The stage starts off in the traditional Gradius manner, providing you with an opportunity to power up before the stage truly begins. You will have the chance to collect two Options, Missiles, the Ripple Laser, and a Force Field. In Salamander, the Beruberumus fly in from the center and expand to the outside. (In the Japanese version of Lifeforce, they do the opposite; fly in from the outside and collapse into a single file line in the center of the screen. Though easier to kill, you only have the opportunity to collect five power ups.)
In the first section of the Bionic Germ, you will encounter Death Hands which are tentacles that extend from the ceiling or floor and reach out to grab you. Shoot the orange segment in the middle to destroy them. Cellular growth will also occur, shrinking the size of safe passage, so don't hang out along the sides. Swarms fly by, so zap them for more power ups. Eventually the screen will split between a top path and a bottom path. Cells along the wall on either side of the path will extend. The top path is safer because it offers more space to avoid getting hit, but the bottom path has another power up opportunity, another Option.
You will emerge into a section with blue walls. More Death Hand tentacles will extend from the linings of various walls. At one point, the very lining of this section will morph and extend downward. Octas patrol this area. If you see gold Octas, there is an opportunity for more power ups. However, they stay relatively close to the edge, and attempting to collect them may cause you to collide with the wall. Only go after the power ups they leave behind if they are a safe distance off the ground.
The next section contains the deadly Sharp Crosses. These are the giant fang-like objects which extend from the floor and ceiling. They cannot be destroyed, and must be completely avoided. They move at regular intervals so you should not have much trouble anticipating their approach. More Octas travel through the area, this time dropping Speed Up power ups. Once again, only collect them if it's safe to do so, and avoid the walls.
When you escape from the Sharp Crosses, you will see Hair lining the edges of the screen. Shortly before this, a large growth of cells will extend, creating only a small passage through the middle of the screen. You can accelerate to the right side of the screen to bypass the danger. Soon, pink corpuscles will appear. These corpuscles will expand in size as they get shot until they ultimately become so big that they explode. Shortly after you encounter them, you will also have to shoot your way through a small webbing of tissue. Beyond the tissue, the corpuscles continue for some time. Continue firing straight ahead and you should be able to blow them up before they have a chance to threaten you.
As soon as the corpuscles stop, two Death Hands will extend from regenerating tissue. Destroy the Death Hands by hitting their weak point, and prepare to move up or down. Watch out for the cannon antibodies, and two more Death Hands, then situate yourself in the middle of the wall of regenerating tissue. Begin to blast a hole through the tissue, and stay on the right side of the screen to avoid getting swallowed up when the tissue returns. You will pass through a gap, but don't give up your position; keep firing through to the next very long wall of tissue until you are all the way through. Keep your Options behind you so that they will shoot away any tissue that might be approaching you from behind.
Most of the time spent in the fight against Brain Golem is simply waiting for him to be ready to fight. The tissue surrounding him wears away. Then he unleashes two very long and indestructible Death Hands. Stay in the bottom left-hand corner of the screen as they appear. Once the second hand is fully extended, and nearly pointing toward you, Brain Golem should begin moving. Start by moving up along the left side of the screen and begin to circle around him in a clockwise direction. Eventually the eye ball, his weakness, will open at the front of the brain. As you pass around his left side, be sure to fire continuously at it, but don't stop moving. Keep moving around him. You may not even have to make two passes before he is destroyed and you are on your way to the next stage.
