Homotoxicosis is a non-physiological condition which arises after reaction of a homotoxin on cells and tissues. A homotoxicosis occurs as a humoral or cellular phenomenon and can be followed by morphological alterations on tissues. The homotoxicosis is named after the homotoxin which triggers it and leads to defensive measures by the organism whose goal is the elimination of the homotoxins and restoration of the physiological conditions when possible.

This refers to the local regulation possibilities of the ground system along with its super- imposed nervous, hormonal and humoral regulation systems. The ground system is composed of the ground substance plus cellular, humoral and nervous components. The ground substance (extracellular matrix) is formed of highly polymerized sugars (proteoglycans and glycosaminoglycans) plus structural and meshing glycoproteins.

The six-phase table (Figure 1) illustrates the chronological courses of various symptoms of a disease within the framework of the ground regulation. The individual phases are transient into each other and demonstrate typical phase-indicating signs. The six-phase table is subdivided into three sections (humoral phases, matrix phases, cellular phases) each of which contains two phases. The biological division runs within the matrix phases.

The humoral phases

In the humoral phases the intracellular systems are not disturbed. The defense system is intact and can excrete the homotoxins via various paths.

Excretion phase: This phase contains manifestations of increased physiological excretion mechanisms.
Inﬂammation phase: Illnesses of this phase are marked by an exudative inﬂammation that enables an accelerated excretion of toxins from the body.

The matrix phases

In these phases, for the ﬁrst time, the homotoxins are deposited in the mesh of the extracellular matrix. Through time its structural components and functions are altered. In the case of continuing illness, increasing stress and damage of the intracellular structures result.

Deposition phase: In this phase the excretion mechanisms of the body are overworked and toxins are deposited in the matrix. This phase often progresses with few symptoms.
Impregnation phase: Diseases in this phase are characterized by the presence of toxins which become a part of the connective tissue and the matrix, along with changes in the structural components and their function. The typically increasingly severe symptoms of this phase demonstrate damage of the organ cells.

The cellular phases

During the cellular phases of a disease, cell systems are increasingly destroyed. The defense system is no longer able to excrete the toxins from the cells or out of the matrix by virtue of its own strength. Typical for these patients is the so-called ‘regulation rigidity.’

Degeneration phase: During this phase, courses of disease cause serious damage, and destruction of larger cell groups of an organ occur.
Dedifferentiation (neoplasm) phase: Diseases of this phase are characterized by the development of undifferentiated, non-specialized cell forms. Malignant diseases stand at the end of this phase.

The biological division refers to the imaginary boundary between the deposition and impregnation phases. It demarcates the pure deposition in the matrix from the integration of toxins into its structural components. Whereas a simple excretion of toxins is possible during the deposition phase, structural and functional changes are found in the impregnation phase. Thus, the spontaneous endogenic excretion of homotoxins is impeded.

The term ‘vicariation’ refers to the transition of the indicating signs of an illness within one phase to another organ system, or the change of fundamental symptoms into another phase with or without a change of the organ system.

Progressive vicariation refers to an aggravation of the total symptoms of an illness.

Regressive vicariation refers to an improvement of the total symptoms of an illness.

The different components of the anti-homotoxic preparations activate the defense system of the body. The immune system with its memory and regulation systems can be compared to the spiritual-mental self, the ego. The deposition phase and more frequently the impregnation phase are characterized by immunological processes such as chronic inﬂammation and auto-aggression. The humoral area (via immunoglobulins from B-lymphocytes) and the cellular area (T-cells, granulocytes, macrophages) still counterbalance each other in this case. A regressive vicariation is still possible in these matrix phases.

Herein lies a great opportunity for anti-homotoxic medicine. The immunological bystander reaction represents a theory of anti-homotoxic therapy for inﬂammatory illnesses. It is based on low dose antigen reactions, particularly of substance combinations in the range of 1X to 14X, with 4X to 8X appearing to be the most favorable. The bystander effect cannot be triggered at higher potencies. Experience shows that higher potencies as well as trace elements and intermediary catalysts are able to stimulate the ground regulation. (Functional circle of anti-homotoxic therapy; Heine 1997.) It is signiﬁcant that for the potency ranges 3X to 12X, a considerable difference exists in the activation of speciﬁc enzyme systems compared to substances conventionally diluted to the same concentration. The dose-action relationship of potentized substances compared to diluted substances demonstrates a non-linear relationship.

Every organism requires energy to maintain its vital functions which must be continuously provided by the metabolism. Disorders of the energy metabolism, therefore, impair the energy supply which is controlled by endogenic regulation. The organism is an energetically open system for which suitable energy, in the form of food, must be supplied and unsuitable energy must be evacuated. In this manner an unstable state of order can be maintained, far from a thermodynamic balance, for a longer period of time; a “life- span.” All reactions of the organism proceed at relatively low temperatures in the aqueous milieu and must be accelerated, i.e., catalyzed. The prerequisite for an effective catalysis is suitable substrates between and in the cells. Because the extracellular space is located in front of the cells, the cells can only react as they have been informed via the extracellular space. The dynamic structure of the extracellular space and its regulation (ground regulation) have therefore a decisive impact on the effectiveness of the extracellular and intracellular catalysts. This depends on the structure of the ground substance (extracellular matrix or simply, matrix). It forms in all cells and cell groups a molecular sieve of matrix components such as highly polymerized sugar protein complexes and sugar complexes (proteoglycans-glycosaminoglycans, PG/GAG’s), structural proteins (collagen, elastin) and meshing glycoproteins (e.g., ﬁbronectin) (Figure 2). As the PG/GAG’s are electro-negatively charged, they are able to bind water and exchange ions as well. They are therefore the guarantors for isoiony, isoosmy and isotony in the matrix.

ground substance, terminal autonomic axons, connective tissue cells (mast cells, defense cells, ﬁbroblasts, etc.) and parenchyma cells. Epithelial and endothelial cell groups rest on a basal membrane which mediates to the ground substance. Every cell surface carries a glycoprotein and glycolipid ﬁlm connected to the ground substance (dotted line), to which the histocompatibility complexes (MHC) also belong. The ground substance is connected to the endocrine system via the capillary system and via the axons to the central nervous system. The ﬁbroblast is the metabolically active center (Heine, 1997.)

The connection to the central nervous system is conducted via the autonomic nerve ﬁbers blindly ending in the matrix. The connection to the system of endocrine glands (pituitary gland, thyroid gland, suprarenal gland, etc.) is conducted via the capillary system which permeates the matrix. Both systems are connected to each other in the brainstem and to superimposed centers of the brain. In this manner, the matrix is regulated not only on site but also under the inﬂuence of superimposed control areas. The regulation center in the matrix is the ﬁbroblast (corresponding to the glia cell in the central nervous system). It reacts immediately to all incoming information (hormones, neural substances, metabolites, catabolites, pH value changes, etc.) with a synthesis of ‘good’ or ‘bad’ information. In this manner every surplus or deﬁcit can lead in certain circumstances to detrimental consequences for the total system depending individually on a vicious cycle.

It is important to note that due to the sieve-like as well as connective properties of the PG/ GAGs, the danger of damaging the matrix also exists through the development of a latent tissue acidity, increase of free radicals and the activation of the proteolytic system turning into a pro-inﬂammatory situation. Ultimately, damage of all humoral and cellular elements may arise progressing at ﬁrst from persistent feelings of ill health to chronic disease and malignant processes (Heine, 1997.)

Homotoxicological remedies have the ability to achieve immunomodulation. This immunomodulation is achieved via ingredients in the remedies used; these remedies contain an amino acid sequence in dilution, therefore remedies with plant extracts, suis organ extracts, nosodes and animal venoms are able to immunomodulate. The critical dilution of the ingredients from 1X-14X, furthermore gives the remedies the ability to induce the immunological bystander reaction, primarily in the Gut Associated Lymphoid Tissue (GALT) and less so in the peripheral tissues.

The normal immune response depends, apart from the non-speciﬁc immune response via the phagocytes, complement and acute phase proteins, on the speciﬁc immune response, mediated by the lymphocytes and their products.

The CD4, CD8 and the family of Large Granular Lymphocytes (Including the Natural Killer Cells) forms part of this normal arm of the immune response. The CD4 and CD8 cells need to be activated by an Antigen Presenting Cell (APC) which will present the antigen by processing it either via the Major Histocompatibility Complex I or II (MHC I or II) or via other molecules such as the CD1 molecule in the intestinal epithelial cell. MHC I will activate CD8 cytotoxic cells, MHC II the CD4 helper cells and CD1 from the Intestinal Epithelial Cells (IECs) will activate CD8 suppressor cells.

CD4 cells have several subclasses of functional cells, namely Th1, Th2, Th3 and also Th4 cells. Th1 cells secrete the cytokines TNF and Interferon gamma and will activate lymphocytes and products which have signiﬁcance within cellular immunity. Under pathological conditions, Th1 cells will cause diseases like Rheumatoid arthritis, Inﬂammatory bowel disease and other organ related autoimmune diseases such as Multiple sclerosis. It is also responsible for the general inﬂammatory processes we see in the tissues in general. Th2 cells on the other hand secrete the cytokines IL-4, 10, 5, and 13 and have signiﬁcance within antibody formation. Th2 cells are also the pathway through which allergic phenomena are mediated in pathological circumstances. In the normal organism, there is a constant oscillation between Th0, Th1 and Th2 cells and this oscillation has a chronobiology similar to most of our other regulatory systems. In factTh1/Th2 oscillation is under the control of the neuroendocrine system, and will follow its diurnal rhythm. Another mechanism which achieves this Th1/Th2 oscillation is the inhibitory effect the Th1 and Th2 secreted cytokines will have on each other. Another cell which can also modulate the normal oscillation is the Th3 cell.

This cell secretes the cytokine Transforming Growth Factor beta, (TGF-ß) and can modulate the balance between Th1/Th2. In addition the Th3 cell and certain CD8 suppressor cells are most likely responsible for the development of our immune tolerance to foods. It seems that the size of the antigen which is presented by the APC will determine whether it will generate a Th1, Th2 or Th3 response. According to Heine, any substance in the dilution from 1X-14X will have the effect of generating a Th3 response, and to a lesser extent, a Th2 response.

This refers, as its name implies, to the induction of cells by a relative non-toxic antigen which will then have an effect on a process such as an inﬂammation which was started by another antigen somewhere else in the body. Let’s look at the bystander reaction (Figure 3).

Figure 3: The bystander reaction

In order to initiate the bystander reaction we need a small dose of antigen, or a remedy containing plant extract, suis organ extract, animal venom or a nosode, each in a speciﬁc dilution. These diluted substances are then taken up by the APC’s in the gut lining which will present them as an antigen to the lymphocytes in the GALT via the MCH or the CD1 binding mentioned above. The processed antigen is then displayed as a motif on the outside of the APC. There will be a motif for each of the ingredients, thus if we give Traumeel, one for Arnica, one for Bellis perennis, etc., or if we give Hepar compositum, one for Hepar Suis, one for Colon Suis and so forth.

After being presented with the motifs on the APC, prolymphocytes of the Th3 type are activated due to the size of the motif (5-15 amino acids), and will differentiate into a population of Th3 cells. There will be a Th3 type cell for each of the motifs presented, thus one for Arnica, Bellis perennis and so forth.

These lymphocytes then migrate to the lymph nodes in the Peyer’s patches and proliferate into billions of copies. This process is called cloning.

The millions of cloned Th3 cells will then through chemotaxis ﬁnd the inﬂammation caused by Th1, Th2 and Th4 lymphocytes and suppress them, thereby restoring the balance and normal oscillation between Th1/Th2 cells. Here the law of similars is at work, as each Th3 cell for Arnica or Bellis perennis for instance, will ﬁnd the corresponding Th1/Th2 cell which looks similar to its motif and suppress it.

The immunological bystander reaction serves as a model for the working mechanism of immunomodulatory remedies which, through a non-toxic substance in a speciﬁc dilution can induce a regulatory cell, the Th3 cell . This regulatory cell, while developed at another site, and acting as an innocent bystander can bring about a balance in the immune system, by down-regulating an inﬂammatory process started by another noxious homotoxin remote from its own activation. The Th3 cell acts as a fulcrum on which the balance of Th1 and Th2 cells rests (Figure 4).

This also conﬁrms one of the ways which Dr. Reckeweg postulated as to how homotoxicological remedies work. He theorized that by giving a non-toxic substance the defense system of the body is activated through another pathway in order to bring about homeostasis.

Figure 4: Diagram of Th3 as a fulcrum

Due to the dilution and ingredients found in certain homotoxioclogical remedies they lend themselves well to this type of immunoregulation.

Homotoxicological medicines have been developed to serve the very speciﬁc purpose of restoring regulation in the organism. Although they may appear as being complex homeopathic compositions, they in fact differ in a number of ways from the normal complex prescription, in that they incorporate various dilutions of remedies, as well as potentized catalysts, allopathics and vitamins, for instance. As our knowledge of molecular biology increases we can witness the deep-acting function of these combinations on the body. We classify the remedies according to the origin of the remedy, the combination, as well as the phase in which they will be useful.

The remedies are made up of four pharmacological groups (PG’s):

The ﬁrst group is the plant materials (PPG’s). Depending on the dilution, these could have either the dominant, secondary or complementary action in the remedy.
The second group is the mineral pharmacological group or MPG’s. In the potency they mostly appear in the remedies, they act as functional regulators, modiﬁers and stimulators.
The third group is unique to Homotoxicology, and is made up of the catalysts (CPG’s). These are mostly in the 6X-10X dilution range, and will act as modulators and regulators. The CPG’s may contain potentized elements of the Krebs cycle, and carrier enzymes of the respiratory chain such as Ubichinon (Coenzyme Q₁₀). Hormones in potentized form, as levothyroxin and cortisone, can also act as catalysts. Certain other substances including Procainum, Glyoxal and Methyl glyoxal will also stimulate the intermediary metabolism, and are thus classiﬁed as catalysts.
The fourth group is the immunomodulators (IPG’s). Potentized Suis organ extracts, nosodes and also venoms of animal origin act as immunomodulators. These substances will induce Th3 cells and through the immunological bystander reaction will be able to modulate the immune response.

Homotoxicological remedies may also be classiﬁed according to the way the above is combined. Five groups stand out for use in the United States:

The Indication-based Heel remedies: These are primarily composed of PPG’s and MPG’s and are often indication-based, as, for example, Traumeel and Vertigoheel. They can be used for acute as well as chronic conditions, and depending on the chronicity, can be used from days to weeks to months.
The Homaccords: These are also primarily composed of PPG’s and MPG’s such as Nux vomica-Homaccord (PPG’s) or Phosphor-Homaccord (PPG’s and MPG’s), which are typically present in potency chords, for instance 3X, 6X, 10X, 30X, 200X, and 1000X. The Homaccords are often organotropic, thus they will support the function of a speciﬁc organ, and due to the potency chord will have a far-reaching action on the organ. They are often used for a period of time, 12 weeks for instance. Due to their potency chords, they often will not give a ﬁrst aggravation seen by other homeopathic remedies.
The Injeels, or Heel remedies: These remedies are like a combination of the indication- based Heel remedy and a Homaccord, and are often directed at treating a speciﬁc indication affecting an organ system. The individual components which are normally PPG’s and MPG’s also come in shorter potency chords than the above, for instance, in potency chords to 10X and 30X.
The Catalysts: These contain substances of the CPG’s mentioned above occasionally with added potentized vitamins and other co-factors of the intermediary metabolism. The catalysts which come in a compositum also may contain PPG’s, MPG’s, as well as IPG’s. They are added as soon as a condition reaches the matrix phases, in other words, once it affects the ground regulation system, and are employed in cycles, as the compositae.
The Compositae: These remedies have been developed as the ultimate regulators and modulators. They often contain all four PG’s, namely PPG, MPG, CPG and IPG, and therefore lend themselves to treatment of all conditions, but especially to those in the matrix and cellular phases. Sometimes, however, they are also employed in the humoral phases, on an Auto-regulatory system level, like Echinacea compositum, which is an excellent remedy to use in the inﬂammatory phase. Towards the right of the biological division, they are employed in cycles of ﬁve to six weeks, and the result is then assessed as to whether they should be repeated or not. The compositae come in oral vials, and many are also available in oral tablets.

Disease does not arrive on the cellular level overnight. It will start off as dysregulation of the Auto-regulatory system (ARS) and then move to the matrix, or Ground regulation level, (GRS) and lastly will manifest on the cellular level. This will correspond to the humoral, matrix and cellular phases of the six-phase table.

When disease is in the humoral phases, it will often be enough to only employ remedies of the PPG and MPG group, and therefore most Homaccords, Heel remedies and Indication-based Heel remedies will sufﬁce to restore self-regulation in a patient. However, when disease reaches the Ground regulation level, we need to add a catalyst, and when it approaches the cellular level, we need to mostly add an IPG as well. It is important to note that there are Indication-based Heel remedies other than a compositum, for example Gripp-Heel, which contains animal venom, (Lachesis) and therefore will act as an immunomodulator as well. In Lymphomyosot there is a catalyst (Levothyroxin) and an immunomodulator (Aranea diadema). The latter can thus be employed in all the phases of the six-phase table, whereas a remedy such as Engystol (Vincetoxinum and Sulfur, thus PPG, and MPG), will not be sufﬁcient on its own in the matrix and cellular phases. We will then have to add a CPG such as Coenzyme compositum, and for instance, a compositum containing PPG’s, MPG’S, CPG’s and an IPG in some form.

The choice of remedy is thus made on the phase in the six-phase table in which the condition is classiﬁed, and on which part of the Auto-regulatory system or the Ground regulation system will need support.

By introducing the vicariation principle into antihomotoxic therapy, Reckeweg pointed out the dynamics of every disease and/or recovery process. The interrelationships which exist between a bio-system and the damaging homotoxins vary continuously during an illness and during the recovery process. The purposeful, self-regulatory forces of the organism usually are retained during illnesses up to and including phases of the six-phase table of homotoxicosis. In contrast, after the Biological Division is crossed, from phase 4 onward, self-regulation and self-recovery is practically no longer possible for the organism. In this case a therapeutic treatment is required to achieve recovery. Following regressive vicariation, a disease often enters phase 2 or 3. This typically requires a change of the antihomotoxic preparation because in phase 2 a symptomatically indicated acute remedy is usually necessary. In phases 2 and 3, which belong to the humoral phases, the self- regulatory capacity of the organism is still present, so that only stimulative medication is required to initiate inﬂammatory mechanisms, particularly in the matrix. Usually the excretion of the disease occurs via the skin or the mucous membranes. Increased perspiration, sputum, strong formation of urine, light diarrhea and fever are welcome signs of a shift out of the cellular disease phases which indicates an improvement of the basic illness. In the acute phases 1 and 2, composita preparations such as Traumeel or certain Homaccords are preferable.

Tablets

Homeopathic remedies prepared in solid form are in most cases mixed with milk sugar (lactose) and then formed into tablets. Tablets should be placed under the tongue and allowed to dissolve gradually without chewing. This permits the active ingredients to be absorbed through the buccal lining of the mouth, thereby evading the stomach where gastric juices might destroy or inactivate the remedy.

Oral drops and oral vials

Liquid homeopathic mediciations should be retained in the mouth long enough for their contents to be absorbed by the mouth’s buccal lining. As with tablets, the goal is to avoid the stomach’s juices which can inactivate the remedy. Therefore, liquids should not be simply swallowed.

Ointments and gels

Topical preparations offer a direct application to the affected area. Ointments and gels may be applied generously, as necessary, by rubbing gently into the skin.

Nasal sprays

Homeopathic nasal sprays are not associated with side effects or the risk of habituation. To thoroughly coat the nasal membranes, inhale deeply through each nostril after application.

Suppositories

Suppositories offer an alternate route of administration for persons unable to take medications orally.

Ear drops

For comfort in administering, warm the liquid by holding the vial in a closed hand for one minute.

Eye drops

Homeopathic eye drops are safe for wearers of contact lenses.

Cough syrup

Homeopathic cough syrups help promote expectoration to shorten the duration of the cough.

Injection solution (Rx)

The injection solution offers doctors the ability to inject medication directly into the affected area. Remedies are contained in vials and diluted in an isotonic sodium chloride solution base.

Organ system / tissue	Left side (regulation / self-healing)			Right side (dysregulation / deterioration)
	Humoral phases		Matrix phases		Cellular phases
	Excretion phase	Reaction phase	Deposition phase	Impregnation phase	Degeneration phase	Dedifferentiation phase
Skin	Increased sweat, cerumen (earwax), sebum and smegma production	Dermatitis, impetigo, abscess, boil (furuncle), otitis externa	Hyperkeratosis, seborrhoeic eczema, naevus, skin papilloma (skin tags)	Atopic eczema (neurodermatitis), urticaria, warts, anal fissures, acne rosacea, hirsutism	Psoriasis, pressure ulcer (decubitus ulcer), radiation dermatitis, pemphigus vulgaris	Squamous cell carcinoma, basal cell carcinoma, melanoma
ENT (Ear–Nose–Throat)	Hypersalivation, increased tear secretion	Otitis media, pharyngitis, stomatitis, gingivitis, aphthae, glossitis, (acute) rhinitis, (acute) sinusitis, laryngitis, dental abscess	Nasal polyp, Eustachian tube catarrh (serous otitis media), periapical granuloma	Atopic rhinitis, hay fever, chronic sinusitis, (iatrogenic) rhinitis, anosmia, Ménière’s syndrome, hearing reduction	Otosclerosis, conductive deafness, ozena, atrophic rhinitis, caries, periodontosis	Leukoplakia, tongue carcinoma, laryngeal carcinoma, nasopharyngeal carcinoma, tracheal carcinoma
Nerves	Increased secretion of neurotransmitters	Neuralgia, neuritis, polyneuritis, meningitis, encephalitis, (acute) trigeminal neuralgia	Neuroma, amyloid deposits, heavy-metal deposits	(Petit mal) epilepsy, paresis, nervous tics, (toxic) neuritis, ADD/ADHD, Guillain–Barré syndrome, (acute) poliomyelitis, (chronic) trigeminal neuralgia	Parkinson’s disease, (grand mal) epilepsy, Alzheimer’s disease, multiple sclerosis, ALS, peripheral nerve atrophy, neurofibromatosis	Glioma, meningioma, astrocytoma
Eyes	(Acute) conjunctivitis	—	Pterygium, floaters (mouches volantes), iris spot (initial)	Uveitis, allergic conjunctivitis, iris spots (chronic), iritis, astigmatism, myopia, presbyopia, keratoconus, pannus, arcus (senilis)	Glaucoma, cataract, hemianopia, macular degeneration, paralytic mydriasis	Retinal tumour, retinoblastoma
Autonomic nervous system	Increased adrenaline and noradrenaline release	Flushing, increased vagal tone, increased sympathetic tone	Ganglioneuroma	Dysautonomia (including orthostatic hypotension)	Sympathetic reflex dystrophy (Sudeck syndrome), Horner syndrome	Pheochromocytoma, neuroblastoma
Bronchi	Sputum / expectoration	(Acute) bronchitis, tracheitis	(Asthmatic) bronchitis, chronic tracheitis (viral), cystic fibrosis	—	COPD (chronic obstructive pulmonary disease), atrophy of the bronchial mucosa	Tracheal carcinoma, bronchial carcinoma
Gastrointestinal system	Increased secretion of digestive juices	(Acute) oesophagitis, (acute) gastritis, (acute) gastroenteritis, colitis	Gastric polyps, intestinal polyps, constipation, melanosis coli	Gastric ulcer, duodenal ulcer, coeliac disease (mild), leaky gut syndrome, dysbiosis	Crohn’s disease, ulcerative colitis, atrophy of small-intestinal villi, coeliac disease (severe)	Barrett’s oesophagus, oesophageal carcinoma, gastric carcinoma, duodenal carcinoma, rectal carcinoma
Bladder	Increased mucus production	Bartholinitis, cystitis, urethritis, infections of the urogenital mucosa	Bladder polyps	Interstitial cystitis	Atrophy of the urogenital mucosa	Bladder carcinoma
Breast (Mamma)	Galactorrhoea	Mastitis	Breast cysts, calcifications in the breast	Breast fibroadenomas, fibrocystic mastopathy	Breast atrophy, gynaecomastia	Breast carcinoma
Liver–gallbladder system	Increased bile salt secretion, increased gastric acid secretion	Pancreatitis, salivary gland inflammation	Gallstones, fatty liver, pancreatic calcifications, pancreatic cysts, liver cysts, Wilson’s disease, salivary gland calcifications	Chronic hepatitis, chronic pancreatitis, viral pancreatitis (e.g., mumps), alcohol-toxic hepatitis, cystic fibrosis	Liver cirrhosis, iatrogenic liver disease	Liver carcinoma, pancreatic carcinoma
Lungs	Acute lung abscess, pneumonia	—	Bronchiectasis, pneumoconiosis	Asthma, cystic fibrosis	Emphysema, chronic lung abscess, interstitial pulmonary fibrosis, pulmonary mycosis	Lung carcinoma
Hormones (endocrine)	Increased hormone levels (thyroid, parathyroid, thymus, intestinal, adrenal, anterior pituitary hormones, insulin, glucagon)	Thyroiditis, e.g., De Quervain thyroiditis	Thyroid cysts, adrenal cysts, adrenal adenoma, pituitary adenoma, thymoma, insulinoma, parathyroid adenoma, goitre, adrenal adenoma	Graves’ disease, Hashimoto thyroiditis (stage 1), postpartum thyroiditis, Cushing’s disease, precocious puberty, adrenal exhaustion	Hashimoto thyroiditis (stage 2), Riedel’s thyroiditis (Riedel’s goitre), parathyroid atrophy	Thyroid carcinoma, parathyroid carcinoma, adrenal carcinoma, carcinoid syndrome
Connective tissue	Increased secretion of metalloproteinases, increased glycoprotein formation	Abscess, reactive inflammatory reaction of the matrix, tendinitis	Lipoma, storage of toxins in the matrix, amyloidosis, mucopolysaccharidosis, calcific periarthritis of the shoulder	Mixed connective tissue disease (MCTD), Marfan syndrome, Ehlers–Danlos syndrome, sphingolipidosis	Scleroderma, carbohydrate-deficient glycoprotein syndrome (CDG), induratio penis plastica, progeria, Dupuytren’s contracture	Sarcoma
Bone, cartilage	Osteomyelitis, chondritis	—	Osteophyte formation, bone cysts	Osteomalacia, osteoporosis (early stage)	Osteoporosis, Paget’s disease	Osteosarcoma
Blood	Leukocytosis, infection anaemia	Thrombocytosis, (reactive) polycythaemia	Eosinophilia, leukopenia, anaemia (including anaemia of chronic disease), increased coagulability of blood	Aplastic anaemia, thrombocytopenia (including idiopathic thrombocytopenic purpura), pancytopenia, polycythaemia vera	—	Leukaemia
Heart	Increased cardiac output, tachycardia	Myocarditis, extrasystoles, acute rheumatic fever	Left ventricular hypertrophy, coronary artery plaques	Angina pectoris, atrial dilatation, cardiac arrhythmias, rheumatic fever with cardiac involvement, mitral valve prolapse (Barlow syndrome), cardiomyopathy	Myocardial infarction, ventricular arrhythmias, valvular stenosis and insufficiency	Sarcoma
Arteries, veins	Increased production of endothelial mediators	Phlebitis, arteritis, endothelial inflammation	Venous stasis, arterial plaques (atheromas), haemorrhoids	Vasculitis, arteriosclerosis, varicose veins, polyarteritis nodosa, angioma, varicocele	Peripheral vascular disease, aneurysm, obliterative arteritis	Angiosarcoma
Lymphatic system	Increased lymph production	Tonsillitis, lymphadenitis, adenoiditis, lymphangitis	Lymphoedema, lymph node swelling, tonsillar hypertrophy, adenoid	Indurated oedema, granulomatous lymphadenitis, cat scratch disease	Lymphatic tuberculosis, elephantiasis	Lymphoma (Hodgkin and non-Hodgkin), lymphosarcoma
Spine, joints	Increased production of synovial fluid, increased cerebrospinal fluid	Arthritis, polyarthritis, synovitis, acute rheumatic disease	Joint hydrops (effusion), gouty tophi, haemarthrosis	Chronic arthritis, Reiter syndrome, hydrocephalus, prolapsed disc	Osteoarthritis, ankylosing spondylitis (Bechterew’s disease)	Sarcoma, chondrosarcoma
Kidney	Frequent urination	Nephritis, glomerulonephritis, pyelitis	Kidney stones, kidney cysts, renal gravel, orthostatic albuminuria, haematuria	Preclinical nephrosis, nephrotic syndrome, chronic haematuria, Goodpasture syndrome, autoimmune glomerulonephritis	Nephrosis, chronic glomerulonephritis, tuberculosis of the urogenital tract	Renal cell carcinoma (hypernephroma), Wilms tumour
Serous membranes	Increased production of serous fluid	Pleuritis, peritonitis, pericarditis	Pleural effusion	Chronic exudative pleuritis and serositis, ascites, chronic pericarditis	Pleural, pericardial and peritoneal tuberculosis; pleural adhesions	Mesothelioma, primary peritoneal carcinoma, primary pleural cancer
Male reproductive organ	Increased production of seminal fluid	Prostatitis, epididymitis, orchitis	Spermatocele, early stage of benign prostatic hyperplasia (BPH)	Benign prostatic hyperplasia (BPH), oligoasthenozoospermia	Infertility	Prostate carcinoma, testicular cancer, seminoma, teratoma
Female reproductive organ	Increased menstruation	Oophoritis, adnexitis, metritis, dysmenorrhoea	Ovarian cysts, uterine polyps, fibroids	Chronic adnexitis, amenorrhoea	Infertility, ovarian atrophy	Ovarian carcinoma, ovarian teratoma, cervical carcinoma
Musculature	Myalgia	Myositis	Myogelosis, myositis ossificans	Muscle weakness, mitochondrial myopathy, autoimmune dermatomyositis	Muscle atrophy, muscular dystrophy	Myosarcoma

Heel Index