Renal system disease

Functional aspects


When disturbed they many have paranoid delusions, delusion of grandeur or can become psychotic. Prior to the advent of DNA-based studies, individuals had been classified as poor or extensive metabolizers PMs, EMs of debrisoquine based on metabolite concentrations in urine samples. Phosphate is retained in the blood and is thus associated with low blood levels of calcium; the parathyroids are overactive in renal failure, and vitamin D is less than normally effective because the kidneys manufacture less of its active form 1,dihydroxycholecalciferol. Tumour that has spread directly through the fatty tissue and the fascia ligament-like tissue that surrounds the kidney. And when you saliva turns alkaline it is for the same reason. While the suggestion and message in this reserve are believed to be steady and accu- take to task at the date of flier, neither the authors nor the editors nor the pub- lisher can agree to any legitimate answerability on the side of any errors or omissions that may be made. The vast majority of cancers have been linked to viral infections.

Introduction


However, it is traditionally dried and made into a starchy extract called Guduchi Sattva. It is similar to arrow-root in appearance. In the ancient text Caraka Samhita 50 great extract categories are described and Guduchi is included in two: It contains a vast amount of information on classical Ayurvedic herbal formulas. Among them Chyavanprash is the most popular rasayana rejuvenative tonic formula in India today.

Like all traditional Ayurvedic formulas, the exact herbal combination can differ but most ingredients are the same. Particularly it alleviates cough and dyspnoea, is useful for the wasted, injured and old people and promotes development of children. It alleviates hoarseness of voice, chest diseases, heart disease, vatarakta, thirst and disorders of urine and semen. It should be taken in the dose which does not interfere with the food intake and digestion.

By using this rasayana the extremely old Cyavana regained youthful age. If this rasayana is used by the indoor method, even the old attains intellect, memory, luster, freedom from diseases, longevity, strength of senses, sexual vigour, increased agni digestion and metabolism , fairness of complexion and carmination of wind. One, shedding the form of the old age, puts on that of the fresh youth.

Charaka described over two dozen poly-herbal formulas that include Guduchi and that are used for a wide variety of ailments. He described a number of anti-pyretic formulas. There was also one for edema in vata combined with pitta. This alkali is an excellent promoter of agni and alleviates splenomegaly, retention of urine, dyspnoea, hiccup, cough, worms, fever, wasting, diarrhea, edema, prameha, hardness in bowels, cardiac pain and all kinds of poison.

After the drug is digested, the patient should eat with sweet meat-soups or milk. He also described one for disorders of the female genital tract and another for kaphaja vomiting. It is an excellent alleviator of vatika disorders. Lastly, Caraka described a number of formulas for unctuous and non-unctuous enemas.

This unctuous enema provides strength to those wasted due to disease, physical exercise, evacuative measures and wayfaring, debilitated, devoid of ojas and having diminished semen. Moreover, it gives good firmness to feet, shanks, thighs, back, shoulder and waist and virility to sterile women and men. It is excellent rasayana and destroyer of wrinkles and graying of hairs.

Most research has been done in test tubes in vitro or in animals in vivo and has yielded some impressive results. A large variety of chemical constituents have now been isolated from Tinospora cordifolia. The major isolated compounds belong to a variety of classes such as alkaloids, diterpenoids lactones, glycosides, steroids, sesquiterpenoids, phenolics, aliphatic compounds, and polysaccharides.

The leaves have also been found to be abundant in protein and fairly high in calcium and phosphorous. The usefulness of Tinospora cordifolia as a cognitive enhancer has been substantiated by some research. For example, healthy volunteers were given an aqueous extract for three weeks in a double blind study.

They were found to have a significant increase in test scores for logical memory and verbal memory. A study gave aqueous and alcoholic extracts to normal and cyclosporine induced cognition deficient rats. Tinospora cordifolia not only enhanced the cognition in normal rats but also in the rats treated with cyclosporine. Guduchi has been studied for its hypoglycemic actions. Crude ethyl acetate, dichloromethane CDM , chloroform and hexane stem extracts of Tinospora cordifolia was studied for inhibition of the alpha glucosidase enzyme.

Another study used an aqueous extract of Tinospora cordifolia to test insulin resistance and oxidative stress in rats. Tinospora cordifolia treatment prevented the increase in glucose by Also, Tinospora cordifolia treatment was effective in preventing the fructose-induced abnormalities in the liver involving lipid peroxidation, protein carbonyl groups, GSH levels, and enzymatic antioxidants.

Tinospora supplies protection against gamma irradiation in mice. Administration of an alcohol stem extract to mice 1 hour before whole body gamma irradiation was shown to increase survival, prevent body weight loss, increase the number of colony forming unit counts in the spleen, restore total lymphocyte counts, increase impaired S-phase cell population and decrease irradiation induced micronuclei.

In another study an aqueous extract was used on mice before being exposed to gamma radiation. The results showed various amounts of protection against the radiation through increased survival time and signs and symptoms of radiation sickness. Another study by the same authors again found an increase in the count of tumor associated macrophages. The reduction in solid tumor growth was significant.

Guduchi has been one of the most versatile and important herbs in the Indian sub-continent since ancient times. An enormous amount of knowledge has been accumulated by thousands of years of direct observation and trial and error.

In our modern era, impressive research has been done on the biological activity and possible application of Guduchi and its chemical constituents. Eds Indian Materia Medica 3rd ed Vol.

Biological and Medicinal properties, a review. Caraka Caraka Samhita Sharma P. Ed Major Herbs of Ayurveda.

The Principles of Traditional Practice. Chowkhamba Sanskrit series Office. Indian Journal of Pharmacology. Iranian Journal of Pharmacology and Therapeutics. Journal of Radiation Research. Immunopharmacology and immunotoxicology, Vol. Food Chem Toxicology 47 9 pp. Within the cornucopia of medicinal plants, few possess such a wide spectrum of qualities and medicinal uses as turmeric.

For countless centuries, many different cultures have used this wonderful, versatile herb to treat a myriad of diseases and ailments. The most well known medicinal action of turmeric is its use as a powerful anti-inflammatory, the effectiveness of which is comparable to pharmaceutical medicines.

However, it also acts as an alterative, analgesic, antibacterial, anti-inflammatory, anti-tumor, anti-allergic, anti-oxidant, antiseptic, antispasmodic, astringent, carminative, cholagogue, digestive, diuretic, stimulant, and vulnerary 6,8, Modern science is beginning to recognize and understand the amazing healing qualities of turmeric and much research is currently being conducted.

Turmeric has been proven effective in treating some of the most intense ailments afflicting the world today including: It can also be used as a mosquito repellent, wound healer, and immediate cure for scorpion stings. Turmeric helps balance the female reproductive and lactation systems, and in men it purifies and improves the health of semen. It is used to treat external ulcers that would not respond to other treatment 6,8, Due to its vast array of medicinal purposes and versatility, turmeric is one of the most important herbs in any natural medicine cabinet.

The healing properties of turmeric lie in the golden fingerlike stalk, or rhizome, the same part that is used to flavor, color, and preserve food.

Turmeric is commonly found in Indian curries, giving the food a golden orange color. Turmeric has also been used as a dye for mustards, canned chicken broth, and pickles. In combination with annatto, turmeric is used to color cheese, dry mixes, salad dressing, butter and margarine 3. The brilliant color has also been used for dyeing silk and wool; the robes of Buddhist monks were traditionally dyed with turmeric Turmeric is a native to South Asia , particularly India , but is cultivated in many warm regions of the world.

It can be found growing extensively in all of India , but does especially well in the regions of Tamil Nadu, West Bengal , and Maharashtra India is the largest producer in the world; Jamacia and Peru are the chief exporters, and Iran the largest importer. There are two main varieties of turmeric: Turmeric became valuable to humans when it was discovered that the powdered rhizome preserved the freshness and nutritive value of foods.

It was originally used in curries and other food to improve storage conditions, palatability, and preservation. Because of its preservation properties, turmeric played a vital role in survival and sustainability in South Asia , and was valued more than gold and precious stones 7.

However, turmeric was eventually replaced by cheaper, synthetic preservatives. Turmeric was used much more extensively by the natives of India than today.

Turmeric was highly valued by the ancient Indo-European people not only for its preservation properties, but for its energetic and spiritual qualities as well.

The Arya culture was a group of people who worshipped the solar system and the sun as a deity. Turmeric was very sacred to them, due to its golden yellow color like sunlight and they believed it had special protective properties 7.

Remnants of this belief still exist today, particularly in South India , where some people wear a dried turmeric rhizome bead the size of a large grape around their neck or arm. This is an ancient talisman tradition used to ward off evil and grant to the wearer healing and protection People of ancient India believed that turmeric contained the energy of the Divine Mother, helped to grant prosperity, cleanse the chakras energy centers in the body , and purify the channels of the subtle body 6.

Even today, Hindu people consider turmeric to have auspicious qualities, and use it in many sacred ceremonies. It is commonly made into a paste and applied to the forehead ajna chakra or third eye during pujas devotional ceremonies and weddings. During a traditional Indian wedding ceremony, the bridge and groom apply a paste of turmeric and sandalwood powder on each other's foreheads.

Traditionally, turmeric was also used to dye the marriage clothing. It was believed that any clothing dyed with turmeric was protection from fever. New clothes would sometimes be stained with a paste of turmeric, lime, and water. Today, magenta dye has become more popular 9. Turmeric has been used for centuries in Ayurveda, the 5, year old natural healing system of India.

It is called by 46 different synonyms, including: This comes from a tradition of married women applying turmeric to their cheeks in the evening in preparation for a visit from Lakshmi The Goddess of Prosperity 7. In Ayurveda, turmeric is believed to balance the three doshas vata, pitta, and kapha.

It has been used by Ayurvedic healers as medicine taken internally in the form of fresh juice, boiled tea, tinctures, or powder, and topically as creams, lotions, pastes, and ointments 1. There are many ancient Ayurvedic formulas utilizing turmeric. Milk boiled with turmeric and sugar was a popular cold remedy and turmeric juice was used to help heal wounds, bruises, and leech bites.

A paste made from turmeric, lime, and salt was commonly applied to sprains and inflamed joints 8. Smoke made by sprinkling turmeric over burnt charcoal was used to relieve scorpion stings within a few minutes that the affected area is exposed to smoke.

Inhaling the fumes of burning turmeric was also used commonly to release copious amounts of mucous and provide instant relief from congestion. The fumes also were believed to help in hysteric fits 8. A pinch of turmeric was also used as an insect repellent in the kitchen 9. A paste made of turmeric alone or with neem leaves was used for ringworm, itching, eczema, and any other parasitic skin condition 8.

The Charakra Samhita section on Therapeutics states that turmeric, black pepper, long pepper, and ox bile was a common remedy for consumed poison or snake bites, up until the last stage The Charakra Samhita also provides a traditional remedy for jaundice: Cigars were made from turmeric paste, cinnamon, castor plant root, lac, red arsenic, deodar, yellow orpiment, and nardus, smeared with ghee and smoked.

Inhalation of the fumes of barley paste with ghee was also a treatment for jaundice Hemorrhoids piles were treated with an ointment of turmeric, hemp leaves, onions, and warm mustard oil or linseed oil, applied externally when the hemorrhoids are painful and protruding 8. Pastes of turmeric were used for smallpox, chickenpox, shingles, ulcers, conjunctivitis, skin blemishes, malaria, and applied to the cut placenta after the birth of a child 8. Turmeric has hundreds of molecular constituents, each with a variety of biological activities.

There are at least 20 molecules that are anti-biotic, 14 that are known cancer preventatives, 12 that are anti-tumor, 12 are anti-inflammatory and there are at least 10 different anti-oxidants 7. One database presented over known biological activities of turmeric Curcumin is the substance that is responsible for the biological activity of turmeric.

Combined with black pepper, curcumin becomes times more potent 4. Curcumin is now extracted from turmeric, sold as supplements, and is the basis of most scientific research. The same components that prevent deterioration of food protect living tissue from degenerating, possibly extending the life span of our bodies 7. These components may work by protecting a person directly, by shielding the biomolecules, or indirectly, by stimulating the natural detoxification and defense mechanisms of the body: Studies show that curcumin subdues NF-Kappa B, meaning that it may work to prevent nearly all diseases afflicting our world today 4.

Much research has been conducted on the various effects of curcumin in the body; the most widely researched is that of its effects on Cancer. Turmeric is considered to fight Cancer in three ways: It neutralizes those substances and conditions which can cause cancer; It directly helps a cell retain its integrity if threatened by carcinogens a substance showing significant evidence of causing cancer or growth of cancer cells ; If a tumor does grow the curcumins can often destroy it There are many reasons why turmeric helps to destroy Cancer.

One of the keys to this activity is the ability of curcumin to inhibit the enzyme Topoisomerase, which is required for the replication of cancer cells. This splits the DNA and thus allows cell replication to occur. Stopping Topoisomerase stops replication which stops the spread of the problem Curcumin is also one of the most studied natural COX-2 inhibitors, which block an enzyme called cyclooxygenase This is beneficial because the COX-2 enzyme helps make carcinogens more active in the body and allows cancerous cells to survive by growing new blood vessels 2.

In essence, curcumin completely blocks the formation of cancer causing enzymes, decreasing the likelihood of cancerous cell formation or growth. Curcumin is also rich in antioxidants, which are important disease fighting substances that help to clean up unstable oxygen molecules free radicals that can damage cells and cause diseases such as Cancer.

Other antioxidants and COX-2 inhibitors are red grapes, green tea, rosemary, and bee propolis 2. In summary, research is showing that curcumin may be more effective treatment for cancer in the beginning phases of the disease, as well as preventative treatment throughout life before cancer even emerges.

A study performed in on 16 cigarette smokers who took 1. Mutagens are substances that cause cell mutation and increase the occurrence of cancer. There is, however, some new research suggesting that taking curcumin may counteract the effectiveness of chemotherapy. Thus, many cancer treatment programs are developing a periodic schedule of use to avoid any issues Ayurveda especially recommends turmeric for cancers of the female reproductive system, specifically breast and uterine cancer, and to treat benign tumors as well Although the current research looks promising, there have been very few long term tests performed on large quantities of humans.

Turmeric was recently nominated by the National Cancer Institute for more study so we can look forward to many more research findings in the future. Turmeric is also a powerful anti-inflammatory herb. It has been shown to be helpful in the treatment of Arthritis, Rheumatoid Arthritis, Osteoarthritis, injuries, trauma, and stiffness from both under activity and over activity It is also helpful after surgery to decrease pain, inflammation and accelerate healing.

One study conducted in showed that a dosage of mg of curcumin a day was more effective in reducing post-surgical inflammation than either the placebo group or anti-inflammatory medication normally prescribed 5. In India , turmeric is considered the standard anti-inflammatory, and yogis use it to help keep their tendons and ligaments free from injury and to assist in their asana practice 6.

In the same way, it minimizes pain and inflammation related to any kind of exercise or strenuous activity. Turmeric is a potent inhibitor of cyclooxygenase 5-lipoxygenase and also 5-HETE production in neutrophils. Reducing these enzymes means less arachidonic acid metabolism, which means less PG2, which means less pain and inflammation 7. Many sources recommend turmeric for Arthritis but the scientific evidence is still unclear and much more research is underway.

Turmeric also has a special action to purify and nourish the blood and skin. External application stops pain and swelling, heals wounds rapidly, and treats many skin diseases ranging from acne to leprosy.

This will clear up skin blemishes, and increase the natural glow and radiance of the skin Turmeric essential oil works wonderfully as an external antibiotic to prevent infections in wounds. A nice formula for a wound healing salve is a mixture of olive oil, beeswax, tea tree oil, aloe, turmeric, arnica, slippery elm, red clover, thyme oil, and vitamin E 9. Since turmeric is bitter and anti-inflammatory, it is excellent for hot skin diseases, red rashes, and especially wet eczema Turmeric essential oil, mixed with citronella, tulsi, and vanillin, works as a powerful insect repellent, and is a natural alternative to D.

T, the most common chemical insect repellent commercially available. Studies show that D. Turmeric also protects the liver from toxins and pathogens.

It is known to both destroy m toxins in the liver, and to rebuild the liver after a toxic attack Turmeric increases the secretion and movement of bile, and may prevent all forms of liver disease. One study shows that curcumin blocks some of the harmful side effects of cigarette smoke, and prevents dangerous chemical formation after eating processed food It is also helpful in treating food poisoning. Traditionally, about 5 grams of Turmeric is taken with a glass of whey, morning and evening, for a month to activate and rebuild a liver 8.

Another good liver remedy could be based on Turmeric, Kutki root, and Milk Thistle seeds. In essence, turmeric helps keep the liver healthy so it can do its job of keeping the body detoxified. Ayurveda uses turmeric to purify and move the blood, as it is a wonderful alterative. It helps to remove stagnant blood while stimulating the formation of new blood tissue 6. Turmeric regulates menses, and decreases the intensity and pain of menstrual periods, and of uterine tumors.

Turmeric is a mild and supportive uterine stimulant and its many actions on the liver suggest that it may assist in balancing hormone levels as well Turmeric also plays a role in pregnancy and birthing in India. Traditionally, it is said that taking turmeric when pregnant will ensure that the child will always have beautiful skin However, turmeric is a mild uterine stimulant, so there is a chance of over stimulation; it is essential to consult a healthcare practitioner before taking any herbs during pregnancy.

Turmeric taken in the last two weeks of pregnancy in warm, organic milk helps to expedite a simple birth, while increasing the health of the mother and child as well. Turmeric is also an analgesic pain reliever and is sometimes used in natural childbirth to decrease pain Turmeric also has a special action to help the entire Gastro-Intestinal system by increasing intestinal flora and generate healthy digestion 6. It is traditionally used for weak stomachs, poor digestion, dyspepsia, parasites, abdominal cramps, to normalize metabolism, to help digest protein and breakdown of fats, to increase absorption, and the ability of the stomach to withstand digestive acids 6.

Turmeric is also a carminative: According to Ayurveda, plants that treat digestion are often the most important herbs of all since digestion is the basis of mental and physical health.

In a double blind study the participants and researches did not know which groups were taking the herb or the placebo conducted in Thailand , mg capsules of curcumin were given to adults suffering from indigestion at six different hospitals. Another major use of turmeric is support of the respiratory system. As an anti-oxidant it protects the lungs from pollution and toxins. It also helps the oxygen transfer from the lungs to the blood.

Turmeric with ghee is traditionally used to get rid of cough and to treat asthma 8. It also supports the heart in many ways. When LDL becomes oxidized, it creates deposits in the walls of blood vessels and contributes to the formation of arteriosclerosis.

Turmeric may also prevent platelet buildup along the walls of injured blood vessels, another common cause of blood clots and artery blockage that can result in heart attacks and strokes Studies are also underway regarding turmeric's believed effects in treating and preventing neurological diseases such as Multiple Sclerosis and Alzheimer's Disease.

This belief generates from the realization that elderly Indian people who eat turmeric on a regular basis are far less likely to develop these ailments than those who do not eat turmeric. In fact, Alzheimer's Disease is 4. It has been noted that people taking anti-inflammatory medication for Arthritis are less likely to develop Alzheimer's Disease 1.

Since turmeric possesses such a powerful anti-inflammatory action, scientists speculate that it most likely will have a preventative effect on such disorders. More research is needed in this area to prove such theories. In a recent study at the Jawaharlal Nehru Centre for Advanced Scientific Research in Bangalore , India , when scientists 'fed' curcumin to HIV-infected cells in the laboratory, the virus stopped replicating Several studies have shown that people who have HIV and AIDS are deficient in many antioxidant vitamins and minerals, and it is believed that it is the powerful antioxidant properties of turmeric that combat the disease In a study at Harvard Medical School , research showed that curcumin prevented the reproduction of HIV by blocking a specific gene that activates the virus and causes it to spread.

Another study showed that it may help decrease the reproduction of HIV This is a currently major topic of research, so we can look forward to updates in the near future. Turmeric can obviously stand the test of time. It has been worshipped, reveled and revered by people for centuries, and still today it is one of the most significant players in the prevention of serious disease as well as the general afflictions of living.

Much more research is underway to prove scientifically what the ancient people of India have known for centuries: Whether suffering from an acute or chronic disease, aches and pains, bumps and bruises, or as preventative maintenance, turmeric can and should be utilized by everyone on a regular basis.

In the words of David Frawley: NutriScience Publishers, Inc, Kaushik, Purshotam, Haridra Turmeric: Chowkhamba Sanskrit Series Office, Varanasi , Cancer Research , Article: Omega-3 fatty acid and phenolic anti-oxidant interventions. Dash, Bhagwan and R. Prashanti de Jager, Article: According to Ayurveda, the traditional medicine of India, the digestive system is the physical root of most diseases in the body.

In other words, as disease develops, its early signs are often seen as digestive problems. Gas, constipation, diarrhea, indigestion, and bloating are all considered to be warning signs of future problems that are more serious. If the digestive system is properly cared for, many diseases can be averted and diseases that are present have a better chance of healing. Ayurveda places a lot of emphasis of the care of the digestive system. In doing so, Ayurveda addresses not only what food is best for an individual, but also how food is best eaten and how it is best combined.

If proper food is taken in the proper manner, most digestive problems go away. For those that do not, Ayurveda utilizes herbs to normalize the function of the digestive system. How do you know if you have digestive problems that may cause future challenges? Most of the signs are obvious. If you have gas, bloating, constipation, diarrhea, or cramping, then you have mild but important signs of imbalance. If you have been diagnosed with irritable bowel syndrome, ulcers, ulcerative colitis, diverticulitis, or GIRD gastrointestinal reflux disorder , your challenges are more serious but can still be helped.

The knowledge of Ayurveda is important to the correction of all digestive imbalances. Proper digestion begins not with what you eat but how you eat it. Here are five simple but important guidelines to assure that your digestion is optimal. Begin meals with a moment of relaxation or grace: When the body is relaxed and focused on the food, digestive enzyme secretion is maximized.

Eat in a calm environment: When the mind is involved in drama and emotion, digestion is disturbed. Turn off the TV, don't discuss intense issues at the dinner table, and avoid eating while driving in the car. Chew your food well: Digestion begins with chewing. Proper chewing allows enzymes in the saliva to begin the digestive process.

Food should be chewed until it is an even consistency. Eat until you are satisfied, not until you are full: Overeating is one of the major causes of digestive upset and subsequent disease in Western countries. The surest way to extend life for most people is to eat less. It is important to learn the difference between genuine hunger and the desire for pleasure through taste. Rest before going on to the next activity: For optimal digestion, it is important to rest after eating. Failure to rest means that the body's physiology will switch away from digestion and toward the activity of the muscles of the body.

This leaves poorly digested food in the digestive system. It is best to wait at least twenty minutes before going on to the next activity.

Simply eating food properly will alleviate a lot of chronic digestive problems, thereby preventing more serious disease. When this is combined with a healthy diet, the effect is even more dramatic and almost all digestive problems disappear.

Ayurveda teaches that the best diet is the one that is proper for a person's constitution; their unique balance of body energies. People with a more vata nature, or those who suffer from constipation and gas, tend to need more cooked foods taken with some oil and spices, including salt.

It may come as a surprise to find that raw salads can cause more gas. Those with a more pitta nature, or those who suffer from burning indigestion and loose stools, need to eat more raw foods and take food that is less spicy and less oily. Deep fried foods are the worst food for people with pitta imbalances. Those with a kapha nature, or those who tend to feel heavy and sluggish and sometimes get nauseous after eating, require food that is dry, light and spicy.

People with a kapha nature thrive as vegetarians. What food should you eat? Ayurveda teaches that everyone is a unique individual. Nothing is right for everyone but everything is right for someone. Ayurveda is a path of finding out what is right for you. For the best personalized dietary plan, consult a Clinical Ayurvedic Specialist. In addition to supporting dietary and lifestyle changes, your Clinical Ayurvedic Specialist may design individualized herbal formulas to give your digestive system and the rest of your body its best chance of getting well.

Ayurveda is based on the belief that nothing is right for everyone and everything is right for someone. This belief comes from an understanding that each of us is unique. Simply put, each of us is biochemically different with different hormonal, enzyme, and neurotransmitter levels.

Each person reacts to the world in different ways. If we are all different, why would we even consider the idea that there must be one program of nutrition that is best for everyone?

Where did the idea come from? The United States Department of Agriculture publishes daily recommended allowances of vitamins and minerals. The American Heart Association also publishes recommendations for the amount of fruits, vegetables, grains, and dairy people should consume.

People routinely use these guidelines to see how they measure up. The problem with statistical models is that the average American is a myth found only in statistical research papers. In real life, individual needs can vary significantly. Meanwhile, current science is simply the best conclusion that can be made given available data. What is accepted as the truth today is often found to be wrong tomorrow. A good case in point is the intake of cholesterol. While America has become obsessed with lowering cholesterol intake, studies published over the last couple of years in the prestigious British Medical Journal reveal that low cholesterol numbers, while protecting against cardiovascular disease, seem to increase the risk of certain cancers.

What should a person do? There are many ideas on the bookshelves about how to eat and stay healthy. New books and ideas are published every month. Ayurveda is a year old science that aims to help a person understand what is right for them as a unique individual. Those who do not receive enough are prone to anxiety, constipation, and sleeplessness among many other conditions.

They need nourishing foods and often have difficulty maintaining a vegetarian diet. People of vata nature should avoid too many salads and fruits as well as beans and take in more grains, dairy and nuts.

Hot, spicy food is believed to lead to a greater incidence of skin rashes, liver weakness, and anger. Large salads are wonderful. If sweet, heavy, oily foods are taken in too great of a quantity it can lead to greater mucous accumulation as well as further weight gain and diabetes mellitus.

People with a kapha nature should avoid all sweets, dairy, nuts, and most grains such as wheat and rice. However, grains such as quinoa and millet can be taken. Nothing is right for everyone, everything is right for someone.

Cooked grains, butter, dairy, nuts, cooked vegetables. Raw Salads, cooked grains, milk, seeds. Salads, cooked vegetables, spicy foods, quinoa, millet, corn flour and buckwheat. Raw salads, fruits, beans. Hot, Spicy foods, sour foods, deep fried foods, fermented foods such as yogurt and vinegar. Dairy, meat, cheese, nuts, wheat and rice. Fats, the long time enemy of those who want to prevent heart disease, are getting a second look in light of new evidence that reveals that fats may play an important role in the prevention of some cancers.

Recent research published in the British Medical Journal has revealed that while low levels of fats protect us against heart disease, they may also increase our susceptibility to certain kinds of cancers.

Another study revealed that milk fats contain substances protective toward our bodies which prevent some cancers from forming. In light of this new research, it is important that each person reassess their attitudes toward fats and oils. Each year it kills more than twice the number of people as all cancers combined. Modern methods of nutrition have focused on the prevention of this group of diseases though diet and exercise. A diet low in saturated fats and cholesterol has been the cornerstone of prevention.

Repeated studies have concluded that lower blood cholesterol levels and triglycerides circulating fats reduce the incidence of these conditions. In addition, it has been shown that exercise also lowers their incidence in part through raising HDL and lowering LDL. HDL and LDL are often called good and bad fats; in fact they are proteins that carry fat within the body. The new research showing that lower fat levels may increase the incidence of some cancers should not come as a great surprise.

Fat has always been known to play an important role in the body, particularly in the production of all cell membranes, many hormones, the sheaths that surround nerves, and the oils that keep our skin healthy. Those who receive too little fat in their diet are more likely to suffer from a multitude of conditions including hormonal imbalances, brittle hair and nails, dry skin, and Raynaud's disease cold, painful sensations in the fingers, toes, ears and nose due to vasospasm of the small vessels.

It would be wrong to conclude that fat is either absolutely good for us or absolutely bad for us. Perhaps this is why there has been so much confusion and disagreement among the experts.

Effective arguments can be made for either point of view. Dean Ornate, MD, well received as an expert in nutrition, advocates very low fat diets as being optimal for preventing and reversing, heart disease. Another recognized expert, Robert Atkins, MD, blames heart disease on high carbohydrate diets and advocates low carbohydrate, high protein diets.

He does not recommend restricting fat. Could both experts be right? Perhaps future research will try to answer an as yet, unasked question. Could higher levels of fat be good for some people and harmful for others?

If so, who would fall into each category? Ayurveda i , the traditional healing system from India, is based upon the understanding that each person is an individual with unique nutritional needs. Ayurveda teaches that those people of vata nature--who are lighter, thin boned, have narrow faces and thin, scanty hair, dry skin, and a nervous or anxious nature--benefit from extra fats and oils in their diet. In fact, according to Ayurveda, the oils reduce their risk of cardiovascular disease.

Meanwhile, those of a more pitta nature--who have a moderate build, focused, intense, deep set eyes and early graying of the hair--and those of kapha nature--stocky, dense bones, short necks, round faces, generally calm and relaxed--become unhealthy when exposed to too much fat. Those of a kapha nature are understood to be the most susceptible to traditional risk factors of cardiovascular disease.

Increased body weight is a known risk factor of CVD and kapha individuals having a slower metabolism are often overweight. With all of this conflicting information, what is a person to do? I am reminded of the wise words of the great Rishi mystic Patanjali in the Yoga Sutras. In summary he says, " Take them all in moderation. If you are very thin, do not fear fats, they are your friend. As Ayurveda teaches, they may reduce your risk of CVD and also of other conditions such as anxiety.

It is best to take healthy fats from naturally occurring sources such as vegetable oils, nuts, milk and eggs. Oils such as olive, sesame and ghee are the best as they are somewhat heavy oils. They have a moderate percentage of saturated fats and are high in mono-unsaturated fats. If you are heavy, reduce your intake of fats. Not only will they increase your risk of CVD but also of diabetes. If you do take oils, use polyunsaturated oils such as safflower, they are lighter.

Everyone should avoid excessive un-natural fats such as those from deep fried foods and oils which are old and rancid. For specific individualized dietary plans, see a Clinical Ayurvedic Specialist. And, remember, to further reduce your risk of cardiovascular, avoid smoking, exercise regularly, relax often, and have your blood pressure checked regularly.

Beware of modern science. There is a tendency to leap into the current theories being promoted as though they express the whole truth. Modern science is outdated every ten years, replaced by newer, still incomplete information. It was, after all, "modern science" that once told us that babies would thrive more on bottled milk than on breast milk, that the chemical DES was safe for pregnant woman, that marijuana has no useful medical value, and that you can safely lose weight by taking the drug fen-phen.

Modern science still tells us that pesticides in reasonable doses are safe. Use common sense and intuition. All great traditional healing sciences Native American, Ayurvedic, Chinese focus on principles of truth, based in spirit, tested though time and which stand eternal.

Moderation is the safest approach unless a person is guided by an expert in the field. Within the field of Western medicine, psychosis is viewed as a complex of visible symptoms and effects rather than as an indicator of a simple root cause. If the condition is left untreated, people can sometimes harm themselves or others. Very little information can be found in Western medicine advocating either diet or lifestyle as a foundation of mental clarity or a cure for mental illness.

What sorts of treatment methods are utilized by these two medical sciences in its management? The objective of this paper is aimed towards the exploration of and answers to these questions.

However, it was the relatively recent years of the 18th century that saw the seeds of modern psychiatry begin to sprout.

Though the Ancient Greeks and Romans had progressive ideas regarding mental illness, the Middle Ages witnessed the end of such revelations. The late 19th century advent of psychoanalysis led to increasingly enlightened exploration and treatment of mental illness. Insanity is no longer considered a medical diagnosis in the United States, although it is still a legal term[6]. Psychotic disorders include schizophrenia an illness involving delusions, hallucinations, abnormal speech, and strange behavior and delusional disorder in which a person has a persistent belief that seems very real to him or her but is not shared by others.

For example, a behavior that may be seen as problematic in our society may be seen as normal within another society[8]. In addition, the introduction of foreign chemicals into the body e. Electroconvulsive therapy also known as electric shock treatment may be applied if all other treatments prove ineffective. Additional treatment methods include early intervention in psychosis, a relatively new but effective concept based upon the observation that identifying and treating a person in the early stages of psychosis can significantly improve their long-term outcome[15].

Unmada is mada toxicity, disorder of the manas mind produced by the dosas vata, etc. Similarly, the Ayurvedic text Charaka Samhita defines insanity as the perversion of the mind, intellect, consciousness, knowledge, memory, desire, manners, behavior, and conduct[18]. As the quality of sattva becomes diminished within the mind, it is only a matter of time before imbalances appear within the three biological humors: In his book, Ayurveda and the Mind: The Healing of Consciousness, Dr.

They are not so much personal or moral failings as an inability to harmonize the forces within us. These include one for each dosha Vatonmada, Pittonmada, Kaphonmada , one for a combination of all three doshas Sannipatonmada , one due to mental shock Citta Ghataja Unmada and one caused by poisons Visaja Unmada [17].

According to Ayurveda, the mind, or manas as it is known in Sanskrit, is composed primarily of the air and ether elements[19]. Thus, of the three doshas vata is commonly behind most psychological disorders[19]. Excess air within the mind causes mental instability and agitation, which leads to excessive thinking, worrying, and ultimately the perception that our problems are much worse than they really are[19].

We are prone to premature or inappropriate action that may aggravate our problems. Pitta-type psychological disturbances occur moderately, as pitta tends to have strong self-control[19]. Excess aggression and hostility are the root cause behind most pitta-type psychological disorders[19]. Problems can arise, however, when vitiated kapha produces blocked channels and clouded senses[19]. Excess kapha within the mind causes mental dullness, congestion and poor perception[19].

According to Frawley, Ayurveda sees the deluded mind as a condition dominated by the quality of tamas or darkness[19]. The mind is absorbed in a blank state in which consciousness of the body is obscured or lost[19]; it is a mindless, non-feeling state of inertia: The quality of tamas generally dominates within the schizophrenic mind as well[19].

In this condition, a person goes into trances, sees hallucinations, hears voices, etc. They may include psychic abilities or psychic sensitivities but are beyond the control of the person.

The person may connect up to the astral plane and lose contact with physical realities. In these cases, the mind goes into an absorption of the dull or blank type and sometimes an astral entity comes in to use the mind.

Interestingly, according to Frawley all severe mental derangement involves some type of astral entity possession or influence[19]. In the circumstances…the mind gets seriously affected and the intellect loses its balance. So the doshas aggravated and vitiated enter the cardiac region, obstruct the channels of the mind resulting in insanity. Furthermore, the text cautions against the disharmonious acts of Prajnaparadha intellectual blasphemy, the failure of the intellect, or crimes against wisdom[21] p.

In Ayurveda two types of insanity are described: Insanity due to exogenous conditions are caused by injuries, poison, fire, and wind[22]. Lord Punarvasu Atreya considers intellectual blasphemy as the Nidana causative factors of this condition. As the dominant dosha within the mind, vata-type psychological disturbances occur most commonly. Fasting, irregular eating habits or insufficient food, and the excessive intake of dry, cold foods easily weaken and upset the vata-dominated mind[19].

Drugs and stimulants easily derange them…Excessive or unnatural sexual activity quickly drains their often low energy. Stress, fear and anxiety affect them emotionally because they lack calm and endurance. Violence and trauma leaves them hurt and withdrawn. Neglect or abuse as a child creates a predisposition for a Vata-deranged psychology. Overly hot, spicy foods easily disturb the pitta mind[19]. Strong, bright colors and sensations irritate their senses[19].

Exposure to violence and aggression increase similar attitudes within them[19]. Sexual frustration, excessive anger and ambition often cause problems as well. Excess pleasure, enjoyment, attachment, too much sleep, sleep during the day, and lack of exercise add to the potential of a psychological disturbance within the kapha-type individual[19]. Educational factors include being overly indulged as a child or emotionally smothered by parents.

Excess vata within the mind causes the individual to become ungrounded and unrealistic, producing overactive and wrong imaginations, hallucinations and delusions[19].

Over activity of the mind results in dispersed life-force energy prana , leaving the afflicted weak, with a diminished connection to the physical body and physical reality. Vata-type psychological disorders are behind feelings of fear, alienation, anxiety, and nervous breakdowns[19].

Insomnia, tremors, palpitations, unrest, and rapid shifts in mood are due to vata as well. Excess pitta heat within the mind produces agitation, irritation, anger, and possible violence[19].

Pitta types can become domineering, authoritarian or fanatic. When disturbed they may have paranoid delusions, delusions of grandeur, or can becomes psychotic. Excess kapha in the mind results in over-attachment and lack in motivation and mental drive that often leads to depression, sorrow, and excessive clinging. Stronger kapha types may find themselves suffering from greed and possessiveness, which renders the mind heavy, dull and depressed[19].

They want to own and control everything, but when control and ownership are lost psychological instability results[19]. In Sannipatonmada insanity caused by the combination of all three doshas[17] , the Ashtanga Hridayam notes that symptoms attributed to all of the doshas appear simultaneously.

The text cautions against the treatment of these patients, as this type of insanity is often too difficult to cure[17]. The person becomes pale, timid, faints often, weeps making sounds such ha, ha etc. Visaja Unmada is insanity caused by poisons. In this type of insanity it is said that the face turns blue, the eyes become red, there is a loss of healthy complexion, strength, physical senses, and the mind is unstable even throughout the different stages of poisoning[17].

Again, the patient who presents with this condition is seen as too difficult to cure and should be rejected by the physician[17]. Physical diseases and mental diseases are caused by the irrevelevent contacts, intellectual blaspheme and suppression of natural urges.

In Ayurveda the primary treatment goal of all psychological illness is the cultivation of sattva[3], as this is the quality that brings balance to body and clarity to the mind. Sattvic activities include spending more time in nature, meditation, yoga, avoiding the influence of the media, and the consumption of a sattvic diet.

Internal and external oleation therapies are the cornerstone of treatment in vata-type insanity. Should the moist, heavy qualities inherent within the oil induce channel obstruction, Vagbhata recommends mixing mild purgatives with the therapeutic oils being used[17]. Numerous vata-reducing impressions may be applied, as they help bring peace and stability to the vata-deranged mind.

Such impressions include sitting or walking quietly and peacefully in a garden, listening to calming music, and gentle exercise such as Hatha Yoga or Tai Chi[19]. For pitta-type insanity, emesis, purgation, and enema therapies administered after oleation and sudation should be administered[17]. Purgative therapy for the head is also recommended[17]. Pitta-reducing impressions include the use of cooling colors blue, white, silver , cool, sweet fragrances like rose and sandalwood, and the use of pitta-pacifying mantras such as Shrim and Sham[19].

Similar to the treatment of pitta-type insanity, kapha-type insanity also calls for emesis, purgation, and enema therapies administered after oleation and sudation, including purgative therapy for the head[17]. Kapha benefits immensely from strong aerobic exercise, cultivating of detachment, and meditation on active, wrathful deities like Kali or Rudra. In the treatment of insanity due to lust, grief, fear, anger, joy, jealousy, and greed i.

Lust should be met with dislike, grief with delight, fear with faith, etc. Patients suffering from insanity due to loss should be given that which is identical to what was bereaved, along with assurances and consoling words.

Should the above therapies prove ineffective, alternate recommendations are described in the Ashtanga Hridayam that, while outdated, are interesting to take note of. Vagbhata also recommends beating the patient with lashes, binding the patient, throwing the patient into a ravine, and confining the patient in a dark room free from weapons, stones, and men[17].

The result of such therapies, he says, is the notion that the fear of death is more powerful than the troubles of the body, thus the disturbed mind becomes free of its abnormalities[17]. The mental condition known insanity is well known to describe a mentally unstable person.

Insanity is a disease that has been common throughout history within every culture of the world, invoking diverse views of understanding and the development of numerous treatment methods. The Western approach to mental illness appears to be primarily concerned with the complicated, minute details of brain chemistry in its quest to understand the logistics of mental disease. The Western tendency is to concentrate on specific aspects of sensory impressions and brain lobes and the effect of various forms of multiple neurotransmitters and hormones within the body.

On the other hand, the condition of mental illness is a much more accepted, explored, and understood concept within Ayurveda and Eastern medicine in general. Whereas Western medicine scrutinizes the minute, Ayurveda is much more concerned with the bigger, simpler picture of humoral and energetic imbalances, which it sees as a physical manifestation of karma that allows for the teaching of spiritual lessons.

Charaka, perhaps, speculates that the avoidance of disease and conservation of health is even more simple: National Library of Medicine, 7 Feb Principles of Ayurvedic Medicine. California College of Ayurveda, American Academy of Psychiatry and the Law, In instances of damage to nervous control, certain typical clinical situations may be differentiated , corresponding to different modes of disordered urinary flow: This bladder becomes greatly distended; the detrusor relaxes and reflex micturition is abolished.

Pressure finally rises sufficiently to overcome the spasm of the sphincters and urine is voided in small amounts. Further accumulation and partial voiding of the overflow recur overflow incontinence. Under these conditions the bladder readily becomes inflamed, which may cause disability or death from chronic ascending urinary infection. This is a small capacity organ around millilitres with frequent emptying; there is reflex control mediated through the sacral segments of the spinal cord; the higher centres do not restrain the detrusor, and the internal sphincter relaxes more readily.

Voluntary assistance from the abdominal muscles helps in this situation if these too have not been paralyzed. There is, however, always some residual urine from incomplete emptying and a risk of infection. In some cases, pressure building within the bladder can be transmitted to the kidneys; without medications or more frequent bladder emptying to relieve the pressure, the kidneys will incur damage.

The bladder becomes tense but contracts only weakly so that, while small amounts of urine are voided, the residual urine may be as high as — millilitres. This condition is known as active incontinence as opposed to the overflow incontinence of the automatic bladder. Here again, more effective emptying of the bladder by catheter drainage may be helpful. Pain associated with urination dysuria can arise from bladder distension, which is then relieved by effective micturition; from inflammation of the lower urinary tract, commonly due to infection but rarely caused by chemical irritants in the urine; and from mechanical irritation by tumour or during the passage of stones.

Dysuria is commonly, but not necessarily, associated with frequency of urination. This in turn may represent either an irritable or contracted bladder; or the actual amount of urine formed may be unusually large polyuria , in which case voiding is likely to be painless. Sometimes polyuria may not be noticed by day but may manifest itself in the need to micturate on several occasions during the night nocturia.

The acute onset of dysuria and frequency suggests urinary infection; sustained polyuria is more likely to be due to renal failure defective concentrating power or to diabetes.

In those who drink beverages into the night, nocturia is physiological. Incontinence, the involuntary passage of urine or feces , may be due to a faulty nerve supply, which either leaves the sphincters relaxed or allows them to be overcome by distension of the bladder.

Comatose and disturbed patients, especially among the elderly, are commonly incontinent. Apart from nerve lesions, the sphincters that normally prevent the escape of urine may be damaged by repeated childbirth, by the growth of the prostate, or by other distortions of the bladder neck.

Medications to relax the bladder and increase its capacity may be helpful. Alternately, more complete bladder emptying by intermittent catheterization may limit the amount of urine leakage. Procedures have been devised to stimulate the sphincters electrically, when their nerve supply is damaged; or to stimulate the bladder to empty itself at set times. For chronic incontinence, however, devices to catch the urine and prevent soiling of clothing are the most practical.

In this section, attention is directed not only to specific diseases of the kidney but also to the syndromes of acute and chronic renal failure , which have multiple causes. Infective disorders of the kidney are dealt with later, as part of the general problem of infection of the urinary tract.

Acute renal failure occurs when renal function suddenly declines to very low levels, so that little or no urine is formed, and the substances, including even water, that the kidney normally eliminates are retained in the body. There are two main mechanisms that can produce acute renal failure. When the cardiac output—the amount of blood pumped into the general circulation by the heart—is lowered by hemorrhage or by medical or surgical shock, the renal circulation is depressed to an even greater extent.

This leads directly to inefficient excretion, but, more importantly still, the kidney tissue cannot withstand prolonged impairment of its blood supply and undergoes either patchy or massive necrosis tissue death. Given time, the kidney tissue may regenerate, and it is on this hope that the treatment of acute renal failure is based.

The form of acute renal failure that is due to a poor supply of blood ischemia has many causes, the most common and most important being multiple injuries, septicemia infections invading the bloodstream , abortion with abnormal or excessive bleeding from the female genital tract, internal or external hemorrhage, loss of fluid from the body as in severe diarrhea or burns, transfusion reactions, and severe heart attacks; a special case is the transplanted kidney, which commonly goes through a phase of acute renal failure that is independent of possible rejection.

The second common mechanism of acute renal failure is toxic. Many poisons are excreted by the kidney, and in the process, like other urinary constituents, they become concentrated and thus reach levels in the tubular fluid that damage the lining cells of the tubules.

Though the tubular cells die and are shed in the urine, regeneration can take place and the patient survive, if he can be maintained during the period of depressed renal function and is not killed by other effects of the poison. Poisons that can affect the kidney in this way are numerous, but the main groups are heavy metals mercury, arsenic, uranium ; organic solvents carbon tetrachloride, propylene glycol, methanol ; other organic substances aniline, phenindione, insecticides ; and antibacterial agents sulfonamides, aminoglycosides, amphotericin , and some fungi e.

In addition to the ischemic and toxic causes of acute renal failure, mention must be made of fulminating varieties of acute renal illnesses that are generally mild e. Another mechanism of acute renal failure is characterized by acute obstruction of the flow of urine from the kidneys; this condition is easily treated by restoring adequate urinary drainage from at least one kidney.

The course of acute renal failure can usefully be divided into three phases: In general, but not invariably, the second of these phases is characterized by a low output of urine oliguria and the third by an increasing urine output polyuria.

The onset phase is dominated by general illness, in which the episode of acute renal failure arises; at this stage there may be evidence of threatened renal damage such as blood in the urine or pain in the loins. At this early stage, renal damage may be reversible by prompt treatment of circulatory failure e. Infection or any underlying causative disorder also must be treated quickly. In the second phase, small amounts of urine, often containing red blood cells, or hemoglobin, are passed; complete absence of urine is not common and suggests that an obstruction is preventing urine from being passed.

In quantitative terms, a urine volume of less than millilitres per day constitutes significant oliguria; this is the least amount in which the excretory demand imposed by an ordinary diet can be met. In the actual situation of acute renal failure, the excretory demands may in fact be much greater, since many of the causes of acute renal failure also are causes of increased breakdown of the tissues in general.

The blood urea increases, the rate of increase being conditioned both by the degree of renal failure and by the amount of tissue breakdown. Besides nitrogen, the kidney can no longer excrete adequate amounts of water, sodium, and potassium. These various inadequacies point the way to the necessary management of acute renal failure—the elimination from intake of any dangerous substance that the kidney can no longer handle.

The diet must either be free of protein or contain small amounts of high-quality protein to lessen tissue breakdown. It must also be free from sodium and potassium: Water cannot be excluded from the intake but must be limited to an amount estimated to equal the unavoidable loss of water from the skin and in breathing.

The weight of the patient and the concentration of sodium in the blood are good guides to the adequacy of water restriction. In the absence of continuing losses of sodium from the body, as might occur from vomiting or diarrhea, a progressive fall in serum sodium implies that too much water is being taken in. Kidney function may recover, often in seven to 10 days. The use of dialysis, the removal of waste products by straining the blood through semipermeable membranes, gives further time for renal recovery.

Potassium can be removed from the body by resins, but this is less often required if dialysis is available. Although by comparison with the oliguric phase the recovery phase presents fewer problems, the convalescent kidney takes time to recover its full regulatory function, and electrolytes and water may be lost at an unusual rate during this stage, requiring replacement.

Most individuals who survive completely recover from acute renal failure, but residual renal damage persists in some persons. In a few, this is so severe as to bring them effectively into the category of chronic renal failure. The artificial kidney has transformed the outlook for many patients with acute renal failure, and this, together with developments in the control of infection with more powerful antibiotics, constitutes one of the miracles of medicine in the last few decades.

The term uremia , though it is sometimes used as if it were interchangeable with chronic renal failure, really means an increase in the concentration of urea in the blood. This can arise in many acute illnesses in which the kidney is not primarily affected and also in the condition of acute renal failure described above. Uremia ought to represent a purely chemical statement, but it is sometimes used to denote a clinical picture, that of severe renal insufficiency. As with acute renal failure, there are many conditions that can lead to chronic renal failure.

The two most common causes are pyelonephritis and glomerulonephritis kidney inflammation involving the structures around the renal pelvis or the glomeruli , and other common causes are renal damage from the effects of high blood pressure and renal damage from obstructive conditions of the lower urinary tract. These primary disorders are described below. They have in common a progressive destruction of nephrons , which may be reduced to less than a 20th of their normal number.

The quantitative loss of nephrons can account for the majority of the changes observed in chronic renal failure; the failure in excretion is due directly to loss of glomerular filters, and other features such as the large quantities of dilute urine represent a change in tubular function that could be accounted for by the increased load that each remaining nephron has to carry.

There are many other causes of chronic renal failure aside from the four common ones. They include congenital anomalies and hereditary disorders; diseases of connective tissue; tuberculosis; the effects of diabetes and other metabolic disorders; and a number of primary disorders of the kidney tubules. Of the many causes, there are some that have importance out of proportion to their frequency, by virtue of their reversibility; these include renal amyloidosis abnormal deposits in the kidney of a complex protein substance called amyloid , whose causes may be treatable; damage to the kidney from excessive calcium or deficiency of potassium; uric acid deposition in gout; the effects of analgesic agents substances taken to alleviate pain and other toxic substances, including drugs.

The person suffering from renal failure, especially in the early stages, may have no symptoms other than a feeling of thirst and a tendency shared with many normal people to pass urine at frequent intervals and through the night; or he may be in a coma , with occasional convulsions.

The general appearance of the sufferer may be sallow because of a combination of anemia and the retention of urinary pigment. Even if not in actual coma, the affected person may be withdrawn; muscle twitchings and more general convulsions may occur. The coma is thought to represent poisoning, and convulsions are often related to the severity of the high blood pressure that commonly complicates advanced renal failure. Blurred vision is also a manifestation associated with high blood pressure.

Bruising and hemorrhages may be noticeable. Although the toxin or toxins of uremia has yet to be identified, the rapid improvement that follows dialysis points strongly to a toxic component.

Urea itself is not notably toxic. Not all the chemical alterations in uremia are simple retentions. There is acidosis —a fall in the alkalinity of the blood and tissue fluids—reflected clinically in deep respiration as the lungs strive to eliminate carbon dioxide. The capacity of the kidney to adjust to variation in intake of salt, potassium, and water becomes progressively impaired, so that electrolyte disturbances are common.

Poor appetite, nausea, vomiting, and diarrhea are common in uremic patients, and these in turn add another component to the chemical disturbance. Phosphate is retained in the blood and is thus associated with low blood levels of calcium; the parathyroids are overactive in renal failure, and vitamin D is less than normally effective because the kidneys manufacture less of its active form 1,dihydroxycholecalciferol.

Parathyroid hormone causes release of calcium from the bones, and vitamin D promotes absorption of calcium from the intestines. These changes can lead to severe bone disease in persons suffering from renal failure, because bone calcium is depleted and the calcium stores are not adequately replenished. In chronic renal failure, excessive production of renin by the kidney can lead to severe high blood pressure hypertension , and the effects of this may even dominate the clinical picture.

In addition to damage to the brain and the retina, the high blood pressure may lead directly to heart failure. Hypertension can also accelerate the progress of renal damage by its impact on the renal blood vessels themselves, setting up a cycle that can be hard to break.

Anemia is also often severe due in part to a failure to produce erythropoietin. The patient in advanced renal failure is vulnerable to infection and other complications, such as vomiting or diarrhea, which need special care.

When symptoms of advanced renal failure appear, deterioration can be delayed by a strict low-protein diet, 18—20 grams of high-quality protein each day. In terminal renal failure, the affected person can be rescued only by some form of dialysis and then maintained by dialysis or transplantation. The primary impact of the disease is on the vessels of the glomerular tuft. Nevertheless, there is convincing evidence that glomerulonephritis does not represent a direct attack on the kidney by an infective agent; it appears to be, rather, an immunologic disorder, in the sense of the formation of antibodies in response to the presence of a foreign protein antigen elsewhere in the body; these form antigen—antibody complexes that lodge in the glomerular tuft or, in a small number of cases, themselves become deposited on the capillary glomerular walls.

In each case the antibody or the antigen—antibody complex reaches the kidney via the circulation, and the mechanism is usually referred to as circulating complex disease.

Glomerular damage is a consequence of the reaction that follows within the glomeruli. These deposits of foreign protein and complexes react with other protein components of blood see the article complement and attract to the site white blood cells and platelets, which also are circulating in the blood; these in turn release protease enzymes and other chemical mediators of tissue injury.

This view of glomerulonephritis is based partly on analogy with the renal damage that can be induced in animals by allergic mechanisms and partly on finding that a protein component of the allergic reaction is deposited in the diseased glomerulus.

Within the general concept of an immunologic disorder, there is ample room for a variety of primary stimuli and of later immunologic disease-causing mechanisms. These include the possibility of primary glomerular damage, causing the glomerulus itself to become antigenic and so to provide a secondary antibody response, and also the participation of or lack of participation of T lymphocytes. Such a diversity is strongly suggested not only by the variations in the glomerular tissues observed both with the ordinary and with the electron microscope but also by the varying manifestations of the disease observed in the affected person.

Typically, glomerulonephritis appears as an acute illness one to two weeks after a sore throat , or—less commonly—after a persistent streptococcal infection of the skin. Other infective agents may be responsible, however, including some viruses and protozoans. A small number of drugs that act as foreign macromolecules can also do so. The affected person has puffiness of the face and ankles and at the same time scanty and noticeably blood-stained urine.

On examination, loose tissues show edema, and the fluid is easily displaced by light pressure; both the blood pressure and the blood levels of urea are slightly or moderately increased. The illness is an alarming one, but the fact is that the acute attack of glomerulonephritis needs no particular treatment other than the eradication of the infection or withdrawal of the offending drug, with some restriction of fluid and protein. Nine out of 10 affected persons recover completely. Exceptional outbreaks, with a higher mortality, have sometimes been observed.

Another possibility is that the affected person may appear to have recovered completely, having lost all symptoms; but the disease process remains active, and there is progressive loss of nephrons, leading ultimately to chronic renal failure. This process may take many years, for most of which the person has no definite symptoms of latent nephritis except that the urine contains protein and small numbers of red blood cells.

It need not be assumed, however, that the finding of protein in the urine proteinuria in the absence of symptoms means automatically that the patient has kidney disease; symptomless proteinuria has many causes and may indeed be found in young people who never develop any later evidence of renal disease. In summary, glomerulonephritis can lead to renal failure within a few weeks or months, after many years of symptom-free proteinuria, or after a period of massive proteinuria, which causes the nephrotic syndrome.

All of these manifestations may sometimes be seen in individuals who have never had, or cannot recall, an acute attack. Renal biopsies in many patients with glomerulonephritis show a range of glomerular reactions that include increased cellularity and basement membrane damage and thickening and varying degrees of progressive destruction of glomeruli. In those who recover, complete resolution of glomerular disease occurs.

A curious form of glomerulonephritis especially common in children is associated with little structural glomerular damage, at least as seen by the ordinary light microscope. Characteristic abnormalities affecting podocytes are revealed by electron microscopy. The condition is usually attended by heavy proteinuria and the nephrotic syndrome. Although the evidence for an immunologic cause of this form of glomerulonephritis is less certain than in other types, and the provoking antigen is unknown, paradoxically the disorder usually promptly resolves when the patient is treated with corticosteroids or other immunosuppressive drugs, and renal failure never occurs.

In the discussion of chronic renal failure, attention was drawn to the cycle in which high blood pressure secondary to renal disease can produce further damage to the kidneys. Clearly, primary vascular disease—disease affecting the blood vessels —could equally well be a cause of renal damage. The most dramatic instance of this is the condition known as malignant hypertension , or accelerated hypertension, which arises when the blood pressure attains extremely high levels, the diastolic figure the blood pressure between heart contractions being millimetres of mercury or higher the normal being around Sustained levels of this magnitude cause serious damage to the arterioles, the smallest of the arteries; this damage is widespread, but as it affects the kidneys it produces rapid destruction of renal substance, with a scarred kidney.

Unless the blood pressure is controlled, malignant hypertension can cause death in a few months; since treatment at an early stage is notably effective, the condition represents an important medical emergency.