Miasm & its Therapeutic Implication
NATIONAL JOURNAL OF HOMOEOPATHY 2003 May / Jun VOL V NO 3.
Dr Hitesh G Purohit
'Bac / Bac / Bac

(Editor: Miasm is all pervasive. Whether studying a remedy or disese or patient, the greater the clarity on the subject, the greater will be our efficacy in Homeopathic Practice.) 

The Hahnemannian classification of diseases based on theory of chronic miasms is a major breakthrough towards the rational therapeutics. Introduction of miasmatic classification of disease became the most important milestone not only for the Homoeopathic world but the entire medical fraternity. Unfortunately this unique contribution has become The most controversial in the Homoeopathic history. It has polarized the Homoeopathic profession. We have Allen, Kent & Robert on one side while Hughes, Hering & others stand on other side who have ignored, misunderstood or misinterpreted this doctrine. Allen is quite right in saying - the character of miasm yields the character of the disease or the form of the illness. Thus miasm - the residual poison in fact permeates into the cell, tissues & spirit of the individual and you see a distinct pattern in the evolution of disease. 

Masters have taught us that miasmatic concepts give an unique perspective to understand man in his totality

Each human being, right from the moment of conception, is characterized by a miasmatic modulation through which his individuality is constantly trying to emerge. Greater the miasmatic obstacles, deeper and extensive is its manifestations in health and disease. It is our day to day experiences of integration of miasmatic totality in handling of chronic illnesses. At the same time clinical experiences taught us immense value of using miasmatic force at a right time in ACUTE EMERGENCY CASES to prevent catastrophe.

Role of Miasmatic remedy in acute cases.
Bronchiolitis is known to be a paediatric emergency as it leads to complication rapidly.
Definition: It is an acute inflammation of the small airways resulting in a clinical syndrome characterized by inspiratory and expiratory wheezing and hyperinflation. More then 70 % cases are due to respiratory syncital virus (RSV)
Age: 2 to 9 months. Later occurrences fall under heading of Hypersensitive Airway Disorders.
Incidences: Mostly in winter & early spring, Males>Females, common in chubby children.
Risk Factors: babies not well breastfed. Crowded localities.H/O viral illnesses in family. Infants of smoking mothers

Clinical presentation: 
Patient presents with:
a) Abrupt respiratory distress with paroxysmal wheezy cough-a)dyspnoea, irritability & restlessness.
b) Non-acceptance of feeds-difficulty in sucking & swallowing.
c) Excessive crankiness.
d) Moaning.
On inquiry
a) H/o URTI in family with appetite diminished or mild fever.
b) Systemic manifestations like diarrhoea or vomiting may or may not be present.
Complications
Biochemical Changes.
a) Respiratory Failure
b) Pneumonia & its allied complications as it traverses from parenchyma to pleura to multiple organs, brain, blood kidney etc.

Physical Examination:
a) Look (sick/ill/active/playful)
b) alae nasi/use of accessory muscles.
c) moaning/grunting
d) Cyanosis - central/peripheral.
e) Temperature/resp rate.
f) On Auscultation - Fine crackles at the end of inspiration & early expiration. Prolonged expiration with
Audible wheezes. Liver and spleen palpable

Investigations:
a) CBC- Normal.
b) Chest X-Ray 1) Hyperluscent lung shadow.2) increase A.P. diameter of chest.3) flattening of ribs.- all signs of inflation

MANAGEMENT:
On the strength of respiratory distress and generals, Bronchiolitis is divided into mild, moderate & severe types. Mild to moderate can be managed at home. In severe Bronchiolitis, hospitalization will be required.
Miasm: Tubercular :
1) Sudden evolution & pace
2) Acute inflammatory response - oedema of bronchiolar wall, Hypersecretion of mucus, round cell infiltration, necrosis of cell wall & collection of cellular debris - Pathology of spasm more than exudate.
3) Low reactivity
4) Lingering infection.
The above understanding help us to handle serious disorder without many problems.

Case 1 :
Name: Master D Birth date: 23.8.99 (8 months)
D.O.C: 4.4.00.
Fa: 34. MO: 30.
Add. Vadodara.

Thermal State: Chilly.
Since last attack Pt.is on Beclate & Asthalin Inhaler twice a day.
O/E Chest: Nad.

Follow - Up:
Treatment was started with Bacillinum 200 every 15 days & inhaler was withdrawn within a week

Later the patient stabilised with weekly doses of the Intercurrent & Constitutional. Later on he had 3 more attacks in 2000 & one in 2001, which responded promptly to Bacillinum & Antim-ars 200 - 1m

CASE 2:
Master P: B.D.29.9.00 (6 months)
Fa: 30 yr. Mo: 26 yr. D.O.C:16.3.01.
Add: Vadodara.

Thermal: C2H2 - C3H2.
F/H Fa: allergic bronchitis, Gr. Asthma. O/E Temp 100. Chest: Few creps with ronchi +. R.R 30 /min: Treatment Started with Pulsatilla 200 4 hourly.

Later on Pt. stabilized with weekly doses of Calc-phos & Bacillinum 200 (infrequently).

Case 3: Name: Master M B D - 15.1.98.
D.O.C. 6.11.98. Address: Vadodara.

Thermal: Hot pt. F/H: Gf - Asthma, Pgmo: Eczema. O/e Chest: Nad.
4th & 5th Month developed Pneumonitis because of Bronchiolitis.
Treatment started with Calc-iod 200 wkly. In Nov - Last attack: pt. was serious, admitted & treated heavily with Inj.Steroid & Deriphyllin with Nebuliser Qds. For 3 days.

FOLLOW UP
6.12.98. _ Cold + Rattling 3 since Morning. Temp.100.Vomiting of food, was not able to sleep because of Cough.
O/E: Temp.100, Chest Ronchi +. Paed.consulted, who started Bronchodilaters + Steroids + Antibiotics. Ars-iod 200 6 hrly.

Later on Pt.settled with Calc-iod 200 with infrequent Intercurrent. He did develop attacks later on but responded promptly to Ars-iod 200 & Bacillinum.

CONCLUSION
All these cases beautifully demonstrate of need of Miasmatic remedy during Handling of acute serious disorder. Allen has mentioned "until you do not resolve miasmatic dyscrasia, you may not able to achieve rapid cure". Clarke in his introduction of Bacillinum write "Bad cases of asthma, Chronic respiratory disease, Copd, often helped by Bacillinum instead of other forces. Dr Cartier has written maximum on Bacillinum and has labeled Bacillinum a Syco- Tubercular remedy.

Biblography
1. Allen’s Chronic Miasm
2. Clarke & Cartier : Bacillinum as a drug.
3. Symposium Volume: ICR publication
4. I JHM volume on Nosodes
5. Paediatric in Homoeopathy : ICR publication