Lectures on Organon of Medicine – Perception of Complex Disease – Understanding Aphorism 74

Understanding the significance of Hahnemann’s clinical advice in aphorism 74 is pivotal in managing complicated expression of disease. We begin to perceive why disease expression is complicated and why understanding the miasm theory is necessary for management.

Hahnemann first begins to explain what exactly complex pathology in chronic disease is, from the homeopathic standpoint and how it is classified for the purpose of clinical management.

In this aphorism, Hahnemann explains what exactly complex pathology in chronic disease is, from the homeopathic standpoint and how it is classified for the purpose of clinical management.

It has been fun and enlightening writing this commentary to the Practical part of the Orgnaon,  as it delights me to see, in light of my experience, Hahnemann’s deep perception of disease over 200 years ago. The human being has hardly changed much in those 200 years. The problems faced then, we still face now, though more modern terminology exists for various problems. It is important as homeopathic students to rediscover the wonder of Hahnemann’s genius insight into disease and its cure, and not be distracted by statements like, “its religion” or “its dogma”. The true principles of homeopathy will hold through any ‘new’ development. Those who can truly retain, master and respect the traditional along with support of ‘new’ ideas in an appropriate context will be the most developed homeopaths of the future.

Understanding the significance of Hahnemann’s clinical advice in aphorism 74 is pivotal in managing complicated expression of disease. We begin to perceive why disease expression is complicated and why understanding the miasm theory is necessary for management.

In this scenario, we question an excessive obsession with new remedies, and search for ultimate simillimum’s in the absence of making accurate homeopathic assessment of disease expression, and without a deep understanding of disease development in individual patients. Crucial in advanced pathology is to observe the course of healing in the right direction of cure.

Hahnemann first begins to explain what exactly complex pathology in chronic disease is, from the homeopathic standpoint and how it is classified for the purpose of clinical management.

Among chronic diseases we must still, alas!, reckon those so commonly met with, artificially produced in allopathic treatment by the prolonged use of violent heroic medicines in large and increasing doses, by the abuse of calomel, corrosive sublimate, mercurial ointment, nitrate of silver, iodine and its ointments, opium, valerian, cinchona bark and quinine, foxglove, prussic acid, sulphur and sulphuric acid, perennial purgatives1, venesections, shedding streams of blood, leeches, issues, setons, etc.,

The first group of chronic disease expressions he speaks of above is the “drug miasm“. This is produced by prolonged use of large doses of drugs. He enumerates some of those commonly used in his day. One shudders to think of being treated with them. But today the vital force continues to be exposed to external ‘bombardment’ both from homeopathic and allopathic camps. Some modern substitutes of the list above are:

Antibiotics, when not prescribed for true acute disease [$72]
Steriods, when prescribed in chronic disease
Multi-drug regimens for cancer patients and other diseases
Cocktail of symptomatic drugs (not tested in this cocktail combination) aimed at suppressing symptoms (hypertension, diabeties, vertigo, etc) in advanced disease
Mood enhancing drugs like Ecstacy, LSD, cocaine, etc, their various derivatives

I have a group of patients who are in this ‘inveterate group’ awaiting their healing. It requires perseverance and patience both from the patient and from the practitioner. I sometimes seek help of my professors as well. They have had 4-5 remedies in the course of 3-4 years and expereince much better health than they when they started treatment. Even though there may be a ‘constitutional remedy’, the number of ‘blocks’ interfering with its action are numerous and one needs intercurrent prescriptions to overcome these phase pictures.

The key is to observe a change in symptom picture – something that a homeopath masters in time when well focused in a classical practice and knows what to look for either in mental state or physical characteristics. There have been numerous classical methodologies evolved to deal with these scenarios and learning them well can only help. I wrote some articles on Miasms Part 1, Part 2, Part 3, Part 4, that highlight some of these methodologies. But there are others as well.

Confused clinical situations could even develop following apparently homeopathic treatment. We need to introspect:

Could ‘homeopathic’ combinations for specific physical disease diagnoses, not followed-up with accurate chronic simillimums be truly homeopathic?
Could ‘deep-acting’ homeopathic remedies prescribed in high potencies solely based on mental/spiritual state, not supported with physical characteristics be truly homeopathic?
Can fixed predetermined protocols based on disease names, without taking into account patient individuality be truly homeopathic?

Hahnemann categorizes observations made, following the weakening of the vital force by external drugs. He gives logical explanations based on homeopathic theory of health and disease.  Let us understand his line of thought carefully.

whereby the vital energy is sometimes weakened to an unmerciful extent,

One of the commonest observations is a weakened of the vital force. One sees these inveterate states of disease where the complexity of disease expression is so marked no remedy covers the picture adequately to cure. The time required for such a reversal of symptoms is long, while the vital force can easily be snuffed out with a strong dose of the simillimum. These are situations that require a palliative, partial, superficial remedy. And even then, one cannot be sure of a positive response. Euthanasia is more commonly observed here.

Or else the vital force goes into survival mode and develops various modus operandi to stay alive.

sometimes, if it do not succumb, gradually abnormally deranged (by each substance in a peculiar manner) in such a way that, in order to maintain life against these inimical and destructive attacks, it must produce a revolution in the organism,

One modus operandi is a “deviation” of the normal course of disease. There is a normal course of disease development from childhood to old age, these are easily cured or palliated with a remedy. Then there is an abnormal course of disease development which results from a deviation of the vital force and hence disease progression. This will not respond to single remedy treatment. A large group of cases today are in this state. Hence the obsession for finding a single ultimate simillimum, for this group of clinical cases would be inappropriate.

and either deprive some part of its irritability and sensibility,

The second modus operandi is observed in patient’s unable to respond to accurate remedies due to an insensibility of the vital force (eg: Opium state) or they develop abnormal hypersensitivity to homeopathic remedies.  The indicated remedy produces aggravations in any potency.  The vital force is too confused to respond in a healing way. The homeopath needs to take the case frame by frame identifying layer over layer of ‘substance abuse’ giving a long time for each prescription to work, with accurate history and investigation into the case. Deal with each picture one after another with accurate remedies, watching closely for when a change of prescription is indicated. These cases need slow follow up over 2-3 years before they clear up for a good constitutional remedy to work. Important during this waiting is to know whether one is moving in the right direction or not. Hering’s Laws and Miasmatic analysis are necessary here.

Eg: A patient of advanced granular conjunctivitis with chemosis and ‘dry eye’. He had been given steriods for many years that stopped working now. He required 4-5 doses of antimiasmatic Thuja for 1.5 years, each of which aggravated initially, before his case cleared up adequately for his constitutional remedy to be obvious. When this happened, Calc Sulph was prescribed which completed the healing within the next 6 months! He’s been well ever since – its been 5 years now.

or exalt these to an excessive degree, cause dilatation or contraction, relaxation or induration or even total destruction of certain parts, and develop faulty organic alterations here and there in the interior or the exterior (cripple the body internally or externally), in order to preserve the organism from complete destruction of the life by the ever – renewed, hostile assaults of such destructive forces.3

The third modus operandi is developing abnormal change in various body organs in an attempt to localize the deviation or derangement while attempting to preserve life. This is the philosophical basis, combined with miasmatic background for many expressions of varicose veins, vascular aneurisms, tumors in various organs, dilation of the heart, cirrhotic livers, cancers in various organs, etc. And yet the external assaults continue, unabated. At what point will we begin to respect our body, soul and vital force? When will we choose the truly gentle cure for the vital force? We question ourselves as patients as well as homeopaths.

These cases when advanced are more often palliated than cured. Specific remedies for specific organ derangements work well in such scenarios. Acute remedies are often needed here before a constitutional remedy can help adequately if cases can progress towards cure.

Eg: A case of cardiac failure with COPD (Chronic breathlessness) will fist need specific remedies dealing with the cardiac failure/breathlessness (Caardus, digitalis, StrophanthusNaja, Antim tart, Antim Ars etc) depending on symptom expression, for a long period of time before a constitutional remedy will be adequately helpful in strengthening the heart function and general state. When cure is not possible, mother tinctures and low potency specific remedies like the above should be prescribed.

Hahnemann supports this aphorism with footnotes on clinical observations of true “plethora” that occur in a woman pre-menstrually due to high hormonal level (progesterone) resulting in fluid retention.

1 The only possible case of plethora shows itself with the healthy woman, several days before her monthly period, with a feeling of a certain fullness of womb and breasts, but without inflammation.’

The second footnote is a detailed tirade against bloodletting which was in “vogue” in Hahnemann’s time, propogated by a physician called Broussais. He condemns this method as cruel, irrational, murderous malpractice based on groundless and absurd theory.  Hahnemann’s arguments below were VERY SOUND if we look at them in light of today’s knowledge of physiology and pathology. But, he was opposed strongly and vehemently by the old school for his opinion in that day – which produced an even stronger condemnation from him while he repeated the need for dynamic potencies for cure.

Often we tend to look outside towards allopathy to find fault with “chemicals” used and suppression created. Have we the same critical eye on what goes on in the homeopathic community? Is being in “vogue” the best homeopathy? It seems criticism is easily available, but either it is ignored by people who refuse to listen, or is not constructive enough to produce positive change in those who need to introspect.

Let us develop a healthy response to criticism, learn to perceive what is being said, and introspect into our practice for a change and life-long growth towards being expert and excellent homeopaths the world needs, seeking to cure as is our one and only mission.

2 Among all imaginable methods for the relief of sickness, no greater allopathic, irrational or inappropriate one can be thought of than this Brousseauic, debilitating treatment by means of venesection and hunger diet, which for many years has spread over a large part of the earth. No intelligent man can see in it anything medical, or medically helpful, whereas real medicines, even if chosen blindly and administered to a patient, may at times prove of benefit in a given case of sickness because they may accidentally have been homoeopathic to the case. But from venesection, healthy common sense can expect nothing more than certain lessening and shortening of life. It is a sorrowful and wholly groundless fallacy that most and indeed all diseases depend on local inflammation. Even for true local inflammation, the most certain and quickest cure is found in medicines capable of taking away dynamically the arterial irritation upon which the inflammation is based and this without the least loss of fluids and strength. Local venesections, even from the affected part, only tend to increase renewed inflammation of these parts. And precisely so it is generally inappropriate, aye, murderous to take away many pounds of blood from the veins in inflammatory fevers, when a few appropriate medicines would dispel this irritated arterial state, driving the hitherto quiet blood together with the disease in a few hours without the least loss of fluids and strength. Such great loss of blood is evidently irreplaceable for the remaining continuance of life, since the organs intended by the Creator for bloodmaking have thereby become so weakened that while they may manufacture blood in the same quantity but not again of the same good quality. And how impossible is it for this imagined plethora to have been produced in such remarkable rapidity and so to drain it off by frequent venesections when yet an hour before the pulse of this heated patient (before the fever and chill stage) was so quiet. No man, no sick person has ever too much blood or too much strength. On the contrary, every sick man lacks strength, otherwise his vital energy would have prevented the development of the disease. Thus it is irrational and cruel to add to this weakened patient, a greater, indeed the most serious source of debility that can be imagined. It is a murderous malpractice irrational and cruel based on a wholly groundless and absurd theory instead of taking away his disease which is ever dynamic and only to be removed by dynamic potencies.


1. Hahnemann, Samuel; Organon of Medicine
2. Hahnemann Samuel; Theory of Chronic Diseases
Allen, JH; The Chronic Miasms
4. Allen T.F; Boenninghausen’s Therapeutic Pocket Book
Boger, CM; A Synoptic Key of the Materia Medica
Boger, CM: Studies in the Philosophy of Healing
7. Das, Ashok Kumar: Treatise on the Organon of Medicine
8. Dhawle, ML; ICR Symposium Voumes I,II,III
9. Kent, James T; Lectures on Homeopathic Philosophy
10. Dudgeon RE, Boericke William; Organon of Medicine by Samuel Hahnemann, Fifth and Sixth Edition Combined.
11. Vijayakar, Praful; The End of Miasumption of Miasms
Banerjea, SK: Miasmatic Diagnosis
13. Little, David: Case Management available on

About the author

Leela D'Souza

Leela D'Souza

Leela D'Souza-Francisco, MD (Hom), CIH (Cardiology) is a Mumbai-based homeopathic professional whose experience includes intensive graduate medical training at India's leading homeopathic medical institution in Mumbai, completed in 1990. She completed her MD (Hom) from MUHS, Nashik in 2008 with a Dissertation entitled "Emergency Management in Homeopathy". She obtained a post graduate MSc (Homeopathy) degree from UCLAN, UK in 2009 with a Dissertation entitled "How Can We Develop Suitable Clinical Trials for Research in Classical Homeopathy". Her present interests include management of in-patients in homeopathic hospitals, and clinical research in classical homeopathy. She has been in practice for over 20 years and is online at www.homeopathy2health.com for the last 15 years. Presently she is Consulting Homeopathic Physician, with specialization in Cardiology at Holy Family Hospital, Bandra, Mumbai.
Visit Dr. Leela D'Souza at her website : http://www.homeopathy2health.com/member.htm
and her at: [email protected]

Leave a Comment