IV Ozone Therapy (Major Autohemotherapy - MaH)

Uses, Benefits, Side Effects, Protocols, and Ozone Therapy Training
Table of Contents

At a glance:

  • IV ozone therapy is the administration of medical grade ozone and oxygen gas into the blood.  A small amount of blood is pulled from the body, mixed with ozone gas, then reinfused.
  • Benefits of IV ozone therapy include immune modulation, improved oxygen efficiency, increased microcirculation, and modulating oxidative stress.  Ozone therapy is used for a wide variety of diseases but is most commonly applied for lyme, autoimmune disorders, mold toxicity, cancer, and general optimization.
  • People generally experience an increase in energy, cognition, and a decrease in pain.
  • The safety of ozone therapy has been demonstrated to have a lower adverse event rate than the use of aspirin.  The most common negative side effect is a herxheimer reaction because it activates the immune system which kills a lot of pathogens and can leave the patient feeling unwell for a short time.
  • Ozone therapy training for practitioners is available here
  • The protocol for autohemotherapy ozone involves drawing 200mL of blood, mixing it with ozone gas, and then infusing it back into the patient.

What is IV major autohemotherapy (MaH) ozone therapy?

IV ozone therapy is the administration of pure medical ozone gas intravenously.  While it is used in hundreds of thousands of patients every year, it is not yet FDA approved and therefore receives controversy, despite having over 2,000 medical studies.

First, a small amount of blood is withdrawn from the patient and into a bag premixed with saline and heparin.  Then, ozone gas is infused into the bag with the blood.  Lastly, it is infused back into the vein.  The entire process takes about 45 minutes.

IV ozone therapy is often called major autohemotherapy or MaH.  

What are the benefits of intravenous ozone treatments?

Ozone therapy stimulates the body toward homeostasis by creating a mild, acute oxidative stress and activates the NRF2 pathway (the same pathway activated during exercise and fasting).    Among many mechanisms of action, ozone therapy is able to increase the body’s natural antioxidant production, enhance oxygen metabolism, and modulate the immune system.

Simply put, ozone is stimulating the body to balance and optimize important systems, such as the immune system, energy systems, blood circulation, and more.  This leads to a cascade of benefits and why clinicians use it in a variety of diseases or athletic enhancement.

Proven Benefits

  • Block the virus’ ability to replicate by balancing the cellular redox state  
  • Modulates the immune system to help with infections and pathogens  
  • Improves oxygenation  
  • Improves microcirculation  
  • Corrects chronic oxidative stress  

Other Purported Benefits of Ozone Therapy

  • When used with blood, deactivates the virus which creates a natural vaccine
  • Elimination of senescent cells.  Cells that are old are supposed to go through a self-destruction mechanism and eliminate themselves from the body.  However, senescent cells get old and never go through this process.  They build up and make the body less efficient

What the patient experiences

  • Increased energy and stamina - Due to improved oxygen efficiency and metabolism
  • Sense of wellbeing - Patients commonly report improved mood and slight euphoria
  • Decreased pain and discomfort - Reduces inflammation which may help to reduce pain.  Also calms down autoimmune discomfort by quieting down the immune system (immune modulator)
  • Improved clarity/decreased brain fog - Due to improved oxygen efficiency and metabolism

Ozone Therapy Diseases Treated

Ozone therapy has many uses because of its fundamental improvement of systems in the body.

In the same line of thought, how many diseases can exercise improve?  Nearly all.  Although it’s not a fair comparison, as nothing will ever replace the need and benefit of exercise, ozone therapy stands on a similar principle.

Ozone therapy works with fundamental systems in the body.  When you look at the research, it almost looks intelligent.  In one study, they looked at patients with hypoxic portions of the brain.  The group of patients that did ozone therapy had an improvement of blood flow and oxygen delivery to the parts of the brain that needed it, but not the others.  Similarly, other studies have observed ozone therapies ability to calm the immune system down if it’s overactive or boost the immune system if it’s underperforming.

How can ozone therapy possibly know to do this?

Well, it’s not the ozone.  It’s YOUR body that knows what it needs.  Ozone therapy acts as the catalyst to enact the intelligence of your body, thereby appearing intelligent.  This therapeutic agent is used in so many conditions because it enacts the intelligence of your body and gets your systems to optimize or function correctly.

These are common reasons IV ozone therapy is used:

And more.

Examples of Studies and Research

IV Ozone for Athletes

Two good studies have been conducted to show the effects of IV ozone therapy for athletes.

The first study included two groups of semi-pro soccer players in Turkey.  The aim of the study was to observe the effects of IV ozone therapy on Vo2 max, indicating endurance and energy.

One group received IV ozone therapy and the other group did not.  

Here is what the study found

“The difference in performance increase was found significant between football players who were treated and not treated with ozone therapy. All athletes performed the same training program for 8 weeks. VO2max was increased 28% in ozone therapy-treated athletes but it was increased 12% in the control group. Max running time was increased 20% in ozone therapy-treated athletes, and it was increased 6% in the control group. In terms of these results, we can say that ozone therapy will be very effective for increasing athletic performance before season or tournaments.”

As you can see, IV ozone produced a significant improvement in Vo2 max over a short 8 week period.  While 28% improvement doesn’t seem like a lot, in young, professional athletes this is a substantial increase and should be cause for consideration of all athletes.

Another study done looked at a similar response.  They observed the effects of ozone therapy on anaerobic threshold, indicating oxygen efficiency.  Someone with a higher anaerobic threshold uses and delivers oxygen to create energy more effectively.

Here is what they found, 

“The fact that a cycle of MAHT had an effect on AT is further evidence of how oxygen-ozone

therapy interacts at several levels. On the one hand the treatment allows the aerobic reserve to be fully exploited by boosting metabolism; on the other it ensures enhanced peripheral delivery of oxygen also by virtue of its effect on erythrocyte 2,3-diphosphoglycerate… In addition to a subjective feeling of well-being and “lightness in the legs”, our athletes had much shorter recovery times. This could be due to both the raised AT and the frequent drop in heart rate during exercise.”

This study indicates that ozone therapy may have a significant impact on athletes:

  • Improved heart rate
  • Improved oxygen delivery
  • Improved energy production
  • Reduced recovery time
  • Improved feeling of wellness

They did note in these studies that athletes typically feel more tired the day after an IV ozone treatment.  This is why athletes should NOT do IV ozone within two days of an important athletic event or game.

IV Ozone for Cancer Patients Undergoing Chemotherapy

It seems that the research on ozone therapy strongly indicates that it improves overall quality of life and helps with toxic side effects of conventional treatments.  More clinical research is needed in other areas on cancer to verify just how helpful it is, with which method, and how much should be done.  It certainly does appear to be safe and not cause any additional harm based on the research above.  

Doctors and patients will have more robust stories on their experiences with cancer and ozone therapy.  Mostly because they are not confined to the progress of research on a non-money making therapy.

If you are doing or considering chemotherapy, ozone therapy has been researched to reduce the toxicity of chemotherapy.  

A review on the use of ozone therapy in adjunct with chemotherapy states the following:

“Ozone therapy can induce a controlled oxidative stress able to stimulate an adaptive antioxidant response in healthy tissue. This review describes the studies using ozone therapy to prevent and/or treat chemotherapy-induced toxicity… In vitro and animal studies, as well as isolated clinical reports, suggest the potential role of ozone as an adjuvant during radiotherapy and/or chemotherapy.” 

In other words, they found ozone therapy reduced the toxicity of the chemotherapy undergone by the patient.  It did this by keeping the cells healthy through increasing antioxidant production.

In the image above, it shows ozone therapy as a preconditioning agent for chemotherapy by improving antioxidant markers.  Studies show that this will significantly improve quality of life for those undergoing chemo.

On the same note, another study found:

“Patients with prostatic cancer were treated with cobalt-60 therapy and ozone (rectally), decreasing the presence of side effects (due to radiation treatment) and the prostatic specific antigen figures… In spite of the positive ozone biological effects, its potential usefulness as an adjuvant in chemo-radiotherapy and its antimetastatic effect

And this was verified under yet another study, that stated: 

“modulation of free radicals and antioxidants by ozone therapy was associated with decreased chemotherapy-induced toxicity.”

One study observed a high percentage of cancer patients significantly reduced fatigue with the use of ozone therapy:

“Fatigue may be cause by all cancer treatments, maybe because the tissue damage or the build-up of dead cells derived products…Patients were treated with Auto Hemotransfusion (GAE) according to the SIOOT (Scientific Society of Oxygen Ozone Therapy) protocols…No side effects were found, and 35 patients (70%) achieved a significant improvement (> 50%) of the symptoms.”

Essentially, it reduces the negative side effects of chemotherapy and helps the body to maintain a healthier terrain.  So the patient experiences a better quality of life with ozone therapy.  

IV Ozone for Hypoxic Brain

Transcranial Doppler and carotid ultrasound studies have demonstrated significant increases in systolic and diastolic velocities in the middle cerebral artery (MCA) and a substantial rise in blood flow in the common carotid artery (CCA) following ozone therapy. These findings suggest reduced vascular resistance and enhanced cerebral perfusion, which are essential for optimal brain function.

Ozone therapy mitigated the vasoconstrictive effects induced hypoxia and allowed for proper blood flow and oxygen delivery.

Studies have indicated that older individuals and those with lower baseline blood flow may experience more pronounced positive effects from ozone therapy, potentially making it an option for cerebral blood flow issues and stroke.

One patient, named Amber, lost her ability to speak and became paralyzed from a stroke.  She gained those functions back after ozone therapy. 

What are the Effects of Ozone Therapy on the Body?

Ozone therapy has a number of positive effects on the body.  This review study details the biochemical effects of IV ozone:

  • Improving oxygen efficiency: Ozone helps signaling to move more oxygen into the cells and making it more available for energy production.  This makes the mitochondria, the energy production part of the cell, more efficient in their energy production and improving overall cell function.
  • Boosting energy production: Ozone enhances a process called glycolysis, which is how the body creates energy (ATP).  Ozone also increases the amount of 2,3-DPG available in the body which helps with oxygen delivery.  The increase of these two things allows oxygen to be more readily released from red blood cells and into the tissues that need it most. 
  • Improving nitric oxide production: Ozone therapy boosts nitric oxide (NO) synthase, an enzyme responsible for making nitric oxide.  Nitric oxide is responsible for relaxing and opening up blood vessels to create proper blood flow. 
  • Enhancing red blood cell function: Ozone therapy has been observed to stimulate erythrogenesis, the creation of new red blood cells.  However, this usually occurs after a number of treatments, not just one. 
  • Improving blood circulation and oxygen delivery: Ozone therapy affects the production of prostacyclin, increasing it as needed to open up blood vessels.  This leads to improved blood flow and oxygen delivery to the needed tissues.  
  • Antioxidant Stimulation: One of the primary mechanisms of ozone therapy is to stimulate the body’s antioxidant defense system.  Oxidative stress is an imbalance of free radicals and antioxidants.  Chronic oxidative stress is the most fundamental cause of aging and disease.  While supplementing with antioxidants such as glutathione is great, getting your body to naturally produce more is the best road to longevity, prevention, and getting out of a slump.  The increase in antioxidant enzymes neutralizes or mitigates the chronic oxidative stress, leading to better outcomes in many areas.  One study actually found that preconditioning with ozone will prevent significant amounts of damage in a traumatic event, such as a heart attack.  Below is an image of heart attacks induced in groups of rats.  On the right, you can see almost normal looking heart function for the group preconditioned with ozone therapy.
  • Modulation of the Immune System: A number of studies have remarked on ozone therapy and its immunomodulatory effects.  The immune system is a delicate balance, you don’t want too much or too little.  So ozone therapy stimulates it back to the correct levels, which is why it can be used in the case of an autoimmune disorder or immune suppression.  For many chronic infections such as lyme and mold, this is helpful to improving the immune systems fight against the infection.
  • Reducing Inflammation: Chronic inflammation is a common factor in most chronic diseases. Ozone therapy has been suggested to reduce inflammation, which could potentially improve overall health and the function of various body systems.
  • Pain Relief: Some studies suggest that ozone therapy might have analgesic (pain-relieving) effects, which could be useful in conditions such as chronic pain or arthritis.
  • Cellular Metabolism Enhancement: By improving oxygen utilization, ozone therapy may boost overall cellular metabolism. This assists the cell’s ability to regenerate and work more effectively.  

As an example for one of the parameters affected by ozone, here is a list of clinical trials that are currently being run to identify ozone’s ability to improve circulation and blood flow.

Is IV ozone safe?

We have put together a comprehensive safety review of ozone therapy that looks at all forms of literature on the subject, both positive and negative.  You can read the safety review on ozone therapy here.

Ozone therapy safety is a concern to people because conventional medicine says, “ozone therapy is a scam” or “ozone therapy is toxic and dangerous”.  

However, it’s usually rooted in a lack of knowledge around the subject.  People don’t say this because they hold an in depth knowledge around the science of ozone therapy.  Usually they are making a sweeping judgment based on their paradigm.  

There are a few out there who have “debunked” ozone therapy using straw man arguments.  For example, a YouTuber chemist “debunked” ozone therapy using the classic straw man argument, propping up an illegitimate source of information, in order to debunk it.  This is akin to me saying, “I’m the best basketball player in the country” then proceed to play a 3 year old in a game of basketball to prove my point.  

A legitimate area of concern is breathing large amounts of ozone gas.  It is well accepted by both ozone therapists and conventional practitioners that ozone cannot be breathed.  

Why can ozone be used in blood or other parts of the body if it cannot be breathed?

There is no antioxidant defense system in the lungs.  So when you breathe ozone gas it can cause irritation.  

Dr. Bocci established the scientific understanding of how ozone can be safely applied.  When ozone is infused into the blood, colon, or other areas used for ozone therapy, it interacts directly with the antioxidant system.  Your body is protected against the oxidative properties of ozone and cascades into the other benefits elicited by the treatment.  

Insert demonstration graphic (ozone cannot be breathed into lung.  No antioxidants.  It can be applied to other parts of the body where antioxidants are present.

A report was conducted by the World Federation of Ozone Therapy.  They evaluated over 300,000 ozone therapy treatments.  In the report, they found that ozone therapy had an adverse event rate of 6 out of 100,000 treatments.  All of which were minor. 

Ozone therapy has a higher safety record than the use of aspirin.

What are the possible negative side effects of ozone therapy?

The vast minority of people experience a negative side effect.  

The most notable negative side effect of ozone therapy is the Herxheimer reaction.  A Herxheimer reaction happens when the patient has an immune system burdened with viral, bacterial, or fungal infections.  Ozone therapy stimulates the immune system.  Then the immune system kills off lots of pathogens, creating a rapid release of endotoxins from the dead pathogens.  This can make people feel sick if it happens too quickly.

The largest IV ozone therapy risk is a Herxheimer reaction.  This is not comfortable and can make the patient feel tired or sick for a few days.  

Herxheimer symptoms include:

  • Headache
  • Nausea
  • Diarrhea
  • Muscle pain
  • Fatigue
  • Fever
  • Rash
  • Swelling

However, it’s avoidable by starting on a lower dose for immune burdened patients to lower ozone therapy risk.  The dose can be increased as tolerated by the patient until the standard dose is reached.

It is not uncommon for a chronically sick patient to feel worse after the first 2 - 4 treatments, then start to feel immensely better for treatments thereafter.

There are other potential negative side effects of ozone therapy outside of a herxheimer reaction:

  • Therapy anxiety (seeing blood can give people anxiety)
  • Fatigue (if they receive too much ozone, it exceeds their antioxidant capacity and they have to regenerate antioxidants, causing fatigue for a day or two)
  • Headache

Are saline bags suitable for ozone IV treatment?

Ozone is a strong oxidant.  Saline bags are made of plastics that break down in exposure to ozone.  You CANNOT inject ozone into a saline bag without blood.  The blood MUST be present in the bag prior to infusing the ozone.  

The reason is because ozone interacts instantaneously with the blood and breaks down into it’s subproperties immediately, due to the robust antioxidant system.  However, if only saline is in the bag, ozone does not readily bond with the saline and stays in the bag.  Ozone, being a strong oxidant, then oxidizes the bag and produces microplastics, which would then be infused into the patient.

Most doctors are using saline bags in IV ozone therapy but the blood must be present within the bag prior to infusing ozone gas.

How much does IV ozone therapy cost?

Ozone therapy cost is generally in the $150 - $300 per treatment.  Five to ten sessions are often prescribed.  But pricing can vary based on the clinic and location.  

IV ozone cost can also vary on the protocol, add-ons, packaging, and form of ozone therapy.

What IV ozone therapy equipment is needed?

The practitioner will generally spend around $10,000 for getting started with ozone therapy.  This includes the equipment and training.  Medical practitioners can join a free training call with an IV ozone nurse by clicking here.

Is there Hands on ozone therapy training for doctors?

Yes, there is hands on training on ozone therapy for medical practitioners.  You can find it here.

Why are there differing IV ozone protocols?

The literature on IV ozone therapy is quite expansive though much of it is summarized in this book. You will see many protocols mentioned such as EBOO, 10 Pass, HiDose and more. The protocol we use, Major autohemotherapy with 150-300mL of blood, has by far the most research and is the most tried and true method of ozone therapy.

It’s backed by 500+ studies and honed over decades.  In consideration of all the different IV ozone protocols, this one has the most evidence of safety and effectiveness.

This protocol minimizes costs by using existing supplies, maximizing your clinic's efficiency and profitability. So there is less expense for the clinic and the patient while still giving the best protocol available.

IV Ozone therapy protocol (Major Autohemotherapy - MaH protocol)

How to do IV ozone therapy.

Equipment Required

  • Medical Grade Ozone Generator
  • Oxygen Tank Regulator
  • Oxygen Tank (Medical)
  • Syringe Fill System
  • IV Pole

Disposables Required

  • 20g or 22g IV Catheter
  • IV Start Kit
  • IV Administration Tubing (without a filter) or Blood Filter IV Tubing 
  • 60 cc Silicone Ozone Syringe x4  
  • Safety Scalp Vein Set - 23g Butterfly Needle with 12in Extension Tube (used to add ozone gas to IV Bag after blood collection from patient)
  • Sodium Chloride 0.9% saline (120 mL)
  • Option A: Use 500ml Normal Saline Bag - infuse 380ml to patient leaving 120ml in the bag for IV Ozone 
  • Option B: Transfer 120ml Normal Saline into a 500ml or 1000ml TPN Compounder Bag to use for IV Ozone
  • Heparin (1,000 units per ml or 5,000 units per ml)
  • 1ml Syringe / with needle 
  • Drape Cloth / Chux
  • Gloves
  • Alcohol Pads
  • Gauze 2x3
  • Coban


  1. Prepare blood collection bag
  1. Option A: 500ml Normal Saline Bag
    1. Prime IV Tubing with normal saline
    2. Obtain IV Access
    3. Attach Tubing to IV Catheter
    4. Infuse 380ml of NS into the patient
    5. Stop the infusion with 120ml remaining in the saline bag
    6. Add Heparin 2000 Units - 5000 Units (Per Provider Discretion)
    7. Go to Step C below
  1. Option B: Transfer 120ml of 0.9% Normal Saline into an empty 500ml or 1000ml TPN Compound bag.
    1. Add Heparin 2000 Units - 5000 Units (Per Provider Preference)
    2. Prime IV Tubing 
    3. Obtain IV Access
    4. Attach Tubing to IV Catheter
    5. Go to Step C 
  1. Place Saline with Heparin mixed bag onto a clean surface (drape/chux cloth) below the patient’s heart.  
  2. Open clamp on IV tubing and allow blood to backfill by gravity to collect a total of 200ml of patients blood
  3. Ensure the line is clear and blood is flowing throughout procedure
  4. Once 200ml of blood collected - total of 320ml in the bag (120 Normal Saline + 200ml Blood) - clamp the IV Tubing and place bag on the IV Pole
  5. Collect 200ml of ozone gas from the ozone generator using 60mL ozone syringe at the predetermined ‘gamma’ dose (see Dosing Guide Below)
    1. To collect Ozone Gas from Generator:
      1. Ensure Ozone Generator is plugged in to electrical source
      2. Attach Oxygen Regulator to the Oxygen Tank (‘open’ the Oxygen tank with a church key to allow oxygen to flow)
      3. Connect Silicone Oxygen tubing from the Oxygen Tank to the back of the Ozone Generator
      4. Using the graph on the top of the Ozone Generator identify the desired ‘gamma’ dose. 
      5. Based on desired gamma dose - follow the graph of the top of the ozone generator for
        1. setting the L/Min flow rate on the Oxygen regulator and
        2. Setting the ozone generator dial
          1. For example: Gamma of 35 gamma - the oxygen regulator will be set at ¼ Liters per min flow rate and the ozone generator dial will be set at 7. Producing 35 gamma per ml
      6.  Collect a total of 200ml of ozone gas based on desired gamma (total of 4 syringes: 3 at 60ml and 1 at 20ml)
      7. Keep full 60ml ozone syringes in an upright position to avoid ozone gas from escaping
      8. Turn oxygen regulator back to 0 and ozone generator dial off
  6. Infuse ozone gas into the bag with 200mL of blood
    1. Attach the Safety Scalp Vein Set - 23g Butterfly Needle with 12in Extension Tube to the 60cc ozone syringe
    2. Insert the butterfly needle into the administration port of the IV Bag
    3. Slowly infuse all 4 ozone syringes of the gas into the blood.
    4. Gently rock the bag back and forth for 30-60 seconds
      1. You should see the contents turn a brighter red.
  7. Unclamp IV Tubing and allow blood mixture to administer to patient via gravity
    1. Note: it should not take longer than 30 minutes
  8. Ensure the line is clear and blood is flowing throughout procedure
    1. Troubleshooting if blood is not flowing
      1. Assess patency of the IV Administration Tubing by
        1. Flushing the line with Normal Saline both towards the patient and towards the saline bag
        2. If clotting in IV Administration line suspected and unable to obtain patency with flushing
          1. Obtain IV Access in another site
          2. Disconnect IV bag from current IV Tubing
          3. Attach new IV Tubing to full bag
          4. Prime new IV Tubing
          5. Connect new IV Tubing / bag to new IV site
          6. Discontinue original IV access site
  9. Upon completion, discontinue IV and apply pressure dressing

Frequency / Titration

  1. Initial IV Ozone Therapy: (New patient to IV Ozone)
    1. Suggested series of 4-8 infusion treatments
    2. One to two IVs per week is the maximum recommendation per patient.  
    3.  If the patient is sensitive to the IV, such as a herxheimer response, reduce frequency and dosing 
  2. Titration of Gamma Dose
    1. If positive or neutral response to prior infusion:
      1.  Increase Gamma Dose by 5-10 with each subsequent IV Ozone treatment to a max of 70 Gamma (Reference Chart Below)  
    2. If fatigue, headache, achiness / herxheimer response to prior infusion
      1.   Reduce gamma dose by 5-10 and/or…
      2.   Reduce Use same dose but decreased frequency per week
  3. Recommended titration schedule based on clinical indications- SEE CHART BELOW

Absolute Contraindications

  • Allergy to heparin
  • Pregnancy
  • Heart disease that has not been consulted with Physician


  • Glucose-6-phosphate dehydrogenase deficiency (favism, acute haemolytic anemia)
  • Patient on blood thinners (Provider discretion)
  • High blood pressure
  • Low blood pressure


Recommended Reference Guide for Dosing and Frequency

**Follow up titration dosing in order of visits. Increase Gamma Dose by 5-10 with each subsequent IV Ozone treatment to a max of 70 Gamma 


F/U- Follow Up

qoM- Every other Month

1/M- One per Month

Res- Resolution

CP- Chronic Pathogen

Image Source: Zotero



[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313773/

[3] https://pubmed.ncbi.nlm.nih.gov/25218903/

[4] https://www.ncbi.nlm.nih.gov/pubmed/28097518


[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674660/





[11] https://www.ncbi.nlm.nih.gov/pubmed/23253326

[12] https://www.springer.com/gp/book/9789048192335

[13] https://www.ncbi.nlm.nih.gov/pubmed/15582356


[15] https://cdn.shopify.com/s/files/1/0507/7129/6441/files/ozone_therapy_on_aneorobic_threshhold.pdf?v=1690850949

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC538510/

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334138/

[18] https://link.springer.com/article/10.1007/s10517-014-2358-7


[21] https://www.mdpi.com/2076-3921/8/12/588

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