The Development of Miasmatic Theory, from Hahnemann to the Present Day

by Richard Pitt

Part One: The Beginning

As is well known, one of Hahnemann’s last contributions to homeopathy was his theory of the origins of Chronic Disease, documented in his book The Chronic Diseases.  A summation of many years of work, it was his attempt to understand the roots of disease and to find homeopathic solutions to this situation.  After many years of revelation after formulating the Law of Similars and the development of provings as a key part of the methodology of homeopathic science, Hahnemann still struggled with many cases that seemingly would not respond to “well-indicated” remedies.  This led him to seek a deeper understanding of why more lasting cures were not being obtained.  The conclusions he drew from this study led him to consider that there were three chronic disease states that were the cause of the underlying disease manifestations.  These are Psora, Sycosis and Syphilis.  Hahnemann’s attention however was much more focused on Psora, which he attributed 7/8ths of all diseases to.  This focus tended to obscure the relevance of the venereal disease miasms, further compounded by the fact that Hahnemann never used the nosodes Medorrhinum or Syphilinum, a key factor in really understanding the full spectrum of the miasms.  For the latter two miasms, his concerns were much more focused on the immediate disease implications of these diseases, more than the inherited vulnerabilities that resulted.

Since Hahnemann’s time, miasmatic thinking has developed considerably, with much more information given to the two main venereal miasms mentioned and to the inclusion of two more miasms, Tuberculinic and Carcinogenic, and more recently a few more miasmatic categorizations, mostly with a specific nosode identified for each.  During this evolution in thinking, from the original ideas of Hahnemann that the roots of disease can be connected to a specific infectious moment in the patient’s life,  his original theory has been developed to include a much broader analysis of miasmatic thinking, especially including the hereditary influence of the original infectious disease state and to understanding miasmatic states as a “gestalt” or pattern of disease symptoms, mental states, characteristics and predispositions, and also to susceptibilities to certain conditions. In other words what has been developed is a whole pattern of expressed mental and physical phenomena and also a recognition of potential states or susceptibilities to such states based on inherited dispositions

This movement away from the specific infectious origin of the miasm to seeing them as fundamental classifications of both disease possibilities and broader social/cultural dynamics has been the most important development in our understanding of miasms.  Also, the clinical knowledge of the relevance of nosodes of various miasms has  maintained the importance of understanding miasms in prescribing, in spite of ongoing debate as to the relevance of miasmatic theory.  The fact that the major nosodes in homeopathy – Psorinum, Medorrhinum, Syphilinum, Tuberculinum and Carcinosin are used so much in our prescribing, especially in children, only gives more weight to the need to understand what Hahnemann had begun to explore and that needs to be taken further.  

However, it is important to look at what Hahnemann was grappling with when faced with the issues he was looking at.  A very good book that explores this issue is “The Theory of Chronic Disease According to Hahnemann” by George Dimitriadis.  In this book Dimitriadis attempts to reveal what Hahnemann said in his writings about miasms and chronic disease and distinguish it from the many theories that have developed since his time.  I will refer to this book for the first part of this discussion as it represents a particular position in homeopathic thinking in attempting to clarify exactly what Hahnemann was saying at the time and not exploring the broader interpretation of miasmatic theory, which will be left to later on.  The book begins by mentioning a few points crucial to the evolution of Hahnemann’s thinking: 1. that apparently disparate disease states were expressions of single disorder, sharing a common cause, which at that time were mainly infectious “miasmatic” maladies such as hydrophobia, venereal disease, yellow fever, measles etc.  2.  That the internalization of itch vesicles in wool manufacturers through local treatment led to deeper, more intense disease states.   This was the beginning of his understanding into recognizing patterns of symptoms as a connected whole with the same underlying cause and the fact of suppression of disease states, which lies at the foundation of miasmatic theory, especially regarding Psora.

Again, it has to be emphasized that the core of his theory of Chronic Disease relates predominantly to Psora.  Although he treated venereal diseases as an acute infectious disease and saw chronic sequelae to these diseases, his attention was in seeking to understand the roots of all non-venereal chronic disease.  Hahnemann observed how chronic disease conditions would be alleviated with good homeopathic care, and yet symptoms would return if circumstances were unfavorable e.g. fright, grief, violent exertion, exposure to cold weather etc.  and repeated doses of the same medicine would have a gradually diminishing effect.  (Organon, aphorism 78, footnote).  

Hahnemann himself questioned whether this was merely due to the lack of an appropriate remedy, one more suited to the disease totality, whether such a remedy even existed, or whether an underlying cause of the disease complexity had yet to be revealed.  Many homeopaths who followed Hahnemann simply took Hahnemann’s first point, even though he himself stated that it was not the case of simply not enough remedies.  However, many homeopaths who practice in a comprehensive way do so without much heed to a miasmatic perspective.  The consideration has to be made whether Hahnemann’s case taking at the time was not detailed enough to reveal the true “chronic” state of the person and therefore the most accurate remedy.  In some ways, we practice differently today than in Hahnemann’s time and our understanding of materia medica has also developed, allowing us to distinguish between similar remedy images by recognizing that certain remedies may work more deeply than others.  Dimitrialis does not discuss this, but simply explores where Hahnemann was going in his evolution of thinking.  However, this is exactly what he quotes Hahnemann saying: “’He, therefore, must find out as far as possible the whole extent of all the accidents and symptoms belonging to the unknown primitive malady’ before he can hope to discover one or more medicines which may homeopathically cover the whole of the original disease by means of its peculiar symptoms.” (P 13. Dimitrialis)   What is implied here is that ALL relevant information in a case needs to be considered, not merely the presenting symptom picture.  However, what has to be recognized is the fact that Hahnemann was understanding that all the phenomena in the patients’ experience are connected, an idea radical enough at the time, but even today is simply not recognized by allopathic medicine.  Any disease state is an imbalance in the whole person, and has an effect on the whole person.  

One of the most significant points Dimitrialis makes in his book is then discussed in the next chapter “Itch” (p. 15) when he quotes Hahnemann in Chronic Diseases referring to a history of an “itch” of some kind in chronic non-venereal disease, and that this itch was due to a former infection.  Dimitrialis emphasizes that the infectious nature of chronic disease, including “itch” is central to Hahnemann’s understanding of miasms and that of psora, but that Hahnemann defined the word infection in a broad sense, meaning an affection from an external stimulus and that it is the vital force that is primarily affected by this external stimulus.  The revelation that Hahnemann had though was that he could begin to identify numerous disease states and symptoms as being simply part of psora, connected to a primary itch eruption.  However, most of the disease states he was seeing were classified as secondary symptoms, not primary, a distinction that he made over many pages in Chronic Diseases.  The fact that Hahnemann attributed so many chronic disease conditions to that of psora led to criticism of his miasmatic theory and was one reason why many homeopaths did not take up his thinking in a serious way.  The other major point revealed here by Dimitrialis pertains to the concept of original causation, and he quotes Hahnemann as follows - “ailments which if they do not belong to the two venereal diseases are but part of the ancient miasma of leprosy and itch; i.e., merely descendants of one and the same original malady (italics mine), the almost innumerable symptoms of which form but one whole and are to be regarded as the parts of one and the same disease in the same way as the great epidemic of typhus fever.”  Here, Hahnemann is seeking to understand the true root of most, if not all non-venereal chronic disease.

Dimitrialis again emphasizes an important point in Hahenmann’s own definition of a miasm, that it is indeed an infectious agent and he used that term to mean any infectious substance dangerous to health. (Dimitrialis p. 18), including acute diseases such as cholera.  He then quotes Hahnemann from his Lesser Writings in which Hahnemann explains clearly how gradually, immunity to certain acute diseases can be developed by exposure to the infectious miasm which over time allows people in a community not to become too seriously sick.  His observations in such matters again show the clarity of his mind and power of observation in looking at the dynamics of disease expression.  The most important observation though, one often quoted, is that Hahnemann when referring to infectious agents was talking about parasites, bacteria or viruses, observations which preceded a bacterial knowledge of many diseases by as much as 50 years.  One of the main points being emphasized by Dimitrialis is that the miasm is not the disease but merely the infectious agent, and he quotes B.K. Sarkar in his Essays on Homeopathy, that Kent’s writings on the matter confused the two states.  The miasm is not the disease.  The internal psoric disease is different than the psoric miasm, which is the infectious agent.  

Dimitrialis states that any tendency to use the word miasm to describe a dyscrasia, diathesis, taint or tendency to disease is wrong.  It is only to mean the infectious agent causing a disease, mainly an internal psoric condition.  While it is important to understand this fact in terms of defining what Hahnemann meant, the distinction may seem to be an academic one as Dimitrialis then continues to describe how infection with a miasm leading to internal psora can create a greater tendency to get many other diseases.  This fact is representative of how miasmatic theory has developed since Hahnemann’s time when a miasmatic influence, often originating in the actual miasmatic disease perhaps generations ago leads to the predisposition to many diseases, some chronic, some acute, some sporadic.  This concept of susceptibility, not explored by Hahnemann in this way, as apparent in the way Dimitrialis describes Hahnemann’s own evolution in thinking, is exactly how many homeopaths practically use an understanding of miasms to seek a deeper totality and roots of disease.  Therefore, many people would feel the distinction is mainly one of the definitions of the word miasm.  All the consequent effects of an infection and disease states and subsequent susceptibility to other disease states conform to most homeopaths ideas of a “miasmatic influence.”  However, it does make a clear distinction between how Hahnemann originally used the word miasm and how it has been used by homeopaths since then, some of whose ideas will be discussed later.  It also reveals how far from Hahemann’s original thinking many more modern interpretations have gone.  This is not a bad thing as much information and experience has been achieved and one of the most important shifts has been that, instead of seeing miasms as merely negative disease states, infections or influence, we can now appreciate that miasmatic influence expresses itself in broader, thematic ways, including even in positive, more evolutionary expressions.  This is far from where Hahnemann was in his own exploration, naturally focusing on the fundamental causes of suffering.  

However, from Hahnemann’s understanding of the infectious nature of psora,  where the term psora was taken from the Hebrew word, Psorat, or fault, and from his description of Psora as that “most ancient, most universal, most destructive and yet most misapprehended chronic miasmatic disease which for many years has disfigured and tortured mankind,” one gets the idea of a fundamental affliction of mankind.  No wonder that some homeopaths, Kent included, attribute this affliction to some variation of original sin, a moral affliction of sorts, even if Hahnemann never meant to say this.  Richard Grossinger, in his book, Homeopathy, The Great Riddle, equates Hahnemann’s writings at this time with Freud’s Civilization and its Discontents, a negative portrayal of the human condition, motivated by frustration and failure as much as anything else.  While that may seem somewhat overly critical, given the proven significance of miasmatic theory, he does make a point when discussing what would have happened if Beethoven had been given his appropriate anti-syphilitic remedy.  Would all of his music been completed or would Van Gogh painted in the way he did.  

However, an even more challenging concept in Hahnemann’s own thinking is explored by Dimitrialis on p. 24 of his book.  Here he states that Hahnemann traces psora back through biblical time, suggesting that its original expression as leprosy was modified over hundreds of years due to hygiene, diet and general modes of living, so the expressions of psoric disease were seen only as a mild itch.  However, Hahnemann concludes that the internal psora has not changed in any fundamental way, and that now the more mild itch is able to be more easily suppressed, “allowing easier development of a legion of secondary symptoms both cutaneous and otherwise.” (Dimitrialis p. 25)  In this way, the latent conditions are activated by the suppression of the primary cutaneous expression.  By implication, he is saying that an unadulterated expression of psora, especially in the form of leprosy is better for the overall health of a person and society as it cannot so easily be suppressed, leading to more serious expressions of diseases seen as secondary symptoms of psora, which include, according to Hahnenmann, 7/8ths of all diseases known to man.  

This conclusion, it needs to be said, is highly speculative on Hahnemann’s part.  As Dimitrialis points out, Hahnemann could not know whether 7/8ths of all disease stem from psora and Hahnemann himself changed his position on whether psora was the cause of ALL or MOST non-venereal disease.  Furthermore, the conclusion that modification of leprosy through diet, hygiene and mode of life throughout hundreds of years only allowed psora to be more easily suppressed, leading to more serious secondary disease has to be questioned.  Perhaps, over the many hundreds of years the original more “acute” expressions of psora on the skin evolved into being a mere itch and that it did indicate that the internal psora was also being tamed.  Therefore, suppression of the primary itch expressions would not lead to the level of suppression that Hahnemann thought.  One other point to consider here is the influence of the other two miasms, syphilis and sycosis.  Hahnemann addresses them in light of their infectious miasmatic origin, with their clear acute and chronic symptom picture.  He doesn’t make the connection between them and psora and that perhaps the spread of these diseases and the inherited susceptibilities subsequent to this may have overshadowed the impact of psora and diseases that originate with it.  In other words, perhaps the other two miasms deserved more attention in Hahnemann’s time and all the disease he attributes to psora could equally be laid at the feet of syphilis and sycosis, not to mention tuberculosis.  

Some homeopaths speculate that syphilis and sycosis could not exist without psora, as psora is the root of all disease, similar to the original sin idea.  However, all three diseases are very different in origin and have their own bacterial imprint, disease manifestation and secondary sequelae.  Psora is more elusive, given that the nature of psoric infection is not as specific as that of sycosis and syphilis and also that there is not just one contagious microbe or parasite.  Scabies, the disease, from which the remedy Psorinum is made, is NOT the origin of psora.  There was much confusion in Hahnemann’s time as to the original cause of scabies, some medical theorists thinking that scabies was one of the most virulent of constitutional epidemics.  Martin Gumpert, in his book on Homeopathy called “Hahnemann, The Adventurous Career of a Medical Rebel “ states that Hahneman was incorrect in making a similar assumption as scabies was merely the effect of an unhygienic lifestyle and the cause was just a parasite.  It was not a reflection of a deeper internal state of disease, and even if Hahnemann knew that it was an infectious disease due to a small living creature, he seemingly drew similar conclusions to many other physicians of his time and stated that “No skin eruption, whatever its nature, should be removed by external remedies…In every case, an improper condition of the whole body, of the entire living organism, is at the root of the trouble, and should be removed by internal remedies….Thereupon the eruption will disappear… and often more speedily than by external remedies.” (Gumpert., p. 198).  However,  destruction of the mite did not necessarily mean the activation of secondary psora.  It is a product of a psoric state, of an unclean situation and it prospers in such situations.  That is why, similar to many psoric conditions, changing the environment and external surroundings appeases much of psora’s primary expressions WITHOUT secondary symptoms being expressed.   One could postulate though that once one disease manifestation has been appeased, another one will arise to take it’s place, which here would lead us to consider the impact of inherited sycosis and syphilis but that is something Hahnemann never contemplated and can be disputed as just speculation. 

Although Hahnemann did not state that scabies was the only cause of the psoric miasm and that many other skin eruptions with different bacterial, parasitical or viral origin could also be involved, the fact is that he chose scabies to make the first nosode from and which has become the “archetypal” nosode of the psoric miasm.  Furthermore, the current theories of the time as to the state of scabies being so formidable a disease can only have influenced Hahnemann in his attempt to find some universal principle in seeking the underlying roots of illness.

Hahnemann also equated leprosy with being a primary form of psora and observed how when the eruptions were virulent on the skin, the internal suffering was much less.  While this is an example of the “psoric” philosophy of the movement from the external to the internal, it is questionable whether leprosy can be classified as psoric.  It has its own bacteriologic origin, it’s own nosode and its own symptom expression.  It also has it’s own broader “gestalt” of mental and physical dynamics and therefore perhaps deserves it’s own miasmatic classification, as some homeopaths have done.  However, within the broadest classification of psora, one could argue that it represents a purely unadulterated psora, free from any constraints of suppression.

Two other important points regarding miasmatic contagion and psora are discussed by Dimitrialis (p. 27) when he discusses Hahnemann’s amazing description of the infectious mechanism of a miasm, how in the instant of infection, the whole person is infected and nothing can be done to reverse it.  This observation has been confirmed by modern science in understanding the incubation periods of disease after initial infection.  The second point, which has always been controversial, is Hahnemann’s contention that the disposition to being infected with psora, “the itch” is almost universal,  “No other chronic miasma infects more generally, more surely, more easily and more absolutely that the miasma of itch…it is the most contagious of all”.   The controversy is amplified as Hahnemann stated that he was one of the few people who were not infected with the psoric miasm, his acute exacerbations being true acute diseases as apposed to acute expressions of a chronic miasmatic disease.  

The description of the infectious mechanism of a miasmatic disease also reveals the dispute between the idea of a miasm as an infection and that it is also a “dynamic” influence, a “vital disturbance” of the whole organism.  It is of course, both, which Hahnemann made clear, but here the fact of their being an actual contagious principle does not take away from the common understanding that all diseases are primarily disturbances of the vital force.

Given that Hahnemann made such claims as to the universality of psora and that it could be so easily caught, and so easily suppressed as historical time passed, and also because of the fact that the primary “itch” expression seemed rather vague and often merely presumed to have been there in some cases, it is little wonder that Hahnemann’s theory of chronic disease was so questioned by his fellow homeopaths at the time and since that time has still been one of the most debated aspects of homeopathic thinking.  Furthermore, as mentioned regarding the disease scabies, one has to ask what exactly is the origin of the infectious matter that Hahnemann refers to when discussing the infectious nature of psora.  

Dimitrialis discusses this in his next chapter, “The Itch Miasm”, in which he states Hahnemann describes it as the following: Herpes (Herpes virus infection; simplex/zoster viruses), Tinea Capitis (Fungal infections), Milk Crust (cradle cap) and Tetter (general term to describe herpes, eczema, psoriasis and herpes).  As is stated in the chapter, Hahnemann was not talking specifically about the disease scabies, although he was very aware of its existence and even postulated the cause being due to small living insects or mites (Dimitrialis p. 32).  This point has been much confused in homeopathic literature and Dimitrialis points out that Hahnemann did not equate psora with the disease scabies, quoting authors such as Richard Haehl (Samuel Hahnemann, His Life and Work, vol 2, p. 160) and Otto Lesser (Textbook of Homeopathic Materia Medica., p. 32).  

One can therefore understand how some confusion has ensued from this, especially in regard to the fact that Psorinum, the remedy made from a scabies nosode is the traditional nosode for psora.  Also, as Dimitrialis points out, milk crust is now known not to be an infectious disease and therefore cannot be a cause for the spread of the psoric miasm.  Dimitrialis states that Hahnemann describes the “itch” eruptions of psora as being 1. an itching vesicular eruption which compels the patient to rub violently enough to open up the vesicles and infect the surroundings, and 2.  the peculiar bitter-sweet itching which began with a voluptuous itch compelling the patient to rub and resulting in a long continued burning sensation.  (Hahnemann, Chronic Diseases, Vol 1, pp. 38-39).  From this description, generalized skin eruptions such as eczema, psoriasis, milk crust etc cannot be included, leaving such skin eruptions such as tinnea, herpes etc.  From this analysis, Dimitrialis concludes that Hahnemann’s attribution of the “universal” ubiquitous nature attributed to the psora miasm is not accurate.  This is important as it forces us to question some of the underlying presumptions about psora and the subsequent generalizations made about it’s universal nature, being “the soil of all disease”.  

Perhaps the main thing to be taken from Hahnemann’s attempt to understand the roots of disease and his explanations in Chronic Diseases is that the key to understanding the evolution of secondary psora (the complex disease pictures listed in Chronic Diseases) is that it is the internalization of the disease process, from the skin to the interior of the body, from the outside to the inside, reversing the order of where the body is trying to go when expressing itself on the skin.  When an eruption is expressing, it is the whole body affected, but the disease is able to express on the skin.  If that avenue is prohibited, disease will express elsewhere.  This we know is true and that is really the legacy of understanding that Hahnemann gives us when describing psora and miasms.  However, Hahnemann also stated that even the spontaneous disappearance of skin eruptions can lead to the development of secondary psora.  Similar to what he said earlier when stating that improved hygiene that alleviates skin disease that then leads to more easy suppression, he is making a conclusion that implies that an unfettered expression on the skin is better for the long term health of a person than a mild eruption which is then suppressed or even disappears spontaneously.  This has to be somewhat of a questionable presumption.

Furthermore, this conclusion has led some more modern homeopaths to conclude that we are now sicker in our society than we were in Hahnemann’s time. (George Vithoulkas, A New Model of Health and Disease, p. 1., introduction).  The internalization process has led to the development of chronic, degenerative disease previously unseen, auto immune diseases, psychological diseases and many other physical, mental and social ills that can be understood to be caused by the suppression of primary disease expressions.  This is a contentious and complex discussion.  The reasons for many modern diseases are not straight forward and while it is clear that powerful conventional medications can suppress disease and that it part of the story of why we have more chronic degenerative disease today, it doesn’t answer the whole picture.  The evolutionary impulse of human society, leading to huge changes in our personal and collective lives over the last two hundred years, has led to many changes, including in our health, some for the better, some for worse.  It can be said that certain diseases express something about the culture and about the time in which they arise.  To imply that we are simply in a downward spiral of physical, mental and moral dis-ease is too simplistic.  The challenges are merely different and as evolution moves inexorably and technology changes and our exposure to environmental toxins changes, then diseases will manifest as an expression of that time.   However, the concept of suppression still stands and will be discussed further later on when looking at the other miasms and how we interpret them in the modern age.  

The fact is that all of us have some susceptibility to disease.  This goes without saying.  However, when external factors are favorable, and our emotional state is in balance, there may not be any outward signs of disease.  However, as circumstances change, underlying states are revealed and our chronic susceptibilities exposed.  These signs and symptoms are specific to each of us and Hahnemann describes this as signs of latent psora.  Latent doesn’t mean the total absence of symptoms, but symptoms based on the affect of circumstances.   We see many people who have a great susceptibility to certain conditions, e.g., frequent colds, headaches, skin conditions etc,. all of which get better or worse depending on circumstance.  It should be considered that in Hahnemann’s time, there were probably a lot more skin eruptions than today, but mainly because circumstances and hygiene were so much worse than today.  How much they were indications of active psoric disease needs to be questioned.  However, these so-called “latent” symptoms do indicate the unique susceptibility to disease that each of us has and what has commonly been described as the constitutional diathesis.  But, Dimitrialis clarifies that this susceptibility or diathesis is not due the psoric miasm.  The miasm is merely the contagious factor that can initiate disease.  Susceptibility and reaction to the psoric miasmatic contagion will depend on “the bodily constitution of a man, his hereditary disposition, the various errors in his education and habits, his manner of living and diet, his employments, his turn of mind, his morality etc”(Hahnemann, Chronic Diseases, vol 1, p. 51)  Therefore, Hahnemann did not mean to state that psora is the root of all disease as suggested by other homeopaths, including of course, Kent.  

What is perhaps most important though in Hahnemann’s theory of miasms is the fact that unless a homeopathic remedy is given that matches the depth of the miasmatic disease, a lasting cure cannot be found.  This we find today as Hahnemann did in his time, in spite of our thorough case taking and analysis.  The remedy needs to match both the breadth and depth of a case and whether one calls it a miasm or not is secondary.  One simply has to understand the whole individual and the complexity of symptoms within this and find the remedy that addresses this the best.  We take this for granted now but it was Hahnemann in his writings that made it clear what we were dealing with and the unfortunate controversies surrounding his miasmatic theory often distracted from this basic fact.

One of the most important aspects of miasmatic theory has been the inherited influence of miasms, that a family history of certain diseases predisposes a person to certain other conditions, including even the specific disease that represents the miasm, e.g., tuberculosis.  Interestingly enough though, Hahnemann did not mention that the actual miasmatic disease itself can be passed on through inheritance.  Dimitrialis explains this clearly and quotes from authors who said it was something that could be passed on from one generation to another.  What is being stated is that the actual miasm (the infectious condition) cannot be passed on, using the definition of the miasm as an infecting agent, and not a predisposition to disease.  We know that the influence of the miasm is passed on through DNA or forms of inherited influence, but not the actual contagion itself.  Dimitrialis states that nowhere in Hahnemann’s writings (apart from a mistranslated quote from Boericke’s 6th edition of the Organon) does he use the word “inherited”.  The main distinction (perhaps rather academic to some) is that where the psoric disease (or syphilis or gonorrhea) cannot be passed on to the next generation, some of its effects can be passed on, even in the most general way, affected behavior and habits.  This last fact is important though as this is how many homeopaths have looked at miasmatic thinking, how a certain “dynamic” influence, a unique gestalt or pattern unique to each miasm does pass from one generation to another and that the actual miasmatic disease (Psora, Sycosis, Syphilis etc) is merely the “mitochondria in the cell of the miasm,” or just one factor, a central key but by no means the complete picture of the spreading influence of the miasmatic disease on all aspects of physical and emotional disease as well as the broader social/cultural dynamic in which miasmatic expression can take place.  One other important aspect of the question of inherited influence is that as the actual miasmatic disease cannot be passed on with it’s own destructive tendencies, what is inherited is more a predisposition or vulnerability to other disease states and not the active disease itself.  

Much of modern writing on miasms, including some of the articles in this journal, explore more this gestalt of influence of various miasms.  However, understanding what Hahnemann was trying to say in the first place is important as a foundation to understand miasmatic theory.  The clinical relevance of this understanding is where various homeopaths have different opinions.  Dimitrialis concludes that what Hahnemann really gave us in these explorations into the nature of disease was the need to explore the characteristic totality of symptoms throughout a person’s life, as, according to his conclusions, most of these symptoms belonged to a single disease state, which he called psora for the vast majority of conditions.  Whether one calls it psora or not he felt was not crucial and furthermore, it implies (according to Hahnemann’s own conclusions) that the complex myriad diseases all belong to one source, which cannot really be proven.  

One further and important point that Dimitrialis brings up is how to identify certain remedies with each of the miasms.  While that is possible with syphilis and sycosis where there is a single contagious miasmatic cause and a specific set of primary and secondary symptoms, it is much harder with psora as there is not one miasmatic contagious cause and where the sheer variety of symptoms of secondary psora make it very difficult if not impossible to be sure, at least according to how Hahnemann defined it. Also, Hahnemann did not make it emphatic that a history of skin eruption had to have been present in order to define it’s psoric identity, as it was often impossible to verify one way or the other.  This only further compounded the difficulty in creating a definable symptom identity for psora. Hahnemann attempted to find remedies that he felt covered the most significant disease states of secondary psora, which he termed anti-psoric but as has been discussed by many homeopaths, this list is by no means complete, and therefore has been one of the impetuses by subsequent homeopaths to refine our interpretation and understanding of miasmatic theory and the relationship of certain remedies to different miasmatic states.  The second part of this article will seek to explore how other homeopaths have grappled with this issue since Hahnemann.

Part Two: The Development

As has been discussed, Hahnemann made a vital and significant contribution to our understanding of the contagious nature of diseases, to the unifying principles of seeking common threads of symptoms in complex disease states, to the idea of suppression and to that of inherited influences of certain diseases.  Although, as mentioned, Hahnemann didn’t mention the word inherited when it came to understanding the influence of his miasmatic diseases, by default, his own conclusions led future generations of homeopaths to consider this one of the most important parts of miasmatic theory.  It also led them to create remedies from other disease states and through the clinical use of nosodes has allowed us to understand much more about the picture of the broader miasmatic influence.  As mentioned earlier, Hahnemann did not use Medorrhinum, Syphilinum, Tuberculinum or Carcinosin and therefore only had a very limited knowledge of the unique image of the influence of these miasmatic diseases.  

As the thinking of miasms developed, some new ideas developed based on the ideas of miasms not only as specific diseases based on infectious agents, but also as archetypal potential, that impacted both physical and mental symptoms and also behavioral dynamics and more categorical themes of human conditioning.  The development of seeing miasmatic influence pass on through generations allowed homeopaths to develop and broaden their knowledge of the pictures of various miasms and their study and use of nosodes of different miasms further developed their uniqueness in homeopathic prescribing.  While some homeopaths would question the need to create new miasms or the type of generalized classifications of miasmatic influence, they are worth exploring to understand the potential significance for prescribing.  

One of the modern interpretations of miasmatic theory has been that of Proceso Sanchez Ortega, in his book “Notes on Miasms”.  The main thread of what Ortega meditated on and wrote about is the predispositions to disease that a miasmatic influence gave and the patterns of expression that each of the three “big” miasms created, revealing, according to Ortega, universal expressions of form and function.  He felt that Hahnemann had (inadvertently) revealed a new schema of biological function that could be used to understand health and disease and which could be compared with other “systemic” orders and methodologies.  Dimitrialis questions this jump in theoretical speculation and makes it clear that this is not what Hahnemann was implying at all.  He furthermore critiques certain assumptions made about each of the miasms, that Psora = functional disease, that Sycosis = overgrowth (proliferative) disease (tumors, warts etc) and that Syphilis = Destructive disease (necrosis, ulcerations) etc.  He states that in Hahnemann’s descriptions of secondary psora, there are many examples of proliferative and destructive diseases.  However, one of the retorts to this is that it is very difficult to define what is truly secondary psora and much easier to do it with sycosis and syphilis which have a clearer symptom picture and specific infectious factor to them.  Also, it is often understood that the earlier in life that proliferative and destructive conditions arise, the more likely it is to be due to a sycotic or syphilitic miasm, or a combination of more than one miasm.  

The question still remains whether the listed categorizations above have some validity or not and whether it is of practical use to make such distinctions, as also whether it is useful to speculate about the true underlying causes of disease.  As homeopaths tend to be philosophical types and because, thanks to Hahnemann, we have embraced a complex system, requiring precise individuation of every case, often of a dizzying array of symptoms, sensations and stories, any system that allows us to categorize and link certain phenomenon together may be of use.  Here Ortega pays homage to other theorists who have sought to understand the function of the human organism in similar ways, by ordaining certain diatheses and other intrinsic qualities to the function and form of human health and disease.  The fact that Ortega veers much further a field than Hahnemann was inclined to go does not invalidate it even if he presumes Hahnemann meant more than he actually did in his own work.  Even if Ortega was not accurate in his analysis of what Hahnemann meant by miasm, what he and many other homeopathic and non-homeopathic writers did was to attempt to understand the complex influences, including hereditary/genetic ones that predisposed people to illness and that could be seen in physical and mental disease, body typology, normal characteristics of personality and social and cultural dynamics that reflect the “dynamic” influence of the chronic miasms.  

It is interesting that Ortega quotes some of same basic passages from Hahnemann that Dimitrialis does to example that Hahnemann was talking about diathesis in disease potential (Ortega, p. 28-30).  Hahnemann was speaking how even when some minor event occurred, there would arise a violent internal reaction to it that would reveal a “psoric diathesis, the fundamental and most common cause of chronic disease”.  Therefore, for practical purposes the distinction between the miasmatic infection and subsequent chronic miasmatic disease does establish a diathesis or disposition to subsequent illness.  The main distinction is that the person who has experienced a primary infection with a miasm is at the mercy of an active disease state whose mechanism is one of continuing internalization and overall health deterioration.  This factor, Dimitrialis explores and makes the distinction between this dynamic and the more “static” susceptibility of those who’ve inherited certain predispositions to illness based on these primary infectious diseases.  However as Dimitrialis mentions, Hahnemann was influenced in his development of these ideas by observing the effects of Syphilis on people, from which he modeled his theory of psora (Dimitrialis p. 29).  He observed the inexorable decline in syphilitic cases and from this made similar conclusions about the nature of all chronic disease, the most prevalent of which he connected to the “itch”, to psora.  

Ortega focuses predominantly on the miasmatic disease state, not the immediate consequences of miasmatic infection.  His interest is in the terrain, the diathesis and susceptibility that has been influenced by the miasm.   Ortega examples this approach by a case example in which he felt a patient needed Calcarea carbonica as a “constitutional” remedy, as apposed to Mercury, which seemed to superficially fit the symptoms.  Here is one example of what many of us take for granted in practicing homeopathy today.  We always look for a “constitutional” based remedy, that is, a remedy indicated for the whole person as much as possible.  That is why it is baffling when studying some of the old books of the 19th century, including much of the therapeutics, where any individual characteristics of the person are not included, much of the information justifying a remedy being based on certain physical characteristics only.  

Ortega and his quoting of other famous South American homeopaths, including Thomas P. Paschero, making the categorizations of Hahnemann’s miasms of Psora, Sycosis and Syphilis into broader diatheses and dyscrasias, is based on a level of experience that Hahnemann couldn’t have.  They had a much deeper understanding of the significance of the sycotic and syphilitic miasm, which as mentioned earlier, Hahnemann didn’t have, not using the nosodes Medorrhinum and Syphilinum, and were able to identify in the 3 miasms, unique dynamics consistent with each, which reflected a broader universality of structure and function.  Furthermore, one of the main ideas of miasmatic influence is that it weaves its way into the constitutional pattern, giving an extra broad dimension or expression to the constitution.  One of the key aspects of homeopathic prescribing is being able to identify constitutional patterns and any general miasmatic influence.  Some cases will present a clear miasmatic pattern while others will not.  The miasmatic influence will not lead to an individual remedy, unless a nosode is clearly indicated but it will help orientate the direction of search for an appropriate remedy.  It is but one tool that we use, more important in some cases than others.  

The contribution that Ortega defined in his descriptions of miasmatic themes, based on work by Paschero and others, was that the three “big” miasms reflected certain fundamental alterations of normal cellular function, which were classified as Deficiency (Psora), Excess (Sycosis) and Perversion (Syphilis).  He is stating that the original miasmatic diseases that Hahnemann explored can be seen as representative of 3 fundamental expressions of imbalance which are intrinsic possibilities of dis-ease expression.  These are inbuilt possibilities or diatheses of a constitution, the degree and intensity of each depending on the inherited influence that all of us are influenced by.  He is not describing, as Dimitrialis points out, the expressions of the miasmatic infectious disease, manifesting in Syphilis, Gonorrhea or Psora, that Hahnemann spoke of.  However, within those diseases lies the kernel to the broader miasmatic expression.  But as the influence of these diseases pass through generations, their influence and expression is diluted, modified and broadened and become wedded to normal and abnormal constitutional function.  Another contribution of Ortega is identifying 3 primary colors to each miasm, blue for psora, yellow for sycosis and red for syphilis.  To accept this analysis, one has to accept the idea of a miasm as a theme, gestalt or pattern.  If one moves in this direction, then other more archetypal qualities can similarly be categorized.  

One other way to consider miasms and constitutional remedy is to say that a remedy reflects a strategic relationship to life, it reveals both the good and not so good ways in which the body/mind struggles to evolve.  The miasmatic influence affects the intensity of this expression – the basic struggle of psora, the intensity and exaggeration of sycosis and the desperateness and violence of syphilis.  The same can be identified with tuberculosis and cancer and perhaps other miasmatic classifications.  One can also see a miasm as a solar system.  The sun is the nosode of the miasm and the planets surrounding the sun are various remedies, each of which reflect a specific strategy or expression of that miasm.  That way, one can understand the miasm as a large potentiality and each remedy reflects merely one part of that totality, circling around the sun and influenced by the nosode, the original place from where the miasm began.  In this way, one can gain a deeper understanding of the miasm by studying the nosode and at least one other remedy of that miasm.  In Psora we have Psorinum and Calcarea carbonica (Ortega’s choice of remedy), in Sycosis we have Medorrhinum and Thuja (the classic anti-sycotic but perhaps its significance is exaggerated – typical sycotic) and Syphilis we have Syphilinum and Mercury (the obvious one and of course the closest to our sun!).   By studying the miasms in this way, we gain an understanding of the essential ideas of the nosode and its bacterial origin, as seen by Hahnemann, and the miasmatic thematic influence as perceived through certain remedies.  One can also study the actual effect of the original infection, especially the diseases Gonorrhea and Syphilis and from there gain an understanding of the “dynamic” influence of these diseases on various constitutions.  This, as has been explained earlier, is much harder to do for Psora because of the lack of specificity of infection for this miasm, one of the weaknesses in Hahnemann’s own theory of Psora.  According to his own analysis, Psorinum the nosode of the disease Scabies, is only one of the possible infectious agents of psora, leprosy being another and herpes and tinea being possibly others.  Each of those infections has it’s own characteristic DNA and morbific influence.  Therefore Psorinum can be said to be one of the examples of psora, but interestingly the picture of this remedy does give a very clear image of some of the essential characteristics of the miasm.  

To summarize the themes of psora and that of the remedy Psorinum, we have the words deficiency or under function.  In the remedy we have a fear of poverty, of being homeless, despair, hopeless, anxiety, great forsaken feeling, coldness and hunger.  The whole feeling is one of a state of passive despair and a feeling that there will never be enough to go around, the actual social reality for most of the planet still, and an experience not that far removed from a majority of people in the advanced countries of the world.  In other words, it represents a state within the archetypal consciousness of all humans, the fear of starvation and not having a home.  It is an existential anxiety often, and in cases these symptoms are obviously more important when it is not the reality of a person, more a delusion, but which feels real all the same.  To extend this theme, it can therefore be said that those people whose focus is predominantly on the struggle to be, to define themselves in the context of their immediate situation – home, work, family, structure, and who find these issues particularly challenging, are under the dynamic influence of the psoric miasm.  This is very clearly portrayed in the remedy Calcarea carbonica, the inside of the oyster shell, where the person needing this remedy experiences the delusion that there is no shell, leaving them feeling exposed, anxious, fearful of the great unknown of the ocean, the dark depths with horrible images, making them feel cold, shivery, fearful, apprehensive and exhausted with the struggle to re-find the shell.  Lycopodium experiences it as an existential anxiety whether he is worthy of his position, a situation he continually stresses over and doubts, especially when having to prove himself he actually OK.  Sulphur doesn’t have such concerns.  His ego is now intact but he suffers from the lack of impetus to actually manifest this ego.  For Sulphur, isn’t the fact that it’s there enough.  Why bother to do anything about it and why bother to let others know.  For Sulphur the challenge is the integration of the self into the larger context of family and society.  Each of these remedies represent a basic struggle and because we are looking at deficiency here, the expression of these states will never be too violent or extreme, even if it seems to be written in the books that each of these remedies can show extreme emotions.  In reality, they rarely do, there is not the impetus or drive.

Whereas in the sycotic miasm, as seen in the remedy Medorrhinum, the theme of exaggeration or excess produces many inflammatory states, with an exaggeration of function.  The expression is intense and focuses on areas of the body to do with water, communication and expansion – sinuses, chest, joints, kidneys and bladder, skin and heart.  Mentally there is a tendency to extremes, unpredictability, intensity, addictions, everything is too much.  There is focus on how one is seen and the ambition to become, not merely content to be as in the psoric miasm.  The degree of egocentricity is that much greater, although of course one sees that with Sulphur, the grand antispsoric (but as is the case, polycrest remedies by definition are influenced by more than one miasmatic influence).  There can be violence, all sorts of extremes and antisocial dynamics in mental behavior, and in physical areas, a tendency to distortion or incoordination in function, especially in earlier years of life than one would expect, e.g., congenital deformities, joint inflammations, urinary tract inflammations, asthma, abnormal skin growths, early heart pathology etc.  Thuja, the archetype of this miasm, shares many of these qualities but reveals its own unique strategy of having to cover up a feeling of distortion or wrongness.  Anxiety, guilt, shame and secrecy are feelings and strategies used to deal with a sense of separation and stigma they can feel.  They feel alone, and don’t know really why and imagine something must be wrong with them.  Again, this fits an archetypal experience – how does one fit into a family, a society, a culture, what strategies do we have to employ to do so.  Thuja is only one remedy that examples this struggle.  To see the sycotic miasm in this light, one can say that now that the ego is clearly identified and expressed, what do we have to do connect to the whole, to everyone else.  This struggle of individuation and then connection is a contrast of opposites, two poles of an archetypal theme of consciousness.  

In the syphilitic miasm, as seen in the remedy Syphilinum, we see the themes of despair, hopelessness with suicidal ideation, violence and destruction in all spheres, anti social behavior, addictions, compulsions.  We see destructive processes physically, with an affinity toward ulcerations, bone decay and pain, congenital disorders, especially to the structure of the body and basically symptoms very similar to syphilis in both acute and chronic forms.  Mercury, Hahnemann’s great antisyphilitic shows symptoms similar to this, with a particular affinity for destructive processes to the mucous membranes, nerves and bones.  Mentally, there is suspiciousness, paranoia, violence, with great sensitivity and intensity.  They don’t feel they fit in, they feel threatened by a malevolent world and feel the need to retreat to a safe, secure place.  So here, we have another archetypal expression, this time one of violence and possible mayhem.  Whereas in Psora the threat is one of not having enough food and of basic survival, here it is a threat of imminent violence, of destruction.  In our society the most profound influence of this miasm is seen in people who cannot fit into society, become degenerate to one degree or other, often imploding in self violence or violence to others.  Our prisons are full of people whose expression is a syphilitic one.  In some ways, the feeling of the syphilitic miasm is to do or to die.  The need is that much more desperate than the other miasms, and if a person cannot find a socially acceptable way to express this energy – the classic genius, idiot savant or similar person who has a one pointed expression in life, an ability to focus extraordinarily intensely on one thing, often excelling in it, but when that energy cannot find an appropriate expression in a “normal” social form, it can become inverted in a self destructive energy that “eats away” at the person.  It is a thwarted expression that because of its intensity is thrown back at the person.  Interestingly, in Syphilinum, there are pains like a line, a fine, piercing pain, which is a similar sensation to that of the overall Syphilitic state – intense, violent, focused, extreme – life is seen from that perspective.

In these descriptions, what is being described is both the physical and mental symptoms that can be related to the specific diseases mentioned as well as a broader gestalt of phenomenon which moves beyond the personal to the collective.  If we are talking of miasmatic influence moving through many generations, then its effect becomes more general and less specific, influencing both physical and mental expression in more diffuse and diverse ways.  This is one reason why the major nosodes are so useful in prescribing and also why they can easily be overused.  One of the justifications for giving a major nosode is when more than one remedy seems to be indicated and also when a well indicated remedy does not seem to work.  Here it is inferring that the influence is more insidious and hidden, more occult and less expressing itself in specific keynotes or essence of the particular nosode itself.  In that sense, it becomes more of an “atmosphere”, similar to the dictionary definition of a miasm.  In this way, a miasm is behaving more like a field effect, similar to the morphogenetic fields described in the work by Rupert Sheldrake.  (See Rupert Sheldrake, A New Science of Life)  In his work, he postulates that all things that have a similar structure (DNA, atomic structure etc) can connect and communicate with one another based on sharing similar “fields” of consciousness and that these patterns of consciousness are past on through time, through generations and have a ”cumulative influence which acts across both space and time.” (P. 13).  So the imprint of the past is past on to the present and the future.  He is postulating this connection for all systems, not only in organic but also inorganic forms.  The hypothesis he makes from this he calls “formative causation”.  In the context of miasmatic conditioning, we are considering the fact that patterns of influence are past on through countless generations, stemming from one or more original infectious diseases, the memory of these original diseases being transplanted in myriad forms through genetic and “vibrational” imprinting, leading to a wider and more generalized influence on human health and behavior.  This imprinting creates a propensity to illness, dependent on other constitutional susceptibilities and external factors that can stimulate this susceptibility into action, manifesting in a multitude of disease patterns and symptom complexes.  

One of the most important practical aspects of this analysis is that it allows a homeopath to organize what seems to be chaotic or random symptoms into a more coherent pattern, enabling connections to be made within a given symptom picture and also allowing the roots of certain conditions to be revealed.  One of the biggest challenges in homeopathy is to see both the breadth and depth of symptoms.  Many symptom pictures look alike, but with a clear understanding of materia medica, one can use it to decipher symptom pictures into clearer totalities and knowledge of miasms and nosodes can be an essential part of this analysis.  Because a nosode is made from diseased material, the potentized nosode has a unique pattern to it, as all remedies do, but the source of the remedy does make it somewhat different.  If the root of a disease e.g., childhood asthma, stems directly from a history of gonorrhea, even a few generations ago, then often, only Medorrhinum will ultimately cure it and take the susceptibility away.  No other remedy will do this.  

Part Three:  The progression.

The next major stage in the development of miasmatic thinking has been the introduction of other miasms.  If the three major miasms, stemming from the primary afflictions that Hahnemann spoke of - to the thematic expressions that Ortega and others described - act as a foundation, then practically speaking, the miasms of Tuberculosis and Cancer belong in a very similar category.  However, there are distinct differences between the two miasms, the most important one being that Cancer is the only miasm that does not stem from an infectious disease.  The other four all have an infectious disease or contagion principle involved in it.  However, for all intensive purposes, it conforms to all the other major criteria for a miasm, in that there is a distinct inherited disposition to it, there is a clear nosode with a profound remedy image and there is a larger pattern of physical and mental symptoms and behavior connected to it.  In other words, there is a systemic totality.  Historically, Tuberculinum was made and proven around the same time as Medorrhinum and Syphilinum and by the same prover, Swan, who conducted provings of these remedies between 1880 and 1885.  Carcinosin, on the other hand, did not having any substantive provings, most of the information coming from clinical anecdotes and observations of Donald Foubister, an English homeopath, who wrote about the remedy in his book Tutorials on Homeopathy.  However, Burnett did a self-proving of Scirrhinum around the time that Tuberculinum and the other nosodes were being used.

When studying tuberculosis, the two key remedies are the nosode Tuberculinum and the remedy Phosphorous.  The image of the tubercular miasm is well-known, the disease itself providing a clear image of one part of its picture, the affinity for the lungs, the breaking down of tissue and the formation of tubercules in the lungs; the chronic cough, night perspiration, emaciation and affinity for other glands in the body and also the bones.  Also, the “tubercular age” gave us the dynamic influence of the disease, affecting the romantic poets and the travelers of the world, exploring far flung places just because it was possible, endlessly optimistic and determined to experience as much as possible before burning out.  The tubercular miasm (as well as the cancer miasm) are interesting to study from the point of view of the circumstances and historical time of their ascendance.  Although there is evidence of TB’s existence for many thousands of years, its proliferation in 19th century industrial cities with their urban congestion and pollution is a direct reflection of the nature of the disease and miasm – a feeling of oppression, pressure, restriction with the consequent desire to escape, to travel, to get away from the imposed restrictions and limitations.  The tubercular person wants to breathe and if they can’t, they implode, like the sunken narrow chest of the classic consumptive.  In the remedy Tuberculinum, one sees these desires, the extremes of craving to travel, to move onto something new, the restlessness and then the dissatisfaction, irritability and destructiveness when they can’t have that.  The latter symptoms can look like all the other major miasmatic pictures, but the former symptoms are more unique to the tubercular miasm.  

Phosphorous expresses the unfettered, freed up tubercular state.  Sensitive, refined, delicate, romantic, open and vulnerable, the person needing Phosphorous floats through life relatively unscathed by the vicissitudes of traumas, like the tubercular nature that in its optimism and openness moves onto the next thing.  However, in Phosphorous we see the physical burn out of the tubercular miasm, the depletion and exhaustion, the affinity for all sorts of chest conditions as well as the liver, the bones and nerves.  Phosphorous can go all the way to actual tuberculosis and complications of all chest infections, however long ago they may have occurred.  Calcarea phosphorica however, possesses much of the classic mental dissatisfaction of the tubercular state, but less of the classic physical condition, its affinity more for the joints and bones than the lungs.  

The cancer miasm is the newest of the big five but perhaps has become the most important of all the miasms in the modern age.  We live in the age of cancer.  It is the disease we all fear and that has traumatized the modern world.  It’s causes are complex which adds to its complications as a homeopathic miasm.  Not all cancers are inherited miasmatic conditions.  Many are caused by modern environmental toxicities, including hormones, both natural and synthetic, especially the estrogens, petroleum based toxins found in the atmosphere and in pesticides etc and an increase in radiation exposure, like x-rays, nuclear exposure etc.  However, we also see themes identified in the cancer miasm that can predispose some people to cancer and to the broader miasmatic condition.  This is clearly seen in the remedy image of Carcinosin, the nosode, and also in cancer remedies such as Arsenicum album, Nitric acid and Conium.  It has been stated by Rudolph Steiner and others that there are two biological expressions: inflammation and tumor formation.  One represents the expressive outward manifestation that we see in a fever, an inflammatory process, and the other is an internalization process, one that “eats away” at itself, manifesting ultimately in tumor formation.  Therefore conditions in which there is excessive inflammation or no inflammation at all, or where there is a morbid internalization, a suppression of normal physical and mental expression, indicates the cancer miasm.

In other words, there is a great tension and polarity between the dynamics of expression and suppression, an actual confusion of identity on a cellular, emotional and existential level.  One of the keynotes of Carcinosin is when there is a history of domination, of oppression in which the person passively accepts this domination, often out of guilt, morbid responsibility and duty or weakness, which is then followed by periodic expressions of fever, rage, dancing, travel, romance, escape, wildness, violence etc.  After a while, the morbid internalization or suppressed emotions seek an escape valve which is then expressed in the ways described.  In any given case though,  a person may be anywhere in this continuum, which may make it harder to see the remedy.  More than any other nosode Carcinosin can look like many other remedies, sometimes all at once.  This is an aspect of the confusion prevalent in its dynamic.  In one stage its all about suppression, denial, morbid grief, something is “eating away” at the person, and the next it’s raging, wild, dancing, traveling, full of romantic ideas.  Control is another key expression here, manifest in the chronic constipation and insomnia.  They can’t let go.  In many ways, it can look similar to the tubercular miasm picture, the main distinction being that the tubercular dynamic will not let the person become so morbidly suppressed.  They will seek escape a lot earlier than in the Carcinosin picture.  However, in practice, it is not always so easy to distinguish between them.  Carcinosin, the remedy, is made from breast cancer tissue, traditionally from one woman, although a new remedy from multiple breast cancer tissue has been made.  There are other cancer remedies as well, including cancer from the stomach and Scirrhinum.  The remedy Conium is one of the great clinical remedies for cancerous conditions and represents a key aspect of the cancer miasm, which is the process of internalization and suppression of feelings, until there is a great slowing and hardness of emotional states, leading to the growth of hard cancerous tissue.  Arsenicum album, on the other hand, as well as Nitric acid expresses the morbid anxiety that can be found in the cancer miasm, the kind of intense anxiety and worry that eats away at the person.  Both remedies are very good remedies for a variety of cancers.

The remedy Carcinosin is now used widely, although even twenty years ago,  Vithoulkas and the Greek homeopaths as well as many in the United States rarely used it.  Its use was mainly popularized by British homeopaths, beginning with Burnett and then by Foubister in the 1960’s.  

Two books that describe well these five main nosodes and the broader miasmatic picture are Dr. H Choudhury’s book, Indications of Miasms and Henny Heudens Mast, The Foundation of the Chronic Miasms in the Practice of Homeopathy.  Choudhury’s book is a very clear explanation of Hahnemann’s original thinking, when he spoke of  the infectious origin of miasms, preempting modern bacteriology and germ theory.  However, Choudhury also proceeds to list many of the secondary symptoms of psora as defined by Hahnemann, which for many homeopaths seems rather vague and generalized and not that helpful in general clinical practice.  There are also some rather questionable descriptions of the characteristics of the psoric state, e.g., “He is a man of hide and seek nature.  In most times the psoric patient is a dishonest man, privacy, wickedness and impurity play a good deal in him.” Also, his list of anti-psoric remedies suffers from similar confusion that Hahnemann’s and subsequent lists have.  He describes, using the source of various authors, the characteristic qualities for the other miasms, including tubercular and cancer miasms.  Some of these descriptions are consistent with commonly accepted qualities, while others are more dubious, e.g., “All the vicious individuals on earth – thieves, robbers and murderers, are the products of Sycosis.  It makes a beast out of man.” (Dr P.N. Bannerjea)  He gives an exhaustive list of the secondary symptoms of the Tuberculosis miasm, and in so doing, merges the original ideas of Hahnemann’s secondary symptoms of psora, which Hahnemann perceived as the inexorable internalization of an active disease state after suppression of the primary infection with the inherited disposition and “diathesis” of chronic disease possibilities.  This further confuses the argument between infection and diathesis presented earlier on by Dimitrialis.  The problem with giving so many apparent secondary symptoms of the tubercular miasm as well as secondary psora is that it takes away from understanding the main thematic dynamics of each miasm and compounds some of the more dubious symptom classifications that Hahnemann identified with the psoric miasm.  

One of the other main ideas that Hahnemann put forward was being able to identify symptoms in a case belonging to various miasms and having to choose a remedy based on which miasm seemed more active.  For example, if there was an active psoric and sycotic influence at the same time, one would begin with a psoric remedy and then follow up with a sycotic remedy and then finish up with a psoric remedy again.  In many cases, this entailed Hahnemann beginning a case with Sulphur, perhaps alternating with Hepar sulph or Nux vomica. He may then follow with a sycotic or a syphilitic remedy if he perceived that miasm to be active.  In his time he was seeing many cases in which acute and chronic symptoms of gonorrhea and syphilis were present and therefore would have been dealing with much more graphic images of symptoms based on these miasmatic influences.  However, the difficulty of looking at cases from this mixed miasmatic perspective is that it can lead homeopaths to somewhat artificially separate individual symptoms from the collective totality and somehow numerically add up the number of symptoms attributable to each miasm.  This can miss the whole point in understanding the value of miasmatic thinking which is to identify if there is one overriding miasm present, which may help identify a remedy and or consider a nosode.  It needs to be emphasized that in many cases, knowing the remedy picture is enough.  There is no need at all to identify which miasm is present or which portion of a case is related to which miasm. 

In Henny Heudens Mast book, she approaches cases by identifying clearly which miasm is active in any given case and recognizing the mixed miasmatic components of various remedies, which can help in perceiving which remedy is the most similar, not just based on specific symptoms, but on the dominant miasmatic and constitutional complexity of both the characteristic symptoms and the overall case.  Her main point is that if we can identify the complete miasmatic picture it will allow us to understand the case as it unfolds over time and how miasmatic layers may be revealed during treatment.  However as in many forms of systemic analysis, a miasmatic perspective may or may not help and it is always possible that it can create confusion for homeopaths that misidentify which miasm seems most prominent.  This especially can happen when individual symptoms are misidentified, which is more likely than when one is analyzing the miasmatic “gestalt” of the whole case.  Heudens Mast discusses how one can learn the symptoms of the miasms to identify them in the different remedies.  This she bases on the classifications that Ortega outlined but uses the following words: too little = psora; too much = sycosis; and destructive = syphilitic.  Her analysis of which symptoms belong to which miasm is interesting and perhaps would not be agreed on by different homeopaths.  It is not always that straightforward as also is  the argument about which remedy belongs to which miasm.  She identifies Nux vomica as psoric whereas other people would say it has a strong syco-syphilitic aspect.  Similarly, in the repertory, in Generalities there are rubrics for Sycosis and Syphilis but not Psora.  Heudens-Mast states that remedies not in either list can generally be classified as Psoric but she does not question or critique the list of remedies in these rubrics and how questionable their miasmatic classification really is.  Therefore, her miasmatic perspective in cases, as outlined in the book, reveals both the strength and weakness of miasmastic philosophy in homeopathic prescribing.

One of the challenges of identifying certain themes of behavior and broader personality qualities as belonging to one or other miasms is that, as with the classifying individual symptoms, it can easily look like a broad overgeneralization in making this classification.  For example, she states that Psora likes consolation and will ask for support (based on the overriding theme of psora being weak).  However, for many people Natrum muriaticum is psoric (struggling for identity and emotional integration) which as we know does not like consolation.  Also, that most guilt is psoric, whereas for some homeopaths, guilt is extremely sycotic.  Also she discusses which professions and which cars a psoric person would have, which seems to be one further step removed from simply looking for the truly characteristic symptoms in any given case.  Some other aspects of her classification of characteristic symptoms of each miasm suffers from similar over generalizations e.g., “Many butchers are syphilitic” (as syphlitic people choose professions where they can use a knife; “cracks in the skin are syphilitic and can be very painful.” (many non syphilitic remedies have strong cracks e.g., Graphites).  “Blue sclera is a tubercular symptom” (whereas it is also a symptom of the cancer miasm.)  

However, the value of defining miasmatic themes in such a broad way is that it can give a good impression or flavor of the dynamic of each miasm and how this generalized dynamic permeates the story of a case and from this can help in the process of the type of remedy one can look for.  Clinically speaking, this is useful as if one sees a strong thread of violence in a case, whether its in dreams or in the life experience, the recognition of the depth of the experience in the case is helpful in identifying a remedy with a similar depth, in this case the syphilitic miasm.  In this way, one can see beyond mere symptoms to include a more complete analysis.

Interestingly, in Heuden’s Mast book, when describing the syphilitic miasm, she uses the word not to describe the disease itself which is how Hahnemann originally defined the term miasm, as described by Dimitrialis earlier.  Her description of the various miasms is in fact a description of the miasmatic susceptibility and impact of the original disease, and not the disease itself.  This conforms to the general understanding of the word miasm as its used in regular homeopathic discourse, even if it is different to Hahnemann’s original meaning.  It is however not clear whether Heudens Mast is talking of syphilis the disease or the miasm when she states that we have all seen the syphilitic disease is the 3rd stage, probably without knowing it was the disease – this is when we see “dullness, an inability to express emotions, depression or physical disturbances.”  What she is describing is most likely NOT the disease syphilis but merely the miasmatic influence of the Syphilitic miasm.  Her descriptions only further confuse the difference here.  She also states that when Syphilis is there, psora  is already there.  As has been discussed earlier, this is open to dispute, especially in the way that Hahnemann originally meant it when he saw each miasm (disease) as being distinct from one another, not built up out of the base of psora.  That interpretation only took real root with Kent’s interpretation of miasms.

Heudens Mast has taken on some of Kent’s analysis in describing the impact of Syphilis, as the mechanism of catching Syphilis is an act of will, leading to “a sense of wickedness or corruption and the desire to hide it’s evidence.”  This is very debatable.  No doubt people didn’t feel good about having Syphilis but in the early years of syphilitic outbreaks in Europe, people were alienated by mainstream society, similar to the way lepers were.  The alienation was due to the social stigma and fear of contagion, not an inbuilt guilt and sense of wickedness.  

One of the unique aspects of homeopathic theory, especially as it relates to miasms is the concept of suppression.  As conventional medicine, and also much of supposed holistic healing focuses on symptomatic treatment, leading mostly to suppression, the understanding that the disease is only being pushed to a deeper level is not recognized.  It is seen as a “different” disease state, not connected to the former one.  In homeopathy, of course, we draw the connection between the two, and an understanding of miasmatic susceptibility gives homeopaths an enlightened perspective on why certain diseases and mental states occur after other more superficial diseases have been suppressed.  Miasmatic theory especially allows us to recognize why certain people react in certain different ways to similar circumstances, for example, the syphilitic drunk, who becomes violent and deranged after one drink, as apposed to the psoric drunk, who merely sits in the corner becoming more befuddled but with none of the violence or wild exuberance of the syphilitic or sycotic miasm.  This aspect of miasmatic thinking is well described in Heudens Masts book, recognizing the way miasmatic influence affects symptom development after suppression of more superficial states.  

The concept of suppression by superficial homeopathic treatment is often discussed in the book.  This is a point of debate within the profession.  Some homeopaths, Heudens Mast included, feel that homeopathy can easily suppress symptoms to a deeper level of miasmatic depth.  However, it can also be argued that in many cases, a superficial remedy may well palliate and not cure, and mostly the effect won’t last and the symptoms will return, similar to many situations in homeopathic treatment – including Hahnemann’s experience – when the remedy simply isn’t the most correct one.  It can be argued that the concept of homeopathic suppression is rather exaggerated and as a result it can lead to a more fearful relationship to prescribing.  George Vithoulkas often talks about the damaging effect of superficial homeopathic treatment, which can create confusion or suppression in a case.  However, many argue that the so-called damage created by the “incorrect” remedy is exaggerated leading to a more fearful and inhibited relationship to prescribing.   One other controversial area discussed by Heudens Mast (p. 105) is the idea that repetition of the remedy too early disturbs the original dose and that one can’t hurry the remedy any more than the stimulative effect of the original dose unless it is obviously clear that the remedy has relapsed or been antidoted.  She gives an example of a case in which the remedy, Lauroceraus, was only repeated once in four years.  For many homeopaths, the experience is that repeating a remedy once every 1-3 months - even if the case has not relapsed - further assists the case, or if it is not needed, it doesn’t interfere.  It is rarely the situation where repetition of the previous remedy that worked well interferes with the action in the case.  Either it works or does nothing.  It is very difficult to know in long term cases when the remedy has ceased its action and therefore “judicious” repetition can be an appropriate strategy.  Heudens Mast takes a very conservative perspective on this, preferring to wait for extremely long periods of time than to repeat a remedy.  The fact that this area of homeopathic strategy is debated so strongly is an interesting aspect of our homeopathic work.  

Heudens Mast’s detailed descriptions of each miasm is a very good study of some of the most important themes for each miasm.  It is helpful for students and practitioners to read this material, along with other sources, including of course studying the materia medica of the main nosodes and complementary remedies, in order to be able to more clearly recognize the main themes of the miasms in cases.  As mentioned earlier, there can be a tendency to over generalize certain themes and also, as is found with miasmatic comparisons, the distinctions are not always that clear.  In spite of the attempts to clearly delineate the main thematic functions of each major miasm – under function, exaggeration and distortion being common words used, in practice the distinctions are not always so clear and there can be many overlaps, similar to the challenge of differentiating between nosodes in clinical practice.  When discussing the tubercular miasm Heudens Mast states that it can only exist when ALL three of the main miasms are present to some degree.  It can’t exist if only two of the miasms are present.  Similar to her position that sycosis and syphilis can only exist if psora is present, she builds a case of the tubercular miasm lying on top of the other miasms. She further states that for the cancer miasm to be present, the other four miasms must be present.  This can clearly be discussed, especially from the original perspective of the miasm as an infectious disease (cancer excepted), with each miasm having a unique signature that can be traced to the original disease and the bacterial origin of that disease. 

In analyzing miasms in this way, we can make a case that each of the miasms are unique and not dependent on one another.  The tubercular can manifest in a similar way to the sycotic miasm in the symptom and behavior presentation but it is a different miasm with a different origin.  It does not depend on the existence of the other miasms.  In Heudens Mast’s opinion, there are few people who are infected with only one miasm.  Most people have at least two, which implies that they need at least two remedies to cure the person, ending with an anti-psoric remedy to address the fundamental root.  This is similar to the concept of finding a basic constitutional remedy that may lie underneath a “lesional” or “fundamental” remedy needed for the presenting symptoms.  However, many homeopaths seek the one remedy that seems to be indicated for the complete picture, and teachers present cases in which just one remedy is given.  This apparent division between the idea that there is only one remedy and more layered approach, whether miasmatically inflected or not, is another of the interesting dichotomies in homeopathic prescribing.  

The implication that each of the miasms are built on top of one another means that if, for example, the cancer miasm is present, a remedy will be needed not only for the cancer miasm but then for at least some of the other miasms afterwards.  However, in practice, that is not seen that often.  Perhaps there is no susceptibility on the other levels and only a cancer miasm remedy is needed.  This again reflects some interesting differences in analysis of complex cases and how much emphasis is put on miasmatic classification.  

Since these “big five” miasmatic states have been well defined and the requisite nosode used along with other complementary remedies, there has been debate about the classification of new miasms, whether they exist separately or are only another expression of one or more of these miasms.  One such possible miasm is the AIDS miasmatic disease.  AIDS erupted onto our world in the late 1970s and 1980’s.  Initially it killed many thousands of people in the United States and Europe, focusing it seemed on the gay population in major urban areas.  The whole evolution and development of AIDS is highly controversial and political.  The inability to isolate the virus and reproduce it to find a vaccine and the highly differentiated symptom complex has confounded the medical profession and society at large.  The stigma of it affecting certain parts of the population more than others – gays, prostitutes, vulnerable people with weak immune systems, like hemophiliacs requiring blood transfusions, has only created further problems in identifying characteristic behavior qualities of the virus and it’s expression.  For homeopaths, it has seemed remarkably like “syphilis revisited”, sudden, violent disease expressions, passed on through sex, leading to destructive changes and often found in cases where there has been a history of suppression of the diseases gonorrhea and syphilis.  There is no doubt some truth to this theory, based just on observing how the disease initially manifested in the West.  However, it also has a unique pattern to it, different to the primary expression of syphilis.  A study of possible causes of the virus causing AIDS is also interesting in this regard.  There is quite a lot of evidence that the virus could have been man made, stemming from contaminated vaccine material that had been incubated in monkey’s kidneys.  The simian virus contamination, (SV40), crossing the animal/human barrier through vaccines has received a lot of attention, and while dismissed by mainstream medical thinkers, remains a possibility when looking at how a new disease suddenly manifested in certain elements of the population.  Heudens-Mast discusses the development of AIDS as a result of the suppression of other diseases, as mentioned above, but especially gonorrhea and syphilis and when mixed with tubercular dynamic, then AIDS may be the result.  No doubt there is truth in this, but it is also important to consider the actual infectious element in this disease.  Some medical theorists (see the work of Peter Duesberg) have even disputed the fact that the virus exists at all, attributing the disease to only the consequences of a suppressed immunity due to lifestyle factors.  However, the sudden explosion of the disease does make us question that a viral factor was involved, that acted as a vector and initiator of the miasmatic susceptibility.  The man-made possibility adds an interesting element to the equation here, and perhaps fits into a broader theme of the AIDS miasm.  This is discussed in Peter Fraser’s book, The AIDS Miasm, in which he identifies the qualities of a breakdown in boundaries, a confusion on all levels of personal and collective identity, a symptom of a broader global consciousness in which boundaries on personal, societal and cultural levels are broken down.  Apart from the disease AIDS, other diseases such as CJD/Alzheimers can be said to be part of this miasm, again reflecting a breakdown in boundaries (as CJD is caused from prions created by feeding livestock animal products never designed to be eaten by animals, a form of cannabilism).  In Fraser’s work, he takes the description out of the personal infectious level – as described by Hahnemann and also further than the broader miasmatic themes as described by Heudens Mast – and describes the miasm as part of a broader social, cultural, phenomenological dynamic.  In other words, the disease is a reflection of the culture changes and challenges at any given time, which often express at times of transition and stuckness.  They are symptomatic of societal change and express the energetic vibrations of a cultural consciousness.  As Fraser says, miasmatic diseases can be seen as “acute diseases of society itself”.  

This way of understanding disease gives another perspective to our understanding of miasms, as expressed both in individual disease and the collective consciousness of society.  It is also a contrast to some extent to the perspective of Heudens-Mast and other homeopaths that see the progression of miasms – psora, sycosis, syphilis, tuberculosis, cancer, aids, as expressions of a deeper degeneration and suppression, leading to ever further degradation of health and by implication, moral well being.  In Fraser’s analysis, these diseases reflect the cultural challenges of the day and although the concept of miasmatic suppression has truth to it, it is not the only way to explain the advent of these diseases.  They are a reflection of a rapidly changing culture, an inexorable change in which opportunities for evolution occur at the same time as disease manifests.  In spite of ourselves, the human species is moving forward (perhaps back as well) and new situations and technologies will evolve, out of which new diseases and mental and emotional challenges will arise.  Nothing exists in a vacuum, and these “new” diseases will manifest as we are all challenged in the ever changing dynamic of evolutionary change.  This perspective adds another dimension to the otherwise depressing analysis of the degeneration of the human species through the suppression of primary expressions of various diseases.  

The AIDS miasm conforms to most criteria of miasmatic thinking, including there being a nosode of AIDS, taken from the blood of a man with AIDS.  However, it’s use has not been verified to anything like the degree of other major nosodes and right now, a unique inherited disposition based on AIDS has not been clearly defined.  It will take another generation or two before any unique patterns may be seen.  However, given the dubious origin of the AIDS virus, it might not pass onto future generations in a similar way to other miasms, and may die out much quicker.  If one sees all disease as merely expressions of energy, then the energy that created AIDS may just go to another disease.  Right now, we are seeing the explosion of Lyme Disease, in some cases acting like neurological AIDS and syphilis cases.  There is quite a lot of evidence to suggest that this disease is also a man made disease, which would lead it to be identified within the AIDS miasm, connected to the breakdown in boundaries between species, in this cases the mutation of a bacteria found on ticks.  As is known, the bacteria is a spirochete, not dissimilar to the spirochete of Syphilis. 

Recently there has been the suggestion of other miasms, based on a combination of a connection to specific disease states, mostly with a nosode attached and a characteristic set of symptoms and also remedies that fit that miasm.  Rajan Sankaran has been the main exponent of these miasms and Roger Morrison explains the qualities that Sankaran identified with these miasms.

1) Each remedy is assigned to a specific miasm and only one.
2) Each miasm was given extremely clear and tight defining characteristics -- both physical and mental -- which are readily identifiable in the homeopathic interview.
3) Each patient has only one miasm evident at any time. 

Some of his thinking is very similar to how Hahnemann defined a miasm, which is of a disease. Hahnemann described a cholera miasm and Sankaran describes a typhoid miasm for example.  Hahenmann also described certain diseases as fixed miasms, which were the childhood diseases such as measles, mumps and chicken pox as these diseases only occurred once in a lifetime.  However, much of Sankaran’s classification is based more on a thematic dynamic than just the disease symptoms, extrapolating a more metaphorical and broader gestalt than just the symptoms connected to the disease.  His first miasm he classifies as an acute miasm, which is purely thematic, not connected to any particular disease or nosode.  He was looking at remedies such as Aconite, Belladonna and Stramonium as part of this miasm.  Interestingly, he includes Lyssin in this miasm, which Hahnemann described as a half-acute miasm, meaning that the disease of rabies has a long prodrome and then a sudden violent action.  We don’t tend to see the rabies miasm (with Lyssin as the nosode) as a broader miasm as not many people in the past survived the acute disease and its impact is much more limited and less prevalent than the other diseases.  The typhoid miasm is clearer to identify according to conventional miasmatic thinking and also has a nosode attached – typhoidinum – although it’s use is more limited to when someone has never been well since having typhoid and not so much as a chronic hereditary disposition.  So it still belongs more in an acute miasmatic influence.  The next new miasm he introduces is the ringworm miasm, with the nosode ringworm attached to it, a remedy he proved himself.  Again, its definition and use is more identified thematically than as an inherited disposition.  He posits it in between psora and sycosis.  Hahnemann identified ringworm as an expression of the psoric miasm but clinically speaking it does make sense to put it in between the two major miasms as many fungal diseases have a sycotic flavor to them.  He then introduces the malaria miasm, which could be said to be a classic Hahnemannian classification, with a clear miasmatic infectious diseases, a clear primary state and well defined secondary states if the primary condition is internalized into the body, leading to chronic problems.  This is how Hahnemann saw the venereal diseases, although Hahnemann saw malaria as part of the psoric miasm, along with most other acute diseases that would have exacerbations at intervals, becoming chronic disease states.  The other new miasm he introduces is the leprosy miasm, with its nosode being Leprominum, a remedy proven by Prakash Vakil, from India.  Hahnemann identified Leprosy as a form of pure psora,  a kind of psora unplugged, no longer leashed in but allowed to flourish on the skin, the centrifugal energy manifesting with an intensity not often seen in psora because of suppression and how disease used to manifest before it was controlled by “civilized” behavior.  This was described earlier on in this article, with the somewhat challenging concepts of the consequence of allowing leprosy to be mollified by hygiene, diet and general good living, leading it to be more easily suppressed and then leading to secondary symptoms of psora.  This has to be said to be somewhat challenging to fully accept and reflects perhaps Hahnemann’s own confusion in establishing the true causes and expressions of psora.  In modern miasmatic thinking, leprosy clearly shows aspects of the syphilitic miasm and as such Sankaran puts it in between the tubercular and syphilitic miasm.  However, even though a chronic disease condition, and one experienced through the ages, Leprosy has not become a chronic miasm with a broader inherited susceptibility as the other major miasms.  It’s image and dynamic has been somewhat split between the psoric and syphilitic miasm.  However, in studying its disease manifestation, one can get a good idea of its broader image and “gestalt” and how certain remedies can be identified with the miasm, e.g., Hura brasiliensis. 

As mentioned earlier, one of Sankaran’s qualifications has been to identify a remedy more exclusively with a certain miasm.  While that can be done in the manner in which he classifies miasms, it is very different to the way other people classify the miasmatic classification of remedies.  Heudens-Mast talks of the percentage of different miasms within certain remedies and most homeopaths understand that so-called “polycrest” remedies have qualities of more than one miasm in them.  To limit each remedy to only one miasmatic influence does seem to be an oversimplification of the whole idea of miasmatic influence.  Similarly, to state that only one miasm can be evident at any one given time contradicts some of the writings and experiences of many homeopaths.  In many cases, it can be seen how a miasmatic influence is affecting the picture that is being presented but it may be apparent that another remedy picture, essentially belonging to a different miasm may be seen underneath.  However, it is true that usually only one miasm will be prominent and will require a specific remedy.

There could be said to be other miasms relating to specific diseases, with different bacterial/viral origins.  Some homeopaths have used nosodes from various diseases like Staphyloccinum, Streptococcinnum, Pneumococcinum and also the bowel nosodes, which have been part of the homeopathic materia medica for many years.  The bowel nosodes have their own picture attached to them, taken mainly from clinical observations of disease symptoms and the appearance of these bacterias in bowel flora.  The nosodes from disease bacteria are often used when a person has never been well since a particular diseases and examples a specific and occasionally useful form of prescribing.

However, for most of our prescribing, the use of the big five nosodes and the impact of the broader miasmatic influence dominates our use of miasmatic prescribing.  The influence of these diseases through many generations and their unique patterns found in many different symptom pictures and disease conditions makes an understanding of miasmatic theory of great significance and validates Hahnemanns’ original postulates about the origin of disease.  The fact that we have taken his thinking much further and developed broader images of the other miasms and even refuted some of his ideas of the origin of psora do not take away from his original thinking.  It is a unique and vital part of homeopathic thinking, one that in time will be revealed to the rest of medicine as a great contribution to the evolution of medical thought and disease classification.