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Intermediate Vision Visual Acuity Standards: As listed below or better; Each eye separately; Snellen equivalent; and With or without correction. Equipment and Examination Techniques Note: If correction is required to meet standards, only corrected visible acuity needs to be examined and recorded. The smallest type correctly learn with every eye separately and each eyes together is recorded in linear worth. If the applicant meets the uncorrected near or intermediate vision commonplace of 20/forty, but already uses spectacles that appropriate the vision better than 20/forty, it is suggested that the Examiner enter the limitation for near or intermediate vision corrective glasses on the certificate. Plates 1-four are for demonstration only; plates 5-10 are screening plates; and plates eleven-24 are diagnostic plates. Web-based color vision functions, downloaded, or printed versions of color vision checks are additionally prohibited. Read and correctly interpret in a well timed method aviation instruments or shows 2. Richmond Products Richmond Products the Examiner should doc the color vision take a look at instrument used, version, answer sheet with the actual subject responses and the score. Examination Techniques In accordance with accepted scientific procedures, routine blood strain should be taken with the applicant within the seated place. Examination Techniques Additional medical data could also be furnished through additional historical past taking, further scientific examination procedures, and supplemental laboratory procedures. When advised by an Examiner that further examination and/or medical data are wanted, the applicant may elect not to proceed. Use of this form will provide the applicant with the reason for the denial and with attraction rights and procedures. Disqualifying Defects the Examiner should verify the "Disq" field on the Comments Page beside any disqualifying defect. Copies of all data concerning prior psychiatric or substance-associated hospitalizations, observations, or remedy. See Report Requirements for objects that have to be lined in addition to additional objects that have to be submitted. Current substance use and substance use/abuse historical past together with remedy and quality of restoration, if applicable; c. Does your diagnosis or findings agree with the diagnosis noted on different supporting or historical documents you reviewed? In that event, authorization for release of the data (by the airman to the skilled reviewer) is required. If on warfarin (Coumadin), the attending physician should affirm stability without problems. Interpretation of testing together with, but not limited to, the checks as specified below. For airmen with flight hours: Note on an Excel spreadsheet any flights, glucose ranges throughout flight, and any actions wanted to appropriate glucose. Analyze to determine share time within the following ranges: 268 Guide for Aviation Medical Examiners a. Maximal train treadmill stress testing (Bruce): beginning at age forty and every 5 years thereafter and at any age when clinically indicated. Customize low glucose to eighty mg/dL and high glucose to one hundred eighty mg/dL for device time-in-vary reviews. Testing ensures each good control and demonstrates the absence of finish-organ damage. In addition, the more time spent in a low blood sugar or hypoglycemic situation, the more likely that the individual is unaware of it, and it could possibly take up to a number of hours for full functional restoration from hypoglycemia. The greatest method to guarantee good blood sugar control in flight is for airmen with diabetes to keep their blood sugars within the acceptable vary whether within the cockpit or on the ground. You should have a backup correction pen and basal insulin available if using an insulin pump. These pumps are relatively immune to the results of strain adjustments and provide obvious benefits to pilots who function plane within the flight ranges. The ability to suspend insulin delivery for a low studying is an effective security characteristic.

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In the primary stage, the patient suffers from delicate diarrhoea and vomiting, which worsens rapidly. The temperature rises however the skin is usually cold and blue and the heart beat is weak. In the second stage of collapse, the body turns into colder, the skin dry, wrinkled and purple. Even at this stage, a relapse might happen or the patient might sink into a condition resembling typhoid fever. Causes Cholera is caused by a brief, curved, rod-formed germ generally known as vibrio cholera. Treatment the treatment ought to to start with aim at combating the lack of fluids and salts from the body. Normally, half a litre of saline, with 30 grams of glucose, ought to be given per rectum each four hours till urine is handed freely. Lemon, onion, green chillies, vinegar and mint ought to be included in the day by day food plan throughout an epidemic of cholera. The leaves of drumstick (sanjana) tree are additionally useful in treatment of this illness. A teaspoon of recent leaf-juice, mixed with honey and a glass of tender coconut water, could be given two or thrice as a herbal medicine in the treatment of cholera. The recent juice of bitter gourd (karela) is one other efficient medicine in the early phases of cholera. Two teaspoons of this juice, mixed with an equal quantity of white onion juice and a teaspoon of lime juice, ought to be given Cholera could be controlled only by rigid purification of water supplies and proper disposal of human wastes. In case of the slightest doubt in regards to the contamination of the water, it should be boiled before use, for consuming and cooking purposes. Other precautions towards this illness include avoiding all raw greens, thorough washing of palms by all those who handle food, and elimination of all contacts with the illness. The genital areas and the exposed areas such because the eyelids, forearms, face and neck are extra vulnerable to it. The cells of the epidermis ( the surface layer of the skin ) are normally protected against harm by the tightly packed squamae of keratin of the sexy layer. This water content material could be decreased by evaporation or by removal of the lipid with which it retains moisture. Degreasing brokers like soaps, if used too incessantly over a short while, will trigger dryness, redness, fissuring and irritation of the skin in virtually everybody. This is usually followed by swelling of the skin as a result of oedema( extreme fluid retention ). About a hundred totally different crops are known to be able to inflicting dermatitis in susuceptible individuals. This consists of most circumstances of industrial dermatitis which arise on the palms or forearms which really are available contact with the irritant. Other causes of this illness are indiscretion in food plan, deficiency of vitamin A and pantothenic acid, and nervous and emotional stress. Treatment As dermatitis might appear as a result of diversified causes, treatment additionally varies accordingly. In this regimen, he ought to take three meals a day of juicy fruits corresponding to orange, grapes, apple, pineapple and papaya at five hourly intervals. Further fasts and a interval on restricted food plan at intervals may be adopted after the resumption of a standard food plan. The warm water enema ought to be used day by day to cleanse the bowels in the course of the first week of treatment and thereafter as necessary. About a hundred grams of Epsom salts ought to be added to a bowlful of scorching water for this function. The mixed juice from apple, carrot and celery is very beneficial in the treatment of dermatitis.

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Anatomy: the needle passes the skin, the subcutaneous tissue, via Indications: gastritis, paptic ulcers, chr. Indications: Cough, excessive sputum, hemiplegia, sore throat, con stipation, dizziness, mania, depression psychosis, etc. Location: 8 cun above malleolus lateralis, one finger width lateral to the margo anterior of the tibia. Anatomy: the needle passes the skin, the subcutaneous tissue, the Anatomy: the needle passes the skin, the subcutaneous tissue, m. Anatomy: the needle passes the skin, the subcutaneous tissue, the There are the m. Indications: somnolence, sequelae of encephalitis, vertigo, amnesia, sequelae of infantile paralysis, drop foot. The Lateral Aspect of the Lower Extremity Nn clunium superiores <- ^ - y> Huantiao Spina iliaca anterior superior Huantiao Trochanter major M. Anatomy: the needle passes the skin, the subcutaneous tissue, through the posterior to the tractus iliatibialis and enters the m. At the junction of the middle and lateral third of the distance between the highest point of the trochanter major of the femur and the hiatus sacralis the Pt. At the knee the condylus lateralis of the femur and the condylus lateralis of the tibia may be seen as a bulging. The Gall Bladder of Foot-Shaoyang, Inferior and posterior to the condylus lateralis of the tibia the caput fibulae may be felt, and the depression below the caput fibulae is the Pt. At the lateral side of the ankle the prominent malleolus Location: Puncture: kuan. In the depression antero-inferior to the caput fibulae, flex Perpendicularly the needle the knee during location. The distance between the trochanter major and the midpoint of the fossa poplitea is divided into 19 equal divisions - 19 curt. Point Fengshi (J&1$ 82-84) Location: Puncture: Anatomy: With the patient standing erect, hands close to thighs, the Perpendicularly 1. The needle passes the skin, the subcutaneous tissue, trac point is at the tip of the digitus medius. Location: Puncture: 5 cun above the tip of the malleolus lateralis, on the Perpendicularly 1-1. Anatomy: the needle passes the skin, the subcutaneous tissue, peroneus brevis and the m. Indications: paralysis of lower extremity, lumbago, pain in the leg, tensor digitorum longus and reaches the interosseus membrane. Puncture: Anatomy: the needle passes the skin, the subcutaneous tissue, and Location: of the fibula. Anatomy: the needle passes the skin, the subcutaneous tissue and reaches the space between the m. Indications: pain in the knee, the ankle and the lower chest, stiff neck, hemiplagia, sciatic neuralgia. Anatomy: the needle passes the skin, the subcutaneous tissue, and There are the v. Indications: Headache, pain of the neck, epilepsy dementia, diseases of the posterior aspect of lumbosacralregion and lower extremity. At the lateral aspect of the buttock the bony pro In the lower portion of the thigh m. Huantiao, transverse section (Right side, inferior dew) At the mid-point of the transverse crease of the fossa poplitea is the Pt. With foot plantar flexion, there is a Chinese letter " K "shaped groove below both sides of the belly of m. V gastrocnemii g tibialis tibialis et , posterso femoris Anatomy: After puncturing the needle passes through the skin and > communis Caput mediale - Caput N.

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Because of the variable circumstances under which a block may be carried out on the battlefield, every approach is described using paresthesia, nerve stimulation, and ultrasound. The military medical triumph represented by this statistic is plain, although the achievement has resulted in other issues, notably in the administration of acute pain. Modern fight casualty care now emphasizes rapid evacuation to progressively greater levels of medical care with crucial care assist supplied always (together with transport). Casualties who earlier have been kept in a war zone for days to weeks till they have been stable for transport now are transported by plane from Iraq to Germany within 8 to seventy two hours of harm. The surroundings of evacuation plane-crowded, deafening, jolting, poorly lit, with limited monitoring capabilities-solely magnifies the difficulties of using opioid-solely pain management remedy. Healthcare suppliers positioned in this scenario are less prone to use enough doses of morphine because of legitimate patient security issues. The large numbers of healthcare suppliers in the evacuation chain and lengthy evacuation distances further complicate opioid use in these sufferers. Fortunately, among the many medical advances arising from the current conflicts are improved understanding and administration of pain in war casualties. This textual content celebrates this development, preserving what has been discovered to serve as a brand new, greater normal for pain administration in this and forthcoming conflicts. The objective of this handbook is to assist with the schooling of anesthesiology residents in the artwork and science of superior regional anesthesia and acute pain medication. As John J Bonica acknowledged in the Management of Pain, "The proper administration of pain remains, in any case, crucial obligation, the main goal, and the crowning achievement of each doctor. It is our hope that the data within this text will be used to ease the burden of their wounds. Deployed military anesthesiologists recognized a disconnect between battlefield and civilian analgesic care that wanted to be bridged. As one supplier put it, "pain management in Baghdad, 2003, was the same as in the Civil War-a nurse with a syringe of morphine. With Lieutenant Colonel Chester Buckenmaier, Chiles started the Army Regional Anesthesia and Pain Management Initiative in 2000. These initiatives have led to larger pain management for wounded soldiers, and their success has been well known in professional and lay journals from Newsweek to Wired journal. In addition, all sufferers must be supplied access to specialty pain administration providers, if wanted. Nursing assist of anesthesia was recognized early on, and an authorized registered nurse anesthetist from every service was added to the board in April 2006. Initial meetings centered on approval of the Stryker PainPump 2 (Stryker; Kalamazoo, Mich) to be used on Air Force military plane and the necessity for patient-controlled analgesia pumps on the battlefield and on evacuation plane. The group developed a collection of coaching modules and consensus recommendations on pain administration for anesthesiologists preparing for deployment (available at: This 12 months marks the 7th 12 months of the workshop, directed by Dr Buckenmaier and taught by senior anesthesiologists from across the nation. Each member of the group has one vote on issues that require agreement/collaboration between providers. Issues that fail to acquire a two thirds majority consensus shall be tabled and re-addressed on the next meeting known as by the President of the group. The President shall be responsible for soliciting meeting issues from members and setting meeting agendas. The position white papers will provide every service anesthesia advisor with collaborative recommendations for issues thought-about by the group. The president may have final editorial authority over any white paper recommendations submitted to the service anesthesiology consultants. One formal meeting shall be on the Uniformed Services Society of Anesthesiology meeting during the American Society of Anesthesiology conference. Meetings will solely be held when a quorum of members (or their proxies) are available.

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However, in procedures utilizing the nerve stimulation method, research have shown that precise stimulation of the musculocutaneous nerve results in a more profitable outcome than a simple injection into the coracobrachialis muscle. It is important to note that though a real axillary sheath could exist, it will not be a tubular construction that neatly homes the terminal branches of the plexus. Instead, it might be a group of connective tissues that encompass the nerves and vessels, creating particular person fascial compartments that can inhibit spread of the native anesthetic. The patient is positioned supine with the operative arm abducted and externally rotated (Figure 10-four). To establish the coracobrachialis muscle for the musculocutaneous block, the biceps muscle is displaced laterally, and the coracobrachialis muscle is palpated simply medial to it. At the extent of the upper half of the humerus, the needle is inserted into the coracobrachialis muscle. If this occurs, the transarterial method for axillary block can be utilized: advance the needle till blood aspiration stops, and deposit half of the native anesthetic volume deep to the artery. Then withdraw the needle till blood aspiration ceases again, and deposit the remaining native anesthetic at this more superficial location. Application of distal strain (see Figure 10-5) during injection might help push the native anesthetic in a more proximal path. Adducting the arm instantly after injection can also assist with proximal spread of native anesthetic. If an arm tourniquet is used through the surgical process, blockade of the intercostobrachial nerve is required (see Chapter eight, Supraclavicular Block). The transverse aircraft provides the best view of the brachial plexus at this level; nerves will seem as hypoechoic roundish buildings with hyperechoic borders. The patient is supine, with the arm abducted 90� and externally rotated so the dorsum of the hand rests on the bed. The probe should be placed excessive in the axilla, at the intersection of the pectoralis major muscle with the biceps muscle (Figure 10-6). At this level, the axillary artery and all three main nerves to be blocked (median, ulnar, radial) should be in view (Figure 10-7). Typical anatomic relations of the nerve to the artery are as follows: the median nerve is positioned superficial and slightly cephalad to the artery, the radial nerve is positioned deep to the artery, and the ulnar nerve is positioned caudad to the artery. Once each nerve is recognized, 10 mL of native anesthetic should be injected around each nerve (Figure 10-eight). As against a area block or stimulation method, blockade of the musculocutaneous nerve underneath ultrasound steering is more precise. While the probe Figure 10-7 Figure 10-eight Figure 10-6 is slowly brought towards the biceps muscle, the musculocutaneous nerve ought to come into sight, both between the biceps and coracobrachialis muscle tissue or inside the body of the coracobrachialis muscle (Figure 10-9). Local anesthetic should be injected when the needle tip is visualized close to the nerve or stimulation of the biceps muscle is famous. However, a single terminal nerve often requires additional supplementation of native anesthetic to "rescue" a lower than sufficient block. These distal injection points may be needed for a patient with circumstances that preclude more proximal injections (eg, preexisting wounds or an infection). Coagulation abnormalities may render the more proximal approaches less desirable due to the shut proximity of major vascular buildings to the needle entry site. These peripheral methods are helpful for minor surgical procedures inside a single nerve distribution, corresponding to wound exploration or small laceration repair. Because of its location inside the ulnar groove, the ulnar nerve has essentially the most reliable landmarks. The ulnar groove is palpated between the medial epicondyle of the humerus and the olecranon process. Ulnar nerve blockade at this level supplies sensory blockade to the medial side of the hand, together with the fifth digit and the medial half of the fourth digit. The brachial artery is the landmark for median nerve blockade at the level of the elbow (see Figure 11-1). The median nerve lies simply medial to the artery and may be blocked using paresthesia, nerve stimulation, or ultrasound steering based mostly on this landmark. Median nerve blockade is beneficial for the anterolateral surface of the hand, together with the thumb by way of center finger. Figure 11-1 the radial nerve lies between the brachialis and brachioradialis muscle tissue, 1 to 2 cm lateral to the biceps tendon. Using the biceps tendon as a landmark, the radial nerve may be blocked utilizing paresthesia, stimulator, or ultrasound-based mostly methods.

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This Fast Fact evaluations key components within the assessment and remedy of dyspnea close to the top-of-life. Etiology the causes of dyspnea embrace a wide spectrum of serious lung or coronary heart conditions, anemia, anxiousness, chest wall pathology, electrolyte disturbances or even urinary retention or constipation. Assessment Looking for easy issues is at all times warranted: is the Oxygen turned on? Is dyspnea a part of an acute anxiousness episode, extreme ache, constipation or urinary retention? Understanding 1) where sufferers are at within the dying trajectory, and a pair of) their identified targets of care, is essential to guide the extent of workup to uncover reversible causes. Treatment � General measures Positioning (sitting up), growing air motion through a fan or open window, and use of bedside rest methods are all useful. In the opioid na�ve patient, low doses of oral (5-10 mg) or parenteral morphine (2-four mg) will present aid for most sufferers; larger doses will be needed for sufferers on continual opioids. Nebulized morphine has been reported to present profit in uncontrolled case reviews, nevertheless a controlled trial demonstrated no greater efficacy or lower fee of side effects in comparison with subcutaneous morphine. When doubtful, a therapeutic trial, primarily based on symptom aid, not pulse oximetry, is indicated in dying sufferers. Patients usually choose nasal cannula administration than a masks, particularly in setting of imminent demise when agitation from the masks is often seen. There is little purpose to transcend four-6 L/min of oxygen through nasal cannula within the actively dying patient. Treatment with different medication Anti-tussives might help with cough (see Fast Fact #200), anticholinergics. Other agents that will have particular disease modifying effects embrace diuretics, bronchodilators, and corticosteroids. Midazolam as adjunct remedy to morphine within the alleviation of extreme dyspnea notion in sufferers with superior most cancers. Nebulized versus subcutaneous morphine for sufferers with most cancers dyspnea: a preliminary research. See Fast Facts # 7, 43 and 146 for help in diagnosing and screening for depression in palliative care sufferers. For sufferers with a prognosis < four weeks, a psychostimulant such as methylphenidate or dextroamphetamine may act inside 1-2 days and be safe in sufferers with out significant cardiovascular disease or delirium. Although the data on psychostimulants are considerably combined, controlled trials have shown profit as each a monotherapy or to augment the consequences of one other anti-depressant (three-5). Because sertraline, citalopram, and escitalopram have lower side impact profiles and are neither activating nor sedating, they might be higher choices for palliative care sufferers (7). The beginning dose of escitalopram is 10 mg/day with a ordinary efficient dose of 10-20 mg/day (eight-10). This class could also be useful for neuropathic ache, vasomotor instability, and anxietypredominant depression. The beginning dose for duloxetine is 30 mg with a ordinary efficient dose of 60-120 mg/day. It has been related to hepatic insufficiency and a worsening of acute-angle glaucoma. They are also confirmed adjuvant analgesics for neuropathic and continual low back ache. Therefore, their use is proscribed to coronary heart-wholesome sufferers under the age of sixty five with comorbid neuropathic ache and insomnia. Although the preponderance of supporting data for the analgesic effects is for amitriptyline (ordinary beginning dose 10-25 mg/day; ordinary efficient dose is a hundred and fifty mg/day), nortriptyline is felt to be less sedating (ordinary beginning dose 25 mg/day; ordinary efficient dose is 50-100 mg/day). Other Medications Mirtazapine has histaminergic side effects that can be useful particularly for most cancers sufferers who usually experience insomnia, poor appetite, and nausea (13). Buproprion is thought to be less sedating and have a lower incidence of sexual side effects, however it might lower the seizure threshold.

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Cross Reference Lateral medullary syndrome Snoring Reduced muscle tone within the higher airway throughout sleep results in elevated resistance to the flow of air, and partial obstruction typically leads to loud snoring. Obstructive sleep apnoea�hypopnoea syndrome presenting within the neurology clinic: a prospective 5-12 months research. Cross Reference Hypersomnolence Snouting, Snout Reflex Sometimes used interchangeably with pout reflex, this term ought to most likely be reserved for the puckering or pouting of the lips induced by fixed pressure over the philtrum, rather than the phasic response to a faucet over the muscle with finger or tendon hammer. Cross References Frontal release signs; Pout reflex; Primitive reflexes Somatoparaphrenia Ascription of hemiplegic limb(s) to one other person. For instance, flexor spasms in sufferers paraplegic as a result of higher motor neurone lesions are sudden contractions of the flexor musculature, notably of the legs, either spontaneous or triggered by light touch. Spasm can also refer to a tetanic muscle contraction (tetany), as seen in hypocalcaemic states. Infantile seizures consisting of transient flexion of the trunk and limbs (emposthotonos, salaam or jack-knife seizures) may be often known as spasms. This is usually a benign idiopathic situation, but the analysis ought to prompt consideration of an optic pathway tumour. Spasmus nutans-like nystagmus is commonly associated with underlying ocular, intracranial, or systemic abnormalities. The extreme resistance evident at the extremes of joint displacement may abruptly give way, a phenomenon often known as clasp-knife (or, confusingly, clasp-knife rigidity). The quantity and pattern of spasticity is determined by the placement of the lesion and tends to be greater with spinal wire than cortical lesions. Scales to quantitate spasticity are available (Ashworth, modified Ashworth, pendulum test of Wartenberg) but have shortcomings. Spasticity can also vary in distribution: for lesions above the spinal wire it sometimes affects the arm flexors and the leg extensors to a greater extent (hemiparetic posture). Slow, laboured speech, with sluggish voluntary tongue movements, may be referred to as spastic dysarthria, which may happen within the context of a pseudobulbar palsy. The pathogenesis of spasticity has traditionally been ascribed to harm to the corticospinal and/or corticobulbar pathways at any level from cerebral cortex to spinal wire. Treatment of severe spasticity, for example, in a number of sclerosis, typically requires a multidisciplinary strategy. Urinary infection, constipation, skin - 330 - Spinal Mass Reflex S ulceration, and pain can all exacerbate spasticity, as may inappropriate posture; appropriate management of those features may ameliorate spasticity. Drugs which may be useful embrace baclofen, dantrolene (a blocker of muscle excitation� contraction coupling), and tizanidine (2 -adrenoreceptor agonist). Intrathecal baclofen given via a pump can also be of benefit in selected instances, and for focal spasticity injections of botulinum toxin may be appropriate. For painful motionless spastic legs with reflex spasms and double incontinence, irreversible nerve injury with intrathecal phenol or alcohol may be advocated to relieve signs. This, or a very similar, constellation of features has also been often known as cortical dysarthria, aphemia, or phonetic disintegration. Speech apraxia has been associated with inferior frontal dominant (left) hemisphere harm within the area of the lower motor cortex or frontal operculum; it has been claimed that involvement of the anterior insula is particular for speech apraxia. The syndrome is assumed to replicate disturbances of planning articulatory and phonatory capabilities, but is most often encountered as a part of a non-fluent aphasia. If not deliberate, it presumably displays a left hemisphere dysfunction within the appropriate sequencing of phonemes. A variant of this foraminal compression test entails rotation, aspect bend, and slight extension of the neck with the application of axial pressure to the head. Cross Reference Radiculopathy Square Wave Jerks Square wave jerks are small saccades which interrupt fixation, transferring the eye away from the primary place and then returning. Very obvious square wave jerks (amplitude > 7 ) are termed macrosquare wave jerks. Their name derives from the looks they produce on electrooculographic recordings. Although square wave jerks may be normal in elderly individuals, they could be indicative of illness of the cerebellum or brainstem. Proprioceptive loss, as in dorsal column spinal illness, can also lead to a gait characterized by high lifting of the toes and in addition stomping (stamping with a heavily accented rhythm) or slapping of the foot onto the ground within the strike part.

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This formulation could be combined with an applicable anti-toxin formulation, like Viola Clear Fire Formula, in instances with microbial activity or warmth-toxin. The typical presentation is one with a historical past of an external pathogen that has depleted the body of both qi and blood, and most obvious in signs and signs related to the guts: irregular pulse, palpitations, and generalized weak spot. Baked Licorice Formula is a versatile formulation, however is often considered the most important formulation when certainly one of two kinds of irregular pulses is current: knotted (ji� m�i) or intermittent (d�i m�i). The knotted pulse is a sluggish to moderate price with an occasional dropped beat at irregular intervals. The intermittent pulse is often moderate in price however misses beats at regular intervals. The consumptive issues which are effectively handled by Baked Licorice Formula are lung atrophy (characterised by a persistent weak pulse in the best cun place with generalized weak spot and shortness of breath) and heart qi and blood deficiency. Ingredients Rehmanniae Radix (Rehmannia, unprocessed / Sheng Di Huang) 28% Jujubae Fructus (Jujube Date, pink / Hong Da Zao) thirteen% Glycyrrhizae Radix Preparata (Chinese Licorice Root, honey-fried / Zhi Gan Cao)12% Cinnamomi Ramulus (Cassia Twig, Chinese Cinnamon / Gui Zhi) 10% Ophiopogonis Radix (Ophiopogon Tuber / Mai Men Dong) 8% Zingiberis Rhizoma Recens (Ginger, contemporary / Sheng Jiang) 8% Polygoni Multiflori Radix (Polygonum Root / He Shou Wu) 7% Rehmanniae Radix Preparata (Rehmannia, cured / Shu Di Huang) 6% Lilii Bulbus (Lily Bulb / Bai He) 4% Ginseng Radix (Asian Ginseng Root / Ren Shen) 4% Chinese Medical Actions Supplements qi, nourishes blood and yin, restores and regulates pulse. Indications Anxiety Arrhythmia Body fluid, harm to, from illness Breathing, issue Cardiac insufficiency Cardiomyopathy Constipation Coronary heart disease Cough, dry and weak Dry mouth and throat Hypertensive heart disease Insomnia Irritability Myocardial infarction, sequella of Myocarditis, sequella of Night sweats Palpitations Pulmonary heart disease Rheumatic heart disease Sputum, frothy Sweating, spontaneous Weight loss, unintended Tongue: Pale and shiny. Pulse: Irregular, dropping a beat at regular or irregular intervals, knotted, or intermittent. It can relieve hypertension and deal with mild cardiovascular illnesses when blood stasis is part of the pattern. Indications Afternoon fever Angina Breast lumps Chest, pain or stifling sensation in Coronary heart disease Depression w/sensation of heat in chest Dry heaves Emotional outbursts or instability Fibromyalgia w/blood stasis Headache w/fastened, piercing pain Hiccough, persistent Hypertension Hypochondriac pain Insomnia and restless sleep Intercostal neuralgia Irritability Palpitations Post-concussion syndrome Tongue: Purple or dark pink, with dark or purple spots on sides. Do not use in instances with heavy menstrual bleeding or any lively hemorrhagic disorder. It is meant to deal with the second and third phases of trauma where preliminary swelling and inflammation have dissipated and what stays is blood stasis and invasion of wind and dampness. The herbs on this formulation center on transferring and supplementing blood to dispel blood stasis, supplementing the kidneys to heal bones and sinews, and dispelling wind and dampness to drive out bi and forestall its return. It is good for rushing the healing of torn ligaments or tendons, broken bones, or damaged cartilage. Ingredients Taxilli Herba (Loranthus, Chinese Mistletoe / Sang Ji Sheng) 10% Angelicae Sinensis Radix (Dong Quai Root, Tang Kuei / Dang Gui) 8% Lycopodii Herba (Clubmoss, Lycopodium / Shen Jin Cao) 8% Acanthopanacis Giraldii Cortex (Acanthopanax Stem Bark / Hong Mao Wu Jia Pi) 8% Spatholobi Caulis (Spatholobus / Ji Xue Teng) 8% Eucommiae Cortex (Eucommia Bark / Du Zhong) 8% Angelicae Pubescentis Radix (Pubescent Angelica Root / Du Huo) 8% Drynariae Rhizoma (Drynaria Rhizome / Gu Sui Bu) 7% Psoraleae Fructus (Psoralea Fruit / Bu Gu Zhi) 7% Dipsaci Radix (Japanese Teasel Root, Japanese Dipsacus / Xu Duan) 7% Olibanum (Frankincense / Ru Xiang) 6% Myrrha (Myrrh / Mo Yao) 6% Notopterygii Rhizoma seu Radix (Notopterygium / Qiang Huo) 5% Jujubae Fructus (Jujube Date, pink / Hong Zao, Da Zao) 3% Pyritum (Pyrite / Zi Ran Tong) 1% Chinese Medical Actions Dispels wind and dampness, knits bones and sinews, dietary supplements and moves blood, relieves pain. For instance, if yin deficiency is prominent, mix Bone & Sinew Formula with Rehmannia Six Formula, or if liver qi stagnation is an underlying problem, mix with Bupleurum & Tang Kuei Formula or Free & Easy Wanderer Plus. It is used to harmonize the inside and exterior, and in shaoyang issues, when the outside has not been completely released. It is usually used for digestive issues resulting from disharmony of liver and spleen. It can be good for joint pain triggered by an acute or current virus, distending pain around the xyphoid, and intercostal neuralgia. Indications Abdominal distension Chills Common chilly w/chest constriction Constitution, delicate Emotional instability Fat digestion, poor Flatulence Gallstones Hepatitis Influenza Irritability Joint pain w/crackling sensation Muscular pressure Nausea Nervous exhaustion Neurotic issues Passive-aggressive behavior Pneumonia Psychological boundary issues Pulmonary tuberculosis Stomach pain Vertebral subluxation Vomiting Tongue: Pale, swollen, with white or yellow coating. It is useful for a diverse vary of signs resulting from liver qi stagnation, poor liver blood, and liver/spleen disharmony. Indications Abdominal distension or bloating Allergies, food Appetite, poor Breast distension or tenderness Breast lumps, fibrocystic Constipation Depression Dizziness Emotional instability Fatigue Hay fever, persistent Headache Hot flashes Hypochondriac pain Irritability Lactation, inadequate Menopausal signs Menstrual pain Menstruation, fatigue after Menstruation, irregular Mood swings Nausea Palpitations Premenstrual syndrome Stools, erratic Uterine bleeding, dysfunctional Weight loss, unintended Tongue: Pale body, barely pink, particularly on the edges. Contraindications: When warmth signs are current, use Free & Easy Wanderer Plus instead. Reduce dose if irritability or digestive disturbance enhance whereas taking this formulation. From the Shang Han Lun, this formulation is a modification of Minor Bupleurum Formula (Xiao Chai Hu Tang) for improperly handled wind-chilly issues. Over centuries of use, this formulation has been expanded to deal with a variety of inner and emotional patterns, particularly those whose signs are marked by fullness within the chest, irritability, and palpitations. Altai anemone (jiu jie chang pu) has been added to assist in transformation of phlegm. This formulation is useful for drug and smoking withdrawal, vivid dreaming, and any pattern of extra qi or yang. Indications Anxiety Chest, fullness in Constipation Convulsions Delirium Dream disturbed sleep Drug withdrawal Emotional instability Fright, issues as a result of Headache Heat sensation in head Hot flashes Hypertension Hypochondriac pain Insomnia Irritability Mania Menopausal signs Palpitations Post-concussion syndrome Post-traumatic Stress Disorder Restlessness Smoking withdrawal Urinary issue or incontinence Tongue: Red, with slippery coating.

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