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| Hpathy Ezine - July, 2005 | ||||
Miasms in Case ManagementPart IV: The Way Forward with the Theory of Miasms-- Dr. Leela D'Souza |
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How relevant is Hahnemann's Theory of Miasms today?Given the number of interpretations and misinterpretations of Hahnemann's Miasm Theory today, its relevance is an important aspect to address. Once we understand exactly WHAT Hahnemann himself meant when he introduced the Chronic Diseases, we have a better idea of how we should approach different concepts that have been derived from it. Has the Chronic Diseases been interpreted based on a thorough understanding of the clinical applications of miasms? Many concepts of this Theory that Hahnemann mentioned in his writing seem to have gone largely unnoticed. But inspite of that, my hope is that each of us as homeopaths aspire to learn a method of miasmatic interpretation for long term case management that is time tested and based on all the general concepts that Hahnemann introduced in the Chronic Diseases. Miasmatic management is an invaluable tool in curing serious chronic diseases. My articles Part II and part III detail two of these time tested concepts. I felt this needed some more clarification with a comparative study, along with a concrete idea of a working method for case management. Hence I decided to follow up with this article and a few illustrative case examples. Once we have throughly understood the miasmatic concepts Hahnemann introduced in the CD two points become clear: 1. Hahnemann's genius for perception of disease, its origin, progression and ultimate consequences, was truly phenomenal for his day and age. 2. The variations in interpretations of Miasm prevalent can be clearly assesed with regard to how far they deviate from the original concept and how effective they are in clinical management. It must be stressed that reading only the Organon to form an idea of the multifaceted concept of Hahnemann's' miasms is incomplete and could give one an erroneous idea of its multidimensional application. Modern Medicine, through Medical textbooks, have taken pains to name various clinical conditions (syndromes) and infections in an attempt to create some order in the chaotic world of disease expression. Inspite of this detailing of symptom presentation for a diagnosis of disease, these authors (all well-read and experienced MD's) would be the first to admit it is often difficult to get a grasp of a clear diagnosis when a patient presents clinically. When diagnosis becomes the only basis for treatment (as in Modern Medicine), one is lulled into a false sense of complacency that after making a diagnosis, one has the answer to treating disease! A truly sincere MD will confess that more often than not in the clinical situation, they have NO IDEA what (disease) they are dealing with, much less being able to cure it! What is helpful to us (as homeopaths) in Medical textbooks, besides giving names to identify various infectious diseases, is that each disease diagnosis is accompanied with possible "complications" of that disease or disease syndrome that have been observed clinically. This is very helpful to a truly miasmatically oriented homeopath. Expecting complications in clinical situations is dependent on the correct or incorrect remedy being prescribed and on the miasmatic background of the patient. If the remedy is not a miasmatic similimum or is a partial similimum that does not cover the miasmatic expression, then there will be a deterioration of the clinical condition (complication) towards a more obvious expression of the predominant miasm in that individual. The answer in this situation, is to find the miasmatically correct similimum or else the miasmatic specific intercurrent, depending on how one reads the clinical situation and the symptom expression. This line of thought allows a homeopath well versed in miasmatic management, to handle most medical complications and serious pathology in an inpatient hospital set up, just as those of the dominant school of medicine do today. Doesn't this, then, give the system of homeopathy the teeth that it needs? My vision for this sort of hospital set up requires a team approach towards (miasmatic) management because the emotional and intellectual demand on a single homeopath in these situations is simply too heavy. Like minded homeopaths need to discover each other and be able to work together to allow for such a possibility of working in the future, so that the Homeopathic System of Medicine can become a relevant alternative system of therapeutics. Already the ICR (Part II) and Dr. Vijaykar (Part III) with their advanced understanding of Hahnemann's miasms have been able to establish themselves in such a manner in Mumbai. Groups of Homeopaths from the ICR run a couple of hospitals (in an around Mumbai) managing patients purely with homeopathy even during emergencies. How relevant then, do you think, Hahnemann's theory of Miasms (well understood) is for the future of homeopathy? For the serious homeopath, very, very relevant!! Why Miasms continue to remain 'Unchartered Territory'I asked a few homeopaths for their feedback on my previous articles as I wanted to guage different perspectives as well as reason why miasms continue to remain a largely unchartered territory for most homeopaths today. My intention in these series of articles has been to highlight a "working" method of miasmatic management while on my own journey towards incorporating this into clinical management. I don't think I've completely arrived yet, but I'm happy to say I'm on my way! I was taught Miasmatic Management in college in 1988 - almost 18 years ago. We followed up clinical cases with our professors to observe miasmatic management over long period of time. Still it took me more than 10 years to fully appreciate and incorporate what I had learnt into my case analysis, synthesis and management. There were many reasons for this delay, but some of the important (homeopathic) ones that are common to all homeopaths I have explained below: 1. One may spend too much time trying to find THE constitutional similimum, often using techniques that are difficult or unclear or one has not mastered properly. What is the answer to this distraction? Once can still pursue the study of unknown remedies and work at
arriving at 'core' similimum remedies. But often in the immediate
clinical situation it is not necessary to vainly try to get to that
point. The remedy must be well chosen based on proving symptoms and verified clinical symptoms in the Materia medica. This will be a similimum to this situation, enough to move the case along Hering's Law of cure to the next presenting picture. If the case has not moved in the right direction, one knows that the first remedy selected needs to be revised. Involved in this process are simple principles of logic and keen observation with an in-depth grasp on Remedy Reaction - basic aspects that each homeopath MUST learn to master. For some time, instead, I got lost in the story of the patient and in trying to find that elusive constitutional in every case. But as I evolved as a homeopath, I realized my mistakes and went back to brass tacks! The good news is, the brass tacks work!! The Boger Boenninghausan method is one such method. But various others worked in a simlar manner including Kent. Hahnemann supported the "Zig-zag" approach as long as we were moving in the right direction. Often, it may be only by the second or third prescription that the deep, internal state of the patient becomes more obvious and one is able to perceive that deep acting chronic similimum. 2. The next problem was to be able perceive the miasmatic background that I had learnt, in the case progressions and management of our patients. Throughly understanding this may need a follow up of at least 2-3 years to see a true miasmatic reversal and healing. But the beauty of Vijaykar's perception of miasms clinically, is that even during cure of the presenting Chief Complaint, one can perceive miasmatic improvement! This expanded the miasmatic horizon of my perception considerably. I was able to perceive miasmatic movment in a much shorter span of 2-3 months, enough to be satisfied in the miasmatic progress of the case towards healing. How do we apply the Miasmatic concept clinically?Here are a few simple steps to begin to apply the miasmatic concept (once understood using Parts I, II, III with further reading of the related books) clinically: a) Take a complete history, that includes details of the past history of diseases right from childhood with treatment details; also include the family history of diseases to understand miasmatic traits and possible inherited miasmatic tendencies. b) Right at the outset, identify
the predominant miasm, the latent miasms and the underlying miasmatic
traits (based on past history and family history
analysis). Be aware that remedy response is palliative if there
is no miasmatic improvement in the followup. In fact a miraculous
"feel good factor" may actually indicate palliation rather
than cure. c) Correlate the indicated (Constitutional) remedy with the miasm expressed in the chief complaint. This means that the pathology expressed in the chief complaint should be a pathology that is covered by the indicated remedy in its Materia Medica, depending on which pathology is predominant at a particular point of time. Learning the miasmatic expressions of different pathologies (Part II) is a simple requirement. Case 1: The chief complaint was a tendency to ovarian cysts and an inability to ovulate regularly causing irregular menses. The patient was already diagnosed with Polycystic Ovary Disease. She was chilly, and was easily exhausted by physical exertion or after public functions. The associated mental state was a need to strive for perfection in everything she did, sensitive to the opinion of others, or at least to certain specific people with a deep need for appreciation. Any apparent inability at various points in her life, to achieve any of this resulted in a feeling of being rejected or forsaken. This had now become an obsessive behavior of sorts in a vicious circle. The miasm expressed here is sycotic, as indicated by the PCOS pathology as well as the obsessiveness. The remedy given was Palladium, which regularized the menstrual cycles to normal as well as helped resolve the mental state towards a relaxation of obsessiveness with perfection. Palladium continued to help various problems for a 2 years with very occasional acute prescriptions in between. The same case later developed a different set of symptoms. There was bloating premenstrually (water retention) with irregular periods for a few months followed by amenorrhea for 3 months. This seemed to be more like 'suppressed menses', since the cyclical changes of the menstrual cycle seemed to take placed with the premenstrual bloating and cramping, but the periods would not arrive! This is still sycotic but was a very old symptom as well. So we'd could say that the case was moving along Herings Law of cure. There was an increase in weight of about 3-4 kgs over the last few months. Another accompanying symptom was hair fall with dryness of the scalp. All these symptoms seemed to have been precipitated by an experience of severe disappointment followed by intense grief. She described this grief as a tremendously excruciating pain locked within her soul that just wouldn't go away. She felt there was no reason to live, but she continued with life as normal on the surface, as was expected of her in her duties. She could not express these feelings to anyone, inspite of the overwhelming grief. Palladium would not help this situation. This long standing grief, being secretive or reserved about her feelings or personal circumstances, fluid retention, suppressed menses, increase in weight indicated a sycotic miasm still active. Nat Mur covered this expression and just a couple doses of 30C released the overwhelming grief, and the menses appeared in 2 weeks, and has remained regular since then. It also stopped the premenstrual bloating, reduced the weight (back to normal) and stopped the hairfall. The mental state that followed is stable, though the grief continues. But it is more easily expressed and accepted, allowing the overwhelming excruciating pain (in her soul) to calm down considerably. Now there is no obvious physical complaint except a tendency to be aggravated by the glare of the sun and its heat. Here we see that Palladium was indicated as a constitutional. The perfectionism and need for appreciation, etc are basic traits of the patient. But it stopped working in the new state, that still expressed with the same (sycotic) miasmatic background. The next remedy Nat Mur may be only a pit stop along the way, but it is obvious that the patient has not deteriorated miasmatically. In fact after Nat Mur, it would seem that the patient has moved out of the sycotic miasm towards a (latent) Psoric expression! Following the miasmatic changes in this case will continue in time, but what is important to note is that the physical expression associated with the mental state, has not deteriorated miasmatically in a progression of disease towards deeper Sycosis or syco-syphilitc expression. This shows that each successive remedy in the series of remedies needed in a case has to reflect this pathological improvement. On the other hand: d) Be aware that one may need to change the chronic remedy and review the case when the chief complaint has changed. The reason is that if one is truly moving along Hering's Law of cure paralleled with Miasmatic reversal, then the new state may require another remedy. The new chief complaint has again to be re-evaluated miasmatically and for the indicated similimum along with concomitant factors and modalities. Once I could recognize more easily the miasmatic expression at the physical and mental level, the remedy choice became clearer. It was easier to analyze the healing process in our old cases, in retrospect, and look at the remedies prescribed at different points. I could easily interpret which ones really worked at the miasmatic level for healing, which remedies simply palliated and took the patient around in circles, and which remedies were probably intercurrent anti-miasmatics. This was an exciting journey for me, which has precipitated in me writing this series of articles. Dr. Vijaykar's perception is an interesting and exciting method of observing miasmatic changes to tell whether pathology (in the chief complaint itself) is moving towards healing or than further deterioration miasmatically. Refer to the Cases detailed in Part III that highlight this. A keen observer can also learn to master this with time. Do read his books for a more detailed understanding of his perspective, but here is an interesting case from him: Case 2: A man came for treatment of allergic rhinitis, easily spraining ankles and backache. The backache was due to sitting for long hours (40 hours!) at a stretch. The sneezing was due to his allergy to the smell of flowers that he was constantly exposed to. After 2.5 hours of history taking, there was no clue as to why he could not avoid being exposed to these flowers that were aggravating him! It was only after questioning the person accompanying him that it was revealed that this man was a spiritual and philosophical leader who had turned away from a life of vice (alcohol, wife beating, stealing), to become a good man. With this change of life, he was able to help many alcoholics reform as well as to come closer to God. He became known as a "messenger of God''. As the Indian tradition would have it, people would some to "venerate" him with flowers once a month. He accepted these followers as a token of love, and so could not avoid them. He did a lot of work for the downtrodden people in the name of God. But, not a word of it was expressed during the 2.5 hour long history taking!! The analysis: Chilly, Thirstless, ardent, religious, sympathetic, secretive traits. There was a tendency to looseness of elastin in the tissues (Ligaments, muscles) which predisposed to easy spraining and straining. All this is a sycotic expression in mind and body. The remedy here was Causticum in sycotic expression, which cured him of all his presenting physical symptoms. Similarities between the ICR Theory of Miasmatic Evolution and Vijaykar Genetic Approach to Miasms.Both Vijaykar and the ICR believe that the miasmatic background of an individual has its roots in inherited traits. These inherited traits may be Psoric, Sycotic, (Tubercular), or Syphilitic depending on the family history of an individual. Which miasms express themselves during an individuals' lifetime is genetically motivated as well as further modified by acquired infection and disease suppression. Both agree that miasmatic progression and disease progression are parallel to each other. Hence Hering's Law of Cure and miasmatic improvement must be clinically observed in tandem while in the same process of healing. Both agree that there is disease evolution over time as one ages from infancy through childhood, adult life, middle age and old age, to death. This disease evolution could also be recognized as a miasmatic evolution. The ICR sometimes resorts to a few "antimiasmatic" intercurrent remedies as indicated to assist the constitutional remedy if needed. Some representative Cases of this approach by Dr. Praful Barvalia, Dr. Nimish Mehta can be found here - Autoimmune Thyroiditis
- Dr. Praful Barvalia Dr. Vijaykar believes that the homeopathic similimum if properly chosen is all that is required for complete cure. I may be mistaken, but I have not seen cases described in his books where he uses a miasmatic intercurrent along with the constitutional. Whether these cases followed up after many years (especially those with complex disease) needed another constitutional remedy, has also not been clearly mentioned. Another differentiating point is that the ICR clearly observes the Tubercular Miasm as a separate entity, whereas Vijaykar has included most of this tubercular expression in Sycosis and partly in (secondary) Psora. J. F. Allen introduced the separate symptom group of the "Pseudo-Psora" Miasm which we term the Tubercular Miasm. The ICR believes that it is the missing link in disease progression after Sycosis but before the destruction of Syphilis. It was found to be the typical response after acute infections where the convalescence was protracted with a "never well since" modality. After Kent introduced Tub Bov, it was found (by a French Group) that a dose of Tub. dealt with the 'miasmatic block' in these conditions and allowed for miasmatic reversal towards health with the constitutional. |
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