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Miasms in Case Management - Part 1

Part 1 : Hahnemann's Miasms in Chronic Diseases

What did Hahnemann mean when he used the term Miasma in the Chronic Diseases?

A Miasma is an obnoxious disease producing agent (external infecting contagion) which is partly psychical (dynamic), partly physical and is inimical to life.(Aph. 31)

Hahnamann used the term “miasma” very frequently in the CD which more accurately conveys his advanced foresight about and external cause and spread of disease. The presence of micro-organisms in the environment and how they were communicated from person to person was not something known in his day. If we check these page (33-38) of the CD:

There are a number of references to what he meant by the term Miasma. He uses phrases like: “…infection with miasmas”; “…severeal other acute miasmas”; “any miasmas, (the organism is)…..infected from without…”; “…the specific contagion..”; ” …half-spiritual miasmas..”

What did Hahnemann mean by the term “Miasm” in the CD as well as in the Organon?

Miasm is the fundamental cause of a deranged vital force. (Aphorism 11) This fundamental cause is due to the Chronic miasm in Chronic diseases. (Aphorism 5).
The dynamic and physical effect of miasma cause a change in the interior of the whole man, his whole being. It isonly after this is complete that there is an external expression of signs and symptoms of disease.
In acute disease, the constitution possesses the required processes to extinguish completely this dynamic effect through a crisis response which results in either healing or death in a short period of time.
But some miasma produce a chronic dynamic effect on the whole being of man to cause chronic disease.

The constitution is unable to overcome this and its effect remains on the (vital force of the) organism its whole life resulting in chronic miasm. This is the fundamental cause of chronic disease. Most of these terms will be found in the CD pages 34, 35.

But, there is hope for cure!

In his Preface to the Fourth Volume of ‘The Chronic Diseases’ (which he initially presented in 5 volumes) Hahnemann states: “The fund or the fundamental essence of this Spiritual Vital Principle, imparted to us men by the infinitely merciful Creator, is incredibly great, if we physicians understand how to maintain its integrity in the days of health, by directing men to a healthy mode of living, and how to invoke and augment it in diseases by purely homeopathic treatment.”

The Fundamental Cause, the Chronic Miasms:

As introduced in the explanation above, Hahnemann observed that many diseases persisted in people all their life, because of what he termed a “fundamental cause” or “chronic miasm“. This resulted in ”chronic diseases” caused by chronic miasmas, in contrast to “acute, self limiting diseases” caused by acute miasmas.

A Chronic disease has an insidious onset of symptoms, slow progress and development over a lifetime due to an inadequate constitutional response to miasma whose effects remained on the organism its whole life.

An Acute disease has a quick onset of symptoms with a rapid progress towards a crisis, an extinguishing response by the constitution against the effects of acute miasma, ending in either recovery or death if not treated. It is of a fixed duration.

The reference in the CD for these Acute and Chronic disease definitions are here.

For all these acute miasmatic diseases the human constitution possesses that process which, as a rule, is so beneficent: to wipe them out (i.e., the specific fever together with the specific eruption) in the course of from two to three weeks, and of itself to extinguish than again, through a kind of decision (crisis), from the organism, so that man then is wont to be entirely healed of them and, indeed, in a short time, unless he be killed by them.*

In the chronic miasmatic diseases nature observes the same course with respect to the mode of contagion and the antecedent formation of the internal disease, before the external declarative symptoms of its internal completion manifests itself on the surface of the body; but then that great remarkable difference from the acute diseases shows itself, that in the chronic miasmata the entire internal disease, as we have mentioned before, remains in the organism during the whole life, yea, it increases with every year, if it is not exterminated and thoroughly cured by art.

Initially chronic diseases seemed to respond to an indicated remedy based on the presenting picture of symptoms. But as time went on, the remedy failed to produce the expected relief and these diseases continued to progress with new symptoms being added to the old picture. If there was a period of time that the external condition improved for a while (due to various external favorable factors, including the aid of a remedy), it was because the internal chronic disease had gone into “latency”. This was a logical conclusion, because once the external favorable factors changed, the disease expressed itself again in full force.

Hahnemann sought, over a 9 year period of careful observation, to understand this ‘fundamental cause’ and how it could have possibly developed. He understood that in most cases, this chronic condition developed from ancient times, due to the chronic effect of a ‘miasm’ precipitated by suppression or inadequate removal of symptoms (dynamic and physical) by external superficial medicinal agents. This formed the basis for the weakness created and maintained on the vital force giving rise to the fundamental cause of chronic disease.

What is important to keep in mind here is that the subsequent classification and clinical treatment of these chronic miasmatic groups were based solely on the picture of external expressions of mind and body, in the form of symptoms presenting as a portrait of disease. See Aphorisms 5-7 of the Organon.

Psora: The Root Cause

In his book “The Chronic Diseases” (CD), Hahnemann observed that there were two clearly recorded ancient manifestations of skin ailments, i.e. two ancient miasmas: ‘leprosy’ and the ‘common eruption of itch’ like that of scabies. These miasms were experienced in some form by every living person and progressed over the centuries without being thoroughly healed, developing into various ‘secondary symptom expressions‘ of a ‘hydra headed monster‘. Over the years, suppression with treatments like quicksilver, Lead, Arsenic, Calomel, Corrosive sublimate, (today’s symptomatic drugs like Antibiotics, Steroidal applications/ pills, etc) never brought about any cure of the underlying disease. Instead, the effect of the (disease producing) miasm caused a deep seated taint on the vital force. This effect is strengthened because every external disease producing agent (miasm) also has a dynamic effect on the constitution along with its physical effects. This ultimately resulted, in a compromised and weakened vital force in what we understand as a “chronic miasmatic disease” expression.

Hahnemann named this original chronic miasmatic disease PSORA. We hence define Psora as a chronic miasmatic disease, a fundamental cause of disease, a hydra-headed monster of disease expression caused by the dynamic as well as physical effects of a miasm on the constitution.

So we see that Hahnemann used the term PSORA based on the external expression of this chronic disease expression – the ITCH which resembled that caused by the scabies mite. This expression on the skin of itching (today commonly observed as allergic dermatitis, or early eczema, or scabies or various fungal infections on the skin) is the most healthy expression of Psora. This means that when the Psoric miasmatic state (in the absence of other ‘secondary’ disease development) is expressed solely by itching symptoms on the skin, the individual has a very healthy constitution and is close to cure. One of the remedies of the Materia Medica that closely expresses the Psoric Miasmatic expression of diseases is Sulphur.

Hahnemann further attributed all disease expression of initial infection (by most infectious agents known today – bacteria, viruses, fungi), inflammatory responses of internal organs, and further development of chronic disease in internal organs (all listed in the CD), as due to the suppression or imperfect removal of symptoms of the primary Psora over the centuries with suppressive or partial treatment. Many a time there may be no obvious outward expression of disease, when suddenly internal (not on the skin) disease symptomatology develops, this is attributed to this underlying “Latent Psora” which is activated by continued stress in the environment.

Syphilis and Sycosis: The Venereal Miasmatic Diseases

Hahnemann then found a group of diseases that were the sequelae of infections that were venereal in origin that is, basically transmitted by venereal contact. It’s amazing how modern medicine too makes that classification of organisms transmitted solely by venereal contact and calls them “Sexually Transmitted Diseases” (STD). Hahnemann grouped these into two categories based on the symptom expression.

He states, that after ‘impure coition‘ if the ‘contagion has taken effect, then the whole living body is in consequence seized by it ….. Only when this penetration of all the organs by the disease caught has been effected, only when the whole being has been effected, only when the whole being has been changed into a man entirely venereal, i.e., when the development of the venereal disease has been completed, only then diseased nature endeavors to mitigate the internal evil and to soothe it by producing a local symptom, which first shows itself as a vesicle or chancre … this chancre is usually in the place where first infected and this symptom is intended by nature to soothe the internal completed malady‘.

The chancre is an ulcerative expression on the skin and defers from the simple itch. It speaks of destruction and necrosis of local tissue and invades into the deeper second layer of skin, the Dermis. These are basic characteristics of this state of miasmatic chronic venereal disease state, which Hahnemann termed SYPHILIS or Syphilitic Miasm. He found the Syphilitic miasmatic expression more widespread than Sycosis in his time, because it easily developed on a vital force severely compromised by “far developed Psora”

Some of the “Syphilitic Miasmatic symptoms” he mentioned were: “Painful ulcers on the tonsils, round copper colored spots that shimmer through the epidermis, eruptive pimples that did not itch on the face with a bluish-red appearance, the painless cutaneous ulcers on the scalp or penis which were smooth, pale and covered with mucous, the boring nightly pains in exostoses.”

What is important to note (for future understanding) in the details above is that the change of state to Syphilitic miasm necessitates that there is a change in the host factor – ‘the whole being has been changed into a man entirely venereal‘. The importance of this is two fold:

1. There has to be a predisposing shift of the whole being (body, mind, soul) towards a venereal type of expression (Syphilitic miasmatic expression), so that there can be a physical expression with the symptom of Chancre or frank syphilis.
This is especially important, as we know for a fact today, that of all the people who directly come in contact (through sexual intercourse) with a person who is in the infective stage, only 30-50% of these people with ever actually develop the symptoms of syphilis. The explanation for this is Hahnemann’s concept of miasmatic background and the homeopathic concept of susceptibility.

2. There exists, before Syphilitic miasmatic expression, an underlying Psoric miasmatic expression, which may be far developed (involving internal organs), i.e.: is either active or latent.

The other Venereal disease manifestation also arose out of “impure coition”. But here, the disease expression was that of tissue growth (instead of tissue destruction as in Syphilis) on the skin of, specifically, the genital organs. Often though not always, Hahnemann observed that these “cauliflower growths” were “attended with a sort of gonorrhea (thickish pus discharge) from the urethra, several days or several weeks, even many weeks after infection through coition“. Once these warts were cauterized (suppressed) the sycotic expression would now “break out in other parts of the body as either white spongy, sensitive, flat elevations in the cavity of the mouth, on the tongue, the palate and the lips, or as large raised, brown and dry tubercles in the axillae, on the neck, on the scalp etc.”

Hahnemann stated that further suppression lead to internal diseases in the body like contraction of tendons of flexor muscles especially the fingers. This entire state of Miasmatic expression Hahnemann termed SYCOSIS, and the remedy he found most suitable and homeopathic to this state was THUJA.

It is interesting to note here, how incomplete was his description of the sycotic miasmatic expression as we know it today. Moreover, he included into his hydra-headed Psora, conditions that would logically belong to Sycosis.

Curing the Miasmata : Hahnemann’s Suggestions for Case Management

Having arrived at this brilliant and path-breaking concept of Fundamental Cause (apart from exciting cause) and Miasmatic nature of Chronic Disease, Hahnemann set about finding the homeopathic method of therapeutics so as to achieve true cure. He laid down various treatment possibilities for case management, some of which are still relevant today. But there is clearly enough scope for defining more enterprising methods, as we will explore later, because there are some very grey areas of observation in some of Hahnemann’s suggestions. This is primarily caused by the wide variety of treatments, drugs, suppressions and therapeutics that a person today is exposed to. Also there is a tremendous advance in Science today that has sharpened and deepened our understanding of various body mechanisms and concept of diseases.

Having said that, Hahnemann’s understanding of these very mechanisms and diseases were nothing short of divine inspiration and genius, given the limited resources available to him.

We will explore some of what he did, which could still prove useful in the wide variety of complex and individual cases we see today, because basic principles and concepts remain the same. Here are some of his suggestions in the theoretical part of the CD.


The clinical manifestation of Psora is in 3 main forms:

1. The Psora that presents with its unrepressed cutaneous eruption. This is a homeopaths dream case, where a single (antipsoric) remedy cures the person totally of this ailment from within. Today only a child, or else someone living in a remote rural area would present with this simplicity of Psoric expression. Most people have been given much suppressive treatment during their lifetime, right from childhood.

For these simple cases that did not have any secondary manifestation of Psora he found Sulphur, Hepar Sulph, Carbo Veg or Sepia most useful to start the case or complete their miasmatic cure.

2. Latent Psora or the Psoric Diathesis: has a potential of developing into serious chronic symptomatic disease following external persistent stress – emotional or physical, drug/medicinal or from microorganisms (miasm). This deceptively asymptomatic state is also almost always associated with the development of the venereal miasmatic diseases.

3. Psora with secondary disease manifestations: These can seldom be cured with a single antipsoric remedy. They require similimum remedies prescribed in succession based on the predominant homeopathic picture, one after another. Hahnemann stresses that this is only to be expected, especially when a miasmatic disease state has developed ‘over several thousand years, passed through several millions of organisms, and developed into innumerable, chronic, non-venereal ailments‘.

Diet and mode of living are essential adjuncts to treatment in these people, if they seek to reach a level of cure with the homeopathic similimum. Hahnemann detailed what he meant by this in the CD. Some of these included removing obstacles to cure as best possible, living with ‘moderation in all things re: diet, exercise, rest, occupation, and personal habits including avoiding alcohol, coffee, etc that were injurious to health and interfered with remedy action. He also cautioned about behavior that was ‘morally and psychically injurious‘.

Hahnemann expected the homeopath taking on cases for homeopathic treatment dutifully advised each one on all the above, based on their individual requirement.

These cases, more often than not, had undergone any amount of (suppressive or imperfect) treatment with massive doses of allopathic drugs, including massive doses of Sulphur and tar, quick silver, calomel, etc., which often created medicinal disease. Hence Sulphur as a homeopathic remedy would be unable to cure these chronic ailments on its own. Hahnemann recommended that it would prove instead, to be a good intercurrent remedy given the above history, or else a remedy to start the case with. Other remedies for similar reasons were Hepar Sulph, Nux Vomica, Merc and Sepia.

Further one had to proceed treatment with the indicated homeopathic similimum based on the presenting picture of symptoms (and principles as detailed in the Organon of the Healing Art), ever vigilant for a change in picture indicating the next prescription, while giving sufficient time for the previous well chosen remedy to act.

Some of the Antipsorics he listed were: Sulphur, Hepar Sulph, Carbo Veg, Carbo Animalis, Sepia, Lycopodium, Guaiacum, Sarsaparilla, Mezerium, Puls, Nux vomica, Opium, Aconite, Cham, Bryonia, Staph, Colocynth, Ignatia, Hyos, Dulc, Coffea, Ipecac, Rhus Tox, Caps, Ars Alb, Phos, Silica, Baryta Carb, Calc Carb, Nat Carb, Ammon Carb, Mag Carb, Graphites, Antim Crude, Metals such as Antimony, Gold, Platina, Iron, Zinc, Copper, Silver, Tin.


These cases presented to Hahnemann in 4 ways:

1. The figwart or cauliflower excrescences on the genitals, sometimes associated with a sort of pus like discharge like gonorrhea from the urethra:

These simple cases with no other complications, responded to remedies such as Thuja or Nitric Acid or both. In some bad cases, the larger warts could be moistened every day with Thuja Mother Tincture, while internal Thuja was being given. Other specific remedies for associated gonorrhea were Cannabis, Cantharides and Copaiva balm.

2. A Cauterized figwart, after bring removed, secondary ailments would develop in its place in the form of similar excrescences appearing in other parts of the body, etc:

This state required the indicated Homeopathic similimum. Sometimes this similimum was Thuja itself; otherwise Thuja was indicated as intercurrent. Sometimes Nitric Acid was alternated as intercurrent remedy especially if there was gonorrhea as well.

3. Sycosis (figwart) complicated with developed Psora (awakened from latency) due to unnecessary assault with Mercurial treatment:

In these cases, curing the figwart could not be done before proper treatment of the Psoric picture, which was “awakened from latency”. The presenting picture usually required the proper Antipsoric similimum before the Sycosis could be treated with doses of Thuja or Nitric Acid.

4. Sycosis that complicated a developed Psora, which had preceded and was induced by badly treated and suppressed Venereal chancre (Syphilis), i.e., a complex, multi miasmatic disease.

These cases presented various pictures at different points of time during treatment. As in the previous case, the Psora had developed due to allopathic mercurial treatment, and its symptoms were predominant. So the first prescription would need to take into account purely the Psoric symptom picture. Once this is helped, then the Sycotic symptom picture comes into prominence requiring the correct anti-sycotic remedy. Once the Sycosis faded away with the anti-sycotic remedy, and then the anti-syphilitic remedy was needed, based on the prominent Syphilitic symptoms. The remedy of choice for Hahnemann here was Mercury.

Often after this improved, Hahnemann noticed that some part of the Psora reared its head again and had to be treated with the antipsoric once more. Hahnemann advised this process of a cycle of remedies prescribed one after another based on the prominent miasmatic picture i.e. ‘alternating treatment (was) to be continued till a complete cure was effected.’


Hahnemann actually felt that the Syphilitic Miasm was more wide spread than the Sycotic. He considered it very simple to cure, if it was not entangled with (developed) Psora.

He observed 3 distinguishing states of the Syphilitic Miasm:

1. The Syphilis stands alone (the Psora is probably latent):

This is only associated with the local symptoms, the Chancre, which may or may not be removed by external applications, and the ‘bubo‘ (regional lymphadenopathy) as well still remains. Unfortunately in some cases the ulcer was removed by local treatment and it resulted in expression of disease in the ‘bubo’s’ causing their painful suppuration.

The cure of this initial stage however required just one dose of the “best mercurial remedy” (the pure semi-oxide of mercury) taken internally.

2. When Syphilis stands alone (without any developed Psora), but deprived of the ‘vicarious local symptom‘ the chancre and the ‘bubo’:

These cases too required the internal Mercury as the remedy. Keen observation of the scarred tissue where the chancre once stood or where the bubo had broken down, would help assess the progress under treatment. If cure had taken place, the skin of this area would no longer be scarred and would begin to look normal – a sure sign that the syphilitic miasm had been healed.

3. When it is already complicated with another chronic disease i.e. with the Psora (already developed), and the local symptoms partially removed by local applications:

The Psora may have developed as natural progression before the venereal disease or Latent Psora may have been forced into expression by numerous assaults on the vital force (by friction with Mercury, large doses of Calomel, Corrosive sublimate, purgatives) in an (imperfect) attempt to remove the local expression of venereal disease. These treatments created Medicinal disease as well.

To tackle this, Hahnemann had a 5 point programme!

1) Remove all hurtful external influences that affect the patient (drugs, various useless treatments, applications, immoral lifestyle, etc).

2) Advise a light, nourishing and strengthening diet.

3) Give the Antipsoric homeopathic similimum first (without taking into account the venereal disease) and allow it its duration of action.

4) Prescribe the next indicated antipsoric similimum for the residual prominent Psoric symptoms.

5) Prescribe for the Venereal disease the best Mercurial preparation and allow it to work as long as there was improvement in those symptoms.

This process or 5 point programme would need to be repeated over and over in difficult cases. The Antipsoric remedy chosen on the basis of the residual Psoric symptoms, the Syphilitic remedy for the residual syphilitic symptoms. As long as the scar remained of the chancre or the bubo, it was a clear sign that the Syphilitic miasm was not yet eradicated.

Hence the sign of cure of the Syphilitic miasm was the disappearance of scar tissue and the skin surface returning completely to normal. Similarly as the sign of removal of Sycosis was the disappearance of the discoloration or scar, caused by cauterization of the fig wart.

Questions that Arise: 

It cannot be stressed enough that this must have been an enormous work for Hahnemann at that point of his life. The understanding of clinical management of (miasmatic) Chronic disease continues to be a facet of homeopathy that requires the best and divinely inspired minds to apply themselves. Many have done so, in various ways, and my articles in subsequent issues of the Ezine will bring some of them into focus. But before that, it is essential that each homeopath understand the concept and principles of Miasms that Hahnemann laid down in The CD.

This article and interpretations of (the theoretical part of) The CD, above, are based on my previous learning and personal understanding of its contents. There is always the possibility of another differing point of view with some of this. I would be grateful for feedback on the same, directly to me at this email id:

Many people feel, after clinical use of these methods, that Hahnemann did not accurately or completely observe the various miasmatic states and chronic disease expressions. This is more obviously true with those disease expressions resulting from Sycosis and the list of complaints that need to be included in the Sycotic Miasm. Just as many diseases he classified into Psora were later (in his lifetime) put into a different Miasmatic group (heralded by Hering) called Pseudo-Psora or Tubercular Miasm.

Another point of importance is, that if Psora had over the centuries developed into a hydra-headed monster, why would Sycosis and Syphilis not develop into hydra headed monsters as well?

That and other newer observations are included in a series of related articles in a modern ever-developing understanding of Miasms and Chronic Miasmatic Clinical Management. It would be exciting exploring all these new and path breaking evolutions of homeopathic thinking from the work of brilliant contemporary minds.


1. The Chronic Diseases, Samuel Hahnemann (Theoretical Part)
2. Organon of Medicine, Samuel Hahnemann
3. The Genius of Homeopathy, Stuart Close, MD
4. Dhawle’s ICR Symposiums (Volume C), Mumbai
5. Theory of Suppression, Predictive Homeopathy Part I, Praful Vijaykar, LCEH
6. The End of Myasumtion of Miasms, Predictive Homeopathy Part III, Praful Vijaykar, LCEH
7. An Insight into Plants, Rajan Sankaran, LCEH
8. The Sensation in Homeopathy, Rajan Sankaran, LCEH

Part 1: Hahnemann's Miasms in Chronic Disease: Welcome
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