10.1371/journal.pone.0214934. Published 2019 Apr 5. Chimberengwa PT, Naidoo M. A description of community-based participatory research of hypertension awareness, prevention and treatment in a district of Matabeleland South Province, Zimbabwe. Afr J Prim Health Care Fam Med. 2019;11(1):e1ee9. https://doi.org/10.4102/phcfm.v11i1.1839. Published 2019 Jan 31. Fisher NDL, Fera LE, Dunning JR, et al. Development of an entirely remote, nonphysician led hypertension management program. Clin Cardiol. 2019;42(2): 285e291. https://doi.org/10.1002/clc.23141. Geraci G, Buccheri D, Zanoli L, et al. Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease. Exp Ther Med. 2019;17(4):3255e3263. https:// doi.org/10.3892/etm.2019.7279. Harshfield EL, Koulman A, Ziemek D, et al. An unbiased lipid phenotyping approach to study the genetic determinants of lipids and their association with coronary heart disease risk factors. J Proteome Res. 2019;18(6): 2397e2410. https://doi.org/10.1021/acs.jproteome.8b00786. Jung HJ, Kwon TH. New insights into the transcriptional regulation of aquaporin-2 and the treatment of X-linked hereditary nephrogenic diabetes insipidus. Kidney Res Clin Pract. 2019;38(2):145e158. https://doi.org/ 10.23876/j.krcp.19.002. Kilpeläinen TO, Bentley AR, Noordam R, et al. Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. Nat Commun. 2019;10(1):376. https://doi.org/10.1038/s41467-018-08008-w. Published 2019 Jan 22. Letourneau LR, Greeley SAW. Congenital diabetes: comprehensive genetic testing allows for improved diagnosis and treatment of diabetes and other associated features. Curr Diab Rep. 2018;18(7):46. https://doi.org/10.1007/ s11892-018-1016-2. Published 2018 Jun 13. M, Huynh K, et al. Exceptional human longevity is associated with Pradas I, Jove a specific plasma phenotype of ether lipids. Redox Biol. 2019;21:101127. https://doi.org/10.1016/j.redox.2019.101127. Sanyoura M, Philipson LH, Naylor R. Monogenic diabetes in children and adolescents: recognition and treatment options. Curr Diab Rep. 2018;18(8): 58. https://doi.org/10.1007/s11892-018-1024-2. Published 2018 Jun 22. Smedegaard SB, Jørgensen JO, Rittig N. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and subsequent central diabetes insipidus: a rare presentation of pituitary apoplexy. Case Rep Endocrinol. 2019;2019: 7592648. https://doi.org/10.1155/2019/7592648. Published 2019 Apr 2.
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Chapter 1 Establishing a therapeutic rationale during treatment
Solati Z, Ravandi A. Lipidomics of bioactive lipids in acute coronary syndromes. Int J Mol Sci. 2019;20(5):1051. https://doi.org/10.3390/ijms20051051. Published 2019 Feb 28. Xie T, Gorenjak V, G Stathopoulou M, et al. Epigenome-wide association study (EWAS) of blood lipids in healthy population from stanislas family study (SFS). Int J Mol Sci. 2019;20(5):1014. https://doi.org/10.3390/ijms20051014. Published 2019 Feb 26. Yang H, Young D, Gao J, et al. Are blood lipids associated with microvascular complications among type 2 diabetes mellitus patients? A cross-sectional study in Shanghai, China. Lipids Health Dis. 2019;18(1):18. https://doi.org/ 10.1186/s12944-019-0970-2. Published 2019 Jan 18.
This chapter discusses the health factors and the purpose and possible effectiveness of isolated and integrative treatment through each stage.
Acute stage
Condition
Purpose of treatment
Hypertension
Stabilizing the patient back to normal blood pressure levels or regular life from a painful event or condition that raised the blood pressure
Herbal formula treatment only
Integrative herbs and drugs
Medical Empathy, Pharmacological Systems, and Treatment Strategies in Integrative Cardiovascular Chinese Medicine. https://doi.org/10.1016/B978-0-12-817574-3.00001-1 Copyright © 2020 Elsevier Inc. All rights reserved.
Pharmaceutical drugs only
3
4
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Purpose of treatment
Arrhythmia
Reversing arrhythmia symptoms during or after a temporary non-life-threatening illness
Hyperlipidemia Stimulating the body's natural ability to digest fats; utilization and distribution of fats for normal body functions that require fats Breaking up the clotted blood or Peripheral removal or foreign obstruction vascular within the affected vessel disease Atherosclerosis Vessel and endothelial protection, control or elimination of vessel inflammation, control or elimination of the fatty streak of the lipid layer Prophylaxis due to borderline diagnosis due to very high cholesterol levels plus age and weight with other steadily developing cardiovascular symptoms Diabetes Control of temporary blood sugar elevation or drop that has caused reversible adverse symptoms, stimulating the body's natural ability to metabolize sugars for normal body functions that require sugars Diuretics Patient experiences a stressor or the effects of an illness that raises blood pressure, causes exhaustion or physical strain, breathing difficulty, and lower body edema
Herbal formula treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Chronic Stage
Condition
Purpose of treatment
Hypertension
Stabilizing the uncontrolled stage 2 blood pressure levels when high blood pressure can affect the eyes, overall well-being, aldosterone production, and lifethreatening circulation to the brain and the kidneys. There can be suspected pheochromocytoma and bilateral renal artery stenosis or stenosis found in one or both kidneys. Patients at the chronic stage and taking nitrates for confirmed diagnoses will have a prior history of serious noncompliance. They may likely not be indicated for Chinese herbal medicine and nutritional supplements, especially vitamin C and cysteine. The effectiveness is still subjective to findings in lab studies, disease stage, body constitution, and overall prognosis. None will have satisfactory clinical effects of much significance over the long term because concentric remodeling in confirmed and advancing diseases states does not present reversal. Pharmacodynamics of nitrates can increase blood pressure and the likelihood of anginal chest pains and emergency events if
Herbal formula Treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
5
6
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Arrhythmia
Hyperlipidemia
Peripheral vascular disease
Purpose of treatment interacted with other ingested pharmaceutical drugs or Chinese herbal medications. Men are especially affected as certain blood pressure medications, with side effects that enhance experiences during sexual encounters, can experience excessively dangerous drops in blood pressure, which can be fatal. Clinical management of advancing heart failure with coronary artery disease and metabolic syndrome as causative factors involves disease surveillance, balancing health factors within subjective yet acceptable ranges. Sustaining normal rhythm to prevent asystole and sudden death Patients have vascular disease and high cholesterol levels, both of which are risk factors for atherosclerosis, myocardial infarction, stroke, and heart disease. They may be on a combination of statins and other cardiovascular drugs to reduce cholesterol levels and chances of mortality Prophylaxis against potential lifethreatening events. These types of patients may have a history
Herbal formula Treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Atherosclerosis
of gait problems when walking, pain in the legs at rest or while sleeping, and circulation problems that may be severe enough to cause blood clots under the skin surface, which result in ulceration after bursting. Underlying health conditions can include atrial fibrillation, problems with the heart valves, and possible recent heart attack/myocardial infarction. Patients at risk of life-threatening symptoms associated with atherosclerosis should be treated only with western medicine methods and approaches. One main reason is for diagnostic and follow-up monitoring of sudden death. Another reason is because patients indicated for blood thinners have an increased risk of bleeding and must use caution in diet and lifestyle, and many herbal formulations will enhance the effects of the drug to dangerous levels. For many patients, medication and lifestyle changes can reduce the health risk and may help them become indicated for the benefits of nutritional supplements and herbal medicines in the future. Prophylaxis due to diagnosis of very high cholesterol levels plus age and weight, other steadily developing cardiovascular symptoms, positive stress test, and percutaneous intervention (PCI) result of 50% or more occlusion
7
8
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Purpose of treatment
Diabetes
Confirmed diabetes diagnosis, patients can present with at least two other common occurrences concerning glycemic levels. The first is diabetic dermopathy. This condition involves the skin, and complaints range from itchiness, flakiness, and acanthosis nigricans of the neck, back, arm pits, elbows, knuckles, and knees to hemorrhage and erosion ulcers that are often complicated by fungal and bacterial infections. The second is hypoglycemia. This happens in patients who are using injected or oral insulin and can occur in patients with diabetes for a variety of reasons including insulin resistance and lack of insulin production. Treatment strategy must include the type and stage of the diabetes and body constitution. Patients should understand proper timing, such as how to predict peak action of insulin when indicated snacks, meals, herbs, and nutritional supplements can be integrated with oral or injected pharmaceutical drugs. Patients with chronic and confirmed diabetes type 1 and 2 frequently
Herbal formula Treatment only
Integrative herbs and drugs
Pharmaceutical drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Diuretics
monitor for several complications including diabetic ketoacidosis (DKA). DKA is preventable but when it does occur symptoms are typically dehydration with elevated glucose levels. They are hospitalized to rehydrate, restore electrolytes, and bring elevated glucose levels under control and stabilized. For patients with uncontrollable diabetes, those who are noncompliant, with DKA or kidney disease, herbs and nutrients may mostly likely be prohibited due to monitoring of a restricted diet, and pharmaceutical drug therapy is required. Heart failure and or kidney failure impending or diagnosed, which compromises overall well-being or threatens life Some patients may need to live on a fluid restriction, including drinks and food, of a minimum of 1 L up to a maximum of 2 L daily. Some patients may need to live on a salt restriction to assist with the desire to drink more fluids.
9
10
Chapter 1 Establishing a therapeutic rationale during treatment
Recovery Stage
Condition Hypertension
Purpose of Treatment
Implementing a strategy to reduce the effects of hypertension, which includes adopting a sustainable lifestyle, earlier blood pressure detection, and understanding of appropriate treatment hierarchies from prevention to surgical intervention leading toward mortality During the recovery stage, when a patient is weaning off of calcium channel blocker (CCB) drug therapy to herbal formulas for hypertension, patients often adopting a lifestyle that improves health. Food and nutritional choices in the diet must exclude pomelo and grapefruit whole or in juices. These products interfere with the pharmacodynamics of the medication, potentially causing harm due to accumulation of unmetabolized drug within the body. It is advised to give a time window of at least 4 h between consuming grapefruit and ingesting CCBs. Reducing diastolic blood pressure in increments of 2 mmHg to help decrease the risk of stroke by 15% and the risk of coronary heart disease by 6% Hyperlipidemia Patients have vascular disease and high cholesterol levels, both of which are risk factors for atherosclerosis, myocardial infarction, stroke, and heart disease. They may be on a combination of statins and other cardiovascular drugs to reduce cholesterol levels and chances of mortality. To help with male virility, leg swelling, back pain, and overall energy. Practitioners may
Herbal formula Integrative Treatment Herbs and Pharmaceutical Only Drugs Drugs Only
Chapter 1 Establishing a therapeutic rationale during treatment
find, among other therapeutic principles, that the traditional Chinese medicine differentiations of blood deficiency and stagnation are obvious. Assisting the patient by balancing yin and yang, qi, and building blood will help them notice marked positive differences in their well-being over time. Atherosclerosis Assisting patients who are at a lower risk due to lipid imbalances and obesity yet are not indicated for drug therapy, and those not indicated for statin therapy may benefit from natural medicine for prevention. Patients who become stabilized after treatment using western medicine methods and approaches may be indicated for natural medicine in the recovery stages. These patients may also notice immune benefits of natural remedies for bacterial and viral infections and herbal medicines that help build energy and wellbeing after illness. Laboratory studies would continue to monitor progress, especially for patients still at risk of adverse health chances due to heart or vessel injuries during the chronic stages. Some patients who are under the care of western medicine physicians may be cleared to introduce natural aspects to treatment with extreme caution and monitoring, such as CoQ10, potassium, and Chinese herbal medicine formulas. These choices should coincide with and be subjective to needs seen in clinical management. Use caution with modifying formulas with herbs, kushen, milk weed, lily of the valley, hawthorn, mao di huang, shu di huang, sheng di huang, and other cardiotonic herbs with glycosides as part of plant or natural substance constituents. Peripheral vascular disease
11
12
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Diabetes
Purpose of Treatment Prophylaxis due to diagnosis of very high cholesterol levels plus age and weight, other steadily developing cardiovascular symptoms, positive stress test, and PCI result of 50% or less occlusion When weaning from nitrates to a modified lifestyle that may involve the use of other medications. When indicated, alternate Chinese medicine formula(s) that recover after illness with pharmaceutical drugs. Administer within 3 h before or after pharmaceutical drug doses. To help the body utilize and regulate normal use of glucose in the blood, normal lipid accumulation and metabolism, and sufficient blood content and levels. Single or simple herb combinations and nutritional supplementation can be used in daily health tonics, short-term regimens, and culinary use to enhance dietary practices. Understanding of the body constitution and proper timing is important. Patients must be educated on how to predict peak action of insulin and other symptoms and be guided about how to create a lifestyle to remain literate and proactive. Monitored through tapering down of prescribed pharmaceutical drugs. It is important to educate them about properly utilizing food and medicine. They should be educated about snacks and meals, and when and how to integrate single or simple herb combinations and nutritional supplements with oral or injected pharmaceutical drugs. Continue a TCM formula that recovers after illness and within 2 weeks after weaning
Herbal formula Integrative Treatment Herbs and Pharmaceutical Only Drugs Drugs Only
Chapter 1 Establishing a therapeutic rationale during treatment
Diuretics
13
from nitrates and pharmaceutical drugs; and incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Continue a TCM formula that recovers after illness and within 2 weeks after weaning from nitrates and pharmaceutical drugs; and incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Patient experiences a stressor or the effects of an illness that raises blood pressure; or causes exhaustion from physical strain, breathing difficulty, and lower body edema. Some patients may need to live on a fluid restriction, including drinks and food, of a minimum of 1 L up to a maximum of 2 L daily. Some patients may need to live on a salt restriction to assist with the desire to drink more fluids.
Prevention Stage
Condition
Purpose of treatment
Hypertension
Implementing a strategy to reduce the effects of hypertension, which includes adopting a sustainable lifestyle, earlier blood pressure detection, and understanding of appropriate treatment hierarchies from prevention to surgical intervention leading toward mortality. Reducing diastolic blood pressure in increments of 2 mmHg to help decrease the risk of stroke by 15% and the risk of coronary heart disease by 6%. Those groups include patients with a family history of hypertension, obesity, and
Herbal formula Integrative treatment herbs and Pharmaceutical only drugs drugs only
14
Chapter 1 Establishing a therapeutic rationale during treatment
dcontinued
Condition
Hyperlipidemia
Peripheral vascular disease
Atherosclerosis
Purpose of treatment weight gain with physical inactivity; excessive consumption of sugar, sodium, and alcohol; multigenerational American citizens with a black (African) ancestry; and physical inactivity. Patients have vascular disease and high cholesterol levels, both of which are risk factors for atherosclerosis, myocardial infarction, stroke, and heart disease. They may be on a combination of statins and other cardiovascular drugs to reduce cholesterol levels and chances of mortality. To help with male virility, leg swelling, back pain, and overall energy. Practitioners may find among other therapeutic principles that the TCM differentiations of blood deficiency and stagnation are obvious. Assisting the patient by balancing yin and yang, qi, and building blood will help them to notice marked positive differences in their well-being over time. Assisting patients who are at a lower risk due to lipid imbalances and obesity yet are not indicated for drug therapy, and those not indicated for statin therapy may benefit from natural medicine for prevention. Patients who become stabilized after treatment using western medicine methods and approaches may be indicated for natural medicine in the recovery stages. These patients may also notice immune benefits of natural remedies for bacterial and viral infections and herbal medicines that help build
Herbal formula Integrative treatment herbs and Pharmaceutical only drugs drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Diabetes
energy and well-being after illness. Laboratory studies would continue to monitor progress, especially for patients still at risk of adverse health chances due to heart or vessel injuries during the chronic stages. Some patients who are under the care of western medicine physicians may be cleared to introduce natural aspects to treatment with extreme caution and monitoring, such as CoQ10, potassium, and Chinese herbal medicine formulas. These choices should coincide with and be subjective to needs seen in clinical management. Use caution with modifying formulas with herbs, kushen, milk weed, lily of the valley, hawthorn, mao di huang, shu di huang, sheng di huang, and other cardiotonic herbs with glycosides as part of plant or natural substance constituents. Prophylaxis due to diagnosis of very high cholesterol levels plus age and weight, other steadily developing cardiovascular symptoms, positive stress test, and PCI result of 50% or less occlusion When weaning from nitrates to a modified lifestyle that may involve the use of other medications. When indicated, alternate Chinese medicine formula(s) that recover after illness with pharmaceutical drugs. Administer within 3 h before or after pharmaceutical drug doses. To help the body utilize and regulate normal use of glucose in the blood, normal lipid accumulation and metabolism, sufficient blood content and levels. Single or simple herb combinations and nutritional supplementation can be used in daily health tonics, short-term regimens, and culinary use to enhance dietary practices. Understanding of the body constitution and proper timing is important. Patients must be educated on how to predict peak action of insulin and other symptoms and be guided about how to create a lifestyle to remain literate and proactive.
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dcontinued
Condition
Diuretics
Purpose of treatment Monitored through tapering down of prescribed pharmaceutical drugs. It is important to educate them about properly utilizing food and medicine. They should be educated about snacks and meals, and when and how to integrate single or simple herb combinations and nutritional supplements with oral or injected pharmaceutical drugs. Continue a TCM formula that recovers after illness and within 2 weeks after weaning from nitrates and pharmaceutical drugs; incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Continue a TCM formula that recovers after illness and within 2 weeks after weaning from nitrates and pharmaceutical drugs, incorporate formula(s) that address rhythm activity, phlegm, and blood sugar. Patient experiences a stressor or the effects of an illness that raises the blood pressure, causes exhaustion from physical strain, breathing difficulty, and lower body edema. Some patients may need to live on a fluid restriction, including drinks and food, of a minimum of 1 L up to a maximum of 2 L daily. Some patients may need to live on a salt restriction to assist with the desire to drink more fluids Patients should monitor weight daily before meals. Concern is for weight gain or loss of more than 3 lb daily or 5 lb weekly.
Herbal formula Integrative treatment herbs and Pharmaceutical only drugs drugs only
Chapter 1 Establishing a therapeutic rationale during treatment
Further Reading Altschul DM, Wraw C, Der G, Gale CR, Deary IJ. Hypertension development by midlife and the roles of premorbid cognitive function, sex, and their interaction. Hypertension. 2019;73(4):812e819. https://doi.org/10.1161/ HYPERTENSIONAHA.118.12164. Bosu WK, Aheto JMK, Zucchelli E, Reilly ST. Determinants of systemic hypertension in older adults in Africa: a systematic review. BMC Cardiovasc Disord. 2019;19(1):173. https://doi.org/10.1186/s12872-019-1147-7. Published 2019 Jul 22. Bosu WK, Reilly ST, Aheto JMK, Zucchelli E. Hypertension in older adults in Africa: a systematic review and meta-analysis. PLoS One. 2019;14(4): e0214934. https://doi.org/10.1371/journal.pone.0214934. Published 2019 Apr 5. Chimberengwa PT, Naidoo M. A description of community-based participatory research of hypertension awareness, prevention and treatment in a district of Matabeleland South Province, Zimbabwe. Afr J Prim Health Care Fam Med. 2019;11(1):e1ee9. https://doi.org/10.4102/phcfm.v11i1.1839. Published 2019 Jan 31. Fisher NDL, Fera LE, Dunning JR, et al. Development of an entirely remote, nonphysician led hypertension management program. Clin Cardiol. 2019;42(2): 285e291. https://doi.org/10.1002/clc.23141. Geraci G, Buccheri D, Zanoli L, et al. Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease. Exp Ther Med. 2019;17(4):3255e3263. https:// doi.org/10.3892/etm.2019.7279. Harshfield EL, Koulman A, Ziemek D, et al. An unbiased lipid phenotyping approach to study the genetic determinants of lipids and their association with coronary heart disease risk factors. J Proteome Res. 2019;18(6): 2397e2410. https://doi.org/10.1021/acs.jproteome.8b00786. Jung HJ, Kwon TH. New insights into the transcriptional regulation of aquaporin-2 and the treatment of X-linked hereditary nephrogenic diabetes insipidus. Kidney Res Clin Pract. 2019;38(2):145e158. https://doi.org/ 10.23876/j.krcp.19.002. Kilpeläinen TO, Bentley AR, Noordam R, et al. Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. Nat Commun. 2019;10(1):376. https://doi.org/10.1038/s41467-018-08008-w. Published 2019 Jan 22. Letourneau LR, Greeley SAW. Congenital diabetes: comprehensive genetic testing allows for improved diagnosis and treatment of diabetes and other associated features. Curr Diab Rep. 2018;18(7):46. https://doi.org/10.1007/ s11892-018-1016-2. Published 2018 Jun 13. M, Huynh K, et al. Exceptional human longevity is associated with Pradas I, Jove a specific plasma phenotype of ether lipids. Redox Biol. 2019;21:101127. https://doi.org/10.1016/j.redox.2019.101127. Sanyoura M, Philipson LH, Naylor R. Monogenic diabetes in children and adolescents: recognition and treatment options. Curr Diab Rep. 2018;18(8): 58. https://doi.org/10.1007/s11892-018-1024-2. Published 2018 Jun 22. Smedegaard SB, Jørgensen JO, Rittig N. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and subsequent central diabetes insipidus: a rare presentation of pituitary apoplexy. Case Rep Endocrinol. 2019;2019: 7592648. https://doi.org/10.1155/2019/7592648. Published 2019 Apr 2.
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Solati Z, Ravandi A. Lipidomics of bioactive lipids in acute coronary syndromes. Int J Mol Sci. 2019;20(5):1051. https://doi.org/10.3390/ijms20051051. Published 2019 Feb 28. Xie T, Gorenjak V, G Stathopoulou M, et al. Epigenome-wide association study (EWAS) of blood lipids in healthy population from stanislas family study (SFS). Int J Mol Sci. 2019;20(5):1014. https://doi.org/10.3390/ijms20051014. Published 2019 Feb 26. Yang H, Young D, Gao J, et al. Are blood lipids associated with microvascular complications among type 2 diabetes mellitus patients? A cross-sectional study in Shanghai, China. Lipids Health Dis. 2019;18(1):18. https://doi.org/ 10.1186/s12944-019-0970-2. Published 2019 Jan 18.