Organon & Philosophy

Using Acute Intercurrent or Intermediate Remedies in Chronic Diseases

Modern homeopaths no longer understand how to use an acute intercurrent remedy. Homeopathic Intercurrent remedies have been called everything from drainage remedies and tandem remedies to support and lesional remedies.


A61: Organon Aphorism by Hahnemann Reference. This symbol represents the paragraph from Hahnemann’s Organon, specifically the Aphorism number from where the reference originated.

CD: Chronic Diseases by Hahnemann Reference. This symbol represents the thought taken from Hahnemann’s Chronic Diseases book.

Using Acute Intercurrent Remedies

Modern homeopaths no longer understand how to use an acute intercurrent remedy. These remedies have been called everything from drainage remedies and tandem remedies to support and lesional remedies. Too many so-called masters, who claim to be constitutional prescribers (homeopaths who say they do chronic “layer” prescribing), totally forbid the use of acute intercurrent remedies and misinform others by saying that the use of acute remedies during the administration of a chronic remedy is suppressive. These individuals always try to find one remedy that goes throughout the chronic case history, no matter what the patient’s present acute disease state may be. They use this “constitutional” remedy for everything, no matter what disease state arises! This limited view is too extreme for the general practitioner of homeopathic healing.

Why does this very rarely work? We only have to refer to Aphorisms 36-40 of the Organon on similar and dissimilar diseases. In Aphorism 38, Hahnemann tells us that the stronger and dissimilar acute disease will postpone or suspend the old chronic and weaker disease. Thus, administering the constitutional/chronic remedy during emergencies such as dangerous pathological crises, severe traumas, overexposure, serious injuries, and virulent acute miasms, is a serious mistake as it runs the risk of disrupting the natural symptom pattern and causing unproductive aggravations as well as accessory symptoms of the chronic remedy!

During an acute crisis the remedy of choice is the acute intercurrent! This acute illness shows a different clinical picture from the chronic natural disease. How could a dissimilar remedy correct this situation? That would fly in the face of our most sacred principle: Like cures like. A homeopath must have the tools to prevent and cure dangerous epidemic diseases, treat emergencies, crises, and acute virulent miasms. The acute remedy must be chosen according to the causal or exciting factor and its active symptoms (von Boenninghausen [VB] method), not according to the chronic case history! The desired middle path is the class of homeopaths who find a balance between those who treat in layers and those who use the grand constitutional remedy for everything. Turning this subject into absolutes will only help create opposing extremist views.

No doubt, the closer the remedy is to the simillimum the deeper and more all encompassing its action will be on the Vital Force (VF). This is a very subtle aspect of the single remedy and minimal dose and is a wonder to perceive. The goal is always to use the minimum number of remedies, the smallest amount of medicine, and the fewest repetitions. Since the simillimum addresses the soil on which acute and chronic diseases grow, it can sometimes cure both acute and chronic manifestations as well as acting as a prophylactic. Especially with the use of Hahnemann’s medicinal solutions (5th and 6th Edition of the Organon), we often find that the adjustment of the succussions or size of the dose will keep the remedy working.

The skillful use of intercurrents is an essential method in classical homeopathy, an aspect of complete case management. Acute intercurrent remedies are used during temporary disruptions of the chronic treatment. For example, “taking cold in the stomach by eating fruit, [cured] by smelling of Arsenicum” (Hahnemann’s Chronic Diseases, 1997, p. 131). These remedies are chosen based on of the exciting cause and the active acute symptoms so that they do not disrupt the deeper layer associated with a different fundamental cause and with the constitution. These intercurrents mainly act superficially so that they will not interfere with the complementary constitutional treatment. They are specialized specifics, which deal with the disruption of the chronic treatment by occasional exciting causes that would delay the cure.

Because of the continued suppression of miasmatic chronic diseases in modern countries, we must know when to use acute intercurrents. If you read the old masters (see von Boenninghausen’s Lesser Writings), you will see that they dealt with horrendous acute situations, which are still present today. Nothing has really changed, except that we have some new acute diseases: SARS (Severe Acute Respiratory Syndrome), West Nile virus, the Four Corner’s disease (hantavirus), etc.

The reason some homeopaths speak about disrupting their chronic cases with acute remedies is that they do not know the strategy behind using acute intercurrents. As mentioned above, if you use the exciting cause and active symptoms of the acute syndrome as a basis for selecting a remedy (VB method), then the intercurrent will not disturb the chronic condition. But if, during an acute attack, the homeopath continues to administer a deeper-acting chronic remedy, which envelopes the previous deeper and often different fundamental causes, this may disrupt the natural layers of symptoms. Simply put, one-dimensional constitutional prescribers are afraid of treating acute diseases because they do not know how to do it.

Hahnemann and Acute Intercurrents

What does Hahnemann have to say about acute intercurrents? He introduced the idea in 1828 by presenting the following examples in Chronic Diseases:

CD Among the mishaps which disturb the treatment only in a temporary way, I enumerate: overloading the stomach (this may be remedied by hunger … ; disorder of the stomach from fat meat, especially from eating pork (to be cured by fasting and Pulsatilla); a disorder of the stomach which causes rising from the stomach after eating and especially nausea and inclination to vomit (by highly potentized Antimonium crudum); taking cold in the stomach by eating fruit (by smelling of Arsenicum); troubles from spirituous liquors (Nux vomica); … when vexation is joined with fright, by Aconite; but if sadness is caused by fright give Ignatia seed; … unhappy love with jealousy (Hyoscyamus); … burning of the skin by Arsenicum; … homesickness with redness of cheeks by Capsicum, etc. (1997, pp. 131-132).

After talking about this first class of acute illnesses, Hahnemann tells us not to continue (to suspend) the chronic antipsoric treatment in cases of epidemic diseases or intermediary diseases, so as not to mix the symptoms of the acute crisis with those of the chronic disease. If one needs to administer a first aid, crisis or genus epidemicus remedy, the constitutional chronic remedy should be withheld until after the crisis subsides.

CD But during the treatment of chronic diseases by antipsoric remedies we often need the other non-antipsoric store of medicines in cases where epidemic diseases or intermediate diseases (morbi intercurrentes) arising usually from meteoric and telluric causes attack our chronic patients, and so not only temporarily disturb the treatment, but even interrupt it for a longer time. Here the other homeopathic remedies will have to be used, wherefore I shall not enter upon this here, except to say that the antipsoric treatment will have for the time to be totally discontinued, so long as the treatment of the epidemic disease which has also seized our (chronic) patient may last, even if a few weeks in the worst cases may thus be lost. But here also, if the disease is not too severe, the above mentioned method of applying the medicine by smelling a moistened pellet (olfactory method) is often sufficient to help, and the cure of the acute disease may thus be extraordinarily shortened (1997, p. 132). (Author’s emphasis and words added.)

The same idea – not taking into account the active miasmatic state in acute events – is reflected in the Organon,

A221 If, however, insanity or mania (precipitated by fright, vexation, alcohol, etc.) suddenly bursts forth as an acute disease from the patient’s usually calm condition, although it almost always arises from internal psora (like a flame flaring up from it), at this initial, acute stage it should immediately be treated, not with antipsoric remedies, but with medicines such as Aconite, Belladonna, Stramonium, Hyoscyamus, Mercury, etc., chosen from the other group of proved remedies and given in highly potentized subtle homeopathic doses, so as to overcome it to the point where the psora returns for the time being to its former, almost latent condition, in which the patient appears to be well.

In such acute flare-ups, Hahnemann tells us to use those very specific acute remedies without taking into account the dominant miasmatic state as we would for chronic cases. This is one of the few exceptions – together with the one-sided diseases, which can be regarded as severe acute situations suspending the chronic miasmatic natural illness – in which we use the VB method. With this method you select the remedy according to modalities, location, sensation and concomitant symptoms. The VF needs an intercurrent remedy in high potency and subtle or minute dose, to subdue a threatening acute flare-up.

Kent and Acute Intercurrents

Kent continued this discussion in his Lectures on Homeopathic Philosophy in Lecture XXVI titled, The Examination of the Patient.

It is important to avoid getting confused by two disease images that may exist in the body at the same time (that does not mean both are equally active). A chronic patient, for instance, may be suffering from an acute disease and the physician on being called may think that it is necessary to take the totality of the symptoms; but if he should do that in an acute disease, mixing both chronic and acute symptoms together, he will become confused and will not find the right remedy. The two things must be separated. The group of symptoms that constitutes the image and appearance of the acute miasm must now be prescribed for. The chronic symptoms will not, of course, be present when the acute miasm is running, because the latter suppresses or suspends the chronic symptoms. … This illustrates the doctrine of not prescribing for an acute and chronic trouble together. … The acute disease is never complicated with the chronic; the acute suppresses the chronic and they never become complex. … Prescribe first for the acute attack, and the symptoms that belong to it. It is well, however, for the physician to know all the symptoms that the patient has of a chronic character, that he may know what to expect, that he may look at the close of the acute attack for the coming out of the old manifestations of psora, although often an entirely new group of symptoms will appear (Kent, 1979, pp. 174-176). (Author’s note added.)

As you can see, here Kent follows Hahnemann and lays to rest those “modern myths” of not treating acutes while you are treating a chronic disorder. He speaks here of true virulent acute miasms, not sporadic befallments or non-threatening exacerbations of chronic miasms. After the acute crisis is over, the homeopath can resume the chronic treatment.

von Boenninghausen and Acute Intercurrents

von Boenninghausen was another homeopath who talked about acute intercurrents in the first published homeopathic repertory (1832), A Systematic Alphabetical Repertory of Homeopathic Remedies. Within a sub-chapter titled Interruption of the Antipsoric Cure is the section, Intercurrent Remedies in Chronic Disease. This section includes a list of acute intercurrents and their symptoms in crisis during chronic treatments. These therapeutic hints are characteristic keynotes of the acute intercurrent remedies and the homeopath must refer to the materia medica for confirmation and differential diagnosis with other remedies. Some examples include:

Stomach, overloading of (main rubric) with sub-rubrics:

·        Deranged with gastric fever, chills and coldness with eructations, Bry.

·        And inclination to it, Ant. crud.

·        By fatty foods, Puls.

·        Chilled as from fruit, Ars.

Among the remedies listed by the Baron are non-miasmatic remedies like Aconite, Antimonium crudum, Arnica, Bryonia, Chamomilla, Coffea, Ignatia, Ipecacuanha, Rhus tox., etc. These are used for acute emotional crises, accidents, vomiting, diarrhea, weakness from loss of fluids, and acute miasms such as colds and flus.

Why would a deep-acting remedy such as Arsenicum be found among these acute intercurrents? It is in the acute list of Hahnemann and von Boenninghausen for use in an upset stomach – in other words an acute local complaint. If Arsenicum had a deeper relationship to the individual’s case history (anxiety, fear of death, fear of contamination, obsessive compulsive behavior, etc.), it should not be used during a serious acute crisis as it might interrupt the chronic treatment and delay the cure. Another more superficial simillimum must be chosen at that point. Most intercurrents are non-miasmatic remedies that have no relationship to the deeper aspects of the case. They are chosen according to the location, sensation, modalities, and concomitants (a complete von Boenninghausen case). These acute intercurrents act as superficial remedies that suit the acute layer of symptoms one wishes to remove, but are not directed toward the underlying miasm or constitution. This also means that we should choose these intercurrents only for serious acute events, only if the crisis needs special attention, and not for every trifling situation as often happens. A homeopath should treat strong acute miasms, painful exacerbations of chronic states, and dangerous crises whenever necessary, because it is preferable to administering allopathic dissimilar drugs.

As an example, let me tell you about choosing the right intercurrent for myself when I was plagued by an annoying, lingering cough and while I was taking a chronic constitutional remedy. After waiting for 14 days and finding that the cough was getting worse, I decided to take an intercurrent. The rubrics included:

·        Cough, dry

·        Cough, with convulsions

·        Cough, constriction in larynx

·        Cough, irritation in larynx

·        Larynx/trachea, irritation in throat-pit

·        Chest, sensation as a band

·        Chest, constriction

·        Larynx, tickling, in throat-pit

·        Irritability, wants to be left alone

·        Very thirsty, usually thirstless except with meals

Far stronger than the rest of the remedies which appeared were Phosphorus (first), and Cuprum (second). Because Phosphorus is a deep-working anti-miasmatic remedy, which would have interrupted my chronic treatment, I decided on Bryonia 200C, (the acute of Phosphorus), split dose in bottle, 12 succussions, 1 tsp. PRN. After one dose my cough was already much better, and it disappeared completely the next day. Later, chronic treatment was resumed.

I asked the following question: “What changes are important in acute diseases?”

ALL the symptoms that have changed since the onset of the cough belong to the cough – for example, being very thirsty now that the cough started when usually I am not thirsty. This becomes very important. It would not be important if I were always thirsty, even before the onset of this cough.

Another very important facet of change in acute diseases is the change in disposition and mental/emotional symptoms: the disposition during the acute disease as compared to the usual disposition will be a key factor. This absolutely must be investigated and plays an important role in finding the remedy. The more drastic this change is, the more important it is. The “feeling of wanted to be left alone” is very unusual for me, and Bryonia, the indicated remedy, certainly has this symptom as well as the great thirst. This resembles, of course, the VB method, where von Boenninghausen only takes into account the mental/emotional symptoms as a tool to differentiate between several remedies close to the case. Hahnemann also stresses the importance of emotional changes in acute diseases.

A213 Therefore one will never cure according to nature—that is, homeopathically—unless one considers the mental and emotional changes along with the other symptoms in all cases of disease, even acute ones, and unless for treatment one chooses from among the remedies a disease agent that can produce an emotional or mental state of its own similar to that of the disease as well as other symptoms similar to those of the disease. Thus Aconitum napellus will seldom or never cure either quickly or permanently if the disposition is calm and undisturbed; nor will Nux vomica if it is mild or phlegmatic; nor will Pulsatilla if it is glad, cheerful and willful; nor will Ignatia if it steady and without fearfulness or irritability.

Hahnemann compares some differences between acute and chronic cases.

A82 … In this investigation one must distinguish between acute diseases of sudden onset and chronic diseases. In the former the principal symptoms become prominent and recognizable to the senses more quickly, so the taking of the case requires far less time and there are far fewer questions to ask, because most of the symptoms are self-evident; whereas in a chronic disease that has been evolving gradually for a number of years, it is far more troublesome to obtain the symptoms.

A99 On the whole it will be easier for the physician to take the case in diseases that are acute or that have arisen recently, because all the symptoms and deviations from the healthy condition, which was only recently lost, are to patient and relatives still fresh in memory, still new and striking.

The physician must of course know everything here also, but he needs to probe far less, because everything he needs to know is told to him, most of it spontaneously.

Proceeding with Treatment After Using an Acute Intercurrent

Again Hahnemann guides us very clearly in Chronic Diseases.

CD The intelligent homeopathic physician will soon note the point of time when his remedies have completed the cure of the epidemic intermediate disease (usually they appear in the form of a fever) and when the peculiar course of the chronic (psoric) malady is continued. The symptoms of the original chronic disease will, however, always be found somewhat varied (altered) after the cure of such a prevailing intermediate disease. … The homeopathic physician will then choose his antipsoric remedy according to the totality of the remaining symptoms, and not simply give the one he intended to give before the intermediate disease appeared (1997, p. 132-133). (Author’s emphasis and words added.)

Therefore, after the acute event (a strong one, that is), one must retake the case with special emphasis on any newly appeared symptoms. The most recent and permanent symptoms point to the next remedy. Some of the chronic symptoms also persist during an acute crisis and thus obtain a higher value for the selection of the simillimum. If the same remedy that was serviceable before the acute crisis is indicated, it may be repeated. If the symptom picture has changed, the new symptoms must be investigated in relationship to all the data associated with the chronic strategies used before. This tells you how disruptive it is to continue administering the chronic remedy during acute crises! It is also wise, after the acute episode, to see whether the constitutional state improves greatly without the administration of any remedy. Better to wait and watch and give a placebo to please the patient until the VF has been able to produce all the symptoms you must prescribe on.

Hahnemann further reminds us in Chronic Diseases to pay attention to another event, which can occur at this point, after treating the acute event, even when the acute has been properly treated:

CD Here is a fitting opportunity to note that the great epidemic diseases … when they complete their course especially without a judicious homeopathic treatment, leave the organism so shaken and irritated, that with many who seem restored, the psora, which was before slumbering (dormant) and latent now awakes quickly, either into itch-like eruptions or into chronic disorders, which then reach a high degree in a short time, if they are not treated properly in an antipsoric manner. … The allopathic physician, when such a patient … dies after all his unsuitable treatment, declares that he has died from the sequelae of whooping cough, measles, etc.

These sequelae are, however, the innumerable chronic diseases in numberless forms of developed psora which (were) unknown and consequently remained uncured (1997, pp. 133-134). (Author’s words added.)

How often do we see a patient in the clinic who comes to us and says, “I had this simple cough (or flu, or small trauma, or small upset), and I have never been well since then.” These statements are explained by the above quote: this “innocent-appearing event” has activated the dormant, often psoric miasm, leaving the patient in a state worse than he ever was before. This is incomprehensible to the patient and his allopathic physician, but easily managed by a well-trained homeopath.

Allopathic Recourse

In a footnote to Aphorism 67, Hahnemann elaborates on situations where allopathic intervention is justified.

A67 Only in the most urgent cases, where danger to life and imminent death do not allow time for a homeopathic remedy to act – neither hours, nor often quarter hours, nor even minutes – in sudden accidents to healthy individuals, such as asphyxiation, apparent death from lightning, choking, freezing, drowning, etc., only in such cases may we and should we as a first measure at least bring back irritability and sensitivity (physical life) by using a palliative …

Apart from the previous examples, if an acute situation becomes dangerously uncontrollable, we can use allopathic palliative treatment to give us a second chance to find the curative homeopathic treatment. This situation is an exception – for example, severe bleeding spells in a patient with chronic ulcerative colitis – and not at all the same as preferring to give your patients OTC drugs or antibiotics as acute interventions, for fear of disrupting the chronic treatment. Obviously those homeopaths do not know the basic principles of homeopathy. They should know that OTC drugs (just like other allopathic drugs) cause a dissimilar disease, thus creating a more complex disease, which is more difficult to treat. They do a disservice to the patient as well as to other homeopaths who inherit such cases. And of course, they have passed up a chance to show how well homeopathy works on acute diseases. The use of allopathic drugs might be an easy way out for the incompetent or lazy homeopath, but it will make the management of that patient’s case a lot more difficult. Antibiotics, for example, may overcome an acute infection, but they do not help the organism overcome future infections. After antibiotics, the person is, to a certain degree, even more susceptible to microorganisms. Some side effects of antibiotics include yeast overgrowth and destruction of the normal flora. Besides, homeopathy is superior to any other treatment that exists for infectious diseases.

What Acute Events Need an Intercurrent Remedy?

Not treating a serious acute event at all is a mistake. Due to its nature, an acute disease evolves in four possible directions. The patient can succumb to it; it will suspend the chronic disease and can become an independent chronic state; or it will combine with the existing chronic disease and create a complex chronic disease, which will be much more difficult to treat. The best outcome is that the strong VF might overcome this acute miasm without causing further sequela. “The physician amuses the patient while Nature cures,” Voltaire said -but this is not a reason to refrain from treating acutes!

Margaret Tyler wrote in her book Homeopathic Drug Pictures (in the lecture on Natrum muriaticum (Natrum mur.) about a crisis situation where she treated a chronic Natrum mur. patient with a severe acute headache. She advises against the use of the chronic constitutional remedy at this time because it may produce severe aggravations. Instead, she suggests using the acute of Natrum mur., Bryonia, to deal with the acute crisis. Afterwards she resumes the chronic remedy to remove the underlying cause. This advice comes from years of clinical experience and should not be ignored. It also means that you do not continue Bryonia once the acute stage is over, as I have seen some homeopaths do!

Which acute crisis needs an acute intercurrent remedy rather than a continuation with the chronic constitutional remedy? As usual, Hahnemann gives us definite guidelines. In Aphorism 73 of the 6th edition Organon, Hahnemann describes three kinds of acute diseases. Group One combines those relating to lifestyle/diet and miasmatic predisposition; Group Two includes epidemic and acutes belonging to idiosyncrasy; and Group Three includes acute miasms such as those belonging to childhood diseases.

Group One acute diseases

Group One is subdivided into three different categories.

A. Acute situations caused by lifestyle or dietary mistakes

A73 … Exciting causes of such acute febrile conditions are: excesses or privation in eating, traumatisms, chilling or overheating, fatigue (from poor lifestyle choices), strains from lifting, etc., or else psychic agitation and upsets (our modern TV, video games, magazines, and now Internet exposure). (Author’s notes added.)

These issues are also discussed in Aphorism 77

A77 Diseases engendered by prolonged exposure to avoidable noxious influences should not be called chronic. The include diseases brought about by:

·         the habitual indulgence in harmful food or drink;

·         all kinds of excesses that undermine health;

·         prolonged deprivation of things necessary to life;

·         unhealthy places, especially swampy regions;

·         dwelling only in cellars, damp workplaces, or other closed quarters;

·         lack of exercise or fresh air;

·         physical or mental overexertion;

·        continuing emotional stress; etc. …

Hahnemann refers to these situations also as “false chronic diseases,” since they can become chronic through continued abuse, but all they will require to be cured is a sensible change to diet and/or lifestyle. He continues:

A77 These self-inflicted disturbances go away on their own with improved living conditions if no chronic miasm is present, and they cannot be called chronic diseases.

In all these cases no remedy is required except placebo (if called for) to temper the demands of the drug-oriented or hypochondriac patient. The best treatment is rest, sleep, appropriate diet, and TLC.

B. Acute situations with a clear exciting factor and strong symptoms

If the exacerbation is moderate to strong, and a clear causality is manifested, an intercurrent remedy, which acts superficially on the chronic miasm, may be chosen according to the VB method, rather than giving a deep-acting polychrest. This will calm the symptoms for the moment without acting too deeply on the case. After the crisis has subsided, complementary constitutional treatment is needed to remove the underlying cause.

Examples of causality include:

·        Acute physical trauma – In these cases the etiology and the organ or tissue affected will help you identify the remedy. In other words, if the injury is a puncture wound compared to a blow (e.g., to the eye), it will correspond to a different remedy  (Ledum and Hypericum versus Arnica and Ruta).

·        Emotional trauma – You must look at the kind of trauma as well as the patient’s reaction to the trauma, which will be determined by the patient’s active miasmatic state. Remember, the trauma can wake up the miasm! The “Mind” section of Kent’s repertory gives many examples of emotional causalities. The patient’s miasmatic reaction to these triggers will help you select the appropriate remedy. For example, we have the tubercular jealousy of Pulsatilla, the psoric one of Nux vomica, the syphilitic one of Hyoscyamus, and the sycotic one of Lachesis.

·        Poisons and vaccinations – These include cases of street drug use, allopathic drug use, food poisoning, etc. The best antidote is not the same or isopathic substance but the most similar remedy. Sometimes you find effects of poisoning when you look into the “relationship of remedies” and when you look at what antidotes that remedy. This information will narrow the group of remedies you need to investigate.

C. Acute exacerbation of a chronic miasm

For example, in this situation the patient may have contracted the flu after losing sleep or partying too much. In this case we do not always want to interrupt the action of the constitutional remedy with an intercurrent remedy. If there is no obvious exciting cause, it may be a healing crisis brought on by the constitutional chronic remedy. Rest, massage, and hot and cold water treatments (hydrotherapy) might be sufficient to render the patient comfortable until this acute exacerbation subsides.

In Third World countries like Kenya, I have found myself exposed to situations like those European and American homeopaths faced at the turn of the 20th century. Many people came to us in an “acute” stage, excited by physical strain (all the women in the village where I worked in Kenya had at least four children and eight was not uncommon), by becoming chilled or overheated, by eating unsuitable food, mental stress, etc. How many of these cases are really acute?

As you can see in Aphorism 73, Hahnemann suggests, and experience confirms, that most of these cases are acute exacerbations of fundamental chronic states and miasms, activated by exciting causes. When the symptoms do not represent an extreme crisis, the simillimum, which suits their constitutional nature, often clears the acute exacerbations and then addresses the fundamental chronic states. That is the majesty of the grand simillimum. This may account for statements by homeopaths such as Massimo Manglialavori who state that it is possible to find a single remedy to successfully treat both chronic and acute situations. However, when the same author claims that “he does not believe in miasms and knows nothing about them,” I wonder about the veracity of his statement. Don’t we all owe it to our patients to investigate before we reject the concept of miasms – or worse still, we fail to investigate at all because of our knee-jerk negative feelings about miasms? Let’s not fall into allopathic reasoning, which borders on fear of and hostility towards one of the greatest discoveries of homeopathy.

Hahnemann says:

A73, In reality most of these acute diseases are only passing flare-ups of latent psora, which returns by itself to a dormant state if the flare-ups are not too violent and if they are quickly eliminated.

Only if the exacerbation is moderate to severe do we want to intervene with intercurrent remedies as an emergency measure. Again, the VB method will help you choose the intercurrent remedy.

In his Lesser Writings, Kent expresses the same scenario:

The acute expressions of a chronic disease have a different management from the acute diseases, e.g., a child suffers from bronchitis at every change of weather. It may grow worse if treated with the remedy for the acute symptoms. The miasm that predisposes the child to recurrent attacks must be considered (Kent, 1994, p. 419). (Author’s emphasis added.)

Group two acute diseases

A73 Then there are sporadic acute diseases, which affect a few individuals at a time here and there, acute diseases brought on by harmful meteorological or telluric influences to which only a few people are susceptible at any one time.

This was long recognized in Traditional Chinese Medicine: certain climate factors are known to influence specific organs which have an affinity for those conditions, e.g., cold to kidneys or dampness to spleen-stomach, though only certain people seem to have a high susceptibility to that particular climate factor. Sometimes, but not always, these diseases form acute layers, which repress the constitutional picture until they have run their course or are removed by homeopathic remedies. These acute disorders are so closely linked to the patient’s chronic susceptibility that they can often be treated with their constitutional simillimum. It is only in emergencies such as sunstroke, dehydration, severe exposure to cold, anaphylactic reactions, poisoning, and severe physical or mental trauma that these cases are truly an acute crisis. In such an exigency, the symptoms will indicate a crisis remedy. Acute miasms present a different situation from sporadic diseases because they involve infectious etiologies.

Hahnemann discusses a second type of sporadic diseases.

A73 Bordering on these are the epidemic diseases, in which many individuals are affected very similarly from a similar cause. In crowded areas they tend to become contagious. These epidemics cause fevers, each with its own characteristics; and because each case of disease in the same epidemic has the same origin, those affected manifest a similar disease process, which, left to itself, ends either in death or in recovery within a limited time. War, floods, and famine are often the exciting causes or the breeders of such diseases.

In acute miasms, the susceptibility factor is closely related to acquired and inherited miasms and family disorders. For this reason, the remedy for the acute miasm may also be the remedy for the patient’s constitutional condition. This is especially common to acute miasms that run a non-threatening natural course with few or no complications. This may not be the case, however, when the acute disease is of a very virulent nature. Because of their intensity, these acute diseases will suspend the chronic disease and an intercurrent acute remedy is needed to deal with this new acute natural disease. It will display a new symptom image that will either run its course or be removed by homeopathic remedies.

In these circumstances an acute intercurrent is the remedy of choice. We’ve all seen patients who have been never well since (NWS) a certain illness.  The NWS acute disease has now become a chronic disease, stronger and dissimilar to the previously treated chronic disease, which is now suspended.  SARS is a good example.

Deep-acting complementary remedies (constitutional and anti-miasmatic treatment) must remove the chronic underlying causes after the acute crisis is ameliorated. Let the constitutional factors, the nature of the disease, and the totality of the symptoms (Organon, Aphorisms 5, 6 and 7) be your guide to the homeopathic remedy, and you will have success. Follow the revelations of the VF and it will demonstrate, through causation, signs and symptoms, which remedy it needs. Trust your recuperated VF to tell you what to do!

Group Three acute diseases

Hahnemann also alludes to the third kind of acute diseases.

A73 Then there are those acute miasms that always recur in their own particular form, which is why they are known by an established name. Some of them are contracted only once in a lifetime, like smallpox, measles, whooping cough, … scarlatina … mumps, etc., while others recur frequently in fairly similar ways, like … the yellow fever of coastal regions, Asiatic cholera, etc.

We see the same in modern times: bubonic plague in India; tuberculosis (TB) and cholera epidemics in South Africa; malaria and TB in Kenya; epidemics during the war between the Tutsi and Hutu in Rwanda and Burundi or the civil wars in Zaire; flu epidemics worldwide, etc. These acute miasms are caused by microorganisms and are self-limiting but tend to form a quick crisis and end either with complications, perhaps even death, or convalescence (a person can fall prey to these illnesses more than once). By contrast, the once-in-a-lifetime illnesses provide permanent immunity after only one attack.

All these acute diseases should be treated with remedies reflecting the picture of the acute miasmatic state alone – the acute genus epidemicus. A follow-up with constitutional and anti-miasmatic remedies to remove the underlying susceptibility is then necessary.

Hahnemann warns us to not pay attention to the name attached to the epidemic disease, like the yearly flu in modern times.

A100 In investigating the totality of symptoms of epidemics and sporadic diseases, it makes no difference at all whether something similar, by the same or a different name, has ever appeared in the world before.

Whether or not such an epidemic is new or unusual makes no difference either in the examination or in the cure, since in any case the physician must presume the true picture of every epidemic to be new and unknown and must thoroughly examine it as it is in all of its details if he wants to be a true and thorough physician who never replaces observation with guesswork, who never lets himself assume that the treatment of any given case in his care is wholly or partly known in advance and that he need not carefully seek out all its expressions.

This is all the more necessary because every epidemic is in many ways unique and upon careful examination is found to be very different from all previous ones falsely bearing the same name, the only exceptions being those caused by the same unvarying infectious agent, such as smallpox, measles, etc.

What a scathing condemnation of present allopathic practices where the severe flu strain of this year was treated, of course unsuccessfully, with a vaccination of the previous flu variety!


We can emphasize that the proper use of an acute intercurrent in the treatment of a patient is essential for a speedy cure of a chronic illness. When and where to use these acute remedies are equally important issues as when to continue the chronic treatment, especially when the homeopath should recognize where the acute manifestation is nothing more than an expression of a chronic miasmatic state. Homeopaths throwing one acute remedy after another to the unsuspecting patient for trifling matters, are just as guilty of misconduct as those homeopaths who refuse to use acute intercurrents under any circumstances. Knowledge of Hahnemann’s teachings is the only guide!


1. Hahnemann, S. 1997. The Chronic Diseases: Their Peculiar Nature and Their Homeopathic Cure. Translated by L. Tafel, edited by P. Dudley. New Delhi: B. Jain Publishers Pvt. Ltd.

2. Hahnemann, S. 1982. Organon of Medicine. Sixth Edition. Translated by J. K?nzli, A. Naudé and P. Pendleton. Washington: Cooper Publishing.

3. Kent, J.T. 1979. Lectures on Homeopathic Philosophy. California: North Atlantic Books.

4. Kent, J.T., 1994. New Remedies, Clinical Cases, Lesser Writings, Aphorisms & Precepts. New Delhi: B. Jain Publishers Pvt.Ltd.

5. von Boenninghausen, C.M.F. 1991. Lesser Writings. New Delhi: B. Jain Publishers Pvt. Ltd.

This article is an excerpt of the new book of Dr Luc, “Achieving and Maintaining the Simillimum: Strategic Case Management for Successful Homeopathic Prescribing.” Full of Life Publishing, PO Box 31025, Santa Fe, NM 87594, USA. Dr Luc is the founder and sole teacher of the Renaissance Institute of Classical Homeopathy since 1993, with schools in Boston, MA, Secaucus, NJ and Las Vegas, NV. For more info: write [email protected] and see

About the author

Luc De Schepper

Luc De Schepper, M.D., Ph.D., Lic.Ac., C.Hom., is a licensed physician and acupuncturist in Europe (since 1971) and the US. (since 1982). He studied and practiced homeopathy extensively for many years, wrote 15 textbooks of homeopathy, alternative medicine and acupuncture and has the largest school of homeopathy in the US. He spends part of his time helping the poor in South Africa, Kenya and Sri Lanka and teaches all around the world, lately bringing homeopathy to China. For more information visit


  • i am a lay person trying to learn homeopathy on my own eventually i will go to school for it but my question is can you recomend a book that explains the diffrence between deep acting remedys and superficial remedys and the order remedys can be used or what follows what.
    i would be very grateful.

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