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History and Philosophy
Chapter 3: The Watershed Years (1828–1830)
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friends and colleagues.
The Watershed Years (1828–1830) is a chronicle of the years during
which Homoeopathy reached full maturity and Hahnemann introduced his
teachings on constitution, temperament, heredity, the vital force and the
chronic miasms in The Chronic Diseases. It also evaluates the methods of
the 4th Organon (1829), which teaches the most evolved version of the
single dose wait and watch method. These are the methods used by a
majority of contemporary homoeopaths.
x X 3
The Watershed Years
(1828–1830)
•••
The 1st Chronic Diseases and 4th
Organon
The Introduction of Homœopathic Pathology
T he Roman-Greco school of medicine was obsessed with classifying disease

states into pathological categories at the expense of their distinctive signs and
symptoms. Their goal was to find concise disease names that could easily be related to
specific types of medicines. Hahnemann taught that it was very counterproductive to
force diseases into artificial arrangements on the basis of a few common symptoms.
He opined that every disease has a singular nature that should be assessed by what
is marked, uncommon and unique about the patient’s symptoms.
Hippocrates taught that all diseases are constitutional in nature and only appear
locally as a last resort to provoke crisis. Hahnemann held a similar view and inte-
grated it into all the editions of the Organon. During the period of the 1st to 3rd
Organon homœopathic case taking was based primarily on the principles of similia
and individualization, although the investigation of collective diseases had begun.
Hahnemann was so disillusioned by orthodox pathology that he questioned the
very idea of disease categories. See aphorism 40 of the 1st Organon.
But diseases, ailments and dyscrasias are such infinitely varied phenomena
that a useful classification of them is impossible, even should such a forced
arrangement of them in separate classes appear essential for purposes of cure.
Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation),
Appendix, 1st Organon, Aphorism 40, p. 194.
96 Volume I | History and Philosophy
Hahnemann renounced the pseudo causations and false disease names used
by the allopaths. He felt it was misleading to classify disease solely by names like
nephritis, gastritis and Bright’s disease. It is more important to study the signs and
symptoms of the patient rather than to fall into conjectures about pathological
titles. To him each disease was a singular, unique event that needed individualized
treatment. Samuel summed up his views in aphorism 46.
Nature has no nomenclature or classification of diseases. She produces single
diseases, and demands that the true healing artist shall treat individually in his
fellow-creatures not the systematic combination constituting a disease genus (a
kind of confounding different diseases together), but each particular disease by
itself; but she forbids the therapeutic treatment of composite groups of disease
constructed by imaginative man instead of individual diseases (which she has
wisely created as separate entities), thus crippling the divine work of healing.
Appendix, 1st Organon, Aphorism 46, p. 195.
The Founder was quite pleased with the success of Homœopathy in acute dis-
eases and acute miasms but by 1816 he was increasingly frustrated by the number of
degenerative chronic cases that were resisting his treatment. See: Chart 3.1 Timeline
| The Chronic Diseases and the 4th Organon; p. 97. Hahnemann previously
collected the symptoms of sycosis and syphilis and noticed similar patterns of char-
acteristics. Once he had recorded the group symptoms he was able to find remedies
that acted curatively. This made the treatment of venereal diseases more consistent.
Now Hahnemann was recording fundamental causes and collective miasms.
As Hahnemann continued to treat non-venereal chronic patients he noticed that
many seemed to get better at first but then slowly declined over time. No matter
what remedies Samuel gave, the patient did not seem to improve over the long run.
He wrote of these prescriptions, “Their beginning was promising, the continuation
less favorable, and the outcome hopeless.”
Still such a favorable pause would never be of long duration, and the return
and repeated returns of the complaints in the end left even the best selected
Homœopathic remedies then known, and given in the most appropriate
doses, the less effective the oftener they were repeated. They served at last
hardly even as weak palliatives.
The Chronic Diseases (Theoretical Part); S. Hahnemann, Nature of Chronic Diseases, p. 25.
This situation greatly troubled the Founder because he knew his therapeutic
system was incomplete. The application of his store of remedies was only palliating
rather than curing non-venereal chronic diseases. He had some successes but the
overall trend was not encouraging. Perhaps the problem was the lack of suitable
remedies for these chronic diseases? Although Samuel knew this was part of the
The Homœopathic Compendium by David Little | www.friendsofhealth.com

Chart 3.1 Timeline | The Chronic Diseases and the 4th Organon
1810–1832
Hahnemann collects The 4th Organon In Remarks on the

Hahnemann attains On the Venereal Disease group symptoms of the integrates insights of Extreme Attenuation of
success in treating acute begins Hahnemann’s itch miasm in German The Chronic Diseases and Homoeopathic Medicines
diseases and acute early investigation of itch casebook D22 that appear upholds the single dose Hahnemann restricts
miasms. miasm and suppression. in The Chronic Diseases. wait and watch method. potency to 30C.
1810–1817 1816–1819 1821 1829 1832
1816–1817 1818 1828–1830 1829–1832

Hahnemann has success Hahnemann introduces In The Chronic Diseases Schreter, Jenichen and
in treating venereal Sulphur in the Materia Hahnemann introduces Korsakov experiment with
miasms but has difficulty Medica Pura and notes its the theory of psora and ultra high potencies.
with non-venereal chronic use in itch miasm for over the anti-psoric remedies.
disease. 2,000 years.
97 
dilemma he was not completely satisfied with this answer. Why were some chronic
patients cured while others were not?
But usually, after repeated attempts to conquer the disease which appeared
in a form always somewhat changed, residual complaints appeared which
the Homœopathic medicines hitherto proved, though not few, had to
leave uneradicated, yea, often undiminished. Thus there ever followed
varying complaints ever more troublesome, and, as time proceeded, more
threatening, and this even while the mode of living was correct and with
a punctual observance of directions. The chronic disease could, despite all
efforts, be but little delayed in its progress by the Homœopathic physician
and grew worse from year to year.
The Chronic Diseases (Theoretical Part); S. Hahnemann, Nature of Chronic Diseases, p. 25–26.
Among all the hopeful signs there was a rather large group of patients that was
still resisting treatment. As Hahnemann watched the decline of these patients he
observed a common thread in the signs and symptoms of various sufferers. How
could the “never-resting, preservative vital force” remove acute diseases with the aid
of remedies but not these chronic symptoms?
The answer to this question, which is so natural, inevitably led me to the
discovery of the nature of these chronic diseases.
Hahnemann postulated that the cause of these chronic diseases was an unknown
primitive miasma and set out to discover its nature. Over the next twelve years
Hahnemann worked on his new project in secret, not even telling his students.
Samuel was now proving new remedies he thought might be effective; investigating
the nature of individual and collective diseases; collating exciting and fundamental
causes; studying acute, half-acute and chronic miasms; recording the effects of
suppression; using exceedingly small doses; prescribing the decillionth potency
(X — 30C); and developing a new case management philosophy. At this time, it
became obvious that the Founder needed to develop a new system of homœopathic
pathology to replace the outmoded allopathic model. Although Samuel’s public
writings taught that most illnesses were individual in nature, privately he was start-
ing to question that hypothesis.
The Itch Disease in Early Homœopathy

In On the Venereal Disease and its Ordinary Improper Treatment (1816) Hahnemann
taught that syphilis was a chronic miasmatic disease caused by a “virus”. At this time
the word “virus” was a term used for infectious disease, before the advent of modern
viral theory. Samuel wrote that the eruption of the chancre was a sign that the whole
organism was infected with the internal disease. The suppression of the chancre causes

Chapter 3 | The Watershed Years (1828–1830) 99 
the internal syphilis to mutate into new destructive symptoms. He also points out
that hydrophobia and smallpox are of a similar miasmatic nature. He then takes
up the subject of the chronic “itch-virus” and its role in internal disease in detail.
The last-named disease belongs to the chronic exanthematous diseases
(like the venereal disease), and in it nature also produces the itch vesicles,
at first in the neighborhood of the part that was originally touched by the
itch-virus, e.g., betwixt the fingers and on the wrist, if the hands (palms)
were first infected. As soon as the itch vesicles have made their appearance
this is a sign that the internal itch-disease is already fully developed.
The Lesser Writings of Samuel Hahnemann; S. Hahnemann (Dudgeon Edition), On the Venereal
Disease and its Ordinary Improper Treatment, p. 649.
In this early rendition of the itch miasm Hahnemann points out that as long
as the eruptions effloresce on the skin the internal disease lies latent in a state of
slumber. The external lesion acts as a pressure valve for the internal itch and slows
down the spread of the miasma.
These itch vesicles are an abnormal organ produced by the inner organ-
ism upon the skin, designed by nature to be the external substitute of the
internal disease, to take the latter upon itself, to absorb it as it were, and
so to keep it subdued, slumbering and latent.
Disease and its Ordinary Improper Treatment, p. 649.
Hahnemann goes on to describe the outcome of suppressing the external lesions

of the itch miasma. Even in this early work the Founder makes a direct connec-
tion between driving in the itch and the development of secondary symptoms like
phthisis, apoplexy, dropsy and insanity. In some cases suppression even causes sud-
den death, often of an idiopathic nature. Samuel also noted that Sulphur is a chief
remedy in the treatment of the internal itch miasm. This completes the essential
areas of study that would be elucidated in The Chronic Diseases.
That this is the case is evident from this, that so long as the vesicles remain
on the skin and continue to itch and discharge, the internal disease can-
not make its appearance, and from this also, that whenever it is partially
destroyed on the skin, without any previous cure being effected of the
internal itch disease (especially if it be of somewhat long standing and have
attained to any extent) by means of the internal employment of its specific
remedy, sulphur, this internal disease then bursts forth rapidly, often in a
frightful manner, in the form of phthisis, asthma, insanity, dropsy, apoplexy,
amaurosis, paralysis, and it not unfrequently occasions sudden death.
Disease and its Ordinary Improper Treatment, p. 649–650.

During the Founder’s lifetime public hygiene was so poor that soft tissue infec-
tions caused by mites, bacteria, fungi, and viruses were epidemic. Most people
suffered from the itch disease in a variety of manifestations at one time or another.
The most common practice was to treat soft tissue infections as local diseases with
topical creams. In aphorism 41 of the 2nd Organon (1819) Hahnemann noted
the connection between the suppression of the itch disease and asthma as well
as pulmonary phthisis. This shows the connection between psora, and what was
later identified as pseudopsora, the tubercular miasm. So even at an early date the
Founder was recording the constitutional nature of skin diseases and the negative
effects of driving the itch inward.
All the maladies which occur after the suppression of the eruption from
the skin, after what is termed driving back the itch (the writings of many
observers abound in such cases), are original symptoms proper to the itch
disease, which remain latent as long as this disease draws off to the skin in
the form of an eruption and thus silences its internal affection, but they
return as soon as this derivative channel is stopped by the topical drying
up of the itch-exanthem.
Appendix, 2nd Organon, footnote, Aphorism 41, p. 189.
The German casebook D22 shows that as early as 1821 Hahnemann was marking
the potential symptoms of psora in his patients with the notation NB. Then he would
collect the symptoms of the itch disease from his casebooks and transfer them into
a manuscript form for his future publication on chronic diseases. For a period of 11
years he observed the symptoms of psora and investigated potential remedies for its
treatment. He tested to see if Sulphur would prove as universal in the treatment of
psora as Mercury had in the treatment of syphilis, but he soon found out that psora
was a much more complicated disease. For this reason, Hahnemann experimented
with the use of a chief remedy and an intercurrent medicine, the alternation of
two remedies, and a series of remedies in sequence in an effort to remove psora. He
introduced a number of new anti-psoric remedies, including many from the mineral
world. He noted any new symptoms brought out on patients and integrated them
with what was known from poisonings, older medical authorities and provings on
the healthy. These investigations formed the foundation for the next development
in Homœopathy, which was the systematic treatment of the chronic miasms.
New Remedies
In 1828 Hahnemann published the first edition of The Chronic Diseases, Their
Peculiar Nature and their Homœopathic Cure, commonly known as The Chronic
Diseases. The Chronic Diseases consisted of three parts; Part 1 explained the theory
of the miasms and Parts 2 and 3 described 15 remedies. Part 4 was added in 1830.

This contained 2 new remedies and 5 from the Materia Medica Pura. This made a
total of 22 remedies in the first edition. The second edition was published in sec-
tions; Parts 1 and 2 in 1835, Part 3 in 1837, Part 4 in 1838. The complete second
edition, including a new Part 5, appeared in 1839. These second editions added 25
anti-psoric remedies, of which 12 were from the Materia Medica Pura and 13 were
new remedies. Hahnemann’s final collection of 47 anti-psorics contained 17 from
Materia Medica Pura and 30 new remedies. The Tafel translation of The Chronic
Diseases treats Aurum Muriaticum as a separate remedy making 48 anti-psoric medi-
cines. The prefaces to these editions contain Hahnemann’s latest insights into the
function of the vital force in cure, the preparation of medicines and recent posology
experiments. Hahnemann had been using the terms inherent energy of the vitality,
vital energy and vital power since 1796. The principles of dynamism and vitalism
are at the root of the original homœopathic paradigm. Hahnemann used the term
the vital force (Gr. Lebenskraft) in the first edition of The Chronic Diseases.
The first edition of The Chronic Diseases contained 15 remedies that Hahnemann
noted as anti-miasmatic remedies. The 15 remedies were Ammonium Carbonicum,
Baryta Carbonica, Calcarea Carbonica (including Calcarea Aceticum), Graphites,
Iodum, Lycopodium, Magnesia Carbonica, Magnesia Muriaticum, Natrum Carbonica,
Nitricum Acidum, Petroleum, Phosphorus, Sepia, Silica and Zincum. Sepia and Silica
had been included in the Materia Medica Pura and the other 13 remedies were new
additions. In the original volume these remedies were published without a list of
provers and observers as is found in the Materia Medica Pura. Hughes suggested that
since Hahnemann was between seventy and eighty years old it was unlikely that he
was still proving remedies on himself. Secondly he stated that as Hahnemann kept
the psora doctrine secret until he shared his ideas with Stapf and Gross in 1827 he
must also have kept the new remedies secret. For this reason, he opines that most, if
not all of the rubrics found in the first edition of The Chronic Diseases were observa-
tions of symptoms brought out in Hahnemann’s patients.
First of all, there is no direct evidence that Hahnemann proved absolutely no
medicines between the years 1817 and 1828. Secondly, Hahnemann did not have to
tell anyone his reasons for choosing to prove certain remedies, as this is not necessary
for the collection of symptoms. It would have been impossible for Hahnemann to
prescribe 15 new remedies for which he had absolutely no symptoms on which to
base a prescription! He must have had at least a rudimentary collection of symp-
toms to administer these remedies on the ill in the first place. Then he could fill
out the collection of symptoms based on the NB symptoms brought out on patients
under treatment. Some have tried to use the fact that the Founder used symptoms
brought out on patients under treatment as an example that Hahnemann did not
practice what he preached in the Organon. The truth is that Hahnemann had used

this method since the time of the Materia Medica Pura and he wrote about it in
aphorism 142 of the Organon.
In the third volume of The Chronic Diseases published in 1830 (which makes
up Part Four of the first edition), Hahnemann included two new medicines, Kali
Carbonicum and Natrum Muriaticum. He also included five remedies that were already
in the Materia Medica Pura, i.e., Carbo Animalis, Carbo Vegetabilis, Causticum,
Conium and Sulphur. There were originally 151 symptoms for Sulphur in the Materia
Medica Pura, which increased to 1,969 in The Chronic Diseases. There is little doubt
that many of these new rubrics came from Hahnemann’s observation of symptoms
brought out in patients under treatment. Hering wrote in the Guiding Symptoms
under Kali Carbonicum, “Provings by Hahnemann, Gersdorff, Goullon, Hartlaub,
Nenning, Rummell and Robinson.” Hering also wrote that Natrum Muriaticum was
“Introduced by Hahnemann, proved by himself, Foissac, Röhl, Rummel, Schreter and
Nenning (Chronische Krankheiten)”. Even Hughes admits that some of the symp-
toms of Natrum Muriaticum are from Hahnemann’s provings in the 30C potency!
The Founder used two terms to describe the collection of symptoms in the 2nd
edition of The Chronic Diseases, i.e., “names of my fellow-provers are…” and “names
of my fellow-observers are…”. In the 2nd edition Hahnemann states that he proved
Sepia when he says that “The abbreviations of my fellow-provers are: Gil., Gouloon;
Gff., von Gersdorff; Gr., Gross; Htb., Hartlaub; Whl., Wahle”. Hering confirms
these facts in the Guiding Symptoms when he states that Hahnemann proved Sepia
along with Gersdorff, Gouloon, Hartlaub, Wahle and Gross. Hering also notes in
the Guiding Symptoms that Nitric Acid was “Introduced by Hahnemann; proved
by himself ” and then lists the names of other co-provers including himself. Hering
says Phosphorus was “Introduced by Hahnemann; proved by himself ” and again
states he was one of the co-provers. This data shows Hahnemann and Hering were
both involved in proving the same remedies for The Chronic Diseases.
The second edition of The Chronic Diseases ran from 1835 to 1839. On top of
the 22 medicines contained in the first edition, the second edition added 25 rem-
edies, out of which 13 are new and 12 appeared in the Materia Medica Pura. The
13 new remedies were Agaricus, Alumina, Ammonium Muriaticum, Anacardium,
Antimonium Crudum, Borax, Clematis, Cuprum, Euphorbium, Mezereum, Nitrum
(Kali Nitricum), Platina and Sulphuricum Acidum. The 12 older remedies were
Arsenicum, Aurum, Colocynth, Digitalis, Dulcamara, Guaiacum, Hepar Sulphuris,
Manganum, Muriatic Acidum, Phosphoric Acidum, Sarsaparilla and Stannum.
Now that the entire subject was out in the open, the list of provers increased and
the number of remedies and symptoms were expanded.
Samuel Hahnemann was well aware that his new doctrine of the miasms and
anti-miasmatic treatment was far ahead of his times. He knew that many would

not understand the depth and breadth of what he was proposing and that much
of what he was saying would fall on deaf ears. In the Author’s Preface to the first
edition in 1828 Hahnemann wrote:
But in communicating to the world this great discovery, I am sorry that
I must doubt whether my contemporaries will comprehend the logical
sequence of these teachings of mine, and will follow them carefully and gain
thereby the infinite benefits for suffering humanity which must inevitably
spring from a faithful and accurate observance of the same; or whether,
frightened away by the unheard of nature of many of these disclosures, they
will not rather leave them untried and uninitiated and, therefore useless.
The Chronic Diseases (Theoretical Part); S. Hahnemann, Author’s Preface to the First Edition–1828,
p. 7.
The Origin of Psora

The Chronic Diseases contains Hahnemann’s first full dissertation on the con-
stitution, predisposition, inheritance, the vital force, environmental conditioning,
individual and collective diseases, and the chronic miasms. In this work the Founder
introduced the first coherent system of epidemiology, the study of infectious miasms
and their long-term effects. In Hahnemann’s day little was known about the processes
of infection and its effect on the immune system. Nevertheless, Hahnemann was
able to carefully record the primary, latent and secondary symptoms of the chronic
miasms. Samuel also recorded the symptoms of a syndrome that is now called
autoimmune disorders and immunodeficiency diseases. The homœopathic version
of these diseases, however, is much more extensive and detailed. The publication of
The Chronic Diseases marks the end of the developmental phase of Homœopathy
and the beginning of its definitive years.
Hahnemann was now of the opinion that most chronic diseases were caused by
collective miasms rather than individual disease states. Hahnemann wrote in 1828
that the itch-miasm, sycosis and syphilis were the three miasms active in Germany
in his time. He did not limit the number of possible miasms. He developed the
collective anamnesis in such a manner that it could be used to assess acute, half-
acute and chronic miasms and choose and find prophylactic and curative remedies.
Homœopathy would now take into account the individual and collective aspects
of disease and tailor the treatment strategy accordingly.
The ancient Greek physicians used the term psora to describe a great variety
of skin diseases. Psora means an itch, fault, pollution or stigma. The internal con-
comitant symptoms of the itch miasm are called internal psora. The allopathic
treatment for the itch diseases consisted of purging the patient with heroic remedies
and treating the skin with sulfur, mercury, or lead ointments. This dubious method

caused more harm than good by “driving in the itch”. After some contemplation
Samuel decided to call the new itch-virus by its ancient name, Psora.
PSORA is that most ancient, most universal, most destructive, and yet most
misapprehended chronic miasmic disease, which for many thousands of
years has disfigured and tortured mankind…
Humanity has suffered from psora, the ancient itch disease, since human beings
lived as cave dwellers. This ancient disease tinder has been passed through millions
of human beings over the millennia. Its inherited and acquired affects are found in
every family tree and on every continent. Human beings have been plagued with
soft tissue infections, numberless skin complaints, and their internal affects, for
generations. The skin is the first line of defense and is intimately connected to the
vital organs, nervous system and the immune system. Hahnemann’s doctrine of
psora meant that the skin diseases could no longer be viewed as local diseases and
treated with topical applications.
The suppression syndrome is intimately integrated with the theory of the miasms.
When the primary lesions of the chronic miasms are suppressed the diseases enter
their latent phase. Occasionally, an exciting cause like mental stress, a physical
trauma, unseasonable weather and the like, will stimulate an acute-like flare-up of
the internal psora producing a localized crisis. Hahnemann explained the connec-
tion between acute-like diseases and the chronic itch miasm in a letter to Stapf in
1828. Samuel was commenting on the case of Stapf ’s wife, who had suffered an
attack of facial erysipelas.
This was an example of the, by no means, rare explosions and sudden
outbursts of the internal psora. These are always quite sudden illnesses,
the cause of which (causa occassionalis): a chill, a fright, a vexation, etc.,
is often very insignificant. They only come singly. Therefore I consider all
maladies that occur epidemically and sporadically as belonging to this class.
The Life and Letters of Dr. Samuel Hahnemann; T. L. Bradford, p. 184.
Hahnemann goes on to say that this subject was not explained well enough
in the first edition of The Chronic Diseases. This letter elucidates the relationship
between many so-called acute diseases and shows that they are really a pathological
crisis caused by the chronic miasms. Hahnemann implies that the susceptibility to
acute miasms and individual sporadic diseases are also based on psora.
Those single outbursts of the internal latent psora, which I have not suf-
ficiently described in my book (which may easily happen in the first edition
of a book), after their speedy defervescence or rapid cure by proper means,
allow the previously latent psora to return to its latent state — as we often

see in the case of poor people that a sudden inflammatory swelling in some
part, a sore throat, an ophthalmia, an erysipelas, or other acute febrile
disease (pleurisy, etc.), comes on in a threatening manner, but if it does
not kill the patient, often subsides by the help of nature (frequently by
the formation of an abscess), and then the stream that had overflowed its
banks returns to its bed; i.e., the psora again becomes latent, but with an
increased disposition to repeat these or similar explosions.
The Founder was not afraid to use words like pleurisy or ophthalmia to describe
a set of symptoms but such names were not sufficient for the prescription of medi-
cine. These symptoms merely represent a chief location that needs to be filled out
with a complete description of the accompanying signs and symptoms. An acute-
like acerbation of psora can produce a dangerous state that either takes the life of
the patient or produces a severe crisis after which the patient slowly convalesces.
However, this amelioration of the local symptoms only marks the return of psora
to its latent state. These acute-like flare-ups will return and become worse as the
internal disease grows. Over time, this latent state will evolve into secondary or
tertiary diseases that attack the internal vital organs and systems producing serious
degenerative states and pathological crisis.
It ought not to cause astonishment that for such very acute outbursts of
latent psora the antipsoric remedies are not suitable, therefore, that spirit.
vini sulphuratus (or even Graphites, which is such an excellent Homœopathic
remedy for erysipelas of the face) was not suitable in the face-erysipelas fever
of your wife. These remedies are appropriate for the slow, radical cure of
the causa prima of the face-erysipelas. Now the unantipsoric remedies (like
Rhus tox. in your case), which correspond to the present transient morbid
picture, are the appropriate medicines; they can quickly quell the existing
acute explosion, so that the condition calms down again into the latent
psora, to which these remedies have little or no affinity.
Hahnemann clearly separated true acute diseases from pseudo-acute disorders

caused by a flare up of the psoric miasm. They both represent acute-like states but
a true acute disease is caused by an external exciting cause while a pseudo-acute
disease is actually a crisis produced by the flare up of a chronic miasm. Hahnemann
suggested Stapf administer acute apsoric remedies for the crisis and then return to
the administration of deep acting anti-psorics. Hahnemann suggested the use of
acute intercurrents during severe crises and chronic anti-psoric treatment for the
underlying cause associated with psora.

To remove the tendency to such outbursts (dangerous sore throats, pneu-

monia, ophthalmia, typhus fever, erysipelas, etc.); that is, to effect a radical
cure of psora, requires the slow specific action of the antipsoric remedies — in
the case of your wife, among other medicines, also Graphites, as you must
give Sulphur soon again.
The Life and Letters of Dr. Samuel Hahnemann; T. L. Bradford, p. 184–185.
In the Materia Medica Pura Hahnemann published the provings of 67 remedies

of which 49 were plants, 16 minerals, and 2 animal remedies. In The Chronic Diseases
Hahnemann published the provings of 47 chronic anti-psoric remedies of which 31
are minerals, 13 are plants and 3 are animal remedies. The Founder took 9 minerals,
7 plants and 1 animal remedy from the Materia Medica Pura and listed them as anti-
psorics. The new remedies included 22 minerals, 6 plants, and 2 animals. This shows
that the emphasis on chronic treatment led to the proving of more mineral remedies.
The anti-psoric remedies are dominated by elements of the periodic table like
Potassium, Sodium, Magnesium, Phosphorus, Carbon, Calcium, Sulphur, Chlorine,
Silica and Iodine. This includes important medicines like Sulphur, Calcarea, Causticum,
Hepar Sulphuris, Graphites, Iodum, Kali Carbonate, Natrum Muriaticum, Magnesia
Carbonica, Silicea, etc. The apsoric remedies are mostly plant remedies like Aconite,
Belladonna, Hyoscyamus, Stramonium, Bryonia, Chamomilla, Colocynth, Coffea,
Nux Vomica, Ipecac, Ignatia, Pulsatilla, Rhus Tox and Staphysagria. This offers a clue
to the medicinal actions of the remedies of the mineral and plant world.
In 1796 Hahnemann wrote that plant remedies produced the rapid alterna-
tion of primary and secondary symptoms during the provings. This means their
symptoms are subject to quick alternations and the production of opposite states.
The mineral remedies are more slow, fixed and steady in their actions and produce
less rapid secondary symptoms. Plant remedies are also known for their quick onset
and rapid actions while the mineral remedies produce deep, long-lasting actions
over time. This makes the apsoric plant remedies more similar to acute diseases and
crises caused by a flare-up of psora and the miasms. The mineral remedies are more
similar to disease processes that are slow moving and fixed like the chronic miasms.
There are anti-psoric plant remedies that produce similar deep actions in line with
their mineral components. The animal remedies are quick acting but they also have
deep long-lasting actions depending on the mineral composition. The minerals are
the basis of the plant and animal worlds.
Proper chronic treatment removes predispositions to acute crisis because it
removes their underlying causa prima. If the primary cause is not addressed, acute-
like acerbations will continue and become more dangerous until life-threatening
secondary diseases are well established. The fast acting apsoric remedies are more
suitable for the treatment of acute crisis because their symptoms are more similar to

these states. The anti-psoric remedies are more slow and steady in their actions mak-
ing them more similar to the long-term degenerative symptoms of chronic diseases.
The doctrine of psora and the chronic miasms had a strong effect on Hahnemann’s
practice of Homœopathy. In his early years the Founder taught that most diseases
were of an individual nature with the collective miasms playing a more limited
role. Now he believed that the universal chronic miasms played a much larger role
than previously understood. As these diseases are of common cause and similar
symptoms Hahnemann began to study them through the collective anamnesis.
In the footnote to aphorism 78 of the 6th Organon Hahnemann wrote that psora
could be implanted “through infection or heredity”.
This is the origin of the chronic genus epidemicus remedies which are commonly
called the anti-miasmatic medicines. Now that he had discovered the collective
nature of the universal chronic miasms he began to place much more emphasis on
the treatment of collective diseases. Hahnemann taught that psora was the mother
of all miasms and that Sulphur was the father of all anti-miasmatic remedies. From
this point on Sulphur and the other cardinal anti-psorics began to play a much
larger role in his clinical practice.
The Founder’s new methodology involved the study of the collective picture
of the miasms (§100–§103) on a larger group. Once a homogenous group of anti-
miasmatic remedies were found it was possible to use individualization to find which
anti-psoric remedy (§82) was best for the patient. First the collective anamnesis is
used to find the most similar group of remedies and then the individual anamnesis
is used to find the personal remedy out of that group. The study of individual and
collective diseases allowed the Founder to see the bigger picture.
Hahnemann’s personal failures led him to believe that his early views were too
limited to treat chronic diseases. Similia and individualization was now combined
with the new classifications of homœopathic pathology including inheritance,
constitution, temperament, susceptibility, causations and the collective study of the
miasms. Some homœopaths were more secure with early Homœopathy and could
not adapt to these new changes. Hahnemann was well aware that his theories were
ahead of the times. Shortly before the publication of his findings he wrote Dr Stapf
about the situation, in a letter dated Sept. 6th 1827.
At least a year will elapse before the others get my book; they will require
more than half a year before they recover from the fright and astonish-
ment at the monstrous unheard of thing, perhaps another half year before
they will believe in it, at all events before they provide themselves with

the medicines, and they will not be able to get them properly unless they
prepare them themselves.
Hahnemann also realized that many of his followers were going to be surprised
by the exceptionally small doses and high potencies he was suggesting. How many
homœopaths were ready to use a minute dose of the decillionth (X — 30C) as a
standard opening potency? The Founder also requested that each dose be allowed
to finish the duration of its action before the remedy is repeated. Could they wait
and watch? Samuel had his doubts about this.
Then it is doubtful whether they will accept the smallness of the doses,
and wait the long time they ought to allow each dose to act. Hence, three
years from this time must elapse before they are able to do anything useful
with them.
With such doubts about his own students, Hahnemann anticipated a “great
uproar” among the orthodox physicians and apothecaries. He knew that his work
contained several controversial positions and dealt with areas of medicine that
were well ahead of his time. To understand a sophisticated theory of infection that
included miasms, primary states, latent stages and secondary diseases was difficult
for the rank and file.
Epidemiology in Homœopathy
The Great Experimenter was the first to teach the constitutional nature of skin
disorders and how they progress into serious internal disorders, especially when
suppressed. Some modern homœopaths do not realize that miasms are the acquired
and inherited effects of infectious diseases. Hahnemann made it quite clear in On
the Mode of Propagation of the Asiatic Cholera (1831) that the cause of cholera miasm
was an “enormously increased brood of those excessively minute, invisible, living
creatures, so inimical to human life…” (The Lesser Writings, p. 758).
The Chronic Diseases (1828) is an early study of inheritance, constitution, tem-
perament, susceptibility, infection, and collective diseases. The infectious miasms
are collective diseases of common cause, fixed character, and similar symptoms. The
case taking method for collective disease is the genus group anamnesis (§100, §101,
§103). The group anamnesis is the source of preventative and curative remedies
for the acute and chronic miasms. Miasms are parasites that have the capability to
breed in the human organism.
Or have these various, acute, half-spiritual miasms the peculiar characteristic
that — after they have penetrated the vital force in the first moment of the

contagion (and each one in its own way has produced disease) and then
like parasites have quickly grown up within it…
The Chronic Diseases (Theoretical Part); S. Hahnemann, Nature of Chronic Diseases, footnote,
p. 75.
Hahnemann says the acute miasms “die out and leave the living organism again
free” if the patient lives through the attack and its sequels. Then he speaks about
the chronic miasms.
On the other hand, are not the chronic miasmas disease-parasites, which
continue to live as long as the man seized by them is alive, and which
have their fruit in the eruption originally produced by them (the itch-
pustule, the chancre and the fig-wart, which in turn are capable of infecting
others), and which do not die off of themselves like the acute miasmas,
but can only be exterminated and annihilated by a counter-infection, by
means of the potency of a medicinal disease quite similar to it and stron-
ger than it (the antipsoric), so that the patient is delivered from them and
recovers his health?
p. 75.
The Founder was well aware of the use of the microscope in scientific investi-
gations. He noted that some miasms have latent states that take years to develop
secondary pathology. Stressful emotional and physical circumstances ignite the
latent miasms causing secondary pathology.
The internal itch disease is, as before mentioned, of such a peculiar nature
that it may remain, as it were, tied down and covered up for a long time
through external favorable surroundings, so that a man may seem, to the
superficial observer healthy for years, even for many years, until circum-
stances unfavorable to the body or the soul, or to both, may arise and serve
as a hostile impulse to awaken the disease slumbering within and thus
develop its germs.
p. 98.
Hahnemann’s original theory of the chronic miasms includes psora (the itch
disease), sycosis (the fig wart disease) and syphilis (the chancre disease). These miasms
may be acquired through a primary infection or their effects can be experienced
through inheritance. The miasms include soft tissue infections caused by fungi,
mites, and bacteria as well as gonorrheal sycosis, tuberculosis, syphilis, AIDS, chronic
infectious hepatitis and endemic miasms like yaws, Lyme disease, and malaria. See:
Chart 3.2 | Cessante Causa – Cessant Effectus; p. 110.

110
Chart 3.2 | Cessante Causa – Cessant Effectus

The Chronic Diseases (1828)
Miasms
Acute miasms Chronic miasms
Self-limiting, short duration Life-long duration
Typhoid, typhus, measles, mumps, etc. Psora, sycosis, syphilis
Group anamnesis, collective

studies
Acute genus epidemicus remedies Chronic anti-miasmatic genus remedies

By the time he wrote The Chronic Diseases Hahnemann was already of the
opinion that the repetition of the same potency over a longer period of time did
not work as well as exposing the patient to several degrees of potency. He suggested
for the most part the lowering of the degrees of potency as the case progresses. For
example, in the instructions on how to apply Thuja in sycosis (page 151) he sug-
gested beginning with Thuja 30C then progressing to lower the potency to 24C,
18C, 15C, 6C. In his dissertation on the treatment of psora he suggests it is useful,
safe and often necessary to repeat the remedy in several different potencies.
In the discussion of the treatment of psora (page 216) Hahnemann suggests
the use of a series of potencies going up and down the scale. Here he speaks of first
giving the 30C followed by the 18th, then perhaps the 24th, followed by the 12th
and 6th etc. Hahnemann started using this method to overcome the side-effects
of repeating the same potency too many times in succession. The repetition of the
remedy in several potencies demonstrated a more gentle prolonged action on the
vital force. By this time, Hahnemann was preparing his medicines on small poppy
seed size pellets so that he could administer smaller doses of his potencies. The size
of his recommended dose is 1, or more rarely, 2 tiny pellets.
Margaret Tyler opined that there were more than the classical miasms but she
did not rush to judgment. In the 1930s she looked to the future while holding on
the best of the past. The universal miasms of Hahnemann are very widespread but
they are not the only existing miasmatic diseases. Some miasms are opportunistic
and are usually found as secondary infections in compromised hosts. These make up
the sub-categories of the primary miasms. Other miasms are endemic to a locality
or rely on a zoological host therefore denying them universal status.
There are seven classes of miasmic kingdoms; the viral, bacterial, rickettsial, fun-
gal, chlamydial, protozoan, and worm. Most of these categories include both acute
and chronic miasms. Reviewing the miasms in genus families offers a group picture
as well as the characteristic signs of each peculiar sub species. This offers knowledge
of the group disease state and leads to similar remedies in individuals. Each of these
seven kingdoms has unique qualities and causes specific kinds of disease states. The
miasmic symptoms always reflect the nature of the infectious agent but the pathway
of the disease modifies them. For example, the suppression of a skin infection favors
the psoric symptoms while the suppression of a lung infection favors pseudopsoric
signs. The suppression of sexually transmitted bacteria tends to produce venereal
syndromes like sycosis and syphilis. Suppressed chlamydia produces a syndrome
more like sycosis than syphilis, showing a connecting point between the two states.
Many disease states are based on multiple causations, environmental condition-
ing factors, and the predispositions of the constitution. That is why every patient
must be treated as an individual by the symptoms of the disease-tuned vital force.

The old doctor also pointed out that there are diseases of common cause and similar
symptoms that affect homogeneous groups. Collective and individual suffering is
combined in a patient suffering from the chronic miasms. These miasms are caused
by a specific genus with relatively fixed symptoms throughout the ages. Examples
of collective disorders include traumas, endemic nutritional disorders and envi-
ronmental diseases, and the infectious miasms. The miasms are social diseases that
have had a great impact on culture and the human psyche as well as affecting the
health of generations.
The Great Debate

Hahnemann’s publication of The Chronic Diseases sparked off a great debate
throughout the homœopathic and allopathic communities. There were three
major types of reaction among the homœopaths. There were some, like Stapf and
Boenninghausen, who completely supported Hahnemann’s new paradigm. The
second group was more skeptical at first but then accepted the basic premise through
the application of its principles. This includes Hering, who was first overwhelmed,
but after examining the facts, became a staunch supporter. Griesselich, who is men-
tioned in the 5th Organon, was quite critical of the psora theory but later in his life
he wrote about it very positively. The overall opinion of many was that Hahnemann’s
teachings on the constitutional nature of skin disorders and suppression were worth
their weight in gold. The third group completely rejected the entire affair out of hand
without any serious investigation. Many of these individuals related more to the
teachings of early editions of the Organon with their larger doses and lower poten-
cies. They could not fathom Hahnemann’s teachings on the vital force, dynamism,
acute and chronic miasms and the use of exceedingly small doses of the decillionth
(X — 30C) potency. For some the entire episode was too much and they retreated
into their old ways of practicing.
Hahnemann’s hypothesis involves twelve major themes.
1. Miasms are infectious diseases of common cause and similar symptoms that
affect a homogeneous group. There are acute, half-acute and chronic miasms.
2. All chronic miasms are constitutional in nature. Their affects can be inherited
from one’s ancestors or acquired by the individual. Hahnemann’s universal
chronic miasms are psora, sycosis and syphilis.
3. Chronic miasms have primary, latent and secondary or tertiary states.
4. The skin is intimately linked to the inner humours, tissues, vital organs and
systems.
5. The suppression of skin lesions and other symptoms causes the miasms to
mutate into new, increasingly destructive internal diseases.

6. The group anamnesis is the method for studying the symptoms of the collective
miasmatic disorders in the populace.
7. The anti-miasmatic remedies must be similar to the essential nature of the
complete chronic miasm.
8. The individual anamnesis is used to select the personal remedy out of the anti-
miasmatic remedies.
9. Many so-called acute diseases and pathological crises are actually flare-ups of
the chronic miasms.
10. Susceptibility to acute miasms and sporadic diseases is linked to the chronic
miasms.
11. Acute remedies are more similar to acute crisis while the anti-miasmatic remedies
are more similar to chronic disease states.
12. Acute intercurrent remedies are prescribed by the exciting cause and active
symptoms of crisis. Chronic remedies are chosen by the fundamental cause
and the chronic symptoms.
Hahnemann’s Chronic Diseases presents so many important ideas that countless
homœopaths have been able to find useful information in the overall hypothesis. A
few seasoned people understood the true ramifications of the Founder’s new theory of
the collective miasms. A good number agreed that the skin was intimately connected
to the humours and vital organs and that suppression could cause serious internal
disease. Although many accepted the basic premise of the constitutional nature of
skin disorders, some found it very hard to believe psora was the cause of most chronic
diseases. Some who supported the Founder’s new works thought his estimation of
the percentage of psoric patients was exaggerated. Samuel, it appeared, had come to
the conclusion that almost everyone had psora to one degree or another. As psora can
be passed on by heredity and infection its effects are bound to be very widespread.
Homœopathic philosophy underwent great changes in the years 1817 to 1828.
Hahnemann had expanded the law of similars to include the spheres of individual
disorders and collective miasms. The introduction of a precise aetiological theme
with exciting, maintaining and fundamental causes took many by surprise. They
were more used to the early Organon where causation was questionable and each
case was considered a unique singular disease. They opined that the introduction
of the miasms and anti-miasmatic remedies were contrary to the law of Similia and
individualization. Some allopaths took up a similar argument saying that the intro-
duction of the causal theory and specific remedies was evidence that Hahnemann
had given up the basic philosophy of Homœopathy. Such debates were circulating
in all medical circles.

One group of practitioners understood that psora was a constitutional disorder

in theory but in practice they found it difficult to treat all skin diseases by internal
remedies alone. They still wanted to fall back on the application of creams, baths
and soaps, especially in the treatment of scabies. C. Burnett later shared the opinion
that scabies could not be treated with internal remedies alone and suggested that it
was best to kill the mites as fast as possible. This seems rather odd as my colleagues
and I have been very successful in curing scabies with internal remedies, especially
in the medicinal solution and split-doses when necessary. Burnett, on the other
hand, had only tried the dry dose. Burnett was critical of Hahnemann in places but
in general he showed great respect for the Founder of Homœopathy.
Some claimed Hahnemann did not know that scabies was caused by a mite that
bored superficially under the skin. They questioned how such things could affect
the constitution. To them “psora” was no more than an external skin lesion that
should be dealt with externally. In Hahnemann’s translation of Monro’s Materia
Medica (1791), the Founder wrote that scabies had a “living cause”. In Anzeiger of
Gotha (1792) he taught that scabies is a living eruption that “has its origin in small
living insects or mites”. Hahnemann suggested in The Chronic Diseases that Sulphur
in potency was capable of curing the fresh primary eruptions associated with the
itch disease. Others did not realize that pimples, boils, tetter and herpes are also
primary eruptions of psora capable of transmitting the disease to others. They did
not understand that the psora hypothesis covers the reaction of the vital force to all
soft tissue infections including those caused by bacteria, fungi, viruses and mites.
A number of observers opined that Hahnemann’s miasms were a euphemism
for an underlying chronic diathesis or constitutional state that demonstrates the
nature of the inner terrain. The psora theory helped many focus on the importance
of heredity in the processes of chronic diseases. They appreciated the teachings on
underlying causes, susceptibility and latent states and applied them in their own way.
They understood that acute disorders and pathological crises are not independent
from the constitutional ground from which they spring. Quite a few adopted the
idea of acute and chronic remedies but not all embraced the idea of apsoric and
anti-psoric medicines. Even some of those who rejected the miasm theory totally
found that the new chronic remedies worked very well on constitutional states.
Over time a few practitioners separated the miasm theory from its causal basis
and used it as a convenient system to classify innate predispositions. The miasm
theory became an expedient way to differentiate groups of symptoms in chronic
diseases. Some consider psora, sycosis and syphilis to be a trinity of innate patterns
found in everyone. They equate the miasms with a triune power of archetypal
forces and attribute all manner of phenomena to them. This assists them in sort-
ing the symptoms and reviewing appropriate remedies in the materia medica. All

of these insights have their value but each only highlights one or another facet of
Hahnemann’s original hypothesis. After Hahnemann left for his Heavenly Abode
in 1843, homœopaths like Boenninghausen, Hering, Wolf, Kent and J. H. Allen
published additional studies on the chronic miasms.
The Treatment of Chronic Diseases

The advent of the psora doctrine caused major changes in Hahnemann’s treat-
ment strategies. The Founder considered psora to be a collective disease that must
be studied in a greater group of patients to find specific anti-psoric medicines. He
taught that suppression and drugging masks the outer symptoms and drives the dis-
ease inward which causes serious conditions and weakens the vital force. Sometimes
patients suffering from suppressed psora do not respond well to remedies chosen by
the presiding symptoms. Sulphur has a peculiar power to remove suppressed psora
from the center to the circumference bringing back the suspended symptoms and
restoring vitality. This may be one of the major reasons why Hahnemann began
many of his cases of psora with Sulphur.
From the years 1817 to 1828 Hahnemann worked tirelessly to construct a
therapeutic system that would be suitable for the cure of chronic miasms. In the
Organon Hahnemann always made the point that if the totality of the symptoms
cease the cause of those symptoms also ceases. In The Chronic Diseases Hahnemann
turned this argument around by stating “Cessante causa, cessant effectus”, When the
cause ceases, the effects cease. The allopaths considered removing the eruptions of
itch on the skin to be the cure of the disease. Hahnemann pointed out that by the
time the eruptions of psora appear on the skin the internal psora has already estab-
lished itself in the inner organism. Removing the eruptions one-sidedly by topical
medicines only suppresses the skin lesions and aggravates the internal psora causing
an increase of secondary symptoms. These secondary symptoms then appear as a great
number of chronic degenerative diseases called by different names in the orthodox
pathology books. Hahnemann also pointed out that these secondary diseases would
also disappear once their internal cause, psora, was cured.
In the first three editions of the Organon Hahnemann suggested that under
ordinary conditions each dose of a homœopathic medicine should be allowed to act
until its duration ceases. In The Chronic Diseases he went to great lengths to explain
this methodology in the treatment of chronic miasms.
It is a fundamental rule in the treatment of chronic diseases: To let the action
of the remedy, selected in a mode homœopathically appropriate to the case of
disease which has been carefully investigated as to its symptoms, come to an

undisturbed conclusion, so long as it visibly advances the cure and the while
improvement still perceptibly progresses.
The Chronic Diseases (Theoretical Part); S. Hahnemann, Psora, p. 214.
Hahnemann points out that in many cases a single dose of a perfectly homœo-
pathic remedy can act on the patient for several weeks to months and complete
the cure. He opines that one can do no better than this no matter how many doses
and remedies were given! In such a case repetitions and changes in remedies only
cause aggravations, relapses and spoil the case. In general it is best for a homœopath
to give a single dose and carefully wait and watch for a reasonable period of time
before assessing the remedy action. Hahnemann notes, however, that there are cases
which make an “exception to the rule” but he warns beginners to be very careful
about repeating the dose prematurely.
One of the principles of The Chronic Diseases is that the nature of the disease
conditions the duration of action of homœopathic remedies. For example, a freshly
arisen primary eruption of itch tolerates the repetition of the anti-psoric remedy
much more rapidly than the secondary states of psora. This is because the primary
stage of the miasms is the acute-like phase of a long-lasting chronic disease. Similar
conditions include acute-like acerbations of a chronic miasm and pathological crises.
During these acute-likes stages the disease state may require more rapid repetition
of the remedies than in the slow-moving secondary stages.
Hahnemann taught that Sulphur was specific to the primary eruptions of psora
and is often indicated at this stage of the disease. It was his experience that many
cases can be cured by the administration of this remedy alone. There are some situa-
tions, however, where the practitioner needs to interpose Hepar Sulphuris Calcareum
between the doses of Sulphur as an intercurrent remedy. Once the psora has reached
the secondary stage it is rarely cured by Sulphur without the aid of other remedies.
Such conditions often require a series of anti-psoric remedies to complete the cure.
Hahnemann noted, however, that when repeating anti-psoric remedies in tedious
chronic complaints caused by psora “it is nearly always necessary to give again from
time to time during the treatment a dose of Sulphur or of Hepar (according to the
symptoms)”.
In fresh eruptions of the itch disease, Hahnemann found that Sulphur, Hepar
Sulph Calcareum, and in some cases Sepia, were the most suitable remedies for
immediate repetition. He also suggested that Nux Vomica or Mercury might be
useful as intercurrent remedies according to the time and circumstances. The details
of this method were further clarified in the footnote to aphorism 246 of the 5th
Organon. In these notes it states that Nux Vomica is very useful as an intercurrent
remedy during the repetition of Sulphur as it calms aggravations and prepares the
vital force to receive further doses of Sulphur. Mercury was used in a similar manner

in cases where large doses of allopathic sulphur had been taken in the past. These
passages were removed in the 6th Organon although Hahnemann’s Paris casebooks
show that he still used intercurrent remedies on occasions in the 1840s when using
the LM potency.
From 1828 to 1840 Hahnemann worked hard at overcoming the problems of a
limited number of remedies and potencies. He was only working with around fifty
well-documented anti-miasmatic remedies. For this reason, the Founder mastered
zigzag prescribing because some of his remedies were partial simillimums. He had
to know how to get the most out of a very small materia medica. Today we have
access to hundreds of well-proven chronic medicines but only a few know how use
them properly against the chronic miasms!
The Medicinal Solution in The Chronic Diseases

From the 1st Organon, Hahnemann spoke about the necessity of giving a single
dose of a medicine and not repeating the dose until there was a relapse of symptoms.
He did not repeat a remedy until the duration of the preceding dose had ceased.
Hahnemann was unhappy with the slow progress of the single unit dose in many of
his chronic patients. He wanted to find a way to elicit a deep healing action while
avoiding aggravation, relapses and accessory symptoms. This led Hahnemann to
experiment with the delivery system of his homœopathic potencies. Over the years
he developed three delivery systems of the potentized remedy i.e., the poppy seed
size dry dose, the olfaction of medicinal vapors, and the medicinal solution. Based
on such experiences, Hahnemann began to conduct new experiments with the
medicinal solution in chronic diseases. In the first edition of The Chronic Diseases
he suggests administering the remedy as a split-dose in aqueous solution rather
than the single dose of globules. See: Chart 3.3 | Posology in The Chronic
Diseases (1828); p. 118.
In cases where the physician is certain as to the homœopathic specific to
be used, the first attenuated doses may also be dissolved in about 4 oz. of
water by stirring it, and one third may be drunk at once, and the second
and third portions on the following days; but it should each time be again
stirred so as to increase the potency and thus to change it. Thereby the
remedy seems to take a deeper hold on the organism and hasten the resto-
ration in patients who are vigorous and not too sensitive.
The Chronic Diseases (Theoretical Part); S. Hahnemann, Psora, footnote, p. 217.
In this method one or two pellets of the remedy are placed in four ounces of
water and stirred well to slightly raise the potency just prior to administration.
This slight change of the potency level alters the remedy so that the organism never
receives the exact same dose twice in succession.

Chart 3.3 | Posology in The Chronic Diseases (1828)
The anti-miasmatic remedy
Olfaction of acute
1 to 2 pellets in 4 oz. of
1 to 2 poppy seed sized intercurrents for
water, 1/3 portion stirred
pellets taken dry on the disruption of chronic
well and taken for 3
tongue treatment by acute
days
disease
Wait and watch the

improvement
New symptoms, new Same symptoms, repeat

Relapse of symptoms
remedy dose
If the medicine is to act more strongly it must be stirred in a little more

water until dissolved before taking it, and in still more water if it is to act
still more strongly, and the physician should order the solution taken a
portion at a time. If he orders the solution taken in one or three days it
must be stirred up not only the first time, but also the other two times, by
which every part thus stirred acquires another somewhat higher degree of
potency, and so is received more willingly by the vital force. To direct the
use of the same solution for a greater number of days is not advisable, as
the water kept longer would begin to putrefy.
The Chronic Diseases (Theoretical Part); S. Hahnemann, Psora, footnote, p. 234.
Even as Hahnemann was developing the poppy seed size pellet dose he was
finding it difficult to utilize in certain cases. This led Hahnemann to apply the
use of liquid solutions to the treatment of chronic disease and the miasms. Many
homœopaths have used the medicinal solution in acute illnesses but its application
in chronic diseases has been largely ignored. Even when the medicinal solution is
used it is often in a glass without succussions or vigorous stirring. This does not
produce the benefits associated with the Paris methods.

In this paragraph from The Chronic Diseases, Hahnemann introduces the triple
split-dose. The medicinal solution is applied on three consecutive days in those
patients who are fairly vigorous and not too sensitive. This technique is a forerun-
ner of the method found in the 5th and 6th Organon in which Hahnemann often
used a series of liquid doses followed by a period of waiting and watching. Some
modern homœopaths are using the triple dose without the medicinal solution. They
administer the first dry dose in 200C, the second dose in 1M, and the third dose
in 10M potency. Their idea is based on Hahnemann’s experiments but it does not
include the breakthroughs of Hahnemann’s advanced posology.
The radical changes Hahnemann suggested were too progressive for some of
the old homœopathic guard. Even Hahnemann’s close students were overwhelmed
by the introduction of homœopathic pathology and the chronic miasms. People
needed time to digest the implications of the Founder’s new paradigm. Everyone
was taken completely by surprise.
The Vital Force in the 4th Organon (1829)

The 4th Organon (1829) is the companion volume of the 1st edition of The
Chronic Diseases (1828). They share a similar philosophical view and case manage-
ment strategies. In the 4th Organon Hahnemann began to integrate his teachings
on the vital force found in The Chronic Diseases directly into the aphorisms. In the
4th edition Hahnemann began to replace terms like body, organism, state of health
and other such words with the terms vital force, vital power and vital energy. The
first extensive introduction to the Organon appears in the 4th edition under the
title: I. Review of the Allopathy of the Old School of Medicine. See: Chart 3.4 |
Introduction to the 4th Organon (1829); p. 120.
In this work the Founder reviews the history of medicine from the homœopathic
view and explains the shortcomings of allopathy. The orthodox school maintained
that their treatments were based on the actions of Vis Medicatrix Naturae, the
healing power of nature. For example, they claimed that “nature” produced bleed-
ing when there was plethora so the physician should also bleed to cure plethora.
They presented such ideas as examples of how one cured naturally by Contraria
Contrariis (opposites cure opposites). Hahnemann was deeply skeptical of such
ideas and pointed out that what they called Physis (nature) was only the activities
of the instinctive, automatic vital force when deranged by the forces of disease.
Hahnemann wrote the following in the preface to the 4th Organon.
That nature, whose self-help was alleged by the traditional school of medi-
cine to be the incomparable healing art and the only thing worth imitating,
is merely the individual nature of the organic man, is nothing but the
instinctive, irrational, unreasoning vital force subject to the organic laws

of our body, which is ordained by the Creator to maintain the functions

and sensations of the organism in marvelously perfect condition so long as
the man continues in good health, but was not intended nor adapted for
the restoration in the best manner of deranged or lost health. For should
our vital force have its integrity impaired by injurious influences from
without, then this force strives instinctively and automatically to free itself
from the adventitious derangement (disease) by revolutionary processes;
but these very efforts are themselves disease; they are a second different
malady substituted for the original one.
Preface to the Fourth Edition.
Chart 3.4 | Introduction to the 4th Organon (1829)
Allopathy Homœopathy
Imperfect imitation of nature by so- Perfect imitation of nature by the true

called healing arts healing art
Mistaking the instinctive acts of the

Recognizing those rare but real cures
deranged vital force for nature’s way of
by nature
healing
Opposites cure Opposites Similars cure Similars
Palliation, suppression, mutation of

True cure with restoration of vitality
symptoms into more serious states.
Hahnemann made it clear that in his mind, the orthodox school was mistak-
ing the instinctive, automatic, unconscious actions of the mistuned vital force for
nature herself. To understand the laws of healing one must apply their reason gifted
mind to the natural processes that actually cure disease. The Founder championed

the idea that conscious intelligence must guide unconscious instinct in accordance
with natural commandments.
But as what has hitherto been termed “healing art” was a mere (imperfect)
imitation of those unhelpful, useless, not infrequently injurious efforts and
operations of this instinctive, unreasoning vital force (misnamed nature)
when left to itself in disease, it will, I think, be conceded that before me the
true healing art was not discovered. But that homœopathy is this healing
art, which had hitherto been sought for in vain, its fundamental principles
teach, its performances prove.
Preface to the Fourth Edition.
In these passages Hahnemann makes one of his most controversial statements.

That is the idea that the vital force is designed for preserving the state of health and
is not well suited for the restoration of health during sickness. On the surface such
an assertion seems contrary to the teachings of Hippocrates as well as the modern
understanding of the immune system. This assertion outraged the orthodox phy-
sicians who considered themselves “ministers of nature” and also confused some
of Hahnemann’s own followers. If one looks deeper, however, there are very valid
observations behind this declaration. Hahnemann returns to this theme in the
footnote to aphorism 19 of the 4th Organon.
I have already shewn, in the Introduction, that this method is an imperfect
imitation of the still more imperfect attempts made by the unintelligent
vital powers (when abandoned to their own resources) to save themselves at
all hazards, a power to which the organism was confided merely to preserve
its harmony so long as health continued. However inapplicable this method
may be, it has for so long a time been practiced by the existing school of
medicine, that the physician can no more pass over it unnoticed than the
historian can be silent on the oppression to which mankind has been subject
for thousands of years beneath the absurd rule of despotic governments.
The Homœopathic Medical Doctrine or The Organon of the Healing Art; S. Hahnemann (Translation
of the 4th Organon by Charles H. Devriant, 1833), footnote 1, Aphorism 17.
The preface and introduction to the 4th Organon states that in chronic diseases
the deranged vital force produces general reactions that tend to attack the healthy
areas of the organism without being able to remove the original disease. Although
the vital energy may remove moderate acute diseases through crisis, serious acute
diseases more often than not end in death. These rather negative statements must
be understood in the context in which they are given. That is, the disease-tuned
vital force may not be the best indicator of how to cure. To cure effectively, gently
and permanently the healing artist must study those rare but true cures carried out

by nature herself. These ideas are integrated into the main text of the 4th Organon
in aphorism 48.
The method we ought to adopt to cure diseases effectually, mildly, and
permanently, is easily discovered by studying the proceedings of nature.
These will teach us to avoid the course pursued by the unintelligent vital
powers, which, like allopathy, tend always to attack the parts that are least
diseased, and to excite a malady dissimilar to the primitive one; a proceed-
ing that never effects a cure in chronic diseases, but always aggravates the
evil, and which, in acute diseases that are not intense, removes them with
difficulty, terminating almost always in death where they are violent and
already dangerous in themselves. Here we may likewise learn to imitate
those rare but real cures (§38, 41) that are performed by the excitement of
a new morbific power whose effects resemble those of the primitive disease,
and which, acting upon the body, destroy and removes the latter promptly.
of the 4th Organon by Charles H. Devriant, 1833), Aphorism 48.
It was Hahnemann’s view that the healing artist should not blindly follow the
instinctive reactions of the disease-tuned vital force because they are part of the
problem, not indications of how to cure. He even goes so far as to say that some
of these attempts at self-healing are similar to allopathy as they produce dissimilar
states that damage the healthy parts while aggravating the original disease through
complications. This rather controversial idea has come of age as modern science
confirms that most of the pathology that takes place in chronic diseases is caused by
the organism’s own deranged pro- and anti-inflammatory hormones and immune
responses which damage the healthy parts of the organism. It was Hahnemann’s
view that the healing artists should use their God-given intelligence to observe
Nature more closely and understand that in the natural world disease is cured by
similar diseases. See aphorism 49.
These cures are, as we see, performed solely by means of homœopathy, which
we have at length attained to, by consulting reason and taking experience
for our guide (§9, 10). By this method alone can we cure disease in the
most speedy, certain and permanent manner, because it is grounded upon
the eternal and unerring law of nature.
Exciting and Fundamental Causes

Hahnemann’s teaching on causation and the categorizations of disease went
through a radical change between 1805 and 1843. Nowhere are the changes in
the homœopathic paradigm more obvious than in aphorisms 5, 6 and 7 of the

3rd Organon compared with 5, 6 and 7 of the 4th, 5th and 6th Organon. The most
important changes are found in aphorism 7 of the 4th edition, which later becomes
aphorism 5 of the 5th and 6th editions. In his early years Hahnemann taught that
similia and individualization alone were sufficient to treat all diseases. The central
causal doctrine of Homœopathy at this time was to refute the concept of the primary
cause and tolle causum (remove the cause) of the orthodox school. In aphorisms 5,
6 and 7 of the 3rd edition Hahnemann wrote that diseases as such are hardly rec-
ognizable in terms of inner changes but certainly recognizable by their symptoms.
In the footnotes he adds that the knowledge of the “prima causa” is non-important
in the matter of healing. For this reason, the healing artist views sickness only in
terms of the totality of the symptoms.
Every medical practitioner knows the difficulty of finding the true cause of
many disease states. Proximate cause often relates to an aetiological constellation
made up of several interdependent factors rather than one single cause. Other
befallments seem to just happen for no observable or logical reasons. Even with
the rapid development of modern sciences, studies at major institutions show that
the diagnosis of the true cause of many diseases is still outside our grasp. Many
causes are so hidden in the past that they can only be witnessed in the signs and
symptoms in the present. Hahnemann felt that it was a mistake to take the internal
changes that take place in the organism as the primary cause of the disease. For
example, to say that fatty degeneration of the heart is the primary cause of heart
attack is an illusion as this is just another symptom of the disease. Why did the
fatty degeneration appear in the heart and arteries in the first place? Is it because
of inherited predispositions, emotional stress, smoking, poor diet, lack of exercise,
obesity or the presence of chronic miasms? Are these internal changes produced by
any one of these factors or a combination of all of them? To look at the pathological
changes as the primary cause is only looking at the effects not the true reasons for
the development of the disease.
To say the primary cause of the patient’s disease state is a stomach, liver or
kidney disorder is not only misleading but also useless in finding a true curative
remedy. What are the real causes behind these internal changes? What produced
the original changes in function that ultimately lead to organic pathology in these
vital organs? The true causes of such diseases are not found in the pathology of the
body alone. Hahnemann continued to maintain that pathological changes in tis-
sues, organs and systems are not the primary cause of disease, but at the same time,
he introduced the homœopathic view of causation. For this reason, the paragraphs
found the 3rd Organon were replaced and the text was updated in accordance with
the new information presented in The Chronic Diseases. The most profound changes

come in aphorism 7 of the 4th Organon, which contains the major breakthroughs
in The Chronic Diseases in a nutshell.
When a cure is to be performed, the physician must avail himself of all
the particulars he can learn, both respecting the probable origin of the
acute malady and the principal phases of the chronic disease, to aid him
in the discovery of their fundamental cause which is commonly due to
some chronic miasm. In all researches of this nature, he must take into
consideration the apparent state of the physical constitution of the patient,
(particularly when the affection is chronic), the disposition, occupation,
mode of life, habits, social relations, age, &c. &c.
No longer was the discussion of aetiology based primarily on refuting the prima
causa of the orthodox school. Now it was the homœopath’s duty to study the excit-
ing causes of acute diseases and the fundamental causes of chronic diseases, which
are often based on the chronic miasms. In researching these areas it is important to
take into account the state of the physical constitution; the nature of the intellect
and emotional disposition as well as situational factors like occupation, lifestyle
and habits, social relationships, age, etc. Hahnemann called these areas of human
life the “attendant circumstances” and considered them an essential foundation for
understanding patients and the cause of their diseases. Case taking in the 4th Organon
included an expanded study of the causal factors, chronic miasms, and concomitant
symptoms related to constitution, temperament and environmental factors. The
approach found in aphorism 7 is updated and transferred to aphorism 5 in the 5th
and 6th edition of the Organon. See: Chart 3.5 | Aphorism 7: Causation and
Attendant Circumstances; p. 125.
By 1828 Homœopathy was no longer a system based solely on similia and
individualization. Now it was necessary to recognize individual and collective cau-
sations as well as singular disorders and group diseases. At this time Hahnemann
spoke in terms of causes, miasms, symptoms and attendant circumstances. Every
area of the patient’s life was assessed in order to understand the causal nature and
attendant factors of the disease state so that the totality of the symptoms would be
as complete as possible. These themes would be expanded and included in more
paragraphs in the 5th and 6th editions of the Organon. This presentation goes far
beyond anything that Hahnemann wrote in the first three editions and bears witness
to the fact that Homœopathy had come of age. See aphorism 8 of the 4th Organon.
The unprejudiced observer, (however great may be his powers of penetration)
aware of the futility of all metaphysical speculations that are not confirmed
by experience, perceives in each individual affection changes of general state

of the body and mind, traces of disease, causalities, and symptoms that are
discoverable externally alone, — that is to say, deviations from the former
sound state of health, which are felt by the patient himself, remarked by
the individuals around him, and observed by the physician. The ensemble
of these available signs represents, in its full extent, the disease itself — that
is, they constitute the true and only form of it which the mind is capable
of receiving.
Chart 3.5 | Aphorism 7: Causation and Attendant Circumstances

4th Organon (1829)
Complete history
Totality of the symptoms
Exciting cause Fundamental cause
Chronic disease usually caused by a

Acute disease
miasm
Attendant
circumstances
Physical constitution, disposition, occupation,

mode of life, habits, social relations, age, etc.
There are those who tend to rely on metaphysical priori that are very hard to
confirm by experience. They are always looking for a transcendental cause or symp-
tom that will explain everything in a few words. These attempts are often based on
subjective interpretations of a single person rather than the objective facts visible

to all. Hahnemann emphasized a Gestalt philosophy in which the whole was more
important than the sum of its parts. In his view it is the assembly of all perceivable
causalities, disease traces and symptoms found in the body and mind that make
up the true portrait of the illness. By viewing the essential nature of the totality of
the symptoms the disease takes on the form of a holographic picture that may be
seen from all sides and by every observer.
In aphorism 9 Hahnemann introduced a category called “causa occasionalis”,
which are exciting and manifesting causes that need to be removed. This includes
removing foreign objects by surgery, using stomach pumps or emetics to remove
poisons and other mechanical problems that need physical assistance. In cases where
there are no such factors Hahnemann writes “we can perceive nothing but the
symptoms, then must these symptoms alone (with due attention to the accessory
circumstances, and the possibility of the existence of a miasm) guide the physi-
cian in the choice of a fitting remedy to combat the disease.” Unlike the first three
editions of the Organon the last three editions all emphasize the need to assess the
totality of symptoms as well as the attendant circumstances (constitution, tempera-
ment, habits, lifestyle, relationships, sexuality, etc.) and the chronic miasms (psora,
sycosis and syphilis).
In the earlier editions of the Organon Hahnemann opined that nature produces
single, unique diseases in each individual that demand the complete individualiza-
tion of each and every case. By the time of the 4th Organon Hahnemann was equally
sure that infectious miasms were collective social diseases based on a common
cause. For this reason, he concluded that there were personal disorders and group
miasms that demanded a different approach. To understand a collective disease
like the acute and chronic miasms demands a much larger study. This is because
each individual patient only shows one facet of the collective miasm, which does
not provide the complete totality of the symptoms. To treat a collective disease it is
necessary to study the miasmic signs in a greater group of patients to find specific
genus epidemicus remedies. Although early Homœopathy addressed this issue in
acute disorders it was not until the 4th Organon that the need to study the chronic
miasms in a similar manner was emphasized. Vide aphorism 96.
This method, so indispensable in epidemic diseases which are for the most
part acute, I have likewise thought proper to apply in a more rigorous man-
ner than has hitherto been done, to chronic diseases principally produced
by a miasm that always retains its identity and to psora in particular. In
fact, it is necessary to search out the whole of the symptoms of these affec-
tions, since each individual they attack only presents a part of them, and
the remainder must be sought for in other patients; so that without hav-
ing observed a great number of persons attacked with one of the chronic

affections which belong to this class, it would not be possible to acquire

knowledge of the totality of the symptoms that characterise them, or, con-
sequently, of the homœopathic remedy which is appropriate to all their
different stages and forms.
By 1821 Hahnemann was already studying the symptoms of the itch disease
through the collective case history. He would carefully mark the potential symptoms
of psora with NB in the margins of his casebooks. From these observations it was
possible for him to construct a group case based on the totality of the symptoms
of the miasms found in hundreds of patients. This collective study brought out the
group symptoms of psora in such a manner that it was possible to find chronic
genus epidemicus remedies for anti-psoric treatment. For the chronic miasm to be
cured the remedy must have the potential to remove the totality of symptoms in
all its stages and forms. If a remedy cannot treat the primary, latent and secondary
symptoms of psora then it cannot properly be called an anti-psoric remedy.
The Wait and Watch Method of the 4th Organon

In the 4th Organon Hahnemann taught that the size of the dose should be
kept as small as possible and suggested the use of tiny poppy-seed size pellets as a
medium for his remedies. At this time, he started most cases with the 30C and then
lowered the potencies to 24C, 18C, 12C and 6C if and when needed. The Founder
gave careful rules regarding the repetition of the remedy and perfected what is often
called “the single dose wait and watch method”. This approach is clearly explained
in aphorisms 242, 243, 244 and 245. See: Chart 3.6 | Single Dose Wait And
Watch Method; p. 128.
So long, then, as the progressive amendment resulting from the dose con-
tinues, it must at least be admitted that, in this case, the action of the
remedy has not yet ceased, and consequently no other medicine should
be prescribed.
In the above passage Hahnemann clearly explains that as long as there is a

progressive improvement one must assume that the duration of the remedy still
continues. As long as the patient is getting better day by day and week by week
the repetition of any medicine whatsoever is forbidden. After this aphorism the
Hofrath proceeds to explain the nature of the work that can be accomplished by a
single dose of an appropriate homœopathic medicine.

128
Chart 3.6 | Single Dose Wait And Watch Method

4th Organon (1829)
Give single test dose and wait

(§242)
Give a new remedy and repeat

Observe period of improvement
process
(§243)
(§247)
Watch for
improvement
If new symptoms to come to a
appear, retake standstill or
the case symptoms
(§246) relapse
(§244)
If old symptoms relapse repeat same

remedy
(§250)

To this we may add that when the remedy is perfectly homœopathic, the
amelioration continues even after its action has terminated. The salutary
operation does not cease immediately after the first remedy has exhausted
its action, not even when several hours, and in chronic diseases several
days, are suffered to elapse without administering another dose. That part
of the disease which has already been destroyed cannot revive again, and
the amendment would still be perceptible for a long time, if even no more
medicines were administered to the patient.
Hahnemann continues by explaining that the improvement produced by a

well-selected remedy will continue for an intermediate period after the duration
of the remedy ceases. This period may last for a few hours in an acute disorder to
several days in a chronic disease. He notes that the symptoms of the diseases that
have been truly cured will not return, and an increase in health will be observable for
some time even without additional medicine. This is the power of the single dose.
When the progressive amendment arising from the first dose of the homœo-
pathic remedy does not terminate in perfect health, (which is rarely the case
in acute diseases), a period of stagnation ensues, which for the most part
is also the limit of the action of the remedy. Until this arrives, it would be
acting without any reasonable motive, or even advantage to the patient,
and in direct opposition to the desired object, as well as to the welfare of
the sufferer, to make him take a fresh dose of the medicinal agent.
In the following paragraph Hahnemann explains his reasons for forbidding all
medicinal interventions until the amelioration reaches a standstill in every direc-
tion. He emphasized the fact that untimely intervention, even with a well-chosen
remedy, runs the risk of producing aggravations and unhomœopathic medicinal
symptoms that mix with the natural symptoms and delay the cure. If the prescriber
does not recognize the nature of these signs, and continues to give more medicine,
there is a danger of causing a serious medicinal disease.
Even a medicine that had produced very salutary effects until a given time
would only aggravate the state of the patient if repeated before the amelio-
ration terminated in all its points. This would be an attack at an improper
moment. In fact, the first dose, when its action, proportioned to the dura-
tion of the disease is exhausted, has already done all the good that this
remedy could till then accomplish — that is to say, it has brought back the
health to the most favourable state it was possible to bring it. A second

dose would now spoil this good result, for it would excite the appearance
of the other non-homœopathic symptoms peculiar to the remedy — that is
to say, it would create a non-homœopathic medicinal disease, which join-
ing itself to the rest of the symptoms of the natural one would constitute
a complicated malady of still greater intensity. In short, it would destroy
all the good effects already produced by the former, or any that might be
expected from it, and thus at least impede recovery.
The statements in aphorisms 242, 243, 244 and 245 are in harmony with
what Hahnemann had written in The Chronic Diseases in 1828. The idea of giving
a single dose and waiting until the improvement ceases in every direction before
giving more medicine is commonly associated with “classical Homœopathy”. Many
of today’s practitioners, especially those who use higher potencies like the 30C,
200C, 1M and 10M use this method. The only exception to the wait and watch
rule is when a remedy produces a dissimilar aggravation marked by new symptoms
without causing any clear improvement. Hahnemann took this as a sign that the
wrong remedy had been given and corrective measures were needed to regularize
the case. This is explained in aphorisms 248 and 249.
There is but one case where another medicine ought to be administered
before the preceding one has exhausted its action; it is that where a dan-
gerous disease far from improving in the slightest degree becomes on the
contrary aggravated by the appearance of fresh symptoms. It is then evident
that the medicinal substance administered in the first instance was not
homœopathic to the existing disease. It is therefore necessary, even before
it shall have finished its effects, to administer another which is more con-
formable to the actual state of the disease.
The appearance of new symptoms not appertaining to the disease under treatment
is a sign that the patient has received the wrong remedy. In cases where there is no
immediate danger these symptoms will often disappear by themselves in a matter of
minutes to hours in acute diseases or a day or two in a chronic complaint. In dangerous
cases, however, this is no time to wait and watch. A new remedy that suits the present
condition must be given immediately without waiting for the cessation of the wrong
remedy. The correct remedy for the presiding symptoms will regularize the case and start
the process of amelioration. Hahnemann continues on this theme in aphorism 249.
This mode of proceeding would be imperative in a still greater degree if,
in any urgent case, the physician who watches the progress of things with

attention, perceives, at the expiration of six, eight, or twelve hours, that he

has made a mistake in the choice of the last remedy, because the patient
grows worse and new symptoms declare themselves. In such a case, it is not
only allowed, but it is even a duty, to repair the error he has committed by
selecting another homœopathic remedy that is as appropriate as possible
to the present sate of the disease. (§161).
In the 4th Organon Hahnemann taught that after the first dose the symptoms
of the patient often change to such a degree that a new remedy is needed for the
remaining complaints. He felt that if a remedy was well selected it would eliminate
all of the symptoms it was capable of removing in a single dose. He raises this idea
in aphorisms 246 and 247.
When the progressive amendment is stopped before the complete restora-
tion of health, and what remains of the disease be examined with attention,
we shall then find the group of symptoms not only diminished but also
changed to such a degree that the same remedy will no longer be homœo-
pathic to it, and so on each occasion it will be necessary to select another
more suitable to the existing state of the malady.
Consequently, when the first dose of the remedy, which has been well
selected, does not effect a perfect restoration to health during the continu-
ance of its action, which it seldom fails to accomplish in recent affections
that develop themselves in a rapid manner, there remains nothing better
to be done, to annihilate what remains of the disease, than to administer
a dose of another medicine as homœopathic as possible to the totality of
the remaining symptoms.
In these passages he suggested that after the single dose one usually finds that
there has been some alteration of the symptoms suggestive of a new remedy. The
casebooks of this period show that Hahnemann was only using around 60 remedies
to treat most of his patients. With such a limited materia medica it is not surprising
that many of these remedies were partial simillimums that caused an improvement
in some areas while not removing symptoms in others calling for a new remedy. For
this reason, it may take a series of remedies to complete the cure. This method is
called “zigzag prescribing” because the improvement proceeds at oblique angles rather
than being a straightforward affair. In aphorism 250 Hahnemann presents a similar
observation in the case of chronic diseases, which were often based on chronic miasms.

In chronic diseases, particularly at the commencement, it seldom happens

that it would be good to administer two doses of the same remedy succes-
sively, not even if the second were delayed till the action of the first had
terminated. If the first dose has done good, the amendment produced will
continue for some time, and in general there is no indication that would
call for a repetition of the same medicine, because that which has not been
improved by the power of a first dose will not yield to a second of equal
strength or even to one that is yet stronger.
A single remedy in a single dose is often all that is needed in a recently developed
disease state but in more protracted chronic diseases this is usually not the case.
A chronic case may need a series of remedies that are administered over a longer
period of time. Hahnemann seems to believe at this time that whatever symptoms
remained uncured by a single dose of a remedy would not be cured by a second or
third dose. The only exceptions to this general rule were the repetition of Sulphur,
Hepar Sulphuris Calcareum, and to a lesser degree Sepia as expressed in The Chronic
Diseases. Hahnemann repeated these cardinal anti-psorics sometimes alone or with
the interpolation of intercurrent remedies to calm the vital force and prepare the
organism for further doses.
The information in paragraphs 247, 248 and 250 of the 4th Organon was replaced
in the 5th edition with instructions on when to allow a single dose to act alone
and when to repeat the same remedy to speed the cure. It appears that by 1833
Hahnemann found that he could gain more benefit by carefully repeating the same
remedy than he thought possible in 1829. This may have been because of the advent
of more experience, new remedies, new reference works and the increased use of
olfaction and liquid doses. The changes in these paragraphs will be discussed in the
following chapter, The Homœopathy of the 1830s.
Posology Methods and Delivery Systems

In the 4th Organon Hahnemann discussed administering remedies in the form
of dry pellets, in aqueous solutions and by olfaction. See: Chart 3.7 | Posology
in the 4th Organon (1829); p. 133. In The Chronic Diseases he spoke of using
solutions under specific conditions, but in the 4th Organon he opined that remedies
work better in general in liquid. In some cases he would add a small amount of
water to the pills in a teaspoon, and at other times he would dissolve the pellets in
a glass of water and give the patient portions of this solution. Hahnemann even
goes so far as to say that pills should be rejected, as their action on the living tissues
is “vague and uncertain”.

133 
Chart 3.7 | Posology in the 4th Organon (1829)
Single remedy
Single dose
Dry pellets Olfaction Liquid solution

(§283) (§283fn) (§284, §286)
Diminished dose Increasingly penetrating

Smallest possible dose
contacts less surfaces dose contacts more
for sensitive patients
and nerves surfaces and nerves
Vapour via nose and 1 pill in spoonful via

1 pill on tongue
respiratory tracts oral tract
Potencies
X: 30C
VIII: 24C
VI: 18C
IV: 12C
II: 6C
As the certain and comparative effects of medicines are never more easily
ascertained than when they are administered in a solution, the physician
ought consequently to employ all medicinal substances in a soluble state
when their constitution does not absolutely require them to be given in a
form of powder. All the other forms in which medicines have, till the pres-
ent time, usually been enveloped, such as pills, electuaries, etc., should be
rejected, because their action upon the living fibre is vague and uncertain.
Hahnemann was very precise about the size of the dose in the 4th edition of
the Organon. He describes the process where one drop of a dynamization is placed
on 300 tiny poppy-seed size pellets making each pill 1/300 of a drop. He suggests
that 1 of these pills placed on the tongue is a sufficient dose for the patient. He
also adds that those who are sensitive should receive the dose by olfaction, which
he considered one of the smallest doses possible.
The best mode of administration is to make use of small comfits or globules
of sugar, the size of a poppy seed, one of these globules having imbibed the
medicine, and being introduced into the vehicle, forms a dose containing
about the three-hundredth part of a drop, for three hundred of such globules
will imbibe one drop of alcohol; by placing one of those on the tongue, and
not drinking any thing after it, the dose is considerably diminished. But if
the patient is very sensitive, and it is necessary to employ the smallest dose
possible, and attain at the same time the most speedy results, it will be suf-
ficient to let him smell once to a phial that contains a globule the size of a
mustard-seed, imbibing the medicinal liquid attenuated to a very high degree.
of the 4th Organon by Charles H. Devriant, 1833), footnote 1, Aphorism 283.
One small pill placed on the tongue only comes in contact with a smaller sur-
face area of the organism. The liquid dose, however, contacts a larger number of
nerves that transmit the power of the remedy to the vital force. This is also true with
olfaction as the fumes of the remedy come in contact with the olfactory nerve to
the brain, the sinuses and the tissues of lungs. Hahnemann notes that in theory one
might imagine that the use of medicines in liquid would weaken medicinal action
but in practice the opposite is true as far as homœopathic remedies are concerned.
By the same reason, the effect of a homœopathic dose is increased when we
augment the quantity of liquid in which it is dissolved to administer it to the
patient, although the proportion of the medicinal substance remains the same;
but then the remedy comes in contact with a much more extended surface,
and the nerves that feel its effects are far more numerous. Although theorists

have asserted that the extension of the medicine in liquid weakens its action,
experience proves the reverse, at least as far as regards homœopathic remedies.
Hahnemann continues with the same theme in aphorism 286 where he explains
the penetrating effect of remedies given in liquid. He suggests that the liquid remedy
is rapidly transmitted from the sensitive parts replete with nerves to all other parts
of the organism. He calls this remedial action “spiritual” in the sense of a dynamic
or virtual effect on the vital force.
The action of liquid medicines upon the body is so penetrating, it propa-
gates itself with so much rapidity and in a manner so general, from the
irritable and sensitive part which has undergone the first impression of the
medicinal substance to all other parts of the body, that we might almost
call it a spiritual (dynamic or virtual) effect.
In The Chronic Diseases Hahnemann recommended the use of 1 or 2 small pel-

lets as an appropriate dose. This set the standard for the use of the dry dose, which
is still the most common method of giving remedies today. In the 4 th Organon,
however, Hahnemann stated his preference for the administration of remedies in a
liquid although he was yet to give the exact details how this was to be carried out.
The Founder also pointed out that olfaction was an excellent method for administer-
ing remedies to those who are sensitive. So in this work Hahnemann reviews three
methods of administering remedies, i.e., as dry pellets, in liquid solutions and by
inhalation. In The Chronic Diseases and the 4th Organon the Founder taught that
as long there was amelioration of the symptoms the repetition of the remedy was
counter-indicated. The repetition of the remedy was allowed only after there was a
clear standstill in the improvement of the symptoms in every direction.
Hahnemann Restricts Potency to 30C

By the 1820’s Hahnemann was convinced that the actions of the 30C were
truly more powerful than the low potencies he had previously administered. As
he was now confronting the chronic miasms he was searching for more powerful
methods of overcoming the obstacles to the cure. For this reason, the Founder
began to experiment with higher potencies of the cardinal anti-miasmic remedies.
Hahnemann’s early use of potencies above the 30C is recorded in the second edition
of the Materia Medica Pura (1826) in his lecture on Thuja.
As the fig-wart gonorrhoea is one of the few permanent miasmatic dis-
eases, I was able to test in the most certain manner the degree of efficacy

of the higher dilutions of thuja juice. Thus I found that even the higher
dilutions, e.g., the decillion-fold or even the vigesillion-fold dilution
(I/XX, made with sixty diluting phials, each of 100 drops), if each
diluting vial were succussed ten times and oftener (that is, with ten or more
shakes of a powerful arm), was not weaker in power than the less diluted
preparations, nor, on account of the enormously diminished arithmetical
fraction, had it sunk to complete powerlessness, to nothing, but, on the
contrary, it had rather become even more intensely charged with the
medicinal virtue of thuja.
Materia Medica Pura; S. Hahnemann, Volume II, Thuja, p. 649.
In this quote Hahnemann discusses the use of the decillionth (30C) and the
vigesillionth (60C) potencies. The fact that Hahnemann was making higher potencies
with 10 or more succussions did not go unnoticed by his students. By 1829 some
of Hahnemann’s pupils began experimenting with their own potencies above the
30C. One of the principal members of this group was Dr Gustav Adolph Schreter
(1803–1864), who was born in Lentschau, Upper Hungary in 1803. His father
was a respected allopathic physician who provided his son with a quality educa-
tion. With his father’s support Gustav attended medical school in Vienna where he
received his diploma in 1826. After his graduation Gustav’s father planned a two year
scientific pilgrimage to France and Germany where he requested his son to study
Homœopathy. At first Gustav was a little reluctant to take on such a journey but
in 1826 he travelled to Leipzig to study Homœopathy with Samuel Hahnemann.
In 1828 Dr Schreter returned to Lentschau to start a practice from where his
reputation spread throughout Eastern Europe. After the successful treatment of
a Polish Countess he was invited to Lemberg, Poland, which is now part of the
Ukraine. Not sure how to proceed, the young doctor asked Samuel Hahnemann
for advice. Hahnemann wrote back and said that Schreter “as the faithful disciple of
Homœopathy, should introduce and spread the new curative method in the interest
of science and of suffering humanity, especially in those countries in which no ray
of the truth had yet penetrated”. Taking this counsel to heart, the young doctor
moved his practice to Poland where he became known as Dr Schreter of Lemberg.
Following on the information Hahnemann published in 1826 in The Materia
Medica Pura, Dr Schreter began to experiment with making potencies that were
above the 30C recommended by Hahnemann in The Chronic Diseases and Organon.
When Hahnemann was informed of these new experiments he was worried that his
students were going too far too fast. He knew that the higher potencies were “more
intensely charged” than the lower potencies and he was concerned about their poten-
tial for producing strong aggravations. Hahnemann writes that he had made Thuja

60C with 10 or more succussions per dilution but in the same article he states that
he now only uses 2 succussions in order to prevent aggravations. The Founder says:
In order to obtain real preparations of sufficiently developed, but at the
same time, suitably moderated, power for even the more and most sensi-
tive patients by the dilution of the medicinal substances for homœopathic
use, for some time back, I have adopted the plan in the case of all fluid
medicines of succussing each dilution vial with only two strokes of the arm.
Materia Medica Pura; S. Hahnemann, Volume II, Thuja, p. 649.
So at this time, Hahnemann was not worried that his potencies were too weak
but that they were too strong, especially on those who were highly sensitive. The
Founder was working hard to find a perfect balance between remedies that were
powerful enough to remove the chronic miasms yet gentle enough to avoid unneces-
sary aggravations. Hahnemann wondered what would happen if everyone starting
using different degrees of potency made in different ways with varying number of
succussions. In September 12th, 1829, Hahnemann wrote a letter to Dr Schreter
which was later published in Stapf ’s New Archive for the Homœopathic Healing Art,
Volume III, Part 2, p. 182, 1846.
I do not approve of your potentising medicines higher than to XII and
XX — there must be a limit to the matter it cannot go on indefinitely. But
by definitely deciding that homœopathic medicine should all be diluted
and potentised up to X [30th centesimal–R.H.] a homogeneous process
arises in the cures of all homœopaths and if they describe a cure, we are
able to work after them in the same degree, since they are operating with
the same tools as we are. Then our enemies cannot reproach us with having
nothing definite, no fixed standard.
Samuel Hahnemann, His Life & Work; R. Haehl, Volume I, p. 322.
In this letter Hahnemann requested that the 30C become the standard potency
for clinical applications. One of the main reasons for this dictum was his concern
that his opponents would claim that Homœopathy has no fixed standards and was
therefore unscientific. For this reason, he recommended that all homœopaths should
use the 30C potency so they could present uniform medical studies. Another factor
was that Hahnemann was ridiculed for the use of the decillionth, and he wondered
what his critics would say about using even smaller fractions of medicine. This letter
must have come as a surprise to Dr Schreter as Hahnemann had already published
the results of his own experiments with the 60C. The idea that all homœopaths
should use 30th potency did not go down well with most of Hahnemann’s students.
Many felt that each homœopath should go by their own experience when it came
to the choice of potency for their patients. Some preferred the lower potencies like
the 6th or 12th, and others wished to experiment with degrees higher than the

30C. Dr Schreter continued to experiment with high potencies and eventually used
dynamizations as high as the 2000th. The editor of the Archive, Dr Stapf, added a
note to the letter saying that it is well known that Hahnemann later changed his
views on this subject.
The Limit Maker

The period around the publication of the 4th Organon (1829) was a time of
great transformation in the philosophy and causal doctrine of Homœopathy. The
teachings of The Chronic Diseases and the chronic miasms were integrated into the
text of the 4th Organon and many anti-psoric remedies were introduced. At the same
time, Hahnemann was working hard to remove any complications that remained
in his new medical system. For this reason, he made several changes in the areas of
pharmaceutical production, case management strategies and posology procedures.
First of all, he limited the number of succussions given to the pharmaceutical potency
to two in order to modify the power of the increased number of dilutions. Then
he limited the amount of the dose to one or two poppy-seed size pills given dry or
by olfaction or in liquid solution. He did this because the drop doses of the stock
potencies were causing too many unnecessary aggravations and accessory symptoms.
He recommended the use of the single dose and emphasized the problems caused
by untimely repetition. He suggested that each remedy be given only one time and
not repeated in most cases. Hahnemann also wrote letters limiting the potency at
30C made by the instructions of the Organon in an effort to maintain a uniform
standard for homœopathic remedies. In some ways, the 4th Organon may be called
the “limit maker” because Hahnemann placed new restrictions on the homœopathic
system to control the rapidly expanding power of the remedies.

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What were Hahnemann's views on disease classification?

What were Hahnemann's views on disease classification?

How did Hahnemann's views on pathology evolve over time?

How did Hahnemann's views on pathology evolve over time?

The Homœopathic

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The Introduction of Homœopathic Pathology

T he Roman-Greco school of medicine was obsessed with classifying disease

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Hahnemann collects The 4th Organon In Remarks on the

1810–1817 1816–1819 1821 1829 1832

1816–1817 1818 1828–1830 1829–1832

The Itch Disease in Early Homœopathy

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Hahnemann goes on to describe the outcome of suppressing the external lesions

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The Origin of Psora

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Hahnemann clearly separated true acute diseases from pseudo-acute disorders

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To remove the tendency to such outbursts (dangerous sore throats, pneu-

In the Materia Medica Pura Hahnemann published the provings of 67 remedies

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Chart 3.2 | Cessante Causa – Cessant Effectus

Acute miasms Chronic miasms

Self-limiting, short duration Life-long duration

Typhoid, typhus, measles, mumps, etc. Psora, sycosis, syphilis

Group anamnesis, collective

Acute genus epidemicus remedies Chronic anti-miasmatic genus remedies

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The Great Debate

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One group of practitioners understood that psora was a constitutional disorder

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The Treatment of Chronic Diseases

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The Medicinal Solution in The Chronic Diseases

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Chart 3.3 | Posology in The Chronic Diseases (1828)

The anti-miasmatic remedy

Wait and watch the

New symptoms, new Same symptoms, repeat

If the medicine is to act more strongly it must be stirred in a little more

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The Vital Force in the 4th Organon (1829)

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of our body, which is ordained by the Creator to maintain the functions

Chart 3.4 | Introduction to the 4th Organon (1829)

Imperfect imitation of nature by so- Perfect imitation of nature by the true