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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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Apparent Conflicts in the Classification of Miasmatic SymptomsAll the articles we have carried over the last few months on Miasms largely agree on the grouping of miasmatic symptom expression. While some symptom expression in these miasmatic classifications tend to overlap, there are symptoms that seem to belong to one miasm in one article and another miasm from another's point of view. Hahnemann on the other hand, clearly demarcated his groups. Conditions that followed an infection of Gonorrhea or Syphilis were put into those venereal miasmatic expressions, anything else was included into Psora which he called the most destructive miasm. This Psoric expression was subdivided into Latent Psora, Primary Psora and Secondary Psora. In secondary Psora (fully developed Psora) he included a vast number of diseases (all detailed in the CD as well as in the Organon) many of which today, based on other derivations of miasmatic concept (Part II and III) have been reclassified into Sycosis, Tubercular or Syphilis. Understanding this from another perspective, "secondary Psora" is an unclear in the clinical entity, given the multifaceted, multimiasmatic and complex disease conditions we are faced with. There are a percentage of cases that are largely Psoric and remain that way without ever developing underlying non-Psoric traits. But most people do not fall into this category. They instead express complex diseases and mixed miasms. Also, if Psora had a latent, primary and secondary manifestation due to a history of suppression, most surely Sycosis and Syphilis would also over the centuries develop latent, primary and secondary manifestations. And why not? It would be best not to get into academic arguments. Rather to
my mind, a conceptual derivation from Hahnemann's Chronic diseases
that would be most helpful with clinical management is the one that
understands Hering's Law of cure in tandem with Miasmatic expression.
The proof of the pudding is in eating it, and both have shown that this concept works clinically, inspite of some differences in symptom classification. This is because the basic concept of disease development and its miasmatic expression are a linear process that can be perceived by the alert and trained homeopath. Matching the remedy to this perception is an art that one can gain with experience. Rules for matching the remedy remain exactly the same as Hahnemann stated - the predominant picture is matched with a similimum remedy that also covers that miasmatic expression in its (miasmatic) proving symptoms. How do we know whether the remedy covers that miasmatic expression? One way out is to use the rubrics in the repertory for Psora, Sycosis, Syphilis. But these are extremely large rubrics and would really get us nowhere with repertorization or even understanding the miasmatic background of a remedy. So we need to miasmatically analyze the provings in the Materia
Medica of that remedy to find out its miasmatic scope. This is an
avenue that needs to be explored in depth - the ICR have done so
in remedy groups. Mental Symptoms vs Physical Symptoms for Miasmatic ClassificationOn the whole, physical symptoms and pathological expression are more reliable to decide on the predominant miasmatic expression than mental symptoms. This is because pathology is fact, whereas mental expression is open to the judgment of each individual homeopath, his prejudice and his perception or the lack of it! A discussion with a colleague on a public list revealed to me that a rejection of moral absolutes by some, in todays relativism has left us floundering on what constitutes moral and immoral behavior. Hence acceptable or unacceptable behavior that arises out of the depraved moral sense of the Syphilitic miasm, or the manipulative tendencies of the Sycotic miasm, or the natural tendency to abide by the moral code in the Psoric miasm, can have as wide a range of interpretations as there are homeopaths! Similarly, perceiving the mental symptoms as expressive of a particular miasm at a point of time requires a little deeper and mature perception of human nature and its foibles on the part of a homeopath, that not everyone is capable of! Hardly reliable for miasmatic prescriptions, unless solidly backed up by obvious physical pathology. So I think it is best that homeopaths concentrate on recognizing the predominant miasmatic expression through the pathology expressed in the chief complaint of each patient first. This is the (only) reliable clue to the predominant miasm, and hence the clue to the correctly indicated, miasmatically similar remedy, that has this pathology in its Materia Medica. Study of Part II of this article series along with the other supporting Miasm articles will give one an idea of the symptoms that indicate miasmatic expression. The steps in the process of miasmatic management have already been detailed above. Other Theories around Hahnemann's Chronic DiseasesMany have interpreted The Chronic Diseases and tried to adapt it to their methods of prescribing. One well known concept is to consider every possible infective agent or miasma into a separate miasmatic expression in itself. A colleague (Feras Hakkak) gave me some feedback on his understanding of this concept, which I replied to from my perspective. I have presented that discussion below and I welcome feedback on how this idea could possibly work especially in terms of long term (miasmatic) case management. I have read other concepts from Ortega, Kanjilal, and others which are close to the concepts I mentioned before. Variations include whether the Tubercular miasm exists separately or not often it may be understood as Psoric miasm compounded with Syphilitic expression. But the fact that Tuberculosis is such a common chronic (incurable) disease today that exists in every culture. Its inherited traits are clearly discernible. It complicates many chronic diseases (most commonly today - AIDS), with a very clear mental and physical group of expressions, it stands on its own as a major miasmatic group. Some others consider Cancer and Vaccinosis to be miasms. Both these don't clearly hold their own for a couple of reasons (and there could well be more):
My answer is that there aren't any. This is obvious because there
is no real expression of a cancer infection. But I'd be happy to
hear a convincing argument to support the idea of a "cancer
miasm" as Hahnemann intended miasms it to be. Cancer needs to be understood in light of the individual expression
in each case in terms of the diagnosis, pathology and prognosis.
These are analyzed as expressions of combined miasms or predominant
miasmatic expression: Psoro-Syphilitic, Syco-Syphilitic, Tubercular-Syphilitic,
etc.
Is the need to consider Vaccinosis as a separate miasm due to the fact that it is caused by artificially modified miasma? How does its expression differ from the basic miasmatic expression of Sycosis? Questions again, that would help qualify if Vaccinosis is a separate miasm or not. Finally, I'd like to introduce a word about Rajan Sankaran's use
of the term "miasm" in his recent prescribing method and
search for the "vital" similimum. I would caution students
that his concepts though brilliant, do not directly co-incide with
Hahnemann's Theory of Miasms in terms of clinical analysis and management
of disease. series. As mentioned earlier, there is a concept of discovering more miasms (that are clubbed into Psora) based on diseases caused by various infecting miasmas that are known in Bacteriology. I spoke with an Iranian colleague as I wanted to get a clearer idea of this concept of Miasmatic management which the Iranian group of 'Hahnemannian' homeopaths had, and seem to find helpful. I conclude this article with an interesting discussion we had we had about this. Feras: I think the story
begins with our observations regarding the acute epidemic diseases.
In such situations, although patients show various pictures, one
(or a few) genus epidemicus remedy will cure most of them. If this
is true, which seems to be, then we can conclude that a specific
type of microbe will cause a diseased state which can be cured with
one (or a few) remedy (remedies), but the manifestations in different
patients will be different due to their susceptibilities. Leela: I think Hahnemann differentiated clearly
between acute "maisma" and Chronic "miasma".
The difference between these two he explained by the inherent properties
of these miasma to affect the "constitution" (which is
his word in the CD). The acute miasma did not produce chronic "miasms",
though they could possibly modify their progress depending on whether
suppressive treatment was used. With this background, I find it a little hard to understand how the assumption you mentioned above helps clinically in miasmatic management. Chronic disease expression (according to Hahnemann) is different from acute disease expression. Acute disease is an immediate reaction of the vital force to the acute miasma resulting in resolution of the disease either by healing or death. Immunologically, there is an ACUTE inflammatory response of neutrophils and eosinophils. Chronic miasm, on the other hand expresses itself after the chronic miasma has taken hold of the whole being of the person, but there is can be no resolution because the vital force has been deranged to an extent that does not allow spontaneous resolution. The immunological response is a chronic inflammatory processes that does not resolve adequately, like that of acute inflammation. Feras: The method used is: to exclude all the symptoms related to diet, lifestyle, etc and among the remaining symptoms collect the active ones and recognise the miasm (disease caused by a specific microbe) which is dominant. The remedy will be known automatically. In fact we have to see the miasm's picture in the patient (and we always see a part of it not the whole picture), and the remedy for that miasm will do the job. It’s like seeing a part of a friend’s face and recognizing him! This is the core idea behind the miasmatic approach of our Iranian friends. If we adopt this view, then we will believe that Hahnemann's Psora is a mixture of many miasms that has to be separated. Then we will have one (or a few) remedy/ies for each miasm, like what we have about Syphilis with Merc and about Sycosis with Thuja. Leela: Hahnemann has the similar instructions
for deciding on the miasmatic similimum which may be a specific
intercurrent remedy or else the chronic similimum. In present day investigations, one can do ELIZA tests to check
for the presence of specific antibodies in the blood which indicate
the history of specific infections. BUt would this be homeopathically
helpful? In homeopathy we're concerned with the symptomatic expression
of the individual at a point in time. Are you saying that one can
observe these symptoms as indicative of a history of causative microbe/miasma? What would be the expectation in terms of healing if this concept
(which sounds allopathic) is clinically useful? Are there clear
cases with results where this theory has worked to cure a microbe-specific
miasm in the longterm? How would this differ from what Hahnemann
termed "Isopathy" which he decided within his own lifetime
was not homeoapthically healing? I'll look forward to hearing more
about all this. Feras: Mercurius is suitable to Syphilis miasm but it doesn’t mean that it can’t be used for other issues. The same with Thuja. I will ask my colleagues who practice with this style to present their cured cases. This will show how it works.The problem is that after Hahnemann nobody has done good research work to study miasms epidemiologically, or I’m not aware of. It should be done to support this style of practice. I leave this to my colleagues. Maybe they have something to offer. And about multi-miasmatic states. It is when more than one miasms are active. Then you have two options. The first one is to give a remedy that has affinity to both of those miasms. The other one is to start with the more dominant one. But I’m not sure about this and we’d better study it from Hahnemann who has talked about this issue in Chronic Diseases, and has given instructions as to which miasm should be tackled first, etc.
Feras: I don’t know how correct these ideas are, and I have not had enough clinical experience to reject or accept them, but it is worth investigating. Anyway, even if it is in line with truth, I think it is a very tedious job to differentiate these so many miasms (microbes) and make detailed lists of their symptoms. Leela: I think I agree with you here. There seems to be an awful lot of (investigative) work to prove that it could be viable. It simplifies matters a whole lot if we put the (miasmatic) symptom expressions into either one of the 3 (or 4) groups after studying clearly what are the the expressions of each of these miasmatic groups. Its a simpler procedure and one that every homeopath can learn to do. Feras: It is really a "Western", "technology-based" method and we could leave it to those who are interested. It is obvious that there are some other methods that work well and do not involve so much sophisticated expensive experimentations, and I believe the more you keep things simple the better it will be. So I think we’d better stick to simpler and more “Eastern” methods like Sehgal, if we come to the conclusion that they work satisfactorily.
Its interesting that you mention Sehgal. I don't think he talked very much about Miasms. Feras:
In the method of the late Dr. M.L.Sehgal (Revolutionized Homeopathy)
there is no mention of miasms. His conception of disease is totally
different and his case-taking and case management are totally different,
accordingly. Here in Iran (and also in the world) seldom you can
find a “Sehgalian homeopath” but I believe his views
ARE worth studying deeply. Leela: Managing a case miasmatically as I understand
it (Part II and III), has very little to do with a specific microbe/miasma
causing the miasmatic state. The symptom expression at any point
of time is enough to plot exactly where on the miasmatic progression
towards health a person is. The similimum is always based on this
symptom picture (charateristic totality or miasmatic totality),
independant of the causative microbe or miasma. Thanks for your time Feras! Your input has been very enlightening for me. Dear readers, do write in if there are any clinically useful concepts around the theory of miasms that you would like to share with us or discuss. Thank you. Dr. Leela D'Souza http://www.homeopathy2health.com/
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