Homeopathy Papers Clinical Cases

Miasms and Facial Features

Grant Bentley and Louise Barton discuss the theory of Chronic Miasms in relation to Homeopathic Facial Analysis. They elaborate it with a clinical case example. The same remedy brought about relief after each visit to the doctor. The results of the study are expected to be dramatic as the treatment of chronic disease is unquestionable.

Hahnemann knew that treating chronic disease was quite different to treating acute disease. In chronic disease patients would often return in a worse state than previously. Hahnemann’s purpose for writing Chronic Diseases was based on a missing principle that did not exist when treating acute disease. He was able for instance, to treat nearly two hundred patients with typhus successfully, as well as treating numerous cases of scarlet fever and typhoid. Despite this Hahnemann failed to achieve the same success by applying the same laws of similia simillibus to chronic cases.

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 (1) – CHRONIC DISEASES

In the above statement Hahnemann questions why the simillimum fails to work in chronic disease when he has seen it work so well in acute.

Chronic Diseases was Hahnemann’s twelve year study into this missing principle. His conclusion was chronic disease has a miasmatic base that acute disease does not have. The following excerpt demonstrates this point.

…by the employment of medicines more suitable for this miasm, he is enabled to render more essential service and almost invariably to effect a perfect cure (2) – Samuel Hahnemann





It became obvious when treating chronic disease that the remedy selected must contain within its influence, more than the simillimum. It must also contain a resonance to the miasm that dominates the patient. In this way chronic remedies must be selected in accordance to both symptom totality and miasm. While some remedies contained the symptom totality, they did not resonate to the miasm, hence why Homœopathic literature is filled with the statement of “a well indicated remedy that fails to relieve”.

Hahnemann’s miasm theory was not approved of by all of his contemporaries. How could a miasm be determined? What were the signs? For instance consider the following quote by Boenninghausen

‘…we have not so far any certain signs by which we can distinguish certainly the domain of one miasma from that of the other.’(3) – C.M.F von Boenninghausen

Many Homœopathic authors have made reference of how miasms influence facial features. Consider the following statements by these well respected authors.

“In the tubercular patient…the face and head is often seen to be the shape of a pyramid” (4) – J.H.Allen

“How generally we see the landmarks of one of these chronic miasms stamped upon the organism. We see it in every feature and every physiological process; in the shape and contour of the body; upon the visual expression, the face, nose, lips, ears, mouth, upon the hair, its growth, lustre and general beauty or lack of it…’(5) – J.H.Allen

“The appearance of people suffering from the syphilitic stigma often tells the story at a glance, for we observe that the head is large and bulging, the hair is moist, gluey, greasy…” (6) – H Roberts

“These children presented a remarkably similar appearance, having blue sclerotics, a cafe au lait complexion and numerous moles” (7) – D Foubister

Outside of Homoeopathy conventional medicine was aware that the children of parents’, who suffered with diseases such as syphilis, often displayed particular facial features. Consider the following list of facial features attributed to syphilis

  • Cupped teeth
  • High arched palate
  • Depressed bridge of the nose or saddle
  • Domed forehead
  • Wide-set eyes (8)
  • Heredosyphilis – Stokes 1926


To demonstrate the effectiveness of using facial features with Homœopathy a case is presented in three parts over a three year period. This patient presented in 2003 with chronic headaches, 2004 with digestive disturbances and 2006 with anxiety. The same remedy brought about relief after each visit.

Homœopathic Facial Analysis (HFA) has been an ongoing and extensive research project of eight years duration. Its effectiveness in the treatment of chronic disease is unquestionable and as dramatic as the results Hahnemann expected.

The case study presented includes a step by step description of HFA in practice, combined with practical case taking in accordance with Hahnemannian principles.

Case by Louise Barton

Female 44

Presented in February 2003 with chronic headaches. She wakes with them and they last all day. She usually rises at 6am and they really set in by 9am. They are worse on her right side and are felt through the temple to the eye and right cheek area – they are also felt in her teeth. For the last fortnight they have been constant. Previously (when she was a manager) she would grind her teeth. She is a health consultant and work is not stressful and she is looking forward to resuming some tertiary studies in the next month to further advance her work. She is very tired and says it is an effort to get up – she feels that she has to crawl out of bed and drag herself around. She gets to bed by 9.30pm but is still awake at 11pm – often checking her emails which she says she can’t leave but must check. At night she snores and when doing exercise can be breathless – she is aware of her heart and wonders if there is an underlying problem. Walking up hills and stairs leaves her exhausted.

Two years ago she had a nervous breakdown at work and she couldn’t go back again but resigned instead. She had been planning a clinic set-up but felt that her manager was against her – in fact everyone was against her and that she was challenged on everything. It was like fighting a losing battle on her own and all efforts were like hitting her head against a brick wall. There was no point to her efforts and she felt an enormous lack of support. She is no good in groups and feels easily challenged, she can’t put her case forward especially to doctors and managers as she isn’t forceful enough. In 1991 when she was a manager she would wake up crying and couldn’t go to work. She felt a newcomer and that work was all about breaking down barriers – it was hard to be both a mate and a manager.

Two years ago after a holiday she didn’t want to go back to work. Everything was building up and she was crying a lot. It was much worse if she was spoken to and she felt she couldn’t cope and didn’t know where she was going. She didn’t want to share this with anyone and didn’t want to cry. Even now thoughts of this time will make her cry. If others cry or are in emotional pain she will cry easily. As a teenager she was volatile and angry and easily worked up – she also argued a lot.

After she left her work she had fear that working for an agency would mean less responsibility but this got better and she got more responsibility as time went on. She fears that others are on a pedestal and there is a gap of inequality between her and them. When she is nervous her neck will freeze and her mouth becomes tense. She particularly dislikes professional dinners and meeting unknown people especially doctors. Her lips will twitch, her neck will freeze and she feels jerky. Sometimes this is felt in the jaw. She dislikes speaking publicly and authority figures in general. In her health work she often feels undermined and enjoyed working with a group of women overseas. In Australia she feels there is no collaboration and teamwork is poor. She likes working as part of a team as each person has different abilities and each can help the others with new problems. She has no problem in asking for help. Conventional medicine she finds frustrating as it segments people into parts, she sees herself as an idealist. When problems arise she doesn’t ignore them but will harbour and fester on them if she can’t do anything about the problem. In particular she gets very angry when she sees specialists influencing patients to have operations. In her work she also sees mismanagement of medical problems and feels as if it is like hitting her head against a brick wall. She knows that others will lose confidence if they don’t know other therapies. Now she has the opportunity to use alternative treatments before conventional treatment is applied.

She is going to study psychology so she can become independent but feels panicked at the amount of work to be achieved. After she commences she knows she will feel better and will push through the work. When she is nervous she can’t study and puts things off – she likes to keep control. In her current work she feels protected and can treat her clients as she wishes as there is support and sharing. The team environment is great – very supportive.


Scalp – oily, hair – oily

Headache – throbbing (similar to crying sensation – fullness)

Wakes feeling puffy – 8-9am onset

Headaches are worse if not going to work or sleeping in – she is better up at 6am

Concentration poor

Right cheek – tightness between cheek, temple and eye with a pulling/pinching sensation, burning sensation

Nose – mucous drip with a hoarse voice and a lump in the throat – < if not drinking enough, < coffee

Nose – blocked almost always – << wine (snoring)

History of hay fever, eyes streaming, < flowers, itchy palate

History of cold sores – lips

Mouth dry – < with stress

Gums – sensitive

Breath – bad in the mornings – almost faecal – others notice

Voice – hoarse most of the time

Exhausted < heat, one time pain in chest

Reflux/heartburn, < coffee, < bread

Flatus < baked beans – much worse lately, < overeating

Appetite – can’t eat early

Loves Thai foods, coriander and salads, meat and vegetables

Not big on sweets, likes savory (nuts, cheese, smoked salmon) – likes delicacies

Loves spicy although chili = diarrhea and stomach pain

Apples = sore teeth, << wine and champagne (loves)

Loves coffee but 3 cups = nausea and shakes

Feels thirsty but doesn’t drink much (6 glasses per day) – urine can be dark

History of diarrhea+++ when traveling –also hemorrhoids

Menses – history of irregular, unable to have children, never wanted to be a career person, menses – pain 10-7 days before – burning explosion inside followed by painful bowel motion – < right side. Heavy period up to 7 days.

Moody – < week before menses – not depressed just flat

Back – occasional sciatica < right side

Knee – occasional sudden weakness < right side

Skin – acne before menses

Abdomen – moles

History of sarcoidosis in twenties, also chronic fatigue and join pains with swollen legs

Family history – artery disease and stroke


As a teenager she would tell off her mother and was naughty and got into trouble. Mostly she was happy but moved many times and found this stressful. In her twenties she suffered a major heartbreak when she lost her love. He was manipulative and cheated on her – she ended up not trusting him and she took years to get over him.

Environment – she hates winter and loves summer but is worse for heat. She also loathes wind and rain

Sleep – wants to sleep in the afternoon and is better at night in her energy. History of dreams of people over her bed – this happened last night – as if a shadow was over her.

Previous treatment – another Homœopath gave her Silica and Ignatia two years ago.


HFA is a complete system incorporating case taking according to both Hahnemann and Kent. It comprises accurate repertorisation and remedy selection based on the miasm.

The miasm of the patient is determined by examination of their facial features and the allocation of each feature into psora, sycosis and syphilis. The principle of the simillimum states that two similar diseases cannot exist in the same body at the same time, the stronger will dominate or if of equal strength will join together to form a complex disease (miasm).

  • HFA Principles
  • Facial features select the miasm
  • The remedy selected belongs to the same miasmatic group as the patient
  • Repertorisation based on 2-3 Mentals and 4-5 Generals


Choosing Rubrics

The second fundamental in Homœopathic prescribing is the totality of symptoms. The rubrics selected for repertorisation must be based on facts. The repertory is not the place for interpretation because it is a program – what comes out is only as good as the information that goes in. Every rubric selected must be obvious and there must be no doubt and no interpretation. When using HFA large rubrics are preferred so as to ensure the remedy is “caught in the net”

MIND; WEEPING, tearful mood; tendency (356) ***

The most dominant emotional state

MIND; DREAMS; business, of (67) **

She talks of business continually but this rubric only contains 10 remedies – this is too small and our remedy may not be included. Dreams of business is chosen as it has the energy of business and contains 67 remedies

MIND; DELUSIONS, imaginations; specters, ghosts, spirits, sees (80) *

It is always useful to choose an individual rubric where possible



GENERALITIES; FOOD and drinks; coffee; agg. (72)

GENERALITIES; FOOD and drinks; alcohol, alcoholic drinks; agg. (116)

GENERALITIES; PAIN; burning; internally (195)


The case had a number of general symptoms – these five rubrics were considered to be worthy of inclusion.


Circumstance legitimizes mental rubrics by providing an objective base. This means that interpretation is left to a minimum and all we need to do is find the best rubric to describe the recurring circumstances happening in the lives of our patients. For example in this women’s story work features prominently. Most of her stress and discussion is around work. Therefore Business as a rubric must feature in her case. The rubric doesn’t have to be literal. With this case the patient is talking of business, not dreaming of it. Energy recognizes the topic no matter what presentation so the largest rubric covering that topic will be acceptable. Alternatively all the Business rubrics can be grouped together as one rubric.


Generals play an important role in any repertorisation because they complete totality. They are the body’s expression of stress and when combined with the mental causes provide us with a complete picture.

From this repertorisation the following remedies appear.

In order – Nux, Puls, Ars, Sulph, Bell, Bry, Calc, Rhus T, Lyc, Merc, Sep

All of these remedies are polychrests but not all of them belong to the same miasm as the patient. The patient’s facial features will narrow down this list of remedies even further.

Facial Features

As Allen, Roberts and Foubister have described, specific facial features are formed by specific miasms. The HFA project has analysed and grouped over seventy different facial features. Each of these facial features has its corresponding miasm. By analyzing facial features we can tell the dominant miasm of the patient.

Remedy Selection

As stated in Chronic Diseases, Hahnemann believed the purpose of understanding the miasm is the ability for the practitioner to include it in the remedy selection, thereby having a remedy that caters for the simillimum as well as the underlying miasm. This is the conclusion to Hahnemann’s Chronic Diseases. The miasm of the remedy must be the same as the miasm of the patient.

Patient’s Facial Features

An analysis of this patient’s facial features into their miasmatic classification is as follows

Lips thin – Psora

Two lines between the eyes – Psora

Down turned eyes – Psora

Hairline – Sycosis

Bridge of nose – Sycosis

Hairline – Syphilis

Chin – Syphilis

Asymmetry – Syphilis

History of teeth – Syphilis

Eyes – size – Psora

Smile – compact – Psora

Facial lines – Psora

Nose – Psora

Forehead – Psora


When charted these features look as follows

Psora Sycosis Syphilis

Lines 1

Eyes 1

Eyes 2


Lines 2



8 features


Bridge of nose

2 features





4 features


Hahnemann states in the Organon that two dissimilar diseases cannot live in the same body at the same time, the stronger will repel the weaker. However if the two dissimilar diseases are of equal strength they will combine to form a complex disease.

Each miasm is a dissimilar disease. Psora is hypofunction and reactivity. Sycosis is hyperfunction and inflammation while Syphilis is dysfunction and submission. Viewed in this light, the Psoric miasm is dominant in this patient because her facial features show that the stronger dissimilar disease of Psora will overpower the weaker dissimilar diseases of Sycosis and Syphilis.

Choosing the Remedy

In this patient’s repertorisation there are four Psoric remedies. These are Bryonia, Sulphur, Pulsatilla and Lycopodium. The beauty of HFA lies in remedy selection. Taking Hahnemann’s directive, the remedy selected must belong to the same miasm as the patient. The patient’s facial features tell us the miasm, research tells us what remedy belongs to what miasm, and the two are brought together. This means in this particular case, despite the fact that there are eleven remedies covering every rubric in her repertorisation, only the four psoric remedies need to be considered. As her tendency to weep was so strong Pulsatilla was chosen

Remedy Choice

Pulsatilla 1M – single dose

Within a few days of the remedy the headaches were gone, her digestion settled, her sleep and energy improved as did her blocked nose.

She was happy with the result and wasn’t seen again until June 2004. This time her digestion was the major issue. She had been sick two months ago after eating curry and red wine which resulted in vomiting all night followed by a week of feeling sick. Ever since there is a knot in her stomach and some burning. She has wind+++ which is < coffee. There is anxiety too as exams are coming up and some headaches have returned. At night she is holding her breath. Her right shoulder is painful and she is dreaming guilt dreams related to her libido. A few weeks earlier she was having scary dreams, being chased, running, arriving late but they have stopped. Her home life is content, her husband is not an achiever, and she focuses on the money and on her garden. Sometimes she gets very angry and will yell at him but afterwards can’t concentrate especially if she needs to study. There are family issues with her husband and her parents and moving. She is weepy and reactive again and her skin is poor. She talks of her work how she believes her ideas are right, that she can put them forward strongly which results in good discussion. She can subdue her tendencies and is less offended if others don’t take her options. No longer nursing (described as dominating, not seeing the person as a whole and others as spiteful) she is a private health consultant and enjoys helping others.

Pulsatilla 1M – single dose

She rings to cancel her follow up appointment as she is feeling all back to normal and all the physical symptoms have gone including the anxiety.

1 August 2006

Her anxiety has returned and it feels like an internal vibration especially in the arms and upper body. She is back at university and these feelings are worse before a presentation – she feels as if she has drunk heaps of coffee. She is waking with headaches that don’t clear until midday and is weeping easily again and constantly thinking of sad things. Worries include her studies, the debt from studying and her job satisfaction. To be independent is her greatest aim. Her family doesn’t understand as she has enough money and loves her work but she worries about the future. She tells of her husband and how he may get cancer due to exposure to toxins years earlier – she weeps as she tells his story. She feels that she should give up study but worries about being the sole provider in the future – she wants security. Sleep is poor and her hip and shoulder ache. The head is heavy and tight across the temples and forehead and it feels full and woolly. If she moves around she feels better – the headache can last till mid morning. Many of her old symptoms have returned – breathless on ascending, pain in her shoulder, pain in her hip, flatulence and anxiety.

Remedy – Pulsatilla 1M single dose – as she has a history of not keeping her follow up appointments as she gets better so quickly, I insist she see me in a few weeks to check on the progress of the remedy.

21 August 2006

She feels a lot better emotionally – this took about five days and she has been fine since. She feels clearer and can plan things properly without expecting they will fall apart. All the headaches have gone and she is continuing with her study and both she and her husband are happy about it. His situation is still unclear but she feels more balanced about it. Her sleep is much improved and her snoring less. Both hip and shoulder pain are 50% improved and her knee is fine. Her period came and was shorter and less painful.


Using Hahnemann’s miasms as the primary foundation for HFA has been invaluable and success rates with patients have soared. It is important to understand that it is Hahnemann’s miasms not a modern interpretation that is being used. As discussed in the Organon (6th edition) there are three primary miasms that will combine when of equal strength. Using this as the basis the following diagrams represent the HFA method.






By following Hahnemann’s instructions on how to combine symptom totality and miasmatic selection, modern Homeopathy is capable of accomplishing all that Hahnemann dreamed possible regarding chronic disease. The benefits for the contemporary practitioner include

Quicker results

Accurate results

Deep acting responses

Self confidence that comes from objective analysis


Too often in Homœopathic constitutional prescribing, practitioners have faced the dilemma of trying to discern one remedy from another. Attempts at overcoming this hurdle have focused primarily on continuing education regarding the nature of our remedies. However, with HFA, trying to spot the increasingly subtle difference between remedies is no longer necessary as we have nature as our guide. The concept of holism means the microcosm reflects the macrocosm. Hahnemann always stated that Homœopaths should be observers of God at work through nature. This is how he discovered the simillimum and the infinitesimal dose. In the same way, HFA follows natures lead and observes facial features as a guide to the underlying dominant miasm. HFA takes the guess work out of miasmatic selection and gives the practitioner an objective base from which they can feel confident.

BOOKS ON HFA – available from www.vcch.org


Extending on Hahnemann’s original idea of three primary miasms, Appearance and Circumstance details the development of the complex miasms – Tubercular, Syco-Psora, Syco-Syphilis and Cancer, as well as the three primary miasms.

Understanding that miasms are genetically inherited influences, the author discusses how each miasm will dominate physical structure, pathology and mental outlook. Recognizing the lifetime influence of a miasm helps to explain the events and circumstances that surround us.

Every individual is dominated by one of these miasms and facial features have been identified and matched to each group to be used as clinical aids. Themes together with facial features enable a practitioner to recognize the dominant miasm of the patient


Hundreds of photos and sketches with detailed visual parameters to aid in the miasmatic analysis of faces. This book is the complete guide to facial analysis and combined with Appearance and Circumstance will allow homoeopaths from students to practitioners to make an accurate miasmatic diagnosis before a remedy is chosen.


1. Hahnemann Samuel, Chronic Disease:Their Peculiar Nature and Their Homœopathic Cure, B Jain Publishers, New Delhi, India
2. Hahnemann Samuel, Chronic Disease:Their Peculiar Nature and Their Homœopathic Cure, B Jain Publishers, New Delhi, India
3. Boenninghausen CMV, The Lesser Writings, B Jain Publisher, New Delhi, India, 1994
4. Allen, JH, The Chronic Miasms Vol. 1 – Psora and Pseudo-Psora, Author 1910, reprint B Jain Publishers, New Delhi, India
5. Allen, JH, The Chronic Miasms Vol. 1 – Psora and Pseudo-Psora, Author 1910, reprint B Jain Publishers, New Delhi, India
6. Roberts H, The Principles and Art of Cure by Homœopathy, Health Science Press, Whitstable, Kent, 1942
7. Foubister, Donald, The Carcinosin Drug Picture, MacRepertory Reference Works
8. Stokes, John H, Modern Clinical Syphilology: Diagnosis, Treatment, Case Studies, WB Saunders, Philadelphia 1926


Grant Bentley – ND Dip Hom Grad Dip Psych Th Prof Memb AHA AROH reg ATMS ANPA

Victorian College of Classical Homœopathy
3A/574 Whitehorse Road
Mitcham, Victoria, Australia 3132
Website www.vcch.org
Phone 61 (3) 9873 0567
Email [email protected]
Fax 61 (3) 9787 5145

About the author

Grant Bentley

Grant Bentley - Grant"™s qualifications include Homeopathy, Naturopathy, Clinical Hypnosis and a Post Graduate Diploma in Eriksonian Psychotherapy. Grant is the current Principal and senior lecturer of the Victorian College of Classical Homeopathy, a position he has held since 1995.

His book, Appearance and Circumstance (2003) details the nature of miasms and how facial analysis can be used to determine the patient"™s dominant miasm. Homeopathic Facial Analysis (2006) gives detailed descriptions and examples of facial analysis. Soul & Survival (2008) defines how miasms influence us in our daily lives and define our individuality.

About the author

Louise Barton

Dip Hom Prof Memb AHA AROH regd

Louise Barton has been in clinical practice since graduating in 1996. She was involved in the Australian Homoeopathic Association (Vic) from 2001, both organising seminars and as President from 2002 - 2004. She teaches at the Victorian College of Classical Homeopathy and has been involved with miasmatic research and the production of her partner Grant Bentley's book Appearance and Circumstance and Homeopathic Facial Analysis.

Leave a Comment