HAR §11-451-14. extent practicable, the actions necessary to evaluate and address facility or vessel problems shall be identified, or required to be identified, by the department

Where determined appropriate by the department, the following tasks shall be conducted: (1) Assemble and evaluate existing data on the facility or vessel, including the results of any removal or remedial actions, and assessments; (2) Develop a conceptual understanding of the site, based on the evaluation of existing data; (3) Identify likely remedial actions and potentially applicable technologies that may be used to address site problems, including the identification of presumptive remedies pursuant to section 11-451-15(d); (4) Identify the type, quality, and quantity, of the data that needs to be collected during the remedial investigation to support decisions regarding response actions; (5) Prepare site-specific health and safety plans that shall specify, at a minimum, protective equipment, medical and surveillance requirements, standard operating procedures, and a contingency plan that conforms with Title 29 of the Code of Federal Regulations §1910.120, revised as of July 1, 1993; (6) Preliminarily identify the nature and magnitude of the threat to public health or welfare, the environment, or natural resources, including the source, amount, location, probable direction of migration, and nature or threat of the release; (7) If natural resources are or may be affected by the release, ensure that state and federal trustees of the affected natural resources have been notified in order that the trustees may initiate appropriate actions, including cost recovery for damages; (8) Develop sampling and analysis plans that shall provide a process for obtaining data of sufficient quality and quantity to satisfy data needs. In certain instances, the department may accept or use existing sampling and analysis plans developed pursuant to section 11-451-11(b)(3). The sampling and analysis plans shall consist of two parts: (A) The field sampling plan, which describes the number, type, and location of samples and the types of analyses; and (B) The quality assurance project plan, which describes the project, quality assurance objectives for data measurements, sample 451-28 1853 274 TREATMENT APPROACHES BY BODY SYSTEM ## HIATUS HERNIA Protrusion of the stomach above the diaphragm. (The Merck Manual) This unpleasant yet common problem is caused when a rupture forms in the diaphragm, creating an opening in which the upper part of the stomach gets pinched (the herniation). Hiatus hernias can be caused by obesity, pregnancy, tight clothing, sudden physical exertion (such as weight lifting), straining, coughing, or abdominal injury. Although most hiatus hernias cause no symptoms, some people experience reflux symptoms. Occasionally, reflux damages the lining of the esophagus, resulting in erosions. Postural gastric reflux, which occurs when gravity forces the stomach into the hernia, is a common presenting sign. This most frequently happens when the patient is bending over or lying down. ## Treatment of Hiatus Hernia The distressing gastric symptoms of this condition may be treated with herbal remedies, but the herniation itself can prove to be a therapeutic challenge. In severe cases, surgery may be necessary. Proper digestion and elimination are pivotal to healing, as is nervous system support. Structural issues are part of the problem, so muscular and skeletal support must be taken into account. Appropriate manipulative therapy, such as osteopathy, may be indicated. ## Actions Indicated Demulcents soothe the lining of the stomach, by either coating the mucosa or exerting anti-inflammatory actions. Anti-inflammatories reduce localized mucosal reactions. Vulneraries speed natural wound healing and may help strengthen the diaphragm. Astringents lessen local bleeding. Carminatives will help with any flatulence or colic. Nervines help ease background stress involvement. ## Specific Remedies Symphytum officinale (comfrey), Althaea officinalis (marshmallow), Filipendula ulmaria (meadowsweet), Calendula officinalis (calendula), and Matricaria recutita (chamomile) can all be seen as possible specifics. Symphytum has an especially valid role because of its content of allantoin, a constituent that promotes wound healing. (See chapter 10 for a discussion of the controversy surrounding the benefits and risks of this herb.) The main treatment goal is to reduce inflammation and facilitate natural healing through the use of demulcent and vulnerary herbs. The focus here is on easing the symptom picture. A Prescription for Hiatus Hernia | Symphytum officinale root | 1 part | | --- | --- | | Althaea officinalis root | 1 part | | Filipendula ulmaria | 1 part | Dosage: 5 ml of tincture combination three times a day. An infusion of these herbs (fresh or dried) may be drunk often to ease symptoms. Carminative nervines may be added if stress is a major component. (Valeriana officinalis is a good example.) ## Chamomile and the Digestive System Chamomile tea, perhaps the best-known herbal tisane, is widely employed as a digestive remedy throughout Europe, and its therapeutic use is well documented. Matricaria recutita is uniquely suited for digestive problems, combining as it does carminative, antispasmodic, anti-inflammatory, antiseptic, and mild bitter actions. Analysis of its constituents reveals the presence of a volatile oil that contains, among other compounds, azulene, chamazulene, and a range of sesquiterpenes. Other constituents in chamomile provide a bitter principle, flavones, glycosides, salicylic acid, coumarin derivatives, and much more. These act together as a biologically evolved whole, each contributing specific effects to create a wonderfully rounded digestive remedy. Through its relaxing, antispasmodic effects on smooth muscles, chamomile soothes colic, gently sedates the central nervous system, and eases the impact of stress. It exerts anti-inflammatory effects upon the lining of the gut and provides valuable antimicrobial actions. The herb also increases overall blood flow to the digestive system through local vasodilatory activity. All of these properties work together to give chamomile an invaluable role in the holistic treatment of many digestive system diseases, especially those associated with colic spasms. Various other indications for this wonderful herb are highlighted elsewhere in this book.