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They seem to stimulate rapid granulation and formation of new tissue so that denuded areas appear to heal more rapidly than with other agents purchase 60 mg cymbalta with mastercard anxiety symptoms jittery. They are effective in eliminating the foul odors that accompany infection of broken down carcinomas cheap 40mg cymbalta amex anxiety depression symptoms, ulcers and so forth discount 40 mg cymbalta amex anxiety symptoms 24 hours day. Minnesota Journal Of Medicine discount 60 mg cymbalta anxiety issues, August 1939 *Read before the Olmsted-Houston-Fillmore-Dodge County Medical Society, January 6, 1938. Recent medical literature contains many excellent articles on the treatment of burns. While numerous methods have been mentioned, in those most generally accepted, tannic acid is employed. In Bettmans treatment, tannic acid is applied in a spray, and this is followed by application of 10 per cent silver nitrate. Apparently, this sequence has distinct advantages over the use of tannic acid alone. Good as these methods are, I have experienced annoyance from infection, and from the long period required for separation and removal of the coagulum in some cases in which I have used tannic acid. It has been a relief to me, therefore, to find a treatment which has eliminated these disadvantages. This method has proved so simple and the results have been so satisfactory, that I have not used any other treatment for burns since the spring of 1935. The ointment is made by mixing 2 drams of the powdered Aloes and about 2 drams of mineral oil in an ounce of white vaseline. The affected area is cleaned as thoroughly as possible and, in some instances when the area is badly soiled, a preliminary application consists of warm moist dressings. These dressings are saturated in a solution composed of a teaspoonful each of borax and sodium chloride dissolved in a quart of water. If the burned area is fairly clean and a greasy substance has been used in first aid treatment, it is not necessary to remove all the grease as it will mix with the ointment that is to be applied. Blisters are carefully protected and the serum is evacuated with a hypodermic needle, after which a small amount of Mercurochrome is injected into each collapsed vesicle. Mercurochrome is used because of its color, and only enough is injected to cover the floor of the emptied vesicle. If the blisters are torn or the burn is deep, Mercurochrome is applied with a cotton swab. Mercurochrome has been omitted in treatment of small burns, and they have remained as free of infection as those in which it has been employed. When this preliminary treatment has been completed, sterile gauze is folded in about four thicknesses, to make an area large enough to cover the burn. If the burn is too large to be covered by one piece of gauze, or if it is in an area where a single piece would not fit snugly, more than one piece can be applied. The gauze is laid on a smooth, sterile towel and is covered with a layer of ointment at least 1/8 inch thick. More gauze may be placed on this dressing and the whole held in place with bandages or other material. No attempt should be made to spread the ointment on the burn, because it will not adhere readily to the raw surface. At the end of that time, the entire dressing can be removed as easily as a piece of wet writing paper is lifted from the top of a table. The surface of the wound does not bleed but has a clean, glazed appearance, as if the area were covered with a thin, transparent film. Unless new blisters have formed, another dressing, prepared as before, is applied and each dressing is left in place for two days. Illustrative Cases It must be stated that, in the period that has elapsed since I have been using the treatment that has been described, I have not encountered any burns of sufficient severity to endanger life. There is no reason to believe, however, that good results might not be obtained by this method in treatment of more extensive burns. Case 1 A man stepped into a pit containing boiling water which had just been released from a pressure cooker in a canning factory. Few blisters were encountered because most of the epidermis adhered to the patients underclothing and stockings when they were removed. In areas the size of a silver dollar, over the maleoli, the burn completely penetrated the integument. Treatment such as has been described was applied and the patient returned to work on the nineteenth day after the injury. The very severe scald involved most of the surface, except the soles, of both feet to above the ankles. This patient lived in the country and came to the office for treatment only four times, on alternate days. Other Cases Two infants suffered smaller burns on the face, arms and chest, by falling against heating stoves. Dressings were easily applied because their application and removal were painless. Two patients, with severe sunburn involving the shoulders and most of the back above the waist, both complained bitterly of pain when they came for treatment but they suffered practically no pain after the first dressing was applied. Comment My interest in Aloes for the treatment of cutaneous conditions began some years ago. Originally, I treated chronic ulcers and some skin diseases with the fresh leaf of Aloe vera, obtained from Florida and the island of Aruba in the Dutch West Indies.
Many girls were hospitalized for weeks buy discount cymbalta 40 mg anxiety symptoms while sleeping, with severe arthralgia and frequent relapses cymbalta 40 mg line anxiety symptoms dry lips. There were also complications buy cymbalta 60 mg overnight delivery anxiety symptoms stomach pain, such as endocarditis buy 30 mg cymbalta free shipping anxiety test questionnaire, pneumonia, metastatic abscesses, and anemia (McEvoy et al. The Disease in Animals: Laboratory and wild rats are healthy carriers and har bor the etiologic agent in their nasopharynx. In one epizootic among laboratory rats, high morbidity and mortality rates were recorded, with such symptoms as polyarthritis, gangrene, and spontaneous amputation of members. In guinea pigs, the agent can produce cervical lymphadenitis with large abscesses in the regional lymph nodes. Some outbreaks have been described among turkeys in which the most salient symptom was arthritis. Source of Infection and Mode of Transmission: Rats are the reservoir of the infection. They harbor the etiologic agent in the nasopharynx and transmit it to humans by biting. According to the epidemiological investigation conducted on the school in Great Britain, the source of infection was drinking water contaminated by rat feces. All outbreaks are due to a common source, whereas sporadic cases are due to a bite from a rat or other rodent. It would seem that man is not very susceptible, since there are very few recorded cases. People who live in rat-infested houses can become infected without contact with rodents (Benenson, 1990). It is suspected that infection in mice and other rodents in lab oratories can be caused by aerosols when these rodents are kept in the same envi ronment as rats. Role of Animals in the Epidemiology of the Disease: Rats are the reservoir of the infection and play an essential epidemiological role. Inoculation of guinea pigs or rats from colonies that are demonstrably free of infection can also be used. A few laboratories use serological tests, such as tube agglutination, complement fixation, or immunofluorescence (Wilkins et al. Other important measures are pasteurization of milk and protection of food and water against rodents. Laboratory rats, mice, and guinea pigs should be kept in separate environments and personnel charged with their care should be instructed in proper handling techniques. These bacteria are not well char acterized and there are no reference strains because it is difficult to culture the spir illum. It is a spiral-shaped bacterium with two or three twists; it is motile, 3 to 5 microns long, and about 0. Occurrence in Animals: the incidence of the infection in rats varies in different parts of the world. The most notable differences are that arthritic symptoms are rare and that four weeks after the bite there is a characteristic eruption with reddish or purple plaques. Fever begins suddenly and lasts a few days, but it recurs several times over a period of one to three months. There is a general ized exanthematous eruption that may reappear with each attack of fever. Although the bite wound heals during the incubation period, it exhibits an edematous infiltra tion and often ulcerates. Treatment consists of intramuscular administration of procaine penicillin for two weeks. Source of Infection and Mode of Transmission: the reservoir is rats and other rodents; their saliva is the source of infection for man. Human infections caused by bites from ferrets, dogs, cats, and other carnivores have also been described. It is presumed that these animals become contaminated while catching rodents and thus act as mechanical transmitters. Diagnosis: Diagnosis is accomplished by dark-field microscopic examination of infiltrate from the wound, the lymph nodes, the erythematous plaques, and from the blood. The most reliable diagnosis is obtained by intraperitoneal inoculation of mice with blood or infiltrate from the wound, followed by microscopic examination of their blood and peritoneal fluid some two weeks after inoculation. Control: Control is based on reduction of the rat population and on construction of rat-proof dwellings. Its normal habitat is the soil; it is a sapro phytic bacteria that requires few nutrients and multiplies abundantly in fecal matter from herbivores. Approximately 60% of the strains in North America belong to capsular serotype 1, and 26% belong to capsular serotype 2. In Japan, capsular serotype 3 predominates in cultures isolated from foals (Timoney et al. A 15 to 17-kilodalton antigen has been identified that is probably associated with the viru lence of R. Since 1923, when the first case of rhodococcosis was described in foals in Switzerland, the disease has been reported on all continents. From the first human case described in 1977 up to 1983, the literature records no more than 13 human cases (Van Etta et al.
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Aida T cheap 40 mg cymbalta anxiety symptoms head tingling, Kimura T discount cymbalta 30 mg free shipping anxiety disorders in children, Ishikawa N purchase cymbalta 60 mg with mastercard anxiety feels like, & Shinkai K (1998) Evaluation of allergenic potential of low-molecular compounds by mouse popliteal lymph node assay cheap 40mg cymbalta otc anxiety support groups. Aikoh T, Tomokuni A, Matsukii T, Hyodoh F, Ueki H, Otsuki T, & Ueki A (1998) Activa tion-induced cell death in human peripheral blood lymphocytes after stimulation with silicate in vitro. Albano E (2002) Free radical mechanisms in immune reactions associated with alcoholic liver disease. Albers R, Broeders A, van der Pijl A, Seinen W, & Pieters R (1997) the use of reporter antigens in the popliteal lymph node assay to assess immunomodulation by chemicals. Albers R, de Heer C, Bol M, Bleumink R, Seinen W, & Pieters R (1998) Selective immunomodulation by the autoimmunity-inducing xenobiotics streptozotocin and HgCl2. Andrade F, Casciola-Rosen L, & Rosen A (2000) Apoptosis in systemic lupus erythe matosus: clinical implications. Andre F, Gillon J, Andre C, Lafont S, & Jourdan G (1983) Pesticide-containing diets augment anti-sheep red blood cell nonreaginic antibody responses in mice but may prolong murine infection with Giardia muris. Angell M (1997) Antipolymer antibodies, silicone breast implants, and fibromyalgia [letter]. Avrameas S (1991) Natural autoantibodies: from horror autotoxicus to gnothi seauton. Bachmann M (2004) Novel autoimmune models: Lessons from recent transgenic and knock in animals. Balazs T (1987) Immunogenetically controlled autoimmune reactions induced by mer cury, gold and D-penicillamine in laboratory animals: a review from the vantage point of premarketing safety studies. Belluzzi A (2002) N-3 fatty acids for the treatment of inflammatory bowel diseases. Berger T, Rubner P, Schautzer F, Egg R, Ulmer H, Mayringer I, Dilitz E, Deisenhammer F, & Reindl M (2003) Antimyelin antibodies as a predictor of clinically definite multiple sclerosis after a first demyelinating event. Bernier J, Fournier F, Blais Y, Lombardi P, Chevalier G, & Krzystyniak K (1988) Immunotoxicity of aminocarb. Betterle C, Dal Pra C, Mantero F, & Zanchetta R (2002) Autoimmune adrenal insuffi ciency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Black C, Pereira S, McWhirter A, Welsh K, & Laurent R (1986) Genetic susceptibility to scleroderma-like syndrome in symptomatic and asymptomatic workers exposed to vinyl chloride. Chemically-induced alterations in sexual and functional development: the wildlife/human connection. Chemically-induced alterations in sexual and functional development: the wildlife/human connection. Bogliun G & Beghi E (2004) Incidence and clinical features of acute inflammatory polyradiculoneuropathy in Lombardy, Italy, 1996. Bouma G & Strober W (2003) the immunological and genetic basis of inflammatory bowel disease. Part 2: Dermatologic and joint disease, the antiphospholipid antibody syndrome, pregnancy and hormonal therapy, morbidity and mortality, and pathogenesis. Bovenzi M, Barbone F, Betta A, Tommasini M, & Versini W (1995) Scleroderma and occupational exposure. Brik R, Tenenbaum G, Blank M, Shoenfeld Y, Barzilai D, Bloch K, & Vardi P (1995) D penicillamine-induced autoantibodies in a mouse model. Brostoff J, Blanca M, Boulton P, & Serrano S (1982) Absence of specific IgE antibodies in toxic oil syndrome. Cantagrel A, Navaux F, Loubet-Lescoulie P, Nourhashemi F, Enault G, Abbal M, Constantin A, Laroche M, & Mazieres B (1999) Interleukin-1fl, interleukin-1 receptor antagonist, interleukin-4, and interleukin-10 gene polymorphisms. Caplan A (1953) Certain unusual radiological appearances in the chest of coalminers suffering from rheumatoid arthritis. Casciola-Rosen L, Wigley F, & Rosen A (1997) Scleroderma autoantigens are uniquely fragmented by metal-catalyzed oxidation reactions: implications for pathogenesis. Chen M, Hemmerich P, & Von Mikecz A (2002) Platinum-induced autoantibodies target nucleoplasmic antigens related to active transcription. Choquet-Kastylevsky G, Vial T, & Descotes J (2001) Drug allergy diagnosis in humans: possibilities and pitfalls. Czirjak L & Kumanovics G (2002) Exposure to solvents in female patients with scleroderma. DAlfonso S, Rampi M, Bocchio D, Colombo G, Scorza-Smeraldi R, & Momigliano Richiardi P (2000) Systemic lupus erythematosus candidate genes in the Italian population: Evidence for a significant association with interleukin-10. DCruz D (2000) Autoimmune diseases associated with drugs, chemicals and environ mental factors. Deng C, Lu Q, Zhang Z, Rao T, Attwood J, Yung R, & Richardson B (2003) Hydralazine may induce autoimmunity by inhibiting extracellular signal-regulated kinase pathway signaling. Final report of the Subcommittee on Risk Management of the Committee to Co-ordinate Environmental Health and Related Progams. Dianzani U, Bragardo M, DiFranco D, Alliaudi C, Scagni P, Buonfiglio D, Redoglia V, Bonissoni S, Correra A, Dianzani I, & Ramenghi U (1997) Deficiency of the Fas apop tosis pathway without gene mutations in pediatric patients with autoimmunity/lympho proliferation. An immunohistochemical study using cryostat sections of the whole knee joint of rat. Brown Norway rats treated with D-penicillamine develop autoantibodies, circulating immune complexes, and disseminated intravascular coagulation. Ezendam J (2004) Mechanisms of hexachlorobenzene-induced adverse immune effects [thesis]. Fabris P, Floreani A, Tositti G, Vergani D, De Lalla F, & Betterle C (2003) Type 1 diabetes mellitus in patients with chronic hepatitis C before and after interferon therapy. Flescher E & Talal N (1991) Do viruses contribute to the development of Sjogrens syndromefl Gaubitz M, Jackisch C, Domschke W, Heindel W, & Pfleiderer B (2002) Silicone breast implants: correlation between implant ruptures, magnetic resonance spectroscopically estimated silicone presence in the liver, antibody status and clinical symptoms. Gleichmann H (1981) Studies on the mechanism of drug sensitization: T-cell-dependent popliteal lymph node reaction to diphenylhydantoin.
Consider the readiness of your system and potential barriers to implementing 1 2 3 4 5 changes Source: the self-assessment questionnaire was developed as part of a research project on team-based opioid management in rural clinics led by Dr order cymbalta 30 mg amex anxiety symptoms in men. To more systematically assess current practices discount cymbalta 30 mg line anxiety getting worse, your system could survey or interview clinicians about gaps in care or issues they encounter purchase cymbalta 60 mg on line anxiety 9 year old daughter, or even ask questions at a staf meeting purchase cymbalta 40mg on line 8 tracks anxiety. Additionally, it is important to include diferent members of the care team, since perspectives might difer depending on ones position. The self-assessment is also a useful tool for getting team members on the same page. While it is not necessary at this stage to a list of patients for each be exhaustive, you will want to collect sufcient data to help you decide on your clinician and calculated system goals (Step 4). This may include access to laboratory services, behavioral health specialists, pain management specialists, addiction specialists, interventionists, buprenorphine waivered clinicians, and the development of a registry for easy referral to these types of specialists and services. Identify areas to improve upon Based on your assessment results, you will likely identify areas for improvement in your policies, prescribing practices, workfows, and resources needed to support care of patients with chronic pain or on long-term opioid therapy. Additionally, the results of your assessment may highlight to clinicians and leaders alike the extent of unsafe practices with opioids. Assess current policies and practices 1 2 3 4 5 to facilitate your implementation teams 7. For example, while a practice may not have integrated behavioral health specialists, there are often community therapists and psychologists who can co-treat. These agreements should be used to facilitate conversations, not solely for documentation purposes. Use immediate-release opioids • Develop a policy to improve consistency across clinicians. Consider doing risk assessment with patients asking for reflls of opioid prescriptions that are for acute pain. You might prioritize the changes that are most needed based on fndings from your assessment (Step 2). Or you might consider not selecting the hardest changes frst but go for an early win to build momentum before progressing to a more involved change in practice. Consider practice-level changes 1 2 3 4 5 to facilitate your implementation teams 12. The following are some examples of goals: • Policies on opioid prescribing will be reviewed and revised within X months. Set measurable goals 1 2 3 4 5 to facilitate your implementation teams Source:. If your practice has an established, structured improvement approach, you should use that approach. Develop a plan that outlines the following: • Who will spearhead changes (Step 1)fl Implement the changes Difculties in implementing practice changes can be minimized by thoughtful planning and by understanding in advance the concerns of stakeholders whose interests and work will be afected. Your system should monitor progress using existing data and approaches outlined in Step 2. For example, complete the self-assessment questionnaire (Appendix C) to assess your practice before you implement changes and periodically refect on progress on each step and selected change. These results can be discussed with the change team to identify any mid-course adjustments that may be needed. Develop a plan for implementing to facilitate your 1 2 3 4 5 selected Guideline recommendations implementation teams 16. These strategies include establishing or revising internal opioid policies, developing registries and using panel management, employing team-based approaches, and efectively using technology, each of which is briefy described below. Throughout this chapter, tips for specifc strategies are provided that are based on the experience of a healthcare system aimed to implement this plan into its primary care practices. Toolkit Part A provides links to examples of comprehensive management and coordination approaches. If availability is inadequate, strongly consider having one or more providers seek a waiver to provide buprenorphine to these patients. Terminology is important Practice-wide policies and standards both support providers in making clinical decisions that protect patient safety. In drugs dispensed by pharmacies in most states and, in some select states, discussing the agreement, by dispensing physicians as well. This may enable the making should be based on a relationship between the clinician and patient, and patient and physician to fnd common ground on potentially an understanding of the patients clinical situation, functioning, and life context. Ensuring Clinicians should consider the circumstances and unique needs of each patient patient safety provides a when providing care, and policies should allow for this as well. How do physicians adopt and apply opioid prescription guidelines in the emergency departmentfl Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. More guidance on how the provider can address this with individual patients is provided in Chapter 1. The additional details provided within the rationale statements, will assist providers with improving the care and treatment of patients living with chronic pain. Patients should receive appropriate pain treatment based on a careful consideration of the benefts and risks of treatment options. In treating chronic pain, providers should continue to use their clinical judgment and base their treatment on what they know about their patients. Clinicians should empathically review benefts and risks of continued high dosage opioid therapy and should ofer to work with the patient to taper opioids to safer dosages. For patients who agree to taper opioids to lower dosages, clinicians should collaborate with the patient on a tapering plan.
The plant can be mixed and boiled together with myin-hkwar (Centella asiatica) leaves to alleviate heart palpitations and anxiety generic 20 mg cymbalta fast delivery anxiety statistics. Tin slices of the plant are eaten frequently to stop vomiting of blood; a decoction can be reduced to one-fourth its starting volume is used to ease chronic joint infammation; plant also used in making medicines to treat gas and bile problems generic 60mg cymbalta mastercard anxiety symptoms zinc, urinary tract infections safe 60mg cymbalta anxiety symptoms eyesight, menstrual disorders order cymbalta 40 mg with amex anxiety when trying to sleep, earaches, and phlegm imbalances. Leaf: Juice from crushed leaves is slightly warmed and used as an ear wash to alleviate earaches. A mixture of the leaves with equal parts of lauk thay (Desmodium triquetrum), ohn hnwai (Aerva javanica), thinbaw maizali (Senna alata), and kone hti-kayone (Mimosa pudica) leaves is made into a tea to promote longevity and prevent illnesses. The medicinal uses of this species in India are discussed in Jain and De Filipps (1991). Seed: Has good febrifuge and antidysenteric properties (these good uses have also been men tioned for the leaves and bark). In India the seed is used for dysentery and as a febrifuge (Jain and De Filipps 1991). A tribe in Borneo uses the latex in decoction as a febrifuge; they also The medicinal plants of Myanmar 185 apply it to festering wounds and snakebites (Perry 1980). The leaves and bark are said to have good febrifuge and antidysenteric properties; also the seed (Perry 1980). Reported chemical constituents of this species include a toxic glycoside; alpha, beta, gamma-antiarin; antiarol; and fats (Perry 1980). Troughout the East, the toxic sap (latex) from this species is known for its use as an arrow or dart poison, and much has been written about it. It proves fatal, however, only when it reaches the blood stream, and can be taken into the mouth without any ill efects (Perry 1980). The juice, in very small quantity, is a mild circulatory and cardiac stimulant, but in large doses it acts as a myocardial poison; and has a strong digitalis-like action (Perry 1980). In India the leaf is fried with the leaves of Emblica and Azadirachta, mixed with mustard oil and applied on sores, smallpox, carbuncles, and used as an anthelmintic; the fower us employed during childbirth to clear the fetus (Jain and DeFilipps 1991). In China latex from the stem is used for abscesses and ulcers; the bark is employed as a gargle; the leaf is used for diarrhea; and the ash made from the root is used for diarrhea and worms, and is also taken after childbirth (Duke and Ayensu 1985). In Indo-China the wood is used as a sedative to treat convulsions, boiled leaves are given to both animals and women to activate the secretion of milk, and the sap is considered antisyphilitic and a vermifuge. On the Malay Peninsula and in the Phil ippines, the ashes of the leaves, with or without oil, are applied to treat ulcers and wounds (Perry 1980). The wood contains a yellow pigment, morin, cyanomaclurin; the bark has tannin; cerotic acid is found in the latex; and the fruit an pulp have sugar, protein, fber, and ash (Perry 1980). Chemical constituents, pharmacological action and medicinal uses of this species in Indian Ayurveda are discussed in detail by Kapoor (1990). Data on the propagation, seed treatment, and agricultural management of this plant are given in Katende et al. In India the bark and exudation are used externally for spleen complaints; the seed is used as a purgative (Jain and DeFilipps 1991). In Indo-China the root is employed as a tonic and deobstruent, and the leaves are used in treating dropsy (Perry 1980). English: Benjamin tree, Java fower, laurel, small-leaved rubber plant, tropical laurel, weeping laurel. In India the milky juice of the plant is used to treat whitening of the cornea of the eye; a decoction of the leaf, mixed with oil, is applied externally to ulcers (Jain and DeFilipps 1991). In Indo-China the latex is mixed with alcohol and prescribed for shock, and the pounded roots are applied to poison arrow wounds (Perry 1980). In India the bark, fruit, and seed are employed as an emetic and purgative (Jain and DeFilipps 1991). In China latex from the stem is used for diarrhea, dysuria, and applied to cracks in the soles of the feet; the fruit is applied to warts (with Allium and Sesbania) (Duke and Ayensu 1985). In Malaya a leaf decoction is used for fever and parturition and a bark decoction for stomachaches, pounded leaves are applied to The medicinal plants of Myanmar 187 boils and ulcerated noses; in Indonesia latex is used for diarrhea and dysuria, and bark and turmeric are mixed with rice water for eczema (Duke and Ayensu 1985). Ayurve dics use the plant for anemia, biliousness, blood disorders, dysentery, epistaxis, hemor rhoids, jaundice, stomatorrhagia, and ulcers; the fruit is used as an emetic, aphrodisiac, lactagogue, and tonic (Duke and Ayensu 1985). On the Malay Peninsula a decoction of the leaves is given as a protective medicine after childbirth and to treat fever, a decoc tion of the bark with that of several other plants is used as another remedy for fever, pounded leaves are applied to boils and (in a compound) to an ulcerated nose; in Indo nesia the latex is ingested to treat diarrhea and painful urination and externally applied to cracks in the soles of the feet, fruit mixed with red onions and Sesbania leaves is used on warts, and a mixture made from the bark and Curcuma ground together with water from red rice is applied to pustulous eczema (Perry 1980). The bark contains tannin, wax, a caoutchouc, and a glucoside principle; the latex contains an alcohol extract and a chloroform extract (Duke and Ayensu 1985). Myanmar: nyaung bokdahae, bodhi nyaung, lagat (Kachin), mai-nyawng (Shan), nyaung-bawdi. Whole plant: Bitter and astringent in taste with cooling properties, drying, and difcult to digest; the bark, roots, fruits, leaves, and sap are known for bringing out brilliance in complexion, cleansing the uterus, and controlling bile and phlegm as well as alleviating heat-induced illnesses, sores, asthma, leprosy, plague, and fstu las. A decoction of bark reduced to one-half the starting volume is taken for many skin problems, rashes, and itching; also used as a mouthwash to cure tooth diseases. Dried and powdered inner bark is applied to fstulae to stimulate healing and new tissue formation. Ash from the bark is sprinkled onto genital sores caused by venereal diseases to promote drying and healing; ash from young bark fltered through fne cloth is rubbed on chronic sores to expedite healing. Bark is also used in medicines to treat burns, breast problems, lock-jaw, and snakebites in animals. Used to cleanse the blood; also used in preparations to treat boils in the groin, hemorrhag ing, and cracked tongues and lips. A decoction of the leaves with jaggery is taken for fatigue to promote strength and well-being. A mixture of the juice from the crushed leaves and the sap is applied topically to treat cracks in the feet. Fruit: The ripe fruit, which has cooling properties, is considered benefcial for the heart. It is used to treat blood diseases, heat or bile conditions, nausea, lung infections, and loss of appetite.