Fenugreek

Fenugreek is an herb native to southeastern Europe, northern Africa, and western Asia, but is widely cultivated in other parts of the world. Its botanical name is Trigonella foenum-graecum; its English name comes from two Latin words meaning Greek hay. Fenugreek is an annual plant that grows 2–3 ft (0.6–0.9 m) tall, with a strong odor and small pale yellow flowers.

The seed of the fenugreek plant contains many active compounds with pharmaceutical applications. The seeds are collected in the autumn. The chemical components of fenugreek seed include iron, vitamin A, vitamin B1, vitamin C, phosphates, flavonoids, saponins, trigonelline, and other alkaloids. The seed is also high in fiber and protein.

General use

Quite apart from its therapeutic value, fenugreek is used as a seasoning and flavoring agent in foods, particularly in Egypt, India, and the Middle East. The maple smell and flavor of fenugreek have led to its use as a spice in foods, beverages, confections, tobacco, and imitation maple syrup. In some countries, the seeds are eaten raw or boiled, or the greens are enjoyed as a fresh salad. Extracts of fenugreek are used in some cosmetic products as well.


In addition to its use in flavoring foods, the antifungal and antibacterial properties of fenugreek are now being applied to food preservation. In June 2002, a high school student from Maryland was awarded a Lemelson- MIT Invention Apprenticeship for her invention of a food packaging paper made from fenugreek seeds.

The best-documented medical use of fenugreek is to control blood sugar in both insulin-dependent (type 1) and noninsulin-dependent (type 2) diabetics. Some studies also show that serum cholesterol levels in diabetics, and perhaps in others, are reduced by fenugreek. Doses as low as 15 mg per day may produce beneficial effects on fasting blood sugar, elevation of blood sugar after a meal, and overall glycemic control.

The use of fenugreek is likely to alter the diabetic patient’s need for insulin or other medications used to control blood sugar. This treatment should be supervised by a health care provider familiar with the use of herbal therapies for diabetes. The recommended doses of fenugreek can vary rather widely.

The seeds of fenugreek can also act as a bulk laxative as a result of their fiber and mucilage content. These portions of the seed swell up from being in contact with water, filling the bowel and stimulating peristaltic activity. For laxative purposes, 0.5–1 tsp of freshly powdered herb per cup of water, followed by an additional 8 oz water, can be taken one to three times daily. Patients should begin with the lowest effective dose of fenugreek; they should also avoid taking oral medications or vitamins at the same time as the herb.

Capsules of fenugreek seed are sometimes recommended as a galactogogue, or agent to increase milk production in the lactating mother. This use of the herb should be undertaken cautiously, since the evidence of safety for the nursing infant is only anecdotal. Some commercial teas promoted for the purpose of increasing lactation use fenugreek as an ingredient, but herbal concentration in teas can vary widely and are generally somewhat low.

There is some evidence that internal use of fenugreek seed can decrease some stone-forming substances in the kidney, particularly calcium oxalate. Patients who are prone to this type of kidney stone may wish to consult a health care provider about the advisability and dose of fenugreek seed for this use.

Fenugreek may encourage a flagging appetite, and is sometimes given during convalescence from illnesses to improve food intake, weight gain, and speed of recuperation.


Cancer researchers are also studying fenugreek for its potential effectiveness as a cancer chemopreventive. It is thought that fenugreek may help to prevent cancer by raising the levels of vitamin C, vitamin E, and other antioxidants in the bloodstream.

Historically, fenugreek has been used as a topical treatment for abscesses, boils, burns, eczema, gout, and ulceration of the skin as it has an anti-inflammatory effect. It is also reputedly useful for a number of digestive complaints, including gastritis and gastric ulcers.

A study published in 2002 found that both an aqueous solution and a gel fraction derived from fenugreek have anti-ulcer effects comparable to those of omeprazole, a standard medication given to reduce gastric secretions. The researchers found that the fenugreek solution protected the gastric mucosa from injury as well as reducing the secretion of gastric acid.

Fenugreek reportedly can be helpful in the induction of childbirth, as it is known to stimulate uterine contractions. For this reason it should not be taken during pregnancy. As a gargle, fenugreek may relieve sore throats and coughing. Arthritis, bronchitis, fevers, and male reproductive conditions are other traditional but unsubstantiated indications for this herb.

Fenugreek seeds

Preparations

Fenugreek may be purchased as bulk seeds, capsules, tinctures, or in teas. Due to the strong, bitter taste, capsules are used most often. The dose is variable, depending on the form of the herb that is used. The seeds may also be soaked to make a tea. For topical use, powdered fenugreek seed is mixed with water to form a paste. Herbal supplements should be stored in a cool, dry place, away from direct light and out of the reach of children.

Precautions

Fenugreek may, when taken in larger amounts than are used to season foods, cause contractions of the uterus. For this reason, women who are pregnant should avoid therapeutic doses. Frequent topical use of fenugreek preparations may cause skin irritation and sensitization. Symptoms of allergic reaction include swelling, numbness, and wheezing. This herb should not be used by anyone with sensitivity to fenugreek.

Large doses (over 100 g per day) may cause intestinal symptoms, including diarrhea, nausea, and gas. Blood sugar can also drop to abnormally low levels. Fenugreek is generally recognized as safe, but its safety is not well-documented for use in small children, lactating women, or persons with liver or kidney disease.

Side effects

Depending on the dose used, fenugreek may cause a maple syrup odor in the patient’s sweat and urine.

Interactions

Fenugreek can enhance anticoagulant activity, and should not be used with other herbs or medications (heparin, warfarin, ticlopidine) that have this effect due to increased risk of bleeding. It can lower blood sugar to a marked degree; blood sugar levels should be monitored closely, particularly in people who are taking insulin, glipizide, or other hypoglycemic agents. Medications that are being taken to control diabetes may need to have dosages adjusted, which should be done under medical supervision.

In theory, since fenugreek is high in mucilage, it can alter the absorption of any oral medication. Corticosteroid and other hormone treatments may be less effective. Monoamine oxidase inhibitors (MAOIs) may have increased activity when used in conjunction with fenugreek.

Ferrum phosphoricum

Ferrum phosphoricum, abbreviated as ferrum phos., is a homeopathic remedy compound made from iron and phosphorus. Its name is Latin for iron phosphate. The homeopathic formula of iron phosphate is derived from mixing iron sulfate, phosphate, and sodium acetate.

General use

Based on the homeopathic “law of similars,” which states that any substance that can cause certain symptoms when given to healthy people can cure sick people with similar symptoms, ferrum phos. is the remedy of choice for patients in the early stages of fever or other inflammatory conditions. It may also be given to patients suffering from low energy or anemia. Of the 2,000–3,000 homeopathic remedies that are available, ferrum phos. is one that often appears on “short lists” of those recommended for a home medicine chest.

It is important to note, however, that homeopaths do not prescribe a given remedy on the basis of a few physical symptoms. They try to match the remedy to the totality of the patient’s symptoms, including emotional characteristics and personality traits. Thus a classically trained homeopath would not give ferrum phos. automatically to every patient who walked into the office complaining of fever or a viral illness.


A contemporary American practitioner of homeopathy recommends giving ferrum phos. when the person does not have clear and distinct symptoms that would point to another remedy. The profile of the ferrum phos. person is that he or she has a lower fever and is more alert than one who needs belladonna but less upset and fearful than one who needs aconite.

Where a patient with the belladonna profile may have a face that is flushed all over with fever, the ferrum phos. patient has clearly defined pink or red patches on the cheeks. The ferrum phos. patient is not focused solely on his or her discomfort and may have conversations with others as if he or she were not ill.

Other characteristics of ferrum phos. patients include a tendency to tire easily. They are nervous, sensitive people, disturbed by anxiety-provoking dreams. They may be restless sleepers, even though their illnesses are often brought on by overexertion. In addition, ferrum phos. patients often bleed easily; they are more prone to nosebleeds or minor bleeding from the gums at the onset of an illness. If they cough up mucus, it is likely to be streaked with blood.

The homeopathic definition of “symptom” is broader than the standard medical understanding. To a homeopath, symptoms represent the body’s attempts to deal with an internal or external ailment. They are guides to choosing the correct remedy rather than problems to be suppressed.

A homeopathic practitioner who is asking a patient about symptoms will inquire about the circumstances (e.g., light or dark, heat or cold, rest or activity, etc.) that make the patient feel better or worse. These factors are called modalities in homeopathy. In terms of modalities, gentle motion and applications of cold make ferrum phos. patients feel better, while cold air, nighttime, standing up, and heavy exertion make them feel worse.

A homeopathic practitioner might prescribe ferrum phos. for any of the following conditions:

• tickling coughs accompanied by chest pain
• laryngitis
• red and swollen tonsils
• fevers that start slowly
• ear infections that have not yet produced pus
• incontinence, involuntary urination with coughing, bedwetting
• rheumatic joints
• menstrual periods that begin with headaches
• anemia
• fatigue
• nosebleeds
• sore throats, especially in singers
• vomiting
• diarrhea
• heart palpitations

Preparations

Ferrum phos. is available in the United States in both liquid and tablet form. It can be purchased from homeopathic pharmacies or over the internet. Common potencies of ferrum phos. are 30C and 6X. The abbreviation 30C stands for a centesimal potency. This indicates that a process of dilution, along with vigorous shaking (succussion) of the remedy, has been repeated 30 times to achieve the desired potency.

The abbreviation 6X indicates a decimal potency, and means that this decimal dilution has been repeated six times. In homeopathic practice, the strength of the remedy is in inverse proportion to the amount of chemical or plant extract in the alcohol or water; thus a 30C preparation of ferrum phos. is considered a much higher potency than a 6X preparation. People using homeopathic remedies at home are generally encouraged to use the lower potencies such as 6X or 12X.

Precautions

The precautions recommended by homeopaths reflect concerns about proper administration of the remedies rather than specifying categories of patients who should not receive a given remedy. The quantity of a homeopathic remedy, for example, is less critical than the frequency of dosing. Homeopathy follows the principle of minimal dosing, which means in practice that the patient is not given a second dose of a remedy (or a dose of a different remedy) until the first has completed its action.

Minimal dosing is based on the homeopathic belief that remedies work by stimulating or “jump-starting” the body’s own natural defenses against illness rather than by killing germs. In general, however, the more severe the patient’s acute symptoms, the more often he or she would be given the remedy. A ferrum phos. patient with a bad cold might be given a dose of the remedy every three to six hours, while one with a milder illness might be given only one or two doses a day.

Precautions regarding homeopathic remedies also include avoiding contamination of the medicine. The patient should not touch the medicine; it should be dispensed into a cup and tipped directly into the patient’s mouth. Homeopathic remedies are not taken with water but allowed to dissolve in the mouth. Patients are asked not to eat or drink for about twenty minutes before and after each dose.

Side effects

Homeopathic remedies rarely have side effects in the usual sense of the phrase because they are so dilute. On the other hand, a homeopathic remedy may sometimes appear to be making a patient’s symptoms temporarily worse as part of the healing process. This temporary aggravation of the symptoms would be regarded by homeopaths as an indication that the remedy is effectively stimulating the patient’s body to heal itself.

Interactions

Homeopathic practitioners are not as a rule concerned with drug interactions, in part because homeopathic remedies are so dilute that there is little of the original substance to interact with a prescription given by an allopathic physician. In addition, the homeopathic “single medicine” principle, according to which a patient is given only one homeopathic remedy at a time for a given illness, also minimizes potential interactions among different remedies.

For example, a ferrum phos. patient would not be given a different cold or cough remedy unless the homeopath determined that the patient’s symptoms were changing and required a remedy with a different symptom profile. There is, however, an ongoing debate among homeopathic practitioners about the legitimacy of combination remedies.

Many homeopathic pharmacies sell preparations that are low-potency combinations of the most commonly used remedies for use at home. Conservative homeopaths maintain that the possibility of interactions among the different ingredients makes it difficult to evaluate the effectiveness of these combinations.

Homeopaths are, however, concerned about the effect of other substances on homeopathic preparations. They believe that remedies can lose potency through interaction with heat, light, or other substances. Guidelines for proper storage of homeopathic remedies include keeping them away from strong sunlight and high temperatures, keeping them in their original containers, and not storing them

Fever

A fever is a rise in body temperature to greater than 100°F (37.8°C).

Description

A healthy person’s body temperature fluctuates between 97°F (36.1°C) and 100°F (37.8°C), with the average being 98.6°F (37°C). The body maintains stability within this range by balancing the heat produced by the metabolism with the heat lost to the environment.

The “thermostat” that controls this process is located in the hypothalamus, a small structure located deep within the brain. The nervous system constantly relays information about the body’s temperature to the thermostat. In turn, the thermostat activates different physical responses designed to cool or warm the body, depending on the circumstances.


These responses include:

• decreasing or increasing the flow of blood from the body’s core, where it is warmed, to the surface, where it is cooled
• slowing down or speeding up the rate at which the body turns food into energy (metabolic rate)
• inducing shivering, which generates heat through muscle contraction
• inducing sweating, which cools the body through evaporation

A fever occurs when the body’s thermostat resets at a higher temperature, which primarily happens in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The chills that often accompany a fever are caused by the movement of blood to the body’s core, which leaves the surface and extremities cold.

Once the body reaches the higher temperature, the shivering and chills stop. When the infection has been overcome or drugs such as aspirin or acetaminophen (Tylenol) have been taken, the thermostat resets to normal. When this happens, the body’s cooling mechanisms switch on. The blood moves to the surface and sweating occurs.

Fever is an important component of the immune response, though its role is not completely understood. Physicians believe that an elevated body temperature has several effects. Certain chemicals in the immune system react with the fever-inducing agent and trigger the resetting of the thermostat.

These immune system chemicals also increase the production of cells that fight off the invading bacteria or viruses. Higher temperatures also inhibit the growth of some bacteria and speed up the chemical reactions that help the body’s cells repair themselves. Changes in blood circulation may cause the heart rate to increase, which speeds the arrival of white blood cells to the sites of infection.

Causes & symptoms

Fevers are primarily caused by viral or bacterial infections, such as pneumonia or influenza. However, other conditions can induce a fever, including these:

• allergic reactions
• autoimmune diseases
• trauma, such as breaking a bone
• cancer
• excessive exposure to the sun
• intense exercise
• hormonal imbalances
• certain drugs
• damage to the hypothalamus

When an infection occurs, fever-inducing agents called pyrogens are released, either by the body’s immune system or by the invading cells themselves. These pyrogens trigger the resetting of the thermostat. In other circumstances, an uncontrolled release of pyrogens may occur when the immune system overreacts due to an allergic reaction or becomes damaged due to an autoimmune disease.

A stroke or tumor can damage the hypothalamus, causing the body’s thermostat to malfunction. Excessive exposure to the sun or intense exercise in hot weather can result in heat stroke, a condition in which the body’s cooling mechanisms fail. Malignant hyperthermia is a rare, inherited condition in which a person develops a very high fever when given certain anesthetics or muscle relaxants in preparation for surgery.

A recent study showed that most parents have misconceptions about fever and view it as a disease rather than a symptom. How long a fever lasts and how high it may go depend on several factors, including its cause and the patient’s age and overall health. Most fevers caused by infections are acute, appearing suddenly and then dissipating as the immune system defeats the infectious agent.

An infectious fever may also rise and fall throughout the day, reaching its peak in the late afternoon or early evening. A low-grade fever that lasts for several weeks is associated with autoimmune diseases such as lupus or with some cancers, particularly leukemia and lymphoma.

Diagnosis

A fever is usually diagnosed using a thermometer. A variety of different thermometers are available, including traditional oral and rectal thermometers made of glass and mercury, and more sophisticated electronic ones that can be inserted in the ear. For adults and older children, temperature readings are usually taken orally. Younger children who cannot or will not hold a thermometer in their mouths can have their temperatures taken by placing an oral thermometer under their armpits. Infants generally have their temperature taken rectally using a rectal thermometer.

As important as registering a patient’s temperature is determining the underlying cause of the fever. The physician can make a diagnosis by checking for accompanying symptoms and by reviewing the patient’s medical history, any recent trips he or she has taken, what he or she may have ingested, or any illnesses he or she has been exposed to. Blood tests hold additional clues.

Antibodies in the blood point to the presence of an infectious agent, which can be verified by growing the organism in a culture. Blood tests can also provide the doctor with white blood cell counts. Ultrasound tests, magnetic resonance imaging (MRI) tests, or computed tomography (CT) scans may be ordered if the doctor cannot readily determine the cause of a fever.

Treatment

Often, doctors must remind patients, especially parents, not to “overtreat” low fevers but to remember that they are symptoms of an underlying disease or condition. Alternative therapies for treatment of fever focus not only on reducing fever but also on boosting the immune function to help the body fight infections more effectively. They include nutritional therapy, herbal therapy and traditional Chinese medicine.

Nutritional therapy

Naturopaths often recommend that patients take high doses of vitamin C to ward off diseases and prevent fever. In addition to vitamin C, other antioxidants such as vitamin A and zinc also boost the immune function. Naturopaths may also suggest reducing sugar intake (even fruit juices) because sugar depresses the immune system. To replace fluid that is lost during fever, patients are advised to drink vegetable juices and eat soups.

Herbal therapy

Western herbalists use tea preparations containing herbs such as bupleurum root or boneset to reduce fever. Mild herbs such as peppermint, elderflower, or yarrow can provide comfort to the child who has a mild fever. Others believe in sweating a fever out, literally. They often recommend that patients take hot baths to induce sweating. This helps induce or increase fever, which is believed to help the body get rid of infections.

Chinese medicine (TCM) offers many herbs and formulas for fevers. There are many distinct kinds of fevers, also called heat syndromes. For example, an excess- heat syndrome is characterized by a high fever, great thirst, and lots of sweating. Deficiency heat syndrome is characterized by a low-grade fever with afternoon fevers or night sweats. For excess heat, herbs that are dispersing and cold in nature are used.

For chronic and low-grade fevers, herbs that tonify the yin (cooling aspect) are used as well as herbs that get rid of heat. There are even herbs such as bupleurum root (called Chai Hu in TCM) that are used for intermittent fevers or conditions alternating between fever and chills. Alternating fevers and chills occur in malaria, conditions connected to AIDS, chronic fatigue syndrome, and Epstein- Barr virus. The individual pattern should be diagnosed by a trained practitioner.

Aromatherapy

Patients can reduce feverish symptoms by inhaling essential oils of camphor, eucalyptus, lemon, and hyssop. These oils can also be mixed with an unscented body lotion or a vegetable oil for aromatherapy massage.

Homeopathy

Homeopathic doctors may prescribe herbal remedies based on the patient’s overall personality profile as well as specific symptoms.

Allopathic treatment

Physicians agree that the most effective treatment for a fever is to address its underlying cause. Also, because a fever helps the immune system fight infection, some clinicians suggest it be allowed to run its course. Drugs to lower fever (antipyretics) can be given if a patient (particularly a child) is uncomfortable.

These include aspirin, acetaminophen, and ibuprofen. Aspirin, however, should not be given to a child or adolescent with a fever since this drug has been linked to an increased risk of Reye’s syndrome. Sponging a child or infant with tepid (lukewarm) water can also help reduce mild fevers.

A fever requires emergency treatment under the following circumstances:

• Newborn (three months or younger) with a fever above 100.5°F (38°C).
• Infant or child with a fever above 103°F (39.4°C). A very high fever in a small child can trigger seizures (febrile seizures) and therefore should be treated immediately.
• Fever accompanied by severe headache, neck stiffness, mental confusion, or severe swelling of the throat. A fever accompanied by these symptoms can indicate the presence of a serious infection, such as meningitis, and should be brought to the immediate attention of a physician.

Expected results

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen. Most fevers do not produce any lasting effects. The prognosis for fevers associated with more chronic conditions, such as autoimmune disease, depends upon the overall outcome of the disorder.

Feverfew

Feverfew (Chrysanthemum parthenium or Tanacetum parthenium) is named for one of the herb’s traditional medicinal uses as a febrifuge, from the Latin febrifugia, indicating its fever-reducing action. This European native of the Compositae (Asteraceae) or aster family has naturalized throughout North and South America, escaping from cultivation. It can be found along roadsides and along the borders of wooded areas. Other common names include featherfew, febrifuge plant, featherfoil, mid-summer daisy, and wild chamomile.

Feverfew is a bushy and herbaceous perennial that grows from a branched and tapering root to produce erect, round and slightly grooved stems. The feathery, aromatic and bitter-tasting leaves are arranged alternately along the length of the many-branched stem. They are a yellow-green, stalked, and bipinnate with deeply cut, toothed segments in an oval shape.

Flowers bloom in mid to late-summer in flat-topped clusters at the end of stems that may reach to a height of three feet. Smaller than daisies, and without the protruding central disk of chamomile, feverfew blossoms have yellow centers consisting of tightly-bunched tubular florets surrounded by creamy white rays. Bees seem to avoid feverfew, deterred by its pungent aroma. The plant self-seeds freely, and thrives in full sun or partial shade in most soil.


General use

Feverfew leaves and flowers are used medicinally. Among its many uses, the herb has become a popular and proven herbal remedy for the treatment of migraine headaches. This important use of the plant was recorded as far back as 1633 by the British herbalist Gerard. With frequent use, over time, feverfew can reduce the frequency, severity, and duration of migraine headaches and allay nausea and vomiting.

It is most effective when used as a preventive. It acts to inhibit serotonin and histamine, substances that dilate blood vessels, and helps to prevent the spasms in blood vessels that trigger migraine headaches. This much-researched herb has been shown to inhibit production of leukotines and other inflammatory substances. It is an effective remedy for relieving the pain and inflammation of arthritis and alleviating hay fever, asthma and other allergy symptoms.

Other traditional uses of feverfew dating back to ancient Greece and Rome include its use as an emmenagogue, which is an infusion taken in cases of sluggish menstruation to relieve congestion and promote periodic flow. The herb has also been used after childbirth to help expel the placenta.

Feverfew was valued in past centuries for its believed protection against the plague and the bite of mad dogs. In the seventeenth century the herbalist John Parkinson recommended feverfew as a remedy to speed recovery from opium overdose. It has also been used in treating alcoholic delirium tremens, and to expel intestinal worms.

The English physician Culpeper recommended an external application of the fresh herb to treat ague, as the disease malaria was once called. Feverfew is a bitter digestive and liver tonic. A hot infusion may reduce fever and congestion from colds. The infusion, taken cold, has tonic properties. Feverfew may relieve mild depression, promote restful sleep, and ease the nerve pain of sciatica and shingles. Externally the strong infusion is an antiseptic skin wash for treatment of insect stings and bites. The wash may also be used as an insect repellent.

Feverfew leaves and stems, gathered fresh, may be used as a dye plant, with a chrome mordant, to produce a light green-yellow color in natural fibres such as wool. Feverfew flowers have a purgative action if ingested, and if the blossom heads are carried into areas where bees are located, the insects will fly away.

The active compounds in feverfew include sesquiterpene lactones, predominantly parthenolide. Other phytochemicals include pyrethrin, volatile oils, tannins, bitter resin, and flavonoids.


Preparations

Feverfew should be harvested just as the plant comes into flower and before the blossoms are fully open. Leaves are removed from the stalks and dried on paper-lined trays in a light, airy room, away from direct sunlight. The dried herb should be stored in clearly-labeled, tightly-sealed, dark glass containers.

Capsules: Feverfew leaf in capsule form, at a 250 mg daily dose, is recommended for medicinal use. It may take four to six weeks before the herb provides noticeable relief. Studies of some commercially-prepared capsules revealed that many did not contain a sufficient quantity of the active ingredient to be medicinally effective.

Feverfew may be more medicinally potent when gathered fresh. Three to four fresh leaves, taken daily over a period of time are medicinally effective. A certified practitioner can help determine the most effective and safest levels for individual cases.

Syrup: Fresh feverfew leaf can be added to honey, or to a simple sugar syrup. The honey will act as a preservative and mask the bitter taste of the herb.

Infusion: Two to three teaspoons of chopped, fresh feverfew leaves are placed in a warmed container. One cup of fresh, nonchlorinated boiled water is added to the herbs and the mixture is covered. The tea is infused for about 15 minutes, then strained. A stronger infusion, using double the amount of leaf and steeping twice as long, is useful as a skin wash for repelling insects, or soothing inflammations and wounds.

The strong infusion has also been used as a mouthwash following tooth extraction. The prepared tea will store for about two days in the refrigerator in an airtight container. Dosage: Feverfew may be enjoyed by the cupful three times a day.

Tincture: Combine four ounces of finely-cut fresh, or powdered dry herb with one pint of brandy, gin, or vodka, in a glass container. The alcohol should be enough to cover the plant parts. Place the mixture away from light for about two weeks, shaking several times each day. Strain and store in a tightly capped, dark glass bottle. A standard dose is 30 drops of the tincture three times a day.

Precautions

Since herbal preparations are not regulated by the Food and Drug Administration (FDA), consumers in the United States should check the labels of commercial products carefully for dosage instructions and the part(s) of the plant used for or contained in the product. A 2002 study of commercial feverfew preparations found wide variations in the recommended dosages and parthenolide contents of the products that were tested.

The researchers found that “.. intake of parthenolide would range from 0.06 to 9.7 mg/day, a 160-fold variation.” Any adverse effects from feverfew preparations or any other herbal products sold as dietary supplements should be reported to the FDA’s Center for Food Safety and Applied Nutrition, listed under Resources.

Feverfew should not be used by pregnant or lactating women. Children under two years of age should not be given feverfew. Chewing the fresh leaves may irritate the mucous membranes in the mouth causing mouth ulcers in some persons. Traditionally the fresh herb was enclosed between slices of bread to minimize the irritation and mask the bitter taste of the fresh leaves. Persons on prescribed blood-thinning drugs should not ingest feverfew as it might interfere with the rate of blood clotting.

Side effects

Feverfew is a safe herb of proven medicinal value. No side effects are reported when taken in designated therapeutic doses. Some cases of contact dermatitis and airborne dermatitis, however, have been reported by researchers in Denmark and the United States.

Interactions

According to the PDR For Herbal Medicines, feverfew may interact with anti-thrombotic medications, including aspirin and warfarin. The tannins in feverfew have been reported to interfere with iron absorption in persons who take supplemental iron.

Taking NSAIDs together with feverfew will decrease the beneficial effects of the herb.

Fibrocystic breast disease

Fibrocystic breast disease is a general term that refers to a variety of symptoms and diagnoses, including breast lumpiness, tenderness, and a wide range of vaguely-defined benign breast conditions. The term is also used diagnostically to describe the appearance of breast tissues viewed under the microscope, on x-ray film, or on ultrasound equipment.

Description

There is no such thing as a typical or normal female breast. Breasts come in all shapes and sizes, with varying textures from smooth to extremely lumpy. The tissues of the female breast change in response to hormone levels, normal aging, nursing (lactation), weight shifts, and injury. To further complicate matters, the breast has several types of tissue, each of which may respond differently to changes in body chemistry.

Fibrocystic breast disease is clearly not a single, specific disease process. Variations or changes in the way the breast feels or looks on an x ray may cause the condition to be called “fibrocystic change.” Other names have been used to refer to this imprecise and ill-defined term: mammary dysplasia, mastopathy, chronic cystic mastitis, indurative mastopathy, mastalgia, lumpy breasts, or physiologic nodularity.


Estimates vary, but 40–90% of all women have some evidence of fibrocystic condition, change, or disease. It is most common among women ages 30–50, but may be seen at other ages.

Causes & symptoms

Fibrocystic condition refers to technical findings. This discussion will focus on symptoms a woman experiences, which may fall under the general category of the fibrocystic condition.

The breast is not a soft, smooth, pulpy organ. It is actually a type of sweat gland. Milk, the breasts’ version of sweat, is secreted when the breast receives appropriate hormonal and environmental stimulation.

The normal breast contains milk glands, with their accompanying ducts, or pipelines, for transporting the milk. These complex structures may not only alter in size, but can increase or decrease in number as needed. Fibrous connective tissue, fatty tissue, nerves, blood and lymph vessels, and lymph nodes, with their different shapes and textures, lie among the ever-changing milk glands. This explains why a woman’s breasts may not feel uniform in texture, and why “lumpiness” may wax and wane.

Fibrocystic condition is the tenderness, enlargement, and/or changing lumpiness that many women encounter just before or during their menstrual periods. At this time, female hormones are preparing the breasts for pregnancy, by stimulating the milk-producing cells and storing fluid. Each breast may contain as much as three to six teaspoons of excess liquid. Swelling, with increased sensitivity or pain, may result. If pregnancy does not occur, the body reabsorbs the fluid, and the engorgement and discomfort are relieved.

These symptoms range from mildly annoying in some women to extremely painful in others. The severity of the sensations may vary from month to month in the same woman. Although sometimes distressing, this experience is the body’s normal response to routine hormonal changes.

This cycle of breast sensitivity, pain, and/or enlargement can also result from medications. Some hormone replacement therapies used for post-menopausal women can produce these effects. Other medications, primarily, but not exclusively, those with hormones, may also provoke these symptoms.

Breast pain unrelated to hormone shifts is called “noncyclic” pain. This area-specific pain is also called “trigger-zone breast pain,” and it may be continuous, or may be felt intermittently. Trauma, such as a blow to the area, or a breast biopsy performed several years before, or sensitivity to certain medications may also underlie this type of pain. Fibrocystic condition may be cited as the cause of otherwise unexplained breast pain.

Lumps, apart from those clearly associated with hormone cycles, may also be placed under the heading of fibrocystic condition. These lumps stand out from enlarged general breast tissue. The obvious concern with such lumps is cancer, although noncancerous lumps also occur. Two noncancerous types, fibroadenomas and cysts, are discussed here.

Fibroadenomas are tumors which form in the tissues outside the milk ducts. The cause of fibroadenomas is unknown. They generally feel smooth and firm, with a somewhat rubber-like texture. Typically a fibroadenoma is not attached to surrounding tissue, and will move slightly when touched. They are most commonly found in adolescents and women in their early 20s but can arise at any age.

Cysts are fluid-filled sacs in the breast. They probably develop as ducts become clogged with old cells in the process of normal emptying and filling. Cysts usually feel soft and round or oval. However, a cyst deep within the breast may feel hard, as it pushes up against firmer breast tissue. A woman with a cyst may experience pain, especially if it increases in size before her menstrual cycle, as many do. Women age 30–50 are most likely to develop cysts.


Sometimes one area of breast tissue persistently feels thicker or more prominent than the rest of the breast. This may be caused by hardened scar tissue and/or dead fat tissue from surgery or trauma. Often the cause of such tissue is unknown.

A number of other breast problems which are benign or noncancerous may be placed under the heading of fibrocystic condition. These include disorders which may lead to breast inflammation (mastitis), infection, nipple discharge, dilated milk ducts, milk-filled cyst, wart-like growth in the duct, and excess growth of fibrous tissue around the glands.

Diagnosis

Breast cancer is the concern in most cases of an abnormal breast symptom. A newly discovered breast lump should be brought to the attention of a family physician or an obstetrician-gynecologist. A physical examination of the area is usually performed. Depending on the findings, the patient may be referred for tests.

The most common tests are mammography and breast ultrasound. A cyst may be definitively diagnosed by ultrasound. To relieve the discomfort, the patient may choose to have the cyst suctioned, or drained. If there is any question as to the fluid diagnosis, the fluid is sent for analysis.

If a lump cannot be proven benign by mammography and ultrasound, a breast biopsy may be considered. Tissue is removed through a needle to obtain a sample of the lump. The sample is examined under the microscope by a pathologist, and a detailed diagnosis regarding the type of benign lesion or cancer is established.

A ductogram evaluates nipple discharge. A very fine tube is threaded into the duct, dye is injected, and the area is looked at for diagnosis. Other breast conditions such as inflammation or infection are usually recognized on the basis of suspicious history, such as breast-feeding and characteristic symptoms such as pain, redness, and swelling. A positive response to appropriate therapies will support the diagnosis.

Treatment

Warm soaks, heating pads, or ice packs may provide comfort. A well-fitted support bra worn day and night can minimize physical movement and do much to relieve breast discomfort. Breast massage may promote removal of excess fluid from tissues and alleviate symptoms. Massaging the breast with castor oil, straight or infused with herbs or diluted essential oils, can help reduce and dissipate fibroadenomas as well as keep women in touch with changes in their breasts.

Many women have reported relief of symptoms when caffeine was reduced or eliminated from their diets. Decreasing salt intake before and during the period when breasts are most sensitive may also ease swelling and discomfort. Vitamins A, B complex, and E and selenium supplements have been reported to be helpful.

Because fat promotes estrogen production, and estrogen is thought to be linked to breast tenderness, low-fat diets and elimination of dairy products also seem to decrease soreness for some women. Restricting salt intake may also help reduce fluid retention and lessen breast pain. It may take several months to realize the effects of these various treatments.

Evening primrose oil (Oenothera biennis), flax oil, and fish oils have been reported to be effective in relieving cyclic breast pain for some women. In addition, a focus on liver cleansing is important to assist the body in conjugation and elimination of excess estrogens. The herb chaste tree (Vitex angus-castus) can be used to help relieve symptoms of premenstrual syndrome (PMS), including breast tenderness.

A Chinese herbalist may recommend Herba cum Radice Asari with Radix Angelicae Sinensis and Flos Carthami Tinctorii for painful breast lumps, or Rhizoma Cyperi Rotundi with Radix Bupleuri and Fructus Trichosanthis for breast masses that swell around the time of menstruation.

Allopathic treatment

A lump that has been proven benign can be left in the breast. Some women may choose to have a lump such as a fibroadenoma surgically removed, especially if it is large. Infections are treated with warm compresses and antibiotics. Lactating women are encouraged to continue breastfeeding, as it promotes drainage and healing. A serious infection may progress to form an abscess which may need surgical drainage.

Once a specific disorder within the broad category of fibrocystic condition is identified, treatment can be prescribed. Symptoms of cyclical breast sensitivity and engorgement may be treated with diet, medication, and/or physical modifications.

Over-the-counter analgesics (pain relievers) such as acetaminophen (Tylenol) or ibuprofen (Advil) may be recommended. In some cases, treatment with hormones or hormone blockers may prove successful. Birth control pills may be prescribed.

Expected results

Most benign breast conditions carry no increased risk for the development of breast cancer. However, a small percentage of biopsies will uncover overgrowth of tissue in a particular pattern in some women that indicates a 15–20% risk of developing breast cancer over the next 20 years. Strict attention to early detection measures, such as annual mammograms, is especially important for these women.

Prevention

No way has yet been proven to prevent the various manifestations of fibrocystic condition from occurring. Some alternative practitioners believe that elimination of foods high in methylxanthines (primarily coffee and chocolate) can decrease or reverse fibrocystic breast changes.

Fibromyalgia

Fibromyalgia is described as inflammation of the fibrous or connective tissue of the body. Widespread muscle pain, fatigue, and multiple tender points characterize these conditions. Many individuals with fibromyalgia describe the symptoms as similar to the aches and pains of a severe case of the flu. Fibrositis, fibromyalgia, and fibromyositis are names given to a set of symptoms believed to be caused by the same general problem.

Description

Fibromyalgia is more common than previously thought, with as many as 3-6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men, particularly women of childbearing age.

Causes & symptoms

The exact cause of fibromyalgia is not known. Sometimes it occurs in several members of a family, suggesting that it may be an inherited disorder. People with fibromyalgia are most likely to complain of three primary symptoms: muscle and joint pain, stiffness, and fatigue.


Pain is the major symptom with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain also tends to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain may fluctuate.

Symptoms of fatigue may result from the individual’s chronic pain coupled with anxiety about the problem and how to find relief. The inflammatory process also produces chemicals that are known to cause fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea, and numbness or tingling of the extremities. Stress, anxiety, depression, or lack of sleep can increase symptoms. Intensity of symptoms is variable ranging from gradual improvement to episodes of recurrent symptoms.

Diagnosis

Diagnosis is difficult and frequently missed because symptoms of fibromyalgia are vague and generalized. Coexisting nerve and muscle disorders such as rheumatoid arthritis, spinal arthritis, or Lyme disease may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The diagnosis is usually made after ruling out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychological problem. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease.

The American College of Rheumatology has developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of the 18 sites known as trigger points. Trigger point sites include the base of the neck, along the backbone, in front of the hip and elbow, and at the rear of the knee and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, exercise, and lifestyle adjustments. Adequate rest is essential in the treatment of fibromyalgia. The diet should include a large variety of fruits and vegetables, which provide the body with trace elements and minerals that are necessary for healthy muscles.

Avoidance of stimulating foods or drinks (such as coffee) and medications like decongestants prior to bedtime is advised. A patient’s clear understanding of his or her role in the recovery process is imperative for successful management of this condition.


Treatments found to be helpful include heat and occasionally cold compress applications. A regular stretching program is often useful. Aerobic activities focusing on increasing the heart rate are the preferred forms of exercise over most other forms of exertion. Exercise programs need to include good warm-up and cool-down sessions, with special attention given to avoiding exercises causing joint pain. Hydrotherapy exercises (exercises in a pool or tub) may be useful in providing a low impact exercise environment while soothing muscle and joint pain.

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Short sessions are most helpful as repetitious movement can aggravate the condition. Specific attention to mental health, including psychological consultation, may also be important, since depression may precede or accompany fibromyalgia.

Relaxation exercises, yoga, aromatherapy, guided imagery, and other relaxation therapies can be useful in easing stress and promoting overall well-being. Acupuncture can be very helpful for symptom relief and in easing the general condition.

Herbalists and aromatherapists may recommend tub soaks or compresses with lavender (Lavandula angustifolia), chamomile (Chamaemelum nobilis), or juniper (Juniperus communis) to soothe muscle and joint pain.

Allopathic treatment

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A treatment program must be individualized to meet the patient’s needs. The rheumatologist, as the team leader, enlists and coordinates the expertise of other health professionals in the care of the patient.

If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medications may be prescribed. Medications prescribed and found to have some benefit include antidepressant drugs, muscle relaxants, and anti-inflammatory drugs.

Expected results

Fibromyalgia is a chronic health problem. The symptoms sometimes improve and at other times worsen, but they often continue for months to years.

Prevention

There is no known or specific prevention for fibromyalgia. However, similar to many other medical conditions, remaining as healthy as possible with a good diet, safe exercise, and adequate rest is the best prevention.