Organon & Philosophy

Miasms in Case Management – IV – The Way Forward with the Theory of Miasms

Written by Leela D'Souza

Once we have throughly understood the miasmatic concepts Hahnemann introduced in the CD two points become clear:

1. Hahnemann’s genius for perception of disease, its origin, progression and ultimate consequences, was truly phenomenal for his day and age.

2. The variations in interpretations of Miasm prevalent can be clearly assesed with regard to how far they deviate from the original concept and how effective they are in clinical management.

It must be stressed that reading only the Organon to form an idea of the multifaceted concept of Hahnemann’s’ miasms is incomplete and could give one an erroneous idea of its multidimensional application.

Part IV: The Way Forward with the Theory of Miasms

How relevant is Hahnemann’s Theory of Miasms today?

Given the number of interpretations and misinterpretations of Hahnemann’s Miasm Theory today, its relevance is an important aspect to address. Once we understand exactly WHAT Hahnemann himself meant when he introduced the Chronic Diseases, we have a better idea of how we should approach different concepts that have been derived from it. Has the Chronic Diseases been interpreted based on a thorough understanding of the clinical applications of miasms? Many concepts of this Theory that Hahnemann mentioned in his writing seem to have gone largely unnoticed.

But inspite of that, my hope is that each of us as homeopaths aspire to learn a method of miasmatic interpretation for long term case management that is time tested and based on all the general concepts that Hahnemann introduced in the Chronic Diseases. Miasmatic management is an invaluable tool in curing serious chronic diseases. My articles Part II and part III detail two of these time tested concepts. I felt this needed some more clarification with a comparative study, along with a concrete idea of a working method for case management. Hence I decided to follow up with this article and a few illustrative case examples.

Once we have throughly understood the miasmatic concepts Hahnemann introduced in the CD two points become clear:

1. Hahnemann’s genius for perception of disease, its origin, progression and ultimate consequences, was truly phenomenal for his day and age.

2. The variations in interpretations of Miasm prevalent can be clearly assesed with regard to how far they deviate from the original concept and how effective they are in clinical management.

It must be stressed that reading only the Organon to form an idea of the multifaceted concept of Hahnemann’s’ miasms is incomplete and could give one an erroneous idea of its multidimensional application.

Modern Medicine, through Medical textbooks, have taken pains to name various clinical conditions (syndromes) and infections in an attempt to create some order in the chaotic world of disease expression. Inspite of this detailing of symptom presentation for a diagnosis of disease, these authors (all well-read and experienced MD’s) would be the first to admit it is often difficult to get a grasp of a clear diagnosis when a patient presents clinically. When diagnosis becomes the only basis for treatment (as in Modern Medicine), one is lulled into a false sense of complacency that after making a diagnosis, one has the answer to treating disease! A truly sincere MD will confess that more often than not in the clinical situation, they have NO IDEA what (disease) they are dealing with, much less being able to cure it!

What is helpful to us (as homeopaths) in Medical textbooks, besides giving names to identify various infectious diseases, is that each disease diagnosis is accompanied with possible “complications” of that disease or disease syndrome that have been observed clinically. This is very helpful to a truly miasmatically oriented homeopath. Expecting complications in clinical situations is dependent on the correct or incorrect remedy being prescribed and on the miasmatic background of the patient.

If the remedy is not a miasmatic similimum or is a partial similimum that does not cover the miasmatic expression, then there will be a deterioration of the clinical condition (complication) towards a more obvious expression of the predominant miasm in that individual. The answer in this situation, is to find the miasmatically correct similimum or else the miasmatic specific intercurrent, depending on how one reads the clinical situation and the symptom expression. This line of thought allows a homeopath well versed in miasmatic management, to handle most medical complications and serious pathology in an inpatient hospital set up, just as those of the dominant school of medicine do today. Doesn’t this, then, give the system of homeopathy the teeth that it needs?

My vision for this sort of hospital set up requires a team approach towards (miasmatic) management because the emotional and intellectual demand on a single homeopath in these situations is simply too heavy. Like minded homeopaths need to discover each other and be able to work together to allow for such a possibility of working in the future, so that the Homeopathic System of Medicine can become a relevant alternative system of therapeutics. Already the ICR (Part II) and Dr. Vijaykar (Part III) with their advanced understanding of Hahnemann’s miasms have been able to establish themselves in such a manner in Mumbai. Groups of Homeopaths from the ICR run a couple of hospitals (in an around Mumbai) managing patients purely with homeopathy even during emergencies.

How relevant then, do you think, Hahnemann’s theory of Miasms (well understood) is for the future of homeopathy? For the serious homeopath, very, very relevant!!

Why Miasms continue to remain ‘Unchartered Territory’

I asked a few homeopaths for their feedback on my previous articles as I wanted to guage different perspectives as well as reason why miasms continue to remain a largely unchartered territory for most homeopaths today. My intention in these series of articles has been to highlight a “working” method of miasmatic management while on my own journey towards incorporating this into clinical management. I don’t think I’ve completely arrived yet, but I’m happy to say I’m on my way!

I was taught Miasmatic Management in college in 1988 – almost 18 years ago. We followed up clinical cases with our professors to observe miasmatic management over long period of time. Still it took me more than 10 years to fully appreciate and incorporate what I had learnt into my case analysis, synthesis and management. There were many reasons for this delay, but some of the important (homeopathic) ones that are common to all homeopaths I have explained below:

1. One may spend too much time trying to find THE constitutional similimum, often using techniques that are difficult or unclear or one has not mastered properly. What is the answer to this distraction?

Once can still pursue the study of unknown remedies and work at arriving at ‘core’ similimum remedies. But often in the immediate clinical situation it is not necessary to vainly try to get to that point.
One of the simplest things every homeopath needs to learn is how to take a focused but complete history of the chief complaint and every concomitant general associated with it – physical and emotional. All the predominant (presently expressed) associated complaints also need to be taken into consideration for this picture.

The remedy must be well chosen based on proving symptoms and verified clinical symptoms in the Materia medica. This will be a similimum to this situation, enough to move the case along Hering’s Law of cure to the next presenting picture. If the case has not moved in the right direction, one knows that the first remedy selected needs to be revised. Involved in this process are simple principles of logic and keen observation with an in-depth grasp on Remedy Reaction – basic aspects that each homeopath MUST learn to master.

For some time, instead, I got lost in the story of the patient and in trying to find that elusive constitutional in every case. But as I evolved as a homeopath, I realized my mistakes and went back to brass tacks! The good news is, the brass tacks work!! The Boger Boenninghausan method is one such method. But various others worked in a simlar manner including Kent. Hahnemann supported the “Zig-zag” approach as long as we were moving in the right direction. Often, it may be only by the second or third prescription that the deep, internal state of the patient becomes more obvious and one is able to perceive that deep acting chronic similimum.

2. The next problem was to be able perceive the miasmatic background that I had learnt, in the case progressions and management of our patients. Throughly understanding this may need a follow up of at least 2-3 years to see a true miasmatic reversal and healing. But the beauty of Vijaykar’s perception of miasms clinically, is that even during cure of the presenting Chief Complaint, one can perceive miasmatic improvement! This expanded the miasmatic horizon of my perception considerably. I was able to perceive miasmatic movment in a much shorter span of 2-3 months, enough to be satisfied in the miasmatic progress of the case towards healing.

How do we apply the Miasmatic concept clinically?

Here are a few simple steps to begin to apply the miasmatic concept (once understood using Parts I, II, III with further reading of the related books) clinically:

a) Take a complete history, that includes details of the past history of diseases right from childhood with treatment details; also include the family history of diseases to understand miasmatic traits and possible inherited miasmatic tendencies.

b) Right at the outset, identify the predominant miasm, the latent miasms and the underlying miasmatic traits (based on past history and family history analysis). Be aware that remedy response is palliative if there is no miasmatic improvement in the followup. In fact a miraculous “feel good factor” may actually indicate palliation rather than cure.
Eg: After a remedy a patient may say that the minute the dose touched my tongue, I began to feel much better. My joint pains improved miraculously. I felt good with more energy. But since the last week but my knee joints returned to hurt the same, in fact now my hip joints are hurting. This is a sign of palliation.

c) Correlate the indicated (Constitutional) remedy with the miasm expressed in the chief complaint. This means that the pathology expressed in the chief complaint should be a pathology that is covered by the indicated remedy in its Materia Medica, depending on which pathology is predominant at a particular point of time. Learning the miasmatic expressions of different pathologies (Part II) is a simple requirement.

Case 1: The chief complaint was a tendency to ovarian cysts and an inability to ovulate regularly causing irregular menses. The patient was already diagnosed with Polycystic Ovary Disease. She was chilly, and was easily exhausted by physical exertion or after public functions. The associated mental state was a need to strive for perfection in everything she did, sensitive to the opinion of others, or at least to certain specific people with a deep need for appreciation. Any apparent inability at various points in her life, to achieve any of this resulted in a feeling of being rejected or forsaken. This had now become an obsessive behavior of sorts in a vicious circle. The miasm expressed here is sycotic, as indicated by the PCOS pathology as well as the obsessiveness. The remedy given was Palladium, which regularized the menstrual cycles to normal as well as helped resolve the mental state towards a relaxation of obsessiveness with perfection. Palladium continued to help various problems for a 2 years with very occasional acute prescriptions in between.

The same case later developed a different set of symptoms. There was bloating premenstrually (water retention) with irregular periods for a few months followed by amenorrhea for 3 months. This seemed to be more like ‘suppressed menses’, since the cyclical changes of the menstrual cycle seemed to take placed with the premenstrual bloating and cramping, but the periods would not arrive! This is still sycotic but was a very old symptom as well. So we’d could say that the case was moving along Herings Law of cure. There was an increase in weight of about 3-4 kgs over the last few months. Another accompanying symptom was hair fall with dryness of the scalp. All these symptoms seemed to have been precipitated by an experience of severe disappointment followed by intense grief. She described this grief as a tremendously excruciating pain locked within her soul that just wouldn’t go away. She felt there was no reason to live, but she continued with life as normal on the surface, as was expected of her in her duties. She could not express these feelings to anyone, inspite of the overwhelming grief.

Palladium would not help this situation. This long standing grief, being secretive or reserved about her feelings or personal circumstances, fluid retention, suppressed menses, increase in weight indicated a sycotic miasm still active. Nat Mur covered this expression and just a couple doses of 30C released the overwhelming grief, and the menses appeared in 2 weeks, and has remained regular since then. It also stopped the premenstrual bloating, reduced the weight (back to normal) and stopped the hairfall. The mental state that followed is stable, though the grief continues. But it is more easily expressed and accepted, allowing the overwhelming excruciating pain (in her soul) to calm down considerably. Now there is no obvious physical complaint except a tendency to be aggravated by the glare of the sun and its heat.

Here we see that Palladium was indicated as a constitutional. The perfectionism and need for appreciation, etc are basic traits of the patient. But it stopped working in the new state, that still expressed with the same (sycotic) miasmatic background. The next remedy Nat Mur may be only a pit stop along the way, but it is obvious that the patient has not deteriorated miasmatically. In fact after Nat Mur, it would seem that the patient has moved out of the sycotic miasm towards a (latent) Psoric expression!

Following the miasmatic changes in this case will continue in time, but what is important to note is that the physical expression associated with the mental state, has not deteriorated miasmatically in a progression of disease towards deeper Sycosis or syco-syphilitc expression. This shows that each successive remedy in the series of remedies needed in a case has to reflect this pathological improvement.

On the other hand:
If Nat Mur was miasmatically suppressive a projected response would have been: Some physical improvement in the bloating, but the grief precipitating in suicidal tendencies. This would indicated an emotional suppression towards the syphilitic miasm.
OR else the suppressed grief may be apparently better for a while, but is associated with further increase in bloating and weight. This would indicate a further physical progression of Sycosis with no miasmatic improvement.
The response, instead, with reversal of the whole state towards a more Psoric expression (emotionally and physically) indicates that Nat Mur was a miasmatic similimum at that particular point in time.

d) Be aware that one may need to change the chronic remedy and review the case when the chief complaint has changed. The reason is that if one is truly moving along Hering’s Law of cure paralleled with Miasmatic reversal, then the new state may require another remedy. The new chief complaint has again to be re-evaluated miasmatically and for the indicated similimum along with concomitant factors and modalities.

Once I could recognize more easily the miasmatic expression at the physical and mental level, the remedy choice became clearer. It was easier to analyze the healing process in our old cases, in retrospect, and look at the remedies prescribed at different points. I could easily interpret which ones really worked at the miasmatic level for healing, which remedies simply palliated and took the patient around in circles, and which remedies were probably intercurrent anti-miasmatics. This was an exciting journey for me, which has precipitated in me writing this series of articles.

Dr. Vijaykar’s perception is an interesting and exciting method of observing miasmatic changes to tell whether pathology (in the chief complaint itself) is moving towards healing or than further deterioration miasmatically. Refer to the Cases detailed in Part III that highlight this. A keen observer can also learn to master this with time. Do read his books for a more detailed understanding of his perspective, but here is an interesting case from him:

Case 2: A man came for treatment of allergic rhinitis, easily spraining ankles and backache. The backache was due to sitting for long hours (40 hours!) at a stretch. The sneezing was due to his allergy to the smell of flowers that he was constantly exposed to. After 2.5 hours of history taking, there was no clue as to why he could not avoid being exposed to these flowers that were aggravating him!

It was only after questioning the person accompanying him that it was revealed that this man was a spiritual and philosophical leader who had turned away from a life of vice (alcohol, wife beating, stealing), to become a good man. With this change of life, he was able to help many alcoholics reform as well as to come closer to God. He became known as a “messenger of God”. As the Indian tradition would have it, people would some to “venerate” him with flowers once a month. He accepted these followers as a token of love, and so could not avoid them. He did a lot of work for the downtrodden people in the name of God. But, not a word of it was expressed during the 2.5 hour long history taking!!

The analysis: Chilly, Thirstless, ardent, religious, sympathetic, secretive traits. There was a tendency to looseness of elastin in the tissues (Ligaments, muscles) which predisposed to easy spraining and straining. All this is a sycotic expression in mind and body. The remedy here was Causticum in sycotic expression, which cured him of all his presenting physical symptoms.


Similarities between the ICR Theory of Miasmatic Evolution and Vijaykar Genetic Approach to Miasms.

Both Vijaykar and the ICR believe that the miasmatic background of an individual has its roots in inherited traits. These inherited traits may be Psoric, Sycotic, (Tubercular), or Syphilitic depending on the family history of an individual. Which miasms express themselves during an individuals’ lifetime is genetically motivated as well as further modified by acquired infection and disease suppression.

Both agree that miasmatic progression and disease progression are parallel to each other. Hence Hering’s Law of Cure and miasmatic improvement must be clinically observed in tandem while in the same process of healing. Both agree that there is disease evolution over time as one ages from infancy through childhood, adult life, middle age and old age, to death. This disease evolution could also be recognized as a miasmatic evolution.

The ICR sometimes resorts to a few “antimiasmatic” intercurrent remedies as indicated to assist the constitutional remedy if needed. Some representative Cases of this approach by Dr. Praful Barvalia, Dr. Nimish Mehta can be found here –

Autoimmune Thyroiditis – Dr. Praful Barvalia
Juvenile Arthritis – Dr. Nimish Mehta
Sjorgen’s Syndrome – Dr. Nimish Mehta

Dr. Vijaykar believes that the homeopathic similimum if properly chosen is all that is required for complete cure. I may be mistaken, but I have not seen cases described in his books where he uses a miasmatic intercurrent along with the constitutional. Whether these cases followed up after many years (especially those with complex disease) needed another constitutional remedy, has also not been clearly mentioned.

Another differentiating point is that the ICR clearly observes the Tubercular Miasm as a separate entity, whereas Vijaykar has included most of this tubercular expression in Sycosis and partly in (secondary) Psora.

J. F. Allen introduced the separate symptom group of the “Pseudo-Psora” Miasm which we term the Tubercular Miasm. The ICR believes that it is the missing link in disease progression after Sycosis but before the destruction of Syphilis. It was found to be the typical response after acute infections where the convalescence was protracted with a “never well since” modality. After Kent introduced Tub Bov, it was found (by a French Group) that a dose of Tuberculinum dealt with the ‘miasmatic block’ in these conditions and allowed for miasmatic reversal towards health with the constitutional.

Apparent Conflicts in the Classification of Miasmatic Symptoms

All the articles we have carried over the last few months on Miasms largely agree on the grouping of miasmatic symptom expression. While some symptom expression in these miasmatic classifications tend to overlap, there are symptoms that seem to belong to one miasm in one article and another miasm from another’s point of view.

Hahnemann on the other hand, clearly demarcated his groups. Conditions that followed an infection of Gonorrhea or Syphilis were put into those venereal miasmatic expressions, anything else was included into Psora which he called the most destructive miasm. This Psoric expression was subdivided into Latent Psora, Primary Psora and Secondary Psora. In secondary Psora (fully developed Psora) he included a vast number of diseases (all detailed in the CD as well as in the Organon) many of which today, based on other derivations of miasmatic concept (Part II and III) have been reclassified into Sycosis, Tubercular or Syphilis.

Understanding this from another perspective, “secondary Psora” is an unclear in the clinical entity, given the multifaceted, multimiasmatic and complex disease conditions we are faced with. There are a percentage of cases that are largely Psoric and remain that way without ever developing underlying non-Psoric traits. But most people do not fall into this category. They instead express complex diseases and mixed miasms. Also, if Psora had a latent, primary and secondary manifestation due to a history of suppression, most surely Sycosis and Syphilis would also over the centuries develop latent, primary and secondary manifestations. And why not?

It would be best not to get into academic arguments. Rather to my mind, a conceptual derivation from Hahnemann’s Chronic diseases that would be most helpful with clinical management is the one that understands Hering’s Law of cure in tandem with Miasmatic expression.
Hering’s Law of cure is a chronological, logical and natural process of disease cure verified over and over again in nature as well as in homeopathic management. Miasmatic progression of disease is opposite in direction to this Law of Cure. Hence Miasmatic improvement has to be parallel in direction to the Law of Cure. Both the ICR’s Disease Evolution and the Genetic/Embryological approach of Dr. Vijaykar follow this logical line of thought.

The proof of the pudding is in eating it, and both have shown that this concept works clinically, inspite of some differences in symptom classification. This is because the basic concept of disease development and its miasmatic expression are a linear process that can be perceived by the alert and trained homeopath. Matching the remedy to this perception is an art that one can gain with experience. Rules for matching the remedy remain exactly the same as Hahnemann stated – the predominant picture is matched with a similimum remedy that also covers that miasmatic expression in its (miasmatic) proving symptoms.

How do we know whether the remedy covers that miasmatic expression? One way out is to use the rubrics in the repertory for Psora, Sycosis, Syphilis. But these are extremely large rubrics and would really get us nowhere with repertorization or even understanding the miasmatic background of a remedy.

So we need to miasmatically analyze the provings in the Materia Medica of that remedy to find out its miasmatic scope. This is an avenue that needs to be explored in depth – the ICR have done so in remedy groups.
Vijaykar has also pointed out a method of understanding the multi-miasmatic expressions of polycrests (see Part III) and other well proved remedies.
Reproving remedies to record symptoms with a miasmatic concept of disease evolution in mind is another possibility (as I mentioned in Part II) of obtaining reliable information in this regard.
Or otherwise re-arranging well recorded proving material of every prover where available right from Hahnemann’s day, in terms of onset, duration and progression of symptoms experienced during a proving is another possibility of observing miasmatic progression of a remedy.

Mental Symptoms vs Physical Symptoms for Miasmatic Classification

On the whole, physical symptoms and pathological expression are more reliable to decide on the predominant miasmatic expression than mental symptoms. This is because pathology is fact, whereas mental expression is open to the judgment of each individual homeopath, his prejudice and his perception or the lack of it!

A discussion with a colleague on a public list revealed to me that a rejection of moral absolutes by some, in todays relativism has left us floundering on what constitutes moral and immoral behavior. Hence acceptable or unacceptable behavior that arises out of the depraved moral sense of the Syphilitic miasm, or the manipulative tendencies of the Sycotic miasm, or the natural tendency to abide by the moral code in the Psoric miasm, can have as wide a range of interpretations as there are homeopaths!

Similarly, perceiving the mental symptoms as expressive of a particular miasm at a point of time requires a little deeper and mature perception of human nature and its foibles on the part of a homeopath, that not everyone is capable of! Hardly reliable for miasmatic prescriptions, unless solidly backed up by obvious physical pathology.

So I think it is best that homeopaths concentrate on recognizing the predominant miasmatic expression through the pathology expressed in the chief complaint of each patient first. This is the (only) reliable clue to the predominant miasm, and hence the clue to the correctly indicated, miasmatically similar remedy, that has this pathology in its Materia Medica. Study of Part II of this article series along with the other supporting Miasm articles will give one an idea of the symptoms that indicate miasmatic expression. The steps in the process of miasmatic management have already been detailed above.

Other Theories around Hahnemann’s Chronic Diseases

Many have interpreted The Chronic Diseases and tried to adapt it to their methods of prescribing. One well known concept is to consider every possible infective agent or miasma into a separate miasmatic expression in itself. A colleague (Feras Hakkak) gave me some feedback on his understanding of this concept, which I replied to from my perspective. I have presented that discussion below and I welcome feedback on how this idea could possibly work especially in terms of long term (miasmatic) case management.

I have read other concepts from Ortega, Kanjilal, and others which are close to the concepts I mentioned before. Variations include whether the Tubercular miasm exists separately or not often it may be understood as Psoric miasm compounded with Syphilitic expression. But the fact that Tuberculosis is such a common chronic (incurable) disease today that exists in every culture. Its inherited traits are clearly discernible. It complicates many chronic diseases (most commonly today – AIDS), with a very clear mental and physical group of expressions, it stands on its own as a major miasmatic group.

Some others consider Cancer and Vaccinosis to be miasms. Both these don’t clearly hold their own for a couple of reasons (and there could well be more):
1. What is the causative organism that could produce a Cancer type expression?

My answer is that there aren’t any. This is obvious because there is no real expression of a cancer infection. But I’d be happy to hear a convincing argument to support the idea of a “cancer miasm” as Hahnemann intended miasms it to be.
Carcinosin has its own remedy picture. Every patient with clinical Cancer does not have this pathological picture.
Many today though advocate using Carcinosin as a nosode for Cancer, including Dr. AU Ramakrishnan. Whether this indicates that Cancer should be a separate miasm will continue to be debated.

Cancer needs to be understood in light of the individual expression in each case in terms of the diagnosis, pathology and prognosis. These are analyzed as expressions of combined miasms or predominant miasmatic expression: Psoro-Syphilitic, Syco-Syphilitic, Tubercular-Syphilitic, etc.
Strangely, the complete repertory lists this rubric:
GENERALITIES; SYPHILIS; hereditary: carc.
2. What is the expression of the “miasm” Vaccinosis that requires it to be a miasmatic group separate to Psora, Sycosis, Tubercular or Syphilis and their various permutation and combinations?

Is the need to consider Vaccinosis as a separate miasm due to the fact that it is caused by artificially modified miasma? How does its expression differ from the basic miasmatic expression of Sycosis? Questions again, that would help qualify if Vaccinosis is a separate miasm or not.

Finally, I’d like to introduce a word about Rajan Sankaran’s use of the term “miasm” in his recent prescribing method and search for the “vital” similimum. I would caution students that his concepts though brilliant, do not directly co-incide with Hahnemann’s Theory of Miasms in terms of clinical analysis and management of disease. series.
But he does borrow some conceptual ideas from Hahnemann which is interesting and helpful in itself in the quest of determining that “vital” similimum. The resemblance stops there! I will present a perspective of his approach in a later issue of the Ezine.

As mentioned earlier, there is a concept of discovering more miasms (that are clubbed into Psora) based on diseases caused by various infecting miasmas that are known in Bacteriology. I spoke with an Iranian colleague as I wanted to get a clearer idea of this concept of Miasmatic management which the Iranian group of ‘Hahnemannian’ homeopaths had, and seem to find helpful. I conclude this article with an interesting discussion we had we had about this.
Feras: I think the story begins with our observations regarding the acute epidemic diseases. In such situations, although patients show various pictures, one (or a few) genus epidemicus remedy will cure most of them. If this is true, which seems to be, then we can conclude that a specific type of microbe will cause a diseased state which can be cured with one (or a few) remedy (remedies), but the manifestations in different patients will be different due to their susceptibilities.
So this forms the assumption that a specific microbe can cause diseases which will be cured by one (or some) specific remedy despite the fact that this microbe will cause different disease pictures in different patients (due to different susceptibility factors).
So if our assumption (specific microbes causing specific diseases) is correct, it will be sufficient to identify microbes, do epidemiological studies, and find the symptoms that are caused by these microbes, one by one.

Leela: I think Hahnemann differentiated clearly between acute “maisma” and Chronic “miasma”. The difference between these two he explained by the inherent properties of these miasma to affect the “constitution” (which is his word in the CD). The acute miasma did not produce chronic “miasms”, though they could possibly modify their progress depending on whether suppressive treatment was used.
Acute “miasmas” caused acute diseases, the expression of which Hahnemann attributed to Psora (psoric miasm) mainly. He also used the term half-acute miasma for Hydrophobia and Rabies infection.
My observation is that the reason for the different totalities presenting during epidemics is not only due to differing susceptibility but also based on the individual response of the “constitution”. This in turn is dependent on whether there is a multimiasmatic background in an individual rather than just Psora.

The chronic miasm is ultimately an expression of a deranged vital force expressing a certain group of symptoms based on the type of chronic miasma (broadly venereal or non venereal) that it has been affected with. Then we have the contribution of inherited traits of chronic miasms. This is furthur complicated by artificial drug disease which causes modifications in disease progression. So it would be the sum of all these expressions that determine the predominant miasmatic expression, not simply the causative miasma.

With this background, I find it a little hard to understand how the assumption you mentioned above helps clinically in miasmatic management.

Chronic disease expression (according to Hahnemann) is different from acute disease expression. Acute disease is an immediate reaction of the vital force to the acute miasma resulting in resolution of the disease either by healing or death. Immunologically, there is an ACUTE inflammatory response of neutrophils and eosinophils. Chronic miasm, on the other hand expresses itself after the chronic miasma has taken hold of the whole being of the person, but there is can be no resolution because the vital force has been deranged to an extent that does not allow spontaneous resolution. The immunological response is a chronic inflammatory processes that does not resolve adequately, like that of acute inflammation.

Feras: The method used is: to exclude all the symptoms related to diet, lifestyle, etc and among the remaining symptoms collect the active ones and recognise the miasm (disease caused by a specific microbe) which is dominant. The remedy will be known automatically. In fact we have to see the miasm’s picture in the patient (and we always see a part of it not the whole picture), and the remedy for that miasm will do the job. It’s like seeing a part of a friend’s face and recognizing him! This is the core idea behind the miasmatic approach of our Iranian friends.

If we adopt this view, then we will believe that Hahnemann’s Psora is a mixture of many miasms that has to be separated. Then we will have one (or a few) remedy/ies for each miasm, like what we have about Syphilis with Merc and about Sycosis with Thuja.

Leela: Hahnemann has the similar instructions for deciding on the miasmatic similimum which may be a specific intercurrent remedy or else the chronic similimum.
I’m unclear how this means that these remedies represent various “miasms” within psora. How does one decide on what constitues the miasmatic expression is of a specific microbe/miasma in the long term – is this based on bateriology? What would these miasms be called? How is the patient’s chronic symptom expression related to a specific infecting miasma?

In present day investigations, one can do ELIZA tests to check for the presence of specific antibodies in the blood which indicate the history of specific infections. BUt would this be homeopathically helpful? In homeopathy we’re concerned with the symptomatic expression of the individual at a point in time. Are you saying that one can observe these symptoms as indicative of a history of causative microbe/miasma?
If I have understood this right, there would be a miasmatic expression for Falciparum Malaria Miasma, Salmonella Miasma, Haemophillus Influenza Miasma, Ascarides Lunbricoids Miasma, etc – whatever the pateint remembers suffering from in his life. Following which, there would be a specific remedy for each of these ‘miasms’ that have been clubbed into psora?

What would be the expectation in terms of healing if this concept (which sounds allopathic) is clinically useful? Are there clear cases with results where this theory has worked to cure a microbe-specific miasm in the longterm? How would this differ from what Hahnemann termed “Isopathy” which he decided within his own lifetime was not homeoapthically healing? I’ll look forward to hearing more about all this.

By the way what is your understanding about multi-miasmatic diseases?

Feras: Mercurius is suitable to Syphilis miasm but it doesn’t mean that it can’t be used for other issues. The same with Thuja. I will ask my colleagues who practice with this style to present their cured cases. This will show how it works.The problem is that after Hahnemann nobody has done good research work to study miasms epidemiologically, or I’m not aware of. It should be done to support this style of practice. I leave this to my colleagues. Maybe they have something to offer.

And about multi-miasmatic states. It is when more than one miasms are active. Then you have two options. The first one is to give a remedy that has affinity to both of those miasms. The other one is to start with the more dominant one. But I’m not sure about this and we’d better study it from Hahnemann who has talked about this issue in Chronic Diseases, and has given instructions as to which miasm should be tackled first, etc.
Leela: Yes, Hahnemann had some specific instructions. Part I of this series details that. But he may or may not have been mistaken, in that there may not be any fixed rules about the sequence. The general rule he put forth though, holds true always – treat the predominant picture of symptoms and if one reaches a block, treat the predominant miasmatic symptoms first.

Feras: I don’t know how correct these ideas are, and I have not had enough clinical experience to reject or accept them, but it is worth investigating. Anyway, even if it is in line with truth, I think it is a very tedious job to differentiate these so many miasms (microbes) and make detailed lists of their symptoms.

Leela: I think I agree with you here. There seems to be an awful lot of (investigative) work to prove that it could be viable. It simplifies matters a whole lot if we put the (miasmatic) symptom expressions into either one of the 3 (or 4) groups after studying clearly what are the the expressions of each of these miasmatic groups. Its a simpler procedure and one that every homeopath can learn to do.

Feras: It is really a “Western”, “technology-based” method and we could leave it to those who are interested. It is obvious that there are some other methods that work well and do not involve so much sophisticated expensive experimentations, and I believe the more you keep things simple the better it will be. So I think we’d better stick to simpler and more “Eastern” methods like Sehgal, if we come to the conclusion that they work satisfactorily.
Leela: Yes, I think if we focused on the properties of miasma (microbes) as causative of miasm, we would not be doing any justice to the art and science of homeopathy. We’d be looking at homeopathy through the eyes of modern medicine! Its a paradigm shift today to be actually looking at disease from the homeopathic perspective instead, right at the outset!
If your Iranian colleagues have cases that have been followed up for at least 5 years to show that this has resulted in miasmatic improvement and what constitutes this improvement in the progress of a case, we’d be interested in hearing more.

Its interesting that you mention Sehgal. I don’t think he talked very much about Miasms.

Feras: In the method of the late Dr. M.L.Sehgal (Revolutionized Homeopathy) there is no mention of miasms. His conception of disease is totally different and his case-taking and case management are totally different, accordingly. Here in Iran (and also in the world) seldom you can find a “Sehgalian homeopath” but I believe his views ARE worth studying deeply.
I will ask my friends to present their cases with the “Hahnemannian” miasmatic approach (as understood by them). Would you do it too, to in order that we see the differences and make comparisons.

Leela: Managing a case miasmatically as I understand it (Part II and III), has very little to do with a specific microbe/miasma causing the miasmatic state. The symptom expression at any point of time is enough to plot exactly where on the miasmatic progression towards health a person is. The similimum is always based on this symptom picture (charateristic totality or miasmatic totality), independant of the causative microbe or miasma.
But it is tempting to consider whether an isopathic nosode or a microbe-specific remedy would be indicated at a point when a past (acquired and suppressed) infection in the patients history rears its head again as expected with Hering’s Law of Cure. Still, whether any of these would be indicated by the symptom picture at that point is not clear. Whether it would help the case progress towards healing is also something that needs to be clarified by repeated clinical experience.

Thanks for your time Feras! Your input has been very enlightening for me.

Dear readers, do write in if there are any clinically useful concepts around the theory of miasms that you would like to share with us or discuss. Thank you.

Dr. Leela D’Souza


About the author

Leela D'Souza

Leela D'Souza-Francisco, MD (Hom), CIH (Cardiology) is a Mumbai-based homeopathic professional whose experience includes intensive graduate medical training at India's leading homeopathic medical institution in Mumbai, completed in 1990. She completed her MD (Hom) from MUHS, Nashik in 2008 with a Dissertation entitled "Emergency Management in Homeopathy". She obtained a post graduate MSc (Homeopathy) degree from UCLAN, UK in 2009 with a Dissertation entitled "How Can We Develop Suitable Clinical Trials for Research in Classical Homeopathy". Her present interests include management of in-patients in homeopathic hospitals, and clinical research in classical homeopathy. She has been in practice for over 20 years and is online at for the last 15 years. Presently she is Consulting Homeopathic Physician, with specialization in Cardiology at Holy Family Hospital, Bandra, Mumbai.
Visit Dr. Leela D'Souza at her website :
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