This article was first published in "Homoeopathy Online". It deals with most of the core issues related to miasms and will provide the general background information.

Introduction

In contemporary Homoeopathy there has been a great advancement of the psychological aspects of the materia medica as well as in our understanding of how to use the mental rubrics of the repertory. The origin of this tradition stems from aphorism 211 of The Organon of Medicine in which Samuel Hahnemann discusses the importance of the mental disposition.

"This holds good to such an extent, that the state of the disposition of the patient often chiefly determines the selection of the homoeopathic remedy, as being a decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician".

With such an emphasis on the mental symptoms is there any reason to study the nature of disease, causation or the classical theory of the miasms? In contrast to this, Hahnemann points out in aphorism 5 and 206 the necessity of understanding the miasms when treating complex chronic diseases. Can the homoeopath construct a complete picture of an individual without knowing how the chronic miasms form layers of disease within the constitution? Can we really manage a complex chronic case without paying any attention to the primary, latent and secondary states of the fundamental miasms? In this presentation I will attempt to approach this rather controversial subject with the help of historical documents combined with the practical experience found in the writings of the masters of our science. Our purpose is to show that what Hahnemann taught in The Organon and The Chronic Diseases is a careful balance between pure vitalism and a deep understanding of the pathogenesis of miasmic diseases. This middle path approach helps transcends the apparent dichotomy between the psychological and physiological aspects of our art and gives the homoeopath the tools necessary to respond to a great variety of situations.

In Search of the Fundamental Cause

From the early days of his career Samuel Hahnemann experienced great success in the treatment of acute diseases but as early as 1816 he was becoming concerned because the constitutional health of his patients seemed to be slowly declining. As he pondered the nature of this continual deterioration in his patients he began to search for a deeper understanding of the processes that lie behind chronic disease. Of these chronic cases he lamented "their beginning was promising, the continuation less favorable, the outcome hopeless." Hahnemann began to wonder about the cause of these complicated chronic diseases that were resisting his treatment. As he continued to administer his remedies he noticed that certain chronic patients, who responded well at first, either relapsed or slowly became more ill. Of this experience he said:

"The remedy which was serviceable the first time would prove less useful, and when repeated again it would help still less". As Hahnemann watched these patients closely he noticed that new symptoms would be added to the old ones that could be removed only "inadequately and imperfectly". Again he would give the most appropriate homoeopathic remedy but each dose was less effective and in the end they worked "no better than weak palliatives". This left Hahnemann searching for the cause of these complicated forms of chronic disease that were resisting his treatment.

For 12 years Hahnemann quietly searched for the fundamental cause of the chronic diseases that was slowly destroying the health of his patients. The outcome of this research was published in 1828 in the first edition of his great work, The Chronic Diseases Their Peculiar Nature and their Homoeopathic Cure, commonly known as The Chronic Diseases. Over the next 11 years he produced 4 more editions of this work that were published in 1830, 1835, 1837 and 1839. In these subsequent editions Hahnemann added new material as well as prefaces in which he gave his latest insights into preparation of the potencies and the dosage for the patient. This work was followed in 1829 by its philosophical counterpart, the 4th edition of Organon. In these works Hahnemann made public for the first time his theory of the chronic miasms. This led to the most controversial period of Homoeopathic history as it marks the first major schism in the history of the homoeopathic school. With the introduction of the theory of Psora and the chronic miasms, as well as the 30c potency, Hahnemann went too far for some of his more conservative followers. They were more secure with the Homoeopathy that Hahnemann practiced in his earlier years and could not adapt to the new territory into which it was expanding. He was well aware that his new ideas were way ahead of the times, and shortly before the publication of his findings, he wrote Dr. Stapf about what he thought the reaction of his students might be.

"They will require more than six months before they recover from the fright and astonishment of this enormous, preposterous affair and will perhaps need another six months before they will believe in it. Therefore, it will probably be three years before they can make any sensible use of it".

Feeling the way he did about the reception of his own homoeopathic students, Hahnemann could only imagine what the orthodox medical community would think. Speaking of these individuals he said that he anticipated a "great uproar " among the allopaths. All of Hahnemann's predictions did take place only much worse than he expected!

The Importance of Aetiology

Since the dawn of medical history there has been a constant search for the causes of the acute and chronic diseases that afflict humanity. This quest made great advances when the ancient Greek physician, Hippocrates, taught that all diseases were caused by the predisposition inherent in the innate constitution and its susceptibility to a constellation of causation rather than any one single effect. In the Greek philosophy disease is caused by an interdependent set of circumstances which disrupts the natural ebb and flow of the pneuma (vital force) within the organism. In the Organon of Medicine Samuel Hahnemann separated the origin of disease into two categories, the exciting and fundamental causes, and related them very closely to the susceptibility of the physical constitution. Vide aphorism 5.

"Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease as well as the most significant points in the complete history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration".

It is necessary for a homoeopath to understand the nature of the exciting causes of acute diseases as well as the underlying fundamental cause of long lasting diseases, which is usually due to the chronic miasms. Acute diseases are self-limiting disorders which have quick onsets, rapid progressions, and a tendency to develop an immediate crisis. Many of these acute diseases are actually acute acerbations of the chronic states latent within the constitution that have been brought forth by exciting factors. The nature of chronic miasmic disease is slow and insidious in its onset and gradual in its progression. These negative transformations gradually increase until they bring on complex pathologies that eventually are the cause of premature old age and death. The chronic miasms are the effects of infections that are non self-limiting which cause considerable damage to the immune system, the vital force, and the constitution.

Hahnemann taught that the susceptibility to the exciting factors lies in the fundamental cause which is attributed to the chronic miasms. The etiology of a disease, the constitution and temperament of the individual, and the totality of the signs and symptoms are three factors that form a complete picture of an illness. In Homoeopathy we often speak of the totality of the symptoms as the basis of selecting a remedy, but sometimes we forget to include the causative factors, the miasms, and the nature of the physical constitution of the individual. Understanding the innate constitution is fundamental to homoeopathic treatment because it holds the keys to an individual's susceptibility as well as the inherited effects of the chronic miasms.

This is why Hahnemann included a complete physical description of each individual constitution when taking a case history. Some constitutions are thin, quick and warm while others are slow, cold and flabby. The physical characteristics of various constitutions have become associated with different miasms and their constitutional remedies. For example, Phosphorus is well adapted to tall, slender, narrow chested, sanguine temperaments who have delicate eyelashes, soft hair and are deeply affected by the TB miasm. Asteria Rubens, on the other hand, is more indicated in flabby, chilly, lymphatic constitutions that are affected by sycosis or the cancer miasm. Each of these constitutions responds to the same stimuli in a completely different manner which helps to determine their anti-miasmic remedies.

What are Miasms?

Hippocrates was the first physician to use the term "miasm" which has its origins in the Greek word for taint or fault. He postulated that certain infectious diseases were transmitted to humans by air and water tainted by miasms. In late 18th century it was a common belief that miasms were impure airs that were responsible for the spread of epidemic diseases among groups of people. Hahnemann realized that the air could carry infectious diseases but he did not consider the pathogenic material to be gaseous in nature. By the late 1790s Hahnemann had realized that syphilis was an infectious blood disease that could mask itself with the symptoms of many different illnesses. Early in his career he made a special preparation called Mercurius Solubilis Hahnemanni that was the standard treatment for syphilis throughout Europe. He soon found that Mercury in homoeopathic potency worked much better on syphilis than the crude poisonous form and he recorded several permanent cures.

A Dutch naturalist named van Leeuwenhoek invented the microscope and published his observations of small living "animalcules" before in his death in 1723. This information led Hahnemann to believe that microorganisms were at the root of many infectious diseases. For this reason he supported the ideas of the animalculists but at the same time upheld the importance of susceptibility of the host constitution. Very early in his career Hahnemann suggested that certain skin eruptions, such as "crusta lactea", were being caused by microscopic "miasmic animalcule" i.e., micro-organisms. At this time there were four major theories about diseases that spread in an infectious manner.

1. Miasma as a foul gaseous exhalation.

2. The theory of the animalcule.

3. The zymotic theory.

4. The theory of spontaneous generation.

The followers of the spontaneous generation theory believed that germs appeared whenever the conditions were right for their development without the need for reproduction. In some sense this is true as where did the "first germ" come from? The zymotists suggested that certain substances called "zymes" that were inert outside the body could lie dormant until the internal terrain made it possible for them to multiply and caused specific diseases. The observations of the zymotists are very similar to the activities of viral material in the human body. The term zymotic can be found in the old homoeopathic literature and is a rubric in the general section of Kent's Repertory. Hahnemann synthesized the ideas of the animalcule and zymes and redefined the Hippocratic term "miasma" to express the constitutional derangements caused by parasitic infections. He carefully separated the self-limiting acute miasms from the syndromes of long lasting diseases and started to develop a special materia medica and repertory for the treatment of the chronic miasms. Therefore, in Hahnemannian Homoeopathy the word "miasm" means the effects of microorganisms on the vital force including the symptoms that are transmitted to the following generations. These chronic miasms are capable of producing degenerative illnesses, auto-immune diseases and lead the organism toward immuno-deficiency disorders.

Hahnemann noticed that each of the chronic diseases has three phases, a primary stage, latent stage, and a secondary or tertiary state. The effects of these miasms were then passed from one generation to the next generation by inheritance and caused predispositions to certain disease syndromes. The three chronic miasms that Hahnemann introduced in 1828 were called Psora (the itch miasm), Sycosis (the gonorrheal miasm) and Syphilis (the chancre miasm). Hahnemann published his miasmic theory long before the presence of germs was widely accepted so most practitioners found it hard to understand such a sophisticated theory of contagion. From the time of Hippocrates healers conjectured about the possibility of invisible organisms causing disease but Hahnemann founded the modern concept of infection. In fact, homoeopathic pathology is still far more advanced than its modern allopathic counterpart which still does not understand the effects of the miasmic processes or their inherited constitutional syndromes.

In the preface of Charles Hempel's translation of the Organon, Constantine Hering recorded that late in his life Hahnemann made further discoveries and developed a new aspect of the theory of Psora with the introduction of a new miasm he called Pseudo-psora. Hering wrote:

"Hahnemann distinguishes the venereal miasms as syphilis and sycosis; and also subdivides psora with pseudo-psora.".

Hahnemann's miasmic theory now contained two venereal and two non-venereal miasms that produced life-long chronic diseases. The two non-venereal miasms are Psora (the itch disease) and Pseudo-psora (the tubercle disease). The two venereal miasms are Sycosis (the fig wart diseases) and Syphilis (the chancre disease). Hahnemann noticed that some cases that appeared to be Psora did not depend exclusively on an external skin eruption for their development. He observed that this disease was infectious in nature and possessed primary, latent, and secondary symptoms as well as inherited aspects. He decided that it was caused by a miasmic agent with a distinct etiology so he separated its symptoms from Psora and made a new classification called the Pseudo-psora, the TB miasm. All of these miasms may be acquired through a primary infection or their effects can be experienced through heredity.

It is sometimes thought that Hahnemann taught that all long-lasting diseases are caused by chronic miasms. This is not the total picture. In the Organon  he mentions three classifications of long lasting disease:

"those caused by continuing stress factors (disorders upheld by maintaining causes which by their nature are not necessarily true chronic disorders §73),

those caused by drug toxicity and faulty treatment (physician caused §74.),

and those caused by infectious miasms (naturally caused §78)."

In modern times the diseases produced by man made toxins must be expanded to include the thousands of potential harmful chemicals released into our environment. Between the environmental degradation caused by our massive industrial complex, the vaccinosis miasm caused by compulsory immunization, and great numbers of new medicines produced by the pharmaceutical industry, the second category of chronic disease has grown tremendously. Illnesses that involve all three factors of causation (continual stress; drugs, toxins, vaccinosis; and natural miasms) are the most difficult to treat because all these factors intermingle to form complex layers.

The Development of the Miasmic Theory

There has been a tendency in modern Homoeopathy to focus more and more on the mental and general symptoms of the individual while paying little if any attention to the classical doctrine of the chronic miasms. This is not a new phenomena as Baron Von Boenninghausen bemoaned the fact in his Lesser Writings  that many practitioners were ignoring Hahnemann's teachings on the miasms as expressed in aphorisms 5 and 206 of the Organon. Even Constantine Hering was skeptical when Hahnemann first introduced his miasmic theory, but after observing the syndromes in his patients, he became a great contributor to the further development of the doctrine. One of the reasons the original theory of the miasms has fallen out of use in case taking is because it has somehow become associated with the concept of orthodox pathology. Are the detailed syndromes that are recorded under the miasmic process really just another form of useless pathology? Can we really take a complete constitutional case through the use of the general symptoms alone while ignoring the presence of the inherited or acquired miasms?

According to the founders of Homoeopathy, to overlook Hahnemann's doctrine of chronic disease is to miss the main point of aphorism 5 of The Organon which deals with the importance of causation, constitution, and the chronic miasms. This trinity forms the foundation of the anamnesis to which the concept of the totality of the signs and symptoms is added in aphorism 5, 6 and 7. Hahnemann classified some remedies into anti-miasmic categories because he discovered that certain deep acting medicines have a similar nature to the syndromes produced by the miasms. What did Kent think about the miasmic doctrine and did it play any part in his case taking methods? Lets see what he has to say about the doctrine of the chronic miasms. Vide Kent's Lectures on Homoeopathic Philosophy, from the lecture called, "The Examination of the Patient".

"A great deal depends upon a physician's ability to perceive what constitutes the miasm. If he is dull of perception he will intermingle symptoms that do not belong together, Hahnemann seems to have had the most wonderful perception, he seemed to see at a glance. Hahnemann was skillful in this respect because he was a hard student of materia medica and because he proved his materia medica daily".

Why does Kent speaks of mixing up symptoms that do not belong together if we only need the totality of the symptoms? Why should we understand which symptoms constitute a miasm? Why is Kent praising Hahnemann's understanding of miasmic layers if his teachings on the chronic disease play no part in Classical Homoeopathy? In his lecture on Natrum Sulphuricum Kent points out the short comings of prescribing on the simple totality of symptoms without any understanding of the underlying miasms. Vide Kent's Lectures on Homoeopathic Materia Medica.

"Asthma, when it is hereditary, is one of the sycotic diseases of Hahnemann......For years I was puzzled with the management of asthma. When a person came to me and asked: "Doctor can you cure asthma?" I would say "No." But now I am beginning to get quite liberal on asthma, since I have learned that asthma is a sycotic disease, and since I have made judicious application of anti-sycotics I have been able to relieve or cure a great number of such cases. You will find in the history of medicine that wherever asthma was cured, it has been by anti-sycotic remedies. That is one of the first things I observed, that outside of sycotics you will seldom find a cure for asthma."

Kent goes on to speak about the limitations of the use of Homoeopathy only on the symptoms without taking into account the underlying miasmic causes and their syndromes.

"While Ipecac, Spongia, and Arsenicum will correspond just as clearly to the supervening symptoms and to everything that you can find about the case, yet what do they do? They palliate; they repress the symptoms; but your asthma is no better off, your patient is not cured."

From these quotes we can see that Kent truly followed Hahnemann's teachings and saw the validity of the theory of anti-miasmic remedies. He also clearly states that using the totality of the symptoms without understanding the miasms underlying the case may lead to mere palliation or suppression of the disease. This is why aphorism 5 of the Organon  stresses the need to understand the fundamental cause as well as the totality of the symptoms. The reason that Ipecac, Spongia and Arsenicum will not cure in these cases is because they are not antisycotics. Another experienced homoeopath, H. C. Allen, offered his opinion as to the use of the totality without an understanding of the chronic miasms and their layers in his classic, The Chronic Miasms.

"I think I hear many say, are not the totality of the symptoms, all there is to disease? Yes, but to me it is necessary to know something of what is behind that grouping of the totality. If you do not know this you are prescribing for a Jack-in-the-box. You cannot follow the evolution of the curative process; you cannot even prescribe intelligently the proper diet for a patient, unless you know the basic miasm. Of course the diseases that are present will help you to some extent, but you have no surety unless you know the underlying basic disturber of the disordered life".

Our old friend Dr. Allen's example of a "Jack-in-the-box" is quite illustrative. If the homoeopath does not know the layers of the miasms in their proper order, they will not know what to look for in the future, so that some dramatic complication may just "pop" out of the vital force as if came out of nowhere. Those who study Hahnemann's teachings are more prepared for what the future might bring and know what to do when obstructions arise. In reference to the hallowed law of the totality of the symptoms, and its use as a guide to the choice of the remedy, Dr. Allen shared his feelings in this way.

"We make no attack upon the law; no cure can be made outside of the law. But we do believe it is necessary to know whether the phenomena presented in a given case are of sycotic, syphilitic or tubercular origin; for the totality grouping of the symptoms must be around the symptoms of the active miasm."

Thus we can see that in Hahnemann's method the totality of the symptoms includes the signs and symptoms of the miasms classified by their layers and listed according to their development. The active miasm is the center on which the totality of symptoms is built so that the remedy chosen matches the underlying miasm syndromes. The symptoms should be arranged in such a manner so that it is easy for the homoeopath to see the layers of the case so they will know what to expect next. Hahnemann states in The Chronic Diseases  that in severe chronic cases the homoeopath may have to use a series of anti-miasmic remedies to complete the cure. This is because in complex disease the layers may represent several etiologies and the miasms can require different remedies as they become exposed. Allen expressed the need to know the layers of a chronic case in the following terms.

"Those brilliant cures that are occasionally made with the single remedy, occur where a single miasm lies behind the phenomena, but where the mixed miasms are present, brilliant cures are not so made, and it is in those cases that it is so necessary to understand the order of their evolution."

Some homoeopaths spend all their time searching for the single constitutional remedy for the patient. When the remedy picture fits Phosphorus they state that the patient is a "Phosphorus constitution". In this way they search for that one special remedy that will solve all the patient's problems. Our elder homoeopaths of years past might have asked, "When was this person a Phosphorus? When they were born? Now? Forever? When they had pneumonia? Because they have the inherited TB miasm?" The search for the grand constitutional remedy may lead the homoeopath to construct permanent essences out of something that is in continual change.

Complex chronic diseases are often made up of many interdependent components rather than one single constitutional factor. Although many cases have been ameliorated by just one constitutional prescription such miraculous responses are the best of circumstances. Homoeopaths who wish to treat chronic diseases must be prepared for the worst! In a more complex chronic illness it may not be so easy to pigeon-hole the entire case into one single remedy. It may take a series of related remedies to remove the miasmic layers as the person moves toward the state of health. This is why it is necessary to know in what order the layers of the case have formed along the timeline so that they may be unraveled in the reverse order by which they developed.

Symptoms and the Miasms

The etiology of a disease, the constitutional temperament of the patient, and the totality of the signs and symptoms are three factors that form a complete picture of a disease. In Homoeopathy we often speak of the totality of the symptoms as the basis of selecting a remedy, but sometimes we forget to include the causative factors, miasms, and the physical constitution of the individual. The physical signs of a person are fundamental to the treatment of chronic disorders because the constitution and temperament shows the effects of the inherited miasms. We must get beyond relying solely on the personal or family history to uncover miasms. The miasms are present in the very symptomatology of the client. The syndromes produced by the miasms point to the fundamental cause even if it cannot be traced in the case taking to a specific etiological factor.

Each of the chronic miasms have their own characteristic signs that are an integral part of the totality of the symptoms. For example, Psora tends to produce irritation, inflammation, and hypersensitivity and Sycosis tends to produce infiltrations, indurations, and over growth. Pseudo-psora tends toward tubercles, fibrosis and suppuration and Syphilis tends toward granulation, degeneration and ulceration.

As far as the physical constitution, Psora tends to make the organism toxic, the skin unhealthy, and perverts the functions of the digestive and eliminative organs. Pseudo-psora tends to produce pipe stem bones, narrow chests, sunken cheeks and sparkling eyes. Sycosis tends to cause heavy bones, water retention, over growth of tissue and slow metabolism. Syphilis tends to cause congenital defects, asymmetrical bony structure, deformed teeth and the classic bull dog face.

The psoric temperament is full of pseudo-scientific, philosophical, political, religious ideas. They are self expressive, talkative, self deceptive and may think they are full of genius yet seem foolish and impractical to others. Pseudo-psora (TB miasm) is romantic, erotic, social, extroverted, cosmopolitan. erratic, optimistic, yet dissatisfied and always wants to change places, jobs, mates, etc.. Sycosis is pessimistic, a hard realist, skeptical, secretive, suspicious, jealous and has fixed ideas and hidden self disgust. Syphilis has a mixture of madness and genius with a deep sense of irony that leads to obsession with death and destruction. They become guilty, self destructive, and end in idiocy, insanity or suicide.

The pains of Psora are itchy, crawling, tickling, and burning; the pains of Pseudo-psora are neuralgic, sharp, piercing, twisting, stitching; the pains of Sycosis are sudden, intense, spasmodic, crampy and colicky; the pains of Syphilis seem lacking for the condition present or are deep, aching, agonizing, and esp. < at night. Psora has fairly scanty, irritating, itchy discharges; Pseudo-psora has pussy, purulent, yellow, bloody, musty discharges; Sycosis has pungent, brine-like, fishy odors with watery greenish or dirty brown discharges; Syphilitic miasm has very offensive, foul, putrid, smelly discharges.

The skin of Psora is dry, rough, unhealthy, every little injury becomes infected and the lesions are itchy and have scanty pus. The skin of Pseudo-psora is translucent, fine, smooth, bruises easily, and its lesions bleed easily and exude excessive pus. The skin of Sycosis is full of warts, flecks, moles, growths, dark discolorations with over growth of hair. Syphilitic skin has brownish red, or coppery color spots, eruptions that do not itch, and a tendency toward easy ulceration.

Classifying Miasmic Rubrics

This list of rubrics goes on and on but I hope these few examples give an idea of how the symptomatology of the miasms is present in the symptoms of the case. It is these symptom pictures that clue the homoeopath into which miasms are present within the constitution of the individual. Thus the etiology points to the symptoms and the symptoms point to the etiology. This is how the homoeopath understands which miasmic layers are dormant, latent and active. All of these factors point to the proper anti-miasmic remedies, which more often than not, are not the nosodes. For example, while taking a case history a client reports that he used to be friendly, outgoing, loved to travel, and had many girl friends (Tubercular miasm), but for the last few years he has changed his lifestyle and become more conservative. Most of his friends have not noticed how much he has changed except that he seems to have settled down. Some people think that he has changed for the better. This is because he is trying to hide the fact that he feels as if he is losing his clarity of mind (Sycosis) as well as his feelings for others (Sycosis).

On further  investigating the changes in this person's temperament the homoeopath finds that he caught gonorrhea due to his cosmopolitan lifestyle (acquired Sycosis) which led to a change in his perceptions (new layer). He was treated with antibiotics which immediately "cured" his symptoms (suppression) but he has felt contaminated from that time (Sycosis and Syphilis). On inquiry we find that since then (never well since) he has suffered with  feelings of guilt (Sycosis), loss of short term memory (Sycosis), has become more angry, suspicious and introverted (Sycosis).

He used to love to have people around (TB miasm), but now he doesn't like visitors, especially strangers (Sycosis). He is especially bothered because he is having difficulty expressing himself and finding the correct words (Sycosis), whereas he used to be quite articulate (Psora and TB miasms). He used to be mentally carefree (TB miasm), but now his mind has become more fixed and obsessive (Sycosis). His joints and muscles are becoming more painful and rigid (Sycosis) and he has developed a fishy order from his arm pits and genitals (Sycosis). His general constitution is tall, thin, with pipe stem bones (inherited TB miasm), but since he became ill, he has gained an unhealthy weight around his hip, abdomen and thighs (Sycosis) and became chilly (Sycosis). His skin is fairly pale and translucent (TB miasm), but as of late, he has been developing a few dark spots and warty flecks (Sycosis)

We can see  that this gentleman's innate constitution is affected by the inherited TB miasm but this has been suppressed by an acquired sycotic syndrome. The TB miasm has affected his basic temperament and helped stimulate the excesses in his lifestyle that brought him to an infection with VD. The TB miasm is now dormant because it has been repressed by the active miasmic symptoms related to the gonorrhea and its suppression. The transformation of his innate temperament from outgoing, social, cosmopolitan (TB miasm) into a suspicious, fixed, private man with feelings of guilt and loss of confidence (Sycosis) are the most important symptoms in his case.

We can see that the totality of his active symptoms are definitely Sycotic so we must search for a remedy for his condition from the antisycotics. A person who prescribes by miasms might think that Medorrhinum should be used but all the symptoms point clearly to Thuja. Thuja will remove this sycotic layer and the individual will become his old tubercular self again. Now his case should be retaken and his innate constitutional remedy should be sought among the remedies that reflect the Pseudo-psoric miasm. This will remove the excesses of the TB miasm from his personality and prevent him from doing the kinds of things that caused him to acquire the gonorrhea in the first place! Understanding how the constitutional remedies relate to the miasms is a fundamental part of the materia medica of chronic disease. This is what Hahnemann was pointing at when he published The Chronic Diseases in 1828 and introduced the idea of categorizing deep acting remedies by the chronic miasms. This is an integral part of our homoeopathic heritage and should not be forgotten if we are to cure the most complex forms of chronic disease.

I hope this article on the classical miasms will prove helpful to those students of Homoeopathy who wish to follow in the footsteps of Samuel Hahnemann. Homoeopathy is a gift from the Most High as well as the summation of several generations of hard work by many individuals. This article is dedicated to those who have gone before, those who are practicing now, as well as those who are coming in the future.

After all, as Hahnemann pointed out, Homoeopathy is De Medicina Futura!

Application of the Miasmic Theory

A Case History of Sycosis

Normally, we think of gonorrhea of Neisser as the only pathogenic agent involved in the transmission of the sycotic syndrome but this may not be the complete picture. The sycotic miasm also causes a person to become susceptible to a whole range of venereal disorders. The most probable candidates are chlamydia, trichomonas vaginalis, ureaplasma urealyticum, and candida albicans. This case is an example of a person with an inherited case of sycosis that was activated by the suppression of a chlamydia infection rather than by a new infection of gonococcus. In many of our old books there are stories of the reinstatement of suppressed discharges during the process of homoeopathic treatment. The following case is an example of how this phenomena comes about. In Homoeopathy we often speak of Hering's laws of cure. One of the most important factors of this law is the reversal of the developmental order of the symptoms. This phenomena was first observed by Samuel Hahnemann and recorded in the 1828 edition of The Chronic Diseases. Hahnemann wrote:

"The latest symptoms that have been added to a chronic disease, which has been left to itself are always the first to yield in an antipsoric treatment; but the oldest ailments and those which have been most constant and unchanged, among which are the constant local ailments, are the last to give way; and this is only effected, when all the remaining disorders have disappeared and the health has been in all other respects almost totally restored."

The following is a case in which an LM potency was used to treat a case of suppressed venereal disease. The client was an Irishman who was studying with a yogi in India. He was a strong, well built, rather coarse kind of a person. He was not stupid in any way yet sometimes one had to say things a few times before he would grasp what you really meant. His appearance was a bit disheveled in that he wore half Indian and half western clothes. I had known him for a few years and I had already observed that many of his habits were rather psoric but the predominance of his psychology demonstrated the sycotic miasm. He was a suspicious sort of fellow who looked out of the corners of his eyes and questioned the motives of others and sometimes held fixed opinions. Compared to the average person in society he was a true religious fanatic as he lived in a cave in far off India with few belongings. These are some of the traits that pointed toward inherited sycosis. At the same time, he also had something of the dullness, genius and madness that is associated with the syphilitic miasm. This appeared to be the deepest, darkest,  most hidden part of his personality. So it seemed that his miasmic states were layered in the following manner; sycosis was the most active layer, followed by psora which was more latent, and syphilis which was quite deep and dormant. These are only some of my personal observations as I had not taken a detailed case history of his chronic states. He went to England for a visit and contracted a severe case of chlamydia. This produced a greenish, dirty discharge as well as much local irritation of the penis. I did not see the case in its acute state so I do not know all of the exact symptoms. He visited a homoeopath who gave him Thuja in the centesimal potency. This did not help the situation so he went to an allopathic doctor who gave him a full course of tetracycline.

The treatment with antibiotics suppressed the acute symptoms so he was left with a little gleety discharge which manifested as a clear or white secretion at the meatus that caused much itching. In the mornings he would express a small amount of the discharge which would return later during the day. He returned to the allopathic clinic and was told he had non-specific urethritis (NSU) and there was nothing they could do about it. From this time forward he developed several of the symptoms of the sycotic miasm. First of all, his prostate gland began to swell and become painful with concomitant pains underneath and in his rectum. This was followed by a loss of memory and dulling of the intellect. Evidently his susceptibility to chlamydia was due to his latent sycotic miasm and this new infection activated the entire syndrome. This was not a simple local urethral discharge caused by NSU. The entire sycotic syndrome began to manifest deeply in his constitution. He began to develop a pain in his lower back that started moving up his spine to his head. At the same time, his extremities were  becoming arthritic and painful. This was followed by a further deterioration of his mental and intellectual levels and his memory really began to slip. He became dull and had difficulty thinking and could not find the proper words when speaking. He began to feel guilty, dirty and contaminated. Although he wore ragged clothes, he was not particularly dirty yet he could smell his own body odor and it upset him greatly.

By now he had dullness, sadness, depression, despondency, doubt of cure, and salvation. When he looked around he would squint his eyes which made him look shifty. His memory continued to fail and his mind became more confused. He became very sleepy, apathetic, tired and lazy as well as more dirty as he started to change his clothes less than before. The symptoms continued to increase over a period of around eight months until he was in pretty bad shape. I formed the totality of the symptoms around the syndrome of the sycotic miasm and the state of his present temperament. His religious and philosophical ideas, rough lifestyle, ragged clothes, depression, despondency, sleepiness, loss of memory, tiredness and laziness led me to investigate the remedy, Sulphur. These mental states were best reflected in Phatak's Materia Medica which gives under mind: "Dull, difficult thinking: misplaces or can not find proper words; when talking and writing. Too lazy to rouse himself and too unhappy to live. Strong tendency to religious and philosophical reveries, with fixed ideas. Hopeful dreamers. Disgust, up to nausea about any effluvia arising in his own body". The itchy nature of his gleety discharge and the redness of his meatus also pointed toward this remedy. This was confirmed by the general concomitants like his warmer constitution, his desire for soupy foods, and his sensitivity to his own body odors.

Sulphur is a multi-miasmic remedy although it is most famous for its antipsoric nature. In Kent's Repertory it is listed as a 2 for sycosis as well as for syphilis. It seems that acquiring the venereal disease brought out this man's inherited sycotic miasm which magnified certain aspects of his potentially Sulfurous nature. Before the acquired venereal disease he seemed quite sycotic as he was more suspicious and closed minded than is usual for psora or Sulphur. It was as if the newly acquired venereal syndrome actually made him more Sulfurous than he was before the suppressed sycotic infection. Perhaps the suppression had produced a complex disease as his symptoms seemed to be rather psoro-sycotic with a dormant, hidden syphilitic layer. I was very excited because Sulphur was one of the only LM potencies I had at the time and I wanted to experiment with them.

In aphorism 281 of The Organon Hahnemann taught that sensitivity can be measured on a scale of 1 to 1000. I felt sure that this gentleman was on the low end of that sensitivity scale. After the suppression of his primary symptoms, a Dutch homoeopath had given him all sorts of high potency remedies yet he felt absolutely nothing. Anyone with an average to high sensitivity would have felt some good or bad reactions to so many high potency remedies yet he felt absolutely nothing. Taking into account the sluggishness of his nature at this time, his rather coarse lifestyle, and the fact he could take so many high potencies without any effects, I decided his constitutional sensitivity was rather low. For this reason I began the case with Sulphur LM 0/3. In The Organon Hahnemann recommends beginning LM cases in the "lowest degrees" of potency. Most chronic cases are started on the LM system with the 0/1 potency, although under certain conditions, cases may be begun with the LM 0/2 and LM 0/3. As this individual seemed to be at the lower end of the sensitivity scale I began the case with Sulphur LM 0/3. This is the highest potency I have used to begin a chronic case at the present date.

I prepared the medicinal solution by placing 1 small #10 pill of the Sulphur into a 4 oz. solution of water mixed with brandy. After succussing the bottle 10 times the client was asked to stir one tablespoon into 4 oz. of water in a glass. From this dosage glass he was advised to take 1 teaspoon as his dose. I asked him to take one dose and come back to see me the next day. When he returned I asked him how he felt and he said, "Oh, I feel all right." I told him to take another dose. At the time he was staying near my house in a room under a Tibetan monastery so it was easy to see him daily. The next day I asked him how he was feeling. and he responded that he felt pretty good. He seemed a little brighter and he didn't have as much of the squinty look to his eyes. He may have been responding to my questions a little better. The rest of the symptoms were exactly the same so I said, "Take it again tomorrow."

It is often said that the LM potency can be repeated daily, or every other day, for months. This is not the total picture as in the note to aphorism 246 Hahnemann explains that this should be done only "if necessary". I'm not recommending that the LM 0/3 should be repeated daily with your average client. In fact, Hahnemann says in paragraph 246 of The Organon that any "marked obviously progressing improvement" is a condition in which a single dose of an LM potency should be allowed to act without repetition. He goes on to say, however, that in "slowly" improving chronic cases the remedy may be repeated at suitable intervals to speed the cure to 1/2, 1/4, or less the time it would take without repetition. If the remedy is over repeated it will either cause aggravations or slow down the curative reaction delaying the cure. In the 6th Organon Hahnemann offers a middle path that lies in-between the method of giving a single unit dose and waiting for a relapse, and the mechanical repetition of remedies. In the LM system the correct remedy may be repeated in cases that show only gradual improvement to speed the cure rather than waiting for a full relapse of the symptoms. This can only be done if the homoeopath is using a medicinal solution which is succussed just prior to ingestion. Hahnemann introduced a similar method for the centesimal potencies in the 5th Organon (1833) and in the 1837 preface in The Chronic Diseases called, Concerning the Technical Part of Homoeopathy.

After six days of repeating LM 0/3 Sulphur my client returned to me and said, "Gosh, I'm feeling a little bit funny". I asked him how he felt and he said, "Well, you know, I keep seeing these kind of black things floating around." He was seeing the black motes which Sulphur often produced during its provings. This remedy is a 3 in Kent's Repertory for black motes. I had repeated LM 0/3 for six days in a row and now the remedy was beginning to mimic the provings of Sulphur. It was obvious that I needed to slow down or stop the remedy. I said, "I don't think you'd better take it today but come back and see me tomorrow". He came back the next day and I said, "How do you feel?" He said, "They're going away. I don't think I even see them anymore." Most LM aggravations pass through rather quickly unless the client is a hypersensitive. These aggravations tend to last for one, two, or three days under normal circumstances. Nevertheless, the power of the remedies must be carefully controlled through adjusting the dose to match the susceptibility of the constitution and being conservative with repetition.

A homoeopathic aggravation is produced when the primary action of the remedy is too strong. This is caused by too large a dose, too high of a potency, or too much repetition of the remedy. For this reason I waited for two more days and then adjusted the dose by taking one teaspoon from the first dosage glass and placing it in a second glass. From this second glass I had the client take one teaspoon as a dose. The following day this gentleman came running over to my house. He looked extremely excited and he had a covered glass in his hand. I asked him what happened and he said he suddenly felt an urging and a pulling down pain which made his penis feel as if it was going to explode! Then he passed four ounces of filthy greenish-yellow putrid pus-like discharge into a glass. The entire episode lasted less than a minute. When someone passes a discharge like this the question comes to mind, where did it all come from? This is one of the mysteries of Homoeopathy. How does the vital force do this? The answer to this question lies outside our normal understanding of pathology.

On seeing the discharge I slowed the repetition of the remedy down to once every three days and all of his symptoms peeled off layer by layer in the reverse order in which they had developed. His mental temperament improved, his memory came back, he lost the feeling of being dirty and contaminated. The pains in his head and spine moved downward toward the coccyx, and the rectum and prostrate stopped hurting. The gleety discharge disappeared and none of these symptoms have ever returned. I slowed down the remedy even further as he continued to improve and then finally stopped it. He was a changed man who later left for England where he studied Homoeopathy and was awarded a certificate. I saw him a few years later in India and he said, "Thanks a lot. You saved my life."

This case, and others like it, shows that the complete sycotic syndrome can be overcome with the skillful use of homoeopathic remedies. The reinstatement of old discharges, and the return of other old venereal symptoms, is a definite sign that the homoeopathic remedy has attained its goal. The removal of these deep miasmic taints from the constitution is one of the greatest gifts of Homoeopathy, because it not only removes the illness from the sufferer, but also from the following generations. In this way the homoeopath can overcome the past, transform the present, and change the future. This is surely the blessing of Providence and the fruits of the dedicated work of Samuel Hahnemann and those who follow in his footsteps.