Open Sesame: The Key To Cracking A Case

March 9, 2011

It is with a sense of excitement that I write this post (apologies for the delay) as I have been preparing for an upcoming seminar (Mind & Miasms: Throwing The Constitutional Switch, which I will be presenting on April 3, 2011, Hahnemann Day). With preparation uppermost on my mind, I thought I would discuss the subject of my presentation here, which is the all-important role of the Mind in disease – its etiology, expression, experience and reversal – as the key that ‘opens a case’.

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The mind-body connection has been discussed ad nauseum and has even become something of a cliché to many, both homeopaths and the lay public. While many practitioners acknowledge this truth and even believe in it, they falter in its application as classical homeopathy meant it to be.

In other words, while many practitioners believe they are addressing mind and body, they apply this knowledge only in a general, superficial sort of way. These homeopaths are guilty of the “sin of symptomatic prescribing”, making them no different from conventional physicians whose mechanistic approach separates, rather than blends, mind and body.


Forgive me if I sound holier than thou. I don’t mean to. This post is a heartfelt attempt to clear a few misconceptions while asserting one simple truth – that there are no shortcuts to practising homeopathy, no formulae to arrive at rubrics and to prescribing the right constitutional remedy.

The human mind is a wonderfully complex phenomenon, and although responsible for the infinite variety in human behaviour, its chicanery becomes the homeopath’s concern when leading the patient down the path of disease. Let us not forget that the myriad personality traits and their unique expression serve one single purpose – to defend. And herein lies the crux of Miasms.

Miasms Is Not A ‘Concept’

I have been teaching homeopathy for more than two decades and it never fails to surprise me when a student asks me to explain “the concept of Miasms”. Far from being a “concept”, Miasm is a state of being – it is THE primary state of existence of the human individual.

Before I get to the crux of this post, there’s something I would like to repeat from previous posts. Before human beings even walked this earth, the evolution of life itself began at the cellular level. And the way in which the cell reacts to injury and harm – its defences – is mirrored by the Mind. Thus, the Mind is nothing but an extension of the cell and its defences. Classical homeopathy, as we all know, calls this defensive pattern of reaction Miasm.

But it is not enough to determine a patient’s Miasm. No, it doesn’t take a genius to assess Maismatic states. Nor is it a challenge to figure out a patient’s key behavioural traits such as passive aggression, an all-pervasive feeling of abandonment or the drive to overachieve. These are external, outward expressions of the patient’s Miasmatic state.

Oh, That Elusive Key!

But the key to opening a case lies not in the ‘what’ but the ‘whys’ and ‘wherefores’. Behaviour is nothing but an outward expression of frustrations, disappointments, psychological traumas and other key issues that are turning points in an individual’s life. These are the ‘whys’ or internal reasons (what I call “key sensitivities”) that lead to the ‘what’ (behaviour). Thus, a behavioural description is insufficient, and arriving at rubrics on the basis of behaviour alone can be very misleading.


Thus the homeopath must ask: What led to this behaviour”? What provoked the patient to become, say, flamboyant and exhibitionistic? What is this particular patient compensating for? What is he denying? What exactly does he fear most? Find the answer to these questions – determine the patient’s “key sensitivity” – and you’ve found the key that will open the case!

It is these key and core issues that are expressed in the patient’s disposition and behaviour, always of course through the prism of his / her Miasm. But to arrive at this “ah experience”, the practitioner must undertake a detailed Case Taking. Like a detective, the homeopath must probe deeper, listen to what the patient is not saying and read between the lines to find embedded clues, always guided by one question – What is the issue the patient is most sensitive to?

A detailed and carefully guided Case Taking will reveal exactly “what makes the patient tick”. Bingo! We have discovered the patient’s “key sensitivity"!

Divining a patient’s key sensitivity is not easy. It means walking through the rubble of a patient’s life with a divining rod loaded with a keen sense of intuition. It means weeding out irrelevant details while picking up relevant clues from debris of the patient’s life. The skilled homeopath eventually pieces them together to form a thread that sews mind and body, disease and health, patient and remedy.

It is only at this stage that the patient reveals their true drug picture. It is only now that you can arrive at the right rubrics and the right constitutional remedy. The right rubrics are terribly nuanced just as remedies are.

Playing “Matchmaker”

Let me illustrate this with an example from my own experience. Mr Shah was many things but most of all, he was a workaholic. In fact, he was obsessed with work, which over the years had become central to his life to the exclusion of all else. When work wasn’t on track or deadlines were not met, Mr Shah turned angry and he turned his rage at both employees and himself.


Mr Shah was also not a talker and the one thing he didn’t like talking about was himself! No, Case Taking wasn’t easy and I had to depend on details provided by his wife. I arrived at the following rubrics: workaholic; ambitious, anger answer obliged to and prescribed Nux Vomica.

A couple of months later, Mr Shah returned to my clinic. He wasn’t feeling better and his urticaria, indigestion and painful, ingrown toenails had grown worse. I asked myself where I had erred. This time, I probed further and spoke to Mr Shah alone while his wife waited outside. Patience and persistence paid off and after a short while, Mr Shah told me that before he was married, he had been jilted by a woman he had loved. However, the young lady refused to marry him as he wasn’t “doing well enough” (read “good job”).

There it was – an emotional, love angle that had injured him deeply. This broken relationship revealed Mr Shah’s “key sensitivity”. This key rejection had led him to compensate and project himself as an ambitious and successful businessman, an armour that would guard against future rejection.

This single fact – the key to Mr Shah’s case – completely altered Mr Shah’s rubrics. The new (and accurate) rubrics: workaholic; ambitious, anger answer obliged to, anger work about (Kneer) = Natrum Mur. Natrum Mur, in the sycotic phase, will exhibit affectation, extravagance and too exclusive.

After discovering the key to any case, the rest is easy. We must uncover how and why the patient progressed from one Miasmatic state to the other. Since all disease reflects a Syphilitic state, we are thus looking for the progression from Psora to Syphilis or Sycosis to Syphilis or, in a classic case, from Psora to Sycosis to Syphilis.

If the patient’s history reveals why the constitution has fallen sick, his key sensitivity will reveal exactly how he has coped; and what went out of control or why he has turned indifferent or what he is compensating for. Critically, his key sensitivity will link effect with cause. Thus, we determine his Miasm at both the physical and mental levels.

When this picture is complete, you will realise that every single time the patient switches from one Miasmatic state to another (“throws the constitutional switch”), it is the “key sensitivity” that turns the key. When we discover the “key sensitivity”, we find the absolute, perfect match, with the levers between human being and plant /animal / mineral meshing perfectly. Only then can we reverse the disease process completely, comprehensively and permanently.

Miasmatic Mathematics?

As I mentioned earlier, there are no shortcuts in homeopathy. Yet, many have fallen prey to them. There are homeopaths who make no bones about prescribing symptomatically (even though they are loathe to admitting it!) and there are those who seem to be more diligent.


Alas, the latter, while paying lip service to the Miasmatic interpretation of disease, use set mathematical formulae within its scope to determine a patient’s rubrics. But merely taking Miasmatic mental and physical rubrics, adding thermals and thirst to them and then scouring the Materia Medica for a possible match is simply not good enough.

To guard against the “sin of oversimplification”, let us return to Mr Shah’s case. The patient said he “needed” to be in an air-conditioned environment at all times. Many would instantly classify him as hot. But his need for an air-conditioned environment was actually not linked in any way to his thermals. Mr Shah was a wealthy businessman and was simply used to air-conditioning! It was a lifestyle choice.

So, beware of the pitfalls while weeding the chaff from the grain. And always remember, to make all the levers of the case and remedy mesh perfectly, you must divine the patient’s key sensitivity – you have to play the game of dominos backwards!

Back To Basics

Here, I have selected key developments in the origin and evolution of the Doctrine of Miasms to reflect the mosaic of thoughts and shift in focus as the greats explored this wonderful healing science. But is an understanding of Miasms enough? Read on…

Hippocrates (460-370 BC)

In the 4th century BC, Hippocrates pronounced: “Omoia omoiois eisin Iamata”, which when translated from Greek means “similars cure similars”. Hippocrates believed that disease was caused by an imbalance in the four bodily humors as well as the influence of external forces. He firmly believed that medicine should aim to build the patient’s strength (immunity).

Samuel Hahnemann (1755-1843)

In spite of the law of “similia similibus curantur”, Samuel Hahnemann, founder of classical homeopathy, found that all medicines known to homeopathy failed to bring a real cure in diseases.

He later realised that there was something deeper that determined disease. Many years later, he propounded his Doctrine of Miasms. He called this deeper determining influence “a groove, a pit or a germ”, which he named “Miasm”. Hahnemann categorised this infection as the three Miasms.

Dr James Tyler Kent (1849-1916)

In Kent’s lectures, he said that thinking, willing and doing represent the three Miasms. “These are the three things in life from which finally proceed the chronic Miasm. The person who loves crime lives in it. It becomes part of his nature and shows itself in the external man. The man who loves truth and humanity, lives in that idea, and it becomes part of his nature and it can be seen in his looks and his life.”

Dr P S Ortega (1919-2005)

Ortega was the first to describe in detail the three basic Miasmatic themes or “big” Miasms. He was also the first to correlate Miasms with cell pathology or fundamental alterations in normal cellular functions. He classified these as Deficiency (Psora), Excess (Sycosis) and Perversion (Syphilis). Ortega said the original Miasmatic diseases that Hahnemann explored represent three fundamental expressions of imbalance and that these were inbuilt or innate predispositions as reflected by the human constitution.

Ortega also applied the doctrine of Miasm to the observation of the human being by describing its expression in an individual’s attitude and appearance.

He was also the first to reveal the Trimiasmatic drug picture.

Dr Prafull Vijaykar

Building on Orgeta’s observations, Dr Vijaykar further explored the correlation between homeopathy and modern science as expressed in cell pathology, extending it to genetics, embryology and physiology.

He explained that every cell or living thing has a survival instinct. To survive, a cell has to defend itself against any kind of hostile stimulus. The primary reaction of any cell is to defend. Dr Vijayakar defines Miasm as the defence of a human being to any stimulus or action. He said it is how a human being defends and reacts that decides their defence. Dr Vijaykar equated Miasms to pathology at the cellular level.

Dr Vijayakar also elaborated on Ortega’s doctrine that Miasm is reflected in one’s constitution, looks, behaviour, nature and attitude.

His Chart of Suppression, which helps understand Hering’s Law of Cure, is invaluable in understanding the progression of disease from one layer to another.

Dr Rajan Sankaran

Dr Rajan Sankaran is best known for his understanding of disease as a delusion, his use of mind symptoms and dreams, his classification of remedy states into kingdoms and his additions to the existing Miasms. According to Dr Sankaran, Miasms represent the pace and desperation perceived by the Individual in a given situation. He classified pace and desperation into ten types: Acute, Typhoid, Ringworm, Psora, Sycosis, Malaria, Tubercular, Leprosy, Syphilis and Cancer.

Dr Rajan Sankaran is best known for his understanding of disease as a delusion, his use of mind symptoms and dreams, his classification of remedy states into kingdoms and his additions to the existing Miasms. According to Dr Sankaran, Miasms represent the pace and desperation perceived by the Individual in a given situation. He classified pace and desperation into ten types: Acute, Typhoid, Ringworm, Psora, Sycosis, Malaria, Tubercular, Leprosy, Syphilis and Cancer.


Every great homeopath before us and those among us too has made great strides in adding to this amazing system of medicine. Unfortunately, bickering, squabbling and petty one-upmanship occasionally eclipses these contributions.

We must applaud each one and strive to add to this great pool of knowledge and its application if we are to hone our skills and heal with confidence and certainty.

I thus conclude that while Miasm is the lock that guards the entry to a case, the patient’s core sensitivity is the key that opens it. After determining the patient’s key sensitivity, we must observe its expression at all Miasmatic levels.

Remember, just as every patient has a key sensitivity, every remedy too has its own unique sensitivity. It is only by understanding both that we can find the perfect match and arrive at the right constitutional remedy.

So how exactly does the practitioner determine this key sensitivity? Unfortunately, the answer cannot be found in the textbooks. The process is the result of assimilating the wisdom of the greats and blending it with the practitioner’s own intuition.

At my upcoming seminar, ‘Mind & Miasms: Throwing The Constitutional Switch’, I will demonstrate with video cases precisely how homeopaths can recognise the key sensitivity in different remedy pictures. Armed with this understanding, it is easy to treat even the most challenging and baffling cases – pathological, incurable and psychiatric disease cases.

Re-awaken the healer in you...
- Dr Anita S Salunke
MindHeal Homeopathy is based in Chembur, Mumbai. To find out more about MindHeal, call: 022-25230530 /
+91-9930363981. Or write to Website: We’ll be happy to answer all your queries.

Join me on a journey of healing as I demonstrate how this magical system of medicine can transform lives, maybe yours too. By digging deep into my case files, I will show you how homeopathy relates to the human condition, delivers patients from physical and emotional pain, and helps them become the best version of themselves. Here's where it all began for me.

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