Copyright © 1990 - 2023 by Robert Dale Rogers. All rights reserved.

No portion of this e-book, except for a brief review, may be reproduced or copied and transmitted, without permission of the author. This book is for educational purposes only. The suggestions, recipes and historical information are not meant to replace a medical advisor. The author assumes no liability for unwise or unsafe usage by readers of this book.  

CLEAVERS

(Galium aparine L.)

(G. vaillantii DC.)

(G. agreste Wallr. var. echinospernum Waller.)

 

NORTHERN BEDSTRAW

(G. boreale L.)

(G. septentrionale Roemer & J.A. Schultes)

(G. strictum Torr.)

(G. hyssopifolium Hoffm.)

 

SWEET SCENTED BEDSTRAW

(G. triflorum Michx.) (G. brachiatum Pursh)

(G. circaezans Michx. var circaezans) YELLOW BEDSTRAW

 

LADY’S BEDSTRAW GOOSEGRASS

(G. verum L.)

 

SMALL BEDSTRAW

(G. trifidum L.)

 

FALSE CLEAVERS

(G. spurium L.)

 

SMOOTH BEDSTRAW

 

WHITE BEDSTRAW

(G. mollugo L.)

 

LABRADOR BEDSTRAW

(G. labradoricum [Wiegand] Wiegand)

(G. tinctorium L. Scop var. labradoricum Weigand)

 

PARTS USED- leaves, flowers, seeds, roots

Galium is from the Greek GALA meaning milk. This may be in reference to the use of cleavers as rennet or milk coagulating substitute, hence the French GAILLET. It may be from the Italian GALA meaning party. The Greek GALION means bedstraw according to one author.

In Scotland, the bedstraw roots were practically depleted from the shiels for the red dye used in Elizabethan party clothes.

These areas became know as gala shiels, and today Galashiels is one of Britain’s main clothing manufacture towns.

Aparine is from the Greek APAIREIN, meaning to seize, in reference to the tenacious velcro-like hooked stems.

Cleavers is descriptive of how weak stemmed plants depend on others for support, using their hooked bristles to “cleave”, meaning to adhere or stick. The term comes from the Old English name for the plant CLIFE from Clifian “to stick”. In Scotland, it is known as sticky willie, and used as a strainer in making flummery, an oatmeal dish boiled down to jelly.

Goose Grass, Gosling Grass, and Turkey-Grass all allude to feed fit only for farm birds.

Bedstraw comes from the legend that it was part of Jesus’ bedding, and hence “our ladies bedstraw”.

Galium aparine and G. verum are introduced annual and perennial plants respectively; while the others are native perennials, all with similar properties.

Grieve, in her Modern Herbal, suggests that cleavers (G. aparine) infusion “has a most soothing effect in cases of insomnia, and induces quiet, restful sleep”. Dioscorides considered the plant useful for countering weariness.

The Cowichan rubbed the introduced Cleavers onto their hands to remove tree pitch, the dried plants were tinder for fire.

Northern bedstraw was used, by early settlers, to stuff mattresses and pillows. The Cree use the roots and combine them with high bush cranberries to produce a red dye.

The roots have to be boiled to the correct colour; for too long and it changes to yellow. Known as KEWETI-NIPEWUSKOSE, the red dye was used to colour porcupine quills.

Northern, Sweet and Small Bedstraw were all used by the Dena’ina of Alaska as hot packs for aches and pains. They were known as wormwood’s partner, or TS’ELVENI VETS’ELQ’A.

The sweet scented bedstraw yields a red dye from the roots, while the coumarin rich flowers are used for their exquisite perfume. In Africa, the root extract is combined with Rumex species, and taken internally to treat blenorrhagia, a discharge from mucous membranes.

The leaves and flowers of both were infused for diuretic effect; hot packs and foot baths for sore aching muscles.

The young plants make an acceptable potherb, served hot with butter, or cooled and added to salads.

Like yarrow, the plant can be crushed and put in the nose to stop nosebleeds.

Natives of the Pacific Northwest rubbed their scalps with mashed cleavers to stimulate hair growth, and as an astringent facial cleanse.

Fresh infusions of the plant, which taste like oriental green tea, are good for insomnia. Cleavers is related to the coffee family, and the small ripe seeds can be roasted and ground to produce an acceptable beverage with no caffeine. The small, unripe seedheads are useful to lace makers, to pad the top of pins.

Today, the bedstraws are listed as ingredients in underarm deodorants; the cooled tea soothes sunburn, complexion problems and wrinkled skin.

he flowers of Yellow Bedstraw (G. verum) have a lovely honey fragrance, and were a favourite for stuffing mattresses in Europe in medieval times. It also curdles milk, and gives a yellow colour to the cheese. Early Tuscans used it to make goat and sheep cheese taste sweeter.

Gerard mentions that residents of Namptwich used the plant for rennet “esteeming it to be the best cheese that is made with it, and in some of the Western Isles, they curdle milk with a strong decoction of this herb.” The famed Double Gloucester Cheese from England is said to get both its tang and rich colour from the use of yellow bedstraw and stinging nettles as vegetable rennet. The roots give a red dye, made more vibrant, and rich with the addition of stannous chloride as a mordant.

K’Eogh, the Irish herbalist wrote, “when applied to burns, the crushed flowers alleviate inflammation, and when applied to wounds, they can heal them.”

Parkinson wrote “these sorts with white flowers have been thought unprofitable, and of no use, but Clausius saith, the poor women in Austria, Hungaria and other places in Germany that gather herbs and roots for their uses that need them, bringing them to the market to sell…by their experience found it good for the sinews arteries and joints, to bath them therewith both to take away their weariness and weakness in them, and to comfort and strengthen them also after travail, cold or pains”.

Joseph Miller wrote of Lady’s Bedstraw, “some commend a decoction of it for the gout; and a bath made of it is very refreshing to wash

the feet of persons tired with over-walking.” Native tribes of Eastern Canada used the flowers for light fevers, kidney problems and convulsions.

Small Bedstraw is a native perennial, often mistaken for a shorter Northern Bedstraw. It prefers marshy ground and stream banks throughout the prairies.

The Ojibwa made infusions of the plant for all kinds of skin diseases such as eczema, ringworm and glandular swellings associated with tuberculosis.

Labrador Bedstraw looks similar to G. triflorum but is smaller and has four whorls of leaves, instead of the latter’s five or six.

False Cleavers is a common introduced annual in gardens and fields. It looks like G. aparine, but has greenish yellow flowers, instead of white, and smaller fruits. The plant is very prevalent in Saskatchewan, on deserted fields and old garden plots. Both plants reduce yields of wheat, flax, barley, rape and field peas.

The powdered leaves are used in Africa to treat eczema, and the burnt ash for oral sores.

Smooth or White Bedstraw is an introduced perennial found in Saskatchewan, and in Alberta for the first time in 1994 by Anne Weerstra while walking along the roadside and railway near Jasper. It looks like G. aparine but the stems are smooth, not bristly.

Like other members of the genus, it curdles milk, and the root contains high levels of pigments that can be applied to seeds to make them distasteful to birds.

Seedlings of G. aparine contain high levels of the anthraquinone aldehyde, nordamnacanthal, which possesses anti-feeding activity against cutworms.

The related G. aegeum contains paeoniflorin, also found in Peony root.

This is an important medicinal compound.

 

MEDICINAL

CONSTITUENTS- G. aparine- various sterols, iridoids including aucubin, asperulosidic and deacetyl- asperulosidic acids, galiosin, scopoletin, nordamnacanthal, asperul-oside, and monotropein; alkaloids such as protopine, harmine and vasicinone; quinazoline alkaloids (1-hydroxy-deoxypeganine, and 8-hydroxy-2,3-dehydro-deoxypeganine). The whole plant is 11.7% protein, of which 7.3% is digestible. Nitrogen/sulphur ratio is 7:1, with large amounts of zinc (127 ppm).

roots- anthraquinone derivatives, including alizarin, xanthopurpurin and its esters, galiosin and simple anthraquinones, including 2-methyl anthroquinone.

G. boreale- polyphenols (7.7%), galactoside (quercitin) and up to 6% oil.

G. triflorum- coumarin, asperuloside, vanillic acid, and 4-hydroxycinnamic acid.

G. verum- various iridoid monoterpenes including asperuloside, V1, V2, and galioside; monotropein, scandoside, desacetyl-asperulosidic acid, asperulosidic acid, 6-acetylscandoside, giniposidic acid, and daphylloside.

Also contains (+)-pinoresinol, epipinoresinol, (+)-medioresinol, isorhamnetin, diosmetin, diosmetin 7-0-beta-D glucopyranoside, ursolic acid, ursolic aldehyde, rubifolic acid, rennin 1%, various flavonoids including rutin, isorutin, palustroside, cynaroside, anthracene derivatives, and chlorogenic acid. The maximum amount of anthracenes is at start of plant growth in May, and again during flowering in July. root- alizarin, n-alkanes mainly C29 and C31.

G. spurium- quercitin galactoside, asperulosides, rutin, caffeic, chlorogenic and ursolic acids, saponins

root- alisarin, rubrierythrinic acid, purpurin.

G. mollugo- mollugin, flavonoids, coumarins, phenolic acids, and iridoid glucosides.

Cleavers is used for skin and urinary problems. Skin conditions that are the result of poor lymphatic drainage respond to both internal and external treatment. Dr. Scudder recommended using cleavers for nodulated growths and deposits on the mucous membranes or skin.

King’s American Dispensatory opens his chapter on cleavers with: “A most valuable refrigerant and diuretic, and will be found very beneficial in many diseases of the urinary organs, as suppression of urine, calculous affections, inflammation of the kidneys and bladder, and in scalding of urine in gonorrhea.”

For psoriasis or other dry ulcerative conditions, use fresh infusions for bathing, as well as drinking as a tea. It combines well with calendula, echinacea, nettles and red clover for this purpose. Poultices of the fresh herb and ground oatmeal help reduce tumours, and skin hardened by ganglia.

Cleavers is useful in skin conditions that weep and damp heat skin problems such as psoriasis, combining well with burdock root and yellow dock root.

Inflamed tonsils, adenoids, lumpy breasts, lipomas and other lymphatic inflammation all respond to cleavers. In fact, the salty, bitter flavor helps treat all swollen, hot lymphatic nodes anywhere in body.

Combine with figwort, red root and echinacea for hot painful nodes

in neck, armpits and groin. Note that red root is neutral, cleavers is cooling and calendula is warming when used as lymphatic decongestants.

Breasts that are generally fibrous rather than scattered cysts or nodes, may suggest the use of red clover, figwort or Easter lily, according to Matthew Woods.

When taken warm it is useful for the acute fever stage of measles, chicken pox and other childhood viral infections, helping resolve and move to skin surface.

Urinary infections in children, with swollen lymph nodes respond well to cleavers. Eli Jones recommended the use of cleavers for cancer of the tongue, when a nodular growth is noticeable and tender to the touch.

Combine fresh juice with equal parts of vegetable glycerine for skin cancers. It soothes inflamed stretch marks, slow healing burns, and suppurating skin conditions, according to Michael Moore.

Recent work by Thring et al, BMC Complement Alt Med 2009 9:27 found cleavers exhibits significant anti-elastase activity. The study found 58% inhibition for the herb, compared to 51% for burdock and 32% for anise and angelica. Rose showed anti-collagenase activity.

It successfully treats kidney and bladder inflammation, scalding urine (including gonorrhea), stone or gravel obstructions, testicular pain and enlarged or inflamed prostate.

For bladder damp heat with dark and difficult urination, combine with amur bark and water plantain root.

Irritability of the vas deferens and seminal vesicles, inflamed prostate and orchitis, or sore testicles, indicate use of this herb.

Cleavers increases circulation of lymph through the dilation of capillaries, at the cellular level, and combined with mild astringency may explain, in part, the healing of gastric ulcers and inflamed urinary tract tissue.

All species contain asperuloside, an anti-inflammatory and mildly laxative agent. This compound and monotropein are about 15 times less stimulating to the bowel than senna, but gentle and effective, nonetheless.

Helen Farmer-Knowles, in her interesting book, The Healing Garden, suggests cleavers be used in the treatment of ME (myalgic encephalomyelitis), or chronic fatigue syndrome.

Work in Poland by Gryzbek et al Int J Pharm 1997 35 found ethyl acetate extracts of the whole herb displayed moderate anti-viral activity against HIV-1.

Work by Berkowitz et al, Journal of Organic Chemistry 1982 47 found asperuloside is chemically converted to prostanoid intermediates.

Cleavers is best thought of as a relaxing, cooling and soothing cleanser. For weight loss, the acids in cleavers speed up the metabolism of stored or adipose fat, combining well with Chickweed, another cooling, heat-clearing herb.

French researchers found extracts of the plant lower blood pressure, as far back as 1947.

During acute hepatitis it helps rid the body of toxins, but without irritating. For this reason, it is useful for alcoholics with fluid retention and urinary symptoms.

It is most powerful as a fresh juice. Applied to slow healing burns, ulcerated skin and inflamed stretch marks, it works very well.

In the East Indies, fresh juice of cleavers has been used to treat gonorrhea. In Portugal, cleavers is used for its diuretic and anti- spasmodic effect in treating kidney problems.

Bedstraw should be considered in formulas treating enlarged thyroid, accompanied by obesity and water retention. Ironically, because of its cooling nature, it should not be used by those who are always cold, and avoided by individuals prone to diabetes.

John Lust recommended cleaver tincture for epileptic seizures too frequent and close together.

The herb combines well with marshmallow for cystitis, with echinacea for throat infections, and with red clover, nettles and figwort for psoriasis.

Matthew Wood has an additional take on cleavers. “It is beneficial in ‘gathering of the nerves’ and inflammation of the nerve endings, tickling and itchy skin. It is a specific in Dupuytren’s contracture and Morton’s neuroma, when the tendons tighten up under the middle finger or toes.”

In Traditional Chinese Medicine, the plant is used for similar properties and known as BAAT SIN CHOU (Mandarin), and BA XIAN CAO (Cantonese). I have also seen it called CHU YANG YAN.

Peter Holmes adds, “in overall gestalt, Cleavers is close to Japanese Knotweed (Fleece Flower).” Not sure I agree totally.

The plant G. aparine var. tenerum shows an anti-cancer effect on leukemia.

Galiosin is similar to the dye ingredient in Madder, a close cousin. It has specific anti-inflammatory and spasmolytic effect on the urinary tract and may contribute to the action of breaking urinary stones and staining urine red like Madder.

Yellow Bedstraw is a specific for swollen ankles, as well as a good diuretic for bladder and kidney catarrh. Externally, a poultice or wash of the fresh herb is used for poorly healing wounds, or as a salve for psoriasis.

John Hill noted an infusion will cure the most violent nose bleeds.

It is a bitter tasting herb, with a long reputation in France for treating epilepsy.

Work by Jaric et al, J Ethnopharm 111:1 identified sedative activity in this species.

The related G. verum var. leiocarpum and variety trachycarpum are used in TCM, and known as PENG ZI CAO.

Sweet Scented Bedstraw (G. triflorum) contains blood pressure lowering substances, according to a study conducted by Knott and McCutcheon, J of Pharmaceutical Sciences 1961 50:11.

 

Northern Bedstraw

 

False Bedstraw or False Cleavers (G. spurium) contains saponins that show activity against both leukemia and breast cancer cell lines.

It is frequently used in Traditional Chinese Medicine, known as

ZHU YIN YIN, CHU YANG YANG, or ZHU YANG YANG.

The plant has bitter, pungent and cold properties that enter the lungs, spleen, heart and kidney meridians.

Extracts have been shown to lower blood pressure without reducing heart rate.

Work by Orhan et al, J Ethnopharm 2012 141 220-7 identified anti-convulsant activity in mice studies, suggesting a rationale for traditional use in epilepsy.

A number of species contain asperuloside, which produces coumarin, and sweet hay scent. Asperuloside can be converted easily to prostaglandins, which are hormone-like compounds that stimulate the uterus and blood vessels, and is thus of interest not only to herbalists, but also the pharmaceutical industry.

Smooth Bedstraw has been investigated for anti-cancer and anti- malarial activity, and the ability to inhibit HIV reverse transcriptase, but with no activity. Grzybek et al, Int J Pharmacog 1997 35.

HOMEOPATHY

Galium aparine acts on the urinary organs, and is a diuretic for water retention, gravel and calculi. It has the power of suspending or modifying cancerous action. There is much clinical proof to confirm

its use in cancerous ulcers and nodulated tumours of the tongue. It is a geriatric tonic.

Recent provings by Misha Roland at 30C potency give a few additional physical symptoms including itchiness, numbness, herpetic eruptions and sciatica. Mental symptoms include being overwhelmed, with changeable moods, and a pricking sensation accompanied by dreams of bees and wasps.

DOSE- 4-5 mls of tincture, three times daily. Mother tincture is made from the fresh plant in flower. For cancer of the tongue, which is tender and painful at night, use 20 drops every three hours. It can also be painted directly on the tumour.

  

PLANT OIL

Sweet scented bedstraw is sun infused, or prepared in a low temperature crockpot, with olive or canola oil in a ratio of 1:5. This could then be used for the vanilla like perfume notes or carrier oil for lymphatic massage blends.

The oil can be used to treat earache, gently warmed and a few drops applied. The fresh juice is also effective, and used in season or from frozen ice cubes.

Cleavers (G. aparine) has been analyzed and found to contain 22.3% hexadecanoic acid. An oil, prepared as above from freshly wilted aerial parts can be used for premenstrual sore breasts, or lumpy breasts associated with fibroadenoma. It is invaluable in cervical lymphatic nodes and swollen glands and in headaches associated with sinusitis.

 

ESSENTIAL OIL

Galium verum essential oil is composed of 29% cis-3-hexen-1-ol, 20% squalene, 10% diethylneglycol monomethyl ether, 7.8% benzyl alcohol, alpha terpineol and dozens of minor compounds.

HYDROSOL

The distilled water (of Cleavers), drank twice a day, helps the yellow jaundice.    CULPEPPER

Lady Bedstraw water is distilled from the herb and root. It is warm and dry, comforting the head and brain and sight. It opens stoppages of the spleen and heals hernia, provokes urine, improves appetite, soothes the stomach, and with wormwood daily is good for ague, fits and fever.           BRUNSCHWIG

FLOWER ESSENCES

Cleavers is an excellent remedy for use by chiropractors. The kundalini energy up the spine is activated. It is also a good flower essence for those having trouble with their father image. Individuals who have difficulty studying or focusing on their chosen careers will likewise benefit from cleavers.    PEGASUS

The elixir made from bedstraw flower helps in opening new internal passages of understanding and in focusing on the essential. A simple flower, it clarifies difficult moments and removes obstacles.      SCHNEIDER

Lady’s Bedstraw (G. verum) essence is for new hope, ideas and grace. It provides freedom from the past.    ICELANDIC

Lady’s Bedstraw essence is for those suffering chronic worry, constant concerns and excruciating mental anguish.    MIRIANA

PERSONALITY TRAITS

Think of cleavers, twisting upwards, and irritating as it does; the urethritis is often experienced from a genital infection lower down. The infection climbs further up the urethra, bladder to the kidneys and adrenal glands. Sexually transmitted diseases, as well as various viral infections will cause irritation, inflaming the prostate- even causing sterility!

The cleaver type is male, with an irritable bladder, and perhaps

intermittent discharge and inflamed prostate.

Homeopathic miasma, relating to ancestral/cellular venereal infection, are treated well with cleavers.

Today, the conception of children to parents with a history of present day, or genetically passed on, venereal patterns leads to future generations of suffering.

Childhood eczema, or the sudden appearance of psoriasis can sometimes be traced to genetic pre-disposition.

On the positive side, the herbalist’s job is the treatment of illness in early stages. Early detection of irritation, discharge or a local skin rash, calls for immediate treatment. The overuse of antibiotics often removes the symptoms, but fails to totally rid the body of the

predisposition to later prostate or bladder cancer. Or more importantly, severe genetic skin disorders in future children can be avoided by early intervention.    DOROTHY HALL

For me, it was easy to see cleavers’ character emerge. I’ve always looked on cleavers as an herb that strives to please. It’s a gentle, tender little soul that loves being loved and yearns to be needed.

One of the more obvious character traits is cleavers’ determination to go home with you its tiny, velcro-like seeds latch onto shoes, socks, pants, shirt....you name it.

It’s a bit on the insecure inside, I suppose, but it can’t help it.          DEWEY

Cleavers has the quality of clinging as in holding on to. On a physical level it has to do with keeping together and holding in. On an emotional level, Cleavers has to do with maintenance, upholding and supporting. On a metaphysical level it can do the same thing. Cleavers would be useful if you wanted togetherness in a club or any group of people; it would help maintain their connectedness.            EVELYN MULDERS

Goose grass stands for ambiguity. Of a hazy, almost unimpressive appearance, goose grass proves itself to be a very strong and resistant plant.

It symbolizes ambiguity; of everything where appearance does not really tally with the true nature, with the essence of existence.            GRIMAUD

The negative aspects of cleavers arise from congested thoughts and irritability, especially over minor things. The person may be quite spiky, capricious, and fidgety. He may fret about the small things and may have an edgy, nervous, high-strung disposition. Urinary frequency often accompanies this nervous disposition. Cleavers helps to clear the moody, fearful, weepy, or self-pitying tendencies, bringing instead a contented, lighthearted approach to life.          CLARE GOODRICK-CLARKE

 

SPIRITUAL PROPERTIES

The finely edged stems remind us of the nerves. Cleavers has a considerable action on the nervous system. I have used it for head, spinal and nerve injuries.

The specific thing I learned was that Cleavers helps people who are irritated by little things, rather than—make similar to above after addition. That is what we would expect for a remedy that helps to filter out little materials.

Bedstraw is a Deer Medicine. These fine-boned, elegantly articulated, but somewhat nervous animals are associated with nerve medicine. The sharp edge of the stem seen in Cleavers is a signature pointing to the nerves, but it also reminds us of the fine, sharp-edged boney structure of the deer.    WOOD

It is important to realize what it means when an inflorescence contains masses of small, regularly formed flowers... Many small regular flowers...are the expression of cosmic forces.    GROHMANN

 

 

BOTANICA POETICA

Cleavers (Galium aparine) Here’s a very clingy weed

Sticks to clothes and other things Its healing properties are great Lymphatic drainage stimulate

It can tone and purify Cleanse the blood, detoxify

Remove the burning of infection Relieve you of an inflammation Cools the heat, reduces fevers Such is true of the plant, Cleavers

Known as Goosegrass, Bedstraw, Clives

Galium Aparine, besides Use it as a birthing bed

Protects a pregnancy, it’s been said Drink the tincture for cystitis

Or a tea for hepatitis

If the neck glands start to swell It’s an herb that should work well It’s diuretic, it’s lymphatic Stimulates and clears the static And if your skin is very dry

It’s an herb you’ll want to try Make a poultice of this weed It’s got everything you need!

SYLVIA CHATROUX MD

 

ASTROLOGY

Venus rules the water economy of the body: the genitourinary system, the hormonal system, the gonads, the veins and the tongue. All kinds of kidney problems and dropsy come into her province. Cleavers removes the Saturn tendency to stagnation in the lymphatic system, cleansing and relieving the congestive and rigidifying tendencies of Saturn. It is beneficial to the bones, ruled by Saturn, as well as to the arteries, sinews, lymph and nerves. In fact, wherever there are long, tubular structures in the body—all ruled by Saturn—cleavers will clear them, flushing the toxins out through the urinary system.

Saturn governs eliminative functions, the bones, joints, ligaments, the spinal column, neck, limbs, and the skin. Cleavers streamlines the body, lessening edemas and restoring the clean lines of the facial contours where there was swelling, especially around the eyes. As a result of taking cleavers, the neck may be smooth, without the lumpy nodules of congested lymph nodes.          GOODRICK-CLARKE

 

RECIPES

FRESH PLANT EXTRACTS- Take 1-2 teaspoons in water up to twice daily. This may be frozen in ice cube trays for out of season usage. Or combine fresh juice with 25% vodka as a preservative. This succus is taken 5-15 ml three times daily.

TINCTURE- 30-60 drops in water up to three times daily. For seizures, try 10-15 drops once or twice daily. For a fresh plant tincture, dry the plant for 24 hours in the shade, and then use a 30% alcohol mixture at 1:5; or use a 1:2 of really fresh herb at 50% for superior product.

FLUID EXTRACT- 4 mls three times daily.

DEODORANT- Take one handful of cleavers to one litre of water and bring to a boil. Simmer for 15 minutes. Leave to get cold, strain and bottle. Put in fridge, and apply to the armpits with a cotton batten. Repeat each week.

NOTE- Remember to use warm water with kidney complaints, and cold water with lymphatic or deep-seated problems.

CAUTION- Some herbalists recommend against using cleavers in hypotension, in cold conditions, or diabetes. The latter is due to an over stimulation of the adrenals, which in turn, can inhibit the effectiveness of insulin, and/or the diuretic effect.

It is not a hard and fast rule, just pay attention to individual needs of the client.

 

  

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