VII CONGRESSO PAULISTA

DE NEUROLOGIA
2011

Ricardo Ghelman, PhD

Mdico da Famlia e Pediatra
Doutorado com Viscum album, 2003
Coordenador do Ncleo de Medicina
Antroposfica
NUMA/UNIFESP/EPM - Departamento de
Obstetrcia
Membro do NUMEPI / UNIFESP

Anthroposophic medicine integrates

conventional medicine with an anthroposophic*
perception of the human being. It starts with a
conventional diagnosis, but includes in its
assessment of the patient the imbalances of the
body and a psychological, mental and spiritual
dimension. It takes a holistic approach to health
and offers specific therapies enhanced according
to anthroposophic principles. It uses both
conventional and anthroposophic medicinal
products. Both the treatment approach and the
use and selection of medicinal products and
other therapies are highly individualised and
intend to bring about a process of development
within the patient, reinforcing the patients natural
self-healing ability.

Anthroposophic medicine was developed in

1920 and has earned a high level of
acceptance within European society. It is used
in both primary and clinical care in over twenty
EU Member States, and offers a high degree of
patient satisfaction. Research shows that the
anthroposophic medical approach is safe and
effective and leads to only a sparing use of
antibiotics; medical insurance policies show
minimal medication costs. Anthroposophic
medicine, as an integrated complementary
medical system, is proven both to be safe and
effective and offers considerable added value
to the health systems in the EU.

Universidade Witten/Herdecke
PD Dr. med. Gerhard Kienle (1923-1983)
1969 Gemeinschaftskrankenhaus
Herdecke
Hospital regional de Doenas agudas
2010 470 Leitos: Innere Medizin,
Onkologie, Neurologie, Neurochirurgie,
Chirurgie, Gynkologie/Geburtshilfe,
Pdiatrie, etc.

Universidade Witten/Herdecke

Die Filderklinik

11/08/14

290 Leitos

Filderklinik

11/08/14

Filderklinik

11/08/14

A dor uma experincia noo-psicosomtica, ou seja, uma

experincia que abrange
aspectos neuro-fisiolgicos
(somticos) e psquicos para um
indivduo com sua biografia
(aspectos noticos).

A Dor tem uma perspectiva que transcende

o estimulo nociceptivo:
Rede de Significados individuais que
permitem elaborar conscientemente ou
no a dor, conforme seu estado de
conscincia.

Desenvolvimento Humano
Diagnstico biogrfico
Individualidade
Somtico
0

Psquico

21
Quatro partos

42

63

Parto fsico:

Os 4 Partos

Maternidade
PARTO como separao fsica da me - incio da mielinizao

Parto vital:
Troca dos dentes,mielinizao e hiperplasia dos alvolos 5 a 7 anos
Da FANTASIA MEMRIA
POR QUE ?
Conscincia dos pensamentos ao final da mielinizao

Parto anmico, animal:

Puberdade 9 a 15 anos
Vida ANIMAL: pelagem, garras gritos, mordeduras, vida solitria ou em bando
COMO EU ME SINTO ?
Conscincia dos Sentimentos durante revoluo hormonal

Parto do Eu:
Maioridade 21 anos
QUEM SOU EU ? QUAL O SENTIDO DA VIDA ? O QUE EU QUERO DA VIDA ?
Conscincia da Vontade , introduo a Auto-educao e a Resilincia

Aos 21 anos
Organizao do Eu perceptvel no corpo:
Equilibrio
Postura
Olhar presente
Homeotermia
Imunocompetncia

Eu presente na psique: Busca de significados

Concentrao
Determinao
Coerncia
Atuao
Presena de esprito

O fundador da teoria da Salutognese,

Aaron Antonovsky, descreve os conceito de
senso de coerncia incluindo:
1. Compreensibilidade
2. Manuseabilidade
3. Significado.

Resilincia, auto-regulao,
Salutognese: termos que expressam a
atuao da Individualidade.
Schweiz Med Wochenschr. 1994 Jul 23;124(29):1267-75.

Pr requisitos ao enfrentamento
adequado
1) Significncia: um sentimento profundo que a
vida faz sentido emocionalmente, que as
demandas da vida so plenas de envolvimento
e comprometimento DOR COM SENTIDO
2) Manuseabilidade: a extenso do sentimento de
que existem recursos para atender as
demandas DOR MANUSEVEL
3) Inteligibilidade: A extenso em que o individuo
considera ou estrutura seu mundo de forma a
torn-lo compreensvel, cheio de sentido,
ordenado e consistente ao invs de catico,
aleatrio e imprevisvel ENTENDO A DOR

Recursos de Enfrentamento
O Corao no centro das aes

Corao

Momento biogrfico e estado de conscincia

O evento doloroso, tanto maior em

intensidade, freqncia e
precocidade na biografia como em
menor regularidade, tende a reduzir
seu significado e gerar reaes
negativas na psique.

Sndrome de stress ps traumtico

X
As reaes positivas podem se
manifestar como um amadurecimento
psquico a partir de foras da
individualidade que chamada a
buscar um significado e um
aprendizado em contrapartida a
tendncia reativa.

God image and happiness in chronic pain patients:

the mediating role of disease interpretation.
Dezutter J, Luyckx K, Schaap-Jonker H,
Bssing A, Corveleyn J, Hutsebaut D.
Department of Psychology, Catholic University of
Leuven, Leuven, Belgium.
jessie.dezutter@psy.kuleuven.b
Pain Med. 2010 May;11(5):765-73. Epub 2010 Mar 26.

OBJECTIVE:
The present study explored the role of the emotional
experience of God (i.e., positive and negative God
images) in the happiness of chronic pain (CP) patients.
Framed in the transactional model of stress, we tested a
model in which God images would influence happiness
partially through its influence on disease interpretation
as a mediating mechanism. We expected God images to
have both a direct and an indirect (through the
interpretation of disease) effect on happiness.
DESIGN:
A cross-sectional questionnaire design was adopted in
order to measure demographics, pain condition, God
images, disease interpretation, and happiness. One
hundred thirty-six CP patients, all members of a national
patients' association, completed the questionnaires.

RESULTS:
Correlational analyses showed meaningful associations among
God images, disease interpretation, and happiness. Path analyses
from a structural equation modeling approach indicated that
positive God images seemed to influence happiness, both directly
and indirectly through the pathway of positive interpretation of the
disease. Ancillary analyses showed that the negative influence of
angry God images on happiness disappeared after controlling for
pain severity.
CONCLUSION:
The results indicated that one's emotional experience of God has
an influence on happiness in CP patients, both directly and
indirectly through the pathway of positive disease interpretation.
These findings can be framed within the transactional theory of
stress and can stimulate further pain research investigating the
possible effects of religion in the adaptation to CP.

Sistema Neuro-sensorial - SNS

Segundo a teoria dos trs sistemas
orgnicos, o SNS - vinculado ao
ectoderma- fica super-estimulado na dor
em detrimento do sistema metablicomotor - vinculado ao endoderma - que fica
quase imobilizado, de tal forma que o
sistema rtmico (SR) - vinculado ao
mesoderma - no consegue harmonizar a
relao entre os dois sistemas polares.

SNS

A dor e os sentidos
Excesso de conscincia di.

Long-term outcomes of anthroposophic

therapy for chronic low back pain: A
two-year follow-up analysis
Journal of Pain Research, june 2009
Harald J Hamre1, Claudia M Witt 2, Gunver s Kienle 1,
Anja Glockmann 1, Renatus Ziegler 3, Stefan n Willich 2,
Helmut Kiene 1,

Background: Anthroposophic treatment for

chronic low back pain (LBP) includes special
artistic and physical therapies and special
medications. In a previously published
prospective cohort study, anthroposophic
treatment for chronic LBP was associated with
improvements of pain, back function, and quality
of life at 12-month follow-up. These
improvements were at least comparable to
improvements in a control group receiving
conventional care.

We conducted a two-year follow-up analysis of

the anthroposophic therapy group with a larger
sample size.
Methods: Seventy-five consecutive adult
outpatients in Germany, starting anthroposophic
treatment for discogenic or non-specific LBP of
!6 weeks duration participated in a prospective
cohort study. Main outcomes were Hanover
Functional Ability Questionnaire (HFAQ; 0100),
LBP Rating Scale Pain Score (LBPRS; 0100),
Symptom Score (010), and SF-36 after 24
months.

Results: Eighty-five percent of patients were women.

Mean age was 49.0 years. From baseline to 24-month
follow-up all outcomes improved significantly; average
improvements were:
HFAQ 11.1 points (95% confidence interval [CI]: 5.5
16.6; p ! 0.001), LBPRS 8.7 (95% CI: 4.413.0; p !
0.001), Symptom Score 2.0 (95% CI: 1.32.8; p !
0.001), SF-36 Physical Component Summary 6.0 (95%
CI: 2.99.1; p ! 0.001), and SF-36 Mental Component
Summary 4.0 (95% CI: 1.16.8; p = 0.007).
Conclusion: Patients with chronic LBP receiving
anthroposophic treatment had sustained improvements
of symptoms, back function, and quality of life,
suggesting that larger multicenter rigorous studies may
be worthwhile.
Keywords: anthroposophy, drug therapy, eurythmy therapy, low back pain, follow-up studies

Organizao Anmica
Quanto teoria das quatro organizaes de
foras, na situao fisiolgica a
organizao vital (OV) se interpe entre a
organizao anmica (OA) e a
organizao fsica (OF) e as trs
organizaes so moduladas pela
organizao do eu (OE).

Na condio dolorosa a OA toca

diretamente a OF.

Interrogatrio orgnico da OA
Sensibilidade e Dores
Tnus muscular das musculaturas
esqueltica (aperto de mo), lisa (tnus
intestinal) e cardaca (presso arterial)
Motricidade grosseira, fina e agilidade
Transpirao
Distribuio da gordura e sua absoro
nimo do olhar

Interrogatrio psquico da OA

Histria das dores

Grau de ateno e excitabilidade
Ansiedade e agitao psico-motora
Viglia, animao, libido, irritabilidade e
disperso
Grau de estresse agudo e crnico.
Grau de medo, preguia, gula, orgulho,
inveja, cobia, luxria e ira

Organizao do EU (OE)
Organizao Anmica (OA)
-------------------------------------------Organizao Vital (OV)
Organizao Fsica (OF)

Intensificao das quatro organizaes

no corpo
CALOR (OE)
DOR (AO)
Padro imunolgico TH1

TUMOR (OV)
RUBOR (OF)

Para alcanarmos a analgesia

necessrio afastar a OA da OF, o
que pode ser alcanado atravs
de trs mecanismos de ao:

1. Estimulando a OV com terapia medicamentosa,

por exemplo atravs do uso de Bryoffilum
calcycium TM via oral ou de forma dinamizada
via SC, e/ou com terapias no medicamentosas
como a Massagem Rtmica.
2. Estimulando a OE com terapia medicamentosa
como Apis ou Stibium e/ou com terapias no
medicamentosas atravs de calor local nas
terapias externas ou Euritmia.
3. Modulando diretamente a OA atravs de
medicaes que a afastam da OF como o
Arsenicum album. Neste mecanismo se incluem
os analgsicos e anestsicos sintticos.

Um risco de lidar com a dor sem

abranger seu significado existe
nos trs nveis - somtico,
psquico e notico.

 Uma dor de entorce com leso ligamentar

bloqueada com analgsico sem prvia
imobilizao pode lesar uma articulao.
Uma dor por perda afetiva no elaborada e
bloqueada com anti-depressivo pode impedir a
finalizao do processo de luto.
Uma dor existencial pela percepo do
sofrimento alheio anestesiada por uma atitude
consumista pode induzir a uma apatia social e
futura depresso. Neste particular uma
educao para a percepo do ambiente social
pode ter papel preventivo.

Enfim dar significado a dor tambm

representa uma forma de modular a
dor, elevando o seu limiar atravs
das foras da individualidade que se
manifestam pela capacidade
salutogentica de compreender e
manusear os conflitos inerentes
experincia humana.

Teraputica Antroposfica
com abordagem multi-disciplinar
rea da Individualidade:
Trabalho Biogrfico (mdicos e psiclogos)

rea Psquica:
Psicoterapia antroposfica e Terapia Artstica

rea Somtica:
Medicina e Farmcia antroposfica
Enfermagem, Nutrio, Odontologia,
Fisioterapia, Fonoaudiologia
Terapias: Massagem Rtmica, Euritmia e
Quirofontica

18 estudos clnicos
Dor e Medicina Antroposfica
1. Wolff, 1973
2. Flemming, 1974
3. Astrup, 1976
4. Krabbe, 1980
5. Halbltzel, 1980
6. Brachmann, 1983
7. Simon, 1985
8. Simon, 1987
9. Hrtzer, 1995
10.Janke, 1997
11.Baranzewitch, 1997
12.Grtner, 1999
13.Grtner, 1999
14.Rivoir, 2001
15.Jeffery, 2002
16.Ostermann, 2003
17.Guala, 2003
18.Hamre, 2005

1973 2005
2308 pacientes
21 a 415 pacientes/estudo

TTTo com MA bem tolerado e

sem complicaes

18 estudos de dor e medicina

antroposfica
1. Hamre,20052. Guala, 2003
3. Janke, 1997
4. Jeffery, 2002
5. Flemming, 1974
6. Krabbe, 1980
7. Astrup, 1976
8. Brachmann, 1983
9. Baranzewitch, 199710.Grtner, 1999
11.Wolff, 1973
12.Ostermann, 2003
13.Grtner, 1999
14.Simon, 1985
15.Halbltzel, 1980
16.Simon, 1987
17.Rivoir, 2001
18.Hrtzer, 1995

Seis estudos prospectivos placebo-controlados

Seis estudos prospectivos coortes

Quatro estudos retrospectivos coortes

Dois estudos retrospectivos comparativos

9 condies dolorosas
1.Cefalia : Wolff, 1973; Flemming, 1974;
Halbltzel, 1980; Krabbe, 1980; Brachmann,
1983; Baranzewitch, 1997; Grtner, 1999
2.Lombalgia e ciatalgia : Hrtzer, 1995;
Ostermann, 2003 e Hamre,2005 3. Cuidados umbilicais neonatais : Janke, 1997;
Guala, 2003
4.Sndrome tnel do carpo : Jeffery, 2002
5. Dor facial : Astrup, 1976
6.Osteoartrite : Grtner, 1999
7.Queimadura : Simon, 1985
8.Dor associada a cirurgia : Simon, 1987
9.Discopatia intervertebral dolorosa : Rivoir, 2001

Enxaqueca
(hemicrania)
Imagem diagnostica:
Fenmeno: cefalia decorrente de
vasodilatao, fotofobia, reduo da
conscincia e padro assimtrico
desencadeado por fatores digestivos
(alimentos ou privao) e
endocrinolgicos (na TPM).
Padro de invaso do SMM sobre o SNS:
excesso de metabolismo no plo neurosensorial.

Conduta Teraputica
Imagem na natureza da organizao trplice

Slica (Si)- atividade de estruturao

translcida (SNS)
Ferro (Fe) mediador, quelante na
hemoglobina, libera luz (SR)
Enxofre (S) atividade expansiva,
dissolutiva (SM)
Pyrita/Quartzo e Urtica urens e dioica
(cristais de silicea aprisionando uma
substancia sulfurosa sob alto teor de ferro)

 Kephalodoron D3; 5% (Ferrum

sulfuricum/Silcea): a combinao de ferro
e enxofre, por um lado, age no ponto de
encontro dos processos digestivos
(metablico enxofre) e respiratrios
(hemoglobina ferro), impedindo que os
processos digestivos transbordem para o
plo neuro-sensorial.
A silcia, ou quartzo, caracterizada por
suas foras de estruturao, que
normalmente existem no SNS, de forma
interiorizada (pensar claro como o cristal).

substare, estar sob

Anthroposophic Therapy for Migraine: A Two-Year Prospective

Cohort Study in Routine Outpatient Settings
Harald J. Hamre*,1, Claudia M. Witt, 2, Gunver S. Kienle, 1, , Anja
Glockmann 1, , Renatus Ziegler 3, andreas Rivoir 4., Stefan N. Willich 2,
and Helmut Kiene

Results: The anthroposophic treatment

modalities used were medications (67% of
patients), eurythmy therapy (38%), art
therapy (18%), and rhythmical massage
therapy (13%). Median therapy duration was
105 days. In months 0-6, conventional
prophylactic antimigraine medications were
used by 14% (n=5/36) of evaluable patients.
The Open Neurology Journal, 2010, 4, 100-110

From baseline to six-month follow-up, physician-rated

Average Migraine Severity improved by 3.14 points
(95% confidence interval 2.40-3.87, p<0.001); patientrated Average Migraine Severity improved by 2.82
points (2.05-3.64, p<0.001); and Symptom Score
improved by 2.32 points (1.68-2.95, p<0.001). In
addition, three SF-36 scales (Social Functioning,
Bodily Pain, Vitality), the SF-36 Physical Component
summary measure, and the SF-36 Health Change item
improved significantly. All improvements were
maintained at last follow-up after 24 months. Patients
not using conventional prophylactic antimigraine
medications had improvements similar to the whole
cohort.

Conclusions: Patients with migraine under

anthroposophic treatment had long-term
improvement of symptoms and quality
of life. Although the pre-post design of the
present study does not allow for
conclusions about comparative
effectiveness, study findings suggest that
anthroposophic therapies may be useful in
the long-term care of patients with migraine.
Keywords: Anthroposophy, combined modality therapy, drug
therapy, eurythmy therapy, migraine, prospective studies.

estudo prospectivos coorte

212 pacientes com dor facial (154 nevralgia
do trigmeo) receberam Aconitum comp.
Via SC 3x/semana e uso tpico 3x/dia.
Aps 6 a 15 meses: 60-69% reduo nas
freqncias das crises, 27-56% reduo
na intensidade e melhora de 47 a 70%
com marcada reduo do uso de
analgsicos (ausncia de efeitos
adversos)
Astrup, 1975

estudo retrospectivo coorte

367 pacientes com osteoartrite de joelhos ou coxofemoral receberam Articulatio coxae ou Genus
D30 assoc. ao Viscum album mali 2%
via SC 2x/semana por 12 meses.
Resultado: 58% de resposta positiva com
ausncia de uso de antiinflamatrios no
hormonais, reduo em 1/3 da dor e elevao
em 15 x na distancia de caminhada.
Grtner, 1999

Viscum album

Heiny and Beuth assessed the plasma

level of -endorphin together with several
immune parameters during the
immunologically optimized mistletoe
treatment of cancer patients. Significant
correlations were found between the endorphin level, the mistletoe lectininduced immunological reactions and the
clinical progress. As an endogenous
opioid, -endorphin levels in plasma
correlated with well-being and relief of pain
in these patients.
Heiny BM, Albrecht V, Beuth J. Correlation of immune cell activities and betaendorphin release in breast carcinoma patients treated with galactose-specific lectin
standardized mistletoe extract. Anticancer Res 1998;18:5836.

Massagem
Rtmica