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    Esoteric Taoism doesn’t solve ego-created prob- lems by demanding the surrendering of one’s individuality to a larger group of guru buy discount alesse 0.18 mg online. The only devotion it demands is a disciplined committment to leading a healthy and harmonious life order alesse 0.18mg otc. Taoist Esoteric yoga is com- patible with any religious belief cheap alesse 0.18mg without prescription. The language of Taoism is not de- fined by any set of mental “beliefs”, but by the “experience” of in- creasingly subtle and powerful forms of chi energy. No mythologi- cal entities or divine symbols are evoked. But if someone chooses to identify this chi with the Christian notion of the Holy Spirit, it will not adversely affect the Taoist method of chi transformation. This holds true at the very highest levels of practice. This same Chris- tian could draw accurate parallels between the Biblical ascent of Elijah on a flaming chariot into Heaven with the Taoist formula for the seventh stage meditation, “Reunion of Man and Heaven”. Simi- lar parallels could be drawn with Buddhist Hindu, or Qabalist sym- bols of spiritual advancement. The point the Taoist masters were making is that the pattern of chi flow and balance is similar in all men, regardless of interpretive belief about their religious experi- ences. Taoist yoga is a theologically neutral method for preparing the dense physical and mental body to consciously receive a more powerful dose of cosmic yin and yang energies. Imagine the aver- age human being is accustomed to functioning on 110 volts. He cannot suddenly absorb into his conscious mind the kundalini en- ergy, which is powered by the subatomic nuclear energy that binds the universe together and is made visible in the radiant heat and - 154 - Chapter XIV light of the sun. To even double the received voltage to 220 re quires considerable conditioning of the body. The more accessible form of Kundalini power is human sexual energy. But to absorb anything above your accustomed voltage is dangerous, like being struck by lightning without a ground wire to the earth. The Taoist system of circulating chi, from the Microcosmic Orbit up to the level “reunite Man and Heaven”, is a grounding rod for Kundalini energy. Modern researchers into spiritual phenomena see the Kundilini as a possible mechanism to describe radical leaps in the evolution of human consciousness. The classic account is Gopi Krishna’s autobio- graphical “Awakening of the Kundalini’ (Shambhala Press). Gopi Krishna was an Indian railroad official who in 1937 experi- enced abrupt, dramatic physical and psychic changes as a result of his yoga practice. Energy began dancing and coursing power- fully through his body, but his initial wonderment and bliss soon faded. He was nearly incapacitated by it as the energy would not stop, sometimes leaving him tormented and sleepless for day on end. Only after twelve years of this nightmare existence was he able to learn how to balance the energy within his body and use it in a newly discovered creative life as a poet and author of a dozen books. The Kundalini Research Institute in New York City reports world- wide over a hundred cases each year of individuals who cannot explain the uncontrollable release of energies in their body, often accompanied by days of sleeplessness, ringing and hissing noises in the ears and flashes of light inside the body. Some are students of yoga or meditation whose teachers abandon them after seeing they are powerless to diagnose or help the condition. For this reason kundalini-oriented practices have earned a repu- tation as dangerous, radical, and unsafe for most westerners seek- ing what they falsely perceive as the fastest path to enlightenment. A number of students suffering from kundalini-like side effects of different meditational practices have come to Mantak Chia for advice. Usually after doing the Microcosmic Orbit or simply putting the tongue to the palate and thinking down, these unpleasant symp- toms disappear. Practitioners of other techniques, sitting, mantra, pranayama, can achieve a high level of awareness and a balanced experience of kundalini-like energies.

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    Associated features include myoclonus purchase alesse 0.18 mg on line, asterixis generic alesse 0.18 mg visa, tremu- lousness alesse 0.18 mg discount, and seizures. Seizures often respond poorly to anticonvulsant medication unless the associated metabolic disturbance has been corrected. Hyponatremia should be corrected at a rate not exceeding 12 mEq/L/day because rapid correction of hyponatremia leads to central pontine myelinolysis. Central pontine myelinolysis may obscure or follow improvement in hyponatremic encephalopathy. The pathologic hall- mark of the disorder is breakdown and loss of myelin in the anterior pons and other brain stem regions, which may be visualized by magnetic resonance imaging. The disorder is associated with alcoholism, electrolyte disturbances, malignant disease, and malnutrition, and it relates particularly to the rapid correction of hyponatremia. A 78-year-old woman is transported to the emergency department after being “found down” by a fami- ly member. Upon arrival at the emergency department, the patient is pulseless and apneic. A “code 10” is called, and advanced cardiac life support is initiated. Chest compressions are performed, and the patient is intubated and oxygenated with 100% fraction of inspired oxygen (FIO2). Pharmacologic therapy with epinephrine and atropine is administered. After the second round of epinephrine and atropine, the patient regains a pulse. She is transferred to the medical inten- sive care unit for further care. You are concerned about the possibility of anoxic-ischemic encephalopa- thy secondary to circulatory arrest. Which of the following statements regarding anoxic-ischemic encephalopathy is accurate? In the mature nervous system, white matter is generally more vulnera- ble to ischemia than gray matter 20 BOARD REVIEW B. In the mature nervous system, the brain stem is more vulnerable to ischemia than the cerebral cortex C. The persistent vegetative state is characterized by the return of the sleep-wake cycle, but wakefulness is without awareness D. Brain death is defined as the loss of all cerebral activity for at least 48 hours Key Concept/Objective: To understand the characteristics of the persistent vegetative state and the definition of brain death The persistent vegetative state is characterized by the return of sleep-wake cycles and of various reflex activities, but wakefulness is without awareness. Recent studies have indi- cated that the minimally conscious state, which is characterized by inconsistent but clear- ly discernible behavior of consciousness, can be distinguished from coma and a vegetative state by the presence of behavioral conditions not found in either of those two conditions; this distinction is important because outcome appears to be different in minimally con- scious patients. Brain death is defined as the loss of all cerebral activity, including activity of the cerebral cortex and brain stem, for at least 6 hours if confirmed by electroen- cephalographic evidence of electrocerebral inactivity or for 24 hours without a confirma- tory electroencephalogram. A 68-year-old woman with a history of alcohol abuse and dependence presents to the primary care clin- ic for evaluation of confusion. The patient is accompanied by her daughter, who is concerned about her mother’s forgetfulness and who feels that her mother has been “making things up. On the basis of the physical exami- nation and a history of confabulation, you make the diagnosis of Wernicke encephalopathy. A deficiency of which of the following is responsible for this condition?

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    Asymptomatic patients with hypothyroidism are at significant risk for myxedema coma D purchase 0.18 mg alesse amex. Patients who are receiving long-term corticosteroid therapy need replacement therapy perioperatively Key Concept/Objective: To understand the management of surgical risk factors It is now clear that the use of perioperative beta blockers can prevent complications after surgery cheap alesse 0.18 mg mastercard, both short term and long term order alesse 0.18mg online. Patients with known CAD who can toler- ate beta blockers should already be taking these drugs. Many experts recommend starting beta blockade before surgery in patients at high risk for CAD. Patients with a diastolic blood pressure below 110 mm Hg are not at significantly greater risk and do not require specific blood pressure man- agement. However, it is clear that in patients with poorly controlled blood pressure who undergo surgery, blood pressure may swing widely, both in hypertensive and hypoten- sive directions. Both high and low blood pressures can cause problems perioperatively. Unless surgery is urgent or emergent, hurried attempts at blood pressure control are not advised. Patients with hypothyroidism, provided they are functional, do not have sig- nificant problems with surgery and do not require special treatment. Patients who are clinically hyperthyroid are at risk for thyroid storm perioperatively, so hyperthyroidism should be well controlled before surgery is undertaken. In normal persons, the daily output of cortisone is approximately 30 mg; peak stress levels are approximately 300 mg a day. Unfortunately, no good studies have been done to determine which patients definitely need supplementation and how long the increase in dose should be maintained. Current practice is to give additional medication to patients who are taking the equivalent of 30 mg or more of hydrocorti- sone a day. For patients at lower dosage ranges, supplemental doses (e. A 24-year-old man presents to the emergency department for evaluation. The patient was in his usual state of health until 7 days ago, when he developed fever and malaise with headache, backache, nausea, vomiting, and abdominal pain. Five days ago, he developed a rash on his face and arms, which has spread over most of his body. Physical examination is remarkable for a prominent rash consisting of diffuse, small macules and papules and occasional pus- tules. Your first consideration is that the patient may have a viral syndrome, such as varicella infection. The possibility occurs to you that a patient with smallpox could present in this way. Which of the following statements regarding smallpox infection is true? In infections of smallpox or varicella, skin lesions typically appear in different stages of development on any given part of the body B. Infectious mononucleosis is the disease most likely to be confused with smallpox C. Patients suspected of having smallpox require significant contact precautions, but airborne precautions are not required D. Only personnel who have been successfully vaccinated within 3 years and who are wearing appropriate barrier protection should be involved in specimen collection for suspected cases of smallpox Key Concept/Objective: To know the clinical manifestations of and appropriate containment methods for smallpox virus Severe varicella is the disease most likely to be confused with smallpox.

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