Hahnemann, in Aph. 72, begins to elaborate on the first requirement of Aphorism 71, the knowledge of disease.
With respect to the first point, the following will serve as a general preliminary view. The disease to which man is liable are either rapid morbid processes of the abnormally deranged vital force, which have a tendency to finish their course more or less quickly, but always in a moderate time – these are termed acute diseases….
He first explains ACUTE disease, which is further elaborated in the Chronic Diseases. The characteristics of acute disease are:
1. Rapid processes
2. Tendency to finish their course more or less quickly
3. Always in a moderate time
Further expanded in Chronic Diseases [p. 32-35]
“For all these acute miasmatic diseases the human constitution possesses that process which, as a rule, is so beneficent: to wipe them out (i.e., the specific fever together with the specific eruption) in the course of from two to three weeks, and of itself to extinguish than again, through a kind of decision (crisis), from the organism, so that man then is wont to be entirely healed of them and, indeed, in a short time, unless he be killed by them.*”
Footnote: Or have these various, acute, half-spiritual miasmas the peculiar characteristic that – after, they have penetrated the vital force in the first moment of the contagion (and each one in its own way has produced disease) and them, like parasites, have quickly grown up within it and have usually developed themselves by their peculiar fever, after producing their fruit (the mature cutaneous eruption which is again capable of producing its miasma) – they again die out and leave the living organism again free to recover?
Learning to distinguish acute disease from the acute exacerbation of chronic disease [explosions of latent psora; Aph 73]  is initially based on perceiving the acute MIASMA that produces the typical symtpom picture. Recognize the diagnosis of medical disease from the standpoint of modern medicine eg: Typhoid, viral infection, measles, etc. Why is this important? It may be the basis for remedy choice. We can predict the progress of disease and would be alert about deterioration of the clinical state which would need an immediate review of the picture and change of remedy [Aph. 167 ]. The next important decision here is – do we prescribe an acute remedy for an apparent acute picture or do we prescribe the chronic/constitutional remedy based on the complete history of the person?
In acute disease, more often than not, an acute (specific) remedy for the acute totality is going to be needed. Clinically these are epidemic diseases [Aph.100-102 ] or diseases like measles, whooping cough, etc that occur once in a lifetime [fixed miasm; Aph 73 ], where the acute totality of symptoms is obvious. But even here when the constitutional characteristics of the person override the acute disease picture, i.e. the host response is stronger than the infecting miasma, that a constitutional remedy or chronic remedy will work better than the acute remedy.
In acute exacerbation of chronic disease, one may be deceived into thinking it is an acute disease. Often there are no clear symptoms pointing to an acute remedy. An acute (superficial) remedy prescribed in such a situation either palliates or suppresses the symptoms, while one may observe the underlying chronic process continue to deteriorate. This is a hard situation to understand clinically and requires the eye of experience. So more often than not a young homeopath with prescribe an acute remedy, suppress the problem with apparent ‘cure’. But the disease rears its ugly head again in a little while – same as before, worse or in a deeper disturbance.
What is the best/ideal thing to do? Always have the chronic remedy well sorted out before such a stage arises. Take a complete chronic history and work out possible chronic remedies. Give the best remedy indicated by the predominant picture.
In very early stages of an acute disease, it helps to prescribe the chronic remedy. The host factor and hence constitutional characteristics are more prominent at this stage. One can even confirm a good constitutional remedy choice. The chronic remedy works as prophylactic. If the response to the chronic remedy is not adequate, an acute remedy is needed. The vital force under the influence of the prescribed constitutional remedy then throws up acute characteristics “asking” for that acutely indicated remedy [Aph. 182 ].
In contrast, ‘trying this or that’ remedy when unsure of the disease picture or consitutional remedy can distort the characteristic picture. It becomes harder to find a good acute remedy. We now have a case of confused vital force and confused homeopath! Most of us have been here, if we’re honest with ourselves. One may need to work through 2-3 remedies in sequence during the acute, to first overcome the distortion in the totality of extra symptoms, before the disease is cured with the indicated acute simillimum.
Did anyone say homeopathic management was a song? Seasoned homeopathic practice is not easy, one respectfully understands this. Thankfully, most of our master homeopaths over a hundred years ago, starting with Hahnemann himself, charted the waters with some clear, reliable guidelines in place. Our task is to learn them sincerely and master them over time.
Aphorism 72 (contd)
– or they are diseases of such a character that, with small, often imperceptible beginnings, dynamically derange the living organism, each in its own peculiar manner, and cause it gradually to deviate from the healthy condition, in such a way that the automatic life energy, called vital force, whose office is to preserve the health, only opposes to them at the commencement
The next category of disease expression is chronic disease, which begins insidiously. These seem like very minor complaints – an itch here, a venereal infection at some point in the past, a viral infection like HIV, EBV, etc.
Chronic Diseases p. 35 states:
In the chronic miasmatic diseases nature observes the same course with respect to the mode of contagion and the antecedent formation of the internal disease, before the external declarative symptoms of its internal completion manifests itself on the surface of the body; but then that great remarkable difference from the acute diseases shows itself, that in the chronic miasmata the entire internal disease, as we have mentioned before, remains in the organism during the whole life, yea, it increases with every year, if it is not exterminated and thoroughly cured by art.
These diseases have almost “imperceptible beginnings”. The vital force is aware of them and begins to fight them sub-clinically. We are not aware they exist. But they deviate the vital force during this fight. The external expression may be some innocuous skin expression that is easily suppressed by local application by the person or the physician, both of whom are deceived by the apparent mildness of the complaint and are thrilled that it has disappeared. Little do they realise they have partnered with that MIASMA to deviate the vital force further and deeper into disease [Aph. 202 ].
Aphorism 72 (contd)
and during their progress imperfect, unsuitable, useless resistance, but is unable of itself to extinguish them, but must helplessly suffer (them to spread and) itself to be ever more and more abnormally deranged, until at length the organism is destroyed; these are termed chronic diseases.
Hahnemann’s aphorism begins to sound like an action thriller here “The Final Destruction“! But the drama is not exaggerated. We need to seriously consider how miasmatic destruction takes place. It starts insidiously, is ignored or suppressed, until it is too late. It is now well grafted into one’s system. Then all that is left is trying to salvage some life span, pill popping!
JH Allen was the first to expound this progress of disease in detail from the miasmatic perspective in his book The Chronic Miasms. He was supported by HC Allen, JT Kent, Muzumdar, CM Boger and a host of masters who took homeopathic prescribing and healing to soaring heights that we are still trying to achieve 100 years later.
Contemporary homeopaths using these methods are few and far between. Some well known ones in India are the Dhawle’s ICR, Mumbai; Dr. Praful Barvalia, Mumbai; David Little www.simillimum.com  , Dr. Subrata Banerjea, Calcutta; to name a few. It is heartening to see many more take an interest and follow this route in clinical management.
Tackling Chronic Disease requires tackling the chronic miasm/s. The chronic miasm/s is made up of two parts:
1. Fundamental Miasm: Inherited miasmatic tendencies, diathesis, genetic weaknesses from one’s parents.
Clinically this may be seen as a tendency to juvenile diabetes or early onset of cancer, or genetic deficiencies and abnormalities, easy tendency to asthma, etc.
2. Acquired Miasms: This, one acquires during one’s lifetime starting from the In-Utero period through childhood to adult life. The acquired chronic miasmas develop on the soil bed of the fundamental miasm, which cause an individual to be more easily susceptible to the acquired ones.
Clinically this is seen when someone develops clinical tuberculosis, affecting a large area of the lung at an early age, while others may only develop the primary complex. Why? Because the inherited a fundamental miasm of psora + syphilis (tubercular) makes him easily susceptible and genetically weakened to invasion by Mycobaterium Tuberculae.
Or someone develops advanced symptomatic HIV infection and in a couple years is on his death bed, while others remain only carriers for 10-15 years. Why? Because the inherited miasamtic diathesis (weakness) did got give his vital force any chance to fight for survival, already being in an advanced state of miasmatic progression (syphilitic) from prior illness; a fertile soil indeed, to plant incurable disease.
Aphorism 72 (contd)
They are caused by infection with a chronic miasm.
It is obvious here, that Hahnemann intended the word Miasm to mean a disease producing agent from the OUTSIDE. The difference in his approach with respect to modern medicine is that this disease producing agent (bacteria, virus, fungi, environmental toxins, etc) has a physiological effect as well as a dynamic effect. Therapy aimed only at the physiological effect is inadequate, partial and hence suppressive in the long-term.
The other difference with modern medicine is that we acknowledge inherited miasmatic diathesis in addition, perceived in the family history of that person. This fundamental miasm [Aph 5 ] combined with the miasma acquired in the individual’s lifetime, found in the person’s past history, is an important aspect to be considered in case management, without the study of which, homeopathic treatment remains incomplete [Aph. 206 ].
Miasmatic expression (psora, sycosis, syphilis, tubercular) in chronic disease is both mental and physical. It is observed in signs and symptoms and is an expression of the vital force deviated as explained above. This is set right with suitable chronic remedies that cover the miasmatic expression and/or constitutional characteristics [Footnote 168, to Aph 287 ].
1. Hahnemann, Samuel; Organon of Medicine
2. Hahnemann Samuel; Theory of Chronic Diseases
3. Allen, JH; The Chronic Miasms
4. Allen T.F; Boenninghausan’s Therpeutic Pocket Book
5. Boger, CM; A Synoptic Key of the Materia Medica
6. 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
12. Banerjea, SK: Miasmatic Diagnosis