In summary, one can say that, although EMCG is a perplexing and puzzling disease, and although there are more enigmas than solutions, we can establish a way of handling the disease, knowing how to divide it into benign or acute forms, and establishing a treatment attitude according to that knowledge. PP and its modifications, in combination with immunosuppressive agents, are the corner-stones to the acute form of the disease complicated by vasculitis, nephritis, chronic hepatitis and CNS involvement. Looking ahead, a new and more specific mode of treatment could emerge from our and others observations that the IgMs in the mixed cryoproteins are antiidiotypes to the IgGs. By producing autoantiidiotypes it might be possible to block some of the immune complex formation and to interfere with the cold precipitation, which is the basic pathophysiological process of essential mixed cryoglobulinemia.