Homeopathy Papers

Francisco X. Eizayaga and the Layer Approach to Homeopathy

Eizayaga identified four normal genetic constitutions: Sulphur, Calcarea carbonica, Calcarea phosphorica, and Calcarea fluorica.

The phenotypical constitutional diagnosis relates to the fundamental disease.

Miasmatic layer

Miasms constitute the morbid terrain and determine the diathetic pathological trends of all individuals. “All human constitutions have a morbid predisposition implicit in them or, in other words, they are inclined to certain illnesses, depending to a great extent on their diathesis or active miasm.”[3]

Morbid tendencies develop slowly and according to a chronology which practically repeats itself in the majority of cases. Francisco Eizayaga identified five miasms: Psora, Sycosis, Syphilis, Tubercular and the Cancer Miasm.

When writing on What must be cured in diseases Eizayaga clearly suggests that  miasmatic treatment requires prescribing the diathetic or miasmatic nosode or nosodes to eliminate the individual’s morbid trend. Nosodes must be customarily administered in high potencies.

In another chapter of his book Eizayaga does not limit miasmatic treatment to the application of nosodes, but points out the anti-miasmatic properties of other remedies and their indications: The morbid process which arises due to the active miasm may prevent the indicated remedy from acting efficaciously, and requires application of the remedy or the nosode that corresponds to this miasm. Each miasm has its typical remedies like Sulphur and Psorinum for Psora, Thuja, Medorrhinum and Nitricum acidum for Sycosis, and Mercurius, Aurum and Syphilinum for Syphilis [4]. Regarding miasmatic treatment he states:

Ever since homeopathy has existed, right from Hahnemann up to today including the most traditional authors like Kent, miasmatic treatment has been achieved by employing the Law of Similitude through the Materia Medica and the repertory.”[5]

He also admits that acute exacerbations of the chronic miasm are effectively prevented with constitutional and fundamental treatment.

Fundamental layer

The phenotypical constitutional diagnosis relates to the fundamental disease and emerges from the pathological sufferings. It comprises the psychophysical constitution and is not measured by the patient’s skeleton, nor by the circulating humors or the predominant metabolic type. It is “measured by the dynamic dysequilibrium of a subject expressed in psychical, general and local symptoms liberated by traumatic circumstances in a predisposed, susceptible person“.[6] This constitutes the fundamental disease.

The functional disturbances occurring within this fundamental layer, may manifest on the psychic and sensitive, general or local organic level. As there is no cell destruction, but only a temporary transformation of cell structure, the pathological stages are limited to irritation, inflammation and dysfunction, with the possibility of “restitutio ad integrum”.

The psychosomatic symptoms are considered to be the symptoms of the patient and precede the symptoms of the disease itself. “They are revealing a pathological alteration of the phenotypical constitution which must be treated with the so-called fundamental remedy or simillimum with which we shall not only cause the disturbed individual to recover but also we will prevent the future evolution and organic localization of the progressing disease“.[7]

The prescription of the fundamental remedy, which is called the simillimum, is based on the patient’s characteristic, psychic modalities, general and local symptoms. “In chronic patients, not only symptoms of the current illness should be taken into account, but rather, and most principally, the chronic and pathobiographic symptoms of the patient, in order to find the profound temperamental and constitutional motivations that have lead to his present state.“[8] “The top hierarchical symptoms to base the prescription on are always those extracted from the pathobiographical history, i.e., the phenotypical constitutional symptoms, those which express the individual psychophysical temperament of the patient when faced with his personal, familial and social reality.”[9]

In functional disturbances as occurring within the fundamental layer, medium, high or very high potencies can be prescribed.

Lesional layer

Within this stage the patient develops lesional pathology due to structural and microchemical changes in the cell. The localization of the pathological process provides us with local symptoms, i.e. particular symptoms localized in organs or systems, which are common or pathognomonic. The case is curable if superficial organs are affected, even if some superficial lesion may persist. The affection of a vital organ transforms the disease into an incurable case.

Lesional diseases are classified as:

  1. 1. Lesional reversible diseases
  2. 2. Lesional irreversible diseases
    1. In lesional reversible diseases the structural alterations that occur on account of functional or organic disturbances, can be cured with “restitutio ad integrum” and complete functional recovery. They are localized when comprising a localized area, or diffuse, when comprising a whole organ or system. They may manifest as lesional reversible mental, general or local disease.


  1. In lesional irreversible diseases, cellular changes cannot be restored ad integrum, because cells have reached a no-return point in the pathological process. One can distinguish between focal and diffuse irreversible lesions. They are localized or focal when comprising a localized area, or diffuse, when comprising a whole organ or system.

Francisco Eizayaga differentiates irreversible diseases according to their curability and gives the following explanation: “Focal irreversible lesions may be cured clinically by means of scarring, but they cannot be cured histologically because there is no “restitutio ad integrum”. Irreversible diffuse lesions, instead, comprise the whole organ and are really incurable, as the scarring of the whole lesion would mean the total annulment of the organ and, therefore, of its function“.[10]

That is, lesional diseases can be grouped according to their curability into:

a)     Reversible and curable diseases.

b)     Irreversible but semi-curable diseases. This occurs in focal lesions that cannot be cured histologically but only clinically, always provided function can be restored or compensated.

c)      Irreversible and really incurable diseases. If the irreversible lesion comprises a whole vital organ only palliation will be possible. If however it comprises a non-vital organ, it will be without general repercussion.

In all these cases homeopathy offers an excellent option for treatment.

Local lesions are chronologically the last to appear and are called the “actual disease” of the individual. “The morbid localizations indicate “the illness the patient has” “, and from thence the treatment must begin.[11] In lesional diseases in which there is a clinical entity, treatment must be directed first at this organic aspect of the disease, “because it is the most serious and the one which must be aided by us first. The prescription must be based on modalized local symptoms, placing the strictly pathological or organic symptoms in a pre-eminent position “.[12]

“It is true that when a clinical disease level and a constitutional or miasmatic fundamental condition coexist, in said case the disease must be treated first and then the patient.”

F.Eizayaga, Treatise on Homoeopathic Medicine, p.292


To choose the remedy only the actual symptoms with their characteristic modalities have to be considered, leading to the prescription of the “similar” remedy. That is, the remedy must cover the pathological symptomatology, yet it must be individualized and modalities considered. Eizayaga emphasized that the common symptoms do not interest us as such, but that the modified symptoms with concomitants and alternating and subjective symptoms, and the rare or peculiar, characteristic symptoms are important for the homeopath. Only these give the strictly individual symptoms. He advised us to make use of all symptoms of the local disease including its modalities and concomitants, and those psychiatric symptoms that “appeared or were exacerbated right from the beginning of the disease and that are not chronic symptoms of the patient which preceded this disease“.[13]

Eizayaga also suggests investigating the fundamental remedy: “The chronic patient, who is to be found in the background of the “actual illness“, presents mental and general symptoms with their corresponding modalities of aggravation and amelioration and his desires and aversions for food. In these symptoms may be found the image of a “patient who suffers the illness“, reinforced and completed by the image that the personal history gives.”[14]

The therapeutic ideal is when the fundamental remedy (simillimum) also covers the symptoms of the clinical entity, i.e. agrees with the lesional remedy (similar), as this gives more certainty regarding success. In this case the simillimum is to be prescribed.

Eizayaga’s comments on how to proceed when the lesional and fundamental remedy do not agree, are somewhat contradictory.

He advises, that in “cases in which there is a clinical entity… what must draw our attention first is this organic aspect of the disease, because it is the most serious and the one which must be aided by us first.” [15] The prescribed remedy has to cover the active pathology by all means. Therefore, he concludes that when the investigation of the fundamental remedy reveals it does not agree with the lesional remedy, treatment should be started with the lesional remedy. Referring to the seriousness of pathology, he advises that the similar remedy for the disease should be prescribed in severe and organic cases, if this differs from the patient’s simillimum. He also advises, that in incurable cases it is “not adequate to use the simillimum remedy, but the one which covers the present sufferings“.[16]

However, in another chapter of his book he writes that the patient’s individuality will always be present and that no strict rule can be given as to whether the lesional remedy is to be taken before the fundamental remedy, simultaneously with it or after it. Each case is to be solve individually.

About the author

Katja Schuett

Katja Schuett

Katja Schutt, Msc, HP, DHM, PGHom, DVetHom, has studied homeopathy with several schools, amongst which David Little’s advanced course stands out as it offers a really deep insight into homeopathic philosophy and materia medica (simillimum.com). Her current focus lies in working with animals and studying history, the old masters, and research.


  • You wrote :
    Although Hahnemann mentions the importance of the constitution, it was only later homeopaths who developed the concept of constitutional prescribing. Based on observation, Hahnemann mentioned in the Materia Medica Pura that Pulsatilla and Nux vomica are most likely to benefit in persons with certain constitutional and temperamental features. However, he did not define constitutional features as a prescribing rule for curative treatment, these are definitely the totality of signs and symptoms.

    This is factually not correct. Hahnemann very clearly mentioned that the mental disposition of the patient must be considered without which no cure can be expected vide aph#213 and its footnote. The totality of signs and symptoms makes a useless and meaningless exercise if it does not include the mental and emotional changes in ALL cases of disease, including acutes. vide aph #213

  • Dear V T Yekkirala,
    thanks for your comments. I would like to mention that prescribing on mentals, or including them, is not the same as “constitutional prescribing”. Of course, the (morbid) state of mind is most important and often reveals § 153 symptoms, thus contributing to the total symptom picture which is used for homeopathic precribing. (Amongst others) These symptoms have been derived from provings which constitute the most reliable source for knowing a-priori which remedy is going to cure – provided it covers the totality of characteristic symptoms of the patient. Constitutional features (as it is refered to usually), however, refer to features which do not change during lifetime and which have been worked out from clinical experience, i.e. these are features which have been observed in patients in which certain remedies have been seen to work the best, like the blond-haired Pulsatilla subject. Blond hair or a dark complexion, however, neither constitute morbid symptoms nor can they been brought out in provings, hence they were never adivsed by Hahnemann for prescribing. As written, the concstitutional approach with constitutional drug “pictures” have only been elaborated by later homeopath like Kent, Tyler, Blackie. BUT, they all emphasized that it is finally the symptom picture that decides for the remedy. In practice, much controversies arise from the fact that the obviously identified constitutional drug picture of the patient does not seem to be identical with the remedy that seemingly covers his totality of symptoms. Practitioners use to solve this problem by using appropriate potencies, ie. higher potencies for identified constitutions, and lower/medium potencies if the symptom picture predominates and does not agree with the basic constitution of the patient, what lead to the development of the layer approach in prescribing (which should finally arrive at the basic constitution). As outlined in the article, there are different concepts of constitutional prescribing which finally determine the different procedures of homeopathic practitioners. But, no matter which definition you prefer, Hahnemann clearly outlined in § 169 Organon how to proceed if two similes are seen in the patient’s case. If confronted with the dilemma of perceiving two different remedies, he advised us to select the remedy which is more homeopathic to the case… for which the totality of the strange, rare, uncommon and characteristic symptoms are crucial, and which, of course, includes mental symptoms as the state of mind is always altered in a disease subject, and as the mentals often held the key for prescribing homeopathically.

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