Medication I Ascites I GIS I Oncology

When ascites puncture is needed in cases of ascites with peritoneal carcinomatosis, it has proven effective to administer a subsequent instillation of a mistletoe preparation into the abdominal cavity (1, 2) (3, p. 602–605) (4, p. 950–953). In the peritoneum, which the “I” and sentient organizations no longer penetrate with sufficient formative activity during the tumorous process, the local effect of mistletoe therapy--which forms, warms and works like immunotherapy--can lead to a reduction in the formation of ascites or even a complete cessation of it.

First infiltrate the puncture site with a local anesthetic, then puncture the ascites with a 14-gauge needle and drain the fluid into a drainage bag as completely as possible. (Two punctures may be required for very large volume ascites.)

After complete emptying, give an intraperitoneal injection of Helixor M via the needle.

1st dose:

  • Inject Helixor A or M 100–200 mg i.p. ad 20 ml diluted with NaCl 0.9%, then rinse again with another 20 ml NaCl 0.9%. 

Following the mistletoe instillation, care must be taken to ensure that the patient moves to improve the distribution of the preparation in the abdominal cavity. For this purpose, it is recommended that the patient rotates three times alternately to the right and left and is temporarily brought into a low head position.

In case of renewed ascites, the puncture is repeated in the same way and the dose of Helixor M is increased in 200 mg increments with each puncture, depending on how well it is tolerated:

Subsequent doses.

  • Inject Helixor A or M 200 mg – 400 mg – 600 mg – 800 mg – 1000 mg i.p. ad 20 ml diluted with NaCl 0.9%, then rinse again with another 20 ml NaCl 0.9%.

The frequency of punctures depends on the speed of the buildup of fluid. Weekly punctures have proven to be successful. There is often a decrease in the frequency of punctures, in some cases the ascites is completely suspended.

Tolerability: These instillations are usually well tolerated. Fever only occurs in isolated cases. Unwanted chambering of the ascites due to fibrin formation was hardly ever observed with the preparations Helixor A or M.

In the presence of allergic diathesis and/or prior therapy with mistletoe preparations, a dose-dependent pseudo-allergic reaction can be triggered.

1 Stange R, Jänsch A, Schrag S, Pflugbeil C, Schlodder D, Pandey-Hoffmann U, Uehleke B. Günstiger Verlauf eines persistierenden malignen Aszites. Forschende Komplementärmedizin 2009;16(1):49–53. [Crossref]

2 Debus M. Intraläsionale Misteltherapie. Der Merkurstab 2009;62(4):304–305.

3 Girke M. Innere Medizin. Grundlagen und therapeutische Konzepte der Anthroposophischen Medizin. 2nd ed. Berlin: Salumed Verlag; 2012. English translation: Girke M. Internal medicine. Foundations and therapeutic concepts of Anthroposophic Medicine. 1st ed. Berlin: Salumed; 2016.

4 Gesellschaft Anthroposophischer Ärzte in Deutschland/GAÄD, Medical Section at the Goetheanum (ed.). Vademecum Anthroposophische Heilmittel. 4th ed. Filderstadt. Vol. 2. Der Merkurstab 2017; Supplement.