Part 4: The Development of the Miasmic Theory
There has been a tendency in modern Homoeopathy to focus more and more on the mental and general symptoms of the individual while paying little if any attention to the classical doctrine of the chronic miasms.
This is not a new phenomena as Baron Von Boenninghausen bemoaned the fact in his Lesser Writings that many practitioners were ignoring Hahnemann's teachings on the miasms as expressed in aphorisms 5 and 206 of the Organon.
Even Constantine Hering was skeptical when Hahnemann first introduced his miasmic theory, but after observing the syndromes in his patients, he became a great contributor to the further development of the doctrine.
One of the reasons the original theory of the miasms has fallen out of use in case taking is because it has somehow become associated with the concept of orthodox pathology.
Are the detailed syndromes that are recorded under the miasmic process really just another form of useless pathology? Can we really take a complete constitutional case through the use of the general symptoms alone while ignoring the presence of the inherited or acquired miasms?
According to the founders of Homoeopathy, to overlook Hahnemann's doctrine of chronic disease is to miss the main point of aphorism 5 of The Organon which deals with the importance of causation, constitution, and the chronic miasms. This trinity forms the foundation of the anamnesis to which the concept of the totality of the signs and symptoms is added in aphorism 5, 6 and 7.
Hahnemann classified some remedies into anti-miasmic categories because he discovered that certain deep acting medicines have a similar nature to the syndromes produced by the miasms.
What did Kent think about the miasmic doctrine and did it play any part in his case taking methods? Lets see what he has to say about the doctrine of the chronic miasms. Vide Kent's Lectures on Homoeopathic Philosophy, from the lecture called, "The Examination of the Patient".
"A great deal depends upon a physician's ability to perceive what constitutes the miasm. If he is dull of perception he will intermingle symptoms that do not belong together, Hahnemann seems to have had the most wonderful perception, he seemed to see at a glance.
Hahnemann was skillful in this respect because he was a hard student of materia medica and because he proved his materia medica daily".
Why does Kent speaks of mixing up symptoms that do not belong together if we only need the totality of the symptoms? Why should we understand which symptoms constitute a miasm?
Why is Kent praising Hahnemann's understanding of miasmic layers if his teachings on the chronic disease play no part in Classical Homoeopathy?
In his lecture on Natrum Sulphuricum Kent points out the short comings of prescribing on the simple totality of symptoms without any understanding of the underlying miasms. Vide Kent's Lectures on Homoeopathic Materia Medica .
"Asthma, when it is hereditary, is one of the sycotic diseases of Hahnemann......For years I was puzzled with the management of asthma. When a person came to me and asked: "Doctor can you cure asthma?" I would say "No."
But now I am beginning to get quite liberal on asthma, since I have learned that asthma is a sycotic disease, and since I have made judicious application of anti-sycotics I have been able to relieve or cure a great number of such cases.
You will find in the history of medicine that wherever asthma was cured, it has been by anti-sycotic remedies. That is one of the first things I observed, that outside of sycotics you will seldom find a cure for asthma."
Kent goes on to speak about the limitations of the use of Homoeopathy only on the symptoms without taking into account the underlying miasmic causes and their syndromes.
"While Ipecac, Spongia, and Arsenicum will correspond just as clearly to the supervening symptoms and to everything that you can find about the case, yet what do they do? They palliate; they repress the symptoms; but your asthma is no better off, your patient is not cured."
From these quotes we can see that Kent truly followed Hahnemann's teachings and saw the validity of the theory of anti-miasmic remedies. He also clearly states that using the totality of the symptoms without understanding the miasms underlying the case may lead to mere palliation or suppression of the disease.
This is why aphorism 5 of the Organon stresses the need to understand the fundamental cause as well as the totality of the symptoms. The reason that Ipecac, Spongia and Arsenicum will not cure in these cases is because they are not antisycotics.
Another experienced homoeopath, H. C. Allen, offered his opinion as to the use of the totality without an understanding of the chronic miasms and their layers in his classic, The Chronic Miasms .
"I think I hear many say, are not the totality of the symptoms, all there is to disease? Yes, but to me it is necessary to know something of what is behind that grouping of the totality. If you do not know this you are prescribing for a Jack-in-the-box.
You cannot follow the evolution of the curative process; you cannot even prescribe intelligently the proper diet for a patient, unless you know the basic miasm. Of course the diseases that are present will help you to some extent, but you have no surety unless you know the underlying basic disturber of the disordered life".
Our old friend Dr. Allen's example of a "Jack-in-the-box" is quite illustrative. If the homoeopath does not know the layers of the miasms in their proper order, they will not know what to look for in the future, so that some dramatic complication may just "pop" out of the vital force as if came out of nowhere.
Those who study Hahnemann's teachings are more prepared for what the future might bring and know what to do when obstructions arise. In reference to the hallowed law of the totality of the symptoms, and its use as a guide to the choice of the remedy, Dr. Allen shared his feelings in this way.
"We make no attack upon the law; no cure can be made outside of the law. But we do believe it is necessary to know whether the phenomena presented in a given case are of sycotic, syphilitic or tubercular origin; for the totality grouping of the symptoms must be around the symptoms of the active miasm."
Thus we can see that in Hahnemann's method the totality of the symptoms includes the signs and symptoms of the miasms classified by their layers and listed according to their development.
The active miasm is the center on which the totality of symptoms is built so that the remedy chosen matches the underlying miasm syndromes. The symptoms should be arranged in such a manner so that it is easy for the homoeopath to see the layers of the case so they will know what to expect next.
Hahnemann states in The Chronic Diseases that in severe chronic cases the homoeopath may have to use a series of anti-miasmic remedies to complete the cure. This is because in complex disease the layers may represent several etiologies and the miasms can require different remedies as they become exposed.
Allen expressed the need to know the layers of a chronic case in the following terms.
"Those brilliant cures that are occasionally made with the single remedy, occur where a single miasm lies behind the phenomena, but where the mixed miasms are present, brilliant cures are not so made, and it is in those cases that it is so necessary to understand the order of their evolution."
Some homoeopaths spend all their time searching for the single constitutional remedy for the patient. When the remedy picture fits Phosphorus they state that the patient is a "Phosphorus constitution". In this way they search for that one special remedy that will solve all the patient's problems.
Our elder homoeopaths of years past might have asked, "When was this person a Phosphorus? When they were born? Now? Forever? When they had pneumonia? Because they have the inherited TB miasm?"
The search for the grand constitutional remedy may lead the homoeopath to construct permanent essences out of something that is in continual change.
Complex chronic diseases are often made up of many interdependent components rather than one single constitutional factor. Although many cases have been ameliorated by just one constitutional prescription such miraculous responses are the best of circumstances.
Homoeopaths who wish to treat chronic diseases must be prepared for the worst! In a more complex chronic illness it may not be so easy to pigeon-hole the entire case into one single remedy. It may take a series of related remedies to remove the miasmic layers as the person moves toward the state of health.
This is why it is necessary to know in what order the layers of the case have formed along the timeline so that they may be unraveled in the reverse order by which they developed.
Next: Symptoms and the Miasms