© Leon I. Hammer, M.D.

LESSON FIVE

Contemporary Oriental
Medicine Foundation
1000 NE 16th Ave.,
Building F, Gainesville,
FL 32601, USA

Dr. Leon Hammer, M.D.

Continuing the series of clinical insights
Sharing the wisdom of over sixty years as a physician, and over forty years as a practitioner of Chinese medicine

One of our website updates focused on an introduction to ecology in

Chinese medicine. This dealt briefly with the idea that symptoms are
both messages from the body’s own intricate self-healing “Never does nature say one
mechanism, and guides to lead us to the true etiological roots of a thing and wisdom another.”
patient’s condition, and its clinical solution. In this Lesson, Dr. - Juvenal

Hammer is going to explore this topic in more detail, examining a

variety of possible etiologies that may be indicated by someone’s
symptoms.

First though, we’d like to share with you a short video on the treatment of ‘long leg’ syndrome.
Although the full version of this protocol also includes detailed assessment of the spine, and
addresses individual spinal subluxations and fixations, this quicker version is both simple and
incredibly effective. We hope you find it useful.

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 © Leon I. Hammer, M.D.

‘Long Leg’ Syndrome



‘Long leg’ syndrome is often the result of a muscular imbalance which causes the pelvis to tilt
and rotate. When present, this condition makes one leg appear longer than the other. Being a
structural block, ‘long leg’ syndrome may prevent the success of other treatments.

It should be kept in mind that the ‘quick method’ described in the following video is actually a
shorter version of a more comprehensive two-stage treatment developed by Dr. Hammer: one
that also involves the adjustment of the spine using acupuncture. Please remember that both the
short and long versions of the treatment can only correct muscular etiologies of differences in
leg length. If the imbalance is due to the loss of bone in either leg or the hip, this adjustment
cannot replace what is physically missing. However, in instances where there is a combination of
bone loss and muscular imbalance, this correction might still be beneficial for pain relief.

Often the ‘quick method’ described in the video is tried first, and if it holds for 15-20 minutes,
the extended protocol is unnecessary and one can proceed to Dr. Hammer’s spinal adjustment
technique. Both the extended version of the ‘long leg’ treatment and the spinal adjustment
technique may be described in future Lessons.

If you scroll to the bottom of the list of Lessons (to the left of this Lesson viewer window), you
will see a link that says ‘Video (click here)’. Click that and then select the ‘Long-leg’ Treatment
(quick version) video. This video will show you how to assess whether ‘long leg’ syndrome is
present in a patient, and show you Dr. Hammer’s simple correction method. Though not as
comprehensive as the extended version, this ‘quick method’ alone can sometimes be enough to
correct a structural imbalance.

It is important to note that, when a practitioner is assessing a patient’s leg length, the patient
must place his hands on top of his head, and not behind it, when he raises his buttocks.

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© Leon I. Hammer, M.D.

The Messages Beyond Conditions

As was mentioned in a Foundation website article, each symptom is first of all a message that
physiology has failed, and that pathology has ensued. If we use regurgitation (GERD) as a model
symptom, we see that allopathic medicine offers endoscopic examination to view possible gross
and microscopic evidence of alterations in the tissue - inflammation, Barrett’s Esophagus,
dysplasia, and potentially cancer - where the stomach and esophagus meet, and organisms,
such as H. Pylori, thrive. (It is my contention that H. Pylori is always present in the stomach, and
that it becomes a problem only when Spleen Qi and Stomach Qi are deficient.)

This information is important, and if the most serious of these possibilities - cancer - is
discovered, biomedicine has interventions that can be life-saving, including surgery, radiation
and chemotherapy. However, cancer can often be managed with Chinese medicine. I find this
therapeutic approach is best used in conjunction with allopathic interventions, the side effects of
which can be greatly ameliorated with Chinese herbs.

For the less serious of the pathologies listed above, medication (prilosec, antibiotics) is offered.
Some patients, in acknowledgement of the psychological aspects of the symptom, will be
offered anti-anxiety or anti-depressive medication. These become very addictive over time, and
have very debilitating withdrawal symptoms, which can last decades. The object is usually to
eradicate the symptom and the gross pathology rather than learn from it, and unfortunately,
many acupuncturists are of the same mindset.

Chinese medicine regards regurgitation as a reversal of the normal, downward flow of Qi, food
and phlegm through the gastro-intestinal system. Normal digestive function is engaged in the
process of the separation of the pure from the impure (via the Internal Duct of the Triple Burner)
and the absorption, transformation and transportation of vital substances to the blood, and to
every cell in the body. The upward reversal of this is due to some form of stagnation, either of Qi,
food or phlegm, or of some combination of all three. All three must move: if not down, then up.
The stagnation can be due an excess or deficient condition.

While all medicines agree that a symptom is a communication of disharmony or pathology, and
intervenes according to accepted protocols, the agreement ends here.

Etiology of Disorder
The identification and organization of Chinese medical conditions leads us to the etiologies of
these conditions and beyond, to the identification of Lifestyle practices (stresses) and
constitutional conditions (terrain). From there, we can progress to the individual roots of the
person’s being.

A comprehension of the etiology or etiologies of regurgitation is valuable beyond relieving the

discomfort and/or the more serious associated conditions listed above. Learning the etiology
gives us an opportunity to interrupt the very process that created the symptom and pathology. It
is a tool for prevention.

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© Leon I. Hammer, M.D.

Chinese medicine regards this symptom, our example of regurgitation, as one with many
possible etiologies, all or only a few of which may be operating simultaneously. The symptom
cannot be treated successfully unless we consider the input of the Liver (Qi stagnation or
deficiency), Spleen Qi deficiency and Stomach Qi stagnation (leading to food stagnation), Kidney
Yang deficiency (underlying Spleen Qi deficiency), Triple-Burner deficiency, and the Lung's ability
to descend the fluid it receives from the Spleen, to say nothing of Lifestyle issues. 

Let us examine each of these.

The Liver
The Liver is responsible for the direction, movement and containment (stagnation) of all Qi. With
regard to the gastro-intestinal system, Liver Qi is essential for the movement of Qi and food
downward, via peristalsis. If Liver Qi is stagnant, either because of the need to repress (contain)
emotions, or because Liver Qi is so deficient, the force necessary for the downward movement -
for peristalsis - is not available. The accumulating Qi and food must move somewhere, and if
down is not an option, substances will move upward. Now we have the symptom of
regurgitation.

At this point in our treatment plan, we could address Liver Qi stagnation due to repression and
Liver Qi stagnation due to deficiency using herbs and acupuncture, and thereby allow the patient
temporary relief from regurgitation. However, the forces that impede or drain Liver Qi are still
operational, and the problem will recur unless we address the causes of the impediment and/or
the deficiency.

Liver Qi stagnation, an exaggeration of the Liver’s normal function of ‘containment’, is usually

due to the repression of emotions: usually frustration that may lead to anger and impotent rage.
Our work now requires us to pose an inquiry to the patient regarding the nature of that
frustration. Sometimes, it is work or domestic situations about which the patient feels helpless.
When I have inquired about what someone would change about his life if he could, the answers
have been similar. One person wished that he did not “always avoid judgment of a finished
product by never finishing”. Another was “afraid of not succeeding so did not try. Offered
important positions and refused - could have been a millionaire by now”. Here, we are close to
the individual root of a symptom that would seem endlessly far from the outer manifestation of
regurgitation, and closer to the ultimate solution. The root for one particular patient was in her
mother’s alcoholism and early rejection of the maternal role: a Kidney Essence issue associated
with fear of the unknown and lack of faith.

One very revealing question that I ask is, “How are you a problem to yourself?” Of course, the
answer varies, but fear of failure (as above) is a frequent response. The pulse is often a useful
tool in these instances. When the Cotton quality is between 3 and 5 (5 being the greatest degree
of a quality), it is a strong sign of ‘suppressed’ emotions. The stagnation associated with the
Cotton quality is usually experienced as a feeling of being ‘stuck’ in life: the life of quiet of ‘quiet
desperation’.

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© Leon I. Hammer, M.D.

Spleen-Stomach Qi Deficiency
The source of Spleen-Stomach Qi deficiency is either Kidney Essence deficiency that begins
anywhere from conception through infancy, or from Lifestyle: usually involving eating habits.
(Kidney Yang-Essence deficiency is discussed below.)

Eating habits that cause Spleen-Stomach Qi deficiency are similar to those causing Stomach
heat, except at a much later stage, and over a much longer period of time. These include eating
foods that are difficult to digest and beyond the initial strength of Spleen Qi, eating excess food
under the same conditions, consuming excessive amounts of fluids, consistent ingestion of very
cold foods, eating irregularly, anorexia and bulimia.

Another less familiar etiology is long-term over-thinking while eating. Eating rapidly can have a
similar effect, as can reading or doing anything except socialising during a meal. Eating for the
Chinese is a sacred social occasion that requires focus on the food, and on the pleasant
conversation that enhances the enjoyment of a meal.

The Spleen can also be depleted through its purpose of serving the Heart for short-term
memory, such as that which occurs among students who cram for examinations and forget what
they memorized immediately afterwards. Over the course of years, especially for those who go
to college and graduate school, this practice drains Spleen Qi.

Spleen Qi deficiency may also stem from Leaky Gut syndrome. This is associated with the use of
antibiotics that have destroyed normal gastro-intestinal flora; around five hundred of these are
necessary for the complete digestion of food. The incomplete breakdown of protein into amino
acids causes the absorption of short chain amino acids - incomplete proteins - recognized by
the immune system as foreign bodies to which an inflammatory response ensues. This creates
an environment in the gastro-intestinal system that promotes the growth of undesirable
organisms. The body then tries to eliminate these through hyper-peristalsis, or diarrhoea,
through which Spleen Qi is depleted. It is also possible that an inappropriate herbal or
acupuncture intervention, treating a deficient condition as if it were excess, could lead to the
draining of Spleen Qi.

Although this is a discussion of etiology and how

symptoms can point us in that direction, I would like to
add that water metabolism is very much a function of
Spleen Qi, which must move fluid to the Lungs for transit
to the Kidneys. Excess fluid is a great stress on the
Spleen and on connective tissue, where it is stored
(connective tissue is controlled by the Spleen).

It is the intention of the digestive system to move food

down, in the opposite direction of regurgitation. It is said
that the Stomach Qi moves down, and the Spleen Qi moves up. This applies only to the
‘tastes’ (the lightest and finest energies from food that are given to each organ for its share of
food’s functional Qi), to some fluid that goes to the Lungs, and to the maintenance of the tissues
that hold organs in place (thus preventing prolapse). Otherwise, the Spleen and the Stomach

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© Leon I. Hammer, M.D.

move Qi downwards through the process known as the Internal Duct, controlled by the Triple
Burner, where the pure is separated from the impure. When the Internal Duct has reached the
limit of its capacity to do this, it treats the excess fluid as a retained pathogen, and stores it in
the connective tissue. A colleague once stated, “On the Yin side, Spleen Qi is weakened and
poorly transforms Food from the Earth (Damp), resulting in a Damp condition pervading the body
and inhibiting normal energy circulation and nourishment deposition (e.g. precursors to ATP
failing to arrive at mitochondria, the myofibrils are not provided with ATP in robust amounts and
the routine depolarization of muscles cannot be reset on the cellular level, resulting in muscle
spasm).

Kidney Yang-Essence Deficiency

Kidney Yang-Essence deficiency is rooted in the exigencies of conception, through pregnancy
and childbirth. In terms of conception, we find the age of the parents, their habits (such as
alcohol, drugs, nicotine), and conditions such as cold and , to be critical to the health of the
offspring. In one case, when the patient’s birth weight was two pounds, twelve ounces at six and
one-half months, conception took place when the parents were living in an unheated cabin
during a long winter. The issue of exposure to external cold at conception was strongly
emphasized by my teacher, Dr. Shen.

Kidney Yang-Essence is the operational Fire that we associate with the Fire of Ming-men
(Ministerial Fire) and thyroid function, and as the source of the Fire of other organs, especially
Spleen and Lung Fire. Therefore a deficiency of Kidney Yang-Essence early in life from insults at
conception, parturition, birth and early infancy will lead to Spleen-Stomach Qi-Yang deficiency.
Moxa on a slice of ginger on Ren 8 is especially valuable for enhancing the Essence weakened
by a Kidney deficiency that is rooted in conception, intra-uterine life, and/or birth.

Triple Burner
Whereas the Heart is the Emperor, the Triple Burner runs the Empire. In this context, we are
concerned with the Triple Burner as an etiology of our sample symptom, regurgitation. The
function of the Triple Burner is found in all three burners, and exercises a measure of control in
each. Overall, this involves integration, balance and homeostasis of all of the body’s functions. In
the middle or burner, this entails the relationship between the Liver and Spleen-Stomach,
alluded to above in our discussion of the Liver. To the extent that this relationship tends towards
imbalance, the Triple Burner strives to maintain balance: in the instance of regurgitation, it
attempts to maintain the Liver’s function of moving Qi down in the gastro-intestinal tract, and to
relieve any interpersonal conflicts that might be contributing to the loss of this function (often
repressed feelings and stagnation).

The middle burner is said to be located in the fundus of the Stomach, and operates its function
of controlling the direction, balance and harmony of Qi within itself, and between the upper and
lower burners. Here, the points Zhong Zhu (SJ 3 (most important)) and Zhong Wan (Ren 12) are

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© Leon I. Hammer, M.D.

most important to the digestive system, and Yin Jiao (Ren 7) to all of the Triple Burner’s
functions in the middle burner. Ye Men (SJ 2) is the central Water point of the entire body, and is
very important to the Spleen’s function of ‘digesting’ water (of which we are eighty percent).
Serving the Spleen, the Triple Burner draws heat from Ming-Men to help the Spleen digest,
absorb, transform and transport food and water.

All of the above - the entire process of separating the pure from the impure of food, and the
proper distribution thereof - are functions of the Triple Burner’s control of the Internal Duct. This
includes the ‘concentrated essences’ that form the ‘five tastes’, the formation, storage and
distribution of Wei Qi, Jin-Ye and all fluids, the formation of Blood, and the excretion of the waste
from this process.

The integrity of the Triple Burner in its service to the Spleen-Stomach Qi in all of its functions,
and its homeostatic function in relationship to the Liver (middle burner harmony), is an inevitable
consideration in the etiology and management of any Spleen-Stomach-Liver digestive
dysfunction, including regurgitation.

The Lung
The Spleen digests fluids and ascends them to the Lungs, which then retain some of the fluids
for moisture, while descending the rest to the Kidneys. The Lungs’ involvement in the etiology of
regurgitation is largely a function of the ability of Lung Qi to descend fluids.

If the Lungs fail to do this, there is an accumulation of fluid in the Lungs in the form of phlegm.
This excess of fluid in the Lungs inhibits the Spleen from moving more fluids to the Lungs, and
so fluid accumulates in the Stomach as phlegm stagnation that inhibits the flow of food and Qi in
their normal downward direction.

Specific Strategies
Depression
Over the years, I have had a number of patients present with episodic depression, who did not
respond to anti-depressant medication or psychotherapy (usually the cognitive type). On inquiry,
some were also found to experience a wide variety of accompanying symptoms, including flu-
like symptoms, blurred vision, nausea, constipation, headache, and especially extreme fatigue,
which forced these patients to rest. Rest, often sleeping for several days, relieved the depression
which, to begin with, was due to a Qi deficiency.

A Chinese medical examination revealed people who were unable to retreat (a function of Liver
Yin). Furthermore, they all were found to have an underlying moderate Qi deficiency, often from
birth: something that is usually a combination of mild to moderate Kidney Essence deficiency,
Heart Qi deficiency, and Heart Blood deficiency, from stress and shock in-utero. All responded
well to nourishing formulas, and one also required thyroid supplementation.

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These people differ from those with severe True Qi deficiencies: those who are too weak to lead
the aggressive Lifestyle that creates the pattern described above, which itself causes the
temporary breakdowns previously mentioned.

Our responsibility is to inform our patients of their limitations,

of their current capacity to function, and how they are going
beyond the tolerance of their terrain. We need to teach them
early signs of collapse and depression, and constructive
methods of retreat - meditation, biofeedback, tai chi, hobbies,
naps, etc. - from work beyond their energy. Collapse in the
form of depression is nature’s way of retreating and resting, of
imposing a ‘governor’ on an unsupportable expenditure of
energy, in the service of restoration and survival.

Ignoring the Ecology of Depression

For example, patients presenting with intermittent depression and withdrawal, who are unable to
retreat and rest when their Qi is depleted, are usually treated with anti-depressants, when what
they really need is to adjust their Lifestyles, and to spare their limited terrain until it can be
enhanced.

Most importantly, the use of anti-depressants for such people deprives them of a true solution to
their condition, and will perhaps further inhibit their ability to retreat, rest and recover. It may also
drive them into more serious disease, against which their periodic collapse is protecting them.
Furthermore, there are many side effects from anti-depressants, including panic and anxiety,
weight gain or loss, intense restlessness, fatigue, sexual dysfunction, gastro-intestinal bleeding,
nose bleeds and bruising. Some of the atypical anti-depressants are associated with heart
attacks.

Questions have been raised about the use of these medications to avoid dealing with personal
internal issues that are painful to confront, yet necessary to psychological growth and change.
There is a saying that the most valuable jewel in God’s crown is pain, and that pain is what God
gives to those he/she loves the most.

Diarrhoea
Diarrhoea is one of nature’s strategies to eliminate excess toxic heat from the body. The
preferred route for the body to eliminate toxins is downward through the bowels and urine.
Some small quantity is eliminated through the Lungs during expiration, and through the skin as
perspiration and skin rashes. It was my practice with people suffering from excess toxic heat to
use controlled diarrhoea as a safe way to eliminate it.

One interesting illustration of this attempt to move heat down is a patient whose feet would
become so hot that he could not sleep unless he put them in ice. In all ways, this person exuded
excess heat, including hypertension (‘heat in the Blood’), and so the only potential solution to the

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© Leon I. Hammer, M.D.

problem of finding another exit for the heat was through the bowels or through a change in his
Lifestyle. Unfortunately, this patient refused both of these treatment options.

Ignoring the Ecology of Diarrhoea

The toxic heat that is not eliminated through the bowels and urine is intolerable to the body, and
must be eliminated elsewhere or stored in a ‘neutral’ part of the body where it is not destructive
to vital organs or a threat to life. Excess toxic heat is sent to the Liver, for elimination through the
Gallbladder. If that process fails, the toxic heat goes into the Blood stored by the Liver, and
circulates through the body to the skin. There, an attempt will be made to eliminate the heat, first
in the form of perspiration and, failing that, in the form of skin rashes. If the toxic heat is not fully
eliminated through the skin, the divergent channels take it to joints, muscles, tendons, ligaments
and fascia, where it creates an inflammatory condition. This ultimately leads to other
complications that are classified as arthritis and myofascial fibromyalgia (inflammation of the
nerve endings).

Heat that remains in the Blood will eventually lead to elevated blood pressure, and to all of the
cardiovascular sequellae including atherosclerosis, stroke and coronary artery disease. The
patient with the hot feet mentioned above, who refused the loose stool solution, suffered
increasing hypertension and required more medication. Eventually, he had one mini-stroke (‘wind
in the channels’).

Thickening Toenails
Many toenails exhibit a thickening, for which there are now powerful internal and local
medications. However, from a Chinese medical perspective, the thickness, attributed to a
fungus, has a direct correlation to a systemic phlegm condition in the body (potentially
candidiasis). Phlegm is toxic, and the body needs to eliminate it, usually in the form of mucous in
the stool. If this strategy is not sufficient, the body continues to attempt to move the phlegm
down, and it appears on the toenails: a perfect culture medium for fungus, which prefers the
dark, humid conditions of perspiring feet in shoes and socks.

Fungus on toenails informs me of a systemic phlegm condition, and rather than indicating to me
that medication is required to eliminate the fungus, impels me to consider how the patient is
creating that internal environment, what Lifestyle habits he needs to change, and what
therapeutic action is required to deal with the phlegm. In classical Chinese medical terms, the
fungus is the branch, and the phlegm and its cause: the root.

Ignoring the Ecology of Thickening Toenails

Without understanding that the toenail fungus indicates that a systemic phlegm condition exists,
the condition will continue to grow internally. This condition, which could be managed with
Lifestyle changes, will eventually cause extensive damage to arteries (atherosclerosis) and to
lungs (bronchitis and asthma), It may also lead to neoplasms throughout the body, phlegm
misting the orifices of the Heart causing mental and emotional problems, Heart valve problems
with growths on the valve leafs, and vaginal Candida issues for women. Via the divergent

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channels, a systemic phlegm condition may travel to the joints, and manifest as a highly-
resistant Damp arthritis.

Temperature
Known throughout history to mothers and physicians, a mild temperature is evidence that a
person is capable of mobilizing Wei Qi (with metabolic heat) to resist external pathogenic
factors, and is to be endured and watched.

Ignoring the Ecology of Temperature

Efforts to eliminate mild ‘fevers’ diminishes the body’s innate ability to defend itself, and leaves it
open to the more serious consequences of the invasion of external pathogenic factors.

Menorrhagia and Nosebleeds

Bleeding is one way the body eliminates excess toxic heat. In women, excessive vaginal
bleeding can be attributed to many causes, some of which are ecological: that is, an attempt by
the body to rid itself of unwanted pathological factors. The most common is excess heat. 

In men, the most common forms of bleeding are ‘nose-bleeds’. 

This symptom should alert us to the possibility of excess toxic heat so that we may address the
underlying issue, and stop the reason for the bleeding. We must search for the source of heat in
a patient, and in her Lifestyle.

Ignoring the Ecology of Menorrhagia and Nosebleeds

Excess heat over time will cause blood to coagulate, which in the female lower burner often
takes the form of uterine fibroids. Surgery is one procedure commonly practiced to remove
fibroids, and there is another that involves the injection of small bead into an artery that feeds
the fibroid, cutting off its blood supply and leading to necrosis. Neither “solution” addresses the
underlying issue: the excess heat that led to blood stagnation and a tumor that the body will
continue unabated to attempt to excrete or neutralize. I recently heard of one patient who
developed severe dermatological problems following a hysterectomy: another attempt by the
body to excrete the excess heat.

These procedures also do not address the other common etiology of Blood stagnation in the
lower burner: a deficiency of the Heart and Circulation that makes them unable to overcome
gravity. Gravity, and the forces required to surmount it, has been a challenge to human
physiology since man first stood erect, and is one of the most overlooked influences on
pathology in the lower body.

‘Nose-bleeds’ are nature’s safety valve in men, at risk of stroke, with excess toxic heat in the
Blood and elevated blood pressure. As a child with my grandfather, and as a medical intern, I
became aware of this relationship between ‘nose-bleeds’ and stroke, and how suppression of

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the bleeding (cauterizing the plexus of vessels in the lower part of the nose) seemed to increase
the incidence of stroke, after middle age especially.

Hot Flashes and Sweats

Persisting in the textbooks is the idea that hot flashes and
sweats are a Yin deficient condition. This puzzled me, since
the same books recommended a formula, Er Xian Tang (Two
Immortals) whose individual herbs are: Yin Yang Huo
(Epimedium (9-15 gm)), Xian Mao (Curculigo (9-15gm)),
Dang Gui (Angelica (6-9gm)), Huang Bai (Phellodendron
(6-9gm)), Zhi Mu (Anemarrhena (6-9gm)).



Two of the herbs, Yin Yang Huo and Xian Mao, are primarily for Yang deficiency and expelling
Wind-Cold-Damp. Regarding Yin deficiency, with Yin Yang Huo there is a disparity between
Chinese Herbal Medicine: Materia Medica (3rd edition) which says that “This herb should not be
taken as decoction over a long period of time, as it can injure the Yin,” and Chinese Herbal
Medicine: Formulas and Strategies where it says, “Herba Epimedii also tonifies Yin and Yang.”
While in Formulas and Strategies it says, “Cortex Phellodendri nourishes Kidney Yin and drains
fire from deficiency,” in Materia Medica (3rd edition) quoting the Materia Medica of
Combinations, it equivocates about the Yin-nourishing issue, and finally says of both Huang Bai
and Zhi Mu, “…mistakenly used, as the water becomes dried (by their bitterness), the fire will
blaze even higher, and contrary to one’s intention, Yang will become separated from Yin and fly
away. This is irremediable.”

In my opinion, hot flashes are the result of Yang leaving due to a separation of Yin and Yang that,
according to the formula Two Immortals, is as much, or even more, a deficiency of Yang than
Yin. A severe deficiency of either will cause this separation and, as the Materia Medica of
Combinations poetically expresses it, Yang will “fly away”. The hot sweat is Yin trying to follow
the Yang and nature’s attempt to heal the separation of Yin and Yang. The reason this occurs
more at night is because the sun’s energy during the day compensates for the inner Yang
deficiency, and also inhibits the Yang escaping.

Ignoring the Ecology of Hot Flashes and Sweats

If the body does not discharge the separated Yang as hot flashes, it will remain in the body and
rise (Yang Rising). This will cause conditions varying from headache to stroke, depending upon
the degree of the person’s excess heat condition, and on other factors such as the body’s ability
to safely emit the excess heat through other avenues (bowels).

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External Pathogenic Factors (EPFs), including Allergies

If the Wei Qi is strong, EPFs and allergens will be repelled without symptoms. If the Wei Qi is
deficient, a second round of defense comes into play that involves symptoms including running
nose and tearing eyes in order to exude the invader from nasal passages. Bronchioles and
bronchi contract to prevent the invader reaching Lung alveoli, causing asthma-like symptoms.
We have already mentioned elevated temperature.

The vast thrust of both Western medicine and recently, regrettably, Chinese medicine, is to
eliminate the symptom: the very mechanism that is preventing the invasion of dangerous factors
that could cause much more severe disease. I am an advocate for the recognition of the vital
function of these symptoms in the service of defense, and their alleviation only in the context of
reinforcing the Wei Qi; it is the weakness of Wei Qi that necessitates the presence of symptoms
in the first place.

Ignoring the Ecology of EPFs

I have already mentioned that suppressing the symptoms that nature has provided as second
lines of defense against EPFs when Wei Qi is deficient is counterproductive, and leads to
pulmonary diseases, bronchitis and pneumonia. These are difficult to treat, and are debilitating.
Of course, there are times when symptoms are so disabling that they need some modicum of
control. However, care should be taken to ensure that ‘control’ falls short of elimination.

Signs and Ecology

Signs - the pulse, tongue, colour, abdominal palpation etc. - as well as symptoms, communicate
the ways terrain is interacting with stress. While they do not tell us as specifically as symptoms
how nature attempts to resolve the distress, the implication of etiology is there in the signs.

The Pulse
Each pulse quality is a sign of the organism's attempt to restore equilibrium, or of its failure to do
so. For example, a Rapid Rate is often a sign that Heart Qi is deficient, and that it must work
harder to complete its physiological mission. If Heart Qi is deficient, the left distal position will be
Feeble rather than Tight (which would be a sign of Heart Yin deficiency), or, if there is excess
heat in the Heart, the left distal position will be Robust Pounding. 



While Reduced Pounding is a sign of an organism attempting to compensate for working
beyond its ‘energy’, it also signifies that compensatory mechanisms are failing. In addition,
Reduced Substance, Diffuse qualities, and an Empty pulse are signs that the compensatory
restorative measures are no longer effective. Our attention must be drawn to searching for the
reason, either in the underlying deficiency (terrain) of a particular organ, or in the Lifestyle that is
causing the organism to work beyond its ability.

Floating qualities are associated with acute disharmonies. The Floating quality is often a sign of
an attempt to eliminate heat (Rapid Rate) or cold (Slow Rate) that is invading from the exterior.

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This quality is a sign of the body’s attempt to restore equilibrium. It is an indication for the
practitioner to assist this process by enhancing Wei Qi, rather than suppressing it by eliminating
the accompanying symptoms of running nose, sneezing, sweating, light temperature, wheezing
and cough, all of which are back-up maneuvres to eliminate a pathogen.

The Flooding Excess quality is a sign that the body is attempting to eliminate accumulating heat
(infection) from an organ or area of the body. Acute examples of this would be in cases of
fulminating hepatitis, cystitis, or ileitis, and chronic instances as with the chronic forms of these
diseases. The early stages of chronic disease are almost entirely due to interference with normal
function. We call this interference stagnation, and it frequently goes unobserved clinically. The
Very Tense quality is most common at this early stage. Attempts to resolve stagnation lead to the
appearance of metabolic heat, which is necessary to overcome the stagnation. This is
accompanied by qualities such as increased Tense (‘string-bow’), and a mild degree of Robust
Pounding in an attempt to eliminate the heat. If that attempt fails, toxic heat accumulates and
the Robust Pounding increases proportionately.

If this toxic (excess) heat cannot be expelled through the normal channels - the intestines, urine,
skin and expired gases (lungs) - some of it enters the Blood and we have Blood Heat. This can
progress to Blood Thick and Hollow Full-Overflowing qualities - signs of increasing heat in the
Blood - and the pulse may become Rapid.



If further attempts to eliminate the heat are not successful, the body must provide fluid (Yin) to
balance the heat. This is first drawn from the affected organ, and when that is depleted, the
body will call forth Kidney Yin: the principal source of Yin in the body. Eventually, that too will be
depleted. At this stage the pulse qualities change to Tight and Wiry (Thin and Hard like a metal
wire), and the pulse may be a little Rapid. At the Blood depth, the Slippery quality will appear as
a sign of turbulence. Later, as the heat inflames the walls of the vessels, a Rough Vibration will
appear at the Blood depth. When heat accumulates, Blood begins to stagnate and we will have
the Choppy quality, especially in areas such as the pelvis.

Over time, this attempt to overcome stagnation and eliminate heat depletes Qi as well as Yin.
The pulse moves to a Diminished or Yielding Qi Depth, and then to Spreading qualities, a
Flooding Deficient Wave, then Reduced Substance, Diffuse, Deep and Feeble-Absent qualities.
The final step in the process of Qi depletion are the qualities associated with the separation of
Yin and Yang, such as the Empty qualities (Empty, Scattered etc.) and Changing Qualities, as
well as those associated with damaged parenchyma such as Rough Vibration, Unstable and
Non-Homogeneous. Blood deficiency usually accompanies Qi deficiency, so that the pulse
might also become Thin. While in women a Thin quality is common (menstruation), in men the
Thin quality is considered a serious sign.

From these few examples, we can see that the pulse qualities inform us of how nature is
attempting to deal with stresses that are afflicting function: Robust Pounding to eliminate excess
heat, Heat in the Blood telling us that the body is unable to eliminate the heat through normal
channels and is diverting to holding patterns, etc.

Lesson Five 13
 © Leon I. Hammer, M.D.

Furthermore, the pulse can tell us all of this often before the onset of symptoms, and provides us
with the most sophisticated early warning system: a working preventive medicine, ecological in
the best sense.

Ecology of the Individual



Ecology is a branch of biology concerned with the relations between organisms and their
environment. The human being is an organism and his environment is in large part his genes, the
lifestyle of his parents from conception to adulthood, the exigencies of that passage involving others,
and finally himself and the inner being that evolves. It is part of our ecological task to discover and
make those connections for our patients, to encourage their awareness of who they are and how
their various environments were involved in their lives up till the present day. Attempts to discover
why a patient might eat to assuage emotional pain, sacrifice himself to ambition, or refuse any routine
or regularity in his life can lead to the most profound insights, to the root of his pain and fear. These
connections are the ecology of the individual.

Among those called to heal, myself included, the strongest impulse is to relieve suffering: to alleviate
the symptom, the messenger. I wish always to remind practitioners that the messenger - the
symptom - can direct us to the stress-terrain interplays of lifestyle and constitutional viability: to the
individual. As importantly, it can also instruct us in the ways that nature heals; from these methods we
can learn valuable interventions.

From conception, an inherent intelligence ceaselessly engages and adapts our innate terrain to life’s
stresses, shocks and trauma. We can learn from this intelligence, and, very rarely, improve on it if we
recognize and respond quickly to its messages. Respect the symptom, respect your nature; don’t kill
the messenger.

In the next Lesson:

Dr. Hammer discusses the subject of Blood, from general Blood deficiency, to less-understood
aspects such as Kidney Blood deficiency, Lung Blood deficiency, and the psychological
implications of Blood disorders.

More information on the Contemporary Oriental Medicine Foundation, along with Dr. Hammer’s
regularly updated thoughts and musings, can be found at www.comfoundation.org.

Lessons are freely circulated by the Contemporary Oriental Medicine Foundation.


Lesson content is produced by Dr. Leon Hammer, M.D. and Oliver Nash. Editing and design by Kira Nash.

Lesson Five 14