General Action. Symptoms analogous to aconitine with onset of tingling and pricking in tongue and lips ascending to face and whole body; facial distortion with dry skin; violent eructations and gastric spasms; spasm of esophagus; photophobia; cataleptic and convulsive phenomena; < by exertion; > by vomiting; erections and pollutions without voluptuous dreams.
Mind. Irritability with anger and fear; apathy and indifference; altered thought and concentration; weakened memory; extreme restlessness as if tickling impels constant motion; symptoms ameliorated by uniform warmth and alternately by entry into warm or cold air.
Head. Headache < on bending forward; vertigo with tinnitus; fullness of head with marked pain in face accompanied by ear ringing.
Face. Bluish-black discoloration; swollen blue lips; marked sensation of facial contraction and distortion.
Mouth. Paralysis of tongue; increased salivation; tingling sensation replaced by furry numbness; diminished taste and oral sensation.
Abdomen. Burning sensation with feeling of ants crawling around abdomen; violent eructations; inclination to vomit without actual vomiting; spasmodic contractions of stomach and abdominal muscles.
Skin. On lower limbs, small serous vesicles and papules, very painful; skin dry.
Respiratory Organs. Hoarse, rough voice; slow, difficult respiration with constrictive sensation in chest and throat.
Heart. Pulse initially frequent then depressed, slow, irregular and intermittent.
Generalities. Tendon jerks; muscular contractions; catalepsy; weakness and debility on exertion.
General Action. Alkaloid obtained from the roots and stems of Aconitum napellus, presenting rapid and intense symptoms chiefly characterised by constrictive burning sensations ascending from the extremities; initial local application produces heat followed by burning pains, acute pricking and pruritus, ending in numbness and anaesthesia; frequently symptoms develop from below upwards; all symptoms > by vomiting; useful in hydrophobia of convulsive or paralytic type; recovery, if it occurs, is rapid and complete; < by mental exertion, agitation, touch; nausea produced by upright posture.(M)
Mind. Anxiety with fear of death; intellect clear though ideas flow slowly, attention impaired; sensation as if dreaming or stupefied; forgetfulness with tremulous extremities.
Head. Vertigo with confusion and roaring in ears, leading to almost instant collapse; fullness of head with inability to support it; headache with stabbing pains in face and head, sometimes accompanied by vomiting (hemicrania cured).
Eyes. Tired sensation; pupils dilated, insensible to light; complete blindness with dilated pupils, vision returning as they contract; blurred vision with vertigo and muscular weakness.(M)
Ears. Pressure and roaring noises; complete deafness.
Face. Fullness of cheeks and temples changing to painful tension, tingling and pricking; tense, swollen appearance; peculiar drawing, stretching and pressure along trigeminal distribution, alternating with occipital stabbing, progressing to sustained severe neuralgic pain; trigeminal neuralgia with supraorbital shooting pains causing vomiting; subsequent tonic facial contractions, trismus, then clonic convulsions; hypocratic facies.
Mouth. Burning of lips and tongue tip; dry, acrid, constrictive sensation in mouth and fauces; rigid tongue; foul, bitter taste or complete loss of taste; increased tooth sensitivity; salivation.
Throat. Burning constriction extending from mouth to stomach; each swallow followed by hydrophobic-like spasm not renewed by sight of water; difficulty swallowing with pain in neck and parotid region, requiring manual support (M); burning in fauces as if a hot coal present (M).
Stomach. Immediate eructations; severe vomiting every two to three minutes initiated by sudden abdominal muscle contraction accompanied by loud cries; vomiting ameliorates all symptoms; marked heat in stomach region; nausea induced by erect posture (M).
Abdomen. Intestinal rumbling occurring immediately in some or two hours after dose in others; sudden diaphragmatic contraction; post-mortem: enlarged dark liver and spleen.
Urinary Organs. Copious diuresis; difficulty and pain in micturition, occasional retention with hypogastric distress (M).
Male Sexual Organs. Unusual nocturnal emissions in experimental subjects.
Heart. On entering warmth pulse at first rapid then small, weak, intermittent; heart sounds audible only at apex.
Extremities. Weakness, trembling, burning, tingling, pricking and numbness; subsequent relaxation following convulsive exertion.
Skin. General tingling.
Sleep. Somnolence with uneasy, tossing sleep.
Fever. Surface cold, moist and very pale; intense chill followed by sudden heat of head and face extending over body, most marked in stomach region, accompanied by sweat.
General Action. Acts primarily as a depressant, producing excessive exhaustion and weakness; anaemia with waxy pallor of the face; intense thirst; burning in the throat; nausea; retching; burning, ulcerative pains in the stomach, as in cancer and debility; profuse exhausting diarrhoea; venous congestion with varicosities and oedema; tendency to hæmorrhages and putrid-typhoid fevers with night sweats; antidotal to narcotics and anaesthetics; local antidote to poisoning by sauces and insect stings .
Mind. Very stupefied and depressed; irritable; alternates between stupor and delirium; confusion of ideas; frequent sighing; attacks of terrible anxiety with breathing difficulty; vertigo with weakness and fainting.
Head. Heaviness and dull, bruised pains in forehead and vertex; vertigo on lying down; headaches from tobacco, opium, coffee or alcohol excess.
Eyes. Black floaters before the vision; burning and smarting as if from smoke.
Ears. Roaring, ringing and singing noises in the ears.
Nose. Frequent catarrhal attacks; epistaxis, especially after falls or blows; itching in the nares; discharge thick, pus-like, streaked with blood, with foul odour.
Face. Wild expression; dilated pupils; pale, waxy, emaciated countenance; cheeks intensely red during fever; localised sweating on the forehead.
Mouth. Tongue pale and flaccid; white film on buccal mucosa; rotten taste; fetid breath; scorbutic ulcers and odontalgia.
Throat. Burning in throat; false white membrane in diphtheria; intense thirst in children, who swallow with difficulty even teaspoonfuls of water.
Stomach. Insatiable burning thirst, screaming for water at night; loathing of salt and cold food; cold drinks lie heavy; bread and butter refused, potatoes excepted; violent burning, ulcerative pain in stomach and chest, followed by cold skin and cold sweat on forehead; sense of pyloric induration and stricture.
Abdomen. Flatulent distension; colicky pains; ascites; sensation of sinking in supine position.
Stool and Anus. Profuse diarrhoea with intense thirst; exhausting colic; haemorrhage from intestines; chronic constipation with great thirst and copious pale urine; ascarides; tensive haemorrhoids; painful burning at stool.
Urinary Organs. Polyuria of pale, phosphate-laden urine; burning along urethra; diabetes with unquenchable thirst and great weakness.
Male Sexual Organs. Weak emissions; seminal loss on coition; painful, fissured, non-retractile prepuce with intolerable pruritus.
Female Sexual Organs. Metrorrhagia; post-partum thirst and exhaustion.
Respiratory Organs. Hoarseness with laryngeal irritation; croup-like barking cough with membranous exudate; hollow inspiration; whistling and rattling in trachea; haemoptysis.
Back. Myelitis with polyuria; back pain relieved only by lying on abdomen.
Extremities. Oedematous swelling of feet and legs; bruised, sore sensation.
Generalities. Convulsions with wild agitation; great emaciation; waxy, anæmic skin; universal anasarca; burning internally and externally.
Skin. Ecchymoses; urticarial eruptions; nevi, warts and callosities.
Sleep. Insomnia; restless night with screaming.
Fever. Cold skin; insidious hectic fever with profuse night sweats; putrid and typhoid types.
Relations. Compare Apis, Ars (although Acetic acid exhibits more prominent gastric symptoms); Carbol ac., Lac defl., Lact ac., Uran nit. Large overdoses antidoted by Magnesia or Calcarea; for depression and agonising sensation, Tabac., Acon.; for febrile, gastric or pulmonary symptoms, Nat mur., then Sep. Antidotal to anaesthetics, Acon., Asar., Coffea, Euphorb., Ignat., Opium, Plumb (colic), Sep., Stram., Tabac. Counteracts poisoning by sauces. Aggravates following Bell., Merc., Arn., Lach.; incompatible after Borax, Caust., Nux v., Ran b.; Scilla and Colchicum more effective when prepared with acetic acid than with alcohol.
General Action. Acts chiefly on the respiratory and alimentary tracts of adults and children. The principal sphere of action is in the mucous membranes of the bronchi, producing a violent dry cough followed by haemorrhagic expectoration; and upon the digestive canal, causing burning, weight at the stomach, profuse flatus, and explosive diarrhoea.
Mind. Patient is markedly weak and restless; disinclined to move or exert oneself; emotional state low, with tearfulness and melancholy accompanying the physical exhaustion.
Head. Slight headache, with giddiness and nausea accompanying the pulmonary haemorrhage.
Eyes. Vision may become blurred during paroxysms of cough and haemoptysis.
Ears, Nose, Throat. Epistaxis may occur in conjunction with pulmonary bleeding; throat and larynx feel raw, with an urgent inclination to cough.
Stomach. Burning in the stomach; sense of weight; eructations with acidity; nausea, especially when coughing or with haemorrhagic vomiting.
Abdomen. Marked flatulence with audible borborygmi; colic-like pains preceding stools; diarrhoea of thin, watery stools, often sudden in onset. Progressive emaciation ensues.
Stool and Anus. Sudden, explosive diarrhoea; stools watery or semi-fluid; sometimes streaked with blood.
Respiratory Organs. Severe, dry, convulsive cough, most violent at night; initial paroxysm unproductive, then followed by expectoration of bright red blood in the morning and dark blood with clots in the evening. Chest dull on percussion, with constant severe chest pain.
Generalities. Profound weakness and progressive emaciation; patient often prefers to lie still. Symptoms < at night and during paroxysms of cough; > by spitting blood.
Relations. Compare: other Euphorbiaceae (e.g., Mercurialis annua, Manihot); in pulmonary haemorrhage: Hamamelis, Ipecacuanha, Millefolium, Phosphorus, Aconitum.
General Action. Acts chiefly on the cerebro-spinal axis and muscular system; produces congestive headache and spinal cord erythema; relieves or provokes epileptiform convulsions; allays or excites restlessness and insomnia; promotes otorrhoea; useful in chlorosis, dyspepsia and typhoid conditions.
Mind. Great anxiety and moroseness; forgetfulness for recent events; brutal insensibility during convulsions; alternation of stupor with dangerous violence; visions of terror and fearful hallucinations; delirium with loss of consciousness preceded by tremors; excitable and irritable, refuses all companionship.
Head. Vertigo on rising, with tendency to fall backwards; confusion of the brain; bruised sensation in occiput and vertex; severe congestive headache compelling the patient to lie with head low; aching pressure in head and spinal cord congestion.
Eyes. Conjunctiva intensely injected; smarting and burning as if from smoke; heaviness of lids.
Ears. Purulent discharge, especially after hemicrania; pulsations and ringing during convulsions.
Nose. Epistaxis with relief of headache; ozzæna with scabs and fissures; constant purulent secretion.
Face. Flushed or pale; transient flushes in epileptics; distorted features during attacks; frothing with blood-tinged saliva at convulsion’s end.
Mouth. Maxillary joints firmly clenched; tongue protuded, tremulous and paralysed; bites tongue during convulsions; scanty speech.
Throat. Scalding sensation in œsophagus; rawness and burning on swallowing.
Stomach. Anorexia with repugnance to food; food feels heavy and cold; eructations and nausea, especially from gall-region; vomiting of sour or bilious matter.
Abdomen. Sensation of hepatic and splenic swelling; colic from excessive flatulence; distension around waist as after malaria.
Stool. Alternating constipation and atonic diarrhoea; haemorrhoidal protrusion with burning and aching in sacral region, > by pressure.
Urinary Organs. Constant urging to micturate; dark orange urine of strong odour as of horse’s urine.
Sexual Organs. In females: uterine pains with stabbing in right ovary; promotes menses. In males: none characteristic.
Respiratory Organs. Dry cough with hepatic discomfort; oppression of chest during convulsions.
Back. Aching in sacrum and sacro-iliac joints; spinal congestion and bruised soreness.
Extremities. Marked trembling of limbs and tongue before convulsions; cold feet; general debility.
Skin. Cold, clammy perspiration; pitting œdema in typhoid states; no primary eruptions.
Sleep. Sleeplessness with tossing and restlessness; vivid terrifying dreams; inability to remain in bed.
Fever. Typhoid-type fever with cerebral and medullary congestion; alternate heat and cold; chills rushing up spinal column.
Modalities. All symptoms < on rising; < in evening and at night; < exposure to cold; > by pressure on haemorrhoids; convulsions preceded by tremor.
Relations. Compare: Artemisia vulgaris, Abrotanum, Cicuta, Hyoscyamus, Belladonna, Stramonium. Orina odour: Benzoic acid, Nitric acid. Use as intercurrent in minor epilepsy where consciousness is partly preserved.
General Action. Acts chiefly to produce emaciation and “consumption,” especially of the lower extremities; marked gastrointestinal irritation with intense hunger and inability to assimilate food; rheumatic metastasis from joints to heart and spine; sudden sore pains in back relieved by motion; skin lax and prone to boils; exudation of blood and moisture from the umbilicus of the newborn.
Mind. Great anxiety and depression; irritability, moroseness; violent fits of anger in children; impulses to cruelty; difficulty of thought; sensation of softening in the brain; occasionally secondary loquacity and exhilaration after cessation of the remedy.
Head. Cannot hold the head up; left cerebral hemisphere easily fatigued by mental exertion; chills along cerebral convolutions with shooting pains; scalp sore, especially on the left, with itching.
Eyes. Dark circles under eyes; vision dulled; spots before the eyes.
Ears. (No prominent clinical symptoms recorded.)
Nose. Dryness; epistaxis in boys.
Face. Wrinkled, pale, aged appearance; comedones with emaciation; hollow cheeks.
Mouth. Viscid, acid taste.
Throat. (No distinct symptoms beyond those of the mouth.)
Appetite. Intense gnawing hunger; craving for boiled bread in milk; voracious appetite despite marked emaciation; loss of appetite with gastralgia.
Stomach. Sensation as if the stomach were hanging or swimming in water, with coldness; burning, gnawing, constrictive pains in the stomach, worse at night.
Abdomen. Marked distension; weak, sinking sensation in the intestines; hard nodules movable beneath the abdominal walls.
Stool and Anus. Food passes undigested; alternation of diarrhoea and constipation; rheumatism after suppressed diarrhoea; protruding, burning haemorrhoids tender to touch or pressure, appearing or aggravating as rheumatic pains lessen, with frequent ineffectual desire and only bloody discharge; expulsive of roundworms, especially Ascarides.
Urinary Organs. (No prominent clinical symptoms recorded.)
Male Sexual Organs. Hydrocele in children.
Female Sexual Organs. Stitching ovarian pains, chiefly left; twisting pains in both ovarian regions, extending to the back; blood and moisture exuding from the newborn’s umbilicus.
Respiratory Organs. Raw, sore sensation of the respiratory tract in cold air; in pleurisy with residual pressure on one side, impeding free respiration (after Acon. and Bry.).
Chest. (No additional symptoms beyond those under respiratory organs.)
Heart and Pulse. Sharp, severe chest pain in heart region from rheumatism; rheumatic metastasis to the heart; weak, small pulse.
Back. Sudden, sore pain in the sacrum, better for motion.
Extremities. Lower limbs emaciated (marasmus) and weak; inability to move them; bruised soreness and weakness worse in the morning; chilblains, itching, frost-bite of fingers and toes; gouty pains of wrists and ankles; early inflammatory rheumatism before oedema.
Generals. Debility and aching all over; inability to move; trembling on slightest exertion; prostration after influenza; numbness of parts; tendency to boils following Hepar sulph.; profound emaciation.
Fever. High fever in rheumatism; hectic fever with chill, profound weakness (marasmus).
Modalities. Worse at night; worse in cold air; better for motion.
Relations. Compare : Artemisia absinthium, Chamomilla, Cina, Gnaphalium and other Compositae; Nux vomica, Agaricus; Bryonia and Barosma for chilblains. Follows well : Aconitum and Bryonia in pleurisy; Hepar sulphur in chilblains.
General Action. Acts principally on the upper digestive tract and the respiratory mucosa. Characteristic is a hard, indigestible sensation lodged at the cardia or lower œsophagus, as of a boiled egg; relieves dyspepsia due to tea or tobacco; eases cough with or without haemoptysis when this sensation as if a hard substance must be expectorated is present.
Mind. Melancholic, depressed; easily nervous and unable to concentrate or think clearly when the gastric symptoms predominate.
Head. Vertigo; sensation of malaise or heaviness in the head with flushed, hot cheeks; headache aggravated after eating and accompanied by epigastric distress.
Eyes. Vision sometimes disturbed by black specks; burning smart in eyes as from smoke; conjunctiva may be mildly injected.
Ears. Dull aching pain in the left external meatus; hearing easily fatigued when digestive disorder is marked.
Nose. Frequent coryza with crusting; nasal mucosa dry or alternately congested and runny; nostrils cracked.
Face. Cheeks flushed or red with concurrent dyspeptic head-symptoms; complexion may appear sallow when chronic.
Mouth. Tongue coated; eructations of sour or bitter fluid; frequent belching relieves pressure pain.
Throat. Sensation of choking or constriction low in the throat; as though something is sticking in the lower œsophagus at swallowing.
Appetite. Great hunger at night with inability to sleep; complete loss of appetite on rising, with ravenous hunger at midday and in the evening; craving for cold drinks.
Stomach. Pain always appearing after eating; sensation of a hard lump or “egg” in the epigastrium which must be “coughed up” though nothing is expelled; frequent eructations; constant gnawing sense of discomfort, worse when weak.
Abdomen. Distension and fullness of epigastrium; sensation as if food remains undigested at cardia; flatulence and griping when debilitated.
Stool. Constipation with atonic rectum; may alternate with occasional semi-fluid evacuation.
Urinary Organs. No prominent urinary symptoms unless secondary to general weakness; urine normal or slightly scanty.
Female Sexual Organs. Menstruation delayed by several months; uterine hypochondriasis with dyspeptic headache and epigastric distress.
Respiratory Organs. Shortness of breath on slightest exertion; cough dry or loose when the “hard body” sensation descends into chest, with or without haemoptysis.
Cardiac. Pulse slow and heavy; heart-beats laborious, with occasional sharp, cutting pains.
Back. Tensive or bruised pain in the lumbar region; occasional sensation of coldness across sacrum.
Extremities. Rheumatic, aching pains in bones and muscles; alternation of heat and chilling in limbs; general weakness.
Generalities. Marked prostration; tendency to chill around the stomach region even when body otherwise feels cold.
General Action. Acts principally on the digestive and hepatic systems and the uterine ligaments; produces great appetite with tendency to overeat; relieves epigastric sinking with copious eructations; mitigates hepatic congestion; supports displaced or relaxed uterine structures.
Mind. Quiet, negligent, yet easily displeased; irritable when touched or spoken to; great loquacity in secondary proving .
Head. Vertiginous sensation as if the head were full of water; confused, stupefied feeling when lying down; bruised pain in occiput.
Eyes. Sensation as of a stye at the outer canthus of the left eye.
Ears. No significant auricular symptoms recorded.
Nose. No significant nasal symptoms recorded.
Face. Pallid countenance with cold, clammy skin; expression of faintness as if the vertex were congested.
Mouth. Slight thirst; saliva increased.
Throat. Unrecorded.
Appetite. Ravenous hunger with gnawing sensation in epigastrium; intense craving for meat, cucumbers, and other raw foods; tendency to eat beyond digestive capacity.
Stomach. Distension of stomach and epigastrium with burning; sensation of faintness in the pit of the stomach; strong heartbeat following distension.
Abdomen. Sickening sensation in intestines; loud rumbling after meals despite great hunger; sensation as if the liver were small and hard and bile deficient.
Stool and Anus. Burning in rectum; constipation.
Urinary Organs. Frequent micturition by day and night; urine pale straw-coloured.
Female Sexual Organs. Sensation of uterine debility—fears miscarriage; aching in fundus of uterus, ameliorated by pressure.
Respiratory Organs. Difficulty of breathing; sensation as if the right lung were small and hard; dry cough deep in chest with soreness.
Heart. Laboured cardiac action; increased palpitations when stomach is distended.
Neck and Back. Pain under right scapula; weakness in sacral region; sensation of cold fluid between shoulders.
Extremities. Cold, shrivelled hands; general muscle contractions; lies with legs drawn up.
Skin. Cold, clammy skin; great prostration; desires constant recumbency.
Sleep. Frequent yawning; somnolence by day; great restlessness at night, tossing from one side to the other.
Fever. Chilliness as if the blood were turned to cold water; violent shaking chills descending over the body.
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.
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.
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
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.
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
Pratzel, H., Die Iontophorese, Med.-Info Nr. 1 (Transcutan GmbH)
Magyarosy, J., Ernst, E., Marr, N., Schmolzl, Ch., …
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)
Pratzel, H., Grundlagen des perkutanen Stofftransports in der Pharmako-Physio-Therapie und Balneotherapie, Dissertation 1985 (quoted in 3)
Pratzel, H., Machens, R., Dittrich, P., Iontophorese zur forcierten Hautresorption von Indometacin und Salicylsaure, Z. Rheumatol. 104, 40, 748 (1986) (quoted in 3)
Zell, et al., publication in preparation
Address of the author: Dr. med. Werner Thiel Orthopedic physician Kirchstraße 9 D‑6635 Bous Germany
Reprinted from Biologische Medizin (1999 Feb) 1:4–8.
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®.)
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®.)
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.)
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
Wissenschaftliche Abteilung der Firma Biologische Heilmittel Heel GmbH. Ordinatio Antihomotoxica et Materia Medica. Baden-Baden. 1996:13.
Stryer L. Biochemie. 4. Auflage. Heidelberg: Spektrum. 1996:779–802.
Harisch G, Dittmann J. Untersuchungen zur Wirkung von Ubichinon-Injeel und Injeel forte mit zellfreien Systemen. Biol Med. 1997;26(3):99–104.
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