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J o urnal o f

Volume 2, Number 2 ) 2008

Integrating Homeopathy
and Conventional Medicine

Biomodulation of Osteoarthritis
Lumbosacral Pain Syndrome A Case Study


I n Fo c u s

Biomodulation of Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . 4

W h a t E l s e I s N e w ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Specialized Applications

Biopuncture Protocols for the Treatment

of Chronic Inflammatory Disorders . . . . . . . . . . . . . . . . . . . . . 10

Re f r e s h Yo u r H o m o t ox i c o l o g y

Movement and the Matrix: The Importance of

Biomechanical Signals in Matrix Remodeling . . . . . . . . . . . . . 13

Around the Globe

Evidence-Based Homeopathy
More Than Results of Double-Blind Studies! . . . . . . . . . . . . . .16

M a r ke t i n g Yo u r P r a c t i c e

Getting Organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

N e w Pe r s p e c t i v e s

Sulfur in Health and Disease:

A Hypothesis on Sulfur Intoxication . . . . . . . . . . . . . . . . . . . . 20

From the Practice

Whiplash Acute Inflammation Becomes Chronic . . . . . . . . 24

Lumbosacral Pain Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Making of ...

Suis-Organ Products in Antihomotoxic Medicine . . . . . . . . . 26

Cover photograph 2008 bilderlounge media

Published by/Verlegt durch: International Academy for Homotoxicology GmbH, Bahnackerstrae 16,
76532 Baden-Baden, Germany, e-mail:
Editor in charge/verantwortlicher Redakteur: Dr. Alta A. Smit
Print/Druck: VVA Konkordia GmbH, Dr.-Rudolf-Eberle-Strae 15, 76534 Baden-Baden, Germany
2008 International Academy for Homotoxicology GmbH, Baden-Baden, Germany

A Holistic Approach
to Chronic Inflammation
Dr. Alta A. Smit

here is no longer any question

that chronic inflammation is
the common denominator in almost
all chronic illnesses, including systemic diseases such as arteriosclerosis and metabolic syndrome.1 In this
issue, though, we examine chronic
inflammations role in disorders of
the structured connective tissue of
the musculoskeletal system. Such
disorders fall into the next to last
column of the Disease Evolution
Table, i.e., the degeneration phase.
We cannot embark on this journey
without venturing into the fascinating world of the extracellular matrix. Although long known to practitioners of biological medicine as
the crux of cell and organ health, it
is now also being recognized by
mainstream medicine. In particular,
the molecular basis of matrix remodeling after injury and as a
normal physiological process is
under increasing scrutiny. This ana-

bolic/catabolic balance depends on

delicate interactions among the immune, endocrine, vascular, and nervous systems, so the complex multitarget interventions available to
bioregulatory medicine are especially suited to restoring the balance.
Dr. Martin Plotkin, an orthopedic
surgeon and co-author of the focus
article, uses such medications extensively in his practice. The focus article concentrates on the modern
pathophysiology of cartilage degeneration, but as connective tissue uses
the same mechanisms in both structured and nonstructured matrix, the
story becomes fascinating once we
examine the effects of mechanical
forces on matrix remodeling (see
Refresh Your Homotoxicology).
Antihomotoxic medicines offer a
holistic approach to disorders of the
musculoskeletal system, and case
studies and protocols demonstrate
the practical applications. Dr. Den-

nis van Aswegen, D.C. speaks out of

long experience with such disorders
in two cases from his practice. Dr.
Edgar Estrada introduces the concept of sulfur intoxication and
highlights a form of suppression
that has not yet been widely recognized. Dr. Peter Smith reports from
the LIGA conference in Oostend,
Belgium. Lastly, Dr. Wilfried Stock
continues the Making of series
with the suis organs, part 2 an article that is well-placed in this issue,
given that organ support is one of
the main pillars of antihomotoxic
treatment in the degeneration

Alta A. Smit, MD

1. Edwards T. Inflammation, pain, and chronic
disease: an integrative approach to treatment and prevention. Altern Ther Health Med

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

) I n Fo c u s

Biomodulation of Osteoarthritis

By Martin Plotkin, MD, and Alta A. Smit, MD


From the homotoxicological perspective, OA falls into the degeneration phase on the Disease Evolution
Table and shares many of the characteristics of degenerative disease
processes, namely, chronic inflammation accompanied by the release
of dangerous free radicals such as
peroxynitrite, disturbance of the
normal cycle of degeneration and
repair, and disturbance of angiogenic balance in the direction of inappropriate vascularization.

Osteoarthritis (OA) is a chronic, disabling condition that affects synovial

joints. Its pathogenesis involves multiple etiologies, including mechanical, genetic, and biochemical factors.
OA is generally described as noninflammatory arthritis in contrast to
rheumatoid arthritis, but this is increasingly recognized as a misnomer, since inflammation does indeed
contribute to both the symptoms
and the progression of OA.1 Morning or inactivity stiffness is a common symptom in OA, but acute inflammatory flares with all the clinical
signs (redness, warmth, swelling,
and further loss of function) are also
common in OA patients.
Figure 1: Degradation and repair in the

matrix. In osteoarthritis, the catabolic/

the most abundant cells and proinflammatory cytokines such as IL-1,

TNF-, and IL-8 are the most
prominent. In contrast, chronic inflammation develops over a longer
period of time and may persist for
weeks, months, or years. Markers of
chronic inflammation such as C-reactive protein (CRP) may be elevated in patients with OA and may be
mediated by IL-6, which is the major cytokine secreted by macrophages. IL-6 may also play a role in angiogenesis, which is another factor
contributing to the pathology of OA
(see below).
The outcome of acute inflammation
is elimination of the irritation, followed by restoration of the tissues
to their original state. In chronic inflammation, on the other hand, inflammation and repair occur concurrently, and the joints remain

Inflammation in osteoarthritis
The effects of subclinical chronic inflammation in OA are now increasingly being recognized.2 The onset
of acute inflammation is generally
sudden, with the above-mentioned
symptoms developing in a matter of
minutes or hours. Neutrophils are

anabolic rhythm is disturbed.

Tumor Necrosis Factor


Bone Morphogenetic
Proteins (Transforming
Growth Factor )



Tissu e I nflammation
an d Degradation
(Free radicals)

Tissu e Repai r


Tissue healing
Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

Matrix fragments

Excessive mechan ical force

Damaged matrix
Increased ROS production
Activation of catabolic signaling
pathways and inhibition of
anabolic pathways

Chronic inflammation

Growth factor release

Degrade damaged matrix

Activation of signaling pathways

and ROS production
Cytokines, chemokines, growth
factors and proteolytic enzymes

U n balanced chon drocyte

metabolic activity
Catabolic > Anabolic

Aged Cell
Poor response to growth factors
Degradative pathways stay on
Continued matrix destruction



Figure 2: Molecular pathophysiology of osteoarthritis (adapted from Loeser 1)

abnormal even after the inflammation subsides. In chronic inflammation, the cells that predominate are
macrophages and often lymphocytic
infiltrates. Chronic inflammation can
therefore be seen as a misguided attempt on the part of chondrocytes
and other cells to eliminate damaged
tissue and to effect repair.
Anabolic/catabolic imbalance
Oscillation between degradation
and repair is a normal occurrence in
the matrix. Although the extracellular matrix is the functional unit in
this process, homeostasis is affected
by chondrocytes. Matrix metalloproteinases (MMPs) are stimulated
by inflammatory cytokines and matrix degradation products to induce
degradation of older or damaged
tissues and are counterbalanced by a
number of growth factors, notably
also members of the TGF- family,
Bone Morphogenetic Proteins

(BMPs), which reciprocally inhibit

the actions of the MMPs and therefore induce tissue healing. This catabolic/anabolic oscillation is of vital
importance in normal tissue integrity.3,4 When the process is disturbed
(due to continuous tissue damage,
either by mechanical stressors or
toxins) or the bodys ability to trigger repair reduced (due to either a
deficiency of growth factors or an
inability to respond to them, as is
seen in old age), an overactive catabolic/anabolic cycle results (see Figure 1).
To better understand cartilage destruction, at least inasmuch as it is
mediated by chondrocytes themselves (sometimes called chondrocytic chondrolysis), we must study
the molecular mechanisms that disrupt the balance between chondrocyte catabolic and anabolic activity.
Since chondrocytes are lost to cell
death at some point in the process of
cartilage destruction, it is also imJournal of Biomedical Therapy 2008 ) Vol. 2, No. 2

portant to know whether these molecular factors also contribute to cell

The cause of chronic synovitis in
OA is not well understood. Debris
or parts of cartilage may be found in
the synovium, where they provoke
typical responses to foreign bodies.
Mechanical injury can also lead to
the secretion of free radicals or reactive oxygen species (ROS).
ROS and chronic cartilage
The role of ROS in cartilage damage
remains controversial. Recently,
Green et al. added to the literature
describing the role of ROS release
after mechanical injury in the progression of cartilage destruction.5
Nitric oxide in particular is implicated in this process and may combine with other ROS to form the
highly toxic compound peroxynitrite.

) I n Fo c u s
ROS also will induce inflammatory
mediators, such as NF-B, IL-1, and
IL-6. ROS have been implicated in
chondrocyte senescence.6 ROS may
also have a direct influence on the
production of Vascular Endothelial
Growth Factor (VEGF), a powerful
stimulator of angiogenesis and
chronic inflammation.7
Angiogenesis and chronic

Neoinnervation also follows angiogenesis and may contribute to pain

in chronic synovitis (see Figure 2).
Targeting these aspects could lead
to novel approaches to treating OA.
The fact that Zeel, a homeopathic
combination medication, is formulated to address these aspects, along
with its excellent tolerability, makes
it an ideal option for treating the
chronic inflammation seen in OA.
Bioregulatory treatment of OA

The formation of new blood vessels

is essential during fetal development
but rarely occurs in adults except in
overzealous attempts at remodeling
and regeneration, as in OA. Inflammatory mediators can stimulate angiogenesis either directly or indirectly. Inflammatory cells that
produce this effect include macrophages and mast cells, which are
present in the OA synovium. Macrophages are generally found wherever abnormal angiogenesis occurs,
as in synovitis and tumors. Angiogenesis may be important in potentiating or perpetuating inflammation, rather than initiating it. On the
other hand, angiogenesis may be indirectly self-perpetuating because it
increases inflammatory cell infiltration and thus increases the cells that
secrete angiogenic factors such as
VEGF and Fibroblast Growth Factor
Vascularization of normally avascular cartilage and at the osteochondral junction is a feature of OA. In
growing individuals, angiogenesis is
required for normal endochondral
ossification to close long bones. This
process is mediated by VEGF from
hypertrophic chondrocytes. In OA,
however, growth through osteophytes at the joint margin also occurs through osteochondral ossification. Cartilaginous extensions of the
articular surface become invaded by
blood vessels, and bone extends
from the subchondral structures.

We have seen in the previous section

that OA is characterized by chronic,
low grade inflammation with frequent flare-ups of acute inflammation. Conventional treatments
(NSAIDs, paracetamol/acetaminophen, and/or intra-articular corticosteroids) act to suppress only certain aspects of the inflammation and
have significant side effects.
Intra-articular administration of
hyaluronic acid attempts to supply
the cartilage with proteoglycan support.9 Combinations of chondroitin
sulfate and glucosamine have long
been used for this purpose in treating OA, with variable evidence of
efficacy.10,11,12 Some promising new
treatments use autologous serum.13
The use of antioxidants in OA has
not been proven to be beneficial and
remains controversial.14
In view of the pathogenesis outlined
above, the use of low-concentration
antigens with a multi-target regulation such as is seen in the antihomotoxic repertoire becomes interesting.

permitting a certain level of inflammation so that degradation of debris

can occur.
Zeel has been used for degenerative
arthritis for many years; empirical
evidence indicates that it is as effective as Cox-1 and Cox-2 inhibitors
in treating OA.22 However, it may
have a special role to play with regard to the pathophysiology of
chronic inflammation. Many of its
ingredients, such as Rhus tox, contain flavonoids, known for their antioxidant effects.23 Rhus tox and Arnica also have been shown to have
effects on IL-6, which is secreted by
macrophages and may play a central
role in chronic inflammation and angiogenesis. In an animal study,
Stankov demonstrated that when
rabbits with experimentally induced
arthritis were treated with either
Zeel or a solvent (reference substance), the Zeel group developed
far fewer erosions and less hypertrophic cartilage than the solvent
group.24 Histochemical analysis also
revealed significant vascularization
of the deeper layers of cartilage in
the animals treated with the solvent,
whereas the Zeel group developed
only a few capillaries. (In view of
the central role that angiogenesis
appears to play in the pathophysiology of OA, this is a very important
finding.) And finally, the arrangement of chondrocytes was also much
more structured in the verum group.
It is interesting to note that the alkaloid sanguinarine, found in Sanguinaria canadensis (one of Zeels ingredients), has been shown to
inhibit VEGF.25,26

Traumeel and Zeel as

combination therapy in OA
Traumeel has been shown in studies
to be both clinically efficacious and
an immune-modulating medication15-21 and should be considered
for its immune-regulating properties, which promote repair while
Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

Ongoing research is clarifying the

complex pathophysiology of OA.
Disruption of the catabolic/anabolic
cycle of the cartilaginous matrix appears paramount. New evidence

) I n Fo c u s

Osteoarthritis is generally described as non-inflammatory arthritis,

but acute flare-ups with clinical signs of inflammation such as redness,

warmth, swelling, pain, and loss of function are common in OA patients

(here: inflamed elbow joint).

suggests that both the generation of

ROS (through mechanical pressure)
and angiogenesis contribute significantly to the development of chronic inflammation, tissue destruction,
and pain. Standard treatment with
NSAIDs aims primarily to reduce
inflammation and control pain. Substances that inhibit MMPs are currently deemed too toxic to be of any
use in OA. Viscosupplements, chondroitin sulfate and glucosamine, and
some other novel treatments are also
used, with variable evidence of efficacy.
Due to the different effects of the
two antihomotoxic medications
Traumeel and Zeel on acute and
chronic inflammation, it is feasible
to administer these two products in
combination: Zeel for long-term
treatment, Traumeel at the beginning of treatment and for acute
flare-ups. Both of these medications
have been shown to have excellent
tolerability profiles. Further research
is warranted to clarify the exact effect of Zeel on angiogenesis and the
effect of the medication on ROS in
chronic inflammation.|
1. Loeser RF. Molecular mechanisms of cartilage destruction: mechanics, inflammatory
mediators, and aging collide. Arthritis Rheum
2. Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology

3. Aigner T, Soeder S, Haag J. IL-1 and BMPs

interactive players of cartilage matrix degradation and regeneration. Eur Cell Mater
4. Yasuda T, Poole AR. A fibronectin fragment
induces type II collagen degradation by collagenase through an interleukin-1-mediated
pathway. Arthritis Rheum 2002;46:138-148.
5. Green DM, Noble PC, Ahuero JS, Birdsall
HH. Cellular events leading to chondrocyte
death after cartilage impact injury. Arthritis
Rheum 2006;54:1509-1517.
6. Yudoh K, Nguyen T, Nakamura H, HongoMasuko K, Kato T, Nishioka K. Potential
involvement of oxidative stress in cartilage
senescence and development of osteoarthritis: oxidative stress induces chondrocyte
telomere instability and downregulation
of chondrocyte function. Arthritis Res Ther
7. Fay J, Varoga D, Wruck CJ, Kurz B, Goldring MB, Pufe T. Reactive oxygen species
induce expression of vascular endothelial
growth factor in chondrocytes and human
articular cartilage explants. Arthritis Res Ther
8. Mentlein R, Pufe T. New functions of angiogenic peptides in osteoarthritic cartilage. Curr
Rheumatol Rev 2005;1:37-43.
9. Bellamy N, Campbell J, Robinson V, Gee
T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of
the knee. Cochrane Database Syst Rev 2006;
10. Barnhill JG, Fye CL, Williams DW, Reda DJ,
Harris CL, Clegg DO. Chondroitin product
selection for the glucosamine/chondroitin
arthritis intervention trial. J Am Pharm Assoc
11. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in
combination for painful knee osteoarthritis.
N Engl J Med 2006;354(8):795-808.
12. Hochberg MC. Nutritional supplements
for knee osteoarthritis still no resolution.
N Engl J Med 2006;354:858-859.
13. Wehling P, Moser C, Frisbie D, et al. Autologous conditioned serum in the treatment of
orthopedic diseases: the orthokine therapy.
BioDrugs 2007;21(5):323-332.
14. Henrotin Y, Kurz B. Antioxidant to treat osteoarthritis: dream or reality? Curr Drug Targets 2007;8(2):347-357.

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

15. Heine H, Schmolz M. Induction of the immunological bystander reaction by plant extracts. Biomed Ther 1998;16(3):224-226.
16. Porozov S, Cahalon L, Weiser M, Branski D,
Lider O, Oberbaum M. Inhibition of IL-1
and TNF- secretion from resting and activated human immunocytes by the homeopathic medication Traumeel S. Clin Dev Immunol 2004;11(2):143-149.
17. Lyss G, Knorre A, Schmidt TJ, Pahl HL, Merfort I. The anti-inflammatory sesquiterpene
lactone helenalin inhibits the transcription
factor NF-kappaB by directly targeting p65.
J Biol Chem 1998;273(50):33508-33516.
18. Zell J, Connert W-D, Mau J et al. Treatment of acute sprains of the ankle. Biol Ther
19. Schneider C, Klein P, Stolt P, Oberbaum M.
A homeopathic ointment preparation compared with 1% diclofenac gel for acute symptomatic treatment of tendinopathy. Explore
20. Birnesser H, Oberbaum M, Klein P, Weiser
M. The homeopathic preparation Traumeel
S compared with NSAIDs for symptomatic
treatment of epicondylitis. J Musculosekelet Res
21. Singer SR, Amit-Kohn M, Weiss S, Rosenblum J, Lukasiewicz E, Itzchaki M, Oberbaum
M. Efficacy of a homeopathic preparation in
control of post-operative pain A pilot clinical trial. Acute Pain 2007;9(1):7-12.
22. Birnesser H, Stolt P. The homeopathic antiarthritic preparation Zeel comp. N: a review of molecular and clinical data. Explore
23. Mersch-Sundermann V, Kassie F, Bhmer S,
et al. Extract of Toxicodendron quercifolium
caused genotoxicity and antigenotoxicity in
bone marrow cells of CD1 mice. Food Chem
Toxicol 2004;42(10):1611-1617.
24. Stankov M, Bly M, Metelmann HW, et
al. Effects of Zeel comp. on experimental
osteoarthritis in rabbit knee. Rheumatologia
25. Basini G, Bussolati S, Santini SE, Grasselli
F. Sanguinarine inhibits VEGF-induced angiogenesis in a fibrin gel matrix. Biofactors
26. Basini G, Santini SE, Bussolati S, Grasselli F. Sanguinarine inhibits VEGF-induced
Akt phosphorylation. Ann N Y Acad Sci

) What Else Is New?

Children who are given honey

before going to bed cough less

than those who receive a cough

suppressant or no medication at all.

Myths in medicine

Honey for coughs

Couch potatoes age faster

Even western medicine is not always

strictly rational, and little headway
has been made against its unfounded
myths and preconceptions. For example, the claim that only 10 percent of the human brain is utilized is
demonstrably false. There is also no
scientific evidence to support the repeatedly postulated health-promoting effects of drinking a daily minimum of eight glasses of water. Hair
and fingernails do not continue to
grow after death, nor does shaving
make hair grow back faster and
thicker. Ophthalmologists agree that
reading by flashlight under the covers at night will not ruin your eyes,
and eating turkey will not make you
sleepy any faster than other, similarly fatty or heavy foods. Forbidding the use of cell phones in hospitals may be conducive to patients
recovery, but to date there is no
proof that radiation emitted by the
phones makes medical equipment
malfunction. In tests, interference
has been noted only in rare instances when mobile phones and medical
electronic devices were in very extremely close proximity.

Honey relieves coughs in children,

according to a randomized study in
which 105 children with upper respiratory infections were given honey, a cough suppressant, or no medication at night before going to bed.
The children who received honey
fared the best not only in terms of
frequency and severity of coughing
but also with regard to quality of
sleep (both their own and their parents).

It has long been known that regular

exercise has positive effects on
health, but now a study conducted
at Kings College in London has
shown that physically active people
also seem to be biologically younger
than their nonathletic age peers.
Scientists used leukocyte telomere
lengths to determine the biological
age of more than 2,400 subjects
ranging in age from 18 to 81. Telomeres are the terminal sections of
DNA that protect chromosomes
from destruction. Over the course of
a lifetime, telomeres become shorter,
leaving the chromosomes more susceptible to damage and disease. Scientists found that older but more
active subjects had the same telo
mere lengths as younger people who
were inactive. It seems, therefore,
that lack of physical exercise accelerates the aging process.
An active lifestyle that includes adequate exercise is both good medicine and a cost-effective anti-aging
strategy. Science has now provided
couch potatoes with one more bit of
motivation to become active.

BMJ 2007;335:1288-1289

Arch Pediatr Adolesc Med


Mozart as medicine
Not only is Mozarts music beautiful, it also has its uses in the ICU. In
one study, 10 patients on artificial
respiration listened to slow movements from Mozarts piano sonatas
through earphones for one hour on
the first day after surgery, with astonishing effects. In comparison to
the control group, the patients who
received Mozart therapy experienced decreases in heart rate and
blood pressure and required significantly less sedation.
Crit Care Med

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

Arch Intern Med


) What Else Is New?

New scientific findings show that

regular physical exercise slows down

the aging process.

Contrary to popular belief,

women do not talk more than men.

However, there are significant

variations within each gender.

Taciturn or talkative?

Fear increases
sensory acuity

Plush bacilli and

huggable microbes

Gender has no bearing on how

much a person talks, according to a
study conducted by Texas scientists
who recorded snippets of students
conversations. They found that in
the course of a day, men talk just as
much as women roughly 16,000
words, on average, although there
were significant variations within
each gender. Taciturn men and
women alike got by on approximately 8,000 words per day, while
chatterboxes of either sex let loose
24,000 words during the same time

Being afraid heightens your sense of

smell. That was the admittedly oversimplified conclusion of an American study that investigated the connection between olfactory acuity
and emotional stress in 12 young
adults. Subjects were asked to identify the non-matching substance in a
series of three chemicals that smelled
very similar. Results improved significantly during the second round
of smell testing, when the participants were exposed to stress in the
form of mild electric shocks. The investigators interpreted this mechanism as a survival strategy that helps
humans sort out dangerous messages from an overabundance of
sensory stimuli.

Theres nothing new under the sun:

Stuffed animals are now available in
the shape of viruses, microbes, and
other germs. The selection of 15
cm-long GIANTmicrobes, as the
American manufacturer calls its cuddly bacilli, includes Helicobacter
pylori, the syphilis germ, and the
AIDS virus (complete with its own
red AIDS ribbon) to name just a
few. Prices for these monster microbes begin at $7.95 US (7 euros).
The real items are usually free, but
theyre harder to get rid of than
stuffed animals.

New Scientist 2007;195(2612);18

Science 2008;319(5871):1842-1845


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intended to replace competent medical advice and practice. IAH or anyone connected to, or participating in this publication does not accept nor will it be liable
for any medical or legal responsibility for the reliance upon or the misinterpretation or misuse of the scientific, informational and educational content of the
articles in this journal.
The purpose of the Journal of Biomedical Therapy is to share worldwide scientific information about successful protocols from orthodox and complementary practitioners. The intent of the scientific information contained in this journal is not to dispense recipes but to provide practitioners with practice information for a better
understanding of the possibilities and limits of complementary and integrative therapies.
Some of the products referred to in articles may not be available in all countries in which the journal is made available, with the formulation described in any article or
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and in a manner that is permitted in his or her respective jurisdiction based on the applicable regulatory environment. We encourage our readers to share
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Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

) Specialized Applications

Biopuncture Protocols for the Treatment

of Chronic Inflammatory Disorders

By Jan Kersschot, MD


spasms and Coenzyme compositum

for tissue repair (damage on the cellular level). Zeel and hyaluronic acid
are used for chronic joint pain in the
elderly and for degenerative joint
disease (cartilage damage). Many
doctors combine several ampoules
in a single injection to achieve better
results (see Table 1).
Local anesthetics can be added as
modulators of neural information
and to make the injections less painful. Biopuncturists use low concentrations of local anesthetics such as
0.5 percent procaine or 0.25 percent
lidocaine.7 Hypertonic dextrose can
also be added to stimulate healing
of injured connective tissues such as
capsules, fascia, ligaments, and periosteum.

Biopuncture is the injection of biotherapeutics into indication or tissue-related zones or points on the
body, as determined through clinical
and functional diagnosis.1 The therapeutic agents may be administered
subcutaneously or injected into
joints, muscles, or ligaments.2 Administering the medications in the
right spots or in the relevant body
zone enhances the clinical effect. Increasing numbers of physicians are
realizing that such injections can expand the scope of their practice.3
Biopuncturists use both antihomotoxic medications and hyaluronic
acid.4,5,6 Lymphomyosot is used for
lymphatic drainage and matrix detoxification and Traumeel is used to
regulate the inflammatory response.
Spascupreel is injected for muscular

) 10

Frequency and location

of injections
Biotherapeutic agents are administered once weekly by injection into
zones or points related to the indication or affected tissue. In selecting
injection sites, we opt for either local injections (e.g., in the pain zone)
or distant injections (e.g., in trigger
points) and select one of four tissue
types for injection:
1. subcutaneous,
2. intramuscular,
3. soft tissues (e.g., a bursa or
around a tendon),
4. a ligament, enthesis, or

Different steps of
local injections

For subcutaneous injections

Lymphomyosot + Traumeel

For soft tissue injections (e.g., tendon)

Lymphomyosot + Traumeel

For intramuscular injections


Lymphomyosot + Traumeel

For intramuscular injections (spasms)

Lymphomyosot + Spascupreel

For ligament injections

Traumeel + dextrose

For chronic inflammation (cellular)

Traumeel + Coenzyme compositum

For chronic inflammation (joint degeneration)

Traumeel + Zeel

Table 1: Examples of standard combinations commonly used by biopuncturists

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

When dealing with chronic inflammatory disorders, a step-by-step

procedure enhances clinical results.1
We begin, for example, with local
administration of a lymphatic drainage agent to cleanse the local matrix.
For this purpose, we use local subcutaneous injections with Lymphomyosot (phase 1 product). Traumeel is
then used for local immunomodula-

Zeel is used to treat chronic joint pain

in elderly patients and for degenerative

joint disease with cartilage damage.

Phase 1 product:


Phase 2 product:


Phase 3 products:

Spascupreel or a Homaccord ampoule

Phase 4 products:

Coenzyme compositum or other compositum or Zeel

Table 2: Phase products used in biopuncture

Step 1:

Once weekly for two weeks: Subcutaneous or soft-tissue injections of

Lymphomyosot and Traumeel in the pain zone

Step 2:

Once weekly for two weeks: Intramuscular injection of Traumeel

(or Lymphomyosot + Spascupreel) into myofascial pain points or trigger
points. Alternatively, injection of Traumeel and dextrose into ligaments

Step 3:

Once weekly for two weeks: Deeper injections of Traumeel + Coenzyme

compositum into the above-mentioned points

phase 1 and phase 2 products, a

mixture of Lymphomyosot and
Traumeel is administered once
weekly for two weeks. These medications are usually injected either
subcutaneously or into the soft tissues surrounding the site of chronic
inflammation. In step 2, Traumeel
(or Lymphomyosot and Spascupreel)
can then be injected into the myofascial pain points or myofascial
trigger points. When painful spots
are found in ligaments, Traumeel
and dextrose are injected into
these spots. In step 3, a mixture of
Traumeel and Coenzyme compositum or Zeel and Coenzyme compositum is used.

Table 3: Example of a standard step-by-step biopuncture treatment for chronic

Clinical applications of
biopuncture in treating chronic
inflammatory disorders

tion (phase 2 product). At a later

stage, we can inject more specific,
symptom-related medications such
as Spascupreel or a Homaccord ampoule if available (phase 3 products).
Finally, we work on a deeper (cellular) level with injections of medications such as Coenzyme compositum, Zeel, or Discus compositum
(phase 4 products). (See table 2).

In cases of chronic inflammatory

disorders, we usually administer six
weekly injections and then give the
body six weeks to respond and
achieve bioregulation and complete
healing. If necessary, the whole process (another series of 6 injections)
may be repeated.

inflammatory disorders

The step-by-step strategy is not set

in stone but can be adapted to each
patients specific situation. Beginning with Lymphomyosot is especially important for hyper-responders (sensitive patients). The three
steps and six weekly sessions shown
in Table 3 are a typical example of
step-by-step biopuncture treatment
of chronic inflammatory disorders.
In the first step, which combines

) 11
Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

) Specialized Applications


Chronic shoulder pain

Chronic knee pain

Chronic Achilles tendinosis

Here are three examples of chronic

disorders: in the shoulder, in the
knee, and in the Achilles tendon.

sion: subcutaneously in the shoulder

pain zone, into muscles or near tendons, and/or into ligaments.

generative joint disease) may be injected into the above-mentioned


Chronic shoulder pain

Chronic knee pain

Chronic Achilles tendinosis

We begin by injecting Traumeel and

Lymphomyosot subcutaneously into
the pain zone (step 1). If the biceps
tendon is tender upon clinical examination, we also administer another injection near the tendon. This
treatment is repeated one week later.
In the third and fourth sessions (step
2), Lymphomyosot and Traumeel
(or Spascupreel) may be injected
into several different muscles (e.g.,
pectoral, trapezius, infraspinatus: see
Figure 1, deltoid) and/or Traumeel
and dextrose may be injected into
the shoulder ligaments (e.g., AC ligament, coraco-clavicular ligament)
or into the joint capsule. In the fifth
and sixth sessions (step 3), injections
of Coenzyme compositum (or Zeel,
in the case of degeneration of the
shoulder joint) may be administered
on several different levels per ses-

We usually begin with two sessions

of subcutaneous injections of
Traumeel and Lymphomyosot in the
pain zone (step 1). If the patellar
tendon is tender, the same combination is also injected near the tendon.
In the third and fourth sessions (step
2), Lymphomyosot plus Traumeel or
Spascupreel may be injected i.m.
(e.g., into the quadriceps) and/or
Traumeel and dextrose may be injected into the collateral ligaments
or the pes anserinus (see Figure 2).
In the fifth and sixth sessions (step
3), Coenzyme compositum (or Zeel
in elderly patients or in cases of de-

Step 1 consists of two sessions of

injections of Traumeel plus Lymphomyosot administered s.c. and
around the tendon (Figure 3). In the
third and fourth sessions, Traumeel
may be injected into soft tissue closer to the tendon while Lymphomyosot plus Traumeel (or Spascupreel) is
injected into the calf muscle (step 2).
In the fifth and sixth sessions, Coenzyme compositum may be injected
near the tendon and into the calf
muscle (step 3).|

1. Kersschot J. Biopuncture A New Clinical
Guide. Aartselaar, Belgium: Inspiration Publishing; in press.
2. Kersschot J. Biopuncture and the Management of Sports Injuries. Albuquerque, NM:
Jaysea Press; 2008.
3. Barkauskas D. Biopuncture in Family Practice. Paper presented at: HSA Congress 2008;
June 8, 2008; Drakensberg Mountains, South
4. Smit A, OByrne A, Van Brandt B, Bianchi
I, Kstermann K. Introduction to Bioregulatory
Medicine. Stuttgart, Germany: Thieme Publishers; in press.

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

5. Kersschot J. Biopuncture in General Practice.

Aartselaar, Belgium: Inspiration Publishing;
2004: 56-57.
6. Arnold W, Fullerton DS, Holder S, May CS.
Viscosupplementation: managed care issues
for osteoarthritis of the knee. J Manag Care
Pharm 2007;13(4)(suppl):3-19.
7. Iwama H, Akama Y. The superiority of waterdiluted 0.25% to neat 1% lidocaine for triggerpoint injections in myofascial pain syndrome:
a prospective, randomized, double-blinded
trial. Anesth Analg 2000;91(2):408-409.

) Re f r e s h Yo u r H o m o t ox i c o l o g y

Movement and the Matrix

The Importance of Biomechanical

Signals in Matrix Remodeling

By Alta A. Smit, MD

To stay healthy, the extracellular matrix (ECM) must

renew itself constantly. The anabolic/catabolic cycle of
tissues is one of the bodys homeostatic mechanisms that
follow a biorhythm. All such processes involve close
orchestration among different systems, namely the
immune system, hormonal system, and local mediators.
Various triggers for remodeling have been postulated,
ranging from denatured tissue to mechanical forces.1

he role of the connective tissue

as a body-wide signaling network has been recognized by the
ancient cultures and has been recently revisited by authors such as
Langevin.2 She also makes the connection between the connective tissue planes and the meridians, thereby offering an explanation of
phenomena observed in daily practice when working with acupuncture points.3
The role of mechanical forces on the
ECM is also becoming clearer, although the exact mechanism of action is still not completely known.
In the past two decades, research has
determined that many cells are sensitive to mechanical forces and can
change their phenotype as well as
the structure of the surrounding
connective tissue. Of even greater
interest, cells that share a common
ECM may alter their mechanical en-

vironment by inducing other cells to

remodel the ECM, as happens in
lung tissue where fibrosis is the outcome, even if there is no inflammation in the environment.4
According to Langevin and others, a
number of possibilities emerge when
looking for possible signals sensitive
to mechanical forces:

tricity.5 This is the working mechanism postulated to explain the recent

discovery that rotational field quantum magnetic resonance (RFQMR)
can be used to regenerate cartilage
in osteoarthritis of the knee joint.6
The major stimulus for bone and
cartilage formation is a piezoelectric
signal generated when the bone or
cartilage is subjected to tension or
compression. This knowledge is
widely used today in orthopedics,
where it is known that bone atrophies, as during space travel or when
immobilized or not used. In these
cases, therefore, movement is encouraged to support better healing,
and ultrasound or other devices may
be used to simulate the piezoelectric
signal. Transmission of this piezoelectric signal is also impaired following joint injury and trauma or in
diseases such as osteoarthritis.7
2. Cellular signals

1. Electrical signals
Szent-Gyrgyi used the term bioenergetics to refer to energy not
confined in biomolecules but emitted or absorbed directly by tissue.
As early as 1941, Szent-Gyrgyi
proposed that electrons can propagate through crystalline structures
both within and between molecules,
forming semiconducting currents
entirely separate from the movement
of ions, previously assumed to be
the only possible basis for bioelec-

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

Connective tissue fibroblasts have

been shown to become active after
mechanical stretching,8 and sports
medicine has documented the effect
of stretching on healing tendons
and other structures.9,10 Even ionic
membrane pumps and cytoplasmic
enzyme reactions have been shown
to respond to mechanical stimuli.
Recent evidence suggests that
stretching may even attenuate inflammatory signals in osteoarthritis


) Re f r e s h Yo u r H o m o t ox i c o l o g y

Microscopic view of

the extracellular matrix

Data suggest that constant application of cyclic tensile strain (CTS)

blocks IL-1-induced proinflammatory genes at the transcriptional
level. The signals generated by CTS
are sustained after its removal, with
their persistence dependent on the
length of CTS exposure. Furthermore, the sustained effects of mechanical signals are also reflected in
their ability to induce aggrecan synthesis. These effects were seen on
transcription factors of inflammatory mediators on chondrocyte stretch
in vivo. These findings, extrapolated
to human chondrocytes, may provide the insight needed to achieve
optimal sustained effects of physical
therapies in the management of arthritic joints.11
3. Plasticity signals

) 14

Structural change of an organism is

closely related to the cells ability to
modulate its pericellular environment, whether in the normal process
of growth, in maintaining homeostasis, or as part of a disease process.
This response of connective tissue to
mechanical stress is well-known.
According to Langevin, it takes
place over days or weeks following
a change in posture or a new activity. It follows remodeling of the ECM
with changes in the collagen matrix
as well as viscoelasticity. Matrix remodeling is an example of a catabolic/anabolic cycle: Proteolytic

enzymes stimulated by tissue damage or inflammatory mediators are

counteracted by antiproteases activated by substances such as TGF-.12
To date, these effects had been noted only in specialized connective
tissue. The possibility that they will
also be found in loose connective
tissue suggests an overall plasticity
reflecting an individuals overall
movement patterns and would also
explain the effect of local inflammatory foci on the entire body, known
empirically to practitioners of biological medicine. Oschman also examines this phenomenon in an article reviewing the role of free
electrons and their antioxidant activity.13
In conclusion, movement of the matrix plays an important role in its
remodeling and regeneration. We
would do well to include stretching
or even aerobic exercise as part of
our patients treatment.14 The need
is especially great in cases of tissue
damage that require remodeling, as
in fractures, osteoporosis, and even
tendon injury.
Supportive bioregulation
As mentioned above, matrix remodeling is a complex process relying
on multiple factors: the immune system for controlled inflammation and
repair, the action of amino acid-dependent proteases and metalloproteinases, normal cortisol diurnal

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

rhythm, and normal angiogenic balance. The three pillars of antihomotoxic therapy (detoxification and
drainage, immunomodulation, and
organ regulation) are essential to ensure matrix health.
It can be postulated that many environmental toxins carry electrical or
chemical charges that may disrupt
subtle piezoelectric signals and affect transcription of mediators, thus
affecting plasticity. The example of
the zebra fish tail, which regenerates completely after being severed,
shows that adult zebra fish have the
capacity to regenerate the caudal fin,
a process that is inhibited by exposure to the ubiquitous environmental contaminant 2,3,7,8-tetrachloro
dibenzo-p-dioxin (TCDD). Fin
regeneration is a complex process requiring precise regulation of several
processes including wound healing,
ECM production, revascularization,
innervation, and bone formation.
TCDD, a persistent organic pesticide, directly inhibits this process.15
The practice of advanced supportive
detoxification with subsequent
drainage is thus recommended for
matrix health. Antihomotoxic medicine combined with proper nutrition
can support this process. Medications such as Thyreoidea compositum and Pulsatilla compositum are
especially suitable for supporting
the matrix biorhythm. Immune
modulation that down-regulates inflammatory mediators and secretion

Photo by Wbensmith; licensed under the Creative Commons

Attribution 3.0 Unported (

of TGF- (part of the working

mechanism of Traumeel) is also of
benefit. These interventions support
matrix remodeling and form the
backbone of treatment of many
chronic diseases. Together with adequate movement and nutrition and
restoration of sleep/wake cycles,
they may ensure normal matrix plasticity and restore anabolic/catabolic

) Re f r e s h Yo u r H o m o t ox i c o l o g y

1. Abraham LC, Dice JF, Lee K, Kaplan DL.
Phagocytosis and remodeling of collagen
matrices. Exp Cell Res 2007;313(5):10451055.
2. Langevin HM. Connective tissue: a bodywide signaling network? Med Hypotheses
3. Langevin HM, Yandow JA. Relationship of
acupuncture points and meridians to connective tissue planes. Anat Rec 2002;269(6):257265.
4. Swartz MA, Tschumperlin DJ, Kamm RD,
Drazen JM. Mechanical stress is communicated between different cell types to elicit
matrix remodeling. Proc Natl Acad Sci U S A
5. Szent-Gyrgyi A. The study of energy-levels
in biochemistry. Nature 1941;148:157-159.
6. Vasishta VG; Kumar RV; Pinto LJ. Rotational
field quantum magnetic resonance (RFQMR)
in treatment of osteoarthritis of the knee
joint. Ind J Aerospace Med 2004;48(2):1-7.

7. Gierse H, Breul R, Faensen M, Markoll R.

Pulsed Signal Therapy (PST) stimulates mitosis of human chondrocytes in culture. In:
Proceedings of the Tenth International Conference
on Biomedical Engineering. Singapore: Humanitas Press, 2000:473-474.
8. Langevin HM, Cornbrooks CJ, Taatjes DJ. Fibroblasts form a body-wide cellular network.
Histochem Cell Biol 2004;122(1):7-15.
9. Zeichen J, van Griensven M, Bosch U. The
proliferative response of isolated human tendon fibroblasts to cyclic biaxial mechanical
strain. Am J Sports Med 2000;28(6):888-892.
10. Timmons JA, Jansson E, Fischer H, et al.
Modulation of extracellular matrix genes reflects the magnitude of physiological adaptation to aerobic exercise training in humans.
BMC Biol 2005;3:19.
11. Madhavan S, Anghelina M, Rath-Deschner
B, et al. Biomechanical signals exert sustained attenuation of proinflammatory gene
induction in articular chondrocytes. Osteoarthritis Cartilage 2006;14(10):1023-1032.
12. Holmbeck K, Szabova L. Aspects of extracellular matrix remodeling in development
and disease. Birth Defects Res C Embryo Today
13. Oschman JL. Perspective: Assume a spherical cow: The role of free or mobile electrons in bodywork, energetic and movement
therapies. J Bodywork Movement Ther 2008;
14. Carmeli E, Moas M, Lennon S, Powers SK.
High intensity exercise increases expression of
matrix metalloproteinases in fast skeletal muscle fibres. Exp Physiol 2005;90(4):613-619.
15. Andreasen EA, Mathew LK, Tanguay
RL. Regenerative growth is impacted by
TCDD: gene expression analysis reveals
extracellular matrix modulation. Toxicol Sci

Structure of the extracellular matrix

) 15

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

) Around the Globe

Evidence-Based Homeopathy

More Than Results of Double-Blind Studies!

63rd Congress of the Liga Medicorum Homeopathica Internationalis

By Peter Rae Smith, MD

From May 20-24, 2008, some 800 delegates met in

Ostend, Belgium, to participate in the 63rd conference
of the Liga Medicorum Homeopathica Internationalis

Opening ceremony

(LMHI). The overall theme of this years conference was

Liga president Dr. Ulrich Fischer

gave the opening remarks, followed
by a moving tribute by David Owen
to the many great British homeopaths and administrators who died
in a plane crash in 1972 on the way
to the last LMHI conference held in
Belgium. Jacques Imberechts inaugurated a commemorative plaque to
George Jahr, the great Belgian homeopath and student of Hahnemann. Ton Nicolai, President of the
European Committee of Homeopathy, then awarded the Globular
Politics Award to Michel Van Wassenhoven, the Chairperson for the
63rd congress. This is given to physicians who, in addition to their
day-to-day work as a homeopathic
doctor, have been instrumental in
the social-political area and apply
the homeopathic principles in all
areas of their lives.

Evidence-based homeopathy more than results of

double-blind studies.

he lovely seaside resort of Ost

end is tailor-made for such
gatherings. The Kursaal conference
center, where the lectures were held,
is located right on the beach, midway along the broad promenade
that stretches for several kilometers
in either direction an ideal site for
walking, jogging, cycling, or rollerblading. The conference also coincided with a four-day gathering of
sailing ships from all over Europe.
A long tradition
Belgium has a long homeopathic
tradition and has hosted no less than
five LMHI (Liga) conferences in
the past. The 2008 event, organized
to celebrate the 20th anniversary of

Queen Paola of Belgium and her

physician, Dr. Maurice Jenaer


sessions at the end of each day provided a useful overview of the progress of the conference.

(to her left), surrounded by participants

at the Liga congress.

the Unio Homoeopathica Belgica

(the Belgian professional organization for medical homeopathy), was
truly international in content and attendance. The conference aimed to
give an overview of effective homeopathic methodologies and strategies that have stood the test of
time. Well-known specialists (including university professors) gave
presentations on provings, clinical
cases, clinical studies, and pharmaco-epidemiological studies. There
were always five or six different concurrent sessions to choose from,
forcing the delegates to make some
difficult choices. Feedback reporting

) Around the Globe

This years Liga congress took place

at the Kursaal conference center
in Ostend, Belgium.

Some highlights of
the conference
Among the many highlights of this
conference, here are a few of special
interest: The first plenary session, on
the Politics, History and Economics of Homeopathy, included Ton
Nicolais talk on the current status
of complementary and alternative
medicine (CAM) in the European
healthcare system and Christian
Boirons Homeopathy is a language.
In another plenary session on Research from proving to doubleblind, Prof. Claudia Witt presented
an important paper on the treatment
of atopic eczema in children. Dr.
Witt is the first person to hold the
Chair for Research in Complementary/Alternative Medicine, recently
endowed by the Karl and Veronica
Carstens Foundation, at the Charit
University Medical Center in Berlin.

To the surprise and delight of the

participants, Queen Paola of Belgium paid an unannounced visit to
the conference, sitting in the audience and listening intently to an interesting presentation by her homeopathic physician, Dr. Maurice
Jenaer, on microimmunotherapy. A
report of her visit aired on local
television that evening. What a wonderful show of support for homeopathy!
A variety of intriguing workshops
dealt with different clinical methods
such as the Masi method, Sankarans
Bombay method, the Vithoulkas
method, etc., while others looked at
actual provings of a broad range of
new (and old) substances. Jan Scholten led a number of sessions on his
work with the Lanthanide remedies.
The provings of this series of 15
rare earth elements appear to show
affinity for the immune system.

Dr. Ulrike Keims satellite symposium, Is there a synergy between

classical homeopathy and homeopathic combination preparations?
was well attended. Dr. Keim, known
to BT readers as a specialist on metabolic syndrome (see BT issue
1/2008), skillfully interwove the
principles of classical homeopathy,
such as miasmatic theory, with the
practical applications of antihomotoxic combination medicines.
Dr. Robbert van Haselen, Head of
Research at Biologische Heilmittel
Heel GmbH, Baden-Baden, gave an
interesting talk entitled Detoxification and drainage historical perspectives and the current scientific
state of the art, which was well received by the audience.
Although the Liga is predominantly
a classical homeopathic organization, presentations dealing with homotoxicology were well received by
the delegates. The next congress will
be held in Warsaw, Poland, in September 2009.|

Dr. Michel Van Wassenhoven,

chairman of the 63rd Liga congress,

received the Globular Politics Award.

Dr. Ulrike Keim gave a satellite

symposium on the synergy

between classical homeopathy

and homotoxicology.

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2


) M a r k e t i n g Yo u r P r a c t i c e

Getting Organized

Professional file management and

returning phone calls
By Marc Deschler
Marketing specialist

In this issue, well deal with two topics: how to use

professional file management to aid in efficient decisionmaking in your practice and how to deal with constant,
annoying phone interruptions during office hours.

Learn to manage files

At some point, all of us have made
very quick decisions about questions
with significant financial impact,
such as buying a car or hiring staff.
On the other hand, we often put off
making much less important decisions for days or even weeks, and
the stack of unanswered mail keeps
on growing. What things do you
leave lying around to deal with later
a whole newspaper with a single
interesting article in it? A letter from
a patient that you want to discuss
with your team?
These steps will help you get the
problem under control:

2008 Blend Images

1. Confront your procrastination

consciously and note what types
of things you tend to leave for
2. Set a time to tackle your entire
to do pile and dont stop until
you have made all necessary decisions.

Do not allow yourself to be interrupted

) 18

by patient phone calls during an

appointment. Patients deserve your

undivided attention, whether in person

or on the phone.
Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

) M a r k e t i n g Yo u r P r a c t i c e

A professional filing system will help you

in your daily decision-making process.

3. On each piece of mail, note what

action it requires: Do you need
to make an appointment, place
an order, discuss it in a team
meeting, file it for future reference?
4. Starting right now, make all such
decisions immediately.

ing the information will take enough

time to allow you to think about
your indecision. If you then go
through the file at regular intervals,
youll find that most of these materials can simply be thrown out.

Organized decision-making requires

an appropriate filing system. Establish folders for interesting topics
you want to be sure not to forget,
such as:
items for your next team meeting
(for example, discuss this column!)
tax tips to bring up at your next
meeting with your tax advisor
patients complaints that you
need to address
Set deadlines for dealing with the
contents of these folders so nothing
gets forgotten.
Of course there are some decisions
that cannot be made on the spot.
For example, you receive information about some very interesting
new electroacupuncture technology,
but theres no place for it in your investment plan at the moment. Make
a habit of saving such materials in a
file cabinet that is located as far from
your desk as possible and that only
you use, so simply filing or retriev-

Many practitioners accept calls from

patients even during office visits.
This practice has at least three distinct disadvantages:

Ill call you back!

1. You may need to interrupt the

patient youre with in the middle
of a very personal conversation.
2. The patient youre with may
overhear confidential information about the patient on the
3. Your work flow is disrupted.
As a general rule, do not allow yourself to be interrupted by patient
phone calls during office hours. This
is especially important during appointments because an interrupted
conversation is much less satisfying
to the patient than even a brief consultation in which he or she can
count on your undivided attention.
Furthermore, privacy of information
is very high on most patients priority list, so it should be preserved at
all costs.

The solution? Institute an efficient

system for returning calls. Your office staff notes all incoming calls and
pulls those patients charts so they
are immediately available when you
have fifteen minutes free to return
calls. If you dont have to search for
missing information, youll spend
less of your precious time on the
phone. Another plus: You get to decide whom you talk to, what you
talk about, and when.
Here are some general rules:
To avoid scheduling conflicts,
make a habit of returning calls at
certain set times. Note these
times in your daily calendar.
Make sure your employees tell
patients when your call-back
time is so they will be available
when you call.
Your office staff should make a
list that includes each callers
name and phone number and the
time and subject of the call.
If no one is available to answer
the phone during office hours,
record an appropriate message
on your answering machine.
If you follow these guidelines,
you will always be able to give
each patient the attention they deserve, whether in person or on the
phone. |

) 19

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

) Ne w Perspectives

Sulfur in Health and Disease

A Hypothesis on Sulfur Intoxication

By Edgar Estrada Serrato, MD

Orthopedist Traumatologist
Biological Medicine

Since antiquity, sulfur has been used as a homeopathic

medicine in various conditions. Its use has been empirical
in nature, it being given in accordance with its various
homeopathic effects when administered to sick patients.
Advances in the study of basic sciences now enable us to
understand many of these empirical applications, giving
them new-found scientific validity. Sulfur plays an active
role in numerous metabolic processes in the healthy
human body.


ulfur is a non-metal, lemon yellow in color, with atomic number 16 in the periodic table of the
chemical elements. Its symbol is S
and it is situated next to phosphorus
(P, atomic number 15) to its left and
chlorine (Cl, atomic number 17) to
its right. The element immediately
above it is oxygen (O, atomic number 8) and the element immediately
below it is selenium (Se, atomic
number 34).
It is characterized by high electronegativity and consequently gains
electrons more easily than it loses
them. Its oxides are acidic and tend
to form anions and oxyanions in
aqueous solution. Solutions in water
are acidic (pKa1 = 7.00).
The essential amino acid methionine, which is apolar and hydrophobic, contains a sulfur atom in its side
chain. It is converted to homo-

cysteine and combines with the

nonessential hydrophilic amino acid
serine to form cysteine, a special
nonessential amino acid. The side
chain of cysteine contains a sulfhydryl (-SH) group, also known as a
thiol group, which can undergo oxidation to form a covalent disulfide
bond (-S-S-) with a second cysteine
from the same or a different polypeptide chain.
The disulfide bonds form in the lumen of the rough endoplasmic reticulum (RER) of the cell in which
oxidizing conditions predominate,
unlike in the cytosol where the prevailing reducing conditions maintain cysteine residues in the reduced
state (-SH). Disulfide bonds (S-S)
are essentially found only in secretory proteins and in the exoplasmic
domains of membrane proteins. The
RER is also the site of synthesis of

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

proteins that subsequently go on to

form part of various cell membrane
The efficient formation of disulfide
bonds in the lumen of the RER depends on the enzyme protein disulfide isomerase (PDI). This enzyme
catalyzes the formation of disulfide
bonds, which catalyze the protein
folding of many proteins. In this
process, PDI catalyzes the cleavage
of some disulfide bonds and the formation of others, which implies an
interchange between pairs of disulfide bonds in the polypeptide chain.
PDI is found in all eukaryotic cells,
particularly in organs such as the
liver and pancreas.
Glutathione and the enzyme glutathione reductase are other enzymes
involved in the formation of the appropriate disulfide bonds in many
proteins and polypeptide hormones.
Similarly, they have been shown to
be involved in the metabolism of xenobiotics. Thus the disulfide bonds
of cysteine contribute to the formation of the three-dimensional structure of the various protein chains.
The sulfate present in urine thus
comes entirely from oxidation of Lcysteine.
The following list shows where sulfur is found in bodily metabolism:
in the structure of the amino
acids methionine, cysteine,
homocysteine, and taurine
in the structure of proteins

) Ne w Perspectives

Sulfur, in its native form,

is a yellow crystalline substance.

in various roles in the immune

system (immunoglobulins,
in adhesion molecules
(cellular = CAM and
intercellular = ICAM)
in membrane receptors,
such as insulin
in leukotrienes, such as LTD4
and LTE4
in the structure of growth
hormone, calcitonin, dehydro
epiandrosterone, insulin, prolac
tin, somatomedin, somatostatin,
synthesis of T3 and T4
in the peptides activin, inhibins,
atrial natriuretic peptide, brain
natriuretic peptide, C peptide,
relaxin, arginine-vasopressin,
epidermal growth factor, nerve
growth factor, platelet-derived
growth factor, erythropoietin
leptin, cholecystokinin
in the structure of collagen
fibers, desmosine, elastin,
fibrillin, fibronectin, integrin,
laminin, osteonectin, keratin
in the structure of articular
cartilage and glycosaminoglycans, chondroitin 4-sulfate
and 6-sulfate, keratan sulfate I
and II, heparin, heparan sulfate,
dermatan sulfate
constituent of the structure of
the vascular wall, endothelins
in the coagulation cascade,
structure of fibrinogen
as a catalyst in the respiratory
chain of the citric acid cycle

in cellular apoptosis (caspase

S-adenosylmethionine, synthesis
of epinephrine, creatinine,
hepatic metabolism of cytochromes and action on xeno
in gastric fluid and pancreatic
vitamins, such as thiamine,
Shigella toxin, diphtheria toxin,
in the pharmaceutical and food
industry and in agriculture
The sources of the sulfur entering
the body are diverse, and the absorption occurs via a number of carriers, including food and the environment. Indirectly, we ingest sulfur
in the form of toxic by-products of
fuels derived from coal and petroleum, which on combustion produce
sulfur dioxide. Direct ingestion of
sulfur occurs primarily in our daily
diet with the consumption of foods
rich in the sulfites used in the food
industry as preservatives and coloring agents to improve shelf life and
color fixation, or with the ingestion
of refined sugar, which is found in a
high percentage of the food and
drink that we consume each day, or
with foods contaminated with pesticides.
The principles of Rudolf Arndt and
Hugo Schulz, which demonstrate
the linear pharmacological relation
between dose and effect, give rise to
Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

the basic biological rule which states

that the physiological action of a
cell increases or decreases in relation
to the intensity of the stimulus:
Weak stimuli stimulate the life functions, moderately strong stimuli accelerate them, strong stimuli act as
inhibitors, and the strongest stimuli
suspend the life functions.
The high consumption of sulfur entering the body is probably transformed into an intense stimulus that
displaces the equilibrium of the matrix and the membrane receptors, a
phenomenon leading to modifications in the network of information
received and transported through
the matrix in the intranuclear, intracytoplasmic, and extracellular spaces.
A cascade effect then ensues that
leads to a change in biochemical,
immunological, and hormonal responses. This also destabilizes the
three-dimensional structure of proteins, which, as we have already
seen, need the presence of the disulfide bonds to maintain their stereochemical presentation and recognition at the cell membrane.
Similarly, changes are produced in
the assembly of collagen and elastin
fibers. Destabilization of the proteoand aminoglycans that form the hydrated fibrous framework for the
extracellular matrix results in competition between the H+ ions of the
weak acid of H2O and the hydrogen
ions of the strong acids SO42- of sulfuric acid H2SO4 and HPO42- of


) Ne w Perspectives
phosphoric acid H3PO4. Proteoglycans and aminoglycans are substances that readily undergo electrolytic
exchange. Their alteration destroys
their capacity to retain water in the
cartilage and extracellular matrix,
changing their state of fluidity to a
state of desiccation or gel formation;
the end result of this alteration is a
loss of the ability of the body to exchange information between different compartments, leading to loss of
the state of systemic equilibrium.
These alterations predispose the patient to chronic conditions such as
diabetes, rheumatic disease, osteoporosis, and arthritis.
What happens in this information
exchange? We do not know exactly,
but can postulate one of the following:
A change in body pH alters the
behavior of the disulfide bonds,
making them more rigid, the result being that the protein chain
loses its capacity to adjust to the
membrane receptor.
An increase in these bonds causes
changes in the three-dimensional
structure of the protein chain.
A loss of the capacity to form
disulfide bonds causes the protein chains to break.
A loss of cohesive strength of the
disulfide bonds makes them
cleave easily.
We do not know exactly how this
destructive process occurs, but we
are familiar with the catastrophic effect of sulfur consumption on the
body. Within a few years, research
will surely reveal to us in detail how
the destructive effect of excessive intake of sulfur on bodily metabolism

Contrast this with the pharmacological viewpoint and therapeutic

indication of allopathic medicine, in
which the damage caused by an excess of sulfur is treated with sulfurbased drugs that the patient takes in
high doses, causing a high degree of
intoxication and consequent worsening of the disease. Although there
may be a relative improvement due
to an initial mechanism, what is seen
long-term is a worsening of symptoms and a chronification of the initial disease process, each time necessitating more combinations of
medicines. We can take as an example the profile and timescale of a
chronic condition such as diabetes.
For chronic diabetic illness, treatment is commenced with sulfonyl
ureas, which are briefly effective.
However, in time the body ceases to
respond to these drugs, making it
necessary to add another oral antidiabetic such as metformin or rosiglitazone, with the patient ultimately
becoming dependent on insulin in
order to manage symptoms and
without this curing the disease. We
return then to the patient as a chronic consumer of pharmacological
substances that provide no cure
but continually exacerbate
the disease course and
the permanent sulfur
intoxication. |

) 22

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

1. Cooper GM, Hausman RE. La Clula. 4th ed.
Madrid, Spain: Marbn; 2008.
2. Esteller M. Epigenetics in cancer. N Engl J
Med 2008;358(11):1148-1159.
3. Etezad-Razavi M, Mahmoudi M, Hefazi M,
Balali-Mood M. Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous
complications. Clin Experiment Ophthalmol
4. Fessenden R, Fessenden J. Qumica Orgnica.
2nd ed. Mexico City, Mexico: Grupo Editorial Iberoamericana; 1984.
5. Foye WO. Principios de Qumica farmacutica.
Barcelona, Spain: Revert; 1984.
6. Ganong WF. Fisiologa mdica. 19th ed. Mexico City, Mexico: Manual Moderno; 2004.
7. Goldsby RA, Kindt TJ, Osborne BA, Kuby J.
Inmunologa. 5th ed. McGraw Hill; 2004.
8. Lodish H, Berk A, Matsudaira P, et al. Biologia Celular Y Molecular. 5th ed. Mxico City,
Mexico: Editorial Medica Panamericana;
9. Meyers F, Jawetz E, Goldfien A. Farmacologa
Clnica. 3rd ed. Mexico City, Mexico: Manual
Moderno; 1977.
10. Murray RK, Granner DK, Mayes PA, Rodwell
VW. Bioqumica de Harper. 15th ed. Mexico
City, Mexico: Manual Moderno; 2001.
11. Nussey SS, Whitehead SA. Endocrinology: an
integrated approach. Oxford, UK: BIOS Scientific Publishers Ltd; 2001.
12. Reckeweg H-H. Materia Medica Homoeopathia Antihomotoxica. 4th ed. Baden-Baden,
Germany: Aurelia; 2002.
13. Schmid F, Rimpler M, Wemmer U. Medicina
antihomotxica. Vol. I Principios clinica
prctica. Baden-Baden, Germany: Aurelia;
14. Scientific opinion of the Panel on Food Additives, Flavourings, Processing Aids and
Food Contact Materials (AFC) on a request
from the Commission on the results of the
study by McCann et al. (2007) on the effect of some colours and sodium benzoate
on childrens behaviour. The EFSA Journal
15. Vannier L. Compendio de Materia Mdica Homeoptica. 4th ed. Mxico City, Mexico: Porra, 1998.
16. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition,
Physical Activity, and the Prevention of Cancer:
A Global Perspective. Washington, DC: AICR;

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Select your language.
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4 Click on The IAH abbreviated course.
5 When you have finished the course, click on Examination.
After completing it successfully, you will receive your
certificate by mail.

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) From the Practice

Whiplash Acute Inflammation

Becomes Chronic

By Dennis van Aswegen, DC

Treatment regimen

Whiplash is a term used to describe an injury to the soft

tissues the muscles, ligaments, and nerves of the neck.
Many people fail to relate their symptoms to a car
accident because the symptoms often begin days, months,
or even years after the accident.

his patient, referred to me by a

local family physician, presented with secondary whiplash symptoms presumably due to an automobile accident several years ago. After
the accident, treatment with NSAIDs
and physical therapy adequately relieved the acute pain of the patients
whiplash, but she remained constantly aware of discomfort in her
neck. As time passed, she continued
to take medication for this chronic
pain, but her symptoms gradually
worsened and eventually became


Fifteen years ago, this female patient,

now 48 years old, had been involved
in an auto accident without wearing
her seat belt and suffered whiplash
and minor cuts and bruises as a result. After the accident, she complained of severe headache and nausea and was hospitalized for two
days. She was given a neck brace to
wear for a minimum of 4-6 weeks
and medication to address possible
She was left with chronic symptoms
(pain in her neck, shoulder, and
arms; stiffness; headaches; restless-

ness) that varied in frequency, sometimes appearing daily, sometimes

with symptom-free intervals of up
to a month. Several months ago,
however, the pain became more pronounced and the pain-free intervals
less frequent. Because the pain prevented her from sleeping, she also
suffered from severe fatigue and irritation.
An initial examination revealed:
decreased range of motion in the
cervical spine
swelling and inflammation in the
cervical and surrounding musculature
tenderness and pain around the
cervical facet joints
active myofascial trigger points
cervicogenic headache
Upper cervical evaluation revealed
an upper neck injury that had not
been addressed by previous practitioners. Jacksons Compression Test
and the Valsalva maneuver were
positive. An MRI revealed a small
hernia between C5 and C6, posteriolateral to right. X-rays showed
early-stage degeneration of the facet

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

Treatment required a combination

of chiropractic (to restore normal
joint mobility and range of motion)
and physical therapy (to restore
muscle flexibility and movement). In
addition, several antihomotoxic
medications were administered:
Spascupreel and Zeel were injected twice weekly into trigger points
along the lumbar vertebrae to improve paraspinal muscular spasms
and myofascial trigger points.
Gelsemium-Homaccord and Lymphomyosot were injected twice
weekly into the painful area to relieve cervical pain and inflammation and cervicogenic headache.
Oral Gelsemium-Homaccord was
also prescribed (10-15 drops 3-4
times per day).
The patient initially reported an increase in pain (possibly due to a reaction phase) but then reported
gradual improvement in the pain
and other symptoms from the 2nd to
3rd week. With less pain and irritation, she was able to relax, and her
sleep pattern improved. Upon conclusion of treatment, she felt energetic, was no longer experiencing
mood swings, and reported excellent concentration at work. Her
quality of life has greatly improved,
as has her family life.|

) From the Practice

2008 JupiterImages Corporation

Lumbosacral Pain
By Dennis van Aswegen, DC

Treatment for lower back pain is not a single therapy but

rather an integration of several therapies.

he patient, who suffered from

longstanding back pain and
had consulted numerous specialists,
had decided to endure his condition
with the help of medication for as
long as possible before resorting to
surgical intervention. As a result, he
became a walking illustration of the
well-known statistic: Back pain is
second only to the common cold as
a cause of lost work time and results
in more lost productivity than any
other medical condition. His condition was interfering not only with
his work but also with his general
day-to-day activities and family life
and even forced him to give up most
of his sporting/outdoor interests.
The patient is a 43-year-old male
with a long history of lower back
pain, which began at a very young
age after various childhood mishaps and enthusiastic participation
in contact sports. Treatment with
NSAIDs was initially effective in
combination with physical therapy,
but as the years passed, the pain began to move into his legs, although
it rarely radiated below the knees. As
a result, treatment became less effective, and the symptom-free intervals
between bouts of pain/restricted
movement became shorter. At a later
stage, even slight abnormal biome-

chanical movements triggered painful symptoms. The patient described

the pain as burning, sharp, shooting,
or pins and needles. It intensified
with long periods of activity such
as walking or cycling. Additional
symptoms included pain-related
insomnia and a painful sensation
when bearing down during bowel
On initial physical examination, the
following orthopedic tests were po
sitive, suggesting an L4/5 disc lesion:
decreased range of motion in active flexion/extension and rotation
straight leg raising (especially the
right leg, above 70 degrees)
Bragards test
Valsalva maneuver
X-ray and MRI studies of the lumbar spine revealed:
disc herniation at the levels of L4
and L5 (more pronounced at the
L5 level and on the right, but with
minimal pressure on the thecal sac)
early facet degeneration from L2
to L5, both left and right
active myofascial trigger points in
the lumbar paraspinal and gluteal
flattening of the lumbar lordosis
irritation and inflammation of the
lumbar facet joints

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

Treatment regimen
Treatment required a combination
of chiropractic and physical therapy.
In addition, several antihomotoxic
medications were prescribed:
Spascupreel was injected twice
weekly into trigger points along
the lumbar vertebrae.
A mixture of Zeel and Discus compositum was injected twice weekly
into the paravertebral muscles to
relieve chronic inflammation and
degeneration of the facet joints
and intervertebral disc.
Colocynthis-Homaccord (which
could also be mixed with Zeel and
Discus compositum) was injected
twice weekly into sites along
the paraspinal muscles to relieve
symptoms of sciatica and neuralgia.
Traumeel tablets were prescribed
for general inflammation and pain
(1 tablet 3 times per day for six
The patient reported a 60 percent
improvement in both pain and range
of motion after four weeks of treatment and an additional ten percent
improvement after six weeks. He has
been able to resume his day-to-day
activities and looks forward to taking up some of his previous sporting
and outdoor pursuits again in the
near future.|

) 25

) Making of

Suis-Organ Products in
Antihomotoxic Medicine

Part 2: Production and Quality Control

By Wilfried Stock, PhD

Suis-organ preparations, an important component of

antihomotoxic therapy, are administered especially to
patients with chronic diseases to stimulate and reactivate
the homologous human organs or tissues. Homeopathically prepared extracts of more than seventy different
organs are available for specific organ support.

he manufacturing of suis-organ
preparations is strictly regulated to ensure their safety. Before production of the mother tincture begins, the identity of the raw material
of animal origin is first confirmed
by a veterinarian. A number of tests
are then performed, including a histological examination. Additional
tests for zoonoses are conducted in
specialized laboratories to ensure
that the animal tissues contain no
pathogens that infect humans. All of
the test results are documented and
archived and must be available before the animal material is processed

Homeopathic extracts
Production of homeopathic extracts
from freshly slaughtered animals or
their organs follows manufacturing
methods 42a or 42b of the German Homeopathic Pharmacopoeia
(HAB).1 In accordance with the
2007 HAB, one part of the animal
ingredient is diluted with nine parts
of 85 percent glycerol (Method
42a). The initial mixture is allowed
to stand for at least five days, after
which the coarsest particles are fil-

Isoelectric focusing, a technique

for separating different molecules

according to electric charge differences,

is used to confirm the identity of

suis-organ mother tinctures. The

) 26

photograph shows a flatbed system

for horizontal applications with
integrated cooling plate and an
external power supply unit.

Journal of Biomedical Therapy 2008 ) Vol. 2, No. 2

tered out. The resulting filtrate is the

mother tincture used in the production of further dilutions.
Method 42b applies specifically to
the production of injectable medications (as defined in HAB 2007,
Method 11) and eye drops (Method
15). The manufacturing process differs from that described in Method
42b only in that one part of the
finely ground raw material is first
mixed with 2.1 parts of 85 percent
glycerol and succussed; for injection
purposes, the first decimal (D1) dilution is then produced using three
parts of this mother tincture and
seven parts water, while the D2 dilution uses one part D1 and nine
parts water.
In accordance with Method 42a,
potentization stages up to and including D2 always involve a 1:10
mix with either 85 percent glycerol
or 15 percent ethanol; beginning
with D3, the carrier is 15 percent
ethanol. The potentized suis-organ

) Making of

A lab assistant positions a precast

polyacrylamide gel on the cooling


extracts are then further processed

into antihomotoxic medications in
accordance with the relevant manufacturing guideline of the HAB.
Quality assurance
In addition to the above-mentioned
microscopic histological examination of the animal raw material, additional analytical testing of finished
mother tinctures takes place in Heels
quality control lab. In particular, the
identity of the mother tincture is
confirmed through isoelectric focusing, a specialized electrophoresis technique applied in accordance
with the European Pharmacopoeia.2
Isoelectric focusing makes it possible
to identify the various components
of a biological material as shown on
an electropherogram. Comparison
to previous production runs then
ensures the uniformity of the current
batch of mother tincture.
Other physical characteristics (color,
opalescence, relative density) of the
mother tincture are also tested.

Viral and bacterial safety

The special conditions under which
donor animals are raised (see Part 1:
Breeding and Raising the Donor
Pigs, BT 1/2008, pp. 24-25) and
extensive testing of the animal tissues for zoonoses ensures that the
quality of the suis-organ extracts
meets modern standards of safety.
The European Pharmacopoeias
general monograph on homeopathic
preparations requires that animal ingredients be free of viral and bac
terial agents to avoid infecting
patients. An assessment report, re
gularly updated, evaluates the viral
safety of the hog tissue.

Because the animal tissues used in

the manufacture of suis-organ medications are derived exclusively from
hogs, which have no known susceptibility to spongiform encephalopathy (BSE), there is no danger of
transmitting the disease. Thus the
suis-organ preparations manufactured and marketed by Heel meet all
the requirements of the law and the
pharmacopoeia with regard to biological materials of this type.|
1. Homopathisches Arzneibuch 2007. Stuttgart,
Germany: Deutscher Apotheker Verlag,
2. European Pharmacopoeia. 6th ed. Strasbourg,
France: Council of Europe, 2007.

Electropherogram of splen suis mother

tincture. Proteins appear as distinct,

sharp zones. The resulting pattern is

unique to a given substance, thus

permitting unambiguous identification.

) 27

Hans-Heinrich Reckeweg
Award 2009
Join in get your experience rewarded
Outstanding scientific research deserves to be acknowledged, and rapid international distribution
of the results provides a useful service to both researchers and potential consumers. In the field of
homotoxicology, Biologische Heilmittel Heel GmbH offers such support in the form of the annual
Hans-Heinrich Reckeweg award.

The main award

valued at 10,000, will be given for completed scientific work of fundamental theoretical and/
or practical significance in antihomotoxic medicine in the related fields of human and veterinary
medicine (no research involving animal testing).

The incentive award

valued at 5,000, will be given for results arising from clinical, case based or fundamental research
in antihomotoxic medicine in the related fields of human and veterinary medicine that invite further
investigation (no research involving animal testing). The prize monies are intended to be invested in
ongoing research into the particular research subject.
The prize will be awarded for results arising from research carried out in a registered practice or
in a laboratory. In either case the results have to be new, not published before and convincing.
Homotoxicology is one of medicines great success stories. Originally conceived as a model to explain
the outstanding efficacy of a distinct class of homeopathic medications, homotoxicology has grown
into a comprehensive theory of disease.
The deadline for submissions is May 31. An independent panel of reviewers will allocate the awards.
The review panel maintains the right to allocate either of the awards to any of the entries. The review
panels decision is final.

Interested parties are welcome to ask for entry details and conditions:
Biologische Heilmittel Heel GmbH, Department of Research,76532 Baden-Baden, Germany
Phone +49 7221 501-227, Fax +49 7221 501-660,,