Clinical Cases Homeopathy Papers Organon & Philosophy

The Art of Miasmatic Case Analysis in a Chronic Case

Written by M.S.Jus

Dr. Mohinder Singh Jus uses a complex case to illustrate how miasms are addressed and treated over a period of time.

The colours indicate to which miasm the respective symptoms belong:






Presenting complaints on 26 January 1999

Mrs. M. is a 50 year old housewife. She is 160 cm tall and weighs 70 kg. She is coming to the surgery, because for the past 6 months she has been suffering from very strong and long lasting menstruation. The gynecologist advised a hysterectomy which the patient refused. She is now looking for an alternative.


Medical History of the Patient

  • Tendency to anaemia as a child
  • Severe atopic eczema as an infant treated “successfully” with ointments. Tendency to worm disease.
  • Hay fever since going to school. Desensitization at 20 years of age.
  • From 20 years of age until the birth of her son: tendency to diarrhoea, < when under stress.
  • She has a history of vaginal thrush with yellow-greenish discharge that smelled unpleasantly of old cheese.
  • Hyperthyroidism 8 years back.
  • Endometriosis. 6 miscarriages.

She was the second of three children and grew up on a farm. The father was strict; he beat the children and the mother when he was drunk. She perceived her mother as kind, but weak and helpless.

  • She has been happily married for 25 years; they have one 15 year old son.
  • When asked, why she only had one son, she replied with tears in her eyes that she would have liked to have at least four children. It did not work out though.
  • She has had 6 miscarriages in her 6th to 12th week of pregnancy (all before her son was born).
  • She was dainty as a young woman and having suffered from anemia since childhood, she thought that was the reason for the miscarriages.
  • Then the doctor said her uterus was too small, her pelvis being too small anyway.
  • Three years later another doctor diagnosed her with endometriosis. She was treated, operated on, but she still did not become pregnant. She had another miscarriage.
  • Finally, when nobody thought it would happen, she got pregnant again and had a son.
  • The baby was healthy, apart from a missing toe of the left foot and a naevus on the neck.


Medical History of the Family

Diabetes mellitus, severe rheumatoid arthritis, osteoarthritis, hypertension, hay fever, severe osteoporosis, asthma, severe myopia, retinal degeneration, fibroid, atopic eczema, psoriasis.



  • She used to be an active, adventurous woman. To the regret of her husband she organized excursions for the weekend, otherwise she was bored.
  • 8 years back she was diagnosed with hyperthyroidism which was treated. Since then she became a lot calmer, almost too calm. She also gained a lot of weight.
  • She is tired easily and has to rest frequently.
  • Her short term memory is bad and she has to write down everything.
  • She enjoys company, but only people who she likes and trusts.
  • With strangers she is reluctant for a start and needs time to open up. It did not use to be the case before, but she had bad experiences and became mistrustful.
  • She prefers relationships which are not too close and needs her space.



  • She is very afraid of cancer, brain hemorrhages and Alzheimer’s disease.
  • Other fears: dogs, thunderstorms, about her son.
  • She would never give a lecture. As a child she suffered from terrible exam nerves.
  • In the house she only does the absolute necessary; she much prefers to work in the garden.
  • She hold grudges and never forgets when someone has hurt her. For that she has a good memory.
  • She likes traveling, preferably to the mountains. She also sleeps best in the mountains.


Food / Drink

  • She likes spicy food, salads and cheese.
  • She prefers cold food.
  • She likes alcohol and enjoys a glass of wine, but only on the weekends.



  • She had her first menstruation when she was 10 years old.
  • The menses has been strong from the beginning. For the past 6 months it has been so bad, that she does not dare leave the house.
  • The cycle is 20-22 days.
  • Before the menses lasted 5 days, meanwhile 8-10 days.
  • She mentions that she often has a sore throat before the menses.


Temperature / Weather

  • She does not tolerate the sun (she gets a headache then)



  • She sleeps mostly on her right side with the window open and her feet uncovered.



The patient gets Medorrhinum XM, 2 doses in a 15 min interval.


2. Consultation on 26 April 1999

  • 3 weeks after taking the homoeopathic remedy she develops a green, bloody putrid smelling vaginal discharge (= old symptom), which has been lasting and is very much annoying.
  • She has more energy and stamina.
  • Overall she feels good and has become more adventurous.
  • She is much more irritated and explosive; but that is bothering her.
  • She is thinking a lot about her childhood and the past.
  • The menses is the same, but lasts less long.
  • Since the remedy she has not had a sore throat before the menses.
  • Her sleep has improved.
  • She got a wart on her left foot and swears that she has never had a wart in her life.



No remedy.


3. Consultation on 15 August 1999

  • The fears of diseases have mostly disappeared. The memory clearly improved.
  • During the first consultation she emphasized how happy her marriage was. Now she complains about her husband “He is so quiet and does not show his emotions”
  • Extremely dry skin, fissures in the corners of the mouth.
  • Menstruation: same strength and duration as of 2nd consult, but acrid, with fissures of the labia.
  • The odour of the menstrual blood is unpleasantly sour.
  • The vaginal discharge has almost disappeared.
  • Again she has a tendency to diarrhoea, stinking, brown, watery with a sudden urge to stool. Had fecal incontinence a few times.



No remedy.


4. Consultation on 11 January 2000

  • She feels stronger and more confident.
  • She still thinks a lot about her childhood and feels a profound sadness.
  • For a few weeks she has been dreaming that she is yelling at her father.
  • For the first time she has developed a sun allergy.
  • The diarrhoea is gone; instead she has more a tendency to constipation.
  • Menstruation: markedly improved, less strong and shorter. The blood is not acrid anymore and the odour is normal.
  • A new symptom is a severe PMS. “It’s like it was in my puberty, I feel moody and weepy before the menses, I find this very annoying.”
  • Sweaty, cold hands and feet when tense.



Natrium muriaticum XM

5. Consultation 15 February 2001

The patient only contacts me a year later.

  • She feels good. She is more understanding with her husband and was able to make peace with her father.
  • She lost 5 kg (without dieting)
  • For the past 3 months her menses stopped (menopause) and she has severe hot flushes.
  • She has become very sluggish.
  • She developed an allergy to certain scents (cosmetics, flowers); she has to sneeze badly and gets itching eruptions on the face and on the neck.
  • She has become very hot.
  • She sleeps restlessly from 4 a.m. onwards.
  • She has watery, explosive diarrhea in the morning on waking.



Sulphur M

6. Consultation 20 June 2001

  • She feels more active and adventurous.
  • She sleeps better.
  • The morning diarrhoea is still there, but it does not annoy her anymore, it feels more relieving.
  • The allergy got worse in the beginning, though for some now it seems to be better.
  • The hot flushes are more bearable.



No remedy.

State after another year

  • Apart from an itching eczema on both shins she is very well. I explain to her the meaning of this eczema and complete the treatment.


Explanations of the Presented Case

Dr. Mohinder Singh Jus

Miasms and their Importance

Being a homoeopath I cannot imagine that I prescribe a remedy without taking into account all aspects of a case. For many colleagues the topic “miasms” seems to be irrelevant. For me it is very important to recognize the various stages of miasmatic disorders in every single case and consider them when choosing a remedy. I find it very fascinating to see how the prescribed homoeopathic medicine alters the miasmatic picture of the case.

The presented case, for example, shows the clear indications for Medorrhinum. The majority of the symptoms are sycotic and tubercular. This strengthens my choice of Medorrhinum. During the treatment Psora manifested itself clearly. This is reflected in the choice of remedy and I was able to complete the case with Sulphur.


Law of Similars

The choice of remedy should not only be based on miasmatic elements. The fact that in this case the majority of symptoms are sycotic-tubercular is not a sufficient reason to prescribe Medorrhinum. There are many other remedies which are the same sycotic-tubercular. The supreme law that has to be obeyed by the homoeopath is the Law of Similars. It is the precise basis for the choice of remedy. The homoeopathic remedy has to correspond with the main characteristics of the patient and the whole case that includes the miasmatic aspects. What I mean is that there are different stages in the similarity between a medicine and a patient.

  • individual symptoms of the patient – symptoms of the remedy
  • misamatic symptoms / miasmatic stigma of the patient and his family – miasmatic elements of the remedy

The better the remedy corresponds, the deeper is the curative action. It needs the whole experience and expertise of the homoeopath to individually evaluate the single aspects in every case. In this case Medorrhinum was prescribed because on the one hand there were many Medorrhinum symptoms present and on the other hand it covered the miasmatic aspects very well.


Curative Actions

The miasmatic aspects are not only important when choosing the first remedy, but also when analyzing the reactions to the prescribed remedy and for choosing the following medicines. After the prescription of a remedy, so called curative actions take place in the patient. Only old symptoms which reappear, as well as symptoms, which had been suppressed in former stages of life, have to be rated as curative actions.


Suppressed symptoms are an additional burden to our Vital Force. The scourge of suppression has pestered suffering mankind since people remember. Out of “compassion” for the patient we are tempted to let a symptom disappear. Before we treat a symptom we should aim at understanding its importance. When a previously suppressed symptom reappears, it is a very positive reaction. It might be unpleasant for the patient – like the reappearing of vaginal discharge in the presented case.

If the treating homoeopath succeeds in convincing the patients of the importance of the reaction, most patients comply.


New Symptoms

It often happens that after the well chosen homoeopathic remedy not only old symptoms reappear, but also new symptoms occur; though without disturbing the correct curative action. The symptoms often have a great miasmatic importance.  Sometime symptoms appear which do not belong to the medical history of the patient, but which belong to the medical history of the family. For example: Several family members had severe osteoarthritis of the knee. After the prescription of the remedy the patient suffers from severe knee pains – for no apparent reason. The pains remain for a while and then disappear the same way. It means, they now appear in a considerably lighter and more harmless way. (Later they would quite possibly become more severe and incurable symptoms.) It is a “protective action” of the correct and deep acting remedy. It has to be assessed as a positive action.


Miasmatic Relief

The so-called miasmatic reliefs are equally important when analyzing the case. They differ in every miasm.


Some examples:

  • Psoric relief: appearing of watery, irritating discharges (e.g. coryza), increased perspiration, urinating, strong menstrual bleeding, diarrhoea
  • Sycotic relief: appearing of yellowish-green discharges (e.g. vaginal discharge, nasal discharge, secretion from a fistula), (re)appearance of warts, tinea
  • Syphilitic relief: nosebleed, pus (bloody, yellowish-green) from abscesses, fistula, ulcers
  • Tubercular relief: fever, perspiration, nosebleed


Such symptoms can manifest themselves as new symptoms. In the presenting case the patient developed a wart. This was a new symptom for the patient. This wart is another manifestation of an underlying sycotic taint and has to be regarded as a miasmatic relief for the patient. With these explanations I wanted to demonstrate how multi-leveled the analysis of a case is, and emphasize the importance of a solid knowledge of the miasms.


Interpretation of the Case

I will now analyze some elements of the case presented. It is a complex-miasmatic case, i.e. all miasms are expressed. One or the other miasm is prevailing depending on the phase of the treatment.  Hahnemann said that Psora is the mother of all disease. It is the basis on which all other miasms grow. In certain people, one or another miasm is predominant. Others have expressions of several miasms. We all have psoric expressions.


1. Consultation

From Psora to Sycosis

When we look at the suppression of the atopic eczema and the hay fever, we see that they were both psoric problems. In conjunction with the other miasms they became more complex complaints. Sycotic and tubercular problems began to manifest themselves. From a young age she had a tendency to anaemia. This anaemia was not the result of a haemorrhage or an infection. It was susceptibility. In order to know more about this “anaemia” we have think about what kind of serious disorders have been running in the family, ancestors. Rheumatoid arthritis, diabetes, osteoporosis, asthma, fibroids, psoriasis are demonstrating an underlying sycotic or syphilitic taint. In this case the diseases would be rather considered sycotic. With a syphilitic dyscrasia one often encounters early or sudden death (e.g. lethal myocardial infarction at 45 years, no warnings).


The suppression of the hyperthyroidism resulted in complete change of character and nature. A happy person full of life became overweight, lazy, dull and almost depressive.  She was a person who used to be always on the move, always amongst people, full of plans and happy. In other words a psoric, tubercular person became heavy – mentally and physically. She became shy, introverted, grudging. She gained weight, mentally and physically. Sycosis took over the reign. You find many sycotic characteristics, symptoms (marked purple). An interesting aspect is: “Got pregnant when she stopped thinking about it.” “Worse thinking of and better distraction” is also a sycotic symptom.



She is a very nervous, anxious and shy patient. “Idiopathic diarrhoea” which gets worse from stress, is a strong psoric sign. “fear of examinations, of certain diseases, thunder, worried about the children” are all psoric.



Repeated miscarriages can be syphilitic or sycotic. The child is born with a “naevus”, missing a toe, is syphilitic. Feels and sleeps better in the mountains is also syphilitic.


Hyperthyroidism is tubercular. Very profuse, strong, long lasting menstrual bleeding, first menses at an early age, fear of dogs, desire for spicy food, adventurous woman, easily tired. They are all tubercular expressions.


Choice of Remedy

On counting, most miasmatic indications and symptoms are sycotic and tubercular. Based on the individual symptoms of the patient and the miasmatic aspects the indicated medicine is Medorrhinum.


2. Consultation

The action of Medorrhinum was wonderful. It followed exactly Nature’s Law of Cure – which is also the homoeopathic law of cure. The patient had more energy, became more adventurous. She showed and expressed her emotions somehow irritated and in emotional outbursts. She slept better. The menstruation lasted less long, without the sore throat etc. She developed an old symptom which manifested itself as a greenish-bloody leucorrhoea. This is something syphilitic, tubercular. She “discharged” her problems. It had to flow. No local treatment was necessary, not even with homoeopathic medicines, etc. Such interventions can result in irreversible suppression.


3. Consultation

She showed further improvements. Her fears had almost vanished. The patient began to show her emotions and realized that her marriage was not as smooth. She came to understand what she had to change. The weight of the inner difficulties (sycosis) shifted more and more to the skin (psora). From the viewpoint of a classical homoeopath this was a very positive development. I waited with repeating, changing or choosing a complementing remedy. Medorrhinum had worked perfectly.


4. Consultation

The patient had become much clearer in herself. She was able to analyze her life and her situation better, but she could not let go of her childhood memories. She felt a profound sadness. She was angry at her father, who had beaten the children and had not given them the needed love and warmth. She tried to let go of her anger. Since this was difficult in reality, she lived it in a dream. She isolated her problem and realized her difficulties caused by a strict upbringing and beatings when she was a child.  A different picture emerged. Natrium muriaticum was prescribed. It matches the picture wonderfully and in my experience it is a great complement to Medorrhinum.


5. Consultation

The patient did not contact me for one year. During this time she made the greatest developments in her life. She developed the courage to do the hard yards, steps others shrink from. This included the “reconciliation with the sad past” and “forgive and forget”. It enables us human beings to lead a grateful and peaceful life. Simple and easy changes are not difficult to implement. When someone can forgive, he will be forgiven too. She had become a “different person”. She was positive, peacefully minded and looked healthy and pretty, despite her eczema. She understood the path of homoeopathic cure and followed it successfully and cooperatively. She lost 5 kg of her weight. She had flushes, erythema, sensitivity to odours, restlessness after 4 a.m. Her Vital Force brought many symptoms to the surface. Above all Psora manifested itself again. All these symptoms lead to a new remedy. I asked myself whether I should change the remedy at all. Should I wait and watch? The changed picture was clear and tempting. I was not yet satisfied with my decision, having used my pen and my knowledge. But I have the following explanation for having prescribed Sulphur: “First of all it is a complement of Medorrhinum and Natrium muriaticum. Secondly the whole picture has changed and thirdly I thought that Sulphur as a great anti-psoric remedy is a good medicine to finalize the case.” Since Psora is the basis of all other miasms, it is generally advisable, to finalize the treatment (of acute and chronic diseases) with an anti-psoric remedy.



Observe how I followed the principles of prescribing in this case with Medorrhinum, even though the patient’s sleep improved in the mountains. The family background, the multiple suppressions and treatments, the journey of her disease, were indications for me to commence the case with a sycotic, tubercular remedy. Not that Medorrhinum is the only medicine with sycotic components; but it covered the totality of symptoms:

–  fear of tumours, Alzheimer’s

–  memory problems

–  does not like to be restricted, does not want to ber owned by someone

–  likes traveling

–  likes alcohol, cheese, spicy food

–  does not tolerate the sun

–  sleeps with feet uncovered etc.

–  water retention, tendency to being overweight

–  endometriosis, miscarriages

–  long lasting menstruation

–  chronic thrush, bloody greenish leucorrhoea


The miasmatic disorders of the patient and the family, plus her symptoms, called for Medorrhinum. The reactions after Medorrhinum confirm the correctness of my choice. The three prescribed medicines Medorrhinum, Natrium muriaticum and Sulphur are covering all aspects of this multi-miasmatic case. We should take enough time for the prescribing and wait even longer before we change or repeat the remedy. This is the key for a successful prescription. We have to watch and analyze the changes which have taken place after the prescribed medicine. Only when we are completely sure that the right time has come, should we use our pen. Otherwise the second best prescription is to wait and be patient. We should refrain from treating the disease of a patient, we should always focus on the patient. With our remedy we help  individuals to cure themselves.

About the author


Dr. Mohinder Singh Jus, DMS (Cal),
Director SHI Homoeopathic College, Switzerland.

Further lecture about miasms:
"Journey of a disease" by M.S. Jus. A comprehensive and practical approach to the miasms.

Available at: Homoeosana, Steinhauserstrasse 51, CH-6300 Zug, [email protected], or

Available for Asia: B. Jain Publisher, India.,


  • DEAR DR,

  • Dr. Jus sir,
    Your Miasmatic as well as symtomatic presentation of this case is marvelous. thank you very much sir. I am waiting further for your informative cases eagerly.Thank you once again.

    from Dr. Niranjan sahoo,

  • Dear Dr jus
    Pleasure reading this informative , analytical , educational , and best of all principally correct article ,
    Please write more such papers to help us apply and improve,
    Dr, rakesh raj m.d.

  • Wonderful multi layered description of a complex case made easy to follow with use of colored illustrations of miasmatic background in each step of case taking and solving. Thank you for sharing.

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