Question: So, how does ointment work? When you apply ointment on your skin for an insect bite, how does it heal the sting? Or, doesn't it?
Kenny Lim: Well it depends on what you use, but normally what we sell in the UK is an anti-inflammatory steroid cream like hydrocortisone 1%. The steroids mess about with the protein synthesis in cells and reduces the inflammation.Kenny Lim: Also I should mention that ointment and cream are slightly different in formulation. Both consist of an emulsion(mixture) of oil and water with a surfactant(it holds the oil and water together) but ointment is usually more "Oily". Most people prefer creams over ointments when it comes to skin conditions because it doesn't leave a greasy mark when you apply it, but generally ointments are better as protective agents(prevent the skin from drying out)
Imran Radzmi: Oooh didn't know steroids interfere with protein synthesis too! How exactly does this occur? I always assumed the swelling is caused from migration of plasma into interstitial fluid in tissue, and steroids would surely cause the latter at least, since it interferes with immunity responses of which inflammation is one of em, interleukins and whatnot
Imran Radzmi: I always found it strange that we cripple the body's natural response to wound healing with anti-inflammatories though, aside from say deletrious immune responses
Kenny Lim: Well generally inflammation is not bad when you talk about bruises and wounds. There's a lengthy article here that explains in detail how steroids (glucocorticoids) work http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751559/
How corticosteroids control inflammation: Quintiles Prize Lecture 2005
www.ncbi.nlm.nih.gov
Imran Radzmi: Fulamak, ok i'll try and read this.
In any case, inflammation helps recovery by reducing blood flow so that fibrin can condense more efficiently ka?
Kenny Lim: No it increases blood flow. So you can get the white blood cells into the inflammation site(in case of infection) and also heat up the area to speed up the process of healing. The idea is to kill off foreign bodies, clean up any foreign material(usually inflammation is initiated by damaged tissue, which floats around and is eaten up by macrophages) and start with the repair process.
Kok Sen Wai: You will be surprised to know how many diseases kills us not on its own but by causing our own body to hurt itself. I haven't counted but I think it might even be in the majority. That's why corticosteroids is a favourite of quack physicians (Chinese TCM practitioners especially, I understand). It really is a wonder drug. The reason why we in mainstream medicine is more reticent in using it willy nilly is that it can cause serious, serious side effects in the long run. Quacks that just want to quickly relieve your obvious symptoms (thus demonstrating how superior they are) have no such qualms.
I got many people telling me how wonderful their TCM doctor is because they managed to "cure" their disease when their Western doctors can't. That's because we aren't into unscrupulous use of corticosteroids. I have seen many people coming in with Cushing's Syndrome from these sort of therapy.
Imran Radzmi: Kenny- Increases blood flow? I always assumed all that swelling would impinge on the vasculature and cause constriction. It's the opposite? There is the heating effect but that can be explained by the increased blood flow..so how is flow increased?
Kok-Yeowch, do you mean ailments like autoimmune disorders and anaphylaxis. Which still makes it strange to me. Then again the basis for autoimmune diseases isn't really understood yeah?
Yeah that makes sense, since most who approach TCM, aside from terminal diseases probably do so for treatment of chronic pain like say poking needles into your arthritic knees lol
All this talk of painkillers reminds me of a study that showed a correlation between elevation of mood and ingestion of anti-inflammatories and pyretics. One could surmise the body that goes into a state of repair might decrease activity and excitability and this might have neurological effects as well. Only read that one study though, and it was a small sample size i think
Kenny Lim: No no, it's the other way around. The vasodilation increases blood flow, and the blood vessels become more "leaky" which allow macrophages and other proteins to enter the affected area, which causes the fluid to leak into the site of inflammation causing the swelling.
Imran Radzmi: Yeah that's what i meant, vasodilation increases blood flow, but i was wondering how swelling which should constrict the vasculature, increase blood flow, but you just answered that by mentioning permeability, which i should have understood anyway given that i mentioned interstitial fluid...stupid me
Imran Radzmi: So it's not necessarily blood flow, but mainly leakage from the vessels isn't it?
Kenny Lim: Well I mentioned vasodilation earlier. That increases the blood flow. As you should know, blood is made of one part plasma too. That fluid leaks out of the blood vessels, making it swell.
Imran Radzmi: Yeah, but you didn't mention where the vasodilation comes from? I was asking if the vasodilation itself was directly CAUSED by the swelling. So, the vasodilation that accompanies wounds and such, occurs separately?
Kenny Lim: That would be histamine and nitric oxide released when tissues are damaged. http://www.daftblogger.com/vascular-response-in-acute-inflammation/
Vascular Response in Acute Inflammation | Daft Blogger - Making it accessible
www.daftblogger.com
Kenny Lim: If you want a bit more detail, you can find mast cells in connective tissue, which contains a resevoir of histamine. When the tissue breaks, mast cells release histamine, and inflammation starts.
Imran Radzmi: Ahh nitric oxide is released, no wondahh.
Pepper Lim: We should make an info graphic to explain this.
Pepper Lim: Kenny, could you break down your explanation on how ointment works into 4 or 5 panels that I can draw? Simple explanation please.
Kenny Lim: Again, going to assume you mean hydrocortisone. I'd start off by explaining what happens in inflammation. In a wound or a bruise, connective tissue is damaged. Histamine is released from this broken tissue, causing vasodilation, cytokines(proteins) are also released, which recruit white blood cells like monocytes(more proteins) which chomp up all the broken and dead tissue. Vasodilation causes increased blood flow and osmotic pressure goes up. Intersitial fluid leaks into the site of inflammation, causing swelling. Hydrocortisone cream interferes with DNA synthesis, which reduces the production of pro-inflammatory proteins, thus reducing swelling.
Pepper Lim: Let me take out my dictionary and try to make sense of it first before I attempt to draw it.
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