The Simplified Elyria Medica

Chapter 2

MEDICINAL AND POISONOUS INGREDIENTS

Animal Based Ingredients:

Ambergris Physter catodom:

Uses: When aged, ambergris has a sweet earthy scent and can be used in ointments, creams, lincti and perfumes.

Beaver Castor fiber:

Uses: Beaver was consumed to treat eye, brain and nerve diseases. It was also believed to be an aphrodisiac.

Fish Oil and Omega-3:

Cod or shark liver:High in vitamin A (risk in pregnancy) and D

Tuna, salmon and cod body:High in omega 3 fatty acids, DHA and EPA.

Therapeutic uses: Anti-inflammatory, blood clots prevention to prevent, heart attack and stroke, reduce triglyceride and cholesterol levels, reduce high blood pressure and treat rheumatoid arthritis.

Side effects: Heart burn, diarrhoea, bad breathe and increased risk of bleeding in susceptible individuals.

Honey:

Uses: On wounds as an antiseptic and promote healing. It was also used in lincti to treat a cough.

Molluscs Strombidae and Muricidae:

Biome (tribe):Found: All over the world, but typically in tropical and subtropical waters.

Side effects, toxicity and poison uses: The toxins from sea snails, cone shells and conch like were used as poisons. They were also used to treat seizures/epilepsy and pain in smaller doses.

Musk:

Therapeutic uses: The secretory glands from deer (Musk) were used in perfumes and as an aphrodisiac. Similar scents can be found in flora as well.

Pearl: Pinctada margaritifera:

Therapeutic uses: Treatment of eye disorders and depression

Toxins and venoms:

From any and all venomous or toxic creatures could be used therapeutically or as a poison based on the different types of effects listed in the overview.

Wax Cera Alba:

Therapeutic uses: Bees Wax is one of the ingredients used to make the base for creams and ointments, even today. It was also used for hair removal, wounds and skin conditions.

Inorganic Ingredients:

Alum: (AM(SO4)2, A = potassium or ammonium and M = aluminium or chromium.

Therapeutic uses: Alum was used to stop bleeding and inflammatory skin conditions. It was also used widely in tanning, cosmetics and in aftershave.

Arsenic

Therapeutic uses: Arsenic was widely used as a poison for human and vermin. It was also misused for its mild hallucinogenic properties which resulted in many fatal overdoses. It was also used to treat necrotic skin lesions and used in toothpaste to treat mouth ulcers, gum disease and tooth decay.

Bezoar stone

Therapeutic uses: General treatment for poisoning

Borax

Biome (tribe): Borax is an inorganic mineral often mined in arid climates (The Waerd and Erishe)

Therapeutic uses: It is a highly toxic substance, often used as a pesticide and poison. It was used as an antiseptic for cuts, bites, stings and wounds. It has also been used (and still is in certain circumstances) as a treatment for gynaecological infections such as yeast infections.

Copper and Cuprite

Therapeutic uses: The treatment of eye diseases

Haematite Also known as bloodstone and Rubrica sinopica [Fe2O3]

A black-grey and red-veined mineral containing about 70% iron.

Therapeutic uses: It was sometimes used as part of treatment for anaemia, especially due to blood loss and traumatic injury

Lapis Lazuli

Therapeutic uses: The treatment of hallucinations and psychiatric illness

Lead (white) compounds PbCO3 and Pb(OH)2

Therapeutic uses: In powder form or incorporated in to creams and ointments to treat skin itch

Mercury

Therapeutic uses: Used topically to kill parasitic skin infestations such as lice and fleas.

Potash (Potassium/Sodium Carbonate): K2CO3 and Na2CO3

Therapeutic uses: Treating dental problems, including toothache.

Salt

Therapeutic uses: Teeth cleaning and treating dental problems. It was also used as an antiseptic and as a purgative (induces both vomiting and diarrhoea).

Silver

Therapeutic uses: Topically as a powder and/or in creams as an antiseptic and mouthwash.

Sulphur

Therapeutic uses: In powder form or in a cream to treat skin itch, as an antiseptic and antibacterial and also to treat bites and stings.

Zinc

Therapeutic uses: In powder form or in creams to treat skin itch and skin infestations.

Plant Based Ingredients:

Adonis species:

Biome (tribe): Found in most places.

Therapeutic uses: Treating heart conditions, as a diuretic and for depression.

Poison uses: It can cause heart attacks, heart failure and cardiac arrest.

Almond: Amygdalus communis or Prunus amygdalus:

Biome (tribe): Originally found in subtropical, arid and semi-arid regions (The Waerd and Erishe), they later spread to most places.

Therapeutic uses: Sweet and Bitter Almonds have been used historically to treat migraines and eye ailments in seed form and oil form.

Sweet almond seeds have been used to treat fever, for pain relief (usually in combination with other ingredients). Sweet almond oil has been used as an aphrodisiac, a laxative (hopefully not at the same time), as a skin moisturiser and to treat inflammatory and infective skin conditions such as dermatitis and boils.

Bitter almond was used to treat gastrointestinal disorders, urogenital and gynaecological disorders of all kinds, including bladder and kidney stones, impotence, menstrual cramps.

Poison uses: Bitter almonds have approximately 50% of the oil content of sweet almonds and contain about 40 times the amount of cyanide compared to sweet almonds. An adult would need to ingest the equivalent of approximate 50 bitter almonds for a fatal dose of cyanide, where-as a child would only need to ingest 5 to 10.

Cyanide Poisoning: Mild to moderate toxicity includes nausea, vomiting, headache, weakness, confusion, dizziness and shortness of breath. Severe toxicity includes coma, respiratory failure, low blood pressure, seizures, and arrhythmias.

Aloe: Aloe sp:

Biome (tribe): Typically found in tropical regions (Janoa, To’resk)

Therapeutic uses: Used topically on the skin for wounds, eye and skin conditions.

Anamirta cocculus (seeds):

Biome (tribe): Found mostly in tropical regions (Janoa, To’resk, Dras)

Therapeutic uses: The picotoxin contained in the seeds can be used as an antidote to narcotic overdoses, such as barbiturates like sodium pentothal (truth serum) or phenobarbital, benzodiazepines like Valium/Diazepam, opioids like morphine. Abuse or recreational use: The seeds contain CNS stimulant chemicals which were abused to produce a “high” and giddy effect similar to being intoxicated with alcohol (yes, alcohol is a CNS depressant not stimulant).

Anise and liquorice: Pimpinella anisum (Apiaceae):

Biome (tribe): Typically found in tropical, semi-arid and arid regions (Janoa, To’resk, The Waerd)

Therapeutic uses: It is a common ingredient used to treat colic, stomach discomfort and gas. Historically these properties were often used for the treatment of dysentery.

Asphodel Asphodelus aestivus:

Biome (tribe): Mostly found in tropical, semi-arid and arid regions (Janoa, To’resk, The Waerd and Erishe).

Therapeutic uses: Historically used to treat chest pain associated with the heart and/or lungs. It was also be used to treat general joint aches and pains.

Astragalus: Astragalus membranous (root), Astragalus spp. Huangqi:

Biome (tribe): Mostly found in temperate and semi-arid regions (Neran, Kypiq, The Waerd)

Therapeutic uses: Historically astragalus has been used as an immune booster to treat cold and flu, hepatitis and cancer.

Side effects and toxicity: It has potentially many and varied side effects. It is believed to reduce the effectiveness of immunosuppressant drugs and make associated conditions such as Rheumatoid Arthritis, Inflammatory Bowel Disease, Lupus Erythematosus and Multiple Sclerosis etc., worse.

Autumn crocus, Meadow Saffron or Naked lady Colchicum autumnale:

Biome (tribe): Found in temperate regions (Neran, To’resk, Kypiq)

Therapeutic uses: The source of the drug colchicine used to treat gout, Mediterranean fever and pericarditis by modifying the immune response.

Side effects and toxicity: The most common side effect of autumn crocus (colchicine) is vomiting and diarrhoea, but it can also be a very toxic poison.

Poison uses: It damages the kidneys and liver, nerves and muscles causing seizures, muscle breakdown (rhabdomyolysis), respiratory failure and suppresses the immune system.

Autumn Skullcap Galerina marginate:

Has the same distribution and toxin as Death Cap mushroom. See Death Cap Mushroom

Balm Melissa officinalis:

Biome (tribe): Found in temperate regions (Neran, Kypiq, maybe To’resk)

Therapeutic uses: Historically used to treat anxiety, depression and psychotic illness.

Balm of Gilead Commiphora gileadensis:

Biome (tribe): Found in semi-arid and arid regions (The Waerd and Erishe)

Therapeutic uses: Historically used to treat seizures and heart conditions.

Bamboo: Bambusa vulgaris:

Biome (tribe): Found in tropical regions (Janoa, To’resk, Dras).

Therapeutic uses: Containing a large amount of silica, bamboo was burned as part of the extraction process for chalk. Chalk was historically and is still a common ingredient used in toothpaste. It was also used to relieve digestive distress associated with heart burn, reflux and diarrhoea, including dysentery.

The chalk powder/ash could also be used topically treat skin conditions especially itch.

Basil: Ocimum basilicum:

Biome (tribe): Found in dry, warm temperate and subtropical regions. (Neran, Kypiq)

Therapeutic uses: Basil has been used during medieval times to treat depression, scorpion stings and inflammation such as in creams and ointments for rheumatoid arthritis. It is also found with anise in colic remedies.

Some cultures used it as a calming agent for anxiety, nervousness and to aid sleep.

Ben tree Moringa peregrina:

Biome (tribe): Found in tropical and subtropical regions (Neran, Janoa, To’resk, Kypiq)

Therapeutic uses: To stop bleeding and haemorrhaging

Bilberry: Vaccinium myrtillus:

Biome (tribe): Found in temperate, mountainous and alpine regions away from the sea (Neran, Kypiq, Hrothi, Brudvir) Therapeutic uses: Bilberry has historically been used to treat night blindness and vision loss associated with diabetic retinopathy. It is believed to increase blood circulation so may have benefits in people with poor circulation and conditions such as Reynaud’s Phenomenon.

Could this help tribes who are not used to cold climates?

It has been known to increase the risk of bleeding by reducing the ability of the blood to clot.

Bilberry is unsafe for use in pregnancy as it strongly stimulates uterine contractions.

Birthwort: Aristolochia species:

Biome: Found almost everywhere

Therapeutic uses: Historically used as a non-specific antidote to some poisons with variable effectiveness. It was also used to ease nausea associated with pregnancy and ease childbirth, urinary tract infections and menstrual cramps.

Black Cohosh: Cimicifuga racemosa:

Biome (tribe): Found in temperate and cooler climates (Neran, Hrothi, Brudvir, Kypiq)

Historically Black Cohosh has been used to treat symptoms of menopause and menstrual cramps.

While not carcinogenic, it may worsen certain types of breast and ovarian cancer. It is also considered hepatotoxic (damaging to the liver) to some individuals.

Black Cohosh may cause nausea, vomiting, dizziness and weight gain.

Black Cohosh also reduces the metabolism of many other drugs/compounds so may increase their efficacy, side effects and toxicity.

Black Nightshade Solanum nigrum:

Biome (tribe): Primarily found in wooded areas (Brudvir, Janoa, Kypiq)

Poison uses: Berries contain a toxic chemical that is toxic to the cardiovascular system and CNS (central nervous system), resulting in nausea, flushing, confusion, hallucinations, delirium, paralysis, coma, cardiac arrhythmias and respiratory failure.

Borage Anchusa species:

Biome (tribe): Found almost anywhere.

Therapeutic uses: Historically used to treat hallucinations, depression, mania and psychotic symptoms.

Buttercup:

Clematis napaulensis:

Biome (tribe): Found in mountainous regions (Hrothi, Brudvir and Yoru).

Therapeutic uses: May be used to treat kidney disorders, including kidney stones.

Clematis orientalis:

Biome (tribe): Found in sunny areas of scrubland and forests near water, arid and semi-arid areas (Neran, Kypiq, Waerd and Erishe).

Poison uses: It can cause, nausea, vomiting, dizziness, muscle spasms, paralysis and damage to the liver.

Calabar Bean Physostigma venenosum:

Biome (tribe): Tropical regions (Janoa, To’resk, Dras)

Uses: See Resurrection lily.

Camphor: Cinnamomum camphora:

Biome (tribe): Predominantly found in tropical regions (Janoa, To’resk).

Therapeutic uses: Preparations containing camphor (and invariably menthol as well) have been and are still widely used to treat the symptoms of the common cold and skin rashes including itch. Camphor has also been used historically to treat malaria, typhoid and general aches, pains, sore joints and muscles aches and pains.

Menthol and camphor are some of the most common ingredients in Vicks® products and many “heat” creams, ointments and liniments, along with various salicylate derivatives (see Willow). When applied vigorously, camphor produces a warming sensation to the area, while producing a cooling effect when applied gently.

Side effects and toxicity: In large doses, including on the skin, camphor is toxic causing seizures, rapid and/or irregular heart rhythm and muscle cramps/spasms.

Cannabis Cannabis sativa var. indica:

Biome (tribe): Found all over Kypiq forests because they are little stoners! (Jokes). With 12 to 13 hours of sunlight each day, it can grow almost anywhere and is well suited to wet environments (Neran, Kypiq, Janoa, To’resk, Dras, Brudvir)

Therapeutic uses: Cannabis has been and is once again beginning to be used as a treatment for pain, seizures and eye conditions such as glaucoma.

Side effects and toxicity: blurred vision, hallucinations, increased appetite (munchies), amnesia, drowsiness, mood changes and psychosis.

Cerbera odallum species:

Biome (tribe): Primary found in swamps and marshy areas (Dras and To’resk).

Poison uses: A very toxic plant, whose poison can stop the heart by blocking calcium channels.

Chamomile: Matricaria recutita:

Biome (tribe): Typically found in temperate areas (Neran, Kypiq, To’resk).

Therapeutic uses: Historically used in creams and ointments to produce a localised anti-inflammatory effect. When ingested, in teas and oral liquids, it has also been used to aid sleep and reduce stomach cramps.

Christ’s thorn jujube Ziziphus spina-christi:

Biome (tribe): Found in tropical, temperate, semi-arid and arid (Neran, Janoa, To’resk, Kypiq, The Waerd, Erishe)

Therapeutic uses: Historically used to treat bee and wasp stings

Cinchona bark, Jesuits’ bark or Peruvian Bark Cinchona sp (Cinchonoideae)

Biome (tribe): Found in tropical areas (Janoa, To’resk, Dras)

Uses: The bark and its extracts Quinine and Quinidine can be used as treatment and prevention of Malaria (Quinine), night time muscle cramps (Quinine) and as an anti-arrhythmic agent (Quinidine)

Side effects and toxicity: blurred vision, sensitivity to sunlight, and other visual disturbances, angina (chest pain), slow–type heart arrhythmias, immune-mediated severe skin rashes and sunlight sensitivity (severe sunburning), liver toxicity and hepatitis, multiple blood disorders and dysfunction of the red blood cells, platelets and white blood cells/immune cells.

Citrus fruits:

Biomes (tribes): Found in tropical and subtropical regions (Janoa, To’resk)

Therapeutic uses: Historically used to prevent scurvy and infection on long sea voyages. Also used to treat colds and flu

Clove: Eugenia caryophyllat:

Biome (tribe): Found in tropical regions (Janoa, To’resk, Dras)

Therapeutic uses: Historically used as a topical anaesthetic particularly for tooth ache and mouth ulcers. Also used in inhalants to treat symptoms associated with cough and cold.

Claviceps purpurea, Clitocybe dealbata, Clitocybe rivulosa and Conocybe filaris (Pholiotina rugosa) mushrooms:

Biome (tribe): Found in grasslands (Neran)

Side effects, toxicity and Poison use: The Clitocybe species have a poison similar to Wolf’s Bane: See Wolf’s Bane

Conocybe contain a poison similar to Death Cap Mushroom. See Death Cap Mushroom

Claviceps contains an ergotamine like substance which is a hallucinogenic similar to the psychedelic drug Lysergic acid diethylamide (LSD, acid or “trips”). Ergotamine has been found to be effective in the treatment and prevention of migraines and depression.

Cornelian cherry Cornus mas:

Biome (tribe): Found in temperate regions (Neran, Kypiq)

Therapeutic uses: Historically used as a generalised antidote to poisoning

Costus Costus speciosus:

Biome (tribe): Found in wet, tropical, forested areas (Janoa, Kypiq, Dras)

Therapeutic uses: Treatment for seizures and epilepsy

Cranberry: Vaccinium macrocarpon:

Biome (tribe): Found in temperate, cool temperate and higher altitude regions (Neran, Kypiq, Brudvir, Hrothi)

Therapeutic uses: Historically used to treat and prevent scurvy on long sea voyages. It has also been used to treat and/or prevent urinary tract infections.

Excessive intake may result in diarrhoea, kidney stones and increased risk of bleeding in susceptible individuals.

Deadly Nightshade Atropa belladonna:

Biome (tribe): Found in temperate regions (Neran, Kypiq)

Therapeutic uses: Historically used to treat pain, muscle spasms and cramps, motions sickness/vertigo, dangerously slow heartbeat, runny nose and insomnia

Side effects, toxicity and poison uses: Deadly Nightshade is associated with blurred vision, dilated pupils and light sensitivity, rapid and irregular heartbeat, dry mouth, confusion, hallucinations, delirium and seizures.

Possible antidote for: Calabar Bean, Resurrection lily, Strychnine and Wolf’s Bane. These may also be possible antidotes to Deadly Nightshade poisoning.

Death Cap Mushroom Amanita phalloides:

Biome (tribe): Found in almost any wooded or forest region (Kypiq, Janoa, Brudvir)

Side effects, toxicity and poison use: Known as one of the most poisonous “toadstools”. The toxins are heat and cold stable so unaffected by cooking or freezing. They typically cause stomach upset and cramps, followed by in no particular order delirium, rapid heart rate, kidney failure, liver failure, heart failure/cardiac arrest.

There is no known cure, especially not in a medieval age, where victims/survivors invariably need liver and/or kidney transplants.

Destroying Angel’s Mushroom or other Death Cap mushrooms Aminata species: (11 species)

Similar biome and toxin to Death Cap Mushroom; See Death Cap Mushroom.

Devil’s claw: Harpagophytum procumbens:

Biome (tribe): Found in temperate, semi-arid and arid regions (Neran, The Waerd and Erishe)

Therapeutic uses: Devils’ claw has been used historically to treat various forms of musculoskeletal aches and pain, including osteoarthritis and gout.

Side effects and toxicity: It has been shown to increase stomach acidity and increase the risk of stomach or duodenal ulcers. In large doses it has been associated with potentially dangerous effects on the rhythm of the heart.

Devil’s claw may also increase the risk of bleeding by reducing the clotting action of the blood and has been shown to affect the metabolism of many other drugs, resulting in increased risk of side effects and toxicity.

Devil’s (or Angel’s) trumpet Datura metel:

Biome (tribe): Found in warm tropical regions (Janoa, To’resk, Dras)

Datura stramonium (another nightshade):

Biome (tribe): Found in temperate areas (Neran, Kypiq)

Uses, side effects and poison uses: Similar to Deadly Nightshade; See Deadly Nightshade.

Possible antidotes: Calabar Beans, Resurrection lily, Strychnine, Wolf’s Bane

Dragon’s blood Dracaena draco (Dracaenaceae):

Biome (tribe) Found in subtropical regions (Janoa, To’resk, Dras, Neran)

Therapeutic uses: Historically used to treat wounds and stop bleeding

Dong Quai/Tang-Kuei/Dang Gui: Radix angelicae sinensis (root):

Biome (tribe): Cool high altitude mountains (Brudvir, Hrothi)

Therapeutic uses: Dong Quai has been used historically to treat symptoms of menopause and other gynaecological conditions. It has also been used to treat pain, inflammation and cardiovascular conditions.

Dong Quai extract has a naturally occurring chemical (furocoumarins) similar to other phytocoumadin compounds like warfarin with potent anticoagulant effects. This increases the risk of severe bleeding especially when used together with other blood-thinning agents.

Poison uses: could be used to cause death by slow bleed over time, or massive haemorrhage.

Echinacea: Echinacea purpurea, E.angustifolia or E.pallida (herb):

Biome (tribe): Found in temperate and semi-arid (Neran, Kypiq, The Waerd)

Therapeutic uses: Typically used to treat the common cold, cough and other viral infections. Sometimes used on wounds, bites and stings.

Side effects and toxicity: Generally well tolerated; however, in patients with asthma, atopic dermatitis, allergies/hayfever and other immune mediated disorders such as rheumatoid arthritis, multiple sclerosis and lupus erythematosus there is a risk of worsening these conditions

Echinacea also affects the metabolism of many drugs, increasing their metabolism and thus decreasing their effectiveness.

Ephedra or Ma Huang ¬Ephedra sp (Ephedraceae):

Biome (tribe): Found widely across relatively dry climates, in scrub, dry river beds, on sandy shores and river banks and on the side of mountains and even tundra, but not tropical, wetlands or swamps. (Neran, Kypiq, Brudvir, Hrothi, The Waerd)

Therapeutic uses: A sympathomimetic that mimics the effects of adrenaline (epinephrine) and noradrenaline (norepinephrine) to increase heart rate, blood pressure, metabolic rate.

Side effects and toxicity: headaches, insomnia, agitation/aggression, high blood pressure, dizziness, heart palpitations and rapid arrhythmias, heart attack, stroke, worsening heart failure.

Poison uses: In high enough doses, could be used to cause a heart attack, haemorrhagic stroke, arrhythmia and cardiac arrest.

Erythroxylum coca var (coca and ipadu) and Erythroxylum novogranatense var (novogranatense and truxillense):

Biome (tribe): Found in tropical regions (Janoa, To’resk, Dras)

Therapeutic uses: Erythroxylum species are the primary source of cocaine. Long before it was abused recreationally; it was used topically in creams, ointments and mouthwashes as a local anaesthetic for the skin, eye and mouth. Could be used as an anaesthetic to relieve pain or prior to surgery.

Side effects, toxicity and poison use: In addition to its addictive nature and the sense of euphoria, it can cause agitation, hypertension (high blood pressure), tachycardia (rapid heart rate), arrhythmias, heart attack, cardiac arrest, seizures, stroke and depression (long term use and withdrawal)

Fennel: Foeniculum vulgare:

Biome (tribe): Found in most places

Therapeutic uses: One of the first known historical uses for fennel was as an antidote for some kinds of mushroom poisoning and snake bites. The severity of the poisoning or envenomation, and the effectiveness of fennel is unknown.

It was also believed to treat diseases of the brain, heart and liver, as well as being used for headaches and pain in general. It is another ingredient often used in colic remedies, to soothe crying baby.

Fenugreek Trigonella foenum-graecum (Fabaceae):

Biome (tribe): Found almost everywhere

Therapeutic uses: Ease stomach and digestive disorders and stimulates labour and lactation in new mothers.

Side effects, toxicity and poison use: It is generally well tolerated; however, it has the potential to significantly increase the risk of serious and potentially life-threatening bleeding due to coumarin-like compounds (warfarin) contained within.

Feverfew: Tanacetum parthenium (leaf):

Biome (tribe) Found almost everywhere

Therapeutic uses: Acute and chronic migraine treatment and prevention. Also general aches and pains and pain associated with arthritis.

Is known to increase the risk of bleeding in susceptible individuals, similar in severity to aspirin and willow bark, but not as severe as anticoagulants such as warfarin and other coumarin compounds.

Foxglove Digitalis purpurea and Digitalis lanata:¬

Biome (tribe): Digitalis purpurea is mostly found in temperate regions (Neran, Kypiq), while Digitalis lanata can be found in woodland and on the side of mountains (Hrothi, Brudvir)

Uses: The Foxglove plant contains several different cardiac glycosides which can be very toxic. Digitoxin and Digoxin are the most common. They typically work by slowing the heart rate but increasing the force of contraction which is why they are primarily used in heart failure and atrial fibrillation (top chambers of the heart of quivering/spasming and not pumping/contracting properly)

Side effects and toxicity: nausea, vomiting, dizziness, blurred vision, confusion, slow heart rate and arrhythmia.

Galbanum Ferula galbaniflua:

Biome (tribe): Mountain slopes (Hrothi, Brudvir)

Therapeutic uses: Historically used to treat mental illness

Garlic: Allium sativum (bulb; preparations include aged garlic extract, powder, oil);

Biome (tribe): Mostly everywhere

Therapeutic uses: Historical use includes prevention of cold and flu. It may also possibly treat high blood pressure, cholesterol, and reduce blood clots.

Side effects and toxicity: Generally well tolerated, but excessive doses may cause increased risk of bleeding similar to that of aspirin and willow bark. It has been known to worsen asthma and cause life threatening allergic reactions in susceptible individuals.

Ginger and Galangal: Zingiber officinale (Zingiberaceae):

Biome (tribes): Predominantly found in the tropics (Janoa, To’resk)

Therapeutic uses: A tonic for vitality, nausea and vomiting and as an aphrodisiac.

Side effects and toxicity: It is generally well tolerated, but may increase the risk of bleeding in susceptible individuals, similar to aspirin and willow bark extract.

Ginkgo Ginkgo biloba (leaf):

Biome (tribe): Found almost anywhere, best suited to moderately hot and summer environments.

Therapeutic uses: Ginkgo has been used historically to improved memory in dementia, prevention of vision loss, high blood pressure and treatment of tinnitus (ringing in the ears).

Side effects and toxicity: Generally well tolerated, it may cause gastrointestinal upset (stomach ache, nausea, diarrhoea) and increases the risk of bleeding similar to aspirin and willow bark extract in excessive doses.

It is also known to affect the metabolism of drugs in unpredictable ways (multiple metabolic enzymes, some increased, some decreased) resulting in potential therapeutic failure or toxicity.

Ginseng Panax ginseng (Asian or Korean ginseng) and Panax quinquefolius (American ginseng) (root):

Biome (tribe): Found in cooler climates (Hrothi, Brudvir)

Therapeutic uses: Historically used to enhance physical performance and cognitive function. Possibly used to treat diabetes and aid weight loss.

Side effects and toxicity: Generally well tolerated, but may cause insomnia, gastrointestinal upset, racing heart or palpitations, increased blood pressure and reduced appetite.

Guarana Paullinia cupana (seed):

Biome (tribe): Tropical (Janoa, To’resk, Dras)

Therapeutic uses: Historically used as a stimulant, weight loss aid and aphrodisiac.

Side effects and toxicity: Generally well tolerated but may cause insomnia, high blood pressure, and seizures with excessive doses.

Hawthorn Crataegus laevigata, C. monogyna or C. folium (berry, flower or leaf):

Biome (tribe): Found in temperate regions (Neran, Kypiq)

Therapeutic uses: May provide benefit in treating chronic heart failure and to improve heart and cardiovascular function

Side effects and toxicity: May cause dizziness, fainting, low blood pressure and cardiac arrhythmias.

Hellebore Helleborus niger and H. albus (Ranunuculaceae):

Biome (tribe): Wet, shady, cooler mountainous type areas are best (Hrothi, Brudvir)

Therapeutic uses: Has been used historically to treat seizures, mania and psychiatric disorders.

Hemlock Conium maculatum:

Biome (tribe): Found in temperate and subtropical regions near waterways (Neran, Kypiq, Janoa, Dras, To’resk)

Therapeutic uses: Has been used historically as a sedative and treatment for muscle spasms.

Side effects, toxicity and poison use: A HIGHLY toxic poison commonly used historically to kill by causing paralysis and CNS depression, leading to respiratory failure.

Possible antidotes: Calabar Bean, Resurrection lily, Strychnine and Wolf’s bane. Likewise Hemlock may potentially be used as an antidote for these poisons.

Henbane Hyoscyamus albus, Hyoscyamus niger:

Henbane is similar to Hemlock. See Hemlock

Hyssop Hyssopus officinalis (Lamiaceae):

Biome (tribe): Found in warm sunny, temperate, tropical and semi-arid environments (Neran, To’resk, The Waerd)

Therapeutic uses: Historically used to treat lung/chest infections, malaria, chronic coughs and as an antiseptic

Indian snakeroot or Devil pepper Rauvolfia serpentine:

Biome (tribe): Found in tropical regions, plains and foothills (Janoa, To’resk, Dras, maybe Neran and Hrothi as well)

Therapeutic uses: Two of the several major chemical extracts include Reserpine and Yohimbine. They may be used for insomnia, high blood pressure, chorea or hyper-movement disorders (Huntingtons chorea), migraine prevention and psychiatric illnesses including catatonia and severe refractory depression.

Yohimbine has also been used as an aphrodisiac.

Side effects, toxicity and poison use: Yohimbine as a poison has been associated with producing confusion, amnesia, short term paralysis and hallucinations

Don’t get the dose for poison and aphrodisiac mixed up or you might end up too confused, paralysed or just forget what you’re supposed to be doing.

Side effects and toxicity: nausea, vomiting, stomach ulcers, dizziness, angina (chest pain), fast and slow arrhythmias, seizures.

Iris Iris florentina L. or I. Mesopotamica (Iridaceae):

Biome (tribe): Found on sunny mountain slopes and steppe (Hrothi, Brudvir)

Therapeutic uses: Treatment of fevers, cough and cold, chest infections, wounds, colic and seizures.

Kava Piper methysticum (rhizome and root):

Biome (tribe): Tropical (Janoa, To’resk, Dras)

Therapeutic uses: Has been used historically to treat anxiety, insomnia and substance addiction.

Side effects and toxicity: It may cause blurred vision and other visual disturbances. In high enough doses it can cause temporary Parkinsonism like symptoms and movement impairment, increased risk of bleeding due to platelet dysfunction (blood won’t clot properly) and reduced immune system (susceptibility to infection) and liver failure resulting in death.

It strongly affects many other medications via metabolism causing reduced effectiveness.

Larkspur Delphinium brunonianum:

Biome (tribe): Found on stony mountain slopes and alpine areas (Hrothi, Brudvir, Yoru).

Side effects, toxicity and poison uses: It is a poison which can cause paralysis, cardiac arrest and respiratory failure.

Possible antidotes: Calabar Bean, Resurrection lily, Strychnine and Wolf’s bane; likewise Larkspur may be used as an antidote to these poisons.

Lavender Lavandula officinalis or Stoachas Lavandula stoechas (Lamiaceae):

Biome (tribe): Found in dry sunny environments (Neran, Kypiq, Hrothi, The Waerd)

Therapeutic uses: Has been used historically to treat migraines, hallucinations, possibly psychiatric illness and as an antiseptic. Some cultures used Lavender as a general antidote for poisons with unspecified effectiveness.

Desert Lavander (The Waerd and Erishe)

Therapeutic uses : Used to treat cold and flu, infections, breathing problems like asthma, and as a sedative for epilepsy, anxiety and insomnia.

Lepiota species mushroom (5 in total):

Similar to Death Cap; See Death Cap.

Mandrake Mandragora autumnalis:

Biome (tribe): Commonly found in subtropical, arid and semiarid areas (Janoa, Dras, To’resk, The Waerd, Erishe)

Therapeutic uses: Historically used to treat insanity and epilepsy, plus was used in creams topically to treat leprosy, and venomous bites and stings.

Side effects, toxicity and poison uses: A HIGHLY toxic poison (leaves) similar to Deadly Nightshade.

Possible antidotes: Calabar Bean, Resurrection lily, Strychnine and Wolf’s bane; likewise, Mandrake may be used as an antidote to these poisons.

Milk thistle or St Mary’s thistle Silybum marianum (seed):

Biome (tribe): Found in temperate regions (Neran, Kypiq)

Therapeutic uses: Has been used historically to treat liver disease and as an antidote to hepatotoxic (liver) poisons.

Mint Mentha species:

Biome (tribe): Found everywhere

Therapeutic uses: A variety of oils such as peppermint and spearmint in addition to menthol have been used particularly with camphor to treat symptoms of cold and flu through inhalation and work by opening nasal passages and the sinuses to relieve congestion. Menthol is also used in “Heat” creams and ointments with camphor and other ingredients.

Common thyme or Garden thyme Thymus vulgaris is a type of mint that is often used as an antiseptic, particularly in mouthwashes for dental infections. Side effects and toxicity: In some individuals, it is known to cause a rash.

Myrtle Myrtus communis:

Biome (tribe): Found in temperate, semi-arid and arid areas (Neran, Kypiq, The Waerd, Erishe)

Therapeutic uses: Historically used for pain and inflammation similar to Willow. It has also been used in creams, ointments and liniments to treat spider bites and may be beneficial for other venomous creatures.

Myrobalan (cherry plum) Terminalia species (arjuana, citrina, chebula, bellerica, emblica):

Biome (tribe) Found in tropical regions (Janoa, To’resk, Dras)

Therapeutic uses: Historically used to treat hallucinations, migraine, general pain and as an aphrodisiac. It could be used topically in creams and ointment to treat joint and muscle aches and pains.

Nerium Oleander:

Biome (tribe): Found in tropical, subtropical and semi-arid regions (Janoa, Dras and The Waerd)

Therapeutically it has a very narrow therapeutic window, meaning you get toxicity at the same or close to the dose that might be used therapeutically. It has a mechanism of action similar to foxglove and other cardiac glycosides. See Foxglove

Side effects, toxicity and poison uses: A poison that is toxic to the heart, potentially causing both fast and slow arrhythmias and cardiac arrest. Mortality is actually rare in adults, but in children and those susceptible to its effects (Brudvir) it can be lethal.

Except for Brudvir, Oleander might be a good non-lethal poison to incapacitate someone but not kill them..

Olive oil Olea europaea:

Biomes (tribe):Found almost anywhere but the extreme environments (NOT Yoru or Erishe).

Therapeutic uses: Used as an anti-inflammatory when ingested or used in a cream or ointment. It has also been used as a moisturiser when used in topical preparations

Opium poppy Papaver somniferum:

Biome (tribe) Found natively and best grown in temperate regions (Neran, Kypiq) but can be grown anywhere.

Therapeutic uses: Most opioid alkaloids are used to treatment for pain, anxiety, insomnia and cough; however, papaverine which comes from the same plant can be used as a smooth muscle relaxant to treat impotence, kidney and gallbladder stones, cardiovascular disease (blockage of heart blood vessels causing angina), cerebrovascular disease (blood vessel blockage that may lead to stroke), peripheral vascular disease (poor circulation)

Side effects and toxicity: Increased heart rate and blood pressure, skin itch, dizziness, drowsiness, headache, seizures and priapism (not as great as you might think)

Priapism could be reversed with Ephedra before irreversible damage occurs, but it may worsen other side effects… see Ephedra

Peony Paeonia species:

Biome (tribe): Found in temperate to alpine regions (Neran, Kypiq, Hrothi, Brudvir)

Therapeutic uses: Historically used to treat seizures and psychiatric illness

Pine resin Pinus species:

Biome (tribe): Mostly found in temperate to subarctic regions (Neran, Kypiq, Hrothi, Brudvir)

Therapeutic uses: Historically used to treat a cough in liquid form and is still used in creams and ointments as a moisturiser and to treat skin conditions particularly itch, inflammatory skin conditions and also wounds.

Podostroma cornu-damae

Biome (tribe): Found in mountainous alpine and subarctic regions (Hrothi, Brudvir, Yoru)

Side effects, toxicity and poison uses: Although a different toxin, it has a similar effect to the Death Cap Mushroom; See Death Cap Mushroom.

Polypody Polypodium vulgare:

Biome (tribe): Mostly found in temperate (Neran, Kypiq)

Therapeutic uses: Historically used treatment of hallucinations and psychiatric illness

Red-behen (sea-lavender) Statice limonium:

Biome (tribe): Found in temperate, tropical and wetlands (Neran, Kypiq, Janoa, To’resk, Dras)

Therapeutic uses: Historically used to treat heart conditions and enhance male virility.

Resurrection lily Lycoris squamigera:

Biome (tribe): Found in tropical and subtropical regions (Janoa, To’resk, Dras)

Therapeutic uses: Prolongs and potentiates the effects of acetylcholine by blocking its metabolic breakdown by acetylcholinesterase. It is used in Dementia to improve memory and cognitive function. It could also be used to treat eye conditions such as glaucoma and conditions of muscle wasting/weakness such as myasthenia gravis.

Side effects, toxicity and poison use: May cause, nausea, vomiting, diarrhoea, profuse sweating, stomach ulcer, dizziness, headache, muscle cramps and twitching, bradycardia (slow heart rate) and seizures.

Possible antidote for: Deadly Nightshade, Devil’s or Angel’s trumpet, Mandrake poisoning and possibly Henbane and Hemlock which are similar

Rhododendron aberconwayi:

Biome (tribe): Found in high mountainous areas (Hrothi, Yoru)

Side effects, toxicity and poison uses: A poison that can cause hallucinations, haemorrhaging, liver and kidney failure

Safflower Carthamus tinctorius:

Biome (tribe): Found in arid and Semi-arid (Erishe and The Waerd)

Therapeutic uses: has been used historically to treat some forms of poisonings and gynaecological and genitourinary conditions (kidneys, bladder and female reproduction organs).

Salep orchis species:

Biome (tribe): Found in temperate regions (Neran, Kypiq).

Therapeutic uses: An antidote to some poisons and treatment of sexually transmitted diseases.

Sea squill Urginea maritima:

Biome (tribe): Found anywhere except arid and semi-arid (Not The Waerd or Erishe)

Therapeutic uses: Historically used to treat heart conditions such as heart failure, or arrhythmia, kidney and bladder conditions.

Sedge (coconut grass) Cyperus Longus:

Biome (tribe): Found in wetlands and on the edge of lakes and rivers in other biomes (To’resk, Dras)

Therapeutic uses: Treatment of heart conditions, including palpitations, arrhythmias, kidney and bladder conditions.

Skullcap Scutellaria lateriflora (leaf):

Biome (tribe): Found in wetlands (To’resk, The Waerd)

Therapeutic uses: Historically used to treat anxiety, insomnia and epilepsy. It may cause giddiness and in excessive doses, stupor, confusion, delirium and coma.

NOT TO BE CONFUSED with the HIGHLY toxic Germander Teucrium species (they look alike) which will certainly result in liver failure and death.

St John's wort Hypericum perforatum (herb):

Biome (tribe): Found in temperate and tropical regions (Janoa, Neran, Kypiq, To’resk, Dras)

Therapeutic uses: Predominantly used to treat depression and anxiety, but also used as an anti-inflammatory.

Side effects and toxicity: It affects the metabolism of just about every other drug known to Mann, reducing their effectiveness potentially resulting in treatment failure.

It also adds to the cumulative effectiveness and toxicity of other antidepressants and similar acting drugs used in the treatment of migraines, Parkinson’s disease and some pain killers.

It may cause restlessness, mania, muscle twitches, insomnia and in extreme cases agitation, aggression and hyperthermia.

Staphisagria (lousewort) Delphinium staphisagria (Ranunculaceae):

Biome (tribe) Found in temperate to semi-arid regions (Neran, Kypiq, The Waerd)

Therapeutic uses: Treatment of skin infections and infestations.

Strychnine tree Strychnos nux-vomica:

Biome (tribe): Found in tropical regions (Janoa, To’resk, Dras)

Side effects, toxicity and poison uses: Strychnine is a potent and highly toxic CNS stimulant. Typically produces seizures, muscle spasms and twitching, tonic-clonic seizures, arrhythmias, coma and death; however, since the brain and CNS are linked to everything, you can probably name it, and it will potentially cause that too.

Antidote: sedatives and supportive treatment to counteract any adverse effects that arise. Possibilities include: Deadly Nightshade, Devil’s or Angel’s trumpet, Mandrake and possibly Henbane and Hemlock.

Sweet basil Ocimum basilicum var. pilosum:

Biome (tribe): Found in tropical regions (Janoa, To’resk, Dras)

Therapeutic uses: Historically used to treat heart conditions and nasal/sinus obstruction in cold and flu.

Tar made from the resins of pine, cedar and cypress trees:

Used for inflammatory skin conditions and skin itch; see pine resin.

Tea tree Melaleuca alternifolia (oil from leaf and branch):

Biome (tribe): Temperate and wetland areas, near rivers, streams and lakes (Neran, To’resk, Dras).

Endemic to Australia (pronounced Os-trar-ya in the native language, some bizarre mixed dialect of Tropical, Wetland and Desert locally called “Bogun”).

Therapeutic uses: Historically used as a mild antiseptic for skin infections, tinea, dandruff, acne, drop bear bites, great white associated limb amputation, croc-wrestling sprains, VB and/or goon induced cuts, bumps and abrasions.

Translation in to Proto-Neran

Drop bears = Koala bear

VB = Victoria Bitter: The finest lager you will find when the fridge is empty, the bottle-o is closed; you’re out of money and stranded in the middle of the Gibson Desert. A lager, fit for a penal colony (that’s penal not penile) and tastes just like it has been pre-drunk and physiologically recycled, then brewed again with old sweaty gym socks and jock straps

Goon = the cheapest, nastiest, box/cask wine or moonshine you can get your hands on

Bottle-o = the local purveyor of alcoholic beverages

Ok back to the being serious….

Tragacanth Astragalus gummifer:

Biome (tribe): Found in temperate, subalpine, highlands and desert with low water supply and full sunlight (Neran, Hrothi, Brudvir, The Waerd, Erishe)

Therapeutic uses: Used in modern pharmaceutics as an emulsifier and thickening agent in suspensions, syrups, and creams etc. it has also been used historically to soothe wounds and burns.

Tribulus Tribulus terrestris (leaf):

Biome (tribe): Found natively in warm temperate and tropical regions, but can survive in almost any environment (Neran, Kypiq, Janoa)

Therapeutic uses: Has been used for enhanced athletic performance, libido and impotence.

Side effects: Lots of babies and exhausted partner

Valerian Valeriana officinalis (root and rhizome):

Biome (tribe): Found in practically any environment except extreme heat (Not The Waerd or Erishe)

Therapeutic uses: It has been used to treat insomnia, anxiety, pain and seizures.

Velvet Beans Mucuna pruriens:

Biome (tribe): Found in tropical regions (Janoa, To’resk, Dras)

Therapeutic uses: Containing a relatively large amount of L-Dopa, it has been used to treat Parkinson’s disease.

Side effects and toxicity: nausea and vomiting are common. Can cause high blood pressure, arrhythmias, heart attack, mania, psychosis and stomach ulcers.

Webcaps Mushroom Cortinarius species:

Biome (tribe): Found in all over the world in wooded and forested regions (Kypiq, Janoa, Brudvir):

Side effects, toxicity and poison uses: Typically causes irreversible kidney damage, leading to kidney failure and death.

No Known antidote

White-behen Centaurea behen (Asteraceae):

Biome (tribe): Found in subtropical, semi-arid and arid highlands

Therapeutic uses: Historically used to treat heart conditions including palpitations and enhancing male virility.

Willow Salix spp. (Salicaceae) (bark):

Biome (tribe): Found in temperate, alpine and arctic regions (Neran, Kypiq, Hrothi, Brudvir, Yoru)

Therapeutic uses: Pain, fever and inflammation.

Side effects and toxicity: May cause stomach ulcers and increases the risk of bleeding. Salicylates have been associated with fatal immune reactions associated with Reye’s syndrome in children with a recent history of viral infection such as cold and flu. The age considered safe varies depending on jurisdiction (some say > 12 years, others > 18 years).

Wolf’s bane, monkshood, devil’s helmet or aconite (root) Aconitum balfourii, Aconitum chasmanthum, Aconitum falconeri, Aconitum ferox, Aconitum heterophyllum:

Biome (tribe): Found in temperate lowlands to alpine highlands (Neran, Kypiq, Brudvir, Hrothi, Yoru)

Therapeutic uses: Historically used in lower doses for pain and inflammation, as a sedative, anaesthetic, treatment for irregular heart rhythm and treatment of a dangerously abnormal rapid heart rate.

Side effects, toxicity and poison use: A HIGHLY cardiotoxic (damages the heart) and neurotoxic (damages the brain and nerves) poison that also causes significant skin irritation and damage (contact dermatitis). Symptoms of poisoning include abnormal heart rhythm and slow heart rate, seizures, paralysis, coma and any number of heart and nervous system related conditions.

Possible antidote to: Deadly Nightshade, Devil’s or Angel’s trumpet, Mandrake poisoning and possibly Henbane and Hemlock which are similar.

Wormwood Artemisia species:

Biome (tribe): Mostly found in tropical and subtropical, arid and semiarid areas (Janoa, To’resk, Dras, The Waerd, Erishe).

Therapeutic uses: It has been used historically to stop bleeding, as an antiseptic and to cures paralysis.

Yew Taxus baccata:

Biome (tribe): Found in wooded areas within a variety of regions, but intolerant to poor-drainage and excessive water. (Neran, Kypiq, Hrothi, Brudvir).

Therapeutic uses: Historically used to treat heart problems, depression and cancer.

It could also be used as a poison, producing the highly toxic chemicals called “Taxanes”. In high enough doses, taxanes can cause nausea and vomiting, neurotoxicity, damaging the nerves and causing seizures, cardiotoxicity, damaging the heart to cause heart failure, arrhythmias involving irregular heart rate (speed) or rhythm (timing), damaging the lungs to cause respiratory failure and severe inflammatory skin reactions.

Chapter 3

Simplified Anatomy and Physiology

Physiology

Introduction

Like the previous chapters, the aim of this chapter is to convey the overall big picture on how the organs are interconnected and the way the body works as a whole without having to delve in to excessive amounts of detail that overshadow the big picture.

The jargon: In the absence of disease, damage or drug, the body exists in a natural state of balance known as homeostasis. Everything including endogenous substances (produced by and from within the body) and exogenous substances (introduced from outside the body), exists in the body within a certain concentration range deemed to be normal for an individuals’ specific circumstances. Furthermore the functioning or performance of each organ system may also be quantified by the concentration of these substances with regard to specific reference ranges, and also be considered normal for a persons’ individual circumstances.

The explanation: So what the hell does that mean? Simply put, everything is normal and how it should be BUT an isolated value for some laboratory test is meaningless without considering the specific circumstances surrounding the person from which the laboratory test was taken. Just because a result is high, low or normal means nothing if you know nothing about the situation.

Let me give you some examples. Would you consider it abnormal for someone to have a pulse/heart rate of 150 beats per minute? Many people might automatically say “Yes”. While they may be correct, they could also be completely wrong, depending on the circumstances! Why? So this “person” may have just had a massive fright, may be in severe pain, has just run the 200 metre sprint or perhaps this is a sleeping 2 week old baby! All of which might make this value fairly normal!

What if I said an individual had a resting heart rate of 32 beats per minute! Again, many people would rush in and say “WOAH!!! That’s dangerously low!!!” Truthfully, in 99.99% of cases you would be correct, but what if I said this was the resting heart rate of Lance Armstrong? Well, that would then be considered normal… It’s still amazing, but it is absolutely normal, for him due to his level of fitness and the strength of his heart.

So context is important…..

Heart and Blood

What does the heart do?

The heart pretty much does one thing and one thing only. It pumps blood around the body. It’s actually more like 4 pumps in 1, rather than just 1 big pump. There are two smaller chambered pumps (atria) at the top of the heart and two larger chambered pumps at the base of the heart (ventricles). The blood and blood vessels are like a river system used as trade routes for your body and organs so that the blood can transport and deliver essential nutrients, vitamins, electrolytes, energy/fuel and oxygen around the body to your organs. It is this system which is also used by medicines, other drugs, poisons, toxins and venoms etc., to deliver their effects to the appropriate (and sometimes inappropriate) places in the body.

The heart receives blood which has already made its oxygen delivery to the body in the right atrium, while it receives blood which has stocked up on oxygen from the lungs again in the left atrium. The right atrium squeezes the blood in to the right ventricle which then pumps the blood to the lungs once it is full. The left atria collects the blood once it has gathered oxygen from the lungs and squeezes it in to the left ventricle which then pumps it around to the rest of the body, via the aorta (a very large thick artery), once it is full.

What happens if the heart or blood doesn’t work properly?

The heart may accumulate damage over time and when forced to work harder than intended for longer than intended. When the heart is damaged over time by disease or suddenly by traumatic injury, the main result is that blood is not pumped as efficiently. This reduces the amount of blood and essential nutrients, vitamins, electrolytes, energy/fuel and oxygen being delivered to the organs. If the blood isn’t working properly then the amount of nutrients, vitamins, electrolytes, energy/fuel and oxygen able to be transported and deliver by the blood itself is reduced. While the heart can heal, the functional deficits experienced due to the damage may be permanent. Generally speaking, the lack of required nutrients, vitamins, electrolytes, energy/fuel and oxygen being delivered around the body produces a feeling or tiredness and fatigue (but so many other things can cause this feeling as well).

One of the typical signs and symptoms associated with damage to the heart is chest pain. It doesn’t necessarily mean that damage has occurred, but may be more like a child screaming when they don’t get what they want. Either way, it is a warning sign that the heart itself is not getting enough oxygen or energy required for functioning because blood carrying oxygen, nutrients and energy is being prevented from reaching the heart due to a clot and/or cholesterol blockage, the heart is not functioning properly and unable to pump the blood efficiently enough or the blood is not able to carry enough oxygen, nutrients and energy due to disease, damage or even blood loss!

Chest pain typically occurs with increased exercise or exertion resulting in an increase in oxygen and energy requirements. The less exertion required for the pain to occur, the more serious the situation AND if pain occurs while resting it is a VERY BAD sign!! If the pain does not go away particularly when resting and/or is not relieved by appropriate medication, you may be having a heart attack (myocardial infarction), which is where the heart muscle has actually started to die because it has been starved of the necessary oxygen and energy required to function.

When heart muscle dies, scar tissue typically forms at the site. This can lead to a disruption in the electrical currents through the heart muscle resulting in an irregular heart beat (arrhythmia). The heart may beat faster or slower (rate) and/or the chambers of the heart may begin pumping at inappropriate times (rhythm). Anything which results in the heart not beating at the correct rate or with the correct rhythm results in the blood not pumping efficiently. If the heart speeds up (tachycardia), the chambers of the heart do not have enough time to fill properly, pumping less blood with each beat. If the heart beats too slowly then the blood does not circulate fast enough and if the heart chambers pump at inappropriate times, it can disrupt the flow of the blood entirely

If the atria tremble rather than squeezing and relaxing properly, it is known as either atrial fibrillation or atrial flutter. This causes blood to pool inside the chamber rather than being pumped and can result in blood clots forming in the stagnant blood. If the clot is then pumped around the body, it may cause a blockage in the leg, a blockage in the lung (pulmonary emboli), a blockage in the heart (myocardial infarction) or blockage in the brain causing stroke, brain damage and death. If a similar thing happens to either ventricle (ventricular fibrillation) and is not corrected immediately, the result is death!

Damage to the blood vessels or other organs may damage the heart by increasing blood pressure and forcing it to work harder. This may result in the chamber of the heart becoming larger due to heart muscles stretching and becoming “saggy” (systolic heart failure). The stretched, saggy muscle is then unable to effectively pump blood effectively. One of the typical signs of systolic heart failure is fluid and blood leaking in to the lungs due to the blood not flowing properly and causing a drowning sensation as the lungs fill with fluid and prevent the person from breathing. If, on the other hand, the heart muscle becomes larger and too toned, the chamber of the heart becomes too small resulting in less blood filling the chamber and being pumped with each beat (diastolic heart failure).

If the heart and/or blood do not function properly, other organs and/or the heart itself start to be affected and can result in damage to any of the organs including the heart. Furthermore if the function of other organs begins to decline, the decline itself or compensatory mechanisms by the organs, may result in further damage to any other including the heart. As you can see, this can start a chain reaction that leads to the complete failure of each and every organ ultimately death.

For information on how other organs may affect the heart and what happens when other organs become damaged, see those specific organs.

One of the last complications associated with damage to the heart is infective endocarditis. This is an infection of the heart muscle typically occurring when valves of the heart are damaged and provide a nice rough surface for bacteria (and sometimes fungus) to stick to. This is an extremely dangerous infection as it not only damages the heart but also has the potential to spread anywhere in the body through the bloodstream as well as causing septicaemia, sepsis or septic shock, which basically results in a body wide inflammatory response that causes the organs to shut down and stop working completely due to reduced blood flow.

What can cause damage to the heart?

Potential causes: In addition to injury or trauma from an accident or fight, damaged may be caused by high levels of low density lipoprotein cholesterol (L-DLC) and blood clots, but NOT high density lipoprotein cholesterol (H-DLC) which is good cholesterol. Infections, autoimmune diseases that attack the heart and other organs, high blood pressure, damage to the lungs, kidneys and liver, plus alcohol, various conventional medicines, herbal and “natural” therapies, toxins, venoms and poisons can also damage the heart just to name a few. Hi stress is also a major factor in damaging the heart.

Liver:

What does the liver do?

The liver performs several functions. The majority of the work done by the liver involves metabolism. So what is metabolism? Metabolism consists of 2 different processes. The first is catabolism which involves “breaking down” substances and the second is anabolism which involves building substances. Anabolic steroids get their name from this process because they build muscle (along with a heap of nasty and dangerous side effects if used inappropriately).

Blood vessels from your stomach and intestines carry nutrients, medication and toxins to the liver to be processed in to other substances, through either catabolism or anabolism. The liver does this so they can be eliminated from the body and/or deactivated/detoxified (medication/toxins) to stop their effects. Although toxins may damage the liver, they are not “stored” by the liver as some would have you believe. Anabolism is like putting a “cap” on a pen or needle to stop it working, or attaching a sign to the substance so that the kidneys or intestines “recognise” it, collect it and dispose of it. Catabolism on the other hand is like cutting up your credit card to stop it from working and activating the ATM.

There’s a catch! Your liver only produces a certain amount of the metabolic enzymes at any given time, for this purpose. If there is not enough for the required “work”, you end up with problems! Take alcohol, if you drink too much a toxic by-product is produced and can’t be detoxified (enzyme ran out early). That toxin then makes you sick in addition to other factors which don’t help.

The liver also metabolises fat, carbohydrates (sugar) and protein to produce energy for the body. If there is excess sugar in your blood it can store it by turning it in to glycogen and release it at another time when extra energy is required. When the liver breaks down protein, it also ends up producing a substance called urea which is released in to the blood and filtered by the kidneys (What if your kidneys don’t work?). The liver also stores some vitamins and minerals such as iron and copper. If your iron stores are low, you can end up with iron deficiency anaemia.

The last two functions of the liver are to produce clotting factors to stop you bleeding and synthesise a protein called albumin. Albumin is important for two reasons, the first is that many substances like medications bind or “stick” to it as they float through the blood stream. This essentially inactivates that substance and acts similar to a reservoir. The second reason albumin is important is that it “holds” the water in the blood stream, through a process known as oncotic pressure (colloid osmotic pressure).

What happens if the liver doesn’t work properly?

The liver may accumulate damage over time and when forced to work harder than intended for longer than intended. When the liver is damaged overtime by disease or suddenly by traumatic injury, all of these functions may be diminished or become entirely absent. Mild and short term damage to the liver may be reversible and the liver may adapt by working harder to compensate for any reduced function; however, if the damage is moderate to severe, or accumulates over a long period of time, the damage may become permanent and begin a gradual decline in to complete and permanent liver failure and death.

The typical signs and symptoms of liver damage and reduced liver function are jaundice (yellowing of the skin and eyeballs) and skin itch associated with the build-up of bilirubin, dark urine and pale faeces due to with blockage of the bile duct and ascites which is the accumulation of fluid in the abdominal cavity due to a lack of albumin and oncotic pressure.

If the liver does not function properly due to damage or injury, metabolic activity will be reduced and substances that would normally be eliminated from the body may accumulate, substances that are deactivated to stop their effects or detoxified (medication and toxins) will continue to produce an effect causing increased side effects and toxicity. Furthermore, the low albumin levels which normal bind substances like medications or toxins and poisons, result in larger concentrations in the blood stream and further increasing the side effects and toxicity already experienced with reduced metabolism.

In addition to this, lack of energy production can cause lethargy and malaise, while the reduced production of clotting factors can result in serious, life threatening haemorrhages (especially if injured). The reduction in albumin production also reduces oncotic pressure within the blood vessels and as a result fluid “leaks” from blood vessels and typically accumulates in the abdominal cavity; A condition known as ascites. The fluid continues to accumulate causing pain and producing a great environment for bacteria to cause an infection known as spontaneous bacterial peritonitis.

A classic consequence of sudden onset liver damage, spontaneous bacterial peritonitis and the accumulation of ammonia in the blood stream (from bacteria and protein metabolism) is hepatic encephalopathy. This is condition of the brain that results in neurological and psychiatric problems due to the ammonia and swelling of the brain. Since this condition affects the brain, it can affect everything causing abnormal behaviour, confusion, problems with speech, sight, swallowing, breathing, the heart, particularly slowing the heart rate, paralysis, seizures, coma and if the pressure builds too much, it can push the brain stem through the bottom of the skull killing you instantly!.

Depending on the type, location and severity of damage, other consequences may arise. For instance, if damage and scarring cause narrowing and reduced blood flow through the portal veins this can lead to high blood pressure called portal hypertension. This can then cause a condition known as oesophageal varices which occurs in much the same way that back pressure in a tube (the veins) may cause the tubing behind the blockage, to expand and bulge like blowing up a balloon. This “ballooning” effect happens in the blood vessels of a persons’ oesophagus or “food pipe” and is very dangerous, because the veins are weak and cannot expand very much resulting in a risk of rupture and bleeding to death due to the already ineffective clotting factors, so the bleeding cannot stop!!

What can cause damage to the liver?

Potential causes: In addition to injury or trauma from an accident or fight, various conventional medicines, herbal and “natural” therapies, alcohol, toxins, venoms and poisons can damage the liver. Infectious diseases such as the numerous hepatitis viruses, autoimmune diseases that may attack the organs and diseases such as Wilsons’s disease (cellular copper accumulation) and haemochromatosis (iron overload) may also cause liver damage. Too much iron causes damage as the iron storage capacity of the liver is finite, so excess of this limit results in damage. A simple infection left untreated, that results in sepsis and septic shock may cause damage to the liver (and other organs) due to reduced blood flow, oxygen and nutrient delivery.

Kidneys

What do the kidneys do?

First and foremost the kidneys function like a filter for the blood. Rather than a single filter, it might be more accurate to say it functions like a series of filters rather than just one big one. It starts very generalised by firstly removing a bulk amount of waste and other substances from the blood and then becomes more selective “fine-tuning” what to keep by reabsorption and what it ultimately gets rid of. The kidneys do this to maintain homeostasis and specific concentrations for individual substance within the blood stream and extracellular fluid (fluid surrounding the cells).

The kidney filters many substances, but not all! Some examples include water, metabolic waste products like urea, creatinine, uric acid, some drugs (not all) and their metabolites, plus electrolytes such as sodium, potassium, calcium, hydrogen and sugars (carbohydrates).

In addition to filtration, the kidneys secrete various hormones to regulate blood flow, blood pressure and blood pH (acidity) throughout the body (renin, prostaglandins, and bradykinin), to produce and mature red blood cells (erythropoietin), and influences bone mineral density by maintaining calcium, phosphorus and Vitamin D levels (1, 25-dihydroxycholecalciferol or calcitriol).

What happens if the kidneys don’t work properly?

The kidneys may accumulate damage over time and when forced to work harder than intended for longer than intended. When the kidneys are damaged overtime by disease or suddenly by traumatic injury, all of these functions may be diminished or become entirely absent. Mild and short term damage to the kidneys may be reversible and the kidneys may adapt by working harder to compensate for any functional decline; however, if the damage is moderate to severe, or accumulates over a long period of time, the damage may become permanent and begin a gradual decline in to complete and permanent kidney failure and death.

This can be explained using an over simplified example of diabetes. If the kidneys are forced to work extra hard to remove excessively high amounts of sugar from the blood, they get worn out (just like machinery). As a result, some substances are not filtered as efficiently and tend to accumulate in the body (urea, creatinine, phosphate), some are not reabsorbed as efficiently and thus filtered excessively (sodium, potassium and calcium) while other substances that wouldn’t normally be filtered, begin “slipping” through the “holes” and “cracks” resulting in excess loss and deficiency (protein). In addition to this, if kidney function becomes significantly impaired, erythropoietin cannot be produced causing a lack of red blood cells and anaemia, Vitamin D3 (Cholecalciferol) cannot be converted to its active form of Calcitriol (1, 25 dihydroxycholecalciferol) resulting in osteoporosis, low calcium and high phosphate levels, while toxic urea levels begin to accumulate along with significant abnormalities in fluid and electrolyte balance.

In the advanced stages of kidney failure symptoms include including volume overload (fluid retention, swelling and oedema), high blood pressure, anaemia, osteoporosis, plus dangerously high potassium levels affecting heart and nerve function (arrhythmia, heart failure, paralysis). Toxic blood levels of urea (uraemia), causes nausea, vomiting, an intense skin itch, damage to the nerves (neuropathy) often resulting in severe nerve pain that is extremely difficult to treat), and central nervous system abnormalities (lethargy, seizures, confusion, delirium, coma, and death). Lastly the reduced excretion of phosphate from the blood results in the accumulation of phosphate and metabolic alkalosis (blood pH increases and becomes too basic/alkaline).

What can cause damage to the kidneys?

Potential causes: Genetic diseases directly affecting the kidneys and indirect damage from other diseases such as autoimmune diseases that attack organs in general, lifestyle diseases (some genetic too) like diabetes and hypertension, infection, traumatic injury to the kidney and crush injuries to limbs, dehydration and severe loss of blood (reduced blood volume), some medication side effects and combination of certain medications together, poisons and toxins.

Lungs:

What do the lungs do?

The lungs perform several functions. Most obvious is intake and transfer of oxygen from the environment to the bloodstream. They also facilitate removal of carbon dioxide and other volatile gases, such as anaesthetics from the bloodstream at the same time, to remove potential dangerous waste products from our bodies. The lungs also supply the air required to make our vocal cords (voice box vibrate) so that we can produce sound and speech.

Breathing and removal of carbon dioxide helps to regulate the pH of the blood. As the amount of carbon dioxide in the blood increases, the pH of the blood becomes more acidic causing respiration to increase in an attempt to remove excess carbon dioxide and restore normal physiological pH to the bloodstream.

The lungs also help to maintain blood pressure by playing a role in the renin-angiotensin system (like the kidneys) where angiotensin I is converted in to angiotensin II and acts as a potent vasoconstrictor (blood vessel shrinker) within the lungs. As the blood vessels shrink, blood pressure increases.

What happens if the lungs don’t work properly?

Unlike the liver and kidneys, the regenerative capacity of the lungs is significantly less, so all but the smallest damage cannot be reversed; however, the lungs may be able to compensate for mild damage by working a little harder and breathing faster and there may or may not be any significant signs of reduced function.

When the damage becomes moderate to severe, gas exchange in the lungs is significantly reduced and increasing respiration is unable to provide adequate oxygen for the blood stream to meet functional requirements (hypoxia/hypoxaemia). The obvious signs of this are breathlessness and reduced ability to exercise. This triggers an increased heart rate (tachycardia) in an attempted to meet functional requirements by delivering the oxygen faster. Oxygen levels in the blood can become so severely reduced that people are unable to even walk a few steps without feeling exhausted and requiring constant medical grade oxygen from a canister. Too much oxygen though is dangerous as it reduces the rate of respiration and can worsen accumulation of carbon dioxide.

The reduced gas exchange in the lungs associated with severe lung damage can also result in an increased level of carbon dioxide (hypercapnia/hypercarbia) in the bloodstream. This results in decreased blood pH and acidosis (excessively acidic blood). As the level of carbon dioxide rises, it stimulates an increase in respiration (tachypnoea and hyperventilation) in an attempt to remove the excess carbon dioxide. Rising levels of carbon dioxide also trigger your heart to beat faster (tachycardia) and possibly irregularly (arrhythmia) in an attempt to speed up the removal of carbon dioxide from the bloodstream. As this worsens is can produce a sense of panic and feeling of suffocation due to the inability to get enough oxygen and eventually lead to convulsions and death if carbon dioxide levels become too high.

The increased heart rate associated with low oxygen and/or high carbon dioxide results in an increased blood pressure and means the heart has to work harder increasing the strain. If damage to the lungs results in damage to the blood vessels in the lungs, this can cause narrowing and increased blood pressure within the lungs known as pulmonary hypertension. The increased work and strain on the heart plus increased backpressure from the lungs often results in heart failure and thus a reduced ability for the heart to pump blood around the body. This then becomes a viscous cycle where reduced rate of blood flow and reduced oxygen in the blood causes the heart to work harder in an attempt to supply enough oxygen to the organs, which increases blood pressure further, increasing the stress already on the heart and worsening the heart failure resulting in a steady decline in heart function and death. Of course this only happens if declining lung function doesn’t starve you of oxygen and suffocate you to death first.

What can cause damage to the lungs?

Potential causes: Genetic diseases directly affecting the lungs such as asthma, cystic fibrosis, alpha1 antitrypsin deficiency and some forms of pulmonary hypertension, as well as indirect damage from other diseases such as autoimmune diseases that attack organs in general. Other causes include smoking, infections, some medication, natural and herbal medication side effects, poisons, toxins and chemicals.

The Simplified Brain

trust me, it’s simplified even if it doesn’t look it

What does the brain do?

In truth, the full extent of the brains function is a mystery, but it pretty much controls every bodily function. Even if the brain doesn’t directly control a specific function, you can be sure that it still influences that function by either enhancing or inhibiting the physiological mechanism which is in direct control.

The brain can be split up in to various structures and regions defined by its function and region of the body that it controls. The problem is that each structure or region of the brain may perform multiple functions and/or control multiple regions of the body as well as multiple brain regions may control or influence the same body region or function.

The Brainstem

The brainstem primarily works on a subconscious level, automating bodily functions such as breathing, body temperature, digestion, arousal (asleep or awake) and swallowing.The Medulla Oblongata is a special region of the brainstem which controls breathing, heart rate and blood pressure.

The Cerebral Cortex

The cerebral cortex can be further divided up to 4 main regions, the frontal lobe, the temporal lobe, the parietal lobe and the occipital lobe.

The Frontal Lobe

The frontal lobe (at the front of the brain) is mostly associated with thinking, reasoning and problem solving, processing emotions, personality traits and social skills, controlling speech production (not understanding spoken words though, that is another area) and voluntary movement.

Some of the main areas within the frontal lobe include Broca’s area, which control the mouth and jaw muscles to produce speech. On top of the brain sitting on the frontal lobe side of the junction between frontal lobe and parietal lobe stretching from one ear to the other is a band of neural brain cells called the primary motor cortex. This area controls voluntary movement for every single part of the body. Each little area of the body, from your big toe to your little finger, your legs, arms, eyelids and everything in between has a specific area located on this strip of brain tissue, which is used to control that specific area.

Everything immediately in front of the Primary Motor Cortex and halfway to the front of the brain is a secondary area which assists movement.

At the very front of the brain is the part of the brain which mostly controls emotions, thinking, reasoning and problem solving

The Temporal Lobe

The temporal lobe (at the side of the brain) is predominantly associated with hearing and processing auditory information including spoken words. It is also the region which controls memory and learning.

The main area(s) of the temporal lobe associated with learning and memory are the Hippocampus and Amygdala (also part of the Mesolimbic System) which share a connection. These two areas interact to first store short term memories and then transfer that information in to long term memory storage and facilitate learning. The Amygdala, located towards the middle of the brain on the temporal lobe, is more than just a memory and learning centre. It also plays a role in storing emotional information associated with memories, processing emotional information, is associated with aggressive behaviour and is linked to certain types of seizures, autism, depression, anxiety, PTSD and fear, including phobias.

The main area of the temporal lobe which processes and understanding the meaning of spoken language is Wernicke’s area which is located at the back of the temporal lobe on the border of the temporal, parietal and occipital lobes.

The Parietal Lobe

The parietal lobe (at the top back portion of the brain) is mostly in control of sensation and perception of the environment around us, including processing writing information, interpreting spatial information such as 3D shapes and the position and the orientation of our body (and others) in 3D space.

Due to the complex interaction between senses, the parietal lobe plays a role in all senses, including the sense of touch (somatosensory), taste (gustation), smell (olfaction), sight (vision) and hearing (audition).

At the junction of the frontal lobe and the parietal lobe, on the parietal lobe side of the “fissure” (the Central Sulcus) which separates the two lobes is a band of neural brain cells that stretches from one ear to the other, similar to that found in the frontal lobe. This band of neural brain cells is called the Primary Somatosensory Cortex and it is responsible for processes sensory information for each little part of the body which corresponds to a specific area on that band of brain tissue.

The Occipital Lobe

The occipital lobe (at the bottom back portion of the brain) is responsible to processing and interpreting visual information and colours from the eyes. That’s pretty much it!!

The Cerebellum

At the base of the skull under the occipital lobe sits the cerebellum, a part of the brain that looks almost like a second brain. The word “Cerebellum” literally means “little brain”. One of the main functions of the cerebellum as we understand it is fine motor control, that is fine tuning movements initiated by other parts of the brain, coordinating multiple simultaneous movements and controlling posture and balance.

The Mesolimbic System and Basal Ganglia

Right in the centre of the brain lays two interconnected regions of the brain called the Mesolimbic System and Basal Ganglia. The Mesolimbic System, also known as the “reward pathway” is an area of the brain associated with those feelings of euphoria and addiction. This area is triggered when you eat your favourite food, have sex and also snort cocaine, just to name a few.

The Basal Ganglia on the other hand is another region of the brain associated with control of voluntary movement, especially when choosing and initiating movement. Just to throw around some big words, the basal ganglia can be further divided in to the globus pallidus, ventral pallidum, substantia nigra pars compacta, substantia nigra pars reticulate, the subthalamic nucleus, the dorsal striatum which consists of the caudate nucleus and putamen and the ventral striatum consisting of the nucleus accumbens and olfactory tubercle.

If you guessed that substantia nigra literally means “black substance” well done!! It’s called this because the nerves in the area are literally black in colour.

If you think putamen is a fancy Spanglish way of calling men whores, then I am sorry to say, but it is not!

What happens if the brain doesn’t work properly?

Your brain is very sensitive to damage. The amazing thing about the brain is that although it has practically no regenerative properties to repair damage, it does have a limited ability to “rewire” itself to force different areas to control new functions. Although functionality is seldom returned completely, the younger you are the easier and more it can “rewire” but as you get older, things become more rigid and harder to change. This process is known as neural plasticity.

With that in mind, if the brain gets damaged you can expect to lose most if not all of the function controlled by the damaged area. If the area that is damaged is in a region of the brain associated with some function that is essential for life like the brainstem, then it is pretty much all over.

Damage, dysfunction or diseases of the frontal lobe is likely to be associated with personality changes, emotional instability, and an inability to concentrate, think clearly or plan. If damage occurs in the primary motor cortex, then movement may be affected in the area of the body corresponding to the position on the brain. If the damage occurs to Broca’s area, then a person will experience a reduced ability or complete inability to express themselves verbally in a condition known as Expressive Aphasia.

If damage, dysfunction or disease of Wernicke’s area (temporal lobe) occurs, then a person will be impaired or completely unable to understand written and spoken words in a condition known as Fluent or Receptive Aphasia. Damage, dysfunction or disease associated with the hippocampus, amygdala or other areas of the temporal lobe will certainly impaired memory and may be associated with personality and behaviour changes, psychiatric/mental illness such as depression and anxiety, and also seizures.

Damage, dysfunction or disease located in the left side of the parietal lobe can be associated with a reduced ability or complete inability to write (agraphia), perform mental arithmetic (acalculia), produce aphasia and an ability to recognise objects (agnosia) or specifically faces (prosopagnosia).

On the other hand, damage, dysfunction or disease located in the right side of the parietal lobe can result in a syndrome known as “contralateral neglect” where the individual is unable to perceive particular regions, or the complete LEFT side of their body due to damage to corresponding areas on the RIGHT side of the brain. This results, for instance in an individual who may get dressed, shower/wash, shave and/or groom themselves on the RIGHT side of the body, but miss the LEFT side as they do not consciously see or perceive anything on that side. Due to redundancy in the brain, RIGHT sided neglect is very rare, but can happen.

No prizes for guessing what happens with damage to the occipital lobe. You get impaired vision duh! This may manifest as total impairment or selective for colour or if associated with abnormal neural firing and seizures it may interestingly be associated with visual hallucinations.

If damage, disease or dysfunction should occur to the cerebellum, loss of coordination (asynergia), the inability to rapidly stop and start or change movement direction (adiadochokinesia), hand and movement tremors, an inability to judge distance (dysmetria) and a wide based walk or staggering (ataxic gait), a tendency to trip or fall, muscle weakness (hypotonia), slurred speech (ataxic dysarthria) and/or a rhythmic side to side oscillation of the eyes (nystagmus) often occurs. A vertical nystagmus may occur but is much rarer.

If the mesolimbic system in the brain becomes damaged, dysfunctional or diseased, an individual may experience mental and psychiatric illness such as depression, reduced ability to cope with stress, schizophrenia, behaviour and personality changes or disorders and addiction disorders.

Damage, dysfunction or disease associated with the Basal Ganglia is typically associated with Motor Neuron Disorders, Parkinson’s disease and Huntington’s chorea. For those unfamiliar with these diseases, Parkinson’s disease is characterised by difficulty moving, particular initiating movement after being stationary, tremors, gait disturbances and the like. Huntington’s chorea is the complete opposite and is associated with uncontrollable “ballistic” type movements that may happen sporadically or frequently.

What can cause damage to the brain?

Potential causes: In addition to injury or trauma from an accident or fight, infections such as meningitis, syphilis and HIV, autoimmune, genetic or other diseases which attack the brain such as Multiple Sclerosis, Parkinson’s disease, Huntington’s chorea, Alzheimer’s and other dementia’s such as Frontotemporal dementia, Pick’s disease, Dementia with Lewy Bodies and Alcoholic dementia.

Epilepsy and other seizure disorders can also cause damage to the brain as well as alcohol, stimulant drugs such as amphetamines, various other conventional medicines, herbal and “natural” therapies, toxins, venoms and poisons.

One of the main causes of damage and dysfunction of the brain is stroke which can occur due to blockage by things such as a clot or cholesterol or haemorrhage which results in bleeding on the brain and a lack of blood supply to areas of the brain downstream of the bleed area. Typically bleeding on the brain also causes seizures.

I have made the choice not to write about some systems in the body such as the endocrine or immune system because I don’t believe they will add much beyond what has already been described.

Chapter 4

Simplified Pharmacology

Part 1: Pharmacokinetics

Before I get started I wish to once again specify that this is a simplified and generalised version so there may be parts that are missing or don’t hold true 100% of the time.

Pharmacodynamics (Drug Effects and Power) is what the therapeutic or toxic substance does to the body and how it produces its effects. Pharmacokinetics (Drug Motion) is essentially the flip-side of the coin and describes what the body does to the substance in return. It is the journey the substances takes in the body from the time it is administered (given or taken), how it gets to its site of action and how the body gets rid of it over time until it is no longer present in the body.

Pharmacokinetics

When it comes to understanding therapeutic or toxic substances, Pharmacokinetics is probably the most overlooked area by everyone doctors, nurses and pharmacists included, except for all but the highest level practitioners in their area. This is because it can be very complicated and a mathematics heavy area involving physics, plus they often fail to understand its significance and importance when selecting a drug (or poison if you’re an educated assassin). It is a commonly held misconception that simply knowing what a substance can do or what it can be used for is all that is required to select the appropriate treatment or poison (I swear with the way many doctors select treatment, they are trying to poison most of their patients). This is a huge fallacy as I will explain.

A lack of understanding of pharmacokinetics and pharmacology (usually drug interactions) in general is single-handedly, the reason why many patients suffer either treatment failure or complications and harm from the very treatment which was supposed to heal them due to ignorant prescribing and administering by health professionals. Pharmacokinetics can be broken down in to the following areas:

• Absorption

• Distribution

• Metabolism

• Excretion

These factors affect everything associated with a drug or poison from:

• Their efficacy (effectiveness) including whether or not they will even work under the given circumstances.

• The best or most appropriate route of administration (way to take them)

• The most appropriate dose to produce the desired magnitude of effect for the individual patient or victim’s situation based on their own specific personal factors which may alter a drugs pharmacokinetic profile.

• How long for the drug to take effect AND how long the effect will last.

  • Influenced by:

  • The maximum concentration reached in the bloodstream or area of effect

  • The time taken to reach the maximum

  • The minimum therapeutic or toxic level

  • The time taken for half the concentration to be metabolically broken down by enzymes and/or filtered by the kidneys

• Potential effects one substance may have on the pharmacokinetic profile of another substance.

Patient specific factors that may alter drug or poisons pharmacokinetic profile and needs to be considered include:

• Age

• Weight

  • Also muscle mass versus body fat

  • Body Surface Area

  • Nutritional status

• Other drugs/poisons currently in the patients system or having been administered recently

• Other comorbidities (current illnesses) especially kidney and liver disease because these organs specifically affect pharmacokinetics

  • Kidneys: Excretion

  • Liver: Metabolism

As you can see, there is a lot that needs to be considered and this is only the simple version. Sadly as I said previously, these factors are seldom taken in to consideration either properly or in their entirety.

Absorption

Absorption is essentially how (and how much of) the substance gets in to your bloodstream. There are many ways to get a substance in to the bloodstream, with some being more effective generally and more effective for a specific substance than others. There are also many complicated factors which affect absorption including pharmaceutical, pharmacological, chemical (structure and properties) and physiological which can limit the viable ways a substance can safely and effectively be given.

This is why some therapeutic or toxic substances can only be given orally, some can only be given intravenously and others can be given a variety of ways.

Absorption is typically considered in terms of bioavailability which is the proportion of administered substance that reaches the bloodstream.

Injections

An injection directly in to the bloodstream is considered to have a bioavailability of 100%, but injections can also be given in to other places such as muscle, skin, joint, spine and even the eye or… other parts I won’t go in to!! If it is not directly in to the bloodstream (intravenous), then the bioavailability may not be 100%.

Muscle and skin injections can be for local effect (around the injection site) or systemic effect (whole body). Unlike an intravenous injection where you get 100% of the dose instantly or however long it takes to give the injection, muscle and skin injections can be useful for prolonging the effect by enabling a small reservoir of drug to be absorbed slower over time. If the injection is for a local effect, systemic absorption needs to be considered or you risk producing unwanted side effects and/or toxic exposure.

Other injection sites are typically used to produce a local effect and minimise systemic exposure, which helps to reduce side effects, but it should always be remember that it is only minimising systemic exposure relative to the dose, so side effects and toxicity may occur due to other factors.

Examples include joint injections of gold (yes gold), potent anti-inflammatory and immune suppressive drugs for rheumatoid arthritis, spinal injections for pain relief and anaesthesia such as epidurals and an intravitreal injection in to the eyeball may be given due to certain infections.

Oral

The most common route of administration is orally. Oral administration is anything that is swallowed, or fed tiredly in to the stomach or intestines via a tube. Anything applied to the inside of the mouth is technically not considered orally administered if it is not swallowed.

Absorption from orally administration can range from 0% to 100%. Sometimes a drug with 0% bioavailability is used to produce a local effect within the gastrointestinal tract. This is often seen with drugs used to treat constipation, diarrhoea and inflammatory bowel disease (ulcerative colitis and crohn’s disease).

There is a catch though! Often the bioavailability is determined for HEALTHY individuals using specific doses with short treatment durations. This is important factor to remember because some of these conditions that are being treated can themselves affect absorption and if either the dose is increased, the dosing frequency is quicker or the duration of treatment is longer than the duration used to derive the absorption profile, this may result in an increased bioavailability and slow accumulation of the drug in the bloodstream. It doesn’t mean it will happen, but certainly needs to be considered depending on the substance and patient’s circumstances.

Thought for CoE If you are an assassin looking to poison your mark, giving too much poison may not produce better or quicker results. Even if the poison is odourless, tasteless and colourless, there is always the chance that TOO MUCH poison could cause irritation, nausea, vomiting, diarrhoea, constipation or other effect which limits the amount that gets absorbed. If you don’t know your drugs or poisons, your plans may fail, just like a healer or physician in game.

More does not mean better!! that applies to everything without exception (except Japanese Chicken Katsu Curry.. you can never have too much).

Medical conditions, drugs, poisons and other substances that cause damage or inflammation to the gastrointestinal tract (GIT) may result in the lining of the stomach and intestines becoming less of a barrier and more “porous” allowing more of the drug and/or more drugs than usual become absorbed and enter the bloodstream.

Furthermore in the case of constipation, diarrhoea or substances that cause either where the time it takes for a substance to go from mouth to bum changes, the amount of substance absorbed also changes. So a drug that under normal circumstances doesn’t get absorbed very well, may have an increased absorption during constipation, if the limiting factor is simply slower absorption. On the other hand, if there is a delay to stomach emptying which can happen in constipation or other conditions, the substance may get absorbed less, if it primary gets absorbed further down the gastrointestinal tract such as the large intestine. Furthermore drugs that are normally absorbed well may not be absorbed during episodes of diarrhoea and vomiting as they may not be given adequate time for absorption to occur.

I now realise how much I have had to think about people’s bums and tums during the course of my profession…. Eeewwwww!!!

Another factor to consider which also gets overlooked in terms absorption is surgery such as when a patient has had a portion of their stomach or bowel removed due to injury or illness such as cancer or inflammatory bowel disease.

Another CoE thought: Would it be cool if being stabbed in the abdomen altered the absorption and thus effectiveness of a drug? Maybe the inflammation and/or infection made you absorb more, so there was a temporary risk of overdosing on the meds needed to heal you? Perhaps you had surgery to remove the damaged portion of stomach or intestines?

The absorption of some substances is affected by the local pH of the stomach or intestines in two possible ways. Firstly, some drugs are ionised or dissociate in either high (alkaline) or low (acidic) pH environments. If a substance becomes ionised in a particular gastrointestinal pH, then it is far LESS likely to be passively absorbed because charged particles are hydrophilic (like to be in water) and have trouble entering the bloodstream by diffusing across the lipid (fatty) cell membranes. If physiological mechanisms exist that actively pump the drug across a membrane barrier or a channel or pore facilitates diffusion, then the ionisation of the drug will be of little consequence.

Likewise if a drug associated or recombinates (goes from separate charged ions/molecules to a single less charged molecule) in a particular pH, then passive diffusion should be facilitated unless the molecule itself has significant charges in it’s chemical structure or the combined molecule is simply too big to cross the membrane one way or another.

The second way that pH can affect absorption is purely via chemical reaction that destroys the drug by making a new substance or two. Both acids and bases can be reactive in this way. The new substance may be inactive or simply cannot be absorbed. This is why some tablets, capsules or liquid suspensions may have enteric coatings or enterically coated particles to protect it from that environment. It may also mean that the drug simply can’t be given orally and is only available as an injection or suppository!!!

Topical

The last way substances may be absorbed is by applying them directly to the surface of the skin, both externally and internally. Absorption from the skin (or mucosal) surface can be erratic, but there are specific places that offer superior absorption. Under the tongue (sublingually) and on the inside of the cheek (buccally) are two such places as these areas allow suitable drugs to enter the bloodstream directly without suffering metabolism via locally occurring enzymes or liver enzymes.

Substances can be applied topically using creams, ointments, lotions, liniments, eye drops, sprays, powders, foams, enemas, suppositories or patches (just to name a few). Many substances will either not be absorbed and not work at all (even sublingually or buccally) or only work locally in that area. This is why applying drugs to the skin is not feasible for all medication.

There are however, a small number of drugs, poisons and other substances which are exceedingly efficient at getting absorbed through the skin (anywhere) which is why it is important to know which do and do not.

Some of the drugs that are very effective at being absorbed through the skin include nicotine patches to treat nicotine addiction from smoking, hormone replacement creams and patches, glyceryl trinitrate (nitroglycerine… yes the highly volatile explosive stuff) patch, spray and sublingual tablets for heart attack and chest pain (angina) and pain killers such as fentanyl and buprenorphine.

Back in the day when industrial strength nicotine sprays were used as an insecticide, more than a few people either died or were admitted to hospital suffering heart attacks due to nicotine exposure. One unlucky S.O.B. that I know of suffered (and survived) two as his clothes were contaminated with nicotine and upon being admitted to hospital his nicotine soaked clothes were sealed up nice and tight in a plastic bag, only to cause a second heart attack when he was being discharged and put his clothes back on!! And for some trivia, I believe this is what caused the death of “Don” Vito Andolini Corleone (Marlon Brando) in the God Father I.

I digress. A blood pressure medication that is meant to work directly on the heart but doesn’t get absorbed via the skin or only works locally on the blood vessels surrounding that area is not going to be particularly effective, generally speaking (there are exceptions). Generally speaking this example would be perfectly safe; however, treating a frail old lady’s glaucoma with a beta-blocker eye drop like Timolol does have the potential to be disastrous if you are not careful. While the eye drop is applied directly to the eye, Timolol may get absorbed systemically and if this old lady were to be particularly susceptible to the effects of timolol, such as she already has low blood pressure or maybe she is on lots of other blood pressure medication then the additive effects of these small drops may be enough to make her dizzy, fall and break a hip or legs…

An important thing to note about topically applied substances, particularly with patches, is that there is a delay to both the effect of the substance and the stopping of the effect as many of the drugs initially create a reservoir within the skin before it starts being absorbed in to the bloodstream in adequate concentrations. It is due to this that even after removing the patch there is still drug in the skin reservoir that will continue to leak in to the bloodstream for some time. This is very important when switching drug/formulations and is often forgotten by everyone!

CoE thought No.3 secretly assassinating a noble with glaucoma or dry eyes by slipping a substance in to it and watching them tumble off the balcony and go splat!! Who’d suspect eye drops? The eye drops don’t have to be medicated; they may just be viscous and cause blurred vision!!

Far out, 6 pages and this is just the beginning of my “simplified” version. Moving on…

Distribution

As the name suggests, distribution is where the substances travel too in the body. Luckily, I think I can really simplify this, even though it can get very complex too.

Typically substances either prefer to stay in the bloodstream or they accumulate and get stored in to particular bodily tissues, such as skin, fat, nails, bones, muscle etc.

Typically speaking, in the absence of any disease or injury to the kidneys or liver, drugs that prefer to stay in the bloodstream are removed by the kidneys and liver a lot faster (generalisation). This means that have a shorter half-life and their effects wear off a lot sooner. On the other hand, it also means a poison that stays in the bloodstream is eliminated from the body sooner, so long as it doesn’t kill you or destroy your kidneys and/or liver first.

Those substances which get stored by the body and other tissue create a reservoir which slowly leaks back in to the bloodstream and can cause a much longer duration of effect. This becomes important when considering chronic toxicity over a long period of time, where a substance accumulates in the body and the amount leaking back in to the bloodstream becomes too high or just has additive effects with a second or third substance.

But it can have advantages. If a medication is given at the safest and most effective dose, at appropriate intervals it can mean it doesn’t have to be given very often. It only needs to be “topped up” and is able to providing therapeutic cover for a medical condition for an extended period of time and reduces the extreme fluctuations in drug concentration within the blood stream.

If this gets messed up though, it can be very difficult to correct the mistake and people can suffer extreme and prolonged side effects and toxicity. So it’s a double edged sword.

But if only it were that simple, because substances in the blood stream can also bind to other things in the bloodstream such as proteins like albumin. When they do, they also act like reservoirs which can have the same effects and those that get stored in other bodily tissues. Furthermore, if you have two substances which like to bind to the same blood component like albumin, then they can compete for a place to bind resulting in more of Drug A, more of Drug B or more of BOTH floating around in the bloodstream. This can result in unpredictable effect, side effects and toxicity.

It doesn’t end there either. If a situation or condition affects this blood component such as a disease or even malnutrition when it comes to albumin (less albumin is produced with malnutrition) there is less places for substances to bind thus resulting in increased blood concentrations and risking toxicity for some drugs. A good example of this is Digoxin, a substance found in the Foxglove plant and is used as heart medication for heart failure and atrial fibrillation often given to elderly patients who are more susceptible to HF and AF but are also more likely to be malnourished and suffer toxicity!!

Digoxin IS a life-saving medication, make no mistake, BUT it can be VERY toxic also. The Foxglove plant was used one of the poisons used in assassinations centuries ago.

I read a misleading article online that claims it is exceedingly difficult to poison someone with Foxglove…. Not if you know what you are doing!!! MWUAHAHAHA!!!!

This same sort of scenario can happen with substances that get stored in bodily tissue such as fat or muscle because different people can have different ratios of fat to muscle which can varying between two people of equal weight but different heights, different ages will have different muscle and fat mass on average, medical conditions which cause changes to either of these and/or the fact that peoples fat and muscle mass often change naturally over time, so for chronic conditions, doses of medication may have to be adjusted over time purely on this basis, without even considering factors associated with aging and other illnesses or medications they may be taking!!

Metabolism

There are hundreds if not thousands of different enzymes in the body, that are involved in drug metabolism alone, let alone general physiological metabolism. Many are produced in the liver and sent in to the bloodstream, but some exist selectively in and around various other bodily tissues/organs. While most people think of metabolism as “breaking down” a substance, it can just as easily be creating a new substance by “adding” other molecules on to it.

“Breaking down” metabolism is called catabolism while “adding” or “building” type metabolism is called anabolism (think anabolic steroids to build muscle). Similar to breaking a substance down, adding to its chemical structure will also alter its chemical, physical and pharmacological properties.

I like to think of catabolism as similar to breaking a pencil. Doing so may stop it working properly, although it may stop working completely, partially or in the end have very little difference and require multiple stages of “breaking” to stop it completely.

On the other hand I like to think of anabolism in two ways. It can be like sticking the lid on a pen thus stopping it from working, or perhaps sticking a sign on it so that it can be identified by other enzymes or bodily functions in order to stop it working and/or remove it from the body.

Easy peasy… Yeah, no!!! if only!!

In reality substances are metabolised by many enzymes, a single enzyme metabolises many substances, multiple substances can competitively compete for metabolism altering the rate and pharmacokinetic profile of its metabolism, age and the persons developmental status affects the level and effectiveness of metabolic enzymes, plus individual genetic mutations can affect how strong and effective the enzymes are, with some mutations causing a complete lack of effect OR lack of the enzyme itself, while other genetic mutations can make them super effective.

This is not all either, some drugs are called prodrugs which intrinsically have no effectiveness at all and require an enzyme to metabolise and convert them in to a second substance which IS active. Someone with an enzyme that doesn’t work or is missing may get absolutely no effect from the drug at all regardless of dose or if they have a super effective enzyme that converts the prodrug, a low or normal dose may be toxic for them as the prodrug is converted way too quickly for their body to handle in other ways.

Of course the effect of absent or super effective enzymes is also the exact opposite for your typical substances because without an effective enzyme that is used to metabolise it, it doesn’t get inactivated and removed from the body so builds up and is toxic while super effective enzymes will make these substances ineffective because they get broken down way too fast and can’t do their job!

Just when you start to get your head around that you find out that some substances, which could be anything like other drugs, food, nutritional status, herbs and even things like cigarette smoke that can alter the effectiveness of metabolic enzymes.

I’ll try to explain: Let’s simplify this to a Substance. Substance A can represent any of the above (food, another drug, herb, cigarette smoke etc).

When Substance A gets in to a person’s bloodstream either voluntarily or without their consent, Substance A may:

• Induce one or more metabolic enzymes such as Enzyme 1:

  • This increases the effectiveness of Enzyme 1, usually by increasing the amount of it present in the bloodstream.

  • This does not occur at a constant amount though. It is proportional to the amount of Substance A present in the bloodstream at any given time, thus there is a stronger effect on Enzyme 1 soon after the initial dose, but gradually reducing over time as Substance A is inactivated or removed from the body

  • Different doses of Substance A will also have a different magnitude of effect on the induction of Enzyme 1.

  • The result of this is that Substance A may cause other substances like Substance B to be metabolised more quickly at a rate that Is proportional to the concentration present in the bloodstream (just reinforcing this).

  • Depending on whether Substance B is a normal substance or a prodrug, whether or not Substance B becomes more active or less active will determine whether its effects on the individual are larger or smaller

  • The magnitude of this effect will also be changing over time as the level of Substance A changes over time and the rate of active Substance B to inactivated Substance B becomes relatively more or less over time.

  • But Substance A may ALSO be metabolised by Enzyme 1, which would mean its own effectiveness and ability to induce Enzyme 1, thus also Enzyme 1’s ability to metabolise Substance B can be altered in unpredictable ways that are neither linear or a nice curve.

  • Add to this other factors which are also affected by plasma concentration such as binding to albumin, storage in to fat etc., and its effectiveness at inducing Enzyme 1 may be altered again, by multiple of these factors which are constantly changing with time.

But that is only part of the equation because Substance A may also:

• Inhibit one or more metabolic enzymes, in which case it would have the exact opposite effect on Enzyme 1 as noted in the previous points.

• Both Inhibit and Induce multiple enzymes, each of which could also act on Substance B AND/OR Substance A itself, thus creating some crazy summation of effects which is frankly impossible to predict without an individual’s genetic sequence, unlock all the mysteries of our DNA and a super computer.

• Lastly Substance A may be affected by one or more enzymes, such as Enzyme 1 and/or Enzyme 2 which may ALSO be induced and/or inhibited by other substances such as Substance B or Substance C

As you can see, the more drugs, medications or substances etc that an individual takes the complexity increases exponentially.

I won’t repeat the previous points for inhibition of metabolic enzymes and a combination of inhibition and induction of multiple enzymes, but they serve as a template for the exact opposite effect and some combination of both.

At times like the last point, this is where Clinical Pharmacists and no one else will be the expert and even then, they are going to simplify the problem by applying a weighting to each factor, cancel out what is considered negligible effect, possibly cancel out effects which are of equal but opposing effect and have their BEST educated and professional guess. Oh and the good ones will do it all in their head!!

Truth is, it can be so complicated that no one, not a single individual on the planet could determine the outcome with 100% certainty and it will come down to an educated guess. Unfortunately this means mistakes will happen and cannot possibly be avoided in all circumstances, especially since there is still much we don’t know or understand.

Thought for CoE I think it would be great to incorporate an unknown element of randomness in to medicine and poisons based on genetics. Just like reality people may be assigned for a particular enzyme or drug a position on the normal distribution, either having a reduced effect to a substance, a normal effect to the substance or a strong, even dangerous and potentially toxic effect to a substance.

This would add in a degree of individualization of medical treatment, where you perhaps start with the average dose most people will respond to and then be required to go back to the physician, medic, healer, herbalist, pharmacologist etc., to adjust the dose for the most beneficial dose without side effects.

This would also mean that illness/debuffs etc are not cured instantly with treatment but require a “course” of treatment over time.

How would this be implemented? Not going to say it would be easy, but my thoughts would be assigning a particular genetic profile for particular drugs, not a blanket effect of reduced, average or high response, but individual settings for each drug OR to make it easy groups of drugs. Then it’s a case of implementing multiple concentrations, strengths and/or doses of each substance which is really just the same as implementing:

• Lite healing potion

• Healing potion

• Strong healing potion

• Super healing potion

Type scenario in most MMO’s…

Can it be done? Sure!! Is it feasible to do so? I hope so, but only SBS will know for sure! Fingers Crossed

Excretion or Elimination

This is simply removing substances and metabolised substances from the body. Some substances are not absorbed into the bloodstream at all and are therefore not metabolised and pooped out unchanged with either very little effect on the body or only localised effects on the gastrointestinal tract. I’d say these substances are only a small minority.

For those substances that are absorbed in to the bloodstream, most are filtered and removed by the kidneys and end up in the urine. Some are sent back to the intestines and faeces but for simplicity sake, this can be left out.

While the kidney has many other functions which I discussed briefly in the previous chapter on physiology, when it comes to excretion it is as simple as the blood being passed through millions of relatively coarse filters in the kidney. I say coarse because they are not very selective and filter many different things in order to remove bulk amounts.

It is only later as these filtered substances travel along tiny tubes in the kidneys that they start to be sorted and are either kept in the urine to be removed from the body or sent back to the blood stream because they are important for the body.

I should not that blood itself, that is the blood cells such as erythrocytes are NOT filtered and if you find blood in your urine that is definitely a bad sign!!

Blood cells remain in the blood vessels!!

Mostly it is electrolytes or bodily salts such as Sodium, Potassium, Calcium etc which are returned to the bloodstream and most foreign substances/chemicals remain in the urine, IF they are removed by the kidneys. There are certain substances, certain drugs which actually work in the kidneys by being filtered though. Any ideas which ones?

With the exception of a fairly new class of anti-diabetes medication which prevents sugar from being reabsorbed and returned to the bloodstream resulting in you passing lolly water, mostly it is diuretics, also known as fluid tablets which work directly in the kidneys. They work directly in those long tubes inside the kidney and depending on which type of diuretic that essentially works by preventing reabsorption of one of the salts. This causes the salt to accumulate and become more concentrated and effectively “trap” water in the tubes. An obvious side effect other than having to urinate a lot is the potential for salts to deplete from the body, which can be very dangerous; however, as with everything in medicine, it is a balancing act between benefits and risks and drowning in your own fluid because you don’t take your fluid tablets is certainly a bad way to go!!

Other than the kidneys, drugs can also be excreted and eliminated by the lungs, especially if it is a volatile gas such as some gaseous anaesthetics, breast milk, which is why you have to be careful if breast feeding, saliva, sweat, tears and even semen, which can be important if on chemotherapy drugs and/or taking medication which can cause birth defects as it is possible to pass on dangerous substances to your partner… but only in a small number of cases

Off the top of my head that is excretion in a nutshell however, I am somewhat sleep deprived so may have missed something

To be continued…. Part 2: Pharmacodynamics

Chapter 5

Simplified Pharmaceutics and Pharmaceutical Manufacturing:

THE DISCLAIMER

*I hate disclaimers because they point out what should be obvious and common sense. Not that people read them anyway, but here we go again

The information contained herein is for entertainment purposes ONLY in the hope that it may help to enrich the Chronicles of Elyria (CoE) gaming experience by potentially adding to the in game knowledge, skill, crafting and professions. It is not intended as a guide or instruction on what and how to do anything in the real world!!

There are many legal, safety and health related reasons why someone should not attempt to reproduce pharmaceutical (or other) products from this document

Most jurisdictions have strict laws, regulations and standards concerning who is allowed to make, store, supply and sell pharmaceutical preparations and breaking these laws can have some pretty severe penalties.

These laws stipulate the kinds of study and/or training one must have done, the kinds of environment it is allowed to be done in, the required documentation that must be completed and kept, the required product testing which must occur, the required equipment that MUST be used etc. (not an exhaustive list).

The views expressed in this document are entirely my own and do not reflect that of Soulbound Studios or the Developers of Chronicles of Elyria.*

END OF DISCLAIMER

Regulation of the Industry in Elyria

From an Elyrian civilization perspective, I would expect laws and regulations about medicines and poisons to be pretty relaxed. It wasn’t that long ago that people could get controlled drugs over the counter, and in some countries you still can. It was only after unwanted side effects and social behaviours became apparent that things become stricter. There is a direct relationship between the observation of side effects including unwanted social behaviour, especially the rarer more dangerous ones and the population size, so in areas of smaller population, potentially dangerous or socially undesirable drugs may be freely available due to the problem appearing smaller than it really is or has the potential to be.

Frankly I see no reason why opium dens and other such establishments of ill repute and an active and legal recreational drug trade would not exist in Elyria, except where it would severely affect the classification and distribution of the game itself.

Simplified Pharmaceutics

Pharmaceutics is the study of relationships between drug formulation, delivery, disposition and clinical response. This means how giving a drug as a tablet or capsule, suspension, mixture, solution, elixir or syrup (all various types of potions), injection (various locations), eye drop, cream or ointment, inhaler/aerosol etc., via the mouth, nose, eye, ear, bloodstream, skin, muscle or lungs etc., affect the absorption, distribution, metabolism, excretion (pharmacokinetics) and overall effectiveness of a drug.

There is a tonne of physics theory involved in pharmaceutics, but unless you are planning or attempting to create a unique, never before made formulation designed to revolutionize medication, then all that work with physics had been done for you by an someone such as an industrial pharmacist when the formulation/recipe was created.

I will not go in to pharmaceutics in any real detail; however, I will explain in simple terms, one important point that illustrates this area.

Suspensions: Suspensions are insoluble solids (usually fine powders) that are dispersed in to a liquid. Suspensions are made in such a way that they allow for an even distribution of solid particles throughout the liquid phase. This is important for administering accurate dosages because if the solid particles were not evenly distributed in the liquid phase, the dose would vary with each dose ultimately leading to either therapeutic failure or potential toxicity.

So how do you get solid particles to evenly distribute throughout a liquid and not either sink straight to the bottom or float on top, because if a powder sinks to the bottom it can result in “caking” whereby the powder forms a solid lump that will not disperse easily?

In a word, Pharmaceutics! This is achieved by adding ingredients to the liquid phase that alter the viscosity (thickness) of the liquid (usually making water thicker), and may also alter the weak forces of attraction and/or repulsion on the active ingredient to prevent caking or clumping. The process by which the solid particles of a drug aggregate or clump together is known as flocculation.

A flocculated suspension is physically stable but at the cost of reducing the bioavailability of the drug (how much reaches the systemic bloodstream).

To separate the individual solid particles and improve bioavailability, particles will carry a weak electrostatic charge on their surface causing a force of repulsion between particles and preventing aggregation, caking and reducing sedimentation rate at the expense of chemical stability ie shelf-life.

The ideal properties required of a liquid used in a suspension are to become thinner or less viscous when shaken or agitated and to become thicker or more viscous when static. This is known as a thixotropic liquid.

Tomato sauce/ketchup is actually an example of a thixotropic liquid.

In Australia, when a pharmaceutical product is made, it is either compounded or manufactured. So what’s the difference?

Compounding is essentially the ad hoc preparation of ONE supply of a particular pharmaceutical preparation, to an individual (usually on prescription). Compounded products are NOT permitted to be made in bulk or batches for storage, supply or sale later as that constitutes Manufacturing and would be considered illegal, even by those trained to do so properly. The reason for this limitation is for public safety as it limits the quantity available and the number of people likely to be exposed should something go wrong in the products preparation. The legislation, knowledge and training for Manufacturing are significantly stricter than for compounding. Anyone who is allowed to manufacture is allowed to compound, but being allowed to compound does not automatically mean you are legally allowed to manufacture.

Tools of the Trade

Alchemical, Apothecary and Herbalism Tools of the Trade in Elyria

It is my view, not necessarily that of SBS, that the following tools would be commonly used by those practicing Alchemy, Apothecary or Herbalism.

• Mortar and Pestle

• Scales

• Spatulas

• Measuring scoops, droppers and/or primitive syringes

• Glass beakers, flasks and graduated cylinders

• Weighing containers and product contains

• Ointment slab

• Heating sources

• Ledger (maybe)

If health related knowledge and understanding of microorganisms, contamination and infection increases, some form of high pressure steam device might be used as a simple autoclave to sterilize products and tools… It wouldn’t be difficult to build, but only an understanding of the need for its use would bring about its invention.

Modern Day Tools of the Trade

Mortar and Pestle

The most iconic piece of equipment used in Alchemy, Apothecary, Pharmacy, Herbalism etc. It is used to grind substances in to powders (pulverising) in a process known as trituration. If used with a liquid the process is known as levigation. It may also be used to simply mix ingredients together. Typically there are two types of mortar and pestle’s, ceramic or stone and glass. Ceramic and stone is great for grinding due to its roughness; however, it is also porous, so if liquids or semi-solids are used, the ingredients may cause a stain. This is when glass is the best option.

A balance or scales

Scales can be a pain and a source of error if not correctly calibrated and accurate weights are not used. Today it is common to have electronic balances to weigh, although some places still cling to the old ways. I imagine that CoE will use scales. Over time, usage of both the scales and the weights for measuring can cause wear and tear and even the oils and acids from the skin can affect the accuracy of weights so it is very important to regularly calibrate and check the accuracy. Weighing too little or too much may result in toxicity or therapeutic failure.

An assortment of glass flasks, beakers, jugs and graduated cylinders etc

These are used to measure volumes and store liquids, gases and solids alike.

There may be times when a metal jug or container is preferable especially if storing large volumes and/or heating is involved; however, glass can still be used in heating.

Spatulas

Typically metal spatulas are used for mixing ingredients. They are used for mixing dry ingredients such as powders, a combination of dry and wet or multiple liquids.

There are times however, when a plastic spatula needs to be used, specifically when the ingredients react with metal…

Syringes, scoops, weighing containers, pipettes, burettes, droppers

Things used to take and transfer smaller amounts of a substance from the bulk quantity for the purpose or weighing and measuring

Weighing paper and weighing boats

These are used to receive solid ingredients so that they can be contained and weighed, while preventing the scales and ingredients from coming in to contact and possibly causing contamination. These receptacles are of negligible weight to facilitate easy weighing. With the introduction of electronic balances, it is not uncommon however, to use other vessels such as a glass beaker and tare it’s weight in order to add ingredients directly in to it, especially if a measured liquid is to be added in also…. Kind of like a short cut.

A clean bench and glass “ointment” slab

Glass slabs are used to mix ingredients with spatulas, when not using a mortar and pestle (or modern machinery) especially when making a cream or ointment to ensure that the drug that is being added to the cream or ointment is added uniformly throughout.

Sieves

Not entirely necessary if using the mortar and pestle to grind a substance in to a fine powder and remove lumps in a process known as trituration.

Product containers

Containers for the final product such as jars, bottles, vials, eye droppers and eye dropper bottles, syringes, moulds/molds (depending on where you are from, and not the fungus type) and fluid bags and tubing etc.

I doubt intravenous or any type of parenteral administration would be in Elyria so fluid bags and the like seem improbable; however, I wouldn’t rule it out altogether as it is always possible that the people of Elyria advanced their medical understanding a lot sooner than on Earth.

A heating and/or cooling source.

A flame or fire to heat ingredients either directly or via a water bath in addition to ice or a refrigeration device for cooling.

Cleaning equipment I doubt this will be used much, at least at the beginning of the game; but may become more important when medical science gains an understanding of microorganisms, infection, hygiene etc. Typically 70% ethanol is used; however, for sterile manufacturing and compounding a bottle of 70% ethanol is only used for 1 day after it is opened due to the risk of contamination, while non-sterile will use the same bottle until either empty or expired. These rules are not law and the strictness of them, ie how long a bottle of 70% ethanol may be used for may vary between countries and sometimes even hospitals or companies.

Sterilization equipment

This is required for sterile manufacturing. There are various ways to sterilize containers and products. Some products should always be made in a sterile environment and/or sterilized upon completion, unless there is knowledge of microbes, this is unlikely to be necessary in CoE at least at launch. It might be possible however, to build a simple autoclave to sterilize products as all that is really required is high pressure steam.

Personal Protective Equipment (PPE)

Depending on the ingredients and substances being used, personal protective equipment may be worn to varying degrees. This may be to protect yourself from irritants, toxins in solid, liquid or gaseous form, cytotoxic (chemo drugs and cell damaging drugs) etc., and also to prevent contamination for the product being made.

For CoE however, I doubt that contamination and sterility will be considered at launch (I could be very wrong as Elyria is not Earth) since it is only in the last 150 years on earth that modern medicine took sterility and microorganisms despite evidence and theories about their existence being proposed as early as 1000 AD etc.

Most of these theories and evidence was ignored throughout Europe however, due to the prevailing theory of miasmas amongst most prominent scientists and doctors of the time.

Records

Record keeping is essential and includes all the information and instructions on what was made, what was used to make it (ingredients), how much was used to make it, when it was made, whom it was made for and the methods that were used to do so. In the case of experimental Apothecary and Alchemy, these records will be very important in case a discovery is made so that you can reproduce, or test the reproducibility of the experiment and results.

I expect record keeping in Elyria to be minimalistic by comparison though with perhaps ledgers that simply outline what the product is, who it was sold to and for how much.

Techniques of the trade

Trituration is the grinding of substances in to a fine powder. Typically this is done with dry substances using a mortar and pestle

Levigation is the trituration of a powder with a liquid in which the powder is insoluble to reduce the particle size.

Geometric doubling is the process of adding two ingredients together in equal weights or volumes. Typically the full weight or volume of the smaller ingredient is combined with an equal amount of a larger ingredient and then thoroughly mixed to create a uniform homogeneous mixture and then the process is repeated until all substances are mixed.

Simplified Pharmaceutical Formulations

Another name for a pharmaceutical formulation could be a pharmaceutical preparation or dosage form.

Solid Formulations

Oral

• Tablets, capsules, lozenges, troches, pastilles, some granules and some powders

Topical

• Some powders

Rectal

• Suppositories – may be considered semi-solid

Vaginal

• Pessaries – may be considered semi-solid

For the sake of simplicity I will be considering troches as fast dissolving lozenges, pastilles as “gummy” tablets and granules as a kind of clumpy powder so will not be going in to any real details about them.

Solid Formulations in Elyria

I am of the opinion that tablets could be easily made using a simple tablet press, but not capsules as the gelatin shell is considerably more difficult and time consuming. I also doubt the need for them would be imagined just yet and necessity is the mother of invention after all…. That and greed! I believe the use of powders would be extensive as they are simple and ready to go once triturated, requiring no further modification. They would be well used topically on the skin for rashes, burns and infections and are easily dispersed in to liquid to make a drink such as a tea. Doses are also easy enough to measure using spoons from bulk containers or the powder could be divided in to little single use sachets of paper or other materials.

I also believe that lozenges may be used as the powdered herb/drug could be combined with single use confectionary, lollies, candy even chocolate which would provide for a pleasant tasting, quickly dissolvable dose used to treat mouth

conditions and systemic conditions alike.

For obvious reasons, I think suppositories and pessaries will be omitted, though it would be funny if suppositories could be used to impart invulnerability from griefers as they are a real pain in the ass!!

Tablets and Capsules

What are they?

A tablet is a hard compressed powder that contains a single specific dose of one or more drugs. A capsule is a hard or soft cylindrical gelatin shell that contains a single specific dose of one or more drugs. If the drug is embedded in to a polymeric matrix, the breakdown and dissolution of the powder may be slowed and controlled to a specific rate allowing for the release and absorption of the drug to occur over an extended period of time. Such tablets and capsules are called “slow-release” or “controlled-release” and offer the advantage of reducing the frequency of administration and extending the duration of medicinal coverage a drug provides. The main disadvantages are in overdoses the toxic effects are seen for considerably longer and slow release medication is ineffective for acute treatment as take much longer for the drug to reach therapeutic levels.

These days individual tablets and capsules generally contain extremely small amounts of medication that are unable to be measured accurately; however, considering most medication requires repeated doses for either a course or indefinitely, a bulk quantity is measured and used to overcome this problem.

Simplified Preparation Method

The bulk amount of a drug X is simply weighed and then combined and mixed thoroughly with a chemically and pharmacologically inert substance Y. The powders are typically triturated into a fine powder and the process of triturating could be used to combine and mix the powders thoroughly (from an Elyrian point of view). With drug X uniformly distributed throughout substance Y a much larger and easily weighed amount of the combined powder can be weighed to obtain exactly one specific dose of drug X. This is then taken and compressed in to a tablet or used to filling a capsule in the most basic form of a tablet or capsule.

Typical ingredients (Excipients)

Some powders that are compressed in to a tablet, much like a powder that has caked at the bottom of a suspension does not always break apart, dissolve or disperse very easily leading to erratic absorption. On the other hand other tablets can disintegrate far too easily, especially in the presence of moisture which can lead to problems with accurate dosing, exposing the unpleasant bitter taste of the drug and even inactivating the drug if it is susceptible to hydrolysis, the chemical breakdown of a substance due to reacting with water.

It is for these reasons and quite a few others that basic tablets and capsules are rarely used these days and other inactive and safe substances known as excipients are added to the powder to control the tablets breakdown and absorption. Often one substance can have multiple uses as an excipient.

Binders: These help to stabilise tablets by causing the powder to stick together and stop disintegration outside the GI tract.

• Starch, lactose, cellulose or microcrystalline cellulose, mannitol

Glidants and lubricants: These excipients reduce friction to help the powder and tablets flow through the machinery without sticking.

• Starch, talc, vegetable oils and fatty acids, silica, magnesium stearate

Disintegrants: There excipients facilitate tablet breakdown inside the GI tract by absorbing water and expanding to break open the tablet.

• Carboxymethyl cellulose (croscarmellose sodium), various starches

Effervescent tablets: Help to cause very fast dissolution and improves the unpleasant taste, producing a carbonated drink.

• Citric or tartaric acid

• Carbonates or bicarbonates

Coatings: Coatings are used to mask the unpleasant taste, make tablets smoother and easier to swallow, while extending shelf-life and protecting the tablet from stomach acid.

• Hypromellose (hydroxypropyl methylcellulose)

• Various sugar coatings

• Starches

• Fatty acids

• Edible waxes

Lozenges, Troches, Pastilles

What are they?

Lozenges, troches and pastilles are not unlike medicated confectionary consisting of sugar and gum (lozenges), gelatin or polyethylene glycol (troche) or glycerol and gelatin (pastilles). Typically these pharmaceutical formulations are used to treat conditions of the mouth and throat or take advantage of buccal absorption which has a faster onset of action and lower metabolism systemically, for systemic ailments.

The main difference, other than texture is that lozenges and pastilles are slow releasing (slow dissolving), while troches are fast acting (fast dissolving) thus troches are perhaps more suited to systemic ailments using buccal absorption while lozenges and pastilles are more suited to localised treatment of the mouth and throat.

Powders

Oral Powders

The only real difference between an oral powder for ingestion and a tablet or capsule is that the powder hasn’t been compressed or enclosed within a gelatin shell. They are typically washed down with a water/beverage or added to water to make a drink such as a tea or carbonated beverage if effervescent.

The advantage of oral powders is that they are already dispersed so would get absorbed faster than a tablet or capsule. They may still require flavouring, effervescence or a flavoured beverage to mask the bitter taste of the drug, but would not need other excipients such as binders, gliders, disintegrants or coatings.

Since the amount of drug would still be very small like tablets and capsules, bulk doses of the drug would still need to be weighed out and then combined with a chemically and pharmacologically inert substance Y as described in *Tablets and Capsules.

If a bulk amount were to be prepared and not divided it is recommended that they not be anything too potent or dangerous as overdose would be very easy due to inaccuracies when being measured out with a 5ml medicine spoon etc. If the powder is in divided doses such as sachets, this is not so much of a problem.

For more details see Tablets and Capsules

Topical Powders

There are different types of topical powders, or perhaps more accurately, there are different names for powders that are applied to different parts of the body.

Dusting powders are applied externally to the skin, but should not be applied to an open wounds unless they are sterilised. It is very important that dusting powders are triturated in to a very fine powder as this helps to avoid localised irritation. They are one example where using a sieve is essential to ensure the powder is of a fine consistency.

Dusting powders typically start with a base of starch, kaolin or talc and are then combined with other ingredients. Talc and kaolin are the preferred bases as they are inert. Dusting powders can be used as antiseptics, astringents, absorbents, antiperspirants and protectants etc.

Insufflations are medicated dusting powders specifically designed for internal use within a body cavity (nose, throat, ear, rectum etc). They are administered via a small kind of manual aerosol known as an insufflator, or via a pressurised aerosol. Typically the pressurised aerosols are reserved for potent drugs. Typically insufflations are antibiotic powders used to treat infections of the ear, nose and throat, although I could see an application for such medication in the treatment of anorectal inflammatory bowel disease with corticosteroids and 5’ aminosalicylates etc The advantage to insufflations is a local effect rather than a systemic effect, so reduced (but not necessarily eliminated) toxicity and side effects.

Semi-Solid Formulations

A cream I made for paediatric burn victims at a children’s hospital

Creams and Ointments

What are they?

What exactly is a cream or ointment and how do they differ from each other? Creams and ointments are the non-medicated base that is used to hold an active ingredient or simply moisturize and protect a topical surface.

We all know that oil and water don’t mix right?

Wrong!

Well sort of. You see in the absence of any other factors a pure oil and pure water combination would not mix too well if at all; however, with the right additive, known as an emulsifier, you can actually get globules of either oil or water to uniformly disperse in to the other to form what is known as an emulsion. Emulsions are thermodynamically unstable biphasic liquid preparations consisting of two or more immiscible (non-dissolving or mixing) liquid phases. Creams are emulsions containing oil droplets dispersed in to water and ointments are emulsions containing water droplets dispersed in to oil.

Some examples of food related emulsions include mayonnaise and butter, while ice cream and frozen yoghurt are 3 phase emulsions consisting of oil, water and air.

Typically emulsifiers (those substances that help oil and water to mix) are amphiphilic containing both a hydrophobic/Lipophilic (oil “liking”) end and a hydrophilic/lipophobic (water “liking”) end that allow it to act as a kind of intermediate bridge or connector between to the phases and stabilise the dispersion. Surfactants are one example of an emulsifier and detergents and soap are an example of a surfactant that uses this property to clean grease and oily residues.

Some examples of natural emulsifiers/surfactants include honey, egg yolk (lecithin), soy bean oil (soy lecithin), mustard, palm oil, coconut oil, rapeseed oil and sunflower oil just to name a few.

So what? What does this have to do with creams and ointments?

Well, a cream is a viscous semi-solid emulsion consisting of oil droplets dispersed in to a water base, while an ointment is a viscous semi-solid emulsion (sometimes straight dispersions or solutions) consisting of water droplets dispersed in to an oily base. Ointments contain a much higher proportion of oil compared to creams. While other variations exist, such as fatty ointments and oily creams, for simplicity we’ll just stick to the basics.

Creams and ointments are used as a pharmaceutical vehicle to carry a medicinal compound that is to be applied to the body’s surface. They have little to no medicinal action themselves other than providing some soothing, protection and hydration etc.

Being water based creams are typically non-greasy and wash off easily while ointments are greasy and tend to be sticky. I have heard ointments referred to as non-washable; however, this is not entirely true. If for some reason you had to wash an ointment off, you would just have to use another oil such as cooking oil instead of water.

While creams are hydrating to the skin, ointments have the advantage that they are more protective and occlusive to trap water in the skin.

Typical ingredients (Excipients)

So we need oil, water and an emulsifying agent right?

Well yeah! But that doesn’t mean you can grab a barrel of crude oil, mix it with toilet water, and squirt in some dishwashing detergent and voila!

Well you could, but no one is going to want that shit!

And it isn’t exactly going to be appropriate to deliver a medicinal compound to the skin, eye, nose, mouth etc.!!

So what ingredients are appropriate and typically used in creams and ointments (Not all at once though)? Not an exhaustive list and everything should be sterile and pharmaceutical grade!

• Purified Water

Oils:

• Arachis oil (Peanut oil – avoid in Peanut allergy)

• Olive oil

• Castor oil

• Liquid paraffin

Waxes and other fatty products:

• Bees wax

• Yellow and white soft paraffin

• Hard paraffin

• Wool fat (lanolin)

Glycerol (glycerine and glycerin) and Propylene glycol:

• Non-toxic

• Hygroscopic: attracts and holds on to moisture

• Emulsifier

• Preservative

• Not to be confused with Ethylene glycol which IS toxic

Emulsifiers:

• Emulsifying Ointments

• Various alcohols that also work as preservatives.

• Not bourbon, scotch, whisky, vodka or anything like that though

Preservatives to stop bacterial growth.

Simplified Preparation Method

Typically ingredients are heated, made liquid and then combined and mixed thoroughly. It is continuously stirred as it cools until it thickens and becomes stable. The cooling process can take some time so stirring can get very tiring without modern machinery.

Solid ingredients, even those that are already in powder form are further ground in to a fine powder in the process known as trituration. If a liquid is used to assist this process and wet the powder such as when making an ointment it is known as levigation. A method of successive geometric doubling is then used to combine the powder and the base before being rubbed into the cream or ointment with a spatula at each “doubling” to make a smooth, grit-free cream or ointment.

As an added bonus, if you did this by hand, you now have an arm that is dead and aches like hell 

It is essential for any product intended for use in an open wound, burn or in the eye to be sterilised to avoid infection. Furthermore it is essential for ophthalmic (eye) preparations to be physiologically compatible with the eye to avoid irritation and potential damage to the eye. To achieve this things like buffers, stabilizing agents, dispersing agents, solubilising agents, anti-oxidants & agents required for tonicity/ viscosity adjustment are added to make sure the product is pH and osmotically balanced

Pastes

Pastes are similar to ointments, with two main differences. The base that is used is not necessarily an emulsion, although an ointment may be used as the base and they contain a comparatively large amount of powder that makes them stiff and difficult to spread.

Typically the base is a simple combination of liquid paraffin and white soft paraffin, but may also be glycerine or castor oil and would be prepared in much the same way as creams and ointments.

Gels

Gels are almost the opposite of pastes resembling something like a super thick suspension (details to follow). They have a simple aqueous based that is not oily and tend to be more water than powder. The water is thickened with a gelling or thickening agent which forms a matrix to trap and hold the water in place. Gelling agents include gelatin, tragacanth, methylcellulose or alginates just to name a few.

They have an advantage over solutions by sticking in place where they are needed, often providing a cooling effect as the water evaporates and may provide a protective film once the water is fully evaporated.

In addition to water and a gelling agent, glycerol is an important additive in many gels due to its hygroscopic and antibacterial properties.

Liquid Formulations

Suspensions

What are they?

Suspensions are biphasic liquid preparations consisting of insoluble finely divided solid powders that are dispersed in to a liquid or semi-solid vehicle with one or more suspending agents to uniformly disperse the solid particles throughout the liquid phase. This is important for administering accurate dosages because if the solid particles were not evenly distributed in the liquid phase, the dose would vary with each dose ultimately leading to either therapeutic failure or potential toxicity.

A classic example of a suspension is paediatric antibiotics. Many liquid cough, cold and allergy medication are also suspensions. But suspensions aren’t limited to ingested products because they can also be medicated inhalers as aerosolized suspensions, oral, nasal, ophthalmic (eye) and otic (ear) drops, injections and practically every other liquid pharmaceutical preparation that contains an insoluble solid in a liquid vehicle.

Another classic example of a topical suspension is calamine lotion.

The cholera vaccine is an example of a suspension where the suspended solid particles are the deactivated/killed Vibrio cholera bacterium.

Suspensions have the advantage that they offer chemical stability for some drugs and they often facilitate a higher rate of bioavailability (amount of active substance/drug that reaches systemic bloodstream) compared to other formulations. The exception to this is solutions which are even better. They are also a great way to mask the unpleasant bitter taste of most drugs.

The main disadvantage of a suspension is the comparatively lower physical stability which may result in sedimentation and caking of the solid particles at the bottom of the liquid. This makes achieving precise doses difficult unless the suspension is packed as single doses.

They are also considerably more difficult to formulate considering just the right amount and combination of suspending agents are required to allow uniform dispersal of the solid particles when shaken and then the resulting increase in viscosity to maintain dispersal when left standing.

Furthermore, changes in environmental temperature can change the properties of the suspending system.

As a result ALL suspensions require thorough shaking before administration of dose.

Desirable properties of suspensions

• Solid particles should settle slowly and be easily redispersed on shaking

• They should be easily poured from container

• They should be chemically inert

• Solid particles should not cake at the bottom

• They should prevent/reduce the degradation of the drug over time.

• They should mask the unpleasant bitter taste of drugs

Suspensions can be used orally, parentally in to the bloodstream or non-oral body cavity, topically to the skin or eye.

It is essential for any product intended for use in an open wound, burn parenterally, or in the eye to be sterilised to avoid infection. Furthermore it is essential for ophthalmic (eye) and parenteral preparations to be physiologically compatible with to avoid irritation and potential damage. To achieve this things like buffers, stabilizing agents, dispersing agents, solubilising agents, anti-oxidants & agents required for tonicity/ viscosity adjustment are added to make sure the product is pH and osmotically balanced

Typical ingredients (Excipients)

Purified water

*Wetting/flocculating agents/Surfactants *

• Benzalkonium choride

• Cetylpyridinium choride

• Polysorbates

• Sorbitan Sesquioleate

• Alcohols

• Potassium and Sodium chorlide

• Sulfates, citrates and phosphate salts

Viscosity modifiers/Suspending agents (thickening agents)

• Carboxymethylcellulose (croscarmellose sodium)

• Methylcellulose

• Xanthan gum

• Agar

• Corn Starch

• Bentonite

• Guar gum

• Tragacanth

• Gelatine

• Accacia

Tonicity/Osmotic modifiers

• Glyerol (Glycerin/Glycerine) *

• Potassium or sodium chloride

• Mannitol

pH buffering agents (parenteral and ophthalmic preparations)

• Anhydrous sodium citrate

• Anhydrous or monohydrate citric acid

• Monohydrate potassium citrate

• Anhydrous sodium citrate

• Anhydrous dibasic potassium phosphate

• Tartaric acid

• Acetic acid

• Sodium bicarbonate

Antioxidants

• Anhydrous or monohydrate citric acid

• Edetate disodium (EDTA) *

• Potassium or sodium metabisulfite

• Alpha-tocopherol (Vitamin E)

• Ascorbic acid or ascorbyl palmitate (Vitamin C or derivative)

* Preservatives/Antimicrobials*

• Glyerol (Glycerin/Glycerine)

• Propylene Glycol

• Alcohols

• Benzalkonium choride

• Benzoic acid

• Butylparaben and Methylparaben

• Edetate disodium

• Potassium or sodium benzoate

Sweeteners and Flavours

• Glyerol (Glycerin/Glycerine)

• Propylene Glycol

• Potassium sorbate

• Sodium saccharin

• Aspartame

• Mannitol

• Sorbitol

• Sucrose

• Sucralose

• Cherry flavour

• Berry flavours

• Citrus flavours

• Peach flavour

• Apricot flavour

• Vanilla flavour

• Chocolate flavour

Preservatives, Sweeteners and Flavours have been given a bad rap. It is true that a small number of people react with some of these additives, most of which has been attributed to artificial colours and flavours; however, not all preservatives, sweeteners and flavours are the same, not all of them are artificial and they are actually essential in medication. Without sweeteners and flavours the drugs in medication would be completely unpalatable and without preservatives they would become contaminated with bacteria, viruses and fungi very easily, reducing their shelf-life and posing a health risk in their own right.

Cherry and berry flavours appear to work the best at masking the bitter taste of drugs. My personal experience is that blackberry flavour works really well and tastes great!!

Note Some excipients have multiple properties and can be used to accomplish multiple effects. One such excipient is glycerol which can be used as a sweetener, a preservative and tonicity modifier. It is completely safe and non-toxic and can reduce the number of ingredients by using it to achieve multiple effects.

Simplified Preparation Method

To make a suspension, the insoluble, dry ingredients are first triturated in to a fine powder using a mortar and pestle. The suspending agent is then added to the powder and mixed. Too much pressure and friction at this point will result in caking and the product becoming very stick and hard to manage. If a wetting agent is used in the formulation, it is added at this point. Next all soluble ingredients and dissolved in to the liquid vehicle. If the formulation uses glycerol or syrup it is added to create a paste, else a small amount of the liquid vehicle is added and a smooth paste free of lumps is made. Small portions of the liquid vehicle are gradually added until the paste becomes a slurry and can be poured in to a graduated measuring cylinder.

The slurry is transferred to a graduated measuring cylinder and the mortar and pestle is rinsed with successive portions of the remaining vehicle.

The suspension is then observed to see if the solid particles are suspended properly, sediment or caked at the bottom and/or flocculated or clumped in the liquid vehicle. It is then adjusted accordingly using the suspending agent, surfactant and/or flocculating agents.

When done adjusting the suspension, any volatile ingredients, colours and/or flavours can be added. Finally more of the liquid vehicle is added to make it up to the final volume/concentration. You now have a suspension.

A suspension of hydroxyurea/hydroxycarbamide (anti-cancer drug) I made up for some kids with leukaemia

Solutions

What are they?

Far simpler than a suspension, solutions are one or more ingredients dissolved in to a liquid solvent. There are no solid particles present in the liquid. They can be used topically, orally and parenterally and of all the pharmaceutical preparations, they have the highest bioavailability.

Solutions have the advantage that they are always homogeneous so the drug is always uniformly distributed throughout the solvent and they have the highest rate of absorption so quickest onset of effect. They are also incredibly easy to prepare.

Disadvantages include being a suitable medium for microbial growth, if an ingredient precipitates, that is comes out of solution to form a solid, the whole product my be ruined, especially if it is an injection and the unpleasant bitter taste of drugs is significantly more pronounced in solution than any other preparation so sweeteners and flavours are essential.

Examples of topically used solutions:

• Gargles and mouthwashes

• Liniments which are alcoholic or oily solutions or emulsions applied to the skin. They are often used in massage containing “heating” ingredients known as rubefacients and counterirritant

• Collodions which are solutions of nitrocellulose in ether or acetone which evaporates to leave a medicated film on the skin ie wart remover with salicylic acid, lactic acid and/or acetic acid as the active ingredient.

• Aerosolised solutions in inhalers and sprays

• Medicated eye, ear, nose or mouth drops

Typical ingredients (Excipients)

• Freshly boiled purified water

• See Suspensions ingredients, pH buffering agents, antioxidants, preservatives, sweeteners and flavours for details

Simplified Preparation Method

Boil water, cool water, triturate soluble solid ingredients to a fine powder, add soluble ingredients, make up to volume with water.. Done!!!

Syrups, Elixirs, Linctuses

Syrups are concentrated, saturated solutions of sucrose in water. This is about 66.7% sucrose in water w/w.

Syrups have the advantage that they reduce oxidation, prevent decomposition of many vegetable substances and prevent bacterial growth. They are also palatable due to their sweet taste.

Elixirs are clear, sweetened, aromatic, alcoholic solutions often used to contain potent drugs. Linctuses are viscous liquid preparations most used for cough and cold usually containing ingredients to breakup and loosen congestion, dry a runny nose, open nasal passages and soothe a sore throat.

Elixir Typical ingredients (Excipients)

• Purified water

• Ethyl alcohol

• Glycerol or propylene glycol

• Colours, flavours and preservatives

• See Suspension ingredients for more details

That’s me going all Breaking Bad

Can’t be too careful when dealing with hydroxyurea/hydroxycarbamide

Holy heck this is going in my bookmarks. Fantastic reference! Keep it up!

The devs will probably have a similar mechanism in the game - kinda like the way Skyrim had it's alchemy and ingredient setup. But knowing them they're probably going to have a lot of weird plant names and stuff. This'll still be amazing.

You should join NA-W and open up an apothecary!!! Aranor forever!!

Thanks guys.

I appreciate the offer Spinam, but I am an Aussie on the Oceania/APAC server already :)

Weird plant names are good :), It will mean herbalists and healers etc will have to work everything out from scratch. I am just hoping this information might serve as a template of sorts. I don't mind if names are changed, but maybe the types of side effects and mechanisms of healing and poisoning might be useful.

Skyrim is a reasonable example of a herbalism system, but I find health, disease, diagnosis, treatment and pharmaceutics (medicinal preparation) side of things it are very much neglected in games.

I would like to add some real depth to the game mechanics. I believe if you break it in to multiple simpler algorithms, you could build a far more complex and realistic system, that is very rewarding.

I hope to cover simplified disease, diagnosis with signs and symptoms and treatment algorithms in the next chapter, followed by pharmaceutics and how to prepare the medicine.

I appreciate the feedback.

Defiantly going to bookmark this for rereading.

Outstanding work Haji!

Wow amazing. You must have been working on this for a while considering how much research must have gone into it.

Thanks Uriel, Helgard and MusaKn

Posted By MusaKn at 8:16 PM - Sun Nov 19 2017

Wow amazing. You must have been working on this for a while considering how much research must have gone into it.

While the write-up so far has been a relatively quick exercise when I get the time, you could say that when this topic is finished (currently working in chapters 3 and 4) it will be a very brief summary of 9 years worth of study and research.

This is a great reference for those of us RPing as herbalists/alchemists, and an idea of the types of reagents we might see in-game. The humor added is definitely appreciated.

Nicely done and good read.

Thanks Scuttle and Athad,

I should be releasing the next chapter in a couple of days and then another one hopefully a few days after that.

Really a nice post ! Good luck with your recruitment !