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Encyclopaedia Homeopathica

SANKARAN R., The Substance of Homoeopathy (sk2)


SANKARAN Rajan

Introduction Introduction
As students of Homeopathy we found the whole system quite confusing - we could see no system, no order. There were many schools of thought and practice. Many rules, dogmas and habits took over where there was a lack of understanding of the principles of the Materia Medica. Our results were consistently poor, yet the occasional brilliant cure convinced me that there was some explanation to such success which, once understood, would allow us to repeat the process with similar results. Studying these successful cases, I tried to understand the main idea behind Homeopathy. This took me on a fascinating journey, leading to a new understanding of health, disease and cure, and this forms the basis of my previous book "The Spirit of Homeopathy". In it, I have explained the concept of disease as a delusion, and how this idea can be applied in practice to heal. The book has become quite popular and many colleagues have reported that they found the ideas very useful in practice. This was only the first step, however, many things had yet to be explained. For the same patient, different homeopaths prescribe entirely different remedies. I had thought initially that this was due to differences in case-taking. But even in seminars where I took cases in front of the audience, and all could observe the same, there were at least twenty different suggestions for the same case. Which meant to me that we were still prescribing on symptoms; each would take some symptoms or some idea and come up with some remedy. There had to be a way, I felt, whereby all could arrive at a small group of closely related remedies, if not the same one. There was a need for a map to chart our way in this ocean of drugs and disease. My effort in the passed two years have been in this direction. I had already developed my concept of disease as delusion, and now wondered if disease states could be classified. I somehow saw such a possibility through Hahnemann's idea of miasms. The idea of miasms, which I had discarded earlier as unimportant for practice, suddenly struck me as a most useful tool to classify disease states. I interpreted the miasms using my understanding of disease as delusion, and the result, I find, is a classification of the most practical utility. Miasms now represent to me the different possible types of reaction, which naturally mean the different types of perception of reality. One type perceives reality as an acute threat and reacts instinctively and suddenly in an impulsive manner. This is the acute miasm, as I have termed it. In psora, reality is seen as a problem that can be solved by a struggle. In sycosis, the problem seems insoluble and the reaction is an attempt to cover-up this inability to cope. The syphilitic perceives the situation as a hopeless, desperate one and becomes destructive as a result. I found that disease states could be beautifully worked out on this framework and the patient understood better; it became easier to arrive at the remedy. To make the process more accurate, more points were required on this map. I worked on other miasms in between the main miasms, and discovered the subacute, ringworm, malarial, leprous, and cancer miasms. These, together with the tubercular miasm, provide a valuable map to study disease. To verify the truth of my hypotheses, I undertook to prepare and prove the Ringworm nosode and also did a proving of Bacillinum. The provings further substantiated what I already found in practice - that the idea of miasms was valid and most useful. The concept of miasms not only helped deepen my understanding of disease processes but also gave me insight into other phenomena in the world around, as for example, the reason for the increase in "new diseases". I am very happy with this discovery. But this was not still enough. The substances that make up the homeopathic Materia Medica had to be understood deeper and if possible, classified and mapped out, just as we have mapped disease states. I got my first hint while preparing a lecture on Argentum metallicum. I noticed that the symptoms of this remedy reveal the qualities of performance and show (e.g. troubles of speakers, singers, preachers, etc.) which I could readily relate to silver itself (silver tongue, etc.). Silver is for show! Similarly, Aurum metallicum (gold) also has a strong theme of performance (Responsibility, Industrious, Conscientious). I wondered if this theme was common to all metals. After studying the metals one by one, I was convinced that all the metals have in common the theme of performance and Copyright 2000, Archibel S.A.

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defense - which, in everyday life too, is their function! This drew my attention to the Periodic Table, which I studied with keen interest. I found that as the metals got heavier (atomic weight), their performance increased in degree. Moreover, closely related remedies were placed in the same group of the Table. E.g. , Palladium and Platinum, two well-known complements in Homeopathy, are placed in the same group - Platinum, the heavier one just below Palladium. I then started studying other elements in the Periodic Table and found a common theme for the cations, another for the anions and then for the salts and acids. There were some elements that could not be understood in their essence from the available proving records; these I decided to prove myself. With some students and colleagues, I conducted a proving of Ferrum metallicum and later, of Iodum. These provings deepened my understanding of these remedies and also of the Periodic Table in general. I studied the well-known idea of using remedies by studying their component parts (e.g. Magnesium and Sulphur in Magnesium sulphuricum) and developed it further. I found that the components of a salt do not just coexist, but there is an interaction between the component ions and an understanding of the ions and their interaction enables us to deduce the possible state of drugs. This is useful even with the old, frequently used drugs, but especially so with the lesser known and poorly proven ones. I put this idea straightaway to test in practice with the most gratifying results. At this point, I met Jan Sholten from Holland who had been working along similar lines. His work confirmed and added to my findings. After studying the minerals, I turned my attention to the animal kingdom. With my friend Jurgen Becker I held a seminar in Bombay, where we proved Naja, the Indian cobra. This proving encouraged us to study snakes in general and we started using other snake remedies like Crotalus cascavella, Crotalus horridus, Vipera and Elaps corallinus based on an appreciation of the quality of a snake, with finer differentiation to decide which one in particular. Having found a theme common to snake remedies, I went further and try to discover if there was a common theme in the entire animal kingdom - there had to be, for animals have distinguishing qualities. Thus I came to my simplest and most important discovery, viz. the differences between remedies (and patients) belonging to the different kingdoms - Plant, Animal, Mineral, Nosode. This discovery was built gradually from observation of several hundred patients and confirmation in several others. These observations of natural phenomena have formed a beautiful map of remedies which, if well understood and correctly used, makes our task so much simpler. The study, however, revealed more clearly than ever the deficiencies in our Materia Medica. There are few well-proved animal remedies and many of the elements in the Periodic Table remain to be proved. It is heartening to find that colleagues like Jeremy Sherr are actively taking up this task. I have found my own knowledge of botany rather poor and hence could not easily link plant sources to the remedy provings. I wish to undertake a detailed study of this shortly, but have for now given in the section on plants some general directions towards this vast kingdom. There is so much to learn still and ignorance is no bliss - it allows the mind no rest. In a seminar in California, I decided to prove Cannabis (in potency, of course) with colleagues. The proving was most rewarding; not only did we learn much about Cannabis, but also made a startling observation. The most characteristic symptoms of the drug was produced in a woman (seminar participant) who had not taken the proving dose! She developed symptoms that she had never experienced before in her life, and these coincided with those who had taken the dose. A similar phenomenon was observed again at the Spiekeroog (N. Germany) seminar, where Bacillinum was proven. The best provings were from those who had not taken the dose. This is enough to set the mind thinking for a long time. In "The Spirit of Homeopathy", I talked about Homeopsychoterapy, i.e. presenting the image back to the patient instead of giving the remedy, in order to bring about awareness in health. This had already demonstrated to me that the homeopathic stimulus need not be in a drug form. I have now chosen another medium - one close to my heart - music. Music can affect the state of mind and produces moods. Why, then, can it not be used curatively on the homeopathic principle? This thought resulted in the music provings, where we proved four tunes (Indian ragas) on large audiences at different places. The results were remarkable, and I think that these proved ragas can be used effectively on the homeopathic principle as music remedies. I had found some aspects of homeopathic philosophy rather puzzling, and the solution, I felt, had to be of great significance. For instance, when does a state crystallize into organic tissue changes? An interesting observation made in a case provided the clue to the answer. I believe my idea on "state and pathology" will be of immense value in practice. These theories and experiments, ideas and experiences, have all helped me to grow as they developed. Though I realize that this is but one step forward in a long journey, even a little ray of light is most encouraging to a mind in darkness and gives impetus to the movement. I wanted to share all these experiences with my colleagues at this stage, and hence this book. I would like the reader to be with me at every step, and therefore urge him or her to read first "The Spirit of Homeopathy" after which this book will be much easier to understand and follow. Copyright 2000, Archibel S.A.

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Finally, while the study of symptoms forms the bedrock of our practice, the ideas in this book will help expand the possible applications of the law of similars. It affords a new view of the world where Homeopathy is brought closer to other branches like Chemistry, Botany, Zoology and Music. As we take each branch of knowledge and move inward, closer to the stem, we are able to relate to the other branches. Once at the very stem, the differences between the branches disappear - we have reached the point of origin of all the various branches, and we are now free to take any of them. I hope this book initiates your movement towards the stem of knowledge, just as the ideas in it have done for me.

The story of this book


(taken from "the spirit of homoeopathy")
The purpose of this introductory is to lead the reader from the ideas expounded in "The Spirit of Homoeopathy" to the most recent developments in my understanding and practice of Homoeopathy. This introduction (intro: into; ducere: to lead) is essential to those who have not read the earlier book and will serve as a revision to those who have already done so. I have thought it best to give some excerpts from "The Spirit of Homoeopathy" as a summary of that book, but would advise the reader to study the book itself and familiarize himself with the concepts detailed therein.
As students of the Homeopathic College, we found the homeopathic Materia Medica very dry, the Repertory mechanical and the philosophy theoretical and obsolete. In fact, philosophy was our worst subject because we could not relate it in any way to practice. We found the lectures so boring that we had literally to be dragged into them This was just the beginning of our troubles. When we started our practice, we found different schools of thought, different ways to look at Homoeopathy. Some practitioners were giving combinations of medicines, some were giving specifics, some were looking only at pathology, a few were basing their prescriptions upon keynotes, and others were using the Repertory. Among the last group some were using Kent's method, others worked with Boger's, and a select few were following Boenninghausen's. Some gave importance to miasms while others criticized them. This situation only added to our confusion.

First steps
Once I got out of college, I started working with the Repertory because of prior familiarity with it and I started repertorizing cases mechanically. I was trying to use the characteristic and peculiar symptoms mainly because there are less remedies in these rubrics which made repertory work easier. I would choose a few characteristic symptoms, look at the relevant rubrics in the Repertory and prescribe the medicine which was common to them. In some cases it worked, but in many it failed. I remember one early case of mine: my grandmother had difficulty in swallowing and I took her symptoms: "Potatoes disagree" and "Choking, esophagus, on swallowing", and from these I came to the remedy Alumina, which helped her wonderfully. However, in many cases this approach failed, and so I poured all my energies into the search of a method which would prove a success in every case. I knew that the clinic was the best laboratory I could find and the scientific mind the best tool. The one principle I have adhered to throughout is to use only one remedy or therapeutic method at a time, and I have tried to keep everything else constant as far as possible. This has helped me a great deal in validating my observations.

Precedence of mentals and generals


Together with my colleague Dr. Jayesh Shah, I started studying our cases of success and failure. What became quite obvious was that those cases in which we prescribed on mentals and generals were much more successful than those in which we had relied upon particular symptoms or used pathology as the basis for our prescription. We looked at this idea purely from a practical point of view without really understanding the reason for it, and started trying it out cautiously in some of our cases. I still remember an early case of "vitiligo" (given in detail in the chapter Central disturbance). I could not get any symptoms from this lady except for my observation that she was a very humorous and talkative person. Also, she was warm blooded and liked to walk in the open air. Repertorizing the symptoms, a) "Loquacity with jesting", b) "Walking in open air ameliorates" and c) "Warmth in general aggravates", I found the remedy Kalium iodatum. However, Kalium iodatum was not even mentioned under the rubric "Skin, discoloration, white spots". I was in a dilemma - Will this remedy work? So far, we had been selecting a remedy based on mentals and generals but we also made sure that the remedy covered the local (presenting) problem as well. This was one of the first cases where the pathology was just not covered. I decided to Copyright 2000, Archibel S.A.

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take a chance by ignoring pathology and gave this lady Kalium iodatum. The remedy worked beautifully. I started asking some questions. Why did it work? How did it work? How could the remedy cure something which is not known to be capable of causing or curing? What was the principle involved? At this time, I suddenly realized that when a remedy is potentized beyond 12 C, there is not one molecule of the original substance left; what remains is only energy. Since there no material substance left, it cannot cause any material changes in the body directly. It can cause no physical, physiological or chemical changes in the body; it can only cause dynamic changes. The sentence that came to my mind was: Potentized remedies have dynamic effect only. This sentence was the door to a totally new look at Homoeopathy and my first step to real understanding of disease. What exactly is a dynamic disturbance? This was the question. We had seen in our practice that a remedy that covers the mentals and generals cures the pathology, even if it is not mentioned in the Materia Medica. We found that in patients, it is the mentals and generals that are common to most patients of a particular remedy, whereas the "particular" or local symptoms differ from person to person.

Central disturbance
So, the general disturbance (represented mainly by mentals and generals), the central disturbance as we called it, comes first and this is followed by changes in the various organ systems depending upon each individual's pathological tendencies. Pathology grows on the central disturbance like a creeper on a stick. What we have to do is to remove the central disturbance.

Components: rubrics connected by a situation


My understanding progressed further when I started asking the question: What is a mental state? I then got the clue, that understanding the mental state of a person is different from listing his mental symptoms. Initially I tried to understand the mental state of patients and remedies in terms of essences or cores, but found that the core did not seem to cover the whole remedy. That is the time when I conceived the idea of understanding remedies in terms of components. Take for example the symptom "Predicts the time of death" in the remedy Aconitum. Immediately two things become clear: one is that Aconitum has fear of death, and secondly it has the ability to predict (clairvoyance). These two components together make the symptom "Predicts the time of death". In this way I started studying remedies as a characteristic combination of components. This idea helped me greatly in practice, but then came the question: Are these components merely unconnected phenomena or is there something in the background which connects them? A hint of the existence of such a background connecting the symptoms can be seen in the study of Fluoricum acidum. In Fluoricum acidum, there are components like "Indifference to loved ones, yet talks pleasantly with strangers", another component is "Increased sexual desire" and a third is "Lack of morality". If we look at these three aspects, they seem at first sight to be unconnected. How, we could ask, is increased sexual desire connected with indifference to loved ones? One situation can explain all these components, namely, when a man finds that he has married someone totally unsuited to him, and needs to dissolve the marriage. In such a situation he needs to develop an indifference to his family, to become irresponsible and have increased sexual desire along with sociability. I looked into the Repertory and found the rubric: "Delusion, marriage, must dissolve", and the only remedy given is Fluoricum acidum! Such observations created a new wave of thinking in my mind and I postulated that components of a state are not unconnected; the connection is that all of them are needed in one particular situation. A corollary to this is that each remedy represents a particular situation and that each patient's state also comes from a particular situation in the past in which the components of his present state were necessary. From these observations the idea of disease as being a survival mechanism in a particular situation became clear. The concept of Situational Materia Medica was born.

Root of disease
As thinking along this line progressed further, I saw that even children (with no special past situations) have states, and that adults too have states which cannot be explained on the basis of past situations in their lives. I came to the conclusion that these states may have been inherited from earlier generations. When I looked at cases in this new light, I found a very striking resemblance between the state of the mother during pregnancy and the state of the infant. I also found similarities between the state of the parents at the time of conception and the state of the child. This is how Copyright 2000, Archibel S.A.

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the idea of roots of disease developed. Roots are tendencies which, when excited, manifest as specific states of disease. These tendencies are impressions from specific situations in the past (or from previous generations) and make a person feel and react as if he is in that situation (delusion).

Delusions: what they really mean


I also realized the importance of the section on delusions, because a delusion is a false perception of reality, and disease too is a false perception of the present. The whole mental state of a person is an expression of this false perception (delusion).

Understanding the mental state


With all this understanding, I tried to find more ways of understanding the mental state of a person and evolved some techniques. One was to use dreams since the theme of a dream represents the prominent components of the state of the dreamer. I also studied the way the patient expresses himself and how he relates to the people around him. Such techniques became an integral part of my practice. With new perceptions in my practice, many ideas were generated. These include ideas about remedy relationships, the Situational Materia Medica of several remedies and ideas about pathological and homeopathic prognosis. Much more importantly, however, I could look at the question of what it really means to be healthy. This could be related not only to Homoeopathy but to Philosophy in general.

Higher purpose of life


Health, I realized, was man's freedom to be in the moment and fulfill the purpose of life. I could not appreciate Hahnemann's vision that man, like all creatures, is an instrument of the spirit and is assigned a specific purpose by it (Aphorism 9 of the Organon). Disease comes in the way of the organism's ability to fulfill this purpose, since it doesn't allow man to react to the present. It makes him react according to a situation from the past. Cure is restoration of health. It is achieved by man becoming aware of his false perception of reality. This is made possible through exposure to his delusion. This is the basis of the law of similars on which Homoeopathy is founded. Practice became more simple; Materia Medica came alive and repertorial rubrics took on a new meaning. Philosophy, which earlier we had to be dragged into, became one with the spirit of life itself.

Sharing insights
Each chapter deals with a specific question. Each idea in this book seems so obvious to me now, but to get to it was a struggle. In practice an idea or question would flash in the mind. Then came sleepless nights while the mind grappled with the problem. Some solution would appear and this had to be tested the very next day case after case. Practice, a strict and impartial judge, mercilessly shatters some of your most carefully constructed theories. The ideas that stood the test of practice were subjected to further scrutiny; further observations were made and then I could go to the next step, just like a mountain climber who makes sure of his foothold before going higher. Step after difficult step I came closer to the understanding of Homoeopathy. I wanted to share all these insights with students who might face the same difficulties that I did. It was with this aim that I gave a series of seminars in Europe and India between 1986 and 1990. I had made some notes for these seminars which, together with some more recent insights, I have now put together and given shape to in the form of this book. It is possible that what I say may not be new - but to have knowledge of and, on the other hand, to actually experience and strongly feel something as correct and true are two very different things. Generally, most classical homoeopaths would agree with the ideas in this book. However, some of the ideas are new in Homoeopathy or at least are not stated so clearly and pointedly elsewhere. This include the ideas of roots of disease, components of mind, importance and use of delusions and dreams, compensated and uncompensated feelings, homeo-psychotherapy and Situational Materia Medica. My view of remedy-states and understanding them through the situations from which they originate promises to be the basis of a new Materia Medica, of which I have made a beginning through this book. If you read through all the chapters, I think that you will get a fairly accurate view of my thoughts and approach. As each chapter was written independently, there is bound to be some repetition and a lack of sequence. I must also add that Copyright 2000, Archibel S.A.

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even though my perception of Homoeopathy has become much clearer, still I have the feeling of having seen only the tip of the iceberg. I therefore make no pretence that this book is either complete or final. At best, I can say I have made an honest attempt to tell you the story so far. My aim in doing so is to stimulate the reader to make his own observations and develop his vision. I am confident that in doing this the wonderful spirit of Homoeopathy will touch you. Truth has the quality of striking deep within.

What is to be cured in disease


(adapted from chapter 9 of "the spirit of homoeopathy")

Vital to developing the homeopathic vision is the understanding of what is to be cured in disease. It is to be able to perceive, to feel and to know as the truth that disease is not something local but a disturbance of the whole being. It is to have the unshakable conviction that if we treat the disturbance at the centre, the local problems will be lessened. It is to understand that remedies in potency produce the central disturbance alone. These points need to be stressed repeatedly, explained and exemplified so that they become a part of our thought process. This and only this conviction can make us staunch and successful homeopaths and remove from our minds the confusions that arise in practice. This vision will make several things clear, and the rules and principles of Homeopathy will become absolutely logical derivatives and no longer remain dogmas. Questions about the importance of mind, the differences in the various approaches to totality, the evaluation of symptoms, the importance of pathology, the site of action of a remedy, selection of potency and the prognosis of the case - all these questions will be solved quite easily once this vision develops. It is for this reason that I am writing this. We are going to begin with one of Hahnemann's most profound observations which he mentions in Aphorism 211 of the "Organon", namely that the mental state often chiefly determines the choice of the remedy. We are going to examine what a mental state means. We are going to talk about peculiar and characteristic symptoms and how they too represent the central disturbance. We will see the oneness of Kent's, Boger's and Boenninghausen's philosophies. We will use case illustrations to bring home all that we have said. Aphorism 211 from the "Organon" reads: "This holds good to such an extent, that the state of disposition of the patient chiefly determines the selection of the homeopathic remedy, as being decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician." Look at the words. It says "the state of disposition", "the state" and not the "symptoms". Hahnemann did not write "this holds true to such an extent that mental symptoms determine the choice of remedy". Try to understand. He did not ask us to record the symptoms. He asked us to understand the "state" of the patient's mind. Don't write "Contradiction, intolerant of", or "Dictatorial", these are all mere symptoms. Understand the state of mind from which these symptoms come. If you look at the symptoms you will be led to many remedies. But if you look at the state, there will be only one. Every remedy has a different state of disposition. Aphorism 212: " The creator of the therapeutic agents had also had particular regard to this main feature of all diseases, the altered state of the disposition and mind, for there is no powerful medicinal substance in the world, which does not notably alter the state of the disposition and mind in the healthy individual who tests it, and every medicine does so in a different manner." Each remedy has a peculiar state of mind which is characteristic to it. Each remedy produces a state. Each patient has a state of mind. If you compare symptoms, you will be lost in the jungle. If you understand the state, you will find that there is only one remedy which produces that state. Aphorism 211 says: "The state of disposition being characteristic, which can least of all remain hidden from the accurately observing physician." Look at the words. We say mental symptoms are most difficult to get, and Hahnemann says, "it can least of all remain concealed"; from whom?, "from the accurately observing physician". The word is observing. If you are able to observe, no patient can hide his mental state from you. He never wrote, "it can least of all remain hidden from the accurately enquiring physician". The physician is an observer. Mental state has to be found mainly by observation, and not by enquiry. You have to look, you have to see, you have to understand and you have to feel the state. You have to experience the Copyright 2000, Archibel S.A.

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experience of the patient. This is the art of case-taking, especially with mental symptoms. It is not just not asking questions like "Are you angry? Are you sad? Are you depressed?" A remedy that covers the mental state and general symptoms of a patient has got a greater possibility of curing than the one that covers the particulars without covering the mentals and generals. This is one of the lessons I have learned from practice. In so many cases I have prescribed on mentals and generals, missing the particular symptoms in the Repertory, and I have been successful. But when I tried the reverse, I have always failed. If a remedy covers the particulars, without covering the generals and mentals, it is bound to fail. Most of you will agree with me, that the two principles that I have given are not entirely novel. They have been emphasized by many masters and teachers of Homeopathy. Now, what is the explanation for these observations? The explanation is the key with which many doors of our philosophy can be opened and the key to reduce the differences between various approaches and schools of thought in Homeopathy. One of the principles of Logic is that controversies arise out of ignorance. When there is knowledge, there is no quarrel, because truth is one. So in persons who seem to be knowledgeable, but who quarrel, there must be ignorance. We will try to resolve the conflict between the various schools and one explanation will resolve many of them.

Know what is curable in disease


In the third Aphorism of the "Organon", Hahnemann describes something very fundamental. The third Aphorism is perhaps one of the most important of the "Organon". He says: "If the clinician clearly perceives: - what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), - if he clearly perceives what is curative in medicines, that is to say, in each individual medicine (knowledge of medicinal power) - and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient, so that the recovery must ensue - to adapt it, as well in respect to the suitability of the medicine most appropriate according to its mode of action to the case before him (choice of the remedy, the medicine indicated), - as also in respect to the exact mode of preparation and quantity of it required (proper dose) and the proper period for repeating the dose - if, finally, he knows the obstacles to recovery in each case and is aware of how to remove them, so that the restoration may be permanent, then he understands how to treat judiciously and rationally, and he is the true practitioner of the healing art." Get the meaning of it: "If the physician, clearly perceives, clearly understands what is to be cured in diseases". Does this make sense? Diseases have to be cured. Hahnemann writes in his first and second Aphorisms: "The physician's high and only mission is to restore the sick to health, to cure, as it is termed. The highest ideal of cure is rapid, gentle and permanent restoration of the health or removal or annihilation of the disease in its whole extent, in the shortest, most reliable and most harmless way, on easily comprehensible principles." Cure is removal of disease. So, the disease has to be cured. Then why is he writing in the third Aphorism, what is to be cured in disease? I consider this word "in" to be very important. The person who knows what is to be cured "in disease" will succeed. I am stressing this point again and again because it needs to be stressed. If we have a clear concept of what is to be cured in disease - we will cure. If we don't, we will not cure. Step by step we are going to use logic to try and find the answer to this question. The first is Aphorism 116: "Some symptoms are produced by the medicines more frequently - that is to say in many individuals, others more rarely or in few persons, some on very few healthy bodies." This refers to provings. When a remedy is proved, it produces some symptoms which are common to all the provers, some symptoms which are common to some of the provers, and some symptoms which are the symptoms of the individual provers. This means that a drug when given to 100 provers will develop some symptoms which are common to all of them, some which are common to 30 or 40, and there will be some symptoms that only individual provers will produce. Now, which are those common symptoms, that all provers will produce? If you read the Materia Medica Pura, in the introduction to Bryonia and Rhus toxicodendron, Hahnemann observed that whoever be the prover, whatever be the symptom, Bryonia will be aggravated from motion and Rhus toxicodendron will be ameliorated by it. These are pure data of observation.

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Mental state versus mental symptoms


This means that general modalities are common to all provers. In Aphorism 212, we have already read that all remedies produce a mental state in all provers which is peculiar to that remedy. Whoever be the prover, Aconitum will produce violence in the mind, Stramonium will produce terror and Pulsatilla will produce a tearful disposition. Hahnemann writes of Aconitum that it cannot be given to a calm person. So, the second thing a remedy produces that is common to all provers is "a mental state". I am trying to point out that having mental symptoms doesn't necessarily mean that the mind is affected. Mind is a state which is produced in all diseases, and in all the provers. The centre has to be captured first. This is the law of disease. There can be no affection of the parts without the affection of the whole. There can be no disease in the organs without central disturbance. Our medicines are potentized. This means that there is no material dose remaining in them. There is no physiological effect. Digitalis has an effect on the heart in physiology not in Homeopathy. In Homeopathy, Digitalis potentized becomes a dynamic agent that causes a central disturbance at the level of mind and generalities first, and then if there is tendency to heart trouble then it will be affected; and if his prostate is susceptible, this will be affected; if his liver is a weak point, it will affect his liver and if he has a tendency to insanity, he will become insane. Digitalis no longer remains a heart remedy. Kent writes that it is one of the best remedies for prostate. Somebody writes that it is a good remedy for liver troubles and jaundice. Somebody else writes: "Vertigo from hunger is Digitalis." Digitalis is not vertigo, not heart, nor liver, lung or spleen. Digitalis is a dynamic disturbance, which it produces in all provers. The term local remedy when it is used for a potentized drug is a misnomer. There are no local remedies when they are potentized. It is clearly written in "Organon" that remedies have dynamic effects only. Potentized remedies have dynamic effects only. There is no physiological, no pathological, no organic effect. A well-proved remedy, if proved further, will give you many more particulars, but not as many more generals. All the particular symptoms for which you are searching can be missing. Kalium iodatum was not proved nor given as a remedy in a person who had a tendency to leucoderma. Therefore you missed it, but the craving for motion in open air, bilaterally symmetrical affections, and the state of mind with loquacity and jesting were produced in most of the provers. Therefore, if a remedy clearly produces mentals and generals, you can assume that if proved in a susceptible person that remedy would have produced the same particulars (local effects). But if you see a remedy that produces particulars, can you assume that it will produce the same mentals and generals? Impossible. Because it had the opportunity and it did not produce them. That is why we say, the remedy that covers mentals and generals has got much greater possibility of curing, than one that covers particulars without covering mentals and generals. It is the central disturbance that comes first, and then this central disturbance will go and act upon those organs which are more susceptible, but with the modus operandi (type of characteristic action) of the central disturbance. So, does the modality represent the central disturbance or the pathology? The peculiar modality represents the central disturbance and not the pathology. The peculiar modality will show you who is the culprit, the cause, Arsenicum or Phosphorus. Suppose your house is susceptible to robbery and the robbery has taken place, does this information give you the name of the culprit? No. The way in which the act of robbery was executed will give you the name of the culprit. The modality will give you the identity of the fellow at the centre who is causing all this trouble. The name of pathology will only point to individual's tendency. What is to be cured in diseases? It is the central disturbance that has to be cured in diseases; and not the pathology. That is the secret. I like to compare disease to the Mafia. The Mafia Organization (we may assume) is governed by certain definite rules and principles. The first rule of Mafia is: Only one don can rule at the centre. Unless the don controls the centre, he cannot act on the periphery. The reverse is not applicable. They will not allow a second godfather to operate; there will be only one godfather, and he has to control the centre, otherwise he cannot operate his smuggling and other rackets. Once you cure the central disturbance, then its aggravating influence on peripheral pathology will disappear. Once you remove the central disturbance, once you remove the P.N. E.I. (Psycho-Neuro-Endocrino- Immunological) disturbance, its aggravating influence on the peripheral pathology will automatically disappear. If you remove the Mafia boss, all the smuggling and other activities will automatically stop. Try and stop the smuggling locally, and nothing will happen. Try to stop the drug racket and it may stop for the time being, but it will come back again. But if you identify the boss and hit him on the head, then everything will stop. As long as you handle particulars as particulars, you will not succeed. The moment you catch the central thread of one remedy, the central thread of the patient, his P.N. E.I. disturbance, everything will become clear. Copyright 2000, Archibel S.A.

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The other thing that becomes clear is that since there is only one central or P.N. E.I. disturbance, all the four systems must indicate the same remedy-state. That means, if a person has a mental state, you cannot prescribe on it alone. You must expect concomitants in the neuro-endocrine-immunologic systems. If you have a nervous symptom, you cannot prescribe on it alone, unless there is no contradiction at the level of mind-endocrine-immunologic systems. To summarize, we have to focus in every case on the central disturbance. It is the factor behind all local problems. It can be identified especially from the mental state and general symptoms. The local peculiarities are also indicative of the nature of the central disturbance and hence can be generalized (Boger). The central disturbance being the same all over, we can find its indications concomitantly in more than one sphere (Boenninghausen). The easiest way of identifying it (especially in illness with bodily pathology) is to understand the mental state (Kent).

The natural classification of diseases Historical perspective


As long as man has known disease he has strived to attribute it to some or the other cause, trying to find some order in these onslaughts on his health, attempting to classify them - such classification offered a feeling of security against the unknown. The peculiarity of the homeopathic system of medicine - distinctive from all other schools - is that it enables the physician to approach even unknown pathological conditions with reasonable certainty of finding a remedy for the patient. Thus a classification was not, for a long time, deemed essential by Hahnemann and other pioneers of Homeopathy. However, in a large number of chronic diseases, Hahnemann found that: "The disease would continue to progress, the remedies employed would do little or no good, and the disease increased from year to year... even when the treatment was apparently conducted strictly in accordance to the doctrines of the homeopathic art as hitherto known. Their commencement was cheering, their progress favourable, their issue hopeless." "And yet, the doctrine itself is built upon the steadfast pillars of the truth, and must ever remain so." Hahnemann was not willing to ascribe these failures to the want of sufficient number of medicines proved, especially as, in spite of additions yearly made to the Materia Medica, no progress was made in the cure of chronic diseases. He says that from the year 1816-1817 the solution of this problem occupied him night and day, and at length he succeeded in solving "this sublime problem through unremitting thought, indefatigable inquiry, faithful observation and the most accurate experiments made for the welfare of humanity." Hahnemann discovered that the chronic diseases nearly always had a pattern that could be related to psora, sycosis or syphilis - the chronic miasms. He proposed that the chronic diseases resulted from badly suppressed scabies (itch), gonorrhea and syphilis respectively. He indicated the drugs likely to be most useful in treating such cases: the anti-miasmatics. With this new understanding of the chronic diseases, Hahnemann found that one became "able to deliver mankind from the numberless torments which have rested upon the poor sick, owing to the numberless, tedious diseases, even as far back as history extends... a great boon (which) had not been put within their (physicians') reach by what Homeopathy had taught hitherto."

The purpose of classification


Hahnemann's classification, based on a theory of origin of diseases, has aroused more controversy than all his other tenets and doctrines. All that he had written earlier (drug provings, law of similia, simplex, minimum, etc.) makes profound sense, being logical. It seems reasonable to study his classification without going into argument as to whether his theory is sound or not. If the classification is of practical utility, if the theory can be understood in spirit and applied in practice, we accept it; if not, we discard it. With this attitude I began to look into Hahnemann's theory of miasms, asking whether it is possible to divide diseases into categories, and whether such a division (classification) helps in arriving at the similimum more easily, for this is the main objective. I find that after understanding the miasms in the light of my own concept of disease as a delusion, my practice of Homeopathy has become much simpler and my prescribing more certain. Any classification is just a means to an end, a way of looking at things. This particular classification has helped me in greatly simplifying remedy selection. I would liken it to a map which put you on the correct street, whereon you could knock at the individual doors and look up the occupants. Copyright 2000, Archibel S.A.

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Understanding miasmas
I have dealt extensively with the concept " Disease is delusion, awareness is cure" in "The Spirit of Homeopathy". Relating this idea to the theory of miasms it becomes clear that the classification of diseases must be a classification of delusions. As drugs are nothing but artificial diseases, the classification is both a "disease state" and a "drug state" classification. We know that disease is a false perception of reality... a delusion. This false perception of reality has its root in an actual situation which existed either in the patient's own life earlier or as a state in the parents. However, the impact of that situation is such that when faced with another situation the patient's reaction is still as though he is in the previous situation. For example, a man suddenly comes to face a lion. He is panic-stricken and flees from the spot. Later, when he suddenly sees a cat, there is terror on his face. In other words, he reacts as though he had seen a lion (previous situation). This is his delusion. Thus we see that disease expressions are the response to a delusion in all cases where there is no exciting / maintaining cause to account for the response. (As in nearly all cases the response is not due to an exciting / maintaining cause which, if present, must be removed, I shall deal with disease entirely as a delusion, qualifying this where necessary). It is these responses that we perceive as symptoms. In order to find out if there was a particular theme to each miasm, I studied some drugs generally accepted to belong to that miasm, attempting to find the common theme in them if there was one. I used Hahnemann's classification of diseases and drugs: 1. Acute : Aconitum, Belladonna, Stramonium 2. Chronic : Psora - Sulphur, Psorinum Sykosis - Thuja, Medorrhinum Syphilis - Mercurius, Syphilinum I shall now give a brief analysis of these groups and the conclusions that could be drawn from the same. I have tried to restrict myself entirely to rubrics that can be found in the text - the conclusions that follow are therefore not based on my personal experience alone, and can be reached by anyone who makes a similar study. The fact remains, however, that I was greatly aided in arriving at these conclusions from my understanding (clinical) of drugs and patients. Thus I recognize Medorrhinum as a person who is very anxious that his weakness should not be exposed and uses egotism to cover up this weakness. As this is an abstraction derived from personal experience, I have not included it in the analysis.

Analysis Acute
Aconitum:
Fear, of walking across a busy street A feeling that Fear, of accidents, of suffocation. something sudden will Death, presentiment of. happen, resulting in Delusion, about to die. sudden death. Belladonna: Delusion, pursued by police and soldiers. Feeling he will be Visions of gallows, with fear. pursued, killed... Fear, alternating with rage. Therefore runs, escapes; rage. Stramonium: Delusion, lost in the wilderness. Impression of danger. Delusion, dogs attack him. Seeks a safe spot. Desires light and company. Children wake up screaming, recognize no one, cling to those nearby. Danger, impression of. A similar study could be made of Hyoscyamus, Veratrum, Lyssinum, etc.

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Conclusion
We find that in all these drugs there is a feeling (delusion) that "there is a strong threat from the outside world", and the person reacts in an instinctive, reflex manner. It will be noticed that Aconitum and Belladonna which are the best examples of the acute miasm are given in Synthetic Repertory (II) under "Sudden manifestations".

Psora
Sulphur:
Fear of poverty. We find that there is Delusion, he is getting thin. a struggle with "ego" Talks of business. and "money". Delusion, disgraced. The feeling is that he Imagines himself a great man; is loosing something though ignorant, despises literary and must struggle men and education. to get it back. Psorinum: Despair of recovery There is a feeling that during convalescence. things may go wrong at Fear of poverty. any time though they are Feeling that business will fail fine at the moment. though it is prosperous. Therefore to keep things Delusion, going to lose his fortune. as they are, Ailments from anticipation. he must struggle. Feels good and bad in turns.

Conclusion
The delusion here has two components: - stress from outside and - anxiety from doubts about his ability (capacity) to deal with this stress: "Will I be able to do it?" However, failure here does not mean the end of the world.

Sycosis
Thuja:
Delusion, is thin. A feeling of a fixed Delusion, is made of glass. weakness in himself As if body is fragile (Phatak's MM). is very evident. Fixed ideas. The patient covers this Religious fanaticism. up by not allowing Insanity, will not be touched or anyone to come near approached (Phatak's MM). him both physically Secretiveness. and psychologically. Medorrhinum: Sensitivity to a slight critique. A feeling that there Sensitive to reprimands. are faults in him that Fear of misfortune. may be noticed and Anticipatory anxiety. evoke criticism. Anxiety when a time is set. Covers up with egotism. Averse to responsibility. Washing hands. Copyright 2000, Archibel S.A.

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Conclusion
The feeling is: "I am incapable of handling this situation. Something is wrong with me." With this admission of a weakness in self is an attempt to cope with it and cover it up. The patient keeps trying to make up for this specific weakness in him even when the situation does not demand it, i.e. though the environment is normal. This feeling probably arises after struggling without success for some time.

Syphilis
Mercurius:
Delusion, surrounded by enemies. Feels viciously Suspicious, considers everyone attacked from all sides his enemy. - a desperate situation Impulse to kill the person which requires him who contradicts. to do desperate things Impulse to kill his beloved ones. to come out of it. Suicidal. Syphilinum: Antisocial. A feeling that there Hopeless despair of recovery. is absolutely no hope. Indifference. The reaction is violent... Horrid depression and antisocial, kills, etc. despair (Boger's SK). Liar, want of moral feeling. Kill, desire to. Washing hands.

Conclusion
The feeling is: "I cannot manage. I can't cope with the problems both inside and outside. I cannot adapt to this unfavourable situation nor can I control or cover up my weakness." The response to this feeling is a drastic do-or-die attempt to change either himself or the environment - a violent process, a last ditch attempt. While the person tries to regain control, there is an internal feeling of despair and futility... the situation appears hopeless.

These conclusions are corroborated by the central features of the infection itself.
Acute : Sudden onset, rapid progress and swift determination - death or recovery. Psora : (Scabies) Itching, a constant struggle, with extreme discomfort fort but not life-threatening, not hopeless. Sycosis : (Gonorrhea) Gleet is the most characteristic manifestation. A chronic, steady, fixed defense with no likelihood of complete recovery, but not a desperate situation. Syphilis : A chronic desperate struggle where the body destroys itself in an attempt to survive - ulceration, caries, etc. A violent effort in a hopeless situation. The body responds to a particular infection in a specific manner. The nature of the infection determines the response. Thus infection with T. Pallidum calls for a specific type of response - the syphilitic response. When a person reacts to any situation in an inappropriate manner, e.g. in a syphilitic manner where all that was required was a struggle, then the underlying miasm is syphilis. Consider a student who has failed an exam. All he needs is to study hard (struggle) to pass the next time. However, if he commits suicide, he evidently felt it was a hopeless situation requiring a drastic solution. This is a syphilitic response and the underlying miasm is syphilis.

Perception of reality differs according to the miasm of the individual. Therefore, to recognize the miasm, determine how reality is perceived by the patient.
Let me illustrate this concept of miasms with an example. Imagine that you are driving a car on a lonely mountain road and suddenly there is a loud noise and the car starts wobbling. You instinctively stop the car and get out as fast as you can. You get palpitations, start sweating and are in a state of great panic and excitement. Once out of you car, you find that Copyright 2000, Archibel S.A.

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it was only a burst tyre. Your panic recedes on realizing that the situation is not threatening. You realize that you have to change the tyre, and start struggling with it, wondering if you can do it. After some time you realize that you are incapable of doing it and light a cigarette while waiting for someone to help you out. Finally you lose all hopes - you know that no one is going the help you out and you cannot do it yourself. So you kick the car angrily and lie down, indifferent to what happens. The four phases of this incident represent the four miasms. 1 - Panic - Acute 2 - Struggle - Psora 3 - Feeling of incapacity and cover up - Sycosis 4 - Despair - Syphilis We can see here how the first stage could possibly require Aconitum, the second Lycopodium, the third Argentum nitricum and the fourth Syphilinum respectively. What is interesting is that the external situation is the same, namely a burst tyre. The various miasms represent a progressive failure to cope with the situation. As the person fails in his struggle (Psora) to cope, he starts developing bad feelings about himself and becomes fixed (Sycosis), and when this reaches a certain level, he becomes filled with despair (Syphilis). Thus, I would like to stress again that the same external situation (reality) is perceived differently depending on the miasm.

Survival response
We must not forget that all symptoms of a disease (or a drug), no matter which miasm they belong to, represent the survival mechanism called for in the original situation, but inappropriate for the moment. In other words, the person is reacting to a situation which does not exist now, but he feels that in order to survive he must respond as if to the original situation. This is his delusion, his disease. A person flees from a lion in order to survive. If he later reacts in the same fashion on seeing a cat, it is undoubtedly inappropriate, for here he doesn't need to flee to survive. The original situation of each remedy demands either an acute, psoric, sycotic or syphilitic response predominantly. The miasm depends on the external situation, its severity and duration and also on the capacity (ability to cope) of the individual to face it. Thus if a dog approaches a child, it will panic; an adult may throw a stone and try to send it away (struggle); a middle-aged person would sit where he is and wave a stick to keep it at a distance - a constant effort so that it does not approach him (fixed, unmoving), while the aged infirm person just wait for the dog to get him. The acute is the immediate reaction necessary to survive. Psora is the reaction to a situation which demands that he struggles with the circumstances outside in order to survive. Sycosis is the reaction to a situation that demands that he accepts his own weakness and covers it up in order to survive. In order to cover up his inadequacies, the sycotic puts up a defense of fixed ideas, neurotic acts, obsessive compulsive habits ("I need to check and recheck my work because I am not good enough"), such as we see in drugs like Silicea, Thuja and Medorrhinum. The syphilitic reaction comes with the realization that adjustment is no longer sufficient and that in order to survive he must bring about a radical change in the internal or external circumstances, or both. This is usually an end stage and the survival response may break down completely, leading to suicide. A good number of people in the world today are in a sycotic state. There is a sense of inadequacy and inferiority, of having a tough time with the self in the struggle for existence. The growth of psychotherapy, self-improvement techniques, etc., are all in response to the rise in sycosis. Unfortunately, however, most such methods manage to achieve the opposite because they only bring about a better adjustment to fixed ways of thinking and living. These are only ways of coping with the same feeling of inferiority rather than a true diminution of the feeling. A girl who feels she is ugly (delusion) may try various methods. "How to look more beautiful?", or "Think positive", e.g. "I am beautiful", etc., but in the final analysis, her feeling is the same ("I am ugly"), but now she is further away from awareness of this feeling. mostly spoken of common infections of the human race and seen that the characteristics of that infection fit in with the miasmatic classification. Here I must point out for clarity that our miasmatic classification is not built around characteristics of any infection. It is based on common states of being, the delusions and reactions most often seen. As infections are secondary to these states, they naturally fit into the classification and help us to understand it more easily, being distinct, well-known entities. The miasmatic classification is one of the most brilliant contributions made by Hahnemann to the medical world. I have benefited immensely from it already though there is much still to be learned.

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Physical expressions
This miasmatic classification of disease, though based on a concept of disease as a delusion, is not restricted to the mental state alone. We know that the mind and body work harmoniously as a unit, and the disturbance is uniformly expressed in both spheres. Acute miasma: An immediate, strong response like high fever, bounding pulse, flushed face, etc., as in Belladonna or Aconitum. Psoric miasma: Expressed by a reaction of body on exposure to environmental stimuli, a reaction to one's surroundings, e.g. sensitivity in the same person to many factors like noise, light, odours, etc., producing functional disturbances, e.g. headache, nausea, discomfort. Sycotic miasma: There is a hypersensitive response to something specific arising out of a deficiency of the normal response, e.g. tumors and allergies. Keloids are a good example where the "deficient" feeling gives rise to an increased attempt to repair the fault. Syphilitic miasma: The situation is not manageable, and thus we find destruction in the form of gangrene, ulceration, etc. It is like burning your own property before retreating in a war (scorched earth policy). Thus, we find the physical and the mental states in tune with each other. Provers experienced a lot of dreams of parties, feasts. The theme seems to be of: dream of danger; of being pursued; of being sad. Aggravation from consolation. Of somebody facing a danger, and the dreamer being unable to help." Conclusion In concluding this section on in-between miasmas, I would like to say that there may be many other miasmas waiting to be discovered. With time, our map will become more and more precise. You must have noticed in the above examples that we have mostly spoken of common infections of the human race and seen that the characteristics of that infection fit in with the miasmatic classification. Here I must point out for clarity that our miasmatic classification is not built around characteristics of any infection. It is based on common states of being, the delusions and reactions most often seen. As infections are secondary to these states, they naturally fit into the classification and help us to understand it more easily, being distinct, well-known entities. The miasmatic classification is one of the most brilliant contributions made by Hahnemann to the medical world. I have benefited immensely from it already though there is much still to be learned.

Correlation with other classifications


As will be seen, this classification of disease corresponds to certain natural as well as scientific classifications. We can therefore say that the basis of this classification is true because it is universal in application.

The four stages of life


Consider the different miasms in terms of a situation where a huge mountain is to be climbed. The acute miasm is the first instinctive, sudden response at the sight of a big mountain: "Oh!" He is taken aback. Psora is the struggle to get to the top; sycosis is the man who is stuck somewhere halfway and has decided to settle down there, while syphilis is the man who is falling down. One might say the acute miasm is the way a child would look at a mountain, while psora, sycosis and syphilis may be represented by the way a youth, a middle-aged and an aged person respectively would look at the mountain. Thus, the acute miasm will be found more in babies and children because this is the time when threatening situations from outside are more often found. The reaction of the acute miasm is an innocent, instinctive and childlike reaction. Therefore, even when we find it (acute miasm) in an adult, there will be a kind of childishness in his response (the type of response helps in recognizing the miasm). In the same way, the psoric miasm will be prominent in the years where one has to stand on one's own feet and face the world - youth and adolescence, a period of struggle. The sycotic miasm will be seen predominantly around the middle age when the person, after struggling long, sees many Copyright 2000, Archibel S.A.

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defects in himself and tries to cover them up. This is the time when ideas become rigid, freedom restricted and the person is content to cope rather than struggle. The age of syphilis is the age of senescence. There is no hope now; the struggle is over. Even coping with the self is not possible and the only way out is death and destruction. In children we see illnesses of an acute nature, like measles, diarrhoea, etc. - conditions which almost always create panic because when untreated, death is a possibility. In young adults, we find functional disturbances like anxiety from problems which are solved with some time and effort, e.g. acne, menstrual disturbances, imbalance of growth. In middle age, we see restrictive diseases such as arthritis, asthma, ischemic heart disease, etc., while in old age, there are more destructive diseases such as myocardial infarction, parkinsonism, gangrene, osteoporosis, etc. These various phases correspond to the acute, psoric, sycotic and syphilitic miasms. This correspondence does not mean that the acute miasm is seen only in children and the syphilitic only in old age. It depends on the intensity of the roots of the disease. If there are roots of equal intensity for diseases belonging to all four miasms, then it is very likely that the acute will become manifest in childhood and so on. In Psychiatry, diseases are classified into Functional, Neurosis and Psychosis. These correspond to psora, sycosis and syphilis.

Personality types The psoric personality


1. The psoric personality has highs and lows. The struggle is like a tug of war with the outside world. Sometimes the balance is on his side and he feels high; at other times, the balance is on the other side and he feels low. 2. The psoric person is seen to be active. The struggle is an active process which becomes apparent especially at times of stress. 3. There is a lack of confidence in facing the situation, a feeling that he may not be able to do it. This causes constant anxiety which becomes marked when he is actually confronted with the situation (active psora). It is also present, but to a much lesser degree when he is not facing a situation. He then has a kind of anticipatory anxiety though he is not so distressed (latent psora). This causes a kind of internal restlessness, insecurity, dissatisfaction, sensitivity and anxiety about the future. But there is always hope, however bad the situation. 4. There will be many and varied dreams. Depending on the everyday situation; the dreams will reflect his anxiety about not being able to cope and about the struggle (effort to cope). 5. The psoric person is usually expressive during case-taking. He is observant, being keen of mind, and therefore describes his symptoms vividly and well.

The sycotic personality


The main feature of the sycotic personality is secretiveness. He is always trying to hide his weakness and is constantly tense. These constant efforts to cover up his weakness make even everyday life stressful. He never hopes to get rid of his weakness; all that he wants is to somehow cover it up. Consequently, he is more closed during the interview. The sycotic person has fixed habits and traits; he thinks and acts in particular ways and even the dreams are specific. The sycotic individual is less active and more reserved than the psoric.

The syphilitic personality


The syphilitic person has neither the highs and lows of psora nor the secretiveness of sycosis; he has a strong pessimistic view of life. He feels that it is not possible to modify what is wrong; it has to be radically changed or destroyed. With this internal feeling which eats him up, he can have impulsive reactions to situations. It does not matter what the situation is - be it an insult, criticism or domination - his feeling is that the matter has gone beyond a tolerable limit and there is no point in trying to adjust. So, the syphilitic person is characterized by deep and chronic pessimism with occasional sudden impulsive violence directed at himself or others - a mercurial temper. The syphilitic personality is also marked by very rigid ideas. These ideas are not only about himself as you see in the sycotic person, but also about the situation. That is why they are usually Copyright 2000, Archibel S.A.

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The acute personality


The features of the acute personality are that he perceives the situation to be one of acute threat and, therefore, reacts instinctively, sharply and intensely. It is a state of alarm and here, feelings about one's own self are not in the forefront. It is as if the situation itself is so overwhelming that it doesn't matter who is facing it - the reaction will be the same. The acute personality has two phases, a compensated and an uncompensated. These two phases are true for all miasms but are especially marked in the acute. If the acute miasm is present in a chronic situation then the person is required to compensate the most, because his actions will otherwise be funny and totally out of context, since they are meant for an acute threatening situation. Many of these unacceptable and "funny" features will be heavily compensated and they will become uncompensated in a stressful situation or will be expressed in their uncompensated form in very special ways. The reactions in these circumstances will be sudden and quick as if the person is facing an acute threat. They can appear to have mood swings but if examined closely, these are actually manifestations of a compensated phase going into an uncompensated phase. In general, the acute personality is excited, excitable and hyperactive, and goes sometimes to the other extreme of being completely shut off and insensitive. The dreams too are full of excitement and represent acute, threatening situations. Many go into a contraphobic behaviour which means they do exactly the opposite in their life to what they fear - a Stramonium (a remedy known for fear of dogs) patient may have many pet dogs. They can also have manic defense reactions like excessively loud laughter or abnormal bursts of courage and cheerfulness. In general, they function at a very high voltage. There may also be sudden, impulsive violence as in the syphilitic personality but without the counterpart of the chronic, deep-seated pessimism.

Physical symptoms of the miasms


When we talk about the physical symptoms of the miasms we do not mean the pathology. What is more important is the nature of the pathological process - the pathogenesis. Thus, an indolent ulcer with hypergranulation (proud flesh) following an injury, etc., would represent the sycotic miasm, not syphilis (ulcer). Whatever the pathology in the case, its physical state will reflect the miasm. The acute miasm will show sudden and violent reactions, exacerbations, threatening conditions that cause panic in the mind of the patient and those around him. An acute miasm does not usually cause chronic structural pathology. However, the acute miasm can aggravate structural pathology especially when the tendency to such a pathology (genetic predisposition) is quite strong in the patient. The psoric miasm in its physical aspect will show the same highs and lows as we see in the mind. It will demonstrate hypersensitivity to external factors and will manifest the same struggle and activity. In its pathology, psora will tend to cause functional disturbances at the level of various systems and reversible pathological changes although this is not invariable. The sycotic miasm in its physical aspect also has a hyper-reaction. In psora the reactions are to a variety of stimuli since the struggle is with outside irritants. Here the weakness is perceived within the self, so sycosis is usually not much affected by external factors; yet it can be aggravated by something very specific. Thus, it does not show a plethora of modalities as does psora. In sycosis, since one is trying to cope with the body's own specific weakness, its reaction will be concentrated at specific sites and organ systems, tending to cause chronic, slow troubles usually with a tendency to overreaction in that particular sphere (note: this aspect is further amplified in pathology and miasms). The reaction will also be the same no matter what the stimulus is or even with no stimulus. Thus, we see overgrowths, hyperimmune responses, fixed and steady states like asthma, and structural pathology. The disease usually has an insidious onset and the course is steady. In sycosis we find a tendency to discharges that leave indelible (fixed) stains. The syphilitic miasm shows slow degenerative processes with occasional, severe sudden destructive episodes (gangrene, myocardial infarction). Such seemingly acute conditions are usually based upon a degenerative process that has been taking place over a long period of time. The acute miasm, therefore, usually shows acute, sudden, intense reactions to stimuli. Psora shows the maximum generalities, the maximum cravings and aversions, and there may be several and varied modalities in the same patient. Sycosis has very special cravings and they are usually limited in number; the modalities too are very specific and few in Copyright 2000, Archibel S.A.

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number. Syphilis too has few and specific cravings and its sensitivity to stimuli is much lesser than psora. They seem not to react up to a certain degree of stimulation, and then react abruptly in a destructive manner.

Physical states, delusions and miasms


The state of the mind and body are always related: the delusion belongs to the person as a whole and is reflected at both levels. Therefore, the symptoms of the body and mind are often found to be common (e.g. hypersensitivity and
irritability), though it is not always easy to see the connection. Let us look at this correlation between the mind and the body in drugs. The main sphere of Staphysagria is sycotic, i.e. a perceived weakness within. The feeling in the mind is that he cannot afford to react sharply to insult or injury, should not expose his "lack of control", and so has to bear (suppress) everything. Therefore, he develops a hyper-response, a hypersensitivity that prevents him from coming into contact with injurious or insulting stimuli. The same reaction exists in the body. The pains of Staphysagria therefore come on from touch, and the main theme of the pain is extreme sensitivity or touchiness. Staphysagria is thus commonly indicated in toothaches, tooth extractions and pains following surgery. We see that there are hyper-responses to definite factors and the response is specific. Note that the mind and body of Staphysagria show not the constant intense irritability as in Belladonna and Chamomilla, but a tremendous sensitivity to a particular spot which, when stimulated, produces a sharp reaction. Arsenicum is a drug with a strong sycotic aspect with its main delusion being that he is old, weak and defenseless, and that there are thieves around who intend to take advantage of his weakness. We see a hyper-response in the form of becoming restless, fastidious, cautious and anxious. In the body, the same feeling of vulnerability to external injurious factors is manifested by its overreaction to several stimuli, especially at night (the time of maximum danger). Arsenicum is aggravated from dust, rich or spoiled food and ice-cream, and the response is in the form of restlessness, burning, diarrhoea, vomiting, cold hands and feet, etc. In the syphilitic state, the perception of the body is that things have gone too far and that he must sacrifice (suicide) or destroy (kill) what cannot be changed. In Mercurius, this feeling is reflected in the physical sphere too in the form of ulcers, with their foul smell and decay representing this destructive process. In Aconitum (acute miasm), there is a feeling that something sudden will happen leading to his death. Mentally this is seen as a "Fear of death", "Anxiety" and "Restlessness", etc. In the physical sphere, we find the racing pulse, palpitation and flushing of face alternating with paleness, etc. To summarize: - The acute is a state of instinctive reaction. The feeling is : "Something terrible is happening". The mind and body react. - In psora, the feeling is: "Something is happening to me and I must do something about it." The mind and the body struggle. - In sycosis, the feeling is: "There is a problem which I am not capable of solving, so I have to find a way around and constantly see to it that it is kept at a distance." The mind and body overreact. - The syphilitic feeling is: "The situation is desperate and hopeless, and I can't cope". There must be change. The mind and body move towards destruction.

Pathology and miasms


Earlier we looked at how certain miasms are more common in particular ages and how some pathologies reflecting the different miasms are also more commonly seen in the different ages, e.g. measles in childhood and degenerations like parkinsonism in old age. Similarly the evolution of the disease will reflect the miasm. For example, with an inflammation of the lungs (pneumonitis), the first reaction is one of severe pain, high fever, restlessness and quickened pulse. This is the stage of the acute miasm and requires drugs like Aconitum, Belladonna. If the condition does not spontaneously resolve at this stage (progress depends on intensity of roots), the body mounts an active inflammatory response with exudation of plasma proteins like fibrinogen which cause consolidation of that portion of the lung. Neutrophils attracted to the site by chemotaxis are enabled by the fibrin scaffolding to engulf the organisms. This is the subacute stage where the body has contained the inflammation but the threat is still present. This stage requires drugs like Rhus toxicodendron and Bryonia; the symptomatology will call for this group. Following this, the body has to clear up the debris for complete resolution. This is a struggle. When this process is unduly delayed, psora is active and drugs like Sulphur and Lycopodium will be required. Normally, the condition does not go beyond this. However, if long term sequelae such as restrictive pulmonary disease due Copyright 2000, Archibel S.A.

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to fibrosis between pleural surfaces, imperfect resolution, etc., are found, it indicates sycosis. Drugs like Silicea are now needed. In some cases, the infection results in a lung abscess, indicating syphilis. Here, we find drugs like Hepar sulphuris and Mercurius often indicated. Depending on the intensity of the roots, the person is carried through to the various stages of pathology described above. If the patient has a predominant psoric miasm, we will often see pathology corresponding to that state persisting. At the same time, we must remember that it is not the pathology which shows the miasm but the state. The pathology per se is not as important as what is characteristic of the pathology in that individual; this is usually in keeping with the mental and physical state. The three together reflect the miasm. The mental (delusion and response), and physical (type of reaction / response at physical level) state have already been discussed. To understand "what is characteristic of the pathology in that individual", let us take the example of an ulcer. We do not conclude from the pathology, i.e. the ulcer, that the underlying miasm is syphilis. Consider the following: - Acute ulceration of the gastric mucosa often results following severe burns - "Curling's ulcer". This shows the acute miasm. - A psoric ulcer would be one following trauma in which there is a struggle to restore the normal skin. These ulcers are sensitive, painful, and there is healthy granulation tissue but the process is slow. - The sycotic ulcer will be indolent, with proud flesh (hypergranulation) and often painless. - Syphilitic ulcers are spreading, unhealthy and destructive. Certain pathologies fall into particular miasms or remedy states, e.g. warts belong to sycosis and call for drugs like Thuja. But if a person has a strong tendency to warts and if his state is Stramonium, this Stramonium state will also aggravate the warts, although Stramonium is not known for such a pathology. This can be understood by an example. If a gangster is well trained in smuggling, may be because his basic nature is that of a smuggler, he will do his job very well. Now, if he is in a country where there are very strict customs restrictions and hence almost impossible to smuggle goods into, he may enter politics but here too, he works in the same manner, i.e. with cunning and secrecy (as if he is still smuggling). A normally chronic problem, e.g. hair loss can, in a particular case, manifest with acute expressions. Stramonium may be the remedy provided there is a Stramonium feeling and reaction to the hair loss; panic and crying for help. We have to find what is the state that indicates the miasm rather than finding the miasm on the basis of the pathology. Some erroneous notions have risen from lack of understanding of this concept. It has been mentioned in our literature, quite correctly that psora does not usually causes structural changes. This must not be taken to imply that where there are structural changes, the case is not psoric. The same holds true for the acute miasm too. In such cases, you are likely to find a strong genetic predisposition to that condition. I believe that miasms are inherited or acquired separately from the tendency to pathology. I further believe that the inheritance of the miasm (specific remedy / disease states) is not genetic and actually takes place because the vital force of the parents is tainted by such states. Only such an explanation can account for my observation that the states of father and mother at the time of conception are seen to be transmitted to the offspring. Finally, we must remember that the miasms are only a classification; what must be cured is the disease state.

Multi-miasmatic disease states and remedies


So far, for the purpose of understanding, we have been considering each miasm separately. However, a disease state is usually a combination of miasms with its main focus on one miasm; likewise, a remedy will have one predominant miasm with extensions into the others. It is most important to perceive each miasmatic state of the remedy in order to understand the disease state in toto, because then we become aware of how a person perceives and reacts to the environment, how he perceives himself, and how he reacts when things within and outside become unmanageable. For example, consider an old man alone in the house with his money. He knows that he is weak and needs people but has to be very careful and cautious or else they will rob him ("Fear , alone, of being"; "Cautious", "Suspicious"). Sometimes, the situation may get too acute and he sees thieves in the house ("Delusion, sees thieves"), or it may not be so bad, in which case it is a struggle to safeguard the money. The situation may go out of hand - he is robbed. It is a hopeless situation and suicide is the only way out. Thus, we see a situation in which elements of all the miasms are found, with sycosis in the forefront. The remedy, as is evident, is Arsenicum. We find that Arsenicum has all the miasms with a predominance of sycosis followed by acute then syphilis and only some psora. Diagrammatically, these multi-miasmatic states could be represented as follows (taking the above specific example to illustrate): Copyright 2000, Archibel S.A.

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Separate states
There can be and usually are two or more miasms in a case, though only one is prominent at a time. We can use an example to illustrate this. Consider a Stramonium state, where there is a hyper-response of fear, sheer terror, with clinging; this could be an acute miasm. However, why does such an intense state exist at all? It might have come from an intense situation but also (and more commonly) from a less intense situation in timid person. Thus, we find that the Stramonium state comes up most easily in Calcarea type of patient. A Calcarea patient when chased by a dog would be likely to develop a Stramonium state while a Platinum type of personality would take a stone and throw it at it. Case: - Child aged 2 years - Recurrent attacks of cold, cough and fever - Fear of strangers, animals - Clinging to mother - Grimacing Stramonium 1M was prescribed for her. Infrequent doses were given for several months. There was no more fever but the recurrent cold remained. Her fear of strangers and clinging decreased, and she stopped grimacing. However, her fear of animals remained and she developed obstinacy, and copious perspiration of the scalp. The remedy she now needed was Calcarea carbonica. However, I have found that acute states can exist independent of other miasms even for a long time. I have seen in practice that the acute remedies (purely acute miasmatic expressions) like Stramonium, Belladonna and Hyoscyamus have effected complete cures in chronic diseases (including reversal of pathology). The reason as already explained, is that though the condition is chronic, the perception of the condition and the expressions thrown out are acute in nature; it is an acute state. For this reason, I have added the acute as the fourth miasm in the classification. A purely acute miasm would exist when the root is very strong of a very intense situation in a person in the past, or an intense situation creating the acute state in the mother during pregnancy. Such occurrences are quite rare, and usually we find the psoric miasm present in nearly all cases, with sycosis and syphilis becoming more and more common. It is seen that in a dominant sycotic state too there is likely to be a psoric element. This is in keeping with our understanding of the miasms. Who is most likely to feel that something is lacking in him? It is one who has struggled to cope with the external situation and failed. He will then feel that something is wrong with him and tries to cover up this perceived weakness. Similarly, in a predominant syphilitic state, there are likely to be both psoric and sycotic elements. This helps us to understand why Hahnemann called psora the mother of all diseases. It is the most likely of all the miasms to be present alone, and is nearly always present when there are other miasms. At any particular time in a case, the state of the patient is usually never purely psoric or purely acute, etc. The main focus of its symptomatology will be on one miasm, but there will be glimpses of symptoms showing the other miasms too. This is easy to understand if we analyze a person's reaction when faced with a situation, for example, the situation of the burst tyre. At the loud bang, the person is bound to get out quickly and be startled, then think: "OK, let me try to change the tyre though I have never done it before... and then, if I can't do it, I will call someone." Finally, he feels: "I can't do it, and there is no one to help. I give up." However, depending on which miasm is prominent, that reaction will be intense and persistent. Where the acute miasm is prominent, the person will continue to look startled with a blanched face and palpitations long after he gets out of the car and realizes that it is only a burst tyre. Other reactions and thoughts may come and go, but this startled expression and fear will persist. Such a state could be diagrammatically represented as follows: The remedy that we give for this predominant acute state must also cover the reactions from the other miasms. In a given case where two or more miasms are found to be prominent, the remedy must cover the most prominent miasm as well as the others. As the state changes, it may be found that a different miasm shows predominance. The following diagram of the same patient's progression in a case is illustrative: We see that the entire diagram illustrates one state where syphilis is prominent but others are present as well. The drug may be Mercurius or Aurum metallicum, etc. After being treated by the indicated drug for a long time (usually years), the state may change with a predominance now of sycosis, for example: It is mentioned in homeopathic literature that Sulphur, Calcarea and Lycopodium follow each other well, i.e. they are often Copyright 2000, Archibel S.A.

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indicated in this sequence. All are psoric remedies with other miasmatic dimensions. The following is a diagrammatic representation of a case where such a sequence occurs. Sulphur Calcarea Lycopodium Diagrammatic representation of the multimiasmatic states of Sulphur, Calcarea and Lycopodium We find that in these psoric remedies, Sulphur has the greatest element of psora, Calcarea has a marked sycotic element too, while Lycopodium is the most syphilitic amongst these three psoric remedies. In fact, I believe Lycopodium, is the most syphilitic of all the psoric remedies. The cyclical sequence thus actually represents the treatment of a predominantly psoric state with the various phases showing a relative prominence of psora, sycosis and syphilis. I would like to stress once again that these changes take place over a large time-scale and the indications for the respective drugs are very clear cut. I find it necessary to bring this point to notice because I have seen a rapid alternation of remedies by many beginners (and some older physicians) with "change of miasm" being offered as a reason.

Classification of remedies according to miasms


There is no formula for classifying a remedy into a particular miasm. Such a classification would depend upon out understanding of the remedy, of its basic delusion. This understanding comes from a deep study of the symptoms, both physical and mental, and from clinical observations. The miasm concept helps us to arrive at an understanding of the basic delusion because if there are traits of a particular miasm in a remedy, the delusion of that remedy must lie in that particular miasm. For example, if we see constant excitability in a remedy, it must lie in the acute miasm and the original situation must be of an acute threat from outside. To take an example, let us consider Arsenicum album. I consider one of the main delusions of Arsenicum to be "Delusion, sees thieves". This is a completely external factor and so, one would classify Arsenicum in the acute or psoric miasm. However, when we examine the symptoms of Arsenicum, we see that there are obsessive and compulsive traits like fastidiousness and a mania for cleanliness. This indicates that there is also a strong sycotic component. When we examine the mind, we see the following symptoms which clearly define the basic delusion: - Delusion, sick, of being. - Delusion, time has come to die. - Desire, for company, yet fear of people. - Fear, of offending a friend. - Mania, wants to be held. He is dependent on others because of his weakness, yet feels that they are people who cannot be trusted, people who are more interested in his money. All the same, he cannot afford to offend them, as he is too weak to support himself. Thus, we find Arsenicum to be predominantly sycotic in dimension. This is borne out by the fact that Arsenicum is given under psora with 1 mark, while under sycosis, it has been given 2 marks (Synthetic Repertory). The following account of a patient's life-style as described by a relative makes it easier to understand Arsenicum. This man improved marvelously on Arsenicum album 1M. A 65 year old man, living in a huge house with two servants. His children are all staying away from him. He calls himself a recluse. He is very fastidious, a collector of curios which he polishes for one hour a day after the servant has finished. For one reason or another, various servants have left the job after working for a long time. He needs them twenty four hours. They are given a place in the house to stay, they are fed, and he has kept a television in a separate room just for the servants. He calls them "my niece" or my "nephew" - never "servant". All the same, he doesn't trust them at all; before leaving the house, he locks up his room, even if he is going out for half an hour. It is very evident to those who know him well that he goes out of his way to please the servants so that they won't rob him. The servants know it too, but don't dare to take advantage of this because the minute he feels they are getting smart, he would change the servants. He usually employs young children or a married couple to work for him - never a single adult. He thinks that everybody, including his own children, is trying to get a share of the money. This is probably because he is himself a greedy person who would go to any lengths to acquire money. This greed, or rather need, is so great that even his children are disgusted and feel: "We don't want his money; let him keep it." Arsenicum also has a syphilitic part, seen in the "Despair of recovery" and a strong "Suicidal disposition". However, the main feeling is that of internal weakness. He feels unloved, dejected and very insecure. The panic, struggle and suicidal disposition all rise from and are related to this one basic point, and so one can say that the main essence of Arsenicum lies in the sycotic miasm with extensions into the other three. Copyright 2000, Archibel S.A.

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In this manner, I have been able to understand remedy states more deeply using the concept of miasms. I shall now give two more illustrative examples. I had believed earlier that the situation of Argentum nitricum arose from being trapped in a situation alone and trying desperately to find a way out. In that case Argentum nitricum would be a psoric remedy, but by examining a little deeper we find that behind all these fears there is something more which, in fact, forms the basis of the fears. Argentum nitricum has several sycotic traits, such as compulsion about time, compulsion about planning things, about doing things in a particular way, and obsessions with fixed ideas that he cannot pass a certain place. So, we see fixed ideas and fixed actions. He must feel a tremendous sense of fault within, which he is trying to cover up by his behaviour. This is shown in the rubric "Fear of losing self-control", which I consider to be one of the leading rubrics of Argentum nitricim. In whatever situation self-control is involved, he becomes highly nervous because he feels he lacks it, e.g. when looking down from a high place or if he has to catch a train. In the very situation where one needs self-control, Argentum nitricum will become panicky. If this man had self-control or felt he had, then no problems would arise. In its symptomatology, Argentum nitricum has panic reactions such as diarrhoea from anticipation, and psoric symptoms like anxiety from anticipation, but there are mainly sycotic symptoms of obsessive and compulsive behaviour. Ultimately, there are syphilitic manifestations like ulcerations and degeneration, when he finds the basic fault not correctable and/or the situation is too stressful for him. The above is another example of how psora is the mother of sycosis. We say this because the feeling that he lacks self-control would arise most often in a person who has struggled for a long time with a situation that needed self-control and failed time and again. A fixed idea then enters him that he lacks self-control. This is the basis of sycosis. When a person loses his struggle in the sycotic state, he develops a syphilitic state. In this way both the sycotic and the syphilitic miasms are based on psora. At a point, it is possible even to predict which psoric remedy would be a counterpart of which sycotic remedy. For example, Lycopodium is likely to be the psoric counterpart of Argentum nitricum since it is involved in a struggle which is concerned with self-control, high places and success. This correspondence is seen in the following rubrics, Argentum nitricum: "Undertakes nothing lest he fails", its counterpart in Lycopodium is "Fear of not being able to reach his destination" and "Fear of undertaking anything". Anacardium comes from a situation where he is the dependent son of a dictatorial parent. The features of Anacardium can seem very acute, especially fear before exams, etc. This is also seen in the rubrics "Delusion, pursued by enemies", "Anxiety as if pursued by enemies". The psoric element is not seen prominently. However, the main focus is on both the sycotic ("Want of self-confidence"; "Cannot rest till things are in place - fastidious") and syphilitic ("Moral feeling, want of"; "Cruelty"; "Kill, desire to"). Thus Anacardium falls in the syco-syphilitic (cancer) miasm. There are only a few remedies that belong almost solely to one miasm. These can be considered archetypes of the miasm. Acute : Aconitum Psora : Psorinum Sycosis : Medorrhinum Syphilis : Syphilinum A study of these remedies with their delusions and responses helps in perceiving the central features of their respective miasms. The reader is referred to "The Spirit of Homeopathy" for the description of Psorinum and Medorrhinum. Here I would like to describe my clinical experience with Aconitum and Syphilinum. A study of these four remedies is essential for an understanding of the respective miasms.

Aconitum napellus
Kent begins the lecture on Aconitum with: "Aconitum is a short acting remedy". Aconitum is a remedy rarely used in chronic conditions. This is not because it has no effect in chronic situations, but because of our bias against some remedies we restrict their use. If we just open up our mind a little we can see how many people around us need Aconitum as a chronic constitutional medicine. Let us study the important components of Aconitum: - Excitement, excitable, nervous; - Fear, of death; - RESTLESSNESS; - Clairvoyance / prophesying; - Frightened easily; Copyright 2000, Archibel S.A.

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- Sudden manifestations (Synthetic Repertory, vol. II, p. 616); - Sensitive / beside oneself; - Anger, violent/violent; - Anguish; - Hurry; - Mood, changeable; - Joy / laughter; - Sadness / weeping; - Irritability. From these components one can get a fairly good idea of an Aconitum person. He is very excitable, can flare up all of a sudden, can get frightened very easily. Pain can make him beside himself. This excitement will be manifested suddenly and violently - violent anger, violent fear, etc., with great restlessness; will go up and down, pace back and forth and show an acute panic reaction. The Aconitum person who is calm can suddenly flare up and starts shouting, can get frightened and start moaning and groaning, and can get so panicky that he can start throwing his arms wildly about. Rubrics : - Gestures, wild throwing motions of the hands; - Shrieking with the pains; - Moaning, groaning, whining. Not only his health, but also the health of people around him causes him great concern; a problem with anyone and he does not react in a cool manner, but always in a panicky, jerky fashion and will raise a big hue and cry, get worked up - paces back and forth - summon all the doctors and may even land himself in the hospital after that - so great is his excitement! No wonder that Hahnemann wrote: "Whenever Aconitum is chosen homoeopathically, you must above all observe the moral symptoms, and be careful that it closely resembles them, the anguish of mind and body, the restlessness, the disquiet not to be allayed." H.C. Allen writes: "This mental anxiety, worry, fear accompanies the most trivial ailment." The great nervous excitability is the most important component of the mental state of Aconitum. One could almost say it is contra-indicated in calm people; we must look for the excitable person - one who cannot take anything easy, everything excites him. Here it comes close to remedies like Nux vomica, Chamomilla, Staphisagria, Coffea and Graphites. Rubric: - Beside oneself. This nervous excitability is linked with other components so as to make Aconitum a unique remedy, different from others. Rubric: - Excitement, nervous. Aconitum should be added to the sub-rubric: "Palpitations, with". The first of these is "Restlessness", "Anxious restlessness". Pierre Schmidt feels it is the most important remedy for "Restlessness, anxious" (Synthetic Repertory). He is excitable and becomes very, very, very restless. Nux vomica is not so restless nor is Staphysagria or Coffea or Ignatia. The anxious restlessness is a feature which is most prominent in Aconitum alone. He just can't sit. He tosses about. It is like Arsenicum and Rhus toxicodendron - only it is more intense, more vigorous, more sudden, more acute. It is not the constant physical restlessness of Rhus toxicodendron. Nor is it the desire to pace back and forth as in Arsenicum. It is a sudden burst of tremendous excitement, fear or anxiety with intense internal restlessness. He does not know where to go, what to do with himself; his mind is just concerned and ruled over by a tremendous anxiety and fear. And then, as suddenly as the whole state came, it just disappears, leaving almost no trace of itself. It comes and goes like a storm. Here it may be compared with Argentum nitricum which also has these sudden anxiety attacks. The only difference is that in Argentum nitricum the anxiety attacks appear in some fixed situations, for instance passing a certain point, in closed places, high places, before engagements, before a journey, etc. In short, Argentum nitricum has more of the phobic kind of neurosis and Aconitum, anxiety neurosis - with nonspecific yet intense anxiety attacks. Naturally, anything that causes more excitement of the mind is bound to aggravate the situation further. Hence, in these times Aconitum avoids crowds and crossing the streets. The proving reads: "Fear to go where there is any excitement." We have already seen two aspects of the Aconitum personality, viz. nervous excitability and restlessness. We have also seen the suddenness of effects, and we have a hint about the anxiety and fear of Aconitum - termed anxiety neurosis. Let us go further. Fear, fright, anxiety dominate the sudden attacks of the Aconitum excitability. Fear, tremendous fear, sometimes Copyright 2000, Archibel S.A.

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nonspecific, sometimes specific, sometimes a definite fear of death. But in any case, sudden, intense fear from trivial causes is characteristic. It is not the insecure feeling of Calcarea, nor the terror of Stramonium, nor the anxiety about health of Arsenicum, Nitricum acidum or Kalium arsenicosum. No, it is the intense, sudden panic state that something is going wrong, something severe, something inexplicable, as if it is the end, it is death. Great restlessness accompanies these states with anguish. The physical symptoms of his state are clear: tremendous palpitation with great anxiety, the face becomes red and hot, respiration is oppressed, limbs feel weak. There is moaning, groaning, howling, loud whining or weeping. Easily startled and very sensitive to noise. It should be added to the rubrics: "Heat" and "Discolouration, red, of face in anxiety and excitement" (Materia Medica Pura). As I have already said, this state is not the permanent state of Aconitum. It soon passes off and then comes the normal state, the steady state of the Aconitum person, which has some characteristics too as we shall see. One thing that is marked in an Aconitum person, even in his normal state, is: "Hurry". The proving symptom reads: "He does everything in a hurry, and runs about the house." He is hurried in movements, in his occupation and in walking. His speech is hasty too - great impatience, wants things at once. The excitability can work the other way too and this person can be a cheerful person, laughing, singing, dancing: "Becomes gay, and inclined to sing and dance". But here again he is excitable and the slightest trifle can change his mood from cheerfulness to anxiety. So, we have moods, changeable and variable. The proving reads: "Alternate attacks of opposite states of humour", "Fitful moods" (Phatak). Rubrics: - Cheerful - alternating with bursts of passion; alternating with moroseness; alternating with madness - foolish; - Ecstasy; - Singing; - Dancing; - Joy, ailments from excessive; - Laughing, spasmodic; - Moods, changeable, variable; - Exhilaration; - Weeping alternating with laughter. I am pointing out the cheerful side of Aconitum to convey the idea that Aconitum person is not always in a panicky state. In fact, it is this cheerfulness that could distinguish it from Argentum nitricum or Arsenicum. See rubric: "Smiles, never" (Arsenicum) and also "Cheerful" (Argentum nitricum is not there) (Synthetic Repertory). This makes of the Aconitum person a quite good company despite his excitability. Rubrics: - Affectionate; - Loquacity. The speech is hasty, or jerky: excited speech, rapid change of thought, wandering speech, jerking suddenly from one to another subject. Rubrics: - Speech, hasty; - Thoughts, wandering, rapid quick. The wandering thoughts is an important aspect of the Aconitum mind. The proving reads: "On attempting to think of one thing, another thought intrudes, this soon supplanted by another and so on." One more dimension of the excitability of the Aconitum person is his easy irritability. This person can get very angry, suddenly. He can shout or even become violent. This can be excited by trifles. Rubrics: - Anger, violent; - Reproaches others; - Irritability; - Contradiction, intolerant of; - Rage, fury; - Shrieking; - Quarrelsome; Copyright 2000, Archibel S.A.

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- Violent; - Censorious; - Throws things away. The people around know that this man is very excitable, he will cool down soon - so, there is no sense exciting him further it is better to keep quiet and allow his anger to subside. They also know that he has no ill will, it is only this sudden excitability that makes him so. The last dimension to the excitability of Aconitum is sadness. Again the three features of the Aconitum personality are found in its sadness: "Sudden", "Intense", "Passes off soon". Rubrics: - Sadness, anxious; chill, during; heat, during; music, from; perspiration, during. It is accompanied by the usual features of Aconitum, viz. "Anguish", "Restlessness", "Moaning and groaning". One other very prominent feature of Aconitum is its "Clairvoyance". The clairvoyance of Aconitum is manifested in its "Prophesying". So, an Aconitum person can get intuitive feelings about people, future events, things. So, he can read faces, and predicts events. Also he can get internal feelings, also things which may not have any foundation in logic or fact. Rubrics: - Clairvoyance; - Prophesying; - Dream, as if in a; - Fancies, excitation of; - Fear, death, of, predicts the time. The last rubric: "Predicts the time of death", is a combination of "Clairvoyance" with "Intense fear of death". The sleep of the Aconitum person also shows symptoms of his excitability in the form of "Somnambulism", "Talking in sleep". The dreams of Aconitum reflect the same excitability and anxiety. The dreams are: - Dreams, anxious, clairvoyant. The sleep can be very restless: Sleepless from anxiety, with constant agitation and tossing, Sleepless - restless - constant tossing, Starting in sleep, Light sleep, Lies on back with the hand under the head or sleeps in a sitting posture with head inclined forward, can't lie on the sides. Some rubrics: - Face, expression, anxious, frightened; - Thirst, burning; - Heat , palms; - Discolouration, red, cheeks; - Perspiration, uncovered parts, on (Phatak); - Desires, beer bitter drinks acids.

Syphilinum
Some rubrics of Syphilinum are: - Antisocial (Phatak's Repertory); - Moral feeling, want of; - Squanders; - Abusive; - Liar; - Dipsomania; - Indifference to the future. The main symptom of Syphilinum is: "Hopeless despair of recovery" (Phatak's Materia Medica). This indicates that the feeling of Syphilinum is one of desperation; whatever he does he cannot regain his position (recover means to gain lost ground), his efforts are finally of no use. This is the broad and general feeling of Syphilinum. In the different remedies of the syphilitic miasm this feeling is more specific than general. In Aurum metallicum this feeling is specific to his duty and responsibility. He feels he can never fulfill it, it is too much for him. In Mercurius the feeling is specific to being dominated - here he feels he must desperately revolt. In Fluoricum acidum the feeling is that Copyright 2000, Archibel S.A.

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he cannot save the relationship, he has to break it. In Syphilinum the feeling is in all these and other spheres - that the situation is beyond his capacity to salvage - it is all too much for him. He desperately tries - this is seen in manic attempts, for example in fanatic and manic religiousness, in manic tendency to wash his hands or keep his bowels clean, etc. But all this is felt to be insufficient - the situation gets too hopeless and the person decompensates into an antisocial - "I don't care" attitude - which can lead to the worst of human behaviour including serial killing. In the pathology of Syphilinum too, one sees the absence of hope. The pathologies are concerned with destruction, poor reaction, ulceration, infarctions, hemiplegias and so forth. It is as if the body has decided, like the mind, to destroy itself because it sees no hope. Syphilis itself is a taint which slowly and steadily destroys; without proper treatment a syphilitic dies a slow, difficult death. The mind and body give up and go into a state of self-destruction without caring what happens. It is not surprising that syphilis in the mother is associated with habitual abortions. The foetus is already in a process of self-destruction, already has the feeling: " I wish I had never been born".

Specific situations
It is very evident from the various examples already given that remedies belonging to the same miasm show their own special individual features. These arise from the specific situation of that drug. Thus, although all the drugs belonging to the acute miasm have the common delusion of a threat from outside, in Belladonna the specific situation is like that of one who is going to be taken to the gallows, while in Stramonium, it is like that of a person lost in a jungle.

Application of the miasms theory Understanding the case


Each case needs to be viewed from the point of his miasmatic totality in order to understand it completely. I cannot

overstress the need to settle upon the miasm before searching for a remedy; the drug must match the pace and nature of the disease. It will not do to give a remedy belonging to the acute miasm in a syphilitic case, e.g. Stramonium where Mercurius is required.
The characteristic symptoms of the case are those which represent the delusion of the patient. The delusion will have acute, psoric, sycotic and syphilitic elements. The acute components of the delusion are: - What he feels outside of him that is urgently threatening (e.g. pursued by animals). - The panic which he has to react to save himself (e.g. desire to escape). The psoric components of the delusion are: - What he feels outside of him that needs adjustment. This will come under the rubrics of delusions and fears (sensations) and feelings - The adjustment he needs to make or the symptoms that represent this adjustment, e.g. obstinate (functions and actions). The sycotic elements are: - What he feels is wrong with himself (e.g. "Delusion, small"). - What symptoms represent his adjustment to his feeling (e.g. "Washing hand", "Egotism"). The syphilitic element again has two components: - What he feels requires a radical change (delusions, sensations, e.g. "Delusion, persecuted"; "Delusion, sinned away his day of grace"; "Despair of recovery"). - What he has an impulse to do (actions, functions) e.g. suicide, murder, abuse, deceit. When we consider all the components of these miasms, we arrive at the basic delusion - the disease. To work in this fashion, after taking the case we could ask ourselves the following questions about the patient: - What is outside (external) that he reacts to? - How does he react? - What is outside that he has to struggle to adjust to? - What does he do to adjust to that? - What in himself does he feel is lacking? - What does he do to adjust to this defect? Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica - What is outside or inside that he feels he must change in order to survive? - How does he want to bring about this change?

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Understanding and differentiating remedy states


Let us look at two remedies that are very similar: Hyoscyamus and Lachesis. Both have loquacity, jealousy, suspicion, foolish behaviour, homicidal tendencies, lasciviousness and persecuted feelings. The difference can be seen through their miasmatic classification: Hyoscyamus is acute, Lachesis is mildly psoric with a strong syco-syphilitic element. By this we mean that the delusion of Hyoscyamus is an external problem. His wife is trying to poison him or run away with someone. The fault is not his and there is nothing he can do but react with suspicion, threats and homicidal violence. Lachesis, on the other hand, has the delusion that not only is there a threat from outside in terms of competition but also that he is lacking; he therefore concentrates on himself and tries to make up for this lack. Once you understand this, you realize why Lachesis has egotism and Hyoscyamus does not, and why Hyoscyamus has the delusion his wife is faithless and Lachesis does not.

Using the repertory


While using the Repertory we must remember that no symptom by itself belongs to any particular miasm. Each symptom has to be examined as to where it originates and what it represents. What is its space, quality and underlying element? In the Repertory, we find under "Washing hands", Psorinum, Medorrhinum and Syphilinum, representing three different miasms. Psorinum is like a motor mechanic who keeps getting dirty and must wash often to keep clean. This is his struggle. Medorrhinum is like a boy who has smoked a cigarette and tries to wash his mouth in order to hide the smell as far as possible, though he knows it will not go. Thus, washing in Medorrhinum is a cover up. In Syphilinum, the situation is like that of a person who has tainted his hands by killing someone - an unpardonable sin - and makes a desperate attempt to wash off the traces of his crime. This is rather like the "hands washing" of Lady Macbeth. In this situation, there is no hope and the person is doomed. Once he realizes he is doomed, he not only stops washing his hands but goes to other extreme - he doesn't care (antisocial, drunkards, etc.)

Selection of the remedy


Miss T.P. , medical student, 22 years of age, came with complaints of : 1) bilateral oedema of feet since four years, aggravated in evening, aggravated by hanging legs down, and 2) scanty menses since four years. Menses suppressed by bathing which also causes swelling of the feet: during a menstrual period, if she took a bath, the menstrual flow would cease abruptly and resume after three to four days. The menses would leave indelible stains, the same also being the case with perspiration. She had numerous complaints before exams: urticaria the evening before the exam, sleeplessness to the extent that she would take (allopathic) medicines, hairfall and also nausea and giddiness before the exams. She had a craving for sweets, chocolates, fish and spices. Averse to milk, and doesn't like meat (feels it is dirty). There is much fear of darkness, robbers, ghosts and high places, marked fear of dogs. She has a very strong image of what she has to be; very self-conscious. Finds it difficult to mix about with others; shy of public places, people. Speech is fast and very tense. Cannot sleep in total darkness; if she wakes up in darkness feels breathless and anxious. Cannot tolerate hunger.

Analysis
External situation : Fear of dogs 3, robbers, ghosts, darkness 3, high places. Internal situation : Timidity, appearing in public; Fear of exams; Conscientious about trifles. Destructive feelings/reactions : None The external situation is threatening: acute miasm. The internal feeling indicates the sycotic miasm. There is not much of psora or syphilis involved here. In a routine prescription, the first group of symptoms would have led to a prescription of Stramonium or a closely related drug. The second group of symptoms would have led to Silicea. From an understanding of the miasms, we know that the drug must have both the acute as well as the sycotic aspects Copyright 2000, Archibel S.A.

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necessarily. Thus, an ordinary evaluation of symptoms might give a secondary place to the acute or sycotic aspect and this may consequently be left out in the repertorial process. However, when we search for a drug which has both, i.e. an acute treat from an animal force (we may not be able to get the exact rubric, i.e. "Fear of dogs", but it is necessary to find a drug having a similar "threat" source) and the sycotic "Deficient" feeling related to exams, etc., we find Aethusa cynapium. Aethusa was given to this patient with a very satisfactory response.

Rubrics
- Anxiety, darkness aggravates. - Timidity, appearing in public. - Fear, examinations, of. - Delusion, dogs, sees. - Respiration difficult, darkness, in. - Menses, suppressed, bathing, from. This is the manner in which we could proceed in selecting the remedy. Evaluation of the symptoms is no doubt important but in this process, we must remember that the most characteristic symptoms are those which point definitely towards a miasm.

Prognosis
Once we understand the miasmatic element in a case, we can anticipate the outcome of the case with greater certainty. The acute miasm has the best prognosis: a rapid cure. Psora, sycosis and syphilis have increasingly poor prognoses. As the multimiasmatic case moves towards psora from syphilis in the course of treatment, the prognosis improves. 5) I am riding a bicycle which is as high as a double-decker bus; people are looking at me. Suddenly I feel scared, I try to brake but it is of no use. So, it shows embarrassment and inability to get out of a situation. Most of the time it is a very difficult situation, it looks hopeless but finally the dreamer gets out of it, as seen in the following dream: 6) There are floods in Bombay, there is scarcity of essential commodities; so I have to go out and walk on a deserted road. It is clean and surrounded by water but I have the feeling that it is going down. There is one coconut tree and below is a small shop blue in colour. Coming closer I see a person inside and a pack of biscuits, fruits. I feel relieved. Provers experienced a lot of dreams of parties, feasts. The theme seems to be of: dream of danger; of being pursued; of being sad. Aggravation from consolation. Of somebody facing a danger, and the dreamer being unable to help." Conclusion In concluding this section on in-between miasms, I would like to say that there may be many other miasms waiting to be discovered. With time, our map will become more and more precise. You must have noticed in the above examples that we have mostly spoken of common infections of the human race and seen that the characteristics of that infection fit in with the miasmatic classification. Here I must point out for clarity that our miasmatic classification is not built around characteristics of any infection. It is based on common states of being, the delusions and reactions most often seen. As infections are secondary to these states, they naturally fit into the classification and help us to understand it more easily, being distinct, well-known entities. The miasmatic classification is one of the most brilliant contributions made by Hahnemann to the medical world. I have benefited immensely from it already though there is much still to be learned.

A new repertory
Disease states (and drug state) take on specific patterns allowing us to classify them logically into groups. We have seen how remedy selection becomes greatly simplified once we arrive at the particular "group" (miasm). It would be most useful to have an arrangement of symptoms which would lead us most swiftly and certainly to the group - the particular miasm. This consideration led me to conceive a new repertory. A repertory is formed by breaking down the entire (whole) disease state with its expressions into components. We subsequently use the repertory to unify various components found in a patient into a sensible entity which we feel represents the disease state. The new Repertory would list various components in a way such that when assembled, the sum would indicate the miasm. Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica Then, further differentiation will enable us to come to the similimum.

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External situation
Threatening Non-threatening e.g. Robbers Exams Animals Problems at work Fire Difficulties in journey

Internal situations (feelings)


Small, Handicapped, Weak, Sick, Dependent, Guilty. Finally, there are actions and destructive feelings which represent syphilis.

Reaction of strength
Positive Negative Dictatorial Homicidal Contradiction, intolerant of Suicidal Revolutionary Antisocial Cruel Each of the main situations in psora and sycosis will be further differentiated into its exact situation. For example, if there is danger in the situation, then it would be differentiated into danger where help is available and where not, danger to life, to property or to relatives, danger that can be avoided or has to be faced, and whether it comes from people or other elements like fire. Thus, we define the exact nature of the danger. Similarly, the internal situation will be finely differentiated. For example, handicapped - is it intellectually, emotionally or physically? Likewise the reactions - e.g. suicidal by hanging, shooting oneself or jumping out of the window. We can also find remedies for a combination, e.g. of unavoidable danger from a natural element in a physically handicapped person. At this point, we can turn to the traditional Repertory for the specific rubrics of fears, delusions and reactions which best represent the particular (specific) situation, and thus arrive at the similimum. Such a Repertory will be very difficult to construct since we have much to understand before we put down the situational Materia Medica of drugs. However, the concept of such a Repertory helps us a great deal in how to proceed to understand a case. The method outlined above may seem tedious but is much simpler, more logical and therefore more certain.

Miasms in between the main miasms Tubercular miasm


The miasmatic classification represents to me a map of diseases, and to plot diseases on this map more specifically it was necessary to have more points on it. Besides the classical trio of psora, sycosis and syphilis, there is abundant literature on the tubercular miasm. Tuberculosis is one of the most widespread and most important infection mankind has known, accounting for much morbidity and mortality. In the pathology of tuberculosis we see much destruction of tissues and lasting disability in the form of restricted lung space, for example due to fibrosis, etc. We have the sycotic aspect wherein the situation is not totally lost but the person lives for the rest of his life with a fixed weakness and very often has tendencies to recurrent colds and other respiratory affections. On the other hand, tuberculosis is also known to have violent, progressive features which are almost totally hopeless without medical intervention - e.g. conditions like T.B. meningitis, miliary tuberculosis, etc. Thus, the tubercular miasm seems to fall between sycosis and syphilis. The main feeling of the patient is a sense of oppression. There is a great need to take a deep breath: oppression of chest, suffocation. The same feeling is found in the mind. The "Concise Oxford Dictionary" defines the word "Oppress" as follows: Copyright 2000, Archibel S.A.

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Oppress: 1) Keep in subservience by coercion. 2) Govern or treat harshly or with cruel injustice. 3) Weigh down (with cares and unhappiness). Oppression: 1) The act or an instance of oppressing; the state of being oppressed. 2) Prolonged harsh or cruel treatment or control. 3) Mental distress. Oppressive: 1) Oppressing; harsh or cruel. 2) Difficult to endure. 3) (of weather) close and sultry. The feeling is that one's weakness is being exploited. We do not have such a rubric in the Repertory but the closest we can find is "Persecution" in which Drosera is one of the most important drugs. The drugs that the best represent the tubercular miasm are Tuberculinum and Drosera.

Drosera rotundifolia
Phatak's Materia Medica gives the following description: "Fears being alone and is suspicious of friends. Imagines being deceived by spiteful envious people." In "Delusion, being deceived", Phatak's Repertory lists only two drugs: Drosera and Ruta. Hahnemann's Materia Medica Pura gives the following symptoms under Drosera: "All day long, uneasiness of disposition and anxiety, full of mistrust, as if he had to do with none but false people. Extremely uneasy, sad disposition, all day - he imagined he was being deceived by spiteful , envious people. Silent and reserved, with anxiety, he always feared he was about to learn something disagreeable. Anxiety, as if enemies would not leave him quiet, envied and persecuted him. He is sad and dejected about the ills of life, which people cause one another and himself, respecting which he is anxious and concerned; at the same time, want of appetite. He is dejected about the malice of others on all hands, and at the same time, disheartened and concerned about the future. Anxiety in solitude - he wished to have someone always near him, could not bear to be without companions and was quieter when he had someone to speak to; but when they again left him in solitude, he was all the more anxious, until he fell asleep; on awaking, the anxiety returned. Very peevish; a trifle put him out of humor. An unimportant circumstance excited him so much that he was beside himself with rage. Obstinate prosecution of resolutions he had formed." The theme of Drosera is that of being stabbed in the back, of being deceived by one's own friends and yet, at the same time, great dependence on them. There is a feeling of weakness due to which he is dependent, but at the same time, he feels his weakness is taken advantage of. This is a typical tubercular feeling. Drosera feels harassed by others and let down by his own friends. Even the cough is described in Phatak's Materia Medica as harassing. The patient reacts to this "oppression" rather violently. The slightest irritation causes violent bouts of cough excited by a tickling sensation in the throat. Drosera, as we have seen, also has a suicidal inclination.

Tuberculinum bovinum kent


We know the expressions of this nosode better than its central feeling. The prominent features are the violence, the desire for change, the need to travel, the boldness and daring, etc. Tuberculinum has very few known delusions. The drug has not been well proved and the indications commonly prescribed on have been derived clinically - these indications are very reliable. There are three delusions available: - Delusion, people seem big; - Delusion, snakes in and around; - Delusion, someone behind him and desire to see. The situation is one where people who do not wish him well ("Delusion, snakes in and around her") are behind him ("Delusion, someone behind him and desire to see"), and they are much more powerful than he is ("Delusion, people seem big"). To understand Tuberculinum better, let us look at the other symptoms: - Hopelessness (Phatak); - Hopeful; Copyright 2000, Archibel S.A.

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- Change, desire for; - Travel, desire to; - Fear of dogs; - Cursing, abusive; - Dream of being a prude; - Shamelessness in children. In my experience, Tuberculinum patients often seem to be breaking free from the bonds of society. They do things which cannot be termed antisocial but are at the borderline of what is acceptable to society. We have young people nowadays who zoom about on motorcycles, go in for wild, daredevil exploits, etc., seeking change and excitement - this represents to me the clinical picture of Tuberculinum, bold and rash. The Tuberculinum patient may be one who sees the rules of society as being too rigid and strict - almost oppressive. Tuberculinum has "Dreams of being a prude" which shows that rules of social conduct, etc., are important in the Tuberculinum situation. It also, as we know, has a desire for change and these two features explain to an extent the typical Tuberculinum patient - the rash, bold person who does daring things and at times is destructive. Jurgen Becker sees the theme of Tuberculinum in the fairy tale of "Red Riding Hood". Riding Hood is the young girl who has been told by her mother to walk along straight path (and no other) in order to reach her grandmother's place. She is warned that if she deviates from this path, she might lose her way and get into trouble. The wolf tempts her to leave the path and try a different one - it promises excitement instead of monotony. Riding Hood takes her chance and, as we know, the wolf reaches the grandmother and eats her up before Riding Hood finds her way to the cottage. The wolf in the story represents the animal side of man; it represents sensuality and excitement without the need for control or discipline. The straight path is what society proclaims to be right - the code of society. I see the Tuberculinum situation today in what has been termed the "generation gap". The youth today feel they have a right to live their own life - they feel imposed upon by the "restrictions" laid down by their orthodox parents. In order to prove (often to themselves) their independence, they do things which are not approved by society. By parents I mean not only those who have given birth but all those who have taken up a responsibility towards a person and to whom that person is consequently responsible. This could be, for example, the church or school, etc. This feeling of being oppressed, of suffering injustice and labouring under a burden difficult to endure is found most prominently here in India. It is, therefore, hardly a surprise to find tuberculosis in vast populations of Indians. This theme of oppression is reflected even in our movies - the common man in India dreams of liberation from oppression (a desire for change) which is what he sees in the movies. We also see in these movies that it is usually a man who is already poor and destitute who is subjected to further atrocities and he reacts in the end with violence, bringing about the desired change. This represents the sycotic and syphilitic aspect of the miasm. We further note that it is usually the malnourished and poor man who develops the disease, especially the more destructive and progressive form - again the strong element of sycosis (weakness) in the background.

Leprous miasm
Speaking of the tubercular miasm, we find another widespread infection in this country (formerly all over the world) leprosy. The leprous miasm has features that indicate that it is almost exactly between tuberculosis and syphilis. Leprosy in its pathology has three distinct types. It has a tuberculoid type which, though progressive, has a better prognosis than the other types - there is hope. At the other end there is the lepromatous leprosy which is rapidly progressive and destructive, resembling syphilis. The intermediate type lies between these two. The main feeling of the leprous miasm must be similar to the tubercular miasm (only much worse) as we find both these infections rampant in this country. Thus, there is intense oppression (lepers are treated worse than animals; often the objects of loathing) and an intense hopelessness, with an intense desire for change. We find that the tubercular, leprosy and syphilitic miasms have such an intense feeling of hopelessness and desire to change the situation, that they often seem acute. Often we find only strong expressions which are the natural outcome of such intense states (especially leprosy and syphilis). According to me, the drug which most characteristically represents the leprosy miasm is Secale cornutum. Kent gives Secale cornutum and Sulphur in bold type in his Repertory under the rubric: "Skin, eruptions, leprosy". The symptoms we find in a leprosy patient are loathing for self, ashamed, abandoned (forsaken), hatred and despised. It is an almost hopeless situation. In Secale we find "Violent", "Fight, wants to", "Forsakes his relatives" and "Becomes shameless", "tries to kill people", "Forsaken" and "Shameless". It is known for its destructive pathologies especially gangrene, which would be one of the Copyright 2000, Archibel S.A.

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prominent pathologies of the leprosy miasm. This miasm requires a much deeper investigation and I have not been able to understand it fully yet. I believe that a large number of patients fall in this miasm but are not recognized.

Cancer miasm
As I have said, the tubercular miasm falls between sycosis and syphilis. If we analyze the progression from sycosis to syphilis, we find that the syphilitic state develops when a sycotic (with a fixed weakness) is subjected to extreme stress (oppression) and is expected to perform well in such a situation. If the sycotic is only subjected to oppression, then tubercular state develops. What if the sycotic is expected to perform exceedingly well, to live up to expectations? This is a common situation today. Everyone has this feeling of weakness within, yet society has greater and greater expectations. We are looking for yet another miasm between sycosis and syphilis, the theme of which is a tremendous effort, stretching oneself beyond the limits of his capacity in order to survive. This miasm should have the sycotic fixity as well as the syphilitic destructive dimension. By now it is quite obvious that we are talking of cancer. We find cancer increasing in incidence all over the world and this is not entirely explained by control of other infections or an increase in life span. The cancer miasm has this theme of superhuman effort in order to survive. It has the sycotic element of building up growths, etc., with fixity and at the same time, the breakdown like syphilis. The feeling of the cancer miasm is that he is expected to fulfil a great demand which he feels incapable of doing. Though he would like to cover up for this, this is not sufficient and he has to put everything he has and much more in a really intense effort to survive, for failure means death and destruction. It is a continuous and prolonged struggle which seems to have no end. The main remedies of the cancer miasm are Carcinosinum and Nitricum acidum. These two remedies are quite unlike each other but if we can see the common theme in them we have grasped the feeling of the miasm. They are like Aconitum and Lyssinum of the acute miasm - very different yet similar.

Carcinosinum
The clinical picture of Carcinosinum is of a person who is a model of perfection - one with whom it is difficult to find fault. We often find a history of high expectations on the part of the parents and usually a high level of performance on the part of the subject to live up to them. We find Carcinosinum listed under: - Ailment from anticipation; - Discontent; - Dancing; - Indifferent; - Fastidious; - Change, desire for; - Sensitive to reprimands; - Travel, desire to; - Timidity; - Suicidal; - Obstinacy; - Dwarfishness; - Dreams of murder. These symptoms show both the sycotic and the syphilitic dimensions and the strong need to perform. The patient is constantly striving to be perfect and in doing so, stretches himself to the limit of his capacity. There is no rest or freedom from tension.

Nitricum acidum
Nitricum acidum has the features of sycosis as well as syphilis equally. It has in its pathology warts and ulcers, both very prominently. The idea of Nitricum acidum is of an intense superhuman struggle to survive - the specific situation here
being like a lawsuit, in which he battles desperately. It has the symptoms: - Obstinate; Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica - Hatred of persons who offended; - Anxiety about health; - Unmoved by apologies; - Delusion, incurable disease, has; - Violent, destructive; - Cursing. We see a constant, fixed and continuous battle with much destruction. The person cannot relax for a moment, nor can he afford to make mistakes (for example in a lawsuit), he must strive for perfection. This is the thread that links Carcinosinum and Nitricum acidum. As the world becomes a more competitive one, the cancer miasm is showing itself in greater frequency, a sign of the desperate struggle to survive.

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Other miasms
Looking around, we find other widespread infections which afflict mankind in near epidemics. I thought of a miasm between the acute and the sycotic miasms. In this miasm there must be an acute feeling of threat that comes up intermittently in phases between which there is a chronic underlying fixed feeling of being deficient. The idea that came to me immediately was the malarial miasm.

Malarial miasm
Malaria is a very common infection marked by periods of relative dormancy, with sudden acute attacks of fever with chills, followed again by a quite phase. The main remedy of the malarial miasm is China. The main feeling of this miasm and China is that of persecution. China has two components, the acute threat with its fear of dogs, etc., on the one hand, and on the other, it has fixed ideas and the chronic, tormented, persecuted and hindered feelings which gives rise to theorizing and planning without any hope of executing these plans. Another important drug belonging to this miasm is Colocynthis. This remedy has severe spasmodic colics and periods of quiescence. Phatak describes the pains as "atrocious". It is as if atrocities are being committed on him - something akin to persecution. It is useful at this stage to differentiate "oppression" and "persecution". The latter is derived from "secut" which means to follow. Persecution is a harassment, something that follows a person and troubles him. Oppression is a continuous feeling of injustice, cruelty and suppression.

Thyphoid miasm
Having discovered these miasms. I wondered if there could be a miasm between acute and psora, and another between psora and sycosis. I concluded that the "subacute" miasm between the acute and the psoric miasms had to be typhoid. Typhoid has a prolonged prodrome with a feeling of malaise, days before the temperature rises significantly. The fever is continuous, rises higher each day and can become quite life-threatening. Typhoid has both the acute features as well as slowness. It is an intense struggle in which there is an acute threat from outside - the response is not just instinctive but has the component of a struggle. The feeling is that of a critical situation, which if properly handled for a critical period, will end in total recovery. One of the main drugs for this miasm is Bryonia. Bryonia has the fear of poverty and the struggle for wealth. It has "Delirium, talks of business" which gives an indication as to how critical and acute the situation is, and how intensely he is struggling against it - Bryonia is also given under "Fear of starving".

Ringworm miasm
As for the miasm between psora and sycosis, I had great difficulty in finding one that had the characteristics of psora, i.e. the struggle with anxiety about success, and sycosis, with its fixity and given up state with no hope of recovery (yet not life-threatening). I was searching for an infection that comes up suddenly with an intense struggle which is not life-threatening but at other times is quiet and fixed. After much thinking and reading, I got the idea that this infection was none other than Ringworm. Ringworm is characterized by periods when it is just another skin lesion and times when it itches terribly like scabies, compelling Copyright 2000, Archibel S.A.

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scratching - thus, there are both the resigned acceptance as well as the element of struggle. In order to confirm this idea, I got a specimen of ringworm scraped from the skin of an infected patient, confirmed it by histopathological examination, then potentized it and proved it on a few volunteers. The volunteers did not know what they were taking. I relied mainly on the dreams to reveal the inner essence of the remedy proving. The main theme of the dreams was a feeling of "trying to do something". On one hand, there were periods of trying to do something with a feeling of hope while at other times, there was resignation and acceptance of the situation, followed again by another trial. This alternation between struggle and giving up was seen in the dreams of most provers of this nosode. For example, one person had a dream that he was inside a little tent and was trying to come out of this tent, but outside the tent were thousands of crows that pecked him when he got out, so that he had to get back again. He would try again but the same process would recur. Similarly, other provers had dreams which represented a situation in their life where they were trying to do something - sometimes with hope, sometimes giving up altogether. No doubt further provings are needed to understand this nosode better, but the initial pilot testing seems to confirm my idea that the ringworm miasm has the main feeling of "Trying". The situation is on the borderline of his capacity and, while not threatening, it is good for him to succeed. So he tries periodically but when he fails, he just gives up and accepts it. This reminds me of the struggle of obese people trying to lose weight. There are periods of struggling, jogging, walking, dieting, followed by periods of acceptance, chocolates and calories. The main remedies for this miasm are Calcarea sulphurica and Calcarea silicata. Calcarea sulphurica has periods when he "Sits and meditates over imaginary misfortune" (nothing can be done) and at other times when he is "Quarrelsome", "Hasty" and "Hurried", etc. He feels he is not appreciated and so tries to win appreciation. When this fails, he just sits and broods over his misfortune. Calcarea silicata has "Anxiety about health" and "Utterly ambitionless" on one side while on the other it also has "Hurried", "Impatient" and "Anticipatory anxiety". The patient feels incapable of performing and gives poor health as an excuse for nor being able to perform but at other times he somehow tries to live up to the expectations.

Conclusion
In concluding this section o in-between miasms I would like to say that there may be many other miasms waiting to be discovered. With time, our map will become more and more precise. You must have noticed in the above examples that we have mostly spoken of common infections of the human race and seen that the characteristics of that infection fit in with the miasmatic classification. Here I must point out for clarity that our miasmatic classification is not built around characteristics of any infection. It is based on common states of being, the delusions and reactions most often seen. As infections are secondary to these states, they naturally fit into the classification and help us to understand it more easily, being distinct, well-known entities. The miasmatic classification is one of the most brilliant contributions made by Hahnemann to the medical world. I have benefited immensely from it already though there is much still to be learned.

Proving of ringworm
I collected the specimen as described earlier and potentized it up to 30 C potency. On the night I potentized the remedy I had a dream: My car is parked near a railway station, a few yards from the clinic. My mother has purchased some things. I can't park my car in the clinic because my space is occupied by someone else. I put my mother on a bullock cart and I am running behind the cart. I go to the clinic and see the manager of the building. I tell him: "I want my car parking space. The lethargy must be shaken." In reality my parking place is sometimes occupied. If it is, I use someone else's place. I get angry but I don't show it. I want to tell the people in charge of the building but I don't. This is the situation in my life where on the one side I want to act (psora) and on the other I don't (sycosis). The provers took the 30 potency every night until the symptoms developed - up to 8 days in some instances. None of them knew what they had taken. Seven of the provers developed symptoms. Prover 1: He had a dream that he was the boss of a hospital, the King. Prover 2: He had a dream in which he was anxious that he had not taken enough notes from the "Organon" and had difficulty trying to Copyright 2000, Archibel S.A.

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pass an exam. Prover 2 is normally anxious. After taking the remedy his anxiety went down. This was a case of cure from the remedy. - Normally I have to rush for my bus. I get very tense trying to reach the college in time. That tension disappeared after the remedy. I thought: "Fine, I cam miss my lecture. I could relax." Anxiety usually led to irritability. My anger has come down a lot. I used to tremble with anger. He use to tear and break things when they didn't work for him. - I had a dream that I was trying to tell my friends to give up smoking. I was trying to force the matter. "Don't smoke", I said. I also had a dream I was playing cricket and doing well. Usually I am sluggish. I can't move in life. I was very strong in the field. I won the match for my team. In the morning I had a pain in my neck on the right side. It started gradually. I tried stretching but it didn't help. I was sleeping or lying with hot applications. In the evening it came back. Sometimes I had a pain in my hand as well as the neck. Prover 3: He dreamt he developed varicose veins, a calcaneal spur and pain in the left eye. He went to the hospital for treatment and was offered a homeopathic mixture. He wanted a single remedy. They told him he would have to wait fifteen days in the hospital. "Cut off my leg then", he said. Some provers developed an aversion to coffee. Three of the provers dreamt of pain in the left eye with inflammation. What was the feeling about the homeopathic mixture of prover 3? In one situation in his life he had been in hospitals for five days in a state between struggle and inertia. What is the significance of dreams in term of the patient's life? We have to look at the dream and what it means to the dreamer. What situation does it call to mind? What feeling does it bring up? Prover 4: He had a dream that all the provers had forgotten to take the first dose. At college they were all told they would dream the same thing. They all felt strange and foolish. He had a dream of having a pinch of salt in his hand. He had a biting pain in the stomach from 4:00-5:30 PM. On the second day at 2:00 PM, he had to press his stomach to ameliorate the pain. He had a yellow/greenish discharge from the left eye. He felt tremendous anxiety in the chest for 5-10 minutes, as if the heart had reduced in size. A fear that something was going to happen, which lasted the whole day. He also had sudden attacks of anxiety. Prover 5: He had a dream that a nephew and cousin were urinating in the bathroom together. The stream of urine was hitting the wall. It was a childish game but it was no use to tell them not to do it. "They always do it. It doesn't work to tell them." Prover 6: He had a dream he was in an old school doing a fashion show. They were all dancing on the stage and the show was good. Then he walked along a corridor and saw his friends sitting in a room doing an exam. He was hiding from the lecturer who walked by. He had another dream of a field of crop and a huge ship. His whole life's survival depended on cutting the crop and making a ship to take the crop. Then he has a big party and in front of him the whole ship is destroyed. This dream didn't tally with the rest of the provers. The dream was about success and failure, and no struggle. In the other dreams you see no panic and no destruction. They were about inertia and struggle. The prover was asked what he felt the dream meant: "It explains my life situation", he said. He was the only prover who had received placebo and at that time I didn't know this. Prover 7: He felt tremendous anxiety. He had a dream that ten patients came at 6:30, all in an acute state and all wanting medicine straight away. He told them to come one at a time. He was told to learn patience. The solution, a doctor tells him, is to learn patience and not to panic. She, the doctor, sees five of the patients and he sees the other five. Prover 8: He felt he was losing his balance in the last few days while riding a bike.

Separate proving
The following is a separate proving by a lady doctor. Here too, the 30 C was used. - Going to a shop; can't recognize where I am - narrow, deserted streets. I bought a black skirt. Then, while returning, again, can't recognize where I am; confused. Then I feel I have a black skirt already, my parents would admonish me. I try to go back to return the skirt. I enter a shop, I don't know if it is the same one. It has tables running all along the Copyright 2000, Archibel S.A.

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walls with cloths just thrown on them. I see a bright blue skirt with a lot of flowers. I want to exchange the black skirt for it. Then I feel it is too much of a bother to go to the salesperson and exchange the skirt so I just pick up the blue skirt, put it in my bag and leave the black skirt there. While leaving I worry: "What if someone catches me?" - I am driving a car, white Maruti, with my family sitting in. I am driving in the side lane and I approach a manhole with many people working around it. The manhole is standing and not flat on the ground. As I reach just near the manhole the man opens it and dirty black water comes gushing out. My mother screams: "Watch... Where are you going", and I quickly reverse the car and just manage to prevent the dirty water from falling on it. While reversing I reverse from one end to the other end of the road at an angle. I knock one cyclist down but he is unhurt and cycles off. I knock down one female who is on a motorbike. She seems to become unconscious and lies down on the motorbike and the bike is moving backwards on its own. I am very scared and feel she will die. But then, suddenly, she gets up and drives off. - I have to catch a flight at 4:30 PM. I come to the airport at 4:00 PM. I am very anxious. My mother is with me but she is very relaxed and I keep saying, "Hurry up, we have to report one hour in advance." Then I want to park the car and I find the cars are all parked in a staircase-like thing in a slant. But to enter this parking place I have to enter it by means of some staircase. I wonder how the car would go up this and I am trying to think how to do this. Then one person moves a lever and the staircase moves to the floor level so that I can drive the car up. I find when I park the car, the car disappears and only keys are left (like all the other cars). Now I wonder : "Should I leave the keys behind or put them in my bag?" There I see two friends and want to talk to them but they do not talk to me and I want to go to them but something happens and I can't. Then I try to find my handbag but I can't and then I see my mother sitting coolly with my bag. Then I realize that the dress I am wearing is inside-out. No one has told me. I want to correct this and try to find a bathroom but can't find one. Feeling anxious. I am trying to catch a flight, trying to park the car, trying to find my bag, trying to find a place to change my dress. These were the symptoms brought out in the proving of the ringworm tissue and I find the results most encouraging in that they seem to confirm my ideas. I conducted another proving of the Ringworm nosode at a recent seminar in Bombay (28th - 29th Aug. 93). I append a review by my friend Mr. Patrick in the "Homoeopathic Links" (Asian Edition 2/93): "The main theme of Ringworm as understood by Dr. Rajan through dreams and physical symptoms of the provers is: trying hard but unable to get it. The mood of the prover was that of irritability, restlessness and some also experienced pricking sensation of soles. Here are some of the dreams narrated by the provers: - A water bottle kept for filling under the tap is overflowing. - I am at my friend's house and all the family members are present (actually he has one brother but in the dream he has also a sister). When I reach there everybody leaves the house and only he stays. Then suddenly someone comes and takes the brother by the hand. They go to the bathroom and I follow them, the newcomer is having a knife in his hand and he covers the brother's face with a mask, I feel it is anesthesia. He is about to kill him, they close the door and I hear him screaming. I turn around and his sister is there again, the newcomer takes her somewhere and she cries for help. Then all the members of the family come back, the sister is being raped but they are cool about it. - One person becomes naked on a road and shows his varicose veins to me. He is not embarrassed. Other people on the road walk as if they are not aware of us (not looking at us). - I go to an office but people don't allow me to enter in and drive me out. - I am riding a bicycle which is as high as a double-decker bus; people are looking at me. Suddenly I feel scared, I try to brake but it is of no use. So, it shows embarrassment and inability to get out of a situation. Most of the time it is a very difficult situation, it looks hopeless but finally the dreamer gets out of it, as seen in the following dream: - There are floods in Bombay, there is scarcity of essential commodities; so I have to go out and walk on a deserted road. It is clean and surrounded by water but I have the feeling that it is going down. There is one coconut tree and below is a small shop blue in colour. Coming closer I see a person inside and a pack of biscuits, fruits. I feel relieved. Provers experienced a lot of dreams of parties, feasts. The theme seems to be: dream of danger, of being pursued, of being sad, aggravation from consolation, of somebody facing a danger and the dreamer being unable to help."

A proving of bacillinum Bacillinum burnett


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A proving of Bacillinum was conducted on the 22nd October 1993 in my seminar at Spiekeroog, an island in the North Sea near the town of Bremen. There were two hundred fifty participants in the seminar, of whom around a hundred took the proving dose, at bed time on the 21st October. They noted down and reported the effects of the drug the next morning at the seminar. All had received Bacillinum 220 C, and were not aware of the drug being proved until after they had reported the symptoms the next day.

Reason for selecting bacillinum


I reached Bremen a day before the seminar and had a meeting with some friends. We thought it would be a good idea to prove a remedy at the seminar. As it was going to be a five day seminar on a quiet, peaceful island with dedicated homoeopaths, we felt it was the ideal opportunity. Then arose the question of the remedy to be chosen for the proving. I asked myself: "What is the main feeling in the seminar and in the world in general today?" I felt, and so did the others, that change is the main feature in the world today. We see change everywhere: political, economic, social and environmental change - and in the past few years, this change has been rapid and tremendous. The same rapid change can be observed in the attitude of the medical profession in general, and the homoeopathic field in particular. In the past few years, there has been a marked activity in the homoeopathic world. The increasing number of seminars, books, provings and ideas are visible signs of such activity heralding change. In fact, the forthcoming seminar, we felt, was a prime example of such a change. It was at Spiekeroog that Dr. Knzli held his traditional yearly seminars, where he taught a rather strict form of classical Homoeopathy. And now, I was going to present some very new concepts at the same place. This change is what all of us desired. It seems as though the old and the traditional is not enough to meet the demand of our time. This desire for change is found in Tuberculinum and the main theme of the tubercular miasm, as I understand it, is the need for rapid change in order to have a hope of survival. We note that the incidence of tuberculosis in the world is rising steadily despite drastic measures like B.C. G. vaccination, sustained treatment with powerful antibiotics, etc. There must be something in the state of human beings that attracts this infection. We decided to prove Bacillinum (Koch).

A summary of the proving effects


I took the dose myself at night. I got a dream that a colleague from Holland was visiting me with her husband, and I had to go from place to place, arranging things in connection with their visit. There was a lot of quick, intense activity in the dream. I woke up with this feeling and went down to the breakfast table in the hotel. I met a colleague from Denmark and asked him about his experience with the proving. He told me that he had a dream full of hectic activity. Several provers used this word "hectic" to describe their feeling. (It is interesting to note that under "Hectic", the C.O. D. gives also: - Hectic fever (or flush): a fever which accompanies consumption and similar diseases, with flushed cheeks and hot dry skin). In the seminar, I asked all the provers to write down their experiences and dreams, and then invited some of them to come and speak out their experience. A brief summary of the proving follows.

Prover a
- Hectic at night. Fast. Many things to be done. Action - intense and hectic activity.

Prover b
- Hectic night. Couldn't sleep till 4:00 am. Feeling warm, hot. A peculiar feeling of painful activity, of high activity in the kidneys. Dream of a mountain/abyss. Feeling: "So what if it is deep?" Going down on a rope, the people above looked so small. Comment: This dream gives the second theme of the proving (the first being hectic activity): a risky situation, taking a risk but feels no fear. There also seems to be a need to take a risk, and hence the descent down the abyss with a rope - the situation seems to warrant a risk.

Prover c
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- Felt fully awake and read. Didn't get tired. Dream of building a house with stones. The workers made a hole. How can this house stand with so many holes?

Prover d
- Hectic at night.

Prover e
- Dream of a mountain and a drunken man. I felt it is my big duty to stay with him. Dreamt of an aeroplane. Dreams were hectic, also sad and frustrating. There were many little cats, black and white. It was my duty to give milk to them. I couldn't do so. Comment: The theme here is of having to do a lot but being unable to cope up... there is hectic and intense activity, also a need to care for others, a sense of duty.

Prover f
- Hectic night. Felt like doing something. Felt very much under pressure. Dreamt of a beach, high water. It was a difficult way through the high water.

Prover g
- Dream of a concentration camp. Also of a 1300 page "Open Testament" of Tolstoy.

Prover h
This person did not take the proving dose but, the same night (of the proving), he awoke with a fright. He had a dream in which he saw lots of cables and wires. He saw a black ground like lava. He saw helicopter-like planes going down with an intense noise; the movements, up and down, left an intense feeling of close danger. He saw a dream of a train full of nuns being deported. Comment: The themes of this dream are similar to the ones before, namely intense activity, risk and even something like a concentration camp with the deported nuns. But this person did not take the proving remedy. I had observed this phenomenon earlier in a proving of Cannabis indica in California, as you will read in this book, i.e. the development of symptoms in a person who hadn't taken the proving dose. But the next speaker startled us even more.

Prover i
This colleague told us that she had seen in the seminars at Bad Boll in the provings conducted there (by Dr. Jurgen Becker and others) that she would develop the symptoms of the proving a week earlier to the proving without even knowing what remedy was going to be proved. A week before the present seminar, she had dreamt that a woman killed a man with a knife. In another dream, a big dog came and bit her neck, she had dream of a narrow restaurant with a feeling that this was too dangerous for her. She also developed physical symptoms like pain in kidney and stomach, and symptoms like asthma.

Prover j
The next prover said: - Previously, I could not take a risk to prove a remedy. This time I could. I felt much calmed down with the proving, a feeling of quiet joy. There was no problem. I had no aggressiveness at all. Surprisingly, my child who always has restless nights, this night slept very well. My mother, however, had an awful night. She had chill and then sweat. Comment: This prover's observation is very unusual, interesting and thought provoking. Can the state of a prover be transmitted to those around him? In other words, does a proving also affect those not taking the dose? Here we enter the realm of the unknown and there is much scope for fantasy. However, observations such as these need to be critically Copyright 2000, Archibel S.A.

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Prover k
- Dream of a toy railway which goes up and down on one rail in a mountain. It is dangerous, risky and fast but had to be done.

Prover l
Dream in which she feels oppressed by neighbours.

Prover m
Dream that a pregnant woman is being pursued by somebody behind her. There is loneliness and violence. Saw a picture of the painting "The cry" by Edward Munch.

Prover n
A colleague who couldn't come to the seminar on that day. She had developed vomiting and diarrhoea, had become restless, had a shaking chill, she was crying, had nausea and oppression, felt hectic. She said she was feeling well in mind, though sick. She had not taken the proving.

Prover o
One colleague reported that she had heard on the phone that his daughter who was several hundred kilometers away had developed hollow cough, was restless and was relieved in clean cold air.

Prover p
- Dream of travelling up a hill, a mountain, on a monorail. Comment: This is the second prover who dreamt of a monorail. The monorail is a very fast train (with an element of risk) and represents the latest change in transportation.

Prover q
- I did not take the remedy, but helped to fill the globuli into the little paper bags (about 2:00 pm). After that there were one and a half hours of break left, my girlfriend and myself walked to the beach and went swimming in the sea. Although I used to freeze very fast, I did not feel the cold, and even afterwards I did not have the desire to put on my clothes again but wanted to run around very fast, enjoy the sun and the sand, an intense feeling of being alive. Comment: The weather at this time on the island was 0 C and we were all freezing in spite of warm clothes. - Also the whole afternoon I moved very fast and liked running and jumping very much ( as far as this was possible during the seminar); there was a very beautiful sunset and upcoming of the moon - a very moody atmosphere - but I just wanted to move, run of joy. After the last part of yesterday's seminar my feeling changed into inner restlessness, the feeling of doubt about many themes, slight fear and there seemed to be danger, but I didn't know where it came from. Comment: The intense activity and the joy of life is seen in this. The feeling of danger and restlessness are seen here. - Although I did not eat too much that day, I was not hungry, but I felt a kind of nausea, pressure round the stomach and a warm sensation in the solar plexus. My girlfriend and me talked a lot about your thoughts about the development of diseases and the "mechanism", how delusions crystallize into pathology, about the depth of delusions and where they come from and mainly about our own delusions, whose main aspect seems to be the same in both of us. We were on the one hand very scared, but on the other hand full of hope because we believe to know a possibility how to solve delusions Homoeopathy cannot solve. Comment: Here we can see that the seminar represented on the one hand risk and, on the other hand, hope. - We then started to focus on pictures that arose in our minds, which were not unknown or completely new to us, but the special thing was the speed these pictures changed without leaving a deep impression of the theme these pictures were Copyright 2000, Archibel S.A.

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about. I turned very sleepy then, and the pictures were not conscious any more. I woke up after I had a dream: I was in a room with several beds and there was an old man who showed to me two other men making love to each other. I awoke very alarmed. Comment: The theme of homosexuality comes up and the person views this as a strange and alarming thing. - I had a second dream: Again this theme of homosexuality, me as a third person watching, but this time it was OK, because it seemed not mere physical contact but much more emotional. When I awoke after that, the feeling of restlessness had disappeared (at about 4:00 am). Then I fell asleep again, it was in a very peaceful atmosphere. I sweated very much, but this sweat seemed to me something very comfortable and pleasant, as if I had sweated out something severe and fearful and dangerous so that I could feel free again. Comment: This shows a resolution where the insane thing seems to be okay and even though it seems strange and alarming at first, later on he sees that emotional contact and warmth are there even though the physical aspect is unchanged. This is probably how he viewed the seminar too and felt that though the form of Homoeopathy has changed, the spirit is the same and with this he could relax. This proving for me is the most impressive proving of the seminar since it brings up all the aspects beautifully and vividly.

Some excerpts from the provers' notes:


- I was standing on a bridge with my back to a big house (which was as I knew a mill, water mill I guess). A few hundred meters ahead of me was a brick church. It must have been sometime in the 18th century for I knew the mill was attacked by French soldiers. I didn't see them but they shot big, very big cannonballs over the church towards the mill. They G-7 the house or the bridge but the cannonballs were that big that I could see them coming and avoid them stepping from one side of the bridge to the other. (Afterwards the cannonballs seemed to me like huge oversized homoeopathic globuli). I never had that dream before, was never much interested in history about, for example, the Napoleonic wars, no aggression against the French. What I think is remarkable is that I didn't worry about myself or about my family in the mill. - A small airport: a small aeroplane with wings like a kite made dangerous loopings, was dependent on the (strong) wind, could not be piloted, then became a helicopter (orange-red with black carrier on it, the carrier went loose, the helicopter fell down making a slow looping and smashed on the ground, plastic pieces flew around, all that 50 meters away from me. I run to the pilot who crept to his microphone (talked with the tower?). I took him under the arm, there was gasoline everywhere, I thought about the possibility of an explosion but didn't hesitate to help. But the pilot didn't want any help, was completely OK. He told me the reason for the crash would have something to do with the toilets (!). One or two minutes later the machine would have worked again. I told him about the mechanic problem of the carrier on the top of the helicopter, but he was not interested in that (fact). - I remember very little dream during the past nights. I was immediately even calmer than before, confident, trustful, tired but feeling good. I did things in a little joyful and a bit magical atmosphere. I slept well but not uninterrupted. Several dreams in which except one there were some problems but they always worked out well and I was confident. Having to get things from my home when away in a country-house and someone says I have to drive there anyway - so I drive there. We arrived. I lock the car door - key inside. But there is another key in one door of the car. I drive the car, go up and down, will have to stop (usually the road is level). The brake pedal is very small and close to the other pedal. But I can make it, feel it in my feet that I find the right pedal. A school mate from fifteen years ago, who was always strange and aggressive, wants to fight. I feel powerful, too, not inferior. But I don't want to fight and he accepts. Another wants to hold me, I make fall a bookshelf to make a symbol. And the situation clears up - I leave. Never dreamt before. I see a long house from a distance, no people, feel a little strange. The door is open, a train comes out, only of metal material and somehow smoking. I realize it's a train bringing people from concentration camp to a crematorium, driving them in alive. (But now the train drives out.) Me and my friends wonder how can people do things like that. We were not personally involved by feelings. I was outside standing and taking a piss. Suddenly I realized there was a child sitting almost in the line of water. I was ashamed about this. It was curiously looking at my running water and I felt it wanted to touch the streaming water. It did not dare to. Then there was an agreement, a "permission". She held her hand into the stream and enjoyed it, played with the water. - A violent, destroying storm. Feeling this is the ruin of the world. I was in a house in the first stage. I saw trees, a total wood flying blown by the wind over the ground in our direction. People were blown on the ground, flying horizontally like Copyright 2000, Archibel S.A.

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the trees. One of these people was clinging to a cross, another flying down over the ground held tight a gutter. Behind me there was an old woman in the room. We felt fear and I said to her: "Now we have to hold the glasses of our windows." Then there were lightnings, flashes. On one window we saw high glowing balls, so big as a church falling in a big hole in the ground, one after another. Then a big amount of smaller burning balls fell from the sky. Then there was nothing left to see, no trees, no houses and there was peace, and quietness. The first time of the night I slept very anxious and restless. After this dream I was totally quiet and slept and enjoyed it very well. - I took the dose at 0:30 on 20th October 93, woke at 4:00 with a dream, the major portion of it I have unfortunately forgotten. It dealt with saving a group of people at a mountain side. At the end of the dream I remember I was driving a bus full of people downhill over a very sandy and hilly area. It was a heavy bus and even though I was standing on the brake with my full body weight I could bring down the speed of the bus only little. But fortunately the speed was always lowered by hilly curves and nothing happen, which was like a miracle to me. - First reaction: physical. The heart started to beat heavy as if it had hard work to do, the temperature went up - I was extremely warm - and had to turn the cover many times, open the windows - feet out of cover, but once out, they got icy cold. Peculiar feeling in the body as if poisoned. Very restless - turned in bed. Kidneys affected - had to go to toilet to urinate three times during night (normally rest). I could not sleep until 4:00 am. That is unusual, I normally sleep after two minutes. I had a sudden fear of cancer. Dreams - I had two dreams that I don't remember and one peculiar dream: "There was a kind of initiation. An old man (master), with white curly hair, was holding a stick over another man, else, could become and same one, could be a ceremony". A kind of initiation to another "dimension"; I have never had this dream before. The ceremony was pleasant. - After getting and just touching the remedy I got some diarrhoea with liquid stools yesterday in the evening and once more in the night (after taking it). In the night and this morning there is also a sickness like vomiting, but I didn't vomit, in the morning some chilliness. The diarrhoea was very explosive... Dreams: Some men jump with the horses over abyss of a sand mountain and the sand is broken. They are buried in it and perhaps some of them die. Those who didn't die say they become violent. I am just a viewer of this without emotion. I want to put some glasses into a cupboard but there are some bottles with poison in it. I take one of them, the bottle is broken and some poison is coming out on my hand where I get an urticaria. I am afraid of being poisoned and perhaps must die. I go by car to some relatives for a celebration because of birthday. I am invited to go with them to the church for a mass. There is a friend of mine and she says that I can help her with the chorus we want to sing. I never had such dreams before. After taking the remedy I had a few minutes in which I was very awake in spite of the fact that before I was very tired. - When I started falling asleep, I had a pulsating sensation in the head (front and back), as if something big pulsating is in there and wants to come out. At the same time I had a dream/vision of a market garden with lots of beautiful flowers in various colours, with one person putting flowers into a pot to sell them. It was very beautiful (never before with these great colours, only in another proving). Dream: I had three brown mice I was responsible for and I was looking for a box for them they can feel comfortable in. They were soft and warm. Dream: I was in a room with some people and suddenly people in uniform came in order to kidnap us. They fixed bombs at the outside of the building and it was a big shock and we were very scared. The first thing I did was that I told them I was pregnant although I wasn't, because I thought they would let me go then. I said several times: "What about that little baby in there?" I woke up and thought - my feeling of danger was actually not strong enough as I would suppose it to be in this situation. Dream: Terrorists said they would make a plane fall down over my city. There were two small children I was responsible for (4 and 8 years about), we had to run but the small one fell into the water we had to cross - it was frozen. He was actually wet and it was terribly cold. We had to run but he was too slow. I carried him but he was too heavy for me. Later on my friend and me tried to escape in a car, but we couldn't find mine. So we took another one, they were all so similar, but it didn't work. Unusual about these dreams is the topic of being responsible for me.

The effect of the proving on the seminar and its resolution


On the second day of the seminar (proving dose taken on the first day), the mood was very different from the first day. There was much restlessness in the room, a lot of activity. We did a lot of things and felt there was much more to be done - and done fast. I myself was going too fast, as though I had to tell all I knew in the remaining four days of the Copyright 2000, Archibel S.A.

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seminar. This relentless pace kept on till the fourth day. I was talking about the Periodic Table of Elements, and had taken up the Halogens. At this point, I remarked that many elements of the Periodic Table were still unproved. This led to further comment that most of the chemical substances in the world were unproved. I considered the various sources of our remedies and the literature available, our Repertories - how incomplete they were, the insufficiency of auxiliary modes of treatment, etc. Gradually, the enormity of our ignorance dawned upon and oppressed us. All felt the need for intense, hectic activity. When I tried to continue the discussion on the Halogens, I could not help but laugh at the foolishness of this attempt to "know everything" - to have total knowledge. All the others soon joined in the laughter; we could see the delusion that we had to know it all or were sunk. The whole atmosphere of the seminar then became relaxed and there set in the peace and joy of life. This feeling of peace persisted long after the seminar in many of us who had earlier felt a need for hectic activity. In fact, this is one excuse I have to offer for the book being delayed!

Conclusion
The proving of Bacillinum at Spiekeroog confirmed the picture I had in mind of the tubercular miasm, on which I had already written in this book. It made the picture clearer and brought it to life. The main themes of the remedy (and the miasm) are: - Intense and hectic activity; - Feeling of danger, risk; - Need to take a risk; - Fearlessness; does not feel fear to the extent demanded by the situation; - Sense of oppression; - Need to help others, especially those in danger; - Hopefulness. We can see from the last rubric that it lies before the syphilitic miasm which is totally hopeless. In Bacillinum, the feeling is of oppression and danger but with the hope of finding a way out if he reacts rapidly - intense activity in the time available. This proving is especially significant as it showed: - The phenomenon of a person developing the symptoms without taking the proving dose; - The effect of the proving on the seminar itself. I have gained a lot from this proving experience and wish that all my colleagues should undergo at least once the experience of a mass proving followed by discussion.

The nosode as the centre-point


OF THE MIASM The nosode of a miasm, for example, Psorinum (psora) and Medorrhinum (sycosis) or Syphilinum (syphilis), represents the centre-point of that miasm. Let us try to understand this a bit further. The nosode is the disease product which is made from the tissue that is fully under the influence of the infection. This tissue is so completely overcome by the infection that it no longer has in it the individuality of the person, but has only the signs of the process of the infection. In the case of scabies, the tissue will have in its quality the struggle of the scabetic infection; in gonorrhoea, the nosode will have the quality of a fixed infection of gonorrhoea, whereas the defeated tissue of syphilis will have the character of total despair and distress. The nosode represents what one might call the defeated tissue completely under the spell of infection and, therefore, manifesting the very basic qualities of that infection or infectious process. Thus, when we study the symptoms of the nosode we are able to understand the centre-point of the miasm; for example, a study of Psorinum shows the very character of the psora, i.e. an intense struggle with a problem from the environment. This problem is nonspecific in the case of Psorinum; it can be a religious problem, a problem about money, a problem about his acceptability, a problem about his love. It has an undifferentiated character. Now, from this undifferentiated sense of struggle, we can then branch out into more specific remedies, e.g. if the struggle is for ego and honour, then the situation would be Sulphur. If this is causing physical insecurity, then it would be Calcarea or Nux vomica, etc. But when this struggle is on all fronts, the struggle is undifferentiated, then the remedy that will be needed is Psorinum. That is why it is often said that the indication of a nosode is when several remedies seem to be indicated or when several remedies fail though seemingly indicated. In the example, the feeling of lack of capacity and the need to struggle was an undifferentiated feeling, and at various times it manifested itself in different forms, e.g. sometimes it manifested as ego problem, sometimes as poverty problem, sometimes as security problem - each time leading to a different Copyright 2000, Archibel S.A.

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prescription, but the basic problem was undifferentiated feeling of lack of capacity and the need to struggle, and this is the central point of the psoric miasm and would need Psorinum as the remedy. The same applies for Medorrhinum and Syphilinum. This idea also fits perfectly well with the miasms in between the main miasms, since, when we study Carcinosinum, we understand the central point of cancer miasm or in Tuberculinum, we understand the undifferentiated feeling of the tubercular miasm. It can therefore be easier to see which nosode is the closest to a particular patient and after fixing the nosode, one can then look around to see which remedy comes closer. This would then help us to limit the area of our search and make it more specific, e.g. if a patient comes with strong destructive and homicidal tendencies, and there is a tremendous sense of desperation in him, one might think that the closest nosode to him would be Syphilinum. Here one would ask whether it is just undifferentiated hopelessness or it is the hopelessness which is marked for a specific area, e.g. an area of high responsibility in which case one would go to Aurum metallicum. I have found this approach very useful in some cases.

What we learn from miasms


In the classification of disease states we have tried to see patterns that may be found in vast populations. The study of disease is in a way a study of mankind... we understand what it means to be a mortal. Human civilization has its own advantages and there is no denying that we have come a long way from the caveman. It is in the nature of man (as opposed to an ape) to understand and harness the power of nature, of natural elements. However, by modifying the environment to extents that are entirely unnatural, man has created certain situations for himself: the problems of war, industrialization, population, political conflicts, etc., are created by humans. To survive in these situations, man developed states of being, appropriate for that time, adopting postures best suited to that situation. When the situation changed, these states of being, these postures, were no longer needed and were therefore usually dropped. It is when these states continue despite the change in situation that things go wrong; then man is under a delusion - he is no longer aware of reality. In order to diminish this delusion which is a stress at the very centre, the body "accepts" infections which best "live out" the delusion. Once this occurs, man is able to accept himself and is accepted by society as well - his behaviour is not so abnormal, considering his infection. Thus, infection is subsequent to an internally created susceptibility. This is what the masters have said in different ways. Thus, we find Stuart Close talking of "satisfying the susceptibility", while Kent says: "The bacteria are the result and not the cause of disease." The man who is internally destructive and violent will be the one to acquire syphilis, a violent destructive disease. These internal states are classified by us as miasms. As mentioned earlier, states develop in response to a situation. The frequency of any disease can be directly related to situations calling for it. The reason for cancer is the attitude of cancer, just as the reason for tuberculosis is the attitude of this condition. The harijan (the low caste) in India was treated like a leper - he was not allowed to use the same water-source, enter the house of a "higher caste" person, etc. This being his situation, it is not surprising that these were the people most likely to develop leprosy. The feeling in the mind manifests in the body. Once this is clear, we cannot help wondering what happens when the infection "invited" by the body is removed by treatment without the basic feeling being altered in any manner. This is the case with antibiotics, and I believe the increasing incidence of new pathologies and infections is just an expression of the body's attempt to substitute the older ("cured") infection with another which fills in the void. The substitute may be less appropriate to the state and this results in a worsening of the patient's general condition - something we recognize as suppression. While the pernicious results of a one-sided treatment are sometimes immediately evident, the major effects are seen on a larger time scale. In the West today, we find increasingly incurable and intractable conditions replacing the older often purely infectious diseases... there is a high incidence of autoimmune diseases, cancers, etc. What is alarming is that trends show that theses conditions, formerly the domain of old age, are now showing up in younger people with a greater frequency. I would say that this was to be expected. What other outcome could result when we remove the syphilitic infection without removing the syphilis in the man's mind? The destructive mind invites destruction, whether in the form of syphilis or AIDS - the latter is to me nothing but syphilis in another guise. In India these late effects are not yet seen in any great measure. However, many of our patients present with complaints very similar to older, well-known infections, so much so that we occasionally confuse the two. But whereas the earlier group of cases would show an acute, self-limiting course with a reasonably definite prognosis (good or bad), the current cases seem to have a uniformly unhappy prognosis with long lasting debility. The last statement is based on my experience especially with young children and their complaints, e.g. measles, etc. The purpose of stressing so much on these morbid matters is to create awareness, for to be aware is to be healthy. Now, Copyright 2000, Archibel S.A.

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we can consider the possible solutions to these problems. As disease is the result of unnatural postures, awareness of these and consequent alteration in our thinking would result in health. Man must obey his natural instincts when they do not go against his community. A simple change in diet and habit would go a long way towards healing, not only because of the physical (bodily) benefit but also due to the changed mental outlook that precedes it. It is most disheartening to watch youngsters and adults alike watching loud noisy and senseless television programmmes, lying on their back, eating junk food all along. Nothing could be more unnatural, more calculated to disrupt health. It would be healthy to eat, sleep and rest as much as is needed - neither too much nor too less. The most potent weapon we possess to promote health is education. In order to educate others, we must be able to recognize what is already existing that is healthy around us, and why it is so. This is not so easy to define and I can only attempt to give a general indication. What are the things that create awareness of our state of being? It could be even a movie or a joke. There are movies which take you into a realm of fantasy, wanting you to be one of the characters of that movie. There are others which touch you deeply and you can identify with that character. Instead of thinking, "I am that", (would like to be), you feel, "That is me!" The latter type of movies are the ones, I feel, best calculated to promote health. There are jokes which excite laughter without really affecting you. Then there are others which make you feel much better after the laughter. I recall one such incident which seemed to have just the sort of effect I am talking about. It was my father's patient who had been talking of suicide for days. The conversation was as follows: - I am going to commit suicide. - How do you propose to do it? - By shooting myself. - Do you have a gun? - No. - Then what is the use of talking about it? Get one and we will discuss it. The patient started laughing at this unexpected "advice" and subsequently improved. What this "joke" has done to him was to create awareness that he really did not intend to die. It is abstract things like these that we must look for and appreciate, hoping that someday we can define them more clearly and use them in practice to heal.

The concept of miasms: a summary


Hahnemann postulated a theory of causation to understand, simplify and treat chronic disease conditions more effectively. While a history of suppressed scabies, gonorrhoea or syphilis is often not available, diseases do show a pattern that corresponds to the above mentioned conditions, enabling us to classify them accordingly. The miasmatic concept treated here is, therefore, not a "theory" of causation but a convenient classification of some practical utility. As an extension of the concept of disease as a delusion, a classification of the disease states becomes a classification of delusions. An acute state often has various kinds of pathology, even of chronic expression, and is often recognized. It is included here with the other three basic miasms. Studying the acute, psoric, sycotic and syphilitic miasms through an analysis of the most prominent remedies belonging to each miasm makes it easier to understand the situation and delusion of that miasm.

Acute state
The delusions of these remedies represent an acute threat and the reaction is strong and instinctive; for example Stramonium: "Delusion, alone in wilderness", "Desire for light and company", "Clinging".

Psoric state
The delusions show a difficult situation where he has to struggle in order to succeed. There is anxiety with doubts about his ability, but he is hopeful and failure does not mean the end of the world; for example Sulphur: "Delusion, getting thin", "Fear of poverty", "Ailment from scorn, embarrassment", "Egotism". He must struggle in order to recover or maintain his position.

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Sycotic state
A feeling of a fixed, irremediable weakness within the self, with an attempt to cope with it and hide it from others - hence covers up with egotism, secrecy, compulsive acts, etc.; for example Thuja: "Delusion, body is made of glass", "Will not be approached or touched".

Syphilitic state
The delusion is that he is faced with a situation beyond salvage, leading to complete hopelessness and despair. In a desperate effort, he tries to change the situation and the result is usually destruction - do or die! For example Mercurius: "Surrounded on all sides by enemies", "Anarchist", "Kill, desire to".

Types of reaction
A man is driving on a mountain when suddenly the tyre bursts with a loud blast. He is excited and panicky, gets out of the car immediately and without thought (acute). He studies the damage and tries to repair it, wondering if he can do it (psoric). After struggling a lot, he realizes that he is not capable of doing it, accepts the situation and smokes a cigarette while waiting for someone to pick him up (sycotic). After two days he realizes no one is going to come and that he is in a desperate, hopeless situation - stuck on a mountain without food. In a drastic measure, he kicks the car down the mountain or gives up totally and awaits death. To cope with the needs of life (stress) we need a certain capacity. Depending on our actual state and intensity of the stress, we move between the acute, psoric, sycotic dispositions. Only if we lose all ability to deal with or to accept the situation do we fall into the syphilitic state. Acute : instinctive response Psoric : struggle Sycotic : cover up of internal weakness Syphilitic : no recovery possible - change or destroy

Acute personalities
Acute personalities react totally instinctively to stress, which they see as a threat or attack from outside. All miasms have compensated / uncompensated states, but acute personalities appear to have especially wide mood swings (change between compensated and uncompensated); they are either excited, excitable, hyperreactive or seem to be completely shut off (of course the personality is mostly compensated; imagine an uncompensated Hyoscyamus, Stramonium, Aconitum in a train!). But we find neither the fixed ideas of sycosis nor the aggressive self-destruction of syphilis. Hyoscyamus, as an example of an uncompensated acute state: loud, foolish, senseless, excited, insane, delusion of supposed blames/injuries.

Psoric personalities
Psoric personalities lack self-confidence, and so constantly have fears and anxieties, especially under pressure and stress. Therefore they suffer from anticipatory anxiety. They are very restless, active, and struggle with their problems. Psoric patients present many and varied dreams; they are expressive and can present and describe their complaints well. You find nervous, hyperreactive personalities; all fears express themselves in a feeling between hope and despair. The despair is not deep-seated. Hope returns very soon. Psorinum: despair of recovery (3) - but always with hope, fear of poverty (poverty means loss, so actually a fear to lose, but this again contains the hope to gain), anticipatory anxieties. In one word: struggling.

Sycotic personalities
Sycotic personalities are above all secretive; they want to hide their weakness; dreams are more fixed and more specific. They develop fixed habits to cover up their fixed (constantly present) weakness. This may express as egotism, secrecy, Copyright 2000, Archibel S.A.

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fastidiousness, etc. They are typical middle-age remedies, less flexible and never hope to get rid of their weakness. They will say: "If I do this or that I can cope and nobody will know my weakness."

Syphilitic personalities
Syphilitic personalities are given to extremes but often show a strong pessimism. They want total change or destruction, trifles may cause suicide, e.g. failing in an exam. Syphilinum: despair of recovery but without hope; antisocial, drunkard, liar... has given up, is finished. Aurum metallicum: despair of salvation, delusion has lost hope or forgiveness, delusion, has neglected his duty and therefore deserves reproach.

How can we understand a patient


USING THE CONCEPT OF MIASMS? 1. We have to answer the question: What is the element in the case? - Acute (threatening); - Psoric (struggle); - Sycotic (weakness); - Syphilis (destructive). 2. Understand and differentiate the remedies, for example Hyoscyamus (acute) vs. Lachesis (psora). Hyoscyamus: (delusion of a) man whose wife tries to poison him, someone tries to hurt and injure him, someone persecutes him. This is why he loses control of himself, becomes foolish. He is never sarcastic, there is no satire in him, he is always excited and presents an instinctive, instant reaction. Lachesis: (delusion of a) person feeling a weakness in herself. She tries to compete with someone better, her survival depends on her winning. Thus she develops egotism, talks a lot about herself, becomes loquacious, sarcastic (putting others down), deceitful (putting herself up). It is the situation of someone who has to compete against a person with better qualities, like a menopausal woman whose husband has a young girlfriend. The game of musical chairs represents the Lachesis theme: two people running around one chair, winner the one who sits down first after the music stops playing. 3. Use and understand the Repertory: Many rubrics contain remedies of all miasms, but all react in different ways, for example "Kill, impulse to": behind this rubric stands the delusion that something is pursuing him. The acute miasm will react in an instinctive way. The psoric state will struggle. The sycotic will try to hide. The syphilitic remedies will collapse or hit back. So, we have to ask ourselves what is the type of reaction, and which type of reaction is the person choosing now (reacting struggling - building - breaking). 4. Expect a sequence of remedies coming up in a case. If a sycotic case is treated, a psoric root can come up. We can see a cycle of syphilitic, sycotic, psoric remedies. 5. Prognosis: The acute state has the best prognosis. The syphilitic state has the worst prognosis: the patient has given up already.

Illustrative cases Case 1


A six year old girl accompanied by her parents and brother came with complaints of recurring cold, cough and fever with acute attacks of tonsillitis. Her appetite was poor and she was not gaining weight. The ENT surgeon had advised tonsillectomy. During the interview she was highly restless and also seemed shy, was clinging to her parents all the time, putting her fingers into her mouth and evading looks. The parents describe her as: very affectionate and caring, would cling to her parents, kiss them, etc., demands a lot of attention, when angry, becomes violent, would scream and pull her mother's hair, slap her and pinch her. She is very afraid of her teacher. When scolded in class, she would pass urine involuntarily. Copyright 2000, Archibel S.A.

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She is very sensitive to what others say about her. She was initially bold but is now afraid of darkness, cow's horns and dogs. She loves company except when hurt - at such times she would prefer to be alone. She has the habit of talking to herself: imitates her teacher, conducts imaginary classes, etc. She loves to dress up beautifully, apply lipstick, etc. She asks: " Am I pretty?", loves to watch "The bold and the beautiful" on TV, thinks people on the road look at her because she is beautiful. She would model in an imaginary fashion show. She is very possessive about her mother, wants to sleep next to her. She becomes very upset if her parents argue and likes to see them affectionate with each other. She is afraid of being kidnapped. Dreams of being kidnapped, of falling into a well, that her mother is dead. She craves sweets, fruits, chocolates, cold drinks and sugar. She is averse to non-vegetarian food and milk. She prefers to eat snacks and fast foods outside rather than usual meals. During pregnancy, the mother was very tense about everything, was not happy. She had many fights with her husband. Theirs was a love marriage, a Christian girl getting married to a Hindu boy - quite unusual here and not approved by her parents. She had always wanted to get married, to be loved by someone. After getting married, she had many problems with her in-laws. Her husband was violent and used to beat her. She was very scared to talk to him. She always felt "alone and helpless" and would cry all the time. She always thought herself very attractive and beautiful.

Analysis
The main feature of the case is the intense excitability of the nervous system. This is seen in the involuntary urination from fright on being scolded by the teacher. The same feeling of being in a threatening situation is seen in the fear of dogs and cow's horns, fear of being kidnapped and dreams of being kidnapped. These fears represent "Delusion that she is about to receive an injury" and "Danger, impression of". We note the clinging to parents, dreams of being kidnapped, dream that her mother is dead and desire for company. These indicate a specific situation - her main feeling is "Delusion, she is always alone" and as this is in a threatening situation, she reacts by "Clinging to persons or furniture" and a need to attract attention: "Delusion, beautiful, she is and wants to be". The feeling is that she is alone, facing danger and about to receive an injury. The whole situation is very acute and threatening. The reactions are instinctive, sudden, for example the involuntary urination. This is an example of the acute miasm. The situation is the same as that of the mother during pregnancy. The mother had left her home and married a man who hit and ill-treated her - she felt alone and forsaken with constant fear. The remedy is Stramonium. With it, the child did well both in her colds as well as in her fears.

Case 2
Her brother, 10 years old, with complaints of recurrent cold, cough, passes stools every time he eats something. He is very affectionate, sensitive yet obstinate. He is badly affected by the fights between parents. While at school, he is constantly worried that his father might be beating his mother. He is intelligent but takes a long time to grasp anything. He can be very destructive - when angry would smash his toys. His mother says his nature is like that of his father. The father's nature (as described by the mother) is violent and hot-headed. He beats her, is scared of losing her. She had thought of leaving him but did not. He is very attached to his parents. He is very possessive about her and suspicious that she may leave him. The boy has a dream of having a magic wand. He craves meat, chicken, fish and fruits.

Analysis
The boy takes after the father. He is violent and destructive. The girl is like the mother. The boy fears his father would beat his mother: "Delusion, persecuted". He is sensitive to persecution and this is expressed as anger and fright. The father is possessive and suspicious of his wife: "Jealousy". He would beat her up: "Jealousy, with rage" and "Striking", "Fear of being betrayed". These indicate Hyoscyamus. The father's state must have intensified once they got married since Hyoscyamus has "Delusion wife is faithless", whereas the mother's state ("Clinging", "Desires company") must have diminished in intensity. Subsequently the violence of the father stimulated an intense Stramonium state in the mother and she saw herself as alone, hopeless and in danger. So, the second child was born with an intense Stramonium state.

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Case 3
Mr. N.A. , 26 years old, teacher of music and drama in a school. He came with complaints of chronic colds, allergy to certain substances, drowsiness after lunch with heaviness of head, palpitation aggravated by lying down and aggravated by hot bath. He was always interested in music, learned to play the piano at the age of seven years. He likes to write (free-lance) for newspapers and magazines. He has difficulty in mixing with people of his own age but gets along very well with children. He also works in a child ward - play therapy. He prefers the company of children as he has a strong desire for approval which he gets more easily from children. He is aggravated by contradiction: "I hate to be corrected. I want to be the best. I want the performance to be very good. My work has always been appreciated." However, he does not ever perform in public. "I am unable to perform. I hate to be seen in public - feel very self-conscious. I would never do anything unconventional, not even wearing bright colours. My dad is like me - prefers to be in the background. I want to be known but not seen." About his temper he says: "I am very irritable. If someone was late in meeting me, I would get angry and walk away. Also if a person doesn't return a borrowed article, I would confront him angrily. I remember things done to me years back quite vividly and write angry letters." He gave an example of his temper. One day, in his absence, some staff member broke his locker in school as they needed something from it urgently. When he came to know about it the next day, he was so wild with anger that he almost broke the main locker in the school office and was restrained with much difficulty. His father had a similar temper. He hates to be misjudged in any way. Talking about his fears, he says: "Since childhood I have always had a terrible fear of dying." He gave an example: Once he slipped while descending a staircase and tumbled down. He was so frightened that he started shouting, "I am dead, I am dead, I am dead." Everybody in the house gathered around him as he lay on the ground with eyes screwed shut, shouting: "I am dead". When he opened his eyes he saw everybody laughing at him. He is afraid of crowds: "I hate to be in a crowd, can't bear to be in a crowded church or rally, feel better on leaving the crowd." He hates to be stuck in traffic. Once he left a taxi caught in the traffic and took a train. He is unnerved if a dog follows him. Slight pain worries him. A slight pain in the jaw and he thinks it is lockjaw. The least headache makes him fear a brain tumor. Eggs cause vomiting and diarrhoea. Dreams: "As a child, dream of a hen in my bed near my feet and I woke up screaming with fear."

Analysis
Here, though at first sight the case seems like that of a chronic situation, we notice that the reactions are very acute, as if reacting to an acute threat: the childhood dream of the hen, fear of dogs, the acute fear when exposed to public, the panic when he is stuck in traffic and the panic on falling down the stairs. This shows us that the case falls in the acute miasm. To come to the remedy, we have to consider his main feelings. The main feeling is as if he has suffered wrong (e.g. the breaking of his locker): "Delusion, wrong, fancies he has suffered". The other reaction when a dog follows him - unnerved - gives us "Delusion, about to receive injury". If these two rubrics are combined, we get Hyoscyamus. This is confirmed by the dreams of a hen which frightened him so much. Hyoscyamus is given under "Delusion sees hens bound with chains". The patient improved radically with Hyoscyamus - the allergies, colds, palpitation and nervous excitability rapidly yielded to treatment. It is interesting to note here that though the patient never appears in public, we cannot consider it to be a sycotic feature and take the rubric "Timidity - appearing in public". His reaction was such an intense terror that he would nearly shriek and have to be dragged on to the stage. It is a very acute feeling as of a threat. He is not concerned about hiding some weakness - just wants to save himself from the public. Hence we have to choose acute rubrics rather than "Timidity". This is an important aspect on which I would like to stress very much: The rubrics selected must reflect the

intensity and nature of the state.

Case 4
Mr. J.M. brought by her son (a homoeopath) with complaints of post herpetic neuralgia, median nerve paralysis, hypertension and diabetes. She had been on steroids for the neuralgia without much relief. She becomes very restless with pain at night, keeps moving about, weeps with the pain, wants to put her hands into cold water. There is a sensation as if nerves are touching the hands. She has been to twelve or thirteen doctors in two months. Copyright 2000, Archibel S.A.

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Her son described her general mental state. She cries a lot when he goes for his job in the hospital and does not allow him to go, weeps a lot when he can't come home, weeps when angry. Obstinate - gets things done by weeping. She was weeping so much with the pain that everyone at home got tense and decided to take her to the hospital. She became calm immediately and started packing things as if going for a picnic. She seemed quite happy. All along, as the son was narrating the case, she kept interrupting him with: "Why is the pain not going? I want immediate relief." She was crying, restless and constantly complaining of pain, she says: "My pain is not hysterical". She is the President of the Lioness Club and is very bold. She comes from a rich family but her in-laws are not very rich. She constantly complains and criticizes her in-laws in their absence but is very nice to them. She likes to go out, travel, make friends, dine out in hotels, etc., feels very lonely when children are not at home but never bothered or scared if they come home late. She loves consolation. Her pain increases when her son comes home. She keeps asking: "Why am I getting thin? Why is this happening to me?" and says: "You people are useless, you can't do anything. You doctors don't know anything." If shouted at, she weeps. She criticizes a lot. Childhood: Mother died when the patient was three years old and father died when she was twelve. She was brought up by her elder brother and sisters. Sometimes she says she has not received enough parental love. She constantly complains that she has suffered this or that, others are treated better than her, etc. She gets wild at times and you can smell hatred on these occasions.

Analysis
We see a strong cry for relief, attention - a demand for instantaneous relief from pain. It is as if the pain is a threat from which she has to be rescued as quickly as possible. This looks acute but on the other hand she feels neglected and makes an attempt to get attention by her efforts and demands. This looks psoric. The whole situation is like that of a child whose parents don't give him attention, without which he cannot live. Therefore, she screams for attention when she feels her needs have to be attended to immediately. On the other hand, even when there are no immediate needs, she makes a constant effort to attract attention. In this case, even as president of the Lioness Club, she sought attention which was not absolutely essential. On the other hand, she felt threatened when left alone, especially by her children and would intensify her efforts. This is a subacute situation. The main feelings can be summarized: - Carried, desires to be; - Reproaches others; - Beside oneself; - Complaining; - Impatience from pain; - Restlessness relieved by being carried about; - Shrieking with pain; - Weeping, child is quiet only when carried about. The remedy is Chamomilla, which is an important drug of the subacute miasm. Her behaviour was childish and hence the above rubrics were chosen though she is not a child. She improved well - her attitude changed gradually and there was complete relief from the pains. Even her blood sugar levels came down.

Case 5
Mrs. V.P. , 40 years, came with her husband and uncle with complaints of recurrent fever. She has been diagnosed as a case of patent ductus arteriosus. The echocardiogram revealed vegetations and the patient had been informed that she had subacute bacterial endocarditis. She has had fever since seven years. During the fever, she had stiffness of the fingers in the morning on waking. She was rather shy, had restlessness of the hands, was wearing five rings on her fingers and also a black thread around the wrist. The rings had different stones in accordance with astrological beliefs. She was always very anxious about her son. He was in America when rioting took place there. She craves milk, especially warm milk, sweats much on the left half of the body.

Analysis
The main feeling in the case is that of a threat which could prove dangerous, even fatal, unless a lot of effort is put in to Copyright 2000, Archibel S.A.

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save the situation. On one side there is hope and efforts while on the other there is danger with fear. This can be seen in the situation of rioting - feeling of acute threat causing fear, panic and restlessness in her. Next we consider the numerous rings worn according to astrological beliefs. This shows an intense effort to save herself from possible disaster. The main pathology itself has fever which is not very high or threatening but there is a possibility of it becoming dangerous. At other times, it is quite normal. The focus of this case lies between the acute feeling and the psoric feeling - there is an intense struggle to overcome the problem. This is the subacute or typhoid miasm. Even the pathology has been termed subacute bacterial endocarditis. The remedy we shall choose must lie mainly in the subacute miasm. It must have the feeling that some mishap is likely to occur without knowing exactly what to anticipate, and the need to put in a lot of effort to save oneself from that. In this case the feelings, when converted into repertorial rubrics, are: - Fear, happen, something will; - Fear, superstitious; - Anxiety about children; - Sleepiness before the heat. We get Rhus toxicodendron. Rhus toxicodendron is a well-known typhoid remedy. It is the only drug given under "Sleepiness before heat" (Knzli's "Kent's Repertorium Generale"). The patient improved very well not only in the fever but also the state of mind. When she came the next time (three months later), she was wearing just two rings, thus also indicating to me that the remedy had the desired effect.

Case 6
Mr. G.M. , 34 years old, comes with hypertension, headaches, ischaemic heart disease and insomnia. Childhood: felt he was not being attended to. Lots of financial crises. "My personality growth was very very ordinary till I left my family to study. Then I achieved my personality." He had frequent attacks of migraine, so severe that he had to take leave from office. Very big family: 25 people. "We were millionaires in Burma but when we left, we had nothing to bring back with us. The weight of all this was on my father. My mother used to have hysterical attacks and in childhood this tension always remained with me, always getting into problems, always mismatched. When we came to Bombay, father had severe problems because of the huge family. I was neglected. My mother could not express her anger at anyone else and so all her frustration was poured on me. I had to work a lot as we were financially not in a good position. After I joined business, my brother and I didn't get along well. Due to his many weaknesses, he became a burden to me and the business. I was the only one handling the big business. I had to close down in 1977 due to losses. At this time I developed high blood pressure. My father expired around the same time. Except for the blood pressure my life was peaceful." He is very critical about family members, finding fault with every one except his wife (love marriage). His wife and mother don't get along well and this is his greatest worry. "As far as personality is concerned, I am very sensitive but don't speak out." He has inclination to read spiritual books, meditate, etc. "My college days - personality point of view - were very good but academically, OK. In business, I keep a low profile. I am cautious not to overdo it." Dreams: - Accidents - train; self, mother or somebody of her age dying; - Sexual (amorous); - Calamities like thunderstorm; - War - as if our building was bombarded; - Of monkeys on trees. "I like monkeys very much. I like their eyes - twinkling, deep stare, jumping, funny, anger, hair on the head, etc. I like to be alone, at peace with nature. I like company of people of similar nature - broad outlook on life, spiritual talking, reading, activities, etc. I like activities where I get importance."

Analysis
We see that this man had many problems since his childhood... the financial problems, not getting enough attention from his parents, being criticized by his mother, the problems with his brother, etc. The feeling here is that life is a struggle. However, there is hope and we don't find the patient having any negative feelings about himself, nor is there despair and resignation (hopelessness). This is the psoric personality. To differentiate between remedies of this miasm, we have the facts that he feels criticized, suppressed and not having received due importance. We also see his attempts to become knowledgeable, gain importance and get recognition. Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica We would select the following rubrics: - Ailments from scorn; - Delusion, disgraced, she is; - Religious speculations, dwells on; - Censorious. The remedy was Sulphur and it helped him beautifully; not only did the hypertension and ischaemic heart disease improve, the patient felt more contented than ever in his life - his internal agitation reduced substantially.

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Case 7
Mr. N., age 29 years, came with a complaints of bronchial asthma since several years. The attack would come on very frequently, starting between 2:00-3:00 am. The attacks could be induced by anxiety. During the attack, the patient felt very weak, did not like to be disturbed, was very intolerant of noise. Very anxious and restless during the attack yet he sits still. He feels lost, does not know what is happening, feels choked up and finds swallowing difficult. Often during attacks, he would wonder if he would survive the attack. The patient was doing textile business and felt his partner had cheated him. He felt very bad as the partner was a close friend. After his loss he started learning to work with computers. He now conducts computer classes. His greatest griefs, he says, are the death of his mother when he was very young and the heavy business losses he had twice. He suppresses his anger most times but at times bursts out. Cravings: sour, fats, spicy food and fruits. Dreams of dead persons.

Analysis
I had given him Staphysagria initially with no effect. On studying the case again, I recognized the following features: the complaints come in attacks - the breathlessness, the anger, etc. He feels suppressed yet sensitive. These features belong to the malarial miasm. Along with this appreciation, the rubrics: "Respiration, asthmatic after midnight and 3:00 am" and "Cough after midnight" led me to China and Arsenicum. I could see that he had features of both, i.e. the cheated feeling of Arsenicum and the harassed feeling of China. The cravings (sour, spices, fruits) also fitted in with China and Arsenicum. However, the specific feature: "Disturbed, averse to being" belongs to China arsenicosum. This is a very well-known malarial remedy. It has also other features: "Periodic asthmatic attacks with great prostration" (Phatak's Materia Medica), "Censorious with dearest friends" and "Restlessness with exhaustion" (Synthetic Repertory). The main feeling of the case is: harassed (China) and betrayed (Arsenicum) by someone but is unable to do anything about it, and hence suppresses the feeling, only letting it out in attacks when things get too much. This is a prominent feature of the malarial miasm, which lies between the acute and sycotic miasms. The acute feature is the sudden great anxiety and weak collapsed condition which looks very threatening while the sycotic feature is the feeling of dependence which compels him to suppress his feelings constantly without being able to retaliate. The patient was given China arsenicosum 10 M with which the frequency of the attacks greatly diminished. He remained free of attacks for six months and then had quite a bad one which responded promptly to China arsenicosum. Incidentally, the patient's father who came later for a very severe eczema (after varicose veins), also improved dramatically under China arsenicosum - one of the most satisfying results I have seen in my practice. The patient's son also needed China arsenicosum, with which his asthma disappeared completely.

Case 8
Dr. (Miss) B.K. , a 24 years old homoeopathic physician, came with the complaint of asthma since age seven years, during exams, relieved by sitting bent forward. She feels very weak during the attack. She has always been very tense before exams and important engagements, trembling when nervous, especially before viva voce. She has a marked fear of dogs (3) and of darkness. When she goes out, she has a constant feeling that people are looking at her. She cannot eat at parties on account of this feeling. Describing her nature, she wrote in the case record that she is proud and leads the life of an obedient, sincere, hardworking person. She is very shy, very serious, lacks confidence and is very much concerned as to what others think of her. She has a marked fear of failure. She is obstinate, fastidious - much affected by disorder - "simple" and feels she cannot adjust in a large family after marriage. Her prospective in-laws want to start Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica a nursing home for her. "They have high expectations of me and I doubt my capability." She is irritable before menses. Dreams: - Missing the train and therefore late for exams; - I don't see the time table properly and therefore prepare for the wrong subject. She craves chocolates and ice-cream. She has profuse perspiration on the back, forehead and palms, staining yellow and sometimes indelible. Menses: stains difficult to wash off. Occasionally breast tenderness before menses. On examination, nails are ribbed vertically and have white spots on them. The soles of the feet are cracked.

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Analysis
The case has strong psoric and sycotic components thus falling into the ringworm miasm. She has sycotic features on the one hand, fastidious, indelible stains left by discharges, while on the other, the fearful aspect seeking security and protection. She tries to live up to expectations at times and hence gets highly nervous, but at other times she just feels she cannot do it. The feature of struggling for a while and then giving up is characteristic to the ringworm miasm. As on the one hand we have features of performance especially with respect to exams and on the other there is need for security and protection, I gave her Calcarea silicata 10 M /1 and there was a remarkable change in her mental outlook and complete disappearance of the asthma.

Case 9
Mrs. S.R. , 37 years, accompanied by her husband, comes with the complaint of pricking pain in the right side of the throat. It began immediately after she ate a mango four months back. She has taken a lot of treatments (antibiotics, etc.) and has been to many ENT specialists without relief. She also has hypertension since the birth of her second child five years ago. Hobbies: housekeeping, cooking, reading magazines. Dreams: "Unpleasant as well as pleasant. The unpleasant one is that I am flying high and want to come down but cannot. The pleasant one is that I got an offer to teach in a nearby school." She did very well in exams, is well qualified (B.A. , D.E. , G.C. E.) yet has been unable to get a good teaching job. Classmates who were much inferior had got jobs. She did get offers but the timing was not suitable. She is very anxious before exams, has palpitations before speaking. "I want to do everything in the best possible manner - perfection." She is more tense before her son's exams than he is. "I feel guilty that I don't devote enough time to my home." She does not want others to think ill of her, is very keen on producing a good impression. The house should be spic and span.

Analysis
The main feature of the case is a lack of confidence. She has anticipatory anxiety, timidity appearing in public and certain compulsions seen as conscientious about trifles, e.g. the house should be spic and span, etc. Her dreams represent the same feeling. "Flying high, wants to come down but cannot" indicates lack of confidence and tension. The other dream indicates success, where she has got a job. The chief complaint is a fixed complaint which came on after eating a mango! Fixed ideas. This is sycosis. The remedy is Silicea.

Case 10
Mrs. S.D. came to the clinic (unaccompanied) with complaints of dark circles around the eyes, diabetes mellitus (taking Daonil 1-1-1), headaches before menses. She is a lawyer (and housewife), very well dressed, bright lipstick. Marked saddle across the cheeks, greasy face. Dreams: Owns a big house with huge rooms by the sea. - I walk on the beach. It is a good house, it is by the beach. - Why walk? - To keep fit because of diabetes. I like to walk. - Fast or slow?

Copyright 2000, Archibel S.A.