Homeopathy Papers

The Constitutional Similar: A New Gateway to the Simillimum in Psoric Diseases

The Constitutional Similar:  A New Gateway to the Simillimum in Psoric Diseases
Written by Frederic Schmitt

Dr. Frederic Schmitt presents another way to look at psoric diseases, that permits a deeper analysis of the patient, and a clearer path to the similllimum.

The chronic psoric diseases per Hahnemann

Homeopathy is based on the therapeutic application of the law of similar “similia similibus curentur”.

Samuel Hahnemann had two stages in his research about the application of this law. Firstly the similar was local for treating acute diseases and for palliation in incurable chronic diseases. Secondly the similar was global for treating chronic diseases.

At the beginning of his practice, the founder had brilliant successes for acute diseases, and in chronic diseases he got improvement, but it was of a short duration, and there were relapses with new and more severe symptoms. Seriously concerned by this observation, he made a twelve years strategic pause during which he looked deep inside the current medical literature and the anamnesis of his patients.

Why should this vital force which, aided by the Homoeopathic remedy is sufficient for the restoration of the integrity of the organism, and for the accomplishment of perfect recovery from the most virulent acute diseases, fail to afford any true or lasting benefit in the various chronic diseases, even though aided by the Homoeopathic remedies, best indicated by the existing symptoms. What prevents its action? In order to answer this most natural question, I was compelled to investigate the nature of these chronic diseases” (The life and letters of Dr. Samuel Hahnemann, John Bradford)

We are going to decipher his reasoning and the conclusion he gave brilliantly in his second major opus ‘the chronic diseases’ published for the first time in 1828. This publication would revolutionize the history of homeopathy. He predicted one year before the publication that the announcement of his new discoveries would produce the effect of a bomb among his disciples:  “They will then require more than half a year to recover from the fright and astonishment at the monstrous, unheard of thing, perhaps another half year before they believe it (Life and Letter of Hahnemann, John Bradford)”.

One of the more difficult points to understand in the work of Hahnemann, is the difference he made between chronic psoric and infectious diseases, and how this distinction allows one to manage complex cases where different miasma are intricate.

From the beginnings of “chronic diseases” Hahnemann endeavored to clarify the subject of his remarks: chronic non-venereal and, beyond, non-infectious diseases in the broad sense. Why this distinction, we will understand in the course of the analysis of this work.

Let us begin at the beginning.

It was a continually repeated fact that the non-venereal chronic diseases, after being time and again removed homeopathically by the remedies fully proved up to the present time, always returned in a more or less varied form and with new symptoms, or reappeared annually with an increase of complaints.” (chronic diseases, trad. Tafel, page 5).

Why, then, cannot this vital force, efficiently affected through Homoeopathic medicine, produce any true and lasting recovery in these chronic maladies even with the aid of the Homoeopathic remedies which best cover their present symptoms; while this same force which is created for the restoration of our organism is nevertheless so indefatigably and successfully active in completing the recovery even in severe acute diseases ? What is there to prevent this ? The answer to this question, which is so natural, inevitably led me to the discovery of the nature of these chronic diseases.”(chronic diseases, trad. Tafel, page 5).

This question therefore tapped the master for twelve years and in this research, he differentiated the diseases he called psoric from those he called venereal (in his time syphilis and sycosis), but we shall see that these are actually chronic infectious diseases, as at the end of his life he had added tuberculosis as a non-venereal infectious disease.

It is therefore necessary to understand this differentiation between psora on one side and chronic infectious miasma on the other.

We shall see that what Hahnemann calls psora is far from modern nosological scabies.

What we are going to talk about applies to non-infectious chronic diseases called “psoric”.

From these researches Hahnemann draws four conclusions.

First conclusion: a localized disease is only the manifestation of a global imbalance.

The Homoeopathic physician with such a chronic (non-venereal) case, yea in all cases of (non-venereal) chronic disease, has not only to combat the disease presented before his eyes, and must not view and treat it as if it were a well-defined disease, to be speedily and permanently destroyed and healed by ordinary homoeopathic remedies, but that he has always to encounter only some separate fragment of a more deep-seated original disease.” (chronic diseases, trad. Tafel, page 5)

A chronic disease affecting an organ should not be considered a localized disease, but rather a local manifestation of an overall disequilibrium of the body. The different symptoms or diseases reaching the same organism and seemingly separated, are in reality only the visible aspects of the same global imbalance. We could say that the deep evil Hahnemann speaks of is an iceberg, whose visible symptoms are several peaks that appear out of the water as separate. The ignorant believes that these symptoms or diseases are separate entities, whereas they are only the visible manifestations of this profound and global imbalance, and he will want to treat them separately. This is what Hahnemann was doing at the beginning of His career, but noticing the failure of this approach, he concluded that the trouble was deeper.
The myth of Hercules and the Lernaean hydra is a perfect example of this. The Lernaean hydra was a monster living in a swamp with a dragon body and nine heads, one of which was immortal. As for the other heads, whenever one of them was cut, two grew back. For the second of the Twelve Works, Eurystheus asked Heracles (Hercules) to kill the Hydra. It was only by cutting with a sword the immortal head that Hercules could come to the end of the monster, and burying it alive under a heavy rock, while it was still giving terrible whistles.

Heads that duplicate when they’re cut are the appearance of new symptoms when you “decapitate” a symptom without worrying about the monster itself.

Second conclusion: the only way to treat a chronic disease is to apply a global similar.

At present, no worthy homoeopath would consider treating a chronic disease solely on the basis of the local symptoms of the disease.

If we take the case of a patient with migraines, to look for a remedy based on a local similarity (the Hering cross: sensation / modalities / localization / concomitants) it will at best have only a transient palliative effect and at worst will cause a suppression of the symptom with displacement (homeopathic metastasis) in the opposite direction of the law of Hering and thus aggravation of the ground, for example disappearance of migraines and appearance of asthma or depression.

To treat a chronic case therefore requires to take into account the essence of the hydra and all its pathological manifestations including the physical and psychic aspect.

In his application of the law of similar, Hahnemann thus passes from a local aspect to a global aspect, from a similar of level 1 to a similar of level 2.


Third conclusion: the nature of the global imbalance is the psora.

“I called this disease psora so as to give it a general designation. I am convinced that it covers not only most of the many skin diseases but also almost most of all diseases with few exceptions, which can be considered as the products of the multiform psora ” (Life and Letters, Bradford).

To Hahnemann, the psora is a constitutional energy imbalance that represents the predisposition to all non-infectious chronic diseases.

Fourth conclusion: to treat the psora it must be done with anti-psoric remedies (constitutional similar).

If one understands psora as a constitutional energy imbalance, one must apply a global and constitutional similar, that is to say that the remedy must be not only similar to the symptoms of the patient but also to its constitution.

It is at this level that our research has made it possible to provide an invaluable aid in making it possible to classify the constitutions. It was therefore possible to classify the remedies and to apply with a precision of watchmaking the constitutional similarity. In other words, the psora is subdivided into different categories that can be called types, and to each type (or each constitution) corresponds to a certain number of remedies.

Psora : diagnosis and treatment

Hahnemann puts in his book “chronic diseases” Psora, sycosis and syphilis on a kind of equal level, and indeed it induces at least two types of confusion: first is that psora is an infectious disease, and the second is that only exist three “miasma” or chronic diathesis as the French homeopaths have names them.

Simply reading the founder’s books clarifies actually the two confusions.

On one hand we shall see, in Hahnemann’s work, psora does not equal scabies while syphilis is syphilis. What he calls Psora has nothing to do with the nosological scabies, unlike syphilis, the figwarts and tuberculosis that he defines nosologically perfectly. There can therefore be no confusion about that.

Furthermore, Hahnemann did not limit to three the number of chronic diseases, as at the end of his life he spoke of tuberculosis as another miasma (in “preface to the American translation of the Organon by Charles Hempel “). So there is no reason to idealize those famous three miasmas as a kind of homeopathic trinity that should not be touched.

On this basis it can be concluded that there are on one side, chronic diseases called psoric and we’ll see what they represent and on the other side, infectious chronic diseases, the number of which cannot of course be limited to the syphilis, genital figwarts or tuberculosis.

Having given the name of psora to the “nine-headed hydra”, we will analyze how Hahnemann describes and includes this entity since it appears that this is not what is medically meant by scabies.

Psora: nosology

We will try here to clarify the confusion that Hahnemann introduces in his writings about psora, calling it “infectious miasma” while the characteristics that he gives are anything except an infection.


Hahnemann distinguishes psora to which he attributes 7/8 of the chronic diseases of mankind, from syphilis and sycosis which share the eighth remaining  ( “chronic disease”).


For the founder, psora is essentially genetic and hereditary:

“The gradual transmission and incredible development of this ancient contagion, for hundreds of generations and through many millions of human organisms, explains to some extent the countless disease forms into which it has evolved throughout the entire human race, especially when we consider the great number of extrinsic factors, and the indescribable diversity of-distinct congenital human constitutions that have contributed to the formation of this great variety of chronic diseases (secondary symptoms of psora).“. Organon § 81

If psora was caused by a mysterious infectious agent transmitted from beginningless time hereditarily, it would be necessary that it became part of the human genome as a single causative agent of almost all chronic diseases of mankind, which seems difficult to accept in the current state of scientific knowledge and from a perspective of pure logic. Psora that Hahnemann described corresponds to another reality or another level of reality.


Regarding the clinical description of psora, when we read the chronic diseases we can decently wonder what is not a symptom of psora!

This observation taught me that not only most of the many cutaneous eruptions which Willau distinguishes with such extreme care from one another, and which have received separate names, but also almost all adventitious formations, from the common wart on the finger up to the largest sarcomatous tumor, from the malformations of the finger-nails up to the swellings of the bones and the curvature of the spine, and many other softenings and deformities of the bones, both at an early and at a more advanced age, are caused by the Psora. So, also, frequent epistaxis, the accumulation of blood in the veins of the rectum and the anus, discharges of blood from the same (blind or flowing piles), hemoptysis, hematemesis, hematuria, and deficient as well as too frequent menstrual discharges, night-sweats of several years duration, parchment-like dryness of the skin, diarrhea of many years standing, as well as permanent constipation and difficult evacuation of the bowels, long-continued erratic pains, convulsions occurring repeatedly for a number of years, chronic ulcers and inflammations, sarcomatous enlargements and tumors, emaciation, excessive sensitiveness as well as deficiencies in the senses of seeing, hearing, smelling, tasting and feeling; excessive as well as extinguished sexual desire; diseases of the mind and of the soul, from imbecility up to ecstacy, from melancholy up to raging insanity; swoons and vertigo; the so-called diseases of the heart; abdominal complaints and all that is comprehended under hysteria and hypochondria—in short, thousands of tedious ailments of humanity called by pathology’ with various names, are, with few exceptions, true descendants of this many-formed Psora alone”. (Chronic diseases, trad Tafel page  9)

Finally, while the founder describes syphilis exactly as we describe it today, and so when he speaks of syphilis it is quite the nosological infection which he speaks about, his description of the psora is sufficiently eloquent and convincing to affirm that it has nothing to do with the nosological scabies, but with something else.

So for Hahnemann, everything that is not syphilis or genital figwarts, and later tuberculosis (so anything that is not chronic infectious disease in the usual sense of the term) is psora.

Dynamic of evolution

Hahnemann particularly emphasizes the skin first stage of psora which, if suppressed, will lead to the development of all chronic non-infectious diseases. However as psora goes back to the dawn of time, the patient is seen mainly at an advanced stage called burst psora. The main characteristic of psora is firstly that it is not infectious, and secondly it has a natural tendency toward worsening, following a centripetal trajectory: from the outside to the inside, superficial to deep organs. The treatment of psoric diseases in allopathy or in level 1 homeopathy (based on local similarity) leads to suppression and to homoeopathic metastasis. Typically, a patient with eczema suppressed with cortisone or with palliative homeopathic treatments will develop asthma or migraine or mental disorders. The suppression causes an evolution toward deeper structures and a more severe pathology, that we call in homeopathic language “metastasis”.

Conversely, in a well led treatment of a chronic (non-infectious) disease, the eruption or the previously suppressed symptom should come back.

Hahnemann actually describes here one aspect of the Hering healing law: the treatment of a disease affecting a deep organ must, in order to heal, see a transfer of the pathological process onto more superficial levels such as a skin rash, a crisis of hemorrhoids or a diarrhea for example. The direction of symptoms follows a centrifugal reverse path from the inside outwards.

In conclusion:

Psora is the name Hahnemann gives to the broad field of chronic diseases that are not infectious. The natural course of the psora follows a centripetal direction and naturally worsens until death.

The logical analysis of Hahnemann’s text leads us to deduce that psora is the name he has given to the genetic or individual constitutional susceptibility to develop a chronic disease, which is also the definition of the constitution in the Eastern and/or Hippocratic traditional medicines .

In other words, psora is the name given to the innate constitutional imbalance, and as a shortcut, we could say that psora is the constitutional ground.

Based on this understanding (psora = constitution) we develop a new constitutional model allowing, as we shall see, to apply a very specific constitutional similar and facilitate the task of the homeopathic practitioner.

Psora and Constitution

The ground

The term ground comes from traditional medicines, eastern (Chinese, Indians) or western (Hippocratic). The ground is the genetic potential of an individual (genotype), determined at the time of conception. It is expressed on a physical, energetic and psychic levels. The ground’s psychic aspect is the temperament or character, the energetic aspect is the humor or pneuma, and the physical aspect the constitution.

Character, pneuma and constitution are the three inborn and genetic components of Human being.

The three ground’s levels
Mind Character or temperament
Energy Pneuma or humor
Body Constitution

The genetic potential (genotype) will be expressed differently (phenotype) according to the context and life story; this is what we call epigenetic. What we are today is the perfect mix between our genetic ground and our life story. I often explain to my patients that the ground is like the rice grain, and the life context like the kind of soil, the amount of sunshine, the watering. It’s the combination of a grain type with the context in which it develops who will determine the beauty and the strength, or resistance capacities to the sheaf diseases.

Ground and health

According to traditional medicines, the vital energy or pneuma is the basis of the body/mind balance. If the pneuma is balanced we are in good health, if it’s unbalanced, we begin being sick. As Greeks and oriental medicines, Hahnemann has a vitalistic conception of the human body.

“In the state of health the spirit-like vital force (dynamis) animating the material human organism reigns in supreme sovereignty. It maintaining the sensations and activities of all the parts of the living organism in a harmony that obliges wonderment. The reasoning spirit who inhabits the organism can thus freely use this healthy living instrument to reach the lofty goal of human existence.“Organon § 9

When man falls ill it is at first only this self-sustaining spirit-like vital force (vital principle) everywhere present in the organism which is untuned by the dynamic a influence of the hostile disease agent. It is only this vital force thus untuned which brings about in the organism the disagreeable sensations and abnormal functions that we call disease. Being invisible, and recognizable solely by its effects on the organism, it can express itself and reveal its
untunement only by pathological manifestations in feeling and function (the only aspects of the organism accessible to the senses of the observer and the physician), i.e., disease symptoms.”. Organon § 11.

Dynamis, is Hahnemann’s word for vital energy. It is the exact equivalent of Galien’s pneuma, of Chinese’s Qi and Indian’s Prana.

When the vital energy (pneuma) is well tuned, the human being is healthy, when it’s untuned, he gets sick.

Ground and disease

If for the founder psora is the deep cause of the non-infectious chronic diseases of human kind (cf “the chronic diseases”), and if disease is an unbalanced state of the vital energy (cf organon), we can conclude that psora is an innate and unbalanced state of the vital energy or pneuma. Most homeopaths agree with that.

According to traditional medicines, from the conception, Pneuma is subject to imbalance. This imbalance is what homeopaths call psora, the susceptibility to chronic diseases.

Psora is an inborn unbalanced state of the vital energy, representing the basis of the susceptibility to chronic diseases.

This definition of psora has at least two advantages. The first one is to perfectly tune to Hahnemann’s psora description given in the “chronic diseases” and to the definition of diseases given in “Organon”, and the second is to get psora out of a pseudo-infectious definition.

Ground types or psora types

Indian and Tibetan Ayurvedic medicines classify the grounds in three main types (the Doshas) :

Kapha (Phlegm), Pitta (Bile) et Vata (Wind) fit with the 3 galien’s pneuma aspects (nervous, vital and natural), and with the three Platonist sectors of the soul (respectively Logos, Thymos and Eros). For Platon, each part is ruled by a basic emotion: desire to Eros, anger to Thymos and Doubt to Logos. Ayurvedic medicines gives to each part an anatomic seat (that may vary with the authors).

The important thing to remember, is the existence of three « types » of psora characterized by somatic criteria for constitution, energy criteria for humor and psychological criteria for mind.

Considering that psora is the potential to disorder of Pneuma, it is possible to quantify this disorder by its three components: wind, bile and phlegm.

At the moment of conception, each individual is wired with a specific “energy code”, based on the three humors previously seen. Each humor could be expressed with a specific state of quality and quantity, with a dynamic interaction with the two others. In other words, we’ll be able to define, for each component, its imbalance in terms of quantity (plethora or deficiency) and quality (dyscrasia).

We can merely say that the three humors are like the three fundamentals colors, from which comes the wide spectrum of colors that nature offers.

Each individual comes at conception with a certain energy code based on Phlegm/Bile/Wind with some dominance of one of them.

Constitution with Wind dominant

The enneagram based integrative typology model we use, describes for each humor, three unbalanced types (two in quantity, excess or lack, and one in quality) giving three imbalances for each humor, leading to the nine enneagram types.

Conclusions :

Psora is an inborn unbalanced state of the vital energy (pneuma), representing the basis for further chronic diseases. Psora is characterized by three components Wind, Bile and Phlegm whose respective proportions determine the energy code or the basic ground of an individual.

Psora : the constitutional similar law


In traditional medicines, the knowledge of the constitution will allow one to individualize a suitable therapy whether nutritional, psychological, medicinal or energetic. This individualization is inherent to these medicines, and no traditional practitioner could consider to determine a therapy without examination and diagnosis of the constitution. Yet it’s more or less what we are doing in homeopathy. Homeopaths base their diagnosis on the similitude between the symptoms of the patient and that of the remedies according to a local or global level of similar, but the constitution is almost never involved. I say almost because some homeopaths (mainly in France) sometimes use classifications such as Leon Vannier or Henri Bernard (carbonic, phosphoric and fluoric).

But in general, in homeopathy, the constitutional diagnosis as a main work method is by no way developed with a reliable and reproducible methodology that allow us to work with all the remedies of the homeopathic materia medica. For a case of (constitutional) psora, the method proposed by Hahnemann is essentially based on a global similar (so-called level 2). However our materia medica has nearly 4000 remedies and to find the constitutional simillimum soon turns to be a very difficult task and is almost impossible. Because of that, the great homeopath, Pierre Schmidt liked to say that the majority of homeopaths work with maximum 100 remedies. In the same way, Alfonso Mazi said that only 5 % of patients have their true simillimum.

Contemporary homeopaths have begun to remedy this difficulty working on the structure of the materia medica. The first step was by giving criteria to differentiate patients constitutionally affected by the mineral , plant or animal Kingdom, and then giving specific features to the different taxonomic families. We will quote as an example the work of Jan Scholten on the periodic table of the elements or his new work on plant taxonomy. Rajan Sankaran has also his classification based on his own understanding of miasms.

It should yet be noted that there is a lot of confusion about what the word miasm means. Most contemporary homeopaths understand the word miasm in the sense of an existential issue. On the contrary, our very extensive practice of the tick-borne diseases, confirms the Hahnemannian understanding of the word miasm in its basic infectious sense (except for the psora). This, therefore, puts some confusion in the profession. What Sankaran means by his “miasms” corresponds to existential problems, which according to our understanding are more characterizations of the primary psora. For more detail on this interesting topic see our page on infectious miasms.

Our approach wants to bring a new model, to work reliably with the constitution in homeopathy. This is where we introduce a third level of similar, the constitutional similar. For the purposes of this new and deeper form of similar,  , how to classify remedies into these constitutions, and how to diagnose a constitution.

  1. To classify the constitutions, we have developed a new tool, the Systemic Typology Model,
  2. For the diagnosis of constitution, we have developed a method of constitutional diagnosis, adapted to our modern practice, the psychoenergy decoding which allows us to diagnose the constitution of the patient using two main tools, traditional energy diagnosis and psychological diagnosis aided by a validated questionnaire.
  3. To propose a scientific classification of homeopathic remedies in the different constitutions.

The constitutional similar

Constitutional similar applies only to constitutional or psoric diseases.

For that, we need to make a differential diagnosis, in order to exclude diseases that are not psoric:

  • Iatrogenic chronic diseases (Organon § 74)
  • Contextual chronic diseases caused by stress, climate, tobacco, alcoholism, drugs, diet, sedentary habits, heavy metals, pollution, etc… (Organon § 77)
  • Infectious chronic diseases such as syphilis, genital figwarts, tuberculosis, etc.

Here are two quotes from the Organon to demonstrate that for Hahnemann, psoric diseases and venereal diseases (that we need to understand to a larger extent as infectious) are actually to be distinguished.

In non-venereal chronic diseases, therefore those most usually arising from psora, one often needs to use several anti-psoric remedies in succession to bring about a cure, each to be chosen because it is homoeopathic to the group of symptoms remaining after the previous one has completed its action.“. § Organon 171

In chronic local diseases that are not obviously venereal, the anti-psoric internal cure is in any case primarily what is required.”. Organon § 195

Having excluded the circumstantial, iatrogenic and infectious chronic diseases, we face the vast field of chronic constitutional diseases, that Hahnemann called “psoric”.

If we can categorize a person by a constitutional energy code as we have seen, it is logically possible to categorize in the same way a natural substance. So, according to our observations, Sulfur presents an energy code dominated by Wind/Vata and more particularly an excess of Wind/Vata (type 7 in the enneagram). Another energy parameter has been added to the three humors described by Galen and the Ayurveda, the three mineral, plant and animal kingdoms.  So, like an abscissa and an ordinate, the energy code of an individual can be characterized by a dominant humor (Wind, Bile and Phlegm) and a dominant kingdom (mineral, plant, animal).

“Energy code” of Sulfur

In this diagram, you can observe the simplified “code” of Sulfur which is :

  • on the line of the ordinates (humor): wind
  • on the line of the abscissa (kingdom): mineral.

Thus, the constitutional energy code of Sulfur -Wind/Mineral- must fit, according to the constitutional similar law, to an individual that has the same energy code -Wind/Mineral.  Our observations conducted on thousands of clinical cases allows us to confirm our initial hypothesis: every patient can be characterized by a double entry: humor/kingdom, in the same way that each natural substance can.

So, for a homeopathic remedy to be able to unroot the primary psora and balance the vital energy (pneuma), the remedy (simillimum) must be similar in term of humor and of kingdom to those of the sick person. This is called the constitutional similar.

In other words, even if two remedies have similar symptoms (on a superficial level), deep symptoms need to fit with the energy of the constitution in order to be really effective and curative. Otherwise, it will be called a simile and will only make a palliation.

The new strategy for choosing the right remedy (the most similar remedy or simillimum) will be to first determine which kind of constitution the patient belongs to (his energy code), and then to look for the remedies that have the same energy code.

This allows us in a relatively easy way to work with a notably larger amount of remedies, of course, if one is able to master the knowledge of the constitutional diagnosis.

In another article, you will discover the Systemic Typology Model that is a new and integrative model that allows one to give to each remedy a very specific energy code. For more info:  www.simillimum.org

About the author

Frederic Schmitt

Frederic Schmitt is a medical doctor (1983), who has practiced Classical Homeopathy in France since 1986. Since 2000 he has developed a unified and systemic constitutional model based on the Enneagram, to apply a new level of similar, the constitutional similar. He has worked on tick-borne diseases (Lyme and co-infections) since 2009 with new and specific protocols that he discovered. Outside of homeopathy he practices Traditional Chinese medicine and kinesiology.


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