One of the most controversial aspects of homeopathy is the theory of the chronic miasms. Originally postulated by Hahnemann himself as the answer to why, despite the law of similars, homeopathic remedies often failed to cure permanently, it was considered insane by even some of his closest followers, who dismissed the idea as the senility of his old age. Others have gone straight to the opposite extreme, contending that miasmatic theory holds not only the key to all human disease, but in fact all human suffering, likening Hahnemann’s psoric miasm to the Christian idea of original sin. While some well-known modern homeopaths have dismissed the miasms entirely, others have expanded upon the original three, adding new miasms or claiming that modern diseases are the result of the original three evolving over time. In part one of this blog, I will focus on just what the concept of miasm means in homeopathy and how it affects homeopathic prescribing. Next month, in part two, I will explore the nature of each of the four most common miasms in depth, with hints on how to detect their presence in a given patient.
To begin, the homeopathic miasm of a disease is not at all the same as the disease itself. One may speak, for instance, of treating the syphilitic miasm, but this is not to be understood as treating the actual disease of syphilis, an infection caused by the spirochete Treponema pallidum. While most of the miasms are associated with chronic infections, they are not to be thought of as a chronic infection. Rather, the miasm of a disease is a specific pattern of reaction that the body employs in an effort to maintain normal homeostasis, that is 1), dysfunctional and 2), inherited. According to the theory, an organism's struggle to survive with a chronic disease can permanently imprint the organism’s vital force, essentially biasing the body’s immune system and other self-healing mechanisms to cope with a specific form of stress. Furthermore, these imprints are heritable and permanent until the disease is cured. This means that if a parent is struggling with a chronic disease, the miasm will be imprinted on the parent and passed down to the children, who will have the miasm but not the original disease. The problem then becomes how to get rid of the miasm in the child, since one cannot cure the child of the original disease, which is not there.
Because a homeopathic miasm is considered an acquired trait that can be passed to offspring, which cannot be explained by genetics, the best explanation for the supposed phenomenon is epigenetics. Basically, the “disease imprint” that one can inherit is stored in the epigenome, consisting of epigenetic changes meant to handle the original stress. The good news would be that unlike a true genetic disorder, these changes would be reversible, and traditional homeopathic theory contends that certain remedies have the ability to do this.
While homeopathic miasms remain an unproven theory, their existence controversial even among homeopaths not to speak of conventional medicine, there is scientific evidence that the stresses faced by our ancestors can cause heritable disease. The best-known case of this, which serves as a model for understanding epigenetics, is the Dutch Hunger Winter of 1944. What happened was this: near the end of WWII, food shortages prompted the Nazis to severely ration food in the occupied Netherlands, creating widespread famine. Numerous people were forced to live for months on 1000 calories or less. The following spring, the war ended and allied forces abruptly ended the famine with relief aid. Amazingly, children born to mothers who were pregnant during the famine were more likely to develop obesity, diabetes, and heart disease later in life when compared to their peer group, born to mothers who got pregnant immediately after the famine. Because the famine’s unique circumstances created such a well-controlled natural experiment, two populations could be compared that were nearly identical except for the fact that their mothers starved during pregnancy. Not only were the offspring of starving mothers more likely to become obese, their own children were more likely to have the same problems. This suggests remarkably that famine can induce epigenetic changes to help an organism survive food shortage, which can be passed to children and create the opposite problem if those children live in an environment with plentiful access to food, namely obesity and metabolic disease.
It is frightening to think that one might be programmed towards obesity or other diseases as a result of the hardships faced by one’s ancestors. The homeopathic miasm theory essentially broadens this concept to include chronic diseases among the stressors which affect us epigenetically. Say an ancestor had tuberculosis, and her body made epigenetic changes to help it survive with a permanent lung infection. If she proceeded to have children while still sick with tuberculosis, or if her disease had been meanwhile suppressed to its latent state without truly being cured, her cells would maintain those epigenetic changes and pass them along to her children. The result might be that her children inherit a hyperreactive airway and develop coughing fits in response to harmless triggers like pollen and cat dander. In other words, the children react to the world in a way that makes sense if they’re struggling to survive with a tubercular lung infection, but makes no sense in any other context, and so becomes problematic to future generations who do not have tuberculosis.
Samuel Hahnemann, who developed this theory, did not suppose that every disease was capable of inflicting a miasm. He posited only three chronic miasms, each based on a chronic disease that has long afflicted humanity. His three miasms were Psora, from the skin infection scabies, Sycosis, from genital warts, and Syphilis, a disease which was frequently lifelong in the era before antibiotics. In his mind, a disease could only impose a miasm if it had the ability to become chronic or latent; typhoid fever, for instance, was not considered to be miasmatic, for the reason that it results in either a permanent cure or death, so could not become chronic enough to produce so deep an effect. On the other hand, the modern homeopath Rajan Sankaran has suggested there is a typhoid miasm, in fact expanding Hahnemann’s three to ten. It has also been claimed that the miasms evolve from each other: Hahnemann held that both Syphilis and Sycosis could not become chronic without underlying Psora, and later homeopaths considered all three of them required to produce the tubercular miasm. Regardless of which theories are correct, in clinical practice miasms are always addressed one at a time, beginning with whichever is identified as the dominant one.
The clearest way to determine a patient’s miasm is to review the individual’s past medical history and family medical history. For instance, if a patient had a badly treated case of syphilis ten years ago that was suppressed with mercury and potassium arsenate, that would be a clear indication for the syphilitic miasm. In Hahnemann’s day this was a commonplace occurrence, and while there are still cases today of patients acquiring miasms from actually having the disease in their lifetime, it is far more likely that the miasm originated in the family medical history. An example that would be relevant today might be a child with developmental delay and a history of frequent chest colds, who does not respond to classical remedies. If it were to be discovered that the child’s great-grandparent died of tuberculosis, this would suggest that the child has the tubercular miasm. In other words, whenever there is a personal or family history of the miasmatic disease, that will likely be the dominant miasm affecting the case.
The limitation of this approach, of course, is that patients may not know their family history. Especially since two of the most common miasms, sycosis and syphilis, are associated with sexually transmitted diseases, it may not be known by the family that an ancestor had this. Or, the simple passage of time may obscure the original disease. The theory of miasms in homeopathy contends that they can be passed down indefinitely, and in fact Hahnemann argued the Psoric miasm affects mankind universally due to the thousands upon thousands of years of skin diseases being suppressed by external treatments. One of the simplest traditional treatments for rashes and skin eruptions is clay, which was available to even the most primitive humans, and was likely used to soothe itching in ancient times. According to Hahnemann, such treatment is dangerous because even if it works, it suppresses the symptoms and imposes a chronic miasmatic state on the patient. Clay is primarily aluminum oxide, and Hahnemann conducted a homeopathic proving of Alumina that suggests it may suppress itching by damaging the nervous system, long before Aluminum was recognized to be neurotoxic.
It is actually quite rare these days to discover in a patient’s family history any one of the diseases thought to lie at the root of Hahnemann’s original miasms. Hygiene has eliminated much of scabies, syphilis died down by the 18th century, and effective antibiotics have dramatically reduced cases of chronic gonorrhea. Tuberculosis was rampant during the 19th century and so is somewhat more likely to be remembered, but how does one determine the presence of a miasm in the absence of family history? Hahnemann’s approach was to generalize the chronic symptoms of each inherited miasm, which he apparently deduced by studying hundreds of years’ worth of medical literature, and then look at the miasms each as a specific pattern detectable in the patient’s totality of symptoms. For instance, a pattern of tissue destruction would imply the syphilitic miasm, whereas a pattern of tissue overgrowth would suggest the sycotic miasm. This is the approach most commonly used by miasmatic prescribers today. Once a miasm’s pattern is learned, it can be recognized in a patient’s symptoms and treated accordingly. In next month’s blog post, I will explore these patterns in greater depth.