Author: Urenus

DR. MED. W. THIEL

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I. Introduction
One of the most important functions of the skin is to protect the organism against noxae and to guarantee regulated exchange of substances between the organism and its environment. If medicaments have to be brought into the organism by the percutaneous route, then this physiological protective barrier has to be overcome.

One method of transporting active substances through the skin into deeper lying tissue or to increase the extent of normal substance diffusion is direct current therapy. Transcutaneous ion transport, known as ionophoresis, is facilitated by this. Nevertheless, a prerequisite for this is that the pharmacologically active component of the dermatic is present in an electrically charged condition. According to whether the active substance is positively or negatively charged, the medicament is applied beneath the anode or cathode.

More recent studies⁴ ⁵ demonstrate that when ionophoresis is compared with diffusion, increased substance transport takes place only in the horny layer of the horrifying squamous cell layer. Since it is just this horny layer which represents the most effective barrier against diffusion of active substances, greater effectiveness can be achieved here by ionophoresis.

However, the active substances are spread within tissue layers lying below mainly by diffusion along the concentration gradient³.

With regard to the therapeutic effectiveness of this method, a pilot study³ after iontophoretic administration of a non-steroidal antirheumatic agent, humeral epicondylopathy being indicated, revealed a significant decrease in average pain intensity in the case of tenderness and total pain sensation, but further assessment features showed only a slight improvement. However, because of the lack of a comparative group, separation of the medicinal from the physical therapy effect was not possible.

In the case of ointments or gel preparations which contain only one medicament with positive or negative charge, substance transport of greater extent with the aid of direct current is evident because of conformity with natural physical laws¹. The therapeutic effectiveness of a combination treatment of direct current/medicament is also documented empirically elsewhere².

In the case of pharmaceutical mixtures, as are present in phytotherapeutic extracts and homeopathic preparations, it is not known as a rule whether the effective constituents are present in ionized form and if so, what charge they have. In addition there is the fact that it must be assumed in the case of these medicaments that several constituents which can also have different electrical charges are therapeutically effective.

The user can change the current direction at the iontophoresis unit in the course of therapy in order to be able to let both the positively and the negatively charged constituents through the skin into the tissue. Nevertheless, electrically neutral substances cannot be transported more quickly into foreign tissue by this method.

The objective of this investigation was to ascertain whether the combination of a Traumeel ointment therapy with iontophoresis has a better therapeutic result, i.e., faster restoration of health, than application of ointment alone. The therapeutic effectiveness of Traumeel ointment in distortions has been proven without doubt in the course of a double blind study⁶. Taking this effectiveness as proven, the therapeutic comparison of Traumeel ointment versus Traumeel ointment/direct current therapy was sufficient for us in this study without inclusion of a placebo.

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II. Patients and methodology

A total of 50 patients with medium degree injuries were included in the study. All had the same type injury of external ligamentous overstretching in the sense of supination distortion trauma. 25 patients were treated exclusively with Traumeel ointment. The other 25 patients were subjected in addition to direct current therapy.

After the injury, immobilization in a Traumeel ointment dressing was provided for two days for all patients. No further dressings were applied after this.

One group of patients received following this a physiotherapy every 2 days in the shape of iontophoresis with a current intensity of 3 mA for a period of 10 minutes per session. The ointment was applied alternatingly for each patient both on the cathode and on the anode. Cold packs were applied in each case following this treatment. Traumeel ointment for daily self-application was prescribed to the patients of the other group. The patients were examined on the day of injury as well as on the 1st, 3rd, 5th, and 7th day. Assessment criteria were pain at rest, under pressure, and in motion, and were documented by means of a 4 point scale (0 = without, 1 = little, 2 = medium, 3 = severe). Furthermore, the circumference was measured with the aid of a tape measure over the narrowest point, the ankle, and the metatarsus. The mobility of the ankle joint was measured according to the neutral zero method. Circumference and mobility were compared with the healthy side in each case and the change in difference was evaluated. Since the patients were competitive athletes, the period up to the first day of return to athletic training was taken as the criterion for assessing the therapy.

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III. Results

1. Return to training
If the two groups are compared with one another with regard to the first day of return to training, it results that more patients in the group treated solely with Traumeel ointment returned to training at an earlier point in time.

Fig. 1: Return to Training

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2. Pain at rest
Fig. 2: Course of the average pain at rest values

The intensity of the pain at rest was documented in the shape of point values on the 1st, 3rd, 5th, and 7th day of treatment.

The starting value of the two groups were different (with iontophoresis 1.9; without iontophoresis 0.8), so that a comparison of the course with regard to this feature could be made only conditionally. However, it can easily be seen from Figure 2 that both starting values decreased over the 7 days continuously and in a comparable ratio. In the group treated only with ointment, the value of 0.1 was reached for pain at rest within 3 days because of the low starting value; in the iontophoresis group, this value was reached only on the 7th day. (However, the higher starting values existed here.)

Since various patients did not appear at some appointments for “nonmedical reasons”, the starting values of these dropping out patients were analyzed separately. Since these were not extreme values, the average trend values of the assessment features were not distorted by the lack of these data.

3. Pain on pressure

Fig. 3: Course of the average pain on pressure values

The starting values in both groups were comparable with regard to this feature (iontophoresis group on average 2.2; Traumeel group on average 1.9). The intensity of pain on pressure also decreased here continuously as can be seen in Figure 3 from 1.9 points to 0.3 points. In the iontophoresis group, the average pain intensity increased at the beginning (from 2.2 to 2.5) and then decreased continuously but significantly slower than in the Traumeel group. On the 7th day of observation, an average residual pain on pressure of 1.1 was still present.

4. Pain on movement
Fig. 4: Course of the average pain on movement values

The starting values of both groups were also comparable in the case of this feature (iontophoresis group on average 2.2; Traumeel group on average 1.9). The intensity of pain on movement also decreased here continuously as can be seen in Figure 4 from 2.0 points to 0.3 points.

5. Mobility
The mobility of the healthy and injured joint was measured according to the neutral zero method and the difference between the two values was formed.

In the Traumeel group, this difference decreased to the value of 3.8° on the 7th day, a negligible value, which lies in the range of the error limits. In the iontophoresis group, a residual angle difference of 10.7° remained on the 7th day after initial deterioration (Fig. 5).

Fig. 5: Course of the average extent of mobility
(Difference between injured and healthy joint)

6. Circumferential measurements
The data of the circumferential measurements are only conditionally suitable for interpretation (see discussion), since the spread (see table 1) and the value range are too large.

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IV. Discussion
In orthopedic traumatology, there is a trend towards treating the consequences of injury with antiphlogistic ointments and to make therapeutic use of the stimulating effect of direct current treatment (galvanization). The ionization of the active substance is considered to be secondary.

As can be seen from the above tables, an increase in swelling in the ankle joint region was noticed in the control examinations in the iontophoresis group. This is attributable to a condition of irritation caused by electrotherapy as well as to sacculation of the hematoma of the distal joints of the metatarsus.

On critical comparison of the two forms of application of iontophoresis and simple treatment with ointments after inital elastotape dressing, the latter musgt be given preference because of the more rapid incidence of effect, in particular for competitive athletes. Exclusive ointment application has also the advantage of being free of irritation. Side effects were not observed in any patient.

On the other hand, iontophoresis has proven itself for patients who cannot tolerate adhesive dressings for several days (lacing effect in varicosis) or who themselves cannot rub in ointments for certain reasons (older people, disabled etc.). Application of ointment alone, i.e. without initial tape dressings, should be performed only for simple bagatelle injuries which require no specific medical supervision.

Literature

1. Pratzel, H., Die Iontophorese, Med.-Info Nr. 1 (Transcutan GmbH)
2. Magyarosy, J., Ernst, E., Marr, N., Schmolzl, Ch., …
3. Schops, P., Seichert, N., Erdl, R., Siebert, W., Pratzel, H., Pilotstudie zur klinischen Wirksamkeit einer definierten Iontophorese mit Indometacin bei Epicondylopathia humeria, Z. Phys. Med. Baln. Klin. 15, 395–399 (1986)
4. Pratzel, H., Grundlagen des perkutanen Stofftransports in der Pharmako-Physio-Therapie und Balneotherapie, Dissertation 1985 (quoted in 3)
5. Pratzel, H., Machens, R., Dittrich, P., Iontophorese zur forcierten Hautresorption von Indometacin und Salicylsaure, Z. Rheumatol. 104, 40, 748 (1986) (quoted in 3)
6. Zell, et al., publication in preparation

Address of the author:
Dr. med. Werner Thiel
Orthopedic physician
Kirchstraße 9
D‑6635 Bous
Germany

Günther Harisch, D.V.M.; Joachim Dittmann, Ph.D.

Reprinted from Biologische Medizin (1999 Feb) 1:4–8.

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Abstract

This study investigates whether the effects of cAMP Injeel® and cAMP Injeel® forte in a cell-free system are unique to these preparations or simply equal the additive effects of their single-potency components. When one of the single-potency components of cAMP Injeel® and Injeel® forte was selected as a base potency and the others were added in succession, recorded enzyme activity correlated with the number of potencies added. In all cases, the inhibiting effect of mixed potencies was greater than that of the single potencies, but in no case did the level of inhibition produced by a mixture equal the sum of the effects of its single-potency ingredients.

Introduction

Potency chords are mixed-potency preparations containing equal portions of three potencies of the same substance—a base potency and two additional levels. These potency chords are available commercially under the trade name Injeel®. The “forte” variation includes four rather than three different potencies.¹

The authors confirm the results of the animal experiments reviewed in the article on potency chords in Volume 6/98 of Biologische Medizin (Franke W: Efficacy of Homeopathic Dilutions in the Form of Potency Chords. J Biol Med. 1998;27(6):276–278). The work of the authors on the effects of single and mixed potencies of cAMP on acid phosphatase activity offers additional impressive proof (probability of error 1%; p < 0.01) that potency chords are superior to single potencies in efficacy.

Hartmut Heine, Ph.D.

Materials and Methods

Active Agents

The active substance cAMP was used in the following forms: 6X, 12X, 30X, 200X, cAMP Injeel® (12X/30X/200X), and cAMP Injeel® forte (6X/12X/30X/200X). All preparations were used in liquid form and were supplied in 5 ml ampules by Biologische Heilmittel Heel GmbH, Baden-Baden. (Please note that these cAMP Injeels® are not available commercially.) All cAMP potencies, as well as the Injeel® and its Injeel® forte variation, were produced according to homeopathic principles. The study utilized a blind test format; all preparations were coded prior to use but decoded prior to statistical analysis.

Chemicals

The synthetic enzyme substrate p-nitrophenyl phosphate was supplied by Serva of Heidelberg (Cat. # 30770). All other chemicals used were of the highest available degree of purity.

Enzyme Test System

The enzyme used was acid phosphatase (AP) derived from potatoes (Boehringer, Mannheim; Cat. # 108197). This enzyme model is biologically relevant because acid phosphatase occurs naturally in the lysosomes of human cells. For use in the experimental setups, the enzyme was diluted 1 : 200 with 10 mM of NaAc (pH 5.6).

Incubation Technique

The catalytic activity of AP was measured by determining the amount of p-nitrophenol formed in a microtiter plate assay. 20 µl of the enzyme suspension (out of a total volume of 120 µl) and the cAMP preparation being tested (or water, in the case of the control) were preincubated together at 30 °C. Two series of assays were performed. In one, the preincubation period was 20 minutes; in the other, 40 minutes. After preincubation, each batch of assay components was mixed with 100 µl of the synthetic substrate (5.5 mM p-nitrophenyl phosphate in 0.1 M citrate buffer, pH 5.6) and reincubated at 30 °C. After five minutes, the reaction was stopped by adding 100 µl of 1 N NaOH, and the quantity of enzymatically formed p-nitrophenol was determined using a temperature-controlled microtiter plate reader (ATT C 340, SLT Instruments, Crailsheim) at a wavelength of 405 nm.

The quantity of p-nitrophenol was determined by applying the reference equation p-nitrophenol [nmol × ml⁻¹] = 64.82 × OD 405 nm – 3.373; correlation coefficient 0.998. p-nitrophenol in various concentrations served as the reference substance.

Figure Captions

Fig. 1: Activity of acid phosphatase (AP) in the presence of different cAMP preparations. The graph presents average values (± standard deviation). The line segment ending in circles represents the control. Statistics (n = 48): All experimental mixtures differed significantly from the control (p < 0.01), and 12X differed significantly from all mixtures (p < 0.01). To show the linear relationship among the values more clearly, the y axis begins at 4 instead of at 0, and a line has been drawn connecting the average values for 12X and the Injeel®. The table below the graph shows the composition of the experimental mixtures.

A) Graph (reproduced qualitatively)

(The original plotted mean AP activity [nmol · min⁻¹ · ml⁻¹] ± SD for each setup, y-axis running from 4–10, control marked by ●, and a trend line connecting 12X → Injeel®.)

B) Assay‐Component Table

Component →	12X	12X / 30X	12X / 30X / 200X	Injeel® (12X/30X/200X)
12X	25 µl	25 µl	25 µl	75 µl
30X	–	25 µl	25 µl	–
200X	–	–	25 µl	–
Injeel® stock*	–	–	–	25 µl
Water	75 µl	50 µl	25 µl	25 µl
Enzyme (AP)	20 µl	20 µl	20 µl	20 µl

*In the “Injeel®” column this refers to the mixed‐potency stock (12X / 30X / 200X).

Fig. 2: Activity of acid phosphatase (AP) in the presence of different cAMP preparations. The graph presents average values (± standard deviation). The line segment ending in circles represents the control. Statistics (n = 48): All experimental mixtures differed significantly from the control (p < 0.01), and 30X differed significantly from all mixtures (p < 0.01). To show the linear relationship among the values more clearly, the y axis begins at 4 instead of at 0, and a line has been drawn connecting the average values for 30X and the Injeel®.

A) Graph

(Original mean ± SD plot, y-axis 4–10 nmol·min⁻¹·ml⁻¹, control ●, trend line connecting 30X → Injeel®.)

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B) Assay-Component Table

Component →	30X	30X / 200X	30X / 200X / 12X	Injeel® (12X/30X/200X)
30X	25 µl	25 µl	25 µl	–
200X	–	25 µl	25 µl	–
12X	–	–	25 µl	–
Injeel® stock*	–	–	–	75 µl
Water	75 µl	50 µl	25 µl	25 µl
Enzyme (AP)	20 µl	20 µl	20 µl	20 µl

Fig. 3: Activity of acid phosphatase (AP) in the presence of different cAMP preparations. The graph presents average values (± standard deviation). The line segment ending in circles represents the control. Statistics (n = 48): All experimental mixtures differed significantly from the control (p < 0.01), and 200X differed significantly from all mixtures (p < 0.01). To show the linear relationship among the values more clearly, the y axis begins at 4 instead of at 0, and a line has been drawn connecting the average values for 200X and the Injeel®. The table below the graph shows the composition of the experimental mixtures.

A) Graph

(Original mean ± SD plot, y-axis 4–10 nmol·min⁻¹·ml⁻¹, control ●, trend line connecting 200X → Injeel®.)

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B) Assay-Component Table

Component →	200X	200X / 12X	200X / 12X / 30X	Injeel® (12X/30X/200X)
200X	25 µl	25 µl	25 µl	–
12X	–	25 µl	25 µl	–
30X	–	–	25 µl	–
Injeel® stock*	–	–	–	75 µl
Water	75 µl	50 µl	25 µl	25 µl
Enzyme (AP)	20 µl	20 µl	20 µl	20 µl

*In the “Injeel®” column this refers to the mixed-potency stock (12X / 30X / 200X).

Setup	Composition	Volumes Added
1	6X	25 µl cAMP 6X + 75 µl water
2	6X / 12X	25 µl 6X + 25 µl 12X + 50 µl water
3	6X / 12X / 30X	25 µl 6X + 25 µl 12X + 25 µl 30X + 25 µl water
4	6X / 12X / 30X / 200X	25 µl 6X + 25 µl 12X + 25 µl 200X + 25 µl water
5	Injeel® forte	100 µl Injeel® forte stock (6X/12X/30X/200X)
6	Control	100 µl water

Fig. 4: Activity of acid phosphatase (AP) in the presence of different cAMP preparations. The graph presents average values (± standard deviation). The line segment ending in circles represents the control. Statistics (n = 48): All experimental mixtures differed significantly from the control (p < 0.01), and 6X and 6X/12X differed significantly from Injeel® forte (p < 0.01). To show the linear relationship among the values more clearly, the y axis begins at 4 instead of at 0, and a line has been drawn connecting the average values for 6X and the Injeel® forte. The table below the graph shows the composition of the experimental mixtures.

A) Graph

(Original mean ± SD plot, y-axis 4–10 nmol·min⁻¹·ml⁻¹, control ●, trend line connecting the series 6X → Injeel® forte.)

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B) Assay-Component Table

Component →	6X	6X / 12X	6X / 12X / 30X	6X / 12X / 30X / 200X	Injeel® forte (6X/12X/30X/200X)
6X	25 µl	25 µl	25 µl	25 µl	–
12X	–	25 µl	25 µl	25 µl	–
30X	–	–	25 µl	25 µl	–
200X	–	–	–	25 µl	–
Injeel® forte stock*	–	–	–	–	100 µl
Water	75 µl	50 µl	25 µl	25 µl	–
Enzyme (AP)	20 µl	20 µl	20 µl	20 µl	20 µl

*In the “Injeel® forte” column, this refers to the mixed-potency stock (6X / 12X / 30X / 200X).

Statistics

The measured values obtained for all setups (activity per volume in nmol × min⁻¹ × ml⁻¹) were subjected to single-factor variance analysis (ANOVA). Subsequently, the Fisher LSD test was performed to directly compare the effect of the control to that of each cAMP preparation or stage in the additive series of cAMP potencies. A probability of error of 1% (p = 0.01) was chosen as the limit of significance.

Results and Discussion

cAMP Injeel®

The cAMP Injeel® used in these experiments is a 1 : 1 : 1 mixture of the single potencies 12X, 30X, and 200X. In numerical terms, adding 75 µl of this mixture to a setup adds 25 µl each of 12X, 30X, and 200X. The design of our experiments took this fact into account, as exemplified by Series 1 (Figure 1):

• Setup 1 (12X) contained 25 µl of cAMP 12X and 75 µl of water.
• Setup 2 (12X/30X) contained 25 µl each of 12X and 30X, plus 50 µl of water.
• Setup 3 (12X/30X/200X) contained 25 µl each of 12X, 30X, and 200X.
• Setup 4 (Injeel®) contained 75 µl of cAMP Injeel® and 25 µl of water.
• Control contained 100 µl of water.

Each setup was mixed with 20 µl of AP suspension and preincubated at 30 °C. After 20 minutes, 100 µl of the substrate solution were added and incubation was continued for five more minutes. The reaction was then stopped and the quantity of enzymatically formed p-nitrophenol was determined through spectrophotometry.

As Figure 1 shows, all cAMP preparations inhibited the catalytic activity of AP. A linear decrease in enzyme activity is apparent in the series 12X → 12X/30X → 12X/30X/200X → Injeel®. A similar tendency was observed both when 30X was chosen as the base potency and 200X and 12X were added one at a time (Figure 2), and when 200X was chosen as the base potency and 12X and 30X were added (Figure 3).

A linear decrease in AP activity was also apparent when the preincubation period was increased from 20 to 40 minutes. Inhibition of AP was more moderate, however, and the recorded values were different (data not shown).

cAMP Injeel® forte

cAMP Injeel® forte is a mixed potency consisting of equal parts of the single potencies 6X, 12X, 30X, and 200X; thus, 100 µl of this mixture contains 25 µl each of 6X, 12X, 30X, and 200X. See the table for the components and test sequence leading to the Injeel® forte variant.

The experiments were conducted in the same way as the Injeel® experiments. As Figure 4 shows, all of these cAMP preparations inhibited AP catalytic activity. A linear decrease is again apparent in the series leading from 6X to the Injeel® forte. The same phenomenon is apparent when 12X, 30X, or 200X is chosen as the base potency (data not shown).

From these results, we can conclude that the effects of cAMP potency chords are not identical to the sum of the effects of the individual potencies they contain. As this example shows, potency chords such as Injeel® or Injeel® forte preparations seem to have qualitatively new and unique effects. Further investigation will be needed in order to determine whether this conclusion also applies to Injeel® and Injeel® forte preparations of other substances.

References

1. Wissenschaftliche Abteilung der Firma Biologische Heilmittel Heel GmbH. Ordinatio Antihomotoxica et Materia Medica. Baden-Baden. 1996:13.
2. Stryer L. Biochemie. 4. Auflage. Heidelberg: Spektrum. 1996:779–802.
3. Harisch G, Dittmann J. Untersuchungen zur Wirkung von Ubichinon-Injeel und Injeel forte mit zellfreien Systemen. Biol Med. 1997;26(3):99–104.
4. Harisch G, Dittmann J. Einfluss von cAMP-Potenzen auf die katalytische Aktivität der Sauren Phosphatase. Erste Hinweise für divergierende Wirkungsqualitäten von Einzelpotenzen und Potenzmischungen. Biol Med. 1998;27(5):212–219.

For the authors

Joachim Dittmann, Ph.D.
Institute for Physiological Chemistry
Veterinary College of Hannover
P.O. Box 71 11 80
D-30545 Hannover
Germany

J. Kersschot, M.D.
Belgium

BioMedical Therapy Magazine Symposium
At the Royal Society of Medicine, London
10. 5. 1997

A. Introduction

Although the use of corticosteroids is accepted as a standard technique in the treatment of several inflammatory diseases, we must recognize that specific injection techniques of anti-inflammatory products are gaining more and more interest. Most physicians, however, tend to regard these techniques as marginal phenomenons. The importance of these injections in the treatment of so-called inflammatory diseases is relatively unexplored and promises to be a fertile area for further investigation.
Since most physicians have never been trained in these techniques, they are anything but expert in this field. I think that every therapist should at least know about the existence of this strategy, even if he or she will not use injections in his or her own practice.
So, I will introduce to you today the therapeutical strategies that focus on injections of non-steroid products. Both chemotherapeutic and biotherapeutic products will be discussed, and several techniques of administrating them will be explained. The clinical cases will try to illustrate my strategies.
I have more than ten years of experience with these techniques in my private practice as a general practitioner in Belgium, and I have noticed that there is a very broad spectrum of medical problems that can be managed with this injection strategy. Today, however, I will only discuss two examples of alternatives for cortisone: the treatment of musculoskeletal pain and the treatment of asthma.
Still, I do not make any claims about the injections described in this lecture, involving the prevention or cure of any disease. Maybe the effects that I have noticed in my private practice are no more than a sophisticated placebo. I cannot be sure that what I am doing is best for the patient unless this practice has been rigorously tested; to check the items that I suggest, large-scale clinical studies are necessary. This lecture can be regarded as an invitation to do so in the near future.

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B. Injection of biotherapeutics

B.1. Injection of biotherapeutics is not a very strategic novelty

Those familiar with biotherapeutics for injection know that many ampoules exist since several decades, especially in Germany. Especially Heel, Pflüger, Steigerwald, Dolisos, Cosmochema, Fides and Hevert are famous for their ampoule preparations. Thousands of them are injected every day, and clinical studies check their efficiency and control their possible side-effects (ref. 20, 21, 28, 29). A wide selection of homeopathic and phytotherapeutic preparations has been on the market in injection form for many years now, and they have been employed in daily medical practice with good success, especially by general practitioners, rheumatologists and orthopaedic doctors. Many authors have already mentioned the use of biotherapeutic ampoules for injection: Bianchi (ref. 3), Claussen (ref. 13), Coeugniet, de La Fuye (ref. 31), Diamond (ref. 44, 45), Fischer (ref. 36), Frase, Gellman (ref. 19), Graf von Ingelheim (ref. 27), Geyer (ref. 24), John, Kleinscholt, Küstermann, Lannugier-Bolling, Meltelmann (ref. 28, 29), Müller, Pollmann, Potrafki (ref. 21), Preusser, Reckeweg (ref. 14), Riley (ref. 16), Risch, Schmid (ref. 17), Subotnick (ref. 43, 48), Thiel (ref. 20), Timmermann (ref. 10), Vorstoffel (ref. 33), Wachter, Werthmann, Weiser (ref. 28), Zenner (ref. 29) and many others (see ref. 1: bibliography).
Since there was no specific name for all the methods that use biotherapeutics for injection on specific spots, I introduced in Belgium the term ‘biopuncture’ (ref. 1, 2, 5), in order to distinguish the use of homeotherapy according to de La Fuye (ref. 31), neural therapy according to Huneke (ref. 11), ampoules over nerve blocks according to Bracho (ref. 12) and segmental acupuncture according to Pistor (ref. 32). At the same time we want to give more credibility and respect to orthodox doctors as to therapists in natural medicine (ref. 1, ref. 8). In this way, we shall stimulate its use, so that the strategy of using these injections is developed in everyday practice.
Let us now go a little deeper:

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C. Biotherapeutics for local injections?

C.1. Subcutaneous injection

One of the most familiar ways of using biotherapeutics in everyday practice. Most of you use them in the oral form, as tablets or drops.
Although you may not be interested in giving injections in your practice, I think it is good to know more about the enormous possibilities of these biotherapeutic drugs. And it might give you a broader view on natural medicine, because injections can act in a more powerful way than oral medication.
The exact choice of the remedy itself (ref. 1, 2, 5).

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C.2. Acupuncture point injections

Those doctors familiar with acupuncture, can enhance their therapeutic effect by injecting intracutaneously or subcutaneously a biotherapeutic product instead of dry needling. This method was mentioned before by de La Fuye, Geyer, Matz, Frase and many other authors.
It is theoretically possible to inject a single remedy into an acupuncture point that is known for certain indications. This combination of homeopathy and Chinese medicine (homoeosinaty) was introduced by de La Fuye. I will give you some examples:

Chelidonium on Liver 13 for drainage of the liver,
Nux Vomica on Bladder 21 for gastritis,
Gnaphalium on Bladder 34 for ischias,
Sulfur on Bladder 52 for eczema,
Cantharis on Kidney 11 for cystitis,
Lobelia on Kidney 27 for asthmatic bronchitis,
Naja Tripudians on Bladder 17 for cardiac neurosis,
Crataegus on Heart 3 for palpitations,
Thuja on Gallbladder 30 for coxarthrosis,
Echinacea on Jenn Mo 19 for cough, asthma, bronchitis
Echinacea on Jenn Mo 22 (for cough, asthma, bronchitis),
Lachesis on Small Intestine 19 for vertigo,
Sulfur on Bladder 31 for climacteric disorders.

Cralonin on Heart 3 for palpitations,
Cralonin on Bladder 15 for palpitations,
Engystol on Small Intestine 14 for asthma,
Vertigoheel on Small Intestine 19 for vertigo,
Mullein pro injectione on Urinary Bladder 31 for climacteric disorders,
Traumeel on Gall bladder 20 for headache,
Spigelon on Gall bladder 20 for headache,
Zeel on Gall bladder 30 for pain in the hip region,
Pulsatilla composition on Jenn Mo 6 for activation of the defensive system.

It is also possible to inject a complex remedy into several points of an acupuncture meridian, like for example Discus compositum over the Governor vessel. Subcutaneous or intracutaneous injections are given on the mid-line of the back, or at the level of every vertebra in the region of the pain.
Those allopathic products should always be used in a diluted way (half a normal dose, adding several ml of physiological fluid and several ml of a local anesthetic), and should be injected with more care than the biotherapeutic one. I use them as a replacement for corticosteroid injections (see also ref. 51). Of course, some injections are given at the physician’s own responsibility, when the product is used in a way for which it has not been registered. Ticlodil is officially designed for the intravenous/intramuscular injection only and an oral Feldene is officially designed for the intramuscular injection only. So, I can not make any claims about their safety and efficacy, until more large-scale clinical studies are performed.

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F. Is it always necessary to give injections?

For those therapists who are not allowed to give injections, I can recommend to do trigger point therapy with stretch and spray, as Travell and Simons suggest. This is an easy and safe technique, and gives interesting results when dealing with several myofascial disorders. The patient is usually very enthusiastic, since he or she has almost immediate relief. Although this effect is temporary, long term effects are achieved with repeated sessions.
Even more interesting is ischemic compression. Ischemic compression is application of progressively stronger, painful pressure on a trigger point for the purpose of eliminating the trigger point’s tenderness and hyperirritability. Similar to acupressure and shiatsu, the thumb is used as the therapeutic tool. But we do not deal with acupuncture points, but solely with active trigger points, which can be found by clinical examination. The thumb action blanches the compressed tissues, which usually become flushed (hyperemic) on release of the pressure. The use of Traumeel ointment during and after the compression, enhances the effects of the treatment.
The clinical effects of the technique depend largely on the skills of the therapist. When looking for the active trigger points, wall plates can help. Textbooks (by Baldry, Travell and Simons) give more fundamental information on this subject. In Belgium, I am giving workshops on trigger point therapy, in order to show how this technique can be performed in everyday practice.

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Case:

Clinical examination shows a painful zone in the right brachioradialis muscle and a small spot at the epicondylus radialis, that is painful on digital pressure. He had ischemic compression on two trigger points in the brachioradialis muscle, twice a week.
He also got a local application of Arnica comp. ointment (e.g. Traumeel) in the right brachioradialis muscle and on that small painful spot at the epicondylus radialis, three times a day. Additional oral treatment with Ferrum-Homaccord, ten drops three times daily, gave complete relief after two weeks.

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Case:

A girl of twelve has suffered a contusion of the lateral part of the thigh while snowboarding. The examination on the evening shows an obvious swelling of the thigh and an extensive haematoma. The region is very sensitive to pressure, and she refuses a local injection. I give her Arnica comp. ointment (Traumeel ointment, which was cooled in the fridge) and she applied it every hour the first day, every two hours the second and third day and four times a day the three next days. Putting the ointment in a refrigerator before application gives an extra cooling down in an acute situation. As an additional therapy, she received Arnica comp. tablets: I told her to take them at the same frequency as the application of the ointment. I asked her to keep the tablets in the mouth as long as possible, to give the product maximum resorption via the oral mucosa. After six days the pain and swelling were completely gone.

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G. Conclusion

Although the use of corticoids is accepted as a standard technique in the treatment of several inflammatory diseases, we must recognize that specific injection techniques of biotherapeutic products are gaining more and more interest. Most physicians, however, are not familiar with these techniques. That is why I wanted to show the importance of these injections in the treatment of so-called inflammatory diseases.
By using biotherapics (drops or tablets), I have experienced that the combination of oral application (drops or tablets) and local treatment (ointment and/or injections) gives interesting results, both in acute as in chronic cases.

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