32nd International Congress on Veterinary Acupuncture

BASICS IN LASER THERAPY AND LASER ACUPUNCTURE

Dr. med. vet. Uwe Petermann (DVM)
49326 Melle, Germany
druwepetermannmelle@t-online.de

Summary
The effect of Low Level Laser Therapy (LLLT) is documented by many scientific investigations.
Although this therapy is proven as very effective it is not appreciated in American and European
universities. In this paper the results of the most important investigations of LLLT are
summarized and the finding of its method of action is reported. Also reported are the findings of
long-standing personal experience in laser acupuncture is reported. The possibility of useful
combination of laser therapy with laser acupuncture is shown in the following fields: COPD
(chronic obstructive pulmonary disease) in horses, chronic back pain in horses, infected tendon
sheath and joint inflammation in horses, purulent sinusitis in horses and dogs, degenerative joint
diseases in horses and dogs, eye conditions in horses, gynaecology and many other fields. In
every indication the acupuncture points used most frequently are introduced.

Key words: Low level laser therapy (LLLT), laser acupuncture, veterinary medicine

History
When Shawlow and Townes (1958) published the construction plans for the laser and Maiman
(1960) presented the first functional ruby-crystal laser to the scientific community, there was
probably no inkling of the enormous range of applications and types that would develop from
this invention. Mester was the first scientist who started in the late sixties with studies about laser
irradiation in human tissue and showed significant increase in wound healing after LLLT. One
can say that he is the father of LLLT.

Areas of laser application in man and animals

Today, lasers find an ever increasing new and varied range of applications all over the world.
The spectrum extends from soft-lasers, for use in cosmetics, to different lasers that are used in
many areas of medicine. So far, the most well-known have been surgical lasers, used for incision
and cauterisation in endoscopic surgery and for the treatment of ablatio retinae in the eye. In
cosmetic surgery, lasers are used therapeutically for the sclerosing of varicose veins, the removal
of birthmarks and brush marks right through to the “vaporisation” of aging skin layers and
collagen production in exhausted subcutaneous tissue.

Therapy and acupuncture lasers

This paper, however, will give a report of a completely different medical application of laser
devices, so-called “Mid-lasers”. Low level laser therapy (LLLT) involves the local treatment of
various tissues with so-called therapeutic lasers. These lasers are diode lasers with the great
advantage of being very compact. The laser diodes are scarcely bigger than a match-head, so that
the entire apparatus including the battery of a modern therapeutic laser can be housed in a device

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the size of a cigar. Thus, whether such a compact laser or a stand-alone device with a laser probe
connected via cable is used, is actually a question of personal preference. These devices basically
work with wavelengths in the infra-red spectrum (600-900 nm). Two types must be distinguished
here. On one hand, there are continuous beam lasers, which continually emit laser light. The
output of these devices lies between 30 and 200 mW. On the other hand we have impulse lasers
that emit very short pulsed laser beams (200nsec each pulse) but with a very high intensity
(90watt pulse peak power). The pulse frequency can be adapted to special resonance frequencies
in different types of tissue.

Light emission by continuous-wave- laser

The first type of acupuncture laser is continuous wave lasers (cw-laser), which continually emit
laser light (Fig. 1). The output of these devices lies between 30 and 200 mW. The laser light
emission can be split into different frequencies to attain optimal resonance in different types of
tissue. In continuous wave-laser, the Bahr, Nogier and other individual frequencies are
modulated as a sinus wave on the basic laser beam.

Figure 1: Cw-laser with 70mW power and integrated Bahr, Nogier,

Meridian- Frequencies and special laser frequencies for the “Chakra” points

Light emission by impulse-laser

The second type of laser is the pulse laser, with which light pulses of very high intensity (peak
pulse power of 30 to 100 Watts) but very short duration (200 nsec) are emitted (Fig. 2). Although
the tissue penetration of laser light with these devices is very much higher, the short duration of
the light beams means that no thermal or even coagulating effects occur in tissues, even at pulse
frequencies of up to 10000 Hz. To this end, primarily the Bahr and Nogier frequency ranges are
used.

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The Bahr frequencies are: Fr.1 – 599.5Hz; Fr.2 – 1199Hz; Fr.3 – 2398Hz; Fr.4 – 4796Hz; Fr.5 –
9592Hz; Fr.6 – 149.9Hz; Fr.7 – 299.8Hz.

The Nogier Frequencies are: Fr.A´ - 292Hz; Fr.B´ - 584Hz; Fr.C´ - 1168Hz; Fr.D´ - 2336Hz;
Fr.E´- 4672Hz; Fr.F´- 9344Hz; Fr.G - 146Hz.

Figure 2: Impulse laser with 90W pulse peak power and integrated
Bahr, Nogier, Meridian- Frequencies and special laser frequencies for
the “Chakra” points; additionally shown, a laser shower with five 30W
impulse laser diodes for area application.

Acupuncture lasers are diode lasers

A big advantage of the diode laser is its high level of efficiency. Whilst the Neodyne-YAG laser
achieves 2-5% and the carbon dioxide laser 5-10% efficiency, that means that 90% and more of
the energy is wasted in heat and not laser light. In contrast, diode lasers reach a level of
efficiency of up to 55%. This also means that no costly cooling system need be installed, which
would immediately reduce their ease of handling. It is for this reason that the diode laser has
been adapted to form an industry standard device, by means of the optical coupling of hundreds
of individual laser diodes. Lasers with an output of 2 kW have been produced, and 6 kW lasers
are foreseen.

Function of the diode laser

With a diode laser, all the components can be accommodated in the smallest possible space, a
fraction of a cubic millimetre. Semiconductor diodes are designed so that negatively charged,
electron-rich and positively charged, low-electron layers are embedded in a crystal matrix. When
an electric field is applied across the diode crystal, electrons move from the electron-rich N-layer
to the electron-poor P-layer. In the laser active zone, only a few atom layers thick, photons are
produced. The resonator is formed from two semiconductor layers which reflect the photons: a
thin layer in which every newly produced photon is forced to travel back and forth in phase with
the existing photons, between the two mirrored end surfaces of the diode. Only when enough
photons are oscillating in phase is their collective energy sufficient to emerge through the front,
semi-permeable mirror of the diode as a laser beam.

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Results of investigations into the effective mechanisms of the therapeutic laser

Physiological basis of laser effects
Research by Popp which established that bio photons play a fundamental role in cell
communication by means of so-called “ultra-weak cell radiation” is one of the most important
pieces of primary research into laser effects. This involves coherent light; in other words, laser
light. The DNA in the cell nucleus can be established as the source of the radiation. These
emissions occur in the infra-red to ultra-violet spectra. It was possible to determine in animal
tumours that with increasing malignancy, the tumour cells lose their mutual light contact that is
important for controlled cell growth. It is assumed that the coherence of the light emissions is
also reduced by other pathological processes, increasing disorder emerges and the resonance
necessary for communication is lost. The use of laser treatment may be practical here in order to
re-establish order. Warnke has specifically made exploratory studies of the infra-red laser.
According to these studies, approximately 70% of the laser energy is reflected from the skin
surface; 15-20% of the entrant energy is dissipated and lost by diffusion in the body tissues. Thus
only 5-10% of the laser energy is absorbed. Absorption is by means of a so-called “antenna
pigment”, the flavoprotein-metal-redox system (Fig. 3), which forms an important link in the
respiratory chain within the mitochondria. Here, absorbed laser photons are transformed directly
into cellular energy. This is particularly beneficial for unhealthy cells and cells in tissue modified
by illness, which have a particularly high energy requirement to perform their functions. The
laser may play a decisive role by providing the necessary energy. Equally, an intense energy
pulse in the nerve cells of the acupuncture points can lead to hyper polarisation and thus to
unblocking of irritations; whereby the demonstrable pain reduction can be attributed to the laser.
The healing of wounds and repair of damaged ligaments are processes requiring high energy
inputs. With laser light, the energy required for the breakdown of waste building blocks and the
synthesis of new building blocks for wound closure can be provided more quickly and ligament
or wound repair accelerated. Important investigations have been made by the pioneer of LLLT,
E. Meister, on this topic, which demonstrated as early as 1969, that the proliferation of collagen
threads and a marked increase in cell activity after 1-3 laser irradiation of wounds. The results
justify the assumption that even in the area not directly irradiated healing is significantly
improved due to the increased diffusion of bioactive substances.

Figure 3: The flavoprotein-metal-redox system in the respiratory chain within the mitochondria.

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More than 300 scientific publications on the effects of LLLT

I personally have almost more than 300 scientific publications on the effects of LLLT. I would
like to select some investigations as representative of the majority of investigated and confirmed
laser therapeutic effects. These established, among other things, the following effects of clearly
defined laser irradiation: vasodilatation with mast cell degranulation, activation of macrophages
and lysozyme, increased circulation in occlusive arterial diseases, treatment of haemangioma,
reduced blood pressure in hypertension, improved capillary circulation in micro-circulatory
conditions, applications for wound healing disruptions, analgesia, for spondylosis related pain
and after a certain time (several weeks of treatment) for curing spondylosis itself, skin-transplant
surgery, for facial paralysis, regeneration of nerve lesions and inhibited nerve functioning.
Further impressive research results are available in the areas of rheumatic therapy, lumbago,
degenerative conditions of the joints, pain control in invasive procedures such as bone marrow
operations, after disc prolapse, dentistry and orthodontics, and orthopaedics, immunology, for
low sperm counts, prostate conditions, sports injuries, infected wounds, corneal ulcers and
lesions, pain relief in herpes neuralgia (Moore et al.).

A particularly interesting study by T. Karu shows by means of in vivo tests on human capillary
blood that laser therapy can considerably increase the clearance of peroxide radicals as measured
by chemoluminescence. Interestingly, the maximum increase in clearance coincided at the peak
of symptoms (viral infection), it was reduced once again during convalescence, and was no
longer observable after recovery. It was also established that the rate of increase was dependent
on the pulse frequency of the laser radiation, the wavelength of the laser light used and the
irradiation dosage. Several investigations confirm a relation between dosage and effect to the
extent that too small irradiation dosages have no positive effect, but then with increasing dosages
an increased effect up to a maximum can be achieved. If the dosage is increased further, the
stimulating effect is reduced until the previous, non-irradiated condition is reached again. Further
studies show that a negative, destructive effect cannot be demonstrated, even with prolonged
irradiation (30 minutes).

Despite these extensive studies, the optimal laser power to be used for therapy and the length of
treatment can still not be clearly established, since there is naturally a considerable difference
between the shaved skin of the laboratory rat and the hairy skin of a dog or horse. On the basis of
my own experience, one can presume an optimal effect on surface structures in veterinary
medicine for laser output of 50-100 mW (continuous beam) or 50 - 100 W peak pulse power
(pulse lasers) over an irradiation time of approx. 20 - 40 sec. For deeper structures, articular
cartilage, ligaments, fistulas, sinusitis, the treatment duration must be increased to approximately
2-3 minutes per point.

The foregoing summary of the current state of knowledge in LLL therapy shows unambiguously
that the laser may be used effectively for the local treatment of traumatised tissue as well as for
acupuncture treatment. Optimal treatment for individual patients thus involves local laser
irradiation in combination with appropriate acupuncture points.

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Fields of laser acupuncture

Healing of wounds
The most simple but nevertheless very effective indication for local laser therapy is the
encouragement of wound healing after trauma or operations; in particular when a rapid resilience
of the wound closure should be achieved or the wound is located in an area which is difficult to
immobilise, such as joints. Even in many cases of infected wounds, where normally long-term
drainage would be required after surgical intervention, per primam healing can often be expected
after laser treatment and suture dehiscence avoided. With wounds with larger loss of skin surface
or after the removal of larger areas of hyper granulation tissue, wound closure normally occurs
very quickly and without complications. With fistula formation and disturbance to the wound
demarcation and above all for deep wounds, laser treatment is to be highly recommended. There
have even been cases of old scars in which the demarcation had clearly not been closed, opening
again after 1-2 laser treatments, cleaning themselves and finally closing up again. Additional
recommended acupuncture points: LIV 3, SP 2; and for demarcation: TH 5 and KID 3.

Local inflammation
Traumatic
Local laser treatment proved effective in the following trauma-related inflammatory conditions:
acute distortion, capsule tearing, pulled muscles and hematoma. The treatment is also very
effective in the treatment of acute and chronic inflammation of the pastern and of acute and
chronic tendonitis. A markedly more rapid and complete reduction of accompanying tissue
swelling and other symptoms of inflammation such as pain and heat also occurs.

Additional to Low Level Laser Treatment (LLLT) two acupuncture points are very important: SP
2 and GB 41. SP 2 is the Tonifying point of the “building energy channel”, Spleen, and so the
“Master point of anabolic processes” in the body. GB 41 is the Prostaglandin point of ear
acupuncture* and works against inflammation.

Infectious
Laser treatment is also exceptionally useful in infectious local inflammations. In many cases of
phlegmonic processes, e.g. after the infection of wounds, in mastitis and even in acute to sub-
acute thrombophlebitis, cure can be achieved when previous treatment with antibiotics has
proved ineffective. Laser irradiation also has an outstanding effect on the maturation and
demarcation of abscesses. This applies, for example, to hoof ulcers or infected inflammations of
the hoof dermis which do not mature and diffusely spread into the rest of the hoof dermis and
which are normally very difficult to manage. Purulent, acute and chronic sinusitis in dogs and
even in horses can usually be effectively treated with laser irradiation, whereby in horses the
affected tooth usually does not have to be extracted and the maxillary sinus does not have to be
trepanned. Lastly, I would like to cite the highly effective option of treating infected joint and
tendon sheath inflammations. At commensurate cost, in most cases excellent treatment success
can be expected here.

Acupuncture points one can combine with the LLLT in these cases are: TH 5, SP 4, GB 41 and
KI 3. TH 5, is the Thymus point at the ear* and is used in two treatment aspects. On one hand it
is used as a confluence point in every treatment of disturbing foci, because it sets tissue
demarcation in motion. On the other hand it is used in combination by Midday – Midnight rule,

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as a Luo point with its partner Luo point SP 4, the Interferon point*, as “wake up points” for the
immune system. GB 41, the Prostaglandin point is used, as the partner Confluence point to TH 5
and works “anti-inflammatory” and “anti- rheumatic” by reduction of Prostaglandin E1. KID 3 is
the most important point for using the body’s inheritance energy and is called in controlled
acupuncture as the master point against “oscillation”. Here “oscillation” means every pathologic
cell radiation which one finds e.g. in every inflammatory process in the body.

Orthopaedics
Laser treatment is used most frequently for spinal problems, all forms of lameness, acute as well
as chronic, in horses and in dogs. But in all conceivable forms of disability with a variety of
causes, in most cases laser treatment is strongly indicated. Very often, costly and unreliable
operations can thereby be avoided, and even conditions not cured or even made worse by
operating can subsequently be alleviated.

Acupuncture points used most often are: LI 4 (Master point against pain), GB 41 (Prostaglandin
point, Master point against rheumatic disease), GB 34 (Master point of muscles), BL 11 (Master
point of bones), LIV 3 (Source point of the Liver), responsible for the muscle energy , SP 2
(Spleen point of the ear* “Anabolic Master point” and for muscle and tendon repair) and other
points, based on location of lameness (e.g. activating the Tendo-Muscular Meridian by treating
the Ting point, the Tonification point and the affiliated Reunion point).

Internal diseases
With internal diseases you normally will not find only liver or only lung or only kidney disease
as normal medicine mostly tells us. In every illness we find combinations of problems in
different channels or, more clearly stated, function circles. But of course we can treat these
western internal diseases as acute and chronic lung diseases, e.g., COPD, liver or bladder disease
or acute or chronic or interstitial nephritis, etc., by laser acupuncture treatment. As in every
especially chronic disease for me it is very important to look for disturbances in the body, like
pollutions, and perturberative fields, like scars and affected teeth, in chronic internal illness as
well. Helpful standard points for liver problems are the tonifying point LIV 8 and source point
LIV 3. This is also the main problem in colic in horses where we can combine SI 3 as master
point of spasm and tonifying point of the small intestine and LI 11 the tonifying point of large
intestine and LI 4 the master point against pain and the source point. In chronic lung disease like
COPD and asthma we find LU 7, the lung point of the ear; KID 7, the kidney point of the ear;
Shu point BL 13, and Mu point of the upper part of Triple Heater, CV17 (Triple Heater is the
Yang partner of Pericardium); and ST 40, the beta-mimetic point of the ear*. In kidney diseases
we can treat as standard the tonifying point KID 7 that is the ear point of Kidney. This point
combines the Yin and the Yang energy of the Kidney. When we have the primary problem with
the only Yin aspect of the Kidney we can use the source point KID 3 and when the only Yang
aspect shall be treated we use GV 3. All these Kidney points are also important when we see a
deficiency in eastern Kidney as we know in most chronic illness and tooth problems and
neurological disturbances.

Gynaecological disorders and birth problems

Gynaecological disorders are normally connected with Spleen and Kidney meridians. So we can
treat points like SP 5, the ovarian ear point*; SP 6, the uterus ear point*; SP 7, the gestagen point

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of the ear*. Also important is the Shu point of Spleen BL 20, and the Mu point LIV 13, which is
the hypophysis or gonadotropin point of the ear*. With these few points we can treat most
gynaecological problems from follicular atresia to behavioural problems in mares that mostly
result from ovarian disorders. In birth problems we also have two very simple points that are
doing a very good job. These are of course the uterus point* and sometimes in situation of
spasms, SI 3. In cases of incorrect fetal positions BL 67 brings the fetus back into the correct
position for birth. The last two points are also effective in cases of retained placenta.

Neurology
Principally, disability in dogs due to discopathy or trauma and in horses due to ataxia should be
mentioned here. Both illnesses are very often curable, however, often at not inconsiderable cost.
Acupuncture points in these cases are very individual. The leading point in every neurological
disturbance is KID 4, the luo point of the kidney meridian, which is very good to combine with
LI 6 the luo point of the large intestine, by the midday – midnight rule.

Eye conditions
With regard to eye conditions, it is principally treatment-resistant corneal injuries, corneal ulcers,
corneal occlusion and also deep eye injuries which may be treated successfully.
Acupuncture points are GB 41, ST 1, TH 23, BL 1 and GB 1.

Local laser treatment as the ideal introduction to acupuncture

If laser treatment of acupuncture points is used to target sympathetic vegetative and humoral
control mechanisms, every local laser treatment can be further improved in their effectiveness.
Acupuncture may be started relatively easily in the areas listed above, using a rather small
number of highly effective acupuncture points. Any acupuncture therapy you can do with
needles, you can do with laser in the same way without any traumatic effect and if you want,
without touching the patient. The straightforward introduction and the possibility it offers of
convincing oneself of the outstanding effectiveness of laser acupuncture in a considerable range
of indicated conditions are strong factors motivating towards making the effort of learning more
about this area. All colleagues who have taken this first step are astonished again and again by
the really significant extension of therapeutic possibilities beyond the known and the hitherto
accepted.

*Every body acupuncture point has a corresponding point at the ear. There is no difference, if
one treats the ear point e.g. the “Lung point” or the identical body point LU 7. Both points can be
treated at the same time to intensify the treatment.

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References
1. Basko I. A New Frontier: Laser Therapy. Calif Veterinarian. 1983; 10: 17.
2. Benson B., et al. Treatment of chronic Back Pain in Horses Stimulation of Acupuncture
Points with a Low Powered Infrared Laser. Veterinary Surgery, 1987; 16, 1, 106-110.
3. Calderhead R.G. et al. A Study on the Possible Haemorrhagic Effect of Extended Infrared
Diode Laser Irradiation on Encapsulated and Exposed Synovial Membrane Articular Tissue in
the Rat. LLLT-Reports. 1992 ; 65-69.
4. Dima F.V. et al. Response of Murine Mammary Adenocarcinoma to Photodynamic Therapy
and Immunotherapy. LLLT-Reports, 1990; 153-160.
5. Gärtner C. LLTP in Rheumatology. Laser Therapy, 1992; 4, 107-115.
6. Ginsbach G. Laser Biostimulation in Plastic Surgery. Laser Therapy, 1993; 169- 173.
7. Karu T.I. Photobiological Fundamentals of Low-Power Laser Therapy. IEEE Journal of
Quantum Electronics. 1987; QE-23, 1703-1717.
8. Karu T. et al. Suppression of human blood chemiluminescence by diode laser irradiation.
Laser Therapy.1993; 5, 103-109.
9. Kerns T. HeNe Lasers Show Promise in Treating Equine Injuries. Lasers & Applications.
1986; Dec: 39.
10. Klide, AM., Martin, BB. Methods of Stimulating Acupuncture Points for Treatment of
Chronic Back Pain in Horses. Journal of the American Veterinary Medical Association. 1989;
10, 1375-1379.
11. Maeda T. Morphological Demonstration of Low Reactive Laser Therapeutic Pain
Attenuation Effect of GaAlAs Diode Laser. LLLT-Reports. 1989; 23-31.
12. Maeno N. Effects of LLLT, Using Helium Neon Laser on Infectious Bovine
Keratoconjunctivitis. LLLT-Reports. 1989; 79-82.
13. McKibbin L. and Paraschak D. A Study of the Effects of Lasering on Chronic Bowed
Tendons at Whitney Hall Farm Limited, Canada, January, Lasers in Surgery and Medicine.
1983; 3: 55.
14. Mester E. et al. Experimentelle Untersuchungen über die Wirkung von Laserstrahlen auf die
Wundheilung. Z. Exper. Chirurgie.1969; 2, 94-101.
15. Midamba E.D. Low Reactive-Level 830nm GaAlAs Diode Laser Therapy Successfully
Accelerates Regeneration of Peripheral Nerves in Human. Laser Therapy.1993; 5, 125-129.
16. Moore, K. C. et al. A double blind crossover trial of LLLT in the treatment of post-herpetic
neuralgia, LLLT Reports. 1988; 7-9.
17. Murakami F. Diode Low Reactive Level Laser Therapy and Stellate Ganglion Block
Compared in the Treatment of Facial Palsy. Laser Therapy.1993; 131-135.
18. Petermann, U. Behandlung von BWS- und LWS-Beschwerden beim Pferd mit
Ohrakupunktur. collegium veterinarium.1989; 20/91-93.

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19. Petermann, U. Lasertherapie in der Veterinärmedizin. Vet Impulse.1998; 24, 12-13.

20. Petermann, U. Laserakupunktur bei infizierter Tendinitis des Pferdes. Prakt. Tierzart, 1999;1.
21. Petermann, U. Acupuncture in Severe Chronic (Allergic) Pulmonary Disease (COPD) in
Horses. Proc. of 31st International Congress on Veterinary Acupuncture, Park City, Utah, USA,
2005; 105-113.
22. Petermann, U. Acupuncture in Emergency Treatment, Proc. of 27th IVAS 2001 World
Congress, Ottawa, Canada, 2001; 45-56.
23. Petermann, U. Laseracupuncture in Post-Operative Fields Veterinary Medicine, Proc. of 27th
IVAS 2001 World Congress, Ottawa, Canada, 2001; 85-98.
24. Rochkind S. et al. The in-vivo-nerve-respond to direct low-energy-laser irradiation. Acta
Neurochir. 1988; 94, 74-77.
25. Rochkind S. et al. Intraoperative Clinical Use of LLLT Following Surgical Treatment of the
Tethered Spinal Cord. LLLT-Reports, 1991; 113-117.
26. Skobelkin O.K. et al. Blood Microcirculation under Laser, Physio- and Reflexo- therapy in
Patients with lesions in Vessels of Low Extremities. LLLT-Reports, 1990 ; 69-77.
27. Trelles M.A. et al. LLLT for Knee Osteoarthrosis. LLLT-Reports, 1991; 149-153.
28. Umeda Y. Blood Pressure controlled by Low Reactive Level Diode Laser Therapy. LLTP-
Reports, 1990; 59-63.
29. Wang L. et al. A Review of Clinical Applications of Low Level Laser Therapy in Veterinary
Medicine. Laser Therapy.1989; 1(4): 183.
30. Warnke, U. Der Dioden-Laser, Deutsches Ärzteblatt, 1987; 44, 2941-2944.
31. Warnke, U. Wie Licht-Energie zu Zell-Energie wird. Ärztliche Praxis Jahrg. 1987; 97, 3039-
3040.
32. Yamada H. et al. Low Level Laser Therapy in Horses. Laser Therapy,1989; 31-35.

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