Chronic Miasms

by Peter Fraser

Hahnemann brought three powerful innovations to the practice of medicine. These three concepts form the three principles of Classical Homœopathy: Like Cures Like, The Minimum Dose and The Single Remedy. Like Cures Like is an ancient idea that is found in Galen and Hippocrates and is a powerful tool in modern medicine where it has had a variety of names the current favourite being The Rebound Effect. Hahnemann's innovation was to see this not just as a methodology but as the exclusive means of bringing about a permanent cure. The second innovation was to prepare remedies in ultra dilute forms, perhaps as much to his surprise as ours, he found the more dilute the remedies were the more powerful they became. The third innovation was to treat not particular symptoms or named diseases but to treat the totality of symptoms being expressed by the patient. The first of these innovations is fundamental to homœopathy is reasonably easy to understand and is accepted by all homœopaths. The second, though straightforward, is counter-intuitive and currently has no mechanism that explains it. It is therefore the thing that makes homœopathy unpalatable to conventional scientists and medics, but is almost universally accepted by homœopaths. The third innovation is the most complicated and the most controversial within homœopathy. In order to appreciate the totality of symptoms, and especially the totality of characteristic symptoms, rather than the total of all symptoms it is necessary to think in a completely different way. The totality of symptoms is never merely an accumulation of simple facts rather it is a confluence of patterns. It requires a different way of thinking which is generally referred to as Pattern Thinking, and one which is now central to many disciplines in advanced physics and mathematics including: fractal mathematics, chaos theory and quantum mechanics. The principle of the single remedy that by its nature requires pattern thinking and a holistic view of the case is the most controversial aspect of homœopathy and one to which many do not feel is important in the way the other two are. For example, The Society of Homœopaths in the UK recently removed the principle of The Single Remedy from the list of principles agreed by its founders. Although Hahnemann grasped the importance of this concept he found it difficult to fully describe and explain. Many of his students had great difficulty grasping the concept in its entirety. It was only the late nineteenth century American homœopaths, many of whom had a grounding in Swedenborgian philosophy and the concept of correspondences, who were able to fully comprehend and develop the concept and the way of thinking. Today we still have a dichotomy between the followers of Kent, the Classical Homœopaths who look for the pattern of symptoms, and the followers of Boenninghausen, the Practical Homœopaths who look for the sum of the symptoms. 

There are many facets of homœopathy that are the direct consequence of these principles. For example the idea of provings comes out of the first principle: like cures like is only useful if you know what the remedy is like and provings are the only accurate way of knowing this. The idea of miasm can be seen to be derived from the third principle. It arose from Hahnemann's attempts to find the deeper pattern behind the obvious symptoms. For the Classical Homœopath the miasm is a way into the deeper pattern of the patient's illness. For the Practical Homœopath it is usually a fact about the history or the family history of the patient.

Just as there are two different ways of looking at the patient and his symptoms so there are two ways of looking at the history of homœopathy and the way in which ideas and concepts developed: you can look at the simple facts or you can look at the patterns that lie behind them. The first is simple but less instructive, the second is more complex and less certain but deeper and more informative and this is what I am attempting to do in this article. 

My understanding of a patient and of the remedy they need comes from observing the patterns of their symptoms and their history. These patterns are the most powerful form of evidence which is why Classical Homœopathy is so powerful but they are regarded by non homœopaths as merely anecdotes. My understanding of miasms similarly comes from observing the patterns in disease and in the historical understanding of disease. These patterns are not obvious primary evidence rather they are the way to a deeper knowledge of the subject.

Miasm is a concept that is peculiar to homœopathy. As such it has no grounding in the outer world. There is no wider definition to which we are held by others that use the term; rather, everyone that uses the term is able to create a new definition suitable to his or her purposes. The confusion thus caused is compounded by layers of meaning, often unspoken, that have been associated with the theory of miasms as it has developed. The theory of miasms has always been primarily a tool for learning more about the nature of the central disturbance or inner disease that is unseen but which is manifested in superficial symptoms. When it is used in this way, as a tool rather than as a doctrine, it is a powerful aid to finding the indicated remedy and the various different interpretations can all inform its usefulness.

The term comes from one of the theories, prevalent in Hahnemann’s time, of how disease was spread. It referred to a noxious and infectious air or gas that clung close to a place, particularly in intermittent fevers such as malaria, or a person as in most contagious diseases. Hahnemann used it to describe the effect on a patient’s underlying constitution of those diseases that were chronic rather than acute. The chronic disease does not have a direct expression but is manifested as a particular set of susceptibilities to acute diseases of a particular and characteristic nature. Treating these acute expressions is at best palliative and at worst suppressive and the only way to obtain a lasting cure is to obtain a picture of the underlying disease and match it to the picture of a remedy. The picture of the underlying disease is obtained by observing the symptoms of the acute diseases and discriminating between those that are common to that acute disease and those that are particular and characteristic of the patient’s expression of that disease and so are characteristic of the underlying chronic disease or miasm. Even contagious diseases are slightly differently expressed in different individuals and so the genus epidemicus reveals a small group of remedies rather than a single remedy.

The ability to determine a picture of something that cannot be seen directly and so whose form can only be deduced from the effects it has is one of the key skills in modern science. It is essential to astronomers in understanding the make up of the universe and to the physicists probing the smallest subatomic particles. It is also the primary skill of the classical homœopath. In order to determine this picture we need to know more than just the symptoms but the pattern that lies behind them.

As Hahnemann described it the chronic disease infects the vitality of a person creating a particular susceptibility to certain forms of acute disease. This can be seen as a simple disease much like an infectious disease but from the start it was also a disease that was grafted onto the person at the deepest level and that was also passed on from parent to child and so becomes part of the constitutional background. It could also be seen as a disease susceptibility that is grafted on to a personal constitutional susceptibility. Some see miasms as a person’s constitutional susceptibility as it is modified and refined by circumstance and by the story of their life rather than an actual disease. Kent highlighted a religious or moral dimension to this, the physical susceptibility corresponding to the moral failings of the patient. In fact, though the definition of what constitutes the chronic miasm is still a major point of dispute for the homœopathic community it is not as important as it seems. The theory of miasms is a tool for finding the remedy and it is a tool that applies and is effective irrespective of the theory that may lie behind it. This is particularly so in homœopathy for two reasons. Since we are looking at patterns created by observable facts rather than just the facts viewed in isolation, informative correspondences of pattern can be found in the unlikeliest places. These patterns can have real and useful meaning even when the facts on which they are based have no direct relevance. Also since those patterns are being compared, as long as the tool used on both sides of the comparison are the same the comparison is in some way valid. This said, the more accurate, detailed and relevant the understanding of the pattern is the more accurate and useful the comparison will be.

There is in homœopathy a fear to be clear and straight forward about what we do and why we do it. This is seen right from the start in Hahnemann’s Chronic Diseases where he talks about the diseases as being of primary importance. He gives a perfectly cogent and complete description of the chronic diseases and of the principles of miasms and their treatment, one that does not mention the Paracelsan alchemy to which it is clearly related. It would be virtually impossible for someone as erudite and perceptive as Hahnemann, the man who discovered and described pattern thinking, not to notice the detailed correspondence between the pattern he observed and what he knew of Paracelsan alchemy in which he was deeply steeped.

The remedies that he chose as exemplars for the remedies to be used in two of the miasmatic diseases, Sulphur and Mercury, are two of the three Prima Materia in Paracelsan alchemy. There are many references to Nitric acid as the second most important of the anti-sycotic remedy. Some homœopaths believe that Hahnemann started with Nitric acid and later moved towards Thuja. He is certainly never as absolute about Thuja as he is about Sulphur and Mercury. It is impossible to believe that Hahnemann would not have seen a correspondence between Paracelsus's prima materia and two of the clearly indicated miasmatic remedies without looking at a correspondence for the third. The fact that he does not discuss this at all shows that he does not explain a significant part of his thinking and so his writing cannot be taken at face value.

Thus Hahnemann stresses the diseases as being important in his writings while in their application it is not the diseases in isolation that give a clear picture so much as the qualities to be found in them. For miasmatic theory is really about an understanding of the qualities that are found in symptoms and so must be present in the underlying disease. 

It seems likely to me that he believed that the system of homœopathy could be described without a need to reference the deeper and more esoteric principles that lay beneath the surface and by doing so he was sparing it unnecessary complication and criticism. He may have believed that the system was complete as it was and would need no further development. However, developments in science have meant that some explanations that were adequate in Hahnemann’s day appear a little ridiculous today. Also the system was further developed, particularly by Hering and Kent under the influence of Swedenborg (about which they were much more open). These factors put Hahnemann’s system under stress and without access to his “working out” it has become very difficult to come to any sort of consensus about what he meant, or rather how his ideas fit within diverse modern concepts.

Many parts of the homœopathic community, from Hahnemann’s time to our own, feel ashamed to be open about what we do and why we do it. The prevailing view has been and remains that if we talk the language of conventional medicine and science and keep quiet about the esoteric elements that are fundamental to the understanding and the practice of homœopathy we will be accepted and welcomed into the mainstream. In fact the reverse is true. Homœopathic philosophy and practice can not be expressed entirely in conventional terms and so any explanation that tries to do so appears incomplete and inaccurate, while the esoteric elements are necessary to understanding and practising homœopathy and can never be completely denied and so they are not only clearly present but we appear to be ashamed of them. For the sake of our own integrity we need to be clear and honest about who we are and what we do. We will never be acceptable to conventional science if much if what we do and think is not only openly acknowledged but also carefully described.

Many people in homœopathy today take Hahnemann at his word and, often self-righteously, ignore the ever present sub-text. For them a disease, and often any disease, leaves a miasmatic imprint which they tend to treat either with a nosode or a specific remedy ignoring the holism that is so central to homœopathic philosophy.

Hahnemann in reality, by analysing and understanding the qualities of acute expressions of disease and of the symptoms they produced was able to understand the qualities of the underlying chronic disease. This indicated the group of remedies with the corresponding general qualities but also highlighted the characteristic and peculiar qualities that need to be known in order to differentiate accurately between possible remedies.

When any action is misperforming it can only do so in three ways. This is clear in alchemical terms and was known to Hahnemann who read and translated many of the important texts. Ortega, author of The Notes on the Miasms, openly applied the pattern of these three possibilities to the miasms and the pattern is an excellent one, a simple one, one that covers all the features of the miasms and so one that allows considerable insight into the miasms and their remedies. The three possible primary qualities of any action or function that is not occurring in an optimum manner are that the action is happening too slowly, that it has become speeded up, or that it is happening in a way that is incorrect. These are the qualities of under-function, of over-function and of mis-function and these are the qualities that define the three primary miasms. These qualities can be quite simply described in the effect that they have. The quality of under-function leads to a continuous effort in order to achieve what is needed and so life becomes a struggle. The psoric miasm is an under-function that leads to a continual feeling of struggle. The sycotic miasm is an over-function that leads to over-production and an excess in secretions and growth. The syphilitic miasm is a mis-function in which processes do not achieve their purpose and so instead of being creative become destructive. These qualities are most clearly expressed in a physical manner but because there is a correspondence between the physical, emotional, mental and spiritual levels of existence they are also expressed on every level. 

A way of simply differentiating the miasms is to look at a particular system or expression. An example is the immune system. In a psoric case or remedy the immune system is underfunctioning and so struggles to deal with an infection. An infection is able to take hold and it takes longer than it should for the immune system to reach a level of activity where it can deal with the infection. Though eventually things work out as they should. In the sycotic case the immune system is always on the ready and over reacts to any stimulus causing unnecessary symptoms and the production of excessive secretions. This is why the remedies of vaccinosis, in which the immune system is forced into a state of unnatural readiness, are ones like Thuja and Silicea which are generally sycotic. In syphilitic cases and remedies the immune system has become mis-directed and instead of attacking foreign bodies it begins to attack the patient's own body in the form of auto immune disease.      

Many remedies are considered to be bi or tri-miasmatic, having qualities from more than one miasm. This is a possible and perfectly valid way of looking at a remedy but it is more accurate, and so more useful, to understand which is the fundamental quality (the miasm) and which are the unusual and characteristic qualities. On the whole the nature of the miasmatic qualities will be more clearly apparent in the physical symptoms while mental and emotional ones can be much harder to interpret. An example of this is can be seen in Lycopodium and Silicea. Lycopodium has many features of the sycotic miasm: a tendency to cover up and to excessive show. However, a look at the physical symptoms, such as the digestive ones, indicates a clear underfunction and lack of activity. The remedy is clearly a psoric one, albeit one whose compensation for its underlying timidity has a sycotic appearance. This in itself is characteristic of the remedy and helps to distinguish it from many other psoric remedies who compensate in other, very different ways. Silicea on the other hand has a timidity that is found in many psoric remedies. Yet the overall physical expression of Silicea is in over-production, the creation of cysts and excessive secretions. It is a sycotic remedy that can be easily differentiated from most other sycotic remedies by the unusual number of symptoms that are usually found in psoric remedies. The symptoms that are not natural to the overall miasmatic quality of the case or the remedy, especially if they are usually found in the other miasms, are the important characteristic ones that will differentiate the remedy from the other remedy characteristic of that miasm. 

Being able to understand a case by the nature of its most basic quality is a tremendously helpful tool, especially in an holistic and multifaceted discipline such as homœopathy. It is firstly a very easy check for any chosen remedy. It is perhaps simplistic to say that the remedy and the case should have the same primary quality and so be of the same miasm but in real practice a remedy that at first seems well indicated can have qualities that do not match the case. Understanding the nature and quality of the way in which function has become disturbed in the patient and some knowledge of the fundamental nature of the remedies will often make clear a basic error in the choice of a remedy. 

Symptoms that are peculiar and characteristic in general may be common within a particular grouping, such as a miasm, and once that grouping has been settled upon are of little practical importance. On the other hand symptoms that are generally fairly common may be unusual within a particular grouping and so peculiar and characteristic among the remedies of that group. A desire not to be observed and watched is common in psoric remedies and so is not characteristic when found in a psoric remedy. However, such a desire is much less common in the sycotic miasm where there is usually a need to be seen and to make a mark and so this symptom would be characteristic in a case that is generally sycotic.

Understanding the miasm and so the fundamental nature of the case will highlight those aspects of the case that are not merely a part of the miasmatic picture but which are characteristic and unusual. These are the really important symptoms that will differentiate the correct remedy from all the other ones that are part of the miasm but not indicated in this particular case.

Using the theory of miasms is also a good way of seeing how the case fits together into a coherent whole. The vast majority of important symptoms will be ones that are common to the miasm. Those that are not, need to be understood for how they relate to the case. It can be that they are not a vital part of the case, leftovers from another time or state or are a part of the susceptibility that is not being fully expressed at this time. In this situation the symptoms are much less important in the picture of the case and it is much less important that they form a part of the indicated remedy. Some of the symptoms will arise from the patient's reaction to the miasmatic state. These symptoms, particularly those which are part of a compensating state, which represent the way in which a patient compensates for the miasmatic influence, indicate the particular and individual way in which the patient's vital force chooses to deal with the stressful situation. This is the thing that we are looking for in the remedy and so to have them clearly highlighted for us is extremely useful.

Another way of looking at the miasm is to see it as a more general disease state needed by a society in the same way that a disease is needed by the individual. The aphorism central to alchemy: that that which is below is like unto that which is above and that which is above is like unto that which is below, illuminates many aspects of homœopathy. It describes the idea of correspondence, that things can have a direct relationship even when they are not connected in a clear physical way. There is a relationship between the macrocosm of society and the microcosm of man. Just as a person who is in a place of stress and difficulty uses a disease to try and find a new balance; so a society that is in a place of stress and discomfort may use a disease to help understand and deal with that stress. Just as the individual's disease is expressed in particular systems and organs so a society expresses its disease in particular individuals and groups of individuals. These societal diseases correspond very closely to the miasmatic diseases and by looking at them in this way we can get a much more rounded and clear understanding of what is most important in describing miasmatic qualities. This I have done in great detail elsewhere. 

The theory of miasms is a way of understanding the underlying qualities of cases and remedies and as such is one of the most valuable tools we have. The three classic miasms offer a primary division of qualities. It is possible to further divide these qualities by creating or discovering further miasms and this can also be useful tool. 

The theory of miasms is not of itself a purely philosophical theory though it does illuminate many philosophical issues and can be used in a philosophical manner. Many of the problems that come out of the theory arise from a doctrinal rather than a practical understanding of what it is and what it can do.

Peter Fraser is a homœopath practising in the UK. He is the Director of the Institute of Homœopathy. He has a special interest in provings and new remedies many of which can be seen at www.hominf.org. He is writing a supplement to Clarke's Dictionary the first entries of which are also posted on the website. He is the author of The AIDS Miasm and the series Using Maps and Systems in Homœopathy of which Mappa Mundi and Realms have been published and Miasms is out very soon.