In the course of his clinical work, Hahnemann noticed that there were certain chronic conditions that he could not treat satisfactorily with homoeopathy. He searched for an explanation of why certain persons were not cured after repetition of the similimum. He noticed, in some cases, that after each dose of a well-chosen remedy, there was less and less of a response.
He concluded that it was not due to a failure of the method but that he had not solved the question of the chronic diseases. Hahnemann wrote that this question constantly occupied his mind for 12 years from 1816 to 1828. The results of his thinking were contained in a major treatise, Chronic Diseases, which he wrote from 1828 to 1830, and developed further in the second edition written between 1835 and 1839. Chronic Diseases consists of five volumes, the first being purely theoretical in which Hahnemann outlines his miasm theory and its relevance for the treatment of chronic disease. The remaining four volumes are practical and contain detailed descriptions of a number of remedy pictures.
Hahnemann’s Three Basic Chronic Miasms The word ‘miasm’ comes from the Greek word meaning polluting or staining. The miasmatic theory was one of the theories for the cause of disease, prevailing in the 18th and 19th century. At the time Hahnemann formulated his theory there was no knowledge of infection in microbiological terms.
Hahnemann postulated that there were three distinct miasms: syphilis, sycosis and psora. Syphilis was a condition which was clearly identified as contagious, even in Hahnemann’s own time and in using these labels for his miasmatic traits, Hahnemann clearly implied that chronic disease has its genesis in contagion, or person to person transmission. Moreover, by applying rational theory to the manifestations, which we now attribute to different stages of infection, Hahnemann reasoned that the miasmatic Influence eventually affects the whole organism, ultimately giving rise to a skin eruption after the miasm has penetrated the entire body. He associated each of the three miasms with characteristic skin manifestations:
- Psora – Eruption (vesicle, tetter, tinea)
- Sycosis – figwart
- Syphilis Chancer
Hahnemann believed Psora to be the main cause of chronic diseases, making up seven-eighths of the total incidence, with one-eighth being caused by the sexually transmitted Sycosis and Syphilis. He considered psora to be the oldest miasm, dating back to antiquity where it manifested itself as scabies. During the middle Ages he postulated that it became more aggressive in the form of leprosy, becoming milder again to present as scabies in modern times. The Hebrew word tsorat meaning a groove, fault, or stigma, was a term often applied to lepers and to those affected during the great plagues, and conveys what Hahnemann had in mind.
Complicating this model was a combination of one or two miasms, which made treatment very difficult and rendered certain cases incurable.
He considered that these miasmatic conditions were curable only as long as the local reactions were still present. Alternatively, progress could be achieved if skin eruptions could be evoked again in the course of treatment.
In Organon Hahnemann suggests that Miasma lurk inside body and can be activated by several factors to derange health in a particular form of chronic disease.
This was a simple but brilliant working model considering the era of scientific darkness he lived in.
Tsorat; Hebrew = groove, fault, stigmata The hydra-headed monster
The fundamental cause of all chronic disease The main presentation ITCH + Eruption
Associated with Gonorrhoea
The main presentation = CONDYLOMATA + Gleet
Associated with syphilis
The main presentation = ULCER + bubo
Table 1: Hahnemann’s Three Basic Chronic Miasms
|Cutaneous presentation||Itch, Eruption, Herpes and Tatter||Condylomata, Gleet||Ulcer, Bubo|
I. Allen proposed Psoric Theory of Disease:
(a) Hahnemann states that the fundamental cause of all disease (including Sycosis & Syphilis) is Psora. Actually what Hahnemann is propagating as his theory of causation of chronic miasmatic diseases is what Allen refers to as the psoric theory of disease.
(b) Hahnemann’s hypothesis was that chronic diseases are chronic because some unknown devitalizing principal subverts life forces in such a way that the dynamic mistunement of health cannot be corrected. He called these unknown devitalizing principles to be chronic miasma (miasma = emanation spreading in the air exerting a morbid influence).
(c) This was Hahnemann’s theory while medical science accepted another theory at that time that is Virchow’s cellular pathology theory. Virchow’s cell, the unit of life was vivified, by chemical processes or by chemical changes. At that very time, Koch formulated the germ theory of disease.
(d) For Hahnemann and Homoeopathy the guiding fundamental principles are-the dynamic origin of disease, the dynamization of drug & the application of similia.
II. Allen proposed Bond of Psora with Life Forces
(a) In the study of Psoric theory of disease we must not look from the biochemical side, but from Vital/ Potential side (Bio-physical side).
(b) Psora is that potential which when becomes well bonded with the life force, it cooperates with this life force. Together these two along with other miasms, cause all physiological deflections, functional disturbances followed by structural and pathological changes.
(c) Under the influence of perverted life action psora’ life force is no longer a true dynamis but it is in bond with another dynamis, psora which knows no law and has no life-giving qualities in it in fact all the dealings of psora are destructive.
(d) It is the same with miasmatic potential; it is an invisible and unseen thing, yet we see the effects of its presence in the organism long before any changes of tissue take place. We see it first, as a rule, first manifest in the mental sphere, then in the physiological or functional, then, finally, in the pathological. The pathological, of course, coming last.
III. Allen proposed Potential Study of Miasmatics
We generally see the landmarks of one of these chronic miasms stamped upon the organism. We see it in every feature and every physiological process; in the shape and contour of the body; upon the visual expression; we see it on the skin; by the response in the very inner being, the mental, the moral, even the spiritual, give us responses of the presence and influence of miasm.
We see disease to be expression of three basic potential (patho-physiological trends). He who has become acquainted with the higher homoeopathics of Hahnemann, which comprises not only of disease potentials but the drug action, can apply the law of similia at a deeper level. As we study these miasms, we see they express themselves in their degrees of action (primary secondary and tertiary); and in their nature (acute, chronic and latent).
IV. Allen proposed Pseudo Psora for the first time
Allen observed a new miasma which he named Pseudo Psora which later came to be known as Tubercular miasma.
James Tyler Kent
James Tyler Kent introduced metaphysical ideas into miasm theory, which stem from his Swedenborgian background. Like Hahnemann he attributed the cause of all disease to psora. According to Kent, however, it is never possible for psora to manifest itself in a healthy race; a weakness must be there first.
He considered this weakness to be original sin, a legacy passed from generation to generation. The syphilitic and sycotic miasms can be contracted through sexual contact, not so psora.
Kent interprets psora as a product of impure thought and human materialism which is itself the precursor of physical degeneration. Kent correlates the diseases of humankind to their aspirations which he interprets as the mirror of their innermost parts.
Kent was also amongst the first to interpret the pathological aspect of miasma.
The primary skin reaction in psora consists of vesicular eruptions. The concept of all pervading miasm suggested to Kent that it is physically seated in the circulatory vasculature.
The mucocutaneous manifestations associated with syphilis are, firstly, the chancre and secondly, the bubo. By this reasoning, tissue destruction is a key characteristic associated with both the disease and its miasmatic counterparts. The proposed loci for the syphilitic miasm are periosteum, bones and brain, as would be expected from the tissue pathologies associated with secondary and tertiary syphilis.
Kent observed an affinity of the sycotic miasm to the soft tissues and those stemming from the mesoderm. He described the sycotic taint as waxy with pale lips, translucent ears, with warts and papillomata. Mucous membranes such as the conjunctiva and sinuses are usually affected. Children born with sycotic tendencies are of a waxy anaemic complexion, they have a poor digestion, their stools frequently contain undigested food, they are worse for heat and fail to thrive. Hahnemann had a very limited understanding of sycosis. Kent took Hahnemann’s ideas further, empirically researching the pattern of sycosis. He gives a useful description of his observations in his lecture notes on Materia Medica in the chapter Natrium sulphuricum and sycosis.
Following Kent’s argument to its logical conclusion, many conditions can be conceptually linked to one of the miasms in terms of their tissue involvement and pathology.
Table 2: Miasms and Pathology
|Sycosis||Mesodermal and Endothelial||Proliferation||Fungation|
|Syphilis||Submucosal and Periosteal||Destruction||Induration / caseation|
H A Roberts linked the miasmatic stigmata with disturbed assimilation. Whereas psora has difficulty in assimilating constructive elements the sycotic patient tends to assimilate to the point of over-growth.
He considered psora to be a deficiency state. Functional disturbances manifest themselves due to lack of vital elements in the system or the inability to assimilate them from foods. There are no structural changes associated with psora; in his definition, these occur in combination with the other miasms. Symptoms are closely related to emotional disturbances. Roberts described the mental condition as one of the strongest characteristics of latent psora. These patients are mentally alert, their mind is keen, anxiety states dominate. There is also restlessness (physical & mental itch).
Roberts expands on the picture of sycosis by painting a mental image. He describes the sycotic patient as being exceedingly suspicious, not even trusting her/himself. As a result, this person goes back to do or say things over again. The sycotic person has the suspicion they will not be fully understood and others will give the wrong meaning to what she/ he conveys. This suspicion can lead to jealousy. The most degenerate features of the sycotic nature are the suspicion, the tendency to harm others and themselves and animals. Quarrelsomeness and irritability are also displayed in the sycotic psychology. The syphilitic state is characterised by structural changes. There are far fewer sensitivities to environment and food. Overall there are also fewer subjective symptoms. The syphilitic appearance is characterized by a large head, moist, gluey, greasy hair with an offensive odour, hair falling out in bunches. Syphilis is known to deform everything. Ulcerations are the mark of the syphilitic stigmata.
Table 3: Miasms and characteristics of metabolism and tissue reaction according to Roberts
|Miasma||Keyword||Characteristics of |
|Psora||Deficiency||Under assimilation |
|Structure intact||Anxiety neurosis|
|Sycosis||Excess||Over assimilation |
|Syphilis||Disorganised||Self assimilation |
inner and outer disruption
Paschero defines psora as a morbid derangement of the whole body imprinted on genome, a particular reactional mode against pathogenic agents.
Psoric defensive reaction = Supernormal or Hyperergic Response limited to functional states with no structural or gross pathology. He identifies the neurovegetative as the mediator of psoric response and he concludes: that there is no difference between psora and allergy, apart from clinical expression Ortega describes three forms of cellular functional alteration, which he relates to the three chronic miasms:
Defect = psora Excess = sycosis Perversion = syphilis
Eizayaga and Ortega
Eizayaga relates the miasms to disturbances of the most important vital functions:
Excitation = psora Dysfunction = sycosis Inhibition = syphilis
Psora is the state of hyperexcitation of vital functions, a dynamic lack of balance of the vital force. It is associated with functional, not lesional disturbances.
He sees sycosis as a perverted functional activity, leading to hypertrophy of the ego and tissues – a perversion of feelings, especially those related to love. Thus the sycotic taint is associated with sexual perversion, obsession, reservation, suspicion, aggressiveness, jealousy.
In 1984, O. A. Julian and M. Haffen give a view of miasms, based in modern concepts of genetics, biochemistry, molecular biology, toxicology, immunology and ecology.
- Psora is renamed as ‘Dysimmunosis’ = Altered immunologic response. The multiple aetiologic agents include: aggression of mineral, chemical, vegetable and animal origins. Psora has multiple manifestations including ‘metastatis and morbid alternate faces’.
- Syphilis = is renamed as ‘Dysmorphogenosis’. The inherited and damaged information is transmitted in an autosomic dominant pattern.
- Sycosis = is renamed ‘Dysmetabolosis’.
It is based on defects in two areas:
– Enzymes-catabolic pathways.
– Transport across cellular membranes.
Both conditions have a base in damaged and mutated DNA
If we review the normal and abnormal repair mechanism of cells and tissues, the classic concept of miasma as obstacles to Vital force trying to cure a diseased organism does not seem to be appropriate. Instead of being considered as obstacles in healing procedure, we should see them, as inherited or acquired, disturbed repair mechanisms of cells and tissues or ‘dysrepair.’
Linking these types of ‘dysrepair’ with knowledge of the homoeopathic concept of reactional modes give the following results:
- The psoric reactional mode can be understood as a defect in molecular repair (e.g., asthma, epilepsy and high blood pressure).
- The syphilitic reactional mode can be understood as a defect in the apoptotic process, which leads cells to an anticipated death (e.g., Alzheimer) or to necrosis, producing ulcerative and destructive lesions (e.g., ulcerative colitis).
- The sycosis reactional mode can be understood as a defect in control of cell division and extracellular matrix production, due to mutation in DNA repair consequences and excessive cell and ECM proliferation with tumour production and fibrous tissue formation.
Sankaran introduces the interesting idea of linking the three chronic miasms to stages in our lives.
He considers that youth is susceptible to acute miasms. Responses at this time are quick and illness can be easily thrown off. The threats are external and provoke a strong instinctive reaction.
During early adulthood, there is still much energy, liveliness and activity (psora) and an openness to express fear and anxiety. Then there comes a struggle to succeed. There is hope and failure does not mean the end of the world.
Then middle age sets in (sycosis). We realize our limitations and to preserve face we start to cover up: hiding our incapacities in order to be accepted. Our reactions and habits are more fixed. This might be seen by some as true for our society. Wisdom and age are no longer valued. People are seen as resources and have a place as long as they keep up with the set pace. The elderly feel they are no longer valued so they try to hide this for as long as possible.
Then comes old age (syphilitic). The time for letting go and decay. This is reflected in the syphilitic miasm. There is despair about recovery but unlike psora without hope.
Recognizes Miasma as dynamic alteration of dynamic vital force, and he recognizes that stamp of miasma is visible at every level of the human organism including mind, autonomic nervous system, metabolic processes, reproductive, repair, Anabolic processes, Catabolic and apoptotic processes, hormonal and autoregulatory mechanisms and on the even human form. Since Hahnemann’s time pathophysiology has moved on and now one thing is clear that in the genesis of disease, immunity is the common denominator. It is clear now that chronic diseases, as well as acute diseases, are caused by disordered immunity. Even mental diseases ruin health via immunity. This has been established by psycho-neuro-immunology.
We can explore miasma theory on the basis of immunity. This author has tried to do so.
Immunity and Homoeopathy
- Altered immunity——-Hypersensitivity reaction——-Immuno damage———Chronic disease
- Immunodeficiency state——-external pathogens cause direct cellular damage——-Chronic disease.
Please take note that Psoric reactional mode is an oscillatory reactional mode because it oscillates between Hypersensitivity reactional immuno-state and Hypo-immuno reactional states.
- By this logic Hypersensitivity, immunoreactions are fundamentally Psoric reactional mode (Psora is the fundamental cause of all diseases-Hahnemann)
- Immuno damage caused by hypersensitivity leads to a spectrum of disorders there are five types of basic hypersensitivity reaction discussed further in section III.
- The author draws a similarity of five miasmas to five basic hypersensitivity reaction in the table below:
Table 4: Hypersensitivity Tissue Damage & Miasma
|Type I||IgE Mediated Hypersensitivity||Anaphylaxis||Psoric [Itch]|
|Type II||Complement Mediated Hypersensitivity||Cytotoxic Reaction||Syphilitic [Cell destruction]|
|Type III||Igm, IgG Mediated Hypersensitivity||Arthus Reaction||Sycotic [Thrombus Formation]|
|Type IV||T-Cell Mediated Hypersensitivity||CMI Delayed Hypersensitivity||Tubercular [Granuloma Formation]|
|Type V||Ag-Ab Mediated Hypersensitivity||Stimulatory Type||Cancer [Stimulate]|
Reference: Miasma by Harsh Nigam