Medication I Edema I Palliative care

The treatment of edema depends on its cause and manifestation in the organism and takes into account the patient’s complaints. Weakness, hypotension and fatigue are often reported by patients undergoing diuretic medication. We can understand how edema occurs when a person’s soul and spirit detach themselves from the life organization and physical body. Anasarca refers to the formation of edema in the subcutis and is usually an expression of a patient’s weakened life organization. More rarely, the person’s astral organization can lead to congestion processes with generalized edema formation.

In view of this, multimodal treatment of edema will support the reintegration of the patient’s soul and spirit and strengthen their weakened life organization.

Peripheral edema and anasarca

Decongestant, congestion-relieving external applications

  • For local application, such as to treat leg edemas:
    Compresses with borage essential oil (available as Borago Essence 20% WALA, WELEDA) , dissolve 6 ml in 300 ml water, wrap the compress from the back of the foot to the calf or groin (1)
    For instructions, see: http://www.pflege-vademecum.de/boragoessenzwickel.php
    Skin Tone Lotion WELEDA (also available as Hauttonikum WELEDA) 1–2 x daily Rhythmical Einreibung treatment of the arm or leg
  • For edemas in different areas, especially in tired patients, possibly with reduced consciousness:
    Citrus compresses , lemon compresses on the torso, lower legs, forearms—alternating with cool compresses (2)
    Borage has a toning effect on the life organization, citrus activates the sensory organization.
  • Edema therapy and prophylaxis:
    Skin Tone Lotion WELEDA (also available as Venadoron Leg Toner, Venadoron® Gel WELEDA), daily
  • Lymphedema:
    Compresses with borage essential oil (available as Borago Essence 20% WALA, WELEDA) , dissolve in 1 liter water (1)
    Borago comp. amp. WALA, 1 amp. s.c. daily
    Quark compresses, 1–2 x daily
    For instructions, see: http://www.pflege-vademecum.de/quarkauflage.php

Diuretic therapy

Treatment with diuretics leads to increased fluid excretion, as well as often to exhaustion, fatigue and hypotension. These complaints are all caused by weak intervention of the soul and spirit of the patient, which are insufficiently effective in the organism. If this leads to activity that is oriented towards the neurosensory system, then a tendency to thrombosis develops. Accordingly, diuretic therapy needs an accompanying treatment that takes the patient’s complaints into account and addresses the underlying, limited connection and effectiveness of the soul and spirit.

  • For exhaustion and fatigue:
    Levico D1 Dil. WELEDA, 20 drops 3 x/d
  • For exhaustion, tiredness and depressive moods:
    Levico comp. amp. WALA, 1 amp. s.c. in the morning
  • For hypotension and orthostatic dysregulation:
    Veratrum album ethanol. Decoctum D3, D4 WELEDA, 20 drops 3 x/d
    Skorodit Kreislauf Inject amp. WALA (for the circulatory system), s.c. up to 1 x/d
    Onopordon comp. B drops WELEDA (also available as Cardiodoron® Dil. WELEDA), 20 drops 3 x/d
  • For leg edema and ulcus cruris:
    Kalium aceticum comp. D6 amp. WELEDA
    Calendula D3 amp. WALA
    Iris germanica Rh D3 WELEDA
    Cinis Capsella comp. ointment (also available as Cinis Capsellae comp. hydrogel), apply locally

Cerebral edema

Corticosteroid therapy is often required for cerebral edemas caused by metastasis or brain tumors. This treatment is adapted as needed in the further course of the clinical symptoms and reduced if possible.
▪ Dexamethasone 4 (8) mg tabl., 1 tabl. 3 x/d

  • The structuring effect of arnica and incense is used:
    Arnika planta tota D3–D6 Dil. WELEDA, 20 drops 3 x/d
    Frankincense/Boswellic acid
  • During and after radiation, the following can bring symptomatic improvement of edema and edema-related symptoms:
    Solum Inject 10 ml amp. WALA, i.v.
  • Structuring forces for the fluid organism can be stimulated with:
    Stannum met. praep. D8 amp. WELEDA
  • For changes in consciousness and cognitive impairment:
    Stibium metallicum praep. D6 amp. WELEDA, 1 ml s.c. or 10 ml i.v.

Helleborus intensifies the formative activity of the astral organization in the nervous system. It counteracts the formation of edema and promotes processes of consciousness (3, p. 446 ff). Helleborus can be very helpful in patients with symptoms after radiation therapy for cerebral metastases or brain tumors. Alternating administration of Viscum and Helleborus has also proven its worth on several occasions (3, p. 446 ff). The potency level can be adapted to the patient’s individual response, especially with regard to consciousness.

  • Helleborus niger aquos. D4 D6, D12 amp. HELIXOR, 1 amp. s.c. in the morning
  • Helleborus niger e planta tota D4, D6, D12 amp. WALA, 1 amp. s.c. in the morning

In cases of cerebral metastasis, we must support the structural strength of the nerve organization (4, p. 612615). We address up-building and shaping forces in the nervous system with potentized Argentum, while potentized Plumbum can support the functions of alertness and consciousness:

  • Plumbum metallicum praep. D20 amp., trit. WELEDA, 1 amp. s.c./i.v. or 1 saltsp. in the morning
  • Argentum metallicum praep. D20 amp., trit. WELEDA, 1 amp. s.c./i.v. or 1 saltsp. in the evening

Symptomatology determines both the choice of medicinal product and the potency level: thus, a pale and emaciated patient will need silver, while someone with a strong constitution (which may be noticeable by a pronounced urge to eat and an appetite that can hardly be stopped) requires lead therapy—e.g., for brain tumors, also independent of corticosteroid medication. Mistletoe therapy needs to be adapted to treat brain edema: high doses may lead to an increase in edema, although discussion of the therapeutic significance of “inflammatory” edema is needed. It goes without saying that we must take into account the amount of space metastases occupies, as well as critical locations, when determining mistletoe dosing.

  • An important medication in cerebral metastasis and brain tumors is:
    Apis mellifica D30 WALA (ex animale) WELEDA, 1 amp. s.c. or p.o. 1–2 x/d
  • In cases of “changes in character” as a result of cerebral metastasis, the following can be of great help:
    Olibanum comp. dil. WELEDA, 20 drops 3 x/d
    Olibanum comp. amp. WELEDA, 1 amp. s.c./i.v. up to several times daily
    Aurum comp. amp. WALA, 1 amp. s.c./i.v. up to several times daily
  • To support formative forces in the area of consciousness:
    Stibium metallicum praep. D6, 10 ml amp. WELEDA, 1 amp. i.v. in the morning
  • In case of accompanying unrest:
    Bryophyllum D5/Conchae D7, 10 ml amp. WELEDA, up to several times daily
  • In the case of impaired cognitive function (thinking ability, concentration, memory) after radiation therapy of the cerebrum, it has proven useful to give:
    Helleborus niger D4 amp. HELIXOR, 1 amp. s.c. in the morning if needed, together with
    Arnica Betula comp. amp. WELEDA, s.c. up to 1 x daily in the morning
    Juglans regia comp. amp. WALA, s.c. up to 1 x daily in the morning
  • In case of perifocal edema—also in the acute phase of whole-brain radiation—consideration may be given to:
    Apis ex animale D12, D20 amp. WALA, WELEDA, 1 ml s.c. daily in the morning and if needed in the evening or
    Bryonia/Stannum amp. WALA, 1 ml s.c. daily in the morning and if needed in the evening
    Solum uliginosum comp. 10 ml amp. WALA, i.v. in the morning and if needed in the evening
    Solum uliginosum comp. 1 ml amp WALA, s.c. in the morning and if needed in the evening
  • During radiation there have been positive experiences with:
    Apis regina comp. amp. WALA, 1 ml s.c. up to 1 x daily in the morning
    Apis regina comp. pill. WALA, 10 pill. 3 x/d
    Solum Inject 10 ml amp. WALA, 1 amp. i.v. 1 x/d

In the chronic phase , less attention should be paid to inflammatory effects than to sclerosing effects. There have been positive experiences treating with Helleborus niger D3-D4, together with Arnica/Betula comp. (see above) (5).

Pulmonary edema and pleural effusion

  • Malignant pleural effusion:
    Pleurodesis
    Talc pleurodesis
    Mistletoe pleurodesis (4, p. 575–576) (6)
    Induction therapy with AbnobaVISCUM Fraxini ((40–)80–160 mg), after draining the effusion fluid. Disconnect the drainage for 4 hours. The aim is a 24-hour effusion of less than 100 ml and the lung adjacent for more than 48 hours (thoracic uptake). Otherwise, repeat the induction usually every other day, increasing the dose (4, p. 575–576) (6).
  • For pain after pleurodesis:
    Bryonia/Aconit amp. WALA, s.c. as needed
    Bryonia Stannum amp WALA, s.c. as needed
    Pleura D 15 amp. WALA, s.c. as needed
  • For persistent coughing:
    Lavender oil thorax compresses
    For instructions, see: http://www.pflege-vademecum.de/lavendeloel-brustauflage.php
  • For cardiac pulmonary edema:
    Cardiac insufficiency therapy
    Carbo Betulae D8 /Crataegus D2 amp. WELEDA, 1 amp. s.c. in the morning
    Oleum Strophanti caps. WELEDA, 1–2 caps. 3 x/d
    Cardiodoron® 1% amp. WELEDA, 1 amp. in the morning
    Aurum/Cardiodoron comp. Dill WELEDA (also available as Cardiodoron®/Aurum comp. WELEDA), 20 drops 3 x/d

Pericardial effusion

  • A pericardial ablation (Perikardese) with Viscum album is effective according to existing experience and leads to lasting success (4, p. 577):
    abnobaVISCUM Fraxini amp. ABNOBA

After draining the effusion, give 40 mg with the catheter still in place and instill intrapericardially with NaCl via the tube system. The system is then disconnected for 4 to 6 hours. After opening, if the effusion is less than 100 ml, disconnect the device for a further 24 hours and check echocardiographically. In case of effusion production that is more than 100 ml, give 60–80 mg and disconnect as described. An echocardiographic check is required (4, p. 577) (6). Corresponding experience exists with other mistletoe preparations, which can be used alternatively, for example, as with intensive pre-treatment with abnobaVISCUM Fraxini (4, p. 577) (6).

Ascites

Ascites can develop as a result of portal hypertension, an expression of the congestive and fibrosis-inducing activity of the subtle members of the human being dominated by the neurosensory system. Heart failure can also lead to congestion-related ascites. Impaired protein synthesis in case of a weakened life organization causes ascites due to decreased oncotic pressure. Other common causes are inflammatory and tumor-associated ascites (peritoneal carcinosis).

  • Diuretics:
    Reduction of sodium chloride intake to less than 2 g/d
    Diuretics (spironolactone, furosemide)
  • For exhaustion and fatigue:
    Levico D1 Dil WELEDA, 20 drops 3 x/d
  • For exhaustion, tiredness and depressive moods:
    Levico comp. amp. WALA, 1 ml s.c. daily in the morning
  • For hypotension and orthostatic dyregulatuion:
    Veratrum album ethanol. Decoctum D3, D4 Dil. WELEDA, 20 drops 3x/d
    Skorodit Kreislauf Inject amp. WALA, 1 ml s.c. up to 1x/d
    Onopordon comp. B drops WELEDA (also available as Cardiodoron® Dil. WELEDA), 20 drops 3x/d
  • For freezing patients or cool kidney deposits:
    Ginger kidney compresses
    For instructions, see: http://www.pflege-vademecum.de/ingwer-nierenkataplasma.php

In case of refractory ascites, we may consider α1 and α2 antagonists (vasoconstriction in splanchnic tissue) and repeated paracenteses, possibly a transjugular intrahepatic portosystemic shunt (TIPS). In malignant ascites, diuretics are only partially effective. A drainage catheter is often necessary.

Malignant ascites

  • There have been positive experiences with mistletoe instillation for malignant ascites:
    Helixor M amp. HELIXOR, 100–200 mg
    Intraperitoneal instillation in 20 ml NaCl 0.9%. Repeat the instillation, depending on tolerability, in doses increasing by 200 mg each (max. 1000 mg), as needed for renewed formation of ascites (4, p. 577) (6).
  • Nausea und full feeling (4, p. 1070–1071):
    Nux vomica comp. amp. WELEDA, s.c. as required
    Nux vomica is used for nausea with cramp-like (and meteoric) complaints. Bitter substances strengthen gastrointestinal motility.
  • For meteoric and spasmodic complaints associated with nausea:
    Nux vomica / Nicotiana comp. amp. WALA
  • Meteoric complaints:
    Carraway oil compresses
    Oleum aethereum Melissae indicum WELEDA, as needed
    Melissa oil WALA, as needed

External applications are of great importance in multimodal therapy: www.pflege-vademecum.de/

Regarding ascites in oncology see also: https://www.anthromedics.org/PRA-0765-DE

1 Kusserow M. Äussere Anwendungen in der anthroposophisch erweiterten Medizin. Weleda Korrespondenzblätter für Ärzte 1992;11:122–153.

2 Medical Section of the School of Spiritual Science at the Goetheanum. Heilmittelangaben Rudolf Steiners. Citrus medica.

3 Association of Anthroposophic Physicians in Germany, Medical Section at the Goetheanum (ed.). Vademecum anthroposophischer Arzneimittel, vol. 1. 4th ed., supplement of Der Merkurstab; 2017. English translation: Vademecum of anthroposophic medicines. 3rd English ed. with CD. Munich: Association of Anthroposophic Physicians in Germany; 2017.

4 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.

5 Debus M. Anwendungsmöglichkeiten von Helleborus niger in der Onkologie. Der Merkurstab 2010;63(6):551–557.

6 Association of Anthroposophic Physicians in Germany, Medical Section at the Goetheanum (ed.). Vademecum anthroposophischer Arzneimittel, vol. 2. 4th ed., supplement of Der Merkurstab; 2017.