The etiology of a disease, the constitutional temperament of the patient, and the totality of the signs and symptoms, are three factors that form a complete picture of a disease. In homeopathy we often speak of the totality of the symptoms as the basis of selecting a remedy, but sometimes we forget to include the causative factors, miasms, and the physical constitution of the individual. The physical signs of a person are fundamental to the treatment of chronic disorders because the constitution and temperament show the effects of the inherited miasms. We must progress beyond a reliance solely upon personal or family history to uncover miasms. The miasms are present in the very symptomatology of the client. The syndromes produced by the miasms point to the fundamental cause even if it cannot be traced in the case taking to a specific etiologic factor.

Each of the chronic miasms have their own characteristic signs that are an integral part of the totality of the symptoms. For example, Psora tends to produce irritation, inflammation, and hypersensitivity; Sycosis leads to infiltrations, indurations, and over growth; Pseudo-psora tends toward tubercles, fibrosis and suppuration; syphilis tends toward granulation, degeneration and ulceration. As far as the physical constitution, Psora tends to make the organism toxic, the skin unhealthy, and perverts the functions of the digestive and eliminative organs. Pseudo-psora tends to produce pipe stem bones, narrow chests, sunken cheeks and sparkling eyes. Sycosis tends to cause heavy bones, water retention, over growth of tissue and slow metabolism. Syphilis tends to cause congenital defects, asymmetrical bony structure, deformed teeth and the classic bull dog face.

The psoric temperament is full of pseudo-scientific, philosophical, political, religious ideas. They are self-expressive, talkative, self-deceptive and may think they are full of genius, yet seem foolish and impractical to others. Pseudo-psora (TB miasm) is romantic, erotic, social, extroverted, cosmopolitan. erratic, optimistic, yet dissatisfied and always wants to change places, jobs, mates, etc. Sycosis is pessimistic, a hard realist, skeptical, secretive, suspicious, jealous and has fixed ideas and hidden self-disgust. Syphilis has a mixture of madness and genius with a deep sense of irony that leads to obsession with death and destruction. They become guilty, self-destructive, and end in idiocy, insanity or suicide.

The pains of Psora are itchy, crawling, tickling, and burning; the pains of Pseudo-psora are neuralgic, sharp, piercing, twisting, stitching; the pains of Sycosis are sudden, intense, spasmodic, crampy and colicky; the pains of Syphilis seem lacking for the condition present or are deep, aching, agonizing, and especially worse at night. Psora has fairly scanty, irritating, itchy discharges; Pseudo-psora has pussy, purulent, yellow, bloody, musty discharges; Sycosis has pungent, brine-like, fishy odors with watery greenish or dirty brown discharges; Syphilitic miasm has very offensive, foul, putrid, smelly discharges.

The skin of Psora is dry, rough, unhealthy, every little injury becomes infected and the lesions are itchy and have scanty pus. The skin of Pseudo-psora is translucent, fine, smooth, bruises easily, and its lesions bleed easily and exude excessive pus. The skin of Sycosis is full of warts, flecks, moles, growths, dark discolorations with over growth of hair. Syphilitic skin has brownish red, or coppery color spots, eruptions that do not itch, and a tendency toward easy ulceration.

Classifying Miasmic Rubrics

This list of rubrics goes on and on but I hope these few examples give an idea of how the symptomatology of the miasms is present in the symptoms of the case. It is these symptom pictures that clue the homeopath into which miasms are present within the constitution of the individual. Thus, the etiology points to the symptoms and the symptoms point to the etiology. This is how the homeopath understands which miasmic layers are dormant, latent and active. All of these factors point to the proper anti-miasmic remedies, which more often than not, are not the nosodes. For example, while taking a case history a client reports that he used to be friendly, outgoing, loved to travel, and had many girl friends (Tubercular miasm), but for the last few years he has changed his lifestyle and become more conservative. Most of his friends have not noticed how much he has changed except that he seems to have settled down. Some people think that he has changed for the better. This is because he is trying to hide the fact that he feels as if he is losing his clarity of mind (Sycosis) as well as his feelings for others (Sycosis).

On investigating the changes in this person's temperament further, the homeopath finds that he caught gonorrhea due to his cosmopolitan lifestyle (acquired Sycosis) which led to a change in his perceptions (new layer). He was treated with antibiotics which immediately "cured" his symptoms (suppression) but he has felt contaminated from that time (Sycosis and Syphilis). On inquiry we find that since then (never well since) he has suffered with feelings of guilt (Sycosis), loss of short term memory (Sycosis), has become more angry, suspicious and introverted (Sycosis). He used to love to have people around (TB miasm), but now he doesn't like visitors, especially strangers (Sycosis). He is especially bothered because he is having difficulty expressing himself and finding the correct words (Sycosis), whereas he used to be quite articulate (Psora and TB miasms). He used to be mentally carefree (TB miasm), but now his mind has become more fixed and obsessive (Sycosis). His joints and muscles are becoming more painful and rigid (Sycosis) and he has developed a fishy order from his armpits and genitals (Sycosis). His general constitution is tall, thin, with pipe stem bones (inherited TB miasm), but since he became ill, he has gained an unhealthy weight around his hip, abdomen and thighs (Sycosis) and become chilly (Sycosis). His skin is fairly pale and translucent (TB miasm), but as of late, he has developed a few dark spots and warty flecks (Sycosis) We can see that this gentleman's innate constitution is affected by the inherited TB miasm, but the expression of the inherited miasm has been suppressed by an acquired sycotic syndrome. The TB miasm has affected his basic temperament and helped stimulate the excesses in his lifestyle that brought him to an infection of VD. The TB miasm is now dormant because it has been repressed by the active miasmic symptoms related to the gonorrhea and its suppression. The transformation of his innate temperament from an out going, social, cosmopolitan (TB miasm) into an suspicious, fixed, private man with feelings of guilt and loss of confidence (Sycosis) are the most important symptoms in his case.

We can see that the totality of his active symptoms is definitely Sycotic so we must search for a remedy for his condition among the antisycotics. A person who prescribes by miasm might think that Medorrhinum should be used, but all the symptoms point clearly to Thuja. Thuja will remove this sycotic layer and the individual will become his old tubercular self again. Now his case should be retaken and his innate constitutional remedy should be sought among the remedies that reflect the Pseudo-psoric miasm. This will remove the excesses of the TB miasm from his personality and prevent him from doing the kinds of things that caused him to acquire the gonorrhea in the first place! Understanding how constitutional remedies relate to the miasms is a fundamental part of the materia medica of chronic disease. This is what Hahnemann was pointing at when he published The Chronic Diseases in 1828 and introduced the idea of categorizing deep acting remedies by the chronic miasms. This is an integral part of our homeopathic heritage and should not be forgotten if we are to cure the most complex forms of chronic disease.

I hope this article on the classical miasms will prove helpful to those students of homeopathy who wish to follow in the footsteps of Samuel Hahnemann. Homeopathy is a gift from the Most High as well as the summation of several generations of hard work by many individuals. This article is dedicated to those who have gone before, those who are practicing now, as well as those who are coming in the future. After all, as Hahnemann pointed out, homeopathy is De Medicina Futura.