Different pharmacologically active substances. synergistic effect. Dipartimento Scientifico Guna S.p.a.

Transcription

1 Bürgi Effect Different pharmacologically active substances mixed together have a potentiating synergistic effect 1

2 TRAUMATOLOGY - GENERAL PART 2

3 Organotrophism and carrier function for homologous human tissues Connective 12/30/200X Bone 12/30/200X Cartilago 12/30/200X GUNA -TRAUMA drops Chamomilla 1X* Hypericum 3X* Arnica 3X** Hamamelis 2X** Bellis 2X*** Calendula 1X**** Symphytum 3X**** Ruta 3X Kalmia 8X Rhus tox. 6X Bryonia 6X Stop to IL1, starter of inflammatory process* The stimulation of the cytokines having Th2-Th3 polarity modulates inflammation** Analgesic action*** PNEI CORE Anti IL 1 4C* TGF-beta 1** IL 10** Beta-Endorphin 6X*** Modulation of all inflammatory process development phases (neurogen*, vasal**, exudative***, restitutio ad integrum****) Tropism remedies, specific for bones, muscles, tendons, ligaments, synovia Activity aimed at all the functional components of ortho-traumatologic pain 3

4 SYMPTOMS CONTROL ACONITUM 6/12/30/200X APIS 6/12/30/200X BELLADONNA 6/12/30/200X FERRUM PHOSP. 6/12/30/200X HEPAR SULF. 6/12/30/200X PYROGENIUM 30/200X BRYONIA 6/12/30/200X PHYTOLACCA 6/12/30/200X CELL NUTRITIONAL SUPPORT Protein synthesis Antioxidative protection GUNA -FLAM drops Classic Homeopathic and and Homotoxicological Remedies Minerals, Vitamins, i, Oligonutrients Trace elements Cytokines,, Hormones,, Homeopathic Neurotransmitters DRAINAGE CONNECTIVE TISSUE 12/30/200X CELL METABOLIC SUPPORT COPPER GLUCONATE 4X NATRUM PYRUVICUM 3X ACIDUM CITRICUM 3X P.N.E.I. REBALANCE ANTI-IL IL 1 4C TGF- β 14C IL104C MELATONINE 6X β-endorphin 6X HYPOPHYSIS 200X 4 PINEAL GLAND 6X Dipartimento Scientifico Guna S.p.a

5 SYMPTOMS CONTROL Modulating local or systemic phlogosis inflammation CELL NUTRITIONAL SUPPORT - TYROSINE 2X - PHENYALANINE 2X - HISTIDINE 2X GUNA -MATRIX drops Classic Homeopathic and Homotoxicological Remedies Minerals, Vitamins, Oligonutrients Trace elements Cytokines,, Hormones,, Homeopathic Neurotransmitters DRAINAGE - PYROGENIUM 12X - FUCUS 3X -THUJA 8X - NATRUM SULFURICUM 8X - CONJUNCTIVA TISSUE 6X -LYMPHATIC VESSELS S 6X - HYALURONIDASE 6X CELL METABOLIC SUPPORT - ASCORBIC ACID 2X - KREBS CYCLE CATALYSTS 6X P.N.E.I. REBALANCE - IL 6 4C -PROLACTINE 6X -DHEA 6X 5

6 GUNA -LYMPHO drops Myosotis Equisetum Hydrocotile Reduction R d i of local l Taraxacum inflammation on Sarsaparilla lymphoepithelial tissues Lymphatic vessel Capillary tisssue Reduction of lymphatic L-Thyroxin spasm on inflammatory Vena basis with consequent restoration of the lymphatic circulation REACTIVATION OF THE LYMPHATIC CIRCULATION Calendula Phytolacca Apis Magnesia phosph. h Humoral immunity stimulation and inhibitory modulation of the excessive cell mediated d compensatory response ANTI-INFLAMMATORY ACTIVITY ON LYMPHOEPITELIAL TISSUES STRENGHTENING OF THE IMMUNE DEFENCE Magnesium phosphoricum Juglans regia HYPERTROPHY AND HYPERPLASY OF LYMPHATIC ORGANS D-L Malic Ac./Fumaricum Ac./Pyruvicum Ac. Trychinoil/Natrium oxalac. Lymphagogue action and stabilization of vasal walls tone with consequent reduction of exudate and lymphoedema Hydrastis Juglans Graphites Hindrance to the proliferative proneness of lymphoepitelial tissues 6

7 TRAUMATOLOGY - MUSCULAR LESIONS 1 EXTERNAL CAUSES = MUSCULAR CONTUSION: THERAPY acute pain, swelling, painful tumefaction, (in case) hematoma - GUNA -MUSCLE AMPOULES + GUNA -NEURAL AMPOULES - GUNA -TRAUMA DROPS - GUNA -MATRIX DROPS - GUNA -FLAM DROPS DROPS: 10 drops 3 times a day, 15 minutes before meal INTERNAL CAUSES = MUSCLE ELONGATION MUSCULAR CONTRACTION - STRETCHING THERAPY - GUNA -MUSCLE AMPOULES + GUNA -NEURAL AMPOULES - GUNA -TRAUMA DROPS - GUNA -LYMPHO DROPS 7

8 TRAUMATOLOGY - TENDINITIS TENDINITIS: edema, heat, tendon stiffness tendinitis tendosynovitis tendoperiostitis etc. THERAPY 80% in Sport Medicine 2 1) CALCANEAN TENDON: - GUNA -HAND/FOOT AMPOULES - GUNA -MATRIX DROPS - GUNA -FLAM DROPS 2) BICIPITAL TENDINITIS: - GUNA -SHOULDER AMP. + GUNA -MUSCLE AMP. - GUNA -FLAM DROPS - GUNA -MATRIX DROPS 3) TENDON PAIN FROM CASTS: 4) PUBIC PAIN: - GUNA -HANDFOOT AMPOULES - GUNA -MATRIX DROPS - GUNA -LYMPHO DROPS - GUNA -HIP AMPOULES - GUNA -FLAM DROPS - GUNA -LYMPHO DROPS - GUNA -MATRIX DROPS 8

9 TRAUMATOLOGY - FRACTURES 3 - OSTEOBIOS TM DROPS - GUNA -ARTHRO DROPS - GUNA -MATRIX DROPS - GUNA -FLAM DROPS + GUNA -.. AMPOULES according to the anatomic localization (e.g. fracture of femor neck: GUNA -HIP, fracture of hand bones: GUNA -HANDFOOT) THERAPY - DISLOCATIONS - GUNA -FLAM DROPS - GUNA -ARTHRO DROPS - GUNA -MATRIX DROPS - GUNA -LYMPHO DROPS - in case of shoulder dislocation: add GUNA -SHOULDER AMPOULES THERAPY 9

10 TRAUMATOLOGY - PERIPHERAL NERVE LESIONS 4 THERAPY COMPRESSION SYNDROMES SPRAIN SYNDROMES (BRACHIAL PLEXUS) POSTOPERATIVE PARESIS - GUNA -NEURAL AMPOULES - GUNA -FLAM DROPS - GUNA -MATRIX DROPS - GUNA -TRAUMA DROPS - SYNDROMES DUE TO HYPEREXTENSION-HYPERFLEXION - GUNA -NECK AMPOULES - GUNA -THORACIC AMPOULES THERAPY - GUNA -LUMBAR AMPOULES 10

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12 FIBROMYALGIA Fibromyalgia is not a new syndrome but a resurrection of the old diagnosis fibrositis Fibromyalgia syndrome is a very common chronic illness whose pathogenesis is reported to be poorly understood Women are more affected than men All races are affected 12

13 FIBROMYALGIA DIAGNOSIS: the patient has to constantly experience the symptoms for more than 3-4 months and have at least 10 Trigger Points into the 18 classical sites + disturbed sleep Commonly associated conditions: irritable bowel syndrome, migraine, phychic depression, obstructive sleep apnoea, general fatigue Several causes have been identified: stress, tension, chill, connective tissue diseases such as 1) osteoarthritis, nerve compression, endocrine imbalance (estrogen deficiency, hypothyroidism) 2) traumas, repetitive strain, overuse 3) physical-mental fatigue, anxiety LAB TESTS AND X-RAY: NEGATIVE FOR SPECIFIC DIAGNOSIS 13

14 THE 18 POINTS TO TEST POSITIVE POINT: needs to be painful to a of 4Kg/cm 2 pressure applied by the examiner s digit POSITIVE POINT: needs to be painful when the applied thumb pressure is sufficient to blanch the nail-bed of the doctor s thumb when he/she presses firmly on the part 14

15 FIBROMYALGIA SYNDROME LOCAL THERAPY GUNA -MUSCLE + GUNA -NEURAL 2 ampoules (4 ml) + 1 ampoule (2 ml) = 6 ml INTO EACH TRIGGER POINT: 0.5 ml TRIGGER POINTS INJECTED PER SESSION: NUMBER OF SESSIONS:

16 FIBROMYALGIA SYNDROME HOME THERAPY Example: GUNA -FLAM DROPS 15 drops 3 times a day 9am 3pm 9pm GUNA -MATRIX DROPS 15 drops 3 times a day 9.30am 3.30pm 9.30pm GUNA -SLEEP DROPS drops a day pm Duration of the therapy: 2 months 16

17 PRACTICAL SOLUTIONS TO YOUR DAILY PRACTICE IN GENTLE & EFFECTIVE PAIN MANAGEMENT THE TOP TEN IN PAIN CONTROL 17

18 SYNERGISM: the remedies boost each other in a synergistic way. The global effect is higher than the single remedy effect BALANCE: in the medicines, remedies are contained in quantities and diluitions to re-balance, without altering, the neuro- immune-endocrine homeostasis COMPLETENESS: the remedies are associated so that every step of the etiopathogenetic cascade and every possible symptomatologic expression the medicine is indicated for is considered 18

19 PAIN MANAGEMENT - LOCAL THERAPY - 19

20 Select application site according to Type of needle acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique.

21 GUNA -NECK Chart of area/zone connections GUNA -SHOULDER GUNA -THORACIC GUNA -HIP GUNA -LUMBAR GUNA -ISCHIAL GUNA -HANDFOOT GUNA -NEURAL Nerve pain GUNA -POLYARTHRITIS Joint pain GUNA -MUSCLE Muscle pain

22 ANATOMICAL STRUCTURE OF AN ACUPOINT 22

23 GUNA -NECK Clinical Indications Neck pain due to cartilage degenerative cervical spine disorders d (cervical osteoarthrosis) th Neck pain due to cervical muscular trigger points Stiff neck syndrome Simple neck pain Whiplash Postural neck ache Mechanical imbalance (facet joint syndrome) Cervical spinal ligament syndrome Cervical spinal nerve root pain Arnold syndrome 23

24 Active ingredients: Cartilago suis 4X HPUS 4 parts; Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Beta-Endorphin 4C, Magnesia phosphorica 8X HPUS, Nux vomica 10X HPUS, Picricum acidum 10X HPUS, Silicea 4X HPUS 2 parts; Crotalus horridus 10X HPUS, Intervertebral disk, Porcine 4X 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 24

25 GUNA -NECK Beta-Endorphin 4C Pain Riduzione symptomatology della sintomatologia reduction by algica means of per UP-REGULATION REGULATION of dei β Endorphin receptors recettori della β Endorfina Stimulation of osteoblasts function and correction of articular structure pathologies P.N.E.I. Homeopathic antalgic core antalgic core Anti- Anti- degenerative inflammatory core 2 core Anti- degenerative core 1 Magnesia phosphorica 12X Picricum ac. 8X Crotalus horridus 10X Nux vomica 10X Reduction of cervical rachis pain symptomatology of different origin: Fibromyalgic origin (Picricum acidum) Spastic and/or congestive origin (Crotalus horr., Nux vomica, Magnesia phosph.) Nevralgic origin (Magnesia phosph.) Anaesthetic origin: Picricum acidum Silicea 4X Anti interleukin 1 alpha 4C Anti interleukin 1 beta 4C Biostimulation cartilage matrix components synthesis (Cartilago) Anti-degenerative action (Discus intervertebralis) Cartilago suis 4X Intervertebral disk, Porcine 4X Modulation of IL1 α and IL1 β pro-inflammatory activity in the trigger phase of inflammation 25

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28 INTERLEUKIN 1 Interleukin 1 (IL-1) is a cytokine secreted by different type of cells of the Immune System (macrophages, monocytes, dendritic cells, fibroblasts and endothelial cells) IL-1 = first discovered IL-1 has various effects on the organism both at general and local level One of these effects is to support inflammatory processes; moreover it stimulates prostaglandins production from different type of cells (muscular, epithelial, etc.), the production of other cytokines (among which IL-2) and the activation and recruitment of other cells of the Immune System: -IL-1α -IL-1 β Those two classes have similar activities but different structures

29 INTERLEUKIN 1 IL 1 IS A PIVOTAL PRO INFLAMMATORY CYTOKINE CENTRALLY INVOLVED IN IMMUNE SYSTEM SYSTEMIC AND LOCAL RESPONSES LEADING TO TYPICAL EFFECTS OF INFLAMMATION DYSREGULATED, PROLONGED SYNTHESIS AND RELEASE OF IL 1 IN CHRONIC INFLAMMATORY SITUATIONS CONTRIBUTE TO A NUMBER OF DISEASES, e.g. RHEUMATOID ARTHRITIS

30 IL 1 ACTIVATES MONOCYTES/ MACROPHAGES INDUCES FIBROBLASTS PROLIFERATION ACTIVATES CHONDROCYTES ACTIVATES OSTEOBLASTS INFLAMMATION SYNOVIAL PANNUS FORMATION CARTILAGE BREAKDOWNS BONE RESORPTION

31 Why use Anti Interleukins (1) Alpha and Beta in the pain management formulas? Interleukins 1 (IL1α; IL1ß) are the most active primary mediators from a biological point of view, secreted by Th1 cells to induce inflammation (Phase A) by means of their own capacity to stimulate the genic expression associated with the whole inflammatory process evolution Even though structurally different (codified by 2 different genes), they act on the same specific receptor. IL1 have a very short half life and are secreted by IL1 themselves when in contact with CD4 lymphocytes IL1 (α; ß) activate cyclooxygenase type 2 (COX2) (A), prostaglandin E2 (B) and nitric oxide (C), so activating the inflammatory process (pro inflammatory Interleukins) As a consequence, Anti Interleukins 1 (α; ß) act as NSAIDs (A), cortisone (B) and, in part,as as salicylates (C), without the negative side effects caused by these allopathic medicines. Consequently, homeopathically diluted Anti IL1 α and ß are successfully used in osteo arthro myalgic pain management therapy (according to Physiological Regulating g Medicine Guna Method)

32 What is the scientific reason for using Anti Interleukins and not Interleukins having anti inflammatory inflammatory properties? Anti inflammatory inflammatory Interleukins (mainly IL10) are secreted by Th2 cells after the activation of Th1 cells (Phase B of Hoff s Commutative Reaction) and, as a consequence, they act after Interleukins 1 α and ß secretion The block of Interleukins 1 α and ß (anti) is therefore more effective than the stimulation of IL10 IL10 has more anti inflammatory action above all in chronic forms than in acute forms

33 INFLAMMATION PHASE A = DEVELOPMENT PHASE B = RESOLUTION YES NO RECOVERY CHRONICIZATION

34 & inflammation development (mesenchyme hydrolysis, tissue acidosis, sympathetic tone, proinflammatory cytokines release: IL1α, IL1β, TNFα, IL12, IL15, IL18, INFα, INF β) inflammation reduction (mesenchyme synthesis, tissue alkalosis, sympathetic tone, anti inflammatory cytokines release: IL10, TGF β 1, etc.) Phase A can last some hours days (acute inflammation: inflammation; sub acute inflammation; inflammation plus; chronic inflammation) The duration of Phase A depends upon: 1) damage level 2) patient s immunoregulation 3) quality and quantity of the therapy

35 ENDORPHIN Endorphins are organic chemical substances produced by the CNS, having antipain and physiological characteristics similar to those of morphine and opium however they have a wider range Endorphins, like a number of morphinic origin alkaloids, can cause states of euphoria and somnolence according to the quantity released

36 Physiological Regulating Medicine in Pain Management Homeopathic microdoses: guarantee lack of negative side- effects avoid troubles concerning tolerance avoid pharmacological catabolites overload in extracellular matrix and organs

37 Most common combinations: Guna -Neck + Guna -Muscle: neck pain due to cervical trigger points, muscletensive occipital frontal headache, whiplash. Guna -Neck + Guna -Neural: brachialgia from cervical arthrosis, cranic neuritis caused by atlo-epistrophic dislocation, muscle-tensive headache, lost of physiological cervical lordosis. Guna -Neck + Guna -Polyarthritis: cervical syndrome caused by rheumatoid osteoarthritis or other autoimmune diseases, cervical syndrome caused by general somatic pain. Guna -Neck + Guna -Arthro: cervical arthrosis, cervical articular discomfort. Guna -Neck + Guna -Trauma: post-surgery recovery, cervical contusions in traumatology and sport medicine. 37

38 GUNA -NECK into specific and selected local Acupuncture Points GB 21 GV 16 GB 20 SI 10 BL 10 GV 15 GB 21 SI 9 GV 14 38

39 GUNA -NECK into Trigger Points and referred into Trigger Points and referred pain zones TP SI 15 BL 10 TP/SI 14 C 7 TP BL 11 C 7 TP = Main Trigger Points and correlated Acupuncture points 39

40 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment a week for 1 month till pain relief, then 1 treatment a month. 40

41 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 41

42 GUNA -THORACIC Clinical Indications Thoracic pain due to cartilage degenerative thoracic spine disorders (thoracic osteoarthrosis) Thoracic pain due to scoliosis Thoracic pain due to thoracic long muscle trigger points Pain due to thoracic spine osteophytosis Simple posterior thoracic pain (thoracic pain syndrome) Mechanical imbalance (costo-vertebral facet joint syndrome) Thoracic spinal ligament syndrome Thoracic spinal nerve root pain Pain from spinal osteoporosis 42

43 Active ingredients: Chininum sulphuricum 8X HPUS 4 parts; Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Beta- Endorphin 4C, Calcarea phosphorica 6X HPUS, Cimicifuga racemosa 4X HPUS, Intervertebral disk, Porcine 4X, Spongia tosta 10X HPUS 2 parts; Chelidonium majus 4X HPUS, Conium maculatum 6X HPUS 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 43

44 GUNA -THORACIC Beta-Endorphin 4C Pain Riduzione symptomatology della sintomatologia reduction by algica means of per UP-REGULATION REGULATION of dei β Endorphin receptors recettori della β Endorfina Constitutional correction of articular structure pathologies P.N.E.I. Homeopathic antalgic core antalgic core Anti- Constitutional inflammatory core core Anti- degenerative core Chelidonium majus 4X Cimicifuga racemosa 4X Conium maculatum 6X Chininum i sulphuricum 8X Spongia tosta 10X Reduction of the dorsal rachis pain symptomatology of different origin, type and localization: Neuro-muscular origin(cimicifuga, i i i if Chininum sulph., Conium) Spastic and/or congestive origin(chelidonium, Spongia) LOCALIZATION Dorsal rachis: direct, all; hepatic reflex, Chelidonium. Intercostal pain: Spongia Calcarea phosphorica 6X Anti interleukin 1 alpha 4C Anti interleukin 1 beta 4C Anti-degenerative and antineuralgic action Intervertebral disk, Porcine 4X Modulation of IL1 α and IL1 β pro- inflammatory activity in the trigger phase of inflammation 44

45 Most common combinations: Guna -Thoracic + Guna -Muscle: thoracic pain due to scoliosis and thoracic long muscle trigger points, pain of the deep paravertebral thoracic muscles. Guna -Thoracic + Guna -Neural: intercostal pain, post-herpetic thoracic neuritis, thoracic spinal nerve root pain. Guna -Thoracic + Guna -Polyarthritis: thoracic syndrome caused by rheumatoid osteoarthritis, general thoracic pain. Guna -Thoracic + Osteobios TM : thoracic vertebral fractures, thoracic vertebral slow healing. Guna -Thoracic + Guna -Arthro: general thoracic osteoarthrosis. 45

46 GUNA -THORACIC into specific BL 42 SI 10 GB 20 BL 11 BL 10 BL 12 BL 41 BL 13 BL 14 BL 15 BL 16 BL 17 Ex Yishu BL 18 BL 19 BL 20 BL 21 local Acupuncture Points Selected according to the most painful area (max 10 points each treatment) GB 30 46

47 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 47

48 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 48

49 GUNA -LUMBAR Clinical Indications Lumbar pain due to cartilage degenerative lumbar spine disorders (lumbar and lumbar- sacral arthrosis) Lumbar vertebral osteophytosis Low back pain due to muscular and tendinous trigger points Simple lumbar pain (low back syndrome) Weak low back syndrome Postural low back ache Lumbar and lumbar-sacral mechanical imbalance Lumbar and lumbar-sacral spinal ligament syndrome Sacro-iliac syndrome Spinal lumbar and lumbar-sacral nerve root pain 49

50 Active ingredients: Alumina 8X HPUS 4 parts; Anti interleukin 1 alpha 4C, Beta- Endorphin 4C, Bryonia alba 4X HPUS, Hamamelis virginiana 6X HPUS, Natrum sulphuricum 8X HPUS, Phosphoricum acidum 6X HPUS, Sepia 4X HPUS 2 parts; Anti interleukin 1 beta 4C, Intervertebral disk, Porcine 4X 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 50

51 Reduction of the lumbar rachis pain symptomatology of different origin, type and localization: Neuro-muscular origin (Bryonia, Alumina, Ac. Phosphoricum). Articular origin (Natrium sulph.) Type cramp-like pain (Ac. phosphoricum); muscular paresis phenomena (Alumina) Localization Lumbosacral rachis: direct, Hamamelis; abdominal reflex, Sepia Homeopathic antalgic core Beta-Endorphin 4C GUNA -LUMBAR Antalgic core Anti interleukin 1 alpha 4C Bryonia 4X Sepia officinalis 4X Phosphoricum p ac. 6X Hamamelis virginiana 6X Alumina 8X Natrum sulphuricum 8X Anti-degenerative and anti-neuralgic action Pain symptomatology reduction by means of UP- REGULATION of P.N.E.I. β Endorphin p receptors Anti- inflammatory core Anti- degenerative core Intervertebral disk, Porcine 4X Anti interleukin 1 beta 4C Modulation M d l of IL1 α and IL1 β proinflammatory activity in the trigger phase of inflammation 51

52 Most common combinations: Guna -Lumbar + Guna -Muscle: low back pain due to muscular and tendineous trigger points, low-back pain caused by strain from prolonged stay in erect position, lumbago caused by sports training. Guna -Lumbar + Guna -Ischial: sacroiliac syndrome, leg neuritis, sciatic neuralgia. Guna -Lumbar + Guna -Neural: low back pain, lumbar neuritis with projected pain to the lower thoracic side. Guna -Lumbar + Guna -Polyarthritis: general lumbar arthrosis, sacroiliac syndrome caused by rheumatoid arthritis. Guna -Lumbar + Guna -Arthro: lumbar arthrosis, lumbar articular discomfort. Guna -Lumbar + Guna -Lympho: pre- and post-surgery surgery recovery of a disc hernia L4-L5, L5-S1. 52

53 GUNA -LUMBAR Ex Shiqizhuixia GV 4 into specific local Acupuncture Points Selected according to the most painful area (max 10 points each treatment) BL 52 Ex Yaoyan BL 31 BL 32 BL 53 BL 33 GV 2 BL 23 BL 24 BL 25 BL 26 BL 27 BL 28 BL 29 BL 30 Ex Huanzhong BL 54 BL 34 GB 30 BL 36 BL 35 53

54 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 54

55 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 55

56 GUNA -ISCHIAL Clinical Indications Sciatica pain Lumbar-sciatic pain Nerve pain in the lower lumbar spine Leg nerve pain due to post-surgery treatment of disk herniation L4-L5, L5, L5-S1 Morton neuroma 56

57 Active ingredients: Aconitum napellus 8X HPUS, Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Arsenicum album 6X HPUS, Beta-Endorphin 4C, Cimicifuga racemosa 4X HPUS, Gnaphalium polycephalum 4X HPUS, Lachesis mutus 8X HPUS, Rhododendron chrysanthum 6X HPUS, Rhus toxicodendron 4X HPUS 2 parts. Inactive ingredient: Sterile isotonic sodium chloride solution. 57

58 GUNA -ISCHIAL Beta-Endorphin 4C Anti interleukin 1 alpha 4C Anti interleunin 1 beta 4C Pain symptomatology reduction by means of UP- REGULATION of β Endorphin receptors Modulation of abdominal wall reflexed e ed sciatic c pain (Lachesis) s) and iliac-sacral lumbar pain (Cimicifuga) Cimicifuga 4X Lachesis mutus 8X Pain modulation by means of a reduction in the progression of osteochondrosis (Cimicifuga), coxo-femoral arthrosis(rhus tox.), backache (Rhus tox). Anti- P.N.E.I. antalgic core inflammatory core Reflexed Primary neuralgic neuralgic pain pain Secondary neuralgic pain Cimicifuga 4X Rhus toxicodendron 4X Modulation of IL1 α and IL1 β pro-inflammatory activity in the trigger phase of inflammation Lachesis mutus 8X Gnaphalium polycephalum 4X Arsenicum album 6X Rhododendron chrysantum 6X Aconitum napellus 8X Modulation of sciatic pain by means of inflammation neurogen phase inhibition (Aconitum and Arsenicum) and direct action on the sciatic nerve (Gnaphalium) 58

59 Most common combinations: Guna -Ischial + Guna -Lumbar: Sacroiliac syndrome, leg neuritis, sciatic neuralgia. Guna -Ischial + Guna -Neural: Leg neuritis and sciatic neuralgia in hyper-acute phase. Guna -Ischial + Guna -Flam: decongesting action of the leg nerves, especially at the level of the vasa nervorum. 59

60 GUNA -ISCHIAL into specific and selected GB 30 local Acupuncture Points BL 36 BL 37 BL 40 BL 39 BL 57 BL 58 BL 60 60

61 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 61

62 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 62

63 GUNA -SHOULDER Clinical Indications Scapular-humeral l h l peri-arthritis iti Shoulder pain Shoulder-arm syndrome Frozen shoulder Shoulder pain due to dislocation, therapeutic rest Epicondylitis 63

64 Active ingredients: Argentum nitricum 8X HPUS 4 parts; Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Beta-Endorphin 4C, Cartilago suis 4X HPUS, Ferrum phosphoricum 8X HPUS, Sanguinaria canadensis 8X HPUS, Tendon, Porcine 6X 2 parts; Iris versicolor 8X HPUS, Ranunculus bulbosus 10X HPUS 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 64

65 Reduction of shoulder pain of different origin and type: Neuralgic origin (Argentum nitricum, Ferrum phosph., Iris) Muscular origin (Ranunculus, Sanguinaria) Acute pain (Ferrum, Iris) Chronic pain (Argentum nitricum, Ranunculus) GUNA -SHOULDER Beta-Endorphin 4C Pain symptomatology reduction by means of UP- REGULATION of β P.N.E.I. Endorphin receptors antalgic core Argentum nitricum 8X Ferrum phosphoricum 8X Iris versicolor 8X Sanguinaria canadensis 8X Ranunculus bulbosus 10X Anti-degenerative and chronic anti-inflammatory action (Tendon, Porcine) Homeopathic antalgic core Anti- inflammatory core Antidegenerative core Cartilago suis s 4X Tendon, Porcine 6X Anti interleukin 1 alpha 4C Anti interleukin 1 beta 4C Modulation of IL1 α and IL1 β proinflammatory activity in the trigger phase of inflammation 65

66 Most common combinations: Guna -Shoulder + Guna -Polyarthritis: scapulohumeral syndrome caused by rheumatoid arthritis or other autoimmune diseases, scapulohumeral periarthritis caused by excessive articular use. Guna -Shoulder + Guna -Muscle: scapulohumeral syndrome by muscle and tendon trigger points of the supraspinatus muscle (80% of the cases), parascapular muscles and trapezius. Guna -Shoulder + Guna -Neural: epicondylitis, referred pain of the scapulohumeral syndrome along the arm and in the muscle districts nearby. Guna -Shoulder + Guna -Trauma: shoulder pain due to dislocation or traumatism. Guna -Shoulder + Guna -Flam: frozen shoulder, scapulohumeral periarthritis in hyper-acute phase. 66

67 GUNA -SHOULDER into specific and selected Shoulder local Acupuncture Points LI 16 LI 15 LU 2 Ex Jianneiling Ex Jianzhong Ex Jianquian LI 14 GB 20 GB 21 GV 16 BL 10 LI 11 LI 16 GV 14 TE 14 SI 10 SI 12 SI 11 SI 9 TE 13 LI 14 67

68 GUNA -SHOULDER into Trigger Points TP/SI 13 TP/SI 12 TP/TE 14 and referred pain zones BL 43 Shoulder TP SI 11 D 4 TP TP/SI 10 TP/SI 9 TP/Ex Jianneiling TP = Main Trigger Points and correlated Acupuncture points 68

69 TP LU 1 TP BL 46 D 7 TP = Main Trigger Points and correlated Acupuncture points 69

70 GUNA -SHOULDER into specific and selected Elbow local Acupuncture Points LI 12 LI 11 LI 10 LI 8 TE 10 SI 8 Ex Quyahgwei SI 7 TE 5 TE 4 LU 5 HT 3 PC 3 SI 4 HT 5 HT 4 SI 7 HT 4 HT 5 SI 8 HT 3 70

71 GUNA -SHOULDER into Trigger Points and referred pain zones LU 5 Elbow TP SI 8 TP TE 9 TP = Main Trigger Points and correlated Acupuncture points 71

72 HT 3 TP Elbow PC 3 TP TP = Main Trigger Points and correlated Acupuncture points 72

73 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 73

74 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 74

75 GUNA -HANDFOOT Clinical Indications Osteoarthritis t th of digits it pain Rhizoarthrosis of the thumb (Forestier disease) Arthrosis pain due to hammer toe Carpal-tunnel syndrome De Quervain disease Metacarpal t l and Metatarsal t pain Morton disease Rheumatoid arthritis of hand/foot Hand/Foot tendon pain due to prolonged immobilization (tendon pain related to casts) 75

76 Active ingredients: Arnica montana 4X HPUS, Viola odorata 6X HPUS 4 parts; Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Beta-Endorphin 4C, Caulophyllum thalictroides 12X HPUS 2 parts; Benzoicum acidum 6X HPUS, Cimicifuga racemosa 10X HPUS, Ledum palustre 6X HPUS, Mercurius solubilis 8X HPUS 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 76

77 GUNA -HANDFOOT Beta-Endorphin 4C Anti interleukin 1 alpha 4C Anti interleukin 1 beta 4C Pain symptomatology reduction by means of UP- REGULATION of β Endorphin receptors P.N.E.I. antalgic core Anti- inflammatory core Modulation of IL1 α and IL1 β pro-inflammatory activity in the trigger phase of inflammation Pain modulation by means of uric acid crystals accumulation inhibition (drainage action) Gout pain Inflammatory pain Degenerative pain Arnica montana 4X Caulophillum thalictroides 12X Ledum palustre 6X Benzoicum acidum 6X Pain modulation by means of degenerative process (arthrosis type) inhibition Viola odorata 6X Mercurius solubilis 8X Cimicifuga racemosa 10X Pain modulation by means of acute inflammation phenomena vasal in particular inhibition (arthrosis type) 77

78 Most common combinations: Guna -Handfoot + Guna -Polyarthritis: rheumatoid arthritis and other autoimmune diseases of hands and feet. Guna -Handfoot + Guna -Neural: carpal tunnel syndrome, neuritis after plaster cast removal, Morton disease, general pain of hand and foot, neuritis of hand and foot. Guna -Handfoot + Guna -Lympho: carpal tunnel syndrome, post surgery recovery. Guna -Handfoot + Guna -Trauma: before and after surgical operations of hand and foot, sports contusions. 78

79 GUNA -HANDFOOT into specific and selected SI 5 SI 4 local Acupuncture Points Wrist LI 5 LI 6 TE 4 PC 6 SI 5 LU 9 HT 5 PC 7 LI 5 SI 6 Ex Zhongquan TE 5 HT 7 LI 6 79

80 SIFENG POINTS PC 8 BIS LI 1 TE 1 HT 9 SI 1 BAXIE POINTS PC 8 HT 8 LU 11 LI 4 TE 2 TE 3 Ex Luozhen Hand HT 7 LU 9 PC 7 Ex Zhongquan TE 4 PC 6 TE 5 BAXIE POINTS LI 2 LI 3 LI 4 LI 5 SI 3 SI 2 SI 1 TE 1 80 SI 5 SI 4 LU 10

81 Foot ST 41 GB 40 ST 42 GB 41 GB 42 GB 43 ST 43 LR 3 ST 44 LR 2 BAFENG BL 67 GB 44 ST 45 LR 1 SP 1 In particularly painful anatomic parts such as hands and foot digits, spray ethyl chloride for 2-3 seconds at a distance of about 20 cm before infiltrating 81

82 GUNA -HANDFOOT into specific and selected local Acupuncture Points GB 38 BL 59 GB 39 Ex Bafeng 3 ST 42 ST 41 ST 44 LR 3 ST 43 LR 2 LR 1 Foot BL 60 BL 63 BL 62 BL 64 GB 42 GB 43 GB 44 ST 45 SP 6 GB 40 GB 41 BL 65 BL 67 KI 3 KI 4 SP 1 SP 2 SP 3 KI 2 SP 5 KI 5 82

83 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 83

84 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 84

85 GUNA -HIP Clinical Indications Hip joint osteoarthrosis Hip joint capsule inflammation Hip joint rheumatoid arthritis Hip joint pain of muscle origin Hip joint pain of nerve origin (burning hip) Hip joint pain due to prolonged bed rest Knee osteoarthrosis 85

86 Active ingredients: Arnica montana 8X HPUS 4 parts; Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Beta- Endorphin 4C, Calcarea fluorica 6X HPUS, Cartilago suis 4X HPUS, Colocynthis 8X HPUS, Rhus toxicodendron 10X HPUS 2 parts; Argentum metallicum 6X HPUS, Formicum acidum 8X HPUS 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 86

87 GUNA -HIP Beta-Endorphin 4C Argentum metallicum 6X Arnica montana 8X Colocynthis 8X Formicum ac. 8X Rhus toxicodendron 10X Pain symptomatology reduction by means of UP- REGULATION of β Endorphin receptors Constitutional correction of articular structure pathology Calcarea fluorica 6X P.N.E.I. Homeopathic antalgic core antalgic core Anti- Constitutional inflammatory core core Anti- degenerative core Reduction of hip pain symptoms of rheumatic origin : Capsule (Formicum ac., Argentum) Tendons and ligaments (Rhus tox) Nerves (Colocynthis) Muscles (Arnica) Anti interleukin 1 alpha 4C Anti interleukin 1 beta 4C Biostimulation of cartilagineous matrix components synthesis (Cartilago) New vessels development stimulation (Argentum) Cartilago suis 4X Argentum metallicum 6X Modulation of IL1 α and IL1 β pro-inflammatory activity in the trigger phase of inflammation 87

88 Most common combinations: Guna -Hip + Guna -Muscle: satellite muscles involvement in case of prearthrosis or hip and knee arthrosis. Guna -Hip + Guna -Neural: inguinal neuritis and neuritis affecting the upper leg, caused by hip arthrosis, burning hip, neuritis due to knee arthrosis. Guna -Hip + Guna -Polyarthritis: coxarthritis due to rheumatoid arthritis and other autoimmune diseases, acute coxarthritis of sportsmen. Guna -Hip + Guna -Arthro: hip joint osteoarthritis, hip joint capsule inflammation. Guna -Hip + Guna -Trauma: before and after surgical operations of the hip, pain caused by prosthesis. 88

89 GUNA -HIP into specific and selected local Acupuncture Points GB 27 GB 28 ST 31 SP 12 ST 30 LR 12 LR 11 LR 10 BL 54 GB 30 GB 29 Hip SP 11 ST 32 GB 31 GB 32 LR 8 SP 9 BL 40 GB 34 GB 27 GB 28 SP 12 ST 31 ST 30 LR 12 LR 11 LR 10 89

90 GUNA -HIP into Trigger Points and referred pain zones TP/Ex Tunzhong GB 29 TP/GB 30 BL 54 GB 30 TP Hip TP = Main Trigger Points TP/GB 33 ST 31 TP TP/SP 10 90

91 Knee 91

92 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 92

93 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 93

94 94

95 GUNA -POLYARTHRITIS Clinical Indications Small joints rheumatoid arthritis of hand and foot Costo-sternal syndrome (Tietze syndrome) Chronic polyarthritis due to autoimmune diseases (e.g. Lupus erythematosus sistemicus) Broken bone syndrome due to viral or protozoic disease Joint pain due to cancer disease (chronic leukemia, monoclonal blood diseases) 95

96 Active ingredients: Salicylicum acidum 2X HPUS 4 parts; Aconitum napellus 6X HPUS, Anti interleukin 1 alpha 4C, Anti interleukin 1 beta 4C, Beta-Endorphin 4C, Drosera 8X HPUS, Ledum palustre 8X HPUS, Viscum album 10X HPUS 2 parts; Colchicum autumnale 10X HPUS, Guaiacum 10X HPUS 1 part. Inactive ingredient: Sterile isotonic i sodium chloride solution. 96

97 GUNA -POLYARTHRITIS Reduction of polyarticular pain symptomatology in acute inflammation having different localization Beta-Endorphin 4C Salycilicum y acidum 2X Aconitum 6X Drosera 8X Colchicum autumnale 10X Guaiacum 10X Pain symptomatology reduction by means of UP- REGULATION of β P.N.E.I. Endorphin receptors antalgic core Acute Anti- inflammatory inflammatory pain core Chronic inflammatory pain Anti interleukin 1 alpha 4C Anti interleukin 1 beta 4C Reduction of degenerative e e articular a pain on a chronic-evolutive basis Ledum palustre 8X Viscum album 10X Modulation of IL1 α and IL1 β proinflammatory activity in the trigger phase of inflammation 97

98 Most common combinations: Guna -Polyarthritis + Guna -Handfoot: rheumatoid arthritis or other autoimmune diseases of the small joints of hand and foot, metatarsalgia, metacarpalgia. Guna -Polyarthritis + Guna -Neural: costosternal syndrome, in cases of presence of satellite neuritis in rheumatoid arthritis or other autoimmune diseases. Guna -Polyarthritis + Guna -Muscle: in cases of prevalence of muscle pain in rheumatoid arthritis or other autoimmune diseases. Guna -Polyarthritis + Guna -Arthro: rheumatoid arthritis, localized or systemic arthrosis, arthritis in single or several areas. 98

99 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 99

100 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 100

101 GUNA -MUSCLE Clinical Indications Trigger points management: acute, subacute, chronic Fibromyalgia syndrome Referred somatic pain area management Dermatomyositisy 101

102 Active ingredients: Arnica montana 4X HPUS, Colocynthis 4X HPUS 4 parts; Belladonna 6X HPUS, Lithium benzoicum 8X HPUS, Muscle tissue, Porcine 4C, Procaine chloride 2X 2 parts; Colchicum autumnale 6X HPUS, Cuprum sulphuricum 4X HPUS, Hypericum perforatum 4X HPUS, Interferon gamma 4C 1 part. Inactive ingredient: Sterile isotonic sodium chloride solution. 102

103 GUNA -MUSCLE Interferon γ 4C Procain P i chloride 2X Arnica montana 4X Belladonna 6X Muscle tissue, Porcine 4C Anti- degenerative core Contusive pain Colchicum autumnale 6X Lithium benzoicum 8X Muscular rheumatism Sprain pain Spastic or cramp-like pain Colocynthis C l 4X Cuprum sulphuricum 4X Hypericum 4X 103

104 Most common combinations: Guna -Muscle + Guna -Neural: mostly combined for the specific action of muscle relaxation + nerve repolarization, fibromyalgia syndrome, muscle pain due to the nerve entrapment. Guna -Muscle + Guna -Neck: all muscle pain due to cervical syndromes. Guna -Muscle + Guna -Thoracic: all muscle pain due to thoracic syndromes. Guna -Muscle + Guna -Lumbar: all muscle pain due to low-back syndromes. Guna -Muscle + Guna -Hip: all muscle pain due to hip or knee syndromes. Guna -Muscle + Guna -Shoulder: all muscle pain due to shoulder or elbow syndrome. Guna -Muscle + Guna -Flam: all muscle aches. 104

105 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 105

106 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 106

107 GUNA -NEURAL NEURAL Clinical Indications Non-specific brachial pain Brachial nerve pain due to cervical entrapment Intercostal nerve pain due to thoracic entrapment Postherpetic neuritis Atypical facial neuritis (Slüder syndrome, Charlin syndrome) Trigeminal neuritis Pain of the temporomandibular joint (TMJ) Arnold syndrome Cervical, thoracic, lumbar and sacrolumbar nerve root pain 107

108 Active ingredients: Aconitum napellus 8X HPUS, Beta-Endorphin 4C, Colocynthis 4X HPUS, Ferrum phosphoricum 2X HPUS, Formica rufa 8X HPUS, Gnaphalium polycephalum 6X HPUS, Iris versicolor 8X HPUS, Kalmia latifolia 2X HPUS, Neurotrophin 4 4C, Paris quadrifolia 6X HPUS 2 parts. Inactive ingredient: Sterile isotonic sodium chloride solution. 108

109 GUNA -NEURAL Beta-Endorphin 4C Kalmia latifolia 2X Ferrum phosphoricum 2X Colocynthis 4X Paris quadrifolia 6X Pain symptomatology reduction by means of UP- REGULATION of β Endorphin receptors Modulation of paresis and paralysis phenomena Kalmia latifolia 2X P.N.E.I. antalgic Inflammatory core aetiology Rheumatoid Vascular aetiology aetiology Degenerative aetiology Gnaphalium polycephalum 6X Iris versicolor 8X Aconitum napellus 8X Reduction of different peripheral nerves inflammation Formica rufa 8X Trophic action on roots and nerve e endings damaged aged because of degenerative or lesionary phenomena Neurotrophin 4 4C Reduction of pain and paraesthetic phenomena by means of hyperemetic action on nerves 109

110 Infiltration points for trigeminal pain Infiltration points for Charlin and Slüder syndromes pain 110

111 Most common combinations: Guna -Neural + Guna -Muscle: mostly combined for the specific action on nerve repolarization + muscle relaxation, fibromyalgia syndrome, muscle pain due to the nerve entrapment. Guna -Neural +G Guna -Neck: all neural pain due to cervical syndromes. Guna -Neural + Guna -Thoracic: all neural pain due to thoracic syndromes. Guna -Neural + Guna -Lumbar: all neural pain due to low-back syndromes. Guna -Neural + Guna -Hip: all neural pain due to hip or knee syndromes. Guna -Neural + Guna -Shoulder: all neural pain due to shoulder or elbow syndromes. Guna -Neural + Guna -Ischial: neuritis of the leg and sciatic neuralgia in hyperacute phase. Guna -Neural + Guna -Flam: all nerve aches. 111

112 Treatment Standard protocol for i.m. administration: 1 ampoule 1-3 times a week according to severity and clinical evolution. Standard protocol according to mesotherapeutic technique using 1-2 ampoules per treatment: 2 treatments for the first 2 weeks, 1 treatment a week till pain relief (average 8-10 sessions). For chronic pathologies: continue 1 treatment t t a week for 1 month till pain relief, then 1 treatment t t a month. 112

113 Type of needle Select application site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapic technique. 113

114 THANK YOU VERY MUCH FOR YOUR KIND PRESENCE AND ATTENTION 114