From the Practice - International Academy of Homotoxicology

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Biomedical
Therapy
J o urnal o f
Volume 3, Number 1 ) 2009
Integrating Homeopathy
and Conventional Medicine
Neuroendocrine
Dysfunction
• Psychogenic Factors in Gastrointestinal Pathology • Bioregulatory Treatment of Dysautonomia
)
Contents
I n Fo c u s
Applied Bioregulation in Neuroendocrine Disease:
Chronic Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
W h a t E l s e I s N e w ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
From the Practice
Metabolic and Endocrine Disorders Associated
With Pseudarthrosis: Presentation of a Clinical Case . . . . . . 10
Around the Globe
Verona – More Than Just Romeo and Juliet ... . . . . . . . . . . . . .15
Practical Protocols
Bioregulatory Treatment of Dysautonomia . . . . . . . . . . . . . . 16
In memoriam
Professor Michael F. Kirkman . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Re f r e s h Yo u r H o m o t ox i c o l o g y
Psychogenic Factors in Gastrointestinal Pathology . . . . . . . 18
M a r ke t i n g Yo u r P r a c t i c e
Communication in Your Practice . . . . . . . . . . . . . . . . . . . . . . . 20
Specialized Applications
The Acupuncture Approach to the
Hypothalamus-Pituitary-Adrenal Axis . . . . . . . . . . . . . . . . . . 22
Making of ...
Manufacturing of Traumeel Injection Solution
Part I: From Work Preparation to Filling . . . . . . . . . . . . . . . . .26
Meet the Expert
Dr. Arturo O’Byrne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Re s e a r c h H i g h l i g h t s
Cover photograph © Sebastian Kaulitzki/Fotolia.de
)2
Nervoheel N vs. Lorazepam for Mild Nervous Disorders . . . 30
Published by/Verlegt durch: International Academy for Homotoxicology GmbH, Bahnackerstraße 16,
76532 Baden-Baden, Germany, e-mail: [email protected]
Editor in charge/verantwortlicher Redakteur: Dr. Alta A. Smit
Print/Druck: VVA Konkordia GmbH, Dr.-Rudolf-Eberle-Straße 15, 76534 Baden-Baden, Germany
© 2009 International Academy for Homotoxicology GmbH, Baden-Baden, Germany
)
Stress and the Immune System
Dr. Alta A. Smit
P
sychoneuroimmunology (PNI)
has come a long way since Walter Cannon’s early work with animals. Cannon observed that any
change in emotional state (such as
anxiety, distress, or rage) was accompanied by total cessation of stomach
movements. Cannon’s research culminated in his seminal work, Bodily
Changes in Pain, Hunger, Fear and
Rage, published in 1915.1
Hans Selye then drew on Cannon’s
research for his own animal experiments. Selye subjected animals to a
variety of adverse physical and mental conditions and observed consistent adaptations that allow the body
to heal and recover. The General
Adaptation Syndrome Selye described is still important in bioregulatory medicine today.2
Even conventional medicine increasingly recognizes the mind-brain
connection and psychoneuroendocrinoimmunology (PNEI). For instance, stress at work is associated
with cardiovascular risk factors such
as BMI, hypertension, and lipid levels. The Whitehall studies examined
this possible larger relationship between work stress and cardiovascular disease in depth.3
Bioregulatory medicine recognizes
and tests for autonomic dysfunction
as one of the main obstacles to regulatory ability in patients. For example, heart rate variability is one of
the main risk factors for cardiac disease.4
In this issue, we present a variety of
articles on the effects of stress on the
immune system, which have been
well-known for decades. In the focus article, Dr. Jesús Agudo gives a
general introduction to the subject.
Dr. Mónica Name presents a case
study demonstrating the effect of
bioregulatory medicines on bone
healing. Dr. Butch Levy examines
the role of acupuncture in the treatment of autonomic dysfunction, and
Dr. Bert Hannosset contributes a
treatment protocol for dysautonomia.
In Research Highlights, we present the
results of a study investigating the
effectiveness of Nervoheel in mild
nervous disorders, and our marketing specialist offers tips on successful communication with your patients. We also examine how ampoule
medications are manufactured (Part
1) and continue our Meet the Expert
Journal of Biomedical Therapy 2009 ) Vol. 3, No. 1
series with an introduction to Dr.
Arturo O’Byrne of Colombia.
It is with great sadness that we remember another expert, Professor
Michael Kirkman. His sudden death
this year leaves a huge void in the
world of homotoxicology. Dr. Damir
Shakambet, who worked closely
with Professor Kirkman in the UK,
contributes a heartfelt obituary.
Dr. Alta A. Smit
References
1. Quick JC, Spielberger CD. Walter Bradford Cannon: Pioneer of stress research.
International Journal of Stress Management.
1994;1(2):141-143.
2. Selye H. A syndrome produced by diverse nocuous agents. Nature. 1936;138(3479):32.
3. Marmot M. UCL Department of Epidemiology and Public Health: Whitehall II Study.
2008. UCL web site. http://www.ucl.ac.uk/
whitehallII/. Updated February 27, 2008.
Accessed July 14, 2009.
4. Institute of HeartMath Research Staff. Science of the heart: exploring the role of the
heart in human performance. Institute of
HeartMath web site. http://www.heartmath.
org/research/research-science-of-the-heart.
html. Accessed July 14, 2009.
)3
) I n Fo c u s
Applied Bioregulation in Neuroendocrine Disease
Chronic Stress
By Jesús Agudo, MD
Chronic stress is often a reaction to the stimuli of a more
or less hostile environment, to which most people living
in the 21st century have succumbed. With increasing
clarity, chronic stress is shown to be a causative agent of
numerous diseases, especially those of neuroendocrine
origin. A new cross-functional medical specialization is
appearing, propelled by increasingly detailed knowledge
about the biological foundations of the relationship
between stress and a variety of diseases: psychoneuro
immunology.
T
)4
he history of medicine has been
a constant struggle between
monism and dualism, between those
researchers who consider the human
being to be a unit and those who see
in the individual the confluence of
2 separate entities: physical and
spiritual, material and immaterial,
metabolism and emotions, body and
soul.
If we go back some 2,600 years,
Hippocrates had already declared
that health was a state inherent to
the individual, whom nature had endowed with self-healing abilities.
Furthermore, while a person lived in
harmony with nature, his or her
health would be maintained or, were
it lost, could easily be recovered.
Disease was only an imbalance resulting from a failure to observe the
rules of Hygeia. Thus, the physi-
cian’s mission would be to help individuals recover the lost equilibrium and teach them to live in
accordance with the laws of nature
(vis medicatrix naturae).
In contrast, students of the school of
Aesculapius believed that for every
disease there was a determined
cause, a separate treatment, and
some organs or systems involved,
and that the most prestigious physician was the one who made the diagnosis and prescribed the correct
treatment. This compartmentalized
and highly specialized vision is that
which now dominates “modern”
medicine, one in which the idea of
the individual is, incorrectly, not
considered to be an indivisible entity, a single unit with one material
component and another apparently
immaterial component.
Fortunately, in the second half of
the 20th century, the development
of that highly specialized and fragmented medicine, with an impressive ability to delve into the core of
the most subtle physiological processes, converged with the other,
more humanist medicine descended
from Hippocrates, which pays attention to the psycho-emotional aspects
of humankind. We could say that
the more cartesian-reductionist and
more fiercely material medicine has
discovered the influence of the human soul on physiopathological
processes.
It is, therefore, absolutely fascinating that more than 2,000 years ago,
the pineal gland was described by
Galen, who credited it with the ability to regulate the flow of thought;
in the 17th century, it was described
by Descartes as the seat of the rational soul. What is surprising is the
insight, from ancient times, that this
area would be the gateway between
body and soul and the approximation of what was being described to
what we know today about the interrelationships between emotions
and their physical responses.
The study of the relationships between mind and body has been
termed psychoneuroimmunology,
and what we are truly faced with is
the most refined, holistic concept of
medical science.
) I n Fo c u s
Stress
Brain
ACh+ 5-HT+ IL-1+ CRH+ GABA- NA+/–
–
IL-1 RA
+
Hypothalamus
CRH+
–
IL-1, IL-6, TNF-a
AVP+
–
Pituitary
NA/A+
Monocytes
Macrophages
A
Adrenaline
NA
Noradrenaline
ACh
Acetylcholine
GABA γ-Aminobutyric acid
5-HT
5-Hydroxytryptamine
IL-1 RA Interleukin 1
receptor antagonist
TNF
Tumor necrosis factor
IL Interleukin
ACTH Corticotropin
ACTH+
Adrenal gland
Cortisol +/–
AVP
Arginine vasopressin
CRH
Corticotropinreleasing hormone
Figure 1: Relationship between the cortex, hypothalamus, pituitary gland,
and adrenal glands (after Lack and Wright1)
The hypothalamicpituitary-adrenal system
The stimuli generated in the cerebral
cortex by adverse situations such as
stress or various pathological mental
processes will create a response in
the limbic system that triggers the
release of several neurotransmitters
(e.g., acetylcholine, 5-hydroxytryp
tamine, interleukin [IL] 1, corticotropin-releasing hormone [CRH],
γ-aminobutyric acid [GABA], and
noradrenaline). These neurotransmitters will ultimately activate the
hypothalamic-pituitary-adrenal axis
according to the cascade described
later (Figure 1).
Corticotropin-releasing hormone
and arginine vasopressin (AVP) are
produced in the paraventricular nuclei of the hypothalamus. These substances are carried to the anterior
pituitary gland, where they regulate
the secretion of adrenocorticotropic
hormone (ACTH or corticotropin).
Adrenocorticotropic hormone travels through the bloodstream to the
cortex of the adrenal glands, where
it stimulates the synthesis and release of glucocorticoids (GCs).
In turn, these GCs exert a negative
feedback on several targets, including the adrenal cortex, inhibiting
their own secretion; the pituitary
gland, inhibiting ACTH production;
and even the hypothalamus itself,
down-regulating the release of
ACTH and AVP. Glucocorticoids
also act on the hypothalamus
through the production of GABA,
which ultimately inhibits this organ’s synthesis of CRH and AVP.
Another intermediate feedback regulator of the release of CRH in this
process would be the one exerted on
the noradrenergic and serotonergic
neurons.2
Finally, we must not forget that the
brain will also exert an influence on
the sympathetic and endocrine system by means of the CRH that regulates the sympathetic nervous system. This has nerve endings in the
bone marrow, thymus, and spleen,
which are the cell factories responsible for cellular and humoral immunity.
The psychoneuroimmunology of stress
It is now clear that CRH plays a
fundamental role in the response to
stress. Administration of CRH produces a broad suppression of immune functions similar to that observed in depression or chronic
stress.
regulates immune functions through
a central pathway and a peripheral
pathway. By means of the central
pathway, it notably suppresses the
proliferation of lymphocytes and
phagocytosis by neutrophils while
increasing the number of neutrophils and cellular aggregation. It al
so decreases the quantity and activity of natural killer (NK) cells and
IgG levels. In the peripheral pathway, its activity is based on the CRH
receptors that exist on macrophages,
monocytes, and helper lymphocytes.
reduces the replication and survival
of spleen cells while simultaneously
encouraging the migration of monocytes.
)5
) I n Fo c u s
We have already seen how stress activates the production of CRH directly in the hypothalamus and indirectly through noradrenergic and
serotonergic neurons. However, it
also activates the autonomic nervous
system. For these tasks, mediation
by intermediaries such as acetylcholine, IL-1, and serotonin is required.
Meanwhile, to balance this reaction,
stress-inhibiting substances are also
present, such as GABA; opioid peptides, whose producing neurons are
closely related to CRH-producing
neurons to establish an equilibrium;
and a third group (e.g., adrenaline/
noradrenaline) that acts on various
senses.
With respect to the sympathetic nervous system, we could say that in
states of stress it will be activated by
CRH, and on being stimulated, it
will produce adrenaline and noradrenaline. Peripherally, these substances will trigger a series of actions, such as an increase in blood
pressure, blood glucose, heart rate,
alertness, and vigilance, and inhibit
the sensation of hunger and growth
through the suppression of growth
hormone (GH).
Stress affects various
vital areas
)6
The immune system
According to recent studies, the role
of cortisol in the inhibition of the
immune system appears to consist of
suppressing the ability of immune
cells to activate their own telomerase
to reproduce their telomeres each
time the cell divides. The telomere
would, therefore, be shortened, a
characteristic observed in pathological conditions, such as human immunodeficiency virus infection, osteoporosis, coronary heart disease,
and even aging.3
Cancerous diseases
Stress significantly reduces the activity of NK cells.4 In laboratory experiments on animals subjected to
stress, the rate of pulmonary metastases from induced breast cancers
doubled.
Studies of women who underwent
surgery for carcinoma of the breast
have also shown a significantly reduced NK cell count in patients with
high stress levels compared with
those who controlled their stress, resulting from uncertainty about the
treatment or prognosis of their disease.5
Infectious diseases
In laboratory experiments on animals subjected to stress conditions,
their response to the flu virus decreased significantly. Along with
high levels of plasma corticosterone,
a decrease in the mononuclear cell
population and a 60% to 95% decrease in IL-2 production in lymphoid organs were observed.
In preschool-aged children subjected to various situations of environmental stress, several changes in the
CD4, CD8, and NK cell counts were
observed, which have been correlated with respiratory diseases.4
Another experiment conducted on
astronauts found that during periods
of stress, there was a decrease in antibodies to the Epstein-Barr virus
nuclear antigens, along with an increase in adrenaline and noradrenaline in the urine and a decrease in
virus-specific T lymphocytes. This
led to the reactivation of the Epstein-Barr virus in 11 of 28 astronauts.6
Wound healing
There also appears to be evidence
from in vitro studies showing that
fibroblasts would be less effective in
matrix repair for recovery from inju-
ries and wounds in situations of psychological stress, precisely because
of the presence of high tissue levels
of corticosteroids. In one study of
student volunteers who underwent
small incisions on mucous membranes, the healing time was 40%
longer during examination periods
than during vacation periods. This
longer duration was associated with
a 30% decrease in IL-1 levels during
examination periods.7
Stress and allergies
In a joint experiment, physicians
and psychologists studied the relationship between stressful situations
and an increase in the most common
signs of allergies (rhinitis, sneezing,
coughing, and conjunctivitis), along
with the peculiarity that the allergic
symptoms worsened in the following days while the stress stimulus
continued. Analytically, this translates to a significant increase in IL-6
and catecholamines in the blood of
stressed patients with symptoms of
allergies.
There is another mediator, vasoactive intestinal polypeptide, that has
been found in increased quantities
in children who have experienced
significant stress (typically parental
separation) and that is closely linked
to sensitization and the onset of allergic phenomena.9
In another recent experiment performed in Canada,10 it was found
that maternal stress in the first 7
years of the child’s life has a significant influence on the rates of childhood asthma because mothers in
this situation are less likely to interact with and show affection to their
children. This is recognized by the
child’s immune system, which could
be considered an “affective” transmission of stress.
) I n Fo c u s
Systemic lupus erythematosus,
depression, and stress
Distinct immunological changes
have been found in patients with depressive syndromes of various degrees and clinical manifestations.11
In contrast to healthy control subjects, an increase in B lymphocytes,
antinuclear antibodies, and serum
immunoglobulins can be observed
in patients with depressive syndromes. Thus, depressive illnesses
can demonstrate a certain relationship to autoimmunity. Also, many
autoimmune diseases are characterized by major episodes of depression, especially systemic lupus erythematosus, regardless of treatment
with GCs.
With depression in general, prolonged activity in the adrenal cortex
is a factor that makes recovery notably difficult. These are patients in
whom the administration of corticosteroids does not exert a negative
feedback on their own cortisol levels.12
Bioregulatory approach to
stress
A fascinating opportunity remains
open for bioregulatory medicine to
establish treatment protocols consisting of immune regulatory medicines (e.g., Echinacea compositum
and Engystol), medicines supporting brain function (e.g., Cerebrum
compositum, Thalamus compositum, Ypsiloheel, Neuro-Injeel, Tonico-Injeel, Nervoheel, and IgnatiaHomaccord), and the classic
organoregulators, such as Ovarium
compositum, Pulsatilla compositum,
Coenzyme compositum, Hepar
compositum, Testis compositum,
Thyreoidea compositum, GaliumHeel, and Ubichinon compositum.
Neurexan, a medication for nervousness and insomnia, has recently been
shown in preliminary studies to be
possibly useful in anticipatory an
xiety.15|
Growth and stress
As previously mentioned, sustained
stress causes high levels of CRH,
which in turn inhibits GH and insulinlike growth factor 1. The circulating corticosteroids also exert a
negative feedback on GH production by the pituitary gland.2
Stress and sleep
Patients experiencing stress have a
poor quality of sleep as a cause and
a result of stress.5,13 Failure to follow
circadian rhythms due to a lack of
sleep reduces the amount of melatonin in the blood to below required
levels. It is, therefore, presumed that
its antioxidant activity cannot be
performed. Also, melatonin’s likely
activity of promoting immunity by
inhibiting the production of gonadotropins is inhibited.1,14
References
1. Lack LC, Wright HR. Chronobiology of sleep in humans. Cell Mol Life Sci.
2007;64(10):1205-1215.
2. Rosales Estrada M. Síndrome de inflamación de
las mucosas: tratamiento antihomotóxico. Colombia: M. Rosales Estrada; 2005.
3. Choi J, Fauce SR, Effros RB. Reduced telomerase activity in human T lymphocytes
exposed to cortisol. Brain Behav Immun.
2008;22(4):600-605.
4. Song C, Leonard BE. Fundamentals of Psychoneuroimmunology. Chichester, England:
Wiley & Sons; 2000.
5. Andersen BL, Farrar WB, Golden-Kreutz
D, et al. Stress and immune responses after
surgical treatment for regional breast cancer.
J Natl Cancer Inst. 1998;90(1):30-36.
6. Stowe RP, Pierson DL, Barrett AD. Elevated
stress hormone levels relate to Epstein-Barr
virus reactivation in astronauts. Psychosom
Med. 2001;63(6):891-895.
7. Glaser R, Kiecolt-Glaser JK. Stress-induced
immune dysfunction: implications for health.
Nat Rev Immunol. 2005;5(3):243-251.
8. Stress, anxiety can make allergy attacks even
more miserable and last longer. ScienceDaily
Web site. http://www.sciencedaily.com/
releases/2008/08/080814154327.htm.
Published August 17, 2008. Accessed July
14, 2009.
9. Stress during childhood increases the risk of
allergies. e! Science News Web site. http://
esciencenews.com/articles/2008/06/18/
stress.during.childhood.increases.risk.allergies. Published June 18, 2008. Accessed
July 14, 2009.
10. Kozyrskyj AL, Mai XM, McGrath P, Hayglass KT, Becker AB, Macneil B. Continued
exposure to maternal distress in early life is
associated with an increased risk of childhood asthma. Am J Respir Crit Care Med.
2008;177(2):142-147.
11. Eiguchi K, Soneira SG. Psiconeuroinmunoendocrinología en enfermedades autoinmunes
(LES). Archivos de Alergia e Inmunología Clínica. 2002;33(suppl 1):S8-S16.
12. McEwen BS. Physiology and neurobiology
of stress and adaptation: central role of the
brain. Physiol Rev. 2007;87(3):873-904.
13. Zisapel N. Sleep and sleep disturbances: biological basis and clinical implications. Cell
Mol Life Sci. 2007;64(10):1174-1186.
14. Plant TM. Hypothalamic control of the pituitary-gonadal axis in higher primates: key
advances over the last two decades. J Neuroendocrinol. 2008;20(6):719-726.
15. Dimpfel W. Psychophysiological effects of
neurexan on stress-induced etropsychograms: a double blind, randomized, placebo-controlled study in human volunteers.
NeuroCode-AG Web site. http://www.
neurocode-ag.com/Poster%20Stresskongress%20Teil%20A.pdf and http://www.
neurocode-ag.com/Poster%20Stresskongress%20Teil%20B.pdf. Accessed July 14,
2009.
)7
Hearing voices when there is nobody
around? A recent study suggests that
high caffeine consumption may
increase a pre-existing tendency
to hallucinate.
Getting a good night’s sleep reduces
the risk of catching a viral infection.
)8
Link between caffeine and
hallucinations?
The more expensive
the better?
For good health,
get enough sleep
A new research study, conducted at
Durham University, UK, examines a
possible link between high caffeine
consumption and an increased tendency to hallucinate. The study assessed typical caffeine consumption
of 200 students, along with stress
levels and proneness to common
hallucinatory experiences such as
hearing voices when no one is present. “High caffeine users” consuming more than the equivalent of
seven cups of instant coffee a day
were three times more likely to hear
voices than “low users” consuming
less than one cup-equivalent.
What’s the theory behind this research? As a result of traumatic
events in their past, many hallucination-prone individuals respond to
current stress by producing increased
amounts of the stress hormone cortisol. Caffeine consumption further
increases release of the stress hormone, and this extra cortisol boost
might exacerbate a pre-existing tendency to hallucinate.
The authors call the findings a first
step in better understanding how
nutrition affects hallucinations. More
research is needed to see if changes
in caffeine intake might help people
to better cope with distressing hallucinations or reduce the frequency
of these experiences.
“If it’s not expensive, it can’t be any
good.” Many people seem to approach
medical care with this attitude. In an
American study, 82 healthy volunteers were given what they thought
was a new pain reliever. In reality, all
of the subjects received identical
placebos, but half of them were told
that the price per tablet was $2.50,
while the others were allowed to believe the medication was very lowpriced. The analgesic effects of the
fake medication were then tested using mild electrical shocks to induce
pain. Subjective sensations of pain
were significantly reduced in the
group receiving the supposedly
more expensive medication in comparison to the other group.
People who sleep well and long
enough are less susceptible to viral
infections, according to a study of
153 healthy men ranging in age
from 21 to 55 years. The subjects
were surveyed about the quantity
and quality of their sleep over a 14day period, after which they were
infected by administering nose
drops containing rhinoviruses. Researchers found that subjects who
slept longer and better got sick less
often than participants who slept
less. For example, participants who
got eight hours of sleep or more
were approximately 2.94 times less
likely to catch colds than those who
slept for seven hours or less. The effects of sleep efficiency (actual sleeping time as a percentage of total time
in bed) were even greater: Participants with 92 percent efficiency or
less were 5.5 times more likely to
develop a cold than those with 98
percent efficiency or more. The immune system appears to need adequate sleep to effectively fend off
germs.
Personality and Individual Differences.
2009;46(4):562-564.
JAMA. 2008;299:1016-1017
Enjoy food and lose weight
Eating rapidly to the point of satiety
increases the risk of obesity. When
3,287 Japanese women and men
were surveyed about their eating
habits, respondents who said they
tended to eat fast until they felt full
were three times more likely to be
overweight than people who ate
slowly and enjoyed their food. It
seems that weightwatchers should
not only pay attention to what they
eat but also to how they eat.
BMJ. 2008;337:a2002
Arch Intern Med. 2009;169(1):62-67
) What Else Is New?
During a coughing attack, airborne
pathogens will be propelled into the
surrounding air for about four meters.
Sexy women wear red
“Red-light” districts and sexy red
lingerie suggest that the color red
has long been associated with male
sexual drive, but this connection had
never been scientifically confirmed.
To test men’s responses to the color
red in relationship to women’s sexual attractiveness, participants were
shown photos of women in front of
different colored backgrounds. Other pictures showed the women wearing different colored tops. The study
found that men saw women posing
in front of a red background or
wearing red tops as sexually more
desirable than the same women in
other photos. Red had no effect on
the men’s assessment of the women’s
other qualities such as intelligence
or kindness. Women shown the
same photos seemed to be colorblind when it came to rating the attractiveness of other women.
Communicating with
patients through positive
images
We humans still think best in images, and abstract numbers are difficult
for most of us to remember. Health
care practitioners should also use
this fact to their advantage and enhance their communication with patients by using pictures and graphic
elements. Researchers from New
Zealand recently investigated the
best way to convey important information about treatments to patients.
Two-thirds of the patients questioned preferred graphically presented information to pure numbers
and percentages. Positive formulations were also considered helpful.
In other words, it is generally better
to emphasize the benefits of a particular therapy instead of stressing
the possible risks of leaving a condition untreated.
Keep your distance to
stay healthy
Many diseases are transmitted by
airborne drops. At work, in the subway, while shopping – wherever we
meet other people, we are bombarded with germs. People who are already sick and coughing are especially likely to contaminate the air
with germ-filled spray. A recent
study investigated how fast this
cloud spreads around a cougher.
Scientists from the USA calculated
the speed of spread at up to eight
meters per second over a period of
approximately half a second. This
means that an attack of coughing
propels germs into the surroundings
for about four meters. Anyone who
wants to make it through cold season unscathed would do well to
keep their distance from other people.
N Engl J Med. 2008;359(15):e19
J Pers Soc Psychol. 2008;95(5):11501164
Ann Fam Med 2008;6(3):213-217
F O R P RO F E S S I ONA L U S E ON LY
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products or ingredients referred to for informational purposes only, is not intended to be a recommendation with respect to the use of or benefits derived from the
products and/or ingredients (which may be different depending on the regulatory environment in your country), and is not intended to diagnose any illness, nor is it
intended to replace competent medical advice and practice. IAH or anyone connected to, or participating in this publication does not accept nor will it be liable
for any medical or legal responsibility for the reliance upon or the misinterpretation or misuse of the scientific, informational and educational content of the
articles in this journal.
The purpose of the Journal of Biomedical Therapy is to share worldwide scientific information about successful protocols from orthodox and complementary practitioners. The intent of the scientific information contained in this journal is not to “dispense recipes” but to provide practitioners with “practice information” for a better
understanding of the possibilities and limits of complementary and integrative therapies.
Some of the products referred to in articles may not be available in all countries in which the journal is made available, with the formulation described in any article or
available for sale with the conditions of use and/or claims indicated in the articles. It is the practitioner’s responsibility to use this information as applicable
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)9
) From the Practice
Metabolic and Endocrine Disorders
Associated With Pseudarthrosis
Presentation of a Clinical Case
Mónica Name Guerra, MD
Bone fatigue is a considerable risk factor causing fractures
in high-performance athletes, as a result of many extrinsic
and intrinsic factors. This article describes a 13-year-old
girl, a professional skater with a fracture of the femur and
atrophic pseudarthrosis 10 months after initial surgical
treatment. A metabolic disturbance was found at the
biological medical consultation; this was managed
holistically, and the patient’s fracture healed after
2 months of antihomotoxic and integrative treatment.
T
he use of unsuitable equipment,
very intensive training schedules, and inappropriate diets are
among the external risk factors that
predispose towards bone pathology
in athletes. Age; mechanical biophysical factors arising from the
bone-muscle relationship, which alter physiological alignment; bone
density; and metabolic or hormonal
imbalances are intrinsic causes of
stress fractures and pseudarthrosis.
Prepubertal girls and women, as a
result of the physiological changes
inherent to their sexual development
and monthly hormonal fluctuation,
are a population especially at risk.1
In 1986, the US Food and Drug
Administration defined pseudar
throsis as nonhealing of a fracture
Figure 1: Fracture
Figure 2: Intramedullary pin
(June 26, 2004)
) 10
9 months after injury. However, depending on the bone and the site of
the injury, this period may vary. In
fractures of the long bones in the
middle third of the femur, a waiting period of 6 months is allowed,
whereas neck fractures should heal
within 3 months after the trauma.2
Although the exact cause of pseudar
throsis is not clear, it is believed that
local factors (e.g., infection and poor
vascularization) and systemic factors
(e.g., nutritional state and hormonal
balance) contribute to nonhealing of
fractures. Although there are opposing opinions, there is considerable
bibliographic evidence implicating nonsteroidal anti-inflammatory
drugs and corticoids as important
factors in fractures that are not healing.3
Pseudarthrosis can be hypertrophic
or hypervascularized and atrophic
or avascular.
Figure 3: Pseudarthrosis at follow-up
) From the Practice
Figure 4: Second operative procedure
Figure 5: Postoperative view 5 months
after the second operative procedure
Clinical case
The patient is a 13-year-old sports
person who, on June 25, 2004, experienced a displaced fracture in the
middle third of the right femur (Figure 1), which required surgical treatment with an intramedullary pin
(Figure 2).
A 5-month postoperative followup X-ray showed pseudarthrosis
(Figure 3). Thus, from an orthopedic
viewpoint of the mechanical instability and hypertrophic pseudar
throsis, a further intervention changing the pin for one of a larger
diameter with double distal locking
was performed on November 17,
2004 (Figure 4).
Five months after the second operative procedure, the fracture was classified as atrophic pseudarthrosis
(Figure 5), and the treating orthopedic surgeon proposed a third intervention. The patient decided to consult a biological medicine specialist
to obtain a second opinion.
Laboratory test
The consultation on April 13, 2005,
showed that the patient was in pain,
with no support from the lower
right limb, and had a high consumption of nonsteroidal anti-inflammatory drugs.
The results of the Meridian Stress
Assessment (developed by Reinhold
Voll) were pancreatic and splenic
dysfunction (Table 1); therefore,
clinical laboratory tests were performed to complete the investigation (Table 2). These test results
showed a state of hypercortisolism
with a normal basal insulin level (no
postprandial insulin test result was
available). The postprandial glucose
response at 30 minutes was normal;
however, at 1 hour, it was very low.
The thyrotropin level was in the
normal range, the free thyroxine
level was normal, and the triiodothyronine level was not obtained. The
parathyroid hormone level was normal; the result of bone densitometry
showed osteopenia.
Patient value
Reference value
Urinary cortisol, µg/24 h
60.86
5-55
Basal blood glucose, mg/dL
79
70-105
Postprandial blood glucose at 30 min, mg/dL
125
> 110
Postprandial blood glucose at 1 h, mg/dL
74
120-170
Postprandial blood glucose at 2 h, mg/dL
94
70-120
Thyrotropin, µUI/mL
2.40
0.35-5.50
Free thyroxine, ng/dL
1.06
0.93-1.70
Parathyroid hormone, pg/mL
31.3
11.0-79.5
Basal insulin, µU/mL
5.02
2.60 -24.90
Organ
Right side
Left side
Lymphatic deg.
48
46
Lung
54
46
Large intestine
34
56
Central nervous
system deg.
42
46
Circulation
46
48
Allergy deg.
42
42
Parenchyma deg.
34
42
Endocrine
46
46
Heart
52
46
Small intestine
44
58
Pancreas
18
Spleen
16
Liver
44
46
Joint deg.
46
36
Stomach
54
52
Fibroid deg.
58
48
Skin deg.
66
58
Fat deg.
56
58
Gallbladder
70
52
Kidney
54
52
Bladder
48
56
Uterus/prostate
48
54
Table 1:
Meridian Stress Assessment results*
Table 2:
Clinical laboratory results
* Normal values, 40-60; Irritation, 61-80;
Inflammation, 81-100; Weakness, 31-39;
Degeneration, < 30
) 11
) From the Practice
Figure 6: Consolidated fracture (June 23,
2005)
Treatment was started as follows:
• Osteoheel,
1 tablet 4 times per day
• Strumeel,
1 tablet 4 times per day
• Momordica compositum,
1 ampoule twice weekly,
10 doses
• Placenta compositum,
10 doses
• Acidum citricum-Injeel,
10 doses
• Lymphomyosot, 1 ampoule
twice weekly, 10 doses
Nutritional changes reducing the intake of rapidly absorbed carbohydrates (refined sugars) and avoiding
high-sodium processed foods (ready
meals and fast food) were recommended.
At the 2-month clinical follow-up,
pain was absent, normal electrical
measurements of the pancreas (44)
and spleen (48) were noted, and radiography showed healing of the
fracture (Figure 6); therefore, the intramedullary pin was removed (Figure 7). Laboratory findings at the
end of treatment were normal.
) 12
Discussion
According to the Meridian Stress
Assessment, this patient had an abnormality of the pancreas. Her low
glucose level, using the result of the
oral glucose tolerance test at 60
minutes, indicates hypoglycemia and
a state of chronic hypercortisolism.
This state of transitory hypoglycemia leads to a functional imbalance
of the hypothalamus-pituitary-adrenal cortex axis4-6; therefore, the response is an increase in β-adrenergic
activity in the hypothalamus, with
the release of the growth hormones
somatotrophin and corticotropin
and increased secretion of cortisol
and epinephrine.5,6
The cortisol acts like a counterregulating hormone and induces the
production of glucose, activating the
gluconeogenesis pathway. If the hypoglycemia persists, the level of cortisol rises, conforming a state of
chronic hypercortisolism.
The increased cortisol levels in this
patient could be secondary to the
hypoglycemia and stress produced
by competitive exercise and the influence of interleukin 6 as a chronic
inflammatory cytokine.7
Intense exercise by high-performance athletes suppresses the function of the T cells and natural killer
cells and increases the release of
cortisol and interleukin 6 proinflammatory factors.7
Cortisol causes a reduction in bone
formation and an increase in re
sorption by various mechanisms
(Figure 8).8
Cortisol antagonizes the action of
1,25-dihydroxyvitamin D3 or calcitriol, which acts on the osteoblast by
increasing the synthesis of tissue
growth factor β (TGF-β) and raising
the number of insulinlike growth
factor receptors, whose anabolic effect regulates bone growth and tissue repair.8-12 Vitamin D3 increases
the synthesis of osteocalcin and osteopontin by improving the mineralization of the collagen fibrils of
the bone when they are depleted.9-12
The formation of hydroxyapatite alters with sodium/calcium interchange in the renal distal tubules,
where phosphorus and magnesium
are also lost. Each gram of sodium
ion in urine corresponds to 26.3 mg
of lost calcium; therefore, salty and
fast food diets are not recommended.13
Ingesting oily seeds and extra virgin
vegetable oils rich in polyunsaturated fatty acids and conjugated lin
oleic acid increases the absorption
rate of calcium in the cells and reduces osteoclastogenesis.14
Acidification secondary to the ingestion of refined sugar and proteins
with sulfur atoms (methionine and
cysteine) alters the mineralization
and metabolism of the bone.9
The concentration of protons in the
plasma and in the extracellular fluid
is about 40 nM, corresponding to a
pH of 7.4; to stabilize and alkalize
this, there are systems that include
balancing phosphate with calcium
and magnesium ions originating
from the bone matrix at the expense
of weakening the bone.9
According to the personal analysis
that I have made of this clinical case,
) From the Practice
Figure 7: Fracture without intramedullary pin (November 28, 2006)
antihomotoxic medications could
hypothetically have acted in the following manner in healing the fracture:
1. Antihomotoxic
medications,
which contain low doses of antigens, could have stimulated the
production of TGF-β from the
lymphocyte line T-helper cell 3.
This TGF-β intervenes in the reconstruction of the bone matrix
by inhibiting the activation of
the osteoclasts and stimulating
the action of the osteoblasts,
promoting the healing of the tissue and the resolution of the inflammation.15-18
2. The bioregulatory effect of Momordica compositum in the
pancreas in controlling hypoglycemia and secondary hyper
cortisolism could be the result
of a possible improvement in the
expression of glucotransporters
in the cells and hypothetically
might increase the secretion
of amylin and preptin. These
2 polypeptides are cosecreted
with insulin from the β cells of
the pancreas; their function is to
stimulate osteoblastic proliferation, reduce osteoblastic apoptosis, and inhibit osteoclastic activity.19-25
3. Possibly, Acidum citricum-Injeel,
a Krebs cycle catalyst and calcium metabolism regulator that
improves the absorption of vitamin D, could act in the renal tubule cells by stimulating the mitochondrial 1a-hydroxylase responsible for transforming 25hydroxycholecalciferol (inactive)
into 1,25-dihydroxycholecalciferol (active) or calcitriol.
Figure 8: Effects of cortisol on bone8
GI Ca absorption
Renal Ca absorption
Bone resorption
LH – FSH
Testosterone
Estrogen
Cortisol
Osteoporosis
Osteoprotegerin
Muscle strength
Osteoblastic
apoptosis
Bone formation
Growth factors
GI
Gastrointestinal
Ca
Calcium
LH
Luteinizing
hormone
FSH Follicle-stimulating
hormone
) 13
) From the Practice
Conclusion
Antihomotoxic treatment drains the
matrix (Lymphomyosot), regulates
the endocrine function of the pancreas (Momordica compositum),
regulates thyroid function (Strumeel),
solves the problem of avascular atrophic pseudarthrosis (Placenta compositum), and re-establishes the
metabolic balance of bone, the intrinsic calcium metabolism, and vitamin D absorption (Osteoheel and
Acidum citricum-Injeel).
Pseudarthrosis is not an exclusively
mechanical problem. It must be confronted integrally, from the profession or lifestyle to the metabolism of
the organism, the diet, the neuroendocrine system, and immunological
modulation. “The whole organism
suffers with the fracture of a long
bone.”26|
) 14
References
1. DeFranco MJ, Recht M, Schils J, Parker RD.
Stress fractures of the femur in athletes. Clin
Sports Med. 2006;25(1):89-103, ix.
2. Cleveland KB. Delayed union and nonunion
of fractures. In: Canale ST, Beaty J, eds.
Campbell’s Operative Orthopaedics. 11th ed.
Philadelphia, PA: Mosby; 2007:chapter 56.
3. Koester MC, Spindler KP. Pharmacologic
agents in fracture healing. Clin Sports Med.
2006;25(1):63-73, viii.
4. Fruehwald-Schultes B, Kern W, Born J,
Fehm HL, Peters A. Hyperinsulinemia
causes activation of the hypothalamus-pituitary-adrenal axis in humans. Intern J Obes.
2001;25(suppl1):S38-S40.
5. Arias P, Arzt E, Bonet E. Estrés y procesos de
enfermedad. Buenos Aires, Argentina: Biblos;
1998.
6. Suliman AM, Freaney R, McBrinn Y, et al.
Insulin-induced hypoglycemia suppresses
plasma parathyroid hormone levels in patients with adrenal insufficiency. Metabolism.
2004;53(10):1251-1254.
7. Rosales Estrada M. Síndrome de inflamación
de las mucosas: tratamiento antihomotóxico. 2nd ed. Colombia: M. Rosales Estrada;
2005.
8. Rubin MR, Bilezikian JP. The role of parathyroid hormone in the pathogenesis of
glucocorticoid-induced osteoporosis: a reexamination of the evidence. J Clin Endocrinol
Metab. 2002;87(9):4033-4041.
9. Koolman J, Röhm K. Bioquímica: texto y atlas.
3rd ed. Stuttgart, Germany: Panamericana;
2004.
10. Clark R. The somatogenic hormones and
insulin-like growth factor-1: stimulators of
lymphopoiesis and immune function. Endocr
Rev. 1997;18(2):157-179.
11. Kurtz A, Matter R, Eckardt KU, Zapf J.
Erythropoiesis, serum erythropoietin, and serum IGF-I in rats during accelerated growth.
Acta Endocrinol (Copenh). 1990;122(3):323328.
12. Gómez JM. The role of insulin-like growth
factor I components in the regulation of vitamin D. Curr Pharm Biotechnol. 2006;7(2):125132.
13. Shortt C, Madden A, Flynn A, Morrissey PA.
Influence of dietary sodium intake on urinary
calcium excretion in selected Irish individuals. Eur J Clin Nutr. 1988;42(7):595-603.
14. Bhattacharya A, Banu J, Rahman M, Causey
J, Fernandes G. Biological effects of conju-
gated linoleic acids in health and disease.
J Nutr Biochem. 2006;17(12):789-810.
15. Abbas AK, Lichtman AH, Pillai S. Inmunología celular y molecular. 6th ed. Barcelona,
Spain: Elsevier Saunders; 2008:3-16, 243263, 267-301.
16. Heine H. Homotoxicología: Una síntesis de las
orientaciones médicas basadas en las ciencias
naturales. 3rd ed. Baden-Baden, Germany:
Aurelia-Verlag; 2004:79-85.
17. Weiner HL, Mayer LF. Oral tolerance: mechanisms and applications. Ann N Y Acad Sci.
1996;778:1-451.
18. Weiner HL, Friedman A, Miller A, et al.
Oral tolerance: immunologic mechanisms
and treatment of animal and human organspecific autoimmune diseases by oral administration of autoantigens. Annu Rev Immunol.
1994;12:809-837.
19. Cornish J, Callon KE, Bava U, et al. Preptin,
another peptide product of the pancreatic
β-cell, is osteogenic in vitro and in vivo. Am
J Physiol Endocrinol Metab. 2007;292(1):
E117-E122.
20. Dacquin R, Davey RA, Laplace C, et al. Amylin inhibits bone resorption while the calcitonin receptor controls bone formation in
vivo. J Cell Biol. 2004;164(4):509-514.
21. Valenzano KJ, Heath-Monnig E, Tollefsen
SE, Lake M, Lobel P. Biophysical and biological properties of naturally occurring high
molecular weight insulin-like growth factor
II variants. J Biol Chem. 1997;272(8):48044813.
22. Buchanan CM, Phillips AR, Cooper GJ.
Preptin derived from proinsulin-like growth
factor II (proIGF-II) is secreted from pancreatic islet β-cells and enhances insulin secretion. Biochem J. 2001;360(pt 2):431-439.
23. Alam AS, Moonga BS, Bevis PJ, Huang CL,
Zaidi M. Amylin inhibits bone resorption by
a direct effect on the motility of rat osteoclasts. Exp Physiol. 1993;78(2):183-196.
24. Cornish J, Callon KE, Cooper GJ, Reid IR.
Amylin stimulates osteoblast proliferation
and increases mineralized bone volume in
adult mice. Biochem Biophys Res Commun.
1995;207(1):133-139.
25. Cornish J, Callon KE, King AR, Cooper GJ,
Reid IR. Systemic administration of amylin
increases bone mass, linear growth, and adiposity in adult male mice. Am J Physiol Endocrinol Metab. 1998;275(4, pt 1):E694-E699.
26. Sodi-Pallares D. Magnetoterapia y tratamiento
metabólico. Publisher unknown; 1994:84.
) Around the Globe
Verona – More Than
Just Romeo and Juliet ...
By Anita Bania, MD
F
human body and the loss of normal
matrix functions in the course of the
aging process. Professor Sergio Serrano introduced the therapeutic use
of biophotons and singlet oxygen
and demonstrated their practical applications in traditional mesotherapy
and biomesotherapy to the group.
Dr. Bianchi is a seasoned expert on
Krebs cycle catalysts and enthusiastically endorses their use in therapy,
both in his youngest patients (such
as low birth-weight babies) and in
mature and elderly patients. We analyzed individual clinical case studies
under Dr. Bianchi’s guidance. From
the perspective of conventional
medicine, all of these cases were at
least very interesting and often very
challenging. All of Dr. Bianchi’s patients had undergone very thorough
diagnosis, often in university hospitals, and their discharge summaries
and hospitalization information
were available. Dr. Bianchi conducted detailed repertorization of each
individual patient, applying the
rules of classical homeopathy and
homotoxicology, and determined
the position of each patient’s condi-
rom November 6 to 8, 2008, in
Verona, Italy, the International
Academy for Homotoxicology presented a practice-based training for
Polish doctors whose practices combine conventional medical training
with elements of homeopathy, homotoxicology, acupuncture, homeosiniatry, and mesotherapy. The small
group of students, all experienced
clinicians, included three internal
medicine specialists and two pediatricians.
The training took place in Dr. Ivo
Bianchi’s private medical practice,
which he runs together with his wife
and daughter. Dr. Bianchi sees patients of virtually all ages, ranging
from infants to geriatric patients.
The group had close contact with
selected patients, had access to their
histories, and was able to examine
them. Each patient was then discussed in detail to determine individually optimized therapies and
recommendations.
Dr. Bianchi had invited two guest
speakers to contribute to the training. Dr. Lugero Graziolli gave a lecture and practical demonstrations on
“Esthetic Biological Medicine: Diagnosis and Therapies,” placing particular emphasis on biochemical and
electromagnetic homeostasis in the
At the end of the training, the
Sightseeing in Verona
tion on a neurovegetative outline he
has developed and enriched with
additional elements drawn from homotoxicology, Chinese medicine,
and conventional medicine.
The training itself was very intense
but well-organized, and the sessions
were just the right length. Between
sessions, we were also able to enjoy
the charming sights of the town of
Verona and see the international
horse show gala HORSELYRIC, for
which Verona is now famous.
We found participating in this training to be highly rewarding and recommend it to all practitioners interested in homotoxicology and holistic
medicine.|
For more information on
practice-based training in
bioregulatory medicine,
please contact the International Society of Homotoxicology and Homeopathy at
[email protected]
) 15
participants received certificates
(far left and right: Dr. Ivo Bianchi
and his wife Marina).
) Practical Protocols
Bioregulatory Treatment
of Dysautonomia
By Bert Hannosset, MD
D
ic nervous system, is much more
common. In this disorder, the human body fails to properly regulate
blood pressure (e.g., orthostatic hypotension), heart rate (e.g., postural
orthostatic tachycardia syndrome),
temperature, vascular constriction/
dilation, and blood supply to the
brain. The results are unpredictable
fainting, low blood pressure, lightheadedness, dizziness, problems
with concentration (“brain fog”),
headaches, fatigue, heart palpitations, exercise intolerance, insomnia,
ysautonomia, formerly called
neurasthenia, exists in two
forms: familial dysautonomia and
non-familial dysautonomia.
Familial dysautonomia is an autosomal recessive genetic disease, the
result of mutation in the IKBKAP
gene on chromosome 9. It occurs
exclusively in Ashkenazi Jews; there
are currently 350 known living cases worldwide. To date, the disease
remains incurable.
Non-familial dysautonomia, a disease or malfunction of the autonom-
DET-phase
Basic and/or
symptomatic
Sympathicodermal
Impregnation
• Ignatia Homaccord
D&D
hot flashes, chills, weakness, seizures, pain, and disability. The causes
of non-familial dysautonomia are
not fully understood but are thought
to include viral infections, exposure
to toxic chemicals, genetic factors (a
variation in the angiotensin II type I
receptor gene), autoimmune disorders (antibodies to neuronal nicotinic acetylcholine receptors of the
autonomic ganglia), adrenal disorders, and trauma (injury or emotional trauma, which damages the autonomic nervous system). (See protocol
in Table 1.)|
Regulation therapy*
Optional
• Advanced supportive
detoxification and drainage
followed by the
• Vertigoheel (dizziness)
• Detox-Kit
IM
• Tonsilla compositum
OR
• Sympathicus suis-Injeel
if available; if not, use
• Tonico-Injeel (exhaustion)
• Cralonin (cardiac weakness)
• Aurumheel (low blood pressure)
• Traumeel (injury)
• Engystol (post-viral)
• Cerebrum compositum
Notes: Ignatia and Moschus = basic homeopathic treatment for dystonia. Advanced supportive detoxification and drainage consists of
Hepar compositum (liver), Solidago compositum (kidneys), and Thyreoidea compositum (connective tissue; also regulates glandular
functions [e.g., pineal body, thyroid, and adrenals]); Coenzyme compositum and Ubichinon compositum for cellular detoxification and
drainage. The Detox-Kit consists of Lymphomyosot, Nux-vomica-Homaccord, and Berberis-Homaccord. Tonsilla compositum downregulates the Th-2 pathway and supports adrenals. Sympathicus suis-Injeel supports the autonomic nervous system. Cerebrum compositum supports the central nervous system and improves blood flow.
Dosages: Ignatia-Homaccord: 15 drops 3 times per day. Regulation therapy: 1 ampoule of each medication 1-3 times per week. Detox-Kit:
30 drops o f each medication in 1.5 liters of water; drink throughout the day.
) 16
Table 1: Protocol for dysautonomia
* Antihomotoxic regulation therapy consists of a three-pillar approach: detoxification & drainage (D&D), immunomodulation (IM),
and organ regulation (OR)
In memoriam
P
rofessor Michael F. Kirkman
died on Saturday, January 18 on
the Isle of Wight, United Kingdom.
He had lectured at St. Andrew’s
Medical School; his medical knowledge ranged from pathology and
tropical diseases to homeopathy, homotoxicology, and nutrition. He was
one of the first doctors to apply an
integrative concept of medicine that
included environmental factors and
detoxification.
He had the courage to challenge
medical conventions and found
himself in the first line of attack for
his use of homeopathic sarcodes and
nosodes. Like Drs. Reich, Gerson,
Bach, and Reckeweg before him, his
dogged persistency, academic ability,
and zeal to advance the “art of medicine” enabled him to carry on with
his mission. He wrote a textbook on
tissue microenvironment and lectured and published articles worldwide. He was one of the first certified lecturers of the International
Academy for Homotoxicology (IAH)
and won an award for the best lecture at the first IAH rollout in BadenBaden, Germany in April 2003.
He founded not only one of the first
nutritional colleges in the UK (the
European College of Nutrition at
the Royal Society for Public Health)
but also the first College of Homotoxicology in the UK; with colleagues, he started the first postgraduate course in bioregulatory
medicine. Last but not least, he was
involved in teaching a course in bioregulatory medicine at the Biomedic
Centre in the UK in collaboration
with two colleagues, Drs Shakambet
and Bosh.
Professor Michael F. Kirkman
(1936 – 2009)
His guidance and support were crucial to those following this path,
and he was full of warmth and enthusiasm for new projects. His mentorship, wise guidance, and friendship, along with his witty and
creative mind, will be greatly missed.
His funeral was held on February 4,
2009 on the Isle of Wight. Professor Kirkman is survived by his wife
Muriel.
Damir A. Shakambet, MD
Hans-Heinrich Reckeweg Award 2010
Join in – have your experience rewarded
Heel annually honors outstanding scientific research in
the field of a unique homeotherapeutic system (homotoxicology) with the Hans-Heinrich Reckeweg Award.
The main award (€ 10,000)
is presented for scientific work of fundamental theoretical and/or practical significance in antihomotoxic
medicine in the fields of human and veterinary medicine.
The incentive award (€ 5,000)
is presented for promising results arising from clinical,
case-based or fundamental research in antihomotoxic
medicine in the fields of human and veterinary medicine. The prize money is intended to fund further research.
Both prizes are awarded for research carried out in a
laboratory or registered practice. All results must be
new, convincing and previously unpublished, and research should not have involved animal testing.
The deadline for submissions is May 31, 2010.
For more information contact:
Biologische Heilmittel Heel GmbH,
Department of Research,
76532 Baden-Baden, Germany
Phone +49 7221 501-227,
Fax +49 7221 501-660, [email protected],
www.heel.com
) 17
) Re f r e s h Yo u r H o m o t ox i c o l o g y
Psychogenic Factors in
Gastrointestinal Pathology
By Bruno Van Brandt
Medical Education Manager of the IAH
Is half a glass of water half full or half empty? Although the
reality remains the same, the way individuals look at it will
definitely change their emotional state. Half full or half
empty makes the difference between positivism and negativism, between stress and inner peace, between psychogenic
factors that will, over the ideomotorical rule in psychology,*
enhance or inhibit physical condition or strength.
E
) 18
motional triggers of immune
disorders are very well-known
in modern medicine, especially
where psycho-neuro-endocrino-immunological (PNEI) effects are seen
as a major trigger within psychosomatic diseases.1 Serotonin, adrenaline, dopamine, and glutamate are
major neurotransmitters in the central nervous system. Serotonin and
adrenaline especially are secreted in
response to stress and emotion. All 4
neurotransmitters mentioned are
also present in a second, almost prehistorical, and often forgotten brain,
called the enteric brain.
This enteric nervous system, located
in the gastrointestinal (GI) tract
(more precisely in the epithelial lining of the esophagus, stomach, and
small and large intestines), is a major
subject in the study of neurogastroenterology and plays an important
role in irritable bowel syndrome
(IBS). According to some researchers, up to 95% of the serotonin
available in the body is located in
the GI tract; of this 95%, 90% is in
the enterochromaffin cells, and the
remaining 10% can be found in enteric neurons. Serotonin plays a key
role in the initiation of peristaltic
and secretory reflexes.2
Although the enteric brain is described as part of the peripheral nervous system, it is also defined as the
second brain,3 in addition to the primary central brain. The central nervous system can influence the enteric brain and vice versa.3 This
could be a possible explanation as to
why an emotional stressor or anxiety can indirectly induce IBS.
During stress, the brain will induce,
over the brain-gut axis, mast cell degranulation in the intestinal tract.
By this degranulation, histamine
and phospholipids are set free in
large numbers, inducing inflammatory pathways. Activation of the gut
immune system may disrupt normal
gut motility, leading to common
symptoms such as diarrhea, cramping, and bloating.4
The inflamed tissues render the enteric nerves overly sensitive and
overactive, deregulating the production of serotonin. Both low and
high levels of serotonin can cause
problems. The same molecule, when
available in a too low or a too high
concentration, may induce the same
clinical symptom: cramps. As Paracelsus already stated centuries ago,
“the dose makes the poison.”
Low levels of serotonin are not only
associated with depression, shortterm memory, and concentration
deficits, but also, at the level of the
enteric nervous system, with bowel
problems such as constipation with
spasm (IBS-C). Emotional stress,
over the PNEI system, can thus induce changes within serotonin levels
at the level of the GI tract and can
induce spasms (Figure 1). A stressrelated nervous or anxious state will
increase the prevalence or intensity
of intestinal spasm over the braingut axis.5
Increased levels of serotonin are associated with intestinal problems
too, such as is seen in diarrhea
accompanied by cramps (IBS-D).6
Selective serotonin reuptake inhibitor package inserts often mention
both symptoms as possible adverse
effects because of the medicationinduced decreased reuptake of serotonin and thus the increased serotonin availability and activity levels.
* Every thought or idea makes the body gravitate to fulfill that thought or idea. William James, The Principles of Psychology (1890)
) Re f r e s h Yo u r H o m o t ox i c o l o g y
The conventional medical approach
to IBS is often the use of antispasmodic agents, such as hyoscine butylbromide, to relieve spasms and
cramps. Research in conventional
medicine also reports the symptomrelieving effects of benzodiazepines
in patients with IBS,7,8 pointing at
the psychogenic factors that increase
the physical symptoms over the
brain-gut axis. A combination therapy of an antispasmodic medication
with a benzodiazepine seems to
have synergic therapeutic effects in
the relief of IBS symptoms.9 Treatments aimed at the gut-brain interface are in development, but have
been difficult to establish because of
adverse effects.10
Bioregulatory treatment
It is thus interesting to look at a bioregulatory approach in these patients. In a comparative study, Nervoheel was found to be noninferior
to lorazepam, a benzodiazepine prescribed worldwide, in the treatment
of mild nervous disorders.11 Spascupreel is a bioregulatory antispasmodic medication that will induce
symptomatic relief of spasmodic
conditions of the intestinal tract. In
a comparative study versus hyoscine
butylbromide, it was shown to possess a noninferior therapeutic effect
in treating intestinal cramps.12 This
effect of Spascupreel can be used in
conditions such as IBS, and, if it is
applied together with a psychogenic
relaxing drug such as Nervoheel, a
synergistic action on the gut-brain
axis may be possible. In this way, a
bioregulatory alternative can be offered for the combination of antispasmodic agent–tranquilizer in
conventional therapy of IBS.
Given the PNEI link between the
central and enteric brain and the experience in conventional medicine
(i.e., antispasmodic drugs in combination with tranquillizers have a
stronger symptom-relieving effect in
IBS), it can be stated that Nervoheel
might play an important therapeutic
role in the bioregulatory relief of
IBS symptoms. Although some benzodiazepines are known to be addictive,13 to my knowledge, no such
risk has ever been reported for Nervoheel. Thus, Nervoheel is a safe alternative to benzodiazepines. In the
same way, Spascupreel is a safe and
effective alternative to hyoscine butylbromide in the symptomatic relief
of patients with IBS. Known adverse
effects of hyoscine butylbromide include constipation, dry mouth, trouble urinating, and nausea. Other adverse effects, which are very unlikely
but reported, include rash, itching,
swelling of the hands or feet, trouble
breathing, increased pulse, dizziness, diarrhea, vision problems, and
eye pain. To my knowledge, none of
these adverse effects have ever been
reported with Spascupreel.
In conclusion, bioregulatory treatment may offer a viable alternative
Stress
Mood disturbances
• Anxiety
• Depression
Central nervous system (brain)
Autonomic nervous system
Enteric nervous system
Intestines
Smooth muscle
in the management of conditions in
which the gut-brain interface causes
deregulation of the enteric nervous
system, the second brain.|
References:
1. Sivik T, Byrne D, Lipsitt D, Christodoulou G,
Dienstfrey H, eds. Psycho-Neuro-EndocrinoImmunology (PNEI). Amsterdam, the Netherlands: Elsevier; 2002. Excerpta Medica
International Congress Series 1241.
2. Grider JR, Kuemmerle JF, Jin JG. 5-HT released by mucosal stimuli initiates peristalsis by activating 5-HT4/5-HT1p receptors
on sensory CGRP neurons. Am J Physiol.
1996;270(5 pt 1):G778-G782.
3. Gershon MD. The enteric nervous system: a second brain. Hosp Pract (Minneap).
1999;34(7):31-32, 35-38, 41-42 passim.
4. Törnblom H, Lindberg G, Nyberg B, Veress B. Full-thickness biopsy of the jejunum
reveals inflammation and enteric neuropathy
in irritable bowel syndrome. Gastroenterology.
2002;123(6):1972-1979.
5. Taché Y. Stress and irritable bowel syndrome:
unravelling the code. International Foundation for Gastrointestinal Disorders Web
site. http://www.iffgd.org/store/viewproduct/211. Accessed July 14, 2009.
6. Singh RK, Pandey HP, Singh RH. Correlation of serotonin and monoamine oxidase
levels with anxiety level in diarrhea-predominant irritable bowel syndrome. Indian J Gastroenterol. 2003;22(3):88-90.
7. Tollefson GD, Luxenberg M, Valentine R,
Dunsmore G, Tollefson SL. An open label trial of alprazolam in comorbid irritable bowel
syndrome and generalized anxiety disorder.
J Clin Psychiatry. 1991;52(12):502-508.
8. Leventer SM, Raudibaugh K, Frissora CL, et
al. Clinical trial: dextofisopam in the treatment of patients with diarrhoea-predominant
or alternating irritable bowel syndrome. Aliment Pharmacol Ther. 2008;27(2):197-206.
9. Ritchie JA, Truelove SC. Treatment of irritable bowel syndrome with lorazepam, hyoscine butylbromide, and ispaghula husk. Br
Med J. 1979;1(6160):376-378.
10. Sanger GJ. 5-Hydroxytryptamine and the
gastrointestinal tract: where next? Trends
Pharmacol Sci. 2008;29(9):465-471.
11. van den Meerschaut L, Sünder A. The homeopathic preparation Nervoheel N can offer
an alternative to lorazepam therapy for mild
nervous disorders. Evid Based Complement
Alternat Med. Published October 25, 2007.
doi:10.1093/ecam/nem144.
12. Müller-Krampe B, Oberbaum M, Klein P,
Weiser M. Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps
in children. Pediatr Int. 2007;49(3):328-334.
13. Cappell H, Busto U, Kay G, Naranjo CA,
Sellers EM, Sanchez-Craig M. Drug deprivation and reinforcement by diazepam in a
dependent population. Psychopharmacology
(Berl). 1987;91(2):154-160.
Figure 1: Stress alters the function
of the gastrointestinal tract via the
brain-gut axis.
) 19
) M a r k e t i n g Yo u r P r a c t i c e
Communication in Your Practice
By Marc Deschler
Marketing specialist
An American study shows that faulty communication is
management’s biggest problem. As a physician, you probably
spend 90 percent of your working time communicating,
both consciously and unconsciously. In the long term,
miscommunication that leads to actual misunderstandings
can put your practice at risk.
R
) 20
eview the requirements of
good communication and make
improvements as needed:
1. Good communicators are made,
not born. Every day brings new
opportunities to practice and refine this ability.
2. We communicate even when
we’re not saying anything. For
example, if you keep your eyes
fixed on the patient’s chart,
you’re giving him the (mistaken)
impression you are not really interested in his problem – his most
important problem, otherwise he
wouldn’t be there! Pay careful
attention not only to what you
say, but also to what you do.
3. Most of the information that gets
stored in the brain is received
through visual channels, and you
can take advantage of this fact by
using written information to
supplement your words. Informational materials give patients
a second chance – if they didn’t
understand something completely, they can read about it later.
An additional tip: To reinforce
your competence in your patients’ minds, print all informational materials on your own letterhead.
4. Assume that anything you’re trying to say can always be misunderstood. This will lead to better
communication on your part,
since you will choose your words
differently and observe reactions
more closely.
5. Not everything you say has to be
print-ready and error-free. It’s
more important that your patients understand what you’re
saying. Avoid pretentious technical jargon.
6. Defining an illness is no help to
the patient. She wants to know
what it means for her, and she
needs to be able to interpret your
message correctly.
7. It’s not what you say, but how
you say it. Pay attention to how
you say something and to how
you reinforce it with body language because nonverbal communication is by far the most
important contributing factor.
8. On the phone, nonverbal communication is eliminated, so you
and your team should make a
special effort to use visual imagery when you speak.
Repeatedly monitor the communication behavior of your staff and offer training and suggestions for improvements as needed.
A clear structure, whether in
communication, documentation, or
filing, will save you time and money.
The answering machine
No one likes talking to a machine.
Not surprisingly, according to one
study, almost 60 percent of callers
hang up when they get a machine,
and of those who do leave a message, only 16 percent are identifiable. Clearly, though, your answering machine is one of the most
important advertisements for your
practice. What do you need to keep
in mind when recording your message?
1. Include your name in your greeting. For example, “Hello, this is
John Sample at XYZ practice.”
2. Meet the caller halfway: “Thank
you for calling. Even though we
can’t answer the phone right
now, we’re still here for you.”
3. Suggest an action: “Please don’t
hang up, but …”
4. In closing, thank them again for
calling.
Your phone message should be wellprepared, not just an afterthought.
Write out an appropriate text and
read it in a clear and friendly voice,
quietly and not too slowly. Your message should flow, so concentrate on
what you’re saying but don’t rush it.
Check your machine now and then
by calling yourself. Your voice will
sound different over the phone than
it does when you’re recording. The
tapes in analog machines eventually
wear out; replace them periodically.
To make sure you get the information you need from your callers, try
handing out cards to your patients
with the most important “W” questions you need in order to return
their calls:
• Who is calling? (name)
• What are you calling about?
• Where can you be reached?
(phone number? E-mail address?)
• When is a good time to reach
you?
Even if you choose not to offer patients the option of leaving a message, your recorded statement should
be appropriate and convincing and
leave them with a professional impression of your practice.
Optimizing record-keeping
It’s always worth looking for opportunities to improve the organization
of your practice, including patient
chart management, which can be a
half-time job in itself if poorly designed. To avoid unnecessary expense to your practice, follow these
rules for chart management:
1. The fewer files you have, the
faster you can find any individual chart. Make sure to keep all of
each patient’s information together in one place!
2. Sort through the files regularly.
Inactive folders simply slow
down your search.
3. Alphabetization is almost always
the best filing system. Using as
many index cards/tabs as possible makes it easier to find what
you need quickly.
4. Re-file charts as soon as possible
after adding to them. Don’t leave
them lying around for someone
to deal with later.
5. Formats and labeling should be
kept consistent so you know
where to look for what you need
without searching.
6. More than three identifying cha
racters (first and second letter of
last name, first letter of first
name) get unwieldy. Color coding (for example, for year of
treatment) can speed up access.
7. File tabs or insert cards should
be used to indicate status.
8. Documentation should be completed immediately after a service is rendered. Here, too, a
well-conceived and consistent
structure is important.
9. For preparing patient charts,
you’ll need a date stamp, a stamp
for diagnostic reports, etc. Charts
prepared for house calls must
also include a blank prescription
form.
10.A quick glance before re-filing
the chart should be enough to
ensure that all necessary entries
have been made.
If you have the equipment and technical know-how, by all means get rid
of paper charts a.s.a.p. You will eliminate a lot of administrative work,
and that expensive EDP system will
finally pay for itself ! In many cases,
the improved work flow even makes
additional investment in new EDP
work stations worthwhile.|
) 21
) Specialized Applications
The Acupuncture Approach to the
Hypothalamus-Pituitary-Adrenal Axis
and Its Interaction With the
Sympathetic and Parasympathetic Systems
By Butch Levy, MD, LAc
In contemplating this article, I was struck by the opportunity to connect and integrate an approach to a Western
anatomical/physiological concept while reflecting on the
use of Chinese medicine and homotoxicology. The sympathetic/parasympathetic system, or autonomic nervous
system (ANS), can be translated into paradigms of activity
and interaction using the Oriental construct of acupuncture
tsubos, or holes, and using homeopathic combinations as
therapeutic interventions. This combined usage is called
homeosiniatry*.
I
) 22
n the US perception of acupuncture, points reflect an anatomical
location where a needle is inserted.
Changing the rotation of the needle
infers a method of enhancing or diminishing its effect (i.e., clockwise is
tonification and counterclockwise is
sedation).
The Japanese approach to needling
technique views acupuncture locations as specific holes. The needle is
inserted along a vector, with a direction and depth. This requires palpatory acumen that translates into a
precise connection into the path of
flow desired.
The extracellular matrix (ECM) is
the common conduit for therapy, be
it physiological stimulation of the
nervous system, the Yin and Yang
energies of Asian medicine, or the
electrical signature of natural molecules, as is seen in homeopathy.1
Within the ECM lie the biological
features that allow nerve impulses to
signal and transmit information for
homeostasis. Layered on that, the
similar concepts of Yin and Yang
theory are reflected within the same
ECM, with cylindrical spirals of
acupuncture holes acting as a transit
system, via the meridian system, for
similar information transmission
concerning the body’s balance.2
Within the Oriental system, the
ECM represents an equivalent concept, expressed as the Triple Heater.
It is said to convey the Qi that is essential in energy transformation and
metabolism. It is considered to be
the fluid interface surrounding cells;
in modern interpretation, it is considered to be the extracellular environment of the cell.
The importance of these statements
is to act as the starting point to treating patients with problems of the
sympathetic/parasympathetic system, by being able to act in creative
ways based on the practitioner’s assessment of the patient. It is often
the situation that a single paradigm
of therapy is inadequate to treat the
complexity of issues generated within the body. This certainly is true
regarding the sympathetic/parasympathetic system influences within us. To integrate these unique therapies requires a brief review of the
connections that make them compatible for the treatment of sympathetic/parasympathetic, or ANS,
imbalance.
Autonomic nervous system
The aspect of the nervous system
that is involved in our discussion is
the ANS. Originating in the hypothalamus, fiber tracts from the various nuclei (e.g., medial, lateral, anterior) travel from the hypothalamus
into the intermediate brain and
through the lower brain, making
connections with multiple other nuclei there before descending into the
spinal cord. These other nuclei also
contribute essential information for
ANS regulation. These pathways are
called the hypothalamospinal tract
* “Homeo” from homeopathy, “sin” from sinology = study of Chinese culture, and “-iatry” from Greek iatros = healer (figuratively: medicine)
© iStockphoto.com/Wolfgang Amri
Acupuncture needles are inserted
into specific points on the body in
order to relieve pain and/or restore
health and well-being.
(HST) and carry information that
activates, stimulates, inhibits, or balances sympathetic and parasympathetic signals. The sympathetic system dominates during activity in the
body and is energy consuming. The
parasympathetic system dominates
when the organism is in resting
phases, including digestion and
sleep cycles.
The sympathetic nervous system is
under the direct control of corticotrophin-releasing hormone (CRH)
in the hypothalamus. Its stimulation
creates an excitatory response in the
sympathetic system while turning
off parasympathetic responses, in
preparation for the fight, fright, or
flight response. Some of the direct
effects seen via increased norepinephrine (adrenaline) are stimulation of cardiac muscle, an increase in
heart rate and breathing, an increase
in blood glucose, sweating, and vasoconstriction. At the same time,
blood volume is expanded via the
CRH activation of the renin-angiotensin-aldosterone system. When
situations of perceived threat occur,
anticipatory readiness is also reflected in increased muscle activity and
visual acoustic startle, reduced appetite, and an inherent protective anxiety to “get out of town” or leave the
scene quickly. To assist these preparations, the visceral tissues become
quiescent, until the danger has
passed.
The spinal parasympathetic system
is composed of the cranial division
(cranial nerves III, VII, IX, and X)
and the sacral division (S2-S4).
These cranial nerves interconnect
with the HST fibers via their nuclei,
located in the midbrain, pons, and
brainstem. The principal HST parasympathetic functions include pupillary and lens adjustments, salivation, heart rate, movement and
secretions in the gastrointestinal
tract, urination, defecation, and erection. Specifically, cranial nerve IX
influences the carotid body and sinus and the pharyngeal mucosa.
Cranial nerve X is related to the larynx and trachea and the thoracoabdominal viscera to the level of the
splenic flexure. The sacral plexus involves the colon distal to the splenic
flexure, the rectum, and the bladder.
The HST of the sympathetic system
extends from T1 to L2/3. The fibers
exit the spinal cord as preganglionic
fibers that release acetylcholine,
which innervates their nearby
preaortic and paravertebral postganglionic receptors, which then release
norepinephrine. These chemical
transmitters then affect the pupils,
sweat glands, blood vessels, lungs,
abdominal viscera, and gastrointestinal tract. The ANS helps coordinate and regulate stimuli coming
from the external and internal environment.
Asian medicine
The seemingly opposite parts of the
ANS imply energies of mutual dependence when considered within
the paradigm of Asian medicine. It
is the Yin and Yang that are considered as the framework of movement
and stillness, night and day, light
and dark, with each aspect requiring
a comparison to its counterpart to
make sense. Although the final step
for our consideration of homeosiniatry is specific injection of tsubos, or
holes, there are essential constructs
in Asian practice that themselves can
act to create an enhancement of energy or the opposite effect of reducing or dampening energetic effects.
The movement of energy, or Qi, is
considered to travel unidirectional
under normal circumstances, along
each specific meridian pathway.
Needling a tsubo along this direction of flow is considered tonifying
or sympathetically stimulating. Needling techniques that are in the direction opposite or counter to established meridian flow will slow or
reduce the energy flow, are considered sedating or quieting to the system, and would be considered parasympathetic.
In protocols using electrical stimulation, a sympathetic or parasympathetic effect can be created via the
circuits used. Electrical charge travels from negative (silver needle or
black grip) to positive (gold needle
or red grip), and electrical flows can
be used to augment or diminish energy solely by adjusting the direction of flow of the electricity. Practitioners can also influence the
activation of sympathetic activity by
) 23
Figure 1: Back Shu points used in
treating disorders of the hypothala-
mus-pituitary-adrenal–sympathetic/
parasympathetic system.
low-frequency electrical stimulation
in the range of 2 to 10 Hz. These
frequencies are used, for example, in
facial nerve palsies and for historic
treatments that were designed to upregulate, so to speak, weak energy
systems within the body. To create a
parasympathetic flow, high-frequency electrical stimulation can be used,
ranging from 100 to 200 Hz for local myofascial injury to 1500 Hz for
sedation of the central nervous system, thereby affecting higher brain
centers for pain regulation (and a
down-regulation of pain).
BL 13 Lung
BL 14 Pericardium
BL 15 Heart
BL 16 Governing vessel
BL 17 Conception vessel
BL 18 Liver
BL 19 Gall bladder
BL 20 Spleen
BL 21 Stomach
) 24
Injection sites
The classic choices for acupuncture
holes that may be integrated to synergistically relate to homeosiniatry
might include the 8 extra vessels,
back Shu points (Figure 1), and
source and auricular points. The extra vessel meridians of Yin/Yang
Wei (Pericardium 6 and Triple Heater 5) connect and distribute all the
Yin and Yang, respectively. The Yin/
Yang Qiao vessels (Kidney 6 and
Urinary Bladder 62) balance all the
Yin and Yang for muscle coordination in the body. Also, the Du Mai
channel, the source of all Yang Qi,
or sympathetic energy, can be augmented by needling from the lower
spine up and can be quieted or sedated by needling from the scalp
down. For the sympathetic concept,
this would mean increasing the
movement in the Yang organs; for
the parasympathetic concept, the Qi
BL 22 Triple heater
BL 23 Kidney
BL 25 Large intestine
BL 27 Small intestine
energy would be augmented in the
Yin organs.
The use of auricular points adds an
essential synergism for balance
within the brain and ANS. Using a
point locator allows exact locations
for treatment. Traditional interpretations used to imply that when one
aspect of the ANS was on, the other
was off, and vice versa. Our society
today creates levels of continuing
stressors, and often the continued
pressure on both aspects of the ANS
results in imbalances that do not fit
conventional rules. Using such a
testing device, areas such as the pi-
In homeosiniatry, bioregulatory
© iStockphoto.com
medications are injected into
tuitary, hypothalamus, preganglionic
and postganglionic nerves, vagus,
parasympathetic nerves, and amyg
dala can be accessed and therapeutically used.
The back Shu points represent a
level of interaction that would be
used to affect the individual organs
that are influenced by the hypothalamus-pituitary-adrenal–sympathetic/parasympathetic system. The first
line relates to organ dysfunction,
whereas the second line has great
benefits in emotional issues that affect its adjacent organ.
Practical application
Some practical examples of homeosiniatry that have application in the
clinic would include the following.
Starting at the hypothalamus, it
would be ideal to directly affect its
function! Tonsilla compositum contains hypothalamus and can act toward directly targeting at the hypothalamic level. Its effect would,
therefore, generalize to the entire
system. Points of injection should
be ones that have general regulatory
ability, such as Stomach 36 or Spleen
6. More often, therapy must be designed to indirectly affect the system, at the feedback loop to the hypothalamus or at the organ itself.
Because hypothalamic CRH controls the production of cortisol, the
negative feedback loop to CRH
is activated when the hypothalamus senses increased cortisol. Therefore, using medications that contain
acupuncture points.
cortisol will reduce the production
of CRH and slow or regulate the
fight or flight response (i.e., sympathetic outflow). Tonsilla compositum (for overall immune stimulation), Thyreoidea compositum (for
connective tissue metabolism), and
Pulsatilla compositum (for support
during chronic inflammation) all
contain cortisone in dilution and
can be used to reduce the output of
CRH and with it sympathetic activity.
Major organs that are activated by
sympathetic stimulation are the
heart, lungs, and the associated circulatory system. To affect these organs, especially in chronic conditions, the back Shu points can be
injected. Because fight or flight is an
excess condition, the points chosen
on the Urinary Bladder line (Urinary
Bladder 14, Pericardium; and Urinary Bladder 15, Heart) are tight
and tense, indicating overactivity.
Chronic myocardial weakness or
coronary circulatory problems can
be treated with Cactus compositum.
Cor compositum can be used for
palpitations, and Cralonin can be
used for chest pains. The lung area,
Urinary Bladder 13, can receive
treatment for bronchospasm, using
Mucosa compositum for wheezing
and cough, Traumeel for inflammation, or Engystol for immune stimulation.
In contrast, when sympathetic activation is quieted down, ideally the
parasympathetic system is activated.
Their innervations primarily involve
smooth muscle contraction and
movement within many hollow organs. The Master Point of the Yin
Qiao, Kidney 6, is considered regulatory of the Vagus, and Atropinum
compositum is very useful for cramping and imbalanced peristalsis. Point
choices might also include the
source points or back Shu points for
the large and small intestines, the
spleen and stomach, and the urinary
bladder and gallbladder. Spascupreel
is effective for intestinal cramps and
bladder spasm and irritability.
In conclusion, any discussion regarding the hypothalamus-pituitary-adrenal–ANS really requires
chapters to credibly explain each of
the topics mentioned in this brief
discussion. What I have attempted
to relate is that the complexity of
disease and our rapidly expanding
technology have created a need to
look beyond individual areas of
focus and embrace a new holism
of care. It is necessary to integrate
multiple disciplines, concepts, and
images to achieve results that succeed. |
References
1. Oschman J. Energy Medicine. Dover, NH:
Churchill Livingstone; 2008:141.
2. Pischinger A. The Extracellular Matrix and
Ground Regulation. Berkeley, CA: North Atlantic Books; 2007:106.
) 25
) Making of …
Manufacturing of
Traumeel Injection Solution
Part I: From Work Preparation to Filling
By Larissa Wörthwein-Mack
To minimize the risk of contamination with microorganisms, special requirements apply to the manufacture of
sterile medications. The standards are high, both for spatial
and technical conditions and for employee qualifications.
For example, manufacturing must take place in so-called
cleanrooms of the appropriate classes, and spatial separation
of the different production steps is required.
M
odern homeopathic combination products like Traumeel
(which is used to treat inflammation
and injuries) contain multiple ingredients. In Traumeel injection solution, there are 14 different active
ingredients, primarily plant substances such as arnica, chamomile,
and calendula. These raw materials
are processed into mother tinctures
and single potencies in accordance
with current regulations of the German Homeopathic Pharmacopeia
(HAB) and the European Pharmacopeia (Ph. Eur.).
Production of a sterile
dosage form
) 26
All manufacturing steps involving
open containers must take place in
Class C cleanrooms, which can be
accessed only through airlocks and
in appropriate protective clothing.
High performance filters reduce the
particulate count in the air, and the
rooms are under positive pressure
with more than 20 air exchanges
per hour. Pressure differentials of
10-15 Pa between cleanrooms of
different classes ensure that when
the door of a cleaner room is opened,
the air streams out and contaminated air cannot flow in. The air is tested at regular intervals for particulate
counts and microbiological loads.
All exposed surfaces in the cleanrooms must be smooth and easy to
clean. The special requirements that
apply to employees engaged in manufacturing sterile products include
regular training in sterile manufacturing, hygiene, and microbiology.
Of course high standards of personal hygiene are also a must, and inside the cleanroom, employees are
not allowed to wear jewelry or
make-up! Regular medical checkups
are also required.
The steps in the production of sterile ampoules are: work preparation,
bulk production, filtration, filling,
sterilization, inspection, labeling,
and packaging. Each individual production step takes place in accordance with clearly defined procedures and current GMP (Good
Manufacturing Practice) guidelines.
Written production instructions for
each product detail all of the individual steps in its production. The
production instructions are based on
the company’s manufacturing specifications, the CTD-HD (Common
Technical Document – Manufacturing Documentation), which is submitted to the regulatory agency.
) Making of …
Producing potency mixtures from
individual potencies according to
manufacturing specifications
Specially trained employees conduct
in-process controls (IPC) at regular
intervals during production. These
controls serve to monitor and direct
the production process, ensuring
high quality and compliance with
all requirements at every stage of
processing.
The production process
The first step takes place in the Work
Preparation department, where
batch-specific production instructions are drawn up. In these documents, employees will record every
detail of the processes involved in
producing the batch.
In the Bulk Production department,
the 14 active ingredients (mother
tinctures, single potencies, and triturations) are manufactured in accor-
dance with the production guide.
Ethanol-water mixtures in varying
concentrations are used as the potentizing medium.
The next step is production of the
so-called bulk solutions. The individual potencies and triturations are
combined into potency mixtures,
which are then further potentized
with water for injection. The resulting intermediate products are then
mixed in large stainless steel tanks,
and a specific amount of sodium
chloride is added to produce an isotonic solution.
IPC workers take samples of the finished bulk solution and test for a
variety of parameters including pH,
isotonicity, and appearance. The
bulk solution is released for further
processing only if all values fall
within the required ranges. This step
Manual potentization of
a potency mixture
Stainless steel batching tank for
producing the solution
Filtering the bulk solution through
a sterile membrane
) 27
) Making of …
Interim storage of the bulk solution
in sterile disposable containers
is followed by bulk filtration, which
removes suspended matter and reduces germs. The filter is a sterile
membrane filter with a pore size of
0.22 µm. The filtered solution is
filled into sterile, flexible, disposable
containers.
The used filter is then tested for integrity, and if it passes the test, the
filtered batch of bulk solution is
transported to the filling equipment
in disposable containers with capacities ranging from 10 to 50 liters.
The containers are connected to the
filling equipment, and the required
quantities of glass ampoules are prepared. Before the actual filling takes
place, a test run of a certain number
of ampoules is filled to check for accuracy of the fill quantity.
If the fill quantities match the target
value, the machine is cleared for filling. Precisely measured fill quantities are then pumped into the sterile
glass ampoules through six filling
nozzles. Finally, a blowpipe is used
to seal the open ampoules by melting their necks to create a closure.
Each machine can fill up to 18,000
ampoules per hour.
In the next issue, you will learn
about the further steps required to
produce a finished, customer-ready
product.|
) 28
Photos by Sonja Bell
Filling and heat sealing the sterile glass
ampoules
) Meet the Expert
Dr. Arturo O’Byrne
By Catherine E. Creeger
A
Back in Colombia, he studied sports
medicine and nutrition in Cali,
where he later also held professorships in biology and physiology.
From 1987 to 1989, as medical director of the professional cycling
team “Caf é de Colombia,” he based
the athletes’ training and maintenance program on biological medicine. During this time, the team
achieved international standing in
particular in mountain racing, resulting in first places in the 1987
Vuelta a España and the 1988 Dauphiné Libéré and a third place in the
1988 Tour de France. His work with
other sports teams had similar results and generated considerable interest in biological therapies in
sports medicine in Colombia.
In 1989, Dr. O’Byrne founded the
teaching hospital “Centro de Medicina Biológica Dr. O’Byrne” in
Cali and began giving courses and
talks for doctors. Since then, his ongoing efforts in disseminating homotoxicology and biological medicine have led him to travel widely,
rturo O’Byrne was born in
1951 in Cali, Colombia, into a
long line of medical doctors. He received his first practical instruction
in surgery from his father in their
family-owned clinic.
Young Arturo was very interested in
photography and designing educational materials, and in college he
collaborated with many of his professors on audiovisual presentations
for classes. This skill in developing
innovative educational tools would
later become one of the foundations
of his professional activities. He
graduated from the Universidad del
Cauca in Popayán, Colombia in
1976 with a diploma in surgery.
During his student years, the climate
in Popayán aggravated the asthma
he had suffered from since childhood. His search for better health
led him to the Colombian physician
Dr. Germán Duque, who pioneered
biological medicine in South America. Duque’s treatments produced a
lasting cure within a few months.
This introduction to alternative
therapeutic methods, including homeopathy and homotoxicology,
marked a radical and irrevocable
turning point in Dr. O’Byrne’s life.
On Duque’s advice, Dr. O’Byrne
travelled to Europe to learn about
integrative biological medicine firsthand. (Later, as medical director of
Santa Margarita Hospital in La
Cumbre, he would become the first
to obtain authorization for a pilot
program in biological medicine in a
National Health Service hospital.)
especially in Latin America. Over
the course of seventeen years, he has
logged more than four million flight
miles and given more than 650 seminars!
Throughout this time, he has remained dedicated to producing
state-of-the-art educational material.
In 2007, with his son Daniel, he
founded BioMD-SA, an academic
services center focusing on professional production of high-definition
3D animation, medical illustration,
etc. His home workstation has three
LCD screens (internet, PowerPoint,
and Photoshop) in use simultaneously. For entertainment on his long
trips, he downloads music of all
genres to his I-pod. (The airlines
serve vanilla ice cream with Baileys
Irish Cream, which also helps to
pass the time!) Dr. O’Byrne enjoys
playing guitar at family gatherings
and is a natural at salsa dancing, but
he is always eager to get back to his
medical projects as soon as the festivities are over. This is the mark of
a true scientist!|
) 29
) Re s e a r c h H i g h l i g h t s
Nervoheel N vs. Lorazepam for
Mild Nervous Disorders
) 30
Introduction
Complementary and alternative
medicine (CAM) is being used more
often, both in Europe and in the
United States. One of the main reasons for the increase in CAM is the
adverse effects seen with conventional medications, leading to the
withdrawal of some of these drugs
from the market. It is believed that
CAM medications are better tolerated than conventional medications.
One of the frequent uses of CAM is
for treatment of functional nervous
disorders, including insomnia, distress, anxiety, restlessness, and burnout. In this study, Nervoheel N, a
CAM medication, was compared
with lorazepam, a conventional benzodiazepine, for the treatment of
functional nervous disorders. Specifically, the effectiveness and tolerability of the 2 medications were
compared. The purpose of the study
was to show the noninferiority of
Nervoheel N vs. lorazepam.
Nervoheel N is a preparation based
on the principles of homotoxicology. Lorazepam has a relatively short
half-life and is favored over longacting benzodiazepines for the
short-term relief of anxiety. Benzodiazepines are contraindicated for
long-term use because of their addictiveness and adverse effects.
The present study was a preliminary
open-label prospective nonrandomized cohort investigation. To our
knowledge, it is the first study to
By Mary A. Kingzette
evaluate the effectiveness of Nervoheel N in a clinical setting.
Methods
This study was performed in 39
centers in Belgium and the Netherlands; these centers offer both conventional and CAM therapy. Patients
enrolled were18 years or older and
suffered from headache, heart palpitations, backache, indigestion, lack
of appetite, mild sexual dysfunction,
fatigue, listlessness, sleep disturbances, restlessness, or lack of concentration. Patients excluded were
those who were unable or did not
want to participate in the study and
those taking both Nervoheel N and
lorazepam.
The study duration was a maximum
of 4 weeks. Patients were examined
at the start of treatment, after 2
weeks of treatment, and after 4
weeks of treatment.
Physicians decided the treatment
used for each patient (after discussion with the patient), and any other
medications taken were not changed
during the study. The dose of Nervoheel N given was 1 tablet 3 times
a day; the dose of lorazepam given
was 2 to 3 mg daily for sedation and
anxiety and 2 to 4 mg nightly for
insomnia. Variations in the dose
were allowed if determined to be in
the patient’s best interest.
The effects of treatment were determined in conversation between the
practitioner and the patient. The se-
verity of symptoms was evaluated
on a 4-point scale (0 indicates
asymptomatic; 1, mild; 2, moderate;
and 3, severe). The overall effect of
the therapies was evaluated on a
5-point scale (excellent, good, satisfactory, no improvement, and worsening of symptoms). Tolerability
was determined by patient-reported
adverse events evaluated by the physician. Overall tolerability of the
treatments was evaluated as excellent, good, moderate, or poor.
Results
A total of 248 patients were included in this study (136 in the Nervoheel N group and 112 in the lorazepam group). After 2 weeks of
treatment, 128 patients in the Nervoheel N group and 106 patients in
the lorazepam group were examined. At the final 4-week examination, the numbers of patients included were 134 and 111, respectively.
There were several differences between the 2 groups at enrollment:
Patients in the lorazepam group
were older and were more likely to
be men, to smoke, and to use alcohol or coffee regularly than patients
in the Nervoheel N group. However,
none of these differences were statistically significant.
There was also no significant difference in the number of nervous disorders between the 2 groups (predominately 2-4 disorders). In both
groups, the most common com-
) Re s e a r c h H i g h l i g h t s
© cherie/Fotolia.de
Sepia, one of the ingredients of
plaints included emotional distress,
jitteriness, and anxiety; and the most
common reasons given for the complaints included work-related anxiety, stress, and family-related anxiety. Most patients in both groups
(> 70%) had not received previous
treatment for their condition.
In both groups, there were significant differences from baseline: The
sum of symptom scores improved by
4.4 points in the Nervoheel N group
and by 4.2 points in the lorazepam
group. However, there was not a
significant difference between the
2 groups.
For both groups, the greatest symptom improvement was seen at the
2-week examination, with slight
continued improvement until the
4-week examination. Even though
most patients chose to maintain
treatment for longer than 4 weeks,
less than 10% did so for longer than
6 weeks. The average duration of
treatment was 31 days in the Nervoheel N group and 29 days in the
lorazepam group.
There was no significant difference
between the 2 groups in overall
therapeutic results (rated as excellent
to good by 72.1% of the Nervoheel
N group and 73.7% of the lorazepam group; P = 0.84).
The tolerability of both treatments
was very good, with only one patient in each group experiencing an
adverse event (both considered unlikely to be treatment related).
Nervoheel N, is prepared from the
secretion of the inkgland of the
cuttlefish (Sepia officinalis).
Notably, the overall patient-assessed
tolerability was significantly better
for the Nervoheel N group vs. the
lorazepam group: Tolerability was
rated as excellent in 81.9% vs. 45.5%
of patients (P < 0.001).
There was no significant difference
between the 2 groups in compliance
scores (P = 0.35), with compliance
ratings of excellent or good for approximately 90% of both groups.
Discussion
This study showed that Nervoheel
N, a homotoxicological medication,
can effectively treat mild nervous
disorders, including aches, palpitations, indigestion, lack of appetite,
mild sexual dysfunction, fatigue,
listlessness, sleep disturbances, restlessness, and lack of concentration.
The study indicated that Nervoheel
N was better tolerated than lorazepam, a traditional benzodiazepine
medication used to treat these disorders.
This being an open-label observational trial, there are limitations to
such a study that are inherent in the
design. First, the enrollment criteria
for mild nervous disorders are somewhat subjective because there are no
standardized rating scales for these
disorders.
Second, the evaluations were left
mostly to the physician’s discretion,
which could result in greater physician bias. However, the fact that the
enrolling centers offer both comple-
mentary and conventional medicine
may reduce this factor in this case.
Third, baseline differences between
groups are inherent in the design of
observational studies, as was also
found in the present study.
There were also other differences
between the 2 treatment groups
(older patients and more male patients, with different lifestyle habits,
in the lorazepam group), which were
addressed with propensity score
analysis but would not exclude all
bias.
However, the strength of observational studies is not so much to show
efficacy, but to show effectiveness in
a practice-based setting and to demonstrate tolerability, in which this
study succeeded.
In conclusion, this 4-week study
showed that Nervoheel N (a homeopathic treatment) was not inferior
to lorazepam (a conventional ben
zodiazepine treatment) for the
short-term relief of mild nervous
symptoms. In addition, significantly
more patients rated the tolerability
of Nervoheel N as excellent compared with the tolerability of lora
zepam. |
Reference
van den Meerschaut L, Sünder A. The homeopathic preparation Nervoheel N can offer an alternative to lorazepam therapy for mild nervous
disorders. Evid Based Complement Alternat Med.
Published October 25, 2007. doi:10.1093/
ecam/nem144.
) 31
IAH Abbreviated
Course
An e-learning course leading to
certification in homotoxicology
from the International Academy for
Homotoxicology in just 40 hours.
1 Access the IAH website at www.iah-online.com. Select your language.
2 Click on Login and register.
3 Go to Education Program.
4 Click on The IAH abbreviated course.
5 When you have finished the course, click on Examination.
After completing it successfully, you will receive your
certificate by mail.
For MDs and licensed healthcare practitioners only
) 32
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