Selecting the potency of Viscum Mali to treat Osteoarthritis
Selecting the potency of Viscum Mali to treat osteoarthritis
Original text: Zur Wahl der Potenzhoehe von Viscum Mali bei Arthrose.
Der Merkurstab 2008, 61: 89– 91. English by A. R. Meuss, FCIL, MTA.
Potencies are given in the English notation, e.g. 6x where the German notation would be D6.
Selecting the potency of Viscum Mali to treat osteoarthritis
Mistletoe preparations not produced at high rotati- on speeds serve the basic treatment of degenerative diseases. The more advanced the chronic or osteo- arthritis the lower should be the potency level. Reactive based on osteoarthritis is pre-treated with higher potencies. Individual adaptation of potency levels according to stage is most effective.
Mistletoe products for the treatment of cancer produced by anthroposophical manufacturers (Abnobaviscum, Iscador, Iscucin, Helixor, Vyso-
rel) are specific to that field, and the manufacturers pro- vide detailed directions for their use. These concern the choice of host tree and also the potency level correspon- ding to the type and stage of the carcinoma, permitting optimum use of the product. According to Rudolf Steiner, the manufacture of mistletoe preparations involves a specific mechanical process.
“Normally” produced products, on the other hand, in- clude Viscum Mali and Viscum Pini by Weleda and WALA. The WALA method is to use an aqueous mother tincture succussed by hand in a rhythm maintained over a period of seven days and fermented.
Essentially Viscum preparations have a broad spec- trum of uses. Among these are general cooling and local weaknesses in the warmth organization, metabolic slug- gishness, premature ageing processes and dissolution of circadian temperature rhythms, degenerative pro- cesses, atrophies and scleroses. All this hypergic organic weaknesses and diseases may promote a tendency to develop cancer at a later time (1).
Viscum is also excellent for treating influenza1 that persists, with weakness in warmth organization. It is also
one of the most important hyypotensives (2, 3) in an- throposophical medicine.
Mistletoe products in homoeopathic form are also part of the classic repertoire in natural medicine, e.g. those by Madaus. Initially Plenosol® was recommended in rising phytotherapeutic concentrations with marked local and systemic side effects (4) From the summer of 2003, Madaus have been offering Plenosol at the single potency level of the 6x, stating that the dosage can be varied (5). The Viscum products of Weleda and WALA, on the other hand, have a broad spectrum of concentrations and potencies, and osteoarthritis, for example, can be treated with these according to the given situation.
In combination with the potentized organ prepara- tion is the basic medicament for osteoarthritis. In prac- tice, correctly dosed mistletoe treatment will often delay the need for an endoprosthesis in the joint for years. This is also of interest to the patient, for the impression is that the first endoprosthesis is often relatively soon fol- lowed by others.
Compared to mistletoe treatment, conventional treatment is merely symptomatic, e.g. with NSAIDs. Ac- cording to a metaanalysis of randomized trials, these are only slightly better than placebo after some weeks of treatment and are therefore at most recommended only for short-term analgesia (6), as there is no real improve- ment in evolution overall.
Mistletoe essentially counteracts degeneration all the more the lower the chosen potency. In practice, one needs to proceed according to the given situation and stage. Incipient osteoarthritis with morning stiffness and coldness in patients who are relatively young, exter- nal application of the ointment at night is sufficient (Vis- cum Mali 5 % Ointment Weleda, or Viscum Mali e planta total 3 % Unguentum WALA), e.g. for a month or two in the cool season of the year.
If several joints are affected and there is a general weakness in warmth organization, one would consider oil dispersion baths with the Werner Junge apparatus and Viscum Mali ex herba W 5 %, Oleum WALA. If one starts treatment in good time, it is possible to reverse the whole process even at this stage. No reference is made in this context to necessary movement therapies such as eurythmy therapy.
3 Der Merkurstab | Roemer | Selecting the potency of Viscum Mali to treat osteoarthritis
1) Oral communication from J. Schuerholz.
2) Personal communi- cation from Markus Sommer.
3) 4 points marking the corners of a rectangle around the patella, plus 3 points along a vertical line passing through the centre of the patella—the centre itself, below this the tuberosity of the tibia and the point which mirrors it around the centre of the patella above in the region
of the quadriceps femoris; 1 point in the back of the knee oppo- site to the patella.
A medium high potency, 12 – 18 x by s.c. injection, is used on the one hand in cases that are not far advanced, and on the other in more advanced cases with the reac- tive inflammatory changes one often sees on examina- tion. The osteoarthritis starts from the head pole of the joint, the cartilage. This splits into fibres, hyalinizes, wears down, and cartilaginous particles mobilized by erosion and microfractures cause painful synovialitis, a futile attempt of the body to heal itself. In this case, one must always treat the reactive inflammatory changes first, using a higher potency, and then go down in poten- cy to treat the actual degeneration. Low potencies given too soon will aggravate the inflammatory reactions.
The more severe the degeneration, the lower should finally be the potency to see a physically evident effect. The decrease in potency should be in stages, as pa-
tients vary in their stimulus thresholds and this is not foreseeable. A general rule of thumb is higher concen- trations are needed and tolerated at more advanced age and a male, robust or sulphuric and hysterical constitu- tion, and that one needs to be more careful in adjusting the dose with allergic patients, physical weakness and a neurasthenic constitution.
One goes down in packs, therefore, e.g. Viscum Mali e plantatota6x,4x,3x,2x,2%,3%,5%WALAuntilone reaches the potency or strength where one gets a local reaction in the form of an erythema. The most effective strength for a patient is one step above the one which just still evokes a local reaction or slight local erythema. Some colleagues who are greatly experienced in guiding mistletoe dosage2 will deliberately accept a passing lim- itation of movement for 2 or 3 days, having first dis- cussed this with the patient, in which case the improve- ment which follows is even more definite.
In contrast to cancer treatment, one does not aim for the marked local reaction or a general febrile reaction seen with even greater concentrations.
The rarely occurring local or general allergic reactions (skin reactions, rigors, dyspnoea, shock) referred to in the information leaflet are as a rule due to starting with low Viscum potencies and not using a gradual, individual ap- proach. The risk does not exist with appropriate use.
Caution is, of course, also required with autoimmune inflammatory joint disease such as pcP or psoriatic arthritis, where mistletoe can cause aggravation during the inflammatory phase. If mistletoe treatment should be required on these indications, WALA offer high poten- cies—Viscum Mali/Pini 40x/60x.
In spite of this, mistletoe is most effective in chronic arthritis if one takes the potency as low as the patient is able to tolerate without side effects. With long-standing arthritis of the large joints with osseous deformation and exostoses this will often mean percentage strengths given by s.c. or i.c. injection. Apart from marked reduc- tion in pain, it may be possible to dissolve pathological exostoses (X-ray evidence) with long-term injection therapy.
The action is enhanced by injecting the mistletoe product i.c. in the pain points around the joint. Good ex-
perience has been gained with Bachmann’s points7 in the case of the knee3.
The lower the chosen potency, the greater the warm- ing, dissolving action of mistletoe right into the physical bone.
The higher the potency, the less does its action pro- mote inflammation and the more systemic or general the effect, also influencing soul and spirit. In this potency range, mistletoe indications include inflexibility of warmth organization, of the psyche and also rigid, com- pulsively neurotic behaviour.
The small finger and foot joints are an exception, e. g. Heberden’s and Bouchard’s nodes. Here medium poten- cies of Viscum Mali (around the 12x) get the best re- sponse. Local application is unpleasant but patients will often accept it because of the good results. In general it only has to be repeated when relatively severe symp- toms recur after 6 – 8 weeks.
The German Anthroposophical Medical Association (GAÄD) has published an Opinion on 14 May 2007 (8, 9, 10) in which mistletoe preparations are referred to as the current standard treatment for chronic arthritides of both large and small joints.
The effect is generally evident in 1 – 4 weeks, some- times following a period of aggravation in the early days. Duration of treatment is months if not years, with inter- vals. It is also recorded that in the small joints, higher po- tencies and longer treatment intervals are adequate.
It must not be forgotten that for reimbursement by insurance companies, mistletoe treatment for chronic arthritis is reimbursed by the GKV insurance company under the heading of “severe pain” (special regulation § 16.4) (8).
Franziska Roemer Hausgaerten 8 D-73087 Bad Boll
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