one of the reasons that tb is thought associated with the syphilitic miasm as well as the psoric is because when treating the tb patients in paris, hahnemann used mercury and cinnabaris a fair bit [according to handley's book.] whether the inference is a fair one is uncertain.

a question arising in a modern context is: 'from whence do sycotic and syphilitic elements in a case arise?" there appear sometimes sycotic/ syphilitic elements in cases without a personal history of stds. it is not clear from whence the venereal miasms would have been aquired in such cases - maybe from in-utero contagion? - maybe from genetic inheritance? maybe from vaccinations? - or a mixture? as far as one can tell, hahnemann only thought of the venereal miasms as arising from venereal contagion or contagion of the foetus/infant by the affected mother or wet-nurse. the vaccination/ genetic ideas expand on what hahnemann knew about.

when many patients present and their full cases taken, there can be many symptoms and evidence suggestive of more than one chronic miasm in action over the years.
initially, all you need to focus on is what is the most ailing problem to the patient in the present, with its direct concomitants. analyse that symptom-complex and it might be miasmatic or not - giving a hint about what type of opening remedy will work best for the patient. if the well-selected remedy fails to act though, and there is a clear history of a certain miasm, it can be useful to use an anti-chronic-miasmatic remedy to facilitate the action of the well-indicated remedy [e.g. see boger's boenninghausen's characteristics, sulfur.]