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By: Manfred Weckenmann, M.D.
The following concise presentation will be comprehensible only to those familiar with the basis of an anthroposophically extended medicine. Nevertheless we will try to use only such concepts as can be understood from the text itself.

Cardiodoron consists of an extract of Primula off. flos 2,5 g, Onopordon acanth. flos 2,5 g and Hyoscyamus niger herba D 2 10,0 g/100 g. According to general experience (Weckenmann 1981) and systematic testing it is indicated in the case of vasolability and orthostatic hypotension. Figures 1-3 illustrate this by means of pulse, pulse-respiration quotient (Q P/R) and orthostasis quotient. For a better understanding of these parameters we will explain them for orthostatic lability: in terms of pulse reaction a tachycardic and a bradycardic form can be recognized. This may serve as a first indication that the patho­logical orthostatic phenomenon is not accompanied by a uniform vegetative tone. On the contrary an increase in vagotonia even to the point of asympathicotonia as well as an in­crease in sympathicotonia can accompany orthostatic insufficiency (Bradbury et al 1925, Reindell et al 1955, Parr 1957, Thulesius 1976, Osten 1977). This is supported by the fact that periods of orthostatic lability are found to occur in a diurnal rhythm, the times of maximum lability occurring at about 3 a. m. and from 12 a. m. to 2 p. m. respectively (Ash­koff et al 1966). At night a narrowing of blood pressure amplitude is predominant, during daytime tachycardia. The former indicates predominating vagotonia, the latter predomi­nating sympathicotonia. (Blood levels of noradrenalin do not correlate with the severity of the pathological orthostatic phenomenon but do correlate with pulse frequency, from Vendsalve 1960 according to Thulesius 1976).

It may at first glance seem surprising that a sympathico-ergotropic reaction could be unfavorable for orthostasis. This will, however, be understood if we take trophotropia and ergotropia to be opposite extremes of a polar organization in the sense in which Ru­dolf Steiner develops these in his first medical course (1920). This polarity is the basis for specific physiological functions on the one hand but on the other hand it provides a natural disposition to illness, if the extremes are not kept in balance. Those processes and organic structures which mediate between the two sides and maintain an equilibrium bet­ween them are in this sense the source of health (Weckenmann 1980 a). We will call them the "middle organization".

The pathological orthostatic phenomenon can be induced from polar extremes — re­sulting in a bradycardic and a tachycardic type. Both types of orthostatic reaction have in common, that the mediating functions are not sufficiently effective.

According to Steiner the respective rates of pulse and respiration to each other as ex­pressed in the pulse-respiration quotient (Q P/R) indicate the polar organization and how it can be harmonized by the rhythmical central organization represented in the heart and the lung. Steiner indicates that the healthy relation of heartbeat and respiration centers around a quotient of four heartbeats to one respiratory cycle of breathing in and out (Q P/R = 4/1 = 4). If heartbeat slows down or respiration increases out of proportion the Q P/R will become smaller — if pulse-rate increases or respiration slows down Q P/R will increase.

Hildebrandt (1960, 1976, 1977) demonstrates that a low Q P/R at rest indicates trophotropism and that an increased Q P/R indicates ergotropism. We understand tropho­tropism to be a preponderation of the biological functions of growth, regeneration and anabolism that predominate naturally during infancy and childhood but also during sleep at night — and we understand ergotropism to be the preponderation of those functions that are the basis of reactions to external stimuli observed in their fullest sense only during periods of waking which are periods of predominating metabolic katabolism.

From a study of the phenomenon of orthostatic collapse — taking it to be a tachycar­dic form of orthostatic lability — Steiner demonstrates that an increase in Q P/R indicates the strong katabolic effect of the nervous system on metabolism and conversely that a dec­rease of Q P/R indicates a weak effect due to a "loosened" connection between the two. (See Bibliographical Index no. 348).

The tachycardic form of orthostatic lability is determined by a hyperactivity from the side of the nervous system, associated with fear while cerebral circulation diminishes, in a sense "not healing" the overactive nervous functions. After such a collapse, the patient is usually temporarily unconscious and the relation of pulse and respiration is reversed —Q P/R falling below 4 just as in case of bradycardic orthostatic lability from the very beginning.

In bradycardic orthostatic lability the opposite of the above is true. The nervous sy­stem is not overstimulated and forced into a state of high activity but it is dulled and, figuratively speaking, sinks into metabolism, being absorbed by it and thereby not leaving for­ces for conscious awareness. It is a state similar to that which is passed through during embryonic growth and to a lesser extent during infancy and in the sleeping phases of life. In such a situation or rather at times when Q P/R tends. in this direction orthostatic can not react sufficiently to the stimulus of the altered and upright position. Some patients show this kind of orthostatic reaction — it is related to the bradycardic form that may occur physiological at night and corresponds to the vagovasal syncope.

Cardiodoron seems to be effective in both types of disturbances, if actual orthostatic lability is present (Weckenmann 1981 a). It is not yet clear whether or not it is also effecti­ve in the case of trophotropic and ergotropic hypertension. Inquiries with colleagues indi­cate that the results are generally better with hypotonic patients than with hypertonic patients.

The purpose of the following study was to determine whether individual case studies would yield fine points that are lost in systematic collections and to find out to what extent individual case studies would agree with the results from more generalized studies.

The patients described here necessarily underwent a certain pre-selection since on the one hand my previous knowledge of them — whether right or wrong — entered in, and on the other hand only certain patients came to me. Hence this group is not a random sam­ple, but speaks for itself. Thus this study is intended to let the reader experience how ob­servations — judgments — decisions — treatments — renewed observations — etc. inter­weave in each unique encounter of patient and doctor. This gives the report a personal style, which I do not wish to avoid. It will be less important for the reader to discover pre­cisely when Cardiodoron is indicated than for him to follow the course presented here, which may help him think over his own way of proceeding in similar situations. Thus the study does not intent to evoke imitation, but to stimulate the reader's own presence of mind for future patient - doctor encounters.

Furthermore, observations of individuals can also lead us to recognize the "type". The type, as it is meant here, need not be identical with a statistical average. It comes to the observer intuitively after evaluation of a particular case.

If individual cases are to be evaluable in this sense, we require above all an accurate description of the symptoms and their modalities, as well as of the observations made during examination (see also Hahnemann). Then in the subsequent consultations one must ask for the symptoms again, check for new ones, and revue the pathological observations. For that purpose in my outpatient records I write down all symptoms and observations under each another in a column, and the days directly next to one another. I use symbols to mark the change in symptoms and findings (Fig. 5).

The patients are asked to speak freely for themselves. For me, questions serve to clarify what has been said or to stimulate further speaking. I ask either quite open questions, not intended to lead, or yes-or-no type questions. As a matter of routine I ask only after appetite, weight, bowel movement and so on. In the following cases the investigations and observations of the course of the disease are unsystematic since they are oriented solely around the therapeutic requirements. I will use diagnostic concepts only for the sake of making myself understood.

Fig. 1
Average pulse rates of orthostatically labile patients standing upright — before and after Cardiodoron. In long term testing (Langzeit-Test) two tests were done before giving Cardiodoron and two tests 40 days and 80 days after therapy with 5 x 20 drops Cardiodoron respectively. Averages were made of the results before and after Cardiodoron.

In short term testing (Kurzzeit-Test) one test was done before giving Cardiodoron and one test an hour after an injection of I ml Cardiodoron 5 % i. m.

It is obvious that the double peak in frequency distribution still remains after therapy. The difference was calculated by the Wilcoxon test.

It can be tested relatively quickly whether a remedy lives up to expectations or not, so long as an effort is made to give single remedies. Single-remedy prescription is much easier to carry out in homeopathic - anthroposophic therapy than in allopathic, since homeo­pathic remedies have a greater sphere of efficacy than allopathic ones. The reason for this is that the therapeutic range of a homeopathic substance includes all the so called side ef­fects — allopathically speaking — as its chief effect. If it takes effect after a number of unsuccessful therapeutic attempts have been made and if it continues to work for an num­ber of months afterwards, then the likelihood of a placebo effect is small.

In order to provide for good conditions, I chose only such patients who had had Car­diodoron alone or with whom Cardiodoron had been added to another therapy of long standing (which was also continued).

Cardiodoron was always administered orally, usually 3 x 20 drops/day.

In the following reports I do not mention all findings, since this is tiring and disturbs clarity. I will however be glad to reply to inquiries.

Fig. 2
The frequency distribution of pulse — respiration quotient (Q P/A) of orthostatically labile patients standing upright before and after Cardiodoron given as described in legend to Fig. 1. The statistical calculations were done according to the T-Test.

Case histories
[1] At the beginning I would like to present a case of misjudgment. A 45-year-old leptosome, blonde woman (Patient no. 1) consulted me. She complained of an inability to walk more than a few hundred meters, and of tiredness. I observed a strong tendency to blush and a tachycardia with intermittent atrial flutter. The respiration was slow and she had a round back and pectus excavatum. The patient spoke hastily and restlessly, and kept squinting as if in pain. The cause of the atrial flutter was a mitral insufficiency stage 2-3, which had brought about atrial dilation and subendocardial damage. The patient had already been treated with Digitoxin and Verapamil; she refused an operation and as­ked me if I could do anything else to help her. Since there appeared to me to be an ergotro­pic hypocirculation, hyperventilation and instable weakness, and since the behavior of the atrium also seemed to fit this picture, I gave Cardiodoron — without success.

This example teaches us that though Cardiodoron affects functional disorders, it will do so only so long as they are 'on the way' to becoming organic deformations, but not when they stem from an already existing organic deformation. The atrium itself was not primarily pathological, and reacted quite normally to the organically caused congestion — namely with fluttering. If I wanted to stop this without improving mitral insufficiency, I would have to suppress the normal reaction of the atrium, i. e. to poison it permanently, and this lies outside the scope of regulatory therapy.

[2] A second observation led to similar results: a 43-year-old woman (Pat. no. 2) had had a mammary cyst operation and also had had kidney stones and gall-bladder colics. For 4.5 years she had observed palpitations for up to 2-3 hours (150-160 P min. -1) with substernal pressure and anxiety, aggravated by rest, excitement, window cleaning and was­hing. She reported sweating in the morning and nausea on rising, especially during change of weather. She had a tendency to gain weight, was constipated, suffered from hemmorroids, sweated at the least exertion, slept badly and ground her teeth. She pushed herself and was over-punctual. She was very carefully dressed, smoked 20 cigarettes and drank 2-3 cups of coffee a day.

This medium weight woman had taut subcutaneous tissue: at first she tended to be pale, later had a redness of the face; she was brunette and had a tendency towards eczema. The extremeties were cold. In the stress test there was a rising of the blood pressure with­out any marked rise in pulse rate, while at rest the blood pressure fell to 120/80 mm Hg. I was unable to detect tachycardic phases. As I assumed that this was a functional circula­tory disorder in the process of becoming permanent, I did not choose a sulphur therapy or Scleron (cf. Steiner in Degenaar 1939), but rather Aurum D10 and evenings Digitalis D3, which improved matters slightly. Later, however, I dropped this idea and decided in the face of the symptoms that the cause of all was a metabolic sluggishness with insuffi­cient stimulation of blood circulation and nervous weakness, and therefore gave Cardio­doron — a primarily sulfuric agent. Without success. Why? The tendency to react with an elevated blood pressure and a fixed pulse rate, the disposition to adiposity and the prec­limacteric situation ought to have taught me that "enlivening" was not primarily the problem; rather it was as if the "upper organization" was immediately imposing its form on everything else. (Possibly this is a key to an understanding of the climacteric situation.) Thus the stage for a therapy with sulfuric and mercurial substances was already passed: in other words, such a therapy could at best work as temporary "counter measure". Thus the high blood pressure at this stage appears to me typologically as a connecting link between the unstable circulatory weakness in the young adult and the deformation of arterioclerosis in the old. Unpublished studies on orthostatic reactions have shown that with increasing bradycardia and hypertension the orthostatic lability yields in favor of regula­tory rigidity.

Here the question arises how to interpret tachycardic phases in this patient. After all, the pathological tachycardia is not related to an exertion of the organism as a whole but seems to appear autonomously. Phenomena such as atrial fibrillation, ventrical tachycar­dia, and others become more frequent with age. Although in their outer aspect they are mostly high-frequency disturbances, according to present day views they arise out of "re­tardations" of the spread of the action potential, for example, which permits the occurrence of reentry mechanisms. Since in old age many processes, especially of the heart, slow down, the danger of developing autonomous accelerations (secondary tachyarrhythmias) is grea­ter than in youth, when primary tachyarrhythmias are present more often. One might with all due caution compare the secondary tachyarrhythmias in some ways with degeneration in cancer. Cardiodoron appears to me to be a remedy only for primary tachyarrhythmia. To be sure, it must remain open whether this patient had a primary or secondary tachyarrhythmia.

Fig. 3
The frequency distribution of the orthostatic quotient of orthostatically labile patients before and af­ter Cardiodoron in short term testing and long term testing. The orthostatic Quotient (OQ) is a mea­sure for the stability while standing up and is calculated according to the formula

OQ = X Bloodpressure-amplitude standing + 52,5
                         X Pulse-rate standing

(Weckenmann 1981). Values of < I are an indication of orthostatic lability. The differences between the results before and after Cardiodoron were calcula­ted with the T- Test.

[3] A 27-year-old patient came with a similar complaint. This man (Pat. no. 3), how­ever, complained of shooting pains in the left chest, ever since childhood, aggravated by excitement, exertional dyspnea, axillary perspiration, trembling in both arms and numb­ness of the limbs.

This fair-skinned patient was vasomotorically flushed, shrugged his shoulders, pulled up his chest in a strange manner, and had loud, excited heart sounds.

His circulation I evaluated as having a juvenile lability: Q P/R of 8 with tachycardia of 100 P min-' at rest, labile T in the ECG with improvement under stress. On the other hand there were signs of incipient rigidity: blood pressure at rest of 155/90 mm Hg. hyper­tensive reactions under stress (100 Watts for 6 min. sitting) to 210/90 mm Hg, and pulse frequency of only 156 min -1.

I decided on Cardiodoron, giving emphasis to signs of juvenile disturbance. The shooting pains in the chest, exertional dyspnea, tachycardia and Q P/R — elevation improved. When­ever he improved, the patient stopped Cardiodoron, then asked for it again. This indicates that it only helped temporarily and that it is not the basic remedy. In a following consulta­tion I should give more importance to the signs of rigidity.

I will now present four cases of patients with experimentally proven trophotropism. All four are leptosome, thin, pale — but not from anemia — shy and quiet. No excitement was to be seen in them.

[4] A 32-year-old woman (Pat. no. 4) complained of an empty feeling in the head with dizziness, yawning, swelling of the eyelids and hands, and also of pain in the nape of the neck growing worse in the morning, palpitations of the heart especially at night in bed, chills, and hard, infrequent bowel movements. She suffered from severe acne, and had a diffuse goiter, a heavily coated tongue and a pulse rate of 54 min -1 while lying and only 64 standing. The Q P/R was perfectly stable at about 4,0 lying and standing. The blood pressure at rest of about 110/72 climbed to 112/80 mmHg standing. Thus it was necessary to assume a regulatory rigidity with vagotonia, since even healthy people usually show a pulse-respiration-quotient rise of from 4 to 5 standing (Weckenmann 1980 a). Fig. 6 illu­strates the result with Cardiodoron (only the first retesting was not at the same time of her menstrual cycle, the second and third retesting were). Rest and standing pulse-rate rose towards the normal region (72 and 80 — 85 min -1 resp.) The Q P/R responded to Cardiodoron with a decrease at rest but reaction towards normal. The low systolic blood pressure at rest and standing improved a bit and the already normal diastolic blood pressure remai­ned unchanged.

Cardiodoron improved the bradyarrhythmia, the regulatory rigidity and also, to an extent, the systolic blood pressure, although the trophotropic situation at rest, messured in terms of the Q P/R seemed to be more pronounced.

This course of treatment also showed that Cardiodoron is effective for a period of 2.5 months in a situation of trophotropic regulatory rigidity with bradyarrhythmia even when there is no orthostatic lability but there is hypotonia. Furthermore, symptoms clear­ly unrelated to the circulation such as constipation were also influenced in the process.

[5] The second trophotropic patient was a 42-year-old woman (Pat. no. 5) suffering from dizziness, dullness and substernal oppression for about ten years. She also suffered from anxiety, perspiration of the head, tremor and attacks of dyspnea for one year. This leptosome patient had a delicate, pale face which presented a certain contrast to the slight accumulation of fat on her legs. The standing test, particularly the last minutes of it, sho­wed the typical signs of orthostatic lability with a pulse rate of 84 P min -1, ca. 11 breaths per minute, a Q P/R around 8 and BP at 110/85 mm Hg. This time the decision for Car­diodoron was easy. The patient took 30 drops every morning. After 30 days the dizziness and the perspiration of the head were better, and all the other symptoms had disappeared. The blood pressure amplitude had not improved, but the "rhythmic ordering" had: 84 P min -1, 14-15 Resp. min -1 and Q P/R around 5.5 i.e. near normal. It can be seen that the improvement of rhythmic ordering alone can be accompanied by well-being although hypotonia remains the same.

[6] The third trophotropic patient was a 33-year-old man (Pat. no. 6). He complained of shortness of breath, which always set in on the day after any physical activity; he also complained of anxiety with tachycardia before entering a room with unknown people. The patient was thin, prematurely old with a red face, partially gray beard, and had strikingly unshaply thorax and abdomen. The Q P/R lying was 20 (!) and 9,9 standing; bradypnea was extreme, improving under stress. The strong relative bradypnea with tachycardia induced by anxiety prompted me to give Cardiodoron. After 4 months of treatment the complaints had almost completely disappeared, even in situations where the patient — as he said earlier — would have suffered definite difficulties. This result could be maintained for more than a year with a regime of 30 drops of Cardiodoron in the evening.

Frequency distribution in percent of pulse rates of orthostatically labile patients while standing (three random samples).
a) Weckenmann 1975,
b) Patients of the Carl-Unger-Klinik 1966-1975 (unpublished),
c) Weckenmann 1973.

[7] The fourth trophotropic patient was a 34-year-old woman (Pat. no. 7) with a 12 year history of migraine-like pains in the nape of the neck and back of the head with simul­taneous vomiting, which were independent of time of day, weather or menses. For 4 years she had also had a lymphoedema on her right leg, which had appeared without apparent cause. The patient had a tendency to chills and had cold extremities.

The x-rays showed a slight spondylosis in the lower and mid cervical vertebral column with irregular lordosis and leftsided scoliosis. The standing test presented the typical pictu­re of a bradycardic orthostatic lability with an orthostasis quotient of 0,84 and a Q P/R of 6,7 standing.

Given the patient's age, the local finding on the cervical vertebral column seemed too small to be the cause of the headaches; and in connection with the lymphoedema and the bradycardic orthostatic lability, the picture pointed to a primary circulatory weakness. I began with alternating hot and cold showers. As fig. 7 shows, the respiratory rate at rest, which had originally been quite depressed, rose, but always went down again while stand­ing. Thus, though the Q P/R at rest did normalize towards 4, the Q P/R standing remained unchanged. The orthostatic response of the systolic blood pressure became positive. The diastolic blood pressure had been normal from the beginning. After this I decided to give Cardiodoron in addition, 30 drops in the morning. Just before the next standing check she had an acute gastroenteritis, which brought about a striking acceleration of the resting respiratory rate with normalization of the Q P/R but also a strong pathological orthostatic response with a drop in respiratory rate. It was not until the last test that the pulse rate at rest and standing was normal, and the respiratory rate for the first time showed a posi­tive orthostatic response in the form of a slight tendency towards normalization with a strongly positive orthostatic response of the systolic blood pressure. The Q P/R remained uninfluenced. The headaches improved under the therapy, occuring less often and requi­ring only 1 tablet of an Aspirin like analgetic (Thomapyrin) instead of three as before.

Then, instead of Cardiodoron, I prescribed Ferrum/Quarz, 1 capsule mornings, where­upon the headaches became still shorter and milder.

The acute process of the gastroenteritis clearly set off an "ergotropic" stimulus. This, however, did not compensate for trophotropia with a stabilisation in standing. A proper mediating process had not occurred. Though Cardiodoron did not improve the effects of the hydrotherapy in a dramatic fashion, it did bring about a better respiratory regulation.

To the four trophotropic cases I would like to add three with an ergotropic autonomic quality.

[8] A 39-year-old female patient (Pat. no. 8) had been feeling very tired for two years. She felt a need to breathe deeply. This would become worse after 10 a. m. and before changes of weather. In general her condition was worse in summer than in winter. She felt palpita­tions, especially walking uphill and before speaking to other people. She complained of abdominal cramping during bowel-movements and of chills. She had an exited-depressed air.

Examination of the leptosome, well-groomed, suntanned patient revealed no patholo­gical findings. Average values in standing were: 95 P min -1, Q P/R 7 and blood pressure 119/95 mm Hg.

In this case I felt quite sure that Cardiodoron would be efficacious. The patient lost all her symptoms within two months. Later, the reactive depressive problem recurred but without the accompanying circulatory problems. What was noteworthy here was the typi­cal aggravation during summer and warm front phases, which always favor hypotonic circulatory disturbances. Nevertheless Cardiodoron improved the situation during the sum­mer months from June till August, though the patient had no holidays.

[9] The next patient a woman of 30 (Pat. no. 9), had already had a tachycardic ortho­static lability which had reacted to Cardiodoron. Now she came again at the age of 35, this time complaining less of orthostatic symptoms than of inner vibration and the need to breathe deeply. She did not feel the tachycardia very strongly at all. It was striking in this patient's case that several unsuccessful attempts at therapy preceded Cardiodoron, under which there was a rapid improvement. No relapse came until three years later, although the patient took no medicine in the meantime.

[10] The third patient (Pat. no. 10) was 45-years-old when she came to me. She com­plained of migraine with nausea and vomiting, aggravated before menses and from overwork, of upset stomach, flatulence, outbreaks of perspiration, rotary vertigo on standing up, difficulty waking up in the morning, exhaustion and cold hands.

The slim, dark-blond patient spoke in a strikingly clipped and fast manner; her throat and nape muscles were sensitive to pressure and hardened. There was an osteochondrosis C3-6, the standing test gave a pulse rate of 91 min -1 with Q P/R of 6.0 and BP at 115/84 mm Hg. — i.e. an orthostatic lability with an orthostasis quotient 0,82 on the border bet­ween tachycardia and bradycardia. Despite the pathologic-anatomical alterations, this see­med such a typical case for Cardiodoron that I prescribed it.

After two months the perspiration outbreaks had disappeared. The improvement of flatulence symptoms was striking, although the therapy consisted only of a "circulatory remedy". Here we touch on the question of the so called secondary symptoms — say so called, because there really is no such thing. A symptom can be less prominent or troublesome, but it is just as characteristic. The remarkable thing is how such symptoms can also disappear under Cardiodoron if the total picture is correct.

Fig. 5
Sample Outpatient Record.
Symbols: ? can't judge; — unchanged; > improved; | disappeared; <aggravated; —> Year duration of symptoms.

Another example of this was given to me by a woman who came to me at the age of 40 (Pat. no. 11) with a 10-year history of unclassifiable pain in the joints. A treatment with vegetarian diet, Folio Betulae, mustard plasters, abdominal compress, Equisetum D15 / Formica 1310, Betonica D3 / Rosmary D3 brought good improvement.

Then, however, the patient suddenly complained of nausea while swallowing. I found no objective alterations: the symptom was a riddle at first. I tried to find a greater context in which to see it, and discovered traits in the patient that seemed to point to Cardiodoron therapy. Hence I interpreted the throat symptom as local "nervous weakness" with insuf­ficient metabolic supply, and gave Cardiodoron — with prompt success.

This can perhaps show how a mysterious symptom will find its place when the general concept is recognized, how this concept may arise more intuitively than logically or rationally, and how the correctness of a certain procedure can be confirmed through the therapeutic steps. I believe that this is a legitimate procedure, though often an unconscious one. However, it can only be valid for regulatory therapy methods, and needs "exact imagination" in Goethe's sense. Those who think differently may pass this of as a placebo effect.

Discussion of the results
How did my expectations of Cardiodoron fit the patients with successful therapy? "Nervous weakness", i.e. the inability to tolerate nervously charged moments, is what I saw in the excitability, the expectation anxiety, and sometimes also to an extent in the headaches. The tendency towards slow respiration was experienced as dyspnea in the tro­photropic patients (very typical!) and this was felt especially on the day following emotio­nal stress and improved with physical stress (Case no. 6 and case no. 7). Since the respira­tory stimulus is very dependent on the waking CNS (Comroe 1968), one can speak of a "falling asleep" of the respiration, from which trophotropic patients suffer particularly. In most cases the pulse rate showed a relative or absolute elevation with indications of cir­culatory depression while standing. This leads to "sedimentation" — an indication that the circulation is insufficiently vitalized when under difficult circumstances, e. g. on stan­ding and in warm weather (Pat. no. 8). In theses cases we can see a correspondence between expectation, interpretation of the symptoms and action of the therapy. There were also indications of the need to differentiate. The effect of Cardiodoron applies largely to primary functional disturbances and not to secondary ones caused by anatomical defor­mations (Case no. 1). Therefore, prescription of Cardiodoron in advanced age should be carefully considered. However, premature aging in relatively young adults does not seem to be a contra indication (Case no. 6).

It can be seen that hypertension becoming stable and incipient signs of bradycardic rhythmic disturbances with retardation of the spread of the action potential, even when this leads secondarily to tachycardia, cannot be brought to a long-term cure with a sulphur therapy such as Cardiodoron (Case no. 2). On the other hand cases of rigid regulatory pat­terns with hypotonia but without orthostatic lability are clearly still treatable with it. This finding, however, should be subject to further testing (Case no. 4).

The frequency of the leptosome build among our Cardiodoron patients is striking. This is explained by the observation that leptosomes tend more often to heightened pulse­respiration-quotient than do pyknotics. (Weckenmann and Schreiber, publication in pre­paration). If a raised Q P/R ratio proves to be an indication for Cardiodoron, then it would be sensible to associate the leptosome body type with this indication.

Disconnected symptoms which are at first hard to classify can disappear with Cardio­doron if the patient's functional system and constitution speak in favor of a Cardiodoron therapy (Case no. 11).

Relapses years later will respond again to Cardiodoron when the symptoms indicate it (Case no. 9).

Experiments have shown that a single daily dose of Cardiodoron can be efficacious.

The preponderance of the female sex found here, however, does not seem a probable indication to me, since though women also predominate in larger groups of orthostatically labile patients, they are also more often ill than men. Thus the ratio of women to men in our clinic was 1,8/1,0 and that of the surrounding population 1,1/1,0 (Statistisches Lan­desuntersuchungsamt Stuttgart).

Fig. 6
Behavior of average values of pulse and respiratory rate, Q P/R and blood pressure lying
and stan­ding 0 for patient no. (4) before and (after) during Cardiodoron.

Fig. 7
Behavior of the average values of pulse and respiratory rate lying • and standing 0 for patient no. (7) before and during hydrotherapy and Cardiodoron.

Is my concept of Cardiodoron and of the patient for whom it is indicated correct? — It seemed surprising how few patients are necessary to obtain indications when one ob­serves exactly, makes exact documentation and prescribes only a single remedy. In this way guide lines arise for new therapeutic approaches and contra-indications. To be sure, we are dealing more or less with therapeutic attempts; but the mistakes appear early on and can be corrected. This manner of finding indications is not statistical but individual.

Authors address:

7024 Filderstadt-Bonlanden
W. Germany



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