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DESCRIPTION
Phlebitis means inflammation of a vein. If inflammation is associated with the formation of a thrombus (a blood clot) in the vein, the condition is called thrombophlebitis. This problem usually occurs in the extremities, particularly the legs. On rare occasions, thrombophlebitis (often shortened to "phlebitis") can affect veins in your arms or neck.
The affected vein may be near the surface of your skin, causing superficial thrombophlebitis, or deep within a muscle, causing deep vein thrombosis (DVT). A clot in a deep vein increases your risk of serious health problems, including a dislodged clot (embolism) traveling to your lungs and blocking a pulmonary artery (pulmonary embolism). Thrombophlebitis can be caused by prolonged inactivity, such as from sitting for a long time in an airplane or automobile or from lengthy bed rest after surgery.
You can use self-care methods to ease pain and reduce your risk of clots. Various treatments, including medications and surgery, also are available for thrombophlebitis.
TYPES OF THROMBOPHLEBITIS
Thrombophlebitis can be either superficial or deep.
SUPERFICIAL THROMBOPHLEBITIS
It is considered superficial if it affects a subcutaneous vein, one of the veins near the skin's surface. In superficial thrombophlebitis, the affected vein can be felt (it feels harder than normal), and may be seen as a reddish line under the skin, with localized swelling, pain and tenderness to the touch. If there is widespread vein involvement, the lymphatic vessels (thin-walled vessels carrying fluid from the tissues to the bloodstream) may become inflamed. Superficial thrombophlebitis is a relatively common disorders. A superficial clot may be brought by trauma, infection, standing for long periods of time, lack of exercise, and intravenous drug use. Pregnancy, varicose veins, obesity and smoking increase the risk of superficial vein thrombophlebitis. Thrombophlebitis may also be associated with environmental sensitivities or allergies. Diagnosis of the condition is usually based on physical findings and/or a medical history indicating an increased risk.
DEEP VEIN THROMBOPHLEBITIS
Deep thrombophlebitis (known as deep vein thrombophlebitis, or DVT) affects the deeper, larger intermuscular or intramuscular veins farther below the skin's surface. DVT is a much more serious condition than superficial thrombophlebitis because the veins affected are larger and located deep within the musculature of the leg. These are the veins responsible for the transport of 90 percent of the blood that flows back to the heart from the legs.
SYMPTOMS OF THROMBOPHLEBITIS
Symptoms of thrombophlebitis may include:
- Warmth, tenderness and pain in the affected area over the vein.
- Skin redness (not always present) and swelling (inflammation) in the part of the body affected.
SUPERFICIAL THROMBOPHLEBITIS
The symptoms include the above plus:
- Red hard and tender cord just under the surface of the skin.
DEEP VEIN THROMBOPHLEBITIS (DVT)
When a deep vein in the leg is affected, you leg may become:
- Painful and tender, most noticeably when you stand or walk.
- Swelling of the limb.
- Fever and chills may sometimes, but not often accompany other symptoms.
- Bluish discoloration of the skin of the affected limb (DVT).
The pain is typically felt as a deep soreness that is worse when standing or walking and that gets better with rest, especially with the leg elevated. The veins directly under the skin may become dilated and more visible.
Inflammation situated in a vein in the pelvis is called pelvic vein thrombophlebitis.
However, many people with deep vein thrombophlebitis have no symptoms.
CAUSES OF THROMBOPHLEBITIS
The reason or reasons for the formation of clots in veins are often unknown. Blood clots can be caused by many different things - namely anything that causes your blood not to circulate properly.
In most cases, clots are probably the result of minor injury to the inside lining of a blood vessel. If the vessel receives a microscopic tear, for instance, this initiates clotting - a normal part of the body's repair processes. Platelets clump together to protect the injured area, and a series of biochemical events is initiated that results in the transformation of fibrinogen, a circulating blood protein, into strands of insoluble fibrin, which are deposited to form a net that traps blood cells, plasma, and yet more platelets. The result is a blood clot.
Other possible causes of deep thrombus formation include:
- Abnormal clotting tendencies.
- Poor circulation.
- Certain types of cancer.
- Behcet's syndrome, a condition affecting the small blood vessels that predispose and individual to the formation of clots.
Factors that increase the risk of DVT include:
- Recent childbirth.
- Surgery.
- Trauma.
- The use of birth control pills.
- Major illness resulting in prolonged bed rest (some studies indicate that up to 35 percent of hospital patients develop DVT).
THROMBOPHLEBITIS RISK FACTORS
Any long period of immobility - whether from being bedridden or sitting during extended periods of travel - is a risk factor for DVT. DVT has been dubbed the "economy class syndrome" due to its association with long-distance air travel, but it can just as often affect people who frequently take trips on buses or trains or in cars. Unusual and tragic cases, such as the death of 39 year-old NBC reporter David Bloom, caused by his riding for days in a cramped military vehicle while covering the Iraq war, occasionally bring DVT to the attention of the public. In fact, any situation that creates restricted blood flow, including:Or anything else, can lead to DVT.
- Inactivity for long periods of time, such as sitting in a car or on an airplane.
- Being confined to bed for a prolonged time, such as after surgery, after a heart attack or after an injury, such as breaking your leg.
- Certain types of cancers, such as pancreatic cancer, that may cause an increase in procoagulants, These are substances necessary for blood clotting (coagulation) in your blood.
- Having had a stroke that caused your arms or legs to be paralyzed.
- Having a pacemaker or having a thin, flexible tube (catheter) in a central vein, for treatment of a medical condition, which may irritate the blood vessel wall and decrease blood flow.
- Obesity or being overweight.
- Inherited clotting disorder or having a family history of a blood-clotting disorder or a tendency to form blood clots easily.
- Pregnancy or just having given birth, which may mean you have increased pressure in the veins of your pelvis and legs.
- The use of birth control pills or hormone replacement therapy, which may make your blood more likely to clot.
- Being a smoker.
- Having varicose veins.
- Damage to the veins due to injury or orthopedic surgery.
The more risk factors you have, the higher your risk of thrombophlebitis. If you have one or more risk factors, be sure to discuss prevention strategies with your health care provider before long periods of inactivity, such as a long flight, a long car ride or after an elective surgery.
THROMBOPHLEBITIS COMPLICATIONS
If thrombophlebitis is in a vein just under your skin (superficial vein), complications are rare. However, if the clot occurs in a deep vein you may develop a serious medical condition known as deep vein thrombosis. If that happens, the risk of serious complications is greater. Complications may include:
- Pulmonary Embolism. If part of a deep vein clot becomes dislodged (embolism), it may travel to your lungs, where it can block an artery and cause a potentially life-threatening situation.
- Heart Attack or Stroke. If you have certain types of congenital heart defects that have caused a hole in your heart - such as a patent foramen ovale (PFO), an atrial septal defect or a ventricular septal defect - a clot traveling through your bloodstream can enter your coronary arteries or brain and cause a heart attack or stroke.
BLOOD FLOW RESTRICTION
The primary risk associated with DVT is a sharp restriction in blood blow through the veins that can result in chronic venous insufficiency, a condition characterized by swelling, increased pigmentation, dermatitis, and ulceration of the affected leg.
DVT can become life-threatening if a blood clot breaks off from the venous lining and travels through the bloodstream to the heart, lung, or brain, where it may lodge in a blood vessel and cut of circulation to those vital organs.
HEART EMBOLISM
If a blood clot blocks the supply of blood to the heart, the result is a heart attack.
MoonDragon's Health & Wellness: Heart Attack
BRAIN EMBOLISM
If a blood clot blocks the supply of blood to the brain, a stroke may occur.
PULMONARY EMBOLISM
If blood flow to the lung is blocked, the result is a pulmonary embolism, a less well known but equally serious scenario.
Chest pain can be a symptoms of both heart attack and pulmonary embolism.
Other common symptoms of pulmonary embolism, besides chest pain are:
- Unexplained shortness of breath.
- Coughing up of blood.
If you have any symptoms of pulmonary embolism, you need emergency medical help at once.
However, despite its potential seriousness, DVT can be completely without symptoms. Indeed nearly half of all people who have it have no symptoms at all. Nine out of ten cases of pulmonary embolism are caused by blood clots that form in the legs and travel to the lungs. More than 600,000 people in the United States have a pulmonary embolism each year, and more than 10 percent die from it. Most who die do so within 30 to 60 minutes after symptoms start. Pulmonary embolism occurs equally in men and women, but the risk of having pulmonary embolism doubles for each 10 years after age 60.
VALVE DAMAGE & THROMBOPHLEBITIS
A potential complication of DVT is postphlebitic syndrome, a permanent condition caused by valves in the leg veins that no longer work properly. For people with this syndrome, clotting takes a long time to clear up, and the result is sometimes an inflammatory reaction that can scar the veins, particularly the valves. These valves act as check valves, allowing the blood to flow only one way (back to the heart). If the valves are defective or become damaged, blood can flow backwards, which allows it to pool in the legs to cause pain, swelling, and sometimes, skin ulceration and varicose veins.
Deep vein thrombosis also may damage valves in the veins in your legs. Veins have valves to prevent blood from flowing back as it is gradually pushed uphill toward your heart. When the valves in the veins of your legs do not work properly, several problems can occur:
- Varicose Veins. The pooling of blood in your veins can cause them to balloon, resulting in varicose veins.
- Swelling. In some cases, the pooling may become so bad that your leg swells (edema).
- Skin Discoloration. With chronic swelling and increased pressure on your skin, discoloration called stasis pigmentation may occur. In some cases, skin ulcers may develop. If you suspect a skin ulcer is forming, call your health care provider.
- Blocked Vein. Deep vein thrombosis can cause a permanent blocking of blood flow in the vein.
THROMBOPHLEBITIS PREVENTION
Blood clots can occur for a number of reasons. One concern many people have is that blood clots can be caused by sitting for hours at a time, as when you are traveling by car or airplane. While sitting for long periods can promote a blood clot that can lead to thrombophlebitis, this occurs relatively rarely. By taking proper precautions, such as periodically stretching your legs or getting up to walk around, you can decrease your risk of developing thrombophlebitis.
PREVENTION TIPS
To prevent thrombophlebitis, quit smoking if you are a smoker because smoking increases your risk of a blood clot.
Sitting during a long flight or car ride can cause swollen ankles and calves. The inactivity also increases your risk of thrombophlebitis in the veins of your legs. To help prevent a blood clot from forming:
- Take a walk. If you are flying, walk around the airplane cabin once an hour or so. If you are driving, stop every hour and walk around.
- If you must stay seated, move your legs regularly. Flex your ankles, or carefully press your feet against the floor or foot rest in front of you at least 10 times each hour.
On flights or car rides lasting more than four hours, take additional precautions to reduce your risk of deep vein thrombosis:
- Avoid wearing tight clothing around your waist.
- Drink plenty of fluids to avoid dehydration.
- Stretch your calves by walking at least once an hour.
If you are at increased risk of deep vein thrombosis, talk to your health care provider before your flight. He or she may recommend:
- Compression stockings.
- A mild blood-thinning medication given before departure. Aspirin therapy is generally not recommended and could thin your blood too much if you are also taking warfarin (Coumadin). However, if you are taking aspirin for other reasons, you should continue taking it.
If you are hooked up to intravenous lines (IV) either at home or at the hospital, routine changing of IV lines helps to prevent phlebitis related to IV lines.
THROMBOPHLEBITIS DIAGNOSIS
Before your health care provider appointment, you can begin some self-care measures.
- You can use a warm washcloth as a compress on the affected area, and elevate your leg to help with any discomfort.
- If you decide to take any pain-relieving medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), be sure to tell your health care provider. These medications can interact with other blood clot-dissolving medications your health care provider prescribes.
PREPARING FOR YOUR APPOINTMENT
You do not need to make any special preparations for an appointment with your health care provider to diagnose thrombophlebitis. Because appointments can be brief, and because there is often a lot of information to cover, it is a good idea to be prepared for your appointment. Here is some information to help you get ready for your appointment, and what to expect from your visit to your health care provider.
Write down any symptoms you are experiencing, including any that may seem unrelated to thrombophlebitis.
Write down key personal information, especially if you have a family history of blood-clotting disorders.
Make a list of all medications, as well as any vitamins or supplements, including herbal supplements or home remedies, that you are taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Be prepared to discuss if you have been seated for long periods of time recently, such as traveling by car or plane. Also, if you are planning to travel and are concerned about your thrombophlebitis risk, tell your health care provider about your travel plans.
Write down questions to ask your health care provider. Your time with your health care provider is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For thrombophlebitis, some basic questions to ask your health care provider include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests will I need?
- What is the best course of action?
- What is an appropriate level of physical activity for me now that I have been diagnosed with thrombophlebitis?
- What about once my clot is gone?
- What are the alternatives to the primary approach that you are suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- What will that cost, and will my insurance cover seeing a specialist? (You may need to ask your insurance provider directly for information about coverage.)
- Is there a generic alternative to the medicine you are prescribing me?
- Are there any brochures or other printed material that I can take home with me?
- What Web sites do you recommend visiting?
In addition to the questions that you have prepared to ask your health care provider, do not hesitate to ask questions during your appointment at any time that you do not understand something.
MEDICAL HISTORY
Your health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your health care provider may ask:
- When did you first begin experiencing symptoms?
- Have you been inactive lately, such as sitting or lying down for long periods?
- Have your symptoms been continuous, or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do you have a family history of health problems related to blood clots?
PHYSICAL EXAMINATION
To diagnose thrombophlebitis, your health care provider will ask you about the discomfort you have had and then look for any affected veins near the surface of your skin.
DIAGNOSTIC TESTS & PROCEDURES
To determine whether you have superficial thrombophlebitis or deep vein thrombosis, your health care provider may choose one of these tests:
DOPPLER ULTRASOUND
Ultrasound is performed by using a wand-like device (transducer) that is moved over the affected area of your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect back, a computer transforms the waves into a moving image on a video screen. A clot may be visible in the image.
CT OR MRI SCANS
Both computerized tomography (CT) and magnetic resonance imaging (MRI) can provide visual images of your veins and may show if a clot is present.
VENOGRAPHY
A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray procedure creates an image of the veins in your legs and feet, to look for clots. This test is used less frequently today because less invasive studies can usually confirm the diagnosis.
BLOOD TESTS
Blood coagulation studies.
Almost all people who develop acute thrombosis have an elevated blood level of a clot-dissolving substance called D dimer. However, D dimer is elevated in other conditions, too. So, although a test for D dimer is very sensitive, it is not very conclusive. Currently, it is most useful for ruling out deep vein thrombosis or for identifying people at risk of developing thrombophlebitis repeatedly.
TREATMENT OF THROMBOPHLEBITIS
If thrombophlebitis occurs in a superficial vein, your health care provider may recommend self-care steps that include applying heat to the painful area, elevating the affected leg and using an over-the-counter non-steroidal anti-inflammatory drug (NSAID). The condition usually does not require hospitalization and improves within a week or two.
Your health care provider may also recommend these treatments for thrombophlebitis, including deep vein thrombosis:
MEDICATIONS
Medications used in the treatment of thrombophlebitis include:ANTICOAGULANTS
If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medication, such as heparin, will prevent clots from enlarging. After the heparin treatment, taking the anticoagulant warfarin (Coumadin) for several months continues to prevent clots from enlarging. If your health care provider prescribes warfarin, follow the directions for taking the medication carefully. Warfarin is a powerful medication that can cause dangerous side effects if not taken properly.
THROMBOLYTICS
Thrombolysis is the breakdown (lysis) of blood clots by pharmacological means. It is colloquially referred to as "clot busting" for this reason. It works by stimulating fibrinolysis by plasmin through infusion of analogs of tissue plasminogen activator, the protein that normally activates plasmin.
Thrombolysis requires the use of thrombolytic drugs, which are either derived from Streptomyces spp. or (more recently) the effect of recombinant technology, where human activators of plasminogen (e.g. tissue plasminogen activator, tPA) are manufactured by bacteria. Some commonly used thrombolytics are:
- Streptokinase.
- Urokinase.
- Alteplase (recombinant tissue plasminogen activator or rtPA).
- Reteplase.
- Tenecteplase.
Formation of blood clots lies at the basis of a number of serious diseases, such as myocardial infarction (heart attack), stroke (ischemic stroke), massive pulmonary embolism, acute limb ischemia. By breaking down the clot, the disease process can be arrested, or the complications reduced. While other anticoagulants (such as heparin) decrease the "growth" of a clot, thrombolytic agents actively reduce the size of the clot.
All thrombolytic agents work by activating the enzyme plasminogen, which clears the cross-linked fibrin mesh (the backbone of a clot). This makes the clot soluble and subject to further proteolysis by other enzymes, and restores blood flow over occluded blood vessels. Apart from streptokinase, all thrombolytic drugs are administered together with heparin (unfractionated or low molecular weight heparin), usually for 24-48 hours. Thrombolysis is usually intravenous. It may also be used during an angiogram (intra-arterial thrombolysis), e.g. when patients present with stroke beyond three hours. In some settings, emergency medical technicians may administer thrombolysis for heart attacks in pre-hospital settings.
thrombolytics are contraindicated in bleeding disorders, active bleeding and when there has been recent surgery. Diabetic retinopathy is a relative contraindication, as is untreated high blood pressure. Warfarin treatment increases risk of bleeding and is a relative contraindication. Streptokinase is contraindicated in patients who have been previously treated with streptokinase, as there is a risk of anaphylaxis (life-threatening allergic reaction) due to the production of antibodies against the enzyme.
ANALGESICS & ANTI-INFLAMMATORIES
Analgesics (pain medications), non-steroidal anti-inflammatory medications (NSAIDS) such as ibuprofen may be given to reduce pain and inflammation.
ANTIBIOTICS
Antibiotics may be prescribed if infection is present.
SUPPORT STOCKINGS
Support Stockings help prevent recurrent swelling and reduce the chances of complications of deep vein thrombosis. Your health care provider may recommend prescription-strength support hose.
FILTER IMPLANTATION
In some instances, especially if you cannot take blood thinners, a filter may be inserted into the main vein in your abdomen (vena cava) to prevent clots that break loose in leg veins from lodging in your lungs. Typically, the filter remains implanted permanently. This procedure usually does not require you to stay in the hospital.
VARICOSE VEIN STRIPPING
Varicose vein stripping is a procedure in which your health care provider can surgically remove varicose veins that cause pain or recurrent thrombophlebitis in a procedure called varicose vein stripping. This procedure, typically done on an outpatient basis, involves removing a long vein through small incisions. Usually, you are able to resume normal activities in two weeks or less. Removing the vein will not affect circulation in your leg because veins deeper in the leg take care of the increased volumes of blood. This procedure is also commonly done for cosmetic reasons.
CLOT REMOVAL OR BYPASS SURGERY
Sometimes, surgery is necessary to remove a clot blocking a vein in your pelvis or abdomen. To treat a persistently blocked vein, your health care provider may recommend surgery to bypass the vein, or a non-surgical procedure called angioplasty to open up the vein. Once angioplasty has opened up the vein, your health care provider inserts a small wire mesh tube (stent) to keep the vein open.
PROGNOSIS
Thrombophlebitis and other forms of phlebitis usually respond to prompt medical treatment.
MEDICAL RECOMMENDATIONS - LIFESTYLE & HOME REMEDIES
In addition to medical treatments, there are some self-care measures you can take to help improve thrombophlebitis.
If you have superficial thrombophlebitis:
- Use a warm washcloth to apply heat to the involved area several times daily.
- Elevate your leg.
- Use a non-steroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), if recommended by your health care provider.
If you have deep vein thrombosis:
- Take prescription anticoagulant medications as directed to prevent complications.
- Elevate your leg if it is swollen.
- Wear your prescription support stockings daily.
CONSIDERATIONS
To make a definitive diagnosis of DVT, a health care provider must rule out a number of other disorders, including cellulitis and occlusive arterial disease. One test commonly used to diagnose DVT is duplex ultrasound. In this procedure, a handheld ultrasonic device is passed over the affected area, and a picture of the blood flow is displayed on a computer screen. A less common test is venography, in which dye is injected into a vein to make blood flow visible on an x-ray. Duplex ultrasound, chest x-ray, and other tests can be used to diagnose pulmonary embolism, as required.
Treatment of thrombophlebitis primarily consists of using anticoagulant (blood thinning) medications. Blood thinners such as heparin and warfarin (Coumadin) do not dissolve clots that have already formed, but can prevent the formation of new clots. Aspirin also can be an effective anticoagulant for treating DVT. The usual recommended dosage is one 80 mg baby aspirin daily. More invasive treatments, such as the use of filters that can be inserted into the veins, and use of potent "clot buster" drugs, which can dissolve large clots quickly, are available for difficult or life-threatening situations.
DVT is a potentially serious problem, and hospitalization may be recommended. An anticoagulant such as heparin or warfarin (Coumadin) is usually given, both intravenously and orally. Surgery may be needed to tie off the affected vein to prevent the clot from traveling to the lungs, a condition known as pulmonary embolism. Recovery time varies, depending on the severity of the disease. Caution: Do not combine vitamin E and prescription blood thinning drugs.
Behcet's syndrome is a chronic multi-system disease distinguished by thrombophlebitis, plus arthritis, iritis, uveitis, and ulceration of the mouth and genitalia. This disease is found worldwide, but is most common in young men of eastern Mediterranean and eastern Asian descent.
RELATED DISORDER LINKS
For more information about blood clotting related disorders, see:
THROMBOPHLEBITIS RECOMMENDATIONS
Eat plenty of fresh fruits and vegetables, raw nuts and seeds, soybean products, and whole grains.
Reduce your consumption of red meat. Better yet, eliminate it from your diet.
Do not consume any dairy products, fried or salty foods, or processed or partially hydrogenated vegetable oils.
Get regular moderate exercise. Walking, swimming, and other exercise improve circulation and prevent sluggishness in the veins, lessening the tendency to form clots.
Take alternating hot and cold sitz baths, or apply alternating hot and cold compresses using the herbs recommended below on this page.
Lie on a padded slant board with your feet higher than your head for 15 minutes a day. This is particularly helpful if you stand on your fee a lot.
Consult with your pharmacist about special elastic support stockings (anti-embolism stockings) to improve circulation. Some stockings are available from Amazon.com, these are only a selection. For more options, use the Amazon.com search box found further down on this page.
If you smoke, stop. Smoking constricts blood vessels, resulting in poor circulation and weakened blood flow. This is particularly important if you are taking birth control pills or hormone replacement therapy.
Avoid wearing tight-fitting clothing that cuts off circulation, such as knee socks with tight bands and girdles.
If you experience a swollen, painful vein that does not get better within 2 weeks, talk to a health care professional.
If symptoms of pulmonary embolism develop, sit down at once and call for emergency help (if someone is with you, have that person make the call). Getting to an emergency room quickly is your best decision.
If you are confined to a bed, move your legs as much as possible to counteract pooling of blood in the veins.
Clean your legs daily to remove germs that can cause infection.
Avoid using products that can dry your skin. Contact your health care provider if you notice any redness or swelling in the legs - these may be signs of infection.
If you develop leg ulcers, keep the ulcers clean and germ-free to prevent infection. Follow your health care provider's recommendations concerning proper care for your ulcers, and be forewarned that leg ulcers may take 3 months to a year to heal.
Avoid wearing socks with tight elastic at the top, which constricts the veins. Choose stockings with wide bands at the top which reduce constriction of blood vessels or choose stockings specially made for people at risk for thrombophlebitis and embolism problems (see above support stockings).
When traveling, take the following preventive measures:
- Do not sit inactive for an entire trip or flight. Get up, move around, stretch. Some airplanes are large enough to allow walking up one aisle and down the another. Some airlines, such as Qantas, offer leaflets suggesting leg exercises that passengers can do in their seats. If you are traveling by car, stop, get out, walk around and stretch every couple of hours.
- Drink plenty of fluids to prevent dehydration. Dehydration causes the blood vessels to narrow and blood to thicken, increasing the risk of DVT.
- Avoid consuming alcohol and coffee, particularly on a long trip. Both contribute to dehydration.
- Avoid sitting with your legs crossed for long periods of time.
In daily life, avoid standing for long periods of time. If you are sitting for long periods of time at work or at home, such as working on a computer, take periodic breaks and get up and move around. Avoid chairs that cut off circulation on the back of the legs while sitting.
HERBAL THERAPY
Alfalfa, Pau D'Arco, Red Raspberry Leaf, Rosemary and Yarrow are antioxidant herbs that improve blood oxygenation.
Herbal Remedies: Alfalfa Supplements & Products
Herbal Remedies: Pau D'Arco Supplements & Products
Herbal Remedies: Red Raspberry Supplements & Products
Herbal Remedies: Rosemary Oil & Rosemary Leaf Supplements & Products
Herbal Remedies: Yarrow Flower Herb Supplements & Products
Butcher's Broom improves circulation.
Cayenne (Capsicum) thins the blood, eases blood pressure, and improves circulation. It can be combined with Ginger, Plantain, and Witch Hazel in a poultice and applied directly to the affected area.
Herbal Remedies: Cayenne Supplements & Products
Ginger, Skullcap, and Valerian root dilate the blood vessels and aid circulation.
Herbal Remedies: Ginger Supplements & Products
Herbal Remedies: Skullcap Supplements & Products
Herbal Remedies: Valerian Supplements & Products
Ginkgo Biloba improves circulation and brain function, and is a powerful antioxidant.
Herbal Remedies: Ginkgold, Ginkgo Biloba Extract, Standardized, Nature's Way, Vegetarian, 60 mg, 150 Tabs
Backed by over 35 years of extensive research, including over 400 published scientific and clinical studies, Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.
Herbal Remedies: Ginkgold MAX, Ginkgo Biloba Extract, Nature's Way, Vegetarian, 120 mg, 60 Tabs
Backed by over 35 years of extensive research, including over 400 published scientific and clinical studies, Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.
Herbal Remedies: Ginkgo Biloba Extract, Standardized, Nature's Way, Vegetarian, 60 mg, 120 VCaps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb. Ginkgo biloba extract is the most frequently prescribed herbal extract by both doctors and pharmacists worldwide and is the best selling natural healthcare product in Europe.
Herbal Remedies: Ginkgo Supplements & Products
Goldenseal can be used to treat leg ulcers. Either make a Goldenseal tea (using water that has been sterilized by boiling prior to making the tea) or use alcohol-free Goldenseal extract. Use a piece of sterile gauze pad with a dropperful of extract or soaked in the tea and place it over the affected area.
Shaman Shop: Goldenseal Root Extract, Alcohol Free, Starwest Botanicals, 1 fl. oz.
Starwest Herbal Extracts are convenient to use, an excellent alternative to herb tea or capsules. Made by a cold process method that extracts the maximum amount of vitamins, minerals, and active constituents of the herb. Starwest Herbal Extracts are made to exacting standards. These extracts have a herb strength of 1 to 1. Packaged in 1 ounce (30 ml) amber bottles with a fitted neck dropper insert and sealed with a tamper-evident, child-proof lid. Goldenseal is a broad spectrum antibiotic and fungicide, effective against a wide range of topical and internal infections of the respiratory, digestive, and urinary tracts. Its use by Native America was widespread. It was used topically for skin and eye infections, as a mouthwash for canker sores, and as a tea for diarrhea, upper respiratory and vaginal infections. It was also used as a yellow dye for skins and fabrics.
Shaman Shop: Goldenseal Root Extract, Alcohol Free, Starwest Botanicals, 4 fl. oz.
This is Starwest's Alcohol Free Glycerites Extract, made with a vegetable glycerine base. Packaged in 1 ounce (30 ml) amber bottles with a fitted neck dropper insert and sealed with a tamper-evident, child-proof lid. Bulk sizes include 4 fl oz and 1 gallon bottles. These extracts are mostly Certified Kosher - all grown in compliance with the National Organic Program.
Herbal Remedies: Echinacea Goldenseal Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Herbal Remedies: Goldenseal Supplements & Products
Hawthorn dilates the blood vessels, lower cholesterol levels, and protects the heart.
Herbal Remedies: Hawthorn Supplements & Products
HAWTHORN Hawthorn is an effective herb for both high and low blood pressure because its powerful antioxidants protect blood vessels from damage while improving oxygen and blood delivery to the heart and the vessels. Simmer 1-2 tablespoons of hawthorn berries in 6 cups of water for 10 minutes. Add 3 tablespoons of hawthorn flowers and leaves; steep 10 minutes more. Strain. Drink 3 cups daily.
Olive Leaf extract aids in preventing infection.
Shaman Shop: Olive Leaf Extract, Health & Herbs, 2 fl. oz.
Used as an infusion, decoction, extract and tincture. Olive leaves have always had a reputation as a health-enhancer. The leaves are astringent and antiseptic. Internally, a decoction of 2 handfuls boiled in a quart of water until reduced to half a pint has been used in obstinate fevers. Both leaves and bark have valuable febrifugal qualities. Modern research is centered on the olive leaf's powerful antibiotic, antiviral and antifungal properties, which support the immune system and yet do not harm beneficial bacteria. Olive leaf contains oleuropein and several types of flavonoids, including rutin, apigenin, luteolin. Oleuropein has been experimentally shown to decrease blood pressure and dilate the arteries surrounding the heart. Oleuropein inhibits the unhealthy oxidation of the 'bad' LDL cholesterol. LDL oxidation is a precursor to hardening of the arteries (atherosclerosis). Mediterranean peoples, who eat plenty of olive products, have a lower rate of atherosclerosis than people who do not. Oleuropein is converted in brine into elenolic acid, which has been clinically shown to have antibacterial actions against several species of human-infecting bacteria. Use 6-12 drops in juice, water, under the tongue or as desired. May be taken 2 times daily. Shake well. Store in cool dark place. Keep out of reach of children. About 30 dropperfuls per fl oz. 30-40 drops per dropperful. Herbal tinctures (extracts) are a highly effective way to administer herbs. They are very concentrated, they work faster than teas and are four to eight times stronger than capsules. Extracts are easily digestible and quickly assimilate into the system.
Shaman Shop: Olive Leaf Tea, 20 Tea Bags
Olive leaf is a delicious and natural tool to fight over one hundred viral and bacterial conditions. Olive Leaf is a caffeine free antioxidant with a mellow flavor that has also been shown to lower blood pressure, reduce cholesterol, improve respiratory response and improve skin health Olive Leaf Tea is flavorful itself and mixes very well with many other herbs and flavorings.
Herbal Remedies: Olive Leaf Herb, Nature's Way, 470 mg, 100 Caps
Europeans have used olive leaf herb for centuries for it's natural benefits. Traditionally grown in the Mediterranean regions of Europe and the Middle East, the olive tree has been used extensively as a source of food, flavoring and oil. - Olive Leaf Contains natural amounts of Oleuropin. Recently, numerous new studies have shown its benefit as an herbal supplement. Recommendation: In addition to the daily diet, take 3 capsules 2 - 3 times daily with water or food.
Herbal Remedies: Olive Leaf Extract, Standardized, Nature's Way, 500 mg, 60 Caps
Nature's Way Standardized Olive Leaf extract is a technically advanced herbal product. Standardization assures specific measurable levels of important compounds that provide beneficial activity in the body. Olive leaf extract standardized to 12 percent oleuropin. Scientifically & technically advanced premium extract. Olive Leaf (Olea europaea) herb has long been used for general well being and has been the focus of research since the 1800's. Oleuropin the bitter glycoside found in the leaves has been identified as a key constituent which provides some of the therapeutic benefits of Olive Leaf. Recommendation: Take 1 capsule two times daily with food or water.
Herbal Remedies: Olive Leaf & Olive Oil Supplements & Products
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Important Acetyl-L-Carnitine 500 mg daily. Protects the brain and blood vessels from fat accumulation.
Acetyl-L-Carnitine Powder, Vegetarian, NOW Foods, 635 mg, 3 oz.,
Acetyl-L-Carnitine, Pharmaceutical Grade, NOW Foods, 500 mg, 100 Caps,
L-Carnitine Liquid, Double Strength, NOW Foods, 16 fl. oz.Coenzyme Q-10 100-200 mg daily. Improves circulation and protects the heart. Increases oxygenation of heart tissue. Has been shown to prevent recurrences in individuals who have had a heart attack.
CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps,
CoQ10, Now Foods, 400 mg, 60 SoftgelsFlaxseed Oil
Or
Ultimate Oil2 teaspoons daily.
As directed on label.To supply essential fatty acids that minimize blood clot formation and keep veins and arteries soft and pliable, promoting cellular and cardiovascular health.
Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 Softgels,
Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.,
Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 CapsGarlic (Kyolic) 2 capsules 3 times daily, with meals. Improves circulation and thins the blood.
Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.,
Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps,
Odorless Garlic Supplement, NOW Foods, 50 mg, 250 Softgels,
Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs,
Every Day Garlic Supplement, Kwai, 30 Tabs,
Garlic Tincture, 100% Organic, 2 fl. oz.,
Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps,
Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.,
Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps,
Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 CapsHeart Science
From Source Naturals1 Tablet 3 times daily. Contains powerful antioxidants, artery lining protectors, cholesterol fighters, herbs, and vitamins that work together to protect the heart and promote cardiovascular function. L-Cysteine
And
L-Methionine500 mg of each daily, on an empty stomach. Take with water or juice, not milk. Take with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption. Protects and preserves cells; and prevents accumulation of fat in the blood vessels. See Amino Acids for more information.
L-Cysteine Structural Support, W/ Vitamin B-6 & C, Vegetarian, NOW Foods, 500 mg, 100 Tabs,
L-Methionine, 500 mg, Plus B-6, 10 mg, 100 CapsLecithin Granules
Or
Capsules1 tablespoon 3 times daily, before meals.
1,200 mg 3 times daily, before meals. Take with vitamin E (below).Emulsifies (breaks up) fats; to increase circulation.
Lecithin Vegetarian Granules, NOW Foods, 97% Phosphatides, Identity Preserved Non-GE, 1 lb,
Lecithin Liquid, NOW Foods, Vegetarian, 16 fl. oz.,
Lecithin Concentrate, Nature's Way, 400 mg, 100 SoftgelsL-Histidine 500 mg daily. Important blood vessel dilator. Magnesium 1,000 mg daily. A natural blood thinner that reduces abnormal clotting. Vital for a healthy heart. Connected to over 300 enzyme actions controlling glucose, proteins, and fats.
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 CapsCalcium 1,500 mg daily. Important in the proper functioning of the cardiac muscle. Works with magnesium.
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 GelcapsMethylsulfonylmethane (MSM) As directed on label. Relieves pain and inflammation.
MSM Cream, With Methylsulfonylmethane, 2 oz.,
MSM Liquid, Pure Lignisul Methylsulfonylmethane, 16 fl. oz.,
MSM, Pure Lignisul Methylsulfonylmethane, 1000 mg, 240 Caps,
MSM, Pure Lignisul Methylsulfonylmethane, 500 mg, 250 Caps,
MSM Powder, Pure Lignisul Methylsulfonylmethane, 4 oz.Pycnogenol
Or
Grape Seed Extract50 mg 3 times daily.
As directed on label.Antioxidants that restore the flexibility to arterial walls and reduce the risk of blood vessel disease and thrombophlebitis. Neutralize free radicals, enhance the action of vitamin C, and strengthens connective tissue, including that of the cardiovascular system.
Pycnogenol W/ Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs, Grape Seed (Grapeseed) (Vitus vinifera), 100% Pure, NOW Foods, 16 fl. oz.Vitamin C With Bioflavonoids 4,000-8,000 mg daily. Extremely important in treating cardiovascular disease. Aids circulation and reduces clotting tendencies. Prevent bruising and promote healing.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 TabsVitamin E Start with 200-400 IU daily and increase slowly to 1,600 IU daily. If you have a clotting disorder or high blood pressure, start with 100 IU and increase slowly to 400 IU daily. Consult your health care provider if you are taking anticoagulant medication. Thins the blood and reduces platelet "stickiness". Strengthens the immune system and heart muscle, improves circulation, and destroys free radicals. Use d-alpha-tocopherol form. Emulsion form is recommended for easier assimilation and greater safety at high doses. Caution: Use this supplement only under the supervision of a health care provider.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 SoftgelsVery Important Bio-Cardiozyme Forte As directed on label. A complex that strengthens the heart muscle. Cardio Logic
From WakunagaAs directed on label. Increases the oxygenation of heart tissue. Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Aids in healing of ulcers and boosts immune function. Needed to maintain proper concentration of vitamin E in the body. Use zinc gluconate lozenges or OptiZinc for best absorption.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps,Helpful Advanced Carotenoid Complex
(Solgar)As directed on label. Contains antioxidants, immune enhancers, free radical scavengers, potential cancer fighters, and heart disease protectors. Body Essential Silica Gel
(Nature Works)As directed on label. Good for healing of veins and skin tissues. Body Language Super Antioxidant
(Oxyfresh)As directed on label. Protects the body from free radical damage, environmental stresses and pollutants.
Oxyfresh Products - Super Antioxidant
Antioxidant Supplement, Vegetarian, Herbal Remedies USA, 60 LiquidVCaps
This super antioxidant supplement combination is a cut above the rest with the antioxidant power of acai, goji, mangosteen and pomegranate.
Orchard Fruits, Vegetarian, Fruit Supplement, Super Antioxidant Activity, Nature's Way, 60 VCaps,
Garden Veggies, Vegetable Supplement, Super Antioxidant Activity, Nature's Way, 60 VCaps,
Lycopene Super Antioxidant Supplement, Nature's Way, 5 mg, 60 Softgels
Vitamin B Complex As directed on label. Speeds healing time and aids all bodily functions. B vitamins work best when taken together.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Liquid Yeast B Complex, Twinlab, 16 Fl oz.,
Vitamin B=50 Complex, W/ Coenzyme B-2, Nature's Way, 330 mg, 100 Caps,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
CIRCULATORY PROBLEMS SUPPLEMENTS & PRODUCTS
Information, supplements and products for Circulatory problems occur when the journey of oxygenated blood through the body is interrupted. Consult with your health care provider before taking supplements. Some supplements may not be compatible with prescribed medications.
Alive! Whole Food Energizer, Multi-Vitamin With Mineral, Nature's Way, 18 mg of Iron Added, 90 Tabs
Nature's Way Alive multi-vitamin with mineral is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands. No other supplement contains more life-giving nutrients than Alive, which is just the way it will make you feel.Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.
Barlean's Flax Oil contains 25% more lignan bearing flax particulate than competing brands. Barlean's Flax Oil is one of the Nation's Top-10 Best Selling Health Products.B-Stress Vitamin Complex With Siberian Eleuthrero (Siberian Ginseng), Nature's Way, 100 Caps
If you are looking for herbal stress relief, you will find B-Stress Vitamin Complex with Siberian Eleuthero, formerly Siberian Ginseng Root to be just what you are looking for.Cellfood Liquid Multi-Vitamin, 100% RDA Spray, 1 fl. oz.
Cellfood Liquid Multi-Vitamin has an absorption and assimilation rate of almost 20 times more than vitamin pill supplementation.Cholesterol Guard Herbal Tea, 20 Tea Bags
A caffeine free Herbal Tea designed to disperse stagnant blood, soften and dilate blood vessels, to maintain healthy cholesterol level and normal blood pressure.Coronary Ease For Heart Health, TCM Formula, Danshen Shuxion, 500 mg, 60 Caps
Made of extracts from red sage root, notoginseng root with rosewood oil, this well-known formula is used in traditional Chinese medicine to maintain regular heart beat and coronary health.Evening Primrose Oil, Cold Pressed, Nature's Way, 500 mg, 250 Softgels
Nature's Way EFA Gold is the highest quality Evening Primrose Oil - guaranteed to contain 10% gamma-linolenic acid (GLA).Folic Acid (Vitamin B-9), 100% Natural, Nature's Way, 800 mcg, 100 Caps
Nature's Way Folic Acid is 100% natural and contains no artificial ingredients or preservatives.Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Garlic oil is often used to soothe the ear and as an antibiotic but most often used as a food and herb and also to lower serum cholesterol and blood pressure and to improve circulation as well as possibly inhibiting the growth of ulcer causing bacteria.Ginkgold, Ginkgo Biloba Extract, Nature's Way, Vegetarian Standardized, 60 mg, 150 Tabs
Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.Heart Formula With Hawthorn CoQ10 & Vitamin E, Nature's Way, 60 Caps
Heart Formula with Hawthorn CoQ10 & Vitamin E represents the powerful synergy of current scientific research and traditional herbal medicine. Key ingredients include Hawthorn Extract, CoQ10, and Natural Vitamin E.Lecithin Concentrate, Nature's Way, 400 mg, 100 Softgels
Nature's Way Lecithin Supplement is 100% natural from soy oil and it contains no artificial ingredients or preservatives.Nattokinase for Circulatory Health, Vegetarian, NOW Foods, 100 mg, 60 VCaps
Natto has been consumed safely for thousands of years for its numerous health benefits. More recently, both clinical and non-clinical studies have demonstrated that Nattokinase supports heart health and promotes healthy circulation.PlasminPlus Thrombolytic, 250 mg, 36 Caps
In China, Plasmin Plus Thrombolytic is used for stroke victims that have suffered paralysis or brain damage, blood clots in the legs and brain, poor circulation, clogged arteries, and to prevent thrombosis associated with airline travel.Selenium, 100% Natural, 200 mcg, 100 Caps
Selenium is an essential component of glutathione, the body's most potent natural antioxidant system. It is a popular choice in many antioxidant regimens.Vitamin A, Nature's Way, 100% Natural, 10,000 IU, 100 Softgels
Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-100 Complex With Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
A complete Vitamin B complex of 8 essential vitamins. B Vitamins are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.
Vitamin B-12 Helps to maintain a healthy nervous system, and helps in the prevention of pernicious anemia. Folic Acid should be taken by all females of child bearing age to help prevent neuro-tube birth defects. Folic acid is also linked to heart health.Vitamin C 500 With Bioflavonoids, Nature's Way, 100% Natural, 500 mg, 250 Caps
Vitamin C 500 With Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin E (D-Alpha-Tocopheryl Acetate), 100% Natural, NOW Foods, 400 IU, 250 Softgels
Vitamin E is a major antioxidant and the primary defense against lipid peroxidation. It is particularly important in protecting the body's cells from free radical/oxidative damage.
Herbal Remedies: Stroke Information
Herbal Remedies: Stroke Supplements & Products
Herbal Remedies: Heart Attack / Myocardial Infarction Supplements & Products
Herbal Remedies: Heart Disease / Cardiovascular Disease Supplements & Products
Herbal Remedies: Leg Ulcers Supplements & Products
CONTACTING MEDICAL CARE
See your health care provider if you have a red, swollen or tender vein - especially if you have one or more risk factors for thrombophlebitis, such as being inactive for a long period of time or a family history of the clotting disorder. If vein swelling and pain are severe or occur with a high fever or shortness of breath, go to an emergency room. These signs and symptoms may indicate deep vein thrombosis, which increases your risk of a dislodged blood clot traveling through your veins to your lungs.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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