EDUCATION AND DEBATE

Chronic diseases:what are they? How are they inherited?

H Montfort-Cabello1*

1 Instituto Superior de Medicina Homeopatica de Ense *nanza e Investigacion Monterrey Mexico

Background: Chronic diseases (CD), miasms or reactional modes, remain one of thedarkest concepts of homeopathy. They are supposed to be heritable and originate aftersuppression of other diseases. Besides this nothing is known about how they mightproduce the large number of diseases mentioned in homeopathic books. They havebeen described in a variety of terms, ranging from Kent and Gathak’s spiritual ormetaphysic conception; the biological-allergic by Paschero, and, Robert’s materialist-nutritional point of view. Flores-Bejar et al have outlined an approach to CD from acellular and bioenergetic point of view.Results: Cellular pathology has led to an understanding of the basic repair mechanismsof every cell and tissue. These mechanisms exist in order to avoid necrosis or cell death.The main mechanisms are molecular repair, apoptosis and cell proliferation.Failure of these mechanisms leads to ‘dysrepair’. Consequences of these ‘dysrepair’mechanisms resemble the homeopathic reactional modes or miasms. These abnormalor ‘dysrepair’ mechanisms are probably the basis of miasms or reactional modes.A new interpretation of miasms is proposed:Psora corresponds to the dysmolecular reactional mode.Syphilis corresponds to dysapoptotic reactional mode.Sycosis corresponds to dysproliferative reactional mode. Homeopathy (2004) 93,88–93.

Keywords: miasms; reactional modes; repair mechanism; dysrepair; cell;homeopathy

IntroductionMiasms, also known as chronic diseases or chronicreactional modes, remain one of the darkest and mostincomprehensible concepts in homeopathy. The psoric,syphilitic or sycosic reactional modes, can allegedlyhelp the homeopathic practitioner to prevent furtherdiseases. But when this concept is confronted withmodern medicine, they appear inexplicable. Here theterm ‘reactional mode’ is used instead of classical termslike ‘Miasm’ (Emanation spreading in the air exerting amorbid influence), or ‘terrain’ (which includes consti-

tutional and acquired factors, which exist before thedisease and condition the prognosis). Terms like‘predisposition’, ‘diathesis’ or ‘reactional mode’ arebetter adapted to current knowledge and language.If we believe that chronic reactional modes are true

entities, and not just peculiarities of the homeopathicworld, we must match them to the current under-standing of pathology. This paper discusses thepathological mechanisms involved. The working hy-pothesis is intended to build a theoretical bridgebetween these concepts and modern cellular biology,pathology and heredity. It is not the intention tointroduce a new or different way to prescribe accordingto similitude, the cornerstone of homeopathic practice.

The classical point of view

Hahnemann described two different categories ofdiseases: ‘acute diseases’, ie the well-known, self-limited,

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*Correspondence: Hector Montfort-Cabello, Hidalgo 1243, Pte.Monterrey, CP 64,000 Mexico.E-mail: hmontfort@att.net.mxReceived 10 October 2003; revised 28 October 2003; accepted12 January 2004

Homeopathy (2004) 93, 88–93r 2004 The Faculty of Homeopathy

doi:10.1016/j.homp.2004.01.001, available online at www.sciencedirect.com

infectious diseases as scarlet fever or smallpox; and‘chronic miasmatic diseases’ ie Psora, Syphilis andSycosis. Hahnemann considered these contagiousentities, with an acute phase usually suppressed bydrugs or topical treatment, and a second chronicphase, which we know now as ‘miasms’. Hahnemann’sCDs have been described as obstacles to the healingability of the vital force, in a huge variety of terms,ranging from the spiritual and metaphysical to thematerialist.Psora is said to be the most common CD. In

‘Doctrine and Treatment of Chronic Diseases’ Hahne-mann stated:1

* Diseases are consequences of derangement of theVital Force, and the cure operates through therecovery of the Vital force.

* Psora, is the most ancient, widest spread of chronicmiasms. It involves contact with the pathogenicagent, suppression of external signs and latterdevelopment of the inner modification that affectsthe whole body usually in 10–15 days.

* Suppression of primitive external manifestations ofskin disease produces the change for other symp-tom(s) or secondary affections.

* CDs are ‘received or imprinted’ by infection orinheritance, many other factors can lead to the fullmanifestation of the disease.2

* Clinical entities considered by Hahnemann as man-ifestations of Psora are listed in Table 1.3

Kent described Psora as the beginning of all physicaldiseases, and as a consequence of the break ofprimitive perfect order of the human being.4 ElsewhereKent traces the origin of Psora to the spiritual level(primitive wrong). Gathak describes the origin ofPsora as a result of ‘wrong thinking’ in men separatedfrom God’s will, followed by a mental derangementwith physical repercussions at the end.5

Paschero defines Psora as a ‘morbid derangement’ ofthe whole body imprinted on the genome, a particularreactional mode against pathogenic agents. The psoricdefensive reaction against an external aggression is,according to Paschero, a supernormal or hyperergicresponse, limited to functional states and withoutstructural or physical pathology. He identifies theneurovegetative system as the mediator of psoricresponse, and he concludes: ‘There is no differencebetween Psora and allergy, apart from clinical expres-sion’.6 Sanchez-Ortega places the CDs at a cellularlevel, describing them in terms of dysfunction: lack(Psora); excess (Syphilis), and perversion (Sycosis).7

Roberts states that the lack or failure to assimilatenutrients by the cells is the main common feature ofalmost all diseases named as psoric. Other classicalauthors like Roux, Witmont, Masci, Speight andKohler may be consulted to have a broader idea ofmiasms. After all these opinions, no logical conclusioncan be drawn or understood in terms of modernmedical knowledge. However, reactional modes arerealities that every careful observer and practitionerfind in everyday practice.

Contemporary views on CDs

Beside these classical points of view, there are somemodern interpretations of the miasm theory.In 1984, in Homeopathie et Terrain, O.A. Julian and

M. Haffen give a view of miasms, based in modernconcepts of genetics, biochemistry, molecular biology,toxicology, immunology and ecology.8 Briefly:

* Psora is renamed as ‘Dysimmunosis’ and is groundedin an altered immunologic response. The multipleaetiologic agents include aggressions of mineral,chemical, vegetal and animal origins. Psora hasmultiple manifestations including ‘metastasis andmorbid alternate faces’.

* Syphilis, or the syphilitic reactional mode is renamedas ‘Dysmorphogenosis’. The inherited and damagedinformation is transmitted in an autosomic dominantpattern.

* Sycosis is renamed ‘Dysmetabolosis’ and is based indefects in two areas: enzymes-catabolic pathways,and transport across cellular membranes. Bothconditions have a base in damaged and mutatedDNA.

In a previous theoretical approach to Miasms theoryin 1987, Flores-Bejar et al described the three miasms,Psora, Syphilis, and Sycosis, respectively, from abiochemical and biological point of view.9

* Psora is characterized by functional, transient butrecurrent, inflammatory and/or allergic reaction.

(a) Psora is an inherited predisposition; its origin is adefect or malfunction in ATP generation.

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Table 1 Hahemann’s list of psoric diseases

BlindnessDiabetes DeafnessHydropesy, cyanosis ParalysisSoftening of bones Mental insanityAmaurosis Pains of thousands of kindsCataracts Varicous cutaneous ulcersDeafness Paralysis, defects of sensesHypertension Chorea, involuntary

movementsGeneral dropsy Scoliosis and cyphosisAnuria, General dropsy GoutJaundice HaemorroidsMelancholic mood AmenorrhoeaParalysis SterilityHysteria, nervous debility Gastric and lung haemorrhageStroke AsthmaEpilepsy Impotence, sexualInvoluntary movements Kidney stonesImbecility

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(b) Psora has two phases: the first, latent Psora, is theinhibition of one or more of cell functions due tofailure to produce energy. This leads cells tomalfunction, producing signs and symptoms ofdiseases. The second stage active Psora is anoveractive or ‘hyperergic’ healing response.

(c) Latent Psora is characterized by the inactivation,or relative lack or availability of Sulphur in thecells. This leads to inhibition of many enzymaticcomplexes.

(d) The reason Sulphur is the most important remedyfor psoric diseases, is its role in many biomole-cules. Theses include insulin, lipoic acid, acetyl-coenzyme A, glutathione, and the most important:the Sulphur containing aminoacids, cystine, cy-steine and methionine. These aminoacids maintainthe tertiary and quaternary structures that deter-mine the conformation of the active site ofenzymes. In the case of mitochondrial enzymes,they make possible intermediate metabolism andproduction of the energy needed by cells.

* Syphilis is characterized by functional and anatomic-structural, chronic or permanent, destructive changes.

(a) It is a defective mode of response to aggression.(b) It is an inherited ‘disease’, deeper than Psora, and

is transmitted in an autosomal dominant patternof varying penetration.

(c) The inherited mutation is located in the DNA thatencodes for the production of enzymes in ATPproduction, similar to the psoric mode. The failureto produce enough ATP leads cells to malfunctionand ultimately to death.

(d) The syphilitic reactional mode might start from apsoric cell or organism, which had been repressedin its efforts to cure itself. If this model ofsuppression is repeated, the accumulation oftoxins will lead to cell death. The vital forceinitiates mechanisms to relocate these toxins,destroying one part of the cell or the whole body,to stay alive.

(e) Mercurius is the main remedy of syphilitic reac-tional mode, because this element reacts withSulphur (Sulphur containing aminoacids) inacti-vating all cellular enzymes. This is the beginning ofdestructive reactional mode, which goes frommalfunction to cellular death.

(f) If a syphilitic process is repeatedly suppressed afurther, more radical mechanism will develop. Thetoxic material will be incorporated into a deeperstructure: the genome, and the sycotic reactionalmode appears.

* Sycosis has its main characteristic proliferation.

(a) Sycosis is an inherited disposition that can bereinforced by repetitive immunization. Its mainmanifestations are: 1. Chronic mucopurulentdischarge from genital and ear–nose–throat mem-

branes; 2. Disposition to oedema and sensitivity tohumidity; 3. Cellular patterns of over proliferationleading to tumours.

(b) The basic defect is an enhanced permeability of thelipid structure of cellular and nuclear membranes.This defect permits abnormal entrance or exit ofions (Na, K,) producing oedema, or entry ofviruses and chemical agents to the DNA structure,producing mutations leading to tumours.

(c) Sycosis has its biological base in mutations ofnuclear DNA, which may or may not be inherited.

(d) The main remedy for sycosis, Thuja occidentalis,resembles the basic defect in sycosis due to itsability to damage the lipid layer of cellular andnuclear membranes, enhancing their permeabilityand the damage to genetic material. The maincomponent in Thuja occ. (Thujone), and allcetonic compounds have the ability to dissolvethe lipid compounds (membranes).

This biochemical approach had many weaknesses,but we think it was a starting point to build amore reliable explanation of CDs, based on currentbiochemical-medical concepts. As a result of allthese concepts there is no consensus about miasms;even now confusions about Sycosis and gonorrheapersist.10

From health to disease

Health is maintained by a dynamic multifactorialbalance between three elements: energy, functions andstructures. Energy is needed to perform the functionsthat maintain homeostasis and restore health fromdisease; energy is also needed to build structures. Thehigher faculties of talking, thinking, moving, etc.,occur in a voluntary mode, the other functions likevegetative or biochemical reactions occur in aninvoluntary mode inherent to life (Vital Force). Allstrive to maintain life in more or less broad range(homeostasis).All these physical (eg muscle contraction) and

biochemical (detoxification, antibodies or hormones-neurotransmitters production, etc.) functions, andcellular reproduction occur due to very preciseinstructions contained in the nuclear and mitochon-drial DNA of cells. If the instruction is erroneous, thefunction will develop wrongly.From this point of view, we can consider disease as

disorders of functions and structures, and the instruc-tions from which they develop. It has been suggestedthat diseases are disorders of information.11 The mostobvious conditions are genetic diseases in whichdefective information is inherited, but further mod-ifications—mutations—in normal genes can occurthrough life leading to degenerative or neoplasicdiseases. Instead of considering CDs as ‘obstacles tocure’, due to a weak vital force, could they beconsidered defects in information?

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Restoring health

Once organisms or cells have been affected bychemical–physical–biological agents or even endogen-ous toxics like reactive oxygen and nitrogen species(ROS and RNS), there are four progressive mechan-isms to restore cells and tissues to a healthy state. Theyexist to avoid the final point of cellular death ornecrosis.12

* The first mechanism, molecular repair (for proteins,lipids and DNA), is mainly through multiplebiochemical reactions, where the main tools arereductants enzymes, glutathione, and tocopherol.The first two components are Sulphur-rich and theiraction depends on the availability of Sulphur.

* If this mechanism is not adequate, the second isstarted: whole cells repair. This is not a widely usedmechanism, because damaged cells usually die to bereplaced by new.

* The third is the physiologic apoptosis or programmedcell death (‘suicide’) directed by nuclear DNA. Verydifferent from necrosis, it deletes damaged and non-viable cells without an amplified inflammatoryreaction, as usually occurs in necrosis (Table 2).The main instruction for apoptosis is located in p53and c-myc genes; bcl-2 is the apoptosis suppressinggene. Caspases, cytokines and other enzymes performapoptosis. If apoptosis is not enough, the fourthmechanism occurs: cell proliferation in adjacenttissues.

* Reproduction of cells replaces damaged and lost cellsand implies activation of the cell division cycle. Thesetwo mechanisms: apoptosis and cell proliferation,usually work simultaneously in rebuilding damagedtissues and organs.

In this process cells usually produce signals thatboost macrophages and blood monocytes to produceelements of extracellular matrix (ECM) and thetransmembrane proteins, which join cells to oneanother (cadherines), and to the extracellular matrix(integrins).All these repair mechanisms are adaptive mechan-

isms of damaged cells to avoid death and/or necrosis.Cell death occurs because the repair mechanismsincluding repair of damaged molecules, eliminationof damaged cells by apoptosis, and replacement of lostcells by cell division are overwhelmed. Other condi-tions which may cause cell death are:

* Exhaustion of resources required for the repair ofproteins, lipids and DNA like antioxidants, glu-tathione, tocopherol, ascorbic acid and hundreds ofenzymes and cofactors.12

* Inability to repair DNA (mutation), because ofdamage to instructions for development of DNArepair mechanism.12

The consequences of malfunction in repair mechan-isms are summarized in Table 3.

* For the molecular repair mechanism: If proteins arenot repaired the result is defective hormones, anti-bodies, enzymes, neurotransmitters, with innumer-able consequences depending on the affected tissues.If lipids are not repaired, the main damage is to thestructure and function of membranes,13 cellular andnuclear, with all pathologies that share defectivemembrane receptor as a fundamental feature. If thedamaged and non-repaired molecule is DNA, theprogression of damage and disease advances to the

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Table 2 Differences between apoptosis and necrosis

Apoptosis Necrosis

Cell Death of single cells Death of groups of neighbouring cellsShrinkage and fragmentation of cells Swelling of cells

Membrane Preserved continuity lysis Smoothing and earlyMitochondria Increased permeability and disordered content released into cytoplasm Swelling and disruptionNucleus Nuclei: clumps and fragmented of chromatin Nuclei: membrane disruptionDNA DNA: fragmented and internucleosomal cleavage DNA: diffuse and random degradationDisposal Phagocytosis without inflammation Inflammation and macrophage invasion

Table 3 Dysfunction of repair mechanisms or ‘dysrepair’ and the corresponding reactional mode

Dysfunction of:

Molecular repair Apoptosis control Proliferation controlPsora Syphilisn Sycosis

Proteins: defective enzymes, antibodies,neurotransmitters and hormones

Damage progress to anticipated death, or deathby necrosis (aberrant apoptosis)n

Uncontrolled division of cells leadingto benign or malignant tumours

Lipids: defective nuclear cellular membranes Abnormal persistence of cell that should die:lymphocytes producing auto-immune diseases

Excessive extracellular matrix elementsproduction with consequent fibrosis

DNA: defective instructions that leads toapoptosis and cell proliferation

Persistent reproduction of cells that should die:tumours.

nMain features of syphilinic miasm.

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next two steps: loss of control of apoptosis and celldivision.

* For the apoptotic mechanism: If this cascademechanism does not work properly, there may bethree different consequences, depending on the site offailure:* A ‘wrong’ apoptosis mechanisms will produce

destruction of cells and tissues by the ‘rough’mechanism called necrosis (always patho-logical), causing ulcers in veins or mucoussurfaces.

* A ‘premature’ apoptosis mechanism, called aber-rant apoptosis, leads to death of cells like neuronsproducing amyotrophic lateral sclerosis, Alzhei-mers, Huntington’s and Parkinson’s diseases.14

This, and the above pattern of cell death bynecrosis, are the main characters of the syphiliticmiasm.

* A ‘delayed’ apoptosis mechanism will produceabnormal persistence of cells that should die butinstead continue functioning, working abnor-mally; eg T lymphocytes producing autoimmunediseases,12 and/or persistent reproduction of cellsthat should die, leading to tumours.

* For the cell reproduction and extracellular matrixproduction mechanisms: If the cell division cycleregulation is damaged, cells enter an uncontrolleddivision pattern that results in tumours. Productionof excessive and abnormal extracellular matrixelements contributes to fibrosis. These two condi-tions are the main characteristics of the sycosicmiasm.

We term these abnormal functions of the repairmechanisms ‘dysrepair’. The word ‘dysrepair’ is not amedical or scientific term, but it is a useful tool tounderstand the consequences of abnormal repair ofcells and tissues.

What are chronic diseases or reactional modes?

If we review the normal and abnormal repair mechan-ism of cells and tissues, the classic concept of CDs asobstacles to Vital Force trying to cure a diseasedorganism does not seem to be appropriate. Instead ofbeing considered as obstacles in healing procedure, weshould see them, as inherited or acquired, disturbedrepair mechanisms of cells and tissues or ‘dysrepair’.Linking these types of ‘dysrepair’ with knowledge of

the homeopathic concept of reactional modes gives thefollowing results (Table 3):

* The psoric reactional mode can be understood as adefect in molecular repair (eg asthma, epilepsy andhigh blood pressure).

* The syphilitic reactional mode can be understood as adefect in the apoptotic process, which leads cell to ananticipated death (eg Alzheimer) or to necrosis,

producing ulcerative and destructive lesions (egulcerative colitis).

* The sycosic reactional mode can be understood as adefect in control of cell division and extracellularmatrix production, due to mutation in DNA repairmechanisms and control of ECM production. Theconsequences are excessive cell and ECM prolifera-tion with tumour production and fibrous tissueformation.

We can illustrate this in a disease like AIDS, inwhich we can observe four different evolutions. Someinfected patients can remain for long periods withoutany manifestation of infection (molecular repairfunctioning effectively). Others develop multiple infec-tions due to poor immune defence (molecular repairfailure), still others develop destructive necrotic lesionssuch as vacuolar myelopathy, acute demyelinatingpolyneuropathy or apthous ulcers (wrong apoptosisleading to necrosis). The last group develops neoplasticmanifestations like Kaposi’s sarcoma (cell divisionmechanism failure).

Are CDsheritable?Can the reactional modes be transmitted genetically?.The clinical entities that we call miasmatic conditions(Table 1) are very different pathologies includingallergic, mental, neoplastic, destructive, necrotic, etc.In almost all multigenic conditions multiple geneticand epigenetic factors (alcohol, diet, drugs or toxics)play a role. Thus, we cannot limit the reactional modesto one type or kind of heredity (autosomic or sex-linked, and dominant or recessive). It is better todiscuss each clinical picture individually and define thereactional mode or the repair mechanism that isaffected.

Conclusions

1. Homeopathic reactional modes are based on thepathology of cells and organisms.

2. Reactional modes are disturbed or abnormal repairmechanisms of living organisms. These repair me-chanisms may not work properly because:

(a) The mechanism is overwhelmed by the magnitudeof the challenge.

(b) Exhaustion of the resources required for repair,including enzymes, antioxidants, vitamins andcofactors.

(c) Failure to repair DNA damage.

3. Each type of reactional mode has its own genesis andphysiopathology.

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4. A modern reinterpretation, conception and denomi-nation for miasms or reactional modes is suggested.The proposed terms are:

Psora: Dysmolecular reactional mode.Syphilis: Dysapoptotic reactional mode.Sycosis: Dysproliferative reactional mode.

5. The next challenge is to investigate if homeopathicmedicines are able to restore the abnormal paths ofhealing or repair.

References

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