Pleurisy

Western Diagnosis
Inflammation of the parietal pleura

**Etiology**
1. Underlying lung process 2. Entry of agent into pleural space 3. Transport by bloodstream 4. Trauma 5. Asbestos exposure

**Signs & Symptoms**
1. Sudden onset 2. Pain aggravation by breathing and coughing 3. Vague discomfort to intense stabbing pain 4. Referred pain via intercostal nerves 5. Rapid, shallow respiration 6. Decreased breathing sounds 7. Pleural friction rub 8. Pain subsides if effusion develops - Dull percussion, no tactile fremitus, decreased or absent breath sounds, egophony at upper border of fluid

**Diagnosis**
-clinical -pleural friction rub is pathognomonic

Treatment
1. Treat underlying disease 2. Wrap chest with elastic bandages 3. Acetaminophen 4. NSAIDS 5. Promote coughing 6. Postural drainage - patient lays prone, with pillows set below diaphragm and upper body hanging over side of table. Cup over lung area to move fluids outward

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======================================================================== IBIS:

Definition:
Inflammation of the pleura of the lungs.

Etiology:
• Pleural injury due to pathology in the lung: e.g. pneumonia, embolism. • Invasion of pleural space by an infectious agent. • Invasion of the pleura by an infectious or noxious agent via the blood-stream or lymphatics. • Pleural trauma. • Pleural inflammation due to asbestos. • Pleural effusion due to chronic ingestion of dantrolene sodium

Nutrition:
eating principles: • eat as little as possible • increase fluids: diluted vegetable juices, broths, herbal teas • short fast

therapeutic foods: • garlic, onions, leeks, turnips, grapes, pineapple, honey, green leafy vegetables (Jensen, p. 61) • increase foods that tonify the Lung • increase foods rich in Vitamin A and C

fresh juices: • carrot (Walker, p. 150) • carrot and spinach (Walker, p. 150) • carrot, beet, and cucumber (Walker, p. 150) • carrot, celery, and parsley (Walker, p. 150)

avoid: • cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, catarrh-forming foods: tofu, meat, ice cream, heavy protein foods, fats, meats, vinegars, shellfish

Botanicals
• Aconitum napellus (toxic): initial stages, clears acute heat. (See Ellingwood, p. 81) • Angelica archangelica (leaf): (British Herbal Pharmacopoeia, p. 26) • Asclepias tuberosa: acute stage; lessens arterial tension (Felter and Lloyd, p. 290) • Atropa belladonna (toxic): for onset of inflammatory conditions (Ellingwood, p. 180) • Bryonia spp. (toxic): sharp, cutting or tearing pain from serous inflammation (Felter, p. 250) • Cimicifuga racemosa: (Ellingwood, p. 145) • Gelsemium sempervirens (toxic): for fever, (See Felter and Lloyd, p. 921) • Linum usitatissimum (flaxseed): as poultice: pleuritic pain (British Herbal Pharmacopoeia, p. 132) • Pilocarpus jaborandi (toxic): clears heat and inflammation (Ellingwood, p. 463) • Veratrum viride (toxic): acute stage with Bryonia alba (toxic) (Ellingwood, p. 86; Harper-Shove, p. 129) • Verbascum thapsus: with exudation (Priest and Priest, p. 95)

Chinese Formulae
• Morus and Lycium C. (Xie Bai San): Lung Heat: coughing, wheezing, fever with skin that feels hot to the touch, all worse in the later afternoon; dry mouth, little or difficult-to-expectorate sputum (Hsu, 1980, p. 173; Bensky and Barolet, p. 90) • Major Bupleurum C. (Da Chai Hu Tang): Liver Qi Stagnation: Alternating fever and chills, fullness in the chest and hypochondriac region with or without pain, bitter taste, nausea, burning diarrhea or no bowel movements, slight irritability, yellow tongue coat. (Hsu, 1980, p. 128; Dharmananda, 1986, p. 154, Yeung, p. 61; Bensky and Barolet, p. 139) • Minor Trichosanthes F. (Xiao Xian Xiong Tang): Lung Obstructed by Phlegm-Heat:focal distention in the chest and epigastrium that are painful to touch, coughing up yellow viscous sputum, constipation, bitter taste, yellow greasy tongue coat. (Hsu, 1980, p. 142; Bensky and Barolet, p. 438) • Bupleurum and Tang Kuei C. (Xiao Yao Wan) (available as patent): Liver Qi Stagnation with Xue Xu (Blood Deficiency): hypochondriac pain, headache, vertigo, bitter taste, dry mouth, fatigue, reduced appetite, pale red tongue (Hsu, 1980, p. 94; Dharmananda, 1986, p. 228; Yeung, p. 263; Bensky and Barolet, p. 147; patent: Zhu, p. 227)

Acupuncture
after assessing the person and palpating, consider these patterns: Lung Heat; Lung Obstructed by Phlegm-Heat; Liver Qi Stagnation

» illustrative combinations: • TW-6, Lv-14 and GB-34 (also consider PC-6 and cupping on area of pain) for pleurisy (Liu, p. 267) • GV-14 and PC-6 for pleurisy (Wei-Ping, p. 133) • Lu-6, UB-12 and UB-13 for pleurisy (Shanghai, p. 197) • St-18 with Kd-27: treat cough and wheezing (Ellis, et al, 1988, p. 123) • GB-37, GB-34, St-40 and Sp-4; Lv-3 and Lv-13; UB-43/48, SI-9, Sp-21, Kd-23 and St-16; LI-7, Ht-3 and SI-4; UB-17 and GB-35; St-13, St-15 and St-16; TW-5, Kd-27, UB-11, UB-12 and UB-13 for pleurisy (Mann, p.94 ) • UB-12 and UB-13: disperse the Exterior, broaden the chest, and regulate Lung function (Finkelstein, p. 39) • Lv-3 and LI-4: open and regulate the Four Gates to facilitate flow of Qi and Xue (Blood) and disperse Stagnation • Lv-5, TW-6 and GB-34: loosen and disperse Qi in the intercostal region (Finkelstein, p. 74) • St-13 and CV-20 for pain in the ribs (Ellis, et al, 1988, p. 121) • St-40 and GB-40: treat stabbing pain in the chest (Shanghai, p. 274) • St-40 and PC-6: dissolve Phlegm, expand chest, harmonize the center, and relieve congestion (Finkelstein, p. 22)

Homeopathy
• Aconitum napellus: first stage, comes on suddenly; burning pains; anxiety; < inspiration, motion, lying on painful side > lying on back • Apis mellifica: dyspnea; esp. difficult inspiration; upper lobes very sore and sensitive • Arsenicum album: < 12-2 a.m.; restlessness; chilly; burning thirst > warm drinks; like company, must sit up; specific for right apex • Asclepias tuberosa: painful respiration, esp. base of left lung; pains > leaning forward • Bryonia: sharp, stitching pain < jar, motion > lying on painful side, pressure; very dry, increased thirst • Cantharis: intense dyspnea; palpitation, frequent, dry cough; tendency to syncope • Ferrum metallicum: chest oppressed; dry, spasmodic cough • Hepar sulphur: cough deep and dull excited by difficulty of respiration; < cold • Kali carbonicum: cutting pain < lying on right side; dry, hard cough about 3 a.m. with stitching pains; whole chest is sensitive • Mercurius solubilis: sharp pains ; sensation muscles are bruised; inability to take full inspiration • Natrum muriaticum: breath short, chest tight; stitching pains in chest and sides with shortness of breath; esp. with long inspiration • Phosphorus: compliment of ars.; respiration oppressed, quick, anxious; heaviness, fullness; tension on chest • Silicea: aching in chest; sometimes only when coughing or sneezing; contusive pain when drawing breath or coughing • Squilla maritima: dyspnea and stitches in chest; violent cough • Sulphur: pains tend to be above nipple < evening, coughing; may be burning pain or sensation of coldness; affects left lung more than right

Subtle Support
• notes: A, A#, B, C, C#, D, D#, E, F, G, G#

• chords: diminished 5th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

Mind/Body
• Lung represents the ability to take in life. (Hay, 1984, p. 173) • Inflammation: fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, p. 170-1)

• Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; facilitates the immune function by assisting the dispersal of the Wei (Protective) Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; and relates to strength and sustainability. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness are associated with excessive grief, sadness, worry, and depression. Worry depletes the Lung Qi. » Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; and inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold. Chronic Lung Yin Xu (Deficiency) increases susceptibility to acute Shi (Excess) conditions such as Phlegm, Wind, Heat and Cold. » Lung Shi (Excess) signs include panting; yawning; sneezing (Seem, p. 28); pain in the upper back, shoulder, and chest; colds with stuffed nose; hoarseness; wheezing respiration; frequent urination with small amounts; heavy chest; reduced lung capacity; coughing; and nasal discharge.
 * Chinese psychophysiology:**

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles, ligaments, and tendons; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)

• Gall Bladder ~ Dan is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; controls circulation of the nourishing and protecting energies [Ying Qi and Wei (Protective) Qi]; expresses itself through the sinews (ligaments and tendons); and opens into the eyes. Its channel purifies Yang energy in the body. » Healthy expressions are kindness, decisiveness, control, and spirit of initiative. » Gall Bladder Xu (Deficiency) signs include insomnia; wandering pains; chest and side pains; swollen breasts (Seem, p. 29); weakness in muscles and tendons of the legs; difficulty standing; asthenia; vertigo; chills; timidity; cowardice; indecisiveness; and excessive sighing.