What Exactly Is a Miasm?
When I was first introduced to philosophy of homeopathy in my first year of Bastyr naturopathic college, I heard the term miasm. It was defined as a hereditary layer of disposition, literally a miasma or swamp. Dr. Samuel Hahnemann, the founder of homeopathy, postulated that through healing miasms it would be possible to eliminate chronic and recurrent disease. In other words, the similimum, or best/exact homeopathic remedy for the individual would relieve symptoms and the removal of the miasm would keep that individual healthy rather than falling sick again and again due to the hereditary tendencies. At that time we learned about were only four miasms: psora (defined then as itch), sycosis (gonorrhea), tubercular (tuberculosis), and syphilis. And there was little information available about how to actually use the miasms to treat patients.
I never really learned, until I went to India ten years after receiving my N.D. degree, what to do with the concept. Bob and I, in the late 80s, were traveling in Mexico and visited the clinic of the famous Dr. Proceso Sánchez Ortega, famous for his work in miasms. We were invited to sit in on a case, along with several of his students. At the end of the case taking, a list was made of each symptom of the patient and each was categorized according to miasms. We found this process interesting, but overwhelming, and confusing. During that early stage of our practice, pre-computer, grid sheets with remedy names and symptoms were, believe it or not, common. We were in our homeopathic infancy in those days. We rarely ventured out beyond the polycrest (forty-five or so “most commonly prescribed remedies”) and heard about the use of miasms to select remedies in obvious cases like patients needing Thuja, Medorrhinum, Tuberculinum, or Syphilinum. There was talk about using these miasmatic remedies as intercurrent remedies—in other words, in between the so-called constitutional remedy. I never prescribed that way because it didn’t really make sense to me. I would have to say, in retrospect, that we found the simillimum (one best remedy for the patient) only by effort and luck, and only periodically, in those early days.
Mumbai Changed Our Practice Dramatically
Having read The Science of Homeopathy by Dr. Rajan Sankaran in 1993, we realized how much we had to learn despite our previous training and a decade of practice. Rajan and his colleagues, having practically memorized the homeopathic literature and taken off from that point, were leaps and bounds ahead of us in all ways. We were humbled, inspired, challenged, impressed…. more than anything we were blown away. Older than these Indian homeopathic colleagues by a good ten years, and having been in practice ourselves about the same number of years, we were novices. Fortunately, that became patently obvious to us immediately on beginning our Indian training, and we became sponges soaking up this new method/material. I would say that we tossed out about 80% we had learned previously and start afresh. That included case taking, case analysis, breadth of materia medica, and potency selection. Our practice, our writing for the Townsend Letter, our subsequent books… all were affected and transformed dramatically by that course in Mumbai, by the eight other times we studied with Rajan in India, and by the many seminars in the U.S. and Hawaii that presented complementary material. Our understanding of patients, remedies, and the unfolding of the cases over time shifted radically. Many of our readers, colleagues, and students were as dazzled by the new information as we were. Those homeopaths who were committed solely to the previous methods, which called “the real Hahnemannian approach” were less impressed, and still are by Rajan’s new system. What one person considers avant garde and revolutionary, another considers heresy.
The Sensation Method and Miasms
Rajan’s Sensation Method has revamped, enriched, and made much more meaningful and practical the miasms. The masterful work written by our colleagues and friends, Nancy Herrick, P.A. and Roger Morrison, M.D. , Miasms of the New Millenium, has elaborated on this method beautifully. This book is so indispensible that I have a copy both in Washington and Chile. Rajan explains that miasms are indicators of the level of intensity, desperation, depth, perception, and pace of the patient’s state. He has also expanded the number of miasms, which progress from immediate to deeper as follows:
- Acute– Think life or death. Someone who perceives herself to be in sudden and extreme danger, do or die, at great risk. Remember that this is the perception of the individual rather than, necessarily, what is happening.
- Typhoid– A concentrated, intense, brief, do-or-die effort and struggle ending in exhaustion, collapse, burnout.
- Psora– Optimism, effort within one’s ability. Literally an itch.
- Ringworm– Trying again and again. Alternation between struggle and resignation.
- Malaria– The patient uses words like limited, harassed, miserable, stuck to describe this state.
- Sycosis– An inherent, unfixable flaw or weakness that requires hiding or covering up. The patient feels he must live with this unavoidably.
- Cancer– The task is insurmountable, beyond all effort, chaotic and requires a superhuman effort and perfectionism to achieve.
- Tubercular– A suffocative, intense, desperate, hectic pace leading in burnout.
- Leprosy– A profound feeling of being dirty, shunned, avoided, disgusted. The scarlet letter syndrome.
- Syphilis– All hope is lost. The situation is beyond survival. There is only destruction, withdrawal, suicide or death.
Rajan’s Schema method further categorizes remedies from many mineral, animal, and 33 plant families according to miasm. This is not definitive but rather a work in process. There are, of course, far more members of each kingdom to fit into any chart. But for me, since I have used this method for the past 25 years or so, as it has continually evolved, so has my use and comprehension of it. The system has allowed me to prescribe countless remedies with which I was previously unfamiliar. The following is one case, out of many, to bring meaning to this method in clinical practice.
Joe: A Case of Severe Depression
This patient has come faithfully for homeopathic care for 25 years. He worked as a manager for a utilities company until he retired a couple of years ago, but what he earned just covered his expenses. He has just enough resources to make ends meet so that he enough money to last for the rest of his life. He is now 65 years old and retired. I tried many remedies with this man over the years. I will summarize the case beginning 18 years ago. At that time, and for some years, I was giving Joe the remedy Chocolate, which actually belongs to the acute miasm. Even though I knew about miasms, I had somehow become confused in this case—just overwhelmed by Joe’s level of despair. It goes to show how a homeopath can miss the obvious, or, at least, the forest for the trees.
Joe: “I am feeling really isolated from people. All my friends are withdrawing. No one wants to be around me. I am not fit to be around. I just turned 54. I was told I’ll live a long time but, if I’m screwed up, I don’t know if I want to live that long. I take things to seriously. And I eat chocolate all the time. When I was younger it gave me mood swings. I was addicted to it and I still am. I feel separate. I’ve had herpes in the past and sometimes I still get an outbreak.
When I was in grade school, I’d be left out. My siblings would go off and I’d be left behind. Loneliness. I didn’t feel part of things. I had three siblings. My father was an alcoholic and fought with my mother all the time. My mom used to beat me up as a kid. She suffered from manic depression. There were times when she threatened to kill me. I never understood why she hated me so much. I actually felt sorry for her. I spent a lot of my younger years trying to get my parents to love me…. being a martyr. I’m told that I’m too hard on myself. I always think I’m wrong and that I don’t deserve love. I’ve been seeing a therapist off and on for years. I guess alienated is a good word to describe how I feel. Unloved. Unacceptable. Alone.
I get some neck, shoulder, and thigh pain. Like I’ve strained it. It started last year and chiropractic hasn’t helped. I’ve cried a lot recently. I tell myself that I’m alienating myself from my friends. That I don’t do a good job at work. The feeling of isolation didn’t improve much from the last dose of the Chocolate. I had chosen the remedy, Chocolate, a member of the Malvale family, whose members feel estranged and indifferent, along with Joe’s longstanding addiction to chocolate. I subsequently gave Joe Magnesium muriaticum, a remedy for profound loneliness, abandonment, and the feeling of being orphaned, alone in the wilderness. As well as a number of different remedies over the years, including Aurum metallicum, Thuja, and, once, Hura, which is a plant belonging to the Euphorbiaceae or spurge family. I was close but never found the simillimum for Joe at that time. I was, I hate to admit, all over the map with the kingdoms and miasms. But Joe was a loyal patient who stuck with me over time until I did find just the right remedy for him. It was many years ago that I did hit on the right family, Anacardiaeceae, but not the right remedy. It is embarrassing to admit my longstanding failure in Joe’s case, but, fortunately, it turned out, eventually, quite well.
I never measured up to what my mother wanted me to be. Even she couldn’t say anything nice about me. I don’t feel the worst I ever have felt. But I isolate myself and think there’s something wrong with me. That nobody likes me. I’m disgusted about my weight.
I get occasional episodes of diarrhea. I overwork. Long hours. I feel like a martyr but I rarely show my anger. Just to myself.”
Right Family, Wrong Miasm
Joe was extremely hard on himself. All of his anger was turned inward rather than to his family or to anyone else. The Anacardium, from the cashew family, covered Joe’s self-hatred, his extreme demand on himself in all situations (cancer miasm), his joint symptoms for which he received chiropractic care, and the periodic bouts of diarrhea. The remedy helped a great deal, helping to improve Joe’s spirits even dramatically at times. But there remained a tremendous self-reproach, even self-hatred that bubbled up often, to the point of his screaming at himself, either internally or aloud. Despite the Anacardium, this came whenever stress was intensified.
Joe was doing “well enough” and continue to have tremendous trust in me to help him. It was six years ago when it dawned on me that the Anacardium had been helping, but that Joe was clearly leprosy miasm, not cancer miasm. From the beginning of his life he had felt discarded, disgusting, like an outcast. Although I knew nothing about the remedy, I prescribed Comocladia, a member of the Anacardiaceae family but belonging to the leprosy miasm.
About the plant remedy Comocladia dentata: According to Rajan’s volume on plants: This is a remedy that covers leprosy. Mental rubrics include, “indifference, apathy to ordinary matters, malicious (with Joe, the malice was self-directed). And from a 2001 Indian proving of the remedy: “Tremendous sadness. She felt stuck, at a standstill, not progressing, not reaching anywhere, not going ahead… unable to think about the future, to see a ray of hope ahead. She felt like a failure… lost interest in life. Wanted to give up altogether. Indifference, total depression. She felt like nothing would change. She did not feel like talking with anyone, would avoid people.” The summary of the feeling in the proving (which has an Indian societal overlay, but still applies in Joe’s case): People from lower castes are stuck. They have to struggle a lot, but there is no progress. Other people may at least have relatives who are financially well off, but with lower castes, the cycle continues… there is no going ahead, no progress.”
Joe’s Long-term Response to Comocladia
As I typically find, to my great relief, after landing upon the simillimum remedy, Joe has done quite well for the past six years. I continue to have appointments with him every six weeks, since I am an important member of his support network. He has some relationship now with a sibling, still has a few close, long-term friends, and feels considerably more positive about himself and his life. He still has intermittent periods of anger directed towards himself, but to a much lesser extent than previously. Some excerpts from his follow-up visits over the past six years post-Comocladia:
“ I’m doing much better with sugar and chocolate. I’m walking every day. I’ve lost a lot of weight… I haven’t needed to take the backup remedy that I am holding… I have actually been having periods of elation and joy since my job is ending. Better than feeling crabby and alienating everyone like I’ve felt sometimes in the past.” He has been able to decrease his chocolate consumption much of the time, though he still has some temporary setbacks. Joe is generally more positive and less self-deprecating, and maintains a better outlook on life. Now that he has retired, he is spending more time with close friends and has been able to enjoy some traveling. Retirement has brought tremendous relief, though he still has to manage his money carefully. Over the past six years, he has taken three doses of Comocladia 200C, six doses of 1M, and four doses of 10M. We continue to have regular appointments, and he considers me an important support in his life. Joe is much happier, treats himself much better, eats chocolate periodically, and his physical symptoms are quite manageable. I sincerely wish I had known enough to find his simillimum earlier, but I am grateful that I have done so. Better late than never. Never underestimate the impact of miasms. Dr. Hahnemann was no fool!
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