text:
The immune system is the body's defense against foreign substances,
such as bacteria or viruses, that may be harmful. An autoimmune disease is an
abnormal condition that occurs when a person's immune system attacks its own
tissues as though they were foreign substances.
Why the body attacks its own cells is not known. Autoimmune
diseases include lupus, rheumatoid arthritis, scleroderma, and Sjögren's
syndrome. Certain types of diabetes and thyroid disease are related to
autoimmune reactions. People who have autoimmune diseases are at an increased
risk for infections.
Last Revised:
May 10, 2012
Healthwise Staff
Medical Review:
Anne C. Poinier, MD - Internal Medicine & Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
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The Philharmonics ‒ Oblivion
Pearls of musical nostalgia
The Philharmonics, the newest and successful ensemble featuring members of the Vienna & Berlin Philharmonic Orchestras as well as two extraordinary jazz musicians lends musical treasures and especially those from imperial times a new life.
You'll always have success with Fritz Kreisler. He was not only one of the most prominent violinists in his time but also an original composer. For a long while he fooled the public and critics alike by naming others as composers of his works, until his trick was discovered and he had to admit that he had written them himself. Those pieces were never really forgotten but until recently were never heard in such a formation, namely string quartet, double-bass, clarinet and piano. Which is not a surprise since The Philharmonics has existed for just a few years. 2007 to be exact.
It all started on a Vienna Philharmonic tour of Japan. While having a shabu-shabu meal in Fukuoka, violinist Tibor Kováč and his double-bass colleague Ödön Rácz questioned why one only hears classical-romantic chamber music or waltzes from Vienna Philharmonic ensembles and never Klezmer, gypsy music, tangos or jazz although many Philharmonic members love these genres and have a good understanding of them. So they decided to take the initiative. The question remained: in which formation should they carry out their plan? With violin and double-bass they couldn't realize their demands on raising this repertoire to a philharmonic niveau, meaning the phrasing and tone-culture typical for the Vienna Philharmonic.
The ideal formation soon crystallized: string quartet, double-bass, clarinet and piano. The first concerts took the ensemble, calling itself The Philharmonics since most of its members came from the Vienna Philharmonic, to the Kittsee palace in Burgenland, to ORF and to the large hall of the Mozarteum in Salzburg, during the summer festival 2008. It was there that prominence like the conductor Riccardo Muti or mezzo-soprano Elīna Garanča sat in the audience. Not only were they enthusiastic, they also recommended them further. In the meantime The Philharmonics has its own series in Vienna's Konzerthaus, plays concerts in leading festivals from Paris, Ravenna and Dresden to Izmir or St. Petersburg. They have enthusiastic fans, sold-out concerts and standing ovations not only in Europe but also in Japan, Singapore or Brazil. In just a short time, they received a "golden disc" for their first Universal/DG CD Fascination.
The ensemble's latest CD is "The Best of" its wide reaching repertoire, so to speak, with the title Oblivion, borrowed from an Astor Piazzolla tango. This because one of the thematic starting points is the period of the dissolution of the Danube monarchy. Arranger František Jánoška gives the lyrical, slow tango a frantic-impulsive facet. Ultimately, it's exciting to remember what diversity in musical style and forms of expression there was in this multi-peopled empire. Tibor Kováč and František Jánoška capture this in the K&K Rhapsody, and when they draw their arch from the sounds of Richard Strauss' Rosenkavalier to Verdi's La forza del destino, from the popular song of a beloved Russian children's film, a Polish polka, a dance from Janáček's opera Jenufa and echoes of Fledermaus to a Hungarian csárdas. The Hungarian accent is evident as well in one of the lively Hungarian dances by Johannes Brahms and in the well-known electrifying csárdas from Ritter Pasman, the comic opera by waltz-king Johann Strauß (son), added as a bonus track.
Musical pearls are also found in neighboring Romania. The Philharmonics show it with George Enescu's popular Rumanian Rhapsody in the chamber music setting by Jacques Enoch, for which in addition the musicians came up with a virtuosic "bird-twittering" cadenza. There is also the bravura piece Hora di Mars by Grigorias Dinicu, like Enescu and Kreisler one of the most celebrated violin virtuosos of his time. Apropos Kreisler: the ensemble doesn't just play his music quasi in classical arrangements but rather in more daring adaptations. In his arrangement of Schön Rosmarin for example, Tibor Kováč shares the solo violin part with the double-bass, masterfully played by Ödön Rácz. Philharmonics pianist František Jánoška – for Bobby McFerrin the leading contemporary jazz pianist – rewrites Kreisler's Prelude and Allegro in the style of Django Reinhardt with the title Presto Fight, turning it into a brilliant jazz number, and then composes a piece called Musette pour Fritz, as a jazzy homage to Fritz Kreisler. An amusing and not at all macabre interpretation. But there's also a piece on this theme adorning the CD program: Camille Saint-Saen's mysterious Danse macabre, originally conceived for voice and piano, later reworked for violin and orchestra, and here heard in an equally effective version for strings, clarinet and piano. These like all of the other classical numbers on the program were arranged by Tibor Kováč. Second-violinist Roman Jánoška plays the jazz violin improvisations.
You also meet singing prominence on this recording: global star Patricia Petibon presents herself as musical star with the nostalgic "Somewhere" from Bernstein's most successful stage work West Side Story and with "Just the Two of Us," she is just as convincing as interpreter of what is probably Bill Withers' most popular hit, that which brought him his second Grammy. And Piotr Beczala, one of today's leading tenors, is resplendent with his glowing highs in the Berceuse from what, in the meantime, is only known anymore by its name, the opera Jocelyn from Benjamin Godard.

subset: commoncrawl


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Policy Collaboratives: Drivers of Green Building and Energy Efficiency in California
A version of this article appears in the September/October 2010 issue of Home Energy Magazine.
September 03, 2010
Despite the best efforts of governments, builders and developers are often left in the dark about changes to local building codes and initiatives. There are ways to turn the light on.
Have you ever stepped into your city's permit office, building plans in hand, only to discover that the city has passed a new green-building code or ordinance that you knew nothing about? You have no choice but to change your project, which causes delays, and since time is money, lost profits. You walk away thinking that green building is a big nuisance. Unfortunately, this scenario happens more often than most cities would like to admit.
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to email@example.com.


text:
Blogging for Business
A version of this article appears in the May/June 2013 issue of Home Energy Magazine.
May 01, 2013
It seems like everyone you talk to these days either has a blog or wants to have a blog. If your business has a web site, you've probably heard how blogging can do wonders for web site traffic and lead generation—right? It's true. In this article, I'll show you how to write a killer blog and make it work for you to grow your business. I've learned a lot and had a lot of success in my three years and 400+ articles writing the Energy Vanguard blog, and I'll tell you what you need to know to be successful with your blog.
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to email@example.com.


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Alternate Names
- Aristolochia Clematis
- Astragalus membranaceus
- Banxia Houpo Tang
- Biminne
- Bing Gan Tang
- Bupleurum, Minor
- Chinese Herbs
- Chinese Patent Remedies
- Coptis Formula
- Daio-Kanzo-To
- Fuzheng Jiedu Tang
- Hange Koboku-To
- Herbs, Chinese
- Hochu-Ekki-To
- Jianpi Wenshen Recipe
- Kampo
- Magnolia and Pinelliae Formula
- Minor Bupleurum
- Saiboku-To
- Saiko-Keishi-To
- Shakuyaku-Kanzo-To
- Shenshao
- Shosaiko-To
- Sho-Seiryu-To
- Shuang Huang Lian
- Toki-Shakuyaku-San
- Tripterygium Hypoglaucum Hutch
- Xuezhikang
- Yi Zhu Decoction
- Zemaphyte
Other Proposed Uses
- Allergies
- Angina
- Asthma
- Cancer Treatment Support
- Cardiovascular Disease
- Chronic Fatigue Syndrome
- Constipation
- Colds and Flus
- Cough
- Dementia
- Diabetes
- Eczema
- Epilepsy
- HIV Support
- Infertility in Women
- Insomnia
- Irregular Menstruation
- Irritable Bowel Syndrome
- Menopause
- Menstrual Pain
- Muscle Spasms
- Osteoarthritis
- Respiratory Infections
- Sexual Dysfunction in Men
- Stress
- Stroke Rehabilitation
- Tension Headache
- Weight Loss
The system of herbal medicine that developed in China differs in several significant ways from European herbal medicine. The most obvious difference is that the Western herbal tradition focuses on "simples," or herbs taken by themselves. In contrast, traditional Chinese herbal medicine (TCHM) makes almost exclusive use of herbal combinations. More importantly, these formulas are not designed to treat symptoms of a specific illness; rather, they are tailored specifically to the individual according to the complex principles of traditional Chinese medicine. For this reason, TCHM is potentially a deeply holistic healing approach. On the other hand, it is both more difficult to use and to study than its Western counterpart.
TCHM is widely used in Asian countries, both in its traditional holistic form and in a simplified disease-oriented version. There have been a few properly designed scientific trials of TCHM, but the evidence base remains highly inadequate. In addition to questions regarding effectiveness, there remain serious safety concerns to be resolved.
History of Chinese Herbal Medicine
Chinese herbal medicine has a long historical tradition, although it is not quite as ancient as popularly believed. Ancient herbology in China focused on potions whose function was part medicinal and part magical, and it lacked a substantial theoretical base. Sometime between the second century B.C.E. and the second century A.D., the theoretical foundations of traditional Chinese medicine were laid, but the focus was more on acupuncture than on herbs. 1 Only by about the 12th century A.D. were the deeper principles of Chinese medicine fully applied to herbal treatment, forming a method that can be called TCHM. This was further refined and elaborated during various periods of active theorizing in the 14th through the 19th centuries. Western disease concepts entered the picture in the 20th century, leading to further changes.
In China today, TCHM is used alongside conventional pharmaceutical treatment. Considerable attempts have been made to subject TCHM to scientific evaluation; however, most of the published Chinese studies on the subject fall far short of current scientific standards. (For example, they generally lack a placebo group.)
In neighboring Japan, a variation of the TCHM system known as Kampo has become popular, and the Japanese Health Ministry has approved many Kampo remedies for medical use. The scientific basis for these remedies remains incomplete, but several studies of minimally acceptable quality have been reported.
Principles of Traditional Chinese Herbal Medicine
Even a basic introduction to the principles of TCHM exceeds the scope of this article. Consider the following nothing more than a taste of this vast medical system.
According to the principles of all Chinese medicine, health exists when the body is balanced and its energy is freely flowing. The term "energy" refers to Qi, the life energy that is said to animate the body. The term "balance" refers to the relative factors of yin and yang—the classic Taoist opposing forces of the universe. Yin and yang find their expression in various subsidiary antagonists such as cold vs. heat, dampness vs. dryness, descending vs. ascending, at rest vs. active, and full vs. empty.
In an ideal state, yin and yang in all their forms are perfectly balanced in every part of the body. However, external or internal factors can upset this balance, leading to disease. Chinese medical diagnosis and treatment involves identifying the factors that are out of balance and attempting to bring them back into harmony. Diagnosis is carried out by means of "listening" to the pulse (in other words, taking the pulse with extraordinary care and sensitivity), observing and palpating various parts of the body, and asking a long series of questions.
It is important to realize that diagnosis according to TCHM differs greatly from Western diagnosis. To understand this, consider two hypothetical patients with the single Western diagnosis of migraine headaches. The first might be said to have "dryness in the liver and ascending Qi," while another might be diagnosed with "exogenous wind-cold." Based on these differing diagnoses, entirely different remedies might be applied. In other words, there is no such thing as a TCHM remedy for migraines per se; rather, treatment must be individualized to the imbalance determined by traditional theory.
The herbal formulas used in TCHM consist of four categories of herbs: ministerial, deputy, assistant, and envoy. The ministerial herb addresses the principal pattern of the disease. Deputy herbs assist the ministerial herb or address coexisting conditions. Assistant herbs are designed to reduce the side effects of the first two classes of herbs, and envoy herbs direct the therapy to a particular part of the body. For example, in the case of "dryness in the liver and ascending Qi" described above, an herbalist might employ a ministerial herb to reverse ascending Qi, a deputy herb to exert a moistening effect, an assistant herb to prevent the stagnation of Qi (Qi stagnation is said to be a side effect of moistening herbs), and an envoy to carry these effects to the liver.
TCHM remedies can also be designed to fit all common causes of migraines simultaneously, mostly by multiplying the number of ingredients. Practitioners of TCHM frown upon this "one-size-fits-all" approach, but it is often popular among consumers and easier to test scientifically.
Types of Chinese Herbal Remedies
To use Chinese herbal medicine in the most traditional fashion, you must visit an herbalist's shop. There, experienced herb preparers will chop, grind, fry, and slice dried herbs according to the prescription given by an experienced herbalist. You will walk home with a packet of dried herbs that need to be prepared according to the instructions, which typically involve adding water, boiling for several hours in a ceramic pot, pouring off the liquid, adding more water, and repeating the process twice more. Certain herbs are supposed to be added right at the end, while others require extra-long preparation.
If you don't wish to carry out such a complex process, or if a classic herbal shop is not available, you may wish to move one step away from tradition and purchase an already-prepared Kampo formula. There are several hundred such formulas designed to match the most commonly seen forms of imbalance. Available in powder, capsule, or tablet form, they can be used much more conveniently than fully traditional herbs. Many Kampo combinations are licensed in Japan and are manufactured there on a large scale by reputable manufacturers.
The lowest level of TCHM, scarcely deserving the name at all, involves so-called Chinese Patent Remedies, which consist most commonly of tiny brown spheres in small brown bottles. They are marketed both for classical imbalances and western disease categories. Patent remedies are inexpensive and widely available. However, there have been so many scandals involving dangerous contaminants not listed on the label that we recommend avoiding this form of treatment entirely. (See Safety Issues .)
In the West, herbal medicine is part of folk medicine. However, in China there is a distinct tradition of Chinese folk medicine that is separate from the orthodox, rather academic TCHM approach. In this Chinese folk medicine, herbs are used more simply, somewhat in the manner of Western herbal medicine. Herbs most commonly used in this manner include astragalus , dong quai , ginger , kudzu ( Pueraria lobata ), licorice , lycium , Panax ginseng , and schizandra . For more information on the use of these herbs, see the appropriate individual articles.
Besides herbs, substances that we might consider supplements are utilized in TCHM. These include extract of human placenta, 76 glandular extracts, and a variety of minerals.
What Is Chinese Herbal Medicine Used for Today?
In the traditional system of Chinese herbal medicine, herbal formulas can be used to treat virtually any condition. Some of the most common uses in China include liver disease ( hepatitis and cirrhosis ), sexual dysfunction in men , infertility in women , insomnia , colds and flus , menstrual pain , irregular menstruation, menopause , and cancer treatment support .
Acupuncture is often used along with herbs as a supplemental treatment; in addition, extraordinarily detailed lifestyle suggestions are common. It is not unusual for a traditional practitioner to "prescribe" dinner, as well as counsel changes in living situation (for example, move from the basement to the first floor or face the bed south rather than north). Exercise systems such as Tai Chi and Qigong may also be recommended.
What Is the Scientific Evidence for Traditional Chinese Herbal Medicine?
To establish the effectiveness of a treatment, it must be put through a double-blind, placebo-controlled trial . For this reason, our database is organized around such studies. However, there are a few issues that make it a bit difficult to study TCHM in this way.
The first problem involves diagnosis. As described above, there is no such thing as a TCHM remedy for migraine headaches, for example. Each person with migraines receives individualized treatment. This introduces an extra wrinkle for experimenters.
The best way to address this issue is as follows. People are chosen to participate in a study based on a Western diagnosis. Next, all participants are diagnosed by a classic herbal practitioner and prescribed a formula specific to their individual constitutions according to the principles of TCHM. Finally, another party steps in and provides participants with either the real formula or a placebo formula, under conditions whereby neither practitioners nor participants know which is which.
Other studies utilize a fixed remedy for all participants, in hopes that it will still prove effective on average. Such an approach doesn't really test the effectiveness of true TCHM; rather, it tests a much-simplified form of it. Still, trials of this type are valid as far as they go.
Numerous other studies simply involve enrolling people with a certain condition and giving each participant an herbal remedy. Researchers then record the extent of improvement. Such "open label" trials , however, prove virtually nothing because even phony treatments will appear to cause benefits. (For more information, see Why Does This Database Rely on Double-blind Trials? ) We do not report open label trials here.
Finally, many of these studies were performed in China, and, up to the time of this writing, research on Chinese medicine conducted in China generally falls far short of modern scientific standards of rigor. 74,75
Chronic Hepatitis
Hepatitis is a serious problem in many Asian countries, and conventional care leaves much to be desired. For this reason, herbal remedies are widely used.
The herbal combination Shosaiko-to (Minor Bupleurum) has been approved as a treatment for chronic hepatitis by the Japanese Health Ministry, and it enjoys wide use in that country and elsewhere. 2 However, a search of the literature uncovered only one large-scale, double-blind, placebo-controlled study supporting its effectiveness. 3 In this 24-week trial, the efficacy of Shosaiko-to was tested in 222 people with chronic active hepatitis using a double-blind, placebo-controlled crossover design. Results showed that use of Shosaiko-to significantly improved liver function measurements compared to placebo. Although these results are promising, an absence of long-term evaluation limits their meaningfulness. (Researchers only followed participants for 3 months.)
Other Chinese herbal remedies have been tested as adjuncts to conventional interferon treatment with promising results. 4 However, published trials are of generally poor quality.
Note: If you are on interferon therapy, you should not use Chinese herbal formulas (or any herbs or supplements) except under the supervision of a physician (see Safety Issues ).
Combination Chinese herbal therapies have also shown a bit of promise for the treatment of chronic hepatitis; tested formulas include Bing Gan Tang, Yi Zhu decoction, Fuzheng Jiedu Tang, and Jianpi Wenshen recipe. 5-7 However, the quality of most of these studies was again quite poor—the results are mixed and overall, the evidence for these remedies remains far too weak to rely upon. Two studies failed to find Chinese herbal treatment helpful for hepatitis C. 46,65
Note: There have been numerous cases of hepatitis and other forms of liver injury caused by Chinese herbs. See Safety Issues for more information.
Liver Cirrhosis
Shosaiko-to, mentioned in the previous section, has also shown some promise for preventing liver cancer and liver fibrosis in people with liver cirrhosis or chronic hepatitis. 8,9 However, the evidence remains marginal. For example, in a double-blind, placebo-controlled study, 260 people with cirrhosis were randomly assigned to take Shosaiko-to or placebo, along with conventional treatment. 10 Over 5 years of evaluation, people taking the herb appeared to be less likely to develop cancer or die, but the results just missed the ordinary cutoff for statistical significance . For the subgroup of participants without hepatitis B infection, the benefits were statistically significant at the usual cutoff point.
Irritable Bowel Syndrome
In a double-blind, placebo-controlled trial, 116 people with irritable bowel syndrome (IBS) were randomly assigned to receive individualized Chinese herbal formulations, a "one-size-fits-all" Chinese herbal formulation, or placebo. 11 Treatment consisted of 5 capsules 3 times daily, taken for 16 weeks. The results showed that both forms of active treatment were superior to placebo, significantly reducing IBS symptoms. However, the individualized treatment was no more effective than the "generic" treatment. Similar results were seen in another study as well. 67
The Kampo formula known as Daio-kanzo-to is a mixture of rhubarb and licorice. In a 2-week, double-blind, placebo-controlled trial, 132 people complaining of constipation were randomly assigned to one of three groups: placebo, low-dose Daio-kanzo-to, or high-dose Daio-kanzo-to. 12 The results indicate that the higher-dose group, but not the lower-dose group, experienced statistically significant improvements in constipation compared to placebo.
In a double-blind, placebo-controlled trial, 220 people with allergic rhinitis were given either placebo or the Kampo remedy Sho-seiryu-to for a period of 2 weeks. 13 The results showed that use of the herbal formula significantly relieved all major symptoms of allergic rhinitis compared to placebo. Based on this and other more preliminary studies, Sho-seiryu-to has been approved by the Japanese Health Ministry for the treatment of allergic rhinitis and allergic conjunctivitis.
Another combination herbal therapy has shown promise for allergic rhinitis as well. In a 12-week, double-blind, placebo-controlled trial, 58 people with allergic rhinitis were given either placebo or an 11-herb combination remedy called Biminne. 14 This combination therapy contains the following herbs:
- Rehmannia glutinosa
- Scutellaria baicalensis
- Polygonatum sibiricum
- Ginkgo biloba
- Epimedium sagittatum
- Psoralea corylifolia
- Schisandra chinensis
- Prunus mume
- Ledebouriella divaricata
- Angelica dahurica
- Astragalus membranaceus
Benefits have been seen in small studies of other formulations as well. 47,84 However, one study failed to find that use of herbal treatments augmented the effectiveness of acupuncture for allergic rhinitis. 48
A double-blind, placebo-controlled study of 96 people with osteoarthritis of the knee tested the effectiveness of a mixture of three Chinese herbs ( Clematis mandshurica , Trichosanthes kirilowii , and Prunella vulgaris ). 15 Participants were randomly assigned to placebo group or one of three other groups: 200 mg, 400 mg, or 600 mg of the herbal formula 3 times daily. After 4 weeks of treatment, significant improvement in arthritis symptoms was seen in all three treatment groups compared to placebo. No dose appeared conclusively superior to the others.
Muscle Spasms
The Kampo remedy Shakuyaku-kanzo-to is a combination of peony root and licorice , commonly used for the treatment of muscle spasms in general. In a double-blind, placebo-controlled study, 101 people with liver cirrhosis who also suffered from severe muscular spasms at least twice per week were given either Shakuyaku-kanzo-to or placebo 3 times daily for 2 weeks. 16 (The herb combination is not specifically aimed at liver cirrhosis. However, people with liver cirrhosis often have muscle spasms, so it made sense to try an anti-muscle-spasm formula on them.) The results showed significant reduction in frequency and severity of spasms among the participants using the herb compared to those taking placebo. However, some participants using the herb developed edema (swelling caused by excess fluid) and weight gain. Researchers attributed this side effect to the licorice constituent. (See Safety Issues for risks associated with the use of licorice.)
Menstrual Pain
In a double-blind trial of 40 women complaining of menstrual pain , the Kampo formula Toki-shakuyaku-san was compared to placebo with good results. 17 The design of this study was interesting because researchers preselected women who, according to the principles of traditional Chinese medicine, would be expected to respond to this Kampo treatment. Over six menstrual cycles, women using the real herbal formula experienced significantly less menstrual pain compared to those in the placebo group. Benefits took three menstrual cycles to develop.
In a 2008 review of 39 randomized controlled trials involving a total of 3,475 women, researchers concluded that the use of traditional Chinese herbs shows some promise in for the treatment of menstrual pain. However, firm conclusions were not possible due to the wide variability of study design and herbs used, as well as the poor quality of many of the studies. 77
A double-blind study of more than 200 people evaluated the effectiveness of Coptis Formula (a traditional combination therapy) with or without the drug glibenclamide for the treatment of diabetes . 18 Coptis Formula appeared to significantly enhance the effectiveness of the drug; however, the herbs produced marginal benefits at best when taken alone.
The Kampo remedy Saiboku-to has been approved by the Japanese Health Ministry for the treatment of asthma . However, meaningful supporting evidence appears to be limited to one small trial. In this double-blind, placebo-controlled crossover study, 33 people with mild to moderate asthma received Saiboku-to or placebo 3 times daily for 4 weeks. 19 Treatment with the herbal remedy improved symptoms of asthma to a greater extent than placebo. Additional measurements suggested that Saiboku-to works by reducing asthmatic inflammation (technically, eosinophilia)
A Chinese study using a proprietary formulation reported benefits as well. 61
A Chinese herbal mixture sold under the name Zemaphyte has shown promise as a treatment for eczema . This formula, based on herbs traditionally used for skin conditions, contains the following:
- Ledebouriella seseloides
- Potentilla chinensis
- Akebia clematidis
- Rehmannia glutinosa
- Paeonia lactiflora
- Lophatherum gracile
- Dictamnus dasycarpus
- Tribulus terrestris
- Glycyrrhiza uralensis
- Schizonepeta tenuifolia
However, a subsequent study of similar design performed by a different research group failed to find significant benefit with Zemaphyte. 22 The reason for this discrepancy is not clear.
In a 12-week, double-blind study, a different traditional Chinese herbal formula also failed to prove more effective than placebo for treatment of eczema. 72
Tension Headache
A topical ointment known as Tiger Balm is a popular treatment for headaches and other conditions. Tiger Balm contains camphor, menthol, cajaput, and clove oil. A double-blind study enrolling 57 people with acute tension headache compared the application of Tiger Balm to the forehead against placebo ointment, as well as against the drug acetaminophen (Tylenol). 23 The placebo ointment contained mint essence to make it smell similar to Tiger Balm. Real Tiger Balm proved more effective than placebo, and just as effective and more rapid-acting than acetaminophen.
Chinese herbal therapies have been investigated for the treatment of HIV , but the results have not been very promising. In a 12-week, double-blind, placebo-controlled trial, 30 HIV-infected adults with CD4 counts of 200 to 500 were given a Chinese herbal formula containing 31 herbs. 24 The results hint that use of the herbal combination might have improved various symptoms compared to placebo, but none of the differences were statistically significant. Interestingly, people who believed they were taking the real treatment showed significant benefit regardless of whether they were in the placebo group or the real treatment group.
In another double-blind, placebo-controlled trial, 68 HIV-infected adults were given either placebo or a preparation of 35 Chinese herbs for a period of 6 months. 25 The results indicate that use of Chinese herbs did not improve symptoms or objective measurements of HIV severity. In fact, people using the herbs reported more digestive problems than those given placebo!
Cancer Treatment
A double-blind study performed in Hong Kong evaluated the potential benefits in cancer chemotherapy of personalized herbal formulas designed according to the principles of Traditional Chinese herbal medicine. 71 In this study, 120 people undergoing chemotherapy for early-stage breast or colon cancer were given either a personalized formula or placebo. Researchers evaluated numerous possible effects of the treatment, but found benefits in only one: reduction of nausea. Note that even this single result is less meaningful than it may seem; it is statistical questionable to use a multiplicity of outcome measures. A review of 15 mostly poor quality trials with 862 patients suggested that Chinese herbal medicine might improve quality of life in patients with non-small cell lung cancer undergoing chemotherapy. 83
For several years, the Chinese herbal combination PC-SPES underwent significant investigation as a treatment for prostate cancer, with apparently impressive results. However, subsequent investigation revealed that PC-SPES contained undisclosed pharmaceutical ingredients (principally, a form of estrogen and the strong blood thinner Coumadin), and that these were probably responsible for its benefits. 26 The treatment has since been withdrawn.
Numerous studies have evaluated traditional Chinese herbal medicine for treatment of liver cancer with generally positive results. 62 However, study design and reporting were markedly substandard.
After a mastectomy, some women develop wound complications. Ninety women who had undergone a mastectomy were randomized to receive 1 of 3 treatments: routine wound care, the Chinese herb Salvia miltiorrhiza (given intravenously for 3 days), or another Chinese herb called anisodamine (also given intravenously for 3 days). 86 The women who received the herbal treatments had fewer wound complications compared to those in the routine wound care group. But, the women who took anisodamine had more adverse effects related to the treatment, like painful urination.
Other Uses for Traditional Chinese Herbal Medicine
A large, double-blind study conducted in China reported that use of the traditional remedy xue-zhi-kang by people with a previous history of a heart attack could reduce the risk that they would suffer a subsequent severe cardiovascular problem, such as a stroke or another heart attack. 63 Chinese herbal medicine may also be helpful for people with angina. In a small, randomized trial of 66 adults with stable angina, Shenshao tablets (containing ginsenosides and white peony) reduced the frequency of angina attacks. 85
In a small, double-blind, placebo-controlled trial, use of the herbal combination Banxia Houpo Tang (also called Hange Koboku-To or Magnolia and Pinelliae Formula) was tested for the treatment of impaired cough reflex in people who had suffered a stroke . 27 The results indicated that the herbal combination was more effective than placebo treatment for improving the coughing response. In another study, 140 people who recently had a stroke were randomized to receive the herbal formula sanchitongshu (200 mg three times daily) plus aspirin (50 mg once daily) or aspirin plus placebo. 88 After one month of treatment, those in the herbal formula group had a greater improvement in their neurological deficits and activities of daily living compared to the aspirin plus placebo group.
While traditional Chinese herbal medicine has a long history of use for infertility, there is not a lot of strong evidence to support its effectiveness. In a 2011 review of 14 randomized trials involving 1,316 women, the addition of Chinese herbal medicine to the prescription medication clomiphene (used to induce ovulation) was associated with increased pregnancy rates. 89 The researchers pointed out, though, that the studies were of poor quality with low sample sizes. As with the earlier review, a 2012 analysis of 30 studies, including 8 randomized trials, also found evidence to support the use of Chinese herbal medicine for improving pregnancy rates.91 This review included trials that compared Chinese herbal medicine alone, with acupuncture, or with standard drug therapy to drug therapy alone. While the researchers concluded that Chinese herbal medicine may improve pregnancy rates , as with the previous review, the quality of the studies was questionable.
Various Chinese herbal formulas have been evaluated for the treatment of respiratory infections. The results of published studies appear to indicate that these formulas are more effective than standard antibiotics, but the poor design of most of these trials precludes placing much faith in their outcomes. 28 One combination therapy called Shuang Huang Lian has better supporting evidence than most.
A review of 17 trials found that there is limited evidence to support the use of Traditional Chinese herbal preparations for the common cold . 82 Although reliable evidence supporting the benefits of Traditional Chinese herbs alone for the treatment of influenza is lacking, a randomized trial involving 410 people with H1N1 influenza found that those who took a combination of 12 Chinese herbal medicines (maxingshigan-yinqiaosan, 200 mL, 4 times daily) along with the antiviral medication oseltamivir (75 mg twice daily) for five days experienced a more rapid resolution of fever compared to those taking oseltamivir alone. 87 One double-blind, placebo-controlled study tested the remedy Hochu-ekki-to for enhancing immune response to influenza vaccine, but failed to find benefit. 63
One study evaluated the effectiveness of an herbal combination containing herbs commonly used for the treatment of cough , but failed to find the treatment effective. 66 ( Note: This study has been incorrectly reported as finding the tested treatment effective; indeed, use of the treatment did help suppress coughing, but so did the placebo treatment, and there was no significant differences between the groups.)
A double-blind, placebo-controlled study of 29 people with chronic fatigue syndrome found indications that use of the Kampo remedy Hochu-ekki-to significantly improved symptoms compared to placebo. 29
In one study, the herbal formula Duhuo Jisheng Wan, widely used for osteoarthritis , proved to be as effective as the standard anti-inflammatory drug diclofenac. 54 However, the herb caused as many side effects as the drug, and was slower to act. (It was so slow, in fact, that its benefits could have been due solely to the placebo effect.) This study did not use a placebo control group.
The Kampo remedies Saiko-keishi-to and Shosaiko-to have been suggested for the treatment of epilepsy , but the supporting evidence is too preliminary to be relied upon. 30-32 Both of these combination treatments consist of bupleurum, peony root, pinellia root, cassia bark, ginger root , jujube fruit, Asian ginseng root , Asian scullcap root, and licorice root , but the proportions are different.
In a review of 21 studies involving almost 3,000 subjects, researchers concluded that Chinese herbs were as effective as commonly prescribed medications for drug withdrawal symptoms in heroin addicts . They could not draw any conclusions, however, regarding which specific herbs were more most beneficial. 80
One study quoted as showing that a Chinese herbal formula can reduce blood pressure actually failed to find any effect on blood pressure. 64
Tripterygium hypoglaucum hutch, another type of herb that is used in TCHM, was found in one study to provide added benefit in treating hives when given along with the medication cetirizine. 90
Other traditional herbal combinations with some supporting evidence (often from studies of questionable quality) include Xiao-Yao-San (Free and Easy Wanderer) for depression and bipolar syndrome , 69,81 Mai-Men-Dong-Tang for allergic asthma , 49 Yi-Gan San for dementia , 50 Bofu-tsusho-san for weight loss and diabetes , 51 Chang Ji Tai for irritable bowel syndrome , 52 and Ondamtanggamibang (a Korean formulation) for reducing symptoms of stress . 53 Qinzhu Liangxue for psoriasis , 78 and red peony root for acute pancreatitis . 79
How to Choose a Practitioner of Traditional Chinese Herbal Medicine
There is no general certification for the practice of TCHM. Many people who are certified in acupuncture , however, have significant training in herbal medicine as well. (In general, 500 hours of specific training is considered necessary.) Some states offer the license of OMD (Doctor of Oriental Medicine); licensed OMDs are generally well versed in TCHM.
Safety Issues
There are several serious safety concerns with the use of TCHM.
One concern involves the use of multiple herbs typical in this approach. In general, conventional medicine makes a point of using as few medications as possible (in theory, at least) because the greater the number of medications, the greater the risk of harm. (Also, when medications are used together and harm does result, it's hard to know which drug was at fault.) From this perspective, formulas consisting of 5, 10, or 30 herbs are quite worrisome.
Interestingly, such combinations are actually designed for the purpose of reducing risks. According to TCHM theory, the various herbs in a formula balance and moderate each other. Unfortunately, this theory has never been put to the test, and there are reasons not to trust it. Simply put, it is very difficult to get an accurate picture of the risks of a treatment if you don't keep systematic records of adverse effects, and the ancient Chinese government had no such system in place. In any case, the individualized nature of treatment would make it almost impossible to track harm. Herbalists would be expected to notice immediate, dramatic reactions to herbal formulas, and one can assume with some confidence that treatments used for thousands of years are at least unlikely to cause such problems in very many people who take them. However, certain types of harm could be expected to easily elude the detection of traditional herbalists. These include safety problems that are delayed, occur relatively rarely, or are difficult to detect without scientific instruments. How would a traditional herbalist ever know, for example, if a treatment caused liver failure in one out of 100,000 people who used it, especially if such failure took 2 or more years to develop? If such a death did occur in the herbalist's patient population, it would probably be attributed to hepatitis or some other common cause.
These factors may explain why Chinese herbal medicine traditionally uses treatments that are now recognized as potentially dangerous, such as mercury, arsenic, lead, licorice, coltsfoot, and Aristolochia.
Mercury, arsenic, and lead accumulate slowly in the body, and for many years their harm can only be detected by lab tests. Licorice (used in many herb formulas to "harmonize" the ingredients) can raise blood pressure and disturb blood chemistry. 33,34 These effects were presumably undetectable to traditional practitioners unless they became quite severe. The herb Aristolochia can cause severe kidney damage and kidney cancer, but only rarely. Modern medical surveillance has uncovered quite a few such cases, 35 but traditional herbology considered the herb worth using. Aristolochia contains aristolochic acid, a substance shown in animal studies to damage the kidney when taken in high enough doses. Chinese herbal products generally list Aristolochia on the label when it is present, but in some cases, Aristolochia was apparently added accidentally—it is similar in appearance to a much safer herb.
Coltsfoot ( Tussilago farfara ), used in Chinese cough syrups and other formulations, contains pyrrolizidine alkaloids, substances that can over time damage the liver. This also does not appear to have been noticed by traditional herbalists. Under modern conditions of medical surveillance, many incidents have been reported in which use of Chinese herbs appears to have various forms of liver injury, including acute hepatitis, chronic hepatitis, hepatic fibrosis, and acute liver failure. 44,55,56,68 Ancient herbal practitioners might not have been able to distinguish these herb-induced illnesses from the effects of infectious hepatitis, a widely prevalent condition, and thereby failed to make the connection; even today, in fact, it appears that many cases of liver failure attributed to hepatitis have in fact been caused by the Chinese herbs used to treat hepatitis! 68
Other reported complications of Chinese herbal treatments include movement disorders and ovarian failure. 57,58
Another set of potential problems arises from the fact that Chinese herbal medicine does not restrict itself to plant products with subtle effects. Many traditional Chinese herbal remedies are, simply put, poisons. When taken in proper doses, they may be safe for use, but dosage miscalculation or use in a particularly susceptible person may lead to serious consequences, including death. For example, in Hong Kong, poisoning caused by the herb aconite (used in numerous Chinese herbal formulas) was sufficiently widespread that public health authorities felt it necessary to launch an information campaign to combat the problem. 45
Besides toxicity caused by Chinese herbs, other problems have been caused by adulteration of herbal products with unlisted ingredients. 36 For example, the Chinese herbal formula PC-SPES, used for prostate cancer, turned out to contain three pharmaceutical drugs—diethylstilbestrol (DES), warfarin (Coumadin), and indomethacin. This appears to have been an intentional adulteration designed somewhat along the lines of a traditional Chinese formula, with one pharmaceutical adulterant that treated prostate cancer balanced by two others to offset the side effects of the first. Unfortunately, the combination is dangerous and has caused at least one case of severe bleeding. 37
In another episode, 8 out of 11 Chinese herbal creams sold in the United Kingdom for the treatment of eczema were found to contain strong pharmaceutical steroids. 38 Other studies have also found steroids in eczema preparations. 59 In addition, Chinese herbal weight loss aids have also been found to contain an unlisted chemical related to the appetite suppressant drug fenfluramine (of fen-phen fame). 60
Herbal products approved by the Japanese government have undergone meaningful safety testing and are very unlikely to contain known toxins or unlisted drugs. However, this does not mean they are completely safe. For example, several case reports suggest that therapy for chronic hepatitis combining an approved herbal formula with the standard drug interferon can cause severe inflammation of the lungs. 39-43
The herbal formulas Takeda Kampo Ichoyaku K-matsu, Taisho Kampo Ichoyaku, and Kanebo Kampo Ichoyaku Hused, all used to treat upset stomach, might reduce the effectiveness of the Parkinson's disease medication levodopa . 70
The bottom line: TCHM is a potentially dangerous form of treatment that should only be used under the supervision of a physician.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 08/2012 -
- Update Date: 08/29/2012 -


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Lubrication systems
All equipment, whether it is rotating or linear motion, needs to be lubricated in order to perform according to specification.
SKF lubrication products are available for any type of vessel. In fact, many lubrication applications on a ship can be completed more efficiently and safely with SKF and Lincoln lubrication systems.
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Principal Proposed Uses
Other Proposed Uses
- Anxiety
- Cancer Prevention
- Depression
- Viral Infections
Citrus aurantium is the Latin name for a fruit called Seville orange, or bitter orange. The juice, peel, and essential oil have all been used medicinally. Traditionally uses include digestive problems, epilepsy, fatigue, insomnia, infections, respiratory problems, skin problems, and many other uses. As a flavoring, essence of bitter orange is found in the drinks Triple Sec and Cointreau.
What is
Citrus aurantium juice and peel contain the stimulant chemical synephrine as well as related stimulants such as octopamine, tyramine, N-methyltyramine, and hordeline. On this basis, Citrus aurantium has been widely marketed as a weight-loss product . However, there is no reliable evidence that Citrus aurantium is effective, and considerable reason to worry that it may cause harm (see Safety Issues ). The reassuring statement made by some manufacturers that Citrus aurantium offers the "benefits of ephedra without the risks" is not supported by scientific evidence.
The only published double-blind, placebo-controlled trial on Citrus aurantium juice did not test the herb alone, but rather evaluated a combination product that also contained caffeine and St. John's wort . 1 While the results were somewhat positive, overall the study was too preliminary to reach reliable conclusions. An even less reliable study evaluated the synephrine constituent of Citrus aurantium and found possible "fat burning" actions. 2 In view of the weakness of the evidence in favor of Citrus aurantium , and the considerable evidence that it presents health risks, we recommend against using it for weight loss.
Other evidence, far too weak to rely upon at all, hints that synephrine-rich Citrus aurantium extracts might have antidepressant effects . 3,4
Besides synephrine and other stimulants, whole Citrus aurantium peel contains including citral, limonene, and several citrus bioflavonoids , including hesperidin, neohesperidin, naringin, and rutin. Weak evidence hints that these substances might have cancer-preventive5,6 and antiviral actions. 7
The essential oil of Citrus aurantium contains linalool and the fragrant substance limonene and might have antianxiety and sedative effects. 8 However, neither of these proposed uses has more than extremely preliminary supporting evidence.
Many Citrus aurantium products are made from the juice and/or concentrated extracts of the peel and are said to contain a fixed percentage of synephrine or total amines. A typical recommended dosage of such products ranges from 100–150 mg two to three times daily. However, these doses may be unsafe.
Safety Issues
Most of the safety concerns regarding citrus aurantium relate to its stimulant constituents.
The drug synephrine is known to produce many unpleasant and possibly dangerous side effects, including headache, agitation, rapid heart rate, and heart palpitations. In some people, it can cause angina pectoris , kidney damage, increased pressure in the eye, and reduced blood circulation to the heart and the extremities. The other stimulant amines in Citrus aurantium may increase such effects. There is one case report of a heart attack that appears possibly related to use of a citrus aurantium supplement, 9 and another that links the herb to stroke. 14Citrus aurantium juice or concentrated extracts can raise blood pressure and increase heart rate 15 and therefore should not be used by individuals with cardiovascular disease or high blood pressure . The herb should also be avoided by people with glaucoma .
Synephrine can also interact with numerous medications and other drugs, including stimulants (e.g., ephedrine , pseudoephedrine (Sudafed), Ritalin, and even caffeine) and anesthetics. The tyramine constituent of Citrus aurantium can cause deadly side effects when combined with drugs in the MAO inhibitor family.
The peel and essential oil of Citrus aurantium may cause photosensitivity (increased tendency to react to sun exposure). For this reason, combination treatment with drugs that cause the same side effect (such as sulfa antibiotics ) is not recommended.
Finally, Citrus aurantium juice can alter the way that the liver processes various medications, potentially raising or lowering their levels. 10-13
In particular, the drugs cyclosporine and felodipine (a calcium channel blocker ) are thought to be affected by Citrus aurantium juice, but numerous other drugs may interact with it as well. For this reason, we recommend that if you are taking any medication that is critical to your health, you should not take Citrus aurantium juice.
Safety in young children, pregnant or nursing women, or people with severe liver or kidney disease has not been established.
Interactions You Should Know About
If you are taking
- Drugs in the MAO inhibitor family: Do not use Citrus aurantium at all.
- Ephedrine, pseudoephedrine (Sudafed), Ritalin, cyclosporine , calcium channel blockers, drugs that cause photosensitivity (such as sulfa antibiotics ), or any medication that is critical to your health: Do not use Citrus aurantium without consulting a physician.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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Shop the skirts trending now. The new season calls for vibrant colours, gingham print and pretty embroidery, as well as cool denim skirts and oversized maxi skirts. The midi skirt is still a key length for Spring/Summer – think metallic pleats, tough PU or slick leather pencil skirts. Want shoes to style them with? Do longer lengths with platform heels and trainers, or style mini skirts with sliders or tie-up sandals .
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Gold BackgroundThese sticker magnets offers you much fun in the office and at home. Suitable as fridge magnets or on writing boards, these lightweight sticker magnets are a great little decorative accessory or as novelty gifts. Magnet measures 3"(w) x 3"(h).
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Need a strong guy to move your stuff? Veterans work together to create a moving company in New York City.
Star Shine NYC in lower Manhattan features a staff of scantily clad women, flat-screen TVs and - soon - a liquor license.
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The glass doors in front are heavily darkened. You can see if there's someone on the other side (so you don't whack them) but they're too dark to make out any details about them.
As I'm leaving with my Bag-O-Dinner, I was starting to push the door open. At the same time a child suddenly appeared on the other side of the door, starting to come in. He jumped back as I pushed the door open, and I almost hit him with it.
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Mazda6 Performance Parts : Intake Kits/Air Filters
Racing Beat Recommended Accessories:
K/N Recharger Kit
The K&N Recharger Kit (K&N 99-5000) is designed to clean and re-oil any K&N filter. A two-step process is used to clean and re-oil the filter for repeated use. Simply remove the filter element from the car, spray on the cleaning solution, let...


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Clinical Trials
Effects on the Immune System of Anti-HIV Drugs in Patients Recently Infected With HIV
National Institute of Allergy and Infectious Diseases (NIAID)
Information provided by (Responsible Party)
National Institute of Allergy and Infectious Diseases (NIAID)
First received: November 2, 1999
Last updated: March 1, 2011
Last Verified: January 2005
History of Changes
The purpose of this study is to find out whether these powerful combinations of anti-HIV
drugs are safe and effective for use in patients in the early stages of HIV infection and to
find out how patients' immune systems react to HIV and anti-HIV drugs.
Doctors generally treat patients in the early stages of HIV infection with the same anti-HIV drugs taken by patients who have had HIV for a long time. These drugs lower the level of HIV in the blood. However, doctors do not know whether patients who take anti-HIV drugs in the early stages of HIV infection actually live longer or have fewer AIDS-related diseases. This study will help doctors answer these questions. In the main study, doctors will look at how 2 different anti-HIV drug combinations affect the immune system. In the 2 substudies, doctors will look at how the body reacts to the hepatitis B vaccine and the tetanus vaccine. These substudies may help doctors learn how HIV-infected patients respond to new infections.
HIV Infections
Biological : Tetanus Toxoid Vaccine
Drug : Indinavir sulfate
Drug : Lamivudine/Zidovudine
Drug : Ritonavir
Drug : Abacavir sulfate
Drug : Amprenavir
Drug : Efavirenz
Biological : Hepatitis B Vaccine (Recombinant)
Drug : Lamivudine
Drug : Zidovudine
|Study Type:
|Study Design:
Primary Purpose: Treatment
|Official Title:
|A Study of the Effects of Combination Antiretroviral Therapy in Acute HIV-1 Infection With an Emphasis on Immunological Responses
Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):
|Study Start Date:
|October 1999
|Primary Completion Date:
|June 2004 (Final data collection date for primary outcome measure)
Detailed Description:
Current treatment guidelines recommend combination ART for acute primary HIV-1 infection.
However, it is not known whether ART given during acute infection delays progression to AIDS
or improves survival rates. Preliminary studies suggest ART given early in HIV infection not
only reduces viral load but also restricts CD4+ cell loss, delays the development of
opportunistic infections, and preserves T-helper cells and naive T cells. The immunologic
basis of these protective effects has not been characterized thoroughly. This protocol
assesses ART's effects on immune responses in early HIV infection through a variety of
cellular, humoral, and virologic assays, including 2 substudies. The substudies focus on
antibody responses to neoantigen immunization (hepatitis B and tetanus). Primary endpoint
analysis occurs at Week 72, but patients may be followed for long-term outcomes.
In the main study, patients with HIV-1 infection of less than 120 days are given the option of taking a potent ART combination of abacavir (ABC), efavirenz (EFV), indinavir (IDV), and lamivudine (3TC) for 96 weeks. [AS PER AMENDMENT 9/15/00: Patients choose either Regimen 1: ABC, 3TC, IDV, and ritonavir (RTV) or Regimen 2: ABC, 3TC, and EFV.] Patients who decline treatment provide a concurrent, non-randomized comparison group. These patients may choose to be considered for study treatment at any time or to start antiretrovirals provided through another source. [AS PER AMENDMENT 9/15/00: If a patient who initially does not start therapy subsequently starts antiretroviral therapy provided by the study (within the 120-day limit), the visit schedule is re-set.] During the treatment period, all patients undergo regular physical exams and blood tests to characterize T cells, viral resistance, antibody responses, and other markers. Patients presenting within 30 days of HIV-1 infection undergo leukapheresis (where available) prior to starting ART. At Month 12, these patients and all untreated patients undergo leukapheresis to assess the proportion of latently infected CD4+ T cells. In addition, all patients in the main study and patients in 2 comparison groups (Cohorts A and B) participate in 1 of 2 substudies of antibody responses to neoantigen. Volunteers are recruited to 2 cohorts to serve as controls. Cohort A volunteers have established HIV-1 infection. Cohort B volunteers are HIV-1 seronegative but at high risk for HIV. In the first substudy, hepatitis B-seronegative patients from the main study and from Cohorts A and B receive hepatitis B vaccine at Weeks 40, 44, and 64 and undergo humoral and cellular response assessments at Week 68. In the second substudy, patients from the main study and from Cohorts A and B who did not qualify for the hepatitis B vaccination undergo intramuscular vaccination with tetanus toxoid at Week 64 and immune responses are assessed at Week 68. Volunteers in Cohorts A and B receive no anti-HIV medication as part of these substudies.
|Ages Eligible for Study:
|16 Years and older
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria
Patients may be eligible for the main study if they:
- Became infected with HIV within the last 120 days.
- Are at least age 16 and have written consent of a parent or guardian if under 18.
- Are willing to practice abstinence or use barrier methods of birth control, such as condoms.
- Are available for at least 72 weeks.
- Patients may be eligible for 1 of the 2 substudies if they:
- Are at least age 16 and have written consent of a parent or guardian if under 18.
- Have had HIV infection for more than 1 year and have a CD4 cell count greater than 500 cells/mm3, or do not have HIV infection but are at risk of getting HIV because of their lifestyle, such as sexual activity or injection drug use.
- Have never had hepatitis B infection or a hepatitis B vaccine and they are available for 28 weeks (hepatitis B vaccine substudy only).
- Have not received a tetanus shot in the past 5 years, have never had an allergic reaction to a tetanus shot, and are available for 8 weeks (tetanus shot substudy only).
- Have taken anti-HIV drugs for more than 7 days for the treatment of HIV. However, anti-HIV drugs taken to help prevent HIV are acceptable.
- Have certain types of cancer.
- Are receiving an experimental treatment.
- Are pregnant or breast-feeding.
- Are allergic to study drugs.
- Have taken certain medications that may interfere with the study.
- Patients will not be eligible for 1 of the 2 substudies if they:
- Are receiving an experimental treatment.
- Are pregnant or breast-feeding.
Exclusion Criteria
Patients will not be eligible for the main study if they:
Contacts and LocationsChoosing to participate in a study is an important personal decision.Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00001119
Locations Show More
|United States, California
|San Francisco Dept of Hlth / AIDS Office
|San Francisco, California, United States, 94102
|United States, Illinois
|Univ of Illinois Chicago / Howard Brown Hlth Ctr
|Chicago, Illinois, United States, 60612
|United States, Massachusetts
|Fenway Community Health Ctr / HIVNET
|Boston, Massachusetts, United States, 02115
|United States, Minnesota
|Univ of Minnesota
|Minneapolis, Minnesota, United States, 55455
|United States, New York
|Bronx-Lebanon Hosp Ctr
|Bronx, New York, United States, 10453
|New York Univ Med Ctr
|New York, New York, United States, 10016
|United States, Ohio
|Univ of Cincinnati
|Cincinnati, Ohio, United States, 452670405
|United States, Rhode Island
|Mem Hosp of Rhode Island
|Pawtucket, Rhode Island, United States, 02860
|United States, Washington
|Seattle HIVNET
|Seattle, Washington, United States, 98104
|Univ of Washington
|Seattle, Washington, United States, 98104
|Fred Hutchinson Cancer Research Ctr
|Seattle, Washington, United States, 98109
|Saint Vincent's Hosp Med Centre
|Darlinghurst, Australia
Sponsors and CollaboratorsNational Institute of Allergy and Infectious Diseases (NIAID)
|Study Chair:
|Lawrence Corey
More Information
|Responsible Party:
|National Institute of Allergy and Infectious Diseases (NIAID)
|ClinicalTrials.gov Identifier:
|NCT00001119 History of Changes
|Other Study ID Numbers:
|Study First Received:
|November 2, 1999
|Last Updated:
|March 1, 2011
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):Immunity, Cellular
Drug Therapy, Combination
HIV Protease Inhibitors
Antibody Formation
Reverse Transcriptase Inhibitors
Anti-HIV Agents
Viral Load
Tetanus Toxoid
Case-Control Studies
Hepatitis B Surface Antigens
Acute Infection
Additional relevant MeSH terms:
Lamivudine, zidovudine drug combination
ClinicalTrials.gov processed this data on March 27, 2020
This information is provided by ClinicalTrials.gov.


text:
New & Notable
A version of this article appears in the May/June 2006 issue of Home Energy Magazine.
May 01, 2006
Notable Products: Energy Recovery Ventilator, Chillin' with the Ice Bear
Energy Recovery Ventilator Energy recovery ventilators (ERVs) capture much of the heat and humidity from stale indoor exhaust air and transfer it to the incoming ventilation air during the winter. During the summer, they transfer heat and moisture from the makeup air to the exhaust air to keep the house cooler and drier while supplying air changes.The use of desiccant systems for humidity conditioning sets ERVs apart from the simpler heat recovery ventilators (HRVs), which transfer heat only. The UltimateAir RecoupAerator 200DX energy recovery ventilation system from Stirling Technology, Incorporated, couples up to 96% heat recovery with exceptional operating efficiency. While the efficiency of conventional permanent split capacitor (PSC) motors drops quickly when running at less than 100% of the rated speed, the brushless DC variable-speed electronically commutated permanent-magnet (ECPM) motor in the 200DX provides almost vanishing power consumption at low speeds. It uses only 34 watts at 70 CFM and 200 watts at 210 CFM. Its low-speed operating efficiency is an industry benchmark— a particularly important advance, as these ventilation products often run nonstop, usually at low speeds.The Electricity Use Index (EUI) is a measure of watts used per CFM ...
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to firstname.lastname@example.com.


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Mercury toxicity occurs when a person is exposed to mercury. Mercury is a naturally occurring heavy metal. Short- or long-term exposure to mercury can cause serious health problems.
Mercury has several forms, including:
- Metallic mercury—a shiny, silver-white, odorless liquid that becomes a colorless, odorless gas when heated
- Methylmercury—a chemical made up of mercury combined with carbon, mainly produced by microscopic organisms in the water and soil
- Mercury salts—white powders or crystals formed when mercury combines with elements such as chlorine, sulfur, or oxygen
Metallic mercury and methylmercury easily reach the brain and are more harmful than mercury salts.
Mercury toxicity may occur when you are exposed to toxic amounts of mercury due to:
- Breathing airborne mercury vapors
- Eating contaminated food, especially fish or shellfish—Larger and older fish tend to have the highest levels of mercury.
- Drinking water contaminated with mercury (rare)
- Practicing religious or folk medicine rituals that include mercury
Metallic mercury can be found in consumer products such as fluorescent light bulbs, batteries, thermostats, and old thermometers. Mercury, combined with other elements, is also found in some types of dental fillings. Research has not shown that this type of filling is harmful to people. Although thimerosol is no longer used in vaccines in the US, the mercury-containing compound is still used in some countries. Research has not shown that it is harmful to people.
Risk Factors
Anyone can develop mercury toxicity as a result of mercury exposure. Certain people are more likely to be exposed to mercury. The following factors increase your chances of being exposed to mercury. If you have any of these risk factors, tell your doctor:
Working in:
- Dental services
- Health services
- The chemical industry
- Other industries that use mercury
- Electric meter repair
- Eating over 6 ounces of white albacore tuna per week
- Eating over 12 ounces a week of fish and shellfish that is considered lower in mercury, such as shrimp, canned light tuna, salmon, pollock, and catfish
- Practicing rituals that include mercury
In addition, pregnant women, their unborn fetuses, and young children are especially vulnerable to the harmful effects of mercury exposure.
Mercury can cause harmful effects before symptoms develop. It is important to contact your doctor right away if you think you have been exposed to mercury, regardless of your symptoms. When symptoms do develop, they may include:
- Redness of the extremities, chest, and nose (dusky pink hands and feet)
- Nausea, vomiting, or diarrhea
- Abdominal pain
- Coughing and chest pain
- Peeling of the hands and feet
- Painful extremities
- Tremors
- Changes in vision or hearing
- Insomnia
- Weakness
- Memory problems
- Headache
- Rapid heart beat
- Eye irritation
- Irritability
- Breathing problems
- Painful mouth
- Fever and/or chills
- Difficulty concentrating
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests may include:
- Blood tests
- Urine tests
- Scalp hair analysis
The most important thing is to stop mercury exposure. Talk with your doctor about other treatments for you. Treatment options include:
Chelation Therapy
Chelation therapy involves putting a chemical known as a chelating agent into the bloodstream. The chelating agent combines with mercury to help remove it from the body. Chelating agents may be given by pill or by injection.
To help reduce the chances of mercury toxicity:
- Avoid using metallic mercury for any purpose.
- If you must use metallic mercury, keep it safely stored in a leak-proof container in a secure space, such as a locking closet.
- Trade in old thermometers or barometers containing mercury for new ones that do not.
- Carefully handle and dispose of items containing mercury, such as thermometers and fluorescent light bulbs.
- Do not vacuum or heat spilled mercury.
- Teach children not to play with silver liquids.
- Properly dispose of old medications that contain mercury.
- Keep mercury-containing medications away from children.
- Learn about wildlife and fish advisories in your area from your local public health or natural resources department.
Limit fish intake to recommended quantities and avoid fish known to be contaminated by mercury:
- Do not eat shark, swordfish, king mackerel, or tilefish.
- Eat up to 12 ounces of fish and shellfish considered lower in mercury per week. These fish include shrimp, canned light tuna, salmon, pollock, and catfish.
- Eat up to 6 ounces of white albacore tuna per week.
- If you want to eat local fish, check to make sure the water is not contaminated. In general, limit your intake of local fish to 6 ounces.
If you spill a small amount of metallic mercury:
- Remove children from the area.
- DO NOT use a vacuum cleaner.
- Carefully roll the bead of mercury onto a sheet of paper or suck it up with an eyedropper.
- Place the bead in a bag or airtight container.
- Contact your local health department to find out how to dispose of the mercury and paper or eye dropper.
- Ventilate the room to the outside.
- Use fans to speed ventilation for at least 1 hour.
Revision Information
- Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
- Review Date: 03/2018 -
- Update Date: 03/18/2013 -


text:
Principal Proposed Uses
For millennia, fenugreek has been used both as a medicine and as a food spice in Egypt, India, and the Middle East. It was traditionally recommended for increasing milk production in nursing women and for the treatment of wounds, bronchitis, digestive problems, arthritis, kidney problems, and male reproductive conditions.
What Is Fenugreek Used for Today?
Present interest in fenugreek focuses on its potential benefits for people with diabetes or high cholesterol . Numerous animal studies and preliminary trials in humans have found that fenugreek can reduce blood sugar and serum cholesterol levels in people with diabetes. It may also be helpful for relief of constipation and menopausal symptoms.
What Is the Scientific Evidence for Fenugreek?
In a 2-month, double-blind study of 25 individuals with type 2 diabetes, use of fenugreek (1 g per day of a standardized extract) significantly improved some measures of blood sugar control and insulin response as compared to placebo. 5 Triglyceride levels decreased and HDL ("good") cholesterol levels increased, presumably due to the enhanced insulin sensitivity.
In a randomized trial of 88 women with moderate to severe postmenopausal symptoms, fenugreek seed husk extract was associated with a reduction in hot flashes when compared to placebo. Fenugreek also improved physical and mental fatigue, and overall well-being.8
Similar benefits have been seen in animal studies and open human trials, as well. 1,2,3
Because the seeds of fenugreek are somewhat bitter, they are best taken in capsule form. The typical dosage is 5 to 30 g of defatted fenugreek taken 3 times a day with meals. The one double-blind study of fenugreek used 1 g per day of a water/alcohol fenugreek extract.
Safety Issues
As a commonly eaten food, fenugreek is generally regarded as safe. The only common side effect is mild gastrointestinal distress when it is taken in high doses.
Animal studies have found fenugreek essentially non-toxic, 6 and no serious adverse effects have been seen in 2-year follow-up of human trials. 7
However, extracts made from fenugreek have been shown to stimulate uterine contractions in guinea pigs. 4 For this reason, pregnant women should not take fenugreek in dosages higher than is commonly used as a spice, perhaps 5 g daily. Besides concerns about pregnant women, safety in young children, nursing women, or those with severe liver or kidney disease has also not been established.
Because fenugreek can lower blood sugar levels, it is advisable to seek medical supervision before combining it with diabetes medications.
Interactions You Should Know About
If you are taking diabetes medications, such as insulin or oral hypoglycemic drugs , fenugreek may enhance their effects. This may cause excessively low blood sugar, and you may need to reduce your dose of medication.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 04/24/2017 -


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text: Tuesday, February 05, 2013 CMS Clarifies Therapy Cap Exceptions for Critical Access Hospital Patients In a meeting with APTA yesterday, the Centers for Medicare and Medicaid Services (CMS) clarified the impact of the therapy cap on patients who receive outpatient therapy services in critical access hospitals (CAHs). CMS stated that for 2013, when a patient receives outpatient therapy services from a critical access hospital, the services will count toward dollars accrued toward the therapy cap. For example, if a patient receives $2,000 of outpatient therapy services in a CAH and upon discharge goes to a private practice to continue therapy services, the private practice would need to obtain an exception (in this case use the KX modifier). However, CMS clarified that for 2013 the therapy cap does not apply to outpatient therapy services provided within CAHs themselves. This means that if the patient continued treatment in the critical access hospital, after exceeding $1,900 in therapy services, there would be no need to seek an exception through the automatic process. That is, the CAH would not need to submit the claim with a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH, the hospital would not need to obtain an exception through the manual medical review process. APTA had been seeking clarification on this issue from CMS since the January 1 passage of the American Taxpayer Relief Act of 2012 (HR 8), which extended the current 2-tier therapy cap exceptions process through 2013. The agency advised APTA last month that it was working with its general counsel for interpretation of the legislative language. Comments And the double standard continues in the name of higher costs. Posted by Kirk on 2/8/2013 4:56 PM Really? So once again private practice PT's take it in the shorts................ Posted by Sue Jeffrey on 2/8/2013 5:01 PM This is great - could you answer a further point for us? If the patient has already met their cap at a private practice or other outpatient facility that is not a CAH, and later in the year comes to outpatient therapy in a CAH,would the CAH need to ask for the cap exception through the established process? I am in a CAH and we would need to learn the cap exception process if this is required. Posted by Beverly Hasson on 2/8/2013 5:32 PM So, if I understand this correctly, the independently owned free standing outpatient PT office gets strapped with the extra paperwork. What is the reasoning? Posted by Clayton on 2/8/2013 6:05 PM Everyone has issues, regardless of the setting, and we all believe that the other guy has it better than we do.for example, a critical access hospital may not deal with the therapy cap, but when a federally insured patient chooses our facility to receive care the have a $75.00 copay, and if they seek services at a private clinic it costs $25.00. Also, if an insured patient on an anthem compass plan chooses a private clinic over our facility, they get a check for$150.00. We have higher costs, because as a facility we have to treat pele in many other areas of the hospital who know and we know will never pay for those services, and therefore we have to try to make up those costs in other departments ie: rehab, lab, radiology, so that at the end of the year we can keep the doors open. Certainly not a perfect system, but as I said we all have issues that we believe have merit! Posted by Derek on 2/8/2013 10:13 PM What about patients who received physical therapy in an outpatient setting and then present to the ER in a hospital!? If the patient is placed in an outpatient or observation status; meeting no criteria for full inpatient admission and have met the therapy cap; if a physical therapist is consulted to evaluate that patient; do we as acute care therapists need to attach a KX modifer? Posted by Marlene Noll -> =NT^DL on 2/8/2013 10:36 PM This is more than just a private practice vs hospital based payment system. Being in the Chicagoland area this affects none of our patients. This will not affect a majority of private practices unless they practice in the rural areas. We all (hospital based OP included) slighted, but these are people with little access to care and it is hard to argue against this ruling. If we could police ourselves as a profession and eliminate wasteful spending, this would not be the issue that it is today. Posted by Vincent on 2/8/2013 10:59 PM There is no setting where this ruling has merit. With or without private practice in a critical access area it alienates and discriminates against private practice PT. If the goal was to increase services in a critical access why not include the private practicePT?No sense Posted by Tom Brocato on 2/9/2013 8:29 AM I agree that there is always room for elimination of wasteful spending in our profession, I am still so relieved for my Medicare patients at my CAH that have multiple health issues that require long therapy in order to truly do them service. Posted by Ali Loraine on 2/9/2013 8:52 PM No offense to you CAH PTs, but a CAH is not the only place MC patients with multiple issues get better with long term PT. Glad though some PTs can provide services without caps restraints. Just shows more discrimination within the PT cap debate. Can't do it here, but can over here..??All PT in critical access area should be included in CAH PT cap ruling. Isn't access for medical needy the real issue? Posted by Tom Brocato on 2/10/2013 8:43 AM My practice is located in an underserved rural area. The reimbursement made to CAH PT/OT is based in large part it's cost report at 101% of cost for Medicare beneficiaries. This puts us at a severe disadvantage coupled with the prejudicial cap requirement. Comments above echo the double standards that exist. Posted by Ray Tresemer on 2/11/2013 8:41 AM Derek, You make a great point. You have higher costs due to treating a bunch of people who cannot pay. Private practices are small businesses unencumbered by unions; do not have a bloated administration and their salaries; but PP does still pay taxes. In a normal consumer situation, the consumer would go to PT-owned PP because it's cheaper and the patient gets at least an equal quality of care. But in Bizarro world, our government chooses to tilt the scales toward a tax-free business group with a long history of questionable billing practices. Posted by Sean on 2/11/2013 3:00 PM As a private practice owner, I pay for all my PT's APTA dues. I expect the APTA to go to bat for us in private practice. I work in a rural area where the therapy cap has a large impact on us. Come on APTA, help us out. Posted by Najib Johnson on 2/13/2013 10:49 AM First, it is not just private practices that have a cap but also all hospitals other than critical access. And, medicare is not denying treatment when the cap is reached, just requiring that you show medical necessity. Please remember that Critical Access hospitals are still held to the same standards of showing medical necessity for treatment. They can not continue to see patients indefinitely just because there isn't a cap ! Last, I would venture a guess that most private practices limit the number of Medicaid/care patient they take on where as hospitals are not able to do that and subsequently carry a very high Medicaid caseload (which we all know we lose money on). Posted by chris on 2/20/2013 9:37 AM There is no difference in the CAH or the private practice patients in rural areas that need access. So, no cap for the CAH, what if they don't provide the same quality of care as our private practice. The patient no longer has the RIGHT to choose who provides their therapy!!Double standard, no other way to look at it. Posted by Scott on 6/28/2013 6:12 PM I've lost trust in the integrity of PPs billing and practice methods. Hospital PT is better for all. Posted by Dan Lanari -> BKS]?M on 11/27/2013 11:00 PM Managing services in a CAH, I feel our metro and PP colleagues pain. Looking back we have very few patients who would actually hit the $3700 cap. The true burden to me is the man-power it takes to track these things takes away from the focus on patient care. Hopefully the APTA and CMS will agree on fair and equitable reform of reimbursement. Posted by FJ on 2/8/2014 8:32 AM


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