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Miasms in Case Management Part 3

Part 3:  Perceiving Hahnemann's Miasms Through Genetics and Embryology

The practice of Homeopathy as well as Modern Medicine was a family profession, which is largely responsible for Dr. Praful Vijaykar having great insights into perceiving the Development of Miasms from the Genetic perspective, and also explaining Hering’s Law of Cure with Developmental Embryology.


These are brilliant applications of modern science to the art and science of homeopathy. If well understood, it could revolutionize our case management and understanding of disease development in individuals. I would encourage homeopaths, who would like to do true and indepth classical homeopathy, to make an added effort to assimilate these series of articles on miasmatic case managment.

Vijaykar’s observations broadly fit in with the ICR understanding of Disease Evolution that I sought to explain in the previous article on Miasms (Part 2). The comparison between them as well as the close link with Hahnemann’s concept of Miasms could easily be another article of interest we could present in a future issue. This effort is to enable the “Miasm Theory” and these concepts to move out of the realm of philosophical discussion and filter down to our everyday case management.


It would require an in-depth study along with a few years of experience with chronic patients to perceive how it all fits in so well. One would then have an added advantage in Chronic case management, with confidence in remedy selection for serious and pathological cases.

I will first attempt to introduce Vijaykar’s embryological perspective of Hering’s Law of Cure. This may sound a bit technical, but it forms the basis of understanding the different miasmatic expressions in different organs of the body. It would help the homeopath to make a study of basic process embryological development. Also study basic processes of acute and chronic inflammation from a good pathology text book. Imagine, there is actually a method to all this madness! The explanations below would be very simple after that. The use of “medical” words, is simply to use the right word to convey the universally accepted meaning – so the help of a simple medical dictionary (while reading) will put it all in perspective. Vijaykar, in his books, overcomes this obstacle by using a lot of story type metaphors to convey his concepts.

Hering’s observation of “Nature’s Law of Cure” and Embryological Development

The human egg after being fertilized begins the process of development into a human fetus. This takes place by cell division and follows a definite pathway of development, which Vijaykar calls the “Nutritive Gradient“. The cell division produces various cells for the development of different organs but all these cells arise initially from only 3 morphologically different germinal layers. These are called:
1. The Ectoderm
2. The Endoderm
3. The Mesoderm
A fourth specialized cell type develops from the Ectoderm as well, called the Neuro-ectoderm.

The Ectoderm gives rise to cells that form tissue of organs that are exposed to the external environment. These include the skin; epithelium of cornea, conjunctiva and iris, lens of the eyes; hair (not roots), nails, teeth enamel, external auditory canal, tympanic Membrane (ear drum); lower part of anal canal, terminal part of male urethra, outer part of vagina; lips, cheeks, gums, outer covering of tonsils.
These are the outermost tissues, the peripheral tissues of Herings Law of cure.

The Endoderm forms cells that are the inner linings (mucosal linings) of the respiratory system, gastrointestinal system, and urinary tracts; Epithelium of the gall bladder and extra-hepatic duct; Endoderm cells of Liver parenchyma. This layer too, when symptomatic is a peripheral expression of disease but deeper to the Ectoderm above.

The Mesoderm develops into into two types of tissue:
1. The Mesenchyme which forms the parenchyma lining of all the internal organs; the connective tissues (Blood, lymph, bones, cartilages, muscles, dermis (skin), fascias and coverings of organs. This tissue is the link between the Endoderm epithelium that forms the inner lining of organs, and mesodermal viscera (below).
2. Mesothelium which forms all the internal organs/viscera: Lung parenchyma; kidneys; muscles which form the trachea; Angioblastic tissue products (heart, blood vessels); Viscera coverings (pleura, peritoneum, pericardium, duramater, piamater, spleen, liver [capsule and fibrous tissue]).
These are deeper tissues, important organs affected only after there is suppression at the Ectodermal and Endodermal level.

The Neuroectoderm forms the Nervous system, both central and peripheral.
They also form the secretory cells of the neuroendocrine glands and neurotransmitters which are scattered in various organs and tissues all over the body. These secretory cells secrete neurotransmitters or hormones and are classified together under the APUD System (Amine Precursor Uptake Decarboxylate System).


The APUD system cells are of 3 types:
1. Neural Crest Origin: Thyroid, Adrenal Medulla, Melanoblasts of the Dermis, Cells in the Uorgenital tract secreting 5-Hydroxytrytamine.
2. Neuro Ectodermal origin: Hypothalamus, Parathyroid, Pituitary.
Some APUD cells of disputed origin are Islets of Langerhans in the Pancreas.
Affection of these tissues, is due to longterm suppression and are the “important organs”, “inside” and “centre” of Hering’s Law of Cure.

The Cycle of Development

This is a short explanation of embryological development that all medical students learn with the study of Anatomy. A homeopath should get familiar with this early process of development in-utero, as it explains Hering’s law of cure beautifully. Also, Vijaykar’s concepts then become very appealing.

The development of the embryo is a fixed and well timed process of development which does not change. If it does, it results in anatomical and physiological abnormality in the final expression of the developed child. The first area to form is the Prechordal plate which ultimately represents the head or brain and subsequently the other organs begin to develop. This denotes a cephalo-caudal (head-tail)axis i.e., the organs that are of a higher level of importance to organs of lower importance of Hering’s law of cure.

In contrast, the development of the Mesoderm is paraxially, from inside outwards and from the dorsal to the ventral region. This differentiates the internal organs from those more peripheral, and the deeper organs as more important than the superficial ones (Hering’s Law).

The Ectoderm is the least important when it forms the skin and most important when it forms the brain or neural tissue. Between the two are the Endoderm and Mesoderm. When we understand which organs originate from which tissue, the difference between organs of more importance and ones of lesser importance become clearer.

Based on the embryological Hering’s understanding explained above the layers of disease progression due to suppression would be:
From: Ectoderm (Skin)
–> Endoderm (Upper respiratory Tract, Liver Cells, Genito-Urinary Tract, Bile Duct)
–> Mesoderm/Connective Tissue (Blood, Lymph glands and system, Bones, Joints, Muscles, Cartilages, Dermis)
–> Organs of the Mesoderm (CVS, Heart and Major vessels, Kidneys – parenchyma, Lungs – parenchyma)
–> Endocrines (APUD System, Pancreas, Thyroid, Pituitary, Adrenals, Testes, Ovary)
–> Neural Plate (Central Nervous System, Sympathetic Nervous System)
–> Changes in “Genetic Code” (Here, Vijaykar refers to the affections of the basic structure and functions of the cell due to Genetic modification).

Hering’s “Law of Cure” hence follows the opposite direction to the cycle of development explained above. The 5 directions of cure are:
1. From organs of more importance to organs of less importance
2. From Above Downwards
3. From Inside to Outside
4. From Center to Periphery
5. In the Chronological reverse order of disease development.

How does one correlate embryological development with disease progression and miasmatic expression?

It would be important at this point to realize that there can exist different types of miasmatic expression at every layer of disease suppression. It is the type of expression that differentiates between the miasms. For example, the skin can manifest either Psoric miasm (simple dermatitis), or Sycotic miasm (Warts) or Syphilitic miasm (Ulcerations). What determines this expression, is the hereditary miasmatic traits as well as acquired miasmatic load.

Another subtle point to note, is the pace of disease progression. The movement is towards a more destructive disease expression over time, ie: A shift from more superficial layers to deeper layers. This is the second determining factor of inherited miasm in an individual. When diseases tend to remain within Ectoderm or Endoderm, it means there is a strong Psoric trait. When diseases tend to move quickly into deeper layers of major vital organs or the derivatives of the neural place, it is indicative of a strong Syphilitic trait. This means that individuals can progress from Psora –> Sycosis –> Syphilis in their lifetime, and this progression is largely dependant on the inherited miasmatic background. Here is another area where the ICR Symposium concept of disease evolution is similar to what Vijaykar has explained. (See Part 2).

An example of this given by Vijaykar is the case of a child who developed blindness at 5 months of age. The child was diagnosed as blind since birth. But the mother insisted that the child used to smile and respond very well to her untill he was 3 months of age. she was sure that he could see at 3-4 months. She would not accept the diagnosis of blindness from birth.


On further questioning, it was found that following a vaccination at the age of 3 months, the child developed a mild rash on the body. Then he had a cold and cough which persisted for a few days which apparently responded to conventional treatment. The mother’s observations were given more importance than the pediatricians’ diagnosis. It was clear that the vaccination stimulated a series of pathological reactions within the body resulting in degeneration of the retina and hence blindness.


Using our understanding of disease progression and miasmatic background as explained above, this is the inference: The child had a strong syphilitic miasmatic trait. Following the vaccination, after a short term Psoric expression, the disease progressed from the Ectoderm (rash) to the Endoderm (cold/cough) and then bypassing the Mesoderm expression, directly affected the neuro-Ectoderm (retinal degeneration). The remedy has to be a strongly syphilitic remedy that produced ailments at a very fast pace, and did not follow the rules.


The basis for the remedy choice was: A/F Vaccination, Destructive, Syphilitic remedy, Chilly, thirsty (physical generals of the child), that moved at a fast pace. The remedy that cured this child’s blindness was Merc Sol.

Cellular Defense Mechanisms and their Miasmatic Correlation

Vijaykar makes use of another well documented observation normal physiology, molecular biology and immune function of a cell to describe and authenticate Hahnemann’s Theory of Miasms. It is interesting to understand the miasms from this perspective : an extrapolation of well known biological mechanisms. I’ll outline in brief these concepts below:

There are 3 basic Functions that an organism or individual cell has evolved for Survival.
1. The first function of the cell is for nutrition of self. Its basic functions are geared to acquire nutrition and oxygen for survival.
2. The second basic function of a living organism or a cellular unit is regeneration or reproduction. This ensures survival of the Species.
3. The third basic function of a cell is the Immunity that is evolved for protections against outside forces for both the individual cell as well as the whole organism.

The importance of considering the changes that are occurring at the cellular or tissue level is because this response is governed by the genes, or genetic make up of the man as a whole. The disease response and expression is governed by the genome in each individual cell that is dependant on the genetic make up of that individual, which can change at different times and different ‘states’ of the individual based on the hereditary (genetic) traits.

A normal cell responds to stressful stimuli in the environment by certain genetically regulated functions (metabolism, differentiation, specialization) in order to restore homeostasis. As the stress (pathological stimulus) continues for a longer period of time, various physiological and morphological adaptations begin to occur resulting in an altered state of homeostasis. Some of these adaptations are cell hypertrophy, cell atrophy or cell injury which may be reversible or can result in final destruction.

There are conceptually 3 Defense Mechanisms a cell employs for survival.

1. The Physiological Defense: the first line of defense. Initially the cell tries to restore homeostasis at the level of its cell wall by promoting production of lysozymes in mucous membranes or unsaturated fatty acids on skin epithelium. These seek to wash off irritants or bacteria or viruses. Ultimately if this does not work, the Acute Inflammatory Response of the cells sets into motion (Calor: heat, Rubor: redness, Dolor: pain, Tumor: swelling, Functio-laesa: temporary absence of function) which tries to localize the irritants, bacteria, virus, etc and get rid of its disease causing influence on the body. This is the Acute Inflammatory Response which is closely intermingled with the process of repair. While acute inflammation works at limiting effect of the pathogens, it also sets of a series of events that heal and reconstitute the damaged tissues.
The Acute Inflammatory Processes in any organ involving the mucous membranes or skin are typical expressions are what Vijaykar tems “Physiological Defense”.

2. The Morphological or “Constructive” Defense: is the second line of defense. Ideally most of the Chronic Inflammatory Process of the immune system come into at this stage. The observation at the cellular (micro) and macro levels is the accumulation of lipids or proteins or glycogen in cell walls or cytoplasm. Chronic inflammatory processes all describe an accumulation of fluids, development of chronic granulomas and healing with fibrous tissue accumulation as part of the immune processes. These express as cysts, tumors, excessive think discharges, pigment depositions, fibrous scarring.

3. The Destructive Defense: When chronic inflammatory processes fail to stem the progress of disease and the pathogens, the next line of defense is immune processes that cause local destruction with the help of secial cells and enzymes secreted, in order to “save the whole by sacrificing a part”. The change to this type of defensive mechanism possibly occurs at the genetic level of the cell – the change towards self destruction rather than survival. These pathologies express as necrosis of parts or gangrenes or ulcerations.

Organon Aphorisms 73, 79, 80 may be paralleled with the observations above. Psora is thus – “Physiological Defense”, Sycosis is “Constructive Defense”, and Syphilis is “Destructive Defense”.

Psora includes the Acute Inflammatory response and other physiological defenses that make use of and sacrifice the 1st basic function of the cell, that of Nutrition. The resultant hypoxia and Ischaemia leads to depletion of energy generation within the cell affecting its long term functioning and health, (unless helped with a similimum remedy). This expression can also be extrapolated in the mental and emotional symptoms.

Sycosis includes defense processes that make use of or sacrifice the 2nd basic function of the cell, that is its capacity to regenerate/reproduce. Mitosis, meiosis, etc are these functions that help in accumulations and growths. This tendency for protection through deception and fortification is the Sycotic extrapolation into the mental state.

Syphilis makes use of destructive Immune processes to defend the organism or the cell. The immune function is the 3rd basic function of the cell which may be sacrificed leading to destruction – locally or at the general level. Auto-immune diseases, destructive diseases of the immune system or other part of the body are part of this. Here too, mentally there is an expression of destruction, loss of moral sense and perversion of the intellect.

Almost Every Disease process evolves in a particular direction: It starts with acute inflammation (Psora) then progresses to chronic inflammation and indurations (Sycosis) and finally towards ulceration and destruction (Syphilis). (Aphorism 72).

Thus, we see a miasmatic evolution in every disease process, acute or chronic during treatment. The extent the disease progresses is determined by the basic miasmatic traits possessed by the individual which are either acquired or inherited. One phase or state may be predominant at a particular point of time. Observation and analysis of the miasmatic evolution of disease in the life of each individual patient, peceiving the miasmatic similimum or series of similimums that would be required and recognizing a reversal of the miasmatic progression towards health, is the hallmark of expert homeopathic management. Observing this reversal is not by merely or simplistically following Hering’s Nature’s Law of Cure, but being able to perceive deeper the Miasmatic reversal towards cure. The choice of remedy then has to be appropriated and be a similimum for this purpose. Only then will we see true Cure in chronic complicated diseases. We will explain this again more clearly with some examples.


Multi-Miasmatic Expression:

Almost every one of us has a multimiasmatic expression of disease. This is because besides the miasms we may have acquired during our lifetime, we have also an inherited miasmatic load that progresses further with every suppressive treatment taken during ones lifetime. Vijaykar details the various physical and mental facets of individual miasmatic expression. That has already been covered in earlier articles on miasms, especially the last one in the previous (May ’05 of Hpathy Ezine) issue. His are valuable insights interpreted from his own experience, so one should go through his book. I have mainly focused on the clinical relevance of these concepts for case management.

Every individual inherits his natural traits and characteristics from his parents.These are in his genes. But not all these genes are expressed in the normal characteristics of the individual. Some genes remain dormant, while some are dominant. The dominant genes are activated to produce and synthesize substances that express the dominant characteristics. From the homeopathic standpoint too, the individual inherits miasmatic traits (genetically based) from his parents. He may have inherited a multimiasmatic expression, but only the dominant miasm expresses itself, with the others lying latent (Hahemann used the term “latent psora”!), having the ability to be activated in the right set of circumstances. This miasmatic load is also modified by miasmatic influences acquired during a person’s lifetime.

Vijaykar explains the process of growth, development and aging as an expression of miasmatic evolution. The essential concept is as follows:
The First Phase from Birth to about 20 years of age normally present with complaints related to the Psoric miasm – Skin problems, frequent colds, diarrheas, various repeated infections that last a short while that helps develop the immune system. These diseases are dealt with through “physiological defense” systems. The mental state is one of learning, growing, working to gain knowledge, satisfying ones basic needs of survival.

The Second Phase from about 20 years to 50 years of age normally present with Sycotic complaints like backache, Rheumatoid arthritis, psoriasis, tumors, fibroids, hypertension and diabetes. The defenses have become accumulative or “constructive”. The mental state is expressed in the need to prosper, to accumulate wealth and power, and to achieve. There is weight gain in general signifying this move towards sycotic expression.

The Third Phase is after 50 years till death. This phase is characterized by catabolism, and a process of destruction that is normal to aging. But it also characterizes a Syphilitic expression. Depending on the miasmatic load, the destructive process sets in either at an earlier age in this phase or only very close to death. A long life and uncomplicated old age is a sign of strong Psoric miasmatic inheritance, which is the secret to a long life of good vitality.


Of course, the miasmatic shift can occur at any time, and it is the miasmatic background that has been inherited along with the amount of stress in the environment that the individual is exposed to that determines this.

Miasms in Hering’s Law of Cure

Earlier we talked about Miasmatic evolution and Hering’s Law of Cure from the embryological perspective. Vijaykar adds one more corollary to Hering’s Law in order to bring in the miasmatic perspective:

The 5 directions of cure are:
1. From organs of more importance to organs of less importance
2. From Above Downwards
3. From Inside to Outside
4. From Center to Periphery
5. In the Chronological reverse order of disease development.
An additional Corollary is:
6. From a more destructive miasm or destructive process towards one that is less destructive. I.e. Either from Syphilis to Psora or Syphilis to Sycosis, or Sycosis to Psora.

A Clinical Example is the case of a man suffering form Leukemia. While he was being treated with a remedy, his WBC count reduces, which may have been a welcome sign, but along with this, his hemoglobin level also began to fall. Leukemia has a Sycotic taint. The fall in WBC is a good miasmatic sign, but the fall in Hemoglobin alongside is an indication of destruction of bone marrow cells that also produce RBC’s. This would be a Syphilitic change towards a destructive defense instead of the sycotic defense of leukemia. This was a wrong direction of cure.

The case was revised and the correct antisycotic similimum was found. After the second prescription. The haemoglobin increased. But the number of leucocytes (WBC’s) increased as well. From the Miasmatic point of view, this was a good movement as the destructive Syphilitic change has reverted back to a sycotic defense. Subsequently there followed a decrease in the total WBC’s while the hemoglobin continued to improve. A subsequent differential WBC count revealed that there was a definite reduction in the number of lymphocytes (chronic inflammatory cells) with a corresponding increase in the Neutrophil count (Acute inflammatory cells). Lab results over the past year did not show any such change in the differential WBC count. The sign of increased neutrophils, as against lymphocytes is a Psoric expression.

This was a miasmatic indication of the correct direction of cure. Besides other signs of Hering’s law that were observed, here was the miasmatic interpretation exhibiting a change from a Syphilitic “Destructive defense” to a Sycotic “Constructive Defense” onwards to a Psoric “Physiological Defense”. The remedy was a miasmatic similimum and was certain to completely cure this patient.

Multimiasmatic Remedies

The multimiasmatic expression exists not only in an individual but also in the remedy proving. As mentioned in my previous article, it would have been interesting if Hahnemann has sought to record proving symptoms giving importance to the miasmatic expression and sequence of symptoms development. But he did not, and so we have the added difficulty today of trying to understand our remedies (especially the polycrest ones) from the multimiasmatic perspective. This is a concept that the ICR symposium have worked on as well in order to understand the different miasmatic expressions in polycrest remedies. The importance of understanding remedies from the miasmatic standpoint is that it helps us perceive a commonly used remedy in an uncommon expression based on the predominant miasmatic expression. The predominant miasm is one of the reasons why we see different and uncommon facets of remedies in different individuals. One does not write these off as “Polarities” simplistically. They have a good reason to show one polarity – and often the explanation is fond when we look deeper into the miasmatic expression of the symptom picture as whole, the physical symptoms being most clearly indicative of the stage of pathological progression.


In Part 2 , the multimiasmatic expression of Baryta Carb was explained from a description given in the ICR Volumes.

Here is the remedy Opium miasmatically analyzed by Dr. Vijaykar.
A Psoric Opium would have:
Physically
1. Epilepsy
2. Hyperacidity
3. Itching of the skin.
Mentally
1. He will be quick and witty
2. He will have easy comprehension
3. He will be easily frightened
4. He would have a good intellect and active memory

The Sycotic Opium would have:
Physically
1. Constipation
2. Ptosis of the eyelids
3. Dropsical condition of the body
Mentally
1. He would be slow and torporous
2. He would be a liar, deceitful and sly.
3. He would be full of ideas with gigantic plans
4. His senses would be blunted with a weakness of memory

The Syphilitic Opium would have:
Physically
1. Painlessness of Complaints.
2. Trembling and Twitching of muscles.
3. Paralytic conditions of bowels, bladder, etc.
4. Comatose and unconsciousness.
Mentally
1. He would appear contented by apathetic.
2. He would be imbecile.
3. He would be ecstatic, eccentric with exalted fancies.
He would be shrieking, screaming and shouting.

Here is an example of how one observes the miasmatic expression of the case and correlates it with the miasmatic expression of a multimiasmatic remedy to cure a serious disease:

A lady came for treatment with Cancer of the Cervix. She was dark, long faced, sharp featured with a slightly distorted bridge of her nose. She was friendly and loquacious. She was an Assistant Editor of a leading Hindi Language magazine. She said she resigned from this post, as her worth had not been recognized. They had not made her the Editor in spite of working hard for the magazine for over 8 years.

At home she led a restricted life because her husband was very strict. He was dictatorial, abrupt and aloof. She had to live her life independent of him because she had virtually no moral or financial support from him. Her son too did not care for her much.

In these circumstances, she was angry with all “males”. She said that she was a good poet whose poems were very well appreciated. She specialized on two themes – they were either for small children or for women/girls.
When she was asked to recite some poems, she recited one she had written for young girls. The gist of the poem was advising girls not to be confined to the kitchen, but to come out of their cage and see the wide world around them. (So far so good!). then she went on to advise these girls to mercilessly kill the people who have caged them. Cut them to pieces and feed them to the insects and rats which are hungry! All this with the intention of advocating liberty!

When asked to recite a poem she had written for children, her eyes sparkled. She stated that she wrote unique poems for children. She started to recite a poem that she titled “Headless”. The poem described a boy of 5 years whose head was cut off. It ended with other boys teasing this headless boy telling him how beautiful they looked. But when they looked over a bridge into the water, the reflection they saw shocked them. All their heads had been cut off and placed on the body of the headless boy they were teasing!

One can imagine the perversion and distortion of her imagination! A poem for children should be pleasant, about beauty and full of joy, but here she wrote on themes that would frighten them to death! It was clear why her “unique” poems never gained popularity as also the reason why she never felt appreciated. This is also the reason why she was not promoted to chief editor and possibly why her husband remained aloof from her.

This is a syphilitic expression of the remedy, which remains at the level of the mind with a physical symptom expression. (Note that there is no obvious expression in social action that one would expect of a typically and predominantly syphilitic remedy like Mercurius) One need not look into Rubrics of dreams and delusions. What is characteristic of her is her Egotism of being a ‘Unique’ person.


The correct rubric in the repertory for her distorted imagination is:
“MIND; STRANGE; crank; opinions and acts, in (SI-962): calc., sulph., verat“.
Her general symptoms were: Very thirsty with heat of the palms and soles. The remedy was SULPHUR with syphilitic expression of the remedy. Sulphur cured her cervical and uterine dysplasia completely much to the amazement of the gynecologist.

Conclusion

This attempt of presenting Dr. Vijaykar’s concepts on miasms hopes to highlight parts of his insight that are brilliant and very useful for case management. I have left out concepts included in his books that were not very relevant clinically or need further elaboration or modification by him in the future.

We all could do with deeper insight into managing our chronic patients miasmatically! As I said earlier, a little bit of indepth study and learning is a must for any homeopath wanting to achieve successful cures clinically, making use of all the tools at our disposal. It adds to the sense of fulfillment in our mission to heal the sick. Do write in with your comments and suggestions.

Dr. Leela D’Souza

Bibliography:

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