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The Development of Miasmic Theory - II

Part Three:  The progression

The next major stage in the development of miasmatic thinking has been the introduction of other miasms.  If the three major miasms, stemming from the primary afflictions that Hahnemann spoke of - to the thematic expressions that Ortega and others described - act as a foundation, then practically speaking, the miasms of Tuberculosis and Cancer belong in a very similar category.  However, there are distinct differences between the two miasms, the most important one being that Cancer is the only miasm that does not stem from an infectious disease.  The other four all have an infectious disease or contagion principle involved in it.  However, for all intensive purposes, it conforms to all the other major criteria for a miasm, in that there is a distinct inherited disposition to it, there is a clear nosode with a profound remedy image and there is a larger pattern of physical and mental symptoms and behavior connected to it.  In other words, there is a systemic totality.  Historically, Tuberculinum was made and proven around the same time as Medorrhinum and Syphilinum and by the same prover, Swan, who conducted provings of these remedies between 1880 and 1885.  Carcinosin, on the other hand, did not having any substantive provings, most of the information coming from clinical anecdotes and observations of Donald Foubister, an English homeopath, who wrote about the remedy in his book Tutorials on Homeopathy.  However, Burnett did a self-proving of Scirrhinum around the time that Tuberculinum and the other nosodes were being used.

When studying tuberculosis, the two key remedies are the nosode Tuberculinum and the remedy Phosphorous.  The image of the tubercular miasm is well-known, the disease itself providing a clear image of one part of its picture, the affinity for the lungs, the breaking down of tissue and the formation of tubercules in the lungs; the chronic cough, night perspiration, emaciation and affinity for other glands in the body and also the bones.  Also, the “tubercular age” gave us the dynamic influence of the disease, affecting the romantic poets and the travelers of the world, exploring far flung places just because it was possible, endlessly optimistic and determined to experience as much as possible before burning out.  The tubercular miasm (as well as the cancer miasm) are interesting to study from the point of view of the circumstances and historical time of their ascendance.  Although there is evidence of TB’s existence for many thousands of years, its proliferation in the 19th century of industrial cities and urban congestion and pollution is a direct reflection of the nature of the disease and miasm – a feeling of oppression, pressure, restriction with the consequent desire to escape, to travel, to get away from the imposed restrictions and limitations.  The tubercular person wants to breathe and if they can’t, they implode, like the sunken narrow chest of the classic consumptive.  In the remedy Tuberculinum, one sees these desires, the extremes of craving to travel, to move onto something new, the restlessness and then the dissatisfaction, irritability and destructiveness when they can’t have that.  The latter symptoms can look like all the other major miasmatic pictures, but the former symptoms are more unique to the tubercular miasm. 

Phosphorous expresses the unfettered, freed up tubercular state.  Sensitive, refined, delicate, romantic, open and vulnerable, the person needing Phosphorous floats through life relatively unscathed by the vicissitudes of traumas, like the tubercular nature that in its optimism and openness moves onto the next thing.  However, in Phosphorous we see the physical burn out of the tubercular miasm, the depletion and exhaustion, the affinity for all sorts of chest conditions as well as the liver, the bones and nerves.  Phosphorous can go all the way to actual tuberculosis and complications of all chest infections, however long ago they may have occurred.  Calcarea phosphorica however, possesses much of the classic mental dissatisfaction of the tubercular state, but less of the classic physical condition, its affinity more for the joints and bones than the lungs. 

The cancer miasm is the newest of the big five but perhaps has become the most important of all the miasms in the modern age.  We live in the age of cancer.  It is the disease we all fear and that has traumatized the modern world.  It’s causes are complex which adds to it’s complications as a homeopathic miasm.  Not all cancers are inherited miasmatic conditions.  Many are caused by modern environmental toxicities, including especially hormones, both natural and synthetic, especially the estrogens, petroleum based toxins found in the atmosphere and in pesticides etc and and increase in radiation exposure, like x-rays, nuclear exposure etc.  However, we also see a theme identified in the cancer miasm that can predispose some people to cancer and to the broader miasmatic condition.  This is clearly seen in the remedy image of Carcinosin, the nosode and also in cancer remedies such as Arsenicum album, Nitric acid and Conium.  It has been stated by Rudolph Steiner and others that there are two biological expressions: inflammation and tumor formation.  One represents the expressive outward manifestation that we see in a fever, an inflammatory process, and the other is an internalization process, one that “eats away” at itself, manifesting ultimately in tumor formation.  Therefore conditions in which there is excessive inflammation or no inflammation at all, or where there is a morbid internalization, a suppression of normal physical and mental expression, indicates the cancer miasm.

In other words, there is a great tension and polarity between the dynamics of expression and suppression, an actual confusion of identity on a cellular, emotional and existential level.  One of the keynotes of Carcinosin is when there is a history of domination, of oppression in which the person passively accepts this domination, often out of guilt, morbid responsibility and duty or weakness, which is then followed by periodic expressions of fever, rage, dancing, travel, romance, escape, wildness, violence etc.  After a while, the morbid internalization or suppressed emotions seek an escape valve which is then expressed in the ways described.  In any given case though,  a person may be anywhere in this continuum, which may make it harder to see the remedy.  More than any other nosode Carcinosin can look like many other remedies, sometimes all at once.  This is an aspect of the confusion prevalent in its dynamic.  In one stage its all about suppression, denial, morbid grief, something is “eating away” at the person, and the next it’s raging, wild, dancing, traveling, full of romantic ideas.  Control is another key expression here, manifest in the chronic constipation and insomnia.  They can’t let go.  In many ways, it can look similar to the tubercular miasm picture, the main distinction being that the tubercular dynamic will not let the person become so morbidly suppressed.  They will seek escape a lot earlier than in the Carcinosin picture.  However, in practice, it is not always so easy to distinguish between them.  Carcinosin, the remedy, is made from breast cancer tissue, traditionally from one woman, although a new remedy from multiple breast cancer tissue has been made.  There are other cancer remedies as well, including cancer from the stomach and Scirrhinum.  The remedy Conium is one of the great clinical remedies for cancerous conditions and represents a key aspect of the cancer miasm, which is the process of internalization and suppression of feelings, until there is a great slowing and hardness of emotional states, leading to the growth of hard cancerous tissue.  Arsenicum album, on the other hand, as well as Nitric acid expresses the morbid anxiety that can be found in the cancer miasm, the kind of intense anxiety and worry that eats away at the person.  Both remedies are very good remedies for a variety of cancers.

The remedy Carcinosin is now used widely, although even twenty years ago,  Vithoulkas and the Greek homeopaths as well as many in the United States rarely used it.  Its use was mainly popularized by British homeopaths, beginning with Burnett and then by Foubister in the 1960’s. 

Two books that describe well these five main nosodes and the broader miasmatic picture are Dr. H Choudhury’s book, Indications of Miasms and Henny Heudens Mast, The Foundation of the Chronic Miasms in the Practice of Homeopathy.  Choudhury’s book is a very clear explanation of Hahnemann’s original thinking, when he spoke of  the infectious origin of miasms, preempting modern bacteriology and germ theory.  However, Choudhury also proceeds to list many of the secondary symptoms of psora as defined by Hahnemann, which for many homeopaths seems rather vague and generalized and not that helpful in general clinical practice.  There are also some rather questionable descriptions of the characteristics of the psoric state, e.g., “He is a man of hide and seek nature.  In most times the psoric patient is a dishonest man, privacy, wickedness and impurity play a good deal in him.” Also, his list of anti-psoric remedies suffers from similar confusion that Hahnemann’s and subsequent lists have.  He describes, using the source of various authors, the characteristic qualities for the other miasms, including tubercular and cancer miasms.  Some of these descriptions are consistent with commonly accepted qualities, while others are more dubious, e.g., “All the vicious individuals on earth – thieves, robbers and murderers, are the products of Sycosis.  It makes a beast out of man.” (Dr P.N. Bannerjea)  He gives an exhaustive list of the secondary symptoms of the Tuberculosis miasm, and in so doing, merges the original ideas of Hahnemann’s secondary symptoms of psora, which Hahnemann perceived as the inexorable internalization of an active disease state after suppression of the primary infection with the inherited disposition and “diathesis” of chronic disease possibilities.  This further confuses the argument between infection and diathesis presented earlier on by Dimitrialis.  The problem with giving so many symptoms of secondary symptoms of the tubercular miasm as well as secondary psora is that it takes away from understanding the main thematic dynamics of each miasm and compounds some of the more dubious symptom classifications that Hahnemann identified with the psoric miasm. 

One of the other main ideas that Hahnemann put forward was being able to identify symptoms in a case belonging to various miasms and having to choose a remedy based on which miasm seemed more active.  For example, if there was an active psoric and sycotic influence at the same time, one would begin with a psoric remedy and then follow up with a sycotic remedy and then finish up with a psoric remedy again.  In many cases, this entailed Hahnemann beginning a case with Sulphur, perhaps alternating with Hepar sulph or Nux vomica. He may then follow with a sycotic or a syphilitic remedy if he perceived that miasm to be active.  In his time he was seeing many cases in which acute and chronic symptoms of gonorrhea and syphilis were present and therefore would have been dealing with much more graphic images of symptoms based on these miasmatic influences.  However, the difficulty of looking at cases from this mixed miasmatic perspective is that it can lead homeopaths to somewhat artificially separate individual symptoms from the collective totality and somehow numerically add up the number of symptoms attributable to each miasm.  This can miss the whole point in understanding the value of miasmatic thinking which is to identify if there is one overriding miasm present, which may help identify a remedy and or consider a nosode.  It needs to be emphasized that in many cases, knowing the remedy picture is enough.  There is no need at all to identify which miasm is present or which portion of a case is related to which miasm.

In Henny Heudens Mast book, she approaches cases by identifying clearly which miasm is active in any given case and recognizing the mixed miasmatic components of various remedies, which can help in perceiving which remedy is the most similar, not just based on specific symptoms, but on the dominant miasmatic and constitutional complexity of both the characteristic symptoms and the overall case.  Her main point is that if we can identify the complete miasmatic picture it will allow us to understand the case as it unfolds over time and how miasmatic layers may be revealed during treatment.  However as in many forms of systemic analysis, a miasmatic perspective may or may not help and it is always possible that it can create confusion for homeopaths that misidentify which miasm seems most prominent.  This especially can happen when individual symptoms are misidentified, which is more likely than when one is analyzing the miasmatic “gestalt” of the whole case.  Heudens Mast discusses how one can learn the symptoms of the miasms to identify them in the different remedies.  This she bases on the classifications that Ortega outlined but uses the words too little = psora, too much = sycosis and destructive = syphilitic.  Her analysis of  which symptoms belong to which miasm is interesting and perhaps would not be agreed on by different homeopaths.  It is not always that straightforward as also is  the argument about which remedy belongs to which miasm.  She identifies Nux vomica as psoric whereas other people would say it has a strong syco-syphilitic aspect.  Similarly, in the repertory, in Generalities there are rubrics for Sycosis and Syphilis but not Psora.  Heudens Mast states that remedies not in either list can generally be classified as Psoric but she does not question or critique the list of remedies in these rubrics and how questionable their miasmatic classification really is.  Therefore, her miasmatic perspective in cases, as outlined in the book, reveals both the strength and weakness of miasmastic philosophy in homeopathic prescribing.

One of the challenges of identifying certain themes of behavior and broader personality qualities as belonging to one or other miasms is that, as with the classifying individual symptoms, it can easily look like a broad overgeneralization in making this classification.  For example, she states that Psora likes consolation and will ask for support (based on the overriding theme of psora being weak).  However, for many people Natrum muriaticum is psoric (struggling for identity and emotional integration) which as we know does not like consolation.  Also, that most guilt is psoric, whereas for some guilt is extremely sycotic.  Also she discusses which professions and which cars a psoric person would have, which seems to be one further step removed from simply looking for the truly characteristic symptoms in any given case.  Some other aspects of her classification of characteristic symptoms of each miasm suffers from similar over generalizations e.g., “Many butchers are syphilitic” (as syphlitic people choose professions where they can use a knife; “cracks in the skin are syphilitic and can be very painful.” (many non syphilitic remedies have strong cracks e.g., Graphites.)  “Blue sclera is a tubercular symptom” (whereas it is also a symptom of the cancer miasm.) 

However, the value of defining miasmatic themes in such a broad way is that it can give a good impression or flavor of the dynamic of each miasm and how this generalized dynamic permeates the story of a case and from this can help in the process of the type of remedy one can look for.  Clinically speaking, this is useful as if one sees a strong thread of violence in a case, whether its in dreams or in the life experience, the recognition of the depth of the experience in the case is helpful in identifying a remedy with a similar depth, in this case the syphilitic miasm.  In this way, one can see beyond mere symptoms to include a more complete analysis.

Interestingly, in Heuden’s Mast book, when describing the syphilitic miasm, she uses the word not to describe the disease itself which is how Hahnemann originally defined the term miasm, as described by Dimitrialis earlier.  Her description of the various miasms is in fact a description of the miasmatic susceptibility and impact of the original disease, and not the disease itself.  This conforms to the general understanding of the word miasm as its used in regular homeopathic discourse, even if it is different to Hahnemann’s original meaning.  It is however not clear whether Heudens Mast is talking of Syphilis the disease or the miasm when she states that we have all seen the Syphilitic disease is the 3rd stage, probably without knowing it was the disease – this is when we see “dullness, an inability to express emotions, depression or physical disturbances.”  What she is describing is most likely NOT the disease syphilis but merely the miasmatic influence of the Syphilitic miasm.  Her descriptions only further confuse the difference here.  She also states that when syphilis is there, psora  is already there.  As has been discussed earlier, this is open to dispute, especially in the way that Hahnemann originally meant it when he saw each miasm (disease) as being distinct from one another, not built up out of the base of psora.  That interpretation only took real root with Kent’s interpretation of miasms.

Heudens Mast has taken on some of Kent’s analysis in describing the impact of Syphilis, as the mechanism of catching Syphilis is an act of will, leading to “a sense of wickedness or corruption and the desire to hide it’s evidence.”  This is very debatable.  No doubt people didn’t feel good about having Syphilis but in the early years of syphilitic outbreaks in Europe, people were alienated by mainstream society, similar to the way lepers were.  The alienation was due to the social stigma, not an inbuilt guilt and sense of wickedness. 

One of the unique aspects of homeopathic theory, especially as it relates to miasms is the concept of suppression.  As conventional medicine, and also much of supposed holistic healing focuses on symptomatic treatment, leading mostly to suppression, the understanding that the disease is only being pushed to a deeper level is not recognized.  It is seen as a “different” disease state, not connected to the former one.  In homeopathy, of course, we draw the connection between the two, and an understanding of miasmatic susceptibility gives homeopaths an enlightened perspective on why certain diseases and mental states occur after other more superficial diseases have been suppressed.  Miasmatic theory especially allows us to recognize why certain people react in certain different ways to similar circumstances, for example, the syphilitic drunk, who becomes violent and deranged after one drink, as apposed to the psoric drunk, who merely sits in the corner becoming more befuddled but with none of the violence or wild exuberance of the syphilitic or sycotic miasm.  This aspect of miasmatic thinking is well described in Heudens Masts book, recognizing the way miasmatic influence affects symptom development after suppression of more superficial states. 

The concept of suppression by superficial homeopathic treatment is often discussed in the book.  This is a point of debate within the profession.  Some homeopaths, Heudens Mast included, feel that homeopathy can easily suppress symptoms to a deeper level of miasmatic depth.  However, it can also be argued that in many cases, a superficial remedy may well palliate and not cure, and mostly the effect won’t last and the symptoms will return, similar to many situations in homeopathic treatment – including Hahnemann’s experience – when the remedy simply isn’t the most correct one.  It can be argued that the concept of homeopathic suppression is rather exaggerated and as a result it can lead to a more fearful relationship to prescribing.  George Vithoulkas often talks about the damaging effect of superficial homeopathic treatment, which can create confusion or suppression in a case.  However, many argue that the so-called damage created by the “incorrect” remedy is exaggerated leading to a more fearful and inhibited relationship to prescribing.   One other controversial area discussed by Heudens Mast (p. 105) is the idea that repetition of the remedy too early disturbs the original dose and that one can’t hurry the remedy any more than the stimulative effect of the original dose unless it is obviously clear that the remedy has relapsed or been antidoted.  She gives an example of a case in which the remedy, Lauroceraus, was only repeated once in four years.  For many homeopaths, the experience is that repeating a remedy once every 1-3 months - even if the case has not relapsed - further assists the case, or if it is not needed, it doesn’t interfere.  It is rarely the situation where repetition of the previous remedy that worked well interferes with the action in the case.  Either it works or does nothing.  It is very difficult to know in long term cases when the remedy has ceased its action and therefore “judicious” repetition can be an appropriate strategy.  Heudens Mast takes a very conservative perspective on this, preferring to wait for extremely long periods of time than to repeat a remedy.  The fact that this area of homeopathic strategy is debated so strongly is an interesting aspect of our homeopathic work. 

Heudens Mast’s detailed descriptions of each miasm is a very good study of some of the most important themes for each miasm.  It is helpful for students and practitioners to read this material, along with other sources, including of course studying the materia medica of the main nosodes and complementary remedies, in order to be able to more clearly recognize the main themes of the miasms in cases.  As mentioned earlier, there can be a tendency to over generalize certain themes and also, as is found with miasmatic comparisons, the distinctions are not always that clear.  In spite of the attempts to clearly delineate the main thematic functions of each major miasm – under function, exaggeration and distortion being common words used, in practice the distinctions are not always so clear and there can be many overlaps, similar to the challenge of differentiating between nosodes in clinical practice.  When discussing the tubercular miasm Heudens Mast states that it can only exist when ALL three of the main miasms are present to some degree.  It can’t exist if only two of the miasms are present.  Similar to her position that sycosis and syphilis can only exist if psora is present, she builds a case of the tubercular miasm lying on top of the other miasms. She further states that for the cancer miasm to be present, the other four miasms must be present.  This can clearly be discussed, especially from the original perspective of the miasm as an infectious disease (cancer excepted), with each miasm having a unique signature that can be traced to the original disease and the bacterial origin of that disease.  In analyzing miasms in this way, we can make a case that each of the miasms are unique and not dependent on one another.  The tubercular can manifest in a similar way to the sycotic miasm in the symptom and behavior presentation but it is a different miasm with a different origin.  It does not depend on the existence of the other miasms.  In Heudens Mast’s opinion, there are few people who are infected with only one miasm.  Most people have at least two, which implies that they need at least two remedies to cure the person, ending with an anti-psoric remedy to address the fundamental root.  This is similar to the concept of finding a basic constitutional remedy that may lie underneath a “lesional” or “fundamental” remedy needed for the presenting symptoms.  However, many homeopaths seek the one remedy that seems to be indicated for the complete picture, and teachers present cases in which just one remedy is given.  This apparent division between the idea that there is only one remedy and more layered approach, whether miasmatically inflected or not, is another of the interesting dichotomies in homeopathic prescribing. 

The implication that each of the miasms are built on top of one another means that if, for example, the cancer miasm is present, a remedy will be needed not only for the cancer miasm but then for at least some of the other miasms afterwards.  However, in practice, that is not seen that often.  Perhaps there is no susceptibility on the other levels and only a cancer miasm remedy is needed.  This again reflects some interesting differences in analysis of complex cases and how much emphasis is put on miasmatic classification. 

Since these “big five” miasmatic states have been well defined and the requisite nosode used along with other complementary remedies, there has been debate about the classification of new miasms, whether they exist separately or are only another expression of one or more of these miasms.  One such possible miasm is the AIDS miasmatic disease.  AIDS erupted onto our world in the late 1970s and 1980’s.  Initially it killed many thousands of people in the United States and Europe, focusing it seemed on the gay population in major urban areas.  The whole evolution and development of AIDS is highly controversial and political.  The inability to isolate the virus and reproduce it to find a vaccine and the highly differentiated symptom complex has confounded the medical profession and society at large.  The stigma of it affecting certain parts of the population more than others – gays, prostitutes, vulnerable people with weak immune systems, like hemophiliacs requiring blood transfusions, has only created further problems in identifying characteristic behavior qualities of the virus and it’s expression.  For homeopaths, it has seemed remarkably like “syphilis revisited”, sudden, violent disease expressions, passed on through sex, leading to destructive changes and often found in cases where their has been a history of suppression of the diseases gonorrhea and syphilis.  There is no doubt some truth to this theory, based just on observing how the disease initially manifested in the west.  However, it also has a unique pattern to it, different to the primary expression of syphilis.  A study of possible causes of the virus causing AIDS is also interesting in this regard.  There is quite a lot of evidence that the virus could have been man made, stemming from contaminated vaccine material that had been incubated in monkey’s kidneys.  The simian virus contamination, crossing the animal/human barrier through vaccines has received a lot of attention, and while dismissed by mainstream medical thinkers, remains a possibility when looking at how a new disease suddenly manifested in certain elements of the population.  Heudens Mast discusses the development of AIDS as a result of the suppression of other diseases, as mentioned above, but especially gonorrhea and syphilis and when mixed with tubercular dynamic, then AIDS may be the result.  No doubt there is truth in this, but it is also important to consider the actual infectious element in this disease.  Some medical theorists (see the work of Peter Duesberg) have even disputed the fact that the virus exists at all, attributing the disease to only the consequences of a suppressed immunity due to lifestyle factors.  However, the sudden explosion of the disease does make us question that a viral factor was involved, that acted as a vector and initiator of the miasmatic susceptibility.  The man made possibility adds an interesting element to the equation here, and perhaps fits into a broader theme of the AIDS miasm.  This is discussed in Peter Fraser’s book, The AIDS Miasm, in which he identifies the qualities of a breakdown in boundaries, a confusion on all levels of personal and collective identity, a symptom of a broader global consciousness in which boundaries on personal, societal and cultural levels are broken down.  Apart from the disease AIDS, other diseases such as CJD/Alzheimers can be said to be part of this miasm, again reflecting a breakdown in boundaries (as CJD is caused from prions created by feeding livestock animal products never designed to be eaten by animals, a form of cannabilism).  In Fraser’s work, he takes the description out of the personal infectious level – as described by Hahnemann and also further than the broader miasmatic themes as described by Heudens Mast – and describes the miasm as part of a broader social, cultural, phenomenological dynamic.  In other words, the disease is a reflection of the culture changes and challenges at any given time, which often express at times of transition and stuckness.  They are symptomatic of societal change and express the energetic vibrations of a cultural consciousness.  As Fraser says, miasmatic diseases can be seen as “acute diseases of society itself”. 

This way of understanding disease gives another perspective to our understanding of miasms, as expressed both in individual disease and the collective consciousness of society.  It is also a contrast to some extent to the perspective of Heudens Mast and other homeopaths that see the progression of miasms – psora, sycosis, syphilis, tuberculosis, cancer, aids, as expressions of a deeper degeneration and suppression, leading to ever further degradation of health and by implication moral well being.  In Fraser’s analysis, these diseases reflect the cultural challenges of the day and although the concept of miasmatic suppression has truth to it, it is not the only way to explain the advent of these diseases.  They are a reflection of a rapidly changing culture, an inexorable change in which opportunities for evolution occur at the same time as disease manifests.  In spite of ourselves, the human species is moving forward (perhaps back as well) and new situations and technologies will evolve, out of which new diseases and mental and emotional challenges will arise.  Nothing exists in a vacuum, and these “new” diseases will manifest as we are all challenged in the ever changing dynamic of evolutionary change.  This perspective adds another dimension to the otherwise depressing analysis of the degeneration of the human species through the suppression of primary expressions of various diseases. 

The AIDS miasm conforms to most criteria of miasmatic thinking, including there being a nosode of AIDS, taken from the blood of a man with AIDS.  However, it’s use has not been verified to anything like the degree of other major nosodes and right now, a unique inherited disposition based on AIDS has not been clearly defined.  It will take another generation or two before any unique patterns may be seen.  However, given the dubious origin of the AIDS virus, it might not pass onto future generations in a similar way to other miasms, and may die out much quicker.  If one sees all disease as merely expressions of energy, then the energy that created AIDS may just go to another disease.  Right now, we are seeing the explosion of Lyme Disease, in some cases acting like neurological AIDS cases.  There is quite a lot of evidence to suggest that this disease is also a man made disease, which would lead it to be identified within the AIDS miasm, connected to the breakdown in boundaries between species, in this cases the mutation of a bacteria found on ticks.  As is known, the bacteria is a spirochete, not dissimilar to the spirochete of Syphilis.

Recently there has been the suggestion of other miasms, based on a combination of a connection to specific disease states, mostly with a nosode attached and a characteristic set of symptoms and also remedies that fit that miasm.  Rajan Sankaran has been the main exponent of these miasms and Roger Morrison explains the qualities that Sankaran identified with these miasms.

1)Each remedy is assigned to a specific miasm and only one.
2) Each miasm was given extremely clear and tight defining characteristics -- both physical and mental -- which are readily identifiable in the homeopathic interview.
3) Each patient has only one miasm evident at any time.

Some of his thinking is very similar to how Hahnemann defined a miasm, which is of a disease. Hahnemann described a cholera miasm and Sankaran describes a typhoid miasm for example.  Hahenmann also described certain diseases as fixed miasms, which were the childhood diseases such as measles, mumps and chicken pox as these diseases only occurred once in a lifetime.  However, much of Sankaran’s classification is based more on a thematic dynamic than just the disease symptoms, extrapolating a more metaphorical and broader gestalt than just the symptoms connected to the disease.  His first miasm he classifies as an acute miasm, which is purely thematic, not connected to any particular disease or nosode.  He was looking at remedies such as Aconite, Belladonna and Stramonium as part of this miasm.  Interestingly, he includes Lyssin in this miasm, which Hahnemann described as a half-acute miasm, meaning that the disease of rabies has a long prodrome and then a sudden violent action.  We don’t tend to see the rabies miasm (with Lyssin as the nosode) as a broader miasm as not many people in the past survived the acute disease and its impact is much more limited and less prevalent than the other diseases.  The typhoid miasm is clearer to identify according to conventional miasmatic thinking and also has a nosode attached – typhoidinum – although it’s use is more limited to when someone has never been well since having typhoid and not so much as a chronic hereditary disposition.  So it still belongs more in an acute miasmatic influence.  The next new miasm he introduces is the ringworm miasm, with the nosode ringworm attached to it, a remedy he proved himself.  Again, its definition and use is more identified thematically than as an inherited disposition.  He posits it in between psora and sycosis.  Hahnemann identified ringworm as an expression of the psoric miasm but clinically speaking it does make sense to put it in between the two major miasms as many fungal diseases have a sycotic flavor to them.  He then introduces the malaria miasm, which could be said to be a classic Hahnemannian classification, with a clear miasmatic infectious diseases, a clear primary state and well defined secondary states if the primary condition is internalized into the body, leading to chronic problems.  This is how Hahnemann saw the venereal diseases, although Hahnemann saw malaria as part of the psoric miasm, along with most other acute diseases that would have exacerbations at intervals, becoming chronic disease states.  The other new miasm he introduces is the leprosy miasm, with its nosode being Leprominum, a remedy proven by Prakash Vakil, from India.  Hahnemann identified Leprosy as a form of pure psora,  a kind of psora unplugged, no longer leashed in but allowed to flourish on the skin, the centrifugal energy manifesting with an intensity not often seen in psora because of suppression and how disease used to manifest before it was controlled by “civilized” behavior.  This was described earlier on in this article, with the somewhat challenging concepts of the consequence of allowing leprosy to be mollified by hygiene, diet and general good living, leading it to be more easily suppressed and then leading to secondary symptoms of psora.  This has to be said to be somewhat challenging to fully accept and reflects perhaps Hahnemann’s own confusion in establishing the true causes and expressions of psora.  In modern miasmatic thinking, leprosy clearly shows aspects of the syphilitic miasm and as such Sankaran puts it in between the tubercular and syphilitic miasm.  However, even though a chronic disease condition, and one experienced through the ages, Leprosy has not become a chronic miasm with a broader inherited susceptibility as the other major miasms.  It’s image and dynamic has been somewhat split between the psoric and syphilitic miasm.  However, in studying its disease manifestation, one can get a good idea of its broader image and “gestalt” and how certain remedies can be identified with the miasm, e.g., Hura brasiliensis.

As mentioned earlier, one of Sankaran’s qualifications has been to identify a remedy more exclusively with a certain miasm.  While that can be done in the manner in which he classifies miasms, it is very different to the way other people classify the miasmatic classification of remedies.  Heudens Mast talks of the percentage of different miasms within certain remedies and most homeopaths understand that so-called “polycrest” remedies have qualities of more than one miasm in them.  To limit each remedy to only one miasmatic influence does seem to be an oversimplification of the whole idea of miasmatic influence.  Similarly, to state that only one miasm can be evident at any one given time contradicts some of the writings and experiences of many homeopaths.  In many cases, it can be seen how a miasmatic influence is affecting the picture that is being presented but  it may be apparent that another remedy picture, essentially belonging to a different miasm may be seen underneath.  However, it is true that usually only one miasm will be prominent and will require a specific remedy.

There could be said to be other miasms relating to specific diseases, with different bacterial/viral origins.  Some homeopaths have used nosodes from various diseases like Staphyloccinum, Streptococcinnum, Pneumococcinum and also the bowel nosodes, which have been part of the homeopathic materia medica for many years.  The bowel nosodes have their own picture attached to them, taken mainly from clinical observations of disease symptoms and the appearance of these bacterias in bowel flora.  The nosodes from disease bacteria are often used when a person has never been well since a particular diseases and examples a specific and occasionally useful form of prescribing.

However, for most of our prescribing, the use of the big five nosodes and the impact of the broader miasmatic influence dominates our use of miasmatic prescribing.  The influence of these diseases through many generations and their unique patterns found in many different symptom pictures and disease conditions makes an understanding of miasmatic theory of great significance and validates Hahnemanns’ original postulates about the origin of disease.  The fact that we have taken his thinking much further and developed broader images of the other miasms and even refuted some of his ideas of the origin of psora do not take away from his original thinking.  It is a unique and vital part of homeopathic thinking, one that in time will be revealed to the rest of medicine as a great contribution to the evolution of medical thought and disease classification.