This holds good to such an extent, that the state of the disposition of the patient often chiefly determines the selection of the homeopathic remedy, as being a decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician.

With such emphasis on the mental symptoms, is there any reason to study the nature of disease, causation or the classical theory of the miasms? In contrast to this statement on the importance of mental symptoms, Hahnemann points out in Aphorisms 5 and 206, the necessity of understanding the miasms when treating complex chronic diseases. Can the homeopath construct a complete picture of an individual without knowing how the chronic miasms form layers of disease within the constitution? Can we really manage a complex chronic case without paying any attention to the primary, latent and secondary states of the fundamental miasms? In this article, I will attempt to approach this rather controversial subject with the help of historical documents and the practical experience of the homeopathic masters. My purpose is to demonstrate that what Hahnemann taught in the Organon and The Chronic Diseases is a careful balance between pure vitalism and a deep understanding of the pathogenesis of miasmic diseases. This middle path approach helps transcend the apparent dichotomy between the psychological and physiological aspects of our art and gives the homeopath the tools necessary to respond to a great variety of situations.

In Search of the Fundamental Cause

From the early days of his career, Samuel Hahnemann experienced great success in the treatment in acute diseases. However, as early as 1816 he was concerned because the constitutional health of his patients seemed to be slowly declining. As he pondered the nature of his patients' continual deterioration, he began to search for a deeper understanding of the processes that lie behind chronic disease. Of these chronic cases he lamented, "their beginning was promising, the continuation less favorable, the outcome hopeless." Hahnemann began to wonder about the cause of these complicated chronic diseases that were resisting his treatment. As he continued to administer his remedies he noticed that certain chronic patients, who first responded well, either relapsed or slowly became more ill. Of this experience he said, "The remedy which was serviceable the first time would prove less useful, and when repeated again it would help still less." As Hahnemann watched these patients closely, he noticed that new symptoms would be added to the old ones that could be removed only "inadequately and imperfectly." Again he would give the most appropriate homeopathic remedy, but each dose was less effective and in the end they worked "no better then weak palliatives." This left Hahnemann searching for the cause of these complicated forms of chronic disease that resisted treatment.

For twelve years Hahnemann quietly searched for the fundamental cause of the chronic diseases that slowly destroyed the health of his patients. The outcome of this research was published in 1828 in the first edition of his great work, The Chronic Diseases: Their Peculiar Nature and their Homeopathic Cure, commonly known as The Chronic Diseases. Over the next eleven years he produced four more editions of this work, published in 1830, 1835, 1837 and 1839. In these subsequent editions, Hahnemann added new material as well as prefaces in which he offered his latest insights into preparation of the potencies and the dosage for the patient. The Chronic Diseases was followed in 1829 by its philosophical counterpart, the 4th edition of Organon. In these works Hahnemann made public for the first time his theory of the chronic miasms. This led to the most controversial period of homeopathic history – first major schism in the history of the homeopathic school. With the introduction of the theory of Psora and the chronic miasms, as well as the 30c potency, Hahnemann went too far for some of his more conservative followers. They were secure with the homeopathy that Hahnemann practiced in his earlier years and could not adapt to the new territory Hahnemann explored. Hahnemann was well aware that his new ideas were radical, and shortly before publication of his findings, he wrote Dr. Stapf about the probable reaction of his students.

They will require more than six months before they recover from the fright and astonishment of this enormous, preposterous affair and will perhaps need another six months before they will believe in it. Therefore, it will probably be three years before they can make any sensible use of it.

Feeling the way he did about the reception of his own homeopathic students, Hahnemann could only imagine what the orthodox medical community would think. Speaking of these individuals, he said that he anticipated a "great uproar " among the allopaths. All of Hahnemann's predictions did take place, but they were amplified even beyond his expectations.