Carol, The way I understand it, to date, is that Hahnemann defined the primary psoric itch eruption as just that, itchy vesicular eruption that compelled scratching and then was followed by a burning sensation.

Not all skin eruptions are itchy.

The thing to keep remembering in Hahnemannian context is that the psoric *miasm* is any infecting agent that is capable of producing a psoric disease. Hahnemann classified these primary eruptions in Chronic Diseases as herpes, tinea capitus, milk crust and tetter. There are many different microbiological organisms that are capable of producing these eruptions. But for the identification to be made as primary psoric symptoms they must be itchy vesicles, that compel to scratch and then burn. Hahnemann believed that the fluid in the vesicles was the contagious element that was spread through scratching, thus the high rate of infection.

It is a misnomer to say that psora and all subsequent diseases affecting humanity is the result of a scabies infection caused by Acarus scabiei. This is not what Hahnemann wrote but it is a misunderstanding and misrepresentation that was perpetuated by Hahnemann's allopathic detractors and, as well, was probably aided and abetted by James Kent who had no regard for the microbiological role in infectious disease. Hahnemann had a totally opposite view.

Even more recently the Kunzli version of the Organon refers to the itch eruption as scabies as if they are one and the same thing.
I'm starting to feel itchy myself by this stage, but I'll continue anyway.

Once infected by the primary psoric agent, and the subsequent external surface symptoms disappear of their own accord or are suppressed, the internal psoric disease lies latent until other stressors, whatever, hereditary factors, combine to produce secondary symptoms of psora. These secondary symptoms are innumerable and vary greatly in form. Big list is given in Chronic Diseases.

So anyway, the point of the footnote of Aphorism 282, as I read it, is that the exception to the rule of beginning the homoeopathic treatment of chronic diseases with small doses and only very gradually increasing them is in the context of treating the *primary* symptoms of the 3 great miasmatic diseases, psora, sycosis, syphilis - that is, when they are still newly on the surface as either a itchy psoric vesicle, a sycotic figwart, or a syphilitic chancre. On such occasions you can administer larger, more frequent doses of LM medicines in increasing attenuations. (Remember we are talking 6th edition Organon and LM potency. And this single aphorism should not be taken out of its context with preceding paragraphs or those following.)

The difference lies in understanding the primary symptom stage as opposed to a psoric flare-up of secondary symptoms. For example you couldn't possibly use large dosing schedules like in the exception to the rule with someone who suffered with eczema or psoriasis, you would probably make them suicidal with the aggravation. Additionally, when treating any long standing chronic disease there is always the danger of unknown hidden pathology within the constitution, so that is why, as I understand it, it is the exception to the rule. Hope this is useful for comparison.