Clinical Application Of The Theory Of Miasms In Management Of Chronic Cases

Abstract
Miasms are complicated to understand and have always been a debating issue in Homeopathy, so their thorough understanding requires a proper study in depth. Homeopaths have come across various cases of multiple suppressions, and it is a difficult task for the physician to receive a clear picture of disease manifestations. It is essential to know the dyscrasia of the person and miasm, which represents the stigma in the system. The highest ideal cure with the complete annihilation of symptoms is possible through the use of constitutional anti miasmatic treatment.
Keywords
Miasm, Psora, Sycotic, Syphilitic, Homeopathy, Management.
Introduction
The Hahnemannian classification of diseases based on the theory of chronic miasms is a breakthrough towards rational therapeutics. Introduction of miasmatic classification of diseases because of the most important milestone not only for the Homeopathic world but the entire medical fraternity.However, Miasm theory is controversial, and many physicians have attempted to explain the theory of miasms, but there is no sole explanation which has been able to explain all that Hahnemann said or wrote on miasms nor has anybody been able to prove that the theory is incorrect. (1,2)
Master has taught that the miasmatic concepts give a unique perspective to understand man in his totality. Miasm is an invisible, dynamic force that is imposed upon every life, starting from an unborn child until the final stage of life. Each human being right from the moment of conception is characterized by a miasmatic modulation through which his individuality is constantly trying to emerge. Every child is imposed by miasmatic influence, which changes not only healthy susceptibility to some degree. Sometimes to such an extent as to destroy the new life.This dynamic force may break down not only the resisting power on the physical plane but the mental faculties as well.Miasm can bring all perversions, all disturbances even up to the level of cells.Hence it is quite obvious that miasmatic influence can lead to unformed and imperfect creation starting from uterus even after that. It is believed that greater the miasmatic obstacles, deeper and extensive, are its manifestations in health and disease. It is our day to day experiences of integration of miasmatic totality in the handling of chronic illnesses. (3,4,5)
We have seen that the penetration of miasm increases from year to year and from generation to generation. What does this indicate? It shows that the human race becomes more and more sensitive, generation to generation to this internal state, and the miasm keeps on plowing deeper and deeper internally. (4,5)
The subversive force is miasmatic affection. To know how it can progress, we must have a sound knowledge of the miasms, their mysterious, but a persistent progression, pause rest, advancement, retrogression and attacks along the unfamiliar line and their modus operandi. Will it be possible to fight with an unseen enemy about whom we are ignorant? So, it is imperative to know everything about the miasm (4,5)
The theory of miasms originated in Hahnemann’s book ‘The chronic disease’ which was published in 1828. Dr Hahnemann declared that the theory was the result of 12 years of the most painstaking work on difficult cases of a chronic character, which he had seen in his practice. (1)
Miasm is an obnoxious disease-producing agent inimical to life and dynamic in nature. The word “miasm” means the effects of microorganisms on the vital force, including the symptoms that are transmitted to the following generations.Hahnemann mentions about three miasms classified into venereal and non-venereal in its origin.The syphilitic and the sycotic are the ones from venereal origin and psora the nonvenereal one as the real fundamental cause of various illnesses. Each miasm has got a peculiar evolution in terms of predisposition, disposition, diathesis, and disease, which influences the course of illness and its peculiar form, which has the stamp of its miasmatic activity. (1,2)
The theory of miasm could be considered as a true genetic theory because these noxious agents are transmitted to offspring. It is believed that the treatment of inherited miasms can prevent genetic transmission as well as protecting succeeding generations. It is observed that the miasmatic states become progressively powerful, partly because the miasmatic states of parents are combined and tend to concentrate on their children.It can be seen that various powerful physical triggers such as excessive use of antibiotics, vaccinations, steroids, and birth control pills play an essential role in arousing inherent miasmatic states.It has been reported that each generation of children becomes weaker and shows a range of miasmatic expressions from learning disorders and autism to cancer and criminal behavior appearing in prior adolescence periods. (3,5,6)
Miasmatic expression and its reaction pattern
Man is exposed to different stressors from the environment. They are physical, emotional, chemical, biological,socio-cultural, religious, spiritual, and economic-political objects and sleep and dreams. These environs may be the causative modalities or the maintaining causes or the modifiers of the disease response in its progression from Psora to Syphilis. (7)
Thus, whenever the constitution is exposed to these stressors, the environmental scanner gets into operation for sizing up the situation through tentative responses until the most appropriate one is selected and develops its reaction pattern. This phase, we recognize as the phase of the disease. A critical analysis of the disease responses to the environmental factors and the final resultant expression, at different levels of organization and areas, leads us to the four categories of constitutions with minimal overlap and distinct predispositions to the development of characteristic disease response. These four great constitutions of psora, sycosis, tubercle, and syphilis are, like all classifications, idealized representative types. (7, 8)
Each of the chronic miasms has its characteristic signs that are an integral part of the totality of the symptoms. For example, Psora tends to produce irritation, inflammation, and hypersensitivity, Sycosis infiltrations, indurations, and overgrowth. Pseudo-psora tends toward tubercles, fibrosis, and suppuration; Syphilis tends toward granulation, degeneration, and ulceration. (8,9)
Miasmatic constitution
In homeopathy, 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. (11,12)
The physical signs of a person are fundamental to the treatment of chronic disorders because the constitution and temperament show the effects of the inherited miasms. We must get beyond relying solely on 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 can not be traced in the case taking to specific etiologic factors. (11)
Active and Latent miasmatic state
There are two states in which miasm would exist and be present. Active miasm is responsible for developing the disease process through the involvement of one or more miasms.It is thought that chief complaints, associated complaints, prognosis, course, evolution, and progress of the acute or chronic disease are under the influence of active miasm. In acute conditions chief and associated complaints are considered for identification of acute miasm. In acute exacerbation of chronic disease and chronic diseases, miasms of chief complaint, associated complaint, mental and physical generals, past and family history of the patient are considered. (6,10)
It is observed that the dormant state of miasm is inherited or acquired miasm, and it exists as a disease potential force. It can be seen in normal life as accessory symptoms without manifestation of any discomfort. (6,10)
It can be identified in two ways:
1) Analyzing diseases suffered by either of his parents and siblings and the previous history of the patient’s illnesses.
2) By analyzing all the expressions or symptoms of patients as a whole or person (mental and physical generals)
The dormant state of miasm shows it’s various expressions through desire, sleep, menstrual or obstetric history, physical makeup like thinness, obesity, and tendencies towards catching a cold, stone formation, suppuration, hemorrhage, thermal reaction. Whenever dormant miasm is triggered on, it develops acute or chronic disease in an individual.It is also known as the predisposition cause of diseases (6,10)
The identification of miasm requires various areas of exploration, such as type of pathology developed in the affected part, pace, or speed of the development of disease, including the pattern of response and characteristic expression of the disease. (8,10)
COMPARATIVE SUMMARY OF HANEMANNIAN MIASMS (11,12)
Features of Psoric Miasm
Psorat = a Groove or a Fault – Attributed to suppressed ‘Itch.’
Location/Tissues affected and the type change –
Functional disorders only.
No structural change with uncomplicated Psora.
Neuro-Vegetative.
Endocrine system – Functional Disorders.
“Sensations as if” and valuable characteristic concomitants.
Skin: dry, scaly, Suppression eruptions wide-spread internal disorders.
Modalities:
A. Causative (“Ailments from”) –
Suppressions:
1. Emotions, Excitement, Grief, Sorrow, Fear.
2. Skin eruptions.
3. Normal discharges, i.e. perspiration.
B. Aggravations –
Standing Motion Exertion, Morning, New Moon, Sun (pains) Menses before, Odours, Touch.
C. Amelioration –
Rest, Lying down, Quiet Heat (pains) Free Eliminations: Perspiration, Urination. Diarrhea, Return of skin manifestations (Suppressed).
Mind –
Hypersensitive, Emotional, Anxious, Fearsome, Restless Concentration, poor Fatigue, Anticipation < Hysteria. Moods, alternating Melancholy Irritability (no Violence).
Sensations and Complaints in General –
Dryness
Hot waves, orgasms, flushes, ebullitions;
Burning-Hands and feet
Alternating states “Sensations as if”
Hunger: all-gone sensation,
Cravings & Aversions, Capricious
Deficiency Disorders
Functional Uterine Disorder
Other Features –
Headaches :
< Sun < cold
Heat >Rest
Biliousness
Vertigo
Skin: Itching, Dry, Rough
<Open Air < Evening
Scratching → Burning
Scaling
Alternate Diarrhoea & Constipation
Diarrhea>
Urination: Retention with chilling, Involuntary
Features of Sycotic Miasm
Attributed to suppressed Gonorrhoea.
Location/Tissues affected and the type change –
Overgrowth of Tissues Fibro-muscular affections:
‘Rheumatism’ and Arthritic conditions.
Tumors (simple, benign).
Warts.
Gouty Diathesis.
Modalities:
A. Causative (“Ailments from”) –
Suppressions-abnormal discharges.
B. Aggravations –
Damp-Wet, getting Wet, Change of Weather, Meat.
Natural eliminations: Sweat, Urine, Stools.
C. Amelioration –
Slow Motion Lying on abdomen, Dry Water Return of suppressed normal discharges (menses).
Leucorrhoea, Otorrhoea, Fistulous discharges, Nasal discharge.
Mind –
Mean, Suspicious, Jealous, Self-condemnation Fixed ideas, Anger → violence (Destruction).
Sensations and Complaints in General –
Slow Recovery: Constantly slipping back Discharges: Greenish-Yellow-Acrid
Odour-Sour, fish-brine.
Anaemia, Anasarca, Stiffness, Soreness, Lameness.
Other Features –
Abdominal colics with mental irritability and acrid discharges
Mottling of the mucous membrane
Red Nose
Features of Syphilitic Miasm
Attributed to suppressed Syphilis
Location/Tissues affected and the type change –
Destruction
Deformation
Suppuration
Ulceration
Skin: Squamous, Coppery eruptions
Suppuration, Ulceration, Fissures
Glands
Bones
Blood-vessels
Modalities:
A. Causative (“Ailments from”) –
Suppressions-abnormal discharges.
B. Aggravations –
Rest, Exertion, Storms, Cold and Heat, Artificial light, Night.
Natural eliminations: Sweat, Urine, Stools.
C. Amelioration –
Motion Cold applications (pains).
Pathological eliminations.
Mind –
Dull, Stubborn, Morose Guilt-complexes, Fixed ideas Comprehension-Slow, Anger→ Violence (Destruction) Rage.
Sensations and Complaints in General –
Slow healing (wounds).
Perspiration-offensive.
Aversion-Meat.
Marasmus, Bone and Periosteal Pains-Boring, Grinding, Restlessness, Physical Pains drive the patient out of bed: floor-walking, Weak joints-easy sprains, Glandular affections.
Other Features –
Headache with Vertigo
< Night
Cold
Motion
Nose-bleed
Band Sensation, Bores the Head into a pillow and rolls from side to side
< Diarrhoea
Principles of miasmatic prescribing
It is observed that the in various incurable diseases such as cancer, rheumatoid arthritis, terminal diabetes, addressing the chronic miasm could weaken the vital force. It is advisable to avoid the selection of the remedy in these cases on miasmatic symptoms because it may work as palliation. On the other hand, acute disease and its exacerbation should be treated with the indicated remedy on acute totality and not consider the miasmatic properties. When acute condition is subsided, then treat the dormant miasmatic state to prevent reoccurrence.-(6,13)
Multi-miasmatic state
The complex chronic disease manifestations are based on various interdependent components rather than one single constitutional factor. It is observed that many cases are cured or relieved by a single constitutional prescription. However, it is always difficult to treat the entire complex chronic disease with one single constitutional remedy. It may take a series of related remedies to remove the miasmic layers as the person moves toward the state of health. In these cases, first, use of an anti psoric remedy, and it is followed by other medicine for dominant miasm, then again finishing the case with an antipsoric. In other words, psoric treatment always comes in between anti-sycotic and antisyphilitic remedies, and the treatment always ends with an antipsoric. It is observed that the use of different remedies in this method requires frequent zigzagging back and forth manifestation. 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.(6,13)
However, our major remedies are multi-miasmatic, and it probably covers more than one miasm. It is commonly assumed that any multi-miasmatic case may start with polychrest, which is likely to cover at least two of the miasms. (6,13)
It is believed that the incorrect use of nosode can stimulate latent miasm. For example, if we prescribe nosode based on medical history such as cancer, syphilis, tuberculosis, which may arouse the latent miasmatic state and deteriorate the condition of the patient. As per our master mention in theory of chronic disease that in a mixed case, as one miasm is cured or disappears, the latent one suddenly becomes active. It is suggested that the first prescription should de on active miasm and wait until a latent miasm becomes active before prescribing for it. The first active miasm may need several remedies before the next miasm appears; For example, a patient with an active sycotic miasm may need Medorrhinum, Thuja, and Natrium sulphuricum before psora appears. (6, 13)
Miasm helps us in understanding the future course of diseases. It is also useful for potency selection and repetition. The knowledge of it allows us to understand the block, which does not allow the main drug to act thoroughly.
Moreover, it helps us to plan and expect the remedy response after the first prescription. For the treatment of one-sided diseases where the symptoms are scanty and an effective totality for drug selection. (6,12,13,)
Conclusion
The three miasms are representing three broad constitutional types that indicate different susceptibilities to the development of illness. Management of miasm depends on proper judgment of active and dormant miasm in acute and chronic state of disease constitution pathology, symptoms along with susceptibility. Miasms theory is a law, which if applied correctly improves the quality of prescription and the percentage of results in Homeopathy.
References
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9) Allen, JH. The Chronic Miasms: Psora and Pseudo-psora: Reprint edition: New Delhi: B Jain Publishers (P) Ltd; 2001:109-139
10) Mehta Kishore.Miasm -The Devious Intrigue, New Delhi: Indian book and periodical publishers, 2008:183-207
11) Dhawale M.L: Principle and Practice of Homoeopathy, 3rd edition, Mumbai: Publisher by Institute of Clinical Research: 2000:305-312
12) Ortega PS.Notes on the miasms,1st English edition, New Delhi: National Homoeopathic Pharmacy,23-41
13) Banerjea SK. Miasmatic diagnosis practical tips with clinical comparisons, Reprint First edition, New Delhi: Published by B Jain publication,2001
About the Author:
Associate Prof. Dr Abhishek Udani
Bhargava Homeopathic Medical College
Anand, Gujarat, India
E-mail: [email protected]
Mobile no.: 9978624694