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Miasms in Case Management - Part II

Part II: Disease Evolution and its Miasmatic Expression

The most significant contribution by the Symposium of Dhawle’s Institute of Clinical Research (ICR) towards the interpretation of Hahnemann’s theory of chronic diseases is their concept of Disease Evolution (natural and drug-induced) in any one individual over time. In the first part of his Chronic Diseases, Hahnemann details any number of cases from decades of medical journals. All show the progress of disease (towards death) after suppression of a superficial “itch” eruption. Hahnemann classified all these diseases under the name Psora, which he called the “hydra-headed monster”.

By contrast, the ICR Symposium understands this progression to be a miasmatic evolution of disease. Their approach brings Hering’s “Law of Cure” into clearer focus. On reflection, the evolution of disease is ultimately the progression of disease in the opposite direction of Hering’s law of cure! Recognizing the importance of this will help us understand the progressive development of miasmatic disease in one individual and hence, the miasmatic cure of that disease.

Dr. K.N. Kasad MB BS MFHom, an excellent classical homeopath who wrote a paper containing most of the details below, lectured at my college in Mumbai. He is best known for his pioneering work with cancer patients. I will quote extensively from Dr. Kasad’s paper which was presented at the ICR Symposium.

Understanding Disease Evolution

We know that the first step towards achieving  proper miasmatic interpretation of a case is to record every detail faithfully with all symptoms complete as to location, sensation, modalities, possible causation and concomitants, as well as past history, family history, personal history including mental and physical generals, and a history of various treatments pursued. All this must then be interpreted in terms of the evolution of the symptoms with respect to time.

An interesting parallel observation here is that the artificial drug disease we see developing during a proving could have actually have been interpreted in terms of an evolving drug disease, if proving information had been recorded in such a manner in the source books of our Materia Medica. Unfortunately, Hahnemann opted for the regional schema in his Materia Medica Pura which takes away the possibility of applying this concept to the earliest provings.

What would this progression of time-expression in artificial drug disease (i.e., in the remedy proving) be?

We begin with the Constitution (Normality) and move through the following miasmatic progression: > Diathesis –> Prodrome –> Psora [Primary –> Secondary] –> Sycosis –> Tubercule –> Syphilis.

All well-proved remedies of our Materia Medica cause symptoms in provers that could be re-organized according to the above progression. Might it not also be possible, keeping this progression in mind, to re-prove remedies today and document the resulting information in this fashion?

The Constitutional Remedy

Even homeopaths who treat according to the concept of the so-called “constitutional remedy” may remain confused about what exactly defines this remedy. Many haven’t a clue or have only a very vague concept; others consider the “constitutional remedy” to be the indicated chronic remedy.

It would be helpful at this stage to define the term “constitution” from a miasmatic point of view. This will clarify what we mean, speaking in terms of the concept of time-expression, when we use the term “constitutional” to define a chronic simillimum.

An individual consists of a psycho-biological apparatus (biological intelligence, intellect, emotion, spirit) involved in the constant struggle to maintain homeostasis. The quality of homeostasis is expressive of the individual’s biological, emotional, and spiritual needs. This psycho-biological apparatus (the human body) evolves in accordance with a codified genetic plan that unfolds progressively, in response to environmental factors, as each individual ages. Based on the immune system or the Psycho-Neuro-Immuno-Endocrine (PNIE) axis, the individual has the potential to survive adverse conditions and reach an adaptive balance which allows survival. This struggle is expressed in external physical signs and symptoms as well as mental symptoms. The homeopathic physician is concerned with understanding the characteristic individuality of this expression in order to find the simillimum, i.e., the single remedy which is matched to the presenting picture of disease symptoms in the patient.

A distinct homogeneous yet characteristic totality is expressed through presenting Symptoms and Concomitants (functional and structural) with an individualized response to various environmental factors known as Modalities. This is expressed at all levels: Body, Mind and Spirit. This homogeneous expression for adaptive balance or homeostasis is what we define as the Constitution of an individual.

The remedy that encompasses the diseased state of this constitutional expression at all levels, body, mind, and spirit, is what is termed “constitutional remedy“. It necessarily coincides with the miasmatic expression of the individual.

We need to note here that earlier concepts of “constitution” can be found in David Little’s articles “Hahnemann on Constitution and Temperaments” on his website

Diathesis is an exaggerated expression of the adaptive balance of the still-healthy constitution—a precarious balance of health, with morbid tendencies which predispose the individual towards disease.

The Disease state can be expressed in 3 phases: the pre-symptomatic phase –> prodrome phase –> nosological disease state. This movement continues along a particular course during an individual’s lifetime, with multi-miasmatic expression evolving, which ultimately ends in death. The disease state is inherent due to a fundamental miasm (Aphorism 5); agents/changes in the environment act only as a spark or trigger.

Suppression occurs by various means (drug-induced, physical agents, surgery, etc). It is vital to understand that suppression produces a change in the expected direction of the process of disease. This change is in the opposite direction of Hering’s Therapeutic Law of Direction of Cure. Suppression may cause one-sided cases; alternating states; complex disease; tardy convalescence or protracted recovery; addictions; periodic or episodic disease; paucity of symptoms; acute fulminating disease expression, etc. The only way to track the cure of a suppressed case is to take a complete history and then evaluate the results according to Hering’s Law of Cure, properly understood.

The intent of the ICR Symposium was to apply this phenomenological point of view in the study of Hahnemann’s Theory of Chronic Diseases and project it on the dimension of time. This research tool could aid in rediscovering the homeopathic Materia Medica through the lost dimension of time. It might also ultimately project the System of Homeopathy as a UNIVERSAL approach to the management (prophylactic, curative, and palliative) of the disease response in all psycho-biological systems.

As stated earlier, disease progression in an individual is due to two main causes:

1. Environmental factors: Physical (sun, lunar energy, radiation, etc.), chemical (drugs, metals, occupational hazards, etc.), biological (bacteria, fungi, vaccinations, etc.), socio-cultural, emotional, and spiritual.
2. The fundamental maintaining cause: The miasms – Psoric, Sycotic, Tubercular and Syphilitic.

While environmental factors are seldom under our control as causative modalities, we have the ability with our remedies to modify the maintaining causes through our understanding of Miasms. In the subsequent notes, we will attempt to explain more fully how to recognize the (predominant) miasmatic expression in a particular individual and manage the case therapeutically to achieve true cure of chronic disease.

All this must, however, be understood as according to Hering’s observations on the evolution of disease, which he says develops:

1. From the periphery to the center.
2. From the superficial to the deeper areas.
3. From the less vital to more vital organs.
4. From the characteristic to the common.
5. From subjective to objective symptoms.

CURE thus takes place according to Hering’s Therapeutic Law of Direction of Cure, from center to periphery, within – outward, above – downwards, from organs of more importance to those of lesser importance, i.e., in REVERSE order of the chronological onset of symptoms.

True healing further implies an alignment of the biological intelligence and the emotion-desire complex with the intellect governed by the spirit.

The 4 great miasmatic constitutions (Psora, Sycosis, Tubercule [PseudoPsora], Syphilis) like all systems of classification are idealized, representative types. These miasmatic states do not exist in the pure form either in physical or emotional manifestation: life is always a mixture. When we understand these limits of classification, then we can employ them as convenient tools in case management.


Hypersensitivity and reactivity in response to environmental stimuli are hallmarks of the Psoric miasm. The system gears itself towards restoring a healthy balance through quick, immediate, and adequate mobilization of the built-in natural defenses at its disposal. A clear example is how simple inflammatory processes resolve rapidly without suppuration and residue, removing all troublesome effects. Study of pathology today gives us clear details of the normal acute inflammatory process; this is what Psora is all about.

Thus, troublesome effects are restricted to the level of the skin and its appendages (the mucous membranes exposed to the environment) and to the level of the mind. Characteristic and classical eruptions and discharges are manifestations of Primary Psora and ideally should be seen in infancy and very early childhood.

When these expressions are blocked due to suppressive measures such as allopathic drugs, homeopathic palliation or suppression, or physical agents, there is a progressive internalization of the trouble towards more vital organs of metabolism, nutrition, glands, RES, CVS and CNS. This is secondary Psoric expression, the cardinal feature of which is functional changes with minimal structural alterations which are all reversible. These functional changes may include incoordinations and imbalances of functions, faculties and processes of the PNIE axis producing symptoms of congestion, dyskinesia of organs and systems, and nutritional disturbances of diverse types.

Hahnemann himself has given us a large number of examples of Psoric expression of symptoms in The Chronic Diseases. From a medical standpoint, all the miasmatic symptoms are functional in nature and follow most of the indications mentioned above about Psoric miasmatic expression. With our understanding of disease evolution, we will see that a few of the listed symptoms would ideally be classified into the Sycotic or Tubercular or Combined Miasmatic disease group.

The article on Personality types of Miasms by George Loukas found here deals adequately with mental expression of Psora.

Hence I prefer to enumerate clinical conditions in the physical sphere that would indicate an underlying Psoric miasm, as these, if present in the chief complaint, are very reliable indicators of the Psoric miasm:

  • The sympathetic nervous system is overactive in contrast to the parasympathetic. The endocrines, especially the thyroid are activated.

  • Thyrotoxicosis without goiter

  • Labile hypertension under emotional stress

  • Deficiencies (minerals, enzymes, vitamins, salts) which require replacement therapy

  • Dryness of mucous membranes and skin

  • Ovarian imbalance leading to functional menstrual disorders

  • Acrid non-infective leucorrhea with an emotional background.

  • The autonomic nervous system controls the visceral organs (GIT and associated organs, RS, CVS and GUT), hence any functional derangements are Psoric in nature.

  • Malabsorption, malassimilation, malnutrition

  • Impotence, sterility, vaginismus

  • Sensitization reactions and allergic responses

  • At the muscular level: spasms – emotional and hysterical

  • Hemorrhages that are vicarious and congestive

  • Hypersensitive reactions to vaccinations

This Psoric hypersensitivity is responsible for the individual features of Craving, Aversions, the Concomitants and reactions to environmental circumstance and time, which guide homeopathic prescribing.

It is important to remember that the Psoric sensitivity does not regress with the advent of Sycosis, Tubercle and Syphilis; it continues concomitantly with a variable course and intensity.

We are thus able to appreciate that the Hahnemannian Totality is an evolutionary one, spreading itself out in space through the four miasmatic expressions. Perceiving these parallel expressions is our aim in clinical management.


An over-stimulated, hypersensitive, and responsive system under continuous bombardment by adverse environmental input is driven into disorientation, hence resulting in a slow-down of activity, with reduced Sympathetic activity and an increase in Parasympathetic activity. Now the system seems to be losing control, leading to inefficient and aberrant immune responses and progressively inefficient metabolic processes. This ultimately results in a system with increasing inertia. The acute inflammatory response has shifted to a chronic inflammatory response which is slow and can be inadequate in the long term.

As I explained in Part 1 of this series, Hahnemann left a large lacuna in his description of the sycotic miasmatic expression. It would seem a more likely and logical conclusion that the sycotic expression developed into a hydra-headed monster as well, over centuries of suppressive treatment. An obvious extrapolation of the sycotic state is that the system, having been pushed into lethargy, mounts a response that seeks to conserve energy or create slow (aberrant) defenses against adverse environmental stimuli.

I will take a little time to list the clinical expressions of the sycotic miasm so that we can recognize its physical expression more easily in our case presentations:

General expressions:

  • Anemia, refractory to haematinics

  • Weakness disproportionate and unaccountable, aggravated by suppression of discharges

  • Fatigue causing slowness, dullness, sluggishness of all processes at the level of intellect, emotions, and body.

  • RES aberration in recognition of self and non self leading to excessive and uncontrolled proliferation of tissue

The altered Mind expressions are described in detail in the accompanying article by George Loukas

Altered Physical Expression:

The physical responses in sycosis are erratic, wandering, sudden, intense, spasmodic (cramps, colic, asthma) and remote metastatic non-suppurative inflammatory reactions. Metastatic means that inflammatory processes continue chronically in organs distant from the area where the original infection took place. The hallmark of the sycotic expression is a tendency to overgrowth (benign tumours) and accumulation of fluid (cysts, swellings) in any disease activity in the body. These are expressions of indolence and sluggishness of different metabolic processes and bio-feedback mechanisms, and a general laxity of the system.

  • Imbalance of adrenal cortical hormones produces pigmentations of the skin, moles, nevi, liver spots, freckles, malar pigmentation

  • Low resistance to infective stimuli result in chronic inflammations of the skin, mucous membranes (catarrhs,) serous membranes, and glands with indurations but without suppurations.

  • Sycotic discharges are typically acrid, thick, greenish-yellow, often indelible, with sour or fishy odor. Oily perspiration staining yellow.

  • Skin eruptions are at the deeper level involving the sweat as well as sebaceous glands. The thickened seborrhic skin is susceptible to secondary infection leading to conditions like sycosis barbae.

  • Suppression of eruptions and discharges makes the patient worse and the sycotic miasm goes deeper. The gonorrheal discharge is one indication where suppression leads to chronic inflammations in local as well as remote areas (metastasis). Non-specific urethritis and Reiter’s syndrome may be indications of this movement.

  • Remote inflammatory responses are typically seen in the pathology of rheumatic fever and nephritis. This type of inflammation is an example of an aberrant immune response where tissues are damaged due to antigen-antibody reaction.

  • The toxemias of pregnancy, where there is damage to capillary walls leading to exudates with mobilization of chronic inflammatory cells and damage to collagen.

  • Rheumatoid arthritis with abnormal globulin processes also fall into this category.

  • Abnormal growth of hair, generalized as well as local.

  • Increased parasympathetic tone leading to an overall decrease in activity of endocrines is reflected in an increase in anabolic processes and a decrease in catabolic processes.

  • Retention of sodium and water (hydrogenoid constitution). Obesity, hypertrophy of tissues and organs (simple tumors).

  • Menstrual irregularity with premenstrual water retention and swelling of breasts.

  • High uric acid, high cholesterol, aberration of lipid metabolism leading to deposits of cholesterol and lipoproteins on blood vessel walls.

  • Hypertension that results from damage to the vascular bed of the kidneys and salt and water retention.

  • Stone formation and deposition of calcium in normal tissues.

  • Colics relieved by lying on the abdomen and knee-chest positions.

  • Gouty conditions, worse with over-indulgence in food and wine.

  • Pain in the insertions of long tendons, muscular aches and pains, recurrent fibrositis in large muscles – all expressions of Gouty-Rheumatic Constitutions. All these tend to be worse in cold damp weather and by rest.

  • Loss of fibro-muscular tone leading to displacements of all organs, collapse of the arches of the feet, sacroiliac strain, relaxation of blood vessels (varices).

  • RES (Reticulo-endothelial system) malfunction results in tumor formation, mostly benign in nature, with a tendency to early malignancy.


With its aberrant, allergic, hypertrophic, spasmodic responses, this indolent system I have just described, having conserved energy, now makes a last ditch effort to survive and return to normalcy. This is despite the continued presence of adverse factors in the environment. But this is now an expression of ‘forced’ mobilization of poor resources rather than the vitality of the Psoric phase and is an indication of movement towards final destruction. At this juncture, we recognize the expression of the Tubercular miasm.

One of the clear backgrounds for a tubercular miasmatic expression is a strong hereditary diathesis, i.e., tuberculosis exists in the family history or in the patient’s own history. In these cases, studied analytically, we often find a direct evolution from the psoric towards the tubercular miasmatic expression with minimal sycotic projection.

All tubercular expressions are observed as ‘Heightened Psora,’ where the phase of hyperactivity is prolonged.

There is a lot of nervous irritability making itself known in restlessness and anxiety at both the physical and the mental level. Read the details of the mental state in George Loukas’s article

Physically, we see:

  • Spasmodic effects, epilepsy, grinding of teeth

  • Overstimulation of the sympathetic nervous system resulting in increased catabolism, decreased anabolism, poor assimilation, and anemia; excessive action of the thyroid, hyperthermia, hectic fever with night sweats ending in severe debility

  • Profuse perspiration with musty, moldy odor

  • Emaciation with ravenous appetite

  • Diabetic syndrome

  • Cracks and fissures of the skin

  • Premature graying of hair

  • Formation of pustules, easy suppurative processes, resulting in scarring.

  • Lupus

  • Loss of elastic tissue

  • Stimulation of the RES resulting in enlargement and induration of glands

  • Generalized lymphadenopathy; soft silken hair down the spine; thin, fair skin; slender body and long fingers; white spots on nails, extremely regular teeth:  all are expressions of the tubercular constitution or diathesis.

  • General debility causing easily vulnerability to biological environs: bacteria (esp. tubercular), viruses, parasites (E. hystolica, G. lamblia, fungi). These give rise to chronic inflammation of the skin, mucous membranes, serous membranes, subcutaneous tissues, lungs etc.

Some characteristic responses of tubercular miasmatic infections:

  1. Tardy convalescence and protracted recovery

  2. Easy suppuration and delayed healing

  3. Healing through fibrosis, scarring, scars break down often

  4. Diabetic acceleration of these processes

  5. Reduced resistance to tubercular infection following respiratory and other infections.

The Tubercular Process expresses itself pathologically through chronic inflammation that results in induration, with subsequent softening, abscess formation, and subsequent fibrosis. There may be scarring of a puckered type with a tendency to break down frequently. The discharges are also characteristic – cheesy, bloody; odor – musty, moldy; taste – sweetish expectoration.

Similar pathology is also found in conditions such as: Hodgkin’s disease, Boeck’s sarcoidosis, pneumoconiosis, beryllium poisoning and Crohn’s disease. All these are expressions of the tubercular miasm and should be managed accordingly.


The long, drawn-out evolution of miasmatic disease expression finally terminates in syphilitic expression which is characterized by destructions at all levels.

Treponema pallidum, the clinical cause of the disease syphilis is one of the typical expressions of the syphilitic miasmatic expression.

Some of the indicators that suggest a syphilitic diathesis in the past history or family history are:

  • History or evidence of clinical syphilis

  • Repeated abortions or miscarriages, still births, neonatal deaths, fetal malformations, placenta praevia, vesicular mole, toxemia of pregnancy

  • Cancer

  • Ectopic tissues (ectopic gestation, mammae, thyroid, uterine endometrium)

This means that if a patient has symptomatology that resembles the clinical features of classical syphilis, we can presume the presence of a strong syphilitic diathesis. When there is a strong hereditary and historical background for this, the syphilitic miasmatic expression is induced very early in life. There is a rapid miasmatic transition with  phases of all other miasms expressed fleetingly before Syphilis manifests,  either after birth or even during intrauterine life. This explains how a short phase of psoric expression can suddenly jump to a syphilitic miasmatic expression such as terminal malignancy in infants or congenital malformations.

Violence is the hallmark of the syphilitic response throughout. It is irrational and dis-proportionate, relentlessly driving toward destruction at all levels from the spirit to the intellect, the emotions as well as the body. There is an erosion of values of life where base-impulses have their full sway. Manic psychosis, psychopathic personalities, criminal propensities, moral depravity, etc., are all examples of this destruction. Again I refer the reader seeking more details to the accompanying article,  Personality Types.

The violence and destruction at the physical level are more reliable indicators of a miasmatically predominant syphilitic expression. This is expressed in the following types of symptomatology:

Skin, Hair, Nails:

Squamous copper-colored eruptions
Itching <night
Cracks, fissures, ulcerations with indurations
Discharges: foul, bloody, acrid
Loss of elastic tissue

Mucous and serous membranes:
Acute and chronic catarrhs with the typical bloody, foul discharges with necrotic pieces of bone or cartilage.
Otitis media with necrosis of ossicles
Mastoiditis with abscess that leads to caries of the mastoid
Inflammatory processes that lead to induration and ulceration and gangrene, but hardly any suppuration
Toxemia, rapid, malignant spread of infections and inflammation.

Skeletal system/teeth:
Necrosis of these structures, leading to crippling deformities of joints (osteoarthritis with osteophytes is primary degree syphilitic (degeneration) and second degree sycotic (new bone).
Dental caries before teeth erupt; bone and peri-osteal pain at night, relieved by cold applications and movement
Osteoporosis leading to fractures and deformities

Ulcerations healing to fibrosis, scarring, and disfiguration as in acne vulgaris or after vaccinations
Eyes: Corneal opacities, unequal, deformed pupils after chronic inflammation of the iris

Degeneration and atrophy of tissues and organs, resulting in loss of function and faculties.

This occurs in two ways:

1. Direct cellular damage

2. Vascular obliterative arthritis with resultant symptoms; a syphilitic dimension of the atherosclerotic process; other associated complications of hemorrhage and thromboembolic phenomena. Vascular dilatation with aneurysms which are a result of loss of elastic tissue.

Nerves/brain/spinal cord:

Degeneration and atrophy of neuronal cells, the axis cylinder, and myelin sheaths resulting in degenerative disorders of the spinal cord, as in amyotrophic lateral sclerosis (ALS), tuberous sclerosis.
Paralysis, occurring as a result of ischaemia, metabolic degenerative states.

Loss of intellectual function, loss of memory, inability to think, comprehend, or learn (Alzheimer’s disease); cerebrovascular accidents where there is degeneration of brain tissue.

Auto-Immune Disorders: These terminate in the syphilitic expression when there is organ degeneration or loss of function, though the earlier phases may be either sycotic or tubercular.

Neoplasia: Precancerous states need to be recognized as having a syphilitic diathesis, and treatment often needs to be started with anti-syphilitic remedies. Advanced states of cancer where tissue destruction and loss of function has already taken place enter the stage of syphilitic miasmatic expression. Fast developing cancers (galloping cancers), cancers that develop at a young age, or those that develop from very early precursor (stem) cells are all signs of the syphilitic miasm.

The syphilitic diathesis includes:

Leucoplakia, atrophic gastritis (commonest cause: pernicious anemia), submucous fibrosis, atrophy of the mucous membranes of the mouth, pharynx, and eosophagus (Plummer Vincent syndrome), Paget’s disease of the nipples, kraurosis vulvae, acanthosis nigricans, etc.


Disease response is found to evolve over time and is a multi-miasmatic process. Individuals often present a Combined Miasmatic Disease Expressionin any number of permutations and combinations, although at any given point of time, one miasmatic expression predominates. If a practitioner faithfully records the anamnesis, he will notice this evolution of disease expression. It is the characteristic concomitants at any given point in time that are essential for establishing the simillimum in each instance. We rarely find one remedy running through all phases.

A complete analysis of the details will give the knowledgeable homeopathic physician a clear mapping of what to expect in the future in terms of remedy choices.

A miasmatically valid totality is built up by patiently collecting data of the entire life history of the patient, stressing the chronological aspects in proper sequence, as well as all other aspects necessary for choosing a remedy. This alone permits the complete Planning and Programming of Homeopathic Treatment right at the outset. This includes the first prescription, the acute totalities with corresponding remedies for each, the chronic totality and the intercurrent totalities based on miasmatic predispositions which do not appear to be covered by the main, well-chosen constitutional remedy.

Dr. K. N. Kasad cautions that most of our failures in this area of miasmatic treatment can be traced to our preference for partial work, partial totalities, due to a ‘constitutional aversion to work’ which over the years has an immense capacity to destroy the best clinical judgment! 🙂

Clinical Management based on the Evolution of Disease Expression

relative to acute disease expression.

 We know that:

1. Acute diseases (dissimilar disease) supervene during the course of chronic disease, or

2. Acute diseases are actually acute exacerbations of a chronic disorder, or

3. Acute phase expressions of a periodic disease, e.g.: asthma.

In type 1, an acute remedy is required. When it completes its action, the constitutional symptoms become more prominent and the chronic or constitutional remedy is then indicated. Premature prescription of the constitutional remedy would produce an aggravation of the acute symptoms. It is thus clear that Time is of vital importance for a physician.

More often than not, type 2 and type 3 require only the chronic or constitutional remedy to control the acute problem and continue progress towards cure.

Disease Evolution: Understanding and Managing a Case of Scarlet Fever

For an understanding of the various aspects that constitute homeopathic management in fast-changing pathology in acute, serious diseases, let’s discuss the management of scarlet fever (as presented by Dr. Kasad) that develops in a person with underlying combined fundamental miasms. It is combined miasms and previous suppressive treatment that lead to the development of complications. Such complications are amply recorded in modern textbooks of medicine.

If homeopathy is to become a system of medicine to be reckoned with in future, it is essential to grasp the nuances of clinical management detailed below.

Scarlet fever manifests as repeated streptococcal infections (psoric/tubercular), as well as a remote inflammatory response in distant organs (sycosis). The RES response to the general presence of germs internally is to throw off their toxins onto the skin to save internal organs (kidneys, heart) from damage.

  • In the initial acute phase of illness there are throat manifestations that require an acute homeopathic simillimum, repeated frequently in high potency, in divided (water) doses. This would abort the infection.

  • In the entrenched phase (i.e., when the throat manifestation has been suppressed), caution is called for in interpreting disease response. This is a stage of deterioration. Any symptomatology pointing towards a generalized reaction of the RES, as opposed to the acute phase (above), indicates that the simillimum required now should be based on the chronic totality and not on the acute totality. Here, too, what is required is the chronic remedy, repeated frequently, in keeping with the pace of the disease, to aid the RES in getting rid of toxins.

  • The next possibility clinically is that even this stage of general skin manifestation is suppressed and the internal organs (heart and kidneys) have already begun to suffer damage as antigen-antibody complexes cause local symptoms at the level of these organs (sycotic). An acute totality again surfaces relative to organ damage, and the alert homeopathic physician picks up this transitory phenomenon. The totality here can either point to an acute simillimum or else a specific organ remedy to abort the damage to the internal organ.

  • This done, the patient travels back in time, as per Hering’s Law of Cure, and the chronic totality is thrown up again, this time in a leisurely manner, allowing enough time for a physician to reach the constitutional, chronic remedy. If this stage is missed, however, the patient once again returns to the acute organ totality, resulting in severe destruction and serious consequences (tubercular/syphilitic).

  • The constitutional remedy has to be continued and repeated frequently till all lab parameters and clinico-pathological signs and symptoms have shown complete reversal of the disease state in the direction of cure. A single dose here and there cannot cure this case. Stopping the remedy too early will also cause the case to slip out of control into deterioration. At the same time, the physician needs to keep track of the sensitivity of the patient’s response. Sensitivity declines as the patient moves into further deterioration and organ damage, and this demands more frequent repetition of the remedy in higher potencies during the acute/sub-acute phases.

  • As the patient begins to improve per Hering’s Law of Cure, sensitivity is once again restored, and a corresponding reduction in the frequency of stimulation becomes necessary. At the same time, the physician has to perceive miasmatic blocks in the further smooth progress of the patient (based on expression of miasmatic symptoms detailed above). This would require the specific anti-miasmatic nosode or remedy before the chronic remedy is continued again.

Obviously, for a scientific homeopathic physician, the phenomenon of disease is one; acute and chronic disease are not seen as separate entities. They are simply two phases in the same process when perceived from the standpoint of evolution in time.

Hahnemann’s Chronic Disease Revisited

As I mentioned in the section on Venereal Miasms in Part 1 of these series:

“What is important to note (for future understanding) in the details above is that the change of state to syphilitic miasm necessitates that there is a change in the host factor – ‘the whole being has been changed into a man entirely venereal’. The importance of this is twofold:

1. There has to be a predisposing shift of the whole being (body, mind, soul) towards a venereal type of expression (syphilitic miasmatic expression) in order to have a physical expression with the symptom of chancre or frank syphilis.

This is especially important since we know for a certain fact nowadays that only 30-50% of those who come into direct contact (through sexual intercourse) with a person in the infective stage ever actually develop the symptoms of syphilis.

Hahnemann’s concept of miasmatic background and the homeopathic concept of susceptibility are the explanations for this fact.

2. There exists, before a Syphilitic miasmatic expression, an underlying Psoric miasmatic expression, which may be advanced in expression (involving pathological changes in internal organs), i.e.: It may be either active or latent.”

We see how the concepts of the ICR Symposium easily follow from Hahnemann’s observations.

First: Miasmatic expression is not merely a reflection of disease caused by an infective organism. If that were the case, then every organism would produce its own “miasm”, shifting the individual into a multitude of miasmatic expressions combined with each other!

This would be a simplistic understanding of what Hahnemann termed “miasmatic expression”. The disease expression clearly falls into one of the major groups above at a particular point in time, based on the symptomatic expression which exhibits itself at the level of the intellect, the emotions, and the body simultaneously. An individual could exhibit different miasmatic expressions at different points of time. The miasmatic expression predominant at any point in time in a particular individual is in parallel with the specific infecting organism (bacteria, virus, fungi, parasite), which play a role in terms of type of clinical symptoms. But it is the underlying (fundamental) miasm that determines which organisms one is susceptible to.

Secondly: Miasmatic expression or predominance is a dynamic + physical expression of disease at a particular point of disease evolution, based on solid, factual evidence of symptoms and should be clearly distinguished from any other basis for using the term miasm. One needs to be careful about (mis)using the term “miasm” especially when modern thinkers contribute their interpretations and suggestions based on the concept of miasms which is not similar to how Hahnemann perceived the theory of miasms.

This dilutes the strength of Hahnemann’s observations and confuses the fledgling homeopath about miasms at a very basic level. Such confusion can affect homeopathic case management for the long term, as it would then be based on poorly founded concepts.

Thirdly: Hahnemann did not consider the expression of the syphilitic miasm by itself, but it was based on primary or secondary or latent psora (that always existed in some form). It is logical then that syphilitic expression could also stem from a sycotic or tubercular miasmatic base, depending on the hereditary diathesis, evolution of disease, and suppression experienced by an individual over his lifetime. Is there any reason why this hereditary expression is not possible?

This is the basis for understanding the evolution of disease as interpreted by the Dhawle’s ICR. The importance of this interpretation does not lie in abstract theories, but in the ability to apply the interpretation clinically in treating serious diseases, reversing them towards cure based on Hering’s Law of Direction of Cure.

Finally: Why doesn’t everyone who is HIV-positive develop frank AIDS? Why do only 30%-50% of people exposed to Treponema Pallidum during an infective coition develop frank Syphilis?

The answer lies in the Dhawle symposium’s interpretation of evolution of disease. To develop frank disease (AIDS or syphilis), the individual must be susceptible to these destructive diseases. To be susceptible to such destructive diseases, there has to be a miasmatic background that allows the destruction to take place. Either a strong syphilitic diathesis or a strong tubercular diathesis would allow an individual to succumb to symptomatic AIDS or syphilis. When this happens, the simillimum must be either a predominantly anti-syphilitic remedy or a predominantly anti-tubercular remedy since, as Hahnemann accurately stated, it is the predominant (miasmatic) symptom picture that must be treated first.

If you read this article earlier (in the May ’05 issue of the Hpathy e-zine), please note that this is a  modified version. Though the content is essentially the same, I have tried to present it in a more reader-friendly format. I hope it expresses the ICR miasmatic concepts with simplicity and clarity, and provides an in-depth perception for serious homeopaths. Your comments and suggests are welcome.

Edit 2: October 06


1. The Chronic Diseases, Samuel Hahnemann (Theoretical Part)
2. Organon of Medicine, Samuel Hahnemann
3. The Genius of Homeopathy, Stuart Close, MD
4. Dhawle’s ICR Symposiums (Volume C), Mumbai
5. Theory of Suppression, Predictive Homeopathy Part I, Praful Vijaykar, LCEH
6. The End of Myasumtion of Miasms, Predictive Homeopathy Part III, Praful Vijaykar, LCEH
7. An Insight into Plants, Rajan Sankaran, LCEH
8. The Sensation in Homeopathy, Rajan Sankaran, LCEH

Part 2: Disease Evolution and its Miasmatic Expression: Welcome
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