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Another reason is that critically tional solutions through a nasogastric purchase generic hoodia pills herbs landscaping, gastrostomy purchase hoodia online pills bajaj herbals pvt ltd ahmedabad, ill clients often require aggressive treatment with or jejunostomy tube purchase hoodia 400mg without prescription wise woman herbals 1, there may be drug–food inter- large numbers cheap hoodia 400 mg with mastercard herbs and uses, large doses, and combinations of actions that impair drug absorption. Overall, therapeutic ef- ing tablets or opening capsules to give a drug by a GI fects may be decreased and risks of adverse reac- tube may alter the absorption and chemical stability tions and interactions may be increased because the of the drug. However, few drugs are available in these for- therapy requires that all involved health care providers mulations. Nurses need to be especially diligent in ad- ution to body cells is unpredictable, the liver cannot ministering drugs and vigilant in observing client metabolize drugs effectively, and the kidneys cannot responses. Dosage requirements may vary considerably among siﬁcations and are also discussed in other chapters. A standard dose may be effective, bials, cardiovascular agents, gastric acid suppressants, subtherapeutic, or toxic. Thus, it is especially im- neuromuscular blocking agents, and sedatives. In many instances, the goal of drug therapy is to sup- cording to the severity of the condition being treated port vital functions and relieve life-threatening symp- and client characteristics such as age and organ toms until healing can occur or deﬁnitive treatment function, and that maintenance dosages are titrated can be instituted. Route of administration should also be guided by creasing adverse effects. Most drugs are given in- be given at approximately the same time each day; travenously (IV) because critically ill clients are often multiple-daily doses should be given at approximately unable to take oral medications and require many even intervals around the clock. Weigh clients when possible, initially and periodi- addition, the IV route achieves more reliable and cally, because dosage of many drugs is based on measurable blood levels. In addition, periodic weights help to assess When a drug is given IV, it reaches the heart and clients for loss of body mass or gain in body water, brain quickly because the sympathetic nervous sys- both of which affect the pharmacokinetics of the tem and other homeostatic mechanisms attempt to drugs administered. What are the learning tions, ﬂuid and electrolyte balance) and response to needs of the client or caregiver in relation to the med- treatment. Ask to see all prescribed and OTC medications the dicate that changes are needed in drug therapy. Serum albumin, which binds acidic potential problem areas (eg, differences between in- drugs such as phenytoin and diazepam, is usually de- structions and client usage of medications, drugs with creased during critical illness for a variety of rea- opposing or duplicate effects, continued use of med- sons, including inadequate production by the liver. Ask if the client takes any herbal medicines or di- Also, unbound molecules are metabolized and ex- etary supplements. If so, try to determine the amount, creted more readily so that therapeutic effects may frequency, duration of use, reasons for use, and per- be decreased. Explain that the Alpha1-acid glycoprotein binds basic drugs and its nurse needs this information because some herbals synthesis may increase during critical illness. As a re- and dietary supplements may cause various health sult, the bound portion of a dose increases for some problems or react adversely with prescription or drugs (eg, meperidine, propranolol, imipramine, lido- OTC medications. Assess the environment for potential safety hazards unless higher doses are given. In addition, these drugs (eg, risk of infection with corticosteroids and other are eliminated more slowly than usual. Provide whatever information and assistance is needed evolved from efforts to reduce health care costs, especially for home management of the drug therapy regimen. The consequences of this trend Most people are accustomed to taking oral drugs, but include increased outpatient care and brief hospitalizations they may need information about timing in relation for severe illness or major surgery. In both instances, clients to food intake, whether a tablet can be crushed, when of all age groups are often discharged to their homes for to omit the drug, and other aspects. Skilled nursing care, such as the nurse may initially need to demonstrate admin- managing medication regimens, is often required during istration or coach the client or caregiver through follow-up. Demonstrating and having the client or ties related to drug therapy apply in home care as in other caregiver do a return demonstration is a good way to health care settings. Some additional principles and factors teach psychomotor skills such as giving a medica- include the following: tion through a GI tube, preparing and administering 1. In addition to safe and accurate administration, teach monitor their effects. If side effects occur, teach them how work within the environment to establish rapport, to manage minor ones and which ones to report to a elicit cooperation, and provide nursing care. Between home visits, the home care nurse can main- is to schedule a home visit, preferably at a conve- tain contact with clients and caregivers to monitor nient time for the client and caregiver. In addition, progress, answer questions, identify problems, and state the main purpose of the visit and approximately provide reassurance. Establish a method for be given a telephone number to call with questions contact in case the appointment must be canceled by about medications, side effects, and so forth. For clients and medication regimen and his or her ability to provide nurses with computers and Internet access, electronic self-care. If the client is unable, who will be the pri- mail may be a convenient and efficient method of mary caregiver for medication administration and ob- communication. If giving medications to a group of patients, start preparing about 30 minutes before the scheduled administration time when possi- ble, to avoid rushing and increasing the risk of errors. Medications and supplies are usually kept on a medication cart in a hospital or long-term care facility. Except for very simple calculations, use pencil and paper to de- crease the risk of errors. If unsure about the results, ask a colleague or a pharmacist to do the calculation. Check blood pressure (recent recordings) before giving anti- hypertensive drugs. Commonly needed reports include serum potassium levels before giving diuretics; prothrombin time or international normalized ratio (INR) before giving Coumadin; culture and susceptibility re- ports before giving an antibiotic. This is often needed to look up new or unfamiliar drugs; other uses include assessing a drug in relation to a particular client (eg, Is it contraindicated? Can a tablet be crushed or a cap- sule opened without decreasing therapeutic effects or increasing adverse effects? Practice the ﬁve rights of drug administration (right drug, These rights are ensured if the techniques described in Chapter 3 right client, right dose, right route, and right time). For example, a drug ordered for 9 AM can be usually given between 8:30 AM and 9:30 AM. For example, sterile equipment and techniques are required for injection of any drug. Follow label instructions regarding mixing or other aspects Some drugs require specific techniques of preparation and ad- of giving speciﬁc drugs. Look for improvement in signs and symptoms, laboratory In general, the nurse should know the expected effects and when or other diagnostic test reports, or ability to function. Ask questions to determine whether the client is feeling Speciﬁc observations depend on the speciﬁc drug or drugs being better.
Desipramine (Norpramin) Depression PO 100–200 mg daily in divided doses or as a single daily dose order hoodia discount herbals on york carlisle pa. Maximum dose purchase generic hoodia herbs used for pain, 300 mg/d Adolescents and older adults: PO 25–100 mg daily in divided doses or as a single daily dose order cheap hoodia on line herbals best. Maximum dose purchase hoodia 400 mg otc vaadi herbals products review, 150 mg/d Doxepin (Sinequan) Depression PO 75–150 mg daily, in divided doses or a single dose at bedtime. Imipramine (Tofranil) Depression PO 75 mg daily in 3 divided doses, gradually increased to 200 mg daily if necessary. Childhood enuresis Maintenance dose, 75–150 mg daily Adolescents and older adults: PO 30–40 mg daily in divided doses, increased to 100 mg daily if necessary Children >6 y: Enuresis, PO 25–50 mg 1 hour before bedtime Nortriptyline Depression PO 25 mg 3 or 4 times daily or in a single dose (75–100 mg) at bedtime. Maximum (Aventyl, Pamelor) dose, 150 mg/d Adolescents and older adults: 30–50 mg/d, in divided doses or a single dose once daily Protriptyline (Vivactil) Depression PO 15–40 mg daily in 3 or 4 divided doses. Adolescents and older adults: PO 5 mg 3 times daily, increase gradually if necessary Trimipramine maleate Depression PO 75 mg daily, in divided doses or a single dose at bedtime, increased to 150 mg/d (Surmontil) if necessary. Adolescents and older adults: PO 50 mg daily, increased to 100 mg/d if necessary Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa) Depression PO 20 mg once daily, morning or evening, increased to 40 mg daily in 1 week, if necessary Elderly/hepatic impairment: PO 20 mg daily Fluoxetine (Prozac, Depression PO 20 mg once daily in the morning, increased after several weeks if necessary. Give Sarafem) Obsessive-compulsive doses larger than 20 mg once in the morning or in 2 divided doses, morning and disorder noon; maximum daily dose 80 mg Bulimia nervosa Prozac weekly (delayed-release capsules), PO 90 mg once each week, starting 7 days Premenstrual after the last 20-mg dose dysphoric disorder (Sarafem) Fluvoxamine (Luvox) Obsessive-compulsive PO 50 mg once daily at bedtime, increased in 50-mg increments every 4–7 days if nec- disorder essary. Maximum dose, 300 mg/d Children 8–17 y: PO 25 mg once daily at bedtime, increased in 25-mg increments every 4–7 days if necessary. Maximum dose 200 mg/d Paroxetine (Paxil, Depression PO 20 mg once daily in the morning, increased at 1 week or longer intervals, if neces- Paxil CR) Generalized anxiety sary; usual range, 20–50 mg/d; maximum dose, 60 mg/d disorder Controlled-release tablets, PO 25 mg once daily in the morning, increased up to Obsessive-compulsive 62. Maximum Panic disorder dose, 40 mg Social anxiety disorder Severe renal or hepatic impairment: Same as for older adults (continued) 168 SECTION 2 DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM Drugs at a Glance: Antidepressant Agents (continued) Generic/Trade Name Indications for Use Routes and Dosage Ranges Sertraline (Zoloft) Depression Depression, OCD, PO 50 mg once daily morning or evening, increased at 1-week or Obsessive-compulsive longer intervals to a maximum daily dose of 200 mg disorder (OCD) Panic, PTSD, PO 25 mg once daily, increased after 1 week to 50 mg once daily Panic disorder Children: OCD, 6–12 y, 25 mg once daily; 13–17 y 50 mg once daily Post-traumatic stress disorder (PTSD) Monoamine Oxidase Inhibitors Isocarboxazid (Marplan) Depression PO 10 mg twice daily, increased to 60 mg/d if necessary, in 2 to 4 divided doses Phenelzine (Nardil) Depression PO 15 mg 3 times daily, increased to 90 mg/d if necessary Tranylcypromine Depression PO 30 mg daily in divided doses, increased to 60 mg/d if necessary (Parnate) Miscellaneous Antidepressants Bupropion (Wellbutrin, Depression (Wellbutrin) Immediate release tablets, PO 100 mg twice daily, increased to 100 mg 3 times daily Wellbutrin SR, Zyban) Smoking cessation (at least 6 h apart) if necessary. Maximum single dose, 150 mg Maprotiline Depression PO 75 mg daily in single or divided doses, increased to a maximum of 300 mg daily if necessary Mirtazapine (Remeron) Depression PO 15 mg/d, in a single dose, at bedtime. Increase by 15 mg/d (at least 1–2 weeks between increments) up to 45 mg/d if necessary Nefazodone (Serzone) Depression PO 200 mg daily in 2 divided doses; increase at 1-week intervals in increments of 100–200 mg/d; usual range, 300–600 mg/d. Elderly or debilitated adults: PO initially 100 mg/d in 2 divided doses Trazodone (Desyrel) Depression PO 100–300 mg daily, increased to a maximum dose of 600 mg daily if necessary Venlafaxine Depression Immediate release tablets, PO initially 75 mg/d in 2 or 3 divided doses, with food. Increase by 75 mg/d (4 days or longer between increments) up to 225 mg/d if necessary. Hepatic or renal impairment: Reduce dose by 50% and increase very slowly Mood-Stabilizing Agent Lithium carbonate Bipolar disorder (mania) PO 600 mg 3 times daily or 900 mg twice daily (slow release forms) (Eskalith, Lithobid) Maintenance dose, PO 300 mg 3 or 4 times daily to maintain a serum lithium level of 0. However, when deactivation After an oral dose, peak plasma levels are reached in is blocked by MAOIs, tyramine is absorbed systemically and about 2 hours. Several metabolites are pharmacologically ac- that should be avoided include aged cheeses and meats, con- tive. Dosage should be reduced with impaired hepatic or centrated yeast extracts, sauerkraut, and fava beans. Acute episodes of depression usually require that should be avoided include CNS stimulants (eg, am- several months of drug therapy. Bupropion is also used as a phetamines, cocaine), adrenergics (eg, pseudoephedrine), smoking cessation aid. In addition to seizures, however, the drug has CNS stimulant effects (agitation, anxiety, excitement, increased Miscellaneous Antidepressants motor activity, insomnia, restlessness) that may require a sedative during the first few days of administration. These Bupropion (Wellbutrin, Zyban) inhibits the reuptake of effects may increase the risk of abuse. It was marketed verse effects include dry mouth, headache, nausea and vom- with warnings related to seizure activity. CHAPTER 10 DRUGS FOR MOOD DISORDERS: ANTIDEPRESSANTS AND MOOD STABILIZERS 169 Mirtazapine (Remeron) blocks presynaptic alpha2- edema, cardiac dysrhythmias, and priapism (prolonged and adrenergic receptors (which increases the release of norepi- painful penile erection). Venlafaxine (Effexor) inhibits the reuptake of norepineph- Consequently, the drug decreases anxiety, agitation, in- rine, serotonin, and dopamine, thereby increasing the activity somnia, and migraine headache as well as depression. The drug crosses the the drug is well absorbed after oral administration, and placenta and may enter breast milk. It is metabolized in the peak plasma levels occur within 2 hours after an oral dose. It is contraindicated during preg- is metabolized in the liver, mainly to inactive metabolites. Adverse effects include CNS (anxiety, nying cognitive and motor impairment), increased appetite, dizziness, dreams, insomnia, nervousness, somnolence, weight gain, dizziness, dry mouth, and constipation. It does tremors), GI (anorexia, nausea, vomiting, constipation, diar- not cause sexual dysfunction. Venlafaxine does not interact with drugs metabolized by should not be taken concurrently with an MAOI or for 14 days the cytochrome P450 system, but it should not be taken con- after stopping an MAOI. An MAOI should not be started until currently with MAOIs because of increased serum levels and at least 14 days after stopping mirtazapine. If a client on venlafaxine is to be transferred Nefazodone (Serzone) inhibits the neuronal reuptake of to an MAOI, the venlafaxine should be discontinued at least serotonin and norepinephrine, thereby increasing the amount 7 days before starting the MAOI; if a client on an MAOI is to of these neurotransmitters in the brain. It is contraindicated in be transferred to venlafaxine, the MAOI should be discontin- pregnancy and liver damage and should be used with caution ued at least 14 days before starting venlafaxine. It is metabolized in the liver and produces two active Lithium carbonate (Eskalith) is a naturally occurring metallic metabolites. It is well absorbed after oral administration, cluding agitation, confusion, dizziness, GI symptoms (nausea, with peak serum levels in 1 to 3 hours after a dose and steady- vomiting, diarrhea), headache, insomnia, orthostatic hypoten- state concentrations in 5 to 7 days. Because of its association with tions should be monitored frequently because they vary widely liver failure, serum levels of liver enzymes (eg, aspartate and among clients taking similar doses and because of the narrow alanine aminotransferases [AST and ALT]) should be mea- range between therapeutic and toxic levels. Approximately 80% of a lithium Nefazodone should not be taken with an MAOI because of dose is reabsorbed in the proximal renal tubules. If a client on nefazodone is to of reabsorption depends on the concentration of sodium in be transferred to an MAOI, the nefazodone should be discon- the proximal renal tubules. A deﬁciency of sodium causes tinued at least 7 days before starting the MAOI; if a client on more lithium to be reabsorbed and increases the risk of lithium an MAOI is to be transferred to nefazodone, the MAOI should toxicity; excessive sodium intake causes more lithium to be be discontinued at least 14 days before starting nefazodone. CNS depression with general anesthetics and decreased me- Before lithium therapy is begun, baseline studies of renal, tabolism of drugs metabolized by the cytochrome P450 3A4 cardiac, and thyroid status should be obtained because adverse enzymes, which are inhibited by nefazodone. Baseline electrolyte Trazodone (Desyrel) is used more often for sedation and studies are also necessary. Carbamazepine (Tegretol) and valproate rently with a stimulating antidepressant, such as bupropion, (Depakene) are commonly used. It is metabolized by the liver and excreted primarily drugs seem to have some beneficial effects but additional by the kidneys. Clinical Herbal Supplement manifestations are nonspeciﬁc and vary in severity. Several studies, most symptoms are present, try to determine their frequency, of which used about 900 mg daily of a standardized extract, duration, and severity. Coping mechanisms vary widely, and be- is thought to act similarly to antidepressant drugs. Some havior that may be helpful to one client may not be helpful herbalists refer to St.
In other words hoodia 400mg low price zen herbals, we need criteria and standards for those aspects of care purchase 400 mg hoodia overnight delivery zeolite herbals pvt ltd. Definitions Criteria refer to specific attributes that are the basis for assessing quality buy generic hoodia 400mg herbs to grow indoors. Standards express quantitatively what level the attributes must reach to sat- isfy preexisting expectations about quality discount hoodia online master card herbals images. An example unrelated to health- care may help clarify the difference between criteria and standards. The scores are thus one of the criteria by which programs judge the quality of their applicants. However, although two programs may use the same criterion— standardized scores—to evaluate applicants, the programs may differ markedly on their standards: one program may consider applicants accept- able if they have scores above the 50th percentile, whereas scores above the 90th percentile may be the standard of acceptability at the other. Sources A shift in the way criteria and standards are derived has been occurring in the healthcare field. Prior to the 1970s, formally derived criteria and stan- dards for quality-of-care evaluations for the most part relied on consensus opinions of groups of clinicians selected for their clinical knowledge and experience and for the respect they commanded among their colleagues (Donabedian 1982). This approach to formulating criteria took for granted that in their deliberations the experts would incorporate the latest scien- tific knowledge relevant to the topic under consideration, but formal require- ments that they do so seldom existed. It was not until the mid-1970s that the importance of the scientific literature in relation to criteria and standards was highlighted, notably by Basic Concepts of Healthcare Quality 37 TABLE 2. At about the same time, Brook and his col- leagues at RAND were the first to use systematic reviews and evaluations of the scientific literature as the starting point for the deliberations of pan- els charged with defining criteria and standards for studies of quality (Brook et al. This focus on the literature—and especially on the validity of the studies within that literature—was reinforced in the 1990s by the evi- dence-based medicine movement, which seeks to put into practice what the best evidence has to say about what is and is not efficacious under a given set of clinical circumstances (Evidence-Based Medicine Working Group 1992; Sackett et al. Thus, criteria and standards have come to revolve increasingly around the strength and validity of the scientific evi- dence and less on the unaided consensus opinions of experts (Eddy 1996). It must be noted, however, that although estimates vary, efficacy has not been definitely established for at least half of what physicians do in their daily practice (Eddy 1993; Sackett et al. Definitive, efficacy-based assessments of quality are therefore impossible to make about much care clinicians provide. On the other hand, even when we do not know what is 38 the Healthcare Quality Book the right thing to do, we often know what is not the right thing to do. Levels When formulating standards, a critical decision that must be made is the level at which the standards should be set: minimal, optimal, achievable, or something in between (Muir Gray 2001). Minimal standards specify what level must be met for quality to be considered acceptable. The impli- cation is that if care does not meet a minimal standard, remedial action is called for. Optimal standards denote the level of quality that can be reached under the best conditions, typically conditions similar to those under which efficacy is determined. Optimal standards are probably most useful as a ref- erence point for setting achievable standards—the level of performance that should be reached by everyone to whom the standards are being applied. One way to define achievable standards is in relation to the level of per- formance of the top quartile of providers of care. The reasoning is that if the top quartile can perform at that level, the other three quartiles should be able to reach it as well (Muir Gray 2001). Since there is no a priori level at which a particular standard ought to be set, a sensible and frequently adopted approach is to choose the level based on why the underlying eval- uation is being conducted in the first place. Using Measurement-Related Concepts How does understanding structure, process, and outcomes; efficacy; and criteria and standards give us insight into quality-of-care measurement issues? The two cases cited at the beginning of this section provide some illustrations. In the first case, minimum standards of quality were specified in terms of nurse staffing levels, a structural measure of quality. The critics are not questioning the choice of measure, nor should they, since structural meas- ures are well suited to detecting lack of capacity to deliver care of accept- able quality. In this case, hospitals that do not meet minimum staffing levels by definition cannot deliver care of acceptable quality (safe care). Put another way, the critics do not challenge nurse staffing levels as a criterion for assessing quality of care. The evidence would have to come from properly controlled studies show- ing that quality of care falls below what can be considered safe levels when Basic Concepts of Healthcare Quality 39 nurse staffing ratios are reduced, holding all else constant. In other words, silencing the critics requires evidence from the kind of studies on which efficacy determinations are based. In the second case, both measures under discussion are process meas- ures. However, mammograms belong to a subset of process measures that represent a kind of resting point along the continuum of the activities that make up the process of care. These kinds of resting points share with most outcomes the characteristic of being discrete events that are relatively eas- ily counted; hence, the label procedural endpoints has been applied to them (Donabedian 1980). Because performing mammograms is certainly the right thing to do for the target population, appropriateness is not in question. If mammograms are not done right—if, because of deficiencies in skill, mammograms are performed incorrectly, resulting in incorrect interpretations, or if they are done correctly but read incorrectly— the mammograms will fail as a means for early detection of breast cancer. Early detection of breast cancer can therefore be claimed to be the better alternative measure of quality: it reflects not just whether mammograms were performed when indicated (appropriateness), but also how well they were done and interpreted (skill). Structural measures are only as good and useful as the strength of their relation to desired processes and outcomes. So, too, process and outcome measures must relate to each other in measurable and reproducible ways—as demon- strated by efficacy studies—to be truly valid measures of quality. Additionally, structure, process, and outcome measures are the build- ing blocks for the criteria on which all evaluations of healthcare quality rest. But whereas the decision on which measures ought to become crite- ria ideally is evidence based—and thus driven by considerations of efficacy, along with the recognition of the distinction between appropriateness and skill—the setting of standards that correspond to the criteria is not based 40 the Healthcare Quality Book on the scientific literature. Instead, the decision to set standards at a min- imal, ideal, or reachable level should properly be driven by the goals behind the specific quality-of-care evaluation in which the standards are to be used. Almost anyone who works in a hospital can tell you which doctors are regarded highly by their patients and colleagues. Describe an instance in which outcomes would not be a good meas- ure of healthcare quality. Please spell out why outcomes would not be a good indicator of quality in that instance. Some third-party payers have been criticized for making judgments about quality of healthcare based almost exclusively on whether a given service should or should not have been provided. In terms of concepts relevant to the definition and measurement of quality of care, what else might these third-party payers take into considera- tion when making judgments about quality of care?
These activities stimulate coordination between hemi- spheres of the cerebral cortex generic hoodia 400mg online herbs chart, and they enable balance and communication between the left and right sides of the body buy hoodia 400 mg with amex herbs and uses. As a general rule cheap hoodia 400mg without prescription ratnasagar herbals pvt ltd, Qigong exercises do not involve stepping movements hoodia 400mg amex herbs mill, but rather are performed in a relaxed stationary position. The emphasis is on proper breathing and postural alignment, as well as Qi flow. The slow speed of the mo- tions, often described as moving in water, lend a meditative aspect to the exer- cises, and allow the practitioner to focus on the physical movements to the exclusion of all outside stimuli. This single-focus technique is useful as a mini-vacation from the worries and problems of your life. One of the nice things about Qigong exercises is that if you are unable to stand for extended periods, or are confined to a wheelchair, it is possible to still use these exercises and enjoy their many benefits, in a manner that we will explore in Chapter 8. Both exercises utilize Qi, are mindful of proper body mechanics, and use deep breathing and relaxation techniques to produce the final fluid motions of the body. The mental outlook when performing either of these arts is similar: A quiet, focused mind is essential to gain the maximum benefit. The combination of linear and round movements, coupled with the proper flow of internal energy, gives a fighting art that is distinct and highly effective. Granted, it may take a bit longer to master the full form, but within a reasonable length of time, you can be practicing the form on your own. My students typically come to me for a year or so, learn the form and all of the attendant variations and subtleties, and then go off and practice on their own. They may start the learning process by coming to class two or three times per week, but when they have the form internalized, they come only once a week or so, to refresh and refine their art. The overall effect from Qigong training is gained through persistent and dedi- cated practice over months and years. Because there are so many methods out there, it is generally advisable to pick one type to start with, and to gain the benefits that are promised from its practice, before moving on to another more compli- cated method. You should also know that it is inadvisable to train in two types of Qigong that are not congruent with one another, that is to say, do not mix hard and soft Qigong methods. When you train in Qigong, you are making changes to your energetic system and also your endocrine system. With the Qigong instruction contained in this book, I can guarantee you that after only one hour of trying the movements, you will have exercises that you will remember and can practice at any time. This is not to say that a certain exercise cannot be used for both medical and spiritual purposes, for ex- ample, but as a general tool of convenience and as a learning aid, the following five styles will be explored in this section: 1. The Taoist styles emphasize joint health, internal and external strength- building, balance, deep breathing, and relaxation. The Buddhist school is aimed at liberating the mind through the Qigong exercises. Many Buddhist exercises are inwardly oriented to focus your attention on the spiritual aspects of your life. As a result, these are often described as static, or non-moving, Qigong exercises. Confucian Qigong has not, to this point, been utilized extensively in the United States, but is still practiced in China. The Medical school teaches patients how to take control of their own illnesses, and also how to prevent them. It also teaches medical people how to use the inner Qi in a dynamic way for healing the aches and pains of others. The Martial school of Qigong focuses on protecting the body from sword cuts, blunt trauma from other-than-edged weapons, and safety from attack by fist or foot. It also trains the body to deliver fatal blows that are enhanced with Qi, such as those found in Burning Palm or Iron Palm methods. Within the various schools of Qigong, you will find very simple and easy-to-do sets, such as the 18-Movement Qigong and Eight Pieces of Brocade, to more com- plicated methods such as Wild Goose Qigong and Falun Gong. All have their rela- tive merits and drawbacks, so once you progress to the stage where you are looking for a new Qigong form, choose carefully. TLFeBOOK Q igong B asics / 39 Introduction to Medical Qigong Traditional Chinese Medicine (TCM) is a holistic system for promoting health through the use of several therapies such as acupuncture, herbal medicine, acupressure massage, and Medical Qigong. The central theory of TCM is to balance the Qi (the vital energy in the body) according to several theories such as Yin-Yang, Five Element, and Six Stages. These theories are used in TCM in general as well as in Medical Qigong in particular. In the Yin-Yang Theory, all of life is composed of two opposing yet comple- mentary forces: the yin (feminine, dark, weak) and the yang (masculine, light, strong). At birth, the human body normally contains equal amounts of both traits. When sickness develops, it can be attributed to a deficiency or excess of either of the two forces. Medical Qigong seeks to restore this balance through movement and breathing exercises. The Five Element Theory states that all things in the universe, including hu- mans, have a collection of traits that correspond to five natural Elements: Wood, Fire, Metal, Earth, and Water. Within each of these elements is found a certain physical and mental representation: Wood: Liver, growth at birth, yang. Qigong exercises affect the actions of the five Elements in the body through Qi flow. Thus, a person who is diagnosed as being Water deficient may have exercises prescribed to improve that Element, thus aiding kidney function. An expert in Medical Qigong is often also a Chinese medicine practitioner, as the ability to di- agnose the five Element signs is vital to both fields. The Six Stages Theory uses the idea that disease attacks certain organs and organ systems according to severity and level of infection. For example, the Great Yang Stage sickness affects the exterior of the body, in addition to the small intes- tine and bladder, while the Terminal Yin Stage affects the pericardium and liver organs and strikes deep within the body. According to the proper diagnosis using this theory, exercises would again be prescribed to alleviate the disease. A more detailed account of Traditional Chinese Medicine can be found in Chap- ter12. The exercises that you will learn here are designed to give your body a tune up at many different levels. They have been refined and tested over thousands of years specifically with medical concerns in mind. So when you do the exercises in their proper form and sequence, you will be stimulating the meridians and channels in the body to enhance the flow of healthy energy (Qi) while at the same time eliminating the unhealthy energy (Sha Qi). Because of the positions assumed during the movements, you are alternately com- pressing and expanding the energy rivers, in addition to exercising the muscles, tendons, ligaments, and joints. By learning proper posture and diaphragmatic breath- ing, you are aiding your body in maintaining optimal health and fitness. The twist- ing of the waist and hips, along with the spinal stimulation, helps to massage the internal organs and the tissue surrounding them. While all of this activity is taking place, you are maintaining a calm and relaxed mental state through your focus on the simple movements.