Abstract: For anyone who has gone through the explanation of Theory of Miasm of different stalwarts the concept becomes more confusing i.e. Hahnemann’s Concept of Miasm may seem different from Kent’s Concept and Sankaran’s Concept. In this article the author explains the evolution of Hahnemannian and Post Hahnemannian Concept of Miasm and their application. Keywords: Hahnemann, Sankaran, Kent, Concept of Miasm, Totality, antimiasmatic medicines, miasm in individuals, miasm in disease, Sulphur, Psorinum, Delusions, Disease.)

Miasms as a concept has always had a love hate relationship with homeopaths right from its conception. It has also been a subject that continues to be controversial, confusing and constantly being redefined since Hahnemann's time. To make matters worse the list of miasms is steadily increasing by the day.

And if anyone ever attempts to read chronic diseases where Hahnemann talks mostly about Psora and links it to every possible affections of mankind, it seems to be poles apart from the colourful pictures of miasms published by the later homoeopaths.

In this article, I have tried to discuss the evolution of miasms; psoric miasm in particular, its relevance and application according to different approaches. For proper explanation the article has been sectioned into three phases:

• Evolution of Dr. Hahnemann's Concept of Miasm.
• Post-Hahnemann Evolution of Miasms:
  • Kentian Concept of Miasm.
  • Sankaran's Concept of Miasm.

HAHNEMANN'S MIASMATIC CONCEPT -

Dr. Hahnemann worked and experimented during his lifetime towards perfecting a system which provided his concept of an ideal cure. He initially classified diseases as Acute and Chronic. However when he was treating some acute conditions, there was an apparent success, ie these cases would do well for some time but soon return with a recurrence of symptoms at intervals; At times the returning symptoms were very similar to those they had before, while at other times there would be an aggravation of the previous condition, or other variations. Considerable study of these cases convinced Hahnemann that there was some underlying chronic cause which was the mainspring of these recurrent acute manifestations.

The deeper cause -

• He realized that he could be treating only an acute part of the real deeper disease.
• These acutes states keep on recurring and this was not what his definition of an ideal cure was all about.

His research and conclusion

He conducted 12 years exhaustive study of documenting his observations in chronic cases with respect to

- Order of symptom appearance as disease progressed in chronological order.

- Classifying patients into groups depending on their starting point of illness.

His research showed an interesting fact that most symptoms almost always began at the level of the skin and mucous membrane. Symptoms then proceeded inwards when the skin symptoms were suppressed. He theorised that these initial suppressions were the fundamental cause of most chronic diseases which followed. This cause was called the miasm.

His experiments identified three groups of skin manifestations -

1. - Group of diseases which followed initial symptom on skin that is 'itch'. These manifestations were termed PSORA.
2. - Group of diseases which followed treatment of symptom on skin that is gonorrhoeal discharge/ wart which he termed SYCOSIS.
3. - Group of diseases which followed initial treatment on skin that is a syphillitic chancre which he termed SYPHILIS.

Hahnemann's book on Chronic diseases is mostly about Psora. He divided all chronic diseases into two classes - psoric and non psoric manifestations. The non psoric miasms were -Sycosis and Syphillis.

Antimiasmatic remedies -

Further he started the process of finding remedies which produce these deeper symptoms along with the acute symptoms. Past history formed an important part of homoeopathic case takings. These so called antimiasmatic remedies when chosen correctly seemed to cure these deeper changes and caused reversal of symptoms in the order of occurrence with the last suppressed symptom erupting at the level of skin before finally curing the patient.

This was the miasmatic theory at work.

EVOLUTION OF KENTIAN CONCEPT OF MIASM -

The later classical homoeopaths differentiated and understood each of these three basic miasms to exhibit a typical peculiar pattern in an individual from their own research and cases.

Miasms as a pattern -

Every constitution is predisposed by his miasm to express a certain pattern of symptomatology in every disease he suffers. They could be elicited in different forms -

Miasm - in individuals - There could be either one or combination of two or more dominant miasms. Fundamental miasm (also called inherited miasm or dominant miasm) is the miasm you are born with. It influences the genotype – your constitution and can be elicited by the constitutional genetic characteristics both physical and mental as well as your family history. The fundamental miasm may lie dormant or could express phenotypically during the disease process (elicited in the past history as well as the present chief complaint).The phenotypic expressions of the fundamental miasm could be latent - When it is subtly expressed in emotional and physical general symptoms or active - When expressed through an evolutionary process as a local disease/sand or organic pathologies.

Miasm - in diseases - Every disease could have either one or combination of more predominant miasmatic patterns but most progress from psora to sycosis to syphillis. It is interesting to see the interplay of miasmatic patterns between the disease and the individual. In most cases the disease progression is largely influenced by the individual's fundamental miasm, vitality and medication. In my experience individuals with a certain fundamental miasm are susceptible to diseases with the same predominant miasm. And even if the disease shows all three miasms in progression it will actively express the miasm similar to that of the individual's fundamental miasm for the longest time. Thus itch is best expressed in a psoric individual, gonorrhoea in a sycotic and syphillis in a syphillitic individual. However a predominant miasm in a particular disease can actually take over and express itself actively and latently to form a layer of another miasmatic pattern and symptomatology traced to the disease itself. This could be different than the fundamental miasms and can completely hide the individual's fundamental miasm and its pattern. Multiple such layers give rise to complex chronic layered diseases.

Miasm - in remedies - Medicines are artificial diseases hence the same concepts apply to them as diseases. They can have either one or combination of more miasms. The latter most prominently found in polycrests. Hence Sulphur is not just a psoric remedy but a multimiasmatic polycrest with a predominant psoric miasm. However it’s worth knowing that there is a syotic sulphur as well as a syphillitic sulphur.

MIASMS AS A PART OF TOTALITY -

Thus miasms are expressed in every symptom- mental (in feelings and expressions), physical (in general and particular sensations and pathology) as well as the personality of an individual. They are expressed in PQRS as well as the common symptoms. They are thus an integral part of totality and hence should be similarly represented in remedy for effective cure in any individual with a chronic disease.

For the present article we will restrict ourselves to study the pattern of psoric miasm.

THE PSORIC MIASM PATTERN IN AN INDIVIDUAL.

Physical Generals and particulars -

• Oversensitivity and Over reactivity to every stimuli eg pain, light, noise, touch etc.
• SOA - Skin and Mucous membrane, PNEI axis.
• PQRS symptoms and valuable concomitants elicited readily with lots of sensations as if.
• Discharges - Clear white watery.
• Pains – intense, sharp with functional pathology.
• Marked oversensitivity to pain
• Recurrent patterns of acute inflammatory reactions or serous inflammations.

Modalities -

- < Emotional disturbances

- < morning

- < slightest exertion

- > rest, sleep.

- > quiet

Conditions encountered are eg recurrent rhinitis, gastritis, acute arthritis, pleuritis, stress diabetes, relapsing fevers etc. All functional changes along Pycho- neuro- endocrino- immunological axis.

Mentals -

• Oversensitive emotionally eg sensitive to hurt, reprimand, pain etc . Lots of fears and anxieties at trifles, dark, strangers, alone, death etc.
• Overwhelmed by emotions. Expresses as over reactivity eg irritability, easily offended, weeps easily, expresses fears by fight or flight reactions.
• Overreactivity and constant struggle against circumstances and situation.

THE PSORIC MIASM PATTERN IN DISEASE - I will use atopic dermatitis as an example. Most would consider this to be a purely psoric disease however this disease shows a progression from psora to syphillis depending on the individual's fundamental miasm.

Here is the psoric expression of the condition -

• Psoric eczema expresses as a borderline dry skin to an extremely rough, red, scaly and itchy skin with a typical Unwashed unhealthy appearance. Scratching can cause occasional weepy skin discharging but with clear serous fluid which heals quickly.
• In Infants - it usually starts between 4 to 6 months of age and the baby develops a red rash. It appears on the cheeks and may spread to the forehead and the backs of arms and legs.
• Psoric Eczema in infants usually disappears between the ages of three and five years.

Its worth knowing what is not psoric pattern in atopic dermatitis – and that could be for example, a bleeding cracked skin, with excessive scaling or a wet weepy skin gluey discharge and recurrent infections.

CHOOSING THE REMEDY IN CASES USING KENTIAN ANALYSIS - As we know to bring about a complete cure it is extremely critical to choose the remedy which covers the fundamental, latent and active miasm in a patient along with the peculiar symptoms. The so called 'miracle cures' with single remedies happen only if one miasm lies behind the whole phenomena or the same remedy covers the fundamental, latent and active miasms.

In most complex cases with multiple miasmatic patterns from different causative factors you need to understand the order of their evolution and causative phenomena and uncover every layer formed from the most superficial progressing deeper until to get to fundamental miasm of individual.

If you give a remedy covering just the symptoms and not the miasm, a stage might come where you need to use a nosode to overcome a so called miasmatic block.

EVOLUTION OF SANKARAN’s CONCEPT OF MIASM -

Sankaran derived the understanding of miasms evolved from his theory of Disease as a delusion. The whole mental state of a person or remedy is expressed in the form of a specific delusion. This false perception is a sort of a lens through which they view the world and live their life in. Studying hundreds of cases in practice has helped him realise that the disease makes someone react not according to present but according to this delusion. This further is expressed as signs and symptoms and pathology. Cure is awareness of this delusion. One way of achieving this, is by prescribing a remedy whose delusion matches the delusion of a person.

Using Hahnemann's miasmatic classification of Miasms and the key antimiasmsatic remedies from each miasm he derived his concept of miasm.

• The first step was to deriving the delusion of each known antimiasmatic remedies of a particular miasm from its mental state, from materia medica, repertories and cases by studying the deepest feelings, delusion section of repertories and dreams.
• The next step was to understanding the common theme of these remedies in one particular miasm to derive his concept for that miasm.

Following our story of the psoric miasm we will look at his concept of the PSORIC MIASM -

He has used the well known antipsoric remedies Sulphur and Psorinum for the initial study.
Step 1 is deriving the delusion of both these remedies using their rubrics and materia medica symptoms. For this I have given the repertorial extraction of the deepest feelings delusins, dreams and expressions of these remedies using the remedy comparison section of the HomeoQuest Software.

SULPHUR DEEPEST FEELINGS AND DELUSIONS

Del disgraced
Del scorned
Del embarrassed
Del Body black
Del Thin getting
Del Poor getting
Del diminished
Want fancied that he would come to.
Del great person he is
Del wealth of
Del tall, things grow taller.
Imagines he is a great man
Fear poverty

SULPHUR EXPRESSIONS -

Successful side -
Creative, Plans makes many.
Inquistive
Talks of business
Busy
Censorious, Critical
Courageous
Egoistic and haughty

Failed side -

Indifference to personal appearance
Foolish pride and happiness
Considers rags as silk
Aversed to business
Cowardice
Discontent and displeased.
Disgust.

This gives us the delusion of Sulphur -

• Someone who is being scorned, suppressed, put down, criticized.
• How does he react to it?
• He needs a constant effort, a struggle to come up again to be someone and earn respect/ego.
• Failing this he will face scorn and may become indolent and show complete lack of effort

PSORINUM DELUSIONS AND EXPRESSIONS -

• Despair of recovery during convalescence
• Fear of poverty
• Feeling that his business will fail though it is prosperous
• Del going to lose fortune
• Fear misfortune and disaster
• A/f Anticipation
• Feels good and bad in turns
• Sick imagines himself to be.

This gives us the delusion of Psorinum -

• Someone who feels his health will fail, he will lose his fortune, he will be sick and not recover. In a way he will lose something.
• How does he react to it?
• He is in despair and anxious but it is not the end of the world. He is in convalescence and doing well. Just lacks confidence and makes constant effort to sustain it.

Step 2 - Deriving the miasm -

• The delusion of each of these remedies is different but remedies but they show a similar way of coping or reacting to the delusion.
• According to him Miasms are these reactions and coping mechanisms. The attitude they adopt to a situation in life.
• The depth, the pace and the desperation with which you perceive or experience the delusion and the sensation are his concept of the miasm.

SANKARAN'S PSORA

The situation is some Stress from outside .And the way they cope is by Struggle ,to achieve and maintain the state with lot of anxiety, doubt about his capacity and lack of confidence to deal with stress.

Psoric personality -

• Hopeful
• Failure is not the end of the world
• Lacks confidence
• Constant fears and anxieties
• Under pressure and stress
• Anticipatory anxiety
• Restless active, struggles with problems
• Dreams varied, many
• Expressive, describes complaints very well.
• Nervous hyperactive personalities
• Hope and despair but despair is not the end of the world.

This is the understanding he uses when he works out his miasm during his case taking process. However this is a concept that can be elicited only when a case is taken according to delusion or sensation method. Applying Sankaran's concept of miasms in a case taken the Kentian way and vice versa is a recipe for disaster.

So in my practice - When I choose to take and analyse a case using the Kentian analysis, I use the miasmatic understanding related to that analysis. Similarly if I take a case using the delusion or sensation method then I use his understanding of miasmatic concept.

Having experimented different approaches and concepts in practice and realising the pros and cons of each in various patients, today I choose an individual approach/method to suit my patient's need and then apply its related miasmatic understanding.

This article is copyright Shilpa Bhouraskar 2010, all rights are reserved by the author.
Please visit her at http://www.homeoquest.com and at her blog http://www.homeoquest.com/blog/.