Systems of Homeopathic Thinking - The challenges of teaching homeopathy today

by Jo Daly, CCH

Having been teaching homeopathy and designing curricula for almost 20 years, I have had the valuable opportunity to work with and observe students in a number of schools in North America and the UK. One of my passions has been to understand the needs of homeopathic students and to adjust the content and style of curricula to meet their needs as prospective practitioners of the healing art. My own training in England in the early eighties was a classical one; indeed my first taste of anything other than the ‘old masters’ came with a dog-eared photo copy of lectures of George Vithoulkas’ dubiously named ‘ Stolen Essences’ being passed around in my final year of school. I subsequently studied with Vithoulkas, then many other teachers on my homeopathic journey as student and practitioner to the present day where in my own practice for the past few years I have been using the system developed by Rajan Sankaran and the Bombay school. My passion has been continuously fuelled by the desire to learn from my failures and improve my results

The teaching of homeopathy in the United States today is a random, uncontrolled event not dissimilar to the Wild West and despite the efforts of the CHC and CHE to bring standards to education, there is little agreement yet about adherence to any standard in the profession. The result is that while a sincere and passionate student will seek out the learning they need no matter what, many students with a greater need for guidance fall by the wayside and fail to become the professional practitioner they set out to be. There may be many reasons for this and I am not addressing all of them here but one particular situation has caught my attention.  In my teaching over the last few years one of the things I have observed is that many students are becoming increasingly confused by the mixture of materials they receive from different teachers and seminars, a true smorgasbord  of  ‘classical’ homeopathic information. It has become much more complex than when we just had a few good polycrests to choose from and the repertory to get us there. Students now often lack a context or overview in which to incorporate all of the new ideas and ‘controversial methods’ that they encounter. The result is often great confusion and oversimplification of what are in reality highly sophisticated ways of finding the similar remedy.

To try to understand this state of confusion I have identified some of the misunderstandings from information gathered from students in various schools. One of the conclusions I came to is that students are receiving much contemporary information, some of which is not well substantiated in clinical cases and that is being integrated randomly with the more traditional classical material without a context in which to distinguish methodologies and sources. Much of the so-called new information and literature appears more ‘sexy’ and easier to apply and yet in their own practice or clinic, students are often hopelessly lost and unable to recognize a simple Sepia case when one walks through the door. Because of this confusion, students ‘mix and match’ analysis methods according to how a case presents or what seminar they just attended. I have noticed that a minority of students are able to rationalize objectively the choices they make in prescriptions. What is not commonly understood is that the new methodologies demonstrated so amazingly in seminars are being developed and used by experienced practitioners who already have years of practice using traditional methods. Many of these practitioners have also conducted provings and have gained a deeper personal knowledge of vital action and reaction. Unfortunately students think they can go home and replicate such prescriptions because they understand the theory presented. The reality is that the practice of sophisticated case taking and analysis techniques requires a depth of understanding and experience that takes a while (sometimes a long while) to develop. This can be misleading and undermining to the new homeopath who needs to build confidence in the basic homeopathic method. Students become overly concerned with the limitations of the ‘classical method’ without realizing that it is one’s own inner limitations as a practitioner that are often the chief obstacle to successful work, not the method being used.

I am attempting in my teaching of new methods to include a context of the continuum of homeopathic thought so that, for example, the new approach of Rajan Sankaran can be seen to have had its seeds in the work of Boenninghausen. What is not generally appreciated is the background of experience in classical prescribing that has lead Sankaran to develop this new system or how profound is his knowledge of materia medica through years of cases and many provings. You cannot just open his Schema and expect to replicate that. As with Sankaran’s new work, the work of Jan Scholten, Mangliavori and many others are often presented to the student as concepts and options that can potentially lead to very strange prescriptions. As with all ideas there is great controversy about what is truly an advancement and what distorts and corrupts the purity of Hahnemann’s work. Of course it is up to each individual to decide for themselves and in this essay I am not commenting on the different contemporary methods and systems themselves but I am attempting to address the way in which they could be integrated into the schools in a more conscious way.

Recent changes in homeopathic thought have provoked much controversy. ‘What would Hahnemann do?’ says my computer mouse pad. I personally think he would be excited and inspired that so much new thinking was arising from his initial work. Aude sapere – he said – and currently many people are daring– but what is true – what works?? What is classical homeopathy actually? Or what is homeopathy?
So called Classical homeopathy, as laid down by Hahnemann has four fundamental tenets:

• The Law of Similars

• The minimum dose

• The single remedy

• The potentized remedy

It is not within these basic tenets that the confusion lies as most of the so- called new methods taught in schools do not stray from these tenets but are a result of an ongoing investigation into how to find the similar remedy.

Controversy and therefore confusion for the student occurs largely in the following main areas:

Use of synthetic prescriptions (e.g. periodic table, group analysis etc)
Synthetic materia medica pictures
Use of unproven remedies
Matching remedies to “the Source”
Using the same remedy for acutes as well as the chronic case
Selecting a remedy based on kingdom classification
Sankaran system of case taking using gestures, levels etc
Different ideas about miasms
Need for Repertories

The most common mistakes that students seem to make include:

Over generalizing of the case
Theorizing and interpretation of mental symptoms
Failing to observe the most characteristic aspects of the case (Para. 153)
Computer data overwhelm –‘the garbage in- garbage out’ syndrome
Faulty or scanty knowledge of materia medica (polycrests particularly)
The “he must be a lion because he has a mane of golden hair and loves meat” syndrome

To help this situation I organized a presentation attempting to put current homeopathic thinking into a contemporary context.  This can provide students with an understanding of the evolution of homeopathic methodology and enable them to have a more conscious awareness of what choices they make in their work. A synopsis of this presentation follows and I hope it will be of use to students and teachers who have also encountered these issues. This is a condensed version of a three-hour lecture with power-point presentation. It is divided into two sections – People and Areas of evolution and is intended to provide an overview and also to direct the student to areas of further study.

PEOPLE
The following people are not intended to be a complete list of “master homeopaths” but they are all people whose work has influenced or significantly changed the course of homeopathic practice through to the present day and therefore they are part of a lineage of evolution “from then until now”.

1. Samuel Hahnemann (1755-1843)
Discovered principle Like cures Like
Conducted provings of about 60 substances and compiled Materia Medica Pura
Wrote 6 editions of The Organon and Chronic Diseases outlining complete instructions for treating the sick
Introduced the concept of the vital force and energetic disturbance.
Prescribed at first only acutely then came up with his Theory of Miasms – led him to believe that all cases needed an antipsoric Rx to be completely healed

The principle of similar remedies was first recognized by Hippocrates (c. 560 B.C.) in ancient Greece. Hahnemann as we all know identified and formalized the Law of Similars and conducted provings of approximately 60+ remedies upon himself and his colleagues. Some of these provings were only observations of two or three people. His knowledge of the substances he proved was a visceral one, acquired from personal experience of how the substance altered his state and he recognized the same pattern of symptoms when he saw them in his patients. Initially he did not require anything other than the words of the provers and his own experience in order to find a similar remedy match. At first Hahnemann’s prescriptions were mainly acute ones and he used no ‘case analysis’ – only matching patient to proving. This was very effective until Hahnemann realized the short lived effect of the remedies and began his research into chronic disease that occupied the rest of his life. The progression of Hahnemann’s thinking is well documented through his six editions of the Organon, Chronic Diseases and Materia Medica Pura. Hahnemann’s work began the exploration of healing that we call homeopathy and indeed his work is still the cornerstone of classical prescribing 200 years later and very little of his ideas have been refuted. All the answers for case management and care of the sick can be found in his writings. Where the controversy arises is on the different methods of finding the similar remedy. This is the point at which the polarity and diversification of thinking begins.

As Materia Medica grew and provings were added towards the later part of Hahnemann’s life, the possibility of choosing a remedy from memory recognition disappeared and since that point, homeopaths have endeavored to create indexes, maps and tools all with the same goal – to help find the similar remedy.

In terms of using potentized remedies to avoid toxic effects, this historically came from Paracelsus (1493-1541) who used alchemy to transform substances prescribed on similars. It was Hahnemann who enabled the use of potentized remedies in homeopathy.

2. Baron von Boenninghausen (1785-1864)
Student of Hahnemann
Wrote the first repertory ‘The Repertory of the Anti-psoric Remedies’
Introduced a more sophisticated method of understanding symptoms
Placed importance on general symptoms and characteristic symptoms
Studied the relationship of remedies in his Concordances.

Baron von Boenninghausen has been credited with constructing the first Repertory in 1832  to aid the process of selecting the remedy from the mass of symptoms gathered. After Boenninhausen and Jahr, repertories became the tool of choice for homeopaths to sift through the mass of symptom information gathered in a case.  Boenninghausen introduced several other new concepts including a more sophisticated method of characterizing symptoms by breaking the symptom into components. His approach also placed emphasis on finding the general symptoms which is in fact the precursor to the “vital sensation” of Sankaran. The Vital sensation is a more specific and sophisticated way of locating the general or ‘global’ sensation in a case. What is interesting is that Boenninghausen was mainly interested in the physical generals and the work of Sankaran in placing emphasis on the chief complaint has come full circle back to that idea.

3. Constantine Hering (1800-1880)
Father of American homeopathy
Wrote Guiding Symptoms of M/M
Discovered the Law of Cure
Did many more provings including Lachesis
Assigned remedies to miasms as a continuation of Hahnemann’s work

Hering’s contribution to homeopathy was huge. He brought homeopathy to the forefront in the United States and was President of the Allentown Academy –the world’s first homeopathic school. He conducted 101 provings on himself including Lachesis, Psorinum and Glonoine. He produced the 10 volume Guiding Symptoms of Materia Medica.

4. James Tyler Kent (1849-1916)
Had a huge impact on the course of homeopathy worldwide
Wrote Kent’s Repertory
Never read the 6th edition of the Organon or knew of the later ideas of Hahnemann
Introduced the harmonic centesimal potency scale using high potencies
Introduced many new ideas into homeopathic practice based on his spiritual beliefs from Emmanuel Swedenborg
Created a method of analyzing a case using a Hierarchy of Symptoms

The work of Kent had a dramatic influence on the course of homeopathy and the main influence in his own practice was the ideas of E. Swedenborg.  Apart from the creation of his Repertory the two main ways in which Kent influenced the course of homeopathy were in his use of potency and his creation of a hierarchy of symptoms for repertorization. In rating the mental and general symptoms as the most important he was the first to prioritize the mind in case analysis. These ideas had their derivation in the beliefs of Swedenborg who spoke of the split between will and intellect, and understanding and how this split is the deepest manifestation of disease. This set the stage for a later progression in homeopathy in which the symptoms of the mind assumed far greater significance in a case. This is different from what Hahnemann stated in the Organon Paragraph 211 in which the emotional state only “tips the scales” of the remedy choice: “This preeminent importance of the emotional state holds good to such an extent that the patient's emotional state often tips the scales in the selection of the homeopathic remedy. This is a decidedly peculiar sign which, among all the signs of disease, can least remain hidden from the exactly observing physician.”

5. Ernest Farrington (1847-1885)
Brilliant lecturer of Materia Medica
Friend and student of Hering
Grouped remedies in families.
Farrington’s contribution is discussed below under Materia Medica.

Evolution of Ideas and Practice in the 20th century
Although there were many renowned and brilliant homeopaths in the 19th and early 20th centuries both in Europe, India and the North America, homeopathy itself experienced a gradual decline and the methodology did not change significantly until the second half of the 20th century when a new wave gradually began to emerge and became the tidal wave we are now experiencing.

6. George Vithoulkas
Vithoulkas has had a great influence on the course of homeopathy and brought about a shift in the way both cases and remedies came to be perceived. His work opened a door to an exploration of the idea of ‘remedy essences’ in which the symptoms of a proven remedy are combined with clinical observations to create a synthetic picture and it is that picture that is matched with the patient, rather than a totality of unrelated symptoms. This method also requires a different form of case taking in which symptoms are weighted according to certain criteria in the case taking in order to determine the ‘center of gravity’ in the case. Vithoulkas, although not himself an MD, hoped to influence the medical establishment by showing that homeopathy is a science and to this end he wrote his “Science of Homeopathy” that is used as a text in many schools.
In the 1970’s and early 1980’s Vithoulkas visited the USA on  a number of occasions, triggering a revival in homeopathy in the USA that lead to the founding of the Hahnemann College in CA.

7.   Proceso Sanchez Ortega
Ortega’s influence was in his approach to miasms. At the LIGA meeting in 1944 he introduced a new approach to miasms and their interpretation in a case. He attributed three characteristic features to Hahnemann’s three miasms vis a vis – under function for psora, over function for sycosis and destruction for syphilis.  Many students today are misinformed and believe that Hahnemann came up with these ideas himself.

8. Jan Scholten
A brilliant mind and original thinker, Jan’s ideas have changed the boundaries of homeopathy . His two ground breaking books: Homeopathy and Minerals and Homeopathy and the Elements have opened up possibilities and introduced new concepts that are already integrated into much of what is practiced and taught. Some of these ideas are still producing great controversy because they are new and different and it takes time before enough good cases using these techniques can be seen to confirm the ideas. I myself presented a case at the NCH conference in 2002 that I would not have found a remedy for without Jan’s information. However there are pitfalls for the student in over simplifying this very advanced system of prescribing. I refer the reader to an essay written by Jan Scholten entitled “What is Homeopathy?” to be found on the Ezine website of Hpathy.com.

9. Jeremy Sherr
Master prover and philosopher extraordinaire, Jeremy in his book The Dynamics and Methodology of Homeopathic Provings, laid down an excellent protocol for provings and has himself undertaken significant provings of major new remedies. Specifically his work on proving remedies on the periodic table has given more substance to the theories about the remedies on the periodic table as postulated by Scholten.

10. Franz Vermeulen
Materia Medica man – Franz, with his amazing ability to research and compile information has done two things. Firstly he has exposed some of the myths surrounding the contents of our materia medicas and repertories in an attempt to make the material more consistent. He has also brought a wider view to materia medica through synthesizing a wealth of information. (In fact some of the assignments I used to give students are now redundant because the student need only open Prisma for a complete answer.) He has defined existing kingdoms classification and brought us new material on Monera and Fungi.

11. Massimo Mangialovori
Well known and respected as a teacher in Europe and North America, Massimo has been demonstrating his ideas through cured cases for which he has set stringent criteria. In an interview with Nick Churchill he said:
“It's beautiful for example that you now have so many seminars and so many people teaching compared with a few years ago, but without an organization to take care of this it's a mess. Many good schools and organizations in Europe are losing power because there's a seminar or even two seminars every weekend. It splits people up and in a short time, if there's no direction, there won't be any schools to put on good seminars. I think that's an important aspect.”
Massimo’s work has been influential not only through his demonstrated knowledge of small remedies but in introducing themes that group remedies according to certain characteristics for example, “Identifying with Society”.

12.   Rajan Sankaran
Rajan Sankaran, himself the son of a homeopath has possibly been the single most influential practitioner and teacher of the last fifty years. This is evident in the influence of his ideas into practice worldwide. His books are in every student’s library and his ideas permeate homeopathic teaching. Many seminars are now occurring with videos and other teachers from India and the USA (including myself) showing cases using this system. Some new schools now are attempting to teach his Vital Sensation system from scratch to beginners rather than as a postgraduate study. Most schools except the more strictly classical ones have integrated his ideas to a greater or lesser degree into their curriculum.
History of the development of ideas in ‘the Bombay School”:
First came the Central Delusion
Then came new aspects of miasms
The new concept of Kingdoms was introduced
This led into the Vital Sensation
This led into a new System of Kingdoms, Miasms and Levels and the Source
This has taken homeopathy to another level in which the proving is not the only source of information

14. Divya Chabra
Sankaran’s wife, also a well respected homeopath has introduced some of her own case taking techniques that are also being used. Because her ideas are more loose and do not constitute a “system” there appears to be less confusion over their use.

15. Dr. Ramakrishnan
From a huge and successful practice in India, Dr. Ramakrishnan has recently been presenting some of his methods for treating serious chronic diseases and especially cancer for which he has developed a protocol. While obviously a very valuable contribution, this is definitely material for the more experienced practitioner.

AREAS of EVOLUTION
For this, I have picked specific areas of homeopathic practice where it is possible to trace a changing pattern of new thought and methodology:

Repertory
As an index to the symptoms of provings the repertory has been the major tool for finding a remedy since the time of Jahr and Boenninghausen. The work of Kent in creating his repertory stands out like a beacon in homeopathic history. When I was a student, Kent’s Repertory was the mainstay of practice and I learned its layout and rubrics thoroughly –I even slept with it by my bed. We all knew its shortcomings including outdated language, shortage of accurate mental rubrics and incomplete remedies but still, the repertory was a dependable tool no matter what the case presented. Kent’s repertory was the given method of repertorization until the advent of computer software about twenty years ago, and is still the tool that most students begin their studies with today. Recently Kent’s Repertory has been revised by Kunzli and mostly superseded by the Complete Repertory produced by Roger van Zandvoort and the Synthesis Repertory produced by Frederick Shroyens. Many other Repertories have also been produced since the time of Kent, each with unique attributes. More recently the ability to repertorize using a computer program was a great leap forward and has almost rendered hard copies of repertories redundant – except when your computer crashes or you find yourself in Sub Saharan Africa!

However the ability to store and access data in a computer program has brought another possibility that has challenged the unique position of the repertory in case analysis. Thanks to the work, mainly, of David Warkentin and Frederick Shroyens, homeopaths can have direct access to provings, materia medica and cases, making a very different approach to pattern matching possible. Software systems allow the user to do a word search thus allowing words or phrases of the case to be sought in the data – allowing the potential for matching of symptoms that could not be done otherwise. This technology has brought a huge leap forward for homeopathy but it’s downside is that it can turn finding the remedy into looking for the proverbial needle in a haystack. This change along with the ‘new systems’ have made the repertory seem like a less useful and attractive tool to many homeopaths and students alike.

Materia Medica
As already stated, Hahnemann proved approximately sixty remedies and had intimate knowledge of all of them. At the end of his life he had around a hundred remedies. A few contemporary homeopaths today use no other remedies than those proven by Hahnemann and his students. Most however think this is an unnecessary limitation to practice, but it represents one extreme of a polarity in thinking that has emerged in the current homeopathic arena.

Most students today rely almost exclusively on their intellect for understanding of materia medica, and also on technology to provide access to the information and this makes for a very great difference when it comes to perceiving disorders that begin in a spiritual vital force. Even the learning of keynotes as a way of memorizing the characteristic symptoms of a remedy has become outmoded –at least in this country. Students today usually receive a synthetic package of information about remedies derived from a wide range of sources and are dependent on the focus a particular teacher may give to the information on different remedies. References are not usually given as to the original source of the information. Is it in the proving? Toxicological? Clinical? Somebody’s essence? Part of a Family remedy picture? And most of all-  how reliable is this information?  I must add that my own knowledge of Materia Medica was greatly influenced by the brilliant lectures of Misha Norland, one of my first teachers, who managed to convey the spiritual side of remedy pictures so artfully.

Until the advent of Vithoulkas’ essence pictures, materia medica was mostly symptom based and except for a few accounts such as Tyler’s Drug Pictures, the idea of a “remedy type” was not conceived of. Synthetic remedy pictures such as the ones described by Catherine Coulter are fun and students love to imagine Mr. Sulphur or pick out a character in a movie but the drawback of this kind of matching is that it essentially ignores aphorism 153 that teaches us to look for the most unusual and characteristic symptoms in each individual case of disease. It also leads to remedies being presented in an archetypal but general way that is essential but also can convey a fixed picture of the type of person who may need this remedy and leads to statements like “he doesn’t seem like a Nux” from students who have maybe never seen a “nux” in person.

The number of substances with provings has changed dramatically in the last few years with so many new provings taking place. Before this, a steady trickle of provings followed Hahnemann’s example with a few people such as Hering making a huge contribution. The new wave of provings and notably those of Jeremy Sherr have added a huge amount of material to the Materia Medica. This is wonderful as it provides us so much more information and often of a more contemporary nature but at the same time it makes the task so much more difficult as choosing a similar remedy is much more complicated than it was for Hahnemann and his followers. This complication, combined with a desire to find an ‘even more similar similar’ is primarily the driving force for using new and different methods of analysis.

Originally a materia medica was the direct words of the provers with some comments and there was no interpretation of meaning. Currently most students use a mixture of different types of materia medica, most of them comprised of synthetic remedy pictures from many sources: toxicology, ancient uses, provings, clinical and theoretical combined together. I think it is important for students to research remedy information themselves and be able to differentiate the direct proving information from the theories and anecdotes.  The topic of the Doctrine of Signatures is another area that, although rejected by Hahnemann as inferior to the information provided by a proving, is now used as part of the complexity of information gathered about a substance.  Sankaran’s sensation method, in which potential remedies may be recognized from “source information” has opened up limitless possibilities for remedy choices, with the worldwide web being a new database. This elegant system can work very well in the hands of experienced practitioners who can perceive the subtleties of energetic patterns and draw the information out of a patient as to exactly what substance echoes their deepest disturbance.

Families and Kingdoms
The greatest example of confusion that I observe in students is in the attribution of a kingdom as a primary eliminatory factor in a case.  It is commonly believed that the idea of kingdoms as a grouping is a recent one. In fact Hahnemann spoke of this first in Chronic Diseases and then Ernest Farrington in his lectures put remedies into groups according to their kingdom:
“We are now ready to begin our study of the various drugs composing the Homoeopathic Materia Medica. For this purpose I have arranged the remedies in three grand divisions, according to the kingdom of nature from which they are derived.”

He wrote for example about the animal kingdom: “You will find, too, that these animal poisons are apt to affect the mind, especially the emotions. They arouse the lowest qualities in human nature, and produce a condition which is truly shocking. Some of them arouse the filthiest lust, the most intense anger, and passions of a kindred nature.” A Clinical Materia Medica, E. A. Farrington.

Recently Rajan Sankaran brought new insight into this approach through his work and several books developing the themes and characteristic symptoms of the kingdoms. This idea now forms an integral part of his sensation system and requires a specific method of case taking in order to use it accurately. When used accurately it is proving to be a valuable tool for narrowing down the choice of remedy to one of the main kingdoms. When used superficially it can be very misleading. This superficial use is often because students do not understand the subtleties of the complete system but use aspects of it in an unintegrated way when it appears to fit the case in front of them. Most specifically the kingdom according to Sankaran must be discovered through a journey taken through different levels of experience and is only in fact revealed with any certainty when one arrives at Level 5. Trying to determine the kingdom at levels 2 or 4 is a recipe for disaster…hence the “he must be a lion” syndrome.

Miasms
Roger Morrison wrote a comprehensive overview of miasmatic thought from Hahnemann to today that I could not improve on so I will just attempt to summarize this controversial and confusing topic for the purpose of this article. For simplification purposes I have divided the topic into three areas:

• Hahnemann’s original ideas as outlined in Chronic Diseases.

• In 1828 Hahnemann published his Chronic Diseases presenting his theory of miasms.

• He came up with his theory after years of research into why well selected homeopathic medicines did not always produce true and lasting recovery in many chronic maladies.

Hahnemann understood a miasm to be a derangement of the vital force that precedes and is more fundamental than the current illness the patient suffers from.
Hahnemann felt that there were 3 of these primitive maladies: PSORA, SYCOSIS, SYPHILIS. Of these three psora was the most fundamental. He saw them as a living, spiritual force.
and these miasms were both contagious and hereditary.

Hahnemann believed that the miasm had to be cured and he and later homeopaths tried to a) Identify the symptoms of the miasm; and b) Assign remedies to one of the miasms.
Hahnemann decided that nearly all of the remedies in Chronic Diseases were antipsorics. Today very few homeopaths have bothered to read the full list of symptoms that Hahnemann ascribes to psora that goes on for over 25 pages.

The subsequent miasmatic confusions, modifications and additions since Hahnemann
Since Hahnemann’s original thinking there has always been confusion about:

• Which remedies belong to which miasm

• Whether a remedy can belong to more than one miasm

Most homeopaths did not understand Hahnemann’s theory or did not see the value of its practical application. Hering wrote: “What important influence can it exert whether a homeopath adopts the theoretic opinions of Hahnemann so long as he holds the principle of the master and the materia medica of our school. What influence can it have whether a physician adopts or rejects the psoric theory so long as he searches for the most similar medicine possible?”

Subsequent homeopaths tried to adjust the ideas to fit their own concepts: Boenninghausen, H.C. Allen, Kent et al. Boenninghausen makes two points in his writings: First he says that long lists of symptoms often do not help us to find the simillimum – something is missing which for him (and Hahnemann) is the knowledge of the miasm of the patient and of our remedies. Second he explicitly states that there may be other miasms beside the original three mentioned by Hahnemann which he leaves for future investigators.

In 1944 came Ortega who introduced the miasmatic descriptions more as archetypes. The benefit of this simplified view of the miasm was that the main thrust of the patient and his constitution could readily be identified much of the time. Thus the practitioner could readily categorize his patient into one of the groups. The concept became widely accepted.

Vithoulkas later gave his definition:
A miasm is a predisposition toward chronic disease underlying the acute manifestation of illness:
Which is transmissible from generation to generation; and
Which may respond beneficially to the corresponding nosode prepared from either pathological tissue or from the appropriate drug or vaccine.

Then other miasms were also possible that fit the three criteria: Infectious, hereditary and nosode. Four more miasms were introduced – tubercular (or pseudo psora), cancer, leprous and rabies. Recently AIDS has been suggested as a further miasm.

Over the years some practitioners have used the original miasmatic ideas with great success, and particularly of interest is Henny Heudens Mast whose new book, The Foundation of the Chronic Miasms in the Practice of Homeopathy describes her work in detail.

Sankaran’s miasms
To summarize, he has used the word miasm to mean a characterizing aspect of symptoms. This is an entirely different usage of the word and the names of the miasms. He has named 9 miasms: Acute, typhoid, ringworm, malaria, sycotic, cancer, tubercular, leprous and syphilitic.

Miasms are seen as the manner in which a person experiences a sensation and can be identified by the depth and degree of desperation.  In this system there is only one miasm that can be seen in a given case at any time and all remedies are categorized into miasms.  In this system, determining the miasm is an intrinsic part of the three aspects of a case – level, kingdom, miasm. These three aspects are taken all together to find the remedy, especially in the plant kingdom. Each remedy is attributed to one miasm only. In his Schema, Sankaran has created a grid reference for the plant families that have been identified so far, giving the remedies for each miasm and each family. This has enabled homeopaths to make prescriptions that would never have been possible before this innovative idea.

Methods of case analysis
Hahnemann didn’t need case analysis – this idea developed in homeopathy as the amount of data became more overwhelming. In sync with everything else in this century, homeopathic thinking and practice is changing at the speed of an email in cyberspace. Against ongoing criticism as to the unscientific nature of homeopathy, our only way forward as a profession is to produce many documented cases that are undeniably cured through homeopathic treatment. In our schools, I believe students should be taught using cured cases with reliable follow ups so that experience comes from real cases and not only theory. Some of the different contemporary methods of case analysis commonly used by students include:

• Totality, essence and keynotes

• Themes

• Finding the ‘verb’

• Cycles and segments

• Circle of elements

• Mappa Mundi

• Core delusion

• Vital sensation

• Group analysis

• Elements system

• Etc (apologies to others whose methods I have not included)

Many students are unaware that these are relatively new ways of analyzing a case and they are unfamiliar with Kent’s hierarchy or Boeninghausen. They are often using methods that are still in the “trial stages” and are therefore not always getting the results they expect or would get if they were able to make a more rational judgment about which approach was most appropriate in a given situation.

What does the homeopathic student need in order to successfully navigate the current homeopathic territory?
How can the schools successfully integrate the old and the new into a curriculum?  What to do? Here are some of my suggestions for the student :

• Develop your own critical thinking – this is the most important tool for success.

• Try to understand what the energy of the case is telling you. Observe the vital force by opening your senses to all that is there in the case without jumping to conclusions or thinking you know the remedy.

• Understanding and application of philosophy – if you get stuck with case management go and read the Organon or Chronic diseases.

• Be able to rationalize the remedy choices you make – know how you got there and what method you used.

• Write down what you did and how you arrived there so that if it doesn’t work you have a record and can learn from your errors.

• Aim for consistency in practice – if you try a new approach stick with it for a while until it resonates or not with what you already do – don’t mix and match!
  
  
  
  Jo Daly CCH
  Jo is a teacher and practitioner based in New York.  She originally trained and practiced homeopathy in the UK and has lived in the USA for the last 18 years.  She has taught homeopathy for over 20 years and most recently has been a Director of the The School of Homeopathy, New York.